Estimating the prevalence and burden of major disorders of the brain in Nepal: methodology of a nationwide population-based study

BACKGROUND: The major disorders of the brain (MDBs), in terms of their prevalence and the burdens of ill health, disability and financial cost that they impose on individuals and society, are headache, depression and anxiety. No population-based studies have been conducted in Nepal. AIM: Our purpose was to assess the prevalence and burden attributable to MDBs in Nepal in order to inform health policy. Here we report the methodology. METHODS: The unusual sociocultural diversity and extreme geographical variation of the country required adaptation of standard methodology. We ran pre-pilot and pilot studies before embarking on the main study. The study design was cross-sectional. The population of interest were adults aged 18–65 years who were Nepali speaking and living in Nepal. We selected, employed and trained groups of interviewers to visit randomly selected households by cold-calling. Households were selected from 15 representative districts out of 75 in the country through multistage cluster sampling. One participant was selected randomly from each household. We used structured questionnaires (the HARDSHIP questionnaire, Hospital Anxiety and Depression Scale, and Eysenck Personality Questionnaire -Neuroticism), culturally adapted and translated into Nepali. We recorded blood pressure, weight, height and waist circumference, and altitude of each household. We implemented various quality-assurances measures. RESULTS: We completed the survey in one month, prior to onset of the monsoon. Among 2,210 selected households, all were contacted, 2,109 were eligible for the study and, from these, 2,100 adults participated. The participation rate was 99.6%. CONCLUSION: Standard methodology was successfully applied in Nepal, with some adaptations. The sociocultural and extraordinary geographic diversity were challenging, but did not require us to compromise the scientific quality of the study

An Overview of Fingerprint Patterns among Students of Gandaki Medical College, Pokhara, Nepal

Introduction: Fingerprint system of positive identification is based on the principle that the arrangement and distribution of fingerprint re­mains constant and persists throughout life and that the patterns of no two hands resemble each other. Methods: A cross sectional study was carried out among 250 students (125 male and 125 female students), aged 17 - 40 years of age, of Gan­daki Medical College, Pokhara, Nepal from 15 March to 13 April, 2017 A.D. The fingertip patterns of both hands were collected and identified with the aid of a magnifying glass and documented as: Loops, Whorls, Arches and Composite type. The data were enrolled in SPSS version 16 and analyzed accordingly. Results: There was a preponderance of loop pattern (52.6%) followed by whorls (39.4%), arches (7.3%) and composite (0.6%). Whorls (41.7%) were more common in males compared to females (37.1%) and females had more arches (9.6%) compared to that of the male counter­parts (5.04%). There was no significant difference in fingerprint pat­terns among male and female students. Conclusion: The predominance of loops amongst other fingerprint patterns along with no significant gender differences in fingerprint pat­terns can be considered as a valuable research finding in the field of forensic science

Comparative study of Pelvi-calyceal system and relationship of structures at hilum of kidney between Nepalese and North Americans

Introduction: Pelvi-calyceal system consists of renal pelvis along with major and minor calyces.The minor calyces unite with their neighbors two or three chambers to form the major calyces. The major calyces drain into the infundibula. The renal pelvis is formed from the junction of the infundibula. The common pattern of arrangement of structures at the renal hilum, antero-poteriorly is renal vein, renal artery and pelvis. Objectives: To compare the study of pelvi-calyceal system and relationship of structures at hilum of kidney between Nepalese and North Americans. Methodology: The gross and prosected kidney specimens were studied for pelvi-calyceal system and relationship of structures at hilum of kidney in Anatomy department. In Nepal, the study was undertaken in Gandaki Medical College, Kaski and in USA, it was done in Well-cornel University, New York. Result: Tricalyceal major calyx were found in 63.8% in Nepalese and Bicalyceal were found in 65.6% North Americans which is statistically significant variations. The number of minor calyces and pyramids varying 6 in Nepalese and 9 in North Americans were also statistically significant (p<0.05). The arrangement of structures at hilum of kidney from anterior to posterior(renal vein, artery and pelvis) in Nepalese and North American kidneys was 86.1% and 62.5% respectively whereas the structures arranged as renal artery, vein and pelvis from anterior to posterior was 13.9% and 37.5% . Conclusion: There are significant variations in pelvicalyceal system and relations of structures at hilum of kidneys of Nepalese and North-Americans

Association of Fingerprints with the ABO Blood grouping among students in Gandaki Medical College

Introduction: Dermatoglyphic study is undoubtedly the most reliable, convenient and acceptable method of individual identification since the fingerprint pattern persist same throughout the life and no two individ­ual has similar pattern. Both blood group and dermatoglyphic pattern have genetic inheritance so an attempt has been made to analyze their correlation with gender and blood group of an individual. Methods: A cross sectional study was carried out in 200 students (105 male and 95 female), aged 17to 27 years, with prior knowledge of their blood group, of Gandaki Medical College, Pokhara, Nepal. The finger­print patterns of both hands were recorded and patterns were observed. Results: Loop was the most common pattern registering 51.8% followed by whorls, arches and composite in both genders. Frequency of loop was higher in both male and female. Frequency of whorl was comparative­ly higher in male (41.3%) compared to female (38.8%). Similarly arch was more common in female (9.89%) than in male (5.05%).Frequency of loop was highest in all blood groups in both male and female; followed by whorls, arches and composite. Both loops and whorls were highest in individual with O+ blood group. Arch was found to be highest in B+ subjects. Conclusion: There was no significant association between distribution of fingerprint patterns, blood group and gender and thus prediction of gender and blood group of a person is not possible based on his finger­print pattern

Pattern of thyroid dysfunction in patients with metabolic syndrome and its relationship with components of metabolic syndrome

BACKGROUND: Thyroid dysfunction (TD) and metabolic syndrome (MetS) are known risk factors for atherosclerotic cardiovascular disease (ASCVD). TD is risk factor for ASCVD mediated by the effects of thyroid hormones on lipid metabolism and blood pressure hence the components of MetS. It is possible that coexistence of these two disease entities and unrecognized TD in patients with MetS might substantially increase ASCVD risk. Moreover, little is known about the relationship between TD and the components of MetS. Thus, the purpose of this study was to evaluate the pattern of TD in patients with MetS and its relationship with components of the MetS. METHODS: A total of 358 previously diagnosed patients with MetS were recruited in the study. The thyroid function test parameters were measured to classify TD at Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal. Statistical analyses were performed using SPSS version 16.0 to evaluate pattern and relationship. RESULTS: The overall prevalence of TD in patients with MetS was 31.84% with high prevalence of subclinical hypothyroidism (29.32%). We found no evidence of a relationship between TD and components of MetS, although there was significant difference in waist circumference between four groups of TD. CONCLUSION: Patients with MetS had subclinical hypothyroidism greatly. Although there was no evidence of any relationship between thyroid status and all components of MetS, TD should be taken into account when evaluating and treating patients with MetS to reduce the impending risk.Prabin Gyawali, Jyoti Shrestha Takanche, Raj Kumar Shrestha, Prem Bhattarai, Kishor Khanal, Prabodh Risal, Rajendra Koj

Agenda setting and framing of gender-based violence in Nepal: how it became a health issue.

: Gender-based violence (GBV) has been addressed as a policy issue in Nepal since the mid 1990s, yet it was only in 2010 that Nepal developed a legal and policy framework to combat GBV. This article draws on the concepts of agenda setting and framing to analyse the historical processes by which GBV became legitimized as a health policy issue in Nepal and explored factors that facilitated and constrained the opening and closing of windows of opportunity. The results presented are based on a document analysis of the policy and regulatory framework around GBV in Nepal. A content analysis was undertaken. Agenda setting for GBV policies in Nepal evolved over many years and was characterized by the interplay of political context factors, actors and multiple frames. The way the issue was depicted at different times and by different actors played a key role in the delay in bringing health onto the policy agenda. Women's groups and less powerful Ministries developed gender equity and development frames, but it was only when the more powerful human rights frame was promoted by the country's new Constitution and the Office of the Prime Minister that legislation on GBV was achieved and a domestic violence bill was adopted, followed by a National Plan of Action. This eventually enabled the health frame to converge around the development of implementation policies that incorporated health service responses. Our explicit incorporation of framing within the Kindgon model has illustrated how important it is for understanding the emergence of policy issues, and the subsequent debates about their resolution. The framing of a policy problem by certain policy actors, affects the development of each of the three policy streams, and may facilitate or constrain their convergence. The concept of framing therefore lends an additional depth of understanding to the Kindgon agenda setting model.<br/