Search

High Mountain Asia has long been known as a hotspot for landslide risk, and studies have suggested that landslide hazard is likely to increase in this region over the coming decades. Extreme precipitation may become more frequent, with a nonlinear response relative to increasing global temperatures. However, these changes are geographically varied. This article maps probable changes to landslide hazard, as shown by a landslide hazard indicator (LHI) derived from downscaled precipitation and temperature. In order to capture the nonlinear response of slopes to extreme precipitation, a simple machine‐learning model was trained on a database of landslides across High Mountain Asia to develop a regional LHI. This model was applied to statistically downscaled data from the 30 members of the Seamless System for Prediction and Earth System Research large ensembles to produce a range of possible outcomes under the Shared Socioeconomic Pathways 2‐4.5 and 5‐8.5. The LHI reveals that landslide hazard will increase in most parts of High Mountain Asia. Absolute increases will be highest in already hazardous areas such as the Central Himalaya, but relative change is greatest on the Tibetan Plateau. Even in regions where landslide hazard declines by year 2100, it will increase prior to the mid‐century mark. However, the seasonal cycle of landslide occurrence will not change greatly across High Mountain Asia. Although substantial uncertainty remains in these projections, the overall direction of change seems reliable. These findings highlight the importance of continued analysis to inform disaster risk reduction strategies for stakeholders across High Mountain Asia. Plain Language Summary: Landslides have posed a major risk in the Himalaya and other ranges of High Mountain Asia. Some previous researchers have suggested that the changing climate will make landslides more common, due to more intense rainstorms. We have looked into whether this will happen across a vast swath of Asia that includes the highest mountains and plateaus in the world. Because the future climate depends on human decisions and activities, we mapped these potential changes under two scenarios: development along current lines and development that is heavily dependent on the use of fossil fuels. We found increasing hazard in both cases, but the change is much greater under the latter. Furthermore, we found that the hazard from landslides triggered by rainfall will increase in every major mountain range at some point in the twenty‐first century. This result implies the need for continued vigilance by engineers, planners, and emergency responders across High Mountain Asia. Key Points: New model analyses suggest that landslide hazard will increase in most parts of High Mountain Asia over the coming decadesEven in regions where landslide hazard is projected to decline by end of the century, it will first increase by the middle of the centuryThe landslide season may shift or intensify in some locations, but a major regime change is not expected [ABSTRACT FROM AUTHOR]

The transboundary Arun River Basin (ARB) spreads across Nepal and Tibet. Nearly 95% of the basin lies in Tibet through which the Pumqu River flows, forming the Arun River once it enters Nepal. The ARB has five large hydropower projects undergoing construction or planned for the future. Rainfall and earthquake‐induced landslides, landslide‐dammed lakes and landslide‐induced glacial lake outburst floods pose major risks to smooth operation of these projects. To safeguard upcoming hydropower projects, areas susceptible to landslides in the ARB must be identified. We used high‐resolution satellite imagery and open‐source tools to generate a multitemporal landslide inventory for the basin. The rigorously quality‐controlled inventory represents a yearly record of landslides from 2011 to 2020. A data‐driven approach was used to map areas susceptible to landslides within the ARB. The multitemporal landslide inventory combined with other readily available Earth observation‐based variables was used to create a landslide susceptibility map. The susceptibility analysis provides a valuable initial estimate of where landslides are likely to initiate. These landslide products could form the basis of more comprehensive local studies to inform hydropower project development. [ABSTRACT FROM AUTHOR]

Background Dengue is a leading cause of febrile illness among international travellers. We aimed to describe the epidemiology and clinical characteristics of imported dengue in returning travellers evaluated at GeoSentinel sites from 2007 to 2022. Methods We retrieved GeoSentinel records of dengue among travellers residing in non-endemic countries. We considered dengue confirmed when diagnosed by a positive dengue virus (DENV)–specific reverse-transcriptase polymerase chain reaction, positive NS-1 antigen and/or anti-DENV IgG seroconversion, and probable when diagnosed by single anti-DENV IgM or high-titre anti-DENV IgG detection. Severe dengue was defined as evidence of clinically significant plasma leakage or bleeding, organ failure, or shock, according to the 2009 World Health Organization guidance. Complicated dengue was defined as either severe dengue or dengue with presence of any warning sign. Analyses were descriptive. Results This analysis included 5958 travellers with confirmed (n = 4859; 81.6%) or probable (n = 1099; 18.4%) dengue. The median age was 33 years (range: <1–91); 3007 (50.5%) travellers were female. The median travel duration was 21 days (interquartile range [IQR]: 15–32). The median time between illness onset and GeoSentinel site visit was 7 days (IQR: 4–15). The most frequent reasons for travel were tourism (67.3%), visiting friends or relatives (12.2%) and business (11.0%). The most frequent regions of acquisition were South East Asia (50.4%), South Central Asia (14.9%), the Caribbean (10.9%) and South America (9.2%). Ninety-five (1.6%) travellers had complicated dengue, of whom 27 (0.5%) had severe dengue and one died. Of 2710 travellers with data available, 724 (26.7%) were hospitalized. The largest number of cases (n = 835) was reported in 2019. Conclusions A broad range of international travellers should be aware of the risk of acquiring dengue and receive appropriate pre-travel counselling regarding preventive measures. Prospective cohort studies are needed to further elucidate dengue risk by destination and over time, as well as severe outcomes and prolonged morbidity (long dengue) due to travel-related dengue. [ABSTRACT FROM AUTHOR]

Carotid endarterectomy (CEA) is an established method of stroke prevention in patients with severe carotid artery stenosis, especially in those with symptomatic disease. Complications of CEA include perioperative stroke, cranial nerve palsy, hemorrhage, and vascular dissection. We present an unusual case of a 66-year-old man who presented for elective right CEA for symptomatic 70% right internal carotid artery (ICA) stenosis due to ulcerated plaque. Following surgery, the patient developed fluctuating neurological deficits consistent with involvement of the right middle cerebral artery territory. Imaging revealed possible mild clamp-induced ICA dissection limited to the ICA in the neck. Despite initial successful anticoagulation management in the neurointensive care unit, the patient returned 2 days later with stroke symptoms, necessitating urgent endovascular intervention. Neurovascular interventions involved aspiration thrombectomy and multiple stenting extending distally into intracranial ICA, which successfully restored cerebral arterial perfusion and normal neurological function. This case highlights the first reported instance of extensive intracranial ICA dissection managed with full-length stenting. This article offers an effective endovascular procedure for preventing a devastating stroke from a complication of a procedure that was performed to prevent it. [ABSTRACT FROM AUTHOR]

Objective: This study investigates the effectiveness of extubation from conventional mechanical ventilation using an endotracheal tube (MVET) compared to synchronized non-invasive positive-pressure ventilation (sNIPPV) using neurally adjusted ventilatory assist (NAVA) and conventional non-invasive positive-pressure ventilation (NIPPV) in extremely low-birth-weight (ELBW) infants. Methods: An institutional review board (IRB) approved this study (#12175) to conduct a single-center randomized control trial including 60 ELBW infants assigned in a one-to-one computer-generated scheme to either sNIPPV using NAVA or NIPPV. The primary outcome involved the need for reintubation, and the secondary outcome involved the assessment of moderate/severe BPD, defined as an oxygen requirement at 36 weeks, as in #NCT03613987 (clinicaltrials.gov). Results: There were 60 ELBW infants enrolled and randomized. The overall gestational age was 26 (1.5) weeks, and the birth weight was 773 (157) g [mean (SD)]. There were no statistically significant differences between the NAVA and NIPPV patient characteristics. There was a 41% extubation failure rate in the NIPPV group and 35% in the NAVA group (p = NS). The NAVA group had less moderate and severe BPD (p = 0.03), a shorter oxygen therapy duration (p = 0.002), a decreased length of stay (p = 0.03), and less need for home oxygen (0, 43%; p = 0.0004). Conclusions: This study found similar extubation failure rates among ELBW infants as in prior studies. However, the NAVA group had lower rates of moderate/severe BPD and need for oxygen at discharge, as well as shorter oxygen therapy duration and length of stay. The use of NAVA may be a reasonable alternative mode of non-invasive ventilation in the ELBW population. [ABSTRACT FROM AUTHOR]

This systematic review aims to determine the effectiveness of non-pharmacological interventions for the management of spasticity in people with multiple sclerosis (pwMS). A comprehensive literature search in health science databases (MEDLINE, Embase, CENTRAL, CINHAL) was performed to identify randomized controlled trials (RCTs) (up to April 2024). Manual searching in journals and screening of the reference lists of identified studies were conducted. Two authors independently selected the studies, assessed the methodological quality, and summarized the evidence. A meta-analysis was not feasible due to the methodological, clinical, and statistical diversity of the included studies. Overall, 32 RCTs (n=1,481 participants) investigated various types of non-pharmacological interventions including: physical activity, transcranial magnetic stimulation (intermittent theta burst stimulation [iTBS], repetitive transcranial magnetic stimulation [rTMS]), electromagnetic therapy, transcutaneous electrical nerve stimulation, vibration therapy, shock wave therapy, self-management educational programs, and acupuncture. All studies scored 'low' on the methodological quality assessment, implying a high risk of bias. The findings suggest 'moderate to low certainty' evidence for physical activity programs used in isolation or combination with other interventions (pharmacological or non-pharmacological), and for iTBS/rTMS with or without adjuvant exercise therapy in improving spasticity in adults with MS. There is 'very low certainty' evidence supporting the use of other modalities for treating spasticity in this population. Despite a wide range of non-pharmacological interventions used for the management of spasticity in pwMS, there is a lack of conclusive evidence for many. More robust trials with larger sample sizes and longer-term follow-ups are needed to build evidence for these interventions. [ABSTRACT FROM AUTHOR]

Climate change is one of the major drivers of biodiversity loss. Among vertebrates, amphibians are one of the more sensitive groups to climate change due to their unique ecology, habitat requirements, narrow thermal tolerance and relatively limited dispersal abilities. We projected the influence of climate change on an endemic toad, Malabar Tree Toad (Pedostibes tuberculosus; hereafter MTT) from the Western Ghats biodiversity hotspot, India, for two different shared socio-economic pathways (SSP) using multiple modeling approaches for current and future (2061–2080) scenarios. The data used predominantly comes from a citizen science program, 'Mapping Malabar Tree Toad' which is a part of the Frog Watch citizen science program, India Biodiversity Portal. We also evaluated the availability of suitable habitats for the MTT in Protected Areas (PAs) under the current and future scenarios. Our results show that annual precipitation was the most important bioclimatic variable influencing the distribution of MTT. We used MaxEnt (MEM) and Ensemble (ESM) modeling algorithms. The predicted distribution of MTT with selected environmental layers using MEM was 4556.95 km2 while using ESM was 18,563.76 km2. Overlaying PA boundaries on predicted distribution showed 37 PAs with 32.7% (1491.37 km2) and 44 PAs with 21.9% (4066.25 km2) coverage for MEM and ESM respectively. Among eight future climate scenarios, scenarios with high emissions showed a decreased distribution range from 33.5 to 68.7% of predicted distribution in PAs, while scenarios with low emissions showed an increased distribution range from 1.9 to 111.3% in PAs. PAs from the Central Western Ghats lose most suitable areas with a shift of suitable habitats towards the Southern Western Ghats. This suggests that MTT distribution may be restricted in the future and existing PAs may not be sufficient to conserve their habitats. Restricted and discontinuous distribution along with climate change can limit the dispersal and persistence of MTT populations, thus enhanced surveys of MTT habitats within and outside the PAs of the Western Ghats are an important step in safeguarding the persistence of MTT populations. Overall, our results demonstrate the use of citizen science data and its potential in modeling and understanding the geographic distribution and the calling phenology of an elusive, arboreal, and endemic amphibian species. [ABSTRACT FROM AUTHOR]

On August 11, 2022, FDA granted accelerated approval to fam-trastuzumab deruxtecan-nxki (DS-8201a, T-DXd, ENHERTU, Daiichi Sankyo) for adult patients with unresectable or metastatic non-small cell lung cancer (NSCLC) whose tumors have activating human epidermal growth factor receptor 2 (HER2) mutations, as detected by an FDA-approved test, and who have received a prior systemic therapy. The approval was based on a prespecified interim analysis of DESTINY-Lung02 (Study U206), a multi-center, randomized, dose-optimization trial in patients with NSCLC harboring activating HER2 -mutations. At the approved dose of 5.4 mg/kg given intravenously every 3 weeks, the overall response rate (ORR) was 58% (95% confidence interval [CI]: 43, 71). The median duration of response was 8.7 months (95% CI: 7.1, not estimable). These results were consistent with response rates observed at the 6.4 mg/kg dose level. The most common (≥ 20%) adverse reactions were nausea, constipation, decreased appetite, vomiting, fatigue, and alopecia. The rate of interstitial lung disease (ILD) or pneumonitis was 6% at the 5.4 mg/kg dose level and 14% at the 6.4 mg/kg dose level. In the setting of similar efficacy and reduced toxicity, approval was granted for the 5.4 mg/kg dose level. The applicant conducted a randomized, dose-optimization study with guidance from the FDA Oncology Center of Excellence's Project Optimus. This is the first approval of a targeted therapy for HER2 -mutated NSCLC. [ABSTRACT FROM AUTHOR]

Radiology plays a very important part in the diagnosis, treatment, and follow-up of children. Computed tomography and magnetic resonance imaging are the two most crucial developments in the modern era. However, the two modalities have their challenges to overcome. Radiation dose is the most unwanted side effect of computed tomography scans while longer scan time along with sedation is a major disadvantage in children during magnetic resonance imaging. Paediatric-specific protocol selection and limiting the exposure to the area of interest aid in reducing the dose during computed tomography scans. Faster scan protocols and sequences can result in imaging without sedation in magnetic resonance imaging. Considering the radiation exposure, "as low as reasonably achievable" principle should be followed strictly in the paediatric population. In this article, possible ways for minimising the radiation dose in computed tomography, as well as effective, short, and sedation-free magnetic resonance imaging, are discussed.

Objective: The objective of the study is to evaluate functional outcomes and community reintegration of disaster survivors in Pakistan. Methods: This was a cross-sectional descriptive study of community-based participants at the Armed Forces Institute of Rehabilitation Medicine, Pakistan. The medical records were screened for eligibility of adults with disaster-related disability. Participants were interviewed in ambulatory clinics using validated measures: Neurological-Trauma Impairment Scale (NIS-Trauma), International Classification of Functioning, Disability, and Health-Generic Set, Community Integration Measure (CIM), Community Integration Questionnaire (CIQ), and EuroQol 5-Dimension 5-Level. Results: Participants were (n = 117, mean age = 35 years) with postdisaster injury up to 17 years; the majority had spinal cord injury (n = 62; 53%) and amputations (n = 44; 38%). At assessment, 80% were independent with mobility (with aids) and 29% with everyday living activities. They reported ongoing fatigue (54.7%), altered sensations (51.28%), and pain (50.43%), but fewer problems with mood and emotions. The impairment severity negatively impacted community activities (NIS-Trauma vs. CIQ: P < 0.001). As impairments improved with time (NIS-Trauma vs. time since injury: P = 0.003), so did community reintegration (time since injury vs. CIQ; P < 0.001) and perceived health status (time since injury vs. EuroQol; P = 0.001). Conclusion: Many participants reported various ongoing disability-related issues; however, majority were dependent with everyday living activities and well adapted in the community. Further robust studies are needed for evaluation of longer-term impact of the disability in disaster victims for the comprehensive healthcare in the community.

Abstract Background Fat tail is a unique trait in sheep acquired during domestication. Several genomic analyses have been conducted in sheep breeds from limited geographic origins to identify the genetic factors underlying this trait. Nevertheless, these studies obtained different candidates. The results of these regional studies were easily biased by the breed structures. Results To minimize the bias and distinguish the true candidates, we used an extended data set of 968 sheep representing 18 fat-tailed breeds and 14 thin-tailed breeds from around the world, and integrated two statistical tests to detect selection signatures, including Genetic Fixation Index (F ST ) and difference of derived allele frequency (ΔDAF). The results showed that platelet derived growth factor D (PDGFD) exhibited the highest genetic differentiation between fat- and thin-tailed sheep breeds. Analysis of sequence variation identified that a 6.8-kb region within the first intron of PDGFD is likely the target of positive selection and contains regulatory mutation(s) in fat-tailed sheep. Histological and gene expression analyses demonstrated that PDGFD expression is associated with maturation and hemostasis of adipocytes. Further retrospective analysis of public transcriptomic datasets revealed that PDGFD expression is down-regulated during adipogenesis in both human and mouse, and is higher in fat tissues of obese individuals than that in lean individuals. Conclusions These results reveal that PDGFD is the predominant factor for the fat tail phenotype in sheep by contributing to adiopogenesis and maintaining the hemostasis of mature adipocytes. This study provides insights into the selection of fat-tailed sheep and has important application to animal breeding, as well as obesity-related human diseases.

Abstract Background Nutritional status is the key concern among the people living with HIV but this issue has been failed to be prioritized in HIV strategic plan of Nepal. This study aims to assess the nutritional status among people living with HIV and determine their associated factors. Methods A hospital based cross-sectional study was conducted where 350 people living with HIV attending the ART clinic were selected using systematic random sampling technique. Nutritional status among people living with HIV was assessed through anthropometry, body mass index; Underweight (body mass index 23 kg/m2). HIV related clinical factors such CD4 count, WHO stage, opportunistic infection, antiretroviral therapy regimen etc. were collected from the medical records. Socio-demographic data were collected using pretested structured questionnaire through interview technique. Multiple linear regression method was employed to determine the association between different independent factors and body mass index score. Results The prevalence of underweight was found to be 18.3% (95% CI: 14.3–22.6). Most of the study participants were overweight/obese (39.1%). After subjection to multiple linear regression analysis, it was found that age, being male, being married, being in business occupation, smoking, hemoglobin level and antiretroviral therapy duration were significantly associated with body mass index score. Majority of the participants in our study lacked diversified food (62.3%). Conclusion Overweight/obesity is an emerging problem among people living with HIV. This group of participants should be screened for the presence of non-communicable disease. This study also highlights the importance of nutritional program being an integral part of HIV/AIDS continuum of care. Therefore, an effort should be made to address the burden of malnutrition by addressing the identified determinants.

Abstract Background Lung ultrasound is an effective tool for the evaluation of undifferentiated dyspnea in the emergency department. Impact of lung ultrasound on clinical decisions for the evaluation of patients with dyspnea in resource-limited settings is not well-known. The objective of this study was to evaluate the impact of lung ultrasound on clinical decision-making for patients presenting with dyspnea to an emergency department in the resource-limited setting of Nepal. Methods A prospective, cross-sectional study of clinicians working in the Patan Hospital Emergency Department was performed. Clinicians performed lung ultrasounds on patients presenting with dyspnea and submitted ultrasounds with their pre-test diagnosis, lung ultrasound interpretation, post-test diagnosis, and any change in management. Results Twenty-two clinicians participated in the study, completing 280 lung ultrasounds. Diagnosis changed in 124 (44.3%) of patients with dyspnea. Clinicians reported a change in management based on the lung ultrasound in 150 cases (53.6%). Of the changes in management, the majority involved treatment (83.3%) followed by disposition (13.3%) and new consults (2.7%). Conclusions In an emergency department in Nepal, bedside lung ultrasound had a significant impact on physician clinical decision-making, especially on patient diagnosis and treatment.

Studying the genetic effects on early stages of human development is challenging due to a scarcity of biological material. Here, the authors utilise induced pluripotent stem cells from 125 donors to track gene expression changes and expression quantitative trait loci at single cell resolution during in vitro endoderm differentiation.

Introduction: Blood pressure measurement has a great implication in medicine. Every medical personnel should have a sound knowledge regarding blood pressure measurement. This study was conducted with the aim of determining the knowledge regarding blood pressure measurement among first and second year medical students of a medical college. Methods: A descriptive cross-sectional study was conducted by Department of Physiology of Nepalese Army Institute of Health Sciences from June to December 2021 after receiving the ethical approval from Institutional Review Committee with registration number 394. One hundred ninety-seven students from first and second year were included in the study using whole sampling technique. Data was entered and analysed using Microsoft Excel 2019 and Statistical Package for Social sciences version 16.0. Descriptive statistics like frequency, percentage for binary data and mean, standard deviation for continuous data were calculated. Results: Among 197 students from first and second year, 175 (88.83%) had satisfactory knowledge regarding blood pressure measurement with score≥8 in Objective Structured Practical Examination. Eighty five (85.86%) students from first year and 90 (91.84%) students from second year had scores ≥8, hence had satisfactory knowledge on blood pressure measurement. A total of 18 (18.18%) first year students achieved a score of 10, while 24 (24.49%) students of the second year scored 12, which were the modal score. Conclusions: The proportion of first and second year students having satisfactory knowledge regarding blood pressure measurement is higher in our study.

Introduction: The traditional teaching-learning process should reform to improve the academic performance and understanding of the students. This study aimed to determine the perceptions of second-year medical students towards early clinical exposure about their approach to educating pregnant women on the physiology of pregnancy. Methods: This was a descriptive cross-sectional study with a mixed-method design comprising both quantitative and qualitative components among second-year medical students of a medical college in Nepal from September 2019 to September 2020. After ethical approval from the Institutional Review Committee (Reference number: 207), 40 students included through the convenience sampling method. These students were subjected to early clinical exposure in the form of educating pregnant women on physiological changes during pregnancy. Data was entered and analyzed using Microsoft Excel 2016. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 34 responses, majority of the students 29 (85.28%) (73.36-97.20 at 95% Confidence Interval) were motivated to learn the physiology of pregnancy after the activity; 15 (44.11%) strongly agreed and 14 (41.17%) agreed to this statement. Thirty-two students (94.11%) claimed that the activity improved their understanding of the physiology of pregnancy. The majority of the students expressed that this approach is pragmatic which ignited more curiosity regarding the subject matter. Conclusions: The majority of the students had satisfactory perceptions regarding their early clinical exposure which was similar to standard data and they expressed that they would like to have similar activities in the future.