Health seeking behavior during pregnancy and delivery in Morang District of Nepal

Background and objectives: Importance of maternal health has been recognized over the last decade, however information about the perception of illness and health care behavior of obstetric complication is lacking. So, this study was conducted to find out the prevalence of taking care during pregnancy and delivery, and to find out the association between sociodemographic characteristics and taking care during pregnancy and delivery. Material and Methods: The study is a cross-sectional study conducted among the residents of Rangeli VDC of Morang District in Eastern Nepal where 300 households were taken as subjects. Semi-structured questionnaire was used and face to face interview was conducted. Chi-square test was applied to find out the association between sociodemographic characteristics and taking care during pregnancy and delivery. Results: Almost forty percent of pregnant women have taken care during pregnancy and delivery i.e. delivery conducted in Health Care Center (HCC). Only 21.8% of women were applied antiseptics after cutting cord and sixty three percent of women have fed colostrums to their babies. All of the women with Brahmin/ Chhetri have conducted delivery in Health Care Center. The women with SLC and higher education have conducted delivery at HCC more (91.1%) than below SLC (51%) and illiterate (12.5%). The women with service have conducted delivery at HCC more than other occupational groups. Conclusion: The problem of taking care during pregnancy and delivery is common and has become a key public health concern for all. Lack of education and poor occupation of wife and husband led some of the respondents not taking care during pregnancy and delivery.

Comparative Evaluation of Angiotensin-Converting Enzyme Inhibitors for their Beneficial Effects in Patients with Ischemic LV Systolic Dysfunction and Undergoing Coronary-Artery Bypass Surgery.

We compared three angiotensin-converting enzyme (ACE) inhibitors, captopril, perindopril, and ramipril, in the presented prospective study for their effectiveness in patients having left ventricular (LV) systolic dysfunction and undergoing coronaryartery bypass grafting (CABG). We enrolled 27 patients in captopril, 43 patients in perindopril, and 70 patients in ramipril group. There was about 25%–36% rise in LVEF after 3 and 6 months of ACE inhibitor administration in all three groups. The reduction in LV diameters did not differ significantly amongst the three groups. There was a significant decrease (p < 0.05) in LV end-diastolic diameter from baseline levels in captopril and perindopril groups after 3 months that got increased after 6 months but remained below pretreatment levels in both the groups. In ramipril group, there was no much change in this parameter from baseline levels at 3 and 6 months of treatment. After 6 months of treatment, the percent reduction in LV end-systolic diameter was also sustained in perindopril-treated patients. The percent reduction was greater in the perindopril group (3 and 6 months: 7.39 ± 5.94 and 7.73 ± 3.43, respectively) as compared to that observed in captopril group (3 and 6 months: 5.67 ± 1.05 and 2.52 ± 3.11, respectively) and ramipril group (3 and 6 months: 7.30 ± 2.75 and 4.93 ± 3.22, respectively). Mitral-valve regurgitation was greatly reduced in the captopril group at 3 as well 6 months of ACE inhibitor administration. However, the percent reduction from baseline levels was not statistically significant amongst the three groups. The percent improvement in functional status was significantly greater in the ramipril treatment group (36.46 ± 3.14) after 6 months of treatment as compared to that of captopril (6.67 ± 10.64) and perindopril (4.17 ± 2.73) group. In conclusion, our data show equal beneficial effects with all three ACE inhibitors under investigation in CABG patients with LV systolic dysfunction, with marginal superiority for perindopril.

Coinfection with Cryptosporidium, Isospora and S. stercoralis in a patient with AIDS--a case report.

A thirty eight year old lady, positive for human immunodeficiency virus (HIV) antibodies, was found to be positive for three different opportunistic parasitic infections. Cryptosporidium, Isospora and S.stercoralis were simultaneously detected from her stool samples. Her CD4 count was 116/cmm. The patient belonged to a slum area with poor sanitation.

Patterns of cardiac disorders and epidemiology of coronary artery disease in urban population of Ahmedabad.

A hospital based study of coronary artery disease (CAD) was carried out in Gujaratis, admitted to Dr Jivraj Mehta Smarak Health Foundation, Ahmedabad. Total 276 subjects were surveyed. CAD was diagnosed by ECG criteria. Prevalence of CAD in hospital admission was 29.6%. Highest incidence of CAD was seen in the age group of 51 to 60 years. Male/female ratio was 1.6:1. As a single risk factor hypertension was ranked first, next was obesity followed by hyperlipidaemia, diabetes, tobacco habits, and family history of CAD. Overall mortality of CAD was 3.99%, being 1.83% for angina pectoris (AP) and 5.39% for myocardial infarction (MI). Mortality rate was higher in subjects having 2 or more risk factors. Incidence of CAD in young (age < 40 years) was very low (1.09%).

Comparative evaluation of anticonvulsant activity of calcium channel blockers in experimental animals.

Pentylenetetrazole (PTZ)-induced convulsions and the maximal electroshock (MES) seizure test were employed to study the anticonvulsant effects of nifedipine (2, 3.5 and 5 mg kg-1), flunarizine (10, 20 and 40 mg kg-1) and diltiazem (10, 15 and 30 mg kg-1). Nifedipine and flunarizine prolonged the latent period and reduced the mean duration of PTZ induced seizures. They also reduced the severity of convulsions and the number of deaths due to PTZ significantly. Nifedipine was more potent in this regard (P < 0.01). All these drugs prolonged the latent period and reduced the duration of tonic extensor phase of MES seizures in a significant manner. Flunarizine was most potent in this test. Complete protection from tonic extensor phase was observed in 10-50% animals pretreated with nifedipine and flunarizine in a dose dependent manner. The response of diltiazem was weak in both these tests. It is concluded that all three calcium channel blockers possess an important but different anticonvulsant effect and their significant clinical use can be made while keeping in view the characteristics of their pharmacological action.

Effect of nifedipine, a calcium channel inhibitor, on sedation produced by reserpine, clonidine and propranolol in mice.

Spontaneous motor activity, rotarod test and observational rating of sedation were employed to study effect of nifedipine on sedation produced by reserpine, clonidine and propranolol. Reserpine (2 mg kg-1), clonidine (4 mg kg-1), and propranolol (40 mg kg-1) significantly reduced spontaneous motor activity and staying capacity of animals on accelerating rotarod (P < 0.01). Observational sedation was also caused significantly as indicated by a higher score in test. Nifedipine (2 mg kg-1) produced no sedation or excitation on its own. Reduction in spontaneous motor activity produced by reserpine and clonidine was partially reversed in animals treated with nifedipine (P < 0.01). A similar effect of nifedipine was also evident on the observational sedation induced by reserpine and clonidine. Effect of these drugs on rotarod times was nearly totally antagonised by nifedipine. Nifedipine did not oppose the sedation produced by propranolol which actually became significantly greater in the animals pretreated with nifedipine in all three tests. It is concluded that nifedipine antagonizes the sedation produced by reserpine and clonidine, probably by blocking central alpha 2-adrenoceptors. The sedative effect of propranolol can be potentiated by nifedipine possibly because of a pharmacokinetic interaction.

Supravalvar aortic stenosis secondary to familial hypercholesterolaemia. Report of two cases.

Two cases of supravalvar aortic stenosis secondary to familial hypercholesterolaemia (type II A hyperlipoproteinaemia) are reported and the role of echocardiography in the diagnosis of this uncommon condition is discussed. The management of these patients is difficult and in one patient the serum cholesterol decreased substantially after treatment with gemfibrozil.