Nevin Manimala

J Neuroimaging. 2025 Jan-Feb;35(1):e70019. doi: 10.1111/jon.70019.

ABSTRACT

BACKGROUND AND PURPOSE: This study presents automated atlas-based magnetization transfer (MT) measurements of the typically developing pediatric cervical spinal cord (SC). We report normative MT ratio (MTR) values from the whole cervical cord white matter (WM) and WM tracts, examining variations with age, sex, height, and weight.

METHODS: MT scans of 33 healthy females (mean age = 12.8) and 22 males (mean age = 13.09) were acquired from the cervical SC (C2-C7) using a 3.0 T MRI. Data were processed using the SC Toolbox, segmented, and registered to the PAM50 template. Affine and non-rigid transformations co-registered the PAM50 WM atlas to subject-specific space. MTRs were measured for the specific WM tracts (left and right dorsal fasciculus gracilis, dorsal fasciculus cuneatus, and lateral corticospinal tracts [LCST]) and the whole WM. Descriptive statistics, correlation analysis, and unpaired t-tests (p < 0.05) assessed relationships with age, height, weight, and sex.

RESULTS: Normative MTR measurements were obtained from all regions. The coefficients of variation were low to moderate. No significant differences (p > 0.05) were found across all the cervical levels. However, significant sex differences were observed in whole WM (p = 0.04) and LCST (p = 0.03). MTR values correlated positively with age, with significant correlations at C5 (r = 0.3, p false discovery rate = 0.04). A decreasing trend in MTR values across levels was found for whole WM (r = -0.2, p < 0.001).

CONCLUSIONS: This study provides an understanding of MTR values in pediatric cervical SC and their variations by sex, age, height, and weight, providing a baseline for comparisons in pediatric SC diseases.

PMID:39923194 | DOI:10.1111/jon.70019

J Neuroimaging. 2025 Jan-Feb;35(1):e70024. doi: 10.1111/jon.70024.

ABSTRACT

BACKGROUND AND PURPOSE: Accurate and consistent lesion segmentation from magnetic resonance imaging is required for longitudinal multiple sclerosis (MS) data analysis. In this work, we propose two new transfer learning-based pipelines to improve segmentation performance for subjects in longitudinal MS datasets.

METHOD: In general, transfer learning is used to improve deep learning model performance for the unseen dataset by fine-tuning a pretrained model with a limited number of labeled scans from the unseen dataset. The proposed methodologies fine-tune the deep learning model for each subject using the first scan and improve segmentation performance for later scans for the same subject. We also investigated the statistical benefits of the proposed methodology by modeling lesion volume over time between progressors according to confirmed disability progression and nonprogressors for a large in-house dataset (937 MS patients, 3210 scans) using a linear mixed effect (LME) model.

RESULTS: The results show statistically significant improvement for the proposed methodology compared with the traditional transfer learning method using Dice (improvement: 2%), sensitivity (6%), and average volumetric difference (16%), as well as visual analysis for public and in-house datasets. The LME result showed that the proposed subject-wise transfer learning method had increased statistical power for the measurement of longitudinal lesion volume.

CONCLUSION: The proposed method improved lesion segmentation performance and can reduce manual effort to correct the automatic segmentations for final data analysis in longitudinal studies.

PMID:39923192 | DOI:10.1111/jon.70024

J Nepal Health Res Counc. 2024 Dec 20;22(3):627-631. doi: 10.33314/jnhrc.v22i03.5406.

ABSTRACT

BACKGROUND: Total extra peritoneal inguinal hernia repair is established approach to inguinal hernia repair usually performed under general anesthesia. Aim of the study was to compare Total extra peritoneal inguinal hernia repair outcome when operated under spinal anesthesia and general anesthesia.

METHODS: A prospective cross-sectional study was conducted at Bir hospital on patients undergoing Total extra peritoneal inguinal hernia repair under either spinal anesthesia or general anesthesia for inguinal hernia from September 2022 to August 2023. Operative time, postoperative hospitalization time, postoperative pain, postoperative adverse effects, level of satisfaction and recurrence rate at one year was compared.

RESULTS: Fifty-eight patients were included, divided into two groups TEP-GA and TEP-SA, 29 in each arm. All procedures were completed by allocated method of anesthesia. Though pain score was low in TEP-SA in initial four hours, 2.79±1.08 (GA) and 1.99±0.97 (SA) and 2.28±1.09 (GA) and 1.80±0.80 (SA) at one and four hours post-operative respectively, no statistical difference was noted between two groups regarding surgery time, pain score complications, hospital stay, recovery or recurrence.

CONCLUSIONS: Spinal anesthesia is at par with general anesthesia for total extra peritoneal inguinal hernia repair, if not better. It may be appropriate anesthetic modality in patients considered high risk for general anaesthesia.

PMID:39923179 | DOI:10.33314/jnhrc.v22i03.5406

J Nepal Health Res Counc. 2024 Dec 20;22(3):616-621. doi: 10.33314/jnhrc.v22i03.5330.

ABSTRACT

BACKGROUND: Medical student syndrome (MSS) entails the development of symptoms of the same disease as the one being studied in medical students. This study aimed to determine the prevalence of Medical student syndrome among medical students in Nepal and identify associated factors.

METHODS: A Cross-sectional study was conducted at Lumbini Medical College Palpa, Nepal on medical students. Google form-based questionnaire was made, and the link was distributed to the students. A cut-off score was derived for Medical student syndrome. Students whose scores exceeded this threshold were categorized as having experienced Medical student syndrome. The responses received from the consenting students were downloaded in a Microsoft Excel spreadsheet and exported to SPSS v 26 and analysed.

RESULTS: The overall prevalence of Medical student syndrome was 17.8%. There was no significant difference in Medical student syndrome scores between genders (p = 0.801). However, year of study significantly influenced Medical student syndrome scores (p = 0.001, η² = 0.069), with final year students reporting higher scores.

CONCLUSIONS: This cross-sectional study revealed a significant prevalence of Medical Student Syndrome among medical students in Nepal, with nearly 18% reporting symptoms of the condition.

PMID:39923177 | DOI:10.33314/jnhrc.v22i03.5330

J Nepal Health Res Counc. 2024 Dec 20;22(3):602-607. doi: 10.33314/jnhrc.v22i03.5303.

ABSTRACT

BACKGROUND: Monitoring during treatment of asthma is usually done by various clinical tools, spirometry, sputum eosinophils and fractional exhaled nitric oxide. Fractional exhaled nitric oxide is a simple and noninvasive tool and has a good agreement with asthma control test score. This study aims to correlate fractional exhaled nitric oxide with asthma control test score.

METHODS: This cross-sectional study was conducted at National Academy of Medical Sciences, Bir hospital, Chest unit, Department of Medicine, over a duration of six months. Patients aged more than 18 years with bronchial asthma diagnosed at least three months prior were included into the study. Those with recent severe exacerbations, known other chronic respiratory disease and smokers were excluded. Asthma control test score was obtained at baseline. All included patients underwent fractional exhaled nitric oxide measurement followed by measurement of Forced vital capacity(FVC) Forced expiratory volume in one second (FEV1) and FEV1/FVC ratio.

RESULTS: Forty patients with a mean age of 40.5±11.1 years were included in the study. Majority were females (65%) and the median duration of symptoms was 24 months (Interquartile range= 18-60). Mean fractional exhaled nitric oxide level was 27.8 (±16.0) parts per billion (ppb) and asthma control test score was 19.3 (±4.7). Mean fractional exhaled nitric oxide levels were significantly different across different severity (well controlled, partially controlled and poorly controlled) of asthma (p=0.013). The mean fractional exhaled nitric oxide values and total asthma control test score shows statistically significant negative correlation (Pearson correlation coefficient (r) = -0.462, p=0.003). Asthma control test and FeNO values guided the change of inhaled steroid dose in 17 of the 40 patients.

CONCLUSION: Fractional exhaled nitric oxide can be used when available, along with asthma control test for monitoring control and adjusting the inhaled steroid dose in asthma.

PMID:39923175 | DOI:10.33314/jnhrc.v22i03.5303

J Nepal Health Res Counc. 2024 Dec 20;22(3):582-591. doi: 10.33314/jnhrc.v22i03.5238.

ABSTRACT

BACKGROUND: Hypertension is a major risk factor for cardiovascular diseases, chronic kidney disease, and dementia. Early detection and management are crucial for preventing these complications. However, many people lack awareness regarding their blood pressure. The study aimed to assess the prevalence of hypertension and its associated factors in rural communities.

METHODS: This cross-sectional study was conducted among 525 middle-aged (35-60 years) residents of the Rupa Rural Municipality, Nepal, from August to December 2020. Chi-square test and multivariate logistic regression were performed to identify the factors associated with hypertension at a 5% level of significance.

RESULTS: More than half (50.9%) of the respondents had normal to elevated systolic pressure, while only one-third (33.9%) had normal to elevated diastolic pressure. Only 47.4% of the hypertensive participants were aware of their hypertensive condition. Being a male (aOR: 1.903; 95% CI: 1.184-3.030), in middle age of 45-55 years (aOR: 2.002; 95% CI: 1.152-3.478), having basic education (aOR: 2.014; 95% CI:1.174-3.455), currently consuming alcohol (aOR: 1.923; 95% CI: 1.095-3.375), and being overweight/ obese (aOR: 1.899; 95% CI: 1.262-2.859) were identified as significant factors associated with hypertension.

CONCLUSIONS: The studys findings emphasize the urgency of interventions to improve awareness of hypertension and its management to improve health outcomes. Targeted interventions will have an opportunity to reduce the burden of hypertension which is an important risk factor for cardiovascular diseases among the middle-aged population.

PMID:39923173 | DOI:10.33314/jnhrc.v22i03.5238

J Nepal Health Res Counc. 2024 Dec 20;22(3):567-573. doi: 10.33314/jnhrc.v22i03.5175.

ABSTRACT

BACKGROUND: Worldwide, Fetal growth restriction is a leading cause of stillbirth, neonatal mortality, and morbidity. Several maternal factors influence fetal growth and increases the risk of fetal growth restriction. Our study aimed to determine the risk factors and perinatal outcome of fetal growth restriction at Tribhuvan University teaching hospital, Maharajgunj, Kathmandu.

METHODS: A prospective study was conducted in the department of Obstetrics and Gynecology at Tribhuvan University teaching hospital. A total of 140 Pregnant women at > 28 weeks period of gestation clinically diagnosed as FGR and fulfilling the inclusion criteria were enrolled in this study. The data was analyzed using SPSS 23. The association between various risk factors and FGR was studied using the binary logistic regression.

RESULTS: Among the 140 FGR fetuses, 27.9 % (39) belonged to the <10th percentile (Mild Fetal growth restriction) and 72.1%(101) belonged to<5th percentile (Severe Fetal growth restriction). Maternal age more than 35 years was found to be statistically significant as a risk factor in the severe Fetal growth restriction group. Among the maternal co-morbidities, hypertensive disorder of pregnancy was found to be the most common co-morbidity followed by heart disease and thyroid disorders. The Fetal growth restriction neonates requiring neonatal intensive care unit (NICU) stay was 42 (30%) and the median neonatal intensive care unit stay was 4 days. The fetal morbidities associated with fetal growth restriction were prematurity,respiratory distress syndrome(RDS), sepsis, meconium aspiration syndrome(MAS) and neonatal jaundice (NNJ). Among the 140 FGR babies, 138 were live born and there were 2 neonatal deaths (NND).

CONCLUSIONS: In our study ,advanced maternal age is found to be a significant risk factor for Fetal growth restriction and gestational hypertension is the most common comorbidity associated with Fetal growth restriction. Therefore, identification of such women, their regular antenatal checkups, fetal surveillance and timely intervention are crucial for better perinatal outcome.

PMID:39923171 | DOI:10.33314/jnhrc.v22i03.5175

J Nepal Health Res Counc. 2024 Dec 20;22(3):562-566.

ABSTRACT

BACKGROUND: Dengue is a viral infection, commonly found in tropical and subtropical regions across the globe particularly in urban and semi-urban settings. There has been significant increase in dengue cases over past two decades. This study aims to determine the prevalence of dengue NS1 antigen, IgM, and IgG antibodies among healthy blood donors at the Nepal Medical College Blood Bank.

METHODS: The descriptive cross-sectional study was carried out at the blood bank of Nepal Medical College between August to November 2023. Ethical approval was received from the Institutional Review Committee of Nepal Medical College (Ref: -080/081). Two hundred and thirty two serum samples from the healthy blood donors were screened with Dengue RDT (SD Bioline Dengue Duo) for detection of NS1 antigen, IgM and Ig G antibodies.

RESULTS: Among the samples 18/232 (7.75%) were found IgM positive and 25/232 (10.77%) were found IgG positive. Similarly, 12/232 (5.17%) showed both IgG and IgM positive; however, all sample tested negative for NS1 Conclusions: Detection of Dengue antibodies in asymptomatic blood donors in endemic areas indicates a potential risk for recipients to contract dengue infection through blood transfusion. Implementing a screening program during dengue outbreaks could effectively mitigate this risk.

PMID:39923170

J Nepal Health Res Counc. 2024 Dec 20;22(3):549-556. doi: 10.33314/jnhrc.v22i03.5109.

ABSTRACT

BACKGROUND: Maternal mental health problems are globally considered as a major public health challenge. Postnatal stress affects mothers and children’s physical as well as mental wellbeing. The objective of the study is to assess stress and coping strategies of postnatal mothers.

METHODS: A cross-sectional descriptive study design was carried out at Immunization clinic of Lumbini Provincial Hospital. Purposive sampling technique was used to collect data among 152 mothers. Data was collected through a structured interview questionnaire using Perceived stress scale and Brief Cope. Data analysis was done through descriptive and inferential statistics.

RESULTS: Findings of the study revealed that 25.7% mothers had mild stress; 72.4% had moderate stress, and only 2% had severe stress. Regarding coping mechanism, mostly used coping strategies were problem focused coping strategies and 90.1% mother adopted adaptive coping. While there was statistically significant between stress and age (p=.016), residence (p=.022) and occupation (p=<.001). Likewise, there was statistically significant between coping and age (p=.003), residence (p=.045), occupation (p=.018), sex of the baby (p=.005) and living during postnatal periods (p=.023).

CONCLUSIONS: The majority of the postnatal mothers had some form of stress. However, most of the postnatal mothers managed their stress through adaptive and problem based coping strategies in their own ways. Thus, there was a prime need to pay attention for promotion of their coping strategies that definitely enhance the mental status of the postnatal mothers.

PMID:39923168 | DOI:10.33314/jnhrc.v22i03.5109

J Nepal Health Res Counc. 2024 Dec 20;22(3):543-548. doi: 10.33314/jnhrc.v22i03.5055.

ABSTRACT

BACKGROUNDS: Eye donation is an act of donating, one’s eyes, mostly the cornea after his/her death. According to World Health Organization (WHO) estimates every 5 second, someone goes blind. There are currently about 45 million blind people in the world which increases by 1 to 2 million every year. The study aimed to identify and explore the awareness of eye donation among university students in Morang, Nepal.

METHODS: A descriptive cross-sectional study was conducted on Undergraduate Students of Purbanchal University School of Health Sciences a constituent college of Purbanchal University situated in Sundarharaicha Municipality of Morang District of Nepal. Population proportionate simple random sampling technique was applied to allocate the sample size.

RESULTS: Among the total of 177 respondents, 22.0% are from the Pharmacy faculty, 22.6% from Public Health, and 55.4% from Nursing. Out of the total respondents, 98.9% were aware of eye donation, while only 1.1% had no awareness. About 86.9%, of the respondents correctly identified the cornea as a donatable part. However, a smaller percentage mentioned the retina (4.0%), eye ball (6.9%), and lens (2.3%).

CONCLUSIONS: The findings of the study on awareness of eye donation suggest the need for targeted educational interventions to enhance understanding the parts of eye for donation and avoiding the misconceptions about various aspects of eye donation among Health Sciences students.

PMID:39923167 | DOI:10.33314/jnhrc.v22i03.5055