Elektrofizjologiczna ocena stanu nerwów łydkowych u chorych na cukrzycę typu 2 bez objawów neuropatii obwodowej

Wstęp. Powszechnie wiadomo o występowaniu neuropatii u chorych na cukrzycę typu 2 (T2DM). Mniej uwagi poświęca się jednak występującym u tych chorych zmianom elektrofizjologicznym w nerwach obwodowych, zwłaszcza przed rozwojem jawnej neuropatiiobwodowej. W związku z tym autorzy przeprowadzili badanie mające na celu ocenę parametrów elektrofizjologicznych nerwów łydkowych obu kończyn dolnych u chorych na T2DM bez objawów neuropatii obwodowej.Materiał i metody. Do badania włączono 35 mężczyzn z T2DM oraz 35-osobową grupę kontrolną złożoną z dopasowanych pod względem wieku i płci osób bez jakichkolwiek objawów neuropatii obwodowej ani chorób zakaźnych, ogólnoustrojowych, metabolicznych czy neuropsychiatrycznych. Od wszystkich uczestników przed rozpoczęciem badania uzyskano pisemną zgodę na udział w nim. Obustronne badanie przewodnictwa nerwowego (NCS) w nerwach łydkowych w obu grupach wykonano w pracowni elektrofizjologicznej, w temperaturze 26 ± 2ºC, z zastosowaniem standardowej antydromowej metody stymulacji. Zmierzono latencję, szybkość przewodzenia, amplitudę i czas trwania obustronnych czuciowych potencjałów czynnościowych (SNAP) w nerwach łydkowych, a następnie porównano uzyskane wyniki.Wyniki. U chorych na T2DM stwierdzono zmniejszoną amplitudę potencjałów SNAP w nerwach łydkowych obu kończyn w porównaniu z osobami z grupy kontrolnej (lewa: 12,46 ± 3,77 μV vs. 16,42 ± 4,58 μV; p = 0,000; prawa: 11,96 ± 4,45 μV vs. 16,62 ± 6,20 μV; p = 0,001), chociaż wartości te znajdowały się powyżej progu wartości prawidłowych wynoszących ≥ 4 μV. Czas trwania potencjałów SNAP w nerwach łydkowych obu kończyn był dłuższy u chorych na T2DM niż w grupie kontrolnej (lewa: 1,99 ± 0,38 ms vs. 1,67 ± 0,27 ms; p = 0,000; prawa: 1,92 ± 0,47 ms vs. 1,55 ± 0,33 ms; p = 0,000).Wnioski. Niższa amplituda i dłuższy czas trwania potencjałów SNAP w nerwach łydkowych obu kończyn dolnych to zmiany elektrofizjologiczne wskazujące na neuropatię obwodową u chorych na T2DM, które można stwierdzić przed wystąpieniem objawów klinicznych neuropatii obwodowej

Electrophysiological status of sural nerves in type 2 diabetes mellitus patients before symptomatic peripheral neuropathy

Introduction. Neuropathies in type 2 diabetes mellitus (T2DM) patients are well known. However, electrophysiological changes in their peripheral nerves, particularly before overt peripheral neuropathy have received much less attention. Hence, we aimed to study the electrophysiological status of bilateral sural nerves in T2DM patients who do not show symptoms and signs of peripheral neuropathy. Material and methods. We selected 35 T2DM male patients and 35 age- and sex-matched control subjects without any clinical evidence of peripheral neuropathy and infectious, systemic, metabolic, and neuropsychiatric illnesses after informed written consent. Nerve conduction study (NCS) of bilateral sural nerves of both the groups was done at the lab temperature of 26 ± 2ºC by antidromic method of stimulation using standard methods. Their latency, conduction velocity, amplitude, and duration of bilateral sural sensory nerve action potentials (SNAPs) were measured and compared. Results. T2DM patients had reduced amplitudes of bilateral sural SNAPs compared to control subjects [left (12.46 ± 3.77) μV vs. (16.42 ± 4.58) μV, p = 0.000; right (11.96 ± 4.45) μV vs. (16.62 ± 6.20) μV, p = 0.001] though they were above the normal cut-off value of ≥ 4 μV. T2DM patients showed prolonged durations of bilateral sural SNAPs compared to the control subjects [left (1.99 ± 0.38) ms vs. (1.67 ± 0.27) ms, p = 0.000; right (1.92 ± 0.47) ms vs. (1.55 ± 0.33) ms, p = 0.000]. Conclusion. Reduced amplitudes and prolonged durations of bilateral sural SNAPs are the electrophysiological alterations, suggestive of peripheral neuropathy, in T2DM patients that appear before they show clinical symptoms and signs of peripheral neuropathy

Effect of gender preference on fertility: cross-sectional study among women of Tharu community from rural area of eastern region of Nepal

BACKGROUND: Son preference is predominant in developing countries especially South Asian countries and its effect is most visible when the fertility is on transition. Nepal is a country in South Asia where the fertility has declined and son is valued highly. This study examines the parent’s gender preference for children and its effect on fertility and reproductive behaviors. METHODS: Study was conducted in Sonapur village development committee of Sunsari district among women of Tharu community of reproductive age (15–49) currently in union and having at least one child. Data was collected by house to house survey. Data was analyzed with IBM SPSS 20 version. Multinomial and binary logistic regression were used to analyze the relationship among variables. RESULTS: Three hundred women of reproductive age were included in the study. Current average age of the respondents was 31.97 years and mean age at marriage was 18.87 (SD +/-2.615). Child Sex ratio (male: female) of the respondents who didn’t want any more children was 1.41. The birth spacing following male baby was 3.09 years whereas the average birth spacing following female baby was 2.71 years. Age of the respondents and education status of the respondents were also significantly associated with contraceptive practice. Presence of only female children in family significantly increased the desire of other children (AOR = 10.153, 95% CI = 2.357-43.732). CONCLUSION: This study finds that the gender preference affects the fertility and reproductive behavior of the respondents and it is necessary to reduce son preference for the health and well being of children and women

Clinical profile and drug utilization pattern in an intensive care unit of a teaching hospital in western Nepal

To analyze the clinical profile of patients admitted to the intensive care unit (ICU) of Manipal Teaching Hospital (MTH) at Pokhara, Nepal, identify the commonly prescribed drugs, drug categories, dosage forms, antimicrobials, sensitivity pattern of antimicrobials and the treatment outcomes. A cross sectional, descriptive study in which he case records of all the patients admitted in the ICU during 1st August to 30th September, 2007 were collected and the details were entered in the patient profile form. The filled patient profile forms were retrospectively analyzed as per the study objectives. Altogether, 201 patients [males 101 (50.25%)] were admitted. Most common diagnosis was 'Myocardial Infarction /Ischemic heart disease' [13.96 % (n=62)]. The median (interquartile range) of the ICU stay was 3 (2-4) days. Cardiovascular drugs [31.7% (n=761) were the most commonly prescribed. Among the antimicrobials, metronidazole was most commonly prescribed followed by ceftriaxone. The morality rate in the ICU was 17.41 % and the major causes of mortality were cardiovascular and respiratory diseases. Antimicrobials was the most common drug category used in the ICU and 'pantoprazole' was the most commonly prescribed individual drug. Cardiovascular and respiratory diseases were major causes of death in the ICU

Role of Information Communication Technology (ICT) in Nepalese Banking Industry

Public and private sectors, organization has been keen to harness the potential of ICT to enhance its administrative, managerial and clinical performance. Successful implementation of the new technology depended upon acceptance by organizational member targets as its end-users. The experiment is done by the help of both primary and secondary data. Primary data have been collected from the structured questionnaire developed for the employee of the bank and the customers. Secondary data have been collected from the website of Nepal Rasta Bank, ICT related journals, banking articles and other published sources. The study purpose is to gain a more complete understanding of the change management factors affecting the acceptance of the. The present study was aimed to explore the prevailing status of the use of ICT in commercial banking services, assess the extent of perceived benefits of the use of ICT and analyze the key problems and their corrective measures so as to leverage the use of ICT in commercial banking in the country. The study found explores the banking sector using the information and technology. The study helps to provide the information about the corns and pros of using information and communication technology in the present context of Nepalese banking sector

Health Problems of Nepalese Migrant Workers and Their Access to Healthcare Services in three countries of Middle East

Background: Migrants’ health is a global public health issue. Middle East countries are the major destination for abroad job among Nepalese workers. This study carried out to identify the health problems among migrant workers and their access to health care in Saudi Arabia, United Arab Emirates (UAE) and Qatar of Middle East. Methods: This was a cross-sectional study; carried out among 480 returnee migrant workers who have given consent for the study.  Data were collected at Tribhuvan International Airport (October 2018) using pretested structured interview schedule after taking approval from Institutional Review Committee of Pokhara University. Data were analyzed using SPSS 20 version. Percentage, mean/median, standard deviation, Chi square test and logistic regression performed. Results: Majority of the returnee migrants workers were male (95.0%) and their mean age was 32.38±5.54 years. Almost ten percent of the participants suffered from at least one health problem during their stay in Middle East; among them, respiratory problems were common (35.6%). Almost all participants (99.6%) had health policy to take care of migrant workers and 93.5 percent participants had health insurance coverage. Female workers (AOR 4.34; CI: 1.54-12.19), and migrants who worked for additional benefits (AOR 2.17; CI: 1.11-4.25) had significantly higher prevalence of health problems than their counterparts (P<0.05).       Conclusion: Almost ten percent migrant workers had at least one health problem during their stay in Saudi Arabia, UAE and Qatar. Almost all workers had the access to health care in Middle East countries. Female workers and the workers who performed additional work (over time) were at higher risk of the health problems. Universal coverage of quality health care for migrant workers in abroad and mainstreaming the route of permission for work is recommended.

Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015

BACKGROUND: In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030 ..

Alcohol use and burden for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2.2% (95% uncertainty interval [UI] 1.5-3.0) of age-standardised female deaths and 6.8% (5.8-8.0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3.8% (95% UI 3.2-4-3) of female deaths and 12.2% (10.8-13-6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2.3% (95% UI 2.0-2.6) and male attributable DALYs were 8.9% (7.8-9.9). The three leading causes of attributable deaths in this age group were tuberculosis (1.4% [95% UI 1. 0-1. 7] of total deaths), road injuries (1.2% [0.7-1.9]), and self-harm (1.1% [0.6-1.5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27.1% (95% UI 21.2-33.3) of total alcohol-attributable female deaths and 18.9% (15.3-22.6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0.0-0.8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.Peer reviewe

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97\ub71 (95% UI 95\ub78-98\ub71) in Iceland, followed by 96\ub76 (94\ub79-97\ub79) in Norway and 96\ub71 (94\ub75-97\ub73) in the Netherlands, to values as low as 18\ub76 (13\ub71-24\ub74) in the Central African Republic, 19\ub70 (14\ub73-23\ub77) in Somalia, and 23\ub74 (20\ub72-26\ub78) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91\ub75 (89\ub71-93\ub76) in Beijing to 48\ub70 (43\ub74-53\ub72) in Tibet (a 43\ub75-point difference), while India saw a 30\ub78-point disparity, from 64\ub78 (59\ub76-68\ub78) in Goa to 34\ub70 (30\ub73-38\ub71) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4\ub78-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20\ub79-point to 17\ub70-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17\ub72-point to 20\ub74-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations