JNMA; Journal Of The Nepal Medical Association[JOURNAL]
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200 papers
Spontaneous Entero-Cutaneous Fistula due to Femoral Hernia: A Case Report.
Chaudhary R, Thapa N, Magar NG … +1 more , Pandit S
JNMA J Nepal Med Assoc · 2025 Dec · PMID 41782977 · Full text
An enterocutaneous fistula is an aberrant connection between the intra-abdominal gastrointestinal tract and skin/wound. Spontaneous enterocutaneous fistula secondary to femoral hernia is extremely rare but may be life-th...
An enterocutaneous fistula is an aberrant connection between the intra-abdominal gastrointestinal tract and skin/wound. Spontaneous enterocutaneous fistula secondary to femoral hernia is extremely rare but may be life-threatening because of sepsis, malnutrition and stuid-electrolyte imbalance. We report an 83-year-old woman who presented with a short history of irreducible right groin swelling associated with feculent discharge. Contrast-enhanced computed tomography revealed a perforated distal ileal loop within a right femoral hernia, forming an enterocutaneous fistula. She underwent emergency laparotomy, segmental ileal resection with Meckel's diverticulectomy, primary ileo-ileal anastomosis and hernia repair without mesh. Her postoperative recovery was uneventful and she remains well on follow-up. This case highlights the need to consider femoral Richter's hernia with spontaneous enterocutaneous fistula in elderly women presenting with atypical groin discharge, and supports early imaging and definitive surgery to prevent morbidity.
Bridging the Diagnostic Gap: Enhancing Orthopedic Infection Management through Laboratory Diagnostics in Nepal.
Khadka RB, Parajuli S, Pahari N
JNMA J Nepal Med Assoc · 2025 Dec · PMID 41782976 · Full text
Orthopedic infections, including implant-associated infections, periprosthetic joint infections, and osteoarticular tuberculosis, pose significant diagnostic and therapeutic challenges globally. In Nepal, limited laborat...
Orthopedic infections, including implant-associated infections, periprosthetic joint infections, and osteoarticular tuberculosis, pose significant diagnostic and therapeutic challenges globally. In Nepal, limited laboratory facilities outside major cities often lead to empirical treatment, resulting in delayed diagnosis, inappropriate use of antibiotics and rising antimicrobial resistance. This viewpoint indicates the importance of integrating microbiological diagnostics into orthopedic practice in resource limited settings. It highlights key laboratory tools, outlines the barriers to their effective use, and proposes locally adaptable strategies to improve diagnostic accuracy, treatment outcomes, and antibiotic stewardship in orthopedic infection care.
Clinical Profile of Patients with Interstitial Lung Disease with Underlying Autoimmune Rheumatic Disease Presenting to a Tertiary Care Setting: A Descriptive Cross-sectional Study.
Risal UP, Pandey R, Pangeni RP
JNMA J Nepal Med Assoc · 2025 Dec · PMID 41782975 · Full text
INTRODUCTION: Interstitial lung diseases are a diverse group of disorders that display considerable overlap clinically, physiologically, and radiologically. A significant subset of these patients has autoimmune rheumatic...
INTRODUCTION: Interstitial lung diseases are a diverse group of disorders that display considerable overlap clinically, physiologically, and radiologically. A significant subset of these patients has autoimmune rheumatic diseases. This study aimed to characterize the clinical profile of patients with autoimmune rheumatic disease-related interstitial lung disease, focusing on demographic features, radiographic patterns, and treatment practices. METHODS: A descriptive cross-sectional study was conducted at the Hospital for Advanced Medicine and Surgery in Kathmandu, Nepal, from May 2022 to May 2023. Patients with interstitial lung disease confirmed by high-resolution computed tomography and a rheumatologist-verified diagnosis of autoimmune rheumatic disease were included. Demographic, clinical, laboratory, imaging, and pulmonary function data were collected and analysed. RESULTS: A total of 36 patients were included, comprising 28 (77.80%) females and 8 (22.20%) males, with a mean age of 58.92 ± 15.89 years. Rheumatoid arthritis was present in 18 (50%) cases, while undifferentiated systemic rheumatic disease was seen in 7 (19.44 %). Extrapulmonary manifestations were the initial presentation in 24 (66.7%) of cases. Usual interstitial pneumonia was identified in 22 (61.1%) patients. The mean forced vital capacity was 65.90 ± 25.38%, and the mean diffusion capacity of the lungs for carbon monoxide was 47.22 ± 23.21%. Methotrexate and hydroxychloroquine were each used by 6 (16.70%) patients, while corticosteroids were used by 11 (30.60%) patients. CONCLUSIONS: Interstitial lung disease is a significant complication of autoimmune rheumatic diseases. Early identification through regular clinical assessment and imaging is essential to prevent disease progression and improve outcomes.
Cost-Effectiveness of Community-Based Interventions for Hypertension Prevention and Management: A Protocol for Systematic Review, Meta-Analysis, and Quality Assessment.
Sagtani RA, Banstola A, Crankson S … +5 more , Ahmed S, Bajracharya S, Archana Shrestha S, Gautam G, Pokhrel S
JNMA J Nepal Med Assoc · 2025 Dec · PMID 41782974 · Full text
INTRODUCTION: Hypertension presents a global health challenge, contributing significantly to household and health system costs. While clinical effectiveness of hypertension interventions is well documented, evidence on t...
INTRODUCTION: Hypertension presents a global health challenge, contributing significantly to household and health system costs. While clinical effectiveness of hypertension interventions is well documented, evidence on the cost-effectiveness of community-based interventions remains limited. This review aims to evaluate the economic evidence of community-based interventions for hypertension prevention and management and compare cost-effectiveness estimates across diverse geographical and implementation settings. METHODS: A systematic search will be conducted across databases such as Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature Plus, American Psychological Association PsyclNFO, National Health Service Economic Evaluation Database, and Cochrane Central, covering literature up to January 2025. Grey literature and preprints will also be included. Eligible Judies will be full economic evaluations comparing two or more community-based interventions, in any language. Two reviewers will independently screen Judies using RAYYAN software. Quality assessment will be performed using validated checkMs. A meta-analysis will be undertaken contingent upon the presence of adequate homogeneity in outcomes and methodologies. DISCUSSION: This review will highlight cost-effectiveness estimates and identify methodological and subject-specific gaps in the literature which can provide comprehensive insights to inform policy decision on CBIs for HTN. While focusing on adult populations may introduce publication bias, this will be considered during interpretation. SYSTEMATIC REVIEW REGISTRATION: This review is registered under PROSPERO, Indentifier: CRD420246129.
Patterns and Factors Associated with the Length of Hospital Stay in the Psychiatry Department of a Tertiary Care Teaching Hospital in Nepal: An Observational Study.
Joshi S, Thapa M, Manandhar A … +1 more , Shakya R
JNMA J Nepal Med Assoc · 2025 Dec · PMID 41782973 · Full text
INTRODUCTION: Inpatient treatment in psychiatry is important due to several reasons, including stigma, cost, family support, admission indication, as well as availability of beds and other resources. In our setting, limi...
INTRODUCTION: Inpatient treatment in psychiatry is important due to several reasons, including stigma, cost, family support, admission indication, as well as availability of beds and other resources. In our setting, limited bed availability and challenges in inpatient services hinder the delivery of quality patient care. Therefore, information on the awareness, functionality, and needs of the inpatient services at our centre is imperative. This study aims to explore the clinicodemographic profile of psychiatric inpatients and examine their association with the length of hospital stay. METHODS: This was a retrospective cohort study of all inpatients from June 2013 to May 2017. The clinicodemographic variables were recorded as per the developed proforma. We summarized the sociodemographic and other characteristics using median and proportions. To identify the factors with a significant impact on the length of stay, we performed multiple linear regression analyses. RESULTS: Of 1085 psychiatric inpatient records available, 1034 were included. The median length of stay was 8 days (Interquartile Range, 5 to 12 days). The patients with psychotic disorders and those receiving electroconvulsive therapy were more likely to have a longer length of stay by 30% and 146%, respectively. CONCLUSIONS: The overall length of stay was relatively short. However, the presence of psychotic disorders and the use of electroconvulsive therapy were associated with prolonged hospitalization.
Mismatch Between Imaging and Histopathology Diagnosis in High and Low-Grade Gliomas: A Case Report.
Adhikari P, Miya JA, Bhandari S … +3 more , Adhikari G, Shrestha A, Tiwari N
JNMA J Nepal Med Assoc · 2025 Dec · PMID 41782972 · Full text
Oligodendrogliomas aie diffusely infiltrating gliomas classified as WHO grade 2 or 3 tumors. While typically presenting with chronic seizures, they may rarely demonstrate imaging features suggestive of high-grade maligna...
Oligodendrogliomas aie diffusely infiltrating gliomas classified as WHO grade 2 or 3 tumors. While typically presenting with chronic seizures, they may rarely demonstrate imaging features suggestive of high-grade malignancy. A 40-year-old lady with untreated seizures for one year presented with acute loss of consciousness and recurrent generalized tonic-clonic seizures. Neuroimaging (CT/MRI) revealed a left temporoparietal lesion with cystic changes and hemorrhage, suggesting high-grade glioma. Histopathological analysis following craniotomy unexpectedly demonstrated WHO Grade 2 oligodendroglioma. This case highlights significant radiologic-histopathologic discordance in glioma diagnosis, emphasizing that radiologic features of high-grade malignancy may occur in low-grade oligodendrogliomas. Tissue diagnosis with molecular profiling remains essential for accurate classification and management.
Prevalence and Antimicrobial Susceptibility of Multi-Drug Resistant Uropathogens in a Tertiary Hospital in Nepal: A One-Year Audit.
Pradhan MM, Sharma S, Poudyal S … +6 more , Gnyawali D, Adhikari S, Chapagain S, Luitel BR, Kattel HP, Chalise PR
JNMA J Nepal Med Assoc · 2025 Jul · PMID 41782724 · Full text
INTRODUCTION: Antibiotic resistance, especially multidrug resistance, poses a global public health threat. It complicates the treatment of infections like urinary tract infections, leading to treatment failure, extended...
INTRODUCTION: Antibiotic resistance, especially multidrug resistance, poses a global public health threat. It complicates the treatment of infections like urinary tract infections, leading to treatment failure, extended hospital stays, and increased healthcare costs. Empirical antibiotic therapy, guided by local resistance patterns, is crucial for patient outcomes and infection prevention. This study analyzes urine cultures from TU-Teaching Hospital from January to December 2024 to investigate the prevalence and antimicrobial susceptibility of multidrug-resistant uropathogens. METHODS: This was a retrospective, observational hospital-based study conducted in a tertiary care center after obtaining the ethical approval from Institutional Review Committee (IRC), (Reference number: 470 (6-11) E2). All samples tested fromJanuary 1, 2024, to December 31, 2024 the period included in the study. Data were collected from the Electronic health records of the Microbiology department and analyzed using Microsoft Excel 16.0.0 and SPSS 30.0.0 software to determine the urine culture positivity rate, the prevalence of multidrug-resistant uropathogens, and their antimicrobial susceptibility patterns with a specific focus on resistance to commonly prescribed antibiotics. RESULTS: A total of 25,315 urine samples were collected for urine culture and sensitivity testing during the study period. Significant bacterial growth was seen in 4,557 (18%). Multidrug resistance was seen in 3,448 (75.66%). The most frequently isolated organisms were Escherichia coli 1724 (50%), Klebsiella 154 (17.7%). and showed resistance to Ceftriaxone (74.61-92.20%), Amoxycillin+Clavulanate (67.58-97%), and Nitrofurantoin (52.29-89.55%) across selectively tested isolates. CONCLUSIONS: Urine samples demonstrated a high prevalence of multidrug resistance to routinely prescribed antibiotics, even among second-line parenterally administered antibiotics. Only costly third-line antibiotics exhibited low resistance.
Disseminated Peritoneal Hydatidosis: A Case Report.
Yadav S, Neupane P, Pathak K … +2 more , Bhattarai A, Jha UK
JNMA J Nepal Med Assoc · 2025 Jul · PMID 41782723 · Full text
Hydatid disease or echinococcosis is caused by a tapeworm of the genus Echinococcus. Several cases of hepatic hydatid cysts are reported worldwide, but disseminated peritoneal hydatidosis with spontaneous rupture of cyst...
Hydatid disease or echinococcosis is caused by a tapeworm of the genus Echinococcus. Several cases of hepatic hydatid cysts are reported worldwide, but disseminated peritoneal hydatidosis with spontaneous rupture of cysts leading to ascites is a rare entity, and only a few instances in literature can be found. We would like to report case of disseminated peritoneal hydatidosis, which was secondary to the rupture of the primary hepatic hydatid cyst. Midline laparotomy with partial pericystectomy with removal of daughter cyst and peritoneal lavage was done.
Comparative Outcomes of Doxorubicin and Cyclophosphamide with Sequential versus Concurrent Paclitaxel in the Adjuvant Treatment of Non-Metastatic Breast Cancer: A Cross-Sectional Analytical Study.
Paudel B, Paudel B, Shrestha R … +7 more , Panthi B, Shilpakar R, Dulal S, Kharel S, Dhungana R, Shrestha B, Singh YP
JNMA J Nepal Med Assoc · 2025 Jul · PMID 41782722 · Full text
INTRODUCTION: Studies have compared the efficacy and toxicities of doxorubicin and cyclophosphamide every three weeks for four cycles followed by four cycles of paclitaxel every three weeks (AC/T); with paclitaxel, doxor...
INTRODUCTION: Studies have compared the efficacy and toxicities of doxorubicin and cyclophosphamide every three weeks for four cycles followed by four cycles of paclitaxel every three weeks (AC/T); with paclitaxel, doxorubicin, and cyclophosphamide (TAC) every three weeks for six cycles for adjuvant treatment of breast cancer in western countries. Genetic and environmental disparities in Nepalese population warrant the need for similar studies in Nepal. This study compares the toxicity patterns and compliance of AC/T versus TAC in the adjuvant treatment of non-metastatic breast cancer in Nepalese women. METHODS: A hospital-based cross-sectional analytic study was conducted at Bir Hospital, Kathmandu after obtaining the ethical approval (Reference number: 931/076/077). Sixty women who completed either AC/T or TAC regimens were evaluated. Confounding was minimized by strict inclusion/ exclusion criteria (restriction), group matching, and random sampling. Primary outcome was grade 3-4 hematological toxicity; secondary outcomes included other adverse effects and compliance. RESULTS: Although hematological toxicities were higher in the TAC group, differences were not statistically significant. Non-hematological toxicities (fatigue, nausea, vomiting, pain, nail changes) were significantly higher in the TAC group. Edema was more prevalent in the AC/T group (p=0.04). Compliance without modification favored AC/T (64.5% vs. 34.5%; p=0.038). CONCLUSIONS: Sequential AC/T demonstrated superior tolerability and compliance. Confounder control through study design and statistical methods strengthens the validity of these findings, though larger studies are warranted.
Gender Differences in Service Utilization and Pattern of Free Presbyopia Glasses Distribution among Patients at Eye Camps in Nepal: A Retrospective Study.
Shah R, Mishra SK, Shankar PR … +5 more , Subedi A, Sharma P, Paudel A, Adhikari PR, Singh AK
JNMA J Nepal Med Assoc · 2025 Jul · PMID 41782721 · Full text
INTRODUCTION: Presbyopia is an age-related refractive condition that causes difficulty in seeing nearby objects clearly. It affects a significant portion of the world's population, especially individuals over 40 years ol...
INTRODUCTION: Presbyopia is an age-related refractive condition that causes difficulty in seeing nearby objects clearly. It affects a significant portion of the world's population, especially individuals over 40 years old. Many studies show variation in the utilization of eye healthcare services according to gender in resource-limited settings like Nepal. This influence access to eye care service. This study aims to investigate gender-based differences in service utilization and prescription patterns at free presbyopia camps in Nepal. METHODS: A retrospective observational study analyzed anonymized socio-demographic and clinical data of 29,943 presbyopic patients attending free eye camps organized by twenty-six NNJS eye hospitals/centers across Nepal from 2020 to 2024. Ethical approval was obtained from the Institutional Review Committee of Nepal Netra Jyoti Sangh. Data on age, gender, and spectacle prescriptions were collected to assess service utilization and gender disparities. RESULTS: Among the total presbyopic patients 15,356 (51.3%) had high presbyopia, with a slightly higher prevalence among males 8,025 (52.3%) compared to females 7,331 (47.7%). Presbyopia prevalence increased with age, peaking at 12,522 (41.8%) in those >56 years. Females had higher prevalence in younger age groups, while males predominated in older groups. CONCLUSIONS: In this study, presbyopia was common in age group >56 years with service utilisation more by male.
Prevalence of Intestinal Parasitic Infestations Among School Going Children of Shree Krishna Sanskrit Tatha Sadharan Madhaymik Vidhyalaya, Surkhet: An Observational Study.
Khadka D, Lama S, Khadka B
JNMA J Nepal Med Assoc · 2025 Jul · PMID 41782720 · Full text
INTRODUCTION: Parasitosis is a major public health concern in developing countries, significantly contributing to childhood malnutrition, anemia, stunted physical and mental growth, and social problems. This study aimed...
INTRODUCTION: Parasitosis is a major public health concern in developing countries, significantly contributing to childhood malnutrition, anemia, stunted physical and mental growth, and social problems. This study aimed to determine the prevalence of intestinal worm infestation and its associated risk factors among school going children. METHODS: A descriptive study was done among school - going children of Shree Krishna Sanskrit Tatha Sadharan Madhaymik Vidhyalaya from March 20 to May 31, 2025. A purposive (non-probability) sampling technique was employed. Prior Informed consent was obtained from participants and guardians. Data were collected using a structured, self-designed proforma. Data analysis was done using SPSS 20. RESULTS: The prevalence of intestinal parasitic infestation among school-going children in this study was 129 (52.41%; 95.00% CI: 46.00%-58.82%). Among children aged 6-9 years, the prevalence was 47 (82.45%), and among females, it was 75 (55.55%). Infestation was found in 46 (92.00%) of children who washed hands with water only after defecation and in 53 (77.94%) of those who had not taken anthelmintic medication. CONCLUSIONS: Parasitic infestations in children included in this study was higher as compared to other published study in Nepal.
Preoperative Sarcopenia in Predicting Postoperative Complications following Gastrointestinal Cancer Surgery: An Observational Study.
Maharjan N, Lakhey PJ, Pradhan S … +2 more , Kandel BP, Bhandar RS
JNMA J Nepal Med Assoc · 2025 Jul · PMID 41782719 · Full text
INTRODUCTION: Surgery is the mainstay for the management of gastrointestinal cancer patients, but it is associated with various complications. Sq identification cf pre-operative factors associated with post-operative com...
INTRODUCTION: Surgery is the mainstay for the management of gastrointestinal cancer patients, but it is associated with various complications. Sq identification cf pre-operative factors associated with post-operative complications is essential. Sarcopenia is increasingly recognized as a prognostic factor of post-operative complications following various cancer surgeries. This study aimed to determine whether precperative sarcopenia is associated with postoperative complications following gastrointestinal cancer surgery. METHODS: A prospective observational study was conducted from April 2019 to August 2020 at Tribhuvan University Teaching Hospital, Nepal. Eighty-nine patients undergoing elective curative gastrointestinal cancer surgery were included in the study. Patients less than 16 years and who did not undergo curative resections were excluded. Sarcopenia was defined using the Skeletal Muscle Index (SMI), which was measured via abdominal computed tomography imaging. Postoperative complications were graded using the Clavien-Dindo classification. Statistical analyses were performed to evaluate the associations of preoperative sarcopenia with postoperative complications using SPSS version 23. RESULTS: Among 89 patients, the mean age was 55.6±13 years, 48 (53.93%) were male, and sarcopenia was present in 36 (40.45%) patients. Clavien-Dindo ≥3 level complication occurred in 17 (47.22%) patients with sarcopenia. CONCLUSIONS: Almost half of the patient with sarcopenia developed post operative complications.
Immediate Tendon Transfer for Functional Reconstruction in Upper Limb Sarcoma Surgery: An Observational Study.
Maharjan B, Singh J, Maharjan D … +4 more , Dhungel B, Poudel RR, Sah KJ, Karki PD
JNMA J Nepal Med Assoc · 2025 Jul · PMID 41782718 · Full text
INTRODUCTION: Upper limb sarcoma surgeries often require sacrificing major nerves to achieve oncologic control, leading to significant functional loss. In low-resource settings where microsurgical reconstruction is limit...
INTRODUCTION: Upper limb sarcoma surgeries often require sacrificing major nerves to achieve oncologic control, leading to significant functional loss. In low-resource settings where microsurgical reconstruction is limited, immediate tendon transfer offers a practical solution for restoring function. This study evaluates functional outcomes following immediate tendon transfer in patients undergoing nerve-sacrificing sarcoma excision. METHODS: This multicentric observational study was conducted at four tertiary centers in Nepal: KIST Medical College and Teaching Hospital, National Trauma Centre, Bhaktapur Cancer Hospital and Nepal Cancer Hospital and Research Centre. The patients who underwent upper limb sarcoma surgery with immediate tendon transfer between January 2021 and May 2024 were included in the study. Data on demographics, tumor type, nerve involvement, surgical procedures, complications, and functional outcomes (Quick DASH, MSTS, and MRC grading) were collected and analysed using SPSS version 20. RESULTS: This study included 14 patients, with a mean age of 34.07±17.05 years. There were 9 (64.28%) male, and dominant limb involvement was recorded in 10 (71.42%) patients. Bone sarcomas were present in 3 (21.42%) patients and soft tissue sarcomas in 11 (78.57%) patients. The radial nerve was sacrificed in 8 (57.14%) patients. The mean QuickDASH score decreased from 85.17 at 6 weeks to 11.95 at 12 months. The Musculoskeletal Tumor Society score increased from 8.57 to 25.71, and Medical Research Council grading was >4 in all patients at 12 months. CONCLUSIONS: Immediate tendon transfer is an effective reconstructive strategy to restore function after nerve-sacrificing upper limb sarcoma surgery.
Medical Education Meets Modern Pedagogy: Medical Students Perspective.
Bhusal S, Poudel A
JNMA J Nepal Med Assoc · 2025 Jul · PMID 41782717 · Full text
The principles of adult learning have significantly transformed medical education, moving away from traditional lecture-based methods to a more interactive, self-directed, and problem-centered approach. This article refl...
The principles of adult learning have significantly transformed medical education, moving away from traditional lecture-based methods to a more interactive, self-directed, and problem-centered approach. This article reflects on the personal experiences of medical students steering into adult learning. Problem-Based Learning, clinical presentations, feedback methods, and innovative assessment tools were the components of this pedagogy. This helped foster critical skills such as communication, teamwork, and self-reflection. This perspective emphasizes the importance of adopting adult learning methodologies to enhance the quality of education and patient care.
Emergency Department Presentations of Chronic Kidney Disease in a Tertiary Hospital of Nepal: An Observational Study.
Neupane RP, Maharjan RK, Shrestha B … +14 more , Poudel B, Dandekhya R, Shrestha TM, Chitrakar S, Dulal AR, Malla A, Silwal A, Karki S, Pokhrel M, Thakur SK, Panthee A, Jha SK, Sah A, Bhujel B
JNMA J Nepal Med Assoc · 2025 Jul · PMID 41782716 · Full text
INTRODUCTION: Progressive chronic kidney disease is associated with complications like hypertension, anemia, mineral bone disorder, metabolic acidosis and electrolyte disorders which lead to higher morbidity, mortality a...
INTRODUCTION: Progressive chronic kidney disease is associated with complications like hypertension, anemia, mineral bone disorder, metabolic acidosis and electrolyte disorders which lead to higher morbidity, mortality and poorer quality of life. Available estimates of chronic kidney disease cases and those receiving treatment suggests an existing gap in care. Therefore, this study aims to estimate the prevalence of chronic kidney disease and its complications in the emergency department of Tribhuvan University Teaching Hospital. METHODS: A cross-sectional descriptive study was done. The participants were chronic kidney disease patients with complications visiting the Emergency Department of Maharajgunj Medical Campus. Census sampling technique was used to enroll all chronic kidney disease patients with complications meeting inclusion criteria, visiting the Emergency Department from 11 October 2023 to 19 September 2024. Ethical approval was obtained from the institutional review committee of the Institute of Medicine, Maharajgunj with the reference number 509(6-11)E2/081/082. Distribution check and descriptive analysis was done using STATA. RESULTS: The prevalence of chronic kidney disease was found to be 2.5%. The most common complications were anemia 399 (53.69%) and hypertensive crisis 396 (53.29%). Least common complications among CKD patients was sepsis 8 (1.08%). Several other complications like arrhythmia, nephropathy, hypoglycemia, obstructive uropathy, pericardial effusion, urinary tract infection, pleural effusion, pneumonia were observed in 50 (6.73%) of the CKD patients. Death as an outcome was reported in 9 (1.2%) of total patients. CONCLUSIONS: Chronic kidney disease proportion in emergency departments is high, with anemia and hypertension being common complications. Targeted interventions might include establishing hemodialysis units and increasing staff awareness.
Missed T8-T9 Translational Fracture with Intact Neurology: A Case Report.
Sharma NK, Banjade RR, Pokharel S … +1 more , Ghimire S
JNMA J Nepal Med Assoc · 2025 Jul · PMID 41782715 · Full text
Translational fracture of the thoracic spine, though rare due to its stability, is often associated with spinal cord injury and neurological deficits. Few cases present with intact neurology. We report a case of a 28-yea...
Translational fracture of the thoracic spine, though rare due to its stability, is often associated with spinal cord injury and neurological deficits. Few cases present with intact neurology. We report a case of a 28-year-old woman who, after a road traffic accident, had persistent back pain with intact neurology. The initial chest radiograph showed a subtle deformity that was missed, likely because a lateral view was not done, and the patient was discharged. Persistent back pain led to CT imaging, revealing a T8-T9 translational fracture, left 4th and 5th posterior rib fractures near the costovertebral junction, and a T7 transverse process fracture. MRI confirmed these findings. She underwent posterior instrumentation and decompression, with symptom relief, and remained asymptomatic on follow-up. Translational thoracic spine fractures, typically associated with neurological deficits, can be missed when neurology is intact. Timely imaging and intervention are crucial for optimal outcomes.
Outcomes of Finger Replantation in Western Nepal: An Observational Study.
Giri P, Shakya S
JNMA J Nepal Med Assoc · 2025 Jul · PMID 41782714 · Full text
INTRODUCTION: Hand injuries involving finger amputations prevalent in young working populations. This study evaluated the demographics and clinical outcomes of finger replantation procedures performed at a regional refer...
INTRODUCTION: Hand injuries involving finger amputations prevalent in young working populations. This study evaluated the demographics and clinical outcomes of finger replantation procedures performed at a regional referral center in Western Nepal. METHODS: This retrospective,observational, cross-sectional 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:1840). All patients who underwent finger replantation procedure with successful artery and venous flow restoration were included. Data on demographics, injury characteristics, surgical techniques, and outcomes were collected. Survival was defined as digit viability for a minimum of 21 days. Functional outcomes were assessed using the Chen functional scoring system at 6 months. RESULTS: A total of 10 finger replantation procedures were performed in 10 patients with mean age of 34.6 ±13.60 years. All patients were male and right-handed. Six (60%) patients were employed in blue-collar occupations. The thumb was commonly affected digit accounting for 6 (60%) cases. The principal mechanism of injury was crush amputation observed in 7 (70%) cases. Five (50%) replanted fingers were categorized as Tamai level III. Successful replantation was achieved in 8 (80%) fingers. Functional assessment revealed Grade I outcomes in 6 (75%) cases and Grade III in 2 (25%) cases. CONCLUSIONS: Finger replantation in a resource-limited setting achieved survival rates comparable to international standards. Success was attributed to younger patient age, shorter ischemia time, and appropriate surgical techniques.
Tracheostomy Care Knowledge among Clinical Nurses in Birat Medical College Teaching Hospital: An Observational Study.
Koirala B, Shah RK, Mahato R
JNMA J Nepal Med Assoc · 2025 Jul · PMID 41782713 · Full text
INTRODUCTION: Tracheostomy, a surgically created opening in trachea, helps to maintain the airway in any respiratory problems. Its post-operative complications reflects the need of proper postoperative care. Good tracheo...
INTRODUCTION: Tracheostomy, a surgically created opening in trachea, helps to maintain the airway in any respiratory problems. Its post-operative complications reflects the need of proper postoperative care. Good tracheostomy care knowledge helps early detection and timely management of tracheotomy related complications. Thus our study intends to assess the tracheostomy care knowledge among the clinical nurses in Birat Medical College Teaching Hospital. METHODS: This cross-sectional observational study was conducted among nurses of ICU, high care, postoperative, and ENT wards at Birat Medical College Teaching Hospital from June to September 2024. A validated 20-item true/false questionnaire assessed tracheostomy care knowledge. Data were analyzed using SPSS v21 after ethical approval and informed consent. RESULTS: Of 136 nurses, 50 (36.76%) had high knowledge, 40 (29.41%) moderate, and 46 (33.83%) low. High knowledge was found in 6 (100%) nurses with a master's degree, 35 (48%) working in ICU, and 6 (75%) with 10 to 20 years of experience. Correct responses ranged from 38 (27.94%) on tube reinsertion to 135 (99.26%) on securing tracheostomy ties. CONCLUSIONS: One-third of nurses had high tracheostomy care knowledge; higher scores were observed among ICU nurses and those with over ten years of experience.
Conjunction of ovarian dermoid cyst in a patient with Pituitary Micro Adenoma: A Case Report.
Aryal SB, Chitrakar S, Panthi A
JNMA J Nepal Med Assoc · 2025 Jul · PMID 41782712 · Full text
Pituitary adenomas are common intracranial tumors, and ovarian dermoids are frequently encountered benign gynecological lesions. While both conditions are individually prevalent, their co-existence is rare and infrequent...
Pituitary adenomas are common intracranial tumors, and ovarian dermoids are frequently encountered benign gynecological lesions. While both conditions are individually prevalent, their co-existence is rare and infrequently reported. This unusual combination may pose diagnostic challenges and warrants further exploration to determine any potential underlying link. We present a case of a 42-year-old Hindu female who was diagnosed case of a pituitary adenoma with a leftsided ovarian dermoid cyst resulting in a gynecological and hormonal imbalance. The diagnosis was confirmed by subsequent related investigations and the patient has been getting symptomatic treatment. This case underscores the importance of a comprehensive differential diagnosis in patients presenting with related symptoms and highlights the value of a multidisciplinary approach for timely diagnosis, effective management, and improved patient outcomes. Despite advancements, the relationship between elevated prolactin levels and the pathophysiology of ovarian dermoid cysts remains unclear. The synchronous occurrence of these two conditions is rare and continues to pose a diagnostic and therapeutic challenge for clinicians.
Blood Group Type and COVID-19 Severity at Tertiary Care Centre, Nepal: An Observational Study.
Rauniyar NK, Pujari LS, Manandhar R
JNMA J Nepal Med Assoc · 2025 Jul · PMID 41782711 · Full text
INTRODUCTION: The respiratory infection with COVID-19 caused by the novel coronavirus SARS-CoV-2, emerged in December 2019 and was later declared a global pandemic by the world health organization. Clinical observations...
INTRODUCTION: The respiratory infection with COVID-19 caused by the novel coronavirus SARS-CoV-2, emerged in December 2019 and was later declared a global pandemic by the world health organization. Clinical observations suggest the role of ABO blood types in susceptibility to COVID-19 infection. The study was designed to find the proportion of blood group distribution across the severity of COVID-19 patients. METHODS: This is an observational cross-section study conducted at a tertiary care hospital. All COVID-19 patient visiting hospital within January to December 2021 were included in the study. Their demographic profile, blood group and COVID-19 severity were recorded. Descriptive analysis of the date was done. RESULTS: There were 399 confirmed case of COVID-19 during study period, out of which 278 (69.7%) were male and 198 (49.62%) were aged between 21-40 years. There were 78 (31.45%) amongst mild COVID-19 and 32 (39.04%) amongst severe COVID-19 (Bilateral Pneumonia) having A positive blood group. CONCLUSIONS: The study suggests that patients with blood group A positive were more in the mild COVID-19, severe COVID-19 group.
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