Browsing by Author "Kharel, Sanjeev"
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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 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.