Browsing by Author "Pokhrel, A"
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Publication Relation between Serum Intact Parathyroid Hormone Level and Hematocrit in Chronic Kidney Disease Patients(Kathmandu University, 2015) Adhikary, LP; Pokhrel, A; Yadava, SK; Khadka, D; Thakur, RABSTRACT Background Anemia is a common complication of chronic kidney disease. There are various causes of anemia in chronic kidney disease patients on hemodialysis. Secondary hyperparathyroidism is one of the less recognized causes of anemia in chronic kidney disease patients. Objectives The main objective of the study is to find the correlation between intact parathyroid hormone and hematocrit level in chronic kidney disease (CKD) patients undergoing hemodialysis. Method Verbal consent was taken from all the participants. Eighty participants between the age of 29 and 70 years with chronic kidney disease having indication of hemodialysis were included in this study. Hematocrit was measured by bioelectrical impedance method and serum intact parathyroid hormone was by using Chemi Luminescence Immuno Assay (CLIA) method. Result A weak reverse correlation was found between serum intact parathyroid level and hematocrit (r= -0.33). Conclusion In chronic kidney disease patient, there is reverse correlation between level of serum intact parathyroid and hematocrit level. This association may have clinical relevance in assessing the cause of unexplained low hemoglobin level in CKD patients. KEY WORDS Anemia, chronic kidney disease, hematocrit, intact parathyroid hormone, secondary hyperparathyroidism.Publication Surgical Management of Primary Hyperparathyroidism: An Institutional Study on Surgical Quality Control(Institute of Medicine, 2017) Nepal, B; Singh, YP; Pokhrel, A; Sayami, P; Sayami, GAbstract Introduction: Surgery is key treatment of primary hyperparathyroidism. With the inclusion of serum calcium measurement in routine biochemistry panel, majority of primary hyperparathyroidism can be detected in earlier asymptomatic phase. Preoperative localization by Ultrasonography and Sestamibi scan combined together along with CT or MRI in ectopic adenoma enables for focused minimal invasive surgery. Intraoperative intact PTH (IPTH) measurement is used as a surgical quality control in primary hyperparathyroidism surgery. This study was undertaken to look into current status of surgical management of primary hyperparathyroidism in the tertiary care center in Nepal. Methods: This was a prospective observational study conducted in Department of Surgery. Tribhuvan University Teaching Hospital Kathmandu, Nepal from November 2014 to October 2016. Demography profile, preoperative symptoms, duration of symptoms, preoperative serum calcium, phosphate, immediate preoperative iPTH level and intraoperative iPTH level, post-operative calcium level and localization techniques were recorded. Final pathology report of each of the patients were recorded. Results: Thirteen patients were operated for primary hyperthyroidism. Mean age of the patients was 36:15 years. None of the patient had multi-glandular disease on preoperative localization. Mean preoperative Calcium level was 12.8±0.9 mg/dl and mean preoperative iPTH level was 998+805 pg ml. As Intraoperative iPTH measurement was used to ascertain the successful adenoma removal, mean IPTH intraoperative iPTH after the removal of the adenoma was 175±167 pg/ml. Mean difference of iPTH was 823±725 (p 0.024). There was mean decrease of 81% of iPTH after surgery well above 50% decrease confirmatory of successful adenoma removal. None of patients had reported with recurrent symptoms till date. Conclusion: Hypercalcemia should be subjected for iPTH scanning to identify more asymptomatic patients and Surgery is key treatment and intraoperative iPTH assay is used for confirmation of adenoma removal. Keywords: Hypercalcemia, Primary Hyperprathyroidism, Focused Parathyroidectomy, iPTH monitoringPublication Use of Magnetic Resonance Imaging in the Evaluation of Acute Cholecystitis in Emergency Setting(Kathmandu University, 2022) Sharma, UK; Thapa, DK; Thapaliya, S; Pokhrel, A; Baskota, B; Rai, UABSTRACT Background Acute cholecystitis is one of the commonest surgical disease. The rapid diagnosis at its early stage is one of the crucial factor in patient care and management. Objective To evaluate the role of magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) in the diagnosis or exclusion of acute cholecystitis, coexisting choledocholithiasis, and acute pancreatitis in emergency setting. Method This study was conducted in the department of radiodiagnosis B&C teaching hospital, Birtamod, Nepal from July 2016 to November 2019. Patients, clinically diagnosed as acute cholecystitis or biliary condition with positive Murphy’s sign with or without jaundice and deranged Liver Function Test, raised Leucocyte counts were evaluated by Magnetic Resonance imaging. The sensitivity, specificity, Positive Productive Value (PPV), Negative Productive Value (NPV) were calculated for the diagnosis of acute cholecystitis. Data was entered and analysed by using SPSS version 20. Result There were 40 patients included in our study. Among them 27 (67.5%) were females and 13 (32.5%) male. The age of the patients ranged from 16 years to 79 years, mean age 49.4 years. Majority of the patients were in the age group of 40-60 years (57.5%). The overall sensitivity, specificity, Positive Productive Value and Negative Productive Value of Magnetic Resonance imaging diagnosis of acute cholecystitis were 100%, 66.6%, 94.4% and 100% respectively. Acute cholecystitis associated with gall stone disease were common and found in 72.5% cases, with sensitivity 96.5%, specificity 27.7%, Positive Productive Value 77.7% and Negative Productive Value 75.0%. Conclusion Magnetic resonance imaging (MRI)/Magnetic resonance cholangiopancreatography (MRCP) is an excellent tool for the evaluation of biliary pathology and can be used for the preoperative evaluation of acute cholecystitis at the emergency setting. KEY WORDS Acute Cholecystitis, Cholelithiasis, Magnetic resonance cholangiopancreatography