Tag: nevin manimala

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):471-476.

ABSTRACT

Background Internal jugular venous cannulation is required in many aspects for patients in intensive care, major surgeries, hemodialysis etc. Superficial cervical plexus block allows field of anesthesia to operate and secure the cannula in awake patient. Objective To study pain relief caused by superficial cervical plexus block of local anesthesia during the procedure of cannulation of internal jugular vein in patients requiring central venous cannulation. Method This prospective observational study was conducted from December 2023 to August 2024 at Dhulikhel Hospital, Kathmandu University Hospital. Sixty four awake patients with American Society of Anesthesia (ASA) I-III requiring central venous cannulation received ultrasound-guided Superficial cervical plexus block with 10 ml of 0.25% ropivacaine prior to internal jugular venous cannulation. Pain score (Verbal Pain Rating Scale) and hemodynamic changes (Heart rate, Mean Arterial Pressure, Spo2) were assessed at key procedural steps: during block, needle puncture, subcutaneous tunneling, catheter insertion, securing and suturing and five minutes post-procedure with any adverse effect and complication. Data were analysed using SPSS 22, student’s unpaired t-test was applied to the continue statistical data and chi square test to the categorical test considering significance p value <0.05. Result All cannulations were successful on the first attempt. Only 1 patient (1.56)% required additional analgesia due to moderate pain during tunneling. Mean pain scores were minimal at all other stages (≤ 1). Hemodynamic parameters remained stable throughout the procedure, with no significant complications observed. Conclusion Ultrasound guided superficial cervical plexus block provides effective analgesia at various stages of procedure avoiding the complications. This study recommends Superficial block as one of the analgesic technique during awake internal jugular venous cannulation to improve patient comfort and procedural safety.

PMID:42318723

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):449-457.

ABSTRACT

Background Nepal’s National Immunization Programme (NIP) has made significant strides in safeguarding public health, notably through the integration of the Inactivated Polio Vaccine (IPV) in national immunization schedule, in 2014, to combat wild poliovirus serotypes. However, a global IPV shortage between 2016 and 2018 left approximately 1.46 million children unvaccinated, creating an immunity gap against Type-2 poliovirus. Objective To evaluate the coverage and equity of Nepal’s national inactivated polio vaccine catch-up campaign (May 26 to June 8, 2024) and identify key areas needing improvement. Method Administrative data from all 77 districts were reviewed and analysed by province, district, and ecological zone. To address this, Nepal launched a nationwide IPV vaccination campaign from May 26 to June 8, 2024, targeting children aged between five years and eight months to eight years and months. Result The campaign achieved national coverage of 95.9%. However, disparities were noted: district-level coverage ranged from 45.2% in Bagmati to 124.7% in Koshi. Province-level performance varied, with Madhesh (111.6%) and Karnali (110.7%) exceeding targets, while Bagmati (88.2%) and Gandaki (75.8%) underperformed. These differences were influenced by terrain, cold chain capacity, population mobility, and urban-rural inequities. Conclusion Nepal’s inactivated polio vaccine campaign largely succeeded in bridging the post-shortage immunity gap, but subnational disparities highlight systemic challenges. Strengthening cold chain infrastructure, improving microplanning through quality data, and tailoring outreach to underserved areas are essential to enhance equity and sustain Nepal’s polio-free status.

PMID:42318720

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):441-448.

ABSTRACT

Background Despite persons affected by disability are expected to increase, limited support services and disparities in resource allocation exist in Myanmar which hinder persons with disabilities in accessing essential needs. This highlights the urgent need for spatial analysis through Geographic Information System (GIS) to better understand distribution of disability, socioeconomic correlations, and inform targeted policy interventions. Objective To provide hotspot clusters of disability prevalence across all districts of Myanmar and examine their distribution based on socioeconomic status along with the spatial autocorrelation patterns using Geographic Information System. Method District Level Report of 2019 of Myanmar Intercensal Survey was used. The data were processed and analysed using Quantum Geographic Information System and GeoDa programmes. Univariate and bivariate spatial analysis were performed using Global and Local Moran’s I statistics along with Local Indicators of Spatial Association to identify spatial clusters of disability rates. Result The overall prevalence of disability was 12.9 per 100 population in Myanmar. Seven hotspots were identified along the Western Region of Myanmar (Moran’s I value of 0.318). In bivariate Local Indicators of Spatial Association analysis, the literacy rate (Moran’s I: 0.216), child dependency ratio (Moran’s I: 0.137) and old dependency ratio (Moran’s I: 0.259) exhibited significant association with disability prevalence. Conclusion This study demonstrated the demographic disparities in distribution of disability prevalence. Moreover, the spatial relationships between socioeconomic factors and disability were identified, offering a foundational understanding for necessary interventions and demonstrating the value of spatial analysis in shaping healthcare strategies.

PMID:42318719

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):433-440.

ABSTRACT

Background Cervical cancer is the most common cancer among women in Nepal. Traditionally, healthcare professionals collect cervical specimens for Human Papillomavirus testing. Still, many women prefer self-collection, allowing them to sample in the comfort of their homes. Self-sampling has shown promise in other countries, but its acceptability in Nepal remains unexplored. Objective To assess the acceptability of Human papillomavirus self-sampling among women in Nepal. Method This community based single arm implementation study was conducted from 5 February 2021 to 17 July 2022 using mixed methods approach. For Cervical Cancer Screening, 1625 women aged 30-60 years were recruited and vaginal samples were collected using self-sampling technique. Quantitative data were collected by assessing sociodemographic, sexual and reproductive characteristics, awareness on cervical cancer and human papillomavirus vaccination, and acceptability. Qualitative data were obtained through in-depth interviews among 31 participants. Descriptive data were reported using frequencies and percentages. In-depth interviews were transcribed and coded using inductive and deductive methods. Result Among 1625 participants, 74% agreed to self-sample for screening. Among them, 98% found it easy to understand the directions to collect vaginal swabs, 96% reported ease in using a brush for sample collection, 89.6% found it painless and comfortable, 19.2% were afraid of hurting themselves while using the brush. Only 5.3% women felt embarrassed while self-collecting the sample. Qualitative results support these findings. Conclusion Increase cervical cancer screening participation rate with positive response towards self-screening indicates that Human papillomavirus self-sampling methods have potential to increase screening uptake, and achieve the national target of 70% screening coverage.

PMID:42318718

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):423-428.

ABSTRACT

Background Periodontal disease can impact several functional elements, such as chewing, swallowing, speech, and appearance, which in turn can affect self-confidence. People suffering from periodontitis typically report a diminished quality of life in comparison to those with healthy gums. Objective To evaluate the impact of chronic periodontal disease on the oral health-related quality of life of a patient visiting the tertiary hospital. Method The descriptive cross-sectional study was conducted among patients visiting the Department of Periodontology and Oral Implantology, Kathmandu University Hospital, using a predesigned/prevalidated self-administered questionnaire for a duration of 3 months from June 2024 to August 2024 after obtaining ethical approval. Data was collected and entered into Microsoft Excel, and further analysis was done using SPSS v21. Result A total of 380 participants were included in the study, comprising 197 (51.80%) males and 183 (48.20%) females. The mean age of the participants was 35.62 ± 13.56 years. The highest mean score was for physical disability (2.81 ± 1.99), indicating that this was the most frequently experienced impact. This was followed by physical pain (2.65 ± 1.96) and psychological disability (2.14 ± 2.22). The least affected domains were social disability (0.62 ± 1.33) and handicap (0.76 ± 1.50), suggesting that participants’ social lives and overall life roles were less impacted by their periodontal condition. Conclusion There was negative impact of periodontal diseases on various aspects of patients’ oral health-related quality of life, including functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap.

PMID:42318716

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):418-422.

ABSTRACT

Background Pancreatobiliary malignancies (PBM) are often diagnosed at an advanced stage, leading to poor outcomes. Studies on the clinical profile and diagnostic efficacy in research limited settings like Nepal are scarce. Objective To describe the clinico-demographic profile characteristic and evaluate the diagnostic yield of endoscopic techniques in-patient with suspected pancreatobiliary malignancy undergoing Endoscopic Retrograde Cholangiopancreatography. Method A retrospective, cross-sectional study was conducted at the endoscopy unit of a tertiary care center of Nepal from January 2017 to January 2023. We included 597 Patients over 18 years of age with suspected pancreatobiliary malignancy who underwent endoscopic retrograde cholangiopancreatography. Data on demographics, clinical presentation and diagnostic results (brush cytology and intraductal biopsy) were analyzed using descriptive statistics. Result Among 597 patients, the majority of patients (70.1%, n=419) were aged 50 years or older, with the highest proportion found in the 60-69 year age group. Significant cases were from the hilly region (52.9%) and Brahmin/Chhetri ethnic group (35.51%). In this study 52.4% were male and the most common presenting symptoms were obstructive jaundice (42.4%), abdominal pain (37.7%), and pruritus (22.8%). Endoscopic retrograde cholangiopancreatography was technically successful for biliary drainage in 93.6% (559/597), primarily using plastic stent (77.4%). Endoscopic retrograde cholangiopancreatography guided tissue diagnosis was done in 57.1% of patients (n=341) to establish histological diagnosis. The most frequent Endoscopic retrograde cholangiopancreatography finding was a distal common bile duct stricture (52.8%). Conclusion The diagnostic yield of Endoscopic retrograde cholangiopancreatography -guided tissue sampling remains suboptimal with biopsy proving superior to cytology. In a resource-constrained setting like Nepal, while considering the cost-effective and most sensitive diagnostic tool for pancreatobiliary malignancy, the preferred sequence for diagnostic tools is sonography, followed by CT scan for initial triage, and then Endoscopic retrograde cholangiopancreatography with brush and/or biopsy with drainage.

PMID:42318715

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):413-417.

ABSTRACT

Background Breast-conserving surgery with radiation therapy is the standard approach for early breast cancer. It provides much better cosmetic effects as well as the same level of overall survival as compared to a mastectomy. Despite strong global evidence supporting breast-conserving surgery, it is less preferred in Nepal, and its outcome in the Nepali context is poorly documented. Objective To assess the oncological outcomes of breast-conserving surgery at a tertiary cancer centre in Nepal. Method This hospital-based retrospective cohort study was done in Bhaktapur Cancer Hospital, Nepal, from 2012 to 2018. All the breast cancer patients who underwent breast-conserving surgery were included in the study and were followed up for at least 5 years postoperatively till 2024 with clinical examination and radiological investigations. The statistical analysis was done using SPSS version 22. The measurement data with a normal distribution were expressed as the mean ± standard deviation. Result The study included 100 patients, with a median age of 43 years (range 25-73 years), and a mean tumor size of 26.34 ± 8.6 mm. The mean hospital stay was 3.9 ± 1.08 days, and 94% patients had no complications. Histologically, invasive carcinoma of no special type was the most common. Five-year disease-free survival and five-year overall survival rate were 96% and 97% respectively. Conclusion Our study concluded that Breast Conserving Surgery has a shorter hospital stay, fewer complications, and good oncological outcomes, so it is a simple and feasible technique for patients with early breast cancer.

PMID:42318714

Turk J Anaesthesiol Reanim. 2026 Jun 19. doi: 10.4274/TJAR.2026.252149. Online ahead of print.

ABSTRACT

OBJECTIVE: Over 75% of women who have post-mastectomy reconstruction feel significant pain right away, and about 50% endure chronic pain. Thus, increasing the efficiency of postoperative pain management is crucial. Our study investigated the effects of ultrasound-guided erector spinae plane blocks (ESPB) and rhomboid intercostal blocks (RIB) on perioperative fentanyl use and pain scores in patients undergoing radical mastectomy surgery.

METHODS: This was a double-blind, randomised controlled trial conducted at a tertiary care hospital. Patients with breast cancer aged 18-70 years and American Society of Anaesthesiologists status I-II who were scheduled for unilateral modified radical mastectomy were included. They were randomly assigned to two groups. ESPB was performed in the ESPB group, and RIB was performed in the RIB group, using ultrasound guidance. Total postoperative fentanyl usage in the first 24 hours was the primary outcome indicator of the study. Intraoperative fentanyl requirements and numerical rating scale (NRS) scores at seven distinct time points were used as secondary outcome measures.

RESULTS: The difference between the mean of total postoperative fentanyl consumption in 24 hours in Group ESPB (2.67±0.68 μg kg^-1) and Group RIB (3.68±1.22 μg kg^-1) was statistically significant (t value: -4.183, df:66, P value: < 0.001). There was no difference in intraoperative opioid consumption between the groups (P=0.7). However, NRS scores were not significantly different between the ESPB group and the RIB group.

CONCLUSION: Our study’s outcome demonstrates ultrasound-guided ESPB to be more effective than RIB in terms of lower perioperative fentanyl consumption.

PMID:42318699 | DOI:10.4274/TJAR.2026.252149

J Med Econ. 2026 Dec;29(1):1738-1749. doi: 10.1080/13696998.2026.2682685. Epub 2026 Jun 19.

ABSTRACT

AIM: This study investigated the financial impact of introducing the once-daily single-inhaler triple therapy (SITT) fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) in Saudi Arabia for adult patients with uncontrolled asthma.

METHODS: The expected 5-year budget impact of introducing FF/UMEC/VI for asthma was modeled using an epidemiology-based approach that included both acquisition and efficacy-related costs. Year-on-year costs were estimated for 2026 through 2030. Changes in healthcare resource utilization after FF/UMEC/VI introduction were estimated from the expected change in asthma control reported in the Phase IIIa CAPTAIN trial. The perspective of the model was the Saudi national healthcare payer; only direct medical costs were included. The robustness of the model was tested using sensitivity and scenario analyses.

RESULTS: It was estimated that in 2026, 12,108 patients in Saudi Arabia would receive FF/UMEC/VI, which will likely increase over subsequent years (2027: 29,615 patients; 2028: 31,191 patients; 2029: 32,938 patients; 2030: 34,727 patients), as validated by local expert opinion. The introduction of FF/UMEC/VI was estimated to save a total of United States Dollars (USD) 10,654,389 over 5 years, or USD 16.32 per patient, with savings increasing each year after introduction. Drug acquisition costs contributed to the greatest impact on the budget, and the model was most sensitive to changes in the market uptake of FF/UMEC/VI. Across all sensitivity and scenario analyses, FF/UMEC/VI was consistently cost saving.

LIMITATIONS: Various model inputs could not be derived from published sources, so multiple assumptions were used. Future market share was estimated from current competitor market share data; as FF/UMEC/VI is the first SITT for asthma to be introduced into Saudi Arabia, there is no historical data on which to base these estimates.

CONCLUSION: Introducing FF/UMEC/VI in Saudi Arabia has the potential to deliver meaningful clinical and economic benefits at both the individual patient and healthcare system level.

PMID:42318691 | DOI:10.1080/13696998.2026.2682685

Cleft Palate Craniofac J. 2026 Jun 19:10556656261461128. doi: 10.1177/10556656261461128. Online ahead of print.

ABSTRACT

BackgroundThis study compares clinical and radiographic outcomes in alveolar bone grafting (ABG) using iliac crest bone graft (ICBG) alone, demineralized bone matrix (DBM) with recombinant human bone morphogenetic protein-2 (rhBMP-2), and ICBG with recombinant human bone morphogenetic protein-2 with demineralized bone matrix (rhBMP2/DBM).PurposeWe evaluated differences in clinical success and radiographic bone formation among grafting techniques for secondary alveolar cleft repair.Study Design, Setting, and SampleRetrospective cohort study of patients undergoing secondary ABG for cleft alveolus between 2017 and 2023 at a tertiary children’s hospital.Independent VariableType of grafting technique: ICBG alone, DBM with rhBMP-2, or ICBG with rhBMP-2.Main Outcome VariablesThe primary outcome was radiographic success (bony bridging on cone-beam computed tomography). Secondary outcomes included vertical bone height and reoperation.CovariatesAge, sex, cleft laterality, and graft type.AnalysesDescriptive statistics and comparative analyses were performed. Statistical significance was set at P < .05.ResultsA total of 432 patients (527 clefts) were included: 196 ICBG, 284 DBM + rhBMP-2, and 47 ICBG + rhBMP-2. Radiographic success was highest in the ICBG + rhBMP-2 group (89.4%) compared with ICBG (65.3%; P = .001) and DBM + rhBMP-2 (61.6%; P < .001). Mean vertical bone height was greater in the ICBG + rhBMP-2 group (7.4 ± 2.6 mm) versus ICBG (4.7 ± 1.9 mm; P < .001) and DBM + rhBMP-2 (4.4 ± 1.2 mm; P < .001).Conclusions and RelevanceICBG combined with rhBMP-2 demonstrates improved radiographic bone formation and vertical height compared with alternative grafting strategies, without increasing reoperation rates.

PMID:42318690 | DOI:10.1177/10556656261461128