Browsing by Author "DB, Karki"
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Publication A review on percutaneous coronary intervention vs. coronary artery bypass graft surgery.(Kathmandu University, 2003) DB, Karki; A,NeopaneNAPublication A Study of the First 350 Cases Referred for EEG in Kathmandu Medical College Teaching Hospital(Kathmandu University, 2004) R, Shrestha; SN, Pradhan; SC, Sharma; KN, Shakya; DB, Karki; BBS, Rana; LN, JoshiElectroencephalography or EEG is a neurological test that uses an electronic monitoring device to measure and record electrical activity in the brain. Epilepsy is defined as a recurrent tendency to unprovoked seizure. About 0.5% to 2% of the population has epilepsy. Material and Methods This is a retrospective study of the first 350 odd cases referred for EEG at Kathmandu Medical College Teaching Hospital, Kathmandu during period November 2002- September 2002 (Mangsir 2058- Bhadra 2059). Results Most patients fall in the age group of 11-20 years and more than 50% referred cases fall in the prime of life, i.e., 11- 30 years. 16% of patients with the history of seizure did not use any AED and 32 % who though had no history of seizures were actually using AED. It is seen that out of 149 reported normal, 57 (38%) had history of seizure; but out of 208 reported abnormal in EEG only 92 (42%) had history of seizure. Discussion EEG is not a very sensitive or a specific tool; however, in our study it was seen to be more sensitive than specific. It is till very useful in classifying seizure types, in locating epileptic focus prior to surgery or in some confusing situation when movement disorder may simulate seizure disorder or vice versa. Conclusion Although EEG is not a very sensitive or specific investigation, it is more sensitive than specific.Publication A Typical Case of Myasthenia Gravis(Kathmandu University, 2003) M, Poudel; GM, Angel; A, Neupane; DB, KarkiNA.Publication Acute haemorrhagic conjunctivitis: an epidemic in august/ September 2003(Kathmandu University, 2003) DB, Karki; CD, Shrestha; S, ShresthaObjective: To clinically analyze 400 cases of red eye attending Nepal Eye Hospital in August/ September 2003 and to study the aetiology of the disease on the clinical basis with available laboratory resources. Materials and methods: It is a prospective study of 400 cases of acute conjunctivitis visiting Nepal Eye Hospital during the epidemic of acute haemorrhagic conjunctivitis in August/September 2003. Result: 30.5% presented in the age group of 20-29 years. Males presented predominantly (73.3%). Maximum number of patients presented at two days of onset of symptoms. All 400 cases had red eye, 89.8% had pain, 86.3% had foreign body sensation and 87.5% had discharge. Bilateral involvement was seen in 73.5% and unilateral involvement in 26.5%, 4.3 % of the total cases had corneal involvement and 20% of the cases had associated fever and preauricular lymphadenopathy. Conclusion: Based on clinical presentation and the report of available laboratory results, picorna virus was found to be responsible for this epidemic of acute haemorrhagic conjunctivitis. Keywords: Haemorrhage, Conjunctivitis, Superficial Punctate Keratitis, Lymphadenopathy, Picorna virus.Publication An Overview of Undergraduate and Postgraduate Medical Education in Nepal and Elsewhere(Kathmandu University, 2004) DB, Karki; H, DixitThough Health Sciences education started in the country as far back as 1934, it was only in 1978 that the MBBS course was started. The first postgraduate (PG) course, which was started, was the MD in general practice, which was started in 1982. It is over the course of the last 22 years, and more specifically after 1993, that there has been a spurt in postgraduate (PG) education. The rapid increase of medical schools / colleges within the country during the last decade, has been the main reason for fulfilling the demand of doctors with postgraduate degrees required for different faculty positions at the newly established medical colleges. This article also looks at the role of foreign qualifications vis-à-vis the local degree for the development of PG programmes within the country. Key words: Postgraduate degree, diplomas, Nepal Medical Council.Publication Analysis of 400 cases of posterior segment diseases visiting retina clinic of Nepal eye hospital(Kathmandu University, 2003) DB, Karki; OK, Malla; RN, Byanju; S, ShresthaObjective: To determine the disease pattern of 400 patients attending Nepal Eye Hospital for strategic planning. Materials and methods: A retrospective hospital based analysis of 400 cases visiting Retina Clinic of Nepal Eye Hospital (NEH) over a period of one year was carried out in order to know the disease pattern for planning purpose. Results: Males slightly outnumbered females (58% versus 42%). The diseases were more common in age group 50 to 59 years. Diabetes mellitus with or without retinopathy was the commonest cause (20.25 %) for attendance in retina clinic followed by hypertensive retinopathy and venous occlusive disorders. Keywords: Posterior segment disease pattern, diabetic retinopathy, hypertension, venous occlusive disease.Publication Clinical profile of typhoid patients(Kathmandu University, 2003) Mathura,KC; DL, Gurubacharya; A, Shrestha; S, Pant; P, Basnet; DB, KarkiObjective: The present study was undertaken to determine the clinical profile of typhoid fever in hospitalised patients. Design: Prospective cross-sectional study. Setting: Kathmandu Medical College and Teaching Hospital Method: Total of thirty patients above fifteen years of age who had clinical features strongly suggestive of typhoid fever and on blood culture found to be positive for salmonella typhi were analysed for clinical features. Result: Among total of thirty cases, there were 17 (57%) males and 13(43%) females. 86% of cases of typhoid fever clustered around 15-30 years of age. Predominant symptoms were fever (100%), headache (90%), abdominal Pain (37%) and constipation (33%). Common clinical signs were splenomegaly (37%), relative bradycardia (27%) and hepatomegaly (17%). None of the patients presented with complications. Conclusion: The clinical profile of typhoid fever in our study revealed not much difference from that of other studies on typhoid fever. Rose spots were not noticed and we did not find a single case of complication of typhoid fever. Probably early initiation of antibiotics prevented the complications. Key words: Typhoid fever, S. Typhi.Publication Clinico-radiological profile of stroke in eastern Nepal: A computed tomographic study(Kathmandu University, 2006) M, Naik; RK, Rauniyar; UK, Sharma; S, Dwivedi; DB, Karki; JR, SamuelAim: Stroke is a frequent cause of death and disability in elderly patients. This study was carried out to establish the pattern of various types of cerebrovascular accident (CVA) in eastern Nepal and to correlate the clinical data and radiological findings in cases of stroke. Materials and methods: All the patients clinically diagnosed as stroke and referred to the radiology department for Computed tomography (CT) of the brain over a period of 1 year were included. Results: There were 150 patients with stroke (104 males and 46 females), aged 7 to 91 years in which infarction (58%) was more common than haemorrhage (42%) in both group of age (≤ 40 years and > 40 years). Smoking was the commonest risk factor noted in 40.66% cases followed by hypertension (40%). Excessive meat consumption (more than 4 times a week) was seen in 69.1% cases. In early Middle Cerebral Artery (MCA) territory infarction presenting within six hours of onset, positive CT findings were seen in 40% cases among which, obscuration of the lentiform nuclei was diagnostic. Conclusion: In this part of Nepal, infarction is more common than haemorrhage as the cause of stroke and in contrary to western population; hemorrhagic stroke constitutes a significantly higher proportion of stroke. Smoking is the commonest risk factor followed by hypertension and it is also seen in combination with alcohol in many cases. Excessive meat consumption could be an additional risk factor for stroke in this part of Nepal. In younger age group (≤ 40 years), haemorrhage is more common than infarction and alcohol consumption is the commonest risk factor. Key Words: Computed tomography, stroke, CVAPublication Correlation between serum-ascites albumin concentration gradient and endoscopic parameters of portal hypertension(Kathmandu University, 2005) DL, Gurubacharya; Mathura, KC; DB, KarkiObjective: We sought to determine the correlation between the level of serum-ascites albumin concentration gradient (SAAG) and the complications of portal hypertension (PHTN), manifested by the presence and grade of esophageal varices (EV). Material and methods: Our study included 32 patients with ascites, demonstrated by ultrasonography, who had measurement of the SAAG. All had upper gastrointestinal endoscopy with assessment of the presence and size of EV. High SAAG was considered to be present when SAAG was >= 1.1 g/dl and Low SAAG when it measured < 1.1 g/dl. Results: We found that 25 of 32 (78.13%) patients had High SAAG and 7 of 32 (21.87%) had Low SAAG. Esophageal varices were present in 18 of 25 (72%) patients with High SAAG and in none of 7 (0%) patients with Low SAAG (p =< 0.001). Among patients with High SAAG, EV were present in four of 8 patients (50%) with SAAG values of 1.10-1.49g/dl; in four of seven patients (57.1%) with SAAG values of 1.50-1.99g/dl; and in ten of ten (100%) with SAAG values of >= 2.0g/dl (p = 0.037). The size of the esophageal varices had no association with the level of SAAG in patients with High SAAG (p = 0.426). Conclusions: In patients with ascites the presence of esophageal varices is associated only with patients with High SAAG. The presence of EV in patients with ascites and High SAAG is directly related to the degree of SAAG. The size of the EV in patients with ascites and High SAAG is not associated with the degree of SAAG. Keywords: Ascites, Serum-ascites albumin concentration gradient (SAAG), Esophageal varices (EV), Portal Hypertension (PHTN)Publication Effectiveness of nicotinic acid and bezafibrate alone and in combination for reducing serum triglyceride level(Kathmandu University, 2005) B, Pradhan; A, Neopane; S, Karki; DB, KarkiObjective: To study the effectiveness of nicotinic acid and Bezafibrate alone and in combination for reducing triglyceride level. Design: It was a randomised, prospective, longitudinal study. Setting: Patients attending a private clinic, and medical department of Kathmandu Medical College, Sinamangal. Methods: This study included 83 consecutive patients, 19 females and 64 males with hypertriglyceridaemia (defined as serum triglyceride >200mg/dl) attending the department of medicine, Kathmandu Medical College, Sinamangal and private clinic. Main outcome measures: Statistically significant reduction of serum triglyceride level. Result: 51 out of 83 patients completed the study in which Nicotinic acid alone reduced the serum trygleceride level from 320.62 ± 104.23 to 182.55 ± 46.21, which is a reduction of 138.07 ± 85.69 (P. value = 001). Bezafibrate when given alone also reduced triglyceride level significantly from 345.25 ± 181.03 to 203.30±93.59 which is a reduction of 141.95 ± 121.130 (P value= .001). When a combination of both drugs was given the reduction of 472.73±247.53 (P value =.002) was achieved. Conclusions: Nicotinic acid is a very effective drug in reducing serum triglyceride level and its effectiveness is similar to Bezafibrate. There is no added benefit of giving a combination of nicotinic acid and Bezafibrate in reducing serum triglyceride level. Keywords: Hypertriglyceridaemia, Nicotinic acid, Bezafibrate. Abbreviations: TG= Triglyceride, TC = Total cholesterol, HDL= High density lipoprotein, LDL= Low density lipoprotein NCEP-ATP III= National Cholesterol Education Programme-Adult Treatment panel 111Publication Injection drug use and tricuspid valve endocarditis(Kathmandu University, 2005) Mathura, KC; N, Thapa; A, Rauniyar; A, Magar; DL, Gurubachharya; DB, KarkiTricuspid valve endocarditis is more common in injection drug users. Pulmonary valve and Eustachian valve endocarditis have been reported but are very rare. Earlier reports of endocarditis in injection drug users emphasized the dominance of right sided involvement. In a series of 105 patients 86 % were right sided and 14 % had left sided involvement. We report a case of isolated tricuspid valve endocarditis in an injection drug user affecting a structurally normal heart and review of the literature on this subject. Key Words: injection drug use, tricuspid valve endocarditisPublication Intermediate uveitis: a hospital based study(Kathmandu University, 2004) OK, Malla; DB, Karki; RN, Byanju; S, ShresthaIntermediate uveitis affecting pars plana, peripheral retina and underlying choroid affects primarily healthy children and young adults. Objective: To study the components of intermediate uveitis at Nepal Eye Hospital in the year 2003 August to 2004 March. Materials and Methods: A prospective study was done in patients with intermediate uveitis visiting Nepal Eye Hospital. Sample size was 50. Specially designed proforma of intermediate uveitis was used to collect particulars of the patients, history, clinical examination findings, investigation reports, management protocols used and the final visual outcome. Results: Intermediate uveitis was seen more in 20 to 29 years age group (38%) and more prevalent in males (52%). Among the study population farmers constituted maximum proportion (36%) and Mongoloid origin was mostly affected (30%). High number of patients were from the central development region with highest proportion from Dhading district (34%). Anterior segment affection with keratic precipitates and anterior chamber cells were noted in 72% of involved eyes. Vitreous cells were noted in all affected eyes while 4% had vitreous snow banking and 3% had vitreous snow balls. Most of the patients (52%) received between topical steroid and posterior subtenon injection of Triamcinolone. Visual Acuity was improved in 52% of cases and remained static in 46%.while deteriorated in 2%. Conclusion: Significantly high number of patients with intermediate uveitis has been reported from the central development region, mainly from Dhading, Kathmandu and Nuwakot districts. People in their third decade were found to be commonly involved and Mongloid origin were more commonly affected. Anterior chamber spill over was seen in higher percentage of patients than described in literature. As the patients presented in milder forms, visual acuity improved is 52% of cases with the treatment protocol followedPublication Knowledge, attitude and practices among health care workers on needle-stick injuries(Kathmandu University, 2003) DL, Gurubacharya.; Mathura, KC; DB, KarkiObjective: This study aimed to assess the knowledge, attitude and practices among health care workers on needle stick injuries. Methods: A 15-item questionnaire was administered to seventy health care workers including nurses and paramedical staffs from different departments of Kathmandu Medical College and Teaching Hospital to measure knowledge, attitude and practices on needle stick injuries. Results: Results showed that 4% and 61% of health care workers, respectively, were unaware of the fact that hepatitis B and hepatitis C can be transmitted by needle-stick injuries. 52 subjects (74%) had a history of needle-stick injuries and only 21% reported the injuries to the hospital authority. Only 23% were in the habit of using gloves for phlebotomy procedures all the time. 79% were of the impression that needle should be recapped after use. Only 66% were aware of Universal Precaution Guidelines. 16 subjects (23%) were negative for HBsAg, Anti-HCV and Anti-HIV and 54 subjects (77%) do not know about their immune status. 42 subjects (60%) had been vaccinated against hepatitis B, while 28 subjects (40%) were not vaccinated against hepatitis B. Only 6 subjects (14%) had been tested for Anti-HBs antibody after hepatitis B vaccination. Conclusion- The survey revealed that knowledge of health care workers about the risk associated with needle-stick injuries and use of preventive measures was inadequate. A standing order procedure (SOP) should be formulated regarding needle-stick injuries in all the health institutions. It should outline precautions to be taken when dealing with blood and body fluids. It should also contain reporting of all needle-stick injuries. Health care workers should be made aware of hazards, preventive measures and post-exposure prophylaxis to needle-stick injuries. A hospital-wide hepatitis immunization programme should also be started. Keywords: needle-stick injury, universal precaution guidelinesPublication Lipid levels in Nepalese population(Kathmandu University, 2004) DB, Karki; A, Neopane; B, Pradhan; A, MagarObjective: To study the lipid pattern of Nepalese population Design: Retrospective study Setting: Patients attending Temple of Healing for consultation Methods: Fasting lipid profile of 2218 blood samples was analyzed. Results: Abnormal total cholesterol(TC) was found in 7.7%. High LDL cholesterol(LDL-C) was found in 5% of cases. 70% of subjects had triglyceride(TG) level more than the upper level of normal. All abnormal lipid level was found in the age group 49-60years. 23% of the study group had low level of HDL cholesterol. Conclusions: abnormal triglyceride level is the commonest lipid abnormality in our population. High total cholesterol and LDL cholesterol is not very common except in the age group 40-49 where it is significantly high in comparison to other age groups. HDL cholesterol level did not decrease significantly with increasing age. Keywords: Lipids, Nepalese populationPublication Publication Management of Typhoid fever in the Department of Medicine at Kathmandu Medical College(Kathmandu University, 2003) M, Dhakal; A, Neopane; N, Subedi; R, Dhakal; DB, KarkiAim 1. To assess the ongoing management strategy of typhoid fever in department of medicine at Kathmandu Medical College, Sinamangal, Kathmandu. 1. To suggest changes, if required for the benefit of patients and doctors Method Prospective study of clinically suspected enteric fever from 2060/01/29 to 2060/04/25. Assessment and analysis of the rationality of the diagnostic parameters that are being used in the ward for clinically suspected enteric fever in unit one of department of medicine. Treatment outcome of the patients with the commonly used antibiotics. Analysis of the sensitivity pattern of the salmonellae isolated among the study group. Result 1. Only 11 cases (37%) were actually culture proven among the 30 cases suspected to be enteric fever on clinical basis. 2. 19 cases (63 %) of the clinically suspected enteric fever were diagnosed only on the basis of single widal test (titre more than 1:320), blood culture being negative. 3. Bone marrow was subjected to culture for salmonella only in 4 Cases (13%) despite blood culture being sterile. 4. The laboratory could provide sensitivity pattern of salmonellae only in 5 cases out of 11 culture positive cases (45%). 5. Eighteen cases (60%) had to be given 3rd generation cephalosporin after not responding to 5 days course of fluoroquinolones (ciprofloxacin or ofloxacin). On the other hand all the cases in the study group subjected to 3rd generation cephalosporin (injection ceftriaxone or cefixime orally) responded well to the treatment. Conclusion 1. We shouldn’t be relying too heavily on a single titre of widal test for the diagnosis of enteric fever and should be sending blood for culture for salmonella and even bone marrow culture, if necessary. This can be concluded on the basis of lots of literature against single widal test in the diagnosis of enteric fever. 2. Widal test should be positive with clearly significant rising titre (with paired sample) or modified widal test has to be performed if one wants to give gravity to the test for the diagnosis of enteric fever. 3. Laboratory personnel’s need to be more serious in their works so as to try to see sensitivity pattern in all positive cultures, if rational use of antibiotics is really desired in view of increasing antibiotic resistance. 4. Fluoroquinolones, once thought to be super powerful antibiotic & still taken as the drug of choice almost everywhere, has been found to be resistant in most of the cases in this study. Though the sample size is too small and there are lots of limitations in this study to come to a firm conclusion, it has borne one serious question in the minds of our unit doctors: Correspondence Dr. Mahesh Dhakal Dept. of Medicine, Kathmandu Medical College, Teaching Hospital Kathmandu University Medical Journal (2003) Vol. 1, No. 3, 197-204 198 whether we are over-using fluoroquinolones for trivial infections and leading to the emergence of resistant strains of salmonellae?Publication Publication Study of patients presenting with symptoms of peripheral neuropathy and thickened greater auricular nerve(2003) A, Neopane; B, Upadhyaya; S, Dungana; DB, KarkiObjective: To analyze symptoms and make a clinical diagnosis of leprosy in patients presenting with symptoms of peripheral neuropathy and found to have thickened greater auricular nerve. Design: Cross- sectional study Setting: Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu. Patients attending the medical out patient department of this hospital were taken in the study. Materials and methods: 40 patients presenting with symptoms of peripheral neuropathy and are found to have thickened greater auricular nerve were included. Results: Thickened greater auricular nerve and sensory symptoms showed male predominance (97.5%). Mean age of involvement was 28.65 years. The symptom most frequently complained of was chest pain (75%), followed by pins and needle sensation 67.5%, burning of the upper extremities, nape of the neck and chest 57.5%, palpitation 45%, disturbed sleep mostly said to be due to burning 35%, sweating 20%, dizziness17.5%, shortness of breath 7.5%, and numbness of the limbs in 2.5%. None of the patients had somatic neuropathy. Autonomic neuropathy was present in 42.5 %. Conclusions: 1. In endemic areas patients with thickened peripheral nerve and sensory symptoms should be diagnosed clinically as primary neuritic leprosy. 2. In absence of objective loss of somatic sensation autonomic neuropathy may be the only early indicator of neuritis. 3. Close follow up of these patients is necessary. Key words: peripheral neuropathy, primary neuritic leprosy, autonomic neuropathy, follow upPublication Technology transfer by faculty exchange between developed and developing countries(Kathmandu University, 2004) DB, KarkiNAPublication Two cases of severe falciparum malaria in KMCTH(Kathmandu University, 2006) SB, Singh; D, Chaudhary; A, Neopane; DB, KarkiMalaria is the most important parasitic disease of man. It is the protozoan infection of RBCs transmitted by bite of blood feeding female anopheline mosquito. Until the 19th century malaria was found throughout Europe, North America and Russia. Since then, it has been eradicated from these areas but in tropics though initial efforts of eradication had been successful, there has been resurgence of disease1 accompanied by increasing resistance of the anopheline vector to insecticide and of the parasite to antimalarial drugs. We report two cases of falciparum malaria in which there was co-existent vivax malarial infection. These two cases were both exposed to highly endemic zone for malaria. Key words: Sequestration, malaria, falciparum.