BackgroundIodine deficiency is a major public health problem in many developing countries including Nepal. The present study was designed to investigate the urinary iodine excretion (UIE), thyroid function status and household salt iodine content (SIC) in school-aged children (SAC) and to establish the relationships between these factors.MethodsA community-based cross sectional study was conducted in selected schools of two districts, Tehrathum and Morang, lying in the hill and plain region of eastern Nepal respectively. A total of 640 SAC, (Tehrathum n = 274 and Morang n = 366) aged 6–11 years, were assessed for UIE and household SIC. Among the 640 children, 155 consented to blood samples (Tehrathum n = 78 and Morang n = 77) to test for serum thyroglobulin (Tg), thyroid stimulating hormone (TSH), free triiodothyronine (fT3) and free thyroxine (fT4). UIE was measured by ammonium persulfate digestion method. SIC was measured by iodometric titration method and Tg, TSH, fT4 and fT3 were measured by immunoassay based kit method.ResultsIn Tehrathum and Morang, 9.5 and 7.7 % of SAC had UIE values of UIE <100 µg/L while 59.5 and 41 % had iodine nutrition values of >299 µg/L, with median UIE of 345.65 and 270.36 µg/L respectively. The overall medians were as follows, Tg 14.29 µg/L, fT3 3.94 pmol/L, fT4 16.25 pmol/L and TSH 3.61 mIU/L. There was a negative correlation between UIE and Tg (r = −0.236, p = 0.003) and a positive correlation between UIE and SIC (r = 0.349, p < 0.0001). We found 19.5 %, n = 15 and 16.7 %, n = 13 subclinical hypothyroid cases in Morang and Tehrathum respectively. Iodometric titration showed only 6.4% (n = 41) of the samples had household SIC <15 ppm. Multivariate analysis revealed that use of packaged salt by SAC of Tehrathum district correlated with higher UIE values.ConclusionsOur focused data suggests that collaborative universal salt iodization (USI) programs are improving the health of children in the Tehrathum and Morang districts of Nepal. We also found that excessive iodine in a large portion of the study groups is a substantial concern and iodine intervention programs need to deal with both deficient and excessive iodine scenarios that can both be present simultaneously in study populations.
Background: Problem based learning (PBL) has made major impact on curricular designing and practice in medical education for the last forty years. Incorporation of PBL approach in medical education has been a challenge and opportunity for both educationists on how to impart change and medical teachers on how to internalise the change. Objectives: This paper aimed to investigate experiences, achievement and responses of medical teachers at B. P. Koirala Institute of Health Sciences (BPKIHS), Nepal. Materials and methods: There were 25 heterogeneous groups of teachers, majority of them were entry level. Pre- and Post- test question were taken from various topics relevant to PBL such as learning strategy and principles of adult learning, PBL practice at BPKIHS, tutorial session and role of a tutor, making resource session interactive, designing PBL problems, planning educational objectives in PBL, formulation of problem for PBL. In addition to it participants' perception on development and dissemination of PBL manual and effectiveness of workshop were also included in the questionnaire. Results: There was significant gain in knowledge following the workshop (p<0.001). The perception of the teacher found quite relevant and useful for adopting new role as tutor. The respondent teachers noted that skills they learned during the training will be applicable to their job situation. They stressed for an additional training for reinforcement and update with new trends and tools in PBL. Conclusion: Therefore, such trainings for faculty development would be highly beneficial to inculcate new competencies in PBL. Key words: BPKIHS; Faculty Development; Problem Based Learning DOI: 10.3126/kumj.v8i1.3237 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 141-145
Metabolic syndrome (MetS) has been found to be associated with inflammatory molecules. This study was conducted among 125 MetS patients at B P Koirala Institute of Health Sciences, Dharan, Nepal to find an association of high-sensitivity C-reactive protein (hs-CRP) and serum uric acid with MetS components. Anthropometric measurements, blood pressure, medical history and blood samples were taken. Estimation of hs-CRP, serum uric acid, blood glucose, triglyceride and high density lipoprotein (HDL) cholesterol was done. hs-CRP had positive correlation with blood glucose (r = 0.2, p = 0.026) and negative with HDL cholesterol (r = −0.361, p < 0.001). Serum uric acid had positive correlation with waist circumference (r = 0.178, p = 0.047). Patients with elevated hs-CRP and uric acid had higher waist circumference (p = 0.03), diastolic BP (p = 0.002) and lower HDL cholesterol (p = 0.004) than others. Elevated hs-CRP and high uric acid were individually associated with higher odds for low HDL cholesterol (7.992; 1.785–35.774, p = 0.002) and hyperglycemia (2.471; 1.111–5.495, p = 0.029) respectively. Combined rise of hs-CRP and uric acid was associated with severity of MetS (p < 0.001) and higher odds for hyperglycemia (8.036; 2.178–29.647, p = 0.001) as compared to individual rise of hs-CRP or uric acid. The present study demonstrates that hs-CRP and serum uric acid are associated with MetS components, and the combined rise of hs-CRP and uric acid is associated with the increase in severity of MetS.
INTRODUCTION: Diabetic nephropathy is one of the major complications of Diabetes Mellitus characterized by persistent albuminuria, elevated arterial blood pressure, a relentless decline in glomerular filtration rate (GFR) and a high risk of cardiovascular morbidity and mortality. METHODS: In this study, urinary micro-albumin estimation was done in 177 diabetic patients. This study aims to ascertain association of glycemicstatus, lipid profile and proteinuria in Type 2 Diabetes Mellitus with nephropathy. RESULTS: Among 177 patients, 26 had frank proteinuria, 79 had micro-albuminuria and 72 were without proteinuria. Increased frequency ofproteinuria was seen in male than female. Micro-albuminuria and frank proteinuria was seen more in older age group. The multiple comparisons showed the significantly increased levels of urea, creatinine, fasting blood glucose in micro-albuminuria and overt proteinuria patients in comparison to without proteinuria. Glycated hemoglobin level was increased with the increasing age group particularly in overt proteinuric patients. CONCLUSIONS: The glycemic control, monitoring of lipid profile and early urinary protein estimation with better management may delay diabetic nephropathy or its further complications in diabetes mellitus. KEYWORDS: diabetes mellitus, diabetic nephropathy, frank proteinuria, glycated hemoglobin, micro-albuminuria.
Birth asphyxia is one of the common causes of mortality and morbidity in neonates and the incidence is 2–9per 1000 live borns. The present work is a retrospective hospital based observational study. Babies born atB.P. Koirala Institute of Health Sciences, Dharan, Nepal during the period from April 2002 to April 2003with gestational age 37 weeks with Apgar score 6 at 5 minutes were included in the study. The aim wasto study the clinical profile, the acid base parameters and the outcome of asphyxiated newborns. Babies withcongenital defects, evidence of infection and maternal drug addiction were excluded from the study. Allbabies were resuscitated according to the guidelines of American Heart Association. Data on 50 birth asphyxia cases were tabulated and analysed. There were 10 (20%) cases of severe birth asphyxia (Apgar score:1-3 ) and 40 (80%) cases of moderate birth asphyxia (Apgar score: 4-6). Staging of hypoxic ischaemic encephalopathy (HIE) was performed according to Sarnat’s staging. Thirty percent of these cases presentedwith various stages of HIE and the incidence was higher in low Apgar score group. The common presentations of HIE cases had depressed neonatal reflexes, seizures, lethargy, and pupillary abnormalities. Thecommon acid base disturbance was metabolic acidosis which was observed only in babies with HIE-3. Twoneonates (4%) died during the hospital stay due to multiorgan failure and severe metabolic acidosis.Key Words: Birth asphyxia, Hypoxic ischaemic encephalopathy, Apgar score
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