Tag: pubmed

Nephrology (Carlton). 2021 Jun 24. doi: 10.1111/nep.13915. Online ahead of print.

ABSTRACT

BACKGROUND: As renin angiotensin system inhibitors (RASi) are widely used in the clinic, early worsening of kidney function (EWKF) after RASi therapy deserves attention, as its clinical significance is unknown. The aim was to evaluate the relationship between EWKF and long-term outcomes including all-cause mortality, kidney and cardiovascular events, in all the patients treated with RASi.

METHODS: We searched PubMed, Embase and the Cochrane databases for controlled trials that compared the outcomes of patients with and without EWKF after RASi treatment. Our primary outcome was all-cause mortality, and secondary outcomes were kidney and cardiovascular events. We pooled data using a random effects model.

RESULTS: A total of 10 studies were enrolled, of which 8 were randomized trials (including 33 454 patients) and 2 were observational studies (including 148 144 patients). Of the 8 randomized trials, 4996 patients with type 2 diabetes, 19 118 with HF, and 9340 with atherosclerotic vascular disease and diabetes with end-organ damage. Both observational studies investigated all kinds of patients with initially RASi treatment. In patients with RASi, the EWKF group had a higher risk of all-cause mortality than the no-EWKF group in the randomized studies (n = 12 254; RR, 1.22; 95%CI, 1.04-1.42; P = 0.02) and in observational studies (n = 148 144; OR, 1.70; 95%CI, 1.43-2.01; P < 0.00001). In patients who experienced EWKF (n = 2246), no statistically significant difference was found between the efficacy of RASi and placebo in all-cause mortality (n = 1762; RR, 0.85; 95%CI, 0.68-1.06; P = 0.14).

CONCLUSION: RASi treatment led to an increased incidence of EWKF which was associated with poorer long-term outcomes. As the benefit of RAS blockade to patients with EWKF was limited, we suggest clinicians use RASi with caution when EWKF occurs.

PMID:34165226 | DOI:10.1111/nep.13915

Kathmandu Univ Med J (KUMJ). 2020 Oct.-Dec.;18(72):407-413.

ABSTRACT

Background Nutrition is believed to be very essential for socio economic development of the country and is an essential component of sustainable development goals. Malnutrition is a major public health problem in Nepal and is more common among under-five year children. Malnutrition among children is complex problem globally, affecting the physical, mental and social development. Objective To estimate the prevalence and explore the associated factors of malnutrition in study population. Method It was a community based cross-sectional study conducted among rural population of Nepal. Wards were selected by simple random sampling technique and household in each ward were selected by systemic random sampling. The mothers of 302 participants aged 12 to 59 months were interviewed for requisite information using pretested questionnaire and anthropometric measurements were taken using standard technique for each participant. Statistical Package for Social Sciences (SPSS) version 16.0 was used for data analysis. Result The prevalence of underweight, stunting and wasting was 36.8%, 37.5%, and 14.6% respectively. We found statistical significant association between underweight and children in lower age group, larger family size, lower level of mother’s education and illness in past one month. Factors that are significantly associated with stunting are children in lower age group, lower level of mother’s education and illness in past one month and wasting is significantly associated with children in lower age group. Conclusion This study showed the prevalence of malnutrition is high in study population. Factors associated with malnutrition were child’s age, family size, mother’s education and illness in past one month.

PMID:34165101

Food Funct. 2021 Jun 24. doi: 10.1039/d0fo03230a. Online ahead of print.

ABSTRACT

Diabetes mellitus is a complex and multifactorial disease with a global prevalence that exceeds 425 million people. Type 2 diabetes mellitus (T2DM) is characterized by a state of insulin resistance, which leads to metabolic alterations that aggravate the state of health of people. Vitamin D deficiency appears to play an important role in the triggering mechanisms of insulin resistance. In this review, an analysis is made of the biochemical mechanisms associated with the insulin-mimetic effect of vitamin D, its supplementation being a possible nutritional strategy for the T2DM treatment. The current scientific evidence is extensive regarding the dose of vitamin D used for an insulin-mimetic effect. However, clinical trials and systematic reviews show statistical differences on glucose, insulin, and glycated hemoglobin levels of patients with T2DM, associated with activation mechanisms of transcription factors related to genes of the glucide metabolism and the insulin receptor, and the regulation of intracellular Ca2+ insulin concentrations. Likewise, an indirect mechanism associated with antioxidant and anti-inflammatory effects has been shown that also leads to sensitivity to the insulin receptor. The use of a specific dose of vitamin D could be an effective alternative in the T2DM treatment, which would reduce the risk of complications derived from hyperglycemia.

PMID:34165135 | DOI:10.1039/d0fo03230a

Kathmandu Univ Med J (KUMJ). 2020 Oct.-Dec.;18(72):386-390.

ABSTRACT

Background Adolescence is a transition phase of life during which a lot of pubertal changes occur. If not dealt properly, many mental and behavioral disturbances can result. Adolescents must have good knowledge and attitude regarding physical and psychosocial pubertal changes. Objective To assess the knowledge and attitude regarding pubertal changes among secondary level students of selected school of Dhulikhel Municipality. Method A quantitative, descriptive cross-sectional study was conducted among secondary level students of Dhulikhel Municipality. Study was conducted among students of grade 9 and 10 of four government and three private schools of municipality. After selection of seven schools, proportionate stratified random sampling technique was done followed by lottery method to select required number of students. Both descriptive statistics and inferential statistics were applied using Statistical Package for Social Science (SPSS) Version 25.0 for data analysis. Result The mean score of knowledge regarding pubertal changes was 26.2±2.9. Likewise, the mean attitude score regarding pubertal changes was 55.4±1.2. Knowledge regarding pubertal change was significantly higher among age group 15-17 years. Females had higher knowledge compared to males. Attitude related to pubertal change was significantly more in respondents who studied in government school. Conclusion Adolescents of Dhulikhel municipality schools had good knowledge and attitude about pubertal changes.

PMID:34165097

Kathmandu Univ Med J (KUMJ). 2020 Oct.-Dec.;18(72):391-395.

ABSTRACT

Background Supracondylar fractures are subclassified as high and low type depending on whether they are above or below the isthmus of the distal humerus and it play an important role in determining outcome. Objective To compare the clinical and radiological outcomes of patients with fractures above and below the distal humeral isthmus treated with closed reduction and percutaneous pinning. Method This is a prospective non-randomized analytical study of 40 patients with displaced extension type supracondylar fracture of distal humerus treated by closed reduction and percutaneous pinning. Radiological and functional outcomes was followed up to 6 months postoperatively. The significance of differences between means (baumann angle, carrying angle and time to recovery) were calculated using the independent t-test. Result Twenty-four (60%) patients were high type and 16 (40%) patients were low type. According to Flynn grading, there was no statistical significance between the high type and low type (p = 0.601). The time to recovery for the high type was 15.58 ± 2.95 weeks and for low type was 18.75 ± 2.18 weeks. Hence, the time to recovery for the low type was longer than high type and it was statistically significant (p = 0.001). Conclusion Low type supracondylar fractures require a longer period for the gain of elbow range of motion. However, in long term the prognosis of low type is comparable with that of high type fracture. Hence, the prognostic value of fracture level in the treatment of displaced supracondylar fractures is not statistically significant.

PMID:34165098

Kathmandu Univ Med J (KUMJ). 2020 Oct.-Dec.;18(72):402-406.

ABSTRACT

Background Suicide is an act of deliberately killing oneself. It is a global health problem and is the second leading cause of death in 15 to 29 years. Thus, studying nursing students’ perception towards suicide attempters has paramount importance in understanding and addressing the existing gaps in healthcare delivery system. Objective To assess the nursing students’ perception towards attempted suicide and to find out the association between perception and selected variables. Method A descriptive, cross sectional design was carried out to assess the nursing students’ perception towards suicide attempters in Kathmandu University School of Medical Sciences. The respondents were 193 nursing students. A structured questionnaire was used in order to collect data. Descriptive statistics including frequency, percentage, mean and standard deviation were calculated to summarize the data and inferential statistics, Mann Whitney-U test was used for the association between perception and selected variables. Result A total 193 nursing students participated in this study. The scores between 1 and 2.4 were considered ‘positive’, ‘unsure’ or ‘uncertain’, between 2.5 and 3.4 and negative for 3.5 and above’ over all nurses showed relatively negative perception towards suicide attempters. According to results from eight domains of perception, those who did not attend the courses on psychiatry nursing presented higher score, which was found to have significant association with permissiveness, unpredictability and incomprehensibility. A younger nursing student shows significant association with incomprehensibility. Younger nursing student showed statistically significant association with duration of suicide process. Conclusion Nursing students are frequently encountered with attempted suicide patients. Therefore, they must be aware of their attitudes toward this group of patients as part of their professional and therapeutic role. Thus a nurse’s positive perception towards attempted suicide can play a key role in communicating and preventing a future suicide attempt.

PMID:34165100

Kathmandu Univ Med J (KUMJ). 2020 Oct.-Dec.;18(72):372-375.

ABSTRACT

Background Chronic obstructive pulmonary disease (COPD) exacerbation is a leading cause of frequent hospital admission. Globally, several studies have reported potential risk factors associated with COPD exacerbations which are largely unknown in Nepalese health care setting. Objective To identify the risk factors associated with hospital readmission within ninety days of discharge in acute COPD exacerbation. Method This is a hospital based retrospective cohort study conducted at Tribhuvan University Teaching Hospital. COPD patients admitted in respiratory ward from August 2019 to November 2019 were followed up till 90 days after discharge. Logistic regression analysis was performed at 95% Confidence Interval (CI) to identify risk factors for readmission in COPD exacerbation. Statistical analysis was performed using SPSS version 20.0. Result Of total 86 patients hospitalized for COPD, 42 (48.8%) had at least one subsequent readmission during post-discharge follow-up period of 90 days. Mean age of patients was 70.55±10.98 years. There were 45 (52.3%) males. Logistic regression analysis revealed preadmission domiciliary oxygen use (Odds Ratio (OR) 2.93; 95% CI 1.195- 7.202; p=0.019), admission in intensive care unit (ICU) (OR 3.060; 95% CI 1.145- 8.179; p=0.026), previous hospital admission for COPD exacerbation (OR 3.230; 95% CI 1.219-8.556; p=0.018), age (OR 0.946; 95% CI 0.905-0.988; p=0.012) and duration of hospital stay (OR 0.901; 95% CI 0.819-0.992; p=0.034) were independently associated with ninety day readmission in COPD patients. Conclusion Five clinical factors were found to be independently associated with COPD readmission in this study. Large multi-centre study at various health care levels is recommended to validate the potential risk factors in different populations and health care settings in Nepal.

PMID:34165094

Kathmandu Univ Med J (KUMJ). 2020 Oct.-Dec.;18(72):376-380.

ABSTRACT

Background Advantages due to immunization are numerous and cannot be avoided but at the same time pain inflicted on babies needs to be addressed when possible. Pain associated with immunization injections has often been overlooked when remedies are available. Objective To find out the effect of breastfeeding on relieving pain during immunization injection in infants. Method An experimental study was conducted at Immunization clinic of B.P. Koirala Institute of Health Sciences (BPKIHS). Total 124 subjects were divided randomly into two groups. Experimental subjects were allowed to breastfeed for 5-10 minutes before immunization while control group was immunized without breastfeeding. Interview Questionnaire was used to obtain demographic variables and measurements were obtained. Measures of pain was recorded using duration of cry and Modified Behavior Pain Scale, by Taddio et al. Data was analyzed by using SPSS 20.0 where variables were assessed with frequency tables, Pearson’s Chi-Square test, independent t test and Mann Whitney U test. Result The mean pain score in experimental group was 7.10 and in control group 7.56 which was statistically significant (p=0.001). The median duration of cry was significantly shorter in experimental group i.e. 25 seconds (IQR: 20-30) than control group 42.5 seconds (IQR: 30-61.5) (p < 0.001). Conclusion Breastfeeding before immunization is effective in reducing pain in infants.

PMID:34165095

Kathmandu Univ Med J (KUMJ). 2020 Oct.-Dec.;18(72):381-385.

ABSTRACT

Background Variation of hepatic artery is very frequent and may predispose the patients to inadvertent injury to the vessels during hepato-billiary surgery. With the advancement of new diagnostic, therapeutic and operative techniques for abdomen, the sound knowledge of variations of hepatic arterial system have become increasingly important for dealing clinicians, surgeons and interventional radiologists. Objective To study the variations of hepatic artery and to evaluate the possible clinical significances. Method A total of 104 images of abdominal computed tomography scans were used for this study. The origin and branching patterns of hepatic artery were recorded. After collecting the data, statistical analysis was done. Result The present study concluded that normal branching pattern of hepatic artery was seen in 86.54% cases, whereas 13.46% cases showed different types of variations. Among them, type II and IV pattern were seen in 0.96% in each, type VI in 1.93%, type VII in 2.87% and the most common variation type IX was seen in 3.85%. There were not a single case of type III, V, VIII and X recorded in this study. Addition to these, one of the variants was common hepatic artery originating from abdominal aorta, was seen in 1.93% of cases while the other variant is unnamed artery arising from superior mesenteric artery, was seen in 0.96% of cases. Conclusion The knowledge of the branching pattern of hepatic artery might be helpful for clinicians to the better understanding of the arterial supply of the liver and may reduce the risk of complications.

PMID:34165096

Kathmandu Univ Med J (KUMJ). 2020 Oct.-Dec.;18(72):329-332.

ABSTRACT

Background The global health community has emphasized the importance of reporting epidemiological data by age and sex groups in the COVID-19 pandemic. However, age and sex disaggregated data of COVID-19 cases and deaths are rarely reported. Such data are very crucial for public to make truly informed choices about their own diseases risk and also for governments for public policy response. Objective To assess age and gender difference among COVID-19 cases and deaths in Nepal. Method This is a retrospective study which uses public data on COVID-19 cases and deaths released by Ministry of Health and Population, Government of Nepal from January to November, 2020. The data analysis was carried out using SPPS software version 26. Result Nepal reported 233,452 confirmed cases and 1,566 deaths of COVID-19 from 23 January 2020 to 30 November 2020. We found statistically significant differences on COVID-19 cases by age and gender in Nepal with higher number of cases among males of economically active age groups (20-60 years). Similarly, we found significant difference in COVID-19 mortality with more death occurred among male group compared to female group and with highest number of deaths among the people of above 60 years. Furthermore, we found differences in cases and deaths among provinces. Conclusion The age and gender differences in COVID cases and deaths in Nepal indicates needs of considering age and sex groups seriously while planning for testing, case management and vaccination against COVID-19 infections in Nepal.

PMID:34165086