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Worldwide Puccinia striiformis f. sp. tritici (Pst) epidemics have been reported to be driven by few genetic lineages, while a high diversity is evident at the Pst Himalayan centre of diversity. This study investigated the relationship between pathotype diversity and genetic structure in Nepal, the eastern Himalayan region, which has been largely unexplored. Despite the high genetic diversity and recombinant structure detected through microsatellite genotyping, characterization of virulence phenotypes for 62 isolates identified only eight pathotypes, with two pathotypes predominant over all the populations. This is in contrast to the Pakistani and Chinese recombinant populations, where high pathotype diversity is associated with genetic diversity. The most prevalent Nepali pathotype was not a unique clonal lineage, but was represented by seven multilocus genotypes from four distinct genetic subgroups, suggesting strong directional selection on virulence genes, resulting in convergent pathotypes in distinct genetic groups. This convergent selection is discussed in comparison with clonal French and recombinant Pakistani populations. Additionally, the Nepali Pst population carried virulence to 17 out of 24 tested yellow rust resistance genes (Yr), with the absence of virulence to Victo and Early Premium and resistance genes Yr5, Yr10, Yr15, Yr24 and Yr26. Virulence to Yr2, Yr7, Yr27 and YrSu were fixed in all isolates, in line with the deployment of these resistance genes in Nepal. The results reflect the influence of resistance gene deployment on selection of virulence and pathotypes in a recombinant pathogen population, which must be considered in the context of durable resistance gene deployment. [ABSTRACT FROM AUTHOR]

Background: Physiotherapy is a relatively young profession in Nepal. Education standards, and workforce organization and representation have improved in recent years, but there is no detailed workforce data to support decision-making and long-term planning. Therefore, this study aimed to describe the demographic characteristics, physiotherapy practice areas, settings and employment characteristics of physiotherapists in Nepal; and to document job satisfaction and the factors that influence it., Methods: In a cross-sectional survey, we asked Nepali physiotherapists about their sociodemographic characteristics, employment or physiotherapy practice area and settings, and job satisfaction. We assessed the associations between sociodemographic factors and job satisfaction among physiotherapists using univariable and multivariable logistic regressions. We invited all Nepali physiotherapists to participate via email, social media and visits to hospitals., Results: Of the 1120 physiotherapists who were contacted, 52% (female: 287; male: 293) completed the survey. The majority of the participants (75%) were less than 30 years old. The majority (73%) held a Bachelor of Physiotherapy degree. Eighty percent were employed at the time of data collection; 58% had 1-4 years of experience. The majority (77%) practiced in or near the capital Kathmandu. Most physiotherapist worked either in private hospitals (46%) or in private physiotherapy practices (26%), rehabilitation centres (19%) and 11% practiced in public hospitals. The most common areas of practice were musculoskeletal physiotherapy (90%) and adult neurology (67%). More than half of the physiotherapist (53%) felt that they were underpaid and 41% were not satisfied with their current job status. The majority of the physiotherapists (67%) reported that they participated in continuing professional development activities. Multivariable logistic regression showed that physiotherapists who had a higher remuneration were more likely to be satisfied with their job., Conclusions: The majority of the physiotherapy workforce in Nepal is well-educated, young and at an early career stage. Most physiotherapists work in musculoskeletal and adult neurological physiotherapy, in private practices or private hospitals near Kathmandu. Job dissatisfaction was common and was related to low annual income. This first nationwide survey described the current physiotherapy workforce and provides comparison data for future physiotherapy workforce surveys., (© 2022 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.)

Understanding the underlying factors that led to maternal deaths through a maternal death review (MDR) throws light on the causes, characteristics and circumstances of the death. We reviewed and report on the implementation of MDR in India, Indonesia, Myanmar, Nepal and Sri Lanka, capturing the experiences of MDR initiatives, follow-up actions and lessons learnet. Overall, while the findings from MDRs have been used to design or change policies and strategies for improvement of services provided, there are still challenges in scaling up these initiatives, particularly in the larger countries., (© 2014 Royal College of Obstetricians and Gynaecologists.)

Chronic renal failure, regardless of its cause, often produces specific dermatological abnormalities, which can develop long before failure manifests clinically. Our aim was to study the clinical pattern of skin and nail changes in chronic renal failure and also study the associations of these changes with age, sex, etiology and duration of the chronic renal failure. A total of 104 diagnosed cases of chronic renal failure were included in the study over a period of 1 year. Equal numbers of age- and sex-matched individuals were taken as controls. The male : female ratio was 1.4:1. The mean duration of chronic renal failure was 19 +/- 20 months. Among cases and controls, 72% and 16% had skin changes, respectively. Xerosis was the most common of the skin changes (28%), followed by hyperpigmentation (20%), pruritus (15%), infectious diseases (5%) and other skin changes (33%) in chronic renal failure patients. Abnormal nail changes were seen in 82% of the cases compared to only 8% of the controls. In the cases, white nail was most common followed by brown and half-and-half nail. Pruritus was significantly higher in the dialysis group whereas the nail changes were significantly higher in the non-dialysis group. The skin and nail changes were common in chronic renal failure and manifested in various forms. Thus, thorough inspection of the integument might reveal markers of occult renal disease.