Browsing by Author "Adhikari, B"
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Publication A Study of Assessment of Partial Edentulous Patients Based on Kennedy’s Classification at Dhulikhel Hospital Kathmandu University Hospital(Kathmandu University, 2013) Sapkota, B; Adhikari, B; Upadhaya, CABSTRACT Background Oral health contributes significantly towards quality of life(QOL). Edentulousness falls in a special category among the various conditions of dental origin. Dietary intake and nutritional status is affected by poor oral health and loss of teeth. This will ultimately compromise general health. Objective To identify the frequency of Kennedy’s classification among partial edentulous patients and to compare occurrence among gender and between upper and lower arches and also to compare edentulousness among employed and unemployed population. Methods This study was carried out at Dhulikhel Hospital Dental Department. The study was conducted randomly among 194 patients in dental OPD who were partially edentulous. A structured pro forma was used to find out the edentulousness based on Kennedy,s classification. Results Among the Kennedy’s classification ClassIII was found to be most common. Among them females and unemployed group were found to have more edentulousness and upper arch was more common. It was also found that females were more conscious and get the replacement of missing teeth among which those having Class IV missing were replaced most often. Conclusion The Kennedy Class III partial edentulousness type is most commonly found in this study. KEY WORDS Edentulousness, kennedy’s classificationPublication Analysis of Factors Associated with Thyroid Dysfunction: A Hospital Based Study(Kathmandu University, 2019) Risal, P; Adhikari, B; Shrestha, R; Manandhar, S; Bhatt, RD; Hada, MABSTRACT Background Thyroid dysfunction (TD) is one of the major public health concerns in Nepal. This study intends to identify factors in association with thyroid dysfunction and its hospital based prevalence. Objective To determine hospital-based prevalence of thyroid dysfunction and to identify and analyze factors in association with thyroid dysfunction. Method A retroprospective cross-sectional study was conducted among patients attending Dhulikhel Hospital-Kathmandu University Hospital (DH,KUH) from January to December, 2015 with prospective part carried out from July to December 2015 in the patients visiting Dhulikhel hospital for health check-up and requested for Thyroid Function Tests (TFTs). Thyroid Function Tests of 1530 subjects were performed in the biochemistry laboratory and semi-structured questionnaire were introduced to 312 participants with convenient sampling method and their anthropometric measurements were taken. Chi-square test, Pearson’s correlation and student-t test were used as a measure to analyze factors. Result Out of total 1530 subjects, 35.3% were having thyroid dysfunction with the prevalence of overt hyperthyroidism, subclinical hyperthyroidism, overt hypothyroidism and subclinical hypothyroidism to be 2.5%, 2.4%, 5.6% and 24.8% respectively. The distribution of thyroid dysfunction was preponderant among females and among older age. The prevalence of thyroid dysfunction was highest among Terai/Madhesi (40.0%) and lowest among Newars (28.5%) with higher fraction of hypothyroidism in each ethnic group. There were significant correlation between Thyroid Stimulating Hormone (TSH) with waist-hip ratio (p<0.05) and weight (kg) with free thyroxine (fT4) (p<0.05). Direct pesticide exposure (p<0.05) was significantly associated with hypothyroidism. The serum fT4 was significantly different (p<0.05) among vegetarian and non-vegetarian whereas TSH and free triiodothyronine (fT3) were not significantly different. Smoking, alcoholism, dietary food habits, diabetes and hypertension were not significantly associated with thyroid dysfunction. Conclusion Thyroid dysfunction was highly prevalent among participants with higher proportion of subclinical hypothyroidism. Besides, direct pesticide exposure found to be factor in association with hypothyroidism, this study could not find significance relation with other established risk factors. KEY WORDS Hyperthyroidism, Hypothyroidism, Thyroid dysfunction, Thyroid function testPublication Awareness and Knowledge of Glaucoma and their Associated Factors among People Visiting a Tertiary Level Hospital in Central Nepal(Kathmandu University, 2022) Shrestha, A; Shrestha, P; Shrestha, T; Shrestha, RM; Sujakhu, D; Dhakal, K; Thapa, G; Adhikari, S; Karki, S; Adhikari, BABSTRACT Background Glaucoma is one of the major causes of irreversible blindness globally. Almost 60 million people globally are affected by glaucoma making it the second leading cause of blindness worldwide. Diagnosis of glaucoma early on is vital for timely management and prevention of blindness. However, it is challenging to diagnose it early because it is asymptomatic in the initial stage, and there is also the dearth of appropriate screening tools. Awareness, knowledge, and beliefs are believed to influence the treatment-seeking behavior of people as well as their uptake of services. Objective To assess the awareness and knowledge about glaucoma among general patients and patient attendants visiting Dhulikhel Hospital. Method We conducted a cross sectional quantitative study among general patients visiting Dhulikhel Hospital. We collected data using face-to-face interviews with semi- structured questionnaires. We analyzed data in R version 4.0.3 (2020-10-10). We presented numerical variables as mean and standard deviation whereas categorical variables as frequency and percentage. We determined factors associated with awareness and knowledge of glaucoma using logistic regression analysis and estimated adjusted odds ratio (AOR) with 95% confidence interval. Result Of 379 participants, a total of 214 (56.5%) participants had heard about glaucoma. Out of the participants who heard about glaucoma, the mean knowledge score was 48.3±21.7 and 53.3% had good knowledge on glaucoma. The odds of having heard about glaucoma were two percent lower (AOR=0.98; 95%CI: 0.97-0.99; p-value 0.036) in the older participants compared to one year younger participant, 1.98 (95%CI:1.01-3.86; p-value 0.046) times higher among literates and 2.79 (95%CI: 1.76- 4.41; p-value < 0.001) times among participants with previous ocular examination. The odds of having good knowledge was 1.94 (95%CI: 1.10-3.42; p value 0.021) times among participants with previous ocular examinations. Conclusion The knowledge and awareness regarding glaucoma in a hospital-visiting population in central Nepal was low. Half of the participants were unaware of the disease glaucoma and half of the participants who heard of the glaucoma had poor knowledge on glaucoma. KEY WORDS Awareness, Glaucoma, KnowledgePublication Central Pancreatectomy for Bilobed Solid Pseudopapillary Tumor of Pancreas(Kathmandu University, 2023) Jha, MK; Ramtel, R; Adhikari, B; Laudari, U; Thapa, A; Rawal, SBABSTRACT Solid-pseudopapillary tumor of pancreas is a rare pancreatic tumor that occurs predominantly in a young female with only a small minority concerning children. These tumors have low malignant potential, found incidentally which are usually single lobed. Surgical resection remains the mainstay of treatment. Our case is 26 years female with vomiting and abdominal pain localized to the right upper quadrant. Computerized tomography scans showed two well-defined hypodense lesions at neck and body of the pancreas with greatest diameter of six centimeter. The patient underwent central pancreatectomy and histopathology confirmed solid-pseudopapillary tumor with complete resection with all resected margin free of tumor. Symptoms may be present such as abdominal pain or vomiting due to compression, mainly in large tumors. In benign cases parenchyma sparing surgery such as central pancreatectomy can preserve the exocrine and endocrine function of pancreas which helps patient to have better postoperative quality of life. KEY WORDS Bilobed mass, Central Pancreatectomy, Solid-pseudopapillary tumorPublication Comparison between Simple and Classical Techniques to Create Closed Pneumoperitoneum(Kathmandu University, 2021) Gharti, BB; Shrestha, PM; Shrestha, A; Basnet, RB; Shah, C; Adhikari, BABSTRACT Background Closed method of pneumoperitoneum using Veress needle is an established technique. Classical closed technique is popular. Simple technique is a modified closed technique. Objective To compare the classical and simple techniques of closed pneumoperitoneum. Method This study was conducted in the department of urology, Bir hospital from August 1st 2019 to March 30th 2021. Total 114 patients were randomized into simple and classical technique of creating closed pneumoperitoneum. Time taken for creation of pneumoperitoneum, complications and failure of creating pneumoperitoneum in each group noted and analyzed. Chi square test, Fischer exact test and student t test were used and p < 0.05 considered significant. Result Among 114 patients, 61 in simple and 53 in classical technique allocated. In simple technique, mean age was 42.98±18.21 years, BMI was 21.84±2.57 kg/m2, mean time for pneumoperitoneum creation was 108.07±21.14 seconds. In classical technique, mean age was 40.15±17.58 years, BMI was 21.94±2.54 (kg/m2), mean time for pneumoperitoneum creation was 189.70±32.21 seconds. Mean time was less in simple technique than classical technique (p < 0.001). Complication rate observed was 6% in each technique (p=0.797) with cumulative rate of 10%. Omental injury was seen in 3.2% in simple technique and 5.6% in classical technique (p=0.662). Retroperitoneal insufflation was seen in 6.5% in simple technique and 5.6% in classical technique (p=0.842). No failed pneumoperitoneum was observed in both groups. Conclusion Simple technique is as effective, reproducible and safe method as classical technique of creating closed pneumoperitoneum. KEY WORDS Classical technique, Pneumoperitoneum, Veress needlePublication Correlation between Computed Tomography and Ultrasonography Findings in Patients with Fatty Liver(Kathmandu University, 2024) Kayastha, P; Paudel, S; Chapagain, P; Shingh, SS; Adhikari, B; Joshi, S; Katwal, SABSTRACT Background Fatty liver disease, linked to obesity, alcohol consumption, and insulin resistance, is characterized by pathological fat deposition exceeding 5%. Its rising global prevalence, particularly in Southeast Asia, highlights the need for effective diagnostic modalities. Objective To find the correlation between computed tomography and ultrasonography findings in patients with fatty liver. Method A prospective cross-sectional study was conducted on 211 patients from December 2016 to October 2017. Patients referred for computed tomography chest and abdomen were included, excluding those with diffuse or focal liver disease other than fatty liver. Computed tomography attenuation values were measured using non- contrast sequences, with participants showing mean hepatic attenuation less than +48 Hounsfield units subjected to further ultrasound and shear wave elastography examinations. Data were analyzed using Microsoft Excel and SPSS, with associations examined through Pearson correlation, ANOVA and Shapiro-Wilk test. Result The study included 100 males and 111 females, aged 21 to 65 years. The mean computed tomography attenuation was +40.31 Hounsfield units. A moderately strong negative correlation was found between Computed Tomography attenuation and ultrasound grades of fatty liver (Spearman’s coefficient = -0.775, p = 0.005). No significant correlation was observed between computed tomography attenuation and shear wave elastography values, nor between patient age and hepatic attenuation. Conclusion This study demonstrates a significant correlation between computed tomography attenuation and ultrasound grades of fatty liver, highlighting their complementary roles in diagnosing fatty liver disease. However, no significant correlation was found between computed tomography attenuation and shear wave elastography values. KEY WORDS Attenuation, Computed tomography, Elastography, Fatty liver, UltrasoundPublication Depression Among Undergraduate Medical Students(Kathmandu University, 2012) Basnet, B; Jaiswal, M; Adhikari, B; Shyangwa, PMABSTRACT Background Psychological stress is common in medical school and associated with depression. Medical education is grooming in Nepal, but only few studies are done concerning mental health of medical students. Objective To assess the prevalence of depression among medical students at different levels of education and find about their stressors. Methods A cross sectional, questionnaire-based survey was carried out among the undergraduate medical students of B.P.Koirala Institute of Health Sciences, Nepal. 50 students each from Bachelor of Medicine and Bachelor of Surgery (MBBS) first and third year were enrolled in the study conducted between November 2008 to January2009. The depression levels were assessed using Zung depression scale. Students were asked to complete the questionnaire and then the depression levels calculated .The stress inducing factors during their course of medical education were also assessed. Results The overall prevalence of depression among the students was 29.78 percent. The prevalence of depression in first and third year was 36.74and 22.22 percent respectively. The prevalence of depression was 32.43 percent among female students versus 28.07 percent in male students. Both first and third year students gave high ratings to academic stress and hectic lifestyle as the main stress inducing factors. Conclusion The prevalence of depression is seen especially in the first year medical students. So, attempts should be made to alleviate the stressors right from the time they join medical school. Since academic stress proved to be one of the major factors, measures to make the academic curriculum more student-friendly are suggested. KEY WORDS Depression, medical students, zung depression scalePublication En Bloc Versus Conventional Resection of Primary Bladder Tumor(Kathmandu University, 2025) Thapa, BB; Shah, AK; Adhikari, B; Mishra, U; Dahal, R; Rasali, N; Basnet, RB; Shrestha, PM; Shrestha, AABSTRACT Background Transurethral resection of bladder tumor (TURBT) is the crucial and standard approach in the diagnosis and management of urinary bladder cancer. Objective To compares conventional piecemeal and en bloc resection techniques in terms of detrusor muscle presence in resected specimens, surgical safety, and feasibility. Method A prospective comparative study conducted from April 2024 to March 2025 included patients with up to three bladder tumors, measuring ≤ 3 cm, who were alternately assigned to undergo either conventional piecemeal resection or en bloc resection. The primary outcome was the presence of detrusor muscle in the resected specimen. Secondary outcomes included operative time duration, bladder perforation, and obturator reflex. The quality of tissue was assessed by pathologists using a Likert scale. Result Eighty-seven patients were included, 43 in the conventional and 44 in the en bloc group. The baseline characteristics and tumor size were comparable. Presence of detrusor muscle in specimens was higher in en bloc group (97.7% vs 83.7%; p = 0.030). Operative duration was shorter in the en bloc group (35.55 minutes vs 43.42 minutes; p = 0.001). A case of bladder perforation was observed in the conventional group. Pathologists observed better specimen orientation and architecture in the en bloc group. Presence of tumor in re-TURBT was 16.0% in the en bloc group and 28.6% in the conventional group (p=0.497). Conclusion En bloc resection yielded a higher presence of detrusor muscle and shorter operative duration with better specimen quality compared to conventional piecemeal resection for tumor ≤ 3 cm. KEY WORDS Detrusor muscle, En bloc resection, Transurethral resection of bladder tumorPublication Feasibility, Safety and Acceptance of Buccal Mucosa Harvest Under Local Anesthesia for Substitution Urethroplasty: Prospective Observational Study in a Tertiary Centre(Kathmandu University, 2024) Pandey, A; Shrestha, PM; Shrestha, A; Basnet, RB; Adhikari, B; Shah, AK; Mishra, UABSTRACT Background Urethral stricture is a challenging condition with significant socioeconomic impacts, often requiring surgical intervention such as urethroplasty. Buccal mucosa grafts (BMG) are a popular choice for substitution urethroplasty due to their favorable outcomes. This study evaluates the feasibility, safety, and acceptance of harvesting buccal mucosa grafts under local anesthesia. Objective To assess feasibility, safety and acceptance of Buccal mucosa harvest under local anesthesia. Method A prospective observational hospital based study to evaluate outcomes of substitution urethroplasty using buccal mucosa grafts (BMG) under local anesthesia. Result Of the 40 patients, 28 had unilateral graft harvests, while 12 had bilateral procedures. The mean graft length obtained was 5.65 cm. Postoperatively, patients experienced a quick recovery, with full mouth opening achieved within an average of 2.78 days and resumption of normal eating within 2.6 days. Minor complications included oral swelling in 15% of cases and food residue in 12.5%. Although 87.5% of patients reported pain at the perineal wound site, the overall pain score averaged 3.58, indicating manageable discomfort. Importantly, 92.5% of patients expressed a willingness to undergo the procedure again if necessary. Conclusion These findings suggest that buccal mucosa graft harvest under local anesthesia is both feasible and well-tolerated. The procedure appears to be a safe alternative to regional or general anesthesia, with minimal complications and a high level of patient acceptance. Future randomized controlled trials comparing local anesthesia to regional or general anesthesia could provide additional insights and further validate these findings. This study contributes to the growing body of evidence supporting the use of local anesthesia in urethral stricture surgery, offering a practical approach to managing this condition effectively. KEY WORDS Buccal mucosa graft, Feasibility study, Local anesthesia, Substitution urethroplasty, Urethral stricturePublication Liver Function Parameters and Validation of Health-Related Quality of Life Assessment of β-Thalassemia Cases at a Tertiary Care Hospital, Lumbini Province, Nepal(Kathmandu University, 2025) Gautam, N; Risal, P; Gupta, RT; Agrawal, KK; Chaudhary, D; Paudel, MS; Adhikari, B; Pokhrel, BR; Tamang, B; Shrestha, J; Sharma, B; Ghimire, SABSTRACT Background Individuals affected by β-thalassemia experience complications such as hepatic hemosiderosis and fibrosis due to frequent blood transfusions, which can lead to iron overload. Multiple blood transfusion burdens in thalassemia, particularly in low- income countries, impact health-related quality of life. Objective Liver function parameters and health-related quality of life were assessed using Nepali version 36 short-form survey instruments to reveal the vitality, physical, mental, emotional, pain, general health, and social functioning of β-thalassemia cases. Method In this cross-sectional study, forty β-thalassemia cases who had visited the Universal College of Medical Sciences tertiary care teaching hospital of Lumbini Province, Nepal were enrolled. The hemoglobin variant band percentage was estimated by D-10 BioRad high performance liquid chromatography (HPLC), Mentzer Index (Mean Cell Volume by Red Blood Cell count) by Beckman hematological analyzer, and serum liver parameters (Bilirubin, Total protein, Albumin, Alanine aminotransferase, Aspartate aminotransferase, Alkaline phosphatase) were estimated by using Diatron fully automated analyzer. The internal consistency of the Nepali version of 36 short- form survey instruments was checked by Cronbach`s alpha was found to be > 0.70 from the recoded value. Data are analyzed using the STATA/MP14, and ANOVA and t-test are applied to test the significance considering p-value < 0.05. Result The frequency of the β-thalassemia Trait (60%) was higher than β-thalassemia Major (30%) and 7.5% β-thalassemia Intermedia co-morbidities with Sickle cell (2.5%) and β/δ variants (2.5%). Higher frequency was found in ethnic groups Muslim (32.5%) followed by Terai indigenous-Tharu (30%) and Madheshi (27.5%). The transfusion- dependent cases have significantly higher Total, Direct, Indirect Bilirubin, and Alkaline phosphatase levels than non-transfusion dependent cases (p<0.001). The physical functioning, general health, emotional health, and vitality were significantly decreased in β-thalassemia Major as compared to β-thalassemia Trait (p<0.001), and significantly correlated with Mentzer index and HPLC patterns (HBA2/HBF) (p<0.05). Conclusion Transfusion dependent β-thalassemia Major and Intermedia had elevated Bilirubin and Alkaline phosphatase levels as compared to non-transfusion dependent β-thalassemia Trait, exacerbating health-related quality of life, emphasizing the preventable disparities for optimized transfusion protocols and psychosocial support. KEY WORDS β-thalassemia, Health-related quality of life, Liver function testsPublication Outcome of Transurethral Vaporisation of Prostate in Small Volume Prostate: A prospective observational study(Kathmandu University, 2024) Dahal, R; Adhikari, B; Mishra, U; Shah, AK; Basnet, RB; Shrestha, A; Shrestha, PMABSTRACT Background Benign Enlargement of Prostate is common in aging men. Transurethral vaporisation of prostate is one modality of minimal invasive management of benign enlargement of prostate. This study assesses the efficacy and safety of transurethral vaporisation of prostate in small volume prostate. Objective To assess the efficacy and safety of bipolar plasma vaporisation of small volume prostate (Prostate Volume less than 40 grams). Method A total of 40 patients with prostate volume less than 40 grams and indications for operative management of benign enlargement of prostate were included. Patients with prior prostate surgery, urethral stricture surgery, presence of vesical calculus, urethral stricture and neurogenic bladder were excluded. Preoperative prostate size was assessed by transrectal ultrasonography. Comparison of preoperative and postoperative hemoglobin, sodium, international prostate symptom score and maximum flow rate was done. Perioperative complications were documented. Result The mean age of patients was 66.88 ± 9.09 years and the mean size of prostate was 32.52 ± 4.66 grams. Significant improvement in IPSS (preoperative 22, postoperative 9) and Qmax (preoperative 8.4 ml/min, postoperative 18.5 ml/min) was noted. There was significant drop in hemoglobin (p < 0.001) but no patients required blood transfusion. There was significant drop in sodium (p < 0.001) but no patients developed transurethral resection syndrome. Most complications were Clavien grade I. Two patients required recatheterization and all were catheter free on follow up. Two patients developed urethral stricture. Conclusion Bipolar transurethral vaporisation of Prostate is effective and safe treatment option for prostate volume less than 40 grams. KEY WORDS Bipolar plasma vaporisation, Lower urinary tract symptoms, Prostate symptoms