Browsing by Author "Aryal, B"
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Publication A comparative study of pregnancy outcome between teenage pregnancy and older reproductive age group in a rural University Teaching Hospital of Nepal(Institute of Medicine, 2018) Aryal, B; Shrestha, UAbstract Introduction: Teenage pregnancy is a common public health problem worldwide and is considered as high-risk pregnancy in terms of health of both mother and child. The objective of this study was to find the incidence and outcome of teenage pregnancy in comparison to older women who delivered in Karnali Academy of Health Sciences Teaching Hospital. Methods: This is a hospital based cross-sectional comparative study conducted in Labor Unit of Karnali Academy of Health Sciences, Jumla over a period of one year from July 2016 to June 2017. The hospital data was retrieved and divided into two groups i.e. teenagers and older age and was compared in terms of incidence and maternal and fetal outcome of pregnancy. The data were analyzed using software package SPSS 16. Results: This study showed that incidence of teenage pregnancy was 24.14%. Maternal and fetal complication like eclampsia/preeclampsia (7.63% vs. 0.44%), cesarean section (44.44% vs. 7.96%) preterm delivery (15.97 % vs. 1.10%), small for gestational age (29.86% vs. 3.31%) and intrauterine fetal death (9.72% vs. 0.66%) occurred more frequently in teenagers in comparison to older age. Similarly, there was increased incidence of congenital anomalies (5.55% vs. 0.44%) among the neonates born to teenage mothers. Conclusion: Incidence of teenage pregnancy in rural and resource-limited part of the country is high, which predispose them into increased risk of maternal and fetal complications like increased incidence of eclapsia/preeclampsia, cesarean section rate, prematurity and its complications, small for gestational age, congenital anomalies and intrauterine fetal death. Key words: teenage pregnancy, maternal outcome, fetal outcome, ruralPublication A rare case of pseudocyesis in a grand multiparous woman in Karnali Academy of Health Sciences: a case report(Institute of Medicine, 2017) Aryal, B; Shrestha, UAbstract Pseudocyesis, sometimes called phantom or false pregnancy is a rare medical condition in which women has false believe of being pregnant. She experiences many signs and symptoms of pregnancy but there is absence of fetus. The etiology of this condition could be the interplay and combination of various psychological, sociocultural and endocrine factors. A case of this rare condition is described in the case report that represents the sociocultural belief of need of specific sex (male) child in the family and believe in traditional healers in rural Nepalese society. Key words: pseudocyesis, grand multipara, sociocultural beliefPublication Age and Gender Differences in COVID 19 Morbidity and Mortality in Nepal(Kathmandu University, 2020) Dhimal, ML; Rana, N; Aryal, B; Adhikari, SK; Shrestha, R; Gyanwali, P; Dhimal, MABSTRACT Background The global health community has emphasized the importance of reporting epidemiological data by age and sex groups in the COVID-19 pandemic. However, age and sex disaggregated data of COVID-19 cases and deaths are rarely reported. Such data are very crucial for public to make truly informed choices about their own diseases risk and also for governments for public policy response. Objective To assess age and gender difference among COVID-19 cases and deaths in Nepal. Method This is a retrospective study which uses public data on COVID-19 cases and deaths released by Ministry of Health and Population, Government of Nepal from January to November, 2020. The data analysis was carried out using SPPS software version 26. Result Nepal reported 233,452 confirmed cases and 1,566 deaths of COVID-19 from 23 January 2020 to 30 November 2020. We found statistically significant differences on COVID-19 cases by age and gender in Nepal with higher number of cases among males of economically active age groups (20-60 years). Similarly, we found significant difference in COVID-19 mortality with more death occurred among male group compared to female group and with highest number of deaths among the people of above 60 years. Furthermore, we found differences in cases and deaths among provinces. Conclusion The age and gender differences in COVID cases and deaths in Nepal indicates needs of considering age and sex groups seriously while planning for testing, case management and vaccination against COVID-19 infections in Nepal. KEY WORDS Age, COVID-19, Gender, NepalPublication Anticoagulant Dependent Pseudothrombocytopenia: A Case Report(Institute of Medicine, 2017) Aryal, B; Adhikari, S; Aryal, N; Pant, VAbstract Pseudothrombocytopenia is a laboratory finding caused by in vitro autoaggregation of platelets (an irreversible change) resulting due to the presence of EDTA in containers. In contrast to serious and potential life-threatening causes of thrombocytopenia, EDTA-pseudothrombocytopenia (EDTA-PTCP) is solely an in vitro effect without any clinical relevance.We report a 24 year old patient from MCTVC hospitalwho presented with common flu. On blood examination there was low platelets count in EDTA anticoagulated sample but he was clinically otherwise normal and there were no symptoms of thrombocytopenia. On smear preparation, in EDTA and Trisodium citrate sample his all blood countparameters were within normal range. This case highlights the importance of slide preparation.Publication Does serum magnesium analysis need to be a part of routine dyselectrolytemia investigation?(Institute of Medicine, 2017) Tuladhar, ET; Pant, V; Aryal, B; Tumbapo, A; Ghimire, S; Sharma, VK; Bhattarai, A; Raut, M; Yadav, BKAbstract Introduction: The fourth most abundant cation in the body and the second most prevalent intracellular cation, magnesium (Mg) is a co-factor for over 300 enzymes. Though magnesium abnormalities frequently accompany other electrolytes abnormalities, during electrolyte investigation, magnesium estimation is often overlooked. This study aims to investigate the occurrence of magnesium abnormalities in serum samples sent, for routine electrolyte measurement like sodium, potassium, calcium and phosphorus, to the biochemistry laboratory of Tribhuvan University teaching hospital. Methods: Serum magnesium measurement was done in 799 serum samples ordered for various electrolyte estimation. Magnesium, Calcium and phosphorus present in sample was analyzed by BT 3500 machine spectrophotometrically. Sodium and potassium ions were analyzed by direct ion selective electrode method. Results: Only 14(1.75%) samples were requested by physician for magnesium estimation out of total 799 samples sent for various electrolyte estimation. When all 799 samples were analyzed for magnesium level, magnesium abnormalities were identified in 76(9.5%), out of which hypermagnesemia was found in 22 (2.75%) and hypomagnesemia in 54 (6.76%) samples. Conclusion: Since, significant numbers of patient's serum sample, sent for estimation of various electrolytes, are found to have magnesium abnormalities, we recommend routine measurement of this analyte along with other electrolytes. Keywords: Magnesium, Sodium, Potassium, Calcium, Phosphorus, DyselectrolytemiaPublication Dysnatremia in Traumatic Brain Injury and its Association with Outcome(Kathmandu University, 2022) Bishokarma, S; Thapa, U; Thapa, M; Singh, AK; Gurung, S; Aryal, B; Maharjan, AMS; Lakshmipathy, GABSTRACT Background Traumatic brain injury on its own results in significant mortality and morbidity but it also contributes to complications that manifest as dysnatremia in the majority of cases. Objective The objective of this study is to assess the association of hyponatremia and hypernatremia with the severity of traumatic brain injury and its impact on mortality. Method This is a retrospective, descriptive, and analytic study conducted during a 1-year period from March 2018 to March 2019. The study population was selected from the patients presenting to the emergency department with TBI in the Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal. All the patients that fulfilled the inclusion criteria of age were enrolled in the study. Patients with known renal disease due to the higher incidence of electrolyte disbalance were excluded. Association of outcome with hyponatremia and hypernatremia were sought using chi-square, fisher exact test and independent t test using SPSS ver 20. Result Over a period of 1 year, 367 patients with traumatic brain injuries were treated in our hospital. Hyponatremia was seen among 55 patients (14.9%) and hypernatremia was seen among 22 patients (5.99%). The age range of patients included in the study was 16 to 87 with a mean age of 37.96 ± 16.512 years. The male to female ratio was calculated as 3.2:1. Mild, moderate, and severe head injuries were 286 (77.9%), 37 (10.1%), and 44 (12%) respectively. Surgical intervention was performed among 77(21%) individuals. Our series showed an association between the severity of traumatic brain injury and hyponatremia however didn’t show an association between the severity of traumatic brain injury and the development of hypernatremia. Conclusion We concluded that the severity of head injury is associated with severity of hyponatremia but not with severity of hypernatremia. Similarly, a strong association existed between the severity of hypernatremia and outcome of patients. However, such association was not seen with hyponatremia. KEY WORDS Hypernatremia, Hyponatremia, Mortality, Severity, Traumatic head injuryPublication Indications of Cesarean Section in a rural referral Hospital(Institute of Medicine, 2018) Aryal, B; Shrestha, UAbstract Introduction: There is a huge difference in cesarean section rate between rural (3.5%) and urban (15%) areas of Nepal. The national CS rate is around 5% whereas global CS rate is 26%. The objective of this study is to find out the delivery profile and rate and indications of CS in a rural university hospital. Methods: This is a three -year’s retrospective cross-sectional study done from January 2016 to January 2019 (Magh 2072 to Poush 2075) at Karnali Academy of Health Sciences, Jumla. The data was retrieved from hospital birth profile records and analyzed using SPSS 20. Permission was taken from Institutional review committee (IRC) to conduct the study. Results: Total number of delivery during this period was 1841 out of which 172 were Cesarean delivery giving a CS rate of 9.3%. The most common indication of CS were fetal distress (33.7%), previous CS (9.3%), failed induction of labor (9.3%). Non progress of Labor (8.1%) and post term pregnancy (8.1%). Majority of the CS were done as an emergency procedure. Conclusion: The CS rate at KAHS teaching hospital was within WHO recommendation of between 5-15% and was very low in comparison to other centers situated in urban areas of the country. The indications of CS was also similar to the other national and international statistics. Key words: Cesarean section, Indications, Nepal, Maternal health, rural area, Global trendsPublication Influence of semen quality on the success of intrauterineinsemination result in a university teaching hospital infertility center(Institute of Medicine, 2017) Aryal, B; Vas, P; Vasan, SSAbstract Introduction: Intrauterine insemination is effective for the treatment of male factor and unexplained infertility. The objective of the study was to understand whether one or more parameters of sperm quality i.e. morphology, motility and concentration have predictive value for the pregnancy outcome of the intrauterine insemination treatment for couple with primary infertility with male factor or unknown cause in the select defined population. Methods: This is a hospital based prospective study of 776 IUI cycles. The study population was those couples between 19-35 years of age who had been trying unsuccessfully to conceive for a minimum of one year. They were randomly distributed into two groups; partner with sperm morphology, motility and concentration below 5th percentile constituted group A and group B comprised of those with above 5th percentile and their IUI outcome was evaluated. Results: A total of 776 IUI cycles were studied out of which 94 clinical pregnancies were obtained, for a pregnancy rate cycle of 12.1%. The study shows that sperm morphology is positively associated with IUI results with statistically significant p value (p=0.034). Likewise, a higher total motility level is positively associated with IUI results. Moreover, incidence of positive IUI results were significantly more with post processing motility with excellent progression >90% with statistically significance p value (P=0.004). Conclusion: Combination of superovulation and intrauterine insemination is an effective means of achieving pregnancy for unexplained and male factor infertility. The probability of pregnancy increases with higher normal morphology, total motile sperms with excellent progression and sperm concentration. If semen parameters are below the 5th percentile value, IVF-ICSI would be preferred. Keywords: Male infertility, primary infertility, sperm morphology, sperm motility, sperm concentration, Intrauterine Insemination