Search

Shakti Shrestha,1 Ramesh Sharma Poudel,2 Dipendra Khatiwada,3 Lekhjung Thapa4 1Department of Pharmacy, Shree Medical and Technical College, 2Department of Pharmacy, 3Department of Community Medicine, 4Department of Neurology, College of Medical Sciences-Teaching Hospital, Chitwan, Nepal Background: The combined medications practice of using antithrombotic agents and statins with or without antihypertensive agents is common in the treatment of acute ischemic stroke in Nepal. Short-term outcomes of the current practice have been studied. We aim to explore the predictors of ischemic stroke outcomes at 3 months, with the current combined medications practice. Methods: The study population (N=56) included acute ischemic stroke patients treated at the Neurology Department of the College of Medical Sciences-Teaching Hospital, Chitwan, Nepal, from May 2014 to August 2014 and followed up at 3 months. Death or disability (modified Rankin scale >2) was defined as poor outcomes. Multivariate logistic regression analysis (P

Municipal solid waste (MSW) management has emerged as one of the major environmental challenges globally. The consequences of inappropriate waste management are manifold and the trend would continue if immediate interventions are not taken for its reversion amid rapid urbanization and current consumption patterns of individuals. The concept of circular economy (CE) can contribute to a paradigm shift in the transformation of the traditional linear approach that does not favour reuse, recycle, recovery concept. Modern and proven waste management practices with collection systems, recycling facilities, sanitary landfills, and waste-to-energy (WtE) and nutrient recovery offer opportunities to improve urban environment through the valorization of waste and by-products in a CE. This study scrutinizes the existing literature on the assessment of circularity and helps to develop a unified circularity framework in the management of MSW in cities. Key aspects such as tools for measuring circularity, nexus and trade-offs, and conditions in promoting CE are discussed. Finally, this paper elucidates the need for circularity, including enablers and inhibitors for promoting circularity in the management of MSW with a case study in the city of Curitiba, Brazil.

Background: Cooking with traditional fuels can lead to severe health issues caused by household air pollution, and can also affect gender equality and drive environmental degradation. In Nepal, despite government efforts to promote electric cooking, more than half of the population still uses traditional fuels, with electric cooking adoption remaining below 1%. Several of the barriers to and enablers of clean cooking vary geographically; however, few studies have considered spatial explicit information in planning national-scale transitions to clean cooking. In this study we provide a spatially explicit roadmap to estimate the required investments and benefits gained from the transition across Nepal., Methods: This study uses geospatial modelling methods to evaluate strategies to achieve the Government of Nepal's vision for a national-scale transition to clean cooking. We integrate the open-source clean cooking geospatial assessment tool OnStove and a spatial multicriteria analysis model. With OnStove, we evaluate which cooking technologies and fuels maximise the net benefits of a clean-cooking transition across each km 2 of the region. With the multicriteria analysis, we weigh stakeholder preferences and prioritise areas of action where policy should be implemented. We used the most up-to-date geospatial data to the year 2023, such as the High Resolution Settlement Layer, Open Street Maps' road networks, the Global Human Settlement Layer, NASA/USGS forest cover maps, and Facebook's Relative Wealth Index, among others. We also relied on data from the Nepal Oil Corporation, the Nepal Electricity Agency, the Central Bureau of Statistic's 2021 national census, and the Alternative Energy Promotion Center. We evaluate four scenarios capturing advances on clean cooking policy up to the year 2022, current market inefficiencies, and the potential effects of new policies for clean-cooking transition in Nepal., Findings: Our results show that transitional and clean cooking technologies provide higher net benefits than traditional options everywhere across Nepal in all scenarios. Our net-benefit analysis shows that around 9563 deaths could be averted yearly if benefits and externalities were perceived and valued correctly. Furthermore, substantial benefits could be achieved in regard to greenhouse gas emissions avoidance, time saved, and health-cost reductions. Our results also show that the current subsidy strategy from the Government of Nepal is well aligned with the benefits achieved under a cost-benefit analysis. In this context, electric cooking can bring the highest benefits to the largest part of the population. The analysis showed how high subsidies for liquefied petroleum gas in Nepal can present trade-offs with energy security and independence, and how this could be avoided by transferring part of the subsidy to cover differentiated electric cooking tariffs. Accounting for stakeholder preferences and sociodemographic and geographical differences to prioritise areas of focus can balance affordability constraints and target the most vulnerable people first, thus achieving integrated and inclusive planning., Interpretation: Using spatially explicit modelling approaches to evaluate strategies for a clean cooking transition can provide more nuanced results that have not been possible before. This approach can enable data-driven and integrated planning to help to understand which locations of a study area should be prioritised for policy application. Integrated planning can help to reduce affordability constraints on the population and design strategies for a sustainable and inclusive transition. These strategies allow financial institutions, donors, impact investors, development organisations, and government agencies to use their resources, funds, and assistance to create a large impact., Funding: Clean Cooking Alliance., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

This study assessed the hydropower potential of a mountain watershed within the Sunkoshi River basin in Sindhupalchok, Nepal, utilizing geographic information systems (GIS) and the soil and water assessment tool (SWAT) hydrological model. Topographical, soil, land use, meteorological, and discharge data were employed to assess the study area for the appropriateness of hydropower generation. SWAT was utilized to delineate the Sunkoshi basin into 23 distinct subbasins and involved the creation of a detailed river network, incorporating various hydrological attributes including stream links, stream order, stream length, and slope gradient. After that, it was employed to simulate river discharges within these subbasins. The Sequential Uncertainty Fitting Version 2 (SUFI-2) algorithm, integrated within the SWAT Calibration and Uncertainty Program (SWAT-CUP), was employed to calibrate and validate the model. This step involved the adjustment of 25 selected parameters to enhance the model's accuracy and reliability in representing the hydrological processes of the Sunkoshi basin. Model performance was assessed utilizing three well-established efficiency criteria: coefficient of determination ( R 2  = 0.79), Nash-Sutcliffe efficiency (NSE = 0.73), and percent bias (PBIAS = 17.59). The study identified 36 sites across streams of order 3, 4, and 5 as having potential for hydropower generation. The hydropower potential at each identified site was evaluated using estimated stream flow and topographical head at various probability of exceedance (PoE) levels (40%, 45%, 50%, and 60%). The aggregate hydropower potential of the basin was quantified, yielding a potential of 371.30 MW at a 40% PoE. The findings suggest that an integrated approach combining SWAT-based hydrological modeling within a GIS can accurately assess a river basin's hydropower potential and provide insights into further evaluation of the comprehensive environmental assessment of the fragile Himalayan watersheds., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2024 Rinki Bhattarai et al.)

Introduction: Administration of an intravenous contrast medium, which is used in various routine hospital procedures, can lead to the development of nephropathy in some patients. This contrast-induced nephropathy is one of the most common reasons for hospital-acquired acute kidney injury. This study aimed to find out the prevalence of contrast-induced nephropathy among patients administered with contrast material at a tertiary care centre., Methods: This descriptive cross-sectional study was conducted from 4 March 2022 to 23 May 2022 at a tertiary care centre after taking ethical approval from the Institutional Review Committee (Reference number: 0812202106). Patients administered with an intravenous contrast medium for diagnostic imaging were included in the study. Data including sociodemographic variables and renal function test results were collected. A convenience sampling method was used. Point estimate was done and 95% Confidence Interval was calculated., Results: Among 174 participants, contrast-induced nephropathy was found in 86 (48.31%) (48.24-48.39, 95% Confidence Interval)., Conclusions: The study showed that the prevalence of contrast-induced nephropathy was higher than findings from other studies done in a similar setting., Keywords: contrast material; kidney disease; prevalence.

Background: Along with many physical issues associated with the HIV/AIDS there are socio-psychological ill-effects including depression, anxiety and stress. The antiretroviral therapy has been successful in prolonging the life but not much information is available on the psychosocial issues and social support from Nepal., Methods: Sequential explanatory mixed method study design was followed. All the patients undergoing antiretroviral therapy in Bharatpur Hospital above 18 years of age and giving consent to participate were conveniently selected. Validated Nepalese version of Becks Depression Inventory and Becks Anxiety Inventory tool while translated and validated Multidimensional Scale of Perceived Social Support scale was used Purposive In-depth Interview was conducted with open ended questionnaire to obtain qualitative data. Chi-square and logistic regression were used for quantitative analysis while manual content analysis was used to analyze the qualitative data., Results: The totals of 288 participants were included in the study About 43% had some level of depression, 98% had very low level of anxiety and almost half of the people had high support. In binary logistic regression model, the significant variables were sex, marital status and occupation. Females had 2.622 times more odds of depression than males, the risk of having depression in occupation group- agriculture and household was 3.661 and 2.508 time more as compared to jobholder respectively. Similarly, single individuals had 2.815 higher odds of depression than couples. Emotional disturbances and fear of vulnerability, stigmatization, dealing with difficulties were the major problems in these groups with good familial and organization support., Conclusions: Clinicians, health and AIDS professionals should routinely screen for depression among other interventions to promote psychological health in HIV/AIDS-positive individuals.

Stevens-Johnson syndrome and toxic epidermal necrolysis represent a spectrum of severe mucocutaneous reactions, while Acute Cutaneous Lupus Erythematosus is a variant of Systemic Lupus Erythematosus. Both are rare conditions, with significant morbidity and mortality; often indistinguishable clinically and pose a diagnostic dilemma for the clinician. We hereby present a unique case of a 17 years old female who presented with widespread vesiculobullous lesions with peeling, desquamation, and crusting of the skin surface, non-scarring alopecia, oral and nasal ulcers, as well as two episodes of generalized tonic-clonic seizures. The patient had a history of intake of itraconazole tablets for a week, 25 days before the disease manifestation.

A new growth method to make highly oriented GaAs thin films on flexible metal substrates has been developed, enabling roll-to-roll manufacturing of flexible semiconductor devices. The grains are oriented in the <001> direction with <1° misorientations between them, and they have a comparable mobility to single-crystalline GaAs at high doping concentrations. At the moment, the role of low-angle grain boundaries (LAGBs) on device performance is unknown. A series of electron backscatter diffraction (EBSD) and cathodoluminesence (CL) studies reveal that increased doping concentrations decrease the grain size and increase the LAGB misorientation. Cross-sectional scanning transmission electron microscopy (STEM) reveals the complex dislocation structures within LAGBs. Most importantly, a correlative EBSD/electron beam-induced current (EBIC) experiment reveals that LAGBs are carrier recombination centers and that the magnitude of recombination is dependent on the degree of misorientation. The presented results directly link increased LAGB misorientation to degraded device performance, and therefore, strategies to reduce LAGB misorientations and densities would improve highly oriented semiconductor devices.

Background: The increasing burden of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome and its association with the stigma, disability, less productive life, diminished immune has overall affected the quality of well being. There are also many factors that directly or indirectly affect the quality of Life of People living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome. Thus, this study aims to assess Quality of Life among people living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome., Methods: A cross-sectional analytical study among 100 individuals of age 18 years and above and diagnosed from 6 month and above attending the ART clinic of Bharatpur Hospital was carried out between using simple random sampling technique. Quality of life was evaluated using World Health Organization Quality of life questionnaire (WHO QOL-BREF instrument)., Results: This study reveals that the Quality of Life median scores were highest for the environmental domain (25±2.6) and lowest for the social domain (11±1.4). The overall Quality of Life median scores in the other two domains were physical domain (23±2.4), and psychological domain (19±3.1). The Quality of Life scores of all four domains were strongly co-related with the total measure of the quality of life. The strongest correlation was seen in psychological domain .Sex, Education, Marital status, Cause of HIV, Co-morbidities of illness, and Family support was statistically associated with overall Quality of Life., Conclusions: Higher education, Good family support and no co-morbidties to the illness has a greater impact in improving the quality of Life.

Background: Baseline stroke knowledge in a targeted population is indispensable to promote the effective stroke education. We report the baseline knowledge, attitude, and practice (KAP) of high school students with respect to stroke from Nepal., Materials and Methods: A self-structured questionnaire survey regarding KAP about stroke was conducted in high school students of 33 schools of Bharatpur, Nepal. Descriptive statistics including Chi-square test was used, and the significant variables were subjected to binary logistic regression., Results: Among 1360 participants, 71.1% had heard or read about stroke; 30.2% knew someone with stroke. 39.3% identified brain as the organ affected. Sudden onset limb/s weakness/numbness (72%) and hypertension (74%) were common warning symptom and risk factor identified. 88.9% would take stroke patients to a hospital. Almost half participants (55.5%) felt ayurvedic treatment be effective. 44.8% felt stroke as a hindrance to a happy life and 86.3% believed that family care was helpful for early recovery. Students who identified at least one risk factor were 3.924 times ( P < 0.001, confidence interval [CI] = 1.867-8.247) or those who identified at least one warning symptom were 2.833 times ( P ≤ 0.023, CI = 1.156-6.944) more likely to take stroke patients to a hospital., Conclusion: KAP of high school Nepalese students regarding stroke was satisfactory, and the students having knowledge about the risk factors and warning symptoms were more likely to take stroke patients to a hospital. However, a few misconceptions persisted.

This data in brief includes forward and reverse scanned current density-voltage ( J - V ) characteristics of perovskite solar cells with PDPP3T and spiro-OMeTAD as HTL, stability testing conditions of perovskite solar cell shelf life in air for both PDPP3T and spiro-OMeTAD as HTL as per the description in Ref. [1], and individual J - V performance parameters acquired with increasing time exposed in ambient air are shown for both type of devices using PDPP3T and spiro-OMeTAD as HTL. The data collected in this study compares the device stability with time for both PDPP3T and spiro-OMeTAD based perovskite solar cells and is directly related to our research article "solution processed pristine PDPP3T polymer as hole transport layer for efficient perovskite solar cells with slower degradation" [2].

We report effects of an interface between TiO2-perovskite and grain-grain boundaries of perovskite films prepared by single step and sequential deposited technique using different annealing times at optimum temperature. Nanoscale kelvin probe force microscopy (KPFM) measurement shows that charge transport in a perovskite solar cell critically depends upon the annealing conditions. The KPFM results of single step and sequential deposited films show that the increase in potential barrier suppresses the back-recombination between electrons in TiO2 and holes in perovskite. Spatial mapping of the surface potential within perovskite film exhibits higher positive potential at grain boundaries compared to the surface of the grains. The average grain boundary potential of 300-400 mV is obtained upon annealing for sequentially deposited films. X-ray diffraction (XRD) spectra indicate the formation of a PbI2 phase upon annealing which suppresses the recombination. Transient analysis exhibits that the optimum device has higher carrier lifetime and short carrier transport time among all devices. An optimum grain boundary potential and proper band alignment between the TiO2 electron transport layer (ETL) and the perovskite absorber layer help to increase the overall device performance.

In this work role of solvent additive namely 1,8 diiodoctane (DIO) on the nanoscale morphology and its relation with the charge transport of poly(diketopyrrolopyrrole-terthiophene) (PDPP3T):PCBM solar cells has been investigated. Addition of DIO led to enhanced structural ordering as observed from optical measurements. Photovoltaic devices processed with DIO additive showed improved efficiencies due to significant enhancement in short circuit current density. Atomic force microscopy (AFM) and Kelvin probe force microscopy (KPFM) images showed that DIO led to finer phase segregation that gave rise to better photovoltaic performance in additive processed active layers. Photoinduced current extraction by linearly increasing voltage (P-CELIV) measurements on PDPP3T:PCBM solar cells revealed higher mobility and extracted charge carrier density for DIO processed devices.

The role of electron selective interfaces on the performance and lifetime of polymer solar cells were compared and analyzed. Bilayer interfaces consisting of metal oxide films with cationic polymer modification namely poly ethylenimine ethoxylated (PEIE) were found to enhance device lifetime compared to bare metal oxide films when used as an electron selective cathode interface. Devices utilizing surface-modified metal oxide layers showed enhanced lifetimes, retaining up to 85% of their original efficiency when stored in ambient atmosphere for 180 days without any encapsulation. The work function and surface potential of zinc oxide (ZnO) and ZnO/PEIE interlayers were evaluated using Kelvin probe and Kelvin probe force microscopy (KPFM) respectively. Kelvin probe measurements showed a smaller reduction in work function of ZnO/PEIE films compared to bare ZnO films when aged in atmospheric conditions. KPFM measurements showed that the surface potential of the ZnO surface drastically reduces when stored in ambient air for 7 days because of surface oxidation. Surface oxidation of the interface led to a substantial decrease in the performance in aged devices. The enhancement in the lifetime of devices with a bilayer interface was correlated to the suppressed surface oxidation of the metal oxide layers. The PEIE passivated surface retained a lower Fermi level when aged, which led to lower trap-assisted recombination at the polymer-cathode interface. Further photocharge extraction by linearly increasing voltage (Photo-CELIV) measurements were performed on fresh and aged samples to evaluate the field required to extract maximum charges. Fresh devices with a bare ZnO cathode interlayer required a lower field than devices with ZnO/PEIE cathode interface. However, aged devices with ZnO required a much higher field to extract charges while aged devices with ZnO/PEIE showed a minor increase compared to the fresh devices. Results indicate that surface modification can act as a suitable passivation layer to suppress oxidation in metal oxide thin films for enhanced lifetime in inverted organic solar cells.

Introduction: This study aimed to evaluate the effectiveness of face-to-face training for teaching rotahaler technique in newly diagnosed patients of asthma and chronic obstructive pulmonary disease (COPD)., Methods: A hospital-based study was conducted among twenty patients who were prescribed rotahaler for the first time. Patients received face-to-face training on rotahaler technique from pharmacist using GINA guidelines. The patients rotahaler technique was assessed after two weeks of training and scored one for correct and zero for incorrect steps. Descriptive statistics were performed., Results: The mean age of the study population was 48.85±20.49 years. Eleven (55%) patients were females. Thirteen (65%) patient were not formally educated in school. Fourteen patients (70%) were able to perform all the steps correctly giving overall median score of eight (7-8)., Conclusions: Face-to-face training seems to be effective approach for teaching rotahaler technique in asthma and COPD patients.

Introduction: Anti-thrombotic, statins and antihypertensive drugs are commonly used for the management of acute ischemic stroke in Nepal but there is no evidence regarding their efficacy in our context. This study aims to explore the efficacy of these combined medications (anti-thrombotic, statins and antihypertensive drugs) in acute ischemic stroke patients for the first time and to assess the risk factors present in those patients., Methods: The study was conducted on 37 acute ischemic stroke patients admitted and treated at the Neurology Department of College of Medical Sciences-Teaching Hospital, Chitwan, Nepal and they were followed at three months (90±10 days). The initial stroke severity and functional disability were evaluated at admission and at 3 months using National Institute of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) respectively. The outcome parameters were functional independence (mRS≤2) and mortality at three months (mRS=6). Frequency distribution, Mann-Whitney U-test and χ2 test were performed for statistical analysis., Results: Out of 37 patients, 27 (73%) were Smoker, 22 (59.5%) had hypertension and 19 (51.4%) were alcohol consumer. The stroke severity on admission was statistically significant with functional independence (P=0.003) and mortality (P=0.015) at three month. Similarly, Rankin grade on admission was statistically significant with functional independence (P=0.001) and mortality (P=0.048) at three month. At three months, 20 (69%) survived patients were independent while mortality was seen in eight (21.6%) patients., Conclusions: The management of acute ischemic stroke with combined anti-thrombotic, statins and antihypertensive drugs seems promising and efficacious in mild to moderately severe ischemic stroke.

Introduction: Birth asphyxia is a serious clinical problem worldwide. It claims approximately 9 million deaths each year. It can lead to serious neurological sequaele, such as cerebral palsy, mental retardation, and epilepsy., Methods: All babies admitted in College of Medical Sciences Teaching Hospital, Chiwan, Nepal, NICU from January 2013 to December 2013 with a diagnosis of birth asphyxia (5 min Apgar<7 or those with no spontaneous respirations after birth) were included in the study (n=125). This was a descriptive observational study. Clinical information was collected (gravida, hour at presentation, mode of delivery, sex of baby, gestational age of the baby, requirement of resuscitation). Neonates were admitted to NICU, observed for complications and managed as per hospital protocol., Results: Among the 722 neonates admitted to NICU, 125 had perinatal asphyxia (17.3%). Babies with Hypoxic ischemic encephalopathy(HIE) Grade I had a very good outcome but HIE III was associated with a poor outcome. Outborn neonates had higher grades of perinatal asphyxia as compared to inborns (p=0.018). Term gestation, Males and Multigravida were associated with a higher rate of birth asphyxia. 22.4% neonates were delivered via caesarean section and 74.4% required bag and mask ventilation at birth., Conclusions: Birth asphyxia was one of the commonest causes of admission NICU. Babies with HIE Grade III had a very poor prognosis. Outborn neonates with birth asphyxia had a higher mortality. Males were frequently affected than females.

Introduction: Primarily, health sector connects two segments - medicine and public health, where medicine deals with individual patients and public health with the population health. Budget enables both the disciplines to function effectively. The Interim Constitution of Nepal, 2007 has adapted the inspiration of federalism and declared the provision of basic health care services free of cost as a fundamental right, which needs strengthening under foreseen federalism., Methods: An observational retrospective cohort study, aiming at examining the health sector budget allocation and outcome, was done. Authors gathered health budget figures (2001 to 2013) and facts published from authentic sources. Googling was done for further information. The keywords for search used were: fiscal federalism, health care, public health, health budget, health financing, external development partner, bilateral and multilateral partners and healthcare accessibility. The search was limited to English and Nepali-language report, articles and news published., Results: Budget required to meet the population's need is still limited in Nepal. The health sector budget could not achieve even gainful results due to mismatch in policy and policy implementation despite of political commitment., Conclusions: Since Nepal is transforming towards federalism, an increased complexity under federated system is foreseeable, particularly in the face of changed political scenario and its players. It should have clear goals, financing policy and strict implementation plans for budget execution, task performance and achieving results as per planning. Additionally, collection of revenue, risk pooling and purchasing of services should be better integrated between central government and federated states to horn effectiveness and efficiency.

Thrombolysis is one of the proven potential treatments for the management of acute ischemic stroke. Intravenous recombinant tissue-plasminogen activator (rt-PA) is the only medically approved biological thrombolysing agent for the treatment of acute ischemic stroke within 4.5h of stroke (2.2% symptomatic intracerebral haemorrhage, 12.7% mortality and 58.0% functional independence), but following the guideline and criteria provided by National Institute of Neurological Disorder and Stroke (NINDS) and SITS (Safe Implementation of Thrombolysis in Stroke) studies. Nepal needs to evidently introduce intravenous rt-PA in its clinical setting for treatment of acute ischemic stroke, which has been approved for more than a decade ago in developed countries. Several modifiable and non-modifiable risk factors can affect the outcomes of the treatment with intravenous rt-PA. Early modification of factors predicting the risk outcomes can be a beneficial tool to justify the thrombolytic treatment. This review aims to discuss the major studies on thrombolysis using rt-PA and main factors that can affect the outcomes of treatment in ischemic stroke.

Introduction: Complications from unsafe abortion are believed to account for the largest proportion of hospital admissions for gynaecological services in developing countries and not to mention the cost it imparts to the health system of a country. Therefore, it is equally important to find out the prevalence and the pattern of abortion among the women who utilize the safe abortion care services and provide a framework to target various health promotion programs including safe-motherhood and reproductive health; such that the future interventions to avoid the unintended pregnancy and unsafe abortion can be implemented accordingly., Methods: A cross-sectional study was conducted in a tertiary care hospital in Kathmandu, Nepal. Social and demographic information of all the women seeking induced abortions from January 2011 to December 2012 were included and the result was analyzed., Result: Abortion contributed to about 1.68% of the total patient served in the hospital that provides both obstetrical and gynecological services. Of the total 4830 patients who underwent induced abortion in this period, the mean age was 27, 92.3% were from the Kathmandu valley and more than one-third women (35.2%) were illiterate who couldn't read and write. Majorities were more than two parity and belonged to higher caste., Conclusion: The socio-demographic profile of the abortion clients in Nepal has remained similar over the years. We need to address the accessibility and availability to the safe abortion care services along with other safe motherhood programs guaranteeing access to safe abortion and post-abortion care to all group of women and also, women education regarding contraception to avoid repeated abortions or unwanted pregnancy in the future.