Browsing by Author "Acharya, S"
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Publication 64-Slice CT Scan in Kathmandu Medical College Teaching Hospital(Kathmandu University, 2008) Karki, DB; Neopane, A; Regmi, S; Acharya, SAbstract 64-slice CT scan is a versatile newly introduced imaging technology, which is capable of diagnosing various diseases from head to toe. The 64-slice CT coronary angiography has a negative predictive value of 100%. Virtual images of bronchi, stomach and colon can provide definite diagnosis. Coronary artery calcification score which predicts coronary artery disease can be calculated by 64-slice CT scan. Key words: coronary angiography, coronary calcificationPublication Cesarean Section without Urethral Catheterization: A Randomized Control Trial(Kathmandu university, 2012) Acharya, S; Uprety, DK; Pokharel, HP; Amatya, R; Rai, RABSTRACT Background Urethral catheterization is done as a routine procedure in cesarean section. It is associated with high incidence of urinary tract infections, discomfort, delayed ambulation and longer hospital stay Objective To determine the feasibility and safety of cesarean section without urethral catheterization. Methods A prospective, randomized controlled trial was carried out from April 2008 to March 2009, in the Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences. Among 150 patients who had undergone cesarean section 75 were catheterized and 75 were uncatheterized. Results First void discomfort was significantly associated with the use of indwelling catheter (OR 6.95, CI 95 %, 3.74 to 12.95; P< 0.001).Significant number of patients with indwelling catheter had signs and symptoms of urinary tract infection (OR 6,CI 95%, 2.59 to 13. 86; P < 0.001). Positive urinalysis for urinary tract infection was high in catheterized group (P <0.001). Hospital stay was shorter in patients without catheter (p < 0.05). None of the patients had bladder injury. There were no significant differences in duration of surgery and ambulation time between two groups of patients. Conclusions Cesarean section can be done safely without urethral catheterization with reduced morbidities. KEY WORDS Cesarean section, urethral catheterization, Urinary tract infectionPublication Deep Brain Stimulation in Parkinsons Disease in Nepal(Kathmandu University, 2018) Shrestha, R; Taira, T; Shrestha, P; Rajbhandari, P; Acharya, S; Pant, BABSTRACT Background Parkinsons disease is a central nervous system degenerative disorder affecting motor system and characterized by progressive tremor, rigidity, gait abnormalities. Surgical treatment of Parkinsons disease is based on the changes in the basal ganglio- thalamocortical circuits which is altered in Parkinsons disease. Currently pallidotomy and Deep Brain Stimulation are available modes of surgical treatment of Parkinsons disease. Objective To know efficacy of deep brain stimulation in Parkinsons Disease in Nepal. Method All patients of idiopathic Parkinsons disease who underwent Deep Brain Stimulation in Annapurna Neurological Institute and Allied sciences since 2014 were included. The standard functional coordinates for Subthalamic nucleus and Globus pallidus internus was used. We used Zamarano-Dujovny (ZD) Fisher Frame with its software. Patients’ Unified Parkinsons disease rating score, Modified Hoehn and Yahr Staging and Schwab and England Activities of daily living Scale were evaluated preoperatively as well as postoperatively. Result Ten patients underwent Deep Brain Stimulation. The male is to female ratio was 2:1. The mean age was 55.4±8.9 years and duration of illness was 5.5±2 years. There was a significant improvement in the scores for the main motor manifestations of the disease between the preoperative off-dopa and postoperative off-dopa/on-stim conditions. There was a significant improvement in Schwab and England Activities of daily living scale scores in the off-dopa condition between the preoperative score and the postoperative M6 score. Conclusion Our result of Deep Brain Stimulation is quite promising. However, it is very expensive and requires frequent follow-up for neuromodulation. KEY WORDS Deep brain stimulation, Parkinsons disease, Unified parkinsons disease rating scorePublication Digital Subtraction Angiography a Door Opener for Neurosurgical Residents who want to Perform Neurointerventional Procedures(Kathmandu University, 2021) Rajbhandari, P; Gurung, P; Rajbhandari, S; Shrestha, D; Acharya, S; Shrestha, R; Shrestha, P; Shrestha, J; Sharma, U; Mali, S; Rajbhandari, R; Neupane, A; Pant, BABSTRACT Digital subtraction angiography (DSA) has been a fluoroscopic golden investigative tool to know the vascular angiography of the brain and spinal cord. The technique in performing this procedure exposes residents in accessing the major vessels, branches of the arch of aorta, selective angiography and diagnosing different vascular anomalies of brain and spine. They are also exposed to the knowledge of different diagnostic catheters, its manipulation, use of dye and radiation exposure and safety. We would like to share our experience in training and disseminating the knowledge of digital subtraction angiography to the residents. KEY WORDS Digital subtraction angiography, Neurosurgical residents, NeurointerventionPublication Efficacy of bronchial cytology in diagnosing lung lesions and its correlation with bronchial biopsy(Institute of Medicine, 2018) Hirachand, S; Sthapit, RR; Gurung, P; Acharya, SAbstract Introduction: Neoplastic and non-neoplastic lung lesions have a high rate of morbidity and mortality. Lung cancer is the frequently diagnosed cause for cancer related deaths and tuberculosis is still the leading cause of death in developing countries. Timely detection of disease plays an important role in the management and long term survival of patients. For early diagnosis different diagnostic modalities are available which include bronchoalveolar lavage, bronchial brush, fine needle aspiration cytology and bronchial biopsy. Bronchoalveolar lavage and bronchial brush are very effective in the diagnosis and differential diagnosis of lung cancers. Bronchial brushings often offer excellent specimens and accurate information about the site of the lesion. Better diagnostic yield is often obtained when cytologic techniques are used together with bronchial biopsy.The present study was undertaken to ascertain the role and diagnostic utility of bronchoalveolar lavage, bronchial brush and bronchial biopsy in diagnosing lung lesions. Method: A prospective study was conducted in the Department of Pathology in Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal from January 2016 to December 2017 (2 years). A total of 48 cases were included in the study. Bronchoalveolar lavage, bronchial brush and bronchial biopsy slides were stained with routine cytological and histological staining and examined. Results: Out of 48 cases, bronchoalveolar lavage smears revealed 24 non-neoplastic, 19 neoplastic and 5 suspicious cases. Bronchial brush smears revealed 24 neoplastic, 22 non-neoplastic and 2 suspicious cases. Bronchoscopic biopsy revealed 31 neoplastic and 17 non-neoplastic lesions. The bronchial brush cytology showed sensitivity of 82.76%, specificity of 89.47% and accuracy of 85.42%. Conclusion: Combination of bronchial cytology and biopsy can be considered as the best procedures for the diagnosis of lung lesions. Keywords: Bronchoalveolar lavage, Bronchial brush, bronchial biopsy, non-neoplastic and neoplastic lung lesionsPublication Health Promoting Lifestyle during Covid-19 Pandemic among Residents of Gandaki Province, Nepal(Kathmandu University, 2022) Shrestha, K; Acharya, S; Poudel, SABSTRACT Background Lifestyle is an important factor to individual’s health and quality of life. Although, the emergence of Corona virus disease 2019 (COVID-19) has forced billions of people to change their lifestyle overnight. Objective To identify health promoting lifestyle during COVID-19 pandemic among the residents of Gandaki Province, Nepal. Method Descriptive cross sectional web based study was conducted among 386 respondents from Gandaki Province. Adults from 18 years and above, who could fill the form online were included using purposive and snowball sampling technique. Data were collected using Health Promoting Lifestyle Profile II (HPLP II) scale and analysed using descriptive (frequency, percentage, median) and inferential statistics (Mann Whitney U test and Kruskal Wallis test). Result Only 18.7% of the respondents had an excellent health promoting lifestyle followed by good health promoting lifestyle among 60.4%. Highest median score was observed in spiritual 27(10-36), and interpersonal relationship subscale 27(9-36). Whereas, the lowest was observed in physical activity 21(8-32) followed by stress management 24(10-32). Statistically significant difference was observed in age and perception of own health status with spirituality; gender, chronic illness and perception of own health status with interpersonal subscale and age, gender, marital status, occupation and perception of own health status with physical subscale. Conclusion The study concludes the need of health education and awareness to promote healthy lifestyle behaviours with a particular emphasis on indoor physical activities and stress management skills with specific consideration to female and elderly. KEY WORDS Adult, COVID-19, Health promoting lifestyle/behaviour, NepalPublication Multiple odontogenic keratocysts associated with Gorlin-Goltz syndrome(Kathmandu University, 2009) Dixit, S; Acharya, S; Dixit, PBAbstract Gorlin-Goltz syndrome or Nevoid basal cell carcinoma syndrome is an autosomal dominant disorder with a predisposition to cancer. Features like basal cell carcinoma, odontogenic keratocysts, calcification of falx cerebri, bifid ribs, pits on palms and soles and hypertelorism are evident. A case of this rare disease seen on a 13 year old female patient is presented here, where multiple odontogenic keratocysts were causing disfigurement of the lower jaw as well as displacement and malocclusion of the lower teeth. Key words: Nevoid basal cell carcinoma syndrome, Gorlin-Goltz syndrome, Odentogenic keratocyst, Calcification of falx cerebri.Publication Role of CaCO3 alone and CaCO3 plus Vitamin D3 in terms of Calcium Phosphorus Product in Chronic Kidney Diseases(Nepal Health Research Council, 2011) Adhikary, L; Acharya, S; Acharya, LBackground: CaCO3 alone and CaCO3 plus vitamin D3 metabolites are commonly prescribed in CKD patients. The objective of this study is to analyze the changes in Ca x P product, calcium level and phosphorus level in CKD patients receiving calcium carbonate alone and calcium carbonate with vitamin D3 in combination. Methods: A prospective, cross sectionalstudy among CKD patients under maintenance hemodialysis two times a week were studied over a period of one year. The patients were divided into two groups receiving oral CaCO3 alone and CaCO3 plus vitamin D3 once a day. The patients were followed for 1 month and result of Ca x P product was analyzed accordingly. Results: Mean decrease of Ca x P product in CaCO3 group is (50.42+/-8.85 to 47 +/-6.63) in one month, p value =0.001(0.6-5) and CI- 95%. There is also significant reduction of phosphorus level in CaCO3 group than CaCO3 plus vitamin D3 group. Mean decrease in phosphorus in CaCO3 group is (5.51+/-0.76 to 5.17+/- 0.05) in one month. P value =0.01(0.14-0.53) and CI 95%. Conclusions: There is a significant decrease in Ca x P product and phosphorus level was observed in CKD patients taking CaCO3 alone. Keywords: calcium carbonate, calcium phosphorus product, chronic kidney disease, vitamin.Publication Utility of Rapid Brilliant Cresyl Blue Stain in Routine Fine Needle Aspiration Cytology(Institute of Medicine, 2017) Gurung, P; Hirachand, S; Thapa, R; Pradhanang, S; Kafle, N; Acharya, S; Sedhain, MAbstract Introduction: Rapid on-site evaluation is commonly performed by pathologists to check for cellular adequacy of fine needle aspirate smears to reduce hospital visits of patients and to make preliminary diagnosis. For rapid evaluation, laboratories use Romanowsky stain, Hematoxylin and Eosin stain, supravital stains and ultra-fast Papanicolaou stain. The aim of the study is to evaluate fine needle aspirate smears on-site for sample adequacy using supravital stain Brilliant Cresyl Blue (BCB), to make preliminary cytological diagnosis and to compare with the routine cytological Papanicolaou stain (Pap) and Giemsa stain. Methods: The study was carried out in the Department of Pathology, Kathmandu Medical College Teaching Hospital from 1st December, 2014 to 31st December, 2015. A total of 115 cases referred from OPD for FNAC were included in the study. FNA was performed under aseptic conditions with a 23-guage needle. Samples were collected for routine stains (Papanicolaou and Giemsa stain) and one air-dried slide was stained with Brilliant Cresyl Blue and examined immediately while patient was in waiting room. Results: Of the 115 cases, the age of patients ranged from 15 to 83 years in which male and female ratio was 1.5:1. There were 35 (30.4%) cases of enlarged lymph nodes, 28 (24%) cases of thyroid lesions, 20 (17.3%) cases of breast lesions, 7 (6%) cases of soft tissue lesion, 3 (3%) cases of salivary gland lesions, 1 (1%) case of lung mass, 1 (1%) case of epididymal swelling and others 20 (17.3%) cases. On rapid staining with brilliant cresyl blue, case sample adequacy was 104 (90%). Repeat aspiration was done in 11 (10%) of cases .Upon rapid staining, 92 (80%) of the cases were benign, 19 (17%) cases were malignant, 4 (3%) cases were inconclusive. After observation of papanicolaou and giemsa stains, there were 94 (82%) benign cases and 21 (18%) malignant cases. Conclusion: On-spot Brilliant Cresyl Blue staining is a good stain to check for sample adequacy and to reduce reaspirations. It is as good as the conventional stains in exhibiting cytomorphology of cells. Keywords: Brilliant Cresyl Blue, cytomorphology, fine needle aspiration cytology, Giemsa stain, Papanicolaou stain