Descriptive study of earthquake-related spinal cord injury in Nepal.

STUDY DESIGN: Descriptive study. OBJECTIVES: To describe the epidemiological features of spinal cord injury (SCI) following the 2015 earthquakes in Nepal. SETTING: Spinal Injury Rehabilitation Centre, Kavre, Nepal. METHODS: Data were collected from the medical records of all earthquake-related patients seen from 25 April 2015 through to 16 June 2016. Data collected included patient demographics, mechanism of injury, initial medical treatment, neurological assessment, complications, neurological/functional outcomes and length of stay. RESULTS: Data from 117 earthquake-related SCI patients were evaluated, with a female-to-male ratio of 1.3:1. In total, 108 patients (92%) sustained vertebral fracture and/or dislocation. Seventy-seven patients had undergone surgical fixation. The majority of patients (81%) presented with paraplegia, of whom most (60%) were incomplete. Thirty-eight (33%) patients had documented pressure ulcers upon admission; six (5%) patients developed new pressure ulcers during their rehabilitation stay. Urinary tract infection was seen in 34 (29%) patients. Seven (6%) patients were diagnosed with deep vein thrombosis. One patient developed clinically significant heterotopic ossification. Significant improvements were seen in patients' functional outcomes before discharge. Two deaths occurred in this patient population. CONCLUSIONS: The Nepal earthquakes resulted in a significant number of SCIs, the majority occurring in women. Incomplete paraplegia was the most common presentation. Pressure ulcer, the most frequent complication, primarily occurred before rehabilitation admission. Continued efforts focused on comprehensive planning, and preparedness for SCI-specific interdisciplinary care following earthquakes, particularly in resource-limited settings, is critical to ensuring survival, preventing complications and optimizing functional outcomes in this patient population.

Maternal and Neonatal Health Knowledge, Service Quality and Utilization: Findings from a Community Based Quasi-experimental Trial in Arghakhanchi District of Nepal.

BACKGROUND: As part of the Partnership for Maternal and Newborn Health Project (PMNH), HealthRight International collaborated with Mother and Infant Research Activities (MIRA) to conduct operations research in Arghakhanchi district of Nepal to explore the intervention impact of strengthening health facility, improving community facility linkages along with Community Based Newborn Care Program (CB-NCP) on Maternal Neonatal Care (MNC) service quality, utilization, knowledge and care seeking behavior. METHODS: This was a quasi-experimental study. Siddahara, Pokharathok, Subarnakhal,Narpani Health Posts (HPs) and Thada Primary Health Care Center(PHCC)in Electoral Constituency-2 were selected as intervention sites and Arghatosh, ,Argha, Khana, Hansapur HPs and Balkot PHCC in Electoral Constituency-1 were chosen as controls. The intervention started in February 2011 and was evaluated in August 2013. To compare MNC knowledge and practice in the community, mothers of children aged 0-23 months were selected from the corresponding Village Development Committees(VDCs) by a two stage cluster sampling design during both baseline (July 2010) and endline (August, 2013) assessments. The difference in difference analysis was used to understand the intervention impact. RESULTS: Local resource mobilization for MNC, knowledge about MNC and service utilization increased in intervention sites. Though there were improvements, many effects were not significant. CONCLUSIONS: Extensive trainings followed by reviews and quality monitoring visits increased the knowledge, improved skills and fostered motivation of health facility workers for better MNC service delivery. MNC indicators showed an upsurge in numbers due to the synergistic effects of many interventions.

Impact and determinants of gender preference in Duhavi VDC of eastern Nepal.

INTRODUCTION: Gender equality has been a priority area of demographic research. One of the major reasons for high fertility and low acceptance of family planning is the prevalence of gender preference among couples. The objectives of this study were to identify the determinants and examine the extent of gender preference on fertility. METHODS: This is a cross-sectional study carried from June 2008 to July 2009 in Duhavi VDC of Sunsari district of Nepal. Three hundred and five randomly selected ever-married women of 15 - 49 years, who had at least one child were the subjects of the study. A questionnaire covering the areas on gender and fertility preference and methods and use of contraception was given and filled up. RESULTS: The study showed that 42.6% of the ever-married women belonged to the 25 - 29 years age group. Around 92% of women whose last child was a male were using family planning methods whereas only 40% of women whose last child was a female were using family planning methods. This difference was statistically significant (P < 0.0001). CONCLUSIONS: The contraception use among the women having a female child was low, showing a desire for a male child which is one of the factors in the increase of family size in our society. Due to the patrilineal society, women are discouraged in the practice of contraception. Effective intervention programs need to be planned and conducted to rectify this situation.

Single-snapshot and intensity-resolved two-photon fluorescence measurements.

We present a single-snapshot (SSS) method for obtaining intensity-resolved two-photon fluorescence (TPF). This simple method uses a digital camera to image the TPF spot on a liquid dye jet. By making a comparison between the local laser and TPF intensities, TPF probabilities are reconstructed. We compare our intensity-resolved TPF results with those obtained by the more common intensity scanning (IS) and z-scan methods. The dependence of the TPF probability on intensity obtained by the SSS method for coumarin-30 exhibits a clear maximum around I approximately 4 x 10(12) W/cm(2) and a postsaturation decrease, while no such effects were found in the data obtained by the other methods. Additionally, theoretical models are presented to extract the overall probability from within the volume integral. To our knowledge, we present the first reported measurements of such intensity-resolved TPF.

Enteric fever: diagnostic value of clinical features.

OBJECTIVES: to evaluate the diagnostic value of clinical symptoms and signs in enteric fever and to propose a clinical diagnostic criterion. DESIGN: Prospective observational study. SETTING: Kathmandu Medical College, Teaching Hospital, Kathmandu, Nepal. MATERIALS AND METHODS: febrile patients with clinical diagnosis of enteric fever were included in the study with the aim of confirming diagnosis with blood culture, or bone marrow culture and evaluating the diagnostic accuracy of various clinical signs and symptoms. RESULTS: 64% of the clinically diagnosed cases had blood/ bone marrow culture positive. The diagnostic accuracy of the various symptoms and signs excluding fever was between 42%-75.5%. Majority of the symptom and sign did not have very high diagnostic accuracy. Hence a diagnostic criterion was proposed and clinical features with diagnostic accuracy more than 50% were taken into consideration. Major criteria included fever with diagnostic accuracy of 64%, headache with accuracy of 75.5% and relative bradycardia with an accuracy of 66%. Minor criteria included vomiting, diarrhoea, Splenomegaly, chills and abdominal pain /discomfort with diagnostic accuracy of 57%, 55%, 55%, 53% and 51% respectively. Finally after combination of various major and minor criteria a final diagnostic criterion was proposed having an accuracy of 66% and including both major and minor clinical symptom and sign. CONCLUSION: clinical diagnosis of enteric fever will be very helpful in a country like ours. Though none of the clinical symptoms and sign have very high diagnostic accuracy a diagnostic criteria may be helpful. Criteria including both major and minor signs and symptoms would be the most appropriate diagnostic tool as it includes the important abdominal symptoms and signs of enteric fever.

Spirometry in evaluation of respiratory diseases.

A hospital based cross-sectional study was conducted from March 2005 to April 2006 to evaluate the distribution of various respiratory diseases by spirometry. A total of 228 consecutive cases referred for spirometry were included of which 65% were male and 35% female. COPD was the commonest referral diagnosis (40%) followed by the diagnosis of shortness of breath (22%). After spirometry the prevalence of COPD was 42%, Asthma 23.5%, Restrictive disease 3.1% and mixed obstructive and restrictive disease 3.5%. 25% of the sample population was smokers and 22% ex-smokers. Hence we conclude that spirometry is a very useful diagnostic tool for preliminary diagnosis of respiratory diseases and should be used more by general practitioners and physicians to make their diagnosis and therapy more scientific.

Marfan's syndrome with aortic valve endocarditis.

Marfans syndrome is an Autosomal dominant disorder of the connective tissues resulting in abnormalities of the musculoskeletal system, cardiovascular system and eyes. It has a prevalence of 1 in 100,000 population1 and occurs in all ethnic groups. It may be familial or due to new mutation (30%), in the fibrillin gene on arm of chromosome 15. It is estimated that one person in every 3000-5000 has Marfans syndrome may have cardiovascular abnormalities and may be complicated by infective endocartditis. About 90% of Marfan patients will develop cardiac complications2. The patient under discussion has musculoskeletal (Tall stature, reduced upper-lower segment ratio, arm-span to height ratio > 1.05, high arched palate) and Cardiovascular features (Severe aortic regurgitation complicated with infective endocarditis).

The unacceptable face of trade.

PIP: This article provides information on the efforts of Oxfam in addressing the problems of illegal trafficking of women in Asia. Oxfam in Nepal views the trafficking in women as an organized crime, which violates the fundamental rights of women. To this effect, Oxfam has developed a program that works at the community, district, regional, and national levels, to create connections to ensure that real experience informs lobbying for international change. At the grassroots level, Oxfam works with a network of 17 organizations and women's human rights groups in the Sindhupalchock district of Nepal. The program encourages affected communities and families to organize themselves for action, and mobilizes local councilors on village development committees in punishing local traffickers. At the district level, Oxfam works to achieve the political commitment to enforce the law against traffickers. Oxfam has succeeded in collaborating with different organizations. It is shown that there is a great potential, both within Oxfam and externally, for cross-program linking and learning on trafficking in women. Since trafficking is a problem in many regions of the world, better strategies are needed to deal with the global market in trafficking and to involve the international community in finding a solution.^ieng

Dealing with hidden issues: trafficked women in Nepal.

PIP: This article discusses approaches to dealing with prostitution in Nepal and exportation of women prostitutes to Asia and the Middle East. It is estimated that over 200,000 Nepalese women are in Indian brothels, and tens of thousands are exported each year to other countries and forced either into prostitution or other oppressive conditions. In Nepal, women prostitutes are rejected as wives or daughters, regardless of the reasons involved. Women Acting Together for Change (WATCH) organized a national public hearing in June 1995 on these issues. During the hearing, 11 women and one man shared their views about being forced into prostitution, the ineffectiveness of the law, and social rejection. Participants at this forum questioned the legal practice of human rights and decided that law was a hindrance. Government representatives on the "listening bench" responded defensively and argued that prostitutes were unwilling to use the law, but agreed that the government should punish traffickers and commit politically to ending the trafficking in women. Roundtable discussions among concerned people after a day of hearings decided to initiate a nationwide coalition against the trafficking in women. The alliance would consist of 17 people and include nongovernmental representatives, lawyers, women who testified, representatives of the National Planning Council, and representatives from women's groups. The sex trade is viewed as a part of the national economy and a very profitable enterprise. Extreme poverty and few employment options are strong incentives for the continuation of prostitution. Patriarchal norms reinforce the view of women as born for the sexual pleasure of men. Nepal's national economy and policies have contributed to family poverty and to migration to other countries where women are exploited. The forum revealed schisms in the government commitment to Article 20 of the constitution.^ieng