Browsing by Author "Dahal, R"
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Publication Analysis of Prognostic Factors of Bell’s Palsy in a Tertiary Care Centre of Eastern Nepal(Kathmandu University, 2021) Paudel, D; Chettri, ST; Sah, BP; Dahal, R; Pyakurel, PABSTRACT Background Bell’s palsy is the most common cause of acute facial peripheral neuropathy commonly encountered in otolaryngology clinics. Studies regarding epidemiology, risk factors, treatment and prognosis of Bell’s palsy are sparse in our settings. Objective To analyze the prognostic factors of Bell’s palsy in tertiary care Centre of eastern Nepal. Method A retrospective chart review of patients diagnosed with Bell’s palsy from 1st January 2005 to 31st December 2018 was done. Records of the patients were obtained from medical record section of BP Koirala Institute of Health Sciences. Result A Total of 208 patients were included for analysis. After six months 72.6% patients had complete recovery. Patients who presented with lower House Brackmann (HB) grade had significantly better complete recovery than those with high grade (89.1% vs 45.6%). The complete recovery was 80.3%, 73.8%, 63.5% and 50% for the patients of more than 30 yrs, 31-45 years, 46-60 years and more than 60 years respectively and the difference was significant (p= 0.012). Alcohol significantly reduced the complete recovery (p= 0.043). Multivariate analysis showed high HB grade score at presentation to be significant predictor of poor prognosis. (p= 0.001 odds ratio 11.262). Conclusion Old age, use of alcohol and the severity of facial nerve palsy at the time of presentation were the bad prognostic factors, severity of the palsy was found to be most significant predictor. KEY WORDS Bad prognostic factors, Bell’s palsy, House brackmann gradePublication Clip Migration in Common Bile Duct: An Uncommon Complication of Laparoscopic Cholecystectomy(Kathmandu University, 2022) Pradhan, U; Gyawali, P; Dahal, R; Joshi Lakhey, PABSTRACT Laparoscopic cholecystectomy is the gold standard procedure for symptomatic cholelithiasis. During the procedure the cystic duct is ligated with titanium clips. Migration of these clips after cholecystectomy is a rare complication and may result in stone formation in common bile duct (CBD). We are here discussing a case of a 29 years female who presented with choledocholithiasis 10 years after laparoscopic cholecystectomy. The clip was incidentally discovered during endoscopic retrograde cholangiopancreatography (ERCP) and stone extraction. The patient was managed successfully at our center. KEY WORDS Clip migration, Endoscopic retrograde cholangiopancreatography, Laparoscopic cholecystectomyPublication Complete Right Ovarian Vein Thrombosis Extending to the Inferior Vena Cava during Early Postpartum Period in a Low Risk Patient(Kathmandu University, 2019) Fatema, N; Acharya, Y; Dahal, R; Sayed, A; Al Yaqoubi, HNABSTRACT Postpartum ovarian vein thrombosis is rare but life-threatening complication of puerperium. It predominantly occurs in the right side of the abdomen, mimicking various other conditions like acute appendicitis, ureteral stones or tubo-ovarian abscess. It is imperative to envisage the possibility of this rare disease even in an uncomplicated pregnancy. Here, we reported a 28-year-old female with no significant underlying risk factors who presented with high-grade fever and right lower abdominal pain after four days of an uncomplicated cesarean delivery. A right-sided complete ovarian vein thrombosis extending to the inferior vena cava was diagnosed and subsequently managed with long-term anticoagulant therapy. She had an uneventful recovery, with repeat imaging after three months showing complete resolution of thrombus. KEY WORDS Ovarian vein thrombosis, Postpartum, Pregnancy complicationsPublication En Bloc Versus Conventional Resection of Primary Bladder Tumor(Kathmandu University, 2025) Thapa, BB; Shah, AK; Adhikari, B; Mishra, U; Dahal, R; Rasali, N; Basnet, RB; Shrestha, PM; Shrestha, AABSTRACT Background Transurethral resection of bladder tumor (TURBT) is the crucial and standard approach in the diagnosis and management of urinary bladder cancer. Objective To compares conventional piecemeal and en bloc resection techniques in terms of detrusor muscle presence in resected specimens, surgical safety, and feasibility. Method A prospective comparative study conducted from April 2024 to March 2025 included patients with up to three bladder tumors, measuring ≤ 3 cm, who were alternately assigned to undergo either conventional piecemeal resection or en bloc resection. The primary outcome was the presence of detrusor muscle in the resected specimen. Secondary outcomes included operative time duration, bladder perforation, and obturator reflex. The quality of tissue was assessed by pathologists using a Likert scale. Result Eighty-seven patients were included, 43 in the conventional and 44 in the en bloc group. The baseline characteristics and tumor size were comparable. Presence of detrusor muscle in specimens was higher in en bloc group (97.7% vs 83.7%; p = 0.030). Operative duration was shorter in the en bloc group (35.55 minutes vs 43.42 minutes; p = 0.001). A case of bladder perforation was observed in the conventional group. Pathologists observed better specimen orientation and architecture in the en bloc group. Presence of tumor in re-TURBT was 16.0% in the en bloc group and 28.6% in the conventional group (p=0.497). Conclusion En bloc resection yielded a higher presence of detrusor muscle and shorter operative duration with better specimen quality compared to conventional piecemeal resection for tumor ≤ 3 cm. KEY WORDS Detrusor muscle, En bloc resection, Transurethral resection of bladder tumorPublication Outcome of Transurethral Vaporisation of Prostate in Small Volume Prostate: A prospective observational study(Kathmandu University, 2024) Dahal, R; Adhikari, B; Mishra, U; Shah, AK; Basnet, RB; Shrestha, A; Shrestha, PMABSTRACT Background Benign Enlargement of Prostate is common in aging men. Transurethral vaporisation of prostate is one modality of minimal invasive management of benign enlargement of prostate. This study assesses the efficacy and safety of transurethral vaporisation of prostate in small volume prostate. Objective To assess the efficacy and safety of bipolar plasma vaporisation of small volume prostate (Prostate Volume less than 40 grams). Method A total of 40 patients with prostate volume less than 40 grams and indications for operative management of benign enlargement of prostate were included. Patients with prior prostate surgery, urethral stricture surgery, presence of vesical calculus, urethral stricture and neurogenic bladder were excluded. Preoperative prostate size was assessed by transrectal ultrasonography. Comparison of preoperative and postoperative hemoglobin, sodium, international prostate symptom score and maximum flow rate was done. Perioperative complications were documented. Result The mean age of patients was 66.88 ± 9.09 years and the mean size of prostate was 32.52 ± 4.66 grams. Significant improvement in IPSS (preoperative 22, postoperative 9) and Qmax (preoperative 8.4 ml/min, postoperative 18.5 ml/min) was noted. There was significant drop in hemoglobin (p < 0.001) but no patients required blood transfusion. There was significant drop in sodium (p < 0.001) but no patients developed transurethral resection syndrome. Most complications were Clavien grade I. Two patients required recatheterization and all were catheter free on follow up. Two patients developed urethral stricture. Conclusion Bipolar transurethral vaporisation of Prostate is effective and safe treatment option for prostate volume less than 40 grams. KEY WORDS Bipolar plasma vaporisation, Lower urinary tract symptoms, Prostate symptomsPublication Vitamin D Deficiency and Acute Otitis Media among Children Visiting a Tertiary Care Centre in Eastern Nepal(Kathmandu University, 2023) Dahal, R; Shah, SP; Mishra, S; Baaniya, BABSTRACT Background There have been various studies to draw out the association between acute otitis media (AOM) and vitamin D deficiency but the results are conflicting. Objective To explore the relationship between vitamin D deficiency and acute otitis media. Method The comparative cross-sectional study was conducted in which children aged five to fifteen years were included. Sixty children diagnosed with acute otitis media were kept in group A while 60 children diagnosed with conditions other than acute otitis media were included in Group B. Then the Vitamin D level was sent in both the groups and compared. Result Fifty-four participants in group A had an insufficient level of Vitamin D while six participants had a sufficient level of Vitamin D and none had an excess level of Vitamin D while in Group B, fiftywo participants had an insufficient level of Vitamin D while eight participants had a sufficient level of Vitamin D. The mean vitamin D of the cases was 22.12 ±7.896 ng/ml, and that of the controls was 22.58 ±7.056 ng/ml for the controls (p = 0.737). Conclusion Both the children with acute otitis media and without acute otitis media had lower levels of Vitamin D in similar proportions. Therefore, we can conclude that there is no association between Vitamin D level and acute otitis media. KEY WORDS Acute otitis media, Children, Vitamin D