Need of The Ministry of Health in Federal Democratic Republic of Nepal.

The constitution of Nepal provides appointing a council of ministers both at federal and provincial levels without defining portfolios. There is a political agreement that MOH will be retained at the federal level. This article draws evidences around the world to meet health needs of Nepalese, the role of provincial ministry of health and coordinating structure at district/local level. The constitution emphasises on health and pronounced in 46 articles which provides guidance for the creation of federalized governance levels at federal, provincial and local levels. Retaining ministry of health at federal level without creating devolved structure at province and local levels in health sector will create difficulty in translating the spirit of the constitution and may not be effective in addressing health issues nationally and meeting global achievements like SDGs. It is suggested to establish an elaborate health system accordingly in Nepal to ensure constitutional mandate of health as a basic human right.

Myocardial bridging: light in the tunnel.

Myocardial bridging is a congenital anomaly in which a segment of a coronary artery runs intramuscularly. Although traditionally considered as a benign condition, myocardial bridging may be associated with clinically important complications such as myocardial ischemia, acute coronary syndromes and sudden death. We report the case of a highly symptomatic 36 years old patient with a myocardial bridge in left anterior descending coronary artery in which surgical treatment was proposed. Previous to surgery a non invasive coronariography with cardiac CT was practised in order to define the anatomy.

A new role for Women Health Volunteers in urban Islamic Republic of Iran.

An action research project was carried out by a team from the National Public Health Management Centre in Tabriz, Iran to test the following hypothesis: Health Volunteers are more able to support health improvements by focusing on community participation and empowerment through facilitating communities to define and solve their own problems than by only providing information on health problems. Training on participatory approaches was given to Women Health Volunteers (WHV) in a pilot area. The results gave evidence that local people could identify and act upon their own health needs and request more information from professionals to improve their own health. Further research is needed however to assess how the pilot can be scaled up and how initial enthusiasm can be sustained.

A new role for Women Health Volunteers in urban Islamic Republic of Iran

An action research project was carried out by a team from the National Public Health Management Centre in Tabriz, Iran to test the following hypothesis: Health Volunteers are more able to support health improvements by focusing on community participation and empowerment through facilitating communities to define and solve their own problems than by only providing information on health problems. Training on participatory approaches was given to Women Health Volunteers [WHV] in a pilot area. The results gave evidence that local people could identify and act upon their own health needs and request more information from professionals to improve their own health. Further research is needed however to assess how the pilot can be scaled up and how initial enthusiasm can be sustained

[Latex myoglobin: a fast early marker in acute myocardial infarction]. / Mioglobina-látex: un marcador rápido y temprano en el infarto agudo de miocardio.

BACKGROUND: To evaluate the diagnostic power of serum myoglobin (Mgb) by latex agglutination as a marker in the first hours of acute myocardial infarction (AMI). METHODS: Two hundred forty-eight serum samples from 53 patients admitted to the Coronary Unit (CU) from the Emergency Department (ED) for suspected AMI were studied. The extractions were carried out upon admission and at 4, 8, 12, 18, 24 and 36 hours after the initiation of symptoms. Myoglobin was analyzed by radioimmunoassay (RIA) and by a semiquantitative method of latex agglutination (Rapitex), in addition to creatine kinase (CK) and MB fraction (CK-MB). Sensitivity (S), specificity (E), positive and negative predictive value (PPV) (NPV) and standard efficacy (SE) of the different markers were measured along with the correlation between RIA and latex methods for Mgb. RESULTS: For a prevalence of 83%, the latex test provided S = 81%, E = 8%, PPV = 97%, NPV = 50%, ES = 0.85; CK S = 43% (*), E = 88%, PPV = 97%, NPV = 24% (*) and ES = 0.31 (*) (* = p less than 0.01) and CK-MB S.63% (*), E = 100%, PPV = 100%, NPV = 34% (*) and ES = 0.31 (*) (* = p less than 0.05). The correlation between latex and RIA in the first 4 hours was r = 0.8243 (p less than 0.0001). On performing the 2 tests separated by 2 in the first 4, latex NPV was 100%. CONCLUSIONS: Mgb - latex is the earliest AMI indicator and has greater diagnostic strength in the first hours than CK and CK-MB. It has a good correlation with Mgb-RIA and is simple and rapid to carry out making it specially useful in Emergency Departments and Coronary Units.