Bir Hospital

Background: Craniopharyngiomas are benign tumor of skull base which often follows an aggressive clinical course. Adamantinomatous subtype are frequently observe in age group 5-15 years. Currently, treatment strategy has relied exclusively on surgery and radiotherapy. Materials and Methods: All pediatric Craniopharyngiomas operated at National Neurosurgical Referral Center, Bir hospital from Nov 2021 to Dec 2023 were included in this study. Results: A total of 17 patients underwent surgical excision of craniopharyngioma. The male to female ratio was 4.6:1. The mean age of the patients was 10.88 ± 4.18 (Range 2 to 16 years). The most common presenting symptoms were headache (64.7%) followed by visual disturbances.12 patients exhibited preoperative hypothalamic pituitary axis dysfunction including central hypothyroidism (35.6%), central diabetes insipidus (29%), growth hormone deficiency (35.6%), adrenocortical insufficiency (23.5%). The Gross total resection was achieved in 6 patients (45%) while subtotal resection was done in remaining 11 patients (55%). Modified Rankin scale score (mRS) on discharge was favorable outcome (mRS 0,1,2,3) in 75% and unfavorable outcome (mRS 4,5) in 19%. There was one mortality. The overall rate of postoperative Diabetes insipidus (DI) was 35.3 % (6/17), visual deterioration (6%), meningitis (11.7%) behavioral disturbances (6%). On 6 month follow up MRI, recurrence was noted in 5 cases, 3(50%) in cases with gross total resection and 2(18.2%) in subtotal resection with adjuvant radiotherapy group. Conclusion: We conclude that Surgical excision of pediatric craniopharyngioma caries a substantial risk of postoperative hypothalamic pituitary dysfunction which significantly impair the quality of life and functional recovery of these patients. A high index suspicion of hypothalamic involvement by tumor and its preservation can improvise patient functional outcome. Postoperative radiotherapy is advised in patient with subtotal resection to improve recurrence free survival.

Introduction: Trigger finger is a common cause of painful digital dysfunction resulting from impaired gliding of the flexor tendon beneath a thickened A1 pulley. Corticosteroid injection is widely used as a first-line intervention for Quinnell Grades II and III trigger finger, but short-term outcomes in Nepalese clinical settings remain limited. This study aimed to evaluate short-term pain reduction and clinical improvement following intralesional injection in these grades. Methods: This prospective observational study was conducted in the Orthopedics Department of a tertiary care center from April 3, 2023, to April 2, 2024. Ethical approval was obtained from the Institutional Review Committee (Ref. No. 245). A convenience sampling technique was used. Each participant presenting with Quinnell Grade II or III trigger finger received a single intralesional injection containing 40 mg of methylprednisolone acetate mixed with 1 ml of 2% lignocaine. Pain was assessed using the Visual Analogue Scale (0–100 mm) at baseline, 1 month, and 3 months. Clinical resolution of triggering and any injection-related complications was systematically recorded. Data were analyzed using Statistical Package for the Social Sciences version 20.0. Visual Analogue Scale scores were analyzed using the paired t-test, Results: The mean baseline Visual Analogue Scale score was 74.50±13.10 mm, which showed a significant reduction to 18.70±16.80 mm at 1 month and further to 13.50±10.50 mm at 3 months (p<0.001). Complete resolution of triggering was achieved in 39 (98%) of the cases. One (2%) patient experienced recurrence and subsequently underwent percutaneous release. A single (2%) case of superficial injection-site infection was recorded, with no major complications reported. Conclusions: Intralesional corticosteroid injection produced marked short-term pain reduction and near-complete symptom resolution in Grade II and III trigger finger, with minimal complications. These findings support its role as an effective and practical first-line treatment in outpatient settings.

Diabetic retinopathy (DR) is one of the most important microvascular complications of diabetes mellitus and remains a major cause of preventable blindness worldwide. Insulin resistance plays a pivotal role in the development of diabetes and its associated complications. The triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance derived from fasting plasma glucose and triglyceride levels, has gained attention as a simple and practical metabolic marker. However, data linking the TyG index with diabetic retinopathy, particularly in South Asian populations, are still limited. A hospital-based cross-sectional study was conducted at Bir Hospital, Kathmandu, Nepal, between April 2023 and October 2024. Adult patients with diabetes mellitus, excluding those with gestational diabetes, acute illness, non-diabetic causes of hypertriglyceridaemia, conditions affecting lipid or glucose metabolism, prior retinal interventions, or non-diabetic retinal diseases, underwent comprehensive clinical, biochemical, and ophthalmic evaluations. The triglyceride-glucose (TyG) index was calculated as ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL) / 2], and participants were categorized into quartiles. Diabetic retinopathy was graded using internationally accepted clinical severity scales. Associations were assessed using univariate and multivariate logistic regression, and ROC curve analysis evaluated the discriminatory performance of the TyG index. Among 83 patients with diabetes mellitus (median age 56 years [IQR 48.5-64], 50.6% male, median diabetes duration 6 years [IQR 3-12]), the median triglyceride-glucose (TyG) index was 9.98 (IQR 9.485-10.445). Diabetic retinopathy (DR) prevalence was 48.2%, increasing across TyG quartiles from 9.5% in Q1 to 85.7% in Q4 (p < 0.001), with a significant trend in DR severity (p < 0.001). TyG correlated moderately with HbA1c (Spearman r = 0.54, p < 0.001). In multivariable logistic regression adjusted for age, total cholesterol, and HDL, the odds ratio for DR per standard deviation increase in TyG was 4.00 (95% CI 1.75-9.16, p = 0.001); for Q4 vs. Q1, 24.15 (95% CI 3.15-185, p = 0.002). Findings were robust in sensitivity analyses excluding insulin users (OR 4.35, 95% CI 1.40-13.5, p = 0.011) and outliers (OR 3.80, 95% CI 1.60-9.00, p = 0.002), and stratified by diabetes duration (≥ 5 years: OR 5.20, 95% CI 1.80-15.0, p = 0.002) and sex (males: OR 3.80, 95% CI 1.20-12.0, p = 0.023; females: OR 4.50, 95% CI 1.30-15.5, p = 0.017). TyG predicted DR with an area under the ROC curve of 0.83 (95% CI 0.75-0.91), comparable to HbA1c (0.77, DeLong p = 0.29); optimal cutoff 9.78 (sensitivity 88%, specificity 67%). A higher triglyceride-glucose index was strongly associated with both the presence and severity of diabetic retinopathy. Given its simplicity and reliance on routinely available laboratory parameters, the TyG index may be a useful marker for identifying diabetic patients at increased risk of retinopathy, particularly in resource-limited settings. Not applicable. This was a cross-sectional observational study and did not involve a clinical trial requiring registration.

The proliferation of augmented reality (AR) filters on TikTok has introduced a hyper-idealized and often racialized standard of beauty. In Indonesia, where post-colonial ideals of whiteness persist, the algorithmic enforcement of light skin tones may exacerbate body dysmorphia. This study investigates the correlation between TikTok beauty filter usage and the intention to engage in skin bleaching practices, examining self-esteem as a mediating mechanism. A quantitative cross-sectional study was conducted using a stratified purposive sampling technique across five major provinces in Indonesia (n = 1,452 adolescent girls, aged 13–19). Participants completed an online survey measuring TikTok Filter Usage Intensity (TFUI), the Rosenberg Self-Esteem Scale (RSES), and the Skin Bleaching Intentions and Practices Scale (SBIPS). Data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM), incorporating Exploratory Factor Analysis (EFA) and Full Collinearity Assessment for Common Method Bias. High-intensity filter usage was significantly associated with lower self-esteem (beta = -0.42, p &lt; 0.001) and higher skin bleaching intentions (beta = 0.38, p &lt; 0.001). Self-esteem partially mediated the relationship between filter usage and bleaching practices (Variance Accounted For = 25.7%). The model demonstrated high predictive relevance (Q-square = 0.312) and explained 58.2% of the variance in skin bleaching intentions (R-square = 0.582). In conclusion, TikTok’s algorithmic filters serve as a significant predictor of chemical body modification behaviors. The digital whitening provided by filters creates a psychological gap, driving the consumption of skin-lightening products.

Emanuel Syndrome Presenting with Respiratory Distress and Feeding Difficulties in an Infant: A case Report from NepalSurabhi Aryal1 , Krishna Kumar Maharjan1 , Sajjad Ahmed Khan2 , Dikshya Devkota3 , Aakash Khatiwada2, Prajita Baral2, Huma Kausar41Dep

ABSTRACTPruritic erythroderma is not always psoriasis. Resistant cases require a broad evaluation for cutaneous lymphoma. Early, timely diagnosis prevents disease progression, improves outcomes, and enhances quality of life, highlighting the need for re‐evaluation when conventional treatments fail.

Background: Hypertension is a leading modifiable risk factor for cardiovascular morbidity and mortality worldwide. In Nepal, prevalence is rising, yet determinants of blood pressure (BP) control remain insufficiently understood. This study examined socio-demographic, lifestyle, and clinical factors associated with BP control among hypertensive patients attending a tertiary hospital. Methods: A descriptive cross-sectional study was conducted at the cardiology outpatient department of Bir Hospital, Kathmandu, between July and August 2018. A total of 360 hypertensive patients, aged ≥18 years with at least one year since diagnosis, were recruited using convenience sampling. Data on socio-demographics, hypertension knowledge, and lifestyle practices were collected using a validated bilingual questionnaire. BP was measured twice, and control was defined as &lt;140/90 mmHg. Logistic regression was applied to identify independent predictors of BP control. Results: The mean age of participants was 50.8 ± 15.3 years; 59.4% were female, 52.5% resided in rural areas, and 48.9% lived in joint families. Overall, 21.9% (79/360) of participants achieved BP control, while 78.1% (281/360) were uncontrolled. Logistic regression showed that rural residence (OR 0.47, 95% CI 0.27–0.84, p = 0.012), alcohol use (OR 0.28, 95% CI 0.13–0.58, p = 0.001), and family history of hypertension (OR 0.50, 95% CI 0.28–0.89, p = 0.021) were associated with poorer control. Conversely, joint family structure (OR 1.51, 95% CI 1.10–2.08, p = 0.011) and reported normal salt intake (~5 g/day) (OR 7.69, 95% CI 2.68–22.0, p &lt; 0.001) were positively associated with BP control. Conclusion: Socio-demographic and lifestyle factors strongly influence BP control in Nepal. Strengthening rural outreach, promoting family-based interventions, and delivering culturally appropriate counseling on alcohol reduction and dietary salt are essential. Future community-based longitudinal studies are recommended to validate these findings and inform national strategies.