Need for Prioritizing Health: An Old War-Cry Reiterated By COVID-19

The poor state of health care in Nepal will be burdened further following the SARS-CoV-2 pandemic. The government failed in timely stockpiling of medical supplies and equipment, development of health infrastructure, including laboratories and quarantine centres, restriction and screening of international travel and information dissemination to the general public. While efforts have now been made to increase the capacity for diagnostic test for SARS-CoV-2, the government still needs to further increase the availability and accessibility throughout the country. This would be the first step in fighting the pandemic. However, it is also important to prepare for the worst case. Similarly, advocacy programs should be developed to inform the general public and alleviate their fears about the disease. These measures would not only help Nepal’s capability to respond to the COVID-19 outbreak but could lay the foundations to improve the health of the citizens in general, even after this epidemic is controlled and could go a long way in developing trust of the government in the populace

On the Lessons Learned from the Operations of the ERBE Nonscanner Instrument in Space and the Production of the Nonscanner TOA Radiation Budget Dataset

Monitoring the flow of radiative energy at top-of-atmosphere (TOA) is essential for understanding the Earths climate and how it is changing with time. The determination of TOA global net radiation budget using broadband nonscanner instruments has received renewed interest recently due to advances in both instrument technology and the availability of small satellite platforms. The use of such instruments for monitoring Earths radiation budget was attempted in the past from satellite missions such as the Nimbus 7 and the Earth Radiation Budget Experiment (ERBE). This paper discusses the important lessons learned from the operation of the ERBE nonscanner instrument and the production of the ERBE nonscanner TOA radiation budget data set that have direct relevance to current nonscanner instrument efforts

Multimorbidity in Diabetic Patients Admitted to a Tertiary Care Center: A Descriptive Cross-sectional Study

Introduction: Multimorbidity is defined as the co-occurrence of two or more chronic conditions in the same individual. Type 2 Diabetes Mellitus rarely occurs without coexisting diseases. With an increasing elder population and longevity, elder adults have a higher prevalence of chronic morbidity, thus increasing the chances of experiencing more than one non-communicable chronic condition, where the impact of multimorbidity is greater than the cumulative effect of the single condition. The study aimed to find out the prevalence of multimorbidity in diabetic patients admitted to a tertiary care centre. Methods: A descriptive cross-sectional study was conducted utilising hospital records of patients with type 2 diabetes mellitus admitted to the Department of Medicine from 1 April 2021 to 1 April 2022. Ethical clearance was obtained from the Institutional Review Committee of the same institute (Reference number: 12082022/07). The diagnosed cases of type 2 diabetic patients aged more than 18 years and confirmed with serum glucose levels were included in the study. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of the 107 diabetic patients, multimorbidity was present in 75 patients (70.10%) (61.42-78.77, 95% Confidence Interval). Conclusions: The prevalence of multimorbidity is higher than the similar studies done in similar settings

Hemoperitoneum among Pediatric Abdominal Trauma Patients Visiting in Emergency Department of a Tertiary Care Centre: A Descriptive Cross-sectional study

Introduction: Pediatric abdominal trauma presents a major challenge for first-line responders in the Emergency Department for assessment and management. The Focused assessment sonography for trauma is a readily available, easy-to-use, and affordable tool for detecting hemoperitoneum during the initial assessment of trauma in the Emergency Department for adult traumatic patients. The aim of this study was to find the prevalence of hemoperitoneum among pediatric abdominal trauma patients visiting the Emergency Department of tertiary care centre through Focused assessment with sonography for trauma examination technique. Methods: This was a descriptive cross-sectional study conducted in the Emergency Department of a tertiary care hospital from 7 April 2019 to 7 April 2020. Among 413 pediatric trauma patients, 93 children (1 to 17 years) admitted to the Emergency Department who underwent focused assessment with sonography for trauma examination were included in the study. Ethical approval was obtained from the Institutional Review Committee (Approval number: 111/19). Convenience sampling was used. Point estimate and 90% Confidence Interval were calculated. Results: Among 93 children receiving focused assessment with sonography for trauma imaging in the Emergency Department with a history of blunt abdominal trauma, the prevalence of hemoperitoneum was 18 (19.34%) (12.61-26.09, 90% Confidence Interval). Conclusions: The prevalence of hemoperitoneum was similar to other studies conducted in a similar setting

Perception and practices of menstruation restrictions among urban adolescent girls and women in Nepal: a cross-sectional survey

Background Menstruation, a natural biologic process is associated with restrictions and superstitious beliefs in Nepal. However, factual data on women’s perspectives on menstrual practices and restrictions are scarce. This study aimed to assess socio-cultural perceptions of menstrual restrictions among urban Nepalese women in the Kathmandu valley. Methods Using a clustered random sampling, 1342 adolescent girls and women of menstruating age (≥15 years) from three urban districts in the Kathmandu valley completed a survey related to menstrual practices and restriction. This was a cross-sectional survey study using a customized program allowing pull-down, multiple choice and open-ended questions in the Nepali language. The self-administered questionnaire consisted of 13 demographic questions and 22 questions related to menstruation, menstrual hygiene, socio-cultural taboos, beliefs and practices. Univariate descriptive statistics were reported. Unadjusted associations of socio-cultural practices with ethnicity, education, four major social classes, three major religions, marital status and family type were assessed using logistic regression models. Results More than half (59%) of the participants were aged between 15- < 25 years. The majority were Hindus (84.5%), reported not praying during menstruation (83.1%) and were encouraged by their mothers (72.1%) to practice a range of menstrual restrictions. Purifying either the kitchen, bed, bedsheets or other household things on the fourth day of menstruation was reported by 66.1% of the participants, and 45.4% saw menstruation as a “bother” or “curse.” There were differences among social classes, where participants of the Janajati caste, an indigenous group, were more likely to enter places of worship [OR (95%CI): 1.74 (1.06–2.86)] and pray [OR (95%CI): 1.79 (1.18–2.71)] while menstruating, compared to the Brahmins. Participants with a master’s degree were more likely to pray while menstruating, compared to participants with less than a high school education [OR (95%CI): 2.83 (1.61–4.96)]. Conclusion This study throws light on existing social discriminations, deep-rooted cultural and religious superstitions among women, and gender inequalities in the urban areas of Kathmandu valley in Nepal. Targeted education and awareness are needed to make changes and balance between cultural and social practices during menstruation

Dome Degradation Characterization of Wide-Field-of-View Nonscanner Aboard ERBE and Its Reprocessing

Earth Radiation Budget Experiment (ERBE) wide-field-of-view (WFOV) nonscanners aboard ERBS and NOAA- 9/NOAA-10 provided broadband shortwave and longwave irradiances from 1985 to 1999. The previous analysis showed dome degradation in the shortwave nonscanner instruments. The correction was performed with a constant spectral (gray assumption) degradation. We suspect that the gray assumption affected daytime longwave irradiance and led to a day-minus-night longwave flux differences (little change in night time longwave) increase over time. Based on knowledge from the CERES process, we will reprocess entire ERBE nonscanner radiation dataset by characterizing shortwave dome transmissivity with spectral dependent degradation using the solar data observed by these instruments. Once spectral dependent degradation is derived, imager derived cloud fraction and the cloud phase as well as surface type over the FOV of nonscanner instruments will be used to model unfiltering coefficients. This poster primarily explains the reprocessing techniques and includes initial comparison of several months of data processed with existing and our recent methods

A CERES-Consistent Long-term Cloud and Clear Sky Radiation Property Dataset Using AVHRR Observations

No abstract availabl

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed