JNMA; journal of the Nepal Medical Association最新文献

{"title":"Overcoming the Challenges of Intravenous Immunoglobulin Resistance in Kawasaki Disease: A Case Report.","authors":"Rahul Kumar Chaudhary, Sajjad Ahmed Khan, Raman Kumar Sah, Shreya","doi":"10.31729/jnma.8837","DOIUrl":"10.31729/jnma.8837","url":null,"abstract":"<p><p>Kawasaki disease, extremely rare vasculitis of unknown etiology characterized by inflammation of small to medium sized arteries of multiple systems. This case report enhances the knowledge and management skills of rare clinical conditions. Here we report a case of a 3-month-old infant presented with acute onset fever, rash, non-exudative conjunctivitis and swellings of hands and legs with blood culture positive sepsis and right coronary artery dilatation. The child didn't respond to treatment with the first dose of intravenous immunoglobulin. Therefore, the immunoglobulin resistant Kawasaki disease in infants needs further evaluation and clinical management at tertiary level hospitals.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"62 280","pages":"844-846"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629355","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":"Piloting Implementation Design and Preliminary Readiness for Universal Suicide Risk Screening Program in Emergency Department of a Tertiary Care Centre, Nepal: A Mixed-Method Study.","authors":"Anmol Purna Shrestha, Roshana Shrestha, Renu Shakya, Pratiksha Paudel, Madeleine Sorenson, Amrita Gurung, Riya Bajracharya, Ajay Risal, Lakshmi Vijayakumar, Ashley Hagaman","doi":"10.31729/jnma.8832","DOIUrl":"10.31729/jnma.8832","url":null,"abstract":"<p><strong>Introduction: </strong>Nearly three quarters of the suicides occur in developing world, however few evidence-based health systems strategies exist to detect and prevent suicide in these contexts. This pilot study evaluates the feasibility of implementing a universal suicide risk screening program in a Nepalese emergency department.</p><p><strong>Methods: </strong>This study reports the preliminary training phases of a pilot implementation trial in the emergency department to evaluate the program. The approval was obtained from the Nepal Health Research Council (Approval no. 447/2021 P), and the Kathmandu University School of Medical Sciences Institutional Ethical Review Board (Approval no. 237/2021) and Yale University IRB (Protocol ID 2000029480). Implementation assessments included suicide screening acceptability, appropriateness, confidence, system priority, and myth knowledge of staff. Implementation strategies were selected, decolonized, and preliminarily trained followed by phased supportive coaching to initiate the screening package. We designed the implementation package through co-design staff focus groups and embedded ethnography.</p><p><strong>Results: </strong>Co-design focus groups (n=8) occurred with staff and leadership. We trained 26 (76.47%) the staff on the Nepali suicide screening tool followed by supported phased initial screening over two months. Implementation assessments demonstrated increased scores on appropriateness, confidence, system priority, and myth knowledge. The implementation package included key strategies to be deployed over six months. The embedded ethnographic observations revealed barriers to effective implementation, such as anticipated stigma, reluctance to engage families, and distrust in referral processes.</p><p><strong>Conclusions: </strong>The pilot study demonstrated that training improves staff appropriateness, confidence, system priority, and myth knowledge. Despite initial barriers, co-designed strategies and phased coaching facilitates screening uptake, highlighting the program's potential for sustainable implementation.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"62 280","pages":"803-813"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629358","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":"Functional Status and Comorbidities in Older Patient Attending Outpatient in a Tertiary Care Hospital: An Observational Study.","authors":"Ananta Aryal, Anil Aryal, Rhijuta Pokharel, Shrinkhala Timsina, Shirjan Gautam, Saurav Jha, Subash Pant","doi":"10.31729/jnma.8797","DOIUrl":"10.31729/jnma.8797","url":null,"abstract":"<p><strong>Introduction: </strong>With the increasing geriatric population, the demand of the geriatric care has been increasing worldwide. Numerous comorbidities like hypertension, COPD, diabetes mellitus, arthritis, are seen commonly in the older population of Nepal, affecting their quality of life. Assessing functional status of individual using Basic Activities of Daily Living and Instrumental Activities of Daily Life scoring is beneficial in predicting the mortality and morbidity among the group. This study hence focuses on determining the comorbidities and functional status of older population.</p><p><strong>Methods: </strong>This descriptive cross-sectional study was conducted from February 2024 to May 2024 in tertiary care hospital at Kathmandu among population of age group above 60 years, after taking ethical approval from Institutional Review Committee (Reference number: 19012024/04). A total of 423 individuals were taken for the study. Data collection for socio-demographic information, comorbidities, functional assessment via Katz and Lawton scale was done and analysed using IBM SPSS.</p><p><strong>Results: </strong>Among the total 423 participants visiting the outpatient department, 188 (44.44%) were males and 235 (55.56%) were females. Basic Activity of Daily Living using Katz scoring, suggested that 377 (89.13%; 95% CI: 85.76%-91.93%)) were independent. Using Lawton scoring for the assessment of Instrumental Activities of Daily Living, it was seen that 170 (40.19%; 95% CI: 35.48%-45.03%) were independent. There were 184 (43.50%) individual with comorbidities.</p><p><strong>Conclusions: </strong>Most of the patients were independent in Basic Activities of Daily Living as per Katz Index of independence and almost half were independent in Instrumental Activities of Daily Living as per Lawton-Brody scale.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"62 279","pages":"734-738"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629337","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":"Demographics of Total Hip and Knee Arthroplasty in Nepal: An Observational Study.","authors":"Ishwor Ghimire Padhya, Suman Subedi, Prakash Gyawali, Sushant Regmi","doi":"10.31729/jnma.8821","DOIUrl":"10.31729/jnma.8821","url":null,"abstract":"<p><strong>Introduction: </strong>Hip and knee arthroplasty surgeries are essential for treating end-stage osteoarthritis, providing significant functional improvements. Despite a global rise in these procedures, Nepal lacks a National Joint Registry, resulting in a gap in tracking the exact number of surgeries, outcomes, and complications. This study aims to address this gap regarding the demographics of hip and knee arthroplasties in Nepal.</p><p><strong>Methods: </strong>An observational study was conducted after obtaining the ethical approval from the Nepal Health Research Council (Reference number: 2024/136) with data collected from prosthesis supplier. The study included all primary hip and knee arthroplasties performed in 2022 and 2023, excluding revision cases and those requiring mega prostheses. Data analysis was performed using Microsoft Excel for descriptive statistics.</p><p><strong>Results: </strong>There were a total of 1259 surgeries, 916 (72.77%) total knee replacements were performed, with a female predominance of 741 (81.42%) and a median age of 67 years(IQR: 62-71). There were 343 (27.23%) total hip replacements surgeries of which 200 (58.31%) were done in males. Most surgeries 1148 (91.18%) occurred within the Kathmandu Valley.</p><p><strong>Conclusions: </strong>Total knee arthroplasty accounted for the majority of cases, showing a predominance of female patients with the majority of surgeries in the capital city.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"62 279","pages":"761-764"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629333","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":"Dural Venous Sinus Variations Observed in Magnetic Resonance Venography at a Tertiary Care Hospital: An Observational Study.","authors":"Sharma Paudel, Ramswarth Sah, Rakesh Kumar Singh, Prakash Kayastha, Shailendra Katwal","doi":"10.31729/jnma.8795","DOIUrl":"10.31729/jnma.8795","url":null,"abstract":"<p><strong>Introduction: </strong>The dural venous system, composed of various sinuses, plays a crucial role in draining deoxygenated blood from the central nervous system. Understanding its anatomical variations is essential to differentiate it from pathological conditions like cerebral venous sinus thrombosis. This study aims to evaluate the anatomical variations of the dural venous sinuses using Magnetic Resonance Venography.</p><p><strong>Methods: </strong>An observational, cross-sectional study was performed in the Department of Radiology from September 2023 to March 2024 after the approval by the Institutional Review Committee (Reference number: 149/080/081(6-11)E2). Magnetic Resonance Venography of 109 adult patients was performed using a 1.5 Tesla MRI scanner. Diameters of the superior sagittal sinus, straight sinus, and transverse sinuses were measured. Variations in transverse sinuses, straight sinus, and confluence were categorized and analyzed.</p><p><strong>Results: </strong>The study included 52 (47.70%) male and 57 (52.30%) female, with median age of 42 (IQR: 30.5 - 56) years. The superior sagittal sinus had the diameter of 6.4 ± 1 mm. Symmetric transverse sinus variant seen was in 80 (73.39%) patients, and left transverse sinus hypoplasia was seen in 20 (18.35%) patients. Variations in the straight sinus and confluence were also documented with a true confluence (type III) was seen in 71 (65.10%) patients.</p><p><strong>Conclusions: </strong>Anatomical variations of the dural venous sinuses as observed in 1.5 Tesla MRI was quite common.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"62 279","pages":"720-724"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629334","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":"Hirayama Disease in a Young Male: A Case Report.","authors":"Suman Paudel, Prerana Singh Rokaha, Pratik Singh Rokaha, Lalit Karki, Paras Thapa","doi":"10.31729/jnma.8804","DOIUrl":"10.31729/jnma.8804","url":null,"abstract":"<p><p>Hirayama disease is a rare benign neurological disease that affects the anterior horn of the spinal cord at C5 to T1, mainly at C7 and C8 due to imbalance growth between the vertebral column and the dura mater leading to microcirculatory disturbances in the anterior portion of the spinal cord due to overstretched cord, especially during flexion of the neck causing unilateral or rarely asymmetrically bilateral upper limb weakness and muscle wasting. It is a case of a 21-year-old boy presented with weaknesses in his left hand and forearm for 2 years which aggravates during cold weather and flexion of the neck. A plain x-ray of the neck and MRI of the cervical spine were conducted which show the features of Hirayama disease.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"62 279","pages":"770-773"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629339","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":"A Five-year Study of Spinal Disorders Among Patients Presenting to the National Trauma Center of Nepal: An Observational Study.","authors":"Badri Rijal, Min Chandra Adhikari, Suzit Bhusal, Reshika Shrestha, Ashlesha Chaudhary, Dipendra Pandey, Mandish Prasad Phuyal, Akanshya Prasai, Aashutosh Chaudhar","doi":"10.31729/jnma.8809","DOIUrl":"10.31729/jnma.8809","url":null,"abstract":"<p><strong>Introduction: </strong>Spinal cord injuries result in severe neurological impairments and disabilities. With an estimated 15.4 million cases globally in 2021, spinal cord injuries are more common in low- and middle-income countries, yet research in these areas is limited. This study aimed to find the pattern of spinal injuries and outcomes associated with spine injuries over a five-year duration at a tertiary trauma care center.</p><p><strong>Methods: </strong>This observational cross-section study was conducted at the National Trauma Center, Kathmandu from 2075 to 2080 B.S. with ethical clearance from the Nepal Health Research Council (Reference number: 968). Total-population sampling was used. A structured proforma was employed as the primary data collection tool. Data was analyzed using SPSS.</p><p><strong>Results: </strong>Of the 20843 patients, 2070 (9.93%) had spinal injuries. The median age was 43 (IQR 32-56) years, with 1391 (67.20%) male patients. The median hospital stay was 12 (IQR 7-20) days. Falls accounted for 1221 (58.99%) cases, and road traffic accidents for 195 (9.42%). Spinal fractures were present in 1076 (51.98%) patients with 456 (42.38%) in lumbar vertebra. There were 225 (10.87%) cases of subluxation with 214 (95.11%) in cervical level.</p><p><strong>Conclusions: </strong>The study provides insights into the patterns and outcomes of spinal injuries over five years of time. The mortality rate and cases of patients leaving against medical advice highlight areas for improvement in patient care and follow-up.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"62 279","pages":"757-760"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629331","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":"Expanding Horizons: Increasing Injectable Vaccine in the Expanded Program on Immunization.","authors":"Birendra Prasad Gupta, Namita Ghimire","doi":"10.31729/jnma.8773","DOIUrl":"10.31729/jnma.8773","url":null,"abstract":"<p><p>The World Health Organization started the Expanded Program on Immunization in 1974, including 6 antigens with up to 8 vaccine doses for childhood vaccination. The number of antigens has now increased to 11 antigens in 21 vaccines. The expansion of vaccination programs to include more antigens and doses has led to concerns about the burden of multiple injections on infants and children, as well as factors such as fear of adverse reactions, pain, and overall acceptability of vaccines. To address these challenges, there's a call for research to focus on developing combined vaccines that can be administered through more acceptable routes, such as oral, nasal, or needleless administration. This approach could potentially reduce the number of injections required and increase the willingness of individuals to receive vaccines. We highlight the importance of ongoing research and innovation in vaccine development and delivery methods to ensure that vaccination programs remain effective, efficient, and acceptable to the communities they serve, particularly in resource-limited settings.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"62 279","pages":"785-788"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629336","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":"Localization of a Bullet in a Firearm Injury Victim Using X-ray Imaging During Autopsy: A Case Report.","authors":"Kaschev Shrestha, Nishana Shrestha, Salmalee Yadav, Dhirendra Yadav","doi":"10.31729/jnma.8811","DOIUrl":"10.31729/jnma.8811","url":null,"abstract":"<p><p>Firearm injuries can result in varying degrees of trauma, depending on factors such as the type of firearm, range, and wound location. This case report presents the role of X-ray imaging in detecting a projectile causing fatal penetrating abdominal trauma in a 45-year-old male. The patient was found with a gunshot wound in his abdomen, and despite medical interventions, he succumbed to his injuries. X-ray imaging revealed a hyper-dense area resembling a bullet lodged in the abdominal cavity. Autopsy confirmed a close-range gunshot with significant internal damage to the peritoneum, mesentery, liver, and the bullet lodged near the L1 vertebra. This case underscores the value of radiological imaging in identifying projectile trajectory and injury severity, particularly in resource-limited settings. X-rays assist in distinguishing between penetrating and perforating wounds, aiding both forensic investigation and legal procedures. The integration of imaging in forensic autopsies improves the accuracy of injury assessment, especially in cases involving gunshot wounds.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"62 279","pages":"780-784"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629340","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":"Navigating Authorship Ethics in Research: Challenges and Responsibilities.","authors":"Jay Bhushan Jha","doi":"10.31729/jnma.8816","DOIUrl":"10.31729/jnma.8816","url":null,"abstract":"","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"62 279","pages":"712-713"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629341","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}