Browsing by Author "Kharel, G"
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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 Vitamin D and Other Risk Factors among Stroke Patients(Kathmandu University, 2015) Pokharel, BR; Kharel, G; Thapa, LJ; Rana, PVSABSTRACT Background Stroke is common neurological problems in Nepal. The common risk factors for stroke are age, hypertension, diabetes, dyslipidemia and atrial fibrillation. Vitamin D is an emerging risk factors for cardio-cerebrovascular disease. Objective This study is to find out Vitamin D and risk factors in stroke patient in Nepalese population. Method We reviewed the record of 281 stroke patients, admitted to Neurology ward of College of Medical Sciences, Bharatpur, Nepal from 1st January to 31st December 2013. The records were analyzed on the basis of age, sex, hypertension (HTN), body mass index (BMI), smoking habits, hemoglobin(Hb), diabetes mellitus(DM), Lipid profile, Atrial fibrillation(AF) and vascular territory with clinical and radiological evidences. The vitamin D analysis was done all stroke patients. Result Total patient were 281, with male 161 and age range from 18 - 87. Ischemic stroke was noted in 86.8% and hemorrhagic stroke was noted in 13.2% of patients. Middle cerebral artery (MCA) ischemia was noted in 51.5% of patients and anterior cerebral artery (ACA) ischemia was noted in 3% of patients. Multiple infarcts were noted in 12.90% of patients. About half of them were smoker, hypertension 47.40%, Diabetes mellitus 24.20% and 14.1% had atrial fibrillation. 174 (61.92%) of the stroke had less than sufficient Vitamin D. Conclusion The common risk factors for stroke patients like smoking, hypertension, diabetes mellitus and atrial fibrillations are present in Nepalese population. The level of vitamin D was also low in stroke patients. KEY WORDS Cardiovascular risks, ischemia, stroke, vitamin D