Browsing by Author "Bhatt, S"
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Publication Diabetic Foot Ulcer and its Associated Risk Factors in Diabetic Patients with Peripheral Arterial Disease Presenting in the University Hospital of Nepal(Kathmandu University, 2024) Karmacharya, RM; Maharjan, S; Vaidya, S; Bhatt, S; Sharma, S; Timalsina, G; Kunwar, K; Joshi, HNABSTRACT Background Diabetic foot ulcers (DFUs) are a common complication in diabetic patients especially in those with peripheral arterial disease (PAD). However, it can be prevented if its risk factors can be identified and adjusted. Objective To investigate the frequency of diabetic foot ulcers and their associated risk factors in diabetic patients with peripheral artery disease. Method Diabetic patients under medication with known peripheral arterial disease diagnosed with Doppler ultrasonography were recruited from the outpatient department of the cardiothoracic and vascular unit, at Dhulikhel Hospital. The patients were interviewed about their demographic details, presenting clinical symptoms, and the risk factors such as smoking, hypertension, cardiovascular diseases, duration of diabetes, and hyperlipidemia. Also, the patients were assessed for any ulcers in their feet. Descriptive statistics and chi-square tests were used to analyze the data. Result The analysis demonstrated diabetic foot ulcers in 24.1% of the total 54 diabetic patients with peripheral arterial disease. The risk factors such as smoking (24.1%), increasing age (68.5%), hypertension (31.5%), and duration of diabetes (72.2%) were found in the majority of the patients. Out of these risk factors, smoking (Odds ratio: 6.81) and increasing age (Odds ratio: 0.28) were significantly associated with diabetic foot ulcers. (p < 0.05) Conclusion Diabetic foot ulcers affected about a quarter of diabetic patients with peripheral arterial disease and were found to be associated with increasing age and smoking. KEY WORDS Complication, Diabetes, Foot ulcers, Peripheral arterial disease, Risk factorsPublication Experience of Surgical Resection and Reconstruction of Chest Wall Tumor in Dhulikhel Hospital(Kathmandu University, 2025) Karmacharya, RM; Vaidya, S; Bhatt, S; Guragai, M; Sharma, S; Bhandari, S; Shrestha, M; Shah, B; Yadav, BABSTRACT Background Chest wall tumors are rare thoracic tumor which can be either primary or metastatic. Conventional radiography is the first line of investigation followed by further imaging like computed tomography or magnetic resonance imaging. When indicated preoperative biopsy by fine-needle aspiration need to be done. Small chest wall tumor can be surgically treated by excision and primary repair. Bigger chest wall tumor is treated by excision and chest wall reconstruction. Objective To know the features of chest wall tumor, symptoms, histopathological findings, surgical procedures performed and outcome following the surgery. Method This is the retrospective study that included chest wall tumor subjected for excision and repair during January 2018 till December 2023 in Thoracic surgical unit of Dhulikhel Hospital. Variables such as presenting complaints, size and extent of tumor, type of surgery, outcome of the surgery, hospital stay, neoadjuvant chemotherapy and post excision chemo or radiotherapy and recurrence of the tumor were included. When primary repair is not possible following wide excision, reconstruction using double prolene sandwich mesh was done. Result There were 38 cases of chest wall tumor. Mean age of the patient was 42 years (SD 15.25 years, range 20 - 68 years). Of them, 22 patients were female (57.9%) and 16 patients were male (42.1%). Chest pain was the most common symptoms (84.2%) followed by lesion in chest (81.6%). Average size of the tumor was 14.8 ± 3.6 cm (Range 5 cm to 25 cm). Most common histopathological finding was neurofibroma (31.6%) filled by schwannoma (15.8%). All the patients underwent wide local excision. In terms of repair, primary repair was possible in 68.4% while in 31.6% patients repair using double prolene and bone cement sandwich was done. Average hospital stay was 6.6 days (SD 2.3, range 3-9 days). Conclusion Chest wall tumor can have different histopathological findings. In patients where wide resection is possible, it can be repaired by either primary repair or by repair using double prolene and bone cement sandwich. KEY WORDS Chest wall tumor, Reconstruction, ResectionPublication Nitrobenzene Induced Methemoglobinemia with Paroxysmal Atrial Fibrillation Treated with Single Volume Exchange Transfusions(Kathmandu University, 2022) Sapkota, P; Vaidhya, N; Bhatt, S; Shrestha, PABSTRACT Methemoglobinemia is a potentially fatal condition if left untreated. Conventional treatment of nitrobenzene induced methemoglobinemia dictates the use of methylene blue, which is the antidote of choice. However, its availability in our setting is limited only to the laboratory use. We present a case of a 21-year-old female with intentional ingestion of nitrobenzene. Clinical history and supportive investigations revealed methemoglobinemia and it was successfully managed with single volume exchange transfusions in absence of specific antidote. While exchange transfusions are indicated for severe cases, it may be useful as an alternative treatment in acute life-threatening conditions where methylene blue is not available. KEY WORDS Exchange transfusion, Methylene blue, Nitrobenzene, Whole bloodPublication Rickettsial Infection amongst Febrile Illness Patient in a Tertiary Care Hospital: A Retrospective Cross-sectional Study(Kathmandu University, 2022) Gurung, RB; Sapkota, P; Bhatt, S; Tamang, A; Joshi, S; Khadka, S; Jaisy, DN; Chalise, S; Shrestha, PABSTRACT Background Rickettsial infection is an emerging neglected tropical disease in the Southeast Asia. In past few years Nepal is also reporting escalating prevalence of rickettsia. The under evaluation is resulting it as undiagnosed or are simply labeled as pyrexia of unknown origin. Objective To find out the prevalence of rickettsia in a hospital setting, assess the socio- demographic and other relevant clinical features of the rickettsia patients. Method This is a hospital based retrospective cross-sectional study from October 2020 to October 2021. This study reviewed the medical records of the department. Result The study included 105 eligible patients and the prevalence rate was 4.38 per 100 patients. The mean age of the participants was 42 years, and the mean hospital stay was 3 (SD ±2.06) days. More than 55% of the participants had fever for less than or equal to 5 days and 9% had Eschar present. Vomiting, headache, and myalgia were the most common symptoms and hypertension, and diabetes were the common comorbidities. Pneumonia and the acute kidney injury were the two complications of the patients as stated in the study. The severity of the thrombocytopenia deducted from admission time to discharge, and the case fatality was 4%. Conclusion The future studies shall consider on collaborative clinical and entomological research. This would help in better understanding of the etiology of supposedly unknown febrile illness and the under-investigated field of emerging rickettsia in Nepal. KEY WORDS Eschar, Febrile illness, IgM titer, Rickettsia, ThrombocytopeniaPublication Sensitivity and Specificity of Ankle Brachial Index for Diagnosis of Peripheral Arterial Disease in Diabetic Patients Presenting to University Hospital of Nepal(Kathmandu University, 2025) Karmacharya, RM; Vaidya, S; Yadav, B; Sharma, S; Bhatt, S; Bhandari, N; Bhandari, S; Maharjan, S; Bhusal, JABSTRACT Background Diabetes is a significant risk factor for peripheral arterial disease (PAD) that increases morbidity and mortality. Hence, early detection of peripheral arterial disease is necessary. Evidence shows Ankle Brachial Index (ABI) as a promising test to diagnose peripheral arterial disease. However, sensitivity and specificity need to be evaluated before clinical use. Objective To determine Ankle Brachial Index sensitivity and specificity for the diagnosis of peripheral arterial disease in diabetic patients. Method Diabetic patients were recruited from Dhulikhel Hospital. Doppler ultrasonography (DUS) was done in all the recruited participants and peripheral arterial disease was assessed. Based on Jager’s criteria, those with grade III and IV stenosis were diagnosed as peripheral arterial disease and underwent ankle brachial index. Ankle brachial indexscores below 0.9 and above 1.5 were considered abnormal. The diagnosis by ankle brachial index was matched against the gold standard doppler ultrasonography to determine its specificity and sensitivity. Descriptive statistics and independent t-tests were used for statistics. P-value < 0.05 was considered statistically significant. Result There were total of 237 diabetic patients of which 31.2% had peripheral arterial disease. We found high sensitivity and specificity of ankle brachial index when tested against doppler ultrasonography with the values ranging from 88.68-89.66% and 86.67-90% respectively. Conclusion Ankle brachial index can be used in clinical settings to diagnose peripheral arterial disease in individuals with diabetes mellitus. KEY WORDS Ankle brachial index, Diabetes, Peripheral arterial disease, Sensitivity, Specificity