Estimation of extra-pancreatic necrosis volume and its correlation with the clinical outcome in acute pancreatitis

Background: The aim of study was to measure extra-pancreatic necrosis volume in acute pancreatitis and associate with the clinical outcome and to determine the threshold volume of extra-pancreatic necrosis that predicts severity of acute pancreatitis.Methods: Hospital based observational study was carried out in the department of radiodiagnosis, Armed forces medical college, Pune, Maharashtra. All cases referred for CT scan in suspected cases of acute pancreatitis (by clinical and/or biochemical parameters) as a part of institutional protocol were included in the study. Multiplanar reconstruction with volumetric analysis was done for measuring the extra-pancreatic necrosis volume (EPNV) using inherent CT scanner volume assessing software.Results: Out of total 41 patients studied, more than one cause was identified in 9 patients. The most common cause of acute pancreatitis was alcohol use 32 (64%), followed by gallstone and diabetes mellitus (8% each). There was a positive correlation between EPNV and duration of hospitalization which was statistically significant with Spearman's correlation coefficient of 0.579 and p<0.001.Conclusions: Our study showed highly significant correlation between the EPNV and the prediction of end organ failure, systemic infection, duration of hospital stay and need for intervention. Statistically patient presenting with EPNV of more than 100 ml was closely associated with end organ failure; hence EPNV may be used as a useful scoring system. This study has highlighted the convenient and easier technique of predicting clinical outcome in patient by simply assessing the severity of acute pancreatitis by measuring EPNV.

Integrated approach for the management of common bean rust (Uromyces appendiculatus) under field conditions

A field experiment was conducted to test the efficacy of different management practices and fungicide application timings for common bean rust management in Chitwan, Nepal. It was conducted in a randomized complete block design (RCBD) with two factors: management practices (Azoxystrobin, Trichoderma viride, maize intercropping + Trichoderma viride, Neem + Garlic extracts, and inoculated and untreated controls) and fungicide application timings (8 days after inoculation and 3 days after inoculation), each with three replications. The minimum disease severity was found with azoxystrobin, which was at par with neem + garlic extract and maize intercropping + Trichoderma at 50 days after inoculation (DAI). The maximum number of rust pustules per cm2 was observed in the control plots (7.56), followed by Trichoderma (4.79) at 50 DAI. The maximum necrotic colonies (%) were observed with the control (36.88%), followed by Trichoderma (25.15%), while the effects of other treatments were at par at 40 DAI. Maize intercropping with Trichoderma resulted in a maximum plant height (201.56 cm), which was at par with azoxystrobin (197.81 cm). The plants treated with azoxystrobin showed maximum green pod yield at one picking (2411.35 g) which was at par with maize intercropping + Trichoderma and neem + garlic extracts. Rust was controlled more effectively when the fungicides were sprayed at 4 DAI than 8 DAI. The maximum disease control was observed with Azoxystrobin; however, as other treatments also had comparable effects, an integrated approach could be adopted for the sustainable management of common bean rust

Effect of Mycorrhiza on Vegetative Growth of Mandarin’s (Citrus reticulata Blanco) Seedlings

Citrus is among the top fruits which are cultivated around the world, and among citrus, Mandarin (Citrus reticulata Blanco) comes first and belongs to the family Rutaceae. A field experiment was conducted in Gorkha, Nepal, from April 2021 to July 2022, to study the effect of different doses of Mycorrhiza in the vegetative growth seedlings. The experiment was set up in a Randomized Complete Block Design (RCBD) with five treatments and four replications. The treatments were named T1: Control, T2: 3g/seedling, T3: 6g/seedling, T4: 9g/seedling, and T5: 11g/seedling, respectively. Eighteen months old seedlings of local Mandarin were uprooted and transplanted in finely pulverized and prepared seedbeds, and Mycorrhiza was added subsequently. Data was collected for plant height, number of leaves, and stem diameter. Data analysis was done through Microsoft- Excel, RStudio, and Analysis of Variance (ANOVA). Results of the study showed that plants treated with 9g of Mycorrhiza produced the highest number of measured parameters compared to plants treated with other doses. Control treatment (0g) produces the least number of plant leaves, Height, and stem diameter, and it can be concluded that a mycorrhizal dose of 9g is the best for the vegetative growth of Mandarin

Alcohol use and burden for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2.2% (95% uncertainty interval [UI] 1.5-3.0) of age-standardised female deaths and 6.8% (5.8-8.0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3.8% (95% UI 3.2-4-3) of female deaths and 12.2% (10.8-13-6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2.3% (95% UI 2.0-2.6) and male attributable DALYs were 8.9% (7.8-9.9). The three leading causes of attributable deaths in this age group were tuberculosis (1.4% [95% UI 1. 0-1. 7] of total deaths), road injuries (1.2% [0.7-1.9]), and self-harm (1.1% [0.6-1.5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27.1% (95% UI 21.2-33.3) of total alcohol-attributable female deaths and 18.9% (15.3-22.6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0.0-0.8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.Peer reviewe

Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-Adjusted life-years for 29 cancer groups, 1990 to 2017 : A systematic analysis for the global burden of disease study

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-Adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572000 deaths and 15.2 million DALYs), and stomach cancer (542000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601000 deaths and 17.4 million DALYs), TBL cancer (596000 deaths and 12.6 million DALYs), and colorectal cancer (414000 deaths and 8.3 million DALYs). Conclusions and Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care. © 2019 American Medical Association. All rights reserved.Peer reviewe

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Geographical Information System: As a Media Tool for Promoting Sustainable Development vis-à-vis Environmental Conservation

Environmental conservation and sustainable development has been a major aspect of the Five Year Plans in Bhutan, and are also important components of Gross National Happiness (GNH). The Kingdom of Bhutan has received international acclaim for its commitment to the maintenance of her biodiversity and places environmental conservation at the core of development strategy. The vision of happiness, peace and prosperity clearly states that the long commitment to the maintenance of biological diversity and productivity is rooted in the understanding of the importance of forest systems to the survival strategies of remote and isolated communities, beliefs and customs, and understanding of sustainable development. The dynamic leadership of His Majesty and the prevalence of strong traditional values have so far played a crucial role in the preservation of country’' rich biodiversity. However, with the ongoing process of decentralization, the responsibilities and powers to maintaining the ecological resources and the overall environment will be vested in local communities, and will also lead to grassroots level planning and management of the resources. A sound database and overall information about the location, quality, and quantity of the country's natural and human resources is therefore the prerequisite for the conservation of biodiversity and for planning for a sustainable future

Primary Total Hip Replacement in A Military Hospital in Kathmandu

Introduction: Total hip replacement is one of the most widely performed and amongst the most successful orthopedic procedures performed worldwide. Even though it is a common orthopedic procedure in developed nations, it is performed only in selected centers in Nepal.  This study will review the functional outcome of total hip replacements carried out in Shree Birendra Hospital. Methods: We reviewed the records of total hip replacements, which were carried out in Shree Birendra Hospital, Kathmandu. Twenty-one hips were cemented and nineteen were uncemented.  Cases were followed up in six weeks, twelve weeks, six months and every year from then on. Outcome in terms of Harris hip score of 40 osteoarthritic hips were measured pre-operatively as well as post-operatively. Results: The mean age of the patients was 50.63 years (range 22-79 years). The commonest reason for the replacement was primary osteoarthritis of the hip. Thirty-nine patients underwent unilateral total hip replacement while in one patient both hips were replaced. The mean Harris hip score for the forty hips that were available at the latest follow-up examination at an average of five years (range two to six and a half years) after the operation was 85.2 ± 7.65 points as compared to the pre-operative mean Harris hip score of 32.38 ± 3.4. Conclusions: Based on improved Harris hip scores, we believe that THR is a good option in patients with end stage arthritis of the hip. Keywords: cemented; primary osteoarthritis; total hip replacement