Nepal Journal of Health Sciences (NJHS) is an Official Peer-Reviewed Scientific Publication of Madan Bhandari Academy of Health Sciences, Hetauda, Nepal. It publishes papers on research in the field of biomedical sciences, covering all disciplines of medicine, dental, medical education, public health, and health care administration, as well as ethical and social concerns related to health. Clinical studies are given priority over laboratory and animal studies by the journal. Original research articles, case studies, systematic reviews, and meta-analyses will be pub­lished in the journal, which would be peer-reviewed. The editorial board invites submissions for editorials, guest editorials, viewpoints, and letters to the editor.
Madan Bhandari Academy of Health Sciences
Patterns and Outcome of Poisoning Case Admitted in ICU of Provincial Hospital of Bagmati Nepal
Introduction: Poisoning is a serious public health issue that can be caused by numerous chemical and pharmacological substances. It is one of the causes of patient admission in Intensive Care Unit. Poisoning has a harmful effect due to exposure to a foreign chemical. A proper assessment, appropriate management and immediate treatment in intensive care unit is necessary for better outcome. Objectives: To describe the patterns of admission and outcome of poisoning case admitted in Intensive Care Unit of Provincial Hospital of Bagmati Nepal. Methods: A retrospective cross-sectional study was conducted and data from November 2022 to November 2023 was collected from the Intensive Care Unit logbook record and chart . Results: Total of 77 patients were admitted with poisoning during 12 months of study period. The mean age of the patients is 32 ± 19 years. Most common age group of poisoning was between 16-45 years. Most of the patient admitted in Intensive Care Unit with diagnosis of poisoning were married 52 (67.5%). Insecticide (55.8%) was the most commonly ingested poison. Most of the cases were suicidal attempts due to family disharmony. Most of the patients 55 (71.4%) completely recovered and discharged while 6 (7.8%) expired at hospital and 2 (2.6%) patients were referred to higher center for further management. Conclusion: The majority of poisoning cases included females between the ages of 16 and 45 who were married and had attempted suicide as a result of family trouble. The most often consumed toxin was insecticide (55.8%) and organophosphorus compound is the most common insecticides used.
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Association of Anterior and Posterior Occlusal Planes with Skeletal Class I, Class II and Class III Malocclusion
Introduction: The occlusal plane is a very vital in stomatognathic system and the association between anterior occlusal planes and posterior occlusal plane plays an important role during orthodontic treatments. Objectives: To assess occlusal planes in skeletal Class I, II, III malocclusion and to find the Association of Anterior and Posteriorocclusal planes with skeletal Class I, Class II and Class III malocclusion. Methods: A cross-sectional study was conducted at KIST Medical College using convenience sampling. Lateral cephalograms of 270 adults with Class I, II, III malocclusion were analyzed to assess angular measurements and their relation to skeletal and vertical patterns. Data were analyzed using SPSS version 16, and descriptive statistics (frequencies, percentages, means, and standard deviations) were computed. Results: The skeletal patterns showed significant difference in anterior occlusal plane angle relative to Sella-Nasion plane and Frankfort Horizontal plane among all classes of malocclusion (p-value =0.001**) having a steeper inclined plane in Class II and flat inclined plane in Class III. Posterior occlusal plane in relation to Frankfort Horizontal plane and Sella-Nasion plane showed lowest angle in skeletal Class III and highest in Skeletal Class I patients. Conclusion: The occlusal planes were found to have impact on the jaw base where variation in its angulation of different occlusal planes had affected sagittal and vertical facial patterns. Anterior occlusal plane relative to Sella-Nasion and Frankfort Horizontal were steeper in Class II and flat in Class III, while the Posterior occlusal plane relative to Frankfort Horizontal showed the same value in Classes II and III.
Emerging Antibiotic Resistance in Streptococcus Pneumonia and Haemophilus Influenzae in Paediatric Pneumonia
Introduction: Pneumonia is the leading cause of death in children under five, primarily caused by Streptococcus pneumonia and Haemophilus Influenza. The emerging antibiotic resistance observed in the commonly occurring pathogens is a major challenge compromising the treatment procedure. Objective: To determine the prevalence and evaluate the antibiotic susceptibility patterns of S. pneumoniae and H. influenzae isolated from paediatric pneumonia patients. Methods: This was a hospital and lab-based prospective observational study conducted from 29th March 2024 to 28th March 2025 at National Medical College Teaching Hospital. A total of 150 children under the age of 15 with confirmed presence of S. pneumoniae or H. influenza in blood or sputum culture are included in the study. Data were entered and analyzed in Microsoft Excel 2016 and SPSS version 27. Descriptive findings were presented in table including frequency, percentage, mean and standard deviation. Results: The high resistance rates to commonly used antibiotics such as ceftriaxone and ampicillin, particularly among S. pneumoniae (63% resistance to ceftriaxone) and H. influenzae (55% resistance to ampicillin), are alarming. The Minimum Inhibitory Concentration -based susceptibility testing shows the ceftriaxone crossing the resistant breakpoint, indicating true resistance and not just tolerance. Similarly, elevated Minimum Inhibitory Concentrationin azithromycin and ampicillin-resistant strains indicate emerging resistance trends in pediatric pneumonia pathogens, especially against commonly used beta-lactam and macrolide antibiotics. The need for regular local antibiogram updates and reconsideration of empirical therapy guidelines is evident. Conclusions: The findings underline the urgent need to reconsider current empirical treatment protocols and promote rational antibiotic use in clinical settings.
Factor Affecting Evidence Based Maternity Care Practice among Nurses in a Tertiary Hospital
Introduction: As the largest group of healthcare professionals, nurses have crucial role for delivering evidence based practice for positive maternity outcomes along with cost effective quality care. The personal and organizational context influences its implementation. Objective: To find out the factor affecting evidence based maternity care practice among nurses in a Tertiary Maternity hospital. Method: Descriptive cross sectional study was done with sample of 84 nurses. Data were collected by using self-administered questionnaires which include attitude scale as well as barrier and facilitator scales. SPSS was used for data analysis. Result: Almost all nurses (97.6%) provided their opinion that evidence based practice is beneficial for the positive patient outcomes and professional development. Majority nurses (78.6%) believed that the care they delivered was evidence based. The nurses demonstrated a positive attitude toward evidence-based practice, with mean score of 2.45 + 0.41. However, they reported experiencing barriers to implementing evidence based practice in their daily clinical practice. Overall barrier scale had a mean score of 2.38 + 0.47, with the organizational subscale identified as the most significant barrier, scoring 2.14 + 0.55. Most important facilitating factor felt by the respondents were ‘Emphasized evidence based practice in nursing curriculum of all level’ (82%); ‘Reward and motivation for evidence based practice’ (79.8%) and ‘Adequate staffing and team work culture’ (79.7%). Conclusion: Emphasizing evidence based practice among nurses, the supporting factors should be enhanced and overcome identified barriers. As a result, the professional development of the nurses is also achieved along with positive health outcomes
Oral Health Related Quality of Life Following Extraction of Impacted Third Molar: A Prospective Analytical Study
Introduction: Surgical extraction of impacted mandibular third molars is among the most frequently performed oral surgical procedures, often associated with postoperative pain, swelling, and functional limitations, adversely affecting patient’s oral health-related quality of life. Although this procedure is widely practiced, limited evidence exists regarding its impact on daily functioning and well-being in the Nepali context. Objective: To assess effect of surgical removal of impacted mandibular third molars on oral health-related quality of life and to examine the influence of age, gender, and surgical difficulty on postoperative recovery. Methods: A prospective analytical study was conducted among 50 patients aged 18-40 years undergoing extraction of partially or completely impacted mandibular third molars. Oral health-related quality of life was measured preoperatively and on postoperative days 1, 3, 5, and 7 using 14-item Oral Health Impact Profile. Surgical difficulty was classified based on clinical and radiographic criteria. Data were analyzed with R statistical software (version 4.0.2), with significance set at p<0.05. Results: Oral health-related quality of life significantly worsened during the first three postoperative days, peaking on day 1 and improving toward baseline by day 7 (mean 14-item Oral Health Impact Profile score: pre-op 3.49±0.37 vs. day 1 post-op 3.70±0.42, P<0.001). The most affected domains were physical pain, functional limitation, and psychological discomfort. Higher surgical difficulty was associated with longer operation time (P=0.03). No significant differences were found across age groups, while females showed slightly slower recovery without statistical significance. Conclusions: Third molar surgery briefly impairs oral health-related quality of life, highlighting the need for counseling and tailored postoperative care.
Haematological Parameters in Relation to Peripheral Smear Examination to Evaluate Morphological Types of Anaemia: A Hospital Based Study
Introduction: Although the diagnosis of anaemia no longer remains a significant challenge in Nepal due to the availability of diagnostic technologies, even in rural settings, the accurate classification of anaemia however, remains challenging due to a lack of qualified pathologists across the healthcare facilities. Objective: To study the morphological types of anaemia in patients visiting Madan Bhandari Academy of Health Sciences Hetauda Hospital. Methods: Hospital based cross sectional study was used to evaluate anaemia based on morphological characteristics and haematological parameters among patients visiting the hematology lab of Madan Bhandari Academy of Health Sciences, Hetauda Hospital from 2021-05-23 to 2021-12-31. By using MIDAS software 386 patients were recruited. Ethical approval was taken from Nepal Health Research Council. Statistical analysis was performed using SPSS version 16, with categorical variables summarized as frequencies and percentages. Result: The majority of participants were diagnosed with microcytic hypochromic anaemia, with a notable predominance among females. Additionally, the highest proportion of cases was observed in adults aged 45 years and older. Conclusion: A concerning finding was that vulnerable groups, women, adults over 45, and children were significantly affected by microcytic hypochromic anaemia. The high prevalence indicates a considerable burden of likely preventable anaemia, underscoring the urgent need for public health action and government-supported dietary interventions.
Occlusal Characteristics of Primary Dentition in Pre-schoolers: A Hospital Based Analytical Cross-Sectional Study
Introduction: The common terminal molar relations are flush terminal, mesial step and distal step. Along with that the normal features of primary dentition are physiological spaces, flush terminal plane, low overjet and overbite and ovoid arch form. Variations in these features would be carried to the succeeding permanent dentition in a more distinct form. Objective: The study aimed to assess the occlusal characteristics of primary dentition in preschoolers visiting one of the tertiary hospitals in Nepal. Methods: An analytical cross-sectional study was conducted in pre-schoolers selected by convenience sampling method. Occlusal characteristics of primary dentition such as molar relation, canine relation, overbite, overjet, crowding and cross bite were recorded. Results: The most common type of molar relation was flush terminal plane (50.8- 51.2%) followed by mesial step (48.1- 48.5%) and distal step (0.4 - 1.2%). Canine relation was predominantly Class I (92-93%) followed by class II (5-6%) and class III. The prevalence of crowding, ideal overjet, ideal overbite, physiological spaces was 9.6%, 79.6%, 60.8%, 60% respectively. The median overjet and overbite were identical across the compared groups at 2 mm (1–2 mm) and 2 mm (2-3 mm) respectively. Conclusions: The most common type of occlusal characteristics were flush terminal plane and class I canine relation. This may be attributed to balanced growth of craniofacial region and anteroposterior arch in most of the children suggesting lower probability of malocclusion in permanent dentition.
Molar Incisor Hypomineralization among School Children in Eastern Nepal: Prevalence, Clinical Patterns, and Predictors
Introduction: Molar Incisor Hypominerlization is notable condition that affects the enamel of first permanent molars, incisors and second deciduous molars, increasing sensitivity, dental decay risk and aesthetic concerns. Objective: This study aims to assess the prevalence and patterns of Molar Incisor Hypominerlization in children aged 6-12 years in schools within Phidim Municipality, Panchthar District, Nepal. Methods: An analytical, school-based study was conducted with 352 children aged 6- 12 years old students from Phidim Municipality. Ethical approval, parental consent and assent forms were obtained. Oral examinations guided by WHO Oral Health Assent Form (2013) and European Academy of Pediatric Dentistry criteria were conducted by a trained dental surgeon. Data were analyzed using IBM SPSS Statistics 25. Results: Molar Incisor Hypominerlization prevalence was 17.6% (62 children: 28 boys, 34 girls) where nine-year-old showed the highest prevalence (25.6%). Affected children with Molar Incisor Hypominerlization averaged 2.58 teeth per child, 2.11 affected molars and 1.76 affected incisors. Permanent first molars were most commonly affected (58.13%), followed by permanent incisors (27.5%). Mandibular molars were more frequently affected than maxillary molars (p < 0.05). No significant gender differences were observed. Molar Incisor Hypominerlization in deciduous molars were over 4 times likely to have it in their permanent molars with an OR = 4.9, 95% CI (1.74, 13.81); (15.1% versus 4.5%, respectively). Conclusion: School based oral health programs are a vital strategy for improving children's access to dental care and reducing the burden of enamel defects.
Association of Microalbuminuria and Renal Function Tests Parameters in Type 2 Diabetes Mellitus
Introduction: Type 2 diabetes mellitus, a metabolic disorder with an increasing global prevalence frequently results in chronic complications like diabetic nephropathy. Microalbuminuria is an early indicator of renal damage and glycemic factors are important for managing diabetes mellitus. Objective: This study was carried to find out the urinary microalbumin and renal function test parameters in type 2 diabetes mellitus patients. Methods: An analytical cross-sectional study was conducted over four months (March to June 2025) at the National Medical College. A total of 300 T2 diabetes mellitus patients were enrolled. Data on FBS, PPBS, HbA1C, serum urea, creatinine, sodium, potassium, and urinary microalbumin were collected and analyzed using SPSS 22. Pearson’s correlation, independent t-test, Smirnov Kolmogorov test and Mann Whitney U test, were applied where appropriate, with p<0.05 considered statistically significant. Results: Poor glycemic control was evident with mean FBS of 193.36 ± 74.86 mg/dL, PPBS of 305.70 ± 87.78 mg/dL, and HbA1C of 8.48 ± 1.84%. Renal function parameters showed elevated urea (66.45 ± 58.39 mg/dL) and creatinine (2.04 ± 1.39 mg/dL). Microalbuminuria was present in 23% and macroalbuminuria in another 13.3% of patients. Strong positive correlations were found between microalbumin and serum urea (r=0.67), creatinine (r=0.62), HbA1C (r=0.17), FBS (r=0.24), PPBS (r=0.21) potassium (r=0.49), and a negative correlation with sodium (r= -0.39) all of which were statistically significant (p < 0.01). Conclusions: The study concluded there is a significant association of urinary microalbuminuria and persistent proteinuria as well as dera ngements in the parameters of renal function test in the type 2 diabetic patients.
Effect of Yoga on Vital Physiological Indicators and Mental Health among Undergraduate Medical Students
Introduction: Yoga is an ancient practice originating from India that has been potentially used to improve physical, mental, and spiritual health. The long-term effects of the practice of yoga are evident; however, the immediate impact of yoga is not very well established, particularly among the population with high academic stress, like medical students. Objective: To investigates the physiological and psychological impacts of a 12 week yoga and meditation program on undergraduate medical students at Madan Bhandari Academy of Health Sciences. Methods: By employing cross-sectional analytical design, the target population of 80 students were grouped into the yoga group and the control group. The pretest and post test data of yoga group on the key health indicators, including the pulse rate, systolic and diastolic blood pressure on the student’s health profile, were taken before and after the student underwent the intervention. The Sahaja yoga technique was a pplied in the intervention. Result: The results revealed significant reductions in heart rate (15.53%) and blood pressure (Systolic blood pressure by 6.12% and Diastolic blood pressure by 13.25%) in the yoga group compared to the control group (4.43% HR, +1.84% Systolic blood pressure, and 2.13% Diastolic blood pressure, all p < 0.001), alongside improvements in perceived stress and anxiety levels. Conclusion: The study concludes that a 12-week yoga and meditation program significantly improved both physiological parameters and psychological wellbeing in undergraduate medical students.
Suicidal Ideation and Suicidal Attempts among the Patients Attending Outpatient Department at Provincial Hospital, Bagmati
Introduction: Suicide is a critical public health issue with devastating impacts on individuals, families and communities. The consequences are often long-lasting for those left behind. Objective: To assess the suicidal ideation and suicide attempts and its associated factors among the patient attending the Psychiatric Outpatient Department at Provincial Hospital of Bagmati Province. Methods: A Hospital based descriptive cross-sectional research design was carried out among the 246 participants, aged 18 years and above from Psychiatric Outpatient Department of Madan Bhandari Academy of Health Sciences, Hetauda Hospital. Data was collected through structured interview schedule consisting of demographic, personal and family history of suicide and disability, public health questionnaire, Generalized Anxiety Disorder, Alcohol use identification questionnaire test. Data analysis was done by suing SPSS version 16. Descriptive findings were presented in table including frequency, percentage, mean and standard deviation. Result: The mean age of the respondent was 37.5±15.014 years. Proportion of males (64.6%) was greater than female (42.7%). Among the total participants, 40.2% had suicidal ideation, 18.3% of the participants having a planned for suicide and 17.5% attempted suicide. Poisoning (48.3%) is the common method used for suicide by attempters. Family structure, family history of suicide, anxiety, depression was associated factors of suicidal ideation and suicidal attempt. Conclusion: Suicidal ideation, planned and attempted were high among the patient attending in Psychiatric Outpatient Department. The common method used for suicide were poisoning, overdoes of medicine and self-hanging.
Age-Related Antimicrobial Resistance in Adults with Lower Respiratory Tract Infections in Nepal
Introduction: Lower respiratory tract infections remain a major health burden in Nepal, and the rising prevalence of antimicrobial resistance poses a significant challenge, particularly in older adults. Objectives: To evaluate antimicrobial resistance patterns among adults with lower respiratory tract infections in Nepal, with a focus on age-related differences. Methods: This retrospective analysis looked at 1,636 culture-positive respiratory specimens collected at Dhulikhel Hospital between January and December 2024. The Clinical and Laboratory Standards Institute guidelines were followed. Extended-spectrum beta-lactamase production was confirmed phenotypically, and multidrug resistance was defined as non-susceptibility to at least one drug in three or more antimicrobial classes. The relationship between age (≥60 years) and resistance outcomes was determined using multivariable logistic regression. Results: Klebsiella pneumoniae (24.90%), Streptococcus pneumoniae (17.50%), and Pseudomonas aeruginosa (11.80%) were the most common isolates. Compared to younger adults, elderly patients (≥60 years) showed a significantly higher prevalence of Multidrug Resistance (56.10% vs 47.20%, p = 0.004) and a higher prevalence of Extended-spectrum beta-lactamase production (31.60% vs 24.50%, p = 0.01). Elderly age was validated by multivariable analysis as an independent predictor of both Extended-spectrum beta-lactamase production (aOR 1.42, 95% CI 1.03–1.97) and Multidrug Resistance (aOR 1.36, 95% CI 1.07–1.74). There were no appreciable age-related differences in the 11.4% of isolates with carbapenem resistance. Conclusion: Adult lower respiratory tract infection patients in Nepal show high antimicrobial resistance rates, with multidrug resistance and Extended-spectrum beta-lactamase pathogens mainly affecting older adults, emphasizing the need for better infection control, age-specific treatments, and antimicrobial stewardship.
Hearing Loss in Diabetic Patients: A Prospective Comparative Study
Introduction: Diabetes mellitus is a chronic systemic disorder characterized by hyperglycemia, various systemic metabolic derangements and complications. Recent research has increasingly reported hearing impairment as one of the complications of diabetes mellitus. The relationship between diabetes and hearing loss has been a subject of investigation for many years. Objective: To evaluate the hearing status of diabetic patients compared with non-diabetic controls and to assess the association of hearing loss with age and duration of diabetes. Methods: A prospective comparative study was conducted in the Department of Ear Nose Throat, Head and Neck Surgery, Bir Hospital, NAMS, Kathmandu, from May 2021 to May 2022. Pure tone audiometry was performed on 89 type 2 diabetes mellitus patients and 89 age matched non-diabetic controls aged 35–60 years. Hearing thresholds were compared between groups, and associations with age and duration of diabetes were analyzed. Results: The mean age of diabetic patients was 48.8 years compared to 46.6 years in controls. Among diabetics, 35.95% demonstrated some degree of sensorineural hearing loss with a mean hearing threshold of 30.23 dB, whereas only 12.3% of healthy controls had hearing loss, with a mean threshold of 24.66 dB. The difference was statistically significant (p<0.05 95% CI). No significant correlation was found between duration of diabetes and hearing loss within the study population. Conclusion: Patients with diabetes mellitus have a significantly higher prevalence of sensorineural hearing loss compared to age-matched healthy individuals, highlighting the need for early audiological screening in diabetic patients
Frequency and Features of Root Canal Treatment among the Patients Visiting a Tertiary Care Center: A Retrospective Study
Introduction: Root canal treatment is a routine endodontic procedure that preserves teeth affected by pulpal or periapical disease. Assessing its prevalence and quality provides insight into patient needs and outcomes. Objective: To evaluate the prevalence and characteristics of root canal treatment among patients at a tertiary care dental center. Methods: A retrospective cross-sectional study was conducted at the Department of Oral Medicine and Radiology of Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Kavre, Nepal. A total of 513 panoramic radiographs of adults (January 2022- January 2023) were reviewed. Data on number and distribution of root canal treated teeth, according to gender, age, jaw, tooth type, quality of obturation, and periapical pathology, were analyzed. Ethical approval was obtained. Results: A total of 387 root canal treated teeth were identified. Root canal treatment was slightly more common in females (51.3%) and most frequent in patients aged 20-30 years. Maxillary teeth accounted for 55.04% of treated teeth, with the maxillary first molar (14.99%) and central incisor (11.37%) being most common. In the mandible, the first molar (21.18%) was most frequently treated. While most obturations were adequate,underfilling (18.34%), overfilling (2.06%), and periapical radiolucency (10.07%) were observed. Conclusion: Root canal treatment was more common in younger individuals, predominantly involving molars. Although most treatments were of acceptable quality, deficiencies and periapical pathology were also noted which emphasizes the need for precise treatment and long-term follow-up
Knowledge, Awareness and Attitude towards Orthodontic Treatment among Patients Visiting the Tertiary Care Center
Introduction: While numerous studies have been conducted among high school students and orthodontic patients, limited research has evaluated knowledge, awareness, and attitude regarding orthodontic treatment among general patients seeking dental care. This study aimed to assess these factors among patients attending a tertiary care center. Objective: To assess knowledge, awareness, and attitude toward orthodontic treatment among patients visiting the tertiary care center. Method: A cross-sectional study was conducted among 303 patients attending the Department of Oral Medicine and Radiology, Kathmandu University School of Medical Sciences, Dhulikhel Hospital. Data were collected using a structured questionnaire with dichotomous (Yes/No) responses assessing knowledge, awareness, and attitude toward orthodontic treatment. Descriptive statistics, including frequency and percentage, were calculated, and Chi-square tests were applied to compare responses by gender. Result: Majority of patients demonstrated a good level of knowledge about orthodontics and the effects of malocclusion. However, their understanding of the causes of malocclusion like genetic factors and habits like thumb sucking, tongue thrusting, and mouth breathing was moderate. Additionally, most participants had limited awareness about the importance and use of retainers following orthodontic treatment. While significant number of patients were knowledgeable and aware of orthodontic care, only few were personally motivated to undergo the treatment. Conclusion: Although the findings were encouraging, indicating that patients had a good level of knowledge, attitude, and practice towards orthodontic treatment, there remains a need to enhance patient education on the importance of retainers and to improve motivation for undergoing orthodontic treatment.
Association between Thyroid Stimulating Hormone and Lipid Accumulation Product in Hypothyroid and Euthyroid Adults in Nepal
Introduction: Hypothyroidism adversely affects lipid metabolism and increases cardiovascular risk. The Lipid Accumulation Product index, based on waist circumference and triglycerides levels, is a simple marker of central lipid accumulation. Hormone deficiency in hypothyroidism leads to elevated cholesterol and triglycerides, both of which contribute to higher lipid accumulation product scores. Exploring this association may provide insight into the cardio metabolic burden of thyroid dysfunction. Objective: To compare the Lipid Accumulation Product Index in hypothyroid and Euthyroid adults and assess its correlation with serum Thyroid Stimulating hormone level. Methods: Cross-sectional comparative study conducted at Dhulikhel Hospital in 130 hypothyroid and 130 euthyroid adults after ethical clearance from Institutional review committee, Kathmandu University School of medical Sciences. Lipid Accumulation Product was calculated using standard gender-specific formulas. Statistical analysis was performed using Spearman correlation and logistic regression. Results: Median Lipid Accumulation Product is higher in the hypothyroid group (54.1) compared to the euthyroid group (38.3), suggesting that hypothyroid patients tend to have greater lipid accumulation (p < 0.001). Thyroid Stimulating hormone was significantly associated with Lipid Accumulation Product even after adjustment for age and sex (p < 0.05). Conclusion: Patients with hypothyroidism have significantly higher levels of Lipid Accumulation Product index. Thyroid Stimulating hormone and lipid accumulation product are positively correlated, supporting it as a metabolic risk marker in thyroid dysfunction.
Perception of Medical Students towards Cadaveric Dissection at a Medical College,Pokhara
Introduction: Cadaveric dissection remains the gold standard for teaching gross anatomy, yet student perceptions vary, particularly regarding its educational value, emotional impact, and the role of alternative modalities. Objective: To assess medical student’s perceptions of cadaveric dissection in the anatomy dissection hall at a medical college in Pokhara, Nepal. Methods: A descriptive cross-sectional study was conducted among all first year MBBS and BDS students (n=130). A validated, pretested 32 item questionnaire covered five domains: educational value, negative experiences/formalin burden, emotions/coping, ethics/professional attitudes, and preferences for alternatives. Descriptive statistics, chi square test and logistic regression were used to analyse data. Results: Of 130 students, 117 participated (response rate 90%). Most agreed that dissection deepened understanding (88.9%), improved retention (86.3%), and provided essential 3-D orientation (83.8%). Negative experiences included dislike of formalin odor (78.6%) and perceived time burden (69.2%). Initial anxiety was reported by 42.7%, with 71.8% noting anxiety reduction after repeated exposure. Respect for cadaver personhood was nearly universal (95.7%). Prior exposure to the deceased significantly reduced high initial anxiety (OR=0.46, p=0.035). Conclusion: First year students strongly valued cadaveric dissection, preferred it over sole virtual methods, and supported blended resources. Enhancing ventilation, early coping support, and humanistic framing can optimize learning.
Clinical Profile and Cardiovascular Disease among Chronic Obstructive Pulmonary Disease Patients
Introduction: Chronic Obstructive Pulmonary Disease is a major cause of morbidity and mortality worldwide, with systemic manifestations beyond the lungs. Cardiovascular disease is one of the most significant comorbidities, yet its prevalence among Chronic Obstructive Pulmonary Disease patients in low-resource settings like Nepal is underexplored. Objective: To assess the clinical profile of Chronic Obstructive Pulmonary Disease patients and determine the prevalence of cardiovascular comorbidities among those attending a tertiary care center in Nepal. Methods: This prospective cross-sectional study was conducted at Tribhuvan University Teaching Hospital, Kathmandu. Seventy adult patients with spirometry confirmed Chronic Obstructive Pulmonary Disease, recruited from inpatient and outpatient services, were enrolled. Patients with pre-existing hypertension, diabetes, or major cardiovascular conditions were excluded. Demographic data, smoking history, exposure risks, symptoms, and spirometry were recorded. Results: The mean age of participants was predominantly above 65 years, with females (61.4%) outnumbering males. Most patients were rural residents (68.6%), with 70% reporting smoking exposure. Symptomatically, half presented with dyspnea, cough, and sputum production, and 48.6% reported grade 4 dyspnea on the Modified medical research council dyspnea scale. Based on the Global Initiative for Chronic Obstructive Lung Disease classification, 57.1% of patients were in group D, indicating high symptom burden and exacerbation risk. Cardiovascular disease was documented in 11.4% of patients. Conclusions: This study demonstrates that cardiovascular disease is a notable comorbidity among chronic obstructive pulmonary disease patients in Nepal, even after excluding common confounders such as hypertension and diabetes. Most patients were elderly, female, and from rural areas with significant smoking exposure.
Nepalese Medical Students’ Perception of Human Cadavers: Ethical Perspectives
Introduction: Cadaveric dissection has long been a cornerstone of medical education. In Nepal, medical students are introduced to cadavers through demonstrations that serve as an essential method for teaching and learning anatomy. Understanding how students perceive the dead body and its dissection is crucial to fostering a respectful learning environment and reinforcing ethical conduct. Objective: This study aims to study medical students’ perceptions of cadavers and to discuss its ethical aspects. Methods: This descriptive cross-sectional study was conducted in Devdaha Medical College through convenient sampling of 160 preclinical medical students. Structured questionnaires were used to collect data, which were kept anonymous. They were entered in Microsoft Excel and the results were expressed in frequency and percentage. Results: Most students felt intense emotions (36.7%), exposed to death (61.5%), and found it to be a transformative experience (75.2%) after dealing with a cadaver. Majority of them agreed to have been considerate towards cadavers (88.1%), contemplate morality (91.7%), respectful (73.4%) and follow the code of conduct (88.1). Maximum students perceived cadaver to be essential to medical education (90%) and obligation to learn (82.6%), while a slightly more (40.4%) disagreed to be desensitize to the emotional and cognitive difficulties. Conclusion: Medical students largely perceive cadavers positively and as learning tools, enabling them to approach dissection with objectivity while fostering a sense of detached concern.
Knowledge, Attitude and Practice on Oral Health among Patients Visiting Dental Center: A Cross-Sectional Study
Introduction: Oral health is a vital component of overall health and quality of life. Poor knowledge, negative attitudes, and inadequate practices regarding oral hygiene contribute significantly to the global burden of dental diseases, especially in low- and middle-income countries. Objective: To assess the knowledge, attitude, and practice of oral health among patients attending a dental centre in Nepal. Methods: A cross-sectional study was conducted among 353 patients attending a dental centre. Data were collected using a structured questionnaire covering socio-demographic characteristics, oral health knowledge, attitude, and practices. Descriptive statistics, chi-square tests, and logistic regression were applied to assess associations between socio-demographic variables and knowledge, attitude, and practice outcomes. Results: The mean age of participants was 36.65 ± 15.88 years, with almost equal gender distribution. Overall, participant’s demonstrated good knowledge of oral health, with 92.1% recognizing the importance of brushing twice daily, 88.1% acknowledging the harmful effect of sugary foods, and 76.8% aware of the impact of dental diseases on general health. Attitudes were generally positive, with 85.8% agreeing that oral health is as important as general health, and 91.8% recognizing the harms of tobacco and alcohol. Conclusion: The study highlights generally good knowledge and positive attitudes toward oral health, but suboptimal practices persist, particularly regarding toothbrush replacement and frequency of brushing. Targeted health education and behavioral interventions are recommended to bridge the gap between knowledge and practice for improved oral health outcomes.
Hematological and Biochemical Reference Intervals in Nepal: A Narrative Review
An accurate interpretation of hematological and biochemical parameters is important for clinical diagnosis and decision making. Hematological parameters, such as hemoglobin, hematocrit, and white blood cell counts, tell about blood health, while biochemical parameters, including liver enzymes, renal markers, lipid profiles, and blood glucose, indicate metabolic and organ function. Reference Intervals (RI), which statistically represent central 95% values of healthy individuals, vary by population due to different factors. This narrative review aims to evaluate the hematological and biochemical reference ranges currently used in major hospitals across Nepal. In this review laboratory reference intervals for regular hematological and biochemical parameters used in 8 different hospitals from Nepal, which are located in Provinces 2, 3 and 4, with internationally accepted standard intervals, taken from recognized international guidelines, including World Health Organization and American Diabetes Association and comparison was done. Laboratory data were collected using a preset proforma designed to systematically record reference ranges from blank report sheets of the respective hospitals. It was found that most of the reference intervals used by these hospitals slightly varied with the internationally accepted standard intervals. However, some parameters like Fasting Blood Sugar, Blood Urea, and CT showed larger variations. Therefore, for accurate diagnosis and treatment of patients in Nepal, such a range of reference intervals shall be used that are based on the country's population, diet, genetics and environment. It is also essential to update the intervals on a timely basis. This ensures the most effective decisions which doctors can make for a patient’s health.