Browsing by Author "Khanal, Inesh"
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Publication Admission Rate of Patients Visiting Emergency Department in a Tertiary Care Center in Kathmandu: A Descriptive Cross-sectional Study(Nepal Medical Association, 2024) Tiwari, Sanjeeb; Tiwari, Jyotshna Sharma; Jha, Jay Bhushan; Regmi, Sushant; Yadav, Dhirendra; Kafle, Ravi; Khanal, Inesh; Shrestha, Aakripa Rani; Shrestha, Shubham; Shakya, Yagya Laxmi; Maharjan, Ramesh Kumar; Gupta, Sanjaya KumarAbstract Introduction: Emergency departments serve as the initial point of contact for patients with a wide range of conditions. Not all patients visiting get admitted to the hospital. The admission rate varies from 20% in the United States to 40.83% in Nepal. Given the variability in these results across different regions, there is a need to better understand the admission rates from the Emergency Department. Methods: A descriptive cross-sectional study was conducted after obtaining ethical approval( Reference Number: 58 (6-11)E2 081/082) in the Emergency Department of a tertiary health care center. Retrospective data was collected from the data register. The data from April 2023 to April 2024 was collected. A sample size of 222 was calculated and convenience sampling was done. Demographic details like age, sex, and data regarding admission status were collected. Data was collected in MS Excel and was analyzed using JASP software. Results: Out of 222 patients that presented to the emergency department, 53 (23.87%)(18.26-29.47,95 % Confidence Interval) were admitted to the ward or intensive care unit of the hospital, whereas 167 (75.23) got discharged, 1 (0.45%) was brought dead and 1 (0.45%) expired. The median age of patients was 43 (IQR: 26-62). The admission rate of females was 20 (17.24%), whereas for males it was 33 (31.13%). Conclusions: The prevalence of admission of patients visiting the emergency department was higher than similar US based studies. There was a higher percentage of female patients presenting to theemergency department, while those being admitted were mostly males.Publication Dengue and Scrub Typhus Co-infection at a Tertiary Care Centre in Nepal: A Case Series in Pediatric Patients(Nepal Medical Association, 2025) KC, Sriram; Pradhan, Bulbul; Khanal, Inesh; Shrestha, Aakripa RaniAbstract This case series highlights four pediatric patients with coinfection of dengue fever and scrub typhus, presenting at Patan Hospital. Dengue fever is caused by flavivirus transmitted by Aedes mosquitoes, and scrub typhus is caused by Orientia tsutsugamushi transmitted by Leptotrombidium mites, which share overlapping symptoms such as fever, headache, and abdominal pain, complicating the diagnosis. The cases were from different geographical regions of Nepal with varied presentation: from febrile illness to severe manifestations like meningoencephalitis and raised intracranial pressure. Two patients presented with hepatosplenomegaly, one with severe rash, and another with pneumonia-like symptoms. Laboratory findings confirmed coinfection, and management included IV antibiotics, antipyretics, and supportive management. Complications such as thrombocytopenia, transaminitis, and allergic reactions required interventions. This case series highlights the importance of early suspicion and treatment of coinfection to reduce prolonged hospitalization and prevent end-organ dysfunction, and mortality, especially in endemic regions.Publication Navigating Medical School with AI: A Student’s Perspective(Nepal Medical Association, 2025) Bhatta, Rohit Raj; Khanal, IneshAbstract Medical school is a strange place where everything feels both déjà vu and jamais vu. You've seen this disease before, but somehow, you still have no idea what’s going on. Traditionally, we've relied on textbooks, scholarly articles, guidance from senior colleagues, and patient interactions to bridge these gaps but with recent advancements in computational models and algorithms, Artificial Intelligence has been a blessing.Publication Neonatal Sequential Organ Failure Assessment Score to Predict Mortality in Neonatal Intensive Care Unit at Tertiary Care Center(Nepal APF Hospital, 2025) K.C., Ganesh; Shah, Ganesh; Chalise, Shiva Prasad; Shrestha, Bijesh; Shrestha, Sailesh; Gautam, Tilak; Khanal, IneshAbstract: Background: The Neonatal Sequential Organ Failure Assessment (nSOFA) score is a tool used to evaluate degree of organ dysfunction in critically ill neonates admitted to neonatal intensive care units (NICUs). The nSOFA score is based on respiratory, cardiac and hematological parameters (total score ranges from 0 to 15). This study aims to evaluate the applicability of nSOFA score to predict neonatal mortality in NICU of Patan Hospital. Methods: This prospective observational study was conducted at the NICU of Patan Hospital, Lalitpur, Nepal from May 2023 to November 2024. The parameters of nSOFA score were recorded at admission and between 48-72 hours of admission. Data were analyzed using EPI-INFO and Easy R software. Results: Among 134 neonates, 105 (78%) survived, and 29 (22%) did not. At admission, a nSOFA score ≥4 had a sensitivity of 69%, specificity of 91.4%, positive predictive value (PPV) of 69% and negative predictive value (NPV) of 91.4% for predicting mortality. At 48-72 hours, a cutoff score of ≥5 showed a sensitivity of 75.7%, specificity of 99%, PPV of 96.6% and NPV of 91.4%. Conclusion: The nSOFA score is a important tool for predicting neonatal mortality in NICUs and can be used to guide clinical decision-making.