Role of CPXM1 in Impaired Glucose Metabolism and Ovarian Dysfunction in Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS), a common female endocrinopathy associated with both reproductive and metabolic disorders, has an unclear etiology and unsatisfactory management methods. Carboxypeptidase X, M14 family member 1 (CPXM1) is a protein involved in follicular atresia, insulin production, and adipose tissue production, though its role in PCOS is not fully understood. We used a 60% high-fat diet (HFD) plus dehydroepiandrosterone (DHEA)-induced PCOS mouse model to determine the role of CPXM1 in abnormal glucose metabolism and ovarian dysfunction in PCOS. We found that serum CPXM1 concentrations were higher in PCOS mice and positively correlated with increased levels of serum testosterone and insulin. In both ovarian and adipose tissues of PCOS mice, CPXM1 mRNA and protein levels were significantly increased but GLUT4 levels were significantly decreased. Immunohistochemistry (IHC) staining of the ovary showed increased CPXM1 expression in PCOS. In addition, the protein expression of phosphorylated protein kinase B (p-Akt) was also significantly decreased in PCOS mice. Furthermore, mRNA levels of inflammatory markers such as TNF-α, IL-6, IFN-α, and IFN-γ were increased in ovarian and adipose tissues of PCOS mice. However, IRS-1, IRS-2, and INSR levels were significantly decreased. Our results indicated for the first time that abnormally high expression of CPXM1, increased adiposity, impaired glucose tolerance, and chronic low-grade inflammation may act together in a vicious cycle in the pathophysiology of PCOS. Our research suggests the possibility of CPXM1 as a potential therapeutic target for the treatment of PCOS.

Perception and Challenges of Preventive Measures of COVID-19 Among Nepalese Frontline Health Professionals: An Unexplored Realism

Background

A new coronavirus causes COVID-19, a developing respiratory illness. Unfortunately, there is little information assessing healthcare workers' understanding of technology and preventative strategies during the Nepalese epidemic. Researchers from other subspecialties uncovered some mythical thoughts. As a result, we decided to put it to the test with healthcare personnel on the front lines. The research also looked at the problems experienced by frontline health care personnel (HCP) because of the COVID-19 strategic shift in work policy.

Methods

Nepalese healthcare workers participated in web-based cross-sectional research. A pre-tested, structured questionnaire utilizing a Google form was used to get self-informed, digitally typed consent, and examine critical perspectives and problems with current technology and COVID-19 prevention efforts.

Results

In total, 243 participants with mean age of 29.66 ± 7.61 years agreed to participate and were doctors (n = 27), health assistants (n = 2), medical intern doctors (n = 1), paramedical (n = 139), pharmacy (n = 1), and paramedical interns (n = 73) in this study. The calculated mean percentage score of knowledge on instruments and tools was 73.64 (SD ± 10.43) %, and perception on COVID-19 transmission and control was 70.06 (SD ± 18.30) %. At various levels, frontline health workers faced significant challenges, including the adoption of digital health technology.

Conclusion

Frontline HCPs are anticipated to have updated knowledge from what the study has outlined. It is recommended to follow national guidelines. Policies should be put in place so that every frontline worker can demonstrate high standards in prevention, control, and equipment use that do not create misinformation among HCPs. Throughout, support for digital health materials and disease control methods for HCPs is essential.

Epidermoid Cyst of the Ear Lobule in Adult

An epidermoid cyst is one of the most common benign cysts of the skin. The cyst is filled with keratin flakes and its wall is composed of keratinized, stratified, squamous epithelium. Epidermoid cysts can occur anywhere on the body, usually along the lines of embryonic fusion and mostly on the face, scalp, neck, chest, and upper back. Around 80% of the epidermoid cysts are seen in ovaries and testicles whereas, in the head and neck, they account for only about 7% and 1.6% of epidermoid cysts are reported in the oral cavity. The condition can be congenital or acquired. Congenital causes are rare and may be caused by the entrapment of ectodermal elements intradermally or subcutaneously during embryogenesis. Acquired causes of an epidermoid cyst may result from traumatic or iatrogenic implantation of epithelial cells into the dermal layer or from obstruction of a pilosebaceous unit in the hair follicle. Surgical excision completes the treatment.

Knowledge and awareness-based survey of COVID-19 within the eye care profession in Nepal: Misinformation is hiding the truth

BACKGROUND

Nepal was under a severe lockdown for several months in 2020 due to the COVID-19 pandemic. There were concerns regarding misinformation circulating on social media. This study aimed to analyse the knowledge and awareness of COVID-19 amongst eye care professionals in Nepal during the first wave of the pandemic.

METHODOLOGY

We invited 600 participants from 12 ophthalmic centres across Nepal to complete a qualitative, anonymous online survey. Altogether, 25 questions (both open and closed-ended) were used. An overall performance score was calculated from the average of the 12 "Knowledge" questions for all the participants.

RESULTS

Of the 600 eye care professionals invited, 310 (51%) participated in the survey. The symptoms of COVID-19 were known to 94%, whilst only 49% of the participants were aware how the disease was transmitted, with 54% aware that anyone can be infected with SARS-CoV-2. Almost 98% of participants recognized the World Health Organization's (WHO) awareness message, but surprisingly, 41% of participants felt that consumption of hot drinks helps to destroy the virus, in contradiction to WHO information. Importantly, 95% of the participants were aware of personal protective equipment (PPE) and what the acronym stands for. Social distancing was felt to be key to limiting the disease spread; whilst 41% disagreed that PPE should be mandatory for eye care practitioners. The mean overall "Knowledge" performance score was 69.65% (SD ± 22.81).

CONCLUSION

There is still considerable scope to improve the knowledge of COVID-19 amongst ophthalmic professionals in Nepal. Opinion is also split on measures to prevent transmission, with misinformation potentially fuelling confusion. It is recommended to follow WHO and national guidelines, whilst seeking published scientific evidence behind any unofficial statements, to accurately inform one's clinical practice.

Activin and inhibin signaling: From regulation of physiology to involvement in the pathology of the female reproductive system

Activins and inhibins - comprising activin A, B, AB, C and E, and inhibin A and B isoforms - belong to the transforming growth factor beta (TGFβ) superfamily. They regulate several biological processes, including cellular proliferation, differentiation and invasiveness, to enhance the formation and functioning of many human tissues and organs. In this review, we have discussed the role of activin and inhibin signaling in the physiological and female-specific pathological events that occur in the female reproductive system. The up-to-date evidence indicates that these cytokines regulate germ cell development, follicular development, ovulation, uterine receptivity, decidualization and placentation through the activation of several signaling pathways; and that their dysregulated expression is involved in the pathogenesis and pathophysiology of the numerous diseases, including pregnancy complications, that disturb reproduction. Hence, some of the isoforms have been suggested as potential biomarkers and therapeutic targets for the management of some of these diseases. Tackling the research directions highlighted in this review will enhance a detailed comprehension and the clinical utility of these cytokines.

Sex Predictability by Using Mandibular Canine Index

BACKGROUND

Canines are known for their higher resistance to trauma and pathological alterations when compared to other teeth. Among all the teeth, canines show highest sexual dimorphism.

METHODS

This descriptive cross-sectional study was commenced from January 2019 to April 2019 after the ethical approval from Institutional Review Committee. The maximum mesio-distal widths of right and left mandibular canines and mandibular inter-canine arch width were measured on the cast with the help of a divider and digital vernier callipers. Mandibular canine index was calculated by dividing the mesio-distal width of each mandibular canine with inter-canine arch width. Data was entered and analyzed using Statistical Package for the Social Sciences version 21.

RESULTS

Sex predictability by using mandibular canine index in the present study showed poor sex predictability (57.5% - 62.5%).

CONCLUSIONS

Sex determination should be done by other methods and mandibular canine index should be used cautiously in Nepalese population.

Prevalence of glue-sniffing among street children

Aim

The aim was to determine the prevalence of glue-sniffing among street children.

Design

A descriptive cross-sectional study design was adopted.

Background

Children are the source of hope and could be the major ailments for the development of society, nation and the world but there are large numbers of children on the street sniff glue and struggling with multiple disease and uncertain future.

Methods

A study was conducted in 52 street children to determine the prevalence of glue-sniffers and its impact on street children in Butwal, municipality of Nepal. This study was conducted in 52 street children, 5- point Likert scale and interview schedule was performed with the help of structured and semi-structured questionnaire to collect data. Finally, the collected data are analysed by using descriptive statistical methods such as frequency, percentage and mean.

Results

The study findings revealed that a large number of children, that is 40.38% was between the age group of 9-12 years and 92.31% were male. The current prevalence of glue-sniffing among street children is 88.46%. Similarly, 58.7% of respondents had started glue-sniffing 1 year ago. Out of 46 respondents who sniffed glue, 89.13% were unaware of its effect. Nearly, half of the respondents 45.65% had encountered health issues such as headache, chest pain and stomach ache.

Conclusions

They have deprived children and denied not only of their rights as children but also of their normal childhood. Without guidance, education and security, they are heading towards an uncertain future. They can have enough potentiality and talent if they are brought into a better environment and might have real hope for the bright future.

Prevalence of Selected Non-Metric Dental Traits in Indo-Nepalese and Tibeto-Nepalese Ethnic Groups of Western Hilly Region

Introduction:

Additional anatomic features present on teeth are called non-metric dental traits. Carabelli’s cusp and shovelling are such traits which are mostly evaluated for identification of ethnicity. The present study aims to determine the prevalence of Carabelli’s cusp and shovelling among Indo-Nepalese and Tibeto-Nepalese ethnic group.

Methods:

A descriptive cross-sectional study was conducted in a tertiary hospital from March 22 to June 22 2019 after obtaining ethical approval from the institutional review committee. The study was conducted among 274 patients and convenient sampling method was applied. Data were analyzed by the help of Statistical Package for Social Sciences version 21.

Results:

Among 274 cases, 153 (55.84%) cases were Indo-Nepalese and 121 (44.16%) were Tibeto-Nepalese. Carabelli’s cusp (16/26) was noticed in 87 (56.86%) of Indo-Nepalese and 45 (37.19%) of Tibeto-Nepalese. Shovelling (11, 12, 21, 22) was present in 47 (30.71%) Indo-Nepalese and 79 (65.28%) of Tibeto-Nepalese. Further, Carabelli’s cusp (16/26) was found in 77 (53.10%) females and 55 (55.12%) males. Shovelling was present in 75 (51.72%) females and 51 (39.53%) males. Bilateralism with respect to Carabelli’s cusp was present in 82 (62.2%) cases. Presence of bilateral shovelling on upper central incisors and lateral central incisors were among 117 (94.35%) and 56 (91.80%) respectively.

Conclusions:

Carabelli’s cusps are frequently found in Indo-Nepalese ethnic group and shovelling of teeth most commonly present in Tibeto-Nepalese population. Further, bilaterism for shovelling of teeth is more common than bilaterism for cusp of Carabelli.

Hand Index- A Forensic Tool for Sexual Dimorphism

Introduction: Amongst the various parameters of identification, sex is one  of the most important elements. Figuring out hand index from measurement of hand dimensions is a convenient way to determine sexual dimorphism. This study aims to find out sexual dimorphism from hand dimensions, obtain cut off points for male and female and check percentage accuracy of sex determination from hand dimensions in Nepalese population. Methods: The data was collected from 400 asymptomatic, healthy working staffs  (229 males & 171 females) above 23 years  in the department of Forensic Medicine and Toxicology of a tertiary care center of Western  Nepal. Measurements of  hand length and hand breadth were taken using standard instruments and hand index was calculated therefrom. Results: The mean (+SD) right hand lengths for male and female were found to be 17.87 cm (+0.87) and 16.93cm (+0.58) respectively. The mean (+SD) left hand lengths for male and female were 17.85 cm (+0.86)and 16.97 cm (+0.56)respectively. The average hand breadth for male was 1.00 cm greater for right hand and 0.96 cm greater for left hand as compared to female hand breadth. Differences in length and breadth of hands for both sexes were statistically significant (p<0.001) with no statistically significant difference of hand dimensions in the same sex. Cut off point for right hand index was found to be 42.32 cm and for left hand, 42.30 cm. Conclusion: Hand dimensions and hand index can be reliably used to determine sex in medicolegal cases, especially where isolated hand is obtained.

Impact of Iron Status on Thyroid Function: A Community Based Cross-Sectional Study in Eastern Nepal

Background: Iron deficiency is the most common nutritional deficiency in the world. The relation between thyroid hormones and iron status is bidirectional. The aim of this study was to assess iron nutrition status and evaluate its relationship with thyroid hormone profile among children of Eastern Nepal. Methods: A  community based cross-sectional study was conducted in eastern Nepal. A total of 200 school children aged 6-12 years were recruited after taking informed consent from their guardians. Blood samples were collected and assayed for free thyroid hormones (fT3 and fT4), thyroid stimulating hormone (TSH), serum iron, total iron binding capacity (TIBC) concentration and percentage transferrin saturation was calculated. Results: The mean serum iron and TIBC was 74.04 µg/dl and 389.38 µg/dl respectively. The median transferring saturation was 19.21%. The overall prevalence of iron deficiency (Transferrin saturation < 16%) was 34% (n=68). The mean concentration of fT3 and fT4 was 2.87 pg/ml and 1.21 ng/dl respectively, while the median TSH concentration was 3.03 mIU/L. Median TSH concentration in iron deficient group (3.11 µg/dl) and iron sufficient group (2.91 µg/dl) was not significantly different. Among iron deficient children 5.9% had   subclinical hypothyroidism (n=4). Iron status indicators were not significantly correlated with thyroid profile parameters in the study population. Conclusions: The prevalence of iron deficiency is high and iron   deficiency does not significantly alter the thyroid hormone profile in the study region.

Estimation of Height from Foot Dimensions

Introduction: Height determination by measuring various body parts is of value in medicolegal investigations as well as in anthropology. The current study was conducted to analyze interrelation between foot dimensions and stature, and to predict stature from foot dimensions. Methods: The study was done in medical students where stature, foot length, and foot breadth were quantified using standard instruments. We calculated correlations between variables with correlation test and predicted stature from foot length and foot breadth using linear regression. Results: The correlation between foot length and stature, and foot breadth and stature were statistically significant in both gender (p < 0.05). Greater correlation coefficient between foot length and stature than that for foot breadth and stature indicated stronger correlation between foot length and stature. Separate formulae were drawn for calculation of stature from foot breadth and foot length by regression analysis. Conclusion: Both foot breadth and foot length were correlated with stature. Foot length was found to be a better predictor of stature.

Excision of choledochal cyst in children by Roux-en-Y hepaticojejunostomy

<p>The aim of this study was to review our experience of total excision with Roux-en-Y hepatico-jejunostomy for the surgical management of type I and type IVa choledochal cysts in 30 children. Among them, 22 were in type I and 8 in type IVa choledochal cysts. All had complete excision and Roux-en-Y hepaticojejunostomy with no morality. Morbidity consisted of prolong drainage (n=2) and late onset cholangitis/pancreatitis (n=4). Choledochal cyst generally has an excellent prognosis with early complete excision and Roux-en-Y hepaticojejunostomy.</p>

Dotting the Three I's for collaborative TB-HIV activities: evaluation of a pilot programme in Kathmandu, Nepal

Setting: The three government tertiary care hospitals providing care for people living with the human immunodeficiency virus (PLHIV) in Kathmandu, Nepal. Objectives: To assess 1) the screening cascades for intensified case finding for tuberculosis (TB), 2) isoniazid preventive therapy (IPT), including demographic and clinical factors associated with treatment interruption, and 3) TB infection control (IC) in the health facilities. Design: A cross-sectional study of new PLHIV enrolled from January 2012 to December 2014. Results: Among 572 registered PLHIV, 91% were on antiretroviral therapy. Of those registered, 561 (98%) were screened for TB and 73 (13%) were diagnosed with TB (17 [25%] sputum smear-positive, 17 [25%] smear-negative and 35 [51%] extra-pulmonary). Among the 488 (87%) PLHIV without active TB, 157 (32%) were initiated on IPT, of whom 136 (87%) completed treatment and 17 (11%) interrupted treatment. Those who experienced adverse events were 12 times more likely to interrupt IPT. TB IC showed gaps in personal control measures and supporting structures and policies. Conclusion: The implementation of the Three I's for collaborative TB-HIV activities in pilot sites in Nepal was successful and should be scaled up.

Amplitude of low-frequency fluctuation (ALFF) and fractional ALFF in migraine patients: a resting-state functional MRI study

AIM

To evaluate the amplitude of low-frequency oscillations (LFOs) of the brain in migraine patients using amplitude of low-frequency fluctuation (ALFF) and fractional ALFF in the interictal period, in comparison to healthy controls (HCs).

MATERIALS AND METHODS

A total of 54 subjects, including 30 migraineurs and 24 gender- and age-matched HCs completed the fMRI. All the data and ALFF, fALFF analyses were preprocessed with the Data Processing Assistant for Resting-State fMRI (DPARSF). All of the statistical analyses were performed using the REST software to explore the differences in ALFF and fALFF between migraine patients and HCs.

RESULTS

In contrast to HCs, migraine patients showed significant ALFF increase in the left medulla and pons, the bilateral cerebellum posterior lobe and right insula. The regions showing decreased ALFF in migraine patients included the bilateral cerebellum posterior lobe, left cerebellum anterior lobe, bilateral orbital cortex, right middle frontal gyrus, bilateral occipital lobe, right fusiform gyrus, and bilateral postcentral gyrus. The fALFFs in migraine patients were significantly increased in the bilateral insular and left orbital cortex, but were decreased in the left occipital lobe and bilateral cerebellum posterior lobe.

CONCLUSION

These ALFF and fALFF alterations in the brain regions of migraineurs are in keeping with the domains associated with pain and cognition. Such brain functional alteration may contribute to further understanding of migraine-related network imbalances demonstrated in previous studies.

Correlation of Computed Tomography findings with Glasgow Coma Scale in patients with acute traumatic brain injury

OBJECTIVE To correlate Computed Tomography (CT) findings with Glasgow Coma Scale (GCS) in patients with acute traumatic brain injury attending in Chitwan Medical College teaching hospital Chitwan, Nepal.MATERIALS AND METHODS A cross-sectional study was performed among 50 patients of acute (less than24 hours) cases of craniocerebral trauma over a period of four months. The patient’s level of consciousness (GCS) was determined and a brain CT scan without contrast media was performed. A sixth generation General Electric (GE) CT scan was utilized and 5mm and 10mm sections were obtained for infratentorial and supratentorial parts respectively.RESULT The age range of the patients was 1 to 75 years (mean age 35.6± 21.516 years) and male: female ratio was 3.1:1. The most common causes of head injury were road traffic accident (RTA) (60%), fall injury (20%), physical assault (12%) and pedestrian injuries (8%). The distribution of patients in accordance with consciousness level was found to be 54% with mild TBI (GCS score 12 to 14), 28% with moderate TBI (GCS score 11 to 8) and 18% with severe TBI (GCS score less than 7). The presence of mixed lesions and midline shift regardless of the underlying lesion on CT scan was accompanied by lower GCS.CONCLUSION The presence of mixed lesions and midline shift regardless of the underlying lesion on CT scan were accompanied with lower GCS. Patients having single lesion had more GCS level than mixed level and mid line shift type of injury.Journal of College of Medical Sciences-Nepal, 2014, Vol.10(2); 4-9

Drug dosage adjustment of patients with impaired renal function at hospital discharge in a teaching hospital

BACKGROUND

Inappropriate dosing and the risk of toxicities are common with the patients with impaired renal function. Therefore, appropriate dosing is obligatory to prevent the drug toxicities. The present study was performed to investigate the appropriateness of dosage adjustment of the drugs that are toxic to kidney and/or metabolized or eliminated (TEM) by kidney.

METHODS

A retrospective study was performed at the time of hospital discharge in the patients with impaired renal function. All patients with renal clearance ≤50 ml/min/1.73 m² were included for the analysis. Data with respect to patient's clinical, medications and their dosages, laboratory findings were extracted from medical record section.

RESULTS

At discharge, there were a total of 848 prescribed drugs in 116 impaired renal function patients. Of them 404 were classified as TEM medication. Dose adjustment according to renal function was judged as necessary in 135 TEM medications and 28 were deemed to be used with caution. Among these, 108 (80% of 135) medications were considered appropriate in dosing, whereas 27 (20%) were inappropriate. Total 14 (10.37%) and 13 (9.63%) times of inappropriate dosing were found in those with moderate and severe renal impairment, respectively. The frequency of inappropriate dosing was not significantly different from moderate than that of the severe renal impairment (p > 0.05).

CONCLUSIONS

The results of the study demonstrated that dosage adjustment of TEM drugs in patients with impaired renal function is less than optimum in a considerable number of patients at hospital discharge. Awareness raising and monitoring system for inappropriate dosing is critical to improve the quality of care in patients with renal dysfunction.

Maxillary anterior teeth dimensions and proportions in a central mainland chinese population

OBJECTIVES

To obtain maxillary anterior tooth dimension and proportion values for the Central Chinese population and to evaluate the existence of sexual dimorphism, any consistent relationships between the tooth ratios, and the presence of golden proportions.

METHODS

Tooth dimensions and proportions of six maxillary anterior teeth were recorded on gypsum casts obtained from 147 subjects (82 women and 65 men). Of these, 115 casts were digitally photographed in a standardised manner and apparent width values for six maxillary anterior teeth were recorded for golden proportion analysis. Existence of sexual dimorphism, any consistent width/height ratio and golden proportions were statistically analysed. One-sample t-test, two-sample t-test, and paired t-test were used to analyse the data.

RESULTS

There were no significant differences between measurements on the right and left side. Sexual dimorphism existed for various tooth dimensions. There was no statistically significant difference for width/height ratios between the two genders for central incisor and lateral incisor. However, canines showed a statistically significant difference. The golden proportion guideline was not applicable for this population.

CONCLUSION

The maxillary anterior teeth dimensions were significantly greater for men than women; however, the mean difference was small (< 0.2 mm) and may not be clinically significant. The golden proportion, or any recurring anterior teeth proportions, was not found for the population. There was a significant difference in width/height ratio of canines between the genders, confirming its greatest gender-based morphological difference.

Seroprevalence of brucellosis in different animal species of Kailali district, Nepal

Introduction: Brucellosis is a contagious disease of livestock with significant economic impact. It is also a zoonotic disease, highly infectious for humans causing a disease called undulant fever or Malta fever. This study was carried out to determine the sero-status of Brucella spp. infection in cattle (cows), buffalo and goat in Kailali district of Far Western Region of Nepal. Materials and Methods: This cross-sectional study was conducted in Kailali district of Nepal during a period from September, 2012 to January, 2013. A total of 233 animal blood samples (50 Cattle, 67 Buffalo and 116 Goat) were collected and tested for Brucella antibody by plate agglutination test (PAT). Results: The seroprevalence of Brucellosis was 12% (28/233). Thirty two percentage (16/50) of cattle, 13.4% (9/67) of buffaloes, and 2.6% (3/113) goats were sero positive (p<0.05). Seroprevalence was higher in females (14.6% vs. 10.6%) (P>0.05) and was higher in younger cattles and older buffalo and goats (p>0.05). Conclusions: This study showed that brucellosis exists as a potential threat in animals of Kailali district. This could be a potential source of infection to humans. Considering the high economic losses it can impart on livestock sector and the possible human health abnormalities, timely facilitation of awareness generation program and adoption of proper prevention and control strategies are recommended. DOI: http://doi.dx.org/10.3126/ijim.v2i1.8005 Int J Infect Microbiol 2013;2(1):22-25