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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

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 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.

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.

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.

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.

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.

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.

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.

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.

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.

Background: Obstetric anal sphincter injury is a complication of vaginal delivery, if left untreated, causes significant maternal morbidities; urinary problems and fecal/ flatus incontinence. The aim of this study was to determine the incidence and describe the obstetric characteristics and functional outcomes of women who had vaginal delivery at Paropakar Maternity and Women’s Hospital Nepal and sustained Obstetric anal sphincter injury. Methods: This retrospective descriptive study included women who had vaginal delivery, irrespective of parity, in the labor room or birthing unit of Paropakar Maternity and Women’s Hospital from April 2018 to September 2020, and sustained Grade III or IV Obstetric anal sphincter injury after 28 weeks period of gestation. Maternal characteristics, obstetric details and perineal status after vaginal delivery were noted after review of hospital records. The patients were further inquired via telephone for their current status of fecal and/or urinary incontinence. Results: The incidence of OASI was 106 (0.33%) among 31, 786 Nepalese women with vaginal birth over a 2-year period. The mean age women with Obstetric anal sphincter injury was 24.6 ± 4.3 years and 45(52.9%) cases belonged to Janajati ethnicity. Fifty two (61.2 %) were primipara and 77 (90.6%) had spontaneous vaginal deliveries. Episiotomy was not performed on most of the patients (63, 74.1%). Problems with flatus holding, stool holding and urine holding was reported by 28.3%, 13.2% and 22.6% women respectively. Conclusions: The incidence of Obstetric anal sphincter injury among Nepalese women with vaginal birth over a 2-year period was 0.33%, which was lower than other South Asian studies. Grade III Obstetric anal sphincter injury was the frequent most type. The injuries were more common in women with Janajati ethnicity, primipara and women who did not have episiotomy. Problems with flatus holding and urine holding were present in almost one-fourth of the women with Obstetric anal sphincter injury at follow up. Keywords: Augmentation; episiotomy; induction; obstetric anal sphincter injury.

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.

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.

Individuals with neurodevelopmental disabilities (NDDs) may be at increased risk for catatonia, which can be an especially challenging condition to diagnose and treat. There may be symptom overlap between catatonia and NDD-associated behaviors, such as stereotypies. The diagnosis of catatonia should perhaps be adjusted to address symptom overlap and to include extreme behaviors observed in patients with NDDs, such as severe self-injury. Risk factors for catatonia in individuals with NDDs may include trauma and certain genetic variants, such as those that disrupt SHANK3. Common etiologic features between neurodevelopmental disabilities and catatonia, such as excitatory/inhibitory imbalance and neuroimmune dysfunction, may partially account for comorbidity. New approaches leveraging genetic testing and neuroimmunologic evaluation may allow for more precise diagnoses and effective treatments.

Abstract Background Infantile botulism (IB) is a devastating and potentially life-threatening neuromuscular disorder resulting from intestinal colonization by Clostridium botulinum and the resultant toxin production. It can present with constipation, descending paralysis, and, potentially, respiratory failure. Botulism is a diagnosis that is more commonly seen in the pediatric intensive care unit (PICU) or on the general pediatric wards and would not typically be managed in the neonatal intensive care unit (NICU), and therefore requires high clinical suspicion to ensure prompt diagnosis and treatment. Case presentation We discuss a case where an infant from central Pennsylvania presented to a Level IV NICU rather than to the PICU for an evaluation for sepsis and was uniquely diagnosed with IB. The infant presented with poor oral feeding and reduced oral intake, hypothermia, and lethargy. His symptoms progressed into hypoxia and acute respiratory failure. Interestingly, this infant had no known exposure to honey or any other identifiable sources of botulism contact. The infant’s twin brother and the other infants who attended the mother’s in-home daycare remained asymptomatic. This infant was initially evaluated and managed for a potential infectious etiology. However, a diagnosis of IB was suspected, and was later confirmed through the detection of botulinum toxin in the infant’s stools. A high level of suspicion allowed for timely treatment with Botulism Immune Globulin neutralizing antibodies (BabyBIG), even prior to confirmatory testing. We describe the process of obtaining BabyBIG, as well as the natural course of illness after treatment in our patient who ultimately made a complete recovery. Conclusions This case highlights the importance of considering infantile botulism as a diagnostic possibility even in the absence of risk factors, and the need for vigilance in diagnosing and treating this rare but potentially life-threatening condition. With timely recognition, subsequent treatment with BabyBIG, and supportive care, infants with infantile botulism can be expected to recover completely. This information is particularly important for neonatologists providing care for infants outside the neonatal period, especially during times of high patient census and resulting overflow of pediatric admissions in the NICU.

Parry-Romberg Syndrome (PRS) is a rare neurocutaneous disorder characterized by gradual facial hemiatrophy. We present a case study of a 64-year-old woman with late-onset PRS and linear scleroderma. The patient exhibited atypical PRS symptoms including leg numbness, hyper-reflexia, trigeminal neuralgia, and severe headaches. Diagnostic evaluations revealed chronic left-sided cerebral infarction, microhemorrhages, and nerve involvement. Treatment options for PRS are limited and aim to manage symptoms. This case highlights the diagnostic challenges of late-onset PRS, emphasizing interdisciplinary approach. Further research and improved therapies are essential for better patient outcomes.

IntroductionPrevious research has suggested that how physicians are paid may affect the completeness of billing claims for estimating chronic disease. The purpose of this study is to estimate the completeness of physician billings for diabetes case ascertainment. MethodsWe used administrative data from eight Canadian provinces covering the period 1 April 2014 to 31 March 2016. The patient cohort was stratified into two mutually exclusive groups based on their physician remuneration type: fee-for-service (FFS), for those paid only on that basis; and non-fee-for-service (NFFS). Using diabetes prescription drug data as our reference data source, we evaluated whether completeness of disease case ascertainment varied with payment type. Diabetes incidence rates were then adjusted for completeness of ascertainment. ResultsThe cohort comprised 86 110 patients. Overall, equal proportions received their diabetes medications from FFS and NFFS physicians. Overall, physician payment method had little impact upon the percentage of missed diabetes cases (FFS, 14.8%; NFFS, 12.2%). However, the difference in missed cases between FFS and NFFS varied widely by province, ranging from −1.0% in Nova Scotia to 29.9% in Newfoundland and Labrador. The difference between the observed and adjusted disease incidence rates also varied by province, ranging from 22% in Prince Edward Island to 4% in Nova Scotia. ConclusionThe difference in the loss of cases by physician remuneration method varied across jurisdictions. This loss may contribute to an underestimation of disease incidence. The method we used could be applied to other chronic diseases for which drug therapy could serve as reference data source.

IntroductionDes recherches antérieures ont suggéré que le mode de rémunération des médecins peut avoir une influence sur l’exhaustivité des demandes de remboursement lors de l’estimation des maladies chroniques. Le but de cette étude est d’estimer l’exhaustivité des données sur la facturation des médecins dans l’optique de déterminer des cas de diabète. MéthodologieNous avons utilisé les données administratives de huit provinces canadiennes pour la période du 1er avril 2014 au 31 mars 2016. Nous avons divisé la cohorte de patients en deux groupes mutuellement exclusifs en fonction du mode de rémunération de leur médecin : médecins rémunérés à l’acte pour ceux payés uniquement de cette façon et médecins non rémunérés à l’acte pour les autres. À l’aide des données sur les ordonnances de médicaments hypoglycémiants (source de nos données de référence), nous avons évalué si les cas de maladie avaient été déterminés avec la même exactitude en fonction du mode de rémunération. Nous avons ensuite corrigé les taux d’incidence du diabète afin d’optimiser l’exhaustivité des cas déterminés. RésultatsLa cohorte comprenait 86 110 patients. Dans l’ensemble, des proportions égales de patients ont reçu leurs médicaments hypoglycémiants de la part de médecins rémunérés à l’acte et de médecins non rémunérés à l’acte. Globalement, le mode de rémunération des médecins a eu peu d’effet sur le pourcentage de cas de diabète omis (14,8 % chez les médecins rémunérés à l’acte contre 12,2 % chez les médecins non rémunérés à l’acte). Toutefois, la différence de cas omis entre les médecins rémunérés à l’acte et ceux non rémunérés à l’acte était très variable d’une province à l’autre, allant de -1,0 % en Nouvelle-Écosse à 29,9 % à Terre-Neuve-et-Labrador. La différence entre les taux observés d’incidence de la maladie et les taux corrigés était également variable d’une province à l’autre, allant de 22 % à l’Île-du-Prince-Édouard à 4 % en Nouvelle-Écosse. ConclusionLa différence entre le nombre de cas omis selon le mode de rémunération des médecins est variable d’une province à l’autre. Cette perte de données contribue probablement à une sous-estimation de l’incidence de la maladie. Il serait possible d’appliquer la méthode que nous avons utilisée à d’autres maladies chroniques pour lesquelles des données de traitement pharmacologique pourraient servir de données de référence.

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.