COMPARISON OF DEXMEDETOMIDINE AND FENTANYL ON AIRWAY RESPONSE AND HEMODYNAMICS DURING TRACHEAL EXTUBATION

Background: Extubation is associated with various circulatory and airway responses. Various pharmacological measures including fentanyl and dexmedetomidine have been used to blunt the reflex without compromising the spontaneous respiration. In this study we wanted to compare dexmedetomidine and fentanyl on airway response, smoothness of extubation and hemodynamic changes. Methodology: A total of 68 patients undergoing surgery under general anesthesia with endotracheal intubation, were randomized into two groups. Group A received dexmedetomidine 0.5 mcg/kg and Group B received 1 mcg/kg of fentanyl with the start of skin suturing over a period of 10 minutes via syringe pump. Airway reflex during suction and smoothness of extubation were assessed. Level of sedation during suction, extubation and then every 5 minutes post extubation for 15 minutes were recorded. Hemodynamic parameters were assessed every 5 minutes with start of test solution till extubation and then every 5 minutes for 15 minutes. Results: A total of 68 patients were evaluated in the study. In dexmedetomidine group, 67.6% of patients had no cough on extubation while in fentanyl group 35.3% of patients had no cough on extubation which was statistically significant (p value 0.015). Mean heart rate during extubation increased in both the groups but the increase was 39% in Group B and 11% in Group A from baseline which was statistically significant (p value < 0.001). There was rise in mean systolic and mean arterial pressure during extubation in both the groups but the increase was significantly higher in fentanyl group. Patients in dexmedetomidine group were more sedated but there were no any adverse events. Conclusion: With the results obtained from the study, it is concluded that dexmedetomidine 0.5 mcg/kg over 10 minutes before extubation is effective in alleviating airway response and haemodynamics compared to fentanyl 1 mcg/kg.

Evaluation of Liver Enzymes and calculation of AST to ALT ratio in patients with acute viral hepatitis

Background: Acute viral hepatitis is a common liver-associated abnormality encountered in clinical practice. The number of biochemical parameters is estimated to detect a hepatic abnormality, which can measure the severity and types of damage to hepatocytes, among which liver enzymes and bilirubin levels are assessed routinely which are raised in acute viral hepatitis.Objective: This study aims to assess the liver enzymes, such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin, and calculation of AST to ALT ratio in acute viral hepatitis and to compare these parameters with the control group.Methodology: This study included a total of 81 subjects diagnosed with acute viral hepatitis as cases and age and sex-matched, the same number of healthy subjects as control. Serum levels of AST and ALT, alkaline phosphatase (ALP), and bilirubin were analyzed using standard methods. Serum AST to ALT ratio was calculated. Data analysis was done using SPSS Version 17.0 and the results were expressed as mean ±standard deviation (SD).Results: A mean serum activities of aminotransferases were statistically significantly raised in viral hepatitis compared to that in control.AST (514.85±350.66 VS 25.65±5.29; p<0.001) and ALT (781.65±525.69 VS 27.94±6.50; p<0.001). Similarly, serum levels of(ALP)were significantly increased in acute viral hepatitis compared to that in control (202.17±75.46 VS 98.83±27.99; p<0.001. However, a ratio of AST to ALT was decreased significantly (0.66±0.15 VS 0.94±0.21; p= 0.001) in acute viral hepatitis compared to that in control.Conclusion: Both the aminotransferases and bilirubin levels are raised significantly, where, a rise in ALT is greater than a rise in AST, hence, the ratio of AST to ALT is decreased significantly in acute viral hepatitis than that in control. Thus, this decreased pattern of AST to ALT can diagnose acute viral hepatitis at an early stage and can help appropriate care and treatment to the patients.

The public-private partnership (PPP) initiative in healthcare system: as the pathways to achieve the SDGs in Nepal

Globally, financing healthcare is one of the biggest challenges and it becomes a life or death issue in poor countries. Nepal is strongly committed to universal health coverage and Sustainable Development Goals. Existing public health services are inadequate to cater to the growing demands of quality health care and Public Private Partnership (PPP) evolved as newer arrangement for robust healthcare system, improved healthcare quality and enhance cost-effectiveness. Nepal has successfully utilized the PPP model in multiple sectors, however there is limited experience in healthcare. Strengthening PPP models in healthcare could be the pathway for Nepal toward SDG’s and UHC achievement.

Serum level of Total Antioxidant Status and Malondialdehyde in the Patients with Polycystic Ovarian Syndrome: a Comparative Study

Background: Polycystic ovary syndrome (PCOS) is a complex endocrine disorder in women of reproductive age and a major cause of infertility. Anti- Mullerian Hormone (AMH), a valid marker of ovarian function, is used for the diagnosis of PCOS. The aim of this study is to assess the serum level of total antioxidant status (TAS) and malondialdehyde (MDA) in the premenopausal women with PCOS. Methods: A cross-sectional analytical study was conducted at Padmashree Diagnostics, Department of Gynecology, India from April 2016 to March 2017. Census method was used to select the samples. The oxidative stress was measured by measuring the level of TAS and MDA. The data was recorded in structured proforma and and enter in SPSS version 16.0. The data were expressed in frequency, percentage, mean and standard deviation and the results obtained were analyzed using pearson’s correlation and student’s t-test. The p-value less than 0.05 was taken as statistically significant. Results: The measured serum AMH level among the patients with PCOS was within normal range in 67.5% (27) and above normal range in 32.5% (13). The serum TAS level in normal AMH group was 814.0 + 291 µMol/L and in above normal range group was 720 + 240 µMol/L, (p <0.001). Similarly, the serum level of MDA in normal AMH group was 6.64 + 0.21 µMol/L, and in above normal range group was 8.78 + 0.22 µMol/L (p = 0.01). The measured level of AMH was significantly associated with the increased level of MDA (p<0.001) and decreased level of TAS (p<0.001). The measured MDA level in high AMH group did show statistically significant than the normal AMH group. Conclusions: Serum level of TAS and MDA along with AMH are valuable diagnostic biomarker for the diagnosis of PCOS in the resource poor settings where ultrasound facility is unavailable.

Association between Crowding and the Effective Maxillary and Mandibular Length among Orthodontic Patients of Kathmandu, Nepal.

Background: During orthodontic consultation, the most frequent major complaint of the patients is dental crowding, which is caused by a disparity between the arch length and tooth size. Objective: The purpose of this study was to evaluate the association between crowding and the effective maxillary and mandibular length in Nepalese orthodontic patients.Methods: The orthodontic records of 390 people (from January 2018 to December 2020) were randomly selected and classified into three skeletal malocclusions based on the ANB angle (Angle formed by point A and point B at the nasion). Subjects with skeletal malocclusions were subdivided into two groups depending on the degree of crowding in the mandibular arch: Group 1 had crowding of < 3mm, and Group 2 had crowding of >3mm. On pretreatment casts, digital vernier calipers (Digimatic, Precise, India) were used to assess dental arch crowding, whereas, on a pretreatment lateral cephalogram, digital cephalometric analysis (Vistadent OC 1.1, USA) was done to quantify effective maxillary and mandibular length. Inter-group comparisons were assessed using a one-way analysis of variance. The correlation was assessed by Pearson’s correlation coefficient (p≤0.05).Results: There was a statistically significant difference in effective maxillary and mandibular length among skeletal malocclusions (p<0.05). Skeletal Class II malocclusion had the greatest mandibular crowding, while skeletal Class III malocclusion had the least. The effective maxillary and mandibular lengths and dental crowding had a significant but weak inverse correlation, whereas a strong but moderate positive correlation existed between the maxillary and mandibular effective lengths (r=0.674) and also between maxillary and mandibular crowding (r=0.631).Conclusion: Effective maxillary length was highest in skeletal class II malocclusion whereas effective mandibular length was highest in skeletal class III malocclusion. The shorter effective maxillary and mandibular lengths showed a weak association with dental crowding.

Community Health Workers (CHWs) to Improve Primary Health Care Services Delivery: A Case of Female Community Health Volunteers (FCHV) Program in Nepal

Community health workers (CHWs) have played a vital role in improving primary healthcare services in different parts of the world, in particular, for those services related to the prevention and control of communicable diseases, immunization services, reproductive health, maternal and child health, HIV/AIDS prevention and care and nutrition promotion. The Female Community Health Volunteers (FCHVs) program, which was introduced in 1988 in Nepal, has now reached over 51,000 FCHVs. They are key community level CHWs in Nepal and have contributed significantly in achieving several health and related outcomes and meeting several Millennium Development Goals. In such, there is also a potential and needs for engaging them to prevent and control emerging health challenges such as non-communicable diseases prevention and control and re-emerging health issues. Their effective involvement to ongoing health programs would be critical to achieving Sustainable Development Goals, agenda in particular “SDG 3 – Health and Wellbeing” by 2030.

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Authorship and Contribution Details

Salivary Flow Rate Before, During and After Insertion of Complete Denture in Different Age Group: a Comparative study

Background: Increase in salivary flow accompanying complete denture insertion is a well-known phenomenon. Complete dentures act as a mechanical stimulant, increasing salivary flow after insertion. This study compares unstimulated and stimulated salivary flow rates before, during, and after insertion of a complete denture in different age groups.Method: Forty subjects meeting inclusion criteria were selected. Unstimulated saliva was collected first. Stimulation was produced by chewing paraffin wax and collected of saliva in a graduated container. This procedure was carried out before insertion, during insertion, 24 hours after, and 7 days after insertion of complete dentures. The study data were entered, edited, and coded in Microsoft Excel. The unstimulated and stimulated salivary flow rate was compared at different time intervals.Result: Unstimulated salivary rate was lowest before denture insertion with mean values of 0.27ml/minute. The highest flow rate was recorded during denture insertion (mean values of 0.60 ml/minute). The mean unstimulated salivary flow rate 24 hours after denture insertion was higher than 7 days after denture insertion. The mean stimulated salivary rate was lowest before denture insertion (mean values of 0.59 ml/minute). The highest flow rate was recorded during denture insertion (mean values of 0.93 ml/minute). There was a declining trend in salivary flow rate after denture insertion i.e. 0.86 ml/minute to 0.75ml/min after 24 hours and 7 days of denture insertion. A gradual decrease in salivary flow rate with an increase in age was noted but the association of age with salivary flow rates was not statistically significant.Conclusion: There was an increase in both unstimulated and stimulated salivary flow rate after insertion of complete denture and age does not affect salivary flow rates before, during (immediately after), 24 hours after, and 7 days after denture insertion.

Stay Home, Stay Safe? Challenges in Resource Limited Settings

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