JNMA; Journal Of The Nepal Medical Association[JOURNAL]
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200 papers
Prevalence of Amlodipine-induced gingival enlargement in a Tertiary Care Hospital: A Descriptive Cross-Sectional Study.
Subedi G, Rijal AH, Lamichhane S … +2 more , Ghimire O, Humagain M
JNMA J Nepal Med Assoc · 2025 May · PMID 41766833 · Full text
INTRODUCTION: Administration of certain drugs such as anticonvulsants, immunosuppressants, and calcium channel blockers leads to well-known sequalae of gingival enlargement. Apart from esthetic consequences, gingival enl...
INTRODUCTION: Administration of certain drugs such as anticonvulsants, immunosuppressants, and calcium channel blockers leads to well-known sequalae of gingival enlargement. Apart from esthetic consequences, gingival enlargement also hinders proper oral hygiene and may be painful for the patient. Determination of primary etiology and subsequent treatment for the same is pre-requisite in the management of gingival enlargement. Therefore, this study was intended to determine the prevalence of gingival enlargement in patients under amlodipine therapy in a tertiary care hospital. METHODS: A descriptive cross-sectional study was carried out after ethical approval from Institutional Review Committee (Reference No: 242/23), in the Department of Internal Medicine and in the Department of Periodontology, Dhulikhel Hospital. The study period was from December, 2023 - May, 2024. Patients under amlodipine therapy for at least six months were assessed. Purposive sampling was done with a total sample size of 450. The prevalence of gingival enlargement along with dosage and duration of drug intake was calculated. RESULTS: Out of 450 participants, drug induced gingival enlargement was seen in 129 (28.70%). Furthermore, among 129 patients, grade 1 gingival enlargement was more prevalent (n=93, 20.70%) while grade 3 gingival enlargement was only seen in 6 (0.90%) of the participants. The dosage and duration of drug intake by patient were also calculated. CONCLUSIONS: Gingival enlargement could be the potential side effect associated with amlodipine usage. It was found to be prevalent in patients under amlodipine therapy. The patients should be well-informed about the consequence, by the treating physician, prior to initiation of amlodipine therapy. Proper oral hygiene measures should be reinforced in such patients from the beginning.
A Combination Of Vein Of Galen Aneurysmal Malformation And Bovine Aortic Arch In Newborn: A Case Report.
Mandal KD, Subedi K, Amatya U … +1 more , Pathak J
JNMA J Nepal Med Assoc · 2025 May · PMID 41766832 · Full text
Vein of Galen aneurysmal malformation is a rare intracranial arteriovenous malformation, coexistence with aortic arch anomalies is even more uncommon, carry high risk of morbidity and mortality related to endovascular pr...
Vein of Galen aneurysmal malformation is a rare intracranial arteriovenous malformation, coexistence with aortic arch anomalies is even more uncommon, carry high risk of morbidity and mortality related to endovascular procedure and poor neurological outcome. Vein of Galen aneurysmal malformation is a dilated venous pouch, a persistence of the embryonic median prosencephalic vein of Markowski. Often presents with high output cardiac failure, severe pulmonary hypertension, and systemic steal leading to hemodynamic compromise and multi organ failure. Bicetre score scale determines the potential treatment option and prognosis of the disease. Aim of the medical treatment is initial stabilization of life threatening condition of severe heart failure followed by the definitive treatment with endovascular embolization. Treatment is a big challenge, specially if coexistence with aortic arch anomalies which increases the morbidity and mortality. We describe a term neonate found to have vein of Galen aneurysmal malformation associated with bovine aortic arch.
Morphological Variations of Coronoid Process in Dry Adult Human Mandibles: A Narrartive Review.
Nirala SK, Yuan L, Mushraf S
JNMA J Nepal Med Assoc · 2025 May · PMID 41766831 · Full text
The coronoid process of the mandible is a significant anatomical structure integral to mastication and mandibular stability. It serves as an attachment site for the masseter and temporalis muscles, crucial for jaw moveme...
The coronoid process of the mandible is a significant anatomical structure integral to mastication and mandibular stability. It serves as an attachment site for the masseter and temporalis muscles, crucial for jaw movement and function. Beyond its functional roles, it holds therapeutic value in reconstructive craniomaxillofacial surgeries, where it serves as a versatile graft material for addressing osseous defects such as fractures, alveolar defects, and sinus augmentations. Anatomically, it exhibits diverse morphological variations, including triangular, hook-shaped, and rounded forms. These variations not only contribute to understanding anatomical differences but also serve as anthropological markers for ethnic characteristics and ancestry in forensic contexts. Radiographic techniques such as orthopantomograms facilitate the identification and analysis of these morphological differences, essential for both clinical assessments and forensic identifications. Gender-specific differences in its morphology highlight the influence of genetic, hormonal, and developmental factors on mandibular structure. In conclusion, the coronoid process exemplifies a multifaceted anatomical structure with implications spanning clinical practice, anthropological research, and forensic sciences. Understanding its diverse roles and morphological variations enhances surgical outcomes, aids in anthropological studies, and contributes to forensic identifications, emphasizing its enduring relevance in both medical and scientific disciplines.
Lessons Learned from the Design and Implementation of the Tuberculosis Free Nepal Initiative.
Shrestha P, Mishra G, Khanal MN … +6 more , Shah NP, Dahal D, Thapa B, Joshi LR, Ghimire N, Wingfield T
JNMA J Nepal Med Assoc · 2025 May · PMID 41766830 · Full text
INTRODUCTION: Nepal has a persistently high burden of tuberculosis. Despite implementation of multiple interventions by the National tuberculosis Program, Nepal is not on track to achieve many of WHO's End tuberculosis S...
INTRODUCTION: Nepal has a persistently high burden of tuberculosis. Despite implementation of multiple interventions by the National tuberculosis Program, Nepal is not on track to achieve many of WHO's End tuberculosis Strategy targets. METHODS: The National tuberculosis Control Centre developed a Google Sheet with key indicators to monitor the tuberculosis -Free Initiative across municipalities. Focal points recorded real-time data, ensuring transparency. National tuberculosis Control Centre compiled, analyzed, and interpreted the data to track progress, evaluate program outcomes, and support future planning. RESULTS: The tuberculosis-Free Initiative achieved significant results in implementing municipalities. A total of 112 END TUBERCULOSIS Committees were formed at the municipal level, with over 1,000 ward-level committees engaged in tuberculosis microplanning. More than 56% of municipalities mobilized community-led monitoring groups, and 16 municipalities conducted annual social audits. tuberculosis-Free Volunteers facilitated screening in 53 municipalities. In 2023, innovative case-finding methods contributed significantly. The sputum courier system identified 1,790 Pulmonary bacteriologically confirmed tuberculosis cases, 554 cases were diagnosed via screening camps and door-to-door visits, and 222 cases through Primary healthcare centre Outreach Clinics. Additionally, 23 patient support groups, 32 youth groups, and 32 civil society organizations were mobilized, strengthening community participation. These efforts highlight the tuberculosis-Free Initiative's impact on enhancing case detection, community engagement, and tuberculosis control strategies. CONCLUSIONS: Developing local level ownership and accountability in the national tuberculosis response, ensuring high quality implementation through robust monitoring and evaluation, and generating and sustaining local resources, requires strong government leadership, advocacy, and capacity building. Within the implementing teams by the stakeholders, frequent initiative reviews, coaching, and mentoring support.
Maternal and Perinatal Outcome in Women with Congenital Heart Disease: An Observational Study.
Paudyal P, Ghimire A, Parajuli BD … +1 more , Khakural P
JNMA J Nepal Med Assoc · 2025 May · PMID 41766829 · Full text
INTRODUCTION: Untreated and residual congenital heart disease in a pregnant woman is concerning for both the mother and the baby. Early diagnosis and management are imperative to ensure survival of both mother and the ba...
INTRODUCTION: Untreated and residual congenital heart disease in a pregnant woman is concerning for both the mother and the baby. Early diagnosis and management are imperative to ensure survival of both mother and the baby. The aim was to study the maternal and perinatal outcomes in women with congenital heart disease. METHODS: An observational study was conducted in a tertiary care hospital over a three-year period from April 2020 to March 2023. The data was collected retrospectively after ethical approval from the Institutional Review Committee [Reference number: 373/ (6-11) E2/076/077]. Total sampling was done where all women with congenital heart disease who delivered in the hospital after twenty-eight weeks of gestation during the study period were enrolled. Data were collected from the record book of labour room, patient files, and labour room, along with mortality audits of the department. Maternal and fetal outcomes were recorded, and descriptive analyses were done. RESULTS: Seventy-three women with congenital heart disease delivered in our center during the study period. The average age of the women was 26.51+ 5.50 years. Among them, 39 (53.4%) of the patients had uncorrected heart conditions. Atrial septal defect was present in 20 (27.39%) pregnant patients. There were 69 (94.52%) live births and four (5.47%) intrauterine foetal deaths. One (1.36%) newborn was diagnosed to have an ostium secundum atrial septal defect, and two (2.73%) newborns were diagnosed to have patent foramen ovale. CONCLUSIONS: The maternal and perinatal outcomes in women with treated congenital heart disease are favourable, whereas the maternal mortality remains high in women with Eisenmenger Syndrome.
Wilson's Disease with Lymphoproliferative Disorder: A Case Report.
Jha A, Shah SK, Pradhan RR
JNMA J Nepal Med Assoc · 2025 May · PMID 41766828 · Full text
Wilson's disease is characterized by copper accumulation in organs like liver, brain, and eyes, presenting with a varied clinical features, making it challenging to diagnose. This report describes a case of Wilson's dise...
Wilson's disease is characterized by copper accumulation in organs like liver, brain, and eyes, presenting with a varied clinical features, making it challenging to diagnose. This report describes a case of Wilson's disease with unusual hematological features. A 12-year-old from Himalayan region presented with weakness, dysarthria, tremors. Initial investigations revealed pancytopenia, and bone marrow showed a lymphoproliferative disorder. He developed behavioral changes, a flat affect, and scanning speech. Wilson's disease was confirmed through Kayser-Fleischer rings, reduced serum ceruloplasmin levels, and elevated urinary copper, supported by imaging.
Carrying Angle Variation in Relation to Gender Among Children: An Observational Study.
Makaju S, Palikhe P, Chaudhary S … +1 more , Rai CK
JNMA J Nepal Med Assoc · 2025 May · PMID 41766827 · Full text
INTRODUCTION: Carrying angle is the angle formed at the elbow joint during full extension and supination of arm and forearm which increases with increasing age till 14 years. This study measures the carrying angle variat...
INTRODUCTION: Carrying angle is the angle formed at the elbow joint during full extension and supination of arm and forearm which increases with increasing age till 14 years. This study measures the carrying angle variation with gender which can be beneficial for pediatricians in diagnosis, treatment planning of the related cases. METHODS: The study was conducted 70 patients of Kathmandu Medical College and Teaching Hospital at Sinamangal and Duwakot between 15 December 2023 to 30 December 2023 after getting the ethical clearance from the Institutional Review Committee (reference no. KMC-IRC 08122023/02) with convenience sampling method. The carrying angle was measured by manual goniometer by drawing the axes in the arm and forearm. The data obtained was analyzed in different age groups and body mass index between boys and girls. The data was analyzed with Statistical Package for the Social Sciences version 25. RESULTS: Out of 70 participants, 38(54.29%) were boys and 32(45.71%) were girls. The mean carrying angle among girls in right side was 10.53±2.52 degrees and 9.05±3.71 degrees for boys (p=0.06). Similarly, on left side it was 10.15±2.37 degrees for girls and 8.76±2.96 degrees for boys (p=0.036). CONCLUSIONS: The Carrying angle on both sides was found to be increased among female children in comparison to male irrespective of different age and BMI groups.
Reinforcement of Peer-Coaching and Clinical Audit to Improve Implementation of Package for Essential Non-Communicable Diseases (PEN) in Nepal: A Pilot Implementation Study Method.
Prajapati D, Sapkota S, Suwal PS … +8 more , Aryal A, Maharjan R, Magar SA, Magar KR, Poudel K, Pyakurel P, Vaidya A, Shrestha A
JNMA J Nepal Med Assoc · 2025 May · PMID 41766826 · Full text
INTRODUCTION: Nepal endorsed and implemented the WHO Package of Essential Non-communicable Disease Intervention. However, its implementation is far from satisfactory. We designed and implemented an intervention to reinfo...
INTRODUCTION: Nepal endorsed and implemented the WHO Package of Essential Non-communicable Disease Intervention. However, its implementation is far from satisfactory. We designed and implemented an intervention to reinforce peer coaching and clinical audit mechanisms in primary-level health facilities, and tested its feasibility and preliminary effectiveness. This paper details the methodology used in designing, implementing and assessing the intervention. METHODS: The study adoptes a hybrid type II implementation trial design. The intervention assignment followed a non-blinded, two-arm, parallel randomized controlled trial design with a 1:1 allocation ratio. Seventeen primary-level public health facilities in Bhaktapur district with at least one trained staff were randomized. The clinical staff at the intervention health facilities received peer-coaching and clinical audit reinforcement, while the control group followed their usual practice. The study was conducted over a 12-month duration from Februay 2022, to January, 2023. A mixed-method approach, applying pre-post assessment and thematic analysis, to inform the intervention development and assess implementation outcomes and its effectiveness was adopted. The study was guided by the Proctor framework. Ethical clearance was obtained from the Nepal Health Research Council (Registraion number: 302/2021). DISCUSSION: The tools and methods that guide intervention implementation and assessment have the potential to be replicated in various settings to design strategies to improve Package of Essential Non-communicable Disease Intervention adoption and sustainment. TRIAL REGISTRATION: This trial is registered with ClinicalTrials.gov (www.clinicaltrials.gov), Identifier: NCT05880784.
Epidemiological Study of Stroke Presenting to the Emergency Department of a Tertiary Hospital: An Observational Study.
Rajbhandari B, Shakya YM, Maharjan RK … +7 more , Shakya YL, Aryal SS, Bhandari P, Neupane RP, Shilpakar O, Nakarmi RN, Shrestha C
JNMA J Nepal Med Assoc · 2025 May · PMID 41766825 · Full text
INTRODUCTION: Stroke remains a major global health burden, ranking as the second leading cause of death and third leading cause of disability worldwide. Low- and middle-income countries, including Nepal, face a dispropor...
INTRODUCTION: Stroke remains a major global health burden, ranking as the second leading cause of death and third leading cause of disability worldwide. Low- and middle-income countries, including Nepal, face a disproportionate share of this burden, characterized by delayed treatment and limited healthcare infrastructure. This study aimed to determine the epidemiological profile of stroke cases presenting to the emergency department of a tertiary hospital in Nepal. METHODS: A cross-sectional study was conducted using medical records of stroke patients presenting to the Emergency Department from August 2022 to September 2023. Data on demographics, stroke type, clinical outcomes, and management were collected and analyzed descriptively using STATA version 17. RESULTS: Of 39,702 emergency department visits, 1,174 (2.96%) were stroke cases. Ischemic stroke occurred in 896 (76.34%) patients, hemorrhagic stroke in 175 (14.89%), and transient ischemic attack in 103 (8.82%). The mean age was 61.79 ± 15.76 years, and 704 (60.00%) patients were male. Admission to the general ward occurred in 1,011 (86.10%) patients, and 43 (3.65%) patients were admitted to the ICU. Thrombolysis was administered to 22 (1.87%) patients, and 11 (0.93%) were referred for thrombectomy. A total of 151 (12.90%) patients arrived within 4.5 hours of symptom onset. CONCLUSIONS: The study highlights the predominance of ischemic stroke, delayed hospital presentations, and limited use of thrombolysis among stroke patients in a high-volume ED in Nepal.
Profile of Neurosyphilis Patients Admitted to a Tertiary Care Centre of Nepal: An Observational Study.
Giri U, Tangbetani LL, Karki A … +1 more , Ghimire JJ
JNMA J Nepal Med Assoc · 2025 May · PMID 41766824 · Full text
INTRODUCTION: Neurosyphilis is a rare complication of untreated syphilis with limited literature. We aimed to look for demographic characters and clinical presentation of patients admitted with the diagnosis of neurosyph...
INTRODUCTION: Neurosyphilis is a rare complication of untreated syphilis with limited literature. We aimed to look for demographic characters and clinical presentation of patients admitted with the diagnosis of neurosyphilis. METHODS: This was an observational cross-sectional study that included analysis of records of neurosyphilis patients admitted to the National Academy of Health Sciences, Kathmandu, Nepal, from May 2015 to April 2024. All patients diagnosed with neurosyphilis were included, while those with incomplete data were excluded. The Centers for Disease Control and Prevention criteria were used to define and categorize neurosyphilis. Continuous variables were summarized as mean ± standard deviation for normally distributed data or as median and interquartile range for skewed data. Categorical variables were described using numbers and percentages. RESULTS: A total of 53 cases were included in the study, with 31 (58.49%) males. The median age was 46 years (interquartile range: 37-60 years). Decreased vision was ovserved in 30 (56.60%) patients, and redness of the eye in 11 (20.75%) and headache in 4 (7.55%). Eye signs were observed in 43 (81.13%) patients. Cerebrospinal fluid Venereal Disease Research Laboratory (VDRL) test was positive in 11 (20.75%) cases. Based on Centers for Disease Control and Prevention criteria, 11 (20.75%) patients had verified neurosyphilis, 34 (64.15%) had likely neurosyphilis, and 8 (15.09%) had possible neurosyphilis. Iintramuscular benzathine penicillin was administered in 26 (49.06%) patients. CONCLUSIONS: There were more male patient with Neurosyphilis in our population. Decreased vision was the most common presentation. Likely neurosyphilis was most common diagnosis among studied population.
Incidental Neoplasm and Histopathological Spectrum of Suspected Acute Appendicitis in Appendectomy Specimen: An Observational Study.
Tiwari A, Sapkota P, Shrestha D
JNMA J Nepal Med Assoc · 2025 Mar · PMID 40656930 · Full text
INTRODUCTION: Acute appendicitis is the most common surgical emergency and histopathological studies are the gold standard for confirmation of clinical diagnosis and key methods of discovering appendiceal neoplasm. Appen...
INTRODUCTION: Acute appendicitis is the most common surgical emergency and histopathological studies are the gold standard for confirmation of clinical diagnosis and key methods of discovering appendiceal neoplasm. Appendiceal neoplasms are uncommon and are mostly identified by pathologic examination after appendectomy for presumed appendicitis as an incidental finding. METHODS: An observational cross-section study was conducted at a Medical College from 1 August 2022 to 31 July 2024. Appendectomy specimens were included in the study after obtaining consent. Ethical approval was taken from the Institutional Review Committee (Reference number: IRC-LMC 05/S-22). Descriptive analysis was done, frequency and proportion were calculated. RESULTS: Among 350 appendectomy cases, 30 (8.57%) cases had negative appendectomies. Out of total 320 patients, 183 (57.19%) were male and 137 (42.81%) were female. Histopathological findings suggestive of acute appendicitis were observed in 164 (51.25%) specimens and there were 6 (1.87%) specimens suggestive of neoplasms. Amongst the neoplasm of appendix 3 (0.94%) were carcinoid tumours. CONCLUSIONS: Appendiceal neoplasms are uncommon which was comparable to previous studies. Carcinoid tumour was the most common incidental neoplasm.
Myasthenia Crisis as First Presentation of MuSk Positive Myasthenia Gravis: A Case Report.
Chhetri D, Bhattarai AS, Joshi P … +1 more , Thapa K
JNMA J Nepal Med Assoc · 2025 Mar · PMID 40656929 · Full text
We report a unique presentation of a 57-year-old female presented with severe respiratory acidosis, which was found to be a case of Musk-positive Myasthenia Gravis. Patient presented with depressed level of consciousness...
We report a unique presentation of a 57-year-old female presented with severe respiratory acidosis, which was found to be a case of Musk-positive Myasthenia Gravis. Patient presented with depressed level of consciousness and respiratory failure, mandating urgent ventilatory support. She responded well with positive pressure ventilation. However, she persistently failed to maintain adequate ventilation after extubation and had to be reintubated. At presentation, the absence of classical symptoms typical of Myasthenia Gravis posed a diagnostic dilemma, initially obscuring the underlying etiology. However, since there was no other identifiable cause for the inability to maintain ventilation, antibody panels were sent which turned out positive for Muscle specific kinase. This case thus highlights the significance of considering atypical neuromuscular presentations, particularly when respiratory compromise is the predominant manifestation, highlighting the necessity for comprehensive neurological evaluation even in the absence of classical symptoms for timely diagnosis and management of Myasthenia Gravis.
Diagnostic Dilemma in Intra-abdominal Cancers.
Baral G
JNMA J Nepal Med Assoc · 2025 Mar · PMID 40656928 · Full text
PROBLEM STATEMENT: A diagnostic dilemma exists in cancer care, especially in intraabdominal lesions. Despite the diagnostic means available so far, clinical decision-making is practically difficult due to diagnostic limi...
PROBLEM STATEMENT: A diagnostic dilemma exists in cancer care, especially in intraabdominal lesions. Despite the diagnostic means available so far, clinical decision-making is practically difficult due to diagnostic limitations. The inherent variation of any means influences decision-making. There is an iceberg-like diagnostic inaccuracy in revealing the specific condition or disease. This clinical decision-making gap is worrisome. CONCLUSION: Besides technological and bio-molecular advancements, the structured working framework would be protective and persuasive in mitigating dilemmas to some extent.
Postpartum Cavernous Sinus Thrombosis Associated with Eclampsia and Gestational Diabetes Mellitus: A Case Report.
Chitrakar S, Aryal SB, Shrestha TM
JNMA J Nepal Med Assoc · 2025 Mar · PMID 40656927 · Full text
Pregnancy is the pro-thrombotic state. The objective of this report is to highlight the rare occurance of postpartum cavernous sinus thrombosis associated with eclampsia and gestational diabetes mellitus, emphasizing its...
Pregnancy is the pro-thrombotic state. The objective of this report is to highlight the rare occurance of postpartum cavernous sinus thrombosis associated with eclampsia and gestational diabetes mellitus, emphasizing its clinical presentation. A 25-year-old Muslim female came with the complaint of headache,post auricular and right parietal region on 8th day post-partum. She had a history of postpartum eclampsia and Gestational Diabetes Mellitus for which she was treated with magnesium sulfate and oral hypoglycaemic agents respectively. MRV showed a filling defect in right transverse sinus, sigmoid sinus, and internal jugular vein. She was then admitted to the ward and was treated with heparin and antibiotics. She was then discharged on oral rivaroxaban. As pregnancy is itself a state of hyper-coagulable state, there seems to be a significant thrombosis risk. Hence clinicians should be aware of the possible thrombotic disorder in the background of this vignette.
Current Status and Future Potential of Machine Learning in Diagnostic Imaging of Endometriosis : A Literature Review.
Shrestha P, Shrestha B, Sherestha J … +1 more , Chen J
JNMA J Nepal Med Assoc · 2025 Mar · PMID 40656926 · Full text
The presence of endometrial tissue outside the uterus is a defining characteristic of endometriosis, a chronic systemic illness that affects women of childbearing age. Despite its enigmatic nature, laparoscopy remains th...
The presence of endometrial tissue outside the uterus is a defining characteristic of endometriosis, a chronic systemic illness that affects women of childbearing age. Despite its enigmatic nature, laparoscopy remains the gold standard for diagnosis, while noninvasive methods such as transvaginal ultrasonography and magnetic resonance imaging are commonly used to aid in preoperative planning. In healthcare, AI has emerged as a game-changing innovation, enhancing patient outcomes, reducing costs, and revolutionizing healthcare delivery, particularly in diagnostic radiology. Images can be analyzed using machine learning, a pattern recognition method. The machine learning algorithm first computes the image characteristics deemed significant for making predictions or diagnoses about unseen images.
Burden of Non-Communicable Diseases and Emerging Attention in Gandaki Province, Nepal.
Khadka KB, Paudel D
JNMA J Nepal Med Assoc · 2025 Mar · PMID 40656925 · Full text
Non-communicable diseases have become a major health challenge globally, including in Nepal. Deaths due to non-communicable diseases in Nepal are increasing, accounting more than half of total deaths. Major contributors...
Non-communicable diseases have become a major health challenge globally, including in Nepal. Deaths due to non-communicable diseases in Nepal are increasing, accounting more than half of total deaths. Major contributors to deaths due to non-communicable diseases include cardiovascular diseases, chronic respiratory diseases, cancers, digestive diseases such as pancreatitis and cirrhosis of liver, and diabetes. To address this, Gandaki Province organized integrated screening sessions for non-communicable diseases covering 2,976 high-risk individuals aged 40 years and above from six districts. The preliminary findings of screenings revealed a high prevalence of hypertension, high blood sugar, obesity, and abnormal cholesterol levels. Designating Falgun as the month for the non-communicable diseases screening campaign throughout the country helps in promoting awareness, screening, and management of these diseases through effective coordination and resource allocation for successful impact.
Internet Addiction among Students of a School in Rupandehi District, Nepal: An Observational Study.
Kafle B, Bagale Y, Tiwari S … +2 more , Pandey N, Pahari N
JNMA J Nepal Med Assoc · 2025 Mar · PMID 40656924 · Full text
INTRODUCTION: Students use internet for various purposes like social networking, playing online games, academic purpose, etc. Excessive Internet use has been associated with adverse psychosocial development, social isola...
INTRODUCTION: Students use internet for various purposes like social networking, playing online games, academic purpose, etc. Excessive Internet use has been associated with adverse psychosocial development, social isolation, impaired social skills, anger and mental health issues. This study aims to find out the prevalence of internet addiction disorder among school going adolescent of a government school of Nepal. METHODS: An observational cross-section study conducted among students of Shree Shanti Model Secondary School after obtaining ethical approval from the Institutional Review Committee. Data was collected from 1 October to 1 November 2023. A convenience sampling method was used. A standard tool Young Internet Addiction Test (IAT) was used to find out if addiction was present or not. RESULTS: Out of a total of 461 students, 137 (29.72%) had mild internet addiction, 21 (4.56%) had moderate addiction, and 303 (65.72%) had no addiction. The mean age of the students was 14.93±0.73 years. A total of 226 (49.02%) were male, and 235 (50.98%) were female. Out of total, 388 (84.16%), used mobile phones for internet access, and the main purpose of internet use was entertainment, reported by 255 (55.31%). YouTube was viewed by 266 (61.99%) users, TikTok by 77 (16.71%), and Facebook by 46 (9.98%). CONCLUSIONS: This study highlights that approximately one-third of students in a government school in Rupandehi, Nepal, exhibit mild to moderate levels of internet addiction. The findings suggest that internet use is predominantly for entertainment, with mobile phones being the most common device used.
Appropriate Use of Proton Pump Inhibitors in General Out Patient Department of a Tertiary Care Center of Kathmandu Valley: An Observational Study.
Bhandari J, Bhandari N
JNMA J Nepal Med Assoc · 2025 Mar · PMID 40656923 · Full text
INTRODUCTION: Proton Pump Inhibitors (PPIs) are widely used medications that suppress gastric acid secretion worldwide. However, they have been linked to an increased risk of chronic kidney disease, hypomagnesemia, and b...
INTRODUCTION: Proton Pump Inhibitors (PPIs) are widely used medications that suppress gastric acid secretion worldwide. However, they have been linked to an increased risk of chronic kidney disease, hypomagnesemia, and bacterial infections, including C. difficile and acid hypersecretion. This study aimed to identify the appropriateness of PPI prescriptions in general clinics. METHODS: An observational cross-section study was conducted in General out patient department of a tertiary care center of Nepal. Purposive sampling was done. The study included 355 clinical notes from the clinic's out patient department with at least one proton pumb inhibitor prescription. Data was collected, and the proportion of different parameters was calculated. RESULTS: Appropriate use of proton pumb inhibitor was 255 (57.74%). Among the total study population, 186 (51.22%) were male. The appropriate use of proton pump inhibitor use by faculties was 83 (61.02%) and 68 (33.68%) reported that it was given to prevent Non-steroidal Anti-Inflammatory Drug-related complications. Pantoprazol was prescribed in 256 (74.62%) cases. CONCLUSIONS: This study suggests that PPIs were appropriate more than 50 percent of the time, but a high number of patients have been prescribed PPIs without a clear indication.
DECAF Score in Predicting Outcomes of Acute Exacerbation of Chronic Obstructive Pulmonary Disease: An Observational Study.
Prajapati A, Sharma Y, Thapa S … +1 more , Devkota S
JNMA J Nepal Med Assoc · 2025 Mar · PMID 40656922 · Full text
INTRODUCTION: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can often lead to hospital admission and has the potential to be fatal. Lack of prognostic research in exacerbation requiring hospitaliza...
INTRODUCTION: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can often lead to hospital admission and has the potential to be fatal. Lack of prognostic research in exacerbation requiring hospitalization that can accurately predict inhospital mortality is a challenge. This study aims to assess value of the DECAF (Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial fibrillation) score as a clinical prediction tool for inhospital mortality, need of intensive care unit (ICU) stay and risk stratification in patients with Acute exacerbation of chronic obstructive pulmonary disease. METHODS: This is an observational cross-section, hospital based study conducted from April 2022 to February 2023 at a tertiary care centre. The patients admitted with the diagnosis of acute exacerbation of chronic obstructive pulmonary disease were included in the study and their DECAF score were calculated. Patients were followed up during hospital stay and their outcome were recorded. The prognostic value of DECAF score was assessed by area under receiver operator characterstics curve. RESULTS: There were 83 patients enrolled in the study out of which 13 (15.66%) died in the hospital and 20 (24.09%) required ICU stay. The area under receiver operator characteristic curve value for mortality owas 0.89 and that for intensive care unit stay was 0.84. CONCLUSIONS: This study shows that DECAF score is a good predictor of inhospital mortality and ICU admission.
Perioperative Anticoagulation and Risk Assessment: Building a Bridge Over a STREAM.
Harrison A, Rayamajhi S
JNMA J Nepal Med Assoc · 2025 Mar · PMID 40656921 · Full text
Perioperative care requires a comprehensive assessment of the risks of bleeding and thrombosis. The 2022 CHEST Guidelines offer an empirical foundation for customized treatment using clinical judgment and risk assessment...
Perioperative care requires a comprehensive assessment of the risks of bleeding and thrombosis. The 2022 CHEST Guidelines offer an empirical foundation for customized treatment using clinical judgment and risk assessment based on CHA2DS2-VASC and HAS-BLED scores. Despite the ease of access to anticoagulation guidelines, decision-making remains challenging, particularly when determining the necessity of bridging therapy with unfractionated or low-molecular-weight heparin. To facilitate this decision, we provide a mnemonic, STREAM, that highlights high-risk situations that require bridging. These include recent stroke or transient ischemic attack, severe thrombophilia, rheumatic valvular disease, recent venous thromboembolism, atrial fibrillation with high CHA2DS2-VASC scores, and mechanical heart valves. This mnemonic offers physicians a methodical approach to optimize perioperative anticoagulation control while minimizing the risk of hemorrhage and thrombosis.
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