Browsing by Author "Mandal, A"
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Publication Clinical Practice Recurrent Severe Obscure Gastro Intestinal- Bleeding in a 20 Year Old Man(Kathmandu Unversity, 2013) Breidert, M; Mandal, A; Koller, A; Huellebrand, N; Malla, BABSTRACT Morbus Osler-Weber-Rendu syndrome also known as Hereditary hemorrhagic telangiectasia (HHT) and Meckel’s diverticulum is a rare combination disorder. Our case presented with the recurrent obscure gastrointestinal (GI) bleeding for several years. He came with a massive active lower gastrointestinal bleeding. Ultimatively, he underwent an exploratory laparotomy along with intraoperative colonoscopy. A Meckel’s diverticulum in combination with multiple erosions was found as a probable cause of the massive gastrointestinal bleeding. An ileo-caeacal resection had been performed and by the pathologist multiple telangiectasias in the resected ileum were established. Blood was sent for genetics and was negative for ENG, ALK-1, and SMAD-4 genes. The patient was discharged after 10 days from time of admission and is under regular follow up without any further bleeding. In this case, despite sophisticated techniques for investigations the cause of the GI-bleeding with several esophagogastroduodenoscopies and colonoscopies, mesenteric angiography and finally an oral double balloon enteroscopy was misdiagnosed till the intra operative endoscopy showed a middle GI-bleeding. The management for obscure GI-bleeding is discussed for countries with lower medical facilities like Nepal in our case with Morbus Osler-Weber-Rendu syndrome. KEY WORDS Meckel`s diverticulum, middle gastrointestinal bleeding, morbus osler-weber-renduPublication Knowledge and practice regarding menstrual hygiene in rural adolescent girls of Nepal(Kathmandu university, 2007) Adhikari, P; Kadel, B; Dhungel, Sl; Mandal, AObjective: This study was done in the adolescent girls to evaluate the knowledge and practice on different aspects of menstrual hygiene. Methods: One hundred and fifty adolescent girls of age 13-15 years from 3 schools of Shivanagar and Patihani village development committees of Chitwan district were involved in this study. Altogether 27 questions were asked to each of them. Results: During our study, we found that they were not properly maintaining the menstrual hygiene. Only 6.0% of girls knew that menstruation is a physiologic process, 36.7% knew that it is caused by hormones. Ninety-four percentages of them use the pads during the period but only 11.3% dispose it. Overall knowledge and practice were 40.6% and 12.9% respectively. Conclusion: Although knowledge was better than practice, both were not satisfactory. So, the girls should be educated about the process and significance of menstruation, use of proper pads or absorbents and its proper disposal. This can be achieved by giving them proper training and health education (by teachers, family members, health educators, and media) so that there won't be any misconception to the adolescent girls regarding menstrual hygiene. Key words: Menstrual Hygiene, adolescent Girls and Nepal