Introduction Cervical cancer is a global leading cause of morbidity and mortality. The majority of cervical cancer deaths occur in developing countries including Nepal. Though knowledge of cervical cancer is an important determinant of women’s participation in prevention and screening for cervical cancer, little is known about this topic in Nepal. This study explores the experiences of cervical cancer survivors and assesses the attitude of family and community towards it and stigma related to this disease in Bharatpur, Nepal. Methods The study design was qualitative methods involving two focus-group discussions. A total of 17 cervical cancer survivors, who have completed two years of cancer treatment were selected purposively from Chitwan. All qualitative data were transcribed and translated into English and were thematically analyzed. Results The majority of the participants had scant knowledge about cervical cancer, its causative agent, showed less cervical cancer screening, delayed healthcare-seeking behavior despite having persistent symptoms before the diagnosis. The main reasons identified for not uptaking the cervical screening methods were an embarrassment and having no symptoms at all. Most of them endured social stigma related to cervical cancer in the form of physical isolation and verbal abuse. Conclusions There is an urgent need for interventions to make women and the public aware of cervical cancer and launch effective health education campaigns, policies for cervical cancer prevention programs. This implementation can save the lives of hundreds of women and help them avoid going through all the negative experiences related to cervical cancer. More studies are required to gain the perspectives, knowledge, experiences, and attitudes of cervical cancer survivors to add to the research.

Introduction Cancer is the second leading cause of death and a major public health problem in the world. This study reports the trend and burden of cancer from 1990 to 2017 along with its risk factors in Nepal. Methods This study used the database of the Institute of Health Metrics and Evaluation’s Global Burden of Diseases on cancer from Nepal to describe the most recent data available (2017) and trends by age, gender, and year from 1990 to 2017. The data are described as incidence, prevalence, disability-adjusted life years (DALY), and percentage change. Results In 2017, the age-standardized cancer incidence and mortality rates were 101.8/100,000 and 86.6/100,000 respectively in Nepal. Cancer contributed to 10% of total deaths and 5.6% of total DALYs in Nepal. The most common cancers were the breast, lung, cervical, stomach and oral cavity cancers. The number of new cancer cases and deaths in Nepal have increased from 1990 to 2017 by 92% and 95% respectively. On the other hand, age-standardized incidence and mortality rates decreased by 5% and 7% respectively. The leading risk factors of cancer were tobacco use, dietary factors, unsafe sex, air pollution, drug use, and physical inactivity. Conclusions This study highlighted the burden of cancer in Nepal, contributing to a significant number of new cancer cases, deaths and DALY. A comprehensive approach including prevention, early diagnosis and treatment, and rehabilitation should be urgently taken to reduce the burden of cancer.

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15 Introduction 16 Cervical cancer is a global leading cause of morbidity and mortality. The majority of cervical 17 cancer deaths occur in developing countries including Nepal. Though knowledge of cervical 18 cancer is an important determinant of women's participation in prevention and screening for 19 cervical cancer, little is known about this topic in Nepal. This study explores the experiences of 20 cervical cancer survivors and assesses the attitude of family and community towards it and 21 stigma related to this disease in Bharatpur, Nepal.22 23 Methods 24The study design is qualitative methods involving two focus-group discussions. A total of 17 25 cervical cancer survivors were selected purposively from Chitwan. All qualitative data were 26 transcribed and translated into English and were thematically analyzed. 28 Results 29Majority of the participants had scant knowledge about cervical cancer, its causative agent, 30 showed less cervical cancer screening, delayed healthcare-seeking behavior despite having 31 persistent symptoms before the diagnosis. The main reasons identified for not uptaking the 32 cervical screening methods are an embarrassment and having no symptoms at all. Most of them 33 endured social stigma related to cervical cancer in the form of physical isolation and verbal 34 abuse. 35 36 Conclusions 3 37 There is an urgent need for interventions to make women and the public aware of cervical cancer 38 and launch effective health education campaigns, policies for cervical cancer prevention 39 programs. This implementation can save the lives of hundreds of women and help them avoid 40 going through all the negative experiences related to cervical cancer. More studies are required 41 to gain the perspectives, knowledge, experiences, and attitudes of cervical cancer survivors to 42 add to the research.43 44 45 46 4 47 48 Cervical cancer is the second most common cancer in females from low-to-middle-income 49 countries. Around 310,000 deaths occur annually due to cervical cancer [1]. Human 50 papillomavirus (HPV) infection is the major cause of cervical cancer. Although most cases of HPV 51 will resolve on their own, persistent infection with certain types of HPV (types 16 and 18) on the 52 cervix can lead to precancerous lesions that can progress to cervical cancer [2]. Nepal has a 53 population of 10.1 million women aged 15 years and older who are at higher risk of acquiring 54 cervical cancer. Cervical cancer is the most frequent cancer among women between 15-44 years 55 of age and it also ranks as 1 st most frequent cancer among women in Nepal. According to the latest 56 data around 1928 women die yearly out of a total of 2942 women who are diagnosed with cervical 57 cancer yearly in Nepal [3]. 58 Early detection of HPV infection through the utilization of Papanicolaou (Pap) testing has been 59 shown to decrease rates of cervical cancer. Because of restricted access to the health care facility 60 and limited knowledge about the preventive techniques for cervical malignancy, the greater part ...

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Introduction: Tetanus is an acute onset neurological disease that is often lethal. It has a high disease burden in low and middle-income countries. Tetanus is caused by a toxin made by spores of the bacterium Clostridium tetani, which are found in soil, dust, and animal feces. The toxin impairs the motor neurons leading to muscle stiffness. However, with the development of a toxoid vaccine, the incidence has sharply declined and is now categorized as a vaccine-preventable disease. The treatment of tetanus is primarily supportive and focuses on managing the complications until the effects of toxins resolve. Case Report: We report the case of a 67-year-old farmer who previously sustained a laceration injury approximately 45 days prior to presenting to the emergency department with abdominal pain and rigidity. After a comprehensive evaluation to rule out other items in the differential diagnoses, he was diagnosed with tetanus based on clinical symptoms and ultimately required mechanical ventilation. The patient was then managed in the intensive care unit and later made an uneventful recovery. Conclusion: This case illustrates an uncommon presentation of tetanus and the latency of the infectious process. Often when patients present with atypical symptoms, it poses a diagnostic dilemma to the clinicians. Thus, it is very important to carefully elicit a history of contaminated injury. This case also highlights the importance of prophylactic vaccine in low and middle-income countries, which can reduce disease-related mortality and morbidity.

Background: The incidence of bladder outlet obstruction is different and varied in both age and gender. Hence this study was conducted to assess the incidence, etiology and management of bladder outlet obstruction in patients above 18 years of age in both sexes.Methods: This was a tertiary care hospital based longitudinal study. A total of 100 cases were recruited during the period between 01st June 2014 to 31st May 2016 with objective evidence of bladder outlet obstruction. The subject's demographic data, incidence, etiological factors and clinical presentations of bladder outlet obstruction were recorded on data sheet and analyzed.Results: Male preponderance was observed in the study. Maximum incidence of bladder outlet obstruction was observed in the age group of 60-69 years. The most common cause for bladder outlet obstruction in males was benign prostate hyperplasia (BPH), where as in females the major etiological factor was bladder neck stenosis. Out of 94 cases causing bladder outlet obstruction in males, 37 underwent TURP, 11 cases were treated with alpha blockers like Tamsulosin (medical management), 9 underwent cystolithotripsy, 8 underwent b/l orchidectomy, 7 underwent radical cystectomy and ileal conduit, 7 underwent VIU, 7 underwent urethroplasty, 5 underwent open prostatectomy, 3 underwent cystolithotomy whereas in female’s bladder neck stenosis treated by bladder neck incision.Conclusions: Men were the most affected with BPH, being the leading cause. Among women, bladder neck stenosis was the main cause. Initial and definitive management were varied between causes, gender and age.

Dysregulation of the innate immune system and inflammatory-related pathways has been implicated in hematopoietic defects in the bone marrow microenvironment and associated with aging, clonal hematopoiesis, myelodysplastic syndromes (MDS), and acute myeloid leukemia (AML). As the innate immune system and its pathway regulators have been implicated in the pathogenesis of MDS/AML, novel approaches targeting these pathways have shown promising results. Variability in expression of Toll like receptors (TLRs), abnormal levels of MyD88 and subsequent activation of NF-κβ, dysregulated IL1-receptor associated kinases (IRAK), alterations in TGF-β and SMAD signaling, high levels of S100A8/A9 have all been implicated in pathogenesis of MDS/AML. In this review we not only discuss the interplay of various innate immune pathways in MDS pathogenesis but also focus on potential therapeutic targets from recent clinical trials including the use of monoclonal antibodies and small molecule inhibitors against these pathways.