Chitwan Medical College

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:Postpartum psychosis (PPP) is a psychiatric emergency with symptoms such as mania, depression, hallucinations, and delusions appearing shortly after childbirth. Neurocysticercosis (NCC), a CNS infection from Taenia solium, can also manifest psychiatric symptoms, complicating diagnosis. This report discusses a rare case of NCC presenting as PPP, emphasizing diagnostic complexities and the need for a multidisciplinary approach.Case presentation:A 23-year-old female presented with psychotic symptoms 15 days postpartum, initially treated for PPP with lorazepam, olanzapine, and haloperidol. Following the development of generalized seizures, neuroimaging revealed NCC lesions. Treatment with albendazole and steroids led to symptom resolution.Discussion:This case highlights NCC’s rare presentation as PPP. A thorough evaluation is crucial, as PPP poses risks to both mother and infant. In regions where NCC is endemic, psychiatric presentations due to this infection create diagnostic challenges, especially in limited-resource settings. Neuroimaging is vital for precise diagnosis, and early intervention with a multidisciplinary team enhances outcomes.Conclusion:The case underscores the complexity of PPP diagnosis and management when coexisting with NCC. Clinicians in endemic regions should consider NCC in postpartum women with atypical psychiatric symptoms, ensuring appropriate investigations. A multidisciplinary approach involving psychiatry, neurology, and radiology is essential for effective management.

Background: Junk food is high in calories but low in essential nutrients, posing a health risk particularly during adolescence. Many low and middle income countries, like Nepal, are experiencing a nutritional shift along with a rising consumption of junk food among school-aged adolescents. Despite its known health risks, junk food remains popular among adolescent school students. This study aims to determine the prevalence of junk food, its consumption patterns and associated factors, among secondary school students of Banganga, Nepal. Methods: A school-based descriptive cross-sectional study was conducted among 270 secondary school students in Banganga municipality ward number 2, selected using stratified random sampling. Data were collected via a self-administrated structured questionnaire. Bivariate and multivariate logistic regression analyses were done using IBM-SPSS version 20. Results: The prevalence of junk food consumption among secondary school students was 74.4%. Fast food was the most consumed category (74.13%) and the most frequently consumed items were biscuit, chocolate, coke and chowmein. Sex, grade, father‘s occupation, living status and parent‘s habit of junk food consumption were significantly associated with junk food consumption at 95% of confidence interval. Conclusion: The high prevalence of junk food consumption among adolescents highlights an urgent need for collaborative efforts between parents, school administrations and other relevant stakeholders to promote healthier food options in school cafeterias and encourage homemade, nutritious foods.

ABSTRACTMoth‐eaten pattern of alopecia can be seen in various dermatological conditions, including lichen planopilaris (LPP). Clinical, trichoscopic, and histopathology correlation can give a clue to the etiology of moth‐eaten pattern of alopecia. Since alopecia in LPP is permanent, early recognition and treatment are necessary to prevent progression of scarring.

Australia's nursing workforce is under intensifying strain, yet an increasing subset of registered nurses (RNs) are not seeking permanence-they are choosing to work exclusively through agencies. This trend is commonly framed as a matter of flexibility or pay. However, such explanations understate what exclusive agency nursing does to professional identity, how it operates as a response to organizational dysfunction, and how policy-practice arrangements enable transient careers within a regulated high-income system. To generate an interpretive, policy-relevant account of how exclusive casual agency employment shapes nurses' professional identities, motivations, career trajectories, and engagement with collective professional advocacy. An interpretivist, constructionist qualitative design was employed. Semistructured interviews were conducted with 16 Melbourne-based RNs who worked exclusively through nursing agencies. Data were analyzed using reflexive thematic analysis (RTA), and the manuscript was reported in line with the Reflexive Thematic Analysis Reporting Guidelines (RTARG). Five themes were constructed. Exclusive agency nursing involved the crafting of a professional self "beyond the ward," marked by transactional workplace relationships, strategic emotional boundary-setting, and a shift toward adaptability as a core competence. Agency work was frequently narrated as strategic withdrawal and resistance to permanent-role conditions-bureaucratic overload, inflexible rostering, and unsupportive leadership cultures associated with burnout. Participants situated their careers within a "casualization ecosystem" in which organizational reliance on contingent labor, agency intermediation, and policy/funding dynamics collectively sustain demand for agency nurses. Yet, this work model generated persistent ambivalence about long-term sustainability and was perceived to fragment professional belonging and weaken collective voice in advocacy and industrial representation. Exclusive agency nursing is not simply an individual preference for flexibility; it is an identity project and a system-level signal of deteriorating employment conditions in permanent roles. Workforce responses that focus only on recruitment incentives or short-term staffing solutions risk entrenching casualization and its downstream effects. Nurse leaders should treat agency reliance as both a staffing strategy and an organizational diagnostic. Reforming permanent roles requires actionable changes-credible roster flexibility, visible supportive leadership, and working conditions that reduce burnout-alongside structured integration practices for agency nurses to protect team cohesion, care continuity, and professional sustainability.

The purpose of this systematic review was to evaluate the association between the timing of solid food introduction during infancy and the risk of childhood obesity. The review specifically examined whether early introduction (before four months of age) is linked with increased risk of overweight or obesity in childhood. We conducted a systematic search of five major databases (PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, and Google Scholar) from inception to January 15, 2025. Eligible studies included observational cohort, cross-sectional, quasi-experimental, and case-control studies that assessed the relationship between the timing of solid food introduction and childhood obesity outcomes. Two independent reviewers screened articles, extracted data, and assessed study quality using appropriate tools (ROBINS-I tool (Risk Of Bias In Non-randomized Studies of Interventions), AXIS, or the Newcastle-Ottawa Scale (NOS). Due to heterogeneity in study design, population, and outcome definitions, a narrative synthesis was conducted instead of meta-analysis. Seventeen studies met the inclusion criteria out of 1,402 screened records. Most studies found that the introduction of solid foods before four months of age was associated with increased risk of childhood obesity or higher BMI z-scores. This association was more prominent in formula-fed infants. However, variation in study design, exposure classification, and measurement outcomes limited comparability. Risk of bias across studies ranged from moderate to serious, primarily due to confounding and reliance on parental recall. Early introduction of solid foods (before four months) appears to be associated with increased childhood obesity risk, particularly in the absence of breastfeeding. Nevertheless, due to variability and methodological limitations across studies, findings should be interpreted with caution. Further high-quality prospective studies using standardized outcome measures are warranted. The review protocol is registered in PROSPERO (CRD42025640375).

A 72-year-old farmer presented with pruritic symmetrical hyperkeratotic scaly plaques on the plantar and medial aspect of the foot for 6 months (Figure 1). The patient denied any lesions in other areas of the body. Scalp, knees, elbows, and nails were normal on examination. The differential diagnosis considered was chronic plaque psoriasis, eczema, and tinea pedis. A Potassium Hydroxide mount was prepared from the skin scrapings, which showed septate, branching, long, narrow hyphae on light microscopy (Figure 2). A diagnosis of hyperkeratotic tinea pedis was made. Oral itraconazole, topical luliconazole lotion, and keratolytics were prescribed to the patient for 1 month. Hyperkeratotic tinea pedis is the second most common form of tinea pedis, characterized by chronic hyperkeratotic scaly plaques with varying erythema of the foot. Hyperkeratotic tinea pedis is often asymptomatic, and resistant to treatment, further distinguishing it from other forms [1]. Hyperkeratinization in tinea pedis is associated with increased expression of pro-inflammatory keratins (K6, K16, K17), dysregulation of basal keratins (K5 and K14), and downregulation of K10 [2]. Recognizing hyperkeratotic tinea pedis is important, as it often mimics psoriasis, or eczema [1]. Early identification ensures timely antifungal therapy and reduces the risk of recurrence and transmission [3]. Sunil Jaiswal: conceptualisation (lead), writing original draft (lead), writing review and editing (lead). Shraddha Uprety: investigation (lead), writing original draft (lead), methodology (lead). Pratichya Thapa: conceptualisation (lead), methodology (lead). Aditi Joshi: investigation (equal), methodology (equal), Prakriti Lamichhane: methodology (lead), conceptualization (supporting). The authors received no specific funding for this work. Patient in this manuscript have given written informed consent for participation in the study and the use of their de-identified, anonymized, aggregated data and their case details (including photographs) for publication. Ethical Approval: not Applicable. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.

ABSTRACTDrug‐Induced Liver Injury (DILI) is a rare but potentially serious adverse effect of many commonly used medications. DILI is a diagnosis of exclusion and requires a high index of suspicion. Amoxicillin‐Clavulanate (A‐C) is a widely prescribed antibiotic known to be one of the leading causes of idiosyncratic DILI. Though well documented in Western countries, cases of DILI are less frequently reported in our region. The usual onset of DILI varies from a few days to 8 weeks after initiation of medication. Here, we report a case of an atypically rapid onset of amoxicillin–clavulanate induced liver injury in a 32‐year‐old female following just two doses.

Background:Unsafe abortion is a major contributor to maternal mortality in low- and middle-income countries. Despite the legalization of abortion and expanded access to services in Nepal, data on abortion practices and patient satisfaction remain limited.Objective:This study aimed to assess abortion methods, their management, and patient satisfaction among women seeking safe abortion services at a tertiary care hospital in Kathmandu, Nepal.Design:A hospital-based cross-sectional study.Methods:The study was conducted from December 2023 to May 2024 among 285 women aged ⩾18 years with gestational age of up to 12 weeks. Data were collected through face-to-face interviews and clinical records, followed by 7-day post-abortion assessment via in-person visits or phone calls. Pearson’s chi-square test and binary logistic regression were performed at a 5% level of significance to identify factor associated with patient satisfaction.Result:Among 285 women, 76.8% underwent medical abortion with oral mifepristone followed by misoprostol via sublingual, buccal, or vaginal routes, while 23.2% received surgical abortion through vacuum aspiration after misoprostol pre-treatment and local anesthesia. Discharge medications commonly included analgesics (paracetamol and ibuprofen) and antibiotics (ciprofloxacin, and metronidazole). Post-abortion contraceptive uptake was 79.3%, with implants (28.8%) and condoms (28.4%) being the most chosen methods. Overall, 50.2% of women reported satisfaction with the abortion services received. Logistic regression analysis showed that higher education (AOR: 5.63; 95% CI: 2.40-13.16), extended family structure (AOR: 7.25; 95% CI: 3.11-16.91), and no history of live birth (AOR: 4.20; 95% CI: 1.48-11.93) were significantly associated with higher satisfaction, while age ⩾35 years was negatively associated (AOR: 0.52; 95% CI: 0.28-0.95).Conclusion:Medical abortion was the preferred method, and overall management was aligned with WHO guidelines. However, patient satisfaction was moderate. Improving infrastructure, ensuring privacy, reducing waiting times, enhancing post-abortion counseling, and providing tailored health education with regular service evaluations are needed to improve the quality of abortion care and patient satisfaction.