Browsing by Author "Lamsal, Ritesh"
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Publication Critical Appraisal of the Curricula of MD Anesthesiology Programs in Nepal using Harden’s 10 Questions(Institute of Medicine, Tribhuvan University, 2025) Paneru, Hem Raj; Joshi, Pankaj; Lamsal, RiteshAbstract: Introduction Anesthesiology in Nepal is evolving beyond its traditional operating room role, increasingly encompassing critical care, pain management, and multidisciplinary support. As surgical and procedural services expand, there is a growing demand for anesthesiologists with advanced clinical, leadership, and research skills. Ensuring that MD Anesthesiology curricula are robust and contextually relevant is essential for meeting Nepal’s diverse healthcare needs. This study aimed to assess whether the curricula included the key principles as outlined in Harden’s 10-question framework. Methods This study critically evaluated the MD Anesthesiology curricula from major Nepalese institutions using Harden’s Ten Questions framework. Curricular documents were collected and analyzed independently by multiple reviewers. Results All programs follow a three-year structure with a mandatory thesis, but variability exists in curricular detail, organization, and emphasis on research or community-based components. Needs assessments and stakeholder engagement are generally absent. Educational objectives are broad but often lack focus on leadership and interprofessional skills. Teaching and assessment methods remain largely traditional, with limited use of active learning or competency-based approaches. Communication of curriculum details and educational environment standards also vary widely. Conclusion MD Anesthesiology curricula in Nepal require comprehensive reform. Implementing evidence-based needs assessments, modern educational strategies, and continuous quality improvement will better prepare graduates to meet the complex challenges of contemporary healthcare.Publication Mucormycosis: An unanticipated progeny of COVID-19(Nepal Medical Association, 2021) Shrestha, Gentle Sunder; Bhandari, Sabin; Lamsal, Ritesh; Gurung, UrmilaAbstract: The rapid surge of COVID-19 cases in the second wave of the pandemic has crippled the healthcare delivery system in Nepal and neighboring countries. Unlike in the first wave of the pandemic, several cases of mucormycosis have been reported in patients with COVID-19 from Nepal and India. In this report, we briefly describe the clinical presentation, diagnosis, and risk factors for mucormycosis and explore why patients with COVID-19 are at an increased risk for developing the infection. As treatment of mucormycosis is challenging and consumes a lot of resources, prevention of mucormycosis is pivotal in low-income countries like Nepal. We also highlight some basic steps that are easy to perform and important to reduce the risk of infection.Publication Post-traumatic Pseudoaneurysm of the Internal Carotid Artery with Intractable Epistaxis: A Case Report Authors(Nepal Medical Association, 2022) Phuyal, Subash; Pandey, Anisha; Bishokarma, Suresh; Lamsal, Ritesh; Sedain, GopalAbstract: Epistaxis is a common otorhinolaryngology emergency. There are several treatment modalities for epistaxis, but bleeding from the internal carotid artery necessitates a particular treatment technique. We report a case of a 22-years old man who presented to us recurrent episodes of epistaxis and blurry vision in the right eye for one month. The patient had undergone maxillo-facial surgery following a road traffic accident one year back. Bleeding episodes were occasionally severe with blood loss of up to 800 to 1000ml. These episodes were managed conservatively with posterior nasal packing and frequent blood transfusions. A computed tomography-angiography revealed a pseudoaneurysm arising from the cavernous segment of the right internal carotid artery which was managed successfully by embolization of the aneurysm sac with coils. Despite the rarity of internal carotid artery pseudoaneurysm in individuals with a history of trauma, doctors must be aware of the possibility. Timely identification and treatment of a pseudoaneurysm can save a person's life.Publication Rational Use of Oxygen in COVID-19 Pandemic – Are We Doing Enough? Authors(Nepal Medical Association, 2021) Shrestha, Gentle Sunder; Lamsal, RiteshAbstract: During the episodes of large case surge of COVID-19, the health care system of many nations have struggled, more so in nations with resource limitations. Recently, Nepal and the neighboring nation India are being hit hard by the pandemic. Management of patients with moderate and severe COVID-19 remains largely supportive, with oxygen therapy being the cornerstone of the management. Procurement, maintenance of oxygen supply system, coupled with avoiding misuse and wastage of oxygen is of paramount importance to better utilize the scarce resources amidst the peaks of a pandemic. Nepal needs to adopt policies to make best use of its oxygen stores and supplies with a collective effort from all stakeholders to save additional lives.Publication The First Successful Endovascular Management of Posterior Fossa Arteriovenous Malformations in Nepal: Case Series(Nepal Medical Association, 2020) Phuyal, Subash; Agrawal, Pooja; Dawadi, Kapil; Paudel, Raju; Lamsal, RiteshAbstract: Posterior fossa arteriovenous malformations represent 7–15% of all intracranial AVMs. They carry a higher risk of rupture than supratentorial AVMs and are associated with considerable rates of morbidity and mortality. Available treatment options include conservative management, microsurgical resection, radiosurgery, endovascular embolization, or combinations of these modalities. Recent advances in endovascular techniques have revolutionized their management with better clinical outcomes. We illustrate two cases of posterior fossa AVMs treated by endovascular techniques with good clinical outcomes. The first patient also had associated flow-related aneurysms. One of these aneurysms had already ruptured, so it was coiled first followed by AVM nidus embolization using the same microcatheter. The second patient had a diffuse type of posterior fossa AVM for which staged-embolization was planned and the first-stage partial embolization was successfully performed.