JNMA; journal of the Nepal Medical Association最新文献

{"title":"Study of Histomorphological Patterns of Uterine Leiomyomas: An Observational Study.","authors":"Archana Tiwari, Pratima Sapkota","doi":"10.31729/jnma.8883","DOIUrl":"10.31729/jnma.8883","url":null,"abstract":"<p><strong>Introduction: </strong>Uterine leiomyoma, also known as a fibroid, is a benign mesenchymal tumor derived from the smooth muscle of the uterus. It is the most common tumor in women with an estimated incidence of 20%-40% in women during their reproductive years. Leiomyoma can occur in any organ, but the most common forms appear in the uterus. This study is conducted to analyze histomorphological patterns of uterine leiomyomas.</p><p><strong>Methods: </strong>An observational cross-section was conducted between 1st June 2021 and 31st May 2023 in the Department of Pathology of a Medical College and Teaching Hospital. Patients with leiomyoma were included in the study. Clinical, sonographic, gross, and histopathology findings were analyzed. Ethical approval for the study was obtained from Institutional Review Committee (Reference Number: LMC10/B-021).</p><p><strong>Results: </strong>There were 100 patients with leiomyoma during the study period, among whom 55 (55%) were 40-49 years old. There were 65 (65%) patients in the group with a parity of two to three. Abnormal uterine bleeding was observed in 60 (60%) of the cases. Histologically 84 (84%) of the cases were simple conventional leiomyoma. The co-existing conditions found were cystic ovarian disease 37 (41.11%), adenomyosis 19 (21.11%), cervical intra epithelial neoplasia 12(13.33%).</p><p><strong>Conclusions: </strong>Conventional leiomyoma is the commonest histological subtype and and the most common clinical presentation is abnormal uterine bleeding.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 282","pages":"88-92"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629391","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":"Audio-Visual Distraction- A Non-Pharmacological Approach to Alleviate Pain in Pediatric Vaccine Administration: An Observational Study.","authors":"Harsshika Bajaj, Akaash Tandel, Uday Rajput, Naresh Sonkawade, Rahul Dawre, Sameer Pawar, Sangeeta Chivale, Pragathi Kamath, Kanchan Sakharkar, Poonam Sancheti, Murlidhar Tambe, Aarti Kinikar","doi":"10.31729/jnma.8856","DOIUrl":"10.31729/jnma.8856","url":null,"abstract":"<p><strong>Introduction: </strong>The routine vaccine injections are one of the most common and painful procedures during childhood specifically in infancy. In order to improve the effectivity of pain reduction during routine vaccination OPD this study was done to analyse the effectiveness of audio-visual gadgets as a distraction tool for pain reduction in infants during the vaccination procedure.</p><p><strong>Methods: </strong>A comparative observational study conducted at a tertiary healthcare center vaccination out patient department. Children aged 1 month to 2 years receiving the vaccine were included in the study. The study group was exposed to audio-visual clip while the control group received the vaccine as per routine vaccination protocol. The Face, Legs, Activity, Cry, Consolability Scale score was used to assess the behavioural reactions to pain which assesses five behavioural areas. The study protocol was approved by the Institute Ethics Committee (Reference number: BJGMC/IEC/1122238-238).</p><p><strong>Results: </strong>The Face, Legs, Activity, Cry, Controllability Scale score were studied among two groups, it was observed that the pain score and every component of the score had a statistically significant lower mean score in audio-visual group as compared to the control group. Mean pain score in the audio-visual group was 6.31±0.79 as compared to 9.57±0.65 in the control group with the p value of 0.001.</p><p><strong>Conclusions: </strong>A lower pain score in response to vaccination with an audio-visual distraction indicates that it can be regularly used to reduce pain during the vaccination procedure and can be used during different painful procedures.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 281","pages":"18-22"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629379","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":"Health Beyond Health: Insights and Implications from the Fourth National Health Summit of Nepal, 2024.","authors":"Jay Bhushan Jha, Anik Bikram Karki, Sanjeeb Tiwari","doi":"10.31729/jnma.8875","DOIUrl":"10.31729/jnma.8875","url":null,"abstract":"<p><p>The 4^th National Health Summit in Nepal, themed \"Health Beyond Health,\" explored the interconnections between health and social, economic, and environmental factors, emphasizing the role of health as a driver of national progress. The summit brought together diverse stakeholders, including policymakers, healthcare professionals, researchers, and civil society leaders, to address transformative health strategies. With subthemes ranging from universal health coverage to the impact of climate change on health, the event highlighted the importance of a holistic, intersectoral approach to health system strengthening. This viewpoint reflects on the summit's outcomes, its inclusive and participatory approach, and the critical need for translating recommendations into actionable strategies to achieve health equity and resilience for Nepal's future.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 281","pages":"68-70"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629385","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 Carrying Angle of Elbow between Patients with and without Lateral Epicondylitis: An Observational Study.","authors":"Sarik Kumar Shrestha, Manoj Kandel, Bhanubhakta Chalise, Keshav Mani Gautam, Sunil Panta, Pritam Chaudhary, Suman Subedi, Prakash Darjee","doi":"10.31729/jnma.8863","DOIUrl":"10.31729/jnma.8863","url":null,"abstract":"<p><strong>Introduction: </strong>Lateral epicondylitis is a common cause of elbow pain, characterized by pain on the lateral side of the elbow joint. Its multifactorial etiology may result from repetitive micro-trauma, overuse of the forearm extensor muscles, use of vibrating tools, and anatomical variables causing lateral wear. In case of increased carrying angle of elbow, the course of extensor carpi radialis brevis during movement can be altered, thus increasing the tension on the extensor carpi radialis brevis tendon and increasing the risk for lateral epicondylitis. This study aims to find out the difference in carrying angle of elbow in patients with and without lateral epicondylitis.</p><p><strong>Methods: </strong>An observational cross-section study comparing carrying angle of elbow in patient with and without lateral epicondylitis was performed after ethical approval from the Institutional Review Committee (Reference number: 080/081-019) Patients presenting who had undergone radiographic examination of the elbow were recruited in the study and divided into the lateral epicondylitis group and the normal group. The mean carrying angle of elbow in both groups was compared using the parametric test.</p><p><strong>Results: </strong>This study included 82 participants, with 41 participants in the lateral epicondylitis group and 41 participants in the normal group. The mean carrying angle of elbow among patients with lateral epicondylitis group was 14.35±1.4 degrees; and the normal group, it was 12.40±1.26 degrees (p<0.001).</p><p><strong>Conclusions: </strong>The carrying angle of elbow in patients with lateral epicondylitis was significantly more than those without lateral epicondylitis.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 281","pages":"52-56"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629382","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":"Computerized Tomography-Based Volumetric Analysis of The Maxillary, Sphenoid, and Frontal Sinuses: An Observational Study.","authors":"Ashish Dhakal, Bikash Lal Shrestha, Monika Pokharel, Samip Shrestha, Subindra Karki, Krishna Sundar Shrestha","doi":"10.31729/jnma.8859","DOIUrl":"10.31729/jnma.8859","url":null,"abstract":"<p><strong>Introduction: </strong>Volumetric analysis of the paranasal sinuses can help evaluate disease extent, treatment, and sinus surgery outcome. This study aims to determine the baseline volumes of frontal, maxillary, and sphenoid sinuses.</p><p><strong>Methods: </strong>An observational cross-sectional study was conducted in a tertiary care center after obtaining ethical approval (Reference number: 264/2021). Computerized Tomography Scan head or Computerized Tomography Scan nose/Paranasal sinus images of patients across all age groups from January to December 2022 were analyzed. Sinus volumes were calculated using Digital Imaging and Communications in Medicine software.</p><p><strong>Results: </strong>The study included 154 patients, median age was 29 years (IQR:22.75 - 39.25) and 84 (54.5%) were male. The median volume of the maxillary sinus was 14.30 cm³ (IQR:10.76 - 18.02), with the right side at 13.82 cm³ (IQR:10.34 - 17.39) and the left at 14.62 cm³ (IQR:11.11 - 18.75). The median volume of the sphenoid sinus was 4.52 cm³ (IQR:3.02 - 6.03), with the right side at 4.42 cm³ (IQR:2.61 - 6.84) and the left at 3.95 cm³ (IQR:2.16 - 6.47). The median volume of the frontal sinus was 2.59 cm³ (IQR:1.42 - 4.59), with the right side at 2.27 cm³ (IQR:0.94 - 4.12) and the left at 3.04 cm³ (IQR:1.22 - 5.04).</p><p><strong>Conclusions: </strong>Male population had larger volumes across all types. The maxillary and frontal sinuses had the largest and smallest volumes respectively.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 281","pages":"33-36"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629383","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":"Epidemiology and Management of Open Fractures in a Tertiary Care Hospital in Nepal: An Observational Study.","authors":"Sagar Maharjan, Arun Kumar Chaudhary, Rohit Shrestha, Pramit Ram Shrestha, Prabesh Gautam, Ashkal Basi, Manasil Malla, Shreedhar Prasad Acharya, Sushant Kumar Khadka","doi":"10.31729/jnma.8860","DOIUrl":"10.31729/jnma.8860","url":null,"abstract":"<p><strong>Introduction: </strong>An open fracture is an orthopedic emergency that requires immediate resuscitation and stabilization. Understanding presentation and management patterns can help prepare in emergency settings. This retrospective descriptive cross-sectional study stated the demographic profile, management pattern, and seasonal distribution of patients presenting with open fractures.</p><p><strong>Methods: </strong>An observational cross-sectional study was conducted in a tertiary care center. Medical records of all patients with open fractures who underwent immediate orthopedic interventions between January 2021 and December 2023 were evaluated retrospectively after obtaining ethical approval from the Institutional Review Committee (Reference number: 29/24). Descriptive statistics were used to analyze data.</p><p><strong>Results: </strong>The study included a total of 133 cases of open fractures managed during the study period. Out of these, male patients were 104 (78.20%) and female patients 29 (21.80%), with a median age of 35.00 (25.00 - 42.00) years. Mode of injuries included road traffic accidents 53 (39.85%) and falls 32 (24.06%). Tibia fracture was seen in 56 (42.11%) cases, and spinal anesthesia was used in 52.63% of cases. External fixators 36 (27.07%) and intramedullary nails 29 (21.80%) were the primary surgical interventions.</p><p><strong>Conclusions: </strong>Male patients with open fractures were more in comparison to female patients. Road traffic accidents were the most common cause of injury. Gustilo III B fractures were the most frequent kind of injury with tibia most commonly involved. External fixator application was the most common procedure for immediate stabilization.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 281","pages":"37-41"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629384","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":"Panniculitis in Anti-MDA-5 Positive Juvenile Dermatomyositis: A Case Report.","authors":"Semra Ayduran, Gulsah Kilbas, Saadet Nilay Tigrak, Selcuk Yuksel, Erdem Comut, Serkan Turkucar","doi":"10.31729/jnma.8874","DOIUrl":"10.31729/jnma.8874","url":null,"abstract":"<p><p>Panniculitis is a rare clinical finding in dermatomyositis. There are few reported cases in the medical literature. In this report, we describe a 17-year-old male patient with anti-MDA5 positive hypomyopathic dermatomyositis who, eight months after diagnosis, presented with indurated nodules on the right forearm and right thigh despite methotrexate and monthly intravenous immunoglobulin treatment. A skin biopsy revealed lobular panniculitis with lymphocytic infiltrate. His lesions were successfully controlled with hydroxychloroquine and azathioprine. This article presents a case regarding the rarity of panniculitis in juvenile dermatomyositis and its treatment strategy.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 281","pages":"61-64"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629387","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":"Carbapenem-Resistant Gram-Negative Bacterial Infections at a Tertiary Health Care Center in Nepal: An Observational Study.","authors":"Dimpi Konwar, Navin Kumar Chaudhary, Poonam Yadav","doi":"10.31729/jnma.8862","DOIUrl":"10.31729/jnma.8862","url":null,"abstract":"<p><strong>Introduction: </strong>Carbapenems are last-resort antibiotics and are considered the drugs of choice for infections caused by multi-drug-resistant bacteria. During the last several years, there has been an alarming global increase in the detection and spread of Carbapenem-resistant organisms among gram-negative bacteria. Therefore, the main objective of this study is to determine Carbapenem-resistant gram-negative bacterial infections.</p><p><strong>Methodology: </strong>A descriptive cross-sectional study was performed. Ethical approval was granted by the Institutional Review Committee (Reference number: CMC-IRC/080/081-071). A total of 3149 non-repeated, different clinical specimens were collected, from November 2023 to February 2024, processed aseptically under the standard protocol of the American Society for Microbiology, and screened according to the Antibiotic sensitivity pattern. The analysis of the results was performed using Microsoft Excel and manual calculations.</p><p><strong>Results: </strong>Out of 3149 samples, 361 had culture-positive. Among 361 isolates, 316 were Gram-negative bacteria, among the specimens, 83 (26.26%) were identified as Carbapenem-resistant gram negative bacteria. Within this group, <i>Acinetobacter baumannii</i> was present in 37 (44.57%) cases, followed by <i>Escherichia coli</i> with 20 (24.09%), <i>Klebsiella pneumoniae</i> with 19 (22.89%), <i>Stenotrophomonas maltophilia</i> with 3 (4.81%), and <i>Pseudomonas aeruginosa</i> and <i>Klebsiella aerogenes,</i> each with 2 (2.40%) cases. The most effective antibiotics against Carbapenem-resistant <i>Enterobacteriaceae</i> included Colistin and Fosfomycin, whereas Carbapenem-resistant non-fermenter included Colistin and Tigecycline.</p><p><strong>Conclusions: </strong>Among Carbapenem-resistant Organisms, <i>Acinetobacter baumannii</i> was most prevalent. The results revealed a significant proportion of infections resistant to commonly used antibiotics, highlighting an alarming trend in antibiotic resistance.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 281","pages":"47-51"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629380","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":"The National Health Summit: Bridging Policy and Practice for Transformative Healthcare in Nepal.","authors":"Sushant Regmi","doi":"10.31729/jnma.8872","DOIUrl":"https://doi.org/10.31729/jnma.8872","url":null,"abstract":"","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 281","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629365","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":"Ultrasonographic Measurement of Skin to Lumbar Epidural Space Depth in Pregnant Women Undergoing Elective Cesarean Section: An Observational Study.","authors":"Sushila Lama Moktan, Milan Kumar Thapa, Ujma Shrestha, Prabin Subedi","doi":"10.31729/jnma.8861","DOIUrl":"10.31729/jnma.8861","url":null,"abstract":"<p><strong>Introduction: </strong>Neuraxial anesthesia is commonly used during cesarean delivery and is preferred for its effectiveness and minimal risks. Accurate identification of the depth of the lumbar epidural space is crucial to ensure successful block and minimize complications. However, this can be challenging in pregnant women due to physiological changes that affect the anatomy of the lumbar spine. Ultrasound is a helpful device for providing real-time visualization of the relevant anatomical structures and facilitating accurate needle insertion. In this study, we evaluated the utility of ultrasound in determining the depth from the skin to the lumbar epidural space in pregnant women undergoing elective caesarean section.</p><p><strong>Methods: </strong>This is an observational cross-section study performed after approval from Institutional Review Committee (Reference number:09062023/03). Using a curvilinear ultrasound probe, imaging of spine at lumbar third and fourth intervertebral space was performed. The measurements were performed in the sitting position with the patients' backs flexed in the parasagittal oblique and transverse median view to determine the distance from the skin to the lumbar epidural space.</p><p><strong>Results: </strong>The mean depth from the skin to the lumbar epidural space/posterior complex in the parasagittal oblique view was 46.84±7.18 mm (95% CI : 45.48-48.20), and transverse median view was 45.27±8.16mm (95% CI :43.73-46.81).</p><p><strong>Conclusions: </strong>The skin-to-lumbar epidural space depth in pregnant women undergoing elective cesarean section was comparable to other studies conducted in similar settings.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"63 281","pages":"42-46"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629367","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}