{"title":"Sociodemographic and Clinical Profiles of Patients Admitted in Tertiary Level Pediatric Hospital of Nepal: An Observational Study.","authors":"Anil Kumar Shrestha, Sushil Gyawali, Bal Mukunda Basnet, Santosh Adhikari, Sobi Lal Maharjan, Pujash Karmacharya, Deepak Raj Paudel","doi":"10.31729/jnma.8911","DOIUrl":"10.31729/jnma.8911","url":null,"abstract":"<p><strong>Introduction: </strong>Child health is crucial in low and middle-income countries. Pediatric healthcare in tertiary-level hospitals addresses complex medical conditions. This study aimed to describe the sociodemographic and clinical profiles of pediatric patients admitted to Kanti Children's Hospital in Nepal.</p><p><strong>Methods: </strong>An observational cross-section study was conducted including all the inpatients under 15 years of age. The data were collected from the hospital medical record section from July 17, 2023 to July 15, 2024, after the ethical approval from Institutional Review Review Committee, (Reference number 2168). The statistical analysis included descriptive statistics to assess demographic characteristics, case types, admission patterns, and outcomes using Microsoft Excel and Statistical Package for Social Sciences (SPSS) 2024.</p><p><strong>Results: </strong>A total of 9682 pediatric cases were included, of which 6389 (65.99%) of the patients were male, with 3305 (34.13%) being aged 1 to 5 years. Among the admitted patietns 2194 (22.66%) had respiratory cause and 1520 (15.70%) had infectious disease. Mortallity rate was 203 (2.09%) and it was 82 (12.06%) in pediatric intensive care unit and 48(10.62%) in neonatal intensive care unit.</p><p><strong>Conclusions: </strong>Respiratory and infectious diseases were the most common cause of admission in pediatric settings with a higher prevalence in younger children. The majority of cases were residing outside the capital city. This study highlighted higher mortality rates in critical care units.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 283","pages":"159-164"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dipesh Chhetri, Amit Sharma Bhattarai, Pankaj Joshi, Kriti Thapa
{"title":"Myasthenia Crisis as First Presentation of MuSk Positive Myasthenia Gravis: A Case Report.","authors":"Dipesh Chhetri, Amit Sharma Bhattarai, Pankaj Joshi, Kriti Thapa","doi":"10.31729/jnma.8896","DOIUrl":"10.31729/jnma.8896","url":null,"abstract":"<p><p>We report a unique presentation of a 57-year-old female presented with severe respiratory acidosis, which was found to be a case of Musk-positive Myasthenia Gravis. Patient presented with depressed level of consciousness and respiratory failure, mandating urgent ventilatory support. She responded well with positive pressure ventilation. However, she persistently failed to maintain adequate ventilation after extubation and had to be reintubated. At presentation, the absence of classical symptoms typical of Myasthenia Gravis posed a diagnostic dilemma, initially obscuring the underlying etiology. However, since there was no other identifiable cause for the inability to maintain ventilation, antibody panels were sent which turned out positive for Muscle specific kinase. This case thus highlights the significance of considering atypical neuromuscular presentations, particularly when respiratory compromise is the predominant manifestation, highlighting the necessity for comprehensive neurological evaluation even in the absence of classical symptoms for timely diagnosis and management of Myasthenia Gravis.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 283","pages":"179-181"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shasank Chitrakar, Saroj Babu Aryal, Tirtha Man Shrestha
{"title":"Postpartum Cavernous Sinus Thrombosis Associated with Eclampsia and Gestational Diabetes Mellitus: A Case Report.","authors":"Shasank Chitrakar, Saroj Babu Aryal, Tirtha Man Shrestha","doi":"10.31729/jnma.8904","DOIUrl":"10.31729/jnma.8904","url":null,"abstract":"<p><p>Pregnancy is the pro-thrombotic state. The objective of this report is to highlight the rare occurance of postpartum cavernous sinus thrombosis associated with eclampsia and gestational diabetes mellitus, emphasizing its clinical presentation. A 25-year-old Muslim female came with the complaint of headache,post auricular and right parietal region on 8th day post-partum. She had a history of postpartum eclampsia and Gestational Diabetes Mellitus for which she was treated with magnesium sulfate and oral hypoglycaemic agents respectively. MRV showed a filling defect in right transverse sinus, sigmoid sinus, and internal jugular vein. She was then admitted to the ward and was treated with heparin and antibiotics. She was then discharged on oral rivaroxaban. As pregnancy is itself a state of hyper-coagulable state, there seems to be a significant thrombosis risk. Hence clinicians should be aware of the possible thrombotic disorder in the background of this vignette.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 283","pages":"182-185"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amit Prajapati, Yubaraj Sharma, Suman Thapa, Sadina Devkota
{"title":"DECAF Score in Predicting Outcomes of Acute Exacerbation of Chronic Obstructive Pulmonary Disease: An Observational Study.","authors":"Amit Prajapati, Yubaraj Sharma, Suman Thapa, Sadina Devkota","doi":"10.31729/jnma.8903","DOIUrl":"10.31729/jnma.8903","url":null,"abstract":"<p><strong>Introduction: </strong>Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can often lead to hospital admission and has the potential to be fatal. Lack of prognostic research in exacerbation requiring hospitalization that can accurately predict inhospital mortality is a challenge. This study aims to assess value of the DECAF (Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial fibrillation) score as a clinical prediction tool for inhospital mortality, need of intensive care unit (ICU) stay and risk stratification in patients with Acute exacerbation of chronic obstructive pulmonary disease.</p><p><strong>Methods: </strong>This is an observational cross-section, hospital based study conducted from April 2022 to February 2023 at a tertiary care centre. The patients admitted with the diagnosis of acute exacerbation of chronic obstructive pulmonary disease were included in the study and their DECAF score were calculated. Patients were followed up during hospital stay and their outcome were recorded. The prognostic value of DECAF score was assessed by area under receiver operator characterstics curve.</p><p><strong>Results: </strong>There were 83 patients enrolled in the study out of which 13 (15.66%) died in the hospital and 20 (24.09%) required ICU stay. The area under receiver operator characteristic curve value for mortality owas 0.89 and that for intensive care unit stay was 0.84.</p><p><strong>Conclusions: </strong>This study shows that DECAF score is a good predictor of inhospital mortality and ICU admission.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 283","pages":"144-148"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Appropriate Use of Proton Pump Inhibitors in General Out Patient Department of a Tertiary Care Center of Kathmandu Valley: An Observational Study.","authors":"Jeetendra Bhandari, Narendra Bhandari","doi":"10.31729/jnma.8913","DOIUrl":"10.31729/jnma.8913","url":null,"abstract":"<p><strong>Introduction: </strong>Proton Pump Inhibitors (PPIs) are widely used medications that suppress gastric acid secretion worldwide. However, they have been linked to an increased risk of chronic kidney disease, hypomagnesemia, and bacterial infections, including C. difficile and acid hypersecretion. This study aimed to identify the appropriateness of PPI prescriptions in general clinics.</p><p><strong>Methods: </strong>An observational cross-section study was conducted in General out patient department of a tertiary care center of Nepal. Purposive sampling was done. The study included 355 clinical notes from the clinic's out patient department with at least one proton pumb inhibitor prescription. Data was collected, and the proportion of different parameters was calculated.</p><p><strong>Results: </strong>Appropriate use of proton pumb inhibitor was 255 (57.74%). Among the total study population, 186 (51.22%) were male. The appropriate use of proton pump inhibitor use by faculties was 83 (61.02%) and 68 (33.68%) reported that it was given to prevent Non-steroidal Anti-Inflammatory Drug-related complications. Pantoprazol was prescribed in 256 (74.62%) cases.</p><p><strong>Conclusions: </strong>This study suggests that PPIs were appropriate more than 50 percent of the time, but a high number of patients have been prescribed PPIs without a clear indication.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 283","pages":"149-153"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Incidental Neoplasm and Histopathological Spectrum of Suspected Acute Appendicitis in Appendectomy Specimen: An Observational Study.","authors":"Archana Tiwari, Pratima Sapkota, Dipesh Shrestha","doi":"10.31729/jnma.8914","DOIUrl":"10.31729/jnma.8914","url":null,"abstract":"<p><strong>Introduction: </strong>Acute appendicitis is the most common surgical emergency and histopathological studies are the gold standard for confirmation of clinical diagnosis and key methods of discovering appendiceal neoplasm. Appendiceal neoplasms are uncommon and are mostly identified by pathologic examination after appendectomy for presumed appendicitis as an incidental finding.</p><p><strong>Methods: </strong>An observational cross-section study was conducted at a Medical College from 1<sup>st</sup> August 2022 to 31<sup>st</sup> July 2024. Appendectomy specimens were included in the study after obtaining consent. Ethical approval was taken from the Institutional Review Committee (Reference number: IRC-LMC 05/S-22). Descriptive analysis was done, frequency and proportion were calculated.</p><p><strong>Results: </strong>Among 350 appendectomy cases, 30 (8.57%) cases had negative appendectomies. Out of total 320 patients, 183 (57.19%) were male and 137 (42.81%) were female. Histopathological findings suggestive of acute appendicitis were observed in 164 (51.25%) specimens and there were 6 (1.87%) specimens suggestive of neoplasms. Amongst the neoplasm of appendix 3 (0.94%) were carcinoid tumours.</p><p><strong>Conclusions: </strong>Appendiceal neoplasms are uncommon which was comparable to previous studies. Carcinoid tumour was the most common incidental neoplasm.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 283","pages":"165-169"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pramila Rai, Ilana N Ackerman, Denise A O'Connor, Ganesh Dangal, Rachelle Buchbinder
{"title":"Burden of Maternal and Neonatal Disorser in Nepal from 1990 to 2019; Analysis of Data from Global Burden of Disease Study: An Observational Study.","authors":"Pramila Rai, Ilana N Ackerman, Denise A O'Connor, Ganesh Dangal, Rachelle Buchbinder","doi":"10.31729/jnma.8916","DOIUrl":"10.31729/jnma.8916","url":null,"abstract":"<p><strong>Introduction: </strong>Nepal continues to face significant challenges with high maternal and neonatal mortality. To improve health and achieve the Sustainable Development Goals of reducing maternal and newborn mortality by 2030, Nepal needs to focus on addressing high-burden maternal and neonatal disorders. The objective of the study was to examine the current burden of maternal and neonatal disorders in Nepal and to assess any changes over time.</p><p><strong>Methods: </strong>We examined the annual Global Burden of Disease Study data on prevalence, deaths, Years Lived with Disability, and Disability-Adjusted Life Years for maternal and neonatal disorders in Nepal for the 1990-2019 period. Estimated annual percentage changes were also calculated to assess the trends of the age-standardised rates of these burden metrics.</p><p><strong>Results: </strong>The analysis found that the prevalence of overall maternal disorder in Nepal decreased by 37% from 128,176 in 1990 to 80,724 in 2019 with Age-Standarised Ratio of 432.07 per 100,000 in 2019 and Estimated Annual Percentange Change of -4.34 (CI 95%: -4.49 to -4.18). Similarly, the overall prevalence of neonatal disorder increased by 57% from 303,146 in 1990 to 475,544 in 2019 with Age-Standarised Ratio of 1521.14 per 100,000 in 2019 and Estimated Annual Percentage Change of 0.98 (95% CI: 0.67-1.29).</p><p><strong>Conclusions: </strong>Our findings emphasise the need to address maternal haemorrhage, indirect maternal deaths, maternal abortion and neonatal disorders in Nepal in future national health programs.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 283","pages":"134-143"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Internet Addiction among Students of a School in Rupandehi District, Nepal: An Observational Study.","authors":"Bikram Kafle, Yashoda Bagale, Suraj Tiwari, Niraj Pandey, Nabin Pahari","doi":"10.31729/jnma.8921","DOIUrl":"10.31729/jnma.8921","url":null,"abstract":"<p><strong>Introduction: </strong>Students use internet for various purposes like social networking, playing online games, academic purpose, etc. Excessive Internet use has been associated with adverse psychosocial development, social isolation, impaired social skills, anger and mental health issues. This study aims to find out the prevalence of internet addiction disorder among school going adolescent of a government school of Nepal.</p><p><strong>Methods: </strong>An observational cross-section study conducted among students of Shree Shanti Model Secondary School after obtaining ethical approval from the Institutional Review Committee. Data was collected from 1 October to 1 November 2023. A convenience sampling method was used. A standard tool Young Internet Addiction Test (IAT) was used to find out if addiction was present or not.</p><p><strong>Results: </strong>Out of a total of 461 students, 137 (29.72%) had mild internet addiction, 21 (4.56%) had moderate addiction, and 303 (65.72%) had no addiction. The mean age of the students was 14.93±0.73 years. A total of 226 (49.02%) were male, and 235 (50.98%) were female. Out of total, 388 (84.16%), used mobile phones for internet access, and the main purpose of internet use was entertainment, reported by 255 (55.31%). YouTube was viewed by 266 (61.99%) users, TikTok by 77 (16.71%), and Facebook by 46 (9.98%).</p><p><strong>Conclusions: </strong>This study highlights that approximately one-third of students in a government school in Rupandehi, Nepal, exhibit mild to moderate levels of internet addiction. The findings suggest that internet use is predominantly for entertainment, with mobile phones being the most common device used.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 283","pages":"170-174"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comparison of Fat Suppression Sequences T2 Weighted Two-Point Dixon and Short-Tau Inversion Recovery in Magnetic Resonance Imaging of Lumbar Spine: An Observational Study.","authors":"Umesh Khanal, Ramswarth Sah, Sushil Kumar Mahato, Shailendra Katwal, Ghanshyam Gurung","doi":"10.31729/jnma.8899","DOIUrl":"10.31729/jnma.8899","url":null,"abstract":"<p><strong>Introduction: </strong>Magnetic Resonance Imaging is a common diagnostic tool used to evaluate various clinical conditions. Different fat suppression techniques such as Short Tau Inversion Recovery and Dixon are employed to enhance diagnostic accuracy. The choice of fat suppression sequence varies based on availability and performance. This study aimed to compare Contrast Ratio and Contrast-to-Noise Ratio of Short Tau Inversion Recovery and Dixon technique.</p><p><strong>Methods: </strong>This observational cross-section study was performed in the Department of Radiology from 8 September 2023 to 7 September 2024 after the approval by the Institutional Review Committee (Reference number: 151/080/081(6-11)E2). Using a complete census method during the study period, MRI-lumbar spines of 384 adult patients were included in the study. Signal intensity values of the lesion, adjacent normal tissue, and noise were recorded for calculation of Contrast Ratio and Contrast-to-Noise Ratio.</p><p><strong>Results: </strong>Among 384 cases, 191 (49.74%) were male and 193 (50.26%) were female with median age 46 (IQR: 35-60) years. The median value of contrast ratio and contrast-to-noise ratio were 0.31 (IQR: 0.14-0.50) and 8.74 (IQR: 3.82-15.50) respectively for STIR sequence while median value of contrast ratio and contrast-to-noise ratio were 0.44 (IQR: 0.19-0.74) and 11.95 (IQR: 5.38-23.18) respectively for Dixon sequence, higher than Short Tau Inversion Recovery.</p><p><strong>Conclusions: </strong>Contrast Ratio and Contrast to Noise Ratio were found higher and background noise lower for Dixon compared to Short Tau Inversion Recovery.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 283","pages":"154-158"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Mucocutaneous Adverse Effects of Methotrexate Toxicity: A Case Series.","authors":"Bibek Subedi, Sajana Bhandari, Sunil Timilsina, Sudarshan Pokhrel, Saraswoti Neupane","doi":"10.31729/jnma.8905","DOIUrl":"10.31729/jnma.8905","url":null,"abstract":"<p><p>Methotrexate is a widely used medication in dermatology, rheumatology, and oncology. However, patient misunderstandings or attempts to expedite symptom relief can lead to overuse, resulting in severe toxicity. This case series presents five instances of methotrexate toxicity due to daily dosing and excessive use for underlying disorders. All patients exhibited fever, skin, and mucosal lesions, alongside abnormal hematological parameters. Management involved immediate cessation of methotrexate, administration of leucovorin rescue therapy, and supportive care. Three patients fully recovered with the resolution of lesions and improved hematological profiles, while two succumbed to the illness. These cases underscore the critical need for early recognition of methotrexate toxicity symptoms and comprehensive patient counseling on proper dosing schedules to prevent such adverse outcomes.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 283","pages":"189-194"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}