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Background: Indigenous buffaloes, as the important livestock species contributing to economy of the country, are the lifeline of livelihood in Nepal. They are distributed across diverse geographical regions of the country and have adapted to various feeding, breeding, and management conditions. The larger group of these native buffalo breeds are present in narrow and stiff hilly terrains. Their dispersal indicates a possible environmental adaptation mechanism, which is crucial for the conservation of these breeds. Results: We utilized whole-genome sequencing (WGS) to investigate the genetic diversity, population structure, and selection signatures of Nepalese indigenous buffaloes. We compared 66 whole-genome sequences with 118 publicly available sequences from six river and five swamp buffalo breeds. Genomic diversity parameters indicated genetic variability level in the Nepalese buffaloes comparable to those of Indian breeds, and population genetic structure revealed distinct geography-mediated genetic differentiation among these breeds. We used locus-specific branch length analysis (LSBL) for genome-wide scan, which revealed a list of potentially selected genes in Lime and Parkote breeds that inhabit the hilly region. A gene ontology (GO) analysis discovered that many GO terms were associated with cardiac function regulation. Furthermore, complementary analyses of local selection signatures, tissue expression profiles, and haplotype differences identified candidate genes, including KCNE1, CSF1R, and PDGFRB, related to the regulation of cardiac and pulmonary functions. Conclusions: This study is a comprehensive WGS-based genetic analysis of the native Nepalese buffalo breeds. Our study suggested that the Nepalese "hilly" buffaloes, especially the Lime and Parkote breeds, have undergone some characteristic genetic changes and evolved increased cardiac and pulmonary function for their adaptation to the steep hilly terrains of the country. [ABSTRACT FROM AUTHOR]

Background: The Ages and Stages Questionnaire 3rd edition (ASQ-3) could be a feasible tool in resource-poor settings. Little is known on the relationship between scores on the ASQ-3 and later intellectual abilities in these settings. Aims: To examine the relationship between ASQ-3 scores during the first and second year of life and intellectual abilities at 4 years of age in Nepalese children. Methods: In a cohort of 600 children at-risk of stunting, the ASQ-3 was performed at 6–11 and 18–23 months, and the Wechsler Preschool and Primary Scales of Intelligence, fourth edition (WPPSI-IV) at 4 years. We examined the relationship between the ASQ-3 scores and WPPSI-IV full scale IQ (FSIQ) using Spearman correlation coefficients and linear regression models. Results: Correlations between ASQ-3 total scores and FSIQ was 0.17 (95% CI 0.07, 0.27) at 6–11 and 0.34 (95% CI 0.26, 0.44) at 18–23 months explaining 2 and 12% of the variance respectively. Except for the communication subscale at 18–23 months with moderate correlations, correlations between the ASQ-3 subscales and FSIQ were weak. Conclusion: Our findings suggest a modest relationship between ASQ-3 scores in early childhood and intellectual abilities at 4 years. [ABSTRACT FROM AUTHOR]

Perinatal mental health is a major public health issue that arises during pregnancy and/or after birth, with substantial implications for social, parental, and maternal functioning, as well as overall quality of life. The study aimed to determine the prevalence of perinatal depression and its associated risk factors among women who visited a maternity hospital in Kathmandu, Nepal. A cross-sectional study was conducted at the Paropakar Maternity and Women's Hospital in Kathmandu. A total of 300 women in their perinatal period were interviewed. The Edinburgh Perinatal Depression Scale (EPDS) was used to measure perinatal depression. The Poisson regression model was used to determine risk factors associated with perinatal depression. The mean age of respondents was 25.5 (SD 4.5) years; average age during their first pregnancy was 23.5 (SD 3.7) years; and 53.7% of respondents were in the antenatal period. The prevalence of depressive symptoms (EPDS ≥ 10) was 40% (95% CI 31.4% to 45.8%). Unsupportive family members (adjusted prevalence ratio [aPR] 2.23; 95% CI 1.75–2.86), postnatal period (aPR 2.64; 95% CI 1.97–3.53), complications faced during delivery (aPR 1.76; 95%CI 1.30–2.39), history of intimate partner violence (aPR 0.48; 95% CI 0.36–0.64), and first pregnancy at the age of ≤25 years (aPR 0.61; 95% CI 0.42–0.88) were identified as key risk factors of perinatal depression. Strong family support and the active involvement of partners in counselling can contribute to alleviating perinatal depression symptoms. Targeted interventions in health and well-being services should be implemented to address mental health burden during both pregnancy and postpartum periods. [ABSTRACT FROM AUTHOR]

Introduction: To find the adherence rate to periodic dilated eye examinations (DEEs) and its determinants among patients with diagnosed diabetes. Research Design and Methods: In this cross‐sectional study of 165 participants with diagnosed diabetes (Type 1/2) attending a general hospital with a diabetes clinic, we explored perceptions of barriers and facilitators of DEE at the individual level using a framework adapted from the health belief model (HBM). Patients were compared using t tests for continuous data and chi‐square tests for categorical data. Results: The rate of adherence to DEE (as defined by DEE within a year) was 62.4% (95% confidence interval [CI] = 55.0%–69.8%). The mean age of the patients was 56.81 (±13.29) years. We found that the mean benefit score was significantly higher, and the mean barrier score was significantly lower in those adhering to DEE (p < 0.001); but the susceptibility, severity, and self‐efficacy scores were not significantly different. Furthermore, those under treatment for diabetes mellitus (DM), those with diabetic retinopathy (DR) in them or their family member, and those with DM duration of 1 year or less were significantly likely to adhere to DEE (p < 0.005). Additionally, those who had received advice for eye screening from their physicians were about 25 times more likely to adhere to DEE (95% CI =6.80–92.05) than those who were not advised. Conclusion: A larger proportion of people with diabetes did not adhere to periodic DEE. Benefits and barriers were found to be determinants in this population. Further exploration in a larger population and the use of HBM to increase adherence to periodic DEE can be tested by targeting behavioral counseling along with other traditional approaches. [ABSTRACT FROM AUTHOR]

• Carriage of vaccine serotypes declined following PCV10 introduction. • Multiple-serotype carriage was reduced following PCV10 introduction. • Pneumococcal carriage density among children was lower following PCV10 introduction. Carriage studies are an efficient means for assessing pneumococcal conjugate vaccine effect in settings where pneumococcal disease surveillance programmes are not well established. In this study the effect of 10-valent pneumococcal conjugate vaccine (PCV10) introduction on pneumococcal carriage and density among Nepalese children using a bacterial microarray and qPCR was examined. PCV10 was introduced into the Nepalese infant immunisation schedule in August 2015. Nasopharyngeal swabs were collected from healthy Nepalese children in Kathmandu between April 2014 and December 2021. Samples were plated on blood agar, incubated overnight, and DNA extracted from plate sweeps. Pneumococcal serotyping was done using the Senti-SPv1.5 microarray (BUGS Bioscience, UK). DNA was extracted from swab media and qPCR performed for pneumococcal autolysin (lytA). A significant decline in prevalence of PCV10 serotypes was observed when comparing pre-PCV10 with post-PCV10 collection periods (36.5 %, 454/1244 vs 10.3 %, 243/2353, p < 0.0001). Multiple-serotype carriage was also observed to significantly decline when comparing pre-PCV10 with post-PCV10 periods (31.4 %, 390/1244 vs 22.2 %, 522/2353, p < 0.0001). Additionally, a significant decline in median pneumococcal density was observed when comparing pre-PCV10 with post-PCV10 periods (3.3 vs 3.25 log10 GE/ml, p = 0.0196). PCV10 introduction was associated with reduced, prevalence of all PCV10 serotypes, multiple serotype carriage, and pneumococcal carriage density. [ABSTRACT FROM AUTHOR]

This study culturally adapted and validated a Nepalese version of the Abuse Assessment Screen (AAS) tool for identifying domestic violence among pregnant women in Nepal, creating the Nepalese Abuse Assessment Screen (N-AAS). International and national topic experts reviewed the initial N-AAS version using the Delphi method, and pregnant women participated in cognitive interviews, providing feedback on the N-AAS as user experts. Subsequent pre-testing of a comprehensive questionnaire, which included the translated version of the N-AAS, occurred in two tertiary care hospitals using an electronic format known as Color-Coded Audio Computer-Assisted Self-Interview (C-ACASI). The study assessed the content validity index, compared the concurrent validity of the N-AAS with the gold standard interview, estimated the prevalence of domestic violence from two hospitals, and calculated the Kappa coefficient. The reliability of the entire questionnaire was also evaluated through a test-retest analysis, with content validity rated as "good to excellent" by topic and user experts and high test-retest reliability (91.2–98.9%), indicating consistency across questionnaires completed at two different time points, with 12% of participants reporting any form of violence. The N-AAS demonstrated ≥91.7% specificity for all forms of abuse, accurately identifying non-abuse cases. In addition, moderate to excellent sensitivity was observed for emotional abuse (52.5%) and physical abuse since marriage (50%), while sensitivity for physical abuse in the past 12 months was 100%. Thus, the N-AAS demonstrated reliable test-retest results with a good Kappa coefficient and specificity, as well as showing excellent sensitivity for detecting recent physical abuse and moderate sensitivity for detecting emotional abuse and physical abuse since marriage. Because cultural context often leads women to normalize and tolerate abuse from spouses and family members and women are thus reluctant to report abuse, the results imply that the N-AAS can serve as a valuable screening tool for domestic abuse in antenatal care settings in Nepal. [ABSTRACT FROM AUTHOR]

This study investigates the determinants of choosing in-kind benefits over cash transfers when their respective values are equivalent. Employing a rigorous two-step experiment with a large sample size (n = 962), we offer real monetary rewards to respondents. In the first step, we asked whether the respondents would choose NRs. 1,000 (≈ US dollars 9) in cash or in-kind benefit that is worth NRs. 1,000. We observe that approximately two-thirds of participants opt for in-kind benefits of equal value to the proposed cash transfer. In analyzing the factors influencing this preference, our results indicate that households with higher non-farm incomes are less likely to choose in-kind benefits. Increasing the non-farm income by NRs. 100,000 respondents are 0.2% less likely to choose in-kind benefits. Furthermore, households with limited savings demonstrate a higher preference toward in-kind benefits over cash transfers. Not having NRs. 25,000 savings would make respondents 10% more likely to choose in-kind benefits. Previously receiving in-kind benefits also increase the likelihood of choosing them over cash. Additionally, households with restricted market access are more inclined to opt for in-kind benefits. Notably, in the second step of the experiment which involves only those who chose cash in the first step of the experiment, only 48% of respondents would opt for in-kind benefits even when values were higher by NRs. 150 to 450. This research sheds light on the factors affecting the decision-making process between in-kind benefits and cash transfers and provides insights into the design of effective social welfare policies. More specifically, findings from this study suggest tailored approaches for assisting people could be followed based on their income level and accessibility to the market. [ABSTRACT FROM AUTHOR]

India's rich diversity encompasses individuals from varied geographical, cultural, and ethnic backgrounds. In the field of population genetics, comprehending the genetic diversity across distinct populations plays a crucial role. This study presents significant findings from genetic data obtained from the Sikkimese population of India. Autosomal markers were crucial for evaluating forensic parameters, with a combined paternity index of 1 × 109. Notably, Penta E emerged as a distinguishing marker for individual identification in the Sikkim population. Fst genetic distance values revealed insights into genetic isolation among different groups, enhancing our understanding of population dynamics in the central Himalayan region. The NJ-based phylogenetic tree highlighted close genetic relationships, of the Sikkim population with the Nepalese population surrounding neighbouring Himalayan populations providing glimpses into common ancestry. In summary, this study contributes valuable data to population genetics and underscores the importance of genetic variation in comprehending population dynamics and forensic applications. [ABSTRACT FROM AUTHOR]

Context: Meditation and related relaxation techniques are good means of alleviating stress and maintaining good health. Osho dynamic meditation decreases several psychopathological variables such as anxious‐depressive syndrome, aggressive behaviors, and depression which is practiced in Nepal and all over the world. Various studies have shown alteration in different hormone levels due to meditation by strengthening adaptive mechanisms. Aim: The aim of this study was to evaluate the effect of Osho meditation on serum hormonal levels in pre‐ and postmeditation participants. Methods: A pre–post study was conducted among 70 healthy volunteers (42 male and 28 female) where various types of Osho dynamic meditation techniques were incorporated together to understand their combined effects on serum hormone levels in participants attending the 7 days meditation camp. Serum hormones such as cortisol, estrogen, progesterone, free triiodothyronine (fT3), free thyroxine (fT4), thyroid‐stimulating hormone (TSH), testosterone, and growth hormone were measured by chemiluminescence immunoassay. Results: Out of 70 participants, 68 participants (97%) had subjective opinion of Osho dynamic meditation being effective in alleviating stress, depression, and anger. Also, there was a significant decline in body weight and body mass index in both male and female populations after a strict vegetarian diet and meditation. Likewise, a significant rise in the level of estrogen (p < 0.001), progesterone (p < 0.001), growth hormone (p < 0.001), testosterone (p = 0.002), and fT3 (p = 0.049) in postmeditation male participants indicates the importance of Osho dynamic meditation on elevating sex hormones such as estrogen, progesterone, testosterone as well as fT3, and growth hormones among Osho meditation practicing participants. Conclusion: Our findings suggest significant changes in the hormonal levels and improvement in stress and depression in participants undergoing Osho meditation. [ABSTRACT FROM AUTHOR]

Background: Multidrug-resistant tuberculosis (MDR-TB), characterized by isoniazid and rifampicin resistance, is caused by chromosomal mutations that restrict treatment options and complicate tuberculosis management. This study sought to investigate the prevalence of pre-extensively drug-resistant (pre-XDR) and extensively drug-resistant (XDR) tuberculosis, as well as mutation pattern, in Nepalese patients with MDR/rifampicin-resistant (RR)-TB strains. Methods: A cross-sectional study was conducted on MDR/RR-TB patients at the German Nepal Tuberculosis Project from June 2017 to June 2018. The MTBDRsl line probe assay identified pre-XDR-TB and XDR-TB. Pre-XDR-TB included MDR/RR-TB with resistance to any fluoroquinolone (FLQ), while XDR-TB included MDR/RR-TB with resistance to any FLQ and at least one additional group A drug. Mutation status was determined by comparing bands on reaction zones [gyrA and gyrB for FLQ resistance, rrs for SILD resistance, and eis for low-level kanamycin resistance, according to the GenoType MTBDRsl VER 2.0, Hain Lifescience GmbH, Nehren, Germany definition of pre-XDR and XDR] to the evaluation sheet. SPSS version 17.0 was used for data analysis. Results: Out of a total of 171 patients with MDR/RR-TB, 160 had (93.57%) had MTBC, of whom 57 (35.63%) had pre-XDR-TB and 10 (6.25%) had XDR-TB. Among the pre-XDR-TB strains, 56 (98.25%) were FLQ resistant, while 1 (1.75%) was SLID resistant. The most frequent mutations were found at codons MUT3C (57.14%, 32/56) and MUT1 (23.21%, 13/56) of the gyrA gene. One patient had SLID resistant genotype at the MUT1 codon of the rrs gene (100%, 1/1). XDR-TB mutation bands were mostly detected on MUT1 (30%, 3/10) of the gyrA and rrs, MUT3C (30%, 3/10) of the gyrA, and MUT1 (30%, 3/10) of the rrs. Conclusions: Pre-XDR-TB had a significantly higher likelihood than XDR-TB, with different specific mutation bands present in gyrA and rrs genes. [ABSTRACT FROM AUTHOR]

Our study provides findings from cultural leadership project based on healing-centered engagement strategies using a transformative convergent mixed methods research design to address mental well-being among young Bhutanese-Nepali refugee women(N = 36). Using a participatory approach, data were collected to explore the feasibility and acceptability of a culturally responsive healing-centered intervention. While quantitative scores showed a significant decrease in anxiety and depression, qualitative findings revealed increased leadership skills, self-esteem, social support, and resilience after the intervention. We discuss the need to promote a holistic view of healing from collective trauma and offer a culturally grounded asset-driven approach to promote hope and healing among refugees. [ABSTRACT FROM AUTHOR]

The study objectives were: (i) to develop and administer a survey to assess childhood lead poisoning (CLP) knowledge, attitudes, practices and prevention barriers (KAP-B) among the Nepali-Speaking Bhutanese (NSB) community in Northeast Ohio; and (ii) to examine the association between socio-demographic characteristics of NSB parents and their understanding of CLP as measured by the constructs of knowledge and attitudes. A Nepali language KAP-B questionnaire was developed and 200 NSB parents with at least one child ≤ 7 years of age from the Akron Metropolitan Area, Ohio were interviewed. NSB parents demonstrated a low level of knowledge about CLP prevention measures. While 82% lived in pre-1978 houses, only 27.5% perceived their house/neighborhood to be potentially lead contaminated. Only 33% of the parents reported understanding lead-related information provided by their child's healthcare provider. Low-level CLP awareness among NSB community emphasizes a need for culturally tailored and linguistically appropriate community-level CLP educational intervention programs in this vulnerable community. [ABSTRACT FROM AUTHOR]

This article aims to contribute to labour recruitment policy by demonstrating the relations between cross‐border mobility and inequality through the lens of migration intermediaries. Drawing on thematic analysis of the MIDEQ project's in‐depth interviews with Nepalese labour migrants (n = 20) in Malaysia, this research reveals the range of migration intermediaries along the recruitment chain, and shows contradictory roles played by migration intermediaries: they help migrant workers access employment and other opportunities thus overcoming inequality in mobility, whilst simultaneously reproducing socio‐economic inequalities and the unequal power relations experienced by migrants. Hence, we identify a "middle space effect" that links migration processes with migration outcomes, reconstructing socio‐economic inequalities in mediated migration. We highlight the role of state policies regarding migration and labour in co‐producing such inequalities, and the embeddedness of middle space intermediaries in unequal global power dynamics, and we offer policy suggestions on regulation of labour recruitment and employment. [ABSTRACT FROM AUTHOR]

Vitamin D deficiency is a global public health concern that provokes bone demineralization and weakening. In response to the decreased vitamin D level, calcium stores wear out. The homeostatic effect of compensatory hyperparathyroidism in vitamin D deficiency incites variable discrepancies in different populations. This study intends to decipher the transition point of PTH in relation to levels of vitamin D in a Nepalese population. A cross-sectional study was carried out at Tribhuvan University Teaching Hospital, Nepal. Serum calcium, phosphorus, intact PTH, and 25-hydroxy vitamin D levels were assayed in an Abbott ARCHITECT Integrated System. A correlation plot of PTH and vitamin D was analyzed in Statistical Package for Social Sciences version 22.0. Using a locally weighted scatter plot smoothing method, the relation between these variables was presented graphically. Among 281 individuals, 30.2% had vitamin D levels below 20 ng/mL. There was an archetypical transition in the PTH levels in concert with the decrease in vitamin D level marked by 2 inflection points (ie, 18.5 and 42.0 ng/mL). Our findings suggest that to augment overall health and avert weakness due to vitamin D deficiency, the levels of vitamin D should be maintained above 42.0 ng/mL in our population. [ABSTRACT FROM AUTHOR]

Background: Endodontic literature search revealed that no study has been conducted to evaluate the prevalence of apical periodontitis (AP) in root canal treated teeth from an adult Nepalese population of Madhesh Province. Consequently, little is known about the extent and risk factors associated with it. This study aimed to determine AP prevalence in root canal treated teeth from an adult Nepalese subpopulation and to analyze the related risk factors including age, sex, tooth type, type of coronal restoration and quality of root canal treatment and coronal restoration as predictors of AP. Methods: Digital panoramic radiographs were evaluated. Periapical status of 300 root canal-treated teeth was scored by using the periapical index. The quality of root canal treatment and coronal restorations were categorized as adequate or inadequate through radiographic and clinical evaluation. The data were analyzed using univariate and multivariate logistic regression models. Results: Prevalence of AP in the present study was 31.7%. In 45.7% of the treated teeth, quality of root canal treatment was adequate whereas 46% of the cases had adequate coronal restorations. Multivariate logistic regression analysis revealed statistically significant associations and remarkably increased risk for AP in teeth with inadequate root canal treatment (odds ratio [OR] = 7.92; 95% CI: 3.96–15.82; p < 0.001) whereas lower risk for AP was found in females (OR = 0.51; 95% CI: 0.28–0.90; p = 0.021) and in teeth restored with crown (OR = 0.22; 95% CI: 0.09–0.51; p < 0.001) and filling (OR = 0.18; 95% CI: 0.08–0.42; p < 0.001). Quality of coronal restoration, tooth type and age of the patient were not found to be the predictors of AP. Conclusions: Within the limits of this study, a high prevalence of AP and poor overall quality of root canal treatment and coronal restoration was found in the subpopulation studied. Quality of root canal treatment, type of coronal restoration and sex of the patient are significant predictors of possible AP development in root canal treated teeth. Substantial efforts are needed to improve the endodontic treatment standards. [ABSTRACT FROM AUTHOR]

Previously, the Vi-typhoid conjugate vaccine (Vi-TT) was found to be highly efficacious in Nepalese children under 16 years of age. We assessed the immunogenicity of Vi-TT at 9 and 12 months of age and response to a booster dose at 15 months of age. Infants were recruited at Patan Hospital, Kathmandu and received an initial dose of Vi-TT at 9 or 12 months of age with a booster dose at 15 months of age. Blood was taken at four timepoints, and antibody titres were measured using a commercial ELISA kit. The primary study outcome was seroconversion (4-fold rise in antibody titre) of IgG one month after both the doses. Fifty children were recruited to each study group.Some visits were disrupted by the COVID19 pandemic and occurred out of protocol windows. Both the study groups attained 100 % IgG seroconversion after the initial dose. IgG seroconversion in the 9-month group was significantly higher than in the 12-month group (68.42 % vs 25.8 %, p < 0.001). Among individuals who attended visits per protocol, IgG seroconversion after the first dose occurred in 100 % of individuals (n = 27/27 in 9-month and n = 32/32 in 12-month group). However, seroconversion rates after the second dose were 80 % in the 9-month and 0 % in the shorter dose-interval 12-month group (p < 0.001) (n = 16/20 and n = 0/8, respectively). Vi-TT is highly immunogenic at both 9 and 12 months of age. Stronger response to a booster in the 9-month group is likely due to the longer interval between doses. [ABSTRACT FROM AUTHOR]

Introduction: Research on health literacy is still at an early stage, lacking a dedicated measurement instrument for assessing children's and adolescents' health literacy. Such tools are necessary to generate the evidence required for informed intervention development. This study translated the validated German HLS-Child-Q15 into the Nepalese context, creating the HLS-Child-Q22-NEP. Methods: The research team initially created the HLS-Child-Q22-NEP using an additional item pool. We conducted thirteen one-on-one cognitive interviews with adolescent students from community schools in three districts of Nepal during the pre-test. We employed verbal probing techniques and deductively analysed the interviews based on Tourneau's model, uncovering four main themes: (1) comprehension (with the two sub-categories: a) item comprehension and b) word comprehension); (2) retrieval; (3) judgement; and (4) response. Results: Overall, participants responded positively to the HLS-Child-Q22-NEP. However, this study revealed comprehension challenges such as unfamiliarity, misunderstandings, and translation issues. Additionally, the study identified retrieval challenges and poor judgement, indicating limitations in the assessment. Participants experienced varying levels of difficulty with some items, emphasising the need for revised instructions. Subsequent revisions, guided by pretest insights, led to the development of the HLS-Child-Q24-NEP. Conclusion: The development of the HLS-Child-Q22-NEP is a significant step in addressing Nepali adolescents' lack of health literacy measurement. Despite its generally positive reception, this study encountered challenges in comprehending the scale, prompting enhancements, and developing the HLS-Child-Q24-NEP. Further research, both qualitative and quantitative, is necessary to evaluate the validity and reliability of the modified items. [ABSTRACT FROM AUTHOR]

The present study is based on oribatid mite material collected from litter and upper soil stratum of Rhododendron–Lithocarpus mountain forest at a single locality from eastern Nepal. A list of 39 species, belonging to 31 genera and 15 families, is presented; of these, one genus and 11 species are reported for the first time from Nepalese fauna. Two new species – Metrioppia petarberonisp. nov. (Peloppiidae) and Galumna (Galumna) gerdalbertiisp. nov. (Galumnidae) – are described. [ABSTRACT FROM AUTHOR]

Objective Changes in normal reference values of thyroid uptake for iodine have been reported due to geographical and chronological fluctuations in dietary iodine intake in different populations. Nepal is a country with mixed ethnicity, with access to dietary iodine in the form of successful universal salt iodination program by the government of Nepal since 1973. The aim of this study was to establish the normal reference values for thyroid uptake of technetium-99m (Tc-99m) pertechnetate in the Nepalese population in iodine sufficiency era. Methods We prospectively evaluated 52 clinically and biochemically euthyroid participants (46 females and 6 males) with age range from 20 to 71 years who underwent a thyroid Tc-99m pertechnetate scan and uptake between December 2019 to November 2023 in the Department of Nuclear Medicine, Chitwan Medical College fulfilling inclusion/exclusion criteria. Biochemical thyroid function tests were reviewed and Tc-99m pertechnetate thyroid uptake values were determined for each patient. Blood was withdrawn for thyroid hormone assessment. Euthyroid participants were then administered 3.5 to 4.5 mCi of Tc-99m pertechnetate intravenously and their percentage thyroid uptake was calculated after 20 minutes. Results The mean and median uptake of Tc-99m pertechnetate in euthyroid patients were 1.26 and 0.85%, respectively, and the interquartile range was 0.7 to 1.7%. The normal reference uptake value for Tc-99m pertechnetate in the studied population ranged between 0.3 and 3.6%. The fifth and 95th percentiles for pertechnetate uptake were 0.5 and 2.9%, respectively. Conclusion The normal reference range for Tc-99m pertechnetate thyroid uptake in Nepalese population was 0.5 to 2.9% that is lower than the currently accepted international standard of 0.75 to 4.5%. Uptake also increased with increasing age. This study highlights the importance of periodically redefining the geographic location specific normal thyroid uptake reference values. [ABSTRACT FROM AUTHOR]

This study aimed to assess the utilization of health care services and its associated factors among people with type 2 diabetes mellitus (T2DM) in Nepal. Data on the utilization of health care services were assessed in 481 adults aged 30 to 70 years with T2DM in Nepal. Multiple logistic regression analysis was performed to determine the factors associated with the utilization of health care services. Over 6 months, 66.1% of participants visited health care facilities or health service providers, followed by specialist visits (3.5%), hospitalization (2.1%), and emergency department visits (1.9%). Visit to health care facilities was significantly higher among those aged 50 to 59 years old (ORA: 1.64), practicing Hinduism (ORA: 2.4), and earning NRs ≥30 000 (≥USD 226.10) (ORA: 1.82) as compared to those aged ≥60 years old, practicing other religions, and with monthly family income NRs ≤10 000 (≤USD 75.37), respectively. The utilization of health care services among people with T2DM in Nepal was reasonably low. Identifying the underlying causes of low use of health care services is of great importance to bridge the gap in using health care services for management of diabetes. [ABSTRACT FROM AUTHOR]

Postcholecystectomy syndrome (PCS) is persistent distressing symptoms which develops following a laparoscopic cholecystectomy (LC); in cases when the condition is severe, readmission may be necessary. However, research on the prevalence of PCS and potential factors associated with PCS in Nepalese patients is still limited. An observational point-prevalence, correlational predictive cross-sectional study was conducted to determine the prevalence of PCS and examine what predicting factors including preoperative anxiety, preoperative dyspepsia, smoking, alcohol consumption, and duration of preoperative symptoms are associated with PCS. A total of 127 eligible Nepalese patients who came for follow-up after 1 week of LC at outpatient department of surgery in one single university hospital, Kathmandu, Nepal, were recruited. A set of questionnaires consisting participants' information record form, Hospital Anxiety and Depression Scale (HADS), Leeds Dyspepsia Questionnaires (LDQ), Fagerstrom Test for Nicotine Dependence (FTND), and Alcohol Use Disorder Identification Test (AUDIT) was administered for data collection. The associations between influential factors and PCS were analyzed using Binary logistic regression. 43.3% of participants reported PCS after 1 week of surgery. The findings from logistic regression analysis affirmed that the patients with preoperative anxiety (OR = 6.38, 95%CI = 2.07–19.67, p < 0.01) and moderate to severe dyspepsia (OR = 4.01, 95%CI = 1.34–12.02, p < 0.05) held the likelihood to report PCS 6.38 and 4.01 times, respectively, greater than others. The implications from study results are that screening of anxiety and patients' tailored interventions to reduce anxiety should be implemented preoperatively. An appropriate health education about persistence of PCS and self-management should be provided to those postoperative patients. [ABSTRACT FROM AUTHOR]

Nepal is one of the most landslide‐prone countries in the world, with year‐on‐year impacts resulting in loss of life and imposing a chronic impediment to sustainable livelihoods. Living with landslides is a daily reality for an increasing number of people, so establishing the nature of landslide hazard and risk is essential. Here we develop a model of landslide susceptibility for Nepal and use this to generate a nationwide geographical profile of exposure to rainfall‐triggered landslides. We model landslide susceptibility using a fuzzy overlay approach based on freely‐available topographic data, trained on an inventory of mapped landslides, and combine this with high resolution population and building data to describe the spatial distribution of exposure to landslides. We find that whilst landslide susceptibility is highest in the High Himalaya, exposure is highest within the Middle Hills, but this is highly spatially variable and skewed to on average relatively low values. Around 4 × 106 Nepalis (∼15% of the population) live in areas considered to be at moderate or higher degree of exposure to landsliding (>0.25 of the maximum), and critically this number is highly sensitive to even small variations in landslide susceptibility. Our results show a complex relationship between landslides and buildings, that implies wider complexity in the association between physical exposure to landslides and poverty. This analysis for the first time brings into focus the geography of the landslide exposure and risk case load in Nepal, and demonstrates limitations of assessing future risk based on limited records of previous events. Plain Language Summary: Mountain region populations are disproportionately impacted by landslide hazards that result in seasonal disruption and loss of life, and restrict longer‐term sustainable development opportunities. Crucially, effective management of landslide risk requires an understanding of both where landslides are likely to occur but also how they intersect with where people live. To address this, we use a numerical model to identify locations that are more likely to experience landsliding in the future, based on a map of where landslides have occurred in the past. We then combine this with population and building data to consider how people's exposure to landsliding varies across Nepal. We find that although landslides are most likely within the higher mountain areas, the low population numbers here mean that people's exposure to landsliding is relatively limited. Similarly, the higher population centers are typically in areas where landsliding is less likely to occur. Locations with relatively high exposure instead generally occur in isolated pockets at the intersection between landslide likelihood and population density within moderate relief areas of Nepal. Understanding this spatial variability in landslide exposure is important for informing future risk‐sensitive land use planning and resource allocation. Key Points: Landslide susceptibility and population distribution generate highly spatially variable exposure to landslides across Nepal44% of land in Nepal has moderate‐high landslide susceptibility, whilst <15% of the population has moderate‐high exposure to landslidingCaution is needed in using short‐term landslide occurrence data to assess future risks due to rapidly changing susceptibility and exposure [ABSTRACT FROM AUTHOR]

Objective. Frenum attachments are folds of mucous membrane that connect the lips to the alveolar mucosa and underlying periosteum. Aberrant positioning of the maxillary and mandibular labial frenum can lead to various clinical issues, including mucogingival problems and midline diastema. The objective of this study was to assess the prevalence of maxillary and mandibular frenal attachments and their association with age, gender, and oral hygiene status in the Nepalese population seeking dental treatment. Materials and Methods. This descriptive cross-sectional study was conducted over a period of 6 months, from February 2023 to August 2023, among patients visiting the Department of Periodontology and Oral Implantology, aged 6 years and above, after obtaining official permission from the Institutional Review Committee (IRC-KUSMS Approval No. 8/23). The study collected data on morphological variations of frenal attachment and various periodontal parameters such as Oral Hygiene Index-Simplified (OHI-S), pocket depth, recession, and midline diastema in both arches. Descriptive statistics, including frequency and percentage, were used to analyze the data. The χ2-test was employed to determine the correlation between gender and types of frenulum attachment, while analysis of variance was used to assess the association of frenal attachments with oral hygiene status. Results. Among 380 patients, the prevalence of frenal attachment was as follows: gingival 248 (65.30%), mucosal 71 (18.70%), papillary 42 (11.10%), and papillary penetrating 19 (5.00%) in the maxilla, and mucosal 225 (59.20%) and gingival 155 (40.78%) in mandible. Among the different morphological variations of frenal attachments, normal frenum was the most common, accounting for 231 cases (60.80%), followed by frenum with a nodule, with 101 cases (26.60%). Conclusions. The study found significant associations between frenal attachment and gender, as well as oral hygiene status. The prevalence of frenal attachments in this study was comparable to findings from previous research. [ABSTRACT FROM AUTHOR]

Aims: The study aims to identify sexual dimorphic features in the arch patterns based on tooth arrangement patterns and the maxillary and mandibular arches using Euclidean Distance Matrix Analysis (EDMA). Settings and Design: A total of 96 Nepalese subjects, aged 18 to 25 were assessed using casts and photographs. Materials and Methods: Thirteen landmarks representing the most facial portions of the proximal contact areas on the maxillary and mandibular casts were digitised. Seventy-eight possible, Euclidean distances between the 13 landmarks were calculated using the Analysis ToolPak of Microsoft Excel®. The male-to-female ratios of the corresponding distances were computed and ratios were compared to evaluate the arch form for variation in the genders, among the Nepalese population. Statistical Analysis Used: Microsoft Excel Analysis ToolPak and SPSS 20.0 (IBM Chicago) were used to perform EDMA and an independent t-test to compare the significant differences between the two genders. Results: The maxillary arch's largest ratio (1.008179001) was discovered near the location of the right and left lateral incisors, indicating that the anterior region may have experienced the greatest change. The posterior-molar region is where the smallest ratio was discovered, suggesting less variation. At the intercanine region, female arches were wider than male ones; however, at the interpremolar and intermolar sections, they were similar in width. Females' maxillary arches were discovered to be bigger antero-posteriorly than those of males. The highest ratio (1.014336113) in the mandibular arch was discovered at the intermolar area, suggesting that males had a larger mandibular posterior arch morphology. At the intercanine area, the breadth of the arch form was greater in males and nearly the same in females at the interpremolar and intermolar regions. Female mandibular arch forms were also discovered to be longer than those of males from the anterior to the posterior. Conclusions: The male and female arches in the Nepalese population were inferred to be different in size and shape. With references to the landmarks demonstrating such a shift, the EDMA established objectively the presence of square arch forms in Nepali males and tapering arch forms in Nepalese females. [ABSTRACT FROM AUTHOR]

Remittance refers to the private income transferred by migrant individuals back to their home country either periodically or regularly. Remittance is an essential source of foreign income for developing countries like Nepal. Poverty, lack of employment, lower wage rate, political instability are major push factors for labour migration. The remittance to GDP ratio of Nepal is highest among the countries of South Asia. In the fiscal year 2023, there was a rise in remittance inflows, which can be attributed to the significant numbers of individuals migrating outside the country. Remittances have partially alleviated poverty, redcued income inquality and enhanced the living conditions of people living in rural areas. While remittance brings some economic advantages to the country, it is equally important to acknowledge the potential long-term negative effects. The increased remittance inflow hasn't contributed much to expand export however has contributed to increased import through excessive consumption. The export sector faces decline from 20031 million in FY2021/2022 to 157140.7 in FY2022/2023. The economy of Nepal is facing appreciation of real exchange rate due to large remittance inflow and use of remittance income on non-productive sector. There is need to devise policies that promote long term growth. [ABSTRACT FROM AUTHOR]

Purpose. The width and thickness of the attached gingiva are important clinical parameters. Considerable variations exist in the same as well as in different individuals. This study aimed to assess the width and thickness of the attached gingiva and its relationship with age, gender, and arch location in the Nepalese population. Methods. An observational cross-sectional study was conducted among 120 individuals visiting the periodontics department, who were categorized into three age groups with an equal distribution of gender in each group. The width of attached gingiva (WAG) was determined using the University of North Carolina-15 probe after locating the mucogingival junction. Data were gathered and entered in Excel sheet version 19, and SPSS version 20 was used for further analysis. The mean and standard deviations were calculated. The independent t-test and one-way ANOVA were used to find out the significant difference between variables. The correlation between dependent and independent variables was discovered with the help of the Pearson correlation test. The significance level was set at 5% with a 95% confidence level. Results. 120 individuals with 1440 teeth were examined to measure the WAG with an equal distribution of gender. The maximum WAG was found on the maxillary right lateral incisor and minimum width on the mandibular left first premolar. The average WAG was greater in the upper arch (3.19 mm) than in the lower arch (2.71 mm). The maximum thickness (1.728 mm) of the attached gingiva was found on the mandibular left first molars and minimum width (0.667 mm) on the mandibular left first premolars. Conclusions. As individuals age, there is a reduction in gingival thickness, accompanied by an increase in the WAG across both dental arches. In terms of gender differences, females exhibit a higher thickness of attached gingiva (TAH) than their male counterparts. [ABSTRACT FROM AUTHOR]

Polymelia is an extremely rare congenital anomaly where an individual is born with an abnormally developed extra or supernumerary limb which is generally shrunken and functionless. A case of thoracomelia (a type of polymelia) was observed macroscopically and confirmed radiologically in 1.5 years old boy born in Nepal with an abnormal supernumerary upper limb attached to his back in the thoracic region. The limb was successfully amputated, and the boy had a favorable outcome after surgical treatment, without any adverse effects or impairment. Understanding the embryogenesis of thoracomelia is essential for unraveling the complex mechanisms underlying this condition and potentially aiding in early diagnosis and intervention. This case report and review aims to shed light on the intricate processes governing forelimb formation and their perturbations leading to thoracomelia. [ABSTRACT FROM AUTHOR]

Introduction: Nepal is a country in South‐east Asia with high suicide. There is ongoing trend of emerging research on suicide from Nepal but there is lack of validated scale in measuring literacy or stigma. In the view of poor media reporting and large treatment gap, this study was conducted. All previous validation studies were done in non‐Hindu populations. Methods: A cross‐sectional study was planned where the short forms of Nepalese literacy of suicide scale (LOSS‐SF‐Nep) and Stigma of Suicide Scale (SOSS‐SF‐Nep) were validated using standard procedure at a medical college in southern Nepal. Medical and nursing students of all batches were approached offline after successful pretesting. The psychometric properties of the scales were tested, and the statuses of literacy and stigma were assessed. Patient Health Questionnaire‐9 and General Anxiety Disorder Scale‐7 were used for revealing depression and generalized anxiety. Results: Three hundred and nineteen Nepalese students participated and most of them were males, belonged to nuclear family, upper‐middle socioeconomic status and represented 46 out of 77 districts of Nepal. The mean score of LOSS‐SF‐Nep was 6.36 ± 1.92 and literacy ranged from 37.9% to 89.7%. The deeper exposure to suicidal patients was associated with better literacy. Factor analysis of SOSS‐SF‐Nep revealed three subscales: stigmatization, isolation/depression, and normalization/glorification and had acceptable psychometric properties. Gender, occupation of head of the family, region and years of education, using mental health services, and depression were associated with variable literacy or stigma. Conclusion: Literacy and stigma scales were validated in Nepali, and SOSS factor structures were revealed with modified descriptors. The literacy and stigma levels in medical students were calculated for the first time in Nepal and Hindu majority population. 1.Literacy and stigma scales were validated in Nepali and the SOSS factor structure was revealed with modified descriptors. 2.The literacy and stigma levels in medical students were calculated for the first time in Nepal and the Hindu majority population. [ABSTRACT FROM AUTHOR]

This article explores the experiences of Nepalese highly skilled migrants who use temporary migration to the Gulf region as a stepping-stone to further migration to developed countries outside the region. Furthermore, we explore the factors that influence migrants' trajectories by applying the aspiration–ability model to understand various migratory steps of the Nepalese stepwise migrations. Here, we distinguish between migrants' aspirations, abilities and structural forces – in South Asia, the Gulf and outside the region – that can either enable or restrict their agency. We find that the countries in the Middle East have emerged as important destinations for Nepalese migrants. It is also argued that the receiving countries in the Gulf are not the most popular destinations for skilled migrants from Nepal. However, for many aspiring skilled migrants, these countries appear to be the most affordable or only available destination at a certain stage of their migration trajectories and professional careers. [ABSTRACT FROM AUTHOR]

Introduction:The sella turcica (ST) is a vital structure located in the median position within the middle cranial fossa and is frequently utilized in cephalometric for assessing craniofacial features. However, there is limited literature available regarding cephalometry of the ST in Nepal. Consequently, this study aimed to establish the normal dimensions of the ST in the Nepalese population and explore the potential difference in radio-morphometric measurement among sexes. Materirals and Methods: This study encompassed a descriptive, cross-sectional chart review conducted at the Upendra Devkota Memorial National Institute of Neurological and Allied Sciences over a three-month period. Morphometric assessment of the ST was performed using computed tomography scans. A single radiologist employed an EV Insite DICOM viewer to measure and record the length, depth, and antero-posterior diameter of the ST. Independent-Samples t-test was employed to compare the means between sexes, and a significance level of p < 0.05 was considered statistically significant. Results:Among the 385 cases analyzed, 199 were male (51.8%) and 185 were female (48.2%), resulting in a male-to-female ratio of 1.07:1. The age range of the patients was 20 to 87 years, with a mean age of 44.5 ± 18.5 years. The mean dimensions of the sella turcica were determined as 9.32 mm for length, 7.07 mm for depth, and 10.29 mm for the antero-posterior diameter. Conclusions:The findings of this study indicate that the ST dimensions in the Nepalese population are relatively smaller compared to those reported in various other countries. Additionally, no statistically significant differences were observed in ST dimensions between males and females within the Nepalese population. These results emphasize the importance of considering populationspecific variations when utilizing cephalometric measurements and provide valuable reference standards for future studies and accurate assessment of craniofacial morphology in the Nepalese population. [ABSTRACT FROM AUTHOR]

Traits of the spore‐bearing generation have historically provided the basis for systematic concepts across the phylogenetic spectrum and depth of mosses. Whether taxa characterized by a simple sporophytic architecture are closely related or emerged from independent reduction is often ambiguous. Phylogenomic inferences in the Funariaceae, which hold the model taxon Physcomitrium patens, revealed that several such shifts in sporophyte complexity occurred, and mostly within the Entosthodon‐Physcomitrium complex. Here, we report the rediscovery of the monospecific, Himalayan endemic genera Brachymeniopsis and Clavitheca, after nearly 100 years and 40 years since their respective descriptions. The genera are characterized by, among other traits, their short sporophytes lacking the sporangial peristome teeth controlling spore dispersal. Phylogenomic inferences reveal that Brachymeniopsis gymnostoma arose within the clade of Entosthodon s.str., a genus with typically long‐exserted capsules. We therefore propose to transfer B. gymnostoma to the genus Entosthodon, as E. gymnostomus comb. nov. Furthermore, Clavitheca poeltii, the sole species of the genus, is morphologically highly similar to E. gymnostomus, and should also be transferred to Entosthodon, but is retained as a distinct taxon, E. poeltii comb. nov., until additional populations allow for testing the robustness of the observed divergence in costa and seta length between the Nepalese and Chinese populations. [ABSTRACT FROM AUTHOR]

At present, climate calamities are occurring often and with major effects. The observed increased frequency of extreme events (heat waves, droughts, heavy rainfall, wildfires, floods, and landslides), unpredictability of monsoons, and other manifestations of climate change are a cause of distress for millions around the world. Climate change also poses a challenge for policymakers in planning for agriculture, industry, disaster management, and overall socioeconomic development. In Nepal, climate consequences are increasing every year. Assessment of climate change perception helps scientific society to understand how it affects us and how to handle the posed challenges before things get much worse. The prime aim of our study is to highlight up-to-date climate change issues in Nepal that need immediate attention and action plans. We conducted a webbased survey to assess climate change awareness among university students and faculty members, irrespective of their field of expertise. The impacts of climate change are reaching everyone. Hence, we considered that the sample population could confront the doom and gloom of climate change. The present study shows that (1) about 94 percent of Nepalese university students and faculty members are aware of climate change issues and their impact and causes; (2) careful action plans/strategies are needed at different levels to address the most pressing local issues, particularly drinking water, floods, and landslides during monsoon season; and (3) government agencies and stakeholders should provide more comprehensive and reliable information about extreme events and climate change consequences. In addition, the outcomes of the present work motivate students, faculty members, and society to prepare for the potential future impacts of climate change. [ABSTRACT FROM AUTHOR]

Background: One of the important aftereffects of rapid global development is international mobility, which has placed the health of migrant workers as a key public health issue. A less-developed country, Nepal, with political instability and a significant lack of employment, could not remain untouched by this phenomenon of migration. Our goal was to identify and determine the predictors of anxiety, depression, and psychological wellbeing among Nepalese migrant workers in Gulf countries (United Arab Emirates, Saudi Arabia, Qatar, Oman, Kuwait, Bahrain) and Malaysia. Methods: A descriptive cross-sectional study was used to collect information from 502 Nepalese migrant workers in the arrival section of Tribhuvan International Airport from May to June 2019 using purposive sampling. Workers with a minimum work experience of 6 months and above were included in the study. A structured questionnaire with socio-demographic items was used along with the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and WHO (five) wellbeing scale for measuring the subjective psychological wellbeing and screening for depression. Results: The mean age of the respondents was 32.97 years. Majority (41.8%) of the respondents had work experience in Qatar and 63.7% had work experience of 1–5 years. The results suggested that 14.4% had mild to severe depression while 4.4% had a moderate level of anxiety. The WHO5 wellbeing index score suggested that 14.1% of the respondents had a score below 13, which is suggestive of poor psychological wellbeing. Further, the country of work (p = 0.043), sleeping hours (p = 0.001), occupation (p = 0.044), working hours (p = 0.000), water intake (p = 0.010) and anxiety level (p = 0.000) were found to be significantly associated with depression score. Similarly, sleeping hours (p = 0.022), occupation (p = 0.016), working hours (p = 0.000), water intake (p = 0.010), and anxiety level (0.000) were significantly associated with the WHO5 wellbeing score. Conclusions: Nepalese migrant workers in the Gulf countries (United Arab Emirates, Saudi Arabia, Qatar, Oman, Kuwait, Bahrain) and Malaysia bear an important burden of psychological morbidities. This highlights the need to prioritize the migrant worker's mental health by Nepal as well as Gulf countries and Malaysia. [ABSTRACT FROM AUTHOR]

The study investigated how adolescent students in Nepal explored massive open online learning courses (MOOCs) in a self-directed learning manner. It used a qualitative approach by conducting 13 individual interviews with these youth. Findings suggest that Nepali adolescent MOOC learners are strongly motivated by natural curiosity toward learning as well as encouragement and inspiration through the local learning community, which is significantly different from adult learners' motivation. In terms of self-monitoring in self-directed learning, adolescent learners need scaffolding to support them in making metacognitive decisions. Furthermore, while self-management skills are necessary for successful MOOC learning, in turn, MOOCs improve self-management skills that can be transformed into other life activities. As shown in this study, the local community of practice plays a critical role in motivating adolescents to continue learning from MOOCs and serves as a significant resource to complement MOOC learning. [ABSTRACT FROM AUTHOR]

Background. Oral mucosa is encountered by various lesions and normal variants. Some are not to be worried about, whereas others may be of significance. Knowing the prevalence of oral mucosal lesions in a particular region helps better evaluate, diagnose, and, thus, manage these lesions. Objectives. To assess the prevalence and distribution of oral mucosal lesions and normal variants among various age groups, genders, and sites of the orofacial region. Methods. This cross-sectional study was conducted in the Department of Oral Medicine and Radiology, KIST Medical College and Teaching Hospital from January 2021 to March 2021. Three different proformas were designed according to age, gender, and location of lesions for entry as per the WHO's guide. The obtained data were entered into a Microsoft Excel sheet for frequency analysis by SPSS, and the results were tabulated. Results. Among the records of 16572 (9703 (58.55%) males and 6869 (41.44%) females) OPD patients, 3495 (21.08%) (1934 (55.33%) males and 1561 (44.66%) females) had OMLs and 2314 (13.96%) (1626 (70.26%) males and 688 (29.73%) females) had normal mucosal variants. The most commonly seen OML categories were tobacco-associated lesions, i.e., 2056 (34.07%), tongue lesions, i.e., 1598 (26.48%), oral potentially malignant disorders, i.e., 815 (13.50%), ulcers i.e., 728 (12.06%), and infectious lesions, i.e., 256 (4.24%). Conclusion. The Nepalese population has a wide range of oral mucosal lesions and normal variants, and this study has attempted to have baseline data for the same. The most common OML was smoker's melanosis. [ABSTRACT FROM AUTHOR]

The number of reports and publications about exploratory action research (EAR) has been increasing in recent years; however, there is still a dearth of studies that examine its effectiveness for improving teaching and learning. This study explores Nepalese EFL teachers' perceptions of EAR, the ways they explored their classroom issues, and how they acted to improve their classroom practices through involvement in an online EAR training course for a year. The data collected from interviews and the teachers' written reports show that these teachers found EAR to be an effective approach to explore their classroom puzzles or problems and develop informed, context-sensitive strategies to solve these. The findings of this study are relevant for teachers, teacher educators, and education policymakers in providing insights into the value of EAR for bringing about changes in teaching and learning situations. [ABSTRACT FROM AUTHOR]

Background: Various factors affect the community integration (CI) of persons experiencing traumatic brain injury (TBI). To ensure positive outcomes in terms of life at home, social activities, and productive work among persons suffering TBI, it is necessary to understand the factors that facilitate or impede CI. Purpose: To compare CI by looking at demographic and clinical characteristics and determine significant predictors of CI among TBI Nepalese persons. Methods: 120 participants were selected using a stratified random sampling technique. A questionnaire was used to identify the participants' demographic and clinical characteristics, and the Community Integration Questionnaire was used to measure CI. Univariate and multivariate analyses were performed for demographic and clinical factors associated with community integration. Results: Using univariate analysis, male, employed, living with family, and independence in performing activities of daily living had significantly higher CI scores than female (t = −4.18, p<.000), unemployed (t = −10.52, p<.000), living with friends (t = −3.30, p<.001), and those with moderate to slight dependence (t = −2.83, p<.005). The multivariate analysis revealed that employment status, living with family, and length of hospital stay were significant predictors of CI among TBI Nepalese persons. Conclusion: Employment status, living with family, and length of hospital stay were significant predictors of CI. These findings suggest that rehabilitation efforts should focus on minimizing hospital stay and promoting both productive and social activities among people surviving TBI. [ABSTRACT FROM AUTHOR]

Aim: To analyze the data from the World Health Organization Nepal STEPS survey 2013 to determine the prevalence of total and domain-specific physical activity (PA) and associated factors among Nepalese adults. Methods: A multistage cluster sampling technique was used to proportionately select participants from the 3 ecological zones (Mountain, Hill, and Terai) in Nepal. The Global PA Questionnaire was used to assess PA. The data were analyzed using quantile and ordinary least square regression. Results: Only 4% of the adults did not meet the World Health Organization PA guidelines. Age had a negative monotonic association with total PA and occupational PA, with the highest difference at the upper tails of the PA distribution. Lower total PA and occupational PA were associated with secondary or higher education, being retired or in unpaid employment, living in Terai or urban areas, and nonsmoking. Age, higher education, unpaid employment, and Terai or urban residence were negatively associated, while being currently married was positively associated with transport-related PA. Conclusion: Increasing age, higher education, unpaid employment, unemployment or retirement, and urban residence were associated with lower PA, with the stronger association at the upper tails of the distribution. The correlates had dissimilar associations across the quantiles of PA distribution. [ABSTRACT FROM AUTHOR]

Background: Transferrable mechanisms of quinolone resistance (TMQR) can lead to fluoroquinolone non-susceptibility in addition to chromosomal mechanisms. Some evidence suggests that fluoroquinolone resistance is increasing among the pediatric population. We sought to determine the occurrence of TMQR genes among quinolone-resistant E. coli and K. pneumoniae causing urinary tract infections among Nepalese outpatient children (< 18 years) and identify molecular characteristics of TMQR-harboring isolates. Methods: We performed antimicrobial susceptibility testing, phenotypic extended-spectrum β-lactamase (ESBL) and modified carbapenem inactivation method tests, and investigated the presence of six TMQR genes (qnrA, qnrB, qnrS, aac(6')-Ib-cr, oqxAB, qepA), three ESBL genes (blaCTX−M, blaTEM, blaSHV), and five carbapenemase genes (blaNDM, blaOXA−48, blaKPC, blaIMP, blaVIM). The quinolone resistance-determining region (QRDR) of gyrA and parC were sequenced for 35 TMQR-positive isolates. Results: A total of 74/147 (50.3%) isolates were TMQR positive by multiplex PCR [aac(6')-Ib-cr in 48 (32.7%), qnrB in 23 (15.7%), qnrS in 18 (12.3%), qnrA in 1 (0.7%), and oqxAB in 1 (0.7%) isolate]. The median ciprofloxacin minimum inhibitory concentration of TMQR-positive isolates (64 µg/mL) was two-fold higher than those without TMQR (32 µg/mL) (p = 0.004). Ser-83→Leu and Asp-87→Asn in GyrA and Ser-80→Ile in ParC were the most common QRDR mutations (23 of 35). In addition, there was a statistically significant association between TMQR and two β-lactamase genes; blaCTX−M (p = 0.037) and blaTEM (p = 0.000). Conclusion: This study suggests a high prevalence of TMQR among the quinolone-resistant E. coli and K. pneumoniae isolates causing urinary tract infection in children in this area of Nepal and an association with the carriage of ESBL gene. This is a challenge for the management of urinary infections in children. Comprehensive prospective surveillance of antimicrobial resistance in these common pathogens will be necessary to devise strategies to mitigate the emergence of further resistance. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this study was to evaluate the COVID-19 knowledge, attitude, and practise of college students in Lalitpur, Nepal, and to investigate how these factors relate to sociodemo graphic factors. Design/Methodology/Approach: College students were surveyed through questionnaire to learn more about their understanding, attitudes, and COVID-19-related behaviours. Binary logistic regression was used to examine the association between these variables. Findings: The survey found that a fair amount of people had a general understanding of COVID-19 symptoms (29.32%), whereas a smaller number had a good understanding of preventive actions (16.42%). It was discovered that students' knowledge of COVID-19 was highly influenced by income, education, and age. The majority of those surveyed (82.11%) thought that following preventive guidelines was very helpful in limiting the spread of the virus. Students' perceptions towards COVID-19 were found to be highly influenced by their age, education, and income. A considerable percentage of the students avoided large gatherings in practise (88.26%), showing the influence of age, education, income, and occupation on preventive practises. However, there was no discernible connection between marital status and COVID-19 preventive strategies. Originality/Value: This study advances knowledge of college students' beliefs, practises, and knowledge of COVID-19. In order to effectively stop the virus from spreading among college students, it emphasises the significance of focused interventions and educational campaigns that emphasise knowledge enhancement, the promotion of preventative measures, and consideration of socio-demographic factors. [ABSTRACT FROM AUTHOR]

Key Clinical message: Fascioliasis poses diagnostic challenges to clinicians for its broad spectrum of hepatobiliary symptoms and lower detection rates. Timely and precise identification avoids long‐standing hepatic complications. Fasciola hepatica, a trematode parasite, inhabits snails and sheep. Human hepatic fascioliasis is a neglected tropical disease with no specific tests. In this instance, the significance of clinical awareness, appropriate imaging, and serological investigations is demonstrated. A young Nepalese girl was diagnosed and managed successfully. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) 'near miss' tool has been extensively used to audit maternal morbidity in low‐ and middle‐income countries. Analysis of the cases of 'near miss' enables a better understanding of the associated factors, identifies deficiencies in the provision of maternity services and lays a foundation for better preventive measures in the future. Aims: To understand the epidemiology, aetiology and determine the aspects of preventability of maternal 'near miss' (MNM) at Kathmandu Medical College. Materials and Methods: A prospective audit of MNM and maternal deaths (MD) was undertaken at Kathmandu Medical College over a period of 12 months. The cases were identified using WHO 'near miss' criteria and areas of preventability in the provision of care determined using the modified Geller's criteria. Results: The total number of deliveries and live births in the study period were 2747 and 2698 respectively. A total of 34 'near misses' and two MDs were identified. The common direct aetiologies of MNM and MDs identified were obstetric haemorrhage followed by hypertensive disorders with one‐third of cases being of indirect aetiology. Fifty‐five percent of cases had some aspects of provider‐ or system‐related preventability with the leading delays being lack of diagnosis and recognition of high‐risk status among patients and lack of interdepartmental communication. Conclusion: The WHO near miss rate at Kathmandu Medical College was 12.5/100 live births. Significant aspects of preventability, especially at the level of the provider, were noted among cases of MNM and MDs. [ABSTRACT FROM AUTHOR]

The World Health Organization has supported the development of national tuberculosis (TB) patient cost surveys to quantify the socio-economic impact of TB in high-burden countries. However, methodological differences in the study design (e.g. cross-sectional vs longitudinal) can generate different estimates making the design and impact evaluation of socio-economic protection strategies difficult. The objective of the study was to compare the socio-economic impacts of TB estimated by applying cross-sectional or longitudinal data collections in Nepal. We analysed the data from a longitudinal costing survey (patients interviewed at three time points) conducted between April 2018 and October 2019. We calculated both mean and median costs from patients interviewed during the intensive (cross-sectional 1) and continuation (cross-sectional 2) phases of treatment. We then compared costs, the prevalence of catastrophic costs and the socio-economic impact of TB generated by each approach. There were significant differences in the costs and social impacts calculated by each approach. The median total cost (intensive plus continuation phases) was significantly higher for the longitudinal compared with cross-sectional 2 (US$119.42 vs 91.63, P  < 0.001). The prevalence of food insecurity, social exclusion and patients feeling poorer or much poorer were all significantly higher by applying a longitudinal approach. In conclusion, the longitudinal design captured important aspects of costs and socio-economic impacts, which were missed by applying a cross-sectional approach. If a cross-sectional approach is applied due to resource constraints, our data suggest that the start of the continuation phase is the optimal timing for a single interview. Further research to optimize methodologies to report patient-incurred expenditure during TB diagnosis and treatment is needed. [ABSTRACT FROM AUTHOR]

Background: Immigrants represent over one-fifth (21.9%) of the Canadian population, which is an increasing trend. Primary care is a gateway to accessing the healthcare system for the majority of Canadians seeking medical services; however, Canada reported a growing shortage of healthcare providers, mainly primary care practitioners. Canadians, including immigrants, encounter many unmet healthcare needs due to various reasons. This study aimed to assess unmet healthcare (UHC) needs and associated factors among Nepalese immigrants residing in Calgary. Methods: A cross-sectional study using a self-administered questionnaire was conducted in 2019. UHC needs were measured based on a single-item question: "During the past 12 months, was there ever a time that you felt you needed medical help, but you did not receive it". A follow-up question was asked to learn about associated unmet needs factors, and the responses were categorized into availability, accessibility, and acceptability. Descriptive and multivariable logistic regression was employed to assess the association between UHC needs and its predictors by using STATA version 14.2. Results: Of 401 study participants, nearly half of the participants (n = 187; 46.63%) reported UHC needs, which was not significantly different among male and female participants (p = 0.718). UHC needs were nearly two times higher among those aged 26–45 (AOR 1.93) and those ≥56 years (AOR 2.17) compared to those under 25 years of age. The top reasons reported for unmet needs were long waits to access care (67.91%), healthcare costs (57.22%), and lack of knowing where to get help (31.55%). Overall, "services availability when required" was a leading obstacle that accounted for UHC needs (n = 137, 73.26%). Nearly two-thirds (n = 121, 64.71%) of participants reported that "accessibility of services" was a barrier, followed by "acceptability (n = 107, 57.22%). Those who reported UHC needs also reported an impact on their lives personally and economically. The most commonly reported personal impact was mental health impact, including worry, anxiety, and stress (67.38%). The most common economic impact reported due to UHC needs was increased use of over-the-counter drugs (33.16%) and increased healthcare costs (17.20%). Conclusions: UHC needs are presented in the Nepalese immigrant population. Accessibility to healthcare is limited for several reasons: waiting time, cost, distance, and unavailability of services. UHC needs impact individuals' personal health, daily life activities, and financial capacity. Strategies to improve access to PHC for disadvantaged populations are crucial and need to be tackled effectively. [ABSTRACT FROM AUTHOR]

Background: Pesticides are essential for agricultural development, but their increased use in developing countries like Nepal poses health risks to farmers. Methods: A cross-sectional study was conducted in wards 1, 2, and 3 of the Tokha Municipality in Kathmandu District to identify the health effects of pesticides and associated factors among farmers. The study included 333 respondents who were interviewed between April 26 and June 04, 2022. Results: The majority of farmers (36.6%) were aged between 40 and 49 years, with a median (IQR) age of 45.0 (38.0 to 51.0) years. All farmers reported using pesticides, with 100% usage in vegetables. Most respondents (73%) reported experiencing health effects: headache (69.5%), skin irritation (42.8%), and burning eyes (31.3%) were the most common symptoms. Only 8% sought medical care. Additionally, 94.6% of respondents had not received training on integrated pest management, and none of them reported using a complete set of personal protective equipment. The study found that older age groups, females, those who were unable to read and write, and those of the Hindu religion, as well as respondents with longer pesticide use, more frequent spraying, and not detecting wind direction, had significantly higher odds of self-reported health problems (P < 0.05). Conclusion: Our findings show that all farmers in the study were using pesticides, and the majority had reported health effects. Therefore, we recommend that farmers receive training on integrated pest management, use a complete set of personal protective equipment, and promptly seek medical care if they experience health issues. [ABSTRACT FROM AUTHOR]

Aims:Abnormal Uterine Bleeding (AUB) is a highly prevalent condition with complex underlying condition. The absence of standardized definitions and uniform criteria for describing menstrual symptoms has posed challenges in investigation and management of the case. This study was conducted to categorize the causes of AUB among Nepalese women of reproductive age using the PALM-COIEN classification system (provided by FIGO) and to describe the bleeding patterns exhibited by them. Methods: A descriptive cross-sectional study was conducted among 139 women of reproductive age group visiting out-patient care in a tertiary care hospital with complaints of abnormal uterine bleeding. The causes of AUB were classified before treatment using the PALM-COEIN system. Results: The mean age of patients was 37.9 ± 10.1 years, with 57.6% of them aged 38 years or more. Structural causes accounted for 31% of the AUB cases, while non-structural causes were present in 69% of them. AUB-O was the most frequent finding 91(65.5%) among the patients, followed by AUB-L in 19 (13.7%) women and AUB-A in 11 (7.9%) women. More than half of the patients (54.7%) were anemic, and hypothyroidism was seen in 14.2% of them. Conclusion: Non-structural causes of AUB particularly ovulatory dysfunction contributed to major cause of AUB. Evidence of various etiological causes of AUB among Nepalese women based on this PALM-COEIN system can provide uniformity in investigation and management of such cases. [ABSTRACT FROM AUTHOR]

Paroxysmal nocturnal hemoglobinuria (PNH) results from a mutation in the phosphatidylinositol glycan class-A gene which causes uncontrolled complement activation with resultant intravascular hemolysis and its sequelae. Eculizumab is a terminal complement inhibitor that blocks this complement activation and has revolutionized the treatment of PNH but comes with an enormous price which can have catastrophic health expenditure in low-middle income countries (LMIC) like Nepal. Here, we discuss the potential way forwards in the treatment of PNH in Nepal and other LMICs. [ABSTRACT FROM AUTHOR]