कुष्ठरोगको जटिलता र हाम्रो समाज

 शिवमन्दिरका ती अनगिन्ती खुड्किलाहरु अनि  हजारौंका भिडमा  पनि हराउन नसकेका केही व्यक्तिहरुमा मेरा आँखा  एकाएक अडिन्छन् । पेशाले म चिकित्सक, त्यसैले पनि होला, मानिसका शरीरका स्वास्थ्य अंगहरुमा भन्दा अस्वस्थ अंगहरुमा आँखाहरु रोकिन पुग्छन् । लस्करै बसेका मुहारहरुमा धेरै असमानता भए तापनि उनीहरूमा केही कुराको समानता भने पक्कै थियो। केहिका हातका औलाहरु साना,झरेका जस्ता थिए भने केहीका खुट्टाका औंलाहरु झरेका जस्ता थिए । कसैका हातका औंलाहरु सबै झरी सकेका थिए भने कसैका खुट्टाका औंलाहरु बाँकी थिएनन् ।  कसैका नाक भिन्न थिए भने कसैका आँखीभौ बाँकी नै थिएनन् ।  उहाँहरु मध्ये कतिले कालो चस्मा, काठको लट्ठी र एउटा थाल  आफैसँग राखेका थिए । यी दृश्यहरू थुप्रै धार्मिक तीर्थस्थलहरुमा देख्न सकिन्छ ।  यस्ता जटिलताहरु थुप्रै रोगले निम्त्याउन सक्ने भएपनि मलाई भने मुख्यतः कुष्ठरोगका जटिलता तर्फ सोच्न बाध्य बनाउँछन् ​। 

विश्वका विभिन्न देशहरुमा कुष्ठरोग उन्मूलन  भइसकेका छन् भने ब्राजिल,भारत र इन्डोनेसिया जस्ता एसियाली एवं अफ्रिकी देशहरूमा कुष्ठरोगका बिरामीहरू  मुख्यतः भेटिन्छन् ।विश्वमा वर्षेनी लगभग दुई लाख व्यक्तिहरुमा कुष्ठरोग ​देखिने कुरा विभिन्न तथ्यांकहरुले पुष्टि गर्दछ।कुष्ठरोगका विरामीहरु भेटिने एसियाली मुलुक मध्ये नेपालमा पनि वर्षमा लगभग तीन हजार  नयाँ विरामीहरु फेला पर्ने आङ्कलन छ ।यद्यपि कोरोना सङ्क्रमणका कारण गत तीन वर्षहरुमा यो संख्या भन्दा थोरै विरामीहरु देखिए तापनि आउने वर्षहरुमा कुष्ठरोगका विरामीहरु नबढ्लान्  भन्न सकिने स्थिति छैन। 

 कुष्ठरोग एक संक्रमक रोग हो​। कुष्ठरोग Mycobacterium leprae भन्ने  किटाणु(ब्याक्टेरिया) को संक्रमणले हुने गर्दछ।   यो ब्याक्टेरिया एक संक्रमित व्यक्तिबाट अर्को व्यक्तिमा नाक र मुखबाट निस्किने पदार्थहरु (खोक्दा, थुक्दा, हाछिउ गर्दा)बाट सर्ने गर्दछ।  संक्रमण हुन लामो समयसम्म संक्रमित व्यक्तिसँग नजिक रहेको हुनु पर्दछ र त्यस्ता व्यक्तिहरूमा ब्याक्टेरियाको मात्रा धेरै भएको खण्डमा छालामा देखिएका फुस्रो छोएको थाहा नहुने दाग बाट पनि अन्य व्यक्तिमा सर्न सक्ने सम्भावना हुन्छ।   कुष्ठरोगले मुख्यतः छाला,नसा, माथिल्लो श्वास नली र आँखामा असर गर्दछ।  

छालामा फुस्रो छोएको थाहा नहुने दाग वा रातो दाग/धब्बा देखिनु, छाला छोएको थाहा नहुनु, शरीरका विभिन्न भागमा डल्लो गिर्खा आउनु,आखिभौ हराउनु,शरीर हातगोडाहरु छोएको थाहा नहुनुर कमजोर हुनु नसा दुख्नु झमझम गर्नु वा मोटो हुनु,नाक बन्द हुनु वा नाकबाट रगत आउनु,आँखाको हेर्ने शक्तिमा कमी आउनु जस्ता विभिन्न लक्षणहरू कुष्ठरोगका हुन सक्छन्। यस्ता लक्षणहरु देखिएमा नजिकैको स्वास्थ्य चौकीमा गएर उपचार गर्नु पर्दछ।  चिकित्सकले बिरामीको छाला,नसा,मासु,आँखा एवं सम्पूर्ण शरीर जाँच गरी  Mycobacterium leprae किटाणु भएको पुष्टि भएमा औषधि-उपचार सुरु गरेमा यो रोग निको हुने गर्दछ। धेरै जस्तो परिवारमा नै यो रोग देखिने भएकाले अन्य परिवारजनमा  यी  लक्षणहरु भए-नभएको आवश्यक जाँचका लागि चिकित्सकले सल्लाह दिने गर्दछन्।   उपचार सुरु भएको केही समयमा नै कुष्ठरोग संक्रमित व्यक्तिले अरूलाई कुष्ठरोग सार्न सक्दैनन्।

उपचारमा ढिलाई गरिएमा यसले थुप्रै जटिलताहरु निम्त्याउने गर्दछ।   हातगोडाका छालाले छोएको थाहा नभई घाउ चोटपटक लागेर हातगोडा डुडो हुने,नसाको जटिलताका कारण हात-गोडाका मासुहरु सुक्दै जाने र अति कमजोर हुने,नसाको दुखाई, आँखामा समस्या भई आँखाको शक्तिमा ह्रास आउने,शरीरमा विभिन्न भागहरुमा डल्लाहरु आएर ज्वरो आइ सिकिस्त बनाउने जस्ता अनेकौं  जटिलताहरु सामना गर्नुपर्ने हुनसक्छ।  

नेपालमा कुष्ठरोगको जनचेतना धेरै नै न्यून रहेको विभिन्न अध्ययनहरुले देखाएका छन्।  यद्यपि कुष्ठरोगको बारेमा जानकारी भएका व्यक्तिहरु पनि उपचारमा ढिलाइ गर्ने गरेको पाइन्छ।   अघिल्लो जन्ममा थुप्रै पापहरु गरेका कारणले गर्दा यो जन्ममा सजाय स्वरुप कुष्ठरोग लाग्ने गर्दछ भन्ने विभिन्न धार्मिक  ग्रन्थहरुमा उल्लेख गरिएको कारणले गर्दा अझै पनि नेपाली मानसिकतामा कुष्ठरोग एक संक्रमण रोग नभैकन पछिल्लो जन्मको पापको रुपमा चित्रित छ ।   अझै पनि नेपालका थुप्रै जिल्लामा कुष्ठरोगीहरुले आफ्नै घर परिवारबाट पनि हेला र तिरस्कार सहनु पर्ने बाध्यता, समाजले हेर्ने दृष्टिकोणमा क्षुद्रता एवं उपचारका क्रममा  छालामा देखिने परिवर्तनले गर्दा  हजारौ व्यक्तिहरु उपचारबाट टाढा हुने गर्दछन्।   उपचार समयमा नभएको खण्डमा देखिने जटिलताका कारण र घर परिवार समाजमा स्थान नपाइएका कारण हजारौ  व्यक्तिहरु विचलित भएका छन् । जिविकोपार्जनको लागि उचित सीप र तालिम नभएका एवं  राज्यले दिने सेवा सुविधाको बारेमा थाहा नभएकाले धेरै व्यक्तिहरु भौतारिएका छन् ।  

सायद यो मन्दिरको खुड्किलाहरुमा एकजनामा पनि  कुष्ठरोग नभएको हुन सक्छ ।  सायद  केही व्यक्तिहरुमा कुष्ठरोग कै जटिलताले यस्तो भएको पनि हुनसक्छ।  कहिकतै जनचेतनाको अभाव,रोगको प्रकृति, समाजको सोच, राज्यको कमजोरी वा हाम्रो हेर्ने दृष्टिकोण-मैले छोटा ती औलाहरु,नभरिएका घाउहरु, कमजोर आँखाहरू, लुला हातखुट्टाहरू,असह्य पिडाहरु र लाचार जिन्दगीमा देख्ने गर्दछु।  

अन्तत: कुष्ठरोग एउटा रोग हो, यो पूर्व जन्मको पाप होइन ।  

-Dr. Yagya Prasad Timalsina

Cervical Cancer- a story of Deepa

Deepa will be 42 this January. Her husband, Ramesh had returned to Nepal from his third visit to Qatar, just before the expiry of his working Visa. He immediately took a bus to Dhunche and walked hurriedly in excitement to reach his family, in the remote hill of Nepal- Cholangpati. His wife and five children were equally excited. The eldest daughter was born when she was 17 years old. The youngest was the only son-born three years back,after repeated attempts to continue the generation for the family.

With the sunset and an early dinner, all the children quickly fell asleep. A reunion of the departed husband and wife turned into intimacy where Ramesh discovered that Deepa was wincing in agony during sexual intercourse. A little later after the moment, Ramesh went to the bathroom to pee where he noticed some blood stains in his genitals. 

Deepa had her first day of menstruation 20 days back, and told the same to her husband. She even mentioned that there had been some blood spotting between her menstruation since last eight months. Ramesh thought it was a normal response of women’s body. The following night, she requested her husband to avoid the sexual intercourse as she was feeling tired with backache, pelvic pain and foul smelling discharge. Ramesh’s stay for two months before his  return wasn’t a pleasurable sexual experience for both of them-with Deepa’s denial, pelvic pain, tiredness and vaginal discharge.

Deepa was in agony from this dreadful experience and cursed herself, however she never visited a doctor for the painful sexual experience. She didn’t feel like eating and was subsequently losing weight. She increased her frequency of smoking, a habit she leant from her mother since childhood- while lighting cigarette for her in the firewood. Eight months after Ramesh’s return,on her birthday, on 5th of January, she noticed her left leg swollen while taking a shower in the cold morning.

This,now, alarmed her. She visited the nearby health post,which referred her to a doctor’s clinic in Dhunche. The doctor then referred her to Kathmandu, for further management.

With detailed history taking, examination and investigations, the doctors found out that she had Metastatic Cervical Cancer- Stage 4B.

Metastatic cervical cancer is an advanced stage cancer of the mouth of the uterus(cervix) where the cancer cells have spread to other parts of the body such as lungs, liver, bone or lymph nodes.

Deepa’s story could have ended differently if:

• She was aware that it wasn’t normal to have spotting,foul smelling vaginal discharge, painful sexual intercourse, pelvic pain, backache etc. and visited a doctor earlier.
• Her husband had known about Cervical Cancer being the reason for refusal of sex.
• She had known the risks for Cervical Cancer such as smoking, early pregnancy, giving birth to many children etc.
• She had screened herself for cervical cancer beginning at 30 years of age and repeated every 5 years.
• She was vaccinated against Human Papilloma Virus (HPV) with appropriate dosage at appropriate age.

January is celebrated as Cervical Cancer Awareness Month.

Hyuna Sung et.al estimated 604,000 new cases and 342,000 deaths in 2020 due to cervical cancer globally. About 90% of the new cases and deaths worldwide in 2020 occurred in low- and middle-income countries. Due to vigorous screening and effective vaccination against HPV, cervical cancers have decreased significantly in developed nations.The contrary is true for the developing nations.

Bruni L. et.al recently has stated cervical cancer as one of the leading cancers in women  in Nepal with 2,244 new cases and 1,493 deaths every year.

Every year, thousands of Deepa suffer in the world and Nepal.

Has Nepal thought anything for our women to prevent the situation that Deepa is facing currently? A question to think for !

-Dr. Yagya Prasad Timalsina

A BURNING ISSUE- CHINA’S DECEMBER 2022 COVID WAVE

Recent media (as in Reuters on Dec 25,2022) speak a lot about the new type of Omicron viruses spreading massively with10 lakhs new cases per day in China’s Zhejiang.

THIS PARTICULAR CORONAVIRUS:

SARS-CoV-2 is the name of the virus causing COVID-19.

SARS-CoV-2,like any other viruses, change with time, a property called as mutation.

Among many variants through mutation, Omicron is leading the infection in the world in the current scenario.

Omicron sub-variant BA.5 is causing a massive rate of infection in China.

This current sub-variant in news media is BF .7 (BA.5.2.1.7),which is creating havoc in the lives of people in China.

The signs and symptoms of the disease are similar to other sub-variants of Omicron.

The rates of infections of this sub-variant are found to be higher than the other variants.

Prevention includes the same principles of physical distancing, masking, avoiding crowded areas, complete vaccination with booster doses, and washing hands/use of sanitizers frequently.

Nepal has no reported case of this particular sub-variant of Omicron virus as of today, but a strict monitoring and regular genomic analysis of the positive cases found in Nepal is required.

(This is subject to change with new information through research, but holds true until the day it was drafted on December 26,2022).

-Dr.Yagya Prasad Timalsina

ACUTE HEPATITIS IN CHILDREN-CAUSE UNKNOWN

Acute Hepatitis in Children-Cause Unknown

In late December 2019, our world witnessed the first cluster of cases of COVID-19 which is still creating a massive havoc for the entire human population of the world. We have been skeptical since then because the first few cases of Wuhan,China engulfed the entire world in no time.

Now, the first few cases causing acute hepatitis have been notified to WHO on April 5 2022. Acute hepatitis– a medical terminology to describe the period of inflammation( local response to cellular injury marked by swelling, redness,heat,pain and loss of function) in the liver lasting less than six months of duration.
10 cases were reported from Central Scotland- the cause for severe acute hepatitis is unknown till date.

What do we know as of today?
74 cases had been reported in the UK till April 8,2022 with similar symptoms. All the cases are reported among children less than 16 years of age.
Hepatitis viruses(A,B,C,D,E) were excluded in the laboratory.However,viruses causing COVID-19 i.e. SARS-CoV-2 and/ or Adenovirus have been found in many cases.
Less than 5 cases from Ireland and 3 cases from Spain are on the investigation with similar symptoms.

So, what is the working case definition?
A confirmed case is a person presenting with an acute hepatitis (non-hepatitis Virus A,B,C,D,E) with AST or ALT over 500 U/L who is 10 years and under, since 1 Jan, 2022.
AST and ALT are enzymes found mostly in liver which increases during liver injury( Normal value varies based on laboratory-ALT 7-55 U/L, AST 8-48 U/L).

Signs and Symptoms :

A child can present with any one or more of the following:

Discoloration of Urine (dark) and/or Stool(pale)

Jaundice (yellowish discoloration of skin, sclera etc)

Pruritis (Itching)

Arthralgia/Myalgia( joint pain/Muscle pain)

Pyrexia(fever)

Nausea,Vomiting or Abdominal Pain

Lethargy and/or loss of appetite

Diarrhea

How severe is it?
All the first 10 cases were detected during hospitalization. All of them were healthy, prior to illness.As of April 11,2022, no deaths had occurred amongst reported cases.However, six children required liver transplantation.

What next?

WHO is monitoring the situation with other member states and the UK along with partners for cases with similar profiles.

Many questions are left unanswered. With time,we hope to find the cause(etiology) of acute hepatitis of this unknown etiology because we are all exhausted to have another outbreak in any form.Hence, it is our duty to stick with the basics to contribute to the better health of everyone.

For more,click on the link below:

https://www.who.int/emergencies/disease-outbreak-news/item/acute-hepatitis-of-unknown- aetiology—the-united-kingdom-of-great-britain-and-northern-ireland https://www.gov.uk/government/publications/hepatitis-increase-in-acute-cases-of-unknown- aetiology-in-children/increase-in-acute-hepatitis-cases-of-unknown-aetiology-in-children