Mifepristone versus intracervical prostaglandin E2 gel for cervical ripening in primigravid patients at term

Background: The cervix has to play dual role in human reproduction. During pregnancy, it should remain firm and closed allowing the fetus to grow in utero until functional maturity is attained while during labour it should soften and dilate, allowing the fetus to pass through the birth canal. Objective of present study was to know and compare the effect of oral Mifepristone with intracervical dinoprostone gel for cervical priming prior to induction of labour at term in an unfavorable cervix of primigravida.Methods: This was prospective randomized comparative study. 100 primigravid patients were included, 50 were placed in each group A and B. Tablet Mifepristone 200mg orally was given in group A patients and intracervical dinoprostone gel induction was done in group B patients. Pre induction Bishop’s score was noted at beginning to compare improvement in Bishop’s score after induction. Mode of delivery and induction to delivery interval in both the groups were studied.Results: After induction with Mifepristone 76% women had successful cervical ripening as compared to 56% with dinoprostone. Rate of vaginal delivery was 70% with Mifepristone and 58% with dinoprostone. There was no significant difference in induction to delivery interval between the groups. Ten percent and 2% belonging to mifepristone and dinoprostone group respectively, required NICU admissions.Conclusions: Mifepristone is more effective than dinoprostone for preinduction cervical ripening as it has high success rate of achieving cervical ripening, however there is no significant difference in the vaginal delivery rate and other maternal and fetal outcome

Percutaneous trigger finger release using 18G hypodermic needle

Introductions: Patients of stenosing tenosynovitis or trigger finger presents with pain, swelling, limitation of finger movement, and triggering. Thickening of the A1 pulley, with resultant entrapment of flexor tendons, is the primary pathology. In failed conservative treatment, surgical release by open or percutaneous technique is used. The aim of this study was to evaluate the results of percutaneous release of trigger fingers using hypodermic 18-gauge needle under local anesthesia. Methods: A cross sectional study of percutaneous release of trigger fingers using hypodermic 18-gauge needle under local anesthesia was performed in outpatient clinic at Janaki Medical College Teaching Hospital, Janakpur, Nepal, from July 2016 to September 2017. Informed consent was obtained. All the patients were followed up on 3rd day, 1st week and one month in outpatient department, and further telephone follow up at three and six months after surgery. Results: There were 38 patients, female 25 and male 13, age 24 to 67 years. Successful release was achieved in 36/38 (95%) with normal activities within 48 hours. None had complications like digital neurovascular injury or tendon bowstringing. One patient had superficial skin infection and was treated successfully with oral antibiotics. Two (5.2%) had pain and recurrent triggering requiring open release in the first week. At one, three and six months follow up patients reported no triggering of released fingers. Conclusions: Percutaneous release with hypodermic 18-gauge needle under local anesthesia was an effective and convenient method with a low complication rate. Keywords: percutaneous release, trigger finger, 18-gauge hypodermic needl

Nitrogen uptake and economics of black rice (Oryza sativa L. indica) under different crop geometries and nitrogen management practices

Black rice has more antioxidants than any other rice variety.  It is considered to have multiple benefits in human health due to the presence of different antioxidants. A field experiment was conducted during rainy season of 2015-2016 to assess the nitrogen uptake, use efficiency and economics of black rice production under different crop geometry and nitrogen (N) management practices in Rampur, Chitwan, Nepal. The experiment was laid out in strip plot design with three replications. The experiment consisted of  treatment combination of three crop geometry (20 cm × 20 cm, 20 cm × 15 cm and 15 cm × 15 cm) in vertical plots and three nitrogen management practices (N level: 30 kg N ha-1, 60 kg N ha-1, and LCC based N-management) in horizontal plots. The results showed that the highest N uptake was recorded from closer spacing (15 cm × 15 cm) with LCC based N management. The net return and B: C ratios were higher at a closer spacing of 15 cm × 15 cm with LCC based N management and closer spacing of 15 cm × 15 cm with N application of 60 kg ha-1. The overall analysis revealed that LCC based N management under closer crop geometry (15 cm × 15 cm) was the best management practices because of high nitrogen uptake and highest monetary return with B: C ratio of 5.76

Tumor reversion: a dream or a reality.

Reversion of tumor to a normal differentiated cell once considered a dream is now at the brink of becoming a reality. Different layers of molecules/events such as microRNAs, transcription factors, alternative RNA splicing, post-transcriptional, post-translational modifications, availability of proteomics, genomics editing tools, and chemical biology approaches gave hope to manipulation of cancer cells reversion to a normal cell phenotype as evidences are subtle but definitive. Regardless of the advancement, there is a long way to go, as customized techniques are required to be fine-tuned with precision to attain more insights into tumor reversion. Tumor regression models using available genome-editing methods, followed by in vitro and in vivo proteomics profiling techniques show early evidence. This review summarizes tumor reversion developments, present issues, and unaddressed challenges that remained in the uncharted territory to modulate cellular machinery for tumor reversion towards therapeutic purposes successfully. Ongoing research reaffirms the potential promises of understanding the mechanism of tumor reversion and required refinement that is warranted in vitro and in vivo models of tumor reversion, and the potential translation of these into cancer therapy. Furthermore, therapeutic compounds were reported to induce phenotypic changes in cancer cells into normal cells, which will contribute in understanding the mechanism of tumor reversion. Altogether, the efforts collectively suggest that tumor reversion will likely reveal a new wave of therapeutic discoveries that will significantly impact clinical practice in cancer therapy

Comparing cross-sectional and longitudinal approaches to Tuberculosis Patient Cost Surveys using Nepalese data.

The World Health Organization has supported the development of national tuberculosis (TB) patient cost surveys to quantify the socio-economic impact of TB in high-burden countries. However, methodological differences in study design (e.g. cross-sectional vs longitudinal) can generate different estimates making the design and impact evaluation of socioeconomic protection strategies difficult. The objective of the study was to compare the socio-economic impacts of TB estimated by applying cross-sectional or longitudinal data collections in Nepal. We analysed data from a longitudinal costing survey (patients interviewed at three-time points) conducted between April 2018 and October 2019. We calculated both mean and median costs from patients interviewed during the intensive (cross-sectional 1) and continuation phases of treatment (cross-sectional 2). We then compared costs, the prevalence of catastrophic costs and the socio-economic impact of TB generated by each approach. There were significant differences in the costs and social impacts calculated by each approach. The median total cost (intensive plus continuation phases) was significantly higher for the longitudinal compared to cross-sectional 2 (US$119.42 vs 91.63, P < 0.001). The prevalence of food insecurity, social exclusion and patients feeling poorer or much poorer were all significantly higher applying a longitudinal approach. In conclusion, the longitudinal design captured important aspects of costs and socioeconomic impacts which were missed by applying a cross-sectional approach. If a cross-sectional approach is applied due to resource constraints, our data suggest the start of the continuation phase is the optimal timing for a single interview. Further research to optimize methodologies to report patient incurred expenditure during TB diagnosis and treatment is needed

Comparing cross-sectional and longitudinal approaches to Tuberculosis Patient Cost Surveys using Nepalese data : Tuberculosis cost survey approaches

The World Health Organization has supported the development of national tuberculosis (TB) patient cost surveys to quantify the socio-economic impact of TB in high-burden countries. However, methodological differences in study design (e.g. cross-sectional vs longitudinal) can generate different estimates making the design and impact evaluation of socioeconomic protection strategies difficult. The objective of the study was to compare the socioeconomic impacts of TB estimated by applying cross-sectional or longitudinal data collections in Nepal. We analysed data from a longitudinal costing survey (patients interviewed at three-time points) conducted between April 2018 and October 2019. We calculated both mean and median costs from patients interviewed during the intensive (cross-sectional 1) and continuation phases of treatment (cross-sectional 2). We then compared costs, the prevalence of catastrophic costs and the socio-economic impact of TB generated by each approach. There were significant differences in the costs and social impacts calculated by each approach. The median total cost (intensive plus continuation phases) was significantly higher for the longitudinal compared to cross-sectional 2 (US$119.42 vs 91.63,

Barriers and facilitators to accessing tuberculosis care in Nepal : a qualitative study to inform the design of a socioeconomic support intervention

OBJECTIVE: Psychosocial and economic (socioeconomic) barriers, including poverty, stigma and catastrophic costs, impede access to tuberculosis (TB) services in low-income countries. We aimed to characterise the socioeconomic barriers and facilitators of accessing TB services in Nepal to inform the design of a locally appropriate socioeconomic support intervention for TB-affected households. DESIGN: From August 2018 to July 2019, we conducted an exploratory qualitative study consisting of semistructured focus group discussions (FGDs) with purposively selected multisectoral stakeholders. The data were managed in NVivo V.12, coded by consensus and analysed thematically. SETTING: The study was conducted in four districts, Makwanpur, Chitwan, Dhanusha and Mahottari, which have a high prevalence of poverty and TB. PARTICIPANTS: Seven FGDs were conducted with 54 in-country stakeholders, grouped by stakeholders, including people with TB (n=21), community stakeholders (n=13) and multidisciplinary TB healthcare professionals (n=20) from the National TB Programme. RESULTS: The perceived socioeconomic barriers to accessing TB services were: inadequate TB knowledge and advocacy; high food and transportation costs; income loss and stigma. The perceived facilitators to accessing TB care and services were: enhanced championing and awareness-raising about TB and TB services; social protection including health insurance; cash, vouchers and/or nutritional allowance to cover food and travel costs; and psychosocial support and counselling integrated with existing adherence counselling from the National TB Programme. CONCLUSION: These results suggest that support interventions that integrate TB education, psychosocial counselling and expand on existing cash transfer schemes would be locally appropriate and could address the socioeconomic barriers to accessing and engaging with TB services faced by TB-affected households in Nepal. The findings have been used to inform the design of a socioeconomic support intervention for TB-affected households. The acceptability, feasibility and impact of this intervention on TB-related costs, stigma and TB treatment outcomes, is now being evaluated in a pilot implementation study in Nepal

How to reduce household costs for people with tuberculosis : a longitudinal costing survey in Nepal

The aim of this study was to compare costs and socio-economic impact of tuberculosis (TB) for patients diagnosed through active (ACF) and passive case finding (PCF) in Nepal. A longitudinal costing survey was conducted in four districts of Nepal from April 2018 to October 2019. Costs were collected using the WHO TB Patient Costs Survey at three time points: intensive phase of treatment, continuation phase of treatment and at treatment completion. Direct and indirect costs and socio-economic impact (poverty headcount, employment status and coping strategies) were evaluated throughout the treatment. Prevalence of catastrophic costs was estimated using the WHO threshold. Logistic regression and generalized estimating equation were used to evaluate risk of incurring high costs, catastrophic costs and socio-economic impact of TB over time. A total of 111 ACF and 110 PCF patients were included. ACF patients were more likely to have no education (75% vs 57%, P = 0.006) and informal employment (42% vs 24%, P = 0.005) Compared with the PCF group, ACF patients incurred lower costs during the pretreatment period (mean total cost: US$55 vs US$87, P < 0.001) and during the pretreatment plus treatment periods (mean total direct costs: US$72 vs US$101, P < 0.001). Socio-economic impact was severe for both groups throughout the whole treatment, with 32% of households incurring catastrophic costs. Catastrophic costs were associated with ‘no education’ status [odds ratio = 2.53(95% confidence interval = 1.16–5.50)]. There is a severe and sustained socio-economic impact of TB on affected households in Nepal. The community-based ACF approach mitigated costs and reached the most vulnerable patients. Alongside ACF, social protection policies must be extended to achieve the zero catastrophic costs milestone of the End TB strategy

Mifepristone versus intracervical prostaglandin E2 gel for cervical ripening in primigravid patients at term

Background: The cervix has to play dual role in human reproduction. During pregnancy, it should remain firm and closed allowing the fetus to grow in utero until functional maturity is attained while during labour it should soften and dilate, allowing the fetus to pass through the birth canal. Objective of present study was to know and compare the effect of oral Mifepristone with intracervical dinoprostone gel for cervical priming prior to induction of labour at term in an unfavorable cervix of primigravida.Methods: This was prospective randomized comparative study. 100 primigravid patients were included, 50 were placed in each group A and B. Tablet Mifepristone 200mg orally was given in group A patients and intracervical dinoprostone gel induction was done in group B patients. Pre induction Bishop’s score was noted at beginning to compare improvement in Bishop’s score after induction. Mode of delivery and induction to delivery interval in both the groups were studied.Results: After induction with Mifepristone 76% women had successful cervical ripening as compared to 56% with dinoprostone. Rate of vaginal delivery was 70% with Mifepristone and 58% with dinoprostone. There was no significant difference in induction to delivery interval between the groups. Ten percent and 2% belonging to mifepristone and dinoprostone group respectively, required NICU admissions.Conclusions: Mifepristone is more effective than dinoprostone for preinduction cervical ripening as it has high success rate of achieving cervical ripening, however there is no significant difference in the vaginal delivery rate and other maternal and fetal outcome