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Nursing Consideration in Rhinocerebral Mucormycosis: A Case Report
(Nepal APF Hospital, 2025) Sharma, Pariksha; Rai, Hasina
Abstract: Introduction : Rhinocerebral mucormycosis is a rare but aggressive opportunistic fungal infection that predominantly affects immunocompromised individuals, particularly those with uncontrolled diabetes mellitus or undergoing immunosuppressive therapy. It demands urgent diagnosis and multidisciplinary management due to its rapid progression and high mortality rate. Case Presentation: This case report describes the clinical course of rhinocerebral mucormycosis in a patient with diabetic ketoacidosis (DKA), further complicated by post-herpetic neuralgia and lower motor neuron (LMN) facial palsy. The patient's deteriorating condition, development of secondary lesions suggesting disseminated infection, central nervous system involvement, and vascular compromise hindered the possibility of surgical debridement, ultimately resulting in respiratory failure and death. Nursing care played a pivotal role throughout, including the management of DKA using glucose-potassium-insulin (GKI) protocols, administration of Amphotericin B, detection of secondary lesions, pain management, monitoring vital parameters, and effective documentation and communication. Conclusion : The case highlights the crucial role of nurses in managing complex intensive care unit presentations, from early recognition of signs and symptoms to coordinating care, administering antifungal and supportive therapies, and providing psychosocial support to the patient and their family. Nursing competence in infection control, neurological assessment, and wound management is crucial for enhancing prognosis in high-risk cases.
Rocuronium-Induced Anaphylactic Shock during Elective Septoplasty: A Case Report Authors
(Nepal APF Hospital, 2025) Bajracharya, Nitendra Raj; Shrestha, Saurav; Dangol, Shova; Paudel, Rabi; Bishwokarma, Pushkar; Shrestha, Surendra Man
Abstract: Introduction : Perioperative anaphylaxis is a rare but potentially fatal complication during anesthesia. Among muscle relaxants, rocuronium is a leading cause of intraoperative anaphylaxis. Early recognition and prompt management are crucial to reduce morbidity and mortality. Case presentation: We report a 14-year-old female with a medical history of Hashimoto’s thyroiditis and dissociative disorder scheduled for elective septoplasty. Following induction with midazolam, fentanyl, propofol, rocuronium, and tracheal intubation, the patient developed severe hypotension, tachycardia, generalized rash, lip swelling, and increased airway pressure, suggestive of Grade III anaphylaxis suspected to be secondary to rocuronium. Immediate management with intravenous epinephrine boluses (300 mcg ×2), fluid resuscitation (2 Litres Normal Saline), hydrocortisone, ketamine, and initiation of an epinephrine infusion (0.1 mcg/kg/min) was done and surgery was postponed. The patient was transferred to the ICU for close monitoring. Epinephrine infusion was tapered off and trachea was extubated the next day, and discharged to the ward on the third day without neurological or respiratory sequelae. Conclusion: This case emphasizes on the importance of early recognition of rocuronium-induced anaphylaxis, rapid administration of epinephrine and aggressive supportive care. The incidence of such reactions remains low, but the high fatality rate necessitates preparedness during anesthesia.
Inhaled Isopropyl Alcohol and Intravenous Ondansetron for Post operative Nausea and Vomiting in Patients Undergoing Laparoscopic Surgery: A Cross-Sectional Study
(Nepal APF Hospital, 2025) Bohara, Chetan; Bhandari, Parshal; Giri, Kshitizma; Bimali, Aayush; Bajracharya, Prashanna
Abstract: Introduction: Post-operative nausea and vomiting (PONV) is frequently encountered in post operative care unit. Effective treatment is promptly warranted to decrease morbidity of patients. Female gender, nonsmoker, young age, laparoscopic gastrointestinal surgeries are major risk factors for PONV. Ondansetron is commonly used for its prevention and treatment. However, inhaled isopropyl alcohol (IPA) can also be used and recently been into practice. In this study we compared inhaled isopropyl alcohol and intravenous ondansetron for treatment of post operative nausea and vomiting after laparoscopic surgery among female patients. Methods: This study was carried out at Lumbini Medical College and Teaching Hospital and included 76 female patients, aged 18 to 60 years, classified as ASA I–II, who were scheduled for laparoscopic surgery. At time of preoperative evaluation, patients were divided into two groups i.e., Group I and Group O, each consisted 38 patients. Post surgery, patients who experienced PONV in the recovery room either received inhalation treatment with 70% isopropyl alcohol (IPA)-(Group I) or 4mg ondansetron intravenously (Group O). Nausea levels were monitored using a verbal numeric rating scale (VNRS) at regular time intervals. A treatment was considered successful if the patient’s nausea and vomiting score decreased by 50% or more Results: Among 76 patients, 29 (38.16%) developed PONV. Both groups had similar baseline characteristics and initial PONV severity with p-value > 0.05. The IPA group experienced faster symptom relief, achieving 50% reduction in symptoms in 4.69 ± 2.02 minutes compared to 7.73 ± 2.59 minutes in the ondansetron group (p = 0.001). Conclusions: Inhaling 70% isopropyl alcohol provided faster relief from postoperative nausea and vomiting.
Three Delays Model and its Determinants for Maternal Death: A Descriptive Cross- Sectional Study Authors
(Nepal APF Hospital, 2025) Joshi, Rijuta; Jaiswal, Ekta; Timalsina, Gyanu; Byanjankar, Sunita
Abstract: Background: Despite significant improvements in reducing maternal mortality in Nepal, preventable deaths persist due to gaps in timely care-seeking, access, and service delivery. The ‘Three Delays Model’ offers a framework to examine delays contributing to maternal mortality and guide targeted interventions. This study was done to analyze the types of delays and determinants contributing to these maternal deaths. Methods: A retrospective cohort study of maternal deaths was conducted Patan Hospital, Nepal, from July 2021 to July 2024. Data were extracted from hospital records and maternal mortality audit reports. The ‘Three Delays Model’ was applied to categorize barriers: delay 1-decision to seek care, delay 2-reaching care, and delay 3-receiving adequate care. Descriptive analysis was performed using Microsoft Excel. Results: This study identified 16 maternal deaths over three years, with highest mortality among primigravida women in late pregnancy and postpartum periods. Indirect causes were predominant than direct obstetric causes. Dealy in seeking health care was the predominant followed by the delay in receiving care. Discussion: The main determinants of the Delay 1 were poor health literacy, cultural norms, and institutional mistrust. Comparative evidence from Nepal and other low-resource settings highlighted overlapping delays and facility-level gaps that compounded the risk. In order to reduce preventable maternal deaths, culturally responsive health education, improved community engagement, and strengthened hospital facilities may be helpful. Conclusion: Maternal deaths in Nepal remain influenced by behavioral and systemic factors, with Delay 1 as the most prevalent underlying cause followed by Delay 3.
Neonatal Sequential Organ Failure Assessment Score to Predict Mortality in Neonatal Intensive Care Unit at Tertiary Care Center
(Nepal APF Hospital, 2025) K.C., Ganesh; Shah, Ganesh; Chalise, Shiva Prasad; Shrestha, Bijesh; Shrestha, Sailesh; Gautam, Tilak; Khanal, Inesh
Abstract: Background: The Neonatal Sequential Organ Failure Assessment (nSOFA) score is a tool used to evaluate degree of organ dysfunction in critically ill neonates admitted to neonatal intensive care units (NICUs). The nSOFA score is based on respiratory, cardiac and hematological parameters (total score ranges from 0 to 15). This study aims to evaluate the applicability of nSOFA score to predict neonatal mortality in NICU of Patan Hospital. Methods: This prospective observational study was conducted at the NICU of Patan Hospital, Lalitpur, Nepal from May 2023 to November 2024. The parameters of nSOFA score were recorded at admission and between 48-72 hours of admission. Data were analyzed using EPI-INFO and Easy R software. Results: Among 134 neonates, 105 (78%) survived, and 29 (22%) did not. At admission, a nSOFA score ≥4 had a sensitivity of 69%, specificity of 91.4%, positive predictive value (PPV) of 69% and negative predictive value (NPV) of 91.4% for predicting mortality. At 48-72 hours, a cutoff score of ≥5 showed a sensitivity of 75.7%, specificity of 99%, PPV of 96.6% and NPV of 91.4%. Conclusion: The nSOFA score is a important tool for predicting neonatal mortality in NICUs and can be used to guide clinical decision-making.
A Clinico-epidemiological Profile of Patients with Alopecia Areata: A Hospital-Based Cross-Sectional Study
(Nepal APF Hospital, 2025) Maharjan, Rupak; Karki, Alina
Abstract: Introduction: Alopecia areata is one of the common types of non-cicatricial alopecia. It is considered an autoimmune disorder and effects hair bearing areas like scalp, eyebrows and beard. It also carries psychological burden. This study aims to evaluate clinicoepidemiological profile of patients diagnosed with alopecia areata attending the dermatology outpatient department (OPD) of a tertiary care center. Methods: After clearance from IRC of the hospital, a cross sectional study was conducted from January 1st 2025- June 30th 2025. Data on patient demographics (age, sex), clinical diagnosis, examination findings were collected in preformed proforma and entered in SPSS version 21.0. Descriptive statistics were used for analyses. Results: In our study 52 cases were diagnosed with alopecia areata during the study period, out of which 40 (76.93%) were males and 12 (23.07%) were females with male female ratio of 3.3:1. Majority of patients 24 (46.15%) were in 31-40 years age group followed by 12 (23.10%) cases in 21-30 years age group. Most of the cases 46 (88.46%) had no symptoms and the disease duration was predominnantly 43 (82.70%) less than 3 months. Scalp 42 (80.76%) was the most common site involved and patchy alopecia 43 (82.70%) was most common pattern seen. Nail changes were found in 11 (21.15%) of cases. Conclusion: In our study, Alopecia areata was more common in males, scalp predominant site involved and patchy hair loss the most common pattern observed.
Stress and Coping Strategies among the Caregivers of the Patients Admitted in Critical Care Units in Tertiary Hospital
(Nepal APF Hospital, 2025) Thapa, Saroja; Pandey, Prabin Raj
Abstract: Introduction: The number of patients with higher severity admitted to critical care units has increased in recent years. Family members suffer physiological, emotional, and psychological changes in addition to financial and organizational losses. Those who struggle with efficient coping may experience interpersonal difficulties and struggle to find solutions to issues. The aim of this study was to explore the stress and coping strategies among the caregivers of the patients admitted in critical care units. Methods: A purposive phenomenological study involving eight caregivers from Intensive Care Unit and High Dependency Unit was conducted, using in-depth interview. Data was collected between August to September 2024. Ethical clearance was obtained from the Institutional Review Committee (Reference number: NAPFH-008/2024) of Nepal Armed Police Force Hospital. The interviews were audio-recorded, transcribed verbatim, translated in English and analyzed using thematic analysis. Results: Out of eight participants, ten themes were identified. These include: a) Lack of information and communication; b) Emotional response to ICU and HDU admission; c) Role strain and physical exhaustion; d)Financial strain; e) Experience of the Critical Care Unit (CCU); f) Seeking Social Support; g) Emotional Regulation and Acceptance; h) Coping Mechanisms; i)Communication and Trust in Healthcare Providers; and j) Maintaining Physical Health. Conclusion: The study found that family members experienced stress in their role as caregivers. People's perceptions of stress had a big impact on the caregiving duties they carry out. The findings showed that coping strategies were implied according to the stress perceived by the family members as caregivers.
Clinico-demographic, Thyroid, and Lipid Biomarkers in Patients with and without Type 2 Diabetes Mellitus in a Paramilitary Hospital, Nepal
(Nepal APF Hospital, 2025) Shrestha, Mahendra Raj; Shrestha, Apurba; Bhat, Dinesh Singh; Maharjan, Rajendra
Abstract Introduction: Diabetes disrupts the hypothalamic regulation of thyroid-releasing hormone and impacts the synthesis of triiodothyronine (T3) and thyroxine (T4), leading to disrupted lipid biomarker levels. This study was aimed how HbA1c correlates with body mass index (BMI), thyroid and lipid biomarkers in patients with and without type 2 diabetes mellitus (T2DM). Methods: This case-control study was conducted at the Tertiary Care Paramilitary Hospital between July 2023 and June 2024, along with 202 T2DM patients and 211 controls. Ethical approval was taken from Ethical Review Board (Reference number:3795). Data on clinico-demographic and anthropometric variables were collected. Fasting venous blood samples were analyzed for HbA1c, thyroid, and lipid profiles. Correlational analyses were conducted using Statistical Package for the Social Sciences (SPSS) version 17 with significance set at p<0.05. Results: The prevalence of T2DM among hospital visitors was 8.12% (202/2,488) [males: 60.40% (122/202); ageMedian: 51 years; BMIMedian: 25.68 kg/m2]. Among T2DM patients, 18.81% (38/202) had dysthyroidism, predominantly hypothyroidism (17.82%, 36/202), especially in females (100.00%, 11/11) and those who were overweight. Additionally, 54.95% (111/202) of T2DM patients had dyslipidemia, with hypertriglyceridemia (50.99%, 103/202) being the most common, particularly among males (94.52%, 69/73) and overweight patients. T2DM patients had significantly higher BMI, triglycerides, and thyroid-stimulating hormone (TSH) levels compared to non-T2DM patients. HbA1c was positively correlated with total cholesterol (p=0.041) and triglycerides (p=0.004), HDL with T3 (p=0.005), and BMI with age (p=0.048). Conclusions: T2DM affected less than one-tenth of hospital-visiting patients, primarily males and those aged 50–59. Dyslipidemia was common among T2DM patients, with dyslipidemia and hypothyroidism being most prevalent in overweight males and females, respectively. Regular testing of triglycerides, TSH, and T4 in T2DM patients can help reduce morbidity.
Clinico-epidemiological profile of Sexually Transmitted Infections in a tertiary hospital: A Cross- Sectional Study
(Nepal APF Hospital, 2025) Karki, Alina; Maharjan, Rupak; Manandhar, Varsha
Abstract: Introduction: Sexually transmitted infections (STIs) are communicable diseases that occurs due to sexual contact. They are a major global health problem which affect quality of life of the patients. Knowledge on frequency and pattern of STIs help in early diagnosis and appropriate treatment. This study was done to determine the prevalence and pattern of various STIs in Nepal Armed Police Force (APF) Hospital, Kathmandu. Methods: This retrospective cross-sectional descriptive study was conducted among patients visiting Dermatology OPD of Nepal APF Hospital from 1st Dec 2019 to 30th Nov 2023. The data were recorded in preset proforma, entered in SPSS software and analyzed using descriptive statistics. Results: A total of 165 patients were included in the study among which 121 (73.33%) were males and 44 (26.67%) were females with male female ratio of 2.7:1. Most of the patients were married and in age group (26-35) years (76, 46.06%). Heterosexual contact was the most common mode of sexual contact. Most common STIs were condyloma acuminata (56, 33.95%) followed by urethral discharge syndrome (37, 22.43%), herpes genitalis (28, 16.97%), vaginal discharge syndrome (20, 12.12%), syphilis (18, 10.90%), molluscum contagiosum (3, 1.81%) and others (3, 1.81%). Conclusion: Viral infections were the most common STIs and were predominantly seen in males. Sexual education and awareness activities are more important to reduce the burden of infections and their proper treatment.
Nutritional Status of Children Under Five Years in a Tertiary Care Center: A Cross-Sectional Study
(Nepal APF Hospital, 2025) Chand, Bharat; Poudel, Drishti; Shrestha, Anil; Thakuri, Pushpa Chand; Thapa, Madhu; Shahi, Anita
Abstract: Introduction: Malnutrition remains a leading cause of under-five mortality globally and in Nepal, with significant rates of stunting, wasting, and underweight. Despite national progress, child nutrition challenges persist, especially among vulnerable groups in hospital settings. This study assesses the nutritional status of under-five children attending a tertiary care center in Nepal. Methods: This descriptive cross-sectional study was conducted among 260 under-five children attending the Pediatric Department of Nepal APF Hospital, Kathmandu, from February to June 2025 after ethical approval. Data were collected through face-to-face interviews with caregivers and anthropometric measurements. Nutritional status was assessed using WHO standards. Descriptive statistics, chi-square test, and logistic regression were used for analysis. Results: Among 260 children under five years, the overall prevalence of malnutrition was 30%, including 10% stunted, 11.2% wasted, and 15.4% underweight. Malnutrition was significantly associated with the child’s age (p < 0.001), with children below 24 months more likely to be malnourished. Father's education level also showed a significant association (p = 0.005), where lower paternal education correlated with higher malnutrition rates. No significant associations were observed with maternal, environmental, or child-rearing characteristics. Conclusion: The present study found a notable burden of malnutrition among under-five children visiting a tertiary care center in Kathmandu with younger age and father’s education significantly associated with malnutrition. Targeted early-life nutritional interventions and improved parental education can help to improve the nutritional status of under five children.
Musculoskeletal Manifestations in COVID-19 Patients at Paramilitary Hospital: A Cross-sectional Study
(Nepal APF Hospital, 2025) KC, Samir; Shrestha, Sailendra Kumar Duwal; Nepal, Prabin; Karki, Umash; Karki, Netra Bahadur; Mahaseth, Adarsha
Abstract: Introduction: Musculoskeletal symptoms are common in coronavirus disease 2019 (COVID-19) but are understudied in low-resource settings such as Nepal. This study aimed to assess the prevalence, spectrum, and severity of musculoskeletal manifestations in adults with acute COVID-19. Methods: We conducted a hospital-based, cross-sectional study at Nepal Armed Police Force Hospital, Kathmandu, from June to September 2023. Adults (≥18 years) with RT-PCR–confirmed COVID-19 were enrolled consecutively. Demographic, clinical, and laboratory data were collected. Musculoskeletal symptoms—myalgia, arthralgia, fatigue, low back pain, and paresthesia—were assessed using standardized questionnaires and severity scores (VAS/NRS). COVID-19 severity was classified per NIH criteria. Associations between symptom prevalence/severity and disease severity or viral load (Ct values) were analyzed using chi-square and ANOVA tests. Results: A total of 250 patients (47.6% male; mean age 49.8±18.1 years) were studied. Myalgia (70.0%), arthralgia (63.2%), and fatigue (61.2%) were the most frequent symptoms, followed by low back pain (44.0%) and paresthesia (4.4%). Symptom severity increased significantly with COVID-19 severity (p<0.001 for all). Myalgia, arthralgia, and fatigue had higher mean scores in moderate/ severe cases. There was a significant inverse association between RT-PCR Ct values and symptom severity, with higher viral loads correlating with more severe symptoms (p<0.001). Persistence of musculoskeletal symptoms at follow-up was observed exclusively in severe cases. Conclusions: Musculoskeletal symptoms, particularly myalgia, arthralgia, and fatigue, are highly prevalent and severe in COVID-19 patients in Nepal, with greater intensity in those with more severe disease and higher viral loads. Persistent symptoms after recovery highlight the need for integrated rheumatological and rehabilitative care in post-COVID management.
Relationship between Preoperative Anxiety and Postoperative Pain among Patients undergoing Elective Surgery in Tertiary Care Center
(Nepal APF Hospital, 2025) Subedi, Seema; Shrestha, Sanjesh
Abstract: Introduction: Preoperative anxiety refers to a patient’s unpleasant state of worry before surgery. Appropriate postoperative pain management benefits patients by reducing postoperative cognitive impairment, improving quality of life, and lowering the risk of chronic postsurgical pain. The aim of this study was to identify the relationship between preoperative anxiety and postoperative pain among patients undergoing elective surgery. Methods: This descriptive cross-sectional study was conducted among patients undergoing elective surgery in the surgical ward of Nepal Armed Police Force Hospital from July to September 2024. Ethical clearance was obtained from the Institutional Review Committee (Reference number: NAPFH-006/2024) of Nepal Armed Police Force Hospital .This ex post facto study was conducted among 109 respondents using a non-probability purposive sampling technique. Data were collected via self-administered standard semi-structured questionnaires (Amsterdam Preoperative Anxiety and Numerical Pain Rating scale). Descriptive statistics including frequency, percentage, and mean were used for data analysis. Chi-square test and logistic regression were performed to identify associations between preoperative anxiety and socio demographic variables. Results: Out of 109 respondents, 86 (78.90%) had preoperative anxiety. Preoperative anxiety showed a significant association with postoperative pain at 2 hours after surgery. Similarly, a significant relationship was also found between age and type of anesthesia during the 6-hour and 24-hour postoperative periods respectively. Conclusions: The study found that the majority of patients experienced preoperative anxiety. A relationship between preoperative anxiety and postoperative pain was observed. It showed that preoperative anxiety had a significant relationship in the immediate postoperative period. Further dimensions like preoperative medications, postoperative medications and care could be added to make the study more effective.
Histopathological Findings in Cholecystectomy Specimens of Gallbladder in a Tertiary Care Hospital in Kathmandu: A Descriptive Cross-Sectional Study
(Nepal APF Hospital, 2025) Maharjan, Rajendra; Khadka, Rajya
Abstract: Introduction: The gallbladder is one of the most frequently resected organs which is examined in a surgical pathology practice. It presents with a wide spectrum of lesion on histopathology. Gallbladder is among the most common organs where incidental gallbladder carcinoma occurs. The study was aimed to find the prevalence of various histopathological spectrum of gallbladder among cholecystectomy specimens in a tertiary care hospital in Kathmandu. Methods: A descriptive cross-sectional study was conducted in the Department of pathology, of a tertiary care hospital from January 1, 2023 to December 30, 2024. Ethical approval was taken from the Institutional Review Committee (Reference number: NAPFH-037/2024). All the patients who had undergone cholecystectomy for gallbladder diseases were enrolled in the study. Enumeration sampling technique was done. Basic statistics and Microsoft Excel were used for data analysis. Results: Out of 400 cholecystectomy specimens, Chronic cholecystitis with specific finding was the most common finding with 270 (67.50%) cases. 11 (2.75%) cases of dysplasia and one (0.25%) case of gallbladder adenocarcinoma was observed. There were 125 (31.25%) males and 275 (68.75%) females with a male to female ratio of 1:2.2. Age ranged from 15 to 83 years with a mean age of 44.32±13.55 years. Gallbladder lesions were observed maximum in age group 30-39 years with 136 (34.00%) cases. Conclusions: The prevalence of histopathological spectrum of gallbladder is similar to other studies done in similar settings. Female predominance was noted in gallbladder lesions.
Prevalence of Anti-Thyroid Peroxidase Antibody in Hypothyroid Patients Visiting Western Regional Hospital: A Cross-Sectional Study
(Nepal APF Hospital, 2025) Bastola, Basanta Kumar; Suresh, Thapa; Regmi, Kiran; Hamal, Surya Bahadur; Poudel, Rajendra; Sharma, Soniya
Abstract: Introduction: Hypothyroidism is a common endocrine disorder with autoimmune thyroiditis increasing as a major cause, especially in iodine-sufficient areas. Anti-thyroid peroxidase (antiTPO) antibodies are important markers of autoimmune thyroid disease. The objective of this study to determine the prevalence of anti-TPO antibodies in hypothyroid patients and their correlation with the type of hypothyroidism, age, gender, and clinical presentation. Methods: This analytical cross-sectional study was conducted among 73 hypothyroid patients attending the OPD and medical ward of Western Regional Hospital (WRH), a tertiary care centre in Gandaki Province. Demographic and clinical data were collected. Laboratory assessments included thyroid function tests and anti-TPO levels using chemiluminescence immunoassay. Descriptive and inferential statistics were applied using SPSS v27. Results: Among 73 participants (mean age 42.1 ± 12.07 years), 81% were female. Anti-TPO antibodies were positive in 38% of patients. Among patients with overt hypothyroidism, 41% were anti-TPO positive, while 36% of subclinical hypothyroidism patients had anti-TPO positivity. No statistically significant associations were found between anti-TPO status and gender (p=0.821), type of hypothyroidism (p=0.666), or age group (p=0.24). Likewise, the common presenting signs and symptoms did not have statistically significant association with the TPO positivity status. Conclusion: Over one-third of hypothyroid patients had anti-TPO antibody positivity, with a slightly higher prevalence in overt hypothyroidism. However, demographic and clinical variables did not significantly correlate with antibody status.
Launching MJAPFN: Bridging Medical Science, Service, and Scholarship
(Nepal APF Hospital, 2025) Shrestha, Sailendra Kumar Duwal
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Dhat Syndrome: A Case Report
(Rapti Academy of Health Sciences (RAHS), 2024) Uprety, Saroj; Jaiswal, Dhiraj prasad
Abstract: Dhat syndrome is a culture-bound syndrome mostly prevalent in the Indian subcontinent. Young men of low or medium socioeconomic class who are single or recently married, are from rural areas, and have a conservative view of sex are most frequently reported to have Dhat syndrome. Individual cases are managed by addressing sexual myths, using relaxation techniques, supportive psychotherapy, anxiolytics, and antidepressants. We present a case of a 23-year-old unmarried male with dhat syndrome who was managed by supportive psychotherapy and antidepressant.
Myositis Ossificans in the Shoulder – A Case Report
(Rapti Academy of Health Sciences (RAHS), 2024) Neupane, Bikash; Panthi, Sagar; Shrestha, Rishishwor; Sherchan, Rupesh Man; Sharma, Nischal; Shrestha, Shrawan; BC, Bom
Abstract: Myositis ossificans is a non-neoplastic, rare medical condition characterized by heterotopic bone formation in non-skeletal muscle or soft tissues. It is an idiopathic disorder in which trauma plays a significant contributing role, typically appearing 4 to 12 weeks after the injury. While the elbow is the most common site, myositis ossificans can occur anywhere in the body and is particularly common in young athletes, especially males in their second to third decades of life. This case study reports the observation of a 27-year-old male who presented with a shoulder mass 9 years after trauma sustained while playing volleyball. The condition was diagnosed as myositis ossificans in the shoulder, around the deltoid muscles. Excision of the mass was performed after confirmation through MRI scans and biopsy.
Cost Variation Analysis of Oral Hypoglycaemic Agents in Type 2 Diabetes Mellitus in Tertiary Care Hospital in Nepal
(Rapti Academy of Health Sciences (RAHS), 2024) Shrestha, Laxmi; Basnet, Ambika; Palikhey, Anjan; Shrivastava, Amit Kumar; Joshi, Bishal
Abstract: Introduction: Diabetes Mellitus is a chronic metabolic condition affecting millions of individuals worldwide. The cost of drug therapy plays a significant role in the treatment of chronic disorders like type 2 diabetes mellitus, where lifelong medication is required. Understanding the cost variations of oral hypoglycemic agents is essential for optimizing treatment and improving patient compliance. This study was aimed at identifying the affordable treatment strategies for the management of type 2 diabetes mellitus. Methodology: A hospital-based cross-sectional study was conducted at the outpatient department of Medicine at UCMS-TH, Bhairahawa, Nepal, from December 2022 to May 2023. The cost of a drug manufactured by various companies, in the same strength and dosage form, was obtained. The difference in maximum and minimum price of the same drug manufactured by different companies and percentage price variation was calculated. Results: Among 250 prescriptions, the percentage price variation was highest in Voglibose (0.3 mg), 454.4%, followed by Metformin (500 mg) 260%, and least with Sitagliptin (50 mg) and Linagliptin (5 mg), i.e., 4.16% and 3.89%, respectively in monotherapy. In combination therapy, Metformin+Glimepiride (500 mg+1 mg) 285.71%, followed by Metformin+Linagliptin (500 mg+2.5 mg) 52.3%, showed maximum price variation. The least variation (3.84%.) was seen in the combination of Metformin+Linagliptin (850 mg+5 mg). Conclusion: A huge difference in the prices of different brands was observed. It is essential to educate prescribers regarding the significant price variation. Prescribing a cost-effective drug by the physician improves the patient’s adherence to the treatment regimen and minimizes the financial burden.
Prevalence of Precancerous Cervical Lesion in Women Attending Cervical Cancer Screening Programme at a Tertiary Level Hospital
(Rapti Academy of Health Sciences (RAHS), 2024) Sharma, Sharmila; Khatri, Binita; Kunwar, Shishir
Abstract: Introduction: Cervical cancer is the second leading cause of cancer deaths in women in developing countries, and their incidence can be reduced by early detection and treatment of related precancerous lesions. Visual inspection with acetic acid (VIA) screening test is common method of finding precancerous cervical lesion. The aim of this study was to determine the prevalence of precancerous cervical lesions in women attending the cervical cancer screening program at a tertiary-level hospital. Methods: This retrospective, cross-sectional study (record review) was conducted among women who attended cervical screening at the Maternal and Child Health (MCH) clinic of Rapti Academy of Health Sciences (RAHS) from Baisakh to Chaitra, 2080. After obtaining ethical clearance from the Institutional Review Committee of RAHS (IRC RAHS), data on the participants’ age, residence, ethnicity, and other reproductive morbidities were retrieved from hospital records. Results: The hospital records of 1,055 women were analyzed in this study. The mean age of the participants was 37.91±10.41 years, with more than one-third (36.5%) in the age group of 31-40 years. Among those who underwent cervical screening, the prevalence of precancerous lesions was 4.4%. No significant associations were found between age (p=0.55), residence (p=0.91), ethnicity (p=0.055), or other reproductive morbidities and the prevalence of precancerous lesions at the 95% confidence level. Conclusion: The prevalence of precancerous cervical lesions was low; however, the findings highlight the need for establishing regular screening programs at the community level.
Epidemiological Profile and Seasonal Variation of Acute Appendicitis
(Rapti Academy of Health Sciences (RAHS), 2024) Panthi, Janardan; Shahi, Dinesh; Pokhrel, Dr. Bishal
Abstract: Introduction: Acute appendicitis is a common surgical condition, typically treated by appendectomy, though conservative management is possible. Understanding its epidemiology and seasonal variation aids in recognizing disease patterns and improving management. This study aims to assess the disease burden and seasonal trends of acute appendicitis. Methods: This retrospective, observational, cross-sectional study was conducted at Rapti Academy of Health Sciences (RAHS) from April 2023 to March 2024, and included 472 patients diagnosed with acute appendicitis, appendicular lump, or abscess, who underwent appendectomy. Data were collected through record review using a preformed proforma. Results: The study found a nearly equal gender distribution, with males comprising 55.1% and females 44.9%. Most participants were aged 20-40 years (41.5%, mean age: 32.48 years). Acute appendicitis was the most common diagnosis (79.2%), and open appendectomy was the most frequently used treatment (72.5%). The highest number of cases occurred in June (10%), with a mean temperature of 33.17°C. No statistically significant correlation was found between environmental factors (temperature, humidity, sunshine) and appendicitis incidence. Conclusion: While none of the environmental factors showed a statistically significant association with the frequency of acute appendicitis, the condition was more common during the rainy season.

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