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.
Cover Page - Vol 47. No 3. December 2025
Copyright (c) 2025 Journal of Institute of Medicine Nepal https://creativecommons.org/licenses/by-nc/4.0
Compliance with WHO surgical safety checklist in otorhinolaryngology in a tertiary care center: A retrospective study
ABSTRACT 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 World Health Organization and completion of its 19-items during surgeries of ear, nose, neck and throat in a tertiary care hospital. Methods: This was a retrospective study conducted in the Department of ENT-HNS, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from 14thApril, 2024 to 15thOctober, 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 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. Time-out section was completed in nearly hundred percent charts. Sign-in was complete in 64 (85.33%) charts. The least completed section was the sign-out section, which was filled in only 8 (10.67%) charts. Conclusion: Utilization and completion of Surgical Safety Checklist in Otorhinolaryngology surgery was below optimum. 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
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. The association between duration of sun exposure and melasma severity was not statistically significant (p= 0.158). Serum testosterone level was lower than the reference range in 14(33.3%) cases. The association of melasma severity with low serum testosterone level was statistically significant (p= 0.031). Conclusion: This study described an association between melasma severity and low serum testosterone level in men. However, a multicenter case and control study with more detailed epidemiological exploration is needed.
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 symptomatic gallstone diseases and other 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 (AMR) organisms has raised concerns regarding the rampant use of antibiotics. Material and Methods This is a single-centered, prospective study done at department of GI and General surgery in KMCTH. 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%), cases with drain placement intraoperatively (28.6%), and those with hospital stay >3 days (26.7%). Among the cases that had growth on bile culture, 100% of the organisms were resistant to the routinely used prophylactic antibiotic. Conclusion Routine bile contamination and bile culture positivity in laparoscopic cholecystectomy is low. While prophylactic antibiotics may not be universally required, selective use is justified in high-risk groups such as immunocompromised patients or those with infective pathology, drain placement, or prolonged hospitalization.
Bile culture; Laparoscopic cholecystectomy; Surgical site infection.
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
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) is a chronic respiratory disease that in most cases has systemic effects like malnutrition that increase morbidity and mortality. Nutritional assessment in COPD is underutilized in Nepal even though the assessment is clinically relevant. Methods: The study involved 140 stable COPD patients, who were studied at the Department of Pulmonology, Institute of Medicine, Tribhuvan University using the 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: Mean age and BMI were 60.6 ± 9.5years and 21.3±3.5 kg/m 2, respectively; 61.4% were males, and 70.7% were rural inhabitants. MNA indicated that 70.0 % were at risk of malnutrition, 12.1% were malnourished and 17.9% of the population was well nourished. GOLD stage (p = 0.034) and BMI (p < 0.001) however had a significant relationship with nutrition status with non-significant relationship between spirometry indices and dyspnea grade. There was a moderately positive association between MNA and BMI (r = 0.501, p < 0.001), but no significant association between MNA and FEV 1 and mMRC. These results indicate that nutritional impairment is more associated with anthropometric than pulmonary parameters. Conclusions: In Nepal, COPD patients have high prevalence of malnutrition and the severity increases with the disease conditions. COPD management should include routine screening of MNA and early nutritional interventions in order to enhance 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.
Clinical and Morphological Evaluation of Meibomian Glands in Dry Eye Disease
Introduction 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 study done in General OPD and 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 Pearsons 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). The mean of OSDI, TBUT, Schirmer test and Lissamine staining were 30.64 (SD± 23.44), 7.6 sec (SD± 8.5), 12.20mm (SD± 6.9) and 2.5 (SD± 2.0) respectively. 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 ENT specialists 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 size of 94, which includes 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 ENT specialist 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 ENT subspecialties; rhinology had the highest concordance (κ = 0.96) followed by pediatric cases (κ = 0.84), ontological 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, cost-effective strategy for ENT 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 preservation is a critical outcome measure in vestibular schwannoma surgery. This study aimed to identify factors predicting postoperative facial nerve function following retromastoid microsurgical resection. Methods: An analytical study was conducted in 30 patients with unilateral Vestibular Schwannoma undergoing retromastoid resection at Department of Neurosurgery, Bir Hospital, Nepal. Patient’s clinical data, intraoperative details, and FN function status were recorded. Univariate and multivariate analysis by SPSS 20.0 statistical software were performed to evaluate the factors predicting facial function prognosis and its recovery. Results: The study included 30 patients (mean age 40.7 years, 56.7% male) with unilateral vestibular schwannomas undergoing retromastoid resection. Most tumors were large (mean size 3.73 cm; 53.3% >4 cm, 70% Koos grade 4). Immediate postoperative facial nerve dysfunction (House Brackmann III-VI) was observed in 76.7% of cases, improving significantly to 83.3% House Brackmann I-II by 6 months. Tumor consistency strongly influenced outcomes: firm/hard tumors had poorer immediate (p=0.001) and delayed (p=0.002) Facial Nerve function compared to soft/cystic tumors. Intraoperative neuromonitoring (used in 20% of cases) improved immediate Facial Nerve outcomes (p=0.001) but showed no long-term benefit (p=0.373). Age ≥30 years predicted worse immediate Facial Nerve function (p=0.012), though this disparity resolved by 6 months (p=0.839). Preoperative Facial Nerve dysfunction correlated with persistent poor outcomes (p=0.0001). Tumor size, extent of resection, and hearing status did not significantly affect Facial Nerve prognosis. One mortality (3.3%) occurred due to postoperative hematoma and hydrocephalus. Conclusion: This study highlights the importance of tumor consistency, preoperative nerve status, and surgical technique in predicting facial nerve outcomes. Findings may guide preoperative counseling and surgical planning.
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: Self-medication with antibiotics (SMA) is the acquisition and self-administration of antibiotics for treating a perceived infection, and their intermittent or continued use for chronic or recurrent diseases without the advice of a qualified health professional. Injudicious use of antibiotics can lead to the emergence of antibiotic resistant bacteria contributing to the development of antimicrobial resistance. 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 informed consent for voluntary participation. The questionnaire comprised statements for knowledge, awareness and perception and practice. Descriptive parameters were used to summarize the data. Results: A total of 156 students participated in the study. The overall percentage of self-medication practice with different antibiotics was 31.41% within the past one year. 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%). 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.
Dentoalveolar Heights in Skeletal Malocclusion: A Dual Plane Study
Introduction Skeletal malocclusions are manifested in sagittal, vertical and transverse discrepancies. Aim of this study was to determine the relationship of dentoalveolar heights among skeletal malocclusion with different growth patterns. Methods In this cross-sectional study, traced cephalometric X-rays were grouped into skeletal Class I, Class II, Class III based on Steiner’s ANB angle and growth patterns based on Steiner’s SN-GoGn Angle and Tweeds FMA angle. A Total of 180 samples were proportionally divided in nine groups based on growth pattern and malocclusion classification. ANOVA was applied for data analysis using SPSS V21. Results Upper anterior dental height (UADH) showed significance differences in all three planes, (Class I: p=0.041, Class II: p=0.043, Class III: p=0.013), Lower anterior dental height (LADH) showed no statistically significant differences across any class of malocclusion (all p > 0.1). In UADH, Class I and III exhibited lower values in horizontal compared to normal, while Class I and II showed lower UADH in vertical compared to horizontal. For UPDH, Class III showed lower values in vertical compared to normal, whereas Class II and III showed lower UPDH in vertical compared to horizontal. In LPDH, a significant reduction was found in Class III individuals with vertical patterns compared to horizontal. Conclusion Significant differences were mainly observed between horizontal and vertical growth patterns in Class II and III. In class I, differences were notable between normal to horizontal and horizontal to vertical growth patterns.
Dentoalveolar height, Skeletal malocclusion, growth pattern
Physical Status and Psychosocial Wellbeing of Child Domestic Workers in Selected Wards of Pokhara
Introduction: Child domestic workers (CDWs) face unique physical and psychosocial challenges; however, research on these issues is limited. This study assesses the nutritional status, physical health, and psychosocial problems among CDWs in selected wards of Pokhara. Methods: A cross-sectional study was conducted among 125 CDWs using a snowball sampling. Data were collected via semi-structured interviews and physiological measurements. Descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (Chi-square test) at a 5% significance level were used. Odds ratios were calculated at a 95% confidence interval. Data analysis was performed using SPSS version 16. Results: Among the CDWs, 50.9% reported inadequate fulfilment of basic needs; 50.4% exhibited stunted stature, 35.2% had low weight for age, and 16.8% were underweight based on BMI. Male CDWs (p = 0.001, OR = 4.929) and those obtaining less than seven hours of sleep per night (p = 0.003, OR = 5.77) demonstrated significantly greater odds of being underweight. Health problems were reported by 47.2%, while 50.9% had sustained work-related injuries. Older CDWs (p = 0.011, OR = 2.679) were significantly more likely to report health problems. Psychosocial problems were observed in 25.6% of the CDWs and were significantly associated with working over eight hours daily (p = 0.036, OR = 2.450), inadequate fulfilment of basic needs (p = 0.002, OR = 3.868), and dissatisfaction with work (p = 0.003, OR = 3.471). Conclusions: Poor nutrition among child domestic workers was associated with inadequate sleep and male sex; health and psychosocial problems correlated with older age, long hours, unmet needs, and dissatisfaction, warranting further longitudinal research.
Postoperative C-Reactive Protein as a Predictor of Postoperative Pancreatic Fistula after Pancreaticoduodenectomy
Introduction Postoperative pancreatic fistula (POPF) has adverse effects on the outcomes of patients after Pancreaticoduodenectomy PD. Thus, an accurate predictor of POPF is essential. This study aimed to identify C-Reactive Protein (CRP) on the first postoperative day (POD1) as a predictor of clinically relevant postoperative pancreatic fistula (CR-POPF). Methods It was a prospective observational study performed at Tribhuvan University Teaching Hospital, Nepal, from March 2019 to November 2019. Forty-nine patients who underwent PD were enrolled in the study. Demography, clinicopathological characteristics, postoperative complications, and CRP on POD1 were recorded. Statistical analyses were performed to identify the association of POD1 CRP with CR-POPF. Results The mean age was 56.94 ± 10.10 years, with a nearly equal gender distribution. Clinically relevant postoperative pancreatic fistula (CR-POPF) occurred in 13 patients (26.5%). Patients with CR-POPF had higher mean postoperative day 1 serum C-reactive protein (CRP) levels (123.84 ± 42.90 mg/L) compared to those without CR-POPF (93.35 ± 67.02 mg/L); however, the difference was not statistically significant (p = 0.134). No significant associations were found between CR-POPF and preoperative or intraoperative variables, including pancreatic duct diameter, gland texture, and operative time. Conclusion Although serum CRP levels on postoperative day 1 were higher in patients who developed clinically relevant POPF, the difference was not statistically significant in this study. Therefore, CRP alone may not be a reliable early predictor of CR-POPF.
Sexual Dimorphism in Permanent Mandibular Canine
Introduction Sexual dimorphism in mandibular canines, which are stable and decay-resistant, aids sex determination. Studies have extensively documented odontometric traits and sexual dimorphism in various ethnic groups. This study sought to assess sexual dimorphism in the mesiodistal diameters of mandibular canines. Methods A cross-sectional study was conducted at People’s Dental College and Hospital, involving 120 participants (60 males, 60 females); equal numbers of Brahmin, Chhetri, and Newa, aged 18 years and above. Mesiodistal widths of healthy mandibular canines, free of pathology, spacing, or rotation, were measured using a digital Vernier caliper. Data were analyzed with SPSS version 16 after entry into Microsoft Excel. Results Males exhibited significantly larger mesiodistal widths (right: 7.42±0.32 mm, left: 7.24±0.36 mm) than females (right: 6.78±0.23 mm, left: 6.62±0.29 mm) (p < 0.001). There was notable sexual dimorphism in the mesiodistal diameters of mandibular canines between the sexes, with the right canine showing a greater degree of dimorphism (9.45%) than the left (9.36%). Among three ethnic groups, there was the highest dimorphism rate of 10.38% on the right and 10.22% on the left among Brahmins, followed by Newa at 9.29% on the right and 8.24% on the left, and Chhetri at 8.34% on the right and 9.80% on the left. Conclusion Mandibular canine mesiodistal width demonstrates significant sexual dimorphism in Newa, Brahmin, and Chhetri populations, with Brahmins showing the greatest difference. These findings support its forensic utility for sex estimation in Nepal, though integration with additional markers is advised due to measurement overlaps. Ethnic-specific databases are needed to enhance forensic applications.
Influence of Ureteric Orifice Configuration on Effective Insertion of Ureteral Access Sheath during Flexible Ureteroscopy
Introduction Retrograde Intrarenal surgeries are facilitated by the use of ureteral access sheaths (UAS) but it is not always possible to insert the sheath on the first attempt. The aim of the study was to determine the possible predictive factors enabling insertion of UAS during flexible ureteroscopy (fURS). Methods All consecutive patients undergoing fURS/RIRS who were not pre-stented were studied and data collected. The study parameters were the demographics of the patients, characteristics of the stones, and perioperative data, including the ureteric orifice (UO) configuration over introductory guidewire. Multivariate logistic regression analysis was used to detect the possible predictors of successful UAS insertion. Results In total, 78 patients who underwent primary fURS were included, with a mean age of 38.9±14.68 years and a male: female ratio of 2.25:1 with an average stone burden of 11.4 mm. There was successful primary insertion of UAS in 47(60.26%) patients. Out of them, 44 of the patients had rounded configuration of the ureteric orifice with a successful primary insertion of UAS in 17 (38%) patients whereas 30 (88%) patients had successful insertion in those with tented configuration of the ureteric orifice over a guidewire with a significant p value (<0.001). In multivariate regression analysis, a tent-shaped UO after guidewire insertion was the only significant predictor (OR:13.70 95% CI:3.76-50.10 with p-value<0.0001) for primary successful UAS insertion into virgin ureters. Conclusion Patients with tent-shaped UOs after insertion of a guidewire were more likely to have an UAS insertion on the first attempt in a virgin ureter.
Table of Contents - Vol 47. No 1. April 2025
Age-Friendly Hospital Environments: Qualitative Exploration of the Senior Citizens and Care Providers’ Perspectives
Introduction Age-friendly hospital environments, and quality care are very crucial for maintaining the health and well-being of older adults. Globally, despite the growing concerns of age-friendly environment, limited research exists on how the senior citizens and their caregivers perceive the hospital environments. Hence, this study explores their perspectives to inform improvements in providing age- friendly care and services. Methods Descriptive phenomenological qualitative research was conducted at two tertiary-level hospitals in Nepal. A total of 28 participants were selected purposively and data were collected through in-depth interview using semi-structured interview guidelines and analysis was done by following Colaizzi's 7-steps of qualitative data analysis method. Results Four main themes were extracted from the data analysis :‘need to access healthcare facilities;’ ‘urgent need for expansion of age-friendly hospital services;’ ‘the age-friendly physical environment; ‘need for information, education, and effective communication in an age-appropriate manner. Participants expected for the availability of transportation facilities, affordable/free hospital services, priority, and prompt services with adequate facilities. Additionally, participants emphasized on continuous presence of care givers, a separate, no queues and digital payment system in billing counter, timely information, a separate geriatric ward/OPD with age-friendly physical infrastructure with religious and spiritual support as essential elements of an age-friendly environment. Conclusion This study highlights the need to create age-friendly hospital environment through development, implementation, promotion of policies, infrastructures, and age-sensitive approaches to enhance the well-being of senior citizens.
Assessment of Adequacy of Analgesics in Post-Operative Orthopedic In-patients using Visual Analogue Scale
Introduction Adequate post-operative pain management in orthopedic patients is essential for optimizing recovery and reducing complications. This study aimed to evaluate the adequacy of analgesic use among post-operative orthopaedic inpatients using the visual analogue scale (VAS). Methods An observational cross-sectional study was conducted on 240 post-operative orthopedic in-patients at Patan Hospital, Lalitpur, Nepal. Analgesic administration patterns were analysed, and pain intensity was assessed at 6 hours and the next morning at 10 am post-operative using VAS score. SPSS 16 was used to evaluate analgesic adequacy and its association with age, gender, surgery type, and anatomical site. Results The majority of patients were male 134 (55.8%) with a mean age of 41.03 ± 16.60 years. The most frequently used analgesics were Pethidine 67 (27.92%) and ketorolac 64 (26.67%). The mean VAS score decreased from 6.43 at 6 hours post-operatively to 4.96 the next morning in major surgeries (p <0.001), and similar statistically significant reductions were observed in other surgical categories and anatomical sites, including spine and pelvis. VAS scores showed a significant reduction in pain across all sites and surgical types, particularly in spine and pelvic surgeries. Major surgeries had higher initial VAS scores, which improved significantly by the next day (p < 0.001). Conclusion Analgesic use in this setting was effective in pain reduction observed among post-operative orthopedic in-patients. These results indicate that timely and appropriate analgesic administration effectively controls post-operative pain in orthopedic in-patients and highlight the importance of protocol-based pain management strategies tailored to surgical invasiveness.