Karnali Academy of Health Sciences

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.

Introduction: Induction of labor (IOL) is a common obstetric procedure aimed at achieving vaginal delivery. Traditionally Induction is reserved for low-risk pregnancies at 41 weeks but as there is increasing complications associated with increasing gestational age; emerging evidence suggests benefits of earlier induction at around 39 weeks. This prospective study evaluates whether IOL at different term gestational age would affect perinatal outcome that would help to optimize timing of induction. Method: Conducted at Patan Academy of Health Sciences, 279 obstetric patients were induced after 38 weeks gestation over a three-month period. Patients with medical complications requiring distinct protocols were excluded. Induction and labor monitoring was performed as per hospital protocol. Outcomes assessed were mode of delivery, indications of Cesarean section, presence of meconium-stained liquor and Neonatal admission. Result: Among 279 induced women, 52.68% achieved vaginal delivery, remaining had cesarean section (CS) which was higher in primigravida. CS rate decreased significantly with advancing gestational age from 56.06% at 38–39 weeks to 15.90% at >40 weeks. The failed induction was more common at 38-39 weeks of gestation (28.78%) whereas MSL was more frequent among >39 weeks group (16.67%) requiring emergency CS. Neonatal admissions to nursery were higher in 39–40 weeks group but NICU admissions were seen only among >40 weeks group. There was no neonatal death or intrapartum stillbirth among induced patient however two inductions were done for antenatal IUFD that occurred after 40 weeks of gestation who had no known risk factors. Conclusion: Induction at 39–40 weeks achieves a favorable balance by reducing cesarean section rate and maintaining optimal neonatal outcome. These findings support tailored timing of labor induction to optimize perinatal outcomes.

Diabetic cystopathy can appear early in young adults with type 1 diabetes and may progress rapidly, making timely urodynamic evaluation essential to prevent irreversible bladder and renal damage. Clinicians should consider cystopathy in young diabetic patients presenting with lower urinary tract symptoms, even when infection is not present.

Nepal’s health policy landscape has shifted from a centralized, curative model to a more preventive, equitable, and decentralized system. Since the first National Health Policy in 1991, subsequent reforms in 1997, 2014, and 2019 have aimed to expand access, strengthen institutional capacity, and align the health sector with global commitments such as the Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC). The National Health Policy 2019 (NHP 2019) represents the most recent and comprehensive effort to advance Primary Health Care (PHC) within a federal governance structure and further reinforce these national and global priorities. This review critically examines NHP 2019 through document analysis of government policies, implementation reports, and peer-reviewed literature; comparative policy review against earlier national policies and regional standards; and evaluation using the WHO health system building blocks framework. NHP 2019 strengthens PHC by expanding health insurance, integrating federal-provincial-local roles, and promoting digital health and essential public health services. Implementation evidence shows progress in decentralization and community-level service delivery. However, major gaps persist, including inequitable financing, rural workforce shortages, weak health information systems, inadequate coordination across government tiers, and limited inclusion of marginalized groups and traditional health practices. NHP 2019 is conceptually strong but faces operational challenges. Its success depends on sustained financing, evidence-driven governance, improved intergovernmental coordination, and equitable workforce and resource allocation. Strengthening monitoring systems and integrating community and traditional health practices are critical for achieving the policy’s vision of healthier and more informed citizens and for guiding decision-makers in advancing PHC-oriented reforms.

Abstract Background Tracheostomy is commonly performed to maintain airway patency or to provide prolonged ventilatory support in elective and emergency settings. Although it offers substantial benefits, tracheostomy may be associated with early and late complications. Fracture and migration of a tracheostomy tube are exceptionally rare, with an incidence of less than 1 in 1000 cases. Such events can lead to life-threatening airway obstruction and present significant anesthetic and airway management challenges during retrieval. Case Presentation We report a 27-year-old male with a tracheostomy placed 18 years ago for prolonged ventilation after a road accident. He had used the same metallic tube without replacement or follow-up. Presenting with mild cough, blood-tinged sputum, and chest tightness, imaging revealed a metallic foreign body in the right main bronchus. Emergency rigid bronchoscopy under general anesthesia allowed successful retrieval of the fractured inner tube through the tracheostomy stoma. Recovery was uneventful. Literature review identified 16 similar case reports of fractured tracheostomy tubes. Both spontaneous and controlled ventilation techniques were used in these cases, emphasizing that anesthetic management should be individualized based on patient stability, airway conditions, and procedural requirements. Conclusions Fracture and migration of metallic tracheostomy tubes are rare but potentially life-threatening. Regular follow-up and timely tube replacement are vital for prevention. Effective management requires coordinated teamwork, careful anesthetic planning, and flexibility in ventilation strategies to ensure safety and good outcomes.

Wearable, rectifiable aerosol photometers (WRAPs), instruments with combined nephelometer and on-board filter-based sampling capabilities, generally show strong correlations with reference instruments across a range of ambient and household PM2.5 concentrations. However, limited data exist on their performance when challenged by mixed aerosol exposures, such as those found in dusty occupational environments. Understanding how these instruments perform across a spectrum of environments is critical, as they are increasingly used in human health studies, including those in which concurrent PM2.5 and coarse dust exposures occur simultaneously. The authors collected co-located, ~24 h. breathing zone gravimetric and nephelometer PM2.5 measures using the MicroPEM v3.2A (RTI International) and the UPAS v2.1 PLUS (Access Sensor Technologies). Samples were collected from adult brick workers (n = 93) in Nepal during work and non-work activities. Median gravimetric/arithmetic mean (AM) PM2.5 concentrations for the MicroPEM and UPAS were 207.06 (interquartile range [IQR]: 216.24) and 737.74 (IQR: 1399.98) µg/m3, respectively (p < 0.0001), with a concordance correlation coefficient (CCC) of 0.26. The median stabilized inverse probability-weighted nephelometer PM2.5 concentrations, after gravimetric correction, for the MicroPEM and UPAS were 169.16 (IQR: 204.98) and 594.08 (IQR: 1001.00) µg/m3, respectively (p-value < 0.0001), with a CCC of 0.31. Digital microscope photos and electron micrographs of filters confirmed large particle breakthrough for both instruments. A possible explanation is that the miniaturized pre-separators were overwhelmed by high dust exposures. This study was unique in that it evaluated personal PM2.5 monitors in a high dust occupational environment using both gravimetric and nephelometer-based measures. Our findings suggest that WRAPs may substantially overestimate personal PM2.5 exposures in environments with concurrently high PM2.5 and coarse dust levels, likely due to large particle breakthrough. This overestimation may obscure associations between exposures and health outcomes. For personal PM2.5 monitoring in dusty environments, the authors recommend traditional pump and cyclone or impaction-based sampling methods in the interim while miniaturized pre-separators for WRAPs are designed and validated for use in high dust environments.

This viewpoint article is a personal narrative of a generalized anxiety disorder (GAD) experience, reflecting the lived reality of denial, awareness, and acceptance of mental illness. It emphasizes early intervention, breaking down stigma, and that recovery is not a linear process. The story brings to life how invisible mental illness can feel, how hard it is to put a name to the struggle, and how therapy and support can slowly bring a sense of hope and healing. It also encourages free dialogue on mental health to foster compassion and reduce stigma. With the use of personal experience and global definitions of mental health, the article focuses on the fact that anxiety struggles are real, valid, and require attention. These reflections are meant to remind anyone walking a similar path to trust their healing, however slow or uneven it may feel. They are also an invitation to open up conversations about mental health, so that it becomes something we discuss with honesty and compassion, rather than silence and stigma.

Introduction: Children constitute the most vulnerable group of any community. Their nutritional status is a sensitive indicator of community health and nutrition. Malnutrition is a very common problem in children under five years of age in Nepal and is a significant contributor to mortality and morbidity accounting for more than half of all child deaths. This study was done to assess the burden of malnutrition and associated factors among children aged 6-59 months. Methods: This was a hospital based cross-sectional study, conducted from June 2022 to May 2023 at the Pediatrics OPD of Karnali Academy of Health Sciences (KAHS), Jumla. A total of 164 children were enrolled for this study. Anthropometric measurements were used as per WHO guidelines to asses three nutritional status: Underweight, stunting, and wasting using descriptive statistics and chi square test were applied using SPSS 16 to assess social and predisposing factors. All the data were recorded in the preformed proforma. It was then, analyzed with the help of SPSS version 16. p-value< 0.05 was considered statistically significant. Results: Prevalence of stunting, wasting, and underweight were 38.4%, 39.1%, and 39.7% respectively. The prevalence of stunting and underweight was seen more in males than in females whereas wasting was very similar in both sexes. Conclusions: The findings showed that there is high prevalence of malnutrition in Jumla, so monitoring of nutrition status in children should be taken seriously and needs to be addressed.