Browsing by Author "Ghimire, Pukar"
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Publication Causes and Outcome of Neurogenic Vision Loss(Nepal Health Research Council, 2024) Ghimire, Pukar; Karn, Ragesh; Gajurel, Bikram Prasad; Ojha, Rajeev; Rajbhandari, Reema; Shahi, Sumit; Panthee, Pradeep; Bhandari, Pragya; Lamichhane, JayaramBackground: Neurogenic vision loss is often a medical emergency. Early evaluation and urgent treatment of the causes is the key to better visual prognosis. Methods: This was a retrospective cross-sectional study based on hospital records of patients admitted to the Neurology department of Tribhuvan University Teaching Hospital with complain of diminution of vision from April 2023 to March 2024. The visual outcome of the patients was recorded based on telephone interviews with the patients or their family members. Results: A total of 64 patients were identified of which 62 were interviewed for visual outcome. The median age was 38 years of which 62.5% were female. Bilateral eye involvement was reported in 59.4% of the cohort and half of the patients had normal optic disc. The distribution of visual acuity at presentation was 39.1% for 6/60 or better, 9.4% for 3/60 to less than 6/60, 32.8% for 3/60 and 18.8% having no perception of light. The commonest diagnosis in decreasing order of frequency was idiopathic intracranial hypertension, neuromyelitis optica spectrum disorder, idiopathic optic neuritis and myelin oligodendrocyte glycoprotein antibody disease with the frequency being 17.2%, 15.6%, 10.9% and 9.4% respectively. Of 62 patients interviewed, 67.7% reported a complete recovery of vision, 14.5% reported a partial recovery and 17.8% reported no visual recovery. Severity of visual loss at presentation was associated with poor visual outcome (p=0.021) whereas age, gender, number of eyes affected and duration of visual symptoms had no significant relation to visual recovery. Conclusions: Idiopathic intracranial hypertension, neuromyelitis optica spectrum disorder, Idiopathic optic neuritis, myelin oligodendrocyte glycoprotein antibody disease were the commonest causes of neurogenic visual loss. The severity of visual loss at onset is a prognostic marker of the visual recovery in these patients. Keywords: Blindness; Vision Disorders; Optic Nerve Diseases; Neural Optical LesionPublication Early Outcome of Neonates Admitted with Meconium Aspiration Syndrome(Nepal Health Research Council, 2023) Bhandari, Isha; Malla, Kalpana Karmacharya; Chaudhary, Brajesh Raj; Ghimire, PukarAbstract Background: Meconium aspiration syndrome is one of the commonest cause of respiratory distress in neonates. The incidence is still high in developing world. This study aims to study the clinical characteristics and early outcome of neonates admitted for meconium aspiration syndrome. Methods: This was a cross-sectional descriptive study done among neonates admitted to the neonatal Intensive Care Unit with a diagnosis of Meconium Aspiration syndrome. Relevant epidemiological, clinical and laboratory data were obtained. The early outcome of those neonate was studied. Results: Out of 140 neonates with a mean birth weight of 2865 + 543 grams,73.6% were male, of which 76.4% were referred cases while 23.6% were inborn. Of them 69.3% had history of thin type of meconium while 30.7% had thick type of meconium during delivery. Of all mothers, 74.3% were primigravida, 4.3% had intrapartum fever of unknown source,11.4% suffered from urinary tract infection while 2.8% had hypertension. Premature rupture of membrane had occurred among 7.9% and oligohydramnios was found in 10%. Half of them (50.7%) had spontaneous vaginal delivery, 44.3% had caesarian section, while 4.8% had assisted delivery. Around one third of the neonates (37.1%) were given supplemental oxygen via nasal prongs, 25.7% via head box, 27.1% via continuous positive airway pressure and 10% intubated. Around half of the neonates (42.1%) had no complications. Complication noted were sepsis, birth asphyxia, seizures and polycythemia in 35%, 14.3%, 5.7% and 2.9% respectively. Mortality occurred among 5.0% of them. Conclusions: Meconium aspiration syndrome is one of the commonest cause of respiratory distress in a neonate which is associated with common maternal risk factors especially in primigravida which included Urinary tract infection, hypertension and oligohydramnios. Keywords: Meconium; meconium aspiration syndrome; newbornPublication Scrub Typhus among Febrile Children in a Tertiary Care Center of Central Nepal: A Descriptive Cross-sectional Study(Nepal Medical Association, 2021) Bhandari, Isha; Malla, Kalpana Karmacharya; Ghimire, Pukar; Bhandari, BibekAbstract: Introduction: Scrub typhus is a mite borne infectious disease caused by Orientia tsutsugamushi, obligate intracellular bacteria, transmitted by chigger mites. Scrub typhus is an emerging febrile illness with clinical suspicion being the only key to diagnosis. This study was conducted to find out the prevalence of Scrub typhus among febrile children in a tertiary care center of central Nepal. Methods: A descriptive cross-sectional study was conducted from January 2018 to December 2019 in the pediatric inpatients of a tertiary care hospital after obtaining ethical clearance from Institutional Review Committee of Institute (Reference number 2020-105). Convenient sampling method was used. Data was analyzed using Statistical Packages for the Social Science version 16. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 1024 febrile patients, prevalence of scrub typhus among febrile children was 55 (5.37%) (3.66-7.08 at 90% Confidence Interval). Of 55 patients, mean age was 9.2 years with 52 (94.6%) of cases diagnosed between July to November. Among 55 patients, other symptoms were vomiting 33 (60%), headache 22 (40%), abdominal pain 19 (34.5%), cough 15 (27.3%), nausea (25.5%), seizure 11 (20 %), and dyspnea 6 (10.9%). Major clinical signs was lymphadenopathy 29 (52.7%). Major complication noted was meningitis 11 (20%). Conclusions: The prevalence of scrub typhus is considerably high during July to November so it should be considered as a differential diagnosis of fever particularly in this period.