Journal Issue: Volume: 47, No. 2 (2025)
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2025
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
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Articles
Neutrophil-to-Lymphocyte Ratio in Predicting Outcomes of Patients with Aneurysmal Subarachnoid Hemorrhage in a Tertiary Care Hospital in Nepal
(Institute of Medicine, 2025) Rijal, Deepika; Paudel, Sujan; Luitel, Prajjwol; Rijal, Bishwa Deepak; Sedain, Gopal; Shilpakar, Sushil Krishna; Sharma, Mohan Raj
ABSTRACT
Introduction: Aneurysmal subarachnoid hemorrhage (aSAH), caused by a ruptured intracranial aneurysm, results in high mortality and disability rates. The Neutrophil-to-lymphocyte ratio (NLR), a simple yet effective marker, holds potential as a valuable prognostic tool, especially in the context of low and middle income countries. The primary aim of study was to predict the outcomes of aSAH patients by modified Rankin Scale (mRS) in 3 months based on admission NLR.
Methods: This observational study was conducted at Tribhuvan University Teaching Hospital from June 2022 to August 2023. Patients with aSAH presenting to the Emergency Department within 72 hours of symptoms were included. Hematological investigations and non-contrast computed tomography of the head were performed. Outcomes were assessed using the mRS after three months.
Results: A total of 51 patients were included. The mean age of the study population was 54.1±13.4 years (Range 25 to 80 years). The most common age group was 50-59 years. Female-to-male ratio was 2.9:1 Patients with poor outcomes had significantly higher admission NLR (7.1±4.7) compared to those with good outcomes (3.7±1.9) (p=0.001). Elevated NLR was significantly associated with worse outcomes at three months (p = 0.001). NLR ≥ 3.63 predicted poor prognosis with 87.5% sensitivity.
Conclusion: This study highlights the utility of NLR in predicting outcomes in aSAH, providing an easy-to-access prognostic marker for risk stratification. The findings are relevant in developing countries, where financial and logistical constraints limit access to advanced neuroimaging and continuous monitoring.
Keywords: Aneurysmal subarachnoid hemorrhage; modified Rankin scale; neutrophil-to-lymphocyte ratio; outcome
Association of Resting Blood Pressure Levels with Pain Sensitivity Parameters among Medical Students
(Institute of Medicine, 2025) Khakurel, Gita; Kharel, Sushil; Karki, Prabin Kumar; Gautam, Kalyan
ABSTRACT
Introduction: Pain perception varies among individuals and is influenced by multiple physiological factors, including blood pressure. The present study aimed to assess the association of resting blood pressure with pain sensitivity parameters among medical students of a medical college.
Methods: This was a cross-sectional study done in first and second year medical students aged 17-25 years. Pain sensitivity was assessed by the Cold Pressor Test. Pearson’s correlation analysis was used to determine the association between blood pressure and pain sensitivity parameters. Data were analyzed using SPSS Statistics, with a significance level set at p<0.05.
Results: Resting systolic blood pressure increased significantly in both sexes (Males:123.13±5.40 to 126.93±3.97; Females:113.35±8.26 to 119.76±5.67) following cold pressor test, while diastolic BP rose significantly only in females. Males had significantly higher pain threshold (23.32±3.00 vs 20.06 ± 4.15) and pain tolerance (92.18±14.06 vs 65.46±12.81) compared to females, while females reported significantly higher pain ratings (6.57±1.64 vs 5.32±1.08) on the visual analog scale (p<0.05). A significant positive correlation was observed between resting blood pressure and both pain threshold and pain tolerance in both males and females. In contrast, pain rating showed a significant negative correlation with both systolic and diastolic blood pressure in males (r = –0.247 and –0.343, p = 0.020 and 0.001, respectively) and females (r = –0.320 and –0.504, p = 0.004 and <0.001, respectively).
Conclusion: This study shows an inverse relationship between resting blood pressure and pain sensitivity, with stronger associations observed in females. The study also highlights sex-based differences in both pain perception and physiological response to cold-induced stress.
Keywords: Blood pressure; cold pressor test; medical students; pain sensitivity
Analysis of Outcomes of Surgery for Chronic Pancreatitis according to International Study Group for Pancreatic Surgery Reporting System
(Institute of Medicine, 2025) Bista, Nimesh; Lakhey, Paleswan Joshi; Kandel, Bishnu Prasad; Pradhan, Sumita; Maharjan, Narendra; Sharma, Deepak; Koirala, Nishnata; Bhandari, Ramesh Singh
ABSTRACT
Introduction: Due to lack of standard reporting system for chronic pancreatitis that could include all the aspect of the disease process. International Study Group for Pancreatic Surgery (ISGPS) formulated a framework for reporting the surgery for chronic pancreatitis. This framework incorporates our recent understanding, management and outcomes of chronic pancreatitis. We aimed to report surgery performed at our department for chronic pancreatitis with this standard reporting system.
Methods: From January 2021 to December 2024, 32 patient who underwent surgery for chronic pancreatitis were enrolled in the study. Patients details of clinical baseline prior to surgery, morphology of diseased pancreas, type of surgery and post operative outcomes were evaluated and reported according to four domains of ISGPS.
Results: A total of 32 patients underwent surgery. Alcohol was the etiology in six (18.75 %) and rest were identified as idiopathic. Diabetes was prevalent in 13 (40.6%) of patient with exocrine insufficiency in only one patient. All patient had parenchymal calcification. Ductal stone was present in 29 (90.6%) with stricture in 16 (50.0%) patients. Longitudinal pancreatojejunostomy with partial pancreatic head resection was the most common surgery performed in 27 (84.3%) patients. Postoperatively two patients had major complications. There was no 90 days re-operation and mortality.
Conclusion:This reporting system is feasible to report surgery for chronic pancreatitis. However, large scale prospective study validation is required.
Keywords: Chronic pancreatitis; ISGPS; reporting; surgery
Sexual Dimorphism in Permanent Mandibular Canine
(Institute of Medicine, 2025) Bajracharya, Mangesh; Shrestha, Dristi; Maharjan, Nisha
ABSTRACT
Introduction: Sexual dimorphism in mandibular canines, which are stable and decay-resistant, aids sex determination. Studies have extensively documented odontometric traits and sexual dimorphism in various ethnic groups. This study sought to assess sexual dimorphism in the mesiodistal diameters of mandibular canines.
Methods: A cross-sectional study was conducted at People’s Dental College and Hospital, involving 120 participants (60 males, 60 females); equal numbers of Brahmin, Chhetri, and Newa, aged 18 years and above. Mesiodistal widths of healthy mandibular canines, free of pathology, spacing, or rotation, were measured using a digital Vernier caliper. Data were analyzed with SPSS version 16 after entry into Microsoft Excel.
Results: Males exhibited significantly larger mesiodistal widths (right: 7.42±0.32 mm, left: 7.24±0.36 mm) than females (right: 6.78±0.23 mm, left: 6.62±0.29 mm) (p < 0.001). There was notable sexual dimorphism in the mesiodistal diameters of mandibular canines between the sexes, with the right canine showing a greater degree of dimorphism (9.45%) than the left (9.36%). Among three ethnic groups, there was the highest dimorphism rate of 10.38% on the right and 10.22% on the left among Brahmins, followed by Newa at 9.29% on the right and 8.24% on the left, and Chhetri at 8.34% on the right and 9.80% on the left.
Conclusion: Mandibular canine mesiodistal width demonstrates significant sexual dimorphism in Newa, Brahmin, and Chhetri populations, with Brahmins showing the greatest difference. These findings support its forensic utility for sex estimation in Nepal, though integration with additional markers is advised due to measurement overlaps. Ethnic-specific databases are needed to enhance forensic applications.
Keywords: Canine; dental; ethnic; forensic; sexual dimorphism
Correlation Between Early Postoperative Urine Output and One-Year Graft Function after Living Donor Kidney Transplantation: A Prospective Observational Study
(Institute of Medicine, 2025) Tamang, Rabindra; Chalise, Pawan Raj; Chapagain, Suman; Poudyal, Sujeet; Pradhan, Manish Man; Luitel, Bhojraj
ABSTRACT
Introduction: The prognostic value of early postoperative urine output after kidney transplantation remains uncertain. This study evaluates its association with one-year graft function and examines additional clinical predictors.
Methods: A prospective observational study was conducted at a tertiary transplant center in 90 renal transplant recipients; 82 completed one-year follow-up. Primary outcome was one year estimated glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration 2021. Exposures included urine output on postoperative days 1 to 3, donor age, warm and cold ischemia times, discharge creatinine, dialysis duration, human leukocyte antigen mismatch, and early surgical complications within 30 days. Primary analysis used linear regression with prespecified covariates. Secondary analysis used logistic regression for eGFR less than 60 mL per minute per 1.73 m2.
Results: Urine output on postoperative days 1, 2 and 3 did not correlate with one year estimated glomerular filtration rate. Complications occurred in 8.5 % (7/82). Body mass index showed no association with one year estimated glomerular filtration rate. In the multivariable model, older donor age and higher discharge creatinine independently associated with lower one year estimated glomerular filtration rate (donor age B = -0.595, p = 0.02; discharge creatinine B = -0.219, p = 0.03). Single-marker receiver operating characteristic analysis showed poor discrimination.
Conclusion: Early post-operative urine output did not correlate with one-year graft function. Future research should focus on additional markers and strategies to improve graft function prediction.
Keywords: Chronic kidney disease; estimated glomerular filtration rate; living kidney donors; renal transplantation