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Background: Globally, the majority of strokes affect people residing in lower-and lower-middle-income countries (LMICs), but translating evidence-based knowledge into clinical practice in regions with limited healthcare resources remains challenging. As an LMIC in South Asia, stroke care has remained a healthcare problem previously unaddressed at a national scale in Nepal. The Nepal Stroke Project (NSP) aims to improve acute stroke care in the tertiary healthcare sector of Nepal. We hereby describe the methods applied and analyze the barriers and facilitators of the NSP after 18 months. Methods: The NSP follows a four-tier strategy: (1) quality improvement by training healthcare professionals in tertiary care centers; (2) implementation of in-hospital stroke surveillance and quality monitoring system; (3) raising public awareness of strokes; and (4) collaborating with political stakeholders to facilitate public funding for stroke care. We performed a qualitative, iterative analysis of observational data to analyze the output indicators and identify best practices. Results: Both offline and online initiatives were undertaken to address quality improvement and public awareness. More than 1,000 healthcare professionals across nine tertiary care hospitals attended 26 stroke-related workshops conducted by Nepalese and international stroke experts. Monthly webinars were organized, and chat groups were made for better networking and cross-institutional case sharing. Social media-based public awareness campaigns reached more than 3 million individuals. Moreover, live events and other mass media campaigns were instituted. For quality monitoring, the Registry of Stroke Care Quality (RES-Q) was introduced. Collaboration with stakeholders (both national and international) has been initiated. Discussion: We identified six actions thatmay support the development of tertiary care centers into essential stroke centers in a resource-limited setting. We believe that our experiences will contribute to the body of knowledge on translating evidence into practice in LMICs, although the impact of our resultsmust be verified with process indicators of stroke care. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Anemia is a common health problem with nonspecific symptoms often overlooked leading to adverse health outcomes. This study aims to assess the clinical profile, types, and etiologies of anemia. MATERIAL AND METHODS: In this hospital based cross-sectional study, patients with anemia were enrolled through convenience sampling. Relevant history, physical examination, and investigations were performed. Statistical package for social sciences software version 20 was used to enter and analyze the data. Categorical variables were expressed as frequencies and percentages. Continuous variables were expressed as median (range). The associations were analyzed by using Fisher's exact test or Chi-square test, as appropriate. RESULTS: Out of 193 patients, 151 (78.2%) were females. The median age was 49 years (range 18-87 years). Most frequent symptoms were easy fatiguability (76.2%), breathlessness on exertion (30.1%), and light headedness (21.8%). Most frequent signs were pallor (75.6%), tachycardia (23.8%), glossitis (16.1%), and nail changes (15.5%). Majority (79.3%) had moderate and 17.1% had severe anemia. Iron deficiency (59.1%) and anemia of inflammation (28%) were common etiologies. Iron deficiency anemia was most commonly due to nutritional deficiency. Age was significantly associated with the type and etiology of anemia. CONCLUSION: Moderate anemia was the most common presentation. Easy fatiguability, breathlessness on exertion, and light headedness were most common symptoms, while pallor, tachycardia, glossitis, and nail changes were the most common signs. Iron deficiency anemia and anemia of inflammation were most common etiologies. Iron deficiency anemia was more common in younger patients, while anemia of inflammation was more common in older patients. [ABSTRACT FROM AUTHOR]

INTRODUCTION Thyroid disorder is common endocrine disorder second to diabetes. With the advancement of laboratory facilities in urban and rural areas, detection rate of thyroid disorder is escalating. Both hyperthyroidism and hypothyroidism can lead to dreaded complication like hypertensive heart disease, coronary arterial disease, arthralgia, severe myalgia, infertility, arrhythmia and many more, so our study helps us to know the awareness amongst a group of population from mid Western partofNepal. MATERIAL AND METHODS This is cross sectional descriptive study, conducted in mid Western region of Nepal, among 105 subjects attending Neuro and Allied Clinic, Bhairahawa, Nepal from 15 August, 2019 to 20 August. 2019. RESULTS Majority 42 (40%) of participants are of age group 36-40 years and are housewives. All are literate and 91 (87%) are married. Most of them 93 (88%) know that it is common in female and one third of them has had their family history positive for this disorder. More than half 37 (53%) of the respondents had inadequate awareness on thyroid disorders whereas 33 (47%) had adequate awareness with mean score 19.9 and 12.4 standard deviation. The maximum score of awareness related question was 42 and minimum 3 obtained by the respondents out of 53. Finally, there is an association between age, education level, occupation status of respondents, respondent's family members or herselfhaving thyroid disease with awareness level (P □ 0.005), but no association between marital status and awareness level. CONCLUSION This study reveals majority of people are aware of thyroid disorder but still awareness is inadequate. So, it is mandatory to perform public awareness by NGOs, INGOs and Government sector about thyroid disorder for early diagnosis and to prevent from its complications. [ABSTRACT FROM AUTHOR]

Background: Stroke related studies in Nepal are primarily hospital-based and mainly from the capital city.Objectives: We aimed to estimate the prevalence of stroke and stroke risk factors in the South-Western community of Nepal.Methods: A cross-sectional study was conducted from May to August 2018 among 549 randomly selected Nepalese participants from diverse ethnicity, aged ≥15 years, in a region with the availability of neurological support facilities. Data were collected using a stroke questionnaire designed for the purpose. Stroke was identified by enumerators using the Balance-Eyes-Face-Arms-Speech-Time (BEFAST) scale, and a senior neurologist confirmed it. We assessed the presence of major risk factors associated with stroke.Results: The crude and age-standardised prevalence of stroke were 2368 and 2967 per 100,000 respectively. Of all the surveyed participants, 61% (n=335) reported consumption of full-fat dairy products >3 days per week, 87.6% (n=481) reported a high intake of salt (>5 g/day), 83.6% (n=459) with a low intake of fruits and vegetables (<400 g/day), 45.2% (n=248) with perceived stress related to work or home, 51.6% (n=283) with financial stress (283, 51.6%), 86.7% (n=457) with low high-density lipoprotein, 96.2% (n=507) with high blood urea nitrogen, 47.1% (n=356) were either overweight or obese 20.4% (n=112) with hypertension and 6.2% (n=34) with diabetes.Conclusions: The prevalence of stroke in the community of the South-Western part of Nepal is relatively higher than that estimated in South-Asia and global context. Our findings suggest an urgent community intervention, particularly with healthy lifestyles changes for future stroke prevention in the high-risk group. [ABSTRACT FROM AUTHOR]