Knowledge and practice of breast self-examination among female patients attending general outpatients in BPKIHS

Background: Breast cancer is the most common and remains a major health problem all over the world, affecting both developing and developed countries. The strategy to detect early breast cancer is important which includes breast self-examination (BSE), clinical breast examination, and mammography. The studies have found that women who reported that they had been BSE performers had their breast cancer detected at a smaller size and earlier clinicopathological stage. There is a paucity of data on the knowledge and practice of BSE in Nepal among the female population of eastern Nepal. Therefore, this study is conducted to know the knowledge and practice of BSE among the female population attending the general outpatient department. Methods: A cross-sectional study was conducted over one and half years among 262 females attending general outpatients, using a semi-structured questionnaire. Results: The majority of the participants (29.4%) were in 3rd decade of life followed by 2nd decade (26%). Forty-one (41%) of the respondents had ever heard of BSE and the main source of information was social media (51%). Only 14.5% had adequate knowledge of BSE. Out of all, only 10.7 % were practicing BSE and the frequency of practice among them was rarely (53.5%). Seventy-two (72%) responded that they don’t know how to perform when asked why they did not perform BSE. Conclusions: This study revealed that most of the participants had low knowledge and practice of BSE. Therefore, developing a health education program to raise awareness about BSE is important.

Spirometry in evaluation of respiratory diseases.

A hospital based cross-sectional study was conducted from March 2005 to April 2006 to evaluate the distribution of various respiratory diseases by spirometry. A total of 228 consecutive cases referred for spirometry were included of which 65% were male and 35% female. COPD was the commonest referral diagnosis (40%) followed by the diagnosis of shortness of breath (22%). After spirometry the prevalence of COPD was 42%, Asthma 23.5%, Restrictive disease 3.1% and mixed obstructive and restrictive disease 3.5%. 25% of the sample population was smokers and 22% ex-smokers. Hence we conclude that spirometry is a very useful diagnostic tool for preliminary diagnosis of respiratory diseases and should be used more by general practitioners and physicians to make their diagnosis and therapy more scientific.

Enteric fever: diagnostic value of clinical features.

OBJECTIVES: to evaluate the diagnostic value of clinical symptoms and signs in enteric fever and to propose a clinical diagnostic criterion. DESIGN: Prospective observational study. SETTING: Kathmandu Medical College, Teaching Hospital, Kathmandu, Nepal. MATERIALS AND METHODS: febrile patients with clinical diagnosis of enteric fever were included in the study with the aim of confirming diagnosis with blood culture, or bone marrow culture and evaluating the diagnostic accuracy of various clinical signs and symptoms. RESULTS: 64% of the clinically diagnosed cases had blood/ bone marrow culture positive. The diagnostic accuracy of the various symptoms and signs excluding fever was between 42%-75.5%. Majority of the symptom and sign did not have very high diagnostic accuracy. Hence a diagnostic criterion was proposed and clinical features with diagnostic accuracy more than 50% were taken into consideration. Major criteria included fever with diagnostic accuracy of 64%, headache with accuracy of 75.5% and relative bradycardia with an accuracy of 66%. Minor criteria included vomiting, diarrhoea, Splenomegaly, chills and abdominal pain /discomfort with diagnostic accuracy of 57%, 55%, 55%, 53% and 51% respectively. Finally after combination of various major and minor criteria a final diagnostic criterion was proposed having an accuracy of 66% and including both major and minor clinical symptom and sign. CONCLUSION: clinical diagnosis of enteric fever will be very helpful in a country like ours. Though none of the clinical symptoms and sign have very high diagnostic accuracy a diagnostic criteria may be helpful. Criteria including both major and minor signs and symptoms would be the most appropriate diagnostic tool as it includes the important abdominal symptoms and signs of enteric fever.

Marfan's syndrome with aortic valve endocarditis.

Marfans syndrome is an Autosomal dominant disorder of the connective tissues resulting in abnormalities of the musculoskeletal system, cardiovascular system and eyes. It has a prevalence of 1 in 100,000 population1 and occurs in all ethnic groups. It may be familial or due to new mutation (30%), in the fibrillin gene on arm of chromosome 15. It is estimated that one person in every 3000-5000 has Marfans syndrome may have cardiovascular abnormalities and may be complicated by infective endocartditis. About 90% of Marfan patients will develop cardiac complications2. The patient under discussion has musculoskeletal (Tall stature, reduced upper-lower segment ratio, arm-span to height ratio > 1.05, high arched palate) and Cardiovascular features (Severe aortic regurgitation complicated with infective endocarditis).