Journal Issue: Volume: 28, No. 2 (2026)
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Volume
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2026
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Online ISSN: 2676-1424; Print ISSN: 2676-1319
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Articles
Frequency and risk factors for intradialytic hypotension in patients undergoing maintenance hemodialysis
(Nepal Medical College Pvt. Ltd., 2026) Yogi, Rubash Nath; Chhetri, Pramod Kumar; Manandhar, Dhiraj Narayan; Yogi, Rusmrita; Upreti, Anup Raj; Singh, Anurag Prasad; Giri, Prapti
Abstract:
Hemodialysis (HD) patients and providers have long struggled with intra-dialytic hypotension (IDH), a complication that continues to challenge the safety and effectiveness of HD. IDH is associated with chronic end-organ damage and remains an independent risk factor for mortality among HD patients. Persistent hemodynamic instability may also accelerate the decline of residual renal function, further worsening clinical outcomes. Because individuals on dialysis already face markedly increased cardiovascular mortality and morbidity, identifying the prevalence and contributing factors of IDH has become an important clinical and academic priority. This observational study was carried out in the Hemodialysis Unit of Nepal Medical College and Teaching Hospital over one year (Baishakh 2079 to Chaitra 2079 B.S, April 2022 to March 2023 AD) without interventions or the collection of patient material. Ethical approval was obtained from the Institutional Review Committee. During each dialysis session, patients were assessed for pre- and post-dialysis weight, blood pressure, and heart rate at multiple intervals, ultrafiltration volume, and any clinical events or medical interventions related to intra-dialytic hypotension. A total of 110 patients participated, contributing 5,232 dialysis sessions. The incidence of IDH varied widely depending on the definition used, measuring 14.47% and 9.42% under stricter criteria, and rising to 62.8% with a more liberal definition. Although HD remains a widely used and generally safe modality, complications such as IDH persist and can be life-threatening. As complications and their associated factors continue to change over time, a more vigilant and systematic approach is needed to identify, monitor, and address them effectively. This highlights the need for ongoing evaluation in HD practice.
Prevalence of oral mucosal lesions in patients with diabetes mellitus attending a tertiary health center in Kathmandu
(Nepal Medical College Pvt. Ltd., 2026) Koju, Sushmit; Ghimire, Pratikshya; Paunju, Nisha; Shrestha, Sonu Dhunju; Thapa, Gunjan; Shrestha, Prashit
Abstract:
Diabetes mellitus is associated with several oral complications due to impaired tissue repair and altered immune responses. Oral mucosal lesions are common among diabetic patients, yet data on their prevalence in Nepal are limited. This study aimed to assess the prevalence and distribution of oral mucosal lesions in diabetic patients attending a tertiary health center in Kathmandu. A cross-sectional observational study was conducted among 221 diabetic patients attending the outpatient dental department of Nepal Medical College Teaching Hospital for a period of 19 months (April 2024-October 2025). Patients above 18 years with a known history of diabetes for at least six months were included. Extraoral and intraoral examinations were performed, and oral hygiene, gingival, and periodontal status were recorded. Data were analyzed using frequency statistics in SPSS v21. The mean age of participants was 54.88 ± 12.45 years, with a mean disease duration of 7.84 ± 5.84 years. Of the participants, 129 (58.4%) were female. The most commonly affected anatomical site was the buccal mucosa 135 (43.5%), followed by the dorsum of the tongue 78 (25.2%). The most prevalent oral lesions were melanin pigmentation 84 (27.1%), oral ulcers 48 (15.5%), and lingual varicosities 36 (11.6%). Other lesions included fissured tongue, coated tongue, hyperkeratosis, and linea alba. Oral mucosal lesions are common in diabetic patients, particularly affecting the buccal mucosa and tongue. Routine oral examinations in diabetic care may facilitate early detection and management of these lesions, contributing to improved oral and systemic health.
Quality of life among end-stage renal disease patients undergoing maintenance hemodialysis in a tertiary hospital
(Nepal Medical College Pvt. Ltd., 2026) Kandel, Shrisa; Shrestha, Bidhan; Paudel, Sakar; Nepal, Upagya; Rayamajhi, Diana; Kandel, Rajan; Sharma, Mrinal; Adhikari, Mamata; Adhikari, Kishor; Ojha, Nirav; Khanal, Sushna; Chhetri, Ananya Kunwar; Paudel, Samir
Abstract:
End-stage renal disease (ESRD), the most advanced form of chronic kidney disease, severely impacts patients' quality of life (QoL), especially in low- and middle-income countries like Nepal. This study aimed to assess the QoL of ESRD patients undergoing maintenance hemodialysis at Chitwan Medical College. A cross-sectional quantitative study was conducted from October 2024 to January 2025 among 107 ESRD patients on hemodialysis for at least six months. QoL was measured using the WHOQOL-BREF tool across four domains: physical, psychological, social, and environmental. Descriptive and inferential statistics were used for analysis. The overall mean QoL score was 48.36 ± 7.44. The environmental domain scored highest (53.85 ± 11.10), followed by social (51.65 ± 11.85), physical (46.06 ± 7.46), and psychological (41.59 ± 8.19). ESRD patients undergoing dialysis in Nepal experience moderate to poor QoL, particularly in psychological and physical domains. Targeted, age-sensitive interventions are essential to enhance their well-being.
Types of anemia in pediatric oncology and non-oncology patients: insights from coulter diagnosis and peripheral blood smear analysis at a tertiary children’s hospital, Kathmandu
(Nepal Medical College Pvt. Ltd., 2026) Subedi, Moni; Pant, Swostika; Pathak, Neera; Shrestha, Sonafi; Bastola, Gargi; Thapa, Sushila; Baral, Kabita Devi; Khanal, Hemanta
Abstract:
Anemia is a significant health burden for pediatric patients, particularly those undergoing cancer treatment in resource-limited settings like Nepal. This study evaluated the diagnostic performance of automated hematology systems by Coulter against manual peripheral blood smear (PBS) analysis for classifying anemia types in a pediatric population. A total of 454 pediatric patients were included, comprising 274 oncology (60.4%) and 180 non-oncology (39.6%) cases. The overall mean hemoglobin was 10.76 ± 2.11 g/dL, with moderate anemia (7.0–9.9 g/dL) being the most prevalent category (118 patients). Anemia severity was concentrated in the non-oncology group (95 of 118 moderate; 19 of 20 severe), while oncology patients predominantly had normal hemoglobin (125 cases). Significant differences in red cell indices were observed: oncology patients had higher mean MCV (8.7 fL higher, p <0.001) and MCH (2.6 pg higher, p <0.001) compared to non-oncology patients. A highly significant association was found between anemia type and clinical status (χ² = 207.012, p <0.001). Normocytic profiles (normocytic normochromic anemia, NNA / normocytic normochromic picture, NNP) dominated the oncology group (51.7% NNP), consistent with anemia of chronic disease. In contrast, microcytic hypochromic anemia (MHA) was more common in the non-oncology group, consistent with iron deficiency. The automated Coulter diagnosis showed a strong agreement with manual PBS findings (r = 0.970, χ² = 922.47, p <0.001). In contrast, MHA was significantly more prevalent in the non-oncology group, suggesting iron deficiency. Given the strong agreement between the systems, the automated Coulter diagnosis serves as a reliable initial screening tool for anemia classification, but PBS confirmation remains essential to differentiate anemia types and guide effective clinical management in developing country laboratories.
Enhancing sustainability in contrast media use: knowledge, implementation and training for radiologic technologists
(Nepal Medical College Pvt. Ltd., 2026) Jha, Abinash; Yadav, Rajesh Prasad; Sah, Suraj
Abstract:
Iodinated contrast media (ICM) are vital for computed tomography and other diagnostic imaging, but their use raises concerns about environmental contamination, dependence on limited iodine resources, rising costs, and supply-chain risks. Radiologic technologists are central to contrast preparation, administration, and protocol implementation. However, there is limited evidence on their knowledge and practices regarding sustainable contrast use in low- and middle-income countries. This study aims to assess knowledge, self-reported practices, training exposure, institutional support, and perceived barriers to sustainable contrast media use among radiologic technologists in Nepal. A cross-sectional online survey was administered to Nepal Health Professional Council–registered radiologic technologists employed in government, teaching, and private imaging facilities. The structured questionnaire evaluated knowledge and awareness, contrast-related practices, training exposure, institutional provisions, environmental considerations, and perceived barriers. Knowledge was defined as the correct identification of weight-based contrast dosing as a sustainable practice. A composite practice score (0–3) assessed renal function evaluation, use of weight-based dosing, and involvement in contrast selection. Data were analyzed using descriptive statistics and chi-square tests. Of 205 respondents, 92.2% demonstrated good knowledge and 82.9% reported good practice (11.2% moderate, 5.9% poor). Renal function assessment prior to contrast administration (97.6%) and weight-based dosing (94.6%) were commonly reported, and 84.4% were involved in selecting contrast type and dose. Awareness that contrast media can pollute water resources was 76.1%, and support for eco-friendly institutional policies was 92.2%. However, only 16.6% had received training on contrast sustainability and 29.3% reported an institutional disposal protocol, despite 91.7% expressing willingness to attend training. Previous training was associated with knowledge (p = 0.046) but not practice (p = 0.259). Radiologic technologists in Nepal show high knowledge and generally favorable self-reported practices in sustainable contrast media use, despite limited formal training and inconsistent institutional support. Targeted education, practical guidelines, and stronger organizational systems may support the adoption of more sustainable, environmentally responsible imaging services.