Antenatal Health Care Service Utilization in Slum Areas of Pokhara Sub-Metropolitan City, Nepal.

BACKGROUND: Half a million women die every year due to pregnancy and childbirth in the world. Among these death, 99% occur in the low and middle income countries. Antenatal care (ANC) provides an opportunity to deliver different services which are important in improving maternal survival. METHODS: A descriptive cross sectional study was conducted from September 2012 - February 2013 among 400 married women of reproductive age group. A pre-tested structured questionnaire were used and data were analyzed using Statistical Package for Social Science(SPSS) for windows version 18.0. Frequency, crude and adjusted odds ratios and confidence intervals were performed. RESULTS: Nearly 27% had four or more antenatal health care utilization(ANC) visits on appropriate time according to schedule of World Health Organization(WHO). In logistic regression, ANC users were found to be more/less likely to be in age group 20 - 35 years (AOR =2.825, 95% CI: 1.166-6.843), education of spouse (AOR 0.361, 95% CI : 0.130-1.000), occupation of spouse (AOR = 0.261, 95% CI: 0.093 -0.739), monthly income of family > 20,000Nrs (AOR = 2.190, 95% CI: 1.041-4.606), planned pregnancy (AOR = 2.417, 95% CI: 1.047 -5.609), death of child (AOR = 3.153, 95% CI: 1.112 -8.944). CONCLUSIONS: This study demonstrated low antenatal care service utilization. Hence, there is a need to increase the availability and accessibility of antenatal care to all women.

Effect of sitting posture on development of scoliosis in Duchenne Muscular Dystrophy cases.

BACKGROUND: Scoliosis is a frequent association in boys with Duchenne Muscular Dystrophy when the ability to walk is lost around nine to 12 years of age. This study assessed the contribution of physical factors including lumbar posture to scoliosis in non-ambulatory youth with DMD in Nepal. METHODS: Linear regression was used to assess effects of time since loss of ambulation, muscle strength, functional severity and lumbar angle as a binary variable on coronal Cobb angle; again logistic regression was used to assess effects of muscle strength and cross-legged sitting on the presence of a lordotic lumbar posture in 22 non-ambulant boys and young men. RESULTS: The boys and young men had a mean (SD) age of 15.1 (4.0) years, had been non-ambulant for 48.6 (33.8) months and used a median of 3.5 (range 2 to 7) postures a day. The mean Cobb angle was 15.1 (range 0 to 70) degrees. Optimal accuracy in predicting scoliosis was obtained with a lumbar angle of -6° as measured by skin markers, and both a lumbar angle ≤-6° (P=0.112) and better functional ability (P=0.102) were associated with less scoliosis. Use of cross-legged sitting postures during the day was associated with a lumbar angle ≤-6° (OR 0.061; 95% CI 0.005 - 0.672; P=0.022). CONCLUSIONS: Use of cross-legged sitting posture was associated with increase in lumbar lordosis. Higher angle of lumbar lordosis and better functional ability are associated with lesser degree of scoliosis.

Early initiation of community-based programmes in Nepal: a historic reflection.

Community-based programmes have long been an integral part of Nepal's health sector strategy and has contributed to the progress seen in maternal and child health. This paper reviews three early community-based programmes - the acute respiratory infection programme and its evolution to the fully scaled-up community-based integrated management of childhood illness programme, the national vitamin A programme and the female community health volunteer programme - and how the Government of Nepal rapidly accepted them to address pressing maternal and child health issues in an evidence-informed manner, moving rapidly from research to feasibility studies, to implementation and scale-up.

Estimation of serum uric acid in cases of hyperuricaemia and gout.

INTRODUCTION: Gout is crystal deposit arthritis and is an ancient disease. The biologic precursor to gout is hyperuricaemia. The prevalence of hyperuricaemia and gout has an increasing trend all over the world including the developing countries. The purpose of this study is to estimate serum uric acid level in hyperuricaemic and gout patients attending a medical college hospital. METHODS: A consecutive 150 hyperuricaemics and 150 gout patients attending Tribhuwan University Teaching Hospital from June to September 2007 were included in this study. The serum uric acid level was measured by the enzymatic (PAP- Uricase) method. The patients with acute gout were interviewed and relevant information was obtained. RESULTS: Males comprised 84% of gout cases. Hyperuricaemia was common in both sexes. The mean age for gout was 47.49 and 56.65 years in males and females respectively. The mean age for the first gout attack was 42.1 +/- 14.0 years. Family history was positive in 22% of cases. The overall mean serum uric acid level in hyperuricaemics was 7.2 +/- 0.7 mg/dL and 8.4 +/- 1.1 mg/dL in acute gout (p 0.0001). The mean serum uric acid level was significantly (p 0.0001) high among males both at the asymptomatic phase and at acute gout. Gout was more common in non-vegetarians (95%) and alcoholics (65.3%). Serum uric acid level was inversely related with the amount of daily water intake (p 0.0001). CONCLUSIONS: Serum uric acid level is significantly high among the male gouty arthritic patients. However, it is also high among asymptomatic hyperuricaemic cases of both sexes.

Japanese cases of type 1 thanatophoric dysplasia exclusively carry a C to T transition at nucleotide 742 of the fibroblast growth factor receptor 3 gene.

Type I thanatophoric dysplasia (TD) is typically a lethal neonatal dwarfism, but a limited number of cases of type I TD cases survive more than one year, suggesting genetic heterogeneity. In this study, we analyzed the fibroblast growth factor receptor 3 (FGFR3) gene in 5 Japanese cases of type I TD with clinical symptoms ranging from lethal to long-survival. In every case, nucleotide sequence analysis of cDNA revealed a C to T transition at nucleotide 742 (C742T) in one allele of the FGFR3 gene, suggesting that type I TD is a rather homogeneous genetic condition, irrespective of clinical course. No association was found between C742T and C882T, although both nucleotides changes were from CpG dinucleotide in a near location.

A novel mutation substituting tryptophan with arginine in the carboxyl-terminal, non-collagenous domain of collagen X in a case of Schmid metaphyseal chondrodysplasia.

A novel nucleotide change in the collagen X gene was identified in a Japanese family with Schmid metaphyseal chondrodysplasia (SMCD). The T to C change at nucleotide 1951 resulted in replacement of tryptophan by arginine at residue 651 (W651R). This missense mutation is considered to be responsible for SMCD because 1, the same mutation was not be identified in the collagen X gene from normal individuals; 2, the mutation segregated with the SMCD phenotype in the index family; 3, the substituted amino acid is highly conserved in type X collagens, and 4, the mutation causes a marked change in the hydrophobicity profile of the surrounding region in the NC1 domain. This novel mutation (W651) seems to have the same impact on bone development as W651X mutation.