Browsing by Author "Hamal, Pawan Kumar"
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Publication Clinical Outcome for Lumbar Disc Herniation Treatment with Intradiscal Oxygen-ozone Therapy(Nepal Health Research Council, 2023) Yadav, Rupesh Kumar; Sherpa, Tshering; Hamal, Pawan Kumar; Pokhrel, Nabin; Thakur, Jay Prakash; Amatya, Shirish Prasad; Piya, RoshanAbstract Background: Low back pain due to disc herniation is a common problem causing frequent hospital visits and loss of working days with major socio-economic impact. Conservative treatments like analgesics, physiotherapy do not work in all patients. Surgical treatment has been main stay of treatment when indicated but is associated with anesthetic and surgical complications. Intradiscal oxygen-ozone chemonucleolysis is minimum invasive procedure done under local anesthesia and has promissing role in shrinking the bulged disc and reducing nerve root compression and related symptoms. This retrospective study was done to see how intradiscal oxygen-ozone chemonucleolysis reduces the pain severity in patient with discogenic low back pain. Methods: Retrospective data were retrieved of those patients who underwent fluoroscopy guided intradiscal oxygen-ozone chemonucleolysis with 5-6 ml of an O2-O3 mixture (concentration of 30 microgram/ml) during the period of two years in Nepal pain care and research center. Numerical pain scale (NRS) at various follow ups were compared to preprocedural NRS. Results: Preprocedural NRS was 8± 1. NRS at three hours, one week, one month, three months and six months were 2± 0.3 (73.44 percent reduction), 2.5± 2 (68.85 percent reduction), 2.3± 2 (72.13 percent reduction), 1.8± 1.7 (77.87 percent reduction) and 1.67± 1.4 (79.51 percent reduction) respectively. Conclusions: Intradiscal oxygen-ozone chemonucleolysis can be useful modality of treatment for discogenic low back pain when failed to respond to the conservative management and in whom surgery is not indicated. Keywords: Chemonucleolysis; disc prolapse; fluoroscopy; low back pain; ozone.Publication Confronting the Threat of Predatory Journals: Time for Nepalese Academia to be Aware(Nepal Health Research Council, 2025) Hamal, Pawan Kumar; Dawadi, Pravakar; Yogi, PrajwalaNAPublication Duration of Anesthesia with Dexmedetomidine as Adjuvant to Ropivacaine in Supraclavicular Brachial Plexus Block: An Observational Study(Nepal Medical Association, 2024) Acharya, Samyukta; Thapa, Chitra; Shrestha, Nisha; Hamal, Pawan KumarAbstract Introduction: Supraclavicular brachial plexus block is effective for upper limb surgeries, with ropivacaine offering prolonged action. Adding dexmedetomidine as an adjuvant may enhance block duration and quality. This study aimed to evaluate the mean duration of anesthesia with dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus blocks. Methods: A observational cross-section study was conducted among patients undergoing supraclavicular brachial plexus block for elective upper limb surgery in a tertiary care center. The block was performed using ultrasound-guided, single-injection technique with 0.25% ropivacaine and 0.5 µg/kg dexmedetomidine. Sensory and motor block durations, along with analgesia, were assessed using standardized scales. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. An ethical approval was taken from Institutional review Committee (Reference number: 026-077/078). Results: The mean duration of anesthesia was 592.42±137.73 minutes (548.62-636.21, 95% Confidence Interval). Sensory and motor block durations were 553.95±138.54 and 555.42±156.24 minutes, respectively, with median onset times of 15 (IQR: 5-22.5) and 24 (IQR: 17-30) minutes. Conclusions: The mean duration of anesthesia with dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus blocks was similar to other studies showing prolonged duration and accelerated sensory and motor block.Publication Functional Outcome of Single-Stage Reconstruction for the Multi-Ligament Injuries of the Knee(Nepal Health Research Council, 2024) Hamal, Bhadra; Karmacharya, Mahesh; Bhattachan, Sijan; Hamal, Pawan KumarBackground: Multi-ligament injuries of the knee are rare injuries that can cause significant impairment of the knee function. There is controversy in the treatment regarding staged versus single-stage surgery. This study was performed to assess the outcome of the single-staged reconstruction of the multi-ligament injury of the knee. Methods: This prospective observational study was done from January 15, 2022 to January 14, 2023. The outcome was analyzed by comparing the preoperative and 12-month postoperative Visual Analog Scale score, Lysholm Score, and International Knee Documentation Committee Score. Results: The mean age of the patients was 28.35 years. among 12 patients 9 were male and 3 were female. Single-staged multi-ligament reconstruction was done in all the cases. The Lysholm score was improved from preoperatively 36.42 ± 1.46 to 95.36 ± 2.84, IKDC score was improved from 24.38 ± 1.64 to 93.86 ± 3.14, VAS score 8.14 ± 1.44 to 0.40 ± 0.60 at 12 months postoperative follow-up which all came to be clinically significant with p-value < 0.001. Conclusions: Single-stage multi-ligament reconstruction of the knee is an effective method of treatment and has excellent outcomes. Keywords: Multi-ligament injury; reconstruction; single-stage.Publication Mapping the Health and Medical Research Excellence in Nepal: A Study of High-Cited Papers During 1994-2023(Nepal Health Research Council, 2024) Vaishya, Raju; Gupta, Brij Mohan; Mamdapur, Ghouse Modin Nabeesab; K.S., Ali; Vaish, Abhishek; Joshi, Pramod; Hamal, Pawan KumarBackground: A bibliometric analysis was performed to map the current status and development trends in medical research in Nepal. It aims to visualize research hotspots within this field and provide effective guidance for future research directions. Methods: A systematic search of the Scopus database was performed to identify high-cited papers (HCPs) on medical research in Nepal between January 1, 1994, and December 31, 2023. Bibliometrics techniques were applied to analyze the publication dates, countries, institutions, journals, authors, and research hotspots. Statistical analysis and visualization were carried output by MS-Excel and VOSviewer software. Results: A total of 326 HCPs were identified that have received 100 to 10719 citations and registered 223.05 Citations Per Paper (CPP). The 47.54% and 95.40% share of the 326 HCPs have received external funding support and are involved in international collaboration, respectively. The 15892 (417 from Nepal) authors, affiliated to 12830 (177 from Nepal) organizations and published in 138 journals participated in 326 HCPs from Nepal. USA (60.45% share) and India. (51.45% share) were the most collaborative countries, while Spain (1609.15 CPP) and Mexico (1597.08 CPP) made the largest citation impact in collaboration with Nepal. C.L. Ranabhat (n=27) and B. Sathian (n=26) were the most productive authors, while D. Acharya (3652.29 and 16.5), and S. Bhattarai (2880.11 and 13.01) registered the highest citation impact (CPP and RCI). Tribhuvan University, Kathmandu (n=72) and Nepal Health Research Council, Kathmandu (n=34) were the most productive organizations, while Kathmandu University (3652.29 and 16.5) and Nepal Academy of Science and Technology, Lalitpur (2941.67 and 13.29) registered the highest citation impact (CPP and RCI). The Lancet (n=75) and British Medical Journal (n=11) were the most productive journals, while The Lancet Neurology (1749.5 CPP), and The Lancet (1371.13 CPP) registered the highest average citations impact. B. Basnyat has the most citation as first author in health and medical research. Conclusions: The present study offers an overview of research characteristics and trends of medical research output in Nepal. It identifies main contributors, core journals, and significant subject topics. The study hopes to assist researchers and practitioners in comprehending the development and trends of medical research in Nepal and discovering potential directions for future research. Keywords: Bibliometric methods; citations; collaboration; high-cited papers; medical research.Publication Prevalence and Risk Factors of Osteoporosis among Postmenopausal Women Visiting a District Hospital of Nepal: An Observational Study(Nepal Medical Association, 2024) Pandey, Dipendra; Basnet, Samina; Pradhananga, Smeena; Shrestha, Sarita; Rijal, Badri; Neupane, Aman; Timilsina, Utsav; Upreti, Amit; Upreti, Apil; Baskota, Rabindra; Hamal, Pawan KumarAbstract Introduction: Osteoporosis and low bone mass affect millions of people worldwide, leading to severe consequences ranging from disability to mortality. This study aimed to determine the prevalence and risk factors of osteoporosis among postmenopausal women in a district of Nepal. Methods: An analytical cross-sectional study involving postmenopausal women from Nuwakot, Dhading, and Rasuwa districts in Nepal was conducted at Trishuli Hospital, Nuwakot. Ethical approval was taken from the Institutional Review Board of Nepal Health Research Council (Reference number: 1768). The prevalence of osteoporosis was determined, and the associated factors were analyzed using multivariate logistic regression. Dual-Energy X-ray Absorptiometry (GE-Lunar Prodigy) was used to measure Bone Mineral Density (g/cm2) at the proximal femur and lumbar spine. Various factors related to osteoporosis were also analyzed. Results: There were 384 postmenopausal women and the prevalence of osteoporosis was 82 (21.35%; 95% CI: 17.25%-25.45%)e. The mean age of female with osteoporosis was 67.52±8.84 years and that without osteoporosis was 55.70±7.69 years (p <0.001). The multivariate logistic regression showed aOR 0.82 for body mass index. Conclusions: The study reports a lower prevalence of osteoporosis than expected in postmenopausal women. There was a significant inverse relationship between osteoporosis and body mass index. However, no significant association was observed between Bone Mineral Density, biochemical variables, smoking, and parity.Publication Respiratory Morbidity and Mortality of Traumatic Cervical Spinal Injury(Nepal Health Research Council, 2023) Pokhrel, Nabin; Neupane, Aastha; Thapa, Nabin; Yadav, Rupesh Kumar; Hamal, Pawan Kumar; Malla, PragyaAbstract Background: Traumatic cervical spinal injuries can severely affect respiratory function and cause significant morbidity and mortality. The typical respiratory morbidity in cervical spine injury is Atelectasis, Ventilator-associated pneumonia, acute respiratory distress syndrome and delayed weaning, etc. The study aims to see the prevalence of respiratory morbidity as well as mortality associated with cervical spine injury. Methods: Cross sectional study based on retrospective data was conducted on the X Sciences with the existing hospital record during the period of 3 years to find out the prevalence respiratory morbidity like Ventilatory Associated Pneumonia, delayed weaning, ARDS, atelectasis of traumatic cervical spine injury, determine the prevalence, type, and impact of respiratory morbidity and mortality in this population. Results: Total no 76 patients data meeting the inclusion criteria included in study. Male patients were more prone to develop traumatic cervical spinal injuries (SCI). The prevalence of respiratory morbidity in term of VAP(57.89), delayed weaning(46.05) and Atelectasis(22.36) was high. Patients with Asia A Neurology has higher association for VAP and delayed weaning, while Asia E Neurology patients had no respiratory morbidity. The study found a significant positive association between respiratory morbidity with hospital stay, and ventilator days (p-value: 0.019 and 0.048). A total of 15 patients died, 28.95% were discharged on request and 40.8% leaving the hospital against medical advice. Conclusions: The prevalence of respiratory morbidity higher in cervical spine injury. Furthermore, it has associated with prolonged ICU and ventilator days and increase in mortality. Keywords: ARDS; atelectasis; delayed weaning; respiratory morbidity; traumatic SCI.