Kathmandu University Medical Journal最新文献

Background Infertility is the inability to conceive after a period of one year of regular unprotected intercourse. The problem of infertility has affected about 10-15% of couples worldwide including Nepal. About 6.9-9.3% is the approximate prevalence of infertility in developing countries. Objective To investigate the age distribution and ethnicity, factors of infertility, and association between age of marriage and infertility among infertile couples attending infertility clinic in the tertiary care. Method A Descriptive Cross-Sectional study was carried out among the participants (n=156) those enrolled between 1st March 2024 and 30thMay 2024 among reproductive age group couples attending in Infertility clinic of Paropakar Maternity and Women's Hospital. Data was collected and analyzed in by using SPSS version 17.0. Result Among 156 infertile couples,19% Brahman, 34% were Chhetri followed by 24% Newar, 16% Mongolian and 7% Madhesi. The study revealed that infertility in 34% of cases was female, 30.1% was male, 22.4% is both male and female, and 13.5% is unknown. The study found that out of 53 infertile females, 41.51% had tubal abnormalities, followed by ovarian, multiple, and uterine abnormalities. The most common problem studied in male was semen abnormalities like asthenozoospermia, oligozoospermia, azoospermia, and teratozoospermia. The mean age of male was 33.37 years with minimum age being 20 years and maximum 48 years. In case of female subjects, mean age was 30.56 years with youngest age being 18 and oldest being 44. Conclusion Infertility is a global health challenge as the fertility rate has been steadily falling since 1976. The incidence of secondary infertility was found to be 6.9-9.3%. This may be linked to changes in people's socioeconomic situations, such as women not having better access to healthcare and education, as well as the successful execution of government policy resource. Fertility varies, nevertheless, depending on factors including caste/ethnic group, religion, ecological zone, and residential region. We should aim to raise the nation's literacy rate and begin the improvement at the local level.

The anatomy of nose and paranasal sinuses is highly complicated and is most often characterised by considerable anatomical variations. These variations have often been linked to the aetiopathogenesis of inflammatory sinonasal pathology. Also apart from diagnostic value, these variations also predispose the surrounding critical structures to iatrogenic trauma during functional endoscopic sinus surgery (FESS). Some of these variations also have a role in recurrence of disease. Computed tomography (CT) is the mainstay of diagnosis and surgical planning for sinonasal diseases, and a structured checklist to assess possible anatomic variants helps to reduce the risk of surgical complications. Hence, we developed a checklist at our centre with the mnemonic "SNOT RACE".

Meditation, an inward journey to explore profound levels of consciousness rooted in Buddhism, has significant physical and psychological benefits, including enhanced well-being, improved concentration, emotional stability, and positive cognitive shifts. This narrative review consolidates past two decades of research on the neurophysiological effects of Buddhist mindfulness meditation based on neuroimaging findings, and aims to examine the Buddhist view of mindfulness meditation in relation to the structural and functional changes in the brain areas in health and diseases. Meditation practices, such as Vipassana in Buddhism, emphasize mindfulness and non-judgmental awareness of oneself and surrounding. Neuroimaging studies have revealed its significant impact on brain regions including structural changes involving anterior cingulate cortex (ACC), temporal lobe, insula, hippocampus, amygdala, thalamus and other areas. Four fundamental mechanisms summarize the mindfulness meditation: attention regulation, body awareness, emotion regulation, and a transformed selfperspective. The scientific explanation of effects of meditation is challenging, and we are only beginning to understand in neurophysiological terms. Previous research on mindfulness meditation has employed diverse methodological approaches, including self-reported measures, behavioral tasks and neuroimaging techniques; but there lacks a standardization, making it difficult to compare the findings. However, the cognitive processes are thought to underlie the potential benefits of mindfulness meditation in promoting mental well-being on an individual and societal level. This review highlights the mechanisms of mindfulness meditation to improve cognitive flexibility and promote mental well-being, in relation to Buddhist philosophy, with implications for individual and societal benefits.

Background The World Health Organization Surgical Safety Checklist (WHO-SSC) reduces surgical complications and morbidity; however, its utilization remains low in low- and middleincome countries. Objective To assess the utilization and completeness of a modified WHO Surgical Safety Checklist at a tertiary hospital in Nepal. Method A descriptive, observational cross-sectional study was conducted in 300 surgeries at Kathmandu Medical College Teaching Hospital (February to May 2024) following ethical clearance. Utilization and completeness of the modified WHO Surgical Safety Checklist (Pre-procedure check, Sign-in, Time-out, Sign-out) were observed passively. Data were analyzed using Microsoft Excel and SPSS v 20. Data were presented in numbers and percentages and Chi-square/ Fisher's exact test used for categorical variables. A p-value of < 0.05 was considered significant. Result WHO Surgical Safety Checklist was utilized in 48.7% of cases, with full compliance in only 8.7%. Utilization rate was seen to be 63% in the Pre-procedure check, while Sign-out was the least performed (29.3%). Highest utilization was seen in the General Surgery department, while the highest completion rate was seen in Neurosurgery (100%). Verbal confirmation (70.2%) was done more than written documentation. Conclusion Despite proven benefits, adherence to WHO Surgical Safety Checklist remains suboptimal. Targeted training and regular audits are essential to improve compliance and patient safety in resource-limited settings.

Structured scientific writing in medicine is seldom a part of curricula especially in non-native English-speaking countries. However, with the right tools and strategies, young researchers and academicians can be assured of artful dissemination of their research. The aim of this study is to propose a checklist that can help authors in structuring a polished scholarly manuscript. In order to achieve this, the authors carried out a literature search across prominent databases like PubMed, MEDLINE and Global Index Medicus to investigate the common reasons for retraction or rejection of manuscripts between 2020 to 2023. The inclusion criteria were as follows: reviews, observational studies, commentaries and editorials published in English since 2020 in the field of healthcare. A total of 32 results were identified, eight of which met the inclusion criteria. The eight included studies were from the field of dentistry, cardiology, neurology, spine surgery, anaesthesiology, nursing, and medically assisted reproduction. The most common reasons for article rejection or retraction were academic misconduct, designing errors, unintentional errors and data fraud. In order to overcome these flaws, the G.R.A.P.E. (Grammar, Reference Management, Archiving, Plagiarism, Equator-Network) checklist is proposed. Satisfying this checklist can result in a well-knit manuscript. The common reasons for article rejection/retraction can be avoided should students and academicians use the recommended strategies and tools as per the proposed checklist.

The reconstruction of a lost alveolar housing is important to achieve a harmonious balance between biology, function, and aesthetics for a prosthesis's successful outcome. Soft tissue ridge augmentation is a periodontal surgical procedure designed to correct mild to moderate horizontal alveolar ridge deformities alongside fixed partial prosthesis, mostly preferred for their aesthetic benefits and less invasive nature as compare to hard tissue augmentation. Moreover, the increase in keratinized tissue and the improved soft tissue profile reduces the risk of future complications and is essential for hygiene maintainance. The purpose of this case report was to present the successful periodontics-prosthodontics synergistic approach to treat a seibert class I moderate type ridge defect with additional vestibular depth and keratinized tissue insufficiency issues in an edentulous molar pontic site using a free gingival onlay graft.

Background Low back pain is a leading cause of disability globally. Obesity, a product of modern lifestyle, is a well-established risk factor for many diseases including spine pathologies. Degenerative lumbar spondylolisthesis is a significant cause of low back pain in the middle-aged and elderly population. However, the literature on relationship between high body mass index and degenerative spondylolisthesis is inconsistent. Objective To investigate prevalence of obesity among the patients with degenerative spondylolisthesis. Method This cross-sectional study was conducted at Tribhuvan University Teaching Hospital, Nepal, involving 81 patients aged ≥ 40 diagnosed with degenerative spondylolisthesis at various lumbar vertebral levels and grades. Anthropometric measurements were obtained and analyzed using an Independent t-test to compare the mean age, height, weight, and body mass index across different levels, grades, and between sexes. Result Among the 81 patients, 59 were female, and 22 were male. The mean age and, BMI were 59.41 ± 10.97 years, and 26.04 ± 4.41 kg/m2 , respectively. A notable 59.3% of patients had Body Mass Index ≥ 25. Patients with grade II spondylolisthesis exhibited significantly higher weight and Body Mass Index compared to those with grade I spondylolisthesis (p = 0.031, 0.013), particularly in female population (p = 0.003, 0.007) and at L4-L5 level (p = 0.003, 0.004). Conclusion Body mass index and weight were significantly higher in patients with grade II spondylolisthesis compared to grade I. This finding underscores the need for further research to understand the relationship between obesity and degenerative spondylolisthesis.

Background COVID-19 caused a global pandemic. It caused significant morbidity and mortality worldwide. The cases peaked at different intervals. The second wave, worldwide, was caused by delta variant. Majority of cases occurred from April 2021 to November 2021. Nepal was also affected during this period, causing a shortage of intensive care unit beds, oxygen supplies, and trained healthcare professionals. Objective To assess the clinical profile and outcome of patients admitted to a tertiary hospital in Nepal. Method An observational study was conducted with data collected from the medical records department after obtaining permission from the hospital authority and ethical clearance from the institutional review board. Sociodemographic variables, clinical profiles including symptoms on presentation, laboratory and imaging reports, duration of hospital stay, and outcome were obtained. Data were entered into SPSS and analysed. Result Among 307 patients,. mean age of the patients was 58.73 years (S.D=17.77). Most common reported symptoms were breathlessness in 59.6% (53.9, 65.1), fever in 58.6% (52.9, 64.2) and cough in 44.3% (38.6, 50.1) cases. The mortality rate was found to be 38.8% (33.2%, 44.5%). Breathlessness on presentation was associated with increased odds of mortality (adjusted odds ratio: 3.24, 95% CI 1.88, 5.60). Males were found to be at 1.77 (95% CI 1.01, 3.11) times risk of death as compared to females. Conclusion Nearly two-third of admitted patients had at least one or more comorbidities. Variability in symptoms on presentation may predict possible patient outcomes. The government should prioritize infectious diseases and plan for disease outbreaks at the national, provincial, and local levels.

Background Dengue hemorrhagic fever (DHF) has re-emerged across the global South, particularly in tropical and subtropical urban areas, driven by environmental changes alongside local demographic and socioeconomic factors. Objective To investigate the spatial patterns and socioeconomic determinants of dengue fever in Nepal from 2020 to 2023. Method Using Geographic Information Systems (GIS), Gi* cluster analysis, and Local Moran's I statistics, the study examined the relationship between socio-economic variables and dengue incidence across districts. Key factors analyzed included population density, urbanization, and night-time light (NTL) intensity. Result Bivariate Local Indicators of Spatial Association (LISA) analysis showed fluctuating correlations between dengue hemorrhagic fever incidence and factors such as population density, urbanization, and night-time light intensity. Moran's I value for population density were -0.083 in 2020, -0.082 in 2021, 0.526 in 2022, and -0.020 in 2023. Similarly, for urbanization, Moran's I values shifted from -0.103 in 2020 to -0.090 in 2021, 0.458 in 2022, and 0.007 in 2023. Night-time light intensity also demonstrated changing correlations, with Moran's I values of -0.091 in 2020, -0.102 in 2021, 0.415 in 2022, and -0.068 in 2023. A notable shift from negative to positive correlations occurred between 2020 and 2022. In 2022, high-incidence dengue hemorrhagic fever clusters emerged in densely populated areas, while distinct spatial patterns were observed in 2020 and 2021. Conclusion Dengue hemorrhagic fever risk spatial models are useful tools for detecting high-risk locations and driving proactive public health initiatives. The study emphasized the importance of dynamic, targeted public health interventions based on spatial and socio-economic factors to effectively manage evolving dengue outbreak patterns.