BackgroundObese people have a higher prevalence of cardiovascular disease, which is supposed to be due to autonomic dysfunction and/or metabolic disorder. The alterations in cardiac autonomic functions bring out the changes in the heart rate variability (HRV) indicators, an assessing tool for cardiac autonomic conditions.ObjectiveTo compare the cardiac autonomic activity between obese and normal weight adults and find out the highest association between the indices of HRV and obesity.MethodsThe study was conducted in 30 adult obese persons (body mass index [BMI] >30 kg/m2) and 29 healthy normal weight controls (BMI 18–24 kg/m2). Short-term HRV variables were assessed using standard protocol. Data were compared between groups using Mann–Whitney U test. Obesity indices such as waist circumference, hip circumference, waist–hip ratio (WHR), and BMI were measured and calculated, and they were correlated with HRV indices using Spearman’s correlation analysis.ResultsIn the obese group, there was a significant increase in the mean heart rate, whereas the HRV parasympathetic indicators were less (eg, root mean square of differences of successive RR intervals [28.75 {16.72–38.35} vs 41.55 {30.6–56.75} ms, p=0.018], number of RR intervals that differ by >50 ms, that is, NN50 [15.5 {2–39} vs 83.5 {32.75–116.25}, p=0.010], etc) and the sympathetic indicator low frequency (LF)/high frequency (HF) ratio (1.2 [0.65–2.20] vs 0.79 [0.5–1.02], p=0.045) was more than that of the normal weight group. Spearman’s correlation between HRV and obesity indices showed significant positive correlation of WHR with LF in normalized unit (r=0.478, p<0.01) and LF/HF ratio (r=0.479, p<0.01), whereas it had significant negative correlation with high frequency power ms2 (r=−0.374, p<0.05) and HF in normalized unit (r=−0.478, p<0.01). There was a nonsignificant correlation of BMI with HRV variables in obese individuals.ConclusionIncreased WHR, by far an indicator of visceral adiposity, was strongly associated with reduced cardiac parasympathetic and increased sympathetic activity in obese individuals defined by BMI. However, BMI itself has a weak relationship with HRV cardiac autonomic markers. Thus, even with a slight increase in WHR in an individual, there could be a greater risk of cardiovascular morbidity and mortality brought about by cardiac autonomic alterations.

BackgroundProblem-based learning (PBL) was introduced into Basic Medical Sciences early in the 1980s at Tribhuvan University (TU), Nepal, followed by other universities where didactic lecture method was still followed as the main teaching strategy. Despite gaining its popularity worldwide as integrated teaching learning method, PBL is not given importance in Nepal. This study aimed to assess the attitude and perceptions of undergraduate medical students regarding learning outcomes of PBL and to know their views about role and qualities of effective tutors for its successful implementation.MethodsThis descriptive study was based on a self-administered questionnaire. The first part of the questionnaire measured students’ perception and attitude toward benefits of PBL and the second part measured students’ perception about role of PBL tutor. Bachelor of Medicine and Bachelor of Surgery (MBBS) first year (2014/2015 academic year) students at Chitwan Medical College, TU, were asked to express their opinions about the importance of learning outcomes by rating each statement on a five-point Likert scale and the responses were combined into three categorical variables: “agree” (strongly agree plus agree), “neutral”, and “disagree” (strongly disagree plus disagree). Data were analyzed using SPSS version 21.0.ResultsApproximately 85.5% participants agreed that PBL is an interesting method of teaching learning. Most of them (86.7%) accepted that PBL is an interactive and a mutual learning method and improves self-directed learning (83.2%). Although 78% had recommended it better than lecture, many (54.2%) pointed it out as a time-consuming method. The participants were also highly rated (80.5%) to the statement - the tutor’s role in enhancing the constructive active learning and maintaining good intra-personal behavior.ConclusionStudent’s attitude toward PBL was positive. They highly appreciated the roles of a tutor as facilitators and motivators for proper activities in PBL session. PBL sessions were considered effective in improving students professional knowledge and refining problem-solving and self-directed learning skills along with enriching teamwork experience.

Background: Urinary tract infections (UTI) during pregnancy issued by improper laboratory investigations situate women at risk of several detrimental complications. Untreated asymptomatic UTI (AUTI) may lead to pyelonephritis preterm birth, low birth weight, etc. Urine culture is used to confirm the diagnosis of UTI. Aim of this research was to carry out to find the prevalence of asymptomatic UTI and to establish antimicrobial drug susceptibility of the pathogens resulting asymptomatic UTI in pregnant women attending at tertiary care, Nepal.Methods: The urine samples were collected by mid-stream clean catch method from 600 pregnant women of age 15-45 years (mean age – 28.84 years) visiting for antenatal check up in the Department of Gynaecology and Obstetrics, Chitwan Medical College (CMC), a tertiary care of Nepal. All the urine samples were subjected to bio-physical, biochemical, microscopic, and microbiological analysis. The prevalence of UTI in three trimesters and in different age groups was obtained together with antimicrobial drug susceptibility tests.Results: On overall l51.83% of urine samples revealed with significant bacteriuria considered as the AUTI. On One- way ANOVA test, there was significant (P< 0.045) prevalence of AUTI when compared among different trimesters, though higher prevalence being in the first (40%) and second (45.33%) trimesters. The prevalence of AUTI was significant (P<0.004) among different age groups of the pregnancy. However, the most affectecd age groups were between 21-29 years. Escherichia coli were the most implicated organism (67.8%) followed by Klebsiella pneumonia (21.6%). The gram-negative bacteria (E. coli, K. pneumonia, and K. oxytoca) were more sensitive against Amikacin, Gentamycin, Meropenem, and Nitrofurantointhan. Other drugs whereas; gram positive bacteria (E. feacalis) had high susceptibility with Vancomycin.Conclusions: There was high incidence of AUTI among the pregnant ladies in the study region; therefore, microbial screening of urine of all pregnant women are must and should be included in the routine antenatal checkups to detect the AUTI to cut down and prevent the maternal and obstetric detrimental complications in them.

INTRODUCTIONDiabetes mellitus type 2 is the most common non communicable chronic metabolic disorder caused by the relative insufficiency of insulin secretion and insulin action. If it is not properly treated or left untreated it is characterized by chronic hyperglycaemia and disordered carbohydrate, lipid and protein metabolism and is associated with the development of specific microvascular complications and of non-specific macrovascular disease. The global prevalence and economic cost of diabetes and its complications are abnormally increasing and become a real problem of developed and developing countries like India and this is projected to increase substantially over the next 2 decades. According to the diabetes atlas, seventh edition 2015 published by the IDF. The total number of people with diabetes in India currently around 69.2 million is expected to rise to 123.5 million by 2040. 2Diabetes complications can affect many parts of body, manifesting in different ways in different people. Moreover, at least one complication is present in large ABSTRACT Background: Diabetes and its complications are one of the leading causes of death and disability worldwide. The aim of the study is to elucidate the prevalence and associated risk factors of microvascular complication among diabetes mellitus type 2 population of Ajmer, Rajasthan India. Methods: This is the study of 464 newly detected type 2 diabetic people screened for their biochemical parameters, attending outpatient department comprising of 256 male and 208 female. The presence of complications was evaluated by relevant investigations. Results: Microvascular complication namely retinopathy was diagnosed in 344 (74%) of type 2 diabetic patients, neuropathy in 200 (43%), nephropathy in 138 (30%). Linear regression analysis concluded that age, body mass index, duration, family history, stress, glycated haemoglobin (HbA1C), triglyceride and total cholesterol were significantly associated with these vascular complications. Prevalence of microvascular complications increases with age, duration, body mass index (BMI), hereditary and poor glycemic control. Conclusions: Retinopathy and neuropathy were the most prevalent microvascular complication in type 2 diabetic population.

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