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Background: Sleep problems during pregnancy may cause many complications that reduce quality of life. Aim: This study aims to determine the relationship between pregnant women's sleep characteristics and depressive symptoms. Methods: A hospital-based, cross-sectional study was conducted. Pregnant women were selected from the population by using the an improbable random sampling method. This study sample included 436 pregnant women who met the study’s inclusion criteria. To collect data, this study used an information form that was developed by the researcher after reviewing relevant literature, the Women's Health Initiative Insomnia Rating Scale (WHIIRS), and the Beck Depression Inventory (BDI). The researchers used face-to-face interviews method to collect data from the participants, pregnant women who were examined in the polyclinic. Results: This study found that 36% of participating pregnant women reported insomnia, and 38.1% experienced depressive symptoms. It also determined that participants who had problems with insomnia, who experienced a change in sleep habits, and who did not wake up feeling rested experienced depressive symptoms 1.64, 2.79, and 2.59 times more than those who didn’t have these problems, respectively. who experienced a decrease in sleep, who experienced an increase in sleep, and who did not wake up feeling rested experienced depressive symptoms 1.61, 3.22, 3.53, and 2.59 times more, respectively, than those who did not have insomnia, who did not experience a change in sleep habits in pregnancy, and who woke up feeling rested, respectively. Conclusion: This study determined that there is a relationship between insomnia and depressive symptoms and that pregnant women experiencing insomnia presented with more depressive symptoms. Keywords: Depressions, last trimester, pregnancy, sleep characteristics.

Background— Experimental studies revealed proinflammatory properties of angiotensin II. We evaluated antiinflammatory effects of the angiotensin II subtype 1 receptor antagonist olmesartan medoxomil alone and in cotherapy with the HMG-CoA reductase inhibitor pravastatin in patients with essential hypertension and microinflammation. Methods and Results— We measured a panel of vascular inflammation markers, including high-sensitivity C-reactive protein, and lipid levels during 12 weeks of therapy with olmesartan (n=100) or placebo (n=99) in a prospective double-blind multicenter study. Pravastatin was added to the double-blind therapy at week 6 in both treatment arms. Blood pressure control was achieved with addition of hydrochlorothiazide. Olmesartan treatment had already significantly reduced serum levels of high-sensitivity C-reactive protein (−15.1%; P P P P P P P P Conclusions— Angiotensin II receptor blockade significantly reduces vascular microinflammation in patients with essential hypertension by as early as week 6 of therapy. This antiinflammatory action of angiotensin II receptor antagonists may contribute to their beneficial cardiovascular effects.

Type-2 diabetes may remain in subclinical form for years before diagnosis. This quiescence of type-2 diabetes is a great concern for health care providers. The earliest change of the type-2 diabetes is the insulin resistance, which is associated with the increased macrovascular risk due to induction of chronic inflammation in the vessels of the body which leads to atherosclerotic change in the vessels. High sensitivity CRP (hs-CRP) is the measure of C-reactive protein with greater accuracy and the lower limit of its assay is .01 mg/L which is more than 100 times as sensitive as the usual CRP measurement (lower limit 5 mg/L). The median level of hs-CRP from blood samples of apparent healthy subjects is 0.8 mg/L. For this, physician uses the hs-CRP parameter as a marker of chronic inflammation in apparently normal healthy individuals, specially for the assessment of atherosclerosis, which is a chronic inflammatory procedure from the very beginning, in type-2 diabetic, obese and hypertensive patients. This vascular atherosclerosis assessment help them to calculate the cardiovascular as well as cerebrovascular risk of those patients. To help the type-2 diabetic patients from the very begining in respect of the prognostic view of the macrovascular risk, estimations of serum hs-CRP in the early stage of these patient may be a enthusiastic one. This descriptive study was carried out by choosing 70 diabetic patient who had no other comorbidity or any complications of diabetes and 35 healthy subjects who were neither diabetic nor had any diseases. Both the groups were non-smoker and non-alcoholic and non-hypertensive, hs-CRP level was measured in both the groups along with the HbA1c%. The mean hs-CRP in diabetic group was 1.13 mg/L and in normal healthy subjects was 0.39 mg/L. This higher level of mean hs-CRP (1.13 mg/L) in diabetic patients is statisticaly significant (P

Background: Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) claimed more than 22 million deaths in the past two decades. About 10,000-15,000 Nepalese are expected to die of AIDS related deaths every year in the absence of effective treatment and care. Major cause of mortality and morbidity in HIV infected people is opportunistic infection (OI). Type of pathogen(s) responsible for OI varies from region to region. Objective: This study attempts to find out OI among HIV seropositive patients visiting MTH, Pokhara. Results: Tuberculosis (30%) was found to be most common OI followed by candidiasis (14%). Pulmonary tuberculosis (21.14%) was more common than extra pulmonary tuberculosis (8.92%). Oral candidiasis (8.92%) was more common than oesophageal candidiasis (5.35%). Conclusion: The study findings indicate that immediate and strong action needs to be taken and guidelines and strategies to tackle the HIV AIDS problems are required and should be equally implemented to achieve a decline in the rate of prevalence of HIV. Key words: HIV, AIDS, Opportunistic infection, Tuberculosis doi: 10.3126/kumj.v6i3.1708 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 335-339

Objective: The aim of the work was to study the socio-demographic variables and their co-morbidity to alcohol consumption and presence of depressive symptomatology. Design: This was a prospective cross-sectional study. Materials and methods: The study was carried out in 53 patients, who were admitted in the wards of Kathmandu Medical College Teaching Hospital (KMCTH) with the diagnosis of mental and behavioural disorder due to the use of alcohol according to ICD-10. The patients were taken from 1st February 2006 to 30th December 2006. All patients were rated using Hamilton Depression Rating Scale (HDRS). Comparison of alcohol intake, depressive symptomatology and their associations with various socio-demographic variables were done using standard statistical procedures. Results: The present study has shown that more than 94.3% of the patients were suffering from depressive episode. Among all the patients, 11.3% were suffering from severe depressive episode. Alcohol intake was more significantly correlated (p = .002) with Brahmin and Chhetri caste. The other significant correlation of alcohol intake and sociodemographic variable was Nuclear family (p=.001). Among these patients the severity of depression was significantly (p= .001) associated with duration of alcohol intake. Marital status was another important factor affecting comorbidity of alcohol intake and presence of depressive symptoms (p =.002). Students of 10th to 12th grades of school were found to be using alcohol more often (45.3%). Middle socio-economic status (60.4%) was using alcohol more frequently than other socioeconomical classes. Conclusion: Severity of depression and alcohol intake was found to be significantly associated with various socio-demographic variables such as caste, family structure, marital status and educational status. Key words: Co-morbidity, ICD-10, Depression, alcohol-related disorders doi: 10.3126/kumj.v6i3.1709 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 340-345

Aim : To assess the complications and visual outcomes associated with cataract surgery in camp patients operated at a tertiary centre. Materials and methods : In a retrospective study, 206 outreach camp patients had undergone cataract surgeries with posterior chamber intraocular lens implantation under peribulbar anesthesia over a period of 6 months. Post-operative complications on Day 1 were graded as per Oxford Cataract Treatment and Evaluation Team (OCTET) definitions. One month postoperative complications, best corrected visual acuity and refractive errors were assessed. Results : 206 eyes underwent cataract extraction with PCIOL implantation. Small incision cataract surgery (SICS) was the commonest method (78.6%) used. The most common first post-operative day complication was mild iridocyclitis (26.2%). The complications were based on OCTET definitions, and showed that 33 % had Grade I and 3.4 % had Grade II complications. The major post-operative complication after 4 weeks of surgery was posterior capsular opacity. 89.8 % of the eyes had a 4 week-post-operative best corrected visual acuity of e” 6/24. The commonest refractive error was myopia with against the rule astigmatism, seen in 86 out of 150 cases. Conclusion : High quality cataract surgery with a low rate of intra-operative complications and good visual outcome can be attained in camp patients operated in the base hospitals, thus justifying more similar screening camps to clear the vast cataract backlog. Key words : cataract surgery, eye camp, visual outcomes DOI: http://dx.doi.org/10.3126/nepjoph.v3i2.5270 Nepal J Ophthalmol 2011; 3(2): 159-164

Background: pleural effusion is the common findings in patients presenting with cardiopulmonary symptoms but specific studies are lacking in Nepal. Objective: The main objective of this study is to find out the various causes of pleural effusion, their mode of clinical presentation and laboratory analysis of blood and pleural fluid to aid diagnosis of patients with pleural effusion. Materials and methods: Retrospective data from July 2009 to July 2007 from all the cases diagnosed with pleural effusion were taken. Altogether 100 cases diagnosed with pleural effusion by chest X-ray (Posterior- Anterior and Lateral view) and Ultrasonogram of the chest were studied. The following parameters were analysed: Patients demographic profile, causes, location (Unilateral, Bilateral), Blood haemoglobin and count, sputum profile, Monteux test, chest Xray and USG findings and pleural fluid analysis[Biochemical, Haematological, Microbiological(culture and stain) and cytological]. This study was analysed by using SPSS 16. Results: The mean age of the patient was 44.89 ± 21.59 and must patients with pleural effusion belong to age group 21- 30. Most common cause of pleural effusion was found to be tubercular effusion followed by parapneumonic effusion. Right sided effusion was seen in most cases of tubercular parapneumonic and malignant effusion whereas bilateral effusion was seen in 87.5% of the patient (7 out of 8) having congestive heart failure and all cases of renal disease (4 out of 4). Shortness of breath (83%), cough (67%) and fever (66%) are the most common mode of clinical presentation. Conclusion: Our study concluded that the most common cause of unilateral pleural effusion is tuberculosis followed by parapneumonic effusion and most cases of those belong to younger age group (21 -30yrs) and most common cause of bilateral pleural effusion is congestive cardiac failure. Key words : Pleural effusion; Tuberculosis; pneumonia; malignancy; protein; ADA DOI: 10.3126/kumj.v7i4.2772 Kathmandu University Medical Journal (2009) Vol.7, No.4 Issue 28, 438-444

La atención sanitaria se realiza, mayoritariamente, siguiendo un modelo convencional, en el que la Atención Primaria y la Atención Especializada actúan como compartimentos estancos, con graves carencias en la relación entre ambos niveles asistenciales. Esta situación origina una serie de disfunciones, sobre todo en los pacientes con múltiples patologías crónicas, que repercuten directamente en la calidad de su atención, en la sobrecarga de los diferentes circuitos asistenciales y en el consumo de recursos por parte del Sistema Sanitario. Ante esta realidad, en 2006 se crea en el Servicio de Medicina Interna del Hospital Universitario de Guadalajara la Unidad de Continuidad Asistencial Primaria-Medicina Interna (UCAPI), que supone una reorganización de la estructura, permitiendo combinar el modelo asistencial convencional propio de esta especialidad con un nuevo marco de trabajo que favorezca la coordinación con Atención Primaria mediante la figura del médico internista de referencia, a través de la consultoría telefónica, sesiones clínicas compartidas entre ambos equipos, autogestión de las agendas e integración de consultas con el empleo del hospital de día y camas de hospitalización. Con este nuevo modelo se logra mejorar la atención a los pacientes pluripatológicos y a los pacientes en fase diagnóstica no demorable, reduciendo visitas a urgencias hospitalarias y optimizando los recursos de hospitalización., Health care is carried out, mostly, following a conventional model, in which primary care and specialised care act as almost isolated compartments, with severe deficiencies in the relationship between both levels of care. This reality directly impacts on the quality of patient care, on the present overloaded healthcare circuits and on the consumption of the Healthcare System´s resources. As a result of the aforementioned situation, in 2006, the Internal Medicine Department of the University Hospital of Guadalajara, created the Primary Care-Internal Medicine Continuity Unit (UCAPI). This new clinical unit involves a reorganization of the structure, which permits to combine the conventional care model of this speciality with the new one. The established synergy favours the coordination with Primary Care through the figure of the consultant internist. This new model requires four basics elements to be in place: telephone consulting, clinical meetings with primary care teams, self-management of agendas as well as integration of the assistance in the medical office with the use of day hospital and conventional inpatient beds. With this new model, it is possible to improve the care of patients with multiple chronic diseases and that of those in which diagnosis must not be delayed thus, avoiding patients going to the hospital emergency department and optimizing hospitalization resources.

A study was made of 162 persons with intermittent claudication who were observed for an average of 8.3 years. These were all the cases that evolved from a population cohort during 18 years of follow-up. They were essentially untreated until rest pain and tissue loss began. Only four progressed to major amputations and three to toe loss. A profile of the person developing intermittent claudication and gangrene in particular reveals a higher prevalence of diabetes and the cigarette habit, as well as hypertension and hypercholesteremia. The comorbidity and subsequent incidence of coronary disease, stroke, and congestive failure was high. Within eight years, almost half developed a major cardiovascular event and 20% of the men and 30% of the women were dead. This cardiovascular morbidity and mortality, as well as intermittent claudication, is predictable in the general population free of cardiovascular disease. Patients being considered for bypass surgery whose only complaint is claudication should be carefully evaluated for risk of cardiovascular morbidity.

This theoretical study examines the main findings and researches regarding the comorbidity between conduct disorder and major depression in adolescence. On the one hand, it is argued that high prevalence of comorbidity imply common risk factors (biological, cognitive- emotional and socio-cultural) and a causal relationship between these mental illness, usually conduct disorder preceding major depression. On the other hand, independent nosological status of this "comorbidity" is advocated on the basis of several external criteria (e.g. response to treatment, course into adulthood and psychopathological profile), which distinguish this mixed clinical entity from conduct disorder and major depression, especially the latter category. These findings are discussed concerning the classification of “depressive conduct disorder” within current diagnosis reference manuals.

An increase in the frequency of corpus cancer over the period 1954-1969 and 1965-1969 in records for the S. Anna Hospital, Turin, and the Piedmont and Aosta Valley areas respectively is reported. Attention is drawn to the fact that more than 30% of patients were in the 66-80 age group (i.e. over the usual age of 56 to 60). A higher frequency of infertility and delayed menopause in patients with such tumours has been proved statistically significant. Diabetes, obesity and hypertension are pathogenetically linked to adenocarcinoma of the endometrium and not to casual associations. The findings are in line with the view that this neoplasia is hormone-dependent and a public health programme for its prevention is proposed.

BACKGROUND: The prevalence of T2DM in Ethiopia is on the rise according to certain studies. Appropriate management approaches are required to achieve desired goals of therapy in the clinical setup. This study was conducted to assess the treatment pattern and the factors associated with BP and FPG control among patients with T2DM in Federal Police Referral Hospital.METHOD: An institution based cross sectional study was conducted from 15th October 2016 to 15th January 2017. A Systematic random sampling technique was employed in selecting the study participants. Data was collected using semi-structured interview and visiting medication records. SPSS version 20 was used for data analysis.RESULTS: Out of a total of 414 participants who fulfilled the inclusion criteria, 361 were successfully interviewed and considered for further analysis. Target BP level was achieved in 206(57.1%) of the patients, whereas the proportion of hypertensive diabetics who attained the recommended BP target was 19.4% (n=40). Of the 361 participants who were checked about their current FPG level, only 142(39.3%) were found to be

Background: Various studies have found a greater prevalence of depression among patients having one or more chronic non communicable disease like diabetes mellitus than in the general population. This co-morbidity is linked with serious health consequences such as high mortality and morbidity, debility, low quality of life and increased health costs. The aim was to determine the prevalence of depression among patients with diabetes attending three selected district hospitals in Rwanda. Sociodemographic factors associated with depression were also explored.Methods: It was a descriptive cross sectional study. A sample of 385 was selected randomly to participate in the study and 339 complete the questionnaires making a response rate of 88%. The Patient Health Questionnaire-9 (PHQ-9) was used to screen depression. Descriptive and inferential analysis were done.Results: The majority of respondents 83.8% (n=284) had depression. Among them 17.9% (n=61) had moderately severe to severe depression while 81.9% (n=223) had minimal to moderate depression. A statistically significant association was found between age and depression (p=0.01) also between gender and depression (p=0.02). Significance was determined at P