Search

By training nurses and midwives on the basics of obstetric ultrasound, high-risk pregnancies in remote Nepalese villages can be identified and triaged. American radiology residents traveling to Nepal can improve their real-time, hands-on ultrasound scanning skills while learning the intricacies of practicing medicine in a low- and middle-income country. Global outreach work is increasing in popularity among US radiologists, emphasizing the importance of training radiology residents in point-of-care ultrasound., (Copyright © 2024 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Background: Systemic Lupus Erythematosus is a multi-systemic disease that has a high morbidity rate. Choroids usually have a distinct structural makeup in different systemic disorders which makes it easier to be used as a potential tool for the study of disease activity., Methods: This study was an observational cross-sectional prospective study with a total of 51 Systemic Lupus Erythematosus patients and 51 normal controls were included. The choroidal thickness values were determined using the Spectralis Spectral Domain Optical Coherence Tomography instrument (Heidelberg Engineering)., Results: The results showed that the mean subfoveal, nasal, and temporal choroidal thickness in Systemic Lupus Erythematosus patients with ocular manifestations had thinner choroidal thickness compared to normal controls with p<0.001, p=0.008, and p<0.001, respectively. On the other hand, Systemic Lupus Erythematosus patients without ocular manifestations had relatively thicker subfoveal choroidal thickness compared to normal controls (p<0.001) but nasal and temporal choroidal thickness were not statistically significant (p=0.264 and p=0.347 respectively)., Conclusions: The findings suggested that choroidal thickness measurement may serve as an indicator of disease activity and prognosis in Systemic Lupus Erythematosus patients, as well as a potential tool to predict the occurrence of ocular manifestations. Thinning of the choroid may be associated with factors such as decreased blood flow leading to atrophy or chronic inflammation, while thickening of the choroid may indicate active stage of the disease and the possibility of severe ocular manifestations in the future.

Introduction: Ischemic strokes in young patients have been increasing. Younger patients with ischemic stroke tend to have a different long-term prognosis than older patients. Young patients who have residual neurological deficits following ischemic stroke affect their quality of life. This study was carried out to find out the prevalence of hypertension among patients with ischemic stroke in a tertiary care hospital., Methods: This descriptive cross-sectional study was conducted in all the patients who were admitted with young ischemic stroke in the Department of Neurology, Nobel Medical College Biratnagar from December 2019 to December 2020 after taking ethical clearance from the Institutional Review Committee (reference number: 332/2019). Convenience sampling was done and data was collected, entered in Microsoft Excel, and analysis was done using Statistical Package for the Social Science software version 16. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data., Results: Out of the total patients with ischemic stroke in the young adults 30 (40%) (95% Confidence Interval= 28.91-51.08) had hypertension. During follow-up at 6 months, 20 (66.7%) of the patients with hypertension had favorable outcomes with a Modified Rankin Score of 0 or 1. Death during a hospital stay or during follow-up was observed in 2 (7%) of patients with hypertension. Mean age of the patients was 40±4.87 years. Most patients were in the age range of 36-45, 24 (80%)., Conclusions: Prevalence of hypertension among young patients with ischemic stroke was high compared to other studies.

Background: High risk pregnant women have increased risk of maternal and neonatal morbidity and mortality. Antepartum surveillance is important and should be effective in such conditions. Modified biophysical profile is the method of antepartum surveillance which comprises of cardiotocography and amniotic fluid index., Methods: A cross-sectional study was carried out in Paropakar Maternity and Women's Hospital from February 2019 to January 2020 to determine the effectiveness of modified biophysical profile. Cardiotocography was interpreted as reactive, equivocal and non-reactive. AFI was considered normal if it was 5 to 24 cm. In the study 172 high risk cases at term and not in labor were included. Each case was subjected to cardiotocography then amniotic fluid index was obtained using real time sonography where it was measured from all four quadrants. Modified biophysical results were obtained and then were divided into 2 arms as normal modified biophysical profile and abnormal modified biophysical profile then analysis was done., Results: Of 172 cases, there were 97 (56.4%) cases in normal modified biophysical profile and remaining 75 (43.6%) in abnormal modified biophysical profile group. The rate of cesarean section increased when there was abnormal modified biophysical profile.  Neonatal resuscitation and admission was increased in abnormal modified biophysical profile., Conclusions: Normal modified biophysical profile in high risk pregnancy had more cases of vaginal delivery and less adverse fetal outcome like low APGAR score, neonatal resuscitation and neonatal intensive care admission.

The novel coronavirus COVID-19 (SARS-CoV-2) was first reported in 31 December 2019 in Wuhan City, China. The first case of COVID-19 was officially announced on 24 January, 2020, in Nepal. Nine COVID-19 cases have been reported in Nepal. We aim to describe our experiences of COVID-19 patients in Nepal. Keywords: COVID-19; experience; Nepal.

Background/objectives: Understanding of the patterns and predictors of intra-household food allocation could enable nutrition programmes to better target nutritionally vulnerable individuals. This study aims to characterise the status and determinants of intra-household food and nutrient allocation in Nepal., Subjects/methods: Pregnant women, their mothers-in-law and male household heads from Dhanusha and Mahottari districts in Nepal responded to 24-h dietary recalls, thrice repeated on non-consecutive days (n = 150 households; 1278 individual recalls). Intra-household inequity was measured using ratios between household members in food intakes (food shares); food-energy intake proportions ('food shares-to-energy shares', FS:ES); calorie-requirement proportions ('relative dietary energy adequacy ratios', RDEARs) and mean probability of adequacy for 11 micronutrients (MPA ratios). Hypothesised determinants were collected during the recalls, and their associations with the outcomes were tested using multivariable mixed-effects linear regression models., Results: Women's diets (pregnant women and mothers-in-law) consisted of larger FS:ES of starchy foods, pulses, fruits and vegetables than male household heads, whereas men had larger FS:ES of animal-source foods. Pregnant women had the lowest MPA (37%) followed by their mothers-in-law (52%), and male household heads (57%). RDEARs between pregnant women and household heads were 31% higher (log-RDEAR coeff=0.27 (95% CI 0.12, 0.42), P < 0.001) when pregnant women earned more or the same as their spouse, and log-MPA ratios between pregnant women and mothers-in-law were positively associated with household-level calorie intakes (coeff=0.43 (0.23, 0.63), P < 0.001, per 1000 kcal)., Conclusions: Pregnant women receive inequitably lower shares of food and nutrients, but this could be improved by increasing pregnant women's cash earnings and household food security.

Background: There is scarce evidence on the impacts of food transfers, cash transfers, or women's groups on food sharing, dietary intakes, or nutrition during pregnancy, when nutritional needs are elevated., Objective: This study measured the effects of 3 pregnancy-focused nutrition interventions on intrahousehold food allocation, dietary adequacy, and maternal nutritional status in Nepal., Methods: Interventions tested in a cluster-randomized controlled trial (ISRCTN 75964374) were "Participatory Learning and Action" (PLA) monthly women's groups, PLA with transfers of 10 kg fortified flour ("Super Cereal"), and PLA plus transfers of 750 Nepalese rupees (∼US$7.5) to pregnant women. Control clusters received usual government services. Primary outcomes were Relative Dietary Energy Adequacy Ratios (RDEARs) between pregnant women and male household heads and pregnant women and their mothers-in-law. Diets were measured by repeated 24-h dietary recalls., Results: Relative to control, RDEARs between pregnant women and their mothers-in-law were 12% higher in the PLA plus food arm (log-RDEAR coefficient = 0.12; 95% CI: 0.02, 0.21; P = 0.014), but 10% lower in the PLA-only arm between pregnant women and male household heads (-0.11; 95% CI: -0.19, -0.02; P = 0.020). In all interventions, pregnant women's energy intakes did not improve, but odds of pregnant women consuming iron-folate supplements were 2.5-4.6 times higher, odds of pregnant women consuming more animal-source foods than the household head were 1.7-2.4 times higher, and midupper arm circumference was higher relative to control. Dietary diversity was 0.4 food groups higher in the PLA plus cash arm than in the control arm., Conclusions: All interventions improved maternal diets and nutritional status in pregnancy. PLA women's groups with food transfers increased equity in energy allocation, whereas PLA with cash improved dietary diversity. PLA alone improved diets, but effects were mixed. Scale-up of these interventions in marginalized populations is a policy option, but researchers should find ways to increase adherence to interventions. This trial was registered at www.controlled-trials.com as ISRCTN 75964374.

Objective: To outline the development of a smartphone-based tool to collect thrice-repeated 24 h dietary recall data in rural Nepal, and to describe energy intakes, common errors and researchers' experiences using the tool., Design: We designed a novel tool to collect multi-pass 24 h dietary recalls in rural Nepal by combining the use of a CommCare questionnaire on smartphones, a paper form, a QR (quick response)-coded list of foods and a photographic atlas of portion sizes. Twenty interviewers collected dietary data on three non-consecutive days per respondent, with three respondents per household. Intakes were converted into nutrients using databases on nutritional composition of foods, recipes and portion sizes., Setting: Dhanusha and Mahottari districts, Nepal., Subjects: Pregnant women, their mothers-in-law and male household heads. Energy intakes assessed in 150 households; data corrections and our experiences reported from 805 households and 6765 individual recalls., Results: Dietary intake estimates gave plausible values, with male household heads appearing to have higher energy intakes (median (25th-75th centile): 12 079 (9293-14 108) kJ/d) than female members (8979 (7234-11 042) kJ/d for pregnant women). Manual editing of data was required when interviewers mistook portions for food codes and for coding items not on the food list. Smartphones enabled quick monitoring of data and interviewer performance, but we initially faced technical challenges with CommCare forms crashing., Conclusions: With sufficient time dedicated to development and pre-testing, this novel smartphone-based tool provides a useful method to collect data. Future work is needed to further validate this tool and adapt it for other contexts.

In forensic casework, investigation of injury severity is important in evaluating the mortality, occasionally in terms of the adequacy of clinical management. The study was conducted with an objective to study the relationship of severity of the injuries using Abbreviated Injury Scale and Injury Severity Score (ISS) with survival period and place of death among fatal cases with abdominopelvic trauma.The total number of cases studied was 80. The injuries in all the body parts were allotted using the Abbreviated Injury Scale 2005, Update 2008, and the ISS was calculated. The male/female ratio was 4:1, and the mean (SD) age was 30.76 (15.2) years. The cause of trauma was road traffic accidents in 82.5% of the cases. The median duration of survival was 2 hours. The mean (SD) ISS was 38.90 (14.89). Abbreviated Injury Scale scores of 5 and 4 were the most common in the region. With increase in the ISS, the survival period was decreased. There was a highly significant difference between the mean ISS of the victims who died prehospital and that of who died in the emergency department (P < 0.005). The mean ISS of the victims who died in the emergency department and of those who died in the ward, intensive care unit, or after discharge was also significantly different (P < 0.05).Although the cases with more severe injuries died sooner, there should be provision of treatment on the spot without delay. More time taken to start the treatment increases the fatalities.

Abdomino-pelvic region is vulnerable to injury in various forms of trauma. This study was undertaken with objectives to study the pattern and type of external and internal abdominal and pelvic injuries and to identify the risk organs in abdomen and pelvis susceptible to trauma among the medico-legal autopsies at the mortuary of a referral centre in eastern Nepal during the period of one year (n = 80). Males constituted 80% of the cases and the mean age of the victims was 30.76 years. The cause of trauma was Road Traffic Accident in 82.5%. The manner of death was accidental in 87.5% and homicidal in 11.25% cases. Liver (57.5%) was the most common organ injured followed by spleen in 37.5% cases. Multiple organs injury was seen in 67.5% and absence of any external injuries was noted in 31.25% cases. Autopsy can play a role in establishing the missed injuries and be helpful to widen the knowledge of the medical faculty in early diagnosis and management of such injuries., (Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)