Cervical cancer screening utilization, and associated factors, in Nepal: a systematic review and meta-analysis

OBJECTIVE

To systematically appraise the existing published literature on cervical cancer screening utilization, and associated barriers and facilitators, in Nepal.

STUDY DESIGN

Systematic literature review and meta-analysis.

METHODS

PubMed/MEDLINE, CINAHL, Scopus, Embase, and, Google Scholar were systematically searched using Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. All quantitative and qualitative studies reporting cervical cancer screening (using the Pap smear test or visual inspection with acetic acid or human papillomavirus test) utilization, barriers, and facilitators for screening were identified. A meta-analysis was performed to estimate Nepal's pooled cervical cancer screening utilization proportion.

RESULTS

The search yielded 97 records, of which 17 studies were included. Fifteen studies were quantitative and two were qualitative. Of the 17 studies, six were hospital-based and six were community-based. The pooled cervical cancer screening utilization proportion (using Pap smear test) among Nepalese women was 17% from the studies in the hospital settings, and 16% in the community. Six studies reported barriers to cervical cancer screening, of which four reported embarrassments related to the gynecological examination and a low level of knowledge on cervical cancer. Three (of four) studies reported health personnel, and two studies reported screening services-related facilitators for cervical cancer screening.

CONCLUSION

Our review reported that cervical cancer screening utilization (16%) is more than four times lower than the national target (70%) in Nepal. Multiple barriers such as low levels of knowledge and embarrassment are associated with cervical cancer screening utilization. Health personnel's gender, counseling, and privacy of screening services were commonly reported facilitators. These findings could help to inform future research, and policy efforts to increase cervical cancer screening utilization in Nepal.

A capillary electrophoresis based approach for the identification of anti-drug antibodies against camelid VHH biologics (Nanobodies®)

Undesired immune responses against protein therapeutics may adversely affect the pharmacokinetics, efficacy, and safety of the product. The presence of anti-drug-antibodies (ADA) has been the key determinant of immunogenic responses. Here we describe the use of a capillary electrophoresis platform for the identification of ADAs against several experimental camelid VHH biologics (Nanobodies®). Hereafter, we refer to this assay as WESADA. We modified the Wes platform by ProteinSimple to screen serum samples for ADA against covalently linked multi-modular Nanobodies and compared it to standard ADA methodologies. We were able to identify ADA positive samples and determine which individual VHH module in a multivalent Nanobody construct stimulated the predominant ADA response. WESADA requires denaturation of the experimental immobilized drug, which could affect recognition of the immunogenic epitope and alter ADA signal. To address this issue, we demonstrated that signal can be immunodepleted by pre-incubation of serum samples with native Nanobody. This capillary electrophoresis based approach allows for rapid analysis without the need for individually tailored assay optimization or reagent labeling, while consuming small amounts of sample and drug. It also allows for the simultaneous ADA analysis of multiple targets of different molecular size in the same experimental sample. WESADA is not intended to replace traditional ADA assay formats, but it facilitates the expedient immunogenic assessment of a large number of experimental drug candidates in the early developmental space.

Facile Synthesis of Bio-Templated Tubular Co₃O₄ Microstructure and Its Electrochemical Performance in Aqueous Electrolytes

Template-assisted facile synthesis of tubular Co₃O₄ microstructures and its electrochemical performance was studied to understand its use as a potential electrode material for supercapacitors. Tubular porous Co₃O₄ microstructures were synthesized using cotton fibers as bio-template. The as-obtained templated Co₃O₄ structure inherits the morphology and microstructure of cotton fiber. The electrochemical performance of the electrode made up of tubular Co₃O₄ structure was evaluated in 3 M KOH, NaOH, and LiOH aqueous electrolytes. The large-surface-area of tubular Co₃O₄ microstructure has a noticeable pseudocapacitive performance with a capacitance of 401 F/g at 1 A/g and 828 F/g at 2 mV/s, a Coulombic efficiency averaging ~100%, and excellent cycling stability with capacitance retention of about 80% after 5,000 cycles. Overall, the tubular Co₃O₄ microstructure displayed superior electrochemical performance in 3 M KOH electrolyte with peak power density reaching 5,500 W/kg and energy density exceeding 22 Wh/kg. The superior performance of tubular Co₃O₄ microstructure electrode is attributed to its high surface area and adequate pore volume distribution, which allows effective redox reaction and diffusion of hydrated ions. The facile synthesis method can be adapted for preparing various metal oxide microstructures for possible applications in catalysis, electrochemical, sensors, and fuel cells applications.

Influence of Urea on the Synthesis of NiCo₂O₄ Nanostructure: Morphological and Electrochemical Studies

The widespread use of miniature electronic devices calls for energy-dense storage strategies. The supercapacitor-based energy storage devices with high areal capacitance are desired energy storage alternative. It is still a challenge to fabricate supercapacitor-based energy devices with consistent performance. The porous metal oxides with large areal capacitance are desired materials for electrode, but there exists a limited understanding of the influence of synthesis parameters on microstructural properties, which largely govern their electrochemical performance. In the present work, hierarchal spinel nickel cobaltite (NiCo₂O₄) nanostructures were synthesized in the presence of the varying amount of hydrolyzing agent via a simple hydrothermal method coupled with a simple post-annealing process. This work focuses on understanding the influence of hydrolyzing agent in controlling the microstructure and hence ensuing electrochemical properties of the NiCo₂O₄ based electrode. Based on the urea hydrolyzing content, the as synthesized NiCo₂O₄ nanostructure varied from the rod, plate to nanoflower. The mesoporous nanostructures, with urea content 1.49 gm, exhibit a sizeable BJH surface area (79.2 m² g^-1) and high mesopore volume (0.140 cm³ g^-1). Remarkably, the NiCo₂O₄ nanoflower shows high specific capacitance of 3143.451 F/g at 2 mV/s scan rate, 1264.5 F/g at 1 A/g current density, energy density of 56 Wh/kg and power density of 8,400 W/kg in 3 M KOH electrolyte. The capacitance loss after 5000 cycles is 48% at the current density of 10 A/g, indicating their excellent cycling stability. The impressive electrocatalytic activity is largely ascribed to the high intrinsic electronic conductivity, superior mesoporous nanostructures and rich surface Ni active species of the NiCo₂O₄ materials, which can largely boost the interfacial electroactive sites and charge transfer rates indicating promising applications as electrodes in future supercapacitors.

Pharmacokinetic Properties of Humanized IgG1 and IgG4 Antibodies in Preclinical Species: Translational Evaluation

Assessment of the factors that regulate antibody exposure-response relationships in the relevant animal models is critical for the design of successful translational strategies from discovery to the clinic. Depending on the specific clinical indication, preclinical development paradigms may require that the efficacy or dosing-related attributes for the existing antibody be assessed in various species when cross-reactivity of the lead antibody to the intended species is justified. Additionally, with the success of monoclonal antibodies for management of various human conditions, a parallel interest in therapeutic use of these novel modalities in various veterinary species has followed. The protective role of neonatal Fc receptor (FcRn) in regulation of IgG homeostasis and clearance is now well recognized and the "nonspecific clearance" of antibodies through bone marrow-derived phagocytic and vascular endothelial cells (via lysosomal processes) is modulated by interactions with FcRn receptors. In this study, we have attempted to examine the PK properties of human IgG antibodies in dog and monkey. These studies establish a translational framework for evaluation of IgG antibody PK properties across species.

Development and evaluation of an oral fast disintegrating anti-allergic film using hot-melt extrusion technology

The main objective of this novel study was to develop chlorpheniramine maleate orally disintegrating films (ODF) using hot-melt extrusion technology and evaluate the characteristics of the formulation using in vitro and in vivo methods. Modified starch with glycerol was used as a polymer matrix for melt extrusion. Sweetening and saliva-simulating agents were incorporated to improve palatability and lower the disintegration time of film formulations. A standard screw configuration was applied, and the last zone of the barrel was opened to discharge water vapors, which helped to manufacture non-sticky, clear, and uniform films. The film formulations demonstrated rapid disintegration times (6-11s) and more than 95% dissolution in 5min. In addition, the films had characteristic mechanical properties that were helpful in handling and storage. An animal model was employed to determine the taste masking of melt-extruded films. The lead film formulation was subjected to a human panel for evaluation of extent of taste masking and disintegration.

Non-adherence to anti-hypertensive medication in low- and middle-income countries: a systematic review and meta-analysis of 92443 subjects

Hypertension is a rising global burden, and low- and middle-income countries account for 80% of deaths due to complications of hypertension. Hypertension can be controlled by adhering to anti-hypertensive medication. However, non-adherence is an increasing challenge. This review aims to systematically evaluate non-adherence to anti-hypertensive medication among adults in low- and middle-income countries and explore factors affecting non-adherence to anti-hypertensive medication. We performed a systematic search for studies published between 1 January 2000 and 31 August 2015. A selection process was performed for data extraction with a combination of Medical Subject Headings terms: 'hypertension' and 'adherence'. Further search criteria were: language ('english'), species ('humans'), and low- and middle-income countries. A total of 22 studies met the inclusion criteria. The pooled percentage of non-adherence when using the eight-item Morisky Medication Adherence Scale (MMAS) was 63.35% (confidence of interval (CI): 38.78-87.91) and 25.45% (CI:17.23-33.76) when using the 80 and 90% cut-off scales. The factors were classified into the five dimensions of adherence defined by the World Health Organization, and the majority of the studies reported factors from the dimension 'social and economic factors'. This systematic review demonstrated considerable variation of non-adherence to anti-hypertensive medication in low- and middle-income countries depending on the methods used to estimate non-adherence. The results showed a high non-adherence when the MMAS eight-item scale was used and low when the 80 and 90% cut-off scales were used. The majority of factors affecting non-adherence to anti-hypertensive medication fell within the World Health Organization defined dimension 'social and economic factors'.

Evaluation of temperature sum models and timing of Quassia amara (Simaroubaceae) wood-chip extract to control apple sawfly (Hoplocampa testudinea Klug) in Sweden

Apple sawfly (Hoplocampa testudinea Klug) is a serious pest in European organic apple production. They hatch during a short period only, making correct timing of control measures crucial. Swedish organic growers have requested a strategy for optimal timing of the Quassia amara (Simaroubaceae) extract against the apple sawfly. The aim of this study was, therefore, to develop methods to predict the timing of Q. amara control in Sweden. A temperature sum model for timely placement of monitoring or mass-trapping sticky traps was validated for Swedish conditions. The average emergence of sawflies occurred at 169 degree days (SD = 20) counted from March 15 (threshold temperature 4 °C). The difference in emergence from existing first flight model of average and maximum 9 and 39 degree days (1 and 9 calendar days) was found acceptable. Accumulated oviposition of 85 % at full bloom (BBCH 65) suggests that mass trapping and monitoring could stop at this time. This is supported by a tendency of decreased trap catches during that period. Three application times for Q. amara were compared: (A) at petal fall (BBCH 67), (B) at a date calculated using female trap catch numbers and temperature sums, and (C) prior to peak egg hatch observed in the field. All treatments resulted in significantly lower percentage of damaged apples compared to the unsprayed control, with significantly less damage (1.3 %) in plots treated according to method (B). The results provide information on adult phenology and methods that could be used to determine timing of mass trapping and insecticide application against the apple sawfly.

Non-communicable diseases in Nepal: challenges and opportunities

Non-communicable diseases constitute a major public health problem in Nepal. They are already killing more people than communicable diseases. However, addressing non-communicable diseases is not getting much attention from the government, academicians and development partners.Simple measures at population and individual level have not been implemented in an effective way. The vision on how to address non-communicable diseases at primary health care level is unclear. However, there is a unique possibility of integrating non-communicable diseases into the existing communicable diseases interventions which need to be tested and potential positive lessons have to be scaled up as soon as possible. The best buy approach as proposed by WHO could be implemented for non-communicable diseases prevention and management through primary health care approach.

Practices and perceptions on contraception acceptance among clients availing safe abortion services in Nepal

BACKGROUND

The Government of Nepal has implemented safe abortion policy since 2002. There are 245 approved sites providing safe abortion services to women across the country. Family planning counselling is one of the components of the safe abortion policy, which is important to reduce unwanted pregnancy, maternal morbidity and mortality due to the consequences of unsafe abortion and the service burden.

OBJECTIVES

This study explains the perceptions, practices and factors affecting the use of family planning among abortion clients attending safe abortion services in Nepal.

METHODS

A cross sectional study was carried out on September, 2008 enrolling 58 women who were waiting in the dressing room for safe abortion services in Paropkar Maternity Hospital, Nepal. All women attending hospital clinic for receiving safe abortion services were approached for interview till the targeted number was fulfilled. A convenience sampling was applied to reach the sample size.

RESULTS

Of the 58 respondents, majority of the respondents were Hindus (83%), residing in Kathmandu district (76%); of the age group 20-29 years (69%); and 98% were married. One fifth (20.68 %) of the respondents had previous history of spontaneous or induced abortion. The main reason for abortion did not want any more babies/ complete family (45%). The knowledge of modern contraception was high (98.27%). The knowledge of emergency contraception was low (25.9%). Side effects was the main reason (48%, n=31) for discontinuation of contraceptives. Intention to use some modern family planning methods after the abortion was expressed by 83% clients. The major enabling factor for continued contraceptive use was the absence of side effects. The family planning counselling was acceptable for 91% clients.

CONCLUSION

Knowledge, acceptance of counselling service and intention to use family planning measure was high in the study participants. There is need to provide skills on adapting with the adverse effect of family planning measure through continuous education and reinforcement.

Feasibility and acceptability of gentamicin in the Uniject prefilled injection system for community-based treatment of possible neonatal sepsis: the experience of female community health volunteers in Nepal

OBJECTIVE

Explore feasibility and acceptability of gentamicin in the Uniject prefilled injection system, in combination with oral cotrimoxazole-p and an appropriate newborn weighing scale, for treatment of possible neonatal sepsis when administered in the community by female community health volunteers.

STUDY DESIGN

In a community-based program in Nepal, 45 volunteers recorded 422 live births. Among these, 82 infants were identified as having possible severe bacterial infection. In all, 67 of these infants were treated with gentamicin in Uniject and 15 were referred to the health facility. Mixed methods were used to collect data about Uniject performance, acceptability and safety.

RESULT

Volunteers successfully treated 67 infants with gentamicin in Uniject. Gentamicin in Uniject performed well and was acceptable.

CONCLUSION

Gentamicin in Uniject, in combination with cotrimoxazole-p and an appropriate newborn weighing scale, is a feasible and acceptable option for treatment of possible neonatal sepsis in the community by female community health volunteers.

Perceived discrimination among people living with HIV in Nepal

BACKGROUND

HIV is one of the major public health problems in Nepal, fuelled by several socio-economic factors. The objective of this study was to explore perceived discrimination among people living with HIV in their own family, society and health facilities.

METHODS

A qualitative descriptive cross-sectional study was conducted with semi-structured face-to-face in-depth interview of 18 people (10 men, 8 women) living with HIV in four districts of Nepal.

RESULTS

Perceived discriminations among people living with HIV were found among family, society and health facilities. In families, the major forms of perceived discrimination were restriction to go outside, exposure to media and use of different utensils for eating purpose. Female HIV positive perceived more violence at household level than males. Financial restriction was also found imposed upon some respondents by the family for being HIV positive. Similarly, restriction to participate in social work, restriction to buy from shops, social harassment and insult were the main forms of discrimination. Perceived discrimination experienced in the health facility yielded very bitter experiences to some respondents, while many had refused treatment because of their HIV status.

CONCLUSIONS

People living with HIV faced different forms of perceived discrimination within family, society and health facility which are thought to be crucial in supporting a person at the time of crisis. Intensive programs that can reduce social stigma and discrimination faced by people living with HIV are a most.

Abstract 223: ΔNp63α, a p53 family member protein, promotes tumor progression in pancreatic cancer

Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related deaths in both men and women. Targeted therapies thus far have failed to demonstrate survival advantage in PDAC and novel therapies are needed. Mutations in Ras and p53 are frequently found in PDAC and promote cancer cell survival, invasiveness and chemoresistance. In contrast, p63, an ancestral member of p53 family, is rarely mutated in cancer. ΔNp63α was shown to be overexpressed in squamous cell tumors of the lung and head and neck and thus has been implicated in carcinogenesis. We tested expression of p63 isoforms in five PDAC cell lines and investigated its role in tumor progression.

Expression of p63 was determined by immunoblotting, real-time quantitative and semi-quantitative PCR in 5 PDAC cell lines. PANC-1 cells, with low levels of p63, were transfected with ΔNp63α cDNA-expressing vector. Conversely, high endogenous p63 levels in T3M4 and BxPC3 cell lines were suppressed by specific shRNA. We studied cell proliferation in a doubling assay, motility in wound assay and invasiveness in Matrigel chambers.

We found that pancreatic cancer cell lines predominantly expressed ΔN isoform of p63, and specifically ΔNp63α variant. ΔNp63α protein and transcript levels were high in T3M4, BxPC3 and Colo-357 cell lines and low in ASPC-1 and PANC-1 cell lines. Interestingly, transcript levels of TAp63, a p63 variant implicated in cellular senescence and suppression of metastases, were near the detection threshold in all cell lines. Overexpression of ΔNp63α in PANC-1 cells resulted in increased proliferation and enhanced migration of those cells but had no effect on invasiveness in serum-free conditions. Incubation of ΔNp63α-expressing PANC-1 cells in presence of epidermal growth factor increased both migration and invasiveness. By contrast, shRNA knockdown of endogenous p63 in BxPC3 cells led to decreased proliferation. Silencing p63 in T3M4 cells resulted in attenuated migration in serum-free conditions and decreased migration and invasiveness in response to epidermal growth factor.

Thus, ΔNp63α is a predominantly expressed isoform of p63 in PDAC cell lines. ΔNp63α plays an important role in PDAC progression and thus its associated pathways may potentially be therapeutically targeted in this disease.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 223. doi:10.1158/1538-7445.AM2011-223

Study on determination of errors in prescription writing: A semi-electronic perspective

BACKGROUND

Prescription writing is one of the most important and basic skills that a doctor needs. Prescribing errors may have various detrimental consequences. Hence, the components of a prescription should be clearly written, free of drug related omission (incomplete prescription), commission (incorrect information) and integration errors, without nonofficial abbreviations, and fulfil the legal requirements of a prescription. Since errors of prescribing are the commonest form of avoidable medication errors, it is the most important target for improvement.

OBJECTIVES

To estimate the types and prevalence of medication errors during transcription.

MATERIALS AND METHODS

A cross sectional descriptive retrospective study was conducted at Nobel Medical Teaching Hospital, Biratnagar, Nepal during a time period from 15th November 2008 to 14th February 2009. A random sample of 268 prescriptions of patients written during a period of one year (18/06/2007 to 17/06/2008) for ten different medical out patient departments of the Hospital were reviewed and the analysis was carried out for determining the different types of errors in writing a prescription.

RESULTS

No error was found regarding the name, age, sex and address of the patients. The error in prescriptions regarding the prescriber's name, qualification, NMC registration number and signature were 85.4%, 99.6%, 99.6% and 15.7% respectively. Similarly, the symbol Rx was missing in 66.8%. Dosage form, quantity, dose, frequency and route of administration were not mentioned in 12%, 60%, 19%, 10% and 63% of the prescriptions respectively. Likewise, strength of the prescribed medicines was not stated in 40% of the cases.

CONCLUSION

There is a need to critically address the legibility of prescription, correct spelling of drugs, authorised abbreviations and all other informations of a prescription concerned with patient, prescriber and drugs to minimise the occurrence of medication errors.

14-3-3sigma Modulates pancreatic cancer cell survival and invasiveness

PURPOSE

The purpose of the present study was to investigate the potential role of 14-3-3sigma in pancreatic ductal adenocarcinoma (PDAC).

EXPERIMENTAL DESIGN

14-3-3 isoform expression was determined by real-time quantitative PCR in laser capture normal pancreatic ductal cells and pancreatic cancer cells and in 5 pancreatic cancer cell lines. PANC-1 cells, with low levels of 14-3-3sigma, were stably transfected with a human 14-3-3sigma cDNA. Conversely, high endogenous 14-3-3sigma levels in T3M4 cells were suppressed by specific short hairpin RNA. Apoptosis, motility, and invasiveness were studied.

RESULTS

The cancer cells in 7 PDAC samples expressed high levels of 14-3-3sigma mRNA by quantitative PCR when compared with normal pancreatic duct cells. 14-3-3sigma protein levels were high in BxPC3, COLO-357, and T3M4 cells, intermediate in ASPC-1 cells, and low in PANC-1 cells. Most cell lines released detectable amount of 14-3-3sigma into conditioned medium. Overexpression of 14-3-3sigma in PANC-1 cells led to resistance to cisplatinum-induced apoptosis, increased basal migration, and increased invasion in response to epidermal growth factor and insulin-like growth factor-I. By contrast, short hairpin RNA-mediated knockdown of endogenous 14-3-3sigma in T3M4 cells did not alter migration but led to enhanced cisplatinum sensitivity, increased invasiveness in response to epidermal growth factor, and decreased invasiveness in response to insulin-like growth factor-I.

CONCLUSIONS

14-3-3sigma contributes to the chemoresistance of pancreatic cancer cells and exerts cell type-dependent effects on cell migration and invasion. Therefore, strategies aimed at suppressing 14-3-3sigma expression and function may have a therapeutic benefit in subgroups of patients with PDAC.

Regulated proteolysis of the IFNaR2 subunit of the interferon-alpha receptor

The type I interferons (IFNs) bind surface receptors, induce JAK kinases and activate STAT transcription factors to stimulate the transcription of genes downstream of IFN-stimulated response elements (ISREs). In this study, we demonstrate that IFNaR2, a subunit of the type I IFN receptor, is proteolytically cleaved in a regulated manner. Immunoblotting shows that multi-step cleavage occurs in response to phorbol ester (PMA) and IFN-alpha, generating both a transmembrane 'stub' and the intracellular domain (ICD), similar to Notch proteolysis. Isolated membrane fractions process IFNaR2 to release the ICD. A chimeric receptor construct is utilized to show that cleavage requires the presenilins and occurs in response to epidermal growth factor and protein kinase C-delta overexpression, as well as PMA and type I IFNs. Fluorescence microscopy demonstrates that a green fluorescent protein-ICD fusion localizes predominantly to the nucleus. A fusion between the ICD and the Gal4 DNA-binding domain represses transcription, in a histone deacetylase-dependent manner, of a Gal4 upstream activating sequence-regulated reporter, while overexpression of the ICD alone represses transcription of a reporter linked to an ISRE. Proteolytic cleavage events may facilitate receptor turnover or, more likely, function as a mechanism for signaling similar to that employed by Notch and the Alzheimer's precursor protein.

Partitioning of naphthalene to gemini surfactant-treated alumina

Partitioning of naphthalene to anionic surfactants adsorbed on alumina in the aqueous phase was studied for immobilization of the contaminant in the subsurface. Three anionic surfactants with different molecular structures were used: a conventional (sodium dodecylbenzene sulfonate, SDDBS), a gemini (dialkylated disulfonated diphenyl oxide with alkyl chain length of 12, DADS-C12), and a dianionic (monoalkylated disulfonated diphenyl oxide with alkyl chain length of 12, MADS-C12). Sorption of the surfactants onto alumina was studied in a series of batch experiments and the effectiveness of the adsorbed surfactants onto aluminum oxide as a sorptive phase for naphthalene was compared.

Binding of dialkylated disulfonated diphenyl oxide surfactant onto alumina in the aqueous phase

Adsorption of a gemini surfactant that has two monomers and a spacer in a molecule (dialkylated disulfonated diphenyl oxide with alkyl chain lengths of twelve, DADS-C12) onto positively-charged aluminum oxide in water was studied and compared with a single-monomer anionic surfactant (sodium dodecylbenzene sulfonate, SDDBS). More mass of the gemini surfactant was adsorbed than the conventional single-monomer SDDBS. Fewer moles of the first were bound to the substrate than the second indicating that larger molecular structure of the gemini surfactant does not hinder the sorption. Both surfactants followed similar sorption mechanisms, however, stronger hydrophobic interactions were shown in the bilayer formation of the adsorbed gemini surfactant.