JNMA J Nepal Med Assoc
· 2025 Oct · PMID 41783642
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Widespread availability of health-related information via social media and artificial intelligence tools is contributing to an emerging pattern of hyperdiagnosis. Individuals, particularly medical students, develop heigh...Widespread availability of health-related information via social media and artificial intelligence tools is contributing to an emerging pattern of hyperdiagnosis. Individuals, particularly medical students, develop heightened health anxiety and excessive fear of illness despite the absence of clinical disease. Nosophobia, which is a part of Medical Student Syndrome, is worsened by digital symptom-checking and constant exposure to disease content on social media.
Nepal S, Marhatta A, Atreya A
… +3 more, Menezes R, Shrestha S, Pahari S
JNMA J Nepal Med Assoc
· 2025 Oct · PMID 41783641
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Mass hysteria is a rare phenomenon that can occur in any community. We report a case of recurrent mass hysteria in a co-education secondary school in Palpa, Nepal. The index case was a 16-year-old girl who exhibited abno...Mass hysteria is a rare phenomenon that can occur in any community. We report a case of recurrent mass hysteria in a co-education secondary school in Palpa, Nepal. The index case was a 16-year-old girl who exhibited abnormal behavior and was diagnosed with psychotic depression. After a few days, several other girls in her class exhibited similar symptoms, culminating in a mass conversion disorder in the school assembly. The situation caused widespread panic among students, teachers, and staff members, ultimately leading to the school's closure. Health workers from the regional tertiary healthcare institute intervened by providing health education to parents, guardians, and students, which was the primary interventional strategy employed. In this case report, we describe the case, discuss the significance and implications, and emphasize the importance of increasing awareness and early diagnosis and treatment of such conditions.
Rasali N, Shrestha A, Shrestha PM
… +6 more, Basnet RB, Adhikari B, Shah AK, Mishra U, Dahal R, Thapa BB
JNMA J Nepal Med Assoc
· 2025 Oct · PMID 41783640
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INTRODUCTION: To aim of study was to predict the success rate of the stone composition by visual assessment during endourological procedures, using Fourier transform infrared spectroscopy as a reference standard. METHODS...INTRODUCTION: To aim of study was to predict the success rate of the stone composition by visual assessment during endourological procedures, using Fourier transform infrared spectroscopy as a reference standard. METHODS: Prospective observational study showed, 150 patients undergoing endourological procedures for urolithiasis between June 2024 and July 2025 were analyzed. The senior consultant, the junior consultant, and the residents visually assessed the stone morpho-constitution (according to Daudon classification) during the endoscopic procedures. Stone samples were obtained which were analyzed using Fourier transform infrared spectroscopy, and the results were correlated with the visual assessment done by the surgeon. RESULTS: Stone analysis by Fourier transform infrared spectroscopy showed 28 (18.67%) of the stones had only one morphological type (pure stones), while 122 (81.33%) had more than one composition of stones (mixed stones). The accurate predictions for pure stones as Uric acid stones and Protein stones, were 43 (84.31%) and 5 (83.33%), respectively, whereas for Calcium Oxalate Monohydrate + Calcium Oxalate Dihydrate (mixed stones) was 126 (79.25%). The overall correct prediction was obtained in 64.44 %. The correct prediction was highest by the senior consultant 110 (73.33%), followed by the junior consultant 97 (64.67%), and the residents 83 (55.33%), respectively. CONCLUSIONS: The overall agreement between visual assessment of urinary stone morphology during endo-urological procedures and Fourier transform infrared spectroscopy-based composition analysis in this study was moderate, with a Cohen's kappa value of 0.62.
Pandey S, Karki SS, Pathak C
… +4 more, Aryal K, Pandey A, Subedi G, Bhandary S
JNMA J Nepal Med Assoc
· 2025 Oct · PMID 41783639
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INTRODUCTION: There is limited evidence describing the demographic patterns of hearing loss in the Nepali context. This study aimed to analyze the audiometrie profiles of patients undergoing pure tone audiometry in a ter...INTRODUCTION: There is limited evidence describing the demographic patterns of hearing loss in the Nepali context. This study aimed to analyze the audiometrie profiles of patients undergoing pure tone audiometry in a tertiary care centre of Eastern Nepal. METHODS: A retrospective analysis was conducted on all patients undergoing pure tone audiometry at B.P. Koirala Institute of Health Sciences, Nepal, between April 2023 and July 2024. Ethical approval was obtained from the Institutional Review Committee (IRC-163-081-82). Census sampling was used, and data on demographics and audiometric profiles were compiled in Microsoft Excel and analyzed with SPSS version 25. RESULTS: Among 3,468 patients (mean age: 42 years, SD ± 20.27 years, M:F ratio 1:1.2), 2629 (75.8%) exhibited some degree of hearing loss. Mild hearing loss was observed in 1225 patients (35.32%). Sensorineural hearing loss was seen in 1010 (32.21%) male vs 1130 (29.77%) female ears and conductive hearing loss was seen in 476 (15.18%) male vs 620 (16.33%) female ears. Sensorineural hearing loss increased from 17 (6.59%) in children under 10 years to 165 (80.88%) in age 80 and above, while conductive hearing loss declined from 87 (33.72%) in those under 10 to 9 (4.41%) in above 80 years. CONCLUSIONS: In this cohort of participants, three-quarters exhibited some degree of hearing loss, with mild loss being more common. Sensorineural loss increased with age and predominant in males, while conductive loss was more frequent in younger patients and females.
Poudel S, Subedi KU, Karmacharya SB
… +4 more, Paudel P, Shrestha R, Maharjan P, Prajapati L
JNMA J Nepal Med Assoc
· 2025 Oct · PMID 41783638
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To address the gap in suboptimal breastfeeding practices and limited access to human milk and its challenges to neonatal health outcomes, the country's first Human Milk Bank, "Amrit Kosh," was established at Paropakar Ma...To address the gap in suboptimal breastfeeding practices and limited access to human milk and its challenges to neonatal health outcomes, the country's first Human Milk Bank, "Amrit Kosh," was established at Paropakar Maternity and Women's Hospital (PMWH) in August 2022. This study presents the experience of its operation, highlighting development, induction, challenges, and future directions for the program. Data were extracted from Human Milk Bank procedure records. Standard quality assurance protocols were followed throughout milk handling and processing, adhering to national guidelines. Of 2859 willing donors, 2820 mothers met eligibility criteria, contributing 1760.35 liters of breast milk. All batches of pasteurized donor human milk (PDHM) passed bacteriological screening, ensuring zero contamination, which was dispensed to 3511 neonates. The successful establishment and safe operation of Nepal's first Human Milk Bank demonstrate the feasibility and impact in a resource-limited setting. Future priorities include securing sustainable funding, expanding community engagement, and scaling the model to other facilities. "Amrit Kosh" has provided critical nutrition while enhancing breastfeeding awareness.
Shrestha S, Bijukchhe SM, Bhandari S
… +1 more, Gurung M
JNMA J Nepal Med Assoc
· 2025 Oct · PMID 41783637
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Nepal has a high burden of enteric fevers. An observational study conducted in a tertiary-level hospital in Nepal over 11 years (2014-2024), reviewing hospital records of all blood culture-positive cases of Typhi and Pa...Nepal has a high burden of enteric fevers. An observational study conducted in a tertiary-level hospital in Nepal over 11 years (2014-2024), reviewing hospital records of all blood culture-positive cases of Typhi and Paratyphi in children, showed a gradual decline in blood culture-positive enteric fever cases with year-to-year variability. Typhoid conjugate vaccine (TCV) was introduced into the national immunisation schedule of Nepal in 2022. We observed that the proportion of Paratyphi cases has increased in the post-typhoid conjugate vaccine years compared with the pre-typhoid conjugate vaccine period. A slight rise in hospitalisation rates for blood culture-positive paratyphoid infections has also been observed in the post-typhoid conjugate vaccine period. These findings underscore the importance of continued surveillance and call for further evaluation of the potential shift in enteric fever epidemiology. The development of effective vaccines targeting both typhoid and paratyphoid remains crucial for comprehensive disease control.
Sharma KR, Palikhe N, Shrestha S
… +3 more, Mahaseth R, Gupta B, Sah R
JNMA J Nepal Med Assoc
· 2025 Oct · PMID 41783636
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Hydatid disease, a zoonotic infection caused by Echinococcus granulosus, typically involves the liver and lungs. Disseminated abdominal hydatidosis is rare and often results from cyst rupture or inadequate treatment. A 2...Hydatid disease, a zoonotic infection caused by Echinococcus granulosus, typically involves the liver and lungs. Disseminated abdominal hydatidosis is rare and often results from cyst rupture or inadequate treatment. A 27-year-old male from rural Nepal presented with abdominal pain, jaundice, and palpable masses. Imaging revealed disseminated hydatid cysts in the liver, peritoneum, and pelvis. He had received albendazole monotherapy abroad. Surgical removal of the cysts was performed, followed by albendazole therapy. This case emphasizes the need for early diagnosis, complete management including surgery and antiparasitic therapy, and awareness of dissemination risks due to incomplete treatment.
Shrestha S, Chaudhary JK, Pokhrel S
… +3 more, Jha IK, Banepali N, K C S
JNMA J Nepal Med Assoc
· 2025 Oct · PMID 41783635
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INTRODUCTION: Gastric cancer is a significant global and national health problem with high incidence and mortality rates. Despite advancements in treatment, local recurrence, mainly peritoneal, is common. Bursectomy, onc...INTRODUCTION: Gastric cancer is a significant global and national health problem with high incidence and mortality rates. Despite advancements in treatment, local recurrence, mainly peritoneal, is common. Bursectomy, once the standard of surgery in resectable GC to reduce recurrence by removing the peritoneal membranes' micro-metastasis, poses risks like pancreatic injury. Japanese guidelines now advise against it due to limited survival benefits, recommending D2 dissection with omentectomy instead. However, bursectomy is still routinely practiced in Nepal. This study evaluates its relevance, risks, and compliance with global guidelines. METHODS: This descriptive cross-sectional study was conducted at Bir Hospital from March 2024 to May 2025, involving 35 patients with resectable stage Ib-III gastric cancer who underwent D2 gastrectomy with bursectomy. Ethical approval was obtained from NAMS IRB. Patients with poor performance status or metastasis were excluded. All procedures were performed by experienced consultant surgical gastroenterologists, and specimens were sent separately for examination. RESULTS: Among 39 selected patients, 35 underwent curative D2 gastrectomy with bursectomy. Among them, 20 (57.14%) were male, with a mean age of 60.54±13.81 years and performance status 0-2. 33 (94.28%) patients had distal gastric lesions; among them, 27 (77.13%) patients had cT3+cT4 lesions. Tumor deposits in the bursa were seen in 3(8.57%) patients. There were procedure-specific complications like 2(5.71%) biochemical leaks, delayed 4(11.43%) gastric emptying, and 3(8.57%) postoperative ileus. There was no mortality. 18 (51.42%) patients were followed up for more than 6 months. CONCLUSIONS: There are tumor deposits in the bursa, and bursectomy doesn't increase the post-operative complications.
Shah B, Sharma P, Bhattarai G
… +4 more, Joshi S, Adhikari A, Sapkota N, Shakya R
JNMA J Nepal Med Assoc
· 2025 Oct · PMID 41783634
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INTRODUCTION: Telepsychiatry has emerged as a valuable modality to bridge mental health gaps. Despite its huge potential in Nepal, it remains understudied. This study described the profiles and experiences of the patient...INTRODUCTION: Telepsychiatry has emerged as a valuable modality to bridge mental health gaps. Despite its huge potential in Nepal, it remains understudied. This study described the profiles and experiences of the patients using the free videoconferencing-based telepsychiatry service initiated at Patan Hospital, a public tertiary care center in Nepal, over four years. METHODS: A retrospective review of clinical records and patients' feedback about the videoconferencing-based telepsychiatry service from May 2021 to May 2025 from the existing service was conducted. Data were analyzed for descriptive statistics using Microsoft Excel 2016. RESULTS: A total of 430 consultations were provided to 145 patients, with a mean age of 34.88±15.27 years; 79 (54.48%) were male, and 123 (84.83%) patients were from outside the Kathmandu Valley. 47 (32.41%) patients had anxiety disorders, followed by psychotic disorders in 44 (30.35%), depression in 18 (12.41%), and bipolar disorder in 14 (9.66%) patients. 69 (47.59%) patients used benzodiazepines, followed by second-generation antipsychotics (46.21%) and SSRIs (40.69%). A subset also received non-pharmacological interventions (21.38%). 49 (81.67%) patients preferred videoconferencing-based telepsychiatry service over face-to-face visits for the initial consultation, and 57 (95.0%) for follow-up visits. However, only 35% followed up. CONCLUSIONS: Our study highlights that implementing a videoconferencing service in a public hospital setting in Nepal is possible and it is preferred by psychiatry patients.
Bhattarai A, Kansakar PBS, Awale L
… +2 more, Ghimire B, Sah HK
JNMA J Nepal Med Assoc
· 2025 Oct · PMID 41783633
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INTRODUCTION: Appendiceal neoplasms are rare and frequently diagnosed incidentally during histopathological examination of appendectomy specimens. Recent data suggest that their incidence is increasing worldwide. This st...INTRODUCTION: Appendiceal neoplasms are rare and frequently diagnosed incidentally during histopathological examination of appendectomy specimens. Recent data suggest that their incidence is increasing worldwide. This study aimed to evaluate the appendiceal neoplasm in appendectomy specimens, determine their clinicopathological presentation, histological subtypes, diagnostic modalities used, and the outcomes at the Tribhuvan University Teaching Hospital, Kathmandu, Nepal. METHODS: A retrospective evaluation of patients diagnosed with appendiceal neoplasm was conducted from January 2013 to December 2023 at Tribhuvan University Teaching Hospital in Kathmandu, Nepal. Ethical approval was obtained from the Institutional Review Board (Ethical Approval Reference No: 32081/082). Various parameters, including demographic profiles, disease pathology and outcomes were studied. RESULTS: A total of 57 cases of appendiceal neoplasm were identified during the study period. The mean age at diagnosis was 47.1±18.5 years. Among them, 29 (50.87%) were male and 28 (49.12%) were female. Of the total cases, 52 (91.22%) cases were primary appendiceal neoplasms, 3 (5.26%) were secondary, and 2 (3.50%) cases remained unclassified. The primary mucinous appendiceal neoplasm was seen in 43 (75.44%), followed by neuroendocrine tumor in 5 (8.77%) cases. Appendectomy was performed in 29 (50.88%) and right hemicolectomy in 15 (26.32%) cases. The major perioperative complications were observed in 2 (3.50%) cases, with 1 (1.75%) case of mortality. CONCLUSIONS: The number of diagnosed appendiceal neoplasms increased over the year with mucinous tumors being predominant followed by neuroendocrine tumor. Appendectomy was adequate in most cases, with limited need for further surgery, and outcomes remain excellent despite few of them developed major postoperative complications.
JNMA J Nepal Med Assoc
· 2025 Oct · PMID 41783632
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INTRODUCTION: Neonatal jaundice is a common condition affecting 60% of term and 80% of preterm neonates within the first week of life. Phototherapy, though the standard treatment for neonatal hyperbilirubinemia, may caus...INTRODUCTION: Neonatal jaundice is a common condition affecting 60% of term and 80% of preterm neonates within the first week of life. Phototherapy, though the standard treatment for neonatal hyperbilirubinemia, may cause complications such as hypocalcemia, a significant but lesser-known side effect. This study compared phototherapy-induced hypocalcemia in late preterm and term neonates with unconjugated hyperbilirubinemia, after 48 hours of phototherapy. METHODS: This hospital-based descriptive cross-sectional study was conducted in the Neonatal Intensive Care Unit of a tertiary care Hospital from 16th August 2022 to 10th July 2023. A total of 150 neonates, both term and preterm, with hyperbilirubinemia requiring at least 48 hours of phototherapy were enrolled. After ethical approval and informed consent, data were collected using a structured questionnaire and analyzed using IBM SPSS Statistics (version 23.0). RESULTS: After 48 hours of phototherapy, calcium decreased in both groups. In term neonates, it decreased from 9.44±0.59 to 8.57±0.73 mg/dL, mean change was 0.87 mg/dL (95% CI 0.77-0.97) and in preterm neonates from 9.10±0.43 to 7.94±0.79 mg/dL, mean change was 1.16 mg/dL (95% CI 1.01-1.31). The between group difference was 0.29 mg/dL (95% CI 0.11-0.47), Cohen's d = 0.55. Hypocalcemia occurred in 19 (21.30%) term and 21 (34.40%) preterm neonates (RR 1.61, 95% CI 0.95-2.73; RD 13.1%, 95% CI 7.2% to 32.8%). CONCLUSIONS: There is a reduction in serum calcium levels in both term and preterm neonates after phototherapy. While exploratory analyses suggested a higher risk of hypocalcemia in preterm neonates, subgroup comparisons were underpowered and should be interpreted cautiously.
Chaudhary K, Shanmugavel A, Shrestha B
… +11 more, Nepal J, Shrestha B, Paudel P, Shrestha K, Shrestha A, Subedi S, Shakya P, Khadka D, Daneault JF, Shrestha A, Rawal S
JNMA J Nepal Med Assoc
· 2025 Oct · PMID 41783631
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INTRODUCTION: Gestational diabetes mellitus is among the most common pregnancy complications with various adverse maternal and fetal outcomes. Mobile health technology offers new opportunities to enhance its care and sup...INTRODUCTION: Gestational diabetes mellitus is among the most common pregnancy complications with various adverse maternal and fetal outcomes. Mobile health technology offers new opportunities to enhance its care and support self-management. The aim of study was to identify usability, acceptability and satisfaction of 'Garbhakalin Diabetes athawa Madhumeha-Dhulikhel Hospital' application to support the treatment and self-management of gestational diabetes mellitus among Nepalese women. METHODS: A cross-sectional study among 46 women of an intervention arm of a parent randomized controlled trial was conducted. The ethical/institutional review boards of Rutgers University (Pro2019001883) and the Nepal Health Research Council approved the study (Ref number: 735/2019). Perceived usability and acceptability of the application was assessed using the System Usability Scale and mobile Health Application Usability Questionnaire. To assess satisfaction with gestational diabetes mellitus care, the Oxford Maternity Diabetes Treatment Satisfaction Questionnaire was used. Frequencies and percentages are reported for categorical variables, and means and standard deviation for continuous variables. RESULTS: The average time spent on the application was 37 minutes per day, with 12 minutes of engagement per session. The mean score on System Usability Scale was 72.12±4.78; 44 (95.56%) participants liked using the application, 45 (97.76%) found it easy, and 40 (86.91%) praised its functional integration. The mean score on the mobile Health Application Usability Questionnaire and Oxford Maternity Diabetes Treatment Satisfaction Questionnaire were 118.32±8.84 and 15.82±4.09 respectively. CONCLUSIONS: The mobile application demonstrated strong usability and was well-accepted by Nepalese women with gestational diabetes mellitus, suggesting it is a promising tool for self-management support.
JNMA J Nepal Med Assoc
· 2025 Oct · PMID 41783630
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Air pollution, often termed a silent danger, contributes to various chronic and infectious diseases. Despite global improvements, Nepal Still faces significant health consequences. Air pollution has a high impact on the...Air pollution, often termed a silent danger, contributes to various chronic and infectious diseases. Despite global improvements, Nepal Still faces significant health consequences. Air pollution has a high impact on the health of Nepalese, especially among vulnerable populations such as young children, the elderly, those with respiratory issues, and pregnant women due to a combination of human activities and geographical factors. The increase in vehicular air pollution in Kathmandu Valley can increase PM2.5 production which can cause respiratory and pulmonary diseases. Strategies to mitigate burden of air pollution in Kathmandu include multi-sectoral approach from the Nepalese and private and public sectors especially through community awareness, strong political will and research implementation strategy. This article aimed to examine present initiatives, point out weaknesses in exiting tactics, and suggest comprehensive methods to lessen the negative effects of air pollution on the socioeconomic well-being and public health of the Kathmandu Valley.
JNMA J Nepal Med Assoc
· 2025 Oct · PMID 41783629
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Extravasation of calcium gluconate can lead to erythema, tenderness, induration, edema and sometimes iatrogenic calcinosis cutis. Subcutaneous calcification may be mistaken for cellulitis, abscess, calcified hematoma, or...Extravasation of calcium gluconate can lead to erythema, tenderness, induration, edema and sometimes iatrogenic calcinosis cutis. Subcutaneous calcification may be mistaken for cellulitis, abscess, calcified hematoma, or osteomyelitis, resulting in unnecessary antibiotic therapy or surgical intervention. A 36+5 weeks male baby with birth weight 2500 grams, presented on 4th day of life with fever and neonatal hyperbilirubinemia. He developed symptomatic hypocalcemia and was treated with multiple doses of intravenous calcium gluconate infusion. At one week follow up he presented with multiple tender hard nodules distributed over previous cannulation sites. He was managed conservatively. Paracetamol was given for pain management. There was complete resolution of lesions by 12 weeks. Radiographs in soft tissue calcification after extravasation of calcium gluconate are initially negative, take one to three weeks to appear and usually months to resolve.
Bhandari A, Bhattarai K, Acharya A
… +1 more, Shrestha SR
JNMA J Nepal Med Assoc
· 2025 Oct · PMID 41783628
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INTRODUCTION: Dyspepsia is a cluster of gastrointestinal symptoms related to feeding due to an organic cause or in the absence of any etiology. H. pylori infection is one of the most prevalent etiologies which is often d...INTRODUCTION: Dyspepsia is a cluster of gastrointestinal symptoms related to feeding due to an organic cause or in the absence of any etiology. H. pylori infection is one of the most prevalent etiologies which is often detected using a rapid urease test. This study aimed to correlate the clinical-endoscopic profile in dyspeptic patients and find out the prevalence of H. pylori infection among those patients. METHODS: This observational cross-sectional study was conducted from 1st August, 2024 to 31st January, 2025 in a tertiary care hospital in Nepal after obtaining ethical clearance from the Institutional Review Committee (Reference number: NMC-IRC/01-081/082). A total of 180 patients aged 18 years and above with dyspeptic symptoms for more than three months were included by total enumeration sampling. Data were collected using a structured proforma, and upper gastrointestinal endoscopy with rapid urease testing was performed. All collected data were entered and analysed using the Statistical Package for the Social Sciences version 16.0. RESULTS: Of the 180 participants, 83 (46.11%) were male and 97 (53.89%) were female. Retrosternal burning was reported by 165 (91.67%) participants and upper abdominal pain by 118 (65.56%). Among the 180 participants, 81 (45.00%) reported current smoking and 67 (37.22%) reported alcohol consumption. CONCLUSIONS: This study highlights that a large proportion of dyspeptic patients were diagnosed with acid peptic disease, and a high prevalence of Helicobacter pylori infection was observed using rapid urease testing compared to previous studies.
Adhikari BN, Sapkota S, Sipai S
… +8 more, Ghimire B, Chaudhary M, Joshi H, Poudel A, Rayamajhi A, Yadav YK, Sah B, Rayamajhi A
JNMA J Nepal Med Assoc
· 2025 Oct · PMID 41783627
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INTRODUCTION: Transfusion-dependent thalassemia is a major public health concern in Nepal, with limited access to comprehensive care and paucity of national data. The main objectives of this study were to explore clinico...INTRODUCTION: Transfusion-dependent thalassemia is a major public health concern in Nepal, with limited access to comprehensive care and paucity of national data. The main objectives of this study were to explore clinico-epidemiological profile, management practices and complications among pediatric transfusion-dependent thalassemia patients at a tertiary pediatric hospital in Nepal. METHODS: This is a retrospective observational study conducted at the Thalassemia Day Care Unit, Kanti Children's Hospital, Kathmandu. Transfusion-dependent thalassemia cases registered from January 2020 to December 2024, aged less than 15 years were included. Data on demographics, clinical features, transfusion and chelation profiles, complications, and nutritional status were acquired from hospital registry and analyzed using descriptive statistics. RESULTS: Out of 187 patients, 121 (64.71%) were males and 156 (83.42%) had β-thalassemia major. Mean age at last follow-up was 7.52±3.68 years. 83 (44.38%) were Janajatis, particularly Tharus 40 (21.39%). Median age at diagnosis was 10 months (IQR 6-22 months), with mean pre-transfusion hemoglobin level 8.86 g/dL, and average transfusion period 2.64±0.83 weeks. Among 167 (89.30%) patients receiving chelation, 37 (19.87%) had good compliance. Endocrinopathies, hepatic dysfunction and cardiac complications were observed in 104 (55.62%), 65 (34.76%) and 2 (1.07%) patients respectively. Serum ferritin levels were above 2500 ng/mL in 92 (49.19%) patients. Regular follow up was done by 56 (29.95%) patients. CONCLUSIONS: β-thalassemia major was the most common type of transfusion dependent thalassemia in our study. There was male predominance, and over half of the patients had iron overload and some form of complications of thalassemia. Regular follow up and compliance to chelation therapy has to be focused for better care of transfusion dependent thalassemia patients.
Khadka M, Nyachhyon R, Raina S
… +3 more, Maharjan N, Poudel P, Gyawali S
JNMA J Nepal Med Assoc
· 2026 Jan · PMID 41783537
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Pyogenic granuloma is a common benign, non-neoplastic inflammatory hyperplasia of keratinized tissue, typically arising in response to chronic irritation, trauma, or hormonal influences. Recently it has been classified u...Pyogenic granuloma is a common benign, non-neoplastic inflammatory hyperplasia of keratinized tissue, typically arising in response to chronic irritation, trauma, or hormonal influences. Recently it has been classified under vascular tumor and termed as a lobular capillary hemangioma by International Society for the Study of Vascular Anomalies. It presents as a solitary, hemorrhagic, often pedunculated, nodules of variable size which typically appears most of the times in the gingiva. This report presents the case of a 43-year-old male with a pyogenic granuloma on the floor of the mouth. This rare location frequently leads to diagnostic uncertainty among clinicians.
Lama TA, Karki H, Khadka K
… +2 more, Pandey RR, Rajbhandari B
JNMA J Nepal Med Assoc
· 2026 Jan · PMID 41783536
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Isolated wrist drop as a presentation of stroke is uncommon and may pose a diagnostic dilemma. We present a case of a 65-year-old man with hypertension and diabetes who presented with sudden-onset weakness of the left ha...Isolated wrist drop as a presentation of stroke is uncommon and may pose a diagnostic dilemma. We present a case of a 65-year-old man with hypertension and diabetes who presented with sudden-onset weakness of the left hand and inability to extend fingers, without any other focal neurological deficits. Noncontrast computed tomography of the head was normal. However, diffusion-weighted magnetic resonance imaging of the brain revealed an acute ischemic infarct involving the right frontoparietal and occipital lobes. A diagnosis of isolated left-sided wrist drop secondary to acute ischemic stroke was made. The patient showed clinical improvement with antiplatelet and statin therapy, along with physiotherapy, on follow-up. Although rare, isolated wrist drop may be a manifestation of stroke, and clinicians must remain vigilant to avoid diagnostic delays and to administer appropriate treatment in a timely manner.
Pandey S, Timalsina A, Pokhrel S
… +2 more, Chhetri V, Ranabhat N
JNMA J Nepal Med Assoc
· 2026 Jan · PMID 41783535
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Culture-negative infective endocarditis is difficult to diagnose because it often presents with vague symptoms, delaying recognition and worsening outcomes. Renal infarction is rare but may be the first clue. A previousl...Culture-negative infective endocarditis is difficult to diagnose because it often presents with vague symptoms, delaying recognition and worsening outcomes. Renal infarction is rare but may be the first clue. A previously healthy 32-year-old woman had intermittent fever for six weeks and sudden right-sided flank pain for two days. Examination revealed a holosystolic murmur and right costovertebral angle tenderness. Investigations showed raised inflammatory markers and a positive rheumatoid factor, while repeated blood cultures were negative. Echocardiography showed severe mitral regurgitation without visible vegetations, and computed tomography angiography confirmed right renal infarction. Using modified Duke criteria, the diagnosis was made and empiric intravenous vancomycin and ceftriaxone were started. Despite intensive care and aggressive therapy, she deteriorated and died from refractory heart failure due to severe valvular dysfunction. This case shows the disease can be insidious even in low-risk patients, stressing early suspicion, multidisciplinary care, and timely surgical evaluation when appropriate.