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.

Menstrual Exclusions in Nepal: Some Evidence of Transition

There is a long history of menstrual restrictions, stigmas and taboos across nearly all religions, regions and cultures. The origins of myths and misconceptions have often been linked to various religious texts and women were prohibited from participating in normal life while menstruating. Culturally, in many parts of the world, menstruation is still considered ‘dirty’ and ‘impure’, although this is not true. Menstruation is often associated with feelings of shame, horror, danger, disgust, and sin. There have been initiatives to change the perception that menstruating women are not polluted, thus bringing an end to traditional customs such as not being allowed to sleep in their own home or touch male relatives to more extreme forms of isolation such as being confined to the ‘cow shed’. This paper draws on research conducted between 2019 and 2021 under a British Academy-funded Global Challenge Research Fund project entitled ‘Dignity Without Danger’. The study employed qualitative methods, covering 160 qualitative interviews and 16 focus group discussions among different caste and ethnic groups in three different ecological areas (mountain, hill, and tarai) in seven provinces in Nepal. Today, menstruating women have relatively more freedom to discuss this topic due to increased awareness that menstruation is a natural process. However, our study shows there are still differences between cultures, religions, castes and ethnic groups, and regions, and a single narrative does not represent the issues related to menstrual exclusion in Nepal. The study shows that many menstruating girls and women are still restricted in a number of diverse ways, from not offering prayers, entering or worshiping in temples, touching holy books, and participating in religious rituals. In some areas, more extreme practices persist which discriminate against women when menstruating. Our research highlights that education and an interdisciplinary, multisector approach are required if menstrual discrimination is to be addressed. Finally, this paper emphasizes the necessity for providing correct knowledge about menstruation to the entire community including elders, males and religious leaders as well as adolescents and young girls. Such knowledge will help them practice safe and hygienic menstrual practices, challenge and reduce their traditional beliefs, misconceptions and restrictions regarding menstruation that are essential to achieving menstrual dignity

Acquired fluoroquinolone resistance genes in corneal isolates of Pseudomonas aeruginosa

Fluoroquinolones are widely used as an empirical therapy for pseudomonal ocular infections. Based on increasing reports on acquired fluoroquinolone resistance genes in clinical isolates of Pseudomonas aeruginosa, we investigated 33 strains of P. aeruginosa isolated from the cornea of microbial keratitis patients in India and Australia between 1992 and 2018 to understand the prevalence of acquired fluoroquinolone resistance genes in ocular isolates and to assess whether the possession of those genes was associated with fluoroquinolone susceptibility. Fourteen out of 33 strains were resistant to at least one fluoroquinolone. We obtained the whole genome sequence of 33 isolates using Illumina MiSeq platform and investigated the prevalence of two fluoroquinolone resistance genes crpP and qnrVC1. To examine the associated mobile genetic elements of qnrVC1 positive strains, we obtained long read sequences using Oxford Nanopore MinION and performed hybrid assembly to combine long reads with Illumina short sequence reads. We further assessed mutations in quinolone resistance determining regions (QRDRs) and antibiotic susceptibilities to ciprofloxacin, levofloxacin and moxifloxacin to examine the association between resistance genes and phenotype. Twenty strains possessed crpP in genetic islands characterised by possession of integrative conjugative elements. The qnrVC1 gene was carried by four isolates on class I integrons and Tn3 transposons along with aminoglycoside and beta-lactam resistance genes. We did not observe any evidence of plasmids carrying fluoroquinolone resistance genes. Resistance to fluoroquinolones was observed in those strains which possessed crpP, qnrVC1 and that had QRDRs mutations. The presence of crpP on its own was not associated with increased resistance to fluoroquinolones

Nonlinear lattice dynamics as a basis for enhanced superconductivity in YBa2Cu3O6.5

THz-frequency optical pulses can resonantly drive selected vibrational modes in solids and deform their crystal structure. In complex oxides, this method has been used to melt electronic orders, drive insulator to metal transitions or induce superconductivity. Strikingly, coherent interlayer transport strongly reminiscent of superconductivity can be transiently induced up to room temperature in YBa2Cu3O6+x. By combining femtosecond X-ray diffraction and ab initio density functional theory calculations, we determine here the crystal structure of this exotic non-equilibrium state. We find that nonlinear lattice excitation in normal-state YBa2Cu3O6+x at 100 K causes a staggered dilation/contraction of the Cu-O2 intra/inter- bilayer distances, accompanied by anisotropic changes in the in-plane O-Cu-O bond buckling. Density functional theory calculations indicate that these motions cause dramatic changes in the electronic structure. Amongst these, the enhancement in the dx2-y2 character of the in-plane electronic structure is likely to favor superconductivity.Comment: 28 pages, including Supplemen

Overcoming the challenges facing Nepal's health system during federalisation: an analysis of health system building blocks.

Nepal's move to a federal system was a major constitutional and political change, with significant devolution of power and resources from the central government to seven newly created provinces and 753 local governments. Nepal's health system is in the process of adapting to federalism, which is a challenging, yet potentially rewarding, task. This research is a part of broader study that aims to explore the opportunities and challenges facing Nepal's health system as it adapts to federalisation. This exploratory qualitative study was conducted across the three tiers of government (federal, provincial, and local) in Nepal. We employed two methods: key informant interviews and participatory policy analysis workshops, to offer an in-depth understanding of stakeholders' practical learnings, experiences, and opinions. Participants included policymakers, health service providers, local elected members, and other local stakeholders. All interviews were audio-recorded, transcribed, translated into English, and analysed thematically using the six WHO (World Health Organization) health system building blocks as a theoretical framework. Participants noted both opportunities and challenges around each building block. Identified opportunities were: (a) tailored local health policies and plans, (b) improved health governance at the municipality level, (c) improved health infrastructure and service capacity, (d) improved outreach services, (e) increased resources (health budgets, staffing, and supplies), and (f) improved real-time data reporting from health facilities. At the same time, several challenges were identified including: (a) poor coordination between the tiers of government, (b) delayed release of funds, (c) maldistribution of staff, (d) problems over procurement, and (e) limited monitoring and supervision of the quality of service delivery and data reporting. Our findings suggest that since federalisation, Nepal's health system performance is improving, although much remains to be accomplished. For Nepal to succeed in its federalisation process, understanding the challenges and opportunities is vital to improving each level of the health system in terms of (a) leadership and governance, (b) service delivery, (c) health financing, (d) health workforce, (e) access to essential medicines and technologies and (f) health information system. [Abstract copyright: © 2023. Crown.

A development cooperation Erasmus Mundus partnership for capacity building in earthquake mitigation science and higher education

Successful practices have shown that a community’s capacity to manage and reduce its seismic risk relies on capitalization on policies, on technology and research results. An important role is played by education, than contribute to strengthening technical curricula of future practitioners and researchers through university and higher education programs. EUNICE is a European Commission funded higher education partnership for international development cooperation with the objective to build capacity of individuals who will operate at institutions located in seismic prone Asian Countries. The project involves five European Universities, eight Asian universities and four associations and NGOs active in advanced research on seismic mitigation, disaster risk management and international development. The project consists of a comprehensive mobility scheme open to nationals from Afghanistan, Bangladesh, China, Nepal, Pakistan, Thailand, Bhutan, India, Indonesia, Malaysia, Maldives, North Korea, Philippines, and Sri Lanka who plan to enroll in school or conduct research at one of five European partner universities in Italy, Greece and Portugal. During the 2010-14 time span a total number of 104 mobilities are being involved in scientific activities at the undergraduate, masters, PhD, postdoctoral and academic-staff exchange levels. Researchers, future policymakers and practitioners build up their curricula over a range of disciplines in the fields of earthquake engineering, seismology, disaster risk management and urban planning