{"title":"Perioperative Anticoagulation and Risk Assessment: Building a Bridge Over a STREAM.","authors":"Anil Harrison, Sushil Rayamajhi","doi":"10.31729/jnma.8910","DOIUrl":"10.31729/jnma.8910","url":null,"abstract":"<p><p>Perioperative care requires a comprehensive assessment of the risks of bleeding and thrombosis. The 2022 CHEST Guidelines offer an empirical foundation for customized treatment using clinical judgment and risk assessment based on CHA2DS2-VASC and HAS-BLED scores. Despite the ease of access to anticoagulation guidelines, decision-making remains challenging, particularly when determining the necessity of bridging therapy with unfractionated or low-molecular-weight heparin. To facilitate this decision, we provide a mnemonic, STREAM, that highlights high-risk situations that require bridging. These include recent stroke or transient ischemic attack, severe thrombophilia, rheumatic valvular disease, recent venous thromboembolism, atrial fibrillation with high CHA2DS2-VASC scores, and mechanical heart valves. This mnemonic offers physicians a methodical approach to optimize perioperative anticoagulation control while minimizing the risk of hemorrhage and thrombosis.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 283","pages":"199-201"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629429","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}
Amogh Bahadur Basnyat, Ganesh Dangal, Aruna Karki, Hema K Pradhan, Ranjana Shrestha, Kabin Bhattachan
{"title":"Broad Ligament Leiomyomata - An Important Differential Diagnosis in Huge Abdominal Mass: A Case Report.","authors":"Amogh Bahadur Basnyat, Ganesh Dangal, Aruna Karki, Hema K Pradhan, Ranjana Shrestha, Kabin Bhattachan","doi":"10.31729/jnma.8908","DOIUrl":"10.31729/jnma.8908","url":null,"abstract":"<p><p>Leiomyomas are a common gynaecological condition affecting 20-30% of women over the age of 35, with prevalence decreasing following menopause. Leiomyomas are most commonly found within the uterus. Rarer extra-uterine locations include the broad ligament, cervix, and vagina. We present an unusual case of multiple Left Broad Ligament Leiomyomata that extended from Left Iliac Fossa and Hypogastrium to Epigastric region in a 50-year-old female. Our case highlights the importance for extra-uterine leiomyoma to be considered as a differential diagnosis in patients presenting with huge abdominal mass suspicious of adnexal tumor or malignancy.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 283","pages":"186-188"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629394","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":"Long-level Intramedullary Spinal Cord Tumor: A Case Series.","authors":"Namrata Khadka, Anil Suryabanshi, Apurva Shrestha, Kumar Paudel, Sameer Aryal, Binit Jha, Sushil Mohan Bhattarai, Binod Rajbhandari, Rajendra Shrestha, Rajiv Jha","doi":"10.31729/jnma.8924","DOIUrl":"10.31729/jnma.8924","url":null,"abstract":"<p><p>Spinal cord tumors, though uncommon, pose significant challenges due to their potential for neurological disability and mortality. Intramedullary spinal cord tumors, particularly Long-level intramedullary spinal cord tumors, present challenging clinical scenarios. Contrast-enhanced Magnetic resonance imaging remains pivotal for radiological evaluation and surgical planning. Notably, aggressive resection is advocated to enhance prognosis, with meticulous attention to preserving neurological function. Advancements in spinal surgery techniques, coupled with intraoperative monitoring, offer promising avenues for improved patient outcomes. We presented three cases of long-level intramedullary tumors, emphasizing the significance of tailored management and presented details, including clinical presentations, radiological findings, and histopathological results.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 283","pages":"195-198"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629404","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":"Burden of Non-Communicable Diseases and Emerging Attention in Gandaki Province, Nepal.","authors":"Khim Bahadur Khadka, Deepak Paudel","doi":"10.31729/jnma.8922","DOIUrl":"10.31729/jnma.8922","url":null,"abstract":"<p><p>Non-communicable diseases have become a major health challenge globally, including in Nepal. Deaths due to non-communicable diseases in Nepal are increasing, accounting more than half of total deaths. Major contributors to deaths due to non-communicable diseases include cardiovascular diseases, chronic respiratory diseases, cancers, digestive diseases such as pancreatitis and cirrhosis of liver, and diabetes. To address this, Gandaki Province organized integrated screening sessions for non-communicable diseases covering 2,976 high-risk individuals aged 40 years and above from six districts. The preliminary findings of screenings revealed a high prevalence of hypertension, high blood sugar, obesity, and abnormal cholesterol levels. Designating Falgun as the month for the non-communicable diseases screening campaign throughout the country helps in promoting awareness, screening, and management of these diseases through effective coordination and resource allocation for successful impact.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 283","pages":"202-204"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629396","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":"Clinical Profile of Patients with Infertility Presenting to Tertiary Care Center: An Observational Study.","authors":"Jyotshna Sharma, Dipty Shrestha, Durga Thapa, Sirjana Rawal, Rijan Kafle","doi":"10.31729/jnma.8925","DOIUrl":"10.31729/jnma.8925","url":null,"abstract":"<p><strong>Introduction: </strong>Infertility, defined as the inability to conceive after a year of regular unprotected sexual activity, is a significant global health concern. It affects couples across the world, with prevalence rates varying between 3.5-16.7% in developed countries and 6.9-9.3% in developing nations. This study aims to explore the sociodemographic profiles and contributing factors in both men and women among infertility patients at a tertiary care center.</p><p><strong>Methods: </strong>An observational cross-section study was conducted at a tertiary care center and participants were between 18 and 42 years old with infertility for one year or longer, excluding those who had received treatment or were pregnant. The data was collected from December 2023 to May 2024. Ethical approval and informed consent were obtained. Data were collected using a structure proforma through in-person interviews or telephone calls and analyzed using Statistical Package for the Social Sciences with descriptive statistics.</p><p><strong>Results: </strong>Among 170 couples with infertility, primary infertility was observed in 124 (72.94%) and secondary infertility in 46 (27.06%). The median duration of marriage was 5 years (IQR: 4-7). Among women, 37 (21.76%) had tubal blockages, 16 (9.41%) had polycystic ovarian disease, and 6 (3.53%) had fibroids. Among men, 58 (34.12%) had semen abnormalities, with oligospermia being the most common in 25 (14.71%). Hormonal analysis revealed that 68 (40%) of women had elevated anti-Müllerian hormone levels, frequently linked to polycystic ovarian syndrome.</p><p><strong>Conclusions: </strong>These findings show that infertility is rarely due to a single cause. It commonly involves both partners and requires a comprehensive approach to diagnosis and treatment.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 283","pages":"175-178"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629397","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}
Palpasa Shrestha, Bibek Shrestha, Jati Sherestha, Jun Chen
{"title":"Current Status and Future Potential of Machine Learning in Diagnostic Imaging of Endometriosis : A Literature Review.","authors":"Palpasa Shrestha, Bibek Shrestha, Jati Sherestha, Jun Chen","doi":"10.31729/jnma.8897","DOIUrl":"10.31729/jnma.8897","url":null,"abstract":"<p><p>The presence of endometrial tissue outside the uterus is a defining characteristic of endometriosis, a chronic systemic illness that affects women of childbearing age. Despite its enigmatic nature, laparoscopy remains the gold standard for diagnosis, while noninvasive methods such as transvaginal ultrasonography and magnetic resonance imaging are commonly used to aid in preoperative planning. In healthcare, AI has emerged as a game-changing innovation, enhancing patient outcomes, reducing costs, and revolutionizing healthcare delivery, particularly in diagnostic radiology. Images can be analyzed using machine learning, a pattern recognition method. The machine learning algorithm first computes the image characteristics deemed significant for making predictions or diagnoses about unseen images.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 283","pages":"205-211"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629399","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":"Diagnostic Dilemma in Intra-abdominal Cancers.","authors":"Gehanath Baral","doi":"10.31729/jnma.8919","DOIUrl":"10.31729/jnma.8919","url":null,"abstract":"<p><strong>Problem statement: </strong>A diagnostic dilemma exists in cancer care, especially in intraabdominal lesions. Despite the diagnostic means available so far, clinical decision-making is practically difficult due to diagnostic limitations. The inherent variation of any means influences decision-making. There is an iceberg-like diagnostic inaccuracy in revealing the specific condition or disease. This clinical decision-making gap is worrisome.</p><p><strong>Conclusion: </strong>Besides technological and bio-molecular advancements, the structured working framework would be protective and persuasive in mitigating dilemmas to some extent.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 283","pages":"132-133"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629401","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":"Clinico-demographical Profile of Pelvis and Acetabular Fracture Presenting in Tertiary Care Center of Nepal: An Observational Study.","authors":"Ranjib Kumar Jha, Santosh Thapa, Asish Rajthala","doi":"10.31729/jnma.8882","DOIUrl":"10.31729/jnma.8882","url":null,"abstract":"<p><strong>Introduction: </strong>Pelvis and acetabular fractures are complex, high-energy trauma and are often associated with life threatening injuries. The majority of them require surgical intervention and extensive rehabilitation. The epidemic figures are necessary to make plan for their management and its complications. We aim to analyze epidemiological profile of patients presented with pelvis and acetabular fracture in our center.</p><p><strong>Methods: </strong>This was observational cross-section study, analyzed on patients admitted with pelvis and acetabular fracture at a tertiary care center through emergency and outpatient department between January to December 2023. The collected parameters were age, gender, mechanism of injury, site of injury, classification of fracture, associated other injuries, management operative or non-operative, early post-operative complications, duration of hospital stay, mortality and Intensive Care Unit admission and they were analyzed. Ethical approval was obtained from Institutinal Review Committee (Reference number: 19/2024).</p><p><strong>Results: </strong>There were 48 (7.27%) pelvis and/or acetabular fracture amongst 660 patient with traumatic fractures. Pelvic fracture was 29 (4.39%) and acetabular fracture was 16 (2.42%). The median age was 38 years (IQR: 25.25-46.75) and 36 (75%) were male. Thirty three (69%) patients required surgery, 17 (35%) patients had additional surgery for associated injury and 14 (29%) required intensive care unit admission. The median hospital stay was 12.5 days and mortality rate were 2%.</p><p><strong>Conclusions: </strong>The proportion of pelvis fracture was comparable to other studies while the proportion of actebular was comparatively higher in this study.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 282","pages":"83-87"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629368","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}
Nabina Malla, Lisasha Poudel, Sushma Pokhrel, Vidya Chaudhary, Prajita Mali
{"title":"Depression among Elderly of Chhayanath Rara Municipality, Mugu, Nepal: An Observational Study.","authors":"Nabina Malla, Lisasha Poudel, Sushma Pokhrel, Vidya Chaudhary, Prajita Mali","doi":"10.31729/jnma.8885","DOIUrl":"10.31729/jnma.8885","url":null,"abstract":"<p><strong>Introduction: </strong>Depression is an important public health issue responsible for considerable morbidity and mortality among elderly. There were very few studies related with depression among elderly from rural community of Nepal. The objectives were to assess depression among elderly in Chhayanath Rara municipality.</p><p><strong>Methods: </strong>An observational cross-section study was conducted among 387 elderly through face-to-face interviews by using Geriatric Depression Scale-short scale (GSD 15) in a municipality of Nepal. Ethical Approval was taken from Institutional Review Committee (Reference Number: 079/80-015 ). Data were entered and analyzed into SPSS version 20. Descriptive statistics was employed to assess the prevalence of elderly depression.</p><p><strong>Results: </strong>The prevalence of depression among elderly was found to be 282 (72.87%; 95% CI: 68.44%-77.30%). Of those, 124 (32.04%) experienced mild depression, 115 (29.72%) had moderate depression, and 43 (11.11%) suffered from severe depression.</p><p><strong>Conclusions: </strong>The prevalence of depression in elderly was found higher compared to previous studies and other population.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 282","pages":"98-102"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629370","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":"Prevalence of Dentinal Hypersensitivity among Dental Patients Visiting Tertiary Care Center: An Observational Study.","authors":"Saru Ghimire, Sagar Ghimire, Samarika Dahal, Sirjana Dahal, Neetika Paudel, Prayash Paudel","doi":"10.31729/jnma.8881","DOIUrl":"10.31729/jnma.8881","url":null,"abstract":"<p><strong>Introduction: </strong>Dentinal hypersensitivity is a widespread condition characterized by a brief, sharp pain arising from exposed dentin in response to external stimuli, which cannot be linked to any other dental conditions. This study aimed to estimate the prevalence of dentinal hypersensitivity among patients attending a tertiary health care center.</p><p><strong>Methods: </strong>A observational cross-section study was conducted, involving 376 patients aged 10-70 years who visited a tertiary care center. Convenience sampling was employed to select participants, and the prevalence of dentinal hypersensitivity was assessed through a questionnaire. Data were collected from the Department of Oral Medicine and Radiology after obtaining ethical approval Institutional Review Committee (Reference number: 385 (6-11) E2 079/80). The analysis was performed using Microsoft Excel, and descriptive statistics were reported .</p><p><strong>Results: </strong>There were 376 patients in the study and the prevlence of dentin hypersensitivity wasa 236 (62.77%; CI 95%: 57.66%-67.67%). Among those diagnosed, 138 (73.02%) were male, and 98 (52.41%) were female. The age-specific prevalence was found to be 30 (50.85%) in patients aged 10-19 years, 73 (63.48%) in those aged 20-29 years, 42 (53.16%) in patients aged 30-39 years, 23 (51.11%) in those aged 40-49 years.</p><p><strong>Conclusions: </strong>This study identified a high prevalence of dentin hypersensitivity among the patient population, with variations observed across different age and sex groups.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 282","pages":"78-82"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629376","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}