Eastern Nepal Research Articles

Diversity of mammalian species in the Kangchenjunga Landscape of eastern Nepal

The Himalayas, including Nepal, are a biodiversity hotspot. However, records on mammalian richness remain incomplete due to resource limitations, inadequate training, and the remote location of study areas. The unprotected forest area of the Panchthar-Ilam-Taplejung region in eastern Nepal is a vital corridor connecting India and Nepal. Using a structured methodology we aimed to increase our knowledge of mammalian diversity in this area. Camera traps were deployed throughout the Panchthar-Ilam-Taplejung area in 53 locations in winter and 54 in spring, accumulating 3014 camera trap days and generating 93,336 images, with a positive trigger rate of 29.8%. The survey revealed 17 species of medium to large-sized mammals and an additional six species of smaller unidentified mammals, including two melanic variations and two previously undocumented species. Activity patterns were calculated for species with more than five image records in both seasons. The findings contribute essential information about the Kangchenjunga Landscape, which can be used to further conservation efforts in this critical ecosystem corridor.

Role of traditional healers in the management of microbial keratitis in eastern Nepal.

Microbial Keratitis (MK) is a leading cause of corneal blindness due to infection and its consequences, with a higher incidence in resource-limited nations. Hospital-based patient records from different parts of Nepal suggest patients often use traditional eye medicine to treat MK. Traditional healers (TH) within the community are often the first point of care for MK management. Little is known of their practice, perceptions, and knowledge around MK management. We aimed to understand the role of traditional healers in the management of MK in south-eastern Nepal. A cross-sectional, mixed method, descriptive study was conducted in the Siraha district of Nepal. A total of 109 traditional healers consented to participate in a survey of knowledge, attitude, and practices. Some participants were also invited to participate in in-depth interviews and focus group discussions. Interviews and focus groups were conducted and recorded in the Maithili language by a native speaking interviewer and transcribed into English. Descriptive analysis was performed for the survey. Data saturation was considered the endpoint for qualitative data collection, and a thematic was analysis applied. Traditional healers believe that infection of the eye can be caused by trauma, conjunctivitis, or evil spirits. They were unclear about differentiating MK from other eye conditions. They provided various types of treatment. Some were confident that they could treat severe ulcers that had not responded to medical therapy, while others thought treating larger diameter ulcers would be difficult. Although there were mixed responses in referring patients with MK, the majority of TH were willing to refer. In a weak health system, traditional healers may help address barriers to healthcare access and reduce delays to definitive care, upon integration into the formal health system and referral pathway.

Mobile health teleconsultation and telemedicine in operating outpatient departments during COVID-19 pandemic at a hospital in Eastern Nepal

ABSTRACT Background: Telemedicine provides a means to deliver healthcare across distances, enhancing efficiency and accessibility, especially in low- and middle-income countries. The COVID-19 pandemic highlighted its importance by reducing the risk of virus transmission while maintaining healthcare delivery. This study evaluates the telemedicine program implemented at B.P. Koirala Institute of Health Sciences (BPKIHS), Nepal, which provided specialist services to remote districts via teleconsultation during the 2020 lockdown. The objectives were to identify the number of patients, the major complaints, and the follow-up departments during teleconsultation. Methods: A retrospective analysis was conducted on teleconsultation data from March 1 to August 31, 2020, across various outpatient departments at BPKIHS. Data from 10,901 patients were reviewed, with variables including age, gender, residence, and consultation medium. Descriptive statistics were calculated using SPSS (version 22). Results: Most of the patients (55.46%) were female, and the majority (30.84%) aged 21–30 years. Most consultations were from the Sunsari district (54.8%) and Koshi state (88.9%). Voice calls were the primary medium (39.62%), followed by WhatsApp video calls (30.08%). Obstetrics and gynecology had the highest consultation rate (16.15%), followed by dermatology (14.4%) and psychiatry (10.37%). Nearly half of the patients (45.0%) had follow-up consultations, primarily for dermatological issues (17.85%). Conclusion: The findings underscore telemedicine’s role in facilitating healthcare access, particularly for women and residents of remote areas, by reducing travel and exposure risks. This study highlights the need for further integration of telehealth technologies to enhance healthcare delivery, suggesting that teleconsultation can efficiently meet healthcare demands in resource-limited settings during and beyond pandemics.

Evaluation of Self-vision Assessment Charts in Schools of Eastern Nepal: A Multi Method Study

Introduction: Globally, over two billion people suffer from vision impairment, almost half preventable. In Nepal, the Eastern Regional Eye Care Program introduced self-vision assessment charts in 137 schools for early eye issue detection. This study assessed the charts' use and perceived impact.Methods: A multi-method study was conducted to evaluate the use of self-vision assessment charts in schools in Eastern Nepal. Ethical approval was obtained from Institutional Review Board (Refrence number: 72-079-040). Quantitative data were collected through a questionnaire survey. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed using framework analysis. Both methods were integrated to enhance understanding of participants' experiences.Results: In this study, 400 students participated in questionnaire survey, 180 in self vision assessment, and 16 teachers in in-depth interviews. Among the participants, 198 (49.50%) of students used the chart, 125 (65.78%) expressed satisfaction, 241 (60.25%) found it useful, 276 (69%) as beneficial, and 253 (63.25%) stated improved health. There were 93 (23.25%) students who felt knowledgeable about its use, with 18 (10%) using it correctly. In 162 (90%) of schools there were adequate chart placement, 23 (12.77%) provided clear signage for viewing points. Teachers recognized the chart's benefits and encouraged its use, but students lacked awareness. Regular use was viewed as beneficial for early detection of eye issues, though challenges included a need for more awareness among students and teachers and reliance on home remedies.Conclusions: Most students and teachers acknowledged self-vision assessment charts’ benefits but had low utilization and accuracy rates. Strategic interventions such as regular informational sessions, teacher motivation, and engagement with eye health experts are essential.

Indigenous Feminism in the Yakthung/Limbu Tribe

The paper deals with the tenets of feminism immanent within the oral narratives, rhetorical traditions, folklores, folktale and culture of the Yakthung/Limbu tribe inhabiting the Himalayan belt, defying the dichotomy of sexes in Western narratives of the society at a universal level. Yakthung/Limbu tribe is an indigenous tribe of Eastern Nepal, Sikkim and West Bengal who are animist and shamanist in nature. Feminism, the belief in social, economic, and political equality of the sexes, although largely originating in the West as a properly structured and well-known theory, the paper endeavors to bring out the tenets of Feminism imbibed within the aforementioned aspects, prior to the inception of Feminism at a Global level. The paper analyzes the excerpts from the Yakthung/Limbu Mundhum, the oral religious scripture of the Yakthung/Limbu tribe wherein the two sexes are made to be at par with each other. The Yakthung/Limbu Mundhum consists of legends, folklores, prehistoric accounts, sermons and moral or philosophical exhortations in poetic language, generically which can be deemed as narrative oral poetry. These are the sources of information, directives, enlightenment for the Limbu’s that exercises an enormous influence in their way of life, customs, rites and rituals. The Yakthung/Limbu Mundhum is transmitted, narrated, recited and possessed by Yakthung/Limbu shamans known as “Peli-Phangsam” or “Murabangs”. The Yakthung/Limbu tribal societies have been practicing and following feminism as a matter of habit and culture that has come down from generations to generations. They do not follow it out of fear, compassion, rational enlightenment, education or compulsion, it is a necessity that comes quite naturally to them. It has been spontaneous and indigenous immanent within their culture and day to day practices. The paper in a way aims to deconstruct the Western narratives of the stature of women that is hitherto taken as ubiquitous and kindle the emergence of a paradigm contrary to the western.

Visual and Surgical Outcomes of Outreach Cataract Surgeries in Ilam District of Nepal: An Observational Study

Introduction: Cataracts are the leading cause of preventable blindness worldwide. Although cataract blindness is reversible, its service coverage remains poor, particularly in rural and hilly areas of Nepal. The study aimed to evaluate visual outcomes of outreach cataract surgeries and associated intraoperative and post-operative complications. Methods: This cross-sectional study was conducted at a district of Eastern Nepal after ethical clearance was taken from the Institutional Review Committee (Reference number: 88). Total 131 subjects had cataract surgeries at the surgical camp, and their pre-operative, one-day and one-month post-operative visual acuities were compared, and intraoperative and post-operative surgical complications were recorded. Visual acuity ≥ 6/12 was considered normal. Data was collected in excel and analyzed in SPSS. Results: The mean age of participants was 71.8±9.51 years, with 70 (53.43%) male. A total of 156 eyes from 131 subjects underwent cataract surgeries and among them 25 (19.08%) cases underwent bilateral cataract surgeries. At the day one of surgery, visual acuity improved to normal in 137 (87.82%) of cases, while after one-month, visual acuity improved to normal in 150 (96.15%) of cases with best-corrected glasses. There were 4 (2.56%) intraoperative complications, which included surgery-induced subluxated bag, premature entry, iris trauma, and posterior capsule rent. Conclusions: The visual and surgical outcomes of cataract surgeries performed at an outreach surgical camp were excellent with minimal surgical complications.

Cardiometabolic multimorbidity and associated risk factors in a cohort identified through community-based screening in Eastern Nepal

Abstract Background Cardiometabolic multimorbidity constitutes a major cause of premature mortality and morbidity in low- and middle-income countries like Nepal. Early detection of associated risk factors and timely management at primary care centres can significantly reduce the impact at individual level. Lack of quality research data in resource poor setting often pose a challenge to plan for efficient delivery of health services. Purpose This analysis of secondary data from a cohort identified through a community based NCD intervention program intends to explore the distribution of cardiometabolic multimorbidity and associated risk factors in adult population of Eastern Nepal. Methods This report is a part of integrated NCD management strategy, a KHDC (Kidney, Hypertension, Diabetes, and Cardiovascular disease) program, implemented through community-based screening and interventions focused on primary level healthcare centres. The KHDC program involved screening of 14,517 individuals aged 18 years and above at baseline during a period of 2019-2023 for selected NCDs, including, cardiovascular diseases, hypertension, diabetes, and kidney disease. Individual level data was collected through anthropometric measurements, participants’ self-report, vitals assessment, laboratory parameters and diagnostic adjuncts including ECG and Echocardiography. Outcome of cardiometabolic multimorbidity1 was defined as presence of two or more of diabetes mellitus, and cardiovascular diseases including myocardial infarction and stroke. Results About 12.8% (n=1862) of the participants had at least one cardiometabolic multimorbidity, while less than one per cent (n=47) had two or more multimorbidity. Presence of at least one multimorbidity was associated with older age ≥ 40 years [OR: 3.870 (95% CI: 3.285-4.558)], male gender [OR: 1.326 (95% CI: 1.202-1.463)], BMI ≥ 23 kg/cm2 [OR: 1.348 (95% CI: 1.208-1.503)], current tobacco consumption [OR: 1.164 (95% CI: 1.038-1.305)] and co-occurrence of hypertension [OR: 1.736 (95% CI: 1.550-1.943)]. The presence of both diabetes mellitus and cardiovascular disease was associated with age ≥ 40 years [OR: 7.612 (95% CI: 1.846-31.395)] and co-occurrence of hypertension [OR: 2.544 (95% CI: 1.401-4.620)]. Conclusion Disproportionate burden of cardiometabolic multimorbidity was apparent among adult population screened in our program. Older age and co-occurrence of hypertension was identified as contributing factors for the presence of such multimorbidity. A baseline information on the distribution and risk factors for the same among general population can provide a valuable insight into understanding the disease progression and prognostic outcomes.Table of Outcomes

Clinical diagnosis and management of spinocerebellar Ataxia in a resource-constrained setting: a case report from Eastern Nepal

Introduction: Spinocerebellar ataxias (SCA) are a diverse group of neurodegenerative disorders with autosomal dominant inheritance, primarily affecting the cerebellum and its connections. Diagnosis typically involves genetic testing, but in resource-limited settings, clinical and neuroimaging assessments become critical. This case report highlights the role of non-genetic methods in diagnosing SCA and outlines management strategies in such settings. Case Presentation: A 41-year-old male presented with a two-year history of progressive gait imbalance, headache, and abnormal speech. He had a family history of similar symptoms in two siblings, but no significant past medical history. Clinical examination revealed scanning speech, dysmetria, and a broad-based gait. Clinical and neuroimaging findings, including cerebellar atrophy, led to a diagnosis of SCA in the absence of genetic testing. Patient management with speech, occupational, and physical therapies, showed gradual improvement. Discussion: SCA, characterized by cerebellar atrophy and a range of clinical symptoms, is typically diagnosed through genetic testing, but clinical and imaging assessments are crucial when genetic resources are limited. This case illustrates that a comprehensive clinical evaluation, including neuroimaging, can support the diagnosis of SCA even without genetic testing. Strategic management emphasizing symptomatic relief and functional improvement through a multidisciplinary approach, including regular follow-up and personalized therapy, are crucial, as evidenced by the timely improvement observed in our case. Conclusion: In resource-limited settings, a comprehensive clinical and neuroimaging assessment is essential for diagnosing Spinocerebellar Ataxia when genetic testing is not feasible. Effective management through multidisciplinary therapies can improve patient outcomes, underscoring the need for innovative strategies to enhance diagnostic and treatment capabilities in such environments.

The Benkar Fault Zone: An Orogen-Scale Cross Fault in the Eastern Nepal Himalaya

Abstract The Benkar Fault Zone (BFZ) is a recently recognized, NNE-striking, brittle to ductile, cross fault that cuts across the dominant metamorphic fabric of the Greater Himalayan Sequence (GHS) and the Lesser Himalayan Sequence (LHS) in eastern Nepal. 40Ar/39Ar-muscovite cooling ages along a transect across the BFZ in the GHS indicate movement younger than 12 Ma. To understand the mode of genesis, and seismo-tectonic implications of the BFZ, we mapped this fault from the Everest region in the upper Khumbu valley toward the south, across the Main Central Thrust, into the LHS and the Greater Himalayan Nappe. We recognize a series of cross faults segments, which we interpret the BFZ system. The currently mapped section of the BFZ is >100 km long, and its width is up to 4 km in the LHS. The BFZ is semi-ductile in the GHS region but is brittle in the south, where it is expressed as gouge zones, tectonically brecciated zones, sharp fault planes, and segments of nonpenetrative brittle deformation zones. From petrographic and kinematic analysis, we interpret largely a right-lateral, extensional sense of shear. Our work did not continue into the Sub-Himalaya, but the BFZ may continue through this zone into the foreland as documented in other Himalayan cross faults. While several genetic models have been proposed for cross faults in the Himalaya and other convergent orogens, we suggest that the BFZ may be related to extensional structures in Tibet. Understanding cross faults is not only important for the tectonic history of the Himalaya but due to the co-location of cross faults and seismogenic boundaries, there may be a causal relationship. Cross faults also follow many of the north-south river segments of the Himalaya and weakened fault rocks on the valley walls may enhance the landslide hazard in these areas.

Etiology and epidemiology of acute exacerbations of chronic obstructive pulmonary disease in Eastern Nepal: a narrative review

This narrative review aims to examine the etiology and epidemiology of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in Eastern Nepal. A systematic search was conducted to identify relevant studies published in English, focusing on combinations of keywords such as “acute exacerbation of chronic obstructive pulmonary disease,” “AECOPD,” “Nepal,” “etiology,” “epidemiology,” “environmental exposure,” “comorbidities,” and “socioeconomic factors.” Synthesizing findings from recent studies, it highlights the multifactorial nature of AECOPD, including the roles of respiratory infections, environmental exposures, and comorbidities. Key findings indicate that respiratory infections (both viral and bacterial) and non-infectious factors such as air pollution and biomass fuel combustion significantly contribute to AECOPD. Socio-economic factors, particularly among women using traditional biomass fuels and engaged in smoking, also play a critical role. The review emphasizes the need for targeted interventions and preventive strategies to manage AECOPD effectively in this region. Conclusions suggest that understanding local patterns of AECOPD etiology is crucial for developing region-specific interventions to reduce exposure to risk factors and manage comorbidities, thereby improving clinical outcomes and reducing healthcare utilization.

Exploration of drug therapy related problems in a general medicine ward of a tertiary care hospital of Eastern Nepal

BackgroundInpatients are at higher risk of Drug Therapy Related Problems (DTRPs), and early identification and management of these DTRPs is crucial for optimal treatment outcomes and ensuring rational drug therapy. ObjectiveThis study aims to assess DTRPs in a general medicine ward of a tertiary care hospital in eastern Nepal. MethodsA three-month prospective observational study was conducted on inpatients admitted to the general medicine ward of the hospital. Pharmacists routinely performed patient drug therapy reviews, by which suspected DTRPs were identified and recorded as per the Pharmaceutical Care Network Europe Association (PCNE) v.9.1 guidelines. Binary logistic regression analysis was used to determine the influence of predictor variables on the occurrence of DTRPs. ResultsA total of 301 inpatients were enrolled, out of which 233 (77.4%) had one or more DTRPs. Altogether, 528 DTRPs with an average of 2.27 ± 0.92 DTRPs per patient were identified. The primary causes of the DTRPs were drug selection (40.47%), treatment duration (16.71%), dispensing (15.75%), and dose selection (13.12%). Antimicrobials were involved in 55.18% of the DTRPs. DTRPs were more prevalent in elderly, comorbid patients, patients with longer hospital stay days, and polypharmacy, which was statistically significant (p<0.05). Furthermore, multivariate binary logistic regression analysis showed that geriatric patients had a higher risk of experiencing DTRPs, with an adjusted odds ratio of 1.832 (1.021-3.286) at p-value < 0.05. ConclusionDTRPs are frequently prevalent in hospital wards, emphasizing the crucial role of clinical pharmacists in identifying, resolving, and preventing DTRPs in inpatient settings for optimal treatment outcomes.

Endemic Prunus species in the high Himalayas, Eastern Nepal, seeking conservation

Prunus species play an important role in preserving the Nepal's unique identity; such as three endemic species of Prunus, Prunus topkegolensis, Prunus jajarkotensis, and Prunus taplejungnica, represent the country's local area. An ecological and social survey of P. topkegolensis and P. taplejungnica was conducted. To analyze these species' regeneration status and population structures, the density of seedlings, saplings, and adult trees were compared, and created a diameter size class diagram. The Wilcoxon signed-rank test was used to compare the average values of seedlings, saplings, and adult trees between two species. To determine the ethnobotanical importance of a species, the relative frequency of citation (RFC) was calculated for various use categories. We classified both species as trees as the average diameter at breast height (DBH) of P. topkegolensis was 19.55 ± 14.66 cm with an average height 5.05 ± 2.28 m, while that of P. taplejungnica was 14.5 ± 7.93 cm with an average height of 4.89 ± 1.66 m. P. topkegolensis had an average 32 ± 31 adult trees, 16 ± 15 saplings, and 21 ± 18 seedlings per 0.1 ha, while P. taplejungnica had 12 ± 5 adult trees, 2 saplings, and 6 ± 4 seedlings per 0.1 ha. The number of seedlings and saplings at the plot level differed significantly between species (W = 75.5, p- = 0.05, and W = 84, p = 0.01, respectively). Both had humped-shaped diameter at breast height size class distribution. However, P. taplejungnica had a more apparent hump-shaped diameter at breast height distribution than P. topkegolensis, indicating that P. taplejungnica has more unsustainable regeneration issues. P. taplejungnica was locally recognized as a separate species from P. rufa, whereas P. topkegolensis was not. P. topkegolensis have seven different use categories, with wood and fuel wood being the most frequently cited, with RFC value 1. Rapid vulnerability assessment (RVA) showed both species are having high conservation threats. In situ conservation measures are suggested to address the issue of poor regeneration and disturbances.

Unusual presentations in systemic lupus erythematosus with concurrent IgA nephropathy lesion: a rare case report from Eastern Nepal

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease involving multiple organs. While lupus nephritis (LN) is seen in SLE, concurrent IgA nephropathy lesion is rare. Uncommon manifestations like cutaneous ulcers and orbital involvement present diagnostic challenges, and this case from Nepal emphasizes careful diagnostic approach in such cases. Case presentation: A 42-year-old female presented with bilateral lower limb swelling, gum bleeding, and epistaxis. Initial evaluation revealed pancytopenia and suspected renal involvement. Renal biopsy showed IgA nephropathy lesions, but clinical and laboratory findings favored lupus nephritis. Treatment with immunosuppressive agents was initiated. Despite therapy, the patient developed cutaneous ulcers and orbital cellulitis. Decreasing anti-ds DNA levels were noted during the course of treatment. Discussion: The diagnosis of lupus nephritis in the presence of IgA nephropathy lesions emphasizes the complexity of SLE diagnosis. Treatment with immunosuppressive agents targeting the underlying autoimmune process, yet the development of cutaneous ulcers and orbital cellulitis highlights the importance of timely intervention in managing SLE complications. In resource-limited settings, clinicians should initiate interventions based on clinical and lab findings while awaiting detailed biopsy results. Conclusion: This case highlights diagnostic challenges in SLE and emphasizes the necessity for careful monitoring and timely intervention in managing complications. The interplay between SLE and IgA Nephropathy (IgAN) suggests that SLE may trigger or exacerbate it, complicating disease management. Further exploration is needed to enhance the understanding and management of complex autoimmune disorders like SLE.

Current and future habitat suitability modelling of Bambusa teres outside forest areas in Nepal under climate change scenarios

Bambusa teres Buch.-Ham. ex Munro (syn. Bambusa nutans subsp. capulata Stapleton) is a fast-growing perennial bamboo that has ecological, economic, cultural and climate change mitigation benefits. However, information on its current and future potential distribution outside forest areas across Nepal and the key factors affecting its growth and distribution are little known. We used a total of 298 occurrence points obtained from the National Bamboo Resource Assessment and 23 environmental variables to project the distribution of B. teres throughout its potential range in Nepal. Maximum entropy model (MaxEnt) was utilized for this study. We assessed the performance of the model using a receiver operating characteristic curve and evaluated the relative importance of predictor variables through a Jackknife procedure. The model achieved a high level of performance with an area under the curve value of 0.928. Precipitation of the coldest quarter (bio_19), temperature seasonality (bio_4) and precipitation seasonality (bio_15) were the significant contributing variables for the distribution of B. teres. The most suitable habitat for B. teres, with a suitability index >0.6, covered 9264.6 km2, with large sections in Eastern and Central Nepal. However, under future climate change scenarios, the area of suitable habitat for the species is projected to increase across Nepal. This study serves as a baseline for assessing potential climate change impacts on B. teres and will enable the development of adaptive measures to protect and establish various bamboo populations outside forest areas in Nepal and globally.

Clinical Profile and Outcome of Twin Babies Delivered at a Tertiary Care Center in Eastern Nepal

Introduction: Twin pregnancies are often associated with higher risks of complications for both the mother and the neonates, particularly in resource-limited settings. This study was conducted at a tertiary care center in Eastern Nepal to assess the clinical profile and outcomes of twin pregnancies. Methods: A descriptive cross-sectional study was carried out in the department of Pediatric and neonatology at Nobel Medical College Teaching Hospital, Biratnagar, Nepal over the period of 6 month (December 2023 to May 2024). Total of 32 twin pregnancies of gestational age of ≥28 weeks, where both twins were alive at delivery were included. Data were collected on maternal and neonatal characteristics, including birth weight, gestational age, Apgar scores, and clinical outcomes. Statistical analyses were performed to compare the outcomes between the first and second twins. Results: In the present, study total of 32 eligible twin were analyzed. The majority of twins were (53.1%) delivered between 32 to &lt;37 weeks of gestation rest 46.87% delivering between 28 to &lt;32 weeks. The average Apgar scores were 6.5 at 1 minute and 8.6 at 5 minutes. The most common clinical feature seen in twin neonates was lethargy which was seen in 32 neonates (50%). NICU admission was required for 70.3% of the neonates. There were no significant differences between groups twin 1 and twin 2 in most health indicators, such as clinical symptoms, hemoglobin, PCV, serum calcium level, jaundice, TTTS, chest X-ray findings, NICU admissions, or overall outcomes (P &gt; 0.05). However, twin 1 had a higher rate of neonatal sepsis (P = 0.048). notable difference was observed in the incidence of neonatal sepsis between the first and second twins, with the first twin being more affected. Neonatal mortality rate in twin in the present study was 7.8%. Conclusion: Twin pregnancies have high incidence of preterm delivery and low birth weight. Requirement of NICU care is more in case of first twin.

Clinical Study of Cutaneous Manifestations in Neonates in A Tertiary Care Center in Eastern Nepal: A Descriptive Cross-sectional Study

Introduction: In the neonatal period, a variety of cutaneous symptoms are frequent. To minimize unneeded therapy and to reduce parents' stress, it's important to distinguish between transient and pathological newborn dermatoses. The purpose of this study is to describe the clinical pattern of cutaneous lesions in neonates. Methods: In this cross-sectional descriptive(IRC/1885/020) study , we enrolled 512 neonates born and admitted in maternal child health care ward and Post Natal ward of a tertiary health care cener irrespective of cutaneous manifestations. Convenience sampling technique was used. They were examined till their stay in hospital and followed up weekly via telephone for development of dermatological manifestations. Results: Out of 512 neonates examined, 415 (81.05%) of neonate had at least one cutaneous manifestation.393 (94.69%) had physiological skin lesions, 22 (5.31%) had pathological skin lesions. The most common physiological skin manifestations were sebaceous gland hyperplasia, mongolian spot, ETN, milia and epstein pearl. The pathological cutaneous manifestations though least common comprised of cradle cap, napkin dermatitis and bacterial infections. Most of the lesions were present within 24 hours of birth and many of them were physiological transient lesion. Conclusions: In conclusion, our study highlights the high prevalence of cutaneous manifestations in neonates, with the majority being physiological in nature. Medical personnel must be well versed in the skin changes of neonates which will further help prevent unnecessary treatment and identify life threatening situations that require additional attention.

Presence of pesticide-tolerant microorganisms in high-altitude pristine lakes within Singalila Ridge of the Himalayas.

This is the first report on high pesticide tolerance displayed by the microbiota isolated from the sediments of two high-altitude lakes, located in the Singalila National Park, Singalila Ridge of the Himalayas. Given the remote location of these lakes, direct exposure to chemical pesticides is highly unlikely. However, the high tolerance to commonly used pesticides exhibited, i.e. up to 250mg/ml, suggests repeated exposure and contamination of the lakes. Microbial growth in the presence of varying concentrations of the pesticides, namely, emamectin benzoate, thiamethoxam, quinalphos, deltamethrin, spiromesifen, flubendiamide, monocrotophos, fipronil, fenazaquin and phorate, was tested. Results showed resistance to all pesticides except fenazaquin and fipronil, up to 250mg/ml. For the latter two, tolerance was displayed up to a concentration of 40mg/ml. Tolerance may potentially result from the transport and deposition of pesticides from nearby locations, particularly the tea plantations of Darjeeling and Eastern Nepal. This may create great ecological risks as these lakes are an important water source for endemic wildlife of this protected area. They also hold great significance to the religious sentiment of the local tribes who worship these lakes as sacred. The study highlights the need for monitoring pesticide contamination in such pristine high-altitude environments and the mechanisms of long-range pollutant transport.

Anthropometric and Nutritional status of Chronic Obstructive Pulmonary Disease presenting in Acute Exacerbation in Tertiary care Hospital in Eastern Nepal

Background: There is scarcity of data regarding the nutritional status of COPD patients presenting in exacerbation in our setup, thus this observational study was conducted. Methods: We performed an observational study of patients with acute exacerbation of COPD, who were admitted in the Department of Pulmonary, Critical care and Sleep Medicine in tertiary hospital in eastern Nepal from April 2023 to June 2023. Results: During the study period, a total of 154 patients of COPD with exacerbations were admitted in our department. The baseline anthropometric parameters, lab parameters as well as the malnutrition scores were determined. The mean BMI was 21.82 ± 3.92 kg/m2 and only 29% had BMI &lt; 18.5 kg/m2.The mean hemoglobin, mean cell volume, serum protein, serum albumin, serum calcium, phosphorus and vitamin D level were 12.43 ± 2.32 g/dL, 84.4 ± 9.41 fL, 6.42 ± 1.74 g/ dL, 3.32 ± 0.34 g/dL, 8.98 ± 0.63 mg/dL, 3.02 ± 0.42 mg/dL, 18.48 ± 8.22 pg/mL and 40%, 12%, 28%, 41%, 31%, 42% and 49% of these values were below the lower normal limit respectively. The nutritional status tool used NRS-2002, MUST and MNAS-F screened malnutrition in about 68%, 51% and 54% respectively. There shows a discrepancy between the evaluation of the malnutrition assessed by BMI with that of nutritional assessment score. Conclusion: COPD who present in exacerbations are malnourished, but use of sole BMI to rule out malnutrition in such group of patients can cause false negative result.

Effect of Nesting and Swaddling on Sleep Duration of Preterm Neonate Hospitalized at Tertiary Care Centre of Eastern Nepal

Background: All preterm neonates’ sleep is disturbed during hospitalization period due to various stressful environmental factors and human error and without focusing in individual developmental care. This impacts neonatal neurological development as well as normal growth resulting lifelong disabilities. Thus, modification of the environment by intervening developmental care could minimize the iatrogenic effect and neuro-developmental delay by decreasing stressful environment. This study was conducted to assess the effect of nesting and swaddling on sleep duration of preterm neonates during hospitalization at B.P.Koirala Instituted of Health sciences (BPKIHS). Methods: True experimental (post-test control design) study conducted among 36 preterm neonates, admitted in Nursery and Neonatal Unit of BPKIHS. The objective of this study was to assess the effect of nesting and swaddling on sleep duration. Consecutive sampling technique was used for total sample size then after random allocation is applied for creates the samples into two groups: experimental and control. Performa was used to collect socio-demographic characteristics. Sleep duration was recorded in self-administer observation form base on the observational behavior characteristics scoring of neonatal sleep by AASM (American Academy of sleep Medicine). As intervention, nesting and swaddling were performed in experimental group, then the sleep was video-recorded for 2 hours for each neonate. Finally, data were analyzed using descriptive and inferential statistics. Results: Among the enrolled neonates, there were 23 male (63.9%) and 13 female (36.1%) preterm. There was significant difference in sleep duration between experimental and control group. The mean ± SD of sleep duration was 59.22 ± 22.61 minute in experimental group and 39.50 ± 8.06 minute in control with p-value 0.001. The mean sleep duration was not associated with other selected study variables except the performed intervention. Conclusions: Nesting and Swaddling can be used as convenient and effective method to increase neonatal sleep duration or rest period.

Geomorphological evidence inconvenient for the antecedent rivers of the Arun and Tista across the Himalayan range

The Arun and Tista Rivers, which flow across the Himalayas, are commonly known as antecedent valleys that overcame the rapid uplift of the Higher Himalayan ranges. To clarify whether the idea of antecedent rivers is acceptable, we investigated the geomorphology of the Himalayas between eastern Nepal and Bhutan Himalayas. The southern part of Tibetan Plateau, extending across the Himalayas as tectonically un-deformed glaciated terrain named as ‘Tibetan Corridor,’ does not suggest the regional uplift of the Higher Himalayas. The 8,000-m class mountains of Everest, Makalu, and Kanchenjunga are isolated residual peaks on the glaciated terrain composed of mountain peaks of 4,000–6,000 m high. The Tibetan glaciers commonly beheaded by Himalayan glaciers along the great watershed of the Himalayas suggest the expansion of Himalayan river drainage by glaciation. For the narrow upstream regions of the Arun and Tista Rivers with less precipitation behind the range, it is hard to collect enough water for the power of down-cutting their channels against the uplifting Himalayas. The fission track ages of the Higher Himalayan Crystalline Nappe suggest that the Himalayas attained their present altitude by 11–10 Ma, and the Arun and Tista Rivers formed deep gorges across the Himalayas by headward erosion.