College of Medical Sciences

Photocatalytic hydrogen (H-2) production represents a highly promising pathway for future H-2 supply, yet efficient photocatalysts for water splitting remain scarce. This study synthesized two covalent organic framework (COF) materials (PorBpy-COF and ZnPorBpy-COF) via the Knoevenagel condensation reaction. These COFs feature a donor-acceptor structure and incorporate highly polar cyano groups, thus enhancing their electron-hole separation efficiency and photocatalytic activity for superior photocatalytic H-2 production. Furthermore, Ni2+ was coordinated to the bipyridine sites of ZnPorBpy-COF, yielding n wt %Ni@ZnPorBpy-COF (n = 1, 3, and 5) and 3 wt %Ni@ZnPorBpy-COF exhibited a H-2 production rate as high as 13.40 mmol g(-1) h(-1), surpassing some previously reported COF-based catalysts, while demonstrating excellent stability over 20 h. This enhancement is attributed to the postconstructed "porphyrin-Zn2+-bipyridine-Ni2+" dual-metallic synergistic system, which improves the charge-carrier dynamics. This work elucidates the structure-function relationship of COF-based photocatalysts, providing insights for next-generation hybrid COF systems.

ABSTRACT A 35‐year‐old female presented with 5 days of fever, fatigue, and myalgia during the post‐monsoon season at Damak Hospital, Jhapa, Nepal. Clinical examination revealed fever (102.7°F), tachycardia (110 bpm), and crackles in the right lower lung field. Laboratory investigations showed anemia (Hb 8.9 g%), leukopenia (3300/cumm), elevated liver enzymes (SGPT, 117 IU/L; SGOT, 94 IU/L; ALP, 391 U/L), and elevated CRP (18.58 mg/dL). ELISA testing demonstrated concurrent positivity for Salmonella typhi IgG/IgM, scrub typhus IgM, and Brucella abortus antigens. Blood and urine cultures were negative. Abdominal ultrasonography revealed hepatosplenomegaly. The patient initially received ceftriaxone and doxycycline, without any response. Following serological evidence of brucellosis, rifampicin 600 mg daily was added, and the patient became afebrile within 3 days. The patient was discharged on doxycycline 100 mg daily for 35 days and rifampicin 600 mg daily for 40 days. At 3‐month follow‐up, clinical examination and laboratory tests confirmed complete recovery. This case highlights the diagnostic challenges posed by serological cross‐reactivity among endemic febrile illnesses in resource‐limited settings, emphasizing the need for cautious test interpretations and clinical correlations.

Background: Craniopharyngiomas are benign tumors that develop in the sellar and suprasellar region of the brain. Their location often leads to significant health complications due to the pressure exerted on nearby critical structures. Surgical removal remains the cornerstone of treatment. One of the major challenges is the high rate of recurrence, which affects approximately 30% to 40% of patients, even after seemingly successful surgery. Gaining these insights of causes of recurrence is crucial for guiding treatment choices and planning effective long-term follow-up care. Objectives: To identify the recurrence predictors of craniopharyngioma and correlate it with other factors. Methods: This observational study was carried out at a tertiary care center over a four-year period, from January 2020 to January 2024 that included 25 patients who underwent surgical removal of craniopharyngiomas. Based on their postoperative follow-up, patients were divided into two groups: those who experienced tumor recurrence and those who did not. Data were collected based on each patient’s demographics, symptoms, imaging findings, tumor subtype, and the presence of β-catenin expression through immunohistochemistry. Results: In this study, the overall recurrence rate of craniopharyngiomas was 40%. Recurrence was notably higher in certain subgroups like in males (68%). Tumors with calcifications on imaging were also more likely to recur (88%). A strong association was also observed between beta-catenin expression and the likelihood of recurrence. In contrast, no significant link was found between recurrence and factors such as gender, preoperative hormonal status. Conclusion: Our findings suggest that younger age at diagnosis, the presence of calcification are all significantly associated with a higher risk of tumor recurrence. Additionally, positive β-catenin immunoreactivity emerged as a potential biomarker for identifying tumors with more aggressive behavior.

INTRODUCTION Gallstone disease is a common cause of hospital admission worldwide, including in Nepal. While many cases are asymptomatic, some develop complications requiring surgery. Laparoscopic cholecystectomy is the standard treatment. Ultrasonography is the main diagnostic tool, but discrepancies with intraoperative findings may occur. This study evaluated its ability to predict operative findings. MATERIAL AND METHODS An analytical cross-sectional study was conducted over six months in the Department of General Surgery at Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, Nepal. Although the minimum sample size was 93, a total of 150 patients with symptomatic cholelithiasis undergoing laparoscopic cholecystectomy were included. Data were analyzed using Microsoft Excel and SPSS version 20. Continuous variables were expressed as mean ± standard deviation and categorical variables as frequency and percentage. Chi-square and concordance analysis were applied, with p< 0.05 was considered significant. RESULTS Among 150 patients, 125 (83.3%) were females and 25 (16.7%) were males. The mean age was 45.44 ± 13.51 years, with most patients aged 41–60 years (47.3%). Preoperative USG showed a distended gallbladder in 49.3% and multiple stones in 54.7%, with the largest stone ≥1 cm in 72% of patients. Intraoperatively, the gallbladder appeared normal in 81.3% of cases, and multiple stones were found in 60.7%. Adhesions were present in 28.7% of patients, and conversion to open surgery occurred in 1.3%. Significant concordance was observed between USG and intraoperative findings for the number and size of stones (p<0.001), while gallbladder wall thickness and pericholecystic collection showed no significant association. CONCLUSION Preoperative ultrasonography predicts gallstone number and size but less accurately assesses gallbladder wall thickness and pericholecystic fluid; intraoperative evaluation remains essential.

Background Peptic ulcer disease (PUD) is an important cause of gastrointestinal morbidity in South Asia, yet contemporary endoscopy-based data from Nepal are limited and rarely capture modifiable risk factors. We aimed to estimate the prevalence and anatomical pattern of PUD and to examine its associated risk factors at a tertiary centre in central Nepal. Methods We conducted a retrospective cross-sectional study of 1,242 consecutive adults who underwent upper gastrointestinal endoscopy between April and December 2025. PUD was defined as an endoscopically confirmed gastric and/or duodenal ulcer. A nested case–control analysis matched 224 PUD cases to 448 ulcer-free controls (1:2) on age and sex; drug, lifestyle and comorbidity exposures were abstracted from medical records. Associations were assessed using logistic regression. Results PUD prevalence was 18.0% (224/1,242). The mean age was 49.6 ± 16.6 years and 50.4% were male. Ulcers were gastric-only in 67.4%, duodenal-only in 18.8% and both in 13.8%; the antrum was involved in 67.9% of cases. Among tested patients, Helicobacter pylori positivity was 94.8% and was near-universal in both cases (97.8%) and controls (95.3%), and therefore did not discriminate cases from controls (odds ratio 1.97; p = 0.19). In an exploratory case–control analysis, NSAID use (adjusted odds ratio [aOR] 7.41, 95% CI 2.09–26.29) and ever-smoking (aOR 2.11, 1.08–4.14) were associated with PUD, whereas alcohol, comorbidities, age and sex were not. Conclusions Approximately one in five endoscopy patients had PUD, predominantly antral, with a shift from duodenal towards gastric ulcers across increasing age and in women. Against a background of near-universal H. pylori infection, NSAID use and smoking were associated with ulceration in an exploratory case–control analysis. These contemporary descriptive data provide a baseline for central Nepal and generate hypotheses about modifiable risk factors that warrant confirmation in prospective studies.