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Background and objectiveThe prevalence of non-alcoholic fatty liver disease (NAFLD) is 60% in patients with type 2 diabetes mellitus (T2DM). NAFLD can lead to non-alcoholic steatohepatitis (NASH), both of which are the leading causes of cirrhosis. This study was undertaken to evaluate whether empagliflozin, a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, reduces liver fat content in these patients after therapy. MethodsAfter enrolling patients of T2DM with NAFLD, they were administered empagliflozin 10 mg once daily orally for six months without modifying existing oral hypoglycemic agents (OHA) if any. All demographic data were collected, and anthropometric measurements, as well as laboratory investigations, were performed, and controlled attenuation parameter (CAP) and liver stiffness (LS) were measured using FibroScan® (Echosens, Paris, France) at baseline, and six months of therapy. The adverse effects related to therapy were also taken into account. ResultsThere was a significant decrease in mean CAP value from 282.07 ± 47.29 dB/m to 263.07 ± 49.93 dB/m and LS from 5.89 ± 4.23 kPa to 5.04 ± 1.49 kPa along with a significant decrease in serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) among the patients. Compared to the baseline, there was a significant reduction in post-treatment weight, body mass index (BMI), and blood pressure (BP). The most commonly observed adverse effects of the therapy were urinary tract infection (UTI) (17.8%), nasopharyngitis (11.9%), and hypoglycemia (10.71%). ConclusionA reduction in hepatic fat content was seen in our prospective study cohort after six months of empagliflozin therapy. Empagliflozin also led to beneficial effects such as weight loss and reduction in transaminases and GGT. Given the absence of significant side effects of the therapy, empagliflozin could be used as an effective treatment modality for T2DM patients with NAFLD, which are two conditions commonly seen in combination.

Leptospirosis is an important zoonotic disease in Nepal; however, there is a lack of information on sources of leptospirosis infection for people and associated risk factors. We implemented a case-control study nested within a cross-sectional survey to investigate zoonotic risks of human leptospirosis among adult, febrile patients seeking treatment in healthcare centres in Kaski District, Nepal, from April to October 2013. The study population was 239 febrile patients; the data consisted of paired blood samples; questionnaires on clinical symptoms; occupational, environmental and animal exposures; and a blood sample from animals in the household. In total, 63 cattle, 92 buffalo, 181 goats, 20 dogs and 14 rodents from 119 households were blood sampled. Serology was performed on the samples using the microscopic agglutination test (MAT) for a panel of 20 serovars with a starting dilution of 1:50. Clinical leptospirosis was defined as a titre of 1:400 or stronger, or a 4-fold or greater rise between acute and convalescent titres, or evidence of seroconversion for one or more serovars represented by a titre of <1:50 in the acute sample and a titre of ≥1:100 in the convalescent sample. The prevalence of clinical leptospirosis was 5.4% (95% CI 2.6%-8.3%). The most common symptoms among recruited participants were loss of appetite and lethargy followed by chills, profuse sweating and backache. No individual clinical symptom nor combination of any two symptoms was significantly associated with clinical leptospirosis. However, owning goats (OR 1.3, CI 95% 1.05-1.66), working in rice fields (OR 1.3, CI 95% 1.11-1.72) and male gender (OR 4, CI 95% 1.12-17.26) significantly increased the risk of clinical leptospirosis in humans. Findings suggest that leptospirosis should be considered in the clinical differential diagnosis among febrile adult patients in Nepal, especially for men, goat owners and/or those who work in rice fields.

Background of the study Induction of labour is the stimulation of uterine contraction priority to the onset of spontaneous labour. It is an obstetrics intervention that should be used when elective birth will be beneficial to mother and baby. It means initiation of uterine contractions by any method (medical, surgical or combined) for the purpose of vaginal delivery.ObjectivesTo assess the existing knowledge of staff nurses regarding maternal and neonatal outcome of induction of labour.To evaluate the effectiveness of self instructional module regarding maternal & neonatal outcome of induction of labour among staff nurses.To associate pre-test knowledge of staff nurses regarding maternal and neonatal outcome of induction of labour with their selected demographic variables.Methods A Pre experimental design (one group pre and post test design) was conducted at ESI Hospital, Bangalore, 60 samples, non-probability convenient sampling technique, structured questionnaire were developed and validated by experts; the reliability that is test retest method was used, administered self instructional module and conducted post test. The Collected data were analyzed by using descriptive and inferential statistics.Major findings of the studyMajority of staff nurses attained were 31-35 years age (37%) had GNM education (83%). About 39% of subjects had above 6 years experiences. SIM is effective in improving staff nurses knowledge regarding maternal and neonatal outcome of induction of labour. (P< 0.05). A significant association was found between knowledge of staff nurses with demographic variables such as age, religion, marital status, educational qualification, total years experiences, monthly income, and previous sources of information.Interpretation and conclusion The findings revealed that the improvement Mean score of all level of knowledge of staff nurses between pre test and post test was 13.75% with ‘t’ test value was 12.88, which was highly significant at p< 0.05. Hence, it is inferred that there is significant increase in the knowledge level of the staff nurses regarding maternal and neonatal outcome of induction of labour after used of Self Instructional Module.

BackgroundAssessment of nonalcoholic fatty liver disease (NAFLD) includes estimation of liver fat (steatosis).Controlled attenuation parameter (CAP) value obtained by FibroScan ® (Echosens, Paris, France) is an alternative to liver biopsy for diagnosing and estimating steatosis (S). This study aimed to estimate the liver fat by CAP in NAFLD patients. MethodsAn observational cross-sectional study was conducted at the Liver Unit of Bir Hospital, from January 2021 to May 2021 after ethical clearance from the Institutional Review Board of the National Academy of Medical Sciences. A convenient sampling method was used. Data were analyzed with descriptive and inferential statistics involving bivariate and multivariate analysis. ResultsA total of 127 NAFLD patients were enrolled. The mean (±SD) CAP value was 271.53 (±50.69) dB/m. Total cholesterol, triglyceride, and body mass index (BMI) correlated positively (p<0.05) while systolic blood pressure correlated negatively with CAP value (p=0.031). On multivariate analysis, patients with BMI ≥25 kg/m 2 were found 3.7 times more likely to have CAP ≥291 dB/m (S3, severe steatosis) than those with BMI <25 kg/m 2 (p=0.048, 95% CI 1.01, 13.50). The mean (±SD) CAP values were 276.19 (±49.93) and 246.60 (±48.50) dB/m among those with BMI ≥25 kg/m 2 and <25 kg/m 2 , respectively (p=0.016, using independent ttest). CAP steatosis grading correlated positively with both the ultrasound grading (p<0.001) and fibrosis grading by liver stiffness measurement (p=0.004). ConclusionIn this observational cross-sectional study of NAFLD patients, the mean (±SD) CAP value was 271.53 (±50.69) dB/m, which corresponds to moderate steatosis (S2). Obese NAFLD patients with ≥25 kg/m 2 were 3.7 times more likely to have severe steatosis (S3) than nonobese NAFLD patients with BMI <25 kg/m 2 .

Introduction: It’s been over a decade since different dental speciality societies have been established in Nepal. These specialities have generated important human resource, which have contributed to uplift dental care syatem in Nepal. The study was designed with the objective of assessing strength and status of dental specialities in Nepal. Materials and Methods: The cross-sectional observational study was conducted from October 2020 to December 2020. Nepal Medical Council (NMC) websites, dental specialities websites as well as personal communication with responsible persons of the dental societies were assessed to collect data. Demographic and professional details, specialist number, age, gender, work place, place of graduation and graduation year were entered into Microsoft Excel Sheet. Data was analyzed based upon frequency distribution and percentage. Result: According to NMC record, total number of dental specialists in dentistry is 616, till December 2020. Out of them, 451 specialists were registered with the dental societies, who were included in this study. There were 6 speciality dental societies in Nepal and most of the societies were a decade old and had more than 50 members. Orthodontics association was the oldest with 164 members. The highest number of specialists were in the age group 30-40 year in all the dental specialties and they were mostly working in Kathmandu valley. Conclusion: Different dental speciality societies have been growing throughout the country which have produced qualified manpower for providing specialized dental services. These societies are contributing towards achieving goals of better oral health care delivery in the nation.

Transient abnormal myelopoiesis (TAM) also known as transient myeloproliferative disorder (TMD), a unique transient neonatal preleukaemic disorder characterized by clonal proliferation of megakaryoblasts, has been usually described to be associated with Down syndrome neonates. However, there are case reports of it occurring in neonates without Down phenotype, who are either mosaic for trisomy 21 or have trisomy 21 restricted to leukemic clone. This case report presents a case of TAM in a phenotypically normal neonate who presented in respiratory distress with features of tumour lysis syndrome (TLS) immediately after birth who was treated symptomatically and had spontaneous remission within three months.