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.
Table of Contents - Vol 47. No 2. August 2025
Copyright (c) 2025 Journal of Institute of Medicine Nepal https://creativecommons.org/licenses/by-nc/4.0
“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.
Hypoxic injury; Perinatal hypoxia; Vocal fold palsy
Moyamoya Disease with Intraventricular Hemorrhage in a Child: A Case Report
Moyamoya disease is a 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.
Moyamoya Disease; Intraventricular Hemorrhage; Pediatric Stroke.
Prognostic Value of Serum Glucose Level in Septic Children in PICU
Introduction Sepsis is a potentially fatal illness brought on by a dysregulated host response to infection. Pediatric sepsis has a high death rate of about 11 % in high income countries. Higher mortality, increased requirement for breathing and inotropic support all are linked to hypoglycemia. 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 PICU of Kanti Children’s Hospital with diagnosis of Sepsis based on clinical and laboratory parameters admitted to the PICU between April 13th and September 17th 2024 with age ranging from 1 month to 14 years. Medical records of those patients were analyzed. 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 Out of a total of 53 patients included 21 were male and 22 were female with male to female ratio of 1.4. The mean age of presentation was 41.97 months. The mean length of PICU stay was 4.64 days. There was no statistical difference in the length of PICU stay (p-value 0.548), use of ionotropic support(p value 1) and septic shock(p value 1) in patients with hypoglycemia. However, abnormal blood glucose was significantly associated with mortality (p value 0.009) and use of mechanical ventilator (p value 0.09). Conclusion In conclusion, our study highlights that hypoglycemia in pediatric sepsis is significantly associated with increased mortality and a greater need for mechanical ventilation. However, no significant relationship was observed between dysglycemia and the 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. Conclusions: Patients with tent-shaped UOs after insertion of a guidewire are 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.
Adequacy of Analgesics in Post-Operative Orthopedic In-patients using Visual Analogue Scale
Introduction: Adequate post-operative pain management in orthopaedic 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: A prospective, cross-sectional study was conducted on 240 post-operative orthopaedic inpatients at Patan Hospital, 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. Descriptive and inference SPSS 16 was used to evaluate analgesic adequacy and its association with age, gender, surgery type, and anatomical site. Results: The majority of patients weremale 134 (55.8%) with a mean age of 41.03 ± 16.60 years. The most frequently used analgesics were and ketorolac 64 (26.67%), followed by Paracetamol 55 (22.92%) and NSAIDs 54(22.50%). showed a significant reduction in pain across all sites and surgical types, particularly in spine and pelvic surgeries. Major surgeries have , which improved significantly by the next day Conclusions: The findings indicate that analgesic use in this setting was effective pain reduction observed among post-operative orthopaedic inpatients. 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. These results indicate that timely and appropriate analgesic administration effectively controls post-operative pain in orthopaedic patients and highlight the importance of protocol-based pain management strategies tailored to surgical invasiveness.
Effect of Altitude on Age of Loss of Ambulation in Boys with Duchene Muscular Dystrophy
Introduction Early loss-of-ambulation (LOA) and death at young age are inevitable in Duchene muscular dystrophy (DMD). Definite treatment of DMD is not available till date. Prolongation of ambulation and management of complications is the goal of treatment. In sports, high-altitude training is popular to improve athletic performance. We investigated the influence of altitude on DMD in relation to age at LOA. Methods It was a cross-sectional study done on 91 DMD patients, who have lost their ambulation, using the database of Muscular Dystrophy Foundation-Nepal. DMD boys living in different elevations of Nepal were divided into <200m (plain), 200-700m (intermediate), 700-1000m (middle), and >1000m (high) groups, and the age at LOA was recorded. Findings were tabulated and analyzed statistically using student's t-test and Log Rank test, with p <0.05 considered significant. Results Out of 91 DMD cases registered, 36 (39.6%), 34 (37.4%) were from plain (Terai) area and high land area of Nepal respectively; accounting 77% of the total patients. The median age at LOA for each group increased with elevation, and the LOA age in the high-land group (median ± SD; 11.20 ± 2.78) was significantly higher than that in the low-land group (9.62 ± 2.02) by about 2 years (p <0.005). Conclusion Our study indicated a longer period of independent walking for DMD patients living in high altitude areas. DMD boys might benefit by rehabilitation at higher altitude.
Analysis of Outcomes of Surgery for Chronic Pancreatitis according to International Study Group for Pancreatic Surgery Reporting System
Introduction Due to lack of standard reporting system for chronic pancreatitis that could include all the aspect of the disease process. International Study Group for Pancreatic Surgery (ISGPS) formulated a framework for reporting the surgery for chronic pancreatitis. This framework incorporates our recent understanding, management and outcomes of chronic pancreatitis. We aimed to report surgery performed at our department for chronic pancreatitis with this standard reporting system. Methods From January 2021 to December 2024, 32 patient who underwent surgery for chronic pancreatitis were enrolled in the study. Patients details of clinical baseline prior to surgery, morphology of diseased pancreas, type of surgery and post operative outcomes were evaluated and reported according to four domains of ISGPS. Results A total of 32 patients underwent surgery. Alcohol was the etiology in six (18.75 %) and rest were identified as idiopathic. Diabetes was prevalent in 13 (40.6%) of patient with exocrine insufficiency in only one patient. All patient had parenchymal calcification. Ductal stone was present in 29 (90.6%) with stricture in 16 (50.0%) patients. Longitudinal pancreatojejunostomy with partial pancreatic head resection was the most common surgery performed in 27 (84.3%) patients. Postoperatively two patients had major complications. There was no 90 days re-operation and mortality. Conclusion This reporting system is feasible to report surgery for chronic pancreatitis. However, large scale prospective study validation is required.
Correlation between Early Postoperative Urine Output and One-Year Graft Function after Living Donor Kidney Transplantation: A Prospective Observational Study
Introduction The prognostic value of early postoperative urine output after kidney transplantation remains uncertain. This study evaluates its association with one-year graft function and examines additional clinical predictors. Methods A prospective observational study was conducted at a tertiary transplant center in 90 renal transplant recipients; 82 completed one-year follow-up. Primary outcome was one year estimated glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration 2021. Exposures included urine output on postoperative days 1 to 3, donor age, warm and cold ischemia times, discharge creatinine, dialysis duration, human leukocyte antigen mismatch, and early surgical complications within 30 days. Primary analysis used linear regression with prespecified covariates. Secondary analysis used logistic regression for eGFR less than 60 mL per minute per 1.73 m2. Results Urine output on postoperative days 1, 2 and 3 did not correlate with one year estimated glomerular filtration rate. Complications occurred in 8.5 % (7/82). Body mass index showed no association with one year estimated glomerular filtration rate. In the multivariable model, older donor age and higher discharge creatinine independently associated with lower one year estimated glomerular filtration rate (donor age B = -0.595, p = 0.02; discharge creatinine B = -0.219, p = 0.03). Single-marker receiver operating characteristic analysis showed poor discrimination. Conclusion Early post-operative urine output did not correlate with one-year graft function. Future research should focus on additional markers and strategies to improve graft function prediction.
Estimated Glomerular Filtration Rate (eGFR)
Prevalence of Variants of Mandibular Second Premolar in Medical students: A Descriptive Cross-sectional Study
Introduction The mandibular premolars have shown diversity in cusp morphology, although they are included under the bicuspid. This has been useful in anthropology and forensic odontology as supporting evidence. This study aimed to determine the prevalence of different types of mandibular second premolars among medical students. Methods: A descriptive cross-sectional study was conducted among 255 medical students after obtaining ethical approval. The number of cusps and the groove pattern present on the mandibular second premolar were examined and recorded using a sterile mouth mirror and explorer. The data was entered in a Microsoft Excel sheet and analyzed by the Statistical Package for Social Sciences (SPSS) version 27.0. Results: The prevalence of the two-cusp variant 319 (62.5%) was more than the three-cusp variant 191 (37.5%). The most common groove type was H type 198 (38.8%), followed by Y type 191 (37.5%) and U type 121(23.7%). The present study showed that the Y-shaped groove pattern was more common in the right premolar 40% (102), and the H-shaped groove pattern was more common on the left side 42.4% (108). The study showed that two cusp-type premolars are more common on the right and left sides of both genders. This study also revealed that two cusp variants are more common than other variants in different ethnic groups examined on both sides Conclusions: The most prevalent variant of the mandibular second premolar was the two-cusps type. H-shaped grooves were most common, followed by Y and U-shaped grooves. H-shaped grooves were more prevalent compared to other types in both males and females.
Emerging Fungus, Candida auris: A Case Report
Candida auris is a growing fungal threat that has sparked global concern. It has been linked to healthcare-related outbreaks and infections around the world and has been reported in numerous countries. This case report describes an infection caused by Candida auris in a 21-year-old patient with a prolonged hospital stay. On the 60th day of admission, the patient developed persistent fever and cerebrospinal fluid culture revealed Candida spp. Identification of the species and antimicrobial susceptibility testing was done by VITEK-2. The isolate was sensitive to flucytosine and voriconazole and resistant to fluconazole and amphotericin B. Voriconazole was started after the culture and sensitivity results.
Perceived Stress and Associated Factors among Adults residing in a Rural Community of Nepal: A Community-based Study
Introduction Stress contribute to disorganized working capacity of adult’s life that leads to various comorbidity. The burden like stress-related common mental disorders are on the rise in Nepal. The aim of the study was to estimate stress level and its associated factors among adults. Methods A community based, Cross-sectional survey was done among 600 adults aged >18 years, residing in Prasauni Rural Municipality, Nepal. Respondents were interviewed in local language using WHO STEPs questionnaire and prevalence of stress was determined by using perceived stress scale. The data was analyzed using IBM SPSS version 20. Odds ratio was calculated to identify the independent predictors of the outcome variable. Results Almost equal portion of the participants were male (47.7%) and female (52.3%). and most of them were of age less than 35 years. Regarding the level of stress, 508 (85.2%) respondents were having low level and 88(14.8%) respondents were having moderate level of stress. Respondents’ age was associated with perceived stress level(p<0.05). Poor sleep quality tends to increase stress 4 times more (OR 4.04, CI 2.257-7.25). Although not significant, tobacco use, physical inactivity, tobacco and alcohol use, and increased blood pressure had higher odds for stress level. Conclusion Stress symptoms are prevalent in low to moderate level among adults of rural community in Nepal. Poor sleep quality is a significant predictor of increase stress level. Further exploratory investigations are needed.
Table of Contents - Vol 46. No 3. December 2024
Copyright (c) 2024 Journal of Institute of Medicine Nepal https://creativecommons.org/licenses/by-nc/4.0
Phenotypic and Genotypic Detection of Metallo-b Lactamase in Non-Fermenting Gram Negative Bacilli Obtained from Clinical Samples in a Tertiary Care Hospital in Nepal
Introduction Non-fermenting Gram-negative bacilli, including Pseudomonas aeruginosa and Acinetobacter baumannii, are significant nosocomial pathogens with limited treatment options due to their intrinsic and acquired resistance mechanisms. Among these, metallo-β-lactamases are of major concern which hydrolyze carbapenems and contribute to antimicrobial resistance. This study aimed to determine the prevalence of Metallo-β-Lactamase-producing non-fermenting gram negative bacilli in clinical specimens using both phenotypic and genotypic methods. Methods A descriptive cross-sectional study was conducted at Nepal Medical College Teaching Hospital from January 2024 to December 2024. A total of 16,954 clinical specimens were processed for culture and sensitivity testing. NFGNB were identified using standard microbiological methods. Antimicrobial susceptibility testing was conducted using the Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. MBL production was detected phenotypically using the Imipenem-EDTA combined disc method. The presence of IMP and VIM genes was confirmed by conventional PCR. Results Among 16,954 specimens, 163 (0.96%) NFGNB isolates were identified, with Pseudomonas aeruginosa (52.1%) being the most prevalent, followed by Acinetobacter species (39.3%) and Burkholderia species (8.6%). MBL production was detected in 22 (13.5%) isolates: Pseudomonas aeruginosa (59.1%), and Acinetobacter species (40.9%). Genotypically IMP and VIM genes were found in 36.4% and 31.8% of MBL-positive isolates, respectively, while one isolate harbored both genes. Notably, 27.3% of phenotypic MBL producers tested negative for both IMP and VIM, suggesting the potential involvement of other MBL genes. Conclusion The significant prevalence of MBL-producing NLFGNB, particularly among Pseudomonas aeruginosa and Acinetobacter species, highlights a serious challenge for antimicrobial therapy and underscores an urgent need for robust infection control and antimicrobial stewardship strategies.
Clinical Characteristics and Pattern of Use of Topical and Oral Antifungal Drugs in Recalcitrant Dermatophytosis: A Hospital-Based Study
Introduction Studies on clinical characteristics of recalcitrant dermatophytosis from Nepal are sparse. The objective of this study was to characterize recalcitrant dermatophytosis clinically and to see pattern of use of existing antifungals drugs in these patients. Methods This was a prospective observational study carried out in department of dermatology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal for a period of one year (December 2022 through November 2023). All the cases of recalcitrant dermatophytosis who visited dermatology outpatient department during this period were included in this study. The study variables included age, sex, occupation, site of involvement, prior use of topical drugs, oral terbinafine and oral itraconazole. Descriptive analysis of data was done using frequencies and percentages. Results Out of sixty cases of recalcitrant dermatophytosis, there were 32(53.3%) females and 28(46.7%) with mean age 34.47(SD +/- 11.96). Plaque (75%, n=45) presentation was the commonest type followed by annular (15%, n=9), polycyclic (6.7%, n=4), and patch type (3.3%, n=2). Multiple sites were involved in 35 patients (58.3%). Most of the patients had used topical corticosteroids (36.7%, n=22) at presentation. Sixteen patients had history of use of oral drugs prior to presentation without any improvement; Itraconazole (23.3%, n=14) was the most common drug used, followed by Terbinafine (1.7%, n=1). Conclusion: Plaque type of recalcitrant dermatophytosis in young female with multiple sites of involvement was the most common presentation. Many patients had used topical corticosteroid and topical antifungals while majority had never used oral drugs prior to presentation in hospital.
Association of Resting Blood Pressure Levels with Pain Sensitivity Parameters among Medical Students
Introduction Pain perception varies among individuals and is influenced by multiple physiological factors, including blood pressure. The present study aimed to assess the association of resting blood pressure with pain sensitivity parameters among medical students of a medical college. Methods This was a cross-sectional study done in first and second year medical students aged 17-25 years. Pain sensitivity was assessed by the Cold Pressor Test. Pearson’s correlation analysis was used to determine the association between blood pressure and pain sensitivity parameters. Data were analyzed using SPSS Statistics, with a significance level set at p<0.05. Results Resting systolic blood pressure increased significantly in both sexes (Males:123.13±5.40 to 126.93±3.97; Females:113.35±8.26 to 119.76±5.67) following cold pressor test, while diastolic BP rose significantly only in females. Males had significantly higher pain threshold (23.32±3.00 vs 20.06 ± 4.15) and pain tolerance (92.18±14.06 vs 65.46±12.81) compared to females, while females reported significantly higher pain ratings (6.57±1.64 vs 5.32±1.08) on the visual analog scale (p<0.05). A significant positive correlation was observed between resting blood pressure and both pain threshold and pain tolerance in both males and females. In contrast, pain rating showed a significant negative correlation with both systolic and diastolic blood pressure in males (r = –0.247 and –0.343, p = 0.020 and 0.001, respectively) and females (r = –0.320 and –0.504, p = 0.004 and <0.001, respectively). Conclusion This study shows an inverse relationship between resting blood pressure and pain sensitivity, with stronger associations observed in females. The study also highlights sex-based differences in both pain perception and physiological response to cold-induced stress.
Internet Addiction among Undergraduate Medical Students and its Association with Sensation-Seeking Traits
Introduction: Easy access to the internet has raised concerns about internet addiction among medical students. This study aimed to assess the prevalence of internet addiction and its relationship with sensation-seeking traits. Methods: A cross-sectional study was conducted at National Medical College, Birgunj, Nepal, from January to June 2023. Ethical approval was obtained from the Institutional Review Committee (Ref. No: F-NMC/620/079-080). Undergraduate medical students were selected through convenience sampling. The Internet Addiction Test (IAT) and Arnett Sensation Seeking Scale were used for data collection, and data were analyzed using SPSS 21 with descriptive statistics, t-test, and Pearson correlation. Results: The study included 155 undergraduate medical students (Mean age: 21.22 ± 1.649 years). Most were fourth-year (n=58, 37.4%), followed by first-year (n=42, 27.1%), second-year (n=29, 18.7%), and third-year (n=26, 16.8%) students. Internet addiction was found in 86 students (55.5%), with 84 (54.2%) showing problematic and 2 (1.3%) severe use. High sensation-seeking traits were observed in 47 (30.3%). Weak negative correlations were found between internet addiction and sensation-seeking (r = -0.143 to -0.126, p > 0.05). Gender differences were observed in sensation-seeking (p = 0.022) and intensity (p < 0.001), but not in internet addiction or novelty (p > 0.05). Conclusion: The study found a high prevalence of internet addiction, with weak negative correlations to sensation-seeking traits, highlighting the need for awareness and interventions on healthy internet use.