Browsing by Author "Gurung, S"
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Publication Are we really in safe hands? How safe is safe?(Kathmandu University, 2008) Pradhan, R; Shrestha, K; Gurung, SNAPublication Dysnatremia in Traumatic Brain Injury and its Association with Outcome(Kathmandu University, 2022) Bishokarma, S; Thapa, U; Thapa, M; Singh, AK; Gurung, S; Aryal, B; Maharjan, AMS; Lakshmipathy, GABSTRACT Background Traumatic brain injury on its own results in significant mortality and morbidity but it also contributes to complications that manifest as dysnatremia in the majority of cases. Objective The objective of this study is to assess the association of hyponatremia and hypernatremia with the severity of traumatic brain injury and its impact on mortality. Method This is a retrospective, descriptive, and analytic study conducted during a 1-year period from March 2018 to March 2019. The study population was selected from the patients presenting to the emergency department with TBI in the Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal. All the patients that fulfilled the inclusion criteria of age were enrolled in the study. Patients with known renal disease due to the higher incidence of electrolyte disbalance were excluded. Association of outcome with hyponatremia and hypernatremia were sought using chi-square, fisher exact test and independent t test using SPSS ver 20. Result Over a period of 1 year, 367 patients with traumatic brain injuries were treated in our hospital. Hyponatremia was seen among 55 patients (14.9%) and hypernatremia was seen among 22 patients (5.99%). The age range of patients included in the study was 16 to 87 with a mean age of 37.96 ± 16.512 years. The male to female ratio was calculated as 3.2:1. Mild, moderate, and severe head injuries were 286 (77.9%), 37 (10.1%), and 44 (12%) respectively. Surgical intervention was performed among 77(21%) individuals. Our series showed an association between the severity of traumatic brain injury and hyponatremia however didn’t show an association between the severity of traumatic brain injury and the development of hypernatremia. Conclusion We concluded that the severity of head injury is associated with severity of hyponatremia but not with severity of hypernatremia. Similarly, a strong association existed between the severity of hypernatremia and outcome of patients. However, such association was not seen with hyponatremia. KEY WORDS Hypernatremia, Hyponatremia, Mortality, Severity, Traumatic head injuryPublication Hepatitis E in the State of Sikkim (North East India)-A report on an outbreak(Kathmandu University, 2018) Gurung, S; Bhutia, PY; Sharma, TABSTRACT Background Hepatitis E virus is a significant public health menace in developing countries and is being reported from newer geographical regions. It is enterically transmitted and causes acute hepatitis. Objective The objective of this study is to correlate the patient details from outbreak of Hepatitis E in 2012 with the water culture done during that period. Method Records of the patients with Hepatitis E virus (HEV) infection in 2012 were analysed. Their serum samples were tested for Immunoglobulin M (IgM) Hepatitis E virus by rapid immunochormatography (ICT) and further confirmed by Immunoglobulin M Enzyme linked immunosorbent assay (IgM ELISA) in National Centre for Disease Control, New Delhi. Water was tested by the Multiple Tube test method using double strength Mc Conkey broth with neutral red and H2S test method. Result Patients with febrile jaundice (n-62) were screened for Hepatitis E virus and 32 were positive by rapid Immunochromatography test and Enzyme linked immunosorbent assay. The overall attack rate was 0.03%. Drinking water from ten different localities in Gangtok were tested and 83% of the water were found to be unsatisfactory for drinking during that period. Conclusion Regular testing of water quality and public education and awareness is important to curb such outbreaks in future. KEY WORDS Acute hepatitis, Hepatitis E virus, Outbreak, SikkimPublication Knowledge, Attitude and Practice in Recurrent Shoulder Dislocation: an analysis of patients presenting at a tertiary referral centre(Kathmandu University, 2023) Joshi, A; Gurung, S; Basukala, B; Rijal, N; Sharma, R; Bista, R; Singh, N; Pradhan, IABSTRACT Background Early diagnosis and treatment of recurrent shoulder dislocation are crucial to avoid complications associated with multiple dislocations. Little is known about knowledge, attitude, and practice of recurrent shoulder dislocation among patients. Objective To assess the knowledge, attitude, and practice among patients regarding recurrent shoulder dislocation. Method A retrospective study of prospectively collected data from December 2019 to November 2022 among patients seeking treatment for recurrent shoulder dislocation at a tertiary care centre was conducted. A 16-item questionnaire, including 5 items regarding patients’ knowledge, 2 items regarding attitude, and 2 items regarding practice on recurrent shoulder dislocation, was devised and responses were recorded. Continuous data were reported as mean ± standard deviation and categorical data were reported as number (percentage). Comparative analysis was done using student t-test. Result A total of 220 patients completed the questionnaire. Out of 220, 159 (72.27%) were not informed about recurrence after first dislocation, 146 (66.36%) felt that they were not properly counselled regarding treatment, and 172 (78.18%) responded that they did not know that recurrent shoulder dislocation can be treated. Among 220 patients, 171 (77.73%) responded that their quality of life was affected by recurrent shoulder dislocation, and first dislocation was relocated by doctors in 116 (52.73%), self in 78 (35.45%), and relatives in 26 (11.82%). The number of dislocations was significantly higher among patients who did not visit the hospital after their first dislocation. Conclusion Majority of the patients have positive attitude, but poor knowledge and practice regarding recurrent shoulder dislocation. The findings would be useful for planning strategies to improve patients counselling regarding recurrent shoulder dislocation. KEY WORDS Knowledge gap, Practice gap, Recurrent shoulder dislocationPublication Phenotypic characterisation and drug sensitivity testing of mycobacteria isolated from extra-pulmonary tuberculosis(Kathmandu University, 2010) Gurung, R; Bhattacharya, SK; Pradhan, B; Gurung, S; Singh, YIAbstract Background: Tuberculosis (TB) is a major cause of morbidity and mortality globally, with most cases occurring in developing countries. The importance of extra pulmonary tuberculosis (EPTB) among all forms of tuberculosis has not yet been ascertained in developing countries Objective: To identify and perform phenotypic characterization of clinically important mycobacterium isolates from extra-pulmonary sites along with drug susceptibility testing. Materials and methods: A total of 513 specimens from patients of (EPTB) with varied presentation were studied. Speciation and characterization of isolates were done on the basis of growth and biochemical characteristics. Drug susceptibility testing for mycobacterium isolates was done by proportion method. Results: Fifty four patients clinically suspected to have extra-pulmonary tuberculosis were culture positive for mycobacteria. On characterization 48 of the 54 isolates were identified as M. tuberculosis, 4 as M. bovis and 2 were M. avium/ intracelulare. Drug susceptibility testing was done for the both M. tuberculosis as well as M. bovis. In single drug resistance, Streptomycin was highest followed by Isoniazid, Ethambutol and Refampicin. Multi drug resistance (MDR) was found in 6 isolates and it was observed only in group I cases. Conclusion: EPTB accounts for 10-15 percent of all cases of tuberculosis. Mycobacterium was present in 10.5 percent samples. 48 isolates out of 54 samples were found to be M. tuberculosis. The maximum numbers of M. tuberculosis were isolated from lymph node aspiration. Key words: Phenotypic characterization, drug susceptibility, extra pulmonary tuberculosis