Background

Background Smoke-free legislation banning tobacco smoking in public places was implemented across Nepal in 2014 with the ambition to reduce the impact of second-hand smoking. As part of a comprehensive policy package on tobacco control, the implementation of the legislation has seen a marked reduction in tobacco consumption. Yet there remains uncertainty about the level of compliance with smoke-free public places. Objectives This study assesses the compliance with smoke-free laws in public places and the factors associated with active smoking in public places in Biratnagar Metropolitan City, Nepal. Methods A cross-sectional study was conducted in the Biratnagar metropolitan city in Province 1 of Nepal from July to December 2019. A total of 725 public places within the metropolitan city were surveyed using a structured survey tool. Active smoking was the primary outcome of the study which was defined as smoking by any person during the data collection time at the designated public place. Results The overall compliance with smoke-free legislation was 56.4%. The highest compliance (75.0%) was observed in Government office buildings. The lowest compliance was observed in eateries, entertainment, and shopping venues (26.3%). There was a statistically significant association between active smoking and the presence of ‘no smoking’ notices appended at the entrance and the odds of active smoking in eateries, entertainment, hospitality, shopping venues, transportations and transits was higher compared to education and health care institutions. None of the ‘no smoking’ notices displayed fully adhered to the contents as prescribed by the law. Conclusion As more than half of the public places complied with the requirements of the legislation, there was satisfactory overall compliance with the smoke-free public places law in this study. The public venues (eateries, shopping venues and transportations) that are more frequently visited and have a high turnover of the public have lower compliance with the legislation. The content of the message in the ‘no smoking’ notices needs close attention to adhere to the legal requirements.

Early May 2021:A 38-year-old SARS-COV-2 positive man with mild symptoms was isolating at home. After several days, he became short of breath with pulse oximetry dropping to 88% on room air. With friends and families frantically calling all nearby hospitals for hours, a hospital bed was finally found. Upon admission, he received supplemental oxygen along with the available medicines. Two days after his admission the hospital ran out of medical oxygen. It was up to the family to find medical oxygen. Even after a full day's search for oxygen by all friends and family, not a single cylinder was found. A day later, gasping, he took his last breath. This is a common occurrence in Nepal during the second wave of the COVID-19 pandemic.Only two months prior, Nepal had reported zero deathson 10 th March 2021, there were 337 new cases diagnosed. 1 Nepalese believed they were now moving towards the end of the pandemic. But, the scientific omens were suggesting otherwise. Across the border in India, a sharp rise in new cases was reported and deaths were soaring. 2 Politicians on either side of the border were breaking the very regulations they had implemented to curb the spread of the virus, as they organised rallies and attended public events. By 14 th May 2021, there were 8520 new cases and 203 new deaths. 1 Nepal has a notorious history of incompetency during times of crises. During the Earthquake in 2015, that cost the lives of more than 8000 people, the government of Nepal was widely criticized for being unable to even manage the aid that came in. The government had frenzied, unable to tend to the people in a particular location. And the COVID-19 pandemic, a calamitous infectious wrath that engrossed the whole nation only showed, again, how ill equipped the country was.Nepal, a low-income country with highly constrained health resources, faces a scarcity of medical supplies including hospital beds, ventilators, oxygen, essential medicines, personal protective equipment, test kits, and vaccines against COVID-19. There is also a scarcity of trained medical professionals. As of 18 th May 2021, 1.86% of the eligible population have been fully vaccinated against COVID-19. 3 The health system has been unable to cope with the increasing number of patients and is at imminent risk of collapse.

Orogastric tube (OGT) insertion is a routine procedure in medical care. It is often inserted in patients after endotracheal intubation. OGT insertion is often a blind procedure. Misplacement of the tube can cause a variety of complications and can sometimes be life-threatening. We present the case of a 71-year-old male patient who experienced a rare proximal esophageal perforation as a complication of blind insertion of the OGT; he required OGT insertion after receiving endotracheal intubation for hypoxic respiratory failure secondary to COVID-19 infection. The esophageal perforation was revealed on a post-procedural roentgenogram and confirmed by a subsequent computed tomography of the chest. Given the small size of the perforation and the absence of clinical instability, conservative management was pursued leading to improvement of the mediastinitis. Although the complications of OGT insertion are uncommon, their consequences can be potentially serious and require a high degree of suspicion.