Background COVID-19 pandemic has provoked a wide variety of psychological problems such as anxiety, depression, and panic disorders, especially among health service providers. Due to a greater risk of exposure to the virus, increased working hours, and fear of infecting their families, health service providers are more vulnerable to emotional distress than the general population during this pandemic. This online survey attempts to assess the psychological impact of COVID-19 and its associated variables among healthcare workers in Nepal. Materials and methods For data collection purposes, Covid-19 Peritraumatic Distress Index (CPDI) Questionnaire, was used whose content validity was verified by Shanghai mental health center. Data for the survey were collected from 11 to 24 October 2020 which was extracted to Microsoft Excel-13 and analyzed. Results A total of 254 health care workers from different provinces of the country participated in this study with a mean age of 26.01(± 4.46) years. A majority 46.9% (n = 119) of the participants were not distressed (score ≤28) while 46.5% (n = 118) were mild to moderately distressed (score >28 to ≤51) and 6.7% (n = 17) were severely distressed (score ≥52) due to the current COVID-19 pandemic. Female participants (p = 0.004) and participants who were doctors by profession (p = 0.001) experienced significantly more distress. Conclusions COVID-19 pandemic has heightened the psychological distress amongst health care service providers. The findings from the present study may highlight the need for constructing and implementing appropriate plans and policies by relevant stakeholders that will help to mitigate the distress among health service providers in the current pandemic so that we can have an efficient frontline health workforce to tackle this worse situation.

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The Nepalese elephant (Elephas maximus maximus) and rhinoceros (Rhinoceros unicornis), are an important part of Nepal’s heritage, culture and wildlife conservation. Despite its importance, not much is known about the helminth parasites that affect elephant and rhinoceros. This study investigates the prevalence of helminth parasites in wild Asian Elephant and wild Indian Rhinoceros.A study was conducted from November 2011 to April 2012 to screen helminth parasites of wild asian elephant and wild Indian Rhinoceros at Chitwan and Bardia National Park of Nepal. Total of 80 samples, 40 each taken from the Wild Asian Elephants and Indian Rhinoceros. The study showed 88.75% overall prevalence of helminthes. The prevalence in Wild Asian Elephant and Indian Rhinoceros was 95% and 82.5% respectively. 97.37% and 72.73% infection were mixed infections in elephant and rhinoceros respectively.Among 38 positive samples of the elephant of CNP and BNP, 9 different types of helminth eggs were found. 15 (39.47%) were positive for Fasciola Spp. With 450 EPG count, 11 (28.95%) for Paramphistomum spp. with 600 EPG, 27 (71.05%) for Schistosoma spp. with 500 EPG, 3 (7.89%) for Dicrocoelium spp. with 900 EPG, 12 (30.16%) for Moniezia spp. with 433.3 EPG, 17 (44.74%) for Oesophagostomum spp. with 1025 EPG, 10 (26.31%) for Chabartia spp. with 1141.65 EPG, 17 (44.74) for Strongyloides spp. with 15558.335 EPG and 23 (60.53%) for Strongylus spp. with 1700 EPG.Similarly out of the 33 positive samples of Rhinoceros of CNP and BNP, 8 different types of helminth eggs were found. 11 (33.33%) were positive for Fasciola Spp. With 558.34 EPG, 10 (30.30%) for Paramphistomum spp. with 525 EPG, 7 (21.21%) for Schistosoma spp. with 475 EPG, 4 (12.12%) for Moniezia spp. with 650 EPG, 6 (18.18%) for Strongyloides spp. with 1466.67 EPG, 4 (12.12%) for Strongylus spp. with 1625 EPG, 9 (27.27%) for Toxocara spp. with 699.98 EPG and 20 (60.61%) for Trychostrongylus spp. with 1149.98 were found to be positive.

Aims: This study aims to determine the socio-demographic and clinical characteristics of the patients presenting with globus pharyngeus in an outpatient clinic of a tertiary care center in Nepal Study Design: Descriptive cross-sectional study. Place and Duration of Study: The study was carried out in the psychiatry outpatient department of Chitwan Medical College, Bharatpur, Nepal between Aug 2021 and Dec 2021. Methodology: Globus pharyngeus was diagnosed after ruling out obvious pathology related to the throat and gastrointestinal system by specialists from the respective departments. The Glasgow Edinburgh Throat Scale (GETS) with its Nepali translation and study-specific structured proforma for sociodemographic and clinical profiles has been used as the study tool. Patients were assessed by the consultant psychiatrist to find out psychiatric comorbidities. Results: Among the one hundred patients with a diagnosis of Globus pharyngeus, most patients were female (n=69), from an urban background(n=63), living in nuclear families (n=57), and were married (n=85). The mean age of patients with globus diagnosis was 37 years. The mean duration of globus symptoms was 32 months. Ninety-seven patients were previously treated for their problems from other centers. Discomfort/irritation in the throat (n=92), Feeling something stuck in the throat (n=91), and pain in the throat (n=81), were common symptoms. Psychiatric comorbidities [lifetime] were seen in forty-two patients. Conclusion: Female gender, age of thirties, married status, belonging to the urban background, living in a nuclear family, and long duration of treatment history are commonly observed characteristics of these patients. Comorbid anxiety and depression are frequently observed psychiatric comorbidities.

Foot and mouth disease (FMD) is endemic in Nepal and significantly impacts the livelihood of farmers, national economy, and trade of Nepal. However, outbreak investigations are not frequently conducted, and there have been limited studies to understand the associated risk factors. A case-control study was performed in dairy cattle farms of Shankharapur and Kageshwari Municipalities, Kathmandu from March to April 2020 to describe the outbreak and identify the risk factors associated with FMD. There were 31 case farms, while 62 farms were selected as control farms (1:2). The information from case and control farms was collected by semi-structured questionnaire survey through field visits and observations. The univariable and multivariable logistic regressions were performed. The farm-level prevalence of FMD was 25.2% (n=31/123). Among the FMD affected farms, the proportion of positive farms in Shankharapur (61.3% (19/31)) was significantly higher than Kageshwori (38.7% (12/31)). The final multivariable logistic regression analysis identified four variables: cattle purchased within 14 days (OR=12.9; CI=2.4-69.5), milk market distance less than two kilometers from the farm (OR=32.7; CI=5.8-186.3), sharing of the bull from other farms for natural insemination (OR=5.7; CI=1.2-26.8), and no vaccination against FMD in the past six months (OR=19.1; CI=2.0-186.2) as significant risk factors for the occurrence of FMD. This study suggests farmers vaccinate their dairy cattle with FMD vaccine as per the vaccination schedule suggested by the veterinarians, practice quarantine measures when new animals are introduced to their farms, practice biosecurity measures in their farms, and do not use bulls from areas where there are ongoing FMD outbreaks.

Introduction: Cerebral embolic protection devices (CEP) have been introduced to capture embolic debris and reduce the risk of stroke during Transcatheter Aortic Valve Replacement (TAVR). Available evidence regarding the safety and efficacy of CEP is inconclusive. Therefore, we aimed to determine the safety and efficacy of CEP use during TAVR. Methods: Major electronic databases were searched for the relevant articles with appropriate search terms. All relevant data from 17 studies were extracted into a standardized form. Statistical analyses were performed using Revman 5.4. Odds Ratio (OR) or mean differences (MD) were used to estimate the desired outcome with a 95% confidence interval (CI). Results: A total of 17 studies involving 204,875 patients (15,880 in the CEP arm and 188,995 in the non-CEP arm) were included. No significant difference in 30-day stroke was observed with the use of CEP between the two groups (OR 0.75, 95% CI 0.55 to 1.03). The use of CEP was associated with a lower odds of 30-day mortality by 39% (OR 0.61, 95% CI 0.53 to 0.70). Based on diffusion weighted-magnetic resonance imaging (DW-MRI), there were no differences in the occurrence of new lesions, the total volume of lesions, and the number of new lesions. In addition, the use of CEP in patients undergoing TAVR was associated with a reduction in major or life-threatening bleeding events (OR 0.89, 95% CI 0.81 to 0.98). No differences were observed in the outcomes of acute kidney injury and major vascular complications between both arms. Conclusion: No significant difference in 30-day stroke was observed with the use of CEP in TAVR patients. The use of CEP was associated with significantly lower odds of 30-day mortality and lower rates of major or life-threatening bleeding compared with no CEP in patients undergoing TAVR. Further studies are needed to confirm current findings

Background: Surgical site infection following Cesarean Section is one of the major potential surgical complications with its incidence ranging from 3-15%. Morbidity and mortality are considerably in­creased after a surgical site infection placing a significant physical, emotional and economic burden on the patient herself. This study is aimed to identify the associated risk factors for postcesarean surgical site infection at a tertiary care hospital in Chitwan. Methods: A descriptive cross-sectional study of 186 women who underwent a cesarean section was carried out in Chitwan Medical College Teaching Hospital, Chitwan, Nepal from 27thDecember 2019 to 19th February 2020. Data were collected from patients using a self-constructed questionnaire and their risk factors were studied. Results: A total of 186 cases were studied and the incidence rate of surgical site infection was 13 (6.99%). The mean age was 26.13±4.94. Among the total cases, 87.10% of cases were literate while 12.90% of cases were illiterate. Out of total surgical site infection cases, infection was more prevalent (84.62%) among those with preoperative hospitalization of ≤ 24 hours and (53.85%) among those who stayed in the hospital for < 5 days. Conclusions: Education level, duration of preoperative hospitalization and total hospital stay were found to be significant risk factors associated with surgical site infection and appropriate measures to address these risk factors help to lower the rate of surgical site infection.

Benedikt syndrome is a rare neurological disorder of the midbrain. Herein, we present a case of Benedikt syndrome, who presented with left-sided body weakness, right oculomotor nerve palsy, cerebellar ataxia, and Holmes tremor in the left upper limb following midbrain infarction. She was treated with aspirin, clopidogrel, and amiodarone.