Upper Gastrointestinal Bleeding Induced by Gastric Ulcer Secondary to Strongyloidiasis: A Case Report

Strongyloidiasis, a parasitic infestation by Strongyloides stercoralis, involves the gastrointestinal tract with a spectrum from duodenitis to enterocolitis. However, gastric involvement with the manifestation of upper gastrointestinal bleeding is an extremely rare condition due to Strongyloides stercoralis. Due to irregular excretion of larvae, unclear symptoms, paucity of effective diagnostic tools and low parasitic load, makes clinicians difficult to reach the diagnosis of strongyloidiasis. Here, we present a case of upper gastrointestinal bleeding due to a large gastric ulcer whose aetiology was identified to be Strongyloides stercoralis infection of the gastric region by the diagnosis of exclusion

Wildlife assessment of the Chandragiri hills, Kathmandu: Potentiality for ecotourism

Wildlife assessments can provide crucial information regarding species richness, relative abundance and spatial, temporal, and ecological information on wildlife habitat associations. The assessment’s information can in turn be used for developing management policies including for establishing touristic zones. We investigated wildlife occurrences in the Chandragiri Hills, Kathmandu Nepal from 2015-2019 to provide baseline data to inform the potential sites for ecotourism. During the study period, we recorded 30 mammal species, 199 bird species, 34 herpetofauna species and 77 butterfly species. The area harbors three globally and six nationally threatened mammal species, two globally and seven nationally threatened with one endemic bird species, one globally and nationally threatened herpetofauna, and one nationally threatened butterfly species. We also explored four potential hiking routes for observing wildlife and providing scenic views of the Himalayan range and Kathmandu city. Therefore, we expect Chandragiri Hills can become one of the hot spot for tourists to observe both common and threatened wildlife species in Nepal

A Study of Labor Migration and Remittance Economy of Nepal; a System Dynamics Approach

There is an increasing trend in emigration from Nepal to developed countries as a migrant worker since last two decades. With an increase in labor emigration there is increasing share of international migrant workers remittance on GNI of Nepal. It has become an area of interest for researchers and economists when the number of people emigrating and amount of inward remittance they send back started to increase. There is substantial debate regarding the relative contribution of inward remittance to sustainable economic development in remittance receiving countries. At the same time increasing labor emigration have different social, economic, political influence to both labor sending and receiving countries. Unavailability of job due to slower economic growth in comparison with increasing labor force entering to labor market and earning difference between Nepal and other labor welcoming countries are key factors influencing migration decision. Similarly, social network people have who are already working in different destination countries and reduction on migration cost due to social network also influence the migration decisions of many people who wish to emigrate as a migrant worker. Rapid increase in inward remittance can be observed to Nepal with an increase in labor emigration since last couple of decades. Officially recorded remittance inflow to Nepal has increased enormously over the last two decade, academic and policy oriented researchers have come up with different findings and conclusions regarding long term impact of remittance on economic growth of the country. However, there is no consensus over, whether remittance contribute to sustainable economic growth by reducing poverty, or weaken long term growth by creating the problem of labor shortage and brain drain. This research analyzes the current mechanism and structure of labor migration, remittance income and use, and how it is influencing economy of the country as a whole. Use of system dynamic approach , causal loop diagram, stock and flow diagram, simulation result from definitive modeling tool ‘Stella architect’ along with complex characteristics of structure of the system such as; time delay, non-linearity, feedback etc. are 4 the factors of this research which makes it unique from other research on same topic. After analyzing the past, present and future trend of different economic variables with the help of simulation result from the model, this study suggests that remittance can exert a weakly favorable impact on long term economic growth. This research also concludes that sustainable economic development can only be achieved with the presence of sound economic policies and institutions

Safety and efficacy of cerebral embolic protection devices for patients undergoing transcatheter aortic valve replacement: An updated meta-analysis

BACKGROUND AND AIMS: Cerebral embolic protection (CEP) devices are employed to capture embolic debris and reduce the risk of stroke during transcatheter aortic valve replacement (TAVR). Evidence is mixed regarding the safety and efficacy of CEP. We aimed to summarize the safety and effectiveness of CEP use during TAVR. METHODS: Electronic databases, including PubMed, PubMed Central, Scopus, Cochrane Library, and Embase, were searched using relevant search terms for articles relating to CEP. All relevant data from 20 studies were extracted into a standardized form. Statistical analyses were performed using Revman 5.4. Odds ratio (OR) or mean differences (MDs) were used to estimate the desired outcome with a 95% confidence interval (CI). RESULTS: Twenty studies (eight randomized controlled trials [RCTs]) involving 210,871 patients (19,261 in the CEP group and 191,610 in TAVR without the CEP group) were included. The use of CEP was associated with a lower odds of 30-day mortality by 39% (OR: 0.61, 95% CI: 0.53-0.70) and stroke by 31% (OR: 0.69, 95% CI: 0.52-0.92). Comparing devices, benefit in terms of mortality and stroke was observed with the use of the Sentinel device (Boston Scientific), but not among other devices. No differences were observed in the outcomes of acute kidney injury, major or life-threatening bleeding events, or major vascular complications between groups. When only RCTs were included, there were no observed differences in the primary or secondary outcomes for CEP versus no CEP use during TAVR. CONCLUSIONS: The totality of evidence suggests a net benefit for the use of CEP, weighted by studies in which the Sentinal device was used. However, given the RCT subanalysis, additional evidence is needed to identify patients at the highest risk of stroke for optimal decision-making

Conduction system pacing vs. biventricular pacing for cardiac resynchronization therapy in heart failure with reduced ejection fraction: An updated systematic review and meta-analysis

Background: Conduction system pacing (CSP) is considered an effective and physiological form of pacing in patients requiring cardiac resynchronization therapy (CRT). Objective: To compare electrocardiographic (ECG), echocardiographic (ECHO) characteristics and clinical outcomes among patients with heart failure with reduced ejection fraction (HFrEF) undergoing CRT with CSP or biventricular pacing (BVP). Methods: This study protocol was registered in the PROSPERO registry (CRD42022375155) and the review was conducted per the PRISMA protocol. Four major databases were searched from inception till October 20, 2022, for relevant studies comparing CSP to BVP for CRT in patients with HFrEF. Results: From a total of 10,072 references identified, 35 full-text were assessed and 18 studies (6 RCTs, 12 observational studies) were included in the review. Following left bundle branch area pacing (LBBAP), on average, paced QRS duration was 28 ms narrower in comparison to BVP (MD -27.69, CI -36.59 to -18.80), and a similar result was obtained with HBP vs. BVP as well. Left ventricular ejection fraction (LVEF) improvement was greater with CSP in comparison to BVP [LBBAP (MD 6.03, CI 4.16–7.91); HBP (MD 3.79, CI 0.46–7.11); HPSP (MD 6.60, CI 4.42–8.78). There were higher odds of being responders (OR 3.82, CI 1.88–7.75)/super responders (OR 2.08, CI 1.53–2.82) (per ECHO findings) in the CSP group, and overall mortality (OR 0.61, CI 0.40–0.93) and hospitalization for HF (HHF) (OR 0.37, CI 0.25–0.55) was lower in CSP group. Conclusion: Our analysis showed better ECG, ECHO, and clinical outcomes in terms of mortality and HHF with CSP compared to BVP