Journal of Public Health Concern Trust (JPHECT)
The Journal of Public Health Concern Trust (JPHECT) is a peer-reviewed health science journal published by Public Health Concern Trust-Nepal (phect-NEPAL), a non-profit organization. Published annually, it features research in public health, medicine, nursing, education and others.
Public Health Concern Trust-Nepal (phect-NEPAL)
High Voltage Electric Burn Injury to Scalp Managed with Phenytoin Dressing
Phenytoin, an antiepileptic medicine was identified by Putnam and Merritt from Harvard Medical School and published in 1937, has also been documented for wound healing by accelerated epithelialization and increased connective tissue activity. 1 Though Phenytoin has also been used for superficial dermal burns, ulcers and diabetic wounds, there is paucity of data in its uses in burn wounds. We hereby present a case where phenytoin powder was used for secondary healing of a high voltage electric burn wound over the scalp with exposed calvarium.
Copyright (c) 2026 Journal of Public Health Concern Trust (JPHECT) https://creativecommons.org/licenses/by-nc/4.0
Limb Salvage with Microsurgical Compound Flap in a Seizure induced Deep Flame Burn Injury
Patients with epilepsy have higher incidence and severity of burn injury. Managing epilepsy is challenging in a Low- and Middle-Income setting, exacerbated by a combination of stigma, traditional beliefs, access to health care, and the burdensome costs of long-term treatment. Management of the disease require lifelong medication and regular follow-up care, which makes compliance a major issue. Here we discuss a patient who had suffered deep burn to both legs after a fall into open fire during a seizure attack resulting in amputation of the left leg, however the right leg was salvaged with local, regional and a free flap.
Posterior Vaginal Wall Fibrosis with Deviated Urethra Following Urethrovaginal Fistula Repair: A Case Report
Urethrovaginal fistula (UVF) is an uncommon but distressing complication of gynecologic surgery. Surgical repair may result in scarring and posterior vaginal wall fibrosis, leading to dyspareunia, introital narrowing, and urethral deviation. Management of such sequelae remains surgically challenging. We present a 35-year-old woman with a history of total abdominal hysterectomy (TAH) for choriocarcinoma followed by chemotherapy developed a urethrovaginal fistula, which was repaired successfully. She later presented with posterior vaginal wall pain and discomfort due to fibrosis and urethral deviation. She underwent Fenton’s procedure with posterior vaginal wall fibrosis was released.
Laparoscopic Suture Cervicopexy in Young Lady with Cervical Elongation
Cervical elongation with apical prolapse in young women poses a surgical challenge when uterine preservation in required. We report a case of 25-years female, P1L1, with symptomatic cervical elongation. She underwent laparoscopic suture cervicopexy with plication of round ligaments and uterosacral ligaments and moschcowitz procedure under general anaesthesia. This surgery had led to a good anatomical correction with satisfactory apical support and the uterus remained centrally positioned with resolution of prolapse symptoms.
Cholecystectomy in Situs Inversus Totalis
Situs inversus totalis (SIT) involves a systemic reversal of visceral organs, complicating both clinical diagnosis and operative strategy. While laparoscopic cholecystectomy is the gold standard for cholelithiasis, its application is challenged by this rare anatomical anomaly. In cases of SIT with dextrocardia, atypical presentations and mirrored anatomy can obscure diagnosis and increase operative complexity. A 39-year-old man was diagnosed with dextrocardia via chest X-ray. Ultrasonography and computed tomography confirmed SIT, cholecystitis, and cholelithiasis. We attempted laparoscopic cholecystectomy using a modified technique involving left-handed maneuvers and adjusted port positions. However, due to dense adhesions between the gallbladder, omentum, and transverse colon, a Critical View of Safety (CVS) could not be achieved. The procedure was converted to an open cholecystectomy via a left subcostal incision. The operation went well, and our patient recovered satisfactorily.
Caecal Carcinoma Mimicking Intestinal Tuberculosis: A Diagnostic Dilemma
Intestinal tuberculosis (ITB) frequently mimics colorectal malignancy in endemic regions, often leading to diagnostic uncertainty. Conversely, colorectal carcinoma may be misdiagnosed and treated as intestinal tuberculosis, resulting in delayed definitive management. We report a case of caecal carcinoma initially diagnosed and treated as intestinal tuberculosis based on clinical findings. Histopathological examination following surgical intervention ultimately revealed adenocarcinoma of the caecum. This case highlights the limitations of empirical antitubercular therapy and emphasizes the need for histological confirmation before initiating long-term treatment.
Placenta Accreta Spectrum: A Case Report and Review of Diagnostic and Management Challenges
Placenta accreta spectrum (PAS) represent a major cause of severe obstetric hemorrhage and maternal morbidity, particularly in women with a history of cesarean delivery and placenta previa. Early antenatal diagnosis and multidisciplinary planning are essential to optimize outcomes. We report a case of placenta accreta spectrum with bladder involvement in a 33-year-old multigravida with a previous cesarean section, diagnosed antenatally by imaging. The patient underwent an emergency classical cesarean section followed by cesarean hysterectomy and bladder repair at 32 + 3 weeks’ gestation due to massive obstetric hemorrhage. Histopathological examination confirmed placenta accreta. This case highlights the importance accurate diagnosis and the need of multidisciplinary approach in a tertiary care center for the optimal outcome.
Augmented Manchester Procedure with Right Sacrospinous Fixation in a young woman
Severe cervical elongation in young multiparous women is a rare cause of pelvic organ prolapse. Achieving durable apical support while preserving the uterus presents a surgical challenge. A 26-year-old unmarried nullipara with 12 years history of pelvic organ prolapse with cervical elongation of 9cm. She underwent Manchester procedure combined with Right sacrospinous ligament fixation of the neo cervix under anesthesia. This combined approach addressed the anatomical defect and provided robust apical suspension. This case demonstrated the feasibility and rationale for this combined approach in a medically complex patient.
Conservative versus Operative Management for Middle Third Clavicle Fractures in Kathmandu Model Hospital
Introduction: Middle third clavicle fractures are common, with treatment options including conservative and operative approaches. This retrospective observational study compares the efficacy, functional outcomes, and complications of these methods at Kathmandu Model Hospital. Methods: Medical records of 80 patients (40 per group) treated between January 2018 and December 2024 were analyzed. Outcomes were evaluated using the Constant-Murley Score (CMS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, radiological union time, and complication rates. Results: Operative management achieved bone union in 10.2 weeks compared to 14.5 weeks for conservative treatment, with better early functional scores at 6 and 12 weeks, but reported higher complications (22.5% versus 15%), including infections and hardware issues. Conservative management had a 10% non-union rate and more malunion but fewer surgical complications. Conclusion: Operative management demonstrated faster union and better early functional outcomes, while conservative management had fewer complications but prolonged recovery. These results offer valuable guidance for making treatment decisions in settings with limited resources.
Assessment of Abbreviated Burn Severity Index Scoring System for Predicting Mortality Outcome in Burns at Kirtipur Hospital
Introduction: Global burn incidence is disproportionately high in low- and middle-income countries, with Southeast Asia serving as an “epicenter” for fire-related deaths. Clinicians frequently face challenges in predicting patient outcomes upon initial presentation, necessitating the use of validated scoring systems. This study evaluates the validity of the Abbreviated Burn Severity Index (ABSI) for predicting mortality at Kirtipur Hospital, Nepal. Method: This observational study reviewed 800 burn in-patients admitted between July 2024 and June 2025. A pre-formatted ABSI proforma was utilized for data collection. Statistical analyses, including univariate and multivariate logistic regression and ROC analysis were performed to identify independent mortality predictors and determine the Lethal Area 50 (LA50). Result: The overall mortality rate was 11.1% (89 deaths). Inhalation injury (OR=14.74) and full-thickness burns (OR=9.06) were the most significant independent predictors of death. While the ABSI score demonstrated excellent univariate discrimination (AUC=0.904), its multivariate contribution was attenuated (OR=0.88, p=0.74), suggesting the score largely captures severity already reflected by TBSA and burn depth. The LA50 point estimate was 47.43% TBSA. Mortality risk stratified by ABSI scores ranged from 9.03% (score ≤10) to 100% (score ≥14). Conclusion: The ABSI is a reliable tool for risk stratification in the local Nepalese context but provides limited independent prognostic information beyond core clinical variables like inhalation injury. Developing locally calibrated models or adopting modified scoring systems is recommended to improve bedside accuracy for family counseling and resource allocation
A Point-Prevalence Study of Serum Phosphorus Levels in Burn Patients at Admission in Kirtipur Hospital
Introduction: In Nepal, an estimated 55,902 burn injuries occur each year, with approximately 2,100 burn-related deaths annually. With little to no resuscitation many patients bear the risk of metabolic and electrolyte derangements during the acute phase. Studies indicate the nadir of Phosphorus occurs between days 3rd to 5th post burn days. Methods: This observational Point-Prevalence study was conducted at a tertiary burn center in Nepal over a 12-months period. Chart review of all burn patients admitted to Burn Intensive Care Unit was done. A predesigned proforma was used to record demographic details, age and gender, and total burn surface area (TBSA). The lab values of Phosphorus, Magnesium and Calcium done at the time of presentation to the emergency Department were recorded. Results: In total, 75 participants, 33 were female, 42 were male with mean age of 29.3 ± 26.64 years and Total Body Surface Area Burn was 25.53 ± 14.05%. Phosphorus level averaged 1.14 ± 0.50 mmol/ml - with 29.3% hypophosphatemia (<0.8 mmol/L) and 13.3% hyperphosphatemia (>1.5 mmol/L), revealing moderate elevation variance. Magnesium averaged 0.80 ± 0.20 mmol/ml with 21.3% hypomagnesemia (<0.7 mmol/L), suggesting moderate depletion Calcium value averaged 1.89 ± 0.22 mmol/ml)—15.5% hypocalcemia (<2.1 mmol/L) indicating widespread calcium deficiency at presentation. Conclusion: lderly patients with burn are particularly at high risk for hypophosphatemia. Hypocalcemia, and hypomagnesemia are also commonly noted.
Effectiveness of an Educational Intervention on Pulmonary Tuberculosis among Monks of BenchenNangten Thoesam Ling Monastery of Pharping
Introduction: Pulmonary Tuberculosis (PTB) is a communicable disease caused by Mycobacterium tuberculosis, transmitted through airborne particles small enough to reach the lungs. PTB remains a major public health concern in Nepal. Studies show that there is a lack of knowledge about PTB, especially in community settings. This study aims to assess the knowledge of PTB among monks and evaluate the impact of an educational intervention at Benchen Monastery. Methods: A pre-experimental one-group pretest-posttest design was implemented, involving 61 monks from BenchenNangten Thoesam Ling monastery to assess the effectiveness of the independent variable “educational intervention” on the dependent variable “knowledge on Pulmonary Tuberculosis (PTB).” A semi-structured questionnaire was used to collect data. Paired sample T-test was used to assess the effectiveness of an educational intervention on knowledge regarding PTB at a level of significance with a p-value less than 0.05. Results: Before the intervention, a majority of monks exhibited low 56(91.8%) to moderate 5(8.2%) levels of knowledge regarding pulmonary tuberculosis. Following the educational intervention, the proportion of monks with high knowledge levels increased significantly to 58(95.1%). Data analysis confirmed a significant difference between pretest and post-test scores, indicating a substantial improvement in knowledge after the intervention. Conclusion: This study concludes the effectiveness of targeted educational strategies in enhancing monk’s knowledge about pulmonary tuberculosis.
Employment Status of Nursing Graduates of Kathmandu Model Hospital School of Nursing
Introduction: Nursing is a vital healthcare profession centered on caring for the sick, injured, and vulnerable, while also promoting health at both individual and community levels. Beyond clinical roles, nurses contribute significantly to research, management, policy-making, and advocacy. Those with advanced education often deliver independent primary and specialized care. While nursing plays a foundational role in global health systems, challenges such as unemployment, underemployment, migration, and skill-role mismatches affect the employment of new graduates, especially in developing countries. This study aimed to assess the employment status of Bachelor of Science in Nursing (BSN) graduates from Kathmandu Model Hospital School of Nursing (KAMHSON). Now, it has become Phect Institute of Health Sciences. Methods: A cross-sectional study design was used to assess the employment status of BSN graduates from the years 2074 to 2080 B.S. Data were collected via a structured questionnaire using a Google survey form, following ethical approval from the IRC of phect-Nepal. Descriptive statistics were applied for data analysis. Results: Among 103 respondents, (73.8%) were employed full-time, (16.5%) part-time, and 1.9% were self-employed. A minority were unemployed (4.9%) or pursuing further studies (2.9%). Most graduates (62.8%) worked in hospitals, mainly as clinical nurses (71.8%), with (67%) in the private sector. Over (70%) secured jobs within six months post-graduation, with (57.3%) employed in Nepal. Others were employed in countries including Australia, the USA, Canada, and the UK. Most reported average workloads (62.1%), but over half (52.4%) were dissatisfied with their income. While (69.9%) intended to continue in nursing, (5.8%) planned to switch careers. Personal interest was the leading motivation for choosing nursing (75.7%) followed by a desire to help the sick (38.8%), with others citing career opportunities abroad, social respect. Conclusion: Most BSN graduates gained employment within six month of graduation primarily in clinical roles. However, dissatisfaction with income and retention issues highlight the need for better policies, professional development, fair pay, and supportive academic environments.
Dry Mopping versus Saline Irrigation of Gall Bladder Fossa after Bile Spillage During Laparoscopic Cholecystectomy
Introduction: Gallbladder perforation with bile spillage is common during laparoscopic cholecystectomy and may lead to complications ranging from mild inflammation to abscess formation. While saline irrigation with suction is traditionally used, some surgeons prefer dry mopping to limit contamination. The optimal approach remains controversial. This study compares peritoneal irrigation and aspiration versus dry mopping in terms of early and late postoperative outcomes. Methods: An observational study was carried out in the department of General Surgery at Kathmandu Model Hospital Institute of Health Sciences/ Kritipur Hospital during the period of 6 months from June 2025 to November 2025, among all patients undergoing saline irrigation or dry mopping following biliary spillage when present during laparoscopic cholecystectomy. Results: One hundred twenty patients were included, 60 patients in each group, 61.6% were female and the rest were male. Majority of the patients belonged to age group 39-55 years (median age 45) in both dry mopping group (group A) and saline irrigation group (group B). There was no significant difference in surgical site infection (SSI) between the two groups (p = 0.272). Dry mopping resulted in fewer surgical site infections, with similar intra-abdominal collection rates, while port site infections were higher in the saline irrigation group. Conclusions: Dry mopping to be better than saline irrigation in terms of increased surgical site infection. There was no statistically significant correlation between intraoperative stone spillage and postoperative outcomes.
dry mopping Laparoscopic cholecystectomy
Knowledge on Legal and Ethical Aspect of Nursing among Nurses Working in Kirtipur Hospital
Introduction: Nurses frequently encounter a range of legal and ethical challenges while caring for individuals through critical life events such as birth, illness, recovery, suffering, and death. Legal guidelines help nurses act appropriately and professionally, while ethical principles govern standards of behavior and moral decision-making. This study aimed to evaluate the level of knowledge of nurses regarding the legal and ethical aspects of their profession. Methods: A cross-sectional study was carried out involving 111 nurses at Kirtipur Hospital. Data collection commenced following ethical approval from the phect-NEPAL Institutional Review Committee. Probability Proportional to Size (PPS) sampling techniques was employed to select the nurses from each department within the hospital. Data were gathered using a semi-structured, self-administered questionnaire and descriptive and inferential statistics is utilized and data was analyzed using the Statistical Package for the Social Sciences (SPSS). Results: The study findings reveal that nurses possessed an overall average level of knowledge regarding the legal and ethical aspects of nursing. Only 25 (22.5%), demonstrated a high level of knowledge, while 62 (55.9%), had a moderate level, only 24 (21.6%) showed a low level of knowledge. A significant association was observed between the nurses’ level of knowledge and their years of experience as well as their respective areas of work. Conclusions: This study identified that even though majority had average knowledge on legal aspects of patient care, only a small percentage had good knowledge on legal and ethical aspect. So based on this study, Kritipur hospital should plan educational, and training programs about legal and ethical aspect of nursing.
Histo-morphological Spectrum of Cystoscopic Biopsies in Kathmandu Model Hospital
Introduction: Urinary bladder lesions are commonly encountered medical problems. Both non-neoplastic and neoplastic lesions are significant causes of morbidity. However, malignant lesions usually result in mortality. Cystoscopy guided biopsy determines the nature of lesion and thus helps in further management of patients. The objectives of this study were to find out the histo-pathological diagnosis and features of various bladder lesions and their frequencies. Methods: This cross-sectional study was carried out in the Department of Pathology, Kathmandu Model Hospital. All the cystoscopic biopsies received from January 2021 to December 2023 were included in the study. Preserved tissue slides were examined under a light microscope by the primary investigator. The histo-pathological diagnosis of each lesion was recorded, along with specific features such as tumor type, grade and depth of invasion. Results: Total 47 cystoscopic biopsies were studied. The majority of patients 12 (25.5%) were in age group 70-80 years and predominant 31 (66%) were male. Neoplastic lesions were more common 31 (66%) and infiltrating and non-invasive urothelial carcoinoma constituted equal in number 14 each (45%). Among the non-neoplastic lesions, non-specific cystitis was the commonest 13 (82%). Conclusion: Neoplastic lesions are more common than non-neoplastic lesions. Neoplastic lesions are more common in male and in age group 70-79 years. Infiltrating and non-invasive urothelial carcinoma are equally common. Non-specific cystitis is the commonest among the non-neoplastic lesions.
Outcome of Bailout Techniques in Non-achievement of Critical View of Safety during Laparoscopic Cholecystectomy
Background: Laparoscopic cholecystectomy (LC) is one of the most commonly performed surgical procedures. It has become the gold standard treatment for gall bladder diseases. But with the growing number of surgeries chances of intraoperative complications increase. Unfortunately, since the widespread use of the laparoscopic technique, the incidence of bile duct injury remains 0.3 -- 0.8%, compared to 0.2% in open operations. This leads to different types of bailout surgeries for the safety of patients. This study is done to evaluate the outcome of bailout techniques used in difficult laparoscopic cholecystectomies when critical view of safety (CVS) cannot be achieved. Methods: This was an observational study conducted in General Surgery Department of Kathmandu Model Hospital and Kirtipur Hospital, Kathmandu, Nepal. All participants admitted for laparoscopic cholecystectomy were included in this study. Participants who had difficult laparoscopic cholecystectomy (DLC) were identified based non achievement of CVS. Demographic profile, indications, risk factors, intraoperative findings and bailout techniques were evaluated. Results: A total of 273 cases were included and analyzed in the study. The incidence of difficult LC was 41(15.01%). Types of Bailouts out techniques done were Fundus First, Sub-total cholecystectomy and open cholecystectomy. An overall conversion rate of LC to open cholecystectomy in difficult LC was seen in 3 (1.09%) of the cases. Intraoperative complications were not seen in 87.8% of the patients. All the patients with bailout techniques had excellent outcomes. The mean duration of hospital stay in difficult LC cases was five days. Conclusion: Different bailout techniques during difficult Laparoscopic Cholecystectomy have excellent outcomes and are recommended to practice.
Clinical Profile of Patients Undergoing Total Laparoscopic Hysterectomy
Introduction: Total laparoscopic hysterectomy (TLH) has emerged as a preferred alternative to abdominal hysterectomy for benign gynaecological conditions owing to its well-known benefits. With increasing use of laparoscopic techniques, it is important to evaluate the clinical profile and surgical outcomes of the patients undergoing total laparoscopic hysterectomy. Methods: This descriptive study was conducted at Kathmandu Model Hospital- Institute of Health Sciences over 5 months period after taking ethical approval. All patients undergoing TLH for benign indication were included in the study. Sociodemographic and clinical characteristics, operative details and immediate postoperative complications were recorded in a predesigned proforma. Data were analysed using SPSS version 20. P-value of <0.05 was considered statistically significant. Results: A total of 73 patients underwent TLH during the study period. The mean age and bod mass index was 46±5.83 years and 28.07±3.94 kg/m2 respectively. The most common presenting symptom was heavy menstrual bleeding (63%, n=46). Fibroid uterus (52.1%, n= 38) was the leading indication for TLH. The mean operative time was 149.04±40.33 minutes. A statistically significant association was observed between increasing uterine weight and longer operative time (p=0.001). The overall complication rate was 23.28% with no bowel or urinary tract injuries. Conclusion: Total laparoscopic hysterectomy is a safe and feasible options for benign gynaecological conditions, even in patients with higher body mass index and larger uterine size. Despite longer operative time, it has favourable perioperative outcome with acceptable complication rates.
Medical education in South Asia: Challenges and Opportunities
Anterior Palatal Fistula Closure with Tongue Flap
Palatal fistula is an abnormal oronasal communication with incidence of 4% to 35% and recurrence up to 25%. Repairing large palatal fistula can be technically challenging. Anteriorly based tongue flap may be the flap of choice for recurrent and symptomatic anterior palatal fistula. A case of bilateral complete cleft lip, alveolus and palate with residual anterior palatal fistula was successfully managed with anteriorly based tongue flap. Postoperative care included liquid diet, oral hygiene and flap division after 2 weeks. Wound healing was satisfactory and uneventful. No flap loss, speech impairment, taste disturbance or functional tongue morbidity was noted. The tongue flap is a highly reliable flap with reported success rates of 85% to 95.5% in management of palatal fistula. Based on our experience, tongue can be considered a good option and highly recommended for the closure of large & recurrent palatal fistula.
Radiographic Assessment of Secondary Autogenous Bone Grafting in Alveolar Cleft Patient at Kirtipur Hospital
Introduction: Alveolar bone graft is the procedure to fill the gap in the gum with bone so the teeth and jaw can grow normally. It is an integral part and most commonly performed procedure in cleft patients. The study is aimed to evaluate the outcomes of secondary alveolar bone grafting through bone fill at alveolar defect site using 2- dimensional radiographs. Methods: We conducted a single center prospective cohort study at Kirtipur Hospital, Nepal from July 1st, 2025 to December 30th, 2025. Patients who underwent alveolar bone graft were evaluated for outcome of grafting through bone fill seen on intra oral radiographs using Kindelan score grading at 3-4 months post operatively. Outcomes were dichotomized as successful (Kindelan score 1–2) and failure (Kindelan score 3–4). Results: We had a total of 16 cases with 6 males (37.5%) and 10 female (62.5%) patients who had a median age 15.5 years (IQR 11.5, 18). Radiographic success as defined by Kindelan score 1–2 was achieved in 12 cases (75.0%) and failure in 4 cases (25%) with no statistically significant association between sex and radiographic success (p = 0.234). There was good to excellent intra-observer agreement (ICC = 0.89 & 0.96 for observer 1 & 2) and excellent inter-observer reliability (ICC = 0.96). Conclusion: Secondary autogenous alveolar bone grafting demonstrated favorable early radiographic outcomes, with 75% of patients achieving satisfactory bone fill at 3–4 months postoperatively. The Kindelan scoring system proved to be a reliable and reproducible method for radiographic evaluation
Macrodactyly of the Hand Managed with Digital Shortening and Nail Bed Grafting
Macrodactyly is a rare congenital condition in which one or more digits grow disproportionately due to overgrowth of bone, soft tissue, and nerves. We report a 31-year-old woman with progressive enlargement of the long and ring fingers of her right hand, causing pain, limited flexion of the long finger, and cosmetic concern. Examination revealed disproportionate digit size, clinodactyly of the long finger, intact sensation, and normal vascularity. Imaging confirmed hypertrophy of bone and soft tissues, with enlargement of the median and digital nerves. The patient underwent digital shortening of the long finger at the distal interphalangeal joint, excision of fibro-fatty tissue, and nail bed grafting, preserving neurovascular structures. At six months, the nail bed graft had fully taken, digit size was reduced, clinodactyly corrected, sensation and circulation preserved, pain resolved, and hand function improved. The patient was satisfied, and no recurrence was observed.
Use of a Buccinator Myomucosal Flap for Wide Recurrent Palatal Fistula Repair
Palatal fistula is a common and challenging complication following cleft palate repair, particularly in recurrent cases with scarred local tissues. The buccinator myomucosal flap (BMMF) provides a well-vascularized regional option for fistula closure. We report a 17-year-old male with a wide recurrent palatal fistula following multiple cleft palate surgeries. The defect, extending from the hard–soft palate junction to the pre-alveolar region, was reconstructed using a posteriorly based unilateral BMMF after nasal layer closure. The flap provided adequate reach and tension-free oral lining. Postoperative recovery was uneventful, with minimal donor-site morbidity. At four-year follow-up, the patient demonstrated stable fistula closure, healthy mucosalization, and no functional complications.
Pedicled Buccal Fat Pad versus Conventional Gelfoam in Management of Lateral Palatal Defect Healing After Primary Palatoplasty
Introduction: Delayed mucosalization of lateral palatal defects following palatoplasty may increase postoperative pain, discomfort, and risk of complications. The pedicled buccal fat pad has been used as a biological dressing to enhance intraoral wound healing; however, systematic evaluation following palatoplasty remains limited. This study aimed to evaluate mucosalization time of buccal fat pad-covered lateral palatal defects and compare outcomes with conventional management. Methods: An observational study was conducted at Kirtipur Hospital, Nepal, from August 2025 to January 2026. Thirty non-syndromic cleft palate patients undergoing primary palatoplasty were enrolled consecutively and divided into two groups: Group A (n=15), managed with purified gelatin (Gelfoam), and Group B (n=15), managed with pedicled buccal fat pad coverage. Postoperative pain, cheek swelling, operative duration, and time to complete mucosalization were assessed. Data were analyzed using descriptive statistics, chi-square test, and independent t-test. Results: Baseline demographic characteristics, defect size, and operative duration were comparable between groups. Mean time to complete mucosalization was significantly shorter in the BFP group (2.20 ± 0.41 weeks) than the conventional group (4.00 ± 1.07 weeks; p<0.05). Postoperative pain on the day of surgery was significantly lower in the BFP group, while no postoperative bleeding was observed. Transient cheek swelling in some BFP cases resolved spontaneously. Conclusion: The pedicled buccal fat pad significantly accelerates mucosalization of lateral palatal defects and reduces early postoperative pain without adding substantial operative time. It is a safe and effective adjunct in cleft palate reconstruction.
Clinical Profile of Women with Lower Urinary Tract Symptoms Visiting Kathmandu Model Hospital
Background: Lower urinary tract symptoms (LUTS) are common among women and can significantly impair quality of life. Despite their high prevalence, LUTS often remain under-recognized and under-treated, particularly in low- and middle-income countries. This study aimed to determine the prevalence, severity, and associated factors of LUTS among women attending a tertiary care hospital in Kathmandu, Nepal. Methods: A hospital-based cross-sectional study was conducted from September 2025 to December 2025 at Kathmandu Model Hospital. A total of 385 women were assessed for any lower urinary tract symptoms were using a validated Bristol Female Lower Urinary Tract Symptoms questionnaire translated into Nepali. Symptoms were categorized into no/minimal, moderate, and severe LUTS based on total scores. Data were analyzed using SPSS version 25, and associations were assessed using the chi-square test, with statistical significance set at p < 0.05. Results: Among 385 participants mild, moderate, and severe LUTS were present in 40.7%(157), 27.0%(104), and 10.3%(40) of women, respectively. Storage symptoms, particularly urinary frequency, were the most common complaints among 76.60%(295). Moderate to severe LUTS were significantly more prevalent in women aged over 40 years and in those with increasing parity (p < 0.001). All women with diabetes mellitus and those with a history of hysterectomy reported LUTS, with the majority experiencing moderate to severe symptoms. No statistically significant association was observed between mode of delivery and LUTS severity. Conclusion: Lower urinary tract symptoms are highly prevalent among 79% women attending tertiary care in Kathmandu, with increasing age, higher parity, diabetes mellitus, and prior hysterectomy being significant associated factors. Early identification and targeted management strategies are essential to reduce symptom severity and improve quality of life among affected women.
Ranking Predictors of Child Dietary Diversity in Nepal Using a Decision Tree
Introduction: Minimum dietary diversity among children (MDD-C) remains low in Nepal, contributing to persistent malnutrition. This study aimed to rank and characterize the association of dietary, socioeconomic, and health-related predictors of MDD-C among children aged 6–59 months in Madhyapur Thimi Municipality of Nepal. Method: A secondary analysis of survey data from 375 children was conducted. Chi-squared tests were used to identify baseline associations of the predictors with MDD-C. A Chi-squared Automatic Interaction Detection (CHAID) decision tree was then fitted to identify key split variables and interaction structures. A CHAID-based sensitivity analysis was used to estimate food groups’ contributions to predicted dietary adequacy by toggling individual food groups from absent to present. Bootstrap resampling was used to quantify the internal variability of these estimates. Result: Overall, 73.6% of children were predicted to achieve MDD-C. The decision tree placed other fruits and vegetables (Group G) at the root level, followed by splits on eggs (Group E), legumes and nuts (Group B), and vitamin A–rich foods (Group F). Sensitivity analysis suggested that enabling consumption of Group G or Group E was associated with the largest expected improvements in predicted dietary adequacy, and bootstrap resampling indicated that this ranking was relatively stable across resamples. Conclusion: This model-based analysis indicates that Group G and Group E foods are strong positive predictors of adequate dietary diversity and offer the largest expected gains among diet-deficient children. Hence, access to Group G and Group E foods could be prioritized as dietary interventions to improve child nutrition.
Granulomatous Inflammation of Gall Bladder
Granulomatous cholecystitis is a condition affecting the gallbladder that is often confused with cancers and other types of cholecystitis, which poses a diagnostic challenge for medical professionals. We share a case of granulomatous cholecystitis in a 51-year-old man with resolving acute pancreatitis and hypertension. Imaging showed thickening of the gallbladder wall and presence of gallstones. Laparoscopic cholecystectomy was performed and histopathological examination confirmed that the patient had granulomatous cholecystitis, characterized by presence of epithelioid histiocytes and multinucleated giant cells. The case highlights the importance of considering granulomatous cholecystitis in the differential diagnosis of gallbladder diseases, especially in patients presenting with chronic inflammation and gallstones. This report underscores the need for high clinical suspicion to differentiate granulomatous cholecystitis from other gallbladder pathologies.
Institutional Report: Kathmandu Model Hospital School of Nursing
Copyright (c) 2024 Journal of Public Health Concern Trust (JPHECT) https://creativecommons.org/licenses/by-nc/4.0
Why Health Outcomes are Poor in the United States Compared to Other First-World Countries and the Way Forward
Diagnostic Challenge in Distinguishing Steven Johnson Syndrome/ Toxic Epidermal Necrolysis from Dengue in Endemic Areas
This case report discusses the clinical course of a female in her mid-20s with a history of seizure disorder who presented with a fever and rapidly evolving dermatological symptoms, later diagnosed as Stevens-Johnson Syndrome (SJS) with Toxic Epidermal Necrolysis (TEN) overlap. Initially presenting with high-grade fever, cough, hypotension, and tachycardia, the patient’s recent travel to a dengue-endemic area led to initial suspicion of an infectious etiology, including dengue fever. However, negative tropical disease tests and the subsequent development of erythematous and painful maculopapular rashes, coupled with mucosal involvement, shifted the diagnosis towards a severe drug reaction. The recent addition of phenytoin to her antiepileptic regimen was identified as the likely trigger for SJS/TEN. With a SCORTEN score of 4, the patient received prompt treatment, including intravenous hydrocortisone and later oral prednisolone along with supportive care. Keywords: Dengue, Drug-induced rash, Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis, Phenytoin