bluuebunny/crossref_metadata_2025_split huggingface dataset:
Future of Clinical Trials in Nepal
Authors: Sathian Brijesh 
Published: December 2011

Nowadays the output—and rewards—of research are based almost entirely on published papers in scientific journals. Scientists in low-income and middle-income settings would like to conduct research for their populations according to their own concerns. They want to be in the frontlines of national and global communications about their country’s experiences. I recommend that properly trained clinical trial experts from developed countries should conduct some workshops on the design, conduct and ethical issues in clinical trials to terminate the research misconduct in developing countries.DOI: http://dx.doi.org/10.3126/nje.v1i2.5090 Nepal Journal of Epidemiology 2011;1 (2):44-46
Hepatic Steatosis and Diabetes Mellitus: Risk Factors, Pathophysiology and with its Clinical Implications: A Hospital Based Case Control Study in Western Region of Nepal
Authors: Mittal Ankush , Sathian Brijesh , Chandrasekharan Nishida , Lekhi Akshay , Rahib Rashad , Dwedi Sanjeev 
Published: December 2011

Background: The perception of nonalcoholic fatty liver disease (NAFLD) as an infrequent and benign condition is swiftly altering in developing countries as there has been an upsurge in non alcoholic fatty liver disease in Asia-Pacific region. NAFLD develops across all age groups and societies and is recognized to occur in 14%–30% of the common population. The foremost risk factors for NAFLD such as central obesity, diabetes mellitus, insulin resistance, dyslipidemia, hypertension, hypertriglyceridemia are currently predominant and puts a very large population at risk of evolving hepatic steatosis in the coming decades. Material and Methods: It was a hospital based case control study carried out in the Department of Biochemistry of Manipal Teaching Hospital, Pokhara, Nepal between 1st January 2010 and 31st Dec 2010. The variables collected were age, gender, fasting blood glucose, total cholesterol, low density lipoproteins, triglycerides, high density lipoproteins, very low density lipoproteins, aspartate transaminase, alanine transaminase. Results: Of the 200 patients of non alcoholic fatty liver disease patients with diabetes mellitus, all the variables except triglycerides shows insignificant disparity in relation to gender. The perceptible difference was observed in mean values of triglycerides for cases of NALFD between diabetes (218.25 ± SD 73.68) and non diabetic subjects (177.54 ± SD73.45) (p=.0001). The mean values of HDL did not illustrate much difference in cases of NALFD with diabetes (41.54 ± SD2.13) and non diabetic subjects (44.24 ± SD2.05). Conclusion: Public health initiatives are undoubtedly of the essence to halt or turn around the global 'diabesity' pandemic, the causal basis of NAFLD. Management of patients with NAFLD should be aimed at treating metabolic risk factors such as hyperglycemia and hypertriglyceridemia. Successful lifestyle adaptation with increased exercise and decreased food intake is able to remove the accumulation of liver fat and can reverse insulin resistance.Key words: Hepatic steatosis; Diabetes mellitus; Risk factors; Nepal.DOI: http://dx.doi.org/10.3126/nje.v1i2.5135 Nepal Journal of Epidemiology 2011;1 (2):51-56
Medications in Bronchospasm and Asthma among the Critically Ill Patients: A Drug Utilization Study from Southern India
Authors: John Lisha Jenny , John Jenny , Devi Padmini , Arifulla Mohamed , Guido Shoba 
Published: December 2011

Objective: Critically ill patients are prone for altered reactivity of the airway and drug therapy has pivotal role in the management of bronchospasm. The objective of the study was to evaluate the prescribing patterns and adverse effects of therapeutic agents for bronchospasm and asthma in the medical ICU.Methods: A prospective observational study was carried out among inpatients of the medical ICU receiving drugs for bronchospasm and asthma.Results: 220 patients received drugs for bronchospasm and asthma. Male preponderance was noticed (60.5%). Salbutamol (R03AC02) 92.7% was the most common bronchodilator prescribed. Ipratropium plus salbutamol (R03AK04) 55.5% was most frequently used bronchodilator combination. All bronchodilators were administered by inhalational route (nebulization) except methylxanthines Conclusion: Utilization patterns of drugs for bronchospasm and asthma were in concordance with treatment guidelines.Key words: Bronchospasm; Asthma; Southern IndiaDOI: http://dx.doi.org/10.3126/nje.v1i2.5136 Nepal Journal of Epidemiology 2011;1 (2):57-59
Case Control Studies in Medical Research
Authors: Sathian Brijesh , Sreedharan Jayadevan , Mittal Ankush , Chandrasekharan Nishida , Baboo Suresh N , S Abhilash E , E Rajesh , Dixit Shyam Bihari 
Published: December 2011

Case-control studies can yield important scientific findings with relatively little time, money, and effort compared with other study designs. Investigators implement case-control studies more frequently than any other analytical epidemiological study. Unfortunately, case-control designs also tend to be more susceptible to biases than other comparative studies. Although easier to do, they are also easier to do wrong. A good design should aim to minimise error and bias. All remaining sources of error and bias should be recognised and decisively evaluated. Case-control studies that are well designed and carefully done can provide useful and reliable results. Investigators must, however, devote painstaking attention to the selection of control groups and to measurement of exposure information. When the number of cases is small, the ratio of controls to cases can be raised to improve the ability to find important differences. Although no ideal control group exists, readers need to think carefully about how representative the controls are. Poor choice of controls can lead to both wrong results and possible medical harm. Awareness of these key elements should help readers to identify the strengths and weaknesses of a properly reported study.Keywords: Bias; Effect size; ConfoundingDOI: http://dx.doi.org/10.3126/nje.v1i3.5569 Nepal Journal of Epidemiology 2011;1(3) 77-80
Hyperuricemia as an Additional Risk Factor for Coronary Artery Disease: A Hospital Based Case Control Study in Western Region of Nepal
Authors: Mittal Ankush , Sathian Brijesh , Kumar Arun , Chandrasekharan Nishida , Farooqui Shamim Mohammad , Singh Shailendra , Yadav Shambhu Kumar 
Published: December 2011

Background In the 21st century, cardiovascular diseases will continue to dominate the disease spectrum and death statistics in both the industrialized and developing worlds. Coronary artery disease (CAD) is the foremost cause of cardiovascular disease related deaths worldwide, with >4.5 million deaths taking place in the developing world. Augmented serum uric acid levels are recurrently come across with hyperlipidemia, atherosclerosis, obesity, glucose intolerance, renal disease, and hypertension which all play a fundamental role in the pathogenesis of coronary artery disease. Materials and methods It was a hospital based case control study carried out in the Department of Biochemistry of Manipal Teaching Hospital, Pokhara, Nepal between 1st January 2010 and 31st December 2010. The variables collected were age, gender, serum uric acid, total cholesterol, low density lipoproteins, triglycerides, high density lipoproteins and very low density lipoproteins. Approval for the study was obtained from the institutional research ethical committee. Results There was insignificant difference for age between groups. In cases of hyperuricemia, there was marked increase in levels of serum uric acid (8.043± 0.43 mg/dl) when compared to controls (4.28 ± 0.66 mg/dl. In patients suffering from coronary artery disease with hyperuricemia, there was marked increased in levels of serum uric acid(8.222 ± 0.39 mg/dl) found to be statistically significant when compared to controls (4.285 ±0.66 mg/dl) and values were quite similar to hyperuricemic patients (8.043 ± 0.43 mg/dl).Further, in patients suffering from coronary artery disease with hyperuricemia, there was marked increased in mean values of serum total cholesterol (257.56 ± 22.65 mg/dl) ) when compared to controls (173.22 ± 32.63mg/dl). Conclusion Hypercholesterolemia due to hyperuricemia is most common modifiable factor for coronary artery disease. Allopurinol and newer urate-lowering agents restores endothelial function in coronary artery disease patients. The ability of physicians to pharmacologically manage serum urate levels, a better understanding of the interaction between hyperuricemia, gout and vascular disease may be critical for the reduction of morbidity and mortality in high-risk coronary artery disease patients.Key words: Hyperuricemia; Coronary artery disease; Nepal DOI: http://dx.doi.org/10.3126/nje.v1i3.5571 Nepal Journal of Epidemiology 2011;1(3) 81-85
Pattern of Blood Pressure Distribution among University Students in Ajman, United Arab Emirates
Authors: Basha S A , Mathew E , Sreedharan Jayadevan , Muttappallymyalil Jayakumari , Sharbatti S A , Shaikh R B 
Published: December 2011

Background Elevated blood pressure has been identified as a silent killer contributing to mortality and morbidity worldwide, hence it is essential to identify the high risk individuals at an early age to prevent the progress of the disease and its co-morbid conditions. Objective The objective of the present cross-sectional study was to assess the pattern of blood pressure distribution among students of medical and allied health professions at Gulf Medical University (GMU) Ajman, United Arab Emirates (UAE). Methods The study was conducted from November 2009 to February 2010. GMU has academic programmes such as Bachelor of Medicine, Physical therapy, Pharm D and Dental Medicine with a multiethnic student population. A pretested structured instrument used for data collection and blood pressure was measured using mercury sphygmomanometer. Descriptive statistics such as means and standard deviation were used to summarize the quantitative variables. The association of age, gender and nationality with systolic and diastolic blood pressure was determined by Pearson's correlation coefficient and a p-value ≤ 0.05 was considered statistically significant. Results The systolic and diastolic blood pressures were evenly distributed across all students irrespective of their age. A significantly higher systolic blood pressure in males was observed when compared to females, but the difference was not significant in diastolic blood pressure. In the present study among medical and allied health science students, the distribution of blood pressure was not associated with age. The mean systolic blood pressure and diastolic blood pressure were seen to be higher among Arabs when compared to Non-Arabs though not statistically significant. Family history of metabolic diseases did not show any association with the mean blood pressure. Conclusion There was a strong association for developing hypertension among male when compared to female gender. Key Words: University students; Age; Gender; Nationality; Systolic blood pressure; Diastolic blood pressureDOI: http://dx.doi.org/10.3126/nje.v1i3.5572 Nepal Journal of Epidemiology 2011;1(3) 86-89
Association of BMI on Systolic and Diastolic Blood Pressure In Normal and Obese Children
Authors: Gundogdu Zuhal 
Published: December 2011

Background Definition of childhood overweight/obesity should aim to identify children with excess body fat in order to treat the associated adverse health outcomes. Objective To investigate relationship between Body Mass Index (BMI) and systolic blood pressure (SBP) and diastolic blood pressure (DBP) values in children between the ages of 6 and 14 year old. Materials and Methods Secondary data gathered from public health screening days at Child Health and Diseases Polyclinic of Kocaeli Metropolitan Municipality Maternity and Children Hospital on 1899 children. Each child was classified on the basis of age- and sex-specific Body Mass Index percentile (BMI%) as normal weight (BMI% < 85th), overweight (BMI% ≥ 85th and < 95th), or obese (BMI% ≥ 95th). Systolic and diastolic blood pressures were compared among age-sex-BMI percentile groups. Results SBP and DBP values are higher in obese and overweight children compared to normal children. Among all children in this study, being overweight and obese increased the likelihood of elevated SBP and DBP values after adjusting for age. Blood pressure (BP) is increasing with increasing BMI in all age groups (6 to 14 year old) and this is also found at a young age. The same trend is also present within the normal BMI% group. Conclusions Our results show that BMI is associated with elevated systolic and diastolic blood pressure in overweight and obese children as well as children in normal BMI% group. BP is increasing with increasing BMI values even in normal group but the increase is more in obese children. Hence, maintaining age related normal growth increase in the BMI in childhood is important in preventing higher BP values later in life.Keywords: Body Mass Index; BMI; Blood pressure; Children DOI: http://dx.doi.org/10.3126/nje.v1i3.5574 Nepal Journal of Epidemiology 2011;1(3) 101-105
Medical Students View about the Integrated MBBS Course: A Questionnaire Based Cross-sectional Survey from a Medical College of Kathmandu Valley
Authors: Banerjee Indrajit , Jauhari Akhilesh Chandra , Johorey Ajay Chandra , Bista Durga , Roy Bedanta , Sathian Brijesh 
Published: December 2011

Background Accreditation of curriculum by students may be useful in further modification of teaching and learning methods in medical colleges of any country specially Nepal. Course curriculum of medical sciences is made by learned professors of Universities, politicians and the government officers without consulting the students for whom it is made. In Nepal, Medical education is an experimental integrated teaching of four and half years for MBBS degree. Until now it has not been assessed as to what type of Doctors we are producing. This paper aims on the objective to find out whether integrated teaching or classical medical studies produce better doctors. Methods The present study was done to assess the teaching, learning and evaluation procedures adopted in Nepal Medical College, Kathmandu by getting feedback from students of 4th (Basic Sciences), 5th-7th semesters and feedback was also taken from a few final year students (Clinical Sciences). A total of nearly two hundred students from this institution participated in this study. A multi-graded questionnaire was prepared and a pilot study of 20 students was done and the results were discussed among the authors to modify the questionnaire. This modified questionnaire was used in the main study. The same questionnaire was used for eliciting feedback from clinical students. The present study was undertaken from August 2008-January 2009. Results Out of 200 medical students, the mean age was found to be 19.4 ± 3 years SD. In gender distribution, male students (61%) were higher than female students (39%). Most of the medical students (70%) wanted to become doctor, to become rich and famous, 90% wanted to go to US (Massive brain drain). 90% of the students perceived that Anatomy is the most interesting and most relevant basic science subject for clinical studies and in Anatomy theory hours of teaching is to be increased (60%). Community Medicine was the most uninteresting subject of Basic sciences and if they are assured of attendance which subject they would not like to attend community medicine classes. 85% wanted that Pharmacology should be reduced in first four semesters and should be extended to seventh semester like Community Medicine. The best teaching method is Chalk and Board Method (60%) and followed by LCD slides (20%). Conclusion: Overall the results were alarming and may be taken up seriously by the policy makers. They can bring about amendments in course curriculum of universities in future.Keywords: Medical Education; Under-graduate; Post- Graduate; Nepal Medical College. DOI: http://dx.doi.org/10.3126/nje.v1i3.5575 Nepal Journal of Epidemiology 2011;1(3) 95-100
Bird Flu, the Hanging Pandemic Threat for Human - It's Risk Assessment and Containment
Authors: Hossain M Anwar , Ahmad M Intakhar , Karim M Manjurul 
Published: December 2011

Bird flu, synonym of avian influenza (AI) caused by influenza A virus, become concern across the world for the possible incidence of the next human influenza pandemic. The latent danger of AI pandemic remains very real, though, the precise timing of occurrence and severity is uncertain. Each avian influenza type A (AIA) contains one of the 16 subtypes of haemagglutinin (HA) and 9 neuraminidases (NA) implicating theoretically 144 subtypes of AIA are possible in circulation, but only H1N1, H2N2 and H3N2 subtypes are documented for past pandemics in humans. In recent years H5N1, H7N3, H7N2, H7N7 and H9N2 are isolated from human samples, though H1N1 and H3N2 are still in circulation. Avian influenza viruses preferentially recognize receptor containing sialosugar chains terminating in sialic acid ?-2,3-galactose in bird, whereas, human preferentially contain ?-2,6-galactose subtype-receptor. To initiate a pandemic outbreak in human, the AIA viruses need alteration of receptor recognition specificity; and perfect match between HA and NA along with optimal cellular tropism. Cyclic nature of bird-flu emergence, and moreover, sporadic human incident reported around Asia and Europe in recent years anticipating a pandemic appearance of bird-flu in time to come. As we are on the edge of this alarming situation, AI prevention and containment can be considered under categories of surveillance, intervention, antiviral drugs, vaccination together with environment management issues.Keywords: Pandemic; Avian influenza; Genetic reassortment; Host specificity; Environment management DOI: http://dx.doi.org/10.3329/bjm.v25i1.4847Bangladesh J Microbiol, Volume 25, Number 1, June 2008, pp 1-8
Treating HIV-Infected Mothers Reduces under 5 Years of Age Mortality Rates to Levels Seen in Children of HIV-Uninfected Mothers in Rural South Africa
Authors: Ndirangu James , Newell Marie-Louise , Thorne Claire , Bland Ruth 
Published: December 2011

Background Maternal and child survival are highly correlated, but the contribution of HIV infection on this relationship, and in particular the effect of HIV treatment, has not been quantified. We estimate the association between maternal HIV and treatment, and under 5 years of age (under-5) child mortality in a rural population in South Africa. Methods All children born between January 2000 and January 2007 in the Africa Centre Demographic Surveillance Area were included. Maternal HIV status information was available from HIV surveillance; maternal antiretroviral treatment (ART) information from the HIV Treatment Programme database was linked to surveillance data. Mortality rates were computed as deaths per 1,000 person-years observed. Time-varying maternal HIV effect (positive, negative, ART) on under-5 mortality was assessed in Cox regression, adjusting for other factors associated with under-5 mortality. Results In total, 9,068 mothers delivered 12,052 children, of whom 947 (7.9%) died before age 5. Infant mortality rate declined by 49% from 69.0 in 2000 to 35.5 in 2006 deaths per 1,000 person-years observed; a significant decline was observed post-ART (2004–2006). The estimated proportion of deaths across all age groups were higher among the children born to the HIV-positive and HIV-not-reported status women than among children of HIV-negative women. Multivariably, mortality in children of mothers on ART was not significantly different from children of HIV-negative mothers (adjusted hazard ratio 1.29, 0.53–3.17; P=0.572). Conclusions These findings highlight the importance of maternal HIV treatment with direct benefits of improved survival among all children under-5. Timely HIV treatment for eligible women is required to benefit both mothers and children.
Current Trends in the Integration and Reimbursement of Complementary and Alternative Medicine by Managed Care, Insurance Carriers, and Hospital Providers
Authors: Pelletier Kenneth R. , Marie Ariane , Krasner Melissa , Haskell William L. 
Published: December 2011

Objectives. To assess the status of managed care and insurance coverage of complementary and alternative medicine (CAM) and the integration of such services offered by hospitals. Methods. A literature review and information search was conducted to determine which insurers had special policies for CAM and which hospitals were offering CAM. Telephone interviews were conducted with a definitive sample of 18 insurers and a representative subsample of seven hospitals. Results. A majority of the insurers interviewed offered some coverage for the following: nutrition counseling, biofeedback, psychotherapy, acupuncture, preventive medicine, chiropractic, osteopathy, and physical therapy. Twelve insurers said that market demand was their primary motivation for covering CAM. Factors determining whether insurers would offer coverage for additional therapies included potential cost-effectiveness based on consumer interest, demonstrable clinical efficacy, and state mandates. Some hospitals are also responding to consumer interest in CAM, although hospitals can only offer CAM therapies for which local, licensed practitioners are available. Among the most common obstacles listed to incorporating CAM into mainstream health care were lack of research on efficacy, economics, ignorance about CAM, provider competition and division, and lack of standards of practice. Conclusions. Consumer demand for CAM is motivating more insurers and hospitals to assess the benefits of incorporating CAM. Outcomes studies for both allopathic and CAM therapies are needed to help create a health care system based upon treatments that work, whether they are mainstream, complementary, or alternative.
Stages of Change for Physical Activity, Diet, and Smoking among HMO Members with Chronic Conditions
Authors: Boyle Raymond G. , O'Connor Patrick J. , Pronk Nicolaas P. , Tan Agnes 
Published: December 2011

Purpose. This paper investigated whether stage of change for health behaviors was associated with the presence of chronic conditions. Design. A stratified cross-sectional survey by mail with telephone follow-up. Settings. This study was conducted at a mixed-model HMO with 650,000 members based in Minnesota. Subjects. The sample consisted of a random sample of 8000 HMO members age 40 or over with systematic oversampling of members with hypertension, diabetes, dyslipidemia, or heart disease. Measures. In addition to demographics, readiness to change for physical activity, fat intake, fruit and vegetable intake, and smoking were assessed. Results. The adjusted response rate was 82.4%. In a logistic regression analysis, members with one or more than one chronic condition had greater readiness to change for three out of four risk factors compared to members with no chronic conditions. Conclusions. The stage-of-change distribution of HMO members with chronic conditions suggests that members at highest risk of adverse health outcomes have the greatest readiness to change behavioral risk factors. Based on these observations, targeted, stage-specific efforts to support behavior change are likely to be both acceptable and effective in HMO members with chronic conditions. Improving stage of change for behavioral risk factors for members with diabetes may present special problems and opportunities.