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In recent decades, the rapid rise in electricity demand has compelled transmission and distribution systems to operate at almost their maximum capacity. This can pose numerous technical challenges such as excessive power losses, voltage and transient instabilities, as well as reduced power quality and reliability. Employment of Flexible Alternating Current Transmission System (FACTS) devices can be an effective approach to obviate such challenges and reinforce the power system functionality. Nevertheless, FACTS devices require a high initial investment, and hence their optimal allocation in terms of various aspects such as type, size and location is of utmost importance. This cannot be achieved without the deployment of optimization techniques. The aim of this paper is to provide a comprehensive review of the existing proposals for the enhancement of power system performance adopting FACTS devices. Adhering to that, an in-depth analysis is carried out, in which the most pertinent options are classified into specific groups based on their optimization objectives. Finally, a comparative analysis is accomplished in which the main attributes and drawbacks of each optimization technique are presented.

ObjectivesMedical oxygen supplementation is essential for treating severe illnesses and plays a critical role in managing life-threatening conditions, especially during the period of increased demand, such as the delta wave of COVID-19. The study aims to evaluate oxygen requirements and production to support effective capacity planning for future health crises.Design and settingCross-sectional quantitative study. Data collection was carried out between 15 March and 19 December 2021.Main outcome measuresThe study used secondary data from Nepal’s Health Emergency Operation Centre. Regarding medical oxygen production, calculations included oxygen generated from both hospital-based oxygen plants and private companies, using their highest capacities for comparison. These production capacities were then assessed using three levels of efficiency (100%, 80% and 50%), revealing significant gaps when compared against the oxygen requirements of hospitalised COVID-19 patients, as guided by WHO recommendations. The results were communicated in terms of J-size cylinders, alongside average daily COVID-19 hospitalizations. Data was inputted and analysed using Microsoft Excel and presented in numbers and percentage.ResultsThe country’s oxygen demand relies largely on the production from private enterprises, with meeting approximately 85.2% of the total requirement. Optimal production ensures that national oxygen needs will be met. The analysis highlighted that at 80% operational efficiency, 90.8% of the hospital’s requirements could be fulfilled. However, if operational efficiency drops to 50%, the fulfilment rate diminishes to 56.7%. The differences in requirement and production of oxygen are consistent across the provinces; however, a huge disparity was notable in Karnali and Sudurpaschim.ConclusionContinuous assessment of production capacities in both hospital and private enterprises producing oxygen is necessary to plan and address the gaps.

Nepal established the health partner coordination for COVID-19 response based on national and international plans and framework to support information-sharing for decision- making and course correction. This paper aims to assess the performance of COVID-19 Health Partner Coordination response in Nepal by adopting coordination best practices and tools from the international humanitarian cluster system. Secondary data from unpublished documents on health partner coordination for COVID-19 response in Nepal was collected and analysed from April 2023 to May 2023. The secondary data were from the review of the health partner coordination meetings conducted for COVID-19 response using a researcher-developed document review tool, responses of health partners on a survey tool adapted from the cluster coordination performance monitoring tool from the Global Health Cluster, and transcript of Focused Group Discussion among health partners. Descriptive analysis of quantitative information and thematic analysis with predefined themes of qualitative information were performed using MS Excel and MS Word respectively. A written approval from the Ministry of Health and Population and an ethical clearance from the Nepal Health Research Council was obtained before conducting the study. More than three-fifths of the meetings showed good results in conduction, process, participation, and documentation of meeting action points with improvement required for follow-up (22.2%). Assessment of health partner coordination subfunctions resulted in either 'good' (>75.0%) or 'satisfactory' (50.1%-75.0%) except for prioritization based on analyses, which was 'unsatisfactory' (<50%). Partners admired good practices of health partner coordination, pointed out some issues, and provided recommendations. COVID-19 has highlighted the importance of effective coordination of health sector for response to a pandemic. Continuation of this practice after addressing the areas for improvement will contribute to health preparedness and readiness for future disasters or public health emergencies.

Background The Human Immunodeficiency Virus (HIV) has a major impact on a person's social and personal lives, affecting both physical and mental health. To meet the global 95‐95‐95 target, it is essential to understand and address the multi‐level challenges to improve the continuum of care for persons living with HIV (PLWH). This study delves into the care‐seeking pathways and barriers encountered by PLWH residing in rural areas of Nepal, shedding light on the complexities of accessing and navigating the continuum of care. Design This study was designed as a qualitative thematic study that consisted of in‐depth interviews among 21 PLWH and key‐informant interviews among four health service providers in rural districts of Koshi province in Nepal. Semi‐structured interview guidelines were used to ensure consistency in the data collection process, followed by Inductive Coding to identify and categorize the data into codes. Subsequently, sub‐themes and themes were developed, and manifest analysis was conducted to analyze the data. The findings of the study are presented in this paper in the form of excerpts. Results The multilevel barriers to HIV care continuum included (i) socio‐cultural barriers such as stigma, discrimination, fear of disclosure, and heavy reliance on traditional healers; (ii) socio‐economic barriers such as poverty, limited access to health insurance, low health literacy and the exclusion of PLWH under Social Security Act; (iii) fatalistic lifestyles characterized by heavy alcohol consumption, and poor adherence to antiretroviral therapy and (iv) health system‐related barriers such as mistreatment by healthcare providers, and long distances to ART centers. Conclusions There is a need to expand services beyond treatment, including community‐focused awareness and sensitization, programs led by community‐based organization, economic empowerment and inclusion of PLWH under social security mechanisms in rural areas for HIV continuum of care. Patient and Public Contribution During the study design phase, two PLWH and two service providers were consulted to discuss the research gap, understand the current practices and discuss the data collection tools and their content. Similarly, four service providers supported implementation of the study and were also consulted to interpret the underlying meaning of the data. One service provider also contributed to the manuscript development process. PLWH and the service providers were also the study participants. The findings of the study are grounded in the data/information provided during the data collection phase, thus meaningfully contributing to this study.

Adverse pregnancy outcomes, including preterm birth and low birth weight, are major global health challenges, leading to millions of newborn deaths each year. Since 1996, periodontitis and related gum diseases have been proposed as potential contributing factors, but research findings remain mixed. Further research is needed to clarify this link. This study aims to assess the status of periodontitis and its association with adverse pregnancy outcomes. A cross-sectional study was conducted among 145 third-trimester mothers attending antenatal care (ANC) checkups at Maternity Hospital in Kathmandu. Data were gathered from medical records, interviews, and oral health screenings using the Community Periodontal Index (CPI) for periodontitis. Birth outcomes were assessed after delivery through medical records, which are considered highly reliable, with established protocols for data entry, consistent documentation, and regular quality control measures ensuring accuracy and consistency across healthcare providers. Ethical approval was obtained from the Nepal Health Research Council (NHRC) (approval no. 423) on September 19, 2023. Periodontitis was observed in 53 (36.6%) participants, with a higher prevalence in individuals aged 30 or more (10, 43.5%) and those who were illiterate (4, 50%). Health conditions such as hypertension, diabetes, and urinary tract infections were associated with higher periodontitis rates. However, no significant associations were found between age, education, obstetric history, or health conditions and adverse pregnancy outcomes. Periodontitis showed a significant association with adverse outcomes, with 56.6% of those with periodontitis experiencing adverse outcomes, compared to 32.6% without periodontitis ( = 0.005). The odds ratio of 2.69 indicates individuals with periodontitis are 2.69 times more likely to experience adverse outcomes. Maternal periodontitis is significantly associated with adverse pregnancy outcomes, with individuals having periodontitis being 2.69 times more likely to experience such outcomes. These findings highlight the importance of incorporating periodontal care into prenatal healthcare.

High speed metal foreign body (FB) caused penetrating injury, with midline fracture of the thyroid cartilage, to the larynx and got impacted in the oesophagus, later passed down to stomach. The larynx was repaired and FB was retrieved with gastrotomy under general anaesthesia. The patient was kept on total parental nutrition for 7 days and discharged on post-operative day 14.

Background Hepatitis B Virus (HBV) infection is a worldwide public health problem. In Nepal, the prevalence of HBV is found to be low (0.9%), although high prevalence (≥8%) of HBV infection is depicted among subgroup/population in the mountain region by various studies. This study assessed the prevalence and the risk of HBV infection among mothers, as well as among the youngest child under 5 years old living with hepatitis B positive mothers in Dolpa, the most remote mountain district of Nepal. Methods The cross sectional study survey was conducted between June and July 2014. All mothers with their youngest child under 5 years old were invited to participate in the survey and tested for hepatitis B surface antigen (HBsAg). The HBsAg positive mothers were further tested by 5-panel HBV test card. Children living with HBsAg positive mothers were also tested for HBsAg. Results One hundred fifty-one mothers, comprising 37% of the total study population in the selected Village Development Committees (VDCs), were surveyed in the mobile health camps. The seroprevalence of HBsAg among mothers and their youngest child under 5 years old living with HBsAg positive mothers were 17% (95% CI, 11.01–22.99%) and 48% (95%CI, 28.42–67.58%) respectively. The majority of HBV infected mothers were indigenous (84%) followed by Dalit (4%) and other castes (12%). Among HBV infected mothers, 40% were hepatitis B envelope antigen (HBeAg) positive. The prevalence of HBsAg was higher among children living with HBeAg positive mothers as compared to HBeAg negative (60% vs 40%) and male children compared to female (60% vs 33%). Thirty-six percent of children were vaccinated with a full course of the hepatitis B vaccine. Of these vaccinated children, 56% were HBsAg sero-positive. Conclusions The HBV infection rate is high among mothers and children living with HBsAg positive mothers in the indigenous population of the most remote mountain community of Nepal.

Sarcomatoid carcinoma of the lung is an uncommon subtype of non-small-cell lung cancer (NSCLC). Even in the early stages, pulmonary sarcomatoid carcinoma (PSC) has a dismal prognosis when compared to other kinds of NSCLC with a mean survival of 9-12 months and a five-year survival rate of around 20%. We present the case of a 68-year-old woman with a two-month history of shortness of breath and cough. Initial computed tomography (CT) scan showed features of interstitial lung disease with chronic obstructive airway changes. After 34 months, the patient's condition worsened with newer complaints of sore throat and hemoptysis. A repeat CT scan showed a ∼49x38x59mm size lesion in the superior segment of the left lower lobe. A core needle biopsy was performed, which revealed tumor cells consisting of irregular tubules and sarcomatoid components. The patient was started on chemotherapy. Unfortunately, she succumbed to her disease. Our case highlights the aggressiveness of PSC.

Background: Renal impairment is regularly seen in hospitalized stroke patients, affecting the outcome of patients, as well as causing difficulties in their management. A prospective cohort study was conducted to assess the trend of renal function in hospitalized ischemic and haemorrhagic stroke patients. The incidence of renal impairment in these subgroups, the contributing factors and the need for renal replacement in renal impaired patients was evaluated. Methods: Alternate day renal function testing was performed in hospitalized stroke patients. Estimated glomerular filtration rate (e-GFR) was calculated and the trend of renal function in the two stroke subgroups (haemorrhagic and ischemic) was assessed, with renal impairment defined as e-GFR < 60mL/ minute per 1.73m 2 . Results: Among 52 patients, 25 had haemorrhagic stroke (mean age 59.81 ± 14.67) and 27 had ischemic stroke (mean age 56.12 ± 13.08). The mean e-GFR (mL/minute per 1.732m 2 ) at admission in the haemorrhagic stroke subgroup was 64.79 ± 25.85 compared to 86.04 ± 26.09 in the ischemic stroke subgroup (p=0.005). Sixteen out of 25 (64%) patients in the haemorrhagic stroke subgroup and 9 out of 27 (33.3%) patients in the ischemic subgroup developed renal impairment (p=0.27). The location of the bleed (p=0.8), volume of hematoma (p=0.966) and surgical intervention (p=0.4) did not predispose the patients to renal impairment. One out of 16 patients with haemorrhagic stroke (who eventually died), and 2 out of 9 patients with ischemic stroke required renal replacement. Conclusion : Renal impairment is commonly seen in stroke patients, more so in patients who suffered haemorrhagic strokes.  The impairment, however, is transient and rarely requires renal replacement therapy.

Background: Renal impairment is regularly seen in hospitalized stroke patients, affecting the outcome of patients, as well as causing difficulties in their management. A prospective cohort study was conducted to assess the trend of renal function in hospitalized ischemic and haemorrhagic stroke patients. The incidence of renal impairment in these subgroups, the contributing factors and the need for renal replacement in renal impaired patients was evaluated. Methods: Alternate day renal function testing was performed in hospitalized stroke patients. Estimated glomerular filtration rate (e-GFR) was calculated and the trend of renal function in the two stroke subgroups (haemorrhagic and ischemic) was assessed, with renal impairment defined as e-GFR < 60mL/ minute per 1.73m 2. Results: Among 52 patients, 25 had haemorrhagic stroke (mean age 59.81 ± 14.67) and 27 had ischemic stroke (mean age 56.12 ± 13.08). The mean e-GFR (mL/minute per 1.732m 2) at admission in the haemorrhagic stroke subgroup was 64.79 ± 25.85 compared to 86.04 ± 26.09 in the ischemic stroke subgroup (p=0.005). Sixteen out of 25 (64%) patients in the haemorrhagic stroke subgroup and 9 out of 27 (33.3%) patients in the ischemic subgroup developed renal impairment (p=0.027). The location of the bleed (p=0.8), volume of hematoma (p=0.966) and surgical intervention (p=0.4) did not predispose the patients to renal impairment. One out of 16 patients with haemorrhagic stroke (who eventually died), and 2 out of 9 patients with ischemic stroke required renal replacement. Conclusion: Renal impairment is commonly seen in stroke patients, more so in patients who suffered haemorrhagic strokes.  The impairment, however, is transient and rarely requires renal replacement therapy.