Relationship between Hemispheric Preference Score and Academic Performance among Preclinical Medical Students Studying Medicine and Dentistry

Background

Understanding the style of learning and thinking (SOLAT) of the students is necessary to keep students actively involved in learning, which could influence the academic performance of the students.

Aim

The objective of this study was to compare the right and left hemisphere preferences for processing information with academic performance of medical students in both theory and practical exams.

Materials and Methods

The hemispheric preference score for learning and thinking style among first year MBBS (95) and BDS (42) students was determined by SOLAT tool prepared by Dr. V. Venkataraman (1994). A comparison of the hemispheric score between high achievers and low achievers in theory and practical exams was performed by using the unpaired Student's t-test and Mann-Whitney U-test.

Results

The mean hemispheric scores for the right hemisphere, left hemisphere, and whole brain were 26.51, 14.5, and 6.76, respectively. High achievers in theory exam and practical exam received a higher left-hemispheric score and whole-brain score than low achievers; the difference in the mean value of hemispheric score was statistically not significant.

Conclusion

There was no statistically significant relationship between academic achievement and hemispheric preference scores.

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.

Awareness of child oral health among parents and caregivers attending Pediatrics OPD at BPKIHS, Dharan

Introduction: Parents and caregivers are the key sources responsible for their children’s good health. They are the basic needs-provider and role models as well for their children to learn good oral habits early on. Thus, their awareness about the factors affecting child oral health is an essential component for the well-being of the child. Objectives: To assess awareness of child oral health among parents and caregivers attending Pediatrics OPD at BPKIHS, Dharan. Methodology: A cross-sectional questionnaire-based study was conducted among conveniently selected 400 parents and caregivers of six months-to-14-year-old children attending Pediatrics OPD, BPKIHS, Dharan. A single interviewer administered pre-tested standardized questionnaires to the participants. The questionnaires consisted of five domains: socio-demographic profile of the participants; child’s oral hygiene practices; child’s feeding and dietary habits; awareness of child’s first dental visit and presence of family dental problems; and child’s dental service utilization. Data were entered in MS excel 2007 and statistically analyzed using SPSS version 11.5. Data analysis included descriptive statistics. Results: Majority (90%) of the parents and caregivers were literate and 44.3% belonged to the lower-class socioeconomic status. 83.3% of the participants reported that their children took a sugary diet and 77.6% of them brushed once daily before breakfast. 91% of the respondents reported the age of the child’s first dental visit to be any age when there was a dental problem. The awareness of the presence of oral health problems in their child was seen in 29.5%, whereas 18% had made previous dental visits. Conclusion: Despite the fact that most parents and caregivers reported factors affecting their children's oral health, there was evidence of lack of awareness and, as a result, low utilization of dental services for their children.

Predictors of Obesity among Type 2 Diabetes Mellitus Patients Attending a Tertiary Care Center of Province 1, Nepal

Background: Obesity and Diabetes Mellitus type 2 have a known association. Yet, the socio-demographic predictors of obesity in special populations like ours (Asian) who have DM remain unclear. The purpose of this study was to determine the socio-demographic predictors of obesity among newly diagnosed Diabetes Mellitus in adults. Materials and Methods: This was a descriptive cross-sectional study conducted in endocrine OPD of Nobel medical college. Total 124 subjects were enrolled who were newly diagnosed Diabetes Mellitus over a period of 1 year. Detailed history was taken for demographic and clinical variables. Height, weight, waist circumference and blood pressure were measured. Besides, Body Mass Index, the dependent variable, was calculated. Subjects were considered to have diabetes based on their fasting and postprandial blood sugar level for the first time. Results: The prevalence of obesity among the study population was 39.5%, overweight was 45.2%. Predictors for this study for obesity were found as abnormal blood pressure and hospital visit after symptoms development. Conclusion: Obesity is a important risk factor for Diabetes Mellitus and higher prevalence of obesity among type 2 diabetes was observed. Predictors for this study for obesity were found as abnormal blood pressure and hospital visit after symptoms development

Effectiveness of oral health education intervention among 12-15-year-old school children in Dharan, Nepal: a randomized controlled trial

Background

School-aged adolescents are in particular need of preventive program to ensure positive long-term oral health and hygiene. The objective of this study was to assess the effectiveness of an oral health education (OHE) intervention on oral hygiene knowledge, attitude and practices (KAP), plaque control and gingival health among 12–15 years old school children in Dharan sub-metropolitan city, Nepal.

Methods

A randomized controlled trial was conducted with parallel study groups, comprising 12–15-year-old school children, 120 in each group. OHE was given to the experimental group at baseline, third and sixth months and to the control group after completion of the study. Interview of the participants were done using a 23-item questionnaire for assessment of oral hygiene KAP. For each question, correct answer was scored as 1 and wrong answer was scored zero. An overall composite score was then created, by adding the individual scores. Oral examination was done using mouth mirror and WHO probe to record Turesky–Gilmore–Glickman modification of the Quigley-Hein plaque index, Gingival index and Dentition status and treatment needs. Analysis was done using chi-square test for categorical data and independent t test, Mann–Whitney U test, repeated measures ANOVA and post hoc Tukey’s test for quantitative data. The level of significance was set at P < 0.05.

Results

There was 54.58% improvement in overall oral hygiene KAP in experimental group (P = 0.001) whereas no improvement was seen in control group at the end of the study. The mean plaque score was improved by 57.67% (P = 0.001) in experimental group in comparison to 4.56% in control group. Gingival index was improved by 49.90% (P = 0.001) in experimental group in comparison to 0.7% in control group. Caries experience was increased in both groups but no significant difference was seen.

Conclusions

The study concluded that oral health education was effective in improving oral hygiene KAP, plaque control and gingival health.

Trial registration The trial was retrospectively registered with Clinical Trial Registry India (CTRI) with identifier no. CTRI/2018/05/013985, registered on 05/21/2018. (http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=23651&EncHid=&modid=&compid=%27,%2723651det%27). Institutional Review Committee, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal provided the ethical approval (Ref. No.: 292/074/075-IRC).

Squat and smile assessment in predicting healing of lower limb fractures fixed with a SIGN nail

BACKGROUND

Irrespective of the treatment method, union is the ultimate goal of any fracture treatment. However, nowadays, rather than the physician-based clinico-radiological methods, the patient-reported outcome measurements assessing their quality of life and function are gaining much popularity. This is specifically true in the part of the world where the patient needs almost complete degree of hip/knee flexion - for social, cultural, religious or occupational reason(s). The ability to squat can assess the mobility and stability of joints and thus the quality of squatting is a proxy reflection of the functional outcome after fixation of lower limb fracture. Thus, we studied to determine the inter-observer and intra-observer reliability of Radiographic Union Score for Tibia (RUST) and Squat and Smile (S & S) test in clinical photograph. We further calculated the sensitivity and specificity of S & S test in predicting healing of lower limb fracture fixed by intramedullary interlocking nail considering RUST as the gold standard.

METHODS

This was a retrospective study of prospectively collected data of solid Surgical Implant Generation Network (SIGN) intramedullary interlocking nailing from a single, university-based, high volume tertiary center where 56 consecutive adults with either tibial or femoral shaft fractures fixed with a SIGN nail within one year and not requiring any surgery till minimum of eighteen-month follow-up were included. Cases without either Anterior-Posterior (AP) view and/or Lateral (Lat.) view follow-up x-ray(s) or proper S & S clinical photograph (at least 1.5-year post fixation) were excluded. The x-rays (RUST criteria) and clinical photograph (S & S grading) were scored by two independent and blinded observers each and repeated after 1 month.

RESULTS

The overall intra-observer reliability was from 0.773 to 0.825 and inter-observer reliability from 0.635 to 0.757 for RUST scoring which was from 0.687 to 0.785 and from 0.301 to 0.650 respectively for S & S scoring. The sensitivity and specificity of S & S in predicting fracture healing were up to 82.22% and 63.64% respectively.

CONCLUSION

The S & S test is reliable to predict the healing of lower limb fracture fixed with an intramedullary nail. The test is more useful to determine healed fractures than to determine non-healed ones. (sensitivity being higher than specificity).

Determinants of severe acute malnutrition among under 5 children in Satar community of Jhapa, Nepal

Background

Severe acute malnutrition (SAM) is the most extreme and visible form of undernutrition plagued by chronic poverty, household food insecurity, lack of education. One of the indigenous and marginalized community of Nepal, Satar/Santhal has often been neglected and is devoid of good education and are economically deprived. This predisposes under 5 children of Satar into malnutrition. The study aims to assess determinants of SAM among children under 5 years of age in Satar community of Jhapa district, Nepal.

Material & methods

A community based matched case control study was carried from September 2019 to February 2020 among under five children of Satar community residing in Jhapa district. Multistage random sampling technique was used to select 50 cases and 100 controls in the ratio of 1:2. Information was collected through personal interview with the parents and anthropometric measurement of the children was measured. Bivariate and multivariate conditional logistic regression analysis was used to explore the determinants of severe acute malnutrition.

Results

A total of 664 children between the age group of 6–59 months were screened for SAM. The prevalence of SAM was found 7.53%. Factors like, low economic status, birth interval less than 2 years, frequency of breast feeding <8 times/day and household food insecurity were found to be significant determinants of SAM. Multivariate logistic regression documented low economic status (AOR: 11.14, 95% CI 1.42 to 87.46); and frequency of breast feeding <8 times/day (AOR: 2.09, 95% CI 1.00 to 4.37) as determinants of SAM.

Conclusion

Low economic status and frequency of breast feeding less than 8times/day were major determinants of SAM among children under 5yrs of age. Ending malnutrition will require greater efforts and integrated approaches to eradicate extreme poverty. Multi-sector approaches have been conducting for SAM in Nepal but there are no specific approaches for marginalized community.

Participation of Community in Prevention and Control of Dengue Fever in Dharan Sub Metropolitan City of Province No 1, Nepal

Background: Dengue fever is known as a break-bone fever and its common symptoms are headaches, high grade fever, muscular, bone pains and decrease of platelets count. Community participation involving local government and household participants in controlling breeding areas of dengue mosquitoes is the only cost-effective and sustainable activities of ensuring prevention and control of Dengue fever. This study aimed to assess the perception of the general population regarding community participation in the prevention of dengue and to verify its effectiveness with the control practices observed at the homes in Dharan sub-metropolitan city of Province No 1. Material and Methods: A cross-sectional study was conducted among 250 households at the Dharan sub-metropolitan city of Province no. 1 in Nepal from August to October 2019. The technique of sample collection was done using purposive sampling and data were collected using a pretested close-ended questionnaire and observational checklists. Results: Slightly over half of the respondents 129 (51.6%) reported a positive attitude regarding community practice and almost three out of five 157 (62.8%) houses were observed to have good dengue control practices. The univariate results revealed attitude of households regarding community participation were significantly associated with the control practices observed in their homes (p<0.001). Conclusion: The study concludes that good community participation in collaboration with health volunteers and health institutions can have a positive impact on the dengue control practices at the household level. Hence, the spread of dengue out-break can be controlled by active collaborative community participation.  

Association of the Pattern and Quality of Sleep with Consumption of Stimulant Beverages, Cigarette and Alcohol among Medical Students

BACKGROUND

Sleep is important in maintenance of proper functioning of both mental and physical functions of human body. Studies have shown there is impact on the sleep parameters with the use of caffeine, cigarette and alcohol. As there is little availability of similar studies here in Nepal, we made an attempt to know the relation of consumption of such substances with the sleep quality and sleep parameters as per Pittsburgh Sleep Quality Index scale.  Methods: A cross sectional study was conducted among the undergraduate students at BP Koirala Institute of Health Sciences, Dharan. Students were asked to complete a self- administered questionnaire to give information about demographic variables and habit of consumption of caffeinated beverages, cigarette and alcohol. The Pittsburgh Sleep Quality Index was utilized after the permission from authority to evaluate sleep quality.

RESULTS

Out of 350, almost half of the students (44.6%) had poor sleep quality. 40.8% students reported sleeping six hours or less per night and 10.1% used medications to sleep. 96% reported consuming caffeinated beverages, 20% consumed cigarettes and 38.3% consumed alcoholic beverages. There was significant association of poor sleep quality with the increased consumption caffeine, cigarette and alcohol (p<0.05).

CONCLUSIONS

Poor sleep is prevalent among the undergraduate students of B P Koirala Institute of Health Sciences and the consumption of caffeine, cigarette and alcohol is associated with increment in poor sleep quality among them.

Analysis of Corneal Astigmatism after Clear Corneal Phacoemulsification : A Prospective Study

Introduction: With the evolution of cataract surgery over the past years and increasing patient demand for spectacle independence, today cataract surgery is moreover a refractive surgery. Surgically induced astigmatism (SIA) hinders post-operative refractive precision by changing the refractive power of cornea. Objectives: To calculate and compare SIA and postoperative spherical equivalent (SE) among eyes undergoing phacoemulsification performed via superior and temporal approach. Methodology: A longitudinal prospective observational study was conducted in a tertiary eye care center. 200 consecutive patients who underwent 2.8mm clear corneal phacoemulsification were allocated in Group A (Superior) and Group B (Temporal) in equal numbers by random lotiery method. Patients with any corneal pathology, glaucoma, retina or macular diseases, with previous history of trauma or ocular surgery were excluded. Preoperative astigmatism, postoperative astigmatism and postoperative SE were calculated at 6weeks follow-up. SIA was calculated using vector analysis software version 2.1 given by Dr Sawhney. Results Eighty patients of group A and 99 patients of Group B were included in the analysis. Preoperative keratometry and astigmatism was comparable between the two groups. Postopera tive astigmatism was significantly lower in temporal incision (0.75± 0.58) group than in superior incision group (1.2±0.71). SIA in-group A was 0.43D and in group B was 0.18D. SE was found to be significantly lower in temporal incision (p<0.01) group. Conclusion Temporal incision is astigmatically more neutral and has betier refractive precision than superior incision clear corneal phacoemulsification.

Rose Angina Questionnaire: Validation in emergency department to detect myocardial infarction in a tertiary hospital of eastern Nepal

Background:

Rose Angina Questionnaire (RAQ) is a useful screening questionnaire for ischemic heart disease validated in different settings; however, its diagnostic ability to predict myocardial infarction (MI) in the emergency is less clear.

Objectives:

To find out the usefulness of RAQ to predict MI in patients presenting to the emergency.

Methods:

A cross-sectional study was conducted at the BP Koirala Institute of Health Sciences (BPKIHS), a teaching hospital in eastern Nepal from 1 January to 30 March 2017, after ethical clearance from the Institutional Review Committee. Informed consent was obtained from the patients for their anonymised information to be published in this study The samples were collected from 100 patients with chest pain aged 40 to 70 years presenting to the emergency. RAQ was applied and its performance to detect MI was compared with emergency and cardiologist diagnosis of MI. Sensitivity, specificity, positive predictive value and negative value were calculated along with descriptive analysis.

Results:

A total of 100 patients were analysed with the mean age of 63.78 years (SD 11.60) and male to female ratio of 1.94. RAQ detected 58 cases (63.8%) with emergency department (ED) diagnosis of MI (true positive) and identified 3 (33.3%) cases with non-MI (true negative). The true positive rate for RAQ to detect MI after cardiologist consultation was 71.6%. RAQ had a sensitivity of 84.91% (95% confidence interval (CI) 72.41% –93.25%) to detect positive troponin, 63.74% (52.99–73.56) to detect positive electrocardiogram (ECG) and 71.60% (95% CI 60.5% to 81.07%) to detect final diagnosis of MI.

Conclusion:

RAQ is a good screening tool to detect MI in the emergency that can be used in isolation or in combination with other diagnostic modalities to detect it early.

Family Planning Practice among People Living with Human Immuno Deficiency Virus/Acquired Immune Deficiency Syndrome

BACKGROUND

Family planning among people living with Human Immuno Deficiency Virus/Acquired Immune Deficiency Syndrome is proved to be effective in preventing Human Immuno Deficiency Virus transmission through sexual and mother to child transmission.We studied family planning practice among people living with Human Immuno Deficiency Virus/Acquired Immune Deficiency Syndrome at reproductive age and its associated factors.

METHODS

We conducted a cross-sectional study in four anti retro viral therapy centers in eastern Nepal from September 2015 to February 2016. Data was collected among 200 samples by face to face interview using pretested semi-structured questionnaire. Bivariate analysis and logistic regression was performed to analyze the associated factors.

RESULTS

Fifty one percent (51%) of participants in reproductive age were currently using family planning methods with male condom being the most common. On bivariate analysis, higher income, higher education, having living children, involvement in decision making, low fertility desire, longer duration in anti-retroviral therapy, family planning knowledge and past counseling were found to be statistically significant in having higher family planning practice. In multivariate analysis,participants with duration in anti-retroviral therapy for 1- 4 years(AOR: 9.2, 95% CI: 1.7-47.5), both spousal involvement in decision making (AOR:37.1, 95% CI: 6.5-211.9) and family planning counseling (AOR: 3.4, 95% CI: 1.0-11.3) were found to have higher odds of family planning practice.

CONCLUSIONS

Male condom is the most common method of family planning practice among HIV patients. Higher income, education status of both partners and having living childrens are the encouraging factor for better practice. Involvement of both partners is associated with higher use of family planning practices. Duration of anti-retroviral therapy use has positive impact on use of family planning practices.

Cellular Alteration of the Oral Mucosa due to Orthodontic Appliances and Tobacco Smoking: A Cytomorphometric Study

Introduction: Fixed orthodontic treatment causes chronic low grade irritation on the oral mucosa. Tobacco smoking is considered to be a risk factor in the development of oral cancer. This study involves a cytomorphometric analysis on the buccal mucosal cells in patients undergoing fixed orthodontic treatment who are tobacco smokers. Methods: Exfoliated buccal mucosal cells were obtained from orthodontic patients (smokers & non-smokers) as well as smokers and non-smokers who are not undergoing any orthodontic treatment. Smears were stained with rapid PAP stain and digital images of 50 cells were analysed using the Image J software. Results: Statistical analysis revealed that there were significant increase in the values of nuclear and cell diameter between non-smokers undergoing orthodontic treatment and smokers (p<0.001 & p=0.014 respectively), and between non-smokers undergoing orthodontic treatment and smokers undergoing orthodontic treatment (p<0.001 & p=0.015 respectively). Also, nuclear area and cell area showed significant differences between many of the study groups. Conclusion: It can be concluded that there are nuclear and cellular alterations in patients undergoing fixed orthodontic treatment who are smokers

Health needs and risky behaviours among inmates in the largest prison of eastern Nepal

PURPOSE

The purpose of this paper is to assess the health status and risky behaviours of inmates in Nepal.

DESIGN/METHODOLOGY/APPROACH

This cross-sectional study was conducted in Jhumka Regional Prison, the largest male prison in eastern Nepal from September 2014 to August 2015. Data were collected through face-to-face interviews from 434 randomly selected incarcerated participants using semi-structured questionnaires.

FINDINGS

The mean age of 434 participants was 35.7 years (SD 13.3). The majority (84 per cent) had at least one current health problem, of which the commonest were respiratory (50 per cent), skin (38 per cent) and digestive (26 per cent). Alcohol (73 per cent) and cigarettes (71 per cent) were the most commonly used substances prior to imprisonment. Approximately, 27 and 11 per cent reported illicit drug use and injectable drug use prior to incarceration, respectively. A total of 204 inmates reported having intercourse with sex workers. Of these, 49 per cent did not use a condom in their last intercourse with a sex worker.

RESEARCH LIMITATIONS/IMPLICATIONS

This paper illustrates that a wide range of physical and mental health problems exist among incarcerated people in Nepal. The study may lack generalisability, however, as it was conducted in a single male prison.

PRACTICAL IMPLICATIONS

The paper suggests a need for medical, psychiatric and substance abuse care in correctional settings to improve the health status of the prison population. It is also important to develop screening policies for blood-borne viral and other infectious diseases in the prison.

ORIGINALITY/VALUE

This is the first study of its kind drawn from prisons in Nepal.

Knowledge of dietary habit and behavior-related determinants of non-communicable disease in women of urban setting of Eastern Nepal

Background: The non-communicable diseases (NCDs) are one of the leading causes of death globally which accounts for 68% out of world’s 56 million deaths in 2012. Around 82% of the premature deaths due to NCDs occur in the low-and middle-income countries and 40% of global NCD-related deaths take place before the age of 70. The study aimed to assess knowledge of dietary habits and behaviour-related determinants of NCD in urban Nepalese women of Eastern Nepal. Materials and Methods: A cross-sectional study was designed by using interviewer-administered questionnaire regarding knowledge on NCD. The definitions used for the study adopted the WHO STEP wise approach to chronic disease risk factor surveillance (STEPS) survey. A total 706 women aged 20–59 years were selected randomly from Inaruwa Municipality of Eastern Nepal. Results: The overall knowledge scores was found to be 62.14% with standard deviation 14.93% and it build up that the diet- and behaviour-related causes (mean score 75.25%), diet quality (mean score 45.27%) fruit and vegetable link (mean score 30.02%), health consequences of obesity (mean score 76.82%), causes of cardiovascular disease (mean score 77.08%) and causes of certain cancers (mean score 36.10%) were calculated. The total score of knowledge regarding NCD was found to be significant with caste/ethnicity, education level, occupation, socioeconomic status, physical activity and fruit intake. Conclusions: Findings revealed the population had good overall knowledge concerning diet and nutrition related to NCD in the relatively new context of the obesity epidemic in urban set up of Nepal. However, there was poor knowledge of the benefit of eating fruit and vegetables and other preventable causes of certain cancers. Nutrition education messages need to be communicated within the general population of women. Education targeting the benefits of vegetables and fruit may have the positive impact on NCD prevention.

Evaluation of nitrate reductase assay in 7H11 agar for diagnosis of multi-drug-resistant tuberculosis in eastern Nepal

Background

Emergence of multi-drug-resistant tuberculosis is a serious challenge for successful global tuberculosis control. Early diagnosis of drug-resistant tuberculosis by direct nitrate reductase assay (NRA) aids in appropriate treatment and reduction in disease transmission, particularly in countries with high tuberculosis burden. The aim of this study was to evaluate the performance of NRA for direct detection of resistance to rifampicin and isoniazid in Mycobacterium tuberculosis in laboratories with limited resources.

Methods

Fifty-eight new smear-positive sputum samples were processed as per the guidelines of revised national tuberculosis control program, India. The performance of NRA on middlebrook 7H11 agar was evaluated for detection of rifampicin and isoniazid resistance directly on smear-positive sputum specimens, and the results were compared with conventional proportion method. Sensitivity and specificity of the test were compared with the gold standard proportion method. Mc Nemar chi-square test was used to find out the significant difference between two methods.

Results

Direct NRA for detection of rifampicin resistance was 85.7% sensitive and 100% specific, whereas sensitivity and specificity of isoniazid resistance were 87.5% and 100%, respectively. Agreement between NRA and proportion method was 98% for both the drugs. The mean days of drug susceptibility testing results were 19.3 days for NRA and 72 days for conventional proportion method. The results of NRA were available in 21 days for 83% of the samples.

Conclusions

Direct NRA on middlebrook 7H11 medium is a highly sensitive, reliable, and significantly faster method to perform drug susceptibility testing. It has the potential to be implemented for rapid detection of multi-drug-resistant tuberculosis against insufficient resources.

Price Variation and Availability of Free Medicine for Non-communicable Diseases

BACKGROUND

Nepal is witnessing rise in non-communicable chronic diseases. Costs of the medicine, availability of the medicine for free in public health sectors and variation of price of medicines may play an important role in the management of chronic disease. The study was undertaken to find out the variation in price of drugs used for treating non communicable diseases among private pharmacies and availability of free essential medicines in public facilities.

METHODS

Randomly selected 33 public health centers and 13 pharmacies were included for the study. Availability of free essential medicines for treating selected chronic diseases was assessed in public health centers and percentage price variation in various branded drugs used for treating these diseases was assessed at the consumer level.

RESULTS

Out of 89 different formulations, variations between maximum and minimum priced brands of more than 100% were observed in 37 formulations and that of > 200% in 22 formulations. Thirty-seven formulations had more than 100% inter-pharmacy variation. The most commonly available free essential medicines was 4 mg salbutamol (88.57%) while the least available free essential drug was levothyroxine 5 mg (9.0%).

CONCLUSIONS

Considerable variation in prices is seen among similar drugs and in prices of same drug in different pharmacies. These factors may have implications in the management of chronic disease in Nepal offsetting the government's effort to control chronic diseases.

Length of Stay of Psychiatric Admissions in a Tertiary Care Hospital

Introduction: The length of stay among psychiatric in-patients is usually longer than that of others. In-patient management is costly and longer length of stay can lead to catastrophic costs. We conducted this study to explore about the length of stay of psychiatric admissions and factors affecting it.Methods: We collected the data of all the patients admitted to the psychiatric ward of B. P. Koirala Institute of Health Sciences from 1st January 2007 to 31st December 2016 from the database of the medical records section after ethical approval. The sociodemographic and clinical variables were analyzed using SPSS 20.0 version. Length of stay more than 3 weeks was considered as long stay. Bivariate and multivariable logistic regression analyses were conducted to identify factors associated with length of stay.Results: There were 3687 admissions during the study period. The average length of stay was 19.36 (±13.14) days. On logistic regression, the factors associated with shorter length of stay were: male gender (aOR= 0.79, 95%CI: 0.68-0.93), being self employed (aOR= 0.17, 95%CI: 0.12-0.22), homemakers (aOR= 0.18, 95%CI: 0.14-0.24), farmers (aOR= 0.20, 95%CI: 0.15-0.27) and students (aOR= 0.23, 95%CI:0.17-0.32). Similarly, factors associated with longer length of stay were: being from other Eastern Terai districts(aOR=1.37, 95%CI: 1.11-1.70), other Eastern Hill districts (aOR= 1.68; 95%CI: 1.29-2.20), diagnosis of schizophrenia and related disorders (aOR=4.01, 95%CI: 1.34-12.0), having medical co-morbidity (aOR= 3.47; 95%CI: 2.49-4.84) and being readmitted (aOR= 1.23, 95%CI: 1.03-1.47).Conclusions: There was significant association of length of stay with gender, age, address, occupation, diagnosis and readmission

CELLULAR ALTERATIONS OF THE ORAL MUCOSA DUE TO ORTHODONTIC APPLIANCES AND TOBACCO SMOKING: A CYTOMORPHOMETRIC STUDY

<p><strong>Introduction</strong>: Fixed orthodontic treatment causes chronic low grade irritation on the oral mucosa. Tobacco smoking is considered to be a risk factor in the development of oral cancer. This study was designed to do a cytomorphometric analysis on the buccal mucosal cells in patients undergoing fixed orthodontic treatment who are tobacco smokers.</p><p><strong>Methods</strong>: Exfoliated buccal mucosal cells were obtained from orthodontic patients (smokers &amp; non-smokers) as well as smokers and non-smokers who are not undergoing any orthodontic treatment. Smears were stained with rapid PAP stain and digital images of 50 cells were analysed using the Image J software.</p><p><strong>Results and conclusion</strong>: Statistical analysis revealed that there were significant increase in the values of nuclear and cell diameter between non-smokers undergoing orthodontic treatment and smokers (p&lt;0.001 &amp; p=0.014 respectively), and between non-smokers undergoing orthodontic treatment and smokers undergoing orthodontic treatment (p&lt;0.001 &amp; p=0.015 respectively). Also, nuclear area and cell showed significant differences between many of the study groups. Based on these results, it can be concluded that there are nuclear and cellular alterations in patients undergoing fixed orthodontic treatment who are smokers. <strong></strong></p>

Knowledge and Attitude Towards Corporal Punishment Among Primary School Teachers of Biratnagar Sub-Metropolitan City, Morang, Nepal

Introduction: School experience has remarkable effect on emotional and personal development of children. Intended developments can be achieved through qualified education. It is quite a challenging fact that corporal punishment is still being used in the schools of Nepal as reported in the news papers and other literature. However, there is littlie information about the knowledge and atitude of teachers towards corporal punishment.Objecive: To assess knowledge and atitude and to identify the association between the selected variables and knowledge and attitude towards corporal punishment among primary school teachers of Biratnagar Sub-Metropolitan City.Methodology Descriptive cross-sectional study was conducted in Biratnagar Sub-metropolitan City, Nepal. A total of 160 primary school teachers were included using total enumeration sampling technique. Data were collected by using self-administered, semi-structured questionnaire and Likert Scale. Written consent was taken from each participant and ethical approval was taken from Institutional Review Board of B.P Koirala Institute of Health Sciences. Statistical analysis was done using SPSS.Results All respondents had heard about corporal punishment but most of them were not clear about the rules against corporal punishment in schools. The mean percentage score of knowledge was 58.81 ± 19.34 and for attitude 56.30 ± 6.98. There was a positive correlation (r=0.455, p <0.001) between knowledge and attitude towards corporal punishment. Majority of respondents scored less than the mean score. Females and government school teachers' knowledge and attitude were found to be more positive.Conclusion The study revealed that the teaching experience, training regarding corporal punishment and childhood experience of corporal punishment were significantly associated with teachers' knowledge and attitude. The government should begin public awareness campaigns to disseminate information on corporal punishment as violence through different media.Birat Journal of Health SciencesVol.2/No.3/Issue 4/Sep- Dec 2017, Page: 248-254

Factors Affecting the Place of Delivery among Mothers Residing in Jhorahat VDC, Morang, Nepal

BACKGROUND

In Nepal, the maternal mortality ratio is 281 per thousand live births, among which 40% mortality occurs during home delivery. Home delivery increases the risk of maternal and neonatal mortality and morbidity due to the birth not assisted by skilled attendant. This study was carried out to determine the factors affecting the place of delivery among the mothers residing in Jhorahat VDC, Morang district, Nepal.

METHODS

A mixed method study using interviews based on semi-structured questionnaire (n=93) among mothers and two focus group discussion among decision makers of the house and female community health volunteers was conducted between November to December 2012. For quantitative data, Chi-square test and Fischer's Exact test were used to examine the association between the selected variables and place of delivery.

RESULTS

More than half (58.1%) of the mothers had institutional delivery and 41.9% of them had home delivery. The most common reason for home delivery was easy and convenient environment (66.7%) and that for institutional delivery was safety (77.8%). There was a significant association between caste, education of mothers, education of spouse, occupation of spouse, per capita income, time to reach the nearest health center, parity, previous place of delivery, number of antenatal visit, knowledge about place of delivery, planned place of delivery, and place of delivery.

CONCLUSION

Maternal health services, such as prenatal care, skilled assistance during delivery and post-natal care, along with adequately equipped health institutions, play a major role in the reduction of maternal morbidity and mortality. Concerted efforts should be made both at community and government levels to increase institutional delivery.

Length of Stay of Psychiatric Admissions in a Tertiary Care Hospital

INTRODUCTION

The length of stay among psychiatric in-patients is usually longer than that of others. In-patient management is costly and longer length of stay can lead to catastrophic costs. We conducted this study to explore about the length of stay of psychiatric admissions and factors affecting it.

METHODS

We collected the data of all the patients admitted to the psychiatric ward of B. P. Koirala Institute of Health Sciences from 1st January 2007 to 31st December 2016 from the database of the medical records section after ethical approval. The sociodemographic and clinical variables were analyzed using SPSS 20.0 version. Length of stay more than 3 weeks was considered as long stay. Bivariate and multivariable logistic regression analyses were conducted to identify factors associated with length of stay.

RESULTS

There were 3687 admissions during the study period. The average length of stay was 19.36 (±13.14) days. On logistic regression, the factors associated with shorter length of stay were: male gender (aOR= 0.79, 95%CI: 0.68-0.93), being self employed (aOR= 0.17, 95%CI: 0.12-0.22), homemakers (aOR= 0.18, 95%CI: 0.14-0.24), farmers (aOR= 0.20, 95%CI: 0.15-0.27) and students (aOR= 0.23, 95%CI:0.17-0.32). Similarly, factors associated with longer length of stay were: being from other Eastern Terai districts(aOR=1.37, 95%CI: 1.11-1.70), other Eastern Hill districts (aOR= 1.68; 95%CI: 1.29-2.20), diagnosis of schizophrenia and related disorders (aOR=4.01, 95%CI: 1.34-12.0), having medical co-morbidity (aOR= 3.47; 95%CI: 2.49-4.84) and being readmitted (aOR= 1.23, 95%CI: 1.03-1.47).

CONCLUSIONS

There was significant association of length of stay with gender, age, address, occupation, diagnosis and readmission.

Prevalence of anemia and iron deficiency in adolescent school girls of Dharan, Nepal

Background: The prevalence of anemia in adolescence girls are said to be 42 to 60% in Nepal. Iron deficiency results from prolonged deficit of iron in diet or increased need for iron during a period of intense growth like adolescence. However, the terms anemia, iron deficiency, and iron deficiency anemia are used interchangeably.Aims and Objective: We aimed to find out the prevalence of anemia and iron deficiency in adolescent school girls of Dharan, Nepal by measuring hemoglobin and serum ferritin levels.Materials and Methods: This cross-sectional study was done in higher secondary schools, including government and private schools, of Dharan conducted by the Department of Basic and Clinical Physiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal. A total of 150 adolescent school girls of Dharan was selected by systemic random sampling method. Hemoglobin and ferritin levels were analyzed by cyanmethemoglobin method and immunoturbidimetric assay respectively. Descriptive statistics, paired t-test and chi-square test were used.Results: Anemic girls were 33.33% (n=50/150). Anemia with iron deficiency was identified in 17.33% girls (n=26/50) and anemia with normal iron level was in 16 % girls (n=24/50). Normal hemoglobin level with iron deficiency was identified in 9% (n= 14/100) girls and normal hemoglobin with normal ferritin level was in 57% (n=86/100) girls.Conclusions: Prevalence of anemia was less in the adolescent school girls of Dharan, Nepal, than the earlier documented reports in which only half the anemic adolescent girls were iron deficient; suggesting that the remaining other anemic girls had other causes of anemia.Asian Journal of Medical Sciences Vol.8(5) 2017 22-26

Association between anxiety and depression with chronic periodontitis

Background & Objectives: It is thought that chronic stress negatively affects immune response efficacy which in turn cause an imbalance between host and parasite leading to periodontal breakdown. The study aims to investigate the association between anxiety and depression with chronic periodontitis.Materials & Methods: This was a cross sectional study comprising of 350 individuals of both sexes, above 25 years of age. The study population was divided into two groups. Group 2 consisted of those subjects with clinical attachment loss of ≥ 3 mm in at least 30% of site examined, and the samples that did not satisfy the above criteria were categorized into Group 1. Group 1 included 184 individuals while group 2 had 166 subjects. Clinical examinations were performed by a single examiner. Psychological instrument used was Hospital anxiety and depression scale (HADS). Chi square and student t test were performed to compare between the two groups.Results: The mean depression scores in Group 1 and Group 2 were 6.64 ± 2.58 and 7.90 ± 2.86, respectively while the mean anxiety scores of Group 1 and Group 2 were 7.76 ± 3.12 and 9.07 ± 3.08, respectively (p<001).Conclusion: Within the limits of this study it is possible to conclude that there was significant association between periodontitis and anxiety, and depression 

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.

Treatment cost on Visceral Leishmaniasis: Case study in endemic districts of Nepal

Background & Objectives: Approximately six million people are at risk of infection from Visceral Leishmaniasis (VL) in Eastern and middle plain region of Nepal. The disease affects the rural poor socio-economical community causing significant death among untreated patients (Per capita income of Nepal US $ 400.00). An effort was made to estimate treatment cost on clinically diagnosed VL patients in three VL endemic districts of Eastern development region of Nepal.Materials & Methods: During one and half year period in 2012/2013, approximately 500 cases were diagnosed as VL from three district hospitals; two zonal hospitals and one tertiary level hospital of Eastern Terai districts of Nepal. Total 172 cases were selected randomly from the three VL endemic districts of Eastern Nepal and interviewed at their homes. Results: On an average, cost for VL treatment during hospitalization was Nepali Rupees (NRS) 4032.67±313.47, where median (IQR) length of hospital stay was 17 (five to 35) days. The patients were  iagnosed symptomatically as VL after 45 ± 6 days of feeling illness. The treatment cost of patient before diagnosis was NRS 2379.93 ± 202.30. Patient reached the treatment center after 17 ± 2 days of diagnosis and referral from community level. Total 83.7% patients came for follow-up after average 30 ± 2 days of discharge with an average expense of RS 360.34 ± 49.88. The death rate of VL patients during treatment and within one month of discharge was 7.6%. It was found that the average funeral cost was NRs 9598.00 ± 1259.00. Conclusion: This study concludes that, average treatment cost for VL treatment during hospital stay was NRs 4032 and before treatment was around NRS 2380 and follow up cost was NRs 360. Early diagnosis and treatment in treatment center without significant delay can not only reduce the hospital stay and treatment cost, but also saves life of VL patients.JCMS Nepal. 2016;12(2):60-5

Domestic violence and its associated factors among married women of a village development committee of rural Nepal

Background

Violence against women is a global public health problem occurring in multitude of contexts and domestic violence is considered to be the most pervasive one. Poor enforcement of policies, limitation of researches and expertise in this field largely accounts for persistence of this problem and nature of domestic violence and its associated factors are poorly understood.

Objectives

This research aimed to estimate the magnitude of different forms of domestic violence and identify its associated factors.

Methods

Community based cross sectional study was conducted among 355 married women of reproductive age group of Kusheshwor, Sindhuli, Nepal. The questionnaire adapted from the World Health Organization Multi-Country Study was used for the face to face interviews. Occurrence of current domestic violence was used as outcome variable in logistic regression. Descriptive and multivariate analysis were performed in order to assess the magnitude of domestic violence and to identify its associated factors respectively.

Results

Self-reported lifetime prevalence of physical violence was 29.6 % and past year prevalence was 15.2 %, while corresponding figures for sexual violence were 6.8 and 2.3 %, and for psychological violence were 31.0 and 18.3 %. Lifetime domestic violence was 38.6 % while in past 12 months, prevalence was 23.1 %. Furthermore, 12.4 % of women were experiencing all forms of violence concurrently. Women with controlling husband and having poor mental health were found to be at higher risk of domestic violence.

Conclusions

Domestic violence is still rampant in our society with several forms of violence occurring together. In a country like Nepal, differentials power in relationship and poor mental health was found to be positively associated with violent episodes. This study highlights the infringement of women rights which can be the cause for serious public health consequences.

A comparative study to find out the relationship between the inner inter-canthal distance, interpupillary distance, inter-commissural width, inter-alar width, and the width of maxillary anterior teeth in Aryans and Mongoloids

Background

One of the most confusing and difficult aspects of complete denture prosthodontics is the selection of appropriately sized maxillary anterior denture teeth. Various guidelines have been suggested for determining the size of anterior teeth, but different opinions have been reported regarding their significance. In the study reported here, the relationships between facial measurements and the width of maxillary anterior teeth in two ethnic groups, namely Aryans and Mongoloids, were determined.

Objective

The aims of the study were to determine the inner inter-canthal distance (ICAD), inter-pupillary distance (IPD), inter-commissural width (ICOW), inter-alar width (IAW), and the combined width of maxillary anterior teeth (CW) in Aryans and Mongoloids and to determine the relationships between these measurements.

Materials and methods

Impressions of the teeth of 170 dentulous subjects (85 males and 85 females) were made with alginate then Type IV gypsum product was poured in. Measurements of the cast maxillary anterior teeth at their widest dimension (contact areas) were made with the Boley gauge. ICAD, IPD, ICOW, and IAW distances were also measured with a Boley gauge.

Results

For all 170 subjects, 85 Aryans and 85 Mongoloids, Pearson’s correlation coefficient (r) for IAW, IPD, ICOW, ICAD, and CW was calculated. In Aryans, highly significant (P<0.001) but weak correlations were found between CW and IAW, IPD, and ICOW. In Mongoloids, a highly significant (P<0.001) and weak correlation was found only between CW and IPD.

Conclusion

Within the limitations of this study, the results suggest that the IAW, IPD, and ICOW for Aryans and IPD for Mongoloids can be used as a preliminary method for determining the width of the maxillary anterior teeth in edentulous patients.

Alcoholic liver disease in Nepal: identifying homemade alcohol as a culprit

Background

Though the type of alcohol consumed is not thought to be associated with alcoholic liver disease (ALD), some studies have shown a beverage-specific effect. In the present study, we aim to study the effects of locally brewed alcoholic beverages on the development of liver disease.

Patients and methods

This cross-sectional study was conducted at the internal medicine department of a university hospital in Nepal. All patients classified as having either alcohol abuse or alcohol dependence by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition were evaluated for the presence of ALD.

Results

A total of 1,500 patients were screened, of which, 447 patients had ALD. Chronic liver disease (CLD) was detected in 144 patients (9.6%). Most of the patients consumed homemade locally brewed alcohol. On multivariate analysis, the following variables were found to be significantly associated with CLD: male sex (odds ratio [OR]: 1.81; 95% confidence interval [CI]: 1.12–2.94; P=0.02): rakshi consumption ≥30 units (OR: 2.53; 95% CI: 1.07–6.01; P=0.04); and tongba consumption (OR: 3.02; 95% CI: 1.22–7.50; P=0.02).

Conclusion

There was a significant increase in the risk of developing ALD with the consumption of rakshi and tongba after adjusting for total units consumed. The absence of striking differences between our patients with CLD and non-CLD patients with regards to the amount of alcohol consumed demonstrates that, although alcohol consumption is a prerequisite for the development of ALD, other factors like type of alcoholic beverage consumed may be involved.

An anthropometric study to evaluate the correlation between the occlusal vertical dimension and length of the thumb

BACKGROUND

Establishment of proper occlusal vertical dimension (OVD) is one of the important tasks for successful prosthodontic therapy. An ideal method for determining OVD in terms of cost, time, and instrument requirements has been sought in prosthodontics by various investigators. However, no such single method has been formulated. In the current anthropometric study, the relationship of the length of the thumb to the OVD was tested in two ethnic groups of Nepal, Aryans, and Mongoloids. The result of this study can be useful in determining proper OVD in edentulous patients.

AIMS AND OBJECTIVES

The primary aim of the present study was to evaluate the correlation between the length of the thumb and OVD in Aryan and Mongoloid ethnic groups. The secondary aim was to compare the correlation between OVD and other anatomic measurements (eye-ear distance and pupil-to-rima oris distance) in these ethnicities.

MATERIALS AND METHODS

The OVD, thumb length, eye-ear distance and distance between pupil of eye and rima oris were measured in a total of 500 adult dentulous volunteers. The correlation between OVD and thumb length as well as other anatomic measurements was checked with Pearson's product moment correlation coefficient. Linear regression analysis was performed to determine the relationship of OVD to the length of the thumb.

RESULTS

The thumb length was significantly (P≤0.05) correlated with strong and positive values (Pearson's coefficient =0.874 in the whole population, 0.826 in Aryans, and 0.944 in Mongoloids). Regression analysis showed that thumb length was significantly related to OVD in both ethnic groups.

CONCLUSION

Within the limitations of the present study, the result implies that thumb length can be used as an adjunct for establishing OVD in the edentulous patients.

Violence, HIV risk behaviour and depression among female sex workers of eastern Nepal

OBJECTIVES

The primary objective of the study was to estimate the prevalence of depression among female sex workers (FSWs) of eastern Nepal. The secondary objective was to search for an association between depression, violence and HIV risk behaviour.

DESIGN

Cross-sectional/observational study.

STUDY SETTING

This study was carried out in five cities of eastern Nepal (Dharan, Itahari, Biratnagar, Damak and Birtamode). Both restaurant-based and street-based FSWs were recruited in the study.

PARTICIPANTS

Women who had been involved in commercial sex activity in the past 6 months and gave informed consent were included in the study.

PRIMARY OUTCOME MEASURE

A score of more than or equal to 16 on the Centre for Epidemiological Studies Depression (CESD) scale was considered as depression.

METHODOLOGY

Face-to-face interviews were conducted with respondents who were sought through a snowball sampling technique. Information regarding their depression status, HIV high-risk behaviour and violence was recorded. The estimated sample size was 210.

RESULTS

We interviewed 210 FSWs (both restaurant-based and street-based). The prevalence of depression among respondents was 82.4%. FSWs who had experienced violence were five times more likely to be depressed than those who were not victims of violence. The odds of depression were six times higher among respondents who were involved in any HIV risk behaviour compared with those who were not involved.

CONCLUSIONS

The present study reports a high prevalence of depression, HIV risk behaviours and violence among FSWs of eastern Nepal. The mental health of FSWs should also be regarded as an important aspect of HIV prevention efforts which can help to promote the overall health of this population.

The alcohol use disorders identification test (AUDIT): validation of a Nepali version for the detection of alcohol use disorders and hazardous drinking in medical settings

BACKGROUND

Alcohol problems are a major health issue in Nepal and remain under diagnosed. Increase in consumption are due to many factors, including advertising, pricing and availability, but accurate information is lacking on the prevalence of current alcohol use disorders. The AUDIT (Alcohol Use Disorder Identification Test) questionnaire developed by WHO identifies individuals along the full spectrum of alcohol misuse and hence provides an opportunity for early intervention in non-specialty settings. This study aims to validate a Nepali version of AUDIT among patients attending a university hospital and assess the prevalence of alcohol use disorders along the full spectrum of alcohol misuse.

METHODS

This cross-sectional study was conducted in patients attending the medicine out-patient department of a university hospital. DSM-IV diagnostic categories (alcohol abuse and alcohol dependence) were used as the gold standard to calculate the diagnostic parameters of the AUDIT. Hazardous drinking was defined as self reported consumption of ≥21 standard drink units per week for males and ≥14 standard drink units per week for females.

RESULTS

A total of 1068 individuals successfully completed the study. According to DSM-IV, drinkers were classified as follows: No alcohol problem (n=562; 59.5%), alcohol abusers (n= 78; 8.3%) and alcohol dependent (n=304; 32.2%). The prevalence of hazardous drinker was 67.1%. The Nepali version of AUDIT is a reliable and valid screening tool to identify individuals with alcohol use disorders in the Nepalese population. AUDIT showed a good capacity to discriminate dependent patients (with AUDIT ≥11 for both the gender) and hazardous drinkers (with AUDIT ≥5 for males and ≥4 for females). For alcohol dependence/abuse the cut off values was ≥9 for both males and females.

CONCLUSION

The AUDIT questionnaire is a good screening instrument for detecting alcohol use disorders in patients attending a university hospital. This study also reveals a very high prevalence of alcohol use disorders in Nepal.

Development Of Atmospheric Pressure Plasma Jet In Air

In this paper, an atmospheric pressure plasma jet (APPJ) in air that is expected to be useful for polymer surface modification has been reported. The plasma jet was produced by applying (10 - 30) kHz, (0 - 20) kV AC source. The electrical and optical measurements have also been reported. The use of solenoid as an external electrode has been found to be more effective in boosting the jet to a distance up to 30 mm even with a small flow rate of air. The characteristic of the proposed APPJ was investigated by measuring the effect of treatment on a PE film on the jet for different exposition time and distance from the nozzle. It has been confirmed that the jet can modify polymer film with a work distance of over 25mm. This plasma jet can be useful for the treatment and cleaning of objects having large structures and could be used in wider areas of application. DOI: http://dx.doi.org/10.3126/kuset.v8i1.6035 KUSET 2012; 8(1): 15-22

Chest radiographs and their reliability in the diagnosis of tuberculosis

Radiology plays an important role in the diagnosis of pulmonary tuberculosis. Many medical practitioners believe in and rely primarily on the chest x-ray for the diagnosis of pulmonary tuberculosis. This study attempts to evaluate the reliability and validity of chest radiographs. This study was carried out in the tuberculosis clinic of BPKIHS. 75 radiographs were chosen for the study and viewed by 25 physicians of varying qualifications. Their findings were compared with the gold standard. The overall sensitivity and specificity was 78% and 51% respectively. There was poor agreement between the best physician and the best radiologist. This study has demonstrated an unsatisfactory sensitivity and specificity of chest x-rays in the diagnosis of pulmonary tuberculosis. The over-diagnosis and over-treatment due to chest x-rays could lead to an unmanageable burden on the resources of a poor country like Nepal. Private practitioners should be made aware about the importance of bacteriological diagnosis of tuberculosis before initiating drug therapy.