Browsing by Author "Koju, R"
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Publication An outbreak of El Tor cholera in Kavre district, Nepal(Kathmandu University, 2005) Tamang, MD; Sharma, N; Makaju, RK; Sarma, AN; Koju, R; Nepali, N; Mishra, SKOutbreak of Cholera still remains major public health problem in most of the developing countries including Nepal. A prospective study was carried out at Dhulikhel Hospital, Kathmandu University Teaching Hospital, Kavrepalanchok during 1st May 2004 to 31st October 2004. A total of 148 stool samples from patients with acute diarrhea were collected and further investigated for Cholera. The study was conducted to establish the causes of the outbreak of acute diarrheal disease, antimicrobial profiles of the stool isolates and parasitic co –infection in Cholera cases. The samples were subjected to standard recommended microbial procedures and confirmation of the isolates was done by seroagglutination using V.cholerae polyvalent O1 and 0139 antisera and monovalent Ogawa and Inaba antisera. Out of the 148 stool samples, 46 cases (31%) were found to be positive for V.cholerae serogroup O1, biotype ElTor, serotype Ogawa. Both sexes were equally affected. Young age group of less than 30 years were mostly affected. Brahmin was the most affected ethnic group. The isolates were sensitive to all the antibiotics tested except co-trimoxazole. Among the laboratory confirmed cholera cases 30% exhibited co-infection with other parasites among which Giardia lamblia and Ascaris lumbricoides were the most common. Key words: Cholera, El Tor, Ogawa, Vibrio, Co-infection, NepalPublication Association of Cardiovascular Risk Factors and Coronary Artery Lesion Among Coronary Artery Disease Patients(Kathmandu University, 2014) Koju, R; Humagain, S; Khanal, KABSTRACT Background Coronary artery disease (CAD) is associated with the numbers of risk factors causing coronary atherosclerosis. Coronary artery stenosis is mostly caused by coronary atherosclerosis. Objective This study aims to analyze the association between coronary artery stenosis and cardiovascular risk factors. Methods An observational study was conducted among CAD patients. The diagnostic coronary angiogram was performed from femoral approach using standard catheters and techniques to find out any abnormalities. Result A total 73 patients (44 male and 29 female) with coronary artery disease undergoing diagnostic coronary angiography was included with the documented cardiovascular risk factors. The coronary stenosis was found in 40 patients on the basis of stenosis grading. Among the established cardiovascular risk factors, sex, diabetes mellitus and smokers show are significantly associated with coronary stenosis among CAD patients. The present study shows the significant association of coronary stenosis among male CAD patients (OR 2.47; CI 0.94 – 6.48, p <0.05) and similar association has been observed in diabetes mellitus (OR 3.32; CI 1.12 – 9.84, p <0.05) and smoking (OR 4.10; CI 1.45 – 11.61, p <0.01). Conclusion The prevalence of CAD is increased with numbers of presence of cardiovascular risk factors. Male gender, diabetes mellitus and smoking are significantly associated with coronary stenosis among CAD patients. However, hypertension and dyslipidemia are comparable between coronary stenosis and no significant stenosis group. KEY WORDS Acute coronary syndrome, coronary angiography, coronary artery disease, stable anginaPublication Community Based Medical Education – Necessity Realization and Practice(Kathmandu University, 2013) Koju, RNAPublication Difficult Journey from Delivery to Discharge, Case of Congenital Diaphragmatic Hernia(Kathmandu University, 2014) Karmacharya, RM; Dangol, S; Shrestha, M; Koju, RABSTRACT We report a case of congenital diaphragmatic hernia which was diagnosed prenatally for which surgical correction was done on second day of life. The child was discharged in 17 days and has resulted in good post repair condition of patient. KEY WORDS Bochdalek, congenital diaphragmatic hernia, hemithoraxPublication Endoscopic Retrograde Cholangiopancreatography at Dhulikhel hospital: Outcome Analysis(Kathmandu University, 2014) Gurung, RB; Purbey, B; Koju, R; Bedi, TRSABSTRACT Background Endoscopic Retrograde Cholangiopancreatography (ERCP) is an important but potentially invasive therapeutic procedure in treating various pancreatobiliary conditions. In Nepal, the ERCP services is limited to a few tertiary care centers mostly in the capital, Kathmandu. Dhulikhel hospital has started ERCP since 2011 providing services to patients from all over the country. The study analyzes the outcome from data since August 2011 to 2013 August. Objective To analyze the results of ERCP done in Dhulikhel hospital, Kathmandu University hospital. Method This is a retrospective study. The ERCP records of all the patients done since August 2011 to August 2013 were retrieved. A total of 516 attempts of ERCP were done since August 2011 to August 2013. Out of these, 423 were included for the analysis. The repeat ERCP for the same patient due to failed cannulation or patients undergone ERCP but incomplete documentation were excluded. The demographic data, indications, the findings, the outcome in terms of success or failure to cannulation, success or failure of stone extraction, stenting and complications were all derived and analyzed. SPSS 16 version was employed for data management and analysis. Result The female: male ratio was found to be 1.7 : 1. The mean age of patients were 50.57±17.8 Years. The most common indication for ERCP were: choledocholithiasis 208(49.17%); followed by: obstructive jaundice 69(16.3% ) of undetermined cause, acute biliary pancreatitis 26(6.4%), suspected bile duct injury during cholecystectomy 18(4.2%), periampullary growth 21( 4.96%), Cholangiocarcinoma 12(2.8%), chronic pancreatitis 10( 2.3%), CBD stent exchange 23(5.43%), dilated cbd 21(4.96%) , acute cholangitis 14(3.3%).The most common finding was CBD stone in 308(72.81%), normal in 51(12.1% ), bile duct stricture in 45(10.63%). Bile duct injury during cholecystectomy was found in 13(3.1%), biliary obstruction due to ampullary growth and pancreatic head mass was found in 21(4.96%) and 6(1.41%) respectively. Choledochal cyst was found in 5(1.2%), chronic pancreatitis in 7(1.7%). Biliary fascioliasis was found in one (0.24%); and roundworm in 1(0.24).The most common complication was acute pancreatitis in 17(4%), post-ERCP cholangitis 6(1.4%), bleeding 6(1.4%), duodenal perforation in 1(0.2%), arrhythmia in 1(0.2%) and one death (0.2%). Conclusion ERCP has been a potentially emerging therapeutic tool for various pancreato-biliary disorders in Nepal. KEY WORDS Cholidocholelithiasis, endoscopic retrograde cholangio Pancreatography, stentingPublication Evaluation of non-HDL-c and total cholesterol: HDL-c Ratio as Cumulative Marker of Cardiovascular Risk in Diabetes Mellitus(Kathmandu University, 2010) Aryal, M; Poudel, A; Satyal, B; Gyawali, P; Pokheral, BR; Raut, BK; Adhikari, RK; Koju, RABSTRACT Background Cardiovascular disease (CVD), is the primary cause of morbidity and mortality in patients with diabetes and have approximately - two to four times higher CVD rate than adult without diabetes. Low density lipoprotein cholesterol (LDL-C) is primarily used as the marker of cardiovascular risk in diabetes despite its several limitations. Although several newer markers of CVD are emerging, no marker has been established in Nepal. Objectives The study was designed to evaluate the non-high-density-lipoprotein- cholesterol(Non- HDL-C) and Total Cholesterol to High density lipoprotein cholesterol (TC:HDL-C ratio) as CVD risk marker in diabetes mellitus. Methods The study was conducted in the Department of Bbiochemistry, Kathmandu University School of Medical Sciences. The study comprised of 76 diabetic subjects and 60 non- diabetic subjects. The anthropometric and biochemical parameters were measured. The Non-HDL-C and TC:HDL-C ratio were also calculated employing their respective formula. Results Body mass index (BMI), waist circumference (WC), blood pressure and lipid parameters were significantly different between diabetic subjects and non-diabetic subjects. There was increased non-HDL-C and TC:HDL-C ratio in subjects with diabetes mellitus. Furthermore, statistically significant correlations of non-HDL-C and TC:HDL-C ratio were obtained with BMI, WC, total cholesterol, HDL-C and LDL-C in diabetic subjects. Conclusions The present study observation revealed that the Non-HDL-C and TC: HDL-C strongly correlate with established independent risk factors such as obesity(WC), elevated blood pressure, HDL-C and LDL-C in diabetes. Thus, the evaluation of Non-HDL-C and TC: HDL-C ratio can be used as the simple, cost-effective and cumulative marker of cardiovascular risk in diabetes mellitus. Key Words cardiovascular risk, diabetes mellitus, Hypertension, lipid profile, Obesity, Non-HDL- cholesterolPublication Improving Health Consciousness and Life Skills in Young People Through Peer-Leadership in Thailand(Kathmandu University, 2013) Teerachote, C; Kessomboon, P; Rattanasiri, A; Koju, RABSTRACT Background Peer leadership is widely recognized as an effective approach to health promotion and empowerment among people of similar ages, especially the youth. Such programs build peer leaders who in turn help empower the youths in their groups to improve their health and life skills related to health. Most previous studies have focused on the effectiveness of such activities in target groups but have neglected to effectively address and explore the transformations in peer leaders themselves. Objectives This descriptive study aimed to investigate the level of social change and health consciousness among student peer leaders in three Youth health promotion programs in Thailand: Friend’s Corner, Smart Consumer and Volunteer Minded Young Dentists, and to compare them with the general students. Methods The study was conducted using a self-administered questionnaire, which was developed based on Tyree’s Social Change Model of leadership, Gould’s concept and Dutta-Bergman’s concept. The study population comprised of 11th grade students (N=660) from Kalasin Province in Thailand, 320 of whom were peer leaders. Results The findings revealed that the peer leaders scored higher than non peer leaders in all domains. Among the peer leaders, it was found that Volunteer Minded Young Dentists group had the highest scores in “controversy with civility”, “social change agent” characteristics, “holistic health perceptions” and “responsibility for one’s own health” regarding health consciousness. Conclusion The results of this study confirmed that the peer leadership approach can help young people to develop life skills through social transformation and increase health consciousness for better status of health in the community. KEY WORDS Consciousness, health, peer group, social change, youthPublication Poisoning cases attending emergency department in Dhulikhel Hospital- Kathmandu University Teaching Hospital(Kathmandu University, 2009) Marahatta, SB; Singh, J; Shrestha, R; Koju, RAbstract Objective: The objective of the present study is to evaluate the characteristics of acute poisoning cases admitted to emergency department over a one year period. The demographic, clinical and psycho-social aspects of the patients were analysed. Materials and methods: A hospital based study was carried out in the emergency department, Kathmandu University Teaching Hospital/ Dhulikhel Hospital, Dhulikhel analysing the data of the poisoning cases attended for one year. The study was carried out amongst inpatients attending emergency with acute poisoning. Results: A total of 54 patients were admitted to the emergency department with acute poisoning. The female-to-male ratio was 1.34:1. Most poisoning occurred in the age group of above 40 years. The mean ages of female and male were 29.87 ±14.85 years and 35.54±15.02 years respectively. By occupation 40.38% of the cases were farmers. Only 35.29% of the patients were illiterate. 79.24% of the cases intentionally consume the poison. Organ phosphorus poisoning (OP) was the most common poisoning. Oral route was the commonest route of poisoning accounting 98.1%. Sixty-six percentage (66.66%) of the cases had the poison stored in their home with 27.7% bought from the market once needed. Among the cases of acute poisoning 5.55% were fatal. Conclusion: The following conclusions were reached: (1) females were at greater risk for poisoning than males, (2) self-poisoning cases constituted the majority of all poisonings, and (3) the main agents of self-poisoning were OP poisoning. Key words: poisoning, insecticides, organophosphorusPublication Prevalence and Associated Risk Factors of Hypertension Among People Aged 50 years and more in Banepa Municipality, Nepal(Kathmandu University, 2012) Manandhar, K; Koju, R; Sinha, NP; Humagain, SABSTRACT Background Hypertension is a cardiovascular disorder rapidly emerging as a major public health problem in developing countries and is the most widely recognized modifiable risk factor for cardiovascular diseases. Objective The objective of this study was to find out the prevalence and associated risk factors with hypertension among people aged 50 years and more in Banepa Municipality, Kavre, Nepal. Methods It is a cross- sectional, population based study which was carried out in Banepa Municipality from May 15 to June 15, 2009. Among total 11 wards of Banepa municipally, wards number 1, 3, 5, 6, 7, and 10 were selected by using Simple Random Sampling Technique and 405 subjects of people aged 50 years and more were selected for study from the selected wards by using Cluster Sampling. The structured interview method was used for collection of data. Mercury sphygmomanometers with standard cuff were used to measure the indirect auscultatory arterial blood pressure. Two consecutive blood pressure readings were taken and average of them was calculated to determine single value of blood pressure. Results The prevalence of hypertension was 44.9 percent (47.75% in male and 42.73% in females). Among them, only 32.9 percent (60/182) were previously diagnosed as hypertension. The higher proportion of hypertensive cases were in age > 65 years (55.49%) than in the age group < 65 years (36.32%). The prevalence of hypertension was seen positively associated with non vegetarian eating habits, alcohol consumption, and > 25 Body max index. Taking green leafy vegetable at least once a week was negatively associated with the prevalence of the hypertension. Conclusion These findings provide important information on the prevalence, associated factors of hypertension in Banepa Municipality. Effective public health measures and strategies are needed to improve prevention, diagnosis and access to treatment of these 50 years and above population. KEY WORDS Associated risk factors, cardiovascular disease, hypertension, prevalencePublication Prevalence of helicobacter pylori in Dhulikhel Hospital, Kathmandu University Teaching Hospital: A retrospective histopathologic study(Kathmandu University, 2005) Makaju, RK; Tamang, MD; Sharma, Y; Sharma, N; Koju, R; Ashraf, MObjective: The main objective of this study was to determine prevalence of Helicobacter pylori infection in Dhulikhel Hospital, Kathmandu University Teaching Hospital. Methodology: Endoscopic antral biopsies from January 1, 2004 to August 31, 2005 were studied retrospectively. Hematoxylin and eosin and Giemsa stained histological sections were examined. Results: Out of 224 patients (Male 125 and female 99) who underwent endoscopic biopsy and included in the study, a total of 76 (33.9%) patients (Male 50 and female 26) were infected by H. pylori. The mean age of the H. pylori infected patients was 40.2 years (SD 16.0). The infection by H. pylori was significantly higher in males than females (p<0.05) with male to female ratio of 1.9:1. The most common (31.3%) histopathologic finding was chronic superficial gastritis followed by normal histology (30.8%). A total of 10 cases (4.5%) of adenocarcinoma and 16 cases (7.1%) of intestinal metaplasia were detected and neither of them showed presence of H. pylori. Two cases (0.9%) were diagnosed as suspected malignancy and both were negative for H. pylori infection. Among gastritis, H. pylori was most frequently observed in chronic active gastritis (86.1%). Two of 69 cases (2.9%) of normal gastric mucosa showed H. pylori. Keywords: Helicobacter pylori, gastritis, endoscopy, prevalence, NepalPublication Preventive cardiology: a brief review from developing country viewpoint(Kathmandu University, 2004) Koju, RNAPublication Relationship Between Arterial Oxygen Saturation and Hematocrit, and Effect of Slow Deep Breathing on Oxygen Saturation in Himalayan High Altitude Populations(Kathmandu University, 2012) Nepal, O; Pokharel, BR; Khanal, K; Mallik, SL; Kapoor, BK; Koju, RABSTRACT Backgroud The oxygen saturation of haemoglobin is reduced in high altitude-living organisms. Increase in the hematocrit is responsible for rise in the hemoglobin concentration so that the oxygen carrying capacity in the hypobaric hypoxic subject is elevated. Objectives To compare two different high altitude populations, in order to study the relationship between arterial oxygen saturation and hematocrit. Methods lIn the cross-sectional study of two populations residing at altitude of 2800 m and 3760 m are compared for the difference in hematocrit. The oxygen carrying capacity of arterial haemoglobin (SaO2) is determined by pulse oximetry. The sample is drawn from the natives of two small villages, Thini at Jomsom (2800 m) and Jharkot (3760 m) in Mustang district of Nepal. The natives at 2800 m are termed as lower high altitude population and local residents at 3760 m are said to be higher altitude population in this study. The sample blood was drawn by venipuncture and packed cell volume was determined by Wintrobe’s method. Results The hematocrit obtained from 3760 m altitude population and the lower high altitude population at altitude of 2800 m differ significantly with the p value < 0.0001and the SaO2 in both the population fails to show any difference with p value > 0.05. Deep breathing exercise in these populations however increased SaO2 significantly. Conclusion The higher altitude natives have greater arterial oxygen saturation than lower altitude population which is due to rise in red cell concentration. The slow deep breathing raises oxygen saturation irrespective of altitude. KEY WORDS High altitude, hematocrit, pulse, oximeter, SaO2, slow deep breathingPublication Thyroid Hormone levels in Highlanders- A Comparison Be- tween Residents of Two Altitudes in Nepal(Kathmandu University, 2013) Nepal, O; Pokhrel, BR; Khanal, K; Gyawali, P; Malik, SL; Koju, R; Kapoor, BKABSTRACT Background The endocrine changes related to altitude adaptation in human have attracted physiologists around the globe for long. A number of high altitude studies to detect the physiological changes have been performed now and then. But, the study to see the hormonal changes to compare populations residing at different high altitudes is a scarce. Hence, we have performed a study in native populations of different high altitude comparing changes in thyroid hormones in western Nepal. The Jharkot population included in this study is at altitude of 3760m and Jomsom population at 2800m height from sea bed. Objective The study is to compare changes in thyroid hormones at two different high altitude natives. Methods To compare thyroid status between high altitude natives at two different altitudes a cross sectional study is performed by random sampling method. The blood sample was collected in a vacutainer from fifty eight individuals after obtaining the informed consent of participants. The blood collected from antecubital vein was centrifuged in an hour and the serum obtained was used for biochemical analysis of free triiodothyronine, free thyroxine and thyroid stimulating hormone. Results Mean free thyroxine (fT4) of Jharkot population is significantly larger (p = 0.001) than Jomsom population. Mean thyroid stimulating hormone (TSH) with p = 0.597, does not indicate the difference between this two population. There is no significant difference between mean free triiodothyronine (fT3) of Jharkot and Jomsom population (p = 0.345). Conclusion The rise in free thyroid hormone at high altitude is not dependent on the thyroid stimulating hormone released from anterior pituitary. The rise in free thyroxine is found at higher altitude and no difference in fT3 level is detected in population studied at high altitudes. KEY WORDS Free triiodothyronine, free thyroxine, TSH, high altitude, t-testPublication Typhoid fever in Dhulikhel hospital, Nepal(Kathmandu University, 2004) Sharma, N; Koju, R; Karmacharya, B; Tamang, MD; Makaju, R; Nepali, N; Shrestha, P; Adhikari, DOne hundred and twelve cases of typhoid fever presenting in outpatient and emergency department of Dhulikhel Hospital in Nepal were studied. In this study, it was found that 71% typhoid fever cases were less than 30 years of age group with male to female ratio of 3:1. Fever over 5 days followed by headache and chills were major presenting symptoms. Widal test and blood culture for Salmonella typhi were positive in 59% and 49% cases respectively. Two third of our study population had total leucocyte count of normal range. The fever clearance time was significantly better with ofloxacin compared to ciprofloxacin (p<0.05) and ceftriaxone compared to chloramphenicol (p<0.05). The release from treatment was significantly shorter with ceftriaxone compared to ofloxacin, ciprofloxacin and chloramphenicol (p<0.01). Ceftriaxone was found to be 100% sensitive to salmonella typhi. Amoxicillin was only 52.1% sensitive to Salmonella typhi. Early diagnosis and institution of appropriate antibiotic therapy is of paramount importance in the management of typhoid patients. Key words: Typhoid fever, salmonella typhi, fever clearance time, release from treatmentPublication Upper gastro-intestinal bleeding: Aetiology and demographic profile based on endoscopic examination at Dhulikhel Hospital, Kathmandu University Hospital(Kathmandu University, 2010) Gurung, RB; Joshi, G; Gautam, N; Pant, P; Pokhrel, B; Koju, R; Bedi, TRSAbstract Background: The upper gastrointestinal bleeding (UGIB) is defined as bleeding within the intraluminal gastrointestinal tract from any location between the upper oesophagus to the duodenum at the ligament of Treitz. It is one of the important medical emergencies worldwide. Objective: The objective of this study is to study the aetiology of upper gastrointestinal bleeding based on endoscopic examination findings in patients of various demographic characteristics. Materials and methods: This is a retrospective observational study. The endoscopic record book from 2007 January to 2009 October was reviewed for all the cases who underwent oesophago-gastro-duodenoscopic examination for upper GI bleeding. The clinico-epidemiological data of all the patients was reviewed and analyzed in concert with the aetiology of bleeding. Results: A total of 90 patients (58 males, 32 females; mean age 45.32+ 18.47 years) of upper gastrointestinal bleeding was studied and analyzed in terms of aetiology of bleeding and demographic profile. Among the ethnic groups, Aryan 46 (51%) was the most common ethnic group to have upper GI bleeding followed by Newars 24 (27%), Mongolians 16 (18%), Dalits 3 (3%) and others 1 (1%). Out of 90 patients, 47( 52.2%) cases was less than 45 years of age, 30(33.3%) of 46 to 65 age ; and 13(14.4 %) more than 65 years of age. Gastric ulcer 23(25.6%) was the most common endoscopic finding, followed by oesophageal varices 14 (15.6%), acute erosive/haemorrhagic gastropathy 11 (12.2%), duodenal ulcer 9(10%), growth 7(7.8%), vascular lesions 3(3.3%), Mallory-Weiss tear 1(1.1%), fundal varices 1(1.1%) and, no cause was identified in 21(23.3%) cases. The peptic ulcer bleeding was the most common finding in Aryan 22(47.9%), whereas oesophageal varices and growth were more common in Newar 7(29.2%) and 3 (12.5%) respectively. Conclusion: Peptic ulcer disease is the most common cause of upper GI bleeding which was most commonly found in Aryan population; followed by oesophageal varices and growth as second and third most common causes and were more prevalent in Newar and Mongolian people. Key words: Endoscopy, Peptic ulcer disease, Upper GI bleeding, VaricesPublication Variation of total serum cholesterol among the patient with thyroid dysfunction(Kathmandu University, 2010) Risal, P; Maharjan, BR; Koju, R; Makaju, RK; Gautam, MAbstract Background: Thyroid hormone has its effect in the lipid metabolism. Thus, thyroid disorder is usually associated with the dyslipidaemia. Hypercholesterolemia is an established risk factor for the cardiovascular disease (CVD) and therefore in case of overt hypothyroidism which is associated with hypercholesterolemia, CVD is most likely to occur. Objectives: controversies still persist about the hypercholesterolemia and sub clinical hypothyroidism. Hence, we conducted our study to elucidate the relation of thyroid hormone with cholesterol in different thyroid disorder. Material and Method: All patients suspected of thyroid disorder within a period of one year were included in the study and free thyroxine-3 (fT3), free thyroxine-4 fT4, Thyroid Stimulating Hormone (TSH) and total cholesterol (TC) in the serum were estimated. Statistical analysis was carried out by using SPSS. 13. Results: Among the 169 cases, 32.5% of the patients were having thyroid disorder. In which 8.3% were of hypothyroid, 7.1% were of sub clinical hypothyroid, 8.3% were of hyperthyroid, 7.7% were of sub clinical hyperthyroid and 1.2% cases were of pan hypothyroid. We observed significant negative correlation between TC & fT3(r = -0.226, p = 0.003), significant negative correlation between total cholesterol & fT4(r = -0.197, p = 0.010) and significant positive correlation between TC & TSH(r = 0.365, p = 0.000). Total cholesterol was significantly raised in hypothyroidism (Mean ±SD 283±53, p = 0.000) in comparison to euthyroid population (mean ±SD, 195±58). But cholesterol was not significantly increased in sub clinical hypothyroidism (mean ±SD, 240±46) Conclusion: Our results show that total cholesterol level in serum is affected by the blood thyroid hormone level. Therefore, screening for hypercholesterolemia could be useful in patients with hypothyroidism to reduce associated disease. Key words: Thyroid hormone, Cholesterol, Nepal