Polypharmacy in elderly cancer patients : challenges and the way clinical pharmacists can contribute in resource-limited settings

The aim of this study was to address the problems associated with polypharmacy in elderly cancer patients and to highlight the role of pharmacists in such cases in resource‐limited settings. A narrative review of existing literature was performed to summarize the evidence regarding the impact of polypharmacy in elderly cancer patients and the pharmaceutical strategies to manage it. This review emphasizes the significance of polypharmacy, which is often ignored in real clinical practice. Polypharmacy in the elderly cancer population is mainly due to: chemotherapy with one or more neoplastic agents for cancer treatment, treatment for adverse drug reactions due to neoplastic agents, the patient's comorbid conditions, or drug interactions. The role of the clinical pharmacist in specialized oncology hospitals or oncology departments of tertiary care hospitals is well established; however, this is not the case in many developing countries. A clinical pharmacist can contribute to solving the problems associated with polypharmacy by identifying the risks associated with polypharmacy and its management in resource‐limited settings. As in many developed countries, the involvement of a clinical pharmacist in cancer care for elderly patients may play a vital role in the recognition and management of polypharmacy‐related problems. Further research can be conducted to support this role

Estimating the Probability of Survival of Individual Shortleaf Pine (Pinus Echinata Mill.) Trees

An individual tree survival model was developed for shortleaf pine (Pinus echinata Mill.) trees. Prediction of the probability of survival of an individual tree is essential when considering growth and yield of a stand. Data for this study were from more than 200 permanently established plots on even-aged natural shortleaf pine stands that were located in the Ozark and Ouachita National Forests. Plots were established during the period of 1985-1987. Plots have been remeasured every 4, 5 or 6 years, and individual tree survival or mortality was recorded at each measurement. These plots were selected to represent a range of ages, densities and site qualities. Logistic regression was used to find the best sets of significant predictor variables in which the response variable was a binary variable `1' for the survival tree and `0' for the mortality tree. Significant variables found in predicting the survival were mid-period basal area per acre (Mid-BA), inverse of ratio of quadratic mean diameter to diameter at breast height (DBH) (DRINV), their interaction and square of DBH. Parameters of the logistic equation were estimated using iteratively re-weighted nonlinear regression. A nonlinear mixed-effects approach was also applied to investigate the plot level effect on the model. Model performance was evaluated using Chi-square goodness-of-fit test, and it was found that the model worked better while estimating the parameters using iteratively reweighted non linear regression than with the nonlinear mixed model. This individual tree survival model can be used to predict the annual survival rate of individual trees of even-aged shortleaf pine forests located in Ozark and Ouachita National Forests and in the surrounding regions.Department of Natural Resource Ecology and Managemen

An Integrated Decision Support Toolbox (DST) for the Management of Mountain Protected Areas

New tools and methodologies are required in systemic planning and management of mountain protected areas. Among others we propose here a decision support toolbox (DST) conceived as an integrated collection of both soft and hard system methodologies, consisting of participatory and computer-based modules to provide a set of integrated, self-contained tools and approaches to support decision-making processes in the management of mountain protected areas. The Sagarmatha National Park and Buffer Zone (SNPBZ) in Nepal was taken as a pilot case. A number of participatory exercises such as participatory 3-dimensional modeling, scenario planning, and qualitative modeling were carried out to understand social-ecological processes and generate a systemic view over space and time. The qualitative models were then converted into computer-based system dynamics models. The design and development of DST software were carried out with an incremental and modular approach. This process involved stakeholder analysis and decision-making processes through a series of consultations. The software was developed with the main modules including scenario analysis, spatial analysis, and knowledge base. The scenario analysis module runs system dynamics models built in Simile software and provides functions to link them with spatial data for model inputs and outputs. The spatial analysis module provides the basic geographic information system functions to explore, edit, analyze, and visualize spatial information. The knowledge base module was developed as a metadata management system for different categories of information such as spatial data, bibliography, research data, and models. The development of DST software, especially system dynamics modeling and its linkage with spatial components, provided an important methodological approach for spatial and temporal integration. Furthermore, training and interactions with park managers and concerned stakeholders showed that DST is a useful platform for integrating data and information and better understanding ecosystem behavior as a basis for management decisions

Translation and cultural adaptation of EORTC QLQ-LC 29 into Nepalese language for lung cancer patients in Nepal

Background: The quality of life (QoL) of patients with lung cancer (LC) may be affected by disease-related limitations such as patients’ functioning, the severity of symptoms, financial problems resulting along with the side effects of the treatment. The objective of this study was to translate LC-specific QoL questionnaire EORTC QLQ-LC29 into Nepalese language for Nepalese LC patients. Methods: In the process of translation, the European Organization for Research and Treatment of Cancer (EORTC) translations guidelines were followed. The translated questionnaire was pilot-tested in a sample of 15 patients with LC. Descriptive statistics were calculated with SPSS version 21.0. Results: All steps of the EORTC translation guideline were followed successfully. Fifteen lung cancer patients were included in the pilot study. Sixty percent were male and the mean age was 49.87 (range 21–76 years). For all items not related to thoracic surgery, patients used the entire range of the response options from 1 to 4 and no missing responses were observed. The highest mean (indicating a high symptom burden) was observed for the item number. 35 (shortness of breath; Mean = 3.33, SD = 1.11) and the lowest mean for an item number. 45 (dizzy; Mean = 1.73, SD = 0.96). Conclusion: The Nepalese version of EORTC QLQ-LC29 is a result of a successfully conducted rigorous translation procedure, and is highly comprehensible as well as acceptable to Nepalese LC patients. Thus, the Nepalese version of EORTC QLQ-LC29 is ready to be used in international clinical studies as well as in Nepalese clinical practice

Voltage Profile Improvement of Distribution System via Integration of Distributed Generation Resources

This study attempts to identify the causes and possible solutions for voltage profile issues in the lower land of Nepal, and is specifically focused on Laukahi feeder, a radial distribution system with an approximate length of 65 km and distributed at 11KV system voltage. Currently, the end-users feeding through this feeder are getting extremely poor voltage along with frequent interruptions in the power supply. In this study, a forward/ backward sweep algorithm is used to analyze the load flow of the distribution system, whereas ant colony optimization (ACO) technique is used to identify the best location for the Distributed Generator (DG) penetrations. After completion of this study, it is found that, the branch loss of the feeder can be reduced up to 87.22%, and voltage profile can be improved from 0.828 pu to 0.982 pu by integrating some form of DGs

Effect of different levels of nitrogen on growth and yield of hybrid maize (Zea mays L.) varieties

Nitrogen (N) fertilizer is considered as one of the most important factors affecting growth and grain yield of hybrid maize. This study was conducted to determine the effects of different rates of nitrogen and varieties on growth and yield of hybrid maize in Lamahi Municipality, Dang, Nepal from June to October, 2019. Three levels of hybrid maize varieties (10V10, Rajkumar F1 and NMH-731) and four levels of nitrogen (160, 180, 200 and 220 kg N ha-1) were evaluated using two factorial randomized complete block design with three replications. The results showed that grain yield and yield attributing traits of hybrid maize varieties increased with the increasing level of nitrogen from 160 to 220 kg ha-1. The application of nitrogen @ 220 kg N ha-1 produced the highest grain yield (10.07 t ha-1), cob length (16.33 cm), no of rows per cob (14.97), no of grains per row (33.37), cob diameter (4.54), thousand grain weight (276.77 g), stover yield (12.91 t ha-1), biological yield (23.00 t ha-1), harvest index (43.80), gross return (NRs. 208940 ha-1), net return (NRs.104488 ha-1) and B:C ratio (2.001). The hybrid maize variety 10V10 produced the highest grain yield (9.35 t ha-1), net returns (NRs. 91740.66 ha-1) and B:C ratio (1.91) accompanied by the highest cob length (16.25 cm), and as number of grains per row (32.35) as compared to other varieties. This study suggested that maize production can be maximized by cultivating hybrid maize variety 10V10 with the use of 220 kg N ha-1 in inner Terai region of Nepal

Economics of potato (Solanum tuberosum L.) production in terai region of Nepal

Potato is an important cash crop of Nepal. Research was conducted from January to May, 2018 in Jhapa, Bara and Kailali districts for economic assessment of potato production in terai region of Nepal. Pre-tested interview schedule was used to collect the primary information; moreover, one Focal Group Discussion and two Key Informant Interviews were performed. Furthermore, relevant literatures were reviewed for secondary information. The simple random method of sampling was used within the clusters that were identified in consultation with District Agriculture Development Office, Potato Superzone Office and agricultural officials of the local government. Altogether, 165 samples, 55 samples from each of the three districts were taken for the purpose of the study. The Statistical Packages for Social Sciences (SPSS) and Microsoft excel software were used for data analysis. The majority of the respond-ents (52.7%) prioritized the source-Own home production/ Neighbors/ Friends as the first major source for seed followed by Cooperatives/ Farmer’s group (20%). More than one third of the farmers (35.2%) sold their produce at Home/Local market/Haatbazar followed by Wholesalers/ Distant market (34.5%). The average gross margin per Kattha from potato production was found NRs. 6604.4 and benefit cost ratio was 2.13. The indexing identified- lack of availability of improved quality seed (I= 0.79) as the most important problem followed by incidence of disease and insect/pest (I= 0.71) for potato production. The provision of technical knowledge to control diseases as well as proper allocation of improved quality seed would help to increase profitability and productivity of potato

Infectious sources of Histoplasmosis and molecular techniques for its identification

Histoplasmosis, a fungal infection caused by Histoplasma capsulatum (H. capsulatum), acquired from contaminated soil with droppings of chicken or birds and found to be distributed in many parts of the world. The prevalence of histoplasmosis has not well studied in Nepal. The common symptoms of acute and epidemic histoplasmosis include high fever, cough, and asthenia and weight loss. Most of the infections associated with histoplasmosis are asymptomatic. People with compromised immune systems such as HIV/AIDS (PLWHA), cancer, and organ transplant recipients are at risk of developing this disease. In this review, we have summarised the current status of histoplasmosis in Nepal and molecular techniques available for its identification. To date, the significant outbreak is not reported in Nepal, but the risk of infection for the vulnerable population cannot be undermined. Appropriate preventive measures and treatment on time can reduce the burden of this fungal disease. Further, this review is also focused on molecular identification of H. capsulatum. Hence, careful considerations by concerned stakeholders for national surveillance programs and the treatment of patients on time after proper diagnosis is highly recommended