Self-assessed health status and obesity vulnerability in rural Louisiana: A cross-sectional analysis.

Rural communities are resource-constrained and at higher risk of obesity and obesity-related conditions. Thus, studying self-assessed health status and underlying vulnerabilities is critical to provide insights to the program planners for effective and efficient planning of obesity prevention programs. This study aims to investigate the correlates of self-assessed health status and subsequently determine the obesity vulnerability level of residents in rural communities. Randomly sampled data were obtained from in-person community surveys in three rural Louisiana counties-East Carroll, Saint Helena, and Tensas-in June 2021. The association of social-demographic factors, grocery store choice, and exercise frequency with self-assessed health was investigated using the ordered logit model. An obesity vulnerability index was constructed using the weights obtained from the principal component analysis. The results show that gender, race, education, possession of children, exercise frequency, and grocery store choice significantly influence self-assessed health status. Around 20% of respondents fall into the most-vulnerable segment and 65% of respondents are vulnerable to obesity. The obesity vulnerability index ranged from -4.036 to 4.565, indicating a wide heterogeneity in the vulnerability level of rural residents. The findings show that the self-assessed health status of rural residents is not promising along with a high level of vulnerability to obesity. The findings from this study could serve as a reference in the policy discussion regarding an effective and efficient suite of interventions in rural communities to address obesity and promote well-being.

Wound healing activity of topical herbal aerosol sprays on diabetic and Varicose Ulcers: A randomized, controlled, open labelled, multi-centric clinical trial.

BACKGROUND: Panchavalkala Kwatha and Jatyadi Taila are recommended for cleaning and healing of non-healing ulcers such as Diabetic Foot Ulcer (DFU) and Varicose Ulcers (VU). OBJECTIVES: Innovative topical aerosol sprays viz. Panchavalkala Kwatha Aerosol Spray (PKS) and Jatyadi Taila (Healz) Aerosol Spray (JTS) were evaluated for healing in DFU & VU against conventional treatment. MATERIALS & METHODS: After obtaining approval from Ethics Commitees & informed consent, 53 patients were randomized in two study groups. In one group, ulcer cleaning was done with PKS and then JTS was used for dressing while in other group, cleaning was done with Hydrogen peroxide and/or Hypochlorite followed by dressing with 10% Povidone iodine. Ulcer examination was done from baseline to every 7th day by Bates Jensen ulcer assessment tool, digital photographs and photographic ulcer assessment tool. Comparison of categorical variables was done using t-test. RESULTS: The dual action of PKS and JTS exhibited potentially comparable effect to the conventional treatment. CONCLUSION: PKS and JTS were found to be effective, comfortable, hygenic and acceptable in management of chronic ulcers.

Pseudohypoparathyroidism type 1 B mimicking Fahr's disease in a 28-year-old female: A case report.

In virtue of precise clinical history, physical examinations, and biochemical/radiological investigations, pseudohypoparathyroidism can be effectively diagnosed, and its types can be differentiated even without exorbitant tests.

Guideline based knowledge and practice of physicians in the management of COPD in a low- to middle-income country.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death, with 80% of the total death occurring in low- to middle-income countries (LMICs). Nepal is one of the LMIC; COPD is a highly prevalent and significant public health issue often underdiagnosed. Medical physicians' good knowledge and practice to diagnose and treat COPD can help reduce the disease burden. OBJECTIVES: To determine the level of knowledge, practice and factors influencing the practice of physicians regarding COPD management based on GOLD guidelines. DESIGN: A cross-sectional descriptive study using a structured questionnaire was conducted among medical physicians working in Bagmati and Gandaki province of Nepal. Out of total scores, physicians knowledge and practice were graded according to Bloom's original cut-off point for good (≥80%), satisfactory (60%-78%) and poor (<60%). RESULT: A total of 152 medical physicians participated in this study. Out of the possible total score 20, the mean score on knowledge was 17.8 ± 2.4, and out of possible total score eight, the mean score on practice was 5.3 ± 1.3. The correlation test between total knowledge and practice scores showed r = 0.18 and p value <0.02. The most selected factors hindering the appropriate management of COPD was lack of patient follow up and lack of professional training in COPD. Other factors included patient unwillingness to discuss smoking quit plan, lack of screening tool, unavailability of spirometry and physician unawareness of available medicine to treat COPD. CONCLUSION: Despite physicians having good knowledge in COPD, the practice in COPD management is below guideline-recommended. There is a significant, very low positive correlation between total knowledge score and practice score. Proper COPD training to physicians, disease awareness among patients, easy availability of diagnostic equipment and medication can help improve physicians' practice and appropriately manage COPD patients.

Cryptococcal meningitis in an immunocompetent individual: A case report.

Cryptococcal meningitis (CM) is mostly seen in immune-compromised patients and rarely occurs in immune-competent individuals. Immunocompetent individuals with CM present with indolent neurological disease and have better clinical outcomes after treatment. However, misdiagnosis is common and these patients may suffer from serious complications with high mortality.

Corrigendum: Applied Research in Low-Income Countries: Why and How?

[This corrects the article DOI: 10.3389/frma.2019.00003.].

Impact of the Federal Conservation Program Participation on Conservation Practice Adoption Intensity in Louisiana, USA.

Conservation practices focusing on improving the soil and water quality of working lands are implemented across the United States, supported partially through the United States Department of Agriculture Natural Resources Conservation Service cost-share or incentive payment programs. We assess whether participation in federal conservation support programs induces a change in the number of conservation practices adopted by farmers. We also identify the factors that affect the adoption intensity of different best management practices. We use survey data collected from Louisiana farmers and estimate models using the matching method and Poisson quasi-likelihood model. We find that participation in the cost-share or incentive program leads to an increase in the number of conservation practices on the farms. Similarly, the use of precision technology application and farm being integrated are likely to have a higher number of on-farm conservation practices. Results have implications for federal working lands conservation support programs in the United States.

Comparative Study of Chikungunya Only and Chikungunya-Scrub Typhus Coinfection in Children: Findings from a Hospital-Based Observational Study from Central Nepal.

OBJECTIVES: Chikungunya and scrub typhus infection are important causes of undifferentiated fever in tropical zones. The clinical manifestations in both conditions are nonspecific and often overlap. This study compares the clinical manifestations and the outcome of chikungunya with chikungunya-scrub typhus coinfection in children. METHODS: A hospital-based observational study was conducted in children below 15 years of age over 16-month duration in 2017-2018. Chikungunya was diagnosed by IgM ELISA. All positive chikungunya cases were subjected to scrub typhus testing, dengue testing, leptospira testing, and malaria testing. Clinical manifestations and outcomes of all patients were recorded. RESULTS: Out of the 382 admitted cases with fever, 11% (n = 42) were diagnosed with chikungunya, and the majority (n = 30, 71.4%) were male. Among the 42 chikungunya cases, 17 (40.5%) tested positive for scrub typhus and one positive for falciparum malaria. Out of a total of 42 chikungunya cases, myalgia, nausea/vomiting, headache, abdominal pain, lymphadenopathy, hepatomegaly, splenomegaly, and edema were 81%, 73.8%, 66.7%, 64.3%, 59.5%, 52.4%, 40.5%, and 38.1%, respectively. Besides, altered sensorium (31%), jaundice (26.2%), dry cough (21.4%), shortness of breath (19%), and seizures (16.7%) were other clinical manifestations present in this group of children. Patients with chikungunya-scrub typhus coinfection reported headaches, pain in the abdomen, dry cough, shortness of breath, seizures, and splenomegaly, significantly more (p value < 0.05) compared to those with chikungunya only. Thirteen (31%) children developed shock, five in the chikungunya group and eight in the chikungunya-scrub typhus coinfection group. Six children in the coinfection group received inotrope. Among the chikungunya-only cases, 22 recovered and one died, whereas in the chikungunya-scrub typhus coinfection group, fourteen recovered and three died. CONCLUSIONS: Both the chikungunya and scrub typhus coinfection groups shared many similar clinical manifestations. In children, coinfection with scrub typhus often leads to modification of the clinical profile, complications, and chikungunya outcome.

Prognostic factors associated with small for gestational age babies in a tertiary care hospital of Western Nepal: A cross-sectional study.

BACKGROUND: Small for gestational age (SGA) is common among newborns in low-income countries like Nepal and has higher immediate mortality and morbidities. OBJECTIVES: To study the prevalence and prognostic factors of SGA babies in Western Nepal. METHODS: A cross-sectional study (November 2016-October 2017) was conducted in a tertiary care hospital in Western Nepal. Socio-demographic, lifestyle factors including diet, and exposures including smoking and household air pollution in mothers who delivered newborns appropriate for gestational age (AGA), SGA and large for gestational age (LGA) were recorded. Logistic regression was carried out to find the odds ratio of prognostic factors after adjusting for potential confounders. RESULTS: Out of 4000 delivered babies, 77% (n = 3078) were AGA, 20.3% (n = 813) were SGA and 2.7% (n = 109) were LGA. The proportion of female-SGA was greater in comparison to male-SGA (n = 427, 52.5% vs n = 386, 47.5%). SGA babies were born to mothers who had term, preterm, and postterm delivery in the following proportions 70.1%, 19.3%, and 10.6%, respectively. The average weight gain (mean ± SD) by mothers in AGA pregnancies was 10.3 ± 2.4 kg, whereas in SGA were 9.3 ± 2.4 kg. In addition to low socioeconomic status (OR 1.9, 95% CI 1.1, 3.2), other prognostic factors associated with SGA were lifestyle factors such as low maternal sleep duration (OR 5.1, CI 3.6, 7.4) and monthly or less frequent meat intake (OR 5.0, CI 3.2, 7.8). Besides smoking (OR 8.8, CI 2.1, 36.3), the other major environmental factor associated with SGA was exposure to household air pollution (OR 5.4, 4.1, 6.9) during pregnancy. Similarly, some of the adverse health conditions associated with a significantly higher risk of SGA were anemia, oligohydramnios, and gestational diabetes. CONCLUSIONS: SGA is common in Western Nepal and associated with several modifiable prognostic factors.

Clinical predictors of radiological pneumonia: A cross-sectional study from a tertiary hospital in Nepal.

BACKGROUND: Despite readily availability of vaccines against both Hemophilus influenzae and Pneumococcus, pneumonia remains the most common cause of morbidity and mortality in children under the age of five years in Nepal. With growing antibiotic resistance and a general move towards more rational antibiotic use, early identification of clinical signs for the prediction of radiological pneumonia would help practitioners to start the treatment of patients. The main aim of this study was to reassess the clinical predictors of pneumonia in Nepal. METHODS: This cross-sectional study was conducted between June 2015 and November 2015 at Tribhuvan University Teaching Hospital, a tertiary hospital in Kathmandu, Nepal. Children aged 3-60 months with a clinical diagnosis of pneumonia by a physician were enrolled in the study. Radiological pneumonia was identified and categorized as per World Health Organization guidelines by an experienced radiologist blinded to patient characteristics. We calculated sensitivity and specificity of clinical signs and symptoms for radiological pneumonia. RESULTS: Out of 1021 children with fever, 160 cases were clinically diagnosed as pneumonia and were enrolled for this study. Among the enrolled patients, 61% had radiological pneumonia. Tachypnea had the highest sensitivity of 99%, while bronchial breathing had the highest specificity of 100%. During univariate analysis, grunting, wheezing, nasal discharge, decreased breath sounds, noisy breathing and hypoxemia were associated with radiological pneumonia. Only hypoxemia remained an independent predictor when adjusted for all the factors. CONCLUSION: Tachypnea was the most sensitive sign, whereas bronchial breathing was most specific sign for radiological pneumonia.

Clinical profile, complications and outcome of scrub typhus in children: A hospital based observational study in central Nepal.

BACKGROUND: Scrub typhus, an important cause of unexplained fever, is grossly neglected and often misdiagnosed in low and middle income countries like Nepal. The main aim of this study was to report on the clinical profile and complications of scrub typhus and its outcome in Nepalese children. METHODS: A prospective observational study was carried out in children aged 1-16 years, admitted to a tertiary care hospital of central Nepal in between July 2016- Aug 2017. Scrub typhus was diagnosed with IgM ELISA. RESULTS: All cases of scrub typhus (n = 76) presented with fever and commonly had other symptoms such as headache (75%), myalgia (68.4%), vomiting (64.5%), nausea (59.2%), abdominal pain (57.9%), cough (35.5%), shortness of breath (22.4%), altered sensorium (14.5%), rashes (13.2%) and seizures (11.8%). Important clinical signs noticed were lymphadenopathy (60.5%), hepatomegaly (47.4%), edema (26.3%), jaundice (26.3%), and splenomegaly (15.8%). About 12% (n = 9) had necrotic eschar. Similarly, thrombocytopenia, raised liver enzymes and raised creatinine values were seen in 36.9%, 34.2% and 65.8% respectively. The most common complications were myocarditis (72.4%), hypoalbuminemia (71.1%), severe thrombocytopenia (22.4%), renal impairment (65.8%), hyponatremia (48.7%) and hepatitis (34.2%). Over two-thirds (69.70%) of the cases were treated with doxycycline followed by combination with azithromycin in the remaining 18.4%. Overall, mortality rate in this group was 3.9%. CONCLUSIONS: Scrub typhus should be considered as a differential in any community acquired acute undifferentiated febrile illness regardless of the presence of an eschar. Myocarditis and acute kidney injury are important complications which when addressed early can prevent mortality. Use of doxycycline showed a favorable outcome.

Applied Research in Low-Income Countries: Why and How?

Research and development (R&D) offer promising clues to address a wide range of socioeconomic problems through the development of new products and services or often by improving the existing ones. High-income countries (HICs) have realized the worth of R&D and invested tremendously in that sector; however, resource-poor low-income countries (LICs) are still far behind in realizing the potential benefit that R&D could offer for economic growth and national development. Even if some LICs have a positive outlook towards the R&D sector, the trend of emulating works from HICs to solve local or regional issues have most often yielded counterproductive results. LICs are suggested primarily to focus on applied research by incorporating their socioeconomic and cultural aspects to solve their everyday problems whose investigation is often ignored in research-intensive nations. Moreover, applied research in LICs offers the potential to provide low-cost and innovative solutions to local and regional problems with global implications.

Clinico-radiological Observations in Meconium Aspiration Syndrome.

INTRODUCTION: To understand and report the prevalence of meconium aspiration syndrome and the clinico-radiological features in a tertiary care hospital of western Nepal. METHODS: An observational study carried out for a year in 2014-15 in all babies with MAS. Clinical and radiological profiles of MAS in relation to gender, gestational age, mode of delivery, birth weight, Apgar score, thickness of meconium, age at admission and the immediate outcome were studied. RESULTS: Out of 584 admitted newborns (male=389; female=186) during the study period, 78 (13.4%) had meconium aspiration syndrome with male: female ratio of 1.2:1. Majority of babies admitted to NICU had thick meconium [n=52 (66.7%)]. There was no statistical significant difference in various parameters such as Apgar score at 1 and 5 minutes, respiratory distress, birth asphyxia, duration of oxygen use, MAS severity and chest x-ray in those with thick MAS compared to thin. Among all newborns with MAS, 59% (n=46) had abnormal radiological findings with over two-folds in those with thick MAS (71.7%)] compared to thin (28%). Hyperinflation (47.8%), diffuse patchy infiltration (37%), consolidation (21.7%) collapse (8.7%), right lung fissure (6.5%) and pneumothorax (8.7%) were the abnormal radiological findings seen in MAS babies. The odds of having APGAR score at 1 minute at least 7 or more was twice unlikely in those having thick meconium compared to thin (P=0.02) Conclusions: Thick meconium is relatively common with more significant abnormal radiological findings and low Apgar score.

Understanding and optimization of the flocculation process in biological wastewater treatment processes: A review.

In the operation of biological wastewater treatment processes, fast sludge settling during liquid-solids disengagement is preferred as it affects effluent quality, treatment efficiency and plant operation economy. An important property of fast settling biological sludge is the ability to spontaneously form big and dense flocs (flocculation) that readily separates from water. Therefore, there had been much research to study the conditions that promote biological sludge flocculation. However, reported findings have often been inconsistent and this has possibly been due to the complex nature of the biological flocculation process. Thus, it has been challenging for wastewater treatment plant operators to extract practical information from the literature. The aim of this review is to summarize the current state of understanding of the factors that affect sludge flocculation so that evaluation of such information can be facilitated and strategize for intervention in the sludge flocculation and deflocculation process.

Neurocysticercosis in Children with Seizures: A Cross-Sectional Study.

BACKGROUND: Neurocysticercosis (NCC), a common cause of seizures in children from low and middle income countries (LMICs), if not diagnosed and treated early enough may lead to considerable morbidity and mortality. There is a lack of data on the prevalence of NCC and its clinical characteristics among those with seizure in South-Western Nepal. AIMS AND OBJECTIVES: To study the prevalence and clinical characteristics of NCC in children with seizures. MATERIAL AND METHODS: All children admitted to Universal College of Medical Sciences, a tertiary hospital in South-Western Nepal with seizures during 2014-16, were tested for NCC. NCC was diagnosed by neuroimaging [computerized tomography (CT) scan or magnetic resonance imaging (MRI)]. We used logistic regression to test the association between NCC with participants' characteristics and clinical symptoms. RESULTS: Among 4962 in-patient children, 168 (104 boys and 64 girls) had seizures (138 with generalized tonic clonic seizures (GTCS) and 30 with focal seizures). 43% of children with seizures had CT scan confirmed NCC. The prevalence of NCC in the oldest children (13-16 years) was significantly greater (57.1% versus 15.6%) compared to the youngest (0-4 years) one (p < 0.001). Among 72 children with NCC, the proportions of children with vesicular, calcified, and colloidal stages were 76% (n = 35), 18% (n = 13), and 6% (n = 2), respectively. Children with focal seizures had 13% more NCC compared to those with GTCS but the result was statistically not significant. The adjusted odds of having NCC among 5-8 years, 9-12 years, and 13-16 years children were 6.6 (1.78-24.60), 11.06 (2.74-44.60), and 14.47 (3.13-66.96), respectively, compared to 0-4-year-old children. Reoccurrence of seizures within the first 3 months of taking antiepileptic drug in those with NCC was approximately 3 times higher compared to those without NCC (11% versus 4%, p = 0.084). CONCLUSIONS: This study shows that NCC contributes significantly to higher prevalence of seizures in children in South-Western region of Nepal.

Factors Affecting the Place of Delivery among Mothers Residing in Jhorahat VDC, Morang, Nepal.

BACKGROUND: In Nepal, the maternal mortality ratio is 281 per thousand live births, among which 40% mortality occurs during home delivery. Home delivery increases the risk of maternal and neonatal mortality and morbidity due to the birth not assisted by skilled attendant. This study was carried out to determine the factors affecting the place of delivery among the mothers residing in Jhorahat VDC, Morang district, Nepal. METHODS: A mixed method study using interviews based on semi-structured questionnaire (n=93) among mothers and two focus group discussion among decision makers of the house and female community health volunteers was conducted between November to December 2012. For quantitative data, Chi-square test and Fischer's Exact test were used to examine the association between the selected variables and place of delivery. RESULTS: More than half (58.1%) of the mothers had institutional delivery and 41.9% of them had home delivery. The most common reason for home delivery was easy and convenient environment (66.7%) and that for institutional delivery was safety (77.8%). There was a significant association between caste, education of mothers, education of spouse, occupation of spouse, per capita income, time to reach the nearest health center, parity, previous place of delivery, number of antenatal visit, knowledge about place of delivery, planned place of delivery, and place of delivery. CONCLUSION: Maternal health services, such as prenatal care, skilled assistance during delivery and post-natal care, along with adequately equipped health institutions, play a major role in the reduction of maternal morbidity and mortality. Concerted efforts should be made both at community and government levels to increase institutional delivery.

Gestational Age Specific Postnatal Growth Curves for Singleton Babies in A Tertiary Hospital of Western Nepal.

INTRODUCTION: Measurement of birth weight, crown-heel length, head circumference and chest circumference used to assess the intrauterine growth of a baby vary with altitude, race, gender, socioeconomic status, maternal size, and maternal diseases. The study aimed to construct centile charts for birth weight, crown-heel length and head circumference for new born at different gestational ages in Western Nepal. METHODS: This was a descriptive cross-sectional study done over a period of 15 months in a tertiary care hospital of Western Nepal. Birth weight, length, head circumference and chest circumference were measured within 12-24 hours of birth. Gestational age was estimated from the first day of last menstrual period and New Ballard's scoring system. Microsoft 2007 Excel and SPSS-16 was used for data analysis. Cole's Lambda Mu Sigma method was used for constructing centile curves. RESULTS: Out of 2000 babies analysed, 1910 samples were used to construct smoothed intrauterine growth curve of birth weight, crown-heel length, and head circumference from 33-42 weeks of gestation. Among all, 1147 (57.35%) were male and 853 (42.65%) were female, mean gestational age was 38.13±2.44 weeks. The means of birth weight, crown-heel length, head and chest circumference were 2744.78 gm, 47.80 cm, 33.18 cm, and 30.20 cm with standard deviations of 528.29, 3.124, 1.78, and 2.35 respectively. CONCLUSIONS: This necessitates the update in the existing growth charts and development in different geographical regions of a country.

Clinicodemographic Profile of Children with Seizures in a Tertiary Care Hospital: A Cross-Sectional Observational Study.

Seizures are one of the common causes for hospital admissions in children with significant mortality and morbidity. This study was conducted to study the prevalence and clinicodemographic profile of children with seizures in a tertiary care hospital of western Nepal. This prospective cross-sectional study conducted over a period of 2 years included all admitted children (2 months-16 years) with seizures. Among 4962 admitted children, seizures were present in 3.4% (n = 168) of children, with male preponderance. 138 (82.1%) children had generalized tonic-clonic seizures (GTCS) and 30 (17.9%) children had partial seizures. GTCS were more common than partial seizures in both sexes (male = 82.7%; female = 81.2%) and age groups. There was no statistical significance in the distribution of seizures (GTCS and partial seizures) with sexes (P = 0.813) and age groups (P = 0.955). Mean ages of children having GTCS and partial seizures were 8.2 ± 4.6 years and 8.2 ± 4.2 years, respectively. Loss of consciousness (55.4%), fever (39.9%), vomiting (35.1%), and headache (16.1%) were common complaints in seizure patients. Significant number of GTCS cases had fever (P = 0.041) and neurocysticercosis (n = 72; 43%) was the most common etiology in seizure patients. Idiopathic epilepsy (38 (22.6%)), meningoencephalitis (26 (15.5%)), and febrile convulsions (14 (8.33%)) were other leading disorders in children with seizures.

Pattern of Pediatric Dermatoses in a Tertiary Care Hospital of Western Nepal.

Pediatric dermatoses are one of the most common presentations in a dermatology clinic and reflect the health and hygiene status of children. The incidence and severity of these skin lesions are influenced by geographical area, seasonal and cultural factors, and socioeconomic status. This study was done to show the prevalence of different pediatric dermatoses in a tertiary care hospital of Western Nepal. Chart reviews of children aged one day to 17 years, presenting to Universal Medical College Teaching Hospital, Nepal, from 1 September 2014 to 30 august 2015, were done. Descriptive analysis and two-sided chi-square test were done. Among 23992 patients visiting the dermatology outpatient department (OPD), 5398 (22.5%) were of pediatric age groups (male/female: 1.2/1); most of them belonged to young teens and teenagers (n = 3308; 61.3%). Three most common dermatoses were fungal infections (18.5%), eczema (14.4%), and acne (10.1%). Fungal infections (n = 653; 65.4%) and acne (n = 284; 51.9%) were common in males, whereas eczema (n = 402; 51.7%) was more common in females. Fungal infection (P < 0.001), eczema (P < 0.001), pigmentation disorders (P < 0.001), and acne (P < 0.01) were significantly more during summer, while scabies was more in winter (P < 0.001). Dermatophytosis, pyoderma, and warts comprised frequently occurring fungal, bacterial, and viral infections, respectively.