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.
Comparison of Outcome of Patients undergoing Coronary Artery Bypass Graft Surgery using Pedicled versus Skeletonized Internal Mammary Artery Graft
Introduction Coronary Artery Bypass Grafting (CABG) is a standard procedure to revascularize the ischemic myocardium.Left Internal Mammary Artery (LIMA)is preferred graft due to its superior long term patency. LIMA can be harvested through either pedicled and skeletonized technique. Skeletonized LIMA is becoming popular due to favourable clinical advantage. This study aimed to compare the clinical outcomes between two harvesting technique. Methods This is a prospective comparative observational study of 41 patients who underwent CABG procedure at cardiac Centre from January 2020 to December 2020. Observational comparative study of 41 patients with 20 patients in Group A(skeletonized LIMA) and 21 patients in Group B (pedicled LIMA ).The clinical parameters like postoperative drain output and patency of LIMA with selective Angiogram of LIMA at 3 to 6 months were compared. Results The mean age of patients in group A was 54.35±6.8 years and in group B it was 57.80±10.88 years. Postoperative drain output was significantly lower in the skeletonized group (426±159.4 mL) compared to the pedicled group (682.85±312.15 mL; p=0.002).The patency of LIMA was 100 percent in Group B and 83% in Group A (p =0.40).Among the three atretic LIMA , two were associated with competitive flow due to recanalized LAD and one patient had proximal LIMA stenosis ,unrelated to harvesting method. There were 3 mortalities, not attributable to the harvesting technique. Conclusion Both skeletonized or pedicled LIMA technique has similar patency at 3 to 6 months following CABG however skeletonized technique is associated with significant lesser postoperative bleeding.
Copyright (c) 2026 Journal of Institute of Medicine Nepal https://creativecommons.org/licenses/by-nc/4.0
Functional Outcome of Flexor Hallucis Longus Tendon Grafting in Late Presenting Tendo Achilles Tear at a Tertiary Care Hospital of Nepal
Introduction Flexor hallucis longus (FHL) tendon augmentation in late presenting Tendo Achilles (TA) tear gives good patient satisfaction. This study aims to analyze the functional outcome of FHL use in TA tear in our setting. Methods A retrospective observational study was conducted at National Trauma Center, Nepal of all the cases of FHL use in TA tears during the last one year. The data were collected from the hospital records and functional outcome assessed at the follow up visit of 6 months. Statistical analyses were performed using SPSS 24. The central tendency was represented with median with Interquartile range (IQR) and mean and standard deviation(SD) were used. To compare the means and median, paired t-test and Wilcoxon ranked-sum test were used, respectively. The p-value less than 0.05 was considered statistically significant. Results Total 30 cases were included in the study. The mean age was 52.27 + 5.32 years. The mean duration to surgery from injury was 9.53 + 4.13 weeks. The mean tear gap preoperatively was 3.02 + 0.69 cm, which after debridement increased to 3.88 + 0.45 cm. The median total AOFOS score preoperative was 48 (IQR 10)which increased to 82(IQR 3), which was statistically significant, p <0.001. Post-operatively, 29(96.67%) cases had good and 1(3.33%) case had excellent outcome. The most common complaints of the patient were pain post-operatively in 22(73.33%) cases, followed by ankle weakness in 19 (63.33%) cases. Conclusion The flexor hallucis longus tendon augmentation in late presenting Tendo Achilles tear gives good functional outcome. But most patients complained of pain and weakness post-operatively.
Head and Neck Reconstruction using Pectoralis Major Myocutaneous Flap in a Tertiary Care Center
Introduction The head and neck defects have multiple reconstructive options available among which pectoralis major myocutaneous flap has remained a reliable option for reconstruction. This study aimed to evaluate outcome of pectoralis major myocutaneous flap reconstruction in head and neck surgery. Methods This is a retrospective observational study done by analyzing the clinical records of 29 cases with reconstruction of head and neck defects due to various etiologies with PMMC flap from January 2021 to December 2025. The data were analyzed using IBM SPSS statistics version 25. Results Out of 29 cases, 21 were males and 8 were females. The most common pathology was squamous cell carcinoma (SCC) (n=27) (93.1%) that involved gingivobuccal sulcus in 12 cases (41.37%). It was followed by buccal mucosa (20.68%), floor of mouth (13.79%), one case each of lip and angle of left mandible (3.45%), tongue (10.34%) and retromolar trigone (6.9%). The PMMC flap had 100% survival rate no partial or total flap loss. However, the flap had complication rates of 34.48% in this study. Gingivobuccal sulcus accounted for most of the complications including four cases (13.79%) and it was followed by two cases each of buccal mucosa and floor of mouth (6.89%), one case each of tongue and lip (3.44%). Conclusion The PMMC flap showed complications like wound dehiscence, seroma and surgical site infection. However, it showed promising result regarding its survival rate and coverage of defects in head and neck.
Frailty and Postoperative Delirium in Elderly patients Undergoing Elective Surgery: An Analytical Study
Introduction Postoperative delirium (POD) in geriatric patients significantly increases morbidity and mortality. Frailty predisposes patients to significant adverse postoperative outcomes. This study evaluates the occurrence of preoperative frailty using Edmonton Frail Scale (EFS) and its association with postoperative delirium in elderly patients. Methods An analytical cohort study was conducted among patients aged ≥ 65 undergoing elective non-cardiac surgery. Preoperative frailty, cognitive reserve and comorbidities were assessed with validated tools. Intraoperative variables including anesthesia type, surgery, surgical duration, intraoperative complications including hypotension were recorded. Postoperative delirium was assessed twice daily for 72 hours postoperatively using confusion assessment method (CAM). Unadjusted and multivariable logistic regression analyses were performed to identify independent risk factor and evaluate the association between frailty and delirium after adjusting for relevant covariates. Results The occurrence of delirium was 9.70%(16/165). Preoperative frailty was present in 55(33.33%) participants. Postoperative delirium was seen in 43.33% of moderate to severe frail group compared to 0.91% in the non-frail group (p <0.001). In the multivariable analysis, after adjustment for age and intraoperative hypotension, the odds of postoperative delirium increased about twofold for every one-point increase in Edmonton Frail Scale score (aOR 2.20; 95% CI 1.57-3.50, p <0.001). Intraoperative hypotension was another significant factor (aOR 12.88; 95% CI 2.66-77.58 p <0.002). Conclusions The preoperative frailty score and intraoperative hypotension were significant predictors of postoperative delirium. Implementing routine frailty screening and hemodynamic stability in frail elderly population are essential strategies to decrease the risk of postoperative delirium.
Distribution of Clinical Isolates of Candida Species among Clinical Specimens in a Tertiary Care Center
Introduction Candida species are the most common cause of mycosis, especially among patients who are immunocompromised, receiving broad spectrum antimicrobial therapy and/or chemotherapy, hospitalized and with diabetes mellitus. The increasing cases of Candida infection by its different species is a subject of concern because each species possess different characteristics features to fail the treatment. Thus, speciation and its prevalence is imperative for the management of candidiasis infection. Methods This is a laboratory-based cross-sectional descriptive study. A total of 149 isolates of Candida were identified from 16,234 clinical specimens and those specimens were processed at Department of Microbiology, Tribhuvan University Teaching Hospital. Growth on Sabouraud dextrose agar were evaluated for colony appearance, germ tube test, chlamydospore formation on corn meal agar and Candida speciation from CHROMagar. Data were analyzed using descriptive statistics and all the statistical evaluation were done by using SPSS version 16.0 software. Results Finding of the study explained C. albicans was the most common isolate out of 149 Candida spp. which was 53.70% of total isolates. Similarly, among NAC species C. tropicalis was the most common isolate followed by C. krusei, C. dubliniensis, C. parapsilosis and C. glabrata. The study revealed that the prevalence of isolates is 0.92% in overall specimens. Conclusion Although C. albicans is the most common isolate of Candida spp., NAC species infection is increasing especially in case of urine and blood stream infection.
Burden of Hypertension in a Rural Community of Western Nepal: A Cross-Sectional Study
Introduction Hypertension is a modifiable risk factor for cardiovascular disease with rising burden in low- and middle-income countries (LMIC) like Nepal. However, reliable community level data from rural Terai regions are scarce. This study was conducted to determine the prevalence of hypertension and to identify its socio-demographic and behavioural risk factors among a rural village of Rupandehi district. Methods A community-based cross-sectional study was carried out in Materiya Village of Rupandehi district, Nepal, from April to July 2025. A total of 290 adults were recruited using systematic sampling, and data were collected with a structured case proforma. Hypertension was defined according to the 2025 ACC/AHA criteria. Descriptive statistics summarized data, and chi-square test, ANOVA, and t-test were applied. Results The mean age of the participants was 39.30±13.9 years, 71.4% were female, and 50% were illiterate. The overall prevalence of hypertension was 46.9%, with males having a significantly higher prevalence (60.2%) than females (41.5%). Prevalence increased progressively with age, from 27.6% in the 20-29 years group to 66.7% in those ≥60 years. Hypertension was significantly associated with alcohol consumption, occupation, and marital status. Only 19% of the hypertensive participants were on treatment. Conclusion This study reveals an alarmingly high burden of hypertension (nearly one in two adults) in the rural western Terai region of Nepal, while awareness and treatment remained low. The strong links with male gender, advancing age, alcohol use, and certain occupations suggest the urgent need for targeted, community-based screening and need for lifestyle modifications.
Assessment of Severity of Blepharospasm in Outpatients in a Tertiary Hospital using Blepharospasm Disability Scale and Jankovic Severity Scale
Introduction Blepharospasm is a condition characterized by involuntary and excessive blinking of eyelids. It is focal dystonia. The purpose of the study was to assess the severity of blepharospasm by both patient and physician rating scales and to compare the correlation between these two scores. Methods It was a single centred retrospective cross-sectional study in outpatient department (OPD) of neurology and Neuro-Ophthalmology of tertiary hospitals of Institute of Medicine (IOM). Data was extracted from the patient files who visited hospital between January 2023 till December 2023. Jankovic Rating Scale (JRS) was used to assess the severity by physician and Blepharospasm Disability Index (BSDI) by patient to self-score their disability. Analysis was done using IBM SPSS version 26. Correlation between physician scored scale and patient reported scores were done by using Spearman’s rho. p-value of <0.05 was considered statistically significant. Results 17 patients were included. The mean age of study population was 56.84 ± 14.37 years, and 58.8% of patients were female. Only 29% were receiving botulinum toxin injection. Mean BSDI score was 5.41 ± 4.77 and mean JRS score was 5.82 ± 0.88. No significant correlation was observed between the BSDI and JRS scores (rho = 0.418, p = 0.095). Conclusion JRS and BDSI are both useful and widely used tools to assess severity of blepharospasm. However, our study showed only moderate correlation between physician and patient rating scales. Reason could be due to small sample size. Larger multicentre studies are advisable.
Comparison of Erector Spinae Plane Block with Transversus Abdominis Plane Block for Postoperative Pain Management in Patients undergoing Total Abdominal Hysterectomy: A Randomized Controlled Trial
Introduction Transversus abdominis plane and Erector spinae plane blocks are used regional anaesthesia techniques for abdominal surgery. This study compares the analgesic efficacy of ESP versus TAP blocks in patients undergoing total abdominal hysterectomy. Methods This randomized study enrolled 44 patients undergoing total abdominal hysterectomy under general anesthesia. Patients were randomly assigned to two equal groups. Group A received bilateral erector spinae plane block, while Group B received bilateral transversus abdominis plane block under ultra sound guidance using 20 ml of 0.25% bupivacaine on each side. Outcomes assessed included time to first rescue analgesia, 24-hour analgesic consumption, postoperative pain scores at predefined intervals, and complications. Results The median time to first request for rescue analgesia was 1 hour in both groups and was not statistically significant (p = 0.408). The 24-hour median dose of rescue analgesia was 50 mg in the ESP group and 100 mg in the TAP group, which was statistically significant (p = 0.022). Comparison of Numeric Rating Scale (NRS) scores between the two groups at 0 and 1 hour postoperatively showed statistically significant differences (p = 0.010 and p < 0.001, respectively). NRS scores at 6, 8, 12, and 24 hours did not differ significantly between the groups, although median scores were lower in both. Complication rates were not significant in either group. Conclusions ESP block significantly reduced 24-hour rescue analgesia consumption compared with TAP. NRS scores differed at 0 and 1 hour, but were similarly low thereafter, indicating comparable overall postoperative analgesic efficacy profiles.
Bupivacaine; gynaecological surgeries; pain management; Regional Anesthesia; visceral pain
Morphometry of Adult Kidney and Arrangement of Structures at the Hilum: A Cadaveric Study
Introduction Renal dimensions and weight are important indicators of kidney function. This study aimed to assess renal dimensions, weight, lobulation, and variations in hilar pattern, and to compare these parameters between the right and left kidneys. Methods A descriptive cross-sectional study was conducted on 124 pairs of morphologically normal kidneys obtained from adult cadavers of the Department of Forensic Medicine, Maharajgunj Medical Campus. Renal length, breadth, thickness, and weight were measured. Lobulation and antero-posterior arrangement of structures at the hilar structures were assessed. Results Among 124 cadavers, 82 were male, and 42 were female. The age ranged from 18 to 81 years, with a mean age of 38.06 years. The mean weight of kidney was 124.71±23.96 g in males and 110.63±24.33 g in females. The mean weight of the kidney was 116.65±24.46 g (right) and 123.25±26.72 g (left). The median length was 10.04 cm (right) and 10.43 cm (left). The median breadth was 5.56 cm (right) and 5.61 cm (left). The median thickness was 2.81 cm (right) and 3.05 cm (left). Lobulation was observed in 8% of right and 16% of left kidneys. The typical pattern of hilar arrangement was seen in 56.5 % of right kidneys and 49.2% of left kidneys. Conclusions The left kidney was greater than the right in length, breadth, thickness, and weight. Renal dimensions were higher in males. Lobulation and variations in hilar arrangement were more frequent on the left side.
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. Conclusion 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.
Role of Functional Evaluation of Intermediate Coronary Artery Lesions with Fractional Flow Reserve in Clinical Decision Making
Introduction Coronary angiography often misjudges intermediate (50-70%) lesions. Fractional flow reserve (FFR) accurately assesses their physiological significance to safely guide revascularization. Addressing limited local evidence, this Nepalese study evaluates role of FFR in determining lesion severity and guiding treatment decisions. Methods This quantitative, cross-sectional study evaluated 43 patients with intermediate coronary lesions undergoing coronary angiography (CAG) at the Manmohan Cardiothoracic Vascular and Transplant Centre, Institute of Medicine, over one year. Patients with prior fibrinolytic treatment, connective tissue disorders, or skip lesions were excluded. Initially, revascularization or medical management was planned based on visual CAG stenosis. Next, resting full-cycle ratio (RFR) and FFR were measured. Significant lesions (FFR ≤0.80, RFR ≤0.89) received percutaneous coronary intervention (PCI); others received medical therapy. This study analysed how FFR/RFR altered initial visually-guided treatment plans. Results This study evaluated 43 intermediate coronary lesions (median age 66; 74% male) mostly presenting with chronic coronary syndrome. It compared visually estimated treatment plans after CAG against RFR/FFR-guided management. Visual assessment planned medical therapy for 88% (n=38) and intervention (PCI) for 12% (n=5). Functional assessment altered management strategy in 18 cases, deferring all five initially planned interventions to medical therapy and upgrading 13 medical management cases to revascularization. Conclusions Functional assessment (FFR/RFR) prevented suboptimal treatment of intermediate lesions. By altering planned management after CAG, FFR showed a promising role in optimal revascularization for intermediate coronary lesions.
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
Magnetic Resonance Imaging Findings in Patients with Asymmetric Sensorineural Hearing Loss and Evaluation of the Clinical Features of Patients with Abnormal Imaging: A Retrospective Study
Introduction This study aims to review the magnetic resonance imaging (MRI) findings in cases with asymmetric sensorineural hearing loss (ASNHL) and to evaluate the clinical features in cases with abnormal findings in MRI that could act as the clinical predictors for intracranial pathology. Methods This study was conducted at the Department of ENT-HNS, T.U. Teaching Hospital, Kathmandu, Nepal. A review of prospectively recorded data from five years (October 2019 to October 2024) on MRI findings and clinical features of cases presenting with ASNHL loss was done. Results A total of 47 cases met the inclusion criteria. Most cases had sudden sensorineural hearing loss (35), while the rest (12) had progressive hearing loss. Seven cases had abnormal MRI findings with vestibular schwannoma being the commonest pathological finding. Symptoms such as tinnitus, imbalance, headache, and tingling sensation in one half of the face had a statistically significant association with the detection of pathological findings in MRI. Conclusion MRI of the brain focusing on the CPA should be advised in all cases with asymmetric hearing loss. However, in scenarios where ordering an MRI is not feasible or can add much more financial burden to the patients, clinical features like tinnitus, headache, imbalance, and symptoms resulting from nerve compression such as tingling sensation in one half of the face can be taken into consideration to selectively scrutinize the patients with MRI.
Satisfaction towards Removable Dentures among Patients visiting Nobel Medical College and Teaching Hospital
Introduction The success of a removable prosthodontics hinges upon both the dentists and patient’s factors like retention, support, speech, mastication. The finish of the prosthesis which includes finalizing the shape, texture and polishing of the dentures also play vital role in the clinical outcomes. Besides, there are other important aspects that affect the success of dentures. The aim of the study is to determine factors affecting the patient satisfaction undergoing removable prosthodontic rehabilitation. Methods This is a cross‑sectional descriptive study conducted among 120 patients undergone removable prosthodontic rehabilitation in Nobel Medical College and Teaching Hospital in 1 year assessed from August to November 2025. Demographic details of participants, patient satisfaction score, prosthodontic history and patient behaviors were studied. Results Majority of study participants were moderately satisfied with the retention, esthetics, speech, mastication, finish of the denture, and overall satisfaction for maxillary and mandibular dentures. The gender, marital and educational status were significantly associated with esthetics of the denture; p = 0.014*, p = 0.034*, p = 0.05* respectively. Smoking habits was significantly associated with retention and duration of wear of prosthesis with the aesthetics of the denture. Total number of removable prostheses used by the patient and their behavior were significantly associated with masticatory performance of denture; p = 0.015* and p = 0.034* respectively. Conclusion In this study, majority of patients were found to be moderately satisfied with the retention, esthetics, mastication, finish and overall satisfaction for denture treatment while majority of them were poorly satisfied with the speech associated to the dentures.
Dialysis Adequacy and Nutritional Status in Patients on Maintenance Hemodialysis
Introduction Dialysis adequacy and malnutrition are key factors contributing to high mortality and morbidity rate in maintenance hemodialysis patients. Previous studies from Nepal have reported very low mean spKt/V and very high malnutrition rates. However, contemporary data on these parameters are lacking in Nepalese patients. So, this study was done to assess the current status of adequacy of dialysis, nutritional status and to determine the association between them in dialysis population in a tertiary care center of Nepal. Methods A cross-sectional study was conducted among 118 maintenance hemodialysis patients at Tribhuvan University Teaching Hospital. Dialysis adequacy was measured using spKt/V and nutritional status was assessed using MQSGA, anthropometric measurements and serum albumin. Chi-squared test, t-test and logistic regression analysis were done to determine independent factors associated with inadequate dialysis. Results The mean spKt/V was 1.3 ± 0.36, with 59.3% of patients achieved adequate dialysis. MQSGA showed that 62.7% of patients had normal nutrition, while 37.3% had mild-to-moderate malnutrition and none had severe malnutrition. Mid arm circumference and mid arm muscle circumference were significantly higher in patients with adequate dialysis. On logistic regress analysis, mid arm circumference was found to be an independent risk factor associated with inadequate hemodialysis (p = 0.03). MQSGA, triceps skinfold thickness, biceps skinfold thickness and serum albumin did not show significant associations. Conclusions Despite improvements in dialysis adequacy and nutritional status over time, many patients continue to receive inadequate dialysis and have malnutrition. Dialysis adequacy is significantly associated with objective measures of muscle mass rather than subjective nutritional scores, highlighting the importance of incorporating simple anthropometric assessments into routine care.
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 Maharajgunj Medical Campus. Measurements were taken after ethical approval from Institutional Review Committee 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 side. This study will be helpful for surgeons in bone grafting and selecting screws and will also be resourceful to anatomists and anthropologists.
Needs and Experiences of Primary Caregivers Rearing a Child with Autism Spectrum Disorder: A Qualitative Study
Introduction Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects both children and their families. Raising a child with ASD presents unique challenges and experiences that this study has aimed to explore to in the Nepalese context. Methods A phenomenological qualitative study was conducted with the inclusion of 10 primary caregivers via purposive sampling of children with ASD of age five to ten years and diagnosis of at least six months from January 2024 to November 2024 in Kathmandu, Nepal. Data were collected through face-to-face in-depth interviews with approval from the Institutional Review Committee of NAIHS. Data analysis was done based on Braun and Clarke’s (2006) thematic analysis method. Results Following six themes as daily parental challenges; Financial constraint; Mixed impact on the health of caregivers; Impact on relationships; Support from government level and quality medical care were extracted based on total 13 subthemes and 54 codes mentioned below with verbatim of participations. Conclusion Caregivers on a personal-level reported challenges arising from a lack of knowledge in managing nutritional needs and behavioral issues, along with financial constraints. At the institutional level, special attention was drawn to the lack of autism-specialized healthcare and high financial expenditures when seeking treatment in Nepal. These findings highlight the need for accessible and specialized healthcare services in Nepal with increase in governmental allowance for children with ASD.
Health Promoting Lifestyle among Health Professionals
Introduction Health promotion is important for health-promoting behaviour and disease prevention, which is associated with improved physical and mental health outcomes. So, this study aimed to find out the health-promoting lifestyle profile of health professionals working in Karnali Province. Methods A descriptive cross-sectional study was done among 217 randomly selected doctors, nurses, and paramedics in Karnali Province. Participants who had at least six months of experience and had no conditions that limited their physical activity. Data were collected by using the structured questionnaire. Mean scores of overall and subscale health-promoting lifestyle were calculated, and a t-test was used to compare differences between demographic variables and health-promoting lifestyle of health professionals. Results The majority of participants (67.74%) were younger than 30 years, with a mean age of 28.92 ± 6.516, and 62.67% were female. A majority (69.12%) of participants perceived their current health as good. In terms of health-promoting behaviours, 62.67% showed a moderate level of engagement. The overall mean health-promoting lifestyle score was 123.99 ± 16.66 out of 208, indicating a moderate practice level among health professionals. Furthermore, a statistically significant difference in health-promoting lifestyle scores with age groups (p = .035) was found, which suggests that age may influence the adoption of health-promoting behaviours. Conclusions Findings indicate that health professionals practiced a moderate level of health-promoting behaviours, underscoring the need for targeted advocacy and awareness to improve the health-promoting practices.
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.
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 and sun exposure in hours. Conclusion Male melasma was common in 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. Conclusion 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.