Polycythemia among Patients with Chronic Obstructive Pulmonary Disease Admitted to the Department of Medicine in a Tertiary Care Center: A Descriptive Cross-sectional Study.

Introduction: Chronic obstructive pulmonary disease is a preventable and treatable disease marked by persistent airflow limitation. Abnormal rise of haemoglobin and/or hematocrit in peripheral blood is known as polycythemia which includes increased haemoglobin: greater than 16.5 g/dl in men or greater than 16.0 g/dl in women and increased hematocrit: >49% for men and >48% for women. Men, current smoking, impaired carbon monoxide diffusing capacity, severe hypoxemia, and high altitude living are risk factors associated with an increased risk for secondary polycythemia. Polycythemia contributes to the development of cor-pulmonale and pulmonary hypertension, which are linked to poor prognosis. This study aimed to find out the prevalence of polycythemia among patients with chronic obstructive pulmonary disease admitted to the department of medicine in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients with chronic obstructive pulmonary disease admitted to the Department of Medicine in a tertiary care centre after receiving ethical approval from Institutional Review Committee (Reference number: 153/079/080). The study was conducted from 15 September 2022 to 2 December 2022. Data were collected from the hospital records. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 185 patients, Polycythemia was seen in 8 (4.32%) (1.39-7.25, 95% Confidence Interval) patients among which 7 (87.5%) were females and 1 (12.5%) were male. Conclusions: The prevalence of polycythemia was lower compared to other similar studies done in similar settings. Keywords: chronic obstructive pulmonary disease; polycythemia; prevalence.

Teachers' screening estimations of speech-language impairments in primary school children in Nepal.

BACKGROUND: The prevalence of speech-language impairments in children have been estimated for several languages, primarily in developed countries. However, prevalence data is lacking for developing countries, such as Nepal. AIMS: (1) To obtain teacher estimates of incidence and overall prevalence of speech-language impairments and its subtypes as a function of gender, age and grade level; and (2) to validate the screening instrument on Nepalese children. METHODOLOGY: The adapted teachers' screening instrument, namely adapted Teachers' Speech and Language Referral Checklist (a-TSLRC), was administered in 2776 (690 and 2086) primary school children aged 5;00-11;11 years (mean = 8;11 years). The screening was conducted at four different points in time, i.e. Incidences I and II, and each incidence consisted of a testing and a retesting phase. Prior to this, teachers were trained in forum meetings, and an information sheet containing an overview of speech-language impairments, and guidelines/criteria for marking the occurrence of speech-language impairments in the TSLRC were disseminated. OUTCOMES & RESULTS: Overall prevalence of speech-language impairments in children was estimated as 8.11%. Specifically, overall speech problems were estimated as 4.68%, and language problems as 8.0%. Additionally, the prevalence by subtypes of speech-language impairments as categorized in the TSLRC were reported to be 2.95% for an articulation/phonological problems, 2.09% for stuttering, 3.42% for a voice problems, 4.97% for a receptive language problems and 7.74% for an expressive language problems. The internal consistency among items was sufficient and a good intra-rater reliability was obtained. CONCLUSIONS & IMPLICATIONS: The study indicates that the overall results of speech-language impairments in children via the adapted in-Nepalese criterion-referenced instrument are supported by international studies. In addition, justifiable reliability and validity was obtained. Therefore, based on these overall evidence, this instrument can be useful for the screening of speech-language impairments in primary school children in Nepal.

Phytochemical investigation of crude methanol extracts of different species of Swertia from Nepal.

BACKGROUND: The genus Swertia is reported to contain potent bitter compounds like iridoids, xanthones and c-glucoflavones that are known to heal many human disorders. In contrast to high ethnomedicinally valued Swertia chirayita, its other species have not been studied extensively, in spite of their common use in traditional medicinal system in Nepalese communities. So, the present study attempts to investigate the content of total polyphenols, flavonoids, antioxidant activity and estimate the rough content of amarogentin, swertiamarin and mangiferin from different species of Swertia from Nepalese Himalayas. METHODS: Whole plant parts of S. chirayita (SCH), S. angustifolia (SAN), S. paniculata (SPA), S. racemosa (SRA), S. nervosa (SNE), S. ciliata (SCI) and S. dilatata (SDI) were collected; total phenolic and flavonoid contents were quantified spectrophotometrically and in vitro DPPH free radical scavenging assay was measured. Thin layer chromatography was performed on TLC aluminium plates pre-coated with silica gel for identification of swertiamarin, amarogentin and mangiferin from those species and semi quantitative estimation was done using GelQuant.NET software using their standard compounds. RESULTS: The phenolic content was highest in the methanol extract of SCH (67.49 ± 0.5 mg GAE/g) followed by SDI, SRA, SNE, SCI, SPA and SAN. The contents of flavonoids were found in the order of SCH, SPA, SRA, SNE, SDI, SCI and SAN. Promising concentration of phenolics and flavonoids produced promising DPPH free radical scavenging values. The IC50 values for the 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging test was lowest in SCH (23.35 ± 0.6 µg/ml), even lower than the standard ascorbic acid among the seven studied species. A significant correlation of 0.977 was observed between the polyphenol content and antioxidant values. The TLC profile showed the presence of all three major phytochemicals; amarogentin, swertiamarin and mangiferin in all of the plant samples. CONCLUSION: Among the seven studied species, SCH showed anticipating results in total phenol content, flavonoid content and DPPH radical scavenging test. The less considered species of Swertia can be a potential source of bioactive amarogentin, and other useful therapeutic compounds in the alarming status of Swertia chirayita as shown by the phytochemical analysis.