Empowering youth as Changemakers for gender-transformative action: a play-based participatory approach in South-East Nepal.

AIMS: This study explored how youth participatory action research (YPAR) methods, specifically play-based activities integrated with cricket, can engage adolescent girls in Nepal's Terai region to identify and address gender-related health challenges. It aimed to assess how these methods contribute to empowering girls, developing research capacities, and promoting gender equity through sports. METHODS: Three interactive workshops were held with adolescent girls forming 'Cricket Changemakers' teams. Through a combination of cricket-based activities, participatory games, and discussions, the workshops aimed to build research skills and explore gender issues in their communities. Qualitative data were gathered through observations, reflective notes, and outputs from play-based tasks. Data were analysed using framework analysis to evaluate the contribution of these activities to key YPAR processes such as power sharing, communication, and strategic thinking. FINDINGS: The play-based methods improved collaboration, networking, and communication among participants. The cricket activities fostered collective power and provided opportunities for girls to reflect on and challenge local gender norms. Participants identified issues including restrictions on mobility, societal expectations, and the unequal distribution of household chores. The workshops facilitated the development of research action plans focused on increasing girls' participation in cricket and shifting community perceptions of girls' roles. CONCLUSIONS: The integration of play-based YPAR methods shows promise for fostering gender-transformative change among adolescent girls in Nepal. These methods created a space for girls to express challenges and co-develop strategies for social change. Findings suggest that sports-based participatory research can be a valuable tool in public health interventions for gender equity, though more work is needed to address methodological challenges and ensure meaningful participation.

Outcome of Endoscopic Myringoplasty Using Gelfoam Versus no Gelfoam in Tympanic Cavity and External Auditory Canal.

Background Absorbable gelatin sponge (gelfoam) is used routinely during myringoplasty as a scaffold that supports tympanic membrane grafts and ossicular chain and to promote hemostasis. However, gelfoam could cause fibrosis, adhesions, granulations, new bone formation within the middle ear cavity and could obstruct the tympanic ostium of the eustachian tube and affects inner ear function and also interferes with the healing process of neodrum and middle ear cavity. Objective To compare the outcome of endoscopic myringoplasty with and without use of gelfoam in external auditory canal and tympanic cavity. Method Fifty patients, with 25 patients in each group who underwent endoscopic myringoplasty with and without gelfoam packing in middle ear cavity and external auditory canal were enrolled in the study. The hearing outcome was assessed by comparing pre-operative ABG (Air bone gap) with post-operative air bone gap and air bone gap closure in speech frequencies (0.5kHz,1kHz, 2kHz,4kHz). The status of graft and hearing results was evaluated on 3months of follow-up in both the groups. Result Out of total 25 patients enrolled for study in both non gelfoam packing group (NGFPG) and gelfoam packing group (GFPG), 24(96%) had graft uptake in each group. The audiological gain in non gelfoam packing group was 11.15±2.4dB whereas in gelfoam packing group it was 12.45±0.81dB. The audiological gain between the two groups did not show any statistically significant (p= 0.190). However, the pre and postoperative hearing difference was statistically significant(p=0.001) in both non gelfoam packing group and gelfoam packing group. Conclusion This study concluded that non gelfoam packing group has similar graft uptake and hearing gain when compared with gelfoam packing group in endoscopic myringoplasty. Hence, myringoplasty can be performed safely without using any gelfoam in the middle ear cavity.

Molecular Investigation of Dengue Virus Serotypes in the Dengue Outbreak of 2022 in Nepal.

Background Dengue, a viral infection highly prevalent in tropical regions, exhibits local variations in risks that are influenced by a combination of climatic, socioeconomic, and environmental factors. It is caused by four distinct, yet closely related serotypes of the dengue virus. Objective To identify the different serotypes of dengue virus responsible for the 2022 outbreak in Nepal, where dengue has been prevalent since 2006 but with limited availability of molecular information on the serotypes. Method Serum samples from suspected dengue patients visiting Dhulikhel Hospital were analyzed using Dengue Rapid Test, for the presence of IgG/IgM antibodies or NS1 Ag. The positive samples were stored at -80°C, and 89 samples were selected for further analysis. RNA was extracted from those positive samples and RT-PCR was performed to identify the serotypes present. Result A higher percentage of sero-positivity was observed in females(52%) compared to males. Positive cases were distributed in 14 different districts, with the highest percentage(58.4%) in Kavre. RT-PCR, of 53 out of 89 serologically positive samples, by RT-PCR revealed that DENV1 was the predominant, followed by DEN3(24.5%) and DENV2(16.9%). DENV4 was not detected in any of the samples. The average Ct-value of all serotypes was 17.6, with DENV3 having the lowest Ct-value of 16.6, indicating slightly higher viremia. Conclusion Our study, although limited in its coverage of Nepal, has provided molecular information on the serotypes responsible for the 2022 dengue outbreak. The high prevalence of DENV1 was observed, while prevalence of DENV3 was accompanied by high viral load.

Thrombolysis with Tenecteplase for Basilar Artery Occlusion in Neuro and Allied Clinic: Importance of Clinical Assessment and Drip and Ship Model in Nepal.

Tenecteplase, a new thrombolytic drug, is now widely recommended and used for treating acute ischemic stroke, and timely thrombolysis within 4.5 hours is crucial for better outcomes. However, due to limited stroke awareness, transportation difficulties, and inadequate access to experts and comprehensive stroke care centers, fewer than 15% of stroke patients in Nepal receive thrombolytic therapy. The "drip and ship" model, which involves starting thrombolysis at a noncomprehensive stroke care center and transferring the patient to another center for further care, can effectively overcome these obstacles, provided trained personnel are available at non-comprehensive stroke care centers. We report a case of acute ischemic stroke treated with thrombolysis within 4.5 hours of symptom onset at a non-comprehensive stroke care center, followed by transfer to another center for ongoing care, demonstrating the feasibility and potential benefits of the drip and ship model in resource-limited settings.

Feasibility, Safety and Acceptance of Buccal Mucosa Harvest Under Local Anesthesia for Substitution Urethroplasty:Prospective Observational Study in a Tertiary Centre.

Background Urethral stricture is a challenging condition with significant socioeconomic impacts, often requiring surgical intervention such as urethroplasty. Buccal mucosa grafts (BMG) are a popular choice for substitution urethroplasty due to their favorable outcomes. This study evaluates the feasibility, safety, and acceptance of harvesting buccal mucosa grafts under local anesthesia. Objective To assess feasibility, safety and acceptance of Buccal mucosa harvest under local anesthesia. Method A prospective observational hospital based study to evaluate outcomes of substitution urethroplasty using buccal mucosa grafts (BMG) under local anesthesia. Result Of the 40 patients, 28 had unilateral graft harvests, while 12 had bilateral procedures. The mean graft length obtained was 5.65 cm. Postoperatively, patients experienced a quick recovery, with full mouth opening achieved within an average of 2.78 days and resumption of normal eating within 2.6 days. Minor complications included oral swelling in 15% of cases and food residue in 12.5%. Although 87.5% of patients reported pain at the perineal wound site, the overall pain score averaged 3.58, indicating manageable discomfort. Importantly, 92.5% of patients expressed a willingness to undergo the procedure again if necessary. Conclusion These findings suggest that buccal mucosa graft harvest under local anesthesia is both feasible and well-tolerated. The procedure appears to be a safe alternative to regional or general anesthesia, with minimal complications and a high level of patient acceptance. Future randomized controlled trials comparing local anesthesia to regional or general anesthesia could provide additional insights and further validate these findings. This study contributes to the growing body of evidence supporting the use of local anesthesia in urethral stricture surgery, offering a practical approach to managing this condition effectively.

Accuracy of Transvaginal Ultrasound Parameters and Bishop Score as Predictors of Successful Induction of Labor in Term High-Risk Pregnancy.

Background Induction is one of the most common interventions in obstetrics practice, accounting for 1.4-35%. Cervical favorability is crucial for successful induction. The Bishop score is simple and assesses preinduction cervical favorability based on five components. However, it has high inter- and intra-observer variability. Alternative objective methods are transvaginal ultrasound parameters (e.g., cervical length, width, and funneling). Objective To assess and compare the predictive value of transvaginal ultrasound and bishop score for vaginal delivery. In addition, the time interval from induction to delivery in women undergoing induction of labor. Method This prospective cross-sectional study included 342 pregnant women, in whom induction of labor was performed at 38-42 weeks of gestation. Cervical length, funneling, and width from transvaginal sonography and bishop scores by digital examination are assessed prior to induction in high-risk cases according to standard protocol. Result In our study, both transvaginal cervical length and bishop score showed similar predictors of successful labor induction, i.e., vaginal delivery. The ROC curve for cervical length showed an optimal cut-off value of ≤ 32 mm, corresponding to a sensitivity of 64.2% and a specificity of 60.0%, whereas the optimal cut-off value for Bishop score was ≥ 5, with a sensitivity of 65.1% and a specificity of 62.0%. However, cervical width and the presence of cervical funneling did not correlate. Both cervical length and Bishop score had a significant correlation as predictors of successful induction, with an OR of 0.93 (95% CI 0.91-0.96), an AOR of 0.96 (955 CI 0.9-0.99), and an OR of 1.41 (95% CI 1.2-1.6) and an AOR 1.2 (95% CI 1.1-1.5), respectively. Conclusion Cervical length and bishop score are both good and equally predict of successful induction of labor.

The risk of cognitive decline and dementia in older adults diagnosed with COVID-19: A systematic review and meta-analysis.

BACKGROUND: Cognitive impairment can be caused by infections with various pathogens, including SARS-CoV-2. Research has yet to determine the true incidence and course of cognitive impairment in older adults following COVID-19. Furthermore, research has theorised that COVID-19 is associated with dementia progression and diagnosis but this association has yet to be fully described. METHODS: A systematic review was registered in Prospero and conducted on the databases PubMed, Embase, Ovid, CENTRAL and Cochrane Library. Studies reporting cognitive impairment and dementia outcomes in post-acute and post-COVID-19 patients aged ≥65 years, and which included control data, were included in this review. RESULTS: 15,124 articles were identified by the search strategy. After eliminating duplicate titles and completing title, abstracts and full-text review, 18 studies were included comprising of 412,957 patients with COVID-19 (46.63 % male) and 411,929 patients without COVID-19 (46.59 % male). The overall mean Montreal Cognitive Assessment (MoCA) score in COVID-19 patients was 23.34 out of 30 (95 % CI [22.24, 24.43]). indicating cognitive impairment. The overall proportion of patients identified as having new onset cognitive impairment was 65 % (95 % CI [44,81]). Subgroup analyses indicated that time since infection significantly improves overall MoCA score and reduces proportion of patients with cognitive impairment. CONCLUSION: This study indicates that cognitive impairment may be an important sequela of COVID-19. Further research with adequate sample sizes is warranted regarding COVID-19's association with new-onset dementia and dementia progression, and the effect of repeat infections. There is a need for development of diagnostic and management protocols for COVID-19 patients with cognitive impairment.

How lignin biosynthesis responds to nitrogen in plants: a scoping review.

Nitrogen (N) plays a critical role in the functioning of key amino acids and synthetic enzymes responsible for the various stages of lignin biosynthesis. However, the precise mechanisms through which N influences lignin biosynthesis have not been fully elucidated. This scoping review explores how lignin biosynthesis responds to N in plants. A systematic search of the literature in several databases was conducted using relevant keywords. Only 44 of the 1842 selected studies contained a range of plant species, experimental conditions, and research approaches. Lignin content, structure, and biosynthetic pathways in response to N are discussed, and possible response mechanisms of lignin under low N are proposed. Among the selected studies, 64.52% of the studies reter to lignin content found a negative correlation between N availability and lignin content. Usually, high N decreases the lignin content, delays cell lignification, increases p-hydroxyphenyl propane (H) monomer content, and regulates lignin synthesis through the expression of key genes (PAL, 4CL, CCR, CAD, COMT, LAC, and POD) encoding miRNAs and transcription factors (e.g., MYB, bHLH). N deficiency enhances lignin synthesis through the accumulation of phenylpropanoids, phenolics, and soluble carbohydrates, and indirect changes in phytohormones, secondary metabolites, etc. This review provides new insights and important references for future studies on the regulation of lignin biosynthesis.

Paradigm shift towards emergency cholecystectomy: one site experience of the Chole-QuiC process.

INTRODUCTION: Substantial evidence exists for the superiority of emergency over delayed cholecystectomy for gallstone disease during primary admission. Despite this, emergency surgery rates in the UK remain low compared with other developed countries, with great variation in care across the nation. We aimed to describe the local paradigm shift towards emergency surgery and investigate outcomes. METHODS: This is a prospective observational study examining patients enrolled onto an emergency cholecystectomy pathway, following the hospital's subscription to the Royal College of Surgeons of England's Cholecystectomy Quality Improvement Collaborative (Chole-QuIC), between 1 December 2021 and 31 January 2023. Multivariate logistical regression models were used to identify patient and hospital factors associated with postoperative outcomes. RESULTS: Of the 307 suitable acute admissions, 261 (85%) had an emergency cholecystectomy, compared with 5% preceding the Chole-QuIC interventions. Waiting time dropped from 67 to 5 days. A total of 208 (79.7%) patients were primary presentations, 92 (35.2%) were classed Tokyo grade 2 and 142 (54.4%) were obese. A total of 23 (8.8%) patients underwent preoperative endoscopic retrograde cholangiopancreatography, and 26 (10%) patients had a subtotal cholecystectomy. Favourable outcomes (Clavien Dindo ≥3) were observed in first presentations (odds ratio (OR) 0.35; p=0.042) and for operation times within 7 days (OR 0.32; p=0.037), with worse outcomes in BMI ≥35 (OR 3.32; p=0.005) and operation time >7 days (OR 3.11; p=0.037). CONCLUSION: A paradigm shift towards emergency cholecystectomy benefits both the patient and the service. Positive outcomes are apparent for early operation in patients presenting for the first time and recurrent attendees, with early operation (<7 days) providing the most favourable outcome in a select patient group.

Pyrexia in Pregnancy and its Maternal and Fetal Outcome.

Background Contemporary obstetrics has witnessed improved maternal and fetal outcomes, owing to several advances. Any source of maternal hyperthermia that results in significant core temperature increase (> 38°C), could potentially affect the fetus. Fetus being an integral part of the feto-maternal unit and pregnancy involving numerous physiological changes and adaptations, pyrexia during the pregnancy affects both the mother and her fetus adversely. Objective To find the etiology and prevalence of fever in pregnancy and to know the effect of fever on maternal and fetal outcome. Method Pregnant ladies with fever > 38°C, presenting to Obstetrics and Gynecology, Department of Dhulikhel Hospital were enrolled in the study. A detailed clinical history, thorough general and physical examinations were done. All risk factors were asked and recorded including all baseline investigations and cases were followed up till delivery. Maternal and fetal outcomes were recorded. Data were recorded in Excel and calculated using SPSS 26. Result Eighty patients presented with complaints of fever were included in this study. The mean age of the patient was 25.49± 4.50 years. Out of 80 patients, 46 (57.50%) presented with fever in the third trimester. The most common etiology of fever being urinary tract infection in 21 (26%) cases followed by respiratory tract infection in 20 (25.1%) cases. Twenty two newborns had low birth weight among which 12 (15%) neonates had IUGR. About 14 (17.5%) neonates were admitted in NICU due to various complications and perinatal mortality was in 9 (11.25%) cases. The most common antepartum complication was preterm labor in 16 (20%) cases. Conclusion Fever in pregnancy is still a challenge to obstetrician and the society at large due its problems related to its prevention, diagnosis, management and its feto-maternal outcome. Hence, an evaluation of the effect and outcomes of fever in pregnancy, provides definite knowledge of clinical epidemiology, and facilitates optimum prioritization of efforts and resources.

Does gender influence retrograde intrarenal surgery (RIRS) outcomes? Data from the Flexible Ureteroscopy Outcomes Registry (FLEXOR).

INTRODUCTION AND OBJECTIVES: As well established flexible ureteroscopy (RIRS). There is still no evidence if gender can have any influence on the outcomes and complication when performing. This study aims to evaluate the role that gender has in performing flexible ureteroscopy from a large series of patients. METHODS: This study retrospectively analyzed patients who underwent RIRS for renal stones from January 2018 to August 2021 within the multicentric FLEXOR registry. Demographics, stone characteristics, perioperative findings, results and complications were analyzed and compared between gender groups. RESULTS: A total of 6669 patients were included, 66.1% were male and 33.9% were female. Stone characteristics was comparable between groups. Female patients had significant higher fever and positive urine culture rates (12% vs. 8% and 37% vs. 34%). Also, females had a slight longer hospital stay (3.8 vs. 3.5 days; P < 0.001) and more residual fragments after the procedure (23.03% vs. 20.97 (P = 0.032). Overall complications were slightly significantly higher in women (15.74% vs. 14% (P = 0.042)) mainly at the expense of fever rates (6.9% vs. 5.7%) whereas the risk of sepsis was similar in both groups. A multivariate analysis showed that larger stone size, multiple and lower pole stones seem to have a negative impact in the incidence of residual stones and complications. CONCLUSION: Our real life global study reflects that female gender may have a correlation with a slightly increased residual fragment rate and overall low grade complications. However, women can safely be treated with RIRS with no increased the rate of sepsis with appropriate care.

Association of Waist Circumference and Body Mass Index among the Students of a Medical College.

Background Obesity and overweight have emerged as significant public health concerns on a global scale. In the pursuit of evaluating body composition and identifying potential health risks, two widely utilized measures are Body Mass Index and waist circumference. These anthropometric indicators are considered economical, practical, and also crucial for screening, monitoring the individual's nutritional status, and anticipating future disease risk. Objective To explore the correlation between waist circumference and Body Mass Index and find out its significance as indicators of health and nutritional status in young adults. Method The study comprises 260 healthy young adults, aged 18-25 years from pre-clinical sciences, Kathmandu University School of Medical Sciences (KUSMS). Anthropometric measurements of height (m), weight (kg), and waist circumference (cm) were recorded. Body Mass Index was calculated by using the formula as body weight (kg) divided by the square of body height (m2). Demographic factors such as age, sex, obesity, and life style factors like smoking, alcohol consumption, and physical activity were noted. Result The study found a positive correlation between Body Mass Index, waist circumference (WC) and weight. However, no association was found between waist circumference and height. The findings also indicated a notably high percentage of 17.69% participants, who were categorized as overweight, while a 9.23% fell into the underweight category. The study confirms that 83.08% of the students have moderate physical activity whereas 14.62% have insufficient and 2.31% have heavy physical activity. Conclusion The study shows a positive correlation between body mass index (BMI) and waist circumference (WC) in young adults aged 18-25 years.

Morphometric Study on Wormian Bone of Dry Adult Skull of Nepalese Population.

Background Accessory (supernumerary bone) is small irregular worm like bone. These bones are also known as wormian bone. Accessory bone develops when additional ossification centers appear and form extra bones. Many bones develop from several ossification centers of ossification and these separate parts normally fuse. Sometimes one of these centers fails to fuse with main bone. Circumscribed areas of bone are seen along the sutures of the cranium where flat bones about, particularly related to parietal bone. Objective To investigate presence and to determine morphologic and morphometric characteristics of wormian (sutural) bones. Method The study was conducted on 25 dry human skulls with unknown gender, ethnicity and race in Department of Anatomy, School of Basic Sciences, Kailashnagar, Bharatpur-5, Chitwan Nepal. The study was conducted on 25 dry human skulls with unknown gender, ethnicity and race in Department of Anatomy, School of Basic Sciences, Kailashnagar, Bharatpur-5, Chitwan Nepal. The deformed skull and skull of pediatrics age group are excluded. The location, shape, number and side of Wormian bone are determined. The SPSS 20 program and descriptive statistical method analysis were used for data analysis. Result Total 25 adult dry skulls were observed in the study. Both sides of skull were observed. Out of 25 skulls Wormian bones are not found in left sided three lambdoidal suture (four percent). Conclusion The knowledge of Wormian bones plays a major role for the neurosurgeons, neuroanatomists, radiologists, forensic experts and anthropologist. Presence of few bones are normal. But multiple Wormian bones need attention as it may have underlying skeletal or central nervous system pathology. In radiographs they mimic fracture lines. Wormian bone at pterion may produce complications in neurosurgical procedures like burr holes.

Acute Kidney Injury Secondary to Rhabdomyolysis Due to Wasp Bite.

Wasp and bee bites have been well known to cause effects in the human body ranging from minor local skin reactions to deadly anaphylactic reactions. They have also been known to disrupt kidney functions or cause liver injury. The kidney injury associated with wasp bite is a well-known phenomenon, but it is still very rare. We report a case of a 74-year-old man who developed rhabdomyolysis and acute kidney injury, three days after he was bitten by wasp. His symptoms improved after nine days of hospital admission, where he received fluid resuscitation and hemodialysis sessions. This report aims to educate clinicians about the diverse effects of wasp bite for timely diagnosis and management.

Clinical Profile and Knowledge, Attitude and Practice of Patients Presenting with Headache.

Background Headache disorders are among the most prevalent and disabling conditions worldwide. People, however, do not seek early advice in developing countries. Objective To study clinical profile of patients with headache and their existing knowledge, attitude, and practice regarding primary headaches. Method Descriptive cross-sectional study conducted among 196 patients. Patients were selected using purposive sampling technique fulfilling inclusion criteria. Patients were interviewed based on semi-structural headache questionnaire and data was collected from 4th October to 21st December 2021. Descriptive statistics was used for analysis and interpretation. Result Among 196 participants, 74% were females, 29.6% of patients were between (31 to 40) years of age. The majority were Hindu and belongs to province 3; 36.7% were homemakers, and 32.2% were literate. Migraine headache was the most common type with 14.3% reporting aura. Most reported headache within 1 to 5 years. The commonest triggers were sunlight 64.8%, crowd 54.7%, stress 39.8%, fasting state 31.7%, cold 26.3%. Almost 39% believed that headache could be a chronic neurologic disorder. Majority had knowledge of the causes, triggers, and the relieving factors. Fifty-five percent seek help of a doctor for first time, and the rest seek help of a pharmacist or self-medication. Only 19% tried to manage the headache triggers; 66.8% felt that lifestyle modification is the best treatment for headache comparing drugs. Conclusion Migraine headache was the commonest headache occurring at middle age group with sunlight being the most common trigger factor. Lifestyle modification was perceived to be the best for headache management.

Solyx Minisling Surgery for Stress Urinary Incontinence: Dhulikhel Hospital Initiative.

Solyx mini-sling surgery is a single-incision procedure that is used to treat stress urinary incontinence (SUI) in women. SUI is a common medical condition characterized by the involuntary leakage of urine with activity such as laughing, coughing, and sneezing. It affects 35% of adult women worldwide. The Solyx sling is a minimally invasive procedure that can be performed through a single vaginal incision. It is a safe and effective treatment for SUI, with a high success rate. The mini-sling is inserted through a small, single incision in the vagina. This makes the procedure less invasive than traditional sling surgery, which requires a larger incision in the abdomen or groin. The Solyx mini sling is also adjustable, which means that the surgeon can make adjustments to the tension of the sling after it is inserted. This helps to ensure that the sling is properly positioned and that the patient experiences optimal results. We have performed Solyx minisling surgery in 182 women and we found it very effective. 96% of women had no leakage of urine while coughing, sneezing after one week of surgery. We have performed this surgery in rural areas of Nepal where there is no facility of cystoscopy.

A rare case of silicosis with hepatitis B infection.

Introduction: Silicosis is a type of diffuse interstitial lung disease caused by inhalation of crystalline silicon dioxide. The number of silicosis cases have been rapidly increasing over the years. Complete cure is not possible so early diagnosis and prevention is required. Case presentation: Our patient came with chief complaints of productive cough, breathlessness progressing to MRC grade 4 and fever. He worked in a flour mill for 15 years and has been symptomatic for the past 4-5 years. Chest examination showed tracheal deviation to the right, bilateral decreased breath sounds and fine crepitations. Chest X ray showed multiple tiny nodular opacities in all lung zones. Pulmonary function test confirmed restrictive lung disease. On CT scan, miliary mottled densities were noted bilaterally along with fibrosis in upper lobes and ground glass appearance in lower lobes. Echocardiography revealed mild pericardial effusion and Abdominal Ultrasound revealed coarse liver texture, splenomegaly and right sided pleural effusion. Patient was also Hepatitis B positive.Patient was treated with Prednisolone, Entecavir, Moxaclav along with symptomatic management. Discussion: Male gender, HIV infection, Smoking, Occupation, Age at first exposure, Duration of exposure and Concentration of inhaled silica dust are the risk factors of silicosis. Individuals with Silicosis are at high risk of developing Tuberculosis and Hepatitis B infection. Pulmonary function test, HRCT and Lung biopsies help in diagnosis of Silicosis. Serological markers and Liver Function Test helps in diagnosis of Hepatitis B infection. Early diagnosis and prevention is essential for better prognosis and Lung transplant is the only definitive management. Complications like progressive fibrosis, infections, cor pulmonale and pneumothorax may result due to Silicosis. Conclusion: Silicosis is a rare chronic inflammatory condition which leads to an immunosuppressed state and may predispose individuals to opportunistic conditions like Hepatitis B. Therefore, early identification of risk factors and clinical features is required.

Drug Utilization Study in Outpatient Department of Ophthalmology in Tertiary Care Hospital.

Background The advancement in drug development and availability of newer drugs has improved overall health services including decrease in mortality and hospital stay. Along, it has brought negative impacts such as polypharmacy and associated adverse drug reactions and antimicrobial resistance. Drug utilization research is an essential approach to understand the drug use pattern, identify the early signs of such irrational drug use and to improve quality of drug use. Objective To study the drug utilization pattern in the Ophthalmology Outpatient department (OPD) of Dhulikhel Hospital, Kathmandu University Hospital (DH-KUH). Method A descriptive, cross sectional study was conducted from March 2019 to August 2019 in patients attending OPD of Ophthalmology in Dhulikhel Hospital, Kathmandu University Hospital. Prescriptions of 311 patients were analyzed using World Health Organization (WHO) International Network of Rational Use of Drug (INRUD) and additional other indices. The descriptive data was presented in mean and standard deviation. Result The average number of drugs per prescription was 2.10±1.35. Out of total 311 prescriptions, drugs prescribed in generic name were 152 (23.30%). Total antibiotics encountered were 247 (37.90%) and total drugs prescribed from National Essential Medicine List (NEML) were 371 (56.90%). Antibiotics 247 (37.90%) were the most commonly prescribed drugs followed by lubricants 146 (22.40%). Conclusion Practice of polypharmacy was very high. Most of the drugs were prescribed in brand names and antibiotics were the most frequently used drugs.

Oral Solid Dosage form Modification in Community Pharmacies of Kavrepalanchok and Bhaktapur Districts of Nepal.

Background People may modify their oral solid dosage form of medicine to deal with problem faced during medicine administration. The modification of dosage form may adversely affect the quality, safety and efficacy of the medicine. Objective To investigate the causes and practices of oral solid dosage form modification among the consumers going to community pharmacies. Method A descriptive, cross-sectional study was conducted in five community pharmacies of Kavrepalanchok and Bhaktapur districts of Nepal. The consumers visiting these pharmacies for their oral solid dosage form of medicine were invited to participate in interview using structured questionnaire. Result Among 419 participants,13.6% of participants reported having problem of taking intact medicine. Most of them (12.4% of total participants) experienced difficulty swallowing the medicine. The swallowing difficulty is significantly associated with age and sex (p < 0.05). Around one third (36.8%) of participant with medicine administration problem modified the dosage form of medicines. One quarter of medicine dosage form modifications (25.0%) were inappropriate. Medicine dosage form modification is associated with age and number of daily medicine intake (p < 0.05). Among participants modifying dosage form of medicines, 66.7% were advised to do so mainly by family and friends; 33.3% were modifying on their own and 76.2% were unaware of possible effects of medicine dosage form modification. About 62.3% of total participants were never asked about any problems on taking medicines by doctor/pharmacists. Conclusion Difficulty swallowing medicines and medicine dosage form modification were prevalent in the Nepalese population. Medicine dosage form modifications also involved inappropriate modifications due to specialized design of such dosage forms. So, it seems important to provide proper counseling while dispensing such dosage forms.

Impact of Albendazole Therapy on Clinical and Radiological Outcomes at One Month in Patients with Active Solitary Neurocysticercosis Patients.

Background Cerebral neurocysticerosis is a common parasitic disease of human nervous system but evidence on duration of albendazole therapy and their outcomes in this condition is inadequate Objective To evaluate the impact of varying duration of albendazole therapy on the clinical and radiological outcomes at one month in patients with active solitary neurocysticercosis. Method This is an interventional study conducted at Upendra Devkota Memorial National Institute of Neurological and Allied sciences, Bansbari over 1 year (2017 March - 2018 February). One hundred eighteen patients with new onset seizure secondary to active solitary cysticercal granuloma either received albendazole therapy for 1, 3, 9 or 21 days with the usual care or only received the usual care. Clinical and radiological outcomes were observed at one month follow-up. The difference in the proportion of the outcome measures between intervention and control groups were assessed using chi-square test. Result Our study included 118 patients with male predominance of 61.9%. Albendazole therapy for 3, 9 and 21 days reduced headache by 57.2%, 70.0% and 63.1% respectively which was higher than those with 1-day therapy or without the therapy. This difference in the proportion was statistically significant at p=0.001. Though seizure recurrence also declined but the difference was not significant (p=0.406) between groups. However, at one-month follow-up, majority of patients who received albendazole for 9 days (14, 70%) and 21 days (14, 73.7%) had normal lesion, while most calcified lesion (21, 67.7%) was observed in those who did not receive albendazole therapy. The difference between lesion among the groups was significant (p < 0.001). Conclusion Albendazole therapy in patients with active solitary neurocysticercosis for 9 days is as effective as 21 days and better than 3 days in headache control and lesion dissolution but seizure control could be achieved irrespective of the treatment.