Neuropsychological Assessment of Older Adults in Nepal for Population-Based Dementia Ascertainment: Needs, Challenges, and Opportunities.

The population of Nepal is rapidly aging, as in other low and middle-income countries, and the number of individuals living with Alzheimer's Disease and related dementias (ADRD) is expected to increase. However, information about the neuropsychological assessment of ADRD in Nepal is lacking. We first aimed to examine the needs, challenges, and opportunities associated with the neuropsychological assessment of older adults in Nepal for population-based ADRD ascertainment. Second, we introduce the Chitwan Valley Family Study-Study of Cognition and Aging in Nepal (CVFS-SCAN), which is poised to address these needs, and its collaboration with the Harmonized Cognitive Assessment Protocol (HCAP) international network. We reviewed the existing literature on the prevalence, risk factors, available neuropsychological assessment instruments, and sociocultural factors that may influence the neuropsychological assessment of older adults for ADRD ascertainment in Nepal. Our review revealed no existing population-based data on the prevalence of ADRD in Nepal. Very few studies have utilized formal cognitive assessment instruments for ADRD assessment, and there have been no comprehensive neuropsychological assessment instruments that have been validated for the assessment of ADRD in Nepal. We describe how the CVFS-SCAN study will address this need through careful adaptation of the HCAP instrument. We conclude that the development of culturally appropriate neuropsychological assessment instruments is urgently needed for the population-based assessment of ADRD in Nepal. The CVFS-SCAN is designed to address this need and will contribute to the growth of global and equitable neuropsychology and to the science of ADRD in low- and middle-income countries.

An Outbreak Investigation of Varicella Zoster among Male Military Personnel in a Military Training Centre.

Introduction: Chickenpox is an acute, highly infectious disease. Outbreaks can occur in adults in closed institutional settings like hostels and barracks. This study aims to report varicella zoster outbreak among male military personnel in a military training centre. Methods: An outbreak investigation of chickenpox in a military training school and tertiary hospital was conducted. Ethical approval was taken from the Institutional Review Committee (Reference number: 267). Data was collected from February 5, 2020 to April 10, 2020 by questionnaire and clinical examination. Case definitions were prepared as per the Centre for Disease Control and Prevention criteria. Data was entered and analysed in Microsoft Excel 2010. Results: Out of the 167 male personnel in the training centre, 90 (53.89%) were susceptible to varicella and 84 (50.29%) were close contacts. The secondary attack rate of varicella zoster was 21.43% (18 cases). The mean age of the patients was 22.33±1.72 years. The mean days of admission were 5±2.28 days. The most common clinical features were generalised rash in 18 (100%), fever in 15 (83.33%), and body ache in 12 (66.67%) cases. Conclusions: Natural history, clinical, and epidemiological features of varicella zoster in a closed institutional setting was studied with the secondary attack rate being less as compared to other studies. Keywords: chickenpox; military; outbreak.

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.

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.

Socio-psychological Study of COVID-19 Pandemic among Healthcare Workers in a Medical College of Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Health care workers experienced considerable psychological distress as a result of COVID-19 due to providing direct patient care, quarantine or self-isolation, and lockdown experience. They are front line workers handling the patients and are at greater risk than others. This study aims to determine the socio-psychological impact of COVID-19 pandemic among healthcare workers of a medical college in Nepal. METHODS: A descriptive cross-sectional study from different institutions of the Nepalese Army Institute of Health Sciences from May 2020 to July 2020 was conducted. Ethical approval was taken from the Institutional Review Committee, Nepalese Army Institute of Health Sciences. A total of 212 responses were collected through Google form along with the Depression, anxiety, stress and scale-21 to assess the level of Depression, Anxiety, and Stress. Analysis of the data was done using Statistical Package of Social Sciences version 22. RESULTS: Respondents with extremely severe depression, anxiety, and stress was found to be 16 (7.5%), 24 (11.3%), and 4 (1.95%) respectively. Most of the respondents do not have travel history, but 6 (2.8%) and 28 (13.2%) have direct and indirect contact respectively with the COVID patients. Daily activities such as food intake, the workload at home, and relationships with family members were increased. 208 (98%) have followed preventive measures such as mouth mask, hand washes, and physical distance. CONCLUSIONS: COVID-19 pandemic has imposed a significant level of depression, anxiety, and stress on health care workers caring for infected patients, with their main concern being the risk of transmitting the infection to their families or acquiring it themselves.

Motivational Profiles of Medical Students of Nepalese Army Institute of Health Sciences.

BACKGROUND: Students enter the medical study with different types of motives. Given the importance of academic motivation for good academic achievement of the students, the present study was designed to reveal the possible relationship between academic motivation and achievement in medical students. METHODS: In this cross-sectional study medical students (N=364) of Nepalese Army institute of Health Sciences were participated and classified to different subgroups using intrinsic and controlled motivation scores. Cluster membership was used as an independent variable to assess differences in study strategies and academic performance. RESULTS: Four clusters were obtained: High Intrinsic High Controlled, Low Intrinsic High Controlled, High Intrinsic Low Controlled, and Low Intrinsic Low Controlled. High Intrinsic High Controlled and High Intrinsic Low Controlled profile students constituted 36.1%, 22.6% of the population, respectively. No significant differences were observed as regards to deep strategy and surface strategy between high interest status motivated and high interest-motivated students. However, both of the clusters had significantly deeper, surface strategy and better academic performance than status-motivated and low-motivation clusters (p < 0.001). CONCLUSIONS: The interest status motivated and interest-motivated medical students were associated with good deep and surface study strategy and good academic performance. Low-motivation and status-motivated students were associated with the least academic performance with less interest learning behaviors. This reflected that motivation is important required component for good learning outcomes for medical students Keywords: Academic performance; controlled motivation; clusters; intrinsic motivation; motivation.

Knowledge, attitude and practice (KAP) study on diabetes mellitus among Nepalese diabetic patients.

Present study was carried out to understand the knowledge, attitude and practices (KAP) regarding diabetes mellitus (DM) among the diabetic patients attending a diabetic education programme. Results showed that the majority of patients had correct knowledge regarding diabetic diet, three-fourths of them were subjected themselves to blood sugar checking at good intervals and almost all were under regular contact with physicians. This study might help in implementation of diabetic education programme giving more emphasis among older and younger groups of patients and encouraged the patients to have more contact with concerning physicians, so that complications that occurring at early stage of disease could be prevented.