Emission of Green House Gases from Grasslands and their Mitigation

The concentrations of green house gases (GHG) in the atmosphere began in pre-industrial times and it continues to increase. This could result into an alarming increase in temperature of up to 5.4 oC by year 2100 due to a net global annual GHG emission of H 4.5-6.5 Gt C equivalent. About 18% of the world’s GHG are contributed by livestock and related activities on grasslands that are spread over almost 35 million Km2.These grasslands give livelihood to over a billion people most of who are poor. Twenty to 70% of the land surface area is degrading often due to overgrazing caused by increased demand for meat and milk, among other factors. A right set of policies that incentivises appropriate management of the grasslands have the potential to reduce up to 30% of the GHG globally. This can be achieved by mainly focussing on reduction in deforestation for pastures, silvo-pastoral improvements and reduction in enteric fermentation in animals, and appropriate manure and fertilizer management, especially on extensive grasslands. Reduction in GHG emissions will also depend upon the level of resource use efficiencies achieved, added intensification to reduce pressure on grasslands, and success or failure of appropriate market and regulatory policy interventions

Clinical profile of Neurosurgical Patients Admitted into the Intensive Care Unit of Rural Tertiary Care Center

Background:Intensive Care Unit (ICU) is a special department of a tertiary hospital for patients with the most severe and life‐threatening conditions which will often require constant and close intensive monitoring, support from specialist equipment and medications in order to maintain normal physiological functions. Teaching Hospital of Karnali Academy of Health Science (KAHS) is the largest tertiary institution in the mid-western region of Nepal providing specialist care. This study will provide information about the clinical profile  and outcome of the neurosurgical patient admitted in our ICU. Methods:This is a hospital based secondary data analysis carried out in the teaching hospital of KAHS, Jumla, Nepal. This study was conductedbetween March 2019 to June 2020. Data were retrieved from ICU record book and which had included demographic characteristics, diagnosis on admission, reason for admission, duration of admission, medical/surgical specialty requesting admission, nature of interventions, and outcome of patients admitted. Results:A total of 31 patients were admitted into the ICU, there were 74.2%(n=23) males and 25.8%(n=8) females giving a male to female ratio of 3:1.  The ages ranged from 3 month to 70 years . The age group of 15−59 years accounted for highest 51.6% (n=16) of all the ICU admissions. Among all cases, highest 64.5%(n=20) cases were presented from Juma. Out of the 31  admissions  77.4% (n=24) was due to head injury ,while other neurosurgical cases (Stroke, spinal cord injury) accounted 22.6%(n=7). Further dividing head injuries, highest 38.7% (n=12) is due to severe head injury, 22.6% (n=7) moderate head injury and 16.1% (n=5) were mild head injury.  Conclusion:Head injuries are the  highest number of neurosurgical admissions into the ICU with  relatively high mortality. Developing a viable trauma team and well equipped neurosurgical ICU with adequately trained staff will help to improve the outcome of patients.  

Rationale of α-Ketoanalogue Supplemented with Low Protein Diet for the Treatment of Chronic Kidney Disease

Background: Chronic kidney disease (CKD) has challenged the healthcare system for years. Use of α-ketoanalogue (KA) supplemented with a low protein diet (LPD) may improve renal function. In this study, we aim to find out the effectiveness of KA supplemented with LPD for the therapy of CKD. Methods: A descriptive cross-sectional study was conducted at Shree Birendra Hospital with 25 control and 25 treatment group. The control group was treated with LPD (0.8 g/kg/day), while the test group was treated with KA (3 tablets/day for 4 weeks followed by 6 tablets/day for the next 16 weeks) along with LPD. The baseline parameters were measured on day 0, then subsequently at week 4, week 12, and lastly at the end of week 16. Results were then compared with the control group for analysis. Results: Serum level of creatinine showed a progressive decline in the treatment group in comparison to the control group. However, there was a progressive decline in the level of blood urea in the first 4 weeks (84.33) and 12 weeks (72.11) of treatment, a slight increment was observed in week 16 (86.06) but the level was below the baseline value. Similarly, the blood level of sodium and potassium was slightly affected by the increase in sodium and decrease in potassium level from the baseline in the treatment group.  The level of serum albumin was increased in the treatment group as compared to the control group.  The systolic blood pressure was increased in both treatment and control group whereas diastolic blood pressure was decreased in the treatment group rather than the control group. Conclusion: KA supplemented with LPD shows a significant improvement in renal function of CKD III patients that delay the time for dialysis or transplant. However, further substantial multi-institutional randomized studies are necessary to generalize the findings

Association between Helicobacter Pylori and Gastric Cancer

Introduction:A casual relation has been thought to exist between Helicobacter pylori infection and gastric cancer. The present study was carried out to find correlation between H. pylori and gastric carcinogenesis. Methods: A case control study was performed in the department of endoscopy, Tribhuvan University Teaching Hospital, between January 2008 and February 2009. All patients having carcinoma stomach on endoscopic evaluation later confirmed by histopathological examination were included. Total 50 healthy individuals, with no positive finding in endoscopy were included in control group. Results: Total 37 cases were analyzed. There were 23 (62.2%) males and 14 (37.8%) females. Majority were above 60 years (46%). Blood group A was commonest group found in patients with carcinoma stomach. Distal part, antrum, 20 (54%) was commonest location of tumor and Borrmann type three was commonest endoscopic type of tumor presentation. Majority of patients received triple therapy and H. pylori detection was low in those treated with triple therapy. Distal tumors were significantly associated with increased prevalence of H. pylori positivity. Total incidence of H. pylori in cases was 54% (20/37). In 15 (75%) cases, H. pylori could be detected by both ELISA and biopsy method. Incidence of H. pylori in controls was 64% (32/50). There was no statistically significant difference in H. pylori presence in cases and control. Conclusions: Our study couldn’t establish association between H. pylori and gastric cancer. More prospective trials can help find out correlation between combination of risk factors and gastric cancer.  Keywords: helicobacter pylori; gastric cancer; risk factors

Exploring the quality of life issues in people with retinal diseases: a qualitative study

Abstract Background The lack of an appropriate retina-specific patient-reported outcome instrument restricts the understanding of the full impact of hereditary retinal diseases and other less common but potentially blinding acquired retinal diseases such as, vascular occlusions, epiretinal membrane, macular hole, central serous retinopathy and other vitreoretinopathies on quality of life. This study aims to explore the quality of life issues in people with hereditary retinal diseases and acquired retinal diseases to develop disease-specific patient-reported outcome instruments. Methods A qualitative research methodology to understand the lived experiences of people with retinal diseases was carried out. Data were collected through semistructured interviews. The coding, aggregation and theme development was carried out using the NVivo −10 software. Results Seventy-nine interviews were conducted with participants with hereditary retinal diseases (n = 32; median age = 57 years) and acquired retinal diseases (n = 47; median age = 73 years). We identified nine quality of life themes (domains) relevant to people with retinal diseases. Difficulty in performing important day-to-day activities (activity limitation) was the most prominent quality of life issue in the hereditary retinal diseases group whereas concerns about health, disease outcome and personal safety (health concerns) was the most prominent quality of life issue in the acquired retinal diseases group. Participants with hereditary retinal diseases had more issues with social interaction (social well-being), problems with mobility and orientation (mobility), and effect on work and finance (economic) than participants with acquired retinal diseases. On the contrary, participants with acquired retinal diseases reported more inconveniences (conveniences) than participants with hereditary retinal diseases, which were mostly attributed to treatment. Participants with hereditary retinal diseases were coping better compared to participants with acquired retinal diseases. Conclusions Our study found that participants with both hereditary and acquired retinal diseases are living with myriad of disease-specific quality of life issues. Many of these issues are completely different and unique to each disease group. Hence, these group of diseases would need separate patient-reported outcome instruments to capture the disease-specific quality of life impacts

Effect of long term high altitude exposure on cardiovascular autonomic adjustment during rest and post-exercise recovery

Abstract Background Despite the successful adaptation to high altitude, some differences do occur due to long term exposure to the hypoxic environment. The effect of long term high altitude exposure on cardiac autonomic adjustment during basal and post-exercise recovery is less known. Thus we aimed to study the differences in basal cardiac autonomic adjustment and its response to exercise in highlanders and to compare it with lowlanders. Methods The study was conducted on 29 healthy highlander males who were born and brought up at altitude of 3000 m and above from the sea level, their cardiac autonomic adjustment was compared with age, sex, physical activity and ethnicity-matched 29 healthy lowlanders using Heart Rate Variability (HRV) during rest and recovery from sub-maximal exercise (3 m step test). Intergroup comparison between the highlanders and lowlanders and intragroup comparison between the rest and the postexercise recovery conditions were done. Results Resting heart rate and HRV during rest was comparable between the groups. However, heart rate recovery after 3 min step test was faster in highlanders (p < 0.05) along with significantly higher LF power and total power during the recovery phase. Intragroup comparison of highlanders showed higher SDNN (p < 0.05) and lower LF/HF ratio (p < 0.05) during recovery phase compared to rest which was not significantly different in two phases in lowlanders. Further highlander showed complete recovery of RMSSD, NN50, pNN50 and HF power back to resting level within five minutes, whereas, these parameters failed to return back to resting level in lowlanders within the same time frame. Conclusion Highlanders completely recovered back to their resting state within five minutes from cessation of step test with parasympathetic reactivation; however, recovery in lowlanders was delayed

Understanding quality of life impact in people with retinal vein occlusion: a qualitative inquiry

Background: Although being the second most common sight-threatening retinal vascular disease after diabetic retinopathy, the patient-centred impact of retinal vein occlusion has not been well studied. This study aims to understand the quality of life issues in people with retinal vein occlusion using a qualitative methodology. Methods: In-depth semi-structured interviews were conducted with 17 patients with retinal vein occlusion. All the interviews were digitally recorded and transcribed verbatim. An inductive analytic approach based on the constant comparative method was used for coding, aggregation, and theme development. The qualitative analysis was done using the software NVivo. Results: Participants had a median age of 73 years (range 34-85 years; females, 71 per cent). Six quality of life themes were identified: concerns about the disease progression and treatment outcome (health concerns), emotional responses to the disease (emotional), experiencing a range of symptoms (symptoms), inability to do things as before (activity limitation), adapting to the visual loss (coping), and inconveniences due to the eye condition (convenience). Participants often felt that lasers and injections did not improve their vision. They feared that their eye condition may come back, or the other eye may be affected. They experienced a range of visual symptoms that affected their day-to-day performance, particularly reading small print, and driving at night. Having multiple treatments and frequent eye appointments were major sources of inconvenience. Patients adopted several coping strategies to manage the stress associated with visual loss. Conclusions: This study shows that several aspects of quality of life are compromised in people with retinal vein occlusion. The findings of this study will be used to identify the item content for a vitreoretinal disease-specific quality of life item bank.Mallika Prem Senthil, Jyoti Khadka, Jagjit S Gilhotra, Sumu Simon, Eva K Fenwick, Ecosse Lamoureux, Konrad Pesudov

The Impact of Adult Uveitis on Quality of Life: An Exploratory Study.

: This exploratory qualitative research was conducted to understand the quality of life (QoL) impacts of adult uveitis to develop a uveitis QoL item bank, and we present here the results of qualitative analysis of uveitis patient experience.: A qualitative approach with phenomenological study design was employed to explore the common QoL domains in uveitis. Data were collected using focus groups and face-to-face interviews. The sessions were audio-recorded, transcribed verbatim, and analysed thematically. NViVo software was used to perform qualitative analysis.: Eight focus groups and 10 interviews were conducted with 41 patients with uveitis. Seven QoL domains were identified, namely symptoms, emotional, activity limitation, health concerns, convenience, social, and economic impact. Although these QoL domains have been previously identified in other eye diseases, the sub-themes within each QoL domain were unique to uveitis. Participants described a variety of symptoms including increased light sensitivity, blurred vision, pain, redness, and tearing. Participants repeatedly described feeling frustrated due to prognostic uncertainty and associated discomfort. Participants were concerned about the frequent relapses of inflammation, as well as side-effects from long-term systemic medications. Uveitis affected their ability to perform daily tasks such as using computers, driving, and reading books. Direct financial impacts included reduced work hours and the costs of treatment and specialist care.: Participants with uveitis experience many symptoms in addition to medication-related inconveniences and activity limitations. The QoL issues identified will be used to develop a uveitis-specific QoL item bank

Additional file 1: of Effect of long term high altitude exposure on cardiovascular autonomic adjustment during rest and post-exercise recovery

Physical Activity Rating (PAR) Questionnaire. (DOCX 12 kb