Stigma related to tuberculosis among patients attending DOTS clinics of Dharan municipality

BACKGROUND

The patients suffering from tuberculosis are receiving shame and unfair treatment from the people living around them within their own society attending DOTS clinic of Dharan municipality.

OBJECTIVE

To assess the stigma experienced by tuberculosis patients and to find out the association between stigma experienced by Tuberculosis patient and the selected variables (socio-demographic characteristics, clinical profile and illness experience).

METHODS

Descriptive Cross Sectional study was done among sixty tuberculosis patients. Stratified random sampling was used to select the main center and sub center of Tuberculosis treatment and population proportionate simple random sampling using lottery method was done. Data was collected using predesigned, pretested performa from Explanatory Model Interview Catalogue developed by World Health Organization.

RESULTS

The study revealed that 63.3% of the subjects were stigmatized. There was association between stigma and variables such as occupation, monthly family income and past history of Tuberculosis. There was also association of stigma with treatment phase, category of the patient and past outcome of illness.

CONCLUSION

Due to lack of knowledge and awareness about Tuberculosis, many patients were stigmatized. Efforts should be made to educate the public about Tuberculosis to reduce stigma experienced by Tuberculosis patients and improve the compliance of the patient.

Understanding of tobacco and lung cancer among medical students in Kathmandu University School of Medical Sciences (KUSMS)

BACKGROUND

Often, lung cancer is diagnosed at terminal stages. Poor awareness about the symptoms or risk factors of lung cancer among medics may be one of the factors for delayed diagnosis.

OBJECTIVE

We explored the knowledge of medical students and their behavior with the patients of lung cancer.

METHOD

Qualitative and quantitative approaches were used for data collection from 153 medical student of Kathmandu University School of Medical Sciences from December 2011 to May 2012.

RESULTS

Among the results, eighty-nine students had over 80% knowledge of the 14 cancer warning signs, among them 83% knew the nine risk factors for lung cancer. Twenty-three students told lung cancer can be hereditary. Sixty five percent of all participants believed that lung cancer can be detected at early stage; of them 81% told that it can be treated. About 24% of the total students were current or exsmokers and about half of them believed that lung cancer does not occur in light smokers. Only 10% have heard of Framework Convention on Tobacco Control in Nepal.

CONCLUSION

Study finds that all medical students who know about any cancers may not necessarily have knowledge about lung cancers. Their perception about the cause of lung cancer may be influenced by their smoking behavior and there was little knowledge of public health measures for smoking control. Awareness about national policies needs to be increased.

The demographics of molar pregnancies in BPKIHS

This is an analysis of the incidence of molar pregnancies and those of complete and partial molar pregnancies across the reproductive age range for BP Koirala Institute of Health Sciences (BPKIHS) in the period 2010-2011. Patients with molar pregnancies registered with BPKIHS from January 2008 to January 2010 were identified. The overall number of molar pregnancies registered was compared to the number of maternities (live births and still births) and total viable conceptions for this year. A retrospective study of 64 cases of molar pregnancies recorded at BPKIHS during the two year time was done. Medical records were reviewed. Incidence, clinical presentation and methods of diagnosis were studied. During the study period, there were 37 complete moles, 23 partial moles, 1 persistent gestational trophoblastic tumor, 1 choriocarcinoma, and 2 invasive moles. The incidence of molar pregnancy was 3.94 per 1000 deliveries. Median distribution was at 22 years of age, and majority (67%) presented during early second trimester. Twenty one (32.8%) women were of blood group A positive and ten (15.6%) presented with severe form of anemia. This study provides detailed data regarding the incidence of partial and complete molar pregnancies with increasing maternal age. It confirms the relation of molar pregnancy with age, and blood group. Complete mole had the highest incidence, affecting mostly younger age group, and usually in the first half of their pregnancy.

Retroperitoneal hydatid cyst challenging the diagnosis: Case report with review of literature

INTRODUCTION

Hydatid cyst is a zoonotic disease caused by a tapeworm, Echinococcus granulosus. A retroperitoneal hydatid cyst is extremely rare and its diagnosis can be challenging, particularly in the early stage as it can mimic several regional pathologies like pancreatic pseudocyst, pancreatic neoplasm, and other retroperitoneal cystic lesions.

PRESENTATION OF CASE

We report a rare case of 39-year-old Nepalese male with a left retroperitoneal hydatid cyst who presented with pain and feeling of mass in the left flank region for 6 months. Diagnosis was made by abdominal computed tomography and magnetic resonance imaging and management was done by partial cystectomy.

DISCUSSION

Retroperitoneal hydatid cysts can present with chronic pain, mass, and symptoms resulting from the mass effect which varies according to the different retroperitoneal locations. Diagnosis of the retroperitoneal cyst can be challenging clinically and radiologically in its early stages. Even in the late stage, ultrasonography may not suffice and additional imaging techniques such as computed tomography or magnetic resonance imaging are required for the diagnosis.

CONCLUSION

In endemic areas, hydatid cyst should be considered while dealing with a retroperitoneal swelling for early diagnosis and prevention of rupture. With a high level of clinical suspicion and radiological findings, retroperitoneal hydatid cyst can be diagnosed and surgery is the principal method of treatment.

A fatal presentation of dermatomyositis

Dermatomyositis (DM) is an autoimmune disease that mainly affects the skin, muscle, and lung. The pathogenesis of skin inflammation in DM is not well understood. We present a 40-year-old male who presented with four months history of generalized skin lesion, pain and weakness. He had elevated transaminases with detectable muscle weakness. This case highlights the need to consider dermatomyositis with skin lesion and weakness; and the use of aggressive immunosuppressive therapies due to its associated vasculopathies.

Delayed identification of massive pituitary apoplexy in pregnancy: A case report

Introduction and importance

Pituitary apoplexy is a very rare cause of sudden and severe headache with a neuro-ophthalmic deficit during pregnancy due to hemorrhage or infarction in the pituitary gland. Delayed identification can be life-threatening to both mother and baby.

Case presentation

A 40-year-old nulliparous female without any prior comorbidities in her 21 weeks of gestation presented with complaints of severe headache, vomiting, decreased vision, and altered sensorium for five days. On a low index of suspicion of pituitary apoplexy, she was managed in the line of impending eclampsia at a local center. On presentation to our center; the neurological deficit had progressed. CT head showed massive pituitary apoplexy with sellar and suprasellar extension. She underwent emergency right pterional craniotomy and resection of the tumor with hematoma evacuation but lost her life on her 2nd postoperative day.

Discussion

In the context of pregnancy, the diagnosis of pituitary apoplexy can get tricky and overlap with other common conditions such as preeclampsia or eclampsia. Magnetic resonance imaging (MRI) is the most sensitive investigation to confirm the diagnosis. Corticotropic deficiency with adrenal insufficiency is a potentially life-threatening disorder for both mother and the fetus if left untreated. The choice between conservative management and surgical approach depends on the neuro-ophthalmic signs, MRI findings, and gestational week.

Conclusion

Pituitary apoplexy should be a differential diagnosis of acute severe headache in pregnancy which when suspected should be investigated promptly. Early identification and multi-disciplinary team management are imperative for better outcomes.

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Pituitary apoplexy is a very rare condition in pregnancy.

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It presents with a sudden and severe headache with neuro-ophthalmic deficits due to hemorrhage in the pituitary gland.

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Delayed identification can have a grave outcome to both mother and baby.