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Tuesday, October 4, 2016

के नेपाल लगायत अविकसित राष्ट्रहरुले स्तन क्यान्सर निदानमा लगानी गर्नुपर्दछ ?

(अन्तरास्ट्रिय जर्नलमा प्रकाशित अनुसन्धानमा आधारित लेख)

नसर्ने रोगहरुबाट हुने कुल मृत्युदर मध्ये क्यान्सरको योगदान विश्वमै प्रमुख स्थानमा पर्दछ। यसलाई नेपाली भाषामा अर्बुद रोगले समेत चिनिन्छ । विश्वमा हुने क्यान्सर मध्ये पुरुषहरुमा प्रोस्टेट क्यान्सर र महिलाहरुमा स्तन क्यान्सरको समस्याले मुख्य स्थान लिएको छ । नेपालमा भने पुरुषमा फोक्सोको क्यान्सर तथा महिलामा पाठेघरको क्यान्सर समस्या ज्यादातर देखिएको बिभिन्न अनुसन्धानले पुस्टि गरेका छन ।

Dr. Bishal Gyawali, Oncologist

नेपाल लगायत अविकसित रास्ट्रहरुमा स्तन क्यान्सरको रुग्णता र भार  बढ्दो छ। यो रोग धनि मुलुकका महिलाहरूको रोग भएतापनि पछिल्लो समयमा जीवनस्तरमा आएको व्यापक परिबर्तन सगै बिस्तारै अविकसित मुलुकका महिलाहरुको मृत्युको प्रमुख कारण बन्दै आएको छं । नेपालमा मुख्यतः चरम आर्थिक अभाब र क्यान्सरको अन्तिम अवस्थामा आएर रोग निदान हुने कारणले गर्दा यस रोगबाट धेरै महिलाहरुको मृत्यु भएको छ । अत: स्तन क्यान्सरबाट हुने रुग्णता र मृत्युको भारबाट बच्न अविकसित मुलुकहरुले रोग निदानमा (Disease screening) लगानी गर्नु आवश्यक देखिन्छ । स्तन क्यान्सर निदानका प्रचलित विधिहरू:
Mammography:  स्तन क्यान्सर निदानमा धेरै प्रयोग हुने विधि हो । जसले क्यान्सरको रुग्णता घटाउन निकै मद्त गर्दछ, प्राय: धनि राष्ट्रहरुमा यो विधि प्रयोगमा छ । तर यो विधि तन्नेरी उमेरका महिलाहरुको रोग निदानमा खासै प्रभाबकारी हुन सकेको छैन । यस विधिको प्रयोगको उपयोगिता बारे अविकसित मुलुकले अनुसन्धान गर्नुपर्ने देखिन्छ । यो विधिले समग्रमा अविकसित मुलुकका महिलाहरुको मृत्युदरलाई कम गर्दैन किनभने अविकसित देशका महिलाहरुमा प्राय: तन्नेरी उमेरमा स्तन क्यान्सर देखिन सुरु गर्दछ ।
Clinical Breast Examination:  यो विधि Mammography भन्दा सस्तो र किफायती पर्न जान्छ स्तन क्यान्सर निदानमा। अत: नेपालमा यसको प्रयोग स्तन क्यान्सर निदानमा भरपुर उपयोग गर्न सकिन्छ।
Disease screening का विधिहरुको रास्ट्रिय स्वास्थ्य प्रणालीमा संयोजन गर्नपुर्ब यसको किफायती (Cost effectiveness) र औचित्यताबारे बारे व्यापक अनुसन्धान गर्नुपर्ने देखिन्छ । अविकसित रास्ट्रहरुले स्तन क्यान्सरको भारलाई घटाउन मुख्यतः धुम्रपान नियन्त्रण कार्यक्रम, स्वस्थ्यकर खानपिन र आहार तथा स्वस्थ्यकर जिबनशैलीलाई बढावा दिने गतिबिधिहरू संचालन गर्नु पर्ने निचोड यस अनुसन्धानले निकालेको छ ।

प्रमुख अनुसन्धानकर्ता
डा.बिशाल ज्ञवाली
क्यान्सर रोग विशेषज्ञ
Nagoya University Hospital, Japan
यस अनुसन्धानबारे बृस्तित रुपमा हेर्नु परेमा कृपया तलको लिंकमा गएर हेर्न सक्नु हुन्छ:















Friday, September 30, 2016

National Public Health Laboratory: National Reference Laboratory of Nepal

National Public Health Laboratory (NPHL) is the government national reference laboratory under the Department of health services & Ministry of Health (MoH) with the mandate of regulatory, networking, capacity strengthening, research and quality assurances of the health care laboratories throughout the country. The major goal of NPHL is to address diagnostic needs due to emerging and re-emerging diseases including neglected tropical diseases.


National Public Health Laboratory (NPHL),Ministry of Health, Nepal

     Special laboratory services available in NPHL:


  • ·      Currently, NPHL has facility of biosafety level (BSL) III lab with real time PCR (RT-PCR) which is in use for testing viral load & Avain Influenza including Swine flu.
  • ·      NPHL has just started to diagnose sickle cell anemia and Thalassemia, this test service is only provided by NPHL in Nepal. Patients don’t need to travel India & other foreign countries to diagnose such disease after available of such facility.
  • ·         Advance immunological tests facilities are provided at low rate cost like TORCH, Tumors markers etc.
  • ·         Special histological & cytological tests facilities are available at low rate cost.
  • ·         Special hormonal tests including thyroid function tests, ADA, etc. at low rate cost.
  • ·         IgM, IgG antibodies based advanced tests mainly focuses on vector borne diseases like Dengue, Scrub typhus, Chikungunia etc.
  • ·         Some other special tests include Western blot (HIV confirmatory), CD4 count test, Stone analysis, bacterial culture etc.
  •    Special vitamin tests like Vitamin B12, Folic acid, Ferritin Vitamin D3 etc.
  •     Advance genetic level research studies are conducted in collaboration with many international health agencies.
                            www.nphl.gov.np



Wednesday, September 28, 2016

Vector Borne Diseases: Raising Health Problems in Nepal

Nepal has been facing burden of communicable diseases including Negated Tropical Diseases (NTDs) called diseases of poverty. Climate change is major risk factor for spreading vector borne diseases from terai region to hilly region. Malaria now become endemic problem in hilly region due to climate change.

Currently Nepal is facing epidemic of Scrub Typhus throughout the country. More than 300 cases has been confirmed on laboratory testing reported by Epidemiology and Disease Control Division (EDCD), Nepal. Seven cases were died from scrub Typhus infection including children. Recently, an entomological study on trombiculid mites has showed that mites has infected by disease causing agents.Out of ten mites, three are infected by disease causative agents reported by Thailand specialist team along with health team from Department of Health Services (DoHS).

National Public Health Laboratory (NPHL), national reference laboratory under Ministry of Health has just diagnosed the Chikungunya case, a viral diseases transmitted to humans by infected mosquitoes. It causes fever and severe joint pain.
Currently there is dengue epidemic in Central Terai region, mainly in Chitwan district. The dengue case were first diagnosed in 2004 and epidemic in 2006 AD. Till 2006 to now, dengue is public health problem for Nepal.
In summary, vector borne diseases including NTDs is major public health problems in Nepal. Concern authorities should focus on mosquito control program through integrated vector control measures. The adverse health effects facing  by climate change is major risk factor for vector borne diseases.

Sunday, September 18, 2016

Type 2 Diabetes and Its correlates: A Cross Sectional Study in a Tertiary Hospital of Nepal

Type 2 diabetes mellitus (T2DM) is an emerging global health problem in Nepal. However, there is still a paucity of information on its burden and its risk factors among service users from a hospital based setting. This is a cross sectional study conducted among the service users of diabetes clinic in Tribhuvan University Teaching Hospital of Nepal. A sample size of 154 was selected systematically from the patient registration from 30th July to 16th August, 2013. Of the 154 participants, 42.85 % had T2DM. Higher mean body mass index (26.50 ± 5.05 kg/m2) and waist circumference (92.47 ± 11.30 cm) was found among the individuals with T2DM and, compared to those without diabetes (Body mass index 25.13 ± 4.28 kg/m2: waist circumference 88.91 ± 12.30 cm) (P = 0.013). In further analysis, the sedentary occupation (aOR 3.088; 95 % CI 1.427–6.682), measure of high waist circumference (aOR 2.758; 95 % CI 1.238–6.265) individuals from lower socioeconomic status (aOR 3.989; 95 % CI 1.636–9.729) right knowledge on symptoms of diabetes (aOR 3.670; 95 % CI 1.571–8.577) and right knowledge on prevention of diabetes (aOR 3.397; 95 % CI 1.377–8.383) were significantly associated with T2DM status. The current findings suggest that health programs targeting T2DM should focus increasing awareness on harmful health effects of sedentary occupation, symptoms of T2DM and its prevention among the urban population.
For more details please see this link:
http://link.springer.com/article/10.1007%2Fs10900-016-0247-x
researchgate.net/profile/Kamal_Ranabhat/publications