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Background and objectivesCardiovascular diseases (CVDs) are main cause of mortality and morbidity among women globally. Menopause, aging and different factors in collaboration leads to increased risk for CVDs among postmenopausal women but study on risk factors of CVDs among postmenopausal women is limited in Nepal. Therefore, we aimed to assess prevalence of behavioural and metabolic risk factors of cardiovascular disease among post-menopausal women.Materials & methodsCommunity based cross-sectional study was carried among 390 post-menopausal women of the Itahari sub-metropolitan city. Multistage simple random sampling technique was used to collect data. Modified semi structured questionnaire STEP I, STEP II and STEP III was used as data collection tool. SPSS version 11.5 used for data analysis. Chi-square test and logistic regressions were performed at 95% confidence interval to find predictors of raised blood pressure and overweight/obesity.ResultsThe mean age of respondents was 63.37 years. The prevalence of current smokers, current alcohol use, less than 5 servings of fruits and vegetables per day, low level of physical activity, overweight/obesity and raised blood pressure was 9.2%, 18.2%, 86.4%, 52.3%, 56.2% and 44.4% respectively. On multivariate analysis strong predictors of overweight obesity were age ≤59 years (AOR: 3.21, CI 1.49-6.89), poor economic status (AOR: 1.764, CI: 1.120-2.779) and low physical activity (AOR: 2.132, CI: 1.350-3.370). Predictors of raised blood pressure were age ≥75 years (AOR: 2.04, CI: 1.01-4.11), unmarried and widow (AOR: 1.815, CI: 1.108-2.971), higher economic status (AOR: 1.752, CI: 1.119-2.740) and smoking (AOR: 4.109, CI: 1.737-9.718).ConclusionPrevalence of behavioural and metabolic risk factors among postmenopausal women in Itahari sub-metropolitan city were alarmingly high. This calls for an early need of intervention and policies at local, provincial and institutional level to address risk factors of CVDs.

Sulfur is one of the essential nutrients that is required for the adequate growth and development of plants. Sulfur is a structural component of protein disulfide bonds, amino acids, vitamins, and cofactors. Most of the sulfur in soil is present in organic matter and hence not accessible to the plants. Anionic form of sulfur (SO42−) is the primary source of sulfur for plants that are generally present in minimal amounts in the soil. It is water-soluble, so readily leaches out of the soil. Sulfur and sulfur-containing compounds act as signaling molecules in stress management as well as normal metabolic processes. They also take part in crosstalk of complex signaling network as a mediator molecule. Plants uptake sulfate directly from the soil by using their dedicated sulfate transporters. In addition, plants also use the sulfur transporter of a symbiotically associated organism like bacteria and fungi to uptake sulfur from the soil especially under sulfur depleted conditions. So, sulfur is a very important component of plant metabolism and its analysis with different dimensions is highly required to improve the overall well-being of plants, and dependent animals as well as human beings. The deficiency of sulfur leads to stunted growth of plants and ultimately loss of yield. In this review, we have focused on sulfur nutrition, uptake, transport, and inter-organismic transfer to host plants. Given the strong potential for agricultural use of sulfur sources and their applications, we cover what is known about sulfur impact on the plant health. We identify opportunities to expand our understanding of how the application of soil microbes like AMF or other root endophytic fungi affects plant sulfur uptake and in turn plant growth and development.

Accessory axillary breast carcinoma is unusual, with an incidence of 0.2 to 0.6%. It is commonly located in the axilla; however, it may be seen anywhere along the milk line. Development is hormone-dependent, similar to normal breast tissue. Here, a 65-year-old postmenopausal multiparous woman presented at the Surgery Outpatient Department (OPD) with a complaint of a lump in her left axilla with multiple overlying skin ulcers for the past four months. A routine bilateral mammogram was performed, which showed a well-defined hypoechoic area measuring 1.2×1.0 cm with no lymph nodes and calcification over the left accessory breast tissue. A wedge biopsy of the lesion revealed Invasive Ductal Carcinoma (IDC). She underwent a left modified radical mastectomy with an extended incision to the left axilla. She also received neoadjuvant chemotherapy with close follow-up. Recent studies suggest that there is no additional advantage with mastectomy over total excision of accessory breast tissue. Axillary clearance is performed if preoperative lymph node biopsy is positive. Early diagnosis and differentiation of accessory breast cancer are the keys to the effective management of the cancer.

For the smeared approximation of a discrete crack, phase-field fracture simulations of brittle materials require suitable finite element meshes in regions where crack propagation is expected to get an accurate resolution of the phase-field function. The straightforward option is to pre-refine the mesh in regions of the expected crack paths. However, this could lead to very computationally intensive simulations due to the high number of elements. Alternatively, adaptive spatial refinement of the finite element mesh is utilized based on appropriate error indicators to obtain the required accuracy in the areas of crack propagation. Different error indicators can be used: the most common one for phase-field fracture simulations is the threshold-based approach, in which elements are refined depending on the value of the phase-field function. Alternatively, the Kelly error indicator can be used as a criterion for spatial adaptivity. It considers the jumps in the gradients of the phase-field function between the elements. We additionally introduce here an error indicator based on configurational forces, that depend on the Eshelby stress tensor. For mode I loading in linear elastic fracture mechanics, the configurational forces have a close connection to the J-Integral and the critical fracture energy Gc, respectively. Therefore, a suitable norm of the configurational forces is introduced as an error indicator here. These three error indicators are introduced and compared to each other in terms of accuracy and efficiency by means of numerical examples for crack growth in the single edge notched shear test.

Introduction: Bicipital Groove (BG) represents an indentation on the proximal humerus which lodges tendon of Long Head of Biceps (LHB) brachii with synovial sheath. It’s medial and lateral walls are formed by lesser and greater tubercles respectively and the transverse humeral ligament converts it into a tunnel. Aim: To find a detailed morphometry attributing to morphological classification of BG among North Indian population. Materials and Methods: The present observational study was conducted over a period of one year on 100 adult intact dry humerii of unknown sexes obtained from Osteology Museum, Department of Anatomy, Shree Guru Gobind Singh Tricentenary (SGT) University, Gurugram, Haryana, India for several morphometric parameters like length, width, depth, length of medial and lateral walls as per descriptive statistics using Statistical Package for the Social Sciences (SPSS) version 21.0. The BG was classified according to the depth, opening angle and medial wall angles. Morphological features like Supratubercular Ridge (STR) of Meyer’s, bony spur on the floor of the groove or thickening of the walls were also observed and the frequency distribution was presented and Independent t-test was applied to compare the parameters on both sides. Results: Out of 100 sample, the mean of each parameter was length 72.98±7.54 mm, width 9.12±2.18.mm, depth 5.49±1.56 mm, medial wall and lateral wall length 54.83±8.62 mm and 60.82±8.01 mm respectively, opening angle 72.27±18.12º and medial angle 65.27±10.71º. Mostly BG had a depth of 4-6 mm with an incidence of 48%. Opening angle of BG was small (

The superiority of nanosized filler particles in improving the elastic and fracture behavior of polymers, in comparison to microsized inclusions, has been substantiated by several experimental observations. Accurate modeling of crack propagation in such heterogeneous materials, however, involves resolution of complex crack topologies while taking into account the coalescence and branching of multiple cracks. Such complexity renders the traditional sharp crack modeling approaches, such as those based on the idea of partition of unity, to be of limited suitability, especially in 3D, since these involve explicit tracking of the evolving crack surfaces. Consequently, phase-field fracture approaches have come up as an attractive alternative to the traditional sharp crack models, especially when complex crack topologies need to be handled. Furthermore, standard two-phase continuum models, owing to their lack of the necessary length scale, are unable to capture the previously mentioned smaller is stronger size effect. In order to remedy this shortcoming, in context of finite strain hyperelasticity, a graded interphase based enhancement of the standard first-order continuum model was introduced in our previous work. The present contribution extends the idea of graded interphases to the phase-field fracture approach. Herein, an interphase region around filler particles, as observed experimentally, having continuously varying or graded material properties is considered. Fracture behavior of the composite material can be controlled by means of the degree of grading employed in determining the elastic and fracture properties within the interphase region. An optimal combination of the graded interphase parameters yields a tougher macroscopic response, as observed in case of tougher interphases, in comparison to the one obtained with a standard phase-field fracture model, The appropriateness of the introduced technique for modeling a wide spectrum of experimentally observed fracture behaviors, depending upon the degree of adhesion between the filler and the matrix phases, is depicted by means of extensive numerical experimentation.

Objective: Family history is a significant risk factor for development of breast cancer, particularly for women of first-degree relatives. For women at high risk for breast cancer, regular screening is the mainstay of risk management. This study aims to find out the breast cancer screening practices among first degree relatives of breast cancer patient. Methods: A cross-sectional study was carried out among 150 purposively selected first-degree female relatives of breast cancer patients undergoing treatment at B.P Koirala Memorial Cancer Hospital, aged between 20 and 60 years. A semi-structured questionnaire was used to collect data by face to face interview, which included socio-demographic characteristics, personal history, awareness on breast cancer and screening practices. Results: The mean age of the participants was 37.6 years (SD 10.9). A total of 116 (77.3%) women had ever practiced breast self-examination (regular=34.7%; irregular= 42.7%) and 42 (28.0%) had ever practiced clinical breast examination (regular=14.7%; irregular=13.3%). Only 10 percent of the women had performed mammogram regularly. Only two-fifth of them had a high level of awareness on risk factors and warning signs of breast cancer. Conclusions: This study showed a low rate of regular screening practices among the first degree relatives of breast cancer patients. There is a need to provide comprehensive, and inclusive information and support and interventions aimed at increasing awareness of the importance of healthy behaviors in cancer prevention among these high-risk groups.

Nepal has witnessed demographic and epidemiological transition resulting in the shift from infectious diseases to non-communicable diseases as the major disease burden. Around 60% of mortalities and morbidities are attributable to non-communicable diseases of which the majority end with the need for palliative care services. The current palliative care services in Nepal are in the infancy stage compared with other services. Undignified dying is a challenging public health problem and as such requires a public health approach to address it with the involvement of all stakeholders. Recognizing the need for the end spectrum of non-communicable diseases patients, the Ministry of Health, Nepal recently introduced the policy to address the unmet need through the community-based palliative care program, a laudable initiation.

Background: The estimation of inter-relationship between various body parameters and stature has been an important tool in anthropometric measurements. It is found to be of great importance in such cases where direct measurement of stature is not possible. A wide variety of parameters are used for estimation of stature including arm spam, hand length, foot length, demi span, knee height, sitting position etc. In this study arm span is used for stature estimation. Aims and Objective: To find the accuracy of arm-span in predicting standing height of both males and females in studied population. Materials and Methods: The study involved 600 participants (300 males and 300 females). The data for study collected from Rajasthan by means of community visits. The standing height and arm-span were measured for each individual and analyzed. Correlation coefficient and regression equation was generated. Results: A positive correlation was found to exist between the arm-span and stature. The correlation coefficient r was found to be 0.9. In the studied population, the arm span was found to be a strong predictor of Stature. Conclusion: It can be concluded that arm-span can be used in estimation of the height of both males and females. Arm span is reliable tool for obtaining the approximate stature of an individual. It can be used for the purpose of medico-legal cases too.

Introduction: Globally, reproductive health and quality of life among female population has been found to be unsatisfactory in developing world. Until 1963, Nepal’s 1854 legal code known as MulukiAin was revised numerous times that banned abortion exempting risk of women’s life. Enactment of New Abortion Policy from 2003 brought landmark reforms to the women’s choice in family planning methods and ended the sufferings of lengthy prison sentences for abortion crimes. This study was conducted to explore the level of awareness about abortion law with regard to health care utilization among women of reproductive age group along with its association with socio-demographic characteristics. Methodology: A cross-sectional study was conducted in March 2014, in Inarwa Municipality among women of reproductive age group (16 to 49 years). Convenient sampling was done to collect data from households. Data was entered and analyzed in SPSS 11.5 and presented in tabular form. Chi-square test was used to show association of awareness of abortion law and socio-demographic variables. Results: education, age at first marriage and age at 1st pregnancy was found to be significant (p value:

Context: Enlargement of osseous tunnels following anterior cruciate ligament (ACL) reconstruction is a newer discovery. This phenomenon is particularly valuable in planning for revision ACL reconstruction. Aim: The purpose of this study was to evaluate prospectively the increase in size of the tibial and femoral bone tunnel following arthroscopic ACL reconstruction with quadrupled hamstring autograft and fixation with biodegradable interference screws. Materials and Methods: A prospective study was conducted on 10 patients who underwent arthroscopic ACL reconstruction with quadrupled hamstring autograft and fixation with biodegradable interference screws. Tunnel width was measured at postoperative 2 weeks and an average of 1-year follow-up (range: 10–13 months). Clinical evaluation was done as per the International Knee Documentation Committee form. Paired Student's t-test and linear regression were used for statistical analysis. Results: There was a mean 14% enlargement in the femoral tunnel (from 9 mm at postoperative 2 weeks to 10.3 mm at postoperative 1 year) and 18% enlargement in the tibial tunnel (from 10.4 mm at postoperative 2 weeks to 12.2 mm at the postoperative 1-year follow-up). Both of these were statistically significant (P = 0.005 for femoral tunnel enlargement and P = 0.008 for the enlargement of the tibial tunnel). No statistically significant association was noted between tunnel enlargement and clinical results. Conclusion: Compared to previous similar studies, less tunnel widening was observed in the present study. We come to a conclusion that less aggressive rehabilitation program and anatomical graft fixation technique can help achieve the goal of minimum tunnel enlargement after ACL reconstruction.

Abstract Background Depression is the most common form of mental disorder among inmates, with a prevalence much higher than in the general population. This study aims to estimate the prevalence of depression among inmates and identify factors associated with it. Methods This cross-sectional study was conducted in Jhumka Regional Prison, the largest prison in eastern Nepal, from September 2014 to August 2015. A total of 434 randomly selected inmates were interviewed using a semi-structured questionnaire examining socio-demographic characteristics, detention status, self-reported health problems, substance use status, and suicidal ideation. Depression was screened using the Center for Epidemiologic Studies Depression scale. Chi-square tests and multiple logistic regression analysis were applied to determine the association between depression and related variables. Results The mean age of the participants was 35.7 years (SD 13.3). The prevalence of depression among the inmates was 35.3%. Approximately 2.3% reported suicidal ideation during imprisonment and 0.9% had attempted suicide inside the prison. In bivariate analysis, depression was significantly associated with previous incarceration (OR = 1.91, 95% CI = 1.05–3.47, p = 0.033), poor self-rated health (OR = 1.75, 95% CI = 1.16–2.64, p = 0.007), frequent appointments when encountering health problems (OR = 1.66, 95% CI = 1.06–2.61, p = 0.028), suicidal ideation (OR = 4.44, 95%CI = 1.13–17.44, p = 0.038) and loss of weight (OR = 1.49, 95% CI = 1.00–2.23, p = 0.049). However, only previous incarceration (AOR = 1.97, 95% CI = 1.04–3.74, p = 0.037) and frequent appointments when encountering health problems (AOR = 1.61, 95% CI = 1.01–2.57, p = 0.046) remained significant in a multivariate model. Conclusions This study showed a high rate of depression among inmates in Nepal. The results suggest a need for psychiatric and rehabilitative care in correctional settings to improve the health status of the inmates.

Abstract Hydrogen sulfide (H2S), a cardioprotective gas, is endogenously produced from homocysteine by cystathionine beta synthase (CBS) and cystathionine gamma lyase (CSE) enzymes. However, effect of H2S or homocysteine on CBS and CSE expression, and cross-talk between CBS and CSE are unclear. We hypothesize that homocysteine and H2S regulate CBS and CSE expressions in a dose dependent manner in cardiomyocytes, and CBS deficiency induces cardiac CSE expression. To test the hypothesis, we treated murine atrial HL1 cardiomyocytes with increasing doses of homocysteine or Na2S/GYY4137, a H2S donor, and measured the levels of CBS and CSE. We found that homocysteine upregulates CSE but downregulates CBS whereas Na2S/GYY4137 downregulates CSE but upregulates CBS in a dose-dependent manner. Moreover, the Na2S-treatment downregulates specificity protein-1 (SP1), an inducer for CSE, and upregulates miR-133a that targets SP1 and inhibits cardiomyocytes hypertrophy. Conversely, in the homocysteine-treated cardiomyocytes, CBS and miR-133a were downregulated and hypertrophy was induced. In vivo studies using CBS+/−, a model for hyperhomocysteinemia, and sibling CBS+/+ control mice revealed that deficiency of CBS upregulates cardiac CSE, plausibly by inducing SP1. In conclusion, we revealed a novel mechanism for H2S-mediated regulation of homocysteine metabolism in cardiomyocytes, and a negative feedback regulation between CBS and CSE in the heart.

Context: Oncosurgery is an emerging branch with the set goals of prolonging the life and ensuring the best possible quality of life to the surviving patient. The use of harmonic scalpel has proved to be beneficial in a variety of surgeries but its role in breast surgery is still controversial. Aims: We conducted this study to compare the intraoperative and postoperative outcomes in modified radical mastectomy using harmonic scalpel versus electrocautery. Subjects and Methods: Fifty female patients with confirmed diagnosis of breast carcinoma and planned for modified radical mastectomy were taken up for surgery. Twenty-five patients were operated using harmonic scalpel (Group A) and another 25 were operated using unipolar cautery (Group B). Results: The mean operative time was significantly longer with harmonic scalpel when compared to that with electrocautery (140.40 ± 29.96 vs. 99.80 ± 24.00 min, P< 0.001). The smaller amount of drainage content (431.60 ± 145.94 vs. 594.20 ± 278.63, P = 0.013) and intraoperative blood loss (426.00 ± 76.54 vs. 502.00 ± 104.56, P = 0.005) in the group operated with the ultrasound harmonic scalpel was statistically significant. There was no significant difference between the groups with regard to drain duration (5.24 ± 0.97, P = 0.127), seroma (12% vs. 16%, P = 0.684), hematoma (4% vs. 4%, P = 1.000), wound infection (24% vs. 32%, P = 0.529), flap necrosis (8% vs. 28%, P = 0.066), pain intensity (measured on visual analog scale) (5.08 ± 1.29 vs. 5.20 ± 1.68, P = 0.778), and lymphedema (4% vs. 8%, P = 0.552). The length of hospital stay could not be compared effectively because all the patients were discharged on the 10th or 11th postoperative day. The cost of the equipment used in the electrocautery group was almost negligible as compared to the harmonic group. Conclusions: The use of harmonic scalpel versus electrocautery is somewhat advantageous but not cost-effective.

Context: Nonsurgical uses of tranexamic acid include the management of bleeding associated with leukemia, ocular bleeding, recurrent hemoptysis, menorrhagia, hereditary angioneurotic edema, and numerous other medical problems. However, there is hardly any documentation of the use of tranexamic acid in laparoscopic cholecystectomy. Aims: This study was conducted to evaluate the role of tranexamic acid in limiting blood loss in laparoscopic cholecystectomy and to evaluate the effect of blood loss on morbidity in terms of hospital stay and mortality of the patient. Subjects and Methods: The study was conducted on sixty patients admitted with gallstones, candidates for laparoscopic cholecystectomy. Thirty patients received an intravenous 20 mg/kg bolus dose of tranexamic acid at induction of anesthesia (Group A), and another thirty did not receive the aforementioned drug at induction (Group B). Statistical Analysis: The two groups were compared, and the data collected were entered and tabulated using Microsoft Office Excel and analyzed using appropriate statistical tests. Results: The mean postoperative hospital stay (2.4 vs. 2.63, P = 0.4147), drain fluid hemoglobin (Hb) (0.83 vs. 0.90, P = 0.2087), drain fluid hematocrit (0.2434 vs. 0.2627, P = 0.3787), mean drain output (85 vs. 87.23, P = 0.9271), mean pulse rate at the start of surgery (74.2 vs. 75, P > 0.999), mean pulse rate 24 h after surgery (75.9 vs. 76.4, P = 0.5775), and mean change in Hb (0.240 vs. 0.266, P = 0.2502) in both the groups were not significant. Conclusions: There is no active role of tranexamic acid in elective laparoscopic cholecystectomy.

Introduction. The prevalence of Pulmonary Tuberculosis (PTB) is much higher in the prison population than in the general population. This study aims to find out the prevalence of PTB and its associated factors among inmates in eastern Nepal. Methods. This cross-sectional study was conducted in Jhumka Regional Prison, the largest male prison of Eastern Nepal from September 2014 to August 2015. Semi-structured questionnaires were used to identify individuals with a cough more than one-week duration among 434 randomly selected inmates. Screening of PTB was done by sputum smear test and/or GeneXpert test. Prevalence of TB was defined as the number of cases detected during the study period divided by the total number of inmates screened during that period. Fisher’s exact test was used to find out the association of PTB with related variables. Results. A total of 434 inmates were screened for PTB with mean age 35.7 years and body mass index 22.7 kg/m2. A total of 68 inmates had a productive cough of more than a week and two patients were already on anti-tuberculosis therapy at the time of screening. Sixty sputum samples were considered for sputum smear/GeneXpert test and 6 of them (10%) had positive results. The prevalence of TB in the Prison was 1843/100,000 population. Chest pain and abnormal chest auscultation findings were found to be significantly associated with PTB. Conclusions. This study showed that there was a high rate of PTB among inmates in Nepal. The results suggest a need for effective screening of PTB and strategies to improve management including reduction of PTB transmission in the prison.

Background: Understanding of risk factors and developing healthy lifestyles is a way of tackling the surging burden of chronic diseases in low-to-middle income countries such as Nepal. Health literacy (HL) has a pivotal role in prevention, adherence to treatment, self-care, and better use of health care; therefore, factors associated with HL need to be studied in the context of Nepal. Objective: This study was conducted to assess the level of HL and explore disease-specific knowledge among patients with chronic diseases. Methods: A cross-sectional study was conducted among 426 respondents with hypertension, diabetes mellitus, or chronic obstructive pulmonary disease from a tertiary care hospital and primary care clinics using face-to-face interviews. HL was measured using a translated and pretested HL questionnaire (the Europe-Asia Health Literacy Survey Questionnaire). Disease-related knowledge was assessed using a validated questionnaire. Key Results: The study found that 27% of the respondents had sufficient HL, 19% had marginal HL, and 54% had inadequate HL. Factors associated with inadequate HL included being older and female, and having lower or no education, unemployment or retired status, poverty, and having a history of smoking or a history of consuming alcohol. HL was a strong predictor of knowledge regarding hypertension (β = 0.32; p < .05), diabetes mellitus (β = 0.41; p < .05), and chronic obstructive pulmonary disease (β = 0.37; p < .05) in multiple regression analyses after adjusting for age, gender, education, marriage, family history of disease, attendance at follow-up clinics at recommended intervals, information received regarding disease at clinics, smoking, and alcohol intake. Conclusions: A sufficient level of HL was uncommon among participants in our study. People with sufficient HL knew significantly more about their diseases or conditions than those with inadequate HL.

Diabetic cardiomyopathy is a leading cause of heart failure. Developing a novel therapeutic strategy for diabetic cardiomyopathy and characterizing animal models used for diabetes mellitus (DM) are important. Insulin 2 mutant (Ins2+/-) Akita is a spontaneous, genetic, mouse model for T1DM, which is relevant to humans. There are contrasting reports on systolic dysfunction and pathological remodeling (hypertrophy and fibrosis) in Akita heart. Here, we used magnetic resonance imaging (MRI) approach, a gold standard reference for evaluating cardiac function, to measure ejection fraction (indicator of systolic dysfunction) in Akita. Moreover, we performed Wheat Germ Agglutinin (WGA) and hematoxylin and Eosin stainings to determine cardiac hypertrophy, and Masson’s Trichrome and picrosirius red stainings to determine cardiac fibrosis in Akita. MiR-133a, an anti-hypertrophy and anti-fibrosis miRNA, is downregulated in Akita heart. We determined if miR-133a mimic treatment could mitigate systolic dysfunction and remodeling in Akita heart. Our MRI results revealed decreased ejection fraction in Akita as compared to WT and increased ejection fraction in miR-133a mimic-treated Akita. We also found that miR-133a mimic treatment mitigates T1DM-induced cardiac hypertrophy and fibrosis in Akita. We conclude that Akita shows cardiac hypertrophy, fibrosis and systolic dysfunction and miR-133a mimic treatment to Akita could ameliorate them.

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

Teenage pregnancy, which is detrimental to the health of mother and child, is a common public health problem worldwide. It is a problem that affects nearly every society- developed and developing alike. The objective of this study was to find out the prevalence of teenage pregnancy and its impact on birth outcome. The cross-sectional study was conducted among the residents of Dhankuta municipality where 246 households were taken as subjects. Chi-square test was applied to find out the significant difference between socio demographic characteristics and outcome variable i.e. birth outcome & age of 1st pregnancy. About 34.6% of respondents were pregnant at below 20 years of age. The teenage pregnancies decreases as education level increases (p

Introduction: Intestinal obstruction is complete or partial blockage of intestinal tract. The main causes for the obstruction are either mechanical such as adhesions, inflammation, tumours, volvulus, and hernia or nonmechanical such as paralytic ileus, metabolic abnormalities, or mesenteric ischaemia. Abdominal X-rays still hold an important part in the management of this condition. Aim: Administration of gastrografin has been proved to be helpful in diagnosing the site of obstruction and gastrografin acts as a therapeutic agent thus minimizing the need for surgery. Materials and Methods: This study was conducted at the Department of General Surgery, Rajindra Hospital, Patiala, Punjab, India. A total of 60 patients with clinically and radiologically demonstrable features of intestinal obstruction were included in the study. Gastrografin was administered in these patients and improvements, if any, were recorded. Results: Out of 60 patients administered gastrografin, obstruction was completely resolved in 57 (95%). Surgery should be considered if obstruction fails to improve after 48 hours of conservative management. Conclusion: Intestinal obstruction is a very common general surgical problem leading to repeated hospital admissions and significant morbidity and mortality. The most common cause of small bowel obstruction is adhesions. Gastrografin administration is effective in early resolution of obstruction, avoidance of surgery and in turn, a shorter hospital stay. So it has a definite role in the management of intestinal obstruction.

Journal of Nobel Medical College Vol. 2, No.2 Issue 4 May-October 2013 Page 62-67 DOI: http://dx.doi.org/10.3126/jonmc.v2i2.8808

Journal of Nobel Medical College Vol. 2, No.2 Issue 4 May-October 2013 Page 11-17 DOI: http://dx.doi.org/10.3126/jonmc.v2i2.8799

Renal Cell Carcinoma (RCC) is notorious for its unpredictable dissemination patterns involving both lymphatic and haematogenous route without a clear-cut preponderance for any. Unlike other intra-abdominal malignancies like colorectal carcinoma, renal cell carcinoma is often known to metastasize to distant sites even after a confident and unsuspecting curative resection or often as the primary presentation constantly adding and agitating our presentation patterns for this sneaky tumour. Presented below is a case of such an unsuspecting female patient. She was referred from the orthopaedic OPD to surgery OPD with a right clavicular swelling which was histopathologically examined and diagnosed as a metastatic renal cell carcinoma following which she was diagnosed with right renal cell carcinoma.

Elevated expression and activity of matrix metalloproteinase-9 (MMP9) and decreased contractility of cardiomyocytes are documented in diabetic hearts. However, it is unclear whether MMP is involved in the regulation of contractility of cardiomyocytes in diabetic hearts. In the present study, we tested the hypothesis that MMP9 regulates contractility of cardiomyocytes in diabetic hearts, and ablation of matrix metalloproteinase-9 (MMP9) prevents impaired contractility of cardiomyocytes in diabetic hearts. To determine the specific role of MMP9 in cardiomyocyte contractility, we used twelve - fourteen week male WT (normoglycemic sibling of Akita), Akita, and Ins2+/- /MMP9-/- (DKO) mice. DKO mice were generated by cross-breeding male Ins2+/- Akita (T1D) with female MMP9 knockout (MMP9-/-) mice. We isolated cardiomyocytes from the heart of the above three groups of mice and measured their contractility and calcium transients. Moreover, we determined mRNA and protein levels of sarco-endoplasmic reticulum calcium ATPase-2a (SERCA-2a), which is involved in calcium handling during contractility of cardiomyocytes, in WT, Akita, and DKO hearts using qPCR, Western blotting and immunoprecipitation, respectively. Our results revealed that in Akita hearts where increased expression and activity of MMP9 is reported, the rates of shortening and re-lengthening (± dL/dt) of cardiomyocytes were decreased, time to 90% peak height and baseline during contractility was increased, rate of calcium decay was increased, and calcium transient was decreased as compared to WT cardiomyocytes. However, these changes in Akita were blunted in DKO cardiomyocytes. The molecular analyses of SERCA-2a in the hearts showed that it was downregulated in Akita as compared to WT but was comparatively upregulated in DKO. These results suggest that abrogation of MMP9 gene prevents contractility of cardiomyocytes, possibly by increasing SERCA-2a and calcium transients. We conclude that MMP9 plays crucial role in the regulation of contractility of cardiomyocytes in diabetic hearts.

Increasing evidence suggests that a sedentary lifestyle and a high fat diet (HFD) leads to cardiomyopathy. Moderate exercise ameliorates cardiac dysfunction, however underlying molecular mechanisms are poorly understood. Increased inflammation due to induction of pro-inflammatory cytokine such as tumor necrosis factor-alpha (TNF-α) and attenuation of anti-inflammatory cytokine such as interleukin10 (IL-10) contributes to cardiac dysfunction in obese and diabetics. We hypothesized that exercise training ameliorates HFD- induced cardiac dysfunction by mitigating obesity and inflammation through upregulation of IL-10 and downregulation of TNF-α. To test this hypothesis, eight week old, female C57BL/6J mice were fed with HFD and exercised (swimming 1hr/day for 5 days/week for eight weeks). The four treatment groups: normal diet (ND), HFD, HFD + exercise (HFD + Ex) and ND + Ex were analyzed for mean body weight, blood glucose level, TNF-α, IL-10, cardiac fibrosis by Masson Trichrome, and cardiac dysfunction by echocardiography. Mean body weights were increased in HFD but comparatively less in HFD + Ex. The level of TNF-α was elevated and IL-10 was downregulated in HFD but ameliorated in HFD + Ex. Cardiac fibrosis increased in HFD and was attenuated by exercise in the HFD + Ex group. The percentage ejection fraction and fractional shortening were decreased in HFD but comparatively increased in HFD + Ex. There was no difference between ND and ND + Ex for the above parameters except an increase in IL-10 level following exercise. Based on these results, we conclude that exercise mitigates HFD- induced cardiomyopathy by decreasing obesity, inducing IL-10, and reducing TNF-α in mice.

Background. This study was done to assess the maternal and sociodemographic factors associated with low birth weight (LBW) babies. Methods. An unmatched case control study was done involving 159 cases (mothers having LBW singleton babies) and 159 controls (mothers having normal birth weight singleton babies). Results. More than 50% of LBW babies were from the mothers with height ≤145 cm while only 9.43% of NBW babies were from the mothers with that height. Finally, after multivariate logistic regression analysis, maternal height, time of first antenatal care (ANC) visit, number of ANC visits, iron supplementation, calcium supplementation, maternal education, any illness during pregnancy, and hypertension were found as the significant predictors of LBW. However, maternal blood group AB, normal maternal Body Mass Index (BMI), mother’s age of 30 or more years, and starting ANC visit earlier were found to be protective for LBW. Conclusion. Study findings suggest that selectively targeted interventions such as delay age at first pregnancy, improving maternal education and nutrition, and iron and calcium supplementation can prevent LBW in Nepal.

Background and objectives: Cardiovascular diseases (CVDs) are main cause of mortality and morbidity among women globally. Menopause, aging and different factors in collaboration leads to increased risk for CVDs among postmenopausal women but study on risk factors of CVDs among postmenopausal women is limited in Nepal. Therefore, we aimed to assess prevalence of behavioural and metabolic risk factors of cardiovascular disease among post-menopausal women. Materials & methods: Community based cross-sectional study was carried among 390 post-menopausal women of the Itahari sub-metropolitan city. Multistage simple random sampling technique was used to collect data. Modified semi structured questionnaire STEP I, STEP II and STEP III was used as data collection tool. SPSS version 11.5 used for data analysis. Chi-square test and logistic regressions were performed at 95% confidence interval to find predictors of raised blood pressure and overweight/obesity. Results: The mean age of respondents was 63.37 years. The prevalence of current smokers, current alcohol use, less than 5 servings of fruits and vegetables per day, low level of physical activity, overweight/obesity and raised blood pressure was 9.2%, 18.2%, 86.4%, 52.3%, 56.2% and 44.4% respectively. On multivariate analysis strong predictors of overweight obesity were age ≤59 years (AOR: 3.21, CI 1.49–6.89), poor economic status (AOR: 1.764, CI: 1.120–2.779) and low physical activity (AOR: 2.132, CI: 1.350–3.370). Predictors of raised blood pressure were age ≥75 years (AOR: 2.04, CI: 1.01–4.11), unmarried and widow (AOR: 1.815, CI: 1.108–2.971), higher economic status (AOR: 1.752, CI: 1.119–2.740) and smoking (AOR: 4.109, CI: 1.737–9.718). Conclusion: Prevalence of behavioural and metabolic risk factors among postmenopausal women in Itahari sub-metropolitan city were alarmingly high. This calls for an early need of intervention and policies at local, provincial and institutional level to address risk factors of CVDs. [ABSTRACT FROM AUTHOR]

Background: Alcohol‐associated cardiomyopathy (ACM) is a cardiac muscle disease characterized by inflammation and oxidative stress. Thromboxane‐prostanoid receptor (TP‐R) plays an important role in the pathogenesis of cardiovascular disease. Herein, we hypothesize that TP‐R mediates alcohol‐induced early cardiac injury. Methods: Eight‐week‐old male C57BL/6 wild‐type mice were fed a chronic ethanol (ET) or control diet (CON) for 10 days followed by a single binge of ethanol or maltose‐dextrin through oral gavage. A cohort of ethanol‐fed mice received SQ 29,548 (SQ), a TP‐R antagonist. RNA sequencing, real‐time PCR, and western blot analysis were performed on left ventricle to investigate alterations in genes and/or proteins mediating oxidative stress, inflammation, and cardiac remodeling. Sirius Red staining was performed to measure myocardial fibrosis. Results: RNA‐sequencing analysis of myocardium from CON and ET groups identified 142 genes that were significantly altered between the two groups. In particular, the gene expression of thioredoxin‐interacting protein (TXNIP), a component of NLR family pyrin domain containing 3 (NLRP3) signaling, which mediates oxidative stress and inflammatory response, was upregulated in response to ethanol exposure. The myocardial protein levels of TP‐R and thromboxane A2 synthase were increased upon alcohol exposure. Ethanol increased the levels of 4‐hydroxynonenal, a marker of oxidative stress, with a concomitant increase in the protein levels of TXNIP and NLRP3, and administration of SQ attenuated these effects. Additionally, ethanol increased the protein levels of pro‐inflammatory mediators, including tumor necrosis factor alpha and the NLRP3 downstream product, secretory interleukin 1 beta, and SQ blunted these effects. Finally, the Sirius red staining of the myocardium revealed an increase in collagen deposition in ethanol‐fed mice which was attenuated by TP‐R antagonism. Conclusion: This study demonstrates that ethanol promotes the NLRP3 signaling pathway within the myocardium, leading to a pro‐inflammatory milieu that potentially initiates early myocardial remodeling, and TP‐R antagonism attenuates this effect. [ABSTRACT FROM AUTHOR]

Introduction- Thyroid Dysfunction has been associated with type 2 diabetes mellitus (DM-2). However, it is not known whether common complications of DM-2 such as diabetic nephropathy, are also present with Thyroid Dysfunction. Aim- To study the association of Thyroid Dysfunction and diabetic nephropathy in patients with type 2 diabetes mellitus. Methodology-A Hospital based cross-sectional Observational study conducted in Mahatma Gandhi Medical College & Hospital, Jaipur, Rajasthan, India from September 2022 to August 2023 on 100 Patients with DM-2. Results- In present study the prevalence of thyroid dysfunction in DM-2 patients was 21%. In present study the prevalence of Subclinical Hypothyroidism (SCH) in DM-2 was 14%, the prevalence of Overt Hypothyroidism in DM-2 was 4%, the prevalence of Subclinical Hyperthyroidism in DM-2 was 1%, and the prevalence of Overt Hyperthyroidism in DM-2 was 2%. There were significant differences in term of Thyroid status in Diabetes patients with respect to Nephropathy i.e. prevalence of DN is higher in patients of DM with Thyroid dysfunction as compared to patients with euthyroid status (P = 0.027) . Conclusion-Thyroid Dysfunction may be independently associated with Diabetic Nephropathy in Indian patients with type 2 diabetes mellitus. This imply that Thyroid Dysfunction may be a new therapeutic target to prevent the development and progression of Diabetic Nephropathy in DM-2 patients. [ABSTRACT FROM AUTHOR]