Accuracy of Glucose Meter Among Adults in a Semi-urban Area in Kathmandu, Nepal

Introduction: Glucose meters are gaining popularity in monitoring of blood glucose at household levels and in health care set-ups due to their portability, affordability and convenience of use over the laboratory based reference methods. Still they are not free of limitations. Operator’s technique, extreme temperatures, humidity, patients’ medication, hematocrit values can affect the reliability of glucose meter results. Hence, the accuracy of glucose meter has been the topic of concern since years. Therefore, present study aims to evaluate the analytical and clinical accuracy of glucose meter using International Organization for Standardization 15197 guideline. Methods: A community based descriptive cross-sectional study was conducted in Kapan, Kathmandu, Nepal in April 2018. Glucose levels were measured using glucose meter and reference laboratory method simultaneously among 203 adults ≥20 years, after an overnight fasting and two hours of ingestion of 75 grams glucose. Modified Bland-Altman plots were created by incorporating ISO 15197 guidelines to check the analytical accuracy and Park error grid was used to evaluate the clinical accuracy of the device. Results: Modified Bland-Altman plots showed>95% of the test results were beyond the acceptable analytical criteria of ISO 15197:2003 and 2013. Park Error Grid-Analysis showed 99% of the data within zones A and B of the consensus error grid. Conclusions: Glucose meter readings were within clinically acceptable parameters despite discrepancies on analytical merit. Possible sources of interferences must be avoided during the measurement to minimize the disparities and the values should be interpreted with caution.

Maculosin, a non-toxic antioxidant compound isolated from Streptomyces sp. KTM18

Context Streptomyces species are prolific sources of bioactive secondary metabolites known especially for their antimicrobial and anticancer activities. Objective This study sought to isolate and characterize antioxidant molecules biosynthesized by Streptomyces sp. KTM18. The antioxidant potential of an isolated compound and its toxicity were accessed. Materials and methods The compound was purified using bioassay-guided chromatography techniques. Nuclear magnetic resonance (NMR) experiments were carried out for structure elucidation. The antioxidant potential of the isolated compound was determined using DPPH free radical scavenging assay. The toxicity of the isolated compound was measured using a brine shrimp lethality (BSL) assay. Results Ethyl acetate extract of Streptomyces sp. KTM18 showed more than 90% inhibition of DPPH free radical at 50 mu g/mL of the test concentration. These data were the strongest among 13 Streptomyces isolates (KTM12-KTM24). The active molecule was isolated and characterized as maculosin (molecular formula, C14H16N2O3 as determined by the [M + H](+) peak at 261.1259). The DPPH free radical scavenging activity of pure maculosin was higher (IC50, 2.16 +/- 0.05 mu g/mL) than that of commercial butylated hydroxyanisole (BHA) (IC50, 4.8 +/- 0.05 mu g/mL). No toxicity was observed for maculosin (LD50, <128 mu g/mL) in brine shrimp lethality assay (BSLA) up to the compound's antioxidant activity (IC50) concentration range. The commercial standard, berberine chloride, showed toxicity in BSLA with an LD50 value of 8.63 +/- 0.15 mu g/mL. Conclusions Maculosin may be a leading drug candidate in various cosmetic and therapeutic applications owing to its strong antioxidant and non-toxic properties

Finding the Money: A stock taking of climate change adaptation finance and governance in Nepal

This report 'Finding the Money: A stock taking of climate change adaptation finance and governance in Nepal' is developed under a multi-country initiative, 'Adaptation Finance Accountability Initiative (AFAI)', by Oxfam in collaboration with the Overseas Development Institute (ODI), World Resources Institute (WRI) and Clean Energy Nepal (CEN). This study takes stock of climate change adaptation/resilience projects and programs funded by international public finance in Nepal. The study covers projects that started or were approved during the period of 2009 to 2012

Non-high density lipoprotein cholesterol versus low density lipoprotein cholesterol as a discriminating factor for myocardial infarction

Abstract Background Serum total cholesterol (TC) and LDL cholesterol (LDL-C) have been used as major laboratory measures in clinical practice to assess cardiovascular risk in the general population and disease management as well as prognosis in patients. However, some studies have also reported the use of non-HDL cholesterol (non-HDL-C). As non-HDL-C can be calculated by subtracting HDL-C from TC, both of which do not require fasting blood sample in contrast to LDL-C which requires fasting blood sample, we aimed to compare non-HDL-C with LDL-C as a predictor of myocardial infarction (MI). Methods This hospital based cross sectional study was undertaken among 51 cases of MI and equal number of controls. MI was diagnosed based on the clinical history, ECG changes and biochemical parameters. 5 mL of fasting blood sample was collected from each research participant for the analysis of lipid profile. Non-HDL-C was calculated by using the equation; Non-HDL-C = TC – HDL-C. Statistical analysis was performed using SPSS 14.0. Results 42 MI cases were dyslipidemic in contrast to 20 dyslipidemic subjects under control group. The differences in the median values of each lipid parameter were statistically significant between MI cases and controls. The lipid risk factors most strongly associated with MI were HDL-C (OR 5.85, 95% CI 2.41-14.23, P value = 0.000) followed by non-HDL-C (OR 3.77, 95% CI 1.64-8.66, P value = 0.002), LDL-C/HDL-C (OR 3.38, 95% CI 1.44-7.89, P value = 0.005), TC/HDL-C (OR 2.93, 95% CI 1.36-7.56, P value = 0.026), LDL-C (OR 2.70, 95% CI 1.20-6.10, P value = 0.017), TC (OR 2.68, 95% CI 1.04-6.97, P value = 0.042) and Tg (OR 2.54, 95% CI 1.01-6.39, P value = 0.047). Area under the receiver operating curve was greater for non-HDL-C than for LDL-C. Non-HDL-C was also found to be more sensitive and specific than LDL-C for MI. Conclusions HDL-C and non-HDL-C are better discriminating parameters than LDL-C for MI. Thus, we can simply perform test for HDL-C and non-HDL-C both of which do not require fasting blood sample rather than waiting for fasting blood sample to measure LDL-C.</p

REFINE (Rapid Feedback for quality Improvement in Neonatal rEsuscitation) : an observational study of neonatal resuscitation training and practice in a tertiary hospital in Nepal.

BACKGROUND: Simulation-based training in neonatal resuscitation is more effective when reinforced by both practice and continuous improvement processes. We aim to evaluate the effectiveness of a quality improvement program combined with an innovative provider feedback device on neonatal resuscitation practice and outcomes in a public referral hospital of Nepal. METHODS: A pre- and post-intervention study will be implemented in Pokhara Academy of Health Sciences, a hospital with 8610 deliveries per year. The intervention package will include simulation-based training (Helping Babies Breathe) enhanced with a real-time feedback system (the NeoBeat newborn heart rate meter with the NeoNatalie Live manikin and upright newborn bag-mask with PEEP) accompanied by a quality improvement process. An independent research team will collect perinatal data and conduct stakeholder interviews. DISCUSSION: This study will provide further information on the efficiency of neonatal resuscitation training and implementation in the context of new technologies and quality improvement processes. TRIAL REGISTRATION: https://doi.org/10.1186/ISRCTN18148368 , date of registration-31 July 2018