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Kathmandu, Nepal

Oli N.,Kathmandu Medical College
Journal of Nepal Health Research Council | Year: 2012

Men having sex with men are hidden population in Nepal due to existing of stigma and discrimination in social, economic and others aspects. Due to present stigma and discrimination majority of men having sex with men do not have access to HIV/AIDS prevention programs that lead to unsafe sexual behavior.The objective of the study was to explore self-perception of stigma and discrimination among men having sex with men in Kathmandu valley. This is a qualitative study. Study was carried out between July 2010 and December 2010 in Kathmandu Valley, Nepal. During study 3 focus group discussions were conducted to explore stigma and discrimination of the respondents in their families, work place, health facilities, from law reinforcement body, and to explore methods of adaptation of men who have sex with men to stigma and discrimination in different areas of their life. A focus group discussions guideline was used for the discussion. Majority of the respondents who reported about discrimination from family members, in work place, in health care facilities and from law reinforcement body were Transgender (Meti). Many of respondents noticed that in some aspects discrimination seems to be decreasing due to rising awareness of homosexual relationship in the society. In spite on rising awareness among society regarding homosexual relationship there is still lots of stigma and discrimination faced by MSMs in all aspects of their life. Source

Bista M.,Kathmandu Medical College
Journal of Nepal Health Research Council | Year: 2011

Proper management of the disease depends upon accurate diagnosis. Fine Needle Aspiration Cytology has become the investigation of choice because of its high accuracy, simplicity, minimal-invasiveness, quick result and reliability. All the patients with thyroid disease, irrespective of age and gender, who underwent thyroid were studied. These patients had their fine needle aspiration Cytology was done in our centre. Detailed history, physical examination, routine investigations, radiological investigations (including CT scans when needed), hormonal assay, (T3, T4, TSH ), ultrasound of neck and FNAC were done. Pre- operative fine needle aspiration results were compared with histopathology results of operated specimen and then analyzed statistically to assess the sensitivity, specificity and accuracy of the result. There were total of 51 patients. Age ranges from 21 to 62 years. The study duration was from May 2006 to February 2011. Out of 51 patients, 82.35% (n=42) were females and 17.64% (n=9) were males. In 43 patients, FNAC showed benign lesions, of which 40 were true negative (TN) and three false negative (FN), which on histopathology reported malignancy. Remaining eight cases were diagnosed as malignancy on histopathology of which seven cases were true positive (TP), one case of false positive (FP) was detected in our study. Over all Sensitivity was 70% and specificity was 97.5% and accuracy of FNAC was 92.1%. FNAC should be performed in all cases of thyroid nodules because of its high sensitivity and specificity to differentiate benign from malignant lesions and counsel the patient as well as plan surgery accordingly. Expenditure, time and the hassle of revision surgery is minimized by the pre operative FNAC report. Source

Joshi S.K.,Kathmandu Medical College | Shrestha S.,Kakani Primary Health Center
Kathmandu University Medical Journal | Year: 2010

Diabetes Mellitus is a global health problem with a worldwide prevalence of 2.8% in 2000. Type 1 diabetes mellitus is an auto immune disorder genetically mediated, while type 2 is more of a life style induced disorder although the role of genetic susceptibility, infections are also equally strong. Many studies have backed up these statements. However, there have been very few researches that show association of diabetes with environmental factors like pollution, exposure to chemicals e.g. mercury, arsenic, psychological condition e.g. depression, stress, and socio-economic conditions e.g. occupation, earnings etc. Recently, the role of these factors in causation and progression of diabetes have received much attention. Thus, this review has been designed to explore more on association of diabetes with physical, socio-economic and psychological environment. Source

Koirala U.,Kathmandu Medical College
Journal of Nepal Health Research Council | Year: 2011

The reported prevalence of biliary tract disruption following laparoscopic cholecystectomy has ranged from 0% to 7% in early reports. Bile leaks are the most common biliary complication of laparoscopic cholecystectomy. Total 530 patients who had undergone laparoscopic cholecystectomy from January 2004 to November 2006 at Kathmandu Medical College Teaching Hospital were studied for biliary complications after laparoscopic cholecystectomy. We reviewed 500 laparoscopic cholecystectomies performed at our institution and found 13 cases of bile extravasation and/or biloma formation and/or bile duct injuries (prevalence, 2.6%). One bile duct transection was acutely recognized and treated with hepaticojejunostomy. Three lateral bile duct injuries were also acutely recognized, two of them were managed with primary repair of CBD without T tube and the other was managed with repair and T-tube drainage. Two patients had postoperative generalized biliary peritonitis, one of whom was undergone exploratory laparotomy and found to have lateral injury on CBD which was managed with repair and T-tube drainage, whereas the other was undergone diagnostic laparoscopy with clipping of duct of Lushka. Two patients presented within seven days with biloma, one was treated with percutaneous drainage alone, the other treated with percutanous drainage was found to be complete transection of CBD on subsequent ERCP and managed with late hepaticojejunostomy. One patient with continued bile leak from surgical drainage tube for more than one week was managed with ERCP, diagnosed to be bile leak from duct of Lushka, managed by sphincterotomy and bile duct stenting. One patient presented with obstructive jaundice 6 months after laparoscopic cholecystectomy was found to have Bismuth type II bile duct stricture and was undergone hepaticojejunostomy. The remaining three had bile leak from surgical drainage which resolved within one week without further complication. Laparoscopic cholecystectomy appears to be associated with a higher incidence of bile duct injury than previous reports of open cholecystectomy. Possible explanations include variant anatomy plus failure to obtain an operative cholangiogram, inadequate dissection, injudicious use of cautery or clip placement, inherent limitations of the procedure, or the learning curve associated with a new technology. Source

Dhakhwa R.,Kathmandu Medical College
Journal of Nepal Health Research Council | Year: 2012

Gastritis has a broad histopathologic and topographical spectrum and leads to different patterns of disease. The introduction of the Sydney system made it possible to grade histological parameters, identify topographic distribution and provide etiological information which would help to generate reproducible and clincally useful diagnoses. The aim of this study was to determine the prevalence of Helicobacter pylori in non-ulcer dyspepsia, duodenal ulcer and gastric ulcer; and to assess the histopathologic features associated with chronic gastritis. Gastric antral biopsy specimens from 200 patients were examined for the prevalence of H. pylori, and were classified and graded histologically. The overall colonization rate of H. pylori was 44%. The colonization rates were 85%, 67% and 41% in patients with duodenal ulcer, gastric ulcer and non-ulcer dyspepsia respectively. There was not much difference between the degree of atrophy and intestinal metaplasia in H. pylori positive and negative cases. Helicobacter gastritis is the commonest type of gastritis present in patients presenting with dyspeptic symptoms. It is more common in patients presenting with duodenal ulcer. Adequate sampling is a must for accurate diagnosis of H. pylori colonization. Source

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