Browsing by Author "Karn, R"
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Publication IgM and IgG Antibodies in Tuberculosis(Institute of Medicine, 2009) Bam, N; Karn, RAbstract Introduction: The diagnosis of tuberculosis relies on the identification of acid-fast bacilli on unprocessed sputum smears using conventional light microscopy. Microscopy has high specificity in tuberculosis-endemic countries, but modest sensitivity which varies among laboratories (range 20% to 80%). Moreover, the sensitivity is poor for paucibacillary disease (e.g., pediatric and HIVassociated tuberculosis). Many supportive investigations including serolological tests being utilized for tuberculosis diagnosis have wide variations in sensitivity, specificity in different studies. The aim of study was to evaluate the recombinant 38 KDa antigen from M. tuberculosis – based Enzyme Immunoassays (EIA) test for its sensitivity, specificity and other statistical parameters. Methods: This hospital based prospective cross-sectional study was conducted at Tribhuvan University Teaching Hospital, Kathmandu, from April 28, 2009 to November 30,2009. Sera from total 90 patients, pulmonary tuberculosis, extrapulmonary tuberculosis and non-tubercular chest infection patients who did not have past TB or exposure history , 30 in each group were used for Pathozyme Myco kit evalution to determine the IgM and IgG antibodies activity against the recombinant 38 KDa antigen of Mycobacteria . Results: In overall tuberculosis, IgM TB had sensitivity 48.3%,specificity 76.7%, positive predictive value 80.6% which was statistically significant(p=0.025) . The IgG TB had sensitivity 66.7%,specificity 83.3%,positive predictive value 88.9% which is statistically highly significant(p<0.001) to diagnose tuberculosis. Utilizing IgM and IgG both together, sensitivity decreased to 44.3%, but specificity increased to 90.0% and positive predictive value 88.5%, which was statistically significant (p=0.006) for the diagnosis of tuberculosis. Conclusions: IgG TB antibody has high sensitivity and specificity for tuberculosis diagnosis, but IgM antibody should also be evaluated along with IgG antibody to increase specificity. Keywords: Extrapulmonary tuberculosis (EPTB), 38 kDa antigen, IgM, IgG TB antibody, Pathozyme-Myco, Pulmonary tuberculosis (PTB)Publication Spectrum of Cryptococcal Meningoencephalitis in Tertiary Hospital in Nepal(Institute of Medicine, 2018) Kharel, G; Karn, R; Rajbhandari, R; Ojha, R; Agrawal, JPAbstract Introduction: Cryptococcal meningoencephalitis is the most frequently encountered manifestation of cryptococcosis and prevalent throughout the globe. The majority of patient suffering from cryptococcosis is immunocompromised and AIDS account for most of the case. We aimed to determine the spectrum of cryptococcal meningoencephalitis at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. Methods: A retrospective study was performed among all the patients (n=15) who were admitted with cryptococcal meningoencephalitis at TUTH over a period of one fiscal year July 2017 to June 2018. Data on patient’s demography, history, complaints, clinical findings, neuroimaging, cerebrospinal fluid (CSF) investigation, hospital medication information, complications, mortality and Left Against Medical Advise (LAMA) were extracted from patient medication records of the hospital. Descriptive statistics was performed using IBM-SPSS 20.0. Results: Of total 15 patients with Cryptococcal meningoencephalitis, majority (9, 60%) had HIV infection. The most common complaints were vomiting (12, 80%) and headache (11, 73%) and clinical findings showed meningeal irritation (8, 53%) and papilledema (4, 27%). Only two neuroimagings among all patients were abnormal. CSF investigation depicted high total cell count (>5cells/mm3), high protein (>45 mg/dl) and positive cryptococcal antibody in all patients while lymphocytic predominance and lower sugar levels (<3 mmol/dl) in 93% along with ADA of <10 U/L in 67%. Amphotericin-B (mean duration 17 days) and fluconazole antifungals were used in all the patients. Twenty seven percent patients died during hospital stay. Pancytopenia, hydrocephalus and hospital acquired pneumonia were observed in 7 percent of patient from each group and 13 percent of cases left against medical advice. Conclusion:Cryptococcal meningoencephalitis is common in People Living with HIV (PLHIV) and caused substantial mortality. Keywords: Cryptococcal Meningoencephilitis, HIV, immunocompromisedPublication The National Institute of Health Stroke Scale Score and Outcome in acute Ischemic Stroke(Institute of Medicine, 2014) Gajurel, BP; Dhungana, K; Parajuli, P; Karn, R; Rajbhandari, R; Kafle, D; Oli, KKAbstract Introduction: Stroke is a focal neurological deficit of sudden onset which lasts for more than 24 hours and has a vascular cause. Various prognostic indices derived from clinical features or patient characteristics and ancillary tests have been used to predict the prognosis of patients with acute ischemic stroke. The aim of this study was to find out the significance of the National Institute of Health Stroke Scale (NIHSS) score on admission in predicting the prognosis of patients with acute ischemic stroke. Method: This is a prospective observational study done in a tertiary care hospital with two hundred patients with acute ischemic stroke Result: Themean NIHSS score in patients with better outcome was 4.6 (± 2.2) and the mean NIHSS score in patients with poor outcome was 14.16(± 7.96). The difference was statistically significant (p=0.000). Conclusion: The baseline neurological status as measured by the National Institute of Health Stroke Scale score predicts the functional status at one month after acute ischemic stroke. Keywords: ischemic stroke, baseline NIHSS score