The manifold costs of being a non-native English speaker in science

The use of English as the common language of science represents a major impediment to maximising the contribution of non-native English speakers to science. Yet few studies have quantified the consequences of language barriers on the career development of researchers who are non-native English speakers. By surveying 908 researchers in environmental sciences, this study estimates and compares the amount of effort required to conduct scientific activities in English between researchers from different countries and, thus, different linguistic and economic backgrounds. Our survey demonstrates that non-native English speakers, especially early in their careers, spend more effort than native English speakers in conducting scientific activities, from reading and writing papers and preparing presentations in English, to disseminating research in multiple languages. Language barriers can also cause them not to attend, or give oral presentations at, international conferences conducted in English. We urge scientific communities to recognise and tackle these disadvantages to release the untapped potential of non-native English speakers in science. This study also proposes potential solutions that can be implemented today by individuals, institutions, journals, funders, and conferences. Please see the Supporting information files (S2-S6 Text) for Alternative Language Abstracts and Figs 5 and 6.

A thalamic epidermoid cyst presenting with memory disturbances: a case report

Epidermoid cysts are benign, slow-growing tumors. They account for 0.2-1.8% of all intracranial tumors and rarely appear as intraparenchymal masses. The most prevalent symptom in people of middle age is an insidious-onset headache.

Case presentation

We present a 20-year-old college student who presented with memory disturbances. The imaging revealed a left thalamic mass. The tumor was excised and diagnosed histopathologically as an epidermoid cyst.

Clinical discussion

Epidermoid cysts resemble epidermal skin cells in histology. The lesion of the thalamus involving the ventrolateral and anterior regions is involved with memory and language. Of note, to our knowledge, no cases of memory issues associated with thalamic epidermoid cysts have been reported in the literature.

Conclusion

The ideal treatment is cystic component removal with complete capsule excision. Sometimes, in cases of incomplete excision, radiotherapy can be another option.

The impact of time at home on potential yield of home-based TB contact investigation

BACKGROUND: The yield of TB contact tracing is often limited by challenges in reaching individuals during the screening process. We investigated the times at which index patients and household contacts were typically at home and the potential effects of expanding the timing of home-based contact investigation.METHODS: Index patients and household contacts in Kampala, Uganda, were asked about their likely availability at different day/time combinations. We calculated the "participant identification gap" (defined as the proportion of participants who reported being home <50% of the time) during business hours only. We then estimated the incremental reduction in the participant identification gap if hours were expanded to include weekday evenings, Saturdays, and Sundays. Statistical significance was assessed using McNemar´s tests.RESULTS: Nearly half of eligible individuals (42% of index patients and 52% of contacts) were not likely to be home during contact investigation conducted only during business hours. Expanding to weekday evenings, Saturdays, and Sundays would reduce this participant identification gap to 15% among index patients and 18% among contacts - while also reducing differences by sex and employment.CONCLUSIONS: Expanding hours for conducting contact investigation or other home-based health interventions could substantially reduce the number of individuals missed and address disparities in access to care.

Outcomes of surgical excison of mass in the eloquent areas of brain : A prospective study at National Academy of Medical Sciences, Bir Hospital

Introduction: The treatment of choice for high and low-grade gliomas is primarily surgical resection, many gliomas of highly eloquent cortical regions still are not operated because of the impending risk of surgery-related deficits. Tumors of eloquent areas like sensorial, motor and language cortex need to be operated carefully so that the symptoms don’t worsen after surgery. However, Intra operative computerized tomography (IOCT), neuronavigation including optical as well as EM (electromagnetic), Neuromonitoring, stereotaxy and awake surgery increase safety, which allows resection of most of these tumors with a considerably low rate of new deficits postoperatively. Materials and Methods: Between 2021 and 2022, a consecutive series of 30 patients who had undergone surgery for tumors on eloquent area of brain, at National Neurosurgical Referral Center (NNRC), National Academy of Medical Sciences (NAMS), Bir hospital were included in this study. Ethical approval was taken from Institutional review board (IRB) of NAMS for the study. Preoperative functional MRI, DTI scan that revealed mass in eloquent brain areas were evaluated. The preformed proforma was used to collect the data including preoperative karnofsky performance score, age, gender, clinical. Manifestations, size and location of tumor, degree of resection, pathological grade. Patient are followed postoperatively for 3 months and postoperative KPS, morbidity and mortality was recorded. SPSS version 22 was used for statistical analysis. Results: Out of these 30 lesion were 13 (43.3%) were WHO grade IV, 5 (16.6% ) were WHO grade III astrocytoma, 3 (10% ) were WHO grade III oligodendroglioma , 2 (6.6% ) were WHO grade II astrocytoma, 4 ( 13.3%) were WHO grade I astrocytoma, 2 were tuberculoma and 1 was cavernoma. Majority of the patients (70%) (n=21 out of 30) presented with seizures. The mean age of the patient was 41.7 years (ranging from 21-71 years). Male predilection was observed accounting 60 % of the cases. Conclusion: The surgery of eloquent areas of brain though carries the risk of increased post operative neurological deficit, with assistance of advanced technology and experienced surgeons it still feasible option especially for young patients with good karnosky score and low grade tumors which has improved overall survival.

Massive Hemoptysis and Pulmonary Thromboembolism in a Patient with Pulmonary Tuberculosis: A Therapeutic Conundrum Managed with Bronchial Artery Embolization

Hemoptysis is a crucial entity taking into account its morbidity and mortality. Pulmonary tuberculosis is the leading cause for massive hemoptysis in our part of the world, which if left untreated may be life threatening. We present a case of a 37-year-old male patient with pulmonary tuberculosis with concurrent pulmonary thromboembolism presenting with massive hemoptysis, which was successfully managed with Bronchial Artery Embolization. This case represents that this measure can be a viable therapeutic choice for a patient with a severe lifethreatening hemoptysis, particularly when other treatment options are unavailable or ineffective.

Evaluating the reliability of media reports for gathering information about illegal wildlife trade seizures

Illegal wildlife trade (IWT) is threatening many species across the world. It is important to better understand the scale and characteristics of IWT to inform conservation priorities and actions. However, IWT usually takes place covertly, meaning that the data on species, trade routes and volumes is limited. This means that conservationists often have to rely on publicly available law enforcement reports of seizures as potential indicators of the magnitude and characteristics of IWT. Still, even these data may be difficult to access, leading conservationists to use media reports of seizures instead. This is the case in countries like Nepal, which have limited capacity in data keeping and reporting, and no centralized data management system. Yet reliance on media reports risks introducing further biases, which are rarely acknowledged or discussed. Here we characterize IWT in Nepal by comparing data from three sources of information on IWT between January 2005 and July 2017: seizure reports from three Nepali national daily newspapers, official seizure records for Kathmandu district, and data on additional enforcement efforts against IWT in Nepal. We found a strong positive correlation between the number of official and media-reported seizures over time, but media under-reported seizure numbers, with 78% of seizures going unreported. Seizures of charismatic, protected species were reported more often and seizure reports involving tigers were most likely to be reported (57%). Media reports appeared to be a good indicator of trends and the species being seized but not overall seizure number, with the media largely underestimating total seizure numbers. Therefore, media reports cannot be solely relied upon when it comes to informing conservation decision-making. We recommend that conservationists triangulate different data sources when using seizure data reported in the media to more rigorously characterise IWT.

Overcoming racism in the twin spheres of conservation science and practice

It is time to acknowledge and overcome conservation's deep-seated systemic racism, which has historically marginalized Black, Indigenous and people of colour (BIPOC) communities and continues to do so. We describe how the mutually reinforcing ‘twin spheres’ of conservation science and conservation practice perpetuate this systemic racism. We trace how institutional structures in conservation science (e.g. degree programmes, support and advancement opportunities, course syllabuses) can systematically produce conservation graduates with partial and problematic conceptions of conservation's history and contemporary purposes. Many of these graduates go on to work in conservation practice, reproducing conservation's colonial history by contributing to programmes based on outmoded conservation models that disproportionately harm rural BIPOC communities and further restrict access and inclusion for BIPOC conservationists. We provide practical, actionable proposals for breaking vicious cycles of racism in the system of conservation we have with virtuous cycles of inclusion, equality, equity and participation in the system of conservation we want.

Why do people purchase antibiotics over-the-counter? A qualitative study with patients, clinicians and dispensers in central, eastern and western Nepal

Introduction

Over-the-counter (OTC) use of antibiotics contributes to the burgeoning rise in antimicrobial resistance (AMR). Drawing on qualitative research methods, this article explores the characteristics of OTC sales of antibiotic in Nepal, its drivers and implications for policy.

Methods

Data were collected in and around three tertiary hospitals in eastern, western and central Nepal. Using pre-defined guides, a mix of semi-structured interviews and focus group discussions were conducted with dispensers at drug stores, patients attending a hospital and clinicians. Interviews were audio-recorded, translated and transcribed into English and coded using a combination of an inductive and deductive approach.

Results

Drug shops were the primary location where patients engaged with health services. Interactions were brief and transactional: symptoms were described or explicit requests for specific medicine made, and money was exchanged. There were economic incentives for clients and drug stores: patients were able to save money by bypassing the formal healthcare services. Clinicians described antibiotics as easily available OTC at drug shops. Dispensing included the empirical use of broad-spectrum antibiotics, often combining multiple antibiotics, without laboratory diagnostic and drug susceptibility testing. Inappropriately short regimens (2–3 days) were also offered without follow-up. Respondents viewed OTC antibiotic as a convenient alternative to formal healthcare, the access to which was influenced by distance, time and money. Respondents also described the complexities of navigating various departments in hospitals and little confidence in the quality of formal healthcare. Clinicians and a few dispensers expressed concerns about AMR and referred to evadable policies around antibiotics use and poor enforcement of regulation.

Conclusions

The findings point to the need for clear policy guidance and rigorous implementation of prescription-only antibiotics.

Record of Indian Roofed Turtle Pangshura tecta (Reptilia: Testudines: Geoemydidae) from Koshi Tappu Wildlife Reserve, Nepal

This paper provides a detailed account of Indian Roofed Turtle Pangshura tecta (Gray, 1831) recorded alive from Koshi Tappu Wildlife Reserve, Nepal. 

Prevalence of Acute Abdomen Admission in Surgery Ward at Tertiary Care Center of Nepal

INTRODUCTION: Abdominal pain is one of the most common reasons for an emergency department visit, accounting to about 8% of all emergency visits in United States. There are very few data available regarding the emergency admission of acute abdomen in Nepal. The aim of this study is to determine the prevalence of acute abdomen admission and their frequency according to the age, sex and month of admission in hospital.  MATERIAL AND METHODS: This was a retrospective descriptive study carried out in Universal College of Medical Sciences, Bhairahawa, Nepal. Admission registers of surgery ward from July 2017 to June 2018 were reviewed. Data regarding the diagnosis, age, sex and month of admission of the patients were collected. Descriptive analyses were done regarding the frequency of disease, distribution of the diseases according to the age, sex and month of occurrences.  RESULTS: Total of 675 patients with acute abdomen were analyzed. Acute appendicitis was the most common cause for acute abdomen accounting for 52% of total admission. It was followed by intestinal obstruction (13%) and acute cholecystitis (11%). Median age of presentation of acute appendicitis was 23 years. Median age of presentation of acute cholecystitis was 42 years. Acute abdomen occured most frequently on April, May and December. Overall, spring season had highest number of admission (31.5%) followed by winter (25.6%).  CONCLUSION: Acute abdomen incidence varies according to age, most commonly found in young adults. Male has higher prevalence of acute abdomen when compared to female with exception of acute cholecystitis.

Knowledge, attitude and practice of healthcare ethics among resident doctors and ward nurses from a resource poor setting, Nepal

BACKGROUND

Healthcare ethics is neglected in clinical practice in LMICs (Low and Middle Income Countries) such as Nepal. The main objective of this study was to assess the current status of knowledge, attitude and practice of healthcare ethics among resident doctors and ward nurses in a tertiary teaching hospital in Nepal.

METHODS

This was a cross sectional study conducted among resident doctors (n = 118) and ward nurses (n = 86) in the largest tertiary care teaching hospital of Nepal during January- February 2016 with a self-administered questionnaire. A Cramer's V value was assessed to ascertain the strength of the differences in the variables between doctors and nurses. Association of variables were determined by Chi square and statistical significance was considered if p value was less than 0.05.

RESULTS

Our study demonstrated that a significant proportion of the doctors and nurses were unaware of major documents of healthcare ethics: Hippocratic Oath (33 % of doctors and 51 % of nurses were unaware), Nuremberg code (90 % of both groups were unaware) and Helsinki Declaration (85 % of doctors and 88 % of nurses were unaware). A high percentage of respondents said that their major source of information on healthcare ethics were lectures (67.5 % doctors versus 56.6 % nurses), books (62.4 % doctors versus 89.2 % nurses), and journals (59 % doctors versus 89.2 % nurses). Attitude of doctors and nurses were significantly different (p < 0.05) in 9 out of 22 questions pertaining to different aspects of healthcare ethics. More nurses had agreement than doctors on the tested statements pertaining to different aspects of healthcare ethics except for need of integration of medical ethics in ungraduate curricula (97.4 % doctors versus 81.3 % nurses),paternalistic attitude of doctor was disagreed more by doctors (20.3 % doctors versus 9.3 % nurses). Notably, only few (9.3 % doctors versus 14.0 % nurses) doctors stood in support of physician-assisted dying.

CONCLUSIONS

Significant proportion of doctors and nurses were unaware of three major documents on healthcare ethics which are the core principles in clinical practice. Provided that a high percentage of respondents had motivation for learning medical ethics and asked for inclusion of medical ethics in the curriculum, it is imperative to avail information on medical ethics through subscription of journals and books on ethics in medical libraries in addition to lectures and training at workplace on medical ethics which can significantly improve the current paucity of knowledge on medical ethics.

Acute renal infarction and cardioembolic stroke in a patient with atrial fibrillation and hyperthyroid-induced cardiomyopathy: a case report

BACKGROUND

Acute renal infarction is a rare entity with varied misleading manifestations resulting in diagnostic delay, misdiagnosis, and treatment leading to renal damage.

CASE PRESENTATION

We report the case of a 28-year-old Dalit Nepalese man who presented with sudden onset occipital headache and later developed severe left flank pain. He was diagnosed with posterior cerebral infarction with hemorrhagic transformation and a subsequent acute renal infarction with atrial fibrillation and hyperthyroid-induced cardiomyopathy. He was managed with oral anticoagulant and antithyroid drug.

CONCLUSION

A high index of suspicion of acute renal infarction is required in patients with risk factors of thrombosis presenting sudden onset flank pain.

Magnesium sulphate in management of severe pre-eclampsia and eclampsia

BACKGROUND

Pre-eclampsia and eclampsia (PE/E) are the second leading cause of maternal mortality in Nepal accounting for 21% of all maternal deaths and 30% of all facility based maternal deaths. For treatment of severe pre-eclampsia and eclampsia (SPE/E), WHO has identified magnesium sulphate (MgSO4) as the most effective and low cost medication. The objective of the study was to explore current situation of SPE/E management using MgSO4 in 10 health facilities of Mid Western Development Region.

METHODS

Descriptive and single group pre-test, post test study design was used for the study. Data were collected by reviewing records, taking interviews and through observation. Knowledge and skills of service provider was assessed and scored (0-100%) before and after the educational intervention.

RESULTS

One year records indicate that 0.5% SPE/E cases were found in Dang Sub Regional Hospital and Pyuthan District Hospital; 0.4% in Bheri Zonal Hospital; 0.9% in Mehelkuna PHCC and 0.5% in Rajapur PHCC. In most of the hospitals, these cases were managed with MgSO4. During pre-testing none of the health facility was able to get standard score (80%) but in post test, 50% health facilities were able to get 80% or higher score.

CONCLUSIONS

Establishing national standard and providing one-time training is not sufficient, it requires refresher onsite training for propermanagement of SPE/E on time to improve maternal and neonatal health.

An ultrasonographic evaluation of solitary muscular and soft tissue cysticercosis

BACKGROUND

Cysticercosis in humans is infection with the larval form (cysticercus cellulosae) of the pork tapeworm T. solium. Encystment of larvae can occur in almost any tissue. The location of cysts in order of frequency is the central nervous system, subcutaneous tissue and striated muscle, vitreous humour of the eye and, rarely, other tissues. High resolution ultrasound can be used in the diagnosis of muscular and soft tissue cysticercosis.

OBJECTIVE

The aim of this study is to evaluate the ultrasonographic findings in cases of muscular and soft tissue cysticercosis.

MATERIALS AND METHODS

It was a retrospective review of the cases of muscular and soft tissue cysticercosis which were diagnosed by ultrasound during June 2007 to May 2009 in the department of Radiology and Imaging, Nepalgunj Medical College Teaching Hospital. A total of six patients were evaluated.

RESULT

There were four males and two females. Age of the patient ranged from 18 to 50 years. All of the patients presented with a swelling with pain in fi ve of them. There was a wide variation in the location of the cysts. In all cases ultrasound revealed a cystic lesion with an echogenic eccentric pedunculated nodule attached to the wall. The mean diameter of the cyst was 6mm. Smooth wall was present in fi ve cases whereas one of the cysts revealed irregular wall. Pericystic inflammatory changes were seen in the adjacent muscles.

CONCLUSION

Ultrasound is a safe and non-invasive method that can be used in the diagnosis of muscular and soft tissue cysticercosis.

Unusually large prostatic utricle cyst

Prostatic utricle cyst is one of the uncommon conditions and only a few cases have been reported. We present a case of unusually large prostatic utricle cyst in a 13- year- old male. He presented with burning urination and post-void dribbling of urine. A cystic mass was felt on digital per rectal examination. Ultrasound pelvis revealed a well-defined midline cystic mass posterior to the urinary bladder. Subsequent magnetic resonance imaging (MRI) of the pelvis demonstrated fluid containing cystic lesion communicating with posterior urethra. Surgical resection of the cyst was performed through the posterior sagittal approach. Follow up of the patient after three months of operation, there was complete resolution of the symptoms.

A study of wasp bites in a tertiary hospital of western Nepal

Hymenopterid stings and subsequent allergic reactions including fatal anaphylaxis are common indications for emergency department visits worldwide. Besides that, sting can cause death as a result of multi-system involvement ranging from intravascular hemolysis, rhabdomyolysis, acute renal failure, hepatic dysfunction and occasionally thrombocytopenia and coagulopathy. Eleven cases (all male, age 35.5 +/- 15.2 years) of wasp bites admitted in the Manipal Teaching Hospital (MTH), Pokhara during 01st February, 2006 to 30th October, 2007 were enrolled in this study. Mean wasp bites number was 48.7 +/- 7.1 (11-100) and mean time to reach the hospital from the bite time was 69.1 +/- 149.7 hours (1.5 h-12 days). Nine patients developed acute renal failure (ARF) and secondary hypertension. Eight patients underwent hemodialysis. Two patients stuck by more than 75 stings developed refractory pulmonary edema and died in the course of treatment. Victims with lesser numbers of wasp envenomation, who received quick initiation of alkaline diuresis and intensive dialytic support had shorter hospital stay and less severe complications.

Scimitar syndrome

A seven month old female child admitted to intensive care unit with increasing respiratory distress. Clinical examination revealed absence of cyanosis, wide and fixed normal intensity second heart sound. Chest radiograph revealed crescent like radio opacity in right lower lung and subsequent contrast enhanced computed tomography (CT) chest demonstrated abnormal vessel in right lung draining into the inferior vena cava.

Solid-pseudopapillary tumour of the pancreas: a report of a rare case

The solid pseudopapillary tumour (SPT) of the pancreas is an uncommon cystic pancreatic neoplasm mostly seen in young females. We present a large SPT in a 16-year-old female who presented with acute onset upper- and mid-quadrant abdominal pain associated with nausea and vomiting for 4 days. The lesion was demonstrated by abdominal ultrasound and by computed tomography, which was successfully removed surgically.

Parkisonism with Shy-Drager syndrome--a case report

A previously healthy 60 years old female patient presented with bradykinesia, postural instability and increased rigidity of both upper and lower limbs for 2 years and was diagnosed as Parkinsonism for last years. Later on she developed features of autonomic dysfunction including postural hypotension, hyperhydrosis and urinary incontinence so was diagnosed as Shy-Drager Syndrome. She was treated with fludrocortisone and nefidipine for the management of postural hypotension. Patient developed aspiration pneumonia during oral feeding, despite of ICU management for the same cause patient died of respiratory arrest.

When left ventricular failure complicates chronic obstructive pulmonary disease: hypoxia plays the major role

INTRODUCTION

As the chronic obstructive pulmonary disease (COPD) progress, is usually accompanied by involvement of the both left ventricle (LV) and right ventricle (RV), and their systolic and diastolic function. Signs and symptoms of LV failure can be difficult to distinguish from those of COPD.

OBJECTIVE

The study was carried out to determine the prevalence of LV systolic dysfunction in the COPD patients and to assess the possible risk factor behind such development.

MATERIAL AND METHODS

It is a prospective study of 60 cases of COPD patients with or without cor-pulmonale attending Manipal Teaching Hospital.

RESULTS

The prevalence of LV systolic dysfunction was found to be 26.7%, and the findings directly correlate with the severity of COPD i.e., the more the severity of the lung disease more the probability for the incidence of LV systolic dysfunction. These data are in support of the hypothesis that hypoxia and the excess accumulation of toxic metabolic products like lactic acid, significant right-to-left shunting through the bronchial circulation explains the diminished LV ejection fraction in severe COPD patients.

CONCLUSION

Routine echocardiography investigation of the severe COPD patients is required for assessing the status of LV function and to rule out the possible association of LV systolic dysfunction.

A rare case of pancreatic mediastinal pseudocyst

Pancreatic pseudocysts are the most common cystic lesions of the pancreas, accounting for 75-80% of such masses. Pancreatic pseudocyst with mediastinal extension is a rare clinical entity and only a handful cases report on dysphagia associated with mediastinal pseudocyst formation.1 We present a case of pancreatic mediastinal pseudocyst that presented with palpitations and dysphagia. Demonstration of cystic lesion in relation to the pancreas on ultrasound and mediastinal extension of the cyst on CT suggested the diagnosis.

Reduction of acute anterior shoulder dislocations under local anaesthesia--a prospective study

OBJECTIVE

To evaluate the application of local anaesthesia for reduction of acute anterior shoulder dislocation

DESIGN

A prospective study of patients coming with anterior dislocation of shoulder to KMCTH from July 2002 to Sep 2003.

SUBJECTS

Patients of aged 15-55 years with no associated fractures of adjoining bones.

RESULTS

A total of fifteen patients with anterior inferior shoulder dislocation were studied and all were reduced safely under local anaesthesia.

CONCLUSION

Use of intra-articular lignocaine for reduction of shoulder dislocation is safe and effective and is beneficial for countries like Nepal where health facilities are minimum in rural and suburban areas.

Comparison Between Diclosulam- and Imazapic-Based Weed Control Systems in Peanut1

Field studies were conducted in Florida and Alabama in 1998 and 1999 to evaluate imazapic [70gai/ha preemergence (PRE) or early postemergence (EPOST)], diclosulam (18 or 26 g ai/ha PRE or 18 g/ha EPOST) or imazapic + diclosulam (35 + 13 g/ha PRE or 35 + 9 g/ha EPOST). These treatments were applied alone or supplemented with either a paraquat + bentazon tank mixture or 2,4-DB. The intent was to determine if diclosulam, which has a mode of action similar to imazapic and is less persistent and less costly, could be incorporated into systems with other herbicides and thereby offer an alternative to imazapic. Maximum yield and economic return were consistently associated with only two treatments, imazapic at 70 g/ha EPOST and imazapic + diclosulam at 35 + 9 g/ha EPOST. However, none of the diclosulam-based systems provided a more favorable economic return than imazapic applied alone due to poor sicklepod control with diclosulam. Sicklepod control with diclosulam was improved with the addition of either paraquat + bentazon or 2,4-DB, but control was less than that obtained with imazapic. Diclosulam-based systems could be identified that were as effective as imazapic alone in controlling Florida beggarweed (diclosulam 26 g/ha EPOST or imazapic + diclosulam PRE or EPOST), bristly starbur (diclosulam 18 g/ha PRE or imazapic + diclosulam PRE or EPOST) and yellow nutsedge (imazapic + diclosulam EPOST). Thus, diclosulam-based systems may offer an economic advantage over imazapic in areas void of sicklepod. Neither diclosulam nor imazapic adversely affected any of five runner-type peanut cultivars (Georgia Green, Southern Runner, ViruGuard, Florida MDR 98, or Florida C-99R) when applied at twice labeled rates.