Browsing by Author "Dangal, G"
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Publication A Point Prevalence Study of the Use of Antibiotics in Six Tertiary Care Hospitals in the Kathmandu Valley, Nepal(Kathmandu University, 2022) Jha, N; Thapa, B; Pathak, SB; Pandey, A; Pokhrel, S; Shankar, PR; Bhandary, S; Mudvari, A; Dangal, GABSTRACT Background Point prevalence survey (PPS) on antibiotic use developed by the WHO has already been used in many hospitals globally. Objective To obtain information on antibiotic prescribtion using point prevalence survey methodology in six private hospitals in the Kathmandu valley. Method This descriptive cross-sectional study was completed during 20th July to 28th July 2021 using point prevalence survey methodology. The study was conducted among inpatients admitted at or before 8:00 AM on the day of survey in various wards. Data was presented as frequencies and percentages. Result Maximum number of patients were above 60 years [34 (18.7%)]. Number of male and female participants were equal [91 (50%)]. Only one antibiotic was used in 81 patients (44.5%) followed by two antibiotics in 71 (39%) patients. Duration of prophylactic antibiotic use was one day in 66 (63.7%) patients. Blood, urine, sputum, and wound swabs were the common samples for culture. Cultures were positive for 17 (24.7%) samples. The common organisms isolated were E. Coli, Pseudomonas aeruginosa and Klebsiella pneumoniae. Ceftriaxone was the most used antibiotic. Drug and therapeutics, infection control committee and pharmacovigilance activities were present in 3/6 (50%) study sites. Antimicrobial stewardship was present in 3/6 (50%) and microbiological services was present in all hospitals. Antibiotic formulary and antibiotic guideline were present in 4/6 sites and facilities to audit or review surgical antibiotic prophylaxis choice in 2/6 (33.3%) sites, facility to monitor antibiotic use in 4/6 (66.6%) and cumulative antibiotic susceptibility reports in 2/6 (33.3%) study sites. Conclusion Ceftriaxone was the most used antibiotic. E. Coli, Pseudomonas aeruginosa and Klebsiella pneumonia were the commonly isolated organisms. Not all parameters for infrastructure, policy and practice and monitoring and feedback were present at the study sites. KEY WORDS Antibiotics, Point prevalence survey, Private hospitals, Tertiary care centersPublication A study of endometrium of patients with abnormal uterine bleeding at Chitwan valley(Kathmandu University, 2003) Dangal, GObjective: To know the causes for the abnormal uterine bleeding in Women at Chitwan Valley and to compare the histopathological findings between the pre-menopausal and postmenopausal women. Design: A descriptive study of patients who have had vaginal bleeding during the period from January 2000 to July 2002. Setting: Department of Gynaecological Oncology of BP Koirala Memorial Cancer Hospital (BPKMCH), Chitwan, Nepal. Subjects: Eighty-four women (aged 45 year and above) having abnormal vaginal bleeding managed at BPKMCH. Main Outcome Measured: Various characteristics of the patients including age, menopausal status, histopathological findings. Results: A total of eighty-four patients were studied. Majority (53.5%) of them were postmenopausal ladies presenting with abnormal vaginal bleeding. The age range was 45 to 81 years, with an average of 63. Only 37% had pathological bleeding including malignancy and about 16.6% of all had malignancies. Malignant diseases were found in 7.7% cases in the pre-menopausal ladies whereas it was 24.3%, three times higher, in the post-menopausal ladies. Conclusion: Carcinoma of the cervix and of the endometrium occurred with increasing frequency with increasing age in this study. So, a thorough work-up is needed for the perimenopausal/postmenopausal women presenting with an abnormal vaginal bleeding especially to rule out malignancies. Keywords: curettage, endometrial biopsy, endometrial cancer, post- menopausal bleeding.Publication Care of Non COVID Patients in COVID-19 Era(Kathmandu University, 2020) Piryani, S; Piryani, RM; Dangal, GABSTRACT The consequences of the COVID-19 pandemic are extensive and far-reaching. Non COVID communicable diseases continue to spread and non-communicable diseases continue to progress. People may access healthcare facilities little bit late due to fear of contracting COVID-19 and present with severe symptoms, even with complications. Nepal has been facing dual burden of both non-communicable and communicable diseases. The number of COVID-19 patients has continuously been rising in Nepal since the start of May 2020. There is an anticipated surge of infectious disease such as malaria, dengue fever, enteric fever, scrub typhus, leptospirosis during summer and monsoon seasons in Nepal. There will be surge of cases of acute undifferentiated febrile illness (AUFI) during monsoon. As fever is one of the very common symptoms of COVID-19, so COVID-19 needs to be considered in differential diagnoses of acute undifferentiated febrile illness. KEY WORDS AUFI, COVID-19, Communicable disease, NepalPublication COVID-19 Booster Vaccine: is it an absolute need?(Kathmandu University, 2021) Ghimire, S; Dangal, GABSTRACT Booster vaccine doses are meant to revive the fading immunity created by prior exposure to an immunizing antigen. They stabilize the antibody response ultimately leading to longer and higher protection against pathogens. Immunological studies done for COVID-19 vaccines have documented a steady decrease in antibody levels among vaccinated individuals and evidence of breakthrough infections over a course of time. With an emerging science behind the need for COVID-19 vaccine booster shots, there equally is a contrasting idea regarding its absolute necessity. KEY WORDS Antigen, Booster, COVID-19Publication COVID-19 in Pregnancy: Pregnant Women Might be at Greater Risk for Severe COVID-19(Kathmandu University, 2020) Dangal, GNAPublication COVID-19 Pandemic and Neonatal Health: What We Know so Far?(Kathmandu University, 2020) Bhandari, TR; Dangal, GABSTRACT COVID-19 first time appeared in December 2019 in Wuhan, China. The number of cases increased rapidly in china and outside and the World Health Organization declared a pandemic on 11th March 2020. The pregnant and postpartum women, child, and neonatal populations are vulnerable to this disease due to immunological and physiological changes. This paper analyzed the published evidence for assessing the effect of COVID-19 on neonatal health and health care. Online published literature was searched from PubMed, Google Scholar, and other official webpages using keywords: “coronavirus/COVID-19/new coronavirus 2019”/SARS-CoV-2 and neonatal health/care/outcomes” and reviewed to prepare this article. COVID-19 is the potential to transmit either mother to fetus or mother/caregiver to neonates. However, neonates born from infected mothers did not show significant clinical features. Pharyngeal-swab, amniotic-fluid, cord-blood, and breast-milk test results were not found positive. Health facility-based vaginal/caesarian delivery was considered a low risk of transmission. However, recommended to separate neonates with infected mothers/caregivers and test immediately after birth to avoid the possible transmission. Mothers/caregivers should take routine preventive measures such as washing hands frequently and avoiding contact with infected people. If neonates suffered from the server acute respiratory distress requires intensive care urgently. Despite the possibility of the intrauterine transmission of COVID-19 direct evidence is still lacking so it needs more studies for further confirmation. The International Pediatric Association suggested preventive programs, curative care, vaccination, and telemedicine care as the minimum services and called on its members to address these cares during the pandemic. KEY WORDS COVID-19, Neonatal care, Novel coronavirus, SARS-CoV-2, Vertical transmissionPublication COVID-19 Vaccination: Urgent Efforts Must Now Be Made to Ensure that Pregnant Women Are Fast Tracked and Prioritized(Kathmandu University, 2021) Dangal, GNAPublication Factors Associated with Intrauterine Fetal Death at Paropakar Maternity Women’s Hospital(Kathmandu University, 2022) Thakur, SK; Dangal, GABSTRACT Background Intrauterine fetal death (IUFD) is a demise occurring at 20 or more weeks of gestation and weight 500 gram or more. Intrauterine fetal death at any point during gestation is a traumatic event not only to the patient but also to the care giver. The purpose of this study is to know the risk factors associated with intrauterine fetal death. Objective To determine the factors associated with intrauterine fetal death. Method Prospective observational study was conducted at Paropkar maternity women’s hospital, Thapathali, Kathmandu. All the cases with intrauterine fetal death were admitted and delivered in the hospital with period of gestation 20 weeks to term pregnancy. All the relevant data were recorded in pre-designed proforma. The collected data were entered in SPSS 25 version for analysis. Result There was a total 5153 deliveries in three months, with prevalence of 1.2% and intrauterine rate of 12.03 per 1000 births. Out of 50 enrolled cases, 78% (n=50) of patient had not attended antenatal checkup. Majority (n=50; 74%), belonged to age group 21-35 years, 48% of intrauterine fetal death were term pregnancies of 37 to 42 weeks of gestation. Maximum 20% of IUFD, weighed between (1-1.5 kg) (1.5-2 kg) and (2.5-3 kg). Thirty-nine babies were macerated and eleven non-macerated. Pregnancy induced hypertension was most common (26%), followed by ante-partum hemorrhage (8%), hypothyroidism and anemia (6%), meconium stained liquor and cord prolapse (6%), gestational diabetes mellitus, congenital anomalies, chronic hypertension (4%), intrauterine growth restriction and urinary tract infection (2%). Twelve cases underwent cesarean section. Postpartum complications were found in 10 cases; 4 cases had postpartum hemorrhage, 4 had prolonged hospital stay and 2 cases developed hemolysis, elevated liver enzyme, low platelet count (HELLP) syndrome. Conclusion This study concluded that maximum no. of intrauterine fetal death were seen antenatally, as 78% of cases were found macerated. The commonest identified risk factor was pregnancy induced hypertension, followed by ante-partum hemorrhage, anemia, hypothyroidism, which seem to be preventable risk factors of intrauterine fetal death, but still unidentified risk factors are of great challenges for the obstetricians. KEY WORDS Ante-partum haemorrhage, Intrauterine fetal death, Postpartum haemorrhagePublication Incarcerated Uterine Prolapse: A Result of Neglect(Kathmandu University, 2024) Adhikari, A; Poudel, A; Dangal, GABSTRACT An 80-year-old lady was brought with the three-month history of irreducible prolapse with infected ulcer at anterior vaginal wall. She initially attempted home remedies for infection with locally available materials. On examination she was ill looking, febrile with stage IV prolapse according to pelvic organ prolapse quantification classification. She was treated initially with antiseptic wash, followed by local estrogen therapy and glycerine. Prolapse was repositioned when edema decreased and held in place with silicon ring pessary with definitive management planned for later date. KEY WORDS Incarcerated prolapse, Irreducible prolapse, UlcerPublication Misleading Diagnosis of Dysgerminoma in a Young Asymptomatic Patient(Kathmandu University, 2020) Maharjan, O; Bajracharya, N; Dangal, G; Karki, A; Pradhan, HK; Shrestha, R; Bhattachan, K; Tiwari, K; Bharati, S; Maharjan, SABSTRACT Dysgerminomas account for approximately one third of all malignant ovarian germ cell tumors (tumors arising from ovarian germinal elements) and are the most common ovarian malignancy detected during pregnancy. They are the only germ cell malignancy with a significant rate of bilateral ovarian involvement that is 15-20 percent. They have a variable gross appearance, but in general are solid, pink to tan to cream colored lobulated masses. They have the best prognosis of all malignant ovarian germ cell tumor variants. Two thirds are stage I at diagnosis, and prognosis is excellent even for those with advanced disease due to exquisite tumor chemosensitivity. The 5 year disease specific survival rate approximates 99 percent. This is a case report of a huge ovarian dysgerminoma in a young unmarried lady that was quite asymptomatic. She underwent laparotomy with right ovarian cystectomy. KEY WORDS Dysgerminoma, Germ cell tumor, Malignant, Pvarian malignanciesPublication Pregnancy Complicated by Acute Pancreatitis with Ascariasis(Kathmandu University, 2020) Thakur, SK; Dangal, G; Karki, A; Pradhan, H; Shrestha, R; Bhattachan, K; Bajracharya, N; Tiwari, K; Bharati, S; Maharjan, O; Maharjan, SABSTRACT Ascariasis lumbricoides infections are common in tropical and sub-tropical countries. As it is one of the common causes for common bile duct obstruction. But in pregnancy is a rare entity. It may present with complications like acute pancreatitis. Here we present a case of 24 year female gravida 2 para 1 at 34 weeks of pregnancy presented with chief complain of pain over epigastric region radiating to back and associated with two episodes of vomiting, non bilious, not mixed with blood. Ultrasonography showed long tubular hyperechoic structure in gallbladder lumen most likely ascariasis and then she was diagnosed as a case of acute pancreatitis with alive ascariasis. KEY WORDS Acute pancreatitis, Ascariasis lumbricoides, Pregnancy, UltrasonographyPublication Prevalence of Hepatitis B and C among HIV Infected Patients in Nepal over 1990-2020(Kathmandu University, 2021) Shrestha, DB; Budhathoki, P; Sedhai, YR; Shrestha, LB; Awal, S; Upadhaya Regmi, B; Yadav, J; Baniya, R; Thapaliya, S; Dangal, GABSTRACT Background Hepatitis B and C (HBV and HCV) are viral infections caused by corresponding viruses. Here in this study we planned to conduct this meta-analysis to pool data on the prevalence and risk factors of HBV and/or HCV among HIV patients in Nepal. Method We used MOOSE guideline for the systemic review of available literature. We searched online databases using appropriate keywords. We used CMA-3 for data synthesis. Odds ratio, and proportion were used to estimate the outcome with a 95% confidence interval where appropriate. We assessed the heterogeneity using the I-squared (I2) test. Result We included nine studies for our synthesis. Pooling of data showed HBV in 4.6% (CI: 3.7-5.6), HCV in 19.7% (CI: 10.8-33.0), both HBV and HCV in 1.3% (CI: 0.5-3.7) in HIV affected individuals. Among HBV co-infected HIV positive patients, 59.5% (CI: 25.5-86.3) were male; 76.1% (CI: 30.1-96.0) were married and 43.6% (CI: 3.8-93.8) had a history of intravenous drug use (IVDU). Among HCV co-infected HIV positive individuals 88.3% (CI: 73.6-95.4) were male; 63.6% (CI: 55.4-71.1) were married; 91.5% (CI: 68.6-98.1) were literate; 59.2% (CI: 49.9-67.9) were on ART; and 92.2% (95%CI: 84.9-96.1) had a history of IVDU. Conclusion The pooled prevalence of co-infection with HBV, HCV, and combined HBV and HCV were 4.6%, 19.7% and 1.3% respectively among HIV positive patients. Thus, it is necessary to appropriately screen for HBV and HCV in individuals diagnosed with HIV and high-risk populations. IVDU remains the most common risk factor found in co-infected individuals. KEY WORDS Coinfection, Hepatitis B, Hepatitis C, HIV Infection, Intravenous, Substance abusePublication Profile of Women receiving Second-trimester Safe Abortion Service at Paropakar Maternity and Women’s Hospital(Kathmandu University, 2022) Shrestha, S; Dangal, G; Ghimire, SABSTRACT Background Second trimester abortions account for a small percentage of abortions globally. Abortion is one of the safest medical procedures. Accessibility of safe and high quality second-trimester abortion care can decrease severe complications associated with it. Objective The profile of women undergoing second-trimester abortion was assessed during the study. The profile includes demographic and clinical aspects. The study also aims to find out the rate of surgical and medical methods of abortion and to understand its indications. Method It is a study based on retrospective data collected from charts available at the comprehensive abortion care center at the Paropakar Maternity and Women’s Hospital. The data from Shrawan to Magh 2077 B.S. was collected and calculations were done on MS Excel. Result Higher proportion of women receiving second-trimester abortion were of the age between 21-25 years (n=31; 31%). Most women were literate (n=69; 69%) and n=38(38%) were nulliparous. The most common indication for abortion was maternal mental issues (n=32; 32%). The rate of medical abortion was higher (n=71; 71%) than surgical method of abortion (n=29; 29%). Conclusion There exists both demographic and clinical variations in women undergoing second- trimester abortion. Though few women undergo second trimester abortion than first-trimester the variation in profile is significant with most women referring to second trimester abortion due to later diagnosis of pregnancy, women facing financial and logistic barriers to health care, victims of violence and women with pregnancy complications or fetal anomalies. KEY WORDS Medical abortion, Surgical abortion, TrimesterPublication The Impact of COVID-19 on Women’s Health in Nepal(Kathmandu University, 2020) Poudel, R; Dangal, G; Caagbay, DABSTRACT COVID-19 has significantly impacted the world and Nepal is no exception. The pandemic has caused a reduction in health service delivery, especially for women’s health conditions, resulting in an increase in challenges for an already vulnerable group. Maternity care, reproductive health services, preventive interventions, nutritional advice and mental health care are not being addressed and with an increase in domestic violence, the health and wellbeing of women in Nepal is precarious and needs to be addressed immediately. KEY WORDS Covid-19, Mental health, Reproductive healthPublication Publication Vaginal Atresia with Cervical Agenesis, a Rare Congenital Malformation(Kathmandu University, 2021) Regmi, DR; Dangal, G; Karki, A; Pradhan, HK; Shrestha, R; Bhattachan, K; Tiwari, KD; Bharati, S; Manandhar, P; Maharjan, SABSTRACT Congenital vaginal atresia and cervical agenesis is a rare congenital abnormality of the female genital tract. Here we report a case of 15-year old girl with primary amenorrhea with hematometra, presented with lower abdominal mass. She was symptomatic since 5 months and visited local hospital after 4 months of onset of her symptoms when it became severe, where diagnostic laparotomy was performed for suspected Adnexal mass. Intraoperatively adnexal mass was adhered with and extended up to the uterus with 16 weeks size of uterus. Abdomen was closed without any further intervention and was referred to higher center for needful. When she presented to Kathmandu Model Hospital, she was asymptomatic on her 5th post-operative day of laparotomy. We planned for surgical intervention after examination and investigation. Drainage with vaginoplasty with amnion graft with placement of mould was done. KEY WORDS Congenital cervical agenesis, Hematometra, Vaginal atresia, VaginoplastyPublication Vesicovaginal Fistula Following Trauma(Kathmandu University, 2024) Shrestha, S; Dangal, G; Karki, A; Pradhan, HK; Shrestha, R; Bhattachan, K; Sah, SABSTRACT Vesicovaginal Fistula (VVF) is an abnormal communication between the bladder and vagina. The major causes of vesicovaginal fistula in developing countries are associated with obstructed labour whereas in developed countries, vesicovaginal fistula results from pelvic surgeries. Rarely vesicovaginal fistula may result due to direct trauma to the pelvis. This is a case of 17 years female who presented with the history of fall from tree 5 years back, sustained genital injury and complained of involuntary leakage of urine one month after the incident. She underwent fistula repair with vaginal approach using Latzko technique. KEY WORDS Vesicovaginal fistula, Trauma, TransvaginalPublication Virology, Clinical Features and Diagnosis of COVID 19: Review Analysis(Kathmandu University, 2020) Bhusal, L; Amgain, K; Dangal, G; Tamang, PD; Shahi, P; Budhathoki, P; Paudel, AKABSTRACT COVID-19 requires unprecedented mobilization of the health systems to prevent the rapid spread of this unique virus, which spreads via respiratory droplet and causes respiratory disease. There is an urgent need for an accurate and rapid test method to quickly identify many infected patients and asymptomatic carriers to prevent virus transmission and assure timely treatment of the patients. This article aims as an outcome of review of the evidence on viral load and its virulence of SARS-CoV2,so that it will help in further understanding the fact useful for investigating and managing the COVID-19 cases. A search of available evidence was conducted in pub-med “COVID-19 viral load and virulence” and its associated characters world-wide and Google Scholar to capture the most recently published articles. The WHO and Centre for Disease Control and Prevention (CDC) database of publications on novel coronavirus were also screened for relevant publications. Abstracts of 55 articles were screened by two authors and 15 were included in this study based on the inclusion criteria. SARS-coV2, the causative agent of COVID-19 falls under the coronavirus family but it has higher infectivity compared to SARS and MERS with higher reproduction numbers(Ro). Virulence has been found to be different throughout the world,however lower compared to SARS and MERS,till date. The most common clinical features have been found to be cough and fever. RT – PCR remains the most sensitive and specific method for the diagnosis of COVID-19 although it is time consuming, costly and requires highly skilled human resources. Hence, newer modalities like RT- LAMP can be alternative for point of care diagnosis as this is both cost effective and requires less skilled human resources. Despite recent advances in disease diagnosis and treatment outcomes using latest technological advances in molecular biology, the global pandemic COVID-19 remains a major headache for governments across the world due to limited testing capacity and lack of appropriate treatment and vaccine. KEY WORDS Coronavirus, COVID-19, Diagnosis of COVID-19, Serological tests, Virulence