JNMA; Journal Of The Nepal Medical Association[JOURNAL]
Sun
200 papers
Prevalence of Low Birth Weight and Its Developmental Vulnerability Among Infants in Nepal: A Critical Review of the Literature and Future Recommendations.
Pudasainee-Kapri S
JNMA J Nepal Med Assoc · 2025 Jul · PMID 41782710 · Full text
Limited research has focused on developmental vulnerability of low birth weight (LBW) infants in Nepal. This review analyzes the prevalence and magnitude of LBW in Nepal followed by developmental vulnerabilities and the...
Limited research has focused on developmental vulnerability of low birth weight (LBW) infants in Nepal. This review analyzes the prevalence and magnitude of LBW in Nepal followed by developmental vulnerabilities and the economic impact of LBW. This is a comprehensive review of current evidence-based literature relevant to the topic. A thorough literature search was conducted across different databases and relevant websites including CINAHL, PsycINFO, Medline, PubMed, Ministry of Health and Population, WHO, UNICEF, etc. Resources cited and kept were articles written in English and dated within the last fifteen years, except for historical and context-specific relevant materials. Majority of research and programs are focused on improving the survival of LBW and preterm infants. There is limited research on developmental outcomes of LBW contributing to a lack of early monitoring, follow-up, and proper interventions. Additional research and interventions targeting parents of LBW infants are needed to reduce the negative developmental consequences of LBW. This review suggests recommendations for future research and the need for education and training among healthcare professionals to improve outcomes.
Knowledge, Attitude and Practice on Pesticide Use among Vegetable Farmers in Madhyapur Thimi Municipality, Nepal: An Observational Study.
Suwal R, Rajbhandari AK, Shrestha VL … +3 more , Bataju M, Sharma M, Khatri B
JNMA J Nepal Med Assoc · 2025 Jul · PMID 41782709 · Full text
INTRODUCTION: Pesticides are groups of toxic chemical compounds designed to use for increased productivity by killing pest. Inappropriate handling of pesticides cause risk to targeted as well as non-targeted organisms an...
INTRODUCTION: Pesticides are groups of toxic chemical compounds designed to use for increased productivity by killing pest. Inappropriate handling of pesticides cause risk to targeted as well as non-targeted organisms and also humans. Consumption of the pesticides is increasing globally and in Nepal. The study aimed to study the existing knowledge, attitude and practices of pesticides use among vegetable farmers. METHODS: A cross-sectional study was conducted among vegetable farmers who had used pesticides in the past 12 months for their farming. A household survey was conducted among 395 farmers from January to April 2023 in Madhyapur Thimi Municipality. Ethical approval was taken from the Ethical Review Board, Nepal Health Research Council (Reference number: 1696). A semi-structured questionnaire was developed from literature review and expert advices. The data was collected through face-to-face interviews. Data was analysed using descriptive statistics using SPSS 26. RESULTS: The mean age of the farm workers was 50.73±11.1 years. Of all farmers 117 (29.62%) were illiterate and 355 (89.87%) farmers received information of pesticides from friends and family. A total of 348 (88.1%) farmers had never received training on pesticide use. However, only 132 (33.41%) farmers always used to wear proper personal protective equipment in practice. Headache was the most common 57 (69.51%) health adverse symptom after pesticides application. CONCLUSIONS: Our study shows that farmers have limited knowledge about pesticides and use them in unsafe ways.
Impulsivity and Childhood Trauma Experience in Borderline Personality Disorder and Healthy Controls: A Comparative Study.
Ghimire P, Joshi S, Shakya R
JNMA J Nepal Med Assoc · 2025 Jul · PMID 41782708 · Full text
INTRODUCTION: Borderline personality disorder is a chronic psychiatric disorder characterized by pervasive patterns of affective instability, self-image disturbances, interpersonal relationship instability, marked impuls...
INTRODUCTION: Borderline personality disorder is a chronic psychiatric disorder characterized by pervasive patterns of affective instability, self-image disturbances, interpersonal relationship instability, marked impulsivity and suicidal behaviour. Impulsive trait is a major component of BPD. Another major risk factor for the development of borderline personality disorder is childhood trauma. The objective of this study was to compare childhood trauma and impulsivity in borderline personality disorder and healthy controls. METHODS: This is a hospital based cross sectional comparative study. Patients seeking treatment in inpatient and outpatient in Department of psychiatry, Patan Hospital, Lalitpur, Nepal who fulfilled the inclusion and exclusion criteria were taken. Patients were divided into two groups: BPD (n=21) and HC (n=42). Childhood trauma questionnaire-28 and Barratt Impulsivity score-11 were filled. RESULTS: The mean Barratt Impulsivity score-11 for borderline personality disorder was 76.95±11.06 and 66.42±8.92 in health controls. The observed difference was statistically significant (p=<0.001). Childhood trauma questionnaire-28 score for borderline personality disorder was 69.05±21.37 and that for healthy control was 46.43±9.27. The observed difference was statistically significant (p-value<0.05). CONCLUSIONS: In this study higher impulsivity and childhood trauma experience was observed with BPD than HC.
Methodological Challenges in Health Research during and after math of COVID-19 Pandemic Era.
Bhattarai S, Shah S, Bashyal BB … +2 more , Sunar CB, Shrestha K
JNMA J Nepal Med Assoc · 2025 Jul · PMID 41782707 · Full text
The global pandemic of COVID-19 has had an impact on health, social and economic sectors. Health research is not exempt from the current crisis and is facing many challenges. The main challenges while conducting health r...
The global pandemic of COVID-19 has had an impact on health, social and economic sectors. Health research is not exempt from the current crisis and is facing many challenges. The main challenges while conducting health research in the COVID-19 context include methodological challenges faced during data collection', 'difficulty in identifying non-verbal cues', 'time constraints' and 'ethical issues. Responding to the crisis, quantitative and qualitative research projects need some modifications to address the challenges of conducting research in the COVID-19 pandemic context. This commentary highlights the major challenges encountered while conducting research during the COVID-19 pandemic and provides ways quality research can be conducted in pandemic or other situations where physical distancing needs to be maintained.
Morphometric Study of the Nutrient Foramina in Dry Femoral Bones at Medical Campus: An Observational Study.
Shrestha A, Bhusal K, Mishra AK … +1 more , Bhandari R
JNMA J Nepal Med Assoc · 2025 Nov · PMID 41782633 · Full text
INTRODUCTION: Femur is not only the longest bone, it also plays a vital role in weight transmission and locomotion. Nutrient artery, crucial in bone remodeling and fracture healing, enters the bone via nutrient foramen....
INTRODUCTION: Femur is not only the longest bone, it also plays a vital role in weight transmission and locomotion. Nutrient artery, crucial in bone remodeling and fracture healing, enters the bone via nutrient foramen. This study investigates the anatomical characteristics of femoral nutrient foramina in Nepalese adults, driven by an increase in femur fractures amidst Nepal's challenging terrain and lifestyle, including trekking, load-carrying, and agricultural activities. We aimed to study the population specific variability in the number, size, and location of nutrient foramina. METHODS: The quantitative study analyzed 96 femurs (49 right, 47 left) from April to June 2025, sourced from the department of anatomy at Maharajgunj Medical College, Kathmandu. Tools like osteometric board, intravenous cannula and magnifying lens were used to measure femoral length, breadth and nutrient foramina location and size. Data were analysed using IBM SPSS Statistics version 21.0 (IBM Corp., Armonk, NY, USA). RESULTS: Findings revealed that 56 (58.33%) of femurs had a single nutrient foramen, while 36 (37.50%) had two. The prevalence of multiple foramina on the right side was 22 (44.89%) compared to the left 14 (29.78%). Overall, 128 foramina were recorded, where 43(33.59%) sized at 22G (0.85 mm). Importantly, over 60% of the foramina were located along the linea aspera followed by medial foramina on the right side. CONCLUSIONS: The study concludes that the majority of nutrient foramina are situated along the linea aspera, with right-sided dominance in count and size, possibly due to biomechanical factors. These insights are significant for forensic/anthropological applications, including medicolegal procedures like skeletal analysis.
Clinical Characteristics and Outcomes of Patients with Constrictive Pericarditis Following Pericardiectomy: An Observational Study.
Sharma P, Yadav L, Timilsina S … +3 more , Agrawal S, Pokhrel A, Chaudhary SK
JNMA J Nepal Med Assoc · 2025 Nov · PMID 41782632 · Full text
INTRODUCTION: Pericardiectomy remains the standard treatment in constrictive pericarditis. The study was aimed to assess the clinical characteristics, etiology and the outcome of patients who underwent pericardiectomy fo...
INTRODUCTION: Pericardiectomy remains the standard treatment in constrictive pericarditis. The study was aimed to assess the clinical characteristics, etiology and the outcome of patients who underwent pericardiectomy for chronic constrictive pericarditis. METHODS: Single center based retrospective cohort study was conducted on the patients who underwent standard pericardiectomy at our center from January 2021 to December 2023. Structured questionnaire was used to observe the record of the participants. Data was entered in Epi-data and exported to IBM SPSS Statistics version 16 for analysis. Ethical approval was obtained from Institute Review Committee, Nobel Medical College and Teaching Hospital (Ref no: 121/2024). RESULTS: The study involved 17 patients, with a mean age of 41.76±13.16 years. Male were higher in number with 12 (70.60%) of total cases. The echocardiography findings included annulus reversus, septal bounce, calcified pericardium, and congested Inferior Vena-Cava. Post-operatively, all 17 patients improved to New York Heart Association (NYHA) function class I or II (11 and 6 patients respectively) from (NYHA) functional class III or IV. The average intensive care unit stay was 3±0.7 days and hospital stay were 9.88±2.86 days. Histopathology report revealed tuberculosis in 15 (88.23%) cases. CONCLUSIONS: The most common cause of constrictive pericarditis was tuberculosis and symptomatic improvement was noticed in all patients.
First Experience of Unlocking The "MIstery" in Benign Prostatic Obstruction in Nepal: A Case Report.
Ghimire S, Adhikari MB, Maharjan B … +2 more , Gautam RK, Khadga A
JNMA J Nepal Med Assoc · 2025 Nov · PMID 41782631 · Full text
Benign prostatic obstruction is a prevalent cause of lower urinary tract symptoms in aging men, traditionally managed with medical therapy or invasive surgery. Minimally invasive surgical therapies like the UroLift® syst...
Benign prostatic obstruction is a prevalent cause of lower urinary tract symptoms in aging men, traditionally managed with medical therapy or invasive surgery. Minimally invasive surgical therapies like the UroLift® system have gained global recognition for their efficacy and safety, yet their adoption in low-resource settings has been limited. We present the first documented case of UroLift performed in Nepal on a 73 years old gentleman with persistent lower urinary tract symptoms unresponsive to dual therapy. The procedure was completed successfully without complications, resulting in significant symptom relief and rapid postoperative recovery. This milestone highlights the feasibility of introducing advanced minimally invasive surgical therapy option like UroLift in Nepal, offering a promising alternative to medicines or surgery for benign prostatic obstruction.
Quality Assessment of Antenatal Care in Public Health Facilities of Nepal's Hilly District: An Observational Study.
Bhattarai SKG, Wajih WA, Joshi SP … +1 more , Sharma B
JNMA J Nepal Med Assoc · 2025 Nov · PMID 41782630 · Full text
INTRODUCTION: Quality of antenatal care is essential for improving maternal and newborn health and plays a vital role in reducing maternal morbidity and mortality. This study aimed to assess perceptions of pregnant women...
INTRODUCTION: Quality of antenatal care is essential for improving maternal and newborn health and plays a vital role in reducing maternal morbidity and mortality. This study aimed to assess perceptions of pregnant women regarding the quality of antenatal care. METHODS: A facility-based descriptive study was conducted among 406 third trimester pregnant women using systematic random sampling. Semi-structured questionnaires were administered through face-to-face interviews in the Nepali language. Both low- and high-risk women who consented to participate were included. Ethical approval and informed consent were obtained. The data were analyzed using descriptive statistics. RESULTS: Among the 406 pregnant women, 317 (78.07%) were between 20-35 years old, 255 (62.80%) were Brahman/Chhetri, and 380 (93.59%) followed Hinduism. About 240 (59.11%) belonged to Joint families, 369 (90.88%) were literate, 237 (58.37%) engaged in agriculture, and 181 (44.58%) were primigravida women. Overall, 287 (70.69%) reported receiving good quality antenatal care. Regarding the perception of quality care during pregnancy in different aspects, good quality care related to antenatal examination was received by 312 (76.84%), antenatal care by 339 (83.49%), 213 (52.46%) received adequate counselling and education, and 289 (71.18%) were satisfied with the service provision. CONCLUSIONS: Although the majority of pregnant women received good quality care during the antenatal period, gaps remained in counselling and education. Strengthening these components is essential to improve the overall quality of antenatal care services.
Oral Ethanol for Methanol Poisoning: A Case Report.
Maharjan R, Maharjan K
JNMA J Nepal Med Assoc · 2025 Nov · PMID 41782629 · Full text
Methanol poisoning usually occurs due to accidental ingestion of distilling and fermenting errors or beverage contamination. The typical presentation includes visual disturbances with severe metabolic acidosis and neurol...
Methanol poisoning usually occurs due to accidental ingestion of distilling and fermenting errors or beverage contamination. The typical presentation includes visual disturbances with severe metabolic acidosis and neurological damage. A 32-year-old male presented with blurring of vision for 2 days, with a history of local alcohol consumption 2 days prior, with severe metabolic acidosis on arterial blood gas analysis, and was clinically diagnosed and treated as methanol poisoning in the absence of a serum methanol assay. He responded favorably to the treatment with timely oral ethanol via Nasogastric tube (56 grams, 0.8 g/kg body weight) followed by hemodialysis. His bedside visual acuity was normal, and his complaint of blurred vision subsided on the following day of treatment. This case demonstrates that timely empirical treatment based on clinical suspicion can be life-saving in methanol poisoning, even in the absence of typical diagnostic markers or access to standard antidotal therapy.
Exploring Perception of Menopausal Symptoms and Social Support Seeking Behavior among Post-menopausal Women: A Qualitative Study.
Paudel P, Thapa S, Shrestha B … +1 more , Shrestha S
JNMA J Nepal Med Assoc · 2025 Nov · PMID 41782628 · Full text
INTRODUCTION: Menopause is a natural phenomenon, however symptoms persist in many women. Geographical location and individual factors influence the perception and care-seeking behavior. There are virtually very limited s...
INTRODUCTION: Menopause is a natural phenomenon, however symptoms persist in many women. Geographical location and individual factors influence the perception and care-seeking behavior. There are virtually very limited studies exploring the perception and health seeking behavior of women in post menopause. Thus, this study aims to explore the perception of women regarding menopausal symptoms and individual, family, institutional and community level support for addressing the symptoms among post-menopausal women. METHODS: An exploratory qualitative study design was conducted among the post menopausal women with symptoms residing in Dhulikhel Municipality. In-depth interviews were taken among 14 participants following a socio-ecological framework. The recorded interviews were transcribed and analyzed using deductive inductive thematic analysis approach. RESULTS: Findings revealed the low level of awareness among women regarding knowledge and perception of menopausal symptoms. Furthermore, most of the women perceived menopause as a normal phase of life and didn't recognize the symptoms. Limited awareness, past reliance on home births, and discomfort with male doctors reduced women's use of health facilities. Community engagement varied some women shared experiences through local networks, while others avoided participation due to age, low literacy, or perceived irrelevance. CONCLUSIONS: The findings from the study highlight the need for culturally sensitive and gender-responsive interventions that strengthen health education, family involvement, community engagement, and empathetic healthcare to improve women's well-being during and after menopause.
Assessment of Food Environment in Public Facilities of Urban Municipalities in Nepal: A Baseline Study for Municipal-Level Healthy Food Procurement and Service Policy Development.
Shrestha N, Pradhananga P, Chaudhary K … +3 more , Ide N, Adhikari N, Shrestha A
JNMA J Nepal Med Assoc · 2025 Nov · PMID 41782627 · Full text
INTRODUCTION: Food environments in public facilities, particularly schools, influence dietary behaviours yet often lack healthy eating standards, particularly in low-resource contexts, contributing to the rising burden o...
INTRODUCTION: Food environments in public facilities, particularly schools, influence dietary behaviours yet often lack healthy eating standards, particularly in low-resource contexts, contributing to the rising burden of non-communicable diseases. This study assessed the current food environment in public facilities within four urban municipalities of Bagmati Province, Nepal, as a baseline survey for developing a healthy food procurement and service policy. METHODS: We conducted a cross-sectional study from May to December 2022 in 355 public facilities, including schools, healthcare facilities, and care homes. We collected data on food procurement, food availability, cooking practices, food advertisement, and hygiene through inperson interviews and observations, and analyzed using STATA 17. RESULTS: Out of 355 public facilities, 349 (98.30%) were schools. Vegetables were available as a healthy option with a median of 12 items per week (IQR: 9-16), followed by fruits 1 (IQR: 0-6) and whole grains 0 (IQR: 0-1). Among unhealthy options, refined grains were available with a median of 14 (IQR: 1021), followed by deep-fried foods 2 (IQR: 0-6) and sugar-sweetened beverages 0 (IQR: 0-1). There were 22 (6.19%) facilities with measures to limit junk food, while 95 (26.76%) had monitoring mechanisms, mainly by facility committees. CONCLUSIONS: The findings highlight a concerning imbalance in public facility canteens, where unhealthy food options are more prevalent. Facilities also have limited canteen monitoring mechanisms and initiatives for promoting a healthy food environment.
Pattern of Medico-legal Cases among Pediatric Patients Presenting to the Emergency Department of a Tertiary Care Center in Nepal: An Observational Study.
Bhujel B, Gurung M, Poudel L … +2 more , Bhandari A, Rajbhandari B
JNMA J Nepal Med Assoc · 2025 Nov · PMID 41782626 · Full text
INTRODUCTION: Pediatric medico-legal cases, encompassing injuries and other unnatural events, pose a significant public health burden, particularly in low- and middle-income countries like Nepal. Lack of comprehensive, l...
INTRODUCTION: Pediatric medico-legal cases, encompassing injuries and other unnatural events, pose a significant public health burden, particularly in low- and middle-income countries like Nepal. Lack of comprehensive, localized data on the spectrum of these cases presenting to emergency departments hinders the development of targeted prevention and management strategies. This study aimed to describe the pattern of medico-legal cases among pediatric patients at a tertiary care center in Nepal. METHODS: A retrospective cross-sectional study was conducted by reviewing the medical charts of pediatric patients (under 18 years) registered as medico-legal cases in the Emergency Department of Tribhuvan University Teaching Hospital from December 2022 to January 2023. Data on demographics, case type, and clinical details were extracted and analyzed using descriptive statistics. RESULTS: Out of 2,936 total medico-legal cases, 297 (10.11%) were pediatric cases. Based on types of incidents, there were 109 (36.70%) road traffic accidents, 68 (22.89%) suicide and self-harm, 47 (15.82%) falls, and 46 (15.49%) physical assaults. Adolescents aged 14-17 years accounted for 147 (49.49%) cases, and males accounted for 182 (61.15%) cases. There were 57 (83.8%) suicide attempts with poisoning, and 10 (52.63%) accidental poisonings with pesticides. Males accounted for 77 (70.64%) of road traffic accidents and 34 (73.91%) of physical assaults, while females accounted for 39 (57.35%) of suicide/self-harm cases. CONCLUSIONS: Road traffic accidents and suicide/self-harm are the leading causes of pediatric medico-legal presentations in this tertiary care setting. The distinct patterns observed across different age and gender groups underscore the need for targeted, evidence-based interventions in injury prevention, mental health support, and public safety to protect this vulnerable population in Nepal.
Rising Trends in Pediatric Type 2 Diabetes: A Comprehensive Bibliometric Analysis of Global Research (1998-2023).
Vaishya R, Misra A, Gupta BM … +2 more , Mamdapur GMN, Vaish A
JNMA J Nepal Med Assoc · 2025 Nov · PMID 41782625 · Full text
Pediatric Type 2 Diabetes is a growing global concern, driven by rising childhood obesity and lifestyle factors. The study aimed to analyze global publication trends, key contributors, and collaborative networks in Pedia...
Pediatric Type 2 Diabetes is a growing global concern, driven by rising childhood obesity and lifestyle factors. The study aimed to analyze global publication trends, key contributors, and collaborative networks in Pediatric Type 2 Diabetes research. A bibliometric analysis of 1,555 Scopus-indexed publications was conducted. Study types, citation metrics, and collaboration networks were evaluated. There was 20.02% annual growth (5 papers in 1998 to 99 in 2023). The USA (42%) led globally, followed by the UK, Canada, and Germany; Finland had the highest citation impact. Original research (70.6%) dominated, mainly on clinical and epidemiological themes. P. Zeitler was the most prolific author, while G. Imperatore's works were the most cited. Strong collaborations existed between the USA and the UK, with the University of Colorado Anschutz Medical Campus as the leading institution. Pediatric Type 2 Diabetes research shows rapid expansion but limited contributions from India and South Asia, highlighting a need for region-specific studies.
Immunohistochemical Expression of P16 in Cervical Lesions: An Observational Study.
Ansari SN, Kunwar R, Vaidya SA
JNMA J Nepal Med Assoc · 2025 Nov · PMID 41782624 · Full text
INTRODUCTION: Cervical cancer is the leading cancer and the predominant cause of cancer-associated deaths among women worldwide. Human papillomavirus infection is the foremost cause of cervical cancer. P16 tumor suppress...
INTRODUCTION: Cervical cancer is the leading cancer and the predominant cause of cancer-associated deaths among women worldwide. Human papillomavirus infection is the foremost cause of cervical cancer. P16 tumor suppressor protein is overexpressed in high-risk HPV infected cells. This has led to the development of P16 as a reliable predictive biomarker to identify women with cervical dysplasia who are at risk of progressing to high-grade cervical intraepithelial neoplasia and invasive cancer. The study aimed to determine the expression pattern of P16 in lesions of the cervix. METHODS: This observational study was conducted at Paropakar Maternity and Women's Hospital, Nepal, from June 2025 to August 2025. All patients who visited the Gynecology outpatient department for abnormal cervical screening were included in the study. An immunohistochemistry test for P16 was performed in histologically confirmed pre-invasive and invasive lesions. RESULTS: Of 88 cervical biopsies, 34 (38.63%) lesions were preinvasive, and 20 (22.72%) lesions were invasive. P16 immunohistochemistry was performed in 52 (59.09%) histologically confirmed dysplastic and invasive cervical lesions. Among 52 dysplastic lesions, 37 (71.15%) cases were P16-positive. Out of 37 P16-positive cases, 17 (45.95%) were preinvasive and 20 (54.05%) were invasive lesions. In pre-invasive group, 1 (10 %) were CIN1 lesion, 2 (28.57%) CIN II lesions, and 14 (93.33%) CIN III lesions were P16 positive, and among 20 invasive lesions, 20 (100%) were P16 positive. CONCLUSIONS: P16 expression was found to increase with the severity of cervical dysplasia and was positive in all invasive cervical cancer cases.
Comparison of the Efficacy of Corticosteroid Injection and Dry Needling in Treating Lateral Epicondylitis: An Observational Study.
Thapa B, Sinha R, Shrestha SKD … +5 more , Mahaseth A, Shivakotee SP, Shrestha S, Nepali M, Yadav S
JNMA J Nepal Med Assoc · 2025 Nov · PMID 41782623 · Full text
INTRODUCTION: Lateral epicondylitis is a common cause of lateral elbow pain that impairs grip strength and daily activities. While corticosteroid injection offers rapid symptom relief, dry needling is a newer, minimally...
INTRODUCTION: Lateral epicondylitis is a common cause of lateral elbow pain that impairs grip strength and daily activities. While corticosteroid injection offers rapid symptom relief, dry needling is a newer, minimally invasive technique that may enhance tendon healing and provide longer-lasting benefits. This study compared the short- and long-term efficacy of corticosteroid injection and dry needling in improving pain and function in patients with lateral epicondylitis. METHODS: This prospective comparative observational study was conducted in the Department of Orthopedics, Shree Birendra Hospital, Kathmandu, from June 2022 to July 2023 after obtaining ethical approval from the Institutional Review Committee (Registration number: 492). Sixty-two patients aged I860 years with clinically diagnosed lateral epicondylitis were consecutively assigned to receive either corticosteroid injection (n = 31) or dry needling (n = 31). Pain and function were assessed using the Patient-Rated Tennis Elbow Evaluation questionnaire at baseline, 3 weeks, and 3 months. Intergroup comparisons were made using t-tests or Mann-Whitney U tests, and intragroup differences were analyzed with paired t-tests or Wilcoxon signed-rank tests. RESULTS: Baseline characteristics were comparable. Corticosteroid injection produced greater short-term improvement at 3 weeks (pain 28.23 ± 10.27 vs 41.71 ± 8.93, p < 0.001), while dry needling showed superior outcomes at 3 months (Patient-Rated Tennis Elbow Evaluation 42.97 ± 16.32 vs 50.45 ± 15.33, p = 0.04). Both interventions achieved significant within-group improvement (p < 0.001). CONCLUSIONS: Corticosteroid injection offers faster initial pain relief, but dry needling yields better long-term functional recovery. Both are effective modalities, with dry needling preferred for sustained management of lateral epicondylitis.
Status of Antibiotic Susceptibility of Polymyxin B And Colistin in the Treatment of Carbapenem Resistant Gram Negative Bacterial Infections: An Observational Study.
Bhattarai AK, Pokharel K, Shrestha MV
JNMA J Nepal Med Assoc · 2025 Nov · PMID 41782622 · Full text
INTRODUCTION: The emergence and rapid spread of multidrug-resistant gram-negative bacteria is a global concern. Polymyxin B and Colistin have gained significance due to the scarcity of new antibiotics and the high morbid...
INTRODUCTION: The emergence and rapid spread of multidrug-resistant gram-negative bacteria is a global concern. Polymyxin B and Colistin have gained significance due to the scarcity of new antibiotics and the high morbidity and mortality associated with carbapenem-resistant gram-negative bacteria. This study aims to assess the antibiotic susceptibility of Colistin and Polymyxin B against carbapenem-resistant gram-negative bacteria. METHODS: This was a descriptive cross-sectional study conducted in a tertiary center of Nepal, from June to August 2025. Specimen resistant to any of the carbapenem drugs at the Clinical Laboratory was evaluated. The incidence of susceptibility or resistance of the Polymyxin and Colistin in the carbapenem-resistant gram-negative bacteria was recorded and assessed. RESULTS: A total of 1,412 Gram-negative bacterial samples were analyzed within the predetermined study period. Among these samples, the prevalence of 395 (27.97%) was from carbapenem-resistant Gram-negative bacteria. There were 185 (46.84%) carbapenem-resistant species, followed by 105 (26.60%) species. Both Polymyxin B and Colistin showed 100% susceptibility across all carbapenem-resistant gram-negative bacteria species and sample sources evaluated. CONCLUSIONS: Polymyxin B and Colistin continue to be vital last-line treatments for carbapenem-resistant gram-negative bacteria. This study found a susceptibility rate of 100% to colistin and polymyxin B among carbapenem-resistant gramnegative bacteria. To maintain the efficacy and reliability of these antibiotics, it is essential to use them judiciously, conduct routine susceptibility testing, and implement ongoing surveillance.
Drug Poisonings among Patients Presenting to the Emergency Department of a Tertiary Care Center in Eastern Nepal: An Observational Study.
Mandal NK, Bhandari R, Rauniyar GP … +1 more , Mandal MK
JNMA J Nepal Med Assoc · 2025 Nov · PMID 41782621 · Full text
INTRODUCTION: Drug poisoning is a major public health concern contributing to emergency visits and hospital admissions. Understanding the patterns and characteristics of drug poisoning cases is crucial for developing tar...
INTRODUCTION: Drug poisoning is a major public health concern contributing to emergency visits and hospital admissions. Understanding the patterns and characteristics of drug poisoning cases is crucial for developing targeted prevention strategies, improving early recognition, guiding appropriate clinical management, and informing public health policies to reduce morbidity and mortality. This study aimed to determine the prevalence and pattern of drug poisoning cases presenting to the Emergency Department of a tertiary care center in Eastern Nepal. METHODS: A prospective observational study was conducted in the Emergency Department of a tertiary care hospital from 1 January to 31 December 2022, after ethical approval (Ref. No: IRC/1466/018). Data from 60 eligible patients were collected using a structured proforma including socio-demographics, type and route of drug exposure, intent (accidental or suicidal), time of presentation, clinical features, management, and short-term outcomes. Descriptive statistics were used for analysis. RESULTS: Among 30,019 emergency admissions, 60 (0.20%) were due to drug poisoning, with 38 (63.33%) cases accounting for females. Intentional self-poisoning occurred in 59 (98.33%) cases, while 1 (1.67%) case was accidental. Among the reported cases, 21 (35.00%) cases involved the use of CNS depressants (benzodiazepines), 18 (30.00%) cases involved analgesics, and 2 (3.33%) cases involved antidepressant use. There were 13 (21.76%) patients who presented within six hours of ingestion and received timely supportive care. There was 1 (1.67%) case of mortality. CONCLUSIONS: Intentional self-poisoning was the predominant form of drug poisoning, mainly involving benzodiazepines and analgesics among young females. Most patients recovered with supportive management, and the case fatality rate was low.
Sociodemographic and Clinical Characteristics of Functional Constipation in Children Receiving Care at a Tertiary Hospital: An Observational Study.
Aryal N, Thapa M, Kunwar BRB … +2 more , G C B, Lamichhane K
JNMA J Nepal Med Assoc · 2025 Nov · PMID 41782620 · Full text
INTRODUCTION: Pooled global prevalence of functional constipation is 14.4% based on Rome IV criteria. The condition often arises from voluntary withholding of faeces due to fear of painful defecation leading to symptoms...
INTRODUCTION: Pooled global prevalence of functional constipation is 14.4% based on Rome IV criteria. The condition often arises from voluntary withholding of faeces due to fear of painful defecation leading to symptoms such as infrequent and painful bowel movements, faecal incontinence, retentive posturing, and urinary complications. The data on functional constipation from developing nations like Nepal remain scarce. This study aims to find out sociodemographic and clinical characteristics of functional constipation among Nepalese children thereby facilitating early diagnosis and intervention strategies to mitigate its impact. METHODS: A descriptive cross-sectional study was carried out over a six-month period, from 1st July to 30th December, 2023, at a tertiary-level hospital with sample size of 241. Children aged 1-15 years meeting the Rome IV diagnostic criteria for functional constipation were included in the study. Demographic information along with clinical history was collected and analysed using STATA13. RESULTS: Hard stools or painful bowel movements were reported in 197 (81.74%) children, stool-withholding behavior in 98 (40.66%), and fecal incontinence in 37 (16.18%). Other associated symptoms included abdominal pain in 161 (66.79%), decreased appetite in 95 (39.00%), and gastroesophageal reflux in 83 (34.44%) cases. Rectal bleeding was observed in 51 (21.16%) and urinary incontinence in 26 (10.91%) children. A family history of constipation was noted in 71 (29.46%) cases. CONCLUSIONS: Functional constipation is a prevalent paediatric gastrointestinal disorder, significantly impacting a child's quality of life. Early recognition and intervention are crucial to prevent complications and enhance outcomes.
Importance of Humanities and Compassionate Care in the Age of Artificial Intelligence.
Subedi M
JNMA J Nepal Med Assoc · 2025 Nov · PMID 41782619 · Full text
The increasing integration of artificial intelligence into healthcare presents both opportunities and challenges. Health science education has long prioritized biomedical knowledge and technical skills, emphasizing diagn...
The increasing integration of artificial intelligence into healthcare presents both opportunities and challenges. Health science education has long prioritized biomedical knowledge and technical skills, emphasizing diagnosis, procedures, and evidence-based practice. Although essential, humanistic dimensions of care continue to be marginalized in curricular design. Integrating health humanities enhances diagnostic sensitivity and emotional intelligence. Health education programs combining ethics and humanities foster moral reasoning and professional identity, reinforcing values like integrity and accountability. Creative activities like writing, art, theater, and storytelling help students reflect on clinical experiences, observe better, and grow emotionally. As AI transforms clinical practice, the ability to understand and respond to the human experience of illness remains vital. Embedding health humanities into professional training ensures ethically grounded and culturally sensitive care. The integration of AI into healthcare should be guided by medical humanities scholars to ensure that empathy remains central and technology complements compassionate care.
Quality of Life in Patients with Chronic Pancreatitis after Frey's Procedure at Tertiary Care Centre: An Observational Study.
Adhikari N, Rana G, Pandey S … +3 more , Sharma D, Bhandari RS, Lakhey PJ
JNMA J Nepal Med Assoc · 2025 Nov · PMID 41782618 · Full text
INTRODUCTION: Approximately 90% of chronic pancreatitis patients experience chronic pain severely impairing quality of life. While medical treatment is usually the first approach, many patients ultimately require surgica...
INTRODUCTION: Approximately 90% of chronic pancreatitis patients experience chronic pain severely impairing quality of life. While medical treatment is usually the first approach, many patients ultimately require surgical intervention. Frey's procedure provides technical advantages and favourable outcomes with a substantial reduction in chronic pain. This study aimed to assess its impact on pain relief and quality of life in a South Asian context. METHODS: A prospective observational follow-up study was conducted in May and June 2025 after obtaining ethical approval. This study included patients who underwent Frey's procedure for chronic pancreatitis in the Department of Surgical Gastroenterology. Quality of life was evaluated using the EORTC QLQ-C30 Version 3 questionnaire, while pain levels were assessed using the Izbicki pain score and the Visual Analogue Scale (VAS). Statistical analysis was performed using IBM SPSS version 26. RESULTS: A total of 27 cases were enrolled in the study, with a median age of 36 (IQR: 23-46)years. There were 19 (70.37%) females. Non-alcoholic chronic pancreatitis was present in 16 (59.25%) cases and alcoholic in 11 (40.75%). The average postoperative hospital stay was 8.77±2.45 days. Sixteen (59.25%) cases had no complications, and 1 (3.70%) patient experienced a major complication. Postoperative VAS scores decreased from 79.26±24.95 to median of 0 (IQR: 0-20), and the median postoperative Izbicki pain score was 2.75(IQR: 0.25-11.50). Quality of life scores were favourable across all domains, with a Global Health score of 12.89±1.19 out of 14. CONCLUSIONS: There are favourable outcomes in different domains of health improving quality-of-life in patients undergoing Frey's procedure for chronic pancreatitis with significant reduction in pain.
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