Browsing by Author "Makaju Shrestha, S"
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Publication Predicting Complicated Appendicitis Based on Neutrophil to Lymphocyte Ratio, A Study in University Hospital of Nepal(Kathmandu University, 2023) Shrestha, B; Koju, R; Makaju Shrestha, S; Shrestha, K; Hada, G; Shakya, YR; Karmacharya, RM; Malla, BRABSTRACT Background Acute appendicitis is one of the most common causes of acute abdomen requiring surgical treatment. Accurately diagnosing appendicitis and identifying complicated appendicitis can be difficult at times. Objective To evaluate the ability of the neutrophil-to-lymphocyte ratio (NLR) to differentiate between uncomplicated and complicated appendicitis. Method This was a prospective hospital-based observational study conducted at the Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital from July 2021 to December 2022. Patients with the clinical diagnosis of acute appendicitis who had undergone emergency appendectomy were included in the study. Informed consent was taken from each patient and data collection was done by filling the proforma. Result A total of 218 patients were included in the study. Male: female ratio was 1.18:1. Mean age of patients was 28.58 ± 16.65 (3-78) years. A significant correlation was found between increasing neutrophil count and neutrophil-to-lymphocyte ratio with complicated appendicitis. However, no significant correlation was found between White Blood Cell counts and complicated appendicitis. Neutrophil-to-lymphocyte ratio > 12.6 was found to be associated with complicated appendicitis. Conclusion A simple, cost-effective, and yet perfect test is not available for identifying complicated appendicitis. Increased Neutrophil count and neutrophil-to-lymphocyte ratio can indicate complicated appendicitis. Elevated WBC counts alone has no role in differentiating complicated appendicitis. According to the results of our study, an neutrophil-to-lymphocyte ratio of 12.6 can help to differentiate complicated from uncomplicated appendicitis. KEY WORDS Appendectomy, Appendicitis, Lymphocyte count, Neutrophils, Receiver operating characteristic curvePublication Predictors of Stone Free Rate and Application of the Size, Topography, Obstruction, Number and Evaluation of Hounsfield Units (S.T.O.N.E) Scoring System in Predicting the Outcome in Patients Undergoing Semi-rigid Ureteroscopic Lithotripsy for Ureteric Calculi at a University Hospital of Nepal(Kathmandu University, 2024) Shrestha, B; Koju, R; Makaju Shrestha, S; Shrestha, K; Karmacharya, RMABSTRACT Background Ureteric colic is common urological emergency in patients with urinary stone disease. Semi rigid ureteroscopic lithotripsy is a widely acceptable treatment modality for ureteric calculi. Objective To evaluate the predicting factors of stone free rate (SFR) and application of the Size, Topography, Obstruction, Number and Evaluation of Hounsfield units (S.T.O.N.E) scoring system in predicting success rate of ureteroscopiclithotrisy (URSL) for ureteric calculi. Method This was a prospective hospital based observational study conducted at the Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital from October 2021 to September 2022. Patients undergoing ureteroscopiclithotripsy using laser and/or pneumatic lithotripsy for ureteric calculi were included in the study. Informed consent was taken from each patient and data collection was done by filling the proforma. Result A total of 82 patients were included in the study. Mean age of patients was 35.89 ± 11.51 years. Overall stone free rate was 80.5%. Stone free rate were 96.67% and 71.15% in moderate (6-9) and high (10-13) S.T.O.N.E score groups respectively. Stone size and S.T.N.O.E score were found to be significantly high in patients with retained stone following ureteroscopiclithotrisy (p value < 0.05). Duration of surgery was significantly high in high S.T.O.N.E score group (p<0.05). However no significant correlation was found between patient characters like age, sex, Body mass index and Hounsfield units of stone with stone free rate in this study. The area under the curve of the receiver operating characteristic curve for the S.T.O.N.E score and stone size were 0.693 and 0.660 respectively in this study. Conclusion Stone size and S.T.O.N.E score can be used as predictors of success following semi- rigid ureteroscopic lithotripsy. The value of S.T.N.O.E score has good predictive value for SFR and duration of surgery. There was no significant impact of patient’s age, sex, Body mass index and Hounsfield units of stone in stone free rate following ureteroscopic lithotrisyin this study. KEY WORDS Body mass index, Lithotripsy, Receiver operating characteristic curve, Ureteroscopy