Introduction: Diabetes mellitus is a major public health concern globally and in Nepal, with a rising burden in rural and underserved regions such as Karnali Province. Physical activity is a key component of diabetes management, yet data from rural Nepal are limited. This study assessed physical activity levels among patients with diabetes mellitus attending a tertiary center and examined their association with glycemic control indicators. Methods: This was a cross-sectional study conducted in a tertiary care center of Nepal, among patients aged ≥20 years with diagnosed diabetes mellitus who attended the hospital during the study period of April 2025 to October 2025. Physical activity was assessed using a structured questionnaire adapted from the International Physical Activity Questionnaire. Glycemic control indicators (HbA1c, fasting blood glucose, and 2-hour postprandial blood glucose) were obtained from laboratory records. Following data collection, statistical analysis was conducted using SPSS 22 software. Descriptive statistics and chi-square tests were applied. Results: Among all participants (N = 145), about two-thirds (66.21%) had poor glycemic control, i.e., HbA1c≥ 6.5%. Nearly 67% reported engaging in more than 600 MET-minutes per week of moderate physical activity, meeting the WHO-recommended levels. Higher physical activity was significantly associated with lower fasting plasma glucose and with lower postprandial blood glucose, although the latter association was not statistically significant. Conclusion: Inadequate glycemic control remained common among diabetes patients and correlated poorly with glycemic control. Integrating physical activity promotion with routine clinical care and public health interventions is essential.
Introduction: Acute poisoning is a major public health issue in Nepal, driving emergency visits, admissions, and deaths mainly from accessible organophosphorus pesticides. Patterns vary by region, with insecticides dominant in developing areas like Nepal, unlike pharmaceuticals in high-income countries. Limited recent prospective data from Nepalese tertiary centers prompted this study to profile demographics, agents, and outcomes. Methods: A prospective observational study was conducted at Bir Hospital Emergency Department, wards, and intensive care units from July to December 2025. The study included 238 patients aged 14 years and above with acute poisoning. A structured pro forma was used to collect data on demographic variables, poisoning agents, timing, and outcomes. Data analysis was performed using SPSS version 16, employing descriptive statistics and chi-square tests, with a significance level set at p<0.05. Results: Females constitute 55.9% (133 out of 238) of the population, with a peak incidence in the 15-25 years age group (37.4%). The majority are unmarried (64.7%) and students (38.7%). The prevalence of suicidal behavior is 83.2%, with the primary agents being Dichlorvos (29%) and Cypermethrin (24.4%). The mortality rate stands at 8% (19 out of 238). Significant associations were observed between age and type (χ²=65.08, p<0.001), gender and type (χ²=25.33, p<0.001), and between arrival time and mortality (χ²=33.2, p<0.001), with a better prognosis when arrival occurred within 2 hours. Conclusion: Young females are suicidal with organophosphorus; early care is key to survival; urge mental health/pesticide controls.
Introduction: Pain following laparoscopic cholecystectomy is multifactorial and necessitates a multimodal approach for management. Paracetamol and Ketorolac are commonly used as part of a multimodal analgesic regimen postoperatively. This study aimed to compare the efficacy of oral paracetamol and ketorolac with intravenous paracetamol and ketorolac for pain management after laparoscopic cholecystectomy. Methods: A prospective cross-sectional comparative study was conducted on 106 patients who underwent laparoscopic cholecystectomy between August 2022 and July 2023. The patients were divided into two equal groups of 54 each: the OPK group (oral paracetamol and ketorolac) and the IPK group (intravenous paracetamol and ketorolac). The primary outcome was a visual analog scale (VAS) score measured 8 h after the operation and on the first postoperative day at 0800h. The secondary outcome was the amount of tramadol used for rescue analgesia. Results: Most participants were female (67.6%), and the mean age of the population was 44.83±1.27 years. The mean VAS scores measured at 8 hours postoperatively and on the first postoperative day in the OPK and IPK groups were not statistically different (5.85±1.52 vs. 6.24±1.32; p=0.28, and 3.21±1.30 vs. 3.50±1.46; p=0.24, respectively). The mean tramadol required as rescue analgesia was higher in the intravenous group (74.07±39.74 mg) than in the oral group (66.67±38.85 mg); however, the difference was not statistically significant (p=0.33). Conclusion:Our study demonstrated comparable efficacy of oral and IV routes of paracetamol and ketorolac for postoperative pain management following laparoscopic cholecystectomy.
Introduction: Spinal anaesthesia is the preferred technique for lower segment caesarean section (LSCS) but is frequently complicated by hypotension. Conventional monitoring may not detect hypotension early, prompting interest in non-invasive predictors such as the perfusion index (PI). This study aims to evaluate the utility of baseline PI as an early predictor of spinal anaesthesia-induced hypotension in parturients undergoing LSCS at a tertiary care centre in rural Nepal. Methods: This prospective observational study was conducted at Karnali Academy of Health Sciences from September 2024 to August 2025 after ethical approval. Parturients aged 18–40 years (ASA I–II) undergoing elective LSCS under spinal anaesthesia were enrolled. Haemodynamic parameters were recorded. Data were analyzed using SPSS v20 with p < 0.05 considered significant. Results: A total of 86 parturients were enrolled with a median age of 27 years and gestational age of 41 weeks. Post-spinal hypotension occurred in 27 (31.4%) patients, with 31 (36%) requiring mephentermine support; bradycardia (3.5%) and vomiting (2.3%) were minor adverse events. Baseline perfusion index showed a significant association with post-spinal hypotension (p < 0.001) and a negative moderate correlation with mean arterial pressure (r = –0.373, p < 0.001) and systolic blood pressure (r = –0.368, p = 0.001), while no association was observed with parity or caesarean history. Conclusion: Baseline PI >3.5 predicts spinal-induced hypotension in elective CS, with higher incidence, lower early MAP, and negative PI-MAP correlation. It may be used for early risk identification and haemodynamic management.
Introduction: Mental disorders are among the leading contributors to Nepal’s disease burden, with depressive and anxiety disorders ranking among the leading causes. However, access to care is grossly unequal. Mental health professionals and services are concentrated in urban centers, whereas rural areas such as Jumla suffer severe shortages of trained providers, medicines, and functional referral systems. Stigma, cultural beliefs, and reliance on traditional healers further delay help seeking from formal services, while many individuals remain untreated even when services do exist. Financial constraints, lack of awareness, and limited health-system capacity widen this treatment gap. Such challenges bring into sharp focus the need to understand barriers to service delivery and to identify feasible, culturally grounded strategies for integrating mental health care within rural primary health systems. Methods: We conducted a narrative synthesis of Nepal-specific literature, implementation reports, and qualitative studies. Sources included published surveys, primary-care evaluations, reviews of stigma and policy, and local JKAHS reports. Results: Promising approaches include supervised task-sharing, culturally tailored community engagement (including partnerships with traditional healers), adaptation of WHO’s mhGAP training, and use of digital decision-support tools. Key recommendations for Jumla include reinforcing health-system supports (reliable medication supply, private counseling space, referral networks), piloting offline-capable e-mhGAP apps, and engaging community stakeholders (FCHVs, local leaders, healers) in co-designing stigma reduction and referral programs. Evidence from Jumla’s recent mental-health conference and local studies underscores readiness for integrated models. Conclusion: Implementation research and monitoring are needed to ensure the feasibility, acceptability, and effectiveness of these interventions in Karnali.
Introduction: Solitary fibrous tumor (SFT) of the nasal cavity is a rare vascular tumor arising from adult mesenchymal stem cells. It occurs most commonly in the pleura, and in the nasal cavity, it is rare. Solitary fibrous tumors (SFTs) of the nose and paranasal sinuses are extremely rare. Case presentation: This article reports a case of a 59-year-old lady presenting with complaints of progressive nasal blockage and recurrent epistaxis. Imaging showed a mass lesion in the left nasal cavity with bone-eroding properties mimicking a malignant lesion. The patient underwent surgery, during which the mass was excised. Histopathological analysis of the specimen was consistent with SFT. Conclusion: This case highlights the importance of diagnosing SFT of the nasal cavity and paranasal sinuses, as their imaging findings and management differ from those of other tumors.
Introduction: Lower limb injuries constitute a significant proportion of trauma admissions in Nepal, frequently requiring complex reconstructive procedures. This study aims to identify the injury patterns and demographic profile of patients undergoing lower limb reconstruction at a tertiary trauma center in Nepal. Methods: This prospective observational study was conducted at the National Trauma Center, Kathmandu. All patients undergoing reconstructive plastic surgery for lower limb trauma by Burns, Plastic and Reconstructive Surgery Department at National Trauma center were included. Data on demographics, comorbidities, mode of injury, injury site, type of injury, mechanism of injury, reconstructive procedures, and complications were collected and analyzed using descriptive statistics. Results: Eighty-five patients were included, of whom 67 (78.82%) were male and 18 (21.18%) were female. The average age was 27.97 years, with only two pediatric patients (ages 10 and 12). A total of 24 patients (28.2%) experienced complications. High-velocity injuries were significantly associated with complications, accounting for 20 out of 24 cases (83.3%) and 16(60%) had open fractures. Of those with complications, 15 patients had comorbidities and diabetic patients had highest number of complications. Conclusions: Lower limb defects requiring reconstruction is most seen in young males. Comorbidities, especially diabetes, mode of injury, type of injury and timing of presentation remain the main risk factors for complications. Timely presentation and availability of reconstructive expertise are critical for limb salvage and better functional outcomes.
Introduction: The carrying angle, the acute angle between the arm and forearm when the upper limb is fully extended and supinated, demonstrates sexual dimorphism and lateral asymmetry. It plays a crucial role in biomechanics and is influenced by various anthropometric factors. This study aims to evaluate the carrying angle in young Nepalese males and females to investigate sexual dimorphism, side differences, and correlations with height, forearm, and arm lengths. Methods: A cross-sectional study was conducted at KUSMS among 160 healthy individuals aged 18–25 years (110 males, 50 females). Carrying angles were measured on both limbs using a manual goniometer. Participants’ height, forearm length, and arm length were recorded. Statistical analysis was performed using SPSS v16.0. Independent and paired t-tests, along with Pearson correlation, were used to analyze sex and side differences and their associations with anthropometric parameters. Results: Females showed significantly higher left carrying angles (8.6°±3.9°) than males (7.3°±3.1°, p= 0.026), while rightside angles were comparable. In males, the right angle was significantly greater than the left (p< 0.001), suggesting lateral asymmetry. Arm length showed a positive correlation with carrying angle in both sexes, more strongly in females (r= 0.408 to 0.459). No consistent correlations were found with height or forearm length. Conclusion: This study confirms sexual dimorphism and right-left asymmetry in the carrying angle among young Nepalese adults. Arm length emerged as a statistically significant correlate, particularly in females. These findings underscore the need for population-specific normative data to aid clinical assessments and orthopedic planning
Introduction: Menstrual distress includes a range of physical, psychological, and emotional symptoms that can negatively affect students’ academic performance, social life, and well-being. Nursing students may face added challenges due to academic pressures and clinical responsibilities. This study aimed to assess the knowledge and effects of menstrual distress among PCL nursing students in Pokhara, Nepal. Methods: A quantitative, cross-sectional study was conducted among 303 PCL nursing students using a census method. Data were collected through a modified Menstrual Distress Questionnaire (MEDI-Q), developed based on the standard MEDI-Q. Permission to use and adapt the MEDI-Q was obtained from the original author. Data were entered in EpiData, and analyzed using IBM SPSS v.22. Chi-square was used, with p < 0.05 considered statistically significant. Results: Results showed that majority of the students (91.74%) were aware of menstrual discomfort, most of them (83.82%) had knowledge of gastrointestinal issues, nearly all (98.34%) understood cognitive changes, and majority (94.71%) recognized physiological changes. Menstrual and inter-menstrual phases showed higher levels of reported distress. Study year and pain intensity were significant predictors of menstrual distress, whereas factors like age, religion, and ethnicity were not. Conclusion: Despite high awareness, menstrual distress is often normalized and unaddressed, affecting students’ mental health, academic performance, and clinical competence. The findings highlight the need for targeted interventions such as institutional support and access to menstrual health resources to improve the well-being and academic experiences of nursing students.
Introduction: Cesarean section (CS) rates are rising globally, often exceeding World Health Organization recommendations. While well-documented in urban centers, data from remote, resource-limited regions such as Nepal’s Karnali Province are scarce. This study aims to determine the key maternal characteristics and clinical indications for CS at a tertiary hospital in a remote setting. Methods: This was a retrospective, cross-sectional study of all deliveries at Karnali Academy of Health Sciences between June 2023 and June 2024. Data on maternal demographics, obstetric history, and CS indications were collected from hospital maternity records. Descriptive statistics were used to analyze the data. Results: Among 801 deliveries, 180 were cesarean sections, yielding a CS rate of 22.5%. The mean maternal age was 24.75±4.92 years, and nulliparous women constituted the largest group (42.8%). Most CSs were emergency procedures (84%). The leading indications were previous CS (16.1%), breech presentation (13.9%), meconium-stained liquor (10.6%), and fetal distress (10.6%). Robson classification analysis identified women with a previous CS (Group 5) as the largest contributor to the overall rate (23.3%). Conclusion: The CS rate in this remote Nepalese hospital is elevated. The high proportion of emergency procedures and the prominence of previous CS as a primary indication highlight critical areas for intervention. To optimize CS use, targeted strategies such as promoting vaginal birth after cesarean and strengthening standardized intrapartum monitoring are urgently needed.
Introduction: An inguinal hernia occurs when tissue protrudes from the abdominal cavity through the inguinal canal. While several theories have been proposed regarding their origin, larger datasets on inguinal hernia incidence can help clarify its pathophysiology. This study aimed to identify the various types of inguinal hernias observed at our center and to investigate the associated risk factors. Methods: This retrospective study included 318 cases of inguinal hernia from February 2024 to February 2025. Complaints recorded were groin swelling with or without pain, family history, lifestyle choices, recurring constipation, bladder issues, and cough. Diagnosis relied on visible groin swelling or a palpable abdominal wall defect. Results: Out of 318 adult patients, 294 were male and 24 female, with a significant difference (P < 0.01). The most common age group was 40–49 years (27% males, 45.74% females), followed by 50–59 years (22% males, 20.83% females). Most patients (58.5%) experienced swelling for less than a year; 7.1% for over two years. There was a significant difference (p<0.05): 163 had right-side hernia, 74 left, and 81 both sides. Types included direct (182), indirect (102), and combined (34). Risk factors: heavy lifting (57.23%), improper bowel movements (43.3%), chronic cough (45%), smoking (41.2%), alcohol use (36.1%), straining during urination (33.33%), and coexisting conditions (13.2%). No risk factors were identified in 18%. Conclusion: In males, especially the right-sided direct type, inguinal hernias are more common than in females. Risk factors include lifting heavy objects, bladder problems, alcohol use, and other health conditions.
Introduction: Adnexal masses represent broad spectrum of gynecological conditions, ranging from benign cysts to malignant ovarian tumors. Accurate diagnosis and characterization are critical for clinical decision-making, including surgical planning, fertility preservation, and oncological referral. Magnetic Resonance Imaging (MRI), with superior soft-tissue contrast, multiplanar capability, and functional imaging techniques, offers improved characterization of adnexal masses. The objective of this study was to evaluate the diagnostic role of MRI in detecting and characterizing adnexal masses. Methods: A hospital-based prospective cross-sectional study was conducted among 80 female patients with adnexal masses identified on USG at the Department of Radiology, College of Medical Sciences and Teaching Hospital, Bharatpur, Chitwan, Nepal. This study was conducted between September 2024 to October, 2025. All patients went MRI evaluation followed by surgical excision and histopathological performance using (sensitivity, specificity, PPV and NPV) of MRI taking histopathology as gold standard. Data were entered and analyzed using SPSS-20. P-value<0.05 was considered as statistically significant. Results: The mean±SD of age was 38.42±6.28 years. Most patients (25%) were in 30-39 years with 62.5% premenopausal. Histopathology revealed 68.8% benign and 31.2% malignant lesions. MRI demonstrated sensitivity 85%, specificity 72%, PPV 78%, NPV 80%, and overall accuracy 77.5%. Restricted diffusion, solid components, peritoneal deposits, and contrast enhancement were significantly associated with the Adnexal masses (p < 0.05). Conclusion: MRI is reliable imaging modality for differentiating benign from malignant adnexal masses, identifying key imaging markers, and guiding clinical management. Integration of MRI into diagnostic pathways improves patient care and reduces unnecessary interventions.
Nepal, home to most of the world’s highest mountain peaks, presents both challenges and opportunities for healthcare delivery, particularly in mountain medicine. It requires tailored approaches to medical care, emergency response, and health research as it is characterized by rugged terrain, limited infrastructure, and diverse cultural settings. This editorial explores the concept of mountain medicine, tracing its historical evolution, outlining its current scope, and discussing its future potential in the Nepalese context. It further proposes the Karnali Academy of Health Sciences (KAHS) as a strategic institution to advance mountain medicine in Nepal, emphasizing interdisciplinary collaboration, capacity building, and sustainable practices. The article advocates integrating mountain medicine into Nepal’s health system to improve outcomes for local communities, mountaineers, and visitors, and highlights KAHS as a key institution to lead these efforts.
Introduction: Endometriosis is a gynecological condition often diagnosed surgically. Non-invasive tools such as CA125 and transvaginal sonography (TVS) may improve early detection. Methods: This descriptive observational study was conducted from April 2017 to October 2018. A total of 77 women with a clinical diagnosis of endometriosis underwent evaluation using serum CA125 and TVS. Surgical and histopathological findings were used as the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: A total of 85 patients were initially included; however, eight were excluded because they did not meet the inclusion criteria. The mean age of the participants was 35.5 years. Dysmenorrhea was the most common symptom, followed by deep- seated lower abdominal pain. When the cutoff of CA125 was taken as 35 IU/ml, sensitivity, specificity, PPV, and NPV were 98.6%,0%,90.8%, and 0% respectively, with an accuracy of 89.6%. ROC curve determined the cut-off point of 55 IU/ml for CA125 with a PPV of 95.7%. Endometriosis was present in 90.9% cases during surgery and was proven histopathologically in 80.5%. A combination of CA125 and endometrioma in TVS had a sensitivity of 80% with an accuracy of 80%. Conclusion: The combined use of CA125 and TVS improves preoperative diagnostic accuracy for endometriosis and may reduce reliance on invasive procedures. Thus, these can be used for initial assessment to avoid diagnostic delay and enable the clinician to plan appropriate surgical treatment.
Introduction: Accurate ocular axial length (AL) measurement is critical for intraocular lens power calculation and refractive outcomes. While optical biometry is the clinical standard, dense media opacities limit its utility. This study evaluated B-mode ultrasound (B-USG) and MRI reproducibility and reliability for ocular AL measurement and assess inter-method agreement as alternative AL measurement methods. Methods: This prospective study included 102 adults (mean age 31.5±6.5 years) with normal ocular anatomy and emmetropic refraction. AL measurement used B-USG (9–12 MHz) and 1.5 Tesla MRI. Two blinded observers performed independent measurements; one repeated measurement after one day. Reliability was assessed using Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM), and Minimum Detectable Change (MDC). Agreement was evaluated with Bland–Altman analysis and Pearson correlation. Results: Mean AL was 23.618±0.726 mm for B-USG and 24.033±0.727 mm for MRI. Both methods showed excellent intra-observer (ICC=0.92 for ultrasound; ICC=0.95 for MRI) and inter-observer reliability (ICC=0.90 for ultrasound; ICC=0.93 for MRI). Strong linear correlation was observed (r=0.95, p<0.001). Bland-Altman analysis revealed significant systematic bias, with MRI measuring systematically longer values (+0.42 mm, 95% CI: 0.38–0.46), with wide limits of agreement (−0.15 to +0.99 mm), indicating non-interchangeable methods. Conclusions: B-USG and MRI are highly reliable and reproducible for AL measurement. However, consistent systematic bias and wide agreement limits restrict interchangeable use for high absolute accuracy applications. These modalities are valuable optical biometry alternatives, provided single method consistency.
Introduction: Comparison of fetal weight by ultrasound with actual birth weight is significant for clinical management as it is very closely linked with the survival and well-being of a fetus. Sonographic fetal weight estimation is an essential component of antenatal care. Hence, ultrasonography has become a vital tool in modern obstetrics practice. However, the reliability of the result depends a lot on the quality of the machine and the skill of the sonographer. Actual birth weights are measured with a scale corrected for zero error before use. Methods: This is a retrospective study in which clients under regular follow-up were sent from the Gynaecology and Obstetrics department, undergoing routine antenatal ultrasound to assess fetal well-being. Considering ultrasound at term (37-41 weeks), the data were retrieved, and a comparison was made between fetal weight by ultrasound and actual birth weight. Results: Women, 214 in number, who delivered in Patan Academy of Health Sciences were enrolled in this study. The mean estimated fetal weight was 2995.11(± SD 383.42) grams, and the mean of actual birth weight was 3033.15 (± SD 501.47) grams. The correlation coefficient between fetal weight estimated by USG and actual birth weight was 0.907 (p < 0.001), indicating a strong positive linear correlation. Conclusion: Ultrasonography is an essential tool for estimating fetal weight before delivery in term pregnancies, with no significant difference from actual birth weight.
Introduction: Lower respiratory tract infections (LRTIs) are a leading cause of pediatric mortality in Nepal. Hyponatremia is a common electrolyte imbalance in severe infections, but its prevalence and impact in high-altitude, resource-limited settings like Jumla are poorly characterized. This study aimed to determine the prevalence and clinical significance of hyponatremia in children hospitalized with LRTIs at a tertiary hospital in Jumla, Nepal. Methods: A hospital-based cross-sectional study was conducted from January 2024 to June 2025, including 80 children aged 1 month to 12 years with LRTIs. Serum sodium levels were measured, and hyponatremia was classified as mild (130-134 mEq/L), moderate (125-129 mEq/L), or severe (<125 mEq/L). Associations with clinical parameters and outcomes were analyzed. Results: The prevalence of hyponatremia was 56.3% (45/80), predominantly mild (77.8% of hyponatremic cases). Hyponatremia was significantly associated with clinical signs of severe respiratory distress, including chest indrawing (p=0.001), crackles (p<0.001), and nasal flaring (p=0.004). Children with hyponatremia had markedly higher needs for CPAP (48.9% vs. 2.9%, p<0.001) and ventilator support (22.2% vs. 5.7%, p=0.010). A longer duration of hospital stay was strongly correlated with lower sodium levels (r=-0.43, p<0.001). Furthermore, significant negative correlations were found between serum sodium and both absolute neutrophil count (r=-0.57, p<0.001) and white blood cell count (r=-0.42, p=0.0001). Conclusion: Hyponatremia is highly prevalent among children with LRTIs in Jumla and is a significant marker of disease severity, associated with increased respiratory support needs and prolonged hospitalization. Routine sodium screening can aid in risk stratification and guide fluid management in this vulnerable high-altitude population.
Introduction: Arteriovenous malformations (AVMs) of the brain are mostly congenital vascular lesions that can present at any age. The risk of rupture and re-rupture persists until it is completely obliterated surgically. Neurogenic pulmonary edema (NPE), a rare but life-threatening event, is characterized by an acute onset of pulmonary edema subsequent to substantial central nervous system (CNS) insult. Case presentation: We report a case of a 13-year-old male child who presented to our emergency room with abnormal body movement and decreased responsiveness 15 minutes prior to presentation. Past history suggested surgical intervention two years prior for right caudate hemorrhage with intraventricular extension (IVE), secondary to an unknown cause, as computed tomography (CT) angiography was refused due to financial constraints. However, current imaging revealed AVM with IVE, likely a rebleed. The patient developed acute pulmonary edema, and chest radiography suggested the same. The patient was admitted and planned for decompressive craniectomy. Despite best efforts, we lost the patient on the second day of admission. Clinical discussion: NPE due to intracranial hemorrhage is a rare occurrence. The clinical presentations of NPE could be as early as the first hours/minutes after injury or as late as 12–24 hours after neurological injury. Although it was identified over a century ago, its sporadic and relatively unpredictable nature and a lack of etiologic diagnostic and treatment modalities may be responsible for its poor recognition. If misdiagnosed or misinterpreted, it can be problematic for a successful outcome. Conclusion: Prompt diagnosis and appropriate management of NPE are essential to maintain cardiopulmonary function and avoid fatal outcomes.
Introduction: Hip fractures in elderly patients are associated with significant morbidity and require effective preoperative pain management. This study compares the efficacy of the Fascia Iliaca Block (FIB) and the Pericapsular Nerve Group (PENG) block for preoperative analgesia in patients with fragility hip fractures. Methods: A prospective observational study was conducted at the National Trauma Center in Nepal, involving 72 patients aged 60 years or older with hip fractures. Patients received either an FIB or PENG block using 20 ml of 0.25% ropivacaine under ultrasound guidance. Pain scores (VAS) were recorded at baseline, 15 min, 2 hr, 4 hr, 6 hr, and 12 hr post-block. Results: The PENG group demonstrated consistently lower VAS scores at all time points. Motor block and complications were also lower in the PENG group. The duration of block performance was slightly longer in the PENG group. Conclusion: The PENG block provided superior analgesia with fewer complications compared to FIB and may be a preferred option for preoperative pain management in elderly hip fracture patients.
This viewpoint article is a personal narrative of a generalized anxiety disorder (GAD) experience, reflecting the lived reality of denial, awareness, and acceptance of mental illness. It emphasizes early intervention, breaking down stigma, and that recovery is not a linear process. The story brings to life how invisible mental illness can feel, how hard it is to put a name to the struggle, and how therapy and support can slowly bring a sense of hope and healing. It also encourages free dialogue on mental health to foster compassion and reduce stigma. With the use of personal experience and global definitions of mental health, the article focuses on the fact that anxiety struggles are real, valid, and require attention. These reflections are meant to remind anyone walking a similar path to trust their healing, however slow or uneven it may feel. They are also an invitation to open up conversations about mental health, so that it becomes something we discuss with honesty and compassion, rather than silence and stigma.
