COVID-19 pandemic and suicides in Nepal: Way forward for prevention

The SARS-CoV-2 pandemic has firmly rooted itself within our countries, communities, homes and now everyday lives. The impact of this global pandemic is immeasurable as it is catastrophic in nature and involves both a human and financial loss. Suicide and self-harm (SH) are both a serious public health and social issue. It is however preventable via the use of timely, evidence-based and many times low-cost interventions and therapies. The current situation depicted Nepal shows a true indicator of the mental health of the nation, as a precipitating factor (i.e., the extreme stress of COVID-19 and the lockdown) has exposed the submerged “ice-berg” phenomenon of disease. It is evident that COVID-19 and the lockdown had a massively negative effect on the mental health of the population in Nepal. The increased rates of suicide and self-harm also simultaneously exposed the great pre-existing fragility of the mental health of the nation. It is therefore vital that both Nepal and other countries alike take cognizance of the fact that extra support and preventative measures need to be introduced during this difficult period and that further national programs must be employed to best aid the mental health of their fellow countrymen.

Similarity, does it necessary mean plagiarism? Stop intentional and exaggerated paraphrasing

During the last two decades, programs have been relied on to detect scientific plagiarism, as it is found that some authors use previous published results or scientific ideas without attributing them to their original authors. But the term similarity has been confused with scientific plagiarism. This led to the need for procedures that are not justified by intuition of mind, and led to the difficulty of conducting important research, unnecessary time wasting and difficulties.

Omicron: The pandemic propagator and lockdown instigator – what can be learnt from South Africa and such discoveries in future

The SARS-CoV-2 virus which causes the disease termed COVID-19 ripped through the globe in the latter part of 2019 and has left a state of fear, death and destruction in its wake. The Omicron variant was officially announced by the South African authorities on the 24th of November 2021, with the first confirmed sample of the infection being collected on the 9th of November 2021. The initial cases were flagged as a possible new variant due to the stark differences in the presentation and clinical features of the patients. At the time of Omicron’s discovery, the predominant variant circulating within South Africa was the Delta variant B.1.617.2 which typically presented with more severe and stark symptoms. Omicron spread rapidly within the Southern African content and abroad, principally South Africa, Botswana, Hongkong and Israel were among the first countries to record cases of the new variant. The first European case of the Omicron variant was confirmed on the 26th of November 2021 in Belgium. Towards the end of November 2021 cases of the new variant had been confirmed and recorded in France, the United Kingdom, Germany, Portugal and Scotland. Additional cases of the Omicron variant have been confirmed in Canada and Australia. At this current point in the development of the Omicron upsurge in cases the international community should aim for further vaccinations among their fellow countrymen, but more so vaccine equality should be ensured. Such equality should be ensured in the developing nations as the virus does not respect any boundaries or territories and thus a higher level of vaccination worldwide will confer greater protection to the global community as a whole.

Acetaminophen poisonings in Chilean healthcare settings: a 20-year story that does not end

Background: Acetaminophen (Paracetamol) is one of the most used and prescribed anti-inflammatory and analgesic drugs worldwide. It has become one of the main drugs related to accidental and intentional overdoses in many countries, including Chile. The objective of this work was to characterize acetaminophen poisonings occurred in Chile between the years 2001 and 2020. Methods: A retrospective study of acetaminophen poisonings among patients who were hospitalized in Chilean public and private hospitals was carried out between the years 2001 and 2020. Data was obtained from the Medical Outcome Statistical Report database. Inclusion criteria were cases of patients who were admitted into either public or private healthcare settings with diagnosis of acetaminophen poisoning according to the WHO ICD-10. Statistical analyses were run to establish associations between variables selected in the study. Results: A total of 2,929 cases were included in the study. 77 % of the cases corresponded to female patients (p<0.05). Patients’ age range went from 0 to 81 years old. Adolescents and young adults resulted more involved in reported cases during the 2001-2020 period (p<0.001). During the first period of the study, accidental poisonings were more commonly reported, however in the recent years intentional cases increased their occurrence, especially among female patients (p<0.05). A multivariate logistic regression model considered as statistically significant (p<0.05) the interaction between the variables age, gender and year of the event. Conclusion: The present study identified a large number of acetaminophen poisonings reported in Chile during the 2001-2020 period. Cases were characterized including patients’ gender, age, and poisoning intent. Health authorities should consider these findings as an opportunity to improve public health associated with the use and misuse of over-the-counter drugs, including acetaminophen

Epidemiologic characteristics, clinical management and Public Health Implications of Coronavirus Disease 2019 (COVID-19) in Pregnancy: A Systematic Review and meta-analysis

Background: The novel coronavirus disease 2019 (COVID-19) outbreak, caused by the pathogenic severe acute respiratory syndrome-2 (SARS-CoV-2) virus, is exponentially spreading across the globe. Methods: The current systematic review was performed utilizing electronic databases i.e. PubMed, MEDLINE and EMBASE. We searched for the keywords "COVID-19 AND "pregnancy" between January 1st, 2020 until December 31, 2020. Results: Out of 4005 records which were identified, 36 original studies were included in this systematic review. Pooled prevalence of vertical transmission was 10%, 95% CI: 4-17%. Pooled prevalence of neonatal mortality was 7%, 95% CI: 0-21%. Conclusion: The contemporary evidence suggests that the incubation period of COVID-19 is 2-14 days, and this infection could be transmitted even from the infected asymptomatic individuals. It is found that the clinical presentation of pregnant women with COVID-19 infection is comparable with the infected non-pregnant females, and the frequent symptoms were fever, cough, myalgia, sore throat and malaise. There are some cases with severe maternal morbidity and perinatal deaths secondary to COVID-19 infection. Under these circumstances, the pregnant women should focus on maintaining personal hygiene, proper nutrition and extreme social distancing to reduce the risk of COVID-19. Therefore, a systematic data reporting for evidence base clinical assessment, management and pregnancy outcomes is essential for prevention of COVID-19 infection among pregnant women.

Postoperative clinical nursing care pathway for patients with mucormycosis: An experience from a tertiary care hospital in Rajasthan, India

Background: The COVID-19 pandemic is a serious global health threat and it has numerous impacts on human life. India faced the problem of the second wave of COVID-19 and an unexpected new predicament in the form of mucormycosis has been added. The use of steroids drugs for long duration and comorbidity with COVID-19 infections are the risk factors of mucormycosis. It is important to understand the postoperative clinical pathway to assess and determine the policy and protocol, which help patients fasten their recovery, prevent further complications and readmission. Methods: A cross‑sectional descriptive design was used to conduct the study. We adopted the validated Immediate Post-Operative Recovery Assessment (IPR-PA) Scale to assess the postoperative clinical nursing care pathway for patients with mucormycosis. Results: The current study shows that patients had highest score in the physiology clinical recovery domain (75.25%) and the lowest post-operative clinical recovery score in psycho-social domain (20.83%). There was a significant positive correlation was found between all the domains. The medication status domains found significantly associated with participants’ age (P=.021) and physiological domains has shown significant association with received oxygen therapy during hospitalization (P=.046). Conclusion: Postoperative clinical nursing care pathway was effective to determine the progress of a patient. It helps us to know the parameter of different domains namely being physiological, physical, psycho-social and medication status. Patients required psycho-social support due to the epidemic and fear from disease.

Corticosteroid induced avascular necrosis and COVID-19: The drug dilemma

The severe and life-threatening nature of the COVID-19 infection, the ARDS (acute respiratory distress syndrome) as well as the cytokine storm induced by the infection, commands lifesaving high doses of steroid therapy. As in all pharmacological therapies adverse effects are present. One such adverse effect which is being reported is corticosteroid induced avascular necrosis of the femoral head/ osteonecrosis of the femoral head. It must be noted that AVN principally affects the femoral head and most commonly the anterolateral aspect thereof as it is the crux of weight bearing. Corticosteroids induce fat mobilization and this thus innately enhances the likelihood of fat emboli developing from the liver to occlude minor blood vessels in the femur, this thereby compromises the microvascular environment. Superadded to this the steroid therapy disrupts calcium metabolism and homeostasis which induces hypertrophy in the intramedullary fat cells, Gaucher cells and inflammatory cells; whilst increasing the activity of osteoclasts, thus increasing bone resorption and decreasing calcium uptake and deposition; ultimately leading to an insufficiency in the trabecular and cortical bone. This insufficiency thus equates to an increased intraosseous pressure which impedes intramedullary circulation and results in avascular necrosis. It is evident that avascular necrosis is directly caused by high dose steroid therapy, however the case reports have very clearly indicated that the rapid onset of AVN post recovery from the COVID-19 infection cannot be solely attributed to steroid therapy and that another benefactor induced by the COVID-19 infection is at play. It is thus vital for treating physicians to take cognisance of this adverse effect post recovery and therefore should ensure that prophylactic bisphosphonate therapy is initiated timeously and congruently.

Polycystic ovary syndrome among Indian adolescent girls – A systematic review and metanalysis

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in the progenitive age group and the leading cause of infertility. The worldwide prevalence of PCOS in women varies between 2.2% to 26%. Due to limited literature on burden of PCOS among adolescent girls, its significance is still unfathomed as a research is few and far between in the present time. We conducted Systematic review and metanalysis to estimate the pooled prevalence of PCOS among Indian adolescent girls (14-19 years).Methods: With the help of a search strategy, two authors searched Scopus, Embase and Pubmed independently. We screened studies considering eligibility criteria and extracted data. Selected studies were assessed for quality and risk biases using the NIH tool. R software was used for analysis.Results: Twelve studies were included in the meta-analysis. The total number of participants in the study was 4473. All studies scored average and above as per the NIH quality assessment tool. The prevalence of PCOS among adolescents based on the Rotterdam criteria was 17.74 per 100 (CI = 11.77-23.71) with I² =97 %. Hospital-based studies had a comparatively higher prevalence of PCOS as compared to community-based.Conclusion: Pooled prevalence of PCOS among Indian adolescents' girls was high, approximately one in five.

COVID-19 airborne transmission: a new frontier of infection

COVID-19 has spread around the globe and infections are still rising despite the development of vaccinations and protocols. Various mutations of the SARS-CoV-2 virus have arisen with a greater rate of transmission and increased virulence. New found research has proven that the new strains of the virus are more virulent and use airborne aerosolized transmission to enable long range spread of the virus. By virtue of the fact that the virus spreads through such means, increases the risk of transmission and contamination highly as the virus can be transmitted via long range and through common ventilation and duct systems. In light of this it is now pertinent for legislation to support the use of personal protection equipment to safeguard the health of the public.

Improving Last-mile Delivery of COVID-19 Vaccines: The Cluster Strategy

Vaccination against the COVID 19 virus is the most effective way to prevent infection and save lives. It is estimated that 285 million doses per month will be needed over the next five months to vaccinate all remaining adults by the end of 2021. To accelerate the vaccination coverage for its population, the state of Uttar Pradesh, North India, has planned a cluster approach to vaccination in rural areas. The cluster strategy is a micro-plan for vaccination by the government of U.P involving intensive mobilisation activities followed by vaccination at centres set up in schools, Panchayat Bhavans and other selected places. It is a people-centred and comprehensive approach, modelled on listening to the intended beneficiaries and stakeholders is vital. It will reduce expenses related to travel and loss of wages for those missing work while travelling far to get vaccinated. The cluster approach is also along the lines of the Near to Home COVID Vaccination Centres (NHCVC) for Elderly and Differently Abled Citizens. The main fear of the health workers regarding the cluster approach is concerning adverse events and their management at the peripheral level. This strategy is only practically possible if an adequate supply of vaccines is available. The cluster approach to vaccination ensures accessibility, includes community participation and is provided free of cost. This is thus in line with the concept of Primary Health Care (PHC) which is essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at a cost the community and country can afford. Popularising this strategy and applying it to other states in a tailored manner based on social and cultural practices can give the nation the necessary momentum to attain the target of herd immunity quickly and curb the COVID-19 pandemic.