An Open Data and Citizen Science Approach to Building Resilience to Natural Hazards in a Data-Scarce Remote Mountainous Part of Nepal

The citizen science approach has gained momentum in recent years. It can enable both experts and citizen scientists to co-create new knowledge. Better understanding of local environmental, social, and geographical contexts can help in designing appropriate plans for sustainable development. However, a lack of geospatial data, especially in the context of developing countries, often precludes context-specific development planning. This study therefore tests an innovative approach of volunteer citizen science and an open mapping platform to build resilience to natural hazards in the remote mountainous parts of western Nepal. In this study, citizen scientists and mapping experts jointly mapped two districts of Nepal (Bajhang and Bajura) using the OpenStreetMap (OSM) platform. Remote mapping based on satellite imagery, capacity building, and mobilization of citizen scientists was performed to collect the data. These data were then uploaded to OSM and later retrieved in ArcGIS to produce a usable map that could be exploited as a reference resource for evidence-based decision-making. The collected data are freely accessible to community members as well as government and humanitarian actors, and can be used for development planning and risk reduction. By piloting in two communities of western Nepal, we found that using open data platforms for collecting and analyzing location-based data has a mutual benefit for researchers and communities. Such data could be vital in understanding the local landscape, environmental risk, and distribution of resources. Furthermore, they enable both researchers and local people to transfer technical knowledge, collect location-specific data, and use them for better decision-making

A prospective cross-sectional study on prescribing pattern of antibiotics on patients suffering from ENT infections in tertiary care hospital, Pokhara, Nepal

Background: This survey was designed to assess and evaluate the prescribing pattern of antibiotics used in patients suffering from ENT (Eye, Nose, and Throat) infections in ENT outpatient departments (OPD) at Manipal Teaching Hospital (MTH), Phulbari, Pokhara, Nepal.Methods: A prospective cross-sectional study was conducted in out-patients of ENT department at MTH for 6 month in which a total of 216 prescriptions were observed randomly and data filled patient profile forms were collected and analyzed.Results: Out of 216 patients, 126(58.33%) were male and 90 (41.67%) were female. Patients of age group 21-30 were maximum (29.16%) followed by age group of 11-20 (22.22%). Only 6.7% of drugs were prescribed from their generic names. Data analysis revealed that about 72.24%, 24.53% and 3.23% of prescription contained one, two and three antibiotic drugs respectively. All together 970 drugs were prescribed in 216 prescriptions out of which 251 (25.87%) were antibiotics drugs. This suggested that the average no. of antibiotics per prescription was 1.16. Among prescribed antibiotics, Amoxicillin (7.56%) of penicillin group, Azithromycin (8.36%) of macrolides, Cefuroxime (9.56%) of 2nd generation cephalosporin followed by Cefpodoxime (32.27%) of 3rd generation cephalosporin and Ofloxacin (6.37%) of quinolones group were frequently prescribed. From analysis, we found that other concomitant medications were also prescribed such analgesics, antihistamines, PPI (Proton Pump Inhibitors) and vitamins, minerals and dietary enzymes. The prescribed antibiotics accounted for large percentage of oral dosage forms (89.90%) followed parental injection dosage forms 5.05%.Conclusions: Prescribing more than one antibiotics was commonly encountered indicating the occurrence of polypharmacy which were based on empirical therapy without any culture and sensitivity test report. Therefore, local hospital culture sensitivity database for ENT infections has to be developed and prescribing with generic name from existing essential drug list or formulary should be encouraged for rational drug therapy

Leprosy post-exposure prophylaxis with single-dose rifampicin

_Objective:_ Leprosy post-exposure prophylaxis with single-dose rifampicin (SDRPEP) has proven effective and feasible, and is recommended by WHO since 2018. This SDR-PEP toolkit was developed through the experience of the leprosy postexposure prophylaxis (LPEP) programme. It has been designed to facilitate and standardise the implementation of contact tracing and SDR-PEP administration in regions and countries that start the intervention. _Results:_ Four tools were developed, incorporating the current evidence for SDRPEP and the methods and learnings from the LPEP project in eight countries. (1) th

Leprosy post-exposure prophylaxis with single-dose rifampicin (LPEP): an international feasibility programme

Background Innovative approaches are required for leprosy control to reduce cases and curb transmission of Mycobacterium leprae. Early case detection, contact screening, and chemoprophylaxis are the most promising tools. We aimed to generate evidence on the feasibility of integrating contact tracing and administration of single-dose rifampicin (SDR) into routine leprosy control activities. Methods The leprosy post-exposure prophylaxis (LPEP) programme was an international, multicentre feasibility study implemented within the leprosy control programmes of Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka, and Tanzania. LPEP explored the feasibility of combining three key interventions: systematically tracing contacts of individuals newly diagnosed with leprosy; screening the traced contacts for leprosy; and administering SDR to eligible contacts. Outcomes were assessed in terms of number of contacts traced, screened, and SDR administration rates. Findings Between Jan 1, 2015, and Aug 1, 2019, LPEP enrolled 9170 index patients and listed 179 769 contacts, of whom 174782 (97·2%) were successfully traced and screened. Of those screened, 22 854 (13·1%) were excluded from SDR mainly because of health reasons and age. Among those excluded, 810 were confirmed as new patients (46 per 10 000 contacts screened). Among the eligible screened contacts, 1182 (0·7%) refused prophylactic treatment with SDR. Overall, SDR was administered to 151 928 (86·9%) screened contacts. No serious adverse events were reported. Interpretation Post-exposure prophylaxis with SDR is safe; can be integrated into different leprosy control programmes with minimal additional efforts once contact tracing has been established; and is generally well accepted by index patients, their contacts, and health-care workers. The programme has also invigorated local leprosy control through the availability of a prophylactic intervention; therefore,

Klebsiella pneumoniae induces host metabolic stress that promotes tolerance to pulmonary infection

K. pneumoniae sequence type 258 (Kp ST258) is a major cause of healthcare-associated pneumonia. However, it remains unclear how it causes protracted courses of infection in spite of its expression of immunostimulatory lipopolysaccharide, which should activate a brisk inflammatory response and bacterial clearance. We predicted that the metabolic stress induced by the bacteria in the host cells shapes an immune response that tolerates infection. We combined in situ metabolic imaging and transcriptional analyses to demonstrate that Kp ST258 activates host glutaminolysis and fatty acid oxidation. This response creates an oxidant-rich microenvironment conducive to the accumulation of anti-inflammatory myeloid cells. In this setting, metabolically active Kp ST258 elicits a disease-tolerant immune response. The bacteria, in turn, adapt to airway oxidants by upregulating the type VI secretion system, which is highly conserved across ST258 strains worldwide. Thus, much of the global success of Kp ST258 in hospital settings can be explained by the metabolic activity provoked in the host that promotes disease tolerance. Keywords: immunometabolism, Klebsiella pneumoniae, immunosuppressive, anti-inflammatory, itaconate, Type Six Secretion Syste

Fungal multisinusitis with intracranial extension

Aspergillosis is the commonest fungal infection of nose and paranasal sinuses. Its invasive form is rare in a healthy patient. A case of fungal multisinusitis with intracranial extension with characteristic computerized tomographic finding is reported. Key Words: Aspergillosis, intracranial extension, CT scan, external frontoethmoidectomy

Leprosy post-exposure prophylaxis with single-dose rifampicin: toolkit for implementation

lNLR, Amsterdam, NetherlandsmPrivate, UKnHealth Services, Dadra and Nagar Haveli, IndiaoNLR, Jakarta, IndonesiapAnti-Leprosy Campaign, Colombo, Sri LankaqUniversidade do Estado de Mato Grosso, Ca ́ceres, BrazilrNational Tuberculosis and Leprosy Programme, Dar es Salaam,TanzaniasGerman Leprosy and Tuberculosis Relief Association, Wu ̈rzburg,GermanytDirectorate General of Health Services, MoHFW, New Delhi, IndiauNational Leprosy Elimination Program, Phnom Penh, CambodiavGerman Leprosy and Tuberculosis Relief Association,Dar es Salaam, TanzaniawSub Directorate Directly Transmitted Tropical Diseases, MoH,Jakarta, IndonesiaxErasmus MC, University Medical Center Rotterdam, Rotterdam,NetherlandsyAmerican Leprosy Missions, Greenville, USAzUniversity of Aberdeen, Aberdeen, UKaaFAIRMED, Colombo, Sri LankaabInstituto Lauro de Souza Lima, Bauru, BrazilAccepted for publication 22 July 2019SummaryObjective:Leprosy post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) has proven effective and feasible, and is recommended by WHO since 2018.This SDR-PEP toolkit was developed through the experience of the leprosy post-exposure prophylaxis (LPEP) programme. It has been designed to facilitate andstandardise the implementation of contact tracing and SDR-PEP administration inregions and countries that start the intervention.Results:Four tools were developed, incorporating the current evidence for SDR-PEP and the methods and learnings from the LPEP project in eight countries. (1) theSDR-PEP policy/advocacy PowerPoint slide deck which will help to inform policymakers about the evidence, practicalities and resources needed for SDR-PEP, (2) theSDR-PEP field implementation training PowerPoint slide deck to be used to trainfront line staff to implement contact tracing and PEP with SDR, (3) the SDR-PEPgeneric field guide which can be used as a basis to create a location specific fieldprotocol for contact tracing and SDR-PEP serving as a reference for frontline fieldstaff. Finally, (4) the SDR-PEP toolkit guide, summarising the different componentsof the toolkit and providing instructions on its optimal use.Conclusion:In response to interest expressed by countries to implement contacttracing and leprosy PEP with SDR in the light of the WHO recommendation of SDR-PEP, this evidence-based, concrete yet flexible toolkit has been designed to servenational leprosy programme managers and support them with the practical means toLeprosy post-exposure prophylaxis toolkit357 translate policy into practice. The toolkit is freely accessible on the Infolep homepagesand updated as required: https://www.leprosy-information.org/keytopic/leprosy-post-exposure-prophylaxis-lpep-programm