搜索结果：JNMA; journal of the Nepal Medical Association

Antimicrobials are the most commonly used medicine. Over-the-counter use of antibiotics is more prevalent in developing countries, contributing to inappropriate use and increasing antimicrobial resistance. Studies regarding over the counter use of antibiotics are lacking in Nepal. The objective of this study was to determine prevalence of over the counter use of antibiotics among patients visiting primary health centre. A descriptive cross-sectional study was conducted among 377 participants from October 2024 to February 2025 at Outpatient department of Melamchi Primary Health Centre after obtaining ethical approval from the Ethical Review Board of Nepal Health Research Centre (Reference no: 820). Written informed consent was obtained and prevalence of over-the-counter use of antibiotics was examined using a structured proforma. Data was entered into Microsoft Excel, and descriptive statistics were calculated. Among 377 participants, 86 (22.81%) were using over-the-counter antibiotics, of which 45 (52.32%) were male and 41 (47.67%) were female. 40 (46.51%) of those participants using over-the-counter antibiotics were older than 15 years, whereas 3 (3.48%) were less than 1 year of age. The most common presenting symptoms in these patients were related to the respiratory system 39 (45.34%). The most commonly used antibiotic was Amoxicillin plus clavulanic acid; 32 (37.20%). The study reported a lower prevalence of over-the-counter use of antibiotics among patients presenting to primary health centers compared to the 'WHO South-East Asia Region'.

Pleural effusion is the accumulation of excessive fluid in the pleural cavity. Despite the high incidence of pleural effusion in Nepal, there is limited data regarding the clinical profile and its management. The study aims to find out the clinical profile and management of pleural effusion in a tertiary care hospital. This is a descriptive cross-sectional study done over 24 months in patients with pleural effusion admitted to a tertiary care hospital in Nepal. Ethical clearance was taken from the Institutional Review Committee (No: 134/20). Census sampling was done. All patients who were diagnosed to have pleural effusion were included in the study. The clinical findings, radiological imaging reports, management record and relevant data of each case were retrieved from the medical records. Data were analysed using Statistical Package for the Social Sciences 25. Among 273 cases ofpleural effusion, 186 (68.1%) were male. The mean age of the patients was 48.83±22.87 and 97 (35.53%) were above 60 years. The pleural effusion on right side was 137 (50.93%). Among all cases, 241 (88.3%) were managed conservatively; 72 (29.88%) with antitubercular therapy and 169 (70.12%) without antitubercular therapy, while surgical management was required in 32 (11.7%) cases. The most common cause of pleural effusion was tubercular in origin; majority of cases can be managed conservatively, and only particular cases require surgical interventions like chest tube placement or thoracotomy.

A good sleep is important for recovery after stress like surgeries in patients. This study aims to study the quality of sleep postoperatively in our population to know the distribution of poor sleepers. A descriptive cross-sectional study was carried out from February, 2025 to April, 2025 after receiving ethical approval 081/082] in tertiary care hospital. The patients who were 18 years and above residing in the hospital after any surgery were included in the study. The general information of the patients was recorded followed by the responses in Pittsburgh Sleep Quality Index Questionnaire. Data was entered in Microsoft Excel 2016 and analysis was done using IBM SPSS Statistics version 16.0 and the descriptive statistics was used in the variables considered. Out of 141 postoperative cases, only 133 participants were included for the analysis of Pittsburgh Sleep Quality Index questionnaire responses. The prevalence of poor sleepers was 92 (69.17%, 95% CI: 60.58%-76.89%). Severe difficulty was observed in the daytime dysfunction (27; 20.30%), sleep quality (17; 12.78%), and sleep latency (17; 12.78%) components of the Pittsburgh Sleep Quality Index. Among the poor sleepers, 67 (50.37%) were female, 40 (30.07%) were in the 40-59 years age group, and 86 (64.66%) were married. Of the total poor sleepers, 64 (48.12%) were within one week of the postoperative period. Poor sleep quality was prevalent after surgery, especially in the first week. It was more noticeable among females, middle-aged adults, and married individuals.

Gestational diabetes mellitus is among the most common pregnancy complications with various adverse maternal and fetal outcomes. Mobile health technology offers new opportunities to enhance its care and support self-management. The aim of study was to identify usability, acceptability and satisfaction of 'Garbhakalin Diabetes athawa Madhumeha-Dhulikhel Hospital' application to support the treatment and self-management of gestational diabetes mellitus among Nepalese women. A cross-sectional study among 46 women of an intervention arm of a parent randomized controlled trial was conducted. The ethical/institutional review boards of Rutgers University (Pro2019001883) and the Nepal Health Research Council approved the study (Ref number: 735/2019). Perceived usability and acceptability of the application was assessed using the System Usability Scale and mobile Health Application Usability Questionnaire. To assess satisfaction with gestational diabetes mellitus care, the Oxford Maternity Diabetes Treatment Satisfaction Questionnaire was used. Frequencies and percentages are reported for categorical variables, and means and standard deviation for continuous variables. The average time spent on the application was 37 minutes per day, with 12 minutes of engagement per session. The mean score on System Usability Scale was 72.12±4.78; 44 (95.56%) participants liked using the application, 45 (97.76%) found it easy, and 40 (86.91%) praised its functional integration. The mean score on the mobile Health Application Usability Questionnaire and Oxford Maternity Diabetes Treatment Satisfaction Questionnaire were 118.32±8.84 and 15.82±4.09 respectively. The mobile application demonstrated strong usability and was well-accepted by Nepalese women with gestational diabetes mellitus, suggesting it is a promising tool for self-management support.

Keratoconus, Stevens-Johnson syndrome, corneal dystrophy, and corneal scar are the sight threatening conditions of the anterior eye. Optical management of these irregular corneas include use of spectacles and contact lenses like corneal lenses (GP) as well as corneo-scleral/mini scleral and scleral lenses. Mini scleral device(MSD) delivers refractive corrections to most of the irregular corneas and provide maximum comfort with proper visual rehabilitation. It also halts the corneal transplant in many cases. The purpose of this study was to determine the clinical profile andvisual outcome ofmini scleral device in different irregular corneas. The hospital based cross-sectional study was conducted between July 2022 to December 2023 in contact lens department of tertiary eye hospital of eastern Nepal. During study period total 208 eyes of 128 patients were included in the study. Eyes with different irregular cornea in which mini scleral device trial was performed were included in the study. The mean age (±SD) of the patients was 21.03 (6.70) with minimum 11 years and maximum 42 years. Majority of them were male 94 (73.44%) and below 30 years of age 113 (88.28%). Majority of eyes had keratoconus 180 (86.54%). After trial of MSD, majority of the eyes 201 (96.63%) achieved normal vision (0.0-0.50 log MAR) among them 84 (40.38%) eyes had achieved 0.0 log MAR visual acuity. Keratoconus was found the most common irregular cornea and majority of eyes achieved normal vision with MSD.

Gender-based violence is a burden throughout Nepal. This study aimed to assess the sociodemographic profile of Gender-based violence cases and shed light on factors associated with these incidents in the Jumla district of rural Nepal. A retrospective observational study involving all the Gender-based violence cases brought for clinical medico-legal examination at the Department of Forensic Medicine and Toxicology, Karnali Academy of Health Sciences, Jumla, Nepal, from January 01, 2022 - December 31, 2023. The study variables included various socio-demographic profiles of these cases. These variables were entered and analyzed using Microsoft Excel (version 16.16.27--201012) and SPSS 23.0. Among the total clinical forensic medicine cases, Gender-based violence was present in 83 (41.92%). All the females were survivors, 53 (63.85%), and all the malex were perpetrators, 30 (36.14%). The median ages of the female and male were 20 years (Range: 11-73) and 19 years (Range: 13-52), respectively. Among these cases, 20 (24.10%) had physical assault, and 63 (75.90%) were related to sexual assault, with all male examinees presenting with sexual assault. Gender-based violence is common among females in Jumla and is primarily inflicted by males due to various sociocultural factors.

Medical negligence, a critical intersection of ethical obligations and legal standards, is an evolving concern in Nepal's medico-legal landscape. This article explores the concept of duty of care, which is fundamental to medical negligence, and emphasizes the need for a robust legal framework to ensure justice for both the patients and the healthcare professionals. The key elements of negligence: duty, dereliction, direct causation, and damage are examined alongside international precedents like Donoghue v. Stevenson, Bolam v. Friern Hospital, Bo-litho v. City and Hackney and Montgomery v. Lanarkshire, which shape standards of care and informed consent. In Nepal, cases such as the Infant Amputation Case, Dr. D.B. Shah v. Srijana KC and the Sterilization Malpractice Case highlight the growing recognition of patient rights and institutional accountability. This article advocates for a dedicated Medical Negli-gence Act to strengthen legal protections, emphasizing expert testimony, informed consent, and institutional responsibility to foster a balanced, ethical, and just healthcare system.

Pressure sore are localized skin and soft tissue damage typically occurring over bony prominences due to impaired blood supply from sustained pressure. This study aims to review the clinical profile of patients with pressure sore and the type of management of pressure sore in regional referral center of western Nepal. This retrospective, observational 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:1839). The study included all patients regardless of age and gender who were treated for pressure sores during the study period, with complete medical records. Patient demographics, sore characteristics, predisposing factors, and treatment modalities were analyzed. There were 21 patients with 42 pressure sore wounds, included with mean age 45.14±25.54 years (range: 16-92 years). Of all patients 16 (79.19%) were male and 16 patients (76.19%) were patients from outside Pokhara Valley. Spinal cord injury was present in 12 (57.14%) patients. The sacral and trochanteric regions were affected with 14 (33.33%) wounds each. There were 26 (61.90%) wounds classified as National Pressure Ulcer Advisory Panel Stage IV. Surgical management was performed in 14 (66.67%) patients with Local flap was used to reconstruct 12 (50%) of the wounds. Pressure sore in this population predominantly affected middle-aged males with spinal cord injuries, presenting with advanced-stage wounds. Local pattern flap was the most common method of soft tissue coverage.

Nepal has a high burden of enteric fevers. An observational study conducted in a tertiary-level hospital in Nepal over 11 years (2014-2024), reviewing hospital records of all blood culture-positive cases of Salmonella Typhi and Paratyphi in children, showed a gradual decline in blood culture-positive enteric fever cases with year-to-year variability. Typhoid conjugate vaccine (TCV) was introduced into the national immunisation schedule of Nepal in 2022. We observed that the proportion of Salmonella Paratyphi cases has increased in the post-typhoid conjugate vaccine years compared with the pre-typhoid conjugate vaccine period. A slight rise in hospitalisation rates for blood culture-positive paratyphoid infections has also been observed in the post-typhoid conjugate vaccine period. These findings underscore the importance of continued surveillance and call for further evaluation of the potential shift in enteric fever epidemiology. The development of effective vaccines targeting both typhoid and paratyphoid remains crucial for comprehensive disease control.

Trauma is a leading cause of morbidity and mortality worldwide. While there has been significant progress in understanding trauma in high-income countries, data from Nepal is limited. This study's main objective was to explore the demographic profile, injury patterns, and treatment of orthopaedic trauma patients presenting to a tertiary-level hospital in Nepal. This was a retrospective study conducted at a tertiary-level hospital of Nepal. All complete records of trauma cases presenting to the hospital from January 2017 to December 2022 were included in the study. Data were collected from electronic and manual records, anonymized, and analyzed with Microsoft Excel 2021. A total of 27,893 complete records were included in the study. Of these, 19,679 (70.55%) patients were male. Patients aged 30-44 years accounted for 9,566 (34.29%) cases. The mechanisms of injury included falls in 12,585 (45.12%) cases and road traffic accidents in 8,524 (30.56%) cases. Fractures were identified in 17,593 (63.07%) patients, with 9,800 cases classified as lower extremity fractures. Additionally, 18,595 (66.67%) patients were referred from outside the district. Orthopaedic trauma was seen more commonly in males and the most common causes of injury are falls and RTA. Fractures were the most common pattern of orthopaedic injuries and lower extremity fractures were the most common.

The complexities in the identification and management of mental disorders have demanded sub-specialization. In Nepal, the number of psychiatrists still does not meet the minimum requirement of the psychiatrist-population ratio. There is a dilemma regarding the need for further subspecialization in psychiatry. This study aimed to assess the perceived need for psychiatry sub-specialization courses among Nepalese psychiatrists. This cross-sectional descriptive study was conducted via an online survey (using Google Forms) among Nepalese psychiatrists and psychiatry residents. Convenience and snowball sampling was used. Data was analysed using Statistical Package for Social Sciences (SPSS), presented in frequency and percentage. Among 165 respondents, 99 (60%) were male, 105 (63.60%) were between 30-40 years of age, 125 (75.80%) were psychiatrists, and 138 (83.60%) expressed a need for further sub-specialization, although only 102 (60%) were interested. The primary reason for not pursuing sub-specialization was the need for general psychiatrists. Fellowship in addiction psychiatry was the most frequently selected sub-specialty. Most of the participants stated that there is a need for pyschiatry sub-specialization in Nepal.

Academies of Health Sciences have increased significantly in Nepal in the past decade to improve access to medical education and quality health services for the general public. They are established with their act. The provincial-level government also established health science academies in the past decade. They are mainly in the urban and geographically accessible regions of the country. There is a great demand for health sciences academies in areas where they do not exist. The Government of Nepal is going to establish the health science academies/ institutions according to the national priorities. This article analyzes the different views of the Integrated Health Sciences Act, commonly known as the Health Sciences Umbrella Act.

Appendiceal neoplasms are rare and frequently diagnosed incidentally during histopathological examination of appendectomy specimens. Recent data suggest that their incidence is increasing worldwide. This study aimed to evaluate the appendiceal neoplasm in appendectomy specimens, determine their clinicopathological presentation, histological subtypes, diagnostic modalities used, and the outcomes at the Tribhuvan University Teaching Hospital, Kathmandu, Nepal. A retrospective evaluation of patients diagnosed with appendiceal neoplasm was conducted from January 2013 to December 2023 at Tribhuvan University Teaching Hospital in Kathmandu, Nepal. Ethical approval was obtained from the Institutional Review Board (Ethical Approval Reference No: 32081/082). Various parameters, including demographic profiles, disease pathology and outcomes were studied. A total of 57 cases of appendiceal neoplasm were identified during the study period. The mean age at diagnosis was 47.1±18.5 years. Among them, 29 (50.87%) were male and 28 (49.12%) were female. Of the total cases, 52 (91.22%) cases were primary appendiceal neoplasms, 3 (5.26%) were secondary, and 2 (3.50%) cases remained unclassified. The primary mucinous appendiceal neoplasm was seen in 43 (75.44%), followed by neuroendocrine tumor in 5 (8.77%) cases. Appendectomy was performed in 29 (50.88%) and right hemicolectomy in 15 (26.32%) cases. The major perioperative complications were observed in 2 (3.50%) cases, with 1 (1.75%) case of mortality. The number of diagnosed appendiceal neoplasms increased over the year with mucinous tumors being predominant followed by neuroendocrine tumor. Appendectomy was adequate in most cases, with limited need for further surgery, and outcomes remain excellent despite few of them developed major postoperative complications.

Ectopic pregnancy is a major cause of maternal morbidity and mortality in the first trimester. Delayed diagnosis often results in rupture, leading to life-threatening complications and adverse fertility outcomes. This study aimed to evaluate the incidence, risk factors, clinical presentation, and management of ectopic pregnancy in a tertiary care center in Nepal. A five-year retrospective observational study was conducted at Nepal Police Hospital, Kathmandu from March 1, 2020, to February 28, 2025. All confirmed cases of ectopic pregnancy were included. Data on socio-demographics, risk factors, clinical features, operative findings, and management were collected from hospital records. Descriptive statistics were applied. Among 1,760 live births, 42 (2.38%) cases of ectopic pregnancy were identified. The mean age of the patients was 29.69±5.41 years, with the majority of cases occurring in women aged 20-35 years. Abdominal pain was the most common presenting symptom, reported in 30 (71.42%) patients. A history of abortion was the leading risk factor, noted in 14 (33.3%) cases. Tubal rupture was observed in 37 (88.09%) patients, and the ampullary region was the most frequent site, involved in 38 (90.47%) cases. All patients underwent surgical management, with laparoscopic unilateral salpingectomy being the most commonly performed procedure in 36 (85.71%) cases. The most common presenting symptom was abdominal pain in patients in the age group of 31-35 years. Most patient presented with ruptured ectopics.

Physician stress has been a growing critical concern worldwide, including the Nepali doctors. However, in the post-COVID-19 era, the evidence on current stress levels remains limited. We conducted a cross-sectional survey between January and March 2024 among Nepal Medical Council-registered doctors working across Nepal. A web-based questionnaire including the 10-item Perceived Stress Scale (PSS-10) was used for data collection. Spearman's coefficients were used to evaluate correlations, and t-tests and ANOVA were used to compare groups. Among 302 medical doctors (median age 33 (IQR 28 to 41) years, 67.22% male), the mean PSS-10 score was 20.45&#xb1;6.38. Overall, 43 (14.24%) had low stress, 205 (67.88%) had moderate stress, and 54 (17.88%) reported high stress. A higher PSS-10 score was associated with female gender, unmarried status, suicidal ideation/attempts, and family conflict. The PSS-10 scores of doctors in government hospitals were 21.80&#xb1;6.43 and of those in teaching hospitals 18.71&#xb1;6.49 (p=0.012). Compared to specialists (18.35&#xb1;7.03), undergraduates and postgraduate physicians reported higher PSS-10 scores (21.61&#xb1;6.15 and 20.62&#xb1;6.05), and post hoc analyses confirmed significant differences (p<0.05). While social/family time was negatively correlated with PSS-10 scores (p<0.001), longer work hours were positively correlated with higher PSS-10 scores (p=0.008). Most participants reported moderate to high levels of stress, indicating a high prevalence of perceived stress among medical doctors in Nepal.

To aim of study was to predict the success rate of the stone composition by visual assessment during endourological procedures, using Fourier transform infrared spectroscopy as a reference standard. Prospective observational study showed, 150 patients undergoing endourological procedures for urolithiasis between June 2024 and July 2025 were analyzed. The senior consultant, the junior consultant, and the residents visually assessed the stone morpho-constitution (according to Daudon classification) during the endoscopic procedures. Stone samples were obtained which were analyzed using Fourier transform infrared spectroscopy, and the results were correlated with the visual assessment done by the surgeon. Stone analysis by Fourier transform infrared spectroscopy showed 28 (18.67%) of the stones had only one morphological type (pure stones), while 122 (81.33%) had more than one composition of stones (mixed stones). The accurate predictions for pure stones as Uric acid stones and Protein stones, were 43 (84.31%) and 5 (83.33%), respectively, whereas for Calcium Oxalate Monohydrate + Calcium Oxalate Dihydrate (mixed stones) was 126 (79.25%). The overall correct prediction was obtained in 64.44 %. The correct prediction was highest by the senior consultant 110 (73.33%), followed by the junior consultant 97 (64.67%), and the residents 83 (55.33%), respectively. The overall agreement between visual assessment of urinary stone morphology during endo-urological procedures and Fourier transform infrared spectroscopy-based composition analysis in this study was moderate, with a Cohen's kappa value of 0.62.

Transfusion-dependent thalassemia is a major public health concern in Nepal, with limited access to comprehensive care and paucity of national data. The main objectives of this study were to explore clinico-epidemiological profile, management practices and complications among pediatric transfusion-dependent thalassemia patients at a tertiary pediatric hospital in Nepal. This is a retrospective observational study conducted at the Thalassemia Day Care Unit, Kanti Children's Hospital, Kathmandu. Transfusion-dependent thalassemia cases registered from January 2020 to December 2024, aged less than 15 years were included. Data on demographics, clinical features, transfusion and chelation profiles, complications, and nutritional status were acquired from hospital registry and analyzed using descriptive statistics. Out of 187 patients, 121 (64.71%) were males and 156 (83.42%) had &#x3b2;-thalassemia major. Mean age at last follow-up was 7.52&#xb1;3.68 years. 83 (44.38%) were Janajatis, particularly Tharus 40 (21.39%). Median age at diagnosis was 10 months (IQR 6-22 months), with mean pre-transfusion hemoglobin level 8.86 g/dL, and average transfusion period 2.64&#xb1;0.83 weeks. Among 167 (89.30%) patients receiving chelation, 37 (19.87%) had good compliance. Endocrinopathies, hepatic dysfunction and cardiac complications were observed in 104 (55.62%), 65 (34.76%) and 2 (1.07%) patients respectively. Serum ferritin levels were above 2500 ng/mL in 92 (49.19%) patients. Regular follow up was done by 56 (29.95%) patients. &#x3b2;-thalassemia major was the most common type of transfusion dependent thalassemia in our study. There was male predominance, and over half of the patients had iron overload and some form of complications of thalassemia. Regular follow up and compliance to chelation therapy has to be focused for better care of transfusion dependent thalassemia patients.

Urinary tract infections are common in both hospital and community settings and impose a significant financial burden. Among Enterobacterales, Escherichia coli and Klebsiella pneumoniae are the leading uropathogens. The rise of carbapenem-resistant strains is concerning due to limited treatment options, with carbapenems often being the last line resort. This study intends to determine the microbiological profile of E. coli and K. pneumoniae uropathogens obtained from a tertiary care hospital. A prospective study was conducted from October 2023 to June 2024 in a tertiary care hospital in Eastern India. Urine samples received for routine culture in the central laboratory were processed following standard microbiological protocols. Bacterial identification and antibiotic susceptibility testing were performed using the VITEK-2 compact system. A total of 958 isolates of E. coli and K. pneumoniae were obtained. Of these, 198 were identified as carbapenem-resistant as per the Clinical Laboratory Standard Institute 2023 guidelines. Of the, 7228 urine samples, 4336 (60%) yielded a positive culture. Among these, 1552 (36%) were gram-negative bacteria. Out of the gramnegative bacteria, 1209 (77.8%) were Enterobacterales. Escherichia coli were 562 (46.4%) and Klebsiella pneumoniae was 396 (32.7%). Carbapenem resistant E. coli was 96 (17%) and Carbapenem resistant K. pneumoniae was 102 (26%). Both the Carbapenem resistant E. coli and K. pneumoniae showed susceptibility to fosfomycin and nitrofurantoin. Urinary tract infections caused by Escherichia coli and Klebsiella pneumoniae are frequent, but Carbapenem resistant strains pose an emerging therapeutic challenge. This study highlights the prevalence and effective antibiotic options.

There is limited evidence describing the demographic patterns of hearing loss in the Nepali context. This study aimed to analyze the audiometrie profiles of patients undergoing pure tone audiometry in a tertiary care centre of Eastern Nepal. A retrospective analysis was conducted on all patients undergoing pure tone audiometry at B.P. Koirala Institute of Health Sciences, Nepal, between April 2023 and July 2024. Ethical approval was obtained from the Institutional Review Committee (IRC-163-081-82). Census sampling was used, and data on demographics and audiometric profiles were compiled in Microsoft Excel and analyzed with SPSS version 25. Among 3,468 patients (mean age: 42 years, SD &#xb1; 20.27 years, M:F ratio 1:1.2), 2629 (75.8%) exhibited some degree of hearing loss. Mild hearing loss was observed in 1225 patients (35.32%). Sensorineural hearing loss was seen in 1010 (32.21%) male vs 1130 (29.77%) female ears and conductive hearing loss was seen in 476 (15.18%) male vs 620 (16.33%) female ears. Sensorineural hearing loss increased from 17 (6.59%) in children under 10 years to 165 (80.88%) in age 80 and above, while conductive hearing loss declined from 87 (33.72%) in those under 10 to 9 (4.41%) in above 80 years. In this cohort of participants, three-quarters exhibited some degree of hearing loss, with mild loss being more common. Sensorineural loss increased with age and predominant in males, while conductive loss was more frequent in younger patients and females.