Published by the Research and Publication Unit of Nobel Medical College, Biratnagar. Full text articles available. JoNMC is also available on its own website. The journal is now accepting online submissions. For information on the process click here. JoNMC is indexed in DOAJ, Index Copernicus and OASPA.
Research and Publication Unit of Nobel Medical College
JoNMC applies the Creative Commons Attribution (CC BY) license to works we publish. Under this license, authors retain ownership of the copyright for their content, but they allow anyone to download, reuse, reprint, modify, distribute and/or copy the content as long as the original authors and source are cited.
Quality Of Life among Pregnant Women in a Tertiary Care Hospital
Background: Pregnancy brings hormonal, metabolic, and emotional changes that can significantly influence a woman’s quality of life. This study aimed to assess Quality of life among pregnant women. Materials and Methods: A descriptive cross-sectional study was conducted at the ANC OPD of Nobel Medical College Teaching Hospital, Biratnagar, from November 2024 to March 2025. A total of 184 pregnant women were selected through convenience sampling. Data were collected via face-to-face interviews using the RAND SF-36 questionnaire. Descriptive statistics (frequency, percentage, median, interquartile range) and inferential statistics (Mann-Whitney U test) were used for analysis. Results: The median QoL score was 67 (IQR: 62–74), with scores of 60 (51–67) for the physical component and 75 (70–82) for the mental component. The highest domain score was in emotional role limitation 100 (66.7–100), while the lowest was in physical role limitation 25 (0–50). Significant differences were noted in the Emotional Role Limitation domain based on the age group (p=0.006) and educational status (p=0.043). Similarly, general Health domain demonstrated a significant difference in terms of religious groups (p=0.024). Likewise, significant differences were observed between occupation in the domain of Energy/Fatigue (p=0.015), Emotional Wellbeing (p=0.002), and General Health (p=0.003). Also, significant difference in pain domain was found between nulliparous and parous women. Conclusion: Based on the findings of the study, it can be concluded that mental health component scored higher than the physical health component. Among all domains, the highest score was observed in emotional role limitation while the lowest was in physical role limitation.
Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
Clinical Spectrum of Cutaneous Malignancies in Nepal: A Retrospective Cross-Sectional Study at Dhulikhel Hospital
Background: Skin cancer epidemiology varies by geography and ethnicity. While basal cell carcinoma predominates globally, squamous cell carcinoma may be more common in high-ultraviolet (UV) regions with darker-skinned populations. Materials and Methods: A 5-year retrospective cross-sectional study (2019-2023) of histologically confirmed skin cancers at Dhulikhel Hospital, Nepal. Data on demographics, histology, tumor sites, and risk factors were analyzed. Pearson correlation assessed the sun exposure association. Results: A total of 140 patients were included. The mean age was 60.04 ± 18.04 years, with 57.1% aged over 60. Males comprised 55% and women 45% (M:F ratio = 1.2:1). Squamous cell carcinoma was the most common skin cancer (52.9%), followed by basal cell carcinoma (42.1%) and melanoma (5%). The head and neck was the most frequently affected site. A history of prolonged sun exposure was present in 75.7% of patients, and a statistically significant correlation was found between sun exposure and skin cancer (Pearson correlation = 0.191, p = 0.024). Six patients had xerodermapigmentosum. Conclusion: Squamous cell carcinoma predominates in Dhulikhel Hospital, Kavre, contrasting global Basal cell carcinoma (BCC) trends. Elderly males with high sun exposure are most affected, highlighting ultraviolet(UV) radiation's role.
Effectiveness of Lecture and Vaccination Centre Visit for Teaching Basics of Immunisation and Cold Chain to Students of Traditional Medicine in Kolkata: A Quasi-Experimental Study
Background: Immunization and cold chain management are integral to public health. Though traditional medicine curriculum includes these topics, students often lack practical exposure. This study evaluates the impact of lecture combined with vaccination center visit on knowledge of immunization and cold chain management among these students. Materials and Methods: A longitudinal, quasi-experimental study was conducted on traditional medicine students visiting the tertiary care hospital in Kolkata from June to December 2024. The intervention includedtwo-hour lecture followed by two-hour vaccination center visit. Knowledge assessments were conducted pre-intervention, post-intervention, and after one-month using a 20-item e-questionnaire on Vaccination &Adverse Event Following Immunisation, Cold Chain and Biomedical Waste Management.Comparisons between pre-test, post-test, and post-1-month test scores were conducted using Friedman test. Results: Among the 80 participantscompleting the study, median scores across all domains improved significantly (Friedman test p <0.001). Vaccines &Adverse Event Following Immunisation scores increased from a median of 0 in the pre-test to 9 in the post-test, with a slight decline to 7.5 after 1-month. Cold Chain scores rose from 2 to 5 and remained stable (post-test vs post-1-month test p 0.386). Biomedical Waste Management scores improved from 1 to 4.5 in the post-test, decreasing marginally to 4 after one month. Total scores showed a remarkable rise from a median of 4 to 17, with slight decline to 15 after a month. Conclusion: Experiential learning combined with lectures enhances knowledge retention among traditional medicine students, highlighting the need for integration of practical training in the curriculum.
Pregnancy Complications and Fetal Outcomes in Obese Pregnant Women in a Tertiary Care Center in Eastern Nepal
Background: Weight gain in pregnancy is normal, but obesity prior to pregnancy may be associated with increased risk of pregnancy and neonatal complications. Materials and Methods: This comparativecross sectional study was conducted in Birat Medical College Teaching Hospital from 2024 August 15 to 2025 May 15, over the period of 9 months. Three hundreds and thirty participants were enrolled in the study, 165 women with Body Mass Index (BMI) 30 as study group and 165 women with normal BMI as reference group. Obstetric and neonatal outcomes were compared between the two groups using student’s t test and Chi-square test. Results: The mean BMI was 32.5±2.56 kg/m2 in study group and 23.20±1.5 kg/m2 in reference or normal weight group. The incidence of Gestational diabetes mellitus (GDM) was 16.97% vs 6.66%(RR2.54,95% CI1.62-3.20, p=0.02), hypertensive disease in pregnancy (HDP) was 21.21% vs 8.48%, (RR 2.5, 95% CI 1.84-2.60, p=0.01) and caesarean section rate was 56.96% vs 30.30% (RR 1.88, 95% CI 1.52-2.70) in study group and reference group respectively. Neonatal admission rate was 23.03% in obese group and 16.36% in normal weight group. Incidence of neonatal death was similar in both groups. Conclusion: Obese pregnant women have higher risk of pregnancy and neonatal complications when compared with normal BMI women.
Comparison of Conventional Alkaline Nasal Douching with Budesonide Nasal Irrigation on Post Endoscopic Sinus Surgery Patients
Background: Postoperative care after endoscopic sinus surgery for chronic rhinosinusitis plays a vital role in enhancing mucosal healing and preventing recurrence. This study aimed to compare the effectiveness of conventional alkaline nasal douching with budesonide nasal irrigation in patients undergone endoscopic sinus surgery. Materials and Methods: This prospective comparative study was conducted at the Department of Ear, Nose and Throat and Head and Neck Surgery at the Manipal Teaching Hospital. A total of 80 patients with chronic rhinosinusitis with or without nasal polyps who underwent ESS were randomly assigned into two groups: Group A (alkaline nasal douche) and Group B (budesonide nasal irrigation) following same regimen of antibiotics, nasal steroids, analgesics and antihistamines. Data were collected from the outpatient department at the time of follow-up on 2, 6, and 10 weeks postoperatively as per the endoscopic Lund-Kennedy scoring system. Results: Budesonide nasal irrigation was significantly more effective in reducing postoperative nasal polyps, edema and scarring as compared to the alkaline nasal irrigation group, particularly at 6 and 10 weeks (p<0.0001). While both groups showed improvements over time, budesonide nasal irrigation demonstrated superior overall outcomes in mucosal healing and endoscopic scores. Conclusion: Budesonide nasal irrigation provides significantly better postoperative results in endoscopic sinus surgery patients with chronic rhinosinusitis compared to conventional alkaline nasal douching. It is more effective alternative for improving patient outcomes post-surgery.
Focused Computed Tomography for the Evaluation of Suspected Appendicitis
Background: A focused computed tomography scan serves as a critical diagnostic modality for acute appendicitis, particularly in instances where clinical findings are equivocal or ultrasound results lack clarity. This study was carried out to assess the diagnostic accuracy of Focused Appendiceal Computed Tomography as a viable alternative to the conventional Computed Tomography of the abdomen and pelvis in patients suspected of having acute appendicitis. Materials and Methods: Prospective cross sectional study of 100 adults were performed with suspected acute appendicitis. Each patient underwent a Computed Tomography of the abdomen and pelvis with both oral and intravenous contrast. A subset of axial images, ranging from the top of the L4 vertebral body to the roof of the acetabula, was extracted from each scan to create the Focused Appendiceal Computed Tomography. After reviewing the focused Appendiceal Computed Tomography images, the conventionalComputed Tomography of the abdomen and pelvis scans were also evaluated, with each patient serving as their own control. The images were analyzed to determine their ability to identify the appendix, diagnose appendicitis, or detect alternative conditions that could explain the presenting symptoms. Results: Out of 100 cases, the appendix was visible in the Focused Appendiceal Computed Tomography scans of 92 patients. In 8 cases, the appendix could not be visualized in either the focused or standard Computed Tomography of the abdomen and pelvis scans.Out of the 100 cases scanned,63 cases were abnormal and 37 cases were normal. Among 63 abnormal cases, Focused Appendiceal Computed Tomography identified 42 cases of acute appendicitis, which was consistent with the findings from the standard Computed Tomography of the abdomen and pelvis. Additionally, 21 patients were found to have alternative diagnoses. Conclusion: In this study Focused Appendiceal Computed Tomography provided identical diagnostic results. There is no difference in performance between Focused Appendiceal Computed Tomography and Conventional Computed Tomography of abdomen and pelvis in diagnosing of acute appendicitis in this study.
Histological Spectrum of Skin Diseases in Tertiary Care Center of Eastern Nepal
Background: Skin diseases are common in developing countries, with their patterns differing significantly across nations and even within various regions of the same country. Histological diagnosis serves as an essential tool for clinicians, guiding accurate patient management and enabling the selection of the most effective clinical interventions. Materials and Methods: This retrospective descriptive study was conducted at the Department of Dermatology, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal, to evaluate the histological spectrum of skin diseases over one year (March 2022–February 2023) after approval of institutional review comitteeof Nobel Medical College and Teaching Hospital . A total of 200 skin biopsy samples were analyzed using hematoxylin and eosin staining, with special stains used as necessary. Results: The majority of patients were male (63.5%) with a mean age of 39.13 years. The most commonly used biopsy technique was punch biopsy (48%), and the lower limb was the most frequent biopsy site (36.5%). Non-neoplastic lesions were predominant (84.5%), with infectious dermatoses—primarily Hansen’s disease—being the most common (47.5%). Papulosquamous disorders, eczema, immunobullous diseases, and connective tissue disorders each accounted for 6.5–13% of non-neoplastic cases. Neoplastic conditions comprised 15.5% of cases, with basal cell carcinoma being the most frequent tumor. Conclusion: Non-neoplastic lesions, particularly infectious dermatoses such as Hansen’s disease, were predominant, accounting for the majority of cases. Other non-neoplastic conditions, including papulosquamous disorders, eczema, and immunobullous diseases, were less frequent but still significant. Neoplastic conditions, primarily basal cell carcinoma, comprised a smaller proportion of the total cases.
Minimally Invasive Percutaneous Nephrolithotomy for Staghorn Calculus – A Single-Center Study
Background: Staghorn calculi, either partial or complete, present a significant urological challenge. Mini-percutaneous nephrolithotomy (mPCNL) has become a less invasive alternative to standard PCNL (sPCNL). This study evaluates the efficacy and safety of mPCNL in treating staghorn calculi. Materials and Methods: A retrospective observational study was conducted on 26 patients at Nobel Medical College Teaching Hospital for one year. Outcomes included stone-free rate (SFR), operative time, complications, and recovery. Results: The SFR was 84.6% (22/26), with failed cases associated with larger stones (mean 42.5 ± 3.2 mm) and higher Guy’s Scores. Mean operative time was 61.2 ± 12.4 minutes, increasing with stone size (p < 0.001). Complication rates were low, supporting mPCNL’s safety. Conclusion: mPCNL is effective for moderate-sized staghorn stones, offering high stone clearance with minimal morbidity
Clinical Patterns and Outcome of Acute Poisoning Cases at a Tertiary Care Hospital in Eastern Nepal
Background: Acute Poisoning is a major health problem with significant morbidity and mortality affecting people of all age groups. The objective of the present study was to find out the clinical features, epidemiological profile, pre-hospital treatment practice and the role of triage variables as severity and outcome indicators. Materials and Methods: All emergency patients with acute oral poisoning were included. Data on triage, demographics, clinical features, poison characteristics, and pre-hospital treatment were recorded using a semi-standardized Proforma. Primary outcomes were mortality and survival; secondary outcomes included admission details and complications. Results: Adult poisoning comprised 3.3% of Emergency admissions, mainly affecting young adults (21–30 years, 33.4%) with a female predominance (62.9%). Most were married (67.6%), educated up to secondary level (62.4%), and were housewives (42.5%) or students (30.3%) from nearby districts. Intentional suicides (92.2%), primarily with organophosphates (30.3%) and rat killers (20.1%), predominated. Over 59.7% arrived within 4 hours, mostly at night (69.6%). Gastrointestinal symptoms (81.1%) were common, with Glasgow Coma Scale of 13–15 in 80.8%. Antidotes were given in 31.6%, intubation in 9%, and complications in 17.5%. Mortality was 6.3%, while 78.4% survived; fatalities had lower Blood Pressure, oxygen saturation, and consciousness. Conclusion: Poisoning is common with agricultural products with housewives and students forming the majority. Young age is commonly involved. Suicidal act at home presenting with gastro- intestinal symptoms visiting at night is common.
Prevalence and Pattern of Medical Comorbidities in New Tuberculosis Patients in Nepal: A Cross-Sectional Study
Background: Tuberculosis (TB) remains a major public health challenge in Nepal. Medical comorbidities can adversely impact the outcomes of TB treatment. This study aims to assess the prevalence and pattern of major medical comorbidities among newly diagnosed TB patients in Nepal. Materials and Methods: This cross-sectional study was conducted from March 2023 to April 2025 at Tribhuvan University Teaching Hospital, Nepal. Adults aged ≥18 years with newly diagnosed TB were enrolled. Patients with incomplete data, prior TB treatment, or pregnancy were excluded. Data on demographic features, smoking history, anemia status, and comorbidities, including diabetes mellitus, chronic liver disease, chronic kidney disease, ischemic heart disease, hypothyroidism, and COPD, were collected. Statistical analysis was performed using SPSS v. 25. Results: Among 140 TB patients (mean age: 48.56 years; 69% male), 80 (57%) had pulmonary TB and 60 (43%) had extrapulmonary TB. A total of 72.1% were anemic. Comorbidities were found in 40 patients: COPD (10.7%), CKD (9.3%), hypothyroidism (5.7%), CLD (3.6%), and IHD (1.4%). Comorbidities were more common in patients aged >60 years and in males. Bagmati Province had the highest proportion of cases (47.9%) and comorbidities. Conclusion: A high burden of comorbidities exists among patients diagnosed with tuberculosis in Nepal. Early detection and integrated management of these conditions are essential for optimizing TB care.
Anxiety and Depression among Undergraduate Medical Students: A Cross Sectional Study
Background: Anxiety and depression are prevalent mental health illness that can affect anyone but most common seen in the medical students. This study finds the prevalence and associated risk factor of anxiety and depression among the medical students. Materials and Methods: A cross section descriptive study conducted among the 187 medical students of first and third year bachelor of medicine and bachelor of surgery enrolled in Nobel Medical College Teaching Hospital using Beck anxiety and depression inventory with questionnaire. Whole sampling was done and study conducted between May and June 2025. Results: Prevalence of anxiety and depression was 29.6% (55) and 58.8% (110) respectively. The prevalence of anxiety in male was 12.9% (12) and depression 53.8% (50). Similarly, the prevalence of anxiety in female was 45.7% (43) and depression 63.8% (60) respectively. Conclusion: This study finds the prevalence of anxiety and depression among the medical students who study bachelor of medicine and bachelor of surgery. The prevalence of anxiety and depression were more in female, those students with insufficient pocket money and substance abuse.
Burden and its Determinants among Caregivers of Patients undergoing Hemodialysis
Background: Chronic kidney disease affects more than ten percent of general population worldwide. Patients with end-stage renal disease require lifelong renal replacement which affects patient’s functioning leading to disruption of conventional lives of both patients and caregivers.The objective of this study was to identify the level of caregiver burden and to identify its determinants. Materials and Methods: A cross-sectional study was conducted in the dialysis unit of Nobel Medical College Teaching Hospital, Biratnagar from November 2024 to January 2025 following ethical approval. A total of 170 respondents were selected through convenience sampling. Data were collected via face-to-face interviews using a structured questionnaire, including sociodemographic details and Zarit Burden Scale. Statistical analysis was performed using SPSS, with ordinal logistic regression used to identify determinants of caregiver burden. Results: Present study showed that majority of the respondents (72.4%) experienced mild to moderate burden, less than two-fifths (15.3%) experienced moderate to severe burden, few of the respondents(9.4%) experienced little or no burden and only2.9%experienced severe burden. Marital status, habit of alcoholism, smoking or substance use, patient’s sex, duration of dialysis, availability of caregiving support and difficulty in meeting health expenses were identified as key determinants of caregiver burden. (p<0.05). Conclusion: This study showed that majority of the caregivers experienced mild to moderate burden. Marital status, habit of alcoholism, smoking or substance use, patient’s sex, duration of dialysis, availability of caregiving support, and difficulty in meeting health expenses were identified as key determinants of caregiver burden.
Prevalence and Occupational Risk Factors of Neck Pain among Desk Based Office Workers
Background: Neck pain is a common work-related musculoskeletal disorder, especially for individuals with sedentary office jobs involving repetitive tasks. Poor posture and ergonomic issues increase stress on the cervical spine and muscles, impacting physical health, raising absenteeism, and reducing productivity. This study aims to investigate the prevalence, risk factors and consequences of neck pain in office workers. Materials and Methods: A cross-sectional survey of 179 participants from two organizations in Biratnagar, Nepal (98 from NMCTH and 81 from NTC) used self-administered questionnaires and convenient sampling to collect data. Results: Working more than 8 hours per day significantly increased the prevalence of neck pain to 78.9%, compared to 61.5% in those working 8 hours or less (p=0.030). Prolonged posture was reported by 74.5% of participants with neck pain, which significantly disrupted daily activities (100%), household chores (94.7%), and outdoor activities (100%) (p<0.001). Conclusion: Neck pain is very common among office workers in Biratnagar, mainly due to long work hours, heavy computer use, and poor posture. These factors seriously affect daily life and work performance. Improving workplace ergonomics and encouraging regular movement are key to reducing this problem.
Clinical Profile of Patients with Chronic Liver Disease
Background: Chronic liver disease is a major problem worldwide. Understanding the demographics, clinical profile, and staging of the condition helps in forming a better management plan for the disease and which reflects the outcomes as well. Materials and Methods: Three hundred and eighty patients with chronic liver disease were prospectively studied at the Department of Hepatology in Nobel Medical college, which is a tertiary care hospital of eastern Nepal, from September 2023 to March 2024. Clinical characteristics, endoscopy results and lab reports were studied. Statistical Package for the Social Sciences (SPSS) version was used for the analysis. Results: Mean age was 48.3±11.1 years with 73 % males. The maximum number of patients [112 (29.5%)] belonged to the age group 45-54 years old. The aetiology of Chronic liver disease was alcohol-related in 81 %. Chronic Hepatitis B virus and Hepatitis C virus-related liver disease was found in 11.6% & 2.6 % of patients. Eighty-six percent had esophageal varices. There were 11.8% patients with MELD score <10, 35.5% with MELD score 10-15, and 52.6% with MELD score >15. Based on the Child-Pugh score, 15.5% of patients were in CPC-A, 38.4% were in CPC-B, and 46.1% were in CPC-C at presentation. Conclusion: Alcohol-related liver disease is the most common cause of Chronic liver disease in Nepal, followed by Chronic Hepatitis B and Hepatitis C virus-related liver disease. Most patients present in their advanced stages, as reflected by esophageal varices and high MELD & Child Pugh scores.
Cardiac Function Outcomes Following Mitral Valve Replacement: A Comparative Analysis of Different Surgical Techniques Based on Our Experiences
Background: Mitral valve replacement is an essential treatment for mitral valve disease. Preserving both anterior mitral leaflet and posterior mitral leaflet during mitral valve replacement can yield good resultsin terms of left ventricular fraction. The study aims to examine whether retaining both leaflets is more advantageous compared to preserving none or only the posterior leaflet, particularly concerning left ventricular function. Materials and Methods: This retrospective study includes 77cases of mitral valve replacement performed over three years in the Nobel Medical College and Teaching Hospital. Demographics, co-morbidities, preoperative, perioperative and postoperative outcomes in terms of left ventricle ejection fraction were noted in pre-structured questionnaires. The ethical clearance was taken from the Institute Review Committee, Nobel Medical College and Teaching Hospital. Results: The study categorized patients into three groups based on their surgical techniques: Posterior mitral leaflet preservation (group I), both leaflet excision (group II),and both leaflet preservation (group III).The mean age of the patients was 43.56 years, with 62.3% being female and 55.8% having thyroid disorder. Atrial fibrillation being most common arrhythmia involving 52 (66.67%). Marked difference in preoperative and postoperative ejection fraction, group I 48.9 ± 7 to 51.9 ± 5.7 (Z= -3.405, p=0.001), group II 53.9 ± 6 to 39.2 ± 6.6 (Z= -3.405, p=0.001) and group III 47 ± 6.9 to 47.1 ± 9.5; t (16) = 0.26, p=0.798respectively. There was significant clinical improvement in New York HeartAssociation functional class. Conclusion: This study shows that patients with leaflet preservation technique had good results in terms of improvement in New York Heart Association class, left ventricular ejection fraction and reduction in left ventricle dimensions.
Spectrum of Lower Gastrointestinal Disease on Colonoscopy and Histopathological Examination in a Tertiary Care Centre in Biratnagar
Background: Colonoscopy is a key diagnostic tool for assessing lower gastrointestinal disorders. Understanding its indications, disease patterns, and histopathological findings is crucial for improving patient care. This study aimed to investigate the common indications for colonoscopy, gastrointestinal disease patterns, and histopathological results. The primary objectives were to determine common colonoscopy indications, understand gastrointestinal disease patterns, and analyse histopathological findings. Materials and Methods: This is a prospective, cross-sectional study conducted at Birat Medical College and Teaching Hospital, Biratnagar, over the period of three months. Patients under 15years of age, with incomplete procedures, or lacking histopathology reports despite undergoing tissue sampling, pregnant women were excluded. Standardized bowel preparation with 4L polyethylene glycol was used. Data collected included demographics, clinical indications, colonoscopic findings, and biopsy results. Results: A total of 341 patients (mean age 46.7 ± 15.7 years) were included. Common indicationswere blood-mixed stools (33.4%), altered bowel habits (27%), and abdominal pain (23.2%). Findings showed normal results in 45.2%, polyps in 16.1%, and inflammatory bowel disease (IBD) in 10%. Histopathological analysis revealed polyps (35%), IBD (20.4%), and malignancy (13.4%). Conclusion: Colorectal cancer was most common in patients with per-rectal bleeding, while polyps were prevalent in those with altered bowel habits. Blood-mixed stools, altered bowel habits, and abdominal pain are the leading indications for colonoscopy. Polyps and IBD were most commonfindings, with malignancy notable in per-rectal bleeding cases.
Maternal and Perinatal Outcome in Twin Pregnancy
Background: The incidence of twin pregnancy has significantly risen over past decade along with the use of various assisted reproductive technologies. Twin pregnancy is associated with increased maternal and perinatal complications and is a high-risk pregnancy which necessitates close supervision of both mother and fetuses during antenatal period. This study aims to evaluate maternal and perinatal outcome of twin pregnancy. Materials and Methods: This was the observational cross-sectional study conducted in 130 pregnant women with twin pregnancy ≥28weeks gestation in Department of Obstetrics and Gynecology from 24 March 2024 to 24 March 2025 at Nobel Medical College Teaching Hospital, Biratnagar, Nepal. Data were collected defining various maternal and neonatal characteristics and outcomes were evaluated in terms of maternal complications and obstetric outcome and statistical analysis was performed for comparison of perinatal outcomes between twins. Results: Out of total 7006 births during this period, 130 were twin pregnancies and 2were triplets. The incidence of twins was 1.85%. The most common maternal complications observed was preterm labor (44.6%) followed by PROM (16.1%), hypothyroidism (13%), pregnancy induced hypertension (13%), anemia (8.4%), and PPH (8.4%). The most common mode of delivery was cesarean section in 91 females. Among the fetal complications low birth weight was seen as the most common complication in both twins. In first twin, low birth weight, respiratory distress, neonatal sepsis, and NICU admission were seen in 83.8%, 22.3%, 13.8% and 18.4% respectively and was higher than second twin. Similarly, intrauterine fetal demise and low Apgar score at 5 min was 3.8% and 18.4% in second twin and was higher than the first one. Perinatal mortality was similar in both twins. Prolonged NICU stay was seen in second twin. Conclusion: Preterm labor was the most common maternal complication while Low Birth Weight as a sequelae of prematurity was most common complication of both twins. RDS and sepsis was higher in first twin while low APGAR @ 5 min was higher in second twin. Considering high risk pregnancy, special care for mothers with twin pregnancies is necessary to mitigate adverse pregnancy outcomes.
A Clinical Study on Chronic Subdural Hematoma and its Surgical Management at a Tertiary Care Hospital in the Eastern Part of Nepal
Background: Chronic subdural hematoma is a common neurosurgical condition, particularly in elderly patients, often associated with minor head trauma and requiring surgical intervention. This study aims to analyse the demographic patterns, clinical presentation, management, complications, and outcomes. Materials and Methods: A retrospective study was conducted on 51 patients who underwent surgical treatment for chronic subdural hematoma. Demographic details, clinical presentation, history of trauma, associated comorbidities, radiological findings, surgical techniques, intraoperative findings, complications, and outcomes were collected and analyzed. Results: In the present study, a total of 51 cases were analyzed for the study. There was male predominance (82.35%) in the study with male-to-female ratio of 5:1. The age of study population ranged from 25 to 88 years, with a median of 54 years (±16.52 SD). Headache was the most common symptom (51%). A history of head trauma within eight weeks was reported in 94.1% of cases. The most common comorbidities were diabetes mellitus (23%). Radiological assessment revealed right-sided hematomas in 56.9% of cases, with 41.2% exhibiting a midline shift greater than 10 mm. Single burr hole drainage was the most performed procedure (78.4%), followed by two burr hole drainage (13.7%), mini craniotomy (5.9%), and decompressive hemicraniectomy (2%). The overall complication rate was low, with recurrence occurring in 3.9% of cases. The functional outcomes were favourable, with 92.2% achieving good recovery at discharge. Conclusion: Chronic subdural hematoma predominantly affects elderly males and is strongly associated with prior head trauma. Burr hole drainage remains the preferred surgical technique.
Disability and Quality Of Life among the Psychiatric Patients: A Cross-Sectional Hospital Based Study in Nepal
Background: To study disability and quality of life within the psychiatric patients presenting to the Psychiatric out-patient unit at a University Hospital. Materials and Methods: It is a hospital based cross sectional study among the patient age group 18-65 years who presented to out-patient unit in Department of Psychiatry in a period of one year after ethical clearance from the institute. Participants were assessed by both validated Nepali versions tools: Disability assessment scale, World Health Organization Disability Assessment Schedule and World Health Organization Quality of Life 8-question scale (N=700). A structured questionnaire was used by the researchers that included personal and demographic characteristics and illness related parameters. The relationships between the variables, Disability, and quality of life were analyzed using independent sample t-tests. Results: Among 700 individuals presenting to the Psychiatric out-patient department and the disorders being categorized into 5 groups (Depressive disorders, Anxiety disorders, Somatoform disorders, Psychotic spectrum disorders, and Others), Anxiety disorders are the most common (49.6%) of cases to be diagnosed. Disability scores show a statistically significant difference (p=0.00), with females having higher disability scores than males. Individuals earning above five lakhs have significantly higher quality of life scores (p=0.00), suggesting a strong association between income and overall well-being. Conclusion: Gender and income show statistically significant relationships with quality of life and disability, whereas other factors exhibit minor variations without strong significance.
Rheumatoid Arthritis Related Interstitial Lung Disease: Patterns in High-Resolution Computed Tomography
Background: Rheumatoid arthritis is a systemic inflammatory disease with extra-articular manifestations, among which interstitial lung disease is one of the most severe, contributing significantly to morbidity and mortality. Early detection of RA-associated ILD is critical, and high-resolution computed tomography has emerged as a highly sensitive diagnostic tool. Materials and Methods: A retrospective, cross-sectional analytical study was conducted at the Department of Radiology, Patan Academy of Health Sciences, from June 2021 to June 2024. High Resolution Computed Topography (HRCT) scans of 400 patients diagnosed with Rheumatoid Arthritis were reviewed for interstitial lung abnormalities. Patterns were analyzed based on lung zones and laterality. Results: Pulmonary abnormalities suggestive of Rheumatoid Arthritis - Interstitial Lung Disease were present in 78% of the patients. The most frequent High Resolution Computed Topography (HRCT) findings were ground glass opacities (39.1%), honeycombing (19.9%), traction bronchiectasis (16.6%), and parenchymal bands (14.8%). UIP (43.75%) and NSIP (30.25%) were the predominant diagnostic patterns. Right lung and lower zone involvement were more common. Nodules, tree-in-bud appearance, and crazy-paving were notably absent. Conclusion: The study found a high prevalence of interstitial lung disease (ILD) among rheumatoid arthritis (RA) patients, with usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP) as the dominant High Resolution Computed Topography (HRCT) patterns. Ground glass opacities and fibrotic changes, especially in the lower lung zones, were the most common radiologic features. Routine High Resolution Computed Topography screening in Rheumatoid Arthritis patients can facilitate early diagnosis of Interstitial Lung Disease and improve clinical outcomes, particularly in resource-limited settings.
Effectiveness of Video Assisted Teaching on Knowledge and Practice Regarding Burping Technique of Newborn among Primi Postnatal Mothers
Background: Burping is the release of gas from the upper digestive tract (esophagus and stomach) through the mouth. Burping baby is a key part of baby’s feeding routine. When baby swallows, air bubbles can become trapped in the stomach and cause discomfort. Burping allows baby to remove some of that gassiness to relieve the pain. It also helps prevent spitting up and provides the comfort. The objective of the study was to assess the effect of video assisted teaching on knowledge and practice regarding burping technique of newborn among primi-postnatal mothers. Materials and Methods: The study was conducted by adopting a pre-experimental design among 51 primi-postnatal mother of post-natal ward, neonatal ward and MCH Ward. Primi-postnatal mothers who fulfilled the inclusive criteria were selected by purposive sampling. A semi-structured interview questionnaire was used to assess the level of knowledge and practice. The tool was explained in detail and the pre-test was conducted. Video-assisted teaching on burping technique was conducted for the primi postnatal mothers and then the post-test was conducted after the 2 weeks of pre-test with the help of same semi structured interview questionnaire. Results: The findings of the study revealed that the overall mean improvement showed both knowledge and practice. A paired t-value of knowledge 11.01, which was statistically significant at (P < 0.001) level and similarly a paired t-test value of practice was 13.13, which was statistically significant at (P <0.001) level and hence both indicates effectiveness of video assisted teaching. Conclusion: The findings suggest that Video-Assisted Teaching is effective in increasing the knowledge and practice of mothers regarding burping technique.
A Rare Presentation of Myeloid Sarcoma as Supraclavicular Mass: A Case Report in Chronic Myeloid Leukemia
Myeloblasts or immature myeloid cells form myeloid sarcoma, an extramedullary myeloid tumor which commonly affects sites like skin, soft tissues, bone, peritoneum, and lymph nodes. Myeloid sarcoma typically occurs during accelerated and blast phase of chronic myelogenous leukemia. It is a very uncommon presentation of CML in its early medullary chronic phase. This is a rare case of CML that presented with an ulcerative lesion on the left clavicular area and a soft swelling in the anterior cervical region above the clavicle, which are aggressive and rare extramedullary manifestations of chronic myeloid leukemia. Notable finding include TLC of 418.92 X 10E9/L, peripheral blood film showed anisocytosis, poikilocytosis, polychromasia, macrocytosis and nucleated RBC, karyotyping for Philadelphia Chromosome was positive. Overall findings are consistent with myeloproliferative neoplasm (chronic myeloid leukemia in chronic phase). The patient started on TKI therapy and showed improvement initially. Despite improvement, patient's relapse suggests potential resistance, emphasizing the need for vigilant follow-up and consideration of alternative treatment strategies.
Bhagavad Gita and Modern Psychiatry: A Framework for Psycho spiritual Healing
Background: This paper explores how the therapeutic principles of the Bhagavad Gita can be integrated with modern psychiatry to heal patients through psycho-spiritual approaches. Methods: This is a comparative historical study design of qualitative nature. It analyzes the teachings such as dharma (righteous action), vairāgya (detachment), abhyāsa (practice), and ātma-jñāna (self-knowledge) and links them to clinical goals like emotional regulation, identity formation, and cognitive clarity. It compares ancient guidance to modern psychological constructs. The study uses Eknath Easwaran’s translation to highlight verses that align with therapeutic principles. It focuses on the emotional journey of Arjuna, one of the key characters and the disciple of Krishna. It highlights Krishna and Arjuna doctor-patient relationship respectively. It describes Arjuna’s breakdown and his path to recovery. The study also explores how Krishna like a doctor employs therapeutic techniques to address Arjuna’s symptoms of anxiety, confusion, and identity loss. Krishna’s techniques reflect the strategies tantamount to cognitive behavioral therapy, mindfulness, and existential approaches. The paper observes emotional transformation of Arjuna which parallels with therapeutic approaches like self-reflection, value alignment, and mental resilience. It also reviews recent medical literatures which support integrating Gita-based ideas in mental health care. It cites articles that compare Gita dialogue to cognitive behavioral therapy (CBT), interpersonal therapy, and mindfulness. It also shows how one can reduce stress, increase life satisfaction, and cope with anxiety. It also explores how Gita techniques such as controlled breathing and meditation can be harmonized with mindfulness training. Conclusion: The paper argues that the Gita, as a psychological guide, offers a structured path to inner balance and self-understanding. It contends that lessons on detachment and duty help regulate emotions and clarify values. Gita’s psychological approach bolsters ethical, spiritual, and cultural insight of modern psychiatry. It bridges Western clinical models with indigenous wisdom. The paper further unveils how Gita’s psychological tools complement evidence-based methods and reinforce therapeutic outcomes and collaborate between psychiatry, psychology, and spiritual studies, offering clarity, purpose, and peace to those in distress. It positions the text as a universal resource that enriches holistic therapy.
Biochemistry in Contemporary Medicine: Connecting Medicine and Molecules
Biochemistry, which was once only considered a basic scientific subject in medical curricula, has now become essential to comprehending disease causes, directing diagnostic procedures, and forming therapeutic approaches. The way that biochemistry is currently used in medicine pushes the limits of precision and individualized healthcare by dynamically integrating molecular discoveries with clinical application.