Journal of Institute of Medicine Nepal (JIOM Nepal) is the premier peer-reviewed multi disciplinary journal in Nepal on print since 1979 AD. It is a multispecialty medical journal carrying the aspirations of all those affiliated with the Institute of Medicine, Tribhuvan University, Nepal. It publishes papers on health and medical issues and is published in English language. It is published by the Institute of Medicine, Tribhuvan University. The journal has been in regular print and over the years, its influence has been growing with increase in submission in numerous subjects ranging from clinical to basic sciences. It has a panel of reputed peer reviewers with specialization in their respective fields. It is our immense pleasure to announce that JIOM Nepal is going to publish Special Issue on the occasion of the 50th Anniversary of Institute of Medicine. We invite all to submit scientific articles related to medicine and allied health sciences, research and education for this special issue.
Psychological Well Being and Quality of Sleep Among Health Care Professionals at Tertiary Care Hospital
Introduction Psychological well-being is linked to positive life outcomes and quality of sleep. Healthcare professionals often experience inconsistent sleep, affecting their well-being and patient care. This study aims to explore psychological well-being and quality of sleep of healthcare professionals and the association between them. Methods A cross-sectional descriptive study was conducted among 305 health care professionals (medical doctors=61, nurses=183, laboratory technicians=61) selected by purposive sampling. A pre-structured questionnaire including socio-demographics, Ryff’s Psychological Well-being (PWB) scale and The Pittsburgh Sleep Quality Index (PSQI) were used. The result has been expressed using descriptive and inferential statistics. Pearson Correlation was used to find relationship between psychological well-being and quality of sleep. Results The mean age of participants was 35.01±3.67 years with female preponderance of 248 (81.3%). PWB differed significantly across professions (p=0.01). Low PWB was reported by 23(37.7%) laboratory technicians, followed by 38(20.8%) nurses and 20(32.8%) medical doctors. Overall, 35.10% of participants experienced poor quality of sleep including, 19(31.1%) medical doctors, 72(39.3%) nurses and 16(26.2%) laboratory technicians. Quality of sleep was not significantly associated with gender and type of profession. A weak negative correlation between PWB and PSQI scores (r=−0.32), indicating that higher PWB was associated with lower PSQI scores, and thus good sleep quality. Conclusion Psychological well-being and quality of sleep demonstrated considerable variation among healthcare professionals. Improving quality of sleep will be an effective strategy to decrease the risk of developing lover psychological well-being among healthcare professionals.
Copyright (c) 2025 Journal of Institute of Medicine Nepal https://creativecommons.org/licenses/by-nc/4.0
Preoperative Fasting Duration and Associated Factors in Pediatric Patients Undergoing Elective Surgery: A Prospective Study
Introduction: Preoperative fasting prevents gastric aspiration, yet pediatric patients often endure prolonged fasting despite “6-4-2” guidelines. This study aims to determine average fasting durations for solid and liquid food in Nepal and identify causes of prolonged fasting and non-adherence to fasting guideline. Methods: A total of 139 children up to 12 years were enrolled in this prospective observational study. Data about the fasting duration and the various causes of prolonged fasting were collected in the pre-operative holding area using a preformed questionnaire. Using the SPSS version 26, the median duration of fasting for each category was calculated, along with their interquartile range (IQR), the percentage of non-adherence, and the causes of prolonged fasting, as well as the signs and symptoms observed in children. Results: Among 139 patients, 133(95.7%) of patients were not compliant with the fasting guideline. The median (IQR) duration of fasting for solid food, breast milk, and clear liquid was 12(3) hours, 5(2.75) hours, and 6(8) hours respectively. The major causes of prolonged fasting were poor NPO adherence, receiving different instructions from different individuals, and not receiving instructions according to the OT list. Among 139 patients, 57(41%) were thirsty, 31(22%) were irritable or crying, 41(29%) had dry mouth/lips with 4(2.8%) patients having skin pinch test positive and 4(2.8%) patients were dehydrated meeting the diagnostic criteria for dehydration. Conclusions: This study demonstrates that fasting durations significantly exceed international guidelines in Nepal, primarily due to inconsistent instructions and non-individualized scheduling.
ASA; elective surgery; pre-operative fasting; pediatric patients.
Artificial Intelligence and Big Data in Medicine: A Nepali Medical Institute Perspective
The integration of big data and artificial intelligence (AI) has been changing the three facets of medicine namely, medical care, medical education and research especially in the last 10 years. By offering the modeling and rapid diagnostic and evaluating facilities and offering personalized approaches they have been reshaping the medical care. These technologies strengthen biomedical research by providing better predictive modelling and optimizing clinical trials. This, in turn, helps in the evidence-based approach to medicine. Similarly, they have the potential to transform medical education as to how the course is designed, how the contents are delivered, and how we assess the competency of the trainees. However, a major concern is the responsible use of these technologies and data privacy. This article briefly discusses the application of these technologies and guidelines regarding their responsible use.
Table of Contents - Vol 47. No 3. December 2025
Cover Page - Vol 47. No 3. December 2025
Thickness of Neurocranium Bones of Deceased Adults: A Cross-Sectional Study
Introduction Thickness of neurocranium is not regular throughout the skull and cranial vault thickness is often observed to be higher in females when compared to males. This study aimed to measure the thickness of neurocranium of deceased adults and compare it across sex, age and laterality. Methods This was a cross-sectional study in which 72 deceased adults were enrolled, that presented in the mortuary of the Department of Forensic Medicine and Department of Anatomy of MMC. Measurements were taken after ethical approval from IRC of Institute of Medicine and after obtaining written informed consent from the relatives of the deceased. Measurements were taken in 9 points total, using an iGaging 8” Digital Outside Caliper. Independent sample t-test was done to compare the thickness between sexes and one-way ANOVA was done to compare the thickness between the bones. Results The mean thickness of frontal, parietal, temporal, occipital bones, and pterion were 5.38(±0.91), 4.67(±0.59), 1.52(±0.50), 6.53(±1.28) and 2.55(±0.74) mm respectively. Thickest point was Occipital Point B with mean thickness of 7.39(±1.70) mm in females and 8.47(±1.46) mm in males and the thinnest point was found to be the squamous part of temporal bone with the mean thickness of 1.48(±0.69) mm in the right 1.65(±0.69) mm in the left cranium of females and 1.43(±0.41) mm in the right and 1.56(±0.40) mm in the left cranium of the males. Conclusion Occipital bone was the thickest bone in the neurocranium and the thickness increased from anterior to posterior. This study will be helpful for surgeons in bone grafting and selecting screws and will also be resourceful to anatomists and anthropologists.
Compliance with WHO Surgical Safety Checklist in Otorhinolaryngology in a Tertiary Care Center: A Retrospective Study
Introduction Surgical safety checklist is crucial for patient safety and enhanced communication between operating team members. It decreases surgical morbidity and mortality. This study aimed to evaluate the utilization rate of Surgical Safety Checklist introduced by WHO and completion of its 19-items during Otorhinolaryngology surgery. Methods This was a cross-sectional, observational study conducted in Otorhinolaryngology Department of tertiary care center, Nepal from 14th April, 2024 to 15th October, 2024. Surgical Safety Checklist attached in 111 charts of patients who had undergone surgeries of ear, nose, neck and throat under General Anesthesia were evaluated. Percentage of utilization and completeness of the checklist were calculated. Results The utilization of the WHO Surgical Safety Checklist in Otorhinolaryngology was found to be 67.56% (75 out of 111 charts). The entirely filled checklist was observed in only 8 out of 75 (10.67%) charts. Seventy-one charts were of elective surgeries while only four charts were of emergency surgeries. Time-out section was completed in nearly hundred percent charts. Sign-in was complete in 64 out of 75 (85.33%) charts. The least completed section was the sign-out section, which was filled in only 8 out of 75 (10.67%) charts. Conclusion Utilization of Surgical Safety Checklist in Otorhinolaryngology surgery was observed in two-thirds of the cases. However, its completeness was poor. Time-out was the most fulfilled section while sign-out was the least filled section in the checklist.
Copyright (c) 2026 Journal of Institute of Medicine Nepal https://creativecommons.org/licenses/by-nc/4.0
Knowledge, Attitude and Practice in Management of Atypical Odontalgia among Dentists
Introduction Atypical odontalgia (AO) is one of the representatives of medically unexplained oral symptoms (MUOS) and is characterized by persistent orofacial pain in absence of any significant clinical or radiographic findings. These conditions are often associated with neuropathic, vascular or psychiatric disorders. It is frequently misdiagnosed leading unnecessary treatments. This study assesses knowledge, attitude, and practices regarding AO among dentists. Methods In this descriptive cross-sectional study, set of 20 questions was developed and tested for face and content validity. Pretesting was done on 10% of the sample (N=181), and necessary modifications were made. The final questionnaire was distributed via Google Forms, and 181 responses were collected. Data were analyzed using SPSS v20. Results Among 181 study participants, 176 (97.2%) actively practiced dentistry to date, and 129 (71.3%) encountered patients with atypical odontalgia. More than half of them, 104 (57.5%) used the term atypical odontalgia, followed by other terminologies like psychogenic pain (23, 12.7%) and chronic idiopathic pain (26, 14.4%). Most of them (93, 51.4%) thought that atypical odontalgia may be of neuropathic, psychological, or vascular in origin. At least once in every six months, or once during their practice, atypical odontalgia was encountered by 35 dentists (19.3%). Out of 181 dentists, 53 (29.3%) have confidence in the management of AO. However, most of them referred to an oral medicine specialist. Conclusion Although atypical odontalgia was commonly encountered in dental practices, notable gaps in attitude, knowledge and management or treatment practices was seen.
Atypical Odontalgia; Chronic orofacial pain; Comorbid factors; Nepalese Dental Practitioners; Psychiatric disorders
Clinical Profile of Male Melasma and Association of its Severity with Serum Testosterone
Introduction Melasma is a common skin condition presenting with symmetric brown pigmentation on sun exposed areas, especially face. Most of the studies in melasma have been focused on females. Few studies in male melasma have revealed lower level of serum testosterone level. This study aimed to describe male melasma in terms of clinical presentation, severity, and relationship with serum testosterone levels. Methods This was a descriptive study where cases of male melasma were assessed for clinical patterns and severity using modified melasma area severity index(mMASI). The association of severity of melasma with serum testosterone level was determined. Results Forty-two males with melasma were enrolled in the study. The age ranged from 20 years to 57 years, with a mean age of 32.7±7.5 years. Majority had Fitzpatrick’s skin type IV and malar pattern was predominant. Average time of sun exposure ranged from 30 minutes to 8 hours. mMASI score ranged from 2.40 to 14.90. Serum testosterone level was lower than the reference range in 14(33.3%) cases. However, multiple linear regression analysis showed that serum testosterone was not independently associated with melasma severity after adjusting for age (β=-0.339, p=0.028) and sun exposure in hours (β=0.442, p=0.008). Conclusion Male melasma was common Fitzpatrick type IV skin with predominant malar pattern. This study showed that serum testosterone was not associated with melasma severity in males after adjusting for age and duration of sun exposure.
Developing A Surgical Rationale of Bile Culture and Sensitivity to Guide Targeted Antibiotics in Laparoscopic Cholecystectomy in a Tertiary Care Hospital in Nepal
Introduction Laparoscopic cholecystectomy is the standard surgical treatment for benign gallbladder conditions. Traditionally, antibiotics have been used empirically in patients to lower the risk of post operative complications. Earlier routine use of antibiotic has now been replaced with single dose preoperative antibiotic. But, the emergence of anti-microbial resistant organisms has raised concerns regarding the use of broad spectrum antibiotics including ceftriaxone to all cases. Methods This is a single-centered, prospective study. Data collection was done between January 2025 to April 2025. There were 148 patients included in the study. Single dose ceftriaxone was given at induction. Bile was collected during the intraoperative period and culture was sent. Association of bile C/S with various preoperative and postoperative factors were analyzed. Results In our study, bile culture was positive in 11 of 148 patients (7.4%). Escherichia coli and klebsiella pneumoniae were the predominant isolates (72%). No significant association of the bile culture colonization was observed with either age, gender or BMI. Those who were immunocompromised had higher bile culture microbial growth rates (21.1% vs. 5.4 %; p = 0.036). Signficantly higher culture growth rates were also noted in infective cases (29.4%). Among the cases that had growth on bile culture, 100% of the organisms were resistant to the routinely used prophylactic antibiotic. Conclusion Routine bile culture positivity in laparoscopic cholecystectomy is low in our study when prophylactic ceftriaxone was given. While additional prophylactic antibiotics may not be universally required, selective use of antibiotic other than ceftriaxone is justified in high-risk groups such as diabetic patients or those with infective pathology.
Factors Associated With Hypertension Among Adult Clients in Provincial Hospital
Introduction Hypertension is one of the major public health problem and its prevalence is increasing across the countries globally. Most of the factors associated with high blood pressure are modifiable. If they are not addressed timely it would burden to health care system. This study aimed to determine the factors associated with hypertension among the adult clients in provincial hospital. Methods This study is a hospital-based case-control design conducted in Lumbini Provincial Hospital with a total 160 (80 cases and 80 controls) samples. The data was collected by face-to-face interview technique using World Health Organization STEP wise approach to Non-Communicable Disease Risk Surveillance instrument version 3.2 from 18 September 2023 to 13 October 2023. Data were entered in SPSS version-21 and analyzed. Chi-square, crude odds ratio and adjusted odds ratio was calculated. Results Clients having a family history of hypertension are 2.3 times more likely to get hypertension (COR= 2.38, 95% CI= 1.262-4.516, p=0.007). Second hand smoker had 2.4 times more chance of getting hypertension (COR= 2.362, 95% CI=1.262-4.516, p=0.007). Alcohol consumers were likely to have high blood pressure 3.0 times more. Other risk factors were inadequate consumption of fruits and vegetables, physically inactive, having a higher BMI, and having comorbidity. Conclusions Most of the risk factors associated with hypertension are behavioural and could be modified. So, policymakers and healthcare professionals need to conduct awareness programs focusing on lifestyle modifications for the prevention of hypertension and to reduce disability and death.
Case-control study, Hypertension, Risk factors
Use of Solid Monoblock Rib cartilage Graft for Augmentation Rhinoplasty in Tertiary Care Centre: A Prospective Study
Introduction Autologous rib cartilage is commonly used graft material for major dorsal augmentation, especially in asian rhinoplasty, however, concern persists regarding warping and donor-site morbidity. This study aims to evaluate the aesthetic satisfaction and complications associated with autologous rib cartilage grafts in augmentation rhinoplasty. Methods This prospective observational study was conducted at the Department of Ear, Nose, and Throat of Kathmandu Medical College from April 2023 to March 2025. Fifty-six patients aged between 18 to 50 years with severe saddle nose deformity either due to congenital or traumatic nasal malformations were included. Patients with nasal polyposis or granulomatous diseases were excluded. Primary outcome was evaluated by using Rhinoplasty Outcome Evaluation (ROE) score (0-24 scale) pre, 6 months and 1 year postoperatively. Secondary outcome included complication rates. Results A total of 56 patients (mean age 31.63 ± 5.68 years; 53.6% female) were included, with congenital abnormalities constituting of 80.4%. Mean ROE scores improved from 8.13 ± 1.74 preoperatively to 18.02 ± 1.22 at 6 months and 18.40 ± 2.15 at 1 year postoperatively (p<0.001). Graft-related complications were warping occurring in 2 cases (3.57%) and graft displacement in 1 case (1.79%). Donor-site morbidity included hypertrophic scar in 2 cases (3.57%) and persistent donor-site pain in 1 case (1.79%). No infections, graft extrusions, or pneumothorax were observed. Conclusion By using solid autologous costal cartilage graft, good patient satisfaction, and minimal donor-site complications can be achieved.
Table of Contents - Vol 47. No 2. August 2025
“Pushing the Boundaries: Breakthrough in Research Culture” A Report on the First Research Conference of the Institute of Medicine (IOM-RECON25)
The First Research Conference of the Institute of Medicine (IOM) was held on 12th July 2025 in Kathmandu with the theme "Pushing the boundaries: breakthrough in research culture" It provided a platform for researchers, clinicians, students, and institutional leaders from IOM’s constituent and affiliate colleges to collaborate, share findings, and inspire innovation, recognizing the need for locally tailored evidence-based healthcare. The event, organized by the Research Department of IOM, featured 52 presentations, including two keynote speeches, 17 invited thematic lectures, two panel discussions, and 31 free paper presentations. Expert chairpersons guided these sessions, facilitating the presentations and discussions. The conference represented a significant step in enhancing IOM’s academic quality and research capabilities. It encouraged collaboration and innovation while promoting evidence-based medical practices.
Prevalence of Bilateral Vocal Fold Palsy in Cases with Perinatal Hypoxia
Introduction There is a notable gap concerning the potential impact of perinatal hypoxia on laryngeal innervation and its role as a causative factor for bilateral vocal fold palsy (BVFP) in children. This study aims to assess the prevalence of BVFP in cases with perinatal hypoxia. Methods This cross-sectional study took place at the Department of Ear, Nose, and Throat (ENT) and the Department of Pediatrics of Institute of Medicine, Kathmandu, Nepal. Institutional Review Board approval was obtained. From November 2019 to March 2023, all children under 2 years of age with documented perinatal hypoxia were included. Exclusion criteria comprised cases without parental consent, identification of another identifiable cause of BVFP, or the child being on oxygen support during examination, preventing laryngoscopy. Additionally, a retrospective cohort analysis included all BVFP patients at the department between January 2013 and November 2019 to validate our findings. Results The study included 21 cases, and none of those with perinatal hypoxia exhibited BVFP. Furthermore, the retrospective cohort of BVFP cases presenting at our department did not reveal a significant history of perinatal hypoxia. Conclusion Our study did not yield compelling evidence linking perinatal hypoxia with BVFP however, considering the constraints of our study, insights from existing literature and absence of prior research in this area, the hypothesis of perinatal hypoxia's impact on laryngeal innervation merits further, more comprehensive research in this area.
Postoperative Endophthalmitis caused by Escherichia coli and Burkholderia cepacia complex: A Rare Case Report
Endophthalmitis is one of the most serious complications following cataract surgery. Early treatment with intravitreal antibiotics with or without pars plana vitrectomy is the standard management but gram-negative bacteria and multi-drug resistant bacteria pose significant challenges as the prognosis is usually poor in such cases. We present a case of post-operative endophthalmitis following cataract surgery caused by multi-drug resistant Escherichia coli as well as Burkholderia cepacia complex.
Mini-Nutritional Assessment Questionnaire for Assessing the Nutritional Status of Patients with Chronic Obstructive Pulmonary Disease: A Cross-sectionalStudy
Introduction Chronic obstructive pulmonary disease (COPD) has systemic effects like malnutrition that increase morbidity and mortality. Nutritional assessment in COPD is not adequately addressed in Nepal even though the assessment is clinically relevant. The objective of the study is to determine the nutritional status of COPD patients based on MNA and to evaluate the correlation between the MNA and demographic, anthropometric and spirometry variables. Methods The study involved 140 stable COPD patients, who were studied using cross-sectional study design. Mini Nutritional Assessment (MNA) was used to determine the nutritional status. Demographic variables, anthropometric and spirometry parameters and clinical variables were taken. The associations were compared based on chi-square, one-way ANOVA, and Pearson correlation whereby p < 0.05 was regarded as significant. Results GOLD stage was associated with nutritional status (p = 0.034), and BMI differed across nutritional categories (p < 0.001). No association was observed between nutritional status and spirometry indices or dyspnea grade (all p > 0.05). MNA score showed a moderately positive correlation with BMI (r = 0.501, p < 0.001), whereas no correlation was noted with FEV1 or mMRC grade. These findings suggest that nutritional impairment is more closely related to anthropometric parameters than to pulmonary function. Conclusion COPD patients have a high prevalence of malnutrition, and poorer nutritional status was associated with more advanced GOLD stages. COPD management should include routine MNA screening and early nutritional interventions to improve clinical outcomes.
Head-Mounted Virtual Reality Display: A Feasible Visualization Tool for Minimally Invasive Surgery
Head Mount devices (Virtual Reality platform) can be used as an alternative display device during minimal invasive surgery. Augmentation reality will be the future of navigation guided surgery and virtual reality is the first step towards the future. We report our experience with the use of virtual reality platform in minimal invasive surgery. Head mount device is feasible and replicable approach for better display during minimal invasive surgery.
Management of Acute Appendicitis during the COVID-19 Pandemic - Experience from a Tertiary Level Hospital of Nepal
Introduction Appendicitis is the most common abdominal emergency and managed by appendectomy. However, during the peak COVID-19 pandemic most cases of uncomplicated acute appendicitis were managed conservatively and appendectomies were performed only after failure of conservative treatment. The objective of the study was to see the outcome of acute appendicitis treated with conservative management. Methods This was ambispective observational cohort study. All cases admitted as acute appendicitis but managed conservatively during the peak COVID period were collected from record section and patient followed up to five years or till patient got operated. Results A total of 33 cases of uncomplicated appendicitis were admitted, of which 21 cases were managed conservatively.Two cases were lost to follow-up. Of 19 cases, 11 cases (57.89 %) had recurrence and were operated. Among them, ten cases were operated on within 6 months, and 1 case after 8 months of the initial conservative treatment. Among the factors considered for treatment options, Alvarado score 8 (6.5-9) vs 9 (7-9), p=0.03 and Tzanakis score 12 (10-12.5) vs 13 (10-13), p= <0.01 were found to be significant indicators for the conservative and operative management groups. Conclusion Conservative management of uncomplicated appendicitis can be an alternative treatment, particularly during pandemic situations. However, patients with high Alvarado and Tzanakis scores should be closely monitored, with surgical intervention performed if there is recurrence of symptoms.
Diagnostic Hystero-Laparoscopy for Evaluation of Female Infertility: A Cross-sectional Study
Introduction Diagnostic hystero-laparoscopy has additional advantage of direct visualization of pelvic pathology along with performing therapeutic surgery at same setting, compared to other diagnostic modalities. This study aims to determine the role of diagnostic hystero-laparoscopy in evaluation of infertile women. Methods This descriptive study was conducted from April to July 2025 including women presenting with infertility and planned for diagnostic hystero-laparoscopy in department of infertility at Paropakar Maternity and Women’s Hospital. Any abnormalities detected during laparoscopy and hysteroscopy were recorded. If any therapeutic procedure was done, that was also noted. A structured proforma was used to collect data and descriptive analysis was done. Results During the study period 36 underwent diagnostic hystero-laparoscopy among which, 20 (55.55%) had primary infertility and 16 (44.44%) had secondary infertility. The mean age was 30.44±4.70 years and the mean duration of infertility was 3.76±3.71 years. The most common pathologies determined on hysteroscopy were uterine polyp and septate uterus, both being 6 in number (16.66%). On laparoscopy tubal block was noted in 22 (61.11%) women followed by pelvic adhesions which was seen in 19 (52.77%) cases. Most frequent therapeutic intervention done during laparoscopy was adhesiolysis (16, 44.44%) and during hysteroscopy were polypectomy and septal resection (6 each, 16.66%). Eleven women (30.55%) had undergone multiple procedures. Conclusion Tubal and peritoneal abnormalities were the two main factors determined on laparoscopy and most prevalent finding on hysteroscopy were uterine polyp and septate uterus. Adhesiolysis, polypectomy and septal resection were the main procedures performed.
Clinical and Morphological Evaluation of Meibomian Glands in Dry Eye Disease
Introduction Studies on Meibomian gland morphology and association with dry eyes are not common in our scenario. The objective of this study was to know the clinical pattern and morphology of Meibomian glands and its association with dry eyes. Methods This was prospective observational study done in Cornea clinic of Nepal Eye Hospital, Kathmandu, Nepal for a period of one year (December 2022 through December 2023). All the patients aged ≥20 years who were diagnosed with Dry eye disease was included in the study. The study variables included age, sex, Ocular surface disease index (OSDI), Schirmer test, Tear break up time (TBUT), Lissamine staining, Meibomian gland loss, Meibomian secretion and dry eyes severity. Descriptive analysis of data was done using frequencies and percentage and correlation between parameters were done using Pearson's test. Results Out of fifty cases of dry eye diseases, there were 24 (48%) male and 26 (52%) female with mean age 46.47 years (SD ± 11.96). Most of the patients presented with grade 2 severity of dry eyes (44%, n=22) and the Meibomian gland loss was mainly grade 3 type (60%, n=30). There was a strong positive correlation (r = 0.621, p < 0.01) between Meibomian gland loss and OSDI Score, also strong positive correlation (r= 0.584, p < .001) Meibomian gland secretion and dry eye severity. Conclusion The severity of dry eye is positively correlated with Meibomian gland loss and the meibum quality.
Dry eye disease; Meibomian gland dysfunction; Meibography.
Efficacy of an Asynchronous Tele-Medicine Model in Otorhinolaryngology
Introduction Access to Otorhinolaryngologists in remote regions is limited in Nepal. The country’s rugged topography is one important cause. Telemedicine may help bridge this gap; however, evidence supporting its effectiveness in low-resource settings is sparse. This study evaluates the diagnostic performance of an asynchronous telemedicine model in Otorhinolaryngology at Tribhuvan University Teaching Hospital. Methods A hospital-based analytical cross-sectional study was conducted in a tertiary care center. A convenience sampling method was used with a minimum sample of 94., The study included patients of all ages. Trained undergraduate medical students recorded the clinical history and examination findings of the participants. Diagnoses made through asynchronous telemedicine using smartphones, endoscopic imaging, and EMR systems by a consultant Otorhinolaryngologist were compared with standard in-person evaluations in 102 patients by a separate ENT specialist independently. Concordance was assessed using Cohen’s Kappa. Results Diagnostic agreement analysis showed high diagnostic concordance across Otorhinolaryngology subspecialties; rhinology had the highest concordance (κ = 0.96) followed by pediatric cases (κ = 0.84), Otology cases (κ = 0.79), and then head and neck cases (κ = 0.79). Diagnostic discrepancies arose mainly due to poor-quality images and the lack of physical examination. Conclusion Asynchronous telemedicine is a viable strategy for otolaryngology diagnostics in resource-constrained settings. It holds potential to improve access to specialist care and optimize referral efficiency in Nepal and similar contexts.
Factors predicting Post-Operative Facial Nerve Function following Retromastoid Vestibular Schwannoma Surgery
Introduction Facial Nerve (FN) preservation is a critical outcome measure in Vestibular Schwannoma (VS) surgery. This study aimed to identify factors predicting postoperative FN function following retromastoid VS surgery. Methods A retrospective analytical study was conducted in 30 patients with unilateral VS undergone retromastoid surgery (RMS) at Department of Neurosurgery, Bir Hospital, Nepal. Patient’s demographic data, clinical data, intraoperative tumor characteristics, and post-operative FN function status were obtained from hospital record. Results The study included 30 patients (mean age 40.7 years, 56.7% male) with unilateral VS undergone retromastoid resection. Most tumors were large (mean size 3.73 cm; 53.3% >4 cm, 70% Koos grade 4). Immediate poor FN function (House Brackmann (HB) III-VI) was observed in 76.7% of cases, improving significantly to 83.3% HB I-II by 6 months. Tumor consistency strongly influenced outcomes: firm/hard tumors had poorer immediate (p=0.001) and delayed (p <0.001) FN function compared to soft/cystic tumors. Intraoperative neuromonitoring (used in 20% of cases) improved immediate FN outcomes (p <0.001) but showed no long-term benefit (p =0.58). Age ≥30 years predicted worse immediate FN function (p =0.012). Preoperative FN dysfunction correlated with persistent poor outcomes (p <0.001). Tumor size, extent of resection, and hearing status did not significantly affect FN prognosis. One mortality (3.3%) occurred due to postoperative hematoma and hydrocephalus. Conclusion Tumor consistency was the strongest predictor, with firm tumors linked to worse outcomes. Intraoperative neuromonitoring aided early function but had limited impact on long-term recovery. Younger age and better preoperative FN status favored recovery.
Vestibular schwannoma, retromastoid approach, facial nerve outcome, House-Brackmann scale
Moyamoya Disease with Intraventricular Hemorrhage in a Child: A Case Report
Moyamoya disease is a rare progressive cerebrovascular disorder in Nepal characterized by stenosis or occlusion of cerebral arteries with abnormal collateral vessels, and hemorrhagic presentation in children is extremely uncommon. We report an 8-year-old girl with intraventricular hemorrhage presenting with seizures, vomiting, and decreased consciousness. Imaging revealed characteristic angiographic features of Moyamoya disease. She was managed with external ventricular drainage and supportive treatment, achieving significant recovery. This case highlights the importance of considering Moyamoya disease in pediatric hemorrhagic stroke and underscores the need for early imaging and timely intervention.
Self-Medication of Antibiotics among Medical and Nursing Students in a Medical College of Kathmandu
Introduction The practice of self-medication of antibiotic among future healthcare professionals can lead to the emergence of antibiotic-resistant bacteria. This study aimed to investigate the prevalence, and underlying factors associated with self-medication of antibiotics among medical and nursing students. Methods A cross-sectional questionnaire based survey was conducted at Nepalese Army Institute of Health Sciences among second year students of MBBS and nursing streams after obtaining approval from Institutional Review Committee and informed consent from participants. The questionnaire comprised statements for knowledge, awareness and perception and practice. Descriptive parameters were used to summarize the data. Results The overall percentage of self-medication practice with different antibiotics was 31.41% within the past one year among 156 total participants. The two most common reasons for self-medication were convenience in getting antibiotics (MBBS 62.1%, BScN 25% and BNS 12.5%) and previous experiences of similar illness (MBBS 58.6%, BScN 66.7% and BNS 87.5%). Azithromycin was the most used antibiotic for self-medication by BNS (62.5%) and MBBS (58.6%) students whereas metronidazole was more commonly used by BScN students (41.7%). MBBS and BNS students primarily self medicated antibiotics for common cold and sorethroat, while BScN students commonly used them for fever and diarrhea. Conclusion This study revealed the practice of self-medication with antibiotics among medical and nursing students albeit less as compared to the other studies. However, such self-medication practice can adversely affect the future of antibiotic related issues especially emergence of antimicrobial resistance.
Antibiotics, antimicrobial resistance, self-medication
Prognostic Value of Serum Glucose Level in Septic Children in PICU
Introduction Pediatric sepsis is a major cause of morbidity and mortality. Abnormal blood glucose is linked with higher mortality, increased requirement for mechanical ventilation and inotropic support. This study is aimed to determine the prognostic value of serum glucose level in sepsis children in PICU. Methods This retrospective study was performed in the Pediatric Intensive Care Unit (PICU) of Kanti Children’s Hospital with diagnosis of Sepsis from April 2024 to September 2024 with age ranging from 1 month to 14 years. The data was collected from the record section. The outcome of sepsis in the form of discharge or death during the hospital stay, length of hospital stay, use of ionotropic support, mechanical ventilation and blood sugar level were tabulated and the data analysis was done by SPSS version 21. Results Among 53 patients enrolled, 21 were male and 22 were female with male to female ratio of 1.4. The median age of the patient is 2.5±4.46 years. The median length of hospital stay was 7± 5days. There was no statistical significance in the length of PICU stay, use of ionotropic support and septic shock in patients with abnormal blood glucose. However, it was significantly associated with mortality (p value 0.009) and use of mechanical ventilator (p value 0.09). Conclusion Our study highlights that abnormal blood glucose level in pediatric sepsis is significantly associated with increased mortality and a greater need for mechanical ventilation. However, no significant relationship was observed between abnormal blood glucose, length of PICU stay and ionotropic support.
Histopathological Profile of Lung Cancer: A Single-Center Study from Nepal
Introduction Lung cancer remains the leading cause of cancer-related mortality globally, accounting for approximately 18% of all cancer death. Despite the global prevalence of lung cancer, epidemiological data from Nepal remain limited. The study aims to bridge these gaps by investigating the histopathological characteristics of lung cancer in a cohort of patients from a tertiary care center in Nepal. Methods This is an observational cross-sectional study conducted at Tribhuvan University Teaching Hospital (TUTH) among lung cancer patients aged greater than 18 years of age from September 2024 to February, 2025. Descriptive statistics was used to summarize demographic and histopathological characteristics. Results A total of 107 lung cancer patients were included in our study. The male:female ratio was 1.3 in our study, while the mean age of the patients was 67 years and standard deviation is 11 years. Squamous cell carcinoma (48%) and Adenocarcinoma (46%) were the major histological subtypes while only 6% cases were Small-cell carcinomas. Conclusion This study analyzes the histopathological and the demographic profile of lung cancer diagnosed at a single tertiary center of Nepal. Non-small cell lung cancer is the most common histological diagnosis in this study. Broader study is needed to explore the clinical and molecular associations.
Critical Appraisal of the Curricula of MD Anesthesiology Programs in Nepal using Harden’s 10 Questions
Introduction Anesthesiology in Nepal is evolving beyond its traditional operating room role, increasingly encompassing critical care, pain management, and multidisciplinary support. As surgical and procedural services expand, there is a growing demand for anesthesiologists with advanced clinical, leadership, and research skills. Ensuring that MD Anesthesiology curricula are robust and contextually relevant is essential for meeting Nepal’s diverse healthcare needs. This study aimed to assess whether the curricula included the key principles as outlined in Harden’s 10-question framework. Methods This study critically evaluated the MD Anesthesiology curricula from major Nepalese institutions using Harden’s Ten Questions framework. Curricular documents were collected and analyzed independently by multiple reviewers. Results All programs follow a three-year structure with a mandatory thesis, but variability exists in curricular detail, organization, and emphasis on research or community-based components. Needs assessments and stakeholder engagement are generally absent. Educational objectives are broad but often lack focus on leadership and interprofessional skills. Teaching and assessment methods remain largely traditional, with limited use of active learning or competency-based approaches. Communication of curriculum details and educational environment standards also vary widely. Conclusion MD Anesthesiology curricula in Nepal require comprehensive reform. Implementing evidence-based needs assessments, modern educational strategies, and continuous quality improvement will better prepare graduates to meet the complex challenges of contemporary healthcare.
Neutrophil-to-Lymphocyte Ratio in Predicting Outcomes of Patients with Aneurysmal Subarachnoid Hemorrhage in a Tertiary Care Hospital in Nepal
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.