Kathmandu University Medical Journal最新文献

{"title":"En Bloc Versus Conventional Resection of Primary Bladder Tumor.","authors":"B B Thapa, A K Shah, B Adhikari, U Mishra, R Dahal, N Rasali, R B Basnet, P M Shrestha, A Shrestha","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Transurethral resection of bladder tumor (TURBT) is the crucial and standard approach in the diagnosis and management of urinary bladder cancer. Objective To compares conventional piecemeal and en bloc resection techniques in terms of detrusor muscle presence in resected specimens, surgical safety, and feasibility. Method A prospective comparative study conducted from April 2024 to March 2025 included patients with up to three bladder tumors, measuring ≤ 3 cm, who were alternately assigned to undergo either conventional piecemeal resection or en bloc resection. The primary outcome was the presence of detrusor muscle in the resected specimen. Secondary outcomes included operative time duration, bladder perforation, and obturator reflex. The quality of tissue was assessed by pathologists using a Likert scale. Result Eighty-seven patients were included, 43 in the conventional and 44 in the en bloc group. The baseline characteristics and tumor size were comparable. Presence of detrusor muscle in specimens was higher in en bloc group (97.7% vs 83.7%; p = 0.030). Operative duration was shorter in the en bloc group (35.55 minutes vs 43.42 minutes; p = 0.001). A case of bladder perforation was observed in the conventional group. Pathologists observed better specimen orientation and architecture in the en bloc group. Presence of tumor in re-TURBT was 16.0% in the en bloc group and 28.6% in the conventional group (p=0.497). Conclusion En bloc resection yielded a higher presence of detrusor muscle and shorter operative duration with better specimen quality compared to conventional piecemeal resection for tumor ≤ 3 cm.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"23 91","pages":"307-311"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of Micronucleus Study on Breast Cytology Smears.","authors":"O Shrestha, R Baral, A Tiwari","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Micronuclei (MN) are extranuclear chromatin bodies that arise due to chromosomal breakage and serve as biomarkers of genomic instability. Their presence has been linked to malignant transformation. Breast cytology offers a minimally invasive method for early detection of breast lesions. Evaluating micronuclei in these smears may enhance diagnostic accuracy by providing an additional objective parameter. Objective To compare the MN score in benign and malignant epithelial neoplasms of the breast as well as compare it within different grades of breast carcinomas. Method A retrospective cross-sectional study was conducted including epithelial breast neoplasms over a period of three years from February, 2021 to February, 2024. May- Grünwald-Giemsa (MGG) and Papanicolaou stained cytology smears of cases whose biopsy sample was also received in department of Pathology were included after ethical approval from institutional review committee. Micronuclei were identified based on established criteria and scored in 1,000 epithelial cells per case. The micronuclei frequency was compared across cytologically diagnosed benign and malignant lesions proven histopathologically. Statistical analysis was performed to evaluate significance. Result The mean micronuclei score was significantly higher in malignant smears compared to benign lesions (p < 0.05). A progressive increase in micronuclei frequency was observed from grade 1 to grade 3 amongst the malignant category. Conclusion Micronuclei scoring on breast cytology smears is a simple, cost-effective and potentially reliable marker of malignancy. It can serve as a useful adjunct in routine cytological evaluation, and also help in predicting the grade of malignancy.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"23 91","pages":"343-346"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant Transformation of Craniopharyngioma: A rare case after 32 years of follow-up.","authors":"G Orhan, A Bozer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Craniopharyngiomas are rare, benign epithelial tumors of the sellar region, with malignant transformation being exceedingly uncommon. We report a case of squamous cell carcinoma arising 32 years after the initial diagnosis of adamantinomatous craniopharyngioma. The patient underwent four surgical resections and two courses of radiotherapy. Following seven years of stable imaging, a rapidly enlarging lesion emerged, invading adjacent skull base structures. Histopathological examination confirmed malignant transformation, characterized by squamous cell carcinoma with beta-catenin positivity. This case highlights the diagnostic and therapeutic challenges posed by such transformation and underscores the importance of long-term follow-up in craniopharyngioma patients. Although radiation therapy has been speculated as a risk factor, its causal relationship remains unproven. Malignant craniopharyngiomas carry a poor prognosis, with limited benefit from conventional therapies. Increased awareness and documentation of such rare cases are essential to improve understanding of underlying mechanisms and guide future management strategies.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"23 91","pages":"402-404"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographic Distribution of Suicide in Kavrepalanchok District, Nepal: A Retrospective Study.","authors":"P K Singh, A Karki, V L Karn","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Suicide remains one of the oldest and most pressing public health challenges, causing profound emotional, psychological, and social trauma for affected families and communities. Common contributing factors include psychological disorders, marital and family disputes, and financial difficulties influenced by geography, gender, and socioeconomic status. While causes may vary, hanging remains the most prevalent method of suicide, followed by poisoning. Objective To examine the geographic and sex-wise distribution of suicide cases and identify high-burden municipalities in Kavrepalanchok District, based on medicolegal autopsies performed at Dhulikhel Hospital from 2nd November 2020 to 13th April 2023. Method A retrospective cross-sectional study was conducted at the Department of Forensic Medicine, Kathmandu University School of Medical Sciences, Dhulikhel. All suicide cases brought for medico-legal autopsy between 2nd November 2020 and 13th April 2023 were included in the study. These individuals were either deceased at the scene or passed away during treatment at the hospital. Cases with an unclear history of suicide or those involving decomposed or skeletonized bodies were excluded. Data were analyzed descriptively using Microsoft Excel and R version 4.4.3. Result A total of 697 autopsies were conducted over a three-year period, of which 468 (67.14%) were identified as suicide cases. Among these, 235 (33.71%) were from outside Kavrepalanchok, and 233 (50.43%) were from within the district. Hanging was the predominant method, accounting for 75.74% of cases overall. Males consistently accounted for a higher proportion of suicides (overall 61.36%) across all three years. An increasing trend in suicide cases was observed over the years, particularly with a rising proportion of suicides due to hanging. The highest number of suicides within the district was reported in Panchkhal municipality (n=32), suggesting a geographic concentration of cases. Conclusion The observed increasing trend in suicide cases over the three-year period, especially among males and through the method of hanging, highlights a significant public health concern. Targeted and coordinated interventions from both government and community stakeholders are essential to mitigate this growing burden.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"23 91","pages":"328-332"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult Granulosa Cell Tumor of the Ovary Diagnosed after Laparoscopic Salpingoophorectomy.","authors":"S N Ansari, E Shrestha, P Kayastha, K B Bista","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Ovarian malignancies of uncommon variety are seen in 10% of cases of all ovarian tumors. Approximately 5% of such cases are granulosa cell tumor of ovary (GCT). In adolecents, the adult type Granulosa cell tumor (AGCT) is rare and the major concern is fertility preservation. Prognosis of the adult type granulosa cell tumor is favorable after surgery, as most cases present at early stages. We report a case of an 18-year girl who presented to our center with histopathological report of the adult type granulosa cell tumor. She underwent laparoscopic left salpingoophorectomy at another center for a 28.5 X 22.5 cm right adenexal mass. The patient denied completion surgery at our center and remained on follow-up. Patient is doing fine on follow-up to date. In young girls who present with complex adenexal mass, a strong suspicion of rare ovarian malignancies like granulosa cell tumor should be considered. For cases with incomplete surgery but fertility concern granulosa cell tumor should be monitored vigilantly for recurrence.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"23 91","pages":"392-394"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Profile and Management of Paederus Dermatitis: Insights from Teledermatology in a Tertiary Care Setting in Nepal.","authors":"E Shrestha, M S Basukala, A Mishra, A Basnet, D Karn, A Tamang","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Paederus dermatitis is a cutaneous reaction caused by the contact of rove beetles (Paederus species) on the skin. Common in tropical regions, including Nepal, this dermatitis poses a diagnostic challenge in remote areas where dermatological care is limited. Teledermatology, employing telecommunications for remote consultations, has shown promise in addressing these limitations, yet its effectiveness in diagnosing and managing Paederus dermatitis in Nepal has yet to be thoroughly explored. Objective To analyze the clinical profile and management outcomes of Paederus dermatitis through teledermatology at a tertiary care hospital in Nepal. Method A retrospective cross-sectional study was conducted on 54 patients diagnosed with Paederus dermatitis through teledermatology at Dhulikhel Hospital between June 2024 and August 2024. Statistical analysis was performed to evaluate associations with demographic and clinical factors. Result The study comprised 54 patients (59.26% males and 40.74% females) with a mean age of 28.4 ± 6.6 years. The most frequent symptoms included itching with a burning sensation (35.2%) and pain (24.1%). Linear erythematous plaques were observed in 42.6% of cases. Only 20.4% reported direct insect contact. Correlation analysis showed weak relationships between age, symptom duration, and lesion count. Multivariate regression indicated a baseline symptom duration of 2.7 days, with no significant association between age or lesion count and symptom duration. Conclusion Teledermatology is a valuable tool in diagnosing and managing Paederus dermatitis in rural Nepal, where direct access to dermatological care is limited. Future research should focus on expanding teledermatology's role in other dermatological conditions.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"23 91","pages":"279-284"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital Health in Nepal: A Perspective on Overcoming Challenges and Leveraging Opportunities.","authors":"S Paudel, D Paudel, F Boucher","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Digital Health, which encompasses eHealth and mHealth, has revolutionized health care with input from information technology, computer science, and data. With the addition of client-centered content, digital health offers to low- and middleincome countries like Nepal the ability to gather, analyze and disseminate health information regardless of geographic and socioeconomic challenges. Nepal has enacted policies to improve the health system while overcoming the barriers of difficult terrain, internet capability, and low education. This paper will survey Nepal's health policy in telecommunication and digital health technology, outline successful interventions, note challenges and make recommendations for future activities.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"23 91","pages":"386-391"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reversing AV Block and Cardiogenic Shock in STEMI Care: A Case Report on Use of Fibrinolysis and Inotrope without PCI in Rural Nepal.","authors":"A Pradhan, P Tamrakar, J Bhandari, P Mahat","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Atrioventricular block and cardiogenic shock are critical complications of inferior wall myocardial infarction with high mortality, especially in resource-limited settings lacking percutaneous coronary intervention. We report a 53-year-old male smoker presenting to a rural hospital with acute chest pain, dyspnea, and profound hemodynamic instability with electrocardiogram showing inferior wall ST-segment elevation myocardial infarction with Mobitz type I atrioventricular block. This case highlights reversal of atrioventricular block with return of hemodynamic stablility using Streptokinase and ionotropes in a rural setting. Therefore, timely fibrinolysis and inotropes in managing inferior wall myocardial infarction with atrioventricular block and cardiogenic shock in percutaneous coronary intervention -inaccessible regions and strengthening rural ST segment elevation myocardial infarction care networks is crucial.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"23 91","pages":"398-401"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Emergency Medicine Services at Rural Outreach Centers: A Comprehensive Needs Assessment for Project ECHO Education Program.","authors":"R K Dangal, K Barun, D Thapa, K Anderson, A Mendoza, R Shrestha, D R House","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Emergency care is a crucial component of Universal Health Coverage; however, Nepal has limited development of emergency services, especially in rural areas. Providers in rural health care facilities have limited experience, emergency training, and resources. The lack of specialized training and resources highlights significant gaps in emergency care delivery, underscoring Nepal's urgent need for targeted education and capacity building. Objective To assess emergency medicine training needs for rural healthcare providers at Dhulikhel Hospital Outreach Centers. Method A cross-sectional study conducted in October-November 2024 surveyed healthcare providers from Dhulikhel Hospital's 18 Outreach Centers (ORCs) to assess emergency medicine training needs. Using a structured questionnaire, the study gathered demographics, emergency conditions encountered, barriers to care, and learning topics of interest. Participants completed the survey through in-person and telephone interviews. Data was analyzed using descriptive statistics. Result Sixty providers participated from all 18 ORCs. Participants included midwives (41.7%), health assistants (26.7%) and medical officers (25%). Most providers (58.3%) had < 5 years of experience. Reasons for referral included the need for lab tests, CT scans, and critical care services. The most significant challenges were insufficient training (96.7%) and lack of supplies (95%). Common emergency conditions managed were trauma, COPD exacerbations, and uncontrolled diabetes. Emergency training interests included poisoning, snake bites, airway, and breathing emergencies. Conclusion This assessment describes challenges and needs critical to improve rural emergency care. Focused investments in training, resources, and support aimed to empower providers can bridge critical gaps in emergency care delivery for rural communities.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"23 91","pages":"317-322"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Outcomes of Anemia in Critically Ill Patients: A Cross-Sectional Observational Study from a Tertiary Intensive Care Unit in Nepal.","authors":"N Simkhada, S Pathak, N Thapa, P Poudel, B Dhakal, G Upadhyay, J Thapa, A Regmi, S Ojha, S Adhikari","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Anemia is a common clinical problem among critically ill patients; however, its prognostic significance remains debatable. In low-resource settings, such as Nepal, data are limited. This study evaluated the clinical, laboratory, and outcome profiles of anemia in a tertiary Intensive Care Unit. Objective To assess the clinical characteristics, laboratory features, and outcomes of anemia in critically ill patients admitted to a tertiary Intensive Care Unit in Nepal. Method This retrospective observational study included 113 adult Intensive Care Unit patients with anemia admitted to Dhulikhel Hospital, Nepal, from October 2024 to March 2025 after obtaining ethical approval from the Institutional Review Committee, Kathmandu University School of Medical Sciences (IRC, KUSMS-156/25). Demographic data, anemia severity, laboratory markers, including peripheral blood smear (PBS), and outcomes, such as mortality and Intensive Care Unit stay, were analyzed using IBM SPSS Statistics version 25.0. Categorical variables were compared with Chi-square tests, continuous variables with independent t-test or MannWhitney U test, and correlations were assessed with Spearman's rank method. Result The median hemoglobin level was 97 g/L (78-112g/L), and mild anemia was the most common (49.5%). Mortality correlated strongly with abnormal peripheral blood smear (p < 0.001, r = 0.52) and moderately with older age (p = 0.012, r = 0.35). Although anemia severity was not statistically significant (p = 0.423), its weak positive correlation (r = 0.15) indicates a potential trend. Conclusion Peripheral blood smear abnormalities and advanced age strongly predict mortality in critically ill patients, while anemia severity alone does not. Routine smear use in resource-limited ICUs may aid early risk stratification and improve care.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"23 91","pages":"323-327"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}