Journal of Kathmandu Medical College

Systemic desensitisation with intravenous lidocaine and ketamine in treatment of refractory fibromyalgia: A case report

Sushila Lama Moktan — 2026-01-29

Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal pain, fatigue, and sleep disturbances. Its pathophysiology is complex, with central sensitization playing a key role where there is dysregulation of pain processing. While standard treatments include pharmacologic and nonpharmacologic interventions, a subset of patients remain refractory to conventional management. Systemic desensitization which modulates central pain pathways may reduce neuronal hyperexcitability and improve pain and function.

This case report describes a 43-year-old female with a history of fibromyalgia unresponsive to conventional therapy, was successfully managed with systemic desensitization using intravenous lidocaine and ketamine. The protocol was repeated every day over a period of one week. The combination appears to target central sensitization mechanisms synergistically, representing a promising therapy in complex pain syndromes.

How many are enough? Crucial role of sample size in research

Naresh Manandhar — 2026-01-29

Assessment of dependency in basic and instrumental activities of daily living among elderly-a community-based study

Rashmi Sakha — 2026-01-29

Introduction: Dependency is defined as receiving help from another person to complete the activity. It concludes six basic activities and eight instrumental activities of daily living. Human body undergoes numerous observable changes as we age, and aging is frequently associated with reduction in bodily functions leading to dependency.
Objective: To assess dependency in basic and instrumental activities of daily living among elderly.
Methodology: Community based cross-sectional study was conducted in different wards of Changunarayan Municipality, Bhaktapur among 310 elderly during Feb 2023-May 2023. Face to face interview was conducted using convenient sampling technique. The collected data was analyzed using descriptive statistics like frequency, percentage and chisquare test was used to see the association.
Results: Study showed that 51 (16.5%) elderly were dependent in basic activities of daily living and 122 (39.4%) revealed dependency in instrumental activities of daily living. Regarding components of basic activities of daily living, 105 (33.9%) had dependency in continence followed by bathing 51 (16.5%). Regarding instrumental activities of daily living 210 (67.7%) had dependency in preparing meal, followed by shopping 152 (49%). There was statistically significant association between age group, marital status, having source of income with level of basic dependency (p <0.005). Age group, sex, educational status, marital status, having source of income, currently living-with also showed statistically significant association with level of instrumental dependency (p <0.005).
Conclusion: One out of six elderly showed dependency in basic activities of daily living and more than one third showed dependency in instrumental activities of daily living.

Emotional intelligence among undergraduate medical students: A cross-sectional study

Bijaya Adhikai — 2026-01-29

Introduction: Emotional intelligence (EI) is understanding one’s own emotions and manage those emotions without disturbing themselves. Numerous investigations have revealed that there is a positive relationship between higher level of emotional intelligence and excellent academic success among students.
Objectives: To assess the level of emotional intelligence among medical students and find out the stream and gender variation in emotional intelligence.
Methodology: A cross- sectional study was conducted among 151 bachelor of medicine bachelor of surgery (MBBS)and bachelor of dental surgery (BDS) students studying in first and second year at KIST medical college from June 2023 to August 2023. EI questionnaire by Emily Sterrett was administered. Frequency, percentage, mean and standard deviation were used as descriptive statistics and t-test was used to see the difference in the mean EI score with significance level <0.05.
Results: Out of 151 students, 102(67.54%) were MBBS students whereas 49 (32.45%) were BDS. The mean Emotional intelligence score (EI) was 108.66±11.77. The mean EI score was found to be higher in BDS students (113.28± 8.84) than MBBS (106.45 ± 12.38) and the difference in the mean score was highly significant. Similarly, females were found to have higher EI score than males and the difference was statistically significant.
Conclusion: The study demonstrates that dental students have higher emotional intelligence than MBBS students and females have higher emotional intelligence than males.

Prevalence and correlates of dental caries among school children in eastern Nepal: A cross-sectional study

Dilip Prajapati — 2026-01-29

Introduction: Dental caries is a major public health concern for children's health and well-being in Nepal.
Objectives: To investigate the prevalence of dental caries and its links to oral hygiene and socioeconomic status among
schoolchildren.
Methodology: An analytical cross-sectional study was conducted from December 2024 to February 2025 among 352
school children aged 6-12 years in Phidim, Panchthar district. Data were collected by the trained dentist using a structured
questionnaire and clinical examinations to determine the Decayed, Missing, and Filled Teeth (DMFT/df) index. Ethical
approval was obtained from the Institutional Review Committee of Kathmandu University School of Medical Science (IRC
No. 252/23). Statistical analysis included descriptive statistics, Pearson's correlation, and logistic regression.
Results: The prevalence of caries was high, particularly in the 6-9 year age group 209 (59.3%) in primary dentition. A
significant knowledge-practice gap was identified: while most children 336 (95.5%) knew sugary food was harmful, 348
(98.9%) were unaware of the correct brushing technique. Consequently, 280 (79.5%) required prompt or immediate
dental treatment. Socioeconomic status (SES) showed significant negative correlation with the DMF index (ρ = –0.135,
p = 0.011). For each one-year increase in age, the adjusted odds of having caries in permanent molars increased by 23%
(aOR = 1.23, p < 0.001).
Conclusion: The study highlights a critical burden of untreated dental caries in this paediatric population, driven primarily
by inadequate oral hygiene knowledge rather than a lack of brushing attempts. The findings underscore an urgent need
for targeted, school-based public health programs.

Microbiological profile of bile sample in patients undergoing cholecystectomy at a tertiary care centre

Beena Jha — 2026-01-29

Introduction: Cholecystectomy is a frequently performed operation for symptomatic cholelithiasis. The presence of
gallstones is associated with the bacterial colonization of the bile.
Objectives: The objective of this study is to access the pattern of bacterial isolates from bile aspirates from cholecystectomy
patients and also to determine antibiogram of isolated organisms.
Methodology: A descriptive cross-sectional study was conducted among 140 patients who underwent cholecystectomy
from 1st October 2024 to 31st December 2024 at Kathmandu Medical College and Teaching Hospital after approval from
Institutional Review Committee. Bile samples received from all the patients who underwent cholesystectomy were
included in this study while samples from other illness were excluded. Intra operatively, bile was aspirated from gall
bladder and sent for culture and antibiotic sensitivity testing.
Result: A total of 33(24%) patient's bile was culture positive. Escherichia coli 18 (54%) was the most common isolates
followed by Psedomonas aeruginosa 6(18%), Klebsiella pneumoniae 4(12%), Klebsiella oxytoca 3(9%) and Acinetobacter
baumanii 2(6%) respectively. Most of the isolates were sensitive to Amikacin, piperacillin /Tazobactam and Meropenem.
Conclusion: Escherichia coli was the most common isolates followed by Pseudomonas aeruginosa. Amikacin, Meropenem
and Piperacillin/Tazobactem were sensitive to most of the organisms except for Acinetobacter baumanii which showed
resistant to theses antibiotics.

Clinical and histopathological outcome of adnexal mass in a tertiary care centre

Dipty Shrestha — 2026-01-29

Introduction: Adnexal mass in women of all age groups is a common presentation. Early diagnosis and intervention play an important role in the management of ovarian cyst as malignant mass is fatal and late diagnosis is associated with high mortality. Thus, timely evaluation and management is essential to improve the prognosis and survival rate of malignant ovarian mass.
Objective: To assess the pattern of outcomes in women presenting with adnexal mass in a tertiary care centre.
Methodology: A descriptive cross-sectional study was conducted in the department of obstetrics and gynecology of Kathmandu Medical College, from 1st January to 1st April 2025 after obtaining ethical clearance from the institutional review committee. All women with adnexal mass meeting the inclusion criteria were enrolled in the study. Convenience sampling method was used. The data was analysed by using statistical package for social sciences, IBM SPSS Statistics for Windows version 20 (IBM Corp., Armonk, N.Y., USA).
Results: Among 56 patients, 19 (33.9%) of them were in the age group of 20-30. Surgical intervention was done in 21 (37.5%) cases, among which total abdominal hysterectomy with bilateral salpingo-oophorectomy was done in 7 (33.3) patients, deroofing in 1 (4.8 %) patient, cystectomy in 9 (42.9%) cases, salpingo-oophorectomy in 3 (14.2%) cases and subtotal hysterectomy in 1 (4.8%) patient. The commonest histopathological examination finding was mature cystic teratoma 8 (39%) followed by serous cystadenoma 4 (19%).
Conclusion: Benign ovarian cysts are common in the reproductive age group and among them mature cystic teratoma and serous cystadenoma are the leading ones.