One Health Journal of Nepal

Pragmatic Pathways for Noninvasive Ventilation in Type 2 Respiratory Failure: From Global Evidence to Nepalese Experience

Niraj Bam — 2025-10-10

Noninvasive ventilation (NIV) is an established first-line intervention for Type 2 (hypercapnic) respiratory failure, offering a highly effective and less invasive alternative to endotracheal intubation. Its efficacy is rooted in core mechanisms, such as pressure support-driven improvements in gas exchange, which address principal causes like COPD and neuromuscular disorders. Several evidence confirms that this approach significantly reduces mortality, morbidity, and hospital length of stay, while preserving natural airway function and patient comfort. While arterial blood gas (ABG) analysis remains the gold standard for initiating therapy, pragmatic clinical indicators—such as tachypnea and accessory muscle use—are vital in resource-constrained settings like Nepal. Building on this foundation, recent advances in pulmonology, including portable ventilators, telemonitoring, and AI-powered analytics, are further elevating patient outcomes. To realize the full potential of these tools, their integration within multidisciplinary teams and expanded access through robust critical care infrastructure are essential for improving survival and quality of life. Therefore, this paper aims to outline a modern, integrated strategy for managing hypercapnic failure that combines advanced technology with equitable, accessible noninvasive ventilation.

Proportion of Brought-in-Dead Cases among Patients presenting at the Emergency Department at a Tertiary Care Hospital in Kathmandu, Nepal

Ramesh Maharjan — 2025-10-10

Introduction: Brought dead (BID) cases, patients declared deceased upon arrival at a health facility before receiving any medical care, represent a significant yet underexplored indicator of emergency system performance. Despite their frequency, there is limited research linking BID cases to deficiencies in prehospital emergency care (PHEC), a system that remains largely underdeveloped in Nepal.

Methods: This is a cross-sectional study was conducted at Tribhuvan University Teaching Hospital (TUTH) in Kathmandu. Phase I involved a retrospective analysis of 322 BID cases (2017–2019). Follow up162 by telephone interviews with bereaved families. Phase II analyzed BID - records from 2019–2022 (n=509). Survey data explored health-seeking behaviour, ambulance use, and emergency response knowledge.

Results: From 2019–2022, BID cases accounted for 45.1% of all emergency department deaths at TUTH with SD 21.65 years; male (57%); arrived via informal transport (59%) and no participants reported using the national emergency number (102) to initiate an ambulance response. Public awareness of first aid and emergency procedures was minimal. BID cases
were reported from both within and outside Kathmandu, with wide variability in travel times. In 86% of cases, no cause of death was documented.

Conclusions: The notably high levels of BID patients witnessed at TUTH highlight critical gaps in Nepal’s prehospital emergency care, including poor public awareness, inadequate ambulance utilisation and systemic delays. Addressing these challenges through improved public education, emergency response infrastructure and accessible PHEC could reduce avoidable prehospital deaths and improve emergency care outcomes.

Menstrual Hygiene Awareness and Practice Among School Going Girls in a Rural Municipality

Sangita Sharma — 2025-10-10

Background: Menstruation is a normal physiological cycle of adolescent girls whereby uterus sheds blood and tissues through the vagina. Menstrual hygiene means adolescent girls using clean menstrual management materials to absorb blood, privacy in changing pad, soap and water for washing the body, and accessibility to dispose of used menstrual absorbent. The objective of this study was to assess awareness and practices on menstrual hygiene among
school going girls in a rural municipality.

Methods: A descriptive cross-sectional study was done using multistage sampling technique in government schools of Jahada Rural Municipality, Morang Nepal. Data were collected among 327 school going girls of grade 8, 9 and 10 using self-administered questionnaire. Tool was validated by calculating I-CVI and S-CVI for awareness (0.93) and practices (0.88). Data were analyzed in SPSS 26 by using the descriptive and inferential statistics.

Results: The study findings revealed that mean age of respondents was 14.70±1.21 years. Most (86.2 %) of respondents had adequate awareness on menstrual hygiene with mother as major (92.7%) source of information. Almost all (95.4%) respondents had appropriate practice on Menstrual Hygiene. Majority (66.4%) of respondents used both disposable sanitary pad and clean cloth pad and one third (28.4%) used only disposable sanitary pad during menstruation. Awareness on menstrual hygiene was significantly associated with mother’s education and occupation with (p=.013) and (p=.032) respectively and father’s education (p=.000). Practices on Menstrual Hygiene of respondents was significantly associated with respondent’s age (p=.041), father’s education (p=.000), and mother’s occupation (p=002).

Conclusion: It is concluded that most of the school girls had adequate awareness and practices on menstrual hygiene. There are some inappropriate practices on disposal of pad which can be improved by education.

Hemodynamic Changes to Insertion of Various Airway Devices: A Comparative Study

Chanda Buddhathoki — 2025-10-10

Introduction: Cuffed endotracheal tubes (ETTs) are the gold standard for airway management during laparoscopic surgeries but are associated with hemodynamic stress and postoperative throat complications. Supraglottic devices like Proseal LMA (PLMA) and Laryngeal Tube Suction II (LTS II) offer better glottic sealing with fewer complications. This study compares the hemodynamic effects and postoperative outcomes of PLMA, LTS II, and ETT in patients under general anesthesia.

Methods: In this comparative cross-sectional study, 90 ASA I–II patients aged 18–65 years undergoing elective laparoscopic cholecystectomy were assigned to PLMA, LTS II, or ETT groups. Following standard anesthesia induction, airway devices were inserted, and hemodynamic parameters (HR, SBP, DBP, MAP) were recorded at defined intervals.

Results: A total of ninety patients with similar demographic characteristics were assessed. The time taken for insertion was the shortest with endotracheal tube (ETT) at 14.4 ± 2.4 seconds, compared to the laryngeal mask airway (PLMA) at 19.4 ± 4.1 seconds and the LTS II at 21.8 ± 3.1 seconds (p < 0.001). After insertion, ETT resulted in a significantly higher increase in heart rate and blood pressure compared to PLMA and LTS II (p < 0.001), which displayed similar and lower levels of response. The incidence of postoperative sore throat was highest with ETT at 60%, as opposed to PLMA at 26.7% and LTS II at 33.3% (p = 0.02). Statistically non-significant dysphagia occurred more often with ETT (16.7%).

Conclusions: PLMA and LTS II are effective alternatives to ETT for elective surgeries, offering greater hemodynamic stability and reduced postoperative throat morbidity.

Pattern of Computed Tomography (CT) Findings in Traumatic Head Injury at a Tertiary Health Care Center, Birgunj

Rakesh Kumar Jha — 2025-10-10

Introduction: Head injuries, especially traumatic brain injury (TBI), represent a global health concern due to their significant physical, cognitive, and societal impacts. This study assesses the prevalence, imaging patterns, and diagnostic role of computed tomography (CT) in craniocerebral trauma.

Methods: A cross-sectional study was conducted from April 2022 to March 2023 at the Department of Radio-diagnosis, NMCTH, Birgunj, Nepal. A total of 85 patients with craniocerebral trauma were included after ethical approval. Patients of all ages and genders were studied, excluding those with hypertension, diabetes, cerebrovascular accidents, bleeding disorders, or anticoagulant therapy. CT imaging was performed using the AQUILION PRIME SP 160-Slice CT machine,
and data on demographics, injury mechanisms, Glasgow Coma Scale (GCS) scores, and imaging findings were analyzed statistically.

Results: A total of 85 patients with head injuries, 72.9% were male, and 27.1% were female, with the highest incidence in the 31-50 age group (40%). Road traffic accidents (RTAs) were the leading cause (64.5%), followed by falls (20%) and physical assaults (16.5%). Common clinical manifestations included loss of consciousness (58.8%) and vomiting (45.9%). CT revealed
abnormalities in 69.4% of cases, with skull fractures (49.4%) and epidural hematomas (41.2%) being the most common findings. Severe injuries had a mortality rate of 57.1%, predominantly due to RTAs.

Conclusions: CT is a vital diagnostic and prognostic tool for assessing head injuries, guiding treatment, and improving outcomes, particularly in severe cases with poor prognostic indicators.

Prevalence of Malocclusion in Patients Visiting Nepal Police Hospital

Sangya Malla — 2025-10-10

Background: Malocclusion is a common dental condition impacting oral health and quality of life. Understanding its prevalence and gender-specific distribution is critical for tailored clinical management and public health planning. This study aimed to evaluate the prevalence of malocclusion types and associated dental anomalies in a cohort of 380 patients, with a focus on gender differences.

Methods: A cross-sectional study was conducted on 380 patients (203 males, 177 females) in patient visiting dental department of Nepal Police Hospital .Data were collected through clinical examinations and categorized according to Angle’s classification for malocclusion (Class I, II Div. 1, II Div. 2, III) and the presence of anomalies such as crowding, spacing, cross bite, and bite discrepancies (open, deep, scissors). Descriptive statistics were used to analyse prevalence rates and gender distributions.

Results: Class I malocclusion was the most prevalent (65.0%, n=247), followed by Class II Div. 1 (18.9%, n=72), Class III (8.4%, n=32), and Class II Div. 2 (7.6%, n=29). Crowding affected 60.5% (n=230) of patients, with males disproportionately impacted (132 males vs. 88 females). Deep bite was observed in 21.8% (n=83), showing a slight female predominance (43 females vs. 40 males). Anterior cross bite (3.2%, n=12) and posterior cross bite (1.8%, n=7) were rare but more frequent in males. Open bite occurred in 5.3% (n=20), predominantly in males . Scissors bite was absent. Gender disparities were notable in Class II subdivisions (males > females) and crowding (males > females), while Class III malocclusion was gender-neutral

Conclusion: Class I malocclusion and crowding dominate orthodontic anomalies in this population, with significant gender based variations.These findings underscore the need for gender-sensitive orthodontic interventions and highlight regional trends, such as the absence of scissors bite.

Complications of Fixed Partial Prosthesis in Nepal Police Hospital: A Cross-Sectional Study

Anjali Tandukar — 2025-10-10

Background: Fixed partial dentures (FPDs) are commonly used prosthetic treatments, yet their long-term success is often compromised by biological, mechanical, and aesthetic complications. Limited data exists on failure patterns and severity in South Asian populations, particularly in resource-limited settings like Nepal.

Methods: A cross-sectional study was conducted at Nepal Police Hospital from March to May 2025, evaluating 75 patients with FPD complications. Statistical analysis included chi-square and Fisher’s exact tests (SPSS v.24), with significance set at p<0.05.

Results: The study found Class IV (combined) failures to be most prevalent (33.3%), followed by Class III (32.0%). FPDs in use for ≥5 years showed significantly higher rates of Class IV failure (43.8% vs. 25.6%, p=0.03, OR=2.27). Zirconia prostheses demonstrated lower Class IV failure rates (27.3%) compared to porcelain-fused-to-metal (PFM) (34.4%), though this difference was not statistically significant (p=0.75). Females exhibited higher rates of class IV failures (40.9%) than males (30.2%), but this trend was not significant (p=0.42).

Conclusion: The findings underscore the importance of monitoring FPDs beyond five years of service, as they are at significantly higher risk for severe class IV complications. While zirconia prostheses showed promising results, further research with larger samples is needed to confirm their advantages. These insights can guide clinical decision-making and patient education, particularly in resource-limited settings.

The Pattern of Bacterial Colonization and Urinary Tract Infection following endo- urological operations with double J Stent. A descriptive study.

Sanjay Bikram Shrestha — 2025-10-10

Introduction: Double J (DJ) ureteral stents are commonly utilized to alleviate urinary blockages but are susceptible to bacterial colonization and the formation of biofilms, which heightens the likelihood of multidrug-resistant infections, including those caused by ESKAPE pathogens. It is essential to comprehend colonization trends and antibiotic susceptibility to inform preventive and treatment approaches.

Methods: A descriptive observational study was carried out involving 110 patients receiving DJ stenting, examining demographics, stent retention periods, bacterial colonization in urine and stent cultures, and antibiotic resistance profiles via standard microbiological methods.

Results: Bacterial colonization was identified in 19.1% of urine specimens and 29.1% of cultures from DJ stents. Escherichia coli was the predominant isolate, with significant occurrences of Klebsiella, Pseudomonas, and Acinetobacter species. The average duration of stent placement was 21.4 days, with the majority of patients (76.4%) retaining stents for more than 14 days. Sensitivity testing indicated favorable responses to amikacin, Piperacillin/Tazobactam, levofloxacin, and nitrofurantoin, while certain resistant strains required colistin or tigecycline.

Conclusion: Extended DJ stenting elevates the risk of colonization by ESKAPE organisms, underscoring the importance of infection control measures, antibiotic stewardship, and the potential use of antimicrobial-coated stents to mitigate multidrug-resistant infections.

Endovenous Laser Treatment (EVLT) for Chronic Venous Disease of Lower Limbs at a Tertiary Care Center: A Descriptive Study

Santosh Joshi — 2025-10-10

Background: Chronic venous disease (CVD) in the lower limbs, mostly caused by reflux in the great saphenous vein, has typically been treated through surgical stripping. Recently, Endovenous Laser Treatment (EVLT) has come forward as a minimally invasive option, offering lower postoperative morbidity. This study aims to assess the short and midterm outcome of EVLT.

Methods: This cross-sectional descriptive research involved 64 adult patients suffering from CEAP C2–C6 chronic venous insufficiency who underwent EVLT at Nepal Police Hospital between March 2024 and February 2025. Patients were assessed using duplex Doppler ultrasound and treated with a 1470 nm diode laser alongside perivenular tumescent anesthesia. Outcomes were evaluated both clinically and sonographically one day, two weeks, and three months following the procedure.

Results: The average age of patients was 43.7 years, with a predominance of males (73.4%). The great saphenous vein was treated in 95.2% of limbs, while the small saphenous vein (14.5%) and incompetent perforators (30%) were treated less frequently. All patients reported pain and visible varicose veins; however, night cramps, bleeding, and skin discoloration were observed less often. Common complications included paresthesia (43.4%), superficial thrombophlebitis accompanied
by bruising (10.8%), pain (6%), burns (3.6%), and recanalization (1.2%), with no incidents of deep vein thrombosis.

Conclusion: EVLT is a safe, effective, and minimally invasive option for addressing chronic venous insufficiency, demonstrating high success rates and few complications. Continuous follow-up is essential to detect any rare recanalization. It is advisable to conduct larger studies with extended follow-up to confirm these results.

Prevalence of Plantar Fasciitis Among Police Personnel: A Cross-sectional Study

Sagun Pradhan — 2025-10-10

Introduction: Plantar Fasciitis (PF) is a painful condition characterized by inflammation of the plantar fascia, a fibrous tissue that supports the foot arch. This condition arises from overstretching the plantar fascia, leading to minute tears where it connects to the heel bone (calcaneum). The findings of this research offer essential insights for developing strategies to prevent and manage plantar fasciitis in high-risk occupational groups, such as police and other military and paramilitary personnel. This study aimed to find out prevalence of plantar fasciitis among police personnel and identify significant contributing factors.

Methods: This cross-sectional study consisted of 161 police staff with posterior heel pain who visited the Orthopedic Outpatient Department of Nepal Police Hospital from January 1, 2024, to December 31, 2024, using a convenient sampling technique.Data analysis was performed utilizing the Statistical Package for Social Science (SPSS) version 20.0.

Results: Among 161 police personnel with a mean age of 33.08 +/- 6.09, underwent the windlass test, and those who tested positive,completed the Foot Function Index (FFI) questionnaire. 42 police personnel demonstrated a positive windlass test, leading to a prevalence of 26.1% for plantar fasciitis within this group. Significant risk factors associated with the onset of PF included high body mass index (BMI), female gender, and prolonged periods of standing, running, and walking. PF was commonly observed in individuals aged 30 to 40 years and in those classified as overweight.

Conclusions: This research identified the prevalence of plantar fasciitis among police personnel experiencing posterior heel pain, with pain being the primary issue. Significant associated risk factors included high BMI, being female, and extended periods of standing or walking. These results highlight the occupational susceptibility of police staff to plantar fasciitis, which can influence their physical performance and overall quality of life.

Surgical Site Infection Following Cesarean Section: A Hospital-Based Cross-Sectional Study

Punam Pathak — 2025-10-10

Introduction: Cesarean section (CS) is one of the most commonly performed surgical procedures in the obstetrics and gynecology department. After urinary tract infection, surgical site infection (SSI) is the most frequent infection found in post cesarean section patients. Optimizing maternal co-morbidities and using evidence-based surgical procedures are both essential for lowering the risk of SSI. This study was carried out to study the prevalence of surgical site infections following cesarean section.

Methods: This was a descriptive observational study in patients who had undergone cesarean sections from Baishak 2079 to Chaitra 2079 at Pokhara Academy of Health Sciences. Following surgery patients were put on regular follow up visits during which signs of infection were noted. Swabs from infected surgical sites were then further sent for microbiological investigations. Data collection was done and were analyzed using SPSS.

Results: Among 315 cases,306 cesarean section cases were included in the study and 9 cases were lost to follow up. In this study post LSCS SSI rate was 12.43%(n=35), of which SSI in elective LSCS was found in 4 cases i.e., 5.06% whereas in emergency LSCS SSI was found in 31 cases i.e., 13.65%. Overall prevalence of SSI was higher in emergency LSCS with obesity being a major risk factor (31.42%). Among culture positive SSI, Staphylococcus (n=11/61.11%) was the most common microorganisms detected followed by Pseudomonas (n=5/27.78%).

Conclusion: Prevalence of surgical site infection in cases of emergency LSCS is high, increasing maternal morbidity. The recognition and correction of associated medical complications in the antenatal period is vital. Staphylococcus being the most common and Pseudomonas the second most commonly isolated organisms.

Association of Periodontal Therapy on Hemoglobin and Erythrocyte Levels in Chronic Periodontitis Patients visiting a Tertiary Care Hospital, Nepal

Prashamsa Shakya — 2025-10-10

Introduction: Periodontitis is an inflammatory condition primarily triggered by persistent bacterial infection. Anemia of chronic disease, which is an anemia driven by cytokines, commonly occurs alongside various chronic inflammatory disorders. The objective of this study is to assess the impact of periodontal treatment on hemoglobin and erythrocyte levels in patients with chronic periodontitis.

Methods: The study included forty patients aged 30 to 60 years diagnosed with chronic periodontitis. At baseline, several blood parameters were recorded, including hemoglobin (Hb), erythrocyte count (RBC), erythrocyte sedimentation rate (ESR), packed cell volume (PCV), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC). The initial periodontal parameters documented included: plaque index, gingival index, probing pocket depth, and clinical attachment level. All participants underwent non-surgical periodontal treatment (scaling and root planing). Blood and periodontal parameters were measured again after 3 months.

Results: The findings indicated that the resolution of periodontal inflammation led to a notable increase in hemoglobin levels and erythrocyte counts. The hemoglobin level rose by 0.32±0.24 gm/dl, while the erythrocyte count increased by 0.10±0.07 million cells/mm3. The erythrocyte sedimentation rate decreased, indicating the alleviation of periodontal inflammation. Nevertheless, the values for MCV, MCH, and MCHC did not show significant changes. There were significant improvements in the plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL) with a reduction in probing depth of 1.35 mm and a gain in clinical attachment level of 1.27 mm (p<0.001).

Conclusion: The findings from this study demonstrate that periodontal treatment contributes to improved hematological parameters in patients suffering from chronic periodontitis.

Patterns of Presentation and Prevalence of Fissure-in-Ano in a Tertiary Care Hospital: A Descriptive Study

Bipin Kumar Shrestha — 2025-10-10

Background: Fissure-in-ano is a prevalent anorectal condition that mainly impacts young adults and is often linked to constipation and eating habits. The objective of this study was to evaluate the demographic characteristics, clinical symptoms, and typical anatomical location of fissure-in-ano in patients attending a tertiary care facility.

Methods: A cross-sectional descriptive study was carried out between May 2025 and July 2025 in the Department of General Surgery at Nepal Police Hospital in Kathmandu. A total of 300 patients aged 18 years and older, who presented with anorectal issues, were recruited via convenient sampling method. Information regarding demographics, dietary practices, history of constipation, clinical symptoms, and the location of the fissure was gathered and analyzed utilizing SPSS version 21.0.

Results: The largest group of patients (65.33%) fell within the age range of 18 to 40 years, with a slightly higher incidence among males (54.67%) than females (45.33%). A significant majority of patients (86%) adhered to a mixed dietary regimen, and more than half (58%) reported a history of constipation. The most frequently observed symptoms were painful defecation (84%), followed by rectal bleeding (54.33%), and constipation (52%). The fissures were mainly found at the posterior midline (92%). The patterns of clinical presentation were consistent across both genders.

Conclusion: Fissure-in-ano typically affects younger adults and is closely associated with constipation and the location of fissures at the posterior midline. Early detection, modifications in lifestyle, and the regulation of bowel habits are essential for both prevention and management.