Background: Previous studies have demonstrated the role of inflammation in diabetic nephropathy (DN). Neutrophil to lymphocyte ratio (NLR) rather than other white cell parameters was found to be a useful inflammatory marker to predict adverse outcomes in medical and surgical conditions. Nevertheless, the value of NLR in predicting DN has not been elucidated. Method: An observational study included 338 diabetic patients, who were followed at our clinic between 2007 and 2009. We arranged our patients into tertiles according to their 2007 NLR. The primary outcome was continuous decrease of GFR >12 mL/min between 2007 and 2009 with the last GFR <60 mL/min. Result: The lowest NLR tertile had fewer patients (2.7%) with primary outcome (i.e., worsening renal function) compared with middle and highest NLR tertiles, which had more patients with primary outcomes (8.7% and 11.5%, respectively) with a significant p-value 0.0164. When other potential confounders were individually analyzed with NLR tertile, the NLR tertiles remained a significant predictor of poor GFR outcome in the presence of other variables (hemoglobin A1C, systolic blood pressure, diastolic blood pressure, age, and congestive heart failure with p-values 0.018, 0.019, 0.017, 0.033, and 0.022, respectively). Conclusion: NLR predicted the worsening of the renal function in diabetic patients. Further studies are needed to confirm this result.
The objective was to study the external causes of death reported in the autopsy centre in Kathmandu, Nepal. A retrospective review of case report documentation of all violent and traumatic death autopsies was conducted in Kathmandu from mid-July 2000 to mid-July 2004. A total of 4383 autopsies were conducted by the Department of Forensic Medicine in Kathmandu. There were 1072 (25%) cases of suicide, 380 (9%) homicide, 1399 (32%) accidental, 598 (14%) deaths as a result of natural diseases and 923 (21%) undetermined causes of death. The number of males was almost twice that of females (sex ratio 2.2:1). Persons aged 15 to 44 years comprised about two-thirds of the total reported fatalities (65.4%). Suicides were mostly reported due to hanging, homicides mostly due to firearms and explosives, accidents mostly due to road traffic injuries. More than 60% of road traffic injuries resulted among pedestrians. Suicides, homicides and accidental deaths remain a poorly identified public health issue in Nepal. Medico-legal autopsy reports can serve as an important tool in understanding fatalities from violence and injuries for countries similar to Nepal. Strengthening a regular mechanism for compilation and utilization of the information, however, remains a major challenge.
BackgroundJob satisfaction among nursing faculty is critical to improving quality of nursing education, producing future nurses who will contribute directly to the health of patients at a local and national level. This study explores factors associated with job satisfaction among graduate nursing faculties in different universities of Nepal.MethodsA cross-sectional study was conducted among nursing faculty with at least one year of teaching in their respective institutions. A 36-items job satisfaction questionnaire with 6-point Likert type responses was administered online. The questionnaire was pre-tested with 30 faculties pooled from multiple institutions. Link to the final survey was sent via e-mail to 327 nursing faculties working in 39 nursing colleges. Respondents were contacted by phone as a follow up to the email to politely remind them about the survey. Data analysis was carried out with SAS University Edition software. Chi-Square test and t-test were used for simple descriptive analysis. A multivariate binary logistic regression model was used to identify the significant factors associated with nursing faculties’ job satisfaction. Adjusted odds ratio was calculated and significance was considered at p ≤ 0.05 with 95% confidence interval.ResultsThe response rate was 54.4%. After retrospective cleaning of data, usable response rate was 52.3% (n = 171). The average age of the nursing faculties was 36.8 ± 7.0 years. Based on the overall job satisfaction score, 36.8% nursing faculties were satisfied with their current job. The coefficient for Cronbach’s alpha was 0.895 suggesting very good reliability of the overall measure. The significant factors associated with job satisfaction were the involvement of the faculties in decision making process related to the department (OR = 4.83) and adequate access to reference materials (OR = 2.90).ConclusionsThis study suggests that nursing faculties have positive attitude towards their job but are dissatisfied with the benefits offered to them and the operating condition of their institutions. Expanding the teaching learning resources, such as reference books, subscription to journals, and continuing education opportunities for nursing faculties through participation in professional meetings would be helpful in improving the quality of nursing education in Nepal.
Background Glassy cell carcinoma (GCC) of the cervix is defined as a rare subtype of adeno-squamous cell carcinoma (ASC) with poor prognosis. We presented our clinical data of patients with cervical GCC and reviewed the outcomes in recent years. Methods From 2011.1 to 2019.7, 20 cases of cervical GCC diagnosed and treated in our institution were reviewed for clinicopathologic features, treatment strategies, and outcomes. Results (I) Twenty cases confirmed as cervical GCC were selected and represented 1.8% of all invasive cervical cancer diagnoses. The median age of all cervical GCC patients was 46 years (range from 33 to 69 years). The main clinical symptoms were abnormal vaginal bleeding and postcoital bleeding. The incidence of stage I, stage II, stage III was 75%, 20% and 5%. (II) Human papillomavirus (HPV) prevalence in cervical GCC was 44.4% (4/9). Of the HPV-positive tumors, HPV genotyping was variable. Tumors of 3 cases were found infected by HPV-18. Another tumor was infected by HPV-16 and HPV-31. Multiple infections were found in 1 case. (III) The disease-free survival (DFS) of early stage cervical GCC cases was 93%, and DFS of advanced stage cervical GCC cases was 67%. DFS of all cases was 85%. The median follow-up interval for surviving patients was 28 months. Three patients recurred, leading to an overall recurrence rate of 15% (3/20). One of 3 recurred cases was from multimodal treatment group who had one high risk factor (pelvic lymph node metastasis) and three intermediate risk factors lympho-vascular space involvement (LVSI), deep stromal invasion, and large tumor size (3.5 cm). Other 2 cases recurred were from radio-chemotherapy group. Conclusions Cervical GCC is associated with high-risk type HPV infection, especially HPV 18. The prognosis of GCC was not poor as depicted in previous studies. Early-stage GCC patients should receive multimodal treatment which reduced recurrence rate and improved survival rate. With the limitation of small sample size, we speculated surgery might play a key role in curing GCC. Patients whose pathology features includes at least two intermediate high risk recurrence or one high risk factor should accept adjuvant treatment after complete surgical management.
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