Journal Issue: Volume: 2, No. 1 (2005)
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Volume
Number
Issue Date
2005
Journal Title
Journal ISSN
3059-9547
Journal Volume
Articles
Medical education in South Asia: Challenges and Opportunities
(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Dangal, Ganesh
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Ranking Predictors of Child Dietary Diversity in Nepal Using a Decision Tree
(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Baral, Dipesh; Lama, Dindu; Dangal, Archana; Baral, Dinesh; Kharel, Jiban; Thapa, Abhishek; Dahal, Pragati; Baral, Swastika
Abstract:
Introduction: Minimum dietary diversity among children (MDD-C) remains low in Nepal, contributing to persistent malnutrition. This study aimed to rank and characterize the association of dietary, socioeconomic, and health-related predictors of MDD-C among children aged 6–59 months in Madhyapur Thimi Municipality of Nepal.
Method: A secondary analysis of survey data from 375 children was conducted. Chi-squared tests were used to identify baseline associations of the predictors with MDD-C. A Chi-squared Automatic Interaction Detection (CHAID) decision tree was then fitted to identify key split variables and interaction structures. A CHAID-based sensitivity analysis was used to estimate food groups’ contributions to predicted dietary adequacy by toggling individual food groups from absent to present. Bootstrap resampling was used to quantify the internal variability of these estimates.
Result: Overall, 73.6% of children were predicted to achieve MDD-C. The decision tree placed other fruits and vegetables (Group G) at the root level, followed by splits on eggs (Group E), legumes and nuts (Group B), and vitamin A–rich foods (Group F). Sensitivity analysis suggested that enabling consumption of Group G or Group E was associated with the largest expected improvements in predicted dietary adequacy, and bootstrap resampling indicated that this ranking was relatively stable across resamples.
Conclusion: This model-based analysis indicates that Group G and Group E foods are strong positive predictors of adequate dietary diversity and offer the largest expected gains among diet-deficient children. Hence, access to Group G and Group E foods could be prioritized as dietary interventions to improve child nutrition.
Clinical Profile of Patients Undergoing Total Laparoscopic Hysterectomy
(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Shrestha, Sabita; Dangal, Ganesh; Karki, Aruna; Pradhan, Hema Kumari; Shrestha, Ranjana; Bhattachan, Kabin; Sah, Sadhana
Abstract:
Introduction: Total laparoscopic hysterectomy (TLH) has emerged as a preferred alternative to abdominal hysterectomy for benign gynaecological conditions owing to its well-known benefits. With increasing use of laparoscopic techniques, it is important to evaluate the clinical profile and surgical outcomes of the patients undergoing total laparoscopic hysterectomy.
Methods: This descriptive study was conducted at Kathmandu Model Hospital- Institute of Health Sciences over 5 months period after taking ethical approval. All patients undergoing TLH for benign indication were included in the study. Sociodemographic and clinical characteristics, operative details and immediate postoperative complications were recorded in a predesigned proforma. Data were analysed using SPSS version 20. P-value of <0.05 was considered statistically significant.
Results: A total of 73 patients underwent TLH during the study period. The mean age and bod mass index was 46±5.83 years and 28.07±3.94 kg/m2 respectively. The most common presenting symptom was heavy menstrual bleeding (63%, n=46). Fibroid uterus (52.1%, n= 38) was the leading indication for TLH. The mean operative time was 149.04±40.33 minutes. A statistically significant association was observed between increasing uterine weight and longer operative time (p=0.001). The overall complication rate was 23.28% with no bowel or urinary tract injuries.
Conclusion: Total laparoscopic hysterectomy is a safe and feasible options for benign gynaecological conditions, even in patients with higher body mass index and larger uterine size. Despite longer operative time, it has favourable perioperative outcome with acceptable complication rates.
Clinical Profile of Women with Lower Urinary Tract Symptoms Visiting Kathmandu Model Hospital
(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Tiwari, Kenusha Devi; Dangal, Ganesh; Shrestha, Ranjana; Karki, Aruna; Pradhan, Hema Kumari; Bhattachan, Kabin
Abstract:
Background: Lower urinary tract symptoms (LUTS) are common among women and can significantly impair quality of life. Despite their high prevalence, LUTS often remain under-recognized and under-treated, particularly in low- and middle-income countries. This study aimed to determine the prevalence, severity, and associated factors of LUTS among women attending a tertiary care hospital in Kathmandu, Nepal.
Methods: A hospital-based cross-sectional study was conducted from September 2025 to December 2025 at Kathmandu Model Hospital. A total of 385 women were assessed for any lower urinary tract symptoms were using a validated Bristol Female Lower Urinary Tract Symptoms questionnaire translated into Nepali. Symptoms were categorized into no/minimal, moderate, and severe LUTS based on total scores. Data were analyzed using SPSS version 25, and associations were assessed using the chi-square test, with statistical significance set at p < 0.05.
Results: Among 385 participants mild, moderate, and severe LUTS were present in 40.7%(157), 27.0%(104), and 10.3%(40) of women, respectively. Storage symptoms, particularly urinary frequency, were the most common complaints among 76.60%(295). Moderate to severe LUTS were significantly more prevalent in women aged over 40 years and in those with increasing parity (p < 0.001). All women with diabetes mellitus and those with a history of hysterectomy reported LUTS, with the majority experiencing moderate to severe symptoms. No statistically significant association was observed between mode of delivery and LUTS severity.
Conclusion: Lower urinary tract symptoms are highly prevalent among 79% women attending tertiary care in Kathmandu, with increasing age, higher parity, diabetes mellitus, and prior hysterectomy being significant associated factors. Early identification and targeted management strategies are essential to reduce symptom severity and improve quality of life among affected women.
Outcome of Bailout Techniques in Non-achievement of Critical View of Safety during Laparoscopic Cholecystectomy
(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Magar, Subas Thapa; Koirala, Udaya; Joshi, Bijendra Dhoj; Dongol, Raj Bhai
Abstract:
Background: Laparoscopic cholecystectomy (LC) is one of the most commonly performed surgical procedures. It has become the gold standard treatment for gall bladder diseases. But with the growing number of surgeries chances of intraoperative complications increase. Unfortunately, since the widespread use of the laparoscopic technique, the incidence of bile duct injury remains 0.3 -- 0.8%, compared to 0.2% in open operations. This leads to different types of bailout surgeries for the safety of patients. This study is done to evaluate the outcome of bailout techniques used in difficult laparoscopic cholecystectomies when critical view of safety (CVS) cannot be achieved.
Methods: This was an observational study conducted in General Surgery Department of Kathmandu Model Hospital and Kirtipur Hospital, Kathmandu, Nepal. All participants admitted for laparoscopic cholecystectomy were included in this study. Participants who had difficult laparoscopic cholecystectomy (DLC) were identified based non achievement of CVS. Demographic profile, indications, risk factors, intraoperative findings and bailout techniques were evaluated.
Results: A total of 273 cases were included and analyzed in the study. The incidence of difficult LC was 41(15.01%). Types of Bailouts out techniques done were Fundus First, Sub-total cholecystectomy and open cholecystectomy. An overall conversion rate of LC to open cholecystectomy in difficult LC was seen in 3 (1.09%) of the cases. Intraoperative complications were not seen in 87.8% of the patients. All the patients with bailout techniques had excellent outcomes. The mean duration of hospital stay in difficult LC cases was five days.
Conclusion: Different bailout techniques during difficult Laparoscopic Cholecystectomy have excellent outcomes and are recommended to practice.