Clinico-pathological characteristics of colorectal carcinoma at university teaching hospital, Nepal

Introductions: Colorectal cancer is a major health problem in developingcountries. The purpose of this study was to analyze the clinico-pathologicalcharacteristics of colorectal carcinoma at Patan hospital, Nepal.Methods: A retrospective chart review was done for patients operatedfor colorectal carcinoma at Patan Hospital from May 2004 to April 2012.Demographic information, chief complains, site of primary cancer, andhistological types were analyzed.Results: There were 73 patients (37 males and 36 females) with colorectalcarcinoma. The mean age was 52 years. There were 21 (28.77%) patients below 40 years of age. Patients with rectal carcinoma presented with bleeding per rectum in 69.70% and 60% of patients with colon cancer presented with pain abdomen. Rectum was involved in 31 (42.47%) and right colon in 30 (41.10%). Adenocarcinoma was seen in 72 (98.63%).Conclusions: The colorectal carcinoma is not only the disease of old age. Wehad 29% of our patients below 40 year. Rectum and right colon were equallyaffected.Keywords: bleeding, colorectal carcinoma, pain abdome

Attempting affirmative political ecologies: Collective transformative learning for social justice in Nepal's community forestry

Whilst political ecology scholarship has contributed much to articulating social injustices associated with Nepal's community forestry, here we took a different approach, by attempting an 'affirmative political ecology.' We drew on feminist and activist scholarship to inspire collective action that engaged directly with challenges of social justice and those charged with delivering it through their work. Guided by theories and practices of 'transformative learning' and a range of associated reflective practices, our participatory action research involved 4 facilitators and (up to) 25 participants who work across Nepal's forest bureaucracy (and for some, the wider community-based natural resource management sector). Together physically, remotely and through our writing, we reflect upon the operation of power in our professional – and personal – lives, exploring how that may enable a more informed and meaningful engagement with social justice within the workplace, and beyond. This article presents the process of our collective reflection and learning, and shares some of its initial outcomes based on the experiences of the 15 co-authors. Whilst 'simply' having the time and space to come together was hugely important, it was the form and feel of that space that was particularly significant, as we focused on co-creating a safe space which was non-judgmental and based on mutual respect, enabling comfortable and open discussion of often unspoken and uncomfortable issues. Ultimately, this article argues that collective practices of reflection and transformative learning can create shared learning, understanding, empathy and solidarity, and thus that it offers hope in the face of on-going social injustices. It therefore urges political ecologists to work towards such caring and affirmative collective engagements with practitioners as one way in which to affect change

Etiology of Acute Diarrheal Disease and Antimicrobial Susceptibility Pattern in Children Younger Than 5 Years Old in Nepal

Diarrhea is a common cause of morbidity and mortality among children younger than 5 years in developing countries. Children from 3 to 60 months of age were recruited from two hospitals in Nepal— Bharatpur Hospital, Bharatpur, and Kanti Children’s Hospital, Kathmandu—in 2006 to 2009. Stool specimens collected from 1,200 children with acute diarrhea (cases) and 1,200 children without diarrhea (control subjects) were examined for a broad range of enteropathogens by standard microbiology, including microscopy, enzyme immunoassay for viral pathogens (adenovirus, astrovirus, and rotavirus) and protozoa (Giardia, Cryptosporidium, and Entamoeba histolytica), as well as by using reverse transcription real-time polymerase for norovirus. Antimicrobial susceptibility testing was performed using the disk diffusion method. Overall, rotavirus (22% versus 2%), norovirus (13% versus 7%), adenovirus (3% versus 0%), Shigella (6% versus 1%), enterotoxigenic Escherichia coli (8% versus 4%), Vibrio (7% versus 0%), and Aeromonas (9% versus 3%) were identified significantly more frequently in cases than control subjects. Campylobacter, Plesiomonas, Salmonella, and diarrheagenic E. coli (enteropathogenic, enteroinvasive, enteroaggregative) were identified in similar proportions in diarrheal and non-diarrheal stools. Campylobacter was resistant to second-generation quinolone drugs (ciprofloxacin and norfloxacin), whereas Vibrio and Shigella were resistant to nalidixic acid and trimethoprim/sulfamethoxazole. This study documents the important role of rotavirus and norovirus in acute diarrhea in children younger than 5 years, followed by the bacteria Shigella, enterotoxigenic E. coli, Vibrio cholera, and Aeromonas. Data on the prevalence and epidemiology of enteropathogens identify potential pathogens for public health interventions, whereas pathogen antibiotic resistance pattern data may provide guidance on choice of therapy in clinical settings.publishedVersio

Use of antibiotics in children younger than two years in eight countries: A prospective cohort study

Objective: To describe the frequency and factors associated with antibiotic use in early childhood, and estimate the proportion of diarrhoea and respiratory illnesses episodes treated with antibiotics.Methods: Between 2009 and 2014, we followed 2134 children from eight sites in Bangladesh, Brazil, India, Nepal, Pakistan, Peru, South Africa and the United Republic of Tanzania, enrolled in the MAL-ED birth cohort study. We documented all antibiotic use from mothers’ reports at twice-weekly visits over the children’s first two years of life. We estimated the incidence of antibiotic use and the associations of antibiotic use with child and household characteristics. We described treatment patterns for diarrhoea and respiratory illnesses, and identified factors associated with treatment and antibiotic class.Findings: Over 1 346 388 total days of observation, 16 913 courses of antibiotics were recorded (an incidence of 4.9 courses per child per year), with the highest use in South Asia. Antibiotic treatment was given for 375/499 (75.2%) episodes of bloody diarrhoea and for 4274/9661 (44.2%) episodes of diarrhoea without bloody stools. Antibiotics were used in 2384/3943 (60.5%) episodes of fieldworker-confirmed acute lower respiratory tract illness as well as in 6608/16742 (39.5%) episodes of upper respiratory illness. Penicillins were used most frequently for respiratory illness, while antibiotic classes for diarrhoea treatment varied within and between sites.Conclusion: Repeated antibiotic exposure was common early in life, and treatment of non-bloody diarrhoea and non-specific respiratory illnesses was not consistent with international recommendations. Rational antibiotic use programmes may have the most impact in South Asia, where antibiotic use was highest

Influences on catch-up growth using relative versus absolute metrics : evidence from the MAL-ED cohort study

Acknowledgements The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) was a collaborative project led by the Foundation for the National Institutes of Health and the National Institutes of Health, Fogarty International Center. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the U.S. National Institutes of Health or Department of Health and Human Services. Funding The MAL-ED study was supported by the Bill & Melinda Gates Foundation, through grants to the Foundation for the National Institutes of Health, and with additional support from the National Institutes of Health, Fogarty Inter- national Center. The funder had no direct role in the writing of the manu- script or in the study design, data collection, analysis or interpretation of study results. We are grateful to the children and caregivers who participated in the study for their invaluable contributions.Peer reviewedPublisher PD

A growing global network’s role in outbreak response: AFHSC-GEIS 2008-2009

A cornerstone of effective disease surveillance programs comprises the early identification of infectious threats and the subsequent rapid response to prevent further spread. Effectively identifying, tracking and responding to these threats is often difficult and requires international cooperation due to the rapidity with which diseases cross national borders and spread throughout the global community as a result of travel and migration by humans and animals. From Oct.1, 2008 to Sept. 30, 2009, the United States Department of Defense’s (DoD) Armed Forces Health Surveillance Center Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) identified 76 outbreaks in 53 countries. Emerging infectious disease outbreaks were identified by the global network and included a wide spectrum of support activities in collaboration with host country partners, several of which were in direct support of the World Health Organization’s (WHO) International Health Regulations (IHR) (2005). The network also supported military forces around the world affected by the novel influenza A/H1N1 pandemic of 2009. With IHR (2005) as the guiding framework for action, the AFHSC-GEIS network of international partners and overseas research laboratories continues to develop into a far-reaching system for identifying, analyzing and responding to emerging disease threats

Full breastfeeding protection against common enteric bacteria and viruses : results from the MAL-ED cohort study

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Enteric dysfunction and other factors associated with attained size at 5 years : MAL-ED birth cohort study findings

Funding Information: The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) is carried out as a collaborative project supported by the Bill & Melinda Gates Foundation, the Foundation for the NIH, and the NIH/Fogarty International Center. This work was also supported by the Fogarty International Center, NIH (D43-TW009359 to ETR).Peer reviewe