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Paudel V.,Northumbria University | Baral K.P.,Patan Academy of Health science
Reproductive Health | Year: 2015

Background and objectives: Women living with HIV/AIDS, in particular, have been positioned as a latent source of infection, and have captivated culpability and blame leading to a highly stigmatised and discriminated life. Despite the situation, women and their particular concerns have largely been ignored in HIV/AIDS research literature. Methodology: A systematic literature search was carried out on major data bases ASSIA, CINAHL, Science Direct, Web of Knowledge, Wiley Inter Science, AMED, Pub Med/Bio Med Central, MEDLINE and Cochrane Library. The articles included for review purpose were gauged against the pre-defined inclusion/exclusion criteria and quality assessment checklist resulting in a final 7 papers. Findings/results: The findings were compiled into five thematic areas: (1) Disclosure as a sensitive issue; (2) Stigma and Discrimination associated with HIV/AIDS and the multidimensional effects on women's health and wellbeing; (3) Internalised Stigma; (4) Women living with HIV/AIDS experiences of being rejected, shunned and treated differently by physicians, family and close friends; (5) Support Group as among the best available interventions for stigma and discrimination. Conclusion: Support groups should be offered as a fundamental part of HIV/AIDS services and should be advocated as an effective and useful intervention. Further research is needed to examine the effect of support groups for women living with HIV/AIDS. A community based randomised controlled trial with support group as an intervention and a control group could provide further evidence of the value of support groups. © 2015 Paudel and Baral.

Shrestha I.,Patan Academy of Health science
Nepal Medical College journal : NMCJ | Year: 2010

Birth weight is an important determinant of infant's well being as low birth weight is known to increase the risk adult onset of diseases like type-2 diabetes and ischemic heart disease. Maternal weight gain is one of the most important independent predictors of infant birth weight. Institute of Medicine of the National Academics, USA has recommended that total weight gain of mothers should be according to their prepregnancy body mass index (BMI). Therefore, this study was conducted to observe the total weight gained by the pregnant women and the correlation between the weights gained by them with the birth weight of their infants. 98 women who delivered full term single baby at Patan hospital were included after taking their verbal consent. The details of the newborn and the history of the pregnant women were taken from the hospital records. The information about the family income, dietary habit, birth spacing and the type of work done by the pregnant women was obtained from the women themselves. The mean weight gain of the mothers was 9.48 (SD = 3.41) kilograms and the mean birth weight of the infants was found to be 2965.66 (SD = 364.37) grams. Multiple Liner Regression Models showed the effect of Gestational weight gain (GWG), Age and Parity on birth weight of the infant. Step-wise multiple regressions gave rise to models that showed effect of GWG and age on birth weight of the infants. This study concluded that gestational weight gain has positive linear relationship (correlation) with the birth weight of infants.

Holmes A.H.,Imperial College London | Moore L.S.P.,Imperial College London | Sundsfjord A.,University Hospital of North Norway | Sundsfjord A.,University of Tromsø | And 5 more authors.
The Lancet | Year: 2016

To combat the threat to human health and biosecurity from antimicrobial resistance, an understanding of its mechanisms and drivers is needed. Emergence of antimicrobial resistance in microorganisms is a natural phenomenon, yet antimicrobial resistance selection has been driven by antimicrobial exposure in health care, agriculture, and the environment. Onward transmission is affected by standards of infection control, sanitation, access to clean water, access to assured quality antimicrobials and diagnostics, travel, and migration. Strategies to reduce antimicrobial resistance by removing antimicrobial selective pressure alone rely upon resistance imparting a fitness cost, an effect not always apparent. Minimising resistance should therefore be considered comprehensively, by resistance mechanism, microorganism, antimicrobial drug, host, and context; parallel to new drug discovery, broad ranging, multidisciplinary research is needed across these five levels, interlinked across the health-care, agriculture, and environment sectors. Intelligent, integrated approaches, mindful of potential unintended results, are needed to ensure sustained, worldwide access to effective antimicrobials. © 2016 Elsevier Ltd.

Maharjan B.R.,Patan Academy of Health science
Journal of Nepal Health Research Council | Year: 2010

Type 2 diabetes is the leading cause of end stage renal disease worldwide. Prevalence of diabetic nephropathy (DN) varies in the different ethnic groups. Nepal is country with great ethnic diversity. This study has been done to find the prevalence of microalbuminuria and macroalbuminuria in the two ethnic groups Jyapu and Brahmin. In our study we have included two ethnic groups Jyapu and Brahmin type 2 diabetic patients. Inclusion criteria: Age ≥ 30 years, clinically diagnosed type 2 diabetic patients. Exclusion Criteria: Patients with a history of urinary tract infection, hematuria, renal failure, intercaste marriage and women with menstruation at the time of sample collection. The overall prevalence of albuminuria was 49.05%. The prevalence of microalbuminuria was 35.89% in Jyapu and 37.73% in Brahmin which was comparable. There was significantly higher prevalence of macroalbuminuria in Jyapu 20.75% and Brahmin 3.77%. Association of dietary habit was seen with microalbuminuria and macroalbuminuria in both ethnic groups. The overall prevalence of albuminuria in type 2 diabetes of our study was high and there was significantly higher macroalbuminuria in Jyapu compared with Brahmin. It, therefore, predicts a higher risk of having kidney disease in Jyapu population.

Sunuwar L.,Patan Academy of Health science
Nepal Medical College journal : NMCJ | Year: 2010

The present study was carried out to explore the mean age at menarche of school going girls of Western Nepal, Pokhara and to determine the factors influencing age at menarche. The data was collected from five schools located within the Pokhara Valley of Western Nepal. Only the students who had experienced menarche were included in the study. Verbal consent was obtained after explaining the objectives of the study; the students were interviewed for personal and family details and information obtained was recorded. The age at menarche was found to be 12.69 +/- 0.95 years. The mean age at menarche of those attending community schools was significantly higher than that of those attending private schools (12.85 +/- 0.87 vs 12.41 +/- 0.99 years). The mean age at menarche was found to be delayed with increase in number of family members and more siblings. The mean age at menarche of the vegetarians was higher than that of non-vegetarians (12.82. +/- 0.81 vs 12.68 +/- 0.95 years).

Butterworth K.,Patan Academy of Health science
Medical Teacher | Year: 2010

Background: Accurate self-assessment is essential to direct life-long learning. Most research on self-assessment is from the West. This study takes place in Kathmandu, Nepal. Aim: To develop tools to aid the development of self-assessment skills in Nepali doctors. Methods: Fifteen doctors were asked to complete three self-assessment tasks per month over a 6-month period; one mini-clinical evaluation exercise, one clinical case review and one significant event analysis. Self-assessment was compared with mentor assessment for each task. Changes over time for each individual were noted. Results were analyzed using SPSS 10.0. Self and tutor scores were compared using Pearson's correlation coefficient. Reliability of the tools was assessed using Cronbach's Alpha. Participants completed a qualitative questionnaire regarding each tool. Results: All three tools had high content and face validity, as well as reliability. The use of the "intra individual" approach, with multiple assessments over time demonstrated that most doctors were able to accurately self-assess in some areas. Feedback from a senior tutor was vital. Doctors appreciated feedback that was immediate, specific and delivered in a safe environment. Even where self-assessment was less accurate, the process itself helped to develop awareness of key learning issues. Conclusions: These self-assessment tools are feasible, reliable and valid for the hospital setting in Nepal. © 2010 Informa UK Ltd All rights reserved.

Shrestha S.,Patan Academy of Health science
Nepal Medical College journal : NMCJ | Year: 2012

Establishing and running a neonatal intensive care unit in a resource poor country is a big challenge. Neonatal Intensive care units (NICU) and Paediatric Intensive care units (PICU) has been started in Patan Hospital from July 2009. The in-born neonates are admitted to NICU and the out-born neonates to PICU. A retrospective hospital based study looking at the common indications for admission and the outcome of the neonates in the intensive care unit was carried out from July 2009 to December 2010. Data was collected from the admission discharge registers at the units and from patient record files. Over the 18 month period there were total 289 neonatal admissions, 214 to NICU and 75 to PICU. More than half of the neonates (53%) admitted to NICU and PICU were preterm. The most common neonatal condition leading to Intensive care unit (ICU) admissions was respiratory distress which accounted for 42%. Of the total neonates admitted to ICUs one third (33.5 %) needed mechanical ventilation. The most common conditions needing mechanical ventilation were hyaline membrane disease (33%) and severe sepsis (24%). The overall mortality rate was 26.6% .The mortality was higher among neonates weighing less than 2.5kg (32%) compared to those weighing >2.5kg (15.5%) (P value - 0.001) and it was higher in babies born before 34 weeks of gestation (P value - 0.009). Neonatal intensive care facilities though is expensive and not readily accessible, establishing a unit can not only save some of the precious lives but also helps in managing critically sick neonates aiming for an intact survival.

Thapa S.,Public Health Institute | Thapa S.,Geneva Foundation for Medical Education and Research | Thapa S.,Patan Academy of Health science | Neupane S.,Valley Research Group
International Journal of Gynecology and Obstetrics | Year: 2013

Objective: To examine the incidence of and risk factors for repeat abortion in Nepal. Methods: Data were analyzed from a survey of 1172 women who had surgical abortions between December 2009 and March 2010 in 2 clinics in Kathmandu, Nepal. Bivariate and multivariate logistic regressions were performed to estimate odds ratios for the risk factors. Results: Among the respondents, 32.3% (95% confidence interval, 29.6-34.9) had repeat abortions. This incidence rose sharply with age and parity, and was higher among those with no intention of having a future child, those attaining primary or secondary level education, and those attending the non-governmental sector clinic. Women with repeat abortion were similar to those with 1 abortion in terms of contraceptive practice. Among women not using contraceptives at the time of the unintended pregnancy, the 3 most commonly cited reasons were ill health, non-compliance with the method intended for use, and dislike of the method. Women with repeat abortion showed a pattern of contraceptive acceptance immediately after the procedure similar to that of women who had 1 abortion. Conclusion: Repeat abortion is emerging as a major public health issue in Nepal, with implications for counseling and provision of abortion, and for family planning services. © 2012 International Journal of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Sreeramareddy C.T.,University Tunku Abdul Rahman | Pradhan P.M.S.,Patan Academy of Health science | Mir I.A.,University Tunku Abdul Rahman | Sin S.,University Tunku Abdul Rahman
Population Health Metrics | Year: 2014

Background: In South and Southeast Asian countries, tobacco is consumed in diverse forms, and smoking among women is very low. We aimed to provide national estimates of prevalence and social determinants of smoking and smokeless tobacco use among men and women separately.Methods: Data from Demographic and Health Surveys completed in nine countries (India, Pakistan, Nepal, Bangladesh, Maldives, Philippines, Cambodia, Indonesia, and Timor Leste) were analyzed. Current smoking or smokeless tobacco use was assessed as response " yes" to one or more of three questions, such as " Do you currently smoke cigarettes?" Weighted country-level prevalence rates for socio-economic subgroups were calculated for smoking and smokeless tobacco use. Binary logistic regression analyses were done on STATA/IC (version 10) by 'svy' command.Results: Prevalence and type of tobacco use among men and women varied across the countries and among socio-economic sub groups. Smoking prevalence was much lower in women than men in all countries. Smoking among men was very high in Indonesia, Maldives, and Bangladesh. Smokeless tobacco (mainly chewable) was used in diverse forms, particularly in India, among both men and women. Chewing tobacco was common in Nepal, Bangladesh, Maldives, and Cambodia. Both smoking and smokeless tobacco use were associated with higher age, lower education, and poverty, but their association with place of residence and marital status was not uniform between men and women across the countries.Conclusion: Policymakers should consider type of tobacco consumption and their differentials among various population subgroups to implement country-specific tobacco control policies and target the vulnerable groups. Smokeless tobacco use should also be prioritized in tobacco control efforts. © 2014 Sreeramareddy et al.; licensee BioMed Central Ltd.

Paudyal B.P.,Patan Academy of Health science
Journal of the Nepal Medical Association | Year: 2011

Lemierre's syndrome is a rare septic thrombophlebitis of the internal jugular vein with frequent metastatic complications following an acute oropharyngeal infection. Immunocompromised patients are at higher risk of developing this syndrome owing to the decreased host response and increased risk of oropharyngeal sepsis. We herein report a 24-year-old woman with severe lupus nephritis on immunosuppressive therapy, who developed Lemierre's syndrome following a pharyngeal infection despite an adequate and timely antibiotic therapy. We hereby draw an attention to the importance of accurate and timely diagnosis and appropriate management of Lemierre's syndrome in immunocompromised patients so as to achieve a successful prognosis for this deadly infection.

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