JNMA J Nepal Med Assoc
· 2025 Nov · PMID 41782617
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Airway emergencies represent some of the most time-critical and high-stress situations in emergency and critical care practice. Cricothyroidotomy, though infrequently performed, remains the definitive lifesaving procedur...Airway emergencies represent some of the most time-critical and high-stress situations in emergency and critical care practice. Cricothyroidotomy, though infrequently performed, remains the definitive lifesaving procedure when conventional airway management fails in a "cannot intubate, cannot oxygenate" (CICO) scenario. This viewpoint discusses a real-life experience of performing bougie-assisted cricothyroidotomy in a patient with tetanus-induced trismus, reviews the technical aspects of the procedure, and highlights the importance of preparedness, simulation training, and equipment readiness. Despite its rarity, the procedure's successful execution can be the difference between life and death, emphasizing the need for continuous skill maintenance among emergency and critical care professionals.
Paudel V, Gyawalee M, Amatya A
… +2 more, Kafle M, Kayastha BMM
JNMA J Nepal Med Assoc
· 2025 Apr · PMID 41769023
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Urticaria is a prevalent inflammatory skin condition significantly impacting patients' quality of life, with chronic urticaria affecting approximately 1% of the global population and 2.4% in Nepal. Despite its growing pr...Urticaria is a prevalent inflammatory skin condition significantly impacting patients' quality of life, with chronic urticaria affecting approximately 1% of the global population and 2.4% in Nepal. Despite its growing prevalence, management of urticaria in Nepal remains inconsistent due to the lack of standardized guidelines. Developing national urticaria guidelines is crucial to standardizing care, improving patient outcomes, optimizing resources, and fostering research. This process involves reviewing global best practices, adapting them to Nepal's unique healthcare context, assessing current practices, and building expert consensus. The guidelines aim to enhance diagnosis and treatment, empower patients and clinicians, and address disparities in care. Their implementation, supported by pilot testing, training, and continual updates, will ensure timely, effective, and equitable care, ultimately reducing the burden of urticaria and improving dermatological health in Nepal.
Yadav YK, Sapkota N, Jha R
… +4 more, Chand A, Pathak K, Thakur G, Kunwar S
JNMA J Nepal Med Assoc
· 2025 Apr · PMID 41769022
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INTRODUCTION: Dietary supplements are widely used by gym-goers to enhance physical appearance and performance, but their inappropriate use poses potential health risks. This study aimed to assess the patterns, motivation...INTRODUCTION: Dietary supplements are widely used by gym-goers to enhance physical appearance and performance, but their inappropriate use poses potential health risks. This study aimed to assess the patterns, motivations, and knowledge of dietary supplement use among gym users in the Lamjung District of Nepal. METHODS: This was an observational cross-section study conducted from December 16, 2020, to January 13, 2021, among 214 gym users. Data were collected using a structured questionnaire based on the Health Belief Model (HBM) framework. Descriptive statistics were used to analyze the data. RESULTS: Among 214 gym users surveyed, 70 (32.71%) reported consuming dietary supplements. Protein and amino acids were used by 49 (70%) of the supplement consumers. The primary motivation for supplement use was muscle mass enhancement 62 (88.57%), followed by increasing strength and power 46 (65.71%). Peers influenced 48 (68.57%) of users, while advertisements had minimal influence 3 (4.29%). Knowledge about supplements showed, 141 (65.89%) believing supplements could contribute to cancer and 126 (58.88%) agreeing that Nepal lacks effective quality control for these products. CONCLUSIONS: Many gym users in Nepal, mostly male students aged 23-28, take dietary supplements - mainly proteins and amino acids - to boost muscle mass, often influenced by peers. The findings reveal gym users perceive high benefits but low health risks from supplements, with peer influence outweighing expert guidance.
JNMA J Nepal Med Assoc
· 2025 Apr · PMID 41769021
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INTRODUCTION: Various factors contribute to the development of dissociative disorders. The ability to cope with different stressful events is key to symptom manifestations in this disorder. This study aims to explore var...INTRODUCTION: Various factors contribute to the development of dissociative disorders. The ability to cope with different stressful events is key to symptom manifestations in this disorder. This study aims to explore various stressors and coping strategies in patients with dissociative disorder and the relationship between coping strategies with stressors and clinicodemographic characteristics. METHODS: This was an observational cross-section study which evaluated patients with dissociative disorder presenting at the Department of Psychiatry in a tertiary care teaching hospital for 6 months (May to October 2017). We collected data on the demographic and clinical characteristics. We used the Presumptive Stressful Life Event Scale (PSLES) and Brief COPE scale to record the stressors and the coping responses, respectively. We summarized numerical variables with median and interquartile range (IQR) and categorical variables with proportions. Spearman rank correlation was run to determine the relationship between the PSLES and each coping strategy. RESULTS: Of 108 patients, 86 (79.62%) patients were studied. 77 (89.53%) patients reported stressful life events, and failure in the examination was the most common stressor. Overall, coping strategies were used minimally. Problem-focused coping strategies were used slightly more frequently. There was no statistically significant correlation between stressors and coping strategies. Only religious coping was found to have a significant correlation with age. CONCLUSIONS: The majority had stressful events. The use of coping strategies was uncommon. Problem-focused coping strategies were used more frequently.
Shah S, Sharma S, Panthi B
… +4 more, Bhandari G, Shrestha A, Chettri LP, Thakur AK
JNMA J Nepal Med Assoc
· 2025 Apr · PMID 41769020
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Osteochondromas are the most common benign bone tumors, frequently affecting the metaphysis of long bones. Their occurrence in flat bones is rare, accounting for only 5% of cases. This report presents a solitary osteocho...Osteochondromas are the most common benign bone tumors, frequently affecting the metaphysis of long bones. Their occurrence in flat bones is rare, accounting for only 5% of cases. This report presents a solitary osteochondroma of the iliac blade, a rare anatomical location. A 17-year-old male presented with a progressively enlarging, painless bony mass on the hip, associated with lower back pain. Imaging studies, including ultrasound and MRI, revealed a bony outgrowth with medullary and cortical continuity and a benign cartilage cap. The patient underwent en bloc excision biopsy under spinal anesthesia, removing the lesion along with a portion of the iliac crest. Osteochondromas in flat bones are rare, posing diagnostic challenges. While imaging provides critical diagnostic clues, histopathology remains essential for confirmation. Surgical excision is the treatment of choice for symptomatic cases. This case highlights the importance of recognizing osteochondromas in unusual locations and employing multidisciplinary approach for optimal diagnosis and management.
Malla M, Nepal R, Regmi S
… +4 more, Neupane D, Shrestha D, Bhandari S, Subedi M
JNMA J Nepal Med Assoc
· 2025 Apr · PMID 41769019
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Non-communicable diseases (NCDs), mainly cardiovascular conditions like hypertension, diabetes, and chronic kidney disease (CKD) are the major causes of morbidities and mortalities worldwide, with lower- and middle-incom...Non-communicable diseases (NCDs), mainly cardiovascular conditions like hypertension, diabetes, and chronic kidney disease (CKD) are the major causes of morbidities and mortalities worldwide, with lower- and middle-income countries (LMICs) bearing the highest burden. As the UN 25*25 targets near their final year and the Sustainable Development Goals approach their last trimester, NCD cases continue to rise, leaving a significant undiagnosed population submerged in the communities and households. In Nepal, a few initiatives have been made at the health-facility level over the past decade. However, they lack people-centric strategies and community-focused intervention with appropriate working guidelines. This article outlines the three-phase development of a community-level screening program in Kathmandu Metropolitan City, providing structured guidelines for health workers to screen and appropriately refer cases of hypertension, diabetes, and CKD, implemented during the large-scale community-based campaigns across 256 sites in Kathmandu Metropolitan in 2024.
Aryal S, Joshi M, Gupta M
… +4 more, Uprety BN, Shrestha RK, Shah P, Rajbhandari P
JNMA J Nepal Med Assoc
· 2025 Apr · PMID 41769018
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INTRODUCTION: The rising incidence of antibiotic resistance is a global threat. Monitoring antibiotic use is one of the strategies to address this issue. Intensive Care Units (ICUs) have high prevalence of antibiotic use...INTRODUCTION: The rising incidence of antibiotic resistance is a global threat. Monitoring antibiotic use is one of the strategies to address this issue. Intensive Care Units (ICUs) have high prevalence of antibiotic use and multidrug-resistant organisms. This study aims to study the status of antibiotic usage within the ICU in a tertiary care center. METHODS: An observational cross-section study was conducted from July 15, 2021 to December 20, 2021 in the adult intensive care unit and record section of a tertiary care hospital of Nepal after approval from Institutional Review Committee. Data were collected from medical records of patients admitted to the ICU from January 1, 2018 to December 31, 2020 and who received antibiotics. Data were presented in terms of days of therapy per 1000 patient days (DOT/1000PD). RESULTS: Total antibiotic consumption increased from 324.2 DOT/1000 PD in 2018 to 564.25 DOT/1000 PD in 2020. Consumption of Watch group antibiotic nearly doubled from 248.21 to 473.23 DOT/1000 PD, while Access antibiotics increased from 49.09 to 73.5 DOT/1000 PD. In contrast, Reserve group antibiotic usage declined from 26.91 to 17.49 DOT/1000 PD. In 2018, highest consumed antibiotics were piperacillin/tazobactam 57.89 (17.89%), azithromycin 53.98 (16.70%), ceftriaxone 49.58 (15.34%) and vancomycin 43.87 (13.57%) DOT/1000 PD. By 2020, their usage increased to 129.87 (23.02%), 69.38 (12.30%), 94.29 (16.71%), and 87.77 (15.55%) DOT/1000 PD respectively. CONCLUSIONS: Total antibiotic consumption increased over the years. There was a substantial rise in the use of Watch group antibiotics, particularly piperacillin/tazobactam, ceftriaxone, azithromycin, and vancomycin. Meanwhile, the use of Reserve group antibiotics declined during the same period.
Giri J, Pradhan N, Shrestha B
… +1 more, Shrestha R
JNMA J Nepal Med Assoc
· 2025 Apr · PMID 41769017
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INTRODUCTION: The term "child development" describes the changes a child goes through from birth to adulthood in terms of their physical, linguistic, cognitive, emotional, and other development. Parents, caretakers, and...INTRODUCTION: The term "child development" describes the changes a child goes through from birth to adulthood in terms of their physical, linguistic, cognitive, emotional, and other development. Parents, caretakers, and family all have an important effect on it, especially during the first two years. The study aims to translate and analyze the psychometric properties of the English version of the (Caregiver Knowledge of Child Development Inventory (CKCDI) into the Nepali version (CKCDI-N) for mothers of children under two years old. METHODS: This was a cross-section validation study carried out in Kageshwori Manohara Municipality from April 2024 to August 2024. Mothers with children under two years were randomly selected for the study. In first part tools were translated and cross-cultural adaptation was done by focused group discussion. This was followed by psychometric evaluation where Cronbach's alpha, factor analysis, and confirmatory factor analysis were used. RESULTS: The content validation indicated the use of a reliable test with a Cronbach alpha of 0.704 for developing skills and 0.705 for developmental stimulation. The original CFA model had poor fit, but the updated model had a fair fit after correlating seven error term pairs. Factor loadings were over 0.50 for every item, and the diagonal values representing AVE square roots were greater than other correlation values. CONCLUSIONS: This reliability and validity of the Nepali Version of CKCDI-N showed that every item displayed as acceptable, and the internal consistency was also satisfactory.
Bhandari PS, Adhikari S, Deo NB
… +2 more, Uprety S, Bastola P
JNMA J Nepal Med Assoc
· 2025 Apr · PMID 41769016
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INTRODUCTION: Gloves provide a physical barrier preventing cross-infection between the operating team members and the patient. However, there is always a chance of the gloves perforating and breaching this barrier. This...INTRODUCTION: Gloves provide a physical barrier preventing cross-infection between the operating team members and the patient. However, there is always a chance of the gloves perforating and breaching this barrier. This study attempts to understand the prevalence of perforation of surgical gloves in orthopedic surgery at Tribhuvan University Teaching Hospital. METHODS: This was an observational cross-sectional study carried out over three months. Gloves from the chief and first assistant surgeons were checked for visible perforation and occult perforation by water leak test. The type of surgery, hand dominance, duration of surgery, time during surgery when perforation occurred, and area of glove perforation were noted. Operative perforation rate, Overall glove perforation, and Operative perforation based on type of surgery, and duration of surgery were calculated. The categorical variables obtained were summarized with frequency and percentage. RESULTS: A total of 166 cases were included in the study. The operative perforation rate was 79 (47.59%; 95% CI: 39.80-55.47%) and the overall glove perforation was 117 (8.81%). Trauma surgery was the most common surgery performed during this study 111 (66.86%) and 56 (50.45%) of trauma surgery cases had glove perforation. Glove perforation was noticed by 25 (43.85%) of chief surgeon during surgery, out of which 11 (44%) of it was between 0.5 to 1 hour. Similarly, 20 (50%) of assistant surgeon noticed glove perforation during surgery, out of which 9 (45%) of it was between 1 to 1.5 hour after starting the surgery. CONCLUSIONS: Perforations of the surgical gloves was comparable to other published literature. Trauma surgery was the most common.
Karki U, Jha A, Parajuli S
… +3 more, Sharma A, Gurung B, Bhattarai D
JNMA J Nepal Med Assoc
· 2025 Apr · PMID 41769015
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INTRODUCTION: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with symptoms manifesting in early childhood. There is limited information regarding the clinical scenario of ASD within Nepal. The study aims...INTRODUCTION: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with symptoms manifesting in early childhood. There is limited information regarding the clinical scenario of ASD within Nepal. The study aims to determine the clinical and socio-demographic profile in children with ASD. METHODS: This was an observational cross-section study which examined the records of children diagnosed with ASD at a Mental Health Clinic in Nepal. Approval for the study was granted by NHRC. The analysis focused on data extracted from clinic records of ASD patients spanning from 16 September 2022 to 15 March 2024 encompassing one and a half years. Data were entered and analyzed using SPSS Statistics for Windows, version 16.0 (SPSS Inc., Chicago, Ill., USA). RESULTS: A total of 138 children were diagnosed with ASD, with a mean age of diagnosis at 42.94 ±17.49 months. Among the participants, there were 110 (79.69%) male, 105 (76.01%) first born with a male to female ratio of 3.9:1 and 114 (82.59% ) were going to regular school. Parents' 39 (28.29%) and relatives' 25 (18.01%) concerns were the primary reasons for seeking a diagnosis followed by referrals from pediatricians 19 (13.79%). The mean Childhood Autism Rating Scale (CARS) score of 34.33±3.99 was indicative of mild to moderate symptoms of ASD. The mean Vineland Social Maturity Scale (VSMS) score of 69.02±13.25 was indicative of mild impairment in socio-adaptive functioning. CONCLUSIONS: The study shows higher rate of ASD among males and first-born children. Early age at diagnosis is encouraging and is associated with better outcomes.
JNMA J Nepal Med Assoc
· 2025 Apr · PMID 41769014
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Axenfeld Rieger Syndrome is autosomal dominant genetic condition, which can present with various ocular and non-ocular findings. Anterior segment dysgenesis is the most common ocular finding leading to glaucoma. Non-ocul...Axenfeld Rieger Syndrome is autosomal dominant genetic condition, which can present with various ocular and non-ocular findings. Anterior segment dysgenesis is the most common ocular finding leading to glaucoma. Non-ocular findings include craniofacial abnormalities, cardiac, dental as well as neurological problems. Mutations in PITX2 and FOXC1 genes have been associated with this condition. FOXC1 mutation causes more ocular findings where as PITX2 mutation has been linked with ocular as well as craniofacial abnormalities. Racial or gender predilection has not been suggested by any literature. Vision loss in these patients is mainly due to uncontrolled glaucoma which needs to be diagnosed and treated urgently.
Sharma P, Singh S, Parajuli A
… +2 more, Dhungel O, Pathak P
JNMA J Nepal Med Assoc
· 2025 Apr · PMID 41769013
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INTRODUCTION: Depression is a common mental disorder associated with considerable degree of burden. This review aimed to examine the prevalence of depression and associated factors in the Nepalese general population. MET...INTRODUCTION: Depression is a common mental disorder associated with considerable degree of burden. This review aimed to examine the prevalence of depression and associated factors in the Nepalese general population. METHODS: The databases Medline (PubMed), Embase, Scopus, Web of Science and NepJOL were searched for identification of peer-reviewed studies reporting the prevalence of depression among non-clinical populations in Nepal along with Google Scholar and citation search. Meta-analysis was conducted using random-effects model to calculate the pooled prevalence estimates. A qualitative synthesis of factors associated with depression was performed. RESULTS: A total of 64 studies comprising a total of 57,553 participants were included. Overall, the pooled prevalence among adult population was 13.75% (95% CI:10.84% to 16.65%). For other population subgroups: 27.49% (95% CI: 17.99% to 32.21%) in children and adolescents, 50.07% (95% CI: 32.82% to 67.33%) in geriatric population, 19.96% (95% CI: 18.00% to 21.91%) in maternal population. There was high degree of heterogeneity (I2 = 99.32). Depression was associated with distinct individual attributes and behaviors, socio-economic circumstances and environmental factors. CONCLUSIONS: Approximately one-seventh of the adult population was found to have depression. There were notable variations in the prevalence and associated factors of depression across different population subgroups.
Banjade RR, Dhakal S, Nepal P
… +1 more, Sharma NK
JNMA J Nepal Med Assoc
· 2025 Apr · PMID 41769012
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Legg-Calvé-Perthes disease is a childhood condition characterized by avascular necrosis of the femoral head, with a poorer prognosis in children over 8 years. This case report describes a 10-year-old boy presenting with...Legg-Calvé-Perthes disease is a childhood condition characterized by avascular necrosis of the femoral head, with a poorer prognosis in children over 8 years. This case report describes a 10-year-old boy presenting with persistent left thigh pain, limp, and limited hip motion following a fall 3 months earlier. Imaging revealed osteonecrosis of the left femoral head with degenerative changes. Despite surgical intervention being the standard for late-onset LCPD, the patient was managed conservatively using bilateral skin traction and a Petrie's cast due to financial constraints. Follow-up monthly for 6 months showed significant improvement, highlighting conservative treatment's potential in resource-limited settings.
Pradhan M, Singh P, Ranjan A
… +2 more, Joshi U, Chhetri P
JNMA J Nepal Med Assoc
· 2025 Apr · PMID 41769011
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INTRODUCTION: Primary mandibular molars have diverse morphological variations. This trait of human dentition is very important for restoring the anatomy of the tooth as well as for the anthropological study to characteri...INTRODUCTION: Primary mandibular molars have diverse morphological variations. This trait of human dentition is very important for restoring the anatomy of the tooth as well as for the anthropological study to characterize the ethnicity. Anatomical landmarks like the cusp, groove and ridges vary even among same species. The study was aimed to assess the number of cusps and occlusal grooves in primary mandibular molars of children. METHODS: An observational cross-section study was conducted among pediatric patients in the Outpatient Dental Department of a tertiary care center from October 2023 to March 2024. Fully erupted primary mandibular molars in children aged 3-6 years were included. Intraoral examination of the patient were performed using Gregory WK criteria. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. RESULTS: Among 303 patients, the study showed 118 (38.94%) left and 106 (34.98%) right primary mandibular first molar had four cusps and a 'Y' groove pattern. Among the 303 subjects, male 58 (34.12%) were having a 4Y pattern followed by 46 (27.06%) 4X pattern, while in 48 (36.09%) 4Y pattern followed by 45 (33.83%) 4X pattern was seen. CONCLUSIONS: The result in present study showed Y groove pattern in occlusal surface of primary mandibular molars with four cusps that can be related with conservative pattern of deciduous molar in context of Nepali population.
Panthee R, Upadhyay M, Agrawal A
… +2 more, Mishra R, Rana P
JNMA J Nepal Med Assoc
· 2025 Apr · PMID 41769010
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This is an extremely rare case of concomitant hypo-hyperdontia with mandibular mesiodens. Concomitant hypo-hyperdontia (CHH) refers to the presence of hypo and hyperdontia in the same patient. Supernumerary teeth may lea...This is an extremely rare case of concomitant hypo-hyperdontia with mandibular mesiodens. Concomitant hypo-hyperdontia (CHH) refers to the presence of hypo and hyperdontia in the same patient. Supernumerary teeth may lead to difficulties such as delayed or ectopic eruption of permanent teeth, spacing, malocclusion, cystic lesions, and retained deciduous teeth. The present study describes an unusual case of an eleven-year-old girl with CHH and a medical history of hyperthyroidism. The Cone Beam Computed Topography (CBCT) results revealed thirty-one permanent teeth with a missing mandibular left lateral incisor, eleven deciduous teeth, and eight unerupted supernumerary teeth (four in the maxilla and four in the mandible). This study aims to outline the etiology, complications, diagnosis, and multidisciplinary approach for the management of a case of supernumerary teeth.
JNMA J Nepal Med Assoc
· 2025 Apr · PMID 41769008
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INTRODUCTION: Chronic kidney disease is emerging public health problems globally. Hemodialysis is the commonest treatment modality but it causes some complications and fluctuation in parameters. This study aimed to asses...INTRODUCTION: Chronic kidney disease is emerging public health problems globally. Hemodialysis is the commonest treatment modality but it causes some complications and fluctuation in parameters. This study aimed to assess the clinical profile and complications experienced by chronic kidney disease patients undergoing hemodialysis. METHODS: This was an observational study conducted from December, 2023 to February, 2024 Patients aged 20 and above, receiving hemodialysis more than three months were included in the study. Descriptive analysis was done. RESULTS: Among 110 CKD patients undergoing hemodialysis, 62 (56.36%) were 50 years of age or younger, with a mean 48.76±13.365. The study population included 66 (60%) male and mean age of the patients was 48.76±13.36. In this study group 90 (81.82%) had two session of dialysis per week. Mean Pre-HD systolic blood pressure was 150.64±23.95 mmHg and Post-HD was 147.64±24.38 mmHg. In this study the mean hemoglobin was 9.38±1.85 gm/dl, glucose was 110.85±46.62 mg/dl, urea 91.81±37.73 mg/dl and creatinine 7.94±2.68 mg/dl. In the patient population undergoing dialysis oliguria was observed in 106 (96.36%), weakness 98 (89.09%) and insomnia was observed in 87 (79.09%. CONCLUSIONS: In this study, more than half of the patient were in the age group of less than or equal to 50 years. Common complications included reduced urine output, weakness, and insomnia. Hypertension was the most common underlying condition, often occurring with diabetes.
Shrestha R, Adil MA, Gautam S
… +5 more, Ray P, Raut RJ, Shrestha D, Chand P, Bista P
JNMA J Nepal Med Assoc
· 2025 Jun · PMID 41768819
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Sacrococcygeal teratoma is a rare tumour of the coccyx that contains tissues from ectoderm, mesoderm and endoderm. It has a female preponderance with an incidence of 1 in 40,000 live births. Its prognosis depends on the...Sacrococcygeal teratoma is a rare tumour of the coccyx that contains tissues from ectoderm, mesoderm and endoderm. It has a female preponderance with an incidence of 1 in 40,000 live births. Its prognosis depends on the tumour size, weight, APGAR scores, age at presentation, intraoperative injury and malignant potential. We report a case of Sacrococcygeal teratoma in a female neonate of birth weight 3.37 kgs, born to a 34 years primigravida. The tumour comprised about 1/3rd of the body weight which created hemodynamic challenges to the new-born. Successful surgical management of the tumour was done with a multidisciplinary team approach.
JNMA J Nepal Med Assoc
· 2025 Jun · PMID 41768818
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INTRODUCTION: The Circle of Willis (CoW) is a crucial cerebral arterial network, and its anatomical variations may influence cerebrovascular health. This study aimed to determine the prevalence and patterns of CoW varian...INTRODUCTION: The Circle of Willis (CoW) is a crucial cerebral arterial network, and its anatomical variations may influence cerebrovascular health. This study aimed to determine the prevalence and patterns of CoW variants using 3 Tesla magnetic resonance angiography. METHODS: This retrospective cross-sectional study was conducted at the Department of Radiology, of a tertiary care center, Nepal, from October 2022 to September 2024 following ethical approval (IRC- 16/2024). Inclusion required adequate 3T MRI imaging using a TOF MRA protocol. (TR 20 ms, TE 3.5 ms, flip angle 15°, slice thickness 0.5 mm). Patients with cerebrovascular disease, prior interventions, or contraindications were excluded. Circle of Willis morphology was analyzed for prevalence, variants, and age/gender correlations using SPSS and Excel. RESULTS: The study included 384 participants of which 206 (53.65%) were male. The mean age was 59.20 ± 16.30 years. A complete Circle of Willis (COW) was observed in 139 (36.19%), while 220 (57.39%) were incomplete. Anterior anomalies 126 (32.81%) primarily consisted of hypoplasia, 95 (75.40%) right A1 dominance and absence 24 (19.05%). Posterior variants 345 (89.84%) involved hypoplasia 155 (44.93%) or absence 189 (54.78%) of the posterior communicating artery, with fetal PCA origin in 121 (31.51%). CONCLUSIONS: This study found common Circle of Willis variations, especially in older adults. Hypoplasia of the posterior communicating artery was the most frequent variation, with differences observed by gender.
Koirala E, Deo GP, Adhikari S
… +2 more, Gauli B, Bajracharya A
JNMA J Nepal Med Assoc
· 2025 Jun · PMID 41768817
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INTRODUCTION: Dengue fever poses a significant public health challenge in Nepal, with increasing severe cases requiring intensive care. Limited data exist on the clinical profile and outcomes of critically ill dengue pat...INTRODUCTION: Dengue fever poses a significant public health challenge in Nepal, with increasing severe cases requiring intensive care. Limited data exist on the clinical profile and outcomes of critically ill dengue patients in resource-limited settings. This study is aimed to characterize the clinical features, outcomes and complications of dengue patients admitted to a tertiary Intensive care unit in Nepal. METHODS: A prospective observational study was conducted at from August to September 2024 after ethical approval. We enrolled 104 serologically confirmed dengue patients (aged ≥16 years) admitted to the Medical Intensive care unit. Exclusion criteria included co-infections with other tropical diseases. Data on demographics, clinical presentation, laboratory parameters (including platelet counts, liver enzymes), organ dysfunction (SOFA score), and outcomes were collected. Descriptive data analysis was used to report frequency, proportion, measure of central tendency and measure of dispersion based on nature of data. RESULTS: The cohort (median age 41 years, 54.8% male) exhibited severe manifestations: thrombocytopenia (median platelets count 49,000/μL; IQR: 30,250-85,000 per μL), hepatic injury 86 (82.7%); median AST 176.5 U/L, ALT 208.5 U/L), and moderate organ dysfunction (median SOFA score 4). Hypertension 27 (25.96%) and diabetes 23 (22.12%) were common comorbidities. Despite 22 (21.2%) developing multi-organ dysfunction syndrome, mortality was remarkably low 1 (0.96%). CONCLUSIONS: Dengue fever cases peak during the month of August and September in endemic areas (Chitwan and surrounding district). Mortality could be reduced in severe dengue with appropriate critical care, highlighting the need to strengthen ICU capacity in endemic regions.