JNMA; Journal Of The Nepal Medical Association[JOURNAL]
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200 papers
Obliterative Hepatocavopathy: The "Acrobatic Dolphin" Mimic as Endovascular Procedure Guide.
Garg A, Rathod K
JNMA J Nepal Med Assoc · 2026 Jan · PMID 41783534 · Full text
Obliterative hepatocavopathy, also known as membranous obstruction of the inferior venacava, is a frequently underdiagnosed vascular condition, seen particularly in low socioeconomic populations in India, Nepal and other...
Obliterative hepatocavopathy, also known as membranous obstruction of the inferior venacava, is a frequently underdiagnosed vascular condition, seen particularly in low socioeconomic populations in India, Nepal and other parts of Asia. This viewpoint presents a distinctive radiographic analogy- the "Acrobatic Dolphin" mimic-observed during venacavography in a patient with membranous inferior venacava obstruction. The dolphin-like configuration, best appreciated in the left anterior oblique view, featured a conical beak-shaped membrane formed by flow dynamics that served both as a diagnostic clue and as an endovascular procedural guide for successful membranotomy. Moreover, recognition of such radiological signs provides powerful mnemonics that enhance clinical education.
Metastatic Tumors from Unknown Primary in Cervical Lymph Nodes: A Decade of Study in a Tertiary Care Center of a Resource-Limited Country.
Kafle S
JNMA J Nepal Med Assoc · 2026 Jan · PMID 41783533 · Full text
INTRODUCTION: Cervical lymphadenopathy may be the first clinical manifestation of an occult primary tumor, and it is a crucial area of investigation due to its significance in cancer diagnosis and prognosis. This study a...
INTRODUCTION: Cervical lymphadenopathy may be the first clinical manifestation of an occult primary tumor, and it is a crucial area of investigation due to its significance in cancer diagnosis and prognosis. This study aimed to establish the spectrum of malignancies metastasizing to cervical lymph nodes of unknown primary origin and to analyze their distribution by age, sex, and nodal site. METHODS: A retrospective descriptive study was conducted over a decade (2015 - 2024 AD) in Tribhuvan University Teaching Hospital (TUTH). All the cases of metastatic tumors in cervical lymph nodes with unknown primary origin were included. RESULTS: A total of 174 cases were studied. Age of patient ranges from 5 years to 90 years, with a mean age of 58±17.3 years. There were 12 (6.89%) lung cancer and 9 (5.17%) thyroid cancer as primary site. On histological examination, there were 44 (25.28%) adenocarcinoma and 25 (14.36%) squamous cell carcinoma. CONCLUSIONS: Lung cancer was more common followed by thyroid and adenocarcinoma was the most common histological findings. The supraclavicular lymph node was most often involved in this study.
Complications of Central Venous Line Insertion: A Case Series.
Shrestha S, Pradhan R, Guragain N
JNMA J Nepal Med Assoc · 2026 Jan · PMID 41783532 · Full text
Central venous catheter (CVC) insertion is a commonly performed procedure in critically ill patients. While generally safe, it carries risks of potentially serious complications, particularly when performed without ultra...
Central venous catheter (CVC) insertion is a commonly performed procedure in critically ill patients. While generally safe, it carries risks of potentially serious complications, particularly when performed without ultrasound guidance or in emergent settings. We report a series of four patients who developed uncommon but significant complications following CVC placement. The first case describes the right internal mammary artery aneurysm after malplacement of CVC line. The second case outlines the formation of sternocleidomastoid hematoma after internal jugular vein access. The third case involved a guidewire retained in the inferior venacava for over one year, discovered incidentally on imaging and removed surgically. The fourth case developed a subclavian artery pseudoaneurysm post-CVC insertion, confirmed on CT angiography and surgically managed. These cases highlights the importance of strict procedural protocols, operator awareness, use of real-time imaging, and post-insertion confirmation imaging to minimize CVC-related complications. Early identification and appropriate management can significantly reduce morbidity.
Clinical Profile of Ectopic Pregnancy in a Tertiary Care Center: A Five-Year Retrospective Study.
Chudal D, Shrestha A, Manandhar R … +4 more , Thakur S, Kharel D, Shrestha U, Basnet B
JNMA J Nepal Med Assoc · 2026 Jan · PMID 41783531 · Full text
INTRODUCTION: Ectopic pregnancy is a major cause of maternal morbidity and mortality in the first trimester. Delayed diagnosis often results in rupture, leading to life-threatening complications and adverse fertility out...
INTRODUCTION: Ectopic pregnancy is a major cause of maternal morbidity and mortality in the first trimester. Delayed diagnosis often results in rupture, leading to life-threatening complications and adverse fertility outcomes. This study aimed to evaluate the incidence, risk factors, clinical presentation, and management of ectopic pregnancy in a tertiary care center in Nepal. METHODS: A five-year retrospective observational study was conducted at Nepal Police Hospital, Kathmandu from March 1, 2020, to February 28, 2025. All confirmed cases of ectopic pregnancy were included. Data on socio-demographics, risk factors, clinical features, operative findings, and management were collected from hospital records. Descriptive statistics were applied. RESULTS: Among 1,760 live births, 42 (2.38%) cases of ectopic pregnancy were identified. The mean age of the patients was 29.69±5.41 years, with the majority of cases occurring in women aged 20-35 years. Abdominal pain was the most common presenting symptom, reported in 30 (71.42%) patients. A history of abortion was the leading risk factor, noted in 14 (33.3%) cases. Tubal rupture was observed in 37 (88.09%) patients, and the ampullary region was the most frequent site, involved in 38 (90.47%) cases. All patients underwent surgical management, with laparoscopic unilateral salpingectomy being the most commonly performed procedure in 36 (85.71%) cases. CONCLUSIONS: The most common presenting symptom was abdominal pain in patients in the age group of 31-35 years. Most patient presented with ruptured ectopics.
Socio-demographic Profile of Clinical Medico-legal Gender-based Violence Cases at Jumla Nepal: An Observational Study.
Acharya A, Aryal UR, Bhattarai K … +5 more , Bhandari J, Kaphle S, Parajuli A, Shakya A, Manandhar N
JNMA J Nepal Med Assoc · 2026 Jan · PMID 41783530 · Full text
INTRODUCTION: Gender-based violence is a burden throughout Nepal. This study aimed to assess the sociodemographic profile of Gender-based violence cases and shed light on factors associated with these incidents in the Ju...
INTRODUCTION: Gender-based violence is a burden throughout Nepal. This study aimed to assess the sociodemographic profile of Gender-based violence cases and shed light on factors associated with these incidents in the Jumla district of rural Nepal. METHODS: A retrospective observational study involving all the Gender-based violence cases brought for clinical medico-legal examination at the Department of Forensic Medicine and Toxicology, Karnali Academy of Health Sciences, Jumla, Nepal, from January 01, 2022 - December 31, 2023. The study variables included various socio-demographic profiles of these cases. These variables were entered and analyzed using Microsoft Excel (version 16.16.27--201012) and SPSS 23.0. RESULTS: Among the total clinical forensic medicine cases, Gender-based violence was present in 83 (41.92%). All the females were survivors, 53 (63.85%), and all the malex were perpetrators, 30 (36.14%). The median ages of the female and male were 20 years (Range: 11-73) and 19 years (Range: 13-52), respectively. Among these cases, 20 (24.10%) had physical assault, and 63 (75.90%) were related to sexual assault, with all male examinees presenting with sexual assault. CONCLUSIONS: Gender-based violence is common among females in Jumla and is primarily inflicted by males due to various sociocultural factors.
Pelvic Floor Dysfunction in Postpartum Nepalese Women: An Observational Study.
Yadav M, Poudel S, Adhikari SP
JNMA J Nepal Med Assoc · 2026 Jan · PMID 41783529 · Full text
INTRODUCTION: Pelvic Floor Dysfunctions (PFD) have been strongly associated with vaginal birth and can significantly affect women's quality of life. This study aimed to determine the prevalence of PFDs during the postpar...
INTRODUCTION: Pelvic Floor Dysfunctions (PFD) have been strongly associated with vaginal birth and can significantly affect women's quality of life. This study aimed to determine the prevalence of PFDs during the postpartum period and its impact on women's daily activities. METHODS: A hospital-based retrospective cross-sectional study was conducted among 747 primiparous women at 9-12 months postpartum, who had delivered term live baby from July to September 2021. The different components of PFD were evaluated using a Nepali translated version of PFDI-20 and the impact on sexual function by BFLUTS questionnaire. The primary outcome was women's self-reported occurrence of urinary, prolapse, defecatory and sexual problems. The impact on women's daily activities was secondary outcomes. Data were analyzed by Spearman's Rho correlation coefficient. RESULTS: Among 747 primiparous women, 194 (25.97%) had pelvic floor dysfunction. The mean age was 23.01±3.6 years, with 94 (48.45%) of PFD cases aged 20-24 years. Stress urinary incontinence was reported by 103 (53.09%), pelvic heaviness by 48 (24.74%), straining during defecation by 23 (11.86%), and dyspareunia by 54 (27.84%). Most women 137 (70.61%) reported no impact on daily life, and 18 (2.40%) were aware of pelvic floor muscle training. CONCLUSIONS: Pelvic floor dysfunction affected a notable proportion of primiparous women, with urinary, prolapse-related, colorectal, and sexual symptoms. Most affected women were young, and labour characteristics such as spontaneous onset, vaginal delivery, and shorter second stage were common.
Road Traffic Injuries, Trends, and Patterns: A Five-Year Retrospective Analysis Using Secondary Police Data in Nepal.
B C R, Khadka J, Devkota G … +3 more , Bhatt PR, Basnet P, Bhatta C
JNMA J Nepal Med Assoc · 2026 Jan · PMID 41783528 · Full text
INTRODUCTION: Road traffic accidents are a major public health concern in Nepal, causing significant morbidity and mortality. The study goal was to determine the trends of road traffic injuries in Nepal from Fiscal Years...
INTRODUCTION: Road traffic accidents are a major public health concern in Nepal, causing significant morbidity and mortality. The study goal was to determine the trends of road traffic injuries in Nepal from Fiscal Years 2020/21 to 2024/25 (mid-July 2020 - mid-July 2025). METHODS: A descriptive retrospective study was conducted to analyze de-identified and pooled road traffic accident records from Nepal, following receipt of ethical clearance from the Nepal Health Research Council (ERB no. 607_2025). Data were analyzed using Microsoft Excel 2019. RESULTS: The findings show that road traffic accidents have shown an apparent spike from FY 2020/21 to 2024/25, with both vehicle collisions and accident incidences ascended significantly. Reported vehicle crashes rose from 33135 in FY 2020/21 to 43165 in FY 2024/25, while total RTAs increased from 20640 to 28692 over the same period. RTAs surged in six provinces of Nepal. Two-wheelers, four-wheelers, and public transport vehicles accounted for the majority of incidents. Speeding 46398 (44.08%), mechanical failure 1173 (39.14%), potholes 685 (21.69%), pedestrian road crossings 5523 (79.55%), and unfavourable weather conditions like fog and mist 122 (26.23%) were major contributing factors. Although injuries increased significantly, fatality rates did not rise in same proportion. CONCLUSIONS: The results show that road traffic accidents are becoming more common in Nepal, especially involving motorbikes, four-wheelers, and public vehicles. Reducing accident rates and their effects may require increased road safety enforcement, better infrastructure, and awareness-raising initiatives.
Perceived Stress Among Medical Doctors Working in Nepal: An Observational Study.
Karki L, Karki AB, Dhakal B … +3 more , Chaudhary A, Chaudhary A, Bhusal S
JNMA J Nepal Med Assoc · 2026 Jan · PMID 41783527 · Full text
INTRODUCTION: Physician stress has been a growing critical concern worldwide, including the Nepali doctors. However, in the post-COVID-19 era, the evidence on current stress levels remains limited. METHODS: We conducted...
INTRODUCTION: Physician stress has been a growing critical concern worldwide, including the Nepali doctors. However, in the post-COVID-19 era, the evidence on current stress levels remains limited. METHODS: We conducted a cross-sectional survey between January and March 2024 among Nepal Medical Council-registered doctors working across Nepal. A web-based questionnaire including the 10-item Perceived Stress Scale (PSS-10) was used for data collection. Spearman's coefficients were used to evaluate correlations, and t-tests and ANOVA were used to compare groups. RESULTS: Among 302 medical doctors (median age 33 (IQR 28 to 41) years, 67.22% male), the mean PSS-10 score was 20.45±6.38. Overall, 43 (14.24%) had low stress, 205 (67.88%) had moderate stress, and 54 (17.88%) reported high stress. A higher PSS-10 score was associated with female gender, unmarried status, suicidal ideation/attempts, and family conflict. The PSS-10 scores of doctors in government hospitals were 21.80±6.43 and of those in teaching hospitals 18.71±6.49 (p=0.012). Compared to specialists (18.35±7.03), undergraduates and postgraduate physicians reported higher PSS-10 scores (21.61±6.15 and 20.62±6.05), and post hoc analyses confirmed significant differences (p<0.05). While social/family time was negatively correlated with PSS-10 scores (p<0.001), longer work hours were positively correlated with higher PSS-10 scores (p=0.008). CONCLUSIONS: Most participants reported moderate to high levels of stress, indicating a high prevalence of perceived stress among medical doctors in Nepal.
Prevalence of Over-the-counter use of Antibiotics among Patients visiting Outpatient Department of a Primary Health Centre: An Observational Study.
Sapkota S, Shrestha K, Prasai P … +2 more , Magar MT, Karki O
JNMA J Nepal Med Assoc · 2026 Jan · PMID 41783526 · Full text
INTRODUCTION: Antimicrobials are the most commonly used medicine. Over-the-counter use of antibiotics is more prevalent in developing countries, contributing to inappropriate use and increasing antimicrobial resistance....
INTRODUCTION: Antimicrobials are the most commonly used medicine. Over-the-counter use of antibiotics is more prevalent in developing countries, contributing to inappropriate use and increasing antimicrobial resistance. Studies regarding over the counter use of antibiotics are lacking in Nepal. The objective of this study was to determine prevalence of over the counter use of antibiotics among patients visiting primary health centre. METHODS: A descriptive cross-sectional study was conducted among 377 participants from October 2024 to February 2025 at Outpatient department of Melamchi Primary Health Centre after obtaining ethical approval from the Ethical Review Board of Nepal Health Research Centre (Reference no: 820). Written informed consent was obtained and prevalence of over-the-counter use of antibiotics was examined using a structured proforma. Data was entered into Microsoft Excel, and descriptive statistics were calculated. RESULTS: Among 377 participants, 86 (22.81%) were using over-the-counter antibiotics, of which 45 (52.32%) were male and 41 (47.67%) were female. 40 (46.51%) of those participants using over-the-counter antibiotics were older than 15 years, whereas 3 (3.48%) were less than 1 year of age. The most common presenting symptoms in these patients were related to the respiratory system 39 (45.34%). The most commonly used antibiotic was Amoxicillin plus clavulanic acid; 32 (37.20%). CONCLUSIONS: The study reported a lower prevalence of over-the-counter use of antibiotics among patients presenting to primary health centers compared to the 'WHO South-East Asia Region'.
Allergy to Ringer's Lactate - Uncommon Cause of Anaphylaxis during Intraoperative Period: A Case Report.
Dangol S, Shrestha SM, Rawal P … +5 more , Bajracharya NR, Shrestha K, Shrestha S, B K P, Paudel R
JNMA J Nepal Med Assoc · 2026 Jan · PMID 41783525 · Full text
Perioperative anaphylaxis is a rare but potentially fatal event, with an incidence ranging from 1:300 to 1:20,000 surgeries and a mortality rate of 3-9%. Its intraoperative occurrence is diagnostically challenging due to...
Perioperative anaphylaxis is a rare but potentially fatal event, with an incidence ranging from 1:300 to 1:20,000 surgeries and a mortality rate of 3-9%. Its intraoperative occurrence is diagnostically challenging due to patient sedation and overlapping drug effects. Crystalloids like Ringer's Lactate are rarely implicated. A 27-year-old American Society of Anesthesiologists grade I female undergoing mastoidectomy developed intraoperative hypotension, tachycardia, and generalized erythema after induction with standard anesthetics and Ringer's Lactate infusion. Anaphylaxis was suspected, and Ringer'Lactate was discontinued. The patient improved rapidly upon switching to normal saline. A subcutaneous challenge postoperatively confirmed Ringer's Lactate as the trigger. This case highlights an uncommon but serious hypersensitivity to Ringer's Lactate. Clinicians must maintain high suspicion for all agents, including crystalloids, during Perioperative anaphylaxis. Prompt recognition, discontinuation of the offending agent, and supportive treatment are crucial. Given the widespread use of Ringer's Lactate, awareness of this rare reaction is essential to prevent misdiagnosis and ensure patient safety.
Beyond the Textbook: A Reflective Journey Through Humanity and Community Based Medical Learning.
Shrestha S, Rimal A
JNMA J Nepal Med Assoc · 2026 Jan · PMID 41783524 · Full text
Medical education extends beyond textbooks, with experiential learning crucial to cultivate empathy, professionalism and social accountability. Our curriculum at the Patan Academy of Health Sciences includes simulations...
Medical education extends beyond textbooks, with experiential learning crucial to cultivate empathy, professionalism and social accountability. Our curriculum at the Patan Academy of Health Sciences includes simulations of being differently abled, medical humanities, communication skill development and community and rural clinical postings. Compassionate communication developed along with critical thinking and growth as a professional when interacting with elderly residents, chronic diseases patients and Female Community Health Volunteers. These reflections highlight the transformational impact of experiential learning in shaping full and competent physicians.
Management of Pressure Sore at Tertiary Care Center in Western Nepal: An Observational Study.
Giri P
JNMA J Nepal Med Assoc · 2026 Jan · PMID 41783523 · Full text
INTRODUCTION: Pressure sore are localized skin and soft tissue damage typically occurring over bony prominences due to impaired blood supply from sustained pressure. This study aims to review the clinical profile of pati...
INTRODUCTION: Pressure sore are localized skin and soft tissue damage typically occurring over bony prominences due to impaired blood supply from sustained pressure. This study aims to review the clinical profile of patients with pressure sore and the type of management of pressure sore in regional referral center of western Nepal. METHODS: This retrospective, observational study was conducted at the Department of Burns, Plastic and Reconstructive Surgery, Charak Memorial Hospital, Pokhara, from January 2023 to December 2024. Ethical approval was obtained from National Health Research Council on 16 February 2025 (Reference no:1839). The study included all patients regardless of age and gender who were treated for pressure sores during the study period, with complete medical records. Patient demographics, sore characteristics, predisposing factors, and treatment modalities were analyzed. RESULTS: There were 21 patients with 42 pressure sore wounds, included with mean age 45.14±25.54 years (range: 16-92 years). Of all patients 16 (79.19%) were male and 16 patients (76.19%) were patients from outside Pokhara Valley. Spinal cord injury was present in 12 (57.14%) patients. The sacral and trochanteric regions were affected with 14 (33.33%) wounds each. There were 26 (61.90%) wounds classified as National Pressure Ulcer Advisory Panel Stage IV. Surgical management was performed in 14 (66.67%) patients with Local flap was used to reconstruct 12 (50%) of the wounds. CONCLUSIONS: Pressure sore in this population predominantly affected middle-aged males with spinal cord injuries, presenting with advanced-stage wounds. Local pattern flap was the most common method of soft tissue coverage.
Dry Eye in Post-menopausal Women Visiting Community Eye Centre: An Observational Study.
Joshi K, Poudel M, Shrestha NM
JNMA J Nepal Med Assoc · 2025 Sep · PMID 41783429 · Full text
INTRODUCTION: Dry eye disease is one of the common disorders that may lead to severe ocular complications, visual impairment or even blindness and sometimes may be a manifestation of underlying systemic disease. Postmeno...
INTRODUCTION: Dry eye disease is one of the common disorders that may lead to severe ocular complications, visual impairment or even blindness and sometimes may be a manifestation of underlying systemic disease. Postmenopausal women are one of the most common groups to be affected by dry eye. The aim of the study was to assess the prevalence of dry eye in postmenopausal women and to describe its distribution according to age and duration of menopause. METHODS: This cross-sectional study was conducted in a community eye center in Bhaktapur from January 2022 to December 2022. The ethical clearance was obtained from Institutional review committee of Tilganga Institute of Ophthalmology (Reference no 27/2021). Detailed history and ocular examinations along with Schirmer test and Tear Film Break Up Time were performed. RESULTS: A total of 384 postmenopausal women were enrolled in the study. 276 (71.88%) patients had dry eye disease.100 (36.23%) patients belonged to 60-69 years of age group. 69 (25%) patients had mild dry eye, 112 (40.58%) patients had moderate dry eye and 95 (34.42%) patients had severe dry eye. Among 235 women with >10 years duration of menopause, 182 (77.45%) patients had dry eye. CONCLUSIONS: Dry eye is the common disorder that occurs in postmenopausal women, that is highly undiagnosed. The increase in age and duration of menopause are related to dry eye.
Cancer Antigen-125 and Carcinoembryonic Antigen in Determining Malignancy Risk in Epithelial Ovarian Tumor: An Observational Study.
Singh R, Shakya B
JNMA J Nepal Med Assoc · 2025 Sep · PMID 41783428 · Full text
INTRODUCTION: Epithelial ovarian cancers make up about 90% of ovarian malignancies and are often diagnosed late due to its vague symptoms. Cancer Antigen-125 (CA-125) and Carcinoembryonic Antigen (CEA), play a pivotal ro...
INTRODUCTION: Epithelial ovarian cancers make up about 90% of ovarian malignancies and are often diagnosed late due to its vague symptoms. Cancer Antigen-125 (CA-125) and Carcinoembryonic Antigen (CEA), play a pivotal role in differentiating benign from malignant ovarian tumors and aid in assessing malignancy risk. METHODS: The study was hospital-based cross-sectional study conducted at Paropakar Maternity and Women's Hospital among 53 women diagnosed with ovarian tumors scheduled for surgery. Data were collected between July to December 2023. Non-epithelial tumors were excluded after obtaining final histopathology report. Preoperative CA-125 and CEA levels were correlated with epithelial ovarian tumors. Data analysis was performed using Statistical Package for Social Sciences software version 29. RESULTS: Among 53 cases, 13 (33.30%) cases belonged to 40-49 years age group, while 5 (45.40%) cases of malignant tumors were in the 50-59 years age group. There were 5 (45.50%) cases of malignant tumors in women with parity two, while 11 (28.20%) cases of benign tumors in women with parity two. There were 39 (73.60%) benign cases, 3 (5.65%) borderline, and 11 (20.75%) malignant tumors. There were 36 (67.90%) serous tumors and 15 (28.30%) cases were mucinous tumors. Cancer Antigen-125 (>35 IU/mL) had high sensitivity 90.90%) and specificity (87.20%) for malignancy, while Carcinoembryonic Antigen (>3 ng/mL) had sensitivity 36.40% and high specificity 89.70% for malignancy. CONCLUSIONS: Cancer Antigen-125 showed high sensitivity and specificity in distinguishing malignant from benign epithelial ovarian tumors. Carcinoembryonic Antigen, while less sensitive, provided high specificity.
Obstructive Sleep Apnea Screening in Patients Attending Medical Outpatient Department of Tertiary Care Hospital of Kathmandu: A Cross-sectional Study.
Shrestha B, Thapa RK, Shrestha B … +2 more , Srivastav A, Rawat L
JNMA J Nepal Med Assoc · 2025 Sep · PMID 41783427 · Full text
INTRODUCTION: Obstructive sleep apnea is a common yet underrecognized condition in people marked by upper airway obstruction during sleep, causing fatigue and serious health consequences. Diagnosing obstructive sleep apn...
INTRODUCTION: Obstructive sleep apnea is a common yet underrecognized condition in people marked by upper airway obstruction during sleep, causing fatigue and serious health consequences. Diagnosing obstructive sleep apnea with polysomnography may not be feasible in resource limited-setting, place as in Nepal. Therefore, this study aims to find the prevalence of obstructive sleep apnea among patients using the STOB-BANG questionnaire as a screening tool. METHODS: A cross-sectional survey was conducted among 265 patients attending the medical outpatient department at a tertiary care hospital. The risk of OSA was assessed using a standardised questionnaire, classifying participants into low-risk (score 0-2) and intermediate-to-high risk (score 3-5) groups. A multivariate logistic model was applied to find the risk factors. RESULTS: Out of 250 patients after exclusion, 183 (73.20%) were age above 50 years and 130 (52%) were hypertensive. Based on the STOP-BANG risk score, 140 (56%; 95% CI: 49.61%-6225%) were categorized as intermediate to high risk and 110 (44%; 95% CI 37.75%-50.39% ) were categorized as low risk of obstructive sleep apnea. Age more than 50 years , male sex, hypertension and diabetes were identified as independent predictors of sleep apnea risk even after adjustment for potential confounders. CONCLUSIONS: The proportion of obstructive sleep apnea was comparably high in our study population.
Jejunojejunal Intussusception in an 11 year old: A Case Report.
Karki S, Bajracharya J, Pyakurel A … +2 more , Jaishi G, Kafle A
JNMA J Nepal Med Assoc · 2025 Sep · PMID 41783426 · Full text
Intussusception is a condition which usually occurs below the age of five. Here we present a case report of an 11 year old boy who presented with abdominal pain. Diagnosis was confirmed by Computed tomography imaging whi...
Intussusception is a condition which usually occurs below the age of five. Here we present a case report of an 11 year old boy who presented with abdominal pain. Diagnosis was confirmed by Computed tomography imaging which showed a Jejunojejunal intussusception. Conservative management was done which led to a successful outcome. This case focuses on the need for considering intussusception in differential diagnosis in patients of age group above 6 years in diagnosis of abdominal pain and obstruction.
Toward an Integrated Model of Health Sciences Academies in Nepal: Policy Rationale, Benefits, and Challenges.
Giri S
JNMA J Nepal Med Assoc · 2025 Sep · PMID 41783425 · Full text
Academies of Health Sciences have increased significantly in Nepal in the past decade to improve access to medical education and quality health services for the general public. They are established with their act. The pr...
Academies of Health Sciences have increased significantly in Nepal in the past decade to improve access to medical education and quality health services for the general public. They are established with their act. The provincial-level government also established health science academies in the past decade. They are mainly in the urban and geographically accessible regions of the country. There is a great demand for health sciences academies in areas where they do not exist. The Government of Nepal is going to establish the health science academies/ institutions according to the national priorities. This article analyzes the different views of the Integrated Health Sciences Act, commonly known as the Health Sciences Umbrella Act.
Visual Outcomes of Early Intravitreal Antibiotics and Factors Affecting Presumed Acute Endophthalmitis Post Cataract Surgery in Tertiary Eye Hospital: An Observational Study.
Rajbanshi L, Singh A, Shreflha K … +3 more , Niraula R, Luite P, Thakur S
JNMA J Nepal Med Assoc · 2025 Sep · PMID 41783424 · Full text
INTRODUCTION: Acute pofl-cataract infectious endophthalmitis is a rare yet serious complicationthat can lead to significant intraocular inflammation and potential loss of vision following cataract surgery. Early diagnosi...
INTRODUCTION: Acute pofl-cataract infectious endophthalmitis is a rare yet serious complicationthat can lead to significant intraocular inflammation and potential loss of vision following cataract surgery. Early diagnosis and prompt treatment are essential to prevent irreversible damage to photoreceptors. While the Early Vitrectomy Study (EVS) provided initial treatment guidelines, clinical approaches have since evolved. METHODS: In this observational, retrospective single-center study at Biratnagar Eye Hospital, we analyzed data from patients diagnosed with presumed endophthalmitis within six weeks of cataract surgery in 2023. All patients received intravitreal antibiotics (vancomycin and ceftazidime) and underwent tap biopsy for microbiological analysis. Data included demographics, clinical features, treatment (intravitreal antibiotics ± vitrectomy), and visual acuity (LogMAR) at baseline and 60 days. The data were recorded in Excel and analyzed using Statical Package for the Social Sciences version 29.0 (IBM Corp., Armonk, NY, USA). RESULTS: The study found that 44 (87.70%) were between 40-80 years old, with males 28 (57.14%). Symptoms appeared primarily within the firfl two weeks pofl-surgery in 31 (62%) of cases. Phacoemulsification 24 (48%) and Small Incision Cataract Surgery 26 (52%) were represented in the patient population. Out of total patients,44 (88%) of the patients received only intravitreal antibiotics. A notable improvement was observed in visual acuity with mean Log MAR values decreasing from 1.395± 0.632 on Day 1 (Snellen equivalent 6/120) to 0.441±0.553 on Day 60 (Snellen equivalent 6/15). No notable variations in visual acuity was observed in age, gender, surgical technique (phacoemulsification vs. SICS), or adjunctive dexamethasone. CONCLUSIONS: Findings suggefled that early therapeutic intervention with intravitreal antibiotics in acute pofloperative endophthalmitis may improve visual outcomes when evaluated at 60 days pofl-treatment.
Parapagus Conjoined Twin : A Case Report.
Bista KB, Ghimire S, Acharya S … +3 more , Subedi DJ, Bista M, Khatiwada P
JNMA J Nepal Med Assoc · 2025 Sep · PMID 41783423 · Full text
This case was brought to our antenatal outpatient department at Bheri Hospital as a referral case from another center. She is a 23-year-old G3P1 at 20w2d gestation with one prior abortion. In her two Ultrasonographies do...
This case was brought to our antenatal outpatient department at Bheri Hospital as a referral case from another center. She is a 23-year-old G3P1 at 20w2d gestation with one prior abortion. In her two Ultrasonographies done in a local clinic, no anomaly was detected, and she was referred for a routine anomaly scan through which conjoint parapagus twin was made. The treatment plan and outcome were discussed with the patient for a conjoined twin dicephalic parapagus type. Medical termination of pregnancy was performed, and she delivered a conjoined female of birth weight 1800 grams. This case illustrates the diagnostic and management challenges of dicephalus parapagus conjoined twins. Reporting such rare cases helps guide counseling, imaging, and individualized management in similar situations.
Achieving Universal Health Coverage and Health-Related Sustainable Developmental Goals in Nepal through Traditional, Complementary and Integrative Medicine.
Giri B, Chattu VK
JNMA J Nepal Med Assoc · 2025 Sep · PMID 41783422 · Full text
Nepal faces significant challenges in providing equitable healthcare due to limited infrastructure, high cost, and geographic barriers. Integrating Traditional, complementary and integrative medicine into the Nepalese he...
Nepal faces significant challenges in providing equitable healthcare due to limited infrastructure, high cost, and geographic barriers. Integrating Traditional, complementary and integrative medicine into the Nepalese healthcare system could address these challenges by offering affordable, culturally relevant, and holistic care. The analysis identifies both advantages, such as cost-effectiveness and cultural acceptance, and challenges, including regulation, standardization, and professional training needs. Recommendations include incorporating TCIM into primary healthcare, providing education and training for healthcare providers, establishing guidelines and regulatory frameworks, conducting research on safety and efficacy, and promoting community engagement. Integrating TCIM could strengthen healthcare delivery, reduce disparities, and support Nepal's progress toward universal health coverage and sustainable development goals.
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