Situation of Advertising Practices among Private Ayurveda Centers of Nepal - A Cross Sectional Study

BACKGROUND

Advertisement plays a vital role in seeking health care services among the people. After the free market policy, advertising has been used by different private institutions for the promotion of their businesses.

METHODS

A descriptive cross-sectional study was done among the 40 private Ayurveda centers registered in the province registry of Nepal using convenience sampling. Semi-structured Interview and Key Informant interviews techniques were undertaken for quantitative and qualitative data collection. Data collected was edited, cleaned, and entered in MS-Excel, followed by analysis in the SPSS 22 version.

RESULTS

Correlation between investment in advertisement and patient flow was found to be highly significant with a relation of 0.89 at 99% confidence level (p-value 0.01). Linear regression analysis shows 77.8 percent variability in the patient flow was explained by advertising. A one-unit increase advertisement investment was found to bring about 0.744 unit increase in patient flow. Unregulated advertising was done through Television, Radio, magazines, social media, and pamphlets. Free health camps conducted by the centers, and patient-to-patient referrals were found to be emerging ways. The phrases in ads like "100% cure" were replaced by the phrases such as "successful treatment" and "without operation treatment".

CONCLUSIONS

This study shows unregulated, haphazard, and unethical advertising predominant among the private centres. There is a need for proper enforcement of the regulating act, formulation of proper guidelines about advertising, social media advertising, its content and censorship before broadcasting.

PSUN370 Refractory Hypoglycemia Associated with a Metastatic Neuroendocrine Tumor Producing Multiple Hormones

Introduction

Neuroendocrine tumors are rare. They are derived from hormone-producing and nerve cells mostly found in GI tract, lung or pancreas. In about half of the cases, work-up does not detect any tumor-related hormone secretion. Even less common, the tumor produces several hormones which may be associated with clinical symptoms.

Clinical Case

A frail 81-year-old male with mild-to-moderate dementia and no history of diabetes presented to the emergency department with complaints of generalized weakness, fatigue, weight loss, poor appetite, diarrhea and shortness of breath for 1-2 weeks. Physical examination was pertinent for cachexia, general pallor, dry oral mucosa and having heme positive stool. Initial laboratory work-up found anemia (Hg 5.8g/dl), low glucose of 43 mg/dL, hypoalbuminemia (Alb 1.9 gm/dL). CT angiogram of abdomen did not show any active bleed but showed incidental diffuse hepatic lesions favoring metastatic disease, pancreatic ductal dilatation and fluid-filled loops of small and large bowel compatible with enteritis. Subsequent endoscopy and colonoscopy were negative for malignancy. Findings of multiple liver lesions prompted a CT-guided liver biopsy which showed a metastatic, well differentiated neuroendocrine tumor WHO grade II/III with positive stains for chromogranin A, synaptophysin, cytokeratin Oscar (Ki-67 less than 20%). MRCP abdomen examination of pancreas showed no focal pancreatic lesions but was suboptimal due to motion artefacts and lack of contrast. Workup for the tumor revealed increased serum serotonin (772 ng/ml), increased 5-HIAA (3,175 ng/ml), increased chromogranin A (48,436 ng/ml) and an increased 24hr Urine 5-HIAA (162mg/24hr). Further workup for the persistent and hypoglycemia showed a random cortisol 24.6mcg/dl. During hypoglycemia, insulin and C-peptide levels were 4.3 uU/L and 1.4ng/ml indicating inappropriately "normal" insulin production consistent with an insulinoma. IGF 1 and IGF 2 levels were withing the normal range.

The hypoglycemia was initially managed with continuous intravenous administration of dextrose and optimization of oral intake, glucagon and octreotide 50 mcg every 8 hours. However, the response to octreotide was insufficient and we were unable to wean the patient off the dextrose. Subsequently we started prednisone 20 mg oral daily and glucose tablets which allowed us to discontinue the intravenous dextrose and the octreotide. Patient was discharged home on hospice care.

Conclusion

Hypoglycemia is a potentially life-threatening condition necessitating prompt action including the administration of intravenous dextrose. The results of the workup indicate that the neuroendocrine tumor produced excessive amounts of both serotonin and insulin contributing to prolonged refractory hypoglycemia. Treatment of this rare condition is challenging and often empirical.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Awareness of Thyroid Disorders among Nepalese Women: A Cross-Sectional Study

Background Thyroid disorders are emerging public health issues. Clients' awareness is crucial for prevention, early diagnosis, and treatment of the thyroid disorders. Studies, assessing knowledge on thyroid disorders among Nepalese population, is lacking. Objective To assess the awareness of thyroid disorders among women, a susceptible subgroup, and find the correlates of poor knowledge. Method A cross-sectional study was conducted among 423 women at the gynecological outpatient department of Tribhuvan University Teaching Hospital. Eighteen-item scale, with a Cronbach's Alpha of 0.913, was developed to assess participant's knowledge on various constructs of thyroid disorder. A linear regression model with Bootstrap approach was used to identify the predictors of the total knowledge score. Result The mean (±SD) age of the participant was 29.2 ± 7.0 years. About 49% of the women had inadequate knowledge, defined at or below the mean cumulative knowledge score. In linear regression, the total knowledge score was significantly lower among participants who were Janajati (β=-2.87, BCa 95%CI=-4.61, -1.11), illiterate (β=- 6.37, BCa 95%CI =-9.14, -3.21), and low income (β=-3.76, BCa 95%CI=-5.68, -1.83). Likewise, a university education (β=5.94, BCa 95%CI=3.50, 8.26), working status (β=4.04, BCa 95%CI=2.19, 5.81), urban residence (β=2.06, BCa 95%CI=0.02, 3.96) and family history (β=2.20, BCa 95%CI=0.71, 3.63) of thyroid disorder predicted higher knowledge score. Conclusion This study identified a poor level of knowledge on thyroid disorders among Nepali women and thus proposes them to be an important subgroup for an intervention or policy aimed at promoting awarenessof thyroid disorders. The findings also warrant increased awareness among these population through hospital and communitybased behavior change communication campaigns.

Biochemical Investigation of Tissue Oxidative Stress and Angiogenesis with Associated Trace Elements in Breast Disease Patients in Uttarakhand, India

Breast cancer is a heterogeneous cancer with diverse clinical symptoms and an ambiguous molecular spectrum. Oxidative damage, antioxidant activity, and angiogenesis combine to form significant complex factors that stimulate breast cancer development and progression. This study is designed to determine level changes in total antioxidant status and markers of lipid peroxidation melondialdehyde (MDA) and angiogenesis vascular endothelial growth factor (VEGF) along with related micronutrients of copper, zinc, magnesium, and iron in malignant and benign breast disease tissue extracts. We assess specificity and sensitivity of those markers using the area under the curve of receiver operator characteristic (ROC) curve analysis. Association studies are done with correlation analysis. The tissue extract level of MDA markers is found to be significantly higher (14.118 ± 1.47 nmol/g tissue; p < 0.05), with significantly depleted levels of antioxidants (5.983 ± 1.661 nmol/g tissue; p < 0.05). The tissue VEGF level also significantly increases in a diseased condition (512.466 ± 5.661 pg/mg tissue) versus the nondiseased condition (422.433 ± 13.615 pg/mg tissue). Related trace-element levels show a significant mixed pattern among studied groups. VEGF emerges as the best discriminatory biomarker of breast cancer presence, in accordance with ROC analysis. Oxidative stress and angiogenesis are found to be important factors in breast cancer development. This study forms the basis for future studies that focus on the relationship between roles of indices studied and cancer induction.

Autologous Bone Marrow Aspirate Therapy for Skin Tissue Engineering and Tissue Regeneration

Introduction: Chronic wounds that are difficult to heal are physical and financial burden to the sufferer and a challenge to the treating physician. Objective: The main purpose of this study was to develop a novel method of using bone marrow (BM) aspirate, either cultured or fresh, as early solution for healing of chronic wounds and further reduce infection and tissue necrosis. Approach: In this case-control study conducted on 75 patients with chronic wounds, 50 patients with aspirate or cultured BM were used as cases and 25 with only daily saline dressings were used as controls. Results: Autologous BM aspirate either as fresh or cultured even without identification, isolation, and selective application of stem cells achieved significant reduction in the wound surface area when compared with control group. Innovation: The application of cultured BM cells had significantly higher percentage reduction of wound size compared to freshly applied BM aspirate; this reflects a high importance of stem cell therapy. Conclusion: The acceptability of the procedure among the patients was highly encouraging. The entire procedure was safe and without any complication.

An Assessment of Oxidative Damage and Non-Enzymatic Antioxidants Status Alteration in Relation to Disease Progression in Breast Diseases

The present study was aimed to evaluate the levels of oxidative stress markers in breast diseases by measuring the 8-hydroxy-2-deoxyguanosine (8-OHdG), vitamin A, vitamin C, vitamin E, and total antioxidant status (TAS) alterations in relation to cell proliferation activity and disease progression. Significant increases in the level of the oxidative damage marker 8-OHdG and cell proliferation activity were observed in breast carcinoma patients in comparison to benign and normal controls, which were accompanied by a significant decrease in non-enzymatic antioxidants and TAS concentrations (p < 0.05). 8-OHdG and cell proliferation levels were negatively correlated with non-enzymatic antioxidants, namely, vitamin A, vitamin C, and vitamin E levels and total antioxidant activity. Altered levels of biomarkers of oxidative stress and cell proliferation activity among the malignant, the benign, and the controls suggest a correlation of increased oxidative stress and cell proliferation activity in the progression of disease in breast carcinoma patients. In conclusion, our results showed that the characterized biomarkers (i.e., low levels of vitamin A, C and D, and the TAS status; and high levels of 8-OHdG) could be used as a suitable method for detecting subjects with malignant and benign breast diseases.

Comparison of success rate of arterio-venous fistula in patients with diabetes vs non-diabetes

Introduction and objective: Definition of chronic renal disease is based on the presence of kidney damage or glomerular filtration rate (GFR 60 ml/min per 1.73 m2) for 3 months, irrespective of cause[1]. Once they are diagnosed as CKD, they are kept either on hemodialysis or peritoneal dialysis or patient undergo renal transplant.[2,3] With this research we may prove that even in a similar circumstances failure rate of AVF is more in diabetes patient.Materials and Methods: Total 50 patients of either gender were taken in this study. Inclusion criteria: CRF with GFR <30ml/min. Arterial diameter >1.5mm and venous diameter >2mm. Preoperative radial artery blood flow >30cm/min. Exclusion criteria: arterial diameter <1.5mm venous diameter <2mm.Written consent was taken from the patient. After preoperative workup surgery was done by 1st author. Arterio-venous fistula was scanned by color Doppler imaging after 4 weeks.Result: There were 31[62%] male, 19[38%] female. Mean age of patients was 55.8 years. 18[36%] were dialysis dependent. Cause of renal failure were diabetes 16(32%), unknown 15(30%), glomerulonephritis 8[16%] and obstructive uropathy 3[6%]. Mean internal diameter of radial artery was 1.91mm [1.5-2.6] and cephalic vein 2.57mm [1.9-3.2].7 patients had swelling of arm, 5 patients has surgical site infections and 15 patients had primary failure; 11 were from diabetic group and 4 from non-diabetic group. Mean duration of surgery was 60.95 minutes [50-75]. Average preoperative velocity in radial artery was 32.94[30-39]cm/sec. Average flow of blood at the end of 4 weeks was 461.42ml/min [0-654]. Between two groups failure rate was significantly high in diabetic patients [p = 0.02]. Failure rate was significantly higher in patients with diabetes more than 10 years [p=0.01].Conclusion: Failure rate of arterio-venous fistula is significantly high in diabetic patients.

Factors Determining Availability, Utilization and Retention of Child Health Card in Western Nepal

BACKGROUND

The immunization card is revised with addition of general information about child health and is later called as child health card. This card is a tool used by Health Management Information System in Nepal. It is important for tracking the records of immunization. Aim is to identify the factors determining the availability, utilization and retention of the child health card in Western Nepal.

METHODS

A cross sectional study was conducted among mothers having children < 24 months old from Gorkha (Western Hill) and Nawalparasi (Western Terai) districts. The sample size for the study was 600 and systematic random sampling was used to select the mothers having less than 24 months old children. Data entry and analysis was done by using SPSS. Qualitative data was analyzed by making matrix.

RESULTS

The average age of respondents was 24 years. The majority of respondents have gained higher level education. Retention of the card was found to be 82.2%. 90.3% retention was seen among 0-12 months children age group whereas it was 74 % among12 to 24 months age group. The reasons for less retention were torn by the child/played by child (54.6%) followed by lack of proper place,unaware about importance and poor quality of card.The new child health cards were insufficient, compelling use of both new and old cards which created problem in consistency. Regarding utilization of child health card, it was found to be used for birth registration and for further studies in abroad.

CONCLUSIONS

The areas of utilization of child health card should be broadened so that the retention of card can be increased. The main reasons for less retention of the card are torn by children and lack of the proper place.

Association between biomarkers of oxidative stress, trace elements, and cell proliferation index in patients with benign and malignant breast diseases

OBJECTIVES

To understand the association between biomarkers of oxidative stress, antioxidants, trace elements, and cell proliferation index in relation to the disease progression in the pathophysiology of breast diseases.

DESIGN AND METHODS

Concentrations of markers of oxidative stress, antioxidants, trace elements, and cell proliferation index were evaluated in the patients with benign breast diseases, malignant breast diseases, and healthy volunteers as controls. Multinomial logistic regression analysis was used to identify the contribution of the selected indexes using odds ratio and associated confidence interval.

RESULTS

The level of markers of oxidative stress (malondialdehyde [MDA]) and cell proliferation index were found to be significantly higher with significantly depleted levels of antioxidants and trace elements in breast cancer patients compared with control subjects as well as benign breast disease patients. A similar pattern of changes were observed between benign and control subjects.

CONCLUSION

An inadequate amount of antioxidant enzymes and trace elements may be an important contributing factor associated with oxidative stress leading to elevated levels of MDA and cell proliferation index in relation to disease progression and clinical stage in the pathophysiology of breast diseases.

Correlation of serum toll like receptor 9 and trace elements with lipid peroxidation in the patients of breast diseases

Toll-like receptors are recognized as redox sensitive receptor proteins and have been implicated in cellular response to oxidative stress. Altered pro-oxidant-antioxidant balance leads to an increased oxidative damage and consequently play an important role in breast diseases. The study was designed to access the oxidative stress status by quantification of byproducts generated during lipid peroxidation and inadequate trace elements during oxidative damage and its effects on the toll like receptor (TLR) activity in patients of breast diseases. Decreased levels of selenium, copper, zinc, magnesium and iron with elevated levels of malondialdehyde (marker of lipid peroxidation) were accompanied by decreased TLR activity in patients of benign breast diseases as well as breast carcinoma. A similar pattern was observed with the advancement of disease and its subsequent progression in breast carcinoma patients. Results of multinomial regression analysis suggest benign breast disease patients are at higher risk of developing breast cancer with high odds ratio of lipid damage.

Need and importance of health protection training in Nepal

By investing in health protection, the health of the nation can be safeguarded from future threats of uncontrolled infectious disease epidemics and disasters. DOI: http://dx.doi.org/10.3126/nje.v5i1.12373

A novel approach to study oxidative stress in neonatal respiratory distress syndrome

Background

Respiratory distress syndrome of the neonate (neonatal RDS) is still an important problem in treatment of preterm infants. It is accompanied by inflammatory processes with free radical generation and oxidative stress. The aim of study was to determine the role of oxidative stress in the development of neonatal RDS.

Methods

Markers of oxidative stress and antioxidant activity in umbilical cord blood were studied in infants with neonatal respiratory distress syndrome with reference to healthy newborns.

Results

Status of markers of oxidative stress (malondialdehyde, protein carbonyl and 8-hydroxy-2-deoxy guanosine) showed a significant increase with depleted levels of total antioxidant capacity in neonatal RDS when compared to healthy newborns.

Conclusion

The study provides convincing evidence of oxidative damage and diminished antioxidant defenses in newborns with RDS. Neonatal RDS is characterized by damage of lipid, protein and DNA, which indicates the augmentation of oxidative stress.

General significance

The identification of the potential biomarker of oxidative stress consists of a promising strategy to study the pathophysiology of neonatal RDS.

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Oxidative stress is important in the pathogenesis of neonatal respiratory distress syndrome (RDS).

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Oxidative stress biomarkers were studied in neonates with RDS.

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The high concentration of products of lipid peroxidation, protein damage and oxidative DNA damage were found.

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High oxidative stress was correlated with presence of RDS in newborns.

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Our results are an important step in continuous monitoring of the neonatal RDS.

NF-κB p65 subunit DNA-binding activity: association with depleted antioxidant levels in breast carcinoma patients

NF-κB is recognized as a redox-sensitive transcription factor and has been implicated in cellular response to oxidative stress. The study was designed to correlate the changes in antioxidant status with the levels of nuclear factor-κB (NF-κB) p65 subunit DNA-binding activity in relation to lymph node involvement, tumor size, and staging in breast carcinoma patients. Case control study comprised of 40 breast carcinoma patients along with 40 age- and sex-matched healthy subjects as controls. Levels of enzymatic/nonenzymatic antioxidants along with the trace elements were measured to study the antioxidant status in the study subjects. Levels of NF-κB p65 subunit DNA-binding activity was estimated by ELISA assay. The levels of enzymatic, nonenzymatic antioxidants, and trace elements were found to be significantly depleted in breast carcinoma patients in comparison to healthy controls suggesting significantly decreased levels of antioxidant activity in the breast carcinoma patients. Also, these results indicate that antioxidant levels decrease progressively with the advancement of stage and subsequent progression of disease. DNA-binding activity of NF-κB p65 subunit was higher in breast cancer patients in comparison to normal healthy controls, and the activity was found to increase with the advancement of disease. Significant correlation was observed between the DNA-binding activity of NF-κB p65 subunit and antioxidant status in the patients. The logistic regression analysis revealed decreased levels of antioxidants and increased level of DNA-binding activity of NF-κB p65 subunit were significantly associated with incidence of breast carcinoma. Depleted antioxidant status and increased level of DNA-binding activity of NF-κB p65 subunit thus point clearly of an association in relation to disease progression, clinical stage, and cytological grade in the pathophysiology of breast carcinoma.

Association of oxidative DNA damage, protein oxidation and antioxidant function with oxidative stress induced cellular injury in pre-eclamptic/eclamptic mothers during fetal circulation

Pre-eclampsia is a devastating multi system syndrome and a major cause of maternal, fetal, neonatal morbidity and mortality. Pre-eclampsia is associated with oxidative stress in the maternal circulation. To have an insight on the effect of pre-eclampsia/eclampsia on the neonates, the study was made to explore the oxidative status by quantification of byproducts generated during protein oxidation and oxidative DNA damage and deficient antioxidant activity in umbilical cord blood of pre-eclamptic/eclamptic mothers during fetal circulation. Umbilical cord blood during delivery from neonates born to 19 pre-eclamptic mothers, 14 eclamptic mothers and 18 normotensive mothers (uncomplicated pregnancy) as control cases was collected. 8-OHdG (8-hydroxy-2-deoxyguanosine), protein carbonyl, nitrite, catalase, non-enzymatic antioxidants (vitamin A, E, C), total antioxidant status and iron status were determined. Significant elevation in the levels of 8-OHdG, protein carbonyl, nitrite and iron along with decreased levels of catalase, vitamin A, E, C, total antioxidant status were observed in the umbilical cord blood of pre-eclamptic and eclamptic pregnancies. These parameters might be influential variables for the risk of free radical damage in infants born to pre-eclamptic/eclamptic pregnancies. Increased oxidative stress causes oxidation of DNA and protein which alters antioxidant function. Excess iron level and decreased unsaturated iron binding capacity may be the important factor associated with oxidative stress and contribute in the pathogenesis of pre-eclampsia/eclampsia which is reflected in fetal circulation.

Oxidative damage markers as possible discriminatory biomarkers in breast carcinoma

The study was designed to evaluate the markers of oxidative damage and to establish their diagnostic utility in breast carcinoma patients. Levels of 8-hydroxy-2-deoxyguanosine (8-OH-dG), protein carbonyl (PC), and malondialdehyde (MDA) along with total antioxidant status (TAS) were measured in breast carcinoma patients and controls. Receiver operating characteristic (ROC) analysis was done to study the diagnostic potential of the oxidative damage markers. Significant increases in oxidative damage markers were observed in breast carcinoma patients compared with the normal controls, which were accompanied by significant decrease in TAS. The logistic regression analysis revealed higher levels of oxidative stress marker and reduced level of TAS were significantly associated with breast cancer. ROC curves analysis demonstrates that 8-OHdG and PC are better indicators for distinguishing cancer patients from controls, followed by MDA and TAS. Our results indicate increased oxidative damage is associated with malignancy in breast cancer patients. High accuracy of oxidative stress markers in indicating cancer presence can be used as discriminatory makers for efficient diagnosis.

Retroperitoneal Hamartoma: A Rare Entity

Retroperitoneal hamartoma in adult is an extremely rare entity. Here we report a case of 23-years-old lady who presented with alarge retroperitoneal mass and abdominal pain. The mass was surgically removed and the diagnosis of hamartoma was made on histological findings. Keywords: hamartoma malformative tumor, retroperitoneal.

Retroperitoneal hamartoma: a rare entity

Retroperitoneal hamartoma in adult is an extremely rare entity. Here we report a case of 23-years-old lady who presented with a large retroperitoneal mass and abdominal pain. The mass was surgically removed and the diagnosis of hamartoma was made on histological findings.

Molecular distortions and chemical bonding of a large pi-conjugated molecule on a metal surface

Normal incidence x-ray standing wave experiments and density functional theory reveal that 3,4,9,10-perylene-tetracarboxylic-dianhydride chemisorbs on Ag(111) in a nonplanar but vertically distorted configuration. The carboxylic O atoms are 0.18 +/- 0.03 angstroms closer to the surface than the perylene core. The distortion is related to weak, local bonds between carboxylic O atoms and the Ag surface which are coupled--through charge transfer into the former lowest unoccupied molecular orbital--to the primary, extended chemisorption bond via the perylene skeleton.