Browsing by Author "Karki, A"
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Publication A National Equity Initiative to Address Noncommunicable Diseases and Injuries: Findings and Recommendation from the Nepal NCDI Poverty Commission(Kathmandu University, 2022) Koirala, B; Adhikari, SR; Shrestha, A; Vaidya, A; Aryal, KK; Kalaunee, SP; Shrestha, A; Mishra, SR; Sharma SK; Karki, A; Maharjan, B; Singh, S; Schwarz, D; Gupta, N; Bukhman, G; Karmacharya, BMABSTRACT We aimed to assess the burden of NCDIs across socioeconomic groups, their economic impact, existing health service readiness and availability, current policy frameworks and national investment, and planned programmatic initiatives in Nepal through a comprehensive literature review. Secondary data from Global Burden of Disease estimates from GBD 2015 and National Living Standard Survey 2011 were used to estimate the burden of NCDI and present the relationship of NCDI burden with socioeconomic status. The Commission used these data to define priority NCDI conditions and recommend potential cost-effective, poverty-averting, and equity-promoting health system interventions. NCDIs disproportionately affect the health and well-being of poorer populations in Nepal and cause significant impoverishment. The Commission found a high diversity of NCDIs in Nepal, with approximately 60% of the morbidity and mortality caused by NCDIs without primary quantified behavioral or metabolic risk factors, and nearly half of all NCDI-related DALYs occurring in Nepalese younger than 40 years. The Commission prioritized an expanded set of twenty-five NCDI conditions and recommended introduction or scale-up of twenty-three evidence-based health sector interventions. Implementation of these interventions would avert an estimated 9680 premature deaths per annum by 2030 and would cost approximately $8.76 per capita. The Commission modelled potential financing mechanisms, including increased excise taxation on tobacco, alcohol, and sugar-sweetened beverages, which would provide significant revenue for NCDI-related expenditures. Overall, the Commission’s conclusions are expected to be a valuable contribution to equitable NCDI planning in Nepal and similar resource-constrained settings globally. KEY WORDS NCDI Poverty Commission, Noncommunicable diseases and injuriesPublication Chromoblastomycosis mimicking Squamous Cell Carcinoma: a case report(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2009) Kayastha, BMM; Shrestha, R; Shrestha, Pan; Karki, AAbstract Chromoblastomycosis (CM), a chronic subcutaneous mycosis, is caused by several dematiaceous fungi, the most common being Fonsecaea pedrosoi . It usually occurs in the lower extremities following traumatic implantation of the organisms. We are reporting a case of rapidly developing case of CM on the unilateral lower limb with a fungating mass like ulcerative lesion and hyperkeratotic warty growth. We could not explain the pattern of this rapid growth which seems to be one of the rare presentations. Scraping from a verrucous lesion in potassium hydroxide preparation revealed mycelia arising from sclerotic bodies The histopathology from the warty lesion showed granulomatous lesion without muriform or medlar bodies. The histopathology from the ulcerative lesion did not show any malignant changes. Our case responded very well to itraconazole. This case is presented here for the rapidity of growth and the development of a fungating mass and bleeding that simulated the behaviour of squamous cell carcinoma.Publication Custodial Death(Kathmandu University, 2023) Singh, PK; Karki, AABSTRACT The authors report a case of death of 16 years old boy in custody of a rehabilitation center. The young boy was taken to hospital for some health issues after severe torture where he was declared dead and brought for medicolegal autopsy under the requisition of investigating authority. Autopsy examination revealed multiple abrasions and intradermal contusions of ante-mortem origin and fresh at the time of death on various parts of the body including intradermal contusions on bilateral soles, subscalpal hematoma, subdural with minimal subarachnoid haemorrhages were observed. Histo-pathological examination of bilateral kidneys revealed features of acute tubular necrosis which is due to release of myoglobin as result of skeletal muscle necrosis sustained due to repeated blunt force trauma. The cause of death was attributed to head injury. Deceased was tortured by hitting over soles which is also known as falanga, and the second most common form of torture after beating the body. The fatal maltreatment and death of people who are detained against their will often raises controversy therefore nonpartisan information on cause of death is required to conclude that human rights were abused. So, medicolegal autopsy provides scientific basis for the occurrence of injury and establishing cause of death. KEY WORDS Autopsy, Custodial death, Necrosis, TorturePublication Hemidiaphragmatic paralysis: A rare complication of cervical herpes zoster(Kathmandu University, 2006) Paudyal, BP; Karki, A; Zimmerman, M; Kayastha, G; Acharya, PHerpes zoster, a sequel of the reactivation of the varicella zoster virus, usually presents with cutaneous eruptions associated with intense pain and burning sensation in the affected dermatomes. Motor weakness, however, can sometimes complicate herpes zoster. In this report we present a case that had diaphragmatic motor weakness as a sequel of herpes zoster lesions in the neck. Key words: Herpes Zoster, Postherpetic Neuralgia, Hemidiaphragmatic ParalysisPublication Mental Health Problems and Social Media Exposure during the COVID-19 Pandemic among Adult Population of Nepal(Kathmandu University, 2023) Dhakal, R; Thapa, M; Karki, A; Shrestha, D; Karki, P; Kaphle, HP; Neupane, N; Sharma, CABSTRACT Background The COVID-19 pandemic is a significant global health crisis that poses a threat to a person’s psychological well-being. A very large number of people got exposed to social network sites during this period which can be hazardous and cause psychological difficulties. There is no prior research or limited studies in this area during emergencies in Nepal. Objective To assess the mental health issues and examine their relationship with social media exposure in adults. Method A descriptive cross-sectional study was conducted by using a validated scale of Depression, Anxiety, and Stress (DAAS-21) and the Insomnia Severity Index (ISI) among 18 years above adult population. Data were collected through an online survey. Descriptive statistics was used to describe sociodemographic data. Binary logistic regression analysis were performed to examine the relationship between psychological problems and social media exposure. Result Out of 422 participants, the overall prevalence of depression, anxiety, stress, and insomnia among the study population were 32%, 28.4%, 24.5%, and 47% respectively. Additionally, 86.5% of individuals said they were frequently exposed to social media. Age, ethnicity, gender, past health problems, and health status were significantly associated with psychological problems. Further, social media exposure was associated with gender and marital status. There was no evidence of an association of psychological problems with social media exposure. Conclusion Depression, anxiety, stress and insomnia are common mental health problems found in the adult population during the time of the first wave of COVID-19 pandemic and highly affected were under 25 years age. Female and unmarried adults are using more social media. KEY WORDS Adult, COVID-19, Mental health problems, Nepal, Social media exposurePublication Misleading Diagnosis of Dysgerminoma in a Young Asymptomatic Patient(Kathmandu University, 2020) Maharjan, O; Bajracharya, N; Dangal, G; Karki, A; Pradhan, HK; Shrestha, R; Bhattachan, K; Tiwari, K; Bharati, S; Maharjan, SABSTRACT Dysgerminomas account for approximately one third of all malignant ovarian germ cell tumors (tumors arising from ovarian germinal elements) and are the most common ovarian malignancy detected during pregnancy. They are the only germ cell malignancy with a significant rate of bilateral ovarian involvement that is 15-20 percent. They have a variable gross appearance, but in general are solid, pink to tan to cream colored lobulated masses. They have the best prognosis of all malignant ovarian germ cell tumor variants. Two thirds are stage I at diagnosis, and prognosis is excellent even for those with advanced disease due to exquisite tumor chemosensitivity. The 5 year disease specific survival rate approximates 99 percent. This is a case report of a huge ovarian dysgerminoma in a young unmarried lady that was quite asymptomatic. She underwent laparotomy with right ovarian cystectomy. KEY WORDS Dysgerminoma, Germ cell tumor, Malignant, Pvarian malignanciesPublication Pregnancy Complicated by Acute Pancreatitis with Ascariasis(Kathmandu University, 2020) Thakur, SK; Dangal, G; Karki, A; Pradhan, H; Shrestha, R; Bhattachan, K; Bajracharya, N; Tiwari, K; Bharati, S; Maharjan, O; Maharjan, SABSTRACT Ascariasis lumbricoides infections are common in tropical and sub-tropical countries. As it is one of the common causes for common bile duct obstruction. But in pregnancy is a rare entity. It may present with complications like acute pancreatitis. Here we present a case of 24 year female gravida 2 para 1 at 34 weeks of pregnancy presented with chief complain of pain over epigastric region radiating to back and associated with two episodes of vomiting, non bilious, not mixed with blood. Ultrasonography showed long tubular hyperechoic structure in gallbladder lumen most likely ascariasis and then she was diagnosed as a case of acute pancreatitis with alive ascariasis. KEY WORDS Acute pancreatitis, Ascariasis lumbricoides, Pregnancy, UltrasonographyPublication Prevalence of Early Repolarization Patterns in Adults(Kathmandu University, 2016) Barakoti, MP; Karki, A; Chaulagain, MK; Karki, DBABSTRACT Background The finding of persistent Junction point elevation of 1 mm or more in adjacent leads in electrocardiogram is considered to be due to early repolarization. This condition was considered benign in the past but presently it is believed to be the rare cause of idiopathic ventricular fibrillation and sudden death. Objective The main objective of the study is to find out the prevalence of early repolarization pattern in subjects having electrocardiogram at Kathmandu Medical College Teaching Hospital. Method Twelve lead electrocardiograms of patients attending Kathmandu Medical College Teaching Hospital were studied. Data was collected for patient particulars. Electrocardiograms were analyzed for the type of early repolarization. Result The overall prevalence of early repolarization pattern of electrocardiogram was 2.82 %. It’s prevalence in male and female was 4.95 % and 0.77 % respectively. The prevalence of different types of early repolarization electrocardiography pattern was 0.70 %, 1.25% and 0.63% of the population studied for type I, II, and III early repolarization patterns. Type IV or Brugada pattern was not detected in our study. Conclusion The commonest pattern observed was type II that is early repolarization pattern in inferior or inferolateral leads. Having knowledge of early repolarization and its type helps to counsel the physicians about the risk of arrhythmia and sudden cardiac death. KEY WORDS Electrocardiogram, prevalence, repolarizationPublication Risk of neonatal hyperbilirubinemia in babies born to ‘O’ positive mothers: A prospective cohort study(Kathmandu University, 2009) Kalakheti, BK; Singh, R; Bhatta, NK; Karki, A; Baral, NAbstract Introduction: Hyperbilirubinemia in a neonate is one of the most common problems that may occur in 60-70 % of term and 80% of preterm babies. It is known to be associated with significant morbidity like neonatal bilirubin encephalopathy and even death. Clinically, and almost exclusively ABO incompatibility occur in ‘A’ and ‘B’ blood group babies of O ‘+ve’ mothers. These babies are reported to be at high risk of severe hyperbilirubinemia (serum bilirubin level more than 16 mg/dl). Objectives: To find out the incidence of hyperbilirubinemia in babies born to ‘O’ positive mothers. To estimate the risk of ABO incompatibility in babies born to ‘O’ positive mothers. Materials and methods: A prospective cohort study conducted in B. P. Koirala institute of Health Science (Department of Pediatrics and Dept. of Gynae and Obstetric) from July 2002 to June 2003. A total of 199 women having ‘O’ positive blood group admitted to the Department of Gynae and Obstetric were included in the study. A piloted proforma was used to collect information. The blood group of neonates was tested by tile and slide method and serum bilirubin was estimated by diazo method in the Central Laboratory Services and Emergency laboratory of BPKIHS. The data was observed and analysis was carried out using statistical software SPSS-10. Results: Total 37 (18.5%) babies had developed hyperbilirubinemia and among them 14 (38%) were from group of babies having ‘O’ Positive blood group and 23 (62%) were from group of babies having other than ‘O’ Positive blood group. There was 2.6 times higher chance of having hyperbilirubinemia in the babies with ABO incompatibility than ‘O’ Positive babies after adjusting other significant variables. Conclusion: Among different significantly associated variables, ABO incompatibility was found to be a major risk factor for neonatal hyperbilirubinemia.It was seen that neonate with ABO incompatibility had two times higher chances of having hyperbilirubinemia than those babies with O ‘+ve’ blood group. This finding in BPKIHS suggests that there is a need of screening cord blood bilirubin and continuous monitoring of bilirubin level in the hospital especially among ABO incompatible neonates. Key words: Hyperbilirubinemia, Neonatal Jaundice, ABO-incompatibilityPublication Study on Corticosteroids use Pattern in Dermatological Practice and Investigating Adverse Effect of Corticosteroids Including its Associated Factors(Kathmandu University, 2015) Shakya Shrestha, S; Bhandari, M; Shrestha, R; Thapa, SR; Karki, A; Prajapati, M; Shrestha, S; KC, S; Karna, DABSTRACT Background Corticosteroids are highly effective drugs with anti-inflammatory and immunosuppressive properties. Due to this, they have become a mainstay of pharmacotherapy in dermatology. However, improper and long term uses are associated with a number of serious adverse effects. Objective To investigate the corticosteroids use pattern, adverse effects and various factors associated with adverse effects in dermatological practice. Method A cross-sectional study was conducted in a dermatology department of tertiary care hospital. All patients using at least one corticosteroids, either topically or systemically or the combination were included in this study. Informed consent was taken from the patients and interviewed using structured questionnaire. Statistical analysis was performed by using SPSS 20. p-value < 0.05 was considered as statistically significant. Result Among the 60 participants under this study, 81.67% of them were females. The mean (±SD) age of the patients was 31.03 years (±15.0). A majority (58.30%) of the patients was prescribed with topical corticosteroids with low potency (25%). Most of them had used corticosteroids for urticaria. Adverse effects were reported by 33.30% of the patients. The most common adverse effect reported was the shedding of skin. Adverse effects was significantly associated with gender; use of systemic corticosteroids; regular use of corticosteroids; discontinuation of dose abruptly; and missed dose. However, there was no significant association between adverse effects and the duration of use of corticosteroids. Conclusion In conclusion, the present study suggested that the proper counselling and clear instruction regarding the use of corticosteroid should be provided to the patients for avoiding the abrupt discontinuation of the prescribed medication leading to treatment failure. KEY WORDS Adverse effect, corticosteroid, dermatology, treatment failure.Publication Sweet's Syndrome: a case report(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2009) Kayastha, BMM; Lama, L; Shrestha, P; Shrestha, R; Karki, AAbstract Sweet's syndrome is a disorder characterized by fever and painful skin lesions. The condition starts suddenly with the appearance of red, slightly raised tender plaques, usually on the back, arms, face or neck. Women are most at risk of Sweet's syndrome, predominantly between 30-50 years of age who have recently had an upper respiratory tract infection. Here we present a 70 years old lady who came with fever and tender erythematous plaques on trunk and limbs. On investigation, leucocytosis with raised ESR was found and the skin biopsy was consistent with Sweet's syndrome. There was dramatic improvement with systemic corticosteroid. Keywords: Sweet's SyndromePublication Vaginal Atresia with Cervical Agenesis, a Rare Congenital Malformation(Kathmandu University, 2021) Regmi, DR; Dangal, G; Karki, A; Pradhan, HK; Shrestha, R; Bhattachan, K; Tiwari, KD; Bharati, S; Manandhar, P; Maharjan, SABSTRACT Congenital vaginal atresia and cervical agenesis is a rare congenital abnormality of the female genital tract. Here we report a case of 15-year old girl with primary amenorrhea with hematometra, presented with lower abdominal mass. She was symptomatic since 5 months and visited local hospital after 4 months of onset of her symptoms when it became severe, where diagnostic laparotomy was performed for suspected Adnexal mass. Intraoperatively adnexal mass was adhered with and extended up to the uterus with 16 weeks size of uterus. Abdomen was closed without any further intervention and was referred to higher center for needful. When she presented to Kathmandu Model Hospital, she was asymptomatic on her 5th post-operative day of laparotomy. We planned for surgical intervention after examination and investigation. Drainage with vaginoplasty with amnion graft with placement of mould was done. KEY WORDS Congenital cervical agenesis, Hematometra, Vaginal atresia, VaginoplastyPublication Vesicovaginal Fistula Following Trauma(Kathmandu University, 2024) Shrestha, S; Dangal, G; Karki, A; Pradhan, HK; Shrestha, R; Bhattachan, K; Sah, SABSTRACT Vesicovaginal Fistula (VVF) is an abnormal communication between the bladder and vagina. The major causes of vesicovaginal fistula in developing countries are associated with obstructed labour whereas in developed countries, vesicovaginal fistula results from pelvic surgeries. Rarely vesicovaginal fistula may result due to direct trauma to the pelvis. This is a case of 17 years female who presented with the history of fall from tree 5 years back, sustained genital injury and complained of involuntary leakage of urine one month after the incident. She underwent fistula repair with vaginal approach using Latzko technique. KEY WORDS Vesicovaginal fistula, Trauma, Transvaginal