bluuebunny/crossref_metadata_2025 huggingface dataset:
Case Report of Fetal Macrosomia with Birth Weight 6.25 kg: A Rare Encounter
Authors: Maskey Suvana , Gurung Geeta
Published: July 2024

Newborn weight exceeding 4000 g or 4500 g is considered as macrosomia, incidence of which varies from 6 to 10% of all deliveries. Maternal diabetes, obesity, age >35 years, male baby, history of previous macrosomia, multiparity are few risk factors. It is associated with several maternal and neonatal complications and presents an obstetric challenge as there is no consensus regarding the most appropriate route of delivery for macrosomic baby. We report a rare case of fetal macrosomia with birth weight of 6.25 kg delivered by cesarean section to 39 years old woman at 38 weeks 6 days period of gestation.
Clinical Spectrum and Demographic Profile of Alcoholic Liver Disease Among Females Attending Tertiary Care Center in Nepal
Authors: Koirala Dinesh , Anees Shahbaaz , Pathak Rahul , Bhandari Brindeswari Kafle , Jha Anurag , Hamal Rabin , Gnawali Arun , Bhusal Mohan
Published: July 2024

Introduction: Alcohol is the most common abused substance in Nepal. Women tend to present with more severe liver disease with a shorter period of excessive drinking and at a lower daily alcohol intake compared to men.
Methods: Adult female patients aged 16 years and above, with a diagnosis of ALD were included for a period of 1 year. Liver disease secondary to other causes were excluded. Demographic profiles, clinical features, laboratory, endoscopic findings, Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease (MELD) of the patients were recorded.
Results: A total of 144 female patients with ALD were included in the study. The mean age of the patients was 48.6 years (SD=12.7). Majority of the patients were from Hilly region (n=66, 45.8%), married (n=135, 93.8%), housewife (n=83; 57.6%), Hindu by religion (n=93; 64.6%), and Tamang (n =39; 27.1%) by caste. Most common clinical features of the patients were abdominal distension (n=117; 81.2%), bilateral lower limb swelling (n=89; 61.8%), jaundice (n=54; 37.5 %) and anorexia (n=53; 36.8%). The main reason for alcohol consumption was found to be family custom in 42.3%. Esophageal varix was present in 119 (82.6%) patients. Out of 124 patients with cirrhosis, 63 (50.8%) patients were in CTP stage C and 103 (83.1%) patients had MELD score ≥ 16.
Conclusion: ALD was predominantly seen among the younger female patients. The most common clinical presentations were abdominal distension, bilateral lower limb swelling, jaundice and anorexia. Among the cirrhotic patients, most of patients were in CTP class C and had MELD score ≥ 16.
Nepal’s First Laser Bronchoscopy: A Case Report
Authors: Sapkota Ranjan , Shrestha Bibhush
Published: July 2024

Light Amplification by Stimulated Emission of Radiation (Laser) is an essential tool for a thoracic surgeon in the management of tracheobronchial lesions: alone or on combination with other modalities of treatment. Post-tracheostomy tracheal stenosis (PTTS) is a well-known entity and often a challenging problem to manage. Here we report a successful use of endotracheal Laser, yet unreported in available English Literature from Nepal, in a 24 year man with PTTS after a protracted hospital stay for traumatic brain injury. The use of Laser bronchoscopy in such cases is safe and feasible, alone or in combination with tracheal dilatation.
Academic Reading, Writing, and Publishing in Nepal: Initiation from Institute of Medicine
Authors: Singh Yogendra P
Published: July 2024

N/A
Clinical Profile, Management and Outcome of Patients Presenting with Acute Pulmonary Embolism at Tertiary Level Cardiac Centre in Nepal
Authors: Poudel Chandra M , Shakya Smriti , Khanal Rajaram , Gajurel Ratna M , Shrestha Hemant , Devkota Surya , Thapa Sanjeev , Manandhar Bhawani , Pathak Surya R
Published: July 2024

Introduction: Pulmonary embolism (PE) is a common, under diagnosed and potentially lethal clinical condition. The aim of our study was to find out the clinical profile, management and outcome of patients with acute PE.
Methods: It was a retrospective study. The participants included patients admitted and diagnosed to have acute PE from January 2014 to December 2019. Patients with high clinical probability and positive D-dimer in low and intermediate clinical probability were diagnosed as acute PE clinically. Data were obtained from the records section of the hospital.
Results: The most common risk factor was found to be smoking. Only two patients were found to have protein C and protein S deficiency (4.4%) and one patient had hyperhomocysteinemia (2.2%). The most common symptom was found to be shortness of breath (97.8%). The most common sign was sinus tachycardia. Right ventricular dysfunction was found in 35.5% of the patients on echocardiogram. Computerized tomography pulmonary angiogram (CTPA) was done in 60% of the patients. The most common CT finding was presence of thrombus in main pulmonary artery in 13.3% of patients. Troponin I was positive in 26.7% of patients and D-dimer was positive in 66.7%. Only 42.2% had evidence of deep vein thrombosis. Only 13.3% were thrombolysed. All the patients received low molecular weight heparin or unfractionated heparin followed by warfarin or dabigatran. The in-hospital mortality rate was 15.6% where the rest of the patients were discharged.
Conclusion: The most common symptom and sign was found to be shortness of breath and sinus tachycardia. Single investigation was not conclusive so multiple investigations were done to reach the diagnosis. Though all the patients received anticoagulation, only few of them were thrombolysed. The in-hospital mortality was found to be 15.6%.
Topical Corticosteroids Utilisation and Cost Variation in Dermatology Outpatient of a Tertiary Hospital in Kathmandu
Authors: Shrestha Deepti , Joshi Smita , Shakya Gurung Rashmi , Poudel Rekha , Upreti Anup R
Published: July 2024

Introduction: Topical corticosteroids (TCs) are one of the important drugs prescribed in skin diseases. Cost is an important factor for compliance to treatment. Cost analysis provides the variation of costs which helps in economic benefit in the use of drugs. Thus the aim of the study was to assess the TC utilisation in Dermatology department and study its cost variation.
Methods: A descriptive cross-sectional study was conducted in the out- patient of Department of Dermatology, Nepal Medical College Teaching Hospital. Patient demographic, disease, name of topical steroid, vehicle, strength, single or combination, cost of the different brands of TCs were analysed.
Results: Out of 216 patients, 109 (50.5%) were females and 67 (31%) were of 21-30 years age group . Dermatitis was the most common skin condition encountered (106, 49.1%). Most common TC prescribed as single therapy was mometasone furoate 0.1%, (51, 23.6%) and betamethasone valerate 0.1% with fusidic acid, (48, 22.2%) as combination therapy. Mometasone furoate 0.1% cream, (15 gm) showed the maximum cost variation (94.7%) in single drug product while clobetasol propionate 0.05% with salicylic acid ointment (20 gm) showed the maximum cost variation (95.55%) in a combination product.
Conclusion: The commonest indication of TCs use in Dermatology outpatient during our study was dermatitis, with commonest TCs prescribed being mometasone furoate. Cream was the most favoured vehicle. Cost variation was as high as 95% . Reduction in this cost variation would ease the financial burden on patients which will help in improving the patient compliance in a resource limited population.
Transplant Renal Artery Stenosis in Living Donor Kidney Transplant Recipients: A Single Center Experience from Nepal
Authors: Dhakal Niraj , Sigdel Mahesh R , Chalise Pawan R , Bhurtyal Nishan , Shah Dibya S
Published: July 2024

Introduction: Transplant renal artery stenosis (TRAS) is the most common preventable vascular complication in kidney transplantation with significant rates of graft loss and mortality. We aimed to study the demographics, prevalence, clinical presentation, and outcome of TRAS.
Methods: We retrospectively reviewed medical records of all living donor kidney transplant recipients at Tribhuvan University Teaching Hospital from August 2008 to May 2021. Cases diagnosed with TRAS by ultrasound Doppler and/or renal CT angiogram were included. Data on demographics, clinical presentation, management, and outcomes were collected and analyzed. Among patients who underwent revascularization, pre and post-procedure creatinine, blood pressure (BP), and antihypertensive medicine burden were compared.
Results: Among 620 living donor kidney transplantation, TRAS was present in 17 recipients (Male:Female = 16:1) (2.6%); mean age was 35.47±12.71 years. The median duration at diagnosis was one- month post-transplant (range: 5 days-9 months). The most common clinical features of TRAS were graft dysfunction and uncontrolled hypertension. Diagnosis of TRAS was confirmed with CT angiography in 13 patients. Ten patients underwent revascularization. Pre and post-revascularization mean serum creatinine was 356±210.49 μmol/L and 122.8±30.48 μmol/L (p=0.007) respectively, mean systolic BP was 200±12.47 mmHg and 133±13.38 mmHg (p=0.005) respectively and mean diastolic BP was 105±15.09 mmHg and 80±9.43 mmHg(p=0.005) respectively. Significant reduction in anti- hypertensive pill burden was achieved.
Conclusion: Prevalence of TRAS was 2.6%. Most cases presented early with hypertension and graft dysfunction. Revascularization of significant stenosis had a favorable outcome in terms of BP control, antihypertensive pill burden, and preservation of renal function.
Central Macular Thickness in Uneventful Phacoemulsification Employing Optical Coherence Tomography
Authors: Ranabhat Sudha , Byanju Raghunandan , Pradhan Sangita , Khadka Simanta , Lamichhane Benju
Published: July 2024

Introduction: Cataract is the most common cause of blindness affecting the global population which can be cured by phacoemulsification surgery. The study aimed to evaluate the central macular thickness following uneventful phacoemulsification surgery and analyze its relation to various factors.
Methods: This prospective study comprised of 63 subjects diagnosed as age-related cataract on the basis of lens opacities classification system III and undergoing uneventful phacoemulsification surgery with capsular bag intraocular lens implantation. The central macular thickness was evaluated using optical coherence tomography at preoperative period and postoperatively on 1st day, 1st week and 5th week. Effective phacoemulsification time was measured intraoperatively.
Results: The mean effective phacoemulsification time was 17.95±14.01 seconds. Best corrected visual acuity improved significantly postoperatively (p=0.03). Mean central macular thickness increased significantly on the 5th postoperative week compared to preoperative assessment (p=0.002). No significant association was detected between patient’s age and preoperative and postoperative central macular thickness. No correlations were observed between effective phacoemulsification time and central macular thickness. Significant association was not noted between central macular thickness and best corrected visual acuity on pre and postoperative examinations.
Conclusion: There was a decrease in central macular thickness on the 1st day and 1st week postoperatively followed by a significant increase on the 5th postoperative week compared to the preoperative period, which was independent of effective phacoemulsification time. Increase in central macular thickness in the postoperative period did not affect the quality of vision.
COVID-19 Infection in Renal Transplant Recipients: Experience from a Tertiary Care Center in Nepal
Authors: Bhurtyal Nishan , Shah Dibya S
Published: July 2024

Introduction: COVID-19 pandemic has challenged the health system globally specially the low to middle income countries. Renal transplant recipient is at risk due to immunosuppressed state. The course of the disease and its outcome is not completely known and there is scarcity of information from developing world.
Methods: The study was carried out at Tribhuvan University Teaching Hospital, Kathmandu from May 2020 till May 2021. All of the renal transplant recipients infected with COVID-19 virus were included in the study. Duration of transplantation, recipient’s comorbidities, clinical presentation including laboratory investigations and outcome in terms of hospitalization, need of intensive care, and need of mechanical ventilation, organ failure and mortality were studied.
Results: There were 71 patients (male/female: 60/11, mean age 42.6±10.4) were included in the study. 72% patients (n=51) required hospitalization. There were 15 patients (21%) who expired. Patients requiring mechanical ventilation were 14 (19.7%), 24 (33.8%) required intensive care, 10 (14%) required hemodialysis support during admission. A prior history of rejection, presence of diabetes, graft dysfunction at baseline, and a higher creatinine at baseline was associated with mortality. Hypoxia, leucopenia, lymphopeniawas predictive with mortality. Raised inflammatory markers as d-Dimer, LDH, development of acute kidney injury was associated with mortality. Presence of acute kidney injury was associated with increased risk of mortality, need of intensive care and prolonged hospitalizations.
Conclusion: COVID-19 infection in renal transplant recipients carries a high risk for mortality. The factors that correlated with risk for mortality were hypoxia, leucopenia, high inflammatory markers and need of mechanical ventilation.
Patient’s Preferences in Selecting Prosthodontist Based on Age and Sex in a Tertiary Hospital in Kathmandu
Authors: Guragain Manjeev , Dahal Sirjana , Joshi Kalit R , Rathi Ankita , Dahal Samarika , Poudel Samikshya S , Pantha Sandesh , Bhochhibhoya Amar
Published: July 2024

Introduction: Most of the dental research has focused on dentist’s perceptions of patients based on their demographic profiles, while little is known about patient’s perceptions of their dentists. Further, there is a lack of data regarding patient preferences in selecting prosthodontists based on gender and age in Nepal. This study aims to investigate the influence of various demographic factors on patient preferences in selecting their prosthodontist.
Methods: A sample of 358 patients presenting at the Department of Prosthodontics, Tribhuvan University Teaching Hospital, Institute of Medicine for replacement of missing teeth took part in this questionnaire-based study. The questionnaire was designed to assess the influence of sex and age of the prosthodontist on the decision to select a prosthodontist. Statistical analysis was performed by SPSS version 16.
Results: Majority (258, 72.1%) preferred treatment by a prosthodontist of age <44 years. There was a significant association seen between participants’ age, sex, and educational status and age preference for prosthodontists. Also, their sex, educational status, and prosthodontist among family and friends were significantly associated with prosthodontist’s sex preference.
Conclusion: There was preference for younger prosthodontists by the study participants but they had no gender preference for having their treatment done.
Proximal Contact Points between Fixed Dental Restorations during Bisque Trial Stage
Authors: Khanal Bibek , Sapkota Srijana Mishra , Thakur Smriti N , Chaulagain Rajib , Adhikari Bhawana
Published: July 2024

Introduction: Proper proximal contact points between a crown and adjacent teeth plays an important role in the gingival health and longevity of the prosthesis. This study was conducted to assess the proximal contact points between a metal ceramic crown and adjacent teeth in bisque trial stage.
Methods: A cross-sectional study was conducted in a total of 75 maxillary and mandibular 1st molar crowns to assess the type of contact points present on the mesial and distal side by using a dental floss. The contact points were categorized as being either open, acceptable or too tight. Descriptive statistical analysis (frequency and percentage) was done using SPSS Software (version 21.0).
Results: In this study 75 crowns were studied to assess the proximal contact points in 150 (75 mesial and 75 distal) sites. A total of 24 (16%) sites showed open contact points, 47 (31.33%) showed acceptable contact points and 79 (52.66%) sites showed too tight contact points.
Conclusion: A significant number of crowns showed open and too tight type of contact points. These can be rectified before final cementation since the assessment was done during the bisque trial stage.
Resistant Uropathogens in Gulmi Hospital: High Time to Take Action
Authors: Shrestha Reena , Pachya Uttam , Thapa Tulsi R , Thapa Pachya Ambika
Published: July 2024

Introduction: Recent study in Nepal showed 29.5% culture positive cases of Urinary Tract Infections (UTIs). Extensive consumption of broad-spectrum antibiotics leading to increased AMR rates amongst uropathogens. This study has been carried out to determine the proportion and types of uropathogens causing infections and their antibiotics susceptibility pattern based on WHO classification of antibiotics- access, watch and reserve ('AWaRe') categories.
Methods: Record review of the urine isolates with antibiotic susceptibility testing reported from Laboratory of Gulmi Hospital from April 2019 to April 2021. Ethics approval was obtained from Nepal Health Research Council (NHRC). Calculation of frequencies and proportions and cross-tabulation was done.
Results: Bacterial yield was found in more than one-third of the total 315 samples. Majorities (84.48%) of them were gram negative bacteria. More than three-fourth of the urine isolates were of female. Urinary isolates showed variable resistance to the 'access' and 'watch' group of antibiotics. There was high resistance to the conveniently prescribed antibiotics like cefixime, ciprofloxacin, ofloxacin, for UTIs. Among tested urine isolates, 75.7% were sensitive to Nitrofurantoin.
Conclusion: The yield of urine culture was 36.83% in our study with higher proportions in female. The resistance was high for conveniently prescribed antibiotics. Sensitive antibiotics like Nitrofurantoin were incorporated in the empirical therapy for UTI in this hospital after the study. It is an awakening call to implement measures to strengthen antimicrobial surveillance with inclusion of the peripheral hospitals to the reporting by capacitating them for quality reporting of the antibiograms.
Correlation of Differential Function and Glomerular Filtration Rate Estimated from Computed Tomography based Renal Volume and Diuretic Renogram in Living Renal Donor
Authors: Rai Bipendra DK , Gnyawali Diwas , Poudyal Sujeet , Pradhan Manish , Chapagain Suman , Luitel Bhoj R , Chalise Pawan R , Gyawali Prem R , Sharma Uttam K , Nepali Rabin , Gurung Ghanashyam
Published: July 2024

Introduction: In renal transplant, serum creatinine and isotope studies are used for determination of donor glomerular filtration rate (GFR). Studies have shown computed tomography measured renal volume can also be used. Our main objective was to assess the accuracy of volume based estimated GFR (vGFR) with diethylene triamine penta acetic acid (DTPA) measured GFR in living kidney donors.
Methods: An observational analytical study was conducted from July 2018 to June 2019 in Department of Urology and Kidney Transplant Surgery and Department of Radiodiagnosis in Tribhuvan University Teaching Hospital where a total of 38 eligible potential donors were evaluated and serum creatinine level, computed tomography with contrast and DTPA renogram were used to measure GFR and differential function.
Results: The mean age of the donors were 42.8±10.9 years with 70% of donors being females. Renal volume was not statistically different between male and female donors. There was moderate correlation between volume based and DTPA based GFR (r=0.76) and differential function (r=0.71). Compared to creatinine, volume based GFR estimate showed better correlation to DTPA renogram. There was no significant difference in differential function estimated by DTPA and volume based estimates (p = 0.96). The upper and lower limit of agreement between the volume based and DTPA based differential function was –4.7 and 4.6 respectively.
Conclusion: GFR measurement by CT volume overestimates total GFR compared to DTPA renogram but it has better correlation than creatinine based estimates. It can be used to estimate the differential function of the donor kidney.
Impact of COVID-19 Pandemic on Pregnant Mothers
Authors: Kapali Gayetri Darshandhari , Koirala Manisa , Katuwal Neeta , Thapa Sangita , Adhikari Anuradha , Gachhadar Rashmi , Neupane Sharmila , Panta Ganga
Published: July 2024

Introduction: The COVID pandemic has detrimental impact on physical and psychological wellbeing of expectant mothers. Fear and worry during pregnancy amplifies risks and can have negative physical and psychological consequences for mother and newborn outcomes. So this study intended to assess the impact of COVID-19 pandemic on pregnant mothers during pregnancy.
Methods: Descriptive cross-sectional study design was applied among 123 pregnant mothers who visited antenatal OPD of Tribhuvan University Teaching Hospital. Data were collected through non-probability purposive sampling technique by using interview schedule. Descriptive statistic and inferential statistics were used to analyze the collected data.
Results: Pregnant mothers faced difficulties to maintain physical wellbeing, 84 (68.3%) did not perform any physical exercise, 96 (78%) were physically inactive, 107(87%) stated absence of sound sleep during pregnancy. Majority i.e. 111 (90.2%) of pregnant mothers perceived fear on outcome of newborn. Likewise, 11(8.9%) had severe impact on their psychological wellbeing during COVID-19 pandemic. Place of residence, number of children and trimester of pregnancy were found to be the strong predictors of psychological impact among pregnant women.
Conclusion: The impact was seen on exercise, sleep, physical wellbeing whereas pregnant mothers seemed more attentive on healthy diet. They expressed more fear on obstetric or newborn outcome and uncertainty on mode of delivery with this panic situation.
Transient Effect of Acute Mental Stress on Corrected QT Interval among Healthy Male Students
Authors: Manandhar Seerina Adhikari , Pramanik Tapas , Amatya Mrigendra , Silvanus Vinutha
Published: July 2024

Introduction: The time taken for depolarization and repolarization of the ventricles is represented by the QT interval. Psychological factors such as active mental stress may influence the action potentials developed in the heart and may alter QT interval of an individual. Therefore, our study was targeted to find the transient effect of acute mental stress on corrected QT interval among the healthy male students.
Methods: An experimental study was conducted among 55 male first year undergraduates, studying medical and dental courses in Nepal Medical College and Teaching Hospital (NMCTH). The study was executed in the Electrocardiography (ECG) lab of Department of Physiology of NMCTH from September 2022 – November 2022. ECG was obtained before and after the application of active/acute mental stress using standard mental arithmetic test (MAT) for 1 minute.
Results: In comparison to rest state, a statistically significant decreased RR interval and increased heart rate (p<0.001) was observed after MAT. A statistically significant decrease in QT interval [0.35±0.05 sec Vs 0.32±0.05 sec] (p<0.001) and QTc interval [0.41±0.05 sec Vs 0.39±0.05 sec] (p<0.001) was observed after MAT. Nevertheless, there was no statistically significant change in QRS duration after the MAT (p=0.16).
Conclusion: Acute mental stress causes shortening of the QTc interval in young healthy males.
Clinical Profile and In-Hospital Outcome of COVID-19 Infection among Patients with Cardiovascular Disease: A Cross-Sectional Study
Authors: Ghimire Roshan , Gajurel Ratna M , Paudel Chandra M , Shrestha Hemant , Khanal Rajaram , Manandhar Bhawani , Shakya Smriti , Shakya Samir , Yadav Vijay , Sharma Manju , Yadav Sutap , Shah Nischal , Thapa Sanjeev
Published: July 2024

Introduction: Coronary heart disease, hypertension, heart failure, diabetes, and other cardiovascular diseases (CVDs) increase the disease severity and in-hospital mortality among patients with COVID-19.
Methods: This is a hospital-based study assessing the effects of CVD on the in-hospital outcomes in patients admitted with COVID-19. Clinical characteristics and in-hospital outcomes were studied in patients with cardiovascular risk factors and underlying CVD.
Results: A total of 108 covid positive patients had an underlying cardiovascular disease/s in various forms with a mean age of 60.69±16.24 years and 55.6% were male. Hypertension and diabetes mellitus were the commonest cardiovascular risk factors. Among these patients, acute decompensated heart failure and cardiac arrhythmia commonly atrial fibrillation were the common cardiac complications. The in-hospital mortality rate was 16.67%. Those who died due to cardiac involvement was 18.2% in comparison to 14.3% of the patients who did not have cardiac involvement, although this could not reach statistical significance. The most common cause of death was multiorgan failure resulting in 44.5% of all cause of death followed by acute respiratory distress syndrome accounting 27.8% and refractory cardiogenic shock with 22.2% involvement. Among those who died vs those who survived length of hospital stay was significantly longer in death group (13.6 days vs 9.11 days, p=0.002)
Conclusion: In patients hospitalized with COVID-19, pre-existing established cardiovascular risk factors and CVD appear to be important contributors to mortality. The involvement of multiorgan predisposes COVID-19 patients to accentuated risk of mortality.
Comparison of Cognition between Elderly with Sensorineural Hearing Loss and Normal Hearing for Age
Authors: Gurung Bikash , Rayamajhi Pabina , Dutta Heempali Das
Published: July 2024

Introduction: Age related hearing loss starts at mid to late adulthood. With ageing, cognitive ability also declines. The aims of this study were to assess, compare and correlate cognition of elderly people having bilateral moderate to profound sensorineural hearing loss with the population of normal hearing for age.
Methods: This observational analytical study included 25 elderly participants between 55 to 75 years of age in each group; Hearing loss Group with moderate to profound sensorineural hearing loss and Normal hearing Group with normal hearing. Based on pure tone audiometry, hearing loss was classified into moderate (41-60 dB), severe (61-80 dB) and profound (81 and above). Cognition status was assessed using a Nepali version of Mini-mental state examination and classified into no cognitive impairment, mild cognitive impairment and severe cognitive impairment. Comparison and correlation of the cognitive impairment was done between the groups.
Results: In Hearing loss Group, 8 (32%) participants and in Normal Hearing Group, 3 (12%) participants had mild cognitive impairment. Means of total Mini-mental state examination scores between the two groups had statistically significant difference (p=0.02) but no significant correlation (Kendall tau b =0.20) between age related hearing loss and cognitive impairment was found.
Conclusion: Though cognitive impairment was found more in participants with age related hearing loss, there was no correlation between age related hearing loss and cognitive impairment.
Lived Experience of Breast Cancer Survivors: A Phenomenological Study
Authors: Lawot Isabel , Gharti Kamala , Singh Shreejana , Sharma Mohan R
Published: July 2024

Introduction: Breast cancer (BrCa) is the most common cancer in women worldwide. The population who survive breast cancer is increasing; even so, they usually have to go through many problems in their life. Except for the diseased part, numerous socio-cultural factors may pose challenges for the survivors. Hence, the aim of this study was to explore the experiences of cancer survivors.
Methods: A phenomenological qualitative design reseach was performed with eight BrCa survivors in Kaski district of Nepal. Data were collected through semi-structured in-depth interviews and analyzed using Colaizzi’s descriptive phenomenological method.
Results: Two major themes were extracted from the in-depth interviews. One was the reaction to the diagnosis and another was fear of disease. Most participants lacked awareness of their cancer diagnosis, and nearly all of them experienced fear that persisted until death. They faced a multitude of physical issues throughout the treatment phase and subsequent years, including headaches, loss of appetite, anemia, gastritis, body pain, and swollen extremities. Additionally, they grappled with psychological challenges such as anxiety and depression, rendering them more susceptible. Financially, due to the exorbitant costs of treatment, they had to resort to borrowing money from others, with the burden primarily falling upon their families
Conclusion: Most of the participants had fear regarding illness, treatments, recurrence, and death. Patients were worried about the cost of care. Therefore, it is imperative for family members and healthcare professionals to recognize the experiences of breast cancer survivors in order to optimize patient health during critical stages.
Outcome of ABO-Incompatible Living Donor Kidney Transplantation: A Single Center Observational Study from Nepal
Authors: Hamal Saurav S , Nepali Rabin , Poudyal Sujeet , Shah Dibya S
Published: July 2024

Introduction: Kidney transplantation is the most effective treatment for end-stage renal disease (ESRD) patients. However, the increasing number of ESRD patients and the limited availability of living and cadaveric donors has led to a growing waiting list for kidney transplantation. ABO-incompatible transplantation has emerged as an alternative for these patients in Nepal.
Methods: This was an observational study of all the patients who underwent kidney transplantation from March 2017-Feb 2019. Data on demography of recipients and donor, blood group, human leukocyte antigen mismatch, induction agent, post-operative complications and creatinine clearance at discharge and one-year post-transplant were collected and analysed. Then we compared patient and kidney graft survival at one year between ABO incompatible and ABO compatible recipients.
Results: During the study period, there were total of 124 kidney transplant recipients among them 12 were ABO incompatible and 112 were ABO compatible recipients. The study showed slightly lower patient and graft survival in ABO-incompatible recipients than ABO compatible recipients (83.3% vs 99.2%, p<0.001). However, death-censored graft survival were similar in both groups (100%,p<0.001). The graft function at one year measured by creatinine clearance was better in ABO-incompatible recipients than ABO-compatible recipients (67.1±11.75 vs 61.87±12.82, p<0.001). Postoperative complications were slightly higher, however, complications at one year were lower in ABO-incompatible recipients.
Conclusion: The study showed that living donor ABO-incompatible kidney transplant recipients have a good outcome at one year but is associated with greater risks of patient and graft loss at early transplant period compared to ABO-compatible recipients.
Cleft Lip and Palate Repair Surgeries in a Tertiary Care Center: A Descriptive Cross-Sectional Study
Authors: Rai Sushant , Niraula Himalaya , Sharma Samit , Shrestha Jayan M , Lohani Ishwar
Published: July 2024

Introduction: The burden of cleft lip and palate in Nepal is high. Surgeries should be performed at the right age and weight for the safety and optimal development. We aimed to identify the socio-demographic and peri-operative attributes of cleft lip and palate patients.
Methods: A descriptive, cross-sectional study of cleft lip and palate surgeries conducted in Tribhuvan University Teaching Hospital, over a two-year period. Variables studied include age and weight at the time of surgery, gender, ethnicity, type of repair, other congenital defects, the length of stay, and complications.
Results: Overall, 28 cleft lip and palate surgeries were performed. The median age at operation of cleft lip patients was six months and of cleft palate patients was 20.5 months. The median weight in kilograms of cleft lip patients was six, whereas of cleft palate patients was 10. The male-to-female ratio among all the patients was 1.2:1. The patients hailed from all seven provinces of Nepal. For cleft lip, Millard technique 13 (93%) was most commonly performed and for cleft palate, the Bardach repair 10 (71.4%) was mostly preferred. Only two patients suffered from peri-operative complications.
Conclusion: Millard technique and Bardach repair were the most commonly performed surgeries for cleft lip and palate respectively. Two peri-operative complications were encountered.
Epidemiology and Demographic Profile of Inflammatory Bowel Disease in Nepal
Authors: Ranjan Mukesh K , Pathak Rahul
Published: July 2024

Inflammatory bowel disease (IBD) is a chronic disease of the gastrointestinal tract. Once thought to be a disease of the developed nations, the burden of IBD has been rising in Asian countries. Inflammatory bowel disease leads to severe impairment in the quality of life of the patients. There have been numerous studies across the globe which have provided new insight into different aspects of this disease. Not only IBD is being diagnosed more but patients are also becoming more aware of this debilitating condition. It is encouraging to see a few studies from Nepal in the recent past. However, the epidemiological and demographic features of IBD remain largely unknown. Through this review, we aim to gain insight into the epidemiology and demographic features of patients with IBD in Nepal.
Superficial Surgical Site Infection in Hand Surgery: A Cross- sectional Study in a Hand Surgery Unit
Authors: Bhandari Prawesh S , Nakarmi Kiran , Chaurasia Lok R , Pudasini Pushkar
Published: July 2024

Introduction: Superficial surgical site infection (SSI) in hand surgery is generally considered to be less common. Infection of surgical site can lead to poor outcomes. Burden of surgical site infection in hand surgery has not been studied in our part of the world. We sought to determine the prevalence rate superficial surgical site infection in patients undergoing hand surgery.
Methods: We used standard definition of CDC National Healthcare Surveillance Network (NHSN) criteria to evaluate 112 consecutive adults undergoing various hand surgery procedures outcome at the end of the second week for superficial SSI. The study was conducted over a period of six month (November 2022 to May 2023).
Results: The prevalence of superficial surgical site infection was 6.25% . Among those affected 0.02% cases were diagnosed based on signs and symptoms criteria. In 0.03% patient the wound discharge yielded Staphylococcus aureus. The most common cause requiring hand surgery were workplace injuries, household injuries, and injuries due to road traffic accounting for 45.54%, 26.79%, and 18.75% , respectively. Crushing type of injury which was the most common of all mechanisms of injury.
Conclusion: The prevalence rates of hand procedures are low but not negligible. This under-evaluated condition must be more extensively evaluated in a multicenter study involving larger population.
Metabolic Syndrome in patients with Urinary Tract Stone Disease: A Hospital based Single Center Study
Authors: Ali Rushudulla , Sigdel Mahesh R
Published: July 2024

Introduction: Patients with urinary tract stones (UTS) are at increased risk of developing metabolic syndrome (MetS). Assessment for MetS could be useful for patients presenting with UTS. We assessed the prevalence of MetS and each of its components in patients with UTS. Correlation of 24-hour urinary, serum calcium and uric acid levels with components of MetS were also done.
Methods: A cross-sectional study was conducted at Tribuvan University Teaching Hospital, Institute of Medicine from August 2021 to July 2022. After the approval from the Institutional Review Committee, 118 consenting adult patients with unilateral or bilateral UTS who fulfilled inclusion criteria were studied.
Results: Thirty-five (29.7%) stone formers had MetS. Among them, 23 (65.7%) were males, and 12 (34.3%) females. The mean body mass index of patients with MetS was 25.96 ± 4.62 kg/m2. In patients with MetS, 24 (68.8%) had high blood pressure and impaired plasma FBS. Twenty-one (60.0%) patients had increased serum triglyceride levels, and 54.3% had reduced HDL-cholesterol. Systolic blood pressure had a significant correlation with hypercalciuria (P=0.01) and hyperuricemia (P=0.046). Serum triglyceride levels were significantly correlated with hypercalcemia (P=0.045). The mean estimated glomerular filtration rate (eGFR) of the study population was 83.48 ± 32.37 mL/min/1.73 m2.
Conclusion: Urinary tract stone disease are associated with metabolic syndrome. Assessment for metabolic syndrome should be considered in patients with urinary tract stone disease
Assertiveness of Nursing Professionals Working in a University Hospital of Nepal
Authors: Shrestha Romina , Mishra Tulashi Adhikari , Banstola Ratna S , Joshi Sarala
Published: July 2024

Introduction: To provide patients with appropriate treatment and foster therapeutic interactions, nurses must possess assertiveness. The study objective was to find out the assertiveness of nurses.
Methods: In this cross-sectional study, 272 nurses were recruited using a proportionate stratified random sampling at Tribhuvan University Teaching Hospital (TUTH), Nepal. Assertiveness was measured with a self-administered questionnaire, 30-item Simple Rathus Assertiveness Schedule. Data analysis was done in SPSS version 16. Independent Sample t-test, Pearson Chi-square test, Fisher’s Exact test, and odds ratio were used to examine the association.
Results: Among nurses, 192 (70.6%) were assertive with a mean assertiveness score of 18.1±14.7. There was a significant association of nurses’ assertiveness with their marital status (p = 0.02), nursing degree (p=0.03), professional designation (p=0.04), employment type (p=0.03), and additional training (p=0.004). Nurses with bachelor-level nursing degrees were 1.8 times more assertive (95% CI = 1.05-3.07) than those nurses with certificate-level nursing degrees. Nursing officers were 2.1 times more assertive (95% CI = 1.02 – 4.2) than staff nurses. Further, permanently employed nurses were 2.63 times more assertive (95% CI = 1.35-5.12), and nurses who received additional training were 2.2 times more assertive (95% CI = 1.29-3.83).
Conclusion: More than two-thirds of nurses working in the university hospital were assertive. Nurses with bachelor-level nursing degrees, with professional designation as “nursing officers”, with permanent employment, and those who received additional training were more assertive. These things should be taken into consideration by the hospital administration to increase assertiveness among nurses.
Measurement of Optic Nerve and Optic Nerve Sheath Diameter in MRI Brain
Authors: Paudel Sharma , Joshi Sweta , Pandey Durga , Kayastha Prakash
Published: July 2024

Introduction: Many diseases affect the size of the optic nerve and optic nerve sheath, measurement of which is important for the diagnosis and treatment of different pathologies of the brain and orbit. This study aimed to measure the diameter of the optic nerve and optic nerve sheath in MRI brain examinations. We also studied their variation according to age, gender, and laterality.
Methods: This cross-sectional, quantitative study was performed in the Radiology Department of Tribhuvan University Teaching Hospital (TUTH). The diameter of the optic nerve and optic nerve sheath were measured in the T2 weighted Dixon Turbo Spin Echo axial images. The diameter was measured at the level of 3mm and 8mm behind the eye globe. The study was completed over a period of 3 months (August 2023 to October 2023).
Results: The mean diameters of the optic nerve were 2.187±0.35 mm/2.14 ± 0.35 mm at 3 mm behind the eye globe and 2.056 ± 0.334 mm/2.11 ± 0.35 mm at 8 mm behind the globe for the right/left sides respectively. The optic nerve sheath of the right/left sides measured 4.50 ± 0.60 mm/4.46 ± 0.56 mm at 3 mm behind the eye globe and 4.16 ± 0.50 mm/ 4.14 ± 0.47 mm at 8mm behind the eyeball.
Conclusion: The measurements for the diameter of the optic nerve and optic nerve sheath complex were similar in both the right and left eyes. There was no significant difference in optic nerve and optic nerve sheath diameters with the age and gender of the participants.
Surgical Training in Resource-Limited Settings: Cost-Effective, Portable and Reproducible Personal Laparoscopic Endotrainer
Authors: Shrestha Sujan , KC Ajay , Shrestha Shiba
Published: July 2024

Introduction: Minimal invasive surgery (MIS) is standard of approach for many surgical pathologies. The best way to enhance the psychomotor skills for MIS is through the disciplined and structured time with the Endotrainer. The cost and portability of available Endotrainer is the main reason for surgeons and residents allocating minimal time for training. Our goal was to create cost-effective and portable Endotrainer that enables skill development at home and classroom setting.
Methods: The framework of this Endotrainer was made-up of local plywood. The anterior surface was divided into nearly equal superior and inferior surface by horizontal plywood stick. A rectangular window was created at the anterior surface for mobile phone or tablet or iPad placement. Similarly, two 8 mm hole were drilled and padded with locally available rubber washer inferior and lateral to rectangular window as laparoscopic ports. For light commercially available mini dimmable LED was installed. The final trainer box was similar in shape and size of medium suitcase, which was portable and could house laparoscopic hand instruments and training pads.
Conclusion: The Endotrainer was easy and cost-effective to assemble. Embodying the essence of portability and reproducibility, this trainer box offers a personal practice tool that empowers trainee to sharpen their skills at their home or classroom.
Pediatric Intensive Care Unit in a Developing Nation: Exploring Acute Neurological Illnesses and Their Clinical Course
Authors: Khanal Babita , Singh Sandeep K , Mishra Rajnish , Kafle Prakash , Sharma Mohan R
Published: July 2024

Introduction: The burden of neurological illnesses is high in pediatric age group. Both primary neurological illnesses and neurological complication of systemic illness are commonly seen in pediatric intensive care unit (PICU). Neurological illness prolongs the length of PICU stay and also increases the mortality and morbidity. To assess the burden and describe the spectrum of acute neurological illness in a pediatric intensive care unit and analyze the early outcome.
Methods: This was a prospective observational study conducted in Department of Pediatrics intensive care unit from January 2022 to December 2022. All children from 1 months to 16 years of age with neurological illness being admitted to PICU were included in the study. Basic demographic characters, diagnosis, treatment modalities and outcome were analyzed.
Results: During study period, 237 (24.89%) were admitted to PICU with neurological illness. Mean age was 66 ± 42 months and 138 (58.22%) were male. Out of 237 children, 196 (82.70%) had primary neurological illness and 41 (17.30%) neurosurgical diagnosis. In primary neurological illness, 102 (52.10%) had primary CNS infection, followed by status epilepticus (21.52%), septic encephalopathy (11.70%), neuromuscular illness (8.16%), and metabolic encephalopathy (4.08%). In neurosurgical cases, 32 (78.04%) had Traumatic Brain Injury and 9 (22%) were shifted to PICU postoperatively. Mechanical ventilation was required in 156 (65.82%) and 88 (37.13%) required inotropic support. The mortality rate in neurological cases was 24 (10.12%) as compared to overall mortality rate of 6.8% in PICU.
Conclusion: Neurological disorders are common in PICU and are associated with higher mortality rate. Primary central nervous system infection, severe traumatic brain injury and status epilepticus were common cause of PICU admission in our cohort.
Knowledge Acquisition Processes and Transient Competitive Advantage in International Non-Governmental Organizations in Kenya
Authors: Kihiu Rosemary , Kaluyu Veronica
Published: July 2024

The purpose of the study was to explore the relationship between knowledge acquisition processes and transient competitive advantage among International Non-Governmental Organizations (INGOS) in Kenya. The study was driven by positivism philosophy and used a descriptive correlational research design. A sample of 392 respondents, program leads and MEAL (Monitoring, Evaluation, Accountability and Learning) or knowledge management leads was obtained using simple random sampling. Data was gathered using a questionnaire that was administered online using google forms. The questionnaire was pretested and found to be reliable since the overall Cronbach alpha was 0.7.  The collected data was analyzed using descriptive statistics (means, percentages, frequencies and standard deviations) and Partial Least Squares Structural Equation Modelling (PLS – SEM).  The findings from the study indicated that knowledge acquisition processes have a significant and positive effect on transient competitive advantage among INGOs in Kenya (t = 18.171, p < 0.05) at 5% significance level.  The recommendation from the study findings for INGOs is to enhance knowledge acquisition processes to enhance their positioning in order to exploit transient competitive opportunities fully through deliberating acquiring market knowledge from external sources such as clients and competitors, using internal knowledge proficiently and investing in research and development in order to feed into innovation
Knowledge Conversion Processes and Transient Competitive Advantage in International Non-Governmental Organizations in Kenya
Authors: Kihiu Rosemary , Kaluyu Veronica
Published: July 2024

The current business and natural environment is characterized by turbulence resulting in an erosion of traditional competitive advantages. The resulting volatility has ushered in an era of temporary advantages collectively termed as transient competitive advantages. This study aimed to explore the relationship between knowledge conversion processes and transient competitive advantage among International Non-Governmental Organizations (INGOS) in Kenya. The study was driven by positivism philosophy and used a descriptive correlational research design. The target population was 1784 programs, MEAL (monitoring, evaluation, accountability and learning) and knowledge management managers in INGOs registered with the NGO Coordination Board,  from which a sample of 392 respondents was obtained using simple random sampling. To gather data, a standardized questionnaire was administered online using google forms. The collected data was analyzed using descriptive statistics (means, percentages, frequencies and standard deviations) and Partial Least Squares Structural Equation Modelling (PLS – SEM). The findings from the study indicated that knowledge conversion processes have a significant and positive effect on transient competitive advantage among INGOs in Kenya (t = 13.088, p < 0.05). The recommendation from the study findings for INGOs to ensure that knowledge acquired is appropriately converted for use through putting in place measures that ensure it is continuously integrated with what is already known and it is validated by stakeholders involved in the operations of the organization.