Clinico-pathologic profile of women with palpable breast lumps in Chitwan Medical College, Nepal

Background: Spectrum of female breast diseases is manifold and includes various non-neoplastic and neoplastic conditions. This study focused on the clinico-pathological profile of several breast diseases, including fibrocystic change, fibroadenoma and breast carcinoma. Methods: This cross sectional analytic observational study included Fine Needle Aspiration Cytology cases of female breast diseases diagnosed over three years from 2011 to 2014 in Chitwan Medical College Teaching hospital in Central Nepal. Univariate analysis was carried out to find out age group-wise proportion of the diseases in relation to five cytologic categories and various cytomorphologic diagnoses. Independent samples t-test was used to find out the significance of difference between mean age of benign and malignant breast diseases. Results: The proportion of benign, suspicious for malignancy and malignant breast diseases was 90.4 %, 0.8% and 8.8 % respectively. The mean age of patients at diagnosis for benign diseases and malignant disease was 31.7± 10.4 years and 49.2 ± 12.0 years respectively. t-test showed difference in mean age between benign and malignant diseases to be statistically significant (t=8.79, p= <0.001). Fibrocystic change and fibroadenoma were the most common breast disease overall and the most common neoplasm respectively. 58.1 %, 25.9 % and 6.5 % of all carcinoma cases in this study were found below 50, below 40 and below 30 years of age respectively. Conclusions: Fibrocystic change and fibroadenoma are most common disease of breast and most common neoplasm of breast respectively. Breast cancer occurs in younger women in Nepal in comparison to women in developed countries. Therefore, breast cancer prevention programs in Nepal should target young women also.

Histopathological Analysis of Endometrial Biopsy in Gandaki Medical College Teaching Hospital, Pokhara, Nepal

Objective: To study the spectrum of histopathological diagnosis of endometrial lesions and their distribution according to age. Methods: All the endometrium samples obtained by the procedure of dilatation and curettage and hysterectomy sent for histopathological examination at Pathology Department of Gandaki Medical College Teaching Hospital, Pokhara, Nepal. The study duration was total 12 months ranging from July 2016 to June 2017. All the endometrial samples were processed, sectioned at 4 - 6 μm and stained with routine H & E stain. Patient’s data including age, sex, procedure of the biopsy taken and histopathological diagnosis were noted. A pathologist, using Olympus microscope, reported the slides. Cases were reviewed by a second pathologist whenever necessary. Results: A total of 128 cases were studied. The most common histopathological diagnosis was proliferative endometrium (28.9%) followed by disorder proliferative endometrium (15.65%). Most of the patients were in age group 36 - 45 years comprising 32.03%. Hydatidiform mole comprised of 7.03% and among Hydatidiform mole, partial mole was more common. Dilatation and curettage (82.8%) was the common procedure in compare to hysterectomy for the evaluation of endometrial lesions. Conclusions: In this study, we observed a variety of endometrial lesions. Most of them are benign; among benign, proliferative endometrium was the common histopathological diagnosis followed by disorder proliferative endometrium. Most common presenting age group was found to be at 36 - 45 years. In evaluation of hydatidiform mole, partial mole was more frequent in compare to complete mole. Conventional dilatation and curettage is the preferred method in developing countries with limited resource to screen endometrial lesion and therefore biopsy should be sent for histopathological examination. Thus histopathological examination of routinely stained hematoxylin and eosin is readily available and widely accepted standard technique for evaluation of the endometrial lesions

Evaluation of Different Thyroid Lesions with Fine Needle Aspiration Cytology and Thyroid Function Tests

Introduction: Swelling of the thyroid gland is a commonly encountered clinical problem in all age groups whether benign or malignant. Fine Needle Aspiration Cytology (FNAC) of the thyroid lesions along with hormonal function test helps in the proper preoperative assessment. Ultimately it changes clinical management and improves the patient outcome. Objectives: To describe the cytomorphological features of palpable thyroid nodules using fine needle aspiration cytology (FNAC) along with the assessment of thyroid hormonal status of the patient. Methods: The study was conducted in the Department of Pathology of Gandaki Medical College and Teaching hospital from January 2017 to December 2017 and included 50 patients with thyroid lesions. Cytological assessment was done using FNAC along with serological assessment of thyroid hormones. Results: In the study 50 cases of thyroid swelling were included and evaluated by cytological and hormonal analysis which comprises of 10% males and 90% females with a with a female to male ratio of 9 : 1. Maximum number of cases was seen in the age range 41 - 60 years (46%), mean age being 44.6 years. The cytological diagnosis comprised colloid goiter (58%), lymphocytic thyroiditis (16%), Hashimoto thyroiditis (10%). Thyroid hormone analysis showed 66% euthyroid, 22% hypothyroid and 12% hyperthyroid. Conclusions: The study showed that FNAC and TFT profile both are essential for the proper management of thyroid lesions. FNAC along with hormonal analysis helps in proper patient assessment and management.  J-GMC-N | Volume 11 | Issue 01 | January-June 2018, Page: 17-2

Disinterested agents or mismatched plans? : Public administration capacities and climate change responses in the least developing countries

Purpose: Developed countries agreed at COP15 to pay US$100bn annually for adaptation and mitigation in developing countries. This paper aims to evaluate how prepared are donors and recipients to spend this money well by analyzing institutional and organizational capabilities for climate change adaptation in least developed country (LDC) administrations using the case of Nepal, a country which can be considered to be an archetypal LDC. Design/methodology/approach: The authors conducted over 100 in-depth structured qualitative interviews with government officials from across the organizational chain in the ministries concerned with climate change, ranging from

Community Survey Report: Pokhara-Lekhnath, Ritthepani-27, Nepal

Community diagnosis is defined as a comprehensive assessment of the state of an entire community in relation to its social, economic, physical and biological environment. It is a process of examining the patterns of disease or health status in the community in order to promote health, prevent disease and manage health services for the community people.  As per the curriculum of Tribhuwan University, B.Sc. Nursing first year, we were provided an opportunity to fulfill the practicum of community health nursing in the assigned area Shanti Tole and Teentara Tole, Pokhara, Lekhnath, Ritthepani-27 from 18th June to 14th July 2017. Total population of Ritthepani was 4529, male population was 2100 and female population was 2429. Each of the 13 students was assigned with 10 different families for community diagnosis in order to promote the health of the individual, family and community. The main objective of community diagnosis was to find out the health related aspects and to provide preventive, promotive, curative and rehabilitative services to the individual and the community as a whole. All the findings were presented among the key members of the community. On survey, total population of 130 houses was found 565, among them 296 were male population and 269 were female population. Sanitation of the community was inappropriate. People were not using the health facilities effectively so they were found suffering from different kinds of diseases most commonly gastritis. The common health seeking practice was going to governmental hospital and traditional healers

Burden of injuries in Nepal, 1990–2017: Findings from the Global Burden of Disease Study 2017

Background: Nepal is a low-income country undergoing rapid political, economic and social development. To date, there has been little evidence published on the burden of injuries during this period of transition.Methods: The Global Burden of Disease Study (GBD) is a comprehensive measurement of population health outcomes in terms of morbidity and mortality. We analysed the GBD 2017 estimates for deaths, years of life lost, years lived with disability, incidence and disability-adjusted life years (DALYs) from injuries to ascertain the burden of injuries in Nepal from 1990 to 2017.Results: There were 16 831 (95% uncertainty interval 13 323 to 20 579) deaths caused by injuries (9.21% of all-cause deaths (7.45% to 11.25%)) in 2017 while the proportion of deaths from injuries was 6.31% in 1990. Overall, the injury-specific age-standardised mortality rate declined from 88.91 (71.54 to 105.31) per 100 000 in 1990 to 70.25 (56.75 to 85.11) per 100 000 in 2017. In 2017, 4.11% (2.47% to 6.10%) of all deaths in Nepal were attributed to transport injuries, 3.54% (2.86% to 4.08%) were attributed to unintentional injuries and 1.55% (1.16% to 1.85%) were attributed to self-harm and interpersonal violence. From 1990 to 2017, road injuries, falls and self-harm all rose in rank for all causes of death.Conclusions: The increase in injury-related deaths and DALYs in Nepal between 1990 and 2017 indicates the need for further research and prevention interventions. Injuries remain an important public health burden in Nepal with the magnitude and trend of burden varying over time by cause-specific, sex and age group. Findings from this study may be used by the federal, provincial and local governments in Nepal to prioritise injury prevention as a public health agenda and as evidence for country-specific interventions

Menstrual hygiene management among women and adolescent girls in the aftermath of the earthquake in Nepal.

BACKGROUND: Menstrual hygiene management (MHM) is an essential aspect of hygiene for women and adolescent girls between menarche and menopause. Despite being an important issue concerning women and girls in the menstruating age group MHM is often overlooked in post-disaster responses. Further, there is limited evidence of menstrual hygiene management in humanitarian settings. This study aims to describe the experiences and perceptions of women and adolescent girls on menstrual hygiene management in post-earthquake Nepal. METHODS: A mixed methods study was carried out among the earthquake affected women and adolescent girls in three villages of Sindhupalchowk district of Nepal. Data was collected using a semi-structured questionnaire that captured experiences and perceptions of respondents on menstrual hygiene management in the aftermath of the Nepal earthquake. Quantitative data were triangulated with in-depth interview regarding respondent's personal experiences of menstrual hygiene management. RESULTS: Menstrual hygiene was rated as the sixth highest overall need and perceived as an immediate need by 18.8% of the respondents. There were 42.8% women & girls who menstruated within first week of the earthquake. Reusable sanitary cloth were used by about 66.7% of the respondents before the earthquake and remained a popular method (76.1%) post-earthquake. None of the respondents reported receiving menstrual adsorbents as relief materials in the first month following the earthquake. Disposable pads (77.8%) were preferred by respondents as they were perceived to be clean and convenient to use. Most respondents (73.5%) felt that reusable sanitary pads were a sustainable choice. Women who were in the age group of 15-34 years (OR = 3.14; CI = (1.07-9.20), did not go to school (OR = 9.68; CI = 2.16-43.33), married (OR = 2.99; CI = 1.22-7.31) and previously used reusable sanitary cloth (OR = 5.82; CI = 2.33-14.55) were more likely to use the reusable sanitary cloth. CONCLUSIONS: In the immediate aftermath of the earthquake, women and girls completely depended on the use of locally available resources as adsorbents during menstruation. Immediate relief activities by humanitarian agencies, lacked MHM activities. Understanding the previous practice and using local resources, the reusable sanitary cloth is a way to address the menstrual hygiene needs in the post-disaster situations in Nepal

Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3

Sustainable Development Goal (SDG) 3 aims to “ensure healthy lives and promote well-being for all at all ages”. While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas of SDG3, examine the association between outcomes and financing, and identify where resource gains are most needed to achieve the SDG3 indicators for which data are available