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Bijay Khatri,1 Anjana Khadka,2 Archana Amatya,3 Sushan Man Shrestha,4 Rajan Paudel4 1Academic and Research Department, B.P. Eye Foundation, Kathmandu, Nepal; 2Department of Health Services, Ministry of Health, Kathmandu, Nepal; 3Save the Children International, Nepal Country Office, Kathmandu, Nepal; 4Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, NepalCorrespondence: Bijay KhatriAcademic and Research Department, B.P. Eye Foundation, Kathmandu, NepalTel +977 984 146 3005Email bj.khatri@gmail.comPurpose: The copper-T (TCu-380A), an intrauterine contraceptive device (IUCD), is widely available and is highly effective in terms of safety and effectiveness. Despite this fact, there is low utilization of IUCD in Nepal. This paper describes the perception and use of IUCD among married women of reproductive age attending an institutional clinic in Bhaktapur, Nepal.Methods: An institution-based cross-sectional study was conducted among 273 married women attending the institutional clinic of Bhaktapur hospital who were interviewed by trained staff nurses using semi-structured questionnaires. Systematic random sampling method was applied to select the participants. Logistic regression analysis was used to determine the relationship between factors associated with utilization of IUCD.Results: Just below half (48.7%) of the participants had heard about IUCD. Only 7.0% of the potential users were currently using IUCD, and all of them had discussed using it with their husbands. Among women aware of IUCD, nearly a quarter of them (23.8%) did not want to use it because of their husband’s disapproval and their assumed fear of decreased sexual pleasure. There was a significant association between previous abortion and use of IUCD, where the women who had a history of abortion had increased odds of using the IUCD by 5.45-times compared to those who had not (p=0.01). The women who were counseled about IUCD by health workers were 2.83-times more likely to use an IUCD than those who were not. The women who had a good knowledge level about IUCD as a method of modern contraception had 2.85-times increased odds of using the IUCD compared to those who had poor or no knowledge about it.Conclusion: The use of IUCD depends on the support of husbands, knowledge about its safety, efficacy, and counseling.Keywords: husband, abortion, counseling, knowledge

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 Background Indigenous buffaloes, as the important livestock species contributing to economy of the country, are the lifeline of livelihood in Nepal. They are distributed across diverse geographical regions of the country and have adapted to various feeding, breeding, and management conditions. The larger group of these native buffalo breeds are present in narrow and stiff hilly terrains. Their dispersal indicates a possible environmental adaptation mechanism, which is crucial for the conservation of these breeds. Results We utilized whole-genome sequencing (WGS) to investigate the genetic diversity, population structure, and selection signatures of Nepalese indigenous buffaloes. We compared 66 whole-genome sequences with 118 publicly available sequences from six river and five swamp buffalo breeds. Genomic diversity parameters indicated genetic variability level in the Nepalese buffaloes comparable to those of Indian breeds, and population genetic structure revealed distinct geography-mediated genetic differentiation among these breeds. We used locus-specific branch length analysis (LSBL) for genome-wide scan, which revealed a list of potentially selected genes in Lime and Parkote breeds that inhabit the hilly region. A gene ontology (GO) analysis discovered that many GO terms were associated with cardiac function regulation. Furthermore, complementary analyses of local selection signatures, tissue expression profiles, and haplotype differences identified candidate genes, including KCNE1, CSF1R, and PDGFRB, related to the regulation of cardiac and pulmonary functions. Conclusions This study is a comprehensive WGS-based genetic analysis of the native Nepalese buffalo breeds. Our study suggested that the Nepalese “hilly” buffaloes, especially the Lime and Parkote breeds, have undergone some characteristic genetic changes and evolved increased cardiac and pulmonary function for their adaptation to the steep hilly terrains of the country.

Abstract 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.

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.

Background:. Despite evidence supporting the benefits of rehabilitation for cancer survivors, the nature of cancer rehabilitation programs is inadequately described in Australia and New Zealand. This study provides insight into current service delivery and challenges for healthcare systems in implementation of cancer rehabilitation programs. Methods:. A cross-sectional survey of directors of public and private rehabilitation services in hospital and ambulatory settings across Australia and New Zealand using the Australasian Rehabilitation Outcomes Centre (AROC) registry evaluated the current delivery of cancer rehabilitation programs, health professional workforce, core care components delivered, barriers and facilitators to service delivery, and unit/organisation-wide cancer rehabilitation activities. Descriptive statistics analyzed quantitative data, and qualitative analyses interpreted item responses. Results:. Of the 300 services, 102 (34%) participants completed the survey. Most services provide non-dedicated cancer rehabilitation programs (n=63), led by rehabilitation physicians, followed by allied health. The common tumour streams referred included central nervous system (67%, n=56), haematological (59%, n=49), prostate (58%, n=48), and lung cancers (58%, n=48). Patients were frequently referred during post-treatment (87%, n=72) and treatment phases (66%, n=55). Core program components were multimodal exercises, fatigue management strategies, and management of medical complications and medications. The main barriers and facilitators toward the uptake of cancer rehabilitation programs were identified. Key activities in education, research, advocacy, and clinical practice improvement were also highlighted. Conclusions:. The survey identified key barriers and facilitators for the implementation of cancer rehabilitation programs. Collaborative efforts of relevant stakeholders, clinicians, consumers, and policymakers need to address barriers to broader implementation of cancer rehabilitation services.

On August 14, 2021, a Mw 7.2 earthquake struck the Tiburon Peninsula of western Haiti triggering thousands of landslides. Three days after the earthquake on August 17, 2021, Tropical Storm Grace crossed shallow waters offshore of southern Haiti triggering more landslides worsening the situation. In the aftermath of these events, several organizations with disaster response capabilities or programs activated to provide information on the location of landslides to first responders on the ground. Utilizing remote sensing to support rapid response, one organization manually mapped initiation point of landslides and three automatically detected landslides. The 2021 Haiti event also provided a unique opportunity to test different automated landslide detection methods that utilized both SAR and optical data in a rapid response scenario where rapid situational awareness was critical. As the methods used are highly replicable, the main goal of this study is to summarize the landslide rapid response products released by the organizations, detection methods, quantify accuracy and provide guidelines on how some of the shortcomings encountered in this effort might be addressed in the future. To support this validation, a manually mapped polygon-based landslide inventory covering the entire affected area was created and is also released through this effort.

Background This study aimed to assess the current status of critical care services in 13 districts of Bagmati Province in Nepal, with a focus on access, infrastructure, human resources, and intensive care unit (ICU) services. Methods A cross-sectional survey was conducted among healthcare workers employed in 87 hospitals having medical/surgical ICUs across Bagmati Province. Data were collected through structured questionnaires administered via face-to-face and telephone survey. Descriptive analysis was used for data analysis, involving frequencies and percentages. Results From 87 hospitals, a total of 123 ICUs were identified in the province, providing 1167 beds and 615 functioning ventilators. The average ICU bed availability per 100,000 population was 19, ranging from 3.6 in Makwanpur to 33.9 in Kathmandu. Out of 13 districts, 95% of beds were concentrated in just four districts, while six had no ICU facilities. Of the available facilities, 69.9% were owned by private entities. One-to-one nurse-to-ventilated bed ratio was maintained by 63.4% of ICUs during daytime, and 62.6% at nighttime. Furthermore, 74.8% of ICUs had consultants trained in critical care medicine. While essential equipment availability was higher in Bagmati province, gaps existed in the availability of oxygen plants and isolation rooms. Similarly, many ICUs offered continuous medical education and cardiopulmonary resuscitation (CPR) training, but improvements were necessary in clinical audits, antibiotic stewardship programs, and research engagement. Conclusions Disparities in critical care resources were evident across districts in Bagmati Province, highlighting the need for a balanced and decentralized approach to ensure equitable access to care. Although there were disparities, numerous ICUs were effectively carrying out multiple critical care procedures. This study suggests conducting a nationwide mapping of ICU resources, prioritizing infrastructure development, optimizing resource allocation, and establishing national protocols.

Background This study aimed to assess the current status of critical care services in 13 districts of Bagmati Province in Nepal, with a focus on access, infrastructure, human resources, and intensive care unit (ICU) services. Methods A cross-sectional survey was conducted among healthcare workers employed in 87 hospitals having medical/surgical ICUs across Bagmati Province. Data were collected through structured questionnaires administered via face-to-face and telephone interviews. Descriptive analysis was used for data analysis, involving frequencies and percentages. Results From 87 hospitals, a total of 123 ICUs were identified in the province, providing 1167 beds and 615 functioning ventilators. The average ICU bed availability per 100,000 population was 19, ranging from 3.6 in Makwanpur to 33.9 in Kathmandu. Out of 13 districts, 95% of beds were concentrated in just four districts, while six had no ICU facilities. Of the available facilities, 69.9% were owned by private entities. One-to-one nurse-to-ventilated bed ratio was maintained by 63.4% of ICUs during daytime, and 62.6% at nighttime. Furthermore, 74.8% of ICUs had consultants trained in critical care medicine. While essential equipment availability was higher in Bagmati province, gaps existed in the availability of oxygen plants and isolation rooms. Similarly, many ICUs offered continuous medical education and cardiopulmonary resuscitation (CPR) training, but improvements were necessary in clinical audits, antibiotic stewardship programs, and research engagement. Conclusions Disparities in critical care resources were evident across districts in Bagmati Province, highlighting the need for a balanced and decentralized approach to ensure equitable access to care. Although there were disparities, numerous ICUs were effectively carrying out multiple critical care procedures. This study suggests conducting a nationwide mapping of ICU resources, prioritizing infrastructure development, optimizing resource allocation, and establishing national protocols.

Overusing antimicrobial growth promoters in poultry farming plays a significant role in spreading drug-resistant Escherichia coli. The widespread practice of colistin for any purpose in chickens can potentially disseminate resistant genes from the environment to humans, posing an undeniable threat to livestock and public health. In Nepal, few reports describe the incidence of E. coli bacteria, which are resistant to colistin. Henceforth, this study's purpose was evaluation of colistin-resistant E. coli from ten chicken farms (commercial and backyard) in Kathmandu Valley. In total 43 E. coli isolates were obtained from fifty chickens. All isolates were resistant to colistin, as detected by their growth on MacConkey Agar containing 4 µg/ml colistin. Antibiotic susceptibility tests were used to define the isolates further. 70.0% of isolates were categorized as multidrug-resistant, while the colistin-resistant isolates showed low resistance to Imipenem. The questionnaire data showed the rampant colistin administration in chicken feed, which may have contributed to the proliferation of E. coli isolates resistant to antibiotics in the valley. These findings highlight the importance of advanced investigation into commercial and backyard livestock to facilitate safe poultry practices.

BackgroundHepatitis E virus (HEV) causes acute jaundice and poses an important public health problem in low- and middle-income countries. Limited surveillance capacity and suboptimal access to diagnostics leads to under-reporting of HEV infections in affected countries, including Nepal. Serum antibodies against HEV are indicative of past infection. We analyzed existing samples from a nationally representative serosurvey to describe the geospatial distribution and factors associated with HEV seroprevalence in Nepal, as a proxy for infection.Methodology/principle findingsA nationally representative cross-sectional serosurvey of 3,922 individuals ≥2 years old from 975 households spread across 65 wards throughout Nepal was conducted between November 2021 and January 2022. Bio-banked samples were tested for anti-HEV IgG. Seroprevalence and its 95% confidence interval were estimated by age, sex, ecological region, municipality type, and other waterborne-disease related risk factors. Bayesian geostatistical models were fitted to observed seroprevalence data and used to generate high-resolution maps of seroprevalence across Nepal. Available samples from 3,707 participants were tested for anti-HEV IgG, and 3,703 were used for final analysis. We found 20.8% (95% CI: 19.5-22.2) of participants had evidence of prior HEV infection. HEV seroprevalence increased with age, and was higher in males (23.5%, 95% CI: 21.5-25.5) than in females (18.6%, 95% CI: 16.9-20.3). Seroprevalence in hilly (28.9%, 95% CI: 26.6-31.2) and mountain (24.6%, 95% CI: 18.8-30.5) regions were significantly higher than in terai (14.2%, 95% CI: 12.7-15.8). While there was no significant difference between urban and rural populations, the predicted seroprevalence was highest in Kathmandu, the capital of Nepal, reaching seroprevalence of 50% in some selected area. No statistically significant differences were found for wealth quintile, water source, and toilet facility.ConclusionsThis study provides population-based serologic evidence that HEV is endemic in Nepal, with the greatest risk of infection in Kathmandu.

Background Direct obstetric causes of maternal mortality account for approximately 86% of all global maternal deaths. In Nepal, 12% of all deaths of women of reproductive age are due to preventable obstetric complications in significant part due to the limited distribution and skill level of human resources. Objectives To address this, the Advanced Skilled Birth Attendant (ASBA) task-shifting initiative was developed to train medical officers to perform Cesarean sections (CSs) and manage obstetric emergencies in Nepal. Until now, there has been limited study of the program’s efficacy. Methods A survey targeting all 234 ASBA graduates resulted in 93 usable surveys for multivariate regression. Additionally, seven rural government hospitals with ASBA graduates were selected for 13 in-depth interviews and 6 focus group discussions. Results were then triangulated. Results Immediately after training, 92.7% of ASBA graduates reported performing CSs, with the majority (65.6%) continuing to perform CSs today. Of the ASBAs not performing CSs, 51.7% could be explained by the lack of a functional operating theater, despite being at hospitals expected to provide CSs. ASBAs were significantly more likely to be performing CSs with a family physician or another ASBA present (p

Objectives: To implement and evaluate a rehabilitation-inclusive service delivery model at a tertiary cancer hospital. Methods: The “Rehab-Toolkit”, a structured assessment tool comprising validated functional measures, was introduced in an inpatient cancer service. Consecutive inpatients were enrolled, and a Reach, Effectiveness, Adoption, Implementation, and Maintenance framework guided the analysis of barriers and facilitators for subacute care at clinic and system levels. Results: The implementation of the Rehab-Toolkit was incorporated into routine inpatient care. Major pre-implementation barriers included: absence of routine standardized functional assessment tools, limited coordination amongst acute and subacute care providers, low awareness of rehabilitation medicine amongst patients and professionals, and insufficient engagement of subacute care with interdisciplinary stakeholders in clinical decision-making. Following the intervention, there was a notable increase in awareness and the contributory role of subacute rehabilitation services, rehabilitation “needs” assessment, and referral pathways. Recommendations for process change included: development of clinical pathways, establishment of subacute referral systems and discharge coordinator roles, inclusion of subacute rehabilitation services in acute interdisciplinary team meetings, enhanced staff education and knowledge. Conclusion: Integration of rehabilitation services into cancer care can proactively manage functional morbidity. While the implementation process proved feasible and effective, robust process evalu-ation and longer term follow-up are necessary for sustained success.

The intermittent nature of solar energy presents a significant challenge to its reliability, particularly in applications that require a consistent energy supply, such as cooking. This issue is especially critical in emerging economies with abundant solar resources, where sustainable energy solutions are needed to reduce reliance on traditional fuels. To address this challenge, this study introduces a novel solar thermal storage (STS), utilizing a metal-based material to accumulate and retain heat for off-sunshine hour cooking. The research focuses on optimizing aluminium as the STS material, evaluating its temperature suitability, efficiency, and heat retention capabilities for household solar cooking applications. Numerical simulations using the OpenFOAM framework were conducted to analyze heat transfer within the cooker, determining the optimal size of the aluminium block based on existing literature and predefined parameters. Practical experiments, including solar-induced heating-cooling cycles and controlled cooking tests, were carried out to validate the findings. Experimental results demonstrate STS's ability to efficiently absorb and retain heat, reaching a maximum of 235 °C during a 5.5-h heating session. The water boiling experiment further confirmed STS's practical utility, effectively transferring stored heat to cooking tasks and sustaining temperatures up to 160 °C even after the test. Additionally, experiments with black lentils and chicken stew highlighted aluminium's suitability for practical cooking applications, showcasing its ability to sustain high temperatures and efficiently transfer stored heat despite longer cooking times. The study's novelty lies in integrating numerical modeling with experimental analysis to optimize STS systems, providing practical guidelines for efficient thermal storage in cooking applications. This research advances beyond previous efforts by providing a validated methodology for the design and optimization of thermal storage systems. It improves the reliability and adaptability of solar energy for cooking applications.

Abstract The kidney and brain play critical roles in the regulation of blood pressure. Neuropeptide FF (NPFF), originally isolated from the bovine brain, has been suggested to contribute to the pathogenesis of hypertension. However, the roles of NPFF and its receptors, NPFF-R1 and NPFF-R2, in the regulation of blood pressure, via the kidney, are not known. In this study, we found that the transcripts and proteins of NPFF and its receptors, NPFF-R1 and NPFF-R2, were expressed in mouse and human renal proximal tubules (RPTs). In mouse RPT cells (RPTCs), NPFF, but not RF-amide-related peptide-2 (RFRP-2), decreased the forskolin-stimulated cAMP production in a concentration- and time-dependent manner. Furthermore, dopamine D1-like receptors colocalized and co-immunoprecipitated with NPFF-R1 and NPFF-R2 in human RPTCs. The increase in cAMP production in human RPTCs caused by fenoldopam, a D1-like receptor agonist, was attenuated by NPFF, indicating an antagonistic interaction between NPFF and D1-like receptors. The renal subcapsular infusion of NPFF in C57BL/6 mice decreased renal sodium excretion and increased blood pressure. The NPFF-mediated increase in blood pressure was prevented by RF-9, an antagonist of NPFF receptors. Taken together, our findings suggest that autocrine NPFF and its receptors in the kidney regulate blood pressure, but the mechanisms remain to be determined.

Pemphigoid diseases (PDs) are a group of autoimmune blistering diseases, including bullous pemphigoid, epidermolysis bullosa acquisita, mucous membrane pemphigoid, linear immunoglobulin A disease, and other rare variants. These diseases are characterized by the presence of autoantibodies that target proteins at the dermal-epidermal junction, resulting in the formation of tense blisters and erosions on the skin and/or mucosa. The current therapeutic approaches, such as systemic corticosteroid, are associated with significant adverse effects, highlighting that safer and more effective treatment options are an urgent clinical need. To address this unmet need, a comprehensive understanding of the detailed mechanisms underlying PDs is essential. Based on their histopathological infiltration in pemphigoid lesions, neutrophils have long been implicated as major contributors to the initiation and progression of the diseases. Numerous in vivo and in vitro studies have investigated the role of neutrophils in the pemphigoid pathology, revealing various pathological mechanisms induced by these cells, including the release of neutrophil elastase and matrix metalloproteinase-9, as well as the formation of neutrophil extracellular traps. The present review provides a comprehensive summary and critical evaluation of the current understanding regarding the role of neutrophils in PDs. In addition, it discusses the potential of targeting neutrophil-associated pathways as a novel therapeutic approach for the diseases.

Abstract 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.

Introduction: Echocardiography is an indispensable tool for the diagnosis and management of cardiac patients. It is important to know the spectrum of cardiac abnormalities detected by echocardiography for the proper management of patients. The aim of this study was to evaluate the echocardiographic diagnosis of patients at a multispecialty tertiary care hospital and find out the prevalence of various cardiac diseases diagnosed via echocardiography. Methods: This was a retrospective cross sectional study carried out at the Echocardiography lab of National Academy of Health Sciences. Records of all patients who had done Echocardiography from February 2024 to April 2024 were analyzed. Ethical approval was obtained from Institutional Review Committee (Reference Number:1231/2080/81). Results: Out of 3593 cases, there were 1750 (48.71%) female and 1843 (51.29%) male. Normal echocardiographic study was seen in 1184 (32.95%). Mean age was 56.13±17.38 years. Left ventricle diastolic dysfunction was seen among 1428 (39.74%), followed by tricuspid regurgitation 1026 (28.55%) and pulmonary hypertension 497 (13.83%). Other findings were, left ventricular hypertrophy 204 (5.67%), Left ventricular systolic dysfunction 165 (4.59%), rheumatic heart disease 102 (2.83%) and, congenital heart disease was the lowest documented finding, seen in 30 (0.83%). Conclusions: Most common diseases diagnosed by echocardiography in our study were, diastolic dysfunction, tricuspid regurgitation and pulmonary hypertension.

Background: Electrocardiogram has been widely applied as a diagnostic tool for cardiovascular disease. The concept of the cardiac vector is crucial for the clinical application in ECG interpretation. Methods: A prospective cross-sectional study was conducted among 116 male subjects, aged 18-25 years, comprising students and staff of Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal, over the period from June to September 2023. Electrocardiograms (ECGs) were recorded using a standard ECG machine with conventional limb leads. The mean electrical axis of the heart for each individual was determined by plotting the net voltage of the QRS complex in Lead-I and Lead-III. The study aimed to analyze the correlation between the cardiac vector and physical measurements, such as height, weight, Body Surface Area (BSA), and Body Mass Index (BMI). Data analysis was performed using SPSS version 27.0. Results: The normal mean electrical axis of the healthy male subjects was observed as 57.88±24.55°. There was significant positive correlation of cardiac vector with height (p< 0.05), whereas negative correlation was observed with weight and BMI (p< 0.01). However, there was no significant correlation with BSA. In our study we observed the maximum left axis cardiac vector as -10° and right axis as 90° among 116 male subjects. Conclusion: We established a cardiac vector with values differing from those reported in other studies, using standard bipolar limb leads in normal, healthy male subjects. It is also examined that greater BMI has shifted the electrical activity of the ventricles to the left.

Vertical transmission of dengue is rare. However, the rapid rise of dengue infection is a risk in pregnancy which can lead to preterm delivery, low birth weight, stillbirth, miscarriage, neonatal morbidity and mortality. Here, we present a case of perinatal transmission of dengue in a term neonate who presented with fever on second day of life and desaturation without respiratory distress. Laboratory findings showed thrombocytopenia, dengue Ag NS1/IgM positive and treatment was started. There was positive maternal history of dengue 10 days prior to delivery. Hence, early investigations with prompt interventions was done leading to uneventful recovery.

Most genetic studies consider autism spectrum disorder (ASD) and developmental disorder (DD) separately despite overwhelming comorbidity and shared genetic etiology. Here, we analyzed de novo variants (DNVs) from 15,560 ASD (6,557 from SPARK) and 31,052 DD trios independently and also combined as broader neurodevelopmental disorders (NDDs) using three models. We identify 615 NDD candidate genes (false discovery rate [FDR] < 0.05) supported by ≥1 models, including 138 reaching Bonferroni exome-wide significance (P < 3.64e-7) in all models. The genes group into five functional networks associating with different brain developmental lineages based on single-cell nuclei transcriptomic data. We find no evidence for ASD-specific genes in contrast to 18 genes significantly enriched for DD. There are 53 genes that show mutational bias, including enrichments for missense (n = 41) or truncating (n = 12) DNVs. We also find 10 genes with evidence of male- or female-bias enrichment, including 4 X chromosome genes with significant female burden (DDX3X, MECP2, WDR45, and HDAC8). This large-scale integrative analysis identifies candidates and functional subsets of NDD genes.