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Our study shows that diabetes and hypertension are common and related problems in people aged >/= 40 years in urban Nepal. The overall sensitivity of the 2-h PG criteria was greater than that of the FPG criteria for diagnosing diabetes, except in subjects aged >/= 60 years.

This paper analyses the patterns of rising type 2 diabetes prevalence in the world with their plausible reasons focusing on control measures. It shows existence of combinations of three patterns of rises, viz. gradual, rapid and accelerated, leading to prevalence of 4–9% now in Europids, 14–20% in migrant or urbanized Asian Indians, Arabs, Chinese, Africans, and Hispanics and above 30–50% in indigenous peoples of Canada, USA, Australia and Pacifi c regions. It demonstrates that though ageing, sedentary life and obesity of people explain gradual rise in Europids, effects of rapid transition in nutritional status of population and of maternal hyperglycaemia on the risk of offspring developing glucose intolerance further add to rapid and accelerated rises respectively. It recommends that current approach of primary prevention of diabetes in people, particularly with impaired glucose tolerance, advocating modest loss of excess weight and moderate-intensity exercise, be widen into concept of control in community covering rapid and accelerated rises. The control programmes essentially are vigorous educational campaign and planning to improve nutritional status of women of childbearing age in rural and poorer sectors of society and to keep weight of adults within recommended body mass index (BMI) range, like 18.5–22.9 kg/m2for Asian and other similar populations. The population-based approaches with examples, considering developing countries, are outlined. The paper emphasizes the importance of keeping prepregnancy weight optimum, preferably below the middle of recommended BMI range, to avoid even sub-clinical maternal hyperglycemia, for prevention and control of accelerated rise in any population. Key Words: diabetes, diabetes control, diabetes epidemiology, diabetes prevention, prepregnancy weight

Background Posting of doctors in remote rural areas has always been a priority for Government; however data are scarce in the country about experience of doctors of working in remote areas after medical graduation.Objective A questionnaire survey of doctors was planned to analyze their experience of working after graduation in remote rural areas in various parts of the country.Method The cross-sectional survey was done by convenience sampling method. A one-page questionnaire with one partially closed-end and five open-end type questions was distributed to the doctors who had worked in remote rural areas after graduation under various governments’ postings.Result Two-third of participants had their home in urban areas and 89.8% had stayed for 1 to 5 years. About half of the participants had difficulty in getting the posting in the remote areas of their choice. Most participants indicated provision of opportunities for Residential (postgraduate) Training as their reasons of going to remote areas as well as their suggestions to encourage young graduates to go there. Similarly most also suggested appropriate career, salary and incentives to encourage doctors to go to work in remote areas. About 85% of participants pointed out the major problem faced while posted in remote areas as difficulty in handling varied situations with no guidance or seniors available around.Conclusion The notable points indicated by the participants are centered on the opportunity for Residential Training and difficulties faced without such training. Residential Training is a priority to be considered while planning the health policy for optimum health care of people.Kathmandu University Medical Journal Vol.12(2) 2014: 121-125

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Background and aims: Body mass index, waist and hip circumference have been using for measurement of obesity, however practically it’s difficult to get these measures accurately because of the various reasons, so an alternative to this could be neck and wrist circumference measurement. As there is scarce report on such anthropometric studies from Nepal, we aimed to find out the correlation between neck and wrist circumference with waist circumference for obesity measure.Method: A cross sectional observational study of total 297(147 male and 150 female) participants, aged above 18 years conducted on 2013 at Kathmandu valley. Anthropometric markers of obesity were measured, including body weight, height, waist, hip, neck and wrist circumferences.Results: A strong positive Pearson correlation of neck circumference with waist circumference was found in both male and females(r=0.64 in male and r=0.86 in female). Neck circumference had strong positive correlation with waist circumference in obese female than in male(r=0.5 in male and r=0.82 in female).Similarly, neck circumference had positive correlation with body mass index(r=0.53in male and r=0.79 in female),hip(r=0.54in male and r=0.76in female), weight(r=0.59in male and r=0.77in female) except waist hip ratio(r=0.59in male and r=0.10in female). Neck circumference cutoff for abnormal waist (>=90cm for male and >=80cm for female) was 34.4cm for male and 32.5 cm for female. Similarly wrist circumference had also positive correlation with waist circumference(r=0.58 and r=0.64 in female) and with weight(r>0.6) in both sexes.Conclusion: Neck circumference which can be relatively easily measured has shown strong correlation with waist.Journal of Advances in Internal Medicine 2014;3(2):47-51.

ObjectivesDespite several investigations, evidence is still controversial regarding the effect of periodontal treatment on diabetes. This study evaluates and compares the effect on glycemic control and periodontal status with or without nonsurgical periodontal therapy in patients with type 2 diabetes mellitus and chronic periodontitis in a Nepalese population.Materials and methodsA total of 82 patients attending the diabetes clinic and fulfilling enrollment criteria with moderate to severe periodontitis were selected. They were assigned in an alternative sequence, into test and control group. Both groups were instructed to continue with their medical treatment without modifications. Scaling and root surface debridement were performed in the test group whereas the control group received oral hygiene instructions with no treatment during the 3-month study period.ResultsThere were 41 participants in each group with the mean age of 50.66±7.70 and 53.80±9.16 years, average diabetes duration of 6.32±4.21 and 6.24±4.00 years, mean body mass index of 24.78±1.85 and 24.6±1.79 kg/m2, and glycated hemoglobin (HbA1c) level of 6.71±0.50% and 6.80±0.45%, in the test and control group, respectively. After 3 months, there was significant reduction in HbA1c levels in the test group compared to the control group (p=0.029). Clinical periodontal parameters of gingival index, probing depth (PD), and clinical attachment level (CAL) significantly improved in the test group (p<0.001) with PD reduction by 0.9 mm and gain in CAL by 0.3 mm compared to the control group (p>0.001) who showed an increase by 0.05 mm.ConclusionThis study showed that nonsurgical periodontal therapy may have a beneficial effect on HbA1c level in moderately controlled type 2 diabetic patients.

Background: Correlation data of different external reference points and methods used to measure venous pressures are scarce in the literature. We correlated central venous pressure with jugular venous pressure measured from sternal angle and with jugular and upper-limb venous pressures from zero level corresponding to mid-right-atrium level. Methods: A hospital-based observational study in the medical and surgical intensive care units was conducted for period of one year.” Central venous pressure was measured from right fourth intercostal space in mid-axillary line and jugular venous pressure from sternal angle and jugular and upper-limb venous pressures from horizontal plane through the midpoint of anteroposterior line from anterior end of right fourth intercostal space to back. We measured central venous pressure by central venous cannulation and jugular and upper-limb venous pressures clinically by JVP Meter®. Upper-limb venous pressure was indicated by collapse of visible veins in dorsum of hands as the arm was slowly raised from dependent position.Results: Correlation coefficient (r) values were 0.61 between central venous pressure and jugular venous pressure from zero level, 0.48 between central venous pressure and jugular venous pressure from sternal angle, and 0.31 between central and upper-limb venous pressures; and 0.67 and 0.50 between central venous pressure measured from right internal jugular vein and jugular venous pressure from zero level and sternal angle respectively and0.52 and 0.44 between central venous pressure from right sub-clavian vein and jugular venous pressure from zero level and sternal angle respectively. Conclusions: Different correlation values indicate the need to have future investigations and consensus on the common external reference point and methods to measure venous pressures. Keywords: CVP; heart failure; JVP; JVP Meter; shock