Browsing by Author "Baral, N"
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Publication Altered serum levels of thyroxine, triiodothyroinine and thyroid stimulating hormone in patients with depression(Kathmandu University, 2007) Das, BKL; Baral, N; Shyangwa, PM; Toora, BD; Lamsal, MObjective: To assess serum level of Thyroxine (T4), Triiodothyronine(T3) and thyroid stimulating hormone(TSH) in patient with depression. Methods: Thirty one clinically diagnosed depressed patients and equal number of healthy, age and sex matched control subjects were included in this study. Ham-D scale was used to classify the degree of depression into mild, moderate and severe grades. The biochemical parameters (T3, T4 and TSH) were estimated using commercially available kits. The data were analyzed by using (SPSS-10 software), one way ANOVA and χ2 test. Result: Female depressed (n = 17) cases outnumber the male depressed cases. The distributions of patients in mild, moderate and severe categories were similar. The T3 and T4 level were found to be significantly raised in the moderate depression as compared to the healthy controls. ANOVA with multiple comparisons testing among the patient group showed a significant high TSH level (F> 3.17) at 5% level of significance. A total of six depressive patients were found to have thyroid abnormalities. Conclusion: This study therefore points towards presence of thyroid dysfunction among the depressive which most often characterized as a “Lower Thyroid Syndrome”. Thus inclusion of thyroid screening test among depressive patients may be helpful in proper management of cases.Publication Influence of duration of symptoms over perioperative outcomes during emergency laparoscopic cholecystectomy(Kathmandu University, 2009) Sharma, SK; Thapa, PB; Maharjan, DK; Dhakal, A; Baral, NAbstract Background: Laparoscopic cholecystectomy is a gold standard treatment for gall stone diseases. Early surgical intervention in acute calculus cholecystitis is feasible and duration of onset of symptoms does not influence the conversion rate. Objective: To compare the safety and feasibility between urgent and delayed laparoscopic cholecystectomy in patients with acute calculus cholecystitis. Materials and methods: This is a comparative study conducted in Department of Surgery, Kathmandu Medical College, during the period of January 2006 to January 2008. Alltogether, 436 patients were analysed out of which 55 were selected as urgent laparoscopic cholecystectomy and were included in the study. Among 55 patients presented with acute calculus cholecystitis were divided into two groups. Group 1 underwent laparoscopic cholecystectomy within 72 hours of onset of pain abdomen and Group 2 after 72 hours of onset of pain abdomen. Results: Conversion rate in Group 1 was 19.44% whereas it was 263% in Group 2 (p = .693). There was no statistically significant difference in mean operating time (p = .412), total hospital stay (p = .626), bile duct injury and postoperative complications. Conclusion: Urgent laparoscopic cholecystectomy is safe and duration of onset of pain abdomen does not influence conversion rate. Key words: Urgent laparoscopic cholecystectomy, Conversion rate, acute calculus cholecystitisPublication Preparing tutors for problem-based learning: An experience from B. P. Koirala Institute of Health Sciences, Nepal(Kathmandu University, 2010) Baral, N; Paudel, BH; Das, BKL; Aryal, M; Gautam, A; Lamsal. MAbstract Background: Problem based learning (PBL) has made major impact on curricular designing and practice in medical education for the last forty years. Incorporation of PBL approach in medical education has been a challenge and opportunity for both educationists on how to impart change and medical teachers on how to internalise the change. Objectives: This paper aimed to investigate experiences, achievement and responses of medical teachers at B. P. Koirala Institute of Health Sciences (BPKIHS), Nepal. Materials and methods: There were 25 heterogeneous groups of teachers, majority of them were entry level. Pre- and Post- test question were taken from various topics relevant to PBL such as learning strategy and principles of adult learning, PBL practice at BPKIHS, tutorial session and role of a tutor, making resource session interactive, designing PBL problems, planning educational objectives in PBL, formulation of problem for PBL. In addition to it participants’ perception on development and dissemination of PBL manual and effectiveness of workshop were also included in the questionnaire. Results: There was significant gain in knowledge following the workshop (p<0.001). The perception of the teacher found quite relevant and useful for adopting new role as tutor. The respondent teachers noted that skills they learned during the training will be applicable to their job situation. They stressed for an additional training for reinforcement and update with new trends and tools in PBL. Conclusion: Therefore, such trainings for faculty development would be highly beneficial to inculcate new competencies in PBL. Key words: BPKIHS, Faculty Development, Problem Based LearningPublication Risk of neonatal hyperbilirubinemia in babies born to ‘O’ positive mothers: A prospective cohort study(Kathmandu University, 2009) Kalakheti, BK; Singh, R; Bhatta, NK; Karki, A; Baral, NAbstract Introduction: Hyperbilirubinemia in a neonate is one of the most common problems that may occur in 60-70 % of term and 80% of preterm babies. It is known to be associated with significant morbidity like neonatal bilirubin encephalopathy and even death. Clinically, and almost exclusively ABO incompatibility occur in ‘A’ and ‘B’ blood group babies of O ‘+ve’ mothers. These babies are reported to be at high risk of severe hyperbilirubinemia (serum bilirubin level more than 16 mg/dl). Objectives: To find out the incidence of hyperbilirubinemia in babies born to ‘O’ positive mothers. To estimate the risk of ABO incompatibility in babies born to ‘O’ positive mothers. Materials and methods: A prospective cohort study conducted in B. P. Koirala institute of Health Science (Department of Pediatrics and Dept. of Gynae and Obstetric) from July 2002 to June 2003. A total of 199 women having ‘O’ positive blood group admitted to the Department of Gynae and Obstetric were included in the study. A piloted proforma was used to collect information. The blood group of neonates was tested by tile and slide method and serum bilirubin was estimated by diazo method in the Central Laboratory Services and Emergency laboratory of BPKIHS. The data was observed and analysis was carried out using statistical software SPSS-10. Results: Total 37 (18.5%) babies had developed hyperbilirubinemia and among them 14 (38%) were from group of babies having ‘O’ Positive blood group and 23 (62%) were from group of babies having other than ‘O’ Positive blood group. There was 2.6 times higher chance of having hyperbilirubinemia in the babies with ABO incompatibility than ‘O’ Positive babies after adjusting other significant variables. Conclusion: Among different significantly associated variables, ABO incompatibility was found to be a major risk factor for neonatal hyperbilirubinemia.It was seen that neonate with ABO incompatibility had two times higher chances of having hyperbilirubinemia than those babies with O ‘+ve’ blood group. This finding in BPKIHS suggests that there is a need of screening cord blood bilirubin and continuous monitoring of bilirubin level in the hospital especially among ABO incompatible neonates. Key words: Hyperbilirubinemia, Neonatal Jaundice, ABO-incompatibilityPublication Subclinical hypothyroidism in eastern Nepal: A hospital based study(Kathmandu University, 2010) Rohil, V; Mishra, AK; Shrewastwa, MK; Mehta, KD; Lamsal, M; Baral, N; Majhi, SAbstract Background: Subclinical hypothyroidism itself is associated with serious complications and also there is a known risk of subclinical hypothyroidism patients getting converted into overt disease. Objectives: The objective of the present study was to find out the prevalence of subclinical hypothyroidism in the suspected cases i.e. amongst the cases attending the thyroid laboratory at B.P. Koirala Institute of Health Sciences, Dharan, Nepal. Materials and methods: It was a retrospective cross sectional study. Data of the free T3, free T4 and TSH estimations of the year 2007 of the Thyroid lab at BPKIHS, Dharan, Nepal was analyzed. ELISA based free T3, free T4 and TSH tests in the serum had been performed in all the cases. Results: Total cases were 1714 including 24.446% males and 75.554% females. Cases with raised TSH levels were 26.021%, cases with normal TSH levels were 54.66% and cases with low TSH levels were 19.316%. Total 350 cases (20.42 %) had subclinical hypothyroid dysfunction which includes 84 (4.901 %) males and 266 (15.519%) females. And the maximum percentage of cases in either gender was between the age groups 20 -59 years. Conclusion: The prevalence of subclinical thyroid hypothyroidism amongst the suspected cases was 20.42 % which is much higher compared to the other parts of the world. The highest percentage was found in the female age group 20 – 59 years. The routine screening of the whole population is not cost effective and on the basis of the present study it is suggested that there may be routine screening of the selected populations, especially women between 20 to 59 years of age in Nepal region. The preferred screening method advised is a sensitive ELISA based TSH test. Key words: Subclinical hypothyroidism