Introduction
The nutritional status in the first 5 years of life has lifelong and inter-generational impacts on individual’s potential and development. This study described the trend of stunting and ...its risk factors in children under 5 years of age between 2001 and 2016 in Nepal.
Methods
The study used datasets from the 2001, 2006, 2011 and 2016 Nepal Demographic Health Surveys to describe the trend of stunting in under 5-year children. Multiple logistic regression analysis was carried out to assess the risk factors for stunting at the time of the four surveys.
Results
The nutritional status of under 5-year children improved between 2001 and 2016. Babies born into poorer families had a higher risk of stunting than those born into wealthier families (AOR 1.51, CI 95% 1.23–1.87). Families residing in hill districts had less risk of stunting than those in the Terai plains (AOR 0.75, CI 95% 0.61–0.94). Babies born to uneducated women had a higher risk of stunting than those born to educated women (AOR 1.57, CI 95% 1.28–1.92).
Discussion
Stunting among under-5-year children decreased in the years spanning 2001–2016. This study demonstrated multiple factors that can be addressed to decrease the risk of stunting, which has important implications for neurodevelopment later in life. We add literature on risk factors for stunting in under-5-year children.
Synthetic fentanyl adulteration has become a significant threat to public safety. It is commonly mixed into other drugs of abuse to lower costs and increase its addictive potential. Diffuse alveolar ...hemorrhage (DAH) is a rare but life-threatening complication associated with the use of fentanyl-laced products. Given the current trend, we anticipate an increase in the incidence of DAH. It is crucial to recognize and treat DAH early in its course for better outcomes. We present a case of DAH due to an overdose of marijuana laced with fentanyl, manifesting as hemoptysis, and provide a review of the current literature on the topic.
Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial infarction in young women. An association of fibromuscular dysplasia (FMD) with SCAD has been well established; a ...significant proportion of SCAD patients may have typical FMD findings in other noncoronary arteries. The current consensus recommends arterial imaging screening from head to pelvis using computed tomography angiography (CTA) or magnetic resonance angiography (MRA) in SCAD. Genetic testing for FMD should be considered in high-risk cases. We present two cases of SCAD associated with FMD and discuss the significance of genetic screening in such patients.
Inducible laryngeal obstruction (ILO)/paradoxical vocal fold motion (PVFM) is a reversible narrowing of the larynx that results from vocal fold motion dysfunction. Distinguishing ILO from asthma can ...be challenging, as they can coexist, and standard tests may not be able to differentiate between the two. However, a flexible laryngoscopy can promptly diagnose ILO. Unfortunately, ILO is often overlooked as a potential cause when evaluating patients with sudden-onset breathing difficulties and respiratory distress. We present a case of a young female who sought frequent treatment at the emergency room (ER) with symptoms of shortness of breath (SOB), rapid heart rate, rapid breathing, and anxiety. Despite receiving treatment for acute asthma attacks, her symptoms persisted. During her most recent hospital admission, a flexible laryngoscopy revealed abnormal vocal fold movements, indicating paradoxical vocal fold dysfunction (PVFD) and muscle tension dysphonia (MTD). A comprehensive treatment approach involving speech therapy, pulmonology, and psychiatry led to significant clinical improvement. This case report highlights the importance of raising awareness among healthcare providers about ILO potentially mimicking bronchial asthma exacerbation.
Myocardial infarction without obstructive coronary artery disease (MINOCA) is a common condition with estimated prevalence of 5 to 15 %. It is not a benign condition and diagnosing the exact ...underlying etiology can be challenging, but it is important to ensure appropriate management of MINOCA patients. Cardiac magnetic resonance imaging (CMRI) can be a valuable and non-invasive test to identify the underlying etiology, as well as to risk-stratify such patients. Both the European Society of Cardiology and the American Heart Association recommend CMRI in diagnostic work up of MINOCA patients. We report a case of an 83-year-old man who presented to the emergency department with atypical chest pain but had significantly elevated cardiac troponin levels, with non-obstructive coronary artery disease on left heart catheterization. Subsequent CMRI led to the diagnosis of acute myocarditis. He was medically managed with good clinical outcomes. We discuss this case in detail and highlight the role of CMRI in MINOCA patients. As our understanding of troponin elevation and its various mechanisms continues to evolve, cardiac MRI has a significant role in diagnosis and management, as demonstrated in our case.
1.Illustrate the clinical relevance and diagnosis of myocardial infarction without obstructive coronary artery disease (MINOCA).2.Explain the role of cardiac magnetic resonance imaging in diagnosis and management of MINOCA.
Solar PhotoVoltaic (SPV) based systems have been widely accepted technology for rural electrification in developing countries. The standalone SPV home lighting system has increasingly been popular ...among rural households, while SPV mini-grid supply system is being promoted for rural electrification schemes. This study uses data from household survey to explore the impact of household characteristics on the preference for electrical energy from SPV systems. Econometric evidence shows heterogeneity in behavioural pattern for these two SPV systems. The flexibility in use and cost of systems might explain this difference. Household characteristics such as monthly household income, household size, occupational status of household head, number of room and type of house significantly influence household’s decision for SPV standalone home lighting systems. For SPV mini-grid supply household’s income and monthly expenditure on kerosene are significant predictors. The result reported in this paper might be a valuable input for policy makers to frame right policy mix with regard to provide subsidy on rural electrification programmes.
Nature-based tourism is the fastest growing tourism in many parts of the world. The attitude toward conservation of nature is measured by individuals' willingness to pay. This study has made an ...attempt to investigate the determinants of tourists' willingness to pay (WTP) for biodiversity conservation. The determinants include a combination of socio-economic and site-specific characteristics of tourists. The study was conducted in Sikkim, which is India's prime nature-based tourism destination. Results show WTP, and effects of education, and income of tourists. Among site-specific characteristics, length of stay and number of spots are the significant determinants of WTP. This empirical research is a valuable input to identify market segment among tourists, which might help to generate more revenues for biodiversity conservation in Sikkim.
Trust of women and families toward health institutions has led to increased use of their services for childbirth. Whilst unpleasant experience of care during childbirth will halt this achievement and ...have adverse consequences. We examined the experience of women regarding the care received during childbirth in health institutions in Nepal.
A prospective cohort study conducted in 11 hospitals in Nepal for a period of 18 months. Using a semi-structured questionnaire based on the typology of mistreatment during childbirth, information on childbirth experience was gathered from women (n = 62,926) at the time of discharge. Using those variables, principal component analysis was conducted to create a single mistreatment index. Bivariate and multivariate linear regression analyses were conducted to assess the association of the mistreatment index with sociodemographic, obstetric and newborn characteristics.
A total of 62,926 women were consented and enrolled in the study. Of those women, 84.3% had no opportunity to discuss any concerns, 80.4% were not adequately informed before providing care, and 1.5% of them were refused for care due to inability to pay. According to multivariate regression analysis, women 35 years or older (β, - 0.3587; p-value, 0.000) or 30-34 years old (β,- 0.38013; p-value, 0.000) were less likely to be mistreated compared to women aged 18 years or younger. Women from a relatively disadvantaged (Dalit) ethnic group were more likely to be mistreated (β, 0.29596; p-value, 0.000) compared to a relatively advantaged (Chettri) ethnic group. Newborns who were born preterm (β, - 0.05988; p-value, 0.000) were less likely to be mistreated than those born at term.
The study reports high rate of some categories of mistreatment of women during childbirth. Women from disadvantaged ethnic group, young women, and term newborns are at higher risk of mistreatment. Strengthening health system and improving health workers' readiness and response will be key in experience respectful care during childbirth.
Introduction
Childhood pneumonia is a major cause of mortality worldwide while household air pollution (HAP) is a major contributor to childhood pneumonia in low and middle-income countries. This ...paper presents the prevalence trend of childhood pneumonia in Nepal and assesses its association with household air pollution.
Methods
The study analysed data from the 2006, 2011 and 2016 Nepal Demographic Health Surveys (NDHS). It calculated the prevalence of childhood pneumonia and the factors that cause household air pollution. The association of childhood pneumonia and HAP was assessed using univariate and multi-variate analysis. The population attributable fraction (PAF) of indoor pollution for causing pneumonia was calculated using 2016 NDHS data to assess the burden of pneumonia attributable to HAP factors.
Results
The prevalence of childhood pneumonia decreased in Nepal between 2006 and 2016 and was higher among households using polluting cooking fuels. There was a higher risk of childhood pneumonia among children who lived in households with no separate kitchens in 2011 Adjusted risk ratio (ARR) 1.40, 95% CI 1.01–1.97 and in 2016 (ARR 1.93, 95% CI 1.14–3.28). In 2016, the risk of children contracting pneumonia in households using polluting fuels was double (ARR 1.98, 95% CI 1.01–3.92) that of children from households using clean fuels. Based on the 2016 data, the PAF for pneumonia was calculated as 30.9% for not having a separate kitchen room and 39.8% for using polluting cooking fuel.
Discussion for Practice
Although the occurrence of childhood pneumonia in Nepal has decreased, the level of its association with HAP remained high.
•We performed a meta-analysis to assess the clinical efficacy and safety outcomes of bempedoic acid.•We found that bempedoic acid is an alternative or add-on therapy to reduce cardiovascular events ...in selective patients.•Bempedoic acid reduced non-fatal myocardial infarction, hospitalization for unstable angina and coronary revascularization significantly.•Further trials may shed more light on the bempedoic acid.
Statins are the cornerstone therapy for primary or secondary prevention of atherosclerotic cardiovascular disease (ASCVD). However, a significant portion of patients are intolerant to statin or show inadequate lipid-lowering. Bempedoic acid (BA) has been shown to decrease low-density lipoprotein cholesterol (LDL-C) in clinical trials. However, the evidence on the effect of BA on clinical cardiovascular outcomes was limited until the CLEAR Outcomes trial. Thus, to fully appraise the available data, we performed this meta-analysis.
PubMed, Pubmed Central, Embase, and Scopus databases were searched for relevant articles published before May 1, 2023. Pertinent data from the included studies were extracted and analyzed using RevMan v5.4.
Out of 2209 studies evaluated, five randomized control trials with 17,384 patients with established ASCVD or at high risk of ASCVD were included for analysis. The BA therapy reduced major adverse cardiovascular events (OR 0.85, CI 0.77-0.93; <0.0001), non-fatal myocardial infarction (OR 0.75, 95 % CI 0.64-0.88; p <0.0001), hospitalization for unstable angina (OR 0.69, CI 0.53-0.89; p = 0.005) and coronary revascularization (OR 0.80, CI 0.61-0.91; <0.0001) significantly without decreasing the risk of all-cause death (OR 1.19, CI 0.73-1.94; p = 0.49), cardiovascular death (OR 1.04, CI 0.87-1.25; p = 0.68) and non-fatal stroke (OR 0.84, CI 0.66-1.06; p = 0.15).
Based on our analysis the bempedoic acid addition to therapy reduced cardiovascular events in selective patients who are either intolerant to statins or do not achieve recommended LDL-C levels despite being on a maximum dose of statins and/or ezetimibe.
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