A pilot study on the pulmonary anthracosis in stray dogs of Kathmandu Valley, Nepal: A potential public health threat for future.

Background and Aim: Kathmandu is a densely populated metropolitan city in Nepal. In recent years, however, the metropolis has been ranked as one of the most polluted cities worldwide. Both humans and animals are susceptible to various respiratory diseases due to chronic exposure to polluted air. Due to the relative similarities in the anatomical structure and physiological functions of the respiratory system between humans and dogs, polluted environments may lead to respiratory illness in similar ways in both species living in the valley. On the basis of information on the air quality in the valley, this study was conceived to assess pulmonary illness in street dogs to discern the health hazards caused by polluted air. Materials and Methods: A total of 76 dogs with clinical signs of tachypnea, dyspnea, sneezing, coughing, mucopurulent discharge, moderate hyperthermia, and anorexia admitted from July 2020 to November 2020 in Animal Nepal for treatment were included in this study. Among them, 24 animals responded to treatment, and 52 dogs died during their stay in the hospital. The 52 dead animals were necropsied, and the lesions that resembled pulmonary anthracosis were further studied grossly and histologically in a blinded fashion by trained veterinary pathologists. Results: Significant morphological alterations were observed in the lungs and associated lymph nodes of 25 animals, indicating pulmonary anthracosis. Gross morphological changes included multiple black foci with hemorrhage, congestion, nodular, and emphysema on the parietal and visceral surfaces of the lungs. The alveolar septa and visceral pleura exhibited deposition of black particles. Congestion, emphysema, and inflammatory exudates were also detected in the lung tissues and lymph nodes. Conclusion: The clinical, gross, and microscopic findings accurately resembled those of pulmonary anthracosis. This life-threatening condition in stray canines may be caused by a critical level of air pollution from different sources and carbon emissions from vehicles. To protect animals and humans living in the Kathmandu Valley, concerned government and non-government agencies should work toward reducing air pollution levels as soon as possible.

Prediction of Hamstring Autograft sizes for Anterior Cruciate Ligament Reconstruction using Preoperative Magnetic Resonance Imaging.

BACKGROUND: The purpose of this study is to determine whether preoperative magnetic resonance image measurements can predict the hamstring tendon autograft diameter during anterior cruciate ligament reconstruction. METHODS: We prospectively evaluated Forty-two patients with anterior cruciate ligament injury who underwent reconstruction using hamstring tendon autograft. Preoperative diameters and cross-sectional areas of the hamstring tendons were estimated using magnetic resonance imaging of the knee. Intraoperative diameters of the hamstring tendon graft were measured using a cylindrical graft sizer. We used Pearson's correlation test to compare the Preoperative and intraoperative graft size measurements. A possible cutoff value for the hamstring graft size was determined using Receiver operating characteristic analysis. RESULTS: The mean age of the patient in the study was 27.5 ± 8.5 years. There were statistically significant correlations between preoperative and intraoperative hamstring tendon graft measurements (P < 0.001). Our study found 13.3 mm² cross-sectional area as the cutoff for predicting 7mm of quadrupled hamstring graft size with both sensitivity and specificity of 85.7 %, respectively. CONCLUSIONS: We can conclude that preoperative magnetic resonance imaging measurements can predict the intraoperative graft size. This study can help in preoperatively planning for the graft choice.

A framework for multi-sensor satellite data to evaluate crop production losses: the case study of 2022 Pakistan floods.

In August 2022, one of the most severe floods in the history of Pakistan was triggered due to the exceptionally high monsoon rainfall. It has affected ~ 33 million people across the country. The agricultural losses in the most productive Indus plains aggravated the risk of food insecurity in the country. As part of the loss and damage (L&D) assessment methodologies, we developed an approach for evaluating crop-specific post-disaster production losses based on multi-sensor satellite data. An integrated assessment was performed using various indicators derived from pre- and post-flood images of Sentinel-1 (flood extent mapping), Sentinel-2 (crop cover), and GPM (rainfall intensity measurements) to evaluate crop-specific losses. The results showed that 2.5 million ha (18% of Sindh's total area) was inundated out of which 1.1 million ha was cropland. The remainder of crop damage came from the extreme rainfall downpour, flash floods and management deficiencies. Thus approximately 57% (2.8 million ha) of the cropland was affected out of the 4.9 million ha of agricultural area in Sindh. The analysis indicated expected production losses of 88% (3.1 million bales), 80% (1.8 million tons), and 61% (10.5 million tons) for cotton, rice, and sugarcane. This assessment provided useful tools to evaluate the L&D of agricultural production and to develop evidence-based policies enabling post-flood recovery, rehabilitation of people and restoration of livelihood.

Anterior Cruciate Ligament Injury among Patients with Knee Injury Visiting the Out-patient Department of Orthopaedics of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Anterior cruciate ligament injury diagnoses are often missed at initial presentation. Though better diagnosed by physical examinations when done by orthopaedics surgeons, proper history is also important in diagnosing it. This study aimed to find the prevalence of anterior cruciate ligament injury among patients with knee injury visiting the out-patient Department of Orthopaedics of a tertiary care centre. Methods: This descriptive cross-sectional study was conducted on patients visiting the out-patient Department of Orthopaedics of a tertiary care centre within the study period from 31 January 2019 to 1 February 2020, after obtaining clearance from the Institutional Review Committee [Reference number: 321(6-11-E)2/075/076]. The anterior cruciate ligament injury diagnosis was made using a Magnetic Resonance Imaging scan. They were inquired about the specific history features at the time of injury: leg giving way, inability to continue the activity, massive swelling of knee joint within 6 hours, and 'pop' heard or felt. Point estimate and 95% Confidence Interval were calculated. Results: Among 127 cases of knee injury, anterior cruciate ligament injury was found in 109 (85.83%) (79.76-91.89, 95% Confidence Interval). History of the leg giving way, inability to continue the activity, massive swelling of the knee and 'pop' heard or felt were present in 90 (82.60%), 92 (84.40%), 91 (83.50%), and 86 (78.90%) cases of anterior cruciate ligament injury respectively. At least two history features were present in 104 (95.41%) cases. Conclusions: The prevalence of anterior cruciate ligament injury was found to be similar to the published studies. Keywords: anterior cruciate ligament; diagnosis; history; orthopaedics.

Comparison of Sonographic Findings of the Rotator Cuff Between Diabetic and Non-diabetic Patients with Shoulder Pain.

BACKGROUND: The aim of study is to evaluate the shoulder by sonography in patients presenting with shoulder pain and correlate the findings observed with the diabetic patient. METHODS: Study was done in 60 patients who presented in the Department of Orthopedics with a history of the shoulder pain. Shoulder ultrasound was performed according to standard protocol, thickness of the supraspinatus tendon, presence of the tear, biceps tendon subacromial subdeltoid effusion and subacromial impingement were assessed. RESULTS: Of the 60 patients, 46 were male and 14 were female. Among them 15 patients were diabetics, 12 patient were male and 3 patient were female. Supraspinatus(SST) tendon thickness was greater in diabetics than in non-diabetics. Similarly, Subacromial bursal effusion, Biceps tendon effusion and Subacromial impingement were also seen in greater frequency in diabetic patients. However, no significant correlation was found between tear and the diabetes. CONCLUSIONS: There was increased supraspinatus tendon thickness, subacromial impingement, subacromial bursal effusion and biceps tendon effusion in diabetic patient compared to non-diabetic patient.

Hospital Resilience After the 2015 Earthquake in Nepal: Results From Semi-structured Interviews With Hospital Staff.

Background: Resilient hospitals are increasingly recognized as a cornerstone of disaster reduction in global policies such as the Sendai Framework for Action. However, current hospital resilience frameworks emerged from pre-disaster conceptualizations, and have not been verified in real-life disaster contexts nor in the frontlines. Our aim was to study a tertiary hospital's resilience after the 2015 earthquake in Nepal, as experienced by its staff. Methods: We undertook a qualitative study in the Tribhuvan University Teaching Hospital (TUTH), where we conducted 18 semi-structured interviews with hospital staff. We inductively created themes to describe the earthquake burden to the hospital, and to analyze individual resilience of hospital staff. In addition, we deductively documented the resilience of the hospital as a system, according to the system resilience dimensions: means of resilience (redundancy and resourcefulness), and ends of resilience (robustness and rapidity). Results: In terms of robustness, TUTH increased its capacity for earthquake victims as elective activities were temporarily interrupted and quality of care was not a priority. Three stages of rapidity were identified: critical rapidity to address immediate needs, stabilizing rapidity until the hospital re-started routine activities, and recovery rapidity. In addition to the disaster plan, emerging adaptations played a major role in redundancy and resourcefulness. We found that individual resilience depended on three determinants: safety, meaningfulness, and sense of belonging. Conclusions: Hospital resilience results from a complexity of emerging and planned adaptations, as well as from interdependencies with individual resilience. Frameworks and plans to improve hospital resilience must reflect flexibility of response, and a concern for well-being of hospital staff is central for sustainable disaster response and improved resilience.

Flood inundation mapping- Kerala 2018; Harnessing the power of SAR, automatic threshold detection method and Google Earth Engine.

Flood inundation maps provide valuable information towards flood risk preparedness, management, communication, response, and mitigation at the time of disaster, and can be developed by harnessing the power of satellite imagery. In the present study, Sentinel-1 Synthetic Aperture RADAR (SAR) data and Otsu method were utilized to map flood inundation areas. Google Earth Engine (GEE) was used for implementing Otsu algorithm and processing Sentinel-1 SAR data. The results were assessed by (i) calculating a confusion matrix; (ii) comparing the submerge water areas of flooded (Aug 2018), non-flooded (Jan 2018) and previous year's flooded season (Aug 2016, Aug 2017), and (iii) analyzing historical rainfall patterns to understand the flood event. The overall accuracy for the Sentinel-1 SAR flood inundation maps of 9th and 21st August 2018 was observed as 94.3% and 94.1% respectively. The submerged area (region under water) classified significant flooding as compared to the non-flooded (January 2018) and previous year's same season (August 2015-2017) classified outputs. Summing up, observations from Sentinel-1 SAR data using Otsu algorithm in GEE can act as a powerful tool for mapping flood inundation areas at the time of disaster, and enhance existing efforts towards saving lives and livelihoods of communities, and safeguarding infrastructure and businesses.

Role of choroidal thickness assessment in unilateral acute anterior uveitis.

Purpose: The aim of our study was to investigate the change in the subfoveal choroidal thickness in unilateral acute anterior uveitis with treatment. Choroidal inflammation is uncommon but can occur in the acute stage of anterior uveitis. Methods: All diagnosed patients with the first episode of unilateral acute anterior uveitis were included in the study conducted for a period of July 2017-July 2018. Choroidal thickness at subfoveal region was measured with spectralis spectral domain optical coherence tomography using enhanced depth-imaging scans. Standardized, masked manual measurement of the choroidal thickness was performed in the center of the ETDRS fields. The unaffected fellow eye of the same patient was taken as a control group and their subfoveal choroidal thickness was measured. Follow up of the patients was done at 2 weeks posttreatment to reevaluate the choroidal thickness. Results: A total of 61 eyes of 61 patients with unilateral acute anterior uveitis were included in the study. The mean central subfoveal choroidal thickness was significantly higher (304.82 ± 73.17 µm) as compared to that of controls (251.28 ± 66.38 µm) at presentation (P < 0.001). Following treatment and at two weeks follow up, the subfoveal choroidal thickness significantly reduced from 304.82 ± 73.17 to 274.46 ± 63.82 µm (P < 0.001). Also the subfoveal choroidal thickness was positively correlated with visual acuity (r = 0.22, P < 0.251) before treatment. Conclusion: Acute anterior uveitis is associated with an increase in the subfoveal choroidal thickness followed by the significant decrease in choroidal thickness with treatment, suggesting that choroid is also inflamed along with anterior segment inflammation.

Non-neoplastic indications and outcomes of the proximal and distal femur megaprosthesis: a critical review.

PURPOSE: Megaprosthesis or endoprosthetic replacement of the proximal and distal femur is a well-established modality for treatment of tumors. The indications for megaprosthesis have been expanded to the treatment of some non-neoplastic conditions of the knee and hip, with the severe bone loss associated with failed arthroplasty, communited fractures in the elderly with poor bone quality, and resistant non-union. Th aim of this study is to find out whether megaprosthesis of the knee and hip is successful in the treatment of non-neoplastic condtions. The study comprises a review of the indications, complications, and outcomes of megaprosthesis of the proximal and distal femur in non-neoplastic conditions of the knee and hip joints. METHODS: We extensively reviewed the literature on non-neoplastic indications for megaprosthesis of the proximal and distal femur after performing a detailed search of the Pubmed database using the medical subject heading (MeSH) terms 'proximal femur replacement' or 'distal femur replacement' and 'hip or knee megaprosthesis.' The data obtained after the structured search were entered into a Microsoft Excel spreadsheet. The frequency distribution of the demographic data, indications, complications, and outcome was calculated. RESULT: We included ten studies (seven proximal femur replacement and three distal femur replacement) of 245 proximal femur and 54 distal femur mega prostheses for treatment of non-neoplastic conditions. Bone loss in failed arthroplasty, either due to periprosthetic fracture or deep infection, was the most common indication for megaprosthesis. Dislocation was the most common complication after proximal femur megaprosthesis, and infection was the leading cause of complications after distal femur megaprosthesis. CONCLUSION: Megaprosthesis for treatment of non-neoplastic conditions around the distal and proximal femur is a viable option for limb salvage, with an acceptable long-term outcome. Although the complications and survival rates of megaprosthesis in non-neoplastic conditions are inferior to a primary arthroplasty of the hip and knee but are comparable or better than the mega prosthetic replacement in the neoplastic conditions. Proximal femoral megaprosthesis has higher dislocation rates and requirement for revision compared to distal femoral megaprosthesis. However, the proximal femoral megaprosthesis has lower rates of infection, periprosthetic fractures, and soft tissue complications, as compared to distal femoral megaprosthetic replacement. Both associated with aseptic loosening but not statistically significant.

Changes in patient admissions after the 2015 Earthquake: a tertiary hospital-based study in Kathmandu, Nepal.

Literature on earthquake impact on hospital admissions is lacking, particularly in low-resource settings. Our aim was to study the pattern of admissions before and after the 2015 earthquake in a tertiary hospital in Nepal. We used routine hospital data from 9,596 admissions, and defined four periods: pre-earthquake (pre-EQ), acute (EQ1), post-acute (EQ2), and post-earthquake (post-EQ). We compared length of hospital stay (LOS) across the study periods using negative binomial regressions. We used logistic regressions to study changes in probability of admission for diagnostic categories, and Generalized Additive Models to model the difference in number of admissions compared to pre-EQ baseline. LOS was longer in EQ1 than during pre-EQ, in particular for injury-related admissions. In EQ1, the odds of injury admissions increased, while they decreased for the majority of other diagnoses, with the odds of pregnancy-related admissions remaining low until post-EQ. The number of admissions dropped in EQ1 and EQ2, and returned to pre-EQ trends in post-EQ, accumulating 381 admissions lost (CI: 206-556). Our findings suggest that hospital disaster plans must not only foresee injury management after earthquakes, but also ensure accessibility, in particular for pregnant women, and promote a quick return to normality to prevent additional negative health outcomes.

Clinical and demographic profile of admitted victims in a tertiary hospital after the 2015 earthquake in Nepal.

BACKGROUND: In 2015, an earthquake killing 9,000 and injuring 22,000 people hit Nepal. The Tribhuvan University Teaching Hospital (TUTH), a reference tertiary hospital, was operational immediately after the earthquake. We studied the profile of earthquake victims admitted in TUTH and assessed what factors could influence hospital length of stay. METHODS: An earthquake victim dataset was created based on patient records, with information on sex, age, date of admission and discharge, diagnosis, and surgical intervention. We performed an initial descriptive overview of the earthquake victims followed by a time-to-event analysis to compare length of hospital stay in different groups, using log rank test and cox regression to calculate Hazard Ratios. RESULTS: There were in total 501 admitted victims, with the peak of admissions occurring on the fifth day after the earthquake. About 89% had injury as main diagnosis, mostly in lower limbs, and 66% of all injuries were fractures. Nearly 69% of all patients underwent surgery. The median length of hospital stay was 10 days. Lower limb and trunk injuries had longer hospital stays than injuries in the head and neck (HR = 0.68, p = 0.009, and HR = 0.62 p = 0.005, respectively). Plastic surgeries had longer hospital stays than orthopaedic surgeries (HR = 0.57 p = 0.006). Having a crush injury and undergoing an amputation also increased time to discharge (HR = 0.57, p = 0.013, and HR = 0.65 p = 0.045 respectively). CONCLUSIONS: Hospital stay was particularly long in this sample in comparison to other studies on earthquake victims, indirectly indicating the high burden TUTH had to bear to treat these patients. To strengthen resilience, tertiary hospitals should have preparedness plans to cope with a large influx of injured patients after a large-scale disaster, in particular for the initial days when there is limited external aid.

Understanding the dynamics in distribution of invasive alien plant species under predicted climate change in Western Himalaya.

Invasive alien plant species (IAPS) can pose severe threats to biodiversity and stability of native ecosystems, therefore, predicting the distribution of the IAPS plays a crucial role in effective planning and management of ecosystems. In the present study, we use Maximum Entropy (MaxEnt) modelling approach to predict the potential of distribution of eleven IAPS under future climatic conditions under RCP 2.6 and RCP 8.5 in part of Kailash sacred landscape region in Western Himalaya. Based on the model predictions, distribution of most of these invasive plants is expected to expand under future climatic scenarios, which might pose a serious threat to the native ecosystems through competition for resources in the study area. Native scrublands and subtropical needle-leaved forests will be the most affected ecosystems by the expansion of these IAPS. The present study is first of its kind in the Kailash Sacred Landscape in the field of invasive plants and the predictions of potential distribution under future climatic conditions from our study could help decision makers in planning and managing these forest ecosystems effectively.

Clinical Epidemiology of Acute Burn Injuries at Nepal Cleft and Burn Centre, Kathmandu, Nepal.

BACKGROUND: Burn injury is a global health problem mainly occurring in developing countries. The Nepal Cleft and Burn Centre at Kirtipur Hospital, Kathmandu, has been providing the acute burn care since 2013 with 7 intensive care unit beds, 30 general beds, and 2 dedicated operating rooms. A similar descriptive study was performed in this center in 2014. These studies will be helpful for developing prevention strategies and monitoring the progress in the standard of care of acute burn patients. METHOD: This is a descriptive retrospective study of the clinical data of acute burn patients admitted from January 1, 2015 to December 31, 2016. RESULTS: There were a total of 567 patients who came from 63 of 75 total districts of Nepal. Two hundred ninety-six (52.2%) patients were females and 271 (47.8%) were males. Two thirds of the patients were young adults. Most of the injuries occurred inside the house (72.1%). Flame burn was the most common mode of injury (66%) followed by scald (21.6%). Only 64 (11.3%) patients arrived on the same day of the injury. The longest time elapsed was 60 days with a median of 4.3 days. Range of total body surface area (TBSA) involved was 1% to 95%. The mean and median TBSAs were 25% and 15%, respectively. Range of hospital stay was 1 to 105 days with a median of 13.3 days.A total of 448 surgical procedures were performed in 384 patients (67.7%). A total of 110 (19.4%) patients died at the hospital. Only 13 patients (3%) survived deep burn injury involving 40% or more TBSA with either cadaveric skin allograft or with skin allograft from the live relatives. CONCLUSIONS: The outcome of burn injuries in Nepal is very poor. Children and females are at high risk. There is a lack of knowledge about burn prevention, proper first aid, and skin donation among the Nepalese population. Delay in presentation and extensive burns are poor prognostic factors. Awareness programs about the proper first aid and the need of a skin bank has to be done to improve the burn scenario in Nepal. Availability of allograft can increase the chances of survivability of patients with extensive burns in Nepal.

Pretreatment of Hardwood and Miscanthus with Trametes versicolor for Bioenergy Conversion and Densification Strategies.

The pretreatment of plant biomass negatively impacts the economics of many bioenergy and bioproduct processes due to the thermochemical requirements for deconstruction of lignocelluluose. An effective strategy to reduce these severity requirements is to pretreat the biomass with white-rot fungi, such as Trametes versicolor, which have the innate ability to deconstruct lignocellulose with a suite of specialized enzymes. In the present study, the effects of 12 weeks of pretreatment with a wild-type strain (52J) and a cellobiose dehydrogenase-deficient strain (m4D) of T. versicolor on hardwood and Miscanthus were explored. Both strains of T. versicolor led to significant decreases of insoluble lignin and significant increases of soluble lignin after acid hydrolysis, which suggests improved lignin extractability. The glucose yields after saccharification using an enzyme cocktail containing chitinase were similar or significantly higher with 52J-treated biomass compared to untreated hardwood and Miscanthus, respectively. The fungal treated biomass, regardless of the strain used, also showed significant increases in energy content and compressive strength of pellets. Overall, the use of T. versicolor as a pretreatment agent for hardwood and Miscanthus could be an environmentally friendly strategy for conversion technologies that require delignification and saccharification, and/or processes that require densification and transport.