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Introduction: The COVID-19 pandemic has affected the entire world, physically, psychologically and socio-economically. It has caused extreme mental stress to not only those infected but also those who had to remain indoors for prolonged period due to lockdown. Aims and Objectives: 1. To study and compare all confirmed suicidal deaths in the first lockdown period upto its peak period (September 2020) with suicidal cases during the previous six months from October 2019 to 24th march 2020. 2. Demographic analysis of suicidal cases with determinants like incidence, sex, & age wise distribution, mode of suicide, any specific causes etc, will be studied & evaluated for any perceptible change from earlier prelockdwn suicidal deaths Materials and Methods: It is retrospective, record review analytical and comparative study based on postmortem examination reports of all cases conducted by all doctors of department of FMT, Nalanda Medical College, Patna who did autopsy during both periods (pre lockdown & post lockdown/unlock) together with study of all police inquests, requisitions (challans), sent by the police investigating officers of concerned cases. Study period- a) 25th march 2020 to September 2020 (lockdown phase). b) October 2019 to 24th march 2020 (Prelockdown phase). Results: Total number of suicides increase from 6.61%in pre-covid period to 8.56% in lockdown period. In the prelockdown phase the cases of hanging were 66.66% but due to poisoning 33.34%. But in the lockdown phase hanging accounted for the 95.45% and poisoning just 4.55%. Conclusions: Lockdown must be needed based, preplanned and financial support to the needy together with behavioural counseling should be undertaken in letter and spirit. There is an urgency to realize the severity of this suicidal tendency.

Introduction: Burns are medicolegally importance as they are commonest cause of unnatural death in India. Burn is an important factor in suicide and homicide all over world. Burns remain a significant public health problem in low/middle-income countries, contributing to substantial morbidity and mortality Aims &Objectives: To find out how thermal burn affect incidence, age, habitat, marital status, manner of death and its medico legal consequence. Materials and Methods: This retrospective study was carried out in a tertiary care hospital during 2014 to 2018 to assess the pattern of burn deaths amongst females brought for Medico-legal Autopsy from various police stations of Patna district under F.M.T department of N.M.C, Patna in the State of Bihar. Total 540 female burn cases brought for autopsy were included in study. Results: The highest numbers of victims were in the age group of 21 to 30 years (42.23%). Majority of the cases were from rural areas 75.19% and 81.85% of the victims were married. Mostly manner of death is accidental 57.40%. Majority of the burn victims death of the studied case were Hindu. Conclusion: Married females of productive age group belonging to rural areas are worst affected in burn injuries. Awareness campaigns targeting safety precautions, opportunities for basic health education and a change in mindset of society towards females are necessary to curb this menace of burn injuries. Keywords: Burn, Female, Nature of Death, Bihar.

Background and ObjectivesPurine-rich element-binding protein A (PURA) gene encodes Pur-α, a conserved protein essential for normal postnatal brain development. Recently, a PURA syndrome characterized by intellectual disability, hypotonia, epilepsy, and dysmorphic features was suggested. The aim of this study was to define and expand the phenotypic spectrum of PURA syndrome by collecting data, including EEG, from a large cohort of affected patients.MethodsData on unpublished and published cases were collected through the PURA Syndrome Foundation and the literature. Data on clinical, genetic, neuroimaging, and neurophysiologic features were obtained.ResultsA cohort of 142 patients was included. Characteristics of the PURA syndrome included neonatal hypotonia, feeding difficulties, and respiratory distress. Sixty percent of the patients developed epilepsy with myoclonic, generalized tonic-clonic, focal seizures, and/or epileptic spasms. EEG showed generalized, multifocal, or focal epileptic abnormalities. Lennox-Gastaut was the most common epilepsy syndrome. Drug refractoriness was common: 33.3% achieved seizure freedom. We found 97 pathogenic variants in PURA without any clear genotype-phenotype associations.DiscussionThe PURA syndrome presents with a developmental and epileptic encephalopathy with characteristics recognizable from neonatal age, which should prompt genetic screening. Sixty percent have drug-resistant epilepsy with focal or generalized seizures. We collected more than 90 pathogenic variants without observing overt genotype-phenotype associations.

Prostate cancer is the most common cancer that affects elderly men. The conventional non-imaging screening test for prostate cancer like prostate antigen (PSA) and digital rectal examination (DRE) tests generally lack specificity. Ultrasound is the most commonly available, inexpensive, non-invasive, and radiation-free imaging modality among all the screening imaging modalities available for prostate cancer diagnosis. The precise segmentation of prostate contours in ultrasound images is crucial in applications such as the exact placement of needles during biopsies, computing the prostate gland volume, and to localize the prostate cancer. Moreover, the low-dose-rate (LDR) brachytherapy treatment in which radioactive seeds are implanted in the prostate region requires accurate contouring of the prostate gland in ultrasound images. Therefore, it is very important to segment the prostrate region accurately for the diagnosis and treatment. This paper aims to present the analysis of existing approaches used for the segmentation of prostate in transrectal ultrasound (TRUS) images. In this survey, different segmentation methods used to extract the prostrate using criteria such as mean absolute distance, Hausdorff distance and time are discussed in detail and compared.

Introduction Nepal has pledged to substantially reduce maternal and newborn death by 2030. Improving quality of intrapartum health services will be vital to reduce these deaths. This paper examines quality of delivery and newborn services in health facilities of Nepal. Methods Data were sourced from the Nepal Health Facility Survey 2015, which covered a national representative sample of health facilities. The datasets were analysed to assess service readiness, availability and quality of delivery and newborn care in a sample of 992 health facilities. Results Of the 992 facilities in the sample, 623 provided delivery and newborn care services. Of the 623 facilities offering delivery and newborn care services, 13.3% offered comprehensive emergency obstetric care (CEmONC), 19.6% provided basic emergency obstetric care (BEmONC) and 53.9% provided basic delivery and newborn service. The availability of essential equipment for delivery and newborn care was more than 80% in health facilities. Except for the coverage of vitamin K injection, the coverage of immediate newborn care was more than 85% in all health facilities. The coverage of use of chlorhexidine ointment to all newborns was more than 70% in government hospitals and primary health care centers (PHCCs) and only 32.3% in private hospitals. Conclusions These findings show gaps in equipment and drugs, especially in PHCCs and private health facilities. Improving readiness and availability of equipment and drugs in PHCCs and private health facility will help improve the quality of care to further reduce maternal and newborn mortality in Nepal.

The embryonal sarcoma of the liver is an extremely malignant, aggressive and infrequent condition of the liver, predominantly affecting children in the age groups of four to ten. The disease manifests with fever, abdominal pain or mass, nausea and laboratory findings suggestive of liver cell injury. The diagnosis can be made using tumor markers, imaging, immunohistochemistry and histopathology. The multimodal management protocol focuses the use of surgical resection, chemotherapy and radiation to significantly improved survival rates and quality of life in these patients.

Subacute sclerosing panencephalitis (SSPE) is a chronic debilitating condition that occurs in children affected with measles. SSPE is broadly distinguished as typical SSPE, the more rampant form, occurring over a period of years following primary measles infection, while the atypical has a more rapidly progressive course over weeks to months. SSPE can present with cognitive, epileptic, autonomic, pyramidal and ophthalmologic manifestations with scholastic decline being the primary feature. The management of SSPE focuses on improvement of quality of life and prolongation of survival which can be achieved with the use of supportive care modalities and immunomodulators respectively. This is a comprehensive review which discusses several parameters of SSPE such as epidemiology, pathophysiology, clinical presentations, and detailed management protocol for this condition. As part of this review, we also discuss a case of rapidly progressive, fulminant and atypical SSPE in a five-year-old male presenting clinically with myoclonic jerks of lower extremities.

Background There are different models for community-based health insurance (CBHI), and in Nepal, among them, the government and the local communities (co-ops) are responsible for operating the CBHI models that are in practice. Aims The aim of this study is to compare the outcomes in relation to benefit packages, population coverage, inclusiveness, healthcare utilization, and promptness of treatment for the two types of CBHI models in Nepal. Methods This study was an observational and interactive descriptive study using the concurrent mixed approach of data collection, framing, and compilation. Quantitative data were collected from records, and qualitative data were collected from key informants in all 12 CBHI groups. Unstructured questionnaires, observation checklists, and memo notepads were used for data collection. Descriptive statistics and the Mann–Whitney U test were used when appropriate. Ethically, written informed consent was obtained from the respondents who participated in the study, and they were told that they could withdraw from the study anytime. Results The study revealed the following: new enrolment did not increase in either group; however, the healthcare utilization rate did (Government 107% and co-ops 137%), while the benefit packages remained almost same for both groups. Overall, inclusiveness was higher for the government group. For the CBHI co-ops, enrollment among the religious minority and the discount negotiated with the hospitals for treatment were significantly higher, and the promptness in reaching a hospital was significantly faster (p

BackgroundChronic obstructive pulmonary disease accounts for a significant portion of the world’s morbidity and mortality, and disproportionately affects low/middle-income countries. Chronic obstructive pulmonary disease management in low-resource settings is suboptimal with diagnostics, medications and high-quality, evidence-based care largely unavailable or unaffordable for most people. In early 2016, we aimed to improve the quality of chronic obstructive pulmonary disease management at Bayalpata Hospital in rural Achham, Nepal. Given that quality improvement infrastructure is limited in our setting, we also aimed to model the use of an electronic health record system for quality improvement, and to build local quality improvement capacity.DesignUsing international chronic obstructive pulmonary disease guidelines, the quality improvement team designed a locally adapted chronic obstructive pulmonary disease protocol which was subsequently converted into an electronic health record template. Over several Plan-Do-Study-Act cycles, the team rolled out a multifaceted intervention including educational sessions, reminders, as well as audits and feedback.ResultsThe rate of oral corticosteroid prescriptions for acute exacerbations of chronic obstructive pulmonary disease increased from 14% at baseline to >60% by month 7, with the mean monthly rate maintained above this level for the remainder of the initiative. The process measure of chronic obstructive pulmonary disease template completion rate increased from 44% at baseline to >60% by month 2 and remained between 50% and 70% for the remainder of the initiative.ConclusionThis case study demonstrates the feasibility of robust quality improvement programmes in rural settings and the essential role of capacity building in ensuring sustainability. It also highlights how individual quality improvement initiatives can catalyse systems-level improvements, which in turn create a stronger foundation for continuous quality improvement and healthcare system strengthening.

High altitude stress leads to lipid peroxidation and free radical formation which results in cell membrane damage in organs and tissues, and associated mountain diseases. This paper discusses the changes in biochemical parameters and antibody response on feeding glutamate to male albino Sprague Dawley rats under hypoxic stress. Exposure of rats to simulated hypoxia at 7576 m, for 6 h daily for 5 consecutive days, in an animal decompression chamber at 32 +/- 2 degrees C resulted in an increase in plasma malondialdehyde level with a concomitant decrease in blood glutathione (reduced) level. Supplementation of glutamate orally at an optimal dose (27 mg/kg body weight) in male albino rats under hypoxia enhanced glutathione level and decreased malondialdehyde concentration significantly. Glutamate feeding improved total plasma protein and glucose levels under hypoxia. The activities of serum glutamate oxaloacetate transaminase (SGOT) and serum glutamate pyruvate transaminase (SGPT) and the urea level remained elevated on glutamate supplementation under hypoxia. Glutamate supplementation increased the humoral response against sheep red blood cells (antibody titre). These results indicate a possible utility of glutamate in the amelioration of hypoxia-induced oxidative stress.

Background Accurate and prompt diagnosis of HIV and syphilis simultaneously has reinforcing effect on their control program because of their prevalent co-infection. Availability of a simple user-friendly two-pronged and affordable detection tools brings down the cost of health care. They are important in the antenatal clinics, with added opportunity for intervention and prevention of mother to child transmission. In cooperation with rapid test kit manufacturers, SD Bioline, NPHL and NCASC, an evaluation of commercially available HIV/syphilis Duo rapid test kit (SD Bioline) to assess its performance and operational characteristics was done in the present study. Method A prospective laboratory-based cross sectional study was conducted at a large Women’s Hospital. Ten thousand pregnant women, visiting the Hospital for antenatal care or for delivery, were enrolled in study. Tests were performed by the SD Bioline HIV/Syphilis Duo kit as well as national algorithm for HIV and syphilis diagnosis which were considered gold standard. Sensitivity, Specificity, positive predictive value and negative predictive value along with kappa coefficient were calculated for the kit under evaluation. Result The sensitivity, specificity, Negative predictive value and Positive predictive value of the kit for HIV diagnosis were 100 % (95 % CI 83.18–100 %, 99.96–100 %, 83.18–100 %, and 99.96–100 %, respectively). Kappa value was found to be 1.0. Out of total cases, results of 9985 (99.85 %) cases were concordant with National algorithm for syphilis diagnosis. Thirteen (0.13 %) cases were found false positive while two were false negative. The sensitivity of the kit for syphilis diagnosis was found to be 95.45 % (95 % CI 84.86–98.74 %) and specificity was 99.87 % (95 % CI; 99.78–99.92 %). Positive predictive value was 76.36 % (95 % CI; 63.65–85.63 %) and Negative predictive value was 99.89 % (95 % CI; 99.39–99.99 %). Kappa value was found to be 0.85. Conclusion The performance characteristics of SD Bioline HIV/Syphilis duo kit were found almost concordant with the kits being used for HIV and Syphilis diagnosis separately. Its implementation in antenatal clinics/VCTs could be an added opportunity for simultaneous diagnosis of HIV and syphilis.