Introduction: Tract dilatation in percutaneous nephrolithotomy can still be difficult to ascertain the optimal depth to prevent over-dilation, causing system perforation and vascular injury or under-dilation, making the establishment of access tract in a single attempt strenuous. This study aimed to use of visual dilator system to obtain real-time visual confirmation during percutaneous tract dilatation. Materials and Methods: The visual dilator system was used. The nephroscope was connected to a standard endoscopic camera system. The dilator system backloaded with an access sheath was passed over a guidewire to dilate the percutaneous tract and position the access sheath under visual guidance. Between December 2015 and December 2016, the visual dilator system was used during percutaneous tract dilatation in 13 percutaneous nephrolithotomy (PCNL) cases with mild or above hydronephrosis. Results: All tracts were successfully dilated in a single attempt. The intervening tissue layers, approach into the target calix, and the access sheath placement could be visually monitored through the dilator wall to confirm accurate dilatation. Mean dilatation time was 3.4-0.9 minutes, hemoglobin drop was 1.4-0.8 g/dL, primary stone-free rate and that after auxiliary treatment were 11/13 (84.6%) and 13/13 (100%), respectively. We experienced over-dilatation in one of the initial cases. No complications were experienced in the rest of the cases. Conclusions: PCNL access tract dilation using the visual dilatation technique is clinically feasible and provides real-time visual monitoring and confirmation of accuracy in dilatation. It may improve the overall safety and efficacy of the PCNL procedure.

Introduction: Fine needle aspiration cytology is a quick and safe technique done for the initial diagnosis of head and neck region masses. This study aims to assess the utility of fine needle aspiration cytology in head and neck palpable masses. Materials & Methods: A descriptive cross-sectional study was done in the Pathology Department of Kathmandu Medical College from 1st February 2023 to 31st December 2023. All the patients with palpable head and neck lumps were included in the study. A convenience sampling method was used. The data was entered and analyzed using the Statistical Package for Social Science (SPSS) version 22.0 Results: Among 650 fine needle aspiration cytology done during the study period, 184 were from head and neck lesions (28.30%). The mean age of the patient was 35.4 years with female predominance. The most common site was lymph node 85 (46.19%) followed by thyroid 39 (21.19%). Reactive lymphadenitis was the most common cause of lymphadenopathy seen in 41(22.2%) patients and colloid goitre was the most common cause of thyroid swelling seen in 26(14.13%) patients. Conclusions: Fine needle aspiration cytology is a useful and reliable technique for the diagnosis of head and neck mass. It helps to avoid unnecessary surgeries and is recommended and guides the clinician in general clinical management.

Introduction: Wrist circumference is a good predictor of obesity and insulin resistance. Wrist circumference may be considered as an indirect determinant of hyperinsulinemia and insulin resistance. The present study aimed to assess wrist circumference as an alternative tool for differentiating patients with coronary artery disease and metabolic syndrome from those without coronary artery disease and metabolic syndrome. Materials and Methods: The study was conducted on patients ≥ 30 years old undergoing coronary angiography following acute coronary syndrome or for evaluation of coronary artery disease. Results: Diabetic, hypertensive, and obese patients had more wrist circumference. High TG, low HDL levels were associated with higher wrist circumference (p=0.005). Wrist circumference was positively correlated with waist-hip ratio (p<0.001). Patients with Metabolic Syndrome have a mean Wrist circumference of 16.54 whereas patients without Metabolic Syndrome have a mean wrist circumference of 15.89(p<0.001). Coronary artery disease patients had higher mean wrist circumference than non-coronary artery disease patients (16.59 vs 15.9) (p<0.001). Triple-vessel disease patients have higher wrist circumference than double-vessel-disease patients; Doublevessel- disease patients have higher wrist circumference than single-vessel disease (p<0.001). Multivariate logistic model shows the main predictors for coronary artery disease are male sex, smoking, high BMI, low HDL, and wrist circumference. Conclusion: Measurement of Wrist circumference can serve as an easy anthropometric marker to identify individuals at risk of cardio-metabolic disorder, and predict the severity of Coronary Artery Disease can be used in large epidemiological studies.

Introduction: Good quality sleep and adequate amount of sleep are important in order to have better cognitive performance, academic performance and avoid health problems and psychiatric disorders. Sleep disturbance is a distressing and disabling condition that affects many people, and can affect on quality of work and education of students. Thus the aim of the study to assess the factors that contributes to the quality of sleep and its impact on academic performance. Materials and methods: This cross-sectional study was conducted among undergraduate medical students of KIST Medical College and Teaching Hospital from May to June 2024 after taking ethical clearance from KIST Medical College and Teaching Hospital- Institutional Review Committee before collecting data from participants. Subjects were recruited by Non-Probability sampling technique from students of first, second, third and fourth years and were asked to fill the self-reported questionnaires, using Pittsburgh Sleep Quality Index. Descriptive statistical analysis was done using Statistical Software for Social Sciences version 16. Results: Out of 280 medical students, 83(29.6%) have poor sleep quality with prevalence among male and female students as 44 (53.01%) and 39(46.99%) respectively. Age, year of study and exam result was found to be statistically significant with p value less than 0.05. Conclusions: This poor sleep quality is directly and indirectly affecting physical and social health as well as the academic performance of the students. Awareness programs concerning the effect of distorted sleep cycle are suggested to be conducted.

Congenital anomalies of lower urinary tract are most common anomalies found in children, but congenital anterior urethral diverticulum is a very rare cause. Here we present 11 month old male child presented with soft cystic swelling in the ventral side of the penile shaft and underwent open diverticulectomy.

Introduction: Renal disease is a significant health problem in Nepal that is creating an increasing health and economic burden. Renal disease usually does not cause symptoms until reaching an advanced stage. Correct diagnosis of renal biopsy requires correlation of clinical, biochemical, and serological parameters and histopathological examination by light microscopy, immunofluorescence, and sometimes electron microscopic examination. The present study was conducted to study the histopathological patterns of all renal biopsy specimens in Nepal with the help of information obtained from Light microscopy and Immunofluorescence examination. Materials and Methods: In this cross-sectional (Prospective study) undertaken at the Pathology Department at Pratham Pathology Laboratory, Lazimpat for 1year duration (January 1ST - December 31ST 2022), all renal biopsy specimens of patients with different glomerular diseases were enrolled. The final diagnosis was made by a pathologist correlating with the histopathological along with immunofluorescence and other clinical and laboratory findings. Results: A total of 195 patient renal biopsy specimens between ages (1-80 years) were enrolled. The majority of patients were in the age group of 21-30 years (23.60%). The study showed slight female predominance with a male-to-female ratio of 1: 1.34. The most common renal disease was Lupus Nephritis with a frequency of 64 with a predominance of Lupus Type IV with a frequency of 34 (17.45. Among all, 21 cases were of Chronic Glomerulonephritis and the most common leading cause for it was IgA Nephropathy with a frequency of 8 (38.10%). Conclusions: The most commonly diagnosed renal disease under a microscope was Lupus Nephritis with a frequency of 34 (17.45%). The leading primary glomerular disease for Chronic glomerulonephritis was IgA Nephropathy with a frequency of 8 (38.10%).

Introduction: Chronic liver disease is a common disease presenting in hospitals in Nepal. A large number of cirrhotics present with hepatic encephalopathy. Various precipitating factors are present which precipitate hepatic encephalopathy. This study was intended to identify the precipitating factors of hepatic encephalopathy and to assess whether identifiable precipitating factors of encephalopathy are present. Materials and Methods: This was a hospital-based observational cross-sectional study conducted at the Department of Medicine, Manipal Teaching Hospital, Pokhara. A total of 80 patients were included. The precipitating factors for encephalopathy were documented along with grading. SPSS was used for data analysis. Results: The mean age of the patients was 54.725 ± 11.33 years. There were 55 males (68.8%) and 25 (31.3%) females in the study. All the patients (100%) had a significant amount of alcohol consumption. It was found that hepatic encephalopathy was more severe in the higher Child-Pugh class as compared to a lower one. At least 1 precipitating factor was identified in 81% of patients. The common precipitating factors were increased protein intake, bleeding, infection, diarrhea, and constipation. Conclusions: We conclude that there are different factors that play a key role in precipitating hepatic encephalopathy, with a high protein diet, constipation, bleeding, and infections being predominant. A minor change in dietary habits, regular follow up and timely visits to the health care facility may result in the identification of these common precipitating factors like infections, constipation, and diarrhea.

Testicular sarcomas constitute only 1–2% of all testicular tumors and are mostly associated with germ cell tumors. Primary intratesticular localization is very rare and must be differentiated from paratesticular locations. Accurate diagnosis and early treatment are essential as it is an aggressive tumor with high metastatic potential and poor prognosis. The optimal treatment is based on radical inguinal orchidectomy and chemotherapy.

Introduction: Hearing disability can impair individual quality of life. It can impede communication, disrupt an individual's psychological and social well-being, and cause them to become socially isolated. We aimed to study the hearing status and etiology of hearing impairment in the patients visiting ENT-Audiology OPD. Materials and Methods: This cross-sectional study was conducted in the ENT-Audiology Department at the National Medical College and Teaching Hospital. Patients suspected of hearing impairment were audiologically evaluated with a MAICO 52 audiometer. A pure tone audiogram was done in each ear of every individual separately and a copy of it was kept along with demographic data and clinical history. Results: Among 410 individuals, 51.9% were males and 48.1% were females; a maximum of individuals were 16-30 (36.6%) years and the mean age was 33.56. Among 410 (820 ears) individuals 16.34%had unilateral hearing impairment and 67.31 %had bilateral hearing impairment. In 686 pathological ears, 51.45% suffered from otitis media followed by presbycusis in 14.47%. The conductive type of hearing impairment in 36.21% of patients and a mild degree of hearing impairment in 36.34% of patients were the most common. Conclusions: The prevalence of hearing impairment in this region is high. Otitis media was found to be the main cause of hearing disability and a mild degree of hearing loss was more evident. Preventive measures, early identification, and treatment can reduce hearing-disabling conditions.

Introduction: Childhood malnutrition is common in low-income and middle-income countries and increases the frequency and severity of pneumonia. The objective of this study was to determine the association between nutritional status and severity of pneumonia in under five children. Materials and Methods: This was a hospital-based cross-sectional study of data of children between 3 months to 5 years admitted in the Department of Pediatrics of Birat Medical College Teaching Hospital with a clinical diagnosis of pneumonia from December 2023 to July 2024. Results: One hundred seventy children were included in the study with a majority of age group 3 to 12 months (46.5 %) and male to female ratio of 3:1. There were 69 (40.6%) undernourished children and 73 (42.9%) anemic. On applying bivariate analysis, undernourishment(p<0.001, unadjusted OR=8.2, and 95%CI,3.9-17.5) and anemia (p<0.001, unadjusted OR=6, and 95%CI,2.9-12.6) were statically significant for severe pneumonia. Conclusions: The risk of having severe pneumonia was higher in children with under-nutrition and anemia. Prevention and treatment of malnutrition in children should be prioritized to reduce severe pneumonia as well as pneumonia-related mortality.