IntroductionLaparoscopic cholecystectomy is the gold standard for treating gallstone disease. The G10 intraoperative scoring system evaluates ten operative parameters, but its utility in low- and middle-income country settings like Nepal remains limited. This study aims to evaluate the sensitivity, specificity, and overall diagnostic performance in predicting surgical difficulty and conversion to open cholecystectomy using G10 scoring system. MethodsFrom July 2025 to January 2026, a diagnostic accuracy study was carried out at Chitwan Medical College's Department of Surgery (CMC-IRC/082/083/006). Using successive sampling, 120 patients undergoing laparoscopic cholecystectomy of age 18 years and above were included. Conversion to an open cholecystectomy was the primary outcome; blood loss, intraoperative complications, operating time, and overall difficulty level were the secondary outcomes. The best cutoff score was found using ROC curve analysis. ResultsThe mean operating time increased significantly (71.7±24.95 to 110±11.55 minutes) with increase in G10 scores from moderate to extreme. The rate of conversion was 50% in extreme group but it was only 3.8% in the moderate group. Conversion to open cholecystectomy was significantly correlated positively with G10 score (r = 0.486, p < 0.001). With a 3.50 cutoff, 90.0% sensitivity, and 83.6% specificity, ROC analysis produced an AUC of 0.867. ConclusionThe G10 intraoperative grading system is a reliable and practical scoring system with high sensitivity and specificity for predicting surgical difficulties and conversion rate, supporting its application in intraoperative decision making.
IntroductionThe availability of evidence on service quality assessment from tertiary-level Ayurveda hospitals in Nepal is limited. Therefore, this study aimed to assess the expectations and perceptions of patients and service quality gaps at Tribhuvan University Ayurveda Teaching Hospital (TUATH). MethodsA descriptive cross-sectional study employing convenience sampling was conducted among 197 samples from OPD/IPD of TUATH from January to September 2023. A validated and modified Nepali version of the SERVQUAL questionnaire, constituting six dimensions - tangibility, reliability, responsiveness, assurance, empathy, and accessibility and affordability—was used to collect data and measured overall and dimension-wise service gap scores. The Wilcoxon signed-rank test was applied to determine statistical significance. ResultsThe overall mean perception score (3.03 ± 0.85) was significantly lower than the expectation score (4.54 ± 0.34), showing a considerable negative service gap (−1.51; p < 0.001). Negative service gaps were observed over all six dimensions. The largest gap was found in assurance (−1.87), followed by empathy (−1.65) and tangibility (−1.46). Conduct of health professionals, patient safety, individualized care, interpersonal interaction, physical facilities, and free medicine supply were found among the major shortcomings. The affordability and accessibility dimension had comparatively smaller but still significant gaps. ConclusionOverall SERVQUAL dimensions in TUATH found substantial service quality gaps, particularly in assurance, empathy, and tangibility. These results show overall dissatisfaction with healthcare service delivery at TUATH and draw attention to improving critical healthcare service dimensions.
IntroductionSexual dysfunction is a common yet under-recognized consequence of alcohol dependence, which can lead to an overall poor quality of life. This study aims to estimate the extent and pattern of sexual dysfunction among patients with alcohol dependence. MethodsThis is a hospital-based, descriptive study among 66 patients with Alcohol Dependence Syndrome visiting the psychiatry department of Kathmandu Medical College. Severity of alcohol dependence was assessed using the Severity of Alcohol Dependence Questionnaire (SADQ). The Arizona Sexual Experience Scale (ASEX) male and female version was used to assess the different domains of sexual experiences. Data was entered in excel and analyzed using R programming and appropriate statistical tools were applied. ResultsThe mean age of participants was 43.09±10.09 years with the majority being male.55% of the participants had severe dependence, and 62.1% had sexual dysfunction. Sexual dysfunction was found to be associated with age, ethnicity, severity and duration of alcohol dependence and quantity of alcohol consumed per day. Erectile dysfunction and low sexual desire were the most common sexual dysfunctions among males, whereas low sexual desire, difficulty in sexual arousal and reaching orgasm were the most common sexual dysfunctions among females. ConclusionSexual dysfunction was observed in more than half of the patients with alcohol dependence syndrome.
IntroductionSkin diseases are common and often require long-term treatment, making rational prescribing essential. This study aimed to assess the drug utilization pattern and prescription cost at the Dermatology Outpatient Department (OPD). MethodsA descriptive cross-sectional study was conducted among 362 patients attending the Dermatology OPD of our center using purposive sampling. Data were collected through structured face-to-face interviews and prescription review. Drug costs were obtained from the hospital pharmacy and standard market prices. Data were analyzed using SPSS version 25. ResultsThe mean age of participants was 38.78 ± 16.16 years, and 251(69.3%) were female. Eczema (54,14.9%) and urticaria (38,10.5%) were the most common diagnoses. Antihistamines (212,58.6%) and emollients/keratolytics (175,48.3%) were the most frequently prescribed drug classes. The mean number of drugs per prescription was 2.89±1.28, exceeding the WHO reference range (1.6–1.8). Only 7(1.9 %) of drugs were prescribed by generic name, while (106, 29.3%) were prescribed from the Essential Medicines List. Topical formulations predominated, and fixed-dose combinations were prescribed in 51 (14.6 %) of encounters, most commonly fusidic acid–betamethasone. The mean prescription cost was NPR 1099.90 ± 959.05 (range: NPR 42–4352). ConclusionPrescribing practices at the Dermatology OPD were characterized by polypharmacy, very low generic prescribing, and limited use of essential medicines, although antibiotic and injection prescribing remained appropriately low. Promoting generic prescribing, regular prescription audits, and rational prescribing practices could improve the quality and affordability of dermatological care.
Introduction: Vitiligo is a chronic autoimmune disorder characterized by depigmentation and is known to be associated with thyroid dysfunction. However, data regarding this association in Nepal are limited. This study aims to ascertain the prevalence of thyroid dysfunction among patients with vitiligo and to evaluate its correlation with clinical parameters. Methods: This hospital-based case-control study involved the enrolment of 100 clinically diagnosed vitiligo patients and 100 frequency-matched controls at Nepalgunj Medical College and Teaching Hospital, Kohalpur, Nepal. Serum thyroid-stimulating hormone (TSH) levels were quantified using chemiluminescent immunoassay (CLIA). Thyroid dysfunction was characterized by TSH levels of less than or equal to 0.39 mIU/L, indicating hyperthyroidism, or more than or equal to 50 mIU/L, indicating hypothyroidism. Statistical analyses were conducted using the Mann-Whitney U test, chi-square test (Yates-corrected) or Fisher’s exact test, and odds ratio (OR) with a 95% confidence interval (CI). Results: The prevalence of thyroid dysfunction was significantly higher among cases compared to controls (26.0% vs. 5.0%; OR = 6.68, 95% CI 2.45–18.22, p < 0.001). Hypothyroidism was observed in 20.0% of cases as opposed to 5.0% of controls (OR = 4.75, 95% CI 1.71–13.23; p = 0.003), while hyperthyroidism was present in 6.0% of cases and absent in controls (p = 0.029). Female patients exhibited a significantly higher incidence of thyroid dysfunction compared to male patients (38.3% vs. 7.5%; OR = 7.67, 95% CI 2.12–27.76, p = 0.001). Additionally, the extent of disease, as measured by body surface area, was significantly correlated with thyroid dysfunction (p = 0.031). Conclusions: Vitiligo is significantly correlated with thyroid dysfunction, particularly hypothyroidism, with a notably elevated risk observed in female patients and those exhibiting moderate disease severity. It is recommended that routine TSH screening be conducted for all individuals diagnosed with vitiligo. Keywords: Case-control study, hypothyroidism, Nepal, thyroid dysfunction, vitiligo
