Journal of National Medical College

Nutrition Central Role in Preventing and Managing Type 2 Diabetes

2025-09-10T04:31:31+00:00

Prevalence of Depression in Substance Use Disorder Patients in Rehabilitation Centers in Pokhara

2025-09-10T05:02:01+00:00

Introduction: The objective of the study is to find out prevalence of depression among substance use disorder patients in rehabilitation centres. It aims to determine the relationship among various drug abusing patterns, prevalence of depression with substance use disorder and severity of depression with duration and frequency of substance abused.
Materials and Methods: The study was done in 3 rehabilitation centres at Pokhara, namely Richmond, Gateway and Helping hands rehabilitation centres. Ethical clearance was approved from Institutional Review committee (IRC) of Gandaki Medical College and Research Centre. One on one interview was taken using self-designed semi structured questionnaire to obtain information about socio-demography, types, duration and frequency of substance abused. Hamilton Depression Rating Scale was used for the rating of depression.
Result: All 110 respondents were men with mean age of 26.57 ±8 years. The prevalence of depression in SUD patients was 38.2%, among whom 69% has mild depression and 31% has moderate level of depression. The link between depression and duration of substance abuse was found to be statistically significant (p<0.001). Only 4.3% had depression who uses substance for less than 1 year whereas among those using substances for over 10 years, 85% had depression. Similarly, occasional substance users had a lower rate of depression (21.4%), while daily users had a much higher rate (57.1%).
Conclusion: This study shows that the longer and more frequently an individual uses substance, the higher their chances are of experiencing depression.

Demographic, Clinical Profile, and Outcome of Guillain-Barré Syndrome Patients in ICU: A Single Center, Retrospective Study

2025-09-10T05:21:48+00:00

Introduction: Guillain-Barré Syndrome (GBS) is an acute, immune-mediated peripheral neuropathy causing progressive muscle weakness and, in severe cases, respiratory failure requiring intensive care unit (ICU) admission. The study was conducted with the aim to analyze the demographic profile, clinical presentation, treatment modalities, and outcomes of GBS patients admitted to a tertiary-level ICU in Nepal.
Materials and Methods: A retrospective study was conducted over five years (January 2020 to December 2024). The data were obtained through the National Intensive Care Registry Foundation (NICRF) platform.
Results: A total of 30 patients were included. Males constituted the majority of the study population (83.4%, n=25), with a mean age of 52.97 years (SD=22.36), mostly in the age group of 61–80 years. Clinically, 83.3% (n=25) presented with progressive limb weakness, while 23% (n=7) had sensory deficits or other symptoms. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) was present in 50% (n=15) of patients, followed by acute motor axonal neuropathy (AMAN) 26.7% (n=8), acute motor and sensory axonal neuropathy (AMSAN) 13.3% (n=4), and Miller Fisher Syndrome 10% (n=3). Respiratory tract infections 23.3% (n=7) and diarrhea 16.67% (n=5) were the most common antecedent events. Treatment primarily involved intravenous immunoglobulin (IVIg) 66.67% (n=20), while 33.33% (n=10) required mechanical ventilation (mean duration 8.5 days). Mortality rate was 6.7% (n=2).
Conclusion: This study shows a male predominance, with AIDP as the primary GBS subtype. The most common type of treatment administered was intravenous immunoglobulin (IVIG).

Study on Sensitivity Pattern of Acinetobacter spp. from Clinical and Environmental Samples of National Medical College, Birgunj, Nepal

2025-09-10T05:38:47+00:00

Introduction: Acinetobacter spp. are saprophytic ubiquitous gram-negative coccobacilli can survive for long periods on dry or moist inanimate surfaces and as commensals on the skin of man and animal which can facilitate its persistence and spread in healthcare facilities. The aim of study is to isolate and evaluate Acinetobacter spp. from clinical and environmental samples for its antibiotic susceptibility profile.

Materials and Methods: This cross-sectional study was conducted at National Medical College and Teaching Hospital (NMCTH), Birganj, Nepal. 500 samples were collected from patients and environment of NMCTH. The samples were processed by use of culture media viz. Chocolate agar (CHA), 5% Sheep Blood agar (BA), and MacConkey agar (MA) plates for isolation of Acinetobacter spp. The characterization of antimicrobial susceptibility profile of isolated Acinetobacter spp was studied by use of Modified Kirby-Bauer disc diffusion technique.

Results: 39.86% Acinetobacter spp were obtained from 276 clinical specimens whereas 48.21% Acinetobacter spp. from 224 environmental samples. The distribution of Acinetobacter spp, more were found in respiratory samples (67.24%), which followed by invasive samples (25.71%) and urinary samples (18.18%). Regarding antibiotic resistance profile, 92.7% Acinetobacter spp showed resistance cefixime, followed by 89% to amoxicillin-clavulinic acid and 86.2% against cefotaxime.

Conclusion: The finding of current study suggests the need of direct efforts to reduce hospital-acquired infections and recommend the revision of the treatment protocol for Acinetobacter infections.

Prevalence of Enterococcus Species and their Antibiogram in a Tertiary Care Hospital of Gandaki Province, Nepal

2025-09-10T05:58:25+00:00

Introduction: Enterococcus species, part of the normal intestinal flora, have emerged as significant pathogens causing healthcare-associated infections worldwide. Their intrinsic and acquired resistance to multiple antibiotics, including last-resort agents, poses therapeutic challenges, especially in low-resource settings such as Nepal. However, data on their prevalence and resistance patterns in Gandaki Province are scarce. The aim of the study is to determine the prevalence of Enterococcus species in clinical samples and evaluate their antimicrobial susceptibility patterns in a tertiary care hospital in Gandaki Province, Nepal.
Materials and methods: A descriptive cross-sectional study was conducted from October 2024 to March 2025 at the Department of Microbiology, Western Regional Hospital, Pokhara Academy of Health Sciences. Ninety-three Enterococcus isolates were recovered from various clinical specimens. Species identification and antibiotic susceptibility testing were performed using standard microbiological methods and the Kirby-Bauer disk diffusion technique following CLSI guidelines.
Results: Enterococcus faecalis was the predominant species (93.5%), followed by E. faecium (6.5%). Both species showed 100% susceptibility to vancomycin. High resistance was noted against penicillin, ciprofloxacin, and ampicillin. E. faecalis exhibited high sensitivity to linezolid, teicoplanin, and nitrofurantoin, while E. faecium showed considerable resistance to penicillin and HLG but remained fully sensitive to vancomycin, linezolid, and nitrofurantoin.
Conclusion: E. faecalis is the most common Enterococcus species in clinical samples from Gandaki Province, with notable resistance to commonly used antibiotics. Continuous antimicrobial resistance surveillance and targeted stewardship interventions are essential to optimize treatment and control multidrug-resistant Enterococcus infections. We recommend strengthening antimicrobial stewardship programs and ongoing surveillance to monitor resistance trends and guide effective therapy against Enterococcus infections.

Bacteriological Profile and Antimicrobial Susceptibility Pattern of Isolates causing Wound Infections

2025-09-10T06:17:06+00:00

Introduction: Wound infections are a major cause of morbidity, often involving a wide range of bacterial pathogens, including multidrug-resistant organisms. Among them, Methicillin-Resistant Staphylococcus aureus (MRSA) has emerged as a significant challenge due to its resistance to commonly used antibiotics and its association with poor clinical outcomes. The rising incidence of MRSA and other resistant pathogens highlights the need for continuous surveillance. This study aims to determine the bacteriological profile and antimicrobial susceptibility patterns of wound infection isolates, with a focus on the prevalence of MRSA, to guide effective empirical therapy and inform antibiotic stewardship practices.

Materials and Methods: A descriptive cross-sectional study was conducted from April 14, 2022 to August 14, 2023 in the Department of Microbiology at Shree Birendra Hospital. A total of 120 pus swab specimens were collected and processed using standard microbiological procedures. Bacterial species were identified through conventional methods, and antimicrobial susceptibility testing was conducted using the disk diffusion technique, following the Clinical and Laboratory Standards Institute (CLSI) guidelines to ensure accuracy and reliability of results.

Results: Of the total bacterial isolates recovered, Gram-negative organisms accounted for 51%, while Gram-positive organisms comprised 49%, indicating a nearly equal distribution. A total of six distinct bacterial species were identified. Staphylococcus aureus emerged as the predominant isolate, representing 35% (n=42) of the total, followed by Klebsiella pneumoniae (17.5%, n=21), Escherichia coli (12.5%, n=15), and Enterobacter spp. (8.33%, n=10). Among the less frequently isolated organisms were coagulase-negative Staphylococci (5.83%, n=7) and Pseudomonas aeruginosa (4.16%, n=5). The most effective antibiotic for Gram positive organism was found to be Linezolid and the less effective was Ciprofloxacin. However, for Gram negative bacteria the most effective antibiotic was Amikacin and the less effective was Cefotaxime. Hence, the etiological agents of wound infection along with their antibiotic susceptibility pattern were determined.

Conclusion: The study highlights a diverse bacteriological profile in wound infections, with a nearly equal distribution of Gram-negative and Gram-positive bacteria, and Staphylococcus aureus as the most prevalent isolate. The presence of multidrug-resistant organisms, including MRSA, underscores the urgent need for regular surveillance and adherence to antibiotic stewardship programs. Continuous monitoring of local antimicrobial susceptibility patterns is essential to guide effective empirical therapy and improve patient outcomes.

A Prospective Observational Study on Clinical Profile and Outcomes of Dilated Cardiomyopathy Patients in a Tertiary Care Center in Nepal

2025-09-10T06:36:18+00:00

Introduction: Dilated cardiomyopathy is the most common cause of congestive heart failure in patients with different cardiac insults. This study aims to explore the signs, symptoms, and outcome of dilated cardiomyopathy in the tertiary level of health care of Nepal.

Materials and Methods: It was a prospective observational study in a cardiology department of the National Medical College, Birgunj. This study was conducted on 152 patients admitted to the cardiology department of the medical college. Demographic data was gathered from each patient in the performed sheet at the presentation time. Signs and symptoms, electrocardiographic and echocardiographic findings were also recorded. Patients’ outcomes were recorded in terms of mortality discharge toward, and leave against medical advice. The descriptive data are presented as the number and percentage for categorical data and mean ± standard deviation for continuous data according to their distribution.

Results: One hundred and fifty-two patients were included in this study. 84(55.3%) were males and 68(44.7%) were females. Mechanical ventilation was used in 36.8% and inotropes in 73.0% of patients. Chest pain, cough, dyspnea, swelling of limbs, and palpitation were present in 8(5.26%), 27 (17.76%), 64 (42.1%), 29 (19.07%), 9(5.9%) of patients. Bilateral Infiltrates, Cardiomegaly, Normal, and Consolidation in left lower zone were present in 29 (19.07%) 107 (70.39%), 12 (7.89%), 4(2.63%) in our study. 98(64.5%) were discharged to home, 52(34.2%) expired and 2(1.3%) of patients underwent leave against medical advice. The use of inotropes, mechanical ventilation, and presence of cardiomegaly on chest x-rays was associated with mortality.

Conclusion: The most common presentation was cough and basal crackles. Cardiomegaly, RS pattern with Left Bundle Branch Block, and global hypokinesia were the most common radiological presentations.

Comparison of Soft and Hard Tissue Response between Screw Retained and Cement Retained Implant Prosthesis: An In-vivo Study

2025-09-10T06:55:09+00:00

Introduction: To mitigate the negative consequences of tooth loss, it's essential to consider tooth replacement. Implants have emerged as a leading treatment modality for effectively restoring lost dentition, meeting both functional and aesthetic demands with remarkable success. This study aimed to assess and compare the soft tissue and hard tissue responses around screw-retained and cement-retained implant prostheses.

Materials and Methods: A prospective in vivo study was conducted, involving ten screw-retained and ten cement-retained implant prostheses placed in selected patients. Clinical parameters, including gingival bleeding index and marginal plaque index, were recorded. Radiographs were taken at 3, 6, and 9 months follow up to evaluate bone loss mesial and distal to each implant using ImageJ software. Statistical analysis was performed, and quantitative data were compared using the Kruskal-Wallis test.

Results: Significant increases in the gingival bleeding index, marginal plaque index, and mean marginal bone loss were observed around both screw-retained and cement-retained prostheses throughout the study period.

Conclusion: Although both retention types showed acceptable clinical performance over 9 months, statistically significant differences in soft and hard tissue responses suggest that clinical outcomes may be influenced by the type of prosthesis. Individual patient factors and clinical conditions should guide the choice of retention method.

Assessment of Acrylic-Colored Gross Specimens as Visual Aids in Human Anatomy Laboratories: An Experimental Approach to Museum Preparation

2025-09-10T07:07:29+00:00

Introduction: Human anatomy is an integral aspect of the curriculum in the first and second year of the medical educational programs in Nepal. A visually appealing and inventive anatomical color museum can help a medical student’s interest in anatomy education. Therefore, the objective of this research is to establish acrylic colored anatomy museum prototype for instructional purposes for medical students.
Materials and methods: 9 anatomically distortion-free specimens from arterial embalmed cadavers were chosen from the department of anatomy of Universal College of Medical Sciences in Bhairahawa, Nepal, which were ethically approved by UCMS/IRC/034/23 for use in research and teaching purpose.
Results: The observational photographic result of colored gross specimen was obtained showing colored specimen of Heart, Lungs, Liver and Kidney. The acrylic coloring technique applied to the wet specimen enhances understanding of the physical characteristics and gives the specimen a shimmering appearance that helps to create museum within limited budget.
Conclusion: The acrylic colored specimen is simple cost-effective technique which has great importance in teaching learning process of human anatomy.

Association of Anemia and Blood Group among Vegetarian and Non-Vegetarian Students of University Campus, Rajarshi Janak University, Janakpurdham, Nepal

2025-09-10T08:39:08+00:00

Introduction: Anemia is the major health problem among the young adults. Its prevalence increases among young adults whose diet doesn’t contain non-vegetarian food is at high risk of getting anemic. Vegetarians are more vulnerable to be anemic whose diet doesn’t contain vit-B12, folic acid and iron supplements. .The prevalence of anemia among students will help identify association between blood groups and vegetarian/non-vegetarian diet in the university campus, Rajarshi Janak University, Janakpurdham.

Materials and Methods: It was a cross-sectional study conducted at the University Campus, Rajarshi Janak University, Nepal Janakpurdham, Nepal. The measurement of Hemoglobin (Hb) was done by Cyanmethemoglobin method Recommended by ICSH and the blood group ABO with RH system was performed by slide agglutination method.

Results: Out of 130 students 51(39.24%) were the prevalence of anemia among young adults. Status of anemia by blood group (n=130) shows that the Blood Group AB has the highest prevalence of anemia, followed by Blood Group O, followed by Blood Group A, and least in B. The association between anemia and blood group was found significant (p=0.050). Among non-vegetarian students38.4% were anemic whereas 60% of vegetarian students were anemic. The association between dietary habits and the anemia was found insignificant (p=0.332).

Conclusion: According to this study, it can be concluded that the anemia was more common among female students, it may a reason for concern because the cause could be due to poor dietary habits or a reduction in food facilities.

Prevalence of Domestic Violence and Associated Factors among Women During Ante-natal Check-up at Medical College: A Cross-sectional Study

2025-09-10T08:53:25+00:00

Introduction: Domestic abuse, also known as domestic violence or intimate partner violence, is a pattern of behavior used to gain or maintain control over an intimate partner. According to the World Health Organization (WHO), one in three women may experience domestic abuse in their lifetime. The study examined the existing prevalence of all forms of domestic violence and its associated factors.

Materials and Methods: This analytical cross-sectional study was conducted at the antenatal clinic of the National Medical College Teaching Hospital. Participants were selected using a random sampling method where lottery method was further used. With pregnant women assigned to interview days based on their outpatient department serial numbers.

Results: More than half (55.4%) of the respondents experienced domestic violence during their lifetime. Psychological violence (52.1%) was the most common form, followed by physical (41.9%) and sexual violence (28.4%). Socio-demographic factors such as lack of education, absence of property ownership, unemployment, early marriage (10-15 years), and arranged marriage were significantly associated with domestic violence (p<0.05). The primary perpetrators were husbands (68.5%), followed by mothers-in-law (29.8%).

Conclusion: The prevalence of domestic violence has increased enormously. The findings emphasize the need for targeted interventions, including education, economic empowerment, and legal measures, to prevent domestic violence and protect vulnerable women.

Socio-Demographic Profiling of Alleged Perpetrators of Sexual Offence Brought for Medico-Legal Examination at a Tertiary Center, Dhulikhel

2025-09-10T09:11:14+00:00

Introduction: Sexual assault is defined as any sexual act committed by one (or more) person against another person without their consent. Sexual assault remains one of the most despicable and cruel crimes that persists in our country.

Materials and Methods: The study was a retrospective cross-sectional study of medico-legal reports of alleged perpetrators examined in between the period of 13 April 2020-12 April 2024 presenting to the Department of Forensic Medicine and Toxicology, Dhulikhel Hospital. The cases will be assessed for the statistics regarding the demography to age, marital status, address, clothes changed, body injury, genital injuries, bite marks, place of incidence, age gap and relationship with the victim.

Results: A total of 129 alleged perpetrators brought for medico-legal examination in the forensic medicine department were included in this study. Majority of the perpetrators belonged to age group between 21 years to 30 years amounting to 34.8% of the cases. Maximum alleged perpetrators were married (58.1%). 34.8% of the alleged perpetrators belonged to O positive blood group. Only 12 out of 129 alleged perpetrators (9.3%) accepted the offence. 53.4% had changed their clothes and 42.6% of them had taken bath after the offence. Most of the incidents (27.1%) occurred in victim's house followed by perpetrator's house (19.4%). The age gap with the victim was 0-10 years in 47.3% cases. Most of the alleged perpetrators (58.1%) were known to the victim.

Conclusion: Most of the married young men were involved in sexual offences. Most of the alleged perpetrators had changed their clothes when brought for examination which is a major challenge in identification of the culprit. Most of the alleged perpetrators were acquaintances. Majority of the assailants were from Panchkhal. The research results could provide useful basic data and would be advantageous for policymakers and program organizers to raise awareness among the public.

Assessment of Risk Factors, Clinical Presentations and Predictors of Stroke Admitted in a Tertiary Care Center of Madhesh Province

2025-09-10T09:27:00+00:00

Introduction: Stroke is the second-leading global cause of death behind heart disease and is a major cause of permanent disability. The risk factors for this condition are grouped as modifiable and non-modifiable factors. The study is designed with aim to assess risk factors, clinical presentations and predictors of stroke subtypes among adult patients visited the stroke unit.

Materials and Methods: A hospital based cross sectional study conducted in National Medical College Teaching Hospital, Birgunj was conducted for 10 months (March 2023 to December 2023). A total of 100 subjects were enrolled after an ethical clearance taken from Institutional Review Committee and a proper consent taken from the concerned. Data was collected and entered in Microsoft Excel and analyzed using Statistical Package of Social Sciences (SPSS) version 20.

Results: A total of 100 subjects of diagnosed stroke enrolled in this study had a mean age of 50.52± 7.0 years. The major participants were male comprising of 66 % (n=66). As per the World Health Organization (WHO) criteria for diagnosis of stroke, 56% (n=56) of the participants had ischaemic stroke while 44% were diagnosed with the hemorrhagic stroke. Hypertension (94%, n=90) was the most common risk factor, followed by family history (n=35), alcohol use (n=25), smoking habit (n=24) and heart failure (n=17). The most common clinical presentation was headache (85%), aphasia (62%), and hemiparesis (55%) as per the complaints and findings of the participants.

Conclusion:The clinical features, risk factors and predictors of stroke in our study are similar to other low and middle resource countries. The findings of the study relates with the basic associations of the different factors with stroke and can be helpful predicting the diagnosis of stroke, enhancing the health education focused on reducing the stroke and launching large scale public health campaign for educating and raising awareness regarding the risk factors and its intervention.

Vulvar Lipoma: A Case Report

2025-09-10T09:39:50+00:00

Introduction: This case report presents a rare instance of vulvar lipoma, a benign, slow-growing neoplasm of adipose origin. A 24-year-old unmarried woman presented with a painless, progressively enlarging vulvar mass. Ultrasound revealed a hyperechoic lesion suggestive of lipoma, confirmed by histopathology following surgical excision. While vulvar lipomas are extremely rare, surgical removal remains the preferred management in symptomatic cases.