Browsing by Author "Khadka, S"
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Publication Aberrant Shape of the Heart, “Gourd Shaped”: A Rare Case of Localized Constrictive Pericarditis(Kathmandu University, 2024) Rajbhandari, S; Joshi, S; Bhattarai, N; KC, P; Rajthala, P; Khadka, S; Neupane, NP; Aryal, M; Rajlawot, KABSTRACT Calcific constrictive pericarditis results commonly from the tubercular lesions in developing countries. The localized calcifications associated with the calcific constrictive pericarditis on its own is rare and the calcification along the atrioventricular groove distorting the heart to a shape of gourd is extremely rare. We present a case to highlight the importance of the early diagnosis of the condition. We have approached the patient with echocardiography and commuted tomography for the diagnosis and hemodynamic evaluation. Early treatment is equally important for this condition, as the calcific constrictive pericarditis is curable with pericardiectomy. However, there lacks a clear consensus for the pericardiectomy in patients with localized calcification and medical therapy can be initiated. KEY WORDS Constrictive pericarditis, Computed tomography, Echocardiography, PericardiectomyPublication Analysis between Vaccinated and Unvaccinated Hospitalized Patients Infected with SARS-CoV-2(Kathmandu University, 2022) Basnet A; Tamang, B; Pokhrel, N; Khadka, S; Shrestha, MR; Ghimire, S; Prajapati, R; Thapa S; Duwal Shrestha, SK; Chand, AB; Amatya, I; Rai, SKABSTRACT Background Severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) variants, which have emerged due to several mutations in spike protein, have a potential to escape immune protection provided by the first-generation vaccines, thereby resulting in breakthrough infections. Objective To identify the socio-demographic factors, clinical features, and outcomes in both vaccinated and unvaccinated hospitalized patients infected with SARS-CoV-2. Method Socio-demographic details, clinical features, and the outcomes among fully vaccinated (double for Covishield/AstraZeneca and BBIBP-CorV and single for Janssen), partially vaccinated, and unvaccinated hospitalized patients with coronavirus disease of 2019 (COVID-19) were collected and analyzed using SPSS version 17. Result Among the hospitalized COVID-19 patients (n=299), 175 (58.5%) patients received a single-dose, 82 (27.4%) double-dose, and 124 (41.5%) did not receive any dose of the COVID-19 vaccines. The risk of SARS-CoV-2 infection when compared between vaccinated and unvaccinated patients was found to be associated among professional degree holders (23.4% versus 9.7%) (p<0.05), professional workers (43.4% vs. 25.0%) (p<0.05), hospitalization to general ward (76.6% vs. 72.6%) (p<0.05), and presence of multiple symptoms (≥3) (86.8% vs. 75.0%) (p>0.05) and comorbidities (≥2) (15.5% vs. 13.7%) (p>0.05). Despite such approximate incidences, the risk of in-hospital mortality among the vaccinated patients was reduced (0.6% vs. 3.2%) (p>0.05), when compared to the unvaccinated patients. The risk of in-hospital mortality was associated with the older age and the presence of multiple comorbidities including bronchial asthma, diabetes, and hypertension. Conclusion Full or partial vaccination against the SARS-CoV-2 variants of concerns might be effective in preventing in-hospital mortality among COVID-19 patients. KEY WORDS COVID-19, Clinical features, SARS-CoV-2, Socio-demographic factors, Vaccine, VariantsPublication Anxiety and Depression during COVID-19 Pandemic among Medical Students in Nepal(Kathmandu University, 2020) Risal, A; Shikhrakar, S; Mishra, S; Kunwar, D; Karki, E; Shrestha, B; Khadka, S; Holen, AABSTRACT Background Medical students’ psychological response to societal lockdown during the COVID-19 pandemic has not been studied much. Objective To assess levels of anxiety and depression among medical students during initial stages of COVID-19 pandemic in Nepal and relate their distress to relevant variables. Method A cross-sectional study with online questionnaire was conducted among medical students at different colleges in Nepal. Hospital Anxiety and Depression Scale (HADS) detected ‘anxiety’ and ‘depression’. The covariates were explored by logistic regression analyses. Result A total 416 medical students [mean age: 22.2 (2.1); males 57.7%, females 42.3%] participated. HADS-anxiety scores [mean: 7.1(4.3)] were significantly and positively correlated with HADS-depression [mean: 5.9 (4.1)] (r=0.695; p < 0.001). Point prevalence of total HADS caseness (HADS-T) was 26.7%. Specific HADS-defined caseness were: anxiety (HADS-A) 11.8%, depression (HADS-D) 5.5%, and comorbid anxiety and depression (HADS-cAD) 9.4%. All four types of caseness were significantly more prevalent among students with a history of mental problems (AOR=4.7, 3.2, 2.6, and 3.2 respectively). HADS-T was higher among those with a concurrent physical illness (AOR=2.4). HADS-T, HADS-A and HADS-D scores were higher among the age group > 22 years (AOR= 2.2, 2.5 and 4.4 respectively). HADS-cAD was almost three- times higher among those with a possible COVID-19 exposure (AOR=2.8). Conclusion A significant number of medical students in Nepal suffered from high levels of anxiety and depression during the COVID-19 shut-down. The students in the higher (> 22 years) age group, those with past mental disorders, possible COVID-19 exposure, and concurrent physical illness showed elevated levels of anxiety and/or depression. KEY WORDS COVID-19, Medical students, Pandemic, Psychological distress, Self-quarantinePublication Behcet’s Disease with Absent HLA Serotyping and Pathergy Test(Kathmandu University, 2021) Ranabhat, S; Byanju, R; Khadka, SABSTRACT Behcet’s disease is a multisystemic vasculitis of unknown etiopathogenesis characterized by recurrent acute inflammation. A 30-year male presented with progressive blurred vision in both eye for one month associated with photophobia, redness and ocular pain. On presentation best corrected visual acuity was 6/9 both eyes. Bilateral ocular examination of anterior segment demonstrated occasional cells. Treatment history of multiple joint pain along with oral aphthous ulcers. Erythematous papulopustular lesion over face, neck, trunk and genital ulcers were being treated. Irrespective of negative human leucocyte antigen B51 and pathergy, patient was diagnosed as Behcet’s disease on the basis of clinical criteria and started with topical steroid and cycloplegic. At one-month, ocular symptoms were relieved. Behcet’s disease is a rare, autoimmune disease, which lacks universal pathognomonic test and investigations, therefore diagnosis is primarily done with international criteria for Behcet’s disease. Multidisciplinary approach certainly helps in early diagnosis and eliminating morbidity. KEY WORDS Behcet’s disease, HLAB51, Pathergy test, Silk road, UveitisPublication Comparative Study between the Use of Pigtail Catheters and Traditional Chest Tube Drain in Cases with Pneumothorax(Kathmandu University, 2022) Vaidya, S; Karmacharya, RM; Shrestha, B; Adhikari, MM; Sharma, R; Khadka, S; Bhandar, N; Hada, GABSTRACT Background Pneumothorax is a condition in which air or other gas is present in the pleural cavity. Mainstay of management of pneumothorax is to remove the air from the pleural space usually done by chest tube insertion. There is still uncertainty whether minimal invasive management with pigtail catheter is sufficient for the management of pneumothorax. Objective To find the effectiveness, safety, tolerability, efficacy of pigtail catheters and large bore chest tubes. Method Prospective comparative study was done in Dhulikhel Hospital between August 2019 till August 2021. Chest tube insertion used to be the only available treatment modality till December 2020 (15 months). Following January 2021 after obtaining ethical clearance for use of pigtail insertion for pneumothorax, this treatment modality was done (8 months). Result Among 76 patients, 52(68.4%) underwent a large bore chest tube and 24 (34.6%) pigtail catheter patients. Mean age of the patients was 48 years (SD 18.01). Duration of hospital stay and length of hospital stay was more in large bore catheters and less in pigtail catheters. Eight hours post tube placement of the expansion of the lungs was present in pigtail and was statistically significant. Pain killer used in pigtail catheters was limited to Non-steroidal anti-inflammatory drugs, for large bore catheter opioids were added and were statistically significant. Conclusion Pigtail catheter is nearly effective as compared to traditional wide bore catheters. KEY WORDS Large bore chest tube, Painkillers, Pigtail, Pleural space, PneumothoraxPublication Depression, Alcohol Use, Antiretroviral Therapy Adherence and HIV Status among HIV-infected from Multiple Antiretroviral Therapy Clinics in Nepal(Kathmandu University, 2019) Kunwar, D; Shrestha, B; Risal, A; Kunwar, R; Khadka, SABSTRACT Background Depression and alcohol use disorder are very common among people living with HIV infection, these disorders are not only common among HIV patients but also associated with antiretroviral therapy (ART) non adherence, morbidity and mortality. Objective The objective of our study is to study the prevalence of Depression, Alcohol use, and ART treatment adherence. Method This is a analytical cross-sectional study. Total of 221 participants were included in the study. Convenient method of sampling was used to collect the data from three district Kathmandu, Lalitpur and Kavre ART (Antiretroviral treatment) clinics. Beck Depression Inventory (BDI) was used for the assessment of depression, Alcohol use disorders identification test (AUDIT) was used for alcohol related problems and Visual analogue scale (VAS) was used for treatment adherence. Chi square test and multiple linear regression analysis were conducted for testing bivariate and multivariate relationship of sociodemographic and clinical factors with depression and treatment adherence. Result The 40% participants found to have depression. Variables associated with depression significantly after multiple regression analysis were employment (p value=0.04) and mode of transmission (p value= 0.003). More than half, 56% of the participant’s CD4+ cells count was <500 per cubic millimetre and 71% participant’s viral load was undetectable. Clinical variables mode of transmission (pvalue=0.000), duration of illness (p value=0.03) and duration of treatment (p value=0.01) were significantly associated with depression. ART treatment adherence was significantly associated with CD4 cell (p value=0.02) and viral load (p value= 0.05). Conclusion Depression is very prominent among HIV positive patients. Low CD4+ cell count and high viral load has been seen among patients who are not adherent to antiretroviral treatment. It is suggested that clinicians should carefully assess the possibility of depressive symptoms in their patients on ART treatment. KEY WORDS Antiretroviral therapy, Adherence, Depression, HIV-infectionPublication Multi-drug Resistant and Extended Spectrum β-lactamase Producing Salmonella Species Isolated from Fresh Chicken Liver Samples(Kathmandu University, 2020) Adhikari, S; Khadka, S; Sapkota, S; Sharma, BR; Ghimire, A; Chalise, M; Gurung, D; Kunwar, SABSTRACT Background Emergence of antibiotic resistance among microbes contaminating the fresh meat products is a global public health concern as they can be easily transmitted to humans through their consumption and contact. Objective The current study was conducted to determine the distribution of antimicrobial resistance among Salmonella species isolated from fresh chicken liver samples with special emphasis on extended spectrum beta-lactamase (ESBL) production. Method A total of 200 fresh chicken liver samples were cultivated for the isolation of Salmonella and further subcultivated to detect extended spectrum beta-lactamase production among them. Antimicrobial susceptibility testing (AST) was done by disk diffusion method using a panel of 7 antimicrobials. Result Out of 200 samples analyzed, 61 (30.5%) samples harbored Salmonella species out of which 15 (7.5%) samples showed the presence of Salmonella Typhi. A significant association was noted in the incidence of Salmonella with various factors pertaining to the butchers, such as age, sex, literacy rate, practices of washing knives and chopping board, wearing aprons and gloves and type of water used (p < 0.05). Salmonella isolates were highly sensitive to amikacin (82.0%) and least sensitive to tetracycline (3.3%). All the isolates were resistant to colistin. Sixty (98.4%) isolates were identified as multi-drug resistant (MDR). The total number of extended spectrum beta- lactamase producers reported among Salmonella isolates was 29 (47.5%). Conclusion The results indicate that the fresh chicken liver samples sold in Bharatpur Metropolis are reservoirs of multi-drug resistant Salmonella, including extended spectrum beta- lactamase producers, that could potentially be transmitted to the humans by direct contact or through inadequate cooking. KEY WORDS Antimicrobial susceptibility testing, Extended spectrum beta-lactamase, Fresh chicken liver samples, Multi-drug resistant, SalmonellaPublication Rickettsial Infection amongst Febrile Illness Patient in a Tertiary Care Hospital: A Retrospective Cross-sectional Study(Kathmandu University, 2022) Gurung, RB; Sapkota, P; Bhatt, S; Tamang, A; Joshi, S; Khadka, S; Jaisy, DN; Chalise, S; Shrestha, PABSTRACT Background Rickettsial infection is an emerging neglected tropical disease in the Southeast Asia. In past few years Nepal is also reporting escalating prevalence of rickettsia. The under evaluation is resulting it as undiagnosed or are simply labeled as pyrexia of unknown origin. Objective To find out the prevalence of rickettsia in a hospital setting, assess the socio- demographic and other relevant clinical features of the rickettsia patients. Method This is a hospital based retrospective cross-sectional study from October 2020 to October 2021. This study reviewed the medical records of the department. Result The study included 105 eligible patients and the prevalence rate was 4.38 per 100 patients. The mean age of the participants was 42 years, and the mean hospital stay was 3 (SD ±2.06) days. More than 55% of the participants had fever for less than or equal to 5 days and 9% had Eschar present. Vomiting, headache, and myalgia were the most common symptoms and hypertension, and diabetes were the common comorbidities. Pneumonia and the acute kidney injury were the two complications of the patients as stated in the study. The severity of the thrombocytopenia deducted from admission time to discharge, and the case fatality was 4%. Conclusion The future studies shall consider on collaborative clinical and entomological research. This would help in better understanding of the etiology of supposedly unknown febrile illness and the under-investigated field of emerging rickettsia in Nepal. KEY WORDS Eschar, Febrile illness, IgM titer, Rickettsia, Thrombocytopenia