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The primary challenges in Berseem clover (Trifolium alexandrinum L.) seed production in Nepal are low productivity levels and substandard quality indicators. To address this issue, the experiments were conducted at the Regional Agricultural Research Station, Khajura, Banke, Nepal, and replicated in farmers' fields using a Randomized Complete Block Design from November 2018 to June 2019. Four irrigation schemes and three levels of foliar sprays of plant bio-regulators were used. The experiment result revealed that three and four irrigations were most suitable for achieving higher seed yield (p<0.05), resulting in 0.99 and 0.93 t ha-1 at on-station and 0.87 and 0.85 t ha-1 at on-farm, respectively. Similarly, two and three sprays of plant bio-regulators yielded better (p<0.05) seed yields of 0.89 and 0.94 t ha-1 at on-station and 0.79 and 0.85 t ha-1 at on-farm, respectively, without significant alteration on days taken to seed maturity and biological yield. The interactions between the levels of irrigation and plant bio-regulators spray were non-significant (p>0.05) for seed yield and biological yield. The experiments demonstrated that three irrigations @ 666.67 kiloliters of water ha-1 at 15-day intervals after one cut at 60 days after sowing, and three foliar sprays of plant bio-regulators (P2O5 @ 2 kg ha-1 + KNO3 @ 4 kg ha-1) at 7-day intervals in the pre-flowering stage, significantly enhanced the seed yield and quality of Berseem clover. [ABSTRACT FROM AUTHOR]

Three moderate earthquakes on November 9, 2022, November 12, 2022, and January 24, 2023 occurred in Western Nepal region of Magnitudes 5.8, 5.4 and 5.8 respectively. The epicenters were ∼100 km away from the Uttarakhand State Earthquake Early Warning System (UEEWS) network which consists of 169 seismic sensors in oval shape network with larger axis of about 280 km in East-West and 120 km in North-South in Uttarakhand-Dharchula seismic gap, a region of central seismic gap of Indian Himalaya. The strong motions recorded by UEEWS were fetched in real-time at the central server in Roorkee through dedicated private network. The central server issued notifications and warning alerts to the public of Uttarakhand on the mobile app, 'Uttarakhand Bhookamp Alert' installed by them. The success story of issuance of warning along with location of triggered sensors, epicenter of earthquakes and lead time people got in these events are elaborated in this article. Specially, these three moderate earthquakes albeit not triggered in the instrumented area, issuance of warning to the public by UEEWS network is noteworthy. Encouragingly, these events have been considered an example to rationalize establishment of earthquake early warning system in the other parts of the Himalayan regions. [ABSTRACT FROM AUTHOR]

Background: Cauliflower production during the late winter season has major problems including the requirement of long duration for its maturity, lower yield and poor postharvest quality, especially in the mid-hill region of Nepal. A field experiment was conducted to access the growth, crop maturity and yield of late-season cauliflower varieties at Puranchaur, Kaski in the mid-hill region of Nepal. Methods: The experiment was arranged in a randomized complete block design (RCBD) with toal eleven late-season cauliflower varieties in which nine were hybrid varieties viz. Freedom, Titan, Ravella, Artica, Bishop, Casper, Indam 9803, NS 106 and Snow Mystique while two were open pollinated varieties viz. Amazing and Snowball 16. The experiment was conducted from November 2016 to March 2017 with four replications. Result: Significantly shorter period for final curd initiation of 76 days was recorded in NS 106 and Indam 9803 which was statistically similar with Amazing. Significantly shorter period for final curd maturation of 90 days was recorded in Amazing which was statistically similar to Bishop and NS 106. Similarly, the highest curd yield of 50 mt/ha was produced by Bishop at 91 days after transplanting (DAT) while the lowest crud yield of 19 mt/ha was recorded in Snowball 16 at 113 DAT. Finally, it was concluded that Bishop found the best hybrid variety for higher curd yield and short duration for maturation while Amazing performed higher yield than Snowball 16 and early maturing variety in the mid-hill region of Nepal. [ABSTRACT FROM AUTHOR]

Due to higher temperatures in Nepal's mid-hill region, postharvest quality of cauliflower faces significant challenges during the late winter season. To address this issue, a field experiment was conducted to evaluate the curd quality of eleven late-season cauliflower varieties. The experiment was set up in a Randomized Complete Block Design (RCBD), with nine hybrid varieties (Freedom, Titan, Ravella, Artica, Bishop, Casper, Indam 9803, NS 106, and Snow Mystique) and two open pollinated varieties (Amazing and Snowball 16). The experiment was carried out over four replications from November 2016 to March 2018. Snowball 16 had the highest TSS value of 5.5 oBrix and pH of 6.5 when compared to other varieties. Snow Mystique had the highest vitamin C content of 48.5 mg/100 g, followed by Amazing and Snowball 16, compared to other varieties. At three, six, and nine days after harvesting, physiological weight loss was 4.0 percent and 8.0 percent in Bishop, and 13.3 percent in Artica, respectively. Snowball 16 received a significantly higher score of 8.5 tasty curds, followed by Amazing. Titan and Artica produced curds with the best appearance and compactness when compared to other varieties. Artica and Titan produced significantly more fresh curds than other varieties. Based on the taste and chemical parameters of the curds for the late winter season in Nepal's Mid-hill region, it was determined that Amazing was the best OP variety, while Artica, Titan, and Bishop were better hybrid varieties. [ABSTRACT FROM AUTHOR]

Cauliflower (Brassica oleracea var. botrytis L.) is one of the most popular vegetable crops. An experiment was conducted to study the response of late season varieties of cauliflower to different sources of nitrogen on growth, yield and postharvest quality at Rampur, Chitwan, Nepal during October 2018 to March 2019. Four late season varieties of cauliflower viz. NS 106, Snow Moon, Yukon, and Candid Charm and three different sources of nitrogen viz. 100% Nitrogen (N) through Farm yard manure, 50% N through FYM and 50% N through urea, and 100% N through urea. The two-factor experiment was laid in RCBD with three replications and twelve treatment combinations. All the recorded growth, yield and postharvest quality parameters were significantly higher and statistically similar in NS 106 and Yukon and significantly lower in Candid Charm. Similarly, significantly higher plant height, canopy diameter, leaf number, curd height, economic yield and biological yield were recorded in 50% N through FYM and 50% N through urea. Significantly lower plant height, canopy diameter, leaf number, economic yield and biological yield, titrable acidity and significantly higher days to curd maturity, vitamin C and dry matter content of leaf and curd, and TSS content were recorded in 100% N through FYM. Results revealed that for higher and postharvest quality of cauliflower during late season at Rampur, Chitwan Yukon or NS 106 both varieties were superior along with 50% N through FYM and 50% N than those of the other varieties. [ABSTRACT FROM AUTHOR]

A study was conducted to evaluate the effect of combined application of urea and poultry manure(viz., 100% N-urea, 75% N-urea + 25% N-PM, 50% N-urea + 50% N-PM, 25% N-urea + 75% N-PM and 100% N-PM) on yield and quality of two varieties of lettuce viz., Green Span and NAI RE KUI DA F1at the Horticulture Farm of Agriculture and Forestry University, Rampur, Chitwan, Nepal from October 30, 2015 to January 30, 2016. Results revealed that the integration of 50% or more N-PM had significantly higher values in growth, yield and quality parameters while the use of 100% N-urea had the lowest one. Similarly, the two varieties significantly differed in all characters and the variety Green Span performed better at all levels of integration of N-urea with N-poultry manure than NAI RE KUI DA F1. Based on interaction effect, Green Span performed better with 100% N-poultry manure while NAI RE KUI DA F1 did better with the combination of 50% N-urea and 50% N-PM. [ABSTRACT FROM AUTHOR]

Introduction: Accurate temperature measurement is important to person, in whom suspicion of infection could result in investigations, administration of antibiotics, and even hospital admission. This study was done with the aim to determine the optimal dwell time of the thermometer in oral and axillary sites required to accurately reflect the stabilized core body temperature. Method: Cross-sectional survey of 113 adult patients was done who were admitted in Manmohan Cardio- Thoracic Vascular and Transplant Center (MCTVC) in the period between 16th July to August 2013. Ethical approval from the Institutional Review Board (IRB) of TUIOM and permission from the respective hospital authority was taken before data collection. Conventional glass mercury thermometer were checked and brought to 95 degree of Fahrenheit before each measurement of the temperature. Two thermometers were simultaneously placed in oral cavity and in the axillary skin sites. Reading of the oral temperature was done in 1 and 3 minutes, similarly, reading of axillary temperature was done in 3 and 5 minutes. Data was analyzed in SPSS 18 by using parametric and nonparametric tests. Results: Findings revealed the mean temperature difference between 1 minute oral to 3 minute axilla was 0.92 ± 0.79 SD, and the 3 minute oral to 5 minute axilla was 0.96 ± 0.82 SD, the difference was significant (P<0.05). Further, the mean oral temperature in 1 minute was 97.75 ± 1.27 SD, and in 3 minutes was 98.69 ± 1.37 SD. Similarly, mean temperature of axilla in 3 minutes was 97.67± 1.40 SD, whereas mean in 5 minutes was 98.43 ± 1.46 SD. The mean difference was significant. Conclusion: The effective time to measure oral temperature was three minute and it was five minutes for axillary measurement. [ABSTRACT FROM AUTHOR]

Introduction: External Ventricular Drainage (EVD) is one of the most commonly performed procedures in neurosurgical practice. EVD related infection is among the most dreaded complications encountered after the procedure with added morbidity and mortality. Objectives: The primary objective of this study was to assess the incidence of EVD infections in this hospital. In addition, the researchers have made an attempt to evaluate the indication for EVD placement, influence of total drainage time on the risk of catheter infection, the most common bacterial spectra in cerebrospinal fluid (CSF) culture, their antibiotic sensitivity pattern, and the association of CSF cell count with bacterial growth. Methods: This is a retrospective study of all patients who underwent EVD placement over a period of two years. Those patients who had bacterial growth in their initial samples were excluded from the study. Results: Out of 62 patients, 54 met the inclusion criteria for analysis. The ventricular catheters were in place from 1 to 23 days. Overall shunt infection rate was 37%. CSF cell count was significantly associated with the occurrence of a positive CSF culture (Fisher's Exact Test, p<0.01). The most common bacterial species isolated were Acinetobacter baumannii and Burkholderia cepacia. Conclusion: Despite many advances in care, there is still a significantly high incidence of EVD related infections. Contrary to earlier reports, the most common bacteria grown in the study were quite different and their antibiotic sensitivity varied accordingly. [ABSTRACT FROM AUTHOR]

Neurological patients managed in specialized intensive care units have better outcomes than those managed in general intensive care units. However, such management strategies cannot be applied to Nepalese healthcare entirely. Effective management is affected by its difficult geographical location (difficulty in transporting sick patients due to the lack of motorable roads and almost nonexistent effective air transport systems) and virtual nonexistence of neurointesivists in the country. While some 'supplies' for the treatment of serious neurosurgical patients are readily available (e.g. central venous pressure lines, arterial lines, ventricular drainage catheter etc.) in major neurosurgical centers in Nepal, others are scarce (e.g. adequate operating room capacity, intracranial pressure monitors, Swan Ganz catheters etc.). In this review an attempt has been made to distill the pertinent literature in the field and recommend what is applicable in the third world countries like Nepal where a profound physical and human resource constrains exist. In addition, realistic proposals for improvement of the current situation are made. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim To determine the prevalence of blindness, visual impairment and the cataract surgical coverage for people aged 50 years and older in the Lumbini Zone and the Chitwan District (Narayani Zone) of Nepal. Methods A population-based cross-sectional study in 2006 selected subjects aged 50 years and older through a random multistage cluster sampling and door-to-door enumeration. Ophthalmic examination included visualacuity assessment and refraction, and anterior and posterior segment examination of the eyes carried out by a trained ophthalmologist and two ophthalmic assistants at centralised locations. Results The survey examined 5138 of 5196 persons enumerated (response rate of 86.8%). The mean age of the subjects was 61 (SD 9.2) years, and 2701 (52.6%) subjects were women. The age - sex-adjusted prevalence of blindness (best presenting vision <6/60) and visual impairment (better-eye presenting visual acuity of <6/18 to $6/60) were 4.6% (95% CI 3.4 to 5.8) and 18.9% (95% CI 16.4 to 21.4), respectively. Blindness was significantly lower in the hill (3.3%) compared with the plain (5.8%) regions (OR 0.6; 95% CI 0.4 to 0.9). The primary causes for blind eyes were cataract (n=228, 48.1%), refractive error (n=149, 31.4%), retinal disorders (n=19, 4.0%) and corneal opacity (n=18, 3.8%). The overall cataract surgical coverage was 66.6%. Cataract surgical coverage was not significantly associated with age, sex, literacy or District. Conclusion Although the prevalence of blindness and visual impairment is lower than 10 years ago, particularly among women, correctable blindness due to cataract and refractive error (79.5% of blind people) remains a significant population health problem in Lumbini Zone and Chitwan District. [ABSTRACT FROM AUTHOR]

Background: Adolescent girls and young women (AGYW) often experience early childbearing and have poor utilization of reproductive, maternal, and neonatal health (RMNH) services in Nepal. Involving men in such services has been increasingly recognized globally to improve gender-equitable reproductive health behaviour in husbands. This qualitative study assessed the implementation of Healthy Transitions' male engagement interventions in Karnali Province, Nepal which were implemented to improve gender-equitable attitudes, and supportive RMNH care-seeking behaviors among the husbands of young women., Methods: We conducted a summative qualitative study that included in-depth interviews with 12 AGYW as primary beneficiaries and their husbands (N = 12) and in-laws (N = 8). In addition, key informant interviews were conducted with health workers (N = 8), local government representatives (N = 4), members of Health Facility Operation and Management Committee (N = 8) and project implementers (N = 12). Due to COVID-19-related travel restrictions and lockdowns, all interviews were conducted via phone calls and online consultation. Data were analyzed using multistage coding and thematic content analysis., Results: AGYW, their husbands, in-laws and health workers were receptive to the Healthy transitions' male engagement initiatives. They perceived that the project contributed a momentum to facilitate men's gender-responsive behaviour. Many participants reported that male engagement interventions, including home visits, community dialogues, and social events improved husbands' support for their wives during menstruation, pregnancy, and childbirth. The activities also facilitated spousal communication and improved the couple's decision-making for family planning use. Women reported that improved support from their husbands increased their self-confidence., Conclusions: This study sheds light on the role of male engagement strategies to improve RMNH in a context where inequitable gender norms and roles are highly prevalent. Our findings highlight the potential to improve RMNH by addressing barriers to male engagement., (© 2022. The Author(s).)

Background: Cervical cancer is the most common cancer among Nepalese women. Cervical cancer screening plays a vital role in reducing the morbidity and mortality of the disease. In this study, we assessed the prevalence of precancerous lesions of cervical cancer from community-based screening programs in Nepal., Methods: In this cross-sectional study involving record review, data were drawn from community-based screening programs in 14 districts by B.P. Koirala Memorial Cancer Hospital in Nepal. All women who underwent cervical cancer screening using visual inspection with acetic acid between June 2017 to December 2018 were included., Results: A total of 7,270 women were screened during the study period with the prevalence of cervical precancerous lesions among 153 (2.1%; 95% Confidence Interval 1.8-2.5) participants. Of which, the highest positivity rate was observed in the age group 30 years and below (46, 3%). The majority (4453, 61%) of the total women screened, were married at age below 20 years and 188 (3%) reported a history of cancer in their families. The most common presenting complaints were low abdominal pain (1236, 17%), low back pain (1152, 16%), itching in the anogenital region (828, 11%), and per vaginal discharge (818, 11%). Cervical cancer was suspected in 25 (0.3%) women., Conclusions: The prevalence of precancerous lesions of cervical cancer is low but with high existing risk factors among Nepalese women of selected districts. The government should implement effective and sustained cervical cancer awareness and population-based screening programs along with a continuum of care. The national criteria for screening should also include young women with known risk factors.

Background: Due to multiple reasons, the faculty members in Nepal devote less than expected time to research and publication. This could be attributable to various challenges unique to each faculty member and their institution. The present study aims to evaluate the potential barriers to publication faced by the faculty of Maharajgunj Medical Campus, Kathmandu, Nepal., Methods: This cross-sectional observational questionnaire-based study was conducted among the 139 faculty members representing various departments of MMC.  Results: The significant barriers were: difficult coordination (43.2%), the response time of the reviewer (48.2%), overburdened with work (39.6%), lack of funds for research (44.6%), limited submission skills (33.8%), poor writing skills (35.3%), difficulties in starting to write (42.4%), lack of time to submit a paper (43.9%), and family commitment (36.7%).  Conclusions: The findings of this study could be used to advocate for a prospective change in the work module to produce competent medical researchers generating high-quality publications.

Background: Senior citizens are at risk of developing mental health problems and the most common are depression and anxiety, which are important public health problems. This study aimed to find out the mental health status and factors associated with it among senior citizens., Methods: The study design was a cross sectional survey. Among the senior citizens residing in Tansen Municipality, Palpa, 245 participants were selected randomly from the list of senior citizens, enrolled in senior citizen allowance scheme. Data was collected by doing face to face interviews using Geriatric Depression Scale -15 and Geriatric Anxiety Scale-10. The data was entered in Epi Data 3.1 and transferred to SPSS version 16 program for analysis., Results: The mean age of the participants was 78.33 years. Most of the participants were female (52.2%), 95.5% were physically independent and 68.2% had some physical problems. Regarding depression, 30.6% and 2% of the participants had the symptoms suggestive and indicative of depression respectively. Whereas, 8.2% had severe symptoms of anxiety. The anxiety and depression were correlated (rs = 0.615) and were associated with companion of living, education status, physical dependency, and comorbid physical problem., Conclusions: Senior citizens have symptoms of depression and anxiety. Having physical health problems, being physically dependent are likely to result in poor mental health in elderly. There is a need to recognize the mental health problem of elderly in community settings.

Background: Medical students are more prone to burnout than the general population and students of other faculties due to the demanding nature of medical education with limited time and resources. Burnout has a negative impact on the academics and personal life of the students which can continue into their professional life and ultimately hamper patient care. The purpose of this study is to determine the prevalence of burnout among medical students of a medical college and find its association with age, gender, and year of study., Materials and Methods: This cross-sectional study was conducted among medical students of a medical college in Kathmandu, Nepal from 14 January to 7 March, 2021. Stratified sampling followed by a simple random sampling technique was employed to select study participants. Data was collected through a self-administered questionnaire using the English version of the Oldenburg Burnout Inventory adapted for students (OLBI-S) and analyzed in STATA version 15., Results: The prevalence of burnout was found out to be 65.9% (n = 229). And of the remaining, 12.7% were exhausted, 11.4% were disengaged and 10.0% were neither exhausted nor disengaged. Burnout had no significant association with age in years, gender, and year of study., Conclusions: This study shows an alarming prevalence of burnout in almost two-thirds of medical students. These results indicate the necessity of employing effective strategies by relevant authorities for the mental well-being of future physicians. Further multicenter prospective studies are required for a better understanding of the prevalence and associated factors of burnout., Competing Interests: The authors have declared that no competing interests exist.

Background: People who inject drugs (PWIDs) have sub-optimal HIV and HCV testing as the available testing services are inadequate in low and middle-income countries. We examined a model of Community-Led Testing (CLT) in Nepal, exploring the feasibility of HIV and HCV testing by trained lay service providers who had similar backgrounds to those of PWIDs. We also assessed the prevalence of HIV and HCV within this study population and the associated risk factors among PWIDs., Methods: A mix-methods cross-sectional study was conducted among 1029 PWIDs in five major districts of Nepal from July 2019 to February 2020. Trained PWID peers performed the screening for HIV and HCV using Rapid Diagnostic Test (RDT) kits. Acceptability and feasibility of the testing was assessed. The participants' sociodemographic characteristics and injecting and non-injecting risk characteristics were determined. The association of risk and prevention characteristics with testing results were assessed using multiple logistic regression., Results: PWIDs shared that the test providers were friendly and competent in counseling and testing. Of total PWIDs (n = 1,029), 20.6% were HCV-positive and 0.2% were HIV-positive. HCV positivity was associated with needle sharing (AOR: 1.83, 95% CI: 1.27,2.64; p = 0.001) and reuse of syringe/needle (AOR: 2.26; 95% CI: 1.34, 3.79; p = 0.002). In addition, PWIDs were more likely to be HCV-positive who started opioid substitution therapy (OST) (AOR: 1.88, 95% CI: 1.26, 2.80, p = 0.002) and attended the rehabilitation center (AOR: 1.66, 95% CI: 1.10, 2.53, p = 0.017)., Conclusions: This CLT model was found to be a novel approach of testing of HIV and HCV which was acceptable to PWIDs in Nepal and showed the high prevalence of HCV and its association with injecting-related risk behaviors and being users of OST and rehabilitation. The findings highlight the need of community-led testing in hotspots, OST settings, and rehabilitation centers to screen new HIV and HCV infections., Competing Interests: The authors have declared that no competing interests exist.

Background: Neurosurgery is a field where time from the incident to get treatment is very crucial. In low-income countries, the referral system is not well developed. In our country, a proper referral system is in the initial phase of development. We conducted a study assessing the number of visits a neurosurgery patient made before finally reaching to our center., Methods: This is a prospective observational study involving seventy patients, conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Demographic characteristics, neurological diagnosis, and numbers of other centers the patients visited and outcome at discharge and in one month was assessed., Results: Thirty-five (50%) patients were males. Thirty-three (47.1%) patients were admitted due to head injury and 13 (18.5%) were diagnosed with subarachnoid hemorrhage. Surgery was done in 32 (45.7%) patients. Fifty-three (75.7%) patients were transferred from other hospitals. Out of 53 patients, 30 (56.6%) and 17 (32%) had visited to one and two hospitals respectively. Unavailability of the neurosurgery facility was the main reason (77.4%) for the transfer. Overall mortality was 12.9%. The trend for mortality and length of hospital stay was higher in the group who visited other centers before coming to us than those who came directly., Conclusions: Visiting multiple hospitals where there is no neurosurgical service available is an important reason for delay. There is a need to develop neurosurgical facilities in the different parts of the country along with establishment of an effective referral mechanism.

Multisystem inflammatory syndrome in children is a new childhood inflammatory disorder associated with respiratory syndrome coronavirus 2 (SARS-CoV-2). This illness of elevated inflammatory markers and multiple organ involvement similar to Kawasaki disease is not commonly reported from Asia. A 17-month-old boy presented with acute onset fever, rash, non-exudative conjunctivitis and swellings of hands and legs. In x-ray chest there was infiltration on the right lower lobe and echocardiography showed evidence of coronary arteritis. The diagnosis of multisystem inflammatory syndrome in children was confirmed on the basis of characteristic clinical features and laboratory parameters fulfilling standard case definition for multisystem inflammatory syndrome in children. The child responded to treatment with intravenous immunoglobulin and high dose aspirin. Hence, amidst SARS-CoV-2 pandemic, multisystem inflammatory syndrome in children should be suspected and effectively treated even in a country like Nepal. Keywords: Kawasaki disease; multiple inflammatory syndrome in children; Nepal; respiratory syndrome coronavirus 2.

Introduction: Health care workers are at higher risk of infection with the coronavirus disease as they are directly involved in the treatment of infected patients and perform aerosol-generating procedures. Proper knowledge of this disease can influence the positive attitude, good practices and enhance their safety. We aim to study the knowledge of COVID-19 among health care workers of the tertiary care hospital of Nepal., Methods: A descriptive cross-sectional study was conducted among health care workers of Shahid Gangalal National Heart Centre from May 20 to June 19, 2020. Ethical approval was taken from the Institutional Review Board (IRB No: 4-2020). Written informed consent was taken from all respondents. Correct answers were summated to reflect the mean knowledge, expressed as a percentage. Data analysis was done using Statistical Package for the Social Sciences version 21., Results: The mean general knowledge score was 95.7%. The mean medical knowledge score was 70.5%. Only 42 (56.8%) of physicians and 103 (53.6%) of nurses had a higher level of medical knowledge regarding COVID-19. Likewise, very few lab technicians 7 (21.9%) and none of the pharmacists had a higher level of medical knowledge., Conclusions: The healthcare workers of this centre have adequate knowledge regarding COVID-19. However, periodic training for all workers, especially the nurses and allied workers, may help to update the knowledge and hence enhance their safety and that of their patients.

Background: Psychiatric comorbidities are common in thyroid disorder patients and complicate patients' life quality as well as disease management. We aimed to explore prevalence of anxiety and depression and identify associated characteristics among patients with thyroid function disorder., Methods: A descriptive, cross-sectional study was conducted on 129 thyroid disorder patients aged ?20 years. A semi-structured questionnaire, Beck Anxiety Inventory, and Beck Depression Inventory were used for sociodemographic characteristics, anxiety, and depression respectively. Group differences were compared (Chi square) or correlations were determined (Pearson's correlation coefficient)., Results: Patients' mean age was 38.09±12.68 years; most were females (102, 79.1%) and hypothyroid (90, 69.8%). Overall prevalence of anxiety and depression were 50.4% and 42.6% respectively. Anxiety was more prevalent in females (54.9% vs 33.3% in males, p=0.046), low economic status (73.9% vs 35.5% in higher status, p=0.019), and hyperthyroid (64.1% vs 44.4% in hypothyroid, p=0.040). Depression was more prevalent in females (47.1% vs 25.9% in males, p=0.048), Janajati ethnic group (54.8% vs 31.1% in Brahmin-Chhetri, p=0.002), lower economic status (69.6% vs 35.5% in higher status, p=0.016), and hyperthyroid (56.4% vs 36.7% in hypothyroid, p=0.037). Associations with occupation, marital status, family type, religion, and duration of illness were not significant., Conclusions: Anxiety and depression are highly prevalent among thyroid disorder patients, especially in females, lower economic status, and hyperfunction type thyroid disorder. Management of thyroid disorders should incorporate treatment of anxiety and depression; routine psychiatric screening of the groups with higher prevalence is advisable.

The pandemic of Coronavirus Disease 2019 (COVID-19) has created paradoxically a good opportunity globally to conduct research in the field of health and social science, and a Lower Middle-Income Country (LMIC) like Nepal is not an exception in this regard. During this ongoing pandemic, the Ethical Review Board (ERB) of Nepal Health Research Council (NHRC) has received numerous research proposals regarding COVID-19. As its main responsibility is to ensure participants' safety, at the same time maintaining the scientific standard of research, the ERB has meticulously gone through all the proposals received so far. During this situation of a health emergency, the ERB of NHRC has had a different experience compared to the usual time. Its strength, weakness, opportunities, and threats have been like never before.

Objective: CD4 T lymphocytes are the most widely used cellular markers to assess the course of HIV infection, clinical staging and, monitoring the effect of antiretroviral therapy. The regional reference range for Eastern, Central and Western development region of Nepal had already been established whereas the same was still lacking in Mid-western and Far-western development region. The objective of this study was to establish reference range of CD4 T lymphocyte in the remaining two development regions and finally the national reference range using data from previous study., Results: The average values (mean ± SD) of CD4 and CD3 T cell in present study was (819 ± 294) cells/μl and (1546 ± 532) cells/μl, respectively. The absolute CD4 T cell (914 ± 303) and CD3 T cell (1671 ± 560) count in female were significantly higher than those from male, CD4 (757 ± 270) and CD3 (1465 ± 499) (p value-0.000). National reference value of CD4 was determined to be (798 ± 335) cells/μl for healthy Nepalese adults.

Introduction: Intestinal parasitic infestation is one of the major health problems in developing countries like Nepal. This study was done to determine the prevalence rate of intestinal parasitic infestation among school children in Duwakot VDC, Bhaktapur, Nepal., Methods: A descriptive cross-sectional study was done in 194 public school children of Duwakot village development committee from August to October, 2019. Ethical clearance was obtained from the Institutional Review Committee (reference no. 1207201915). Simple random sampling was done. One hundred and ninety-four public school children individuals of 6 to 14 years of age were enrolled. Collected stools were examined for the presence of parasites macroscopically and microscopically. Microscopic examination was carried out by direct wet mount using normal saline (0.9%) and Lugol's iodine (0.5%) mount. The data obtained were computed and analyzed using Statistical Package for the Social Sciences version 16.0., Results: A total of 194 stool samples were collected from school children and examined. The prevalence of intestinal parasitosis was 26 (13.40%). The commonest organism was Giardia lamblia in 22 (11.34%) cases. Among helminthic infection, 2 (1.03%) cases each were infected by Hymenolepis nana and Hookworm respectively., Conclusions: The prevalence rate of intestinal parasite infestation in Nepal shows considerable decline in recent years. However, more effort is required by public health resources to minimize the problem further.

Background: Urinary tract infection (UTI) is one of the frequently diagnosed infectious diseases which is caused mainly by Escherichia coli. E. coli confers resistance against the two major classes of antibiotics due to the production of extended spectrum β-lactamase enzymes (ESBL), biofilm, etc. Biofilm produced by uropathogenic E. coli (UPEC) protects from host immune system and prevent entry of antimicrobial compounds. The main objective of this cross-sectional study was to determine the correlation of biofilm production and antibiotic resistance as well as to characterize the pgaA and pgaC genes responsible for biofilm formation among uropathogenic ESBL producing E. coli., Methods: A total of 1977 mid-stream urine samples were examined and cultured for bacterial strain identification. ESBL was detected by combined disc method following CLSI whereas biofilm formation was analyzed by semi-quantitative method. Furthermore, the pgaA and pgaC genes responsible for biofilm formation in UPEC were detected by multiplex PCR. All the statistical analyses were done via IBM SPSS Statistics 21 where Pearson's correlation test were used to determine correlation (-1 ≥ r ≤ 1)., Results: E. coli was the predominant causative agent, which accounted 159 (59.3%) of the Gram-negative bacteria, where 81 (50.9%) E. coli strains were found to be ESBL producers. In addition, 86 (54.1%) E. coli strains were found to be biofilm producers. Both the pgaA and pgaC genes were detected in 45 (93.7%) the UPEC isolates, which were both biofilm and ESBL producers. Moreover, there was a positive correlation between biofilm and ESBL production., Conclusion: The analyses presented weak positive correlation between biofilm and ESBL production in which biofilm producing UPEC harbors both pgaA and pgaC genes responsible for biofilm formation.

Introduction: Staphylococcus aureus is one of the commonest cause of nosocomial infections. Resistant Staphylococcus aureus strain has become a matter of concern. This study was done to find out the prevalence of Staphylococcus aureus from different clinical samples., Methods: The descriptive cross-sectional study was carried out in the Clinical Microbiology laboratory from January 2019 to June 2019. Ethical approval was received from the Institutional Review Committee (Ref: 28122018010). Six hundred sixty-six sample size was calculated. Convenient sampling was done. Staphylococcus aureus was identified on the basis of its microscopy and morphological characteristics followed by catalase and coagulase test. Antibiotic sensitivity test of misolated pathogens was done using Muller Hinton Agar by Kirby-Bauer method. Statistical analysis was done by Excel 2018, point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data., Results: Out of the 666 bacteria isolated from clinical specimens, 133 (19.96%) were Staphylococcus aureus at 95% confidence interval (12.91-13.60%). Seventy nine (78.95%) of which is isolated from pus and wound infections. Out of 133 Staphylococcus aureus, 94 (70.64%) were Methicillin-Resistant Staphylococcus aureus., Conclusions: This study provides valuable information regarding the high prevalence of Staphylococcus aureus from pus and wound infections. The alarming number of Methicillin-Resistant Staphylococcus aureus is worrisome finding. Antibiotics like Vancomycin and Linezolid which has not developed resistance should be cautiously used only in Methicillin-Resistant Staphylococcus aureus cases.

Introduction: Acinetobacter species are short, stout, gram-negative coccobacilli, generally considered to be a relatively low-grade pathogen. However, its resistance towards multiple classes of antibiotics through an array of resistance mechanisms including its ability to form biofilm has led to its emergence as an important pathogen in hospital settings. This study was done to determine the prevalence of biofilm former and Extended-spectrum Beta-Lactamase producer among Acinetobacter species., Methods: A descriptive cross-sectional study was done in the clinical microbiology laboratory, Kathmandu Medical College from January to June 2019. Convenient sampling method was used. Ethical approval was taken from the Institutional Review Committee, Ref no. 2812201805. Preliminary identification followed by characterization of Acinetobacter species was done. Antibiotic susceptibility test was done using the Kirby-Bauer method following Clinical and Laboratory Standards Institute guidelines. Extended-spectrum Beta-Lactamase was detected by combined disc method and Biofilm detection was done using congo red agar method. Statistical Package for Social Sciences 16.0 version statistical software package was used for statistical analysis. Point estimate at 95% Confidence Interval was calculated along with frequencyand proportion for binarydata., Results: Among 108 Acinetobacter species, 86 (79.7%) Acinetobacter calcoaceticus-A. baumannii complex was seen. Seventy-eight (72%) of the isolates were multidrug-resistant, 34 (31%) of the isolates were Extended-spectrum Beta-Lactamase producer and only 10 (9.3%) of the isolates, were biofilm producers., Conclusions: Multidrug-resistant Acinetobacter spp. with the ability to produce Extended-spectrum Beta-Lactamase is prevalent in our hospital settings. Strict compliance with infection control practices is necessary to curb its spread.

Background: Dermatophytosis are the most common types of cutaneous fungal infection seen in human and animals affecting skin, hair and nails caused by dermatophytes. The diagnosis of dermatophytes is based on the clinical observation and laboratory diagnosis by direct microscopic examination and fungal cultures. The present study is undertaken to isolate different type of dermatophytes causing fungal infection., Methods: A prospective cross-sectional study design was used in a total of 90 clinically suspected cases of dermatophytic infection attending the out patient department of Kathmandu Medical College and Teaching hospital (KMCTH). Skin scraping, hair and nail samples were collected from the patients and were processed by direct microscopy and culture using standard protocol. Dermatophytes were identified based on the microscopic arrangement of microconidia and macroconidia., Results: Dermatophytosis was more common in the age group of 21-40 years and was more predominant among male with male to female ratio of 1.7: 1. Among the total clinically suspected cases of dermatophytosis, 53 were positive in direct microscopy and only a total of 20 were positive by culture. Most common clinical type observed in our study was Tinea corporis(25%) followed by Tinea cruris. Trichophyton rubrum(50%) was the commonest aetiological agent in majority of clinical types followed by Trychophyton mentagrophytes(35%)., Conclusions: The study highlighted T. corporis followed by T. cruris and T. unguim as the most common clinical pattern of dermatophytosis with a male predominance and 21-40 years being the most affected age group. T. rubram was the most common aetiological agent causing dermatophytosis.

Background: Labour analgesia, though practiced worldwide, is not very popular in low-income countries. The aim of the study was to assess the awareness, attitude, acceptance, and reasons for hindrance of labour analgesia among patients visiting a tertiary care center in the capital city Methods: It was a cross sectional study conducted in Obstetrics and Gynecology outpatient department of Kathmandu Medical College Teaching Hospital in the month of August 2017. All pregnant patients presenting for antenatal checkup was included. Data was collected based on a questionnaire after informed consent. Statistical analysis was done in SPSS version 20 and results were expressed in frequencies and percentage., Results: Total of 270 pregnant women participated in the study. Out of these forty-four (16.3%) patients were aware about labour analgesia. The acceptance rate was high (72.2%). Majority (84.6%) had no problem with expenditure associated with labour analgesia., Conclusions: Despite low awareness about painless delivery among the antenatal women, the acceptance rate is high.

Background: Epidural analgesia is one of the most popular modes of analgesia for child birth. There are controversies regarding adverse effects and safety of epidural analgesia. This study was conducted to study the immediate effects of the maternal epidural analgesia on the neonate during early neonatal phase., Methods: A prospective cohort study of 100 neonates born to mothers administered epidural analgesia were compared with 100 neonates born to mothers not administered epidural analgesia in terms of passage of urine, initiation of breast feeding, birth asphyxia and incidence of instrumentation., Results: There was significant difference among the two groups in the passage of urine (P value 0.002) and incidence of instrumentation (P value 0.010) but there was no significant difference in regards to initiation of breast feeding and birth asphyxia., Conclusions: Epidural analgesia does not have any effect on the newborns in regards to breast feeding and birth asphyxia but did have effects like delayed passage of urine and increased incidence of instrumentation.

Japanese encephalitis (JE) is a mosquito-borne zoonotic disease that has pigs as the major amplifying hosts. It is the most important cause of viral encephalitis in people in Nepal and is spreading in its geographic distribution in that country. Pig farming is increasing in Nepal due to reducing cultural biases against pigs and government programs to support pig farming for poverty alleviation. Major strategies for JE prevention and control include education, vector control, and immunization of people and pigs. This study used a survey of 400 pig farmers in 4 areas of Nepal with different JE and pig farming histories to explore regional variations in farmer awareness and actions towards JE, the association of awareness and actions with farm and farmer variables, and the implications of these associations for public health education. Exposure to JE risk factors was common across pig farms and pig farming districts but there were significant district level differences in knowledge and practices related to on-farm JE risk reduction. Social factors such as literacy, gender, and cultural practices were associated with farmer attitudes, knowledge and practices for JE control. JE vaccine uptake was almost non-existent and mosquito control steps were inconsistently applied across all 4 districts. Income was not a determining factor of the differences, but all farmers were very poor. The low uptake of vaccine and lack of infrastructure or financial capacity to house pigs indoors or away from people suggest that farmer personal protection should be a priority target for education in Nepal. This study re-enforces the need to attack root causes of people's personal disease prevention behaviours and take into account local variation in needs and capacities when designing health or agriculture education programs.

Japanese Encephalitis (JE) is a vector-borne disease of major importance in Asia. Recent increases in cases have spawned the development of more stringent JE surveillance. Due to the difficulty of making a clinical diagnosis, increased tracking of common symptoms associated with JE-generally classified as the umbrella term, acute encephalitis syndrome (AES) has been developed in many countries. In Nepal, there is some debate as to what AES cases are, and how JE risk factors relate to AES risk. Three parts of this analysis included investigating the temporal pattern of cases, examining the age and vaccination status patterns among AES surveillance data, and then focusing on spatial patterns of risk factors. AES and JE cases from 2007-2011 reported at a district level (n = 75) were examined in relation to landscape risk factors. Landscape pattern indices were used to quantify landscape patterns associated with JE risk. The relative spatial distribution of landscape risk factors were compared using geographically weighted regression. Pattern indices describing the amount of irrigated land edge density and the degree of landscape mixing for irrigated areas were positively associated with JE and AES, while fragmented forest measured by the number of forest patches were negatively associated with AES and JE. For both JE and AES, the local GWR models outperformed global models, indicating spatial heterogeneity in risks. Temporally, the patterns of JE and AES risk were almost identical; suggesting the relative higher caseload of AES compared to JE could provide a valuable early-warning signal for JE surveillance and reduce diagnostic testing costs. Overall, the landscape variables associated with a high degree of landscape mixing and small scale irrigated agriculture were positively linked to JE and AES risk, highlighting the importance of integrating land management policies, disease prevention strategies and promoting healthy sustainable livelihoods in both rural and urban-fringe developing areas.

People with type 2 Diabetes have an elevated risk for developing cardiovascular disease (CVD) for which dyslipidemia is the major contributor. Diabetic patients have characteristic pattern of dyslipidemia with decreased level of high density lipoprotein cholesterol (HDL-C) and elevated triglycerides (TG) level. However, in diabetes mellitus, low density lipoprotein cholesterol (LDL-C) which is used as one of the markers for the risk of CVD, is underestimated so in such cases the levels of non-High density lipoprotein cholesterol (non-HDL-C) can be a stronger predictor of CVD as it strongly correlates with atherogenic lipoproteins. Therefore, an attempt has been made to evaluate the level of non-HDL-C as a newer marker for the risk of cardiovascular disease and to find out the pattern of dyslipidemia in diabetes mellitus. The present study comprised of 82 type 2 Diabetic cases and 81 non-diabetic controls. Among the diabetics, the majority of the subjects (61.0%) were HDL-C dyslipidemic. However, among the controls, the maximum numbers of individuals (40.7%) were TG dyslipidemic. Diabetics have significantly elevated ratio of total cholesterol to high density lipoprotein cholesterol (TC/HDL-C) and the significant increased levels of non-high density lipoprotein cholesterol (non-HDL-C) compared to controls which can be used as markers of dyslipidemia and can also be used to predict the risk of cardiovascular disease in type 2 Diabetes Mellitus.

Introduction: Corneal infection is one of the major causes of monocular blindness in developing countries., Objective: To determine the epidemiological characteristics, predisposing factors, microbiological pattern, sensitivity pattern and treatment outcome of microbial keratitis., Materials and Methods: A retrospective analysis of hospital records of 414 patients with diagnosed infective keratitis was done. The outcome measures were microbial isolates, their sensitivity to therapeutic agents and treatment outcome., Results: Of the total, 312 (75.4 %) patients were farmers by profession, 138 (33.3 %) had a history of ocular trauma and 17(4.1 %) were using topical corticosteroids. Among the 138 cases of the corneal ulcer with trauma, 52 (37.68 %) had fungi isolated in culture (RR=0.54, 95% CI = 0.44 - 0.68) and 32 (23.19 %) had a bacterial growth. Cultures were positive in 300 (72.5 %) cases, having 138 (33.3 %) patients with pure fungal infection, 121 (29.2 %) with pure bacterial and 41 (9.9 %) with mixed infection. Fusarium spp was the most common fungal pathogen while Staphylococcus epidermidis was the commonest bacterial isolate. The most sensitive antibiotics for the Gram positive bacteria was cephazolin (84.92 %), while for Gram negative, ciprofloxacin and ofloxacin were the most effective (79.31 %). Of 414 cases of corneal ulcers, 363 (87.7 %) cases healed completely., Conclusion: Microbial keratitis is mostly seen in farmers in this part of the world. Fusarium and Staphylococcus epidermidis were the most common isolates. Cephazoline and ofloxacin were the most effective antibiotics for Gram positive and Gram negative organisms respectively., (© NEPjOPH.)

Introduction: CD4 T lymphocyte is the most commonly used cellular marker in tracking Human Immunodeficiency Virus (HIV) infection progression and monitoring effect of antiretroviral therapy (ART). Due to lack of local reference values of CD4 and other T lymphocytes in Nepal, most clinical decisions are based on the reference ranges of western countries., Methods: This study was conducted at three major hospitals/laboratory of central, eastern and western Nepal during November 2008 through July 2009. Using the predefined criteria, 602 (200, 202 and 200 from central, eastern and western regions respectively) healthy adult volunteers of age range 18-60 years were recruited with equal representation from each age group and sex. Blood specimens were screened for HIV following standard algorithm using ELISA and two rapid test kits based on different principles. Samples with discordant test-results were excluded. HIV sero-negative specimens were further analyzed for CD4, CD8, and CD4:CD8 ratio, and absolute lymphocyte count (ALC) by FACS count (Becton Dickinson, USA) and automated cell counter (BC-3000 Plus, Shenzhen Mindray Biomedical Electronics, Germany) respectively., Results: The average value (mean± standard deviation) of CD4, CD8, CD4/CD8 ratio and ALC of Nepalese adult population were found to be 786 ± 248, 567±230, 1.52 ± 0.59 and 2712 ± 836 respectively. All four parameters but CD8 were significantly different with sex and females had relatively higher values. However, none of these parameters reported significant difference with age except the ALC., Conclusions: Nepalese healthy adult populations have significantly different T lymphocyte subsets compared to other countries. The present reference ranges of CD4 and other T lymphocytes may be used for any clinical purposes including classifying and monitoring disease status in HIV infected individuals, immune status evaluation, monitoring ART and accordingly making amendment in national HIV treatment guidelines in Nepal.

Introduction: Uncorrected refractive error is an important cause of childhood blindness and visual impairment., Objective: To describe the patterns of refractive errors among children attending the outpatient clinic at the Department of Pediatric Ophthalmology, Lumbini Eye Institute, Bhairahawa, Nepal., Subjects and Methods: Records of 133 children with refractive errors aged 5 - 15 years from both the urban and rural areas of Nepal and the adjacent territory of India attending the hospital between September and November 2010 were examined for patterns of refractive errors. The SPSS statistical software was used to perform data analysis., Results: The commonest type of refractive error among the children was astigmatism (47 %) followed by myopia (34 %) and hyperopia (15 %). The refractive error was more prevalent among children of both the genders of age group 11-15 years as compared to their younger counterparts (RR = 1.22, 95 % CI = 0.66 - 2.25). The refractive error was more common (70 %) in the rural than the urban children (26 %). The rural females had a higher (38 %) prevalence of myopia than urban females (18 %). Among the children with refractive errors, only 57 % were using spectacles at the initial presentation., Conclusions: Astigmatism is the commonest type of refractive error among the children of age 5 - 15 years followed by hypermetropia and myopia. Refractive error remains uncorrected in a significant number of children., (© NEPjOPH.)

Purpose: To find out the epidemiologic features in 686 consecutive cases of fungal keratitis presenting in a tertiary eye hospital in the western region of Nepal., Materials and Methods: A prospective hospital - based study was carried out on 1880 consecutive patients presenting with corneal ulcer in the outpatient department and cornea clinic of Lumbini Eye Institute, Bhairawa, Nepal. The socio-demographic data, predisposing risk factors, prior treatment modalities, laboratory results and the distribution pattern of fungus species were analyzed., Results: Diagnosis of fungus keratitis was established in 686 (36 %) out of the total study group of 1880 cases. The spectrum of fungi isolated were Fusarium species (Fusarium spp.) in 219 (31.9 %), followed by unidentified dematiaceous 151 (22 %), curvularia 122 (17.7 %) and unidentified hyaline in 111 cases (16.1 %). Men (59.3 %) were more commonly affected than women (40.6 %). The young adults age group of 31-40 years was most commonly involved (26.6 %). Corneal trauma (58 %) and topical steroids (12 %) were the most common predisposing risk factors noted., Conclusion: In contrast to the other studies done in Nepal, we found Fusarium to be the most common fungal isolate causing corneal ulcer followed by unidentified dematiaceous, unidentified hyaline and curvularia. Corneal trauma was the commonest predisposing risk factor in causing fungal keratitis., (© NEPjOPH.)

Introduction: There is an increasing awareness about the needs of students with low vision, particularly in developing countries where programs of integrated education are being developed. However, the appropriate low vision services are usually neither available, nor affordable., Objectives: To study the profile of students with low vision in Lumbini Zone of Nepal., Materials and Methods: A cross-sectional study included students with low vision from 8 integrated schools. The reading performance was measured using their own text-books with optical low vision devices prescribed for near reading. The reading rates were measured on a range of print sizes. The Standard Clinical Low Vision Assessment Form and the National Low Vision Program protocol were used. SPSS software was used in data analysis., Results: Of 46 students enrolled, 23 had a mild visual impairment, 18 had severe visual impairment and 5 were blind. Spectacles were needed for 29 (63 %) students. Of the 11 students who had been wearing glasses, the visual acuity improved in 4 with a change in prescription. 91 % of the students had near vision better or equal to 1.5 M with optical low vision services for near reading. The reading rate was 24 WPM at the age of 5 years, whereas at the age of 21 years, it was 55 WPM., Conclusion: The majority of the students with low vision need optical low vision services. Accurate refraction is important in these students. The reading rate increases significantly with improved near visual acuity., (© Nepal Ophthalmic Society.)

Background: Trans-pars plana vitrectomy (TPPV) is an effective surgical procedure to retain the useful vision in vitreoretinal diseases., Objective: To evaluate the surgical outcome of pars plana vitreoretinal surgery., Study Design: Retrospective non-comparative interventional case series., Materials and Methods: A hospital-based retrospective interventional study of series of cases was carried out in retina clinic of Lumbini Eye Institute, Nepal, over a period of one-and-a-half years. Records of 64 patients who underwent vitreo-retina surgeries were reviewed. Demography, duration of symptoms, risk factors and indications, preoperative and post-operative visual acuity, intra-operative and post-operative complications were analyzed., Outcome Measurement: The parameters studied were post-operative visual acuity and complications., Results: Of 64 patients, 61% presented 2 months after the onset of symptoms. Preoperatively, 65.5% had visual acuity of hand motions to 3/60 followed by perception of light only in 26.6%. The main indication for TPPV was vitreous haemorrhage (VH), in 53%. The visual acuity improved to better than 6/60 in patients with VH (68%), whereas, overall, in 72% of the subjects, it improved by 2 lines postoperatively. The commonest intra-operative complications were iatrogenic retinal break (5, 7.8%) at the sclerostomy site., Conclusion: The main indication for TPPV is vitreous haemorrhage. Useful vision can be restored by pars plana vitrectomy in the majority of the patients. Retinal break is the commonest complication of TPPV.

Use of antimicrobial agents (AMAs) is associated with significant reduction in morbidity and mortality. However, indiscriminate and injudicious use of AMAs leads to the ineffective treatment, increased adverse effects, exacerbation or prolongation of illness, emergence of bacterial resistance and an additional burden of an expensive medical cost to the patients. So controlled use of AMAs at right dose, right interval and right duration is of utmost importance. In this retrospective study, prevalence and prescription patterns, and cost of the prescribed AMAs in the hospitalized patients in the department of internal medicine in a tertiary care center were analyzed. A total of 428 hospitalized patients were included in the study. Out of 428 patients, 274 (64.0%, P < 0.01) patients received AMAs for therapeutic (66.4%) and prophylactic (24.1%) purposes. In 9.5% patients AMA prescription was inappropriate. Use of intravenous route was significantly higher (55.48, P < 0.01) than the oral route. COPD with acute exacerbation was most frequent condition for AMA prescription. Majority (90.42%) of AMA prescriptions were based on empirical basis. Mean number of AMA per patient was 2.12 (minimum 1 and maximum 8). Most frequently prescribed AMA was Ceftriaxone (30.2%) from cephalosporin group (33.9%, P < 0.05). Patients received AMAs for the duration of 1-31 days and total cost of single AMA dosage regimen was as high as $ 482.3. As most of the hospitalized patients were prescribed AMA empirically, strategic AMA prescription guidelines and AMA prescription monitoring systems are extremely necessary in the hospitals to prevent emergence of microbial resistance and to expedite the cost effectiveness of medical treatment.

The increase in life expectancy in developing countries and as a result of increasing obesity and other life style changes, the global incidence of type 2 diabetes mellitus (T2DM) is increasing. The purpose of this study was to investigate the prevalence of T2DM and impaired fasting glucose (IFG) in semi-urban population of Nepal and to compare the prevalence between men and women and among different age groups. A total 740 adults (286 men and 454 women) aged 21 to 94 years (men +/- SD; 45.6 +/- 15.6 years) were included. The prevalence of T2DM and IFG was 9.5% and 19.2% in the whole population. Prevalence of T2DM was higher in men (11.8%) then in women (7.9%), similarly IFG was noted higher in men (25%) then in women (15.4%0). The prevalence of T2DM and IFG was seen to be increased with age in the whole population. Among women, the prevalence of T2DM and IFG was 2.9% and 12.8% in 21 to 40 years age group, 9.7% and 13.8% in 41 to 60 years age group and 15.4% and 27.7% in > 60 years age group. Among men, it was 4.7% and 22.6% in 21 to 40 years age group, 13.3% and 30.5% in 41 to 60 years age group and 23% and 17.3% in > 60 years age group. To conclude, the overall prevalence of T2DM and IFG increases with age. Prevalence of IFG is highest among middle age men where as the prevalence of T2DM is highest among older men.

The birth-preparedness package (BPP) promotes active preparation and decision-making for births, including pregnancy/postpartum periods, by pregnant women and their families. This paper describes a district-wide field trial of the BPP implemented through the government health system in Siraha, Nepal, during 2003-2004. The aim of the field trial was to determine the effectiveness of the BPP to positively influence planning for births, household-level behaviours that affect the health of pregnant and postpartum women and their newborns, and their use of selected health services for maternal and newborn care. Community health workers promoted desired behaviours through inter-personal counselling with individuals and groups. Content of messages included maternal and newborn-danger signs and encouraged the use of healthcare services and preparation for emergencies. Thirty-cluster baseline and endline household surveys of mothers of infants aged less than one year were used for estimating the change in key outcome indicators. Fifty-four percent of respondents (n=162) were directly exposed to BPP materials while pregnant. A composite index of seven indicators that measure knowledge of respondents, use of health services, and preparation for emergencies increased from 33% at baseline to 54% at endline (p=0.001). Five key newborn practices increased by 19 to 29 percentage points from baseline to endline (p values ranged from 0.000 to 0.06). Certain key maternal health indicators, such as skilled birth attendance and use of emergency obstetric care, did not change. The BPP can positively influence knowledge and intermediate health outcomes, such as household practices and use of some health services. The BPP can be implemented by government health services with minimal outside assistance but should be comprehensively integrated into the safe motherhood programme rather than implemented as a separate intervention.

Visceral leishmaniasis (VL) or Kala-azar is a potentially fatal vector-borne zoonotic disease caused by a protozoan parasite, Leishmania donovani. Nepal, together with India, Bangladesh, Brazil and Sudan constitutes the five countries of the world where more than 90% of VL occurs. In Nepal, the disease affects eastern Terai region which lies adjacent to the Bihar state of India. Although leishmaniasis is regarded as a significant health problem in Nepal by the Ministry of Health, there is no active case detection programme in the country. Information on the morbidity and mortality is thus very limited. The objectives of this study were to determine the up-to-date morbidity and mortality trend for VL in Nepal. Data collected from eight zonal hospitals in the Terai region suggests that the first confirmed case of VL was recorded in 1980. By 2003, the disease has spread to 14 districts of central and eastern regions of Nepal, and nearly six million people residing in these districts were at the risk of acquiring the disease. A total of 25890 cases with 599 deaths were reported during the year 1980-2006 (up to July). The case fatality rate (CFR) varied from 0.23% to 13.2%. District-wise analysis showed that, during 2003, highest incidence (per 100,000) was in Mahottari district (184), followed by Sarlahi (100) and Sunsari (96). The highest CFR was in Dhanusha (2.9%) followed by Bara (2.4%) and Saptari (2.0%). Majority (70.9%) of persons affected by VL were aged 15 years and above, followed by 10-14 years (13.9%), 5-9 years (11.9%) and 1-4 years (3.3%). The incidence of VL in Nepal seems to be increasing at a faster rate indicating that the existing control programs have been ineffective. To achieve success in control programs, the existing ones should be amended as there is evolution of resistance in the parasite as well as the vector. Public health education, to make the people aware about preventive aspects of the disease is important. The possibility of the existence of animal reservoirs should also be considered and checked out for better control measures.

Objective: To evaluate HIV/AIDS training for traditional healers (THs) in far western Nepal., Methods: We collected data using a structured questionnaire and assessed THs' knowledge of HIV transmission, misconceptions and preventive measures immediately prior to the initial training conducted from June to December 1999, and then 9-12 months after the training in 2000. We also conducted six focus group discussions (FGD) and assessed THs' performances after the training. We interviewed 12 key informants about their perceptions towards the trained THs., Results: THs significantly improved their knowledge of HIV transmission, misconceptions and preventive measures after the training. The FGD and key informant interview results showed that the trained THs provided culturally acceptable HIV/AIDS education to the local people, distributed condoms and played a role in reducing the HIV/AIDS-related stigma., Conclusions: THs have a potential to work as key players in HIV/AIDS programmes in Nepal.

Introduction: His Majesty's Government amended the Nepal Criminal Code (Muluki Ain)--for Liberalising abortion law in the month of Chaitra 2058 (March 2002) and Royal Assent was given on 10th Asoj 2059 (27th September 2002). Accordingly Comprehensive Abortion Care (CAC) Services was initiated in the country. Kathmandu Medical College after enlisting with Ministry of Health started this service from June 2004., Objective: This study was carried out to know--1. Reasons for undergoing CAC service. 2. The complications after the CAC services. 3. The various contraceptive methods adopted by the client following CAC., Methodology: Hospital based prospective study was carried out in Department of Obstetrics & Gynaecology at KMCTH from the period July 2004 to April 2005. Total 160 patients who asked for CAC were enrolled in the study. Counselling, history taking and general examination and per vaginal examination was carried out at the visit. CAC was performed with premedication with Doxycycline 100 mg and Ibuprofen 400 mg half an hour before the procedure. Paracervical block was also given with 1% xylocaine. MVA was performed as described in standard techniques. Patient was discharged after 1-2 hours of observation and with contraception opted by the clients., Results: Main reason for performing CAC was unwanted pregnancy in 66.75%. Complication following CAC was 1.25%. Post CAC contraception was adopted by 93%. Most preferred method was Inj. Depoprovera, Conclusion: The reason for CAC service asked by the patients was unwanted pregnancy. CAC service performed had minimal complication and also gave the opportunity for contraception.

This study aimed to find out the maternal mortality rate (MMR) in mothers dying after admission to the gynaecology and obstetrics ward of BP Koirala Institute of Health Sciences, Nepal, and to analyse the most common causative factor. There was a total of 58 mortality cases in 6 years.The MMR in 1997--1998 was 12/100,000 live births, in 1998--1999 144/100,000, in 1999--2000 294/100,000, in 2000--2001 450/100,000, in 2001--2002 546/100,000 and in 2002--2003 400/100,000. The most common cause of death was septic-induced abortion and its complications, followed by eclampsia and puerperal sepsis.

Meat is an important source of protein and a valuable commodity in resource-poor communities. In many developing countries, lack of appropriate slaughtering facilities and unsatisfactory slaughtering techniques are causing unnecessary losses of meat as well as invaluable by-products from animal carcasses. Slaughtering places are frequently contaminated and may not be protected against dogs, rodents and insects. Meat products coming from such conditions are often deteriorated due to bacterial infection or contaminated, which may cause food poisoning or diseases in consumers. In many developing countries, regulations concerning meat inspection and/or control are inadequate or non-existent allowing consumers to be exposed to pathogens including zoonotic parasites. In Nepal, buffaloes contribute about 64% of the meat consumed, followed by goat meat (20%), pork (7%), poultry (6%) and mutton (2%). Goat and poultry meat is acceptable to all castes of people while buffalo meat is consumed mainly by the Newar ethnic group. Previously, pork was consumed only by people belonging to low castes, however, in recent years, the consumption of pork has increased in higher castes as the caste system has become more relaxed. Until recently, there were no official meat inspection regulations in the country, however, in 1999, the national government legislated an as-yet-to-be implemented Animal Slaughtering and Meat Inspection Act which mandates slaughterhouse construction and meat inspection and control. Due to the lack of implementation of the Meat Inspection Act and resultant absence of meat inspection, meat from sick or parasite-infected animals is serving as a source of infection to humans as well as other animals. In addition, meat quality is adversely affected by careless handling conditions in the slaughtering places as well as in the meat markets or shops. For improvement in animal slaughtering and meat inspection in both rural and urban areas of Nepal, several strategies are to be recommended. Sustainable capacity building should be introduced including training of veterinarians, meat inspectors and butchers as well as building of slaughter facilities. Government policies on slaughter procedures including ante-mortem examination, meat inspection and stamping of meat should be implemented. Programmes should be instituted with strong focus on prevention and control of meat-borne diseases to reduce infection risk of consumers and meat handlers and to avoid contamination of the environment. Lastly, emphasis should be put on improving the animal husbandry system in Nepal. These same actions can be undertaken in other developing countries to assist with improving meat inspection and control, thus helping with prevention and control of cysticercosis as well as other important meat-borne diseases.