Chitwan Medical College

Malnutrition remains one of the most pressing global health crises, exacerbating paediatric mortality in low- and middle-income countries. It has long-term implications, from immediate health concerns to weakened immune function and reduced economic productivity. Despite decades of progress driven by international collaboration, contemporary global disruptions have counteracted the gains in combating malnutrition. The US Agency for International Development (USAID) abruptly withdrew support, aggravating the situation, which previously funded large-scale nutrition programmes and health interventions across more than 50 countries. USAID tailored its assistance to nutritional rehabilitation, maternal-child health and healthcare infrastructure, significantly curbing child malnutrition in countries like Pakistan, South Sudan and Yemen. The dissolution of these programmes has placed millions of vulnerable children at increased risk of malnutrition. This editorial accentuates the urgency of addressing the funding gap left by USAID's cessation and calls for coordinated policy interventions, increased domestic investment in nutrition programmes and global collaboration through alternative funding sources. Strengthening food security initiatives, bolstering healthcare supply chains and launching public awareness campaigns on maternal and child nutrition are critical in preventing a worsening public health crisis.

Dyskeratosis congenita (DC) is a genetic disorder characterized by multisystem involvement. The most commonly affected systems are the mucocutaneous, bone marrow, and lungs. Though rare, chronic liver disease (CLD) has increasingly been reported to be associated with DC. The hepatic involvement can range from asymptomatic transaminasemia to end-stage liver disease. In this series, we present two cases of adult male patients with DC and decompensated CLD.

Cross-border postgraduate education is reshaping the public health workforce, yet little is known about what “return” looks like in aid-reliant health systems where authority, resources, and evidence are co-produced across government, research institutes, and international organizations. In Nepal, internationally trained public health scholars re-enter a mixed institutional landscape shaped by global higher-education markets, donor accountability regimes, and transnational procurement and supply chains. This study examines how Nepali returnees translate overseas training into system-facing work upon returning home, and how the timing of key milestones shapes what becomes actionable. Semi-structured interviews were conducted with 12 Nepali public health scholars who returned after postgraduate study abroad (five doctoral graduates; seven master’s graduates) and were working in Nepal at two research institutes and two international non-governmental organizations. Positive deviance purposive sampling targeted returnees with identifiable system impact. Data were analyzed using applied thematic analysis, guided by Bronfenbrenner’s bioecological model (micro-, meso-, exo-, and macrosystems), with the chronosystem examined as a cross-cutting influence. Four interconnected themes described patterned engagement across ecological levels. (1) Microsystem—reconstituting role and voice at home: return decisions were anchored in close relationships and early workplace recognition, with a time-sensitive shift from “credentialed outsider” to trusted colleague. (2) Mesosystem—boundary navigation: participants described convening and translating across institutions, with coordination accelerating after early probation and crystallizing around budget cycles, grant windows, and emergencies. (3) Exosystem—rules, resources, and distant decision-makers: procurement timelines, ethics review procedures, donor reporting templates, and customs/banking processes frequently determined the feasibility and tempo of reforms. (4) Macrosystem—national imaginaries, credential politics, and moral horizons of work: participants described credentials as opening initial doors, but sustained legitimacy depended on visible delivery amid shifting political and administrative cycles; some trained in regional Asian hubs emphasized the practical transferability of methods and policy argumentation. Across themes, timing mattered: family events, contract endings, fiscal quarters, monsoon disruptions, and crisis periods re-shaped constraints and opportunities. In this cohort, returnee contribution was bioecological and time-sensitive: agency was not simply “brought home,” but assembled through relationships, cross-organizational brokerage, arm’s-length governance, and national legitimacy contests, all modulated by temporal milestones. Treating return as a time-sequenced ecology of action—rather than skill transfer—can better inform how governments, funders, and academic institutions design re-entry supports, procurement and reporting architectures, and evidence-use processes so that international learning more reliably translates into public value. Not applicable.

Auditory-triggered motor events in infancy present a significant diagnostic challenge due to overlap between epileptic and non-epileptic startle phenomena. We report the case of a term female infant with neonatal-onset seizures and subsequent development of reproducible sound-triggered jerky movements, raising diagnostic uncertainty between exaggerated startle reflex and reflex auditory epilepsy. The child initially presented with seizures on the third day of life and was treated with phenobarbital. During early infancy, brief motor events consistently precipitated by sudden auditory stimuli were observed, later accompanied by spontaneous seizures and developmental plateauing. Serial electroencephalography (EEG) revealed evolution from focal frontotemporal interictal epileptiform discharges to multifocal epileptiform activity with marked sleep activation, while repeated brain magnetic resonance imaging remained structurally normal. Over time, global developmental delay with hypotonia and impaired motor milestones became evident. The electroclinical trajectory suggested an evolving epileptic encephalopathy within the epileptic encephalopathy with spike-wave activation in sleep spectrum, despite the absence of a classic continuous spike-and-wave during sleep pattern. Whole-exome sequencing identified a homozygous HEXA gene variant of uncertain significance, without definitive biochemical or clinical evidence of GM2 gangliosidosis. The child was managed with multiple antiseizure medications and supportive neurodevelopmental interventions, resulting in partial seizure control but persistent developmental impairment. This case underscores the importance of longitudinal electroclinical correlation in infants with stimulus-triggered motor events and highlights that reproducible auditory-induced events with evolving epileptiform EEG abnormalities and developmental impact strongly favor reflex auditory epilepsy over non-epileptic exaggerated startle, even in the setting of normal neuroimaging and genetic uncertainty.