Bir Hospital (बीर अस्पताल) is the oldest and one of the busiest hospitals in Nepal. It is located at the center of Kathmandu city. The hospital is run by the National Academy of Medical Sciences, a government agency since 2003.The hospital provides medical and surgical treatments. It current has a capacity of 535 beds.[citation needed]It provides some post graduate medical training e.g. general surgery, internal medicine, orthopedic surgery, pathology etc.
Multiple sclerosis (MS) is the most common demyelinating disease of the CNS and disproportionately affects younger individuals, yet it remains underdiagnosed and undertreated in many low and middle-income countries. We describe key barriers to timely diagnosis and effective management of MS in Nepal, including limited public and clinician awareness; restricted access to neurologic care, MRI, and essential laboratory testing; and the high cost of long-term treatment. We also outline practical, context-specific adaptations such as simplified diagnostic pathways, use of affordable immunosuppressive therapies, and sustained advocacy by the Multiple Sclerosis Society of Nepal to improve access and affordability. Our experience illustrates pragmatic, low-cost strategies that may support more equitable MS care in resource-constrained settings.
Rare undiagnosed diseases impose a substantial burden on patients, families, and health systems. Collectively they affect an estimated 300-350 million people worldwide. Of these, approximately 250 million live in low- and middle-income countries (LMICs). Many rare diseases have a genetic basis and can be diagnosed using molecular testing. However, patients in LMICs often lack access to advanced diagnostics and specialist care, leading to prolonged diagnostic odysseys and significant distress. To address this gap, the Global Genomic Medicine Collaborative (G2MC) implemented a Rare Disease Pilot Project to enable clinical genomic testing at six LMIC sites (Chile, Malaysia, Mexico, Nepal, South Africa, Sri Lanka). Using trio exome sequencing for 18 selected families, supplemented by chromosomal microarray as indicated, definitive molecular diagnoses were established in 5 families (pathogenic/likely pathogenic variants explaining the phenotype). An additional 8 families had suspected molecular diagnoses with strong phenotype correlation that require functional validation, while 5 families remained undiagnosed at the end of the pilot. The integration of genomic data into clinical decision-making enabled definitive diagnoses, precise management, and genetic counseling for these patients. The pilot also strengthened local capacity building by conducting cross-site case conferences and enabling local reanalysis of sequence data at sites with bioinformatics capabilities. This study demonstrates the feasibility, effectiveness, and adaptability of implementing exome sequencing in resource-limited settings and highlights its potential to transform rare disease diagnosis and care in LMICs.
BACKGROUND:Antimicrobial resistance (AMR) poses a major global health threat, with health-care-associated infections contributing substantially to mortality. Attributable disease burden remains poorly quantified by relying on cross-sectional and microbiology data. We aimed to characterise AMR epidemiology and disease burden associated with ventilator-associated pneumonia and bloodstream infection in a network of hospitals in Asia. METHODS:This large-scale, prospective, multinational, multicentre cohort study consecutively enrolled patients of any age with microbiologically-confirmed ventilator-associated pneumonia, hospital-acquired bloodstream infections, or health-care-associated bloodstream infections from 41 selected hospitals capable of standardised prospective data collection in 19 Asian countries and regions. Patients with pathogens typically associated with community-acquired infection or not recognised causes of health-care-associated infection were excluded according to predefined protocol criteria, and patients were followed for 28 days. The primary outcome was 28-day mortality from infection onset. Pathogen profiles, antimicrobial prescriptions, attributable mortality, and health-related quality-of-life outcomes were analysed. FINDINGS:Between Sept 1, 2022, and Feb 28, 2025, 10 111 patients were enrolled, and after exclusions, 9496 patients were included in the final analysis. 9642 infection episodes were analysed, comprising 6597 (68·4%) bloodstream infections and 3045 (31·6%) ventilator-associated pneumonia. Of these infections, 7102 (73·7%) of 9642 infection episodes were associated with AMR bacteria, and Gram-negative bacteria were predominant (7599 [78·8%]). Crude 28-day mortality was 2674 (37·7%) of 7102 AMR infection episodes and 1900 (40·6%) of 4683 multidrug resistance infection episodes, with the highest for carbapenem-resistant Acinetobacter spp (CRA; 51·3%) and carbapenem-resistant Enterobacterales (CRE; 48·4%). AMR-attributable mortality was the highest in ventilator-associated pneumonia (16·9%, 95% CI 13·0-20·9), individuals aged 5-14 years (11·7%, 95% CI 1·6-21·8), individuals aged 15-49 years (11·2%, 95% CI 7·2-15·2), and lower-middle-income countries (10·7%, 95% CI 7·0-14·4). By pathogens, CRA and CRE had the highest attributable mortality (19·4%, 95% CI 14·1-24·7 vs 16·2%, 95% CI 12·8-19·6) and also had the poorest quality-of-life outcomes. Most carbapenem-resistant Gram-negative infections were treated with carbapenems (57·8%) or polymyxins (35·6%). INTERPRETATION:AMR bacterial bloodstream infections and ventilator-associated pneumonia were common and associated with high mortality and reduced quality of life in Asia, particularly in infections due to carbapenem-resistant Acinetobacter spp and CRE, and among children and younger adults. The widespread use of suboptimal antimicrobial regimens highlights the urgent need for equitable access to effective therapies and context-specific evidence to guide antimicrobial stewardship. FUNDING:Wellcome Trust, National University of Singapore, Yong Loo Lin School of Medicine, Duke-NUS Medical School, Nanyang Technological University (Lee Kong Chian School of Medicine), Singapore National Centre for Infectious Diseases, and Singapore Medical Research Council.
Cytopathology in Nepal has expanded considerably over recent decades, playing a key role in the diagnosis of both malignancies and infectious diseases. This article reviews the historical evolution, current practices, specimen types, processing techniques, and reporting systems in Nepal. It also outlines cytopathology training, workforce development, and cervical cancer screening initiatives. Despite this progress, access to advanced ancillary techniques such as immunocytochemistry and molecular testing remains limited, with reliance on referral laboratories. Ongoing challenges include resource constraints, uneven infrastructure, and limited subspecialty training opportunities. Strengthening diagnostic capacity through expanded infrastructure, quality assurance, and targeted training will be essential for future growth. Due to limited published data, some observations are based on the authors' experience.
Background: Diaphyseal fractures of the femur constitute approximately 1.6% of skeletal trauma encountered in the pediatric population. While historical management emphasized prolonged immobilization via traction and spica casting, contemporary practice increasingly favors operative stabilization to accelerate functional recovery and mitigate complications associated with extended recumbency. Among children aged 6–14 years, treatment options include secondary spica application, elastic stable intramedullary nailing (ESIN), submuscular plating, or external fixation for open injuries. This investigation assesses clinical and radiographic outcomes following stainless steel flexible intramedullary nailing for displaced femoral shaft fractures within this age cohort. Methods: This is a retrospective study of 30 patients in the age group of 6-14 years with displaced femoral shaft fractures that were fixed with stainless steel flexible intramedullary nail under fluoroscopy at Narayani hospital Birgunj. Patients were followed clinically and radiologically for six months. The results were evaluated using Flynn’s criteria. Technical difficulties and complications associated with the procedure were also analyzed. Results: Excellent outcomes were achieved in 18 cases (60%) and satisfactory results in 12 (40%), with no poor outcomes. The mean patient age was 9.5 years. Road traffic accidents were the predominant injury mechanism (60%), and middle-third fractures were most common (66.7%). The mean hospital stay was 10 days, and all fractures achieved radiographic union at an average of 10 weeks. Entry-site soft tissue irritation occurred in 5 patients. Three cases demonstrated mild malalignment with an average limb length discrepancy of 0.5 cm; all remained asymptomatic and required no revision surgery Conclusion: Flexible intramedullary nailing provides a minimally invasive, growth-sparing fixation method with a high rate of excellent outcomes and a low complication profile in children aged 6–14 years. Larger multicenter studies with extended follow-up are recommended to further validate long-term functional results.
