Dementia care landscape in Nepal: Understanding the context, barriers, and opportunities for the development of a national dementia care plan.

OBJECTIVE: This study was conducted to comprehensively understand the context, barriers, and opportunities for improving dementia care, treatment, and support. The objective is to guide the development of a national dementia care plan. METHODOLOGY: This document review was conducted by analyzing literature available in the public domain, including scientific publications, project documents/reports, media reports, and hospital records. Additionally, annual reports published by the Department of Health Services, national census and demographic and health survey reports, Old Age Homes, and other relevant government reports were examined. Firsthand information was gathered from relevant stakeholders based on the World Health Organization's situational analysis framework for dementia plans. This framework encompasses four domains: Policy context (national ministries, legislation, policies, strategies, plans related to dementia, mental health, aging, and disability), service delivery assessment (health and social care workforces, services, support and treatment programmes, and promotion of awareness and understanding), and epidemiological indicators (prevalence and incidence rates of dementia, risk factors). Ethical clearance was obtained from the Institutional Review Committee (IRC) of B.P. Koirala Institute of Health Sciences (IRC no.2658/023). RESULTS: Existing policies in Nepal inadequately address the needs of people with dementia and their caregivers. Concerning health services, the Government of Nepal provides financial subsidies to individuals diagnosed with dementia; however, numerous hurdles impede access to care. These obstacles include geographical and structural barriers, an inefficient public healthcare system, weak governance, financial constraints, low awareness levels, stigma, and inadequate workforce. Furthermore, the absence of robust nationally representative epidemiological studies on dementia in Nepal hampers the development of evidence-based plans and policies. Similarly, there are no interventions targeted at caregivers of people with dementia, and no initiatives for dementia prevention are in place. CONCLUSIONS: This review underscores the urgent need to formulate a comprehensive national dementia care plan to address the growing challenges. Key priority action areas include the integration of dementia care into primary healthcare services, training workforce to provide the care, increasing awareness, mitigating stigma, developing caregiver support programs, and initiating high-quality research to inform evidence-based policymaking.

A systematic review on the role of biosecurity to prevent or control colibacillosis in broiler production.

This systematic review aimed at investigating the role that biosecurity can have in preventing or controlling colibacillosis in broiler production. Primary studies with natural or experimental exposure to avian pathogenic Escherichia coli, evaluating any biosecurity measure to prevent or control colibacillosis in broiler chickens with at least one of the following outcomes: feed conversion ratio (FCR), condemnations at slaughter, and mortality due to colibacillosis, were included. A systematic search was carried out in 4 databases according to the Cochrane handbook and reported following the PRISMA 2020 directions. Studies (n = 3,886) were screened in a 2-phase process and data matching the inclusion criteria were extracted. Risk of bias assessment was performed. Four studies reporting biosecurity measures to prevent or control colibacillosis in broiler production were included. In all studies, only disinfection during either the pre-hatching period (n = 3) or the post-hatching period (n = 1) was evaluated as biosecurity measure in broiler production, as well as its effect on FCR (n = 2) and mortality (n = 4) due to colibacillosis. No studies with effects on condemnations at slaughter were found. Due to the heterogeneity of studies in regard to interventions and outcomes, meta-analysis was not carried out. The limited findings of this systematic review do not provide a comprehensive evidence to statistically evaluate the efficacy of biosecurity to prevent or control colibacillosis in broiler production. The scarcity of evidence found suggests that further and deeper investigations on the topic are needed, considering the variety of interventions related to biosecurity.

Comparison of the Mean Cross-sectional Area of the Median Nerve between Pregnant and Non-Pregnant Women Using Ultrasonography in a Tertiary Level Hospital, Nepal.

Background The median nerve is subjected to compression in the carpal tunnel giving rise to a constellation of symptoms known as carpal tunnel syndrome. It is the most frequent form of peripheral entrapment neuropathies and is most prevalent in the middle age females. The most common cause of this syndrome is idiopathic. One of the known secondary causes is pregnancy. Objective To compare the mean cross sectional area of median nerve using ultrasound in pregnant and non-pregnant females at carpal tunnel inlet and its variations with different trimesters. Method The study was conducted during a period of one year (October 2014 to September 2015). A total of 204 participants were evaluated among which 102 were nonpregnant and 102 were pregnant. Among the 102 pregnant participants, 34 females each were in the first, second, and third trimesters. A convenience sampling technique was used for the selection of the participants. The mean cross-sectional area of the median nerve was calculated in both of these groups in both hands by using the direct method. The mean cross-sectional area of non-pregnant female was used as the reference value to which that of pregnant female were compared. Data obtained were compiled and analyzed using Statistical Package for Social Sciences Version 16. Result The overall mean cross-sectional area of the median nerve in non-pregnant females was 6.76 ± 1.05 mm2 and in pregnant females was 6.84 ± 1.09 mm. No statistically significant difference was noted in the mean cross-sectional area of the median nerve in either hand in both pregnant and non-pregnant females. No statistically significant difference was noted in the overall mean cross-sectional area between the non-pregnant and pregnant females. There was no significant difference in the mean cross-sectional area within the different trimesters in both hands on intergroup comparisons. Conclusion Ultrasound examination of the median nerve and measurement of its crosssectional area is a useful diagnostic tool in the evaluation of carpal tunnel syndrome. Ultrasound has the advantage of easy availability, low cost, quick scan time, able to scan a long segment of nerve and examine the structures in both static and dynamic states. Besides, it also helps in the identification of various anatomic variants and pathologies within or adjacent to carpal tunnel.

Barriers and enablers of vigorous intermittent lifestyle physical activity (VILPA) in physically inactive adults: a focus group study.

BACKGROUND: Vigorous Intermittent Lifestyle Physical Activity (VILPA) refers to brief bouts of vigorous intensity physical activity performed as part of daily living. VILPA has been proposed as a novel concept to expand physical activity options among the least active. As a nascent area of research, factors which impede or encourage VILPA in physically inactive adults are yet to be explored. Such information is pertinent in the design of future interventions. We examined the barriers and enablers of VILPA among physically inactive adults using the Capability, Opportunity, Motivation, Behavior (COM-B) model as a conceptual framework. METHODS: We recruited a sample of self-identified physically inactive middle-aged and older adults (N = 78) based in Australia to take part in 19 online focus groups across three age groups: young-middle (age 35-44), middle (age 45-59) and old (age 60-76). We analyzed interviews using a critical realist approach to thematic analysis. Identified barriers and enablers were subsequently mapped onto the COM-B model components. RESULTS: The data generated 6 barriers and 10 enablers of VILPA that corresponded to COM-B concepts. Barriers included physical limitations (physical capability), perceptions of aging, need for knowledge (psychological capability), environmental constraints (physical opportunity), perceptions of effort and energy, and fear (automatic motivation). Enablers included convenience, reframing physical activity as purposeful movement, use of prompts and reminders (physical opportunity), normalization of taking the active option, gamification (social opportunity), sense of achievement, health improvements, personally salient rewards (reflective motivation), identity fit, and changing from effortful deliberation to habitual action (automatic motivation). CONCLUSION: The barriers and enablers of VILPA span capability, opportunity, and motivation beliefs. Promoting the time-efficient nature and simplicity of VILPA requiring no equipment or special gym sessions, the use of prompts and reminders at opportune times, and habit formation strategies could capitalize on the enablers. Addressing the suitability of the small bouts, the development of specific guidelines, addressing safety concerns, and explicating the potential benefits of, and opportunities to do, VILPA could ameliorate some of the barriers identified. Future VILPA interventions may require limited age customization, speaking to the potential for such interventions to be delivered at scale.

Prevalence of gastrointestinal helminth parasites in rhesus macaques and local residents in the central mid-hills of Nepal.

Rhesus macaques (Macaca mulatta) are distributed across Nepal in close association with humans and with a high probability of sharing of soil-transmitted intestinal helminth parasites. This study was carried out to determine the prevalence, richness and risk factors of gastrointestinal (GI) helminth parasites among rhesus macaques and humans in the Daunne Forest area, a community managed forest in the central mid-hills of Nepal. A total of 190 fecal samples, including 120 samples from rhesus macaques residing around the Daunne Devi Temple and in the surrounding forest, and 70 from local people, were microscopically examined by direct wet mount, floatation and sedimentation methods. Seasonal and age-sex based variations in helminth parasite prevalence were analyzed. Among the rhesus macaques, the total parasite prevalence was 39.2 %. Strongyloides sp. accounted for the highest prevalence (19.17 %) followed by Ascaris sp. (13.33 %), hookworm (10.83 %) and Trichuris sp. (4.17 %). Among the humans, Ascaris lumbricoides (11.3 %) was the only parasite detected. The Sorenson's coefficient of similarity of GI parasites between the macaques and local people at the generic level was 0.4. Mean parasite richness for the macaques was 1.21 ± 0.41 (SD) per infected sample. Parasite prevalence in the summer season (41.4 %) was higher than in the winter season (36 %). Adult macaques (41.67 %) had higher GI parasite prevalence than the young (30.77 %) and infants (27.27 %). Among the adult macaques, the prevalence rate was significantly higher (P=0.005) in females (52.46 %) than in males (22.86 %). Our results indicate that the temple rhesus macaques have a high prevalence of GI helminth parasites and could pose a potential zoonotic risk. As such, the need for routine monitoring and an effective management strategy is essential.

Chronic Spontaneous Urticaria: Clinical Profile, Autologous Serum Skin Test Positivity and Associated Impairment in Quality of Life in Nepalese Patients.

Background Chronic Spontaneous Urticaria is considered to be an autoimmune phenomenon in half of the total cases. Autologous serum skin test is a simple screening test for the presence of auto-antibodies in chronic urticaria. Significant impairment in quality of life have been observed in autologous serum skin test positive cases. There are limited literatures on chronic spontaneous urticaria, autologous serum skin test and associated Dermatology Life Quality Index in Nepal till date. Objective To find the proportion of autologous serum skin test positive cases in chronic urticaria and impairment in quality of life in such patients. Method This was a retrospective review of outpatient records of patients diagnosed with chronic spontaneous urticaria, from January 2018 to December 2019, from a tertiary care hospital in Kathmandu, Nepal. Details of the patients, autologous serum skin test and dermatology life quality index scores were analyzed and presented. Result Among the total 114 cases positive autologous serum skin test was seen in 48.2% of cases. The mean total Dermatology Life Quality Index score was 8.06±6.64. A significantly higher quality of life impairment was observed in in patients with positive autologous serum skin test as compared to the negative ones. The odds of finding a positive autologous serum skin test in patients with angioedema was 2.1, however the difference was not statistically significant. Conclusion Chronic spontaneous urticaria was more common in females as compared to males. A positive autologous serum skin test was present in half of the patients which was in turn associated with a greater impairment of quality of life.

Real Time Trans-Rectal Elastography of Prostate Correlation with Histopathology in a Suspected Case of Prostate Cancer.

Background Early detection of prostate cancer, the second most common cancer in men worldwide, is the key for its successful treatment. Commonly used clinical criteria and imaging tools for detection of prostate cancer are less sensitive. Objective This study was aimed to find role of real time transrectal elastography of prostate for detection of prostate cancer. Method Study was conducted in 66 patients with clinical suspicion of prostate cancer, who were sent for ultrasound guided prostate biopsy. Transrectal ultrasound with real time elastography was performed in all the patients prior to the biopsy and looked for hard areas within the prostate. Then six-core tru-cut biopsy were taken in six zones of prostate, including the hard areas detected in the elastography. The histopathology report were correlated with the elastography findings. Result Median prostate specific antigen of the patients was 11.5 ng/ml with interquartile range of 8 to 23.5 ng/ml. Digital rectal examination showed hard nodular findings in 35 patients. Transrectal ultrasound showed 81 hypoechoic lesions in 31 patients. Elastography showed 127 hard areas in 31 patients. Histopathology showed 90 positive biopsy cores in 23 patients. Cancer detection rate of elastography was 82.6%. At 95% confidence interval, patients with elastography detected hard lesions had 19.4 times more likelihood to have prostate cancer. Sensitivity of elastography was high as compared to digital rectal examination and transrectal ultrasound alone. Conclusion Transrectal elastography had high sensitivity over clinical tools and transrectal ultrasonography for detection of prostate cancer.

Correlation of Pelvic Parameters with Isthmic Spondylolisthesis.

Background Spondylolisthesis is one of the major causes of low back pain. The anterior shift of the vertebra is mostly at L4 and L5 levels. Several types have been described, most common being the isthmic type. Pelvic parameters are said to be associated with development and progression of listhesis, and should be evaluated while treating it. Objective To study the correlation of Pelvic parameters with isthmic spondylolisthesis. Method It was a cross sectional case control study. In 68 cases with Isthmic Spondylolisthesis and of 34 cases with low back pain without listhesis (control), the spinopelvic parameters like lumbar lordosis, pelvic incidence, pelvic tilt and sacral slopes were measured together with degree of slip with lateral radiographs. Findings were analyzed and compared with control group. Result In control group, the pelvic incidence was 50.44±4.78o , the sacral slope was 34.38±6.79o , the pelvic tilt was 15.97±5.31o , and the lumbar lordosis was 46.76±6.78o . In Isthmic Spondylolisthesis group, the pelvic incidence was 60.85±6.79o , the sacral slope was 40.40±6.91o , the pelvic tilt was 20.63±7.51o , and the lumbar lordosis was 57.31±7.11o . The difference in spinopelvic parameters amongst control and Isthmic Spondylolisthesis group was statistically significant (p < 0.001). The degree of slip was directly proportional to the pelvic incidence angle (grade I=52o , II =62o and III 72.5o ). Conclusion Spino-pelvic parameters are higher in isthmic spondylolisthesis group and is significantly associated with severity of the slip.

Sonographic Quantification of Ovarian Volume in Adults Attending General Health Checkup and General Out Patient Department in Tribhuvan University Teaching Hospital.

Background Ultrasonography is the easily available, cheap and reliable method for evaluation of ovaries. Ovarian volume is the major factor in the diagnosis of various ovarian pathologies and confusing discrepancies are found in the literature. Objective To determine the ovarian volume among individuals attending outpatient department in tertiary level hospital. Method Descriptive cross sectional study design was used; 305 patients of 16-60 years attending general outpatient department in the Tribhuvan University Teaching Hospital, Kathmandu, Nepal were included. Ovarian volume was calculated by using transabdominal ultrasonography. Data was collected in the predesigned proforma and analyzed using statistical package for the social sciences software. Result The study showed mean total ovarian volume 5.95 ± 2.44 cc (centimeter cube) with mean right ovarian volume 5.94 ± 2.70 cc and mean left ovarian volume 6.05 ± 2.79 cc. Significant decrease in ovarian volume with age was observed. Height and weight did not show significant correlation with ovarian volumes and no significant variation seen in the volumes of right and left ovaries. Periovulatory ovaries show significantly higher volumes on right side than luteal phase. Similarly, significantly higher volume of left ovary seen in mixed ethnic group than mongoloid group. Conclusion Measurement of ovarian volume is important for evaluation and management of ovarian disorders. Ultrasonography which is readily available, simple and cost effective is better suited for our environment than other imaging modality. Values of ovarian volume from this study may provide a baseline of normal ovarian volume in our community.

Chondrodysplasia Punctata: A Case Report of Fetal Warfarin Syndrome.

Chondrodysplasia punctata is abnormal calcification in the cartilage of developing bones and has been seen in association with deranged vitamin K metabolism. Warfarin, an oral anticoagulant acting on vitamin K dependent clotting factors is known to cause chondrodysplasia punctata. Despite the knowledge of the condition the management of patients with prosthetic heart valves might require use of the drug for anticoagulation. Here, we present a case of a fetal warfarin syndrome in a second born child of a 27 year lady under warfarin for prosthetic heart valve. The pregnancy was complicated by polyhydramnios in third trimester and terminated at term by normal vaginal delivery. The baby was well, except for facial dysmorphism in the form of depressed nasal bridge, narrow nares and suspected left choanal atresia. Radiograph revealed stippled ephiphysis of vertebra, femora and humera supporting diagnosis of fetal warfarin syndrome. The baby did not develop any perinatal complication and was discharged home.

Risk factors for meticillin-resistant Staphylococcus aureus colonization in dialysis patients: a meta-analysis.

BACKGROUND: Patients on dialysis are particularly vulnerable to meticillin-resistant Staphylococcus aureus (MRSA) infections and MRSA colonization is associated with increased risk for severe infections in this population. AIM: Determination of risk factors for MRSA colonization among dialysis patients. METHODS: This is a systematic review and meta-analysis of studies reporting risk factors of MRSA colonization. We performed a PubMed and EMBASE literature search to identify all studies on risk factors for MRSA colonization among patients undergoing dialysis treatment. Previous hospitalization, type of dialysis access, comorbid conditions, dialysis vintage, gender, length of time on dialysis, and previous antibiotic use were extracted and assessed for possible association with MRSA colonization in this population. FINDINGS: Ten out of 8252 articles, presenting data on 2364 dialysis patients, were included. We found that hospitalization within the previous 12 months [odds ratio (OR): 1.93; 95% confidence interval (CI): 1.04-3.58] and the use of temporary dialysis access (relative risk: 1.66; 95% CI: 1.06-2.60) were associated with a significantly higher risk of MRSA colonization. MRSA carriage was associated with lower serum albumin levels compared to non-carriage (OR: 0.8; 95% CI: 0.68-0.95) and was higher among patients with chronic lung disease (OR: 2.16; 95% CI: 1.04-4.51). There were no data on patients undergoing peritoneal dialysis. CONCLUSION: Active surveillance approaches, including potential decolonization strategies, are suggested to focus on these subgroups of haemodialysis patients with hospitalization within the previous year, temporary dialysis access, lower serum albumin levels, and chronic lung disease comorbidity.

Evaluation of antibody response of killed and live vaccines against porcine epidemic diarrhea virus in a field study.

BACKGROUND: Porcine epidemic diarrhea virus (PEDV) is an infectious, highly contagious virus, and is an etiological agent of acute entero-pathogenic diarrhea in swine. OBJECTIVES: Evaluation of the antibody response of two types of PEDV vaccines is to be carried out. ANIMALS AND METHODS: Sows were vaccinated with either live or killed commercial PEDV SM98 (GenBank: GU937797.1) vaccines. Four different groups of sows with five sows in each group were used in this study: the unvaccinated negative control group, the killed virus vaccination group with killed virus boosting (K/K), the live virus vaccinated group with live virus boosting (L/L), and the combination group vaccinated with live virus and subsequently boosted with killed vaccine (L/K). Sows were vaccinated intramuscularly twice at four and two weeks prior to farrowing with 2ml/head vaccine dose. Antibody titers in sow and piglet serum one week after farrowing and that in colostrum were compared by enzyme-linked immunosorbent assay (ELISA) and serum neutralization test. RESULTS: Vaccination with K/K vaccine induced the highest level of IgG and IgA in sow serum, colostrum, and especially in piglet serum, with the lowest levels found in the L/L group. The major neutralizing activity was also found in the K/K group, particularly in colostrum, with piglets bearing higher neutralizing activity compared to sow sera. Among recombinant spike S1, S2, S3, and nucleocapsid N protein of PEDV, S3 protein presented the highest antibody level in the K/K group. CONCLUSION: Killed PEDV SM98 vaccine induced higher antibody levels. CLINICAL IMPORTANCE: This study clearly confirms that killed vaccine has induced higher antibody levels and may contribute to the design of future research and vaccine programs.

Comparison of serum neutralization and enzyme-linked immunosorbent assay on sera from porcine epidemic diarrhea virus vaccinated pigs.

BACKGROUND: Porcine epidemic diarrhea virus (PEDV) is an economically important pathogen of swine. OBJECTIVE: Serum neutralization (SN) and enzyme-linked immunosorbent assay (ELISA) test results as well as the utility of spike proteins S1, S2, and S3 and entire nucleocapsid protein were compared. ANIMALS AND METHODS: Serum samples from 400 pigs vaccinated against PEDV strain SM98P were collected from 78 farms in Korea. SN test and ELISA were performed to confirm the presence of antibodies. For prokaryotic expression of partial fragments of spike protein the size and location of S1, S2, and S3, and full nucleocapsid protein, polymerase chain reaction was performed using specific primers. RESULTS: Comparison of these results demonstrated that there was a correlation between the SN and ELISA results. Sera with higher neutralizing activity also had higher IgG titer. The antibody profiling data presented the correlation of neutralizing activity with the level of spike protein antibody. In particular, the S3 region may have an important role in neutralizing activity. CONCLUSIONS: We confirmed that the carboxy-terminal region that includes the endodomain of the S protein induced stronger neutralizing activity than the region that includes the ectodomain. CLINICAL RELEVANCE: The region of the S protein may have a stronger neutralizing KPEDV-9 epitope and could be useful for the evaluation of future PEDV vaccine efficacy.

Common site of urinary calculi in kidney, ureter and bladder region.

Urolithiasis is an ancient disease with global distribution. It refers to stones originating anywhere in the urinary system. Urinary calculi or stones are the most common cause of acute urinary system obstruction. The study was aimed with finding out the common site of urinary calculus in kidney ureter bladder (KUB) region. This was a prospective cross-sectional study conducted from June 2012 to September 2012 at Tribhuvan University, Teaching Hospital, Maharajgunj. A total 240 urolitiasis patients were enrolled for plain KUB examination. Site of urinary calculus was identified by observing KUB film of the subjects under the supervision of radiologist. The data were analyzed prospectively with outcome measures of gender & stone location. Out of 240 patients, 138 were male and 102 were female with male to female ratio of 1.35:1. The age ranged from 9 to 83 years. Out of total 240 patients, 71.9% (187) patients belonged to productive age group (20-60 years). Total number of urinary calculi was 345 in which 208 were found in male patients and 137 were found in female patients. Of total 345 calculi, 237 were renal stones, 47 were ureteric stones, 22 of the stones were found in pelviureteric junction (PUJ), 33 of stones were found in vesicoureteric junction (VUJ), and 6 were in bladder. In conclusion, urinary stone disease is a major public health problem in a developing country like Nepal with male and productive age group predominance. Kidney stones are most common. Distal ureter is the most common site of ureteric stone.

Infant and young child feeding practices in Chepang communities.

BACKGROUND: Infant and young child feeding (IYCF) practices differ in communities due to difference in knowledge, culture, health service utilization, and other socio-economic factors. The objective of this study was to explore the knowledge and practices of Chepang mothers on ICYF and their correlates. METHODS: Cross sectional descriptive study was conducted in Chepang communities of Makawanpur district. Quantitative methodology was used in which 360 mothers of under children under two were randomly selected. Logistic regression analysis of selected child feeding indicators were done to find their association with socio-economic and health related factors. RESULTS: Feeding practices of mothers were found better than their knowledge level. About 35% had knowledge about early initiation of breastfeeding. Exclusive breastfeeding and introduction of complementary foods at the age of six months were 81% and 90% respectively. Literate mothers were found initiating breastfeeding early than the illiterate (OR=2.61, 95% CI, 1.59-4.27). Growth monitoring service utilization was found to have significant association with exclusive breastfeeding practices (OR= 2.75; 95% CI, 1.30-5.78). Feeding diverse complementary foods was associated with average monthly family income and duration of food sufficiency. CONCLUSIONS: Feeding practices in Chepang community were associated with health and socioeconomic determinants. Some of the feeding practices were found good however, meal frequency for the children 9-23 months of age and feeding diverse foods for children 6-23 months were found lower which needs to be improved through health education programs. Qualitative studies are needed to explore cultural factors.