Suchergebnisse

Background: To evaluate the presentation of isolated para-aortic lymph node recurrence after definitive treatment, and to analyze the effect of salvage treatment on the survival rate. Methods: A retrospective study was done for patients with invasive carcinoma of the uterine cervix treated with various modalities of treatment at Shaukat Khanum Memorial Cancer Hospital Research Center Lahore Pakistan from December, 1999 to August 2004. Results: The incidence of radiographically detected para aortic lymph node recurrence was 3.7% by FIGO stage at original diagnosis was 3 (50 %) in stage IIIB, 2 (33.3%) in post hysterectomy status and 1 (16.7%) in stage IB cervical carcinoma. Total 4 (66.7%) patients with para-aortic lymph nodes recurrences were identified with in the first 12 months after the initial treatment and 2(33.3%) had their recurrence after 12 month. Leg swelling, low back pain and hydronephrosis were observed when inquired for the presentation in those patients with recurrence in paraarotic lymph nodes. Hydronephrosis was the commonest finding (50%) either alone or in association with other symptoms. And 3 (50%) of the patient were died within two year of the diagnosis of recurrence.Three patients are still on follow up, one with progressive disease in liver and one with chronic renal failure, and one asymptomatic. Patient who received radiation alone had overall survival of 3.16 months after the recurrence compared with >12 months overall survival for those treated with chemotherapy. Conclusions: Symptoms like leg swelling, low back pain and hydronephrosis helps a lot to detect the early paraaortic recurrence, hydronephrosis being commonest. Although the number of patients with para-aortic recurrence were very small and the follow up time was too short to make any recommendations for salvage treatment or survival advantages, as a definitive treatment for isolated para aortic lymph nodes we can offer both radiotherapy or chemotherapy. Key words: cervix; carcinoma; lymph nodes; para-aortic; recurrence. DOI: 10.3126/jnhrc.v7i2.3016 Journal of Nepal Health Research Council Vol.7(2) Apr 2009 103-107

The concept of 'resilience' has been subject to a number of critiques. In this paper, we examine three of the most common: i) that resilience is a 'top‐down' policy discourse that pays too little regard to local specificities; ii) that resilience policy represents a neoliberal shift towards the responsibilization of communities and a retreat of the state from its role in providing protection; and iii) that the focus on resilience tends to divert attention away from the underlying social, political, and economic causes of vulnerability. Using data collected in post‐earthquake Nepal from Barpak, the village at the epicenter of the 2015 Gorkha earthquake, the District Headquarters, and at the national level in Kathmandu, we argue that these critiques have mixed salience in this particular context, but that the first and third in particular point to important problems in the ways in which the Government of Nepal and its international partners have approached the task of enhancing the resilience of Nepalese communities. We argue that while there are benefits to considering resilience at the community level, it is important to recognise the inequalities within communities, how these might be reflected in differential levels of vulnerability, and how they might be reinforced through resilience building programmes.

Community diagnosis is defined as a comprehensive assessment of the state of an entire community in relation to its social, economic, physical and biological environment. It is a process of examining the patterns of disease or health status in the community in order to promote health, prevent disease and manage health services for the community people. As per the curriculum of Tribhuwan University, B.Sc. Nursing first year, we were provided an opportunity to fulfill the practicum of community health nursing in the assigned area Shanti Tole and Teentara Tole, Pokhara, Lekhnath, Ritthepani-27 from 18th June to 14th July 2017. Total population of Ritthepani was 4529, male population was 2100 and female population was 2429. Each of the 13 students was assigned with 10 different families for community diagnosis in order to promote the health of the individual, family and community. The main objective of community diagnosis was to find out the health related aspects and to provide preventive, promotive, curative and rehabilitative services to the individual and the community as a whole. All the findings were presented among the key members of the community. On survey, total population of 130 houses was found 565, among them 296 were male population and 269 were female population. Sanitation of the community was inappropriate. People were not using the health facilities effectively so they were found suffering from different kinds of diseases most commonly gastritis. The common health seeking practice was going to governmental hospital and traditional healers.

A new coronavirus disease (COVID-19) caused by a novel pathogen (SARS-CoV-2) spread rapidly around the world in the early months of 2020, and was declared a pandemic by the World Health Organization (WHO) on 11 March. COVID-19 has, and continues to have, large implications for individuals, societies, and for national health systems across the globe. Due to its novelty and impact, it has challenged all health care systems where the virus has taken hold. The ways in which governments and health systems have responded have varied widely across the world. In the case of Nepal, the pandemic represented a major test for the newly decentralised health system, created as a result of the implementation of the 2015 federal constitution. This paper, which forms a part of our large on-going study of the decentralisation of the health system in the country, presents some of the early evidence on the effectiveness of the actions taken by Federal, Provincial and Local Governments and the levels of cooperation and coordination between them.

A new coronavirus disease (COVID-19) caused by a novel pathogen (SARS-CoV-2) spread rapidly around the world in the early months of 2020, and was declared a pandemic by the World Health Organization (WHO) on 11 March. COVID-19 has, and continues to have, large implications for individuals, societies, and for national health systems across the globe. Due to its novelty and impact, it has challenged all health care systems where the virus has taken hold. The ways in which governments and health systems have responded have varied widely across the world. In the case of Nepal, the pandemic represented a major test for the newly decentralised health system, created as a result of the implementation of the 2015 federal constitution. This paper, which forms a part of our large on-going study of the decentralisation of the health system in the country, presents some of the early evidence on the effectiveness of the actions taken by Federal, Provincial and Local Governments and the levels of cooperation and coordination between them.