Overview of oral health status and associated risk factors in maritime settings: An updated systematic review.

OBJECTIVES: The aim of this study is to provide an updated overview of the oral health status and associated risk factors in maritime settings. METHODS: We systematically searched PubMed, Ovid Embase, Web of Science, CINAHL and SCOPUS from January 2010 to April 2023. Two independent reviewers extracted the data. The quality of included studies was assessed using relevant assessment tools. RESULTS: A total of 260 records were found in the initial search; 24 articles met the inclusion criteria. Most studies had descriptive design, and only two randomized controlled trials were found. The main oral health issues noted are oral cancer, dental caries, periodontal diseases, oral mucosal lesions, and dental emergency. Male seafarers have higher risk of oral cancers in the tongue, lips, and oral cavity while oral mucosal lesions are more prevalent among fishermen. CONCLUSIONS: Dental caries and periodontal diseases are prevalent in both seafarers and fishermen. The consumption of tobacco, alcohol, fermentable carbohydrate, and poor oral hygiene are risk factors that affect the oral health status at sea. The occurrence of oral diseases in maritime setting requires more attention of researchers and authorities to develop strategies to tackle these issues. TRIAL REGISTRATION: Systematic review registration number in PROSPERO: CRD42020168692.

May Measurement Month 2019: an analysis of blood pressure screening results from Nepal.

May Measurement Month (MMM) is a global initiative to screen high blood pressure (BP) in the community and increase awareness at the population level. High BP is the leading risk factor for mortality worldwide and in Nepal. This study presents the results of the 2019 MMM in Nepal. Opportunistic BP screening was conducted in 30 out of 77 districts across Nepal and aged ≥18 years at the community and public places. BP was measured three times in a seated position. A total of 74 205 individuals participated in the study, mean age 39.9 years, and 58% were male. BP measurements for the second and third readings were available for 69 292 (93.3%) individuals. The proportion of the population that were hypertensive was 27.5% (n = 20 429). Among those hypertensives, 46.3% were aware of their hypertensive status and of these, 37.5% were on antihypertensive medication. Only 54.3% of those on antihypertensive medication had their BP controlled. Of the community screened, those self reporting to have diabetes, current tobacco users, and current alcohol drinkers were 6.7%, 23.6%, and 31.9%, respectively; 20.6% of the participants were overweight, and 6.5% were obese. Since the first BP screening campaign, MMM 2017 in Nepal, the number of participants screened has largely increased over the years. MMM's success in Nepal is through a coordinated mobilization of trained health science students and volunteers in the communities. The Nepal MMM data demonstrates that large community-based BP screening campaigns are possible in low resource settings.

Diabetes among tuberculosis patients and its impact on tuberculosis treatment in South Asia: a systematic review and meta-analysis.

The escalating burden of diabetes is increasing the risk of contracting tuberculosis (TB) and has a pervasive impact on TB treatment outcomes. Therefore, we conducted this systematic review and meta-analysis to examine the burden of diabetes among TB patients and assess its impact on TB treatment in South Asia (Afghanistan, Bangladesh, Bhutan, Maldives, Nepal, India, Pakistan, and Sri Lanka). PubMed, Excerpta Medica Database (EMBASE), and CINAHL databases were systematically searched for observational (cross-sectional, case-control and cohort) studies that reported prevalence of diabetes in TB patients and published between 1 January 1980 and 30 July 2020. A random-effect model for computing the pooled prevalence of diabetes and a fixed-effect model for assessing its impact on TB treatment were used. The review was registered with PROSPERO number CRD42020167896. Of the 3463 identified studies, a total of 74 studies (47 studies from India, 10 from Pakistan, four from Nepal and two from both Bangladesh and Sri-Lanka) were included in this systematic review: 65 studies for the prevalence of diabetes among TB patients and nine studies for the impact of diabetes on TB treatment outcomes. The pooled prevalence of diabetes in TB patients was 21% (95% CI 18.0, 23.0; I2 98.3%), varying from 11% in Bangladesh to 24% in Sri-Lanka. The prevalence was higher in studies having a sample size less than 300 (23%, 95% CI 18.0, 27.0), studies conducted in adults (21%, 95% CI 18.0, 23.0) and countries with high TB burden (21%, 95% CI 19.0, 24.0). Publication bias was detected based on the graphic asymmetry of the funnel plot and Egger's test (p < 0.001). Compared with non-diabetic TB patients, patients with TB and diabetes were associated with higher odds of mortality (Odds Ratio (OR) 1.7; 95% CI 1.2, 2.51; I2 19.4%) and treatment failure (OR 1.7; 95% CI 1.1, 2.4; I2 49.6%), but not associated with Multi-drug resistant TB (OR 1.0; 95% CI 0.6, 1.7; I2 40.7%). This study found a high burden of diabetes among TB patients in South Asia. Patients with TB-diabetes were at higher risk of treatment failure and mortality compared to TB alone. Screening for diabetes among TB patients along with planning and implementation of preventive and curative strategies for both TB and diabetes are urgently needed.

When sexual offence is an unexpected diagnosis - exploration of medical, legal and social aspects in Nepalese scenario.

In Nepal, following allegations of sexual assault, the survivor is taken by the police to a Government Hospital for medical examination and sample collection. To provide an integrated service to survivors of gender-based violence, a One-Stop Crisis Management Centre (OCMC) is established in many Government Hospitals. However, paediatric survivors of sexual abuse frequently seek initial care at the emergency department, as most present with a medical complaint rather than for sexual abuse. It is therefore important to train emergency physicians with the skills required to identify the features and diagnose a case of sexual assault. We present a case where the diagnosis of sexual assault of a child was an incidental finding and discuss the challenges faced in dealing with such cases in non-OCMC Hospital.