Blog
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21/04/2020 16:53
Patient Education
What is Pimple or acne?
Acne is the medical term for pimples. They are the disorders of pilo-sebaceous unit, i.e. hair follicle and sebaceous gland (oil secreting gland). They occur when pores get clogged with dead skin and oil, and bacteria accumulate. Then, the skin gets inflamed and can turn red or swell. It is the most common skin disorder, affecting an estimated 85 percent of adolescents in western countries, whereas in Nepal and India, it’s around 40-50% in adolescents.
How does acne develop?
There are four basic events involved in the development of acne lesions.
- Hair follicles get blocked with keratin which combine with sebum (an oily substance), creating a plug in the follicle.
- The sebaceous glands, enlarge during adolescence and sebum production increases.
- The increase in sebum allows for the overgrowth of a bacterium called Cutibacterium acnes that normally lives on the skin.
- Inflammation occurs as a result of bacterial overgrowth or other factors. This can lead to the rupture of the follicle and the formation of a swelling, abscess or tender pimple.
What are the aggravating factors of acne?
Multiple factors have been proposed to cause precipitation or aggravation of acne including cosmetics, drugs, stress, hormones, sunlight, seasonal variation etc.
Stress — Psychological stress can probably worsen acne. Acne severity appeared to worsen during times of increased stress. Stress is frequently implicated in the aggravation of acne while acne itself induces stress.
Hormonal changes — Hormonal changes during adolescence cause the sebaceous glands to become enlarged. Although acne is principally a disorder of adolescence, the prevalence of adult patients with acne is increasing.
Diet — The role of diet in acne is controversial though studies have found weak associations between cow's milk and an increased risk of acne, perhaps because of hormones that occur naturally in milk. However, there is no strong evidence that milk, high-fat foods, or chocolate increase the risk of acne.
Is there anything I can do on my own to reduce acne?
Yes. The way you take care of your skin has a big effect on your acne. Here's what you should do:
- Try to be cool, calm and stress free. You can also try some yoga or music.
- Wash your face to remove dirt and grease. Use warm water. Use a gentle non-soap facial skin cleanser. Do not scrub your face, because that can make acne worse and damage the skin.
- Do not pick or squeeze pimples. This can make acne worse and damage the skin. It also can lead to infections.
- Avoid oil-based make-up and skin products. They can make acne worse. If you use a moisturizer for your face, a moisturizer labeled as "non-comedogenic" is often best.
- Moisturizers — Use of a moisturizer minimizes dryness and skin peeling. Moisturizers that are labeled as "noncomedogenic" are less likely to block skin pores.
- Sun protection — Some acne treatments increase the skin's sensitivity to sunlight. To minimize skin damage from the sun, avoid excessive sun exposure and use a broad-spectrum sunscreen with SPF 30 or higher.
How is acne treated?
There is no single best treatment for acne and is also individualized. Treatment depends upon the grade of the disease using different types of medicines. Please don’t use the medication without the doctor’s supervision.
- Topical medication
- Medicines you put directly on your skin – These can be gels, creams, or lotions. Examples: retinoid, salicylic acid, glycolic acid, antibiotics
- Oral Medication (Pills)
- Antibiotic, Retinoid, Hormones
Can I treat my own acne in these Lock Down periods?
Do not use OTC (over the counter) product that contain steroids. If you have mild acne, you may try non-prescription acne products like facewash. But, you need to be under observation of skin doctor. In rare cases, you might have a severe allergic reaction to these products, so for the first 3 days, try them on just a small area. If you do not improve after 3 months, or if you have moderate or severe acne, you must visit dermatologist.
What about my scars from acne?
Try not to pick up the pimples or use harsh measures. If you have severe or ugly scar, they might need some treatment using some surgeries, LASER or chemicals or combination of all of those. But, majority of the scars would heal with time. Protect from sunlight to prevent pigmentation.
What if I get pregnant during medicine use?
Discuss with the doctor about planning of your family before starting any medication. Many of medicines used in acne could be harmful in the pregnancy.
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18/04/2020 17:13
Korea, a quest
I am making a video as a vlog where I had visited the Republic of South Korea, the country which pulsates with a high tech economy and holds the first spot among the world's most innovative countries. The visit was during winter of 2018 for a month as an academic and exploring journey. The sole purpose of the visit was a fellowship in department of dermatology at Seoul National University Hospital but I could learn many more than academics. The Korean Peninsula offered me a dazzling range of experiences about time, people, religion, food, technology and beautiful landscapes and 5000 years of culture and history. You feel very safe 24/7. Koreans traditionally believe that the taste and quality of food depend on its spices and sauces, the essential ingredients to making a delicious meal thus Kimchi is a culture. Soju, Korean ale is cheaper than water. People are always in a hurry from early morning. The highest number of latest smart phone users must be in Korea. Every Korean has 3 parts in their name. The currency is South Korean Won which is cheaper than Nepalese Rupee. Seoul, the capital of S. Korea is a perfect blend of rich cultural heritage, a dynamic present & the eternal beauty of nature with 10 million inhabitants from all over the country and around the world, living and working in modern skyscrapers and moving rapidly through a sophisticated infrastructure. People of all parts of world are seen in Namdeumun and Dongdeumun market. Lotte is brand in every sector. Home of Samsung, LG and Hyundai-Kia, South Korea was named the world's most innovative country in the Bloomberg Innovation Index. Nepali Embassy estimates about 40,000 Nepali migrant workers, 2,500 students and about 1,000 other professionals in S. Korea. Though there were many places to visit, I did not have chance to go everywhere. But I had made a promise upon my return that I will quench my thirst in next visit. Jay Nepal Special Thanks to: Dr Dong Hun Lee and entire SNUH Dermatology family Dr Chang Hwan Bae and his staffs Mr Narahari Pokhrel Mr KP Sitaula Mr Subhash Chandra Paudel Mr Ganesh Shrestha Mr Rajendra Shrestha NRNA S. Korea Women for Women
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06/04/2020 22:41
Gazal
मनको अतीत बनोस, प्रित नबनोस
वर्षाको पानी बनोस, शीत नबनोसमधुशालामा नै हुर्कन्छ समय
प्याला झै आफ्नै बनोस, बहिस्कृत नबनोसहार जीतको द्वन्दनै खेल हो यात्रा
प्रस्फुटीत बनोस, उत्कण्ठीत नबनोसगीतको सङ्गीतमा मौलाउनै पर्छ
परिष्कृत बनोस, घृणीत नबनोस -
10/09/2019 22:20
“डक्टर सा'व मलाई दाद भयो लौन अब के गर्ने ?”
एकदिन एक वरिष्ठ व्यक्ति 'ओपिडी'मा आए र खुसुक्क भने, 'डाक्टर सा'ब, दाद भएजस्तो छ, अप्ठ्यारो ठाउँमा चिलाएर सुत्नैसकेको छैन, लाजैमर्दो भईसक्यो लौ न के गर्ने ?' नभन्दै विगत ६ महिनादेखि एक किसिमको ढुसी (दाद)ले उनको पुरै शरीरभरी डेरा जमाइसकेको रहेछ । पेशाले उच्च ओहोदामा पुगिसकेका ती व्यक्तिले उपचारका नाउँमा धेरै रकम खर्च गरिसकेका रहेछन् । तैपनि उचित उपचारको अभावका कारण निको नभएर धेरै दुःख पाएका रहेछन । यो त एउटा प्रतिनीधि उदाहरण मात्र हो । यसरी दादको समस्याले धेरैलाई सताइरहेको हुन्छ ।
दादलाई कसैले दाज, दिनाउ, दिनाई भन्ने गरेपनि र अंग्रेजीमा 'रिंगवोर्म' (Ringworm) भनिन्छ । यसलाई मेडिकल भाषामा 'टिनिया' (tinea) नामले चिनिन्छ । सबै उमेरका व्यक्तिलाई यो समस्याले पीडा दिने गरेको पाइन्छ । दादको समस्या विशेषतः छालारोगको विभागमा आउने दुई तिहाई सम्मका बिरामीको टाउको दुखाई बनिरहेको पाइन्छ ।
के हो त दाद वा 'रिंगवोर्म' ?
यो एक किसिमको ढुसी, 'डर्माटोफाइट' (dermatophyte) छालाको संक्रमणलाई ढुसी (दाद) भनिन्छ । धेरैजसो यो 'रिंग' आकारको भएकोले यसलाई 'रिंगवोर्म' पनि भनिएको हो । यसले हाम्रो शरीरको धेरै गुम्सिएर रहने भाग जस्त तिघ्राको काप, काखीमुनी, स्तनको मुनिपट्टिको भाग लगायत शरीरका अन्य त्यस्तै ठाउँहरुमा असर गर्ने गर्दछ । यसले छालामात्रै नभएर रौँ तथा नङलाई पनि सजिलै असर गर्न सक्छ।
के कारणले हुन्छ दाद ?
यो संक्रमित व्यक्तिबाट जो कोहिलाई पनि सजिलै सर्न सक्छ । संक्रमित व्यक्तिको लत्ताकपडा, जुत्ता चप्पलको प्रयोगबाट पनि सर्न सक्छ । संक्रमित घरपालुवा जनावरको सम्पर्कबाट वा ढुसी भएको ठाउँजस्तै खेतबारी, पौडीपोखरी, चौर, बगैचा, जिमखाना तथा अन्य ठाउँमा खाली खुट्टा हिडेमा पनि सर्न सक्छ । विशेषत : गर्मी र वर्षातको समयमा यो रोगका संक्रमितहरु धेरे हुन्छन् । तराईका जिल्लाहरुमा दादका संक्रमित बढी हुने गरेपनि अत्याधिक रुपमा देखिने गरेकाले यो आम समस्याका रुपमा देखिदै आएको छ । अधिक पसिना आउने व्यक्तिहरु, सरसफाईमा ध्यान नदिने तथा रोगसँग लड्न सक्ने क्षमता ह्रास भएका व्यक्तिहरुमा देखिने गर्छ ।
दादका लक्षणहरु
छालाको दाद धेरैनै चिलाउने हुन्छ । यो शरीरको काप कापमा र अन्य भागमा गोलो 'रिंग' जस्तै आकारमा बढ्दै जाने खालाको रातो या फुस्रो रंगको कत्ले घाऊजस्तो भएर सुरु हुन सक्छ । कहिलेकाँही औंलाको कापमा हिलोले खाएको जस्तो चिलाउने घाऊपनि देखिन्छ र फरक खालका पीप भरिएको घाऊमा पनि दाद देखिने सम्भावना हुन्छ । ढुसीले नङको संक्रमण गरेमा नङ बाक्लो हुने, रंग परिवर्तन हुने वा टुक्रा परेर झर्ने हुन्छ । टाउकोको कपालमा संक्रमण भएमा कपाल आफै झर्ने वा सजिलै उखेलिने तथा कपालमा चायाँ बढ्दै गइ घाउपनि हुनसक्छ ।
दाद निको पार्ने उपायहरु
- दादको लक्षण देखिएमा नजिकको स्वास्थ्य संस्थामा गई चर्मरोगसम्बन्धि तालिमप्राप्त चिकित्सक वा विशेषज्ञको सल्लाह बमोजिम औषधी उपचार गर्नुपर्छ ।
- खाने चक्की, क्याप्सुल, मल्हम, पाउडर, स्याम्पु वा साबुन दादको उपचारमा प्रयोग हुने औषधिहरु हुन ।
- चिकित्सकको सल्लाह नलिइ औषधी प्रयोग गर्नुहुँदैन । यदि गलत औषधी प्रयोग गरियो भने दाद भनै पुरै शरीरभरी फैलने खतरा हुन्छ । तसर्थ, समयमै उचित उपचार गराउनु नै बुद्धिमानी हुन्छ ।
- यो रोगबाट बच्न र पुन नहोस भन्नका लागि व्यक्तिगत सरसफाइमा ध्यान पुर्याउनु आवश्यक हुन्छ ।
- अरुले प्रयोग गरिसकेका कपडा, जुत्ता प्रयोग हुँदैन ।
- गुम्सिने खालका वस्त्रहरु लगाउनुहुँदैन ।
- मोजा र भित्रि कट्टु दैनिक रुपमा परिवर्तन गर्नुपर्छ ।
- खुट्टामा दाद छ भने पहिला मोजा लगाएपछि मात्र अन्य कपडा लगाउनुपर्छ ।
- सकेसम्म खाली खुट्टा हिड्नु हुदैन ।
- खेलकुद वा व्ययाम पछि सफा पानीले नुहाउने गर्दा पनि दादको संक्रमणबाट जोगिन सकिन्छ ।
- स्विमिङ पुलमा पौडी खेलिसकेपछि पुन सफा पानीले राम्रोसँग नुहाउनु पर्छ ।
- नुहाइसकेपछि सफा र सुख्खा कपडाले शरीर सुख्खा हुनेगरि पुछ्नु पर्दछ ।
- घरपालुवा जनावरहरुलाई सफा सुघ्घर राख्नुहोस र कुनै समस्या देखिएमा भेटनरी डाक्टरबाट उपचार गराउनुहोस ।
यी उपायहरु अवलम्बन गर्ने हो भने दादको समस्याबाट मुक्त रहन सकिन्छ ।
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10/09/2019 22:12
के कपाल झरेर हैरान हुनुहुन्छ ?
कपाल (रौँ) स्तनधारी जीवको पहिचान हो l यो केराटिन नामको प्रोटिनले बनेको भएपनि हरेक मानिसको कपालको बनोट फरक फरक हुन्छ l मानिसको शरिरमा कपालको छुट्टै महत्व छ l यसले मानिसको सौन्दर्यलाई निखार्ने मात्र नभई शरीरलाई न्यानो प्रदान गर्ने, हानिकारक विकिरणबाट सुरक्षा गर्ने, रोग र पोषण र हर्मोनको स्थिति जनाउने लगायत वैज्ञानिक लिङ्ग पहिचान, बिधिबिज्ञानबाट व्यक्ति पहिचान, जाति पहिचान आदिमा मद्दत पुर्याउछ l कपालसंग हाम्रो सामाजिक, सांस्कृतिक, आर्थिक नाता गासिएको छ l महिलाहरुले लामो कपाल राख्ने र पुरुषहरुले धर्म अनुसार मुन्डन गर्ने पुरातन समयदेखि चलिआएको चलन आजसम्म पनि विद्यमान छ l आजकाल कपाल सौन्दर्यको पर्याय नै भैसकेको छ l अहिलेको आर्थिक विश्वमा कपाल हटाउने र कपाल उमार्ने प्रक्रियामा करोडौ रकम खर्च भैरहेको छ l
कपाल झर्नु अथवा तालु खुईलिनु सामान्य प्रक्रिया हो l प्राय सबै जनाको कपाल झरिरहेको हुन्छ र करिब १०० देखि १५० दैनिक रौँ झर्छ l अझ नुहाएको दिन, स्याम्पु गरेको समयमा दुइ गुना सम्म झर्छ l असामान्य रुपमा कपाल झरेको छ भने पक्कै त्यसको कारण र समाधान खोजिनु पर्छl
कपाल झर्ने कारणहरु
- बंशानुगत: पुरुष र महिलामा हुने सबैभन्दा प्रमुख कारण
- कुपोषण: पोषणको गडबडीले, विभिन्न प्रोटिन, कर्बोहाइड्रेट, भिटामिन र मिनरलको कमि
- हर्मोन: पुरुष र महिलाको शरिरमा हुने सेक्स हर्मोन, थाईराईड हर्मोन आदिमा गडबडी
- शारीरिक अवस्था: रक्तअल्पता, गर्भवती अवस्था, गर्भपतन, स्तनपान, अप्रेसन पछि,
- तनाब: शारीरिक तथा मानसिक तनाब
- कपालका र छालाका रोगहरु: चाया, दाद, घाउखटिरा, छालाको क्षयरोग
- औषधिहरु: हर्मोनहरु, केमोथेरापी, रेडियोथेरापी
- चोटपटक
- दीर्घरोग तथा क्यान्सर
तालु खुइलिनु धेरै मानिसको लागि चिन्ता को बिषय हो l पुरुषमा मात्र नभई महिलामा पनि तालु खुइलिने गर्दछ l यसरि तालु खुइलिदा पुरुष र महिलामा फरक तरिकाले कपाल झर्छl खत बस्ने र खत नबस्ने गरि दुई किसिमले कपाल झर्ने हुन्छ l वंशानुगत तरिकाले कपाल झाने भनेको आफ्नो दाजुभाइ, दिदीबहिनी, बुवा, हजुरबुवाहरुको कपाल झर्ने संग सम्बन्धित छ l कपाल झर्ने जीन (Gene) पुस्तापुस्ता देखि हस्तान्तरण हुदै आएको हुन्छ l
कुपोषणको कारणले गर्दा शरीरमा विभिन्न पौष्टिक तत्वहरुको कमी हुन्छ र यसले पनि कपाल झर्छl धेरै जस्तो यो बच्चा, बृद्ध र दीर्घरोगीहरुमा हुन्छ l हर्मोनको कारणले पनि कपाल झर्ने गर्छl सेक्स हर्मोन र थाइराइड हर्मोनको कारणले कपाल धेरै आउने र झर्ने दुबै हुनसक्छ l विभिन्न शारीरिक अवस्थामा पनि कपाल झर्ने हुन्छl गर्भवती हुँदा, बच्चालाई स्तनपान गराउदा, रक्ताअल्पता हुँदा, कुनै पनि कारणले थला पर्दा, बिरामी हुँदा वा कुनै अप्रेसनपछि पनि कपाल झर्न सक्छl यतिमात्र नभई कुनै पनि कारणले मानसिक तथा शारीरिक तनाब हुँदा पनि पनि कपाल झर्छl
यति मात्र नभई कपाल झर्ने कारण कपाल र छालाको आफ्नै रोगकै कारणले पनि हुन्छl जस्तै चाया, ढुसीदाद, एक्जिमा, एलर्जी, घाऊ, खाटीरा, खोइलो, ठेउला, क्षयरोग, क्यान्सर आदिl बेस्सरी कसेर कपाल बाँध्यो भने, कपालमा विभिन्न केमिकल वा औषधिहरु को प्रयोगले, रंगाऊदा, कपाललाई स्ट्रेट गर्दा वा धेरै चिसो वा तातो चीजले पनि कपाल चुडिन वा झर्न सक्छl कुनै औषधिहरु जस्तै खाने चक्की पिल्स, हर्मोन र क्यान्सरको औषधिहरुले पनि कपाल झार्न सक्छनl
रोकथाम तथा उपचारका उपायहरु
कपाल झर्दैमा आत्तिनु हुन्न l कपाल झर्ने रोगहरु प्राय वंशानुगत हुन्छन् वा शरीरको पोषण तथा हर्मोन कारणले हुन्छन् l त्यसैले सन्तुलित खानपानमा ध्यान दिने बानि गर्नुपर्छ/ जथाभावी तथा अनाबस्यक औषधी तथा चिजबिज नलाऊनु हुँदैन l कुनै पनि औषधि खादा वा प्रयोग गर्दा चिकित्सकको सल्लाह बिना खानु र लगाउनु हुँदैन l कुन कारण ले कपाल झरेको छ, त्यो पत्ता लगाएर उपचार गर्नुपर्छl जस्तो कि ढुसीदादले गर्दा कपाल झरेको छ भने त्यसको औषधि खाने, लगाउने वा कपाल धुने गर्ने l यसको लागि चर्मरोग तथा कपालको बिशेषज्ञ चिकित्षकको सल्लाह लिनुपर्छl सबै रोगको लागि औषधिको जरुरत नहुन पनि सक्छ l रोग अनुसारको उपचार प्रक्रिया फरक फरक हुन्छl कुनै रोगको लागि छोटो समयको खाने र लगाउने औषधि हुन्छ भने कुनै लामो समय सम्म खाने र लगाउने हुनसक्छl अहिलेको आधिनिक युगमा विभिन्न अत्याधुनिक पध्दतीहरु कपाल उमार्न र हटाउन प्रयोग हुदै आइरहेका छन्l प्रकाश र लेजर पद्धति नया पिढिको बैज्ञानिक उपचार महँगो भएपनि यसको आकर्षण बढ्दै गैरहेको छl यति मात्रै नभई तालु खुईलिने समस्या को लागि कपाल रोप्ने प्रबिधी (Hair Transplant) पनि गर्न सकिन्छl त्यसैले समयमा नै उचित परामर्श लिऊ र उपचार गरौँ
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20/06/2015 18:51
Why do many students fail?
Why do many students fail? The reasons are very intricate and multidimensional. In simple words, it’s the flaw in the curriculum which is not met by our educational system as it demands to be achieved.
We all know that no other educational activities in Nepal attracts as much public attention, sympathy and temptation as the annual School Leaving Certificate Examinations (SLC). This year is the eighty second session of SLC where about 5.7 lacs students across the country participated and out of which about 47 percentage succeed in their last ever number scoring SLC result.
The SLC assumes its great significance because the success opens the windows of opportunities for higher studies and widens the prospect for employment whereas failure narrows the options for progress. It’s an unfortunate to quote that the failure is more common than success with high rates among students from public schools, rural area, backward communities and more girls than boys, leading to huge wastage of the resources invested.
Nation’s prosperity and success being closely related to young human capital, depends on the quality of its education. It is therefore the countries like Nepal have embraced education as a chief instrument in making policies. Similarly, educational policy has immense role in infrastructural development, economic growth, social inclusion and justice, scientific advancement. Also, education is believed to cure all sort of illnesses of today’s disturbed society and transform them to superior ones.
I also appeared in SLC examination in 2057 BS with hope of scoring better result. As I was the usual topper at my school, my parents, teachers and friends had noble expectations on me. We were the first batch of new curriculum with 800 full marks in-total. During that period, board toppers were treated like celebrities and the better collages awarding them with scholarships. But unfortunately my name was enlisted among the 68 % of failures as I could not get my symbol number in the list of pass students. The Gorkhapatra national daily only used to be the medium for determining the success or failure in very first day. My number was missing even in internet which I hardly got access. The Final Result – I was fail. All my dreams collapse all of sudden. I was vacant, speechless and felt like I was abandoned by the fortune. However, there was a narrow hope but strong faith inside me. Many flight of ideas flushed into my mind whether my answer sheet was lost, or somebody might have played foul to make me fail. I waited for the marks ledger sheets for few days and I found that I was failed in Compulsory Mathematics with twelve out of hundred. Then, I was confident that it’s a mistake. I completed all the procedures for retotalling the marks which took almost 3 months. In meantime, the new session in college had started but I was unqualified. I explained my conditions with a college principal which made him to approve my admission. Probably for the first time in history someone got admitted in intermediate level without passing SLC. Result of retotalling provided me formal key of the Iron-gate. I passed with distinction and got scholarship both in intermediate and MBBS (Ministry of Education). Now I am doing my doing my post graduate degree i.e. Doctor in Medicine (MD) in Institute of Medicine.
Yearly, as we all analyse the outcomes of SLC, we see more failures than success. Success is bestowed with cashes, scholarships, admirations whereas the majority of students who swallow failures suffer from variety of agonies, depressions, suicidal tendencies and many more. The failures need to be addressed properly to prevent a young and energetic capital from being wasted. The failures need to be counselled to prevent from emotional, psychological, spiritual or social breakdown. The student should not lose hope and commit incorrigible mistakes event the scores are as unexpected. Most importantly, there should be measures to inhibit as much as the failures by revising the curriculum or by strengthening the educational manpower. Curriculum revision based on vocational training should be encouraged to reduce the unemployment. We have to wait for the outcome of grading system which will be commencing next year.
