Cardiovascular diseases are the leading cause of global mortality, with a disproportionate burden in low- and middle-income countries. Adolescence is a formative stage when risk behaviors such as poor diet, inactivity, and substance use often begin and become ingrained. At the same time, this period offers an opportunity to equip young people with cardiovascular health awareness and Cardiopulmonary Resuscitation skills, enabling them to safeguard their own future health and respond effectively in in critical moments where immediate action saves lives. This review synthesizes global and regional evidence on nurse-led, school-based educational programs addressing cardiovascular health awareness, recognition of heart attack symptoms, and immediate lifesaving skills among adolescents.
Introduction: Extended Spectrum beta lactamase producing gram negative bacteria are global concern as they harbour plasmid mediated enzymes encoded by blaTEM, blaCTX-M and blaSHV genes. Methods: Blood samples were received from patients admitted in various ICUs of Adesh hospital. Identification and antimicrobial susceptibility testing was done by Vitek 2 compact system. Phenotypic detection of ESBL production was done by Combined disc synergy test. Single PCR was used for detection of blaCTX-M, blaTEM and blaSHV genes. Results: Out of total 1875 blood samples processed, 120 blood samples showed bacterial growth. Prevalence of bacteremia was recorded as 120 (6.40%). 1196 (63.77%) patients were males and 679 (56.77%) were females, 76 (6.35%) bacteremia recorded from male patients and 44 (6.48%) from female patients. The prevalence of blood stream infection was seen 20 (9.52%) in SICU. Out of 120 bacterial growths, 75 identified as E. coli 29 (38.66%), K. pneumoniae 27 (36%), P. aeruginosa 07 (9.33%), A. baumannii 12 (16%). 33 (44%) were recorded as ESBL producers and 42 (56%) isolates were non-Extended Spectrum beta lactamase producers. Out of 33 phenotypically positive Extended Spectrum beta lactamase producer isolates, blaTEM gene was detected 22 (66.66%) followed by blaCTX-M 21 (63.63%). Conclusions: Extended Spectrum beta lactamase detection has less use in clinical management rather it is important to identify epidemiological linkages. For clinicians, recurrent isolation of Extended Spectrum beta lactamase producing organisms’ isolation from ICUs may be an issue related to Infection Prevention and Control.
Introduction: Chronic low back pain is a common condition that affects millions of people worldwide, and the sacroiliac joint has been identified as a potential source of this pain. Despite its prevalence, the diagnosis of sacroiliac joint dysfunction is challenging, and there is no definitive diagnostic test available. Therefore, clinical diagnosis is often used to identify such patients. The aim of this study was to determine the prevalence of sacroiliac joint dysfunction in patients with chronic low back pain using clinical diagnosis. Methods: Two hundred and twenty-five adult patients with chronic low back pain for more than three months’ duration attending the outpatient department of Orthopedics of Kathmandu Medical College Teaching Hospital were included. Five provocation tests, namely pelvic compression, Flexion Abduction External Rotation, Gaenslen test, distraction, and thigh thrust were done and if three or more of the above tests were positive, the patients were labelled as having sacroiliac joint dysfunction. Demographic data, the presence of sacroiliac joint dysfunction, occupation, and duration of low back pain were analyzed using descriptive statistics. Results: Among 225 patients, the mean age of the participant was 44.96 years (±14.85) and 124 (55.11%) were female. Sacroiliac joint dysfunction was found in 49 patients, which accounts for a prevalence of 21.77%. Conclusions: The prevalence of sacroiliac joint dysfunction in our study is 21.8% which is similar to the global prevalence.
General Practitioners in Nepal are trained for one of the broadest clinical scopes in the region - primary care, emergency medicine, obstetrics, rural surgery, critical care, yet nearly two-thirds of sanctioned General practicioners posts nationwide sit vacant. This viewpoint, drawn from a keynote delivered at the 5th National Health Summit and 30th All Nepal Medical Conference in Chitwan, argues that Nepal’s path to equitable, efficient health care does not require new capacity and sophisticated care so much as better use of what already exists. Standing on the Astana Declaration and the General Practice Reformative Agenda 2024, Primary Health Care Center as the foundation for Universal Health Coverage and the Sustainable Development Goals reframes the General practitioner from “gatekeeper” to “health agent”.
Introduction: Urinary tract infections are global health concerns requiring empirical antibiotic therapy. The increasing cases of antimicrobial resistance in developing countries, such as Nepal, are a challenge to standard treatment protocols. This study aims to determine the prevalence, antimicrobial susceptibility patterns and two-year trend of uropathogens at Kathmandu Medical College Teaching Hospital. Methods: A retrospective cross-sectional study was conducted using 1,410 culture-positive urine samples collected between April 2023 and April 2025. The antimicrobial susceptibility was determined using the Kirby-Bauer disc diffusion method as per Clinical and Laboratory Standards Institute guidelines. The data were statistically analysed using IBM SPSS version 26.0. Results: Out of 1,410 culture-positive samples, Escherichia coli was isolated in 912 (64.68%) and Klebsiella pneumoniae in 231 (16.38%). Multidrug resistance was detected in 661 (46.88%) isolates; males were 258 (62.02%) and females were 403 (40.54%). Escherichia coli demonstrated resistance to cefixime in 516 (58.04%) and ciprofloxacin in 83 (52.87%) isolates. Conclusions: Escherichia coli continues to be the most common uropathogen and the two-year antimicrobial susceptibility trends show that nitrofurantoin is still useful in uncomplicated cases despite increasing resistance trends. This finding underlines the importance of ongoing surveillance and frequent updating of local antibiograms to ensure continued adequate empiric treatment decisions in tertiary care centres.
Trichoblastoma is a dermal based benign basaloid epithelial and stromal tumor with a complex architecture, with differentiation towards a primitive hair follicle typically seen arising on hair-bearing skin. It usually manifests as a single, well-circumscribed, slowly growing nodule and smaller than 2 cm that has predisposition to head and neck, with a preference for the scalp. The distal extremities are infrequent sites. Giant trichoblastoma may reach upto 10 centimetres in size and have only limited documentation in medical literature and most of these reported cases were found on the scalp, arm or thigh. These lesions can clinically and radiologically mimic malignancies due to their size and morphological ambiguity. Isolated reports have been documented on the malignant transformation to trichoblastic carcinoma, although it is rare. Most of these occur sporadically, though some cases show genetic alterations, involving PTCH1 gene on chromosome 9q22.3 which further has been linked to familial syndromes, like Brooke–Spiegler syndrome and Brooke–Fordyce syndrome.
Introduction: The discrepancy between healthcare capacity for surgical interventions and surgical diseases has been a major challenge, resulting in long waiting times for surgical interventions. This study aimed to determine waiting times for various urological interventions, identify contributing factors, and assess the resulting impact on patients’ lives. Methods: This is an observational cross-sectional study carried out on 428 patients who underwent urological procedures in the department of urology and kidney transplant surgery from May 2024 to February 2025. Descriptive analysis was done to assess demographic characteristics, the reason for visiting the center, types of procedure, the tentative and exact duration of waiting time, causes of delay, approximate expenses for surgery, and the impact of the waiting list on patients’ lives. Results: The waiting times for urgent, semi-urgent, elective and minor procedures were 11.07±8.40 hours, 31.11±18.15 days, 190.41±97.54 days, and 24.66±13.30 days, respectively. Long queues for surgery 336 (78.50%) and busy operation schedules 324 (75.70%) were causes of delay from the patients’ and surgeons’ perspectives, respectively. A total of 162 patients (37.84%) patients either had to take loans or sell their assets for the urological procedures. Interruption of work to support the family’s livelihood was the reported by 210 (40.07%) and work routine was compromised by 137 (32.01%), Conclusions: From the patients’ perspective, long queues for surgery were the primary cause of delay, while surgeons most often attributed delays to busy operating schedules. The prolonged waiting times have resulted in significant psychosocial and economic burdens on patients.
Introduction: Type 1 diabetes mellitus is a chronic autoimmune disease that leads to destruction of the pancreatic beta cells responsible for insulin production. The principal etio-pathological factors in type 1 diabetes include genetic predisposition, autoimmunity and viral infections; many of which also contribute to pathogenesis of various other co morbidities. The aim of the study was to determine prevalence of other coexisting conditions associated with type 1 diabetes. Methods: This descriptive cross-sectional study was conducted in pediatric diabetic clinic from January to December, 2025. Data was collected via semi structured interview of patient and parents through history, examination, laboratory and ophthalmologic evaluation reports. Discrete variables presented as number and percentage and continuous variables presented as mean±standard deviation. Results: Among 55 patients diagnosed as type 1 diabetes, hypothyroidism was noted in 5 (9.09%) patients. Fourteen (23.63%) patients were observed to have short stature, 17 (30.90%) had wasting and 12 (21.81%) were underweight; in total 25 (45.45%) diabetes cases had a form of undernutrition either stunting or wasting or underweight or all. Fifteen (27.27%) patients had delayed puberty, 9 (16.36%) had vitamin D deficiency and 3 (5.45%) had anemia. Total 14 (25.45%) cases were recorded to have diabetes complication (retinopathy, uveitis, cataract, peripheral neuropathy, diabetic foot, hypertension, lipid disorder, still birth). Conclusions: A variety of coexisting conditions including malnutrition, vitamin deficiencies, genetic condition, autoimmune diseases and diabetic complications were observed among our patients.
Introduction: Tongue carcinoma behaves aggressively and spreads early to cervical lymph nodes. Whether level IIb should be routinely dissected remains debated: metastasis to this sublevel is uncommon, yet dissection risks postoperative shoulder morbidity. We conducted this study to determine how often level IIb nodal metastasis occurs in patients with carcinoma of the tongue who were treated at our center. Methods: A total of 85 patients with carcinoma of the tongue were enrolled in a prospective study. Level IIb nodal status was examined in relation to age, sex, primary tumor subsite, clinical stage, and level IIa nodal status. Point estimate at 95% Confidence Interval was calculated along with frequency and percentages for binary data, and mean and standard deviation for continuous data. Results: Out of 85 patients, 14(16.47%; 95% CI: 10.07-25.77) had level IIb metastasis. The mean age was 54.09±14.10 years, and 68(80.00%) patients were male. Among those with level IIb disease, 13 (92.86%) had primary tumors at the lateral border of the tongue. Level IIb positivity was confined to stage IV patients. Isolated level IIb disease was found in 2 (2.35%) patients. Ten of the 14 patients with level IIb involvement also had concurrent level IIa metastasis. Conclusions: Level IIb metastasis occurred mainly in advanced tongue carcinoma and was strongly linked to level IIa nodal disease. Selective preservation of level IIb may be considered in early stage cases, but should not be routinely applied in patients with advanced disease.
Carbon monoxide poisoning is a leading cause of accidental death due to its colorless, odorless and ability to cause tissue hypoxia via carboxyhemoglobin formation. A multi-victim incident in Lalitpur, Nepal, took place where five of six family members died following indoor charcoal burning in a poorly ventilated room whereas a 23-year-old male survived. Autopsy findings included pinkish-red lividity, organ pinkish red discoloration, and visceral congestion. This case highlights the diagnostic challenges of carbon monoxide poisoning, where classical signs are inconsistent, and also emphasizes the importance of correlating scene investigation, autopsy findings, and toxicology. It shows the consequences of indoor combustion in enclosed environments and the potential for multi-victim fatalities in a single setting. The differential outcome observed in the sole survivor shows the influence of exposure and environmental factors in carbon monoxide toxicity. Preventive measures such as improved ventilation and public awareness are essential to reduce such fatalities.
Introduction: Infective endocarditis is a life-threatening condition with rising incidence now days leading to a serious complications like heart failure, stroke and multiorgan dysfunction. Staphylococcus aureus has become a leading causative organism now days world-wide. Limited research in Nepal highlights the need to explore the epidemiology, clinical profiles, and outcomes of Infective endocarditis. This study addresses these gaps in a tertiary care setting. Methods: This single-center, hospital-based cross-sectional study was conducted from April, 2022 to April, 2024 in the cardiology department of Manmohan Cardiothoracic Vascular and Transplant Center. A total of 39 patients aged 18 years and older, diagnosed with infective endocarditis based on modified Duke’s criteria, were included. Data were analyzed using MS Excel and SPSS version 26.0, employing percentages, means, medians, and standard deviations. Results: Among the 39 patients with infective endocarditis, 33 (84.61%) were male, with a mean age of 34±13.49 years. The mean hospital stay was 23.28±15.47 days. The culture isolated Enterococcus 3 (7.69%), Staphylococcus 3 (7.69%) and Streptococcus 1 (2.56%). The predisposing factors included rheumatic heart disease 17 (43.58%), IV drug user 12 (30.76%), and prosthetic valve 4 (10.25%). The complications seen were heart failure 8 (20.5%), septic shock 4 (10.25%) and AKI 4 (10.25%) with overall mortality of 9 (23.08%). Conclusions: Infective endocarditis continues to impose a substantial clinical burden in Nepal, with high rates of complications and in-hospital mortality despite contemporary management.
The digital health landscape in Nepal is in a crucial juncture of transitioning from individual donor-funded pilots to a national-level architecture that is integrated and supported by the Digital Health Blueprint and the National Health Sector Strategic Plan (2023-2030). Tracking health services interoperability standards through FHIR, implementation of open-source Electronic Medical Record Systems such as OpenMRS and deployment of Distric Health Information Software 2 Tracker modules for longitudinal patient monitoring at the municipal level have shown significant progress. The momentum is, however, constrained by structural challenges, such as geographical inequalities in Information and Communication Technology infrastructure, low digital literacy, high turnover of the healthcare workforce and the absence of common standards for electronic data. Nepal needs to shift the focus from project funding to institutionalized funding, institutionally designed training of workforces, and strong data governance. Although new developments, such as big data analytics and blockchain, offer exciting future avenues, the first is to have a solid base infrastructure that works dependably at scale and is stable, secure, and interoperable.
Introduction: Acute heart failure is a major cause of hospitalization worldwide and is associated with significant morbidity and mortality. Atrial fibrillation, a common comorbidity in acute heart failure, may adversely influence clinical outcomes; however, data from low- and middle-income countries, including Nepal, remain limited. This study aimed to determine the prevalence of atrial fibrillation and evaluate its association with in hospital outcomes among patients admitted with acute heart failure. Methods: This hospital-based cross-sectional study was conducted in two tertiary care centers in Kathmandu, Nepal, over one year. A total of 156 patients aged ≥18 years admitted with acute heart failure were included. Data on demographics, comorbidities, and echocardiographic parameters were collected. Adverse hospital outcomes were defined as a composite of in-hospital mortality, acute kidney injury and stroke. Results: The mean age of patients was 62±11.50 years, with 85 (54.48%) males. Reduced ejection fraction (<40%) was observed in 96 (61.53%) of patients. Hypertension 50 (32.12%), diabetes 44 (28.21%), and smoking 41 (26.31%) were common risk factors. Valvular heart disease was seen as cause in 59 (37.82%) cases. Adverse hospital outcomes occurred in 49 (31.41%) patients; acute kidney injury, mortality and stroke were 36 (23.07%), 11 (7.05%) and 2 (1.28%) patients respectively. Atrial fibrillation was seen in 60 (38.46%) patients and was significantly associated with adverse outcomes compared to non-AF patients (p<001). Conclusions: Atrial fibrillation is significantly associated with worse in-hospital outcomes in patients with acute heart failure, highlighting the need for early identification and aggressive management.
Introduction: A hospital based cross-sectional study was conducted to determine the prevalence and pattern of ocular morbidities among pediatric patients attending a tertiary eye hospital in Nepal. Methods: 424 children visiting the pediatric department of Nepal Eye Hospital were selected based on systematic sampling. The enrolled subject underwent a detailed ophthalmic examination including visual acuity, refraction, anterior segment, and fundus evaluation along with the cover test in order to rule out any strabismic binocular vision anomalies. Results: Out of 424 samples with mean age of 9.05±3.82, 218 (51.42%) were male and 206 (48.58%) were female. Refractive error was the most common ocular morbidity among 231 (54.48%) of the participants followed by ocular infections affecting 70 (16.50%) of the enrolled subjects. Although refractive error had equal gender-based predisposition, it was reported to be higher in the children of age group between 1 to 12yrs 140 (33.01%). A predominance of astigmatism, particularly compound myopic astigmatism, was observed among the individuals, followed by low-magnitude myopia. Beside anomalies of refraction, strabismus, amblyopia, Retinopathy of Prematurity, cataract, and ocular allergy were also reported in a considerable proportion. Conclusions: Higher prevalence of ocular morbidities among pediatric population reflects the need of early diagnosis, evaluation, and management as visual impairment in the early age can have serious impact in their overall development.
Introduction: The 2015 Constitution of Nepal guarantees health as fundamental right, while the Consumer Protection Act 2018 provides legal remedies for medical negligence. There has been surge in consumer court decisions awarding substantial compensation creating fear among doctors. Hence, the study was aimed to find out the knowledge and perspectives on constitutional rights to health and Consumer Protection Act among doctors. Methods: This mixed method cross-sectional study was conducted at a 150-bed community hospital from November 2025 to January 2026 following Institutional Review Committee approval. Using census sampling, 66 doctors completed semi-structured questionnaire assessing demographics, knowledge of constitutional health rights and Consumer Protection Act 2018, and their perspectives using a five-point Likert scale. Focused group discussion with 11 doctors explored the understanding, implications and challenges, with data analyzed through descriptive statistics and thematic analysis. Results: All respondents identified constitutional rights to health with high awareness of informed consent 54(91.53%) and health information 53(89.83%). Though 55(83.33%) were aware that Consumer Protection Act 2018 covers healthcare services, only 20(30.30%) respondents correctly identified Consumer Courts as complaint authority. While 47 (71.21%) respondents reported fear of complaints leading to defensive medical practices, 51(77.27%) agreed that knowledge and awareness on constitutional health rights and consumer protection laws guide clinical decisions. However, doctors lack legal awareness as financial barriers, fear and ethical conflicts highlight the need for systemic reform. Conclusions: The study found reasonable awareness of constitutional health rights among doctors, however; the knowledge gaps was existent regarding Consumer Protection Act provisions, jurisdictional authorities and legal liabilities.
Ventricular arrhythmias during general anesthesia are commonly benign but may occasionally present abruptly and progress despite the absence of identifiable risk factors. We report a case of intraoperative ventricular bigeminy occurring during laparoscopic cholecystectomy in a 68-year-old female with no comorbidities and good functional capacity. The arrhythmia developed shortly after surgical incision, progressed from isolated ventricular premature complexes to ventricular bigeminy, and resolved following prompt pharmacological intervention. This case highlights the importance of vigilant intraoperative monitoring, systematic exclusion of reversible causes, and timely management of ventricular ectopy even in low-risk patients.
Introduction: Ectopic pregnancy is a potentially fatal condition and an important cause of early pregnancy morbidity. This study aimed to determine the hospital based prevalence, clinical profile, reproductive history, management, and outcomes of ectopic pregnancy at a tertiary hospital in Sudurpaschim Province, Nepal. Methods: A hospital-based retrospective descriptive study was conducted in the Department of Obstetrics and Gynecology at Seti Provincial Hospital, Sudurpaschim Province, Nepal. Medical records of women diagnosed with ectopic pregnancy from April 2018 to April 2023 were reviewed. Demographic characteristics, clinical presentation, reproductive history, diagnostic investigations, site of implantation, management, and outcomes were extracted from hospital records. Data were analyzed using Statistical Package for the Social Sciences version 21. Descriptive statistics were used to summarize the findings. Results: A total of 114 eligible cases of ectopic pregnancy were included among 13,247 gynecological admissions, yielding a hospital-based prevalence of 0.86%. Patients aged 21-35 years accounted for 73.68% of cases, and 101 (88.60%) were multigravida. Pelvic inflammatory disease 61 (53.51%) and previous abortion 61 (53.51%) were frequent reproductive histories. The fallopian tube was the site of implantation in 111 (97.37%) cases, predominantly ampullary 74 (64.91%). Amenorrhea 76 (66.67%) and abdominal pain 56 (49.12%) were common presenting symptoms. Surgical management was performed in 104 (91.23%) patients, most frequently salpingectomy 72 (63.16%). Recovery occurred in 102 (89.47%) patients, while 12 (10.53%) developed postoperative wound infection. No maternal deaths were recorded. Conclusions: Ectopic pregnancy was commonly observed among women of reproductive age, particularly multigravida patients, with most cases managed surgically and favorable outcomes.
Introduction: Knee osteoarthritis is a common cause of pain and functional limitation. Previous studies have reported inconsistent relationships between radiographic severity and functional impairment. The aim of this study was to determine the correlation between functional status and radiographic grading in patients with knee osteoarthritis. Methods: A hospital-based cross-sectional study was conducted in Kathmandu, Nepal. Adults aged 40-90 years with knee osteoarthritis diagnosed using the American College of Rheumatology criteria were included. Functional status was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index and the Timed Up and Go test. Radiographic severity was graded using the Kellgren-Lawrence system. Correlations between demographic, functional, and radiographic variables were analyzed. Results: A total of 185 patients were included. Kellgren-Lawrence grade showed a significant positive correlation with WOMAC score (r = 0.55, p < 0.001) and TUG score (r=0.71, p < 0.001). Age demonstrated a positive correlation with WOMAC score (r = 0.41, p < 0.001) and Kellgren-Lawrence grade (r = 0.64, p < 0.001). Body mass index showed a weak positive correlation with WOMAC score (r = 0.25, p = 0.0006) and no statistically significant correlation with Kellgren-Lawrence grade (r = 0.14, p = 0.058). Conclusions: In this study, poorer functional status was positively associated with greater radiographic severity in patients with knee osteoarthritis. Objective functional assessment using the Timed Up and Go test may complement radiographic evaluation in clinical practice; however, the findings should be interpreted as associations rather than causal relationships.
