Browsing by Author "Gautam, N"
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Publication Appendiceal Neuroendocrine Tumor Mimicking Acute Appendicitis(Kathmandu University, 2022) Gautam, N; Makaju, R; Basnet, D; Lama, B; Maharjan, PB; Dahal, SABSTRACT Appendiceal carcinoids are the most frequent tumors arising from the appendix, comprising between 32 and 57% of all the appendiceal tumors. The gross appearance of the appendix showed perforation at the tip with 30 ml of periappendicular collection. On histopathological examination, carcinoid tumor on the tip of appendix was found with tumor cells arranged in tubules, acini and nests infiltrating the muscularis propria and sub serosa. Perineural and vascular invasion was not seen. Immunohistochemistry for Synaptophysin was positive with Ki-67 labelling index of 2%. We present a case of appendiceal neuroendocrine tumor with the chief complaint of acute appendicitis. KEY WORDS Appendectomy, Appendix, Carcinoid tumorPublication Association of Different Biochemical and Hemodynamic Characteristic with Type 2 Diabetes Mellitus and Hypertension in Nephrolithiasis Patients(Kathmandu University, 2023) Katwal, BM; Gautam, N; Shrestha, S; Adhikari, R; Baral, H; Jha, SK; Jha, GABSTRACT Background Although Nephrolithiasis is a common condition caused by a wide variety of metabolic or environmental disturbances, its being one of the major factor of morbidity. Incidence of kidney stone disease (KSD) is highly affected by metabolic disorders and change in blood pressure and glucose. Objective To find out association of different biochemical and hemodynamic parameters with various glycemic status and hypertension in kidney stone disease. Method A cross sectional study was conducted in patients diagnosed as nephrolithiasis by using re¬nal ultrasonography and underwent nephrectomy between January 2019 to January 2021 in Shahid Dharmabhakta National Transplant Centre (SDNTC). A total of 100 subjects with 60 male and 40 females were enrolled. Glycemic status was categorized based on criteria of American Diabetes Association (ADA) and hypertension was defined as BP ≥ 140/90 mm Hg in right arm supine position. All biochemical and hemodynamic profile was carried out following standard protocol. Result Out of 100 patients enrolled, pre-diabetes accounted for 31% followed by diabetes (4%). However, hypertension comprised of 66% in total subjects. Serum urea, cholesterol and triglyceride level were found to be increased by 84.6%, 67.7% and 64.7% respectively in diabetes followed by increase of 3.9%, 19.5% and 3.1% respectively in prediabetes when compared to normal glycemic condition in nephrolithiasis subjects. Serum fasting blood glucose, creatinine and uric acid level was observed significantly higher (p=0.003, p=0.004, p < 0.001 respectively) in hypertensive patients. Duration of hospital stay was also seen positively correlated with hypertension. Conclusion Not only diabetes, prediabetes also manifests the increased risk of kidney stone disease along with hypertension. There is significant impairment in renal function and lipid profile based on diabetes mellitus and hypertension. Early identifying these systemic diseases, different biochemical and hemodynamic parameters and proper treatment accordingly may minimize risk and prevent serious complication in these patients. KEY WORDS Diabetes mellitus, Hypertension, NephrolithiasisPublication Cartilaginous Choristoma of Tonsil: A hidden clinical entity(Kathmandu University, 2021) Gautam, N; Makaju, R; Basnet, D; Lama, B; Maharjan, PBABSTRACT Choristoma is a tumor like mass which is an ectopic rest of normal tissue due to embryological developmental defect. The presence of choristoma in tonsil is extremely rare. On histopathological examination, mature hyaline cartilage were found surrounded by lymphoid follicles. We present a case of cartilaginous choristoma with the complaint of recurrent tonsillitis. KEY WORDS Cartilaginous choristoma, TonsilPublication Correlation between Sonoelastographic, Doppler and Histopathological Findings in Chronic Kidney Disease Patients in Tertiary Care Centre(Kathmandu University, 2022) Jha, SK; Lohani, B; Pant, AD; Chataut, D; Regmi, D; Bhatta, U; Gautam, N; Jha, GABSTRACT Background Ultrasound (USG) with Doppler examination of intrarenal vessels is the imaging modality of choice employed in patients with renal failure and is commonly performed early in the clinical course. The pulsatility index (PI) and the resistive index (RI) of downstream renal artery have been found to correlate with renal vascular resistance, filtration fraction and effective renal plasma flow in chronic renal failure. Pathological process in any tissues alters their elastic properties which can be assessed non-invasively through newer technique like elastography. Objective To correlate the findings obtained by sonoelastographic, doppler and histopathological studies in chronic kidney disease patients. Method Study was done in 146 patients referred to Department of Radiodiagnosis and Imaging, TUTH for native renal biopsy. Renal sonographic morphology (length, echogenicity, cortical thickness), Sonoelastography (Young’s modulus) and Doppler parameters (peak systolic velocity, resistive index) were assessed. The grading of estimated GFR (eGFR) was calculated based on chronic kidney disease (CKD) criteria. Result Among 146 patients, 63 (43.2%) were females and 83 (56.8%) were males. Maximum patients were in age group of 41-50 years (25.3%) followed by age group 51-60 years (24%). Mean age of patient was 42.06±14.70 for males and 39.57±12.54 females. Maximum mean Young’s modulus was seen in eGFR stage G1 with 46.57±19.51 kPa followed by in stage G3a with 36.46±10.01 kPa and observed to be statistically non-significant (p=0.172). However, statistical significance difference was noted between the resistive index and elastographic measurement of Young’s modulus (r=0.462, p=0.0001). Minimum mean cortical thickness was seen in eGFR stage G5 with 4.42±1.48 mm followed by stage G4 with 5.57±1.24 mm (p= 0.0001). Cortical thickness is decreasing as eGFR stage was increasing in our study (p=0.0001). Resistive index is increasing with decrease in renal size (r=-0.202, p=0.015). Conclusion Ultrasonography along with doppler study and elastography have limited role in diagnosing the pathology of chronic kidney disease, however, it has significant role in the disease progression. KEY WORDS Chronic kidney disease, Doppler, Elastography, Resistive index, UltrasonographyPublication Gastric Neoplasm: A Clinicopathological Study in the Tertiary Care Center of Nepal(Kathmandu University, 2024) Basnet, D; Makaju, R; Gurung, RB; Gautam, N; Shrestha, B; Maharjan. PB; KC, PABSTRACT Background Gastric carcinoma is the commonest upper gastrointestinal malignancy contributing to global burden of cancer morbidity and mortality. Objective The objective is to study distribution of the gastric neoplasm according to age, sex, symptom, gross appearance, histological type and degree of differentiation. Method This was a retrospective study done from January 2022 to December 2023 in the Department of Pathology, Dhulikhel Hospital - Kathmandu University Hospital (DH - KUH). Relevant clinical data of the patients were obtained from the histopathological records of the patient from the pathology department and biopsies stained with Haematoxylin and Eosin were studied under the light microscope. Result A total of 40 cases of gastric neoplasm were studied out of which 36(90%) were malignant and 4(10%) were benign epithelial tumors and precursor lesions. Most frequent presentation was dyspepsia, abdominal pain, vomiting, dysphagia, anemia, anorexia and weight loss. Male to female ratio was 1.4:1. The age of the patient ranged from 33 to 89 years with mean age of 63.3 ± 13.4 years. Most common site of gastric neoplasm was pyloric antrum. Ulceroproliferative growth was most common gross morphology. Malignant neoplasm were more common. Intestinal type adenocarcinoma consisted of 28 (70%) cases followed by diffuse type 6 (15%) and mixed type 1 (2.5%). Diffuse adenocarcinoma was more common in females. Moderately differentiated adenocarcinoma was the most common differentiation. Conclusion The present study provided a fair insight into the clinciopathological features of gastric neooplasm in our institution. KEY WORDS Adenocarcinoma, Diffuse type, Gastric, Intestinal typePublication Lipid Profile and Ultrasonographic Grading in Alcoholic and Non Alcoholic Fatty Liver Patients(Kathmandu University, 2021) Shahi, A; Gautam, N; Rawal, S; Sharma, U; Jayan, AABSTRACT Background Fatty liver disease (FLD) is a common and major chronic liver disease. It has been implicated that patients have disorders of lipid metabolism and are involved in the pathogenesis of fatty liver. Hence, it was designed to observe the association between lipid profile and fatty liver disease. Objective This study was undertaken to evaluate the association of lipid profile status, hemoglobin and albumin levels with fatty liver disease patients diagnosed based on ultrasonography (USG). Method This Cross-sectional study was undertaken in the Department of Internal Medicine with the collaboration of the Department of Radiology and Department of Biochemistry, Universal College of Medical Sciences-Teaching Hospital (UCMS-TH), Bhairahawa, Nepal from March 2019 to February 2020 in a total of 100 patients diagnosed with fatty liver disease by ultrasonography. The fasting blood was collected for lipid profile and carried out in the automated analyzer following standard protocol. Result In 100 cases, the male to female ratio was 1.8:1. Fifty six percent of the total cases presented with alcoholic fatty liver disease (AFLD) while the remaining 44% with nonalcoholic fatty liver disease (NAFLD). The spectrum of lipid abnormality was observed with increased total cholesterol (TC), Low Density Lipoprotein (LDL), increased triglycerides (TG), Very Low Density Lipoprotein (VLDL) in alcoholic fatty liver disease cases as compared to nonalcoholic fatty liver disease cases. However, it has been observed that TG/HDL and Non-HDL/HDL were higher in nonalcoholic fatty liver disease as compared to alcoholic fatty liver disease. Moreover, a statistically significant difference was observed in HDL between AFLG2 and NAFLG2 (p-value: 0.012). Conclusion Dyslipidemia and decreased HDL have been implicated in fatty liver diseases. USG in conjunction with Non-HDL/HDL, TG/HDL, hemoglobin, and albumin can be useful in early screening and monitoring of dyslipidemia in fatty liver patients. KEY WORDS Alcoholic fatty liver, Dyslipidemia, Non-alcoholic fatty liverPublication Liver Function Parameters and Validation of Health-Related Quality of Life Assessment of β-Thalassemia Cases at a Tertiary Care Hospital, Lumbini Province, Nepal(Kathmandu University, 2025) Gautam, N; Risal, P; Gupta, RT; Agrawal, KK; Chaudhary, D; Paudel, MS; Adhikari, B; Pokhrel, BR; Tamang, B; Shrestha, J; Sharma, B; Ghimire, SABSTRACT Background Individuals affected by β-thalassemia experience complications such as hepatic hemosiderosis and fibrosis due to frequent blood transfusions, which can lead to iron overload. Multiple blood transfusion burdens in thalassemia, particularly in low- income countries, impact health-related quality of life. Objective Liver function parameters and health-related quality of life were assessed using Nepali version 36 short-form survey instruments to reveal the vitality, physical, mental, emotional, pain, general health, and social functioning of β-thalassemia cases. Method In this cross-sectional study, forty β-thalassemia cases who had visited the Universal College of Medical Sciences tertiary care teaching hospital of Lumbini Province, Nepal were enrolled. The hemoglobin variant band percentage was estimated by D-10 BioRad high performance liquid chromatography (HPLC), Mentzer Index (Mean Cell Volume by Red Blood Cell count) by Beckman hematological analyzer, and serum liver parameters (Bilirubin, Total protein, Albumin, Alanine aminotransferase, Aspartate aminotransferase, Alkaline phosphatase) were estimated by using Diatron fully automated analyzer. The internal consistency of the Nepali version of 36 short- form survey instruments was checked by Cronbach`s alpha was found to be > 0.70 from the recoded value. Data are analyzed using the STATA/MP14, and ANOVA and t-test are applied to test the significance considering p-value < 0.05. Result The frequency of the β-thalassemia Trait (60%) was higher than β-thalassemia Major (30%) and 7.5% β-thalassemia Intermedia co-morbidities with Sickle cell (2.5%) and β/δ variants (2.5%). Higher frequency was found in ethnic groups Muslim (32.5%) followed by Terai indigenous-Tharu (30%) and Madheshi (27.5%). The transfusion- dependent cases have significantly higher Total, Direct, Indirect Bilirubin, and Alkaline phosphatase levels than non-transfusion dependent cases (p<0.001). The physical functioning, general health, emotional health, and vitality were significantly decreased in β-thalassemia Major as compared to β-thalassemia Trait (p<0.001), and significantly correlated with Mentzer index and HPLC patterns (HBA2/HBF) (p<0.05). Conclusion Transfusion dependent β-thalassemia Major and Intermedia had elevated Bilirubin and Alkaline phosphatase levels as compared to non-transfusion dependent β-thalassemia Trait, exacerbating health-related quality of life, emphasizing the preventable disparities for optimized transfusion protocols and psychosocial support. KEY WORDS β-thalassemia, Health-related quality of life, Liver function testsPublication Perception of Medical Students Regarding TU-IOM MBBS Curriculum and Teaching Learning Methods in Nepal(Kathmandu University, 2022) Gautam, N; Dhungana, R; Gyawali, S; Dhakal, S; Pradhan, PMSABSTRACT Background The present Bachelor of Medicine and Bachelor of Surgery (MBBS) curriculum under Tribhuvan University - Institute of Medicine (TU-IOM) was last revised twelve-years back. Though the curriculum was built upon internationally approved recommendations on curriculum design, it is ineffectively practiced in most medical schools of Nepal with major focus on didactic teaching-learning. The curriculum, hence, needs effective implementation and revision. Objective To identify the strengths, weaknesses, and areas of improvement in the medical curriculum through student-based feedback and outline the possibility of incorporating newer evidence-based teaching-learning methodologies in Nepal. Method This is a descriptive and cross-sectional study. With appropriate ethical approval, a questionnaire was developed and disseminated virtually to all medical students of Nepal under TU from MBBS fourth year onwards. The questionnaire comprised of Likert and close-ended questions. The data analysis was followed after receiving the filled questionnaire through Google forms. Result A total of 337 respondents participated in the study. The most effectively implemented components out of the SPICES model were Integrated learning (I) and Community- based learning (C), with 73.89% and 68.84% responses. There were 94.7% (319) students who favored the incorporation of research in the core curriculum. Only 34.2% (115) students found PowerPoint lectures, the most utilized form of teaching- learning in Nepal, as engaging. The respondents (84.6%) showed a high degree of readiness to incorporate newer evidence-based teaching-learning tools such as flipped learning, blended learning, and peer-to-peer learning. Conclusion This study shows that effective interventions must be rethought on various aspects of the curriculum, taking students’ feedback on the table while considering curricular revision. KEY WORDS Bachelor of Medicine and Bachelor of Surgery (MBBS) curriculum, Medical students, Problem based learning, Teaching learning methodsPublication Plexiform Schwannoma Clinically Masquerading as Thrombosed Vein(Kathmandu University, 2024) Basnet, D; Makaju, R; Gautam, N; Shrestha, B; Budhathoki, AABSTRACT Plexiform schwannoma is a rare benign nerve sheath tumor usually located in trunk, head, neck, upper extremities and occasionally in lower extremities. It is usually less than 2 cm in size and generally affects young adults. The tumour is composed of schwann cells and exhibit a plexiform growth pattern both in gross or histologic examination and is frequently accompanied by multinodularity causing serpentine distortion. Plexiform neurofibroma commonly mimics plexiform schwannoma and it is important to differentiate between them, as recurrence and malignant potential are more common with plexiform neurofibroma. We present the case of a 14-year-old female with history of a nodular soft tissue mass over his right foot measuring 11 cm in length. A Doppler scan of the foot was suggestive of thrombosed superficial vein in right foot. The histological evaluation of the mass revealed Plexiform schwannoma. S-100 immunostaining is diffuse and strong confirming the diagnosis of Plexiform schwannoma. KEY WORDS Hematoxylin and eosin, Histopathology, Plexiform, SchwannomaPublication Retroperitoneal Cyst of Mullerian Type(Kathmandu University, 2023) Basnet, D; Makaju, R; Gautam, N; Shretsha, BABSTRACT Retroperitoneal mullerian cysts are rare, benign neoplastic cyst of urogenital subtype. They are usually asymptomatic and may present with symptoms if they grow considerably in size with pressure over the adjacent organ or follow infection, hemorrhage or rupture. Histologically, these cyst are lined with benign ciliated columnar epithelium. We present the case of a 30-year-old female with history of abdominal distension and epigastric pain. The mass excised was in retroperitoneal space and microscopic examination revealed benign cyst of mullerian origin. KEY WORDS Microscopic examination, Mullerian cyst, RetroperitoneumPublication Triple vessel diseasetreated funcitional endoscopic sinus surgery(Institute of Medicine, 2018) Gautam, N; Pradhan, B; Thapa, N; Hira; Sharma, AAbstract Triple vessel disease, a coronary artery diseasecaused by narrowing of plagues which is cholesterol deposit on the vessel wall resulting abnormal and gradual ticking-off the lining of the heart arteries condition known as atherosclerosis. The narrowing usually develops slowly over many years. Thishigh-risk case was operated by the team in TUTH ENT Operation theater. We report a 75-year-old man with triple vessel diseasewith diagnosisof right allergic fungal rhinosinusitis with left deviated nasal septumsuccessfully undergone right Functional Endoscopic Sinus Surgery and recovered. It had emergent condition. Keyword: FESS :Functional Endoscopic sinus surgeryPublication Upper gastro-intestinal bleeding: Aetiology and demographic profile based on endoscopic examination at Dhulikhel Hospital, Kathmandu University Hospital(Kathmandu University, 2010) Gurung, RB; Joshi, G; Gautam, N; Pant, P; Pokhrel, B; Koju, R; Bedi, TRSAbstract Background: The upper gastrointestinal bleeding (UGIB) is defined as bleeding within the intraluminal gastrointestinal tract from any location between the upper oesophagus to the duodenum at the ligament of Treitz. It is one of the important medical emergencies worldwide. Objective: The objective of this study is to study the aetiology of upper gastrointestinal bleeding based on endoscopic examination findings in patients of various demographic characteristics. Materials and methods: This is a retrospective observational study. The endoscopic record book from 2007 January to 2009 October was reviewed for all the cases who underwent oesophago-gastro-duodenoscopic examination for upper GI bleeding. The clinico-epidemiological data of all the patients was reviewed and analyzed in concert with the aetiology of bleeding. Results: A total of 90 patients (58 males, 32 females; mean age 45.32+ 18.47 years) of upper gastrointestinal bleeding was studied and analyzed in terms of aetiology of bleeding and demographic profile. Among the ethnic groups, Aryan 46 (51%) was the most common ethnic group to have upper GI bleeding followed by Newars 24 (27%), Mongolians 16 (18%), Dalits 3 (3%) and others 1 (1%). Out of 90 patients, 47( 52.2%) cases was less than 45 years of age, 30(33.3%) of 46 to 65 age ; and 13(14.4 %) more than 65 years of age. Gastric ulcer 23(25.6%) was the most common endoscopic finding, followed by oesophageal varices 14 (15.6%), acute erosive/haemorrhagic gastropathy 11 (12.2%), duodenal ulcer 9(10%), growth 7(7.8%), vascular lesions 3(3.3%), Mallory-Weiss tear 1(1.1%), fundal varices 1(1.1%) and, no cause was identified in 21(23.3%) cases. The peptic ulcer bleeding was the most common finding in Aryan 22(47.9%), whereas oesophageal varices and growth were more common in Newar 7(29.2%) and 3 (12.5%) respectively. Conclusion: Peptic ulcer disease is the most common cause of upper GI bleeding which was most commonly found in Aryan population; followed by oesophageal varices and growth as second and third most common causes and were more prevalent in Newar and Mongolian people. Key words: Endoscopy, Peptic ulcer disease, Upper GI bleeding, Varices