Browsing by Author "Joshi, S"
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Publication Complete elimination of tetanus is still elusive in developing countries: A review of adult tetanus cases from referral hospital in Eastern Nepal(Kathmandu University, 2007) Joshi, S; Agarwal, B; Malla, G; Karmacharya, BAim: To analyse demography, clinical presentation, treatment, complications and outcome of patients with tetanus over a 2-year period. Materials and methods: A retrospective analysis of medical records of all patients with tetanus admitted to the intensive care unit of B.P Koirala Institute of Health Sciences, Dharan, Nepal between July 2004 and June 2006. Results: Tetanus accounted for 1.1 % of our ICU admission. Eight tetanus patients (mean age 52 years; M: F ratio 7:1) were admitted. The tetanus prone wounds of seven patients were managed at home. The most common presenting complaints were trismus and stiffness of neck and back (87.5%). Elective intubation was followed by tracheostomy in all the patients. Overall mean duration of ventilatory support was 12.5 days. Treatments given in ICU were diazepam, magnesium sulphate, tetanus immunoglobulin, metronidazole, wound management and supportive measures. Five patients (62.5%) developed autonomic instability and three patients had ventilatory associated pneumonia (37.5%). Average ICU stay was 15.1 days while hospital stay was 20.1 days. Five patients (62.5%) survived the course of disease. Two patients (25%) left the hospital against medical advice while the other (12.5%) died in ICU. Conclusion: Tetanus is a vaccine preventable disease. Tetanus prone wounds should be managed appropriately. Respiratory compromise and autonomic instability are the main causes of morbidity and mortality. Early recognition, intense support and prompt treatment improves morbidity and mortality of patients diagnosed with tetanus.Publication Faculty opinion survey following attendance to teacher training workshops in Kathmandu Medical College(Kathmandu University, 2004) Joshi, S; Pradhan, A; Dixit, HIntroduction: With the growing awareness of the importance of teaching and learning in Universities, the need to improve professional qualities in teachers has been identified. Aim and Objectives: This paper describes the outcome of the impact of teacher training workshops on faculty- teaching performance. Methodology: A total of 30 faculties who had undergone teacher training in the one-year period were included in the study. Survey questionnaire were distributed and all the forms were returned. Results: All (100%) respondents found the teacher training to be very useful/useful for improvement of teaching skills. A total of 76.66% said that the skills learnt in the workshop were very applicable, 80% perceived changes in students’ classroom behaviour and found their lecture to be more participatory and interactive. As for their own change in behaviour, 66.66% respondents experienced better interaction with the students in classroom. Discussion: The overall impression of the training was very positive. Future studies should include student feed back and classroom teaching observation for faculty teaching evaluation. We also need to utilise the feed back information obtained in this article, to further improve the strength of the future teacher training workshops. The future workshops should include sessions in problem-based learning and follow up refresher courses. Key Words: Teacher- training, Survey, KMCPublication Kala-azar (Visceral Leishmaniasis) from Khotang(Kathmandu University, 2006) Joshi, S; Bajracharya, BL; Baral, MRKala-azar is a chronic infection of reticuloendothelial system caused by flagellated protozoan, leishmania donovani injected into human host by the bite of the sand fly (phlebotomous) previously infected by biting and sucking the blood of a patient of leishmaniasis. It is characterized by irregular fever of long duration, large spleen and liver, anaemia, leucopenia and progressive emaciation. This article reports a case of a 10year old girl from Khotang, a nonendemic zone for Kala-azar, who presented with long history of abdominal distension for 11months, fever for 9months, cough for a week and weight loss. Clinical examination revealed pallor, enlarged liver and huge splenomegaly. Investigations confirmed the diagnosis of kala-azar by the presence of L.D bodies in bone marrow smear. The patient is being treated with i.v Amphotericin B in Infectious Disease Hospital, Teku. Key words: Abdominal distension, fever, pallor, splenomegaly, L.D bodies.Publication Measurement of Right Atrial Volume and Diameters in Healthy Nepalese with Normal Echocardiogram(Kathmandu University, 2014) Karki, DB; Pant, S; Yadava, SK; Vaidya, A; Neupane, DK; Joshi, SABSTRACT Background The size of right atrium is expected to be different in diverse healthy ethnic groups. It is important to know the normal size of right atrium in our healthy population. Objective The study aimed to find out the normal values of right atrial volume, right atrial short axis diameter and right atrial long axis diameter in healthy Nepalese population with normal echocardiographic findings. It also looked at correlations between right atrial dimensions and the right atrial volume. Method Verbal consent was taken from all the participants. One hundred participants between the age of 18 and 60 years with normal echocardiographic findings and without any chronic disease were included in this study. Right atrial volume was measured by using area length method. Right atrial short axis diameter and Right atrial long axis diameter were measured in the four chamber view. Result The mean right atrial volume was 23.64±5.36 ml (range 11.30 - 40.00 ml).The range of right atrial short axis diameter and right atrial long axis diameter were 1.34-3.80 cm and 2.4-4.7 cm respectively. Conclusion The size of right atrium in the Nepalese population is smaller compared to western population. Male right atrial volume size is greater than female in Nepalese population similar to western population. The findings of normal value of right atrial volume and right atrial diameter in Nepalese population will help the physician to assess patients with various conditions affecting the right atrium. KEY WORDS Nepalese population, right atrial short axis diameter, right atrial long axis diameter, right atrial volume.Publication Publication Percutaneous dilational tracheostomy: An initial experience in community based teaching hospital(Kathmandu University, 2006) Joshi, S; Agrawal, B; Deo, GP; Bhattarai, BK; Rahman, TR; Biswas, BKPercutaneous dilational tracheostomy (PDT) is frequently performed in the intensive care unit to prevent the long term complications associated with prolonged endotracheal intubation. Objective: To report the analysis of our experience with percutaneous dilation tracheostomy. Study Design: A prospective documentation of 40 patients who received percutaneous dilational tracheostomy in a multidisciplinary intensive care unit during a 12-month period. Method: The patients demographic, indications of intubation and PDT, time required to perform the procedure, complications and the outcome of these patients in the intensive care unit were noted. Result: Among 425 patients, 40 underwent percutaneous dilational tracheostomy that included 22 females and 18 males with the median age of 35 years. Prolonged ventilatory support was the most common indication for tracheostomy. The average duration of intubation before PDT was 5 days. Median procedure time was 20 minutes. Complications included minor bleeding in two (5%), subcutaneous emphysema with pneumothorax in two patients (5%), tracheal stenosis in three (7.5%), tracheo-esophageal fistula and glottic granuloma in one patient each (2.5%). Among forty patients, 28 (70%) were discharged to the ward, 8 died in intensive care unit and 4 left hospital against medical advice. Conclusion: Percutaneous dilational tracheostomy is a safe, quick and effective way for long term airway management in critically ill patients.Publication Study of Antibody Recognition Pattern of HCV by Western Blot Method(Kathmandu University, 2003) Joshi, SHCV is a positive strand RNA virus, and is a member of the Family Flaviviridie. HCV show substantial nucleotide sequence variability distributed throughout the viral genome, particularly the HVR1 region that is suggested to be immunogenic in humans. HVR1 is the most heterogeneous region within the E2 genome and peptide corresponding to this region, can be detected by homologous sera. To study the serum reactivity to peptides obtained from HVR1 region of the E2 region of the HCV genome, western blot can be performed in place of Enzyme - Linked Immuno Sorbent Assay (ELISA), if the expressed recombinant protein is insoluble & cannot be extracted or purified from the host cell. Key words: - HCV, serum reactivity, western blot