Objectives Cervical cancer is the most common malignancy among Nepalese women. Rational prevention measures are informed by epidemiological data on human papillomavirus (HPV) prevalence. Methods Cervical specimens were obtained from 932 married women aged 15-59 years from the general population of Bharatpur, Nepal, as well as from 61 locally diagnosed invasive cervical cancers (ICC). HPV was detected using a GP5?/6? PCR-based assay. Results Among the general population, the overall prevalence of HPV was 8.6% (6.1% for high-risk types). Prevalence of abnormal Pap smears was 3.6%, including five high-grade squamous intraepithelial lesions. Residence in slum housing, lower education level, C3 sexual partners in a woman's lifetime, and husband's extramarital affairs were significantly associated with HPV positivity. HPV prevalence was relatively constant across all age groups. HPV16 was the most common type, both among the general population (1.9%) and among 54 women with HPVpositive ICC (68.5%). HPV18 (22.2%) and 45 (5.6%) were also common in ICC. Conclusions Nepal has an intermediate burden of HPV infection, lower than many areas in India and China. Approximately 80% of cervical cancer in Nepal is theoretically preventable by HPV16/18 vaccines. In the meantime, screen-and-treat approaches should be encouraged to overcome difficulties that were encountered to recall women with screening-positive findings.

Cervical cancer is the most common form of cancer among women in developing countries. Hospital based data in Nepal also showed cervical cancer is most commonly occurring cancer among women in Nepal. Pap smear is the very significant screening test for reduction of incidence and mortality from cervical cancer but many developing countries failed to obtain high coverage of target population. Hence failed to achieve major impact of cervical cancer screening. National guidelines for cervical cancer and prevention in Nepal is formulated in 2010 and set target population age range of 30-60 with 50% coverage of target population with in a five years span. This study was aimed to elicit baseline survey of cervical cancer screening in a locale where resource for cervical cancer screening is easily available. Population based cross sectional study was done from October 2006 to March 2007. 1547 ever married women aged 16–59 were selected with cluster randomization procedure from Bharatpur municipalities, where BPKMCH (BP Koirala Memorial Cancer Hospital) is located. Free cervical cancer screening was conducted in collaboration with International Agency for Research on Cancer (IARC) France and BPKMCH. Ethical clearance was obtained from Nepal Health Research council. Interviews were performed using a standard questionnaire to elicit required information. Out of 1033 participants 394 were 16-29 years old. Among them 117 (30%) had at least one Pap test prior coming to the clinic. 16(4%) were age 16-19, 42(11%) were age 20-24 and 59 (15%) were age 25-29. This concludes Present opportunistic cervical cancer screening in Bharatpur is directed towards screening significant proportion of women with less risk.DOI: http://dx.doi.org/10.3126/jmmihs.v1i4.11994Journal of Manmohan Memorial Institute of Health SciencesVol. 1, Issue 4, 2015page : 3-8

Introduction: During a week-long orientation program at KIST Medical College newly joined first year undergraduate medical (MBBS) students are introduced to the institution, to teaching-learning activities, to the MBBS curriculum and to faculty members. The program has been conducted previously for three batches of students but feedback has not been obtained. Hence the study was conducted to study knowledge and attitude scores of students before and after the orientation program among the newly joined fourth batch of students, and note student perception about the effectiveness of different sessions. Method: A questionnaire administered at the end of the program measured knowledge and attitudes of students about selected subject areas before and after the program. Students were asked to indicate their present level of knowledge and attitude and also indicate their levels at the beginning of the program. The median knowledge and attitudes scores were calculated and compared among male and female respondents. The median scores before and after the module was compared using appropriate nonparametric tests (p <0.05). The effectiveness of different lecture sessions was also studied. Result: Sixty-three of the 72 students (87.5%) participated in the study. Forty students (63.5%) were male, 21 (33.3%) were female and two did not mention their gender. The median knowledge and attitudes scores significantly increased after the program. The effectiveness score was 3 for most sessions expect a few where the score was 4. Conclusion: The knowledge and attitude scores in different subject areas improved after the module. The program was perceived by students to be effective. Orientation program for first year undergraduate medical students: knowledge, attitudes and perceptions

As data and metadata from the SARS-CoV-2 pandemic mature, the true impact on non-cancer, non-emergency surgical practice is becoming apparent. The authors present data on the impact of gallstone disease in their unit during 5 months of the COVID-19 pandemic (March 2020 to August 2020) compared with the equivalent period in 2019. Although the total number of patients presenting with gallstone disease was comparable, there was a decrease in patients with cholecystitis and perforation (although it is possibly too early for these to have presented), and there was a small but worrying increase in patients with gallstone pancreatitis. With the recent increase in alert level to 4 and increased government restrictions in an attempt to avoid a second national lockdown, a consistent national approach is required to mitigate these risks.

Complete androgen insensitivity syndrome is a rare X-linked recessive disorder. In patients with this syndrome, testicular tumors, especially seminoma, may develop after puberty. Gonadal malignancies like sertoli cell tumor, yolk sac tumor; embryonic teratoma and unclassified sex cord stromal tumor are rare in these patients. We present here, a case of complete androgen insensitivity syndrome with sertoli cell adenoma in a 25 years old patient who presented to us with history of primary amenorrhoea and bilateral inguinal swellings and was managed with bilateral gonadectomy.DOI: http://dx.doi.org/10.3126/njr.v1i1.6327 Nepalese Journal of Radiology Vol.1(1): 61-64

Introduction: The gut mucosa in portal hypertension is the seat of microcirculatory changes that compromise its integrity and increase its susceptibility to damage. The mucosal changes in portal hypertension may require pharmacological, directed endoscopic or portal decompressive therapy. The objective of the study is to find out various upper gastrointestinal tract endoscopic findings in patients of portal hypertension.Methods: A prospective, cross-sectional, observational study of sixty patients of portal hypertension was conducted from June to October 2009. The esophagus, stomach and upper duodenum was visualized for any changes, especially by taking the tip of the instrument close to the mucosa.Results: Out of total, 60, 47 (78.3%) cases were cirrhotic and 13 (21.7%) cases were non-cirrhotic portal hypertension. The most frequent upper GI endoscopic finding was esophageal varices 56 (98.3%) followed by gastropathy 49 (81.6%), gastric hyperemia 19 (31.6%), duodenal hyperemia and erosive gastritis 16 (26.6% in each) and gastric varices 12 (20%). Esophageal varices were equally prevalent among cirrhotic and non cirrhotic portal hypertensive patients, 46 out of 47 (97.9%) and 13 out of 13 (100%) respectively. Gastropathy was more prevalent in cirrhotic patients with 87.2% vs. 75% in NCPF followed by 40% in EHO. However, duodenal ulcers were seen only in EHO 12.5%. Erosive gastritis was more prevalent in EHO (75%) followed by NCPF (60%), however, it was less frequent in cirrhotic portal hypertension (14.8%).Conclusions: The most common upper GI endoscopic finding in portal hypertensive patients were found to be esophageal varices followed by gastropathy, peptic ulcer disease (gastric and duodenal hyperemia, chronic gastritis, erosive gastritis, gastric ulcer and duodenal ulcer)._______________________________________________________________________________________Keywords: gastrointestinal tract; portal hypertension; varices.

Introduction: We are increasingly noticing isolated left axis deviation (LAD) in electrocardiogram in younger people with diabetes without obvious heart disease and association of LAD with glucose intolerance has not been explicitly raised before. We planned a study of ambulatory adults with borderline (0o to –30o) and moderate-to-marked (<–30o to –90o) LAD looking into their possible association with glucose intolerance with fasting plasma glucose (FPG) ≥100mg/dL. Methods: We consecutively enrolled adults aged 30 or more, with electrocardiogram normal duration QRS axis between 0o to –90o, without cardiac symptoms, not on any medication, attending outdoor-clinics for health checkup. Results: Out of 100 participants enrolled, about 90% were aged between 30 and 60 and 47% had borderline and 53% moderate-to-marked LAD. Moderate-to-marked LAD group had higher frequencies of abnormal blood pressure (BP), FPG, and lipids than borderline LAD group even after conditioning effects of age and sex (p≤0.03) and of FPG after conditioning effects of BP (p=0.02). The frequencies of glucose intolerance were 48.9% even in borderline LAD with 84.9% in moderate-to-marked LAD group. In moderate-to-marked LAD group mean values of BP, FPG, and lipid profiles were higher (p<0.001) and abnormal. In borderline LAD group though mean BP and lipid values were normal, FPG was impaired. Conclusions: Impaired mean FPG values and high frequencies of glucose intolerance in both borderline LAD group with normal BP and moderate-to-marked LAD group with conditioning of effects of BP in relatively younger ambulatory adults without cardiac symptoms indicate possible association between LAD and glucose intolerance. Keywords: diabetes; ecg; glucose intolerance; left axis deviation.

BackgroundThe national treatment guidelines of Nepal have adopted Artemisinin Combination Therapies (ACTs) for the treatment of uncomplicated falciparum malaria since 2004. Emergence of Artemisinin resistance in the Greater Mekong Sub-region (GMS) and beyond may become a threat for Nepal as well. The main objective of this study was to assess the therapeutic efficacy of antimalarial drug artemether-lumefantrine in uncomplicated P. falciparum infected patients at health centers/hospitals treated over the period of 2 years (2013–2014).MethodsGiemsa stained thick and thin smears, prepared from uncomplicated falciparum malaria patients who visited the selected sentinel sites in Nepal during 2013 to 2014 and met the inclusion criteria that included parasitemia (1000–10,000 /μL of blood), were evaluated until 28 days after ACTs treatment, following a World Health Organization (WHO) therapeutic efficacy protocol. Based on the re-occurrence of fever and resurge in parasitemia, the study patients were classified as resistant or susceptible. Blood specimens on filter papers were further analyzed by Polymerase Chain Reaction (PCR), specifically for the K13 propeller gene mutation (a recently identified molecular marker for ACT resistance).ResultsA total of 56,013 suspected malaria cases were screened for this study. Of which, 120 (0.21%) were infected with falciparum malaria. Out of 120, 28 cases of P. falciparum (28/120; 23.33%) were enrolled in the study, of which 24 cases completed the post-treatment follow up for 28 days. Only one case out of 24 (4%) was identified as a late treatment failure (LTF). K13 mutation, a proxy indicator for ACT resistance in parasites, was not detected on the day 1, which indicates resistance had not yet reached the molecular level.ConclusionOnly one case of late treatment failure was identified in this study. ACT combination using artemether-lumefantrine was still effective for the treatment of uncomplicated falciparum malaria in Nepal. A close monitoring and supervision for ACT resistance is essential for future malaria treatment in Nepal.