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Rajeev Shrestha,1,* Sunil Shrestha,2,3,* Binaya Sapkota,4,* Santosh Thapa,5 Mukhtar Ansari,6 Asmita Priyadarshini Khatiwada,2 Rohullah Roien,7 Akihiko Ozaki8 1Department of Pharmacy, District Hospital Lamjung, Lamjung, Nepal; 2Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Province Bagmati, Nepal; 3Department of Nursing, Nobel College, Sinamangal, Kathmandu, Nepal; 4Department of Pharmaceutical Sciences, Nobel College, Affiliated to Pokhara University, Kathmandu, Province Bagmati, Nepal; 5Jeevee Health, Kathmandu, Nepal; 6Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia; 7Medical Research Centre, Kateb University, Kabul, Afghanistan; 8Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan*These authors contributed equally to this workCorrespondence: Rajeev Shrestha; Rohullah Roien Email rajiv2stha@gmail.com; rohullahroien@kateb.edu.afAbstract: Generic medicines are being promoted in many countries for their added benefits over branded drugs, such as reduced price, therapeutic equivalence, and convenience to the patients. However, generic prescribing is still not up to the optimum level in Nepal to assure access to cost-effective, quality medicines to the public and to reduce the overall economic burden and practice-related errors of medications. This review aimed to discuss the current scenario of generic medicine, generic prescribing, hurdles on the one hand, and potentials ways in promoting generic medicine usage and generic prescribing in Nepal on the other. Extensive literature on generic medicine usage and generic prescribing practice in Nepal was reviewed. This review found some of the major challenges to be addressed for the proper implementation of generic medicine prescribing, and utilization. These challenges include lack of facilities and competency to assure therapeutic equivalence of different brand-name medicines, lack of understanding about generic medicines among health care providers (HCPs) and the public, and lack of stringent regulation towards promoting generic medicines. Rational pharmaceutical promotion and awareness about generic medication to the medical students are also inevitable towards promoting the practice of generic medicines. The practice of generic medicine and generic prescribing is not possible without the assurance of therapeutically equivalent generic alternatives. The study recommended the prompt effort of the regulatory authority to enforce the generic prescribing and generic substitution policy through strengthening policies, procedures and laboratory testing to assure citizens’ right to access to cost-effective, and affordable quality medicine, as the Nepal’s National Health and Drug Policy mandated.Keywords: branded generics, brand medicines, generic medicines, generic prescribing, generic substitution, Nepal

The order Chiroptera includes 55 species in Nepal, which have been recorded within a wide range of elevation between 64 and 4154 m above sea level. Assessing the potential distribution ranges in present climatic scenarios and forecasting changes in distribution ranges in future climate have been adopted to predict likely adverse impacts on biodiversity and natural ecosystems. However, very few studies have assessed the impact of climate change on bats globally and locally. We assessed the current potential distribution ranges of six representative species of bats occurring in Nepal using species distribution models (SDMs) and predicted their responses in future climatic scenarios. The occurrences of the representative species of bats were projected with six to eight environmental variables under the different climatic scenarios; present, and socioeconomic pathways 4.5 and 8.5 for the years of 2050 and 2070 deploying maximum entropy modeling. We used Arc GIS 10.7.1 to calculate the distribution range, area, and elevation for the bat species. Among 18 uncorrelated bioclimatic variables eight variables significantly contributed to the SDMs. Among the six species, two showed a wider range of current distribution. Under the future climatic scenarios, distribution ranges and latitudinal and elevation shifting were found to be species specific. Future distribution ranges for two species are predicted to be constricted, but no significant changes are predicted for the others. Major parts of the current and future distribution ranges of the bat species lie outside the current protected areas of the country. Landscape level and species‐specific conservation policies are necessary for bat conservation, and future surveys of bats should be targeted in western Nepal. [ABSTRACT FROM AUTHOR]

У цьому дослідженні порівнюються характеристики газового зондування плівок ZnO та 5% легованих Fe ZnO (Fe-ZnO), синтезованих методом спінового покриття. Рентгенівський аналіз виявив полікристалічну природу спочатку підготовлених плівок, показавши зменшення розміру кристаліту з 25,69 ± 0,95 нм для ZnO до 19,49 ± 0,72 нм для Fe-ZnO. Крім того, введення Fe в ZnO збільшило заборонену зону, при цьому значення змістилися з 3,190 ± 0,105 еВ для ZnO до 3,244 ± 0,147 еВ для Fe-ZnO і зменшили розміри зерен. Зменшення розмірів зерен сприяло збільшенню газової реакції плівки ZnO. Експерименти з зондуванням парів етанолу, проведені в більш широкому діапазоні температур 100-300oC, показують, що найкраща газова реакція плівки Fe-ZnO при 260 oC становить 17,8 ± 0,4, що майже в 1,5 рази більше, ніж у плівки ZnO при тій же температурі. Крім того, варто зазначити, що тонка плівка FeZnO продемонструвала швидшу реакцію та відновлення порівняно з тонкою плівкою ZnO, з часом відгуку та відновлення 32 ± 2 та 162 ± 3 секунди, відповідно, для впливу етанолу 40 ppm. Ці висновки сприяють глибшому розумінню механізмів зондування газу як у тонких плівках ZnO, так і в Fe-ZnO, які є перспективними для майбутніх розробок у технології газових сенсорів. [ABSTRACT FROM AUTHOR]

The government of Nepal has been providing high priority to subsidy programs to support farmers and boost the national economy. Increasing access to and effectiveness of the subsidy program is important to enhance growth of agricultural sector. However, there has always been a concern about access to and effectiveness of the subsidy programs to address the problem of farmers in Nepal. This study was carried out to determine the factors affecting farmers' access to the agricultural subsidy. For this, a multi-stage sampling method was employed, and altogether 120 commercial vegetable growers from Dhading and Makwanpur districts of Nepal were selected using simple random technique. Descriptive statistical tools and binary logistic regression were used to analyze the data. Out of the total sampled households, 55.83% had accessed at least one agricultural subsidy program, and the highest number of sampled households (39.17%) received the subsidy for agricultural tools. The result of binary logistic regression revealed that factors like ethnicity, membership in agricultural groups or co-operatives, farm visit by extension agents, and participation in agricultural training were significantly (p<0.01) influencing farmers' access to agricultural subsidy. Hence, the farmers are suggested to operate through agricultural groups or co-operatives, and the concerned authorities and policymakers should emphasize agricultural extension services and agricultural subsidy simultaneously for synergistic effects. [ABSTRACT FROM AUTHOR]

Typhoid fever is a significant public health concern with most of the sufferers between 15 and 25 y of age in Nepal. We undertook this study to demonstrate Vi polysaccharide conjugated with diphtheria toxoid (Vi-DT) conjugate vaccine which is non-inferior to Typbar typhoid conjugate vaccine, a Vi polysaccharide vaccine conjugated with tetanus toxoid (Vi-TT) with a focus on the adult population from Dhulikhel Hospital which was one of the total four sites in Nepal. In this study, we assigned the eligible participants in 1:1:1:1 ratio by block randomization, and stratified into three age groups (6 months to less than 2 y, 2 y to less than 18 y, and 18 y to 45 y), allotted to Group A, B, C, and D. Group A, B, and C received 25 μg (0.5 mL) of Vi-DT study vaccine and participants in Group D received 25 μg (0.5 mL) Vi-TT vaccine. We descriptively analyzed safety in all the participants receiving one dose of the investigational vaccine. The anti-Vi-IgG seroconversion rate in Vi-DT recipients was 99.71% (97.5% CI 98.04-99.96; 344 of 345 participants) and 99.13% (94.27-99.87; 114 of 115) in Vi-TT recipients which indicates that Vi-DT vaccine is non-inferior to Vi-TT vaccine. In safety aspect, 16.81% of total subject had at least one solicited adverse reaction and 22.61% of the Vi-TT participants experienced at least one solicited adverse reaction with most of them being local adverse reactions. None of the enrolled participants reported serious adverse events. Our study shows that a single dose of the Vi-DT vaccine is immunogenic, safe to administer and non-inferior to the Vi-TT vaccine four weeks after vaccination.

Competing Interests: Competing interests: None declared.

Bone homeostasis within the skeletal system is predominantly maintained by bone formation and resorption. Where formation of new bone involves maturation of stromal cells to mineral and matrix secreting mature osteoblasts, which requires cellular energy or adenosine triphosphate (ATP). Alterations in systemic metabolism can influence osteoblast functioning. In line with this, type 2 diabetes mellitus (T2DM), a common metabolic disorder is also associated with reduced bone formation and increased risk of fracture. Impairment in lipid metabolism is one of the key features associated with T2DM-related pathologies in multiple tissues. Therefore, we tested the hypothesis that the reduced bone formation reported in obese murine models of impaired glucose tolerance is a function of disrupted lipid metabolism in osteoblasts. We first confirmed that mice fed a high fat diet have reduced bone microarchitecture along with lower bone formation rates. Interestingly, osteoblasts from obese mice harbor higher numbers of cytosolic lipid droplets along with decreased bioenergetic profiles compared to control cells. Further supporting this observation, bone tibia cortex demonstrated higher total lipid content in high fat diet fed mice compared to control-fed mice. As a further proof of principle, we generated a novel murine model to conditionally delete Plin2 in osteoblast-progenitor cells using Prrx1-Cre, to enhance lipid droplet breakdown. Our data demonstrate that knocking down Plin2 in an osteoprogenitor specific manner protects from high-fat diet induced osteoblast dysfunction. Furthermore, the mechanism of action involves enhanced osteoblast fatty acid oxidation. In conclusion, the current studies establish that high fat diet induced glucose intolerance leads to perturbations in osteoblast lipid metabolism, thus causing lower bone formation, which can be protected against by increasing fatty acid oxidation., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Society for Bone and Mineral Research.)

Angina Bullosa Hemorrhagica is characterized with rapid appearance of soft, blood-filled blisters on the mucosa of oral cavity and oropharynx. It is a benign condition, and is not associated with any systemic hematological disorder. No etiological factors have been identified and there are no established guidelines for its management. The current case report describes the sudden appearance of large, bluish, soft lesion on the soft palate which was managed with incision and drainage, and healed completely over the next three weeks., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Objective: Examine the association between military blast exposure and functional status among veterans with a focus on functional disability as a proxy for quality of life and explore the potential modifying effect of hearing loss on this association., Study Design: Prospective cohort., Setting: Multi-institutional tertiary referral centers., Patients: 540 veterans., Exposure: Self-reported military blast exposure with and without tinnitus; high-frequency hearing loss (yes/no)., Main Outcome Measure: WHO Disability Assessment Schedule 2.0 questionnaires at baseline and annually over 5 years. The odds of membership into three functional disability trajectory groups: low functional disability, moderate functional disability, and high functional disability., Results: Of 540 veterans, 197 (36.5%) self-reported a blast exposure history, and 106 of 197 (53.8%) reported tinnitus as a direct result of the blast. Blast exposure without tinnitus increased the odds of moderate functional disability compared with low functional disability (odds ratio [OR] = 1.5; 95% confidence interval [CI], 0.92-2.51), which strengthened among those with blast with tinnitus (OR, 3.6; 95% CI, 2.1-6.1). Blast exposure without tinnitus also increased the odds of membership to high functional disability versus low functional disability (OR, 2.2; 95% CI, 1.1-4.8). Hearing loss further increased the odds of reporting functional disability. The probability of low functional disability was approximately 60% if there was no history of blast or hearing loss, dropping to 20% if there was blast, tinnitus, and hearing loss history., Conclusions: Blast exposure negatively affects the quality of life of veterans, especially when compounded with tinnitus and hearing loss., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2024, Otology & Neurotology, Inc.)

Tick-borne pathogens (TBPs) in dogs are a major global health concern, with their zoonotic importance often being neglected in developing countries due to a lack of surveillance. This study aimed to highlight the incidence of six important TBPs belonging to the genera Babesia, Theileria, Hepatozoon, Anaplasma, Ehrlichia, and Rickettsia in a total of 230 community dogs from two sites: Lumbini and the Kathmandu Valley, of Nepal. A total of 75 (32.6 %) dogs were found to be infected with at least one TBP, with 11 (4.7 %) being co-infected with more than one TBP. The detection rates of TBPs were 13.9 % (n = 32) for Ehrlichia canis, 9.1 % (n = 21) for Anaplasma platys, 8.6 % (n = 20) for Babesia vogeli, and 6.5 % (n = 15) for Babesia gibsoni. None of the samples were positive for Theileria, Hepatozoon, or Rickettsia. There was a significant association between A. platys and E. canis infections, respectively, with the locations from which the samples were collected. Infections of TBPs in community dogs might be the source of infection for pet dogs or even humans in shared habitats. Further studies are needed to determine the prevalence and diversity of TBPs in dogs in other regions of Nepal. As some of these parasites are zoonotic, concerted efforts are required to raise awareness of, and control efforts for, these tick-borne pathogens., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Inspite of high prevalence of mental illness in developing countries, access to health care for addressing mental health issues has several existing barriers at different levels leading to disproportionate adverse health outcomes, summarised as the three Ds of death, disability, and health-economic deficit. This study aims at examining the perspectives of patients with mental illness on barriers to access mental care., Methods: In this study, we searched EMBASE, PubMed, Scopus and PsycNet databases. Database search examined qualitative articles on barriers to access mental health care published from January, 2013 to January, 2023. Papers appropriate for inclusion were selected in the South Asian Association for Regional Cooperation (SAARC) nations, employed qualitative methodologies, and focused on patients, caregiver, or healthcare practitioners' perspective on challenges to access care. The Mixed Methods Appraisal Tool (MMAT) - Version 2018 was used to assess quality., Results: Out of 351 papers, only 24 met the inclusion requirements. A multilevel conceptual framework guided the reporting of emergent themes. Patient with mental disorder experienced four levels of barriers while receiving mental health services: 1. sociocultural (family support, community support networks, and cultural attitudes), 2. organizational (organizational characteristics, service access, and inadequacy of resources), 3. structural (poor implementation of existing policy) and 4. individual levels (knowledge, attitudes, and individual characteristics)., Conclusions: Complex, interlinked, multilevel barriers existed while accessing MHS for patient in SAARC nations. To improve access to MHS, multilevel solutions ought to tackle individual, organizational, societal, and structural barriers at various phases of the care pathway is imperative., Competing Interests: Declaration of Competing Interest The authors have declared that no competing interest exist., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Narcissistic personality disorder (NPD) is associated with a complex interplay of genetic, neurobiological, and environmental factors. In this case report, we discuss the association between adverse childhood experiences (ACEs) and the development of NPD in adulthood., Case Presentation: Here, we report a clinical case of NPD to illustrate how ACEs, particularly physical and emotional neglect, combined with early life parental overvaluation, can impair emotional regulation and self-worth, contributing to the development of narcissistic traits. We analyse, in light of existing literature, how ACEs are associated with a wide spectrum of personality disorders, how parental overvaluation is linked to grandiose narcissism, and how childhood neglect and abuse are associated with vulnerable narcissism., Conclusion: ACEs are the primary risk factor for the development of NPD in adulthood. Dysfunctional household environments and parenting practices compound the association between ACEs and pathological narcissism. It is important to address childhood trauma for the prevention and treatment of NPD. Further research is necessary to clarify how individual factors influence the relationship between ACEs and pathological narcissism., Competing Interests: Declarations. Ethical approval and consent to participate: Not applicable. Consent for publication: Written informed consent was obtained from the patient for the publication of his personal or clinical details, along with any identifying images, in this study. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: To investigate the sociodemographic, anthropometric, biochemical, lifestyle and cardiometabolic risk factors associated with type 2 diabetes (T2D) among First Nations Australians., Methods: A systematic review of prospective cohorts and cross-sectional studies was conducted. Electronic data sources (MEDLINE/PubMed, Embase, CINHAL, and PsycINFO) were searched for peer-reviewed articles until August 2023. We reviewed observational and interventional studies on T2D that reported sociodemographic, anthropometric, lifestyle, and biochemical risk factors for Australian First Nations people. Narrative synthesis was applied without meta-analysis. We highlighted the major risk factors for T2D by reporting the most significant findings from individual studies in the results. The review followed PRISMA guidelines., Results: The review included 20 eligible studies: 12 cross-sectional studies and 8 prospective cohort studies. The findings from these studies showed that First Nations people who resided in very remote areas (Modified Monash Category 7; MM7) (OR = 1.61; 95% CI: 1.03, 2.52), living adjacent to food store stocking "Western" food items (OR = 2.92; 95% CI: 1.51, 5.63), rented their home (OR = 2.07; 95% CI: 1.30, 3.30) and part-time employment (OR = 2.47; 95% CI: 1.54, 3.95) were associated with a statistically higher risk of developing T2D. First Nations people who had obesity class 1 (BMI > 30 kg/m 2 ), central obesity (WC > 88 cm in women; >102 cm in men), and higher waist-to-hip ratio (WHR) (≥ 1.0 in men and 0.85 in women) were more likely to have T2D. First Nations people with elevated triglycerides (≥ 1.7 mmol/L) (OR = 4.9; 95% CI: 2.7, 8.8), one standard deviation (SD) increase in C-reactive protein (CRP) value (AHR = 1.23; 95% CI: 1.05, 1.45) and lower levels of vitamin D (< 53 nmol/L) (AOR = 2.15; 95% CI: 1.10, 2.18) were significantly associated with a higher risk of T2D. However, no significant association was found with either daily smoking or daily alcohol., Conclusion: To address the First Nations Health Gap attributed to T2D in Australia, interventions should prioritise remote areas, socioeconomic disadvantage, central obesity, elevated triglycerides, and vitamin D deficiency. This was the first comprehensive systematic review examining sociodemographic, anthropometric, biochemical, lifestyle, and cardiometabolic risk factors associated with T2D among First Nations Australians., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)