Mental Health Status of Migrant Nepalese Workers Rescued By Government of Nepal During the Corona Virus disease -19 Pandemic.

BACKGROUND: The corona virus pandemic rapidly sweeps across the world; it is inducing a considerable degree of depression, stress and anxiety concern in the population at large and among certain groups in particular, such as migrant workers. The aim of the study is to find out mental health status of migrant workers rescued by Nepal Government from different countries during corona virus disease -19-19 pandemic. METHODS: Cross-sectional descriptive study involving 427 returned migrant workers was conducted using the depression, anxiety and stress scale -21(DASS-21). Association between socio-demographic variables to mental health status was performed using chi-square test and p-value <0.05 was considered as significant level. RESULTS: Out of 427 participants, 4 % of respondents found to have extremely severe level of stress followed by 1.9 % extremely severe level of depression and 2.3% extremely severe level of anxiety. The association between mental health status and covariates showed that depression, anxiety and stress were associated with the place of residence, educational status of the respondents, and their perception of corona virus disease -19 risk at workplace, and test for COVID-19 after arrival to Nepal. CONCLUSIONS: The study revealed that job loss, visa and employment contract expiry were the main reasons for migrant workers to return Nepal. Nearly one fourth of the respondents had suffered from depression, nearly one third from stress and 17% from anxiety. Necessary psychosocial interventions should be formulated and implemented for addressing the mental health problems of migrant workers during the corona virus disease -19-19 pandemic.

The Impact of Basic Police Training and Scale Diet on Body Composition and Aerobic Performance of Nepal Police Officers Trainees.

INTRODUCTION: Executing their daily duties, police officers are expected to perform complex, physically demanding activities, often at maximal levels of exertion. Given these criteria, training must be rigorous enough to ensure that when trainees graduate, they are competent in their response to crisis and flexible enough to sustain this for the span of their career. The present study aimed to determine the impact of scale diet and physical training (SDPT) on body composition and aerobic performance among Nepal police officer trainees. METHOD: We conducted a cross-sectional analytic study among 570 Nepal Police recruits from Nepal Police Academy of Butwal and Kathmandu. Null hypothesis was created followed by an alternative hypothesis. Alpha (1 - ?) for the above-mentioned study design were set. Parametric statistical analysis was done with criteria set for acceptance or rejection of the null hypothesis. We collected the data from the field as per Nepal police basic exercise and diet  protocol to determine the effect of physical training and scale diet on body composition and aerobic performance. We enrolled all the recruits  from March to May, 2019 who met the eligibility criteria in the study. We used Microsoft Excel 2013 for data entry and R program (version: 4.0.3) for statistical analysis.  Results:There was a significant rise in aerobic performance (4.51 ± 3.39 ml/kg/min) and remarkable reduction in body fat (-4.49 ± 2.33 %) and Body Mass Index (-0.433 ± 1.00 kg/m2) after SDPT among participants with normal BMI at the time of recruitment. Body fat was significantly reduced (-4.36 ± 2.3%) and aerobic performance was significantly increased (6.93±4.70 ml/kg/min) among overweight participants at the time of recruitment. CONCLUSIONS: The methodology adopted in the physical training of Nepal Police was effective in reducing body mass index and fat, improving the physical capacity. .   Key words: Scale Diet; Physical Training, Body Fat; Aerobic Performance; VO2max, Body Mass Index.

Plasma Vitamin B-12 Levels and Risk of Alzheimer's Disease: A Case-Control Study.

INTRODUCTION: Vitamin B-12 deficiency is a frequent condition in the elderly population. High homocysteine levels, which can contribute to arterial damage and blood clots in blood vessels, usually indicate a deficiency in vitamin B-12. Different studies have shown an association of raised total homocysteine with incident Alzheimer's disease. This study aimed to evaluate the association between vitamin B-12 levels and the risk of Alzheimer's disease (AD). METHODS: A case-control study with a sample size of 90 was conducted at Tertiary hospital, Kathmandu. The participants who visited the psychiatric outpatient department from 2019 onward at Tertiary hospital, Kathmandu, were recruited. The Mini-Mental State Examination (MMSE) was administered to the participants by a trained medical doctor. The medical doctor used the MMSE scores to classify the participants into two groups: the healthy control group and the AD group. RESULTS: The AD group had higher percentages of hypertension (20.9%), diabetes (13.6%), smoking habit (27.3%), vitamin B-12 deficiency (22.7%), and alcohol consumption (13.8%) relative to the control group. Among these features, a significant association was found between alcohol and vitamin B-12 status and between systolic blood pressure and MMSE score. CONCLUSION: This study concluded that there is an association between low levels of vitamin B-12 and the risk of AD. Further studies are needed to determine the cause-effect.

Potential Novel Modules and Hub Genes as Prognostic Candidates of Thyroid Cancer by Weighted Gene Co-Expression Network Analysis.

BACKGROUND: Although thyroid cancer (THCA) is one of the most common type of endocrine malignancy, its highly complex molecular mechanisms of carcinogenesis are not completely known. MATERIALS AND METHODS: In this study, weighted gene co-expression network analysis (WGCNA) was utilized to construct gene co-expression networks and evaluate the relations between modules and clinical traits to identify potential prognostic biomarkers for THCA patients. RNA-seq data and clinical data were downloaded from The Cancer Genome Atlas (TCGA). Other independent datasets from the Gene Expression Omnibus (GEO) database and the Human Protein Atlas database were performed to validate findings. RESULTS: Finally, 11 co-expression modules were constructed and four hub genes, CCDC146, SLC4A4, TDRD9 and MUM1L1, were identified and validated statistically, which were considerably interrelated to worse survival of THCA patients. CONCLUSION: This research study revealed four hub genes may be considered candidate prognostic biomarkers and potential therapeutic targets for THCA patients in the future.

Status of COVID-19 Patients and Associated Stigma After Discharge from Designated Health Facilities of Kathmandu Valley: A Telephonic Survey.

BACKGROUND: COVID-19 is a highly contagious viral disease. The anxiety, misinformation about COVID-19, and the fear of being infected by the virus have led to widespread stigma in local communities. Thus, we conducted a study to evaluate the status of patients and disease-associated stigma of patients who recovered from COVID-19. METHODS: Status of discharged/ improved COVID-19 individuals were followed after their discharge within 2 months after COVID-19 status through telephonic interview. Data of interview was recorded in excel sheets, which was imported in Stata v. 15. Simple descriptive analysis performed and finding presented in appropriate tabulation. Further binomial logistic regression analysis was performed for post-treatment stigmatization. RESULTS: Among 365 case details retrieved, 262 cases contained contact details. Among them, 221 total phone calls were made, of which only 94 could reach for phone interview. 50 (53.19%) were male; 59 (62.77%) were married; and 85 (90.43%) were Hinduism by religion. Majority (n=74, 78.72%) were asymptomatic. The average hospital/isolation stay of patients was 11.23±4.75 days. Among interviewed individuals, 24 (25.81%) reported some type of stigmatization. Individuals with comorbidities and tested for travel purpose has less chance of stigmatization comparing than others. Higher the age in years and longer the duration of hospital/isolation stay; higher the odds of having stigmatization. CONCLUSIONS: High level of stigma was seen among COVID-19 survivors. The stigma associated with COVID-19 was shown to increase with age and length of hospital stay while the stigma decreased with the presence of co-morbidities and was tested for travel purposes.

Prevalence of Anemia in Adolescent Girls attending Specific Schools of Kavrepalanchok, Nepal.

INTRODUCTION: Adolescents comprise individuals in the age group 10 to 19 who are undergoing a period of gradual transition of growth and development. Adolescent girls are at high risk of anemia and malnutrition. This research has been aimed to find the prevalence of anemia in adolescent girls attending specific schools of Panchkhal municipality in Kavrepalanchowk in Nepal. METHODS: A descriptive cross-sectional study was conducted in one government and one private school of Panchkhal Municipality of Kavre district in adolescent girls of age 10 to 19 from December 2017 to April 2018 attending grade five till ten in the field practice area of a medical college. After ethical approval, anthropometric measurements of height, weight, and blood were taken for hemoglobin estimation. Descriptive analysis was done in Microsoft excel 2016. RESULTS: Out of 95 adolescent girls, fourteen (14.74%) adolescent girls were anemic. The mean age was 13.35±1.629 years, mean height and weight were 1.58m and 44.11kg, respectively. CONCLUSIONS: This study shows a lower prevalence of anemia than reported by national data, but it is higher than that reported by developed countries. Anemia and undernutrition have long terms detrimental effects on adolescent girls, so health education and prevention is necessary.

Mobile Swab Collection Vehicle; a Blend of Necessity, Innovation, and Technology in a Resource-poor Country.

Mobile Swab Collection Vehicle is a concept that has been innovated by a team of medical and non-medical personals based upon the dire need to perform throat or nasopharyngeal swab collections to do reverse transcription polymerase chain reaction  'RT-PCR' quickly, safely, and comfortably during this Corona Virus Diseases 2019, 'COVID-19' pandemic in a resource-poor country like Nepal. Inputs from the health care workers, beneficiaries, and engineers have been taken to construct this vehicle-mounted booth for swab collection. This vehicle is the 'first of its kind' in Nepal. Keywords: COVID-19; Nepal; swab collection vehicle.

Status of self-esteem in medical students at a college in Kathmandu: A descriptive cross-sectional study.

Background: Self-esteem is vital to living a happy, confident and content life. Medical students experience various forms of stress due to academic, financial and social pressures which could affect their levels of self-esteem. This study aims to study the status of self-esteem among undergraduates of a medical college at Tribhuvan University, Nepal. Methods: After receiving the ethical approval from the Institutional Review Committee (IRC) of NAIHS; we conducted a descriptive cross-sectional study among the first- to fifth-year medical students from December 2020 to April 2021. 190 were selected for the study using a stratified random sampling technique. This study used the Rosenberg self-esteem scale to measure self-esteem of the participants. A Google Forms questionnaire was sent to the participants via email. Then, the data obtained were entered in the Google sheet and later analyzed using SPSS 27. A Chi-square test was used to identify potential differences in self-esteem scores among different variables. A p-value of < 0.05 was considered statistically significant.  Results: This study included a total of 180 participants, among which, 18.9% (13.19% to 24.61%; at 95% CI) students showed low self -esteem. 74.4% (68.02% to 80.78%; at 95% CI) students had normal self-esteem and 6.7% (3.05% to 10.35%; at 95% CI) students had high self-esteem. The mean self-esteem score was 19.19 (15.01 to 23.37; at 95% CI). Female participants suffered more than males from low self-esteem, and third-year students had the highest percentage of low self-esteem (30.77%). Conclusion: The majority (74.4%) of medical students had normal self-esteem. However, 18.9% students had low self-esteem, among which, third-year students suffered the most (30.77%). Likewise, females exhibited higher prevalence of low self-esteem compared to males. Interventions to boost the level of self-esteem should be carried out to help medical students become confident and efficient doctors.

Development and validation of a novel survival model for head and neck squamous cell carcinoma based on autophagy-related genes.

BACKGROUND: In view of the critical role of autophagy-related genes (ARGs) in the pathogenesis of various diseases including cancer, this study aims to identify and evaluate the potential value of ARGs in head and neck squamous cell carcinoma (HNSCC). METHODS: RNA sequencing and clinical data in The Cancer Genome Atlas (TCGA) were analyzed by univariate Cox regression analysis and Lasso Cox regression analysis model established a novel 13- autophagy related prognostic genes, which were used to build a prognostic risk model. A multivariate Cox proportional regression model and the survival analysis were used to evaluate the prognostic risk model. Moreover, the efficiency of prognostic risk model was tested by receiver operating characteristic (ROC) curve analysis based on data from TCGA database and Gene Expression Omnibus (GEO). Besides, the other independent datasets from Human Protein Atlas dataset (HPA) also applied. RESULTS: 13 ARGs (GABARAPL1, ITGA3, USP10, ST13, MAPK9, PRKN, FADD, IKBKB, ITPR1, TP73, MAP2K7, CDKN2A, and EEF2K) with prognostic value were identified in HNSCC patients. Subsequently, a prognostic risk model was established based on 13 ARGs, and significantly stratified HNSCC patients into high- and low-risk groups in terms of overall survival (OS) (HR = 0.379，95% CI: 0.289-0.495, p < 0.0001). The multivariate Cox analysis revealed that this model was an independent prognostic factor (HR = 1.506, 95% CI = 1.330-1.706, P < 0.001). The areas under the ROC curves (AUC) were significant for both the TCGA and GEO, with AUC of 0.685 and 0.928 respectively. Functional annotation revealed that model significantly enriched in many critical pathways correlated with tumorigenesis, including the p53 pathway, IL2 STAT5 signaling, TGF beta signaling, PI3K Ak mTOR signaling by gene set variation analysis (GSVA) and gene set enrichment analysis (GSEA). In addition, we developed a nomogram shown some clinical net could be used as a reference for clinical decision-making. CONCLUSIONS: Collectively, we developed and validated a novel robust 13-gene signatures for HNSCC prognosis prediction. The 13 ARGs could serve as an independent and reliable prognostic biomarkers and therapeutic targets for the HNSCC patients.

Psychological distress in Nepalese residents during COVID-19 pandemic: a community level survey.

BACKGROUND: COVID-19 pandemic has created unprecedented health and economic impact. Psychological stress, anxiety and depression are affecting not only COVID-19 patients but also health professionals, and general population. Fear of contracting COVID-19, forced restrictive social measures, and economic hardship are causing mental trauma. Nepal is a developing country from South Asia where the COVID-19 pandemic is still evolving. This online survey has been carried out to understand impact of COVID- 19 on mental health of Nepalese community dwellers. METHODS: The COVID-19 Peritraumatic Distress Index (CPDI) questionnaire adapted from the Shanghai Mental Health Centre was used for online data collection from 11 April-17 May 2020. Collected data were extracted to Microsoft excel-13 and imported and analyzed using SPSS (Statistical Package for Social Sciences) version-22. An initial univariate analysis was conducted for all variables to assess the distribution. Logistic regression analyses were done to estimate the odds ratios of relevant predicting variables. RESULTS: A total of 410 participants completed the self-rated questionnaires. Mean age of study participants was 34.8 ± 11.7 years with male preponderance. 88.5% of the respondents were not in distress (score less than 28) while, 11% had mild to moderate distress and 0.5% had severe distress. The prevalence of distress is higher among age group > 45 years, female gender, and post-secondary education group. Health professional were more likely to get distressed. Respondents with post-secondary education had higher odds (OR = 3.32; p = 0.020) of developing distress as compared to respondents with secondary education or lower. CONCLUSION: There is lower rate of psychological distress in city dwellers and people with low education. Adequate intervention and evaluation into mental health awareness, and psychosocial support focused primarily on health care workers, female and elderly individuals is necessary.

Air Medical Evacuation of Nepalese Citizen During Epidemic of COVID-19 from Wuhan to Nepal.

In December 2019, the world was disrupted by the news of a new strain of virus known as Novel Corona virus, taking lives of many in China. Wuhan, the capital of Central China's Hubei province is said to be the place where the outbreak started. The city went on a lockdown as the disease spread rapidly. After the lockdown, most countries like India and Bangladesh airlifted their citizens who were studying in Wuhan. Similarly, Nepal also has many youth studying medicine in Wuhan. Pleas for help from the students reached the government. This was a first encounter of such experience for Nepal government. With the help of Health Emergency Organizing committee, Epidemiology and Disease Control Division, Nepal Army Hospital, Nepal Police Hospital, Waste Management team, Nepal Ambulance service, Tribhuwan Airport and Royal Airlines the government of Nepal planned, organized and successfully brought back all the 175 students on 15 the February, 2019 from Wuhan, China. The aim of the present article is to share the experience, the challenges faced and recommendations for future similar cases. Keywords: evacuation; Nepal; Novel Corona virus; Wuhan.

Outbreak Investigation Following the 2015 Earthquake Disaster in Nepal.

BACKGROUND: Infectious disease outbreaks following natural disasters are reported in literature. Outbreaks were documented following natural disasters in many countries including Haiti. Such possibility following 2015 Nepal earthquake was a public health concern. Risk factors needed evaluation by post-disaster outbreak investigation. Hence, present study was undertaken to investigate potentials for such outbreak and to generate evidence for public health intervention. METHODS: The study was conducted between April - May, 2015, with the cooperation of National Public Health Laboratory, Epidemiology and Disease Control Division, Nepal Health Research Council and the Chinese team. Rapid Response Teams visited earthquake affected districts and collected samples for analysis. Syndromic surveillance approach was followed. Samples were collected from syndromic patients under supervision. Those sick prior to earthquake or receiving treatment were excluded. Blood, stool and throat swab samples, as indicated, were collected. Drinking water and food samples including captured live mosquitoes from inhabited areas were obtained for study with the help of EDCD. Laboratory analysis was performed at the NPHL. RESULTS: Total samples were 360 (114 biological, 246 environmental). Salmonella spp. was detected in two and Varicella zoster in one blood sample. Influenza B virus was detected in one throat swab. Rota virus was detected in two, Shigella dysenteriae in one and Salmonella spp. in one stool sample. No pathogen detected in water or food samples. Mosquitoes tested negative for dengue virus. CONCLUSIONS: Post-earthquake outbreak investigated in disaster phase-2. Diarrheal, enteric fever pathogens and Influenza B virus were detected. Environmental samples tested negative for pathogens. Vigilance is necessary for other risk factors.

Type 2 Diabetes and Its correlates: A Cross Sectional Study in a Tertiary Hospital of Nepal.

Type 2 diabetes mellitus (T2DM) is an emerging global health problem in Nepal. However, there is still a paucity of information on its burden and its risk factors among service users from a hospital based setting. This is a cross sectional study conducted among the service users of diabetes clinic in Tribhuvan University Teaching Hospital of Nepal. A sample size of 154 was selected systematically from the patient registration from 30th July to 16th August, 2013. Of the 154 participants, 42.85 % had T2DM. Higher mean body mass index (26.50 ± 5.05 kg/m2) and waist circumference (92.47 ± 11.30 cm) was found among the individuals with T2DM and, compared to those without diabetes (Body mass index 25.13 ± 4.28 kg/m2: waist circumference 88.91 ± 12.30 cm) (P = 0.013). In further analysis, the sedentary occupation (aOR 3.088; 95 % CI 1.427-6.682), measure of high waist circumference (aOR 2.758; 95 % CI 1.238-6.265) individuals from lower socioeconomic status (aOR 3.989; 95 % CI 1.636-9.729) right knowledge on symptoms of diabetes (aOR 3.670; 95 % CI 1.571-8.577) and right knowledge on prevention of diabetes (aOR 3.397; 95 % CI 1.377-8.383) were significantly associated with T2DM status. The current findings suggest that health programs targeting T2DM should focus increasing awareness on harmful health effects of sedentary occupation, symptoms of T2DM and its prevention among the urban population.