Journal of Nepal Health Research Council
Journal of Nepal Health Research Council is published quarterly ( four times a year) and distributed by Nepal Health Research Council. The statements or opinions expressed in the Journal are the personal views of authors and do not represent the official views of JNHRC editorial board or Nepal Health Research Council.
Nepal’s First Whole Genome Sequencing of the Monkeypox Virus: Imported Cases from Saudi Arabia with Evidences of Secondary Transmission
Monkeypox (Mpox) is an infection caused by a zoonotic orthopoxvirus that is being reported in non-endemic regions. We present here 4 confirmed and probable cases managed at Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu. Three patients were Nepalese men returning from Saudi Arabia with fever, malaise, and papulopustular rashes. The fourth case, the wife of one patient, developed fever, myalgia, lethargy, headache, and later vaginal pustular lesions progressing to ulcers, indicating secondary transmission. Lesion swabs and crust samples underwent real-time PCR at the National Public Health Laboratory (NPHL), Teku, Kathmandu, Nepal targeting G2R and F3L genes, all testing positive (Ct ?35). Positive samples were sequenced in-country at NPHL for the first time using the PrimalSeq protocol on an Illumina MiSeq platform. Genome analysis confirmed Clade IIb A.2, matching strains circulating in Europe and the Middle East. NPHL’s clade identification was concordant with WHO reference laboratories, validating Nepal’s genomic capacity. Keywords: Clade IIb A.2; genome sequencing; Monkeypox; Mpox; Nepal
Copyright (c) 2026 Shivendra Kumar Jha, Priya Karna; Gaurab Pandey; Pratik Kunwar, Ranjan Raj Bhatta, Nirajan Bhusal https://creativecommons.org/licenses/by-nc/4.0
National Summit of Health and Population Scientists in Nepal : Achievements and Lesson Learned Over a Decade
For the past eleven years, Nepal Health Research Council (NHRC) has been organising an annual event: National Summit of Health and Population Scientists in Nepal. This has become the leading platform for connecting research, policy, and practice in the country. Since its inception in 2015, it has evolved with changing public health needs, national reforms, and global priorities such as evidence-based decision making, the Sustainable Development Goals (SDGs), federalisation, resilience, equity, population, and climate change. In 2015, the NHRC welcomed 500 participants and delegates. Over the past eleven years, annual participation has consistently exceeded 1,000 attendees. During the coronavirus disease 2019 (COVID-19) period, more than 10,000 individuals joined virtually. The NHRC has strengthened multi-sector collaboration, expanded partnerships, and developed the event as a key policy dialogue platform for translating research into action. Key achievements include shaping national policy discourse, promoting a culture of evidence-informed decision making, research excellence through competitive awards, generating more than 1,600 research presentations, and publishing scientific evidence during public health emergencies. It also highlighted the visibility of the NHRC and its role in promoting evidence in practice. However, challenges persist in ensuring systematic follow?up, effective translation of evidence into policy and practice, and deeper engagement of provincial governments and communities. This article reviews the evolution of the summit, its achievements, and policy influence, and identifies opportunities to further strengthen its impact. Keywords: Evidence-based decision making; federalisation; health research policy; health systems strengthening; national summit.
Copyright (c) 2026 Namita Ghimire, Upama Ghimire, Riya Regmi, Bishnu Prasad Marasini, Sudip Paudel, Meghnath Dhimal, Pramod Joshi https://creativecommons.org/licenses/by-nc/4.0
Physical Activity in Nepal at a Crossroads
Copyright (c) 2026 Narayan Subedi, Rajan Shrestha, Susan Puudel https://creativecommons.org/licenses/by-nc/4.0
Post Operative Pain During and After Root Canal Treatment in a Government Hospital Setting in Nepal
Background: Postoperative pain is a most common symptom of endodontic patients after root canal treatments (RCTs). The aim of this study was to evaluate Postoperative pain during and after root canal treatment (RCT) among patients at a government hospital of Nepal. Methods: Maxillary and mandibular teeth with necrotic pulp or irreversibly inflamed pulp, with or without preoperative pain, were included in this study. Subject’s age and gender, as well as pulp status and preoperative pain status, were recorded. Root canal treatment was done using a standard protocol. Visual analog scale (VAS) and facial rating scale were used to record the level of pain felt. Results: A total of 400 patients were enrolled in the study. The VAS score for pain decreased from 6(4-8) recorded before RCT, to 0 (0-4) during and 0 (0-0) after RCT and the difference was statistically significant (P<0.001). Similarly, in Facial rating scale, the scores decreased significantly from 2(2-5) before RCT to 0(0-0) during and 0(0-0) after RCT (P<0.001). There was significant difference in facial rating scores during root canal treatment between males and females (P=0.014). Conclusions: Postoperative pain significantly decreases after the initiation of root canal treatment. No significant difference was found in VAS score between male and female whereas significant difference was found in facial rating scores during root canal treatment between males and females. These findings of facial rating score emphasize that biological and psychosocial factors make females more susceptible to experiencing pain. Keywords: Facial rating scale; necrotic pulp; post-operative pain; RCT; visual analog score.
Copyright (c) 2026 Rupam Tripathi; Sirjana Dahal, Nisha Acharya, Manisha Nepal, Nitin Khanduri, Samita Lamichhane https://creativecommons.org/licenses/by-nc/4.0
Evaluating the Effect of Expressed Breast Milk and 10% Dextrose in Procedural Pain Relief in Neonates
Background: In neonates painful procedures are performed with minimum to no regard for pain relief. Even if neonates are unable to communicate pain, it doesn’t negate their ability to experience it. This study observed the effect of expressed breast milk (EBM) and 10% dextrose (10%D) during venipuncture in neonates. Methods: A hospital based cross sectional comparative study was conducted from November 2021 to October 2022. Purposive sampling of 110 neonates who received expressed breast milk and 10% dextrose were assessed via Premature Infant Pain Profile - Revised (PIPP-R) pain assessment tool along with heart rate (HR), oxygen saturation (SpO2) and duration of cry. Data was collected and analyzed via independent t test using Statistical Package for Social Sciences version 25. Results: The mean ± standard deviation of heart rate and oxygen saturation in expressed breast milk group was 168.57 ± 8.9 per minutes (min) and 95.31 ± 1.42% and in 10% dextrose group was 174.27 ± 9.02 per min and 93.80 ± 1.15% respectively. Mean duration of cry in expressed breast milk group was 51.89 ± 16.66 seconds (sec) and 10% dextrose group was 73.55 ± 24.05 sec with a significant difference (p=0.001). The premature infant pain profile revised score was recorded at 30 sec, 1 min and 3 min and 5 min and a significant difference was noted at 30 sec (p=0.000) and 1 min (p=0.047) after venipuncture. Conclusions: Expressed breast milk have better analgesic effect than 10% dextrose. Keywords: Expressed breast milk; neonate; neonatal pain; oral dextrose; PIPP
Copyright (c) 2026 Richa Baniya; Shraddha Dangol, Sagun Manandhar, Samprada Tripathee, Ashram Poudel Upadhyaya, Sabina Shrestha https://creativecommons.org/licenses/by-nc/4.0
Clinical Outcome of Patients Admitted to Critical Care Unit in Karnali Province
Background: Life-threatening illnesses are rising globally, disproportionately affecting patients from developing countries. The outcome of such illness depends on the critical care services provided to the patients. Constrained resources may impact the quality and outcome of critical care. This study aims to assess the outcomes of critically ill patients admitted to the Intensive Care Unit (ICU) of a hospital in remote Karnali Province of Nepal Methods: This retrospective observational study reviewed data of ICU patients admitted from July 2021 to July 2022 in Province Hospital, Karnali, Nepal. Analysis included data on socio-demographic information, clinical diagnosis, duration of stay in ICU, use of mechanical ventilator, and outcomes of patient admitted to the ICU. Results: A total of 745 patients were admitted within the specified time period. The most common diagnoses were chronic obstructive pulmonary disease (COPD), poisoning, and acute coronary syndrome(ACS). Non-communicable diseases accounted for 60% of admissions. Overall, 17% of patients received support via mechanical ventilation. 50% of patients admitted in the ICU were recovered. The ICU mortality rate was 22 %, whereas 23% left the ICU against the medical advice. Age (p<0.001), ventilator use (p<0.001), and source of admission(p<0.001) were significantly associated with death in the ICU. Though the mortality rate varied significantly across diagnoses, septic shock and COPD attributed to the highest mortality. Conclusions: Non-communicable diseases were the most common cause of admission to the ICU of the hospital. Half of the ICU patients had poor outcomes, with one out of four succumbing to death. Factors like suboptimal speciality services and equipments, poor infrastructure development, and poor human resources might have contributed to poor outcomes in such settings. Keywords: Critical care; intensive care; mortality; prognosis; pulmonary disease chronic obstructive.
Copyright (c) 2026 Khechar Nath Paudel; Mahesh Kumar Khanal, Subarna Bhandari https://creativecommons.org/licenses/by-nc/4.0
Knowledge And Attitudes Regarding Infant Feeding and Immunization among Pregnant Women Visiting Antenatal Clinics
Background: Deficits in maternal knowledge and perceptions can lead to suboptimal infant feeding and incomplete immunization, impacting child health. Given a lack of recent data in culturally diverse Eastern Kathmandu, this study explores pregnant women’s knowledge and attitudes regarding infant feeding and immunization. Methods: A cross-sectional study was conducted among pregnant women at antenatal clinics in Eastern Kathmandu (Feb-Mar 2025). Data were collected via a validated, self-administered questionnaire after informed consent. Multivariable logistic regression identified predictors of knowledge and attitudes on infant feeding and immunization. Statistical significance was set at p < 0.05. Results: A total of 371 pregnant women participated. There was high knowledge gap in infant feeding practice 208 (56.1%) and high knowledge in immunization 277 (74.7%). Positive attitudes were observed in 341 (93.2%) intending to exclusively breastfeed and 369 (98.4%) believing immunization is safe. Lower knowledge was linked to younger age (<21 years; AOR 0.27, 95% CI 0.07–0.78) and lack of formal education (AOR 0.22, 95% CI 0.03–0.97 for feeding; AOR 0.11, 95% CI 0.03–0.39 for immunization). Positive attitudes were more common among homemakers (AOR 4.86, 95% CI 2.44–9.93) and women with higher parity (AOR 6.14, 95% CI 2.60–15.61 for third or higher). Conclusions: The study reveals a significant gap in knowledge regarding infant feeding practices, especially among younger and less educated pregnant women in Eastern Kathmandu. Although attitudes are positive, targeted interventions are needed to address knowledge gaps, especially regarding exclusive breastfeeding. Keywords: Attitude; immunization; infant feeding; knowledge; pregnant women.
Copyright (c) 2026 Santosh Adhikari, Tribhuwan Bhattarai, Prakriti Karki, Kshitij Kunwar , Ramesh Dhakal , Lok Raj Bhatta, Sabin Rimal , Manisha Gaire, Raj Kumar Nepal , Srijana Bhattarai , Praveen Suthar https://creativecommons.org/licenses/by-nc/4.0
Knowledge, Attitude and Practice of Forensic Odontology among Dental Practitioners
Background: The major application of forensic odontology includes the identification of human remains using antemortem and postmortem dental records where an individual is skeletonized, burnt, decomposed, or diminished and cannot be identified by regular methods. The present study aims to assess the knowledge, attitude, and practice of forensic odontology in dental practitioners. Methods: This questionnaire-based cross-sectional descriptive study was done among dental practitioners working in different hospitals, medical colleges and dental clinics in Kathmandu, Nepal. A total of 171 general dental practitioners, specialists and faculty members were included in the study. The questionnaire included eight questions related to knowledge, four questions on attitude and four questions on practice. The data obtained was entered into a Microsoft Excel sheet and analyzed using the Statistical Package for Social Sciences Version 21. For knowledge, attitude and practice scores, frequency, percentage, mean, and standard deviation were calculated. The independent sample t-test was used to compare the knowledge, attitude and practice scores between general dentists and specialists. Results: The mean knowledge score was 6.70±0.73, the mean attitude score was 2.05±0.97and the mean practice score was 2.68±0.89. Of the total study participants, 170 (99.4%) had adequate knowledge,122(71.3%) had adequate attitude, and 153(89.5%) had adequate practice. There was no statistically significant difference in mean knowledge and practice scores between general dentists and specialists. The mean attitude score was found to be higher among general dentists than among specialists, which was statistically significant (p-value less than 0.05). Conclusions: The study highlights a gap between dentists’ knowledge and their attitudes and practices regarding forensic odontology. While they are well-informed, there is a need to improve their practical engagement and record-keeping for effective forensic application in medicolegal cases. Keywords: Cross-sectional study; dentist; nepal; professional role.
Copyright (c) 2026 Radha Baral , Samarika Dahal https://creativecommons.org/licenses/by-nc/4.0
Level of Coping Skills among Psychology and Non-Psychology Students in Colleges of Kathmandu Metropolitan City
Background: Coping skills play a vital role in managing stress and adversity, influencing psychological well-being, particularly among university students. Students of psychology are expected to possess better coping mechanisms due to their academic training. This study aimed to assess the level of coping skills among psychology and non-psychology students and to examine the association of coping skills with selected demographic variables. Methods: A comparative cross-sectional study was conducted among 271 undergraduate and graduate students (126 psychology and 145 non-psychology) from selected colleges in Kathmandu. Stratified random sampling was employed to ensure representation from both groups. Data were collected using the Coping Scale developed by Hamby, Grych, and Banyard. Data analysis was performed using SPSS software, applying descriptive statistics and independent samples t-tests to compare coping skills between groups. Results: Among participants, 51.3% had medium-level coping skills, followed by high (25.8%) and low (22.9%). Psychology students scored significantly higher in coping skills than non-psychology students (mean = 37.33 vs. 34.74, p < .001). Males reported higher coping levels than females (p = .018). Residence, mobility preference, and employment status were not significantly associated with coping skills. Conclusions: Psychology students exhibited significantly better coping skills compared to their non-psychology counterparts. Gender differences were also observed, with males demonstrating stronger coping mechanisms. The findings underscore the need for targeted coping interventions, especially for non-psychology students. Keywords: Coping skills; Kathmandu; non-psychology students; psychology students.
Copyright (c) 2026 Kishan Ghimire; Bindila Gautam https://creativecommons.org/licenses/by-nc/4.0
Blood Lactate Clearance as a Predictor of Mortality in Children Undergoing Cardiac Surgery with Cardiopulmonary Bypass
Background: Pediatric cardiac surgery is still a high-risk procedure, with mortality being a significant concern. Lactate clearance has been demonstrated to enhance outcomes in critically ill adult populations; however, data regarding its significance in the context of pediatric cardiac surgery has been limited, particularly in resource-limited settings like Nepal. The aim of this study was to evaluate lactate clearance as a predictor of mortality in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods: This was a prospective observational cohort study conducted at Shahid Gangalal National Heart Center (SGNHC) involving 129 pediatric patients (?14 years) undergoing elective cardiac surgery for congenital heart disease. Lactate levels were measured at several time points: T0 (post-induction), T1 (ICU admission), and T6, T12, T18, and T24 hours postoperatively. Patients were classified into two groups based on their lactate clearance rates: high (?10%) and low (<10%).The primary outcome was in-hospital mortality; secondary outcomes included duration of mechanical ventilation, inotropic support, and ICU stay. Results: Non-survivors (n=20) had significantly lower lactate clearance at all time points compared to survivors (n=109) (p<0.001). High lactate clearance was associated with reduced mortality (1.9% vs. 22%, p=0.03), shorter mechanical ventilation (11.29±4.73 vs. 14.56±6.73 hours, p<0.001), and shorter ICU stay (48.85±7.26 vs. 66.64±25.46 hours, p=0.004). Conclusions: Lactate clearance is a significant prognostic marker of mortality in pediatric patients undergoing elective cardiac surgery for congenital heart defects. The ongoing monitoring of lactate clearance may facilitate the early identification of high-risk patients in the early postoperative period and guide interventions that could potentially improve postoperative outcomes. Keywords: Blood lactate clearance; cardiopulmonary bypass; mortality, Nepal; pediatric cardiac surgery.
Copyright (c) 2026 Smriti Mahaju Bajracharaya, Ushna Shrestha, Ashish Govinda Amatya https://creativecommons.org/licenses/by-nc/4.0
Association Between Vitamin D Levels and Vitamin D Receptor (VDR) Gene Polymorphisms in Nepalese Population
Background: Vitamin D deficiency is a global public health concern. Small variations in the proteins involved in vitamin D metabolism affect levels and physiological roles of vitamin D. However, there is a paucity of data regarding such factors in our population. This study was designed to assess the distribution of polymorphisms of vitamin D Receptor (VDR) gene (rs2238136 and rs731236) in vitamin-D deficient Nepalese population. Methods: A total of 400 apparently healthy individuals visiting our center were enrolled. Five ml of blood was collected in gel vial and EDTA vial. The 25(OH)D levels were estimated in ABBOTT Architect autoanalyzer. After extracting genomic DNA, the VDR gene polymorphism (rs2238136 and rs731236) was analyzed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The amplified products, 135 bp and 716 bp were digested using restriction enzymes Bpu10IA and TaqI for rs2238136 and rs731236, respectively, electrophoresed on 2% agarose gel and visualized under UV illuminator. Statistical analysis was done using SPSS version 21.0. Results: The distribution of both rs2238136 and rs731236 followed Hardy-Weinberg equilibrium. There were 24 AA, 238 GG, and 138 AG genotypes found in rs2238136, whereas 226 TT, 34 CC, and 140 TC genotypes were found in rs731236. In contrast to rs731236, vitamin D levels varied among genotypes of rs2238136. Conclusions: In our population, there was a higher prevalence of GG genotype (rs2238136) and TT genotype (rs731236). Increased prevalence of vitamin D deficiency in our region may be due to these genetic variations. Keywords: Genetic polymorphism; restriction fragment length polymorphism; vitamin d; vitamin d receptor.
Copyright (c) 2026 Sujata Baidya, Pratibha Kandel, Smrity Rajkarnikar, Anil Kumar Sah, Apeksha Niraula, Eans Tara Tuladhar, Yagya Laxmi Shakya, Niraj Bam, Vijay Kumar Sharma, Binod Kumar Yadav https://creativecommons.org/licenses/by-nc/4.0
In-hospital outcome of Transcatheter Aortic Valve Implantation at Shahid Gangalal National Heart Centre, Kathmandu, Nepal
Background: Transcatheter aortic valve implantation (TAVI) has emerged as a well-established treatment for severe aortic stenosis since its first application in humans in 2002. In Nepal, the inaugural TAVI procedure was performed in February 2022 at the Shahid Gangalal National Heart Centre. This study aims to share our initial experiences and outcomes of TAVI at our center. Methods: We conducted a retrospective observational study involving all patients who underwent TAVI at our facility between February 2022 and February 2024. This report details patients’ baseline clinical characteristics, procedural data, complications, and in-hospital outcomes. Results: A total of 19 patients underwent TAVI during the study period. The age of patients ranged from 59 to 90 years, with a mean age of 75.2 ± 7.5 years; 10 patients (52.6%) were female. Four cases (21.1%) involved patients with bicuspid aortic stenosis. Baseline mean aortic valve area measured 0.8 ± 0.1 cm², and the pre-procedural mean pressure gradient was 52.2 ± 10.1 mmHg. Post-procedure, two patients (10.5%) required permanent pacemaker implantation. The balloon-expandable valve was utilized in 12 cases (63.2%), while the self-expandable valve was used in 7 cases (36.8%). The overall procedural success rate was 100%, and all patients were discharged following TAVI, with a mean hospital stay of 4.5 ± 1.8 days. A mild paravalvular leak occurred in one patient (5.3%). Post-TAVI, the mean aortic valve pressure gradient decreased to 8.1 ± 2.6 mmHg. Conclusions: The outcomes of our initial TAVI procedures are promising, with in-hospital complication and mortality rates comparable to international standards, reinforcing the safety and efficacy of this intervention within our setting. Keywords: Aortic Stenosis; balloon expandable valve; self-expandable valve; transcatheter aortic valve implantation.
Copyright (c) 2026 Chandra Mani Adhikari, Amrit Bogati, Birat Krishna Timalsena, Md. Sajjad Safi, Pratik Thapa, Vijay Ghimire, Rahul Yadav, Dipanker Prajapati https://creativecommons.org/licenses/by-nc/4.0
Prevalence and Predictors of Glycemic Control among Diabetic Patients in in Lalitpur, Nepal
Background: Diabetes Mellitus is a growing public health concern. Despite advancements in treatment, prevalence of uncontrolled diabetes continues to rise. Hence, this study aimed to find out prevalence of glycemic control and its predictors among diabetic patients. Methods: A cross-sectional study was conducted in Lalitpur. Diabetic patients aged 18 years or older, on treatment for more than three months, and with HbA1c test within last three months were included. Data were collected through interviews using semi-structured questionnaire based on WHO Stepwise approach. Total 212 participants were selected through convenience sampling. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression. Results: More than half of the participants were middle-aged (53.77%) and female (51.89%), with 82.08% residing in urban areas. Most of participants (93.87%) had Type 2 diabetes. Nearly all participants (99.52%) were on oral antidiabetic drugs, while 9.43% also received insulin therapy. Overall, 67% had poor glycemic control (HbA1c ?7%), and 33% had good control (HbA1c <7%). Poor control was significantly associated with current residence, duration of diagnosis, duration of treatment, insulin therapy, and blood pressure. Regression analysis showed that rural residents had 2.54 times higher odds of poor glycemic control (p = 0.04), and participants with uncontrolled blood pressure were 2.47 times more likely to have poor glycemic control (p = 0.03). Conclusions: Two thirds of participants had poor glycemic control, highlighting the need for targeted interventions, particularly for rural residents and those with uncontrolled blood pressure to prevent diabetes related complications. Keywords: Diabetes; glycemic control; Nepal.
Copyright (c) 2026 Sanchita Subedi, Shruti Regmi, Samridhi Chauhan https://creativecommons.org/licenses/by-nc/4.0
Relationship Between Pyuria and Bacteriuria in Suspected Cases of Urinary Tract Infection
Background: Urinary tract infection is one of the most common infections encountered worldwide and is a major public health problem. Urinary tract infection is diagnosed based on clinical features, pyuria and bacteriuria. The aim of this study was to determine the relationship between pyuria and bacteriuria in patients with suspected cases of urinary tract infection at Tribhuvan University and Teaching Hospital, Kathmandu. Methods: A cross-sectional descriptive study was carried out from September to December 2023 in the Department of Microbiology at Tribhuvan University and Teaching Hospital. One thousand urine specimens were collected by the convenience sampling method from patients with suspected urinary tract infection and processed for routine macroscopic and microscopic examination followed by culture. The organisms were identified by standard microbiological methods as described by American society for Microbiology. Chi-square test was used wherever applicable with a p value<0.05 regarded as statistically significant. Results: Out of 1000 urine specimens examined, pyuria was seen in 331(33.1 %) specimens. Among the 331 urine samples with pyuria, 137 (41.3 %) urine samples showed significant bacterial growth. Out of 669 urine specimens without pyuria, 33 (4.9%) showed significant bacterial growth. Escherichia coli was the most common organism causing urinary tract infection both with pyuria (71/98, 72.4%) and without pyuria (27/98, 27.6%). Culture positivity increased with the rising number of pus cells in the urine. This correlation between pus cell counts and culture positivity is statistically significant (p < 0.001). Conclusions: Pyuria and significant bacteriuria may not always correlate in suspected cases of urinary tract infection. However, as the number of pus cell increases in microscopic examination of urine per high power field, the likelihood of getting urine culture positive result also increases. Keywords: Bacteriuria; culture; pyuria; urinary tract infection.
Copyright (c) 2026 Shristi Raut, Nitesh Raj Thapa, Junu Richhingbung Rai, Hari Prasad Kattel, Sangita Sharma, Hari Prasad Kattel, Sangita Sharma https://creativecommons.org/licenses/by-nc/4.0
Validation of Harmless Acute Pancreatitis Score for Non- Severe Acute Pancreatitis
Background: In contrast to more complicated scoring systems requiring many parameters, Harmless Acute Pancreatitis Score (HAPS) which is very simple to calculate, has already been described in the literature as a predictor of non-severe acute pancreatitis. In this study, we aimed to validate this score in the form of sensitivity and specificity in predicting non severe course of acute pancreatitis. Methods: This study was conducted over 1 year among patients admitted with acute pancreatitis in a tertiary care center of Nepal. The HAPS scores were calculated using the data obtained at admission and all patients were classified according to Revised Atlanta Classification 2012. Data were compared in terms of diagnostic parameters like (absence of abdominal guarding or rebound tenderness, creatinine < 2mg/dl or hematocrit of <43 for male and <39.6 for female) and sensitivity, specificity, positive and negative predictive value were determined. Results: Out of 120 patients, 46 were female and 74 were male. HAPS were positive in 62 and negative in 58 patients. HAPS, a negative scoring system, correctly predicted the disease severity in 105 patients, with the specificity of 94.3% and sensitivity of 82.1%. Statistical analysis showed moderate agreement (Kappa = 0.751, p < 0.001), when compared with Revised Atlanta Classification. Conclusions: HAPS score was effective in identification of patients who will run non-severe course of acute pancreatitis. Assessment can be completed within an hour from the presentation, making it an easy, rapid, cost effective and convenient screening tool. This helps in decision making for the management of non-severe pancreatitis (HAPS positive) at an optimal level of care and to refer/admit severe (HAPS negative) pancreatitis. Keywords: Acute pancreatitis; HAPS score; Nepal; revised atlanta classification.
Copyright (c) 2026 Sushan Shrestha, Bharat Mani Banjade, Bibechana Pradhan https://creativecommons.org/licenses/by-nc/4.0
Association of Salt Taste Sensitivity Threshold with Blood Pressure and Obesity Indicators among Healthy Young Adults
Background: Salt preference in diet can vary according to the salt taste sensitivity threshold among the individuals. This study aims to know the salt taste sensitivity threshold (STST) among healthy Nepalese adults and its association with blood pressure and anthropometric measures like Body Mass Index, waist Circumference and waist by hip ratio. Methods: This cross-sectional study was carried out among 104 healthy Nepalese volunteers between 20-30 years of age in the department of Clinical Physiology, Maharajgunj Medical Campus. The ethical clearance from Institutional Review Committee was taken in From June to October, 2024. The salt taste sensitivity threshold was elicited with different concentrations of salt solutions. The blood pressure, and anthropometric measures like body mass index, waist circumference and waist by hip ratio were measured. All inferential statistics were calculated at a 5% level of significance. Results: Among the study participants, 86.5% were in normal STST category. The mean body mass index (21.60 ± 2.82 kg/m2), waist circumference (78.03±11.10 cm) and waist by hip ratio 0.74±0.052) in high STST participants was comparatively more with statistically significant difference (P: 0.04; P <0.001, P<0.001). The association of systolic blood pressure was significant with STST (P:0.004). Also, the association of waist circumference and waist by hip ratio with STST was significant among female (P: 0.005; P:0.006). Conclusions: The healthy participants had mostly normal STST. The elevated systolic blood was associated with high STST which suggests of reducing salt intake for minimizing such risks. Keywords: Blood pressure; Salt; Taste threshold; Waist circumference; Waist by Hip ratio.
Copyright (c) 2026 Sonam Chaudhary, Sabita Kandel, Lava Shrestha, Narayan Mahotra, Munna Alam https://creativecommons.org/licenses/by-nc/4.0
Changes in Corneal Curvature and Astigmatism After Phacoemulsification Surgery
Background: This study aimed to investigate the relationship between anterior corneal curvature and astigmatism before and after phacoemulsification surgery. Methods: A total of 90 eyes from 90 participants who underwent phacoemulsification with a 3.0 mm superior-temporal clear corneal incision were included in this longitudinal study. Each participant underwent a comprehensive ocular examination, including refraction and keratometry readings (k-readings) obtained using an automated keratometer on the IOL Master. Examinations were conducted preoperatively, on the first postoperative day, at one week, and four weeks postoperatively. The four-week postoperative refractive astigmatism was estimated and predicted with preoperative k-readings. Results: The mean preoperative and postoperative refractive astigmatism was -0.74±0.49D and -0.36±0.18D, with a mean difference of -0.38±0.46D (p<0.001). The proportion of with-the-rule (WTR) astigmatism increased significantly at four weeks postoperatively (71.1%) compared to preoperatively (16.7%). Linear regression analysis showed that postoperative refractive astigmatism was not significantly influenced only by preoperative anterior k-readings obtained using the automated keratometer (?=-0.046; p=0.77). Conclusions: A supero-temporal 3.0 mm clear corneal incision has shown stability in minimizing postoperative surgically induced astigmatism (SIA) in phacoemulsification cataract surgery. Postoperatively, posterior corneal curvature changes may attributes to surgically induced astigmatism which may be benefited by toric intraocular lens implantation (IOL) for better visual outcome. Keywords: Auto refractometer; incision; keratometry-readings; phacoemulsification; surgically induced astigmatism.
Copyright (c) 2026 Pramod Kumar Yadav, Sabitri Bhatta, Suresh Awasthi, Sagun N Joshi, Madhu Thapa, Niraj Dev Joshi, Arjun Sapkota, Gauri Sr Shrestha https://creativecommons.org/licenses/by-nc/4.0
Study of Thyroid Function and Lipid Profile in Depression Patients
Background: Depression is a common mental disorder, associated with a global increase in disabilities and suicidality. Different factors are responsible for depression in which thyroid dysfunction and dyslipidemia are the biological causes. This study aimed to find the association and alteration of thyroid function tests and lipid profiles among patients with depressive disorders. Methods: A case-control study was performed on patients being managed for depressive disorder visiting the Psychiatry Department of Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The blood samples were collected from 40 newly diagnosed cases of depressive disorder not under any drugs and 80 from healthy individuals. Thyroid hormones and lipid profile parameters were analyzed in Johnson and Johnson, ECI Vitros 3600, US, Ortho Clinical Diagnostics, and BT-1500. Data were collected and statistical analysis was done using SPSS version 22. Results: Among the 40 patients with depressive disorders, 27.5% had thyroid dysfunction with sub-clinical hypothyroidism, overt hypothyroidism, and hyperthyroidism among 12.5%, 12.5%, and 2.5% respectively. Similarly, dyslipidemia was observed in 37.5% of participants. About 52.5% of patients managed for depressive patients were found to have anxiety as well. Despite an alteration of thyroid hormones, there was no significant correlation between thyroid hormones and lipid parameters in patients being managed for depressive disorder. Conclusions: This study concludes that thyroid dysfunction and dyslipidemia are seen among depressive patients with unclear reasons. For proper diagnosis and treatment of depression, it is better to carry out thyroid function tests and lipid profiles. Keywords: Depressive disorder; dyslipidemia; thyroid dysfunction.
Copyright (c) 2026 Sagun Suwal, Sujata Baidya, Mandira Chhusyabaga, Rabita Karanjit, Sunita Makaju, Sagun Ballav Pant, Vijay Kumar Sharma https://creativecommons.org/licenses/by-nc/4.0
Background: A number of published studies demonstrated that smoking represents an increased risk for the development and progression of periodontal disease. Smoking affects the microbiota composition, immune response, and the healing capacity of the periodontium. The aim of this study is to determine the status of periodontal disease in smokers and have an overview about the need for smoking cessation and awareness programs to provide better periodontal health. Methods: A cross-sectional observational study was carried out on 231 patients visiting the dental OPD of Bir Hospital who were smokers using convenience sampling. CPI modified index was carried out, and a comparison and analysis of the impact of different smoking status on periodontitis was done. Results: Out of 231 smokers, 229 individuals (99.13%) had gingival bleeding, 209 individuals (90.47%) had periodontal pockets greater than 3mm and 198 individuals (85.71%) had loss of attachment more than 3mm. Conclusions: Gingival bleeding, periodontal pocket and loss of attachment were significantly more prevalent among smokers, highlighting the importance of smoking cessation and awareness programs. Keywords: Gingival bleeding; loss of attachment; periodontal pocket; periodontitis; smoking.
Copyright (c) 2026 Shaili Pradhan, Anugya Karanjit, Krishna Prasad Lamichhane, Asmita Koju, Garima Khadka, Suchana Adhikari https://creativecommons.org/licenses/by-nc/4.0
Community Perception of Abortions in Different Districts of Nepal
Background: Abortion remains a significant public health concern in Nepal, contributing to maternal mortality and posing a complex challenge to women’s reproductive health. This study explores the complex nature of community perceptions regarding attitudes and perceptions on abortion, perceived factors influencing abortion, perceived consequences of abortion, and existing modern and traditional practices of abortion in Nepal. Methods: A qualitative study was conducted across 12 districts in Nepal, involving 228 community members, including community healers, Female Community Health Volunteers, women leaders, in-laws, and men. Data was analyzed by applying a thematic analysis approach. Results: Findings highlighted a dichotomy in knowledge of abortion, encompassing both progressive views (considering it a women’s right) and regressive notions (viewing it as a sin). Participants also recognized the positive aspects of abortion, such as its role in reducing maternal mortality ratios and improving child health. The study identified factors influencing abortion decisions like the desire to limit family size, entrenched gender dynamics with strong son preference, and pregnancies resulting from relationships outside marriage. Furthermore, abortion was also perceived as a solution for pregnancies arising from rape, incest, or with fetal disabilities. Participants shared a range of consequences associated with abortion, including prevalent misconceptions. They indicated that modern abortion practices like the use of abortion pills were on the rise compared to traditional methods. Nevertheless, unsafe self-medication remained a concern, particularly among rural women. Conclusions: To address these challenges effectively, it is imperative to understand the underlying reasons behind these perceptions and develop targeted interventions that enhance women’s access to safe abortion in Nepal. Keywords: Abortion; community perception; unsafe abortion practices.
Copyright (c) 2026 Suruchi Shahi, Sanju Maharjan, Manish Gautam, Kriti Lamichhane, Parash prasad Phuyal, Bhogendra Dotel, Sujan Karki https://creativecommons.org/licenses/by-nc/4.0
Association of Safe Abortion Knowledge and Contraceptive Use among Ever-Married Women of Reproductive Age
Background: A considerable number of pregnancies end in unsafe abortions after two decades of abortion legalization. Over half of pregnancies resulting in abortions are unplanned, and a significant number of married women have unmet family planning requirements. To minimize unwanted pregnancies and unsafe abortions, the study intends to weigh the impact of the knowledge about the legality and restrictions surrounding abortion among women and the use of contraceptives. Methods: This is a cross-sectional study conducted in Nepal using multistage sampling. The study focused on 1976 ever-married women and utilized sampling weights to ensure representative results. It investigated the relationship between awareness of legal knowledge of abortion and conditions and the use of contraception by women. Results: Women who are aware of the legality of abortion and legal conditions for abortion were more likely to have utilized contraception. Fewer women from Madhesi and Muslim communities used contraception. Contraception use was inversely correlated with education. Adolescent girls were less likely to utilize contraception. When compared to the skilled service group, the non-working group’s odds of choosing to use contraception were significantly lower (aOR,0.503). The likelihood of ever using contraception did not significantly differ between the wealth quintiles, urban and rural people, or residents of provincial settings. Conclusions: Knowledge of the legal status and indications for abortion is associated with increased use of contraception. Empowering women and girls with knowledge and access to a full range of sexual and reproductive health services can ensure improved reproductive health and rights. Keywords: Abortion knowledge; contraceptive use; ever-married; safe abortion; women of reproductive age.
Copyright (c) 2026 Kritee Lamichhane, Sujan Karki, Amit Timilsina, Jivan Devkota, Khusbu Poudel, Jagadishwor Ghimire https://creativecommons.org/licenses/by-nc/4.0
Perceptions of MBBS Interns Regarding Internship Training in Nepal
Background: Internship, an integral part of the MBBS course, includes mandatory clinical rotations during which interns apply knowledge, develop patient management skills, build competencies, and mould themselves into competent medical professionals. However, perceptions of competency achievement and overall internship experience may vary. This study assessed the perceptions of MBBS interns in Nepal regarding their internship training. Methods: This cross-sectional study was conducted between 20 November 2022 and 20 January 2023 among MBBS interns from various medical schools who had recently completed or were completing their internships. A semi-structured, self-administered questionnaire in English was distributed to the eligible interns using Google Forms. The questionnaire included a five-point Likert scale and closed- and open-ended questions on clinical skills, teamwork, conflict and stress management, postgraduate plans, internship satisfaction, and recommendations for improvement. Results: A total of 280 interns (male: 61.8%) responded to the questionnaire. Most interns (92%) reported enjoying their internships, while 57.5% felt that the MBBS curriculum adequately prepared them for training. High self-reported proficiency was observed in medical history-taking (86.5%), patient communication (75%), managing common health problems (67.5%), triaging (66.4%), and physical examinations (65.3%). Excessive duties or workload (55%) were the most common challenge, while learning professional skills was viewed as the most valuable aspect of the internship. Additionally, 59% believed that interns should be treated respectfully by medical teams, patients, and their relatives. Collaborative discussions (34%) were the primary conflict resolution strategy, while support from friends and family was the most common stress management method. Conclusions: MBBS interns reported positive perceptions of their internship experiences and expressed confidence in their professional competencies across most domains of their internship. Keywords: Education; internship and residency; medical; Nepal; students.
Copyright (c) 2026 Ajaya Kumar Dhakal, Devendra Shrestha, Nisha Jha, Moon Thapa, Raju Kafle, Daman Raj Poudel, Shanti Regmi, Anand Kumar Jha, Namrata KC, Divya KC https://creativecommons.org/licenses/by-nc/4.0
Workplace Violence against Registered Doctors in Nepal
Background: Workplace violence against health workers is rising globally. This study aimed to assess the nationwide prevalence and associated factors of workplace violence against Nepal Medical Council-registered Nepali doctors. Methods: A nationwide web-based study was conducted among 420 Nepal Medical Council-registered Nepali doctors using a Google form. Data was cleaned and coded in Ms Excel 2021 and then analyzed using IBM SPSS version 21.0. Frequencies and proportions were calculated for categorical variables. Chi-square test was used to assess the associations between different independent variables with presence of workplace violence, taking p-value of less than 0.05 as statistically significant. Significant variables from bivariate analysis were fitted in binomial logistic regression model to determine strength of association at 95% confidence interval. Results: Overall, 196 (46.67%) doctors experienced some form of workplace violence, with verbal abuse being the commonest (194; 46.19%). No action was taken against perpetrators in 11 (42.31%) physical violence, 125 (64.43%) verbal abuse and 15 (71.43%) racial harassment cases. Doctors working in more than two clinics/hospitals (AOR 4.09, p-value 0.007, 95% CI 1.50-11.48) and having zero vacations in the last six months (AOR 3.08, p-value 0.036, 95% CI 1.07-8.82) were found to be at higher risk of physical violence. Verbal abuse was more likely among those working in government hospitals (AOR 0.55, p-value 0.004, 95% CI 0.37-0.83) and working over 48 hours a week (AOR 1.89, p-value 0.003, 95% CI 1.25-2.86). Conclusions: The burden of workplace violence was notably high in Nepal (46.67%), mainly verbal abuse (46.19%). Long working hours, lack of rest and working in multiple clinics/hospitals were the contributing factors. Keywords: Doctors; Nepal; workplace violence.
Copyright (c) 2026 Varsha Manandhar; Baidehi Upadhyaya, Aman Shakya; Alisha Manandhar, Jem Maharjan, Srijana Bhurtel, Saurav Shah; Ayush Jha, Brihaspati Sigdel, Milan Adhikari https://creativecommons.org/licenses/by-nc/4.0
Normative Reference Value for Hand Grip Strength and Sit and Reach Test among School Age Children
Background: Physical fitness indicators such as hand grip strength (HGS) and flexibility, are essential markers of children’s growth and functional development. This study aimed to establish culturally relevant normative reference values for hand grip strength (HGS) and the sit-and-reach test (SRT) among school-aged children (6–12 years) in Dhulikhel, Nepal, and to examine the associations of these measures with age, Gender and body mass index (BMI). Methods: A cross-sectional study was conducted among 359 (52.4% male, 47.6% female) typically developing school children aged 6 to 12 years in Dhulikhel. A TKK (Takei Hand Grip Dynamometer Model T.K.K. 5401) dynamometer was used to measure handgrip strength, and a specially constructed box was used for the sit-and-reach test. Data were analyzed using descriptive statistics with the Statistical Package for Social Sciences, version 26. Results: Hand grip strength differed significantly by age and sex, with males demonstrating higher mean right (12.11 kg) and left (11.33 kg) handgrip strength than females. Age-stratified analysis revealed a progressive increase in handgrip strength with age in both hands (p < 0.01). Likewise, flexibility showed no significant gender (p = 0.61) or age-related differences (p = 0.10). BMI correlated moderately with handgrip strength (right: r = 0.485; left: r = 0.494) but weakly with flexibility (Spearman’s rho = 0.037). Conclusions: This study provides culturally relevant normative reference values for handgrip strength and flexibility in school-aged children and its association with age, gender and BMI. Keywords: Dynamometer; flexibility; handgrip; normative values; strength.
Copyright (c) 2026 Anjana Panthee, Nirupama Singh, Nistha Shrestha https://creativecommons.org/licenses/by-nc/4.0
Shock Index and Modified Shock Index as Predictors of Adverse Maternal Outcomes in Primary Postpartum Hemorrhage
Background: Postpartum hemorrhage is a leading cause of maternal morbidity and mortality, particularly in developing countries like Nepal. Early identification of women at risk is vital but traditional methods are sometimes subjective. Simple objective tools are of high importance in times of need. This study aimed to evaluate and compare the predictive performance of the Shock Index and Modified Shock Index for adverse maternal outcomes after primary postpartum hemorrhage. Methods: A hospital based cross sectional study was conducted at a tertiary maternity hospital in Nepal. The study included 281 women diagnosed with primary postpartum hemorrhage. Heart rate, systolic blood pressure and mean arterial pressure were recorded at 1 and 2 hours postpartum. Shock Index and MSI were calculated. The adverse maternal outcomes such as including blood transfusion, surgical interventions or intensive care unit admissions were analyzed. The predictive ability of Shock Index and Modified Shock Index was analyzed using Receiver Operating Characteristic curve analysis. Results: Both Shock Index and Modified Shock Index were significant predictors of adverse maternal outcomes. The single best predictor was identified as Shock Index as measured at 1 hour in women who underwent cesarean delivery, with an Area Under the Curve of 0.811 (95% CI: 0.754–0.868). For vaginal deliveries at 1 hour, Shock Index and Modified Shock Index performed similarly (Area Under Curve 0.777 and 0.776, respectively). Predictive ability decreased at the 2 hour mark, especially for patients post-cesarean delivery. Logistic regression confirmed that cesarean delivery and Shock Index at 1 hour were strong and independent predictors of the adverse outcomes. Conclusions: The Shock Index is a simple and effective tool for the early detection of increased risk of adverse outcomes from postpartum hemorrhage. Modified Shock Index in particular showed greater overall predictability. Its routine implementation in postpartum monitoring, primarily in low-resource settings can significantly aid the triage and facilitate early life saving interventions. Keywords: maternal mortality; modified shock index; postpartum hemorrhage; shock index.
Copyright (c) 2026 Sapana Amatya Vaidya; Madhu Shakya, Anita Maharjan, Shree Ram Khadka, Manisha Yadav, Jwala Thapa, Tripti Shrestha, Aswini Kumar Sah, Soni Newa, Ganesh Dangal https://creativecommons.org/licenses/by-nc/4.0
Knowledge and Attitude on Sexual and Reproductive Health among Migrant and Non-Migrant Adolescent Girls
Background: Adolescent girls in Nepal, particularly those from migrant backgrounds, face barriers in accessing accurate sexual and reproductive health (SRH) information and services. Migration status may influence SRH knowledge, attitudes, and behaviors; however, comparative data within urban school settings are limited. To assess and compare SRH knowledge and attitudes among migrant and non-migrant adolescent girls in high schools of Biratnagar, Nepal. Methods: A descriptive cross-sectional study was conducted among 200 participants (100 migrants, 100 non-migrants) using stratified quota sampling. Data were collected via a structured questionnaire and analyzed in SPSS v25 with descriptive and inferential statistics (Chi-square test). Results: Significant disparities were found between the two groups. Migrant girls demonstrated markedly lower awareness of contraceptive methods (e.g., 0% knew about implants and IUDs), STI symptoms (27.5%), and menstrual hygiene practices. They also reported lower comfort in discussing SRH topics with peers, parents, and health professionals. In contrast, non-migrant girls exhibited higher knowledge levels and more positive attitudes toward SRH services and education. Conclusions: The study highlights a critical gap in SRH awareness and attitude between migrant and non-migrant adolescent girls in Biratnagar. Tailored interventions, including inclusive school-based education, culturally sensitive outreach, and peer-led initiatives, are recommended to address these inequities and promote SRH equity among vulnerable adolescent populations. Keywords: Adolescents; migrants; non-migrants; sexual and reproductive health.
Copyright (c) 2026 Shraddha Bajracharya, Stephen Jay Atwood, Uma Langkulsen https://creativecommons.org/licenses/by-nc/4.0
Retrospective Multifacility Evaluation of the Rural Obstetric Ultrasound Program’s Impact on Antenatal Care
Background: Rural women in Nepal continue to face challenges accessing antenatal care (ANC). To address these challenges, the rural obstetric ultrasound program (ROUSG) was introduced to bring basic ultrasound services to rural health facilities, enabling earlier detection of complications and timely referral. This study assessed whether ROUSG improved ANC attendance, complication detection, and perinatal outcomes. Methods: This retrospective comparative study was conducted at seven health facilities in Kailari Rural Municipality, Kailali District. ANC records of women aged 20-49 were compared across two 12-month periods: before and after ROUSG implementation. Data were analysed using descriptive and inferential statistical tests, with significance set at p ? 0.05. Results: After implementation of ROUSG, the distribution of delivery methods differed significantly (p = 0.032), with fewer vaginal deliveries and more assisted deliveries. A higher proportion of complications was identified, including malpresentation (1.1% vs. 1.9%), hypertension (1.1% vs. 2.3%), and abortion-related complications (1.6% vs. 2.1%). In contrast, early ANC attendance (first and second visits) and facility-based deliveries remained largely unchanged. Maternal mortality was zero in both periods, and neonatal mortality remained low at 0.3% (2 cases) in the pre-ROUSG group and 0.2% (1 case) in the post-ROUSG group. Conclusions: The ROUSG program was associated with greater identification of pregnancy-related complications and changes in delivery management, but no increase in ANC attendance or facility deliveries. These findings suggest that while ultrasound strengthens diagnostic capacity, persistent barriers such as cultural norms, transportation challenges, and limited counselling must also be addressed to improve maternal care-seeking behaviours in rural Nepal. Keywords: Infant mortality; maternal mortality; prenatal care; rural health services; ultrasonography.
Copyright (c) 2026 Seema Sharma, Ritsuko Wakabayashi https://creativecommons.org/licenses/by-nc/4.0
Traditional Medicine Utilization and Determinants in the Rural Area of Manang, Nepal
Background: Traditional medicine (TM) has been an integral part of the rural health care system of Nepal. Despite its widespread use, there exists a notable gap in research on TM utilization and the predictive factors influencing it in rural settings. This study aimed to investigate the use of TM and associated factors in the rural area of Manang, Nepal. Methods: A population-based quantitative cross-sectional study was conducted among 103 individuals from October 2021 to February 2022. A semi-structured questionnaire was used as a research tool. Proportionate and simple random sampling were employed to select the study participants. A logistic regression model was used to assess the determinants of TM utilization among the participants. Results: Overall, 88 out of 103 (85.4%) participants were found to be utilizing traditional medicine. The use of TM was predicted by low monthly income (OR: 4.00, 95% CI: 1.049–15.260, p=0.042) and perceived health status (OR: 8.40, 95% CI: 0.015–0.947, p=0.044). Herbal medicine (68.1%), traditional healers (59.1%), and homeopathic medicine (48.9%) were the primary TM practices among the study populations. Conclusions: People with low income often make TM a more affordable option due to its use of local, inexpensive materials, whereas people who see themselves as healthy or have had a positive experience with TM may prefer it for its cultural and personal value. Keywords: healing practices; healthcare system; herbal plants; homeopathy; traditional medicine.
Copyright (c) 2026 Sandip Pahari, Sansila Pokhrel; Amritraj Pokhrel; Sundar Lamichhane, Deepak Raj Upadhyay, Rival Kushwaha, Denish Yadav, Puskar Adhikari, Sahil Chandra Yadav https://creativecommons.org/licenses/by-nc/4.0
Long-Term Effects of Topical Anti-Glaucoma Medications on Conjunctival Cell Morphology by Impression Cytology
Background: Glaucoma is a major cause of irreversible blindness worldwide. Reduction of intraocular-pressure (IOP) using topical anti-glaucoma medications remains the mainstay of treatment. However, prolonged use of these medications may induce adverse effects on the ocular surface. Methodology: This cross-sectional observational study, conducted at the B.P. Koirala Lions Centre for Ophthalmic Studies, Maharjgunj Medical Campus from February 2023 to August 2024. Patients of primary open angle glaucoma receiving topical anti-glaucoma medications for at least three months were enrolled. Conjunctival- Impression Cytology samples were obtained and graded according to Nelson’s grading system. Data analysis was done using SPSS version 16. A p-value <0.05 was considered statistically significant. Results: 128 eyes from 128 glaucoma patients were analyzed, including 54 males (42.2%) and 74 females (57.8%), with mean age of 58.16 ± 14.44 years. Patients using prostaglandin-analogues demonstrated 39.3% Grade-2 and 27.3% Grade-3 changes. Duration of medication use exceeding three years was significantly associated with higher Nelson grades (p < 0.05). Older patients, particularly those aged 61–70 years, exhibited greater cytological changes (p = 0.005). A significant positive correlation was observed between duration of medication use and severity of conjunctival changes (r = 0.597, p < 0.001). Males exhibited more severe conjunctival changes than females (p = 0.009). Conclusions: Prostaglandin-analogues showed most severe conjunctival cytological alterations. Longer duration of medication use, advancing age, and male gender were significantly associated with conjunctival changes. Keywords: Anti glaucoma medications; conjunctival morphology; impression cytology, ocular surface disorder.
Copyright (c) 2026 Sareena Pachhai; Madhu Thapa; Pragati Gautam, Nisha Sharma https://creativecommons.org/licenses/by-nc/4.0
Antimicrobial Resistance in Bacterial Isolates from Patients Attending a Cancer Center
Background: Bacterial infections are the most frequent complications in patients with malignancy, and the epidemiology of nosocomial infections among cancer patients has changed over time. There is increasing evidence from different parts of the world with high percentage of antimicrobial-resistant bacterial isolates in cancer patients. This study aimed to characterize the antimicrobial resistance in the bacteria isolated from clinical specimens from the cancer patients. Methods: A hospital-laboratory-based, cross-sectional study was conducted on the bacteria isolated from the patients taking medical services at Nepal Cancer Hospital and Research Center (NCHRC), Lalitpur, during June 2023 to May 2024. All the clinical specimens received at the Department of Pathology and Laboratory Medicine, from patients admitted in the wards and OPD of the hospital were processed following standard guideline and protocol for isolation, phenotypic identification and antibiotic susceptibility testing. Results: Out of the 4273 samples processed, bacterial growth was observed in 23% (987) of the samples with 1016 bacterial isolates. The most common isolates were E. coli 36% (364), Klebsiella pneumoniae 24 % (241), Pseudomonas aeruginosa 14% (144) and Citrobacter freundii 8% (78). Bacterial infection was significantly associated with age, gender, fever and prior antibiotic use. Antimicrobial susceptibility testing clearly showed that Gram-negative bacterial isolates were highly resistant to Amoxycillin-clavulanate (66.7% to 100%), Nitrofurantoin (60% to 100%) and least resistant to Amikacin (28% to 50%).Gram-positive were found to be resistant to Amoxycillin-clavulanate (36.8% to100), Ciprofloxacin (35.3% to 68.6%) and least resistant to Vancomycin (14.3% to 17.6%). Multidrug resistance was observed in 68% of the gram-negative and 46.5% in gram-positive bacterial isolates Conclusions: The result clearly indicates the need for local antibiotic resistance/susceptibility dashboard, updated periodically for aligning the local treatment protocols for the hospital, which could help to rationalize the antimicrobial prescription, leading to better patient outcome in terms of morbidity and mortality in highly vulnerable group, like cancer patients. Keywords: Antimicrobial resistance; bacterial infection; cancer; multi-drug resistance.
Copyright (c) 2026 Archana Katuwal, Hari Prasad Dhakal, Banita Gurung, Sanjib Adhikari, Supriya Sharma, Komal Raj Rijal, Megha Raj Banjara, Prakash Ghimire https://creativecommons.org/licenses/by-nc/4.0
Echocardiographic Evidence of Right Ventricular Dysfunction in Patients with Dilated Cardiomyopathy
Background: In dilated cardiomyopathy (DCM), clinical attention primarily focuses on left ventricular (LV) functions, often neglecting the right ventricle (RV). This study aimed to describe the demographics of the patients with a focus on echocardiographic parameters and prevalence of RV dysfunction (RVD) in DCM. Methods: This cross-sectional descriptive study was conducted in the Cardiology Unit, Department of Internal Medicine, Nepal Manipal Teaching Hospital, Pokhara, from September 2024 to August 2025. Patients who had echocardiographic evidence of DCM were evaluated for RVD based on four criteria: tricuspid annular plane systolic excursion (TAPSE), RV peak systolic velocity (RVS’), myocardial performance index (MPI) also known as TEI index, and RV ejection fraction (RVEF). Data were collected in a structured proforma, and statistical analyses were carried out. This study was approved by institutional research committee. Results: Of 100 patients (53 males, 47 females; mean age 58.59±11.98 years), mean TAPSE was 19.32±4.08 mm, RVS’ 11.92 ±1.96 cm/s, TEI index 0.49 ±0.097, and RVEF 44.7%±8.04. RVD was diagnosed in 44 patients by at least one criterion. Individually, RVD was identified in 29 patients by TAPSE, 29 patients by TEI criteria, 16 patients by RVS’, and 40 by RVEF. TAPSE and TEI index showed identical classification results (p = 1.000, two-sided exact test), with no statistically significant difference in their performance. Conclusions: RVEF identified the highest proportion of RVD (40%), supporting its role as a comprehensive reference standard for global RV systolic function. TAPSE exhibited higher sensitivity and specificity than TEI for detection of right ventricular dysfunction. Keywords: Echocardiography; dilated cardiomyopathy; Nepal; right ventricular function; TAPSE; TEI index.
Copyright (c) 2026 Subash Sapkota, Sandeep Guragain, Sanjib Bastola, Rojina Paudel, Samata Nepal https://creativecommons.org/licenses/by-nc/4.0