Nevin Manimala

Colorectal Dis. 2025 Dec;27(12):e70321. doi: 10.1111/codi.70321.

ABSTRACT

BACKGROUND: Excisional haemorrhoidectomy is often associated with intense post-operative pain and delayed recovery. Bacterial colonization may contribute to this discomfort, and metronidazole has been proposed as an analgesic adjunct. This study compared the analgesic efficacy of topical metronidazole with oral metronidazole.

METHODS: A systematic search was conducted in PubMed, Scopus, and the Cochrane Central Register through May 2025. Randomized controlled trials comparing topical metronidazole with oral metronidazole for post-operative pain after haemorrhoidectomy were included. Visual analogue scale (VAS) scores on post-operative days 1, 3, and 7 were pooled. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed with the I² statistic. Risk of bias (RoB 2) and certainty of evidence (GRADE) were evaluated.

RESULTS: Four RCTs involving 439 patients (218 topical, 221 oral) met inclusion criteria. No significant differences were found between topical and oral metronidazole at day 1 (MD -0.1; 95% CI -0.3 to 0.2; I² = 25%), day 3 (MD -0.4; 95% CI -1.3 to 0.6; I² = 94%), or day 7 (MD -0.2; 95% CI -1.0 to 0.5; I² = 90%).

CONCLUSION: Topical and oral metronidazole showed similar short-term analgesic efficacy after haemorrhoidectomy.

PMID:41319118 | DOI:10.1111/codi.70321

Orthod Craniofac Res. 2025 Nov 30. doi: 10.1111/ocr.70069. Online ahead of print.

ABSTRACT

BACKGROUND: This retrospective study aimed to evaluate the skeletal and dentoalveolar effects of maxillary expansion using the Invisalign First system in the mixed dentition.

METHODS: The study was conducted in the orthodontic department of the Fourth Affiliated Hospital of Zhejiang University School of Medicine between 2021 and 2024. Inclusion criteria were mixed dentition patients with maxillary transverse deficiency, fully erupted first molars, arch width discrepancy ≤ 5 mm, mild to moderate crowding and pre-peak growth status (CS2). Exclusion criteria were Angle’s Class III malocclusion, previous orthodontic treatment, congenitally missing teeth, TMJ disorders, cleft lip/palate, or use of additional appliances. All patients were treated with a standardised digital protocol using the Invisalign First system with optimised expansion support attachments. No additional buccal root torque was programmed, and Class II elastics were not used. Pre- and post-treatment intraoral scan digital models and cone-beam computed tomography data were obtained. Measured parameters included arch width, nasal width, apical base width, alveolar width, palatal depth and first molar inclination. Statistical analyses were performed using paired t-tests for normally distributed data and Wilcoxon signed-rank tests for non-normally distributed data, with a significance level set at p < 0.05.

RESULTS: The study included 45 patients (mean age 8.84 ± 1.01 years; mean treatment duration 18.26 ± 0.95 months). Significant transverse increases were observed in all maxillary arch widths, particularly in the canine and deciduous molar regions (canine dental width: 4.17 ± 1.91 mm, p < 0.001; first deciduous molar width: 3.86 ± 1.93 mm, p < 0.001; second deciduous molar width: 4.38 ± 1.78 mm, p < 0.001). Corresponding significant expansion was noted at the alveolar bone level (anterior alveolar process width: 4.04 ± 3.37 mm, p < 0.001; posterior alveolar process width: 2.51 ± 1.71 mm, p < 0.001). The maxillary first molars showed controlled buccal inclination of 1.6° ± 4.09° (p < 0.01). The upper arch perimeter increased by 3.68 ± 2.95 mm (p < 0.001) with crowding reduction of 3.83 ± 3.00 mm (p < 0.001). No significant palatal depth changes occurred (0.42 ± 3.36 mm, p = 0.41).

CONCLUSION: In the mixed dentition, the Invisalign First system can effectively expand the maxillary dental-alveolar width, maintain molar inclination and improve the transverse deficiencies and arch form in the canine-premolar region.

PMID:41319100 | DOI:10.1111/ocr.70069

J Cell Mol Med. 2025 Dec;29(23):e70962. doi: 10.1111/jcmm.70962.

ABSTRACT

Lung cancer prognosis varies significantly among patients, highlighting the need for accurate prediction tools. Emerging evidence suggests that the immune microenvironment plays a crucial role in lung cancer progression and treatment response. We collected RNA expression profiles and clinical data of lung cancer patients from TCGA and GEO databases. Differential expression analysis identified 276 lung cancer-associated genes using strict statistical criteria (logFC > 1, FDR < 0.05). Unsupervised consensus clustering divided patients into ‘lung cancer-related’ and ‘non-lung cancer-related’ subgroups. We evaluated 10 machine learning algorithms and 101 algorithmic combinations for prognostic model development. Single-cell RNA sequencing data were analysed using Seurat and CellChat to investigate immune cell interactions within the lung cancer microenvironment. Our prognostic model demonstrated excellent predictive performance with AUC values of 0.874, 0.891 and 0.925 at 1, 2 and 3 years, respectively (C-index = 0.874). Six key immune genes (TLR2, TLR4, CCR7, IL18, TIRAP and FOXP3) showed cell-type specific expression patterns in the lung cancer microenvironment. Intercellular communication analysis revealed complex signalling networks between B cells, T cells, NK cells and dendritic cells. CIBERSORT and ESTIMATE analyses confirmed significant differences in immune infiltration between high-risk and low-risk patients, with distinct patterns of T cell subsets, macrophages and dendritic cells. This study provides a reliable prognostic tool for lung cancer and offers insights into the critical role of the immune microenvironment in lung cancer pathogenesis. Our findings may guide the development of personalised immunotherapy strategies for lung cancer patients.

PMID:41319095 | DOI:10.1111/jcmm.70962

J Nepal Health Res Counc. 2025 Oct 17;23(2):282-287. doi: 10.33314/jnhrc.v23i02.4848.

ABSTRACT

BACKGROUND: Lack of a structured referral system is a challenging hurdle in developing countries like Nepal that delays in management. Identification causes of delays and their timely management is of immense importance. The study aimed to assess the maternal and fetal outcome of referred-in obstetric patients and to identify various maternal determinants of referrals inParopakar Maternity and Women’s Hospital.

METHODS: A prospective study was conducted during 3 months duration from May to June 2021 among undelivered obstetric cases who were referred to Paropakar Maternity and Women’s Hospital. Study excluded self-referrals, without referral slips and postpartum patients. Maternal determinants, mode of management, maternal and fetal outcomes were noted.

RESULTS: Out of 47 cases enrolled, most common diagnosis of referral was hypertensive disorder accounting for 19.14% followed by intrauterine growth restriction comprising 10.6%. Of total, 55.3% of referred patients were from the district hospitals. Ambulances rescued 78.7% of cases and 10.6% were rescued by helicopter. About 12.7% of the referred cases required intensive care management. Live birth were 86.3%, still birth 4.5% and 9.1% of Intrauterine Fetal Death.

CONCLUSIONS: Among the varied high risk cases, most common diagnosis at the time of referral was hypertensive disorders followed by cases requiring critical care and surgical management. This highlights need and scope of strengthening emergency obstetric care centres and early identification and treatment of high risk cases antenatally at every level of health centres.

PMID:41319084 | DOI:10.33314/jnhrc.v23i02.4848

J Nepal Health Res Counc. 2025 Oct 17;23(2):256-262. doi: 10.33314/jnhrc.v23i02.4817.

ABSTRACT

BACKGROUND: Male involvement in family planning not only enhances the couple’s uptake but also provides continuity through spousal coordination to meet the family planning need. The study aims to assess the factors associated with male involvement in family planning utilization.

METHODS: A descriptive cross-sectional study design was used in Madhyabindu Municipality from14th August to 10th September 2022. After proportionately selecting from each ward, the data was collected through a systematic random sampling technique among Tharu married males who were living together with reproductive age group wives. Data was analysed by using SPSS version-16. Descriptive and inferential statistics were used for the data analysis.

RESULTS: Of the 151 males, almost half (49.7%) of the male had completed secondary level education. The majority (80.1%) had decided together by husband and wife about the contraceptive use. The majority (67.5%) of the male had active involvement in family planning utilization, while half (51.7%) of them visited family planning clinic and users of modern family planning methods were 40.4%. Most of (95.4%) them had easy access to temporary FP services and majority (74.2%) had easy access to permanent FP services. Education (p = 0.001), prior use of contraception (p = 0.001), and easy access to permanent family planning methods (p = 0.012) were statistically significant with male involvement in family planning utilization.

CONCLUSIONS: Two-fifth of the males were users of family planning methods. Education, prior use of contraception and easy access to family planning services were the significant factors associated with male involvement in family planning utilization.

PMID:41319083 | DOI:10.33314/jnhrc.v23i02.4817

J Nepal Health Res Counc. 2025 Oct 17;23(2):296-303. doi: 10.33314/jnhrc.v23i02.4812.

ABSTRACT

BACKGROUND: Health promoting lifestyle refers to the healthy practices that improves health. The objective of the study was to assess health promoting lifestyle and health related quality of life among hypertensive patients attending a tertiary level hospital.

METHODS: Cross sectional study design was used among 255 hypertensive patients, selected purposively from those attending cardiology OPD. Data were collected by using Health Promoting Lifestyle Profile tool and Short Form-36 Health Survey tool through face to face interview. Data were analyzed by using descriptive, inferential statistics with SPSS version 16.

RESULTS: Health promoting lifestyle among hypertensive patients was at intermediate level (median score=130) with the highest score in spiritual growth (29.48) and the lowest score in physical activity (12.33) subscale. Health related quality of life among hypertensive patients was good (median score=64.45) with the highest score in mental health (80.61) and the lowest score in role physical (49.90) subscale. Health promoting lifestyle and health related quality of life were found positively correlated (r=0.757) and statistically significant (p <0.001). This study found that increasing age, longer duration of hypertension and presence of comorbidities were associated with lower HRQOL whereas being married and being literate were associated with higher HRQOL (p<0.005). Hierarchical regression analysis revealed that being married, education level, presence of comorbidities and six subscales of health promoting lifestyle (spiritual growth, interpersonal relationship, nutrition, health responsibility, stress management and physical activity) were influencing factors of health related quality of life among hypertensive patients (p<0.005).

CONCLUSIONS: Health promoting lifestyle is an important factor that influences health related quality of life among hypertensive patients.

PMID:41319081 | DOI:10.33314/jnhrc.v23i02.4812

J Nepal Health Res Counc. 2025 Oct 17;23(2):320-328. doi: 10.33314/jnhrc.v23i02.4762.

ABSTRACT

BACKGROUND: Cardiovascular diseases are a leading cause of death globally, with physical inactivity as a significant risk factor. In Nepal, lifestyle-related health issues are rising, necessitating an understanding of physical activity patterns in specific groups like secondary school teachers. This study aims to assess the status of physical activity and associated factors among secondary school teachers in Pokhara, Nepal.

METHODS: A cross-sectional study was conducted from December 2022 to April 2023 among 406 secondary school teachers in Pokhara. Physical activity was measured using the IPAQ-long form, and other variables were collected through self-administered questionnaires. Univariate and bivariate analyses were followed by logistic regression to calculate adjusted odds ratios (aOR) for factors associated with moderate and high physical activity.

RESULTS: Most participants were male (53%) and Brahmins/Chhetris (69.2%), with a mean age of 38.65 years. The majority (86.3%) met WHO physical activity guidelines, with 65.3% reporting moderate and 21.5% high activity levels. Higher physical activity was associated with being male (aOR: 2.19, 95% CI: 1.11-4.35), higher education (aOR: 2.88, 95% CI: 1.45-5.73), walking while teaching (aOR: 9.13, 95% CI: 4.20-19.87), and access to walking areas (aOR: 2.28, 95% CI: 1.12-4.62).

CONCLUSION: Male teachers, those with higher education, and those who walked while teaching were more likely to engage in higher physical activity. Access to walking-friendly environments also positively influenced activity levels. Promoting walking friendly spaces and addressing educational and occupational factors could enhance physical activity among teachers. Keyword: Cardiovascular disease; international physical activity questionnaire; metabolic equivalents.

PMID:41319075 | DOI:10.33314/jnhrc.v23i02.4762

J Nepal Health Res Counc. 2025 Oct 17;23(2):243-246. doi: 10.33314/jnhrc.v23i02.4753.

ABSTRACT

BACKGROUND: Sexual assault is one of the most traumatic crimes which leaves a deep mental and emotional scar in the victim’s life. Mostly girls are the victims of sexual assault whereas boys are also victimized but are few in number. This heinous incidence hampers the normal growth and development of a growing child making them vulnerable to psychiatric disorder, drug abuse disorder and anti-social conducts in adult. This study aims at identifying the incidence of child sexual abuse in different municipal areas of Kavrepalanchok district of Nepal Methods:This is a retrospective study in which data of sexual assault victim less than 18 years presented at emergency department of Dhulikhel Hospital, KUSMS through One-stop Crisis Management Center (OCMC) by the investigating authority was studied. The data from 2076/09/01 B.S. to 2080/12/30 B.S. was included in the study. Total of 127 cases were studied.

RESULTS: Mandandeupur rural municipality reported highest number of child victims of sexual assault i.e., 14.17%. Out of 127 victims, 4 of them were male and rests were female. Most of the victims (74.01%) were of 12-18 years age. Most of the perpetrators (51.18%) were strangers to the victim. The cases of sexual assault with children occurred mostly in the places other than house (45.66%). More than one fourth of the victims (26.77%) sustained some type of bodily injuries.

CONCLUSIONS: Sexual assault among children is predominant among females and mostly between the teenager age group with perpetrators being stranger to the victim Psychological screening of the potential pedophiles could lead to minimizing the incidence of child sexual assault and abuse. Psychosocial counseling to the victim is must to prevent the devastating psychological effects of sexual abuse.

PMID:41319074 | DOI:10.33314/jnhrc.v23i02.4753

J Nepal Health Res Counc. 2025 Oct 17;23(2):329-334. doi: 10.33314/jnhrc.v23i02.4752.

ABSTRACT

BACKGROUND: Asymptomatic bacteriuria in hemodialysis patients is a common problem due to their decreased immunity and renal function which often leads to development of urinary tract infection and other complications. However, there are no adequate guidelines that recommend the routine screening and management of such patients in most of the developing countries including Nepal resulting in antibiotic misuse. This study was done to find the magnitude of asymptomatic bacteriuria among hemodialysis patients along with their antibiotic susceptibility and related risk factors.

METHODS: A descriptive cross-sectional study was conducted on hemodialysis patients from July 2023 to January 2024. Midstream clean catch technique was used for urine collection. Urine specimens were processed for identification of uropathogens and their antibiotic susceptibility test by Kirby Bauer disk diffusion method following standard guidelines. Statistical analysis was done by Excel 2016 and SPSS 26, the point estimate was calculated at a 95% confidence interval.

RESULTS: The overall prevalence of asymptomatic bacteriuria was 27%. Escherichia coli (43.47%) was the most frequent isolate. Imipenem and Amikacin were the most sensitive antibiotics among Gram negative isolates while Ceftriaxone and Nitrofurantoin were the most resistant antibiotics. Pseudomonas aeruginosa was the major multidrug resistant pathogen. Hypertension and Diabetes Mellitus were commonly associated risk factors for asymptomatic bacteriuria in hemodialysis patients.

CONCLUSIONS: This study demonstrates high prevalence of asymptomatic bacteriuria among hemodialysis patients. Routine screening of asymptomatic bacteriuria aids in early detection and management of complications along with optimization of antibiotic use.

PMID:41319073 | DOI:10.33314/jnhrc.v23i02.4752

J Nepal Health Res Counc. 2025 Oct 17;23(2):343-350. doi: 10.33314/jnhrc.v23i02.4724.

ABSTRACT

BACKGROUND: Adequate nutrition during pregnancy is crucial for maternal and fetal health. This study aims to assess the nutritional status, food insecurity, and socio-demographic factors affecting the nutritional status of pregnant women in this region.

METHODS: A cross-sectional study was conducted among 903 pregnant women in Kailali district. Data were collected using structured questionnaires covering socio-demographic characteristics, food insecurity and knowledge of nutrition. Nutritional status was assessed using Mid-Upper Arm Circumference (MUAC). Statistical analysis was performed to identify associations between nutritional status and various factors.

RESULTS: The majority of women (68.6%) had normal nutritional status (MUAC >23 cm), while 31.4% were either had severe or moderate malnutrition. Approximately 10% to 12% of participants reported food insecurity. A significant association was found between higher MUAC and factors such as sufficient nutrition knowledge, regular antenatal care visits, increased dietary intake, and a higher pre-pregnancy BMI. Ethnic disparities were also noted, with Dalit, Janjati, and Brahmin women having higher MUAC compared to Madeshi and Muslim women.

CONCLUSIONS: Nutritional deficiencies and food insecurity remain significant challenges for pregnant women in Kailali district. Strengthening nutrition education, improving food security, and promoting antenatal care can improve maternal nutrition and health outcomes.

PMID:41319071 | DOI:10.33314/jnhrc.v23i02.4724