Intra-articular autologous conditioned plasma reduces pain in early osteoarthritis and improves stiffness in advanced osteoarthritis knee: a prospective observation

Background: In this study, we aimed to investigate the effects of single-dose intra-articular autologous conditioned plasma injection as the treatment for early and advanced osteoarthritis knee. Methods: A single centre-based prospective observational analysis was conducted among patients who opt for conservative management by intra-articular autologous conditioned plasma Injection between July 2022 to June 2023. Total 46 patients were included and analysed in study on 1, 3, and 6 months’ follow-up after ACP injection. The WOMAC score and its sub scores were analysed and compared pre-procedure and on subsequent follow ups. Results: A total of 46 patients were analysed in the study, with male predominance of 56.5% with mean BMI of 27.37±5.35. On KL grading, 34.8% patients had KL grade II Osteoarthritis, 52.2% had grade III and 13.0% had grade IV. On comparison of WOMAC score and its sub-scales, all the values were found to be statically significant while comparing before injection (p value <0.0001) and one month follow up and before injection and six months’ follow-up (p value <0.0001). Conclusions: Six months following intra-articular autologous conditioned plasma injection, there was a noteworthy decrease in pain in early stages of osteoarthritis and improvement in knee stiffness in advanced stages of osteoarthritis as compared to the pre-treatment state

Effect of heat stress on crossbred dairy cattle in tropical Nepal: Impact on blood parameters

Chitwan district of Nepal has been known as the dairy kingdom of the country considering its strategic location andpotential to easily provision inputs and produce as well as market quality milk across the country. However, theclimate especially during summer has been a challenge to farmers that potentially compromise the daily milk yieldof cows. Therefore, sixteen crossbred dairy cattle were placed in a RCBD fashion to assess the impacts of cold waterbathing in ameliorating effect of heat stress on their performance and body physiology. Routine assessment of themicroclimate within the experimental shed and blood parameters was made. The results from the experimentinferred that frequency of bathing (none, once, twice or thrice a day) did not have any significant impact onHaemoglobin, Haematocrit, Sodium, Potassium, Chloride and Bicarbonate levels in the blood plasma(p>0.05). Inaddition, the animals did not exhibit any signs of physiological distress clinically either. A detailed study scopingtemperature humidity index and over a number of other milk and blood parameters are to be tested across a numberof other available breeds too in order for the researchers to come to a meaningful strategy to beat the heat stress

Effect of Heat Stress on Crossbred Dairy Cattle in Tropical Nepal: Impact on Blood Parameters

Chitwan district of Nepal has been known as the dairy kingdom of the country considering its strategic location andpotential to easily provision inputs and produce as well as market quality milk across the country. However, theclimate especially during summer has been a challenge to farmers that potentially compromise the daily milk yieldof cows. Therefore, sixteen crossbred dairy cattle were placed in a RCBD fashion to assess the impacts of cold waterbathing in ameliorating effect of heat stress on their performance and body physiology. Routine assessment of themicroclimate within the experimental shed and blood parameters was made. The results from the experimentinferred that frequency of bathing (none, once, twice or thrice a day) did not have any significant impact onHaemoglobin, Haematocrit, Sodium, Potassium, Chloride and Bicarbonate levels in the blood plasma(p>0.05). Inaddition, the animals did not exhibit any signs of physiological distress clinically either. A detailed study scopingtemperature humidity index and over a number of other milk and blood parameters are to be tested across a numberof other available breeds too in order for the researchers to come to a meaningful strategy to beat the heat stress

Functional outcome of the treatment of AO-ASIF type C distal humerus fracture using Lambda plate

Introduction: Although the use of two plates for the treatment of type-C distal humerus fracture is popular, site of plate placement still is under debate. Use of Lambda plate for the fracture treatment can be easier and settle the dispute. This study aims to evaluate the functional outcome of the surgery using Lambda Plate. This can be a reference for surgeons and helps them make the decision about choice of implant for type C distal humerus fracture treatment among Nepalese people. Methods: This interventional study used Lambda plate for the treatment of type C fracture of distal humerus. Patients were examined at 4, 12, and 24 weeks respectively for the measurement of the outcome. Visual analogous scale was used for assessment of pain, range of motion for functional recovery and Mayo Elbow Performance Score was used for the assessment of functional outcome. Paired-samples t-test and linear regression was used to for data analysis. Results: Functional outcome at the last follow-up was excellent in 24(53.33%) patients, good in 18(40%) patients and fair in 3(6.67%) patients. Range of motion of elbow increased significantly with every follow-up (p-value <0.001). Average angle of flexion at last follow-up was 117.53°±11.74 while loss of extension was 7.53°±4.86. Average number of patients had their fracture union at 19.84±2.38 weeks. There was no association of age, sex and union weeks with functional outcome when measured with MEPS. Conclusion: Fixation of distal humerus fracture by using Lambda plate gave excellent and satisfying outcome in terms of pain, range of motion and objective functional outcome

Etiology of Acute Diarrheal Disease and Antimicrobial Susceptibility Pattern in Children Younger Than 5 Years Old in Nepal

Diarrhea is a common cause of morbidity and mortality among children younger than 5 years in developing countries. Children from 3 to 60 months of age were recruited from two hospitals in Nepal— Bharatpur Hospital, Bharatpur, and Kanti Children’s Hospital, Kathmandu—in 2006 to 2009. Stool specimens collected from 1,200 children with acute diarrhea (cases) and 1,200 children without diarrhea (control subjects) were examined for a broad range of enteropathogens by standard microbiology, including microscopy, enzyme immunoassay for viral pathogens (adenovirus, astrovirus, and rotavirus) and protozoa (Giardia, Cryptosporidium, and Entamoeba histolytica), as well as by using reverse transcription real-time polymerase for norovirus. Antimicrobial susceptibility testing was performed using the disk diffusion method. Overall, rotavirus (22% versus 2%), norovirus (13% versus 7%), adenovirus (3% versus 0%), Shigella (6% versus 1%), enterotoxigenic Escherichia coli (8% versus 4%), Vibrio (7% versus 0%), and Aeromonas (9% versus 3%) were identified significantly more frequently in cases than control subjects. Campylobacter, Plesiomonas, Salmonella, and diarrheagenic E. coli (enteropathogenic, enteroinvasive, enteroaggregative) were identified in similar proportions in diarrheal and non-diarrheal stools. Campylobacter was resistant to second-generation quinolone drugs (ciprofloxacin and norfloxacin), whereas Vibrio and Shigella were resistant to nalidixic acid and trimethoprim/sulfamethoxazole. This study documents the important role of rotavirus and norovirus in acute diarrhea in children younger than 5 years, followed by the bacteria Shigella, enterotoxigenic E. coli, Vibrio cholera, and Aeromonas. Data on the prevalence and epidemiology of enteropathogens identify potential pathogens for public health interventions, whereas pathogen antibiotic resistance pattern data may provide guidance on choice of therapy in clinical settings.publishedVersio

Functional Outcome of Intra-articular Fractures of Distal Radius: ORIF with Locking Plate vs CRPP

Background: Distal radius fractures are common, costly, and increasing in incidence. Closed reduction and percutaneous K wires fixation and ORIF with locking plate fixation are two of the mostly used surgical treatments for dorsally displaced distal radius fractures. However, there is uncertainty which of these treatments is superior. Methods: This is a prospective study on 40 patients. Twenty patients had closed reduction and percutaneous pinning (CRPP) with K wires (Group A) and 20 patients had open reduction and internal fixation (ORIF) with locking plate and screws (Group B). Evaluation were done in the means of DASH scores and ROM of operated wrist on 1.5 months, three months and six months follow up period. Results: Though the overall functional outcome is comparatively better with Group B, the significant difference for most variables like DASH Scores, extension, supination and ulnar deviation were found at early part of treatment only. The flexion and radial deviation bear no significant outcomes at all intervals of evaluations. Superficial wound infection was more common in patients treated with K-wires but otherwise no difference in complication rates was noted. Conclusion: Locking plate fixation provided lower DASH scores and reduced total postoperative complications compared to CRPP group over six months follow-up period. However, these differences were significant in early part of treatment. Further research is required to better delineate the confirmation

Cancer Registration in Nepal: Current Status and Way Forward

Cancer registration is an organization for the systematic collection, storage, analysis, interpretation and reporting of data on subjects with cancer. Cancer Registry was initiated in 1995 and expanded as National Cancer Registry Program since 2003 by BP Koirala Memorial Cancer Hospital with the support of World Health Organization. NCRP currently includes 12 hospital-based registries. First time in Nepal, BPKMCH piloted population-based cancer registry in 2013, which included 15 districts covering 25.8% of total population of Nepal. NCRP is important to assure the quality of data from all the registries to ensure the availability of reliable and valid data of cancer cases. This will further help policymakers to develop prevention and control strategies of cancer. This paper reviews the current status of cancer registries in Nepal and discusses challenges and future prospective related to NCRP. National cancer registry should further include major hospitals in Nepal to give scientific information on cancer trends by community, provinces and regions and analyze on survival of cancer cases

The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal

Stop TB Partnership/UNOPS – TB REACH project (grant number: 5–31); European Union, Horizon 2020 – IMPACT TB project (grant number: 733174).Background The World Health Organization (WHO) End TB Strategy has established a milestone to reduce the number of tuberculosis (TB)- affected households facing catastrophic costs to zero by 2020. The role of active case finding (ACF) in reducing patient costs has not been determined globally. This study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding (PCF), and to determine the prevalence and intensity of patient-incurred catastrophic costs in Nepal. Methods The study was conducted in two districts of Nepal: Bardiya and Pyuthan (Province No. 5) between June and August 2018. One hundred patients were included in this study in a 1:1 ratio (PCF: ACF, 25 consecutive ACF and 25 consecutive PCF patients in each district). The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical costs. Catastrophic costs were calculated based on the proportion of patients with total costs exceeding 20% of their annual household income. The intensity of catastrophic costs was calculated using the positive overshoot method. The chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and costs. Meanwhile, the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of diagnosis. Results Ninety-nine patients were interviewed (50 ACF and 49 PCF). Patients diagnosed through ACF incurred lower costs during the pre-treatment period (direct medical: USD 14 vs USD 32, P = 0.001; direct non-medical: USD 3 vs USD 10, P = 0.004; indirect, time loss: USD 4 vs USD 13, P <  0.001). The cost of the pre-treatment and intensive phases combined was also lower for direct medical (USD 15 vs USD 34, P = 0.002) and non-medical (USD 30 vs USD 54, P = 0.022) costs among ACF patients. The prevalence of catastrophic direct costs was lower for ACF patients for all thresholds. A lower intensity of catastrophic costs was also documented for ACF patients, although the difference was not statistically significant. Conclusions ACF can reduce patient-incurred costs substantially, contributing to the End TB Strategy target. Other synergistic policies, such as social protection, will also need to be implemented to reduce catastrophic costs to zero among TB-affected households.Publisher PDFPeer reviewe