Manipal Teaching Hospital (MTH) (मणिपाल टीचिंग हस्पिटल) is the teaching hospital of Manipal College of Medical Sciences (MCOMS) and is located in Fulbari, Pokhara, Nepal. It is owned by Manipal Education and Medical Group, MEMG.Manipal College of Medical Sciences (MCOMS), Pokhara was established in 1994 with an MBBS programme. MCOMS was the first private medical institute in Nepal established after liberalization in 1990. MCOMS was conceived after an agreement between Government of Nepal and Manipal Education and Medical Group MEMG in 1992. The MBBS program began in December 1994 with temporary recognition by Nepal Medical Council and Affiliation to Kathmandu University. The first batch passed final MBBS in July 1999 and completed internship in July 2000.Western Regional Hospital back in 1996 known as Gandaki Zonal Hospital was initially used for clinical teaching purposes. Green Pastures Hospital and Regional Tuberculosis Center are being used till date partially. The 700-bed Manipal Teaching Hospital (MTH), Pokhara was inaugurated in 1998 by Shree 108 Jagat Guru Shankaracharya. Prof. Dr. O.P Talwar was the first Medical Superintendent of MTH. It was enriched to 865 beds with expansion of services in Cardiology, Gastroenterology, Neurology, Neurosurgery, and Surgical Oncology.
Impetigo is a common, contagious superficial bacterial skin infection predominantly affecting children aged two to five years. Severe presentations are rare but can be diagnostically and therapeutically challenging, particularly in rural, resource-limited settings. We report a 7-year-old girl from rural Nepal with severe non-bullous impetigo contagiosa unresponsive to initial therapy with topical mupirocin and oral cephalexin. Due to the absence of culture and sensitivity facilities and the high regional prevalence of methicillin-resistant Staphylococcus aureus (MRSA), empirical oral doxycycline was initiated. Marked improvement occurred within 48 hours, with complete resolution by day 7. This case underscores the importance of flexible, evidence-based empirical therapy for suspected MRSA in pediatric patients when diagnostic resources are unavailable, and highlights the short-term safety and efficacy of doxycycline in children.
Introduction and importance: Median arcuate ligament syndrome (MALS) is a rare and often underrecognized cause of postprandial abdominal pain resulting from extrinsic compression of the celiac artery by the median arcuate ligament. Diagnosis is challenging due to nonspecific symptoms, overlap with common gastrointestinal conditions, and dynamic anatomical variations. Case presentation: A 48-year-old woman with a 2-year history of postprandial epigastric pain underwent multiple evaluations across specialties without a definitive diagnosis. Contrast-enhanced computed tomography ultimately revealed focal celiac artery stenosis with post-stenotic dilatation and well-developed collateral circulation between the common hepatic artery and superior mesenteric artery, confirming MALS as the cause of her symptoms and guiding a multidisciplinary management plan. Clinical discussion: MALS results from extrinsic compression of the celiac artery, occasionally compounded by variations in arterial origin, ligament position, or neural plexus involvement. Its nonspecific presentation often mimics common gastrointestinal conditions, making imaging essential for diagnosis. Emerging evidence suggests that prominent collateral circulation in the setting of significant celiac artery stenosis is associated with symptom development, as demonstrated in our case. Conclusion: MALS should be considered as a diagnosis of exclusion in patients with persistent postprandial abdominal pain. Recognition of prominent collateral circulation alongside significant celiac artery stenosis may serve as a key indicator of disease severity and symptomatic correlation.
BACKGROUND:Surgical site infections (SSIs) are among the most common complications following colorectal surgery. This study aimed to systematically review existing evidence on the outcomes of subcutaneous negative suction drain versus no drain in adults undergoing colorectal surgeries. METHODS:A systematic review and meta-analysis was conducted to compare the SSI rates between subcutaneous negative suction drain and the no-drain in adults (18 years or older) undergoing colorectal surgery. Randomized controlled trials (RCTs), prospective, or retrospective studies till 2025 reporting use of subcutaneous negative suction drain in elective and emergency colorectal surgeries were included. SSI was defined based on Center for Disease Control and Prevention (CDC) criteria. Results were expressed as Relative Risk (RR) and Confidence interval (CI) of 95%. A p value < 0.05 was considered statistically significant. RESULTS:Combined data from 2177 patients across 10 studies (four: RCTs, five: retrospective cohort, and one: prospective cohort) showed a significant reduction in overall SSIs by 60% (RR = 0.40; 95% CI, 0.30-0.53; p < 0.0001) in groups with a subcutaneous negative suction drain compared to those without. There was a significant reduction in superficial SSIs by 58% (RR = 0.42; 95% CI, 0.26-0.66; p = 0.0002). There was no significant reduction in deep SSIs and organ-space SSIs. The included studies were of medium to high quality. CONCLUSIONS:Subcutaneous negative suction drains reduce overall and superficial SSI after colorectal surgery, but do not affect deep or organ-space infection. ORIGINALITY STATEMENT:This paper provides updated evidence demonstrating that subcutaneous negative suction drains significantly reduce overall and superficial surgical site infections after colorectal surgery, and acknowledges their limited effect on deep and organ-space infections, supporting selective use. TRIAL REGISTRATION:The study protocol was registered with PROSPERO international prospective register of systematic Reviews (Registration ID: CRD420251012636).
Introduction and importance:Neuromyelitis optica spectrum disorder (NMOSD) is an antibody-mediated central nervous system disorder, typically presenting with optic neuritis (ON) and longitudinally extensive transverse myelitis (LETM). Detection of anti-aquaporin 4 (AQP4) antibodies establishes the diagnosis, even in patients without classic clinical features. Case presentation:A 32-year-old female presented with progressive ascending quadriparesis and sensory deficits. Neurological examination revealed significant hypotonia and weakness, more pronounced in the lower limbs. Spinal magnetic resonance imaging showed LETM involving cervical and thoracic segments, correlating with symptoms. AQP4-IgG positivity confirmed the diagnosis of NMOSD. The patient showed no improvement with intravenous methylprednisolone and plasmapheresis. Subsequent early initiation of Rituximab, combined with comprehensive physiotherapy, resulted in significant functional recovery within a follow-up period of 1 year. Clinical discussion:NMOSD variably presents with limited or atypical presentations. Early-stage disease may be easily overlooked, particularly in the absence of classical optical or spinal symptoms. Early recognition followed by timely initiation of pharmacotherapy and prompt escalation to targeted immunotherapy like Rituximab - which depletes peripheral B cells and reduces pathogenic AQP4-IgG antibody production targeting disease pathophysiology - can lead to significant neurological improvement. When combined with comprehensive physiotherapy, these interventions support motor recovery, enhance mobility, and improve overall quality of life. Conclusion:Early recognition of NMOSD and timely escalation to Rituximab, especially when first-line therapies fail, can drive meaningful neurological recovery. Coordinated physiotherapy further strengthens functional outcomes, highlighting the importance of an integrated therapeutic approach in severe or refractory disease.
Abstract Background and aims The Nepal Stroke Project (NSP), implemented since 2021, is a comprehensive multi-component programme aimed to strengthening stroke care across population, hospital, health system, and policy levels. This study presents the NSP impact evaluation, assessing whether and how NSP plausibly contributed to observed improvements in stroke care and outcomes. Methods We conducted a theory-based contribution analysis guided by an Theory of Change developed iteratively with national and international stakeholders. Impacts were assessed at population, hospital, health system, and policy levels using mixed methods, including registry data, document review, surveys, focus groups, and interviews. A realist evaluation lens was applied to explore context–mechanism–outcome configurations and investigate alternative explanations. Results At the health system level, NSP achieved substantial workforce development and increased the visibility and prioritisation of stroke care. Physicians reported strengthened professional confidence, enhanced leadership engagement, and participation in international research collaborations, with external validation identified as a key enabling mechanism. However, translation of knowledge into routine clinical practice was partially constrained by structural inertia and limited regulatory support. NSP public awareness activities contributed to increased stroke knowledge in target areas, although no measurable changes in health-seeking behaviour were observed. At the policy level, NSP contributed to the development and endorsement of a national stroke protocol through sustained advocacy in collaboration with WSO and WHO. Conclusions NSP plausibly contributed to multi-level improvements in stroke care in Nepal by combining capacity building, advocacy, and international partnership. Its Theory of Change provides a blueprint for strengthening stroke systems in comparable resource-limited settings. Conflict of interest Funding: Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ)
