Background and importance: High-altitude pulmonary edema (HAPE) is a potentially fatal, non-cardiogenic pulmonary edema that develops after rapid ascent above 2500 m. Its incidence is influenced by ascent rate, altitude, and individual susceptibility, with risk factors including overexertion, cold exposure, respiratory infection, and genetic predisposition. Despite Nepal’s extensive high-altitude trekking activity, published HAPE reports remain limited. This case series describes the clinical presentation, diagnostic features, and management outcomes of HAPE in Nepalese trekkers to promote early recognition and guide timely interventions. Methods: This retrospective case series included patients with HAPE managed at a tertiary care center in Nepal. Cases were identified from hospital records, and relevant literature was narratively reviewed to contextualize findings. Case presentation: Four previously healthy adults developed acute HAPE after rapid ascent above 4000 m in Nepal. They presented with dyspnea, cough, hypoxemia (SpO 2 55–60%), and bilateral crackles. Imaging confirmed non-cardiogenic pulmonary edema. All patients received supplemental oxygen, nifedipine, and supportive care, resulting in gradual clinical improvement and discharge within 3–5 days. Clinical discussion: This series highlights the clinical variability of HAPE and emphasizes early diagnosis, descent, and oxygen therapy as mainstays of treatment. Rapid ascent, excessive exertion, cold exposure, and preceding respiratory infection were identified as common triggers. Diagnosis relied on clinical assessment supported by imaging, including bedside ultrasound. All patients recovered with conservative management. Conclusion: HAPE is life-threatening but reversible with prompt recognition and management. Strengthening clinician awareness, training, and early diagnostic capacity in high-altitude regions is essential to reduce associated morbidity and mortality.

Introduction:Cervical cancer remains a major public health concern in low- and middle-income countries, including Nepal. The International Federation of Gynecology and Obstetrics (FIGO) 2018 staging system for cervical cancer introduced stage IIIC for tumors with lymph node metastasis, reflecting the prognostic significance of nodal involvement. This study aimed to evaluate stage migration from FIGO 2009 to FIGO 2018 and to validate the prognostic performance of the revised staging system in locally advanced cervical cancer.Methods:In this retrospective cohort study, we consecutively included 155 patients with histologically confirmed cervical cancer treated with definitive radiotherapy or chemo-radiotherapy at Kathmandu Cancer Center between August 2016 and June 2019. Patients were initially staged according to the FIGO 2009 criteria and retrospectively restaged according to the FIGO 2018 criteria. Recurrence patterns were documented, and overall survival (OS) and disease-free survival were estimated using the Kaplan-Meier method with log-rank tests for group comparisons. All patient identifiers were removed, and the study conformed to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Ethical approval was obtained from the Nepal Health Research Council (approval number: 655/2020P), and the requirement for written informed consent was waived.Results:Under FIGO 2009, most patients were classified as stage IIB (47.7%) and IIIB (36.7%), whereas under FIGO 2018, this led to 34.2% in stage IIB and 31% in stage IIIC1. Stage migration occurred in 38.7% of patients, predominantly from IIIB (58.3%) and IIB (35.4%) to IIIC1. Both staging systems demonstrated decreased OS with advanced stages; however, stage IIIC1 patients had better OS than stage IIIB patients under the FIGO 2018 staging, likely reflecting heterogeneity in tumor extent and treatment factors. Five-year OS rates were not significantly different between the 2 staging systems. Recurrence was observed in 29.2% of patients, with distant metastasis being the most common pattern.Conclusions:The FIGO 2018 staging system results in substantial stage migration and highlights heterogeneity among node-positive (stage IIIC1) patients. Consideration of tumor extent and nodal burden is important for accurate prognostication. These findings support the need for further studies to refine the staging system and improve its prognostic precision in cervical cancer.

Introduction: Supratentorial intraventricular tumors are rare central nervous system neoplasms located deep within the ventricular system. Their proximity to eloquent neural pathways and critical vascular structures makes surgical management technically challenging. Data from low and middle income regions remain limited. This study evaluates the clinical features, histopathological patterns, surgical approaches, and outcomes of patients treated at a tertiary neurosurgical center in Nepal. Material and Method: A retrospective observational study was conducted including 27 consecutive patients who underwent surgical resection of supratentorial intraventricular tumors between September 2020 and August 2025. Demographic, clinical, radiological, histopathological, operative, and postoperative data were collected and analyzed. Statistical analysis included descriptive statistics, chi-square testing, logistic regression modeling, and calculation of confidence intervals. Institutional Review Committee approval was obtained prior to study initiation. Results: The mean age was 24.9 ± 13.2 years, with a male predominance of 21 (77.8%). Headache was the most common presenting symptom, occurring in 14 (51.9%) patients. Colloid cyst was the most frequent histopathological diagnosis, identified in 7 (25.9%) patients, followed by subependymal giant cell astrocytoma in 5 (18.5%) and choroid plexus tumors in 5 (18.5%). The transcortical-transventricular approach was most frequently utilized in 14 (51.8%) cases. Postoperative hydrocephalus requiring cerebrospinal fluid diversion occurred in 5 (18.5%) patients. Overall mortality was observed in 3 (11.1%) patients. No statistically significant association was found between tumor type or surgical approach and postoperative complications. Conclusion: Microsurgical resection remains the cornerstone of management for supratentorial intraventricular tumors in resource-limited settings. Although acceptable surgical outcomes can be achieved, postoperative hydrocephalus continues to be a significant challenge. Larger prospective multicenter studies are needed to optimize surgical strategies and improve patient outcomes.

Introduction: Nepal’s population is 30 million, and 28% are under the age of 14. There are only 116 neurosurgeons, with none specifically committed to pediatric neurosurgical practice, nor is there a dedicated pediatric neurosurgery center. Consequently, there is an immediate need for developing pediatric neurosurgery practices, requiring analysis of the most prevalent neurosurgical disorders endemic to Nepal to identify areas of treatment focus, in addition to training for pediatric neurosurgical subspecialists. In response to these needs, we present our initial experience surveying the current pediatric neurosurgical caseload at the tertiary referral center in Nepal and summarize key learning points derived from a visiting rotation at a high-volume United States (US) pediatric neurosurgical practice. Materials and Methods: Retrospective case analysis at a tertiary level neurosurgical referral center in Nepal; all operative cases 18 years of age or younger over a 5-year period were included, categorized by pathology and treatment. Following this, a three-month rotation at Boston Children’s Hospital (BCH) was subsequently reviewed to identify key learning points relevant to impacting practice upon return to Nepal. Result: There were 601 cases performed during the 5-year period. Male to female ratio was ~2:1. Common operative cases included trauma, hydrocephalus, tumors, brain abscesses, vascular malformations, craniovertebral junction anomalies, spinal dysraphism and seizure. With a focus on these conditions, rotation lessons from BCH were identified to improve treatment of these specific conditions in Nepal, with major learnings in operative efficiencies and resource allocation. The learning was applied to make changes in practice in the hospital. Conclusion: This work provides a current review of pediatric neurosurgery in Nepal and has highlighted the common neurosurgical treatments provided. These data will direct future areas of focus for training and resource allocation for planning a dedicated unit in Nepal. In addition, the experience at the US teaching hospital has led to the development of novel treatment strategies upon return to Nepal.

Introduction: Spontaneous intracranial hemorrhage is the presence of a parenchymal bleed in the absence of trauma or surgery in brain. The original Intracerebral hemorrhage score utilizes the cut-off age of 80 years, whereas the modified Intracerebral hemorrhage score used a lower cut-off age which may better prognosticate the outcome of Intracerebral hemorrhage in the populations with shorter life expectancy. The primary objective of this study was to compare the original with modified intracerebral hemorrhage scores in predicting mortality in Nepalese population with intracerebral hemorrhage. Materials and Methods: Patients ≥16 years, with spontaneous Intracerebral hemorrhage, who were admitted in Tribhuvan University Teaching Hospital in the Department of Neurosurgery and Neurology between 15th March, 2019 and 30th November, 2019, were included in the study. Original and modified Intracerebral hemorrhage scores were recorded separately at the time of admission. The outcome was measured using the modified Rankin Scale at 6 months. To compare the predictive ability of original and modified Intracerebral hemorrhage for mortality and outcome, receiver-operating characteristics curves were compared; and areas under the curve was calculated. DeLong’s test was used to compare the area under the Receiver Operating Characteristic. Sensitivity and specificity were calculated for the diagnostic accuracy; and were plotted in Receiver Operating Characteristic. Youden's index was calculated to determine the discrimination ability of both scores. Result: A total of 89 patients were enrolled in the study. Only thirteen patients (14.6%) were ≥80 years. The 30-day and 6-month mortality was 24.7% and 33.7% respectively. Hosmer-Lemeshow test showed a good model fit for both the scores for mortality and good outcome at 6 months. Conclusion: Prediction of 30-day mortality by modified intracerebral hemorrhage score is similar to the original intracerebral hemorrhage score. However, there was a slight trend of better prediction for good outcome at 6 months, using the modified score.

Background: Functional neurosurgery, particularly Deep Brain Stimulation (DBS) and ablative procedures like pallidotomy and thalamotomy, has emerged as a powerful tool in the treatment of medically refractory movement disorders. However, its application in low-resource countries like Nepal is limited. This study presents our early experience with surgical management of movement disorders at Bir Hospital using DBS and lesioning techniques. Methods: This is a prospective study from the period of April 2024 to June 2025 at the National Neurosurgical Referral Center (NNRC), National Academy of Medical Sciences (NAMS) Bir Hospital. Patients with advanced Parkinson’s disease or primary dystonia underwent surgical intervention. Four patients received bilateral Globus Pallidus internus (GPi) DBS, one patient received bilateral subthalamic nucleus(STN)DBS and three underwent unilateral radiofrequency pallidotomy. All surgeries were performed under local anesthesia except for IPG placement, which was done under general anesthesia. Patients were evaluated for improvement in tremor, rigidity, camptocormia, and dystonia. Clinical outcomes and complications were assessed over a follow-up period of up to one year. Results: All patients demonstrated significant clinical improvement in motor symptoms postoperatively. Four patients with over 1-year follow-up maintained sustained benefits. The remaining four, with early 1 month follow-up, also showed encouraging results. The outcomes between DBS and pallidotomy groups were clinically comparable. All procedures were completed safely with no perioperative complications. Cost remains the major barrier to widespread DBS adoption in Nepal. Conclusion: Both DBS and pallidotomy are effective and safe for the treatment of movement disorders. In resource-constrained settings, lesioning offers a viable and affordable alternative. Early surgical referral and government subsidy for DBS can improve access and patient outcomes in Nepal.

Ultrasound-guided chemoport insertion reduces mechanical and infectious complications compared with the landmark-based (blind) insertion technique. However, data are limited from low-resource settings where breast surgeons commonly perform the procedure. This prospective observational study evaluated the safety and outcomes of ultrasound-guided right internal jugular vein (RIJV) chemoport insertion performed by a breast surgeon at a single center in Nepal (November 2023 – May 2025). All procedures were performed in an operating theatre under local anesthesia using a standardized ultrasound-guided Seldinger technique. Among 146 patients scheduled for chemotherapy, 121 patients with breast cancer (mean age 48 ± 11 years; 121 female) underwent successful chemoport implantation (100% cannulation success). Indications were neoadjuvant (40%), adjuvant (59%), and palliative (1%) chemotherapy. No intraoperative complications (e.g., pneumothorax, arterial puncture, hemothorax) occurred. Late complications (5.0%) included port pocket infection (0.8%), port exposure due to skin tension (1.7%), and catheter blockage from delayed flushing (2.5%). Ultrasound-guided RIJV chemoport insertion by a trained breast surgeon is a safe and highly effective procedure with a low complication profile in a resource-limited setting. This supports the integration of this skill into surgical oncology practice, where interventional radiology access is constrained.

Background Medial compartment knee osteoarthritis (OA) is a common degenerative joint disorder and a major cause of chronic pain and functional impairment, particularly among middle-aged and older adults. In low-resource healthcare settings, access to procedures such as knee arthroplasty remains limited. Proximal fibular osteotomy (PFO) has emerged as a minimally invasive, joint-preserving surgical technique that may improve load distribution across the knee and correct varus alignment in selected patients. Objective This study aimed to assess the functional and radiological outcomes of PFO in patients with medial compartment knee OA at the 12-month follow-up. Methods A hospital-based prospective single-arm interventional study was conducted among 42 patients with Kellgren-Lawrence grade II-III medial compartment knee OA who underwent PFO at a tertiary care center in Nepal. The primary outcome was the change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 12 months. Pain intensity was assessed using the Visual Analog Scale (VAS). Radiological parameters included medial joint space width and tibiofemoral varus angle. Patients were evaluated at six and 12 months postoperatively. The Wilcoxon signed-rank test was used for non-normally distributed variables (VAS and WOMAC), and paired t-tests were used for normally distributed radiological parameters. Statistical significance was set at p<0.05. Results The mean age of participants was 56.90±9.33 years. Significant improvements were observed at 12 months. The mean VAS score decreased from 7.29±1.13 preoperatively to 3.33±1.76 (p<0.001). The mean WOMAC score improved from 75.36±8.68 to 33.60±12.94 (p<0.001). The medial joint space width increased from 2.04±0.39 mm to 3.74±0.46 mm (p<0.001), and the tibiofemoral varus angle improved from 8.44°±2.29° to 4.40°±2.43° (p<0.001). Excellent functional improvement (≥75% reduction in WOMAC score) was achieved in 61.9% of patients. The overall complication rate was 19%, with most complications being minor and transient. Conclusions PFO was associated with significant improvements in pain, functional outcomes, and radiological parameters at 12 months in this cohort, with an acceptable complication profile. These findings suggest that PFO may be a useful joint-preserving option in selected patients with medial compartment knee OA, particularly in resource-limited settings. However, results should be interpreted cautiously due to the single-arm study design and lack of a comparator group.

Cervical cancer is the second commonest cancer among women in Nepal. The objective of the study was to evaluate the quality indicators (QIs) in radiotherapy management of cervical carcinoma and establishment of organizational priorities feasible in our setting. The retrospective study included 83 patients with locally advanced cervical carcinoma who had taken treatment at Bhaktapur Cancer Hospital in 1 year. Participants were selected based on convenience sampling. All 19 QIs in cervical cancer management according to The European Society of Gynecological Oncology (ESGO)/European Society for Radiotherapy and Oncology (ESTRO) were chosen for assessment. These QIs were calculated for all patients and compared with the ESGO/ESTRO standard target. Frequencies and percentages were calculated. Binomial 95% of the rates for QI adherence was also calculated for each QI. Of the 19 QIs, very high adherence rates were observed in QIs associated with brachytherapy like Treatment with brachytherapy boost (97.59%), Imaging for Image guided Adaptive Brachytherapy (100%), and Brachytherapy after the patient has received a total EBRT dose ≥36 Gy (100%). Compliance was good for patients receiving primary chemo-radiotherapy (86.74%) and center treating adequate cases (100%). Very low adherence rates were observed for pretreatment work-up (0%), use of intensity modulated radiotherapy (2.4%), on-board image guided radiotherapy (0%), clinical trial participation (0%), and follow-up program and sexual rehabilitation (0%). Multidisciplinary team meeting discussion of cases (48.19%), use of interstitial brachytherapy when required (12.34%), and EBRT dose of 45 Gy/25 fractions (27.71%) also had a low adherence rate. The study highlighted rates of compliance to cervical radiotherapy QIs in our hospital. Low adherence to various QIs was identified. On the basis of these findings, mitigating strategies could be planned at our center.

Introduction: Kangaroo Mother Care is a cost-effective intervention based on skin-to-skin contact and exclusive breastfeeding that improves survival in preterm and low birth weight infants. Early initiation of Kangaroo Mother Care during respiratory support has shown benefits in stabilizing vital parameters and improving oxygenation. The aim of this study was to find out the effectiveness of early Kangaroo Mother Care during oxygen therapy in preterm neonates. Methods: This was a quasi-experimental study conducted among 62 preterm neonates of less than 37 weeks of gestation who were on assisted respiratory support, admitted in neonatal ward and neonatal intensive care unit of Tribhuvan University Teaching Hospital from May 2023 to March 2024. Ethical approval was obtained from the Institutional Review Board of the Institute of Medicine (Reference no: 545(6-11) E2). The enrolled neonates were alternately assigned to the two groups interventional and conventional care group. Neonates in intervention group were started on KMC while still receiving oxygen therapy while the conventional care group received daily routine care. Data was collected in predesigned performa and was entered in Statistical Package for the Social Sciences version 26. Results: The duration of oxygen therapy was shorter in the Kangaroo Mother Care group than in the conventional group, with a mean difference of 29.30 h (95% CI 45.98 to 12.62; p=0.001). Hospital stay was shorter in the same group (6.47± 2.84 vs 7.55±3.74 days; p=0.215). Complications were also less frequent, and vital parameters improved significantly after one hour of Kangaroo Mother Care. Conclusions: Early Kangaroo Mother Care during oxygen therapy reduces duration of oxygen therapy, hospital stay and neonatal complications along with stabilization of vital parameters.

Unstable peritrochanteric fractures are a major challenge in orthopedic trauma, with high morbidity and mortality, especially among the elderly. Their incidence is rising in Nepal due to an aging population. The Proximal Femoral Nail (PFN) provides stable fixation for these fractures, but data on functional outcomes in resource-limited settings are limited. This prospective study evaluated Harris Hip Score outcomes in patients treated with PFN at a tertiary care center in Nepal. A prospective interventional study was conducted at Karnali Academy of Health Sciences from November 2021 to May 2025. Forty-seven patients with unstable AO/OTA 31-A2 and 31-A3 fractures were treated with PFN and followed for 18 months. The primary outcome was functional recovery measured using the Harris Hip Score (HHS) at scheduled intervals. Statistical analysis was performed using repeated measures ANOVA to assess changes over time and identify predictors of outcome. The mean age of patients was 69.45 ± 11.17 years, with a male predominance (53.2%). The mean HHS improved significantly from 30.57 ± 5.10 at 1 month to73.30 ± 25.97 at 18 months(Wilks' Lambda = 0.636, F = 7.98,p = 0.003). Age and operative time were significant predictors of functional outcome (Age: F=13.02,p=0.001; Operative time: F=11.42,p=0.002). The overall complication rate was 36.1%, with varus collapse observed in 19.1% of patients and screw cutout in 17.0%; however, the presence of these complications did not significantly impact the final functional recovery (p > 0.05). PFN fixation effectively treats unstable peritrochanteric fractures in Nepali patients, showing sustained 18-month improvement, especially for younger patients with shorter operative times, proving successful even in resource-limited settings.

PurposeThe emergence of multidrug-resistant organisms (MDROs) in burn patients poses a significant threat to patient outcomes and healthcare systems, especially in resource-limited settings. Burn injuries compromise the skin barrier and often require invasive interventions, increasing the risk of infection and antimicrobial resistance. This study aimed to determine the prevalence of multi-drug resistance (MDR) and identify the associated risk factors.Patient and MethodsA retrospective study was conducted among burn patients admitted to Nepal Cleft and Burn Center, Kathmandu, from January to December 2023. All culture-positive isolates were assessed to determine the prevalence of MDR and distribution of common pathogens. Sociodemographic and clinical data were evaluated using multivariate logistic regression to identify predictors of MDRO infection.ResultsAmong 535 burn patients, 348 had positive cultures. The prevalence of resistant organisms was 56.82%, comprising MDR (n = 155), Extensively Drug-Resistant (XDR) (n = 147), and Pan-drug Resistant (PDR) (n = 2). The most common Gram-negative isolates were Pseudomonas aeruginosa (29.0%), Klebsiella pneumoniae (18.1%), Citrobacter koseri (17.5%), Acinetobacter baumannii (16.4%), and Escherichia coli (13.8%). Among Gram-positive organisms, Coagulase-negative Staphylococci (15.5%) and MRSA (13.2%) were identified. The use of catheters, nasogastric tubes, and ventilators was significantly higher in MDRO cases. Bloodstream (18.8%), urinary (12.8%), and catheter-related infections (11.2%) were also observed among patients. Intensive Care Unit (ICU) admission [Adjusted Odds Ratio (AOR): 3.047, 95% Confidence Interval (CI): 1.089–8.528; p = 0.034] and nasogastric tube use [AOR: 11.830, CI: 1.339–104.489; p = 0.026] were significant predictors of MDRO infection.ConclusionMDRO infections are highly prevalent (56.82%) in burn patients. ICU stay and use of invasive devices are key risk factors. These findings underscore the importance of antimicrobial stewardship, stringent infection control measures, and routine surveillance for antimicrobial resistance in burn units.

ABSTRACTBackgroundWhile abdominal tuberculosis (ATB) is a great masquerader, it can cause significant morbidity and mortality. We aim to evaluate the presentation and management outcomes of patients with abdominal TB referred to us for surgical management.MethodsThis is a retrospective study of patients with definitive or presumed ATB from January 2010 to July 2022 at a tertiary care hospital in Nepal. The data on clinical presentation, diagnosis, management, and short‐term outcomes were analyzed.ResultsSixty‐six patients with a definitive (25) and presumed (41) diagnosis of ATB were analyzed with a mean age of 32.6 years. Patients presented with moderate to severe anemia (57.1%), intestinal obstruction (53.0%), abdominal lump (30.3%), intestinal bleeding (4.5%), and peritonitis (27.3%) including intestinal perforation (6.1%). A total of 34 (51.5%) patients received surgical management. Intestinal obstruction was a significant risk factor for the need of surgery. Conservative management was successful in 37.1% and 31.3% of patients with intestinal obstruction and peritonitis respectively. Ileum and caecum were the most common sites of intestinal tuberculosis. Bowel resection and stoma were done in 13 (38.2%) and 10 (29.4%) patients respectively. There were 4 (6.1%) overall mortality including two operative mortalities. The common surgical complications were iatrogenic bowel injuries (13.1%), wound infection (32.3%), rectus sheath dehiscence (17.6%), and intra‐abdominal abscess (14.7%). The median hospital stay was 8.5 days.ConclusionSurgical intervention in complicated ATB is associated with high morbidity and mortality. Judicious conservative management in ATB can be tried in selected patients.

Introduction: The requirement for mechanical ventilation is one of the major indications for admission in pediatric intensive care unit. Increased burden of disease, limited availability of pediatric critical care services, and lack of manpower make its use challenging in Nepal. The objective of this study was to determine the clinical characteristics and outcome of children requiring non-invasive and invasive ventilation in our setting. Methods: This is a retrospective study done at Patan Academy of Health Sciences from April 2021 to April 2024. All children from neonates to 15 years of age requiring mechanical ventilation were enrolled. Data analysis was done by JASP 0.18.3.0 version Results: Of 965 admitted children, 413 (43%) required mechanical ventilation and 45% were females. The mean age of patient was 30.1+43.7 months. Of 413 children, initially 101 (24.5%) patients were invasively ventilated and 312 (75.8%) were kept on non-invasive ventilation. The common indications for requirement of mechanical ventilation were respiratory failure in 259 (63%), shock in 64 (15%), low GCS-44 (11%), postoperative care in 41 (10%) and others in 5 (1%). Of 413 children, 302 (73%) survived, 71 (17%) expired. Sepsis with septic shock was the leading cause of death in 22 (31%) patients followed by oncological diseases in 15 (21%). In this cohort, mortality was statistically significant in children &gt;5years (p=0.02) and children requiring inotropes (P&lt;0.001). Conclusion: In this cohort, respiratory cause was most common indication for requirement of mechanical ventilation. Invasively ventilated patients of older age group and requirement of inotropes had poor outcome in our settings.

Ectopic pregnancy is a major cause of maternal morbidity and mortality in the first trimester. Delayed diagnosis often results in rupture, leading to life-threatening complications and adverse fertility outcomes. This study aimed to evaluate the incidence, risk factors, clinical presentation, and management of ectopic pregnancy in a tertiary care center in Nepal. A five-year retrospective observational study was conducted at Nepal Police Hospital, Kathmandu from March 1, 2020, to February 28, 2025. All confirmed cases of ectopic pregnancy were included. Data on socio-demographics, risk factors, clinical features, operative findings, and management were collected from hospital records. Descriptive statistics were applied. Among 1,760 live births, 42 (2.38%) cases of ectopic pregnancy were identified. The mean age of the patients was 29.69±5.41 years, with the majority of cases occurring in women aged 20-35 years. Abdominal pain was the most common presenting symptom, reported in 30 (71.42%) patients. A history of abortion was the leading risk factor, noted in 14 (33.3%) cases. Tubal rupture was observed in 37 (88.09%) patients, and the ampullary region was the most frequent site, involved in 38 (90.47%) cases. All patients underwent surgical management, with laparoscopic unilateral salpingectomy being the most commonly performed procedure in 36 (85.71%) cases. The most common presenting symptom was abdominal pain in patients in the age group of 31-35 years. Most patient presented with ruptured ectopics.

Background: Endoscopic Retrograde Cholangiopancreatography is an essential therapeutic modality for pancreaticobiliary diseases, but its outcomes and complication rates vary across clinical settings. This study assesses indications, success rates, and complications of Endoscopic Retrograde Cholangiopancreatography (ERCP) in a tertiary care center in Nepal. Materials and Methods: A prospective cross-sectional study was conducted at the Department of Gastroenterology, Nobel medical college teaching hospital, from November 2024 to October 2025. All adults undergoing ERCP for therapeutic indications were included. Demographics, indications, procedural details, and complications were recorded. Statistical analysis was performed using SPSS version 26, with chi-square tests applied to assess associations. Results: A total of 151 patients underwent ERCP, with a mean age of 55 ± 16.5 years; females accounted for 63.6%. Choledocholithiasis was the most common indication (76.8%). Selective biliary cannulation was successful in 97.4%, and overall procedural success was 90.7%. Endoscopic sphincterotomy was performed in 88.1% of patients, while 11.9% required precut. Immediate complications occurred in 19.2%, most commonly post-ERCP pancreatitis (5.3%) and bleeding (5.3%). Papilla type showed a statistically significant association with complications (p = 0.006). Conclusion: Most patients underwent ERCP for benign diseases like common bile duct (CBD) stone and benign biliary stricture. Despite extensive research and refinement of this technique ERCP-related complications remain a major issue. The identification of risk factors for ERCP-related complications and implementation of measures that decreases the risk of complications and its prompt identification and treatment are key to ensuring good clinical outcomes.

Introduction and Importance:Wild (mad) honey poisoning is caused by grayanotoxins, naturally occurring neurotoxins found in the nectar of certain Rhododendron species native to mountainous regions of Nepal, India, Bhutan, and Turkey. While typically associated with hypotension and bradycardia, wild honey ingestion may also lead to anaphylactic reactions. This case series presents ten patients who developed varying degrees of toxicity following the ingestion of wild honey.Case Presentation:We describe ten cases that presented to the emergency department with symptoms following wild (mad) honey ingestion. Clinical presentations ranged from mild pruritus, dizziness, and hypotension to life-threatening syncope and airway compromise. All patients underwent immediate evaluation and were managed with atropine, intravenous fluids, antihistamines, steroids, and in select cases, adrenaline and oxygen therapy.Clinical Discussion:Of the 10 patients, 7 were male and 3 female, ranging from 25 to 71 years of age. The onset of symptoms ranged from 10 minutes to 2 hours post-ingestion. Common manifestations included syncope, bradycardia, hypotension, respiratory distress, and generalized burning sensation. All patients recovered fully with symptomatic and supportive management. One patient experienced symptoms lasting up to 72 hours, necessitating intensive care monitoring.Conclusion:Wild (mad) honey poisoning can present with a wide clinical spectrum, including anaphylaxis. High clinical suspicion based on ingestion history is crucial, especially in endemic areas. Early recognition and timely supportive care are essential to ensure full recovery. However, this study is limited by its small sample size, single-center design, reliance on patient-reported ingestion history, and the inability to quantify grayanotoxin levels. Further research is needed to better understand the toxicokinetics and to establish standardized management protocols.

Introduction: Chronic subdural hematoma (cSDH) presents a significant neurosurgical challenge, particularly in elderly patients and those with predisposing factors such as chronic alcohol consumption or coagulopathies. While burr-hole evacuation is the standard surgical technique, alternative approaches exist. The cSDH score, incorporating variables such as age, Glasgow Coma Scale (GCS), hematoma thickness, midline shift, motor function, and orientation, offers a comprehensive assessment tool. This study aims to evaluate the cSDH score's predictive ability for outcomes in chronic SDH patients using the Modified Rankin Scale (mRS) at discharge and after six months. Methods: Patients diagnosed with unilateral chronic subdural hematoma at Tribhuvan University Teaching Hospital between December 2019 and April 2021 were included. Data on cSDH score variables were collected at admission, and outcomes were assessed using mRS at discharge and after six months. Analysis included receiver-operating characteristic (ROC) curve to evaluate discrimination ability and analysis of variance to assess predictive variables. Results: The study comprised 74 patients, with headache being the most common presentation. At discharge, fifty-five patients (74.3%) of patients had favorable outcomes, increasing to fifty-six patients (75.7%) after six months. Analysis indicated associations between preoperative GCS, age, hematoma thickness, midline shift, motor function, orientation, and unfavorable mRS outcomes. ROC analysis demonstrated excellent discrimination ability of the cSDH score, with AUCs of 0.936 at discharge and 0.948 after six months. Conclusion: The cSDH score proves valuable in predicting outcomes for chronic subdural hematoma patients. However, largermulticenter studies are needed to validate the predictive ability of the score in patients with chronic subdural hematoma.

Background: Globally, the elderly population is increasing rapidly. Along with age, cancer and other co-existing medical conditions affect the performance status of the elderly. It plays a key role in treatment decisions and is an independent prognostic indicator. The objective of the study was to assess the performance status of elderly cancer patients attending the Tertiary Cancer Centre in Nepal. Method: A descriptive cross-sectional study was conducted among 100 elderly cancer patients admitted for treatment. Purposive sampling was used, and data were collected via face-to-face interviews. Data were entered and analysed by using SPSS version 20. Descriptive and inferential statistics were calculated. Result: The respondents’ ages ranged from 60 to 82 years, with a mean and standard deviation of 66±5.32. The majority of respondents were in the 60-69 age group. Twenty-five respondents were in stage IV. The majority of respondents have surgery for treatment (71.0%). Pain was the most common (57.0%) side effect experienced by respondents, and performance status was affected by side effects among 66.0%. Co-morbidities were present among 64.0% and among them, 71.0% had hypertension. More than half of the respondents had a good ECOG performance status (51.0%) and were independent in functional status (55.0%). There is a significant association between level of ECOG performance status with age (p-value =0.011), staging (p-value=0.029), and co morbidities (p-value=0.042). Conclusion: The study showed that over half of the respondents had good ECOG scores and were functionally independent, highlighting the need for stronger primary and secondary prevention efforts to support early diagnosis and better performance status.

Purpose: Corneal blindness is a significant cause of vision impairment in Nepal, with corneal scarring emerging as a major contributor despite advances in eye care infrastructure. In Nepal, primary eye care services are mostly provided by allied ophthalmic personnel. This study aims to assess the awareness, attitudes, and practices regarding corneal donation and transplantation among allied ophthalmic personnel in community eye centers under the Tilganga Institute of Ophthalmology. Methods: A questionnaire-based, cross-sectional study was conducted among 44 allied ophthalmic personnel from 19 community eye centers. Data were analyzed using SPSS software. Results: Most respondents (77.3%) understood corneal donation as posthumous, and 97.7% were aware of its benefits for patients with corneal blindness. Regarding age of donors, 56.8% believed all age groups could donate, and 31.8% set an age limit (1–75 years). Although 81.8% pledged to donate their eyes, 66.7% of those unwilling cited religious beliefs. Approximately 72.7% reported they had experience counseling patients regarding corneal donation, but 60% of those who had not, cited lack of training as a barrier. Referrals for corneal transplantation were made by 54.4%, mainly because of corneal scarring. Conclusions: The results of this study reveal a solid foundation of knowledge and practices related to eye donation and transplantation in Nepal but also highlights critical gaps in knowledge and areas for improvement. Efforts to rectify gaps could benefit both Nepal and the 33 countries reliant on corneas from Nepalese donors.