Post-dural puncture headache (PDPH) is a common neuraxial anesthesia complication, often poorly managed conservatively. We report successful bilateral transnasal sphenopalatine ganglion block (SPGB) in a 52-year-old obese hypertensive woman (ASA II) who developed severe PDPH (pain 8/10) after accidental dural puncture during hysterectomy anesthesia. After 12 hours of failed conservative therapy, SPGB with 4% lidocaine reduced pain from 8/10 to 2/10 within 10 minutes, with complete resolution by 8 hours and sustained relief over 24 hours, no adverse effects. This case demonstrates transnasal SPGB as a rapid, effective, safe bedside alternative to epidural blood patch for PDPH.
Introduction: Antinuclear antibodies (ANAs) detected by indirect immunofluorescence (IIF) on HEp-2 cells are a diagnostic hallmark of systemic lupus erythematosus (SLE). Specific patterns are linked to clinical manifestations. Data on ANA patterns and their clinical correlations in South Asian populations, particularly Nepal, remain limited. Methods: This hospital-based cross-sectional study included 167 SLE patients (≥16 years) diagnosed by 2019 EULAR/ACR criteria. ANA testing was performed using IIF on HEp-2 cells, with patterns classified according to ICAP. Clinical data and immunological markers (anti-dsDNA, ENAs) were collected. Statistical analysis used Chi-square tests, with p < 0.05 considered significant. Results: Among 167 patients (82% female, median age 39 years), the most prevalent patterns were nuclear homogeneous (NH; 45.5%), nuclear fine speckled (NFS; 25.7%), and nuclear coarse speckled (NCS; 16.8%). NH significantly associated with arthritis (p = 0.02), non-scarring alopecia (p = 0.03), lupus nephritis (p = 0.02), thrombocytopenia (p = 0.02), direct Coombs test (p = 0.04), anti-dsDNA (p < 0.001), anticardiolipin IgG (p = 0.03), lupus anticoagulant (p = 0.01), anti-histone (p = 0.01), and anti-nucleosome antibodies (p < 0.001). NFS associated with malar rash (p = 0.01). Anti-Sm/RNP and anti-RNP 68 strongly associated with NCS (p < 0.001 for both). Conclusions: This study reveals specific ANA patterns and their significant clinical and immunological associations in Nepalese SLE patients. The NH pattern correlates strongly with severe manifestations such as lupus nephritis and with multiple autoantibodies, highlighting the importance of ANA pattern analysis for diagnosis and risk stratification.
Introduction: The increasing integration of social media into academic life has raised concerns about its psychological impact on students, particularly those in demanding health profession programs. Nursing students face unique stressors from clinical postings and academic pressure that may drive compulsive social media use and threaten self-esteem. This study was done to determine the levels of social media addiction and self-esteem, examine whether social media addiction predicts self-esteem, and identify associated factors among undergraduate nursing students in Nepal. Methods: A cross-sectional analytical study was conducted among 158 undergraduate (B.Sc.) Nursing students (100% response rate) at Birat Medical College, Nepal, using a census approach. Data were collected using the Social Media Addiction Scale-Short Form (SMAS-SF) and Rosenberg Self-Esteem Scale (RSES). Descriptive statistics, independent t-tests, one-way ANOVA, Pearson's correlation, and simple linear regression were applied. Results: The mean social media addiction score was 95.72 (SD = 16.42), with 86.08% classified as having moderate-to-high addiction. Mean self-esteem was 17.50 (SD = 2.78), with 17.72% reporting low self-esteem and none reporting high self-esteem. Social media addiction significantly predicted lower self-esteem (β = -0.40, p < 0.001, R² = 0.16). Appearance dissatisfaction, senior year, and longer sleep duration were significantly associated with self-esteem (p < 0.001). Conclusions: Social media addiction significantly and negatively predicts self-esteem among nursing students in Nepal. The high prevalence of addiction and low self-esteem warrant targeted interventions addressing digital literacy, stress management, and self-esteem building in nursing curricula.
Introduction: Benign prostatic enlargement (BPE) is common in elderly men, and its prevalence increases with age. Acute urinary retention (ARU) is one of the most significant events in the natural history of BPE. This study assessed the prevalence of significant intravesical prostatic protrusion (IPP) and its correlation with prostate volume (PV) in patients with ARU due to BPE. Methods: This hospital-based cross-sectional study was conducted in the Department of General Surgery at Lumbini Medical College and Teaching Hospital, Palpa, Nepal, over five months. A total of 94 men aged 45–85 years with ARU due to BPE were included using consecutive sampling. Assessment included clinical history, laboratory investigations, and transabdominal ultrasonography to measure PV and IPP. IPP >10 mm was considered significant. Statistical analysis included descriptive statistics and Pearson's correlation coefficient. Results: Mean age was 66.7 ± 10.4 years, mean PV was 42.9 ± 13.2 cc, and mean IPP was 10.8 ± 6.3 mm. Significant IPP (>10 mm) was present in 35 patients (37.2%). Grade I prostatomegaly (20–40 cc) was most common (54.3%). IPP showed a moderate positive correlation with PV (r = 0.394, p < 0.001). Half of the patients (50.0%) had previous ARU, and 33.0% had pyuria. Conclusions: Significant IPP was present in over one-third of patients with ARU due to BPE. IPP correlated moderately with PV, suggesting that PV alone cannot fully explain the degree of protrusion. IPP may serve as a useful non-invasive tool to identify patients who might benefit from early surgical intervention.
Introduction: Schizophrenia is a disabling brain disorder affecting approximately 24 million people worldwide. Epidemiological data on schizophrenia from western Nepal are sparse. This study aimed to determine the hospital-based prevalence and sociodemographic profile of schizophrenia among patients attending the psychiatric outpatient department of a tertiary care center in western Nepal. Methods: This retrospective, record-based, descriptive study reviewed records of patients visiting the center over a two-year period from January 2022 to December 2023. All patients diagnosed with schizophrenia according to ICD-10 criteria were included using total enumeration. Data were retrieved from the OPD register using a semi-structured proforma and analyzed with descriptive statistics using Microsoft Excel. Ethical approval was obtained from the Institutional Review Committee. Results: A total of 7,739 patients attended the psychiatric OPD, of whom 192 were diagnosed with schizophrenia, giving an overall hospital-based prevalence of 2.48%. The prevalence was 2.75% in 2022 and 2.17% in 2023. Males constituted 53.98% of cases in 2022 and 67.09% in 2023. The most common age group was 20–29 years (28.31% in 2022; 37.97% in 2023). Unemployed patients (30.97%) were most common in 2022, while students (32.91%) were most common in 2023. Secondary education was the most common educational level, and most patients were married. Conclusion: Schizophrenia constituted a notable proportion of psychiatric OPD attendances. Cases were predominantly young, married males with secondary education. These findings provide baseline data to guide mental health service planning in western Nepal.
