Browsing by Author "Dhakal, A"
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Publication Awareness and Knowledge of Oral Cancer among Medical Students in Kathmandu University School of Medical Sciences(Kathmandu University, 2017) Pokharel, M; Shrestha, I; Dhakal, A; Amatya, RCMABSTRACT Background Oral cancer is a major public health problem worldwide. It has high mortality rates and chances of survival is relatively superior when detected early. Lack of knowledge and awareness about oral cancer among medical students may contribute to delay in diagnosis and treatment. Objective To assess awareness and knowledge of oral cancer among medical students. Method A cross-sectional study conducted among 286 students by Department of Otorhinolaryngology and Head & Neck surgery, Kathmandu University School of Medical sciences between July to August 2016. A questionnaire with questions on socio-demographic profile, awareness and knowledge of oral cancer was used. Independent sample t test and Pearson Chi-square tests were used for statistical analysis. Result Out of 329 students approached, 286 participated in the study yielding a response rate of 86.9%. Symptoms of oral cancer as reported were ulceration in mouth (92.3%), oral bleeding (85.0%),whitish or reddish patch (84.3%), halitosis (75.5%) and swelling in neck (74.5%), trismus (69.2%), numbness (67.1%), loosening of teeth (49.3%) and tooth sensitivity (41.6%). The perceived risk factors were smoking (97.2%), tobacco chewing (96.5%), chronic irritation (86.7%), immunodeficiency (83.9%), poor oral hygiene (88.5%), human papilloma virus infection (82.5%), dietary factors (81.1%), alcohol (79.4%), ill-fitting dentures (72.4%), hot spicy food (65.4%) and hot beverages (58.0%). Significant differences were found between pre-clinical and clinical students for knowledge of risk factors, signs and symptoms of oral cancer (p<0.001). Conclusion There is deficiency of knowledge among medical students about some aspects of oral cancer. Active involvement while examining patients and taking biopsies of malignant and premalignant lesions may help in improving students’ knowledge about oral cancer. KEY WORDS Awareness, knowledge, oral cancer, risk factorsPublication Evaluation of Etiology of Epistaxis and its Management in Dhulikhel Hospital(Kathmandu University, 2015) Shrestha, I; Pokharel, M; Shrestha, BL; Dhakal, A; Amatya, RCMABSTRACT Background Epistaxis is one of the most common and most difficult emergencies presenting in 7-14% of the general population each year. Although its lifetime incidence is about 60%, only 6% require formal medical intervention but they can be serious and even life threatening. Objective The main objectives are to study different etiology, types, modality of treatment of epistaxis. Specific objective is also to find out if the modality of treatment is associated with age, site, amount of bleeding and etiology. Method It is a prospective, cross sectional, longitudinal, analytical study done in Department of ENT, Dhulikhel hospital, Kathmandu University School of Medical Sciences (KUSMS) from Aug. 2010 to Aug. 2013. Data was collected. This study was cleared through institutional review committee of hospital. Statistical analysis was done using SPSS 16.0. Result 487 patients were studied during the period. There was significant association between age group with type of treatment (p value 0.002); and with admission (p value < 0.001). Significance in the study was also shown in the correlation between site of bleeding and the type of treatment and also with alcohol intake with site of bleeding (p value < 0.001).However there was no significance between hypertension and the type of treatment methods chosen (p value >0.01). Conclusion Management of epistaxis is challenging. Most are managed by non surgical means whereas some by surgical treatment. Non surgical treatment is still useful, safe and cost effective. Type of treatment and need for hospital stay is related to age and site of bleeding. KEY WORDS Age group, epistaxis, modality of treatment, site of bleedingPublication Influence of duration of symptoms over perioperative outcomes during emergency laparoscopic cholecystectomy(Kathmandu University, 2009) Sharma, SK; Thapa, PB; Maharjan, DK; Dhakal, A; Baral, NAbstract Background: Laparoscopic cholecystectomy is a gold standard treatment for gall stone diseases. Early surgical intervention in acute calculus cholecystitis is feasible and duration of onset of symptoms does not influence the conversion rate. Objective: To compare the safety and feasibility between urgent and delayed laparoscopic cholecystectomy in patients with acute calculus cholecystitis. Materials and methods: This is a comparative study conducted in Department of Surgery, Kathmandu Medical College, during the period of January 2006 to January 2008. Alltogether, 436 patients were analysed out of which 55 were selected as urgent laparoscopic cholecystectomy and were included in the study. Among 55 patients presented with acute calculus cholecystitis were divided into two groups. Group 1 underwent laparoscopic cholecystectomy within 72 hours of onset of pain abdomen and Group 2 after 72 hours of onset of pain abdomen. Results: Conversion rate in Group 1 was 19.44% whereas it was 263% in Group 2 (p = .693). There was no statistically significant difference in mean operating time (p = .412), total hospital stay (p = .626), bile duct injury and postoperative complications. Conclusion: Urgent laparoscopic cholecystectomy is safe and duration of onset of pain abdomen does not influence conversion rate. Key words: Urgent laparoscopic cholecystectomy, Conversion rate, acute calculus cholecystitisPublication Reflux Symptom Index and Reflux Finding Score in Diagnosis of Laryngopharyngeal Reflux(Kathmandu University, 2016) Pokharel, M; Shrestha, I; Dhakal, A; Purbey, B; Amatya, RCMABSTRACT Background Although laryngopharyngeal reflux is a common condition encountered in otolaryngological practice, its diagnosis is not very easy because of its indistinct symptoms Objective To assess the efficacy of proton pump inhibitors versus proton pump inhibitors with lifestyle modification in patients with laryngopharyngeal reflux. Method Prospective, analytical study conducted in Department of Otorhinolaryngology and Head and Neck Surgery at Dhulikhel Hospital, Kathmandu University Hospital between January 2015 to January 2016. Eighty two patients with laryngopharyngeal reflux having Reflux symptom index > 13 and Reflux finding score > 7 were included. Patients were divided into 2 groups. Group A comprised of patients treated with proton pump inhibitors alone and Group B with Proton pump inhibitors with lifestyle modification. Pre and post therapeutic reflux finding score and reflux symptom index were compared. Result The mean reflux symptom index score difference before and after treatment in group A was 16.70 and group B was 14.58. Similarly, mean reflux finding score difference before and after treatment in group A was 8.68 and group B was 9.92. Comparison of reflux finding score and reflux symptom index scores before and after treatment revealed improvement in both groups and the difference was statistically significant (p<0.001). However, comparison of pre and post therapeutic and scores between group A and B, showed no statistical significance. Conclusion The extent of symptomatic improvement correlated positively with both proton pump inhibitor therapy alone as well as with proton pump inhibitor therapy along with lifestyle modification. Although addition of lifestyle modification offered incremental benefit for treating laryngopharyngeal reflux, it was not found to be statistically significant. KEY WORDS Laryngopharyngeal reflux, reflux finding score, reflux symptom indexPublication Role of Endoscopic Modified Inlay Butterfly Cartilage Perichondrium Myringoplasty in Hearing Outcome and Graft Uptake(Kathmandu University, 2017) Shrestha, BL; Dhakal, A; Pradhan, A; Rajbhandari, PABSTRACT Background The endoscopes have better optics and magnification with wide angle of view due to angled lenses. It provides the excellent resolution of image in surgeries having many difficult anatomic nooks and corners like; antero-inferior recess of external auditory canal, middle ear cavity and difficult areas to visualize under microspore like sinus tympani. Likewise, the use of cartilage has very low metabolic rate, provide support to prevent retraction and reacts minimally to inflammatory reaction, so it has advantageous role in closure of tympanic membrane perforations. Objective The main objective of our study is to see the graft uptake rate and hearing results after endoscopic cartilage myringoplasty with our own modification. Method This is a prospective, cohort study conducted among 37 patients who underwent endoscopic modified inlay butterfly cartilage perichondrium myringoplasty using tragal cartilage. The hearing was assessed by comparing pre with post-operative ABG (Air bone gap) and ABG closure in speech frequencies (500Hz, 1KHz, 2KHz, 4KHz). Result Among 42 patients, 37 (88.09%) had graft uptaken. Other five patients had residual perforation because of infection. The post-operative ABG was smaller than pre- operative ABG.(26.41±8.47dB and 36.57±12.13dB respectively). The mean ABG closure was 10.15±10.23dB. The ABG closure was ≤ 10dB in 28(75.6%) patients. Conclusion Endoscopic modified inlay butterfly cartilage perichondrium myringoplasty has advantages in terms of hearing results and graft uptake rate as it is comparable or even better than others. So, it is advisable to perform this technique without any difficulty. KEY WORDS Air bone gap, cartilage, endoscope, myringoplastyPublication Socio Demographic Predictors in Delayed Presentation of Head and Neck Cancer(Kathmandu University, 2016) Pokharel, M; Shrestha, I; Dhakal, A; Amatya, RCMABSTRACT Background Head and neck cancer is a major public health problem worldwide. In spite of the increase in incidence, there has been paucity of research on socio demographic factors influencing head and neck cancer. Objective To study the influence of various socio demographic factors on late presentation of head and neck cancer. Method Prospective, analytical study conducted in 69 patients with Head and neck malignancies in Department of Otorhinolaryngology and Head and Neck surgery, Kathmandu University School of Medical sciences between January 2015 to January 2016. Collected data were entered and analyzed using IBM SPSS statistical software 21.0. All the socio demographic variables were compared between the early and late presentation groups of patient using Chi-square test. A ‘p’ value of < 0.05 was considered statistically significant. Result Forty eight were male and 21 were female. The age of patients ranged from 34 to 70 years (mean age 52.03). Twenty patients were diagnosed in stage I, 13 in stage II, 20 in stage III and 16 in stage IV. Significant association was seen between stage of head and neck cancer and duration of illness (p=0.007), educational status of patient (p=0.003) and educational status of patient’s care taker (p=0.005). However, no statistical association was seen between stage at diagnosis of head and neck cancer and gender, type of family, previous consultation, systems of alternative medicine adopted before diagnosis, smoking habit, alcohol intake, tobacco chewing habit and occupation. Conclusion The results of this study suggest that educational status may influence the presentation of head and neck cancer. KEY WORDS Head and neck cancer, stage at diagnosisPublication Study of Microorganism Growth Pattern in Nasal Pack of Patients Visiting the Department of ENT, Head and Neck Surgery(Kathmandu University, 2015) Shrestha, I; Pokharel, M; Dhakal, A; Amatya, RCM; Madhup, S; Sherchan, JBABSTRACT Background Nasal packs are utilized nearly by otorhinolaryngologists for controlling epistaxis and post nasal procedures. Complications have been reported due to them; therefore the use of antibiotics is a common practice among otorhinolaryngologists. Objective To detect microbiological flora associated with nasal packing and find evidence to support the benefit of systemic antibiotics with it. Method A prospective, analytical study was conducted on 51 patients presenting to the Department of ENT, KUSMS from June to September 2015 who required nasal packing. Approval of the local Institutional review committee (IRC) was taken. The mid part of the pack was collected in a sterile bottle under aseptic technique and sent to microbiology department. Specimen collection, culture, identification tests were done according to the guidelines by American Society for Microbiology. Data were collected using the individual patient records and Microsoft Office Excel 2007. Statistical analysis was performed with SPSS 16.0. Result Among the 51 cultures; 33 (64.7%) were positive. In 18 (35.3%) cultures no organism was grown. Statistical analysis did not show significance between duration of pack kept with microbial growth (p=0.051) or the type of pack kept (p=0.212) .It showed significance with foul smell of the pack to the growth (p=<0.001). Conclusion Microbiological flora was associated with nasal pack. Antibiotic soaked nasal packs have lesser incidence of positive bacterial growth when compared with plain nasal packs. Nasal packs kept for less than 48 hours have lesser incidence of positive bacterial growth when compared with nasal packs kept for more than 48 hours. Therefore, administering systemic antibiotics in cases when we plan to keep the pack for longer duration is recommended. KEY WORDS Epistaxis, microbiology, nasal packPublication Study to Compare and Evaluate Traditional vs. Endoscopic Septoplasty(Kathmandu University, 2015) Shrestha, I; Pokharel, M; Dhakal, A; Amatya, RCMABSTRACT Background Surgery on a deviated septum has seen several modifications since its inception starting from radical septal resection to preservation of the possible septal framework. Objective To compare the efficacies of “Endoscope Septoplasty” over “Traditional Septoplasty” in treating pathological septum and turbinates, in terms of their outcome. Method Prospective descriptive study conducted on 60 patients who presented to the Department of ENT, Kathmandu University School of Medical sciences during a period of two years. The severity of the symptoms of the patients was scored using a visual analogue scale which was compared post operatively to subjectively evaluate the efficacy of either surgery. Objective assessment was done by nasal endoscopy. P value in case of subjective and objective evaluation was done by applying Z- test. Result The mean age ± SD was 29.5±1.2 .Maximum patients fell into age group of 21-30 with 31.7 % followed by 11-20 with 28.3% and then 31-40 with 25 %. There were total 35 males (58.3%) and 25 females (41.7%). Among the symptoms, nasal obstruction seems to be dominating with total of 83.3%, followed by postnasal drip with 66.6% and then headache with 60%. The types of dislocation was compared, there were 66.7% cases with DNS and Spur whereas only 10 % with isolated spur. C shaped deformity was seen in 30% and S shaped in 26.6 % cases. Significance in Z test, is seen in subjective assessment post surgery for nasal obstruction, headache and rhinorrhea and for objective assessment post surgery for persistent contact with turbinates. (p value set to 0.01) Conclusion Endoscopic surgery is an evolutionary step towards solving the problems related to deviated nasal septum. It is safe, effective and conservative alternative to conventional septal surgery. KEY WORDS Endoscopic approach, septoplasty.Publication Study to Compare and Evaluate Traditional vs. Endoscopic Septoplasty(Kathmandu University, 2015) Shrestha, I; Pokharel, M; Dhakal, A; Amatya, RCMABSTRACT Background Surgery on a deviated septum has seen several modifications since its inception starting from radical septal resection to preservation of the possible septal framework. Objective To compare the efficacies of “Endoscope Septoplasty” over “Traditional Septoplasty” in treating pathological septum and turbinates, in terms of their outcome. Method Prospective descriptive study conducted on 60 patients who presented to the Department of ENT, Kathmandu University School of Medical sciences during a period of two years. The severity of the symptoms of the patients was scored using a visual analogue scale which was compared post operatively to subjectively evaluate the efficacy of either surgery. Objective assessment was done by nasal endoscopy. P value in case of subjective and objective evaluation was done by applying Z- test. Result The mean age ± SD was 29.5±1.2 .Maximum patients fell into age group of 21-30 with 31.7 % followed by 11-20 with 28.3% and then 31-40 with 25 %. There were total 35 males (58.3%) and 25 females (41.7%). Among the symptoms, nasal obstruction seems to be dominating with total of 83.3%, followed by postnasal drip with 66.6% and then headache with 60%. The types of dislocation was compared, there were 66.7% cases with DNS and Spur whereas only 10 % with isolated spur. C shaped deformity was seen in 30% and S shaped in 26.6 % cases. Significance in Z test, is seen in subjective assessment post surgery for nasal obstruction, headache and rhinorrhea and for objective assessment post surgery for persistent contact with turbinates. (p value set to 0.01) Conclusion Endoscopic surgery is an evolutionary step towards solving the problems related to deviated nasal septum. It is safe, effective and conservative alternative to conventional septal surgery. KEY WORDS Endoscopic approach, septoplasty.Publication Thyroid Isthmus Agenesis in a Patient with Papillary Carcinoma of Thyroid(Kathmandu University, 2016) Rajbhandari, P; Shrestha, BL; Dhakal, A; Amatya, RCMABSTRACT Thyroid gland is the largest of all endocrine glands. It is composed of two lobes. These two lobes are joined by an isthmus and this resemble the letter “H”. A wide range of morphological variations and developmental anomalies of the thyroid gland like hypoplasia, ectopy, hemiagenesis, and agenesis have been reported in literature. Out of these, the incidence of agenesis of the thyroid isthmus is rare, and very few cases have been reported. In our report, 28 year old male patient was found with agenesis of thyroid isthmus with papillary carcinoma in the right lobe of thyroid. During the operation it was seen that the right and left thyroid lobes were independent from each other and isthmus was absent. We will present a case of thyroid isthmus agenesis and discuss the clinical importance and the incidence of this case. KEY WORDS Agenesis, papillary carcinoma, thyroid gland