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Diabetic Retinopathy among Diabetic Patients at a Tertiary Care Hospital: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2022) Bastola, Pradeep; Khatiwada, Saurav; Khadka, Mandira; Dahal, Polina; Bastola, Sheeksha
Abstract Introduction: The alarming rise in the prevalence of diabetes mellitus is a global public health and economic problem. Diabetic retinopathy is the most common ocular morbidity in the diabetic population and is the leading cause of blindness among the working-age group. This study was aimed to find out the prevalence of diabetic retinopathy in diabetic patients attending to the department of ophthalmology of a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted in the Department of Ophthalmology of a tertiary care hospital from 15th August to 30th November 2021. Ethical clearance was taken from the Institutional Review Committee (Reference number: CMC-IRC/078/079-021). Convenience sampling was done. Basic demographic data, risk factors, clinical characteristics, and prevalence of diabetic retinopathy were noted. Data entry was done using Statistical Package for the Social Sciences version 26.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: Among 540 participants, 146 (27.04%) (23.29-30.79 at 95% Confidence Interval) study subjects had diabetic retinopathy changes in at least one eye. Smoking in 88 (60.27%), type 2 diabetes mellitus in 139 (95.21%), hypertension in 85 (58.22%), raised glycated hemoglobin levels in 120 (82.19%) were the major factors observed in the study subjects. Conclusions: The prevalence of diabetic retinopathy was higher in our study when compared to national studies.
Gestational Diabetes Mellitus among Pregnant Women Delivering in a Tertiary Care Hospital: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2022) Singh, Sumi; Yadav, Manisha
Abstract Introduction: Gestational diabetes mellitus is increasing globally leading to significant maternal and foetal morbidity. This study aimed to find out the prevalence of gestational diabetes mellitus among pregnant women delivering in a tertiary care hospital. Methods: A descriptive cross-sectional study on a total of 3034 pregnant women was conducted in a tertiary care hospital from 14th April 2017 to 13th April 2018 with ethical approval from Research and Institutional Review Committee (Reference number: 061-077/078) of the hospital. Pregnant women who met the eligibility criteria were included in the study. Convenience sampling was done. Data were analysed using the Statistical Package for the Social Sciences version 24.0 and Microsoft Excel. Point estimate at 99% Confidence Interval was calculated along with frequency and percentage for binary data. Results: Among 3034 patients who delivered in the tertiary centre, the prevalence of gestational diabetes mellitus was found to be 104 (3.42%) (2.57-4.26 at 99% Confidence Interval). The majority of women were of maternal age >30 years in 69 (66.34%). Out of which 48 (46.15%) women had family history of diabetes mellitus. Thirty-eight (36.53%) patients required a caesarean section. The most common obstetric complication was polyhydramnios in 35 (35.57%). Conclusions: The prevalence of gestational diabetes was lower when compared to other studies done in similar settings. The majority of women were of higher maternal age, had family history of diabetes mellitus and were also obese.
Coping up with Stress as a Medical Student
(Nepal Medical Association, 2022) Acharya, Jiya; Sahani, Shambhu
Abstract Psychological stress is one of the most common problems faced by medical students in their day to day life. There are a variety of manifestations of stress and these manifestations can directly or indirectly hamper the performance of a medical student. Knowing proper measures to manage stress as well as time can help medical students live their life in a more practical way. Practising mindfulness, mental health awareness and seeking help from experts can be beneficial in coping with stress as a medical student.
Integrated Electronic Health Record System in a Tertiary Care Centre: A Single Centre Implementation Experience
(Nepal Medical Association, 2022) Agrawal, Pawan Kumar Bajaj; Giri, Baburam; Gupta, Priyanka; Khatri, Rohit; Devkota, Shreya
Abstract An integrated electronic health record system is a common platform for efficient and active interaction of four major subsystems namely the medical record system, laboratory system, picture archiving and communication system and enterprise resource planning system. Barriers like knowledge and attitude of computer usage, time consumption, information technology workforce, electricity, cost of technology and devices, data safety and security deter institutions from implementation. However, implementation of this system is inevitable with its inherent advantages of efficient storage and timely retrieval, comparison of lab and imaging data over time, cash billing, institutional resource planning and finally ease of processing insurance claims as the Government of Nepal is looking forward to financing public health sector through the national health insurance system. Many hospitals struggle to implement and maintain integrated electronic health records. We aimed to discuss the steps undertaken to integrate this system in a district hospital setting with the inherent challenges and the subsequent impact.
Aspiration of a Row of Artificial Dentures in an Adult: A Case Report
(Nepal Medical Association, 2022) Dulal, Malati; Tripathi, Prashant; Shrestha, Amit; Acharya, Kunjan; Niroula, Sailesh
Abstract Clinical findings of foreign body aspiration, generally, are subtle. Scrutinous clinical suspicion is always recommended. Here, we present a rare case of an adult male, who under the influence of alcohol had aspirated a row of his artificial denture without his conscience of where his denture got missing and presented to our outpatient department with non-specific symptoms. With clinical examination and advanced diagnostics, he was successfully managed with rigid bronchoscopy. With the advancement in diagnostic techniques and our widened knowledge of the condition, utmost early detection has been possible and our case report reinforces the need for a low threshold for foreign body aspiration suspicion, especially in adults with dentures, and the use of rigid bronchoscopy as a plausible tool for the prompt management of the aspiration.
Surgical Removal of a Long-Standing Impacted Firearm in Neck: A Case Report
(Nepal Medical Association, 2022) Adhikari, Arun; Mahoto, Nain Bahadur; Khatri, Bijay
Abstract The gunshot neck injury is an emergency and must be addressed immediately. However, as our case report, a long-standing retained foreign body (firearm) in the deep neck is rare. Surgical removal of a long-standing foreign body is challenging for the operating surgeon. A 36-year-old male with a history of a firearm injury to the neck dating 16 years back with complaints of recent onset of pain was evaluated. A computed tomography scan of the neck showed a metallic foreign body located in close proximity to the right common carotid artery. Neck exploration was performed under general anaesthesia, and the foreign body was removed without complications. The patient has recovered following the intervention and has resumed his normal activities. The use of methylene blue helps to locate the foreign body during surgery. However, the choice of intervention for a stable patient with a penetrating neck injury remains based on cases.
Mucinous Carcinoma of the Skin: A Case Report
(Nepal Medical Association, 2022) Jhunjhunwala, Adarsh Kumar; Magar, Dilasma Gharti; Upreti, Dipesh; Thapa, Niku; Ghosh, Arnab; Thapa, Sushma; Regmi, Sudeep; Timilsina, Bishowdeep
Abstract Primary mucinous carcinoma of the skin is a rare malignant neoplasm showing predilection to the periorbital region. These tumours are indolent and low-grade, with a tendency for local, sometimes multiple, recurrences. Distinguishing between these primary neoplasms and the more frequent metastatic mucinous deposits on the skin from primaries in the breast and gastrointestinal tract constitutes a diagnostic dilemma. In this case report, we have put forth the findings of a 70-year-old male who presented with a slow-growing periorbital swelling and was subsequently diagnosed with mucinous adenocarcinoma. An extensive workup in search of another primary tumour failed to show a primary malignancy elsewhere and the diagnosis of primary mucinous adenocarcinoma of the skin was rendered.
Minimal Change Disease in an Adult: A Case Report
(Nepal Medical Association, 2022) Neupane, Shashank; Pudasaini, Prasamsa; Sharma, Anupam; Sharma, Shriya; Adhikari, Aakriti; Roka, Kumar
Abstract Minimal change disease is an important cause of nephrotic syndrome in children, however, few cases are seen among adults. There is very little literature regarding the occurrence of minimal change disease in adults. We reported a case of a 63-year-old male who presented with the complaint of swelling around the eyes mostly during the morning for 18 days and frothing of urine for 7 days. On examination, the patient was ill-looking and had edema around the eyes and over the ankles. After preliminary investigations, renal biopsy was performed and electron microscopy revealed diffuse effacement of foot processes of visceral epithelial cells suggesting minimal change disease (podocytopathy). The patient has been treated with tablet prednisolone 60 mg per oral once daily, tablet ramipril 2.5 mg per oral once daily, and tablet torsemide 20 mg per oral twice daily. Hence, minimal change disease should also be considered as a differential diagnosis in adults presenting with the features of nephrotic syndrome.
A Spatial Model of Socioeconomic and Demographic Determinants of Dengue Hemorrhagic Fever in Nepal
(Kathmandu University, 2025) Mahato, RK; Htike, KM; Yadav, A; Baral, S; Yadav, RK; Kafle, A; Sharma, V
ABSTRACT Background Dengue hemorrhagic fever (DHF) has re-emerged across the global South, particularly in tropical and subtropical urban areas, driven by environmental changes alongside local demographic and socioeconomic factors. Objective To investigate the spatial patterns and socioeconomic determinants of dengue fever in Nepal from 2020 to 2023. Method Using Geographic Information Systems (GIS), Gi* cluster analysis, and Local Moran’s I statistics, the study examined the relationship between socio-economic variables and dengue incidence across districts. Key factors analyzed included population density, urbanization, and night-time light (NTL) intensity. Result Bivariate Local Indicators of Spatial Association (LISA) analysis showed fluctuating correlations between dengue hemorrhagic fever incidence and factors such as population density, urbanization, and night-time light intensity. Moran’s I value for population density were -0.083 in 2020, -0.082 in 2021, 0.526 in 2022, and -0.020 in 2023. Similarly, for urbanization, Moran’s I values shifted from -0.103 in 2020 to -0.090 in 2021, 0.458 in 2022, and 0.007 in 2023. Night-time light intensity also demonstrated changing correlations, with Moran’s I values of -0.091 in 2020, -0.102 in 2021, 0.415 in 2022, and -0.068 in 2023. A notable shift from negative to positive correlations occurred between 2020 and 2022. In 2022, high-incidence dengue hemorrhagic fever clusters emerged in densely populated areas, while distinct spatial patterns were observed in 2020 and 2021. Conclusion Dengue hemorrhagic fever risk spatial models are useful tools for detecting high-risk locations and driving proactive public health initiatives. The study emphasized the importance of dynamic, targeted public health interventions based on spatial and socio-economic factors to effectively manage evolving dengue outbreak patterns. KEY WORDS Dengue, Gi* statistics, Local indicators of spatial association, Socio-economic status, Spatial analysis
Efficacy of Budesonide Nasal Irrigation in Comparison to Normal Saline Irrigation in Post-Operative Management of Functional Endoscopic Sinus Surgery
(Kathmandu University, 2025) Shrestha, BL; Sijapati, D; Dhakal, A
ABSTRACT Background Nasal irrigation with normal saline and topical steroid spray forms the mainstay of treatment in post endoscopic sinus surgery patients. However nasal sprays may not deliver optimum dosage of drug to the paranasal sinus mucosa. Budesonide nasal irrigation solves this problem by delivering drugs in a high-volume high-pressure system. Objective The main objectiveof this study will provide insight into the efficacy of budesonide nasal irrigation following functional endoscopic sinus surgery (FESS) surgery and will help to establish new protocols in future. Method Forty-four patients were included and divided into 2 groups of 22 each. One arm received normal saline nasal irrigation and the other arm received budesonide nasal irrigation (1 mg in 500 ml) twice daily. Patients were followed up at 1st post-operative week and 10th post-operative week and on each visit Sino-Nasal Outcome Test (SNOT) 22 and Lund Kennedy Endoscopic scores (LKES) were assessed. Result The mean scores in the first visit was SNOT 22 : 15.73 + 8.897 vs 12.73 + 16.110 (p < 0.05) and LKES : 2.82 + 1.097 vs 1.77 + 1.52 (p > 0.05) in the saline and budesonide groups respectively. The mean scores in the second visit was SNOT 22 : 7.09+3.87 vs 3.73 + 8.70 (p < 0.05) and LKES : 1.64 + 0.790 vs 0.18 + 0.501 (p < 0.05) in the saline and budesonide groups respectively. Thus the budesonide arm had statistically significantly better scores when compared to the normal saline group. Conclusion Budesonide nasal irrigation with a positive pressure high volume device was found to have better efficacy when compared to normal saline irrigation. Budesonide nasal irrigation may be used in the post-operative management of endoscopic sinus surgery patients. KEY WORDS Budesonide, Endoscopic surgical procedure, LKES, Nasal irrigation, SNOT 22
Radiological Assessment of Femoroacetabular Impingement Morphology Using Computed Tomography in Asymptomatic Young Population
(Kathmandu University, 2025) Koirala, S; Gupta, MK; Baral, P; Adhikari, K
ABSTRACT Background Femoroacetabular impingement is regarded as precursor of osteoarthritis. Various studies have discussed the prevalence of femoroacetabular morphology but only few studies have been done on asymptomatic population using cross-sectional imaging. Objective To determine the prevalence of femoroacetabular impingement morphology in young asymptomatic population on computed tomography. Method This cross-sectional study was done in 200 individuals who underwent computed tomography for abdominal pathologies without any symptoms of hip pain, hip pathology or osteoarthritis. Multiplanar images were reformatted and assessed for the presence of parameters associated with femoroacetabular impingement; alpha angle greater than 55°, femoral head-neck offset less than 8 mm, angle of acetabular version less than 15°, lateral center edge angle greater than 40°. Result At least one of the femoroacetabular impingement morphology was detected in 162 hips. The prevalence of abnormal hip joint was higher in male patients than in female patients (47.3% vs 31.8%). Prevalence of cam morphology was 14.5%, pincher was 17.5% and mixed morphology was 8.5%. Prevalence of cam and mixed morphology were common in male hips however there was no statistically significant difference in prevalence of pincher morphology between male and female hips. Conclusion Femoroacetabular morphology was noted with high frequency in asymptomatic young population on computed tomography. Diagnosis of femoroacetabular impingement syndrome should be based on combination of clinical and radiological findings. KEY WORDS Alpha-angle, Cam, Femoroacetabular impingement, Pincher
Takayasu Arteritis Masquerading as Shoulder Pain: A Case Report
(Nepal Medical Association, 2022) Poudel, Prabhat; Oli, Paras; Ojha, Prashant; Yadav, Radhay Shyam; Poudel, Binaya Raj
Abstract Takayasu arteritis is a rare progressive chronic granular inflammation of the vessels that mainly affects the aorta and its branches. It is widely distributed in the world population and mainly involves young Asian women, manifesting as a systemic illness with myriads of cardiovascular signs and symptoms. The current case focuses on a young girl who had shoulder pain and weakness as the only manifestation of underlying Takayasu arteritis. Early clinical identification of the disease and control with disease-modifying anti-rheumatic drugs could improve the outcome and prevent devastating sequelae.
Physician Burnout: Time for Systemic Change, Not Just Resilience Training
(Kathmandu University, 2025) Shrestha, A
NA
Mean Canal-body Ratio among Specimens of Dried Lumbar Vertebrae in the Department of Anatomy of a Medical College: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2022) Shrestha, Iju
Abstract Introduction: Lumbar spinal canal stenosis is assumed to be one of the chief causative factors for low back pain. The measurement of lumbar canal and body dimensions has thus become an important tool for the diagnosis and treatment of spinal stenosis. This study aims to find out the mean canal-body ratio among specimens of dried lumbar vertebrae in a medical college. Methods: A descriptive cross-sectional study was done in a medical college from May, 2021 to July, 2021. Ethical clearance was taken from the Institutional Review Committee (Reference number: 0502202103) and whole sampling was done. Seventy-three intact dried lumbar vertebrae were studied for the dimensions of the body and canal in transverse and anteroposterior planes. The findings were recorded and the canal body ratio was calculated using the transverse diameters of the spinal canal and vertebral body. The data obtained were computed and analysed using Microsoft Excel 2013. Point estimate at 95% Confidence Interval was calculated along with mean and standard deviation for continuous data. Results: The mean canal-body ratio was observed to be 0.53±0.032. The vertebral canal-body ratio was observed to be 0.58 in L1 followed by 0.53 in L2, 0.51 in L3, 0.49 in L4 and 0.53 in L5. Conclusions: The mean canal-body ratio observed in the present study was comparable to studies done in similar settings.
Positive Bacterial Culture among Lower Respiratory Tract Specimens of Patients in a Tertiary Care Centre: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2022) Khadka, Shusila; Barakoti, Achut; Adhikari, Ram Prasad; Khanal, Laxmi Kant; Sapkota, Jyotshna
Abstract Introduction: Lower respiratory tract infection accounts for a great burden of disease worldwide. The problem has further increased due to increasing antimicrobial resistance. This study was done to find out prevalence of positive bacterial culture among lower respiratory tract specimens of patients in a tertiary care centre. Methods: A descriptive cross-sectional study was done in the Laboratory of Clinical Microbiology in a tertiary care centre from May, 2021 to October, 2021. Ethical approval was received from the Institutional Review Committee (Reference number: 045-077/078). A total of 635 specimens were collected by convenience sampling. The specimens were cultured as per standard microbiological techniques. Antibiotic susceptibility was performed following Clinical and Laboratory Standards Institute (2020) guidelines. Microsoft Excel was used for data entry and analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion. Results: Among the 635 lower respiratory specimens, 112 (17.63%) (111.97 to 112.03 at 95% Confidence Interval) showed positive bacterial culture. Klebsiella pneumoniae 44 (37.93%) was the commonest isolate followed by Acinetobacter calcoaceticus baumannii complex 34 (29.31%). Conclusions: The prevalence of positive bacterial culture among lower respiratory specimens was lower when compared to other studies done in similar settings.
Hypertension among Current Cigarette Smokers Visiting Outpatient Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2022) Rai, Chandra Kala; Kafle, Rita; Makaju, Sarbada
Abstract Introduction: Hypertension is a common physical condition with high blood pressure for a prolonged period. Long risk factors like age, overweight, high dietary salt intake, smoking, sedentary lifestyle, and term hypertension might lead to various cardiovascular diseases. The normal blood pressure, systolic, is 90-119 mm Hg and diastolic 60-79 mm Hg. The objective of this study is to find out the prevalence of hypertension among current cigarette smokers patients in an outpatient department of a tertiary care centre. Methods: A descriptive cross-sectional study was done on 385 outpatient department patients in a tertiary care centre from September, 2021 to February, 2022. The sample was collected by a convenience after approval from the Institutional Review Committee (Reference number: 0505202105). Outpatient department patients who had past history of smoking cigarette>100 cigarettes and who is still smoking were included in the study. Data were analysed by using the Statistical Package for the Social Science software version 16.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data and mean and standard deviation for continuous data. Results: Among 385 patients, 209 (54.28%) (47.64-60.92 at 95% Confidence Interval) were hypertensive patients. One hundred fifty-six (40.51%) males and 53 (13.76%) females were hypertensive. Conclusions: The prevalence of hypertension was higher when compared to other studies done in similar settings.
Adenocarcinoma among Patients Diagnosed with Lung Cancer in a Tertiary Care Centre: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2022) Ansari, Farmud; Ghimire, Ram Hari; Shrestha, Nischal; Yadav, Sushil
Abstract Introduction: Lung cancer is the leading cause of cancer deaths all over the world and adenocarcinoma is the most common type. Diagnosis is made usually at an advanced stage of lung cancer in patients, making it nearly impossible to cure. The aim of this study is to find out prevalence of adenocarcinoma among patients diagnosed with lung cancer in a tertiary care centre. Methods: A descriptive cross-sectional study was carried out in the Department of Pulmonary Medicine of a tertiary care centre among 69 patients from October, 2018 to September, 2019. Ethical approval was taken from the Institutional Review Committee of a tertiary care hospital (Reference number: 54/2018). A convenience sampling technique was used. Data were entered and analysed using the Statistical Package for the Social Sciences version 21.0. Point estimate at 90% Confidence Interval and descriptive statistics were interpreted as frequency, percentage, or as mean and standard deviations. Results: Among 69 lung cancer patients, adenocarcinoma was seen in 27 (39.13%) (29.47-48.79 at 90% Confidence Interval). Out of 27, 10 (37.04%) were male and 17 (62.96%) were female. Chronic obstructive pulmonary disease was the major comorbidity seen among 17 (62.96%) patients. Conclusions: The prevalence of adenocarcinoma was similar to other studies done in similar settings.
Accidental Olanzapine Consumption in Children
(Nepal Paediatric Society (JNPS), 2017) Kumar, Kalenahalli Jagadish; Samatha, Aleti; Marda, Srikanth; Chaudhary, Divya
Abstract: Olanzapine is commonly used an atypical antipsychotic drug. Overdose is characterized by agitation, deep coma, blurred vision, myosis, respiratory depression and cardiovascular effects. Cardiovascular toxicity includes alterations in blood pressure, conduction disturbances like prolongation of the QRS/ QT intervals or ventricular dysrhythmias. We report two children with Olanzapine poisoning who presented with altered consciousness and one of them had ECG abnormality. Both of them recovered and discharged.
Variations of Dermatological Findings in New-Borns of a Community Hospital in Nepal
(Nepal Paediatric Society (JNPS), 2017) Shrestha, Asim; Shrestha, Smriti
Abstract: Introduction: Skin manifestations are common in neonates. The prevalence of skin changes and their association with neonatal and maternal factors are not adequately documented in Nepal. It is important to differentiate common benign skin lesions from infrequent skin changes that cause morbidity, requiring medical management. The objectives of this study were to determine the pattern of skin lesions in new-borns and their association with maternal and neonatal variables. Material and Methods: This was a prospective, cross-sectional study conducted in obstetric unit of the hospital from December 2016 to May 2017. Outborn babies and babies shifted to NICU were excluded. Results: A total of 935 new-borns were examined. The commonest skin lesions were Mongolian spot (66.7%), Erythema toxicum (46.6%), Milia (44.4%), Epstein pearls (26.4%) and Salmon patch (11.9%). Mothers aged 35 years or older (63.6%) had statistically significant association with Erythema toxicum (p=0.01). Erythema toxicum was more in primiparity, term pregnancy and caesarean section delivery. Milia was associated with male babies. Salmon patch was seen more in term pregnancy. Congenital melanocytic nevus, haemangioma and port-wine stain were noted in three, two and one new-borns respectively, which alter morbidity and hence are important to diagnose in time. Conclusion: We found that 93.8% of neonates had at one or more skin lesions. The majority of skin lesions were benign and transient. Erythema toxicum was seen commonly in mothers aged 35 and more. Salmon patch was seen more in term pregnancy.
Study of Correlation of Neonatal Outcomes with Gross Abnormalities of Placenta and Umbilical Cord
(Nepal Paediatric Society (JNPS), 2017) Nair, Bindu T; Raju, Uma
Abstract: Introduction: Perinatal outcome of new-borns is greatly influenced by abnormalities of placenta and umbilical cord. In most of the deliveries, whether home or institutional, the placenta and umbilical cords are discarded without examination. Due to paucity of information on abnormalities of placenta and cord, there is hardly any correlation with foetal outcomes. The aim was to study the correlation between the foetal outcome and the different types of abnormalities of placenta and umbilical cord. Materials and Methods: A prospective, cross-sectional, descriptive, randomised study was conducted from January 2016 to December 2016 in a tertiary care hospital in North India. The study was carried out on 1000 term singleton newborns. The placenta and umbilical cords were obtained from both normal and caesarean section deliveries. A proforma was used to gather data from the patients and new-borns. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20 (SPSS Inc, Chicago, IL, IBM version) along with Microsoft Excel (2010 version). Results: One thousand placentae and umbilical cords were examined of which high placental weight/birth weight ratio, gross anomalies of placenta (infarctions, calcifications and retro placental haematoma), marginal (battledore and velamentous) umbilical cord insertions, long umbilical cords and single umbilical artery were associated with negative foetal outcomes. Conclusions: There was a high incidence of adverse foetal outcome with placental and umbilical cord abnormalities. Education of our health personnel dealing with deliveries on the importance of proper examination of the placenta and umbilical cords should be emphasised and instituted upon.

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