Journal of Gandaki Medical College-Nepal
An official publication of the Gandaki Medical College Teaching Hospital & Research Centre Pvt. Ltd. Journal of Gandaki Medical College-Nepal (JGMC-N) is indexed in the Research4Life, Directory of Open Access Journals (DOAJ), NepJOL, NepMed and Google Scholar.
Gandaki Medical College Teaching Hospital & Research Center Pvt. Ltd.
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Challenges in peer review in Nepali medical journals
Peer review remains the cornerstone of quality assurance in scientific publishing, yet its effective implementation faces unique obstacles in resource-limited settings. In Nepal, rapid growth in medical research output, coupled with a small pool of experienced reviewers and rising submission volumes, has strained the peer-review system of local journals. Key challenges include a limited number of qualified reviewers (only ~1,800–2,000 active health-science researchers with h-index ≥1 serving >70 journals), widespread lack of formal reviewer training, reliance on manual editorial processes, intense pressure from academic promotion criteria, and frequent institutional conflicts of interest. These factors contribute to prolonged review times (median 118–124 days), high reviewer refusal rates, and occasional compromises in rigour. Strengthening peer review in Nepal requires a coordinated national effort: standardized and transparent processes, structured reviewer training and mentorship programmes, wider adoption of online journal systems, public recognition or continuing medical education credits for reviewers, and cultivation of peer review as an integral component of scientific citizenship. Addressing these bottlenecks is essential to enhance the credibility, efficiency, and global visibility of Nepalese medical journals.
Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by-nc/4.0
Counting every mother: Strengthening maternal mortality data in Nepal- A narrative review article
Introduction: Maternal mortality remains a major public health concern in Nepal, and accurate measurement is vital for evidence-based policymaking and achieving Sustainable Development Goal 3.1, which targets a reduction in maternal deaths. This study reviews methodologies used to measure maternal mortality and evaluates the quality of related data across four dimensions- completeness, accuracy, timeliness, and consistency. Methods: A narrative review was conducted using national data sources such as the National Population and Housing Census, Demographic and Health Surveys, and Maternal Mortality and Morbidity Studies. Relevant WHO and UN guidelines were reviewed to assess the extent to which Nepal’s methodologies align with global standards. Results: The Demographic and Health Surveys provides standardized maternal death information but is limited by small sample sizes, recall bias, and the absence of cause-of-death data. The national census offers comprehensive coverage and regional disaggregation, yet data accuracy is affected by cultural barriers, underreporting, and reliance on household reporting. While Demographic and Health Surveys ensures methodological consistency across survey rounds, the decennial census restricts trend analysis due to infrequent data collection. Demographic and Health Surveys produces relatively timely data, but the census suffers from delayed reporting and limited inclusion of mobile populations. Overall, both data sources contribute valuable insights but demonstrate gaps in completeness, accuracy, and timeliness. Conclusions: Strengthening Nepal’s maternal mortality data requires adopting WHO-recommended standards, integrating International Classification of Disease- Maternal Mortality classifications, enhancing statistical validation, and leveraging digital data systems. Reliable, timely, and consistent data are essential for effective maternal health planning and achieving national and global maternal mortality targets.
Epidemiological analysis of lumbar spine degenerative disease diagnosed by MRI: Level-wise and sex-based distribution in the Gandaki province population
Introduction: Degenerative diseases of lumbar spine is a significant global health concern causing low back pain and is leading contributor of disability and economic burden worldwide. Approximately 266 million people living with low back pain are suffering from lumbar degenerative disease globally and affecting 3.6% of population each year. Because of accurate non-invasive assessment of spinal degenerative diseases, Magnetic Resonance Imaging is considered to be the gold standard tool for imaging spine. This study aimed to determine the frequency of degenerative lumbar spine diseases across different spinal levels and to assess the distribution of degenerative diseases according to sex and age. Methods: A descriptive cross-sectional quantitative study was conducted with 348 participants of age group 28 to 81 years in the Radiology department of Pokhara Academy of Health Sciences in Gandaki province of Nepal. Magnetic Resonance Imaging of the participants were conducted and T1 weighted, T2 weighted, and STIR sequences were done to get sagittal, axial and coronal images of the lumbar spine. Pattern of Lumbar spine degenerative diseases were assessed. Results: The most common site of the diseases was L4/L5 and L5/S1 level. The most common disease diagnosed was disc bulge (91.09%). The degenerative diseases were found in 58.90% of the females compared to 41.1% of the males. The commonest age group to have this disease was 41 to 50 years of age. Conclusions: Women are more susceptible to the disc degenerative diseases causing lower back pain at the lower level of lumbar spine.
Awareness on cervical cancer and screening practice among married women in selected wards of Pokhara Metropolitan city
Introduction: Cervical cancer is a major public health issue in low and middle income countries like Nepal. Despite being preventable and treatable, high incidence and mortality persist due to low awareness and screening. This study aimed to assess awareness and screening practices related to cervical cancer. Methods: A descriptive cross-sectional study was conducted among 257 married women aged 30 to 60 years in Pokhara Metropolitan City using simple random sampling. Data were collected through structured face to face interviews, entered into Epi Data version 3.1, and analyzed using SPSS version 16.0. Descriptive and inferential statistics, chi square test and Pearson’s correlation coefficient were applied for analysis. Results: Among respondents, 142(55.25%) were aged 30–40 years, 123(50.20%) had secondary education, and 105(40.86%) were homemakers. Marriage between ages 15 to 19 years was reported by 140(54.47%). Adequate awareness of cervical cancer was found in 122(47.47%), and 106(41.25%) had undergone screening. Awareness was significantly associated with age, ethnicity, husband’s education, and duration of marriage. Screening practice was significantly associated with age, ethnicity, income, age at marriage, duration of marriage, and menstruation status. A weak positive correlation was observed between awareness and screening practice. Conclusions: Over half of the married women exhibited inadequate awareness and low screening uptake. Enhancing cervical cancer education and promoting screening uptake is recommended.
Post-operative retention of urine after general and spinal anesthesia in general surgical patients
Introduction: Post-operative urinary retention (POUR) is an underestimated troublesome condition following surgery in which a patient cannot urinate even when the bladder is completely filled. with consequences like bladder dysfunction, urinary tract infection, and catheter-related complications. It is important to be aware and to identify patients at risk of developing POUR. The aim of the study was to determine the incidence and risk factors of POUR in general surgery patients. Methods: We conducted a prospective cohort study among 487 patients from January 2024 to April 2025. Ethical approval was obtained from the institutional review committee. Consecutive sampling method was used. The categorical variables were presented as frequencies, and were compared using the chi-squared test. Continuous variables were compared using the student's t test. P-value of <0.05 was considered statistically significant. Results: Total 487 patients were included in the study, of which 82 patients (63 males and 19 females) developed POUR with an overall incidence of 16.83%. Mean urine output was 563.7 ml. The mean age of POUR patients was significantly higher than for non-POUR patients (52.5±15.65 years vs. 47.8±14.55 years, p=0.0087). males (p=0.004), diabetes (p=0.0016), spinal anesthesia(p<0.001) were significant risk factors for the development of POUR. Conclusions: The incidence of POUR is higher in males, elderly patients, diabetes and patients undergoing surgery under spinal anesthesia.
Comparison of post-operative complications following surgical removal of impacted mandibular third molars using rotary instruments and piezosurgery
Introduction: This surgical exodontia of mandibular third molar are often associated with a range of postoperative complications like pain, swelling, bleeding, trismus (reduced mouth opening), and in more severe cases, nerve damage and dry socket that can significantly impact a patient’s quality of life. This study was aimed to evaluate and compare the complications associated with surgical removal of impacted mandibular third molar with rotary and piezosurgery devices. Methods: The prospective comparative study was conducted among total 48 patients who required surgical removal of impacted mandibular third molars of varying depth and angulations. Patients were selected and divided alternately into two equal groups of 24 each. Group I underwent surgery with a conventional rotary instrument, while Group II was treated using a piezosurgery unit. Post-operative assessment for complications was done on Days 1, 3, and 7Continuous variables were compared using independent sample t-tests and ANCOVA, whereas, categorical variables were presented as frequencies and percentages and analyzed using Chi-square test. A p-value of less than 0.05 was considered statistically significant. Results: The comparison of pain scores revealed no significant difference between the groups on postoperative Day 1, however, patients treated with piezosurgery experienced significantly less pain on Day 3 and Day 7 compared to the rotary group. Patients in the piezosurgery group consistently showed lower values when swelling was compared and the differences were statistically significant on Days 1 and 3 (p = 0.037 and 0.041 respectively). Conclusions: The surgical removal of impacted mandibular third molars demonstrated that piezosurgery offers several post-operative advantages. Patients treated with piezosurgery experienced significantly less pain, swelling, and trismus compared to those treated with rotary instruments, particularly during the early recovery phase.
Estimation of size of sella turcica using computed tomography in patients visiting a tertiary care center in Kaski district
Introduction: Sella turcica is a saddle-shaped depression in the body of the sphenoid bone. The deformity in sella turcica size indicates an abnormality within the cranium. Thus, the objective of the study was to estimate the normal size of sella turcica in Nepalese population using computed tomography and to determine whether its’ size varies with age and sex. Methods: A cross-sectional analytical study was conducted among 250 patients visiting Department of Radiology, Gandaki Medical College from April 11 to July 12, 2024. The patients advised for computed tomography of head were enrolled in the study. The demographic data and sizes (length, anteroposterior diameter and depth) of sella turcica were recorded. Univariate analysis including frequencies and percentage for demographic data and size of sella turcica were calculated. ANOVA test was used to determine the association between size of sella turcica with age groups. Independent t-test was used to determine association of size of sella turcica with gender where p-value <0.05 was considered statistically significant. Results: The mean length, antero-posterior diameter and depth of sella turcica was found to be 10.94±6.90 mm, 12.42±2.26 mm and 7.99±1.49 mm respectively. There was statistically significant increase in length and anteroposterior diameter of sella turcica with age (p<0.05). All the dimensions of sella turcica were highest for males which was not significant. Conclusions: The mean length, antero-posterior and depth of sella turcica was 10.94 mm, 12.42 mm, and 7.99 mm respectively. Furthermore, the length and antero-posterior diameter of sella turcica increased with age while all dimensions of sella turcica didn’t vary with respect to gender.
Safety and efficacy of bipolar versus monopolar transurethral resection of the prostate in benign prostatic hyperplasia: A comparative study
Introduction: Monopolar transurethral resection of the prostate (TURP) is considered the gold standard for surgical management of be­nign prostatic hyperplasia (BPH). Recently, TURP using bipolar electrocautery is increasingly used with promising results over conventional TURP. The aim of this study was to compare the peri-operative outcomes between monopolar and bipolar TURP. Methods: In this study, patients who underwent TURP between January 2023 and June 2025 were analyzed retrospectively. The patients were divided into two groups: monopolar TURP (n=71) and bipolar TURP (n=116). The parameters including prostate volume, symptoms scores, maximum flow rate (Qmax), resection time, resected tissue weight, decrease in hemoglobin and sodium, and complications were recorded and analyzed. Results: The amount resected prostate tissue was significantly greater in bipolar TURP (19.4±9.4 vs 16.4±7.0 g, p=0.023), although the resection time was comparable between two groups. Bipolar TURP (bTURP) resulted early catheter removal (2.35±0.6 vs 2.77±1.4 days; p=0.007) and shorter hospital stay (4.28±0.6 vs 4.68±0.9 days; p=0.001) than monopolar TURP (mTURP). There was significant decrease in post-operative serum sodium concentrations in mTURP (3.14 ± 3.0 vs 1.5 ± 2.4 mEq/L, p<0.001). The improvement in symptoms, quality of life, Qmax, and complications encountered were similar in two groups. Transurethral resection (TUR) syndrome occurred in one patient in mTURP group whereas none occurred in bTURP group. Conclusions: Bipolar TURP is as effective and safe as monopolar TURP in BPH. Moreover, bipolar resection has the additional advantage of early catheter removal, shorter hospital stay, minimal electrolyte imbalance, and less post-operative morbidity.
Trends in intentional and unintentional events among paediatric patients at a tertiary care center in Gandaki Province, Nepal
Introduction: The poisoning and paediatric medicolegal cases among children have been a major cause of hospital admission and a significant global health problem, including Nepal. Unintentional event like poisoning is common among infants and younger children, whereas in older children, poisoning is usually intentional. The aim of this study was to find out the trends in the Intentional and Non-intentional events among paediatric cases admitted to a tertiary care center. Methods: The hospital records of children admitted in Paediatric Intensive Care Unit (PICU) of tertiary care center, Gandaki Province, Nepal from April 2020 to March 2024 were analysed. After ethical approval from Institutional Review Committee, hospital files of 105 patients were conveniently chosen for analysis. The data were analysed using SPSS version 25.0. Results: Among 105 admitted cases, 53(50.48%) were males and 52(49.52%) were females. The median (interquartile range-IQR) age was 4.5 years (IQR=2-12 years). Seventy-four percent of cases had unintentional events. Pesticides were the common ingestion source for both unintentional and intentional events. Interpersonal issues being the common reason (70.83%) of intentional event. The likelihood of intentional event was 11.2 times more among females than male participants (Crude odd ratio: 11.29; 95% CI: 3.10-41.01; p< 0.001). The median (interquartile range) of age for intentional event: 14(13-15) was significantly higher than unintentional event: 3(2-6), p<0.001. Conclusions: The unintentional events were common in younger children and intentional events among older children and pesticides being the most common poisoning, highlighting the need of control of availability of toxic pesticides, education regarding safety storage and mental health education for adolescence.
Radiation dose metrics for plain head, chest, and abdomen CT scans: An initiative toward establishing institutional diagnostic reference
Introduction: Computed Tomography (CT) examinations contribute to the largest portion of radiation exposure among X-ray-based medical imaging sources. The radiation output of the scanners should be monitored and optimized periodically to reduce radiation dose to the patients. This study aimed to explore the existing radiation dose metrics for plain head, chest and abdomen CT scans for creating institutional diagnostic reference levels and compare them with available national and international data. Methods: The CT parameters and dose metrics data were acquired from 226 patients of 15 years and above. The dose metrics, volume CT dose index (CTDIvol) and dose-length product (DLP) of plain head, chest and abdomen were obtained from the local picture archiving and communication system (PACS). The mean as well as the 2nd and 3rd quartile values of CTDIvol, DLP and effective dose were calculated. CTDIvol of the head is referenced to a 16 cm diameter standard phantom- polymethyl methacrylate, and 32 cm diameter for the chest and abdomen. The DLP values were applied to K-coefficients to find out the effective dose; ED = K x DLP. Results: The 2nd and 3rd quartile values for CTDIvol are 43, 8.5, and 9.25; 43,10.6 and 10.9 mGy respectively, for head, chest and abdomen. The 2nd and 3rd quartile DLP values are 821, 341, and 497.5; 864.1, 397.6 and 579.7 mGy-Cm. The institutional achievable (median) effective doses are 1.72, 4.77 and 7.46 mSv, and the institutional Diagnostic Reference Values (DRL) or 75th percentile values of effective dose are 1.81, 5.56 and 8.69 mSv for head, chest and abdomen respectively. Conclusions: The dose metrics of the plain head, chest and abdomen were reported for creating an institutional DRLs and compared to available national and international data. This study points to the need for optimization of the chest and abdomen protocol; chest protocol for relatively higher CTDIvol and DLP values and abdomen for a higher DLP value.
Functional and radiological outcome of minimally invasive percutaneous plate osteosynthesis in distal third tibia fracture
Introduction: Distal one-third tibia fractures are among the most frequent lower limb injuries, often resulting from high-velocity trauma. The morbidity associated with these fractures arises from articular involvement, soft tissue damage, and compromised vascularity. Treatment outcomes largely depend on fracture pattern, bone quality, and associated injuries. This study aimed to evaluate the functional and radiological outcomes of minimally invasive percutaneous plate osteosynthesis (MIPPO) in distal third tibia fractures. Methods: This prospective study was conducted at Gandaki Medical College, Pokhara, over 12 months, enrolling 45 patients aged 18–60 years with closed, displaced, extra-articular distal tibia fractures. Following informed consent, all patients underwent MIPPO using a distal tibia locking plate (DTLP) and were followed for six months. Functional outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score at six months, and radiological union was recorded in weeks. Results: The mean patient age was 37 years, with the highest proportion in the 20–30-year age group (n=16, 35.5%). Radiological union occurred at 12 weeks in 30 patients (66.6%) and at 24 weeks in 15 patients (33.4%). At six months, 26 patients (57.7%) scored 90–95 on the AOFAS scale, 10 (22.2%) scored 75–85, and 9 (20%) scored 50–65. Overall outcomes were excellent in 23 (53.1%), good in 13 (28.9%), fair in 4 (8.9%), and poor in 5 (11.1%). Postoperative complications were minimal, limited to superficial infections in 3 patients (6.7%). Conclusions: MIPPO provides biological advantages, minimizes complications, and significantly improves functional outcomes in distal tibia fractures.
Assessment of denture hygiene habits among the denture wearers visiting a tertiary hospital of Nepal
Introduction: Denture plaque is a dense layer of microorganism developed on surfaces of prosthesis. This plaque usually harbors various bacteria and fungus which can cause infections. For cleaning denture various cleaning regimens are used such as denture cleaners, soap. Various researchers have found that denture brushing is the most common practice among denture wearers but approximately 50% of them do not remove prosthesis overnight. The aim of our study was to assess denture hygiene practice among denture wearers. Methods: A descriptive cross- sectional study was done in Patan Academy of Health Sciences with convenience sampling in the people wearing denture. Data collection was done by face to face interview and clinical examination.These collected data was entered and analyzed in Excel to find out prevalence of denture hygiene habits. Results: Most of study participants 283(74.10%) wore interim removable partial denture. All of the study participants cleaned their denture. Of them, majority 181(47.40%) cleaned their denture once a day. Most of the study participants 330(86.40%) removed denture at night and 13.60% did not remove denture at night. 46(12%) of our study group did not remove prosthesis while brushing. Of those who removed prosthesis while brushing used soap for cleaning. Conclusions: All our study population cleaned denture, majority of them cleaned denture once a day with soap water and brush, small number of people didn’t remove the denture at night and while cleaning. This denture hygiene practice concludes the need of awareness of denture hygiene practice to denture wearer for good oral hygiene.
Agreement between cervical cancer screening methods in Nepal: A cross-sectional study
Introduction: Cervical cancer is a leading health concern in Nepal, prompting the utilization of various screening methods like visual inspection with acetic acid (VIA), human papillomavirus deoxyribonucleic acid testing (HPV DNA), and liquid-based cytology (LBC). Yet, understanding their comparative performance remains subject of research. Hence, this study aimed to assess the agreement levels among VIA, HPV DNA, and LBC. Methods: A cross-sectional survey was conducted involving 68 women aged 30 to 60 years visiting Paropakar Maternity and Women's Hospital. Each woman underwent LBC, VIA, and HPV DNA testing during their outpatient visits after receiving written informed consent and taking detailed history. Those with positive results from any test underwent cervical biopsy and managed. Data were analyzed using SPSS version 22.0 to calculate agreement percentages and kappa values, which range from -1 to 1, with 1 indicating perfect agreement. Results: The result showed 7% positivity rate for visual inspection with acetic acid, 5.9% for Human papillomavirus deoxyribonucleic acid testing, and 4.4% for liquid-based cytology. Agreement between VIA and LBC stood at 85.3%, with a low Kappa value of 0.0047, VIA and HPV DNA testing agreed at 83.8%, with a Kappa value of 0.0064. Conversely, LBC and HPV DNA testing showed higher agreement at 95.6%, with a moderate Kappa value of 0.55. Conclusions: While there is some agreement between LBC and HPV testing, the preliminary findings suggest a difference between agreement and Kappa values between VIA and LBC, as well as VIA and HPV testing, which requires confirmation in a larger, powered study.
Comparison of ondansetron and tramadol for prevention of shivering in patients undergoing lower limb surgery under spinal anesthesia
Introduction: Shivering is a common and unpleasant phenomenon in patients undergoing spinal anesthesia that leads to several complications. The purpose of this study was to compare the incidence and severity of shivering in patients who received ondansetron and tramadol preemptively for the prevention of intra-operative shivering. Methods: A prospective, observational, comparative study was conducted on 100 patients, of both genders, aged 18 to 60 years with an American Society Anesthesiology Physical Status I or II, undergoing lower limb surgeries under spinal anesthesia. Patients were randomly assigned to two study groups, ondansetron (Group ON) or tramadol (Group TM) according to the medication they received 30 minutes before spinal anesthesia. The incidence of peri-operative shivering, grades of shivering, skin temperature changes and adverse effects were observed. Results: Group TM had significantly less shivering than Group ON. In group ON, 37.5% had grade 1, 8.3% grade 2, and 4.1% grade 3 shivering. Group TM had 14.8% grade 1, with no higher-grade shivering. The difference in intensity was also significant. A significant drop in axillary temperature was observed at 75 and 90 minutes post spinal anesthesia. Complications were significantly higher in Group TM, with 25 patients experiencing nausea, vomiting, or sedation, compared to just one patient in Group ON. Conclusions: Tramadol was more effective than ondansetron in preventing intraoperative shivering, however, Ondansetron was better tolerated with lower incidence of nausea and vomiting.
Diagnostic performance of FibroScan in liver fibrosis staging in a tertiary care hospital of Nepal
Introduction: Liver fibrosis is the excessive accumulation of extracellular matrix proteins resulting from chronic liver injury caused by viral hepatitis, non-alcoholic fatty liver disease, or alcoholism. If undiagnosed, it can progress to cirrhosis, liver failure, and hepatocellular carcinoma, emphasizing the need for early detection. Although liver biopsy was once the gold standard for fibrosis assessment, it is invasive and prone to complications and sampling errors. To overcome these limitations, non-invasive imaging methods such as FibroScan have been developed. This research aimed to study the diagnostic performance of FibroScan in liver fibrosis staging in a tertiary care hospital of Nepal. Methods: A hospital-based cross-sectional study was conducted among 60 adult patients with chronic liver disease. All participants underwent liver stiffness measurement using FibroScan and liver biopsy. Fibrosis was staged according to the METAVIR scoring system. Cut-off values of ≥7.1 kPa and ≥9.5 kPa were used to define significant (≥F2) and advanced fibrosis (≥F3), respectively. Diagnostic performance metrics including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the ROC curve (AUC) were calculated. Mean liver stiffness was compared across fibrosis stages. Results: Histopathology revealed F0–F1 in 30%, F2 in 20%, F3 in 23.3%, and F4 in 26.7% of patients. For significant fibrosis (≥F2), elastography showed sensitivity 88.6%, specificity 89.2%, PPV 81.6%, NPV 93.5%, accuracy 89%, and AUC 0.93. For advanced fibrosis (≥F3), sensitivity was 90%, specificity 83.3%, PPV 84.4%, NPV 89.3%, accuracy 86.7%, and AUC 0.91. Mean liver stiffness increased significantly with fibrosis stage (F0–F1: 5.8 ± 1.2 kPa to F4: 12.5 ± 1.5 kPa; P = 0.01). Conclusions: FibroScan is a reliable non-invasive tool for detecting significant and advanced liver fibrosis, demonstrating high diagnostic accuracy and good correlation with histopathological findings.
Comparison of complications following primary and secondary wound closure after surgical extraction of impacted mandibular third molars among patients visiting a tertiary care center, Gandaki Province
Introduction: The surgical extraction of impacted mandibular third molars is often associated with post-operative complications and is affected by degree of impaction, surgical technique, operator skill and wound closure method. The purpose of this study was to compare the effect of primary and secondary wound closure after surgical removal of impacted mandibular third molars. Methods: A hospital-based cross-sectional study was conducted in 40 patients and were divided into two groups using lottery method of 20 each. Twenty patients underwent primary closure of the wound while other 20 underwent secondary closure. Post-operative pain, swelling and trismus were evaluated on third and seventh day of extraction. Results: The mean age of the patient was 31.57 years (ranging from 28 to 42). The mean VAS score for pain was more on third day in patients with primary closure (2.70±0.733). This finding was statistically significant (p<0.001). On seventh day, it was more for the patients with primary closure but was not statistically significant. The mean VAS score for swelling was more on third day in patients with primary closure (3.70±0.73). Furthermore, it was same on seventh day for both groups (0.50±0.51). Both of these findings were not statistically significant. The secondary closure group had a higher mean mouth opening than the primary closure group on third day (40.35±0.93) which was statistically significant (p<0.001). In seventh day, both groups had the same mean mouth opening (41.20±0.89) which was not statistically significant. Conclusions: The secondary wound closure technique had a significant advantage over primary wound closure concerning pain, swelling and trismus.
Predictors of Central Line Associated Blood Stream Infections (CLABSI) among patients admitted in Intensive Care Unit of a teaching hospital
Introduction: Central venous catheters (CVCs) are commonly used in critically ill patients for various indications, including hemodynamic monitoring, administration of medications, and other therapeutic interventions. Central Line Associated Blood Stream Infections (CLABSI) are serious complications of CVCs, leading to increased morbidity, mortality, and healthcare costs due to immunosuppression, prolonged catheter use, and frequent access. The study was designed to explore the predictors of CLABSI among patients admitted in intensive care units (ICU). Methods: A prospective, observational study was conducted among 112 patients with CVCs from February 2023 to January 2024, recruited through consecutive sampling, using a structured proforma. The data was analyzed using descriptive and inferential statistics. Results: A total of nine episodes in 112 patients succumbed an incidence of CLABSI of approximately 8.03%, with a rate of 10.05 per 1,000 catheter days. Age, site of port, number of catheter days, and associated co-morbidities were significantly associated with the incidence, at the level of p-value <0.05 with gram-negative organisms being the most dominant causative organisms. Conclusions: The high incidence of gram-negative organisms suggests potential challenges in infection control, antimicrobial stewardship, and patient outcomes. These results emphasize the need for rigorous surveillance, early detection, tailored antimicrobial therapy and infection control protocols in ICUs.
Role of ultrasonography in evaluation of various causes of pelvic pain in first trimester of pregnancy
Introduction: Pelvic pain in early pregnancy presents a diagnostic challenge due to overlapping physiological and pathological causes. Ultrasonography is the primary modality for prompt and accurate diagnosis. The aim of this study was to evaluate the role of ultrasonography in determining the underlying causes of pelvic pain in first trimester pregnancies. Methods: A hospital-based cross-sectional study was conducted from April 2023 to September 2024 at the Radiology Department of Gandaki Medical College, Pokhara. A total of 87 pregnant women presenting with pelvic pain in their first trimester were evaluated using abdominal ultrasonography; transvaginal scans were performed when required. Results: Among the 87 pregnant women presenting with first-trimester pelvic pain, the mean age was 28.5±6.2 years (range 20–45 years), with most participants between 20 to 29 years. Nearly one-third were primigravida, and 35(40.2%) were nulliparous. A history of pelvic surgery was reported in 18(20.7%) of cases. The most frequent cause of pelvic pain was normal pregnancy 45(51.7%), followed by ectopic pregnancy 21(24.1%), abortion 12(13.8%), blighted ovum 3(3.4%), and simple ovarian cyst (22.3%). Less common causes included acute appendicitis, dermoid cyst, fibroid uterus, and distal ureteric calculus 1(1.1% each). Conclusions: Ultrasonography is an essential first-line imaging modality in the evaluation of pelvic pain in early pregnancy. It enables accurate differentiation between viable pregnancy, pregnancy loss, and non-obstetric causes, guiding timely management and improving maternal outcomes.
Glycemic control among type 2 diabetes mellitus patients visiting the Emergency department of Gandaki Medical College: A cross-sectional study
Introduction: Diabetes mellitus (DM) is a metabolic disorder which is characterized by increased blood glucose level. Glycated hemoglobin (HbA1c) is the most reliable indicator of long-term glycemic control as it accurately reflects an individual’s blood glucose levels during the preceding 2 to 3 months. Elevated level of HbA1c has been identified as a significant risk factor for other diseases such as cardiovascular diseases, stroke. This study aimed to evaluate the glycemic control in type 2 DM. Methods: After obtaining an ethical clearance, patients with Type 2 DM, confirmed according to American diabetes association criteria, who attended to the Gandaki Medical College Emergency Department were enrolled in this study. Results: Out of 117 patients, prevalence of poor glycemic control was 24.80% followed by inadequate control was 37.60% and fair control was 21.40%. HbA1c level did not show statistical significance with other risk factor. Conclusions: In this study, hypertension, COPD, hyperthyroidism and hypothyroidism were found as comorbidity in (53.0%) each of diabetes patients.
A study of PALM-COEIN classification of abnormal uterine bleeding in perimenopausal women: An observational cross-sectional study
Introduction: Abnormal Uterine Bleeding (AUB) is a common gynaecological issue affecting a large number of women of reproductive age group, especially during perimenopause. The International Federation of Gynaecology and Obstetrics (FIGO) developed a new classification system, PALM-COEIN, to standardize the terminology, diagnosis, and investigations of the causes of AUB. Therefore, this study aimed to investigate the structural (PALM) and functional (COEIN) component of the PALM-COEIN system in perimenopausal women complaining of AUB. Methods: This observational cross-sectional study was done at Gandaki Medical College, Pokhara among 100 perimenopausal women (aged 40 years and above till 1 year beyond menopause) admitted with complaints of AUB. After thorough history and examination, a clinical diagnosis was made as per PALM– COEIN classification. Analysis was done on the relative contributions of the different causes of the PALM and COEIN components. Then, endometrial sampling and hysterectomy specimen was assessed by histopathology. Results: A total of 100 women of perimenopausal age groups were studied. PALM and COEIN groups accounted for 72% and 28% respectively. Leiomyoma was the commonest cause of AUB (39%) followed by polyp (22%). Majority of the women (58%) were between 40-44 years of age, 89% were multiparous women. Overweight women (BMI of 25 to 29.99) were 47%. Proliferative endometrium (37.14%) was the most common histopathological finding, followed by secretory endometrium (22.85%). Conclusions: In perimenopausal women with abnormal uterine bleeding, leiomyoma was the most common structural cause, and proliferative endometrium was the most common non-structural cause. None of the cases were found to have malignancy or coagulopathy
Role of multidetector CT Urography in patients with hematuria
Introduction: With the advancement in imaging abilities like thin slicing, volume rendering and 3D reconstruction, multidetector CT urography has been a preferred over other imaging modalities for the comprehensive assessment of kidney, ureter and bladder. Hematuria is one of the commonly encountered complaints of patients in hospital. The aim of our study was to evaluate the role of Multidetector computer tomographic urography in hematuria and guiding the clinician to find cause and manage it. Methods: A hospital based prospective cross-sectional study conducted among 228 patients in the duration of one year who presented with either gross or microscopic hematuria and fulfilled the inclusion criteria. Data collected were analyzed using Statistical Package for Social Sciences version 26.0. Results: Patients commonly presented with gross hematuria 148(64.9%). Most common cause of hematuria as per our study was urolithiasis, 103 patients. Calculus predominantly involved kidney 66(64%) or kidney and ureter 14(13.5%). Hydronephrosis was seen in 87(38.2%) of patients and hydroureter in 37(15.4%) of patients. Normal excretion was observed in 202(88.6%) patients whereas delayed excretion and non-excretion was seen in 13(5.7%). Infection/inflammatory conditions occurred in 34(14.9%) patients, pyelonephritis 17(50%) and cystitis 11(32.3%) being the common occurrences. Most common benign mass occurred in kidney, 65% of all renal masses. Bladder mass was found to be malignant in 80% of the detected bladder masses. Out of five detected adnexal masses, 3(60%) was found to have benign characteristics. Incidental findings included spectrum of diseases and disorders that included anatomical variants, lesions in other sites and congenital defects. Conclusions: With the findings from our study, we can conclude that MDCT Urography is found to be highly accurate in detecting the causes of hematuria and guide in timely management. It is also useful in detection of other underlying conditions with the incidental findings.