Police General Hospital

Introduction: Neonatal respiratory disorders are among the leading causes of admissions to neonatal intensive care units due to respiratory distress in the early neonatal period. However, studies on their spectrum and outcomes among Nepalese neonates are limited. This study aimed to find out the proportion and types of respiratory disorders among admitted newborns, along with associated complications and outcomes. Methods: This descriptive cross-sectional study was conducted in the Neonatology Unit of a tertiary care hospital from July 1, 2023 to June 30, 2024, among all inborn neonates meeting the inclusion criteria. Convenience sampling was applied, and the sample size taken was 150. Ethical approval was obtained from the Institutional Review Committee (Ref no 241/080/081-IRC). Data were entered in Microsoft Excel 2007 and analyzed using Statistical Package for the Social Sciences version 11.5. Results: Among 150 newborns, the most prevalent morbidity was Transient Tachypnoea of Newborn 56 (37.30%), followed by Meconium Aspiration Syndrome 46 (30.70%). Similarly, 27 (18%) had complications, and 123 (82%) had no complications. Likewise, 134 (89.30%) babies recovered and were discharged, and 7 (4.70%) died during the course of treatment. Conclusions: This study concluded that the most common morbidity was Transient Tachypnea of the Newborn, followed by Meconium Aspiration Syndrome. This study emphasizes early identification of different types of respiratory disorders and common complications among neonates with respiratory distress which will help in early recognition and treatment thereby minimizing complications and mortality.

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: Tibial plateau fractures, frequently caused by road traffic accidents, disrupt articular congruity and elevate the risk of secondary osteoarthritis. Although anatomical locking compression plates are widely used for fixation, outcomes for Schatzker III-VI fractures remain underexplored. This study evaluated the functional and radiological outcomes of Schatzker type III-VI fractures treated with locking compression plates. Methods: In this observational study, 30 patients with Schatzker III-VI fractures underwent locking compression plates fixation at a single center between November 2021 and December 2022. Ethical clearance was obtained from the Institutional Review Committee (15 August 2021). Functional outcomes were assessed using the Knee Society Score at a minimum 4-month follow-up. Radiographic union was evaluated on standard anteroposterior and lateral radiographs, defined as bridging callus across at least three of four cortices on two orthogonal views with no visible fracture line. Data were analyzed descriptively, continuous variables were expressed as mean ± standard deviation, and categorical variables as frequencies and percentages. Results: The mean patient age was 44.50±14.38 years, with road traffic accidents being the predominant injury mechanism. At the 4-month follow-up, the mean Knee Society Score was 75.33±7.53. Good outcomes were observed in 21 (70%) of patients and excellent outcomes in 5 (16.70%). Fair and poor outcomes were each observed in 2 (6.70%) of cases. Radiographic union was evident in 28 (93.30%) of fractures. Complications included superficial infection 6 (20%) and knee stiffness 4 (13.30%). Conclusions: In patients with Schatzker type III-VI fractures, treatment with locking compression plates achieved high rate of good-to-excellent functional outcomes and fracture union at 4 months, supporting its role as an effective surgical strategy for these injuries.

<title>Abstract</title> Background The complexity of osteoporosis risk stratification often leads to substantial knowledge-to-practice gaps and diagnostic variability. This study evaluates the efficacy of a deterministic rule-based clinical decision support system (CDSS) in operationalizing the 2021 Thai Osteoporosis Foundation (TOPF) guidelines to standardize clinical decision-making. Methods A within-subject randomized experimental study was conducted with 65 physicians (22 juniors, 43 seniors) who evaluated 20 clinical vignettes. Participants were randomized to assess cases under manual and CDSS-supported conditions. Primary outcomes included decision accuracy compared to an expert consensus gold standard, decision time, and system usability, analyzed using paired statistical tests. Results The CDSS significantly improved overall risk classification accuracy from 70.3% to 84.8% ( <italic>p</italic> &lt; 0.001) and treatment selection accuracy from 78.5% to 85.4% ( <italic>p</italic> = 0.003). Crucially, the intervention demonstrated a robust "equalizing effect": junior physicians achieved a 22.3% accuracy gain ( <italic>p</italic> &lt; 0.001), effectively eliminating the baseline expertise gap compared to senior physicians. Decision efficiency was maintained, with no statistically significant increase in processing time ( <italic>p</italic> = 0.322). The system usability score was 69.1, indicating good potential for workflow integration. Conclusion Implementing a transparent, rule-based logic engine successfully mitigates cognitive biases and neutralizes experience-based performance variability. This study confirms that operationalizing clinical guidelines through digital analytics is a scalable strategy to bridge the expertise gap and ensure guideline-concordant management in primary care.

BackgroundThis study aimed to (1) compare the clinical phenotype and outcomes of patients with transthyretin amyloidosis (ATTR) harboring the p.Ala117Ser variant versus those with wild-type ATTR (wtATTR), and (2) delineate the clinical spectrum of ATTR at our institution.MethodsWe conducted a single-center observational study of 43 consecutive symptomatic ATTR patients and 7 asymptomatic carriers of pathogenic ATTR variants. All underwent structured evaluation in the cardiomyopathy (CM) clinic. The primary endpoint was a composite of all-cause mortality or heart/heart–liver transplantation.ResultsAmong the 50 patients enrolled with ATTR, hereditary ATTR (hATTR) accounted for 53%. Within the hATTR group, the p.Ala117Ser variant was the most frequently identified pathogenic variant, representing 40% of cases. Of the 43 symptomatic patients, 41 (95%) were diagnosed with ATTR-CM. Symptomatic p.Ala117Ser patients were younger, had universal neuropathy, and exhibited less advanced cardiac involvement compared with wtATTR. Three-year event-free survival was higher in p.Ala117Ser patients, remaining significant after excluding asymptomatic carriers (log-rank p = 0.006). Univariate predictors of adverse outcomes included wtATTR, prior heart failure hospitalization, elevated NT-proBNP, older age, increased wall thickness, and higher NYHA class. Multivariate analysis identified p.Ala117Ser variant as independently associated with improved outcomes (HR 0.23, 95% CI 0.06–0.95).ConclusionsThe p.Ala117Ser variant emerged as the most common hATTR in our cohort. Symptomatic carriers were younger, had universal neuropathy (100%), had less advanced cardiac disease, and demonstrated superior survival and transplant-free outcomes compared with wtATTR. These findings highlight the value of genotype-guided evaluation and the potential for precision therapies tailored to regional TTR variants.Trial registrationClinical Trial Number: Not Applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12872-025-05313-3.

Background and Objectives: Large language models (LLMs) offer promising applications in healthcare, including drafting referral letters. However, access to LLMs specifically designed for medical practice remains limited. While ChatGPT is widely available, its ability to generate comprehensive and clinically appropriate neurology referral letters remains uncertain. This study aimed to systematically evaluate the completeness and quality of neurology referral letters generated by ChatGPT for standardized clinical scenarios. Materials and Methods: Five standardized clinical scenarios representing common neurological complaints encountered in family medicine settings (headache, memory problems, stroke/TIA, tremor, radiculopathy) were used. Using a consistent prompt, ChatGPT (GPT-4o, 2025 release) generated 10 referral letters per scenario (50 letters in total). A dual board-certified neurologist and family physician scored the letters using a 30-point rubric across multiple domains: completeness (demographics, chief complaint, history of present illness, physical exam findings, management, and consultation questions) and quality (language level, structure, and letter length). Descriptive statistics and inferential analyses (ANOVA and Kruskal-Wallis tests) were applied to assess performance across scenarios. Results: The mean total score was 25.76/30 (95% CI: 24.85-26.67). Completeness averaged 87%, while language and structure consistently scored above 90%. Content gaps appeared in 36 out of 50 letters (72%), mainly in the history of present illness and physical examination sections. Variability was observed across letters, though not statistically significant between scenarios (ANOVA: F = 1.14, p = 0.352; Kruskal-Wallis: H = 3.52, p = 0.475). Conclusions: ChatGPT produced neurology referral letters of high linguistic quality but variable completeness, especially for clinically complex content. The variability pattern among letters reflected model inconsistency rather than case type. The reliance on a single rater and use of a non-validated rubric represent limitations. Future studies should include multiple raters, inter-rater reliability testing, and validated scoring frameworks. Ultimately, access to tailored LLMs exclusively trained for medical documentation could improve outcomes while safeguarding patient privacy.

Background and objectiveMost troubling of painless gastrointestinal endoscopy is hypoxia and hypotension. Esketamine has sympathomimetic and respiratory protection, which combined with midazolam and propofol may reduce these troubles. So, this study aims to explore the efficacy and safety of this regimen.MethodsIn total, 318 patients who received painless gastrointestinal endoscopy from November 2022 to April 2023 were included and randomly divided into two groups at 1:1: 0.1 µg/kg sufentanil (Suf) or 0.15 mg/kg esketamine (Esk) group. Except for analgesics, all patients were given midazolam and propofol. The incidence of hypotension and hypoxia (SPO2 < 93%) during the examination was observed.ResultsCompared with the Suf, the Esk group reduced the incidence of hypotension (12.8% vs 36.2%, 95% confidence interval (CI) 13.20—33.09, P < 0.001), respiratory depression (apnea > 30 s) (2.1% vs 15.4%, 6.47—20.52, P < 0.001), and hypoxia (7.1% vs 16.1%, 1.07—16.92, P = 0.018), but may increase the incidence of coughing (P < 0.001) and increased secretions (P = 0.032). There was no significant difference in the examination and recovery time (P > 0.05).ConclusionEsketamine, midazolam, and propofol for painless gastrointestinal endoscopy can achieve opioid-free sedation and reduce the occurrence of hypotension and hypoxia. However, the dosages of this regimen need to be further explored to avoid coughing and increased secretions.Trial registrationThis study has been registered in the Chinese Clinical Trial Center (https://www.chictr.org.cn/index.html, Date: November 3, 2022, No: ChiCTR2200065379).Supplementary InformationThe online version contains supplementary material available at 10.1186/s13063-025-09073-5.

ObjectivesThe objective was to evaluate the efficacy and safety of escalating tofacitinib from 10 mg to 15 mg daily in NSAID-refractory axial spondyloarthritis (ax-SpA) patients with inadequate 12-week response to 10 mg.MethodsThis was a pragmatic, open-label, single-arm, dose-escalation study (24 weeks). 101 patients were enrolled (ITT); 88 completed both week-12 and week-24 assessments (evaluable). All started tofacitinib 10 mg daily. At week 12, those achieving ASDAS-CRP (Ankylosing Spondylitis Disease Activity Score - C-reactive protein) major improvement (MI; Δ≥2.0) continued 10 mg; non-responders escalated to 15 mg. Outcomes included ASDAS-CRP (Clinically Important Improvement (CII)/MI/inactive disease), Assessment of SpondyloArthritis International Society criteria (ASAS 20/40), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Ankylosing Spondylitis Quality of Life (ASQoL), and 36-Item Short-Form Health Survey (SF-36); safety was monitored per Common Terminology Criteria for Adverse Events (CTCAE) v5.0.ResultsOf the evaluable cohort (n=88), 57 (64.8%) achieved MI at week 12 and continued 10 mg; 31 (35.2%) escalated to 15 mg. By week 24, mean ASDAS-CRP improved from 4.4→1.7 (10 mg) and 4.0→2.2 (15 mg). In the escalation subgroup, ASDAS-CRP improved 3.0 ± 0.7→2.2 ± 0.7, BASDAI 3.9 ± 1.3→2.9 ± 1.2, and ASAS 20/40 responses rose to 93.5%/45.2%. Six patients discontinued due to AEs (5 transaminitis at ≤10 mg; 1 breast tumour). Rhinitis was more frequent with 15 mg (58.1% vs 31.6%). No TB, VTE, MACE, or deaths occurred.ConclusionsIn patients not meeting 12-week targets on 10 mg, escalation to 15 mg yielded additional clinically meaningful improvement with a safety profile generally comparable to 10 mg. Selective escalation may be a feasible treat-to-target strategy where alternatives are limited.

The coexistence of Intellectual Disability (ID) and Autism Spectrum Disorder (ASD) presents a complex clinical scenario that requires comprehensive and personalized interventions. This article explores the neurobiological mechanisms underlying the comorbidity of ID and ASD, highlighting the shared genetic and synaptic pathways that contribute to both conditions. The discussion also covers the prevalence of comorbidities such as epilepsy, sleep disorders, and gastrointestinal issues, which exacerbate the challenges in diagnosis and treatment. A multidisciplinary approach, combining behavioral, educational, and pharmacological interventions, is essential for addressing the unique needs of individuals with ID and ASD. Future directions point to the use of advanced neuroimaging, artificial intelligence, and personalized therapies based on genetic markers, which promise to revolutionize treatment strategies. Emphasis is placed on the importance of early intervention and lifelong support to improve functional outcomes and quality of life. The need for ongoing research, policy development, and family involvement is underscored as critical factors in optimizing care and inclusion for this population.