Browsing by Author "Kharel, Sanjeev"
Now showing 1 - 5 of 5
Results Per Page
Sort Options
Publication Aspirin Desensitization and Percutaneous Coronary Intervention in a Patient with Aspirin Hypersensitivity and Acute Coronary Syndrome: A Case Report(Nepal Medical Association, 2024) Acharya, Suman; Gyawali, Siddinath; Kharel, Sanjeev; Upreti, Dinesh; Bhusal, Khem Raj; Maharjan, Silvia; Shrestha, Hemanta; Gajurel, Ratna ManiAbstract Hypersensitivity to aspirin is rare disorder occurring in 1.88% of the patients. Aspirin-hypersensitive patients requiring single antiplatelet agent may be treated with clopidogrel, an alternative antiplatelet agent. However, aspirin desensitization is more cost-effective than the usage of clopidogrel in these patients. Furthermore, aspirin desensitization is of greater value in patients requiring dual antiplatelet therapy, for example following procedures like percutaneous transluminal coronary angioplasty (PTCA) instead of using non-aspirin-based combinations. Herein, we report a 74-year-old hypertensive male presented with features of acute coronary syndrome and planned for percutaneous transluminal coronary angioplasty of RCA followed by dual antiplatelet therapy. Since he had aspirin allergy, desensitization was done using rapid desensitization protocol for which he responded well. This case highlights the importance of aspirin-desensitization in patients with aspirin allergy instead of choosing non-aspirin based antiplatelet agents.Publication Comparative Outcomes of Doxorubicin and Cyclophosphamide with Sequential versus Concurrent Paclitaxel in the Adjuvant Treatment of Non-Metastatic Breast Cancer: A Cross-Sectional Analytical Study(Nepal Medical Association, 2025) Paudel, Bishal; Paudel, Bishnudutta; Shrestha, Rakshya; Panthi, Bishal; Shilpakar, Ramila; Dulal, Soniya; Kharel, Sanjeev; Dhunagana, Reechashree; Singh, Yogendra Prasad; Shrestha, BipsanaAbstract Introduction: Studies have compared the efficacy and toxicities of doxorubicin and cyclophosphamide every three weeks for four cycles followed by four cycles of paclitaxel every three weeks (AC/T); with paclitaxel, doxorubicin, and cyclophosphamide (TAC) every three weeks for six cycles for adjuvant treatment of breast cancer in western countries. Genetic and environmental disparities in Nepalese population warrant the need for similar studies in Nepal. This study compares the toxicity patterns and compliance of AC/T versus TAC in the adjuvant treatment of non-metastatic breast cancer in Nepalese women. Methods: A hospital-based cross-sectional analytic study was conducted at Bir Hospital, Kathmand after obtaining the ethical approval (Reference number: 931/076/077). Sixty women who completed either AC/T or TAC regimens were evaluated. Confounding was minimized by strict inclusion/ exclusion criteria (restriction), group matching, and random sampling. Primary outcome was grade 3–4 hematological toxicity; secondary outcomes included other adverse effects and compliance. Results: Although hematological toxicities were higher in the TAC group, differences were not statistically significant. Non-hematological toxicities (fatigue, nausea, vomiting, pain, nail changes) were significantly higher in the TAC group. Edema was more prevalent in the AC/T group (p=0.04). Compliance without modification favored AC/T (64.5% vs. 34.5%; p=0.038). Conclusions: Sequential AC/T demonstrated superior tolerability and compliance. Confounder control through study design and statistical methods strengthens the validity of these findings, though larger studies are warranted.Publication Comparison of Safety Of Oral Ivermectin with Topical Permethrin in the Treatment of Scabies: A Comparative Study(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2024) Tripathee, Rishab Dev; Sitaula, Seema; Kharel, SanjeevAbstract: Introduction: The mite Sarcoptes scabiei var. hominis is the cause of scabies, a skin illness. The Food and Drug Administration (FDA) approves permethrin cream (5%) for the treatment of scabies and is also recommended by the Centers for Disease Control and Prevention (CDC) as first-line topical therapy for scabies. Oral ivermectin, a novel antiparasitic agent that has been extensively used for several parasitic infections and can be used as an alternative approach for the treatment of scabies. This comparative study aimed to describe the adverse effects of ivermectin and permethrin and their comparison. Objective: To compare the safety outcomes of ivermectin and permethrin for the use of scabies. Methods: This is the prospective open-labeled randomized and comparative study carried out in the outpatient department of dermatology and venereology at Tribhuvan University Teaching Hospital, Kathmandu. In Group A, patients received oral Ivermectin tablets at a dose of 200 μg/kg on day 1 before breakfast, and in Group B, patients received topical Permethrin 5% cream to be applied all over the body below the neck at night twice a week apart. Results: This study included 93 patients who met the inclusion criteria, with 45 patients belonging to the Ivermectin group and 48 patients belonging to the Permethrin group. In the ivermectin group, the most common side effect reported was nausea, followed by abdominal discomfort and headache. In the Permethrin group, the most common side effect was a burning sensation on the skin after application of the drug, followed by irritation and erythema, which were present in 3.2% and 2.2% of patients, respectively. The difference in overall side effects between the two groups was statistically not significant. (p=0.682) Conclusion: Our study concludes that a single dose of oral Ivermectin given at a dose of 200 micrograms/kg is comparable to Permethrin cream 5% used twice a week in terms of safety standards. Neither drug caused any life-threatening adverse reactions in the patients.Publication Growing Need for Web-Based Simulation in Low and Middle-Income Countries: A Narrative Review(Nepal Medical Association, 2024) Ghimire, Rakesh; Kharel, Sanjeev; Giri, Subarna; Hamilton, Allan JAbstract Simulation education is the bridge between learning clinical medicine in the classroom and delivering it at the bedside. As healthcare simulation has matured over the last two decades, it has begun to evolve many of the same methodologies. Rapid technological advancements across the fields of computer science, bioengineering, and curriculum design have helped to provide healthcare that is delivered more efficiently, effectively, and ethically. Web-based simulation programs (Web-SP) are poised to provide an efficient way to deliver asynchronous training in healthcare professionals’ education. Web-SPs could also sponsor specialty-specific, web-based fellowships for clinicians of LMICs. The COVID-19 pandemic provided unique insight into the robustness of web-based learning tools that permitted remote learning opportunities. Under similar circumstances, should they arise again, Web-SPs would be a valuable tool for sustaining medical training under conditions where only remote learning may be feasible. Studies indicate that cost-effective simulation training can be delivered to learners in remote, low-resource areas worldwide, including South Asia, where access to such education is limited. We aimed to explore the effectiveness, challenges, and strategies for implementing web-based simulation education in low- and middle-income countries, based on a thorough PubMed search focused on web-based simulation programs in medical education.Publication Histopathological Profile of Lung Cancer: A Single-Center Study from Nepal(Institute of Medicine, Tribhuvan University, 2025) Paudel, Bishal; Dhungana, Reechashree; Shrestha, Rakshya; Panthi, Bishal; Kharel, SanjeevAbstract: Introduction Lung cancer remains the leading cause of cancer-related mortality globally, accounting for approximately 18% of all cancer death. Despite the global prevalence of lung cancer, epidemiological data from Nepal remain limited. The study aims to bridge these gaps by investigating the histopathological characteristics of lung cancer in a cohort of patients from a tertiary care center in Nepal. Methods This is an observational cross-sectional study conducted at Tribhuvan University Teaching Hospital (TUTH) among lung cancer patients aged greater than 18 years of age from September 2024 to February, 2025. Descriptive statistics was used to summarize demographic and histopathological characteristics. Results A total of 107 lung cancer patients were included in our study. The male:female ratio was 1.3 in our study, while the mean age of the patients was 67 years and standard deviation is 11 years. Squamous cell carcinoma (48%) and Adenocarcinoma (46%) were the major histological subtypes while only 6% cases were Small-cell carcinomas. Conclusion This study analyzes the histopathological and the demographic profile of lung cancer diagnosed at a single tertiary center of Nepal. Non-small cell lung cancer is the most common histological diagnosis in this study. Broader study is needed to explore the clinical and molecular associations.