Journal Issue: No. 287 (2025)
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Volume
63
Number
Issue Date
Journal Title
Journal ISSN
JNMA Print ISSN: 0028-2715; Online ISSN: 1815-672X
Journal Volume
Volume 63
(63)
Articles
Comparative Outcomes of Doxorubicin and Cyclophosphamide with Sequential versus Concurrent Paclitaxel in the Adjuvant Treatment of Non-Metastatic Breast Cancer: A Cross-Sectional Analytical Study
(Nepal Medical Association, 2025) Paudel, Bishal; Paudel, Bishnudutta; Shrestha, Rakshya; Panthi, Bishal; Shilpakar, Ramila; Dulal, Soniya; Kharel, Sanjeev; Dhunagana, Reechashree; Singh, Yogendra Prasad; Shrestha, Bipsana
Abstract
Introduction: Studies have compared the efficacy and toxicities of doxorubicin and cyclophosphamide every three weeks for four cycles followed by four cycles of paclitaxel every three weeks (AC/T); with paclitaxel, doxorubicin, and cyclophosphamide (TAC) every three weeks for six cycles for adjuvant treatment of breast cancer in western countries. Genetic and environmental disparities in Nepalese population warrant the need for similar studies in Nepal. This study compares the toxicity patterns and compliance of AC/T versus TAC in the adjuvant treatment of non-metastatic breast cancer in Nepalese women.
Methods: A hospital-based cross-sectional analytic study was conducted at Bir Hospital, Kathmand after obtaining the ethical approval (Reference number: 931/076/077). Sixty women who completed either AC/T or TAC regimens were evaluated. Confounding was minimized by strict inclusion/ exclusion criteria (restriction), group matching, and random sampling. Primary outcome was grade 3–4 hematological toxicity; secondary outcomes included other adverse effects and compliance.
Results: Although hematological toxicities were higher in the TAC group, differences were not statistically significant. Non-hematological toxicities (fatigue, nausea, vomiting, pain, nail changes) were significantly higher in the TAC group. Edema was more prevalent in the AC/T group (p=0.04). Compliance without modification favored AC/T (64.5% vs. 34.5%; p=0.038).
Conclusions: Sequential AC/T demonstrated superior tolerability and compliance. Confounder control through study design and statistical methods strengthens the validity of these findings, though larger studies are warranted.
Knowledge, Attitude and Practice on Pesticide Use among Vegetable Farmers in Madhyapur Thimi Municipality, Nepal: An Observational Study
(Nepal Medical Association, 2025) Suwal,Rajan; Rajbhandari,Ajay Kumar; Shrestha, Vijaya Laxmi; Bataju,Mahima; Sharma,Mahesh; Khatri,Bijay
Abstract
Introduction: Pesticides are groups of toxic chemical compounds designed to use for increased productivity by killing pest. Inappropriately handling of pesticides cause risk to targeted as well as non-targeted organisms and also humans. Consumption of the pesticides is increasing globally and in Nepal. The study aimed to study the existing knowledge, attitude and practices of pesticides use among vegetable farmers.
Methods: A cross-sectional study was conducted among vegetable farmers who had used pesticides in the past 12 months for their farming. A household survey was conducted among 395 farmers from January to April 2023 in Madhyapur Thimi Municipality. Ethical approval was taken from the Ethical Review Board, Nepal Health Research Council (Reference number: 1696). A semi-structured questionnaire was developed from literature review and expert advices. The data was collected through face-to-face interviews. Data was analysed using descriptive statistics using SPSS 20.
Results: The mean age of the farm workers was 50.73±11.1 years. Nearly three in ten (29.62%) were illiterate. Insecticide was the most common form (97.21%) of pesticides used and 89.87% farmers received information of pesticides from friends and family. A total of 88.1% farmers had never received training on pesticide use. A total of 90.12% farmers had knowledge that use of personal
protective equipment is necessary during pesticide application. However, only 33.41% farmers always used to wear proper personal protective equipment in practice. Headache was the most common (69.51%) health adverse symptom after pesticides application.
Conclusions: Our study shows that farmers have limited knowledge about pesticides and use them in unsafe ways.
Impulsivity and Childhood Trauma Experience in Borderline Personality Disorder and Healthy Controls: A Comparative Study
(Nepal Medical Association, 2025) Ghimire, Pratistha; Joshi, Sulochana; Shakya, Rabi
Abstract
Introduction: Borderline personality disorder is a chronic psychiatric disorder characterized by pervasive patterns of affective instability, self-image disturbances, interpersonal relationship instability, marked impulsivity and suicidal behaviour. Impulsive trait is a major component of BPD. Another major risk factor for the development of borderline personality disorder is childhood trauma. The objective of this study was to compare childhood trauma and impulsivity in borderline personality disorder and healthy controls.
Methods: This is a hospital based cross sectional comparative study. Patients seeking treatment in inpatient and outpatient in Department of psychiatry, Patan Hospital, Lalitpur, Nepal who fulfilled the inclusion and exclusion criteria were taken. Patients were divided into two groups: Borderline Personality Disorder (n=21) and Healthy Control (n=42). Childhood Trauma Questionnaire-28 and Barratt Impulsivity score-11 were filled.
Results: The mean Barratt Impulsivity Score-11 for borderline personality disorder was 76.95±11.06 and 66.42± 8.92 in health controls. The observed difference was statistically significant (p=<0.001). Childhood trauma questionnaire-28 score for borderline personality disorder was 69.05±21.37 and that for healthy control was 46.43±9.27. The observed difference was statistically significant (p-value<0.05).
Conclusions: In this study higher impulsivity and childhood trauma experience was observed with BPD than HC and childhood trauma experience was correlated with impulsivity.
Outcomes of Finger Replantation in Western Nepal: An Observational Study
(Nepal Medical Association, 2025) Giri, Piyush; Shakya, Sujan
Abstract
Introduction: Hand injuries involving finger amputations prevalent in young working populations. This study evaluated the demographics and clinical outcomes of finger replantation procedures performed at a regional referral center in Western Nepal.
Methods: This retrospective,observational, cross-sectional study was conducted at the Department of Burns, Plastic and Reconstructive Surgery, Charak Memorial Hospital, Pokhara, from January 2023 to December 2024. Ethical approval was obtained from National Health Research Council on 16 February 2025 (Reference no:1840). All patients who underwent finger replantation procedure with successful artery and venous flow restoration were included. Data on demographics, injury characteristics, surgical techniques, and outcomes were collected. Survival was defined as digit viability for a minimum of 21 days. Functional outcomes were assessed using the Chen functional scoring system at 6 months.
Results: A total of 10 finger replantation procedures were performed in 10 patients with mean age of 34.6 ±13.60 years. All patients were male and right-handed. Six(60.00%) patients were employed in blue-collar occupations. The thumb was commonly affected digit accounting for 6(60.00%) cases. The principal mechanism of injury was crush amputation observed in 7(70.00%) cases.Five (50.00%) replanted fingers were categorized as Tamai level III. Successful replantation was achieved in 8(80.00%) fingers. Functional assessment revealed Grade I outcomes in 6(75.00%) cases and Grade III in 2(25.00%) cases.
Conclusions: Finger replantation in a resource-limited setting achieved survival rates comparable to international standards. Success was attributed to younger patient age, shorter ischemia time, and appropriate surgical techniques.