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.
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.
Clinical Outcome of Laparoscopic Pyeloplasty in a Tertiary Hospital
Section: ORIGINAL ARTICLES Keywords: DTPA, laparoscopy, PUJO, pyeloplasty Laparoscopic pyeloplasty is preferred surgery to treat patients with pelvi-ureteric junction obstruction (PUJO). The main objective of the study was to assess outcome of laparoscopic pyeloplasty in our university hospital. This was retrospective descriptive observational study which included 36 patients diagnosed with PUJO by Computed Tomography (CT) intravenous urography (IVU) and diuretic DTPA (Diethylenetriamine pentaacetic acid) renogram presented to Dhulikhel hospital from 1st January 2023 to 30th January 2025. Patient were reviewed in terms of demographic characteristics, clinical presentation and radiological findings. Statistical correlation with the presence of crossing vessels was analyzed using student’s t-test and Fisher’s exact test. Mean age was 30.03±10.66 years, 17 (47.22%) female and 19 (52.78%) male patient. Most of the patient were asymptomatic 38.89% followed by pain 33.33%. Crossing vessel compression was noted in 10 patient (27.78%). Mean operative duration was 174.17±18.80 minutes. Mean hospital stay was 2.67±0.48 days. A statistically significant correlation was noted between the presence of crossing vessels and gender, as well as kidney stones. Recurrence noted in 1 patient (2.78%) managed with redo laparoscopic pyeloplasty. Laparoscopic pyeloplasty is safe, effective option for treatment of PUJO with comparable success rate, less post operative pain, short hospital stay however operative duration is prolonged.
Antimicrobial Resistance Profile and Molecular Screening of blaKPC Gene among Clinical Isolates of Pseudomonas aeruginosa from a Tertiary Care Hospital, Nepal
Section: ORIGINAL ARTICLES Keywords: Pseudomonas aeruginosa, MDR, ESBL, blaKPC gene, Nepal Pseudomonas aeruginosa is a major opportunistic pathogen with increasing antimicrobial resistance, creating significant treatment challenges in hospital settings. This study aimed to determine the antimicrobial resistance profile of P. aeruginosa and screen for the blaKPC gene among meropenem-resistant isolates. A descriptive cross-sectional study was conducted from December 2021 to May 2022, yielding 75 non-duplicate isolates identified through standard microbiological methods; antimicrobial susceptibility testing was performed using the Kirby- Bauer technique, and 17 meropenem-resistant isolates underwent PCR for blaKPC detection. Sputum (33.33%) and pus (29.33%) were the most common specimen sources, and multidrug resistance was observed in 54.7% of isolates, particularly among inpatients and ICU cases. High-rate resistance to ceftazidime and piperacillin was noted, while carbapenem resistance remained moderate (21-23%). None of the meropenem-resistant isolates carried the blaKPC gene, indicating alternative carbapenem resistance mechanisms. These findings highlight a substantial burden of MDR P. aeruginosa and underscore the need for ongoing surveillance and strengthened infection control practices.
Prevalence of Appendicular Perforation among Patients Undergoing Emergency Appendectomy at a Tertiary Care Hospital
Section: ORIGINAL ARTICLES Keywords: Appendicitis, luminal diameter, perforation, WBC Appendicitis is a common cause of abdominal pain, and misdiagnosis or delayed diagnosis of acute appendicitis leads to perforation, postoperative complications, and an increased length of hospital stay. A retrospective study was performed at the Department of Surgery, Nepal Medical College Teaching Hospital, Gokarneshwor Municipality-8, Kathmandu, from Jan 2020 to Dec 2022, involving 235 patients who fulfilled the inclusion criteria. In our 3-year study, 235 patients (139 males and 96 females) underwent emergency appendectomy. Pain was present in all patients, with a mean duration of 24.89 ± 6.835 hours and a WBC ranging from 9,600 to 18,400 cells/mm3. The average luminal diameter was 9.362 ± 1.3 mm. A total of 22 patients (9.4%) had a perforated appendix. Perforation was more common among males. Similarly, perforated patients presented with pain for 24.5 ± 7.7 hours and a WBC of 15,454 ± 1818.044 cells/mm3. Imaging revealed the luminal diameter of 10.7 ± 1.069 mm. The prevalence of perforation among patients with appendicitis was relatively low with higher male-to-female ratio and a substantial portion of patients occurring in the 18-23 years age group.
Prevalence of Constipation in Children: its Causes in Relation to Diet Pattern and Psychosocial Aspects
Section: ORIGINAL ARTICLES Keywords: Constipation, Nepal, Bristol, high fiber Pediatric constipation is one of the common gastrointestinal conditions in children presenting with varying complains which are easy to detect from history, but the condition is often under diagnosed. It has significant impact on daily life troubling the children and their parents with complains like hard and painful defecation, abdominal pain, voluntary stool retention and blood in stool. Prevalence of constipation has been found in wide variation among studies from multiple western as well as Asian countries, but there are no studies from Nepal. This cross-sectional study was conducted at our center including children from 2-14 years of age presenting to pediatric OPD. Children were diagnosed by using ROME IV criteria for constipation and analyzed for demographic profile, presenting symptoms, socio-economic conditions, psychological aspects and dietary habits. Out of total 400 children, 127 (31.8%) had constipation with slight male predominance (M:F=1.2:1). Most constipated children had Bristol type I and type II stool with frequency ≤3 episodes per week. Most common complaint was passage of hard stool (88.2%) and painful defecation (52.8%). Outdoor toilet facility was one of the predisposing factors and aversion to use school toilet was the most common precipitating psychological factor. Increased fruits and vegetables intake reduced its incidence and predominant cow’s milk intake increased it. Thus constipation is not an uncommon condition among Nepali children and it is associated with different feeding habits and psychosocial factors. The increased intake of high fiber diet along with availability of indoor toilets reduces the risk of constipation in children.
A Study on Acute Pesticide Poisoning in a Tertiary Care Center Of Eastern Nepal
Section: ORIGINAL ARTICLES Keywords: Antidote, organophosphate, organochlorine, pesticides, rodenticides, self-poisoning Acute pesticide poisoning is a significant public health concern in developing countries, including Nepal, where agriculture remains a major occupation. The easy accessibility and improper handling of pesticides contribute to both intentional and accidental poisonings. This study is intended to evaluate the clinical characteristics, treatment outcomes, and patterns of acute pesticide poisoning among patients presenting to the emergency department of a tertiary care center in Eastern Nepal. A descriptive cross-sectional study was done in the emergency department of a tertiary care center in Eastern Nepal during a defined study period. Data were collected using a structured proforma, including demographic details, type and route of poisoning, clinical presentation, management provided, and patient outcomes. Descriptive statistical techniques were employed to interpret the data. A total of 688 cases of acute pesticide poisoning were included. The majority of patients were young adults aged 15–30 years, with a higher prevalence among females. Organophosphates were the most commonly implicated agents (44.2%) followed by rodenticides and organochlorine. Most cases were intentional ingestion. Common symptoms included vomiting, altered sensorium, and respiratory distress. Supportive management, along with atropine and pralidoxime for organophosphate poisoning, was provided. The majority recovered with timely intervention, though 19.6% experienced complications and 6.3% mortality was recorded. Acute pesticide poisoning remains a prevalent and preventable health issue in Eastern Nepal, particularly among young individuals. Early recognition and prompt management are essential to improving outcomes. Strengthening regulation on pesticide sales, public awareness, and mental health interventions are critical to reducing the incidence of such poisonings.
Maternal Dietary Patterns and Infant Birth Outcome among Nepalese Mother and Child in Tertiary Hospital: A Birth Cohort Study
Section: ORIGINAL ARTICLES Keywords: Fetal macrosomia, infant, newborn, nutrition, pregnancy outcome, cohort study Maternal nutrition during pregnancy significantly impacts fetal health in the long term. Inadequate nutrient intake can lead to maternal anemia, which increases the risk of other complications and maternal mortality. It can also result in fetal growth retardation and low birth weight. Both the quality and quantity of nutrition are crucial during this critical period. The current study aimed to analyze the relation between maternal dietary patterns and infant birth outcome among Nepalese mother. This study was hospital-based birth cohort prospective study. Ethical approval was taken from Paropakar Maternity and Women’s Hospital (Ref no: 63/1180). It was conducted from March 2023 to December 2024 at Paropakar Maternity and women’s Hospital. A total of 367 participants were recruited for the study. The pregnant women who attended ANC OPD at 20 to 26 weeks of gestation were selected. Convenience sampling method was used. Dietary intake assessment was done and the pregnancy outcomes was recorded after delivery. Descriptive statistics, chi-square (χ2) test, and Manova Test was applied. Dietary assessments showed higher adequate consumption of pulses, green leafy vegetables, and dairy products, with a significant relationship (p = 0.001) between dietary adequacy and fetal macrosomia, despite only 4.3% of neonates being macrosomic. Maternal age and occupation had no significant impact on delivery outcomes, and neither did smoking, alcohol, or chronic diseases. Adequate dietary diversity was associated with better mode of delivery outcomes, though it did not significantly affect other neonatal outcomes. Maternal nutrition, particularly dietary diversity, is crucial for neonatal outcomes, with significant associations found for adequate food consumption and delivery outcomes, while other maternal factors showed no significant effects.
Perception on Menstruation among Male Undergraduate Students in Dhangadhi Sub-Metropolitan City, Nepal
Section: ORIGINAL ARTICLES Keywords: Perception, menstruation, male undergraduates, Nepal Menstruation is a natural biological process in females. It is often associated with stigmas and misconceptions, particularly among the males. Understanding male perception towards menstruation is crucial for promoting awareness and reducing gender-based biases. Despite its significance, men's perceptions on menstruation are generally poorly understood, which can impact societal views and relationships. This study aimed to find the perception and knowledge of menstruation among male undergraduate students in Dhangadhi Sub-metropolitan City, Nepal. The rationale was to address the gap in understanding male perception, which significantly influence societal views on menstruation. A cross-sectional survey of 350 students was conducted using semi-structured questionnaire to assess socio-demographic characteristics, perceptions, knowledge, and experiences related to menstruation. The study revealed that 52.3% of students held negative perception, while 47.7% had positive views. A significant proportion (56.3%) lacked adequate knowledge about menstruation. Socio-demographic factors like ethnicity, family type, and educational level were significantly associated with the perception. The study highlights the need for awareness programs to improve menstrual health literacy and reduce stigma. Significance: The findings underscore the importance of involving the males in menstrual health awareness to combat societal stigma and promote men’s involvement in women’s sexual and reproductive health.
Management of Cardiovascular Medical Emergencies: An Institutional Based Assessment of Knowledge, Attitude and Practice among Dental Students
Section: ORIGINAL ARTICLES Keywords: Cardiovascular, dental, medical emergency Occurrence of cardiovascular accidents inside a dental office is not a surprising event given the stress many patients associate with dental care. Upon graduating from dental school as a dental practitioner, students must be prepared to deliver appropriate measures promptly for successful management of cardiac emergencies occurring in dental clinic. However, there are no documented studies on such preparedness in Nepal yet. Thus, an institutional based cross-sectional study was conducted from June-August 2025 among dental students in Kathmandu, Nepal to assess their level of knowledge, attitude and practice on management of cardiovascular medical emergencies plus it's variation based on age, gender and different academic levels of study. A pre-validated close-ended questionnaire consisting of 22 questions was used to assess the study parameters. Statistical analysis was conducted using the chi-square test and binomial regression. Regarding knowledge assessment, significant gaps were identified in several topics. Out of 138 participants, over half (53.6%) were still confused regarding the CPR (cardio-pulmonary resuscitation) procedure, only 21.7% knew the common cause of cardiac arrest in children and 25.4% understood the functional capacity assessment using metabolic equivalent tasks (METs). About half of the students (52.2%) favored cardio-cerebral resuscitation (CCR) over traditional CPR procedure, with 4th year students showing significantly more positive attitudes (66.7%) compared to interns (41.3%) (p=0.015). Age group and gender were not significant predictors of attitude towards CCR. Only, 44.2% of the students expressed willingness to perform mouth-to-mouth resuscitation on unconscious patients. The practice assessment revealed concerning gaps in emergency preparedness and experience. Only 5.8% of students had encountered cardiac emergencies in clinical settings and merely 11.6% had participated in mock emergency drills. A minority (14.5%) felt capable of managing code blue situations, with interns showing higher confidence (28.3%) compared to 4th year students (2.6%) (p=0.008). However, there was significant variation in continuing education participation, with 4th year students showing higher engagement (66.7%) compared to postgraduate students (29.4%) (p=0.028). Expertise in management of cardiovascular medical emergencies is essential for dental students who will eventually become dental health-care professionals. They have a critical need for clinical exposure and training in managing such situations.
Descriptive Study of Different Types of Road Traffic Accidents at a Tertiary Care Centre in Kathmandu City
Section: ORIGINAL ARTICLES Keywords: Epidemiology, injuries, Nepal, road safety, road traffic accidents Road traffic accidents (RTAs) pose a major public health issue worldwide, resulting in over 3,000 fatalities each day across the globe. Low- and middle-income nations account for roughly 85% of these deaths and 90% of the annual disability-adjusted life years lost. Nepal is ranked 79th in the world for RTA-related fatalities, making it the 11th leading cause of death in the nation. Factors such as difficult terrain, adverse weather, insufficient infrastructure, and poor traffic management significantly contribute to the elevated accident rates. The purpose of this study was to examine the epidemiological features of road traffic accidents in Kathmandu, with an emphasis on demographic trends, temporal distribution, types of vehicles involved, and patterns of injury. A retrospective hospital-based study was carried out at Nepal Medical College Teaching Hospital from January 1, 2021, to December 31, 2021. All cases of RTA in Kathmandu who presented to our hospital were included in this study. All complete RTA cases within the city of Kathmandu were included in the analysis. Data were gathered concerning age, sex, injury locations, time of occurrence, and day of the week. Statistical analysis was conducted using SPSS version 21. During the study period, a total of 296 RTA cases were documented. Males accounted for 219 cases (73.99%) compared to 77 females (26.01%), resulting in a male-to-female ratio of 2.84:1. The age group most affected was 20-29 years (217 cases, 73.31%). Friday had the highest number of accidents (113 cases, 38.18%), with peak occurrences during daytime hours (143 cases, 48.31%). Two-wheelers were involved in 244 cases (82.43%), making them the most prevalent type of vehicle. Extremity injuries were the most common (290 cases, 97.97%), followed by head injuries (113 cases, 38.18%). Young males aged 20-29 years using two-wheelers are at highest risk for RTAs. The predominance of extremity and head injuries emphasizes the critical need for helmet use and improved road safety measures. Targeted interventions including strict traffic law enforcement, infrastructure improvements, and public awareness campaigns are essential to reduce RTA incidence and severity.
Stress and Anxiety among Pregnant Women attending Tertiary Care Hospital at Pokhara, Nepal
Section: ORIGINAL ARTICLES Keywords: Anxiety, pregnant women, stress Pregnancy is a period of great joy, also great stress to women both physically and mentally. Even in healthy women pregnancy may give rise to much anxiety because of anticipated uncertainty associated with it. The study aimed to assess the stress and anxiety among pregnant women. A descriptive cross-sectional research design was used. The study population consists of pregnant women who were 12-38wks pregnant and attending to Gynae/Obs OPD for regular checkup at Gandaki Medical College Teaching Hospital and Research Centre. Data were collected from Falgun 6 to Chaitra 25, 2080. A purposive sampling technique was used. Pregnancy Stress Rating Scale (PSRS) and Perinatal Anxiety Screening Scale (PASS) was used to collect the data. Collected data were entered, coded and edited into SPSS (16) and analyzed using both descriptive and inferential statistical methods. Of total 33.9% moderate, 32.6% had severe and 33.4% Eustress (normal stress) level of stress. There were no any statistically significant association between level of stress and selected variables. Similarly, 74.2% had minimal, 23.4% mild to moderate and 2.4% respondents have severe level of anxiety. Family support was statistically significant with level of anxiety during pregnancy (p=0.05). There was statistically significant of average positive correlation between stress and anxiety (r=0.605, p=0.001) among pregnant women. In majority of pregnant women have higher stress which reflect the higher anxiety.
Estimation of Stature from Foot Length Measurements in Students of a Medical College of Kathmandu: A Cross-sectional Study
Section: ORIGINAL ARTICLES Keywords: Identification, stature, mass disasters, foot outline measurements, regression formula Identification refers to the determination of individuality of a person based on certain physical characteristics. It has been proved by researchers that a strong co-relation exists between one’s stature and footprint/ foot outline measurements. Estimation of stature forms a basic domain during the investigation of unknown/ comingled human remains. The dimensions measured in the lower extremities of the body have greater association with the stature of the individual than those from the upper extremities. This study was conducted from May 2024 to October 2024 AD in 153 medical students of Nepal Medical College, Kathmandu. The height of each person of the study was measured using height scale and right and left foot length was measured using vernier calipers. Linear regression formula (a+bx) for estimating the stature of male and females and of total subjects, was obtained from the data entered in SPSS version 16. Based on the data, the mean height of males was 170.41 ± 6.12, that of females was 158.28 ± 6.21. The right and left foot length of males was 24.41 ± 1.24 and 24.64 ± 1.26 and for females was 22.36 ± 1.17 and 22.39 ± 1.19 respectively. Significant associationwas obtained between the height and foot lengths of males and females of the study.Regression formulae were obtained from the respective heights and foot lengths of total sample, males and females which showed significant co-relation (P <0.0005). Based on the results obtained from the data, it is evident that there is significant co-relation between stature and foot length and foot length measurement. This study has limitations regarding small study population and intra-observer and inter-observer bias.
Communication Pattern between Musculocutaneous and Median Nerve in Arm: A Cadaveric Study
Section: ORIGINAL ARTICLES Keywords: Brachial plexus, musculocutaneous nerve, median nerve The brachial plexus is a major nerve network that supplies upper limb. Musculocutaneous nerve (MCN) and median nerve (MN) are two of the branches of cords of brachial plexus which may communicate resulting in the most common variation of the plexus. Recognition and knowledge of such possible anatomical variation will be helpful in the field of neurology, anesthesia and surgery. This study aims to determine the incidence of communication pattern between MCN and MN. Formalin fixed, 50 cadaveric upper limbs of both sides available in the Department of Anatomy were dissected over a period of one year from August 2024 – July 2025. The brachial plexus, MCN and MN were exposed carefully. If Communication was present between MCN and MN, it was classified with reference to Le Minor classification. Variation that does not relate with Le Minor classification was presented as other pattern. The communication between MCN and MN were found in 13 upper limbs (26.0%) and in remaining 37 upper limbs (74.0%) it was absent. Regarding classification of the communication patterns, distribution were found to be; Type I in 37 (74.0%), Type II in 8 (16.0%), Type V in two (4.0%) and other types in three (6.0%) upper limbs (Le Minor classification). MCN communicates with MN after piercing through the coracobrachialis muscle in eight of the upper limbs (Type II). While in two specimen, the communication was present before piercing the coracobrachialis muscle, grouped as other type. MCN was completely absent in two of the upper limbs (Type V).
Atypical Presentation of Autoimmune Pancreatitis
Section: CASE REPORTS Keywords: Atypical, autoimmune, pancreatitis Autoimmune pancreatitis (AIP) is an inflammation in the pancreas from an autoimmune etiology. It is often difficult to diagnosis with significant morbidity and mortality. It can present with two subtypes of AIP type 1 and type 2. There is limited data on the treatment of autoimmune pancreatitis. Most patients are respond to corticosteroid therapy.
Knowledge of the Effect of Pesticide Use in Vegetables and Fruits on Health and Environment among Consumers: A Descriptive Cross-sectional Study
Section: ORIGINAL ARTICLES Keywords: Knowledge, pesticide, persistent organic pollutants According to the WHO, pesticides are chemical compounds that are used to kill pests, including insects, rodents, fungi, and unwanted plants (weeds) or it is any substance, or mixture of substances of chemical or biological ingredients intended for repelling, destroying, or controlling any pest, or regulating plant growth. Persistent organic pollutants circulate globally as a set of toxic chemicals that are persistent in the environment and can last for several years before breaking down. This study aims to find out the knowledge of consumers on effects of pesticide used in vegetables and fruits on health and environment. A descriptive cross-sectional study was conducted among visitors of patients, students, and staff at tertiary center after getting ethical approval from Institutional Review Committee. Individuals who know effects of pesticides on health were included in the study and those who did not give consent for study were excluded. Convenience sampling method was used. Out of 324 participants, 146 (45.10%) of participants reside in urban areas, followed by semi-urban 107 (33.0%) and rural 71 (21.90%). Organophosphates are the most common pesticides used on fruits and vegetables, 167 (51.54%). The risk of pesticide residues to health was known by 295 (91.0%) of respondents. According to the majority, 291 (89.80%) pesticides used are bad for the environment, and only 33 (10.20%) think that pesticide use is not bad for the environment. This descriptive cross-sectional study concludes diverse levels of knowledge among consumers regarding the effect of pesticide use in vegetables and fruits, as well as knowledge level influenced by education, income, and geographic location. There is an urgent need for accessible, clear communication through labelling and public education to bridge these gaps and to promote sustainable consumer practice.