Nepalese Army Institute of Health Services

One of the major components of state power is the national army, which is the center of the institutions of all modern polities. The necessity and circumstance shaped the Nepali Army as it pursued modernization, making significant advances during the premiership of Jung Bahadur Rana. This qualitative research work relies on the evidence presented in the historical books, scholarly journals and research articles which are supported with the archival documents of Nepali Army Library. It analyzes the reformation projects of Jung Bahadur concerning the organization, recruitment, training and discipline, manufacturing of arms, infrastructure and administration with references to the military history of Nepal. His policies transformed the army into a centralized institution as it had been a feudal tradition. It strengthened the national defense and concentrated the political power of the country in the nineteenth century Nepal. It ensured internal stability and improved the foreign policy of Nepal. This paper presents the reforms of Jung Bahadur in terms of the modernization theory, and how the process of military modernization helped in strengthening the state and the development of the Nepal’s national identity and strategic independence.

The rapid advancement of Artificial Intelligence (AI) has fundamentally reshaped contemporary security systems, leading to significant improvements in surveillance, threat detection, and incident response across both physical and digital domains. By leveraging machine learning algorithms, neural networks, and predictive analytics, AI enhances the speed and precision of security operations while reducing human error and reliance on purely manual decision-making. In physical security contexts, AI-driven systems analyze real-time video feeds to detect anomalous behavior, identify individuals, and track suspicious movements with high accuracy. In digital security, AI supports malware detection, network intrusion prevention, and phishing mitigation through continuous learning from evolving threat patterns. Moreover, the integration of AI with big data analytics enables comprehensive risk assessment by processing large volumes of heterogeneous data, thereby facilitating early threat identification and proactive mitigation. Natural language processing techniques further contribute by detecting potential insider threats through the analysis of communication patterns and textual data. This paper adopts a qualitative, literature-based methodology grounded in thematic analysis. This paper draws on secondary data obtained from peer-reviewed journal articles, policy reports, and authoritative industry publications related to AI applications in security systems. The analysis synthesizes existing scholarship to identify dominant trends, operational benefits, and critical challenges associated with AI-driven security frameworks.The central objective of this paper is to examine how AI is transforming modern security systems while critically assessing the ethical, legal, and governance challenges that accompany its adoption. The findings indicate that although AI significantly enhances efficiency, predictive capability, and system resilience, persistent concerns related to data privacy, algorithmic bias, transparency, and over-reliance on automated decision-making continue to pose serious risks. This paper underscores the necessity of robust regulatory frameworks, transparent AI decision processes, and sustained human oversight to ensure responsible and trustworthy AI deployment. Ultimately, the paper argues that AI should be viewed not as a replacement for human judgment, but as an augmentative tool that strengthens security systems when embedded within ethical, legal, and organizational safeguards.

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.

Introduction: Variations in facial skeletal morphology can influence electromyographic activity in masticatory, neck, and trunk muscles. While Twin Block Appliance therapy has been shown to alter the neuromuscular pattern of the masseter and temporalis muscles, there is a lack of literature on its effects on neck muscles and postural changes in the mandible. This study aims to assess the electromyographic activity of neck muscles before and after Twin Block Appliance therapy in growing patients with Class II malocclusion and hyper-divergent growth patterns. Methods: A study was conducted on 15 growing patients (aged 9-14 years) diagnosed with skeletal Class II malocclusion and hyper-divergent growth patterns, who were undergoing Twin Block Appliance therapy. Bilateral electromyographic activity of the Sternocleidomastoid and Trapezius muscles was recorded using bipolar surface electrodes. Measurements were taken during postural rest position, maximum voluntary clenching, and neck movements at the initiation of treatment and subsequently at 1, 3, 6, and 9 months of Twin Block Appliance therapy. Results: The changes in electromyographic activity of neck muscles were assessed using analysis of variance and a paired t-test. During the postural rest position and neck movement, the electromyographic activity of the Sternocleidomastoid and Trapezius muscles showed a tendency to decrease from baseline to the end of treatment; however, these changes were not statistically significant. Additionally, there was a non-significant increase in neck muscle electromyographic activity during maximum voluntary clenching. Conclusion: Twin Block Appliance therapy does not significantly impact electromyographic activity of the Sternocleidomastoid and Trapezius muscles in patients with hyper-divergent Class II malocclusion.

Background: Depression is one of the common psychiatric comorbidity in individuals with epilepsy and is associated with poor quality of life, increased suicidal ideation, social handicaps and increased morbidity. Epilepsy is a highly stigmatized condition even today leading to discrimination and marginalization with significant social limitations. The objective of the present study was to determine the prevalence of depression and perceived stigma in individuals with epilepsy along with identification of factors associated with it. Methods: The study employed a descriptive cross-sectional observational design and was conducted among patients with epilepsy attending the Psychiatry and Internal Medicine outpatient departments (OPDs) of Devdaha Medical College over a 6-month period, from 1st Jan 2025 to 31st June 2025. Ethical approval was obtained from the Institutional Review Committee of the same institute (approval number: 23/2024). A convenience sampling technique was utilized. The Epilepsy Stigma Scale was administered to assess perceived stigma. Point estimates were calculated with a 95% Confidence Interval. Results: Out of 195 total participants, 102 (52.2%) were males. The median age was 32 years. Depression was present in 92 (48.2%) patients, most of them had moderate depresssion (84.23%). Perceived stigma was present in 129(66.2%) patients with epilepsy according to epilepsy stigma scale where mean score was 4.83±2.07. Using the Chi-square test, significant associations were found between depression and several variables including gender, type of family, family income, occupation, duration of epilepsy, and perceived stigma (p < 0.05). Conclusion: The prevalence of depression was almost half among individuals with epilepsy, and more than two-thirds experienced perceived stigma. These findings indicate the need to integrate mental health screening and support into epilepsy care in Nepal.

IntroductionPercutaneous nephrolithotomy (PCNL) is the standard practice for the treatment of large renal stones. There has been a gradual shift from “standard” PCNL to increasingly less invasive forms of PCNL in recent years. Innovations in both the technology and techniques of PCNL continue to improve the safety and efficacy of renal stone surgery. Total tubeless mini-PCNL (TTmPCNL) is a minimally invasive form of PCNL where the risks and benefits are still under evaluation. The aim of this study was to assess the safety and efficacy of TTmPCNL.MethodsThis observational study was conducted in the Urology unit, Department of Surgery, Nepalese Army Institute of Health Sciences (NAIHS), from January 2025 to May 2025. All patients fulfilling the inclusion criteria (stone size 10–30 mm, no urinary tract infection, age ≥ 18 years) underwent prone TTmPCNL utilising pneumatic lithotripsy under fluoroscope guidance were enrolled in the study. Follow-up was performed to determine the stone-free rate (SFR), incidence of postoperative complications, and length of hospital stay.ResultsA total of 44 TTmPCNL procedures were performed in patients aged 45.1 ± 13 years (mean ± standard deviation (SD)). The size of the renal stone was 19.7 ± 4.9 mm (mean ± SD). Stone complexity burden was assessed using Guy’s stone scoring system (GSS). The postoperative decrease in haemoglobin was 1.32 ± 0.47 gm/dl (mean ± SD), the postoperative complication rate was 15.9%, and the SFR was 95.5%. The length of hospital stay was 1.5 ± 0.6 (mean ± SD) days. Significant differences in the stone-free rate (p = 0.02) and incidence of postoperative complications (0.008) were noted among different GSS groups.ConclusionTTmPCNL is a safe and effective surgical treatment option for the treatment of carefully selected renal stone disease, with an acceptable complication rate, short hospital stays, and high SFR.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12894-025-01934-0.

Stroke-Like Migraine Attacks After Radiation Therapy (SMART) Syndrome: A Case Report and Review of a Rare Delayed Complication of Cranial IrradiationShiv Jha 1, Yugant Khand 2, Surabhi Ranjan 3, Monika Pandit 4, Eric Mariuma 1Department of Neurology,

Obesity in non-diabetic adults remains a significant clinical challenge, prompting the need for effective pharmacological therapies that achieve meaningful weight loss with acceptable tolerability. Semaglutide, a selective glucagon-like peptide-1 (GLP-1) receptor agonist, and tirzepatide, a dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist, have shown promise in recent trials. However, direct comparisons across their dose ranges are lacking.This systematic network meta-analysis (NMA) compared multiple doses of tirzepatide (5 mg, 10 mg, 15 mg, and maximum tolerated dose (MTD)) and semaglutide (2.4 mg and MTD) versus placebo in non-diabetic adults with obesity. Eight randomized controlled trials comprising 7,179 participants were included. The primary outcome was the percentage change in body weight. Secondary outcomes included changes in waist circumference, the proportion achieving ≥15% weight loss, and safety outcomes such as discontinuation due to adverse events and gastrointestinal side effects. A random-effects model was used for all analyses, and small-study effects were assessed using comparison-adjusted funnel plots and Egger-type regression.All active interventions resulted in significantly greater weight loss compared to placebo. Tirzepatide MTD demonstrated the greatest effect (mean difference (MD): −20.90%; 95% confidence interval (CI): −24.93 to −16.87), followed by tirzepatide 15 mg (MD: −18.08%; 95% CI: −20.38 to −15.78), tirzepatide 10 mg (MD: −14.93%; 95% CI: −17.23 to −12.63), semaglutide MTD (MD: −14.40%; 95% CI: −19.82 to −8.98), semaglutide 2.4 mg (MD: −11.78%; 95% CI: −13.91 to −9.64), and tirzepatide 5 mg (MD: −11.49%; 95% CI: −14.65 to −8.34). Similar dose-dependent effects were observed for waist circumference and the likelihood of achieving ≥15% weight loss. The certainty of evidence for this ≥15% weight loss outcome, assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework applied to our NMA estimate threshold, was high for most interventions, except moderate for semaglutide MTD and tirzepatide 5 mg. The highest odds of treatment discontinuation due to adverse events were observed with semaglutide MTD (odds ratio (OR): 7.36; 95% CI: 2.56 to 21.15) and tirzepatide MTD (OR: 5.56; 95% CI: 2.28 to 13.58). Gastrointestinal side effects were more common with higher-dose regimens. No publication bias was detected.Tirzepatide at 15 mg and MTD offers the greatest efficacy for weight loss in non-diabetic adults with obesity, though at the cost of increased gastrointestinal side effects and higher discontinuation rates. These findings support a clear dose-response relationship and underscore the importance of tailoring treatment decisions to individual patient tolerability and goals.

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