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

A preliminary randomized double blind placebo-controlled trial of intravenous immunoglobulin for Japanese encephalitis in Nepal

BACKGROUND: Japanese encephalitis (JE) virus (JEV) is a mosquito-borne flavivirus found across Asia that is closely related to West Nile virus. There is no known antiviral treatment for any flavivirus. Results from in vitro studies and animal models suggest intravenous immunoglobulin (IVIG) containing virus-specific neutralizing antibody may be effective in improving outcome in viral encephalitis. IVIG's anti-inflammatory properties may also be beneficial. METHODOLOGY/PRINCIPAL FINDINGS: We performed a pilot feasibility randomized double-blind placebo-controlled trial of IVIG containing anti-JEV neutralizing antibody (ImmunoRel, 400mg/kg/day for 5 days) in children with suspected JE at two sites in Nepal; we also examined the effect on serum neutralizing antibody titre and cytokine profiles. 22 children were recruited, 13 of whom had confirmed JE; 11 received IVIG and 11 placebo, with no protocol violations. One child (IVIG group) died during treatment and two (placebo) subsequently following hospital discharge. Overall, there was no difference in outcome between treatment groups at discharge or follow up. Passive transfer of anti-JEV antibody was seen in JEV negative children. JEV positive children treated with IVIG had JEV-specific neutralizing antibody titres approximately 16 times higher than those treated with placebo (p=0.2), which was more than could be explained by passive transfer alone. IL-4 and IL-6 were higher in the IVIG group. CONCLUSIONS/SIGNIFICANCE: A trial of IVIG for JE in Nepal is feasible. IVIG may augment the development of neutralizing antibodies in JEV positive patients. IVIG appears an appealing option for JE treatment that warrants further study. TRIAL REGISTRATION: ClinicalTrials.gov NCT01856205

Kawasaki Disease like Multisystem Inflammatory Syndrome in a Toddler during SARS-CoV-2 Pandemic in Nepal.

Multisystem inflammatory syndrome in children is a new childhood inflammatory disorder associated with respiratory syndrome coronavirus 2 (SARS-CoV-2). This illness of elevated inflammatory markers and multiple organ involvement similar to Kawasaki disease is not commonly reported from Asia. A 17-month-old boy presented with acute onset fever, rash, non-exudative conjunctivitis and swellings of hands and legs. In x-ray chest there was infiltration on the right lower lobe and echocardiography showed evidence of coronary arteritis. The diagnosis of multisystem inflammatory syndrome in children was confirmed on the basis of characteristic clinical features and laboratory parameters fulfilling standard case definition for multisystem inflammatory syndrome in children. The child responded to treatment with intravenous immunoglobulin and high dose aspirin. Hence, amidst SARS-CoV-2 pandemic, multisystem inflammatory syndrome in children should be suspected and effectively treated even in a country like Nepal. Keywords: Kawasaki disease; multiple inflammatory syndrome in children; Nepal; respiratory syndrome coronavirus 2

Status of gastrointestinal parasites in red panda of Nepal

Red pandas are known to be highly susceptible to endoparasites, which can have a prominent impact on the population dynamics of this endangered species. There are very limited published reports on prevalence and risk of parasites in wild populations of red panda, especially localized reports. This study attempts to provide an in- depth insight of the status of endoparasites in red pandas, which is critical for strengthening conservation efforts. A total of 272 fecal samples were collected through systematic sampling across the red panda distribution range in Nepal and coprological examination was completed using standard techniques. It was followed by an estimation of prevalence and mean intensity of parasites, as well as statistical analysis, which was carried out using R statistical software. Parasite prevalence was documented in 90.80% (n=247) out of 272 samples examined which includes seven different species along with three genera of parasites belonging to Protozoans (3 species), Cestodes (1 genus, 1 species) and Nematodes (2 genera, 3 species). Nematodes predominated in all infected samples (87.62%). Prevalence of Ancyclostoma duodenale (n=227, 70.06%), having a mean intensity of 3.45 ± 2.88 individuals per sample, was observed, followed by Ascaris lumbricoides (n=19, 5.86%) and Entamoeba histolytica (n=24, 7.41%). Eight variables for assessing the determinants of infestation were tested: protected areas; non-protected areas; aspect; elevation; slope; and distance to water sources, herding stations, and settlements. Only the settlement displayed significant association (β=-1534e-04, t=-2.192, p=0.0293) though each parasite species displayed dissimilar association with different variables. This study indicates the urgent need of improving existing herding practice through habitat zonation, rotational grazing, medication of livestock, and prohibition of open defecation within and around red panda habitat

Data from: Red panda fine-scale habitat selection along a Central Himalayan longitudinal gradient

Red panda Ailurus fulgens, an endangered habitat specialist, inhabits a narrow distribution range in bamboo abundance forests along mountain slopes in the Himalaya and Hengduan Mountains. However, their habitat use may be different in places with different longitudinal environmental gradients, climatic regimes, and microclimate. This study aimed to determine the habitat variables affecting red panda distribution across different longitudinal gradients through a multivariate analysis. We studied habitat selection patterns along the longitudinal gradient in Nepal's Himalaya which is grouped into the eastern, central, and western complexes. We collected data on red panda presence and habitat variables (e.g., tree richness, canopy cover, bamboo abundance, water availability, tree diameter, tree height) by surveys along transects throughout the species’ potential range. We used a multimodal inference approach with a generalized linear model to test the relative importance of environmental variables. Although the study showed that bamboo abundance had a major influence, habitat selection was different across longitudinal zones. Both canopy cover and species richness were unimportant in eastern Nepal, but their influence increased progressively toward the west. Conversely, tree height showed a decreasing influence on habitat selection from Eastern to Western Nepal. Red panda's habitat selection revealed in this study corresponds to the uneven distribution of vegetation assemblages and the dry climatic gradient along the eastern‐western Himalayas which could be related to a need to conserve energy and thermoregulate. This study has further highlighted the need of importance of bamboo conservation and site‐specific conservation planning to ensure long‐term red panda conservation

Pervasive human disturbance on habitats of endangered red panda Ailurus fulgens in the central Himalaya

Red pandas (Ailurus fulgens) live in the dense forests of mid-hills of the Himalaya and feed almost exclusively on bamboo. They are vulnerable to extinction due to human induced disturbances. Habitat loss, degradation and fragmentation along with poaching are the most pressing anthropogenic threats to red panda conservation. The extinction risk to red pandas is further compounded by their life history traits. However, there is a paucity of information regarding human impact on red panda habitats. We have used presence and absence data collected from entire red panda range in Nepal, including habitat both inside and outside the Protected Areas (PAs) to examine the impact of human disturbance on their distribution. Our findings indicate that red panda prefer less disturbed habitats but will occupy human disturbed areas. Signs of poaching and cattle trails were significantly associated with red panda presence throughout Nepal while livestock faeces and landslides were negatively associated. Plant disturbance, presence of solid waste and proximity to herders' shed were significantly associated with presence of red panda in PAs whereas landslides and livestock faeces were significant disturbance variables outside the PAs. The findings show that red panda habitats are invariably disturbed and that integrated conservation programs such as awareness, livelihood support that reduces human dependency on forests, and regulations are must

Landscape variables affecting the Himalayan red panda Ailurus fulgens occupancy in wet season along the mountains in Nepal.

The Himalayan red panda is an endangered mammal endemic to Eastern Himalayan and South Western China. Data deficiency often hinders understanding of their spatial distribution and habitat use, which is critical for species conservation planning. We used sign surveys covering the entire potential red panda habitat over 22,453 km2 along the mid-hills and high mountains encompassing six conservation complexes in Nepal. To estimate red panda distribution using an occupancy framework, we walked 1,451 km along 446 sampled grid cells out of 4,631 grid cells in the wet season of 2016. We used single-species, single-season models to make inferences regarding covariates influencing detection and occupancy. We estimated the probability of detection and occupancy based on model-averaging techniques and drew predictive maps showing site-specific occupancy estimates. We observed red panda in 213 grid cells and found covariates such as elevation, distance to water sources, and bamboo cover influencing the occupancy. Red panda detection probability [Formula: see text] estimated at 0.70 (0.02). We estimated red panda site occupancy (sampled grid cells) and landscape occupancy (across the potential habitat) [Formula: see text] at 0.48 (0.01) and 0.40 (0.02) respectively. The predictive map shows a site-specific variation in the spatial distribution of this arboreal species along the priority red panda conservation complexes. Data on their spatial distribution may serve as a baseline for future studies and are expected to aid in species conservation planning in priority conservation complexes

Difference in neutralizing antibody titres to JEV in children with acute encephalitis syndrome treated with IVIG or placebo.

<p>Median and inter-quartile range of the difference in JEV PRNT₅₀ titres pre and post treatment is presented. Patients are grouped according to treatment. Difference in tires was assessed via Wilcoxon-Mann-Whitney test. Note: Two patients who received IVIG were not included in this analysis because of insufficient sample to undertake PRNT measurements.</p

Tigers in the Terai: Strong evidence for meta-population dynamics contributing to tiger recovery and conservation in the Terai Arc Landscape - Fig 2

<p>Minimum Convex Polygon (MCP) from multiyear camera trap surveys carried out in a) core area of Suklaphanta National Park; b) Babai valley within Bardia National Park.</p