Objective: To assess the pathway to care among patients with epilepsy up to the tertiary care centre Methods: It is a hospital based, cross-sectional descriptive study of 47 patients visiting BPKIHS psychiatry OPD. Written informed consent was taken from the patients and the primary caretaker. A semi structured Performa was used to record the basic sociodemographic details. Pathway Interview Schedule developed by WHO was used to collect the data. Results Majority (66.0%) of subjects were male. Generalized Seizures were most common (76.6%) type of seizure followed by complex-partial seizure (10.6%). More than half (51.1%) first contacted dhami-jhakri for treatment of their illness. About sixty two percent of patients had the first contact with the treatment provider less than 4 yrs ago. Thirty eight percent subjects sought treatment as per advice from the family members while only 2.1% sought treatment as per advice from the healthcare worker. The most common presenting complaints were sudden loss of consciousness in 89.4%of patients. In majority of patients (57.4%), problem arised ≤ 4yrs back. Significant high numbers of patients (51.1%) were prescribed alternative forms of treatment like herbal medications, talisman, offerings and sacrifices and jhadphook for their presenting problem. About eighty seven percent patients had to travel ≤12 hours for the treatment while 10.7% had to travel a distance of >24 hrs for treatment. The mean duration that one had to travel for seeking treatment was 7.95±14.58 hours. It was found that the mean duration that one patient spend before coming to a hospital for modern treatment was 5.64 months. Conclusions People suffering from epilepsy are still using the traditional healing practices leading to delay in the patient care. These findings call for a comprehensive educational program that can remove the misconcepts regarding the illness. DOI: http://dx.doi.org/10.3126/jucms.v1i1.8418   Journal of Universal College of Medical Sciences Vol.1(1) 2013:  20-25

Self-injurious behavior (SIB) or self-mutilating behavior (SMB) is rare but can occur in temporal lobe epilepsy. Such a behavior during seizures is not usually recalled by patient. Here is a case with self mutilating behavior in left temporal lobe epilepsy, presented because of its rare manifestation and diagnostic dilemma. A 19 year old unmarried Muslim student presented to emergency with SMB, guilty rumination and a persecutory delusion. The patient was intermittently confused about place and time. In subsequent assessments, he was found harboring death wishes and suicidal ideation. He transiently had auditory hallucination and thought broadcasting. He episodically tried to harm himself by severely biting only his left ring finger. It was difficult to influence him during such episodes. EEG revealed left temporal lobe seizure. Diagnosis of 'Epilepsy and Organic Psychosis' was made. The patient responded well to Antiepileptic and Antipsychotic medications. Keywords: seizure, self injurious behavior, suicide, temporal epilepsy.

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Background: Difference in health literacy skills among peoples is a cause of health inequality and has a profound effect on health care system. Correlation between health literacy and health outcome of patient subsequently demands identification of patient’s health literacy level by health professionals. Objective: The study aims to assess the health literacy knowledge and understanding of registered nurses working in tertiary care teaching hospital. Methods: A cross-sectional method was employed among 125 registered nurses. Health Literacy Knowledge and Experience Survey (HLKES-2) was used to gather knowledge related data. Descriptive statistical tools, t Mann-Whitney U test and Kruskal-Wallis H were used to analyze the data. A focus group discussion (N=10) was conducted to obtain nurses' understanding of health literacy. Results: Majority of nurses had not heard the term health literacy before. Finding suggest gap in health literacy knowledge among nurses. Knowledge scarcity was in almost all areas but noticeably in the area of evaluation of healthcare teaching. Half of the respondent scored less than 50% of the total score. Analysis demonstrated that Health literacy knowledge was independent of nurses' characteristics. Conclusion: limited knowledge of health literacy among nurses stresses for integration of health literacy education in nursing curriculum and continuing education.

Introduction: Despite the increasing prevalence of diabetes, lack of awareness about the disease, its consequences and lack of quality care in diabetes lead to delayed presentation to health care giver that might be associated with more number of complication and co-morbid condition of the disease which may adversely affect the outcome of the patient. Therefore we undertook this study to determine the common symptoms that lead to admission of patients suffering from diabetes along with the complications they present and their outcome.Methods: We analyzed data from the medical records available among admitted patients with diabetes over a period of 6 months.Results: Among 200 subjects with mean age of 52 years, majority had Type 2 diabetes mellitus, 53% were males and more than half had some other comorbidities. Most of them, 68% had microvascular complications, and 27% of them had some form of macrovascular complications.Conclusions: Despite of continuous effort from various organizations, micro and macrovacular complications are very high among diabetic patients, so more emphasis has to be given on prevention of these complications at various level of health care delivery system.Jour of Diab and Endo Assoc of Nepal 2018; 2 (1): 4-8