Knowledge of Stroke among Hypertensive Patients in Dhulikhel.

Background More than 50% of patients with stroke have hypertension, a common modifiable risk factor for stroke. Studies reported that 90% of diagnosed hypertensive patients do not seek for treatment in Nepal and the reason for this remains unexplored. There is a possibility that lack of knowledge of stroke and its potential causes may be the reason. Objective To assess the knowledge of stroke in a group of patients with hypertension in suburban Nepal. Method Hypertensive patients visiting a tertiary care hospital in Nepal were approached and were included if they were 18 years or older. We used the Nepali version of 'Awareness of Stroke, Risk Factors, and Treatment' questionnaire to assess the knowledge of stroke. Descriptive statistics were used to analyze the results. Result A total of 273 patients were included with the mean age of 56 years. Almost half (48%) of the patients were uneducated. We found that only 24% of the patients identified brain as an organ affected by stroke, only 32% were aware about more than one warning signs of stroke, 64% reported that they were unaware of the treatment options for stroke and only 5% reported control of blood pressure as a part of stroke management. The commonest reported identifiable risk factor for hypertension was high blood pressure (44%). Conclusion There are significant knowledge gaps regarding stroke in hypertensive patients. Although most patients recognized hypertension as a risk factor for stroke, they were unaware of treatment options. Increasing awareness of hypertension as a risk factor for stroke may help to prevent the stroke burden in Nepal.

Longitudinal increases in blood biomarkers of inflammation or cardiovascular disease and the incidence of venous thromboembolism.

Essentials Inflammatory and cardiac diseases are associated with increased venous thromboembolism (VTE) risk. Our prospective study assessed rise in inflammatory or cardiac biomarkers and VTE risk. A greater 6-year rise in N-terminal natriuretic peptide is associated with increased VTE incidence. Volume overload or impending cardiac disease may contribute to VTE occurrence. SUMMARY: Background We previously showed that participants in the population-based Atherosclerosis Risk in Communities (ARIC) cohort with elevated levels of blood biomarkers of inflammation or cardiac disease were at increased risk of venous thromboembolism (VTE). Objective We hypothesized that ARIC participants with larger 6-year increases in the levels of three biomarkers - C-reactive protein (CRP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and troponin T - would also have an increased subsequent risk of VTE. Methods We measured changes in the levels of these biomarkers in 9844 participants from 1990-1992 to 1996-1998, and then identified VTEs through 2015. Results A greater 6-year rise in the level of NT-proBNP, but not in that of CRP or troponin T, was significantly associated with increased VTE incidence over a median of 17.6 years of follow-up. After adjustment for other VTE risk factors, those whose NT-proBNP level rose from < 100 pg mL-1 to ≥ 100 pg mL-1 had a hazard ratio for VTE of 1.44 (95% confidence interval [CI] 1.15-1.80), as compared with the reference group with an NT-proBNP level of < 100 pg mL-1 at both times. This hazard ratio was slightly higher (1.66, 95% CI 1.19-2.31) during the first 10 years of follow-up, but was attenuated (1.24, 95% CI 0.99-1.56) after adjustment for prevalent and incident coronary heart disease, heart failure, and atrial fibrillation. Conclusions The two most likely explanations for our results are that: (i) an increasing NT-proBNP level reflects increasing subclinical volume overload and potentially increased venous stasis or subclinical PE that had gone unrecognized over time; or (ii) an increasing NT-proBNP level is a risk marker for impending cardiac disease that places patients at risk of VTE.

Unresolving Pneumonia with Pleural effusion: Pulmonary Paragonimiasis.

Paragonimiasis is a zoonosis caused by many species of Paragonimus commonly P. westermani. Human get infected by eating raw, salted, pickled, smoked, partially cooked crustaceans (crayfish or crabs). Clinical manifestations ranges from non-specific symptoms like pain abdomen, diarrhea, urticarial rashes, fever to pleuropulmonary symptoms like cough, hemoptysis, chest pain and dyspnea. A 48 years, female presented at TUTH emergency with fever on and off for nine months, cough and shortness of breath for three months, lethargy, malaise and urticaria with history of raw crab intake one month prior to the onset of symptoms. Blood and pleural fluid analysis revealed raised total counts with eosinophilia and x-ray showed bilateral infiltration of lower lobes with pleural effusion. Diagnosis was confirmed by microscopic examination of sputum for Paragonimus. She responded well to Praziquantel. Pulmonary paragonimiasis must be considered in the differential diagnosis of unresolving pneumonia and unexplained hypereosinophilia.

A lifetime experience of violence and adverse reproductive outcomes: findings from population surveys in India.

Intimate partner violence (IPV) is a global public health issue that threatens the reproductive health of women. Despite a growing demand for research on the potential threat of IPV in relation to adverse reproductive outcomes, there have been no population-based studies of India. The current study analyzed the National Family Health Survey 3, which contained detailed information on types of violence in relation to the single question of pregnancy outcomes. The dataset was used to assess the association between a lifetime experience of IPV and terminated pregnancies among married Indian women. Multiple logistic regression analysis was then used to assess the association between these variables, controlling for socio-demographic characteristics. Results showed that 39.6% of Indian women have experienced violence by their husbands, while 18.3% of women have terminated a pregnancy during their lifetimes. The odds ratio of a terminated pregnancy among women who had experienced any type of partner violence was 1.62 (95% CI (confidence interval) = 1.51-1.73). All combinations of violence except a combination of emotional and sexual violence were associated with an increased risk of a terminated pregnancy. These results suggest that prevention of IPV would reduce the high incidence of terminated pregnancies, thus improving maternal health in India.

Intimate partner violence in Sri Lanka.

To describe the current situation of intimate partner violence (IPV) in Sri Lanka, and to propose possible interventions to prevent IPV, we performed a literature survey for articles and reports on IPV in Sri Lanka. Our results suggested that prevalence of IPV is high (40%) in Sri Lanka. Most of the IPV studies were conducted in health care institutions and missed IPV victims who had not attended a health care institution. A common belief in Sri Lanka, even among medical students and police officers is that IPV is a personal matter that outsiders should not intervene. The laws against IPV identify the physical and psychological IPV, but not the sexual IPV. To improve this situation of IPV in Sri Lanka, we recommend IPV education programs for medical students and police officers, community awareness programs on IPV, and amending the laws to identify sexual IPV. We also recommend well designed community based research on IPV.

Working conditions of bus drivers in the private sector and bus crashes in Kandy district, Sri Lanka: a case-control study.

OBJECTIVE: To explore the effects of working conditions of private-bus drivers on bus crashes in Kandy district, Sri Lanka. METHODS: A case-control study was carried out from August to September 2006. All private-bus drivers registered in Kandy district and involved in crashes reported to the police between November 2005 and April 2006 (n = 63) were selected as cases. Two control groups were included: private-bus drivers working on the same routes as the case drivers (n = 90) and private-bus drivers selected randomly from other routes of the district (n = 111). Data were collected using an anonymous self-administered questionnaire. Associations between working conditions and crashes were analysed using logistic regression. RESULTS: A strong association was observed between drivers' disagreements about working hours and bus crashes (matched controls, adjusted odds ratio (AOR) 5.98, 95% CI 1.02 to 34.90; unmatched controls, AOR 18.74, 95% CI 2.00 to 175.84). A significant association was also observed between low salaries (

Unintentional injuries among school adolescents in Kathmandu, Nepal: a descriptive study.

OBJECTIVE: To describe detailed mechanisms and activities at the time of unintentional injuries among adolescents in Kathmandu, Nepal. METHODS: A school-based study was conducted on 1557 students in grades 6-8 across 14 schools, using a self-administered questionnaire during August-September 2003. Mechanisms and activities were coded using the Nordic Medico Statistical Committee's classification. FINDINGS: Falls (65%) and cuts (63%) were the most common injuries, followed by transport-related injuries (36%) and burns (22%). In urban areas, falls (59%) were the most common injuries, followed by transport-related injuries (50%); in semi-urban areas, falls (66%) and cuts (65%) were the most common injuries, followed by transport-related injuries (34%). At the time of falls, boys were generally engaged in sports while girls were engaged in walking on streets or on stairs in houses, in both areas. Falls from trees among boys and falls from roofs among girls were also common in semi-urban areas. Cut injuries while processing food were common among boys and girls in both areas, whereas agricultural work was also a source of injury in semi-urban areas. Pedestrian injuries were common during transport among boys and girls in both areas; boys in semi-urban areas were almost equally likely to be injured during cycling. Burn injuries while cooking and serving food were more common among girls in semi-urban areas. CONCLUSION: Falls, cuts, transport-related injuries, and burn injuries were quite prevalent among adolescents in Kathmandu. The reported injury mechanisms and activities posing injury risks have implications for future interventions.