Gallbladder carriage of invasive Salmonella is considered fundamental in sustaining typhoid fever transmission. Bile and tissue was obtained from 1,377 individuals undergoing cholecystectomy in Kathmandu to investigate the prevalence, characteristics and relevance of invasive Salmonella in the gallbladder in an endemic area. Twenty percent of bile samples contained a Gram-negative organism, with Salmonella Typhi and Salmonella Paratyphi A isolated from 24 and 22 individuals, respectively. Gallbladders that contained Salmonella were more likely to show evidence of acute inflammation with extensive neutrophil infiltrate than those without Salmonella, corresponding with higher neutrophil and lower lymphocyte counts in the blood of Salmonella positive individuals. Antimicrobial resistance in the invasive Salmonella isolates was limited, indicating that gallbladder colonization is unlikely to be driven by antimicrobial resistance. The overall role of invasive Salmonella carriage in the gallbladder is not understood; here we show that 3.5% of individuals undergoing cholecystectomy in this setting have a high concentration of antimicrobial sensitive, invasive Salmonella in their bile. We predict that such individuals will become increasingly important if current transmission mechanisms are disturbed; prospectively identifying these individuals is, therefore, paramount for rapid local and regional elimination.

BackgroundLocal people in the Himalayan region use a wide range of wild and non-cultivated edible plants (WNEPs) for food, spice, medicinal, and cultural purposes. However, their availability, use, status and contribution to livelihood security are poorly documented, and they have been generally overlooked in recent agro-biodiversity conservation and management programmes. The study aimed to investigate WNEP diversity and current status in a part of the Kailash Sacred Landscape—a transboundary landscape shared by Nepal, India and PR China—in terms of collection, use, management and conservation initiatives.MethodsMultiple methodologies and tools were used for data collection. A series of participatory tools (45 key informant interviews, 10 focus group discussions, a crop diversity fair, direct observation of species through a transect walk and rapid market assessments) was followed by a household survey (195 respondents) and complemented by a literature review.ResultsThe study recorded 99 WNEPs belonging to 59 families of which 96 were angiosperms, one gymnosperm and two pteridophytes. Species were used for food, spice, medicine, rituals and income generation. Thirty-five species had multiple uses, including these: 40 species were used for fruit and 31 for vegetables. WNEPs contribute significantly to daily food requirements, especially the vegetables. The use value of Dryopteris cochleata was found highest (0.98) among frequently used vegetable species. The values of informant consensus factor were found maximum for worms in the stomach (0.99) and minimum for skin disease treatment (0.67). Nearly 85% of households depended exclusively on WNEPs for at least more than a month per year. Results on the importance and use of different species, gender roles in WNEP activities and conservation approaches are presented.ConclusionsPeople living in the Kailash Sacred Landscape depend significantly on WNEPs, and this is especially critical in times of food shortage. The WNEPs have considerable potential as an important supplement to cultivated food crops. Farmers prioritise species with multiple use values and popular vegetables. However, there are numerous challenges and interventions needed to ensure conservation and management of species and their continued availability to support food security and local livelihoods.

COVID-19 global pandemic has badly hit the business of farmers whose story has largely been in the shadows. The main objective of this article is to highlight the connection of global pandemic with agricultural and food systems. For this, secondary data were collected through online portals, daily national newspapers, and published scientific articles and analyzed. The result shows that from pandemic to lockdown, locust to heavy rainfall, unsold crops to rotten crops, financial crisis to acute hunger, has brought agricultural activities to standstill, where people value only those who can produce food for them. It is high time for action and priority must be given to the farmers who are putting their hard work to thrive the whole world as that of police and health workers. The government needs to take vigorous steps to facilitate farmers using automated machinery facilities like autonomous tractors, seeding robots, robotic harvesters, drones and ICTs, toll-free numbers; enhancing quality seeds, fertilizers and direct financial funding on vulnerable farmers to build agricultural sector resilience to the pandemic. 

Study Design: Epidemiological retrospective study. Objective: To describe the demographics, timing to surgery, delay, short-term neurological recovery, and complications in surgically treated subaxial cervical trauma in a resource-constrained country. Methods: Thirty consecutive subaxial cervical trauma patients presenting to a trauma hospital in Nepal between December 2015 and August 2017 were analyzed as a retrospective cohort. Patients were segregated into 4 groups based on the timing to surgery: within 2 days, 3 to 7 days, 8 to 30 days, and >31 days. Results: There were 27 male and 3 female patients with mean age 40 years. Twenty-four sustained fall injury, and 27 patients were from outside Kathmandu. No patients were treated within the first 48 hours; only 9 were treated between 3 and 7 days, 16 between 8 and 30 days, and 5 a month later. Major delay was finance and operating room availability. Thirteen patients had a C6C7 involvement followed by C5C6 in 6 patients. Seven patients had complete neurological deficit while 18 patients had incomplete deficit. A total of 46.7% improved their neurology in 6 months. No neurological recovery was observed in complete deficit patients. Conclusion: Seventy percent of our patients were treated longer than 1 week after injury, which would likely be considered unacceptable in most first world countries. As expected, the outcomes for many of these patients were far worse than reported in North American centers with early access to medical care and insurance. Despite this, nearly half of our patients improved neurologically following treatment; hence, surgery holds hope of some restoration of neurologic deficits.

Objective: Drug-related problems (DRPs) are frequent in hospitalization where multiple changes in patient's medication regimen, and lack of continuity of care may be accompanied. The aim of present research was to identify DRPs, drug classes involved in DRPs as well as associated factors with the occurrence of DRPs and to assess the pharmacist interventions in a tertiary care teaching hospital.Methods: A prospective observational study was carried out in a tertiary care teaching hospital, over a period of 6-month from November 2015 to April 2016. All the in patients admitted to all departments of hospital, who satisfied the selection criteria, were included in this study. Necessary demographic and clinical data were collected from the case records. The Pharmaceutical Care Network Europe Classification Version 5.01 was used to classify DRPs. The treatment data were analyzed to determine the rate, pattern, clinical significance, and outcomes of DRPs.Results: A total of 300 patient case sheets were reviewed during the study, out of which 143 DRPs were identified from 93 patients. Male (%) predominance was noted over females (%). The most common DRP was drug interactions 47.55% (68) followed by drug use problems 19.58% (28), drug choice problems 14.68% (21), others 11.88% (17), dosing problems 4.89% (7), and adverse reaction 1.39% (2) were identified. Conclusion:DRPs are common among the wards of hospital. Clinical pharmacist's role in identification, resolution, and prevention of DRPs helps in achieving better therapeutic outcomes and improved patient healthcare.