Patan Academy of Health Sciences

Acute pancreatitis (AP) is a gastrointestinal disorder frequently associated with gallstones, hypertriglyceridemia, and alcohol use. Drug-induced pancreatitis has been documented in the medical literature, with various medications implicated as potential triggers. We report a case of a 31-year-old man with hypertension who presented with severe upper abdominal pain and was diagnosed with AP. Extensive diagnostic evaluation excluded common causes, pointing towards losartan. Symptomatic management and cessation of losartan led to improvement. This is a rare instance of losartan-induced AP. The patient experienced symptoms after a year of use, suggesting that pancreatitis can occur at any time during therapy. The underlying mechanisms are unclear; however, they might include decreased bradykinin breakdown leading to localized pancreatic duct angioedema. This highlights the importance of differentiating drug-induced pancreatitis from idiopathic causes. This case highlights the importance of considering pancreatitis in differential diagnosis, particularly in patients lacking typical risk factors.

Background:Pyrexia of Unknown Origin (PUO) remains a significant diagnostic challenge in low-resource settings, where limited laboratory capacity and fragmented health systems impede timely etiologic identification. In Nepal, evidence on institutional readiness, diagnostic capacity, and system-level barriers for PUO care is limited, hindering standardized clinical decision-making and timely diagnosis. This study assessed the diagnostic capacity, workforce expertise, and governance structures for PUO management across Nepal.Methods:A concurrent mixed-methods study was conducted across 11 tertiary care hospitals in six provinces of Nepal. Quantitative data on governance, service delivery, diagnostics, human resources, infrastructure, and financing were collected using standardized facility assessment tools and descriptively analyzed using SPSS version 23. Qualitative data were obtained from 33 key informant semi-structured interviews (hospital administrators, clinicians, and laboratory personnel), transcribed verbatim, and subjected to thematic analysis in NVivo with intercoder reliability assessment. Findings were integrated through triangulation.Results:Quantitative assessments revealed limited institutional preparedness for PUO management, characterized by the absence of dedicated clinical guidelines, formal referral pathways, and designated focal points in most hospitals. Basic diagnostic services were widely available; however, access to advanced molecular diagnostics was inconsistent and often dependent on external laboratories, contributing to diagnostic delays. Qualitative findings contextualized these gaps, highlighting fragmented governance, weak interdisciplinary coordination, and heavy reliance on empirical treatment of pyrexia, frequently influenced by prior antibiotic exposure. Human resource constraints were prominent, particularly shortages of infectious disease specialists, pediatric expertise, microbiologists, and trained laboratory personnel. Infrastructure limitations, inefficient referral mechanisms, and substantial out-of-pocket expenditures further constrained optimal care. Digital health tools, including electronic medical records and telemedicine, were inconsistently implemented despite being viewed as potential facilitators of improved coordination and follow-up.Conclusions:Management of PUO in Nepal is limited by system-level weaknesses in governance, diagnostic capacity, workforce skills, financing, and digital health integration. Closing these gaps through standardized clinical guidelines, strengthened laboratory systems, focused workforce training, improved referral pathways, and strategic digital health investments could shorten diagnostic timelines, improve patient outcomes, and advance national priorities such as antimicrobial stewardship and epidemic preparedness.

Introduction: Septic shock is a leading cause of mortality and morbidity among children globally. Although dopamine has traditionally been used, emerging evidence suggests epinephrine may be more effective. This study was conducted to identify the proportion of children responding to epinephrine and to document associated survival outcomes and side effects in a resource-limited tertiary setting. Methods: This prospective observational study was conducted over 14 months at a tertiary care university hospital. Ethical approval was obtained from the hospital's institutional ethics committee (Reference number: 184/075/076). We enrolled 31 children aged 1 month to 16 years with fluid-refractory septic shock. Participants received epinephrine infusions at incremental doses starting at 0.1 μg/kg/min and escalating by 0.1 μg/kg/min every 10 minutes to a maximum of 0.3 μg/kg/min until shock resolution. Outcomes included the proportion of shock resolution, survival, and duration of hospital stay. Data were entered in Epidemiologic Information and Microsoft Excel. Results: Shock resolved in 24 (77.40%) patients with epinephrine alone, while 7 (22.60%) patients achieved resolution within the first hour, and 7 (22.60%) required additional vasoactive agents, primarily noradrenaline. Side effects included feeding intolerance in 3 (9.60%) and hyperglycemia in 2 (6.40%) children. There were 7 (22.60%) deaths, and 24 (77.40%) children survived to discharge. Conclusions: Epinephrine could be considered an effective agent for the reversal of fluid-refractory septic shock in children. It appeared to offer survival benefits with minimal life-threatening side effects in this cohort.

Background: Masturbation is a common and normal sexual behavior, also observed among children. Despite its benign nature, childhood masturbation (CM) often causes parental concern. However, literature on CM from South Asia remains scarce. Objectives: We aimed to see the available clinical evidence on CM in South Asia, considering clinical presentation, diagnosis, and management. Methods: This narrative review was conducted through comprehensive searches of PubMed, Scopus, Google Scholar, and Google without time restrictions, using both Medical Subject Headings and free-text terms. Eligible studies included original articles, case series, and case reports involving CM from South Asian countries. Results: Eighteen studies (2006–2025) comprising 148 children were included, mostly from India ( n = 11). Case reports ( n = 10) and case series ( n = 5) predominated. Ages ranged from 4 months to 7 years, with a female predominance (62.2%). Common presentations were rhythmic body movements, leg crossing, facial flushing, grunting, sweating, and seizure-like episodes. Pediatricians were consulted as the first level carer in most of the cases, and laboratory tests were usually normal. Non-pharmacological interventions, behavior therapy, psychoeducation, and parental counseling were frequently used ( n = 16) and found effective. Conclusions: CM in South Asia is a relatively less-reported clinical entity. Increasing awareness, promoting culturally sensitive interventions, and prioritizing non-pharmacological management can improve the status quo. Future research should move beyond case reports toward population-based studies that explore the prevalence and psychosocial impacts of CM in South Asia.

Introduction Stroke remains a leading cause of death and disability worldwide, with a high burden in low-resource settings like Nepal. Timely administration of intravenous thrombolysis is critical for improving outcomes in patients with acute ischemic stroke. However, delays in receiving thrombolysis can significantly reduce its effectiveness and impact recovery. This study aimed to explore and understand the reasons contributing to delays in thrombolysis among stroke patients in emergency departments within low-resource settings through a qualitative approach. Methods A qualitative study was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Eighteen participants, including ten stroke patients and eight witnesses, were interviewed using a semi-structured guide. Data were analyzed using thematic analysis to identify common themes regarding treatment delays. Results The study identified four primary reasons contributing to delays in thrombolysis treatment: (a) failure of patients and witnesses to recognize stroke symptoms early, (b) limited availability of thrombolysis services in the hospitals, (c) financial barriers to seeking care, and (d) delayed diagnosis or misdiagnosis by healthcare professionals. Conclusion This study highlights the significant barriers to thrombolysis delays in Nepal. Key interventions, such as improving public awareness of stroke symptoms, increasing access to thrombolysis services, and reducing financial barriers, are necessary to improve outcomes in stroke patients.

BackgroundAcute gastroenteritis (AGE) is a major cause of morbidity and mortality in children under five, especially in low- and middle-income countries. Despite advances in healthcare, the burden of AGE remains significant in Nepal. This study aimed to evaluate the clinico-demographic profile and management outcomes of under-five children with AGE admitted to Patan Hospital.MethodsA descriptive cross-sectional study was conducted at Patan Hospital, including 236 under-five children admitted with AGE between January 2021 and December 2023. Data were collected retrospectively from medical records and analyzed using SPSS version 16.ResultsThe prevalence of AGE was 14.32% among hospitalized under-five children. The mean age of children was 1.55 years. Most children (77.6%) presented with some dehydration, while severe dehydration was noted in 3.8% of cases. Antibiotics were used in 30.93% of cases, with ceftriaxone being the most commonly prescribed (29%). Zinc supplementation was administered in 38.14% of cases. Intravenous fluids were the primary mode of rehydration in 91.95%.ConclusionThis study highlighted significant gaps in adherence to clinical guidelines, particularly regarding the underuse of zinc and ORS. The high rate of empirical antibiotic use highlights the need for better diagnostics to guide targeted therapy and reduce antimicrobial resistance.DisclosuresAll Authors: No reported disclosures

Introduction: Solitary fibrous tumor (SFT) of the nasal cavity is a rare vascular tumor arising from adult mesenchymal stem cells. It occurs most commonly in the pleura, and in the nasal cavity, it is rare. Solitary fibrous tumors (SFTs) of the nose and paranasal sinuses are extremely rare. Case presentation: This article reports a case of a 59-year-old lady presenting with complaints of progressive nasal blockage and recurrent epistaxis. Imaging showed a mass lesion in the left nasal cavity with bone-eroding properties mimicking a malignant lesion. The patient underwent surgery, during which the mass was excised. Histopathological analysis of the specimen was consistent with SFT.Conclusion: This case highlights the importance of diagnosing SFT of the nasal cavity and paranasal sinuses, as their imaging findings and management differ from those of other tumors.