COVID-19 Diagnosed by Real-Time Reverse Transcriptase-Polymerase Chain Reaction in Nasopharyngeal Specimens of Suspected Cases in a Tertiary Care Center: A Descriptive Cross-sectional Study.

INTRODUCTION: The emergence of severe acute respiratory syndrome coronavirus-2 pandemic is critically challenging the whole world. The real-time reverse transcriptase-polymerase chain reaction is the most widely used confirmatory test for COVID-19 detection. This study aimed to find out the prevalence of COVID-19 infection detected by gold standard reverse transcriptase-polymerase chain reaction test in a tertiary care center of Nepal. METHODS: A descriptive cross-sectional study was conducted in Karnali Academy of Health Sciences from May to August 2020 after taking ethical approval from the Institutional Review Committee of Karnali Academy of Health Sciences, Jumla. Convenient sampling was used. A total of 361 participants enrolled in this study who have done real-time reverse transcriptase-polymerase chain reaction for screening of COVID-19 infection. Also, a designated questionnaire was obtained from persons with a travel history and close contact. Statistical Package for the Social Sciences software was used for the statistical analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: The prevalence of COVID-19 was 167 (46.3%) (95% Confidence Interval= 41.16-51.44) by real-time reverse transcriptase-polymerase chain reaction test. Out of 361 samples, 339 (93.9%) were male and 22 (6%) were female. The highest frequency of the participants belongs to the age groups of 20-40 years. CONCLUSIONS: The findings showed a high prevalence of COVID-19 detected by reverse transcriptase-polymerase chain reaction test. Further studies are necessary to improve the precision of prevalence estimations.

Persistent Positivity of Reverse Transcriptase-Polymerase Chain Reaction Test among Patients with COVID-19 in Rural Teaching Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: The persistence positivity detected for severe acute respiratory syndrome coronavirus 2 ribonucleic acid by real-time reverse transcriptase-polymerase chain reaction test in asymptomatic coronavirus disease 2019 positive patients has attracted a lot of attention. There is limited data on the duration of viral shedding. We aimed to determine the proportion of coronavirus disease patients with persistent positivity of real-time reverse transcriptase-polymerase chain reaction test in a teaching hospital of Nepal. METHODS: A descriptive cross-sectional study was conducted using medical records from May to September 2020 in a teaching hospital of Nepal. The study was approved by the Institutional Review Committee of Karnali Academy of Health Sciences (Reference no 077/078/03). Convenient sampling method was used. Data was analysed by Statistical Package for the Social Sciences. Point estimate at 90% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Of the total 95 cases, 9 (9.5%) cases (4.6-14.4 at 90% Confidence Interval), were repeat positive after achieving the first negative. The mean day required of achieving the last negative for the repeat positive group was 62.11±3.95, range (60-70 days). The mean time duration for the virus shedding was found to be 20.43±12.19 days (range 7-60 days) after the first positive test result. CONCLUSIONS: This study concludes that there might be a persistent positivity of the polymerase chain reaction test among patients with COVID-19. The majority of the patients were test positive for 8-14 days, and some were positive till 60-70 days.

Health beliefs and practices regarding cervical cancer screening among women in Nepal: A descriptive cross-sectional study.

The health beliefs and practices regarding cervical cancer screening among women in the mountainous and Terai region of Nepal were investigated and examined for the differences. A descriptive cross-sectional study was conducted with a purposive sample of 216 in mountainous and 294 in Terai. The interview tools were a socio-demographic scale, a Nepalese Health Belief Model Scale for Cervical Cancer followed by the Screening Test. Chi-square test, binary logistic regression, Mann-Whitney U, and Kruskal-Wallis were used to analyze the data. The results showed that the screening rate was low for both regions with a significant difference in the benefit of screening and health motivation. Being older and having a positive family history of cervical cancer were shown to be predictors screening practice. Women from both groups preferred female doctors for screening. Culturally appropriate educational interventions focused on the benefits and obstacles of screening is needed to improve the beliefs of cervical cancer and screening and increase the screening rate. Nurses need to be aware of health beliefs regarding cervical cancer during cervical screening and education.

Infiltrating CD4 and CD8 lymphocytes in HPV infected uterine cervical milieu.

PURPOSE: Tumor infiltrating lymphocytes (TILs) have been extensively described in anti-tumor immunity, but their functional alterations in the immunoediting processes during neoplastic progression in the uterine cervix are still not clear. Our aim was to gain insight into cervical tissue T cell populations, determine if there are any differences in the localization and quantity distribution of T lymphocytes, and to evaluate their role in disease regression or progression in the cervical neoplastic milieu. PATIENTS AND METHODS: Serial section analysis of immunohistochemically stained CD4 and CD8 lymphocytes was performed on a total number of 72 samples, categorized into four cohorts: 23 HPV non-infected (HPV-) normal cervix, 20 HPV infected (HPV+) normal cervix, 17 HPV+ low grade cervical intraepithelial neoplasia (CIN), and 12 HPV+ high grade CIN. RESULTS: Low infiltrating lymphocytes (ILs) in normal cervix and high ILs in CIN were observed, while the trend of ILs increased with increasing grade of CIN, which was statistically significant (P<0.0001). Quantitative and localization analysis between the subsets of T cells showed that, in the epithelial layer, infiltrating CD8+ lymphocytes (CD8+ILs) were significantly higher than CD4+ILs in HPV+ normal cervix, while the trend decreased with increasing grade of CIN (P=0.011). Whereas, in the stromal layer, CD4+ILs were predominant in all study groups and no statistical difference was found between these groups. However, tumor infiltrating CD8+ lymphocytes (CD8+TILs) were noted to be significantly higher than CD4+TILs in severe dysplastic cases. CONCLUSION: T cell infiltrates were predominant as the grade of the lesion progressed into more advanced lesions, which likely represent the lesions that have persisted over time. The variation in the infiltration rate and the location of CD4+ILs and CD8ILs may suggest the efficacious role of CD8 T cells in eliminating HPV infected cervical epithelial cells and also provides insight into the complex role of TILs in facilitating and mediating sustained anti-tumor responses, hence preventing tumor outgrowth.

Prevalence of Teenage Pregnancy in A Community Hospital of Rural Nepal: A Cross-sectional Study.

INTRODUCTION: Teenage pregnancy is a public health concern. Maternal and neonatal health outcomes are negatively impacted in teenage pregnancy. The objective of the study is to find the prevalence of teenage pregnancy in a community hospital of rural Nepal. METHODS: A descriptive cross-sectional study was conducted at Okhaldhunga Community Hospital, Okhaldhunga, Nepal. Ethical approval was taken from the Institutional Review Committee of the hospital. Data were retrieved from July 2007 to July 2017 from the hospital record books. The total of 7054 records of deliveries were reviewed from the hospital records and whole sampling was done. Subgroup analysis was done on basis of age, ethnicity, gravida, para, period of gestation, mode of delivery, maternal or neonatal complications and birth weight. Data entry was done in Microsoft Excel and point estimate at 95% CI was calculated along with frequancy and proportion for binary data. RESULTS: The total of 7054 deliveries were conducted in ten years among which 2050 (29.06%) were teenage deliveries at the 95% CI (28.52 to 29.06). The highest percentage of teenage delivery was found among Janajati ethnicity of 1056 (53.3%). Amongst teenage delivery, a significant tear was found in 157 (7.9%) as a maternal complication. Perinatal deaths were found in 27 (1.4%). CONCLUSIONS: The trend of teenage pregnancy remains almost same over ten years in the Okhaldhunga Community Hospital. The overall prevalence of teenage delivery is higher than the national figure. Low birth weight babies, premature delivery, perineal and cervical tears were the common complications. Further health education and awareness programs might help to reduce the teenage pregnancy rate.

Ingestion of Bell Clappers by a Shaman in Jumla, Nepal: A Case Report.

Accidental foreign body ingestion is a common problem encountered in Emergency. Deliberate foreign body ingestion may result due to an act of insanity or an act of daring. A shaman locally known as Dhami was brought to Emergency with the history of ingestion of bell clappers. He denied the history of psychiatric illness or substance abuse. On physical examination, there were signs of peritonitis. Laparotomy was done to remove the foreign bodies. Post-operative period was uneventful. Apart from the surgical intervention, psychological counselling was given to him. This is a rare interesting case due to the fact that the 15 cm long foreign bodies passing all the way through without significant injury and finally causing obstruction in ileocecal junction and perforation in the distal ileum. Keywords: foreign bodies; Nepal; shaman.

Impact of cervical cancer on quality of life of women in Hubei, China.

We aimed to assess the quality of life (QOL) of the patients with cervical cancer after initial treatment, the factors affecting QOL and their clinical relevance. A total of 256 patients with cervical cancer who visited Zhongnan Hospital of Wuhan University from January 2017 to December 2017 were enrolled in this study. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 item (EORTC QLQ-C30) and cervical cancer module (EORTC QLQ-CX24) was used to assess the QOL of patients. More than half of the patients with cervical cancer reported an excellent QOL. Symptoms mostly experienced were insomnia, constipation, financial difficulties, and menopausal symptoms. Global QOL and social functioning were statistically associated with education level, occupation, the area of living, family income and treatment modality. Similarly, role functioning showed significant association with the stage of cancer, treatment modality and time since diagnosis. The rural area of living and poor economic status of the patients with cervical cancer has a negative impact on overall quality of life. Younger and educated patients are more worried about sexuality. Patients treated with multiple therapies had more problems with their QOL scales than patients treated with surgery only.

Burden of cervical neoplasia in mid-western rural Nepal: a population-based study.

OBJECTIVE: To assess the burden of cervical neoplasia in mid-western rural, Nepal using cytology, visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI). METHOD: A cross-sectional, population-based study was conducted. Total of 2,279 married, non-pregnant women aged 20-65 years participated in a screening clinic from May 2016 to January 2017. All eligible women completed self-report of socio-demographic and reproductive health data followed by screening tests. Biopsies were obtained from areas on the cervix assessed by VIA and or VILI to be abnormal. Final disease was confirmed by biopsy report. RESULTS: A total of 96.09% (n=2,190) women were eligible for this study with mean age 32.78±9.33 years. The overall rate of positive cytology, VIA, and VILI were 3.69%, 12.45%, and 16.89%, respectively. Sixty-two cases were biopsy proven cervical neoplasia. Altogether 78 (3.69%) cases were cytologically abnormal: 25 (1.18%) were atypical squamous cells of undetermined significance, 33 (1.56%) were low-grade squamous intraepithelial lesion, 11 (0.52%) were high-grade squamous intraepithelial lesion, and 9 (0.42%) were squamous cell carcinoma. Illiterate women appeared to be at higher risk for cervical neoplasia (p<0.001). Similarly, age ≥46 years (p<0.013), participant's multiple marriages or sexual partners (p<0.005), and positive human immunodeficiency virus status (p<0.001) were significantly associated with abnormal cytology. CONCLUSION: Based on cytology report, there is 3.69% prevalence of cervical neoplasia among women in a rural region of mid-western, Nepal. A "screen and treat" approach would be more attractive in low resource settings.

Prevalence and type-specific distribution of human papillomavirus infection among women in mid-western rural, Nepal- A population-based study.

BACKGROUND: Cervical cancer is the most common cancer among women in Nepal. The prevalence of human papillomavirus (HPV) 16 and or HPV 18 among women with cervical pre-cancer and cancer is higher than the incidence of HPV in the world population. The population-based epidemiological data of HPV in the general population in most parts of the country remains unknown. The objective of this study was to assess the prevalence and type distribution of HPV infection and association of abnormal cytology with high risk HPV infection among women in mid-western rural, Nepal. METHODS: A population-based cross sectional study was conducted in Jumla, one of the most remote districts in Nepal. A total of 1050 cervical samples were collected from married and non- pregnant women aged 20-65 years during mobile Cervical Cancer Screening Clinics conducted from May 2016 to January 2017. The presence of HPV DNA was firstly confirmed by HPV consensus PCR using PGMY09/PGMY11 designed primers, then HPV positive samples were further genotyped by the membrane hybridization method to detect the 21 high-risk HPV (HR-HPV) and low-risk HPV types. The prevalence of HR-HPV among women with normal and abnormal cytology was calculated. Data were analyzed using SPSS software for Windows. P < 0.05 was considered statistically significant. RESULTS: A total of 998 women were eligible for this study with the mean age 32.6 ± 8.6 years, and the mean marital age was 16.7 ± 3.8 years. The overall prevalence of HPV infections was 19.7%. HR-HPV and low-risk HPV were 11.7 and 8.7% respectively. The six most common HR-HPV types were HPV16, 39, 58, 33, 51 and 18. HR-HPV infection among the women with abnormal and normal cytology was of 27.3 and 10.8% respectively. CONCLUSIONS: There was a higher prevalence of HR-HPV infection among women living in Jumla than other parts of Nepal. This study provides preliminary information on overall HPV and type-specific HR-HPV prevalence, HR-HPV 16, 39, 58, 33, 51, and 18 are the most prevalent genotypes in this region. The data contribute to the epidemiological knowledge about HPV and type-specific HR-HPV genotypes prevalence in mid-Western Nepal.

Knowledge, attitude, practice and barriers of cervical cancer screening among women living in mid-western rural, Nepal.

OBJECTIVE: To find out the knowledge, attitude, practice, and barriers of cervical cancer screening in mid-western rural, Nepal. METHODS: A hospital-based cross-sectional study was conducted. Women aged 20 or more were interviewed using a structured questionnaire regarding the socio-demographic information, knowledge, attitude, practice, and barriers to the cervical cancer screening. RESULTS: Total of 360 participants were recruited for this study, mean age was 30.13±10.4 years. More than 87% of participants had inadequate knowledge, but around 72% had a favorable attitude towards cervical cancer screening. There was a significant portion of women (86.4%) had never done any cervical cancer screening test. Despite being higher literacy rate of Brahmin and Chhetri ethnic group, they were less likely to attend the cervical cancer screening than Dalit and Janajati (p<0.001); and those who had a positive family history of cancer were more likely to attend the cervical cancer screening (p<0.001). Similarly, married women, who had adequate knowledge and or favorable attitude, were more likely to practice cervical cancer screening, though statistically not significant. Factors such as "No symptoms," "Lack of awareness," "Embarrassment," etc. were the most common barriers for the cervical cancer screening. CONCLUSION: The adequate knowledge and practice of cervical cancer screening were meager among rural Nepalese women, but most of them had a favorable attitude. There is an imperative need for related awareness programs to promote the uptake of cervical cancer screening tests.

Quality of Life of Nepalese Women Post Mastectomy

Introduction: Worldwide breast cancer is the common invasive cancer among the females. The quality of life of women after treatment, which is often a mastectomy, is frequently decreased. Objective: To determine the life quality of Nepalese women post mastectomy. Materials and Methods: One hundred seven women after a mastectomy were selected and interviewed by using the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire and its Breast Specific Module to assess women's quality of life. Result: The study findings revealed a good score on global health status/quality of life. The respondents performed well on functional and symptom scales. In the Breast Specific Module, all respondents performed poor regarding sexual function and sexual enjoyment. Global Health Status was found useful among the women involved in service/business/agriculture and the survivors using breast prosthesis. In Breast Specific Module, systemic therapy side effects showed strong statistical associations with age, marital status, occupation, education, use of breast prosthesis and co-morbidity. Body image was highly significant with age, occupation, education, use of breast prosthesis and co-morbidity. Conclusion: Based on the study findings, counseling, and a structured educational programme is recommended to improve the QOL of women after a mastectomy.

Accuracy of Visual Tests for Primary Cervical Cancer Screening in Rural Nepal.

INTRODUCTION: In Nepal, cervical cancer is the most common female cancer. Unfortunately, there is no uniform effective screening system available all around the country. The objective of this study is to evaluate the cytology, Visual Inspection with Acetic Acid and with Lugol's Iodine alone or in combination to detect a pre-cancerous lesion in rural Nepal. METHODS: It is an analytical cross-sectional study. Convenience sampling technique was used to select participants who were apparently healthy, married, non- pregnant women of aged 20-65 years for cervical cancer screening program. Screening tests were performed on all eligible women (n=2143) after socio-demographic and reproductive health data collection. A biopsy was applied as a gold standard test. Cross-tabulations were used to describe the test sensitivity, specificity, positive predictive value, and negative predictive value at a 95% confidence interval. Diagnostic odds ratio was also calculated. RESULTS: A majority, 2143 (94%), of women accepted and participated in this study. The sensitivity vs specificity of cytology, VIA, and VILI was 57.1% vs 98.3%, 71.4% vs 88.8% and 78.6% vs 85.1%, and of the co-testing of 'Both positive VIA and VILI' and 'Either positive VIA or VILI' was 64.3% vs 85.7% and 90.1% vs 83.7% respectively. Negative predictive value of all tests exceeded 99.7%. Cytology had the highest Diagnostic odds ratio (64.9), followed by the co-test 'Either positive VIA or VILI' (27.7). CONCLUSIONS: Cervical cancer screening by co-testing 'Either positive VIA or VILI' is more useful than cytology; VIA and or VILI are easy, safe, feasible and well-accepted tests in a low resource setting, Nepal.

Anxiety and depression among patients with chronic obstructive pulmonary disease and general population in rural Nepal.

BACKGROUND: Anxiety and depression are usually under diagnosed among the patients with Chronic Obstructive Pulmonary Disease (COPD), which has a negative impact on patient quality of life through restriction of activities, loss of independence, and decreased social functioning. The purpose of this study was to describe the levels and characteristics of anxiety and depression in patients with COPD in Nepal as compared to the general population. METHODS: A hospital-based observational comparative analytical study was conducted in the United Mission Hospital, Tansen and the Okhaldhunga Community Hospital, Okhaldhunga, Nepal from June 1st 2015 to April 15th 2016. A convenience sample of two groups of participants were recruited: patients with COPD (study group) and visitors to the facility (comparison group). Anxiety and depression were measured with the Beck Anxiety and Depression Inventory Scale. RESULTS: A total of 198 individuals participated in the study; 93 with COPD and 105 from the general population. The mean age of the respondents was 58.24 ± 12.04 (40-82) years. The mean scores for anxiety and depression in COPD group were 23.76± 9.51 and 27.72± 9.37 respectively, while in comparison group, the mean score for anxiety was 8.01± 6.83 and depression was 11.60 ± 8.42. Both anxiety and depression scores were statistically significant between the groups with p value <0.001. CONCLUSIONS: Anxiety and depression were almost three times more common in COPD patients compared to the participants from the general population. Early assessment and multi-model treatment of anxiety and depression should be part of management in COPD.