Browsing by Author "Koirala, S"
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Publication Analgesia before Performing Subarachnoid Block in the Sitting Position in Patients with Proximal Femoral Fracture: A Comparison between Fascia Iliaca Block and Femoral Nerve Block(Kathmandu University, 2015) Ghimire, A; Bhattarai, B; Koirala, S; Subedi, AABSTRACT Background Positioning for subarachnoid block (SAB) in patients with femoral fracture is painful and may remain suboptimal requiring use of large doses of opioids. These patients generally being elderly with multiple comorbidities and frailty are likely to have many undesirable effects of opioids including respiratory depression and confusion. Objective The objective was to compare the feasibility and effectiveness of fascia iliaca compartment block (FICB) and femoral nerve block (FNB) in reducing pain associated with positioning for subarachnoid block in patients undergoing proximal femoral fracture fixation procedures. Method Group FICB patients (n=15) received fascia iliaca block with 30 ml of 1.5% lignocaine with adrenaline and group FNB patients (n=15) received femoral nerve block with 15 ml of 1.5% lignocaine with adrenaline. After the study blocks, patients were kept on supine position for at least 20 minutes before shifting them to the operation theatre. Pain was assessed by using visual analog scale values before the block and during the position for subarachnoid block. Time to perform subarachnoid block, quality of positioning and acceptance was recorded. Result Visual analog scale values during positioning for SAB were lower in FIB group than in FNB (1.0±1.1 versus 2.1±0.8; P<0.05). Time to perform SAB was shorter in FIB than in FNB (109.6±28.2 seconds versus 134.8±31.9 seconds; P<0.05). Quality of patient positioning for SAB was comparable between the groups. Patient acceptance was less in group FNB (P<0.05). Conclusion Fascia iliaca compartment block provides better analgesia than femoral nerve block in terms of facilitating optimal positioning for subarachnoid block in patients undergoing proximal femoral fracture fixation procedure. KEY WORDS Fascia iliaca compartment block, femoral nerve block, positioning pain, subarachnoid blockPublication Assessing the Level of Knowledge in the Preconceptional Use of Folic Acid Supplement among Primigravida Women(Kathmandu University, 2018) Koirala, S; Pokharel, SABSTRACT Background Folic acid deficiency is one of the most common vitamin deficiencies among women of childbearing in developing countries. Folic acid intake prior to, and during, the first months of pregnancy significantly reduces the risk of fetal neural tube defects. Objective To find out the level of knowledge regarding the benefits and use of preconceptional folic acid supplements among pimigravida women. Method A hospital based cross-sectional study was conducted among 250 primigravida women attending obstetric outpatient department of Kathmandu Medical College Teaching Hospital. A pretested questionnaire was administered using systematic random sampling technique and data was analysed by SPSS version 16.0 using descriptive and inferential statistics. Result Study revealed that 10.8% respondents had good knowledge whereas, 65.6% had poor knowledge about preconceptional folic acid supplementation. 87.2% had taken folic acid at some point of pregnancy and 17.6 % of pregnant women had taken preconceptional folic acid. 21.2% had heard about folic acid supplement and 20% had known about benefits of preconceptional folic acid. 17.6% knew that it should be taken one month before conception and 16% answered that it could prevent neural tube defects. Conclusion Majority of primigravida women lack the knowledge of preconceptional folic acid. Most women planning to get pregnant are also not taking folic acid supplementation. KEY WORDS Folic acid, Neural tube defect, Preconception, Primigravida, SupplementPublication Intimate Partner Violence and Adverse Pregnancy Outcomes(Kathmandu University, 2022) Koirala, SABSTRACT Background Intimate partner violence (IPV) is an abuse or harm that occurs in a close relationship. The World Health Organization (WHO) estimated that, globally, 35% of women living in industrialized and developed countries have experienced exposure to intimate partner violence and during pregnancy it is associated with low birth weight, preterm birth, and even death of the baby. Objective To find out proportion of intimate partner violence and adverse pregnancy outcome among postnatal mothers who recently delivered their baby. Method A cross-sectional study was conducted among 220 postnatal mothers using a structured questionnaire based on 13-item WHO Violence against women instrument in Nepali language. Face-to-face interview technique was used to collect data using consecutive sampling technique at Kathmandu Medical College teaching Hospital. The data were analyzed using SPSS version 20. Result In recent pregnancy, 32.7% of women had experienced intimate partner violence at least once, which has been categorized as physical 28.6%, psychological 30.9%, and 22.7% sexual violence. Among them, 36% had low birth weight babies, 24% had preterm, 2.8% had dead baby, and 35% reported abortion in previous pregnancy. In the binary logistic regression, intimate partner violence was significantly associated with preterm baby (OR-1.143, 95% CI- 0.386-3.384, p=0.002), low-birth weight (OR- 0.237, 95% CI- 0.093-0.602, p ≤ 0.001), and abortion (OR-0.021, 95% CI- 0.003-0.175, p ≤ 0.001). Conclusion One in three women experienced intimate partner violence during their recent pregnancy and is associated with adverse pregnancy outcomes. Programs targeting screening of intimate partner violence against women should therefore be emphasized during reproductive health services such that adverse pregnancy outcomes can be prevented. KEY WORDS Intimate partner violence, Low birth weight, Pregnancy outcomes, Preterm birthPublication Menstrual Hygiene Management among Nepalese Adolescent Schoolgirls: Results from a cross-sectional study(Kathmandu University, 2024) Shrestha, A; Shrestha, S; Koirala, S; Subedi, P; Tiwari, D; Karmacharya, BMABSTRACT Background Adolescent schoolgirls in Nepal lack adequate support to manage menstruation. Little studies have been conducted to date to learn how menstruation affects daily lives of adolescents and how they were managing it. Menstruation also comes costly in rural Nepal and the majority of them do not have capacity to afford menstrual products due to high price. Objective The main objective of this study is to assess about menstrual challenges among adolescent girls of rural Nepal. Method We deployed descriptive, cross-sectional study to analyze adolescent girls’ experience of menstruation from purposively selected schools in Kavre and Sindhupalanchowk districts of rural Nepal. The data was collected from May to July 2024 among adolescent girls using semi-structured questionnaire of grade 8 and 9. The adolescents were questioned regarding their own experiences with menstruation. The interview included household related information, water, sanitation and hygiene practices, self-menstruation practices and management, challenges they had been facing, and sociocultural taboos about menstruation. Result All schools included in this study were government schools. 38% of an adolescents reported of starting their menstruation at an age of 12 years. 39% of the respondents reported of having an ability to challenge the existing social taboos relating to menstruation. Above 60% uses sanitary pads as a menstrual product and for the disposal of these products, 50% respondents reported of throwing them in the dustbin followed by burying (21%) and burning (16%). And 10% of the respondents reported of throwing the used menstrual products into Indrawati river. Majority of respondents reported of not being able to visit temples and performing any religious visits during menstruation and the main reasons behind was family prohibition and fear of divine retribution. Conclusion Access to management materials of menstruation is problematic in the surveyed schools especially in the rural areas where almost half of the girls do not have access to sanitary pads and they resort to the use of cloth. Lack of affordability for purchasing sanitary napkins were the most crucial predictors of menstrual hygiene management. The Government of Nepal should take an initiative to provide schoolgirls with sanitary pads in order to improve menstrual hygiene management in all across schools within Nepal, particularly in rural areas. KEY WORDS Menstruation, Menstrual hygiene management, Sanitary napkinsPublication Outcome of Surgical Resection of Craniopharyngioma: Single Center 12 Years’ Experience(Kathmandu University, 2018) Bishokarma, S; Shrestha, S; Ranabhat, K; Koirala, S; Shrestha, D; Panth, R; Gongal, DNABSTRACT Background Craniopharyngiomas (CPs) are rare epithelial tumors arising from the Rathke’s pouch remnant located along the path of the craniopharyngeal duct accounting for 1.2-4% of all primary intracranial brain tumors, the primary treatment of which is surgery. Objective Whether radical surgical resection or partial resection followed by radiotherapy is a topic of debate. We presented our 12 years single center experience on surgical resection of craniopharyngioma. Method This was a descriptive cross-sectional study conducted among forty-five patients who underwent transcranial resection of craniopharyngioma during a period of 12 years. Data were collected from medical record archives. Glassgow outcome score (GOS), electrolyte imbalance and visual complications were assessed as outcome measure. GOS > 3 was considered favorable while score ≤ 3 was considered unfavorable. Recurrence of tumors were analyzed. Result Out of 45 patients, 28 patients were male with male to female ration of 1.64. Mean age was 32.22±16.42 years. Supra-sellar craniopharyngioma were the most common location. Gross total resection was accomplished in 32 patients (71.1%) while subtotal resection among 13 patients (28.9%). Post-operative Diabetes Insipidus was developed among 35 patients (77.7%). Adamantinomatous craniopharyngioma was the most common histopathological type. Postoperative MRI with contrast was repeated to ascertain the completeness of resection. All patient with subtotal resection received radiotherapy. Follow up period ranged from 3 months to 8 years with mean of 4.2 years. Favorable outcome (GOS>3) was seen among 41 patients while unfavorable among 4 patients. Recurrence seen among 4 patients (8.9%). Overall mortality was 4 (8.8%). Conclusion Gross total excision of craniopharyngioma has a favorable outcome with acceptable morbidity. KEY WORDS Adamantinomatous, Craniopharyngioma, Pterional craniotomy, Radiation therapyPublication Paediatric Stroke: A Rare Presentation of Iron Deficiency Anemia in a Four Year Old Child(Kathmandu University, 2016) Subedi, K; Koirala, S; Basnet, R; Poudel, AABSTRACT Paediatric stroke is an uncommon syndrome with even lesser annual incidence rates of arterial ischemic stroke in infants and children. In children the diagnosis of stroke is frequently delayed or missed. This is due to subtle and nonspecific clinical presentations, a complicated differential diagnosis and a lack of awareness by physicians and also delay in the seeking of medical attention as in our case. We report you a rare case of a four year old child from remote Nepal who presented to our Out Patient Department after a long gap of around four months after the sudden onset of loss of consciousness and decreased movement of right limbs who after detailed history examination and lab investigations and imaging revealed ischemic stroke due to iron deficiency anemia. KEY WORDS Anemia, iron deficiency, pediatric strokePublication Pompe Disease: Cyanosed Hypotonic Infant with Normal Respiratory Rate(Kathmandu University, 2015) Koirala, S; Poudel, A; Basnet, R; Subedi, KABSTRACT Infantile hypotonia or floppy infant is a diagnostic challenge when it presents with other presenting complaints such as fever, cough or diarrhea. Many times the hypotonia goes unnoticed when other symptom covers the hypotonia and child continues to receive the treatment for other symptoms. We report a rare case from Nepal of infantile Pompe disease who presented with the history of fever and cough in the recent earthquake disaster camp at remote part of Sindhupalchowk, Nepal. He was being treated as a case of pneumonia. Pompe disease can be diagnosed clinically by taking detailed history and correlating the clinical findings during the presentation with other symptoms. In our case the normal respiratory rate, reduced Spo2 and presence of crackles dominated the hypotonia and was mistreated as pneumonia. High index of suspicion is necessary in diagnosing Pompe disease. KEY WORDS Developmental delay, hypertrophic cardiomyopathy, hypotonia, normal respiratory rate, pompe diseasePublication Postoperative Complications of Transsphenoidal Pituitary Adenectomy: A Single Institution Based Experience(Kathmandu University, 2019) Koirala, S; Shrestha, BK; Lohani, S; Bishokarma, S; Devkota, UPABSTRACT Background Inside a cranium, pituitary gland seats in an area of complex anatomical construct. Further it holds a very important physiological role to maintain all bodily function. Pituitary adenoma being one of the commonest tumors of that intricate area is preferably tackled with transsphenoidal approach. However, as in any surgery, it is also not without postoperative complications. Objective To examine and categorize all the postoperative complications that we have encountered in our center after pituitary surgery. Method A retrospective study of patients who had undergone transsphenoidal pituitary adenectomy in past five years was conducted at a tertiary level neurosurgical center and various postoperative complications during hospital stay were noted and analyzed. Result In our series of 53 patients, we met different postoperative complications, out of which diabetes insipidus (DI) was the commonest. Other electrolyte abnormalities excluding diabetes insipidus was the second most common followed by Cerebrospinal fluid leak. Post-operative hematoma requiring re-exploration, panhypopituitarism, seizure and meningitis were among the rare complications. No statistically significant association was noted between tumor size, patient age and sex with surgical complications. Conclusion Postoperative complications should be anticipated in transsphenoidal pituitary surgery even though it is considered to be a relatively safe undertaking. Knowing about these complications is the first step in preventing them. KEY WORDS Complications, Pituitary tumors, Postoperative, Transsphenoidal surgeryPublication Profile and risk factors analysis on surgical outcome of rhegmatogenous retinal detachment(Nepal Health Research Council, 2002) Koirala, S; Shrestha, J K; Abdullah, ZPublication Propofol Sedation During Spinal Anaesthesia - A Dose Finding Study(Kathmandu University, 2011) Ghimire, A; Bhattarai, B; Rahman, TR; Singh, SN; Koirala, S; Tripathi, MABSTRACT Background It is important to be able to measure and maintain a specific sedation level to compare outcomes of different levels of sedation during anesthesia and the aims include general patient comfort, freedom from specific discomfort, and some amnesia for both the block procedure and the surgical operation, in order to meet the patient’s preference and safety. In this prospective randomized clinical study, we compared the three different infusion doses of propofol. Objective To find out the appropriate infusion dose of propofol for optimal sedation without causing undue side effects in patients undergoing spinal anaesthesia. Method One hundred twenty patients ASA PS I-II were randomly allocated to three groups 1, 2 and 3 receiving propofol infusion at the rate of 25, 50 and 75 microgram/kg/ min with concentration of (0.5%), (1%) and (1.5%) respectively. They were observed for sedation score, hemodynamic parameters and satisfaction level. The adverse effects like respiratory depression, nausea and vomiting score were assessed. Result Median sedation score increased in a dose dependent manner, with significantly higher scores in group 2 and 3 compared with group 1. Hemodynamic parameters were better in group 1 and 2 as judged by mephentermine requirement. The awakening time after stoppage of infusion was significantly delayed in group 3 (p < 0.001). Respiratory depression, nausea and vomiting were comparable clinically. Almost three fourth of the patients were satisfied with the techniques used. Conclusion Propofol infusion at the rate of 50mcg/kg/min for sedation in spinal anaesthesia provides optimal sedation, early awakening and excellent satisfaction level in the postoperative period KEYWORDS propofol, sedation, spinal anaesthesia.Publication Radiological Assessment of Femoroacetabular Impingement Morphology Using Computed Tomography in Asymptomatic Young Population(Kathmandu University, 2025) Koirala, S; Gupta, MK; Baral, P; Adhikari, KABSTRACT Background Femoroacetabular impingement is regarded as precursor of osteoarthritis. Various studies have discussed the prevalence of femoroacetabular morphology but only few studies have been done on asymptomatic population using cross-sectional imaging. Objective To determine the prevalence of femoroacetabular impingement morphology in young asymptomatic population on computed tomography. Method This cross-sectional study was done in 200 individuals who underwent computed tomography for abdominal pathologies without any symptoms of hip pain, hip pathology or osteoarthritis. Multiplanar images were reformatted and assessed for the presence of parameters associated with femoroacetabular impingement; alpha angle greater than 55°, femoral head-neck offset less than 8 mm, angle of acetabular version less than 15°, lateral center edge angle greater than 40°. Result At least one of the femoroacetabular impingement morphology was detected in 162 hips. The prevalence of abnormal hip joint was higher in male patients than in female patients (47.3% vs 31.8%). Prevalence of cam morphology was 14.5%, pincher was 17.5% and mixed morphology was 8.5%. Prevalence of cam and mixed morphology were common in male hips however there was no statistically significant difference in prevalence of pincher morphology between male and female hips. Conclusion Femoroacetabular morphology was noted with high frequency in asymptomatic young population on computed tomography. Diagnosis of femoroacetabular impingement syndrome should be based on combination of clinical and radiological findings. KEY WORDS Alpha-angle, Cam, Femoroacetabular impingement, PincherPublication Risk Factors of Malnutrition among under Five Children Admitted in Kanti Children’s Hospital in Nepal(Kathmandu University, 2021) Karki, S; Koirala, S; Shrestha, SABSTRACT Background World Health Organization (WHO) stated that malnutrition is a major global health and social problem from which many people are suffering, particularly children. Poor feeding and care practices, insufficient nutrient intake, high rate of infection and teenage pregnancy are the immediate causes of chronic malnutrition. Objective To identify the risk factors for malnutrition among under five children. Method A case control study was carried out among the mothers having under-5 years’ children who were admitted in the Kanti Children’s Hospital of Nepal from 1st August 2019 to 7th September 2020. Non-probability purposive sampling technique was used to select 50 children with malnutrition and 100 children without malnutrition matched on age, sex and setting. A structured interview was used to collect data from mothers of both cases and controls. Descriptive and inferential statistics were used to analyze the data. Result Present study reveals that 58% girl got marriage before 20 years. After confounders adjusted, mother’s age ≥ 20 years at marriage (OR: 2.74, 95% CI: 0.98-7.63. p=0.05), and mother’s age ≥ 20 years at child birth (OR: 7.74, 95% CI: 2.37-25.27. p=0.001), were significantly associated with having malnutrition among under five children. Similarly, accessibility of health facility (OR: 3.31, 95% CI: 1-10.94. p=0.05), fathers who completed master in education (OR: 0.08, 95% CI: 0.01-0.88. p=0.04), children who lived in joint family (OR: 0.25, 95% CI: 0.07-0.86. p=0.03), child < 2.5 kg at birth (OR: 0.18, 95% CI: 0.05-0.62. p=0.01), and second and third or above in order (OR: 0.09, 95% CI: 0.01-1.04. p=0.05) had significantly less chance of having malnutrition. Children’s whose birth interval was 2-3 years were significantly (OR: 9.74, 95% CI: 1.16-82.23. p=0.04) associated with the occurrence of malnutrition. Children who had suffered from multiple co-morbidities in last one year were (OR: 4.55, 95% CI: 0.48-43.03. p=0.18) more chance of having malnutrition. Likewise, the mothers who feed colostrum to their child had (OR: 2.28, 95% CI: 0.52- 9.26. p=0.29) almost two-fold less chance of having malnutrition. Mothers who had done exclusive breast feeding ≥ 4 months had (OR: 40.55, 95% CI: 3.35-1.490.92. p=0.008) significantly associated with having malnutrition. Conclusion Low education status of father, living in single family, exclusive breast feeding ≥ 4 months, lack of balance diet were significant risk factors of malnutrition. Based on finding, reliable longitudinal studies, interventions and program to educate parent for prevention of malnutrition are necessary in future. KEY WORDS Malnutrition, Mothers, Risk factors, Under five childrenPublication Study of Depression, Anxiety and Stress among the Medical Students in two Medical Colleges of Nepal(Kathmandu University, 2016) Kunwar, D; Risal, A; Koirala, SABSTRACT Background Medical education is intended to prepare graduates for a promoting health and caring for the sick. Medical students are confronted with significant academic, psychological and existential stressors. There is insufficient information regarding psychological morbidity among Nepalese medical students. Objective To determine the prevalence of depression, anxiety and stress, among the medical students in Nepal, and its association with sociodemographic characteristics. Method A cross-sectional questionnaire based study was conducted including all students from first to fifth year of student using convenience method of sampling from Kathmandu University Medical School (KUSMS), Dhulikhel and Manipal College of Medical Sciences (MCOMS), Pokhara, Nepal. Depression, Anxiety and stress were assessed using Depression Anxiety and Stress Scale (DASS). Additional questions regarding demographic variables were also included in the survey. Data analysis was done on Statistical Package for the Social Sciences SPSS version 16. Result A total of 538 students participated in the study giving a response rate of 89.6%. Aamong them 56.5% were from age group 21-25 years, 42.2% were below 20 years and only 1.3% were above 25 years of age. Among them 52% were female and 48% were male. Our study found that the overall prevalence of depression was 29.9%, anxiety was 41.1% and stress was 27% among all participated medical students. Depression was significantly associated (OR 2.23, 95% CI 1.43-3.47, p<0.001) with living condition (living in hostel or rented house). Conclusion The higher level of psychiatric morbidity depression 29.9%, anxiety 41.1% and stress 27% among undergraduate medical students warrants needs for strategic plans to alleviate depression anxiety and the stressors right from the time they join medical school and has to be continued till they finish the course. KEY WORDS Anxiety, depressive disorder, medical students, Nepal