Browsing by Author "Pokharel, BR"
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Publication A Prospective Study of Commonly Prescribed Drugs in the Management of Neuropathic Pain and its Medication Adherence Pattern(Kathmandu University, 2016) Shrestha, R; Silwal, P; Basnet, N; Shakya, Shrestha S; Shrestha, R; Pokharel, BRABSTRACT Background Neuropathic pain is one of the common complains of patients visiting neurology and orthopedic departments in hospitals. Management of neuropathic pain is difficult and is often symptomatic rather than being curative. Adherence to medication is necessary for pain management to be effective. However, there are various factors related to patient, physician, drug regimen and other socio-economic affecting adherence. Objective To study commonly prescribed drugs in neuropathic pain management and the medication adherence pattern including its associated factors. Method Patients already diagnosed as neuropathic pain were interviewed using structured questionnaire and data entered in Microsoft Office Excel 2007. Informed consent was taken from the patients. Result Among the 84 patients in the study, 69% were females. Majority 53.6% of patients had low back pain as cause of neuropathic pain. Anticonvulsants were mostly prescribed (75%) followed by non-steroidal anti-inflammatory drugs (52.4%) and Methylcobalamin (47.6%). More than 50% (n=49) patients were not adherent to the prescribed medication and majority (61.2%) of them were housewives. Significant association was observed between patient’s adherence to gender, occupation, polypharmacy, drug regimen, cost and availability of medicine. Conclusion Anticonvulsants were commonly prescribed drugs in patients with neuropathic pain. Neuropathic pain was seen more in females with low back pain. Majority of patients were non-adherent and forgetfulness was the major reason for missing dose in them. KEY WORDS Low back pain, medication adherence, neuropathic pain, non-adherencePublication Association of Seizure, Facial Dysmorphism, Congenital Umbilical Hernia and Undescended Testes(Kathmandu University, 2012) Thapa, LJ; Pokharel, BR; Paudel, R; Rana, PVSABSTRACT With the advances in neurogenetics association of epilepsy and intellectual disability with chromosomal abnormalities are being increasingly recognized. While onset of seizures with mental retardation at an early age indicate chromosomal abnormality, combination of characteristics facial dysmorphism and congenital abnormalities gives a clue of a particular syndrome. In addition MRI findings may help in confirming the diagnosis. A nine years old boy is presented where early onset seizure, mental retardation, delayed development of speech, presence of facial dysmorphism,, umbilical hernia and undescended testes suggested possibility of chromosomal 6q deletion disorder. Important deletion disorders are discussed and importance of clinical examination is stressed. KEY WORDS Chromosome deletion, Cryptorchidism, Facial dysmorphism, Seizures, Umbilical herniaPublication Relationship Between Arterial Oxygen Saturation and Hematocrit, and Effect of Slow Deep Breathing on Oxygen Saturation in Himalayan High Altitude Populations(Kathmandu University, 2012) Nepal, O; Pokharel, BR; Khanal, K; Mallik, SL; Kapoor, BK; Koju, RABSTRACT Backgroud The oxygen saturation of haemoglobin is reduced in high altitude-living organisms. Increase in the hematocrit is responsible for rise in the hemoglobin concentration so that the oxygen carrying capacity in the hypobaric hypoxic subject is elevated. Objectives To compare two different high altitude populations, in order to study the relationship between arterial oxygen saturation and hematocrit. Methods lIn the cross-sectional study of two populations residing at altitude of 2800 m and 3760 m are compared for the difference in hematocrit. The oxygen carrying capacity of arterial haemoglobin (SaO2) is determined by pulse oximetry. The sample is drawn from the natives of two small villages, Thini at Jomsom (2800 m) and Jharkot (3760 m) in Mustang district of Nepal. The natives at 2800 m are termed as lower high altitude population and local residents at 3760 m are said to be higher altitude population in this study. The sample blood was drawn by venipuncture and packed cell volume was determined by Wintrobe’s method. Results The hematocrit obtained from 3760 m altitude population and the lower high altitude population at altitude of 2800 m differ significantly with the p value < 0.0001and the SaO2 in both the population fails to show any difference with p value > 0.05. Deep breathing exercise in these populations however increased SaO2 significantly. Conclusion The higher altitude natives have greater arterial oxygen saturation than lower altitude population which is due to rise in red cell concentration. The slow deep breathing raises oxygen saturation irrespective of altitude. KEY WORDS High altitude, hematocrit, pulse, oximeter, SaO2, slow deep breathingPublication School Teachers’ Knowledge about Epilepsy in Kathmandu Metropolitan City(Kathmandu University, 2015) Khanal, K; Maharjan, R; Pokharel, BR; Sanjel, SABSTRACT Background Studies on Knowledge towards epilepsy among school teachers are very limited on developing countries especially with reference to Nepal. Level of knowledge of schoolteachers plays an important role on providing a greater educational support for epileptic child and to maintain good communication skills between epileptic and normal child. Objective Objective of this study is to assess the level of knowledge about epilepsy and its associated factors among school teachers. Method A cross sectional study was conducted from 10th June to 4th July, 2014 among 165 teachers teaching in six different schools of Kathmandu Metropolitan City. A self- administrated questionnaire consisting of structured and multiple choice questions were designed to collect information on the teacher’s socio-demographic profile and knowledge about epilepsy. A scoring system was developed for each question: each correct answer was given a score of 1, and a score of 0 for wrong answer. Total score was categorized on two categories: Good Knowledge and Poor Knowledge. Result Teacher’s age did not correlate significantly with their knowledge about epilepsy but total years of teaching experiences and knowledge about epilepsy were found to be positively correlated (ρ= 0.165, p= 0.01). Academic qualification of teachers and different teaching level were associated with level of knowledge (p= 0.023, p= 0.021). Significant difference on knowledge score was found among teachers having different academic qualification (p= 0.019). Conclusion All teachers were aware about epilepsy, but their knowledge about epilepsy was not sufficient therefore, health education training program about epilepsy is needed for teachers. KEY WORDS Epilepsy, knowledge, school teachersPublication Vertical Gaze Palsy with Skew Deviation(Kathmandu University, 2013) Pokharel, BR; Thapa, LJ; Paudel, R; Rana, PVSABSTRACT With the advancement of neuroradiology, clinical localization followed by radiology, had made neurology more interesting. Vertical gage palsy as presentation cerebrovascular disease is not so common. Vertical gaze palsy usually localizes the lesion to dorsal mid brain. A 56 years male patient presented with sudden onset vertigo, diplopia, transient loss of consciousness and sways toward right side while walking. Clinical examination showed vertical gaze palsy with skew deviation along with swaying towards rt. during walk. MRI brain showed – infarct involving dorsal midbrain at superior colliculus level and medial thalamus KEY WORDS Mid brain, skew deviation, thalamus, vertical gaze palsyPublication Vitamin D and Other Risk Factors among Stroke Patients(Kathmandu University, 2015) Pokharel, BR; Kharel, G; Thapa, LJ; Rana, PVSABSTRACT Background Stroke is common neurological problems in Nepal. The common risk factors for stroke are age, hypertension, diabetes, dyslipidemia and atrial fibrillation. Vitamin D is an emerging risk factors for cardio-cerebrovascular disease. Objective This study is to find out Vitamin D and risk factors in stroke patient in Nepalese population. Method We reviewed the record of 281 stroke patients, admitted to Neurology ward of College of Medical Sciences, Bharatpur, Nepal from 1st January to 31st December 2013. The records were analyzed on the basis of age, sex, hypertension (HTN), body mass index (BMI), smoking habits, hemoglobin(Hb), diabetes mellitus(DM), Lipid profile, Atrial fibrillation(AF) and vascular territory with clinical and radiological evidences. The vitamin D analysis was done all stroke patients. Result Total patient were 281, with male 161 and age range from 18 - 87. Ischemic stroke was noted in 86.8% and hemorrhagic stroke was noted in 13.2% of patients. Middle cerebral artery (MCA) ischemia was noted in 51.5% of patients and anterior cerebral artery (ACA) ischemia was noted in 3% of patients. Multiple infarcts were noted in 12.90% of patients. About half of them were smoker, hypertension 47.40%, Diabetes mellitus 24.20% and 14.1% had atrial fibrillation. 174 (61.92%) of the stroke had less than sufficient Vitamin D. Conclusion The common risk factors for stroke patients like smoking, hypertension, diabetes mellitus and atrial fibrillations are present in Nepalese population. The level of vitamin D was also low in stroke patients. KEY WORDS Cardiovascular risks, ischemia, stroke, vitamin D