Browsing by Author "Dulal, S"
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Publication Barriers to up take cataract Surgery in Gandaki Zone, Nepal(Kathmandu University, 2004) Sapkota, YD; Pokharel, GP; Dulal, S; Byanju, RN; Maharjan, IMObjective: Cataract though avoidable remains as leading cause of blindness in Nepal. Though, Himalaya Eye Hospital rendering high quality surgical service through its base hospital and out reach service in Gandaki Zone having cataract surgical rate is below 1500 per million. Therefore, it is mater of interest to investigate the reason and the finding would be helpful to plan the future cataract programme to CSR to desirable level, if we know the reason(s) that forced them living as blind in community and not seeking available surgical services. Method: All person with cataract affecting their visual acuity to <6/60 (corrected) in either eye found in stratified cluster design sampling were enrolled in the study. They were interviewed with structured questionnaire investigating their knowledge and attitude of their visual impairment and barriers for not seeking cataract surgical service to date. Results: A total of 303 eligible subjects were enrolled in the study. Out of them 57.8 % of people knew about the cataract and they also think their vision impairment is due to cataract. But 56.11 % of people were not aware their vision will improve. Surgical camp attendant or operated patients were found to be effective media to spread the message that the cataract is curable. Among the barriers: fear for surgery 31.1 %, lack of attendant and geographical distance 32.8 %, Financial 24.1 % and Other clinical reason were found to be 12 % as a reason for not seeking available surgical service. Conclusion: The cataract service marketing, eye health education disseminating the information on cataract and its curability is not found to be adequate. Therefore, the future cataract programme should give more concentration on creating awareness on cataract and subsidizing the available surgical service and service need to be brought to more proximity for the needy poor people. Key Words: cataract, barriers, Gandaki zonePublication Clinicopathological Analysis of Oral Lesions - A hospital based retrospective study(Kathmandu University, 2019) Poudel, P; Upadhyaya, C; Humagain, M; Srii, R; Chaurasia, N; Dulal, SABSTRACT Background Proper diagnosis plays a key role that determines treatment and prognosis of the disease. To give appropriate clinical diagnosis, clinicians must be well aware of the presentation and demographic information of the lesion including the rare ones. Histopathology is still considered as gold standard in diagnostic pathology but final diagnosis becomes difficult unless detailed clinical and radiological descriptions are given. Hence an interdisciplinary approach is needed which requires correlation between both clinical and pathological details. Objective To analyze the clinicopathological details of all the oral lesions diagnosed in Dhulikhel hospital within the period of two years and to assess the concordance between clinical and histopathological diagnosis of these lesions. Method Laboratory record file of all the oral lesions diagnosed between January 2016 to December 2017 were retrieved from the department archives and the data were collected. The extracted data were analyzed using SPSS version 23.0. Result A total of 237 cases were analysed in the present study. Odontogenic cysts were the most common category followed by benign lesions. However considering the individual lesion, mucocele was the commonest lesion followed by squamous cell carcinoma. Total concordance between clinical and histopathologic diagnosis was found in 56.5% cases. The most clinicopathological agreement was seen for benign lesions followed by malignant lesions. Conclusion Mucocele and oral squamous cell carcinoma are the two most common lesions found among the patients visiting our hospital. The cases of oral squamous cell carcinoma are on a rise with each subsequent year. At present, though it is the second most common entity, it can be hypothesized that it may be higher up on the list. Therefore, oral healthcare awareness is paramount and this may be one of the best ways to reduce the oral cancer incidence rates and lowering the healthcare management burden. KEY WORDS Agreement, Concordance, Diagnosis, Prevalence, Oral lesionsPublication Etiology, Pattern, Treatment and Outcome of Maxillofacial Fractures at Dhulikhel Hospital(Kathmandu University, 2021) Chaurasia, NK; Upadhyaya, C; Dulal, SABSTRACT Background Maxillo-Facial region is one of the prominent parts of human body and is more vulnerable to injury when any form of trauma is encountered. Injury to this region can result in fractures and pattern of fractures often depends upon the mechanism of injury as well as direction of impact. Objective To determine the etiology, pattern, treatment, and outcome of maxillofacial fractures presenting to Dhulikhel hospital. Method The records of all the patients with maxillofacial injuries presenting to the department of oral and maxillofacial surgery of dhulikhel hospital between period of December 2012 to November 2019 were included in the study. The data regarding age, sex and etiology were recorded. The etiologies were classified as Motor vehicle accidents (MVA), interpersonal violence, fall injuries, sports related injuries, occupational hazards, gunshot injuries and animal attacks and others. Similarly, the pattern of fractures was recorded according to classification by anatomical site. The types of treatment performed was also recorded. Treatment outcome in the form of any post- operative complications were recorded. Result Out of 1366 patients with maxillofacial injuries, 378(27.7%) patients had fracture of maxillofacial region. The most common etiology was motor vehicle accidents (53.7%) followed by fall injury (31.2%). Zygomatico-maxillary complex was the most common type of fracture (27.9%). Open reduction and internal fixation were the most common form of treatment provided (85.4%) and post-operative complications were minimal (5.0%). Conclusion Motor vehicle accidents still remain the most common cause of maxillofacial fractures. Midface fractures are more common than mandible fracture. The present study provides an insight into changing etiology and pattern of maxillofacial fractures and open reduction and internal fixation remains the most favored treatment of maxillofacial fractures with minimum complications. KEY WORDS Maxillofacial trauma, Maxillofacial fractures, Motor vehicle accidents, Treatment outcomePublication Juvenile Ossifying Fibroma of Maxilla(Kathmandu University, 2018) Chaurasia, NK; Koju, S; Dulal, S; Upadhyaya, CABSTRACT Ossifying fibroma (OF) is a rare, benign, non-odontogenic tumor of the jaw which comes under the group of fibro-osseous lesions. Ossifying fibromas of the mandible are more common than in the maxillary region. Juvenile ossifying fibroma has been distinguished from conventional ossifying fibroma on the basis of patient’s age, site predilection, and clinical behavior. The lesion should be differentiated from other fibro-osseous lesions as its management varies from surgical enucleation to complete resection. Present report describes the case of juvenile ossifying fibroma of anterior maxillary region in a 7 year old male patient, with a detailed description of clinical, radiographic, histopathologic features, and its surgical management. KEY WORDS Fibro-osseous lesions, Juvenile, Maxilla, Ossifying fibromaPublication Prevalence, Pattern and Risk Factors of Oral Cancer -A single institute-based study from Nepal(Kathmandu University, 2023) Chaurasia, NK; Upadhyaya, C; Dulal, S; Shakya, M; Adhikari, BR; Upreti, SABSTRACT Background Cancer of lip and oral cavity is the most common type of cancer in male population in South East Asia. Although it is a multifactorial disease, tobacco and alcohol use are the most common risk factors involved. Oral cancer has a direct relationship with deleterious habits. Inadequate knowledge about the disease and lack of awareness about its risk factors play vital role in increasing incidence of oral cancer. Objective To determine the prevalence and pattern of oral cancer as well as to find out the risk factors associated with development of oral cancer. Method The hospital records of the patients with histo-pathologically confirmed oral cancer between November 2011 to December 2021 were studied. Data regarding age, sex, associated risk factors and pattern of oral cancer were recorded. Descriptive statistics were obtained and recorded in tabulated form. Result Total of 312 (53.6%) cases out of 582 biopsies turned out to be histo-pathologically confirmed oral cancer. Out of 312 cases of oral cancer, 294 (94.27%) were squamous cell carcinoma. Total number of males were 196 (66.7%) and females were 116 (37.1%). The mean age was 56.2±13.4 years. Smoking (34.7%) was the most common risk factor and gingiva (42.6%) was the most common site of involvement. Conclusion Squamous cell carcinoma is the most common type of oral cancer and gingiva is the most common site of involvement. Tobacco smoking is the major risk factor for developing oral cancer. KEY WORDS Oral cancer, Risk factors, Smoking, Tobacco