Urinary physiology and hypoxia: a pilot study of moderate-altitude trekking effects on urodynamic indexes

Exposure to high altitude is one of the most widely used models to study the adaptive response to hypoxia in humans. However, little is known about the related effects on micturition. The present study addresses the adaptive urinary responses in four healthy adult lowlanders, comparing urodynamic indexes at Kathmandu [1,450 m above sea level (a.s.l.); K1450] and during a sojourn in Namche Bazar (3,500 m a.s.l.; NB3500). The urodynamic testing consisted of cistomanometry and bladder pressure/flow measurements. Anthropometrics, electrocardiographic, and peripheral capillary oxygen saturation data were also collected. The main findings consisted of significant reductions in bladder power at maximum urine flow by ~30%, bladder contractility index by 13%, and infused volume both at first (by 57%) and urgency sensation (by 14%) to urinate, indicating a reduced cystometric capacity, at NB3500. In addition to the urinary changes, we found that oxygen saturation, body mass index, body surface area, and median RR time were all significantly reduced at altitude. We submit that the hypoxia-related parasympathetic inhibition could be the underlying mechanism of both urodynamic and heart rate adaptive responses to high-altitude exposure. Moreover, increased diuresis and faster bladder filling at altitude may trigger the anticipation of being able to void, a common cause of urgency. We believe that the present pilot study represents an original approach to the study of urinary physiology at altitude

Exploring the influence of precipitation extremes and human water use on total water storage (TWS) changes in the Ganges-Brahmaputra-Meghna River Basin

Climate extremes such as droughts and intense rainfall events are expected to strongly influence global/regional water resources in addition to the growing demands for freshwater. This study examines the impacts of precipitation extremes and human water usage on total water storage (TWS) over the Ganges-Brahmaputra-Meghna (GBM) River Basin in South Asia. Monthly TWS changes derived from the Gravity Recovery And Climate Experiment (GRACE) (2002–2014) and soil moisture from three reanalyses (1979–2014) are used to estimate new extreme indices. These indices are applied in conjunction with standardized precipitation indices (SPI) to explore the impacts of precipitation extremes on TWS in the region. The results indicate that although long-term precipitation do not indicate any significant trends over the two subbasins (Ganges and Brahmaputra-Meghna), there is significant decline in rainfall (9.0 ± 4.0 mm/decade) over the Brahmaputra-Meghna River Basin from 1998 to 2014. Both river basins exhibit a rapid decline of TWS from 2002 to 2014 (Ganges: 12.2 ± 3.4 km3/yr and Brahmaputra-Meghna: 9.1 ± 2.7 km3/yr). While the Ganges River Basin has been regaining TWS (5.4 ± 2.2 km3/yr) from 2010 onward, the Brahmaputra-Meghna River Basin exhibits a further decline (13.0 ± 3.2 km3/yr) in TWS from 2011 onward. The impact of human water consumption on TWS appears to be considerably higher in Ganges compared to Brahmaputra-Meghna, where it is mainly concentrated over Bangladesh. The interannual water storage dynamics are found to be strongly associated with meteorological forcing data such as precipitation. In particular, extreme drought conditions, such as those of 2006 and 2009, had profound negative impacts on the TWS, where groundwater resources are already being unsustainably exploited

Operative procedure options in tuberculosis of dorsal spine with neurological deficit

Abstrac

Treatment of Recurrent Anterior Dislocations of Shoulder by Laterjet-Bristow Operation: An Experience

abstrac

Comparison of nutrition properties of stinging nettle (Urtica dioica) flour with wheat and barley flours

Stinging nettle (Urtica dioica. L) is a wild, unique herbaceous perennial flowering plant with stinging hairs. It has a long history of use as a food sources as a soup or curries, and also used as a fiber as well as a medicinal herb. The current aim was to analyze the composition and bioactive compounds in Nepalese Stinging nettle. Chemical analysis showed the relatively higher level of crude protein (33.8%), crude fiber (9.1%), crude fat (3.6%), total ash (16.2%), carbohydrate (37.4%), and relatively lower energy value (307 kcal/100 g) as compared to wheat and barley flours. Analysis of nettle powder showed significantly higher level of bioactive compounds: phenolic compounds as 129 mg Gallic acid equivalent/g; carotenoid level 3497 μg/g; tannin 0.93 mg/100 g; anti-oxidant activity 66.3 DPPH inhibition (%), as compared to wheat and barley. This study further established that nettle plants as very good source of energy, proteins, high fiber, and a range of health benefitting bioactive compounds

Comparison of nutritional properties of stinging nettle (Urtica dioica) flour with wheat and barley flours

Stinging nettle (Urtica dioica. L) is a wild, unique herbaceous perennial flowering plant with Stinging hairs. It has a long history of use as a food sources as a soup or curries, and also used as a fiber as well as a medicinal herb. The current aim was to analyze the composition and bioactive compounds in Nepalese Stinging nettle. Chemical analysis showed the relatively higher level of crude protein (33.8%), crude fiber (9.1%), crude fat (3.6%), total ash (16.2%), carbohydrate (37.4%), and relatively lower energy value (307 kcal/100 g) as compared to wheat and barley flours. Analysis of nettle powder showed significantly higher level of bioactive compounds: phenolic compounds as 129 mg Gallic acid equivalent/g; carotenoid level 3497 μg/g; tannin 0.93 mg/100 g; anti-oxidant activity 66.3 DPPH inhibition (%), as compared to wheat and barley. This study further established that nettle plants as very good source of energy, proteins, high fiber, and a range of health benefitting bioactive compounds

TREATMENT OF IDIOPATHIC SCOLIOSIS BY HARRINGTON INSTRUMENTATION

An adolescent idiopathic right-sided thoracolumbar scoliosis has been corrected surgically with Harrington distraction and compression instrumentation with posterior fusion for the first time in Nepal. Key Words: Idiopathic scoliosis, Harrington system

Data_Sheet_1_Adopting social health insurance in Nepal: A mixed study.docx

ObjectiveThe Social Health Insurance Program (SHIP) shares a major portion of social security, and is also key to Universal Health Coverage (UHC) and health equity. The Government of Nepal launched SHIP in the Fiscal Year 2015/16 for the first phase in three districts, on the principle of financial risk protection through prepayment and risk pooling in health care. Furthermore, the adoption of the program depends on the stakeholders' behaviors, mainly, the beneficiaries and the providers. Therefore, we aimed to explore and assess their perception and experiences regarding various factors acting on SHIP enrollment and adherence.MethodsA cross-sectional, facility-based, concurrent mixed-methods study was carried out in seven health facilities in the Kailali, Baglung, and Ilam districts of Nepal. A total of 822 beneficiaries, sampled using probability proportional to size (PPS), attending health care institutions, were interviewed using a structured questionnaire for quantitative data. A total of seven focus group discussions (FGDs) and 12 in-depth interviews (IDIs), taken purposefully, were conducted with beneficiaries and service providers, using guidelines, respectively. Quantitative data were entered into Epi-data and analyzed with SPSS, MS-Excel, and Epitools, an online statistical calculator. Manual thematic analysis with predefined themes was carried out for qualitative data. Percentage, frequency, mean, and median were used to describe the variables, and the Chi-square test and binary logistic regression were used to infer the findings. We then combined the qualitative data from beneficiaries' and providers' perceptions, and experiences to explore different aspects of health insurance programs as well as to justify the quantitative findings.Results and prospectsOf a total of 822 respondents (insured-404, uninsured-418), 370 (45%) were men. Families' median income was USD $65.96 (8.30–290.43). The perception of insurance premiums did not differ between the insured and uninsured groups (p = 0.53). Similarly, service utilization (OR = 220.4; 95% CI, 123.3–393.9) and accessibility (OR = 74.4; 95% CI, 42.5–130.6) were found to have high odds among the insured as compared to the uninsured respondents. Qualitative findings showed that the coverage and service quality were poor. Enrollment was gaining momentum despite nearly a one-tenth (9.1%) dropout rate. Moreover, different aspects, including provider-beneficiary communication, benefit packages, barriers, and ways to go, are discussed. Additionally, we also argue for some alternative health insurance schemes and strategies that may have possible implications in our contexts.ConclusionAlthough enrollment is encouraging, adherence is weak, with a considerable dropout rate and poor renewal. Patient management strategies and insurance education are recommended urgently. Furthermore, some alternate schemes and strategies may be considered.</p

Data_Sheet_2_Adopting social health insurance in Nepal: A mixed study.CSV

ObjectiveThe Social Health Insurance Program (SHIP) shares a major portion of social security, and is also key to Universal Health Coverage (UHC) and health equity. The Government of Nepal launched SHIP in the Fiscal Year 2015/16 for the first phase in three districts, on the principle of financial risk protection through prepayment and risk pooling in health care. Furthermore, the adoption of the program depends on the stakeholders' behaviors, mainly, the beneficiaries and the providers. Therefore, we aimed to explore and assess their perception and experiences regarding various factors acting on SHIP enrollment and adherence.MethodsA cross-sectional, facility-based, concurrent mixed-methods study was carried out in seven health facilities in the Kailali, Baglung, and Ilam districts of Nepal. A total of 822 beneficiaries, sampled using probability proportional to size (PPS), attending health care institutions, were interviewed using a structured questionnaire for quantitative data. A total of seven focus group discussions (FGDs) and 12 in-depth interviews (IDIs), taken purposefully, were conducted with beneficiaries and service providers, using guidelines, respectively. Quantitative data were entered into Epi-data and analyzed with SPSS, MS-Excel, and Epitools, an online statistical calculator. Manual thematic analysis with predefined themes was carried out for qualitative data. Percentage, frequency, mean, and median were used to describe the variables, and the Chi-square test and binary logistic regression were used to infer the findings. We then combined the qualitative data from beneficiaries' and providers' perceptions, and experiences to explore different aspects of health insurance programs as well as to justify the quantitative findings.Results and prospectsOf a total of 822 respondents (insured-404, uninsured-418), 370 (45%) were men. Families' median income was USD $65.96 (8.30–290.43). The perception of insurance premiums did not differ between the insured and uninsured groups (p = 0.53). Similarly, service utilization (OR = 220.4; 95% CI, 123.3–393.9) and accessibility (OR = 74.4; 95% CI, 42.5–130.6) were found to have high odds among the insured as compared to the uninsured respondents. Qualitative findings showed that the coverage and service quality were poor. Enrollment was gaining momentum despite nearly a one-tenth (9.1%) dropout rate. Moreover, different aspects, including provider-beneficiary communication, benefit packages, barriers, and ways to go, are discussed. Additionally, we also argue for some alternative health insurance schemes and strategies that may have possible implications in our contexts.ConclusionAlthough enrollment is encouraging, adherence is weak, with a considerable dropout rate and poor renewal. Patient management strategies and insurance education are recommended urgently. Furthermore, some alternate schemes and strategies may be considered.</p