Browsing by Author "Manandhar, A"
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Publication A Diagnosis Missed for Several Years- Wegener’s Granulomatosis(Kathmandu University, 2011) Paudyal, BP; Pantha, S; Ranjitkar, N; Manandhar, A; Arjyal, AABSTRACT Wegener’s granulomatosis is a form of systemic vasculitis of small to medium sized vessels and affects upper respiratory tract, lungs and kidneys along with various organs. It causes necrotizing granulomatous inflammation of the affected parts and presents with positive antineutrophil cytoplasmic antibodies in more severe forms. Being a systemic disease with the potential to affect any organ-systems with a wide range of clinical presentations, it is associated with a risk of delay in diagnosis with resultant setback in institution of appropriate treatment. Confusion may arise due to an extent of histological similarity between Wegener’s granulomatosis and the more prevalent tuberculosis, both causing granulomatous inflammation of the affected parts. Here, we present two cases of this rare disorder where the diagnosis was missed for several years in the beginning causing a delay in institution of specific therapy which led to the development of complications. KEY WORDS delayed diagnosis, multisystem disease, systemic vasculitis, Wegener’s granulomatosisPublication Acute Kidney Injury in Neonates with Perinatal Asphyxia in a Tertiary Care Hospital of Nepal: a cross-sectional study(Kathmandu University, 2025) Gautam, S; Gautam, P; Chaudhary, A; Dahal, A; Manandhar, A; Giri, P; Dulal, A; Pokhrel, SABSTRACT Background Renal involvement is the most common form of systemic complication in neonates with perinatal asphyxia. Acute Kidney Injury (AKI) can be oliguric or non oliguric. There is no consensus on the definition of acute kidney injury in neonates, which makes early diagnosis and management difficult. Acute kidney injury leads to significant morbidity and mortality in neonates. Objective Current study aims to explore the prevalence of Acute Kidney Injury in Neonates with perinatal asphyxia and its relation to the severity of Hypoxic Ischemic Encephalopathy (HIE). Method A single-center, retrospective, cross-sectional study was carried out to analyze the cases of perinatal asphyxia in the Neonatal Intensive Care Unit (NICU) and Neonatal Ward (NNW) for a period of three years (September 2020 to August 2023) in a tertiary care center. The study analyzed 195 neonates with perinatal asphyxia and Hypoxic Ischemic Encephalopathy (HIE). Data analysis was done using Statistical Package for Social Sciences (SPSS) version 25. Descriptive statistics(mean ± SD for continuous variables; percentages for categorical variables) and chi-square test (to compare categorical associations) were applied. The prevalence of acute kidney injury and its relation to grades of HIE were determined using a chi-square test. Result The prevalence of acute kidney injury among cases of perinatal asphyxia was 17.4%. The prevalence of acute kidney injury increased with an increase in the grading of hypoxic ischemic encephalopathy. Acute kidney injury was predominant among males with a male-to-female ratio being 3.2:1. Oliguric acute kidney injury was more common than non-oliguric acute kidney injury. 8.8% of cases had mortality, with the majority of cases being hypoxic ischemic encephalopathy grade II. The Chi- square test found a statistically significant association between hypoxic ischemic encephalopathy grades and acute kidney injury (p value=0.0113, i.e., p < 0.05) Conclusion Acute kidney injury remains one of the common complications of Perinatal Asphyxia (PA). There was a significant association between acute kidney injury cases and grades of Hypoxic Ischemic Encephalopathy (HIE), with HIE II being the most common type. Screening for acute kidney injury in case of hypoxic ischemic encephalopathy should be prioritized. KEY WORDS Acute kidney injury, Birth asphyxia, Oliguria, Perinatal asphyxiaPublication Outcomes of Laparoscopic Cholecystectomy in a Tertiary Hospital in Nepal(Kathmandu University, 2023) Shakya, YR; Manandhar, A; Laudari, U; Patel, JN; Karmacharya, RM; Sah, S; Malla, B; Shrestha, B; Maharjan, S; Dahal, AABSTRACT Background Laparoscopic Cholecystectomy (LC) is the gold-standard surgery for symptomatic cholelithiasis with low mortality and morbidity. Objective The main objective of this study is to study the outcomes of laparoscopic cholecystectomy in Dhulikhel Hospital over the period of seven years. Method The records of all the patients who underwent laparoscopic cholecystectomy in Dhulikhel Hospital from January 1, 2015, to December 31, 2021 were reviewed. Patient demographics, indication of surgery, hospital stay, and number of conversions to open cholecystectomy were collected. The percentage, mean and median were calculated for socio-demographic information and Chi-square test was performed to measure the association between socio-demographic characteristics, duration of hospital stay, and operative procedure. Result Out of 2106 patients who underwent laparoscopic cholecystectomy from January 1, 2015, to December 31, 2021, 584 (27.73%) were male, and 1522 (72.27%) were female. The female-to-male ratio was 2.6:1. The median age of the patients was 40 years (IQR=52-30). Most common indications for surgery were symptomatic cholelithiasis in 1740 (82.62%) patients along with chronic cholecystitis in 268 (12.73%) patients, and Post ERCP Cholecystectomy in 92 (4.37%) patients. Median hospital stay was three days. Out of 2106 cases, 24 cases were converted to open cholecystectomy. Conclusion Laparoscopic cholecystectomy is the gold standard treatment for benign diseases of the gallbladder and can be performed safely as day care surgery to reduce the cost, length of hospital stay, and long waiting list in low and middle-income countries. KEY WORDS Cholecystectomy, Cholecystitis, Gallstone, Laparoscopy, Post-ERCP