TREND ANALYSIS OF AREA, PRODUCTION, PRODUCTIVITY, AND SUPPLY OF POTATO IN SINDHULI DISTRICT AND NEPAL: A COMPARATIVE STUDY

The study; conducted from January, 2020 to June, 2020; focuses on the comparative study of the area, production, and productivity trend of potatoes over 50 years in Sindhuli district and Nepal and a brief overview on quantity supply to the Kalimati fruits and vegetable market. The time-series data from 1968/69 to 2017/18 of Sindhuli and Nepal along with 6 years supply data (2013/14-2018/19) from different districts to Kalimati market were collected from reliable sources (Ministry of Agriculture and Livestock Development and Kalimati Fruits and Vegetable Market Development Board) and analysis was done using Microsoft Excel. Between 1968/69 and 2017/18, the area under potato cultivation in Nepal and Sindhuli has changed by 573 percent and -46 percent respectively while production increased by 907.6 percent in Nepal and 46 percent in Sindhuli. After 1982 dramatic shift in production was observed in Nepal as there was 7 percent of growth rate while in Sindhuli, the production trend highly fluctuates throughout the period. The average yield was 9.75mt/ha and 8.75mt/ha for Nepal and Sindhuli district. Sindhuli district contributes 1.16 percent of Nepalese potato growing area and 0.91 percent of Nepalese potato production. The trend of quantity supply reveals that during 6 years, Indian potato contributes 58 percent of the total amount that came into Kalimati market, while within-country Kavre has the largest share of 19 percent followed by Kathmandu-6 percent and Dolakha-4 percent. However, the trend of quantity supply of potatoes seems highly fluctuating and the Nepalese market is dominated by Indian imports

Flash VEP in Clinically Stable Pre-Term and Full-Term Infants

Purpose Pre-term infants are at risk of abnormal visual development that can range from subtle to severe. The aim of this study was to compare flash VEPs in clinically stable pre-term and full-term infants at 6 months of age. Methods Twenty-five pre-term and 25 full-term infants underwent flash VEP testing at the age of 6 months. Monocular VEPs were recorded using flash goggles on a RETIscan system under normal sleeping conditions. Amplitude and peak time responses of the P2 component in the two eyes were averaged and compared between the two groups. Multiple regression analyses were performed to assess the relationship of the P2 responses with birth weight (BW) and gestational age (GA). Results At 6 months corrected age, pre-term infants had significantly delayed P2 peak times than full-term infants (mean difference: 10.88 [95% CI 4.00–17.76] ms, p = 0.005). Pre-term infants also showed significantly reduced P2 amplitudes as compared to full-term infants (mean difference: 2.36 [0.83–3.89] µV, p = 0.003). Although the regression model with GA and BW as fixed factors explained 20% of the variance in the P2 peak time (F2,47 = 5.98, p = .0045), only GA showed a significant negative relationship (β = −2.66, p = .003). Neither GA (β = 0.21, p = .28) nor BW (β = 0.001, p = .32) showed any relationship with P2 amplitude. Conclusions Our results demonstrate that, compared with full-term infants, clinically stable pre-term infants exhibit abnormal flash VEPs, with a delay in P2 peak time and a reduction in P2 amplitude. These findings support a potential dysfunction of the visual pathway in clinically stable pre-term infants as compared to full-term infants

SubFoveal Choroidal Imaging in High Myopic Nepalese Cohort

Current image captioning models produce fluent captions, but they rely on a one-size-fits-all approach that does not take into account the preferences of individual end-users. We present a method to generate descriptions with an adjustable amount of content that can be set at inference-time, thus providing a step toward a more user centered approach to image captioning

Middle mountains forests of Nepal

Publication no. 3201

High mountains and high Himal forests of Nepal

Publication no. 4201

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Epstein-Barr Virus-induced Cholestasis: A mimic of Primary Biliary Cholangitis in middle-aged females

Epstein-Barr Virus-induced Cholestasis: A mimic of Primary Biliary Cholangitis in middle-aged females Background Epstein-Barr Virus (EBV) is a non-hepatotropic virus that is known to cause acute hepatitis, usually manifesting with elevated transaminases, but rarely it presents with markedly elevated Alkaline Phosphatase (ALP) and symptoms of cholestasis in the absence of the classic features of infectious mononucleosis. We present a case of EBV-induced cholestatic hepatitis in a middle-aged female. Case report A 54-year-old female with a medical history of Factor V Leiden mutation presented to the Emergency Department with two weeks history of progressive fatigue and pruritus. She reported associated decreased appetite and mild headache but no fever or abdominal pain. Her review of systems was otherwise negative. Significant examination finding includes scleral icterus, excoriation marks, and tender cervical lymphadenopathy. Relevant laboratory findings were leukocytosis with lymphocytosis and atypical lymphocytes on the blood smear, mildly elevated sedimentation rate 49 mm/hr and C-reactive protein 1.14mg/dl, positive EBV IgM antibody, high EBV DNA quantification 1030 copies/ml, markedly elevated ALP 747 (34-104 IU/L) and Gamma Glutamyl transferase (GGT) 349 (9-64 IU/L), elevated Aspartate Transaminase (AST) 99 (13-39IU/L) and Alanine Transaminase 133 (7-52IU/L). Acute hepatitis panel (hepatitis B surface antigen, hepatitis B core IgM antibody, hepatitis A IgM antibody, hepatitis C antibody) and anti-mitochondrial(M2) antibody were negative. Computed tomography (CT) of the abdomen/pelvis, Magnetic Resonance Cholangiopancreatography (MRCP), and chest radiograph were unremarkable. She received symptomatic treatment and improved; one-month follow-up laboratory tests revealed normal liver function tests. Conclusion The markedly elevated ALP and GGT in a middle-aged female with pruritus and fatigue often raises our suspicion of primary biliary cholangitis or an obstructive hepatobiliary etiology, prompting further expensive and sometimes invasive investigations. A physician should include EBV serology during the initial work-up of patients with cholestasis, especially those with unusual presentation

Independent to wheelchair-bound within months, a debilitating course of statin-induced necrotizing myopathy

Introduction Statins are commonly prescribed drugs with well-known adverse effects. However, failure to address its side effects over time may lead to disastrous consequences. The variable onset of myopathy and presentation could easily delay the diagnosis, as in our case. Case Presentation We present a case of a 64-year-old lady who developed debilitating necrotizing myopathy following the use of atorvastatin. Her initial symptoms started as mild left-sided hip pain and weakness. She was initially started on 10 mg of atorvastatin which was later increased to 40 mg 6 months before the symptom onset. She was misdiagnosed as having probable lower vertebral disc inflammation, which was treated with oral steroids with no improvement in her symptoms. She was ultimately wheelchair-bound in a matter of 9 months. At presentation, she had marked weakness of the proximal muscle groups, including hip flexors, knee flexors, deltoid, and biceps. Labs revealed a high creatinine kinase (CK) of 7075 (normal: 30-223) IU/L, lactate dehydrogenase (LDH) of 1127 (normal: 140-271) IU/L, and aldolase of 52 (normal: 1.5-8.1) U/L. The erythrocyte sedimentation rate (ESR) was normal at 13 (range: 0-20) mm/hr. The autoimmune panel was positive for 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) immunoglobulin G antibody with titers of \u3e 150 (Normal: 0-19) and Speckled antinuclear antibodies with titers of (1:180). The paraneoplastic panel was negative. Magnetic resonance imaging of the left thigh showed diffuse musculature edema and findings suggestive of diffuse myositis. A quadriceps muscle biopsy revealed inflammatory myopathy with extensive necrosis of myofibers consistent with necrotizing inflammatory myopathy. She was treated with solumedrol, intravenous immunoglobulins (IVIG), plasma exchange, azathioprine, and physical therapy resulting in significant improvement in strength. Discussion This case emphasizes evaluating patients on statins at every follow-up visit for side effects. Our patient developed debilitating side effects due to failure to address statin use during subsequent evaluations

Profitability, marketing, and resource use efficiency of ginger production in Rukum west, Nepal

The study was designed to investigate the profitability, marketing, and resource use efficiency of ginger production in Rukum west. The sample size of 62 ginger-growing farmers out of 187 farmers was determined using slovin’s formula. In addition, 20 traders from two major market hubs Simrutu and Jhulneta were interviewed. The pre-tested semi-structured interview schedule was administered to interview a randomly selected sample size. Data were analyzed using descriptive and statistical tools, including the Cobb-Douglas production function. Result showed that the average area under ginger cultivation was 0.14 ha. A major portion (46.56%) of the cost was found to be incurred by the seed alone in ginger cultivation. The benefit-cost ratio (2.02) indicates that ginger production enterprise was profitable. The productivity of ginger in the study area was estimated to be 11.39 Mt/ha, while per kg cost of production was found to be (NRs 35.67 = USD 0.30). Most of the gross income (78.85%) was found to be contributed by fresh ginger. Similarly, gross margin, market margin, and producer’s share were found to be 21.16, 33.33, and 62.97%, respectively, for 1 kg of ginger. The indexing technique identified high-cost with low-quality seed and price instability as the major problems associated with the production and marketing of ginger, respectively. Cobb-Douglas production function estimated the value of return to scale at 0.889, implying that ginger production exhibited decreasing returns to scale. A study on resource allocative efficiency revealed that farm yard manure and total labor were underutilized resources while seed rhizome was overutilized resource. Thus, for optimal allocation of resources, expenditure on farm yard manure and total labor need to be increased by 87.374% and 39.908%, respectively. The study concluded that an effort should be made to bridge the gap between optimal resource utilization and current practices. For this, it is prime important to interconnect the combined efforts of ginger growers, provincial government, or any developing partners