Background Hypertension is a major modifiable risk factor for cardiovascular disease, the world’s leading cause of death. The prevalence of hypertension is disproportionately higher in South Asian countries than in other regions of the world. Screening for hypertension in primary care settings remains a challenge in many South Asian countries, including Nepal. Nepal is located in the Himalayan Mountains region, posing significant geographical challenges for its rural citizens to access primary health care and service delivery. This barrier increases the costs and inconvenience for rural Nepalis to access hypertension screening and treatment. As a result, the prevalence of hypertension in Nepal tripled in the last 25 years to 22.4%-38.6%. Nepal’s Ministry of Health and Population relies on female community health volunteers to link health centers and communities to provide basic health services. Over 50,000 of these volunteers in Nepal have received basic health care training and are assigned to take care of maternal and child health. Due to limited health care resources, adopting new methods to control hypertension is an urgent need in Nepal. Several recent studies in Nepal have recommended extending the role of female community health volunteers to include hypertension management through blood pressure monitoring and home-based education. Objective The goal of this study was to assess if a mobile health–based female community health volunteer approach of combining the traditional community health volunteer program with digital technologies would be feasible and acceptable in rural Nepal. Methods In this study, we recruited 17 female community health volunteers and extended their role from maternal and child health to hypertension management through screening blood pressures. Results All 17 female community health volunteers successfully measured 1113 rural Nepalis’ blood pressures, identified 169 hypertensive patients, and collected health behaviors data of the 169 hypertensive patients. Among the 169 patients, 70% of them had a mobile phone, and 92% were interested in receiving health-related information via a mobile phone. Among those who were interested in receiving information via a mobile phone, 84% preferred voice calls, and 7% and 1% preferred texting and apps, respectively. Conclusions Results from this study indicate that a digital health intervention that leverages feature-phones combined with female community health volunteers may be an acceptable and pragmatic way to implement an evidence-based program to reduce hypertension in rural Nepal.

The neonatal abstinence syndrome (NAS) is a potentially life threatening illness associated with significant morbidity especially in the neonatal period. A case of NAS due to codeine prescribed for pain relief during pregnancy is reported.Clinicians should be aware that narcotic derivatives prescribed in late pregnancy can give rise to this type of problem. (Arch Dis Child 1997;76:F59-F60) Keywords: codeine; withdrawal; neonatal abstinence syndrome.The neonatal abstinence syndrome (NAS) is most commonly described in association with narcotic use by pregnant addicts.1 It is also seen with many other classes of drugs including non-narcotic sedatives, stimulants, antidepressants, anti-epileptics and neuroleptics. More recently, work has focused on symptoms appearing in ventilated neonates after sedation with opiate derivatives.3 NAS following narcotic use by non-addicted mothers is rare, but there are case reports of symptoms after prescribed oral derivatives during late pregnancy. 2 The association with codeine has been noted in two case reports, the most recent almost 20 years ago.4 5 We describe a case of NAS that can be clearly ascribed to the regular use of codeine during the last trimester of pregnancy. Moreover, there was no immediate suspicion that the withdrawal symptoms were attributable to codeine, resulting in a delay in diagnosis and treatment. Case reportA 25 year old well controlled insulin dependent diabetic was admitted at 34 weeks of gestation after spontaneous rupture of membranes. She had miscarried at 9 weeks and had a healthy girl born at 34 weeks. The present pregnancy had been uneventful before the onset of labour. With good uterine contractions and satisfactory fetal tachygraphic monitoring, labour appeared to be progressing well. However, after 15 hours of labour the cervical os had failed to dilate and with increasing diYculty in controlling maternal blood glucose (hyperglycaemia) the decision was taken to perform a caesarean section.A boy weighing 2.5 kg (75th centile) was born in good condition with Apgar scores of 9 at 1 minute, 10 at 5 and 10 minutes, and an umbilical cord pH of 7.4. At 2 hours of age he was admitted to the neonatal unit with a blood glucose concentration of 1.2 mmol/l and grunting respirations, and started on a continuous dextrose infusion.The grunting settled and there were no further low blood glucose recordings in the first 24 hours. Clinical assessment of gestation was consistent with maternal dates. There was no evidence of macrosomia or dysmorphic features. At around 24 hours of age a tremor (jittery) was noticed. As the day progressed the tremor became pronounced. Although alert, the baby was restless and irritable with a strong cry. At 36 hours of age a convulsion was witnessed with movements of the tongue and limbs. Lasting seconds, the convulsion was thought not to warrant anticonvulsant treatment. Other symptoms appearing during this time included intolerance to feeds' with large non-bilious gastric aspirates, an occasional apnoea associated wit...

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A multi-centred study was designed to collect dengue epidemiologic data from government and registered private hospitals/clinics and maintained archive of frozen specimens in bio-bank to be used for future dengue epidemic control program, and assess the epidemiology of dengue fever (DF) by evaluating biochemical and oxidative status of patients. ELISA IgM antibodies test was done to confirm DF. From August 2010 to December 2011, 101 confirmed blood samples of DF patients referred to pathology lab of Jinnah Hospital Lahore were subjected to the epidemiologic assessment by evaluating the biochemical and physiological indices and alterations of circulating antioxidants. Clinical features of DF patients and effect of fever on blood components and serum proteins of liver were recorded. The hospital stay in DF, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) showed significant difference. Significant increases in serum alanine amino transferase (ALT) (P=0.000), aspartate amino transferase (AST) (P=0.000), alkaline phosphatase (ALP) (P=0.000), malondialdehyde (MDA) along with significant decreases in total protein (TP) (P=0.000), reduced glutathione (GSH) (P=0.000), superoxide dismutase (SOD), catalase (CAT) (P=0.000), and sialic acid contents (P=0.016) were observed. A positive correlation existed between bound sialic acid levels, liver enzymes and circulating antioxidants (r=0.656, P=0.016). In the present study, alterations of circulating antioxidants in DF suggest that DF might be a metabolic response to an acute, self-limiting tropical viral infection, and a consequence of the viral inflammatory process.

Studies reporting the effects of oxytocin on the health of lactating animals are lacking and still no such data is available on Nili Ravi buffalo, the most prominent Asian buffalo breed. The present study was conducted to investigate the effect of oxytocin on physiological and metabolic parameters of lactating Nili Ravi buffaloes. Healthy lactating buffaloes (n = 40) of recent calving were selected from a commercial dairy farm situated in the peri-urban area of district Faisalabad, Pakistan. These buffaloes were randomly allocated to two equal groups viz experimental and control, comprising 20 animals each. Twice-a-day (morning and evening) milking practice was followed. The experimental and control buffaloes were administered subcutaneously with 3 mL of oxytocin (10 IU/mL) and normal saline respectively, prior to each milking. Serum biochemical profile including glucose, total cholesterol (tChol), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), total proteins (TP), C-reactive protein (CRP), liver enzymes aspartate transaminase (AST), alanine transaminase (ALT), and metabolic hormones triiodothyronine (T₃) and thyroxine (T₄) were studied. Results revealed significantly higher (P ≤ 0.01) levels of glucose, total cholesterol, LDL-C, triglycerides, total proteins, and C-reactive protein in experimental (oxytocin-injected) lactating buffaloes compared to control group. Liver enzymes AST and ALT as well as serum T₄ concentration was significantly higher (P ≤ 0.01) in oxytocin-injected lactating buffaloes as compared to control animals. It was concluded that oxytocin had the key role in increasing the metabolic parameters and hormones, resulting in the optimization of production. But, at the same time, it may pose a threat to the animal health.

Angiogenesis is a multi-factorial physiological process deregulated in human diseases characterised by excessive or insufficient blood vessel formation. Emerging evidence highlights a novel role for microRNAs as regulators of angiogenesis. Previous studies addressing the effect of miR-133a expression in endothelial cells during blood vessel formation have reported conflicting results. Here, we have assessed the specific effect of mature miR-133a strands in angiogenesis and the expression of endothelial angiogenic genes. Transfection of miR-133a-3p or -5p mimics in primary human endothelial cells significantly inhibited proliferation, migration, and tubular morphogenesis of transfected cells. Screening of gene arrays related to angiogenic processes, and further validation by TaqMan qPCR, revealed that aberrant expression of miR-133a-3p led to a decrease in the expression of genes encoding pro-angiogenic molecules, whilst increasing those with anti-angiogenic functions. Ingenuity Pathway Analysis of a collection of genes differentially expressed in cells harbouring miR-133a-3p, predicted decreased cellular functions related to vasculature branching and cell cycle progression, underlining the inhibitory role of miR-133a-3p in angiogenic cellular processes. Our results suggest that controlled delivery of miR-133a-3p mimics, or antagomirs in diseased endothelial cells, might open new therapeutic interventions to treat patients suffering from cardiovascular pathologies that occur with excessive or insufficient angiogenesis.

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This study aimed at exploring how the perception about leadership styles affected the functionality of the Higher Education Institutions. We used a self-administered questionnaire to a sample of 328 administration and faculty members of several public sector universities. The data collected were analyzed through structural equation modeling in AMOS 26. We found significant results between autocratic and democratic leadership styles as determinants of organizational functionality; such that the perceived autocratic leadership style negatively affected organizational functionality and the perceived democratic leadership style positively affected organizational functionality. The effect of laissez-faire was however statically insignificant. We thus conclude that the perception of a democratic leadership style improves organizational functionality; whereas, the perception of autocratic leadership negatively affects organizational functionality. Practically, the study shows as the employees are given the right to participate in the matters of a higher education institution, the organization becomes more functional.