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Crop raiding and livestock predation are major conservation problems throughout most protected areas in Nepal, including the Khaptad National Park (KNP). However, no information exists on the extent of crop raiding, livestock predation, and animal attacks among villages surrounding KNP. We conducted a survey of 304 households in 30 villages in four districts (Bajhang, Bajura, Doti, and Achham) in the buffer zone of KNP between 24 May and 20 June 2019, using the snowball sampling technique. All households experienced numerous major incidents of crop raiding between April 2017 and May 2019. Major wildlife involved were Wild Boar Sus scrofa, Himalayan Black Bear Ursus thibetanus, Rhesus Macaque Macaca mulatta, Barking Deer Muntiacus vaginalis, Common Leopard Panthera pardus, Golden Jackal Canis aureus, and Porcupine Hystrix spp. Of the 304 households, all had their crops raided over the past two years, 55.5% (n = 169) faced livestock predation, and 2% (n = 6) attacks resulting in death or injury. Over 40% of households reported taking mitigation measures to minimize crop raiding. Common measures such as night guarding, noise making, use of scarecrows, watch dogs, and fencing were practiced. More than half of respondents had negative opinions towards wildlife but they still believed that wildlife should be conserved. There was no or negligible correlation between general opinion of respondents towards wildlife and wildlife conservation with their education, sex, or involvement in natural resources management group. We established baseline information on crop raiding and livestock predation in villages surrounding KNP. Gathered information will be transmitted to relevant authorities to design and implement measures to mitigate such conflicts.

Background: Jaundice is considered as one of the most prevalent and common clinical problems during neonatal period which may require interventional treatment. Transcutaneous bilirubinometry is a simple method for estimating bilirubin levels and diagnosing jaundice in neonates. This study was done to compare transcutaneous bilirubin and total serum bilirubin in jaundiced neonates. Methods: A hospital based prospective cross-sectional study of neonates from Out Patient Department, Emergency Ward, and Neonatal Intensive Care Unit with clinical jaundice was conducted between January 2016 and December 2016, at Kanti Children’s Hospital, Maharajgunj, Nepal. A total of 162 neonates were interviewed using preformed questionnaires. Then the correlation between the transcutaneous bilirubin and plasma bilirubin level was assessed by linear regression analysis. It was then analyzed with the help of SPSS Version 20. p-value

The translocon-associated protein (TRAP) complex resides in the endoplasmic reticulum (ER) membrane and interacts with the Sec translocon and the ribosome to facilitate biogenesis of secretory and membrane proteins. TRAP plays a key role in the secretion of many hormones, including insulin. Here we reveal the molecular architecture of the mammalian TRAP complex and how it engages the translating ribosome associated with Sec61 translocon on the ER membrane. The TRAP complex is anchored to the ribosome via a long tether and its position is further stabilized by a finger-like loop. This positions a cradle-like lumenal domain of TRAP below the translocon for interactions with translocated nascent chains. Our structure-guided TRAP mutations in Caenorhabditis elegans lead to growth deficits associated with increased ER stress and defects in protein hormone secretion. These findings elucidate the molecular basis of the TRAP complex in the biogenesis and translocation of proteins at the ER., Nature Structural & Molecular Biology, 30 (6), ISSN:1545-9993, ISSN:1545-9985

Sirenomelia (mermaid syndrome) is a rare congenital fetal anomaly with characteristic feature of complete or partial fusion of lower limbs. Additional malformations are genitourinary abnormalities, gastrointestinal abnormalities, anomalies of the lumbosacral spine and pelvis and absence or poor development (agenesis) of one or both kidneys. It has incidence of 0.98 to 4.2 per 100,000 live births. Since antenatal diagnosis of this universally lethal condition is possible, pregnancy can be terminated at the earliest.We report a case of sirenomelia baby born to a twenty one years old female at 41 weeks of gestation at Karnali Academy of Health Sciences, Jumla Nepal.

Background Acute rhinosinusitis (ARS) refers to a group of disorders characterized by inflammation of the respiratory epithelium of the nose and paranasal sinuses lasting from 7 to 28 days. In the treatment of ARS in addition to an antibiotic, intranasal corticosteroids hasten the clearance of bacteria, decrease the frequency and severity of disease recurrence, and reduce the duration of infection. The purpose is to compare the efficacy of the combination of mometasone furoate nasal spray (MFNS) with amoxicillin and amoxicillin alone in the treatment of acute rhinosinusitis. A total of 120 patients (≥ 12 years) were randomized into 2 groups: group A (N: 60) receiving amoxicillin 500 mg thrice daily alone and group B (N: 60) receiving amoxicillin 500 mg thrice daily and MFNS 200 μg twice daily for 7 days. Patients were followed up after 7 days. The Sino-Nasal Outcome Test-22 (SNOT-22) questionnaire was taken before and after. The total score of SNOT-22 was compared between the groups. Results There was a reduction in the mean total SNOT score in both groups from 21.32 ± 11.29 to 9.37 ± 6.55 in group A and from 26.68 ± 11.97 to 3.07 ± 3.46 in group B which were statistically significant (p < 0.001) in both groups. The posttreatment mean score with the amoxicillin group was 9.31 ± 6.55 and that of the amoxicillin and mometasone furoate group was 3.07 ± 3.46, and their mean difference was 6.3 ± 0.95. In comparison, MFNS with amoxicillin was significantly (p < 0.001) superior than amoxicillin alone. Conclusion Patients receiving amoxicillin alone or amoxillin with MFNS, both showed improvement of symptoms in ARS. However, amoxicillin with MFNS showed significantly higher improvement and relief of symptoms in ARS than amoxicillin alone.

Indian pangolin is distributed throughout South Asia, from eastern Pakistan to much of India, south of the Himalayas, southern Nepal, Bangladesh, and Sri Lanka. It is classified as an Endangered (EN) species, listed under Appendix I of the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES). Although its population is declining at an alarming rate there seems to be little information available on this species across its range. This has created a knowledge gap for sustainable management and conservation of the species. For effective planning, it is necessary to study the trends in research of the species and monitor these gaps to realign research focus on current conservation needs. We systematically reviewed all the published English literature on Indian pangolin between 1980 and 2020 to synthesize range-wide current state of knowledge on this species. Internet-based searches in Google Scholar produced 3320 results. After a set of selection processes, 64 literature were assessed. During the 1980–2020 time period, 31 journals published articles on Indian pangolins. The maximum number of the study was conducted in 2020 (n=10). Among the range countries, most literature was based on India (n=24), whereas the least was on Nepal (n=1). Studies on the Indian pangolin were mostly focused on the theme ecology (48%, n=31). More than 63% of the research (n=40) was based on primary sources of information or empirical studies. We recorded a total of 12 distinct methods used to study Indian pangolin where community interview (n=19) was the most often utilized approach. We investigated the trend and spatial distribution of Indian pangolin research, identified research gaps, assessed methods employed in Indian pangolin research and provided conservation recommendations. We expect that findings from our study will help to fill in gaps on Indian pangolins and be useful in their conservation.

Background: Adolescent pregnancy is a multifactorial social and global health problem, es­pecially in remote, rural setting in low-middle-income countries. This study was conducted to determine the perinatal outcome of adolescent pregnancy of this region. Methods: A retrospective study was conducted in Karnali Academy of Health Sciences (KAHS), Jumla among nulliparous pregnant adolescent women aged 15 to 19 years (n=363) and those aged 20 to 24 years (n=445) who delivered in this hospital from April 2017 to April 2020 AD. Maternal and perinatal characteristics were compared between these groups. The categorical data between adolescent and adult women were compared. Chi-square test, Odds ratio and 95% confidence interval were examined using SPSS version 16. Results: During the study period, the incidence of adolescent pregnancy was 22%. The adolescent mothers had significantly higher incidence of anemia (p=0.005, OR:2.7; 95% CI:1.34-5.78), abnor­mal fetal presentation (p=0.006, OR:3.1; 95%CI:1.38-7.31) and preterm deliveries (p value

We conducted a detailed study in comparing physico-chemical parameters of glacier melt water between two years (2016 & 2019) in upstream sites with an elevation ranging from 4100 m to 3550 m above sea level of Ponkar glacier, Manang district, Nepal. We conducted onsite testing of physical parameter like pH, electrical conductivity, total dissolved solids, turbidity by using multiprobes and chemical parameters like anions, cations, total silica and heavy metals were analyzed following standard methods from APHA, AWWA, WEF (2012). The mean concentration of total silica was found to be higher in upstream sites than downstream. The elemental ratio Ca/Si was found to be higher in glacial melt water with low elemental values for K/Na, Na/Cl and K/Cl. The average concentration of parameters like electrical conductivity, turbidity, total hardness in glacier melt water was recorded to be higher in year 2019 than 2016. The mean concentration of anions and heavy metal was recorded to be higher in year 2016 than 2019. This study has provided a baseline information in comparing physico-chemical parameters in glacial melt water of Ponkar glacier and will be helpful in mitigating adverse impacts of climate change in Nepal’s glacier.

The Chinese Pangolin (Manis pentadactyla) is a “Critically Endangered” insectivorous mammal. There is a lack of information on the ecology, distribution and behavior of this species in Nepal, even though community forests in the Midhills Region of Nepal are considered to be prime habitats for the species. We conducted an ecological assessment of the habitat use of this species in nine community forests covering an area of 170.69 ha in Balthali village in Kavrepalanchok district, Nepal. We divided each forest into 50 × 50 m grids and searched for Chinese Pangolin burrows along 50 m transects in each grid. We categorized burrows into two types, new and old burrows, and recorded 10 environmental variables for each burrow. We found a total of 542 burrows, including 323 old burrows and 219 new burrows. The average width and height of a burrow opening was 21.66 ± 3.94 cm (n = 542) and 22.42 ± 5.02 cm (n = 542). The total density of burrows in the study area was 3.1 ha−1, with new burrows density of 1.2 ha−1 and old burrows density of 1.8 ha−1. We found most burrows in sites with an elevation range of 1400 - 1500 m above sea level, gentle slopes, brown colored soil, high density of tree crown cover and undergrowth vegetation, southern exposure, within 150 m from a water source and less than 200 m from a human settlement. Our study has generated baseline data on the habitat use of Chinese Pangolin, which we hope will help in designing site-specific action plans for Chinese Pangolin conservation in Kavrepalanchok district, Nepal.

Introduction: COVID-19 has spread all around the world with huge toll of human lives and suffering since it evolved in China. Nepal had slow rise in morbidity due to COVID 19 in early days but has been gripped by the pandemic's exponential growth lately. This study was conducted with the aim to describe the clinical and epidemiological features of Nepali children in early phase of the pandemic. Methods: This was an observational study conducted at 11 COVID care centres designated by the Government of Nepal with availability of supervision by paediatricians between January and August 2020 in children under 18 years of age diagnosed with COVID 19. Data was collected based on definitions outlined in data collection resources available at WHO-ISARIC Global COVID-19 clinical resources platform and analysed. Results: One hundred and twenty one children diagnosed with COVID 19 who presented to the designated centres were enrolled. Majority of children (83.4%) were identified as a part of contact tracing, 28.1% had an identified contact to a person with COVID 19 prior to their diagnosis and 20.7% had another household member diagnosed with COVID 19. The mean age of admitted children was 8.8 years (SD 5.6 years) with the largest proportion being adolescents (40.5%). Male (58.7%) children were more commonly affected. There were 15 (12.4%) infants and 8 (6%) of them were under two months of age. Most children (87, 71.9%) were asymptomatic, 21 (22.3%) had mild symptoms and six (4.9%) had moderately severe symptoms. Fever (18.2%) was the most commonly reported symptom. All children were discharged after a median of 14 days of hospitalisation. Conclusions: Nepali children of all ages are affected by COVID 19 and present with asymptomatic or mildly symptomatic infection. Fever and respiratory symptoms are the most commonly reported symptoms. Most children do not develop complications. Continued surveillance in larger population of children as the pandemic unfolds will generate more stringent observations.

Organizations design sustainability framework to proactively assess and manage risks, make financial decisions, and to generate positive environmental and social impact. Empirical research in developed markets show that sustainable practices enable organizations to manage global risks such as COVID-19 and perform better than competitors. This paper explains how sustainable integrated approaches can enable organizations in emerging markets to have a robust model to overcome and flourish after times of crisis, by looking at a case study in Nepal.

Chinese Pangolins (Manis pentadactyla) are Critically Endangered and one of the most illegally traded mammals globally. We generated first COI sequences from five individuals of this species from N...

Foreign body ingestion should be considered as an important differential in a child with difficult asthma. We report an 11‐year‐old male child with foreign body aspiration who initially was diagnosed and treated as difficult asthma. Later on, he was diagnosed to have a foreign body in the right bronchus, which was successfully removed by flexible bronchoscopy.

There are two species of pangolins –Chinese (Manis pentadactyla) and Indian (M. crassicaudata) – in Nepal. Despite being one of the most illegally traded group of mammals in the world, there is scant information on pangolin trade in Nepal. We synthesized nation-wide information on pangolin seizures for 2015–2020 period to elucidate extent and network of illegal pangolin trade in Nepal. We recorded a total of 56 pangolin seizures in Nepal in 2015–2020 period. Pangolin scales were confiscated in all 56 seizures totaling to 154.12 kg along with confiscation of live and dead pangolins, and whole pangolin hide in some seizures. That amount of scales would have fetched up to $19,922 in local market and the price could reach up to $116,993 in an international black market. At least 209 pangolins could have been killed and illegally traded in Nepal between 2015 and 2020. Pangolin trade is widespread throughout Nepal with seizures recorded from almost a quarter of all 77 districts and almost third of 61 districts where pangolins are found. Most seizures occurred in country’s capital Kathmandu (n = 29). Additionally, we identified districts adjoining Kathmandu, and districts bordering Nepal-China and Nepal-India as major routes and points in pangolin trade network. A total of 95 people were involved in pangolin poaching that included local residents from 26 districts in Nepal. The pool of convicts was dominated by males and Nepali nationals between 20 and 30 years old. Most major ethnic groups in Nepal were involved in pangolin trade with the highest involvement of people from the Tamang ethnicity (36%). Presence of pangolins is reported from all 18 districts from where seizures were recorded and 26 districts from where convicts originated suggesting active involvement of locals in pangolin poaching and trafficking. We have generated baseline information on illegal pangolin trade in Nepal for 2015–2020. We expect that this information will be helpful to law enforcement agencies to curb existing pangolin trade in Nepal.

This manuscript focuses on the Belt and Road Initiative (BRI) of China, whereby the focus is on the engagement of big data analytics to comprehend logistics exertion. China is the trendsetter for revolutionary practices in trade, logistics, and technology. The recent progress the nation is thriving is on ‘One Belt One Road’ project whereby 65 countries are involved. It aims to connect continents and circulate smooth trade between them. This paper addresses the role of the database to identify the inter-model logistics in BRI. The merits of this project in the perspective of economic growth are measured through a quantitative study with 112 samples. Goal-setting theory is used to construct a conceptual framework for the research. Multivariate analysis is executed with SmartPLS 3.3.3 followed by an in-depth structural equation modeling. Normal distribution of data was given importance as in statistics the real-value of random variables whose distributions are not known, thus Gaussian distribution of data was used. Out of 6 Hypotheses, it is noted that five are significantly positive. Hypothesis testing is concluded based on p-value and t-statistics. The outcome of research suggests that big-data analytics is a major contributor in determining the significant model on logistics in Belt and Road Initiative.

Alzheimer's disease is a neurological disorder in which the death of brain cells causes memory loss and cognitive decline. The role of treatment is not limited to pharmacology, but also involves many factors, such as the psychological, social, and economic aspects of the patient and family. It is important to consider the use of AChe inhibitors in patients with mild to moderate AD, despite cost issues and in the absence of any other immediate progression. Although there are allots of currently available inhibitor for acetyl cholinesterase but there is no selective potent inhibitor for AD. so, there is an urgent need discover of compounds that are active against Acetyl cholinesterase, along with there is need of molecular modeling for identifying functional groups that may be important for inhibiting Acetyl cholinesterase activity.

Herpes zoster generally occurs after the exposure of VZV following varicella. This case report emphasizes a rare case of HZ in an infant without prior history of varicella or its exposure in the baby, other siblings, and mother during or after the pregnancy.

INTRODUCTION: In outpatient department (OPD) of hospital in low and middle income countries (LMICs), pediatric ear, nose and throat (ENT) disorders are common and huge variation in number is being reported in different seasons. This study aimed to study the prevalence and seasonal effect of ENT disorder in children. MATERIAL AND METHODS: One year (Jan-Dec, 2015) retrospective data of children (0 months-17 years) visiting ENT outpatient (ENT-OPD) department at Universal College of Medical Sciences-Teaching Hospital, Nepal was analysed. Descriptive statistics were calculated to report the prevalence of ENT disorders for various sub-groups including season. In addition to quantifying the prevalence of ENT disorders in children, the seasonal influence of each disorder was analysed. RESULTS: Out of 14,126 patients visiting the ENT-OPD, 3,423 (24.23%) were children. The mean age of children having ENT- disorders were 8.4±5.1, 10.6±4.6 and 10.7±4.7 years respectively with male-female ratio of 1.3:1. During all seasons 2,645 (77.3%) had ear problems, 328 (9.6%) nose disorders and 450 (13.14%) throat disorders. The percentage of children with ear disorders declined significantly with increase in age unlike those with nose and throat disorders (P < 0.001). Seasonal trend analysis showed that children had significantly higher number of ear disorders during summer and autumn seasons (P

Bardet‐Biedl Syndrome (BBS) is a rare autosomal recessive disorder with a wide spectrum of clinical manifestations like retinal dystrophy, obesity, polydactyly, mental retardation, hypogonadism, and renal dysfunction. We report a case of 14‐year‐old obese boy with poor scholastic performances, hypothyroidism, and poor vision diagnosed as BBS.

Introduction: Perinatal mortality rate is a sensitive indicator of the quality of obstetric and pediatric health services. It also helps us to evaluate the efficiency of health care provided by a particular hospital. The aim of this study was to evaluate the cause of perinatal death in a tertiary care medical centre, which may help to reduce the incidence of perinatal death and improve the quality of care. Methods: The two-year retrospective study of perinatal deaths was done at Karnali Academy of Health Sciences (KAHS), Jumla from March 2017 to April 2019. Data was collected from monthly perinatal audit and annual mortality reviews. Registers in the maternity ward, sick Neonate Care Unit, and files of dead newborns kept in the record section of the hospital were studied and reviewed. Results: A total of 1354 deliveries were conducted in the 24 months period at KAHS with a perinatal mortality rate of 36.08 per 1000 total birth and early neonatal death rate of 12.8 per 1000 live birth. The Perinatal mortality was higher in low birth weight and premature baby. The cause of stillbirth and early Neonatal death were identified. Most of the early neonatal death was due to Prematurity (41.17%) followed by Birth Asphyxia and Neonatal Sepsis. Conclusion: Prematurity and its related complication were the most common cause of early neonatal death followed by birth Asphyxia and Neonatal Sepsis. There is a need to improve antenatal, early identification of high-risk pregnancy as well as Neonatal Intensive Care Unit (NICU) to further reduce deaths due to prematurity and birth asphyxia. Keywords: Perinatal Mortality Rate; Early Neonatal Mortality Rate; Rural Areas; Jumla DOI: http://doi.org/10.3126/jkahs.v2i2.25178

Introduction: Nepal is a low socioeconomic country and adolescent pregnancy can have a deleterious effect on the mother, child and the community. The aim of this study was to know the incidence of teenage pregnancy and its outcomes in the mid-western region of Nepal Method: This was a retrospective study conducted in Karnali Academy of Health Science, Jumla, Nepal. Data were collected from the hospital records from October 2017 to September 2018. Result: The incidence of teenage pregnancy was 22.6% among total deliveries. Most of them were Primigravida (84.9%). Majority of them were 18 years of age (47.5%). Caesarean section accounted for 10.8%. In perinatal outcome, the incidence of preterm birth was 15.1%, and extremely low birth weight was 2.2%, very low birth weight was 1.4% and low birth weight was 12.2%. Maternal complication accounted for 33.09%. Conclusion: The study concluded that the incidence of teenage pregnancy is considerably high and it is associated with an increases risk of an adverse outcome to both mother and newborn. Therefore, education and awareness can be helpful in reducing adolescent pregnancy and its adverse outcomes. Keyword: Adolescent pregnancy, teenage pregnancy, Karnali Academy of Health Science, Jumla, Nepal, Intrauterine Fetal Death, World Health Organization (WHO) DOI: http://doi.org/10.3126/jkahs.v2i2.25169

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.

Ossification of laryngeal cartilages usually begins at the age of 20 years in males and at the age of 22 years in females. Ossification in the cricoid cartilage begins from behind to forward. Oesophagus is one of the most common sites for the foreign body. The most common cause of impaction in adults is a meat bolus. A case of 37 years female presented with feeling of pricking sensation in the throat after eating chicken meat which was associated with difficulty in deglutition. X-ray of the neck in antero-posterior view and lateral view was done which showed radio-opaque shadow in front of C6 vertebrae. Rigid oesophagoscopy under general anesthesia was done based on clinical and radiological findings. On rigid oesophagoscopy, foreign body was not seen except minimal injury on the mucosal wall which was 15 cm from the upper incisors. What we can conclude from our case is that, it is always better to confirm a diagnosis of suspected foreign oesophagus with a CT-Scan or Upper GI endoscopy if available to avoid an unnecessary interventions and suffering of patients.

Thyroid hemiagenesis is a very rare congenital abnormality, in which one thyroid lobe fails to grow. Most of the patients are usually associated thyroid disease. The prevalence of thyroid hemiagenesis ranges between 0.05% and 0.2% within the literature. We hereby report a case of 29 years male with left lobe thyroid hemiagenesis with right lobe thyroiditis presented with a feature of hyperthyroidism. Thyroid hemiagenesis can be associated with hyper or hypothyroidism. In our case patient had a feature of hyperthyroidism with dearranged TFT. In our case we detected thyroid hemiagensis incidentally with the help of ultrasonography. Ultrasonography was the investigation that detected thyroid hemiagenesis. Ultrasonography is the most cost-effective means of diagnosing thyroid hemiagenesis. We further performed the thyroid scan to detect any hyperfunctioning thyroid gland or ectopic thyroid. Thyroid scan helped detect thyroiditis in the right thyroid lobe.

Voltage-gated Ca2+ channels play a key role in the regulation of arterial tone and blood pressure. The aim of this study was to determine whether the association of calcium voltage-gated channel subunit alpha1 C (CACNA1C) rs1006737 with essential hypertension (EH) exists in both Chinese Han and ethnic Russian populations of Northeast Asia. We used a case-control study of 2 ethnic groups in the same latitude geographical area to investigate the association between the susceptibility of EH and rs1006737 polymorphism. A total of 1512 EH patients and 1690 controls in Chinese Han people (Heilongjiang Provence, China), 250 EH patients, and 250 controls in ethnic Russian people (Chita, Russia), participated in this study. All participants were genotyped using the TaqMan SNP genotyping assay (Agena Company). Baseline characteristics and the minor allele frequencies of rs1006737 vary substantially among common Chinese Han and ethnic Russian people. Allele A was found to be a risk factor for EH in Chinese Han [(odds ratio) OR 1.705, (confidence interval) 95% CI: 1.332-2.182, P

Chinese Pangolins (Manis pentadactyla) are Critically Endangered and one of the most illegally traded mammals globally. We generated first COI sequences from five individuals of this species from Nepal. BLASTn search of our 600 bp sequences at GenBank showed pair-wise identity between 99.17% and 100% to M. pentadactyla. There were three haplotypes and a total of five variable sites among five M. pentadactyla sequences. Neighbor-joining tree revealed that all M. pentadactyla from Nepal clustered into same group further splitting into two sub-groups albeit with low bootstrap value, suggesting potential multiple geographic origins. The K2P distance was 0.3% within group and 0.7% between four sequences from Bhaktapur and Kavrepalanchok districts (Mape2, Mape3, Mape5 and Mape6) and museum sample (Mape10). This study has generated reference samples for M. pentadactyla from Nepal and will be helpful in understanding dynamics of illegal trade of this species and in successful identification of M. pentadactyla from Nepal even in the absence of intact specimens.

Introduction: Feeding intolerance is common among the preterm neonates and is associated with different co-morbidities like respiratory depression, respiratory distress syndrome, apnea, hyperbilirubinaemia, and hypoxic ischaemic encephalopathy. Aim: To find the incidence of feeding intolerance in preterm neonates from 28-34 weeks of gestation along with the clinical signs and co-morbidities associated with feeding intolerance. Materials and Methods: A prospective observational hospital based study was conducted in Neonatal Intensive Care Unit (NICU) and postnatal ward of Universal College of Medical Sciences, a tertiary care hospital situated in western Nepal for 12 months (June 2018 to May 2019). All admitted preterm neonates between 28-34 weeks of gestation were included in the study and were followed-up for any neonatal morbidities along with feeding intolerance. Feeding intolerance was defined when the newborn had vomiting and/or abdominal distension and/or increased gastric residual volume with normal disruption of feeding process. Babies with feeding intolerance were subjected to final analysis for clinical signs and co-morbidities. Results: Out of 490 admitted preterm babies (28-34 weeks), 54 (11.02%) had feeding intolerance with 33 (61.1%) babies in the very low birth weight group. The mean birth weights of the total enrolled babies (n=490) and feed intolerant (n=54) babies were 1550 gm and 1418 gm, respectively. Different co- morbidities associated with feeding intolerance were respiratory distress (25.9%), respiratory distress syndrome (22.2%), jaundice (16.7%), apnea (5.6%) and necrotising enterocolitis (3.7%). Among the total 37 preterm deaths, four babies were in the feeding intolerance group. Majority of all feed intolerant babies had vomiting 49 (90.7%) followed by gastric residue (57.4%), abdominal distension (55.6%), and reduced or absent bowel sounds (7.4%), respectively. The incidence of feeding intolerance was increased in babies fed with formula feed (p=0.46) and when feeding was started

BackgroundDespite 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.MethodsThis 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.ResultsOut 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.ConclusionTachypnea was the most sensitive sign, whereas bronchial breathing was most specific sign for radiological pneumonia.

DOI: https://doi.org/10.3126/jucms.v6i2.22467 Introduction: Healthy, full term, exclusively breastfed infants are expected to lose weight in the first days following birth. There are conflicting opinions about what constitutes a normal neonatal weight loss. This study was conducted to establish the reference weight loss pattern in exclusively breastfed neonates. Materials and methods: A cross sectional observational study was conducted at a tertiary care hospital of western Nepal for a period of 12 months. All babies delivered were recruited. Newborns with birthweight of > 2500 grams without any congenital anomalies and Apgar score >7/10 were finally included for analysis. Breast feeding was started as soon as possible and all newborns were fed within 6 hours of life. If breast feeding was not possible within first 2 hours of life, expressed breast milk (EBM) or formula feeding was initiated as recommended. Data was analyzed showing distribution and frequency of various parameters like initiation of breastfeeding, weight of babies at different time intervals and weight loss patterns. Results: Out of 1000 babies subjected to analysis, majority were males (n= 517, 51.7%). The average time of initiation of breast feeding was less than 6 hours. The weight loss pattern in babies was 7.1% at 72 hours of life. Conclusion: Breast feeding was initiated as soon as possible in all healthy term neonates. The average weight loss pattern in all term healthy newborns were almost similar. Keywords: Breast feeding, weight loss pattern, initiation of breast feeding

Objectives: Neonatal morbidity and mortality rates reflect efficiency of health services of a country. This study was conducted to identify the clinical profile, pattern of diseases and common causes of mortality and morbidity in neonates admitted to neonatology unit. Methods: The study was conducted in Neonatal Unit of Karnali Academy of Health Sciences, Jumla for a period of one year from 1st May 2017 to 30th April 2018. Data of all admitted patients were reviewed and analyzed in terms of gender, gestational age, age at presentation, weight, cause of admission and their outcome. Diagnosis was made on clinical examination, radiological findings and laboratory investigations. Data were analyzed using SPSS version 20. Results: Out of 153 neonates admitted during the study period, 2 were excluded because of deficient record. Full-term neonates were 122(80.7%) while preterm were 29 (19.3%). Low birth weight (LBW) babies were 32 (21.18%).Neonatal sepsis 91 (60.26%) was the most common cause of hospital admissions followed by meconium aspiration syndrome 21(13.9%) and prematurity 10(6.62%). Out of 151 newborns, 112 babies (74.1%) were discharged after improvement, 15(9.93%) left against medical advice, 13(8.6%) babies were referred to higher centers for intensive care and there were 9 (5.9%) mortalities and 2(1.3%) got absconded. Conclusion: The majority of neonatal morbidity is due to sepsis, prematurity and respiratory causes. All these causes are preventable to some extent and, can be effectively treated in order to reduce morbidity and mortality. Keywords: New Born, Mortality, Admission, Sepsis

Background Earthquakes impact child health in many ways. Diseases occurring immediately following an earthquake have been studied in field based hospitals but studies on the inpatient disease pattern among children without trauma in a permanent hospital setup is lacking. Methods We examined the diagnoses of all children without trauma, admitted to Kanti Children’s Hospital, Kathmandu for fifteen-week duration (from 4th week to end of the 18th week) following the 7.8 magnitude Nepal earthquake on 25th April 2015. The admitted children were grouped based on direct effect of earthquake on their family (house damaged or family member injured or dead) and on whether their place of residence was located in an earthquake affected district. Most common diagnoses were identified and their distribution between the aforementioned groups analyzed to examine differences, if any, in disease occurrence or presentation. The fifteen weeks study duration was divided into three parts of five weeks each, to study trends in illness presentation. Variables were compared among various groups using appropriate statistical tests (p

In many developing world, respiratory problems such as chronic obstructive pulmonary disease (COPD) has been of major concern and is attributed to the indoor air pollution. The aim of this study was to monitor the indoor air quality and assess its health impact on 104 subjects of 35 households of Thame Village Development Committee, Solukhumbu District. It was carried out for nine days in November 2008. In the Kitchen, emission of Carbon monoxide (CO) and Particulate matter (PM) in the size range ≤ 2.5 μm (PM2.5) were monitored as an indicator of indoor air pollution. The instruments used were UCB particulate monitor and HOBO CO meter. Similarly, Spirometer was used to assess the respiratory function. PM2.5, concentration varied between 0.4mg/m3 and 10mg/m3. Maximum concentration of about 10 mg/m3 was observed for traditional cooking stove (TCS) with no chimneys. For the modern or improved cooking stoves ICS) with ventilation from pipes and chimneys, the concentrations were below 0.4mg/m3. Similarly, the average indoor air CO concentration for 8 hours has been found to be between 5 and 30 ppm, depending on different stove types. The highest concentration of about 200 ppm was observed at the time of cooking (ca. 2 hours average) using TCS with chimney only. In addition, health spirometry test was performed on 70 subjects of Thame Village Development Committee (VDC) and 34 subjects of different villages and background. The spirometry test indicated that ca. 14% of the subjects showed mild obstruction whereas ca. 5% showed moderate obstruction. It has to be noted that despite the recent switch to the alternative cleaner energy source from the polluting solid fuels, the long term exposure in the past might show its adverse effect in the old ages.

Curcumin, a natural polyphenolic compound, has commonly been used as a food additive or in many traditional medicine remedies for over 2,000 years in many Asian countries. Melatonin is a hormone secreted from pineal glands of mammals and possesses diverse physiological functions. Both curcumin and melatonin have the effective potential to inhibit proliferation of various types of cancers, but there is no report on their combination for bladder cancer treatment, and the underlying mechanism remains poorly understood. In the present study, we investigated whether the combination of curcumin and melatonin leads to an enhanced inhibition of cell proliferation in bladder cancer cells. Our results showed that the combinational treatment enhanced the repression of nuclear translocation of NF-κB and their binding on COX-2 promoter via inhibiting IKKβ activity, resulting in inhibition of COX-2 expression. In addition, combined treatment with curcumin and melatonin induced cell apoptosis in bladder cancer through enhancing the release of cytochrome c from the mitochondrial intermembrane space into the cytosol. These results, therefore, indicated that melatonin synergized the inhibitory effect of curcumin against the growth of bladder cancer by enhancing the anti-proliferation, anti-migration, and pro-apoptotic activities, and provide strong evidence that combined treatment with curcumin and melatonin might exhibit an effective therapeutic option in bladder cancer therapy.

Background. Low birth weight (LBW) is defined as the birth weight of live born infants below 2500 g, regardless of gestational age. It is a public health problem caused by factors that are potentially modifiable. The purpose of this study was to determine the socioeconomic, obstetric, and maternal factors associated with LBW in Lumbini Provincial Hospital, Nepal. Methods. The study was conducted using case control study design with 1 : 2 case control ratio. A total of 105 cases and 210 controls were taken in this study. Data were entered on Epi data software version 3.1 and exported to Statistical Package for Social Science (SPSS) software version 25 for analysis. Characteristics of the sample were described using mean and standard deviation. Bivariate analysis was done to assess the association between dependent and independent variables. The ultimate measure of association was odds ratio. Variables found to be associated with bivariate analysis were entered into a multivariable logistic regression model to identify predictors of LBW. Results. The mean age of the participants was 25.98 years with ±4.40 standard deviation. Mothers with literate educational background (AOR 0.32, 95% CI 0.13–0.81), housewife (AOR 2.63, 95% CI 1.11–6.20), vaginal mode of delivery (AOR 0.45, 95% CI 0.25–0.82), gestational age Conclusion. Educational and occupational status, mode of delivery, gestational age, maternal weight, and history of LBW were found to be independent predictors of LBW. There is need of developing coordination with education sector for increasing educational status of mothers and adolescent girls. Social determinants of health need to be considered while developing interventional programs. Similarly, interventional programs need to be developed considering identified predictors of low birth weight.

DOI: https://doi.org/10.3126/jkahs.v1i3.24156 A rare phenomenon, natal teeth are observed in infants at birth .The incidence of this anomaly has been approximately 1:1000 to 1:6000 live births. Presence of natal tooth may lead to numerous complications. Natal teeth can interfere with breastfeeding and, if excessively mobile, may be swallowed or aspirated during nursing. In this article, a case report is presented where a natal tooth was present in the mandibular incisor region. Due to the possibility of aspiration because of the presence of mobility and also as the teeth are causing discomfort to the mother during breast feeding, the teeth was extracted under topical anaesthesia and the healing was found to be satisfactory. Keywords: Natal teeth, Neonatal teeth, Complication

BackgroundScrub 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.MethodsA 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.ResultsAll 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%.ConclusionsScrub 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.

Goldenhar syndrome (GS), a rare condition, occurring due to defect in development of first and second branchial arches, is characterized by a combination of various anomalies involving face, eyes, ears, vertebrae, heart, and lungs. The etiology of GS is not fully known, although various hypotheses have been proposed along with its genetic association and many other causes. Facial asymmetry and hypoplasia of the mandible are characteristic features of GS along with microtia and preauricular appendages and pits. Dextrocardia or pulmonary hypoplasia in GS has previously been reported separately. We report a 7-year-old female child of GS with combination of anomalies, dextrocardia, and pulmonary hypoplasia, which is a rare association.

Parthenolide (PTL) is a sesquiterpene lactone compound obtained from Tanacetum parthenium (feverfew) and inhibits the activation of nuclear factor (NF)-κB. Epoxymicheliolide (EMCL) is a compound which is structurally related to PTL; however, EMCL is more stable under acidic and alkaline conditions. As a biologically active molecule, the detailed mechanism by which EMCL inhibits tumor activity remains to be elucidated. The present study evaluated the effect of EMCL on renal cell carcinoma (RCC) cells and identified the underlying mechanisms. It was found that treatment with EMCL significantly inhibited the proliferation of RCC cells in vitro and increased the induction of apoptosis by activating the mitochondria- and caspase-dependent pathway. Simultaneously, EMCL suppressed cell invasion and metastasis by inhibiting epithelial-mesenchymal transition, as observed in a microfluidic chip assay. Furthermore, using immunofluorescence analysis, an electrophoretic mobility shift assay and a dual-luciferase reporter assay, it was shown that treatment with EMCL significantly suppressed the expression of cyclooxygenase-2 by inhibiting the translocation of NF-κB p50/p65 and the activity of NF-κB. Collectively, the results indicated that EMCL suppressed tumor growth by inhibiting the activation of NF-κB and suggested that EMCL may be a novel anticancer agent in the treatment of RCC.

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.

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.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.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.This necessitates the update in the existing growth charts and development in different geographical regions of a country.

Introduction: Measurement of birth weight (BW), crown heel length (CHL), head circumference (HC) and chest circumference used to assess the intrauterine growth of a baby vary with altitude, race, gender, socio economic status, maternal size, and maternal diseases. The study aimed to construct centile charts for BW, CHL and HC 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. BW, length, HC and CC were measured within 12-24 hours of birth. Gestational age was estimated from first day of last menstrual period, maternal ultrasonology 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 BW, CHL, and HC from 33-42 weeks of gestation. 57.35% (1147) were male, mean gestational age was 38.13 ±2.44 weeks, where 21.5% were preterm and 1.7% post term. The means of BW, CHL, HC and CC 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. These data vary as compared to the Kathmandu data, in case of birth weight for 10th and 90th centiles, and at 90th centile in case of length. Conclusions: This necessitates the update in the existing growth charts and develop in different geographical regions of a country.

Not present

Sclerema neonatorum is a form of panniculitides characterized by diffuse hardening of subcutaneous tissue with minimal inflammation. It usually affects ill and preterm neonates. Prognosis is usually poor in many cases despite aggressive management. Various treatment modalities (antibiotics, intravenous immunoglobulin, steroids, and exchange transfusion) have been explained in literature. Steroids due to its easy availability and low cost can prove to be lifesaving in such cases, especially in resource poor countries. Here, we report a case of sclerema neonatorum in a one-week preterm baby treated successfully with parenteral steroids and antibiotics.

Several CC-motif chemokine ligands (CCLs) can block HIV-1-binding sites on CC-motif chemokine receptor 5 (CCR5) and inhibit viral entry. We studied single-nucleotide polymorphisms (SNPs) in genes encoding three CCR5 ligands (CCL3 (MIP-1a), CCL4 (MIP-1b)and CCL5 (RANTES)) along with an adjacent gene encoding a CCR2ligand (CCL2 (MCP-1)) to identify candidate markers for HIV-1 infection and pathogenesis. Analyses of 567 HIV-1 serodiscordant Zambian couples revealed that rs5029410C (in CCL3 intron 2) was associated with lower viral load (VL) in seroconverters, adjusted for gender and age (regression β=-0.57 log(10), P=4x10(-6)). Inaddition, rs34171309A in CCL3 exon 3 was associated with increased risk of HIV-1 acquisition in exposed seronegatives(hazard ratio=1.52, P=0.006 when adjusted for VL of the initially seropositive partner and genital ulcer/inflammation). SNPrs34171309 encodes a conservative Glu-to-Asp substitution. Fiven eighboring SNPs in tight linkage disequilibrium with rs34171309all showed similar associations with HIV-1 acquisition. How these multiple CCL3 SNPs may alter the occurrence or course of HIV-1 infection remains to be determined [corrected].

A laboratory study on the influence of the combination of ultrafine fly ash (UFFA) and silica fume (SF) on the properties of fresh and hardened concrete is described. Also compared are the performance of concrete incorporating UFFA and SF (ternary blend of cement), concrete incorporating UFFA or SF (binary blend of cement), and control portland cement concrete. The test results show that the incorporation of SF or UFFA in concrete resulted in higher strength and improved durability (resistance to chloride penetration). These benefits were found to be more pronounced in the SF concrete. However, the SF concrete demonstrated several limitations such as low slump and high early-age shrinkage. These limitations were not observed in the UFFA concrete; addition of UFFA increased the slump and decreased the early-age shrinkage. To minimize the shortcomings of SF without losing its strength and durability benefits, a concrete mixture incorporating both SF and UFFA was prepared. The test results show that the incorporation of both SF and UFFA produces a concrete mixture that demonstrates high early-age strength and improved durability similar to those properties in SF concrete. In addition, unlike SF concrete, the new concrete mixture demonstrates a higher level of slump and a lower level of free shrinkage.

This paper presents the results of management-oriented research on energy, forest, and human health issues in a remote mountain area, the Sagarmatha National Park and Buffer Zone (SNPBZ), Nepal. The research was based on a broader, integrated participatory framework ultimately intended for use in adaptive management. The present study focused on the application of a participatory modeling framework to address problems related to energy demand and consumption, forest condition, and indoor air pollution, which were defined by the stakeholders as important issues to be addressed. The models were developed using a generalizing design that allows for user-friendly adaptation to other contexts (free download at http://hkkhpartnership.org). Moreover, we simulated management scenarios in collaboration with all modeling actors with the aim of building consensus on the understanding of the system as well as supporting decision-makers' capacity not only to respond to changes, but also to anticipate them. Importantly, the system dynamics assessment found that the SNPBZ forests are affected by an increasing demand for fuelwood (occurring due to tourism growth), as one of the main sources of energy. Selected forests show an average reduction of 38% in forest biomass from 1992 to 2008. This shows that the business-as-usual scenario is unlikely to result in the preservation of the current forest status; in fact, such preservation would require 75% of fuelwood to be replaced with alternative energy sources. At the same time, a 75% reduction of fuelwood use (and an 80% reduction of dung use) would reduce indoor carbon monoxide (CO) concentrations to the standard limits for CO exposure set by the World Health Organization.