Bone marrow aspiration cytology in the diagnosis of hematologic and non-hematologic diseases in a multi-specialty hospital in Nepal

Background: Peripheral blood smear examination and other routine laboratory assays are not always sufficient to diagnose various diseases which affect the blood and bone marrow. A bone marrow aspirate examination is essential in most of the cases.Methods: This work was a hospital-based cross sectional analytical observational study carried out in the department of pathology at the Chitwan Medical College, Teaching Hospital, Nepal, over a period of 3 years from January, 2013 to December 2015. Bone marrow was aspirated from posterior superior iliac crest under local anesthesia; sternum was the alternative site in obese patients. Univariate analysis was performed for each variable using frequency distribution and means with the help of Statistical Package for Social Sciences 20.0 (SPSS 20.0) software.Results: One hundred and fifty-nine patients were included in the study. Eight cases of 'dry tap' were excluded, for whom bone marrow biopsy was advised. Anemia was the largest group followed by malignancy, infection and miscellaneous diseases. Among anemia, megaloblastic anemia was the most common, followed by aplastic anemia, dyserythropoietic anemia and myelopthisic anemia. The category 'malignancy' consisted of leukemia, multiple myeloma and myelodysplastic syndrome. Regarding individual diseases, megaloblastic anemia was the most common haematological disorder followed by immune thrombocytopenic purpura, leukemia and aplastic anemia.Conclusions: Bone marrow aspiration cytology is a mildly invasive technique which can diagnose many haematological and non-hematologic diseases that can be confirmed by more advanced investigations, if needed: serological, biochemical or molecular. However, bone marrow sample cannot be obtained (dry tap) in a proportion of cases. In such cases, a bone marrow biopsy needs to be performed

Health Literacy Before and After Education

BackgroundIn Nepal tuberculosis, outdoor and indoor air pollution, cigarette smoking, smoking during pregnancy, poor working and health conditions in industries are common. Perceptions about various aspects of lung health among non-medical personnel working in medical schools in Nepal have not been previously studied. Method  The study was carried out during January 2009. Basic demographic information was collected. Participants’ perceptions about various aspects of lung health were studied by noting their agreement with a set of 50 statements using a modified Likert-type scale. The median total score and scores of various subcategories were calculated. The scores were compared among various subgroups of respondents using appropriate non-parametric tests. After noting the deficiencies a structured interactive session to correct them was conducted. Participant perceptions were studied immediately after the session using the same questionnaire and the scores compared to those before the session.ResultsFifty-one respondents completed the questionnaire before the education session and 31 did so post-session. The majority of respondents were female, less than 40 years of age, either Brahmins or Chhetris, belonged to middle socioeconomic group; high school educated and used gas at home for cooking. The median total score was 182 before the session and increased to 218 post-session (maximum possible score 250). There was a significant increase in the scores of different subcategories also. ConclusionNon-medical personnel in a Nepalese medical school had good knowledge and understanding of various aspects of lung health which further improved following an educational session