Browsing by Author "Nepal, A"
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Publication Benign Sinonasal Masses: A Clinicopathological and Radio- logical Profile(Kathmandu University, 2013) Nepal, A; Chettri, ST; Joshi, RR; Karki, SABSTRACT Background Benign nasal and paranasal sinus masses are commonly encountered in clinical practice. Though benign, certain nasal polyps, fungal sinusitis, hemangiomas and fibro-osseous tumors can present with locally destructive features and deformities, mimicking malignancies at once. Objective This study was carried out to recognize the great variety of benign nasal lesions and their frequency in our region. Methods A retrospective chart analysis of cases presenting as mass in nose and paranasal sinus that underwent surgery over three years duration at our institute was done. A provisional diagnosis was made after clinical assessment and radiological investigations, but the final diagnosis was established after histopathological examination. Results A total 331 cases presented as masses in nose and paranasal sinus presented during the period. The clinicopathological examination aided by endoscopic and imaging studies revealed the non neoplastic benign masses in 293 and neoplastic masses in 38. Polyps were the commonest lesions constituting 70% cases followed by rhinosporidiosis in 10%. Fungal sinusitis, squamous papillomas, hemangiomas and inverted papillomas were found to be in order of 4.5%, 4%, 3.5% and 3% respectively. Rare cases like “rhino- oto-cereberal” form of mucormycosis, angiomyoma, and psammomatoid ossifying fibroma were also observed in the study. Conclusion Most of the nasal polyps/fungal sinusitis can be diagnosed clinically. However many a times Computer tomography (CT) scan and biopsy are necessary to differentiate them from each other and treatment plan. Certain benign tumors have high potential for malignant transformation while others can present with locally destructive features and deformities. KEY WORDS Angiomyoma, benign, fungal, polyps, rhinosporidiosis, sinonasalPublication Methicillin Resistant Staphylococcus Aureus in patients visiting Western Regional Hospital, Pokhara(Institute of Medicine, 2008) Rijal, KR; Shrestha, N; Pahari, N; Shrestha, B; Paudel, B; Nepal, A; Ghimire, P; Rijal, BAbstract Introduction: Methicillin Resistant Staphylococcus aureus (MRSA) continues to be a major cause of serious infection in hospitals and in the community worldwide. This study was performed to determine the prevalence of Methicillin resistant Staphylococcus aureus in healthy school children and patients visiting Western Regional Hospital of Pokhara. Methods: The children from three Schools namely Janapirya Higher Secondary School, Sublime School and Ratnajyoti School and patients visiting Western Regional Hospital were selected for the study. This study was conducted by The School of Pharmaceutical and Biomedical Sciences during July to November 2007. One hundred eighty four Nasal swabs were collected from the healthy school children younger than 15 years old and one hundred clinical samples such as pus, wound swabs were collected from patients attending Western Regional Hospital. Collected nasal swabs and clinical swabs were analyzed for the growth of Staphylococcus aureus on mannitol salt agar (MSA). S. aureus was isolated and identified by mannitol fermentation, coagulase positivity and DNase positivity. Antimicrobial susceptibility test was performed on Muller-Hinton agar (MHA) medium by Modified Kirby-Bauer disc diffusion method. Results: Out of 284 samples, 184 were nasal swabs, from healthy school children and 100 were clinical samples from patients attending Western Regional Hospital. Out of total nasal swabs (n=184), S. aureus was isolated from 30.97 % (n=57). Out of 57 isolates of Staphylococcus aureus, isolated from healthy school children 56.14 % (n=32) were MRSA. Out of 100 clinical samples isolated from hospital patients, S. aureus was isolated from 45% (n= 45).Out of 45 isolates of S. aureus, 75.55% (n=34) were MRSA. Prevalence of MRSA was statistically significant in clinical specimens in comparison with nasal swabs isolated from healthy school children (P < 0.05). Conclusion: This study showed a high prevalence of MRSA carriage in school children and hospital patients of Pokhara valley and this may indicate the spread of MRSA in the community. Larger community based studies and regular surveillance of MRSA are needed to assist in the development of therapeutic guidelines for MRSA. Keywords: Staphylococcus aureus, MRSA, MHA, Modified Kirby-Bauer methodPublication Post-tonsillectomy Hemorrhage in Patients Receiving Ketorolac Analgesic(Kathmandu University, 2023) Yadav, D; Dangol, B; Shrestha, N; Pandit, S; Nepal, AABSTRACT Background Ketorolac, the non-steroidal anti-inflammatory drug, is thought to have less sedation as well as postoperative nausea and vomiting in comparison to opioids, but with higher risk of post-tonsillectomy hemorrhage as reported in some of the literatures. There is no consensus till date in the use of ketorolac in the management of pain following tonsil and adenoid related surgeries. Objective To find out the incidence of hemorrhage following tonsil and adenoid related surgeries in patients receiving ketorolac in postoperative period. Method This is a retrospective chart review of patients undergoing tonsil and adenoid related surgeries who had received ketorolac during April, 2013 to May, 2019 at department of ENT-HNS, Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal. Post-tonsillectomy hemorrhage rate was calculated in pediatric and adult patients. Result During the study period, 103 patients (male – 50 and female – 53) received ketorolac in postoperative period. Tonsillectomy and adenotonsillectomy were performed in 71and 32 patients respectively. Forty-five patients were < 18 years whereas 58 were ≥ 18 years. Most common indication for surgery was recurrent tonsillitis (66/103) followed by adenotonsillar hypertrophy (31/103). Post-tonsillectomy hemorrhage was observed in 15 patients; among them, four out 45 were < 18 years and 11 out of 58 ≥ 18 years. All five patients out of 15, who required surgical intervention for post-tonsillectomy hemorrhage, were ≥ 18 years and were operated for recurrent tonsillitis. Rest of the patients (10/15) were managed conservatively. None of the patients required blood transfusion. Conclusion Ketorolac is not associated with increased risk of post-tonsillectomy hemorrhage in children and can safely be administered. Whereas in adults, recurrent tonsillitis being the most common indication for tonsillectomy, it should be used cautiously. KEY WORDS Adenoidectomy, Adenotonsillectomy, Ketorolac, Tonsillectomy, Non-steroidal anti- inflammatory drugsPublication Primary Salivary Gland Tumors in Eastern Nepal Tertiary Care Hospital(Nepal Health Research Council, 2010) Joshi, R R; Nepal, A; Chettri, S T; Bhattarai, M; Ghimire, A; Karki, SMethods: A retrospective observational study of all the salivary gland tumors treated in the department of Otolaryngology, B. P. Koirala Institute of Health Sciences during April 2004 to March 2009 was done. Age, sex, presenting features, radiological findings, histopathological type of the tumor and type of surgery were recorded and descriptive analysis was done to calculate frequencies, percentage and their relations.                       Background: The knowledge of the distribution and pattern of salivary gland tumors in the tertiary care center can provide overview of the disease pattern in the region. It also helps in planning the strategies to treat the disease and launch the awareness program in the community to this largely curable disease. Results: Out of total 51 cases, 81% (n=41) were benign and 19% (n=10) malignant tumors. Male to female ratio was 1:2.1.Mean age for benign and malignant tumors were 32.3 and 46.5 years respectively. Parotid tumor outnumbered all other sites comprising 69%, followed by submandiibular 18% and minor glands 13%. Pleomorphic adenoma was the commonest tumor (76%) of all primary salivary gland tumors. Benign to malignant tumor ratio of parotid, submandibular and minor glands were 6:1,3.5:1 and 1.3:1respectively. Adenoid cystic carcinoma (40%) and mucoepidermoid carcinoma (30%) were commonest malignant tumors. Conclusions: The principal site for salivary gland tumors in eastern Nepal population was the parotid and the pleomorphic adenoma outnumbered all other tumors. Most of the cases in both benign and malignant group presented with painless lump often misleading the gravity of disease.                    Key words: parotid, pleomorphic, salivary, submandibular, tumorPublication Profile of Pediatric patients with Foreign Body Aspiration requiring Bronchoscopy in a Tertiary Care Center(Kathmandu University, 2025) Paneru, M; Nepal, A; Yadav, D; Dangol, B; Shrestha, N; Maharjan, L; Maharjan, RABSTRACT Background Foreign body aspiration (FBA) is a common pediatric emergency, particularly in children under five, due to immature airway protection reflexes and their tendency to explore objects orally. It is the fourth leading cause of accidental death in children under three, making early diagnosis and prompt management crucial. Objective To assess the profile of pediatric patients requiring bronchoscopy, identify associated clinical presentations, evaluate complications, identify the types of foreign bodies, and the most frequent site of lodgment. Method Clinical data of three years, from April 2021 to April 2024, were retrospectively collected from medical records. The study included children below 14 years of age who underwent rigid bronchoscopy for suspected foreign body aspiration at a tertiary care center. Their clinical profiles and various presenting symptoms were analyzed. Result Among 37 cases, the highest incidence (43.2%) was in children aged 1-3 years, with males comprising 73%. Cough and wheezing were the most common symptoms (19 cases). Organic foreign bodies, mainly peanuts and beans, were found in 22 cases, while metallic sharp objects (pins) were present in 5 cases. The right main bronchus was the most affected site (22 cases), and post-procedural pneumonia developed in 5 cases. Conclusion Foreign body Aspiration predominantly affects young children, with organic objects being the most common. Rigid bronchoscopy remains the gold standard for diagnosis and treatment, emphasizing the need for early intervention to prevent complications. KEY WORDS Airway obstruction, Bronchoscopy, Foreign bodies, Pediatrics, Respiratory aspiration