Browsing by Author "Chaudhary, A"
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Publication Acute Kidney Injury in Neonates with Perinatal Asphyxia in a Tertiary Care Hospital of Nepal: a cross-sectional study(Kathmandu University, 2025) Gautam, S; Gautam, P; Chaudhary, A; Dahal, A; Manandhar, A; Giri, P; Dulal, A; Pokhrel, SABSTRACT Background Renal involvement is the most common form of systemic complication in neonates with perinatal asphyxia. Acute Kidney Injury (AKI) can be oliguric or non oliguric. There is no consensus on the definition of acute kidney injury in neonates, which makes early diagnosis and management difficult. Acute kidney injury leads to significant morbidity and mortality in neonates. Objective Current study aims to explore the prevalence of Acute Kidney Injury in Neonates with perinatal asphyxia and its relation to the severity of Hypoxic Ischemic Encephalopathy (HIE). Method A single-center, retrospective, cross-sectional study was carried out to analyze the cases of perinatal asphyxia in the Neonatal Intensive Care Unit (NICU) and Neonatal Ward (NNW) for a period of three years (September 2020 to August 2023) in a tertiary care center. The study analyzed 195 neonates with perinatal asphyxia and Hypoxic Ischemic Encephalopathy (HIE). Data analysis was done using Statistical Package for Social Sciences (SPSS) version 25. Descriptive statistics(mean ± SD for continuous variables; percentages for categorical variables) and chi-square test (to compare categorical associations) were applied. The prevalence of acute kidney injury and its relation to grades of HIE were determined using a chi-square test. Result The prevalence of acute kidney injury among cases of perinatal asphyxia was 17.4%. The prevalence of acute kidney injury increased with an increase in the grading of hypoxic ischemic encephalopathy. Acute kidney injury was predominant among males with a male-to-female ratio being 3.2:1. Oliguric acute kidney injury was more common than non-oliguric acute kidney injury. 8.8% of cases had mortality, with the majority of cases being hypoxic ischemic encephalopathy grade II. The Chi- square test found a statistically significant association between hypoxic ischemic encephalopathy grades and acute kidney injury (p value=0.0113, i.e., p < 0.05) Conclusion Acute kidney injury remains one of the common complications of Perinatal Asphyxia (PA). There was a significant association between acute kidney injury cases and grades of Hypoxic Ischemic Encephalopathy (HIE), with HIE II being the most common type. Screening for acute kidney injury in case of hypoxic ischemic encephalopathy should be prioritized. KEY WORDS Acute kidney injury, Birth asphyxia, Oliguria, Perinatal asphyxiaPublication Arthroscopic Debridement for Mucoid Degeneration of Anterior Cruciate Ligament - A Single Institution Experience from Nepal(Kathmandu University, 2023) Shrestha, R; Khadka, SK; Maharjan, S; Basi, A; Dahal, A; Chaudhary, A; Acharya, SP; Malla, MABSTRACT Background Mucoid degeneration of anterior cruciate ligament is characterized by infiltration of mucoid-like material scattered throughout the anterior cruciate ligament substance. It is an uncommon condition, but previously, underdiagnosed or often misdiagnosed as an anterior cruciate ligament tear. Objective To present our early experiences with mucoid degeneration of anterior cruciate ligament in last five years in terms of clinical presentation and the outcomes of arthroscopic management. Method This was a retrospective descriptive cross-sectional study on patient who received arthroscopic debridement for mucoid degeneration of anterior cruciate ligament in Dhulikhel Hospital over five years period (2017 May to 2022 April). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale that has been translated and validated to be used in local (Nepali) language and context was used for evaluation of outcome evaluation. Result Twenty-one patients of mean age 44.21 years, predominantly females (18), were managed in five years period. The mean Western Ontario and McMaster Universities Osteoarthritis Index score was 16.33±10.47 with a range of 0 to 36 (11.57 to 21.09 at 95% confidence interval). The mean Western Ontario and McMaster Universities Osteoarthritis Index score converted on a scale of 0 to 100 was 17. Thirteen patients had isolated Mucoid degeneration of anterior cruciate ligament whereas nine others had associated either meniscal tear or chondral lesions. Conclusion Mucoid degeneration of anterior cruciate ligament could be a cause of knee pain in middle-aged patients and arthroscopic debridement can improve the patient’s symptoms and provide a good functional outcome. KEY WORDS Anterior cruciate ligament, Arthroscopy, Debridement, Mucoid degeneration, WOMACPublication Association of HBA1c and Plasma Glucose Levels with Diabetic Retinopathy(Kathmandu University, 2025) Shrestha, P; Chaudhary, A; Shrestha, JKABSTRACT Background Diabetic retinopathy is one of the leading causes of blindness worldwide. The relationship between glucose level and development of diabetic retinopathy has always been an area of interest and constantly evolving. Objective To determine the association of glycosylated hemoglobin and plasma glucose levels with different grades of diabetic retinopathy. Method A hospital based cross sectional study was conducted among 504 patients with type II diabetes mellitus attending the Department of Ophthalmology in a University Hospital for one year duration. Relevant history regarding diabetes mellitus was recorded for all patients. The status of diabetic retinopathy in each patient was diagnosed by detailed ophthalmological examination and classified according to International Classification of Diabetic Retinopathy Scale. All the patients were evaluated for their glycosylated hemoglobin, fasting and post prandial blood glucose levels. Bivariate analysis using t-tests and chi-square tests was used to measure the strength of association between the different variables. An Analysis of Variance (ANOVA) test was used to evaluate the association between the means of different variables. Result Total 504 patients constituted of 254 males (50.39%) and 250 (49.60 %) females. Almost half of the study population had poor glycemic control and deranged fasting and post prandial blood sugar levels. Diabetic retinopathy was observed in 124 (24.60%) patients and diabetic macular edema was observed in 42 (8.33%) patients. Poor control of glycosylated hemoglobin (> 7.6) was seen in 88 (70.96%) cases of diabetic retinopathy and 34 (80.95%) cases of diabetic macular edema. Uncontrolled fasting and postprandial blood sugar levels were associated with a significant number of cases of diabetic retinopathy and of diabetic macular edema respectively. A statistically significant association was observed between increasing grades of diabetic retinopathy and higher glycosylated hemoglobin and plasma glucose levels. Conclusion Higher the level of glycosylated hemoglobin and plasma glucose levels, more severe is the grade of diabetic retinopathy. KEY WORDS Diabetic retinopathy (DR), Fasting blood sugar, Glycosylated hemoglobin (HBA1c), Non-proliferative diabetic retinopathy (NPDR), Proliferative diabetic retinopathy (PDR)Publication ele-colleaguography - Adjunct to Intraoperative Time Out for Safe Laparoscopic Cholecystectomy(Kathmandu University, 2024) Laudari, U; Chaudhary, A; Chaudhary, A; Thapa, PBABSTRACT Laparoscopic cholecystectomy is a common surgical procedure, and strategies for preventing biliovascular injury include intraoperative time-out and intraoperative cholangiography. However, the feasibility of intraoperative cholangiography is limited in certain regions due to cost and training constraints. This article introduces the concept of “Tele-colleaguography” as an adjunct to intraoperative time-out during laparoscopic cholecystectomy, particularly in low-resource settings. Tele- colleaguography, a term coined to signify remote consultation with senior surgeons using video applications like WhatsApp and Viber, presents a potential solution to prevent bile duct injuries. The viewpoint discusses the potential benefits of Tele- colleaguography, and the role of modern technology such as 5G, and references key studies that support this approach. KEY WORDS Intraoperative time-outs, Laparoscopic cholecystectomy, Tele-colleaguographyPublication Prevalence of Renal and Urinary Tract Diseases among Pediatric Cases Admitted in a Tertiary Hospital in Developing Country(Kathmandu University, 2024) Gautam, S; Gautam, P; Chaudhary, A; Dahal, A; Giri, P; Poudel, SABSTRACT Background Kidney disease includes diseases of the glomerulus, tubular disorders, and conditions associated with hematuria or proteinuria. Urinalysis can be a reliable and easy tool to screen. Objective In this study, we aim to study the prevalence of renal and urinary tract diseases among the pediatric population in a tertiary hospital in Nepal. Method A single-center retrospective cross-sectional study was conducted from 2022 to 2023 in the pediatric department. Information was obtained regarding clinical- epidemiological profile, associated condition, investigations, diagnosis, and duration of hospital stay, management, and outcome. Result The prevalence of renal disease was 5.6%, with urinary tract infection being the most common diagnosis. Maximum cases presented between one and five years with a male-to-female ratio of 1.1:1 and 80.9% of the patients had new onset disease. The mean duration of hospital stay was six days. The mortality rate in renal diseases was 3.2%. Conclusion Renal diseases make up a significant portion of pediatric admissions. Renal diseases contribute to significant morbidity and mortality. A large number of cases of renal diseases are due to infective etiology hence they are preventable and curable. Renal disease in children presents with vague symptoms and signs. Routine screening of renal diseases is needed for early diagnosis and reduction in morbidity and mortality. KEY WORDS Kidney diseases, Pediatrics, Urinary tract infection