Journal Issue: Volume: 38, No. 1 (2016) April
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2016
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
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Articles
Mobile teledermatology for rural Nepal: Dermatologic care using mobile phone in a primary health care centre
(Institute of Medicine, 2016) Shrestha, DP; Suwash, B; Gurung, D; Uprety, A; Bhattarai, S
Abstract
Introduction: Skin diseases are among the five most common health problems in Nepal. We have now tested the validity of mobile teledermatology with mobile phones to find a safe and easy way of diagnosis and treatment of skin diseases for the most vulnerable people in remote areas without access to derma- tologists.
Methods: A medical officer at a primary health care centre examined the patient, obtained information of the patient and the skin disease, took photographs of the skin lesions. Then he transmitted all these data via Viber to a dermatologist in Kathmmandu, who in real time formulated diagnosis and treatment and sent it via Viber to the medical officer. Subsequently the patient was examined face to face by a blinded dermatologist at the same primary health care centre. The time taken for each modality of consultation was recorded. A third dermatologist analysed and compared the diagnoses formulated during telederma- tology and the face to face consultations.
Results: Altogether 107 skin diseases were diagnosed in 101 patients. There was an overall concordance of 88% between the diagnoses of skin diseases by mobile teledermatology and face to face consultations (Cohen k coefficient 0.85). The average face to face consultation time was 5 minutes, while it was 7 min- utes more for teleconsultation. More than 75% of the photos were of good quality.
Conclusions: Mobile teledermatology using smartphones is a reliable, useful, cost effective method to provide expertise for improving dermatologic care for the needy population in rural and remote parts of Nepal.
Keywords: teledermatology, dermatologic care, rural Nepal, mobile phones
Single visit approach for Cervical Cancer Prevention in a mobile screening clinic
(Institute of Medicine, 2016) Singh, M; Shrestha, S B; Manandhar, A; Ranjit, R; Pradhan, R; Shah, A; Verma, S; Malla, K
Abstract
Introduction: Cervical cancer is the third most common cancer in women worldwide, but the most preventable cancer. The objectives was to determine the feasibility and acceptability of immediately treating VIA positive women with thermocoagulation in a single-visit approach (SVA) in preventing cervical cancer.
Method: This was a community-based programme organized in collaboration with Nepal Australian Cervical Cancer Foundation and Thermocoagulation unit donated by Tropical Health and Education Trust in a mobile screening camp set up in five different underserved areas in Gorkha, Nepal. Total women were 1071 aged 30-60 yearrs in 5 days in December, 2016, had come for cervical cancer screening. Women who were VIA positive had thermocoaculation for treatment.
Results: Total screened women were 1071, the rate of VIA positive was 115(10.7%). 100% percent of positive result accepted treatment. All VIA positive patients except for one woman who was suspected of having invasive cervical cancer had treatment with thermocoagulation. Of all treated women only 5(4.38%) had minor side effect.
Conclusion: For cervical cancer screening, the single-visit program was feasible and the degree of acceptability was 100% in this underserved population. Single visit programs provide an opportunity to increase the rate of immediate treatment of lesions with minimal side effect compared with delayed treatment after obtaining colposcopy guided biopsy report in later visit.
Keywords: cervical cancer, mobile screening, VIA, SVA, thermocoagulation
Nephrotic syndrome in Nepalese children: clinical profile, histopathology and outcome in a tertiary care center of Nepal
(Institute of Medicine, 2016) Basnet, S; Poudel, DR; Khanal, S; Thapa, NB
Abstract
Introduction: The demographic, clinical features, steroid response, histopathology and complications of all children diagnosed with nephrotic syndrome at Tribhuvan University Teaching Hospital over a 3-year period.
Methods: A retrospective study was conducted among patients who were admitted in the Pediatrics ward of Tribhuvan University Teaching Hospital with the diagnosis of Nephrotic syndrome from April 2010 to April 2013.
Results: During the study period from 2010 April to 2013 April, there were total of 80 patients admitted with the diagnosis of nephrotic syndrome. There was male preponderance with sex ratio 1.28:1. Mean age of patient at first episode was 8.51±4.33 years. Among the admitted patients, 48.8% (41) of children had single episode whereas steroid resistance was observed in 16.2% (13) of patients. Hematuria and hypertension were present in 21.2% (7) and 50% (40) of patients respectively. Renal dysfunction was present in 21.2% (17). Pneumonia was the most common complications 18.8% (15), followed by UTI 8.8%(7), spontaneous bacterial peritonitis 3.8% (3) and acute renal failure 7.5% (8). Two patients had multiple complications. Alternative therapies were used in 25% (20) of patients and cyclophosphamide was used most commonly as alternative therapy which was used in 17.4% (14). Most common histopathological diagnosis was FSGS 30.3% (10) followed by MPGN 15.5% (5), SLE nephropathy 15.5% (5) and IgA nephropathy 15.5% (5)
Conclusion:
The clinical course of childhood NS in Nepal is similar to the developed world. Differences at Presentation included older age and increased prevalence of microscopic hematuria, hypertension.
Keywords: childhood, nephrotic syndrome, histology, outcome
Effectiveness of Educational Intervention on Life Style Management among Coronary Heart Disease Patients Attending a Cardiac Care Centre in Kathmandu
(Institute of Medicine, 2016) Shrestha, R; Shrestha, S
Abstract
Adopting healthy life style reduces Coronary Heart Disease (CHD) progressions which help to enhance quality of life of CHD patients. The aim of this study was to identify the effectiveness of educational intervention on "Living well with CHD".
Methods: A one group pretest-post test design was used. The study was conducted during November to December 2015. Total 100 subjects were selected for pre test, base line information were collected using convenient sampling technique. The educational intervention package of one hour teaching sessions were arranged in separate room in OPD of Sahid Gangalal National Heart Centre (SGNHC) regularly for one week period with one session per day and each participant was provided the booklet prepared in Nepali language during the education sessions. After one month of education intervention program, post test was conducted with 90 subjects using same interview questionnaire and feedback questionnaire.
Results: The result shows that the knowledge regarding life style management was significantly higher among post test group than pre test group at 0.0001 levels. The percentage of respondents with inadequate level of knowledge decreased sharply from 57% to 1% where as those with adequate knowledge increased to 99% from 43%, which was found to be statistically significant (p value=0.0001).
Conclusion: Study concludes that the education intervention programme has considerably in increased knowledge regarding life style management among CHD patients. Therefore, it is recommended that this educational intervention programme may be conducted to CHD patients in similar settings with fruitful outcome.
Keywords: Educational intervention, lifestyle management, coronary heart disease