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Evidence-based deep dives authored by our consultant team — neurology by Dr. Jitendra Prasad Yadav (MBBS, MD (Internal Medicine), FICN (Neurology), FCNV, FIHM, NMC 8029), psychiatry & CBT by Dr. Ruja Shrestha (NMC 19766), orthopedics & foot care by Dr. Bodh Raj Gautam (NMC 23071), and rheumatology & autoimmune disease by Dr. Shree Narayan Yadav (NMC 14227). Each topic follows international guidance and links to clinic services.
48 authoritative topics
All topics are authored and medically reviewed by the consultant who wrote them.
Chronic migraine is defined by headache on ≥15 days/month for >3 months with migrainous features on ≥8 days. At Kathmandu Neurology Clinic & Cognitive Center, Dr. Jitendra Prasad Yadav (NMC 8029) applies ICHD-3 criteria, headache-diary analysis, medication-overuse review and red-flag screening to separate chronic migraine from tension-type, cluster and secondary headaches.
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vestibularNot all dizziness is ear disease. Vestibular migraine presents with recurrent vertigo lasting minutes to days, often with photophobia or migraine history, while BPPV is brief rotational vertigo triggered by rolling over or looking up. Dr. Jitendra evaluates positional testing, migraine history and central red flags to guide next steps.
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cognitive-neurologyMCI is objective cognitive impairment (typically 1–1.5 SD below norms) with preserved functional independence and no dementia. Annual conversion to dementia is 10–15% in clinic samples vs 1–2% in cognitively normal elders. Dr. Jitendra uses MoCA/MMSE, informant history and subtype classification (amnestic vs non-amnestic) to plan follow-up at the clinic.
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behavioral-neurologyPrefrontal circuits mediate planning (dorsolateral), reward/social control (orbitofrontal) and initiation (medial/cingulate). Lesions produce executive failure, disinhibition or apathy respectively. Dr. Jitendra evaluates informant history, FAB/MoCA and MRI volumetry to localize and prognosticate.
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epilepsyA first unprovoked seizure warrants careful history (witness account, video if available), neurological exam and risk stratification. Dr. Jitendra discusses EEG, MRI, recurrence risk, driving/lifestyle advice and when medication is indicated — decisions shared with patient and family, not protocol-driven.
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cerebrovascularTIA is a transient focal deficit with no infarct on imaging — yet 10–20% have stroke within 90 days, half within 48 hours. Dr. Jitendra emphasizes rapid evaluation, ABCD2 risk, antithrombotic/antihypertensive/statin secondary prevention and rehabilitation planning at the clinic.
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headache-medicineMedication-overuse headache (MOH) affects roughly 1–2% of the general population and up to half of chronic headache clinic attendees. It develops when acute headache medications — simple analgesics on ≥15 days/month or triptans, opioids, and combination analgesics on ≥10 days/month — are used for more than three months. Dr. Jitendra Prasad Yadav (NMC 8029) screens every frequent-headache patient at Kathmandu Neurology Clinic & Cognitive Center for MOH because it is the single most common reason preventive treatment appears to fail.
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headache-medicineMost recurring headaches are primary disorders such as migraine or tension-type headache, but certain features raise concern for a secondary cause — bleeding, infection, raised pressure, vascular injury or tumour. Red-flag screening is systematic at Kathmandu Neurology Clinic & Cognitive Center: Dr. Jitendra Prasad Yadav (NMC 8029) applies the SNOOP framework and ICHD-3 secondary-headache logic to decide who needs urgent imaging or emergency care and who can be managed confidently without it.
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headache-medicineTension-type headache (TTH) affects up to 80% of people at some point and is the second most disabling condition worldwide by years lived with disability. It presents as bilateral pressing or tightening pain of mild-to-moderate intensity, without the nausea and sensory sensitivity that define migraine. Because it overlaps with neck pain, stress, sleep problems and analgesic overuse, misclassification is common — Dr. Jitendra Prasad Yadav (NMC 8029) uses ICHD-3 criteria and diary review at Kathmandu Neurology Clinic & Cognitive Center to separate TTH from migraine and medication-overuse headache, since their treatments differ fundamentally.
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cognitive-neurologyVascular cognitive impairment (VCI) spans the spectrum from mild executive slowing to vascular dementia and is the second most common cause of dementia after Alzheimer disease — yet it is also the most preventable, because its drivers are the same vascular risk factors that cause stroke. Dr. Jitendra Prasad Yadav (NMC 8029), whose practice bridges stroke medicine and cognitive neurology at Kathmandu Neurology Clinic & Cognitive Center, evaluates patients with memory or slowness concerns specifically for vascular contributions: hypertension, diabetes, atrial fibrillation, prior silent infarcts and white-matter disease.
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cognitive-neurologySleep disorders are both neurological and systemic — chronic insomnia, obstructive and central sleep apnea, restless legs syndrome, parasomnias, circadian rhythm disorders, excessive daytime sleepiness, shift work sleep disorder and REM sleep behavior disorder frequently overlap with headache, epilepsy and cognitive concerns. Dr. Jitendra Prasad Yadav (NMC 8029), Founder of Nepal Sleep Clinic & Headache Center, Dillibazar, evaluates sleep-related neurological disorders with sleep evaluations, diagnosis, CPAP therapy management and long-term care planning — among the few physicians in Nepal actively involved in neurological sleep medicine.
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cognitive-neurologyPeripheral neuropathy, diabetic neuropathy, radiculopathy, nerve compression syndromes, myopathy, motor neuron disorders, neuromuscular junction disorders and chronic nerve pain syndromes require careful distribution mapping, metabolic review and electrodiagnostics. Dr. Jitendra Prasad Yadav provides comprehensive diagnosis and management with EMG and NCS interpretation — distinguishing demyelinating from axonal, entrapment from generalized, and myopathic from neurogenic patterns.
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Cognitive-behavioral therapy (CBT) is the first-line psychotherapy for generalized anxiety disorder, social anxiety, panic disorder, and specific phobias. At Dr. Ruja's clinic, treatment begins with a functional analysis of anxiety triggers, cognitive restructuring of maladaptive thoughts, and graduated exposure hierarchies. Unlike medication-only approaches, CBT addresses the maintaining factors — avoidance, safety behaviors, and catastrophic misappraisal — that perpetuate anxiety over time.
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mood-disordersMajor depressive disorder affects over 280 million people globally and is the leading cause of disability worldwide. At Dr. Ruja's clinic, depression assessment begins with structured screening (PHQ-9), thorough differential diagnosis (medical mimics, bipolar screening, grief), and risk stratification for self-harm. Treatment follows a stepped-care model: mild depression with watchful waiting and behavioral activation; moderate depression with psychotherapy ± pharmacotherapy; severe depression with combined treatment and closer monitoring.
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traumaPost-traumatic stress disorder develops in 5–10% of trauma-exposed individuals, characterized by intrusive re-experiencing, avoidance, negative alterations in cognition and mood, and hyperarousal. Dr. Ruja's approach follows the International Society for Traumatic Stress Studies (ISTSS) phased model: safety and stabilization first, then trauma processing (PE, CPT, or EMDR), then reconnection and meaning-making. Complex PTSD and dissociative presentations require extended stabilization before trauma-focused work.
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child-psychiatryChild and adolescent mental health disorders affect 10–20% of young people globally, yet most conditions are under-diagnosed until adolescence or adulthood. At Dr. Ruja's clinic, assessment integrates developmental history, school functioning, family dynamics, peer relationships, and collateral information from caregivers and teachers. Treatment modalities are adapted to developmental stage: play therapy and parent management training for young children; CBT and family therapy for adolescents; and careful pharmacotherapy when evidence supports it.
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addictionSubstance use disorders affect over 36 million people globally and carry high mortality from overdose, medical complications, and suicide. Dr. Ruja's clinic provides integrated dual-diagnosis treatment, recognizing that addiction rarely occurs in isolation — depression, PTSD, ADHD, and personality disorders frequently co-occur and must be treated simultaneously. Treatment combines medication-assisted treatment (MAT), motivational interviewing, relapse prevention therapy, and harm reduction principles.
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anxiety-disordersObsessive-compulsive disorder affects 2–3% of the population and is characterized by intrusive, distressing thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce anxiety. Dr. Ruja's clinic specializes in exposure and response prevention (ERP), the gold-standard psychotherapy for OCD. Unlike generic anxiety management, OCD requires targeted interventions that break the obsession-compulsion cycle through deliberate, sustained exposure to the feared stimulus without performing the ritual.
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mood-disordersBipolar disorder affects 1–2% of the population and carries significant mortality from suicide, medical comorbidity, and functional impairment. Accurate diagnosis distinguishes bipolar I (mania), bipolar II (hypomania + depression), and cyclothymia from unipolar depression — a critical distinction because antidepressants can destabilize bipolar patients. Dr. Ruja's clinic emphasizes mood charting, long-term pharmacotherapy (lithium, valproate, lamotrigine, atypical antipsychotics), and psychoeducation for adherence and early warning sign detection.
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sleep-psychiatrySleep disturbance is both a symptom and a maintaining factor in virtually every psychiatric disorder. Insomnia increases depression risk 2–3-fold, worsens anxiety and PTSD, and is a prodromal marker of mania. Dr. Ruja's clinic treats sleep as a primary therapeutic target, not merely a secondary complaint. CBT for insomnia (CBT-I) is first-line, with pharmacotherapy reserved for severe or treatment-resistant cases. Addressing sleep often improves psychiatric outcomes more rapidly than treating the psychiatric condition alone.
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geriatric-psychiatryMental health disorders in older adults are under-recognized and under-treated, yet depression affects 10–15% of community-dwelling elders and up to 30% of those in residential care. Delirium affects 10–30% of hospitalized medical patients and is a psychiatric emergency. Dr. Ruja's clinic provides comprehensive geriatric psychiatric assessment: differential diagnosis of depression vs dementia vs delirium, medication review for anticholinergic burden and polypharmacy, behavioral management of dementia-related agitation, and caregiver psychoeducation and support.
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women-mental-healthWomen experience depression and anxiety at twice the rate of men, with onset often linked to hormonal transitions: premenstrual, perinatal, and perimenopausal periods. Perinatal mental health disorders affect 10–20% of mothers and have profound effects on infant bonding, development, and family functioning. Dr. Ruja's clinic provides gender-informed psychiatric care: screening for PMDD, perinatal depression and anxiety (Edinburgh Postnatal Depression Scale), postpartum psychosis risk assessment, and hormone-related mood disorders with integrated treatment plans.
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stress-burnoutBurnout is recognized by the WHO as an occupational phenomenon characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. It affects 20–30% of working adults and has significant psychiatric consequences: depression, anxiety, substance use, cardiovascular disease, and immune dysfunction. Dr. Ruja's clinic treats burnout as a systemic problem requiring assessment of workload, recovery capacity, boundary integrity, and meaning in work — not merely stress management techniques.
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psychotherapyPsychotherapy encompasses a diverse range of evidence-based treatments, each with specific mechanisms of action, indications, and evidence bases. No single therapy is universally superior — the best approach depends on diagnosis, severity, patient preference, and therapeutic alliance. Dr. Ruja's clinic draws from multiple modalities: cognitive-behavioral therapy (CBT) for anxiety and depression, dialectical behavior therapy (DBT) for emotion dysregulation, interpersonal therapy (IPT) for relationship-focused presentations, EMDR for trauma, and acceptance and commitment therapy (ACT) for experiential avoidance. The clinic emphasizes measurement-based care and transparent discussion of what each therapy offers.
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Diabetic foot disease affects up to 25% of people with diabetes during their lifetime and is the leading cause of non-traumatic lower-limb amputation. At Dr. Bodh Raj’s clinic, diabetic foot management follows a structured limb-salvage pathway: risk stratification (monofilament testing, vibration sense, ankle-brachial index), wound classification (Wagner or University of Texas system), infection control (IDSA/IWGDF criteria), offloading, vascular assessment, and multidisciplinary coordination with endocrinology, vascular surgery, and podiatry.
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foot-ankleFoot and ankle complaints account for a significant proportion of orthopedic presentations, ranging from biomechanical dysfunction to acute trauma and degenerative disease. At Dr. Bodh Raj’s clinic, foot and ankle assessment follows a systematic protocol: history of pain pattern, activity level, footwear, and biomechanics; gait analysis; static and dynamic musculoskeletal examination; neurovascular assessment; and targeted imaging (X-ray, ultrasound, or MRI) when clinical findings warrant further evaluation.
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plantar-fasciitisPlantar fasciitis is the most common cause of heel pain, affecting approximately 10% of the population at some point in their lives, and accounts for over 1 million physician visits annually. At Dr. Bodh Raj’s clinic, plantar fasciitis management follows a structured evidence-based pathway: accurate diagnosis (excluding fat pad atrophy, calcaneal stress fracture, Baxter’s neuropathy, and seronegative arthropathy), progressive non-operative treatment (stretching, orthotics, extracorporeal shockwave therapy, PRP), and surgical referral only after 6–12 months of failed conservative care.
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nail-conditionsNail disorders affect up to 10% of the general population and are more common in older adults, athletes, and people with diabetes or peripheral vascular disease. At Dr. Bodh Raj’s clinic, foot nail conditions are evaluated systematically: fungal infection (onychomycosis) is confirmed by KOH preparation or culture; ingrown toenails are classified by severity (Grade I–III) and treated with conservative or surgical approaches; and nail dystrophy is differentiated from melanoma, psoriasis, and lichen planus. Proper nail care education is emphasized as a preventive strategy.
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fracture-careFractures are among the most common orthopedic presentations, ranging from low-energy fragility fractures to high-energy polytrauma. At Dr. Bodh Raj’s clinic, fracture management follows established principles: accurate classification (AO/OTA system), assessment of fracture stability and soft tissue envelope, appropriate stabilization (casting, plating, nailing, or external fixation), and structured rehabilitation to restore function. Open fractures require emergent irrigation, debridement, and antibiotics within the golden hour.
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joint-replacementTotal joint replacement is one of the most successful and cost-effective interventions in modern orthopedic surgery, with >95% survivorship at 15 years for both hip and knee arthroplasty. At Dr. Bodh Raj’s clinic, joint replacement follows a patient-centered pathway: shared decision-making, preoperative optimization (weight loss, diabetes control, smoking cessation), evidence-based implant selection, enhanced recovery after surgery (ERAS) protocols, and structured rehabilitation for early mobilization and functional recovery.
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sports-injurySports injuries span a spectrum from acute ligament ruptures and muscle strains to chronic overuse tendinopathies and stress fractures. At Dr. Bodh Raj’s clinic, sports injury management follows a structured return-to-play pathway: accurate diagnosis (clinical examination augmented by ultrasound or MRI), risk stratification for return to sport, evidence-based treatment (operative vs non-operative), and graduated rehabilitation with objective return-to-play criteria. The emphasis is on evidence over tradition — many commonly used treatments lack strong evidence.
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osteoarthritisOsteoarthritis (OA) is the most common joint disease worldwide, affecting over 500 million people globally, and is the leading cause of disability in older adults. At Dr. Bodh Raj’s clinic, osteoarthritis management follows a stepped-care model: patient education, weight management, exercise therapy, pharmacological management (analgesia and intra-articular injections), and surgical referral (arthroscopy in select cases, osteotomy, or joint replacement) when conservative measures fail. The emphasis is on function and quality of life, not just radiographic appearance.
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pediatric-orthopedicsPediatric orthopedic conditions require an understanding of the growing skeleton, where growth plates, bone remodeling capacity, and age-specific pathologies differ fundamentally from adult presentations. At Dr. Bodh Raj’s clinic, pediatric orthopedic assessment integrates developmental history, growth status (Tanner staging, bone age), and age-appropriate examination to manage conditions ranging from developmental dysplasia of the hip and clubfoot to scoliosis, Slipped Capital Femoral Epiphysis (SCFE), and pediatric sports injuries.
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spine-painLow back pain is the leading cause of disability worldwide, affecting over 540 million people at any given time. Neck pain affects 20–40% of adults annually. At Dr. Bodh Raj’s clinic, spine pain management follows a biopsychosocial model: accurate diagnosis (red flag screening, clinical examination, targeted imaging), classification by pain generator (disc, facet, sacroiliac joint, radiculopathy, stenosis), evidence-based non-operative care (exercise therapy, manual therapy, psychological support), and interventional procedures or surgery when conservative measures fail.
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wound-careWound care is a critical component of orthopedic practice, encompassing acute surgical wounds, traumatic lacerations, and chronic wounds (venous, arterial, pressure, and diabetic). At Dr. Bodh Raj’s clinic, wound care follows a systematic approach: wound assessment (etiology, dimensions, wound bed, exudate, peri-wound skin, edema), classification (TIME framework — Tissue, Infection/Inflammation, Moisture balance, Edge of wound), evidence-based treatment (debridement, dressings, compression, offloading), and monitoring for healing trajectory. Wounds not healing within expected timeframes require reassessment of diagnosis and treatment.
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musculoskeletal-preventionPrevention of musculoskeletal injury and disability is the most cost-effective approach to orthopedic health. Physical inactivity is a leading risk factor for chronic disease and disability, while regular exercise reduces the risk of osteoporotic fractures by 20–40%, knee osteoarthritis by 15–30%, and chronic low back pain by 25–40%. At Dr. Bodh Raj’s clinic, musculoskeletal prevention is integrated into clinical care: exercise prescription, fall prevention, osteoporosis management, ergonomic advice, and prehabilitation before surgery to optimize postoperative outcomes.
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Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterised by symmetric polyarthritis that, if inadequately treated, leads to irreversible joint destruction, disability, and increased cardiovascular mortality. The treat-to-target (T2T) strategy — endorsed by EULAR, ACR, and APLAR — mandates achieving remission or low disease activity within six months through rapid DMARD initiation and protocolised escalation. At Dr. Shree Narayan's clinic, DAS28-ESR or DAS28-CRP is measured at every visit, methotrexate is initiated within the diagnostic window, and biologic or targeted synthetic DMARDs are escalated at three-month intervals when targets are not met. This approach reduces radiographic progression by up to 70% compared with conventional symptom-driven management.
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lupusSystemic lupus erythematosus (SLE) is a prototypic systemic autoimmune disease characterised by loss of self-tolerance, autoantibody production, and immune complex-mediated inflammation affecting virtually every organ system. At Dr. Shree Narayan's clinic, SLE management follows a treat-to-target paradigm using the SLEDAI-2K activity index, organ-specific damage assessment via the SLICC/ACR Damage Index, and a hydroxychloroquine-centred regimen that reduces flares, thrombosis, and mortality across all disease subtypes. Lupus nephritis — the most significant predictor of poor long-term outcome — is managed with protocolised induction and maintenance immunosuppression guided by renal biopsy classification. Antiphospholipid antibody screening and thrombosis risk stratification are integrated into routine follow-up.
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spondyloarthropathyAnkylosing spondylitis (AS) is a chronic inflammatory axial spondyloarthropathy characterised by sacroiliitis, enthesitis, and progressive spinal fusion that leads to significant functional impairment if untreated. At Dr. Shree Narayan's clinic, early diagnosis is pursued using the ASAS classification criteria (inflammatory back pain plus MRI sacroiliitis or HLA-B27 plus two additional spondyloarthropathy features), and treatment follows a T2T approach using BASDAI and ASDAS scores to guide escalation from NSAIDs to biologic DMARDs. Anti-TNF agents remain first-line biologics, with IL-17 inhibitors (secukinumab, ixekizumab) offering an alternative for patients with inadequate response or contraindications to anti-TNF therapy. Peripheral manifestations including enthesitis, dactylitis, and arthritis are addressed concurrently.
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crystal-arthropathyGout is the most prevalent inflammatory arthropathy worldwide, caused by deposition of monosodium urate (MSU) crystals in joints and soft tissues resulting from chronic hyperuricaemia. At Dr. Shree Narayan's clinic, definitive diagnosis rests on polarised light microscopy demonstrating negatively birefringent needle-shaped MSU crystals in synovial fluid or tophus aspirate. Acute flare management follows a step-up approach from colchicine to NSAIDs to corticosteroids, while long-term urate-lowering therapy (ULT) is initiated with allopurinol using a treat-to-target strategy aiming for serum urate less than 6 mg/dL (360 micromol/L) to achieve crystal dissolution and prevent flares.
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vasculitisVasculitis encompasses a heterogeneous group of disorders characterised by inflammation of blood vessels that can affect any organ system and range from life-threatening systemic disease to isolated cutaneous involvement. At Dr. Shree Narayan's clinic, vasculitis classification follows the 2012 Chapel Hill nomenclature (large, medium, and small vessel), and assessment integrates ANCA serology (c-ANCA/PR3, p-ANCA/MPO), imaging (CT/MR angiography, PET-CT), and tissue biopsy where feasible. Treatment is stratified by disease severity using the BVAS (Birmingham Vasculitis Activity Score) and VDI (Vasculitis Damage Index), with induction immunosuppression transitioning to long-term maintenance to prevent relapse.
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autoimmune-diagnosticsAutoimmune serology is the cornerstone of rheumatic disease diagnosis, yet interpretation requires understanding of test sensitivity, specificity, and clinical context. At Dr. Shree Narayan's clinic, autoimmune serology interpretation follows a structured approach: ANA screening with pattern recognition (homogeneous, speckled, nucleolar, centromere), confirmation with disease-specific antibodies, and integration with clinical phenotype. A positive ANA in isolation is clinically meaningless — up to 15-25% of healthy individuals have low-titre ANA. The diagnostic value lies in titre magnitude, pattern, and correlation with disease-specific autoantibodies such as anti-dsDNA, anti-Sm, anti-CCP, and anti-Scl-70.
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biologic-therapyBiologic disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) have transformed the management of inflammatory rheumatic diseases, enabling remission in conditions previously refractory to conventional therapy. At Dr. Shree Narayan's clinic, biologic selection is guided by disease phenotype, serological status, comorbidity profile, patient preference, and evidence from randomised controlled trials. Pre-treatment screening encompasses infection risk assessment (TB, hepatitis B/C, HIV), vaccination status, cardiovascular risk stratification (particularly for JAK inhibitors), and malignancy history. Therapeutic drug monitoring (TDM) using trough levels and anti-drug antibodies is employed to differentiate primary non-response from immunogenic secondary loss of response.
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osteoarthritisOsteoarthritis (OA) is the most prevalent joint disease worldwide, affecting over 500 million people, characterised by progressive cartilage degradation, subchondral bone remodelling, synovial inflammation, and debilitating pain. At Dr. Shree Narayan's clinic, OA management follows a stepwise, patient-centred approach: structured exercise and weight management as the foundation, pharmacological analgesia as adjuncts, and image-guided intra-articular procedures (corticosteroids, hyaluronic acid, platelet-rich plasma) for patients who remain symptomatic. Joint replacement is recommended when conservative measures fail and functional limitation, pain, and reduced quality of life meet agreed thresholds.
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fibromyalgiaFibromyalgia is a chronic centralised pain condition characterised by widespread musculoskeletal pain, fatigue, sleep disturbance, cognitive dysfunction, and emotional distress, affecting 2-4% of the adult population with a strong female predominance (7:1). At Dr. Shree Narayan's clinic, fibromyalgia management adopts a multidisciplinary biopsychosocial model integrating pharmacotherapy (duloxetine, pregabalin, amitriptyline), structured exercise therapy, cognitive-behavioural therapy (CBT), and sleep hygiene. The 2010/2011 ACR criteria (Widespread Pain Index plus symptom severity score) have replaced the older tender point examination, enabling diagnosis without physical examination and facilitating primary care recognition.
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autoimmune-overlapConnective tissue overlap syndromes occur when patients fulfil classification criteria for two or more autoimmune rheumatic diseases simultaneously or sequentially, creating diagnostic and therapeutic challenges. At Dr. Shree Narayan's clinic, overlap syndrome recognition requires systematic antibody profiling (anti-U1 RNP for MCTD, anti-PM-Scl for myositis-scleroderma, anti-Ku for overlap myositis), comprehensive organ assessment, and longitudinal follow-up to detect disease evolution. Undifferentiated connective tissue disease (UCTD) represents an early or incomplete phase that may evolve into a defined connective tissue disease over 5 to 10 years in approximately 30% of cases, requiring structured surveillance.
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autoimmune-overlapPregnancy in women with rheumatic disease requires meticulous preconception planning, medication reconciliation for teratogen avoidance, disease activity optimisation before conception, and close perinatal monitoring for maternal flare, pre-eclampsia, and fetal complications. At Dr. Shree Narayan's clinic, a multidisciplinary pregnancy planning clinic coordinates rheumatology, obstetric, and neonatal care. Disease activity in the 6 months before conception is the strongest predictor of flare during pregnancy and adverse outcomes. Key teratogens requiring discontinuation include methotrexate, leflunomide, mycophenolate mofetil, and JAK inhibitors, all of which must be discontinued at least 3 to 6 months before attempted conception.
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musculoskeletal-medicineMusculoskeletal ultrasound (MSUS) has emerged as an indispensable point-of-care tool in rheumatology practice, enabling real-time assessment of synovial inflammation, joint effusion, tendon pathology, and crystal deposition without radiation exposure. At Dr. Shree Narayan's clinic, MSUS is used for diagnostic assessment (differentiating inflammatory from mechanical joint disease), guided aspiration and injection (improving accuracy to greater than 95%), and monitoring treatment response (quantifying subclinical synovitis and power Doppler activity). Grey-scale ultrasound detects synovial hypertrophy and effusion, while power Doppler ultrasound identifies active neovascularisation correlating with histological synovitis and predicting structural progression.
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Authority topics are structured, evidence-based deep dives into specific neurology conditions. Each topic is authored and medically reviewed by Dr. Jitendra Prasad Yadav (MBBS, MD (Internal Medicine), FICN (Neurology), FCNV, FIHM), drawing on 15+ years of clinical experience of clinical practice at National Trauma Center (NAMS) and Kathmandu Neurology Clinic.
Unlike general health articles, authority topics follow international diagnostic criteria — ICHD-3 for headache disorders, AAN guidelines for neurodegenerative conditions, and WHO classifications for epilepsy and stroke. They are designed to bridge the gap between specialist knowledge and patient understanding.
Neurology conditions are complex and often misunderstood. Patients frequently encounter fragmented information online that lacks clinical context. Authority topics provide a single, reliable reference point where patients can learn about their condition, understand diagnostic criteria, explore treatment options, and know when to seek urgent care.
Each topic links directly to relevant clinic services, appointment booking, and related blog posts — creating a clear path from education to action. This approach supports informed conversations between patients and their neurologist.
Each topic is authored by a consultant neurologist with 15+ years of specialist experience, follows international diagnostic criteria (ICHD-3, AAN, WHO), and is medically reviewed before publication. Content links to clinic services and is regularly updated as guidelines evolve.
No. These topics are educational and designed to help you understand conditions, prepare for appointments, and have informed discussions with your clinician. Diagnosis requires a personal neurological examination, history, and sometimes investigations — none of which can be replaced by reading alone.
Topics are reviewed periodically and whenever major guideline updates are published. If you notice outdated information, please contact the clinic so it can be reviewed and corrected promptly.
Content on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.