Prevalence of multimorbidity and its associated risk factors among population of Mechinagar municipality of Nepal

Background

Multimorbidity is a group of conditions, it has significant impact on the population as a whole, resulting in lower quality of life, higher mortality, frequent use of medical services, and consequently higher healthcare costs. The objective of this study is to document the prevalence of common multimorbidity and its associated risk factors among population of Mechinagar Municipality.

Methods

Community-based cross-sectional study was conducted where selected multimorbidity were assessed in selected areas of Mechinagar municipality of Jhapa District . Systematic random sampling technique was used to select 590 adult participants from three pre-defined pocket areas. Pre-designed semi-structured multimorbidity assessment questionnaire for primary care (MAQ-PC)was used to assess prevalence of multimorbidity. Multiple logistic regression was conducted to identify the strongest determinants of multimorbidity.

Results

The prevalence of multimorbidity was 22.4%.Hypertension, Diabetes mellitus and COPD was seen in 39.2%, 7.8.% and 4.4% of the participants respectively . Participants with advancing age i. e. 40-49yrs were 12.62 times (AOR) more likely to have multimorbidity compared to their counterparts who were 20-29yrs old( p=<0.01,CI3.01-15.28) after adjusting for occupation, physical activity and family history of kidney disease. Working individuals, Physical inactivity and positive family history of kidney disease were the strongest determinates of multimorbidity.

Conclusions

The study revealed that participants with increasing age, working individuals, physical inactivity and family history of kidney disease were more vulnerable of having multimorbidity. The findings of our study indicate need of intervention strategies and community-based health promotion programs in reducing burden of chronic disease among adult population.

Catastrophic health expenditure on chronic non-communicable diseases among elder population: A cross-sectional study from a sub-metropolitan city of Eastern Nepal

INTRODUCTION

This study was conducted with the objective to analyze the out-of-pocket (OOP) healthcare expenditure and catastrophic healthcare expenditure (CHE) on chronic non-communicable diseases (CNCD) among the elderly population, and the association of CHE on CNCD with associated factors among the same population.

MATERIALS AND METHODS

We collected data from the elderly population of Dharan Sub-metropolitan city of the Eastern Nepal via door-to-door survey and face-to-face interview. The ten wards out of twenty were chosen by lottery method, and the equal proportion out of 280 samples was purposively chosen from each of ten wards (28 participants from each selected ward). The data were entered in Microsoft Excel 2019 v16.0 and statistical analysis was performed by using statistical package for social sciences, IBM SPSS® v21. The chi-square test was used to test the group differences. Multivariable logistic regression was used to determine independent factors associated with CHE (all variables with P < 0.20), and adjusted odds ratios (AOR) were calculated at 95% confidence interval (CI).

RESULTS

The median household, food and health expenditures were 95325 (72112.50-126262.50), 45000 (33000-60000) and 2100 (885.00-6107.50) NPR respectively. The proportion of the participants with CHE was 14.6%. The single living participants had 3.4 times higher odds of catastrophic health expenditure (AOR = 3.4, 95% CI = 1.2-9.6, P-value = 0.022) than those who are married. Similarly, those who had cancer had 0.1 times lower odds of CHE (AOR = 0.1, 95% CI = 0.0-0.2, P-value = <0.001) than those without cancer.

CONCLUSION

The elder population had significant financial health shocks due to chronic health ailments. There should be the provision of mandatory health insurance programmes for elderly to cut down the catastrophic healthcare expenditure. Similarly, there should be the provision of exemption scheme for vulnerable elderly who are more likely to face catastrophic expenditure from all available health facilities.

Undiagnosed and Uncontrolled Hypertension and Access to Health Care among Residents of an Urban Area of Eastern Nepal: a Cross-sectional Study

Background The burden and complication of hypertension is increasing as most of the people living with hypertension are unaware of their condition and those who are already diagnosed with it do not have their blood pressure under control. Objective To assess the prevalence of undiagnosed and uncontrolled hypertension among residents of Itahari sub metropolitan city of eastern Nepal, along with its associated socio demographic and behavioral risk factors and access to health care services. Method Cross sectional study was conducted in five wards of Itahari, among 1161 participants, using population proportionate to sample size sampling technique. Face to face interview was conducted with participants for data collection applying semi- structured questionnaire and physical measurement like blood pressure, weight and height. Result Prevalence of hypertension was 26.5% includingundiagnosed 11.0% and previously diagnosed 15.5%. Among diagnosed, 76.6% had uncontrolled blood pressure and 56.70% were taking anti-hypertensive medicine, and 7.8% were under Ayurvedic medicine. More than 70% participants preferred private health facility for treatment and 22.7% had faced financial barrier to seek healthcare. About 64% of participants did not visit health services or had visited only once in past six months. Increasing age, Body Mass Index (BMI), smoking status and positive family history were found to be significantly associated with hypertension at < 0.05 level. Conclusion Prevalence of hypertension is high and awareness regarding available health services in local primary health center and its utilization is lacking among participants. Regular screening program for hypertension and awareness program to disseminate the knowledge of availability of primary health center should be conducted.

Prevalence of Intimate Partner Violence and Associated Factors Among Married Nepalese Men in Kathmandu Metropolitan City

BACKGROUND

Intimate Partner Violence is defined as the intentional use of physical force, or power, threatened or actual against on self/others or groups that results in injury, death, psychological harm.

METHODS

A community-based cross-sectional study was conducted in Kathmandu Metropolitan city in 2018. An adequate sample of 210 married men was selected from randomly selected 10 wards of Kathmandu Municipality. A semi-structured questionnaire including standard scales was used for data collection. Multivariate analysis was performed to find out the association of Intimate Partner Violence with different variables.

RESULTS

The mean age of male respondents was 40.19 years. More than half of the respondents were Janajatis. Overwhelming respondents were Hindu (religion). Intimate Partner Violence was estimated in forms of Physical violence, 31.9%, Sexual violence, 4.3%, and Psychological violence, 50.5%. Age, age at marriage, marriage type, marriage decision, spousal age gap, family income, education, smoking habit and depression were independently associated with violence. However, family income and education were found to be significant factors associated with violence even after adjusting the effects of other potential factors.

CONCLUSIONS

Strong association of Intimate Partner Violence with family income, and education of male respondents was observed. More than half of the males had psychological violence and nearly one-third of the participants had Physical violence. The study concludes that Intimate Partner Violence among males could not be neglected.

Andrographolide - A prospective remedy for chikungunya fever and viral arthritis

AIM

Andrographolide, the major bioactive compound of the plant Andrographis paniculata, exerts anti-inflammatory, cyto-, neuro- and hepato-protective effects. Traditional remedies for infectious diseases include A. paniculata for maladies like fever, pain, rashes which are associated with chikungunya and other arboviral diseases. Since andrographolide and A. paniculata have potent antiviral properties, the present review aims to provide a comprehensive report of symptoms and immunological molecules involved in chikungunya virus (CHIKV) infection and the therapeutic role of andrographolide in the mitigation of chikungunya and associated symptoms.

MATERIALS AND METHODS

Studies on the therapeutic role of A. paniculata and andrographolide in chikungunya and other viral infections published between 1991 and 2021 were searched on various databases.

RESULTS AND DISCUSSION

The havoc created by chikungunya is due to the associated debilitating symptoms including arthralgia and myalgia which sometimes remains for years. The authors reviewed and summarized the various symptoms and immunological molecules related to CHIKV replication and associated inflammation, oxidative and unfolded protein stress, apoptosis and arthritis. Additionally, the authors suggested andrographolide as a remedy for chikungunya and other arboviral infections by highlighting its role in the regulation of molecules involved in unfolded protein response pathway, immunomodulation, inflammation, virus multiplication, oxidative stress, apoptosis and arthritis.

CONCLUSION

The present review demonstrated the major complications associated with chikungunya and the role of andrographolide in alleviating the chikungunya associated symptoms to encourage further investigations using this promising compound towards early development of an anti-CHIKV drug. Chemical Compound studied: andrographolide (PubChem CID: 5318517).

Re-exposure to alarmin HMGB1 and cytokine IL-1 beta induces differential innate immune response generation in mouse brain

Innate immune memory, a crucial mechanism of epigenetically mediated myeloid cell plasticity, alters subsequent immune responses majorly by two types of immunological imprinting, training, and tolerance. Recent pioneer studies provided proof-of-principle for generation of both types of innate immune memory in brain macrophage, microglial cells. This novel study was designed to investigate whether the pattern of immune response generation, induced by peripheral administration of recombinant alarmin HMGB1, alone and in combination with other recombinant cytokines, is affected by prior exposure. The experimental outcomes revealed that full length recombinant HMGB1 exposure for seven consecutive days exhibit inflammatory response as evidenced by enhanced expression of inflammatory biomarkers and neurodegeneration. In contrary, combined doses of HMGB1 and IL-1β, for three and seven consecutive days, exhibited lower inflammatory state compared to its alone HMGB1 counterpart. The immune tolerance state was evident by microglial polarization towards non-reactive M2 state, lower astrocyte activation, epigenetic reprogramming, and decreased neurodegeneration. This is the first demonstration that HMGB1 and IL-1β priming can differentially affect inflammation in the brain when a host is confronted with a second, third stimulus or so on. The findings were further validated by suppressing major regulators of epigenetic reprogramming, by intranasal delivery of specific siRNAs targeting those regulators. These results may provide new evidence for the involvement of recombinant endogenous cytokine induced generation of innate immune tolerance within microglial cells and indicated the possible potential role in mediating cognitive and behavioural alterations during inflammatory diseases.

Forty years after Alma-Ata: primary health-care preparedness for chronic diseases in Mozambique, Nepal and Peru

Background

Four decades after the Alma-Ata Declaration, strengthening primary health care (PHC) remains a priority for health systems, especially in low- and middle-income countries (LMICs). Given the prominence of chronic diseases as a global health issue, PHC must include a wide range of components in order to provide adequate care.

Objective

To assess PHC preparedness to provide chronic care in Mozambique, Nepal and Peru, we used, as ‘tracer conditions’, diabetes, hypertension and a country-specific neglected tropical disease with chronic sequelae in each country.

Methods

By implementing a health system assessment, we collected quantitative and qualitative data from primary and secondary sources, including interviews of key informants at three health-system levels (macro, meso and micro). The World Health Organization’s health-system building blocks provided the basis for content analysis.

Results

In total, we conducted 227 interviews. Our findings show that the ambitious policies targeting specific diseases lack the support of technical, administrative and financial resources. Data collection systems do not allow the monitoring of individual patients or provide the health system with the information it requires. Patients receive limited disease-specific information. Clinical guidelines and training are either non-existent or not adapted to local contexts. Availability of medicines and diagnostic tests at the PHC level is an issue. Although medicines available through the public health care system are affordable, some essential medicines suffer shortages or are not available to PHC providers. This need, along with a lack of clear referral procedures and available transportation, generates financial issues for individuals and affects access to health care.

Conclusion

PHC in these LMICs is not well prepared to provide adequate care for chronic diseases. Improving PHC to attain universal health coverage requires strengthening the identified weaknesses across health-system building blocks.

Genetic gains with rapid-cycle genomic selection for combined drought and waterlogging tolerance in tropical maize (Zea mays L.)

Rapid cycle genomic selection (RC-GS) helps to shorten the breeding cycle and reduce the costs of phenotyping, thereby increasing genetic gains in terms of both cost and time. We implemented RC-GS on two multi-parent yellow synthetic (MYS) populations constituted by intermating ten elite lines involved in each population, including four each of drought and waterlogging tolerant donors and two commercial lines, with proven commercial value. Cycle 1 (C₁ ) was constituted based on phenotypic selection and intermating of the top 5% of 500 S₂ families derived from each MYS population, test-crossed and evaluated across moisture regimes. C₁ was advanced to the next two cycles (C₂ and C₃ ) by intermating the top 5% selected individuals with high genomic estimated breeding values (GEBVs) for grain yield under drought and waterlogging stress. To estimate genetic gains, population bulks from each cycle were test-crossed and evaluated across locations under different moisture regimes. Results indicated that the realised genetic gain under drought stress was 0.110 t ha^-1 yr^-1 and 0.135 t ha^-1 yr^-1 , respectively, for MYS-1 and MYS-2. The gain was less under waterlogging stress, where MYS-1 showed 0.038 t ha^-1 yr^-1 and MYS-2 reached 0.113 t ha^-1 yr^-1 . Genomic selection for drought and waterlogging tolerance resulted in no yield penalty under optimal moisture conditions. The genetic diversity of the two populations did not change significantly after two cycles of GS, suggesting that RC-GS can be an effective breeding strategy to achieve high genetic gains without losing genetic diversity.

Andrographolide attenuates complete freund's adjuvant induced arthritis via suppression of inflammatory mediators and pro-inflammatory cytokines

ETHNOPHARMACOLOGICAL RELEVANCE

Traditional plant-derived medicines have enabled the mankind in curing the wide spectrum of diseases throughout the ages. Andrographis paniculata (Burm.f.) Nees, is one of the traditional plant used as a folk medicine for the management of inflammation, arthritis, viral-bacterial infections and other ailments in India, China, Malaysia and other South-East Asian countries. Its major bioactive compound; andrographolide, a diterpenoid, also exerts cytoprotective properties and is reported to be effective in neuroprotection, hepatoprotection, etc. AIM: The study is aimed to explore the role of andrographolide in treatment of complete freund's adjuvant (CFA) induced arthritis.

MATERIALS AND METHODS

The influx of immune cells, release of pro-inflammatory cytokines and subsequent accumulation of synovial fluid (swelling) and pain manifest into the disease. The present study used CFA induced Balb/c mice model and treated them intraperitoneally with andrographolide and dexamethasone (used as a positive control) on alternate days for six days. After 6 days, blood and peritoneal macrophages were collected to evaluate the expression of various arthritic markers and paw edema was measured on all days.

RESULTS

The in vitro and ex vivo experiments showed that andrographolide treated animal group had reduced paw edema, cell cytotoxicity and nitric oxide production than dexamethasone treated animal group. Further, the study revealed the mechanistic role of andrographolide in treatment of arthritis by suppressing battery of molecules like COX-2, NF-κB, p-p38, CD40, TNF-α, IL-1β and IL-6 involved in arthritis.

CONCLUSION

The study showed the potent anti-arthritic effects of andrographolide and warrants further investigations on andrographolide for the development of safe and effective anti-arthritic drug.

Study of Health-Related Quality of Life and Healthcare Utilization among Type 2 Diabetic Population in an Urban Area of Eastern Nepal

INTRODUCTION

Diabetes mellitus is a major cause of morbidity and mortality and places huge burden on public health funding. Diabetes affects quality of life through associated complications, comorbidity, and disease burden. Consequently, people have frequent healthcare visits. This study assessed quality of life and healthcare utilization patterns among type 2 diabetic populations in an urban area of eastern Nepal.

METHODS

A cross-sectional study was conducted among 270 participants of age ≥20 years with type 2 diabetes in Itahari using a semistructured questionnaire. A D-39 questionnaire was used to assess quality of life. Five wards were selected by systematic random sampling, and the population was proportionate according to the sample size. Multiple linear regressions were conducted to identify the factors associated with quality of life and its domains.

RESULTS

The highest mean score ± SD was found in the domain anxiety and worry (57.34 ± 11.08). About 18.5% of the participants perceived extremely affected quality of life. Hypertension (55.55%) was the most common comorbidity. Age, marital status, literacy, alcohol, disease duration, comorbidity, and complications were significantly associated with overall quality of life. In last 6 months of duration, 93.7% had hospital visits. Among them, 8.1% had emergency visit and 5.9% were admitted in the hospital.

CONCLUSION

People with diabetes in this study were more affected in the domain anxiety and worry. The frequency of healthcare access and utilization in patients with type 2 diabetes was high. The quality of life among them could be improved by taking care on healthy behavior, comorbid conditions, and complications.

CXCR7: A key neuroprotective molecule against alarmin HMGB1 mediated CNS pathophysiology and subsequent memory impairment

High mobility group box 1 (HMGB1) is an endogenous alarmin that drives the pathogenesis of neurodegenerative disorders including cognitive decline. Therefore, HMGB1 is thought to be a common biomarker as well as promising therapeutic target for neuroinflammation associated with neurocognitive disorders. Here, for the first time, we have unmasked the potential inhibitory effect of a novel receptor of HMGB1-CXCL12 complex; atypical chemokine receptor 3 (ACKR3/CXCR7) on HMGB1 induced glial phenotype switching, neuroinflammation, and subsequent memory loss. Upregulation of CXCR7 inhibits HMGB1-CXCL12 complex induced peripheral immune cells infiltration to CNS by regulating blood-brain barrier (BBB) integrity in HMGB1 induced dementia model of mice. Whereas, gene knockdown study by RNA interference (non-invasive intranasal delivery to animal model) shows CXCR7 ablation aggravates inflammatory responses in hippocampus region and immune cell infiltration to CNS tissue by breached BBB. This study also indicates the important role of CXCR7 molecule in maintaining CNS homeostasis by balancing M1/M2 microglia, A1/A2 astrocytes, long term potentiation/long term depression markers which ultimately ameliorates HMGB1 induced neurodegeneration, synaptic depression and memory loss (assessed by both radial arm maze and Morris water maze) in male mice model of dementia. Overall, the study summarizes several significant protective functions afforded by CXCR7 against HMGB1 induced disbalance in neuroimmunological axis, neurodegeneration and memory loss and thereby provides a new paradigm for strategic development of novel therapeutics against neurodegenerative diseases with dementia as a common symptom.

Disruption, changes, and adaptation: Experiences with chronic conditions in Mozambique, Nepal and Peru

Chronic conditions are an increasing problem in Low- and Middle-Income Countries (LMICs) yet, the challenges faced by low-income populations with these conditions in such countries are not well understood. Based on in-depth interviews with people affected by chronic conditions and their family members, this paper describes the experience of patients suffering from diabetes or hypertension in rural communities of Mozambique, Nepal, and Peru. We analysed our data using the concepts of disruption and adaptive strategies, finding that despite being very different countries, the implications in daily lives, interpersonal relationships, and family dynamics are similar, and that oftentimes such impact is defined along gender lines. We show that adjustments to living with a chronic disease are not always easy, particularly when they imply changes and reconfiguration of roles and responsibilities for which neither the individual nor their families are prepared. The study adds to the literature on the disruptive effects of chronic conditions and stresses the importance of contextualising disruptive experiences among disadvantaged populations within weak health systems. Our findings highlight the relevance of understanding the challenges of developing adaptive solutions to chronic care in resource-scarce contexts.

Use of Pesticides and Health Risk among Farmers in Sunsari District, Nepal

BACKGROUND

An increasing widespread use of Pesticides is as an issue in the agricultural sector. Pesticides use is one of the occupational risks in farmers of low-income countries including Nepal. Objective of this study was to explore the health effects of Pesticides among agricultural farmers of Sunsari.

METHODS

A community based cross sectional study was carried out in Duhabi-Bhaluwa of Sunsari District, Nepal from September 2015 to February 2016. Non-probability sampling technique was used to enroll the total 300 study participants. Data were collected by face to face interview with farmers using pre-tested semi structured questionnaire. Data were recorded by reading the original container of the Pesticides.

RESULTS

Fungicides (60.3%), Herbicides (56.3%), pyrethrum (35.3%) and Organophophate (11.6%) Pesticides were commonly used by the agricultural farmers in their farms. The health problem within 48 hours after application of pesticides was reported by more than one-sixth (17%) of the farmers. Dizziness (74.5%) and headache (58.8%) were the most common health problems found among the farmers. Skin irritation (19.6%), nausea (13.7%), paraesthesia (9.8%), restlessness (5.8%), eye irritation (5.8%) and vomiting (1.9%) were also reported by pesticides handlers. Factors associated with health problems were hazardous pesticides use (AOR=26.95, CI 6.15 - 118.0), good knowledge on impacts of pesticides (AOR=3.16, CI 1.09-9.13), determination of wind direction first and spray (AOR=2.25, CI 1.08-4.67), working experience of 20-29 years on farm (AOR=3.38, CI 1.05-10.83).

CONCLUSIONS

One-sixth of the farmers reported health problems. Farmers working with hazardous Pesticides were in need of special attention in terms of safe handling, determing the wind direction and spray.

Respiratory Problems among Workers of Udayapur Cement Factory in Eastern Nepal

BACKGROUND

There have been very limited studies regarding health of the cement factory workers in Nepal. This study aimed to find out the prevalence of health problems and the factors associated with respiratory symptoms among the workers of Udayapur cement factory.

METHODS

This is a cross-sectional study conducted from March to August 2015 in Udayapur cement factory in eastern Nepal. All the workers working in the factory more than a year were included in the study. Thedata was collected by using a semi-structured questionnaire consisting of socio-demographic characteristics,type of work, reported health problems, use of personal protective measures.Chi-square test was used to determine the association of respiratory symptoms with related variables.

RESULTS

A total of 295 workers were included in this study with mean age of 45.9 years (SD=7.7). Majority 279 (94.6%) were males. The most common health problems were musculoskeletal pain (55.6%) followed by eye problems (33.2%). Among them, 17(21.1%) reported that they had at least one respiratory problem and chest tightness while running/climbing and wheeze were the most common. A total of 233 participants (79%) used at least one form of personal protective equipment. Low education, longer duration of work and smoking were found to be positively associated with respiratory symptoms.

CONCLUSIONS

Respiratory problems were high among the workers of the cement factory. Proper use of PPEs and dust control measures should be promoted among the workers.

Respiratory Disorders Among Dust Exposed Workers

Introduction: Exposure to dusts and hard physical work is common in developing industrialized countries. Acute and chronic respiratory illnesses are highly been reported from jute and textile industry. This study was undertaken to explore status of respiratory health among the workers of jute and textile industries.Methods: This descriptive cross-sectional study enrolled 315 workers from each of textile and jute industry of Eastern Nepal. Almost all the workers were selected from the textile industry whereas those from dust prone areas of jute industry. Workers were interviewed using pre-tested questionnaires. Measurement of height, weight and peak expiratory flow rate was done. Results: Majority were non-smokers in both the industries 230 (73%) in Jute vs. 223 (70.8%) in Textile. Most of the workers had the working experience of less than five years; jute 134 (42.5%) vs. textile 180 (57.1%). Upper respiratory disorder was found in more than 1/5 of workers (68) in jute vs. 1/20 of workers (18) in textile industry. One and two workers suffered from chronic bronchitis in the jute and the textile industry respectively. Chest tightness was reported among 4 (1.3%) in jute vs. 17 (5.4%) in textile workers, cough symptoms among 86 (27.3%) in jute vs. 26 (8.3%) in textile industry. Low practice of personal protective measure was seen in both industries. The mean score of PEFR of workers in jute mill was lower than the workers in textile industry.Conclusions: Workers with acute respiratory disorders were more in the jute industry while chest tightness was more in the textile industry. Chronic respiratory problems did not appear to be alarming in both the industries. Use of personal protective measures should be promoted among the dust exposed workers. Key Words: dust exposure; peak expiratory flow rate; respiratory disorder.

"If you will counsel properly with love, they will listen": A qualitative analysis of leprosy affected patients' educational needs and caregiver perceptions in Nepal

BACKGROUND

Leprosy remains a disease of concern in many countries including Nepal. To achieve the target of elimination, the WHO strategy promotes comprehensive education of patients, healthcare workers (HCWs), and the public on leprosy-related issues. However most educational programs are based on the concerns of HCWs and not on patients' needs. The objective of this paper is to explore the educational needs of leprosy affected patients in Nepal and compare them to the needs perceived by HCWs.

METHODOLOGY/PRINCIPAL FINDINGS

Semi directive interviews were conducted with patients and HCWs. The data was analyzed using the basic interpretative qualitative framework. The study was conducted in two leprosy referral centers, one university hospital and one primary health care center: Lalgadh Leprosy Hospital and Services Centre, Anandaban Hospital and its satellite clinic in Patan, B. P. Koirala Institute of Health Sciences in Dharan, and the Itahari primary health care centre. The results show that there remains a lack of knowledge regarding the disease (origins, manifestations, prevention and treatment) contributing to late care seeking behavior and high levels of stigma, with an important psychological and financial stress for patients. All of the HCWs displayed a good understanding of patients' difficulties and needs and acknowledged the key role of patient education. However, they expressed several challenges in managing patients due to lack of time, human resources and training in patient education.

CONCLUSIONS/SIGNIFICANCE

Further efforts need to be made to increase patients' general knowledge of the disease in order to motivate them to seek healthcare earlier and change their perception of the disease to reduce stigma. HCWs need proper training in patient education and counseling for them to acquire the necessary skills required to address the different educational needs of their patients. The use of lay and peer counselors would be an option to address the workload and lack of time expressed by HCWs.

Morbidity Profile of Under Five Children Residing in Barbote Village Development Committee of Ilam District of Eastern Nepal

Introduction: In 2017, the under five mortality rate in low-income countries was 69 deaths per 1000 live births–around 14 times the average rate in high-income countries. Children constitute a vulnerable group and the first five years can be considered as a transition phase from the mother's womb to a social platform. Morbidity status of very young children is considered to be an important index of the health status of the community. However, studies done to assess the morbidity profile of Children in rural Nepal are few, and the children's health status is largely unknown. The information collected through Health Management Information System (HMIS) of Nepal Government mainly represent the population that accessed the services but do not represent the population that utilized private clinics/hospitals or did not access it at all. Objective: This study was conducted to assess the morbidity status of under-five children and its associated factors in Barbote Village Development Commitiee (VDC) of Ilam district of eastern Nepal. Methodology: A community based cross-sectional study was conducted among all the eligible under five children of Barbote VDC of Ilam District for two weeks from 16-30 March, 2016. Face-to-face interviews were conducted with the legal guardian/ caretaker of the children with pre-tested, semi-structured questionnaire. Calibrated & validated equipment were used for simple biophysical measurements. Odds Ratio (OR) with confidence limit was calculated to examine the strength of association between the variables with the probability of significance set at 95% of Confidence interval (CI).Ethical permission was taken from the Institutional Review Committee (IRC) of BP Koirala Institute of Health Sciences, Dharan. Results: Of the total 406 under-five children studied, 35.5% complained of illness such as acute respiratory infection, diarrhea and fever within the past two weeks. Regression analysis by the backward conditional method disclosed the fact that children of households with low socioeconomic status and those using biomass fuel for cooking were significantly associated with presence of illness. Conclusion: More than one-third of the under-five children in BarboteVDC of eastern Nepal were found to be ill mostly due to preventable causes. Factors significantly associated with the presence of illness included the use of biomass fuel and low socio-economic status. 

Health Literacy and Knowledge of Chronic Diseases in Nepal

Background:

Understanding of risk factors and developing healthy lifestyles is a way of tackling the surging burden of chronic diseases in low-to-middle income countries such as Nepal. Health literacy (HL) has a pivotal role in prevention, adherence to treatment, self-care, and better use of health care; therefore, factors associated with HL need to be studied in the context of Nepal.

Objective:

This study was conducted to assess the level of HL and explore disease-specific knowledge among patients with chronic diseases.

Methods:

A cross-sectional study was conducted among 426 respondents with hypertension, diabetes mellitus, or chronic obstructive pulmonary disease from a tertiary care hospital and primary care clinics using face-to-face interviews. HL was measured using a translated and pretested HL questionnaire (the Europe-Asia Health Literacy Survey Questionnaire). Disease-related knowledge was assessed using a validated questionnaire.

Key Results:

The study found that 27% of the respondents had sufficient HL, 19% had marginal HL, and 54% had inadequate HL. Factors associated with inadequate HL included being older and female, and having lower or no education, unemployment or retired status, poverty, and having a history of smoking or a history of consuming alcohol. HL was a strong predictor of knowledge regarding hypertension (β = 0.32; p < .05), diabetes mellitus (β = 0.41; p < .05), and chronic obstructive pulmonary disease (β = 0.37; p < .05) in multiple regression analyses after adjusting for age, gender, education, marriage, family history of disease, attendance at follow-up clinics at recommended intervals, information received regarding disease at clinics, smoking, and alcohol intake.

Conclusions:

A sufficient level of HL was uncommon among participants in our study. People with sufficient HL knew significantly more about their diseases or conditions than those with inadequate HL. [HLRP: Health Literacy Research and Practice. 2018;2(4):e221–e230.]

Plain Language Summary:

Very little is known about health literacy in Nepal. We conducted a study to learn how much people in Nepal with hypertension, diabetes, or chronic obstructive pulmonary disease knew about their condition and sought to check its association with health literacy. We found that more than one-half of the participants did not have adequate health literacy levels. Participants who were older, female, uneducated, retired from work, or poor had lower levels of health literacy. We also found that those with high levels of health literacy had better knowledge of their disease. Therefore, we recommend that in Nepal health literacy should be measured for each patient and support regarding management of his or her condition should be provided if necessary.

Moving from formative research to co-creation of interventions: insights from a community health system project in Mozambique, Nepal and Peru

Different methodological approaches for implementation research in global health focusing on how interventions are developed, implemented and evaluated are needed. In this paper, we detail the approach developed and implemented in the COmmunity HEalth System InnovatiON (COHESION) Project, a global health project aimed at strengthening health systems in Mozambique, Nepal and Peru. This project developed innovative formative research at policy, health system and community levels to gain a comprehensive understanding of the barriers, enablers, needs and lessons for the management of chronic disease using non-communicable and neglected tropical diseases as tracer conditions. After formative research, COHESION adopted a co-creation approach in the planning of interventions. The approach included two interactions with each type of stakeholder at policy, health system and community level in each country which aimed to develop interventions to improve the delivery of care of the tracer conditions. Diverse tools and methods were used in order to prioritise interventions based on support, resources and impact. Additionally, a COHESION score that assessed feasibility, sustainability and scaling up was used to select three potential interventions. Next steps for the COHESION Project are to further detail and develop the interventions propositioned through this process. Besides providing some useful tools and methods, this work also highlights the challenges and lessons learned from such an approach.

Catastrophic health expenditure among industrial workers in a large-scale industry in Nepal, 2017: a cross-sectional study

OBJECTIVES

The study aimed at estimating out-of-pocket (OOP) expenditure, catastrophic health expenditure (CHE) and distress financing due to hospitalisation and outpatient care among industrial workers in Eastern Nepal.

METHODS

We conducted a cross-sectional study involving industrial workers employed in a large-scale industry in Eastern Nepal. Those who were hospitalised in the last 1 year or availed outpatient care within the last 30 days were administered a structured questionnaire to estimate the cost of illness. CHE was defined as expenditure more than 20% of annual household income. Distress financing was defined as borrowing money/loan or selling assets to cope with OOP expenditure on health.

RESULTS

Of 1824 workers eligible for the study, 1405 (77%) were screened, of which 85 (6%) were hospitalised last year; 223 (16%) attended outpatient department last month. The median (IQR) OOP expenditure from hospitalisation and outpatient care was US$124 (71-282) and US$36 (19-61), respectively. Among those hospitalised, the prevalence of CHE and distress financing was found to be 13% and 42%, respectively, and due to outpatient care was 0.4% and 42%, respectively. Drugs and diagnostics account for a large share of direct costs in both public and private sectors. More than 80% sought hospitalisation and outpatient care in a private sector.

CONCLUSION

Industrial workers face significant financial risks due to ill health compared with the general population. Poor utilisation and higher cost of care in public health facilities warrant strengthening of public sector through increased government spending. The labour act 2014 of Nepal should be strictly adhered.

2D Effective Electron Mass at the Fermi Level in Accumulation and Inversion Layers of MOSFET Nano Devices

In this paper an attempt is made to study the 2D Fermi Level Mass (FLM) in accumulation and inversion layers of nano MOSFET devices made of nonlinear optical, III-V, ternary, Quaternary, II-VI, IV-VI, Ge and stressed materials by formulating 2D carrier dispersion laws on the basis of k → ⋅ p → ⋅ formalism and considering the energy band constants of a particular material. It is observed taking accumulation and inversion layers of Cd3As2, CdGeAs2, InSb, Hg1-xCdxTe and In1-xGaxAsyP1-y lattice matched to InP, CdS, GaSb and Ge as examples that the FLM depends on sub band index for nano MOSFET devices made of Cd3As2 and CdGeAs2 materials which is the characteristic features such 2D systems. Besides, the FLM depends on the scattering potential in all the cases and the same mass changes with increasing surface electric field. The FLM exists in the band gap which is impossible without heavy doping.

A Modified Mean Gray Wolf Optimization Approach for Benchmark and Biomedical Problems

A modified variant of gray wolf optimization algorithm, namely, mean gray wolf optimization algorithm has been developed by modifying the position update (encircling behavior) equations of gray wolf optimization algorithm. The proposed variant has been tested on 23 standard benchmark well-known test functions (unimodal, multimodal, and fixed-dimension multimodal), and the performance of modified variant has been compared with particle swarm optimization and gray wolf optimization. Proposed algorithm has also been applied to the classification of 5 data sets to check feasibility of the modified variant. The results obtained are compared with many other meta-heuristic approaches, ie, gray wolf optimization, particle swarm optimization, population-based incremental learning, ant colony optimization, etc. The results show that the performance of modified variant is able to find best solutions in terms of high level of accuracy in classification and improved local optima avoidance.

Latrine coverage and its utilisation in a rural village of Eastern Nepal: a community-based cross-sectional study

Background

A little more than 1/3rd of the rural households in Nepal have improved latrine facility. The government of Nepal is working towards making an open defecation free area all over Nepal. There is no data found in literature searches regarding the status of latrines and its utilisation in Nepal. This study aims to estimate the coverage and utilisation of latrine and its associated factors in a rural community of Nepal.

Methods

We conducted a cross sectional study in March 2015–September 2015 among 625 households in Hattimuda Village, Morang district in Eastern Nepal using semi-structured pre-tested questionnaire with observational checklists.

Results

Out of 623 households, 473 (76.9%) have latrine facilities. There is an increase in latrine coverage in Hattimuda by 37% (38.9% in 2011 to 75.9% in 2016). Majority of the latrines (89.9%) were functional, however 32.3% needs maintenance. The extent of latrine utilisation among those households with a toilet at home was satisfactory (94.3%). Presence of child below 5 years of age at home (OR 2.37, 95% CI 0.05–0.46), functional latrine (OR 27.37, 95% CI 6.84–109.45), frequency of cleaning (OR 3.66, 95% CI 1.09–12.29) and latrine constructed with self-initiation (OR 4.21, 95% CI 1.06–16.66) are factors significantly associated with the utilisation of the latrine.

Conclusions

While the coverage needs to be increased, appropriate interventions to increase the utilisation of latrine needs to be in place so that the village moves closer to open defecation free (ODF) status. As other studies are not found from Nepal, the findings from this study can be used a reference for other rural areas of Nepal.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-017-2539-3) contains supplementary material, which is available to authorized users.

A New Hybrid MGBPSO-GSA Variant for Improving Function Optimization Solution in Search Space

In this article, a newly hybrid nature-inspired approach (MGBPSO-GSA) is developed with a combination of Mean Gbest Particle Swarm Optimization (MGBPSO) and Gravitational Search Algorithm (GSA). The basic inspiration is to integrate the ability of exploitation in MGBPSO with the ability of exploration in GSA to synthesize the strength of both approaches. As a result, the presented approach has the automatic balance capability between local and global searching abilities. The performance of the hybrid approach is tested on a variety of classical functions, ie, unimodal, multimodal, and fixed-dimension multimodal functions. Furthermore, Iris data set, Heart data set, and economic dispatch problems are used to compare the hybrid approach with several metaheuristics. Experimental statistical solutions prove empirically that the new hybrid approach outperforms significantly a number of metaheuristics in terms of solution stability, solution quality, capability of local and global optimum, and convergence speed.

Cardiovascular involvement in severe malaria: A prospective study in Ranchi, Jharkhand

BACKGROUND & OBJECTIVES

Malaria is considered as the most important parasitic disease of humans, causing seri- ous illness that can be fatal, if not diagnosed and treated immediately. It is a multisystem disorder affecting nearly every system of the body. The aim of the present study was to evaluate the involvement of cardiovascular system in severe malaria using non-invasive methods.

METHODS

This prospective study was conducted on patients of severe malaria who were admitted between June and November 2015 in the Department of Medicine, Rajendra Institute of Medical Sciences and Hospital, Ranchi, Jharkhand, India. A total of 27 cases (18 males and 9 females; age ranging between 15 and 70 yr) of severe malaria (P. falciparum 24; P. vivax 1; mixed 2) were diagnosed by microscopic examination of peripheral blood smear and bivalent rapid diagnostic test (RDT) kit. The assessment of cardiovascular system was done by clinical examination, chest X-ray, ECG and transthoracic echocardiography.

RESULTS

In all, 7 (26%) patients were found to be suffering from circulatory failure, out of which one was P. vivax case and rest were cases of P. falciparum infection with high parasite density. One patient died due to cardiovascular collapse. ECG revealed sinus bradycardia [Heart rate (HR): 40-60] in 7% of the cases, extreme tachycardia (HR: 120-150) in 3.7% of cases and premature arterial ectopic with tachycardia in 3.7% of patients (p <0.05). The echo- cardiographic findings were global hypokinesia with decreased left ventricular ejection fraction (<55%) in 11.1%, grade 1 left ventricular diastolic dysfunction in 3.7%, mild tricuspid regurgitation (TR) with mild pulmonary artery hypertension (PAH) in 3.7% and mild pericardial effusion in 3.7% of the cases. The ECG and echocardiography changes indicated myocardial involvement in severe malaria.

INTERPRETATION & CONCLUSION

The present study indicated involvement of cardiovascular system in severe malaria as evidenced from ECG and echocardiography. The study also revealed that cardiovascular instabilities are common in falciparum malaria, but can also be observed in vivax malaria.

Augmentation of humoral and cellular immunity in response to Tetanus and Diphtheria toxoids by supercritical carbon dioxide extracts of Hippophae rhamnoides L. leaves

Hippophae rhamnoides L. commonly known as Seabuckthorn (SBT), a wild shrub of family Elaegnacea, has extensively used for treating various ailments like skin diseases, jaundice, asthma, lung troubles. SBT leaves have been reported to possess several pharmacological properties including immunomodulatory, antioxidant, anti-inflammatory, antimicrobial and tissue regeneration etc. The present study was undertaken to evaluate the adjuvant property of supercritical carbon dioxide extracts (SCEs 300ET and 350ET) of SBT leaves in balb/c mice immunized with Tetanus and Diphtheria toxoids. The dynamic changes in the immune response were measured in terms of humoral and cell-mediated immune responses. We have seen the effect of SCEs on immunoglobulin subtypes and secondary immune response generation. In addition, the effect of SCEs on antigen specific cellular immunity was evaluated. Our results show that SCEs 300ET and 350ET significantly enhanced antibody titers in response to both TT and DT antigens. The secondary immune response generated was significantly increased in case of TT immunized animals. SCEs also enhanced cytokine levels (IFN-γ, IL-4, TNF-α and IL-1β) and increased lymphoproliferation. Besides, both SCEs did not show any toxic effects. Therefore, the study suggests that SCEs are safe and have potent immunostimulatory activity and hence, seems to be a promising balanced Th1 and Th2 directing immunological adjuvant for various veterinary as well as human vaccines.

Morbidity patterns among the welders of eastern Nepal: a cross-sectional study

BACKGROUND

Welding process has many hazards that the welders are exposed to resulting in numbers of health effects and diseases. Safety measures and practices among welders are important ways of preventing or reducing the health hazards associated with this occupation. We conducted this study to find out the morbidity patterns among the welders working in eastern Nepal.

METHODS

A cross sectional study was conducted among 300 welders using semi structured questionnaire. Morbidity categories were classified based on symptoms experienced in past 6 months.

RESULTS

All the welders learned welding by apprenticeship, without any formal health and safety training. Injury was the most common problem at work followed by skin problems and eye symptoms. Age of the welders, duration of employment & welding hours per day were associated with the morbidities among the welders.

CONCLUSIONS

There is a need for occupational health services for welders in Nepal. While further research may be required to make policy recommendations, the current study provides a baseline morbidity burden among these welders to look for interventions to promote health and safety at work for this neglected group of workers in Nepal.

Work-related injuries among farmers: a cross-sectional study from rural Nepal

Background

Agriculture work is one of the most hazardous occupations across countries of all income groups. In Nepal, 74 % of people are working in the agricultural sector. This study aims to identify patterns and factors associated with injuries among farmers of rural Nepal.

Methods

A community-based cross-sectional study was conducted in a rural village in eastern Nepal. House to house visit was done to collect data from the farmers. The study included 500 farmers from Shanishchare village in Morang district of Nepal. A pre-tested semi-structured questionnaire was used to collect data on socioeconomic profile, agriculture work and injury. Prevalence of injuries among farmers in the last 12 months was calculated along with factors associated with the injuries.

Results

The overall prevalence of work- related injuries among farmers was 69 % in the last 12 months. Common injuries among the farmers were cuts (79.7 %), puncture wound (11.3 %) and laceration (7.5 %). Hand tools were responsible for most of the injuries followed by slipping at work, sharp instruments, animals and fall from height. Upper limb injury comprised of 67 % of all injuries and the most involved part was fingers (43 %). The average number of years worked in farming by the respondents was 23.6 ± 13.6 years. Age and working experience of the farmers was found to be significantly associated with the occurrence of injuries among the farmers.

Conclusions

The prevalence of injury among farmers in this study was high. Further research is needed to identify interventions to reduce the agricultural injuries in Nepal.

Distribution and Biology of Mallada desjardinsi (Neuroptera: Chrysopidae) in India and Its Predatory Potential Against Aleurodicus dispersus (Hemiptera: Aleyrodidae)

In this study, we report the prevalence of Mallada desjardinsi (Navas) in seven geographical regions of India and provide the first report of its kind outlining the preying of all stages of the spiraling whitefly, Aleurodicus dispersus Russell, by M. desjardinsi Sampling was conducted in seven regions of two provinces in India, Bengaluru (Karnataka) and Tiruppur (Tamil Nadu), which demonstrated that M. desjardinsi populations were most dense at the former and least at the later. To the best of our knowledge, this is the first report of its kind outlining observations regarding the biology and feeding potential of M. desjardinsi on A. dispersus under laboratory conditions. It was observed that the second nymphal stadium of A. dispersus was most preferred prey for M. desjardinsi and the least preferred was the A. dispersus adult. It was also seen that the third stadium of M. desjardinsi consumed more A. dispersus individuals than any other life stages. The longevity of female and the total developmental period of M. desjardinsi were computed as 27.6 ± 1.69 and 24.1 ± 0.99 d, respectively. The average total number of eggs laid by the M. desjardinsi female was 211.1 ± 6.35 eggs. M. desjardinsi was observed to be extremely efficient in terms of prey searching and predatory potential with respect to A. dispersus The results of this study indicate strongly that M. desjardinsi has the potential to be used for the control of A. dispersus.

Gynaecological and other health problems of postmenopausal women and their health seeking behaviour in rural Terai, Nepal

Background: There is very few data available in menopausal study done in Nepal.   The data is even less on the various gynecological and medical problems postmenopausal women are suffering from. This study was done in Duhabi area, a community in Eastern Nepal, around the Comprehensive Health Service area of a   community hospital under B.P Koirala Institute of Health Sciences.Objective: This study was done to document the various gynecological problems among the postmenopausal   women and their relation with the socio-demographic characteristics.Methods: By using specific questionnaire, 234 post-menopausal women were   interviewed regarding menopausal symptoms, other gynaecological problems and   medical problems and their health seeking behaviour. Results: Our study showed   that the most common symptoms among the post-menopausal women were loss of libido (53%) and hot flushes (41.5%). Other noted symptoms found were vaginal   dryness (29.1%) and excessive vaginal bleeding (14.5%). The most common urinary symptoms were urgency (34.2%), dysuria (17.1%) and incontinence (17.1%). Uterine prolapse was reported by 6.4% of respondents. The most common medical condition seen in our study was low back ache (70.1%). Despite majority (62%) seeking medical treatment for their symptoms only 1.7% of the respondents were using hormone replacement therapy.Conclusion: The prevalence of gynaecological problems among the post-menopausal women was high in our study with the main symptoms of loss of libido and hot flushes. Majority of women with postmenopausal   symptoms sought medical care for their problems.   Health Renaissance 2014;12(2): pp: 87-91

Effect of organic carbon chemistry on sorption of atrazine and metsulfuron-methyl as determined by (13)C-NMR and IR spectroscopy

Soil organic matter (SOM) content is the major soil component affecting pesticide sorption. However, recent studies have highlighted the fact that it is not the total carbon content of the organic matter, but its chemical structure which have a profound effect on the pesticide's sorption. In the present study, sorption of atrazine and metsulfuron-methyl herbicides was studied in four SOM fractions viz. commercial humic acid, commercial lignin, as well as humic acid and humin extracted from a compost. Sorption data was fitted to the Freundlich adsorption equation. In general, the Freundlich slope (1/n) values for both the herbicides were <1. Except for atrazine sorption on commercial humic acid, metsulfuron-methyl was more sorbed. Desorption results suggested that atrazine was more desorbed than metsulfuron-methyl. Lignin, which showed least sorption of both the herbicides, showed minimum desorption. Sorption of atrazine was best positively correlated with the alkyl carbon (adjusted R (2) = 0.748) and carbonyl carbon (adjusted R (2) = 0.498) but, their effect was statistically nonsignificant (P = 0.05). Metsulfuron-methyl sorption showed best positive correlation with carbonyl carbon (adjusted R (2) = 0.960; P = 0.05) content. Sorption of both the herbicides showed negative correlation with O/N-alkyl carbon. Correlation of herbicide's sorption with alkyl and carbonyl carbon content of SOM fractions suggested their contribution towards herbicide sorption. But, sorption of metsulfuron-methyl, relatively more polar than atrazine, was mainly governed by the polar groups in SOM. IR spectra showed that H-bonds and charge-transfer bonds between SOM fraction and herbicides probably operated as mechanisms of adsorption.

Hypoxia-Induced Inflammatory Chemokines in Subjects with a History of High-Altitude Pulmonary Edema

High altitude hypoxia is known to induce an inflammatory response in immune cells. Hypoxia induced inflammatory chemokines may contribute to the development of high altitude pulmonary edema (HAPE) by causing damage to the lung endothelial cells and thereby capillary leakage. In the present study, we were interested to know whether chronic inflammation may contribute to HAPE susceptibility. We examined the serum levels of macrophage inflammatory protein-1α (MIP-1α), monocyte chemoattractant protein-1 (MCP-1) and interleukin-8 in group (1) HAPE Susceptible subjects (n = 20) who had past history of HAPE and group (2) Control (n = 18) consist of subjects who had stayed at high altitude for 2 years without any history of HAPE. The data obtained confirmed that circulating MCP-1, MIP-1α were significantly upregulated in HAPE-S individuals as compared to the controls suggestive of chronic inflammation. However, it is not certain whether chronic inflammation is cause or consequence of previous episode of HAPE. The moderate systemic increase of these inflammatory markers may reflect considerable local inflammation. The existence of enhanced level of inflammatory chemokines found in this study support the hypothesis that subjects with past history of HAPE have higher baseline chronic inflammation which may contribute to HAPE susceptibility.

Development of an automated ballast water treatment verification system utilizing fluorescein diacetate hydrolysis as a measure of treatment efficacy

Methods for verifying ballast water treatments in foreign vessels are needed to protect the Great Lakes from the discharge of live non-native organisms or pathogens. A prototype automated viability test system using fluorescein diacetate (FDA), a membrane permeable fluorogen, to differentiate live from dead bacteria and algae is described. The automated fluorescence intensity detection device (AFIDD) captures cultured algae or organisms in Detroit River water (simulated ballast water) on 0.2 μm filters, backwashes them from the filter into a cuvette with buffer and FDA for subsequent fluorescence intensity measurements, and washes the filters with sterile water for serial automated reuse. Preliminary manual versions of these procedures were also tested. Tests of various buffers determined N,N-Bis(2-hydroxyethyl)-2-aminoethanesulfonic acid, N,N-Bis(2-hydroxyethyl)taurine (BES) and 3-(N-morpholino)propanesulfonic acid (MOPS) at pH 7.0 to be the best buffers, causing the least spontaneous FDA breakdown without inhibiting enzymatic activity. Fluorescence in the presence of live organisms increased linearly over time, and the rate of increase was dependent on the sample concentration. Following simulated ballast water treatments with heat or chlorine, the fluorescence produced by Detroit River samples decreased to near control (sterile water) levels. Automated measurements of FDA hydrolysis with a reusable filter backwash system should be applicable to near real-time remote-controlled monitoring of live organisms in ballast water.

A Household Survey on Awareness of Hiv/Aids Among Rural People of Chandbela Vdc Of Eastern Nepal

Background: In the past 20 years HIV/AIDS has become an increasing global phenomenon. The rising trend of morbidity and mortality has not only changed the demography but also poses a huge socio-economic burden on well-being of households, communities and country. In Nepal as the epidemic is maturing. However, the epidemic has never been maintained in the general population through heterosexual transmission in Nepal, rather it is driven by the infections among higher risk populations and their sexual partners. Objectives: To assess the knowledge about HIV/AIDS among household level. Material and Methods: A household based survey was conducted in all the nine wards of Chandbela VDC. Interview was conducted using pre-tested semi structured questionnaire which included socio demographic profile and characteristics to assess awareness on HIV/AIDS. The data was analyzed to calculate percentages and proportions. Results: Out of total population (7034), 50.39% were male and 49.60% were female. Majority of the males and females were literate i.e. 73.58% and 51.37% respectively. Out of 1274 households, 946(74.25%) households were below poverty line, where 19.34% of people did agriculture for living and 3.3% were migrant worker. Most of the people 73.2% were aware and had heard about HIV/AIDS from various medium like 24.53% from radio, 15.19% from friends However, 16.8% of the people never heard of HIV/AIDS. According to 33% of people unsafe sexual practice could transmit HIV/AIDS and 28.83% of people thought avoiding unsafe sexual Practice can prevent from acquiring HIV/AIDS. Of the total respondents, 61.6% of the people believed that even a healthy looking person can have HIV/AIDS. Attitude towards HIV/AIDS patients of majority of population (55.93%) was to avoid any kind of relation or contact with patient. Conclusion: Although majority of the population were literate, were aware of and had heard about HIV/AIDS, the attitude towards the patient was not positive.DOI: http://dx.doi.org/10.3126/jonmc.v3i1.12235Journal of Nobel Medical CollegeVol. 3, No.1 Issue 6, 2014,  Page: 35-39

Adsorption and leaching behaviour of bispyribac-sodium in soils

Adsorption-desorption of the herbicide bispyribac-sodium was studied in four Indian soil types. Bispyribac-sodium was poorly adsorbed in the four soils and adsorption decreased with an increase in the herbicide concentration in solution. Freundlich adsorption coefficient (Kf) values for bispyribac-sodium ranged between 0.37 and 0.87. Slope (1/n) values varied from 0.2 to 0.31 suggesting that bispyribac-sodium adsorption was highly dependent on its initial concentration in solution. Bispyribac-sodium adsorption showed a positive correlation with soil pH (r = 0.809) and clay content (r = 0.699) while no correlation was observed with the organic carbon (r = 0.063) content. Sorbed herbicide was completely desorbed during a single desorption step suggesting that the herbicide was bound by weak adsorptive forces. Leaching studies of herbicide in soil 1 packed column indicated complete loss of soil applied herbicide under a simulated rainfall equivalent to 162 mm.

A comparative immunological analysis of CoCl2 treated cells with in vitro hypoxic exposure

The hypoxic preconditioning of mammalian cells has been shown to have beneficial effects against hypoxic injuries. However, very little information is available on the comparative analysis of immunological responses to hypoxic and hypoxia mimetic exposure. Therefore, in the present study, mouse peritoneal macrophages and splenocytes were subjected to hypoxia exposure (0.5 % O2) and hypoxia mimetic Cobalt chloride (CoCl2) treatment to evaluate their effect on immune response and delineate the underlying signaling mechanisms. The results obtained indicated that super oxide generation increased while TLR4 expression and cell surface markers like CD25, CD40 and CD69 were suppressed in both the treatments as compared to normoxia. Cobalt chloride treatment increased NF-κB expression, nitric oxide (NO) and iNOS expression, cytokines TNF-α and IL-6 as compared to hypoxia exposure. Our study showed that CoCl2 stabilizes HIF-1α to create hypoxia like conditions but it mainly influences the inflammatory response via NF-κB signaling pathway by skewing the production of proinflammatory molecules like TNF-α, IL-6 and NO.

Influence of boron addition to Ti-13Zr-13Nb alloy on MG63 osteoblast cell viability and protein adsorption

Cell proliferation, cell morphology and protein adsorption on near β-type Ti-13Zr-13Nb (TZN) alloy and Ti-13Zr-13Nb-0.5B (TZNB) composite have been investigated and compared to evaluate the effect of boron addition which has been added to the Ti alloy to improve their poor tribological properties by forming in situ TiB precipitates. MG63 cell proliferation on substrates with different chemistry but the same topography was compared. The MTT assay test showed that the cell viability on the TZN alloy was higher than the boron containing TZNB composite after 36 h of incubation and the difference was pronounced after 7 days. However, both the materials showed substantially higher cell attachment than the control (polystyrene). For the same period of incubation in fetal bovine serum (FBS), the amount of protein adsorbed on the surface of boron free TZN samples was higher than that in the case of boron containing TZNB composite. The presence of boron in the TZN alloy influenced protein adsorption and cell response and they are lower in TZNB than in TZN as a result of the associated difference in chemical characteristics.

Rhodiola inhibits dengue virus multiplication by inducing innate immune response genes RIG-I, MDA5 and ISG in human monocytes

Recognition of virus infection by retinoic acid-inducible gene (RIG) I and melanoma differentiation-associated protein (MDA) 5, which are RNA helicases, and interferon-stimulated gene (ISG) 15 activates cascades of signal transduction pathways leading to production of type I interferons and proinflammatory cytokines that orchestrate the elimination of the viruses. However, it has been demonstrated that RNA-helicase-mediated innate immunity plays an essential role in defending the host from infection. In our efforts to identify plant-derived antivirals that selectively enhance ISG- and RNA-helicase-mediated antiviral immune responses, we identified a plant, rhodiola, that significantly promoted ISG, RIG-I and MDA 5 gene expression and an antiviral immune response against dengue virus (DENV) infection. Rhodiola induced interferon (IFN) β and other cytokines, including IL-1β, TNF-α, IL-6 and IL-8, in infected cells. It was also found that rhodiola upregulated phosphorylated eIF-2α, PKR and NF-kB in infected cells. In addition, the number of NK cells was also increased by rhodiola treatment in dengue-virus-infected human PBMCs. Treatment with a crude extract of rhodiola (RAE) resulted in effects in the 20 % range, which is similar to the magnitude of the same effects observed in DENV infections. Taken together, our results imply that rhodiola induces pharmacological modulation of RIG-I, MDA 5 and ISG signal transduction pathways in favor of the induction of a beneficial antiviral immune response against dengue virus, which can be a novel therapeutic strategy for management of infection.

Awareness of occupational hazards and use of safety measures among welders: a cross-sectional study from Eastern Nepal

OBJECTIVE

The proper use of safety measures by welders is an important way of preventing and/or reducing a variety of health hazards that they are exposed to during welding. There is a lack of knowledge about hazards and personal protective equipments (PPEs) and the use of PPE among the welders in Nepal is limited. We designed a study to assess welders' awareness of hazards and PPE, and the use of PPE among the welders of eastern Nepal and to find a possible correlation between awareness and use of PPE among them.

MATERIALS AND METHODS

A cross-sectional study of 300 welders selected by simple random sampling from three districts of eastern Nepal was conducted using a semistructured questionnaire. Data regarding age, education level, duration of employment, awareness of hazards, safety measures and the actual use of safety measures were recorded.

RESULTS

Overall, 272 (90.7%) welders were aware of at least one hazard of welding and a similar proportion of welders were aware of at least one PPE. However, only 47.7% used one or more types of PPE. Education and duration of employment were significantly associated with the awareness of hazards and of PPE and its use. The welders who reported using PPE during welding were two times more likely to have been aware of hazards (OR=2.52, 95% CI 1.09 to 5.81) and five times more likely to have been aware of PPE compared with the welders who did not report the use of PPE (OR=5.13, 95% CI 2.34 to 11.26).

CONCLUSIONS

The welders using PPE were those who were aware of hazards and PPE. There is a gap between being aware of hazards and PPE (90%) and use of PPE (47%) at work. Further research is needed to identify the underlying factors leading to low utilisation of PPE despite the welders of eastern Nepal being knowledgeable of it.

Potential pharmacokinetic role of organic cation transporters in modulating the transcorneal penetration of its substrates administered topically

PURPOSE

We hypothesize organic cation transporters (OCT) may have a potential role in determining the pharmacokinetics and toxicity of organic cation drugs applied topically. Hence, in the present in vivo study, we attempted to evaluate the role of OCT in modulating the transport of its substrates after topical application.

METHODS

New Zealand albino rabbits of either sex were used. Transcorneal penetration of OCT substrates tetraethylammonium and metformin after single instillation was evaluated in the absence and presence of OCT blockers (quinidine and atropine). Aqueous humor (AH) samples were collected through paracentesis amounting to 70-100 μl under topical anesthesia at various time intervals. The samples were subjected for estimation of both substrate as well as blocker concentrations using liquid chromatography mass spectrometry.

RESULTS

Topical pre-treatment (30 min before substrate) of OCT blockers significantly decreased the transcorneal penetration of OCT substrates after single topical administration. The levels of blockers reaching AH in the presence of substrates were also modulated at 60 min after its administration as compared with its control.

CONCLUSION

OCT are functionally active in the uptake of their substrates from tear to AH. Therefore, OCT in the corneal epithelium may be positioned from apical to basolateral. When administering their substrates/blockers topically, both may be competing for OCT for their uptake across the cornea, thereby decreasing the corneal penetration. Hence OCT can have a potential pharmacokinetic role in modulating the ocular bioavailability of their substrates administered topically, which are used as ocular therapeutics.

Hypoxic Stress Induced TREM-1 and Inflammatory Chemokines in Human Peripheral Blood Mononuclear Cells

Hypoxia is a condition of low pO2, which creates a unique microenvironment affecting cell phenotype and subsequent immune response generation. Little is known about the impact of hypoxia on the phenotypic expression of NK cell, TREM-1, TLR-4 and inflammatory chemokines. In the present study we have determined the frequency of peripheral blood populations of CD16/CD56 (NK Cells) expressing cells, presence of activation marker CD354 (TREM-1), Toll like receptor (CD 284) on the cell surface and chemokines IL-8 and RANTES in the cellular supernatant of normoxia and hypoxia exposed cells by flow cytometry. GRP-78 expression was determined by reverse transcriptase polymerase chain reaction. The blood was collected from healthy individuals and exposed to normoxic and hypoxic (0.5 %) environment for 24 h. The percentage of NK cells (CD 16/56) was marginally up regulated while TLR-4 expression was diminished in hypoxia exposed cells as compare to the normoxic cells. TREM-1 expression was significantly up-regulated (p < 0.05) in hypoxia as compared to the normoxic control. In addition when monocytic cell line THP-1 was exposed to 0.5 % hypoxia for 24 h, TLR4 expression was significantly decreased in hypoxic cells as compared to normoxic cells. Furthermore, GRP-78 mRNA expression was also upregulated by hypoxia or LPS exposure. These events are paralleled by strengthening up-regulation of the chemokines IL-8 and RANTES an otherwise necessary event for the chemotaxis of the neutrophils and macrophages to the inflammatory site. In conclusion, this study provides a novel insight into the mechanism linking low oxygen tension to the regulation of immune and inflammatory responses, leading to new perspectives of the role of hypoxia in programming immune cell functions.

Sugar partitioning in sprouting lateral bud and shoot development of sugarcane

Sugarcane is a leading energy crop of the world due to its ability to capitulate high sucrose. To understand the mechanism associated with shoot establishment from the lateral bud of sugarcane setts, at the time of germination, we established shoots and these shoots were incubated in total darkness and dark/light regime. The concentration of sugars (sucrose and hexoses) and activities of sugar metabolizing enzymes were measured from 0 to 21 days with 7 days intervals during shoot establishment using sugarcane cultivar CoS 97264. A decrease in sucrose concentration and increase in hexoses level was observed in intermodal tissues whereas in the shoots, the level of both sucrose and hexoses increased continuously during shoot establishment. During 0-21 days shooting period, the dry mass of internodes declined by 20 and 25% in plants incubated in dark/light and darkness respectively. All invertases, soluble acid invertase, neutral invertase and cell wall bound invertase were expressed with almost similar pattern in both the intermodal tissues and the shoots. The activity of enzyme sucrose synthase, measured within first 10 days of shooting in both types of tissues, appeared to be higher particularly in sugar breakdown direction. In the shoots, slight increase in sucrose synthase activity in sucrose synthesis direction was observed throughout shooting period in the shoots. The results suggest that sucrose is the main substrate used during shoot establishment and that shoot establishment period is characterized by increased activities of invertases and sucrose synthase and increased level of hexoses in the shoots.

Heart rate variabilty changes during first week of acclimatization to 3500 m altitude in Indian military personnel

Acute exposure to hypobaric hypoxia induces the changes in autonomic control of heart rate. Due to emergencies or war like conditions, rapid deployment of Indian military personnel into high altitude frequently occurs. Rapid deployment to high altitude soldiers are at risk of developing high altitude sickness. The present study was conducted to evaluate the acute exposure to high altitude hypobaric hypoxia (3500 m altitude) on the autonomic nervous control of heart rate in Indian military personnel during first week of acclimatization Indices of heart rate variability (viz; R-R interval, total power, low frequency, high frequency, ratio of low to high frequency) and pulse arterial oxygen saturation were measured at sea level and 3500m altitude. Power spectrum of heart rate variability was quantified by low frequency (LF: 0.04-0.15 Hz) and high frequency (HF: 0.15-0.5 Hz) widths. The ratio of LF to HF was also assessed as an index of the sympathovagal balance. Mean R-R interval decreased significantly on day 2 on induction to altitude which tended to increase on day 5. Total power (TP) decreased high altitude and tended to recover within a week. Both HF and LF power showed decrement at 3500m in comparison to sea level. The ratio of LF to HF (LF/HF) at 3500m was significantly higher at 3500m. SpO2 values decreased significantly (P < 0.05) at high altitude on day-2 which increased on day-5. We conclude that autonomic control of the heart rate measured by heart rate variability was altered on acute induction to 3500m which showed a significant decrease in parasympathetic tone and increase in sympathetic tone, then acclimatization seems to be characterized by progressive shift toward a higher parasympathetic tone.

Tobacco use and associated factors among adolescent students in Dharan, Eastern Nepal: a cross-sectional questionnaire survey

INTRODUCTION

The tobacco use among the youth, in both smoking and smokeless forms, is quite high in the South East Asian region. Tobacco use is a major proven risk factor and contributes substantially to the rising epidemic of non-communicable diseases.

OBJECTIVES

To estimate the prevalence of tobacco use and determine associated factors among adolescent students of Dharan municipality.

DESIGN

Cross-sectional study.

SETTING

Secondary and higher secondary schools of Dharan municipality in Sunsari district of Nepal.

PARTICIPANTS

Students in middle (14-15 years) and late adolescence (16-19 years) from grades 9, 10, 11 and 12 were included.

PRIMARY OUTCOME MEASURE

Ever tobacco use which was defined as one who had not used any form of tobacco in the past 1 month but had tried in the past.

METHODOLOGY

Self-administered questionnaire adapted from Global Youth Tobacco Survey was used to assess tobacco use among the representative sample of 1312 adolescent students selected by stratified random sampling from July 2011 to July 2012.

RESULTS

Out of 1454 students, 1312 students completed the questionnaires with a response rate of 90.23%. Prevalence of ever use of any tobacco product was 19.7% (95% CI 17.7 to 21.6). More than half of the tobacco users (51.9%) consumed tobacco in public places whereas almost a third (75.6%) of the consumers purchased tobacco from shops. Multivariate analysis showed that tobacco use was associated with late adolescence (OR: 1.64; 95% CI 1.17 to 2.28), male gender (OR: 12.20; 95% CI 7.78 to 19.14), type of school (OR=1.72; 95% CI 1.01 to 2.94), Janajati ethnicity (OR: 2.05; 95% CI 1.39 to 3.01) and receiving pocket money ≥Nepalese rupees 500/month (OR: 1.45; 95% CI 1.04 to 2.03).

CONCLUSIONS

Tobacco-focused interventions are required for school/college going students to promote cessation among users and prevent initiation, focussing on late adolescence, male gender, government schools, Janajati ethnicity and higher amount of pocket money.

Corrosion behaviour of heat treated boron free and boron containing Ti-13Zr-13Nb (wt%) alloy in simulated body fluid

The corrosion behaviour of heat treated Ti-13Zr-13Nb (TZN) and Ti-13Zr-13Nb-0.5B (TZNB) alloys in Hank's solution has been investigated. The microstructure of the heat treated TZN alloy consisted of α, β or martensite. Addition of boron to TZN alloy led to the formation of dispersed TiB particles and modification of microstructure. In general, the furnace cooled TZN sample showed lower corrosion potential (E(corr)) than the air cooled sample. Aging of water quenched samples decreased the E(corr) value. The passive current density of TZN samples varied within a narrow range. Presence of boron in TZN alloy decreased the corrosion potential and substantially increased the passive current density. Results showed that boron deteriorated the corrosion resistance of TZN alloy.

Functional analysis of sucrose phosphate synthase (SPS) and sucrose synthase (SS) in sugarcane (Saccharum) cultivars

Sucrose phosphate synthase (SPS; EC 2.4.1.14) and sucrose synthase (SS; EC 2.4.1.13) are key enzymes in the synthesis and breakdown of sucrose in sugarcane. The activities of internodal SPS and SS, as well as transcript expression were determined using semi-quantitative RT-PCR at different developmental stages of high and low sucrose accumulating sugarcane cultivars. SPS activity and transcript expression was higher in mature internodes compared with immature internodes in all the studied cultivars. However, high sugar cultivars showed increased transcript expression and enzyme activity of SPS compared to low sugar cultivars at all developmental stages. SS activity was higher in immature internodes than in mature internodes in all cultivars; SS transcript expression showed a similar pattern. Our studies demonstrate that SPS activity was positively correlated with sucrose and negatively correlated with hexose sugars. However, SS activity was negatively correlated with sucrose and positively correlated with hexose sugars. The present study opens the possibility for improvement of sugarcane cultivars by increasing expression of the respective enzymes using transgene technology.