Seema Guragain, S. K. Mandal, Nitu Sharma, G. D. Adhikari, Mark J. Richman, Ajay Kumar Yadav
Background Ultrasonography (US) is an important modality for investigating breast lesions, as it lacks radiation exposure, differentiates between solid tumor and fluid-filled cysts, and is particularly-useful for young females with dense breast tissue. This study aimed to determine test characteristics (sensitivity, specificity, positive and negative predictive values, and accuracy), and the prevalence of breast cancer, among patients undergoing diagnostic breast US for clinically-detected abnormalities in a tertiary care cancer hospital in Nepal, comparing US findings with histopathology and cytopathology.Data and Methods A cross-sectional study was conducted among a convenience sample of 418 female patients who underwent diagnostic breast US between April 15 and September 10, 2022. Data were entered and analyzed on SPSS 25.0. Prevalence of cancer was determined among US patients who were referred for tissue diagnosis on the basis of clinical or US findings. Sensitivity, specificity, positive and negative predictive values, and accuracy of US in detecting breast lesions in comparison to histopathology and cytopathology findings were calculated. Results The study respondents’ age ranged from 13 to 75 (±11.8) years. Among 97 patients who underwent fine needle aspiration or biopsy based on US findings, 52 (12.4% of total) were diagnosed with breast carcinoma. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of US to detect breast cancer were 94%, 100%, 93.7%, 100%, and 96.9%, respectively. Conclusion Among women with breast complaints or physical examination findings, diagnostic US revealed a high prevalence in the population investigated and demonstrated very good sensitivity, specificity, and accuracy to detect breast cancer. This study confirms the important role of ultrasound in the evaluation of breast lesions, particularly in underdeveloped countries.
背景 超声造影（US）是检查乳腺病变的一种重要方式，因为它没有辐射暴露，能区分实体肿瘤和充满液体的囊肿，对乳腺组织致密的年轻女性尤其有用。本研究旨在确定尼泊尔一家三级癌症医院中因临床检测到的异常而接受乳腺 US 诊断的患者的测试特征（灵敏度、特异性、阳性和阴性预测值及准确性）以及乳腺癌的患病率，并将 US 结果与组织病理学和细胞病理学结果进行比较。 数据和方法 在 2022 年 4 月 15 日至 9 月 10 日期间，对 418 名接受乳腺 US 诊断的女性患者进行了方便抽样的横断面研究。数据用 SPSS 25.0 进行输入和分析。根据临床或 US 检查结果转诊进行组织诊断的 US 患者的癌症患病率被确定。与组织病理学和细胞病理学结果相比，计算了 US 检测乳腺病变的敏感性、特异性、阳性预测值和阴性预测值以及准确性。结果 研究对象的年龄从 13 岁到 75 岁（±11.8）岁不等。在 97 名根据 US 检测结果进行细针穿刺或活检的患者中，52 人（占总数的 12.4%）被确诊为乳腺癌。US 检测乳腺癌的敏感性、特异性、阴性预测值、阳性预测值和准确性分别为 94%、100%、93.7%、100% 和 96.9%。结论 在有乳房不适或体格检查结果的妇女中，诊断性 US 在调查人群中的发病率很高，而且在检测乳腺癌方面表现出非常好的灵敏度、特异性和准确性。这项研究证实了超声波在乳腺病变评估中的重要作用，尤其是在不发达国家。
{"title":"Breast Carcinoma among Patients Undergoing Breast Diagnostic Ultrasonography in a Tertiary Care Hospital in Nepal","authors":"Seema Guragain, S. K. Mandal, Nitu Sharma, G. D. Adhikari, Mark J. Richman, Ajay Kumar Yadav","doi":"10.46405/ejms.v5i1.487","DOIUrl":"https://doi.org/10.46405/ejms.v5i1.487","url":null,"abstract":"Background Ultrasonography (US) is an important modality for investigating breast lesions, as it lacks radiation exposure, differentiates between solid tumor and fluid-filled cysts, and is particularly-useful for young females with dense breast tissue. This study aimed to determine test characteristics (sensitivity, specificity, positive and negative predictive values, and accuracy), and the prevalence of breast cancer, among patients undergoing diagnostic breast US for clinically-detected abnormalities in a tertiary care cancer hospital in Nepal, comparing US findings with histopathology and cytopathology.Data and Methods A cross-sectional study was conducted among a convenience sample of 418 female patients who underwent diagnostic breast US between April 15 and September 10, 2022. Data were entered and analyzed on SPSS 25.0. Prevalence of cancer was determined among US patients who were referred for tissue diagnosis on the basis of clinical or US findings. Sensitivity, specificity, positive and negative predictive values, and accuracy of US in detecting breast lesions in comparison to histopathology and cytopathology findings were calculated. Results The study respondents’ age ranged from 13 to 75 (±11.8) years. Among 97 patients who underwent fine needle aspiration or biopsy based on US findings, 52 (12.4% of total) were diagnosed with breast carcinoma. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of US to detect breast cancer were 94%, 100%, 93.7%, 100%, and 96.9%, respectively. Conclusion Among women with breast complaints or physical examination findings, diagnostic US revealed a high prevalence in the population investigated and demonstrated very good sensitivity, specificity, and accuracy to detect breast cancer. This study confirms the important role of ultrasound in the evaluation of breast lesions, particularly in underdeveloped countries.","PeriodicalId":254508,"journal":{"name":"Europasian Journal of Medical Sciences","volume":" 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139621923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Rapid on-site evaluation (ROSE) is a technique where transbronchial needle aspiration (TBNA) cytology samples are rapidly stained and screened for diagnostic material in the procedure room, during the procedure. We hypothesized the sensitivity of ROSE in patients with sarcoidosis is very low, leading to unjustified use of an expensive technique.Data and Methods This was a retrospective study at an inner-city hospital. Medical records of all patients who underwent EBUS-TBNA of mediastinal and hilar lymph nodes with ROSE over a 3-year period were evaluated. The sensitivity, specificity, and positive and negative predictive values of ROSE in patients with sarcoidosis were calculated, with pathologic diagnosis by cell block as the “gold standard.” Patients with malignancy were used as a comparison. Results One hundred eighty-four patients who had ROSE on EBUS-TBNA of mediastinal and hilar lymph nodes were included. Thirty were diagnosed with sarcoidosis, 95 with malignancy, and 59 with benign lymph nodes. The sensitivity of ROSE in patients with sarcoidosis was 44%, specificity and positive predictive value were 100%, and negative predictive value was only 17%. Conclusion Given low sensitivity and negative predictive value, ROSE may not be as useful in diagnosing sarcoidosis as it is in diagnosing malignancy.
背景 现场快速评估（ROSE）是一种在手术过程中，在手术室对经支气管针吸（TBNA）细胞学样本进行快速染色和筛查诊断材料的技术。我们假设肉样瘤病患者对 ROSE 的敏感性非常低，从而导致不合理地使用昂贵的技术。 数据和方法 这是一项在市内医院进行的回顾性研究。研究评估了 3 年内所有接受 EBUS-TBNA 和 ROSE 检查纵隔和肺门淋巴结的患者的病历。以细胞包块病理诊断为 "金标准"，计算了肉样瘤病患者 ROSE 的敏感性、特异性、阳性预测值和阴性预测值。恶性肿瘤患者作为对比。结果 共纳入 184 名纵隔和肺门淋巴结 EBUS-TBNA 检查出 ROSE 的患者。其中 30 人被诊断为肉样瘤病，95 人被诊断为恶性肿瘤，59 人被诊断为良性淋巴结。肉样瘤病患者的 ROSE 敏感性为 44%，特异性和阳性预测值均为 100%，阴性预测值仅为 17%。结论 由于灵敏度和阴性预测值较低，ROSE 在诊断肉样瘤病方面的作用可能不如在诊断恶性肿瘤方面。
{"title":"Utility of Rapid On-Site Evaluation on Endobronchial Ultrasound-Guided Transbronchial Needle Aspirate of the Mediastinal and Hilar Lymph Nodes in Patients with Suspected Sarcoidosis","authors":"Vikas Pathak, Mark J. Richman, Prekchha Jha","doi":"10.46405/ejms.v5i1.514","DOIUrl":"https://doi.org/10.46405/ejms.v5i1.514","url":null,"abstract":"Background Rapid on-site evaluation (ROSE) is a technique where transbronchial needle aspiration (TBNA) cytology samples are rapidly stained and screened for diagnostic material in the procedure room, during the procedure. We hypothesized the sensitivity of ROSE in patients with sarcoidosis is very low, leading to unjustified use of an expensive technique.Data and Methods This was a retrospective study at an inner-city hospital. Medical records of all patients who underwent EBUS-TBNA of mediastinal and hilar lymph nodes with ROSE over a 3-year period were evaluated. The sensitivity, specificity, and positive and negative predictive values of ROSE in patients with sarcoidosis were calculated, with pathologic diagnosis by cell block as the “gold standard.” Patients with malignancy were used as a comparison. Results One hundred eighty-four patients who had ROSE on EBUS-TBNA of mediastinal and hilar lymph nodes were included. Thirty were diagnosed with sarcoidosis, 95 with malignancy, and 59 with benign lymph nodes. The sensitivity of ROSE in patients with sarcoidosis was 44%, specificity and positive predictive value were 100%, and negative predictive value was only 17%. Conclusion Given low sensitivity and negative predictive value, ROSE may not be as useful in diagnosing sarcoidosis as it is in diagnosing malignancy.","PeriodicalId":254508,"journal":{"name":"Europasian Journal of Medical Sciences","volume":" 25","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139621088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Trans-fatty acids, commonly referred to as trans fats, were discovered in the early 20th century with the development of hydrogenation – a chemical process that converts liquid vegetable oil into solid fats. Initially perceived as a healthier alternative to saturated fats due to their stability during cooking and longer shelf life, more recent research has linked trans fats to a number of adverse health outcomes.1There are two types of trans fats: naturally occurring and artificial. Naturally occurring trans fats are found in small amounts in meat and dairy products from ruminant animals, such as sheep, cows, and goats, where the fats are formed in the gut of the animal. By contrast, artificial trans fats, also known as industrially produced trans fatty acids (iTFAs), are created through hydrogenation, which is the process utilized in the production of margarine and shortening.1 The consumption of trans fats leads to increased LDL (bad) cholesterol and decreased HDL (good) cholesterol levels. This unfavorable cholesterol profile can contribute to cholesterol accumulation in the arteries, elevating the risk of heart disease and stroke.2 The inclusion of trans fats as part of the daily diet increases the risk of coronary heart disease by 21% and the risk of death due to the disease by 28%.3 The consumption of trans fats also promotes inflammation, which can lead to the development of stroke, diabetes, and other chronic illnesses from excessive activation of the immune system. Moreover, consuming trans fats disrupts the normal functioning of the endothelial cells lining the inner wall of blood vessels, thereby compromising their responsiveness.4Trans fat is present in many processed and fried foods, including snacks and fast foods.1 The amount of trans fat in a food item depends on the number of times vegetable oil is heated during preparation, with increased heating leading to more significant health consequences. Specifically in South Asian cuisine, dishes cooked in vegetable ghee and certain steamed vegetable sweets like Jerry, Lalmohan, and Gundpak have been found to contain excessive amounts of trans fats.5According to the World Health Organization (WHO), there is no safe level of trans fat consumption; WHO recommends the intake of trans fats be limited to less than 1% of total daily energy intake.6 To provide a comprehensive strategy for eliminating iTFAs from the global food supply, the WHO introduced the REPLACE package, which contains a set of practical actions and guidelines for governments, industries, and civil society to make concerted efforts toward achieving this goal.
{"title":"Initiatives to Regulate Industrially Processed Foods","authors":"Shrina Pyakurel","doi":"10.46405/ejms.v5i1.489","DOIUrl":"https://doi.org/10.46405/ejms.v5i1.489","url":null,"abstract":"Trans-fatty acids, commonly referred to as trans fats, were discovered in the early 20th century with the development of hydrogenation – a chemical process that converts liquid vegetable oil into solid fats. Initially perceived as a healthier alternative to saturated fats due to their stability during cooking and longer shelf life, more recent research has linked trans fats to a number of adverse health outcomes.1There are two types of trans fats: naturally occurring and artificial. Naturally occurring trans fats are found in small amounts in meat and dairy products from ruminant animals, such as sheep, cows, and goats, where the fats are formed in the gut of the animal. By contrast, artificial trans fats, also known as industrially produced trans fatty acids (iTFAs), are created through hydrogenation, which is the process utilized in the production of margarine and shortening.1 The consumption of trans fats leads to increased LDL (bad) cholesterol and decreased HDL (good) cholesterol levels. This unfavorable cholesterol profile can contribute to cholesterol accumulation in the arteries, elevating the risk of heart disease and stroke.2 The inclusion of trans fats as part of the daily diet increases the risk of coronary heart disease by 21% and the risk of death due to the disease by 28%.3 The consumption of trans fats also promotes inflammation, which can lead to the development of stroke, diabetes, and other chronic illnesses from excessive activation of the immune system. Moreover, consuming trans fats disrupts the normal functioning of the endothelial cells lining the inner wall of blood vessels, thereby compromising their responsiveness.4Trans fat is present in many processed and fried foods, including snacks and fast foods.1 The amount of trans fat in a food item depends on the number of times vegetable oil is heated during preparation, with increased heating leading to more significant health consequences. Specifically in South Asian cuisine, dishes cooked in vegetable ghee and certain steamed vegetable sweets like Jerry, Lalmohan, and Gundpak have been found to contain excessive amounts of trans fats.5According to the World Health Organization (WHO), there is no safe level of trans fat consumption; WHO recommends the intake of trans fats be limited to less than 1% of total daily energy intake.6 To provide a comprehensive strategy for eliminating iTFAs from the global food supply, the WHO introduced the REPLACE package, which contains a set of practical actions and guidelines for governments, industries, and civil society to make concerted efforts toward achieving this goal.","PeriodicalId":254508,"journal":{"name":"Europasian Journal of Medical Sciences","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126334106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
r. Badri Raj Pande’s experience1 is an example of the ‘hostile’ socio-cultural environment into which the family planning program in Nepal was first introduced – and also an illustration of how the program has continued to grow and flourish over the years. His account also reminded me of some of my own personal experiences in early days of the program.It was in 1973 that Dr. Wheeles from Johns Hopkins University brought a set of laparoscopic instruments for tubal sterilization to Nepal. He demonstrated the use of the instruments to a few of us – obstetricians and gynecologists – at Paropakar Maternity and Women’s Hospital (commonly referred to as Prasuti Griha or Maternity Hospital) in Kathmandu, where we were working at that time. Dr. Kanti Giri led this ground breaking effort, and I was among the first group of just a few doctors who participated in the training. The successful effort resulted in eventually introducing laparoscopic female sterilization (LFS) under local anesthesia through mobile camps in communities where there were no hospitals or trained doctors to perform sterilization operations.2-6 Nepal became a ‘pioneer’ country to provide LFS as a new permanent method of controlling fertility. Over the years, female sterilization has become the most widely used contractive method in Nepal.7-9By way of informing the potential female clients of the procedure, we – the attending doctors and nurses – would tell women that a small injection is administered in their umbilical region and a tube will be inserted to look through a ‘durbin’ (telescope) and then a knot would be tied in a safe manner to prevent pregnancy. In doing so, the term ‘operation/surgery’ was purposely avoided so the women would not be scared. At times I used to ask women why they did not send their husbands for a vasectomy instead of them going for the procedure. Their most common response was that the husband had to work for their livelihood and that they (the women) didn’t want to take any chances, and risk something happening to the family’s source of livelihood. In those days, having multiple wives was also considered a symbol of affluence and wealth. During our ‘camp’ days in Pokhara, in which Dr. Kanti Giri and I were attending surgeons, one person brought two wives over two successive days. He showed up with yet a third wife on the third day, and both Dr. Giri and I insisted that he should get a vasectomy – to which he agreed, reluctantly.Over the years, as the program expanded, LFS became more popular – and remains so today.9,10 While in the early years, sterilization was accepted only among women who had already given birth to at least four children, perception of the procedure has changed considerably over the years, and as of 2022, the average number of children a sterilized woman has is about two.10 As aptly noted in the “Brief Communication,”1 Nepal’s family planning program has made significant progress over the last five decades. The path to progress has cer
{"title":"Introduction of Laparoscopic Tubal Sterilization in Nepal’s Family Planning Program","authors":"S. M. Dali","doi":"10.46405/ejms.v5i1.488","DOIUrl":"https://doi.org/10.46405/ejms.v5i1.488","url":null,"abstract":"r. Badri Raj Pande’s experience1 is an example of the ‘hostile’ socio-cultural environment into which the family planning program in Nepal was first introduced – and also an illustration of how the program has continued to grow and flourish over the years. His account also reminded me of some of my own personal experiences in early days of the program.It was in 1973 that Dr. Wheeles from Johns Hopkins University brought a set of laparoscopic instruments for tubal sterilization to Nepal. He demonstrated the use of the instruments to a few of us – obstetricians and gynecologists – at Paropakar Maternity and Women’s Hospital (commonly referred to as Prasuti Griha or Maternity Hospital) in Kathmandu, where we were working at that time. Dr. Kanti Giri led this ground breaking effort, and I was among the first group of just a few doctors who participated in the training. The successful effort resulted in eventually introducing laparoscopic female sterilization (LFS) under local anesthesia through mobile camps in communities where there were no hospitals or trained doctors to perform sterilization operations.2-6 Nepal became a ‘pioneer’ country to provide LFS as a new permanent method of controlling fertility. Over the years, female sterilization has become the most widely used contractive method in Nepal.7-9By way of informing the potential female clients of the procedure, we – the attending doctors and nurses – would tell women that a small injection is administered in their umbilical region and a tube will be inserted to look through a ‘durbin’ (telescope) and then a knot would be tied in a safe manner to prevent pregnancy. In doing so, the term ‘operation/surgery’ was purposely avoided so the women would not be scared. At times I used to ask women why they did not send their husbands for a vasectomy instead of them going for the procedure. Their most common response was that the husband had to work for their livelihood and that they (the women) didn’t want to take any chances, and risk something happening to the family’s source of livelihood. In those days, having multiple wives was also considered a symbol of affluence and wealth. During our ‘camp’ days in Pokhara, in which Dr. Kanti Giri and I were attending surgeons, one person brought two wives over two successive days. He showed up with yet a third wife on the third day, and both Dr. Giri and I insisted that he should get a vasectomy – to which he agreed, reluctantly.Over the years, as the program expanded, LFS became more popular – and remains so today.9,10 While in the early years, sterilization was accepted only among women who had already given birth to at least four children, perception of the procedure has changed considerably over the years, and as of 2022, the average number of children a sterilized woman has is about two.10 As aptly noted in the “Brief Communication,”1 Nepal’s family planning program has made significant progress over the last five decades. The path to progress has cer","PeriodicalId":254508,"journal":{"name":"Europasian Journal of Medical Sciences","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128124356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Richman, Rida Nasir, Stephen Guilherme, Daisy Puca, Demetra Menoudakos, Jeffrey Wang, Rochelle Hall, Melissa Cheta, Lisa Iyeke
Bacterial vaginosis (BV) is the most-common cause of abnormal vaginal discharge among women of reproductive age, though many are asymptomatic. It is caused by the replacement of normal vaginal Lactobacillus with Gram-negative and anaerobic organisms. BV has assumed increasing public health importance through associations with numerous adverse outcomes in both gravid and non-gravid women. Risk factors for BV include smoking, non-White race, prior BV, current other sexually transmitted diseases (STDs), inserting items in the vagina (e.g., sex, douching), and menses. Symptomatic BV has been associated with pelvic inflammatory disease (PID), miscarriage, premature rupture of membranes, chorioamnionitis, premature labor and delivery, postpartum endometritis, and post-hysterectomy vaginal cuff cellulitis. Anaerobic Gram-negative rods common to BV have also been independently associated with endometritis or PID, even in the absence of clinical BV. BV has also been independently associated with an increased risk of acquiring STDs, including acquiring and transmitting HIV. BV is not an STD, though recent sexual intercourse and multiple sexpartners are risk factors. BV causes a malodorous, white or gray vaginal discharge and is diagnosed through Amsel’s criteria. Treatment with metronidazole or clindamycin is important for symptom relief and to prevent adverse obstetric consequences, particularly among high-risk women who have had a previous preterm delivery or have a pre-pregnancy weight <50 kg.
{"title":"Bacterial Vaginosis: A Review of Pathophysiology, Epidemiology, Complications, Diagnosis, and Treatment","authors":"M. Richman, Rida Nasir, Stephen Guilherme, Daisy Puca, Demetra Menoudakos, Jeffrey Wang, Rochelle Hall, Melissa Cheta, Lisa Iyeke","doi":"10.46405/ejms.v5i1.475","DOIUrl":"https://doi.org/10.46405/ejms.v5i1.475","url":null,"abstract":"Bacterial vaginosis (BV) is the most-common cause of abnormal vaginal discharge among women of reproductive age, though many are asymptomatic. It is caused by the replacement of normal vaginal Lactobacillus with Gram-negative and anaerobic organisms. BV has assumed increasing public health importance through associations with numerous adverse outcomes in both gravid and non-gravid women. Risk factors for BV include smoking, non-White race, prior BV, current other sexually transmitted diseases (STDs), inserting items in the vagina (e.g., sex, douching), and menses. Symptomatic BV has been associated with pelvic inflammatory disease (PID), miscarriage, premature rupture of membranes, chorioamnionitis, premature labor and delivery, postpartum endometritis, and post-hysterectomy vaginal cuff cellulitis. Anaerobic Gram-negative rods common to BV have also been independently associated with endometritis or PID, even in the absence of clinical BV. BV has also been independently associated with an increased risk of acquiring STDs, including acquiring and transmitting HIV. BV is not an STD, though recent sexual intercourse and multiple sexpartners are risk factors. BV causes a malodorous, white or gray vaginal discharge and is diagnosed through Amsel’s criteria. Treatment with metronidazole or clindamycin is important for symptom relief and to prevent adverse obstetric consequences, particularly among high-risk women who have had a previous preterm delivery or have a pre-pregnancy weight <50 kg. ","PeriodicalId":254508,"journal":{"name":"Europasian Journal of Medical Sciences","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130584876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Mental health issues are among the top ten causes of disease burden worldwide. Many people waiting for mental health treatment are being resorted to emergency or crisis services and evidence points to low levels of satisfaction with these services. The purpose of this scoping review is therefore to explore the experiences of mental health patients accessing prehospital settings, for example emergency care through ambulance use and emergency medical services, and community care.Data and Methods To identify a knowledge gap and sources of evidence, a scoping review was conducted that examined research about the experiences of people accessing prehospital and community care. A scoping review using a systematic and comprehensive literature search of databases resulted in the inclusion of 10 articles. These articles were synthesised using thematic analysis and resulted in five different themes related to access of community and prehospital based sources.Results The themes identified were: (i) communication; (ii) relationship with patients and family members; (iii) attitude of providers and trust established; (iv) care and support; and (iv) satisfaction. Some themes overlap and were interrelated. For example, attitudes of healthcare staff determined the type of communication with patients: either positive or negative. In turn, communication by healthcare staff also affected the relationship formed with the patients and the trust established with them. In addition, results of quantitative studies were presented separately.Conclusion The review identified that mental health service users accessing prehospital and community-based services are seeking support because of dissatisfaction with immediacy of responses elsewhere. To meet this increased demand, paramedics need further education and support on mental health to ensure the appropriate care of these service users. Keywords prehospital, community mental health services, mental health, paramedics
{"title":"Mental Health Care Experiences in Prehospital and Community Settings: A Scoping Review","authors":"Preeti Mahato, U. Rolfe","doi":"10.46405/ejms.v5i1.457","DOIUrl":"https://doi.org/10.46405/ejms.v5i1.457","url":null,"abstract":"Background Mental health issues are among the top ten causes of disease burden worldwide. Many people waiting for mental health treatment are being resorted to emergency or crisis services and evidence points to low levels of satisfaction with these services. The purpose of this scoping review is therefore to explore the experiences of mental health patients accessing prehospital settings, for example emergency care through ambulance use and emergency medical services, and community care.Data and Methods To identify a knowledge gap and sources of evidence, a scoping review was conducted that examined research about the experiences of people accessing prehospital and community care. A scoping review using a systematic and comprehensive literature search of databases resulted in the inclusion of 10 articles. These articles were synthesised using thematic analysis and resulted in five different themes related to access of community and prehospital based sources.Results The themes identified were: (i) communication; (ii) relationship with patients and family members; (iii) attitude of providers and trust established; (iv) care and support; and (iv) satisfaction. Some themes overlap and were interrelated. For example, attitudes of healthcare staff determined the type of communication with patients: either positive or negative. In turn, communication by healthcare staff also affected the relationship formed with the patients and the trust established with them. In addition, results of quantitative studies were presented separately.Conclusion The review identified that mental health service users accessing prehospital and community-based services are seeking support because of dissatisfaction with immediacy of responses elsewhere. To meet this increased demand, paramedics need further education and support on mental health to ensure the appropriate care of these service users. Keywords prehospital, community mental health services, mental health, paramedics","PeriodicalId":254508,"journal":{"name":"Europasian Journal of Medical Sciences","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128916432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Rana, Bijay Chandra Acharya, A. Jalan, Manju Pandey, H. Subedi, I. Dhungana, N. Lamichhane, B. Shrestha
Introduction: Vulvar cancer is not an uncommon condition, accounting for 4-6% of all female genital tract cancers. More than ninety percent of cancers are squamous cell type. In this study, we have attempted to retrospectively analyze the socio-demographic profile of vulvar cancer patients managed at BP Koirala Memorial Cancer Hospital. Material and methods: This is a descriptive cross-sectional study, that altogether included 77 patients from January 2009 to December 2019 diagnosed with vulvar cancer conducted at BP Koirala Memorial Cancer Hospital, Nepal. All the demographic and clinicopathological data were collected and analyzed using SPSS 16.0 software. Tumor staging was standardized according to the International Federation of Gynecology and Obstetrics (FIGO) staging system. Quantitative data were represented as mean and standard deviation whereas categorical variables were expressed as frequencies and percentages of an appropriate denominator. Results: Among 77 patients, the median age was 55 years. Most were married (97.4%, n=75), farmers (53.2% n=41), smokers (45.45%, n=35), had poor personal hygiene (65.6%, n=50) and illitrate (61%, n=47). The most common presentation was ulcer or growth (88.31%, n=68). Inguinal lymph nodes were palpable in 80.5% (n=62) of patients, out of which 26% (n=20) had fixed and fungating lymph nodes. Most diagnosed clinical was stage III (40.25%, n=31), stage IV (27%, n=21), stage II (19.48%, n=15) and Stage I (13%, n =10). The most common histological grading was moderately differentiated SCC (50.6%, n=39). Management was surgical in 72.72% (n=56) and rest 27.27%(n=21) were sent for chemoradiation. The most common postoperative complications were lymphedema (27%, n= 15) and wound infections (12.5%, n=7). Recurrence observed in 28.57% (n=22) of cases. Conclusion: Vulvar cancer is more common among smokers and farmers. The disease is already locally advanced at the time of diagnosis. However, surgery is the main modality of treatment.
{"title":"A retrospective analysis of Vulva Carcinoma patients treated at a cancer center in Nepal in ten years","authors":"S. Rana, Bijay Chandra Acharya, A. Jalan, Manju Pandey, H. Subedi, I. Dhungana, N. Lamichhane, B. Shrestha","doi":"10.46405/ejms.v3i2.381","DOIUrl":"https://doi.org/10.46405/ejms.v3i2.381","url":null,"abstract":"Introduction: \u0000Vulvar cancer is not an uncommon condition, accounting for 4-6% of all female genital tract cancers. More than ninety percent of cancers are squamous cell type. In this study, we have attempted to retrospectively analyze the socio-demographic profile of vulvar cancer patients managed at BP Koirala Memorial Cancer Hospital. \u0000Material and methods: \u0000This is a descriptive cross-sectional study, that altogether included 77 patients from January 2009 to December 2019 diagnosed with vulvar cancer conducted at BP Koirala Memorial Cancer Hospital, Nepal. All the demographic and clinicopathological data were collected and analyzed using SPSS 16.0 software. Tumor staging was standardized according to the International Federation of Gynecology and Obstetrics (FIGO) staging system. Quantitative data were represented as mean and standard deviation whereas categorical variables were expressed as frequencies and percentages of an appropriate denominator. \u0000 \u0000Results: \u0000Among 77 patients, the median age was 55 years. Most were married (97.4%, n=75), farmers (53.2% n=41), smokers (45.45%, n=35), had poor personal hygiene (65.6%, n=50) and illitrate (61%, n=47). The most common presentation was ulcer or growth (88.31%, n=68). Inguinal lymph nodes were palpable in 80.5% (n=62) of patients, out of which 26% (n=20) had fixed and fungating lymph nodes. Most diagnosed clinical was stage III (40.25%, n=31), stage IV (27%, n=21), stage II (19.48%, n=15) and Stage I (13%, n =10). The most common histological grading was moderately differentiated SCC (50.6%, n=39). Management was surgical in 72.72% (n=56) and rest 27.27%(n=21) were sent for chemoradiation. The most common postoperative complications were lymphedema (27%, n= 15) and wound infections (12.5%, n=7). Recurrence observed in 28.57% (n=22) of cases. \u0000Conclusion: \u0000Vulvar cancer is more common among smokers and farmers. The disease is already locally advanced at the time of diagnosis. However, surgery is the main modality of treatment.","PeriodicalId":254508,"journal":{"name":"Europasian Journal of Medical Sciences","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122830742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Implementation research (IR) is increasingly undertaken in the health field globally. This paper presents a scoping review of IR undertaken in Nepal. Methods We conducted a scoping review of literature on IR in Nepal according to the PRISMA- ScR checklist. The eligibility criteria were defined as papers conducted in Nepal that focused on studies of programs or policies that emphasize targeting health interventions, and addressed at least some aspects of IR. We searched Embase, PubMed, and the Global Health: Science and Practice database for papers from January 1, 2015 through November 30, 2022 using Medical Subject Headings terms based on our eligibility criteria. We reviewed the full text of the final set of articles and extracted relevant information for inclusion in this review. Results Twenty-three articles were included in the final stages for data extraction. The numbers of IR have increased over the years; the largest numbers were published in 2021. About 52% had a first author from Nepal, and 39% had a senior author from Nepal. About 52% were focused on non-communicable diseases. The objectives of the studies were diverse; most were conducted in understanding the factors that influenced implementation. Most of the studies were guided by IR theories or frameworks; and were done in collaboration with international partners. Only a few studied implementation strategies and implementation outcomes. Conclusion The vast majority of the IR conducted in Nepal has focused on understanding the contextual facilitators and barriers to implementation; only a few studies have examined implementation strategies and implementation outcomes.
{"title":"Implementation Research in Nepal – A Scoping Review, 2015-2022","authors":"A. Shrestha","doi":"10.46405/ejms.v4i0.456","DOIUrl":"https://doi.org/10.46405/ejms.v4i0.456","url":null,"abstract":"Background Implementation research (IR) is increasingly undertaken in the health field globally. This paper presents a scoping review of IR undertaken in Nepal. \u0000Methods We conducted a scoping review of literature on IR in Nepal according to the PRISMA- ScR checklist. The eligibility criteria were defined as papers conducted in Nepal that focused on studies of programs or policies that emphasize targeting health interventions, and addressed at least some aspects of IR. We searched Embase, PubMed, and the Global Health: Science and Practice database for papers from January 1, 2015 through November 30, 2022 using Medical Subject Headings terms based on our eligibility criteria. We reviewed the full text of the final set of articles and extracted relevant information for inclusion in this review. \u0000Results Twenty-three articles were included in the final stages for data extraction. The numbers of IR have increased over the years; the largest numbers were published in 2021. About 52% had a first author from Nepal, and 39% had a senior author from Nepal. About 52% were focused on non-communicable diseases. The objectives of the studies were diverse; most were conducted in understanding the factors that influenced implementation. Most of the studies were guided by IR theories or frameworks; and were done in collaboration with international partners. Only a few studied implementation strategies and implementation outcomes. \u0000Conclusion The vast majority of the IR conducted in Nepal has focused on understanding the contextual facilitators and barriers to implementation; only a few studies have examined implementation strategies and implementation outcomes.","PeriodicalId":254508,"journal":{"name":"Europasian Journal of Medical Sciences","volume":"158 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116115213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper presents a review of social theories of aging including early theories based on role, disengagement, activity, and continuity, and more recent theories based on modernization, feminism, gerotranscendence, and interactionism. The elements, assumptions and possible biases, and strengths and weaknesses of each major theory are discussed. Since gerontology is multidisciplinary, the variety of theoretical perspectives can be viewed as a strength of this particular field. Similarly, the theories have foci representing micro and macro approaches, functional and conflict approaches, social structural and social psychological approaches, and historical and economic approaches. The possibility of Euro-centric and male-centric biases of theory should not be ignored. Cross-cultural research can further contribute to refining and strengthening the social gerontology knowledge base and its value informing a wider diversity of areas, including public health and medicine.
{"title":"Social Gerontology Theory","authors":"Ed Rosenberg","doi":"10.46405/ejms.v4i0.454","DOIUrl":"https://doi.org/10.46405/ejms.v4i0.454","url":null,"abstract":"This paper presents a review of social theories of aging including early theories based on role, disengagement, activity, and continuity, and more recent theories based on modernization, feminism, gerotranscendence, and interactionism. The elements, assumptions and possible biases, and strengths and weaknesses of each major theory are discussed. Since gerontology is multidisciplinary, the variety of theoretical perspectives can be viewed as a strength of this particular field. Similarly, the theories have foci representing micro and macro approaches, functional and conflict approaches, social structural and social psychological approaches, and historical and economic approaches. The possibility of Euro-centric and male-centric biases of theory should not be ignored. Cross-cultural research can further contribute to refining and strengthening the social gerontology knowledge base and its value informing a wider diversity of areas, including public health and medicine.","PeriodicalId":254508,"journal":{"name":"Europasian Journal of Medical Sciences","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121595907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Regmi, N. Aryal, P. Simkhada, Edwin Roland van Teijlingen
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{"title":"Excessive Mortalities among Migrant Workers: The Case of the 2022 FIFA World Cup","authors":"P. Regmi, N. Aryal, P. Simkhada, Edwin Roland van Teijlingen","doi":"10.46405/ejms.v4i0.455","DOIUrl":"https://doi.org/10.46405/ejms.v4i0.455","url":null,"abstract":"The abstract is not available. Please click on Download PDF to get full-text article.","PeriodicalId":254508,"journal":{"name":"Europasian Journal of Medical Sciences","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116857851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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