Kathmandu Medical College

OBJECTIVE:To evaluate the effectiveness of interventions on physical activity promotion in low-income and middle-income countries (LMICs). DESIGN:Systematic review and meta-analysis. DATA SOURCES:PubMed, EMBASE, CINAHL and Cochrane CENTRAL. ELIGIBILITY CRITERIA:Randomised controlled trials and quasi-experimental studies published between January 2010 and September 2024. Primary outcomes included standardised mean difference (SMD) in physical activity outcomes reported mainly in metabolic equivalent to task (MET) minutes, physical activity minutes and sedentary behaviour. Data were synthesised using random-effects meta-analysis to calculate the SMD reported in a 95% CI, and the risk of bias was assessed using Cochrane Risk of Bias 2 (RoB 2) and Risk of Bias in Non-Randomised Studies of Interventions tools (ROBINS-I). SMDs of 0.2, 0.5 and 0.8 were interpreted as small, medium and large effects as per Cohen's threshold. RESULTS:23 studies involving 12 689 participants from LMICs were included in the meta-analysis. Results indicated a small but statistically significant overall effect on physical activity (SMD=0.29, 95% CI 0.13 to 0.46, I²=96%). Significant improvements were observed for MET minutes (SMD=0.42, 95% CI 0.21 to 0.64, I2=94%) and physical activity scores (SMD=0.86, 95% CI 0.38 to 1.35, I2=91%), but not in total physical activity minutes, sedentary time or energy expenditure, indicating interventions mainly enhanced activity intensity. Interventions via apps and interactive calls were most effective, though overall evidence certainty was low to very low because of heterogeneity and imprecision. CONCLUSIONS:Interventions, primarily delivered through mobile apps or interactive calls, led to small improvements in physical activity intensity and could have significant public health benefits in LMICs. Future interventions should be context-specific and backed by robust trials to increase their impact and inform sustainable policy. PROSPERO REGISTRATION NUMBER:CRD42023412477.

Impetigo is a common, contagious superficial bacterial skin infection predominantly affecting children aged two to five years. Severe presentations are rare but can be diagnostically and therapeutically challenging, particularly in rural, resource-limited settings. We report a 7-year-old girl from rural Nepal with severe non-bullous impetigo contagiosa unresponsive to initial therapy with topical mupirocin and oral cephalexin. Due to the absence of culture and sensitivity facilities and the high regional prevalence of methicillin-resistant Staphylococcus aureus (MRSA), empirical oral doxycycline was initiated. Marked improvement occurred within 48 hours, with complete resolution by day 7. This case underscores the importance of flexible, evidence-based empirical therapy for suspected MRSA in pediatric patients when diagnostic resources are unavailable, and highlights the short-term safety and efficacy of doxycycline in children.

Background/Objectives: Antimicrobial resistance (AMR) poses a global threat, exacerbated by the overuse and misuse of antimicrobials. This study evaluated antimicrobial use and prescribing patterns among inpatients in three tertiary hospitals in Nepal. Methods: A cross-sectional point prevalence survey of the inpatient module of the standardized Global-PPS methodology was conducted across three tertiary hospitals in Nepal during the 2022 Global-PPS Period 2 (P2) survey, carried out between May and August 2022. Data were collected via a paper-based form (University of Antwerp;) and analyzed descriptively. Antimicrobial use was defined as the proportion of inpatients receiving at least one systemic antimicrobial on the day of the survey. Results: Of 379 patients eligible for the study, 233 (61.5%) received at least one antimicrobial, with the highest prevalence observed in adult and neonatal intensive care units (ICUs). Out of 371 antibiotic prescriptions, third-generation cephalosporins (30.2%) and carbapenems (8.1%) were the most frequently prescribed, and 61.0% of overall antibiotics belonged to the Watch group of WHO AWaRe classification. Surgical prophylaxis often exceeded recommended durations, with 91.5% of prophylactic antibiotics prescribed for more than one day. Empirical therapy dominated 56.33% of all prescriptions, with targeted therapy limited to 4.04%. Conclusions: The high overall prevalence of antimicrobial use, the reliance on empirical therapy, and over-reliance on Watch-group antibiotics and Unclassified AWaRe antibiotics highlights the urgent need for robust antimicrobial stewardship programs in Nepal.

Rheumatic symptoms can be associated with malignancies. Although sacroiliitis is not a classic paraneoplastic syndrome, malignant infiltration of sacroiliac joints by multiple myeloma can mimic inflammatory rheumatologic disease. Multiple myeloma (MM), a plasma cell malignancy often presenting with bone pain, can involve axial skeletal structures, including the sacroiliac joints. We report a 40-year-old male with chronic low back pain and bilateral ankle enthesitis, unresponsive to nonsteroidal anti-inflammatory drugs (NSAIDs), along with systemic symptoms. Initial HLA-B27 positivity and imaging suggested Spondyloarthritis (SpA), but a poor treatment response prompted further evaluation. Serum protein electrophoresis, immunofixation, and bone marrow biopsy confirmed IgG-kappa MM. The coexistence of HLA-B27 positivity and sacroiliac joint changes mimicking axial spondyloarthritis poses a significant diagnostic pitfall, underscoring the need to consider multiple myeloma in patients with atypical features or a poor response to standard rheumatologic therapy.

BACKGROUND:Accurate physical activity data are essential for public health planning. In low- and middle-income countries, self-reported questionnaires often overestimate activity. This study compared physical activity estimates from a self-reported questionnaire with wrist-worn accelerometer data among adults in Nepal. METHODS:A cross-sectional study of 423 adults (aged 18-69 y) in Pokhara, Nepal, was conducted. Participants completed the Global Physical Activity Questionnaire (GPAQ) and wore an Axivity AX3 accelerometer on the nondominant wrist for 7 days. Accelerometer outcomes included moderate to vigorous physical activity (MVPA) minutes, light-intensity activity, and sedentary time. Accumulated self-reported MVPA was calculated by summing domain-specific physical activity minutes during work, transport, and leisure time. To compare accelerometer and GPAQ-derived estimates, we used the sign test that assesses paired median differences. RESULTS:Median daily MVPA was 15.3 (Q1-Q3: 4.1-37.5) minutes per day measured by accelerometer and 43.3 (Q1-Q3: 24.8-109.3) minutes per day by GPAQ. GPAQ reported a higher estimate, with a median paired difference of 25.7 (Q1-Q3: 3.8-87.4) minutes per day (P < .001). Only 41.7% of participants met World Health Organization's physical activity recommendations based on accelerometer-measured MVPA, compared with 81.9% by GPAQ. CONCLUSIONS:GPAQ reported substantially higher estimates of bouted MVPA compared with accelerometry in this semi-urban adult population. This study supports the value of complementing GPAQ-based surveillance with device-based measurement in representative subsamples and locally calibrated interpretation. Cost-effectively integrating accelerometers and locally validating self-report tools can improve physical activity surveillance. Financial and technical support are critical in low-resource settings to ensure fair tracking toward global targets.