COVID-19 Pandemic: Public Health Implications in Nepal.

Over the past few decades, we have seen several outbreaks of zoonotic coronavirus infections. These viruses have the potential of interspecies transmission leading to pathogenesis in humans. This particular respiratory coronavirus initially named 2019-nCOV, is known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In the current situation, abiding to the general health guidelines is utmost important to maintain stronger immunity for fighting infections and protection from other environmental hazards

The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) Scoring: the Diagnostic and Potential Prognostic Role

BACKGROUND: Necrotizing fasciitis (NF) is a devastating soft tissue infection associated with potentially poor outcomes. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score has been introduced as a diagnostic tool for NF. We aimed to evaluate the prognostic value of LRINEC scoring in NF patients. METHODS: A retrospective analysis was conducted for patients who were admitted with NF between 2000 and 2013. Based on LRINEC points, patients were classified into (Group 1: LRINEC /= 6). The 2 groups were analyzed and compared. Primary outcomes were hospital length of stay, septic shock and hospital death. RESULTS: A total of 294 NF cases were identified with a mean age 50.9 +/- 15 years. When compared to Group1, patients in Group 2 were 5 years older (p = 0.009), more likely to have diabetes mellitus (61 vs 41%, p \u3c 0.001), Pseudomonas aeruginosa infection (p = 0.004), greater Sequential Organ Failure Assessment (SOFA) score (11.5 +/- 3 vs 8 +/- 2, p = 0.001), and prolonged intensive care (median 7 vs 5 days) and hospital length of stay (22 vs 11 days, p = 0.001). Septic shock (37 vs. 15%, p = 0.001) and mortality (28.8 vs. 15.0%, p = 0.005) were also significantly higher in Group 2 patients. Using Receiver operating curve, cutoff LRINEC point for mortality was 8.5 with area under the curve of 0.64. Pearson correlation analysis showed a significant correlation between LRINEC and SOFA scorings (r = 0.51, p \u3c 0.002). DISCUSSION: Early diagnosis, simplified risk stratification and on-time management are vital to achieve better outcomes in patients with NF. CONCLUSIONS: Beside its diagnostic role, LRINEC scoring could predict worse hospital outcomes in patients with NF and simply identify the high-risk patients. However, further prospective studies are needed to support this finding

Impact of COVID-19 on community health: A systematic review of a population of 82 million

The novel coronavirus disease 2019 (COVID-19) outbreak, caused by the pathogenic severe acute respiratory syndrome-2 (SARS-CoV-2) virus, is exponentially spreading across the globe. As there is paucity of published literature, the influence of COVID-19 on community health remains unclear. Therefore, we aimed to conduct a systematic review of the literature on the impact of COVID-19 on community health. The current systematic review was performed utilizing electronic databases, i.e., PubMed, MEDLINE, and EMBASE. We searched for the keywords "COVID-19" AND "community health" between January 1, 2020, until May 10, 2020. Although, limited evidence is available regarding quarantine to prevent COVID‐19, most studies considered quarantine as an essential public health measure to minimize rate of infection and mortality. Under these circumstances, people should focus on maintaining personal hygiene, proper nutrition, and extreme social distancing to reduce the risk of COVID-19. Besides, that there is a need to provide professional psychological support to reduce mental ill-health. We have highlighted two different public health approaches in South Asian countries, namely Nepal and India

Current scenario of organ donation and transplantation in Kerala, India

Organ transplantation has been an accepted mean of treating patients with severe organ failure in India for nearly five decades. However, the organ donation rate of people who have died in India is very low (0.26 per million population), and this low rate partly contributes to the deaths of 500,000 people every year due to lack of available organs. This editorial highlights some of the key issues in one Indian state namely Kerala

Cigarette smoking dose-response and suicidal ideation among young people in Nepal: a cross-sectional study

Background: Worldwide, tobacco smoking is a major risk factor for morbidity and early mortality among adult population. The present study aimed to find out the association between current smoking and suicidal ideation among young people in Nepal. Materials and Methods: A cross-sectional questionnaire-based survey was carried out among 452 youths from Pokhara, Nepal. The present study included both genders (age 18-24 years) who were smokers as well as non-smokers. Results: Across the study period, 452 participants were identified after matching for age, and sex (226 in the smoking group and 226 in the non-smoking group). The mean age of participants was 21.6±1.2 years and 58.8% were males. The overall rate of suicidal ideation in our cohort was 8.9%. Smokers were slightly more likely to report suicidal ideation than non-smokers (aOR 1.12). The risk of developing suicidal ideation was 3.56 (95% CI 1.26-10.09) times more in individuals who smoked greater than 3.5 cigarettes per week (p=0.01). Conclusion: The rate of suicidal ideation was slightly higher among smokers and a dose-response relationship was identified with the number of cigarettes smoked per week. Being aware of the link between smoking and suicidal ideation may help health care professionals working with young people to address more effectively the issues of mental well-being and thoughts about suicide

Post-Traumatic Stress Disorder among the Flood Affected Population in Indian Subcontinent

Globally, frequent flooding causes higher magnitude of disaster among the developing and developed nations. Particularly, the Indian subcontinent is considered as highly vulnerable area for natural disaster and is affected most because of limited resources and coping strategies for post-disaster rehabilitation. Apart from the great impact on human health, floods have considerable impact on mental health. The most frequently diagnosed psychological illness in flood affected population is post-traumatic stress disorder (PTSD). In India, the incidence of PTSD in major natural disasters varies considerably depending upon the magnitude of event, with the highest rates reported of around 70%. Studies conducted during initial few months post-disaster, showed a higher occurrence of psychiatric manifestations. On the other hand, some reports suggested contrary results under similar circumstances. Notably, extreme age (children and elderly), female gender, socioeconomic status, pre-existing mental health issues and financial crisis post-disaster are the potential predisposing factors influencing the vulnerability of PTSD. In Indian context, the variability in the magnitude of psychiatric illness is mainly attributed to the ethnic diversity (vulnerable population), severity and type of flood event and social support. Still there is more to explore regarding the long-term sequelae of catastrophic floods on physical and mental trauma on disaster-affected populations

A survey of Post-Traumatic Stress Disorder, Anxiety and Depression among Flood Affected Populations in Kerala, India

Background: Globally, post traumatic stress disorder (PTSD) is one of the most common psychiatric illnesses following a disaster. We aimed to evaluate the relationship between the socio-economic and flood exposure factors with PTSD, depression and anxiety among the flood-affected populations in Kerala, India. Methods: A cross-sectional household survey was conducted from November 2019 to January 2020 in Kozhikode district of Kerala, India. Adults (≥ 18 years), who were permanent residents and had been directly exposed to the flood, were invited to take part in the study. Individuals with a history of mental health issues and those who had other stressful situations in the past were excluded. The survey questionnaire was based on three screening tools: (1) PTSD Checklist for DSM-5 (PCL-5); (2) patient health questionnaire (PHQ-9); and (3) generalized anxiety disorder (GAD-7). Data included sociodemographic factors and flood exposure variables. The primary outcome variable was psychiatric morbidity (PTSD, anxiety and depression). Results: A total of 276 respondents (150 males/126 females) participated in the study. A significant correlation was observed between total score on PCL-5 and GAD-7 (r=0.339, p=0.001) and PHQ-9 (r=0.262, p=0.001). Females had significantly higher total PTSD symptom severity scores (8.24±5.88 vs. 6.07±5.22; p=0.001), severity of symptoms of intrusion (4.66±3.60 vs. 3.69±3.20; p=0.04), increased level of anxiety (2.54±1.94 vs. 1.79±1.53; p=0.001) and depression (3.02±2.26 vs. 2.04±1.67; p=0.001) compared to males. However, the gender difference for PTSD symptoms disappeared when controlling for age. Conclusion: The findings of this survey revealed that the vast majority of respondents (92 percent females and 87 percent males) still had subclinical psychiatric symptoms one year after the flood. Therefore, tailored psychological interventions are warranted to counter the long-lasting impact of flooding on the mental health of individuals

Epidemiologic characteristics, clinical management and Public Health Implications of Coronavirus Disease 2019 (COVID-19) in Pregnancy: A Systematic Review and meta-analysis

Background:  The novel coronavirus disease 2019 (COVID-19) outbreak, caused by the pathogenic severe acute respiratory syndrome-2 (SARS-CoV-2) virus, is exponentially spreading across the globe. Methods: The current systematic review was performed utilizing electronic databases i.e. PubMed, MEDLINE and EMBASE. We searched for the keywords "COVID-19 AND "pregnancy" between January 1st, 2020 until December 31, 2020. Results: Out of 4005 records which were identified, 36 original studies were included in this systematic review. Pooled prevalence of vertical transmission was 10%, 95% CI: 4-17%. Pooled prevalence of neonatal mortality was 7%, 95% CI: 0-21%. Conclusion: The contemporary evidence suggests that the incubation period of COVID-19 is 2-14 days, and this infection could be transmitted even from the infected asymptomatic individuals. It is found that the clinical presentation of pregnant women with COVID-19 infection is comparable with the infected non-pregnant females, and the frequent symptoms were fever, cough, myalgia, sore throat and malaise. There are some cases with severe maternal morbidity and perinatal deaths secondary to COVID-19 infection. Under these circumstances, the pregnant women should focus on maintaining personal hygiene, proper nutrition and extreme social distancing to reduce the risk of COVID-19. Therefore, a systematic data reporting for evidence base clinical assessment, management and pregnancy outcomes is essential for prevention of COVID-19 infection among pregnant women

Development and implementation of a potential coronavirus disease 2019 (COVID-19) vaccine: A systematic review and meta-analysis of vaccine clinical trials.

Background: To date, there is no comprehensive systematic review and meta-analysis to assess the suitability of COVID-19 vaccines for mass immunization. The current systematic review and meta-analysis was conducted to evaluate the safety and immunogenicity of novel COVID-19 vaccine candidates under clinical trial evaluation and present a contemporary update on the development and implementation of a potential vaccines. Methods: For this study PubMed, MEDLINE, and Embase electronic databases were used to search for eligible studies on the interface between novel coronavirus and vaccine design until December 31, 2020. Results: We have included fourteen non-randomized and randomized controlled phase I-III trials. Implementation of a universal vaccination program with proven safety and efficacy through robust clinical evaluation is the long-term goal for preventing COVID-19. The immunization program must be cost-effective for mass production and accessibility. Despite pioneering techniques for the fast-track development of the vaccine in the current global emergency, mass production and availability of an effective COVID-19 vaccine could take some more time. Conclusion: Our findings suggest a revisiting of the reported solicited and unsolicited systemic adverse events for COVID-19 candidate vaccines. Hence, it is alarming to judiciously expose thousands of participants to COVID-19 candidate vaccines at Phase-3 trials that have adverse events and insufficient evidence on safety and effectiveness that necessitates further justification

Incidence, Demographics, and Outcome of Traumatic Brain Injury in the Middle East: a Systematic Review

BACKGROUND: Traumatic brain injury (TBI) is a serious global public health challenge. We aimed to assess the pattern of TBI in the Middle East, as reported in the last decade. METHODS: Literature searches were conducted on PubMed, MEDLINE, and Google scholar electronic databases. The search terms used in different combinations were epidemiology, incidence, case fatality, mortality, intracranial injury, brain injury, head injury, and the country names. Additional searches were conducted using reference lists of studies and review articles for selection of relevant articles. The search yielded 1082 articles; of which 701 duplicates and 346 articles were excluded. Thirty-five original studies met the inclusion criteria. Data were extracted using standardized Excel form and pilot tested. Median with interquartile range (IQR) was used to estimate the incidence rate and mortality of TBI. RESULTS: In the Middle East region, the median TBI incidence rate per capita was 45 (IQR, 38.5-367) per 100,000. The overall median emergency department-based TBI mortality, which included all age groups and all injury severities, was 10% (IQR, 7.75-15.75). We estimated the overall median mortality for head trauma studies based on emergency department admissions as 6% (IQR, 3-18) among all age groups and all injury severities. The overall TBI-related median mortality in the intensive care unit-based studies was 25% (IQR, 15.5-47). CONCLUSIONS: The epidemiology of TBI in the Middle East remains understudied. The use of a globally recognized definition of TBI will contribute greatly to improve its reporting, analysis, and interpretation and to establish appropriate injury prevention programs