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Hemophagocytic lymphohistiocytosis (HLH), is a fatal systemic hyperinflammatory syndrome. HLH may be due to immunosuppression, infections, cancer, or autoimmune diseases with fever and cytopenia. HLH which occurs in adult-onset Stills disease (AOSD) is called secondary HLH, also known as macrophage activation syndrome (MAS). Here, we present a case of a 36-year-old Nepalese female, with no known comorbidities presented with a history of fever, sore throat, multiple joint pain, fluctuating rash, hair loss, and unintentional weight loss for a month. She was hypotensive, with a high-grade fever. She had swollen eyelids, and erythematous macular rashes in the face, trunk, and extremities with the rest of the systemic examinations normal. Investigation showed leukocytosis, with anemia, and a blood smear showed neutrophilic leukocytosis. ESR/CRP and lactate dehydrogenase (LDH) were elevated, and ferritin was 38,291 ng/mL. Tropical disease screening, blood culture, viral serologies, imaging for malignancies, and autoimmune disease panels were negative. She met the diagnostic criteria for AOSD. MAS was suspected of abnormally high ferritin levels, and a bone marrow aspiration biopsy was done. She was given IV steroids with some improvement. The biopsy showed hypercellular marrow with erythroid hyperplasia, dyserythropoietic changes, and increased macrophages with phagocytic activity suggestive of MAS. She was started on dexamethasone and cyclosporine which eventually improved her condition. Several complications can arise in AOSD, around 15% of these patients can have MAS which is regarded as one of the most severe complications. With studies showing a mortality rate of more than 50% in patients of AOSD with MAS which is five times more than the mortality rate with AOSD alone, understanding this combined picture and timely aggressive treatment has a huge importance., Competing Interests: The authors declare no conflicts of interest., (© 2025 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Organic Photovoltaics (OPV) is a very promising technology to harvest artificial illumination and power smart devices of the Internet of Things (IoT). Efficiencies as high as 30.2% have been reported for OPVs under warm white light-emitting diode (LED) light. This is due to the narrow spectrum of indoor light, which leads to an optimal bandgap of ≈1.9 eV. Under full sunlight, OPV devices often suffer from poor stability compared to the established inorganic PV technologies such as crystalline silicon. This study focuses on a potentially very cost-effective Indium Tin Oxide (ITO) free cell stack with absorber materials processed from non-halogenated solvents. These organic solar cells and modules with efficiencies up to 21% can already achieve remarkable stabilities under typical indoor illumination. Aging under 50,000 lux LED lighting leads to very little degradation after more than 11 000 h. This light dose corresponds to more than 110 years under 500 lux. For modules encapsulated with a flexible barrier, extrapolated lifetimes of more than 41 years are achieved. This shows that OPV is mature for the specific application under indoor illumination. Due to the large number of potential organic semiconducting materials, further efficiency increase can be expected., (© 2023 The Authors. Small published by Wiley-VCH GmbH.)

Introduction: Intimate partner violence (IPV) is a significant public health concern in Nepal and its prevalence has increased during the COVID-19 pandemic. This study aimed to assess the prevalence of IPV among married women of reproductive age in Nepal during the pandemic., Methods: A web-based survey was conducted with 420 participants using a validated questionnaire adopted from the World Health Organization. Descriptive and inferential statistical analyses were performed., Results: Our study found that 52.62% of participants experienced IPV during the COVID-19 pandemic with economic violence being the most prevalent type (38.81%) and followed by behavioral control (37.14%), emotional violence (26.20%), physical violence (21.43%), and sexual violence (14.05%). Despite the high level of IPV, only 14% of participants sought help and only 6% reported the violence to the police. Univariate analyses showed that factors such as the husband's level of education and occupation, number of children, property ownership, husband's alcohol use, relationship and quarrels with the husband, fear of the husband, and participation in decision-making were associated with an increased risk of IPV. Multivariate analysis revealed that women involved in decision-making faced a 2.52 times higher risk of violence, that women who reported daily quarrels had a risk 5.47 times that of women who did not endorse fights, and that women who were afraid of their husbands had a risk 16 times that of women who did not report fear., Conclusion: This study reveals a concerning prevalence of IPV among married women in Nepal during the COVID-19 pandemic. Our findings emphasize the low reporting rates and help-seeking behavior among IPV victims. They also highlight the significant influence of factors such as participation in decision-making, frequent quarrels, and fear. These findings underscore the urgent need to establish support systems for IPV victims and develop targeted interventions tailored to the local context. Furthermore, conducting comprehensive research and understanding the interplay of contributing factors can guide the formulation of effective strategies to combat this pervasive societal problem., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

In this systematic review, we evaluate the safety, tolerability, and immunogenicity of vaccination efforts against Alzheimer's disease (AD) in human subjects from both ongoing and completed vaccination trials. Databases like PubMed, Embase, and Scopus were used to identify relevant articles on completed vaccination trials whereas the clinicaltrials.gov database was used for identifying ongoing clinical trials for vaccination against AD in humans until January 2022. Only interventional randomized or non-randomized clinical trials which reported on the safety and immunogenicity of vaccine against AD in humans were included. Cochrane risk of bias tool-2 (RoB-2) or risk of bias in non-randomized studies- of intervention (ROBINS-I) was used for risk of bias assessment as appropriate. A narrative descriptive synthesis of the findings was done. Sixteen randomized/non-randomized clinical trials (phase I: six and phase II: 10) for seven different types of vaccines against AD were identified comprising a total of 2080 participants. Apart from the development of meningoencephalitis in 6% of patients receiving AN1792 in an interrupted phase II trial, the rest of the trial reported promising results on the safety and immunogenicity of vaccines. While only a subset of reported adverse events was treatment related, none of the fatalities reported during the trial were considered related to vaccine administration. The serological response rate ranged from 100% (4/16 trials) to 19.7% in an interrupted trial. Although current trials show promising results, adequately powered phase III studies are needed to conclusively establish the safety, immunogenicity and therapeutic efficacy of vaccines., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Thakur et al.)

Snakebite is an important public health issue around the world. In Nepal, it affects a huge number of people mostly belonging to low-income households who are involved in agriculture. Although snakebite has a serious impact on the Terai population, a few studies suggest that snakebite also occurs frequently in hills and mountains. In the absence of sufficient studies related to snakebites in these geographical regions, it is tough to sketch a true picture and estimate the magnitude of snakebites in those areas. Because of this, the healthcare system is probably not prepared enough to handle the victims of snakebites. This demands a proper study of the burden of the issue in these regions and appropriate initiatives for addressing it., Keywords: antivenom; Nepal; snakebite.

Introduction: and importance: We reported a case of secondary spontaneous pneumothorax (SSP) in a 70-years-old male with acute exacerbation of COPD (AE COPD) managed with improvised chest tube drain (ICD)., Case Presentation: He presented with sudden onset breathlessness and oxygen saturation of 78%. With prolonged expiration on auscultation, he was treated as AE COPD with oxygen therapy, nebulization with albuterol/ipratropium, and injectable antibiotics and steroids. The patient was not improving with treatment on third day, and non-critical respiratory distress continued. Considering the alternative diagnosis, the chest X-ray was done which revealed right sided spontaneous pneumothorax and COPD. Due to his reluctancy to go to higher center for chest tube insertion during ongoing COVID-19 pandemic, we inserted ICD (intravenous set put in saline bottle) at our primary care. Following drainage, breathlessness improved and saturation increased. Then inpatient symptomatic treatment for COPD was continued for three more days. He was discharged on inhalers after fifth day and asked for follow up after 10 days. He came after 1 month and on repeat chest X-ray, his right sided pneumothorax resolved completely and COPD was in control with inhaled medications. There was no recurrence of pneumothorax in five months follow up., Clinical Discussion: ICD is a safe, and an alternative option in resource limited setting. However, the guidelines recommend chest tube insertion as appropriate treatment., Conclusion: This would remind the physicians to anticipate the alternative possibility, and to re-examine those with AE COPD who are not improving as expected with oxygen and nebulization therapy., (© 2022 The Authors.)

Introduction: Vero Cell, AstraZeneca, Janssen, mRNA-1273 (Moderna), and Pfizer COVID-19 vaccines have been authorized for emergency use in Nepal. These vacines have been linked to some adverse effects, including fever, myalgia, and headache. Furthermore Bell's Palsy a rare adverse effect was also reported to be associated with the use of mRNA-1273 (Moderna) vaccine in some patients., Case Presentation: In this case report we present a 17-year-old female who acquired Bell's Palsy following the administration of mRNA-1273 (Moderna) COVID-19 vaccination., Discussion: The possible etiology of BP that has been suggested is infection by reactivated viruses, such as the varicella-zoster virus (VZV), herpes simplex virus type 1 (HSV-1), human herpesvirus 6, and the Usutu virus, [1] the most accepted hypothesis is the one with reactivation of latent Herpes Simplex Virus type 1 in the geniculate ganglia of the facial nerves, an autoimmune mechanism through the mimicry of host molecules by the antigens of the vaccines., Conclusion: Though the extent of association between the mRNA vaccination and the development of Bell's Palsy has yet to be confirmed, this example highlights the need to closely monitor side effects and repercussions after receiving a new vaccine., (© 2022 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Introduction: Pathway of psychiatric care is defined as the sequence of contacts with individuals and organizations initiated by the distressed person's efforts and his significant others to seek appropriate health care. This study aimed to find the prevalence of non-psychiatric referral as first encounter among patients attending the psychiatry outpatient department of a tertiary care hospital., Methods: A descriptive cross-sectional study was carried out from 29th March 2015 to 25th April 2015 in the outpatient department of the department of psychiatry of a tertiary via direct interview using the World Health Organization's encounter form. Ethical approval was taken from undergraduate medical research protocol review board (Reference number 105/071/072). Psychiatric diagnoses were made by respective consultants using the International Classification of Diseases-10 Clinical Descriptions and Diagnostic Guidelines criteria. Data was entered in the Microsoft Excel 2007 and analyzed by Stata version 15. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data., Results: Out of 50 patients, 26 (52%) (38.2-65.8 at 95% Confidence Interval) of new cases in the outpatient department had non-psychiatric referrals. Among them, 13 (26%) referred from faith healers, 7 (14%) from the general hospital and 6 (12%) from medical out patient department., Conclusions: The prevalence of non-psychiatric referral for the patients seen for the first time in the psychiatry outpatient department was similar to findings from studies done in different parts of South East Asia.

Inadequate, unscientific, and lack of optimum utilization of fertilizer management devoid of site-specific nutrient management have been the significant constraints of maize ( Zea mays L.) production in Nepal. Therefore, a multi-locational farmers' field was planned and executed at two VDCs of Morang district in the Terai region of Nepal from December 2015 to May 2016. Nutrient Expert (NE) and Farmer's Fertilizer Practices (FFP) treatments were imposed in a randomized complete block design (RCBD) with twenty replications. The research explored highly significant results in terms of plant number m - 2 , cob numbers m -2 , cob length, kernel rows cob -1 , kernels kernel row -1 , test weight, grain, stover, and biological yields and harvest index. NE showed the highest yield (8.06 tons ha -1 ) among the two treatments tested than FFP (4.52 tons ha -1 ). While comparing net revenue, NE-based fertilizer recommendation gave the significantly higher (NRs.151.116 thousand ha -1 equivalent to $1281 ha -1 ) result than FFP (NRs.84.834 thousand ha -1 equivalents to $707). The result suggests adopting NE practices to minimize the yield gaps and increase the productivity of maize in Morang and adjoining agro-climatic conditions of eastern Terai, Nepal., Competing Interests: The authors declare no conflict of interest., (© 2021 The Authors. Published by Elsevier Ltd.)

Background: Sleep is important in maintenance of proper functioning of both mental and physical functions of human body. Studies have shown there is impact on the sleep parameters with the use of caffeine, cigarette and alcohol. As there is little availability of similar studies here in Nepal, we made an attempt to know the relation of consumption of such substances with the sleep quality and sleep parameters as per Pittsburgh Sleep Quality Index scale.  Methods: A cross sectional study was conducted among the undergraduate students at BP Koirala Institute of Health Sciences, Dharan. Students were asked to complete a self- administered questionnaire to give information about demographic variables and habit of consumption of caffeinated beverages, cigarette and alcohol. The Pittsburgh Sleep Quality Index was utilized after the permission from authority to evaluate sleep quality., Results: Out of 350, almost half of the students (44.6%) had poor sleep quality. 40.8% students reported sleeping six hours or less per night and 10.1% used medications to sleep. 96% reported consuming caffeinated beverages, 20% consumed cigarettes and 38.3% consumed alcoholic beverages. There was significant association of poor sleep quality with the increased consumption caffeine, cigarette and alcohol (p<0.05)., Conclusions: Poor sleep is prevalent among the undergraduate students of B P Koirala Institute of Health Sciences and the consumption of caffeine, cigarette and alcohol is associated with increment in poor sleep quality among them.

The electrically insulating space layer takes a fundamental role in monolithic carbon-graphite based perovskite solar cells (PSCs) and it has been established to prevent the charge recombination of electrons at the mp-TiO 2 /carbon-graphite (CG) interface. Thick 1 μm printed layers are commonly used for this purpose in the established triple-mesoscopic structures to avoid ohmic shunts and to achieve a high open circuit voltage. In this work, we have developed a reproducible large-area procedure to replace this thick space layer with an ultra-thin dense 40 nm sputtered Al 2 O 3 which acts as a highly electrically insulating layer preventing ohmic shunts. Herewith, transport limitations related so far to the hole diffusion path length inside the thick mesoporous space layer have been omitted by concept. This will pave the way toward the development of next generation double-mesoscopic carbon-graphite-based PSCs with highest efficiencies. Scanning electron microscope, energy dispersive X-ray analysis, and atomic force microscopy measurements show the presence of a fully oxidized sputtered Al 2 O 3 layer forming a pseudo-porous covering of the underlying mesoporous layer. The thickness has been finely tuned to achieve both electrical isolation and optimal infiltration of the perovskite solution allowing full percolation and crystallization. Photo voltage decay, light-dependent, and time-dependent photoluminescence measurements showed that the optimal 40 nm thick Al 2 O 3 not only prevents ohmic shunts but also efficiently reduces the charge recombination at the mp-TiO 2 /CG interface and, at the same time, allows efficient hole diffusion through the perovskite crystals embedded in its pseudo-pores. Thus, a stable V OC of 1 V using CH 3 NH 3 PbI 3 perovskite has been achieved under full sun AM 1.5 G with a stabilized device performance of 12.1%., Competing Interests: The authors declare no competing financial interest., (Copyright © 2020 American Chemical Society.)