Projected changes in climate over the Indus river basin using a high resolution regional climate model (PRECIS)

A regional climate modelling system, the Providing REgional Climates for Impacts Studies developed by the Hadley Centre for Climate Prediction and Research, has been used to study future climate change scenarios over Indus basin for the impact assessment. In this paper we have examined the three Quantifying Uncertainty in Model Predictions simulations selected from 17-member perturbed physics ensemble generated using Hadley Centre Coupled Module. The climate projections based on IPCC SRES A1B scenario are analysed over three time slices, near future (2011-2040), middle of the twenty first century (2041-2070), and distant future (2071-2098). The baseline simulation (1961-1990) was evaluated with observed data for seasonal and spatial patterns and biases. The model was able to resolve features on finer spatial scales and depict seasonal variations reasonably well, although there were quantitative biases. The model simulations suggest a non-uniform change in precipitation overall, with an increase in precipitation over the upper Indus basin and decrease over the lower Indus basin, and little change in the border area between the upper and lower Indus basins. A decrease in winter precipitation is projected, particularly over the southern part of the basin. Projections indicate greater warming in the upper than the lower Indus, and greater warming in winter than in the other seasons. The simulations suggest an overall increase in the number of rainy days over the basin, but a decrease in the number of rainy days accompanied by an increase in rainfall intensity in the border area between the upper and lower basins, where the rainfall amount is highest

Preemptive use of Small Dose Fentanyl Suppresses Fentanyl Induced Cough

ABSTRACT Backgroun

Prevalence of Arsenicosis in Terai, Nepal

This paper summarizes the findings of surveys on arsenicosis cases conducted during 2001-2004 in terai, Nepal, by governmental and non-governmental organizations in their respective project areas and by some national and international institutes. Studies were conducted in six arsenic-contaminated districts of terai, namely Nawalparasi, Bara, Parsa, Rautahat, Rupandehi, and Kapilvastu. In these districts, arsenic contamination in tubewells varied from 2.1% to 25.7%. The prevalence of arsenicosis was, on average, 2.2% and varied from 0.7% in Kapilavastu district to 3.6% in Nawalparasi district. In the community-based study, the highest prevalence (18.6%) of arsenicosis was found in Patkhouli village of Nawalparasi, where 95.8% of tubewells were contaminated with arsenic. The prevalence of arsenicosis was higher in older age-groups (>50 years) of both the sexes. Males suffered more from arsenicosis than females (odds ratio: 2.50, 95% confidence interval 1.80-3.47). Skin manifestations, such as melanosis and keratosis, were the common symptoms of arsenicosis. Most patients were identified in the early or mild stage of the disease. They are expected to recover if further exposure to arsenic could be avoided by providing arsenic-safe drinking-water through intervention measures

Prevalence and risk factors associated with chronic kidney disease in Nepal: evidence from a nationally representative population-based cross-sectional study.

OBJECTIVE: This study aimed to determine population-based prevalence of chronic kidney disease (CKD) and its associated factors in Nepal. STUDY DESIGN: The study was a nationwide population-based cross-sectional study. SETTING AND PARTICIPANTS: Cross-sectional survey conducted in a nationally representative sample of 12 109 Nepalese adult from 2016 to 2018 on selected chronic non-communicable diseases was examined. Multistage cluster sampling with a mix of probability proportionate to size and systematic random sampling was used for the selection of individuals aged 20 years and above. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome in this study was population-based prevalence of CKD in Nepal. A participant was considered to have CKD if the urine albumin-to-creatinine ratio was greater than or equal to 30 mg/g and/or estimated glomerular filtration rate is less than 60 mL/min/1.73 m2 at baseline and in follow-up using modification of diet in renal disease study equations. The secondary outcome measure was factors associated with CKD in Nepal. The covariate adjusted association of risk factors and CKD was calculated using multivariable binary logistic regression. RESULTS: The overall prevalence of CKD in Nepal was 6.0% (95% CI 5.5 to 6.6). Factors independently associated with CKD included older age (adjusted OR (AOR) 2.6, 95% CI 1.9 to 3.6), Dalit caste (AOR 1.6, 95% CI 1.1 to 2.3), hypertension (AOR 2.4, 95% CI 2.0 to 3.0), diabetes mellitus (AOR 3.2, 95% CI 2.5 to 4.1), raised total cholesterol (AOR 1.3, 95% CI 1.0 to 1.6) and increased waist-to-hip ratio (AOR 1.6, 95% CI 1.2 to 2.3). CONCLUSION: This nationally representative study shows that the prevalence of CKD in the adult population of Nepal is substantial, and it is independently associated with several cardiometabolic traits. These findings warrant longitudinal studies to identify the causes of CKD in Nepal and effective strategies to prevent it

District Health Service Management

District Health System Management is a comprehensive study of the health system of the district as a unit of national health system. The report of District Health System Management has been prepared as per the MBBS 4th year (Third phase) curriculum of Tribhuvan University (TU), Institute of Medicine (IOM), Nepal after the field placement of our group in Gorkha and Kaski districts. We prepared regional health directorate profile, regional tuberculosis center profile, district profile, district health profile of Kaski, hospital profile of Western Regional Hospital, Kaski, and critical analysis on human resources of the Aampipal hospital. We prepared five year plan on ICU services of Gorkha District Hospital and conducted epidemiological study on COPD in WRH, Pokhara. The techniques used in this study were observation, interviews, interactions, participation, secondary data retrieval, analysis and presentation using specific tools and guidelines devised for the same. The field practice proved to be a milestone in enabling the students to develop aptitude in the fields of management, administration and communication in different health set-ups of the country. It is in fact once-in-a lifetime opportunity for the medical students to imbibe the practicality of management skills at various levels

Overcoming Multidrug Resistance of Antibiotics via Nanodelivery Systems

Antibiotic resistance has become a threat to microbial therapies nowadays. The conventional approaches possess several limitations to combat microbial infections. Therefore, to overcome such complications, novel drug delivery systems have gained pharmaceutical scientists’ interest. Significant findings have validated the effectiveness of novel drug delivery systems such as polymeric nanoparticles, liposomes, metallic nanoparticles, dendrimers, and lipid-based nanoparticles against severe microbial infections and combating antimicrobial resistance. This review article comprises the specific mechanism of antibiotic resistance development in bacteria. In addition, the manuscript incorporated the advanced nanotechnological approaches with their mechanisms, including interaction with the bacterial cell wall, inhibition of biofilm formations, activation of innate and adaptive host immune response, generation of reactive oxygen species, and induction of intracellular effect to fight against antibiotic resistance. A section of this article demonstrated the findings related to the development of delivery systems. Lastly, the role of microfluidics in fighting antimicrobial resistance has been discussed. Overall, this review article is an amalgamation of various strategies to study the role of novel approaches and their mechanism to fight against the resistance developed to the antimicrobial therapies.</jats:p

Ethnobotany in the Nepal Himalaya

<p>Abstract</p> <p>Background</p> <p>Indigenous knowledge has become recognized worldwide not only because of its intrinsic value but also because it has a potential instrumental value to science and conservation. In Nepal, the indigenous knowledge of useful and medicinal plants has roots in the remote past.</p> <p>Methods</p> <p>The present study reviews the indigenous knowledge and use of plant resources of the Nepal Himalayas along the altitudinal and longitudinal gradient. A total of 264 studies focusing on ethnobotany, ethnomedicine and diversity of medicinal and aromatic plants, carried out between 1979 and 2006 were consulted for the present analysis. In order to cross check and verify the data, seven districts of west Nepal were visited in four field campaigns.</p> <p>Results</p> <p>In contrast to an average of 21–28% ethnobotanically/ethnomedicinally important plants reported for Nepal, the present study found that up to about 55% of the flora of the study region had medicinal value. This indicates a vast amount of undocumented knowledge about important plant species that needs to be explored and documented. The richness of medicinal plants decreased with increasing altitude but the percentage of plants used as medicine steadily increased with increasing altitude. This was due to preferences given to herbal remedies in high altitude areas and a combination of having no alternative choices, poverty and trust in the effectiveness of folklore herbal remedies.</p> <p>Conclusion</p> <p>Indigenous knowledge systems are culturally valued and scientifically important. Strengthening the wise use and conservation of indigenous knowledge of useful plants may benefit and improve the living standard of poor people.</p

Prevalence and Risk Factors of Postpartum Depression Within One Year After Birth in Urban Slums of Dhaka, Bangladesh

Postpartum depression (PPD) is a serious pubic health concern and known to have the adverse effects on mother’s perinatal wellbeing; and child’s physical and cognitive development. There were limited literatures on PPD in Bangladesh, especially in urban slum context. The aim of this study was to assess the burden and risk factors of PPD among the urban slum women. A cross-sectional study was conducted between November-December 2017 in three urban slums on 376 women within first 12 months of postpartum. A validated Bangla version of Edinburgh Postnatal Depression Scale was used to measure the depression status. Respondent’s socio-economic characteristics and other risk factors were collected with structured validated questionaire by trained interviewers. Unadjusted Prevalence Ratio (PR) and Adjusted Prevalence Ratio (APR) were estimated with Generalized Linear Model (GLM) and Generalized Estimating Equation (GEE) respectively to identify the risk factors of PPD. The prevalence of PPD was 39.4% within first 12 months following the child birth. Job involvement after child delivery (APR = 1.9, 95% CI = 1.1, 3.3), job loss due to pregnancy (APR = 1.5, 95% CI = 1.0, 2.1), history of miscarriage or still birth or child death (APR = 1.4, 95% CI = 1.0, 2.0), unintended pregnancy (APR = 1.8, 95% CI = 1.3, 2.5), management of delivery cost by borrowing, selling or mortgaging assets (APR = 1.3, 95% CI = 0.9, 1.9), depressive symptom during pregnancy (APR = 2.5, 95% CI = 1.7, 3.8) and intimate partner violence (APR = 2.0, 95% CI = 1.2, 3.3), were identified as risk factors. PPD was not associated with poverty, mother in law and any child related factors. The burden of postpartum depression was high in the urban slum of Bangladesh. Maternal mental health services should be integrated with existing maternal health services. Research is required for the innovation of effective, low cost and culturally appropriate PPD case management and preventive intervention in urban slum of Bangladesh

Transitional Probability-Based Model for HPV Clearance in HIV-1-Positive Adolescent Females

BACKGROUND: HIV-1-positive patients clear the human papillomavirus (HPV) infection less frequently than HIV-1-negative. Datasets for estimating HPV clearance probability often have irregular measurements of HPV status and risk factors. A new transitional probability-based model for estimation of probability of HPV clearance was developed to fully incorporate information on HIV-1-related clinical data, such as CD4 counts, HIV-1 viral load (VL), highly active antiretroviral therapy (HAART), and risk factors (measured quarterly), and HPV infection status (measured at 6-month intervals). METHODOLOGY AND FINDINGS: Data from 266 HIV-1-positive and 134 at-risk HIV-1-negative adolescent females from the Reaching for Excellence in Adolescent Care and Health (REACH) cohort were used in this study. First, the associations were evaluated using the Cox proportional hazard model, and the variables that demonstrated significant effects on HPV clearance were included in transitional probability models. The new model established the efficacy of CD4 cell counts as a main clearance predictor for all type-specific HPV phylogenetic groups. The 3-month probability of HPV clearance in HIV-1-infected patients significantly increased with increasing CD4 counts for HPV16/16-like (p<0.001), HPV18/18-like (p<0.001), HPV56/56-like (p = 0.05), and low-risk HPV (p<0.001) phylogenetic groups, with the lowest probability found for HPV16/16-like infections (21.60±1.81% at CD4 level 200 cells/mm(3), p<0.05; and 28.03±1.47% at CD4 level 500 cells/mm(3)). HIV-1 VL was a significant predictor for clearance of low-risk HPV infections (p<0.05). HAART (with protease inhibitor) was significant predictor of probability of HPV16 clearance (p<0.05). HPV16/16-like and HPV18/18-like groups showed heterogeneity (p<0.05) in terms of how CD4 counts, HIV VL, and HAART affected probability of clearance of each HPV infection. CONCLUSIONS: This new model predicts the 3-month probability of HPV infection clearance based on CD4 cell counts and other HIV-1-related clinical measurements