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Forest fires have become more intense and frequent in recently changing climates. The wide variety of pollutants released by forest fire include greenhouse gases, photochemically reactive compounds, and fine and coarse particulate matter. This study investigated the impact of forest fire events on air quality in the Kathmandu Valley during March–April 2021 using ground air quality monitoring stations and satellite data. The three fire periods were studied (a) Pre-fire from 21st - 23rd March (b) first-fire episode from 24th −27th March and (c) second fire episode from 1st – 5th April of 2021. The concentrations of PM 2.5 reached to maximum 199 μg/m3 during pre-fire period, 371 μg/m3 and 280 μg/m3 during first and second fire event respectively. The second fire episode had lower PM 2.5 concentration despite higher fire counts (449) compared to the first episode suggesting influence of fire activities near to vicinity of Kathmandu valley during second fire episode. There was a two-day lag between the beginning of forest fire events and an increase in PM 2.5 levels in Kathmandu. Satellite observation showed varying patterns for different pollutants. HCHO levels responded quickly to fire activity, while AOD and CO levels increased after a few days. Also, low wind speed, low temperature, and low relative humidity additionally elevated these pollutants in Kathmandu. This study emphasizes the extent of the impact of forest fires on air quality and the importance of considering meteorological and satellite data to understand the distribution of pollutants during such events. [Display omitted] • Nepal experienced intense forest fire during March and April 2021. • Significant increase in PM 2.5 concentration and other atmospheric pollutants including HCHO, CO and O 3 • Observed the lag of few days between the beginning of forest fire events and an increase in PM 2.5 levels. • High aerosol are the results of both forest fire episode in Nepal and their local emissions. [ABSTRACT FROM AUTHOR]

Objectives: To compare the outcomes of standard- and mini-percutaneous nephrolithotomy (PCNL) for the treatment of staghorn stones. Patients and Methods: The data of consecutive adult patients who underwent PCNL for the treatment of staghorn stones, between July 2015 and December 2019 from three hospitals, were retrospectively reviewed. All cases were performed in a prone position under fluoroscopic guidance. The nephrostomy tracts were dilatated to 30 F in standard-PCNL and to 18–20 F in mini-PCNL. Stones were fragmented with pneumatic lithotripsy in both groups. Fragments were removed with forceps in the standard-PCNL, while they were evacuated through the sheath using the vacuum clearance effect in mini-PCNL. A ureteric stent was inserted after mini-PCNL, while a nephrostomy tube was inserted after standard-PCNL. Results: The study included 153 patients; 70 underwent standard-PCNL and 83 underwent mini-PCNL. The stone-free rates of PCNL monotherapy were comparable for both groups (83% for mini-PCNL and 88.6% for standard-PCNL, P = 0.339). The incidence (12% vs 24.3%, P = 0.048) and severity of complications were significantly lesser with mini-PCNL (P = 0.031). Standard-PCNL was associated with increased rate of blood transfusion (12.9% vs 2.4%, P = 0.013) and a significant decrease in haemoglobin (P = 0.018). Hospital stay was significantly longer for standard-PCNL than mini-PCNL (median stay of 6 vs 3 days, P < 0.001). Conclusions: The efficacy of mini-PCNL was comparable to standard-PCNL in the treatment of staghorn stones. The advantages of mini-PCNL included a lesser incidence and severity of complications, and shorter hospital stay. [ABSTRACT FROM AUTHOR]

The purpose of this study was to translate, cross-culturally adapt, and assess the reliability and validity of the Pelvic Girdle Questionnaire (PGQ) in pregnant Nepalese women. The cross-cultural adaptation process was conducted according to the Guillemin guidelines. Reliability and validity were assessed using cross-sectional design. The participants responded to questionnaires of sociodemographics, the Nepali version of the PGQ, the Oswestry Disability Index, the Patient-Specific Functional Scale, the 5-item version of the Edinburgh Depression Scale, and the Numerical Pain Rating Scale. The internal consistency was assessed with Cronbach's alpha. The test–retest reliability was calculated using the intraclass correlation coefficient and smallest detectable change. Construct validity was assessed by testing 9 a priori hypotheses that examine correlations between the PGQ activity and symptom subscales, and also among the PGQ subscales and Oswestry Disability Index, Numerical Pain Rating Scale, Patient-Specific Functional Scale, and 5-item version of the Edinburgh Depression Scale. Spearman and Pearson's correlation were used to assess the correlations. A sample of 111 pregnant women were included in the study. The Cronbach's alpha for the Nepali version of the total PGQ was good (α = 0.83), and the test–retest reliability was acceptable (ICC 2.1 , 0.72) with a measurement error of SDC 95% 18.6 points. Seven of the 9 hypotheses found support, which confirms acceptable construct validity of the Nepali PGQ. The Nepali version of the PGQ is a reliable and valid tool for assessing pelvic girdle pain in pregnant Nepalese women. [ABSTRACT FROM AUTHOR]

Purpose: Severe hemorrhage after percutaneous nephrolithotomy is a rare but alarming event. If local tamponade fails to control bleeding, the current treatment of choice is superselective renal arterial embolization. If initial embolization is unsuccessful, repeat embolization or nephrectomy is often required. To our knowledge we report the first study of risk factors for failed initial superselective renal arterial embolization. Materials and Methods: We retrospectively reviewed the records of 17,619 patients who underwent a total of 19,185 percutaneous nephrolithotomies from January 2007 to April 2012 at 6 centers. Study inclusion criteria were percutaneous nephrolithotomy and severe postoperative renal hemorrhage requiring superselective renal arterial embolization. Data on patients in whom initial embolization failed were compared to those on patients with successful embolization on univariate and multivariate analysis. Results: Of the 17,619 patients 117 (0.6%), met study inclusion criteria, including 90 males and 27 females. Initial treatment failed in 12 patients (10.3%), 8 underwent repeat superselective renal arterial embolization, 3 required 3 embolizations and 1 underwent nephrectomy. Complete bleeding cessation was achieved in all 11 repeat embolization cases. We identified 3 risk factors for failure of initial superselective renal arterial embolization, including multiple percutaneous access sites, more than 2 bleeding sites identified on renal angiogram and gelatin sponge alone used as the embolic material. Conclusions: Carefully selecting patients for multitract percutaneous nephrolithotomy, making an extra effort to identify all bleeding vessels during angiography and not using gelatin sponge as the only embolic material could potentially decrease the risk of failure of initial superselective renal arterial embolization after percutaneous nephrolithotomy. [ABSTRACT FROM AUTHOR]

Over the last decade, several flood early warning systems have been established in Nepal, helping reduce the number of people affected and killed by floods. However, there are still challenges in communicating flood warning to the most vulnerable. The unavailability of real-time monitoring in smaller streams and tributaries has created challenges for communicating early warning. The ongoing restructuring process of the multilevel governance system in the country also presents challenges, specifically institutional such as insufficient coordination among relevant agencies, lack of adequate personnel, limited budget, and unclear roles and responsibilities. This study uses the Alexander framework (2015) to identify gaps in flood early warning communication in relation to their technical, institutional and socio-cultural components. Qualitative research methods in the form of key informant interviews and on-site focus group discussions were conducted at the national, district and local levels to collect data, taking Ratu watershed as a case study. Based on our analysis, we conclude that, first, while progress has been made in the monitoring and forecasting of floods, integration of socio-cultural aspects that can make early warning information accessible to the most vulnerable has to be strengthened. Second, warning messages need to be co-designed with communities and tailored to meet their diverse needs for proper dissemination and timely protective action. Finally, for flood risk communication to bridge 'the last mile' in terms of reaching the most vulnerable in the community must take account of their distinct social, economic and political experiences in both content and delivery of the information. [ABSTRACT FROM AUTHOR]