Browsing by Author "Phuyal, Mandish Prasad"
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Publication A Five-year Study of Spinal Disorders among Patients Presenting to the National Trauma Center of Nepal: An Observational Study(Nepal Medical Association, 2024) Rijal, Badri; Adhikari, Min Chandra; Bhusal, Suzit; Shrestha, Reshika; Chaudhary, Ashlesha; Pandey, Dipendra; Phuyal, Mandish Prasad; Prasai, Akanshya; Chaudhary, AashutoshAbstract Introduction: Spinal cord injuries result in severe neurological impairments and disabilities. With an estimated 15.4 million cases globally in 2021, spinal cord injuries are more common in low- and middle-income countries, yet research in these areas is limited. This study aimed to find the pattern of spinal injuries and outcomes associated with spine injuries over a five-year duration at a tertiary trauma care center. Methods: This observational cross-section study was conducted at the National Trauma Center, Kathmandu from 2075 to 2080 B.S. with ethical clearance from the Nepal Health Research Council (Reference number: 968). Total-population sampling was used. A structured proforma was employed as the primary data collection tool. Data was analyzed using SPSS. Results: Of the 20843 patients, 2070 (9.93%) had spinal injuries. The median age was 43 (IQR 32-56) years, with 1391 (67.20%) male patients. The median hospital stay was 12 (IQR 7-20) days. Falls accounted for 1221 (58.99%) cases, and road traffic accidents for 195 (9.42%). Spinal fractures were present in 1076 (51.98%) patients with 456 (42.38%) in lumbar vertebra. There were 225 (10.87%) cases of subluxation with 214 (95.11%) in cervical level. Conclusions: The study provides insights into the patterns and outcomes of spinal injuries over five years of time. The mortality rate and cases of patients leaving against medical advice highlight areas for improvement in patient care and follow-upPublication Pediatric Usher Syndrome Type 2A with Coexisting Rheumatic Heart Disease and Upper Gastro-Intestinal Bleed: A Case Report(Nepal Medical Association, 2024) Yadav, Bishal; Khadka, Tunam; Shah, Toyendra Jung; Phuyal, Mandish Prasad; Lamichane, Rajesh; Chaurasiya, BikashAbstract Usher syndrome is a rare autosomal recessive disorder characterized by progressive sensorineural hearing loss and retinitis pigmentosa, typically present from birth and later symptoms, including loss of night vision and peripheral vision slowly progressing to blindness. The condition exhibits clinical and genetic diversity and currently lacks the definitive treatment. This report presents a case of a ten-year-old female diagnosed with Usher syndrome type IIA via whole exome sequencing. The delayed onset of visual symptoms often leads to a misdiagnosis to isolated deafness in early years. The early identification allows for better prognosis through surveillance and intervention in hearing and visual impairments. If usher patients can receive a timely diagnosis, genetic molecular therapies may help preserve the photoreceptors, subsequently development of blindness could be delayed or possibly be prevented.Publication Tracking Progress of National Health Summit Declarations - Health Policy Analysis: A Qualitative Study(Nepal Medical Association, 2025) Shrestha, Ashis; Poudel, Lisasha; Tikhatri, Dipesh; Regmi, Sushant; Jha, Jay Bhushan; Baniya, Shreya; Phuyal, Mandish Prasad; Prasai, Akanshya; Kunwar, Sunil; Chand, Amit; Karki, Prakriti; Tamrakar, Nurusha; Sapkota, Ritu; Yadav,k RamanAbstract Introduction: The National Health Summit is a policy discussion platform that advocates the policy statement stated by National Health Policy 2019 which results in a set of declarations to address issues in the health system. This study’s objective is to monitor the extent of declaration’s implementation, its facilitators-barriers, and to formulate recommendation for future National Health Summit declarations and implementation strategies. Methods: This is a qualitative study conducted by Nepal Medical Association. in November-December 2024. Ethical approval from Nepal Health Research Council, Ethical Review Board (Reference number: 1069). The study was designed using the Realistic Evaluation Framework to look into the “context” which are the external factors impacting implementation of the declarations, the “mechanism” which are key elements facilitating or hindering policy changes, and the “outcome” which were the tangible results of NHS declarations. Results: Review and analysis of the participant responses identified policy influene and advocacy as contexts. The mechanisms identified were political and bureaucratic challenges, collaboration, finaicial hurdles, commitment, accountability, leadership, evidence based practices. The outcome discussed were health system strengthening, health workforce, governance, innovation, advocacy and digaital transformations. Conclusions: Implementation of declaration is challenging, with fragmentation as major health issues, however, continuous advocacy has had a synergistic effect in implementation and prioritization of the policy.