NepMed Repository :: Browsing by Author "Paudel, S"

Browsing by Author "Paudel, S"

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A Retrospective Study of Magnetic Resonance Imaging Findings in Acute Encephalitis Syndrome
(Institute of Medicine, 2015) Songmen, S; Panta, OB; Maharjan, S; Paudel, S; Ansari, MA; Ghimire, RK
Abstract Introduction: MRI is the imaging modality of choice to investigate acute encephalitis and is recommended in all patients as soon as possible in whom diagnosis is uncertain. This study aimed to study the pattern of brain involvement in MRI in patients with acute encephalitis syndrome and to correlate the findings with clinical and laboratory data. Methods: The study was a retrospective hospital record based review conducted at Tribhuvan University Teaching Hospital. MRI and records of patients undergoing MRI for acute encephalitis syndrome during two years duration was studied. Data analysis was done using IBM SPSS 20.0. Results: A total of 47 MRI were studied among which 11(23.40%) were pediatric and 36(76.59%) were adult population. Edema was the commonest manifestation. Cerebral hemisphere (temporal lobe) was the commonest location involved 34(72.3%). Basal ganglia and thalamus involvement was also fairly common. Five (26.31%) out of 19 patients had positive Japanese encephalitis, 5(26.31%) had HSV antigen positive serology and in 8(42.10%) no etiology could be found. Posterior fossa and basal ganglia involvement was the most predominant findings in Japanese encephalitis and involvement of medial temporal lobe was seen in all cases of Herpes encephalitis. Fifteen patients had good prognosis: complete recovery or minimal residual deficit, while four patients were either dead or left against medical advice. Conclusion: Medial temporal lobe involvement was seen in all cases of Herpes encephalitis; and thalamus and basal ganglia involvement was predominant pattern in Japanese encephalitis. Posterior fossa involvement was common probably due to a non-conventional etiological agent. Keywords: Acute Encephalitis Syndrome, MRI, Herpes encephalitis
Analysis of mammographic findings in a tertiary care hospital of Nepal
(Institute of Medicine, 2015) Humagain, M; Paudel, S
Abstract Introduction: Mammography is commonly the first line imaging procedure in screening of breast cancer in women. It is also commonly used as diagnostic test in the assessment or characterization of palpable breast mass along with ultrasonography. The purpose of our study was to assess the mammographic findings in women undergoing screening and diagnostic mammography. Methods: This was a prospective cross sectional study analyzing the outcomes of 497 consecutive screen-film mammographic examinations, 369 (74.2%) diagnostic and 128 (25.8%) screening, performed in female patients from 4th July 2012 to 15th October 2012 in Tribhuvan University Teaching Hospital. Analysis was based on the final assessment report of mammogram reviewed by the experienced radiologists following Breast Imaging Reporting and Data System (BI-RADS) classification. BI-RADS score 4, 5 and 6 were considered as positive, BI-RADS score 1, 2 and 3 were considered as negative and BI-RADS score 0 was considered inconclusive requiring additional imaging. Results: The mean age of women was 46.3 years (range 26-83 years). Among 369 cases of diagnostic mammograms 300 (81.3%) were negative, 27 (5.4%) were positive and rest 42 (8.4%) were inconclusive. Among 128 cases of screening mammograms, 117 (91.4%) were negative, 11 (8.6%) were inconclusive and none of them were positive. Among total (497) numbers of mammographic examinations, 417 (84%) were negative, 27 (5.4%) were positive and 53 (10.6%) were inconclusive. BI-RADS 1 was the most common reported finding comprising 26.8% in diagnostic and 12.1% in screening group. Conclusion: Analysis of diagnostic mammography examinations yields different results compared with those of screening examinations, including different patient demographics; higher number of positive findings; and possibly higher cancer detection rates. Diagnostic and screening data should be segregated during record keeping and analysis of combined results should be based on known differences between diagnostic and screening outcomes. Keywords: BI-RAIDS, diagnosttic, mammography, screening
Body Mass Index in Patients with Degenerative Spondylolisthesis: A descriptive cross-sectional study
(Kathmandu University, 2025) Kafle, KR; Lakhey, RB; Ghimire, N; Paudel, S; Paudel, S; Kafle, D
ABSTRACT Background Low back pain is a leading cause of disability globally. Obesity, a product of modern lifestyle, is a well-established risk factor for many diseases including spine pathologies. Degenerative lumbar spondylolisthesis is a significant cause of low back pain in the middle-aged and elderly population. However, the literature on relationship between high body mass index and degenerative spondylolisthesis is inconsistent. Objective To investigate prevalence of obesity among the patients with degenerative spondylolisthesis. Method This cross-sectional study was conducted at Tribhuvan University Teaching Hospital, Nepal, involving 81 patients aged ≥ 40 diagnosed with degenerative spondylolisthesis at various lumbar vertebral levels and grades. Anthropometric measurements were obtained and analyzed using an Independent t-test to compare the mean age, height, weight, and body mass index across different levels, grades, and between sexes. Result Among the 81 patients, 59 were female, and 22 were male. The mean age and, BMI were 59.41 ± 10.97 years, and 26.04 ± 4.41 kg/m2, respectively. A notable 59.3% of patients had Body Mass Index ≥ 25. Patients with grade II spondylolisthesis exhibited significantly higher weight and Body Mass Index compared to those with grade I spondylolisthesis (p = 0.031, 0.013), particularly in female population (p = 0.003, 0.007) and at L4-L5 level (p = 0.003, 0.004). Conclusion Body mass index and weight were significantly higher in patients with grade II spondylolisthesis compared to grade I. This finding underscores the need for further research to understand the relationship between obesity and degenerative spondylolisthesis. KEY WORDS Body mass index, Epidemiology, Obesity, Spondylolisthesis
Chronic Spontaneous Urticaria: Clinical Profile, Autologous Serum Skin Test Positivity and Associated Impairment in Quality of Life in Nepalese Patients
(Kathmandu University, 2022) Paudel, S; Parajuli, N; Sharma, R; Parajuli, S
ABSTRACT Background Chronic Spontaneous Urticaria is considered to be an autoimmune phenomenon in half of the total cases. Autologous serum skin test is a simple screening test for the presence of auto-antibodies in chronic urticaria. Significant impairment in quality of life have been observed in autologous serum skin test positive cases. There are limited literatures on chronic spontaneous urticaria, autologous serum skin test and associated Dermatology Life Quality Index in Nepal till date. Objective To find the proportion of autologous serum skin test positive cases in chronic urticaria and impairment in quality of life in such patients. Method This was a retrospective review of outpatient records of patients diagnosed with chronic spontaneous urticaria, from January 2018 to December 2019, from a tertiary care hospital in Kathmandu, Nepal. Details of the patients, autologous serum skin test and dermatology life quality index scores were analyzed and presented. Result Among the total 114 cases positive autologous serum skin test was seen in 48.2% of cases. The mean total Dermatology Life Quality Index score was 8.06±6.64. A significantly higher quality of life impairment was observed in in patients with positive autologous serum skin test as compared to the negative ones. The odds of finding a positive autologous serum skin test in patients with angioedema was 2.1, however the difference was not statistically significant. Conclusion Chronic spontaneous urticaria was more common in females as compared to males. A positive autologous serum skin test was present in half of the patients which was in turn associated with a greater impairment of quality of life. KEY WORDS Autologous serum skin test, Chronic urticaria, Dermatology life quality index, Quality of life
Co-relation between Non-specific Knee Joint Pain and Osteoarthritis
(Institute of Medicine, 2016) Humagain, M; Paudel, S; Hengwoju, S
Abstract Introduction: Osteoarthritis (OA) is a degenerative joint disease. Pain is the worst and most frequent problem in OA patients that leads to disability. The rate of knee joint pain has been found to be correlated with OA in many studies. The association of knee pain with OA differs by gender, with advancing age and nature of occupations. Knee radiograph is preferred by most of the physicians for the initial assessment of the knee joint pain. This study was carried out to see the relation between knee joint pain and OA along with age, sex and occupation. Methods: In this prospective cross-sectional study, knee radiographs of 200 patients performed in the Radiology Department of T.U. Teaching Hospital for nonspecific knee joint pain were reviewed. Pain was considered as non specific pain when there was no history of trauma or any known disease affecting the joint and no significant abnormality related to any disease entity was found during clinical examination. The study was conducted over a period of three months between July to September 2015. The proforma was filled and then collected data were analyzed using SPSS software to show the relation between knee joint pain and OA. Results: Among total of 200 knee x-rays, 63% (126) were female and 37% (74) were male. The highest number of population was in the age group of 50-59 year, which comprised 26% of total population and lowest population was in >80 year group comprising 0.5% of total population. Housewives were highest in number comprising 39.5% (79) followed by farmer 19% (38), physical worker 15.5% (31), people in service 12.5% (25), business 7.5% (15) and student 6% (12). Of the total population, 59% (118) had radiographic features of OA changes. Most affected people were older than 50 years and all patients older than 70 years had OA changes. No OA was seen in people younger than 20 years. Highest percentage of OA was found in housewives accounting 51.7% followed by farmers (18.6%) and business people (4.2%. No OA was found in students involved in the study. Conclusion: The study demonstrated that the occurrence of OA is more common finding in population with non-specific knee joint pain. OA is more common in females and population of age ≥50 years. OA is most common in housewives and least in students. Keywords: knee, pain, osteoarthritis, x-ray
Comparison of the Mean Cross-sectional Area of the Median Nerve between Pregnant and Non-Pregnant Women Using Ultrasonography in a Tertiary Level Hospital, Nepal
(Kathmandu University, 2023) Adhikari, G; Regmi, PR; Paudel, S; Lamichhane, B; Kayastha, P; Maharjan, S; Amatya, I
ABSTRACT Background The median nerve is subjected to compression in the carpal tunnel giving rise to a constellation of symptoms known as carpal tunnel syndrome. It is the most frequent form of peripheral entrapment neuropathies and is most prevalent in the middle age females. The most common cause of this syndrome is idiopathic. One of the known secondary causes is pregnancy. Objective To compare the mean cross sectional area of median nerve using ultrasound in pregnant and non-pregnant females at carpal tunnel inlet and its variations with different trimesters. Method The study was conducted during a period of one year (October 2014 to September 2015). A total of 204 participants were evaluated among which 102 were nonpregnant and 102 were pregnant. Among the 102 pregnant participants, 34 females each were in the first, second, and third trimesters. A convenience sampling technique was used for the selection of the participants. The mean cross-sectional area of the median nerve was calculated in both of these groups in both hands by using the direct method. The mean cross-sectional area of non-pregnant female was used as the reference value to which that of pregnant female were compared. Data obtained were compiled and analyzed using Statistical Package for Social Sciences Version 16. Result The overall mean cross-sectional area of the median nerve in non-pregnant females was 6.76 ± 1.05 mm2 and in pregnant females was 6.84 ± 1.09 mm. No statistically significant difference was noted in the mean cross-sectional area of the median nerve in either hand in both pregnant and non-pregnant females. No statistically significant difference was noted in the overall mean cross-sectional area between the non-pregnant and pregnant females. There was no significant difference in the mean cross-sectional area within the different trimesters in both hands on intergroup comparisons. Conclusion Ultrasound examination of the median nerve and measurement of its cross- sectional area is a useful diagnostic tool in the evaluation of carpal tunnel syndrome. Ultrasound has the advantage of easy availability, low cost, quick scan time, able to scan a long segment of nerve and examine the structures in both static and dynamic states. Besides, it also helps in the identification of various anatomic variants and pathologies within or adjacent to carpal tunnel. KEY WORDS Carpal tunnel, Mean cross sectional area, Median nerve, Ultrasonography
Comparison of Ultrasonography with Computed Tomography in Diagnosis and Staging of Lung Cancer
(Kathmandu University, 2024) Paudel, S; Kayastha, P; Suwal, S; Nepal, B; Bhusal, KR; Bhusal, KR; Katwal, S; Regmi, PR
ABSTRACT Background Ultrasound (US) can aid in lung cancer diagnosis and staging in peripheral-based lesions by demonstrating chest wall invasion, aiding as a guide to biopsy, and detecting supraclavicular lymph nodes which are often missed by computed tomography (CT). Objective This study is to compare the ultrasound with computed tomography in the diagnosis and staging of lung cancer. Method This was an observational prospective study conducted from October 2020 to April 2023 in patients with or suspected lung cancer sent for imaging assessment to the Department of Radiology and Imaging. Out of 306 patients who underwent computed tomography scan, a total of 234 patients with proven lung cancer were subjected to ultrasound of the chest, liver, bilateral adrenal, and supraclavicular regions for the evaluation of lung mass, pleural effusion, and metastasis in lung, adrenal, and supraclavicular lymph nodes. Diagnostic values of ultrasound to detect peripheral lung lesions, chest wall invasion, pleural effusion, liver and adrenal metastasis, and supraclavicular lymph nodes were compared with contrast-enhanced computed tomography scans. Ultrasound’s performance was evaluated against computed tomography scans as the gold standard, using the chi-square test, z-test, and area under the curve for comparison (p < 0.05 for significance). Result The majority of patients (53.8%, n=126) were aged 61-75, with 53% being male and 89% smokers. Ultrasound was superior in detecting pleural effusion (sensitivity 80.3%, NPV 92.2%, AUC 0.860) and supraclavicular lymph nodes (sensitivity 72.2%, NPV 91.6%, AUC 0.817). Conclusion In resource-constrained settings like Nepal, where advanced imaging may be limited, integrating ultrasound with contrast-enhanced computed tomography significantly improves lung cancer diagnosis. This non-radiation approach is particularly beneficial for peripheral lesions, patients with renal function impairment and aiding effective staging of lung cancer. KEY WORDS Computed tomography, Lung cancer, Role, Ultrasound
Correlation between Computed Tomography and Ultrasonography Findings in Patients with Fatty Liver
(Kathmandu University, 2024) Kayastha, P; Paudel, S; Chapagain, P; Shingh, SS; Adhikari, B; Joshi, S; Katwal, S
ABSTRACT Background Fatty liver disease, linked to obesity, alcohol consumption, and insulin resistance, is characterized by pathological fat deposition exceeding 5%. Its rising global prevalence, particularly in Southeast Asia, highlights the need for effective diagnostic modalities. Objective To find the correlation between computed tomography and ultrasonography findings in patients with fatty liver. Method A prospective cross-sectional study was conducted on 211 patients from December 2016 to October 2017. Patients referred for computed tomography chest and abdomen were included, excluding those with diffuse or focal liver disease other than fatty liver. Computed tomography attenuation values were measured using non- contrast sequences, with participants showing mean hepatic attenuation less than +48 Hounsfield units subjected to further ultrasound and shear wave elastography examinations. Data were analyzed using Microsoft Excel and SPSS, with associations examined through Pearson correlation, ANOVA and Shapiro-Wilk test. Result The study included 100 males and 111 females, aged 21 to 65 years. The mean computed tomography attenuation was +40.31 Hounsfield units. A moderately strong negative correlation was found between Computed Tomography attenuation and ultrasound grades of fatty liver (Spearman’s coefficient = -0.775, p = 0.005). No significant correlation was observed between computed tomography attenuation and shear wave elastography values, nor between patient age and hepatic attenuation. Conclusion This study demonstrates a significant correlation between computed tomography attenuation and ultrasound grades of fatty liver, highlighting their complementary roles in diagnosing fatty liver disease. However, no significant correlation was found between computed tomography attenuation and shear wave elastography values. KEY WORDS Attenuation, Computed tomography, Elastography, Fatty liver, Ultrasound
Correlation of Pelvic Parameters with Isthmic Spondylolisthesis
(Kathmandu University, 2021) Shrestha, S; Lakhey, RB; Paudel, S; Kafle, D; Pokharel, R
ABSTRACT Background Spondylolisthesis is one of the major causes of low back pain. The anterior shift of the vertebra is mostly at L4 and L5 levels. Several types have been described, most common being the isthmic type. Pelvic parameters are said to be associated with development and progression of listhesis, and should be evaluated while treating it. Objective To study the correlation of Pelvic parameters with isthmic spondylolisthesis. Method It was a cross sectional case control study. In 68 cases with Isthmic Spondylolisthesis and of 34 cases with low back pain without listhesis (control), the spinopelvic parameters like lumbar lordosis, pelvic incidence, pelvic tilt and sacral slopes were measured together with degree of slip with lateral radiographs. Findings were analyzed and compared with control group. Result In control group, the pelvic incidence was 50.44±4.78o, the sacral slope was 34.38±6.79o, the pelvic tilt was 15.97±5.31o, and the lumbar lordosis was 46.76±6.78o. In Isthmic Spondylolisthesis group, the pelvic incidence was 60.85±6.79o, the sacral slope was 40.40±6.91o, the pelvic tilt was 20.63±7.51o, and the lumbar lordosis was 57.31±7.11o. The difference in spinopelvic parameters amongst control and Isthmic Spondylolisthesis group was statistically significant (p < 0.001). The degree of slip was directly proportional to the pelvic incidence angle (grade I=52o, II =62o and III 72.5o). Conclusion Spino-pelvic parameters are higher in isthmic spondylolisthesis group and is significantly associated with severity of the slip. KEY WORDS Isthmic spondylolisthesis, Lumbar lordosis, Pelvic incidence, Pelvic tilt, Sacral slope
Diagnostic efficacy of ultrasonography in acute appendicitis
(Institute of Medicine, 2012) Lohani, B; Gurung, G; Paudel, S; Kayastha, P
Abstract Introduction: Acute appendicitis is the most common acute condition of the abdomen requiring surgery in both adults 1,2 and children. 3-5 The overall frequency of appendicitis for symptomatic patients younger than 20 years is 41%; the frequency for those older than 20 years is 59%. Methods: This was a prospective cross-sectional study involving 104 patients aged between 8 and 68 years with clinical suspicion of acute appendicitis. Patients with suspected acute appendicitis were evaluated with high frequency linear transducer using graded compression technique. Per operative findings were noted and histopathological examination were carried out in all the cases for confirmation of acute appendicitis. Sensitivity, specificity, negative predictive value, positive predictive value and accuracy of ultrasonography were calculated by using statistical method. Results: Among 104 patients (61 males and 43 females) with clinical diagnosis of acute appendicitis, ultrasonography was positive for acute appendicitis in 79 patients (75.96%). On histopathological examination, 94 appendices (90.38%) were acutely inflamed. The sensitivity of ultrasonography for the diagnosis of acute appendicitis was 78.72% with specificity of 60%. Positive predictive value, negative predictive value and accuracy of ultrasonography were 94.87%, 23.07% and 76.92% respectively. Conclusion: Ultrasonography is a useful method of diagnosing clinically suspected acute appendicitis especially in doubtful cases. Keywords: Acute appendicitis, diagnosis of appendicitis, ultrasonography
Digital Health in Nepal: A Perspective on Overcoming Challenges and Leveraging Opportunities
(Kathmandu University, 2025) Paudel, S; Paudel, D; Boucher, F
ABSTRACT Digital Health, which encompasses eHealth and mHealth, has revolutionized health care with input from information technology, computer science, and data. With the addition of client-centered content, digital health offers to low- and middle- income countries like Nepal the ability to gather, analyze and disseminate health information regardless of geographic and socioeconomic challenges. Nepal has enacted policies to improve the health system while overcoming the barriers of difficult terrain, internet capability, and low education. This paper will survey Nepal’s health policy in telecommunication and digital health technology, outline successful interventions, note challenges and make recommendations for future activities. KEY WORDS Digital Health, Health system, Nepal
Efficacy of tazarotene cream plus clindamycin gel vs tretinoin cream plus clindamycin gel in treatment of mild to moderate acne vulgaris: a randomised trial
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2013) Paudel, S; Agrawal, S; Dhali, TK
No Abstract:
Evaluation of image quality in chest radiographs
(Institute of Medicine, 2013) Chand, R B; Thapa, N; Paudel, S; Pokharel, G B; Joshi, B R; Pant, D K
Abstract Introduction: Conventional chest radiography is a proven and a useful procedure for imaging of the main airways, lungs, mediastinum, heart, pleura and chest wall. The basic view is Postero- Anterior (PA) of chest in upright position. The role and importance of quality of radiograph is to help the radiologists and the clinicians in the diagnosis of diseases and its management. Thus it is important to show entire anatomical structure, respiration accuracy by counting 6 anterior ribs/ 10 posterior ribs, adequate penetration to see the lower thoracic intervertebral discs through the heart and scapula out of lung fields. The study is an attempt to quantify the quality of chest radiographs by evaluating the quality of depiction of the anatomical and physical details. Methods: A cross sectional study was carried out from June to September, 2012 in Tribhuvan University, Teaching Hospital, Maharajgunj. Chest radiographs were collected in the scheduled examination days and evaluated by under the guidance of Radiologist. Five image criteria i.e. anatomical coverage, adequate inspiration, adequate penetration, rotation and scapula out of lung fields were categorized and descriptive statistics were calculated using SPSS version 11.5 software. Results: A total 1101 chest radiographs were collected from the radiology department for evaluation. Among them about 52.3% chest radiographs met all image criteria but remaining 47.7% did not meet these criteria due to inadequate arrested inspiration (34.8%), inadequate penetration (24%), rotation (21.8%), scapula not out of lungs field (14.7%) and no anatomical coverage (3.8%). Conclusions: The results identified that performing good quality chest radiograph according to Europcan guidelines is difficult. To a great extent the quality of chest radiographs depends upon skill of radiographer, equipment condition (x-ray machine, CR reader) and co-operation of patients. This is always challenging for radiographer and technologist. Keywords: Evaluation, image quality, chest radiographs
Falcine Meningioma with Massive Calvarial Hyperostosis
(Institute of Medicine, 2014) Subedi, K; Suwal, S; Chataut, D; Paudel, S
Abstract Meningiomas are neoplasms of meningeal origin. Hyperostosis is a peculiar but common sign of meningioma. Though common in skull base meningiomas, massive calvarial hyperostosis is rare in the vertex, with only few reported cases. We report a rare case of massive calvarial hyperostosis due to falcine meningioma, illustrated with multimodality imaging. Keywords: CT Scan, Hyperostosis, Meningioma, MRI, X-ray
Giant cell tumor of patella
(Institute of Medicine, 2012) Paudel, S; Kayastha, P; Pokharel, P; Shah, A; Ghimire, RK; Ansari, MA
Abstract Giant cell tumor of bone also known as osteoclastoma is a distinct clinical, roentgenographic and pathologic entity with specific characteristics. It is a benign but locally aggressive neoplasm of the epiphyseal or metaphyseal-epiphyseal region of long tubular bones extending to the articular surface. It usually occurs after skeletal maturation and is one of the rare bone tumors that more frequently affects women. We report here a case of giant cell tumor originating from the right patella diagnosed on fine needle aspiration cytology.
Radiographic findings in non specific low back pain
(Institute of Medicine, 2015) Humagain, M; Paudel, S; Maharjan, A
Abstract Introduction: About 40% of people have low back pain (LBP) at some point in their lives. Non specific LBP where precise pathoanatomical diagnosis cannot be given comprises almost 85% of patients with isolated low back pain. Lumbosacral radiograph is preferred by most of the physicians for the initial assessment of the LBP. It is therefore crucial to evaluate patients with LBP and assess for possible relationship between low back pain and patient characteristics. Methods: In the study, lumbosacral radiographs of 200 patients with nonspecific LBP coming to Radiology department of T.U. Teaching Hospital were reviewed between July to September 2014. The findings were classified under various categories, tabulated in the Proforma and data were analyzed using SPSS software system. Results: Among total of 200 patients, 45% (90) were male and 55% (110) were female. The study included patients of different age ranging from 13 to 92 years with highest number in 30-3 and 40-49 age groups accounting for each 23% of total population. Lumbar spondylosis, normal radiographs and loss of lumbar lordosis were the most common three findings comprising 105 (52.5%), 55 (27.2%) and 24 (12%) of radiographs respectively. Lumber spondylosis was the most common finding after the age of 30 years with highest in the age group of 60-69 years comprising 93.8 % (15) of radiographs in that age group. Most of the radiographs of younger patients below 30 years of age were normal. Conclusion: The study demonstrated that the occurrence of lumber spondylosis was the highest among the radiographs of patients with low back pain. The loss of lordosis and disk degeneration was also significant factors associated with low back pain. Keywords: Low back pain, lumbo-sacral spine, radiograph
Real Time Trans-Rectal Elastography of Prostate Correlation with Histopathology in a Suspected Case of Prostate Cancer
(Kathmandu University, 2021) Basnet, B; Suwal, S; Chataut, D; Lohani, B; Paudel, S
ABSTRACT Background Early detection of prostate cancer, the second most common cancer in men worldwide, is the key for its successful treatment. Commonly used clinical criteria and imaging tools for detection of prostate cancer are less sensitive. Objective This study was aimed to find role of real time transrectal elastography of prostate for detection of prostate cancer. Method Study was conducted in 66 patients with clinical suspicion of prostate cancer, who were sent for ultrasound guided prostate biopsy. Transrectal ultrasound with real time elastography was performed in all the patients prior to the biopsy and looked for hard areas within the prostate. Then six-core tru-cut biopsy were taken in six zones of prostate, including the hard areas detected in the elastography. The histopathology report were correlated with the elastography findings. Result Median prostate specific antigen of the patients was 11.5 ng/ml with interquartile range of 8 to 23.5 ng/ml. Digital rectal examination showed hard nodular findings in 35 patients. Transrectal ultrasound showed 81 hypoechoic lesions in 31 patients. Elastography showed 127 hard areas in 31 patients. Histopathology showed 90 positive biopsy cores in 23 patients. Cancer detection rate of elastography was 82.6%. At 95% confidence interval, patients with elastography detected hard lesions had 19.4 times more likelihood to have prostate cancer. Sensitivity of elastography was high as compared to digital rectal examination and transrectal ultrasound alone. Conclusion Transrectal elastography had high sensitivity over clinical tools and transrectal ultrasonography for detection of prostate cancer. KEY WORDS Biopsy, Prostate cancer, Transrectal elastography
Satisfaction from Utilization of National Health Insurance Program in Nepal: Service User’s Perspective
(Kathmandu University, 2024) Ghimire, S; Agrawal Sagtani, R; Paudel, S
ABSTRACT Background Health insurance is recognized as a valuable resource for improving healthcare access for financially disadvantaged individuals, resulting in better health outcomes and increased productivity. The satisfaction and experiences of health insurance users are crucial for enhancing services and policies. Objective To assess the satisfaction of users within the national health insurance program. Method A household survey in Bhaktapur district of Nepal, conducted between September and November 2019, assessed satisfaction with health insurance services under the national program. Interviews were conducted with 173 individuals who had utilized the insurance scheme, using a structured questionnaire. Collected data were analyzed with STATA 13 software, and logistic regression analysis determined associations between satisfaction and independent variables. The study adhered to the STROBE Checklist guidelines for standardized reporting of results. Result The most satisfied domain was the registration and renewal process, while the least satisfied domain was the information about insurance services. In the adjusted analysis, literacy was the only variable significantly associated with satisfaction, with literate individuals (AOR 2.5, 95% CI 1.12-5.66) being more likely to be satisfied with the health insurance program compared to illiterate individuals. Conclusion The study found generally high satisfaction levels among individuals utilizing health insurance services. However, dissatisfaction was particularly linked to the information provided by health facilities about these services. Literacy was identified as a significant factor influencing satisfaction with the health insurance program. This highlights the need for an awareness program to educate the insured community about the diverse benefit packages available. KEY WORDS Health insurance, Health service users, Health service utilization, Satisfaction
Socio Demographic Profiling of Victims of Sexual Offense in Kavrepalanchowk District: a cross-sectional study at a tertiary care center, Nepal
(Kathmandu University, 2024) Khan, AS; Pokharel, S; Paudel, S; Poudel, P; Karki, A
ABSTRACT Background Sexual offence is an umbrella term referring to a classification of sexual acts and experiences that are imposed, pressured, coerced onto a person. The latest information from women children and senior citizen survey center of Nepal stated that about 2321 rape cases were recorded in the year 2020 to 2021. Objective This study is aimed at socio-demographic profiling of victims of sexual assault, identify the most vulnerable age group and the area with highest incidence for future sexual assault prevention. Method The descriptive cross-sectional study at Dhulikhel Hospital (December 2018 to June 2023) analyzed 136 sexual offense cases via convenience sampling. Data were collected from medical records, following ethical approval. Incomplete or unrelated cases were excluded, and hospital/national protocols were adhered to. Data analysis was conducted using Microsoft Excel with descriptive statistics. Result Out of 136 victims, most were aged between birth and 20 years (71.32%), while only 1.47% were aged 60-80 years. The youngest victim was 15 months old, and the oldest was 65 years. Females comprised 98.52% and males 1.48% where all the males were victims of sodomy. The type of offence most prevalent was rape (70.58%) followed by indecent assault (19.11%), with some cases of incest (7.35%). The municipality with the most number of cases was Panauti (16.16%), followed by Panchkhal (13.23%) and Bhumlu with 10.29%. The majority of the cases took place in the year 2077 BS rounding up to 39 cases in Kavrepalanchowk district. However, noting the numbers in the year 2080 BS, there seems to be a rapid rise of cases as there have already been 19 cases in four months. Conclusion The most vulnerable group for sexual offenses was the population below the age 20 and most of the cases occurred in Panauti municipality which emphasizes the need of sexual and moral education in that place and age group. The areas in Kavrepalanchowk district with increasing cases of sexual offenses should incorporate standardized protocols in implementing education as well as strict regulations of the community guidelines. KEY WORDS Gender-based violence, Kavrepalanchowk district, Nepal, Sexual education, Sexual offense
Sonographic Quantification of Ovarian Volume in Adults Attending General Health Checkup and General Out Patient Department in Tribhuvan University Teaching Hospital
(Kathmandu University, 2020) Upadhyaya, RP; Ansari, MA; Jha, A; Kayastha, P; Paudel, S
ABSTRACT Background Ultrasonography is the easily available, cheap and reliable method for evaluation of ovaries. Ovarian volume is the major factor in the diagnosis of various ovarian pathologies and confusing discrepancies are found in the literature. Objective To determine the ovarian volume among individuals attending outpatient department in tertiary level hospital. Method Descriptive cross sectional study design was used; 305 patients of 16-60 years attending general outpatient department in the Tribhuvan University Teaching Hospital, Kathmandu, Nepal were included. Ovarian volume was calculated by using transabdominal ultrasonography. Data was collected in the predesigned proforma and analyzed using statistical package for the social sciences software. Result The study showed mean total ovarian volume 5.95 ± 2.44 cc (centimeter cube) with mean right ovarian volume 5.94 ± 2.70 cc and mean left ovarian volume 6.05 ± 2.79 cc. Significant decrease in ovarian volume with age was observed. Height and weight did not show significant correlation with ovarian volumes and no significant variation seen in the volumes of right and left ovaries. Periovulatory ovaries show significantly higher volumes on right side than luteal phase. Similarly, significantly higher volume of left ovary seen in mixed ethnic group than mongoloid group. Conclusion Measurement of ovarian volume is important for evaluation and management of ovarian disorders. Ultrasonography which is readily available, simple and cost effective is better suited for our environment than other imaging modality. Values of ovarian volume from this study may provide a baseline of normal ovarian volume in our community. KEY WORDS Ovary, Ultrasonography, Volume

Browsing by Author "Paudel, S"

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