Background: Depression is a common mental disorder, associated with a global increase in disabilities and suicidality. Different factors are responsible for depression in which thyroid dysfunction and dyslipidemia are the biological causes. This study aimed to find the association and alteration of thyroid function tests and lipid profiles among patients with depressive disorders. Methods: A case-control study was performed on patients being managed for depressive disorder visiting the Psychiatry Department of Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The blood samples were collected from 40 newly diagnosed cases of depressive disorder not under any drugs and 80 from healthy individuals. Thyroid hormones and lipid profile parameters were analyzed in Johnson and Johnson, ECI Vitros 3600, US, Ortho Clinical Diagnostics, and BT-1500. Data were collected and statistical analysis was done using SPSS version 22. Results: Among the 40 patients with depressive disorders, 27.5% had thyroid dysfunction with sub-clinical hypothyroidism, overt hypothyroidism, and hyperthyroidism among 12.5%, 12.5%, and 2.5% respectively. Similarly, dyslipidemia was observed in 37.5% of participants. About 52.5% of patients managed for depressive patients were found to have anxiety as well. Despite an alteration of thyroid hormones, there was no significant correlation between thyroid hormones and lipid parameters in patients being managed for depressive disorder. Conclusions: This study concludes that thyroid dysfunction and dyslipidemia are seen among depressive patients with unclear reasons. For proper diagnosis and treatment of depression, it is better to carry out thyroid function tests and lipid profiles.Keywords: Depressive disorder; dyslipidemia; thyroid dysfunction.

Maternal perception of fetal movement is an important predictor of fetal wellbeing. Decreased perception of fetal movement by the mother is associated with increased maternal and fetal morbidity. The purpose of this study is to compare the fetomaternal outcome of decreased with normal fetal movement at term pregnancy. A comparative study comprising 140 women, 70 cases of normal fetal movement and 70 cases of decreased fetal movement were taken and their fetal and maternal outcomes were compared in terms of maternal and fetal outcome. The group of females below 20 years old had a higher occurrence of decreased fetal movement 8.7% (n=6) compared to 1.4% (n=1) in the normal fetal movement group. The prevalence of risk factors were similar among both the groups. Induced deliveries were higher in the decreased fetal movement group, 27% (n=19) compared to 21.4% (n=15) in the normal fetal movement. Caesarian section was more in the decreased fetal movement 54.3% (n=38) compared to 27.1% (n=19) in the normal fetal movement group which is statistically significant. The most common indication of caesarian section was non reassuring cardiotocography which comprised of 15.7%(n=11). Incidence of postpartum hemorrhage was higher in the decreased fetal movement (11.4%,n=8) then normal fetal movement (2.9%,n=2). Decreased fetal movement in comparison to normal fetal movement has increased operative intervention most common indication being non reassuring cardiotocography. Incidence of post partum hemorrhage was higher in the decreased fetal movement group. Fetal outcomes were similar in both groups.

Bicipital groove, the narrow sulcus present between the greater and lesser tubercles of proximal humerus, is an important anatomic landmark during prosthetic replacement of humeral head. Bicipital groove variations are associated with diseases of biceps tendon causing painful shoulder. The study aims to outline the morphometry of bicipital groove and create some baseline data which may be useful in arthroplasties and interpretation of radiologic anatomy of the shoulder. A quantitative cross-sectional observational study was conducted on 100 dry humerus bones from convenience sampling of dry bones available at the Department of Anatomy, Maharajgunj Medical Campus. The length of bone was measured with osteometric board. Side of bone was determined. The length, width and depth of bicipital groove was measured with Vernier calipers. Data was analyzed in SPSS version 17 and frequencies, descriptive statistics were calculated along with bivariate analysis using independent samples T-test and Pearson's correlation. Out of the total 100 humeri studied, the mean length was 296.7 mm (22.04 SD). Mean length, width and depth of bicipital groove were 69.6 mm (6.6 SD), 6.34 mm (1.64 SD), and 5.75 mm(1.5 SD) respectively. The length and width of bicipital groove were positively correlated with length of bone. The study investigated the morphometry of bicipital groove and its relation with length of humerus. The findings will have potential implications in clinical and surgical practice including shoulder prosthesis and arthroplasty.

Surgical site infections (SSIs) are classified as superficial, deep and organ incisions. This study was conducted to determine the prevalence of anaerobic bacteria in SSIs in Nepal. Total 641 patients were recruited from general surgery, orthopaedics, obstetrics and gynaecology units from October 2020 to December 2022. Surgical wound specimens from suspected SSIs were collected and processed for anaerobic culture for bacterial isolation from pus, fluids and tissues with the help of conventional and rapid methods. The odds ratio for logistic regression for categorical variables was used to determine the significance of association of host risk factors with blood parameters. The antimicrobial resistance of anaerobic bacteria was observed by agar dilution method. The overall rate of SSIs was 311 (48.52%) where only anaerobic SSIs was 61 (9.52%). The anaerobic bacterial isolates from pus 43 (70.5%), fluid 14 (22.9%), tissues 4 (6.55%) from postoperative wounds accordingly. Infection rate in elective surgery cases were higher 38 (62.3%) than in the emergency surgery cases 23 (37.2%). Comorbidities and site of infections were significantly associated (p< 0.05) with anaerobic culture positive SSIs. Predominant isolates were Bacteroides fragilis 19 (31.15%), Bacteroides thetaiotamicron 12 (19.67%), Clostridium perfringens 12 (19.67%) followed by Peptoniphilus asaccharolyticus and Peptoniphilus anaerobius 5 (8.20%) each. Clostridium sporogens, Prevotella melaninogenica, Porphyromonas gingivalis and Propionibacterium isolates were 2 (3.28%) each. Metronidazole resistance was seen the highest numbers 33 (54.09%) of the isolates. Susceptibility test is essential for proper prescription of antibiotics for anaerobic bacterial infections highlighting the urgent need to revise antibiotic regimens to improve the treatment of SSIs.

Families caring for individuals with mental illness often encounter significant challenges that impact their daily lives, including work, relationships, and social well-being. These responsibilities can result in high levels of stress and emotional strain. In Nepal, there is limited qualitative research on how family members perceive mental illness, manage caregiving duties, and cope with related stress. This study aims to explore the lived experiences of primary family caregivers, focusing on their challenges, coping strategies, and overall understanding of mental illness. The study involved ten family caregivers from the Mental Hospital in Lagankhel and Chiryau Polyclinic in Kathmandu, collected through semi-structured interviews. Data was analyzed using thematic analysis and coded in NVivo, identifying shared patterns and meanings. Ten caregivers aged 30 to 64 (mean age 47.8) described their roles as deeply demanding and painful. They faced challenging behaviors and often sacrificed their own needs, resulting in emotional distress and exhaustion. The caregivers reported experiencing anxiety, burnout, guilt, anger, and social stigma. To cope, they relied on strategies such as crying, distraction, adaptation, inner resilience, and support from family or social networks. Many also found personal growth, emotional strength, and a clearer understanding of mental illness and its treatment. Finally, participants emphasized the critical need for education, professional and family support, systemic services, government-facilitated healthcare access, and financial assistance to sustain effective caregiving. This study highlights the intense challenges faced by family caregivers of individuals with mental illness and underscores the need for strong support systems. Understanding their experiences and coping strategies can help guide targeted interventions, ultimately improving support for both caregivers and those they care for.

Leave against medical advice is a more prevalent challenge in Intensive Care units of developing countries compared to developed ones. This prospective observational study was done included 466 patients aged ?18 years who underwent leave against medical advice in a level three intensive care unit of a medical college. The patient admitted to the intensive care unit who chose to leave against the clinicians' advice was referred to as leaving against medical advice. All data were first entered into an Excel sheet and then transferred to a statistical package for the social sciences-16 for analysis. The descriptive data are presented as the number and percentage for categorical data and mean ± standard deviation for continuous data according to their distribution. A total of 466 patients were included in the study, and among them,273(58.58%) were male and 193(41.41%) were female. Middle- aged patients account for 234(50.21%) cases. Most patients, 460(98.71%) were admitted from the emergency department. LAMA occurred most frequently during morning shift, 258(55.56%) and in the month of Chaitra 19.4%.The mean ICU stay was 2.53±1.92 days. Internal Medicine accounted for 221(47.2%) who underwent leave against medical advice. 59(12.6%) were mechanically ventilated. Poor prognosis was the primary reason in 278(59.64%) patients who underwent leave against medical advice. Poor prognosis and financial problems were the most common reasons for patients to leave against medical advice. Therefore, government and other institutions should address this as a critical issue in patient management.

Hysterectomy is the most common gynaecological surgery. Hysterectomy is done by laparoscopic approach, open abdominal approach and vaginal approach. Laparoscopic approach has gained popularity among gynaecologists as well patients for its different benefits of minor perioperative complication, reduced intraoperative blood loss, and shorter period of hospital stay. However, there may occur some complications in laparoscopic hysterectomy which includes intraoperative organ injury, intraoperative blood loss, conversion into laparotomy, postoperative fever, surgical emphysema, port site infection, severe gastritis and haemorrhage. Similarly, we encountered a case of vault haemorrhage following total laparoscopic hysterectomy in our institution on 15th postoperative day leading to massive blood loss. Secondary haemorrhage is rare but occurs more often after laparoscopic hysterectomy than after other hysterectomy approaches. Secondary haemorrhage following total laparoscopic hysterectomy is an emergency condition and early diagnosis and prompt treatment is required. Keywords: Complications; hysterectomy; secondary haemorrhage; TLH.

In mid-2023, Nepal experienced a significant outbreak of conjunctivitis, affecting over 60% of outpatients in eye hospitals and prompting school closures. The outbreak, peaking in August, predominantly impacted children and individuals with compromised immunity. Clinical manifestations included sudden-onset redness, foreign body sensation, watery discharge, and occasional lid swelling. Most cases exhibited acute haemorrhagic conjunctivitis, with management involving ocular lubricants, personal hygiene, and topical antibiotics. This case series from Himalaya Eye Hospital in Pokhara details the genomic epidemiology and clinical characteristics of conjunctivitis cases during the outbreak. To understand the causative agents, conjunctival swabs from patients were subjected to unbiased metagenomic next-generation sequencing (mNGS) in Illumina iSeq100 at Dhulikhel Hospital Kathmandu University Hospital Results: This case series revealed the presence of Enterovirus C (coxsackievirus strain A24) as the major pathogen responsible for the outbreak. This case series contributes valuable insights into the genomic diversity of conjunctivitis-associated viruses, highlighting the potential of mNGS in enhancing diagnostic capabilities and guiding public health responses.

In Nepal, a substantial proportion of women marry before the age of 18, which is considered as early marriage (EM). The age at which women marry has a direct impact on fertility patterns, family size, and health outcomes of mothers and children. This study aims to assess the levels of age at first marriage (AFM) and significant determinants associated with EM among Nepali women. This is a secondary data analysis for which data were obtained from Nepal Demographic and Health Survey 2022. The survey was based on a cross-sectional study design applying two- stage stratified cluster sampling. The AFM levels were analyzed using basic statistics, and a multiple logistic regression model was utilized to identify significant determinants associated with EM. The model's fit was evaluated using the H-L (????2) and Pearson's tests. Current age of women, women's education, region of residence, caste/ethnicity, husband's education, spouse age difference and age at first menstruation were identified as significant determinants associated with EM. Women with no education face a significantly higher risk of EM - Odds Ratio (OR): 21.67 compared to those with higher education, while from other Terai caste (OR:1.58), and Dalit communities (OR:1.51), and women in Madhesh (OR:2.38) and Karnali (OR:1.94) provinces also exhibited higher risks compared to their reference groups. The risk of EM is higher among women with no or basic level education, those in Madhesh and Karnali provinces, and from Terai caste and Dalit communities. A large spousal age gap also contributes to this practice. Addressing these issues can help reduce EM among women in Nepal.

The median nerve, normally formed by two roots from the medial and lateral cords in relation to the axillary artery, but variations in its roots and unusual communications with other nerves are common. These anatomical differences can compromise anesthesia and are vulnerable to iatrogenic injury during surgical procedures of the upper limb. This study was conducted to determine the prevalence of such anatomical variations in axillary and arm regions. A descriptive cross sectional study was conducted on 66 upper limbs from embalmed adult human cadavers, selected using a convenience sampling method. The median nerve was observed after dissections in the axillary and arm regions for variations in formations and nerve communications. Variations were photographed, and the data were recorded and analyzed using SPSSTM version 20. The median nerve was most commonly formed in the axilla (78.78%), with one case showing a high formation at the apex. A third root was present in 7.58% of cases, and one rare case involved four roots. Communication with the musculocutaneous nerve occurred in 13.63% of limbs, including a case with two separate communicating roots. Communication with the ulnar nerve was observed in 3.03% of cases. Anomalous origin, aberrant branching patterns, and unusual communications of the median nerve are possible and clinically significant. Awareness of such variations is essential for accurate diagnosis, effective anesthesia, and safe surgical interventions involving the upper limb.