Browsing by Author "Gyawali, Siddinath"
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Publication Adenosquamous Carcinoma of Gallbladder with Unusual Prognosis: A Case Report(Nepal Medical Association, 2023) Gyawali, Siddinath; Pokhrel, Biraj; Sharma, Deepak; Bhatta, Naveen Chandra; Kandel, Bishnu Prasad; Lakhey, Paleswan JoshiAbstract The adenosquamous carcinoma of the gallbladder is a rare variant accounting for only 1-4% of all primary gallbladder carcinoma. Regardless of the histological types, all gallbladder carcinomas have silent and rapid progression resulting in delayed diagnosis and poor prognosis. Even with medical and/or surgical interventions, the median survival of patients with adenosquamous carcinoma, one of the histological variants, is less than a year. However, we present a case of adenosquamous carcinoma with an unusually better prognosis. A 70-year-old female patient, after being diagnosed with gallbladder carcinoma was suggested for surgical resection but was lost to follow-up since then. Two years later, the patient presented and was managed with extended cholecystectomy. The slow progression and non-recurrence of the tumour during follow-up for two years after the surgery indicates a better prognosis in this case.Publication Aspirin Desensitization and Percutaneous Coronary Intervention in a Patient with Aspirin Hypersensitivity and Acute Coronary Syndrome: A Case Report(Nepal Medical Association, 2024) Acharya, Suman; Gyawali, Siddinath; Kharel, Sanjeev; Upreti, Dinesh; Bhusal, Khem Raj; Maharjan, Silvia; Shrestha, Hemanta; Gajurel, Ratna ManiAbstract Hypersensitivity to aspirin is rare disorder occurring in 1.88% of the patients. Aspirin-hypersensitive patients requiring single antiplatelet agent may be treated with clopidogrel, an alternative antiplatelet agent. However, aspirin desensitization is more cost-effective than the usage of clopidogrel in these patients. Furthermore, aspirin desensitization is of greater value in patients requiring dual antiplatelet therapy, for example following procedures like percutaneous transluminal coronary angioplasty (PTCA) instead of using non-aspirin-based combinations. Herein, we report a 74-year-old hypertensive male presented with features of acute coronary syndrome and planned for percutaneous transluminal coronary angioplasty of RCA followed by dual antiplatelet therapy. Since he had aspirin allergy, desensitization was done using rapid desensitization protocol for which he responded well. This case highlights the importance of aspirin-desensitization in patients with aspirin allergy instead of choosing non-aspirin based antiplatelet agents.Publication Breast Cancer among Cancer Patients Visiting the Department of Internal Medicine of a Tertiary Centre(Nepal Medical Association, 2024) Shrestha, Rakshya; Paudel, Bishal; Panthi, Bishal; Gyawali, Bindu; Pandey, Anup; Khanal, Surendra; Gyawali, SiddinathAbstract Introduction: Breast cancer is one of the most common cancers worldwide both in terms of incidence and mortality. Its incidence has been on an increasing trend in developing nations including Nepal, however, there is very limited evidence of its demographic profile in our setting. This study aimed to find out the prevalence of breast cancer among cancer patients visiting the Department of Internal Medicine of a tertiary centre. Methods: A descriptive cross-sectional study was conducted among cancer patients visiting the Department of Internal Medicine of a tertiary care centre using retrospectively collected data from 1 August 2022 to 30 July 2023 after obtaining ethical approval from the Institutional Review Committee. Histopathologically confirmed cancer patients were included and those with incomplete and duplicated data were excluded. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 2067 cancer patients, the prevalence of breast cancer was 102 (4.93%) (4.00-5.87, 95% Confidence Interval). The mean age was 50.51±2.08 years. The most commonly affected age group was 40 to 60 years constituting 61 (59.80%) patients. Histologically, invasive breast cancer of no special type was the most common and was found in 91 (89.22%) patients. Conclusions: The prevalence of breast cancer was similar to other studies done in similar settings.Publication Hepatocellular Carcinoma among Patients with Chronic Liver Disease in a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2024) Gnawali, Arun; Pathak, Rahul; Koirala, Dinesh; Pandey, Rajesh; Hamal, Rabin; Jha, Anurag; Bhandari, Brindeswari Kafle; Gyawali, SiddinathAbstract Introduction: Hepatocellular carcinoma is the most common primary liver cancer. Viral hepatitis, alcohol abuse, and autoimmune hepatitis are the common causes of hepatocellular carcinoma. Usually patients present at advanced stages where curative treatment is no longer possible. This study aimed to find the prevalence of hepatocellular carcinoma among patients with chronic liver disease in a tertiary care centre. Methods: This is a descriptive cross-sectional study conducted in a single tertiary care centre from March 2020 to August 2022. The study was done among inpatients of the Department of Gastroenterology after ethical approval from the Institutional Review Committee. A total population sampling method was used and data were collected using predetermined proformas. Point estimate at 95% Confidence Interval was calculated. Results: Among 1440 patients, hepatocellular carcinoma was seen in 54 (3.75%) (2.77-4.73, 95% Confidence Interval). At the time of diagnosis, 48 (88.89%) were symptomatic. The presenting symptoms were weight loss seen in 35 (64.81%) being the most common. Out of them, 37 (68.52%) consumed alcohol and 40 (74.07%) smoked cigarettes. Conclusions: Hepatocellular carcinoma is a notable concern. Alcohol-related liver cirrhosis is the most frequent condition encountered in patients with hepatocellular carcinoma in our setting.Publication Hormone Receptors and HER2 Status of Patients with Breast Cancer in a Tertiary Center of Nepal: A Descriptive Cross-Sectional Study(Institute of Medicine, 2023) Shrestha, Rakshya; Panthi, Bishal; Gyawali, Siddinath; Kharel, Sanjeev; Paudel, BishalABSTRACT Introduction: The second most prevalent cancer among women in Nepal is breast cancer. The assessment of human epidermal growth factor receptor-2 (HER2), progesterone receptor (PR), and estrogen receptor (ER) status in patients with breast cancer is currently regarded as standard practice because of its prognostic and predictive value. This study aims to find the incidence of Hormone receptor and HER2 status in patients with breast cancer. Methods: This was a descriptive observational cross-sectional study that assessed the immunohistochemistry markers of different histological types of breast cancer patients who visited a tertiary center in Nepal. Retrospective data from August 1, 2022, to July 30, 2023, were gathered from computer records of all the patients diagnosed with breast cancer who visited the Tribhuvan University Teaching Hospital (TUTH). SPSS version 26.0 was used for statistical analysis. Results: A total of 102 patients with breast cancer were included. The mean age of the patients was 50.51±12.08 years. Only one patient was male. The analysis showed that 62 (60.78%) of total patients had ER/PR positive breast cancer and 40 (39.2%) were HER2 positive with a higher number among Janajati and the age group 41-60 years. Similarly, the incidence of triple-negative breast cancer was 21 (20.59%) of all patients. Conclusion: The majority of breast cancer patients in our study were ER/PR positive, followed by HER2-positive and triple-negative cases. A higher prevalence was observed among the Janajati ethnic group and those aged 41-60 years. Keywords: Breast cancer, immunohistochemistry, triple-negative breast cancerPublication Knowledge Regarding Antibiotic Use, its Resistance and Consequences among Higher Secondary Students in Private Schools of Kathmandu Valley(Institute of Medicine, 2019) Deo, Satish K; Gautam, Naveen; Gyawali, Siddinath; Shrestha, Deepti; Yadav, ShikhaABSTRACT Introduction The lack of awareness on the appropriate use of antibiotics, its dose and duration is one of the leading causes of global antimicrobial resistance (AMR). AMR poses a growing threat to public health, as infections from resistant strains of microbes become increasingly difficult to treat, resulting in prolonged illness and greater risk of death. Hence, this study would be an important reference for determining the scope of the problem which will be essential for formulating and monitoring an effective response to antibiotic use and its problem of resistance. Methods A descriptive cross-sectional study was done among higher secondary level students from selected schools in Kathmandu valley. Baseline data was collected after a tutorial session through semi-structured questionnaires which was based on past researches and verified using expert consultation. Ethical consideration was maintained throughout the study. Descriptive statistics was used to find out the KAP level including knowledge score and attitude-practice score of the selected population. Results Among 465 participants conducted in our research, the overall average knowledge score of the participants was found to be 73.3% while the attitude-practice score was 60.53%. It was found that 80.86% of the participants had heard the term “antibiotic resistance”. The knowledge score percentage among the students of grade 10 and 11 had no significant difference (p value= 0.592). Conclusion Our study concludes that if topics like antibiotics and their judicial use is well covered in school curriculum, it can produce measurable change in knowledge, attitude and practice level of the students. Keywords: Attitude, antibiotics, antimicrobial resistance, knowledge, practicePublication Prevalence of Anxiety and Depressive Symptoms among Hospitalized Patients Diagnosed with COVID-19(Nepal Health Research Council, 2024) Sharma, Sandipa; Gyawali, Siddinath; K.C., Niranjan; Sapkota, Subash; Shrestha, Siddhartha Kumar; Bataju, Pujan; K C, Rumi; Lamichhane, Ram PrashadBackground: A series of acute, atypical respiratory diseases was identified in Wuhan, China, which was named Coronavirus disease (COVID-19) by the World Health Organization (WHO), and the disease was later declared a pandemic. This disease has psychological effects in addition to physiological symptoms. This study aims to find out the psychological impacts of disease in the form of anxiety and depressive symptoms among hospitalized patients diagnosed with COVID-19. Methods: A multicentric descriptive cross-sectional study was conducted among patients diagnosed with COVID-19 who were admitted from July 1, 2021 to August 15, 2021 in six different hospitals. Ethical approval was obtained from the Nepal Health Research Council (reference number 284). COVID-19 was diagnosed using Reverse Transcription Polymerase Chain Reaction (RT-PCR) or COVID-19 antigen test. Data were collected from the patients using proforma containing the demographic profile and two questionnaires (Hospital Anxiety and Depression scale and Global Health Questionnaire-12) translated into the Nepali language. Results: Among 360 patients who participated in the study, 194 (53.9%) were males and 166 (46%) were females. Symptoms of anxiety and depression were seen in 161 (44.7%) and 253 (70.3%) of the participants respectively. Similarly 349 (96.9%) of them were found to have clinically significant mental distress. Conclusions: The prevalence of anxiety and depressive symptoms among hospitalized patients diagnosed with COVID-19 is significantly high compared to the general population. Keywords: Anxiety; coronavirus disease-2019; cross-sectional study; depression; psychological effect.