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91-550: The hospital was conceived and supported by the Dhulikhel community, as a health service provider. The hospital was inaugurated by the late king Birendra Bir Bikram Shah Dev in 1996, as a collaborative project of the Dhulikhel Municipality , NepaliMed and Dhulikhel Health Service Association. The hospital was started to provide outpatient service, 24 hours emergency, inpatient from beginning. Dr. Ram KM Shrestha

182-415: A Rasmussen aneurysm , resulting in massive bleeding. Tuberculosis may become a chronic illness and cause extensive scarring in the upper lobes of the lungs. The upper lung lobes are more frequently affected by tuberculosis than the lower ones. The reason for this difference is not clear. It may be due to either better air flow, or poor lymph drainage within the upper lungs. In 15–20% of active cases,

273-400: A family died from the disease, the other infected members would lose their health slowly. People believed this was caused by the original person with TB draining the life from the other family members. Although Richard Morton established the pulmonary form associated with tubercles as a pathology in 1689, due to the variety of its symptoms, TB was not identified as a single disease until

364-585: A few Buddhist Stupa. In the centre of the old town is the Narayan Temple with its yellow metal roofs. It is dedicated to Lord Krishna whose birthday is celebrated in August. Alongside is the Harisiddhi Temple. Both the temples are adorned with profuse wood carvings and fronted by two Garudas. Bhagwati Temple is situated at the top of the western part of the town. The GaukhureshworMahadev Temple

455-656: A half day. A longer walking route includes trail to Nagarkot and Namobuddha. The Municipality also forms one of the points for Mountain Biking with challenging terrains as well as the site of people with rich ethnic culture and the scenery of mountain ranges along the way. Routes include Dhulikhel-Panauti, Dhulikhel-Khopasi, Dhulikhel-Palanchowk-Dhulikhel, Dhulikhel-Namobuddha-Dhulikhel. One can also do activities like bird and butterfly watching from various points in Dhulikhel Municipality. Hazaar Sindhi stands out as

546-412: A holistic approach; quality service delivery; rational community-based methods; innovative public health interventions; and effective partnership programs. It aims to implement these measures and services through rigorous monitoring and evaluation methods, in order to ensure that its main objective, to act as a coordinating unit for other departments in the hospital, is successfully carried out. Currently,

637-631: A latent infection of TB. New infections occur in about 1% of the population each year. In 2022, an estimated 10.6 million people developed active TB, resulting in 1.3 million deaths, making it the second leading cause of death from an infectious disease after COVID-19 . As of 2018, most TB cases occurred in the WHO regions of South-East Asia (44%), Africa (24%), and the Western Pacific (18%), with more than 50% of cases being diagnosed in seven countries: India (27%), China (9%), Indonesia (8%),

728-416: A medieval city inhabited for at least five centuries. The plan of the city is based on ancient Hindu planning doctrine with the position, shape, scale & dominance between buildings, temples, public squares all having their own meaning and harmony. There are organically developed compact settlements around Dhulikhel. One of such old settlements is Shreekhandpur, which lies 2 km west of the core city near

819-685: A microscope. Since MTB retains certain stains even after being treated with acidic solution, it is classified as an acid-fast bacillus . The most common acid-fast staining techniques are the Ziehl–Neelsen stain and the Kinyoun stain , which dye acid-fast bacilli a bright red that stands out against a blue background. Auramine-rhodamine staining and fluorescence microscopy are also used. The M. tuberculosis complex (MTBC) includes four other TB-causing mycobacteria : M. bovis , M. africanum , M. canettii , and M. microti . M. africanum

910-498: A nominated leader from their own community, who ensures that the loan is paid back in monthly installments, with an additional four percent interest rate. The interest in turn generates a sum of money for another woman to join the group. The women from the micro-finance groups have gone on to purchase animals for livestock farming such as pigs, goats, and chickens; or have invested in materials to start their own small businesses like candle-making. To date, over 300 women have benefited from

1001-658: A number of people with tuberculosis into the cave in the hope of curing the disease with the constant temperature and purity of the cave air; each died within a year. Hermann Brehmer opened the first TB sanatorium in 1859 in Görbersdorf (now Sokołowsko ) in Silesia . In 1865, Jean Antoine Villemin demonstrated that tuberculosis could be transmitted, via inoculation, from humans to animals and among animals. (Villemin's findings were confirmed in 1867 and 1868 by John Burdon-Sanderson . ) Robert Koch identified and described

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1092-964: A population of 34,142. Of these, 58.6% spoke Nepali , 22.9% Tamang , 17.0% Newar , 0.3% Magar , 0.3% Maithili , 0.2% Rai , 0.1% Bhojpuri , 0.1% Hindi , 0.1% Sunuwar , 0.1% Thangmi , 0.1% Tharu and 0.1% other languages as their first language. In terms of ethnicity/caste, 26.7% were Hill Brahmin , 23.4% Tamang , 19.1% Newar , 16.3% Chhetri , 2.9% Sarki , 2.7% Magar , 2.0% Kami , 1.3% Damai /Dholi, 1.3% Thakuri , 0.9% Gharti/ Bhujel , 0.6% other Dalit , 0.5% Rai , 0.5% Sanyasi/Dasnami, 0.3% Gurung , 0.2% Thami , 0.2% Tharu , 0.1% Hajam /Thakur, 0.1% Majhi, 0.1% Musalman , 0.1% Pahari , 0.1% Sunuwar , 0.1% Yadav and 0.3% others. In terms of religion, 74.8% were Hindu , 21.6% Buddhist , 3.2% Christian , 0.1% Muslim and 0.3% others. In terms of literacy, 74.9% could read and write, 2.2% could only read and 22.9% could neither read nor write. Dhulikhel Municipality has plenty education institutes, including

1183-407: A small decrease in case numbers. Some countries have legislation to involuntarily detain or examine those suspected to have tuberculosis, or involuntarily treat them if infected. The only available vaccine as of 2021 is bacillus Calmette-Guérin (BCG). In children it decreases the risk of getting the infection by 20% and the risk of infection turning into active disease by nearly 60%. It

1274-408: A tourist destination. Dhulikhel is an ideal station to stop for overnight stay while going to Tibet and coming back to Kathmandu. The snowfed mountains seen from Dhuklikhel are a fine panoramic. When a blue haze covers the lower portion of the mountains, they seem to be floating in the air. Green inviting hills of which still virgin and some turned into beautifully carved agricultural terraces cater to

1365-489: A treat for tourists especially in the summer season. As per the figures of Central Bureau of Statistics Total population of Dhulikhel Municipality is 33,981 with 16,675 male and 17306 female. The population density is 582 per km . with an average growth rate of 0.65. There are 7039 Households with average size of 4.5. Dhulikhel Municipality boasts as a major touristic destination with attractions that range from natural scenario to cultural and historical elements. One can view

1456-401: A tuberculosis infection does become active, it most commonly involves the lungs (in about 90% of cases). Symptoms may include chest pain and a prolonged cough producing sputum. About 25% of people may not have any symptoms (i.e., they remain asymptomatic). Occasionally, people may cough up blood in small amounts, and in very rare cases, the infection may erode into the pulmonary artery or

1547-427: A university, Kathmandu University . The number of basic education schools are 24 and 6 as run by Government and Private Institutions while Secondary Schools number are 11 and 8 respectively. There is also a school run by Monastery in the municipality. Altogether, there are 50 schools in the area. Like the national statistics in favor of literacy rate of men, Dhulikhel Municipality has 85.63% literate male population while

1638-423: A year. There are significant number of cases referred from different parts of the country. Since opening of Banepa Bardibas highway connecting eastern Terai, the number of patients from Terain region has significantly increased. Dhulikhel hospital collaborated with Kathmandu University to start Kathmandu University School of Medical Sciences to run various medical programs and serves as a university hospital for all

1729-398: Is Mycobacterium tuberculosis (MTB), a small, aerobic , nonmotile bacillus . The high lipid content of this pathogen accounts for many of its unique clinical characteristics. It divides every 16 to 20 hours, which is an extremely slow rate compared with other bacteria, which usually divide in less than an hour. Mycobacteria have an outer membrane lipid bilayer. If a Gram stain

1820-403: Is a Community radio Station. Tuberculosis Tuberculosis ( TB ), also known colloquially as the " white death ", or historically as consumption , is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria . Tuberculosis generally affects the lungs , but it can also affect other parts of the body. Most infections show no symptoms, in which case it

1911-536: Is a founder of the hospital who started this hospital to provide quality healthcare service to all. The hospital covers a population of 2.7 million people from Bhaktapur , Dolakha , Kavrepalanchowk , Ramechhap , Sindhupalchok , Sindhuli and other districts. Dhulikhel Hospital has provided services to people from more than 50 out of 75 districts of the country. About 2.7 million people from Kavrepalanchowk, Sindhupalchowk, Bhaktapur, Dolakha, Ramechhap, Sindhuli, Kathmandu, Lalitpur and surrounding districts are served in

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2002-449: Is able to reproduce inside the macrophage and will eventually kill the immune cell. The primary site of infection in the lungs, known as the Ghon focus , is generally located in either the upper part of the lower lobe, or the lower part of the upper lobe . Tuberculosis of the lungs may also occur via infection from the blood stream. This is known as a Simon focus and is typically found in

2093-653: Is also rare and is seen almost only in immunodeficient people, although its prevalence may be significantly underestimated. Other known pathogenic mycobacteria include M. leprae , M. avium , and M. kansasii . The latter two species are classified as " nontuberculous mycobacteria " (NTM) or atypical mycobacteria. NTM cause neither TB nor leprosy , but they do cause lung diseases that resemble TB. When people with active pulmonary TB cough, sneeze, speak, sing, or spit, they expel infectious aerosol droplets 0.5 to 5.0 μm in diameter. A single sneeze can release up to 40,000 droplets. Each one of these droplets may transmit

2184-499: Is conducting awareness programs targeting these farmers, with regards to the proper use of pesticides in crop farming. The program aims to first raise the issue of pesticides as a health hazard amongst farmers and their families, and then tackle the increasingly widespread and improper use of pesticides. Dhulikhel Dhulikhel is a municipality in Kavrepalanchok District of Nepal. Two major highways,

2275-444: Is difficult, as is diagnosing the disease in those who have a weakened immune system. A diagnosis of TB should, however, be considered in those with signs of lung disease or constitutional symptoms lasting longer than two weeks. A chest X-ray and multiple sputum cultures for acid-fast bacilli are typically part of the initial evaluation. Interferon-γ release assays (IGRA) and tuberculin skin tests are of little use in most of

2366-412: Is known as latent tuberculosis . Around 10% of latent infections progress to active disease that, if left untreated, kill about half of those affected. Typical symptoms of active TB are chronic cough with blood-containing mucus , fever , night sweats , and weight loss . Infection of other organs can cause a wide range of symptoms. Tuberculosis is spread from one person to the next through

2457-509: Is not widespread, but it is a significant cause of tuberculosis in parts of Africa. M. bovis was once a common cause of tuberculosis, but the introduction of pasteurized milk has almost eliminated this as a public health problem in developed countries. M. canettii is rare and seems to be limited to the Horn of Africa , although a few cases have been seen in African emigrants. M. microti

2548-489: Is often used to screen people at high risk for TB. Those who have been previously immunized with the Bacille Calmette-Guerin vaccine may have a false-positive test result. The test may be falsely negative in those with sarcoidosis , Hodgkin's lymphoma , malnutrition , and most notably, active tuberculosis. Interferon gamma release assays , on a blood sample, are recommended in those who are positive to

2639-468: Is on the east of the town near Tundikhel Recreation Park. Further up hill, is located the Bhagwati (Kali) Temple, which is a pagoda. Other monuments in dhulikhel are sarswoti temple, dakshinkali, huge statue of lord buddha, bhimsen, balkumari, lankhana mai, tepucha madya, bhairabh nath, bajrayogini, etc. To promote local culture Dhulikhel has one FM radio station Radio Madhyapurba F.M. – 104 MHz Which

2730-797: Is one of the Department of Community Programs’ newest initiatives. The program raises awareness on deforestation and climate change in the rural communities and incorporates awareness campaigns into local school curricula. Thus far, two schools have been involved and more than 1,005 trees have been planted. The Micro-Finance program was in 2008 at the Bahunepati Health Centre. Today, Dhulikhel Hospital has 31 micro-finance groups in five outreach centers (Bahunepati, Kattike Deurali, Dapcha, Solombhu, Baluwa). The micro-finance programs were created to financially assist women in rural communities. Each micro-finance group consists of 10 women with

2821-501: Is performed, MTB either stains very weakly "Gram-positive" or does not retain dye as a result of the high lipid and mycolic acid content of its cell wall. MTB can withstand weak disinfectants and survive in a dry state for weeks. In nature, the bacterium can grow only within the cells of a host organism, but M. tuberculosis can be cultured in the laboratory . Using histological stains on expectorated samples from phlegm (also called sputum), scientists can identify MTB under

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2912-423: Is poor as of 2019 . The Centers for Disease Control and Prevention (CDC) stopped recommending yearly testing of health care workers without known exposure in 2019. Tuberculosis prevention and control efforts rely primarily on the vaccination of infants and the detection and appropriate treatment of active cases. The World Health Organization (WHO) has achieved some success with improved treatment regimens, and

3003-464: Is termed caseous necrosis . If TB bacteria gain entry to the blood stream from an area of damaged tissue, they can spread throughout the body and set up many foci of infection, all appearing as tiny, white tubercles in the tissues. This severe form of TB disease, most common in young children and those with HIV, is called miliary tuberculosis. People with this disseminated TB have a high fatality rate even with treatment (about 30%). In many people,

3094-518: Is the earlier form of the present Nepal Bhasha name Dhau_khyo. Dhali or Dhau means yogurt and Khela or Khyo means field in Nepala Bhasha. It is said to have come from the Lichchhi name Dhawalasrotapura. Dhulikhel was the eastern border of ancient Nepal Mandala , and it was one of the territories of Bhaktapur kingdom. Dhulikhel was among the last places to be annexed to the country Gorkha that

3185-483: Is the most widely used vaccine worldwide, with more than 90% of all children being vaccinated. The immunity it induces decreases after about ten years. As tuberculosis is uncommon in most of Canada, Western Europe, and the United States, BCG is administered to only those people at high risk. Part of the reasoning against the use of the vaccine is that it makes the tuberculin skin test falsely positive, reducing

3276-734: The B.P. Highway and the Araniko Highway pass through Dhulikhel. Araniko Highway connects Kathmandu , Nepal's capital city with Tibet 's border town of Kodari . Dhulikhel is located at the Eastern rim of Kathmandu Valley , south of the Himalayas at 1550m above sea level and is situated 30 km southeast of Kathmandu and 74 km southwest of Kodari. The Majority of people in Dhulikhel are Newars , and Brahmin , Chhettri , Tamang and Dalit are also living in outer area of

3367-551: The Kathmandu University , and is also a centuries-old Newari and Magar settlement. The settlement is protected by Swet Bhairav (an incarnation of Lord Shiva) and Narayan (Vishnu) deities. Gorkhanath temple also lies here. There are numerous temples in the town depicting traditional and old Newari craftsmanship. These are places of worship for local people. The core area of Dhulikhel has interesting narrow cobbled streets and lanes embedded with number of Hindu Shrines and

3458-416: The bacillus Calmette-Guérin (BCG) vaccine. Those at high risk include household, workplace, and social contacts of people with active TB. Treatment requires the use of multiple antibiotics over a long period of time. Antibiotic resistance is a growing problem, with increasing rates of multiple drug-resistant tuberculosis (MDR-TB). In 2018, one quarter of the world's population was thought to have

3549-458: The lymphatic system (in scrofula of the neck), the genitourinary system (in urogenital tuberculosis ), and the bones and joints (in Pott disease of the spine), among others. A potentially more serious, widespread form of TB is called "disseminated tuberculosis"; it is also known as miliary tuberculosis . Miliary TB currently makes up about 10% of extrapulmonary cases. The main cause of TB

3640-547: The 1820s. Benjamin Marten conjectured in 1720 that consumptions were caused by microbes which were spread by people living close to each other. In 1819, René Laennec claimed that tubercles were the cause of pulmonary tuberculosis. J. L. Schönlein first published the name "tuberculosis" (German: Tuberkulose ) in 1832. Between 1838 and 1845, John Croghan, the owner of Mammoth Cave in Kentucky from 1839 onwards, brought

3731-647: The 19th and early 20th centuries as the disease became common among the urban poor. In 1815, one in four deaths in England was due to "consumption". By 1918, TB still caused one in six deaths in France. After TB was determined to be contagious, in the 1880s, it was put on a notifiable-disease list in Britain. Campaigns started to stop people from spitting in public places, and the infected poor were "encouraged" to enter sanatoria that resembled prisons. The sanatoria for

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3822-681: The District Government Office, Adolescent Health Programs and extra-curricular School Health Clubs have been formed. Furthermore, first aid trainings have been provided for teachers from 11 schools in cooperation with local governmental health center staff. Between 2011 and 2012 the re were 72 various health programs at 120 different schools. 10,9384 students were screened for dental, ENT, ophthalmic problems. Farmers in Nepal face severe health risks due to their heavy use of pesticides in crop farming. The Department of Community Programs

3913-524: The Himalayan range at an 180 panoramic view of mountains including Mt. Annapurna , Mt. Ganesh Himal , Mt. Langtang, Mt. Phuribichyachu, Mt. Gaurishankar, Mt. Lhotse among others. Other natural attractions include locations like Tundikhel plus cultural and religious sites like Bhagawati, Kalidevi, Gita Mandir, Gaukhureshwor. The name Dhulikhel is coming from the Nepal Bhasha word Dhali_khela, which

4004-698: The Mantoux test. These are not affected by immunization or most environmental mycobacteria , so they generate fewer false-positive results. However, they are affected by M. szulgai , M. marinum , and M. kansasii . IGRAs may increase sensitivity when used in addition to the skin test, but may be less sensitive than the skin test when used alone. The US Preventive Services Task Force (USPSTF) has recommended screening people who are at high risk for latent tuberculosis with either tuberculin skin tests or interferon-gamma release assays . While some have recommend testing health care workers, evidence of benefit for this

4095-550: The Philippines (6%), Pakistan (6%), Nigeria (4%), and Bangladesh (4%). By 2021, the number of new cases each year was decreasing by around 2% annually. About 80% of people in many Asian and African countries test positive, while 5–10% of people in the United States test positive via the tuberculin test. Tuberculosis has been present in humans since ancient times . Tuberculosis has existed since antiquity . The oldest unambiguously detected M. tuberculosis gives evidence of

4186-688: The active disease. Use of certain medications, such as corticosteroids and infliximab (an anti-αTNF monoclonal antibody), is another important risk factor, especially in the developed world . Other risk factors include: alcoholism , diabetes mellitus (3-fold increased risk), silicosis (30-fold increased risk), tobacco smoking (2-fold increased risk), indoor air pollution , malnutrition, young age, recently acquired TB infection, recreational drug use, severe kidney disease, low body weight, organ transplant, head and neck cancer, and genetic susceptibility (the overall importance of genetic risk factors remains undefined ). Tobacco smoking increases

4277-554: The air when people who have active TB in their lungs cough, spit, speak, or sneeze . People with latent TB do not spread the disease. Active infection occurs more often in people with HIV/AIDS and in those who smoke . Diagnosis of active TB is based on chest X-rays , as well as microscopic examination and culture of bodily fluids. Diagnosis of latent TB relies on the tuberculin skin test (TST) or blood tests. Prevention of TB involves screening those at high risk, early detection and treatment of cases, and vaccination with

4368-458: The arrival of streptomycin and other antibiotics, although the disease remained a significant threat. In 1946, the development of the antibiotic streptomycin made effective treatment and cure of TB a reality. Prior to the introduction of this medication, the only treatment was surgical intervention, including the " pneumothorax technique", which involved collapsing an infected lung to "rest" it and to allow tuberculous lesions to heal. Because of

4459-628: The bacillus causing tuberculosis, M. tuberculosis , on 24 March 1882. In 1905, he was awarded the Nobel Prize in Physiology or Medicine for this discovery. In Europe, rates of tuberculosis began to rise in the early 1600s to a peak level in the 1800s, when it caused nearly 25% of all deaths. In the 18th and 19th century, tuberculosis had become epidemic in Europe , showing a seasonal pattern. Tuberculosis caused widespread public concern in

4550-454: The background and passes showcases a number of cultural highlights and rich biodiversity. Visits to hill stations like Chisapani, Nagarkot along with Dhulikhel will be less challenging than going to himalayas routes but with equal thrill and rewards. Dhulikhel municipality is one of the starting or the middle points for hiking routes. These include walks to Panauti, Kavre village, Opi village as well as to Hazaar Sindhi all of which take as long as

4641-423: The bacterium is enveloped by the macrophage and stored temporarily in a membrane-bound vesicle called a phagosome. The phagosome then combines with a lysosome to create a phagolysosome. In the phagolysosome, the cell attempts to use reactive oxygen species and acid to kill the bacterium. However, M. tuberculosis has a thick, waxy mycolic acid capsule that protects it from these toxic substances. M. tuberculosis

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4732-444: The battle ended and Dhulikhel was won on B.S. 1820 Kartik 10 on Sunday. The next day, Khadpu and Panauti were conquered whereas on Kartik 14 Gorkhalis won Banepa, Sanga and Nala. Until B.S. 1972, administrative center of Kavrepalanchok was at Chautara . Then, it shifted to Banepa until B.S. 1980 after which it subsequently shifted to Dhulikhel which stands till date. At the time of the 2011 Nepal census , Dhulikhel Municipality had

4823-586: The beholders' pleasure. Geographically, the plains rise gradually up to the green mountains and further into the snow-capped Himalayas. The panorama offers a view of the Himalayan ranges stretching from Mount Annapurna in the far west to Mount Karolung in the Far East. More than twenty Himalayan peaks including Mt. Annapurna (8091 m), Mt. Ganesh Himal (7429 m), Mt. Langtang (7234 m), Mt. Phuribichyachu (6637 m), Mt. Gaurishanker (7134 m), Mt. Lhotse (8516 m) and many others can be seen from Dhulikhel. The oldest area of

4914-425: The cattle and human tuberculosis diseases were similar, which delayed the recognition of infected milk as a source of infection. During the first half of the 1900s, the risk of transmission from this source was dramatically reduced after the application of the pasteurization process. Koch announced a glycerine extract of the tubercle bacilli as a "remedy" for tuberculosis in 1890, calling it "tuberculin". Although it

5005-434: The community directly about their needs, aims, and goals concerning healthcare. The outreaches not only provide basic health services, but also a platform on which all the community programs begin. Many preventive, promotive and curative services are provided to all outreach rural communities. Various NGOs and INGOs also provide services to the community at grassroots level through the outreach centers. In addition to training

5096-509: The conduction of financial transactions, there are 7 Banks, including all categories of Financial Institutions. The Banks include Nabil Bank, Banijya Bank, Agriculture Bank, Century Bank, Civil Bank, Dev Development Bank and Naya Nepal laghubittya bikas Bank. Dhulikhel Municipality is a major part of the Kathmandu Valley Cultural Trekking Trail. This five-day trail provides a short trek with himalayas in

5187-711: The declaration of a global health emergency by the World Health Organization (WHO) in 1993. There is a popular misconception that tuberculosis is purely a disease of the lungs that manifests as coughing . Tuberculosis may infect many organs, even though it most commonly occurs in the lungs (known as pulmonary tuberculosis). Extrapulmonary TB occurs when tuberculosis develops outside of the lungs, although extrapulmonary TB may coexist with pulmonary TB. General signs and symptoms include fever, chills , night sweats, loss of appetite , weight loss, and fatigue . Significant nail clubbing may also occur. If

5278-640: The developing world. IGRA have similar limitations in those with HIV. A definitive diagnosis of TB is made by identifying M. tuberculosis in a clinical sample (e.g., sputum, pus , or a tissue biopsy ). However, the difficult culture process for this slow-growing organism can take two to six weeks for blood or sputum culture. Thus, treatment is often begun before cultures are confirmed. Nucleic acid amplification tests and adenosine deaminase testing may allow rapid diagnosis of TB. Blood tests to detect antibodies are not specific or sensitive , so they are not recommended. The Mantoux tuberculin skin test

5369-538: The disease in the remains of bison in Wyoming dated to around 17,000 years ago. However, whether tuberculosis originated in bovines, then transferred to humans, or whether both bovine and human tuberculosis diverged from a common ancestor, remains unclear. A comparison of the genes of M. tuberculosis complex (MTBC) in humans to MTBC in animals suggests humans did not acquire MTBC from animals during animal domestication, as researchers previously believed. Both strains of

5460-620: The disease, since the infectious dose of tuberculosis is very small (the inhalation of fewer than 10 bacteria may cause an infection). People with prolonged, frequent, or close contact with people with TB are at particularly high risk of becoming infected, with an estimated 22% infection rate. A person with active but untreated tuberculosis may infect 10–15 (or more) other people per year. Transmission should occur from only people with active TB – those with latent infection are not thought to be contagious. The probability of transmission from one person to another depends upon several factors, including

5551-463: The emergence of multidrug-resistant tuberculosis (MDR-TB), surgery has been re-introduced for certain cases of TB infections. It involves the removal of infected chest cavities ("bullae") in the lungs to reduce the number of bacteria and to increase exposure of the remaining bacteria to antibiotics in the bloodstream. Hopes of eliminating TB ended with the rise of drug-resistant strains in the 1980s. The subsequent resurgence of tuberculosis resulted in

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5642-569: The first genuine success in immunization against tuberculosis in 1906, using attenuated bovine-strain tuberculosis. It was called bacille Calmette–Guérin (BCG). The BCG vaccine was first used on humans in 1921 in France, but achieved widespread acceptance in the US, Great Britain, and Germany only after World War II. By the 1950s mortality in Europe had decreased about 90%. Improvements in sanitation, vaccination, and other public-health measures began significantly reducing rates of tuberculosis even before

5733-406: The greatest Hindu festival. They use to purchase chilies and other daily necessities in Nepal and return to their homeland. In those days, a whole day walk from Kathmandu to Dhulikhel was comfortable for Tibet trippers with easily available of food and water at Dhulikhel at the evening for overnight stay. After adjoining with Tibet by motorable road in 1965, Dhulikhel got a face lift and developed as

5824-446: The hospital with stage three uterine prolapse. Since 2008, the department has specifically recruited nurses from the hospital for awareness programs on uterine prolapse in the outreach centers. This program through education highlights the importance of hygiene and healthcare for school children and teachers. The School Health Programs are focused on encouraging education on topics such as hygiene, toilet use, and first aid. Working with

5915-1026: The hospital's own staff at the Outreach Centes, training courses for health personnel from government health centres are also conducted. The partnership work covers other areas of Nepal. Technical assistance is provided to eight hospitals all over the Nepal. The partners include: Through the Department of Community Programs, the staff at the Dhulikhel Hospital coordinate many [public health] programs designed to uplift communities by improving their standard of living. Various public health programs have been conducted: plantation programs around schools and villages; first aid training; hygiene and sanitation teaching for school children; awareness programs for women (for issues like cervical cancer , breast cancer, uterine prolapse ); and mental health awareness programs for both women and school children. Current Public Health Programs include: Plantation programs

6006-431: The host's immune system. Macrophages and dendritic cells in the granulomas are unable to present antigen to lymphocytes; thus the immune response is suppressed. Bacteria inside the granuloma can become dormant, resulting in latent infection. Another feature of the granulomas is the development of abnormal cell death ( necrosis ) in the center of tubercles . To the naked eye, this has the texture of soft, white cheese and

6097-400: The infected macrophages. When other macrophages attack the infected macrophage, they fuse together to form a giant multinucleated cell in the alveolar lumen. The granuloma may prevent dissemination of the mycobacteria and provide a local environment for interaction of cells of the immune system. However, more recent evidence suggests that the bacteria use the granulomas to avoid destruction by

6188-439: The infection spreads outside the lungs, causing other kinds of TB. These are collectively denoted as extrapulmonary tuberculosis. Extrapulmonary TB occurs more commonly in people with a weakened immune system and young children. In those with HIV, this occurs in more than 50% of cases. Notable extrapulmonary infection sites include the pleura (in tuberculous pleurisy), the central nervous system (in tuberculous meningitis ),

6279-613: The infection waxes and wanes. Tissue destruction and necrosis are often balanced by healing and fibrosis . Affected tissue is replaced by scarring and cavities filled with caseous necrotic material. During active disease, some of these cavities are joined to the air passages ( bronchi ) and this material can be coughed up. It contains living bacteria and thus can spread the infection. Treatment with appropriate antibiotics kills bacteria and allows healing to take place. Upon cure, affected areas are eventually replaced by scar tissue. Diagnosing active tuberculosis based only on signs and symptoms

6370-463: The medical programs. Kathmandu University School of Medical Sciences is running MBBS, BDS, BSc. Nursing, BNS, BPT, MD/MS in different specialties in this hospital. The department has expanded since 1996. It now works as a coordinating unit between the hospital’s various medical departments and numerous rural communities that previously had no access to immediate healthcare facilities. The department attempts to address health issues in remote areas through

6461-537: The middle and upper classes offered excellent care and constant medical attention. What later became known as the Alexandra Hospital for Children with Hip Disease (tuberculous arthritis) was opened in London in 1867. Whatever the benefits of the "fresh air" and labor in the sanatoria, even under the best conditions, 50% of those who entered died within five years ( c. 1916). Robert Koch did not believe

6552-483: The need of 5.28% population while the remaining 4.41% use electricity for the cooking purpose. The number of households using improved cooking stoves (ICS) is 1645 (23.37%). This has helped reduce the carbon emission while making the use of the resources efficiently. There are 4 FM Radios based in Dhulikhel Municipality with a few more frequency also received in the area. The FM in Dhulikhel include Radio Namobuddha, Radio Madhyepurba, Grace FM, and Radio Sheferd. Regarding

6643-700: The needs of women and how they can be helped. In 2011-2012 a total of 29,681 women from different rural vicinities were involved in the Awareness Programs. The major topics discussed were: cervical cancer, uterine prolapse, breast cancer, menstural hygiene, and tuberculosis . The Department of Community Programs is also raising awareness on teenage pregnancies , dysmenorrhoea , family planning , and sexually transmitted infections . Dhulikhel Hospital operates on all uterine prolapse cases without charge. Due to societal restrictions many women in rural areas do not talk about their cases and cases often come to

6734-596: The newly infected person becomes infectious enough to transmit the disease to others. A number of factors make individuals more susceptible to TB infection and/or disease. The most important risk factor globally for developing active TB is concurrent HIV infection; 13% of those with TB are also infected with HIV. This is a particular problem in sub-Saharan Africa , where HIV infection rates are high. Of those without HIV infection who are infected with tuberculosis, about 5–10% develop active disease during their lifetimes; in contrast, 30% of those co-infected with HIV develop

6825-599: The number of infectious droplets expelled by the carrier, the effectiveness of ventilation, the duration of exposure, the virulence of the M. tuberculosis strain , the level of immunity in the uninfected person, and others. The cascade of person-to-person spread can be circumvented by segregating those with active ("overt") TB and putting them on anti-TB drug regimens. After about two weeks of effective treatment, subjects with nonresistant active infections generally do not remain contagious to others. If someone does become infected, it typically takes three to four weeks before

6916-434: The people of vicinity and they started fleeing their homes. Just fifty households remained back in Dhulikhel. Despite this, Mahindra Sing Rai fought valiantly. Prithivi Narayan Shah was frustrated to see yet another defeat when one soldier stabbed Mahindra Sing in the back and roped spear. He died on the spot. His brother, Naamsing also was stabbed with khukuri (cited by Somdhwoj Bista, Shahi sainik Itihaas: 36). In this way,

7007-518: The place, including Thulochaur Kavre, and Gosaikunda forest in the vicinity areas there as many as 72 species of birds (60% residents and 35% migratory) can be sighted. Dhulikhel has been for centuries an important trading centre on the commercial route linking Nepal to Tibet . Since time immemorial, people of Nepal travel to Tibet to bring home salt and gold. Likewise, the Tibetans every year with their flocks of sheep enter into Nepal during Dashain ,

7098-563: The program. Micro-insurance Programs were launched at the end of 2010. For just 50 rupees per month, the Micro-insurance Program has ensured that all the women involved in the micro-finance programs and their children are covered for basic medical healthcare. The staff from the Department of Community Programs and the Gynaecology/Obstetrics department work together within the outreach centers to find out

7189-528: The residents of the municipality have access to pipeline water supply, a figure slightly better than the national average of 80%. Among the total households 64.23% (4522 HHs) are equipped with toilet while the remaining 35.76% (2518 HHs). Residents of Dhulikhel Municipality use a number of sources of fuel for cooking, with traditional source, i.e., Firewood forming the largest chunk, 60.47%. Next are other non-renewable sources of fuel, Kerosene and LP Gas, constituting to 29.84%. Guitha, locally made produce, addresses

7280-435: The risk of developing active TB increases to nearly 10% a year. If effective treatment is not given, the death rate for active TB cases is up to 66%. TB infection begins when the mycobacteria reach the alveolar air sacs of the lungs, where they invade and replicate within endosomes of alveolar macrophages . Macrophages identify the bacterium as foreign and attempt to eliminate it by phagocytosis . During this process,

7371-414: The risk of infections (in addition to increasing the risk of active disease and death). Additional factors increasing infection susceptibility include young age. About 90% of those infected with M. tuberculosis have asymptomatic , latent TB infections (sometimes called LTBI), with only a 10% lifetime chance that the latent infection will progress to overt, active tuberculous disease. In those with HIV,

7462-455: The same rate is 65.77% for female, making up for a total literacy rate of 75.26%. School enrollment rate of 99% sees slightly higher rate than the national average of 96%. Of the total 37 early childhood education based establishments, 33 are school based while 4 are community based. Dhulikhel Municipality has one hospital – Dhulikhel Hospital. In addition, there is a Primary Health Center, 6 Health Posts including 3 Urban Health Posts. 81.4% of

7553-465: The test's usefulness as a screening tool. Several vaccines are being developed. Intradermal MVA85A vaccine in addition to BCG injection is not effective in preventing tuberculosis. Public health campaigns which have focused on overcrowding, public spitting and regular sanitation (including hand washing) during the 1800s helped to either interrupt or slow spread which when combined with contact tracing, isolation and treatment helped to dramatically curb

7644-565: The top of the lung. This hematogenous transmission can also spread infection to more distant sites, such as peripheral lymph nodes, the kidneys, the brain, and the bones. All parts of the body can be affected by the disease, though for unknown reasons it rarely affects the heart , skeletal muscles , pancreas , or thyroid . Tuberculosis is classified as one of the granulomatous inflammatory diseases. Macrophages , epithelioid cells , T lymphocytes , B lymphocytes , and fibroblasts aggregate to form granulomas, with lymphocytes surrounding

7735-411: The town, the southern end, is an assembly of old Newari houses, often occupied by 20 or more members of the local extended families. Their most valuable assets are the beautifully carved windows and doors, fine examples of traditional Newari craftsmanship. The old town is made up of four toles called wotole(वटोल), etole (ईटोल), dutole (दुटोल), chochhe tole (चोच्छे टोल ). The narrow streets, are typical of

7826-594: The town. Drinking water in Dhulikhel is some of the best water in Nepal. It was made with the help of the German NGO German Technical Cooperation . Located 30 km to the east of Kathmandu valley, Dhulikhel Municipality was established on 2043/11/05 constituting 9 wards. At present, with the expansion of area, the municipality consists of 12 wards covering a total of 54.62 km . Dhulikhel Municipality receives an annual rainfall of 1500mm. The average temperature of 20 C makes it

7917-467: The transmission of both tuberculosis and other airborne diseases which led to the elimination of tuberculosis as a major public health issue in most developed economies. Other risk factors which worsened TB spread such as malnutrition were also ameliorated, but since the emergence of HIV a new population of immunocompromised individuals was available for TB to infect. During the HIV/AIDS epidemic in

8008-695: The tuberculosis bacteria share a common ancestor, which could have infected humans even before the Neolithic Revolution . Skeletal remains show some prehistoric humans (4000 BC ) had TB, and researchers have found tubercular decay in the spines of Egyptian mummies dating from 3000 to 2400 BC. Genetic studies suggest the presence of TB in the Americas from about AD 100. Before the Industrial Revolution , folklore often associated tuberculosis with vampires . When one member of

8099-435: The work of the Department of Community Programmes can be categorised as the following: Majority of the work of the Department of Community Programs is carried out by the outreach centers. At the 14 outreach centers and one school health clinic round-the-clock healthcare services are provided to the people living in the catchment areas. All of these outreach centers were started after thorough discussions and meetings addressing

8190-533: Was being expanded by Prithvi Narayan Shah . Yogi Narharinath , in Itihas Prakash writes about the difficulty Prithvi Narayan Shah faced in conquering Dhulikhel. He writes: "Prithvi Narayan Shah found it difficult to capture Dhulikhel. He got scared by the bravery of the locals. Being unable to conquer the place despite fighting for six months, he installed a fort in the hill above side. Staying there, he gave training and organized numerous forces. This scared

8281-478: Was not effective, it was later successfully adapted as a screening test for the presence of pre-symptomatic tuberculosis. World Tuberculosis Day is marked on 24 March each year, the anniversary of Koch's original scientific announcement. When the Medical Research Council formed in Britain in 1913, it initially focused on tuberculosis research. Albert Calmette and Camille Guérin achieved

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