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https://hdl.handle.net/20.500.14572/6

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Etiological Factors of Infertility among Couples Visiting Kathmandu Model Hospital: A Descriptive Cross-sectional Study
(Public Health Concern Trust-Nepal (phect-NEPAL), 2024) Bhandari, Srijana; Dangal, Ganesh; Karki, Aruna; Pradhan, Hema Kumari; Shrestha, Ranjana; Bhattachan, Kabin
Abstract: Introduction: Infertility is one of the major health related concern in developing countries, affecting couples in various aspects of life such as emotional, mental, social, and financial. Hence, knowing about the prevalence and its causative factors can help to estimate its burden in the society and provides insight for proper investigation and management of the infertile couples and to address the major burden of the society. Also knowing about various etiological factors of infertility helps to address them timely with close follow up during antenatal period for better perinatal outcomes. Methods: A cross-sectional study was carried out among 134 couples visiting Gynacelogy OPD of a tertiary hospital using pretested structured questionnaire. Non probability convenience sampling was done and the data was analysed using SPSS version 25.0. Descriptive statistical method was used for analysis. Results: Primary and secondary infertility was noted in 64.2% and 35.8% couples respectively. Among females, ovulatory disorder was the most common cause of infertility with polycystic ovarian syndrome found in 17.9% female along with unilateral fallopian tubal blockage seen in 17.9% followed by hypothyroidism found in 10.44%.Whereas in male, asthenospermia was the most common cause found in 32.25% followed by oligospermia found in 9.67% male. Conclusions: The study provides valuable insights into the etiological factors of infertility among both men and women. The identified causes underscore the complexity of reproductive health and emphasize the need for a holistic approach to fertility assessments and interventions to reduce the burden of society and also for good perinatal outcomes.
Practices, Attitudes of Doctors and Patient’s Perspectives Regarding Breaking Bad News at a Tertiary Health Centre
(Public Health Concern Trust-Nepal (phect-NEPAL), 2024) Aryal, Prayush; Tamrakar, Nijina; Yadav, Bharat Kumar; Pokharel, Yagya Raj
Abstract: Introduction: Breaking bad news using SPIKES protocol will help effective bad news delivery to the patients. Assessing doctor’s practices and attitudes in bad news delivery and exploring patient’s perspectives on how bad news was delivered to them could give information about doctors’ communication with patients. This study aimed to assess doctors’ practices and attitudes of breaking of bad news and explore patients’ perspectives. Methods: The authors did questionnaire based qualitative and quantitative cross sectional study at a tertiary health centre in Nepal. They asked 75 doctors from various departments regarding their practices of breaking bad news as per SPIKES protocol. They inquired the same number of patients/relatives about how the bad news was broken to them. Practice scores among doctors were analyzed. The response of patients were compared with the doctors’. Results: MD residents and doctors from Pediatric ICU/Neonatal ICU had better practice scores than Medical officers and doctors from Emergency department respectively. Consultants felt more confident in breaking bad news. Eighty four percent of the doctors wanted to deliver the bad news to the family members first than the patient. Most of the doctors believed they broke bad news as per the SPIKES protocol. However, as per patient’s perspectives they were not delivered the news as per the protocol. Conclusion: Most of the doctors agreed to practice breaking bad news as per SPIKES protocol and felt confident in doing so. There was a discrepancy regarding patient’s perspectives and doctor’s practice in how delivery of bad news was done.
Prevalence of Thyroid Disorders in First Trimester of Pregnancy at Kathmandu Model Hospital
(Public Health Concern Trust-Nepal (phect-NEPAL), 2024) Pradhan, Hema Kumari; Dangal, Ganesh; Karki, Aruna; Shrestha, Ranjana; Bhattachan, Kabin
Abstract: Introduction: Thyroid disorder is a common endocrine disorder in pregnancy. The reference range of thyroid function is lower in pregnancy. Optimum thyroid function is required to prevent complications in mother and fetus. Pregnant ladies without symptoms of thyroid disorder may have abnormal value. This study was done to find the prevalence of thyroid disorder in pregnant ladies attending Kathmandu Model Hospital in first trimester. Methods: This was an observational study of pregnant ladies who attended Obstetrics and Gynecology Department of Kathmandu Model Hospital from September 2021 to February 2022. Pregnant ladies in first trimester with singleton pregnancy without history of thyroid disorder were included in the study. Thyroid function test (TFT) was done after obtaining consent. Data were collected and analyzed. Results: A total of 488 pregnant ladies were included in the study. Thirty-seven (7.58%) pregnant ladies had abnormal result, out of which 34 (6.96%) had subclinical hypothyroidism (SCH). Conclusion: Subclinical hypothyroidism was high in the present study and BMI was not associated as risk factor.
Inception of Journal of Public Health Concern Trust
(Public Health Concern Trust-Nepal (phect-NEPAL), 2024) Dangal, Ganesh
High Voltage Electric Burn Injury to Scalp Managed with Phenytoin Dressing
(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Kharel, Animesh; Magar, Mangal G; Karki, Bishal; Nakarmi, Kiran K; Rai, Shankar Man
Abstract: Phenytoin, an antiepileptic medicine was identified by Putnam and Merritt from Harvard Medical School and published in 1937, has also been documented for wound healing by accelerated epithelialization and increased connective tissue activity. 1 Though Phenytoin has also been used for superficial dermal burns, ulcers and diabetic wounds, there is paucity of data in its uses in burn wounds. We hereby present a case where phenytoin powder was used for secondary healing of a high voltage electric burn wound over the scalp with exposed calvarium.
Limb Salvage with Microsurgical Compound Flap in a Seizure induced Deep Flame Burn Injury
(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Yadav, Manish K; Magar, Mangal G; Karki, Bishal; Nakarmi, Kiran K; Rai, Shankar Man
Abstract: Patients with epilepsy have higher incidence and severity of burn injury. Managing epilepsy is challenging in a Low- and Middle-Income setting, exacerbated by a combination of stigma, traditional beliefs, access to health care, and the burdensome costs of long-term treatment. Management of the disease require lifelong medication and regular follow-up care, which makes compliance a major issue. Here we discuss a patient who had suffered deep burn to both legs after a fall into open fire during a seizure attack resulting in amputation of the left leg, however the right leg was salvaged with local, regional and a free flap.
Posterior Vaginal Wall Fibrosis with Deviated Urethra Following Urethrovaginal Fistula Repair: A Case Report
(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Yadav, Rosy; Tiwari, Kenusha Devi; Dangal, Ganesh; Karki, Aruna; Pradhan, Hema Kumari; Shrestha, Ranjana; Bhattachan, Kabin
Abstract: Urethrovaginal fistula (UVF) is an uncommon but distressing complication of gynecologic surgery. Surgical repair may result in scarring and posterior vaginal wall fibrosis, leading to dyspareunia, introital narrowing, and urethral deviation. Management of such sequelae remains surgically challenging. We present a 35-year-old woman with a history of total abdominal hysterectomy (TAH) for choriocarcinoma followed by chemotherapy developed a urethrovaginal fistula, which was repaired successfully. She later presented with posterior vaginal wall pain and discomfort due to fibrosis and urethral deviation. She underwent Fenton’s procedure with posterior vaginal wall fibrosis was released.
Laparoscopic Suture Cervicopexy in Young Lady with Cervical Elongation
(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Sah, Sadhana; Dangal, Ganesh; Karki, Aruna; Pradhan, Hema Kumari; Shrestha, Ranjana; Bhattachan, Kabin; Shrestha, Sabita
Abstract: Cervical elongation with apical prolapse in young women poses a surgical challenge when uterine preservation in required. We report a case of 25-years female, P1L1, with symptomatic cervical elongation. She underwent laparoscopic suture cervicopexy with plication of round ligaments and uterosacral ligaments and moschcowitz procedure under general anaesthesia. This surgery had led to a good anatomical correction with satisfactory apical support and the uterus remained centrally positioned with resolution of prolapse symptoms.
Cholecystectomy in Situs Inversus Totalis
(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Magar, Subas Thapa; Koirala, Uday; Joshi, Bijendra Dhoj; Shakya, Sudip; Bhadel, Pushpa Lal
Abstract: Situs inversus totalis (SIT) involves a systemic reversal of visceral organs, complicating both clinical diagnosis and operative strategy. While laparoscopic cholecystectomy is the gold standard for cholelithiasis, its application is challenged by this rare anatomical anomaly. In cases of SIT with dextrocardia, atypical presentations and mirrored anatomy can obscure diagnosis and increase operative complexity. A 39-year-old man was diagnosed with dextrocardia via chest X-ray. Ultrasonography and computed tomography confirmed SIT, cholecystitis, and cholelithiasis. We attempted laparoscopic cholecystectomy using a modified technique involving left-handed maneuvers and adjusted port positions. However, due to dense adhesions between the gallbladder, omentum, and transverse colon, a Critical View of Safety (CVS) could not be achieved. The procedure was converted to an open cholecystectomy via a left subcostal incision. The operation went well, and our patient recovered satisfactorily.
Macrodactyly of the Hand Managed with Digital Shortening and Nail Bed Grafting
(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Shrestha, Debesh; Chaurasia, Lokraj; Nakarmi, Kiran; Pudasaini, Pushkar
Abstract: Macrodactyly is a rare congenital condition in which one or more digits grow disproportionately due to overgrowth of bone, soft tissue, and nerves. We report a 31-year-old woman with progressive enlargement of the long and ring fingers of her right hand, causing pain, limited flexion of the long finger, and cosmetic concern. Examination revealed disproportionate digit size, clinodactyly of the long finger, intact sensation, and normal vascularity. Imaging confirmed hypertrophy of bone and soft tissues, with enlargement of the median and digital nerves. The patient underwent digital shortening of the long finger at the distal interphalangeal joint, excision of fibro-fatty tissue, and nail bed grafting, preserving neurovascular structures. At six months, the nail bed graft had fully taken, digit size was reduced, clinodactyly corrected, sensation and circulation preserved, pain resolved, and hand function improved. The patient was satisfied, and no recurrence was observed.
Caecal Carcinoma Mimicking Intestinal Tuberculosis: A Diagnostic Dilemma
(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Dangol, Raj Bhai; Koirala, Udaya; Joshi, Bijendra Dhoj; Shakya, Sudip Ratna; Khambu, Ashok; Karmacharya, Sriya; Timsina, Nischit
Abstract: Intestinal tuberculosis (ITB) frequently mimics colorectal malignancy in endemic regions, often leading to diagnostic uncertainty. Conversely, colorectal carcinoma may be misdiagnosed and treated as intestinal tuberculosis, resulting in delayed definitive management. We report a case of caecal carcinoma initially diagnosed and treated as intestinal tuberculosis based on clinical findings. Histopathological examination following surgical intervention ultimately revealed adenocarcinoma of the caecum. This case highlights the limitations of empirical antitubercular therapy and emphasizes the need for histological confirmation before initiating long-term treatment.
Use of a Buccinator Myomucosal Flap for Wide Recurrent Palatal Fistula Repair
(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Singh, Sunil Kumar; Goit, Bipulesh; Thapa, Swosti; Pradhan, Leeza; Shakya, Pramila
Abstract: Palatal fistula is a common and challenging complication following cleft palate repair, particularly in recurrent cases with scarred local tissues. The buccinator myomucosal flap (BMMF) provides a well-vascularized regional option for fistula closure. We report a 17-year-old male with a wide recurrent palatal fistula following multiple cleft palate surgeries. The defect, extending from the hard–soft palate junction to the pre-alveolar region, was reconstructed using a posteriorly based unilateral BMMF after nasal layer closure. The flap provided adequate reach and tension-free oral lining. Postoperative recovery was uneventful, with minimal donor-site morbidity. At four-year follow-up, the patient demonstrated stable fistula closure, healthy mucosalization, and no functional complications.
Anterior Palatal Fistula Closure with Tongue Flap
(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Goit, Bipulesh; Singh, Sunil Kumar; Thapa, Swosti; Pradhan, Leeza; Shakya, Pramila
Abstract: Palatal fistula is an abnormal oronasal communication with incidence of 4% to 35% and recurrence up to 25%. Repairing large palatal fistula can be technically challenging. Anteriorly based tongue flap may be the flap of choice for recurrent and symptomatic anterior palatal fistula. A case of bilateral complete cleft lip, alveolus and palate with residual anterior palatal fistula was successfully managed with anteriorly based tongue flap. Postoperative care included liquid diet, oral hygiene and flap division after 2 weeks. Wound healing was satisfactory and uneventful. No flap loss, speech impairment, taste disturbance or functional tongue morbidity was noted. The tongue flap is a highly reliable flap with reported success rates of 85% to 95.5% in management of palatal fistula. Based on our experience, tongue can be considered a good option and highly recommended for the closure of large & recurrent palatal fistula.
Placenta Accreta Spectrum: A Case Report and Review of Diagnostic and Management Challenges
(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Shrestha, Sabita; Ghimire, Nitesh; Dangal, Ganesh; Shrestha, Ranjana; Bhattachan, Kabin
Abstract: Placenta accreta spectrum (PAS) represent a major cause of severe obstetric hemorrhage and maternal morbidity, particularly in women with a history of cesarean delivery and placenta previa. Early antenatal diagnosis and multidisciplinary planning are essential to optimize outcomes. We report a case of placenta accreta spectrum with bladder involvement in a 33-year-old multigravida with a previous cesarean section, diagnosed antenatally by imaging. The patient underwent an emergency classical cesarean section followed by cesarean hysterectomy and bladder repair at 32 + 3 weeks’ gestation due to massive obstetric hemorrhage. Histopathological examination confirmed placenta accreta. This case highlights the importance accurate diagnosis and the need of multidisciplinary approach in a tertiary care center for the optimal outcome.
Augmented Manchester Procedure with Right Sacrospinous Fixation in a young woman
(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Tiwari, Kenusha Devi; Shrestha, Ranjana; Dangal, Ganesh; Pradhan, Hema; Bhattachan, Kabin; Shah, Sadhana
Abstract: Severe cervical elongation in young multiparous women is a rare cause of pelvic organ prolapse. Achieving durable apical support while preserving the uterus presents a surgical challenge. A 26-year-old unmarried nullipara with 12 years history of pelvic organ prolapse with cervical elongation of 9cm. She underwent Manchester procedure combined with Right sacrospinous ligament fixation of the neo cervix under anesthesia. This combined approach addressed the anatomical defect and provided robust apical suspension. This case demonstrated the feasibility and rationale for this combined approach in a medically complex patient.
Granulomatous Inflammation of Gall Bladder
(Public Health Concern Trust-Nepal (phect-NEPAL), 2015) Dangol, Nixon; Basnet, Ranga Bahadur; Parajuli, Sharmila; Amatya, Riti
Abstract: Granulomatous cholecystitis is a condition affecting the gallbladder that is often confused with cancers and other types of cholecystitis, which poses a diagnostic challenge for medical professionals. We share a case of granulomatous cholecystitis in a 51-year-old man with resolving acute pancreatitis and hypertension. Imaging showed thickening of the gallbladder wall and presence of gallstones. Laparoscopic cholecystectomy was performed and histopathological examination confirmed that the patient had granulomatous cholecystitis, characterized by presence of epithelioid histiocytes and multinucleated giant cells. The case highlights the importance of considering granulomatous cholecystitis in the differential diagnosis of gallbladder diseases, especially in patients presenting with chronic inflammation and gallstones. This report underscores the need for high clinical suspicion to differentiate granulomatous cholecystitis from other gallbladder pathologies.
Multiple dysraphic anomalies with double thoracic meningocele and lumbosacral myelomeningocele, concurrent Chiari malformation Type I, diastematomyelia, lipomyelomeningocele and hydrocephalus: a case report and literature review
(Institute of Medicine, 2005) Rai, BDK; Shilpakar, SK; Bagan, M
NA.
How I do it: Bullet removal from head and neck regions
(Institute of Medicine, 2005) Baskota, DK
Abstract A retrospective, observational study to find out a reliable, simple and cost effective new technique (Needle guided technique) for exact localization and successful removal of bullets from head and neck regions was currently carried out in the Department of ENT- Head & Neck Surgery of Tribhuvan University Teaching Hospital Kathmandu, Nepal. Altogether two bullets of two patients were exactly localized and removed successfully without any complication in this region by applying this new technique. The result of this study so far indicates that “Needle guided technique” is reliable, simple and cost effective technique to localize bullets especially in head and neck regions followed by their successful removal, which is recommended to doctors working without advanced radio diagnostic support and even for those who cannot afford for the advance radio diagnosis.
Does peers’ sexual behaviors affect adolescents’ sexual behaviors?
(Institute of Medicine, 2005) Joshi, S
Abstract This study is aimed to determine female adolescents’ reproductive and sexual health behaviors in order to promote healthy reproductive behaviors. A descriptive correlation design was used to identify the main predictor of female adolescents’ reproductive and sexual health behaviors. Four hundred samples were selected from urban government schools of Lalitpur; findings revealed that more then half of respondents (56%) felt very comfortable to communicate with their peer than others. There were statistically significant relationships between female adolescents’ with their peers’ reproductive and sexual health behaviors (r = 0.646; p = <0.05). Further analysis revealed that peers’ reproductive and sexual health behaviors were the main predictor of female adolescents’ reproductive health behaviors (B = 646, t = 15.91 p <0.05). Perhaps, to tackle the developmental needs, female adolescents took help of their peers than with others. If concerned authorities desire for responsible reproductive health behaviors among female adolescents, the trained peer groups need to be involved in health delivery system while rendering services to this vulnerable group.
Paediatric clinical teaching: comparison of two medical schools
(Institute of Medicine, 2005) Sharma, PR; Bhattarai, P; Sharma, M
Abstract Clinical paediatric teaching in undergraduate medical education is important to impart essential skills in communicating, diagnosing and formulating management plans for common childhood illness of the country so as to reduce existing high mortality and morbidity rates. Private medical colleges are facing challenges in paediatric teaching because of the unavailability of paediatric patients with different clinical signs; both the inpatient and outpatient paediatric attendance at their teaching hospitals is very discouraging at present. At the same time, they are plagued with inadequate investigative facilities. We conducted a study to evaluate some of the clinical skills in the students during their final examination. The study showed marked differences among students in some of the essential neonatal skills and other common paediatric problems. Statistically significant differences were found in the majority OSCE stations. The mean wrong answers in one medical school were 42.2% (Std D. 30.1 %) and the other school was 24.9% (Std. D 18.3 %). In one medical school the mean of signs that were rightly performed for the essential neonatal examination were 1.4% (Std. Dev. 1.1 %) and in other schools it was 10.4% (Std. Dev 6.1%). This shows that it is necessary to standardize pediatric teaching in the country’s medical schools.

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