Thakur P, Joshi N, Sah PK
… +4 more, Thakur M, Mandal RK, Thapa JB, Jaiswal S
JNMA J Nepal Med Assoc
· 2025 Sep · PMID 41783421
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Single fetal demise in a monochorionic diamniotic twin pregnancy poses significant risks to both mother and the surviving twin. We report a monochorionic diamniotic twin pregnancy where one fetus demised at 17 weeks, and...Single fetal demise in a monochorionic diamniotic twin pregnancy poses significant risks to both mother and the surviving twin. We report a monochorionic diamniotic twin pregnancy where one fetus demised at 17 weeks, and pregnancy was prolonged by 10 weeks with expectant management. At 28+3 weeks, an emergency cesarean section was performed for preterm premature rupture of membranes. The mother had no major complications. The surviving twin weighed 1350 grams at birth and required neonatal intensive care unit care for respiratory distress and sepsis but showed significant improvement and was discharged after two months. This case is unique due to 10-week prolongation after single intrauterine fetal death, especially with favorable maternal and neonatal outcome.
K C B, Dhakal A, Paudel S
… +4 more, B K SK, Shrestha S, Yadav P, Taksari P
JNMA J Nepal Med Assoc
· 2025 Sep · PMID 41783419
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INTRODUCTION: Intensive care units are specialized units where critically ill patients are managed with constant monitoring and advanced support. The aim of the study was to find out the outcomes of patients admitted to...INTRODUCTION: Intensive care units are specialized units where critically ill patients are managed with constant monitoring and advanced support. The aim of the study was to find out the outcomes of patients admitted to the intensive care unit at a tertiary care hospital in a province of Nepal. METHODS: This descriptive cross-sectional study was conducted at a tertiary care hospital from 1st February to 30th April, 2023. Ethical clearance was obtained from the Institutional Review Committee (Reference number: 48/079-080). Convenience sampling was used and a total of 390 patients admitted to the intensive care unit during the study period were included. Data were collected from hospital records and entered into Microsoft Excel 2016. Analysis was done using Statistical Package for the Social Sciences. Frequency and percentages were used for binary data and mean and standard deviation for continuous data. RESULTS: Out of 390 patients admitted, 230 (59.00%) were males, and 162 (41.54%) were aged 60 years or older. Respiratory system involvement was diagnosed in 92 (23.59%) patients, and hepatobiliary conditions in 74 (18.97%) patients. Discharge against medical advice occurred in 187 (47.95%) patients, 109 (27.95%) expired, and 59 (15.13%) were referred. The mean duration of intensive care unit stay was 3.15±2.88 days. CONCLUSIONS: Respiratory and hepatobiliary conditions were the most common reasons for intensive care unit admissions. A high rate of discharge against medical advice and mortality was observed compared to previous studies.
JNMA J Nepal Med Assoc
· 2025 Sep · PMID 41783418
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INTRODUCTION: Closed globe injury is a common cause of visual impairment worldwide, affecting both anterior and posterior segments of the eye. This study aimed to determine the posterior segment findings and treatment ou...INTRODUCTION: Closed globe injury is a common cause of visual impairment worldwide, affecting both anterior and posterior segments of the eye. This study aimed to determine the posterior segment findings and treatment outcomes in patients with closed globe injury at a tertiary eye care center in Nepal. METHODS: A prospective observational study was conducted on 58 patients with clinically diagnosed closed globe injury at a tertiary eye care center in Kathmandu from February 2020 to July 2021. Ethical approval was obtained from the Institutional Review Committee of the National Academy of Medical Sciences (Ref: 76/2077/078). Detailed demographic, clinical, and ocular examination findings were recorded. RESULTS: Among the 58 patients, 48 (82.76%) were males and 10 (17.24%) females, aged 18-71 years. Fist injuries were, reported in 19 (32.76%) cases, with the left eye affected in 32 (55.17%) patients. At presentation, 30 (51.72%) had normal vision, while 7 (12.07%) were blind. At 6 months, 46 (79.31%) achieved normal visual acuity, with only 1 (1.72%) remaining blind. Commotio retinae was observed in 27 (46.55%) cases of posterior segment findings. At the 6-month follow-up, 44 (75.86%) had fully recovered, while 14 (24.14%) exhibited posterior segment complications, including 4 (6.90%) with choroidal rupture and 2 (3.45%) with optic disc atrophy. CONCLUSIONS: Closed globe injury significantly contributes to visual disability, with fist injuries and commotio retinae being common. Young adults are predominantly affected. Early diagnosis and management are critical to optimize visual outcomes.
JNMA J Nepal Med Assoc
· 2025 Sep · PMID 41783417
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INTRODUCTION: Hearing impairment is a prevalent yet under-recognized condition in Nepal. Adults with hearing loss may experience stigma, social isolation, emotional distress, and reduced quality of life. Evidence from Ne...INTRODUCTION: Hearing impairment is a prevalent yet under-recognized condition in Nepal. Adults with hearing loss may experience stigma, social isolation, emotional distress, and reduced quality of life. Evidence from Nepal on the psychosocial impact of hearing impairment remains limited. This study aimed to assess hearing handicap among adults with hearing impairment. METHODS: A hospital-based, cross-sectional descriptive study was conducted among 103 adults with hearing impairment attending an Ear, Nose, and Throat department of tertiary hospital in Nepal. Data were collected using the validated Nepali version of the Hearing Handicap Inventory for Adults - Screening version, along with socio-demographic and audiological profiles. Descriptive statistics were used for analysis. RESULTS: Of 103 participants, the mean age was 45.38±20.30 (95% CI:41.46 -49.30) years. Audiological assessment revealed 69 (67.99%) had bilateral hearing impairment, 45 (43.69%) had mild hearing loss, and 42 (40.78%) had sensorineural hearing loss. Overall, 66 (64.08%) of participants reported hearing handicap, with 43 (41.75%) classified as mild-to-moderate and 23 (22.33%) as severe hearing loss. Perceived handicap was reported among 16 (80%) older adults aged 60-74 years and 35 (72.92%) males. Similarly, 4 (100%) people with profound hearing loss compared to 23 (51.11%) with mild hearing loss reported handicap. Likewise, 34 (80.95%) with sensorineural hearing loss and 57 (82.61%) with bilateral involvement reported handicap. CONCLUSIONS: Most adults with hearing impairment experience hearing-related handicap, influenced by the severity, type, and laterality of hearing loss. The majority of these individual have severe degree, sensorineural type and bilateral hearing impairment.
JNMA J Nepal Med Assoc
· 2025 Sep · PMID 41783416
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INTRODUCTION: Quality of life is a crucial dimension of overall wellbeing, particularly for frontline health workers whose roles involve high responsibility and exposure to occupational stressors. This study aimed to des...INTRODUCTION: Quality of life is a crucial dimension of overall wellbeing, particularly for frontline health workers whose roles involve high responsibility and exposure to occupational stressors. This study aimed to describe the quality of life and selected related characteristics among frontline health workers in selected federal-level government hospitals in Nepal. METHODS: A descriptive, cross-sectional study was conducted among 460 participants selected through systematic random sampling. Data were collected using the WHOQOL-BREF tool for quality of life, the PHQ-9 for depressive symptoms, the Rosenberg Self-Esteem Scale, and a work stress questionnaire. Ethical approval was obtained from the Nepal Health Research Council. RESULTS: Out of 400 respondents, 189 (48.25%) of frontline health workers reported average or low quality of life. Depressive symptoms were present in 104 (26%) of respondents, 239 (59.75%) experienced high work-related stress, and 205 (51.25%) respondents reported low self-esteem. CONCLUSIONS: The findings indicate that a considerable proportion of frontline health workers experience lower levels of quality of life, with notable burdens of stress and depressive symptoms. Workplace policies focusing on reasonable working hours, adequate staffing, and supportive environments are needed to promote well-being and job satisfaction.
Thakur L, Shrestha P, Thapa KR
… +4 more, Shrestha DK, Verma A, Khanal MN, Dhungana A
JNMA J Nepal Med Assoc
· 2025 Sep · PMID 41783415
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INTRODUCTION: The diaphragm dysfunction is being increasingly recognized in chronic respiratory diseases. Ultrasonography offers a simple, non-invasive method for assessing diaphragmatic structure and function. This stud...INTRODUCTION: The diaphragm dysfunction is being increasingly recognized in chronic respiratory diseases. Ultrasonography offers a simple, non-invasive method for assessing diaphragmatic structure and function. This study aimed to evaluate and compare diaphragm thickness and excursion in patients with Chronic Obstructive Pulmonary Disease, Interstitial Lung Disease and healthy volunteers. METHODS: A cross-sectional observational study was conducted among patients with Chronic Obstructive Pulmonary Disease, Interstitial Lung Disease and healthy controls. Diaphragm ultrasonography was performed to measure thickness at tidal expiration and tidal inspiration, maximal inspiration , thickening fraction, diaphragmatic excursion during quiet breathing, and maximal inspiration. Mean values were calculated and compared across groups. Correlations between mMRC score and FEV1 and FVC were also assessed. RESULTS: A total of 75 participants were included: 25 Chronic Obstructive Pulmonary Disease patients, Interstitial Lung Disease patients and healthy volunteers each. All the parameters on both sides were comparable. Diaphragm thickness during tidal breathing were similar across groups. Diaphragm thickness during maximal inspiration and thickening fraction were lowest in Chronic Obstructive Pulmonary Disease, intermediate in Interstitial Lung Disease, and highest in healthy controls. Diaphragmatic excursion was reduced in Chronic Obstructive Pulmonary Disease compared with Interstitial Lung Disease and controls, with similar trends in maximal inspiration. Dyspnea severity negatively correlated with FEV1 and FVC in both Chronic Obstructive Pulmonary Disease and Interstitial Lung Disease patients. CONCLUSIONS: Chronic Obstructive Pulmonary Disease patients exhibited the greatest impairment in diaphragmatic contractility and excursion, followed by Interstitial Lung Disease, taking healthy volunteers as reference. Diaphragm ultrasonography provides useful physiological insights and may serve as an adjunctive tool in assessing respiratory muscle function in chronic lung disease.
Mahaseth RK, Upadhyaya R, Panjiyar PC
… +3 more, Jha N, Singh N, Rathod R
JNMA J Nepal Med Assoc
· 2025 Sep · PMID 41783414
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INTRODUCTION: Breast cancer is a leading public health concern for women in Nepal, making early detection critically important. Nurses serve as vital patient educators, and their own knowledge, attitude, and practice reg...INTRODUCTION: Breast cancer is a leading public health concern for women in Nepal, making early detection critically important. Nurses serve as vital patient educators, and their own knowledge, attitude, and practice regarding breast self-examination are therefore essential. The study was aimed to find out the level of knowledge, attitude, and practice concerning breast self-examination among staff nurses at a tertiary care hospital. METHODS: A descriptive cross-sectional study was conducted in a tertiary care hospital in Kathmandu, Nepal from June 1st to September 30th, 2025. Ethical clearance was obtained from the Institutional Review Committee (Reference number: NMC/IRC/01/24-25). A total of 180 staff nurses were included in the study using a total enumerative sampling method. Data were collected with a pretested, self-administered questionnaire based on previous literature. Data were entered and analyzed using Statistical Package for the Social Sciences version 23.0. RESULTS: Among the 180 nurses, a good level of knowledge regarding breast selfexamination was found in 70 (38.89%) participants. A favorable attitude was seen in 74 (41.11%) nurses. Regarding practice, 133 (73.89%) participants reported performing the examination on a monthly basis. CONCLUSIONS: While a large proportion of participants reported performing BSE on a monthly basis, gaps in technical knowledge and variability in attitudes were identified. These findings highlight the coexistence of regular practice with variable knowledge and mixed perceptions among nurses.
JNMA J Nepal Med Assoc
· 2025 Dec · PMID 41782989
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Open clavicle fractures are rare, accounting for only 1.8% of all fractures. This report describes a 37 year old male with an open Gustilo Anderson grade II midshaft clavicle fracture (Robinson type 2B1) caused by a wood...Open clavicle fractures are rare, accounting for only 1.8% of all fractures. This report describes a 37 year old male with an open Gustilo Anderson grade II midshaft clavicle fracture (Robinson type 2B1) caused by a wood cutting machine. He was hemodynamically stable but had an 8*6 cm wound with exposed clavicle. Initial emergency care included tetanus prophylaxis, intravenous antibiotics, and wound debridement. Definitive fixation was performed on day four using an 8 hole anatomical locking plate with screws. Postoperatively, progressive physiotherapy led to uneventful wound healing and good functional recovery. The case emphasizes that open clavicle fractures should be managed like open long bone fractures, with timely debridement, adequate antibiotics, and early surgical fixation, but simple arm pouch sling immobilization is sufficient until definitive fixation. This report contributes to the limited literature on open clavicle fracture management and supports operative stabilization for favorable outcomes in similar injuries.
Fatmawati ID, Sutrisno R, Nugroho FA
… +3 more, Appukutty M, Chin YS, Wirawan NN
JNMA J Nepal Med Assoc
· 2025 Dec · PMID 41782988
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INTRODUCTION: Obesity and poor body composition are major contributors to chronic disease risk inadults. This review aimed to compare the effectiveness of exercise-only, diet-only, and combined interventions in improving...INTRODUCTION: Obesity and poor body composition are major contributors to chronic disease risk inadults. This review aimed to compare the effectiveness of exercise-only, diet-only, and combined interventions in improving body composition outcomes. METHODS: A systematic review and meta-analysis were conducted based on Judies published between 2016 and 2024 from Scopus, Web of Science, and ScienceDirect. Forty-six Judies involving 3,429 adults across five continents met inclusion criteria. Quality appraisal followed PRISMA and MMAT guidelines. A meta-analysis using RevMan 5.4 included six eligible Judies. RESULTS: Combined interventions resulted in the most consistent improvements in body mass index (BMI) (SMD, -1.74; 95 % CI: -3.07 to -0.40; P = .01 ), body fat percentage (%BF) (SMD, -2.40; 95 % CI: -2.91 to -1.88; P < .00001), and total body water (TBW) (SMD, 1.54; 95 % CI: 1.04 to 2.04; P < .00001). Exercise-only and diet-only approaches also improved BMI and fat mass but had limited effects on muscle mass and TBW. CONCLUSIONS: Integrated interventions combining physical activity and dietary changes are more effective than single-modality strategies. Programs of at least 12 weeks with supervision and cultural adaptation are recommended for optimal improvements in adult body composition. SYSTEMATIC REVIEW REGISTRATION: This Systematic review is registered at PROSPERO (Reference number: CRD420251020596).
Khanal S, Ojha N, Poudel A
… +4 more, Giri A, Karki H, Yadav CS, Tiwari K
JNMA J Nepal Med Assoc
· 2025 Dec · PMID 41782987
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Sacral agenesis is a rare cause of neurogenic bladder which leads to urinary incontinence, recurrent urinary tract infections, and progressive renal dysfunction. The coexistence with situs inversus adds anatomical comple...Sacral agenesis is a rare cause of neurogenic bladder which leads to urinary incontinence, recurrent urinary tract infections, and progressive renal dysfunction. The coexistence with situs inversus adds anatomical complexity, posing challenges in clinical and surgical management. We reported a case of a 23-year-old male with sacral agenesis and situs inversus presenting with incontinence and recurrent urinary tract infections. The patient was non-compliant to clean intermittent selfcatheterization. He underwent successful urinary diversion with a left-sided ileal conduit. Postoperative recovery was uneventful, with improved renal parameters and quality of life. Urinary diversion using a left-sided ileal conduit is a rare but feasible option for treatment when right-sided diversion is contraindicated. This case highlights that left-sided ileal conduit is a safe and effective option in managing neurogenic bladder in the context of sacral agenesis and situs inversus, underscoring the need for early recognition and individualized surgical planning in congenital anomalies.
JNMA J Nepal Med Assoc
· 2025 Dec · PMID 41782986
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INTRODUCTION: When parents have higher academic-related demands from their children and when children have higher household workload, academic stress occurs. Consequently, student cannot concentrate on their studies and...INTRODUCTION: When parents have higher academic-related demands from their children and when children have higher household workload, academic stress occurs. Consequently, student cannot concentrate on their studies and hamper their academic performance. Nonetheless, family support can be a vital contributor to academic success of a child. Therefore, the objective of this study was to assess the level of parental pressure, family support and household workload in high school students in rural part of Nepal. METHODS: A cross-sectional study was conducted in Thabang village of Rolpa district among 521 students of class 11 and 12 using a self-structured questionnaire based on literature reviews. The questionnaire for parental pressure had 10 items, for household workload had 6 items and for family support had 7 items. The data collection period was from June to August 2019. Ethical approval was taken from Nepal health research council (reference no. 233/2019). Descriptive statistics were reported to find out the frequency, percentage, mean, and standard deviation. RESULTS: Findings of this study showed that there was low parental pressure among 242 (46.45%) students, low family support among 240 (46.07%) students, and high household workload among 135 (25.91%) students. CONCLUSIONS: The participants had low parental pressure in academic areas as well as low family support but they had high workload of household chores. High household workload and low family support may lead to academic stress in students which can hamper academic performances of the students.
Bohara C, Rimal A, Bhandari P
… +4 more, Sapkota LP, Bastola P, Gyawali S, Atreya A
JNMA J Nepal Med Assoc
· 2025 Dec · PMID 41782985
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INTRODUCTION: Intensive care units (ICUs) play a vital role in managing critically ill patients, but mortality rates remain high, especially in resource-limited settings like Nepal. This study aimed to describe the patte...INTRODUCTION: Intensive care units (ICUs) play a vital role in managing critically ill patients, but mortality rates remain high, especially in resource-limited settings like Nepal. This study aimed to describe the patterns and clinical characteristics of mortality cases in the ICU of a tertiary care hospital in western Nepal, with specific focus on sex-based differences and their associated comorbidities. METHODS: A retrospective study was conducted at Lumbini Medical College Teaching Hospital, Nepal, over a one-year period (January 1 to December 31, 2024). This record-based study included mortality data of all ICU patients who died during their hospital stay and had complete medical records. Data on demographics, clinical parameters, comorbidities, laboratory findings, and need for mechanical ventilation were extracted using a structured proforma. RESULTS: A total of 82 (21.93%) ICU mortality cases were included out of 374 ICU admissions, consisting of 45 (54.88%) male and 37 (45.12%) female. Median age was 63 (IQR: 46-73) years in males and 70 (IQR: 58-78) years in females. There was clustering of mortality, with 13 (15.85%) deaths occuring in September and 11 (13.41%) in November. The median age of diabetic patients was 72 (IQR: 66-77) years, while the median age of non-diabetic patients was 57.50 (IQR: 44 -73.50) years. The mean systolic blood pressure in diabetic patients was 117.79±22.64 mmHg, and in non-diabetic patients was 102.35±30.20 mmHg. CONCLUSIONS: The clustering of mortality was seen during a four-month period from August through November. Male patients constituted a majority of ICU deaths due to natural causes.
Lawot I, Bajracharya K, Shrestha N
… +5 more, Singh S, Joshi DR, Adhikari J, Thapa MR, Sharma MR
JNMA J Nepal Med Assoc
· 2025 Dec · PMID 41782984
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INTRODUCTION: Any form of intimate partner violence during pregnancy can push women into critical situations. It may result in inadequate prenatal care, poor nutrition, depression, and even death, which are all preventab...INTRODUCTION: Any form of intimate partner violence during pregnancy can push women into critical situations. It may result in inadequate prenatal care, poor nutrition, depression, and even death, which are all preventable maternal outcomes. For the neonate, the effect can be low birth weight, preterm birth, and even neonatal death. Therefore, this study aims to assess the prevalence of intimate partner violence among postnatal mothers attending Health Centres. METHODS: A descriptive cross-sectional design with a probability cluster sampling technique was used for the study. The data was collected using interview schedules from 325 postnatal mothers using a modified form of the domestic violence tool from the Nepal Demographic Health Survey. RESULTS: A total of 92 (28.30%) of mothers experienced some form of violence. Specifically, 62 (19.08%) endured psychological abuse, 49 (15.08%) suffered actual physical violence, and 52 (16.00%) were victims of sexual violence. CONCLUSIONS: This study reveals a significant prevalence of intimate partner violence, with over a quarter of postnatal mothers experiencing some form of abuse. These findings highlight a critical public health issue in Nepal, indicating that a substantial number of mothers and their infants are at risk of severe health consequences due to violence from an intimate partner.
Tuladhar LR, Sharma S, Pokhrel S
… +3 more, Dhamala N, Lamichhane U, Karki S
JNMA J Nepal Med Assoc
· 2025 Dec · PMID 41782983
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INTRODUCTION: Acute poisoning and drug overdose cases are common to emergency department visits worldwide, with variation according to regional factors. In Nepal, easy availability to agricultural chemicals and locally s...INTRODUCTION: Acute poisoning and drug overdose cases are common to emergency department visits worldwide, with variation according to regional factors. In Nepal, easy availability to agricultural chemicals and locally sold toxins such as wild honey present specific toxicological challenges. This study aims to observe the patterns of poisoning and drug overdose cases in a tertiary care hospital, including the distribution of accidental and intentional self-harm cases, types of poisoning agents, demographic characteristics, and clinical outcomes. METHODS: A descriptive cross-sectional study was conducted from March 1 to November 30, 2024, at Nepal Medical College and Teaching Hospital after receiving ethical clearance (Ref. No. 41-080/081). All poisoning cases presented with acute poisoning or drug overdose during that time period were included. Data on age, gender, type of poison, and outcomes were compiled and analyzed using SPSS version 16. Descriptive statistics was applied. RESULTS: Among 215 cases, 192 (89.30)% were accidental and 23 (10.70%) were intentional self-harm. Females accounted for 102 (53.10%) of accidental poisonings and 16(69.60%) of intentional self-harm cases. A total of 104 (48.40%) patients were in the age group of 19-39 years. Insecticides were the most common agents in both accidental 65 (33.90%) and intentional 12(52.20%) cases. Wild honey poisoning made up 23 (12%) of accidental exposures, especially in older adults. Hospitalization was required in 98 (51%) of accidental and 14 (60.90%) of intentional cases. Around 89 (41.39%) of patients left against medical advice. Mortality was low 2 (1%), narrowed to accidental cases only. CONCLUSIONS: The predominance of insecticide poisoning, female vulnerability, and the concentration of cases among young adults is alarming.
Joshi R, Shrestha K, Shrestha S
… +3 more, Bajracharya S, Thapa K, Khadka S
JNMA J Nepal Med Assoc
· 2025 Dec · PMID 41782982
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INTRODUCTION: In low- and middle-income countries like Nepal, with limited resources, the oesophagogastroduodenoscopy facility may not be available widely due to its high cost and availability constraints. Most of the st...INTRODUCTION: In low- and middle-income countries like Nepal, with limited resources, the oesophagogastroduodenoscopy facility may not be available widely due to its high cost and availability constraints. Most of the studies done to predict the presence of esophageal varices in cirrhotic patients are on either serum ascites albumin gradient or platelet count to splenic diameter as the noninvasive parameter. This study aims to assess the platelet count to splenic diameter ratio and serum ascites albumin gradient as non-invasive screening parameters for esophageal varices in patients with decompensated hepatic cirrhosis and ascites. METHODS: An observational study was conducted recruiting decompensated chronic liver disease patients, aged 18 to 65 years, having no previous or recent endoscopic diagnosis of esophageal varices from June to December 2022 using a purposive sampling method. Serum ascites albumin gradient, platelet count, spleen diameter by abdominal ultrasonogram, and platelet count to splenic diameter ratio were calculated. Later upper gastrointestinal endoscopy was performed to confirm the presence of esophageal varices. RESULTS: Among 150 enrolled patients, 110 (73.33%) had esophageal varices. Of the cases of esophageal varices, 80% had high SAAG, and 68.18% had low platelet count to splenic diameter ratio. SAAG (≥ 1.1 g/dl) alone had a balanced sensitivity of 80% and specificity of 85%. CONCLUSIONS: Serum ascites albumin gradient and platelet count to splenic diameter ratio could be considered as a non-invasive screening parameter of esophageal varices in low-resource settings as a low-cost alternative.
Khwaja H, Rajan AR, Lingayat N
… +1 more, Dhasal S
JNMA J Nepal Med Assoc
· 2025 Dec · PMID 41782981
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Griscelli syndrome (GS) is an uncommon disorder characterized by partial albinism, which gives hair a silvery-grey sheen and variable immunodeficiency or neurological impairment, with pancytopenia, immune dysfunction, he...Griscelli syndrome (GS) is an uncommon disorder characterized by partial albinism, which gives hair a silvery-grey sheen and variable immunodeficiency or neurological impairment, with pancytopenia, immune dysfunction, hepatosplenomegaly, neurological impairment, hypogammaglobulinemia, and variable cellular immunodeficiency. Three variants GS1, GS2 and GS3 have been described in different phenotypes of the disease with varying presentation. We present two neonates, born two years apart, to parents with third-degree consanguinity. Both had features of partial albinism and neutropenia at birth. Microscopy of hair showed characteristic large aggregates of pigment granules dispersed irregularly along the hair shaft. Given their family history and high clinical suspicion, a diagnosis of Griscelli syndrome was made. Early diagnosis of Griscelli syndrome can offer treatment options like Bone Marrow Transplant and prevent fatal complications like hemophagocytic lymphohistiocytosis. Supportive management during transplantation comprises of antimicrobial therapy, immunoglobulin replacement, and vigilant monitoring for complications like graft versus host disease.
Bajracharya M, Maharjan SK, Shrestha D
… +1 more, Pathak C
JNMA J Nepal Med Assoc
· 2025 Dec · PMID 41782980
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INTRODUCTION: Anthropometric measurements of the external ear provide valuable normative data for applications in clinical practice, reconstructive surgery, forensics, and ergonomics. As ear morphology varies by populati...INTRODUCTION: Anthropometric measurements of the external ear provide valuable normative data for applications in clinical practice, reconstructive surgery, forensics, and ergonomics. As ear morphology varies by population, sex, and age, population-specific reference data are essential. This study aimed to determine the normal dimensions of the outer ear among adult patients. METHODS: A cross-sectional study was conducted from 8th to 28th September 2025 among 157 adult patients (82 males and 75 females) visiting the hospital with normal external ears. Standardized auricular measurements, including auricular height, auricular width, lobular height, and lobular width, were obtained bilaterally using a digital vernier caliper following established anthropometric landmarks. Data were analyzed using descriptive statistics to calculate the mean and standard deviation. RESULTS: The mean right and left auricular heights were 63.38 ± 6.19 mm and 63.13 ± 6.49 mm, respectively, while auricular widths were 33.81 ± 6.26 mm (right) and 33.82 ± 6.23 mm (left). Minimal bilateral asymmetry was observed. Males exhibited greater auricular height and width, whereas females showed marginally larger lobular dimensions. Lobular height demonstrated greater variability than width across both sexes. CONCLUSION: The study revealed strong bilateral symmetry in external ear measurements, with clear sexual dimorphism-males having larger auricular dimensions and females slightly larger lobules. This finding provide baseline data for Nepalese adults and hold relevance in forensic identification, prosthetic design, and reconstructive surgery. Further large-scale, multiethnic studies are recommended to validate and expand upon these findings.
Aryal S, Sagtani RA, Acharya T
… +1 more, Bashyal R
JNMA J Nepal Med Assoc
· 2025 Dec · PMID 41782978
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Tutors play a key role in the success of a Problem-Based Learning program. Effective training is essential to prepare them for this role. To support new faculty, Patan Academy of Health Sciences developed a comprehensive...Tutors play a key role in the success of a Problem-Based Learning program. Effective training is essential to prepare them for this role. To support new faculty, Patan Academy of Health Sciences developed a comprehensive four-phase tutor training program, which includes orientation, tutor shadowing, supervised tutoring, and supervised student assessment. Training is delivered by Patan Academy of Health Sciences faculty with formal Problem-Based Learning training and extensive facilitation experience. The program combines theoretical knowledge with hands-on practice to help tutors develop the skills needed to facilitate Problem-Based Learning effectively. Trainees are evaluated by trainer and awarded certification upon meeting competency standards. This program has enhanced the quality and success of Problem-Based Learning at Patan Academy of Health Sciences. Its effectiveness is regularly assessed using participant feedback and student assessments of tutors to ensure continuous improvement.