Cervical lymph node metastasis in squamous cell carcinoma of the buccal mucosa: a retrospective study on pattern of involvement and clinical analysis.

BACKGROUND: The study was performed with an aim to map the pattern of metastasis of squamous cell carcinomas of buccal mucosa to various cervical lymph node levels and analyze its correlation with primary tumor size and histo-pathological grading. MATERIAL AND METHODS: 254 patients with squamous cell carcinoma of the buccal mucosa treated with surgery first approach were analyzed retrospectively. The tumor size was noted from pre-operative CT Scans and were divided into early and advanced tumors. The resected specimen was studied to note the histo-pathological grading of the squamous cell carcinoma and the metastatic deposits at various lymph node levels. RESULTS: Out of 254 patients (149 females, 105 males), 145 patients showed histo-pathologically proven metastatic deposits in one or more lymph nodes out of which there were 56 patients showing occult metastasis. 78/145 patients showed metastatic involvement of level IB and/or IA lymph nodes, 31 showed involvement of level II and/or I lymph nodes, 27 showed involvement of level III with or without involvement of level I and II and 9 showed metastasis to level IV and V lymph nodes with or without level I, II or III lymph nodes. Cervical lymph node metastasis had statistically significant association with tumor size with advanced tumors showing worse pattern of metastatic spread beyond level I and II lymph nodes. As the degree of differentiation of squamous cell carcinoma reduced, they were more prone for cervical metastasis with moderately and poorly differentiated squamous cell carcinoma showing higher involvement of level III, IV and V lymph nodes. CONCLUSIONS: The majority of buccal mucosa cases showed metastasis to level I, II and III lymph nodes out of which level IB and/or IA was most frequently involved. Metastasis to level IV and V lymph nodes was rare and was seen especially in patients with advanced primary tumor and poor histo-pathologic differentiation.

Human resource for health production capacity in Nepal: a glance.

BACKGROUND: Shortage of human resources for health is apparent in Nepal. The current HRH strategy has tried to address the demand for skilled birth attendants, MDGPs, gynecologists, anesthetists, radiologists and other health workforce. Despite the increased number of institutions, there is still shortage of health workforce due to ineffective monitoring. This study was undertaken to find out the situation of HRH production in Nepal. METHODS: This cross sectional study was conducted from September 2012 to February 2013. The primary focus was on the quantitative method by using the format for the data collection. The main study samples were the academic institutions of Nepal. The finding was analyzed and tabulated in the summary form. RESULTS: There were a total of 294 institutions to produce different cadres of health workforce in Nepal. Staff nurses (101) and CMAs (76) have been produced by the maximum number of institutions. The result revealed that the institutions were not producing the graduates upon their capacity, only 1,451 staff nurse graduated annually against the capacity of producing 4,017 per annum. Although Nepal has a capacity to produce 1,760 MBBS, 267 MD and 116 MS doctors, only 1,074 Nepali MBBS, 222 MD and 95 MS doctors graduated per year. CONCLUSIONS: The health institutions performance is lower in producing HRH compared to their capacity in the country. A long-term effort is now required to match demand and supply of the HRH in the country.

Effectiveness and efficiency of Aama Surakshya Karyakram in terms of barriers in accessing maternal health services in Nepal.

BACKGROUND: The Family Health Division along with the MoHP developed a policy that recommended provision of incentives to all delivering mother by removing the parity condition and termed Safe Delivery Incentive Programme (SDIP) to make it more appropriate. The SDIP was branded as AamaSurakshyaKaryakram (ASK). The main objective of the study was to find out the effectiveness and efficiency of AamaSurakshyaKaryakram to address barrier in accessing maternal health services in Nepal. METHODS: An exploratory and cross sectional descriptive study was conducted by quantitative and qualitative tools and techniques. To provide comprehensive coverage, five districts have been selected representing four development (eastern, central, western and far-western) and three (mountain, hill and flat) ecological region were selected. RESULTS: Out of 47 exit client interviews conducted in this study, 51 percent were done in Sunsari, followed by Sarlahi (17%), Dadeldhura (17%), and Arghakhanchi (15%). Most of these mothers (94%) delivered their children in the hospitals, and rest (6%) in PHCCs. Sixty percent mothers were in the age group of 20-25 years, while 45 percent were from Tarai/Madhesi group followed by Brahmins/Chhetries group (34%). Total 70% mothers were found to be literate. 55% mothers were found to be visiting health facilities during labour pain. 2% mothers were visiting heath facilities before labour pain started. Rest mothers were visiting health facilities after one or two days of labour pain. Total 70% mothers were able to reach the health facility within 60 minutes, while 13 percent mothers were able to reach the facility more than 3 hours, and 17% were in between. All mothers who visited PHCCs were able to reach the facility within 60 minutes while analyzing health facility-wise. CONCLUSIONS: Mothers delivered at home as they were not well prepared to go to health facility. Lack of transportation facility hindered for institutional delivery. None of them figured out that there was a provision of transport incentive; they only knew that there was a cash payment, but they didn't know exactly for what specific purpose mothers were receiving such payments. Ask found to be effective and efficient in order to address barriers occurring inside the health facility and financial barrier except geo-graphical barrier in accessing maternal health services in Nepal.

Assessment of medical and health institutions registered as research centres in Nepal.

BACKGROUND: There were several reports in the various mass media regarding misuse of the word "research" by various organization and it has been argued that putting the word "Research" in any agency's name made easier to get the various medical from abroad without paying or paying minimum or discounted government tax than others. The objectives of the study was to find out the status Medical and Health institutions designated as Research Centres in Nepal. METHODS: A cross sectional prospective study was carried in medical and health institutions of Nepal. Data regarding the registration of institutions/organizations having the word "research" in its name were collected from concerned registered organizations. Formative evaluation method was adopted in which information were added continuously, organized systematically and analysed periodically during the evaluation period. RESULTS: There were altogether 370 health related research centers registered in MoI and CDO at the district level till 31 December 2010. These research centers were located in 33 districts of Nepal. Among these there were 65 (82%) health facilities and 305 (18%) NGOs designated as research centers. The region wise the range of number of research centers among five regions was 4 to 283. The highest number of research centers level. The highest number of research centers was found in Kathmandu district. Out of 370 research centers, 85 research centers (72 from among health facility related research centers and 13 from among NGO related research centers) were selected randomly for evaluation purpose, which represented 23 percent of sample selection. The sample selection was not less than 20 percent in each category of research centers. One fifth research centers were found to conduct health related research progam. Among which majority (more than 50%) of NGO related research centers was found to conduct health research. There were few (14%) health facility related research centers that actually conducted health related research program. The study also shows that majority 73 (86%) of the research centers didn't start the research yet. CONCLUSIONS: Forty percent of the research centers in Nepal didn't know the actual reason for putting the word "research" into their signboard. A regulation has to be made to safeguard and maintain the integrity of research in Nepal.