The challenges faced by women-owned companies in Afghanistan under COVID-19 and Taliban

The COVID-19 pandemic and the shift of power to the Taliban have negatively affected women-owned companies. This study aimed to explore the external and internal challenges of women-owned businesses from March 2020 to January 2022 in Afghanistan. In-depth semi-structured interviews were conducted from December 2021 to January 2022 with 29 women-owned company owners and chief executive officers (CEOs) based in five provinces of Afghanistan. Data were analyzed using thematic analysis. The themes are COVID-19 external challenges: movement restriction, inability to access the market, and financial issues. COVID-19 internal challenges: financial and production problems. Taliban governance external challenges: regulation on women's activities, economic crisis, and market downturn, and Taliban governance internal challenges: financial issues, production issues, and staff mental wellbeing. The study concluded that challenges due to the COVID-19 and Taliban governance presented strong shocks to women-owned companies that may precipitate the closure of these companies or the immigration of businesswomen. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Use of telemedicine and artificial intelligence in Eye and ENT: A boon for developing countries

Developing countries like Nepal face challenges in accessing health services due to sparse distribution in communities, difficult geographic terrain, limited transportation, poverty, and lack of health human expertise in rural areas. The COVID-19 pandemic added woes to the wound. To address this gap, the Hospital for Children, Eye, ENT, and Rehabilitation Services adopted an innovative approach to remote rural patient care using telehealth and artificial intelligence in close coordination with IT professionals and healthcare professionals. We developed a deep learning-based disease prediction model that incorporates telemedicine with AI for screening and diagnosing Eye and ENT diseases using nonspecialist health workers. Deep learning-based disease prediction models in Diabetic Retinopathy (DR) and Glaucoma added quality specialized services to telehealth. This paper presents the adoption of digital innovations and the incorporation of telehealth to tackle various diseases. To predict DR, 61,458 colorful retinal photographs from fundus photography and 1500 for Glaucoma were used. To reduce the biases, EyePACS data sets were also incorporated. Inception V3 transfer learning model was used for DR and employed DenseNet architecture for Glaucoma. An accuracy of more than 90 %in both models was achieved. Accurate specialized diagnosis, better medical care, patient monitoring, limited specialized hospital visits, and easier with shorter wait times are now possible. In the future, this successful model can be replicated nationally and in other developing countries. © 2022 IEEE.

Whole Genome Sequence Analysis to Identify SARS-CoV-2 Variant in Nepal

Background The spread of SARS-CoV-2 has become a global public health crisis. Nepal is facing the second wave of COVID-19 pandemic but, there is still a limited data on the genomic sequence of SARS-CoV-2 variants circulating in Nepal. Objective The objective of this study is to sequence the whole genome of SARS-CoV-2 in Nepal to detect possible mutation profiles and phylogenetic lineages of circulating SARS-CoV-2 variants. Method In this study, swab samples tested positive for SARS-CoV-2 were investigated. After RNA extraction, the investigation was performed through real-time PCR followed by whole genome sequencing. The consensus genome sequences were, then, analyzed with appropriate bioinformatics tools. Result Sequence analysis of two SARS-CoV-2 genomes from patient without travel history (Patient A1 and A2) were found to be of lineage B.1.1. Similarly, among other four samples from subjects returning from the United Kingdom, genomes of two samples were of lineage B.1.36, and the other two were of lineage B.1.1.7 (Alpha Variant). The mutations in the consensus genomes contained the defining mutations of the respective lineages of SARS-CoV-2. Conclusion We confirmed two genomic sequences of variant of concern VOC-202012/01 in Nepal. Our study provides the concise genomic evidence for spread of different lineages of SARS-CoV-2 - B.1.1, B.1.36 and B.1.1.7 of SARS-CoV-2 in Nepal.Copyright © 2021, Kathmandu University. All rights reserved.

Developing dynamic capabilities for community collaboration and tourism product innovation in response to crisis: Nepal and COVID-19

International tourism will continuously face challenges to fully recover after COVID-19 unless destinations implement universally agreed upon public health protocols that make travellers feel safe. This challenge is even more daunting for least developed countries like Nepal, which relies on rural, nature and adventure tourism. These rural regions, already under stress prior to COVID-19, must now address the pandemic's consequences before availing themselves of opportunities for more sustainable tourism development that experts believe the pandemic confer. We use "mutual gaze” to examine how exchange relationships between rural and urban stakeholders shape collaborative decisions on tourism development. We conceptualise tourism development interactions through the innovative development of unique offerings to attract domestic tourists during the pandemic. Data on Nepal's rural tourism sector reveal that representative local associations enable innovation through the integration of dynamic capabilities and resources in the development of sustainable tourism products. While the study confirms the significant role government plays in facilitating cooperation among stakeholders to legitimise relationships and ascertain sustainability goals, it reveals organic collaboration is essential for inclusive planning and decision making at grassroots' level. © 2021 Informa UK Limited, trading as Taylor & Francis Group.

Online education status at dental colleges COVID-19 pandemic in Nepal

Background The COVID-19 pandemic has caused lockdown situation impeding all educational institutions including dental colleges. The circumstance demanded online classes as the alternative strategy for continuation of education. Objective To assess current practice and perception about online education among faculties of dental colleges in Nepal. Method A cross-sectional study was conducted among 208 faculties of all dental colleges in Nepal. Data collection was done through structured online questionnaire comprising demographic information, practice and perception of the respondents towards online education. Descriptive statistics surveyed the frequency distribution and Chi-square test assessed the difference in perception among the faculties of different universities. Result The response rate was 74.3%. Faculties commonly used PowerPoint presentation (96.6%) on Zoom platform (83.3%) using laptop (94.7%) with Wi-Fi connection (91.8%). Majority of faculties had good or satisfactory access to internet (94.8%). The faculties believed that the online class environment was interactive (95.2%);but it was not effective (86.5%) as live classroom. Majority of the faculties (79.4%) felt tracking of students' presence was difficult. There was no significant difference on perception towards online class among the faculties of Kathmandu University, Tribhuvan University and BP Koirala Institute Health Sciences at p <0.05. Conclusion The COVID-19 pandemic has paved the way for e-learning in dental education in Nepal. Faculties agree to complete the theory syllabus and conduct sessional exams as an alternative during the lockdown period. However, they show strong reservations in carrying out practical/clinical simulations and university exams online. Training on e-learning and institutional strategy for online education is recommended. Copyright © 2020, Kathmandu University. All rights reserved.

Age and gender differences in COVID 19 morbidity and mortality in Nepal

Background The global health community has emphasized the importance of reporting epidemiological data by age and sex groups in the COVID-19 pandemic. However, age and sex disaggregated data of COVID-19 cases and deaths are rarely reported. Such data are very crucial for public to make truly informed choices about their own diseases risk and also for governments for public policy response. Objective To assess age and gender difference among COVID-19 cases and deaths in Nepal. Method This is a retrospective study which uses public data on COVID-19 cases and deaths released by Ministry of Health and Population, Government of Nepal from January to November, 2020. The data analysis was carried out using SPPS software version 26. Result Nepal reported 233,452 confirmed cases and 1,566 deaths of COVID-19 from 23 January 2020 to 30 November 2020. We found statistically significant differences on COVID-19 cases by age and gender in Nepal with higher number of cases among males of economically active age groups (20-60 years). Similarly, we found significant difference in COVID-19 mortality with more death occurred among male group compared to female group and with highest number of deaths among the people of above 60 years. Furthermore, we found differences in cases and deaths among provinces. Conclusion The age and gender differences in COVID cases and deaths in Nepal indicates needs of considering age and sex groups seriously while planning for testing, case management and vaccination against COVID-19 infections in Nepal. Copyright © 2020, Kathmandu University. All rights reserved.

Extracorporeal Membrane Oxygenation in Patients with Covid-19: Duration and Outcomes

INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) has been utilized as a rescue therapy for patients with severe ARDS. Multiple case series have suggested that the duration of veno-venous ECMO support in patients with COVID-19 pneumonia may be longer than patients with ARDS secondary to alternative etiology. However, the impact of longer run of ECMO on patient outcomes are not clear. METHOD(S): This was a retrospective study performed at Mayo Clinic Florida and Mayo Clinic Rochester, tertiary ECMO centers in USA. Analysis includes all consecutive patients who were placed on VV ECMO for COVID-19- induced ARDS between January 2019 to March 2022. The study population was classified into two groups: short term ECMO duration (< 4 weeks) and prolonged ECMO support (>4 weeks). Demographic data, baseline clinical characteristics, treatments administered, mechanical ventilator data, lab data, ECMO data and outcome related data were collected and analyzed. RESULT(S): A total of 63 COVID-19 patients were included. For the entire cohort, the 30 day mortality was 6%, the 90 day mortality was 30% and the median duration of ECMO support was 35 days (IQR 38). A total of 6 (10%) patients went on to receive lung transplant. Among these, 25(40%) patients required ECMO for < 4 weeks and 38(60%) patients for >4 weeks. The median SOFA values (13 vs 11, 0.016) for the <=4 weeks cohort was higher. Both groups received similar COVID-19 therapies: glucocorticoids (96 vs 100%, p=0.397), tocilizumab (52 vs 50%, p=1.000), antivirals (88 vs 87%, p=1.000), and convalescent plasma (48 vs 45%, p=1.000). The cumulative mortality rates for the 2 groups were 8% vs 5% at 30 days (p=1.0), 12% vs 42% at 60 days (p=0.013), 12% vs 50% at 90 days (p=0.002) and 12% vs 50%(p=0.002) at 180 days. CONCLUSION(S): The study demonstrated that a substantial number of COVID19 patients require ECMO for > 4 weeks. In this cohort, the mortality rate in the first 4 weeks of ECMO support was low, at 6%. The patients who required ECMO for >4 weeks were more likely to have higher mortality compared to the patients treated with ECMO for shorter duration.

INTERACTIONS OF AEROSOL DROPLETS WITH VENTILATED AIRFLOWS IN THE CONTEXT OF AIRBORNE PATHOGEN TRANSMISSION

This multidisciplinary study provides a comprehensive visualization of airborne aerosols and droplets coming into contact with crossflows of moving air utilizing both experimental particle measuring methods and multiphase computational fluids dynamics (CFD). The aim of this research is to provide a Eulerian visualization of how these crossflows alter the position and density of an aerosol cloud, with the goal of applying this information to our understanding of social distancing ranges within outdoor settings and ventilated rooms. The results indicate that even minor perpendicular crossflows across the trajectory of an aerosol cloud can greatly reduce both the linear displacement and density of the cloud, with negligible increases in density along the flow path. © 2022 American Society of Mechanical Engineers (ASME). All rights reserved.

On to Quantifying the Effect of Droplet Size Distribution on the Airborne Transmission of the Virus

This research will study a novel aspect of the physics of COVID-19 transmission associated with actively altering droplet size distribution. Viruses can be transmitted through droplets and aerosols released during speaking, sneezing, and coughing phenomena. We previously found that these distributions can be altered using food ingredients. The study will be carried out to study the hypothesis of relaxed guidance in social distancing and mask usage is possible with the proposed approach using CFD models of human sneezes. The adult human is positioned inside a ventilated room condition and the droplet/aerosols are to be released to explore the impacts of the various distributions that relate to how the food ingredients vary the function, hence, the size of the droplets will be the function of the use of food ingredients. Results study the concentration of droplet particles at various distances away from the mouth, also called exposure maps and indicate that Corn Starch and Xanthum usage increase the exposure intensity level, while Xanthum reducing the exposure area implies that social distancing can be reduced with its use. In contrast, the use of Lozenge and Zingiber reduces the exposure level, related to the increase in the viscosity and reduction of the mass flow rate of saliva. Copyright © 2022 by ASME.

Anxiety, Depression and Functional Impairment among Health Care Workers during COVID-19 Pandemic: A Crosssectional Online Survey.

Background COVID-19 is an infectious disease caused by a newly discovered coronavirus. The number of cases and dramatic loss of human life worldwide created psychological problems among general public, including health care workers. Objective To determine the burden of anxiety, depression, and functional impairment among health care workers in the early days of lockdown during the first wave of COVID-19 outbreak in Nepal. Method A hospital-based cross-sectional study was carried out among all the employees of Hospital for Children Eye ENT and Rehabilitation Services, Bhaktapur during the COVID-19 pandemic lockdown from April 3, 2020 to May 2, 2020 using an online questionnaire. The tools used were adopted from Nepali version of Hospital Anxiety and Depression scale (HADS) and Nepali version of WHO Disability Assessment Schedule (WHODAS 2.0). Result The mean age (SD) of the participants (n=86) was 32.53 (7.92) years. Male and female participants were equal in number. The point prevalence of anxiety and depression was 25.6% and 14.0%, respectively. Females had a higher prevalence of both anxiety (39.5% vs 11.6%, p < 0.01) and depression (18.6% vs 9.3%, p=0.351). Clinical and nonclinical staff both had a higher prevalence of both anxiety (31.0% and 20.5%, p=0.265) and depression (16.7% and 11.4%, p=0.478). The mean functional impairment score (WHODAS 2.0) among all participants and participants with anxiety and depression was 19.47 (95% CI: 18.13-20.80), 21.27 (95% CI: 18.08-24.46), and 19.92 (95% CI: 15.28- 24.56), respectively. Conclusion Anxiety and depression during the first lockdown due to COVID-19 pandemic were highly prevalent in clinical and non-clinical employees. Besides controlling the outbreak, special consideration should be given to mental health.

LUNG CAVITY: A RARE FINDING IN COVID-19

SESSION TITLE: Post-COVID-19 Infection Complications SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Chest CT features in COVID-19 pneumonia include scattered ground-glass infiltrates in milder cases to confluent ground-glass change, dense consolidation, and crazy paving in the critically ill. However, cavitary lesions are uncommon in these patients. We present a case of lung cavity in a patient who had recent COVID-19 pneumonia. CASE PRESENTATION: A 33-year-old male diagnosed with COVID-19 four weeks ago presented with hemoptysis and exertional dyspnea. He had pleuritic chest pain without fever, night sweats, weight loss, skin rashes, hematemesis, or epistaxis. He had COVID-19 in Brazil, where he had received dexamethasone, hydroxychloroquine, ivermectin, colchicine, azithromycin, and rivaroxaban. The last dose of rivaroxaban was three days prior to the presentation. He had no history of travel to caves or exposure to birds or animals. His past medical history included hypertension, diabetes, and bariatric surgery. He had no history of smoking or IV drug use. He had moved from Brazil to the United States six years ago and worked as an interpreter. Physical examination was notable for stable vitals with O2 sat of 99%. Systemic examinations were unremarkable. Blood work including CBC, platelet count, PT/INR was within normal limits. COVID-19 testing (PCR) was negative. A chest CT revealed bilateral scattered ground-glass opacities with central cavitation in the left lower lobe concerning for septic pulmonary emboli. HIV 1/2, ANA, rheumatoid factor, and Quantiferon TB gold were negative. Blood cultures showed no growth. An echocardiogram was negative for any vegetations. Bronchoalveolar lavage from the left lower lobe was negative for AFB and gram staining. Sputum cultures, fungal cultures, and NAAT for Mycobacterium tuberculosis were negative, as was the cytology. He was started on amoxicillin-clavulanic acid during his hospital stay. He did not experience any recurrence of hemoptysis and was discharged home. The subsequent follow-up chest CT scans showed resolving cavitation at one month and a complete resolution of the cavity at 3 months. DISCUSSION: Cavitary lung lesions are usually related to fungal, mycobacterial, autoimmune, parasitic, thrombotic, or neoplastic etiologies. While not often seen in patients with viral pneumonia, lung cavitation can rarely occur in COVID-19. Mycobacterium tuberculosis and Nocardia were suspected given the history of being an immigrant and a recent trip to Brazil. As these tests were negative and the lung cavity resolved over a few months with conservative treatment, the etiology of the cavity was attributed to a late presentation of COVID-19 pneumonia. CONCLUSIONS: COVID-19 has variable complications which are still to be explored. The lung cavity in a COVID patient is an under-recognized entity. This case report highlights the need for further studies to determine the cause of cavitation, which could be related to COVID infection or its treatment. Reference #1: Selvaraj V, Dapaah-Afriyie K Lung cavitation due to COVID-19 pneumonia. BMJ Case Reports CP 2020;13:e237245. Reference #2: Chen Y, Chen W, Zhou J, Sun C, Lei Y. Large pulmonary cavity in COVID-19 cured patient case report. Ann Palliat Med 2021;10(5):5786-5791. doi: 10.21037/apm-20-452 Reference #3: Zoumot, Z., Bonilla, MF., Wahla, A.S. et al. Pulmonary cavitation: an under-recognized late complication of severe COVID-19 lung disease. BMC Pulm Med 21, 24 (2021). https://doi.org/10.1186/s12890-020-01379-1 DISCLOSURES: no disclosure on file for Raul Davaro;No relevant relationships by Susant Gurung No relevant relationships by Bijay Khanal No relevant relationships by Anil Phuyal No relevant relationships by Kamal Pokhrel No relevant relationships by REGINA SHRESTHA No relevant relationships by Mithil Gowda Suresh

Risk perception, mental health impacts and coping strategies during COVID-19 pandemic among Filipino healthcare workers

Background: COVID-19 pandemic has caused an extraordinary situation, especially for the healthcare workers (HCWs), leading to increased psychological stress. The aim of the study was to estimate the prevalence of different grades of anxiety and depression across different centers in the Philippines and identify demographic factors associated with them. Design and Method: A cross-sectional, web-based, multi-center study was conducted among HCWs of Philippines from April 20- May 20, 2020. The study instruments used were the Generalized Anxiety Disorder (GAD-7) scale and Patient Health Questionnaire (PHQ-9). Risk perception scores were analyzed using Mann-Whitney and Kruskal-Wallis test. Logistic regression was done to identify factors significantly associated with symptoms of anxiety and depression determined. Results: A total of 516 HCWs were included in the study. Most of them have anxiety symptoms (70.74%), but only half of them have symptoms of depression (50.97%). In addition, gender, age, marital status, living status, occupation, work premises, and availability of mental health services were significantly associated with the participants' anxiety symptoms. In contrast, gender, marital status, occupation, and work premises were significantly associated with depression symptoms. Conclusion: This study reiterates the fact and demonstrates that COVID-19 has disrupted the mental well-being of HCWs in the Philippines. Majority of HCW was psychologically affected by COVID-19. Therefore, there is a dire need to address mental illness amongst HCWs and frame guidelines based on proven algorithms to overcome these mental illnesses.

The psychological impact of COVID-19 pandemic in health care workers: a cross-sectional study in Nepal

BACKGROUND: COVID-19 pandemic has affected the healthcare workers (HCWs) worldwide. We plan to assess the psychological impact of this pandemic in different groups of HCWs including female community health volunteers (FCHVs) at various types of health facilities in Nepal, factors associated with it and the degree of satisfaction with the ongoing mental health support system. METHODS: A cross-sectional web-based survey with an option of telephone interview was conducted from June 20 to July 7, 2020. The questionnaire included socio-demographic characteristics, work related characteristics, substance use history, and degree of satisfaction with family, society and institutional support. Depression, anxiety, and stress scales (DASS-21) and the impact of events scale-revised (IES-R) tool were used to access the level of psychological impact. Linear regression was used to analyze factors associated with psychological outcome. RESULTS: Out of 608 respondents, the overall prevalence of depression, anxiety, stress, and post-traumatic stress disorder (PTSD) was 20.89%. 24.18%, 13.82%, and 15.46% respectively. Nurses had higher depression, anxiety, stress, and PTSD scores while FCHVs had high depression and PTSD compared to doctors. For various types of health facilities, HCWs working in provincial-level hospitals had high-stress level. Similarly, "have to go into quarantine" and increased level of substance abuse were directly associated with poor psychological impact. Finally, 62% of HCWs did not have any institutional mental health support system. Among those who had institutional mental health support, 39.4% were not satisfied. CONCLUSIONS: We found mild to extremely severe level of depression, anxiety, stress, and PTSD among HCWs in Nepal. Urgent plans are required to mitigate the mental health risk caused by this current pandemic.

MSD V-PLEX SARS-CoV-2 ASSAY to IDENTIFY VACCINATED and INFECTED INDIVIDUALS

Background: The prevalence of vaccinated, previously infected, and individuals at risk of SARS-CoV-2 infection is important for epidemiologic studies and public health interventions. Asymptomatic infections and reluctance to disclose vaccination status hinder accurate assessments of the current state of the epidemic. Since COVID-19 vaccines generate immune responses to spike (S1), but not nucleocapsid (N), it is possible to differentiate between vaccinated, infected, and unexposed individuals by comparing antibody reactivity to each antigen. The MSD V-Plex SARS-CoV-2 IgG assay can potentially differentiate each state in one test by simultaneously evaluating IgG reactivity to the S1, receptor binding domain (RBD), and N proteins. Methods: The MSD assay was validated with three sample sets: known vaccination with no previous infection (n=158);known infected and not vaccinated (n=157);and samples collected prior to the COVID-19 pandemic in 2016 (n=144). Of the previously infected individuals, 15 (9.6%) were hospitalized;sample collection occurred a median of 48 days after a PCR-positive result. Using an algorithm, samples with positive results on both S1 and RBD but negative on N were classified as vaccinated. Samples with a positive result on all three proteins were considered to be infected with the possibility of subsequent vaccination. Any other result was classified as unexposed. Sensitivity and specificity for each state were calculated. Results: Reactivity to each antigen is shown in the figure. 100% (95% confidence interval [CI] 97.7-100), 92% (95% CI 86.3-95.5), and 0.7% (95% CI 0.02-3.8) of vaccinated, infected, and unexposed samples were positive for S1. 100% (95% CI 97.7-100.0%), 91% (95% CI 85.5-95.0%), and 0.7% (95% CI 0.02-3.8%) of vaccinated, infected and unexposed samples were positive for RBD. 0% (95% CI 0-2.3), 86% (95% CI 79.6-91.0), and 2.1% (95% CI 0.4-6.0) of vaccinated, infected and unexposed samples were positive for N. Algorithm sensitivity and specificity for classification of vaccinated samples were 100% (95% CI 97.7-100) and 96.7 (95% CI 94-98.4). For the classification of samples from previously infected individuals, sensitivity and specificity were 83.4% (95% CI 76.7-88.9) and 100% (95% CI 98.8-100). Conclusion: This study establishes the sensitivity and specificity for a high-throughput assay ideal for SARS-CoV-2 seroprevalence studies. Future research should focus on applying this assay in health care settings to guide practice and policy to mitigate the pandemic.

Developing a Virtual Nature Laboratory of Faculty Social Science (LAV-FIS) to Assists Field-Based Learning during Pandemic: A Need Analysis Review

The Covid-19 outbreak has affected several aspects of field-based learning. The best way to ensure the survival and safety of everyone involved in field-based learning is to adapt and integrate technology. In response to this problem, numerous innovations in learning technology that lead to the virtualization of the learning environment have begun to emerge. However, the various application products developed have fallen short of the expectations of students. As a result, in order to design the optimal virtual application for use in fieldbased learning, a needs analysis must be done. This study offers an understanding of student needs for virtual field-based learning applications. An online survey of 140 active university students was carried out to do so. The results showed that students require applications with sophisticated features that resemble the real world for the implementation of online field-based learning. They expect the incorporation of online meeting features, 360 Virtual Reality Panorama, access to learning videos, augmented reality, learning materials, chatbox, and multimedia into the software that will be developed. © 2022. All Rights Reserved.

Whole Genome Sequence Analysis to Identify SARS-CoV-2 Variant in Nepal

Background The spread of SARS-CoV-2 has become a global public health crisis. Nepal is facing the second wave of COVID-19 pandemic but, there is still a limited data on the genomic sequence of SARS-CoV-2 variants circulating in Nepal. Objective The objective of this study is to sequence the whole genome of SARS-CoV-2 in Nepal to detect possible mutation profiles and phylogenetic lineages of circulating SARSCoV-2 variants. Method In this study, swab samples tested positive for SARS-CoV-2 were investigated. After RNA extraction, the investigation was performed through real-time PCR followed by whole genome sequencing. The consensus genome sequences were, then, analyzed with appropriate bioinformatics tools. Result Sequence analysis of two SARS-CoV-2 genomes from patient without travel history (Patient A1 and A2) were found to be of lineage B.1.1. Similarly, among other four samples from subjects returning from the United Kingdom, genomes of two samples were of lineage B.1.36, and the other two were of lineage B.1.1.7 (Alpha Variant). The mutations in the consensus genomes contained the defining mutations of the respective lineages of SARS-CoV-2. Conclusion We confirmed two genomic sequences of variant of concern VOC-202012/01 in Nepal. Our study provides the concise genomic evidence for spread of different lineages of SARS-CoV-2 - B.1.1, B.1.36 and B.1.1.7 of SARS-CoV-2 in Nepal.

Social responsibility for health during COVID-19 pandemic

Health is a fundamental right for which concerned sides should bear the responsibility at the individual, societal, state, and international level. Not only curative but preventive, promotive, and rehabilitative services should also be availed in accessible, affordable, and acceptable form. The quest for health becomes more intense during adverse periods like a pandemic. The whole world has witnessed the COVID-19 pandemic, the unprecedented pandemic of this century. This quest is more dismal in developing nations like Nepal when even resource- rich countries are laid down by it. The quest of health demands, hence more during this pandemic, for the bearing of the responsibility by all. Here, we have made an attempt to draw together the general and some specific responsibilities of various direct stakeholders in this pandemic with multifaceted mayhem. We have incorporated here, the responsibilities of the public, COVID and non-COVID patients, media personnel, health science students, professionals, institutions, state, and media to ensure or safeguard the health of self and others in this pandemic.

Comparison of telemedicine and in-person psychotherapy for CPAP adherence in a population of veterans

Introduction: Obstructive sleep apnea (OSA) is the second most common sleep disorder among Veterans and carries risk of serious health complications when untreated. The gold standard for OSA treatment is Positive Airway Pressure (PAP). However, adherence to PAP therapy is chronically low. Interventions to enhance adherence include education, practical support, and psychotherapy. Cognitive behavioral therapy and motivational interviewing have been shown to improve CPAP usage by approximately 1 hour per night. Telemedicine-delivered CPAP education and telemonitoring-with-feedback has demonstrated improved adherence in patients with OSA. Our study evaluated the effectiveness of a telemedicine group psychotherapy intervention for Veterans diagnosed with OSA and found to be nonadherent to CPAP therapy. The intervention is delivered in four weekly 60-minute sessions. Methods: We identified a cohort of 29 patients who participated in the intervention via telemedicine from April 2020 - September 2020 (Telemedicine Psychotherapy cohort). The cohort was compared to a historical control of 35 patients who participated in the in-person group psychotherapy from April 2019 - September 2019 (In-Person Psychotherapy cohort). Through retrospective chart review, we analyzed baseline and post-intervention data from both cohorts. Demographics collected included age, sex, BMI, ethnicity, zip code, as well as medical and mental health comorbidities. Data collected from the medical record included: OSA severity, pre- and post-psychotherapy 90-day average nightly CPAP usage (in minutes), number of psychotherapy classes attended (out of 4) and number of sleep clinic visits at 90-days post-psychotherapy. We used descriptive statistics to provide summary data of this sample and t-test to evaluate Veteran's average CPAP usage per night and number of sleep clinic visits at 90-days post-psychotherapy between cohorts. Results: Compared to a cohort of in-person group psychotherapy to improve CPAP adherence, a telemedicine-based cohort demonstrated improvement in 90-day average nightly CPAP usage by an average of 76 minutes per night. (p=0.08) Additionally, patient engagement with the sleep clinic at 90 days following completion of telemedicine psychotherapy was significantly higher compared to in-person psychotherapy (p<0.001). Conclusion: In a haphazardly-collected convenient sample of veterans during the COVID-19 pandemic, telemedicine psychotherapy led to improved CPAP usage. Veterans who underwent telemedicine intervention also significantly increased engagement with the sleep clinic.