Assessing the Nepalese health system's readiness to manage gender-based violence and deliver psychosocial counselling

Violence against women (VAW), particularly intimate partner violence (IPV) or domestic violence, is a major public health issue, garnering more attention globally post-coronavirus disease 2019 (COVID-19) lockdown. Health providers often represent the first point of contact for IPV victims. Thus, health systems and health providers must be equipped to address survivors' physical, sexual and mental health care needs. However, there is a notable lack of evidence regarding such readiness in Nepal. This study, utilizing a concurrent triangulation design, evaluated the readiness of public health facilities in Nepal's Madhesh Province in managing VAW, focusing on providers' motivation to offer psychosocial counselling to survivors. A cross-sectional study was conducted across 11 hospitals and 17 primary health care centres, where 46 health care providers were interviewed in February-April 2022. The study employed the World Health Organization's tools for policy readiness and the Physician Readiness to Manage IPV Survey for data collection. Quantitative and qualitative data were collected via face-to-face interviews and analysed using descriptive and content analysis, respectively. Only around 28% of health facilities had trained their staff in the management of VAW. Two out of 11 hospitals had a psychiatrist, and a psychosocial counsellor was available in four hospitals and two out of 17 primary health care centres. Two-thirds of all health facilities had designated rooms for physical examinations, but only a minority had separate rooms for counselling. Though a few health facilities had guidelines for violence management, the implementation of these guidelines and the referral networks were notably weak. Hospitals with one-stop crisis management centres demonstrated readiness in VAW management. Health providers acknowledged the burden of IPV or domestic violence and expressed motivation to deliver psychosocial counselling, but many had limited knowledge. This barrier can only be resolved through appropriate training and investment in violence management skills at all tiers of the health system.

Occlusion in the Flow of New Drugs for Cardiovascular Disease

There is a large misalignment between unmet need and both private and public investment activity in cardiovascular disease. In this paper, we quantify the magnitude of the gap, analyze a range of potential root causes in two main categories (issues of feasibility and valuation), and propose steps toward solutions to close the gap.

Low Molecular Weight Antioxidants (LMWA) and their Orchestration

Every day we hear more and more about free radicals and how they are linked with innumerable diseases and health conditions from ageing to muscular degeneration and even some forms of cancer. The problem is not in knowing that these microscopic enemies exist. We know that they do! The problem is how to fight them so that they are rendered harmless. Under normal metabolic conditions each cell of human body is exposed to about 1010 molecules of superoxide anions (primary free radical) each day. For a person weighing 150 pounds, this amounts to about 4 pounds of superoxide per year, a substantial amount! Once formed, superoxide can react through catalytic pathways in the cell to form many other reactive oxygen/nitrogen species (ROS/RNS). The antioxidant defense system in the human body is extensive and consists of multiple layers, which protect against different types of ROS/RNS. Many of the biological effects of antioxidants appear to be related to their ability not only to scavenge the deleterious free radicals but also to modulate cell signalling pathways.   Nepal Journal of Medical Sciences | Volume 02 | Number 02 | July-December 2013 | Page 171-180 DOI: http://dx.doi.org/10.3126/njms.v2i2.8971  

Management of intra-articular fracture of calcaneus by combined percutaneous and minimal internal fixation

BACKGROUND

Fractures of the calcaneus are among the most challenging for the orthopaedic surgeon. The treatment of the intra-articular calcaneum fracture remains controversial due to complications and complexity of surgical anatomy. Treatment of calcaneal fracture ranges from non-operative treatment to operative. We present intraarticular fracture of calcaneus treated by combined percutaneous and minimal internal fixation.

METHODS

All cases evaluated either by X-ray or CT scan. All fractures were sanders two or three type evaluated by CT scan and either joint depression or tongue type fracture by X-ray. Lateral approach was used, posterior facet was exposed, reduced and fixed with one 4 mm canulated cancellous screws and 2 axial pins percutaneously from tuberosity. Clinical evaluation of the outcomes was done by modified Rowe Score.

RESULTS

Out of 22 patients, 14 were male and 8 cases were female. Average age of the patients was 30.5 yrs (15-63 yrs). Mode of the injury was RTA in 6 cases and fall from height in 16 cases. There was no soft tissue problem in any patient. All fractures united without secondary displacement in an average of 8 weeks. Average duration of follow up was 26 months (6-37 months). Average Modified Rowe Score was 80 (Range 55-95). Ten patients had excellent, 10 had good and 2 had satisfactory outcome.

CONCLUSIONS

Intra-articular fracture of the calcaneus can be well managed by minimal opening at the fracture and fixation by single cancellous screw and 2 axial k-wires, so minimizes complications and results in comparable outcomes.

Primary non-Hodgkin's lymphoma of bone arising from hip

Non-Hodgkin's lymphoma can present as either a nodal form with local or regional lymphadenopathy or less commonly, as an extranodal form outside the lymphatic system. Primary lymphoma of bone (PLB) is uncommon malignancies. Here we present a case of primary non-Hodgkin's lymphoma of bone arising from hip with clinical and radiological diagnostic difficulty.

KEYWORDS

lymphadnenopathy; malignancies; Non-Hodgkin's lymphoma; primary bone lymphoma.