JNMA; Journal Of The Nepal Medical Association[JOURNAL]
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200 papers
Prevalence of Gingival Recession in the Nepalese Population Visiting Tertiary Care Hospital.
Rijal AH, Napit R, Chhetri PM … +6 more , Pandey S, Poudel S, Ghimire P, Adhikari B, Lamichhane S, Humagain M
JNMA J Nepal Med Assoc · 2025 Jun · PMID 41768816 · Full text
INTRODUCTION: Gingival recession is the exposure of root surface by an apical shift in the position of the gingiva. Exposure of the tooth surface leads to caries of the root surface, abrasion, erosion, sensitivity, esthe...
INTRODUCTION: Gingival recession is the exposure of root surface by an apical shift in the position of the gingiva. Exposure of the tooth surface leads to caries of the root surface, abrasion, erosion, sensitivity, esthetic concern and interproximal plaque accumulation. So, the objective of the present study was to find out the prevalence of recession in Nepalese population and its etiological factors. METHODS: A descriptive cross-sectional study was conducted among 350 participants for a period of December 2023 to February 2024 at Department of Periodontology and Oral Implantology, Dhulikhel Hospital after obtaining ethical approval from Institutional Review Committee (Reference no: 229/23). Written informed consent was obtained and gingival recession and its associated factors were examined using well-formed proforma. Data were entered into Microsoft excel and descriptive statistics were reported. RESULTS: Out of a total of 350 participants, the prevalence of gingival recession was found to be 170 (48.56%, 95% CI = 43.33-53.73%). Among the participants, 177 (50.57%) were male, with 86 (48.58%) having gingival recession, while 84 (48.55%) of the remaining female participants had gingival recession. In the 40-49 years age group, 62 (72.09%) individuals had gingival recession. Gingival recession was observed in 48 (64.87%) participants with poor oral hygiene, 31 (67.39%) using a hard toothbrush, 22 (61.12%) with a history of prosthodontic treatment, 7 (70%) with subgingival restorations, and 3 (100%) with papillary penetrating frenal attachment. CONCLUSIONS: The study reported a high prevalence of gingival recession among sample Nepali adult population compared to other studies and there were multiple etiologies associated with it.
Validation of Nepali Version of the University of Washington Quality of Life Questionnaire for Head and Neck Cancer Patients.
Paudel D, Karki AB, Parajuli B
JNMA J Nepal Med Assoc · 2025 Jun · PMID 41768815 · Full text
INTRODUCTION: Quality of Life encompasses physical, functional, emotional, and social well-being, often assessed via self-reported questionnaires. The University of Washington Quality of Life instrument, designed for Hea...
INTRODUCTION: Quality of Life encompasses physical, functional, emotional, and social well-being, often assessed via self-reported questionnaires. The University of Washington Quality of Life instrument, designed for Head and Neck Cancer patients, is a validated, concise, and practical tool widely used in clinical settings. The objective of the study was to translate and assess the content and face validity of the Nepali version of the University of Washington Quality of Life Questionnaire version 4.1-N and evaluate its psychometric properties in head and neck cancer patients. METHODS: A prospective study was conducted at BP Koirala Institute of Health Sciences and BP Memorial Cancer Hospital, enrolling 203 patients. The study was conducted in two phases. In the first phase, we translated the original questionnaire into Nepali and validated its face and content validity. In the second phase, we assessed its internal consistency, reliability, construct, and discriminant validity in Head and Neck Cancer patients. RESULTS: The University of Washington Quality of Life Questionnaire version 4.1-N demonstrated strong internal consistency (Cronbach's α = 0.87), and excellent test-retest reliability and stability (r = 0.93). A strong correlation (r > 0.50) was observed between similar domains of the University of Washington Quality of Life Questionnaire version 4.1-N and EORTC QLQ-C30 and HN355. UWQOL composite scores demonstrated a strong correlation with all domains of global questions at admission, as well as after 3 and 6 months of treatment (p < 0.01). CONCLUSIONS: The Nepali version of University of Washington Quality of Life Questionnaire version 4.1-N is a valid and reliable instrument to assess the quality of life of head and neck cancer patients patients in Nepal.
Clinical Characteristics and Outcomes of Patients Managed with Percutaneous Dilatational Tracheostomy in the Intensive Care Unit: A Retrospective Observational Study.
Pradhan UL, Karki B, Paneru HR … +3 more , Shrestha PS, Shrestha GS, Acharya SP
JNMA J Nepal Med Assoc · 2025 Jun · PMID 41768814 · Full text
INTRODUCTION: Percutaneous dilatational tracheostomy (PDT) has emerged as a preferred minimally invasive alternative to surgical tracheostomy for critically ill patients requiring prolonged mechanical ventilation, though...
INTRODUCTION: Percutaneous dilatational tracheostomy (PDT) has emerged as a preferred minimally invasive alternative to surgical tracheostomy for critically ill patients requiring prolonged mechanical ventilation, though comprehensive data from Nepal remains limited. This study aimed to evaluate the practice of PDT and analyze clinical outcomes in a tertiary level ICU in Nepal. METHODS: A retrospective observational study was conducted at Level III ICUs Nepal from April 14, 2021 to April 12, 2024. All patients aged 18 and older who underwent percutaneous dilatational tracheostomy during ICU stay in the study duration were included. Ethical approval for the study was obtained from the institutional review committee [Ref. 583. (6-11) E2]. Data on clinical characteristics, procedural techniques, complications, and outcomes were collected from electronic records and individual file records from hospital record department. RESULTS: The study population comprised predominantly males 53 (63.86%) with a median age of 49 (IQR: 30-62) years. Neurological disorders, particularly intracranial haemorrhage, were the most common admission diagnosis 53 (63.86%). The mean duration from mechanical ventilation to PDT was 16 (IQR: 11-20) days and the main indication was prolonged mechanical ventilation 62 (74.7%). Grigg's guidewire dilator forceps technique was used 77 (92.77%) of the time. Immediate complications occurred in 12 (14.46%) of cases. The hospital survival rate was 42 (50.6%) with 69 % of survivors achieving decannulation before discharge. CONCLUSIONS: PDT is a safe bedside procedure for critically ill patients needing prolonged ventilation, with only minor, non-life-threatening complications observed in our tertiary care setting.
Comparative Effectiveness of Omeprazole and Lansoprazole in Gastroesophageal Reflux Disease (GERD): A Review Article.
Gustinanda R, Zulkarnain F, Permatasari M … +1 more , Farciana AC
JNMA J Nepal Med Assoc · 2025 Jun · PMID 41768813 · Full text
This review discusses the use of Omeprazole and Lansoprazole as therapy in patients with Gastroesophageal Reflux Disease (GERD). GERD is a digestive tract disorder caused by repeated reflux of stomach contents into the e...
This review discusses the use of Omeprazole and Lansoprazole as therapy in patients with Gastroesophageal Reflux Disease (GERD). GERD is a digestive tract disorder caused by repeated reflux of stomach contents into the esophagus. GERD is often characterized by symptoms of a burning and burning chest (heartburn). The most widely used pharmacological therapy to treat GERD is Proton Pump Inhibitor (PPI) drugs, such as Omeprazole and Lansoprazole with a working mechanism that inhibits the proton pump that H+ ions exit from the gastric parietal cells. The method used in writing this article review is an electronic literature study by accessing national and international journal search sites. The results obtained are based on effectiveness, Omeprazole is more effective and faster in reducing and maintaining gastric acid pH. Based on the adverse effects of the drug, Omeprazole has a lower potential risk of causing diarrhea. Omeprazole has the most minimal cost analysis when viewed from the cost aspect and Omeprazole has a faster onset than Lansoprazole.
Clinical and Demographic Profile of Patients Undergoing Surgery for Chronic Subdural Hematoma at a Tertiary Care Hospital in Nepal: An Observational Study.
Raut R, Karki H, Shrestha D … +4 more , Chapagain D, Jha JB, Regmi S, Bista P
JNMA J Nepal Med Assoc · 2025 Jun · PMID 41768812 · Full text
INTRODUCTION: Chronic subdural hematoma is increasingly common in aging populations and presents with a wide range of presentations. Despite its rising incidence, there is a lack of clinical and demographic characterizat...
INTRODUCTION: Chronic subdural hematoma is increasingly common in aging populations and presents with a wide range of presentations. Despite its rising incidence, there is a lack of clinical and demographic characterization of chornic subdural hematoma in the Nepali population. This study aimed to describe the demographic and clinical characteristics of chornic subdural hematoma patients. METHODS: A retrospective observational cross-sectional study was conducted in the Department of Neurosurgery of a tertiary care center. Data were retrospectively collected from all patients who underwent surgery for chornic subdural hematoma between March 2022 and March 2024. Variables such as age, sex, clinical presentation, risk factors, length of hospital stay, and in-hospital mortality were recorded. Data were entered into Microsoft Excel and analyzed using the Statistical Package for Social Sciences software 16.0. RESULTS: Among 52 patients, 39 (75%) were male. The mean age of patients was 63.10±14.72 years (95% CI: 59.00-67.21), with 34 (65.38%) patients aged over 60 years. The median length of hospital stay was 7 days (IQR: 6-8 days). Twenty-five (48.08%) patients had a history of head trauma, followed by 15 (28.85%) with chronic alcohol use. Motor weakness, altered mental status, and headache were common clinical manifestations, presenting in 27 (51.92%), 18 (34.62%), and 15 (28.85%) patients, respectively. There were 4 (7.69%) recurrences and 3 (5.77%) deaths following surgery for chornic subdural hematoma. CONCLUSIONS: Chornic subdural hematoma was more common among elderly male, especially those with a history of head trauma and chronic alcohol use. Motor weakness and unilateral hematomas were common findings.
Misdiagnosis of a Term Abdominal Ectopic Pregnancy: A Case Report.
Bista KB, Pariyar R, Poudel A … +2 more , Yadav KK, Ghimire S
JNMA J Nepal Med Assoc · 2025 Jun · PMID 41768811 · Full text
Abdominal ectopic pregnancy is a rare and life-threatening condition, often misdiagnosed due to its nonspecific clinical presentation and imaging challenges. We present a case of a 20-year-old primigravida at 39+6 weeks...
Abdominal ectopic pregnancy is a rare and life-threatening condition, often misdiagnosed due to its nonspecific clinical presentation and imaging challenges. We present a case of a 20-year-old primigravida at 39+6 weeks of gestation that was initially misdiagnosed as complete placenta previa with transverse lie and was only identified as abdominal ectopic pregnancy intraoperatively. An emergency cesarean section was planned for suspected placenta previa, during which an intact amniotic sac was found in the peritoneal cavity, with placental attachment to the greater omentum, left ovary, and fallopian tube for which cesarean section was converted to the laparotomy. The baby was live at birth but succumbed to respiratory distress on the third day of life. A multidisciplinary team helped in optimizing maternal outcomes. Early recognition, appropriate imaging, and surgical expertise are essential to reduce morbidity and mortality.
Considerations on the Management of Zinc Phosphide Toxicity and Proposed Therapeutic Approaches.
Faress F, Jodaki K, Abdolkarimi L … +2 more , Nasrabadi ZN, Marashi SM
JNMA J Nepal Med Assoc · 2025 Jun · PMID 41768810 · Full text
Zinc phosphide (ZnP) is a rodenticide commonly used in agriculture for pest control, but it can cause acute human poisoning, through ingestion in suicide attempts. The toxicokinetics of ZnP are not well understood, altho...
Zinc phosphide (ZnP) is a rodenticide commonly used in agriculture for pest control, but it can cause acute human poisoning, through ingestion in suicide attempts. The toxicokinetics of ZnP are not well understood, although it is believed that its primary mechanism of toxicity involves the inhibition of Complex IV of Cytochrome C Oxidase, similar to aluminum phosphide (ALP) poisoning. However, there are notable differences between the two. The rarity of acute ZnP toxicity and the misconception that it mirrors ALP poisoning have hindered the development of effective treatment strategies. This review critically examines the challenges of existing treatment protocols and proposes new approaches based on current evidence. A thorough literature review on the management of ZnP and ALP poisoning was conducted. Due to the delayed onset of symptoms in ZnP poisoning, aggressive gastrointestinal decontamination is recommended prior to toxin absorption. Furthermore, the potential for acute liver failure in early ZnP cases requires targeted treatment for hepatic injury. Since systemic absorption of phosphine can produce effects similar to ALP poisoning, existing ALP treatment protocols may also aid in managing ZnP toxicity. This study proposes a treatment protocol for ZnP poisoning, emphasizing the need for further randomized trials to validate its effectiveness.
Contextual Adaptation, Translation, and Validation of the Affiliate Stigma Scale among Primary Caregivers of Children with Physical Disabilities in Nepal: An Observational Study.
Banskota B, Bhatta D, Bhusal R … +2 more , Yadav PK, Banskota AK
JNMA J Nepal Med Assoc · 2025 Jun · PMID 41768809 · Full text
INTRODUCTION: The experience of affiliate stigma can cause psychosocial problems among caregivers of children with physical disabilities, seriously affecting children's care and rehabilitation. To measure this stigma, we...
INTRODUCTION: The experience of affiliate stigma can cause psychosocial problems among caregivers of children with physical disabilities, seriously affecting children's care and rehabilitation. To measure this stigma, we aimed to adapt and validate the widely accepted Affiliate Stigma Scale in the Nepali language. METHODS: This study was conducted among 220 primary caregivers of children with physical disabilities, who presented at the Hospital and Rehabilitation Centre for Disabled Children, Nepal, from April to June 2024. The original tool was adapted, translated, followed by experts' reviews, and pretesting. The final Nepali version was then administered among conveniently selected participants through face-to-face interviews. Data analyses comprised different parts, including item analysis, reliability, validity analysis, and Exploratory Factor Analysis, performed using SPSS version 16. RESULTS: Item analyses revealed strong item-total correlations (r=0.31-0.76) for all 21 items except A3 (r=0.23). Critical Ratios indicated high discriminative power (CRs>0.30) for all items. The reliability test showed a strong Cronbach's alpha coefficient (0.90), and odd-even split-half reliability (0.83 and 0.80). The tool exhibits good discriminative validity (p=0.04), and high convergent validity (r=-0.33, p<0.00). Moreover, exploratory factor analysis results supported the three-factor structure of the original scale, though some issues were identified: item A3 not loading onto any of the three factors, some cross-loadings, and items from different domains grouping together. CONCLUSIONS: Despite having the problematic structure of the scale, it was still found highly reliable and valid in measuring affiliate stigma among the study population.
Navigating Uncertainty: The Future of Nepal Demographic and Health Survey and Nepal Health Facility Survey in Evolving Public Health Landscape in Nepal.
Paudel D
JNMA J Nepal Med Assoc · 2025 Jun · PMID 41768808 · Full text
Effective data systems are essential for driving focus and processes within health systems. Demographic and Health Surveys (DHS) and Health Facility Surveys (HFS) play a critical role in providing nationally representati...
Effective data systems are essential for driving focus and processes within health systems. Demographic and Health Surveys (DHS) and Health Facility Surveys (HFS) play a critical role in providing nationally representative data on service quality, health indicators, and resource allocation. Although the next round of Nepal Health Facility Survey was scheduled for 2026 and Nepal Demographic and Health Survey for 2027, these surveys face uncertainty due to recent decisions by the new U.S. administration to cut foreign aid, including support for the DHS project. In Nepal, data from DHS and HFS are indispensable for evaluating health systems, shaping evidence- based policies, and monitoring public health progress. However, funding uncertainties threaten to create data gaps, may distort health sector priorities, and diminish opportunities for developing future leaders in health sector. This situation highlights the urgent need for innovative solutions, investments in robust routine data systems, and strengthened collaboration among stakeholders to ensure the continuity of vital health system data.
Navigating Medical School with AI: A Student's Perspective.
Bhatta RR, Khanal I
JNMA J Nepal Med Assoc · 2025 Jun · PMID 41768807 · Full text
Medical school is a strange place where everything feels both deja vu and jamais vu. You've seen this disease before, but somehow, you still have no idea what's going on. Traditionally, we've relied on textbooks, scholar...
Medical school is a strange place where everything feels both deja vu and jamais vu. You've seen this disease before, but somehow, you still have no idea what's going on. Traditionally, we've relied on textbooks, scholarly articles, guidance from senior colleagues, and patient interactions to bridge these gaps but with recent advancements in computational models and algorithms, Artificial Intelligence has been a blessing.
Visual Functions in Patients with Optic Neuritis Pre and Post Treatment: An Observational Study.
Malla S, Shrestha S
JNMA J Nepal Med Assoc · 2025 Jun · PMID 41768806 · Full text
INTRODUCTION: Optic neuritis is an inflammatory condition affecting the optic nerve. It presents with sudden diminution of vision, also affecting colour vision, contrast sensitivity and stereoacuity. Steroids are given i...
INTRODUCTION: Optic neuritis is an inflammatory condition affecting the optic nerve. It presents with sudden diminution of vision, also affecting colour vision, contrast sensitivity and stereoacuity. Steroids are given in optic neuritis to reduce inflammation of optic nerve. The aim of this study was to compare the visual functions in patients with optic neuritis before and after treatment with steroid therapy. METHODS: This prospective study was conducted from November 2021 to October 2022 in the Department of Ophthalmology of a tertiary-level hospital. Thirty-seven eyes affected by optic neuritis of were included in the study. All the patients were given IV methylprednisolone for 3 consecutive days followed by oral prednisolone for 11 days in tapering doses. Visual functions such as visual acuity, colour vision, contrast sensitivity and stereoacuity at presentation and after treatment were compared. RESULTS: Among 37 eyes, 24 (64.86%) had best corrected visual acuity <1/60-perception of light at presentation, improving after six weeks with 21 (56.76%) achieving visual acuity 6/6-6/18. At presentation, only 1 (2.71%) had normal colour vision while at six weeks, 9 (24.32%) had normal colour vision. Contrast sensitivity could not be assessed in 29 (78.37%) cases at presentation due to poor vision, which reduced to 12 (32.43%) at six weeks. None had good stereoacuity at presentation; however, 6 (16.22%) had good stereoacuity after six weeks. CONCLUSIONS: The study showed that steroid therapy improved visual functions in patients with optic neuritis.
Lived Experience of Patients Living with Glaucoma: A Qualitative Study.
Singh AK, Thakur KK, Mishra SK … +2 more , Pandit B, Karn RR
JNMA J Nepal Med Assoc · 2025 Jun · PMID 41768805 · Full text
INTRODUCTION: Glaucoma is the leading cause of irreversible blindness in the world. There are limited qualitative study focusing on patients' experience of glaucoma. The aim of the study was to explore the lived experien...
INTRODUCTION: Glaucoma is the leading cause of irreversible blindness in the world. There are limited qualitative study focusing on patients' experience of glaucoma. The aim of the study was to explore the lived experiences of patients living with glaucoma. METHODS: A qualitative study was conducted involving eight patients from January 2024 to June 2024 at glaucoma department of an eye hospital after approval from the institutional review committee (Reference number: BEH-IRC/093/024), using in-depth interview. Semi-structured interviews were carried out with selected participants until data saturation was achieved. The interviews were audiorecorded, transcribed verbatim, and analyzed using thematic analysis. Patients receiving glaucoma treatment for more than five years and willing to participate were included in the study. RESULTS: Out of the eight participants, seven were male with mean age of 43.12±12.86 years. Based on the interviews, seven main themes were identified. These include experiences and ideas about the moment they first noticed the condition, their emotional response after being diagnosed, a sense of relief after receiving accurate information, how they manage the disease, their sources of information, changes in their work life, and the involvement of family members in attending regular glaucoma checkups. CONCLUSIONS: This study explored the experiences of patients living with glaucoma. Findings showed that the patients with early diagnosis, proper education with counseling, proper treatment and regular follow up preserved their visual function.
Normative Data for The Dimensions and Volume of Pituitary Gland in The General Population Undergoing Magnetic Resonance Imaging Under a Tertiary Care Center: An Observational Study.
Paudel S, Rokaha PS, Rokaha PS … +3 more , Bista A, Subedi N, Thapa NB
JNMA J Nepal Med Assoc · 2025 Jun · PMID 41768804 · Full text
INTRODUCTION: The pituitary gland is a pivotal neuroendocrine organ responsible for regulating essential physiological functions. Normative data on its dimensions and volume are crucial for identifying pathological chang...
INTRODUCTION: The pituitary gland is a pivotal neuroendocrine organ responsible for regulating essential physiological functions. Normative data on its dimensions and volume are crucial for identifying pathological changes in clinical settings. However, such reference values are often limited or population-specific. This study aimed to establish normative data for pituitary gland dimensions and volume in the general population undergoing magnetic resonance imaging (MRI) at a tertiary care center. METHODS: A total of 870 subjects of all age groups presumed normal pituitary morphology were evaluated using magnetic resonance imaging. Mid sagittal T1 weighted image and coronal T2 weighted images on magnetic resonance imaging were used to measure height, length and width of the pituitary gland. Data was stratified into 10 groups on the basis of age group in each sex to observe the differences. RESULTS: The height and volume of the pituitary gland showed variations with age. Positive correlation was observed between the mean height and volume for the sexes combined which was statistically significant with Pearson correlation coefficient r=0.82 (p<0.001). CONCLUSIONS: This study provides normative data for measurements of the pituitary gland and its variations based on age and sex.
Vaginal Neoplasm in a Breast Cancer Survivor.
Roy B, Rathore R, Singhal S … +2 more , Halder S, Singh N
JNMA J Nepal Med Assoc · 2025 Jun · PMID 41768803 · Full text
According to GLOBOCAN 2022 data, Carcinoma breast is the second most common malignancy worldwide after lung and ranks 4 in mortality worldwide. Breast cancer can metastasize to various organs. The incidence of vaginal me...
According to GLOBOCAN 2022 data, Carcinoma breast is the second most common malignancy worldwide after lung and ranks 4 in mortality worldwide. Breast cancer can metastasize to various organs. The incidence of vaginal metastasis in carcinoma breast is 1-2%. Here we present a patient with post menopausal bleeding with vaginal mass. She had a history of Triple negative carcinoma left breast 3 years back, treated by Modified Radical Mastectomy followed by chemo radiotherapy. Vaginal biopsy was suggestive of a metastatic carcinoma breast. MRI and PET CT showed isolated vaginal growth. Due to poor performance status and multiple medical comorbidities, decision was taken to treat her with single agent Paclitaxel 3weekly until disease progression. This case report points out the necessity for thorough gynaecological examination in a cancer survivor, either via clinical examination, routine PAP smear or imaging.
Factors Influencing Postpartum Depression in Nepal: An Integrative Review.
Rijal J, Rijal S, Upadhyay R
JNMA J Nepal Med Assoc · 2025 May · PMID 41766839 · Full text
Postpartum depression remains a critical concern in Nepal, influenced by various socio-cultural and healthcare-related factors. Therefore, this integrative review aimed to analyze and synthesize its key determinants with...
Postpartum depression remains a critical concern in Nepal, influenced by various socio-cultural and healthcare-related factors. Therefore, this integrative review aimed to analyze and synthesize its key determinants within the Nepalese context. Fourteen articles met the eligibility criteria after systematically searching five electronic databases. The review underscores that increased age, low socioeconomic status, limited educational attainment, unintended pregnancies, inadequate support, and maternal health issues are the prominent risks. Cultural inclinations, such as a preference for male children and lack of adequate antenatal care, contribute to the severity of the condition. The findings stress the need for culturally sensitive strategies, early screening efforts, and the assimilation of mental health care and maternal services. Iwt advocates for focused interventions and future longitudinal studies, and the insights are valuable for healthcare professionals, policymakers, and future investigations to improve maternal health outcomes in Nepal.
Accuracy of Magnetic Resonance Imaging in Diagnosis of Anterior Cruciate Ligament and Meniscus Tear: An Observational Study.
Thapa S, Panta S, Adhikari A … +2 more , Upadhyay HP, Shrestha SK
JNMA J Nepal Med Assoc · 2025 May · PMID 41766838 · Full text
INTRODUCTION: Magnetic resonance imaging is used for the diagnosis of anterior cruciate ligament and meniscus tears but its value in the diagnosis of these pathologies is limited. This study aims to evaluate the diagnost...
INTRODUCTION: Magnetic resonance imaging is used for the diagnosis of anterior cruciate ligament and meniscus tears but its value in the diagnosis of these pathologies is limited. This study aims to evaluate the diagnostic value of magnetic resonance imaging in diagnosing anterior cruciate ligament and meniscus tears. METHODS: This was an observational cross-section study conducted at a tertiary-level hospital in Nepal. The patients operated on for anterior cruciate ligament and/or meniscus tear were considered for the study. The accuracy of magnetic resonance imaging was calculated by comparing its findings with those in arthroscopy. RESULTS: The total number of cases were 134. The sensitivity and specificity were as follows: medial meniscus 88.81%, 95.10%; lateral meniscus 57.12%, 95.14%; anterior cruciate ligament 96.12%, 75%. The sensitivity and specificity of the injuries for 3 Tesla vs 1.5 Tesla Magnetic Resonance Imaging were as follows: medial meniscus 89.20%, 97.84% vs 87.52%, 87.52%; lateral meniscus 65.25%, 100% vs 30%, 90.91%; anterior cruciate ligament 96.12%, 75% vs 96.12, 75%. CONCLUSIONS: The sensitivity of magnetic resonance imaging in diagnosing anterior cruciate ligament injury was higher while specificity was higher for lateral meniscus injury. The study also showed that 3 Tesla was better than 1.5 Tesla magnetic resonance imaging in diagnosing meniscus injury.
Anaesthetic Management of Foreign Body Bronchus at University Teaching Hospital of Nepal: An Observational Study.
Koirala M, Parajuli BD, Joshi P … +2 more , Ghimire B, Bhattarai AS
JNMA J Nepal Med Assoc · 2025 May · PMID 41766837 · Full text
INTRODUCTION: Rigid bronchoscopy is the preferred method for extracting airway foreign bodies, as it allows grasping forceps to extract foreign bodies while maintaining ventilation through a side port. The main challenge...
INTRODUCTION: Rigid bronchoscopy is the preferred method for extracting airway foreign bodies, as it allows grasping forceps to extract foreign bodies while maintaining ventilation through a side port. The main challenge to the Anesthesiologists is to maintain oxygenation and ventilation while sharing the common field with the surgeons. This study intends to evaluate our current practices, challenges, and intraoperative events to enhance patient safety during these procedures. METHODS: This is a prospective observational study that included patients with suspected or confirmed bronchial foreign bodies who underwent rigid bronchoscopy from February 2023 to February 2025. Data were collected by the anesthesiologists using the structured proforma, covering the anesthetic technique, complications, and details of foreign bodies. SPSS version 22 was used for analysis. RESULTS: A total of 41 rigid bronchoscopies were performed, including three repeat procedures. Intraoperative complications included desaturation in 29 (70.73%), vocal cord edema in 16 (39.02%), slipping of foreign body in 8 (19.51%), and both bradycardia and airway bleeding in 6 (14.63%) cases each. Postoperatively, 23 (56.10%) patients required mechanical ventilation, and one (2.44%) patient experienced cardiac arrest. During preoperative preparation, intravenous glycopyrrolate and steroids were used in 38 (92.68%) and 34 (82.93%) cases, respectively. For induction and maintenance, intravenous anesthesia was the most common technique, with muscle relaxants used in 39 (95.12%) cases. Of the 41 bronchoscopies, 30 (73.17%) achieved successful foreign body removal, while five (12.20%) required thoracotomy referrals. CONCLUSIONS: Desaturation was the most common intraoperative complication. About half of the patient required mechanical ventilator postoperatively.
Responding to A Hazardous Materials Incident in Nepal.
Phuyal N, Shrestha A
JNMA J Nepal Med Assoc · 2025 May · PMID 41766836 · Full text
Paper talks about hazardous materials incidents in Nepal that threaten health, safety and the environment. Rapid urbanisation and industrial growth have made chemical, biological, radiological and nuclear emergencies mor...
Paper talks about hazardous materials incidents in Nepal that threaten health, safety and the environment. Rapid urbanisation and industrial growth have made chemical, biological, radiological and nuclear emergencies more likely, but there is still not a clear national plan or complete chemical inventory, leaving the health sector unprepared. Emergency responders rely on the Emergency Response Guidebook and the Wireless Information System for Emergency Responders, but many are not aware of these tools or trained to use them. The Nepalese Army has a dedicated chemical, biological, radiological and nuclear platoon, yet hospitals still lack decontamination protocols, equipment and trained staff. Co-ordination between agencies is weak, resources are limited and exercises are rare. It feels like the pieces do not fit together. We suggest developing national guidelines aligned with international standards, forming dedicated response teams, running regular training sessions and including chemical incident plans in hospital disaster plans to improve preparedness.
Scar among Bacillus Calmette-Guerin Vaccinated Children Presenting to an Immunisation Clinic at a Tertiary Hospital in Nepal: An Observational Study.
Dhakal AK, Kc D, Shrestha B … +4 more , Shrestha D, Neupane N, Acharya S, Shrestha S
JNMA J Nepal Med Assoc · 2025 May · PMID 41766835 · Full text
INTRODUCTION: Bacillus Calmette-Guerin vaccination is associated with the development of scarring at the vaccination site in most children within 12 weeks of vaccination. However, due to various factors, some children do...
INTRODUCTION: Bacillus Calmette-Guerin vaccination is associated with the development of scarring at the vaccination site in most children within 12 weeks of vaccination. However, due to various factors, some children do not develop scars. The aim of the study was to determine the prevalence of scar failure and the differences in clinical characteristics between scar-positive and scar-negative children. METHODS: This observational cross-section study was conducted between 12 September 2022 and 15 April 2024 on children attending a vaccination clinic at a tertiary care hospital for 12 or 15-month vaccination. A purposive sampling method was used, and 386 children were enrolled in the study. During medical history, information was collected on Bacillus Clamettte-Guerin vaccination, child and maternal clinical profiles, and hospitalisations for respiratory tract infections in children. RESULTS: Among 386 infants, prevalence of BCG scar was 341 (88.34%; 95% CI: 91.81 %-91.37%). Vaccination was confirmed in 94.82% by history and card. The median scar size was 4mm (IQR: 2,5 mm) transversely and 3 mm (IQR: 2,5) vertically. Thirty-two (8.30%) infants required hospital admission for respiratory infections; none received anti-tubercular treatment. CONCLUSIONS: The BCG scar formation was higher compare to the scar failure. The scar failure was comparable to other studies.
Delayed Diagnosis of Tricuspid Atresia: A Case Report.
Yogi RN, Awasthi SR, Mandal AK … +3 more , Shahi K, Thani KP, Pradhan S
JNMA J Nepal Med Assoc · 2025 May · PMID 41766834 · Full text
Tricuspid atresia is a rare cyanotic congenital heart disease that impairs oxygenation. A 16-month-old female child from a rural area in Nepal presented with shortness of breath, cyanosis of the lips and extremities, fee...
Tricuspid atresia is a rare cyanotic congenital heart disease that impairs oxygenation. A 16-month-old female child from a rural area in Nepal presented with shortness of breath, cyanosis of the lips and extremities, feeding difficulties, and severe acute malnutrition. The patient had been diagnosed with cyanotic congenital heart disease at nine months but had sought treatment from shamans due to financial constraints. Diagnostic echocardiography at the referred center revealed tricuspid atresia type IB with a ventricular septal defect. While awaiting surgery, the child collapsed and was revived after cardiopulmonary resuscitation. Emergency surgery was then performed. After surgery, the child had a stormy recovery and was subsequently discharged home in stable condition.
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