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Background: Patient satisfaction is an integral component of patient care. This concept has been already integrated in the developed nations and the topic is getting interest in developing nations. Hence attempt has been made to address the satisfaction of the patients in different settings and hospitals. The objective of this study was to assess the satisfaction and likely sociodemographic factors affecting the satisfaction among the outpatients. Methods: A cross-sectional study was conducted among 207 outpatients visiting different departments of the hospital by systematic random sampling method. The satisfaction was assessed by the abbreviated form of Patient Satisfaction Questionnaire-18 and the mean scores of seven domains were obtained. Results: Mean satisfaction level was 3.53(0.40) out of 5. Highest level of satisfaction was in interpersonal manner domain and the lowest in accessibility and convenience domain. None of the sociodemographic variables was significantly associated with the overall satisfaction (p>0.05). Enrollment into the national health insurance, occupation and educational status of the patients were found to significantly affect one or more domains. Conclusions: This study showed that the overall satisfaction was fair; hence there is room for improvement for better patient satisfaction. Hospital needs to focus on easy accessibility and convenience of the healthcare facilities and resources to the patients. Keywords: Nepal; patient satisfaction; socio-demographic tertiary hospital.

Cartap, a nereistoxin derivative from the marine annelid Lumbriconeresis heteropoda, is widely used as a pesticide, targeting pests like caterpillars. While the WHO classifies it as moderately hazardous, with a recommended daily intake of 0.05 mg/kg, human toxicity reports are limited. A 34-year-old female was admitted after consuming an unknown poison. She reported epigastric pain, burning sensations, sweating, vomiting, dyspnea, palpitations, and restlessness, compounded by alcohol intake. Initially treated for organophosphate poisoning, her cholinesterase level was 8.91. It was later confirmed she ingested 100 ml of 50% concentration cartap. Treatment included amiodarone for supraventricular tachycardia and intravenous N-acetylcysteine, magnesium sulfate, and midazolam for general tonic clonic seizure. Cartap, toxic through ingestion and skin contact, can cause symptoms such as vomiting, convulsions, and cardiac issues like supraventricular tachycardia. Supportive care is crucial, and awareness of its risks is necessary.

Key Clinical Message This case illustrates sarcoidosis as a potential complication of COVID‐19, highlighting the need for a comprehensive diagnostic approach, including histopathology and prolonged monitoring, to distinguish it from post‐COVID fibrosis. Further research is crucial to elucidate these associations and understand their underlying mechanisms. Abstract Severe Acute Respiratory Syndrome Coronavirus‐ 2 (SARS‐CoV‐2), a positive‐sense single‐stranded RNA virus, causes COVID‐19 and has been linked to autoimmune disorders. Sarcoidosis is a multi‐system disease that is frequently triggered by infections. It is characterized by non‐necrotizing granulomas in multiple organs. We present a case of sarcoidosis as rare sequelae of COVID‐19. A 26‐year‐old man presented with mild COVID‐19 symptoms, followed by prolonged fever and cough despite initial therapy, prompting a provisional diagnosis of post‐COVID fibrosis. A subsequent assessment at a tertiary hospital revealed dyspnea, weight loss, and abnormal chest imaging, all of which were consistent with pulmonary sarcoidosis with pulmonary tuberculosis as a differential diagnosis. A biopsy taken during bronchoscopy confirmed pulmonary sarcoidosis and treatment with inhalation steroids resulted in symptom relief, which was followed by remission with oral steroid therapy. Sarcoidosis is a systemic disease of unknown etiology, characterized by non‐necrotizing granulomas in multiple organs. It may be triggered by infections and involves an abnormal immune response. COVID‐19 can potentially initiate sarcoidosis, with both sharing common immune mechanisms. Diagnosis involves imaging and biopsy, and treatment typically includes glucocorticoids and regular monitoring. This case report emphasizes the potential link between COVID‐19 and autoimmune conditions like sarcoidosis, highlighting the need for a comprehensive diagnostic approach and long‐term observation to distinguish between sarcoidosis and post‐COVID fibrosis.

Abstract Background Leprosy is an infectious disease with a slow decline in global annual caseload in the past two decades. Active case finding and post-exposure prophylaxis (PEP) with a single dose of rifampicin (SDR) are recommended by the World Health Organization as measures for leprosy elimination. However, more potent PEP regimens are needed to increase the effect in groups highest at risk (i.e., household members and blood relatives, especially of multibacillary patients). The PEP++ trial will assess the effectiveness of an enhanced preventive regimen against leprosy in high-endemic districts in India, Brazil, Bangladesh, and Nepal compared with SDR-PEP. Methods The PEP++ study is a cluster-randomised controlled trial in selected districts of India, Brazil, Bangladesh, and Nepal. Sub-districts will be allocated randomly to the intervention and control arms. Leprosy patients detected from 2015 − 22 living in the districts will be approached to list their close contacts for enrolment in the study. All consenting participants will be screened for signs and symptoms of leprosy and tuberculosis (TB). In the intervention arm, eligible contacts receive the enhanced PEP++ regimen with three doses of rifampicin (150 − 600 mg) and clarithromycin (150 − 500 mg) administered at four-weekly intervals, whereas those in the control arm receive SDR-PEP. Follow-up screening for leprosy will be done for each individual two years after the final dose is administered. Cox’ proportion hazards analysis and Poisson regression will be used to compare the incidence rate ratios between the intervention and control areas as the primary study outcome. Discussion Past studies have shown that the level of SDR-PEP effectiveness is not uniform across contexts or in relation to leprosy patients. To address this, a number of recent trials are seeking to strengthen PEP regimens either through the use of new medications or by increasing the dosage of the existing ones. However, few studies focus on the impact of multiple doses of chemoprophylaxis using a combination of antibiotics. The PEP++ trial will investigate effectiveness of both an enhanced regimen and use geospatial analysis for PEP administration in the study communities. Trial registration NL7022 on the Dutch Trial Register on April 12, 2018. Protocol version 9.0 updated on 18 August 2022 https://www.onderzoekmetmensen.nl/en/trial/23060

Introduction: Low intake of fruit and vegetable (F&V) increased the risk of non-communicable diseases, followed by disability and death. The fact that many diseases in adulthood have their origins in habits formed during childhood is undeniable. Therefore, the study assessed the prevalence of fruit and vegetable consumption among young schoolchildren aged 5 to 9 years. Methods: A cross-sectional study was carried out among 352 children from March 8 to September 4, 2020. The multistage sampling method was used to select samples. A face-to-face interview was done with one of the parents at their home. Univariate and bivariate analyses were computed at a 5% level of significance. Ethical approval was obtained from the Nepal Health Research Council. Results: Out of 352 children, none of the children met the WHO recommendation of F&V of ≥5 servings per day. Around two percentage (2.30%) of children consumed neither fruits nor vegetables, while only 46(13%) had taken F&V at least three servings per day. Children’s higher F&V intake was found to be associated with family monthly income, parents’ higher education, the presence of a fruit and vegetable shop nearby, and giving money to children. Conclusions: Intake of F&V as compared to the recommendation was very low in the study area. This requires an immediate response including nutrition education for parents, teachers, and decision-makers and increasing easy access to F&V.

Introduction: A number of studies have shown that anosmia and dysgeusia present as symptoms of COVID-19. These symptoms can appear with sudden onset following COVID-19 infection. The objective of the study was to observe epidemiological and clinical profile of COVID-19 patients who had experienced anosmia and dysgeusia. Methods: A cross-sectional study was carried out in Ear, Nose and Throat outpatient department of Pokhara Academy of Health Sciences over a period of two months, from February 2022 to March 2022. Patients visiting the outpatient department were enquired about the COVID-19 infection status in the past and symptoms related to taste and smell impairment were asked about. Results: Out of total 198 patients, 141 (71%) had experienced impairment of taste and smell, either one or both, while the rest did not develop such features after testing positive for COVID-19 virus. Conclusions: Anosmia and dysgeusia were common features in COVID-19 infection.

To assess mental wellbeing among persons affected by leprosy, this study aimed to validate the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) and the Patient Health Questionnaire (PHQ-9, depression tool) in Province 1 and 7, Nepal. Using purposive and convenience sampling, cross-cultural equivalences were assessed through semi-structured interviews with persons affected by leprosy (>18 years). Data were transcribed, translated, analysed and discussed with experts before revising the tools. Psychometric properties of the scales were assessed using an interviewer-administered questionnaire with cases affected by leprosy and controls not affected by leprosy (>18 years). Statistical analysis included internal consistency, construct validity, floor and ceiling effects, and interpretability. The qualitative study included 20 respondents of whom eleven were female. The statements in the original tools were rephrased to questions as participants had difficulties understanding the statements. Six additional changes were made to ensure items were understood well. The quantitative study included 90 cases (46% female) and 50 controls (54% female). The WEMWBS and PHQ-9 had adequate psychometric properties. Cronbach's alphas were 0.85 and 0.76, respectively, indicating good internal consistency, 75% of hypotheses for construct validity were confirmed, no floor and ceiling effects were found, and data to help users interpret results are presented. Our study provides evidence that the adapted versions of the WEMWBS and PHQ-9 have good cultural validity to measure mental wellbeing and depression among persons affected by leprosy in Province 1 and 7, Nepal.

Multimorbidity, also known as multiple long-term conditions, leads to higher healthcare utilisation, including hospitalisation, readmission, and polypharmacy, as well as a financial burden to families, society, and nations. Despite some progress, the economic burden of multimorbidity remains poorly understood. This paper outlines a protocol for a systematic review that aims to identify and synthesise comprehensive evidence on the economic burden of multimorbidity, considering various definitions and measurements of multimorbidity, including their implications for future cost-of-illness analyses. The review will include studies involving people of all ages with multimorbidity without any restriction on location and setting. Cost-of-illness studies or studies that examined economic burden including model-based studies will be included, and economic evaluation studies will be excluded. Databases including Scopus (that includes PubMed/MEDLINE), Web of Science, CINAHL Plus, PsycINFO, NHS EED (including the HTA database), and the Cost-Effectiveness Analysis Registry, will be searched until March 2024. The risk of bias within included studies will be independently assessed by two authors using appropriate checklists. A narrative synthesis of the main characteristics and results, by definitions and measurements of multimorbidity, will be conducted. The total economic burden of multimorbidity will be reported as mean annual costs per patient and disaggregated based on counts of diseases, disease clusters, and weighted indices. The results of this review will provide valuable insights for researchers into the key cost components and areas that require further investigation in order to improve the rigour of future studies on the economic burden of multimorbidity. Additionally, these findings will broaden our understanding of the economic impact of multimorbidity, inform us about the costs of inaction, and guide decision-making regarding resource allocation and cost-effective interventions. The systematic review's results will be submitted to a peer-reviewed journal, presented at conferences, and shared via an online webinar for discussion.

Background: Dengue is a neglected tropical disease, and Scrub typhus is an emerging tropical illness in Nepal. Coinfection between them is found in literature and clinical practice. The objective of this study is to describe and compare the demographic, clinical, and laboratory characteristics of patients with mono and coinfection of Dengue and Scrub typhus. Methods: This was a single-center hospital-based retrospective study, performed at Beni District Hospital, Nepal. The patient who was diagnosed with mono and coinfection of Dengue and Scrub typhus from 1st January 2020 to 16th September 2020 were included. Data regarding demographic characteristics, symptoms, signs, and laboratory parameters were collected and analyzed. Results: In 53 patients who fall under the inclusion criteria of our study, 12 patients had coinfection with dengue and Scrub typhus with headache being the most common symptom regardless of mono or coinfection followed by myalgia and arthralgia. Total platelet counts at the time of admission were lower in the coinfection group with increasing thrombocytopenia during the disease course in comparison to mono-infection. The maximum temperature recorded, elevation in hepatic enzymes, and duration of defervescence were more in the coinfection group in comparison to dengue and scrub mono-infection. Conclusions: Mono and coinfection of Dengue, Scrub typhus present with common clinical symptoms, laboratory findings. With limited resources for screening and diagnosis, clinical prediction based on symptoms alone or together with lab parameters is difficult which is further difficult in the presence of Co-infection. Keywords: Clinical; coinfection; dengue; laboratory parameter; scrub typhus

Abstract The development of an optimal treatment modality to improve the therapeutic outcome of breast cancer patients is still difficult. Poor antigen presentation to T cells is a major challenge in cancer immunotherapy. In this study, a synergistic immunotherapy strategy for breast cancer incorporating immune cell infiltration, immunogenic cell death (ICD), and dendritic cell (DC) maturation through a reactive oxygen species (ROS)‐responsive dual‐targeted smart nanosystem (anti‐PD‐L1‐TKNP) for the simultaneous release of DOX, R848, and MIP‐3α in the tumor microenvironment is reported. Following local injection, anti‐PD‐L1‐DOX‐R848‐MIP‐3α/thioketal nanoparticle (TKNP) converts tumor cells to a vaccine owing to the combinatorial effect of DOX‐induced ICD, R848‐mediated immunostimulatory properties, and MIP‐3α‐induced immune cell recruitment in the tumor microenvironment. Intratumoral injection of anti‐PD‐L1‐DOX‐R848‐MIP‐3α/TKNP caused significant regression of breast cancer. Mechanistic studies reveal that anti‐PD‐L1‐DOX‐R848‐MIP‐3α/TKNP specifically targets tumor tissue, resulting in maximum exposure of calreticulin (CRT) and HMGB1 in tumors, and significantly enhances intratumoral infiltration of CD4+ and CD8+ T cells in tumors. Therefore, a combined strategy using dual‐targeted ROS‐responsive TKNP highlights the significant application of nanoparticles in modulating the tumor microenvironment and could be a clinical treatment strategy for effective breast cancer management.

Dual-receptor targeted (DRT) nanoparticles which contain two distinct targeting agents may exhibit higher cell selectivity, cellular uptake, and cytotoxicity toward cancer cells than single-ligand targeted nanoparticle systems without additional functionality. The purpose of this study is to prepare DRT poly(lactic-co-glycolic acid) (PLGA) nanoparticles for targeting the delivery of docetaxel (DTX) to the EGFR and PD-L1 receptor positive cancer cells such as human glioblastoma multiform (U87-MG) and human non-small cell lung cancer (A549) cell lines. Anti-EGFR and anti-PD-L1 antibody were decorated on DTX loaded PLGA nanoparticles to prepare DRT-DTX-PLGA via. single emulsion solvent evaporation method. Physicochemical characterizations of DRT-DTX-PLGA, such as particle size, zeta-potential, morphology, and in vitro DTX release were also evaluated. The average particle size of DRT-DTX-PLGA was 124.2 ± 1.1 nm with spherical and smooth morphology. In the cellular uptake study, the DRT-DTX-PLGA endocytosed by the U87-MG and A549 cells was single ligand targeting nanoparticle. From the in vitro cell cytotoxicity, and apoptosis studies, we reported that DRT-DTX-PLGA exhibited high cytotoxicity and enhanced the apoptotic cell compared to the single ligand-targeted nanoparticle. The dual receptor mediated endocytosis of DRT-DTX-PLGA showed a high binding affinity effect that leads to high intracellular DTX concentration and exhibited high cytotoxic properties. Thus, DRT nanoparticles have the potential to improve cancer therapy by providing selectivity over single-ligand-targeted nanoparticles.

Introduction Japan has experienced a shift toward a multicultural society, and an increasing number of immigrant children have enrolled in its educational systems. Unforeseen experiences may affect the mental well-being of these children and undermine their holistic development; however, research is scarce. This article explores parents’ concern on Nepalese children's experiences in Japanese schools. We aim to reveal the issues that may inform healthcare professionals and schools in best supporting immigrant students. Methods Qualitative survey methods were adopted in an online survey tool to access and collect data from 13 Nepalese parents whose children (age 6–18 years) attended the schools (elementary or junior high school) in four prefectures of Japan. Thematic analysis was used to analyze the data. Results The following four themes were identified: (i) interaction and relationship; (ii) feeling different and meals at school; (iii) academic exclusion—lack of assistance/review at home; and (iv) emotional distress, peer exclusion, and bullying. Conclusion Our findings suggest that because of the linguistic and cultural differences, children had difficulty communicating, leading to poor interpersonal relationships. Subjects reported changes in daily living patterns at home and school, and children felt different, shy, and unable to make friends or get involved. There were problems with school meals as well, and parents expressed concern over a lack of academic assistance. Some noteworthy emotional aspects were inability to be happy at school and bullying or exclusion from peers. They did, however, express the impression that Japanese students and teachers are cooperative. Overall, these findings have implications for schoolteachers, nurses, health personnel, parents, and others who promote the mental well-being and holistic development of children. This study provides a basis for mental health educational programs targeting the relationship between migrant and native students to create an inclusive society for all.

Abstract Pigmented basal cell carcinoma is a rare variant of basal cell carcinoma, with only a limited number of reported cases. Because of its similar clinical presentation, it is often over‐diagnosed as malignant melanoma. Along with case presentation, the clinical, microscopic features, and differential diagnosis are discussed in this case report.

Purpose: To document the demographic profile of the SHAPU outbreak amidst the COVID-19 pandemic. Methods: A multicentric cross-sectional study of the 2021 SHAPU outbreak during the second phase of the COVID-19 outbreak. Results: A total of 135 patients were diagnosed with SHAPU from August to December 2021, 77 (57%) were children <16 years, males 54.8% and 34.8% had direct physical contact with white moths and 41.5% had severe type of SHAPU. Dramatic increment in the moth abundance was noted in these outbreak sites. Few cases presented with atypical ocular findings, unlike past outbreaks. Due to the ongoing COVID-19 pandemic with restrictions on travel and transportation, timely management was difficult and good visual outcome was achieved only in mild-moderate cases with an early presentation. Conclusion: The surge in the number of SHAPU patients, its occurrence in areas previously unreported, and some atypical presentation added raised suspicion of a possible link between COVID-19 and SHAPU. SYNOPSIS: Increase in SHAPU patients, incidence in unreported areas of Nepal, atypical ocular presentations and shift in disease affection from children towards adults population have raised doubt between connections between SHAPU, white moths and COVID pandemic. [ABSTRACT FROM AUTHOR]

Key Clinical Message: This case illustrates sarcoidosis as a potential complication of COVID‐19, highlighting the need for a comprehensive diagnostic approach, including histopathology and prolonged monitoring, to distinguish it from post‐COVID fibrosis. Further research is crucial to elucidate these associations and understand their underlying mechanisms. Severe Acute Respiratory Syndrome Coronavirus‐ 2 (SARS‐CoV‐2), a positive‐sense single‐stranded RNA virus, causes COVID‐19 and has been linked to autoimmune disorders. Sarcoidosis is a multi‐system disease that is frequently triggered by infections. It is characterized by non‐necrotizing granulomas in multiple organs. We present a case of sarcoidosis as rare sequelae of COVID‐19. A 26‐year‐old man presented with mild COVID‐19 symptoms, followed by prolonged fever and cough despite initial therapy, prompting a provisional diagnosis of post‐COVID fibrosis. A subsequent assessment at a tertiary hospital revealed dyspnea, weight loss, and abnormal chest imaging, all of which were consistent with pulmonary sarcoidosis with pulmonary tuberculosis as a differential diagnosis. A biopsy taken during bronchoscopy confirmed pulmonary sarcoidosis and treatment with inhalation steroids resulted in symptom relief, which was followed by remission with oral steroid therapy. Sarcoidosis is a systemic disease of unknown etiology, characterized by non‐necrotizing granulomas in multiple organs. It may be triggered by infections and involves an abnormal immune response. COVID‐19 can potentially initiate sarcoidosis, with both sharing common immune mechanisms. Diagnosis involves imaging and biopsy, and treatment typically includes glucocorticoids and regular monitoring. This case report emphasizes the potential link between COVID‐19 and autoimmune conditions like sarcoidosis, highlighting the need for a comprehensive diagnostic approach and long‐term observation to distinguish between sarcoidosis and post‐COVID fibrosis. [ABSTRACT FROM AUTHOR]

Objectives Economic evaluations of interventions for people with mental–physical multimorbidity, including a depressive disorder, are sparse. This study examines whether such interventions in adults are cost-effective.Design A systematic review.Data sources MEDLINE, CINAHL Plus, PsycINFO, Cochrane CENTRAL, Scopus, Web of Science and NHS EED databases were searched until 5 March 2022.Eligibility criteria We included studies involving people aged ≥18 with two or more chronic conditions (one being a depressive disorder). Economic evaluation studies that compared costs and outcomes of interventions were included, and those that assessed only costs or effects were excluded.Data extraction and synthesis Two authors independently assessed risk of bias in included studies using recommended checklists. A narrative analysis of the characteristics and results by type of intervention and levels of healthcare provision was conducted.Results A total of 19 studies, all undertaken in high-income countries, met inclusion criteria. Four intervention types were reported: collaborative care, self-management, telephone-based and antidepressant treatment. Most (14 of 19) interventions were implemented at the organisational level and were potentially cost-effective, particularly, the collaborative care for people with depressive disorder and diabetes, comorbid major depression and cancer and depression and multiple long-term conditions. Cost-effectiveness ranged from £206 per quality-adjusted life year (QALY) for collaborative care programmes for older adults with diabetes and depression at primary care clinics (USA) to £79 723 per QALY for combining collaborative care with improved opportunistic screening for adults with depressive disorder and diabetes (England). Conclusions on cost-effectiveness were constrained by methodological aspects of the included studies: choice of perspectives, time horizon and costing methods.Conclusions Economic evaluations of interventions to manage multimorbidity with a depressive disorder are non-existent in low-income and middle-income countries. The design and reporting of future economic evaluations must improve to provide robust conclusions.PROSPERO registration number CRD42022302036.

Background. The relationship between alcohol dependence and suicidal tendency is well recognized. Self-harm by cut throat is an uncommon but is potentially life-threatening when attempted. We present a description and discussion of a series of three cases of alcohol dependence syndrome who presented with self-inflicted cut throat wounds during the lockdown period from 24th March to 7th July 2020 due to the COVID-19 pandemic at the largest tertiary care hospital in Nepal. Case description. During the three and a half months of COVID-19 lockdown, we had three cases of alcohol dependence syndrome presenting to emergency services with a self-inflicted cut throat injury. Two cases were diagnosed as having alcohol withdrawal delirium and one case as alcohol-induced psychotic disorder (alcoholic hallucinosis) as per the international classification of mental and behavioral disorders diagnostic criteria for research. All three cases were alcohol dependent for more than a decade, but with no prior self-harm attempts. Necessary surgical interventions were done by the Department of Otorhinolaryngology, and in liaison with the Department of Psychiatry, appropriate psychiatric management was done. All three cases had uneventful outcomes in regard to wound care and mental disorder. Conclusion. Suicidal precautions should be taken in alcohol dependence during phases of consumption and abstinence. Screening for alcohol dependence and withdrawal should be a standard process in all self-harm cases that present to the emergency department during a crisis.

BackgroundA key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016.MethodsDrawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita.FindingsIn 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries.InterpretationGBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations.FundingBill & Melinda Gates Foundation.

Introduction: Psychological distress among healthcare workers amidst COVID-19 pandemic has emerged as a serious health problem. Understanding its magnitude is crucial to guide policies and interventions to improve their psychological wellbeing. This study assessed the psychological distress and its associated factors among health care workers in Nepal during the COVID-19 pandemic. Methods: A cross-sectional online survey was carried out among 427 health workers currently working in Nepal from April 25 to June 10, 2020. Psychological distress was measured using “The Kessler Psychological Distress Scale” (K10). Descriptive statistics and inferential statistics were computed at a 5% level of significance. Ethical approval was taken from Nepal Health Research Council. Results: A total of 427 healthcare workers participated in the study. Out of the total participants, 50.4% were males. Nearly half of the participants were medical doctors (48%) followed by nurses (22.2%), health assistants (12.2%) and 61% were non-government employees. The healthcare workers who experienced symptoms of psychological distress were 28.9%. Out of 123 respondents who had symptoms of psychological distress, 19% had mild, 7.3% had moderate and 2.6% had severe psychological distress. Female healthcare workers were more likely to have psychological distress than males [AOR: 1.75, CI: 1.05-2.92]. Conclusions: Psychological distress in healthcare workers during the COVID-19 pandemic is a matter of serious health concern. This issue demands urgent comprehensive intervention embracing the provision of a supportive environment and protective equipment, screening psychological outcomes and psychological counseling especially targeting female healthcare workers.

Introduction: The height measurement is an important anthropometric measurement which can be directly correlated with health status of an individual. Body weight of an individual refers to total body mass and is also important indicator of health status of people. Body mass index (BMI) is a key index for relating weight to height. It is defined as the body mass divided by the square of the body height, The BMI is an attempt to quantify the amount of body tissue mass in an individual, and then categorize that the person as underweight, normal weight, overweight or obese. Objectives: To find out the average height and weight, to calculate BMI and find out its average value and to correlate height and weight in Nepalese population. Methodology: A cross sectional study was conducted in subjects from different parts of Nepal. Three hundred twenty one healthy subjects of 25-40 years of age group were studied. Height and weight of subjects were recorded and BMI was calculated. Data were analyzed using SPSS. Result: In overall Nepalese population, Mean height was found to be 156.6 ± 6.3 cm; mean weight 56.6 ± 11.4 kg and BMI 20.9 ± 1.8 kg/m2. Pearson’s correlation co-efficient(r) for height and weight was 0.88. Conclusion: There was partial positive correlation between height and weight. There was statistically significant difference in height, weight and BMI between Nepalese male and female(p

BackgroundIn the past 15 years, the decline in annually detected leprosy patients has stagnated. To reduce the transmission of Mycobacterium leprae, the World Health Organization recommends single-dose rifampicin (SDR) as post-exposure prophylaxis (PEP) for contacts of leprosy patients. Various approaches to administer SDR-PEP have been piloted. However, requirements and criteria to select the most suitable approach were missing. The aims of this study were to develop an evidence-informed decision tool to support leprosy programme managers in selecting an SDR-PEP implementation approach, and to assess its user-friendliness among stakeholders without SDR-PEP experience.MethodologyThe development process comprised two phases. First, a draft tool was developed based on a literature review and semi-structured interviews with experts from various countries, organisations and institutes. This led to: an overview of existing SDR-PEP approaches and their characteristics; understanding the requirements and best circumstances for these approaches; and, identification of relevant criteria to select an approach. In the second phase the tool's usability and applicability was assessed, through interviews and a focus group discussion with intended, inexperienced users; leprosy programme managers and non-governmental organization (NGO) staff.Principal findingsFive SDR-PEP implementation approaches were identified. The levels of endemicity and stigma, and the accessibility of an area were identified as most relevant criteria to select an approach. There was an information gap on cost-effectiveness, while successful implementation depends on availability of resources. Five basic requirements, irrespective of the approach, were identified: stakeholder support; availability of medication; compliant health system; trained health staff; and health education. Two added benefits of the tool were identified: its potential value for advocacy and for training.ConclusionAn evidence-informed SDR-PEP decision tool to support the selection of implementation approaches for leprosy prevention was developed. While the tool was evaluated by potential users, more research is needed to further improve the tool, especially health-economic studies, to ensure efficient and cost-effective implementation of SDR-PEP.

Background: Sedentary lifestyle is a major modifiable risk factor that usually starts from childhood. High screen time is associated with sedentary lifestyle in children; and parents might have played a role in screen time among the children. This study aims to assess the role of parents in the screen time of young children aged five to nine years in Pokhara metropolitan city in Nepal. Methods: A cross sectional study was done among 360 children where respondents were one of the parents of those children. Face to face interview was done using a semi structured questionnaire between March 8 and September 4, 2020. A daily screen time 2 hours was found among 48.6% children. The screen time of >2 hours children was significantly associated with the educational qualification of parents, parental worry and parental permission to watch the screen for tasks like eating, doing homework, not going out or making free time for parents. The screen time of children was not associated with socioeconomic characteristics like parental occupation. Conclusion: Parental characteristics have role in the screen time of children. Parental factors must also be considered while implementing programs to reduce children’s screen time.

Introduction: With occurrence of COVID-19, many countries have initiated lockdown in an effort to control the pandemic. These measures can only be effective when the people co-operate. The awareness and health-related behavior have a major role in determining society’s response. Meanwhile adolescents are at the risk of deviating from disciplined health-related behaviors due to turbulence arising from their hormones despite of their awareness. This study aims to study COVID-19 awareness and its impact on health-related behavior of adolescents. Methods: A descriptive cross-sectional web-based online study of 299 adolescents enrolled in various educational programs, between ages 13 to 19 years was conducted between June 18, 2020 and July 11, 2020 in Nepal. The questionnaire consisted of demographic characteristics, 16 items on knowledge and 40 items on behavior. Descriptive statistics, chi-square tests and binary logistic regression were conducted in Statistical Package for the Social Sciences. Results: A total of 299 adolescents were enrolled in the study. Majority (92.6%) of the adolescents had adequate awareness. Positive health-related behavior was seen in 72% of the adolescents. Spiritual behavior was the most affected in comparison to physical, social and psychological behavior. Adolescents with adequate awareness on COVID-19 were 10.67 times more likely to perform positive health related behavior (P=0.005; 95% CI=2.01-56.47). Conclusion: Majority of the adolescents had adequate awareness. Significant percentage of adolescents had positive health-related behavior. Positive behaviour was not proportionately in level with adequate awareness. Effective health programs and policies are needed to transform adequate awareness into positive health-related behaviour for effective control of disease.

Objective The purpose of this health system's study is to assess the availability of Emergency Obstetric Care (EmOC) services in birthing centres in Taplejung District of eastern Nepal. Methods A cross-sectional survey was conducted in 2018 in all 16 public health facilities providing delivery services in the district. Data collection comprised: (1) quantitative data collected from health workers; (2) observation of key items; and (3) record data extracted from the health facility register. Descriptive statistics were used to calculate readiness scores using unweighted averages. Results Although key health personnel were available, EmOC services at the health facilities assessed were below the minimum coverage level recommended by the World Health Organisation. Only the district hospital provided the nine signal functions of Comprehensive EmOC. The other fifteen had only partially functioning Basic EmOC facilities, as they did not provide all of the seven signal functions. The essential equipment for performing certain EmOC functions was either missing or not functional in these health facilities. Conclusions for Practice The Ministry of Health and Population and the federal government need to ensure that the full range of signal functions are available for safe deliveries in partially functioning EmOC health facilities by addressing the issues related to training, equipment, medicine, commodities and policy., Author(s): Amrit Banstola [sup.1] , Padam Simkhada [sup.2] , Edwin van Teijlingen [sup.3] , Surya Bhatta [sup.4] , Susma Lama [sup.5] , Abisha Adhikari [sup.4] , Ashik Banstola [sup.1] [sup.6] [...]

Introduction: Dengue is an infectious disease. This disease is prevalent mainly in the terai belts of Nepal. But in the last few years, the cases are in increasing trend in the hilly areas of Nepal. The aim of this study was to find out the prevalence of admitted dengue cases among adult dengue-positive cases in a tertiary care centre. Methods: This was a descriptive cross-sectional study done at a tertiary teaching hospital after obtaining ethical approval from the Institutional Review Committee (Reference number: 063/2077/2078). Convenience sampling was used. The data of serologically confirmed dengue cases, during the period of 1 August 2019 to 1 December 2019, of ages above 15 years, were collected from the hospital records. Point estimate and 95% Confidence Interval were calculated. Results: Out of 922 adult dengue-positive patients, 347 (37.63%) (36.04-39.22, 95% Confidence Interval) were admitted. Among them, 154 (44.38%) cases were seen during the month of September. A total of 264 (76.08%) were the inhabitants of the Kaski district. A total of one hundred seventy eight (51.29%) cases were males. The most common symptoms seen were fever among 335 (96.54%) patients and headache among 141 (40.63%) patients. Leukopenia was seen in 192 (55.33%) patients and thrombocytopenia was seen in 165 (47.55%) of the admitted cases. Conclusions: The prevalence of admitted dengue cases was higher as compared to other studies done in similar settings.

Abstract Lyonia ovalifolia (angeri) is a deciduous tree whose shoot and leaves are toxic. Its chemical constituents include grayanane diterpenoids, lyoniol A, and other toxic compounds. Young children might consume it intentionally or unintentionally, with subsequent adverse health outcomes and even mortality depending on the amount ingested. We present a case of an adolescent girl who developed poisoning on ingestion of angeri leaves.

A brain atlas is essential for understanding the anatomical relationship between neuroanatomical structures. Standard stereotaxic coordinates and reference systems have been developed for humans, non-human primates and small laboratory animals to contribute to translational neuroscience research. Despite similar neuroanatomical and neurofunctional features between the sheep and human brain, little is known of the sheep brain stereotaxy, and a detailed sheep atlas is scarce. Here, we briefly discuss the value of using sheep in neurological research and the paucity of literature concerning the coordinates system during neurosurgical approaches. Recent advancements such as computerized tomography, positron emission tomography, magnetic resonance imaging, functional magnetic resonance imaging and diffusion tensor imaging are used for targeting and localizing the coordinates and brain areas in humans. Still, their application in sheep is rare due to the lack of a 3D stereotaxic sheep atlas by which to map sheep brain structures to its human counterparts. More recently, a T1- and T2-weighted high-resolution MRI 3D stereotaxic atlas of the sheep brain has been generated, however, the journey to create a sheep brain atlas by which to map directly to the human brain is still uncharted. Therefore, developing a detailed sheep brain atlas is valuable for the future to facilitate the use of sheep as a large animal experimental non-primate model for translational neurological research.

Introduction: Virtual reality (VR) gameplay is popular with a range of games and educational resources available. However, it puts high demands on the visual system. Current evidence shows conflicting impacts on visual parameters. Therefore, this study explores the changes to vision following VR gameplay. Methods: The study was conducted at the School of Health Sciences, University of Liverpool. All participants had binocular vision with good visual acuity and no manifest strabismus. Participants were assessed before and after playing 15 minutes of the VR game Beat Saber, which incorporated convergence and divergence movements. Clinical assessments including near point of convergence (NPC) and near point of accommodation (NPA) using the RAF rule; accommodative convergence to accommodation (AC/A) ratio; motor fusion using the prism fusion range (at 33cm), accommodation facility using +2.00/–2.00DS flipper lenses, and stereoacuity using the Frisby stereo test were assessed before and after playing. Results: Seventy-eight participants (19–25 years old) were included in the study, with 16 males and 41 females respectively. The breakpoint of convergence reduced by 0.5 cm (p = 0.001). The binocular accommodative facility improved by 2 cycles per minute (cpm); p = 0.004. The mean, near horizontal prism fusion range (PFR) base break and recovery points both worsened by of 5.0 dioptres (p = 0.003), whereas the mean near horizontal PFR base in recovery point improved by of 4.0 dioptres (p = 0.003). Discussion: The study validated previous findings as VR gameplay over-exercised and fatigued convergence muscles, but to a small degree. The VR experience improved the participants’ ability to change focus quickly and improve accommodation, as well as the divergence function of the eye. However, as the participants were retested directly after the VR gameplay, the findings were limited to short term effects on vision.

Introduction and Objectives: Chronic kidney disease is an increasing health problem worldwide and the burden of such patients is increasing in developing countries like Nepal as well. The final treatment for End Stage Renal Disease is only renal replacement therapy. The objective was to study the demographic and clinical profile of patients with End Stage Renal Disease undergoing haemodialysis. Methods: This was a prospective, observational study carried out in a tertiary hospital after obtaining ethical consent from the Institutional Review Board. The study period was from June 1st to August 31st, 2019. Thirty seven patients, older than 15 years who were on maintenance haemodialysis on regular basis in the hospital for at least 3 months were selected for the study. Patient’s records were used for the data collection as well as direct questionnaire to the patients on follow up for routine haemodialysis. Data were entered into Statistical Package for the Social Sciences 21 and descriptive analysis was done. Results: Twenty-six patients were under 50 years with male: female ratio of 1.64:1. Mean duration of haemodialysis of patients was 3.82 years. Most common cause for end stage renal disease was hypertension followed by idiopathic cause. Anaemia and hypocalcaemia were found to be the common complications associated with the patients. Conclusions: Prevention and early treatment may be the key to decrease the incidence of chronic kidney disease patients and also halt the progression to End stage renal disease.

Introduction: Perceived risk, preventive behavior and enabling environment play vital role to prevent COVID-19 transmission in health care settings. The study aimed to assess perceived risk, preventive behavior and enabling environment among healthcare workers of different cadre during COVID-19 pandemic in Nepal. Methods: A cross sectional online survey was conducted among 427 health workers from April 25 to June 10, 2020. A structured questionnaire was prepared in Google form. Perceived risk was measured using 10 items scale, value ranging from 10 to 50. Descriptive and inferential statistics were computed at 5% level of significance. Ethical approval was taken from Nepal Health Research Council. Results: Of total, 49.6% respondents were male; 38.4% were from government organizations and 48.0% were doctors. Mean perceived risk was 31.8, 32.8, 31.3 among doctors, nursing professionals and others respectively; and it did not have significant difference among them. However, significant differences were observed in different items of perceived risk across difference cadre of health workers. Most of the health workers reported practice of preventive behavior always or most of the time. Of total, 5.4% doctors and 6.9% other health workers reported they had sometimes access to soap and water. 11.7% doctors, 7.5% nursing professionals and 7.8% other health workers had sometimes access to hand sanitizer; 18.0% doctors, 10.4% nursing professionals and 12.1% other health workers had sometimes access to face mask. Conclusion: Perceived risk of COVID-19 was high, preventive behavior was satisfactory; but access to enabling environment was poor. Therefore, adequate attention should be given to ensure the availability of protective equipment at work place.

Abstract The COVID-19 pandemic has exceeded over sixty-five million cases globally. Different approaches are followed to mitigate its impact and reduce its spreading in different countries, but limiting mobility and exposure have been de-facto precautions to reduce transmission. However, a full lockdown cannot be sustained for a prolonged period. An evidence-based, multidisciplinary approach on risk zoning, personal and transmission risk assessment in near real-time, and risk communication would support the optimized decisions to minimize the impact of coronavirus on our lives. This paper presents a framework to assess the individual and regional risk of COVID-19 along with risk communication tools and mechanisms. Relative risk scores on a scale of 100 represent the integrated risk of influential factors. The personal risk model incorporates age, exposure history, symptoms, local risk and existing health condition, whereas regional risk is computed through the actual cases of COVID-19, public health risk factors, socioeconomic condition of the region, and immigration statistics. A web application tool ( http://www.covira.info ) has been developed, where anyone can assess their risk and find the guided information links primarily for Nepal. This study provides regional risk for Nepal, but the framework is scalable across the world. However, personal risk can be assessed immediately from anywhere.