Exosomes derived from adipose stem cells in combination with hyaluronic acid promote diabetic wound healing

Diabetic wound is one of the main challenges in dermatology. Although stem cell-based treatment has therapeutic benefits in wound repair, the clinical application is still limited. Herein we investigated whether adipose stem cells -derived exosomes (Exo) loaded on hyaluronic acid (HA) could promote healing in diabetic rats. Sixty diabetic rats were randomly planned into the control group, Exo group, HA group, and HA+Exo group. On days 7, 14, and 21, five rats from each group were sampled for stereological, molecular, and tensiometrical assessments. Our results indicated that the wound closure rate, the total volumes of new epidermis and dermis, the numerical densities of fibroblasts, the length density blood vessels, collagen density as well as tensiometrical parameters of the healed wounds were significantly higher in the treated groups than in the control group, and these changes were more obvious in the HA+Exo ones. Furthermore, the expression of TGF-β and VEGF genes were meaningfully upregulated in all treated groups compared to the control group and were greater in the HA+Exo group. This is while expression of TNF-α and IL-1β, as well as numerical densities of neutrophils decreased more considerably in the HA+Exo group in comparison to the other groups. Generally, it was found that using both HA injection and exosomes has more effect on diabetic wound healing.

Fluorescence Resonance Energy Transfer (FRET)-Based Sensor for Detection of Foodborne Pathogenic Bacteria: A Review

Sensitive and rapid determination of foodborne pathogenic bacteria is of practical importance for the control and prevention of foodborne illnesses. Nowadays, with the prosperous development of fluorescence assays, fluorescence resonance energy transfer (FRET)-derived diagnostic strategies are extensively employed in quantitative analysis of different pathogenic bacteria in food-related matrices, which displays a rapid, simple, stable, reliable, cost-effective, selective, sensitive, and real-time way. Considering the extensive efforts that have been made in this field so far, we here discuss the up-to-date developments of FRET-based diagnostic approaches for the determination of key foodborne pathogens like Staphylococcus aureus, Escherichia coli, Vibrio parahaemolyticus, Salmonella spp., Campylobacter spp., and Bacillus cereus in complex food-related matrices. Moreover, the principle of this technology, the choosing standards of acceptor-donor pairs, and the fluorescence properties are also profiled. Finally, the current prospects and challenges in this field are also put forward.

LncRNA-miRNA interaction is involved in colorectal cancer pathogenesis by modulating diverse signaling pathways

LncRNAs function as molecular sponges for miRNAs to control their availability for targeting mRNA molecules. This procedure indirectly regulates the expression of cancer-related genes. Some lncRNAs also directly interact with miRNAs, leading to their degradation or sequestration, which can negatively impact gene expression. miRNAs, on the other hand, play a critical role in controlling the expression of genes, including oncogenes and tumor suppressor genes. Multiple types of cancer have been linked to the onset and progression of miRNA dysregulation. Even though there is a lot of potential for treating CRC by targeting the LncRNA-miRNA axis, several challenges remain to be overcome. The specificity of the targeting approach, delivery methods, resistance, safety, and cost-effectiveness are critical research areas that must be addressed to advance this field and improve treatment outcomes for people with CRC.

Addressing Domestic Violence in Antenatal Care Environments in Nepal (ADVANCE) - study protocol for a randomized controlled trial evaluating a video intervention on domestic violence among pregnant women

BACKGROUND

Domestic violence (DV) prior to, and during pregnancy is associated with increased risks for morbidity and mortality. As pregnant women routinely attend antenatal care this environment can be used to offer support to women experiencing DV. We have developed a video intervention that focuses on the use of behavioral coping strategies, particularly regarding disclosure of DV experiences. The effectiveness of this intervention will be evaluated through a randomized controlled trial (RCT) and a concurrent process evaluation.

METHODS

All pregnant women between 12-22 weeks of gestation attending routine antenatal care at two tertiary level hospitals in Nepal are invited to participate. DV is measured using the Nepalese version of the Abuse Assessment Screen (N-AAS). Additionally, we measure participants' mental health, use of coping strategies, physical activity, and food security through a Color-coded Audio Computer Assisted Self Interview (C-ACASI). Irrespective of DV status, women are randomized into the intervention or control arm using a computer-generated randomization program. The intervention arm views a short video providing information on DV, safety improving actions women can take with an emphasis on disclosing the violence to a trusted person along with utilizing helplines available in Nepal. The control group watches a video on maintaining a healthy pregnancy and when to seek healthcare. The primary outcome is the proportion of women disclosing their DV status to someone. Secondary outcomes are symptoms of anxiety and depression, coping strategies, the use of safety measures and attitudes towards acceptance of abuse. Follow-up is conducted after 32 weeks of gestation, where both the intervention and control group participants view the intervention video after completing the follow-up questionnaire. Additionally, a mixed methods process evaluation of the intervention will be carried out to explore factors influencing the acceptability of the intervention and the disclosure of DV, including a review of project documents, individual interviews, and focus group discussions with members of the research team, healthcare providers, and participants.

DISCUSSION

This study will provide evidence on whether pregnant women attending regular antenatal visits can enhance their safety by disclosing their experiences of violence to a trusted person after receiving a video intervention.

TRIAL REGISTRATION

The study is registered in ClinicalTrial.gov with identifier NCT05199935.

Job Satisfaction among School Teachers in Duwakot, Bhaktapur District, Nepal

Introduction: Job satisfaction is one of the determinant factors for professionals. The job satisfaction concerning school teachers reflects their strong motivation towards their job. This study aimed to measure the job satisfaction among teachers of Government and Private schools of  Changu Narayan Municipality. Methods: A cross-sectional study was done at seven government and five private schools of wards no. 1 and 2 of Changu Narayan Municipality Bhaktapur District, Nepal over one month (20th April - 19th May 2021). Schools of Changu Narayan Municipality Ward No. 1 and 2 were purposively selected. The data was collected through validated questionnaire on Job Description Index (JDI)8 which consists of 17 domains. Data were entered in Excel and data analysis was done in SPSS version 20. Results: The overall job satisfaction was 65.77±11.52 which indicates that the majority of teachers were highly satisfied with their job. Conclusion:  The findings of this study indicate job satisfaction among  school level teachers was satisfied in their occupation especially in teaching profession. The domain sources of job satisfaction in school teachers appear to be work itself, coworker, relationship with students and sense of achievement. Whereas motivation in profession is most likely to be less job satisfaction among Government and Private schools.

Gaming Disorder among Medical College Students during COVID-19 Pandemic Lockdown

Background The frequent lockdown in Nepal during COVID-19 pandemic had brought various kinds of complexities such as stress among college students. This situation had created uncertainty of future academic career of undergraduate students in medical colleges. Some previously published literature showed gaming as a coping mechanism against stress. Objective To assess the gaming behavior of Medical college students during lockdown in COVID-19 pandemic. Method A cross-sectional study was conducted during lockdown period of July to August 2020. A total of 412 college students were enrolled. Online Google forms were shared to all the eligible students through email, viber and messenger with the help of class representative. Collected data were analyzed in SPSS version 20.0. Result The prevalence of gaming disorder was 8.5% among 260 internet gaming users. About 69.2% of the participants reported that their gaming behavior had increased due to stress of COVID-19 pandemic. Gender and spending more time online per day showed significant associations with greater scores on the internet gaming disorder. Conclusion During lockdown period of COVID-19 pandemic, the gaming behavior of medical college students has increased.

Twin-beam sub-shot-noise raster-scanning microscope

By exploiting the quantised nature of light, we demonstrate a sub-shot-noise scanning optical transmittance microscope. Our microscope demonstrates, with micron scale resolution, a factor of improvement in precision of 1.76(9) in transmittance estimation gained per probe photon relative to the theoretical model, a shot-noise-limited source of light, in an equivalent single-pass classical version of the same experiment using the same number of photons detected with a 90% efficient detector. This would allow us to observe photosensitive samples with nearly twice the precision, without sacrificing image resolution or increasing optical power to improve signal-to-noise ratio. Our setup uses correlated twin-beams produced by parametric down-conversion, and a hybrid detection scheme comprising photon-counting-based feed-forward and a highly efficient CCD camera.

The Prevalence of Gender Inequalities and Violence in the Eastern Nepal

Background Gender inequality and gender based violence is more established in societies with stratification and stronger gender norms. Objective To determine prevalence of gender violence, perception on gender issues and awareness on sexual trafficking and rights among men and women in Morang district of Nepal. Method This cross sectional study was conducted among 810 men and 1190 women in twenty different VDCs of Morang district using self-administered computer based self-interview methods during October-November 2016. Result Male in comparison to female reported more physical abuse during their lifetime. Females (n=259, 21.7%) reported more severe lifetime emotional abuse (n=148, 18.2%) compared to the males. Lifetime severe sexual abuse was reported by a close to five percent (n=95) of both sexes. The severe forms of partner violence include choking, threat or use of weapon and setting on fire was identified to be perpetrated by both the sexes. More than 50% (n=1095) of the respondents had known someone using physical violence against their partner in the community. The involvement of female in key economic decision-making was reported by less than 12%. Nearly 72% (n=1441) were aware of occurrence of sexual trafficking from Nepal while only 46% (n=918) were aware of sexual trafficking occurring from their vicinity. Conclusion The study confirms that despite awareness on gender equality and sexual trafficking, the prevalence of violence and adherence to stronger gender stereotypes, stigmas and roles indicates much need of awareness for establishing equalities and reducing gender violence.

Epidemiology of Work-Related Musculoskeletal Symptoms and Illnesses among Brick Kiln Workers in Kathmandu Valley, Nepal

Background Workers in the brick manufacturing industries require to carry heavy loads, do repetitive work and remain in awkward postures for extended periods of time. These activities may cause them to develop work-related musculoskeletal symptoms and disorders. Objective To investigate the epidemiology of musculoskeletal symptoms and disorders among brick manufacturing workers as well as similar exposure groups among brick kiln workers. Method An analytical cross-sectional study was conducted during February - March 2015 in the Kathmandu Valley. From 16 brick kilns, 400 interviewees involving green brick molding, green brick stacking/carrying, red brick loading/carrying, coal crushing/ carrying and firing were recruited. An unmatched equal size of reference group of grocery workers was maintained for comparison. Prevalence of all musculoskeletal symptoms and disorders were computed and compared among brick workers and grocery workers as well as similar exposure groups among brick kiln workers. Result The musculoskeletal symptoms and disorders were prevalent in 90.5% of the exposed and 82.2% of the reference group. Brick kiln workers were about two times more likely to experience musculoskeletal symptoms and disorders compared to the reference group. When the associations among similar exposure groups were evaluated, there were significantly high prevalence of musculoskeletal symptoms and disorders among green brick molders, red brick loaders/carriers and coal crushers/ carriers in comparison to firemen. Conclusion This study showed a high prevalence of musculoskeletal symptoms and disorders among brick kilns workers. Among all similar exposure groups, coal crushing/carrying task significantly elevated with all types of musculoskeletal symptoms and disorders.

Diversity, Distribution, Use Pattern and Evaluation of Wild Edible Plants of Uttarakhand, India

<p>Wild edible plants are crucial not only for their role as a source of food and nutrition but are also integral part of culture and traditions of the Himalayan societies. Because of availability of diverse altitudinal, topographical and microclimatic conditions, the state of Uttarakhand supports a huge diversity of wild edible plants. Most of the species of wild edible plants in Uttarakhand are primarily consumed as a food by the local communities residing in remote hilly regions. However, several other species are consumed for their medicinal and health promoting benefits. The availability of enormous diversity of wild edible plants in the region has attracted attention of researchers. Consequently, research has been carried out on different aspects of wild edible plants. These include studies on distribution and use pattern, development of propagation protocols and bioprospecting and biochemical evaluation. As a result of this, some of the species are being utilized at commercial scale, and thus are considered capable of providing alternate options of livelihood for marginal communities residing in far flung areas of the state. However, there are several other promising species of wild fruits in the region, which need attention for conducting research on various aspects so that their optimum nutritional and economic potentials could be harnessed in sustainable manner.</p>

Screening for Hypertension and Obesity in Rural Population of Nepal

Background Hypertension is a major non-communicable disease and obesity is a risk factor for non-communicable diseases around the globe. The prevalence of hypertension and obesity is gradually increasing in Nepal. Most cases in the rural population of Nepal remain undiagnosed due to lack of routine screening and awareness. Objective To screen the cases of hypertension and obesity in a rural population of Nepal and also to depict the association between them. Method A cross sectional study was used to collect data on age, sex, height, weight and blood pressure through a screening health camp. Only the respondents who were not already taking antihypertensive drugs were included in this study. The measurement of blood pressure and body mass index was done using standard instruments. Joint National Committee VII classification was used to classify hypertension and World Health Organization classification was used for Body Mass Index. Analysis was done in IBM SPSS version 20. Result Out of the total respondents, 69.8% were female and 30.2% were male, and mean age was 48.73 (±16.25) years. Among them, 375 (30.17%) respondents were found to be hypertensive and 137 (11.02%) were pre-hypertensive. Similarly, 27% male participants and 72 % female participants were obese. Almost three-fifths of the obese participants were hypertensive. Conclusion Pre-hypertension and hypertension were seen in 11.02% and 30.17% of the study population respectively. As routine screening of hypertension and obesity is not done in our country, most of them remain undiagnosed.

Airborne Particulate Matter and Health Condition in Brick Kiln Workers in Kathmandu Valley, Nepal

Background Air quality monitoring in brick kilns indicates very high concentrations of airborne particulate matter. Air pollution from brick kilns poses an enhanced threat to the environment and to human health. Objective To evaluate airborne particulate matter concentration and health status of brick kiln workers. Method A cross-sectional comparative study was conducted in the Kathmandu valley targeting all brick industries and their workers during January - March 2015 and March - April 2016. A total of 16 brick kilns and 800 participants (400 brick workers as exposed and 400 grocery workers as referent) were selected for study. A direct-reading, Dusttrak model 8533 was used for air sampling. Nepali version questionnaire was applied to obtain epidemiological data. SPSS version 16 was used to perform statistical analysis. Median, mean, range and proportion were calculated and Mann-Whitney U test, Kruskal-Wallis test and chi square (c2) test were applied to test significance. Result Mean values of particulate matter concentrations for brickfields were as follows: Total Suspended Particulate Matter (TSPM): 5.179 mg/m3, PM10: 4.958 mg/m3, respirable suspended particulate matter (RSPM): 4.140 mg/m3, PM2.5: 3.965 mg/m3, and PM1: 3.954 mg/m3. The mean concentrations for grocery workers were; TSPM: 0.089 mg/ m3, PM10: 0.089 mg/m3, RSPM: 0.085 mg/m3, PM2.5: 0.082 mg/m3 and PM1: 0.082 mg/m3. Among brickfield workers, red and green brick loading zones had results that exceeded the ACGIH Threshold Limit Values for TSPM and RSPM. Workers complaints of injury were 52% and 44.2%, and illnesses were 88.5% and 82.2%, respectively among exposed and referent. The occurrence of injuries/illnesses during work showed significant association between exposed and the referent groups at 0.05 level. Conclusion The high level of airborne particulate matter in the brick fields requires action for the protection of workers. The availability of health services within brick industries needs to be enhanced.

Attitude of medical students towards occupational safety and health: a multi-national study

BACKGROUND

Work-related diseases contribute immensely to the global burden of diseases. Better understanding of attitudes of health care workers towards occupational safety and health (OSH) is important for planning.

OBJECTIVE

To assess the attitude of medical students towards OSH around the globe.

METHODS

A questionnaire assessing the attitude towards OSH was administered to medical and paramedical students of 21 Medical Universities across the globe. In the current study 1895 students, aged 18-36 years, from 17 countries were included. After having performed a principal components analysis, the associations of interest between the identified components and other socio demographic characteristics were assessed by multivariate linear regression.

RESULTS

Principal component analysis revealed 3 components. Students from lower and lower-middle-income countries had a more positive attitude towards OSH, but the importance of OSH was still rated higher by students from upper-income countries. Although students from Asian and African continents showed high interest for OSH, European and South-Central American students comparatively rated importance of OSH to be higher. Paramedical students had more positive attitude towards OSH than medical students.

CONCLUSION

The attitude of students from lower-income and lower-middle-income towards importance of OSH is negative. This attitude could be changed by recommending modifications to OSH courses that reflect the importance of OSH. Since paramedical students showed more interest in OSH than medical students, modifications in existing health care system with major role of paramedics in OSH service delivery is recommended.

Performance and carcass characteristics of guinea fowl fed on dietary Neem (Azadirachta indica) leaf powder as a growth promoter

The present work aimed at studying growth pattern and carcass traits in pearl grey guinea fowl fed on dietary Neem (Azadirachta indica) leaf powder (NLP) over a period of 12 weeks. Day old guinea fowl keets (n=120) were randomly assigned to four treatment groups, each with 3 replicates. The first treatment was designated as control (T0) in which no supplement was added to the feed, while in treatments T1, T2 and T3, NLP was provided as 1, 2 and 3 g per kg of feed, respectively. The results revealed a significant increase in body weight at 12 weeks; 1229.7 for T1, 1249.8 for T2, and 1266.2 g T3 compared to 1220.0 g for the control group (P<0.05). The results also showed that the supplementation of NLP significantly increased feed intake (P≤0.05) which might be due to the hypoglycaemic activity of Neem. A significant increase was also found in the feed conversion ratio (FCR) of the treated groups over the control, showing that feeding NLP to the treated groups has lowered their residual feed efficiency. The results of the study demonstrate the beneficial effects of supplementing NLP on body weight gain and dressed yield in the treated groups in guinea fowl. NLP is, therefore, suggested to be used as a feed supplement in guinea fowl for higher profitability.

Hand washing practice among health care workers in a teaching hospital

BACKGROUND

Health care associated infection has been identified as one of the major challenges of modern medicine and remains as a major health concern around the globe. Hands of the health-care workers are potential vehicle for transmission of pathogenic organisms within the healthcare environment. Hand washing is widely accepted as one of the most effective measures in prevention of health care associated infections.

METHODS

A descriptive cross-sectional study was conducted to assess the hand washing practice among the doctors, intern doctors, nurses, medical students and nursing students in a multi specialty, non government tertiary care teaching hospital in Kathmandu. Summary statistics and chi-square tests were performed and the type I error was set at 0.05 for analysis.

RESULTS

Out of the total 336 participants of the study, there was significant difference in hand washing practice among the participants (P<0.001). Hand washing practice both before and after the patient examination was found to be highest among the nursing students followed by the nurses. The frequency of hand washing after exposure to hospital instruments, blood or other body fluids among the participants was remarkably high (more than 90%) in all groups. Nearly 99% of the participants agreed upon the fact that hand washing could be an effective measure in preventing health care associated infections.

CONCLUSIONS

The healthcare workers understand the importance of hand washing but tend to wash their hands selectively depending upon the indications. The majority of the health care workers wash their hands after the patient care than before.

Antimicrobial susceptibility patterns of Salmonella typhi and Salmonella paratyphi A in a tertiary care hospital

BACKGROUND

Enteric fever is still an important public health problem in developing countries including Nepal. A changing antibiotic susceptibility pattern of Salmonella typhi and Salmonella paratyphi A and emergence of multi drug resistance has increased to a great concern. Aim of the study was to investigate the antibiotic susceptibility pattern of Salmonella typhi and Salmonella paratyphi A.

METHODS

Study was carried out at the department of microbiology in Kathmandu Medical College. Blood culture samples were collected from suspected enteric fever patient and tested microbiologically by standard procedure. Antibiotic susceptibility test was performed by Kirby-Bauer disc diffusion method and results were interpreted by National Committee for Clinical Laboratory (NCCLS) guideline.

RESULTS

Of total 78 (2.0%) Salmonella serotype isolated from 3,980 blood culture samples, in which 47 (60.3%) were S. typhi and 31 (39.7%) were S. paratyphi A. Isolates were from all age group median age being the 25 years. Among the tested antibiotics S. typhi was susceptible towards Ciprofloxacin (100%) followed by Gentamicin (97.9%), Ofloxacine (95.7%), Ceftriaxone (95.7%) and Chloramphenicol (93.6%). In case of S. paratyphi A most of the tested antibiotics showed high percentage of susceptibility and least susceptible antibiotic for S. paratyphi A was Ampicillin (25.8%). Three isolates of S. typhi showed multidrug resistance.

CONCLUSIONS

A considerable variation was observed in the antimicrobial susceptibility pattern of S.typhi and S. paratyphi A. Hence antibiotic susceptibility test must be sought before instituting appropriate therapy to prevent from further emergence of drug resistance.

Iniencephaly clausus: A case report with review of literature

Iniencephaly is a rare neural tube defect characterized by extreme retroflexion of the head with the absence of neck due to spinal deformities. The important features that help us to diagnose a case of iniencephaly are occipital bone deficit leading to enlarged foramen magnum, fusion of malformed cervical and thoracic vertebrae, and upward turned face with chin continuous with chest because of the absence of neck. The differential diagnoses include anencephaly with spinal retroflexion, Klippel–Fiel syndrome, nuchal tumors such as teratoma, goiter, and lymphangioma and Jarcho–Levin syndrome. Previously many case reports on radiological features of iniencephaly are published, but there are very few articles on necropsy findings and differential diagnosis. In the present case we have discussed in detail the necropsy findings of iniencephaly clausus with special reference to differential diagnosis.

Assessing carrageenan-induced locomotor activity impairment in rats: comparison with evoked endpoint of acute inflammatory pain

BACKGROUND

Most animal models currently used to evaluate antinociceptive efficacy of analgesics rely on the assessment of evoked pain behaviours as primary endpoints.

METHODS

Here, we have developed and characterized the carrageenan-induced locomotor activity impairment (CLAIM) model to objectively assess non-evoked inflammatory pain behaviour in rats. In this model, 100 µL of 1% carrageenan was subcutaneously injected into the plantar aspect of the right hind paw and exploratory behaviour in the novel testing chamber was recorded using an automated locomotor activity system.

RESULTS

Carrageenan-injected animals exhibited an exploratory behavioural deficit 2-7 h following injection compared to saline-injected animals. The severity of impairment was carrageenan dose related, and sensitive to the light intensity in the testing room. The effects of standard analgesics on CLAIM were examined 2 or 3 h following carrageenan injection. Diclofenac and ibuprofen, in a dose range exerting no effect on locomotor activity in naïve rats, exhibited dose-related reversal of CLAIM (ED(50) = 1.5 and 5.0 mg/kg, respectively), with comparable efficacy on carrageenan-induced thermal hyperalgesia (ED(50) = 2.0 and 6.0 mg/kg, respectively). Gabapentin and duloxetine produced no reversal of CLAIM, or attenuation of thermal hyperalgesia. Efficacy discrepancy was noted for morphine on thermal hyperalgesia and CLAIM. Additionally, amphetamine dose dependently reversed CLAIM, and similarly increased locomotor activity in normal animals.

DISCUSSION AND CONCLUSION

The results presented here demonstrate that CLAIM provides an objective assessment of non-evoked pain behaviours for acute inflammatory pain. The pharmacological profile of standard analgesics supports that CLAIM model can be used to identify agents to treat acute inflammatory pain in the clinic.

Occupational Safety and Health Studies in Nepal

Occupational safety and health are key issues today, with growing industrialization and labor market. To introduce and maintain a high standard of safety and health at workplace, it is essential to have an overall picture of the present workplace scenario, different hazards and probable health effects. This is a review of all previously published articles on occupational safety and health in Nepal. Key words such as Nepal, Occupation, Safety, and Health were used to search for relevant articles in PUBMED and Google Scholar. A total of 15 research articles were found, which dealt with different forms of work, like agriculture, health services, child labor, small scale household industries, brick kilns, and textile factories. The overall status of occupational safety and health does not look satisfactory. Standard work situations and criteria have to be set up and regular monitoring should be done to ensure the maintenance of quality at work. Key Words: environment; exposure; hazards; labor; work place DOI: http://dx.doi.org/10.3126/ijosh.v1i1.4725 International Journal of Occupational Safety and Health, Vol 1 (2011) 19-26

How Robust are our Methods of Detecting Impaired Glomerular Filtration Rate in the Intensive Care Unit?

BACKGROUND

Serum creatinine is not a sensitive marker to assess early loss of renal function in acute kidney injury. Timed creatinine clearance and several formula used to predict glomreular filtration rate have not been validated.

METHODS

In a prospective observational study in 50 adult patients admitted to the intensive care unit with apparent normal renal function, we assessed the glomerular filtration rate by the formula methods and timed creatinine clearance.

RESULT

The mean serum creatinine was 0.77mg/dl, SD ± 0.15 (range 0.5-1.14 mg/dl). The mean measured creatinine clearance was 87.15 ml/min/1.73m(2), SD ± 20.5 (range 56.9-137 ml/min/1.73m(2)). In 25 (50%) patients, one hour urinary creatinine clearance was <80 ml/min/1.73m(2) and in two (4%) patients, the creatinine clearance was <60 ml/min/1.73m(2). Spearman correlation coefficient and regression analysis revealed a statistically significant correlation for the Cockcroft-Gault and predictive equations when compared with measured creatinine clearance. The differences between the predictive equations and creatinine clearance, as illustrated by the ±95% confidence interval in the Bland-Altman graphs was very significant [Cockcroft- Gault = -40.3 to 17.7 ml/min/ 1.73m(2), Modification of Diet in Renal Disease equation = -46.2 to 30.6 ml/min/1.73m(2) and the simplified Modification of Diet in Renal Disease equation = -72.8 to 24.8 ml/min/1.73m(2)].

CONCLUSION

Formula methods and creatinine clearance are more sensitive than serum creatinine in detecting early phase of acute kidney injury. However, there is no agreement between these methods of glomerular filtration rate estimation.

Asymptomatic throat carriage rate and antimicrobial resistance pattern of Streptococcus pyogenes in Nepalese school children

BACKGROUND

Streptococcus pyogenes or Group A streptococcus (GAS) causes several suppurative and non suppurative infections. In addition to pharyngitis and skin infections, GAS are also the causative agent of post-streptococcal infection syndromes such as acute rheumatic fever (ARF) and post-streptococcal glumerulonephritis (PSG). GAS frequently colonises in the throat of an asymptomatic person. Pharyngeal carriage rates of GAS among healthy school children vary with geographical location and seasons.

OBJECTIVES

We carried out this preliminary study to determine the throat carriage rate and antimicrobial resistance trend of Streptococcus pyogenes or Group A streptococcus (GAS) among the Nepalese school children.

MATERIALS AND METHODS

Four schools situated at different locations of Kathmandu valley were included in the study. Throat swabs from 350 students of age group 5-15 years were collected, immediately transported to the laboratory and were processed for S. pyogenes following standard microbiological procedures. Antimicrobial susceptibility testing of the isolates was performed by Kirby Bauer disc diffusion method following CLSI guidelines.

RESULTS

S. pyogenes was isolated from 10.9% (38/350) of the screened children. The GAS colonisation rate was statistically insignificant (P>0.05) with sex and age sub-groups, although the rate was slightly higher among girls and age sub-group 9-12 years. No significant difference in carrier rate was observed among different schools (P>0.05). All isolates were susceptible to azithromycin. No resistance was detected for penicillin and its derivative antibiotic ampicillin. Highest resistance rate was observed for cotrimoxazole (71.0%) followed by chloramphenicol (7.8%), ciprofloxacin (5.2%) and erythromycin (5.2%).

CONCLUSION

Antibiotic resistant GAS isolated from asymptomatic Nepalese school children is a public health concern. When screened and appropriately treated with antibiotics, carriers can be prevented from spreading of streptococcal infections in the school environment and the community. Preventing cross infections would ultimately reduce the incidence of life-threatening sequelae which are debilitating and difficult to treat. It is recommended to conduct regular screening and GAS surveillance in schools, and maintain rational use of antibiotics to minimise GAS carriage/infections and resistance.

Voilence against women in Nepal: role of health care workers

DOI: 10.3126/kumj.v7i2.2695Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 89-90

A study of injuries and violence related articles in Nepal

INTRODUCTION

Nepal lacks sufficient data on injury and violence. Studies have been done in different regions but there is not a nationwide study on this topic. So, we have designed this systematic review to get a cumulative picture of injury and violence status in Nepal.

METHODS

We searched Medline database, Google scholar database and also all the national medical journals for relevant studies on injuries and violence. Our eligibility criteria included studies done in Nepal, evaluating the incidence of different forms of injuries, and their causes and effects. We excluded case reports, editorials and reviews. All together, we had 23 studies. We made cumulative analysis wherever possible.

RESULTS

All the studies were descriptive. In overall, the incidence of injuries was twice as common in male as in female with the ratio of 2.1:1. The economically active population between 20-50 years of age was mostly involved in injuries. Road traffic injuries were the most common form of injuries, most of which (42.5%) involved motorcycles. Pedestrians (48.6%) were the most vulnerable group of population. Falls (48.9%) were the most common cause of neuro traumatic accidents.

CONCLUSIONS

Our systematic review suggests that injuries and violence pose a big problem; road traffic accidents make the most part of it.

Occupational health in small scale and household industries in Nepal: a situation analysis

INTRODUCTION

Making working conditions safe and healthy is the interest of workers, employers and the Government.Although it seems simple and obvious, this idea has not yet gained meaningful recognition in Nepal.

MATERIALS AND METHODS

The study was conducted in ten small scale industries of Kathmandu valley. Altogether 545 questionnaires on socioeconomic and occupational history were filled up. Similarly, Workplace Occupational Health Assessment was done in all ten industries. A thorough medical examination of 135 child workers was done using a structured questionnaire to find out the health effects due to occupational hazards.

RESULTS

Out of the total 545 workers present in the industries under study, 135 (24.8%) were child workers. Higher proportion of child workers (97%) was illiterate compared to 3% of children with primary level education. Among the child workers, 23 (17%) were girls. The majority of the child labourers were suffering from conditions like otitis externa, otitis media, scabies, anaemia, upper respiratory diseases, nasal problems, abdominal pain etc.

CONCLUSION

The occupational health and safety practices in small scale industries in Kathmandu have been found to be unsatisfactory. Child labour is a serious problem. Out of ten industries, six have employed child workers and the working conditions range from bad to terrible. Health and welfare of the child workers was also not satisfactory.

Environmental health effects of brick kilns in Kathmandu valley

INTRODUCTION

Brick kilns operating in Kathmandu valley are known to be a leading cause of air pollution. The main objective of this study was to assess the effect of brick kilns on environment and human health. This study has been done at Duwakot VDC in Bhaktapur.

METHODS

This study was conducted during brick kilns operating and not operating periods. Different methods were used for data collection, such as household environmental health survey, school health examination, and air quality measurement for total suspend particles, particulate matter of size less than 10 microns, Sulphur Dioxide, Oxides of Nitrogen, and Carbon Monoxide.

RESULTS

A total of 330 individuals were interviewed during household environmental survey and majority of them expressed about smoke related respiratory discomfort at home and surrounding. Out of 141 school children who underwent thorough physical health examination, 79 students were from Ganesh Public School (located near to brick kilns) and 62 were from Nabin English School (far away from brick kilns). Statistically significant high odds ratios for respiratory problems like tonsillitis (4.17 95% CI 2.05, 8.45) and acute pharyngitis (4.08 95% CI 2.01, 8.33) were observed among the students from Ganesh Public School. Average value of particulate matter of size less than 10 microns and total suspend particles for the pre operation time was 0.029 mg/m3 and 0.033 mg/m3 respectively whereas, it reached 0.050 mg/m3 and 0.056 mg/m3 respectively during the brick kiln operation time.

CONCLUSION

The concentration of various air pollutants was higher during the operation of brick kilns at Duwakot. Similarly, the health status of the school children attending the school close to the vicinity of the brick kilns was worse compared to the students attending the school away from the brick kilns.

Acquaintance with the actuality: community diagnosis programme of Kathmandu Medical College at Gundu village, Bhaktapur, Nepal

INTRODUCTION

In Nepal, various field programs such as community diagnosis programmes (CDP) have been initiated to make the education of doctors, nurses and dentists more community oriented and relevant and suited to the health care scenario. Community diagnosis refers to the identification and quantification of the health problems in a community and identification of their correlates for the purpose of defining those individuals or groups at risk or those in need of health care. The article presents the main activities of community diagnosis as a core component of community-based education for the medical students at Kathmandu Medical College, Kathmandu, Nepal.

METHODOLOGY

A 4 weeks' Community Diagnosis Programme was conducted by MBBS II students (9th Batch) of the Kathmandu Medical College under the supervision of the Department of Community Medicine in November 2006 in the rural community of Gundu VDC (village development committee). The tools used included pre-tested questionnaires, weighing machines, measuring tapes, stethoscopes and sphygmomanometers. After the data collection and compilation, the students presented their findings in oral presentations, accompanied by a written report, including essential recommendations for improving the health status of these communities.

RESULTS

The students benefited from the necessary process of integrating clinical skills and a public health approach, so as to enhance their epidemiological thinking and be of greater use to the communities where they will practice. The community also benefited by achievement of behavioral changes leading to healthier lifestyles and increased awareness of health-related matters and their role in quality of life.

CONCLUSIONS

CDP is a way to practically demonstrate that the link between a medical college and society is possible. That is, a medical college can serve the community and thus society, with specific activities to improve health and the skills of students who will serve as future health professionals.

Comparison of antinociceptive actions of standard analgesics in attenuating capsaicin and nerve-injury-induced mechanical hypersensitivity

Intradermal capsaicin injection produces immediate spontaneous pain behaviors, and a secondary mechanical hypersensitivity (SMH) that is employed in the clinic as a model potentially predictive of human neuropathic pain. Presently, we have characterized capsaicin-induced SMH in rats, and compared pharmacological actions of standard analgesics in this and two nerve injury models, the L5/L6 spinal nerve ligation (SNL) and sciatic nerve chronic constriction injury (CCI) models. Intraplantar capsaicin produced dose-related SMH (enhanced paw withdrawal response to von Frey monofilament stimulation at an area away from injection site) that lasted for over 4 h. While pretreatment with a potent selective transient receptor potential vanilloid receptor-1 (TRPV1) antagonist A-425619 (1-isoquinolin-5-yl-3-(4-trifluoromethyl-benzyl)-urea) prevented development of acute nocifensive (flinching) behavior immediately following capsaicin injection (ED(50)=4.9 mg/kg), the compound failed to attenuate the SMH when administered 2 h following capsaicin (10 microg/10 microl). Additional standard analgesics were also tested 3 h following intraplantar capsaicin in the SMH model. Comparison of their potencies in attenuating mechanical hypersensitivity in capsaicin, SNL and CCI models revealed similar ED(50)s for morphine (2.3 mg/kg, 1.6 mg/kg and 3.2 mg/kg, respectively), gabapentin (33.1 mg/kg, 33.9 mg/kg and 26.3 mg/kg, respectively) and lamotrigine (9.1 mg/kg, 8.9 mg/kg and 15.5 mg/kg, respectively). Duloxetine produced 50-65% effect at the highest tested dose (50 mg/kg), whereas the highest tested doses of morphine (10 mg/kg), gabapentin (85.5 mg/kg) and lamotrigine (30 mg/kg) all produced >70% efficacy in capsaicin SMH, SNL and CCI models. In contrast, celecoxib and ibuprofen showed weak effects in all three models. All standard analgesics generally had weak efficacy in attenuating capsaicin-induced immediate acute flinching behavior when administered before capsaicin. These results provide further support to the suggestions that distinct pharmacological mechanisms underlie capsaicin-induced acute nocifensive and SMH behaviors, and certain neuronal mechanisms underlying neuropathic pain states are also contributory to capsaicin-induced SMH.

Involvement of the TTX-resistant sodium channel Nav 1.8 in inflammatory and neuropathic, but not post-operative, pain states

Antisense (AS) oligodeoxynucleotides (ODNs) targeting the Nav 1.8 sodium channel have been reported to decrease inflammatory hyperalgesia and L5/L6 spinal nerve ligation-induced mechanical allodynia in rats. The present studies were conducted to further characterize Nav 1.8 AS antinociceptive profile in rats to better understand the role of Nav 1.8 in different pain states. Consistent with earlier reports, chronic intrathecal Nav 1.8 AS, but not mismatch (MM), ODN decreased TTX-resistant sodium current density (by 60.5+/-10.2% relative to MM; p<0.05) in neurons from L4 to L5 dorsal root ganglia and significantly attenuated mechanical allodynia following intraplantar complete Freund's adjuvant. In addition, 10 days following chronic constriction injury of the sciatic nerve, Nav 1.8 AS, but not MM, ODN also attenuated mechanical allodynia (54.3+/-8.2% effect, p<0.05 vs. MM) 2 days after initiation of ODN treatment. The anti-allodynic effects remained for the duration of the AS treatment, and CCI rats returned to an allodynic state 4 days after discontinuing AS. In contrast, Nav 1.8 AS ODN failed to reduce mechanical allodynia in the vincristine chemotherapy-induced neuropathic pain model or a skin-incision model of post-operative pain. Finally, Nav 1.8 AS, but not MM, ODN treatment produced a small but significant attenuation of acute noxious mechanical sensitivity in naïve animals (17.6+/-6.2% effect, p<0.05 vs. MM). These data demonstrate a greater involvement of Nav 1.8 in frank nerve injury and inflammatory pain as compared to acute, post-operative or chemotherapy-induced neuropathic pain states.

Complete 1H and 13C NMR assignments of six saponins from Sapindus trifoliatus

Complete 1H and 13C spectral assignments are reported for six saponins from the pericarp of Sapindus trifoliatus (Hindi name: Reetha) collected from Madhya Pradesh and Maharashtra, India, using only 1D and 2D NMR methods. The structures of the compounds were elucidated as hederagenin 3-O-(3-O-acetyl-beta-D-xylopyranosyl)-(1-3)-alpha-L-rhamnopyranosyl-(1-2)-alpha-L-ara-binopyranoside, hederagenin 3-O-(4-O-acetyl-beta-D-xylop-yranosyl)-(1-3)-alpha-L-rhamnopyranosyl-(1-2)-alpha-L-arabinop-yranoside, hederagenin 3-O-(3,4-O-diacetyl-beta-D-xylopy-ranosyl)-(1-3)-alpha-L-rhamnopyranosyl-(1-2)-alpha-L-arabinopy-ranoside, hederagenin 3-O-(3,4-O-diacetyl-alpha-L-arabinop-yranosyl)-(1-3)-alpha-L-rhamnopyranosyl-(1-2)-alpha-L-arabinop-yranoside, hederagenin 3-O-(beta-D-xylopyranosyl)-(1-3)-alpha-L-rhamnopyranosyl-(1-2)-alpha-L-arabinopyranoside and he-deragenin 3-O-(alpha-L-arabinopyranosyl)-(1-3)-alpha-L-rhamno-pyranosyl-(1-2)-alpha-L-arabinopyranoside. It is concluded that saponins of this complexity approach the limit of structural complexity, which can be solved by NMR alone, precisely and quickly.

Combining ability in the F1 and F2 generations of diallel cross in hexaploid wheat (Triticum aestivum L. em. Thell)

The F(1) and F(2) progenies of a ten-parent diallel cross (excluding reciprocals) of hexaploid wheat (Triticum aestivum L. em. Thell) were analyzed for combining ability for quantitative and quality traits. The results indicated significant differences among the parents for general combining ability (gca) and crosses for specific combining ability (sca) for all the characters studied. The gca and sca components of variance were significant for all the traits. However, the gca component of variance was predominant indicating the predominance of additive gene effects for the traits studied. Among the parents Durgapura 65, HD 2285, Lok-1, Raj 1972 and HD 2329 were the best general combiners for grain yield and average to high combiners for tillers per plant, grain yield per spike, grains per spike and 1000-grain weight. The best specific crosses for grain yield were Sonalika x WH 157, HD 2428 x Durgapura 65, Durgapura 65 x Sonalika, HD 2428 x Lok-1 and CPAN 3004 x Raj 1972. The parent Raj 1972, Lok-1 and HD 2285 were the best general combiners for grain yield and protein content, however, Raj 3077 was the best general combiner for protein content. The most suitable specific crosses for protein content were HD 2329 x HD 2285, HD 2428 x Raj 1972 and CPAN 3004 x WH 157. Most of the specific crosses for grain yield as well as protein content involved high x average, average x average and average x poor general combiners. To ensure further increase in grain yield along with high protein, combinations of desirable yield components is advocated. Inclusion of F(1) hybrids showing high sca and having parents with good gca, into multiple crosses and/or bi-parental mating, or diallel selective mating could prove a worthwhile approach for further improvement of grain yield in bread wheat.

Arylacetamide kappa-opioid receptor agonists produce a tonic- and use-dependent block of tetrodotoxin-sensitive and -resistant sodium currents in colon sensory neurons

We have previously reported that U50,488 [(trans-3,4-dichloro-N-methyl-N-[2-(1-pyrrolidinyl)-cyclohexyl]benzeneacetamide] enantiomers contribute to visceral antinociception by a nonopioid receptor-mediated blockade of sodium currents in colon sensory neurons. The present experiments were undertaken to examine the effect of arylacetamide kappa-opioid receptor agonists (kappa-ORAs) U50,488 and EMD 61,753 [(N-methyl-N-[1S)-1-phenyl)-2-(13S))-3-hydroxypyrrolidine-1-yl)-ethyl]-2,2-diphenylacetamide HCl] on tetrodotoxin-sensitive (TTX-S) and -resistant (TTX-R) sodium currents, and the mechanism of their sodium channel-blocking actions. Whole cell patch-clamp experiments were performed on colon sensory neurons from the S1 dorsal root ganglion identified by content of retrograde tracer 1.1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine metanesulfonate. The concentration-response curves of U50,488 and EMD 61,753, for tonic inhibition of total, TTX-S, and TTX-R sodium currents were similar (EC50 values for U50,488 and EMD 61,753 were 8.4 +/- 1.69 and 1.2 +/- 1.78 microM, respectively). In contrast, the peptide kappa-ORA dynorphin was without effect in these experiments. U50,488 (10 microM) shifted the voltage dependence of steady-state inactivation curves for total, TTX-S, and TTX-R currents to more negative potentials. Inhibition was present at holding potentials of -100 to -20 mV. After the tonic block elicited by 10 microM U50,488, repetitive stimulation with 5-ms depolarizing pulses at a frequency of 3 Hz further enhanced the inhibition of total, TTX-R, and TTX-S currents by 43.8 +/- 4.9, 46.2 +/- 4.9, and 40 +/- 3.2%, respectively. These results demonstrate that arylacetamide kappa-ORAs nonselectively inhibit voltage-evoked sodium currents in a manner similar to local anesthetics, by enhancing closed-state inactivation and induction of use-dependent block.

Environmental noise induced hearing loss in Nepal

INTRODUCTION

Noise pollution in urban cities is a serious problem and steadily increasing over the years. This has direct and indirect affect to the people that can lead to the health hazard.

OBJECTIVES

To find out environmental noise induced health effect on people residing in an urban community and to predict the risk of the environmental noise induced hearing loss.

MATERIAL AND METHODS

One hundred fifty questionnaires were filled up for the environmental noise pollution survey. For the case control study, 36 exposed and 25 non-exposed residents of Kupondole were included. Based on the place of residence (main road and 20 min. walking distance from the main road), subjects were divided into exposed and non-exposed group concerning environmental noise. Demographic data and information about health problems was obtained by a structured interview. Audiometric test was performed using manual audiometer. Odds ratios (OR) and their 95% confidence intervals (95% CI) for noise induced hearing loss were estimated using logistic regression. Adjustment for occupational noise was done.

RESULTS

The major health effect induced by the environmental noise was observed as lack of concentration followed by irritation, fatigue and headache. The crude OR and 95% CI for the exposed subjects was 4.2 (1.4, 12). After adjustment for occupational noise, the OR (95% CI) was 4.0 (1.2, 13).

CONCLUSION

This study shows that exposure to noise causes wide range of health effects. For the exposed subjects there was an increased risk of noise induced hearing loss. The risk was significantly increased also after adjusting for occupational noise.

Nonopioid actions of U50,488 enantiomers contribute to their peripheral cutaneous antinociceptive effects

The ability of arylacetamide kappa-opioid receptor agonists (kappa-ORAs) to block sodium channels by a nonopioid mechanism has been previously documented. The present experiments were undertaken to test whether two enantiomers of the arylacetamide kappa-ORA (trans)-3,4-dichloro-N-methyl-N-[2-(1-pyrrolidinyl)-cyclohexyl]benzeneacetamide (U50,488), (+)-(1R,2R)-U50,488 and (-)-(1S,2S)-U50,488, are antinociceptive in the formalin model by a peripheral, nonopioid receptor-mediated mechanism. Although both enantiomers have been previously shown to block sodium channels with comparable potencies, only (-)-(1S,2S)-U50,488 has activity at the kappa-opioid receptor (KOR). In the formalin test, intrapaw administration of U50,488 enantiomers as well as lidocaine exhibited significant dose-related attenuation of formalin-induced flinching behavior. The rank order of potency of the drugs tested was (-)-(1S,2S)-U50,488 > (+)-(1R,2R)-U50,488 > lidocaine. The antinociception produced by lower doses of (-)-(1S,2S)-U50,488 was blocked by intrapaw nor-binaltorphimine as well as by antisense knockdown of the KOR. Such pretreatments, however, did not block the antinociception produced by (+)-(1R,2R) U50,488, lidocaine, or higher doses of (-)-(1S,2S)-U50,488. These data suggest that the sodium channel blocking effects of U50,488 and similar kappa-ORAs can contribute to their peripheral antinociceptive actions.

Occupational cancer in Nepal--an update

This article is a discussion of occupational cancer in Nepal. The knowledge of specific problems of occupational cancer in Nepal is very scarce. Few researches on occupational cancer have been done in Nepal. A case-control study done recently has revealed a high risk (OR 4.2 95% CI: 1.4, 12) for lung cancer among the workers, who have worked in the exposed occupations. The incidence of cancer is thought to be rising every year. In this article an attempt has been made to establish the probable occurrence of carcinogens in the middle and large scale manufacturing industries in Nepal and the approximate number of workers exposed to different hazardous substances at the work places.