Traditional plant use in Nepal has been documented for millennia. The importance of plants as medicine has not diminished in any way in recent times, and traditional medicines are still the most important health care source for the vast majority of the population.This paper examines the ethnobotany and traditional use of plants extracted from the vulnerable alpine zone in the Dolpa, Humla, Jumla and Mustang districts of Nepal.The results of this ethnobotanical study indicate that a very large number of plant species is used as traditional medicines. There were 107, 59, 44 and 166 species of ethnomedicinal importance in surveyed areas of Dolpa, Humla, Jumla and Mustang district respectively. Of these, 84 common species, used at least in two districts, were selected to enumerate their ethnomedicinal properties. The 84 species belonged to 75 genera and 39 families.The commonest species in this pharmacopoeia were: Allium wallichii, Cordyceps sinensis, Dactylorhiza hatagirea, and Rheum australe. A total of 21 species were most common in three districts and 59 in two districts. The genera Aconitum, Allium, Arisaema, Berberis, Corydalis, Gentiana, Hippophae, Juniperus and Rhododendron each possessed two species with ethnomedicinal use. Labiatae was the most medicinally important family with five species used, followed by Araceae, Compositae, Liliaceae, Polygonaceae, Ranunculaceae, Scrophulariaceae and Umbelliferae, each contributing four species.

Human papillomavirus (HPV) infections are associated with development of anogenital lesions in men. There are no reports describing the distribution of non-alpha HPV types in the anal canal of a sexually diverse men group. The HIM (HPV in Men) Study is a multicenter study of the natural history of HPV infection in Brazil, Mexico and USA. At baseline, 12% of anal canal specimens PCR HPV-positive were not typed by the Roche Linear Array and were considered unclassified. Our goal was characterizing HPVs among these unclassified specimens at baseline and assess associations with participant socio-demographic and behavioral characteristics. Unclassified HPVs were typed by sequencing amplified PGMY09/11 products or cloning of PGMY/GP+ nested amplicons followed by sequencing. Further analysis was conducted using FAP primers. Of men with unclassified HPV at the anal canal, most (89.1%) were men who have sex with women (MSW). Readable sequences were produced for 62.8% of unclassified specimens, of which 75.2% were characterized HPV types. A total of 18, 26, and 3 different α-, β- and γ-HPV types were detected, respectively. Compared to older men (45-70 years), α-HPVs were more commonly detected among young men (18-30 years) whereas β-HPVs were more frequent among mid-adult men (31-44 years). β-HPVs were more common among heterosexual men (85.0%) than non-heterosexual men. β2-HPV types composed all β-HPVs detected among non-heterosexual men. The high prevalence of β-HPV in the anal canal of men who do not report receptive anal sex is suggestive of other forms of transmission that do not involve penile-anal intercourse.

Aim To compare 6‐month adherence, persistence and treatment patterns among patients initiating once‐weekly glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs), dulaglutide versus semaglutide, and dulaglutide versus exenatide BCise, using claims from the HealthCore Integrated Research Database. Materials and methods Patients aged ≥18 years, with type 2 diabetes, ≥1 claim for dulaglutide, semaglutide or exenatide BCise during the index period February 2018 to December 2018 (index date = earliest GLP‐1RA fill date), no claim for GLP‐1RAs in the 6‐month pre‐index period, and continuous enrolment 6 months pre‐ and post‐index were included. Dulaglutide users were propensity‐matched 1:1 to semaglutide users (3852 pairs) or exenatide BCise users (1879 pairs). The proportions of adherent (proportion of days covered ≥80%) patients were compared using chi‐squared tests. Persistence, measured as days to discontinuation, was analysed using a Cox regression model. Results Matched cohorts (dulaglutide:semaglutide and dulagutide:exenatide BCise) were balanced in baseline characteristics and the mean age was 54 and 55 years, respectively, with approximately 51% and 49% women, respectively. At 6 months, significantly more dulaglutide users were adherent than semaglutide (59.7% vs. 42.7%; P <0.0001) or exenatide BCise users (58.1% vs. 40.3%; P <0.0001). Cox regression showed that dulaglutide users were less likely to discontinue therapy than semaglutide (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.66, 0.76) or exenatide BCise users (HR 0.59, 95% CI 0.53, 0.65; P <0.0001, both). Conclusion At 6‐month follow‐up, a higher proportion of patients initiating dulaglutide were adherent to and persistent with their treatment, compared to matched patients initiating either semaglutide or exenatide BCise.

Background: With semaglutide’s FDA approval in Dec 2017, this study sought to provide real-world evidence on its effectiveness in a cohort of early users. Methods: Claims and lab result data from a broad national U.S. CI and MA population were used to identify T2DM patients who initiated semaglutide between 12/1/17 - 6/30/18 (first claim date set as index). Of these, patients who had ≥12-month pre-index health plan eligibility as well as ≥1 HbA1c result within both ≤3 months pre- and ≥3 months post-index were selected. Changes in HbA1c were assessed in all patients, GLP-1 naïve patients and GLP-1 naïve patients with a pre-index HbA1c &gt;9%. Results:Of 107 individuals with T2DM initiating semaglutide, 48.6% were female with median age of 52 years. HbA1c was significantly reduced in all patients (-1.3%), GLP-1 naïve patients (-2.0%) and HbA1c &gt;9% GLP-1 naïve patients (-2.9%) (all p&lt;0.001, Figure 1). Attainment of HbA1c &lt;7% increased from pre- to post-index: 22.4 - 46.7% (all), 11.8 - 49.0% (GLP-1 naïve) and 0 - 32.0% (pre-index HbA1c &gt;9% GLP-1 naïve) (all p&lt;0.001). Conclusions: Semaglutide initiation was associated with a significant reduction in HbA1c and increase in HbA1c goal attainment in real-world practice in this preliminary T2DM cohort. Ongoing research will include a broader group of semaglutide users as well as allow for longer post-initiation follow-up to fully assess its effect. Disclosure J. Visaria: Employee; Self; HealthCore. T. Dang-Tan: Employee; Self; Novo Nordisk Inc. P.V. Petraro: Employee; Self; Novo Nordisk Inc. B.K. Nepal: None. V. Willey: Employee; Self; HealthCore. Funding Novo Nordisk

The objective of this retrospective real-world observational study was to compare 6-month (mo) adherence and persistence among patients (pts) initiating weekly GLP-1 receptor agonists (GLP-1RA), dulaglutide (DU) vs. semaglutide (SEMA) or DU vs. exenatide QW (EQW) BCise pen in the U.S., using claims from the HealthCore Integrated Research Database (HIRD®) between August 2017 and June 2019 (index date=earliest GLP-1RA fill date). Pts ≥18 yrs old, with T2D, no claim for GLP-1 RAs in the 6 mos pre-index period, ≥1 claim for DU, SEMA or EQW during the index period, and continuous enrollment 6 mos pre- and post-index were included. DU users were propensity-matched 1:1 to SEMA (3,852 pairs) or EQW (1,879 pairs) users. Matched cohorts (DU:SEMA/DU:EQW) were balanced in baseline characteristics and the mean age was 54/55 years with approximately 49/51% males, respectively. At 6 mos, DU users were more likely to be adherent [Proportion of Days Covered (PDC)≥80%] than SEMA (odds ratio [OR]=1.986, 95% CI=[1.81, 2.18]) or EQW users (2.06 [1.81, 2.34]) (table). Cox regression showed that DU users were less likely to discontinue therapy than SEMA (hazard ratio [HR]= 0.71, 95% CI=[0.66, 0.76]) or EQW users (0.59 [0.53, 0.65]) (table). At 6-mos follow-up, pts initiating DU had higher medication adherence, and were more persistent to their treatment, compared to pts initiating either SEMA or EQW. Disclosure R. Mody: Employee; Self; Eli Lilly and Company. M. Yu: Employee; Self; Eli Lilly and Company. Employee; Spouse/Partner; LifeLabs. Stock/Shareholder; Self; Eli Lilly and Company. B.K. Nepal: None. M. Konig: Employee; Self; Eli Lilly and Company. M. Grabner: Research Support; Self; Eli Lilly and Company.