Browsing by Author "Karki, S"
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Publication 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 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 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 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 translucencyPublication Risk Factors for Pneumonia in Children under 5 Years in a Teaching Hospital in Nepal(Kathmandu University, 2014) Karki, S; Fitzpatrick, AL; Shrestha, SABSTRACT Background Pneumonia is a leading cause of mortality among children under-five years of age globally. The WHO (2014) has reported that indoor air pollution caused by cooking and heating with biomass fuel, living in crowed homes and parenting smoking are risk factors of pneumonia. Objectives The objective of the study was to identify the risk factors for pneumonia among children under-5 years of age. Methods A case control study was carried out among the mothers having under-5 years children who were admitted in the paediatric ward of Dhulikhel Hospital in 2012/13. A convenience sampling technique was used to select 50 children with pneumonia and 150 children with non-pneumonia diseases matched on age, sex and setting. A semi-structured interview consisting of questions related to risk factors for pneumonia was used to collect data from mothers of both cases and controls. Results Sex of the child did not differ by case/control group whereas the children with pneumonia were slightly older with 26% cases and 15% controls older than 3 years of age. Mother’s education was similar in both groups as was family income. Living in a household with a chulo with smoke increased the odds of having pneumonia significantly, with the risk almost 4 times greater if the chulo was located within the same building (OR: 3.76, 95% CI: 1.20-11.82, p=0.02). Children who had diarrhea in the past 3 months were protected from pneumonia (OR: 0.38, 95% CI: 0.18- 0.82, p=0.01). An increasing trend of pneumonia was observed among children of tobacco smoking parents with greater risk if both parents smoked; it was, however, not statically significant (OR: 2.21, 95% CI: 0.56-8.82, p=0.26). Conclusion The present study suggests that two factors related to smoke, presence of a smoky chulo in a household and both parents smoking, are modifiable risk factors related to pneumonia in young children. Reliable longitudinal studies, interventions, and programs to educate parents in prevention are important for reducing mortality and morbidities related to acute respiratory illnesses in Nepal. KEY WORDS Mothers, pneumonia, risk factors, under 5 childrenPublication Role of Ultrasound as Compared with ERCP in Patient With Obstructive Jaundice(Kathmandu University, 2013) Karki, S; Joshi, KS; Regmi, S; Gurung, RB; Malla, BABSTRACT Background The diagnosis of obstructive jaundice relies on proper history taking, clinical examination, laboratory investigations and different non invasive imaging modalities like Ultrasonography (USG), Cholangio Computed Tomography (CCT), Magnetic resonance Imaging (MRI) with Magnetic Resonance Cholangio Pancreatography (MRCP) and invasive modalities like endoscopic retrograde cholangiography (ERCP) and percutaneous trans hepatic cholangiography (PTC). Objective To compare the role of ultrasound with endoscopic retrograde cholangiography and to determine the major causes of obstructive jaundice in our prospect. Methods This was a prospective, analytical study conducted on 88 patients presenting to Department of Radiodiagnosis and Imaging at Dhulikhel Hospital-Kathmandu University hospital from March 2011 to August 2012 with clinical diagnosis of obstructive jaundice. Sonographic evaluation was performed in Siemens acusion x-150 and x-300. The final diagnosis was made by endoscopic retrograde cholangiography and /or surgery and confirmed histopathologically. Results The most common benign causes of obstructive jaundice were choledocholithiasis (63%), CBD stricture (12.3%), cholangitis (8%) and pancreatitis (6.85%) whereas cholangio carcinoma (6.85%) and carcinoma head of pancreas (4%) comprised of the malignant causes . Ultrasonography had sensitivity of 100% and specificity of 89% in detecting choledocholithiasis. It was found to be 98.78% sensitive and 83.33% specific in cholangiocarcinoma. Similarly in pancreatitis, the sensitivity of ultrasonography was 97.59% and sensitivity was 66.67%. Conclusion Ultrasonography acts as a valuable diagnostic imaging modality in detecting the causes of obstructive jaundice. Due to its easy availability, non invasive nature and cost effectiveness, it can be considered as the first line imaging technique/ tool. ERCP is the invasive imaging tool and can be used for both diagnostic and therapeutic purpose. KEY WORDS ERCP, obstructive jaundice, ultrasonographyPublication Seroprevalence of anti HCV antibodies among blood donors in Kathmandu valley, Nepal(Kathmandu University, 2008) Karki, S; Ghimire, P; Tiwari, BR; Rajkarnikar, MAbstract Aims and objectives: To study the seroprevalence of anti HCV antibodies among Nepalese blood donors in relation to their age, sex, type of donation and times of donation. Materials and methods: Descriptive cross-sectional study conducted in Nepal Red Cross Society (NRCS), Central Blood Transfusion Service (CBTS), Kathmandu, from December 1, 2006 to September 1, 2007. A total of 33,255 blood donors were screened for anti HCV antibodies by ELISA. Donor’s information was collected from blood donor’s record form and statistical analysis was done using the software ‘SPSS 11.5’ and ‘Winpepi ver. 3.8’. Result: The seroprevalence of anti HCV antibodies in blood donors was 0.66% (95% CI= 0.58-0.76). Higher seroprevalence was observed in male donors (0.7%, 95% CI= 0.6-0.8) than in female donors (0.4%, 95% CI= 0.2-0.6) (P < 0.05). The seroprevalence was highest (0.82%) in the age group of 21-30 years and there was signi cantly decreasing trends in seroprevalence with increasing age (P < 0.05). The highest seroprevalence among the male donors (0.88%) was also observed in the age group of 21-30 years (P < 0.001). Among female donors the seroprevalence (0.47 %) was highest in age group 41-50 years (P > 0.05). The seroprevalence of anti HCV was signi cantly higher in volunteer donors (0.7%) than in replacement donors (0.4%) (P < 0.05). Similar seroprevalence of anti HCV was observed in rst time (0.65%) and repeat blood donors (0.67%) (P > 0.05). Conclusion: The seroprevalence of anti HCV antibodies among blood donors in this study was similar to the seroprevalence reported for general population by other studies. Similar seroprevalence in rst time and repeat blood donors as well as higher seroprevalence in volunteer donors than in replacement donors are the potential threats to safe blood supply, which urges the need of more effective donor education and counselling of blood donors. Key words: Seroprevalence, Anti HCV antibodies, Blood donors, Kathmandu valley, Nepal.Publication Sonographic Measurement of Fetal Pinna Length in Normal Pregnancies(Kathmandu University, 2011) Joshi, KS; Chawla, CD; Karki, S; Shrestha, NCABSTRACT Background Many studies have emphasized on fetal pinna measurements and morphologic features to use this structure as an additional marker for fetal chromosomal anomaly. Objectives To assess relationship between fetal pinna length and gestation age and develop a nomogram. To assess relationship between fetal pinna length and head circumference and biparietal diameter. Methods Fetal pinna measurements from the tip of helix to the end of lobe were obtained prospectively in 850 singleton pregnant women between 15 and 40 weeks’ gestation Normal case was defined as normal sonographic findings during examination and normal infant examination at birth or both. Final study population was 787. The relationship between gestational age in weeks to pinna length in millimeters was analyzed by simple linear regression. Correlation of fetal ear length measurements with gestational age, biparietal diameter and head circumference were also obtained. Results Linear relationships were found between fetal pinna length and gestational age [Pinna Length (mm)=1.044xGestational age (weeks) -3.857]. A nomogram of normal pinna length was obtained. High correlation was found between pinna length and gestational age (r=0.942; p< 0.001), pinna length and head circumference (r=0.931; p< 0.001). Significant correlation was found between pinna length and biparietal diameter (r=0.934; p=0.004) Conclusions The results of this study provide a nomogram for fetal pinna. The study also provides relationship and good correlation between pinna length and other biometric measurements. KEY WORDS gestational age, pinna length, sonographyPublication Sonography in Acute Ureteric Colic: An Experience in Dhulikhel Hospital(Kathmandu University, 2014) Joshi, KS; Karki, S; Regmi, S; Joshi, HN; Adhikari, SPABSTRACT Background Computed tomography is considered as an imaging modality of choice in acute ureteric colic. However due to concerns regarding radiation exposure, sonograms are re-emerging as imaging methods in such situations. Objectives To evaluate the role of sonography in detection of calculus in acute ureteric colic. Methods Total 384 patients were enrolled. Hydronephrosis was graded as mild, moderate or severe. Calculus was detected as an intraluminal echogenic focus with distal shadowing with twinkling artifact. Number, size and position of the calculi were assessed. Patients were categorized into four groups:I. ureteric colic only II. ureteric colic with hematuria III. ureteric colic with hydronephrosis and IV. ureteric colic with hematuria and hydronephrosis and then the possibility of detection of calculi has been compared among these groups. Results Out of 384 patients, 254 were found to have calculi ranging between 2.7-27mm. Nineteen had in the pelvis/ pelviureteric junction, 64 in proximal ureter, 125 in distal ureter, 6 at iliac crossing and 40 at vesicoureteric junction. Two hundred forty one had single and 14 had multiple calculi. Calculus detection is easier in category III and IV patients. The sensitivity and specificity of ultrasonography were 87.98% and 93.07%. Degree of hydronephrosis is strongly correlated with the number of calculi but weakly correlated with the size of the calculus. Conclusion Sonogram can be used in all cases of acute ureteric colic. Hydronephrosis is the most important finding because it paves the way out for the detection of calculus. KEY WORDS Calculus, hydronephrosis, sonography, ureteric colicPublication The Role of Argyrophilic Nucleolar Organizer Region (AgNOR) Study in Cytological Evaluation of Fluids, Especially for Detection of Malignancy(Kathmandu University, 2012) Karki, S; Jha, A; Sayami, GABSTRACT Background Serous effusion smears reported as “suspicious for malignancy” pose problems in clinical management. Silver staining for argyrophilic nucleolar organizer regions (AgNOR) has proved useful in making a cytopathologic differential diagnosis between benign and malignant cells. Nucleolar organizer regions(NORs) are loops of DNA located in acrocentric chromosomes. These NORs are visualized by silver staining technique that recognizes these argyrophilia associated proteins which are increased in malignancy. Objective This study aimed to distinguish reactive mesothelial cells from malignant cells in serous effusions using these NORs. Methods A total of 174 serous effusions received at the Department of Pathology, TUTH, during a period of one year were included in the study. Smears were studied by conventional Papanicolaou and Giemsa stains. AgNOR counts, variation in size and dispersion of AgNOR dots in smears were graded and compared in malignant and non-malignant effusions. Results Mean AgNOR counts of 10.43±0.73 and 10.21±0.51 in malignant peritoneal and pleural effusions, respectively, were significantly (p<0.0001) greater as compared with counts of 2.12±0.54 and 2.11±0.54 in non-malignant effusions. The AgNORs were irregular in shape in malignant effusions whereas they were comparatively larger, single dots in benign effusions. AgNOR size and dispersion were of higher grade in significantly greater proportion of malignant as compared with non malignant effusions (p<0.0001). Of the cytologically suspicious samples, nine were in the malignant range and one was in the benign range. Conclusion AgNOR study appears to be clinically useful as an additional diagnostic tool for use in serous effusion when the cytologic diagnosis is difficult. KEY WORDS AgNOR , cytology, effusions