Introduction: Nasotracheal intubation (NTI) is a widely used technique in maxillofacial and oral cavity surgeries to provide better surgical access. Conventional NTI, while effective, is associated with complications such as nasal bleeding and oral cavity trauma. The bougie-assisted NTI technique, combined with video laryngoscopy, has been proposed to improve the success rate of firstattempt intubations and reduce trauma and other complications. Objectives: The study aimed to evaluate the effectiveness and safety of the bougie-assisted NTI technique, focusing on the success rates of first and second intubation attempts, time required for intubation, hemodynamic changes, and incidence of complications like nasal bleeding and mucosal injury. Methodology: This prospective observational study was conducted at Nepal Medical College from February 2024 to July 2024. A total of 36 patients, aged 18 years or older, scheduled for elective maxillofacial and oral cavity surgeries were included. The bougie-assisted technique was adopted under general anesthesia, and video laryngoscopy was employed for visualization. Hemodynamic parameters and complications were recorded at predefined intervals. Data were analyzed using descriptive statistics. Results: Among 36 patients who underwent nasal intubation, 28 patients (77.8%) were successfully intubated on the first attempt, and 8 patients (22.2%) required a second attempt, There were no cases of esophageal intubation, or oral cavity injury. The incidence and severity of nasopharyngeal trauma was significantly decreased. The heart rate, systolic blood pressure, have no significant change (p< 0.05), But the diastolic blood pressure increase in 10,and 15 minutes was significant (P > 0.05) in pre-intubation and post-intubation hemodynamic. The aim of the study was bougie-assisted technique would result less hemodynamic change, easy to intubate, less time required to intubate without nasopharyngeal trauma. Conclusion: Bougie assisted technique for nasotracheal intubation increases the rate of success on first attempt while reducing complications such as nasal or oral trauma and epistaxis. Therefore, we recommend using the bougie assisted technique for nasal intubation.

Introduction: Retinopathy of Prematurity (ROP) is a major cause of preventable blindness in preterm infants. This study aims to determine the incidence of ROP and associated risk factors in preterm infants in a tertiary care hospital in Nepal. Methods: A cross-sectional study was conducted over 18 months in NICU. Preterm infants with gestational age ≤34 weeks or birth weight ≤2000 grams were screened for ROP. Maternal and neonatal data were analysed to identify risk factors. Results: A total of 75 preterm infants were screened, with 19 (25.3%) diagnosed with ROP. Infants with ROP had significantly lower gestational ages (mean 30.52 ± 1.5 weeks) and birth weights (mean 1308.94 ± 288.98 grams) compared to those without ROP (mean gestational age 31.94 ± 1.74 weeks, mean birth weight 1646.25 ± 432.29 grams). Prolonged duration of supplemental oxygen (mean 13.47 ± 4.77 days in the ROP group) was also significantly associated with ROP (p=0.001). Mode of delivery was a significant factor, with caesarean delivery more frequent among ROP cases (p=0.016). Other factors, such as APGAR scores, neonatal jaundice, and neonatal sepsis, showed no significant association with ROP. Conclusion: The incidence of ROP was 25.3% with low gestational age, birth weight, and prolonged oxygen use as key risk factors. Early screening is essential for timely intervention in Nepal.

Introduction: Mobile phones are an often-overlooked source of microbial contamination in healthcare settings and pose a serious risk for the spread of hospital-acquired infection. Objectives: The objective of this study was to isolate the aerobic gram-positive cocci and gram-negative bacilli and their antibiotic susceptibility pattern from healthcare workers' mobile phones in a hospital. Methodology: The hospital-based descriptive cross-sectional study was conducted in the Clinical Microbiology Laboratory of Nobel Medical College Teaching Hospital, Biratnagar, Nepal, from May 2024 to October 2024. Identification of pathogenic aerobic gram-positive cocci and gram-negative bacilli from mobile phones of healthcare workers (HCW) was done by standard protocol, and antimicrobial susceptibility testing was done by Kirby- Bauer disc diffusion method following Clinical Laboratory Standard Institute guidelines. Results: A total of 215 (100%) swab samples were collected from healthcare workers' mobile phones, 152 (70.6%) samples showed significant bacterial growth by culture, and 63 (29.3%) mobile phone samples showed no growth. The most common organisms isolated were Staphylococcus aureus, followed by Escherichia coli and coagulase-negative Staphylococcus (CONS). All the gram-positive cocci were sensitive to linezolid, teicoplanin, and vancomycin, and gram-negative aerobic bacteria other than Pseudomonas were sensitive to gentamycin, cephalosporins, and Extended-Spectrum Beta-Lactamase (ESBL) producing gram-negative aerobes were sensitive to meropenem, piperacillin/tazobactam and cefepime. Conclusion: The present study highlights that healthcare workers' mobile phones carry pathogenic organisms, the most common in our setting was Staphylococcus aureus. This study also showed that gram-positive cocci were sensitive to linezolid, teicoplanin, and vancomycin, and gram-negative aerobic bacilli other than Pseudomonas were sensitive to gentamycin, cephalosporins, and ExtendedSpectrum Beta-Lactamase (ESBL) producing gram-negative aerobes were sensitive to meropenem, piperacillin/tazobactam and cefepime.

Introduction: Long COVID is described as signs and symptoms that continue or develop after acute COVID-19. In most cases, long COVID symptoms resolve within 1-5 months. Long‐term health sequels of the COVID‐19 are a major public health concern. However, evidence on post‐acute COVID‐19 syndrome is still limited, particularly for children and adolescents. Objectives: To investigate the prevalence, symptoms, duration and risk factors of long COVID. Methodology: A prospective, observational, longitudinal study was done in BMCTH, a tertiary care centre. Sixty children up to the age of 14-year, diagnosed as COVID-19 by RT-PCR and antibody were included. Follow-up of children were done within 1-3 months and 3-5 months after the treatment of acute COVID-19. Symptoms and duration of symptoms were noted on follow-up after the treatment of acute COVID-19. Results: Out of 60 children, 45 (75%) children were followed within 1-3 months and 3-5 months. Among them, 14 (31.11%) developed long-COVID symptoms. Long COVID symptoms were common in children of one year 5 (33.33%) with predominance of male 9 (36%) compared to female children 5 (25%).The long COVID symptoms were mostly respiratory and neuropsychiatric like cough 7 (50%), difficulty in breathing 5 (35.71%), fever 3 (21.43%), headache 2 (4.28%) fatigue2 (14.28%), Chest/ abdomen pain 2 (14.28%), loss of appetite 1 (7.28%). Severity of acute COVID-19 and multisystem inflammatory syndrome in children were risk factors for long COVID. The symptoms subsided mostly within 3 months. Conclusion: Thirty-one percent hospitalized children developed long COVID; mostly respiratory and neuropsychiatric symptoms. Long COVID symptoms subsided within three months after treatment.

Introduction: Postpartum hemorrhage is the leading cause of maternal mortality worldwide, especially in resource-limited settings like Nepal. Simulation-based training is a proven educational approach that equips healthcare providers with the critical knowledge and skills necessary to manage postpartum hemorrhage effectively. Objectives: The objective was to evaluate the effectiveness of simulation-based training on Helping Mothers Survive: Bleeding After Birth in strengthening healthcare providers’ competencies in managing PPH and shock in a tertiary hospital in eastern Nepal. Methodology: A simulation-based educational intervention was conducted in two phases: first phase took place on 26-27th June, 2023 and the second on 3-4th January, 2024, among 44 healthcare professionals. Helping Mothers Survive standardized assessment tools were used for Pre-test and Post-test knowledge on postpartum hemorrhage, and shock management and skill evaluations in Active Management of Third Stage of Labour, atony, bimanual compression, and condom tamponade, and shock management. Data were analyzed using paired t-tests in SPSS version 23, with p < 0.05 considered significant. Results: Among 44 healthcare professionals the mean knowledge scores for postpartum hemorrhage and shock management improved significantly from 11.77 ± 1.89 to 14.0 ± 1.01 (p < 0.001) and 4.27 ± 1.32 to 7.38 ± 0.56 (p < 0.001) respectively. OSCE results showed that all participants passed Active Management of Third Stage of Labour L and shock management. Forty-two out of 44 participants (95.45%) successfully performed atony management, bimanual compression, and condom tamponade. Conclusion: Simulation-based education significantly improved knowledge and skills among healthcare professionals working in maternity units. However, two participants who fell short highlight the need for frequent, ongoing training.

Introduction: Excision of the radial head was frequently indicated in the past, as the radial head was considered to have a minimal role in the stability and biomechanics of the elbow. Now, it has been established that the radial head has an important role, and its removal has shown to alter the stability and biomechanics, due to which surgeons are motivated to preserve or replace the radial head during fracture management. Objectives: This study aims to study the short-term clinical outcome and patient satisfaction of radial head replacement with prosthesis. Methodology: This study was conducted among patients who underwent radial head arthroplasty. A study tool was prepared for data collection, and the data was refined in Excel and analyzed using SPSS 20. Outcomes were assessed by using different parameters like range of motion, mayo elbow performance score, time to return to work, patient satisfaction, and complications. Results: This study had sixteen participants with a mean age of 40.19 ± 11.391 and a male-to-female ratio of 3:1. Mayo Elbow Performance Scores (MEPS) had a median (IQR) score of 85 (80-96.25). The median for extension was 5°, for flexion was 140°, and for both pronation and supination was 80°. The median time taken for return to work was two months, and 12.5% of the patients reported being dissatisfied. Conclusion: Radial head arthroplasty preserves the elbow stability and reestablishes normal functioning of the elbow after radial head fracture Mason type III.

Introduction: Vision is a fundamental component of safe driving. Any significant loss of visual function such as vision, field of vision, color vision, or contrast sensitivity/ability to see light and traffic signals in bad weather and night will diminish a person’s ability to operate a motor vehicle safely on today’s congested high-speed roadways. Objectives: To find out the pattern of ocular and ear morbidity of city rickshaw driver of Biratnagar metropolitan city. Methodology: The descriptive cross-sectional study was conducted at Biratnagar Eye Hospital (BEH), Biratnagar. The socio-demographic variables, assessment of uncorrected and corrected visual acuity for distance and near, color vision, stereopsis/depth perception, anterior and posterior segment ocular examination was done. Ear examination was performed by using otoscope and torch light. Results: Among 154 participants, mean age (±SD) was 38.09(±9.66) and all of them were male 154(100%). Nearly half 74(48%) of the participants were in the age group 26-40 years among them majority had completed secondary level education 94(61%) and 121(78.6%) had no driving license. More than half of the participants 79 (51.3%) reported previous history of eye examination. Normal color vision and stereopsis was found in 142(92.2%) and 89(57.8%) participants respectively. Majority of them 306(99.35%) had normal best corrected visual acuity. Only 2 of them had history of Road Traffic Accident (RTA). More than two-thirds of the participants had no ear morbidity. Conclusion: Distance visual acuity was found good but presbyopia was the most common ocular morbidity and stereopsis was found abnormal among electric rickshaw driver. Majority of them had no ear morbidity

Introduction: Fine needle aspiration cytology is a well-established, rapid, safe and cost-effective diagnostic technique and is increasing in popularity to diagnose mass lesions in intra-abdominal organs. Deep-seated organs are safely sampled and routinely aspirated using the fine needle under radiological guidance. Objective: To diagnose intra-abdominal masses using ultrasound-guided fine needle aspiration cytology and to categorize them as malignant, benign, suspicious, inflammatory, and unsatisfactory according to organ-wise. Methodology: This was a hospital-based prospective cross-sectional study carried out in Birat Medical College Teaching Hospital, where 77 cases were included in which FNAC was done for intra-abdominal masses under ultrasound guidance. Air dried smears were prepared for Giemsa stain and wet smears were prepared for PAP stain. The smears were classified as unsatisfactory, inflammatory, benign, malignant, and suspicious for interpretation categories. Results: A total of 77 patients with intra-abdominal lesions were included in this study. The patient age ranged from 13 to 90 years, out of which 37 cases (48.1%) were males and 40 cases (51.9%) were females. Out of the total 77 cases, 76.6% of cases were reported to be malignant followed by 9.1% inflammatory, 6.5% suspicious, 5.2% inadequate and 2.6% benign. The liver was the most common site for FNAC comprising 35 (45.5%) cases. Conclusions: In cases of intra-abdominal masses, the most common site for FNAC was the liver. Similarly, the most common cytological findings were malignant cases, followed by inflammatory, suspicious, unsatisfactory, and benign cases.

Introduction: Stroke causes neurological dysfunction by cerebral or spinal infarction. Ultrasound of the carotid arteries is beneficial for the management of carotid atherosclerosis. Multiple risk factors exist for the occurrence of large artery stroke. Methodology: This prospective descriptive study was conducted in a tertiary Care Centre from March 2023 to March 2024. Ethical clearance was taken from the Institutional Review Committee (Ref no: 816/2023). Purposive sampling was used to include 204 patients with stroke/transient ischemic attacks. Variables collected were demographics, evaluation of comorbidities, previous medical history, family history, and carotid ultrasound including grayscale and color Doppler. Results: The mean age of the patients was 68.39 ± 9.35 years with a male predominance. Carotid plaques were seen in 91.67%. The most common artery was the left common carotid and the most common type of plaque was the heterogeneous type. Severe narrowing of the arteries was seen in 20.09% with complete occlusion in 8.33% and 8.82% of cases in the right and left internal carotid arteries respectively. Increasing age, hypertension, diabetes, dyslipidemia, smoking, and family history were important risk factors for the occurrence of stroke. A carotid intima-medial thickness of over 1 mm was observed in 40.68% and 35.76% of the right and left common carotid arteries, respectively. Conclusion: Carotid gray scale ultrasonography revealed significant carotid plaque status in patients of stroke. The presence of comorbidities increases the risk of stroke and carotid plaque. Color Doppler ultrasound of carotids is a useful tool for managing carotid atherosclerosis.

Introduction: Anxiety is a common problem experienced by patients with chronic kidney failure undergoing hemodialysis therapy. Hemodialysis can be a challenging experience for patients, often leading to psychological distress, including anxiety which may vary from mild, moderate, severe to panic. Objectives: To find out the prevalence of anxiety among hemodialysis patient and its association with selected socio-demographic and clinical variables. Methodology: The study used a descriptive cross-sectional research design. A total, 108 hemodialysis patients were chosen using a non-probability purposive sampling method. Anxiety symptoms were assessed using Hamilton Anxiety Rating Scale. Data was collected using face-to-face interview method. SPSS version 20 was used for data analysis. Results: The mean age of the participants was 48.44 years ranging from 20 to 81 years. More than one-third (38.9%) of the participants belonged to the age group 45-59 years. More than half (54.6%) were females. About one-third had mild anxiety symptoms. Hemodialysis duration showed significant (p<0.05) association with anxiety. Conclusion: The study concluded that nearly one fourth of the respondents had no anxiety symptoms whereas about one-third had mild anxiety symptoms. Likewise, one-fourth of the respondents had severe anxiety symptoms. Hence, psychosocial counselling and collaborative treatment approach is needed to reduce the anxiety symptoms among the hemodialysis patient.