Browsing by Author "Gautam, P"
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Publication Acute Kidney Injury in Neonates with Perinatal Asphyxia in a Tertiary Care Hospital of Nepal: a cross-sectional study(Kathmandu University, 2025) Gautam, S; Gautam, P; Chaudhary, A; Dahal, A; Manandhar, A; Giri, P; Dulal, A; Pokhrel, SABSTRACT Background Renal involvement is the most common form of systemic complication in neonates with perinatal asphyxia. Acute Kidney Injury (AKI) can be oliguric or non oliguric. There is no consensus on the definition of acute kidney injury in neonates, which makes early diagnosis and management difficult. Acute kidney injury leads to significant morbidity and mortality in neonates. Objective Current study aims to explore the prevalence of Acute Kidney Injury in Neonates with perinatal asphyxia and its relation to the severity of Hypoxic Ischemic Encephalopathy (HIE). Method A single-center, retrospective, cross-sectional study was carried out to analyze the cases of perinatal asphyxia in the Neonatal Intensive Care Unit (NICU) and Neonatal Ward (NNW) for a period of three years (September 2020 to August 2023) in a tertiary care center. The study analyzed 195 neonates with perinatal asphyxia and Hypoxic Ischemic Encephalopathy (HIE). Data analysis was done using Statistical Package for Social Sciences (SPSS) version 25. Descriptive statistics(mean ± SD for continuous variables; percentages for categorical variables) and chi-square test (to compare categorical associations) were applied. The prevalence of acute kidney injury and its relation to grades of HIE were determined using a chi-square test. Result The prevalence of acute kidney injury among cases of perinatal asphyxia was 17.4%. The prevalence of acute kidney injury increased with an increase in the grading of hypoxic ischemic encephalopathy. Acute kidney injury was predominant among males with a male-to-female ratio being 3.2:1. Oliguric acute kidney injury was more common than non-oliguric acute kidney injury. 8.8% of cases had mortality, with the majority of cases being hypoxic ischemic encephalopathy grade II. The Chi- square test found a statistically significant association between hypoxic ischemic encephalopathy grades and acute kidney injury (p value=0.0113, i.e., p < 0.05) Conclusion Acute kidney injury remains one of the common complications of Perinatal Asphyxia (PA). There was a significant association between acute kidney injury cases and grades of Hypoxic Ischemic Encephalopathy (HIE), with HIE II being the most common type. Screening for acute kidney injury in case of hypoxic ischemic encephalopathy should be prioritized. KEY WORDS Acute kidney injury, Birth asphyxia, Oliguria, Perinatal asphyxiaPublication Antibiotic sensitivity pattern on cluster endophthalmitis caused by Gram negative organism(Institute of Medicine, 2017) Thapa, M; Gautam, P; Joshi, SN; Khanal, SAbstract Introduction: Endophthalmitis is a rare but devastating complication of intraocular surgery occurring in 0.07%-0.3% of total surgeries. With the introduction of Phacoemulsification through corneal incision, incidence of endophthalmitis has increased in recent days. Outcome of endophthalmitis is worse when it is caused by gram negative organisms. Methods: Hospital based prospective study of cluster endophthalmitis following cataract surgery done on a single day. Surgeries were performed at BP Koirala Lions Centre of Ophthalmic Studies, IOM, Kathmandu, Nepal. Results: 8 cases of acute endophthalmitis following cataract surgery were included in the series. Out of them 8, 87.5% (7) had isolates in the both anterior chamber and vitreous tap. Ali patients had infection due to e-coli. 4 cases had mixed growth of E.coli and Staph. aureus in vitreous and anterior chamber both 3 patients had growth of E.coli only in both vitreous and anterior chamber. And 1 patient had growth of E.coli in vitreous only. All the patients complaint of severe pain after few hours of surgery, Visual acuity in 6 patients was CFCF and 1 patient was hand movement (HM), 1 patient had perception of light only. Intravitreal injection of vancomycin (1 mg/0.1ml) and Amikacin (0.4mg/0.1 ml) and Dexamethsone (0.4mg/0.1ml) was given in all cases after AC and Vitreous tap on the first day. On 2nd day all patients underwent vitrectomy and intra vitreal injection repeated in half dose. Out of 8 cases, 3 (37.5%) developed RD. 1 (12.5%) had to undergo evisceration. 1 (12.5%) patients developed cornel opacity, 3(37.7%) patients has good visual recovery visual acuity of 6/6-6/36. Conclusion: Even after aggressive treatment acute postoperative endophthalmitis due to gram negative bacteria has a bad prognosis. Keywords: endophthalmitis, gram negative organisms, E-coliPublication Assessment of Range of Motion of Temporomandibular Joint among Dental Students of Dhulikhel Hospital(Kathmandu University, 2024) Luitel, A; Bali, H; Gautam, P; Shrestha, R; Singh, N; Gurung, KABSTRACT Background Restriction in mandibular range of motion (ROM) is one of the main signs of mandibular dysfunction and an important criterion for evaluation of functional state of the masticatory system. Objective The objective of this study was to evaluate the normal ROM of Temporomandibular Joint (TMJ) among dental students of tertiary care hospital at central region of Nepal. Method After ethical clearance, cross- sectional study was conducted between August to September 2022 among all dental students who gave consent. The inter-incisal opening, bilateral lateral excursion and protrusion were measured thrice using 15 cm metallic scale and an average was considered to reduce ambiguity. The data was entered in Microsoft excel and transferred to SPSS version 20 for statistical analysis. The descriptive statistics was calculated and independent t test was applied to compare the mean between genders. Result Total of 145 students (25 males and 120 females) were included with the mean age of 21.32 ± 1.29 years. The overall mean inter-incisal opening was 44.82 ± 5.80 mm, right lateral excursion was 8.23 ± 2.11 mm, left lateral excursion was 8.70 ± 1.80 mm and protrusion was 5.65 ± 1.87 mm. There was statistically significant difference in right and left lateral excursion and protrusion among genders. Conclusion The inter-incisal opening of participants in our study appeared towards lower range of normal mouth opening while lateral excursion appeared consistent with those described in the literature. The protrusive movement of our participants was decreased, compared to those recorded in the literature. KEY WORDS Inter-incisal opening, Lateral excursion, Protrusion, Temporomandibular jointPublication Coronary Artery Disease in Nepal: Current Perspective, Challenges, Need for National Practice Guidelines, and Potential Solutions(Kathmandu University, 2022) Prajapati, D; Bhandari, N; Gautam, P; Dhital, R; Shrestha, AABSTRACT South Asians are estimated to have a 40% increased risk for coronary artery disease as compared to populations from other regions. Nepal, as a South Asian country, should also analyze the burden of coronary artery disease and its risk factors to minimize cardiovascular morbidity and mortality. We reviewed the barriers to cardiovascular care and its services in low- and middle-income countries, including Nepal. The identified barriers included coronary artery disease risk factors, access, cost, adherence to cardiovascular care, awareness, knowledge gaps, and socioeconomic and health system challenges. The possible strategies to reduce coronary artery disease included national, regional, and local perspectives. It also highlighted the involvement of community workers and local leaders, education, patient-centered intervention, easy access to drugs and treatments, rehabilitation and public health measures, innovation within the health care system, and multi-sectoral involvement. This review provides insights into the current situation of coronary artery disease and its possible solutions. KEY WORDS Coronary artery disease, Disease burden, Nepal, Risk factors, South AsiaPublication Efficacy of small incision cataract surgery in community based eye camps: a report from Sindupalchowk, Nepal(Institute of Medicine, 2015) Gautam, P; Dhungel, P; Adhikari, HB; Dhungel, SAbstract Introduction: Health camp provides service to patients, near to their home, living in remote places with inadequate health facilities, like remote places of Nepal. This study was carried to assess the visual outcomes and complications associated with cataract surgery in camp patients, operated in a camp setting at community level in Sindhupalchowk. Methods: In a retrospective study, 23 outreach camp patients had undergone cataract surgeries with chamber intraocular lens implantation under peri-bulbaranaesthesia. Post-operative complications on day-1 were examined. Patients with any complications were managed conservatively and referred for further management to tertiary eye care centre. Results: 23 eyes underwent cataract extraction with intra ocular lens implantation. Small incision cataract surgery (SICS) was the commonest method (91.6%) used. 69.57% were female and 30.43% were male. The commonest first post- operative day complication was mild conjunctival congestion and sub-conjunctival haemorrhage. On Day-1 of post-operative Normal to Near-normal vision (6/6-6/18) was seen in 14(60.82), Moderate low vision 6/24 to 6/36 in 5 (21.74%), Severe low vision 6/60-3/60 in 3(13.04%), and Moderate blindness <3/60 in 1(4.35%) of the operated patients. Conclusion: High quality cataract surgery with low rate of intraoperative complications and good visual outcome can be obtained in camp patients operated in community level under skilled man power suggesting more similar surgical camps to reduce the burden of preventable blindness due to cataract. Keywords: community eye camp, cataract surgery, visual outcomesPublication Orbito-Cranial Injury Caused by Penetrating Wooden Piece(Institute of Medicine, 2013) Gautam, P; Shah, DNAbstract We present the case of a 35-year-old man with history of fall 2 days back and an upperlid laceration with foreign body seen in the wound with a new onset of seizure disorder that was found to harbor anintra-parenchymal foreign body related to orbital trauma. Imaging revealed a pneumo-cephalus in the extra-axial space over right frontal lobe anterior pole with focal laceration in basal area of frontal lobe with an obliquely oriented fat/ air attenuating foreign body lodged in the basal area of frontal lobe extending from roof of orbit medially with foreign body indenting the right globe inferiorly.Publication Publication Prevalence of Renal and Urinary Tract Diseases among Pediatric Cases Admitted in a Tertiary Hospital in Developing Country(Kathmandu University, 2024) Gautam, S; Gautam, P; Chaudhary, A; Dahal, A; Giri, P; Poudel, SABSTRACT Background Kidney disease includes diseases of the glomerulus, tubular disorders, and conditions associated with hematuria or proteinuria. Urinalysis can be a reliable and easy tool to screen. Objective In this study, we aim to study the prevalence of renal and urinary tract diseases among the pediatric population in a tertiary hospital in Nepal. Method A single-center retrospective cross-sectional study was conducted from 2022 to 2023 in the pediatric department. Information was obtained regarding clinical- epidemiological profile, associated condition, investigations, diagnosis, and duration of hospital stay, management, and outcome. Result The prevalence of renal disease was 5.6%, with urinary tract infection being the most common diagnosis. Maximum cases presented between one and five years with a male-to-female ratio of 1.1:1 and 80.9% of the patients had new onset disease. The mean duration of hospital stay was six days. The mortality rate in renal diseases was 3.2%. Conclusion Renal diseases make up a significant portion of pediatric admissions. Renal diseases contribute to significant morbidity and mortality. A large number of cases of renal diseases are due to infective etiology hence they are preventable and curable. Renal disease in children presents with vague symptoms and signs. Routine screening of renal diseases is needed for early diagnosis and reduction in morbidity and mortality. KEY WORDS Kidney diseases, Pediatrics, Urinary tract infectionPublication Systemic Lupus Erythematosus with antiphospholipid Syndrome Presenting as Seizure Disorder and Retinopathy(Institute of Medicine, 2014) Sharma, AK; Sitaula, S; Thapa, M; Gautam, P; Shrestha, GS; Gajurel, BP; Sigdel, MRNA.