Nepal Medical College Journal (NMCJ) is a Scientific Medical Journal published quarterly in English by Nepal Medical College in Kathmandu, Nepal. The Journal is printed in two-column format. Subjects covered include all aspects of health and diseases including clinical and experimental studies and medical education (in the form of original full papers, short communications, critical reviews, editorial commentaries, conference summaries and book reviews). Research is pivotal at NMCTH, with the Nepal Medical College Journal (NMCJ) serving as a platform for peer-reviewed studies on tropical diseases, public health, and clinical innovations. Collaborations with international institutions enhance research scope, addressing Nepal-specific issues like infectious diseases and maternal health. This emphasis on evidence-based practice fosters advancements in medical knowledge and policy.
Isolated Duodenal Injury following Blunt Trauma: A Case Report
Section: CASE REPORTS Keywords: Abdominal injury, case report, duodenum, Nepal Isolated duodenal injury following blunt abdominal trauma is rare and diagnostically challenging, requiring a high index of clinical suspicion. Early diagnosis and treatment is mandatory and further leads to decreased morbidity and mortality. We herein present a case of a 34-years-old male with an alleged history of trauma from a high-speed road traffic accident who was diagnosed with isolated duodenal injury following a contrast-enhanced computed tomography scan of the abdomen, and pelvis. Primary repair of the duodenal laceration was done.
Rare Presentation of Restraint Injury Over the Bilateral Axillae: A Case Report
Section: CASE REPORTS Keywords: Restraint injury, bilateral axillae, latissimus dorsi musculocutaneous flap Physical restraints are frequently used in intensive care units to prevent treatment interference in agitated patients. Although restraint-related complications are well documented, pressure ulcers occurring at unusual anatomical site are rarely reported. We report a 52-years-old male who developed bilateral axillary pressure ulcers following prolonged physical restraint during an intensive care unit stay after decompressive craniectomy for traumatic intracranial hemorrhage. Restraints were applied to the wrists and ankles with straps passing through the axillae. This case highlights a rare but preventable complication of physical restraint use. Proper application, vigilant monitoring, and early identification of complications are essential.
Assessment of Risk of Developing Type 2 Diabetes among the Adult Population Residing at Gokarneshwor Municipality, Kathmandu
Section: ORIGINAL ARTICLES Keywords: Adults, Indian diabetic risk score, type 2 diabetes mellitus Diabetes is agrowing global burden disease for individuals, families and countries. It has emerged as a major global health challenge affecting people in low- and middle-income countries including Nepal. Diabetes leads to extensive morbidity and mortality, prediction of one’s high risk for type II diabetes is an important issue as it can lead to early recognition and treatment. Therefore, this study was carried out to find the risk of developing type II Diabetes among the adult population residing at Gokarneshwor Municipality in Kathmandu. A descriptive cross-sectional study was conducted among 202 adults aged 18 years and above of Gokarneshwor Municipality in ward number 1 from August-September 2025. Non-probability convenience sampling techniques was used to collect the data. SPSS-16 was used for data entry and analysis. Descriptive statistics such as median, frequency and inferential statistics such as chi-square tests were used. The study revealed that over a third (38.1%) of respondents were below 35 years. Majority (66.3%) of respondents were female and only (33.7%) were male. Only (20.3%) of the respondents had family history of diabetes. Most of the respondents (65.3%) performed moderate physical exercise. Less than half (39.1%) of the respondents had waist circumference ≥90 in females and ≥100 in males. The proportion of respondents with high risk, moderate risk and low risk of developing diabetes were 29.7%, 50.5%, and 19.8% respectively. The analysis showed body mass index (P =0.003) was significantly associated with risk of developing type 2 diabetes. The study showed nearly one-third of the study participants were in high-risk group and half of them were at moderate risk of developing type II diabetes Mellitus. This increasing risk of development of type 2 diabetes in this population can be prevented by prompt awareness of preventive measures through lifestyle modifications.
Biochemical Differentiation of Alcoholic and Non-Alcoholic Fatty Liver Disease: A Comparative Study of Lipid Profile and De Ritis Ratio in Ultrasonography-Diagnosed Patients
Section: ORIGINAL ARTICLES Keywords: NAFLD, AFLD, De Ritis ratio, lipid profile, ultrasonography, fatty liver disease, AST/ALT ratio Fatty liver disease encompasses two clinically overlapping but pathophysiologically distinct entities: alcoholic fatty liver disease (AFLD) and non-alcoholic fatty liver disease (NAFLD). While abdominal ultrasonography remains the standard first-line imaging modality, it cannot differentiate between these two conditions, making non-invasive biochemical markers essential - particularly in resource-limited settings where liver biopsy and advanced elastography are often inaccessible. This comparative cross-sectional study enrolled 146 adult patients (≥18 years) with ultrasonography-confirmed fatty liver disease at Nepal Medical College and Teaching Hospital between July and December 2025; 59 (40.4%) were classified as AFLD and 87 (59.6%) as NAFLD. Serum AST, ALT, total cholesterol (TC), triglycerides (TG), HDL, and LDL were measured, and the De Ritis ratio (AST/ALT) was calculated. The Shapiro-Wilk test confirmed non-normal distribution for most variables; the Kruskal-Wallis and Mann-Whitney U tests were used for group comparisons, with multivariable logistic regression to identify independent predictors. The De Ritis ratio showed a significant bivariate association with AFLD (χ² =5.78, p =0.016; Cramér’s V =0.199) but did not retain independent significance on multivariable analysis (adjusted OR =1.30, 95% CI: 0.55-3.05, p =0.545). Total cholesterol (adjusted OR =1.05, 95% CI: 1.03-1.06, p <0.001) and triglycerides (adjusted OR =0.96, 95% CI: 0.92-0.99, p =0.012) were the key independent discriminators. ROC analysis confirmed excellent diagnostic accuracy for TC (AUC =1.000) and LDL (AUC =0.808) in identifying AFLD. Lipid profiling, combined with clinical history and ultrasonography, offers a practical and cost-effective non-invasive approach to differentiating AFLD from NAFLD in resource-constrained clinical settings.
Implementation of ICF-based Assessment and Treatment Course for Children with Cerebral Palsy by Health Professionals of Nepal: A Cross-Sectional Study
Section: ORIGINAL ARTICLES Keywords: Cerebral Palsy, Health professionals, ICF, Implementation, Nepal The International Classification of Functioning, Disability and Health (ICF) provides a holistic framework for the assessment and management of cerebral palsy. Although ICF-based training was provided to Nepalese health professionals between 2016 and 2018, its implementation in clinical practice has not been evaluated. This study assessed the implementation of ICF-based practice among trained health professionals in Nepal and identified barriers, facilitators, and prerequisites for successful implementation. A cross-sectional survey was conducted from June 2020 - June 2021 using a pilot-tested, self-developed questionnaire based on normalisation process theory. The questionnaire assessed four domains: coherence, cognitive participation, collective action, and reflexive monitoring. Data were collected through Google Forms or direct administration. Of the 48 eligible health professionals, 32 responded (response rate: 66.7%). Most participants considered the ICF approach valuable, and 84.4% supported its integration into routine clinical practice. Family-centred care was identified as a major advantage over previous approaches. Most respondents believed ICF could be implemented with minor modifications. Time constraints were the most commonly reported barrier (24/32), with streamlined outcome measures and improved team workload distribution suggested as potential solutions. Overall, health professionals perceived the ICF framework as beneficial for multidisciplinary, standardized, and comprehensive care. Addressing organizational barriers and adapting implementation strategies may facilitate successful integration of ICF-based practice in Nepal.
Outcomes of Laparoscopic Pyeloplasty at A Tertiary Care Centre in Kathmandu
Section: ORIGINAL ARTICLES Keywords: Laparoscopy pyeloplasty, PUJO, outcome, Nepal Ureteropelvic junction obstruction (UPJO) causes hydronephrosis and is often diagnosed in childhood, though many cases present in adulthood as undetected congenital disease. While open pyeloplasty has been the traditional gold standard with high success rates, laparoscopic pyeloplasty offers comparable outcomes. Since 2022, our institution has adopted this approach, and this study retrospectively evaluates our initial experience. This was a single-center, retrospective study of patients who underwent laparoscopic pyeloplasty at the Department of Urology, KIST Medical College and Teaching Hospital, Lalitpur, Nepal. The study was conducted on cases performed from January 2022 to March 2025. Median age was 23 years with male predominance (60%). Right-sided UPJO was more common (54%). Flank pain predominated (74%) the presenting symptoms. Mean operative time was 152 minutes. Open conversion occurred in three cases. Symptom relief occurred in 88.6%, with improved split renal function and eGFR. Laparoscopic pyeloplasty is feasible at KIST Medical College and Teaching Hospital, with satisfactory short-term outcomes despite an initial learning curve. Larger prospective studies with longer follow-up are needed to validate long-term efficacy.
Pattern of Head Injuries in Cases of Fatal Head Trauma admitted at Tertiary Care Centre in Eastern Nepal
Section: ORIGINAL ARTICLES Keywords: Assault, head injury, road traffic accident, Nepal A head injury describes a vast array of injuries that occur to the scalp, skull and brain. Among all regional injuries, those of the head are the most common and important ones in forensic practice as head injuries are one of the leading causes of death and disability worldwide. The present study aims to establish this fact by means of examining the pattern of head injuries which are an indirect indicator of severity of trauma. This hospital - based descriptive, cross-sectional study was carried out in Nobel Medical College Teaching Hospital in 210 cases of head trauma Including patients with head injuries (scalp injury, skull fracture, intracranial hemorrhage and brain injury) while excluding dead on arrival cases. Road traffic accidents (RTA) account for more than half of all cases 51.9% compared to 26.7% cases fall from height, 10.5% assault and 11.0% due to other reasons. Males are more frequently affected across all types of incidences, 72.5% male, 27.5% female involved in RTA, 55.4% male and 44.6% female in fall from height and 63.6% male, 36.4% female in assault cases. 109 RTAs cases were the most common among young and middle-aged adults, 56 falls from height cases showed a bimodal distribution, mainly affecting children and elderly people while assault was most common in the economically active adult age group. Alcohol abuse cases (18 out of 210) were relatively low compared to some global trauma statistics. In this study most common cause of head injury was found to be RTA followed by fall from height where males were more prone to injuries. The study showed a statistically significant relationship between age group of victims and type of incidence. Thus preventive measures focusing on age group should be implemented for safety and security purpose.
Characteristics of Ptosis presentation at Dhulikhel Hospital: A cross-sectional study
Section: ORIGINAL ARTICLES Keywords: Drooping, eyelid, nepal, ophthalmology, ptosis Ptosis is a common oculoplastic disorder that ranges from a cosmetic concern to a cause of visual impairment. This study aimed to describe the demographic profile, clinical features, etiological patterns, and visual impact of ptosis at a tertiary eye centre in Nepal. A hospital-based cross-sectional study was conducted at the Department of Ophthalmology, Dhulikhel Hospital– Kathmandu University School of Medical Sciences, from 1 May to 1 July 2023. Following ethical approval, data were collected using a structured proforma from all patients with ptosis, covering demographic details, clinical history, ocular examination findings, eyelid measurements, associated conditions and visual acuity. Ptosis severity was assessed clinically and confirmed using marginal reflex distance. The study included 51 patients, with a mean age of 36.84 ± 21.16 years and 26 (51%) males. Ptosis was unilateral 26 (51%) and long-standing 33 (64.7%). No identifiable precipitating factor was found in 35 (68.6%) patients. Congenital ptosis was present in 7 (13.7%). The mean marginal reflex distance was 2.31 mm in the right eye and 2.04 mm in the left eye. Moderate to severe ptosis was observed in 28 (54.9%) patients. Visual impairment in the better eye was present in 13 (25.5%) patients, including 4 (7.8%) with severe visual impairment or blindness. Associated systemic or neuromuscular conditions were identified in 6 (11.8%) patients. Ptosis commonly presents as a unilateral, long-standing condition with a significant proportion of patients experiencing moderate to severe disease and visual impairment. Early detection and comprehensive evaluation are essential to optimize visual outcomes.
Determinants of Preterm Birth among Women Referred from Community Health Facilities for Delivery: A Comparative Cross-Sectional Study
Section: ORIGINAL ARTICLES Keywords: Determinants, district hospital, laboring women, preterm birth, referral centre Preterm birth (PTB) is a major global health concern and a leading cause of neonatal morbidity, mortality, and long-term developmental challenges, particularly in resource-limited settings. This study aimed to compare factors associated with preterm birth among pregnant women referred from the community to a referral centre and a district hospital for delivery. A comparative cross-sectional study was conducted from 1st January to 30th June 2023 at a tertiary referral hospital and a district hospital in southern India. A total of 334 pregnant women referred from community health facilities (health posts, primary health care centre, and community health centre) to a referral centre and a district hospital for delivery were enrolled in the study, with 167 participants recruited from each facility using purposive sampling. Data on socio-demographic, obstetric, and newborn factors, including preterm birth, were collected using a pretested structured interview schedule. Statistical analysis included descriptive statistics, Chi-square tests, and binary logistic regression, with significance set at p <0.05. Preterm birth was more frequent in the district hospital (40.1%) than in the referral centre (33.5%), particularly among primiparous women. Women aged 26–30 years had a higher risk of PTB, while rural residence, private employment, and higher socioeconomic status were protective. Overall, PTB was influenced by maternal age, parity, occupation, residence, socioeconomic status, and facility-related factors. Determinants of PTB vary across health facilities, reflecting the influence of maternal, socioeconomic, and contextual factors on neonatal outcomes. Strengthening antenatal care, improving referral pathways, and addressing social and economic disparities are essential to reduce preterm births and improve newborn health in resource-limited settings.
Enhancing Sustainability in Contrast Media Use: Knowledge, Implementation and Training for Radiologic Technologists
Section: ORIGINAL ARTICLES Keywords: Computed tomography, environmental impact, Iodinated contrast media, radiologic technologists, sustainable healthcare Iodinated contrast media (ICM) are vital for computed tomography and other diagnostic imaging, but their use raises concerns about environmental contamination, dependence on limited iodine resources, rising costs, and supply-chain risks. Radiologic technologists are central to contrast preparation, administration, and protocol implementation. However, there is limited evidence on their knowledge and practices regarding sustainable contrast use in low- and middle-income countries. This study aims to assess knowledge, self-reported practices, training exposure, institutional support, and perceived barriers to sustainable contrast media use among radiologic technologists in Nepal. A cross-sectional online survey was administered to Nepal Health Professional Council–registered radiologic technologists employed in government, teaching, and private imaging facilities. The structured questionnaire evaluated knowledge and awareness, contrast-related practices, training exposure, institutional provisions, environmental considerations, and perceived barriers. Knowledge was defined as the correct identification of weight-based contrast dosing as a sustainable practice. A composite practice score (0–3) assessed renal function evaluation, use of weight-based dosing, and involvement in contrast selection. Data were analyzed using descriptive statistics and chi-square tests. Of 205 respondents, 92.2% demonstrated good knowledge and 82.9% reported good practice (11.2% moderate, 5.9% poor). Renal function assessment prior to contrast administration (97.6%) and weight-based dosing (94.6%) were commonly reported, and 84.4% were involved in selecting contrast type and dose. Awareness that contrast media can pollute water resources was 76.1%, and support for eco-friendly institutional policies was 92.2%. However, only 16.6% had received training on contrast sustainability and 29.3% reported an institutional disposal protocol, despite 91.7% expressing willingness to attend training. Previous training was associated with knowledge (p = 0.046) but not practice (p = 0.259). Radiologic technologists in Nepal show high knowledge and generally favorable self-reported practices in sustainable contrast media use, despite limited formal training and inconsistent institutional support. Targeted education, practical guidelines, and stronger organizational systems may support the adoption of more sustainable, environmentally responsible imaging services.
Types of Anemia in Pediatric Oncology and Non-oncology Patients: Insights from Coulter Diagnosis and Peripheral Blood Smear Analysis at a Tertiary Children’s Hospital, Kathmandu
Section: ORIGINAL ARTICLES Keywords: Anemia, automated hematology analyzer, pediatric oncology, peripheral blood smear, resource-limited settings Anemia is a significant health burden for pediatric patients, particularly those undergoing cancer treatment in resource-limited settings like Nepal. This study evaluated the diagnostic performance of automated hematology systems by Coulter against manual peripheral blood smear (PBS) analysis for classifying anemia types in a pediatric population. A total of 454 pediatric patients were included, comprising 274 oncology (60.4%) and 180 non-oncology (39.6%) cases. The overall mean hemoglobin was 10.76 ± 2.11 g/dL, with moderate anemia (7.0–9.9 g/dL) being the most prevalent category (118 patients). Anemia severity was concentrated in the non-oncology group (95 of 118 moderate; 19 of 20 severe), while oncology patients predominantly had normal hemoglobin (125 cases). Significant differences in red cell indices were observed: oncology patients had higher mean MCV (8.7 fL higher, p <0.001) and MCH (2.6 pg higher, p <0.001) compared to non-oncology patients. A highly significant association was found between anemia type and clinical status (χ² = 207.012, p <0.001). Normocytic profiles (normocytic normochromic anemia, NNA / normocytic normochromic picture, NNP) dominated the oncology group (51.7% NNP), consistent with anemia of chronic disease. In contrast, microcytic hypochromic anemia (MHA) was more common in the non-oncology group, consistent with iron deficiency. The automated Coulter diagnosis showed a strong agreement with manual PBS findings (r = 0.970, χ² = 922.47, p <0.001). In contrast, MHA was significantly more prevalent in the non-oncology group, suggesting iron deficiency. Given the strong agreement between the systems, the automated Coulter diagnosis serves as a reliable initial screening tool for anemia classification, but PBS confirmation remains essential to differentiate anemia types and guide effective clinical management in developing country laboratories.
Quality of Life among End-Stage Renal Disease Patients Undergoing Maintenance Hemodialysis in a Tertiary Hospital
Section: ORIGINAL ARTICLES Keywords: End stage kidney disease, hemodialysis, quality of life, Nepal End-stage renal disease (ESRD), the most advanced form of chronic kidney disease, severely impacts patients' quality of life (QoL), especially in low- and middle-income countries like Nepal. This study aimed to assess the QoL of ESRD patients undergoing maintenance hemodialysis at Chitwan Medical College. A cross-sectional quantitative study was conducted from October 2024 to January 2025 among 107 ESRD patients on hemodialysis for at least six months. QoL was measured using the WHOQOL-BREF tool across four domains: physical, psychological, social, and environmental. Descriptive and inferential statistics were used for analysis. The overall mean QoL score was 48.36 ± 7.44. The environmental domain scored highest (53.85 ± 11.10), followed by social (51.65 ± 11.85), physical (46.06 ± 7.46), and psychological (41.59 ± 8.19). ESRD patients undergoing dialysis in Nepal experience moderate to poor QoL, particularly in psychological and physical domains. Targeted, age-sensitive interventions are essential to enhance their well-being.
Prevalence of Oral Mucosal Lesions in patients with Diabetes Mellitus attending a Tertiary Health Center in Kathmandu
Section: ORIGINAL ARTICLES Keywords: Diabetes mellitus, lesion, oral, prevalence Diabetes mellitus is associated with several oral complications due to impaired tissue repair and altered immune responses. Oral mucosal lesions are common among diabetic patients, yet data on their prevalence in Nepal are limited. This study aimed to assess the prevalence and distribution of oral mucosal lesions in diabetic patients attending a tertiary health center in Kathmandu. A cross-sectional observational study was conducted among 221 diabetic patients attending the outpatient dental department of Nepal Medical College Teaching Hospital for a period of 19 months (April 2024-October 2025). Patients above 18 years with a known history of diabetes for at least six months were included. Extraoral and intraoral examinations were performed, and oral hygiene, gingival, and periodontal status were recorded. Data were analyzed using frequency statistics in SPSS v21. The mean age of participants was 54.88 ± 12.45 years, with a mean disease duration of 7.84 ± 5.84 years. Of the participants, 129 (58.4%) were female. The most commonly affected anatomical site was the buccal mucosa 135 (43.5%), followed by the dorsum of the tongue 78 (25.2%). The most prevalent oral lesions were melanin pigmentation 84 (27.1%), oral ulcers 48 (15.5%), and lingual varicosities 36 (11.6%). Other lesions included fissured tongue, coated tongue, hyperkeratosis, and linea alba. Oral mucosal lesions are common in diabetic patients, particularly affecting the buccal mucosa and tongue. Routine oral examinations in diabetic care may facilitate early detection and management of these lesions, contributing to improved oral and systemic health.
Frequency and Risk Factors for Intradialytic Hypotension in Patients Undergoing Maintenance Hemodialysis
Section: ORIGINAL ARTICLES Keywords: Chronic kidney disease, hemodialysis, intradialytic hypotension Hemodialysis (HD) patients and providers have long struggled with intra-dialytic hypotension (IDH), a complication that continues to challenge the safety and effectiveness of HD. IDH is associated with chronic end-organ damage and remains an independent risk factor for mortality among HD patients. Persistent hemodynamic instability may also accelerate the decline of residual renal function, further worsening clinical outcomes. Because individuals on dialysis already face markedly increased cardiovascular mortality and morbidity, identifying the prevalence and contributing factors of IDH has become an important clinical and academic priority. This observational study was carried out in the Hemodialysis Unit of Nepal Medical College and Teaching Hospital over one year (Baishakh 2079 to Chaitra 2079 B.S, April 2022 to March 2023 AD) without interventions or the collection of patient material. Ethical approval was obtained from the Institutional Review Committee. During each dialysis session, patients were assessed for pre- and post-dialysis weight, blood pressure, and heart rate at multiple intervals, ultrafiltration volume, and any clinical events or medical interventions related to intra-dialytic hypotension. A total of 110 patients participated, contributing 5,232 dialysis sessions. The incidence of IDH varied widely depending on the definition used, measuring 14.47% and 9.42% under stricter criteria, and rising to 62.8% with a more liberal definition. Although HD remains a widely used and generally safe modality, complications such as IDH persist and can be life-threatening. As complications and their associated factors continue to change over time, a more vigilant and systematic approach is needed to identify, monitor, and address them effectively. This highlights the need for ongoing evaluation in HD practice.
A Rare Presentation of Perianal Ulcer in a Patient with Non-Hodgkin’s Lymphoma
Section: CASE REPORTS Keywords: Perianal ulcer, diffuse large B-cell lymphoma, immunocompromised patient Perianal ulcers are rare but clinically significant presentation in immunocompromised patients, particularly in those with hematological malignancy such as non-Hodgkin’s lymphoma (NHL). In these individuals, immunosuppression predisposes them to infections, impaired wound healing and secondary malignancies. We present a unique case of large necrotic perianal ulcer in a patient with recently diagnosed diffuse large B-cell lymphoma (DLBCL), discussing its clinical course, diagnostic and management challenges. A 55-year-old male presented with a 3 week history of perianal pain and 4 days of difficulty in micturition. Examination revealed a large necrotic ulcer with extensive tissue involvement. He had undergone incision and drainage of perianal abscess 2 months back and was recently diagnosed with non-Hodgkin’s lymphoma by biopsy 3 weeks back. Histopathological evaluation confirmed diffuse large B-cell lymphoma involving the perianal region. This case highlights the diagnostic and therapeutic challenges of managing complex perianal ulcers in immunocompromised patients.
Beyond the Cholinergic Crisis: Non-Oliguric Acute Kidney Injury in Organophosphate Poisoning
Section: CASE REPORTS Keywords: Acute kidney injury, cholinesterase inhibition, non-oliguric AKI, organophosphate poisoning, tubular toxicity Organophosphate (OP) poisoning is a common toxicological emergency, primarily presenting with cholinergic manifestations. Acute kidney injury (AKI) is an uncommon but clinically important complication of OP poisoning, usually attributed to secondary factors such as hypotension, dehydration, rhabdomyolysis, or sepsis. However, intrinsic renal injury may occur even in the absence of these classical risk factors. We report a case of a 24-year-old male who developed non-oliguric acute kidney injury following intentional ingestion of an organophosphate compound containing chlorpyrifos 50.0% and cypermethrin 5.0%. The patient presented with features of cholinergic excess and markedly reduced plasma cholinesterase levels. He remained hemodynamically stable during hospitalization without persistent hypotension or need for renal replacement therapy. Laboratory investigations showed a transient rise in serum creatinine, peaking on the second day and returning to baseline with supportive management. Serum creatine kinase levels were normal, and urine output was preserved throughout the hospital stay. This case suggests the possibility of intrinsic tubular injury as a mechanism of AKI in organophosphate poisoning. Routine monitoring of renal function may help in early detection of renal involvement even in clinically stable patients. Awareness of non-oliguric AKI as a potential complication of organophosphate toxicity is important for timely supportive management.
Perception and Feedback of Basic Science Medical Undergraduate Students on Various Teaching -Learning in Pharmacology at Patan Academy of Health Sciences
Section: ORIGINAL ARTICLES Keywords: Pharmacology, teaching-learning methods, problem based learning (PBL), medical students Effective and safe drug therapy education is a core component of pharmacology teaching for MBBS students. Regular evaluation of teaching-learning methods, especially through student feedback, is essential for improving teaching quality. This study aimed to assess the perception and feedback of first- and second-year MBBS students at Patan Academy of Health Sciences (PAHS) regarding pharmacology teaching-learning methods. A descriptive, cross-sectional study was conducted among 134 students using a structured questionnaire. Data were analyzed using descriptive statistics. Problem-Based Learning (51.1%) was the most preferred method, followed by group discussion (30.8%). Prescription writing, experimental graphs, and case writing were the most engaging practical topics. A majority recommended increasing clinical-based learning. Students favored interactive and clinically integrated pharmacology teaching methods, highlighting the need for more problem-based and case-based learning approaches.
Clinical Profile and Antimicrobial Prescription Pattern in Patients Undergoing Cholecystectomy at a Tertiary Care Hospital
Section: ORIGINAL ARTICLES Keywords: Antimicrobial prescription pattern, gallstone, cholecystectomy Although guidelines advise against routine antibiotic prophylaxis in low-risk elective laparoscopic cholecystectomy, overprescribing remains common. Evidence on patient profiles and antibiotic use in Eastern Nepal is limited. This study aimed to determine the clinical profile and antibiotics prescription pattern in patients undergoing cholecystectomy. A descriptive cross-sectional study was conducted among 254 patients undergoing cholecystectomy at B.P. Koirala Institute of Health Sciences between September 2023 and June 2024. Demographic, clinical, and prescribing data were extracted from patient files and prescription cardex. Antibiotics utilization pattern was evaluated using WHO core drug use indicators. Data were analyzed using SPSS-20. Out of 254 patients, most patients were female (78.35%), with a mean age of 46.21±14.46 years. Symptomatic gallstone disease was the main indication (92.52%). A total of 748 antibiotics were prescribed, averaging 2.94±0.46 per patient. Penicillin–β-lactamase inhibitor combinations predominated (49.19%), with ampicillin/sulbactam accounting for 48.79% of all prescriptions. Only 0.67% of antibiotics were prescribed by generic name, 11.09% were from the National List of Essential Medicines, and 78.20% were fixed-dose combinations. Injectable antibiotics accounted for 69.12% of prescriptions. The mean duration of therapy was 8.18±3.15 days. Culture testing was performed in only 0.40% of cases. Antibiotic use in cholecystectomy showed excessive use of broad-spectrum fixed-dose combinations, prolonged therapy, and poor adherence to essential medicine and generic prescribing principles. Strengthening antimicrobial stewardship and implementing procedure-specific guidelines are urgently needed.
The Role of C‑reactive Protein Testing in Predicting the Severity of Acute Pancreatitis
Section: ORIGINAL ARTICLES Keywords: Acute pancreatitis, C-reactive protein, Nepal Acute pancreatitis is a clinical condition characterized by enzymatic inflammation of the pancreatic parenchyma due to several etiologies. Its severity and diagnosis are based on the revised Atlanta Classification. Most cases resolve without any complications but few proceeds towards severe acute pancreatitis. Hence, several scoring systems have been formulated to predict the severity of acute pancreatitis and out of them, C-reactive protein (CRP) is one of the easily accessible markers used to predict the severity. This was a single center descriptive observational cross-sectional study conducted at Nepal Medical College Teaching Hospital, Kathmandu from June 2024 to June 2025. All patients who were admitted with acute pancreatitis and had undergone CRP test within 48 hours of admission falling into our inclusion criteria were included after obtaining an informed consent. Of 110 patients 23 (20.9%) were classified as severe acute pancreatitis and 9 (8.2%) died. Seventy-five cases were male and 35 cases were female. CRP values within 48 hours were comparable to Atlanta classification and other severity indices of pancreatitis.
Phenotypic Characterization of Antimicrobial Resistance Mechanisms Among the Clinical Isolates of Acinetobacter spp. in a Tertiary Care Hospital, Nepal: A descriptive cross-sectional study
Section: ORIGINAL ARTICLES Keywords: Acinetobacter spp., MDR, ESBL, AmpC, β-lactamase, Nepal The global emergence and spread of multidrug-resistant Acinetobacter spp. have become a significant challenge for managing and treating their infections effectively. The aim of this study was to explore the prevalence of antimicrobial resistance phenotypes (MDR, ESBL, AmpC β-lactamases, MBL, KPC) among Acinetobacter spp. and to determine their antimicrobial susceptibility patterns. A descriptive cross-sectional study was conducted from December 2021 to May 2022 at Nepal Medical College Teaching Hospital, Nepal on 55 non-repetitive clinical isolates of Acinetobacter spp. Isolation, identification and antimicrobial susceptibility testing was done following standard microbiological techniques. Different β-lactamases (ESBLs, AmpC β-lactamase, MBL and KPC) were detected by standard phenotypic tests. Out of 6,344 clinical specimens processed, 1025 (16.16%) showed bacterial growth. The prevalence of Acinetobacter spp. among the grown isolates was of 5.36% (n=55). The highest positivity rate among the processed sample was found in the sputum sample (3.21%) followed by pus (1.21%), body fluids (0.51%), urine (0.47%), and blood (0.31%). The rate of isolation of Acinetobacter spp. was higher among the isolates from inpatient (n=378) than the isolates from out-patients (n=647) (10.05% vs 2.63%). The prevalence of MDR, ESBL, AmpC β-lactamases and MBL producing Acinetobacter spp. was 67.27 % (n=37), 25.45% (n=14), 14.55% (n=8), and 34.54% (n=19), respectively. Two isolates were detected as KPC phenotypes. Six isolates (10.91%) showed both ESBL and AmpC B-lactamase co-producers. All isolates were susceptible to polymixins and colistin sulphates. Tigecycline resistance was among 29.09 % of isolates. More than 70.00 % of the isolates were resistant to most commonly used first line antibiotics (cefixime - 80.00%, ceftazidime - 78.12%, cefotaxime - 76.36%, ciprofloxacin - 72.72%, ofloxacin - 70.90%, cotrimoxazole - 81.82%). Almost half of the isolates were resistant to carbapenems (imipenem -46.64%, meropenem - 41.82%), piperacillin-tazobactam (49.00%) and amikacin (54.55%). The study shows a high proportion of Acinetobacter spp. as MDR with significant presence of ESBL, MBL, AmpC and KPC resistant phenotypes in our set-up. Over 70% resistance to the commonly used antibiotics further highlights the therapeutic challenges posed by these pathogens. The findings from the study emphasize the need for continuous monitoring and implementation of effective control strategies to curb the spread of resistant Acinetobacter infections.
Identification of the Risk Factors for Sight Threating Diabetic Retinopathy Presenting in a Tertiary Eye Hospital
Section: ORIGINAL ARTICLES Keywords: Diabetes duration, diabetic macular edema, HbA1c, hypertension, proliferative diabetic retinopathy Diabetic retinopathy (DR) is a leading cause of blindness among working-age populations globally, with sight-threatening diabetic retinopathy (STDR) which includes diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). So identifying the predominant risk factors is vital for targeted screening and prevention.This study aims to find the independent risk factors associated with the development of sight-threatening DR (STDR). A case-control study was conducted involving 50 type II diabetic patients. The case group (n=28) comprised patients diagnosed with DME or PDR, while the control group (n=22) consisted of diabetic patients with no diabetic retinopathy (NO DRP) or mild NPDR. Data on age, sex, diabetes duration (DM), hypertension (HTN), fasting blood sugar, postprandial blood sugar, and HbA1c were collected. Univariate and multiple logistic regression analyses were performed to calculate crude and adjusted odds ratios (ORs). In univariate analysis, DM duration (OR=1.19, 95% CI: 1.09-1.30, p<0.001), HbA1c (OR=3.87, 95% CI: 1.84-8.15, p<0.001), and postprandial blood sugar (OR=1.10 per 10 mg/dL, 95% CI: 1.01-1.20, p=0.035) were significant risk factors. However, in the multiple logistic regression model adjusting for all covariates, only DM duration remained a statistically significant independent predictor (Adjusted OR=1.20, 95% CI: 1.08-1.34, p=0.001). Patients with diabetes for over 10 years had a twelve-fold increased odds of STDR (OR=12.0, 95% CI: 2.70- 53.3) compared to those with less than 5 years' duration. Duration of diabetes is the strongest independent risk factor for sight-threatening diabetic retinopathy. While glycemic control is important, long-term exposure to the diabetic milieu appears to be the primary driver of disease progression. These findings underscore the critical need for intensified ophthalmologic surveillance in patients with long-standing diabetes.
Range and Variation of Fetal Left Ventricular Outflow Tract Angle in Normal Pregnancy
Section: ORIGINAL ARTICLES Keywords: Congenital heart defects, fetal ultrasonography, left ventricular outflow tract, normal pregnancy The purpose of studying the fetal Left Ventricular Outflow Tract angle in normal pregnancy is to establish a baseline measurement for prenatal evaluations. Identifying deviations from the normal Left Ventricular Outflow Tract range can help detect congenital heart defects, particularly conotruncal anomalies, aiding in early diagnosis and improved clinical management. This research aims to enhance the accuracy of fetal heart assessment using ultrasonography. The Left Ventricular Outflow Tract angle is measured as the angle between the longitudinal axis of the left ventricle and the outflow tract (the aorta as it exits the heart). Its measurement requires precise imaging and proper alignment of the ultrasound probe. The study included 394 pregnant females, with mean age of 27.3 years and mean gestational age was 26.8 weeks. The Left Ventricular Outflow Tract angle ranged from 129 to 163 degrees (mean = 145.5 degrees, SD = 6.24). The cardiac axis ranged from 31 to 53 degrees (mean = 43.3 degrees, SD = 3.50). One-way ANOVA showed no significant difference in mean LVOT angle across gestational age groups (F = 0.713, p = 0.639..One-way ANOVA demonstrated no significant difference in mean LVOT angle across cardiac axis categories (p = 0.435). Left Ventricular Outflow Tract angle did not significantly correlate with gestational age and cardiac axis indicating that these factors do not significantly affect the Left Ventricular Outflow Tract angle in normal pregnancies.
Quality of Life of Women with Infertility in Gandaki Province, Nepal
Section: ORIGINAL ARTICLES Keywords: Infertile women, non infertile women, reproductive age, subfertility Infertility is socially and emotionally challenging for married couples and can lead to significant stress, anxiety, and depression that adversely impact their quality of life. The study aimed to compare the quality of life among infertile and non-infertile women and identify factors associated with their quality of life. A cross-sectional analytical study was conducted among infertile and non-infertile women to compare their quality of life using the WHO Quality of Life-BREF (WHOQOL-BREF) questionnaire. Altogether, 92 married women of reproductive age (20-49) facing infertility/subfertility problems were selected as cases, and controls were selected in a 1:1 ratio with cases after matching. Written and verbal consent was obtained from patients, and ethical approval was obtained from the Nepal Health Research Council. Epi-data was used for data entry, and data was analyzed using SPSS. The data collection in this study was from May 20th, 2019, to June 20th, 2019. Multivariable analysis was applied to the variable after bivariate analysis for the adjustment. Fertile women reported significantly higher perceived stress (28.9±4.6 vs. 25.3±3.4, p<0.001), anxiety (8.7±3.0 vs. 7.8±2.9, p<0.001), and depression (8.1±2.7 vs. 6.9±2.5, p<0.001) compared to non-infertile women. Perceived social support was significantly lower in infertile women (p<0.001). Factors such as perceived stress (AOR 10.1, 95% CI: 3.5–29.2) and perceived social support (AOR 3.4, 95% CI: 1.2–10.1) were key determinants of QoL among infertile women. Among non-infertile women, moderate-to-severe depression (AOR 14.6, 95% CI: 2.4–89.9) and reproductive health problems (AOR 3.5, 95% CI: 1.0–12.5) significantly impacted QoL. The findings of this study revealed that the overall and inter-domain score on the quality of life of infertile women was lower than that of non-infertile women. The majority of the cases perceived social discrimination and violence. From multivariate analysis, perceived stress, and perceived social support were found as important determinants of quality of life among infertile women, and moderate to severe levels of anxiety, depression, perceived social support, and reproductive health problems were found as determinants of quality of life among non-infertile women.
Comparative Study of Aural Packing with Antibiotic and Steroid Cream with Antibiotic and Steroid Ear Drops in Acute Otitis Externa
Section: ORIGINAL ARTICLES Keywords: Acute otitis externa (AOE), external auditory canal, aural packing Acute Otitis Externa (AOE) is a common inflammatory condition of the external auditory canal, typically presenting with acute pain, itching and swelling. Treatment usually involves topical antibiotic-steroid therapy, delivered either as aural packing or ear drops. However, the comparative effectiveness of these two methods in relieving pain has not been well established. This study aims to compare the effectiveness of antibiotic-steroid aural packing versus antibiotic-steroid ear drops in reducing pain among patients with AOE. A comparative prospective study was conducted at Nepal Medical College Teaching Hospital from January to June 2025. A total of 112 adults with clinically diagnosed AOE were enrolled and randomized into two groups: Group 1 received neomycin-betamethasone aural packing, and Group 2 received the same medication in ear drop form. Pain was assessed using the Numerical Rating Scale (NRS) on Day 0, Day 3, and Day 7. Both groups showed significant reductions in pain from baseline to Day 3 and Day 7 (p <0.001). Mean pain scores at Day 0, Day 3, and Day 7 were 7.91, 2.43, and 0.05 in Group 1, and 7.54, 2.29, and 0.05 in Group 2. No statistically significant differences were found between groups at any time point (p >0.05). Antibiotic-steroid aural packing and antibiotic-steroid ear drops are equally effective in relieving pain in acute otitis externa. Given the similar outcomes and greater ease of use, ear drops may be preferred as first-line therapy, while packing may be reserved for cases with severe canal edema or poor drop penetration.
Effects of Wearing Facial Masks on Pulmonary Function, Oxygen Saturation, Heart Rate and Blood Pressure During the Six-Minute Walk Test in Healthy Subjects
Section: ORIGINAL ARTICLES Keywords: Surgical mask, six-minute walk test, pulmonary function, oxygen saturation, exercise capacity The widespread use of surgical masks has prompted concern over their physiological effects during exercise, particularly with scarce data from South Asia; this randomized crossover study therefore evaluated 80 healthy young adults in Nepal performing six-minute walk tests with and without a surgical mask, finding that mask use significantly reduced walking distance (537.9 ± 24.9 m vs. 564.8 ± 22.3 m; p <0.001) and post-exercise oxygen saturation (95.8 ± 1.6% vs. 98.1 ± 0.8%; p <0.001), significantly decreased post-exercise pulmonary function (FVC and FEV1; both p <0.01), and led to significantly higher post-exercise heart rate and systolic blood pressure (both p <0.01), indicating a small but measurable physiological burden during light exercise which, while tolerable for healthy young adults, highlights a need for caution and further study in vulnerable populations with cardiorespiratory conditions.
Therapeutic Drug Monitoring and Adverse Drug Reactions of Lithium in Patients Diagnosed with Bipolar Affective Disorder at a Tertiary Care Center in Eastern Nepal
Section: ORIGINAL ARTICLES Keywords: Adverse drug reactions, bipolar disorder, lithium, therapeutic drug monitoring Lithium is a widely used mood stabilizer in management of bipolar affective disorder but its narrow therapeutic index (0.6–1.2 mmol/L) requires therapeutic drug monitoring to ensure both efficacy and safety. This descriptive cross-sectional study was conducted in the Psychiatry Ward of B.P. Koirala Institute of Health Sciences, Dharan, Nepal, over a period of 9 months (July 2022 to March 2023). Serum lithium concentrations and associated adverse drug reactions following lithium therapy in hospitalized patients with bipolar affective disorder was assessed, while also categorizing serum lithium levels as sub therapeutic, therapeutic, or supra-therapeutic. A total of 46 patients diagnosed with bipolar affective disorder and receiving lithium therapy were enrolled via convenience sampling. The mean age of participants was 29.13±9.25 years, with a male predominance (58.7%). Most patients (63.0%) had serum lithium levels within the therapeutic range (0.6-1.2 mmol/L), while 21.7% were sub-therapeutic (<0.6 mmol/L) and 15.2% were above the therapeutic range (>1.2 mmol/L). The most common adverse drug reaction was hand tremor (33.0%), followed by weight gain (22.7%), difficulty concentrating (16.7%), leukocytosis (7.6%), hypothyroidism (6.1%), nausea (4.5%), polyuria (4.5%) and polydipsia (4.5%). The findings highlights that although most patients achieved therapeutic lithium levels, a significant proportion had levels outside the target range. Routine monitoring of serum lithium levels, along with timely dose adjustments is therefore essential to optimize treatment outcomes and minimize adverse effect.
Exploring the Effect of Diversity and its Impact on Learning among Medical Students
Section: ORIGINAL ARTICLES Keywords: Diverse, awareness, equity, inclusion, diversity workshop As the world becomes increasingly diverse, it is essential for medical professionals to be adequately prepared. This project aims to explore awareness of diversity in the learning environment and perceptions of equity and inclusion in medical school. The methodology used included developing and implementing questionnaire items (23) related to diversity awareness and perception of inclusion in medical school using a 5-point Likert scale. Subsequently an awareness training workshop was conducted. Convenience and snowball sampling technique was used for total n= 247 (pre-workshop), n=210 (post-workshop) participants. A total of 247 (Female=147, Male=100) student’s pre-workshop data followed by diversity workshop training conducted for 210 (Female=125, Male=85), post workshop data was collected. A comparison of pre- and post- workshop data revealed significant differences in some questionnaire items (1, 3, 4, 7, 8, 11, 13, 15, 22, and 23) that includes awareness of diversity policies, valuing and appreciating the differences and understanding the learning perspective. These findings suggest that existing diversity policies are insufficient on their own. Implementing comprehensive awareness programs is essential to fostering understanding, respect, and a sense of belonging, thereby enhancing effective learning in diverse populations.
Health Expenditures in the Families and its Relation to Non Communicable Diseases and Multi-morbidity amongst its Adult Members in Selected Wards of Kageshwori Manohara Municipality, Kathmandu, Nepal
Section: ORIGINAL ARTICLES Keywords: Health expenditures, non-communicable diseases, adults, Kageshwori Manohara Healthcare services, one of the basic necessities of life, are meant to provide social protection to the households but its rising cost has put financial burden on them. The rise in the prevalence of non-communicable disease as well as multi-morbidity as a result of increased life expectancy has added to this cost burden the households as the treatment is likely to be needed throughout the lifetime. As a part of National Health Insurance Program in an attempt to address the problem of high healthcare expenditures, the local government has recruited enrollment assistants from each ward to conduct home visit, explain families about the benefits of health insurance and enroll them in this national scheme. Hence it is very important that the data related to health expenditures incurred by family members in a year is available in the wards. Community based survey was carried out in ward 3 and 2 of Kageshwori Manohara Municipality of Kathmandu District, Nepal, in September 2023 and April 2024, respectively. Out of 848 households covered, annual health cost incurred by the family as a part of their annual income could only be obtained from 793 households (93.5%). Out of these households, health cost exceeded 10% of their annual income in 28.4% of the households and this was significantly associated with a household member having a non-communicable disease and multi-morbidity. Households living below the poverty line set at NRs. 200/person/day was seen to be significantly associated with having catastrophic health expenditure i.e. exceeding 10% of their annual income.
Completeness of Computed Tomography (CT) Requisition Forms in a Tertiary Care Center of Nepal: A Mixed-Method Study
Section: ORIGINAL ARTICLES Keywords: CT requisition forms, clinical audit, documentation completeness, patient safety, Nepal Properly completed Computed Tomography (CT) requisition forms are essential for accurate imaging, timely diagnosis, and patient safety. Incomplete documentation may lead to delays, errors, and potential harm. This audit evaluated the completeness of CT requisition forms at Nepal Medical College Teaching Hospital. A cross-sectional audit of 267 CT requisition forms was performed. Data on patient demographics, clinical information, and administrative details were collected and analyzed against established standards. Descriptive statistics were used to quantify completeness. Patient name and age were recorded in 99.3% and 98.9% of forms, respectively, while 97.4% documented patient sex. Hospital numbers were missing in 50.2%, provisional diagnosis in 59.6%, and the referring department in 77.9%. Doctor signatures were absent in 29.2%, and allergy history was omitted in 92.5%. Only 7.5% of the forms were fully complete. The audit revealed considerable gaps in the completion of CT requisition forms. Targeted interventions, staff training, and periodic re-audits are recommended to enhance documentation quality and patient safety.
Morphometric Analysis of the Anterior Cruciate Ligament – A Cadaveric Study
Section: ORIGINAL ARTICLES Keywords: Morphometry, anterior cruciate ligament, knee joint The knee joint is the bicondylar variety of synovial joint of the human body formed by the articulation of lower end of femur with the tibia and patella. The anterior cruciate ligament (ACL) is an intra-articular, extra synovial ligament which is most frequently damaged ligament and also requires reconstructive surgery. As there are variation among the age, gender and different populations, the morphometric understanding of ACL is essential. This study aimed to assess the morphometric analysis of ACL in a cadaver. A descriptive observational study was carried out in the Department of Human Anatomy, Nepal Medical College Teaching Hospital from August 2024 to July 2025 in 26 cadavers including both right and left knees. The formalin preserved cadaveric knees were dissected, exposing the knee joint following the standard procedures. The length and breadth of the ACL were measured by Digital Vernier Caliper. The mean and standard deviation was calculated applying SPSS-16. All the 52 knees were measured and the mean length of ACL was 38.5 ± 0.49 mm and mean breadth of ACL was 10.00 ± 0.19 mm. The mean length of right and left side ACL was 38.60 ± 0.47 mm. and 38.40 ± 0.52 mm respectively. Similarly, the mean breadth of right and left side of ACL was 9.70 ± 0.16 mm and 10.31 ± 0.22 mm respectively. The present study concluded that the variation in both length and breadth of right and left ACL exists. A thorough understanding of ACL is mandatory during surgical intervention and reconstructive procedure of anterior cruciate ligament.