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Introduction: Type 2 diabetes mellitus is the commonest form of diabetes affecting more than 90% of the diabetic population worldwide. The prevalence of type 2 diabetes and its complications are increasing in the world, including developing nations like Nepal. This study aimed to determine the association between the lifestyle risk factors and the risk of type 2 diabetes mellitus in Nepalese population. Methods: This is hospital based cross sectional observational study done in the urban area of Nepal. Records of clients coming for the general health checkup in Grande International Hospital were evaluated in this study. Comparisons of the lifestyle factors in participants having and not having type 2 diabetes mellitus were done. Results: Significant associations with diagnosis of diabetes mellitus (DM) type 2 were seen in age (P ≤ 0.001), associated hypertension (P ≤ 0.001), dyslipidemia, family history of DM (P ≤ 0.001), alcohol use (P ≤ 0.001), and tobacco use (P ≤ 0.001). Logistic regression analysis showed that the odds of having diabetes were high in age group above 40 (OR – 6.9, CI 3.82 – 12.47), history of hypertension (OR- 3.84, CI 2.42 – 6.08), tobacco users (OR-2.26, CI 1.12 – 4.53), alcohol users (OR-3.99, CI 2.47 – 6.44), family history of DM (OR-2.44, CI 1.53 – 3.89), and abdominal obesity in both males (OR-3.9, CI 2 – 7.4) and females (OR-9.6, CI 3.78 – 24.35). Conclusions: The modifiable risk factors - obesity, smoking and alcohol use carry significant risks of developing type 2 diabetes. These red flag signs call for urgent attention to look for and rectify the modifiable risk factors in Nepalese population to prevent diabetes.

Introduction: Postgraduate specialization is perceived as essential for success with high competition for enrolment. The reasons how medical students choose their postgraduate specialty are complex. Understanding the factors that influence career choice helps in workforce planning. So, we tried to identify the specialty preferred by postgraduate students and the factors that influenced these choices in a post graduate institution.Methods: A cross-sectional observational study was conducted in National Academy of Medical Sciences. All the postgraduate students of batch 2011 AD were enrolled for the study. The responses were rated on a five point Likert scale.Results: Significant gender preference was observed in specialties. General Surgery, Internal Medicine and Orthopedics were chosen by male students (P-Values, respectively, 0.001, 0.033 and 0.000) while Obstetrics and Gynecology and Ophthalmology being chosen by female students (P-Values, respectively, 0.000 and 0.006). Significant difference was observed between male and female student responses to the factor – scope in future (P – value 0.042), between married and unmarried students to the factor – workload flexibility (P – value 0.011), students who tried to go abroad versus who didn’t, for the factor – Illness of self/family/friend (P – value 0.016), and between those who worked in rural area versus those who didn’t, to the factor – Influence of friends/ seniors (P – value 0.038).Conclusions: Various factors affect the choices for preferred specialty. Policy makers should look at the needs of the nation, and ensure that specialty postgraduate education programs reflect those needs. Keywords: career choices; likert scale; medical education; postgraduate specialty. | PubMed

Background: ABO discrepancy is any deviation from the expected pattern of red cell antigen grouping with serum-grouping or when the forward-grouping results do not correlate with reverse-grouping results. This study was done to determine the incidence and causes of ABO discrepancies and to identify the correct blood group for safe blood transfusions. Methods: This is a retrospective descriptive study. It was done on 9970 samples collected between June 2017and May 2018. All ABO typing records kept at the Grande International Hospital (GIH) blood bank laboratory were reviewed. Results: During the study period, 9970 blood grouping tests were performed. ABO discrepancies occurred in 26 of them. Discrepancies were more prevalent in the age of 20-30 and 30-40 years. Majority were seen in patients with history of pregnancy/miscarriage (30%) and with any Carcinoma (23%). The most common blood group involved was B with 34% frequency. 96% were reverse discrepancy type, 84% with extra antibody which was resolved by incubating the sample at 37°C for 30 minutes signifying most probably A and B subgroups and auto/allo antibodies. Conclusion: This study emphasizes the need of considering ABO discrepancies in blood banks for donors and recipients for safe blood transfusion to avoid any fatal complications. This discrepancy ratio of 1/384 is more than in other studied population of other countries and also higher than ABO mismatched transfusion in standard centers in Nepal. Repeat testing and investigating for ABO subgroups and auto/allo antibodies is important.

INTRODUCTION: The day care laparoscopic cholecystectomy (DCLC) is found to be safe and effective in developed countries. However, it has not been well accepted in our part of the world probably because of lack of infrastructures,established norms and published reports. We have analyzed the safety and feasibility of the procedure in the recently established first dedicated day care surgery centre of the country. METHODS: All the patients with American society of anaesthesiologist (ASA) score I and II admitted for laparoscopic cholecystectomy are included. Operation are performed in the morning and closely observed till evening. Patients found to be medically fit to discharge; having a responsible person at home and who can make their own arrangements in case of problems were advised for discharge. Follow up was done by telephone call from next morning. RESULTS: Total 35 patients underwent laparoscopic cholecystectomy. Age range was between 16-65 years and most of them were females (88%). Only 30 patients were operated in early morning and were eligible for day care surgery. 25 (83%) Patients were advised for discharge but only 10 (33%) could make arrangement. Other 15 patients could not go home mainly due to different psychosocial reasons. Only one patient needed readmission and Complications observed were minor and relatively few. CONCLUSIONS: Day care laparoscopic cholecystectomy is safe and feasible in our set up. Acceptance of the procedure is expected to increase once it is regularly practiced and awareness in improved. Keywords: day care, laparoscopic cholecystectomy, surgery, Nepal.

Inferior vena cava thrombosis (IVCT) is a rare complication of deep vein thrombosis (DVT) in the legs. The etiology of IVC thrombosis can be divided into genetic versus nongenetic (environmental/acquired) etiological factors found in Virchow's triad of stasis, endothelial injury, and hypercoagulability. Hyperhomocysteinemia is a rare risk factor for venous thromboembolism and atherosclerotic disease. Hence, very few cases have been described to date to knowledge. A case of a 78‐year‐old hypertensive man who presented with hyperhomocysteinemia‐induced DVT of the left leg extending toward an anatomically normal IVC is discussed in the report.

Non Communicable diseases (NCDs) are now endemic in low and middle income countries. Nepal had a high burden of communicable diseases (CDs) which has now been overtaken by NCDs. Although prevention and control of NCDs is prioritized in national policies and strategies, there is no proper monitoring system. This study aims to review the morbidity pattern among the adults seeking preventive general health checkup in a major tertiary care hospital in Kathmandu. 3000 cases were evaluated. 53.6% were males and 46.4% were females. The mean age of cases was 44.9 yrs. Most of the cases ranged from 40 to 60 years of age. Almost half of them were from Kathmandu district. Nearly 78% participants live a sedentary life. Abdominal obesity was seen in 27.5% of females and 21.7% of males. Nearly 49% of cases were overweight and 24% were obese. Almost 21 % of the cases were smokers and about 36% of them consumed alcohol. Only 9% are vegetarians. 10% have diabetes and 20% have hypertension. 69% of females and 43% of males have less than normal bone mineral density. The government and private sectors must focus on strengthening preventive and curative services for early detection of risk factors and management of NCDs.

Inferior vena cava thrombosis (IVCT) is a rare occurrence and is a result of leg deep vein thrombosis (DVT). The etiology of IVC thrombosis can be divided into congenital versus acquired etiological factors found in Virchow’s triad of stasis, injury, and hypercoagulability. Hyperhomocysteinemia is a rare risk factor for thromboembolism.