Patan Academy of Health Sciences (PAHS) (पाटन स्वास्थ्य विज्ञान प्रतिष्ठान) is an autonomous, not-for-profit, public institution of higher education established in 2064 B.S. (2008 A.D.) with the charter granted by the Parliament of Nepal. The stated aim of the PAHS is to work in close partnership with the national health system to improve the health care services in the remote/rural areas primarily through producing technically competent and socially responsible health care workers. Currently PAHS has been running School of Medicine and School of Nursing and aims to run School of Public Health in near future. PAHS MBBS curriculum focuses on holistic care of individual and community. PAHS preferentially enrolls students from rural areas and trains them in curriculum that emphasizes on community health and is subsequently provides support for its graduates who work in the rural areas.S. (2008 A.D.) with the charter granted by the Parliament of Nepal.
BACKGROUND:In low-income and middle-income countries, where typhoid fever remains a major public health problem, WHO recommends the use of typhoid conjugate vaccine (TCV). Here, we report vaccine effectiveness up to 8 years following a single dose of TCV in Nepal. METHODS:TyVOID was a prospective cohort study that extended the follow-up of children enrolled in a phase 3, double-blind, randomised controlled trial in Lalitpur, Nepal (TyVAC; Nov 20, 2017, to Oct 20, 2021). Children aged 9 months to 15 years were randomly assigned (1:1) to receive Vi-tetanus toxoid conjugate vaccine (Vi-TT) or a capsular group A meningococcal conjugate (MenA) vaccine. After unmasking and crossover vaccination, our study followed the trial participants until Oct 31, 2025. TyVAC participants who received Vi-TT were eligible for this study and categorised into either the 2017-18 cohort or 2020-21 cohort, depending on when they received the Vi-TT vaccine. The primary outcome, which was assessed in children who received both Vi-TT and MenA vaccines and with known TCV vaccination status during the government catch-up campaign in 2022, was the incidence of blood culture-confirmed typhoid identified through facility-based passive surveillance and medical record review. Adjusted incidence rate ratios (IRRs) were estimated using Poisson regression adjusted for age and sex. Vaccine effectiveness at 1-5 years and 4-8 years post-vaccination was estimated using a test-negative design among febrile children presenting to surveillance clinics, comparing odds of Vi-TT vaccination between culture-confirmed typhoid cases with negative controls. FINDINGS:16 131 TyVAC participants were enrolled at TyVOID baseline, of whom 14 850 provided information on Vi-CRM197 vaccination during the government catch-up campaign. After crossover and unmasking, the primary analysis population included 4941 participants vaccinated with Vi-TT in 2017-18 and 4856 participants vaccinated with Vi-TT in 2020-21. In 4856 participants in the 2020-21 Vi-TT cohort, 2402 (49·5%) were female, 2454 (50·5%) were male, and the median age at Vi-TT vaccination was 10·4 years (IQR 7·3-13·7). In 4941 participants in the 2017-18 Vi-TT cohort, 2482 (50·2%) were female, 2459 (49·8%) were male, and the median age at Vi-TT vaccination was 7·7 years (IQR 4·5-11·0). During a median follow-up of 3·7 years (3·7-3·8), the typhoid incidence rate was 111 per 100 000 person-years (95% CI 64-177) in the 2017-18 cohort and 46 per 100 000 person-years (18-94) in the 2020-21 cohort (adjusted IRR 2·41 [95% CI 1·00-5·80]; one-sided p=0·025). Vaccine effectiveness was 77% (95% CI 46-90; p=0·0006) in the 2020-21 Vi-TT cohort (1-5 years after vaccination), and 53% (8-76; p=0·027) in the 2017-18 Vi-TT cohort (4-8 years after vaccination). INTERPRETATION:A single Vi-TT dose confers strong protection in the first 4 years among Nepali children, with evidence of waning by 8 years. These findings support consideration of a booster dose to sustain protection in school-age children who remain at high risk of typhoid fever. FUNDING:Gates Foundation and Wellcome Trust.
Background:Chronic kidney disease (CKD) and atrial fibrillation/flutter (AF/AFL) frequently coexist in older adults, sharing common risk factors such as hypertension, diabetes, and coronary artery disease. However, long-term national mortality trends among patients with concurrent CKD and AF/AFL remain poorly defined. The primary research question of this study is to examine how the combined presence of CKD and AF/AFL has influenced mortality rates in older adults in the U.S. over the past 26 years. Methods:We analyzed mortality data from the CDC Wide-Ranging Online Data for Epidemiologic Research database for U.S. adults aged ≥65 years from 1999 to 2024. Deaths listing both CKD (ICD-10 N18.0-N18.9) and AF/AFL (I48) were identified. Age-adjusted mortality rates (AAMRs) per 100 000 population were calculated using the 2000 U.S. standard population and stratified by sex, race/ethnicity, census region, and urban-rural status. Temporal trends were assessed using Joinpoint regression to estimate annual percentage change (APC). Results:A total of 203 662 deaths were attributed to concurrent CKD and AF/AFL. The overall AAMR increased from 4.9 per 100 000 in 1999 to 30.0 per 100 000 in 2024. Mortality rose rapidly from 1999 to 2011 (APC: +12.3%, P = 0.0016), followed by a slower, non-significant increase from 2011 to 2024 (APC: +3.9%, P = 0.0767). Mortality was higher in men and in nonmetropolitan areas. Non-Hispanic White and Black populations showed the greatest increases, while Hispanic and Asian/Pacific Islander groups had the lowest rates. The Midwest and West exhibited the highest regional burdens, with notable state-level variation. Conclusions:Mortality linked to concurrent CKD and AF/AFL has risen sharply, with widening disparities by sex, race, and geography. Integrated, equitable care strategies are urgently needed.
Type 1 diabetes is a non-preventable chronic disease that predominantly affects young people, accounting for 10-15% of all diabetes cases. The condition is multidimensional, affecting various aspects of life, and daily living requires consistent effort, lifestyle modification, and close monitoring. This study aimed to explore the lived experiences of patients with Type 1 diabetes attending the outpatient department of Patan Hospital, focusing on their perspectives on living with the disease condition. A descriptive phenomenological research design was used for the study. Data were collected from 22 purposively selected patients who attended the Medicine and Pediatrics Outpatient Department (OPD) of Patan Hospital. Patients aged 15 years and above, with at least one year since initial diagnosis, were included in the study. Colaizzi's descriptive phenomenological method was used for data analysis. Ten themes emerged from the analysis: (1) Initial hospitalization (2) Solidarity in illness and support systems (3) Learning process and acceptance (4) Changes and adjustments (5) Diabetes management challenges (6) Concerns and worries (7) Socioeconomic and structural challenges (8) Healthcare experiences (9) Type 1 diabetes-related stigma (10) Experiences of living with Type 1 diabetes during the COVID-19 pandemic. The study highlights a lack of awareness in the community on Type 1 diabetes, experiences of stigma were also reported by the participants. It also emphasizes the need for regular parental counseling to prevent overprotection. Financial burden appeared as a significant challenge in the study. The study further suggests that authorities ensure access to insulin and other essential medical supplies during lockdowns, as participants reported difficulties in obtaining them. School-related difficulties point towards the importance of effective implementation of the "School Health Nurse" program. These findings indicate the need for greater awareness, psychological support, and healthcare preparedness to improve the quality of life of individuals living with Type 1 diabetes.
Background : Internet accessibility is rapidly increasing, bringing the world closer together. However, excessive internet use may lead to behavioral addictions that have adverse psychological and physical health effects. High academic demands and unsupervised internet use may increase vulnerability to internet addiction (IA) among students. This study assesses the prevalence of IA and its association with insomnia, depressive symptoms, and behavioral factors among undergraduate students in Eastern Nepal. Methods : A cross-sectional study was conducted among 211 undergraduate medical and nursing students at B.P. Koirala Institute of Health Sciences in Dharan. Students were randomly selected, and data was collected through a self-reported questionnaire comprising socio-demographic characteristics and scales such as Young’s Internet Addiction Test, Insomnia Severity Indexand Patient Health Questionnaire-9. Statistical analyses were performed using the Chi-square test and multivariable logistic regression. Results : Approximately one-fourth (23.2%, 95% CI=17.7%-29.5%) of students reported having IA. The proportion of insomnia and major depression were 12.8% and 21.3% respectively. Students with IA were significantly more likely to have clinical insomnia symptoms (OR=4.00, p=0.004) and experience depressivesymptoms (OR=2.70, p=0.015) compared to students without IA (p<0.001). There was a significant association of IA with problematic alcohol use (OR=3.1, p=0.043). Multivariable analysis confirmed the association of insomnia and depression with IA even after adjusting for potential factors. Conclusion : The prevalence of IA was relatively high among students studying medicine and nursing and strongly associated with insomnia and depression. These findings highlight the need for awareness about its effects on mental health through community or educational intervention.
