Browsing by Author "Karki, S"
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Publication A Rare Case of Large Left Lateral Wall Vaginal Myoma(Kathmandu University, 2021) Shrestha, A; Mudbari, J; Tamrakar, SR; Pradhan, N; Makaju, R; Karki, SABSTRACT Vaginal leiomyomas are rare, they are uncommon benign tumor with variable clinical presentation. They usually present as a mass per vaginum or dyspareunia or pressure symptoms on the neighbouring structures. We present a case of 47 years lady with mass per vaginum and difficulty in walking and chronic pelvic pain. Her clinical findings suggested a large mass in the left vaginal wall, the mass was approximately 12 x 10 cm in size hindering the visualization of the cervix. Her ultrasonography showed bulky uterus with mass occupying the cervix. This finding was not correlating with the clinical findings. Magnetic resonance imaging (MRI) was done and it was reported as mass lesion in pelvis separate from the cervix abutting the rectum posteriorly. Ultrasonography (USG) guided biopsy was done which was reported as Leiomyoma. She underwent vaginal myomectomy and was confirmed in histopathology as Leiomyoma. A leiomyoma is a smooth muscle tumor that arises from the muscular part of the uterus and rarely seen in the vaginal wall. KEY WORDS Chronic pelvic pain, Leiomyoma, Mass per vaginumPublication A Study on Variations of Branching Pattern of Hepatic Arteries with its Clinical Significance(Kathmandu University, 2020) Mansur, DI; Karki, S; Shrestha, A; KC, BABSTRACT Background Variation of hepatic artery is very frequent and may predispose the patients to inadvertent injury to the vessels during hepato-billiary surgery. With the advancement of new diagnostic, therapeutic and operative techniques for abdomen, the sound knowledge of variations of hepatic arterial system have become increasingly important for dealing clinicians, surgeons and interventional radiologists. Objective To study the variations of hepatic artery and to evaluate the possible clinical significances. Method A total of 104 images of abdominal computed tomography scans were used for this study. The origin and branching patterns of hepatic artery were recorded. After collecting the data, statistical analysis was done. Result The present study concluded that normal branching pattern of hepatic artery was seen in 86.54% cases, whereas 13.46% cases showed different types of variations. Among them, type II and IV pattern were seen in 0.96% in each, type VI in 1.93%, type VII in 2.87% and the most common variation type IX was seen in 3.85%. There were not a single case of type III, V, VIII and X recorded in this study. Addition to these, one of the variants was common hepatic artery originating from abdominal aorta, was seen in 1.93% of cases while the other variant is unnamed artery arising from superior mesenteric artery, was seen in 0.96% of cases. Conclusion The knowledge of the branching pattern of hepatic artery might be helpful for clinicians to the better understanding of the arterial supply of the liver and may reduce the risk of complications. KEY WORDS Hepatic artery, Hepatic artery proper, Left hepatic artery, Right hepatic arteryPublication A Study on Variations of Branching Pattern of Renal Artery with its Clinical Significance(Kathmandu University, 2019) Mansur, DI; Karki, S; Mehta, DK; Shrestha, A; Dhungana, AABSTRACT Background The kidneys are supplied by a single renal artery originating from abdominal aorta. However, recent literature reports great variations in renal blood supply. Hence, it becomes mandatory for the clinicians to understand the abnormality and variations in the renal vasculature. Objective To evaluate the branching pattern of renal artery and its variations. Method The study consisted of Computed Topographic images of 206 kidneys. Numbers and branching pattern of renal artery were recorded. The data was analyzed for presence or absence, source of origin and type of accessory renal artery. Result The present study revealed that 73.79% of kidneys were supplied by a single renal artery, 25.72% by double renal artery and 0.49% by triple renal artery. The hillar branching pattern was recorded in 38.83% and early branching pattern was in 34.95%. The presence of accessory renal artery was recorded in 26.21%. They were originated from abdominal aorta in 22.81% and 3.40% from main renal artery. The prevalence of superior polar artery was found in 6.79%, hilar in 10.19% and inferior polar in 9.22%. Conclusion The knowledge of variations of renal artery becomes essential for the clinician to plan the adequate surgical procedures and to avoid any vascular complication. KEY WORDS Abdominal aorta, Accessory renal artery, Renal arteryPublication A Survey on Oral Health and Practice of Nepalese in Areas Affected by Earthquake in 2015(Kathmandu University, 2017) Rokaya, D; Suttagul, K; Karki, S; Rokaya, N; Seriwatanachai, D; Humagain, MABSTRACT Background Understanding post-earthquake oral health indicators is essential for developing oral health interventions of the victims. Presumably, due to a geographic difficulty, there has been no investigation to reveal the oral health status of individuals after the Gorkha earthquake in Nepal. Objective The main objective was to determine the oral health and practice of Nepalese affected by earthquake in April-May, 2015. Method The epidemiological cross sectional study was done at 5 different districts (Sindhupalchok, Dadhing, Bhaktapur, Kathmandu and Kavre) of Nepal from September till November, 2015. Altogether 500 subjects aged form 16 to 80 years of age living in the transitional shelters community were included in earthquake- affected areas. Different parameters were studied from past and present medical and dental problems, habits, oral hygiene habits. DMFT, gingival index, periodontal index were studied and correlation was studied among them. Result It shows that 98% of the participants had plaque and 96.4% of the participants had calculus. Mean decayed was 9, mean missing was 4 and mean filling was 1. 22.60% of the participants had score 0, 34.8% had score 1, 34% had score 2 and 8.60% had score 3 of mean gingivitis index. 10% of the participants showed score 0, 36% showed score 1, 35% showed score 2, 10.2% showed score 3 and 8.2% showed score 4 of mean periodontal index. Moreover, significant correlation was observed among DMFT index, gingival index and periodontal index (p<0.001). Conclusion The oral health care practice, oral hygiene habits, nutritional intake of the people have been affected in the earthquake affected areas. It showed high caries index, gingival index and periodontal index in earthquake affected people suggesting further efforts are needed for an oral health improvement. Data from this study may be used as basic information for oral health planning and future steps in oral health care preventive and therapeutic programs. KEY WORDS Dental caries, disaster, gorkha earthquake, oral health, periodontitisPublication Awareness and Knowledge of Glaucoma and their Associated Factors among People Visiting a Tertiary Level Hospital in Central Nepal(Kathmandu University, 2022) Shrestha, A; Shrestha, P; Shrestha, T; Shrestha, RM; Sujakhu, D; Dhakal, K; Thapa, G; Adhikari, S; Karki, S; Adhikari, BABSTRACT Background Glaucoma is one of the major causes of irreversible blindness globally. Almost 60 million people globally are affected by glaucoma making it the second leading cause of blindness worldwide. Diagnosis of glaucoma early on is vital for timely management and prevention of blindness. However, it is challenging to diagnose it early because it is asymptomatic in the initial stage, and there is also the dearth of appropriate screening tools. Awareness, knowledge, and beliefs are believed to influence the treatment-seeking behavior of people as well as their uptake of services. Objective To assess the awareness and knowledge about glaucoma among general patients and patient attendants visiting Dhulikhel Hospital. Method We conducted a cross sectional quantitative study among general patients visiting Dhulikhel Hospital. We collected data using face-to-face interviews with semi- structured questionnaires. We analyzed data in R version 4.0.3 (2020-10-10). We presented numerical variables as mean and standard deviation whereas categorical variables as frequency and percentage. We determined factors associated with awareness and knowledge of glaucoma using logistic regression analysis and estimated adjusted odds ratio (AOR) with 95% confidence interval. Result Of 379 participants, a total of 214 (56.5%) participants had heard about glaucoma. Out of the participants who heard about glaucoma, the mean knowledge score was 48.3±21.7 and 53.3% had good knowledge on glaucoma. The odds of having heard about glaucoma were two percent lower (AOR=0.98; 95%CI: 0.97-0.99; p-value 0.036) in the older participants compared to one year younger participant, 1.98 (95%CI:1.01-3.86; p-value 0.046) times higher among literates and 2.79 (95%CI: 1.76- 4.41; p-value < 0.001) times among participants with previous ocular examination. The odds of having good knowledge was 1.94 (95%CI: 1.10-3.42; p value 0.021) times among participants with previous ocular examinations. Conclusion The knowledge and awareness regarding glaucoma in a hospital-visiting population in central Nepal was low. Half of the participants were unaware of the disease glaucoma and half of the participants who heard of the glaucoma had poor knowledge on glaucoma. KEY WORDS Awareness, Glaucoma, KnowledgePublication Awareness and Knowledge of Glaucoma and their Associated Factors among Staffs in a Tertiary-level Hospital in Central Nepal(Kathmandu University, 2022) Shrestha, A; Shrestha, P; Shrestha, T; Shrestha, RM; Sujakhu, D; Dhakal, K; Thapa, G; Adhikari, S; Karki, S; Poudel, LABSTRACT Background Since glaucoma-related blindness may only be prevented with early identification and treatment, finding asymptomatic individuals in the target population is critical. It is thus important to determine the awareness and knowledge on glaucoma. Objective To determine the knowledge and awareness on glaucoma among the staff of a tertiary level hospital in central Nepal. Method This was a cross sectional study among the staffs of Dhulikhel Hospital who participated voluntarily in the study. The data was collected through the administration of semi-structured questionnaires. R version 4.0.3 (2020-10-10) was used for the data analysis. Categorical variables are presented as frequency (percentages) and the numerical ones are presented as mean (standard deviation). Adjusted odds ratio (AOR) with 95% confidence interval were estimated through logistic regression analysis for determining factors associated with awareness and knowledge of glaucoma. Result A total of 107 (89.2%) participants had heard about glaucoma of which 93 (86.9%) had good knowledge and 14(13.1%) had poor knowledge on glaucoma. The mean score of knowledge was 64.1±16.9. Only 47.7% of the participants said that glaucoma also has an asymptomatic course. We could not find an association of awareness and knowledge of glaucoma with any of the selected sociodemographic variables. Conclusion Although there was a fairly good glaucoma related awareness and knowledge among hospital staff, we found lack of understanding on some critical issues on glaucoma, mainly related to its asymptomatic nature. There is thus room for improvement in educating about glaucoma even in healthcare settings. Given the necessity of expanding glaucoma awareness in the public, hospital staff might potentially serve as messengers to the communities KEY WORDS Awareness, Glaucoma, Hospital Staffs, Knowledge, PracticePublication Benign Sinonasal Masses: A Clinicopathological and Radio- logical Profile(Kathmandu University, 2013) Nepal, A; Chettri, ST; Joshi, RR; Karki, SABSTRACT Background Benign nasal and paranasal sinus masses are commonly encountered in clinical practice. Though benign, certain nasal polyps, fungal sinusitis, hemangiomas and fibro-osseous tumors can present with locally destructive features and deformities, mimicking malignancies at once. Objective This study was carried out to recognize the great variety of benign nasal lesions and their frequency in our region. Methods A retrospective chart analysis of cases presenting as mass in nose and paranasal sinus that underwent surgery over three years duration at our institute was done. A provisional diagnosis was made after clinical assessment and radiological investigations, but the final diagnosis was established after histopathological examination. Results A total 331 cases presented as masses in nose and paranasal sinus presented during the period. The clinicopathological examination aided by endoscopic and imaging studies revealed the non neoplastic benign masses in 293 and neoplastic masses in 38. Polyps were the commonest lesions constituting 70% cases followed by rhinosporidiosis in 10%. Fungal sinusitis, squamous papillomas, hemangiomas and inverted papillomas were found to be in order of 4.5%, 4%, 3.5% and 3% respectively. Rare cases like “rhino- oto-cereberal” form of mucormycosis, angiomyoma, and psammomatoid ossifying fibroma were also observed in the study. Conclusion Most of the nasal polyps/fungal sinusitis can be diagnosed clinically. However many a times Computer tomography (CT) scan and biopsy are necessary to differentiate them from each other and treatment plan. Certain benign tumors have high potential for malignant transformation while others can present with locally destructive features and deformities. KEY WORDS Angiomyoma, benign, fungal, polyps, rhinosporidiosis, sinonasalPublication Clinicoradiologic Evaluation of Eagle’s Syndrome and its Management(Kathmandu University, 2013) Pokharel, M; Karki, S; Shrestha, I; Shrestha, BL; Khanal, K; Amatya, RCMABSTRACT Background Eagle’s syndrome (Elongated styloid process) is often misdiagnosed due to its vague symptomatology. The diagnosis relies on detail history taking, palpation of styloid process in tonsillar fossa and imaging modalities. Objective To assess the length and medial angulation of elongated styloid process with the help of three dimensional computed tomography (3D CT) scan and to describe our clinical and surgical experience with patients suffering from Eagle’s syndrome. Method Prospective, analytical study conducted from August 2011 to August 2012 among 39 patients with Eagle’s syndrome. Detailed history taking, clinical examination and 3D CT scan was performed. Length and medial angulation was calculated. Patients with styloid process length longer than 2.50 cm underwent surgical excision via intraoral approach. Medial angulation of styloid process on both sides was correlated with each other using rank correlation coefficient. Wilcoxon Signed Rank test was applied to test significant difference between pre-operative and post- operative symptoms scores. Result Significant positive correlation was found between the medial angulation of styloid process on right side and left side (ρ =0.81, p<0.001). Significant difference was also observed between pre and post-operative symptoms scores (z=-5.16, p<0.001) . Conclusion Possibility of Eagle’s syndrome should always be considered while examining patients with vague neck pain. 3D CT reconstruction is a gold standard investigation which helps in studying the relation of styloid process with surrounding structures along with accurate measurement of its length and medial angulation. KEY WORDS Eagle’s syndrome, elongated styloid process, three dimensional computed tomographyPublication Comparative Study of Common Bile Duct Diameter between Normal and Post Cholecystectomy Cases Using Trans-abdominal Ultrasonography(Kathmandu University, 2022) Paudel, RC; Karki, S; Suwal, S; Palikhe, A; Mandal, D; Manandhar, MABSTRACT Background Increase in common bile duct diameter can occur because of different causes. Post cholecystectomy status is one of the potential causes. Many studies done in the past show different results and are hence inconclusive. Objective To see if the post cholecystectomy cases would have a statistically significant change in common bile duct diameter. Method We carried out a study in 100 cases (46 post cholecystectomy cases and 54 cases with intact gall bladder, measuring their common bile duct diameters and performing an unpaired t test to see if the mean in common bile duct among these two groups of cases was statistically significant. Result One hundred cases, 46 post cholecystectomy cases and 54 cases with intact gall bladder were included in our study. An unpaired t-test was used to compare the common bile duct diameters in these two groups. Our findings showed that the difference in common bile duct diameter between the cases with intact gall bladder and those who underwent cholecystectomy was significant for both one tailed and two tailed studies (p < 0.001). Hence, it can be stated that post cholecystectomy status increases the common bile duct diameter. Conclusion An increased Common bile duct diameter in post cholecystectomy case could be because of the post cholecystectomy status itself and not due to some other obstructive cause. So careful decision is necessary before subjecting the patient to further invasive/non-invasive investigations and treatments. KEY WORDS Cholecystectomy, Common bile duct, Diameter, Dilatation, UltrasonographyPublication Computed Tomographic Evaluation of Craniocerebral Trauma in Dhulikhel Hospital(Kathmandu University, 2017) Suwal, S; Karki, S; Mandal, D; Poudel, RCABSTRACT Background Craniocerebral trauma is common health problem in emergency department of any hospital. CT is commonly indicated to to rule out any significant intracranial abnormalities in these patients, so that timely intervention of the significant intracranial pathologies can be done. Objective The study is done to evaluate CT findings of head injury patients in Dhulikhel Hospital. Method This prospective hospital based study was done in Department of Radiology of Dhulikhel Hospital in the period of January 2015 to December 2015. CT findings of the head trauma patients undergoing CT in the Department of Radiology were reviewed and analysed. Result The study was done in 484 patients, 165 female and 319 male patients. Mean age of the patients was 30.87 ± 19.25 years. Among them 205 patients showed abnormal CT findings, scalp injury being the commonest one, followed by skull fracture. 60 patients showed abnormal intracranial findings. There was significant correlation of skull fracture and abnormal intracranial findings in this study. Conclusion This study provided the normal and abnormal CT findings in head of the craniocerebral trauma patients in Dhulikhel Hospital. Abnormal CT findings were predominantly extra-cranial and were overlapping with intracranial abnormal findings. KEY WORDS CT, Craniocerebral trauma, skull fracturePublication Correlation between Preoperative High Resolution Computed Tomography (CT) Findings with Surgical Findings in Chronic Otitis Media (COM) Squamosal Type(Kathmandu University, 2017) Karki, S; Pokharel, M; Suwal, S; Poudel, RABSTRACT Background The exact role of High resolution computed tomography (HRCT) temporal bone in preoperative assessment of Chronic suppurative otitis media atticoantral disease still remains controversial. Objective To evaluate the role of high resolution computed tomography temporal bone in Chronic suppurative otitis media atticoantral disease and to compare preoperative computed tomographic findings with intra-operative findings. Method Prospective, analytical study conducted among 65 patients with chronic suppurative otitis media atticoantral disease in Department of Radiodiagnosis, Kathmandu University Dhulikhel Hospital between January 2015 to July 2016. The operative findings were compared with results of imaging. The parameters of comparison were erosion of ossicles, scutum, facial canal, lateral semicircular canal, sigmoid and tegmen plate along with extension of disease to sinus tympani and facial recess. Sensitivity, specificity, negative predictive value, positive predictive values were calculated. Result High resolution computed tomography temporal bone offered sensitivity (Se) and specificity (Sp) of 100% for visualization of sigmoid and tegmen plate erosion. The performance of HRCT in detecting malleus (Se=100%, Sp=95.23%), incus (Se=100%,Sp=80.48%) and stapes (Se=96.55%, Sp=71.42%) erosion was excellent. It offered precise information about facial canal erosion (Se=100%, Sp=75%), scutum erosion (Se=100%, Sp=96.87%) and extension of disease to facial recess and sinus tympani (Se=83.33%,Sp=100%). high resolution computed tomography showed specificity of 100% for lateral semicircular canal erosion (Sp=100%) but with low sensitivity (Se=53.84%). Conclusion The findings of high resolution computed tomography and intra-operative findings were well comparable except for lateral semicircular canal erosion. high resolution computed tomography temporal bone acts as a road map for surgeon to identify the extent of disease, plan for appropriate procedure that is required and prepare for potential complications that can be encountered during surgery. KEY WORDS Cholesteastoma, high resolution computed tomography, temporal bonePublication Correlations Between Symptoms, Nasal Endoscopy Computed Tomography and Surgical Findings in Patients with Chronic Rhinosinusitis(Kathmandu University, 2013) Pokharel, M; Karki, S; Shrestha, BL; Shrestha, I; Amatya, RCMABSTRACT Background Although Chronic rhinosinusitis (CRS) is increasing in prevalence and incidence, its diagnosis and treatment still pose a challenge. The Task Force on rhinosinusitis (TFR) advocates the use of symptom based criteria. However, many otorhinolaryngologists depend on diagnostic nasal endoscopy and computed tomography(CT) of paranasal sinuses for diagnosis of CRS. Computed tomography has been extensively relied upon in confirming the presence of CRS, in assessing severity of disease, surgical planning and management decisions. Despite its widespread use, several studies have failed to correlate findings on CT with symptom severity. Objective To determine the correlations between symptoms described at presentation, radiological findings, endoscopy and extensiveness of surgery. Methods Longitudinal, prospective, analytical study conducted from August 2011 to August 2012 among 87 patients diagnosed as CRS according to the TFR criteria. Symptom, endoscopic, radiological and surgical scoring was done by using Lund and Mackay staging system. Pearson correlation coefficients between scores for symptoms, endoscopy, sinus CT and surgery was determined. Results When overall symptom score was correlated with radiological score and endoscopy score, it was found to be statistically significant (p= <0.01). However, no significant relationship was found between Lund and Mackay symptom and surgery score. Conclusion The symptom criteria used by TFR for CRS diagnosis are not very specific for sinus disease. A detail assessment of the subjective and objective criteria (CT and endoscopy) is necessary for tailoring surgical plan but should not be relied upon for determining the extensiveness of surgical intervention. KEY WORDS Chronic rhinosinusitis, lund and mackay staging system, task force on rhinosinusitisPublication Determination of Sex from the Foramen Magnum using 3DCT: A Nepalese Study(Kathmandu University, 2017) Singh, PK; Tamrakar, D; Karki, S; Menezes, RGABSTRACT Background Identification is of utmost importance in any medicolegal investigation with sex determination being one of the principle indicators of identity. Sexing of bones becomes easy when the skeletal remains are complete. However, the problem arises when the bones are fragmented. Many researchers have undertaken several studies in different populations to determine the sex with reasonable accuracy using numerous measurements of the skull including those of the foramen magnum. Objective The present study was aimed to find the sexual dimorphism of the foramen magnum in the Nepalese population by analyzing the antero-posterior length, transverse diameter and area of the foramen magnum. Method The antero-posterior length and transverse diameter of the foramen magnum were measured using three-dimensional computed tomography (3DCT) images of the head in a cohort of 100 Nepalese subjects. Radinsky’s and Teixeria’s formulae were used to calculate the area of the foramen magnum. Discriminate function analysis was used to analyze sex differences. Result Mean values of antero-posterior length and transverse diameter of the foramen magnum in males were higher than in females. The mean of the area calculated using Radinsky’s formula was smaller than that calculated by Teixeira’s formula and the areas calculated were higher in males. The measurements of the foramen magnum and the areas calculated showed significant difference (p<0.001) between males and females. Discriminate function analysis for the measurements of the foramen magnum and the areas calculated showed high predictability for both the sexes. Discriminate function analysis showed a maximum predictability of 75%. Conclusion Considering the percent of predictability of sex from the various variables related to the foramen magnum in the Nepalese population, it can be concluded that its restricted applicability in forensic investigations should be constrained to cases of fragmentary skull bases. KEY WORDS Foramen magnum, forensic anthropology, identification, sex determination, sexual dimorphismPublication Effectiveness of nicotinic acid and bezafibrate alone and in combination for reducing serum triglyceride level(Kathmandu University, 2005) Pradhan, B; Neopane, A; Karki, S; Karki, DBObjective: To study the effectiveness of nicotinic acid and Bezafibrate alone and in combination for reducing triglyceride level. Design: It was a randomised, prospective, longitudinal study. Setting: Patients attending a private clinic, and medical department of Kathmandu Medical College, Sinamangal. Methods: This study included 83 consecutive patients, 19 females and 64 males with hypertriglyceridaemia (defined as serum triglyceride >200mg/dl) attending the department of medicine, Kathmandu Medical College, Sinamangal and private clinic. Main outcome measures: Statistically significant reduction of serum triglyceride level. Result: 51 out of 83 patients completed the study in which Nicotinic acid alone reduced the serum trygleceride level from 320.62 ± 104.23 to 182.55 ± 46.21, which is a reduction of 138.07 ± 85.69 (P. value = 001). Bezafibrate when given alone also reduced triglyceride level significantly from 345.25 ± 181.03 to 203.30±93.59 which is a reduction of 141.95 ± 121.130 (P value= .001). When a combination of both drugs was given the reduction of 472.73±247.53 (P value =.002) was achieved. Conclusions: Nicotinic acid is a very effective drug in reducing serum triglyceride level and its effectiveness is similar to Bezafibrate. There is no added benefit of giving a combination of nicotinic acid and Bezafibrate in reducing serum triglyceride level. Keywords: Hypertriglyceridaemia, Nicotinic acid, Bezafibrate. Abbreviations: TG= Triglyceride, TC = Total cholesterol, HDL= High density lipoprotein, LDL= Low density lipoprotein NCEP-ATP III= National Cholesterol Education Programme-Adult Treatment panel 111Publication Fine Needle Aspiration Cytology with the Assistance of Radiological Tools in the Diagnosis of Deep-Seated Lesions(Kathmandu University, 2021) Dhakal, R; Makaju, R; Karki, S; Dhakal, BABSTRACT Background Fine needle aspiration (FNA) with radiological assisted tools such as ultrasonography (USG) and computed tomography (CT) are effective in obtaining high yield aspiration of tissues located in technically difficult places such as deep-seated. It is a simple outpatient procedure with low cost as compared to surgical biopsies. Objective To study the cytomorphological features of deep-seated lesions according to the site of occurrence, and to categorize them with respect to age, sex and behavior of lesions. Method This was a descriptive cross-sectional study of 125 patients who underwent image- guided fine needle aspiration cytology of deep-seated lesions. The study was conducted in the Department of Pathology and Department of Radiodiagnosis, Dhulikhel Hospital- Kathmandu University Hospital, between January 2017 and December 2018. Under radiological guidance, aspiration was performed under negative pressure, and adequate material was obtained. Smears were stained with Giemsa and Papanicolaou stain. The prepared slides were examined under a microscope. Result Of the 125 patients who underwent USG and CT-guided fine needle aspiration cytology (FNAC), 68(54.4%) were female and 57(45.6%) were male. The age of the patients ranged from 13 to 84 years. The maximum number of patients was above 50 years. The nature of lesions was categorized as malignant 78(62.4%), followed by 23(18.4%) inflammatory and benign 1(0.8%). Conclusion Image-guided fine needle aspiration cytology is a safe diagnostic procedure, as it provides real-time visualization of tip insertion in anatomical structures. It provides high yield and a better representation of the samples. KEY WORDS Computed tomography, Fine needle aspiration, UltrasonographyPublication Imaging in Infertile Female Patients Who Underwent Hysterosalpingography Investigation at Dhulikhel Hospital(Kathmandu University, 2016) Karki, S; Suwal, S; Tamrakar, SR; Poudel, RABSTRACT Background Fallopian tube and uterine abnormalities are the most common cause of female infertility, accounting for 30% of cases. Hysterosalpingography is the safe, minimal invasive radiographic technique for evaluation of uterine cavity and fallopian tubes defects. The purpose of the study was to assess the various uterine and tubal abnormalities leading to infertility Objective To assess the abnormalities in uterus and fallopian tubes detected on Hysterosalpingography (as causative factors of infertility in a tertiary care centre for proper decision making in treatment. Method This is the prospective cross sectional study done in department of radiology Dhulikhel hospital, Kathmandu University Hospital between January 2015 to January 2016 with complain of infertility. Hysterosalpingography was performed using ionic contrast medium (10-20 ml of 76% urograffin) under digital fluoroscopy. Radiographic films were obtained and analyzed. Demographic data and radiological findings were reviewed and the obtained data analyzed with SPSS version 16. Result Out of the total 100 patient, 75 had primary infertility while 25 had secondary infertility. The age ranged from 19 to 43 years with mean age of 27.75 years. Normal Hysterosalpingography findings were seen in 37% cases. Tubal abnormalities were seen in 34%, uterine abnormalities in 23% and both tubal and uterine abnormalities in 6% patients. The most common tubal abnormality detected on Hysterosalpingography was tubal block 75%. Out of the 30 patients who had tubal block, unilateral block was noted in 76.7% patients whereas bilateral block was noted in 23.3%. Hydrosalphinx was seen in 25% cases with tubal abnormality. Among the 29 cases with various uterine abnormalities, bicornuate uterus 9% was the most common abnormality Conclusion Hysterosalpingography is an easily available radiographic procedure that can demonstrate a wide variety of uterine and tubal abnormalities for the initial assessment of infertility which can avoid unnecessary and sometimes more aggressive procedures. KEY WORDS Hysterosalpingography, hydrosaphyinx, infertility, tubal blockPublication Medical Students’ Perception towards Online Education at Kathmandu University School of Medical Sciences, Dhulikhel, Nepal(Kathmandu University, 2023) Karki, S; Pun, K; Shrestha, B; Mansur, DI; Sah, BKABSTRACT Background Online education has gained popularity in various fields, including medicine, owing to its flexibility and time-saving advantages. The COVID-19 pandemic has further accelerated its adoption as an alternative to traditional in-person learning. Medical students appreciate the ability to study at their own pace, access resources remotely, and engage in virtual collaboration and networking. Objective The objective of this study was to determine the perception of online education among medical students. Method A cross-sectional descriptive study was conducted at Kathmandu University School of Medical Sciences (KUSMS), Nepal, comprising 332 participants. A Google Form questionnaire was used to assess their perceptions and responses deliberated on a three-point Likert scale. Descriptive analysis was used to determine the respondents’ views. Result The results showed that a significant majority (64.8%) of the respondents agreed that accessing the internet for online education was easy. However, only 35.5% felt comfortable attending online lectures at home. Regarding the effectiveness of online learning, the majority (66.3%) disagreed that it was similar to traditional classroom lectures. More than half (51.5%) of the respondents agreed that online classes were time-consuming and (71%) required breaks during sessions. Surprisingly, only 27% expressed a preference for online education. Additionally, a notable proportion (87%) disagreed that online education could provide similar real-world skills. Moreover, the majority (85%) disagreed that conducting exams for theoretical and practical/clinical courses virtually was possible. Conclusion Despite the availability of internet access for the majority of students, a significant proportion expressed discomfort with online education. Only a quarter preferred it, and many disagreed that it could replicate the traditional classroom experience or provide comparable skills. Training all faculties, providing high-speed internet, improving student interaction, and giving online demonstrations can enhance student preferences and online quality. KEY WORDS Medical students, Online education, PerceptionPublication Mothers’ Perception of Their Children’s Play in Dhulikhel Hospital, Nepal(Kathmandu university, 2021) Karki, S; Shrestha, S; Shrestha, KABSTRACT Background Play is a cherished part of childhood that offers children holistic developmental benefits and parents the opportunity to fully engage with their children. However, modern-day children are spending significantly less time in outdoor play due to a number of factors including technological advancements, more time involved in structured activities, and a greater emphasis on early cognitive learning. Objective To assess perception of mothers on their children’s play. Method This was a descriptive cross-sectional study was carried out among the 228 mothers having at least one child children who attended in Paediatric OPD of Dhulikhel hospital of Nepal from 21st June, 2018 to 16th July, 2019. Ethical approval was obtained from the Institutional Review Committee (IRC) of Kathmandu University School of Medical Sciences (KUSMS). Research instrument was developed by Barnett and was adopted for this study with permission from the author. Systematic random sampling technique was used to select mothers and face to face interview was carried out to collect information. Result Perception on play of children in the mothers was varied. Most of mothers agreed on different sub scales of play with mean range 2.07-3.01 in which they were agreed on freedom play with mean score 3.01±0.40, importance of play with mean score 2.93±0.37 and nearly agreed on maternal rule with mean score 2.89±0.50, play safety with mean score 2.92±0.36, child’s choice with mean score 2.96±0.49 and disagreed on imaginative play with mean score 2.42±0.59 and gender typing with mean score 2.07±0.51. Conclusion Although almost all respondents had positive attitudes towards different component of the play, they disagreed on gender typing and imaginative play which is very important for developing problem solving skill of children based on their gender. So, nursing faculties, pediatricians and nurses can use the findings to develop awareness on importance of gender typing and imaginative play among mothers. KEY WORDS Children, Mothers, Play, PerceptionPublication Multi-Detector Computed Tomography Evaluation of Normal Appendix(Kathmandu University, 2016) Suwal, S; Karki, S; Mandal, D; Poudel, RCABSTRACT Background Appendix is a blind-ended tubular structure arising from caecum, with variable intraluminal contents and position. Acute appendicitis is one of the common indications for emergency radiological investigation. Objective To assess visualization rate, size and position of normal appendix by Computed Tomography (CT). Method This cross-sectional observational study was done in 198 individuals undergoing abdominal CT without suspicion of acute appendicitis and without any pathology localized within right iliac fossa. Axial and coronal reformatted images of non- enhanced and contrast enhanced CT of abdomen were evaluated for visualization of appendix. Visualized appendices arising from caecum were traced and tip localized. Contents within the appendicular lumen were also evaluated and maximum transverse diameter of appendix measured. The relationship between appendicular diameter, intraluminal content and position with different age groups & gender were also derived. Result Visualization rates of appendix were 90% (93% male and 87% female) in non- enhanced CT and 97% (99.8% male and 95.4% female) in enhanced CT. The mean diameter of the appendix was 6.2 ± 1.16 mm. Most common location of the tip of appendix was pelvic position, followed by retrocaecal position. Most of the appendices showed intraluminal air. Conclusion Multi-Detector Computed Tomography is superior over ultrasonography (USG) in detection of appendix. Modifications of CT protocol reduce limitations of CT over ultrasound in evaluation of appendix. Ultrasound size criteria for appendicitis (>6 mm) is not applicable in CT as normal appendix can measure >6 mm in CT. KEY WORDS Diameter, location, normal appendix, multi-detector computed tomographyPublication Nuchal Translucency in Normal Fetus and Its Variation With Increasing Crown Rump Length (Crl) and Gestational Age(Kathmandu University, 2013) Karki, S; Joshi, KS; Tamrakar, SR; Regmi, S; Khanal, KABSTRACT Background Nuchal translucency (NT) is the fluid collection behind the fetal neck which can be measured by ultrasound at 11-14 weeks of gestation. Increase in the nuchal translucency thickness is associated with various congenital anomalies. Objective To study the relationship between nuchal translucency thickness, crown rump length and gestational age in normal fetus. Methods Prospective analytical study conducted on 211 pregnant women from March 2011 to August 2012. Measurement of Nuchal translucency thickness and crown rump length was performed by ultrasound at 11-14 weeks of gestation. The relationship between nuchal translucency thickness, crown rump length and gestational age was studied by using linear regression analysis. Results The mean CRL was 63.67+13.48mm (range 41.2-88mm) and mean NT thickness was 1.55+0.35mm (range 0.8-2.7mm), respectively. The median gestational age was 12.9 weeks. The regression equation which shows relation between median NT thickness and CRL was described as follows: expected NT thickness = 0.013CRL+0.725, (R2 = 0.258, p <0.001). There was increase in the incidence of NT thickness more than or equal to 2.5mm; 1.7% in fetus between 12-12.9 weeks of gestation to 15.1% in fetus between 14.0-14.9 weeks. Conclusion Our study offers normative data of NT thickness in normal fetus, which can be used as reference to screen various chromosomal and congenital abnormalities between 11- 14 weeks of gestation. NT thickness increased with increasing CRL and a false positive rate increases with increasing gestational age. KEY WORDS Crown Rump length, gestational age, nuchal translucency