Introduction: Cervical spine accounts for only 20.8% of traumatic spinal fracture. Although relatively rare, the incidence and economic burden of traumatic cervical spine fracture (TCSF) has been increasing. Methods: A single-center, hospital-based retrospective descriptive study was conducted to find out the epidemiology of TCSF among all patients admitted to the center from January 1, 2018 to December 31, 2024. TCSF diagnoses were classified and entered according to International Classification of Disease (ICD-11). Results: A total of 357 patients were included, with mean age of 45.66±16.72 years and male:female ratio of 3.64:1. Fall injuries were the predominant mechanism followed by road traffic accidents. According to ICD-11, NA22.3 (multiple fractures of the cervical spine) constituted the largest category (47.34%, n=169), with the C6 being the most frequently injured anatomical site (n=108). Neurological evaluation revealed normal baseline status in 214 (59.94%) cases. Case fatality rate was 6.16% (n=22), while 257 (71.99%) patients were discharged after recovery. Conclusions: TCSF admissions remained relatively stable during 2018–2023, with an increase observed in 2024. Cases predominantly involved middle-aged males, with falls being the leading mechanism of injury. Multilevel involvement was common, and C6 was the most frequently affected vertebra. Most patients experienced recovery, while the case fatality rate was 6.16%.
In February 2025, an anonymous Facebook post revealed a resident doctor’s suicide attempt at a major teaching hospital in Nepal. The incident highlighted systemic issues in Nepali residency programs like power asymmetry. This is unopposed due to a lack of regulatory protection. There are no formal mechanisms to protect and safeguard the well-being of residents. While developed countries mhave implemented reporting systems to address abuse and implemented hour caps. In Nepal, a culture that glorifies suffering during training has enabled harm across generations of doctors. This is an urgent call to action for protective policies to foster compassionate training environments.
Adenomyoepithelioma (AME) of the breast is an exceptionally rare biphasic neoplasm. Although predominantly benign, malignant AME (M-AME) presents considerable diagnostic challenges. We report a 75-year-old woman with a painless, progressively enlarging 5×5 cm left breast mass. Mammography demonstrated well-defined opacities with irregular margins and fine calcifications (BI-RADS 5), whereas core needle biopsy favored a benign lesion with epithelial and myoepithelial proliferation arranged in nests and trabeculae. Wide local excision established the diagnosis of biphasic M-AME with myoepithelial carcinoma (pT3, Nottingham Grade 2), characterized by increased mitotic activity, comedo-type necrosis, and perineural invasion. Immunohistochemistry confirmed dual epithelial and myoepithelial differentiation. Notably, the tumor demonstrated estrogen receptor positivity, an uncommon finding in M-AME. The patient subsequently underwent completion mastectomy and remains recurrence free at two-year follow-up. This case underscores the diagnostic limitations of core needle biopsy and the importance of excisional biopsy when radiologic and histopathologic findings are discordant.
Recent flash floods have again highlighted the fact that the first responders at the site of disaster were the personnel from security forces. This is not unique to Nepal, but across many low- and middle-income countries, where the primary responders are generally the uniformed personnel. The role is not limited to major disasters but even in the road traffic accidents where the injured, and the community reach out to the local police authority for rescue. The obvious cause is the nonexistent or fragmented prehospital care system. The development of the currently rudimentary prehospital care and ambulance services can be a logistically and financially overwhelming for countries where the basic health care facilities are just developing in vastness of the harsh terrain. But, utilizing the investment already made upon the military and force personnel, complemented with necessary trainings and adequate resources, equipment, protocols and support, the basic care of the injured at the early hours of injury, can be strengthened and more lives can be saved while they wait for formal medical care.
Introduction: Drains are routinely placed after head and neck surgery to prevent hematoma and seroma, although they may prolong hospital stay. This study aimed to find the length of hospital stay and complications among patients undergoing clean head and neck surgery with and without drains. Methods: This study was conducted in a tertiary care center using records of patients who underwent clean head and neck surgery from April 2021 to March 2024 after ethical approval (Reference number: drs2412171966). All eligible patients were included using total enumerative sampling. Data were analyzed using JASP version 0.18.3. 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 174 patients, 82 (47.13%) had a drain placed. The mean length of hospital stay was 5.67±2.02 days (95% CI: 5.23-6.12 days) with a drain and 4.12±1.39 days (95% CI: 3.83-4.41 days) without a drain. Any complication occurred in 25 (30.49%; 95% CI: 21.58-41.14) patients with a drain and 17 (18.48%; 95% CI: 11.87-27.61) patients without a drain. Seroma occurred in 10 (12.20%) and 6 (6.52%), hematoma in 5 (6.10%) and 7 (7.61%), and re-exploration in 3 (3.66%) and 5 (5.43%) patients, respectively. Conclusions: Drain placement in clean head and neck surgery was associated with a longer hospital stay, without a demonstrable reduction in seroma, hematoma or re-exploration. As the study was not powered to detect differences in these uncommon complications, prospective studies with standardized indications for drain placement are needed before routine drain use is abandoned.
