Antimicrobial stewardship (AMS) programs can decrease non-optimal use of antibiotics in hospital settings. There are limited data on AMS programs in burn and chronic wound centers in low- and middle-income countries (LMIC). A post-prescription review and feedback (PPRF) program was implemented in three hospitals in Nepal with a focus on wound and burn care. A total of 241 baseline and 236 post-intervention patient chart data were collected from three hospitals. There was a significant decrease in utilizing days of therapy per 1000 patient days (DOT/1000 PD) of penicillin (p = 0.02), aminoglycoside (p < 0.001), and cephalosporin (p = 0.04). Increases in DOT/1000 PD at post-intervention were significant for metronidazole (p < 0.001), quinolone (p = 0.01), and other antibiotics (p < 0.001). Changes in use of antibiotics varied across hospitals, e.g., cephalosporin use decreased significantly at Kirtipur Hospital (p < 0.001) and Pokhara Academy of Health Sciences (p = 0.02), but not at Kathmandu Model Hospital (p = 0.59). An independent review conducted by infectious disease specialists at the Henry Ford Health System revealed significant changes in antibiotic prescribing practices both overall and by hospital. There was a decrease in mean number of intravenous antibiotic days between baseline (10.1 (SD 8.8)) and post-intervention (8.8 (SD 6.5)) (t = 3.56; p < 0.001), but no difference for oral antibiotics. Compared to baseline, over the 6-month post-intervention period, we found an increase in justified use of antibiotics (p < 0.001), de-escalation (p < 0.001), accurate documentation (p < 0.001), and adherence to the study antibiotic prescribing guidelines at 72 h (p < 0.001) and after diagnoses (p < 0.001). The evaluation data presented provide evidence that PPRF training and program implementation can contribute to hospital-based antibiotic stewardship for wound and burn care in Nepal.

Background: Sub-clinical hypothyroidism (SCH), overt hypothyroidism and metabolic syndrome (MetS) are recognized risk factors for atherosclerotic cardiovascular disease and Type 2 diabetes mellitus (DM- II).Thyroid function affects MetS parameters including blood pressure (BP), fasting blood sugar (FBS), serum triglycerides (TG) and high density lipoprotein cholesterol (HDL-C). But the relationship between MetS and thyroid functions is yet to be identified clearly. The present study is to investigate the frequency of MetS in patients of SCH and overt hypothyroidism. Materials and Methods: A hospital based cross–sectional study was conducted at Swastik referral laboratory and research centre. In this study, 50 patients with overt hypothyroidism, 50 patients with SCH and 129 euthyroid controls were enrolled. National Cholesterol Education Program- Adult Treatment Panel III (NCEP-ATP III; 2005) revision criteria were used to diagnose metabolic syndrome. Thyroid function test (TFT: FT3, FT4 and TSH) was done by using chemiluminescence immunoassay (CLIA) and other tests by using a semi-auto analyzer. ANalysis Of VAriance (ANOVA) test was performed using SPSS (version 16.0). Result: There was a significant difference in the mean of the waist circumference (p=0.031), BP systolic (p=0.010), BP diastolic (p<0.001)), FBS (p=0.001), serum HDL-C (p=0.031) and serum TG (p=0.003) between control, subclinical and overt hypothyroidism group (p<0.001). Prevalence of MetS was 25.6 % in euthyroid controls whereas 44.0% in the SCH group and 62.0% in the overt hypothyroid group (p<0.001). Conclusion: Thyroid dysfunction may be responsible for the development of metabolic syndrome.

Poverty is one of the major factors that bring obstacles in any kind of growth and development in any part of the world. The problem of poverty is complex in our country so there is a need of appropriate policies that can reduce social inequality and maintain social justice in Nepalese societies. Appropriate social policies can bring positive changes in the life of rural and urban poor. In this light, this article focuses on the role of social policies on poverty reduction and alleviation.[

Introduction: The risk of active Tuberculosis increases after HIV seroconversion. It progressively increases with declining immunity. Tuberculosis (TB) epidemics in HIV has led to a dramatic upsurge in global TB incidence, resulting in remarkable increase in morbidity and mortality. Many clinical studies had shown that TB is one of the commonest opportunistic infection. This study is conducted to see the incidence of tuberculosis as an opportunistic infection in patients with HIV getting combined antiretroviral therapy (cART) Materials and Methods: This was a hospital based cross-sectional comparative study. Five hundred patients with HIV who are getting cART were enrolled in the study. Results: Analysis of individuals with HIV in our study amongst the 500 patients 266 (53.2%) were males and the remaining 234 (46.68%) were females. Amongst these HIV patients 48(18.04%) males and 17(7.26%) females had tuberculosis. 65(13%) of patients were TB/HIV co-infected. 2(4.1%) of these male TB/HIV patients had cervical gland TB. Conclusion: The incidence of tuberculosis in HIV infected individuals is high. TB is the commonest opportunistic infection (OIs) in people living with HIV/AIDS. Males are predominant gender to have TB/HIV co-infection.

It gives me great pleasure to know that Pokhara Academy of Health Sciences, (PAHS) has come out with its first publication of medical journal of Pokhara Academy of Health Sciences (MJPAHS). This can be a beginning of implementation of the policy of federal Government of Nepal to set at least one government medical college in each province. PAHS has been established in the year 2016 (2072 B.S) with an aim to begin postgraduate medical education in province number 4 and provide quality care and affordable medical service to all, in general, poor and marginalized people in particular. It also aims to carry out scientific research and study in different health related areas of this region. Accordingly we have formed IRC, Medical Education Department and Journal Editorial Board to carry out all its activities. This journal publication has been possible only because of collaborative, cooperative and untiring efforts of editorial board. I congratulate Dr. Bhogendra Bahadur KC and all other members of Editorial Board for this great job. I am sure this journal will fulfil the academic needs of all faculties and students and academics of different health institutes of this region.