Breastfeeding and female labor force participation: the probability of survival of children in Nepal under 3 years old.

BACKGROUND: The number of breastfeeding mothers participating in a labor force to generate income has been increasing in Nepal. In this regard, the study aims to assess the survival of Under 3 children in Nepal from the mother based on their labor force participation and breastfeeding status. METHODS: Data for the study were obtained from the Nepal Demographic and Health Survey 2016. The sample size of the study was 2,994 live births children, born in the last three years prior to the day of the interview. The robust hazard ratio and cox proportional hazard regression were conducted between dependent and independent variables with 95% confidence intervals (CIs) to conclude. RESULTS: From a total of 2,994 live births, 85 children died within 36 months of birth. More than 80% of the non-working mothers were breastfeeding their children. The findings shows that the survival of children under-3 is positively associated with the interaction with the mother's work and breastfeeding status (Hazard Ratio 0.428, 95% CI 0.24, 0.75), family structure (Hazard Ratio 1.511; 95% CI 1.37, 1.655), relationship with the household head (Hazard Ratio 0.452; 95% CI 0.311, 0.65), wealth quintiles (Hazard Ratio 0.390; 95% CI 0.33, 0.46), caste (Hazard Ratio 0.652; 95% CI 0.60, 0.69), and religion (Hazard Ratio 2.015; 95% CI 1.09, 3.70) with model CI 95%, Log pseudo likelihood = -521.39236, prob. χ2 = 0.005 and time at risk = 52,748. CONCLUSIONS: The highest rate of child survival was from the working mothers as well as continuing breastfeeding their children followed by mothers breastfeeding the child but not working, compared to mothers working but not breastfeeding the child, and mothers who were neither working nor breastfeeding their children respectively. This study provides clear evidence that breastfeeding is very important for the probability of survival of the child aged below 36 months and work of mother also have some positive impact on child survival. Employers should be encouraged to have a breastfeeding policy in the workplace through the establishment of a breastfeeding facility, and a flexible work schedule. At the same time government should also regulate the paid maternity leave and encourage societal support for the breastfeeding mothers.

Maternal near miss at Kathmandu Medical College: An analysis of severe maternal morbidity at a Nepalese tertiary care facility.

BACKGROUND: The World Health Organization (WHO) 'near miss' tool has been extensively used to audit maternal morbidity in low- and middle-income countries. Analysis of the cases of 'near miss' enables a better understanding of the associated factors, identifies deficiencies in the provision of maternity services and lays a foundation for better preventive measures in the future. AIMS: To understand the epidemiology, aetiology and determine the aspects of preventability of maternal 'near miss' (MNM) at Kathmandu Medical College. MATERIALS AND METHODS: A prospective audit of MNM and maternal deaths (MD) was undertaken at Kathmandu Medical College over a period of 12 months. The cases were identified using WHO 'near miss' criteria and areas of preventability in the provision of care determined using the modified Geller's criteria. RESULTS: The total number of deliveries and live births in the study period were 2747 and 2698 respectively. A total of 34 'near misses' and two MDs were identified. The common direct aetiologies of MNM and MDs identified were obstetric haemorrhage followed by hypertensive disorders with one-third of cases being of indirect aetiology. Fifty-five percent of cases had some aspects of provider- or system-related preventability with the leading delays being lack of diagnosis and recognition of high-risk status among patients and lack of interdepartmental communication. CONCLUSION: The WHO near miss rate at Kathmandu Medical College was 12.5/100 live births. Significant aspects of preventability, especially at the level of the provider, were noted among cases of MNM and MDs.

A case of scar endometriosis in cesarean scar: A rare case report.

INTRODUCTION: Scar endometriosis is a rare entity characterized by presence of functional endometrial tissue in the site of surgical scar. Cesarean section scar is the most common reported site. We herein report a case of cesarean scar endometriosis in a 43-years-old female patient. CASE PRESENTATION: A 43 year old female, with history of lower segment cesarean section 8 years back, presented to our center with complains of pain and palpable lump during menstruation, at the site of cesarean scar. On ultrasonography she was said to have some pathology in her previous surgical scar site. On MRI, a soft tissue mass measuring 25 × 35 mm within the subcutaneous tissue of anterior abdominal wall on the left side was seen. She was planned for surgical removal of the tissue. DISCUSSION: Scar endometriosis is a rare entity. The iatrogenic implantation of the hormone sensitive endometrial tissue into the edge of the wound during surgery best explains its occurrence. They usually present as a painful nodule in the site of surgical scar that undergoes cyclic variation with the menstrual cycle. Diagnosis can be confirmed by radiography. Treatment options can be medical and surgical, the latter being more effective and the preferred one. CONCLUSION: Scar endometriosis often mimics with variety of clinical conditions, so high degree of suspicion is necessary. Efforts should be aimed at minimizing the transfer of endometrial tissue into the subcutaneous area. Gloves replacement prior to closure can avoid the implantation of endometrial tissue into the abdominal wall.

A case of huge ovarian cyst in second trimester: A rare case report.

Introduction: Large cystic masses are rare in pregnancy. Corpus luteum cysts and theca lutein cysts are common are most common among all. Ovarian masses are usually discovered as an incidental finding during routine obstetric ultrasonography. Management depends upon the size of the mass, and the symptoms produced by the mass. Case presentation: Our case describes an incidental finding of a large ovarian cyst during the second trimester, in a 24-year-old female patient. Per abdominal examination revealed a huge mass in the epigastrium, left hypogastrium, and left lumbar region, along with 20 weeks sized uterus. Ultrasonography revealed a cystic mass of 11.9 cm × 11.7 cm X 15.9 cm, with multiple septations and cystic areas. After other baseline investigations, she was planned for surgical removal of the mass. Upon histopathologic examination after surgical excision, the mass was found to be mucinous cystadenoma. Discussion: Large ovarian masses are uncommon during pregnancy. The most common complications of ovarian masses in pregnancy are torsion, rupture, infection, or malpresentation of the fetus. Surgical management can be done if the mass presents with acute symptoms like torsion, or if the size of the mass is greater than 5 cm. Non-obstetric surgery for cyst removal can be done electively during the second trimester, or irrespective of the period of gestation if there are acute symptoms. Conclusion: Large ovarian masses are usually rare during pregnancy. It is necessary to properly evaluate the case of ovarian masses during pregnancy, to decide the appropriate line of management.

Thoraco-omphalopagus conjoined twin: A rare case report.

INTRODUCTION AND IMPORTANCE: Conjoined twins represent a rare phenomenon and the etiology has not been clarified yet. There is a high rate of stillbirth and neonatal deaths resulting in very few cases surviving long enough for surgical separation. CASE PRESENTATION: A 33-year-old gravida 2 para 1 mother without any first and second trimester antenatal care visits was diagnosed to have conjoined twins in the third trimester. Mother and her family chose to terminate the pregnancy for which elective lower section cesarean section was done with the delivery of female conjoined twins, both of them subsequently declared dead within 4 h of birth. CLINICAL DISCUSSION: A conjoined twin gestation provides inimitable intricacy for obstetric management irrespective of the patient's areas of care. Early diagnosis through ultrasonography can be done and detailed evaluation is necessary along with fetal echocardiography regardless of site of fusion. Cesarean section is the recommended mode of delivery as this reduces various complications. CONCLUSION: The obstetricians' role in timely prenatal diagnosis, counseling, and organization of interdisciplinary medical care is indispensable in cases of conjoined twins.

Bilateral ovarian mucinous carcinoma (stage III) with omental involvement and incidental hydronephrosis: A rare case report.

INTRODUCTION: Though ovarian malignancies are common, mucinous ovarian carcinomas of high grade are rare. They usually occur in a young female under 40 years of age. Here, we present a case of mucinous ovarian carcinoma (stage III), with omental involvement and incidental hydronephrosis in a 67-year-old female patient. CASE PRESENTATION: A 67-year-old female patient presented to us with a history of lower abdominal pain for 2 months and per-vaginal discharge for the last 6 days. On deep palpation of the abdomen, a nodular mass occupying the suprapubic region was found. Bimanual palpation revealed a mass on the right and left adnexa. After visualization of septate cystic mass bilaterally on CECT, she was planned for staging laparotomy with bilateral salpingo-oophorectomy (BSO) with infra-colic omentectomy with peritoneal cytology. Incidentally, a horseshoe-shaped kidney with right mild hydronephrosis was found. After surgery and histopathologic examination, mucinous ovarian carcinoma (stage III), with omental involvement was confirmed. DISCUSSION: Mucinous ovarian carcinomas are rare malignancies, with different natural history, molecular profile, and prognosis as compared to other epithelial tumors of the ovary. These carcinomas can be either primary or secondary (those metastasized to the ovary from elsewhere), and this differentiation is essential. The therapeutic approach to the patients depends upon the stage at which these carcinomas are diagnosed. CONCLUSION: Mucinous ovarian carcinomas are rare and have unique features among the epithelial ovarian carcinomas. Appreciation of these features will surely make a positive impact in improving the management and thus the prognosis of these carcinomas.

"Upgrading self-esteem: Effectiveness of cognitive enhancement package among psychiatric inpatients."

OBJECTIVE: To assess and compare the self-esteem before and after administration of cognitive enhancement package among psychiatric inpatients. DESIGN & METHOD: Quantitative approach, Non-Equivalent control group pre-test and post-test design under quasi experimental research design was used for study. Total 60 psychiatric inpatients whose scores came out to be 25 and less in Rosenberg Self-esteem scale were enrolled in the study. Samples were selected by using purposive sampling method. Total four sessions of intervention were provided with 80 to 100 min for overall tasks. Interventions comprised of total three sub-tasks and each task was followed by daily assessment of progression with the help of self-care activities checklist for self-care activities, Ferrara Group Experience scale for group interaction and Mini-Mental Status Examination for cognitive functioning. Post-test was taken on fifth day of intervention. RESULTS: The results showed that mean score of self-esteem (14.17 ± 2.00), self-care activities (3.83 ± 2.34) and group interaction (20.83 ± 7.42) along with cognitive functioning (18.23 ± 6.07) in pre-test were in lower level comparatively than in post-test after administration of Cognitive Enhancement Package which is self-esteem(20.17 ± 3.24), self-care activities (6.82 ± 2.31), group interaction (37.90 ± 5.71) and cognitive functioning (24.80 ± 4.12) at the 0.05 level of significance (p ≤ 0.05). However, the score remained same or decreased in case of comparison group who only received routine hospital care. CONCLUSION: All in all, present study concluded that different innovative psychological approaches like Cognitive Enhancement Package can be incorporated along with usual psychopharmacology in order to promote the overall wellbeing and better rehabilitation for the psychiatric inpatients.

Elderly Gravida with Bombay Blood Group and Placenta Previa Managed with Autologous Blood Transfusion.

The Bombay blood group is a rare blood type with an incidence of around one in a million. There is no known reported case of an obstetric patient with the Bombay blood group from Nepal. People with this rare blood group can receive blood only from those with the same blood type. We report an elderly gravida with the Bombay blood group who had a pregnancy complicated by diabetes, placenta previa, and transverse lie (back up) following an in vitro fertilization. Placenta previa posed a greater risk of hemorrhage and hence the need for transfusion. The main challenge was arranging blood for transfusion, and as the Bombay blood group was unavailable, she was managed with autologous blood transfusion which was performed for the first time in a pregnant lady in our institute. She underwent Cesarean section for placenta previa with transverse lie, and both mother and baby were sent home in good health.

Deficient crisis-probing practices and taken-for-granted assumptions in health organisations.

The practice of crisis-probing in proactive organisations involves meticulous and sustained investigation into operational processes and management structures for potential weaknesses and flaws before they become difficult to resolve. In health organisations, crisis probing is a necessary part of preparing to manage emerging health threats. This study examined the degree of pre-emptive probing in health organisations and the type of crisis training provided to determine whether or not they are prepared in this area. This evidence-based study draws on cross-sectional responses provided by executives from chiropractic, physiotherapy, and podiatry practices; dental and medical clinics; pharmacies; aged care facilities; and hospitals. The data show a marked lack of mandatory probing and a generalised failure to reward crisis reporting. Crisis prevention training is poor in all organisations except hospitals and aged care facilities where it occurs at an adequate frequency. However this training focuses primarily on natural disasters, fails to address most other crisis types, is mostly reactive and not designed to probe for and uncover key taken-for-granted assumptions. Crisis-probing in health organisations is inadequate, and improvements in this area may well translate into measurable improvements in preparedness and response outcomes.