Older Adult Perspectives towards Health Literacy and Knowledge of Chronic Diseases in Nepal: A case study

Background: The individual level of health literacy directly affects the health outcomes of any people. Older adult people are more vulnerable to chronic diseases than other groups of people. Also they have low health literacy and poor understanding of diseases than any other age group of people. Aim: This study aim is to explore older adult perspectives towards health literacy and knowledge of chronic diseases. Methods: The study was taken during December 2019 in the Budhanilkantha Municipality of Kathmandu district of Nepal. Semi-structured interview was conducted in four older adult participants with chronic diseases. It included health knowledge, level of understanding of chronic disease conditions, and the use of health services. Inductive analysis was followed for the patterns, themes, and categories of analysis to emerge. Results: Health literacy and knowledge of chronic diseases, health belief system, and experience of health problems were the emerging themes included here. The study results finds that lack of disease knowledge, low health literacy, health belief system, socio-economic, and cultural factors were influencing factors to chronic diseases among older adults. Participants had a minor knowledge of chronic diseases; they had lack in knowledge regarding their own chronic diseases. Conclusion: Health literacy is an important factor of understanding, accessing and utilizing health knowledge and health services. It is most important that the health literacy of the people is necessary to improve for positive health and gaining the knowledge of chronic diseases. To overcome the chronic health problems it is most important to improve the health knowledge, understanding of chronic diseases, and literacy level to the older adult people

Accuracy of bedside index for severity in acute pancreatitis ‘BISAP’ score in predicting outcome of acute pancreatitis

Introduction: Early identification of severe acute pancreatitis is of paramount importance in the management and for improving outcomes. Bedside index for severity in acute pancreatitis (BISAP) is a simple and accurate score for stratification in acute pancreatitis. This study was conducted to find out the accuracy of BISAP score in predicting outcomes of acute pancreatitis in local population. Method: We prospectively analyzed 96 patients with acute pancreatitis from February 2019 to December 2019. Revised Atlanta classification was used to stratify mild, moderately severe and severe pancreatitis. BISAP score was calculated within 24 hours of admission. Accuracy was measured by area under receiver operating curve (AUC). Result: Out of 96 patients, alcohol related acute pancreatitis accounted for 74.7%. There were 63.2% of mild AP, 37.3% of moderately severe AP, 9.4% of severe AP and 15.8 % of pancreatic necrosis. The AUC for moderately severe AP, severe AP and pancreatic necrosis were 0.77 (CI 0.68-0.87), 0.95 (CI 0.90-0.99) and 0.87 (CI 0.79-0.96) respectively. The statistically significant BISAP cut off for diagnosing sever AP was≥3, and ≥2 for moderately sever AP and pancreatic necrosis. There was positive correlation between revised Atlanta severity of acute pancreatitis and length of hospital stay (r=0.41). Mortality was 3.3 % which was seen in BISAP score 3 or above. Conclusion: BISAP is a simple predictive model in identifying patient at a risk of developing different severity of pancreatitis and its outcome in our population

Correlation of Uric Acid with Glomerular Filtration Rate in Chronic Kidney Disease

Introduction: Chronic Kidney Disease is a worldwide public health problem that affects millions of people from all racial and ethnic groups. Identification of a Chronic Kidney Disease is a major risk factor for cardiovascular morbidity and mortality and is attributed to hyperuricemia. Evidences show that high serum uric acid contribute directly to glomerulosclerosis, interstitial fibrosis and atherosclerosis that correction of hyperuricemia associated with Chronic Kidney Disease will slow the progression of chronic renal failure.  Methods: A hospital based cross-sectional study on chronic kidney disease patients including 57 patients on conservative treatment attending Bir Hospital with diagnosis of chronic kidney disease was performed. Detailed clinical history, examination and investigations including uric acid were done. Chronic Kidney Disease staging was done according to estimated glomerular filtration rate estimated by Cockcroft-Gault equation. Prevalence rate of hyperuricemia in Chronic Kidney Disease and its stages were calculated and compared with each other. Results: A total of 57 Chronic Kidney Disease cases were enrolled, with male to female ratio of 2:1 and mean age 51.63±17.75 years. Hyperuricemia was present in 55 (96.49%) of study population. Though prevalence of hyperuricemia increased with Chronic Kidney Disease stage, there was no significant difference in mean value of uric acid in different stages. Hyperuricemia and stages of Chronic Kidney Disease had negative correlation which was statistically significant. Conclusions: Hyperuricemia is highly prevalent among Chronic Kidney Disease patients with conservative management. The severity of hyperuricemia increases as Chronic Kidney Disease stage progresses

Sonographic and histopathological findings in ovarian dermoid cyst

Introductions: Ovarian dermoid cyst occurs most commonly in reproductive age group. It consists all three layers of germ cells, in variable composition resulting in wide spectrum of USG findings. This study aimed to find the association between sonographic and histopathological findings of dermoid cyst. Methods: This was a retrospective study consisting of 55 cases of complex ovarian cysts with features of dermoid cyst, during two years 2013-2015. The diagnostic accuracies of trans-abdominal sonography findings were compared with post-operative histopathology reports. Results: Among 55 cases of complex ovarian cyst with sonographic features of dermoid, histopathology was benign in 52 (94.5%) and malignant in 3 (5.5%). In 52 benign cysts, 25 (48.0%) were teratoma and 27 (51.9%) were other benign masses. Conclusions: The accuracy of ultrasound was 95% in the diagnosis of ovarian cyst and is the modality of choice for initial workup of ovarian mass. Keywords: complex ovarian mass, dermoid cyst, histopathology, sonograph

Echogenic liquor at term pregnancy on ultrasonography is not always meconium

Introductions: The presence of echogenic amniotic fluid at term pregnancy on sonography is uncommon. Finding of meconium in the amniotic fluid by ultrasound is used to predict mode of delivery of fetus, fetal wellbeing and risk of intrauterine fetal demise. We aim to observe the clinical significance of echogenic liquor at term pregnancy.Methods: This was a retrospective study of 102 cases of echogenic liquor at gestation age between 36 and 41 weeks (term pregnancy) during five years 2010 to 2015. Amniotic fluid index (AFI) was calculated. Fluid was observed for presence of vernix caseosa or meconium stain during spontaneous and artificial rupture of membrane. The APGAR score of baby was taken twice at 5 and 10 minutes.Results: Among the 102 patients with echogenic amniotic fluid at term, 83 (81.4%) were vernix and 19 (18.6%) had meconium stain. Low APGAR scores were found in 5 (0.9%) and normal score in 97 (95.1%) indicating good fetal outcome. Among these cases, 89 (87.3%) had normal AFI and 13 (12.7%) had decreased liquor.Conclusions: There were no association between echogenic liquor and meconium stain, AFI or APGAR score of the baby in term pregnancy.Keywords: AFI, echogenic liquor, fetal outcome, prenatal ultrasound, term pregnancy, vernix or meconiu

Renal ultrasound and voiding cystourethrogram in children with recurrent urinary tract infection

Introductions: Urinary tract infection (UTI) is common in children and vesicoureteric reflux (VUR) is a risk factor for the UTI. Renal ultrasound, voiding cystourethrogram (VCUG) and nuclear renal scanning are used to confirm VUR. Recent studies show that ultrasound has a low sensitivity and specificity for VUR. Aim of the study was to assess the findings of renal ultrasound and VCUG in recurrent urinary tract infection and presence of VUR. Methods: This cross-sectional study retrospectively reviewed 208 cases of children with recurrent UTI who had ultrasound and VCUG in at Patan Hospital during 2010 to 2015. Sensitivity and specificity of both tests were analysed. Amount of contrast required for VCUG with or without VUR was analysed. Results: Among the 209 patients with recurrent UTI, 51 (24.51%) had VUR and 157 (75.48%) were normal. In ultrasound, 196 cases (94.2%) were normal, 11 cases (5.3%) had mild hydronephrosis and 1 (0.5%) had moderate hydronephrosis. VUR cases needed more amount of contrast medium than normal patients while performing VCUG. Conclusions: Ultrasound alone is not diagnostic of VUR and VCUG is required to confirm diagnosis. Mire amount of contrast volume is required in VUR cases than no VUR. Keywords: recurrent UTI in children, renal ultrasound, voiding cystourethrogram VCUG, vesicoureteral reflux VU

Evaluating the Effectiveness of Interventions to Improve the Follow-up Rate for Children With Visual Disabilities in an Eye Hospital in Nepal: Nonrandomized Study

Background: Monitoring ocular morbidity among pediatric patients requires regular follow-up visits. We found that the follow-up rate was poor among children in our setting. Therefore, we intended to assess the effectiveness of 2 interventions—(1) counseling and (2) SMS text messaging and phone calls—to improve the follow-up rates. Objective: This study aimed to evaluate the effectiveness of 2 interventions, counseling and SMS and phone calls group, as well as a routine standard care for improving the follow-up rate of pediatric patients. Methods: A Nonrandomized, quasiexperimental design was used. Children (aged 0-16 years) with ocular conditions requiring at least 3 follow-up visits during the study period were included. A total of 264 participants were equally allocated to the 3 intervention groups of (1) counseling, (2) SMS and phone calls, and (3) routine standard care group. A 20-minute counseling session by a trained counselor with the provision of disease-specific leaflets were given to those in the counseling group. For the second intervention group, parents of children received an SMS text 3 days before and a phone call 1 day before their scheduled follow-up visits. Participants allocated for the routine standard care group were provided with the existing services with no additional counseling and reminders. Participants attending 3 follow-ups within 2 days of the scheduled visit date were considered compliant. The difference in and among the proportion of participants completing all 3 follow-up visits in each group was assessed. Results: The demographic characteristics of the participants were similar across the study groups. Only 3% (8/264) of participants completed all 3 follow-up visits, but overall compliance with the follow-up, as defined by the investigators, was found to be only 0.76% (2/264). There was no statistically significant difference in the proportion of follow-up between the intervention groups. However, the proportion of participants attending the first and second follow-ups, as well as the overall total number of follow-ups, was more in the SMS and phone-call group followed by the counseling group. Conclusions: We did not find any evidence on the effectiveness of our interventions to improve the follow-up rate. The primary reason could be that this study was conducted during the COVID-19 pandemic. It could also be possible that the intensity of the interventions may have influenced the outcomes. A rigorously designed study during the absence of any lockdown restrictions is warranted to evaluate intervention effectiveness. The study also provides useful insights and highlights the importance of designing and systematically developing interventions for improving the follow-up rate and ensuring a continuum of care to children with visual disabilities in Nepal and similar contexts. Trial Registration: ClinicalTrials.gov NCT04837534; https://clinicaltrials.gov/ct2/show/NCT04837534 International Registered Report Identifier (IRRID): RR2-10.2196/3157

Ultralight vector dark matter search using data from the KAGRA O3GK run

Among the various candidates for dark matter (DM), ultralight vector DM can be probed by laser interferometric gravitational wave detectors through the measurement of oscillating length changes in the arm cavities. In this context, KAGRA has a unique feature due to differing compositions of its mirrors, enhancing the signal of vector DM in the length change in the auxiliary channels. Here we present the result of a search for U(1)B−L gauge boson DM using the KAGRA data from auxiliary length channels during the first joint observation run together with GEO600. By applying our search pipeline, which takes into account the stochastic nature of ultralight DM, upper bounds on the coupling strength between the U(1)B−L gauge boson and ordinary matter are obtained for a range of DM masses. While our constraints are less stringent than those derived from previous experiments, this study demonstrates the applicability of our method to the lower-mass vector DM search, which is made difficult in this measurement by the short observation time compared to the auto-correlation time scale of DM

Predictors of treatment response in cirrhotic patients with overt hepatic encephalopathy: Treatment response in hepatic encephalopathy

Introduction: Hepatic encephalopathy (HE) is a frequent complication and one of the most debilitating manifestations of liver cirrhosis, which negatively impacts patient survival. This study aims to identify the factors influencing the treatment response in patients with liver cirrhosis and HE. Method: This was a prospective observational study conducted from July 2019 to June 2020 in a tertiary referral center in Nepal. The ethical clearance was obtained from the Institutional Review Board of the center (Reference No. 46/076/77). Patients with Liver cirrhosis with HE grade II or more were included. Standard medical therapy for HE was given to all the patients, and treatment response for the first five days post admission was recorded. The response was categorized as a good response, no response, and deterioration, based on improvement or deterioration of the patient`s symptoms or changes in West Haven criteria. Result: In this study total of 78 patients were enrolled and included in the final analysis. The mean age was 50.17± 10.36 years and 63(80.76%) were male. Alcohol was the etiology of cirrhosis in 62(79.5%). Seventy-two (92.3%)  patients had a good response to the treatment, 3(3.8 %) of patients had no response, and the rest 3(3.8%) deteriorated. On logistic regression, high creatinine, high bilirubin, and low serum protein were the predictors of non-response to standard therapy (p<0.05). Conclusion: High serum creatinine, high bilirubin, and low serum protein were the predictors of non-response to standard therapy in patients with Liver Cirrhosis with Hepatic Encephalopathy. Keywords: Hepatic encephalopathy, liver cirrhosis, predictors, respons