Browsing by Author "Ojha, Rajeev"
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Publication Causes and Outcome of Neurogenic Vision Loss(Nepal Health Research Council, 2024) Ghimire, Pukar; Karn, Ragesh; Gajurel, Bikram Prasad; Ojha, Rajeev; Rajbhandari, Reema; Shahi, Sumit; Panthee, Pradeep; Bhandari, Pragya; Lamichhane, JayaramBackground: Neurogenic vision loss is often a medical emergency. Early evaluation and urgent treatment of the causes is the key to better visual prognosis. Methods: This was a retrospective cross-sectional study based on hospital records of patients admitted to the Neurology department of Tribhuvan University Teaching Hospital with complain of diminution of vision from April 2023 to March 2024. The visual outcome of the patients was recorded based on telephone interviews with the patients or their family members. Results: A total of 64 patients were identified of which 62 were interviewed for visual outcome. The median age was 38 years of which 62.5% were female. Bilateral eye involvement was reported in 59.4% of the cohort and half of the patients had normal optic disc. The distribution of visual acuity at presentation was 39.1% for 6/60 or better, 9.4% for 3/60 to less than 6/60, 32.8% for 3/60 and 18.8% having no perception of light. The commonest diagnosis in decreasing order of frequency was idiopathic intracranial hypertension, neuromyelitis optica spectrum disorder, idiopathic optic neuritis and myelin oligodendrocyte glycoprotein antibody disease with the frequency being 17.2%, 15.6%, 10.9% and 9.4% respectively. Of 62 patients interviewed, 67.7% reported a complete recovery of vision, 14.5% reported a partial recovery and 17.8% reported no visual recovery. Severity of visual loss at presentation was associated with poor visual outcome (p=0.021) whereas age, gender, number of eyes affected and duration of visual symptoms had no significant relation to visual recovery. Conclusions: Idiopathic intracranial hypertension, neuromyelitis optica spectrum disorder, Idiopathic optic neuritis, myelin oligodendrocyte glycoprotein antibody disease were the commonest causes of neurogenic visual loss. The severity of visual loss at onset is a prognostic marker of the visual recovery in these patients. Keywords: Blindness; Vision Disorders; Optic Nerve Diseases; Neural Optical LesionPublication Low Estimated GFR Predicts Hemorrhagic Complication in Acute Ischemic Stroke: A Meta-analysis(Institute of Medicine, 2021) Nepal, Gaurav, Gaurav; Shrestha, Gentle S; Yadav, Jayant K; Pathak, Santosh; Ojha, RajeevABSTRACT Introduction: Intracerebral hemorrhage (ICH) can occur in patients following acute ischemic stroke (AIS) and results in significant long-term morbidity and mortality. Patients with renal impairment have a higher risk of bleeding. Therefore, AIS patients with renal impairment may have a higher risk of such complications. We performed a meta-analysis of observational studies to determine the relationship between renal impairment and hemorrhagic complications in patients with AIS. Methods: This meta-analysis was conducted following the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed, Google Scholar, Web of Science and China National Knowledge Infrastructure (CNKI) were searched to identify studies published between 1995 and 2020. Relative risk estimates of all the included studies were pooled to calculate pooled OR and 95% confidence intervals. Results: Fourteen studies involving 10,033 AIS patients from Asia, Europe, and North America were included. We found that patients with renal impairment as indicated by low eGFR had a higher odds of developing any ICH (OR: 1.7; 95% CI: 1.13 to 2.57; p=0.011; I2=87.2%) following AIS. Similarly, we found that patients with renal impairment had a higher odds of developing symptomatic ICH (SICH) (OR: 1.7; 95% CI: 1.32 to 2.17; p<0.001; I2=37.3%) following AIS. Conclusion: There is an increased odds of developing any ICH and SICH in AIS patients with renal impairment. Keywords: Acute ischemic stroke, glomerular filtration rate, hemorrhagic transformation