Browsing by Author "Adhikari, Shital"
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Publication A Case Report: Dengue Fever with Right Quadriceps Hematoma(Nepalese Respiratory Society, 2025) Jha, Birendra; Bhattarai, Ujjwol; Pandey, Bikash; Thapa, Ram; Devkota, Neha; Adhikari, ShitalAbstract; Muscle hematomas are rare complications in dengue fever. We report a case of a 40-year-old male patient admitted with dengue fever, complicated by a spontaneous right quadriceps hematoma. The patient with NS1-positive presented with a low platelet count, 20,000/μL. During his hospital stay, the patient developed swelling and pain in the right thigh, and a right quadriceps muscle hematoma was confirmed by ultrasonography (USG). His hemoglobin level was 7.6 g/dL and his hematocrit was 22.1%. He received one pint of packed red blood cells (PRBC) along with supportive care. Monitoring of laboratory parameters, including the size of the hematoma was done until it resolved spontaneously. Despite its rarity, we must recognize and manage this dengue fever complication appropriately. Such complications have not been well documented in the literature.Publication Clinical profile and outcome of Dengue fever in Medical Intensive Care Unit of a Tertiary Level Hospital: An Observational Study(Nepal Medical Association, 2025) Koirala, Eliza; Deo, Gopendra Prasad; Adhikari, Shital; Gauli, Basanta; Bajracharya, AkritiAbstract Introduction: Dengue fever poses a significant public health challenge in Nepal, with increasingsevere cases requiring intensive care. Limited data exist on the clinical profile and outcomes of critically ill dengue patients in resource-limited settings. This study is aimed to characterize the clinical features, outcomes and complications of dengue patients admitted to a tertiary Intensive care unit in Nepal. Methods: A prospective observational study was conducted at from August to September 2024 after ethical approval. We enrolled 104 serologically confirmed dengue patients (aged ≥16 years) admitted to the Medical Intensive care unit. Exclusion criteria included co-infections with other tropical diseases. Data on demographics, clinical presentation, laboratory parameters (including platelet counts, liver enzymes), organ dysfunction (SOFA score), and outcomes were collected. Descriptive data analysis was used to report frequency, proportion, measure of central tendency and measure of dispersion based on nature of data. Results: The cohort (median age 41 years, 54.8% male) exhibited severe manifestations: thrombocytopenia (median platelets count 49,000/μL; IQR: 30,250–85,000 per μL), hepatic injury 86 (82.7%); median AST 176.5 U/L, ALT 208.5 U/L), and moderate organ dysfunction (median SOFA score 4). Hypertension 27 (25.96%) and diabetes 23 (22.12%) were common comorbidities. Despite 22 (21.2%) developing multi-organ dysfunction syndrome, mortality was remarkably low 1 (0.96%). Conclusions: Dengue fever cases peak during the month of August and September in endemic areas (Chitwan and surrounding district). Mortality could be reduced in severe dengue with appropriate critical care, highlighting the need to strengthen ICU capacity in endemic regions.Publication High-Resolution Computed Tomography (HRCT) Chest Findings in Active Pulmonary Tuberculosis(Nepalese Respiratory Society, 2025) Adhikari, Deepak; Raut, Yuvaraj; Poudel, Dipesh; Paudel, Bigyan; Bhatt, Manali; Adhikari, ShitalAbstract: Background: Tuberculosis (TB) is an airborne infection caused by the acid-fast bacillus Mycobacterium tuberculosis. It is estimated that about 10.8 million people fell ill with tuberculosis worldwide, and about 1.25 million of them died in 2023. In Nepal, nearly half of the population are estimated to harbor latent TB. Early diagnosis and effective treatment are the mainstay of the control of tuberculosis. Objective: This study aimed to evaluate the diagnostic utility of high-resolution computed tomography (HRCT) of the chest in detecting active pulmonary tuberculosis (PTB). Methods: It is a case-control study done in the Department of Radiodiagnosis at Chitwan Medical College, Teaching Hospital from August 2022 to January 2023. Adult patients with presumptive pulmonary TB who underwent both microbiological testing for Mycobacterium tuberculosis, and High-Resolution CT (HRCT) chest imaging were included. Patient’s demographics, clinical features, sputum microscopy for acid-fast bacilli (AFB), GeneXpert for MTB, and relevant HRCT chest findings were recorded in a predesigned proforma. Data were entered into Microsoft Excel and analyzed using IBM SPSS version 20.0. Results: Data from 72 patients with active pulmonary TB were analyzed. Of these, 46 patients (63.9%) had Mycobacterium tuberculosis identified via AFB staining, while the remaining 26 (36.1%) were diagnosed using GeneXpert. The control group included 35 sputum-negative cases where bacteria could not be isolated using GeneXpert. The mean age of patients was 56 years, and the majority were male (68.1%). The most frequent HRCT findings in active TB cases included tree-in-bud appearance (69.4%), enlarged mediastinal lymph nodes (65.3%), and consolidation (56.9%). The tree-in-bud pattern was significantly more common in TB-positive patients compared to controls. Conclusion: Common HRCT chest findings in pulmonary tuberculosis were tree-in-bud appearance, mediastinal lymphadenopathy, and consolidation. Tree-in-bud appearance in HRCT was significantly associated with bacteriologically confirmed pulmonary tuberculosis. When microbiological confirmation is delayed or negative, HRCT chest findings can support early initiation of treatment in suspected cases, thereby reducing community transmission and improving patient outcomes.Publication Study of Point of Care Lung Ultrasound in Patients with Acute Respiratory Failure Authors(Nepalese Respiratory Society, 2022) Puri, Niraj; Adhikari, Shital; Bhattarai, Madhur Dev; Gauli, Basanta; Gurung, Sailesh; Patel, Sunil; Wagley, PratikAbstract: Introduction: An acute dyspnea has been a common cause of hospital admission throughout history. When formulating a treatment plan based on limited clinical information, a rapid diagnosis is important. Bedside maneuvers and tests that deliver rapid and reliable results represent a cornerstone of diagnostics medicine. Methods: This was a one-year cross-sectional research conducted at Chitwan Medical College Teaching Hospital. Consecutive patients with acute dyspnea whom were admitted for ≤ 6 hours were included in the study. A 5MHz micro-convex probe was used as the optimal single probe. Data entry and descriptive analysis were done in IBM SPSS version 20.0. Point estimate at 95% confidence interval was calculated along with frequency and descriptive statics. Results: Pneumonia was the most common overall ultrasound diagnosis with combined frequency of 47%. With a Positive Predictive Value of 94.11% and Negative Predictive Value of 97.01%, anterior pneumonia exhibited a sensitivity of 94.11% and specificity of 97.11%. Similarly, Posterior Lateral Alveolar Points (PLAPS) pneumonia had a sensitivity of 94.11% and specificity of 98.08%, with a PPV of 94.11% and NPV of 98.80% respectively. The clinical accuracy for pulmonary edema was the greatest with 96.77%. while COPD/asthma had least accuracy with 81.25%. Conclusions: POCUS of the lung, has a high sensitivity and specificity, especially for evaluation of acute causes of dyspnea such pulmonary edema and pneumonia. It is more sensitive than Chest X ray alone and should be integrated while making clinical diagnosis.