NepMed Repository :: Browsing by Author "Poudel, P"

Browsing by Author "Poudel, P"

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Clinical Characteristics and Outcomes of Anemia in Critically Ill Patients: A Cross-Sectional Observational Study from a Tertiary Intensive Care Unit in Nepal
(Kathmandu University, 2025) Simkhada, N; Pathak, S; Thapa, N; Poudel, P; Dhakal, B; Upadhyay, G; Thapa, J; Regmi, A; Ojha, S; Adhikari, S
ABSTRACT Background Anemia is a common clinical problem among critically ill patients; however, its prognostic significance remains debatable. In low-resource settings, such as Nepal, data are limited. This study evaluated the clinical, laboratory, and outcome profiles of anemia in a tertiary Intensive Care Unit. Objective To assess the clinical characteristics, laboratory features, and outcomes of anemia in critically ill patients admitted to a tertiary Intensive Care Unit in Nepal. Method This retrospective observational study included 113 adult Intensive Care Unit patients with anemia admitted to Dhulikhel Hospital, Nepal, from October 2024 to March 2025 after obtaining ethical approval from the Institutional Review Committee, Kathmandu University School of Medical Sciences (IRC, KUSMS-156/25). Demographic data, anemia severity, laboratory markers, including peripheral blood smear (PBS), and outcomes, such as mortality and Intensive Care Unit stay, were analyzed using IBM SPSS Statistics version 25.0. Categorical variables were compared with Chi-square tests, continuous variables with independent t-test or Mann- Whitney U test, and correlations were assessed with Spearman’s rank method. Result The median hemoglobin level was 97 g/L (78-112g/L), and mild anemia was the most common (49.5%). Mortality correlated strongly with abnormal peripheral blood smear (p < 0.001, r = 0.52) and moderately with older age (p = 0.012, r = 0.35). Although anemia severity was not statistically significant (p = 0.423), its weak positive correlation (r = 0.15) indicates a potential trend. Conclusion Peripheral blood smear abnormalities and advanced age strongly predict mortality in critically ill patients, while anemia severity alone does not. Routine smear use in resource-limited ICUs may aid early risk stratification and improve care. KEY WORDS Anemia, Critical Illness, Intensive care unit, Nepal
Clinicopathological Analysis of Oral Lesions - A hospital based retrospective study
(Kathmandu University, 2019) Poudel, P; Upadhyaya, C; Humagain, M; Srii, R; Chaurasia, N; Dulal, S
ABSTRACT Background Proper diagnosis plays a key role that determines treatment and prognosis of the disease. To give appropriate clinical diagnosis, clinicians must be well aware of the presentation and demographic information of the lesion including the rare ones. Histopathology is still considered as gold standard in diagnostic pathology but final diagnosis becomes difficult unless detailed clinical and radiological descriptions are given. Hence an interdisciplinary approach is needed which requires correlation between both clinical and pathological details. Objective To analyze the clinicopathological details of all the oral lesions diagnosed in Dhulikhel hospital within the period of two years and to assess the concordance between clinical and histopathological diagnosis of these lesions. Method Laboratory record file of all the oral lesions diagnosed between January 2016 to December 2017 were retrieved from the department archives and the data were collected. The extracted data were analyzed using SPSS version 23.0. Result A total of 237 cases were analysed in the present study. Odontogenic cysts were the most common category followed by benign lesions. However considering the individual lesion, mucocele was the commonest lesion followed by squamous cell carcinoma. Total concordance between clinical and histopathologic diagnosis was found in 56.5% cases. The most clinicopathological agreement was seen for benign lesions followed by malignant lesions. Conclusion Mucocele and oral squamous cell carcinoma are the two most common lesions found among the patients visiting our hospital. The cases of oral squamous cell carcinoma are on a rise with each subsequent year. At present, though it is the second most common entity, it can be hypothesized that it may be higher up on the list. Therefore, oral healthcare awareness is paramount and this may be one of the best ways to reduce the oral cancer incidence rates and lowering the healthcare management burden. KEY WORDS Agreement, Concordance, Diagnosis, Prevalence, Oral lesions
COVID 19 Vaccine Breakthrough Infection among Health Care Workers
(Kathmandu University, 2023) Tamrakar, D; Katuwal, N; Adhikari, P; Banjara, M; Shrestha, N; Poudel, P; Shrestha, R
ABSTRACT Background Mass vaccination is considered the primary strategy for reducing the impact of COVID-19, and it has been implemented globally. Objective To study the extent of SARS-CoV-2 infection and breakthrough infection among the HCWs who were fully vaccinated for at least 14 days and investigated the relation between neutralizing antibody response and breakthrough infection. Method This study was a retrospective cohort study among health care workers at Dhulikhel Hospital Kathmandu University Hospital from December 2021 to October 2022. The interviews with semi structured questionnaire were conducted in person or over phone. Out of 1450 participants 137 fully vaccinated HCWs without breakthrough infection were randomly selected for the prospective serological cohort. Result Out of 1079 participants’ majority (51.8%) were of age 25-34 years. Two thirds (66.7%) were females. More than half of participant (54.7%) had infection with SARS-CoV-2 at least once whereas more than one third people (35%) had reported SARS-CoV-2 infection 14 days after receiving full vaccination. Infection after vaccination had less moderate and sever/critical illness and less need for hospitalization as compared to infection before vaccination. Staffs who were directly involved in patient care had higher chance of breakthrough infection compared to those not involved directly in patient care. Those who had prior infection or booster dose had relatively higher antibody level and participants with low level of antibody had higher chance for breakthrough infection (35.3%) than participants with moderate to high level of antibody (11.9%). Conclusion Vaccinations significantly decreased severe diseases and the need for hospitalizations. Breakthrough infection was higher among the health care workers involved in direct patient care and with low level of antibody. KEY WORDS Antibody level, Breakthrough infection, COVID 19, COVID 19 vaccination
Effect of Breastfeeding on Relieving Pain during Immunization in Infant
(Kathmandu University, 2020) Bhurtel, R; Yadav, U; Chaudhary, R; Shah, S; Poudel, P; Pokhrel, RP; Sharma, S
ABSTRACT Background Advantages due to immunization are numerous and cannot be avoided but at the same time pain inflicted on babies needs to be addressed when possible. Pain associated with immunization injections has often been overlooked when remedies are available. Objective To find out the effect of breastfeeding on relieving pain during immunization injection in infants. Method An experimental study was conducted at Immunization clinic of B.P. Koirala Institute of Health Sciences (BPKIHS). Total 124 subjects were divided randomly into two groups. Experimental subjects were allowed to breastfeed for 5-10 minutes before immunization while control group was immunized without breastfeeding. Interview Questionnaire was used to obtain demographic variables and measurements were obtained. Measures of pain was recorded using duration of cry and Modified Behavior Pain Scale, by Taddio et al. Data was analyzed by using SPSS 20.0 where variables were assessed with frequency tables, Pearson’s Chi-Square test, independent t test and Mann Whitney U test. Result The mean pain score in experimental group was 7.10 and in control group 7.56 which was statistically significant (p=0.001). The median duration of cry was significantly shorter in experimental group i.e. 25 seconds (IQR: 20-30) than control group 42.5 seconds (IQR: 30-61.5) (p < 0.001). Conclusion Breastfeeding before immunization is effective in reducing pain in infants. KEY WORDS Breastfeeding, Immunization, Infants, Pain
Eosinophilic Granuloma of Mandible: A Diagnostic Challenge
(Kathmandu University, 2018) Bajracharya, B; Poudel, P; Bajracharya, D; Bhattacharyya, S; Shakya, P
ABSTRACT Eosinophilic Granuloma is the mildest and localized form of Langerhans Cell Histiocytosis and is characterized by clonal proliferation of Langerhans cells. It is a rare disease, accounting for less than 1% of all the osseous neoplasms. It has predilection for the axial skeleton and incidence in jaws is just 7.9%. It lacks pathognomonic clinical and radiographic trait and hence is difficult to make a correct diagnosis without histopathological and immunohistochemical examination. This report describes a case of Eosinophilic Granuloma of mandible in 30 years old male who presented with complain of unhealed extraction wound and was clinically diagnosed as chronic suppurative osteomyelitis. The final diagnosis of Eosinophilic Granuloma was made only after histopathological and immunohistochemical evaluations. KEY WORDS Eosinophilic granuloma, Immunohistochemistry, Langerhans cell histiocytosis
Juvenile Generalized Myasthenia Gravis: Presented as Unilateral Blepharoptosis and Successfully Managed with Pulse Intravenous Methylprednisolone
(Kathmandu University, 2021) Poudel, P; Anand, A; Ghosh, S
ABSTRACT Myasthenia Gravis is a rare autoimmune disorder of childhood and this is rarer in South Asia. We present a pre-pubertal 7 year old female child of seropositive Generalized Juvenile Myasthenia Gravis. She presented with unilateral blepharoptosis and later generalized symptoms appeared. Ice-pack test, Neostigmine challenge test and acetylcholine receptor antibody test were positive. Serum muscle specific tyrosine kinase antibody test was normal. She did not have thymic abnormalities. She did not respond to high dose (26 mg/kg/day) of Pyridostigmine and oral Prednisolone (2 mg/kg/day), but was successfully treated with a combination of pulse intravenous Methylprednisolone (30 mg/kg once a month for 6 months) and daily doses of oral Prednisolone (2 mg/kg/day) along with Pyridostigmine without significant side effects. This combination can be considered a potential inexpensive treatment for Juvenile Myasthenia Gravis in a resource limited area where other immunosuppressive treatments such as intravenous immunoglobulin is expensive and unaffordable. KEY WORDS Blepharoptosis, Child, Methylprednisolone, Muscle weakness, Myasthenia gravis
Pattern of Dental Problems among Patients Visiting a Dental Hospital during COVID-19 Pandemic
(Kathmandu University, 2020) Dixit, PB; Dixit, S; Dahal, S; Poudel, P; Roy, D; Manandhar, N
ABSTRACT Background Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Nepal is a part of this worldwide corona virus disease. In this critical situation, the patients have a sense of insecurity visiting dental hospital. Objective To assess the pattern of dental problems in patients visiting a dental college during COVID-19. Method A descriptive cross-sectional study was conducted in Dental Hospital of Kathmandu Medical College and Teaching Hospital from May to August 2020. The patients visiting the Dental hospital were assessed for dental problems. Data were analyzed in Statistical Package of Social Sciences version 20. Frequency and percentage for pattern of dental problems were calculated. Result Most of the patients of age group of 14 to 31 years 530 (36.53%) had dental problems during the survey period. Out of total patients having dental emergency, 739 (50.93%) were males and 712 (49.07%) were females. Majority 545 (37.56%) visited the dental hospital for endodontic consultation followed by emergency consultation for oral surgical procedures 298 (20.54%). Least consulted dental emergency condition was prosthodontic consultation 18 (1.24%). Conclusion The study findings showed that the major dental problems in patients causing emergency visit to dental hospital during COVID-19 pandemic period were dental pain and swelling requiring endodontic consultation and the least need felt is prosthodontic consultation. KEY WORDS COVID-19, Dental problems, Pattern
Perception of Undergraduate Dental Students Regarding Teaching Learning Methods in Oral Pathology
(Kathmandu University, 2024) Poudel, P; Adhikari, BR
ABSTRACT Background Third year is considered crucial in undergraduate dental education as this is when students start to have clinical exposure and taught about various oral pathologies. Many a times, students fail to make proper clinical and pathological correlation. It is the responsibility of teacher to impart adequate knowledge to the students regarding a disease in most effective way. Understanding the students perception is an effective way of making new roadmaps for teaching. Objective To assess undergraduate dental student’s perspectives regarding oral pathology along with the effectiveness of various teaching learning methods and assessment methods currently used by faculties of Department of Oral Pathology. Method This cross sectional study was conducted from June 2023 to July 2023 among 136 undergraduate dental students of Kathmandu University School of Medical Sciences by using the pretested questionnaire. Convenience sampling method was used. The data collected were entered into the Microsoft Excel Sheet and statistical analysis was done using Statistical Package for the Social Sciences version 20. Result A total of 136 students participated in the study. Among them, 46 (33.8) were from third year, 51 (37.5) were from fourth year and 39 (28.7) were from fifth year. Half of the students believed that oral pathology is an interesting subject. Most of students; 66 (48.5) participants strongly agreed that knowledge of oral pathology helps in clinical training. Except two students, all the participants said that integration of oral pathology teaching with clinical training will help in better understanding of diseases. More than half of the students 71 (52.2) agreed that lectures and demonstrations taken by faculties has stimulated interest in the subject. Most students 80 (58.8) believe that formative assessment serve the purpose of analyzing the cognitive skill. Sixty six (48.5) students agree that MCQs are an effective tool for analyzing cognitive skills. Conclusion The overall perception of undergraduate dental students regarding the oral pathology subject and the teaching learning method used by faculties is good. However, incorporation of case based learning, integration of oral pathology with other clinical subjects and taking regular feedback from students may be of great use in providing holistic and effective learning environment. KEY WORDS Dental, Oral pathology, Perception, Teaching learning methods, Undergraduate
Peripheral Cemento-Ossifying Fibroma
(Kathmandu University, 2017) Humagain, M; Dawadi, A; Srii, R; Poudel, P
ABSTRACT Peripheral cemento-ossifying fibroma (PCOF), a relatively uncommon lesion, reactive in nature is seen as an overgrowth of the gingival tissues often leading to periodontal problems. It is a benign tumor with slow-growing potential commonly affecting the anterior maxilla whose pathogenesis till date is uncertain. It is usually challenging to diagnose peripheral cemento-ossifying fibroma based on clinical observation and examination, hence histopathological examination is mandatory to arrive at an accurate diagnosis. Recurrence of the lesion is common unless and until it is completely excised. We present the report of two cases of peripheral cemento-ossifying fibroma of our department, complaining of a mass in the gingiva of posterior maxilla and mandible. KEY WORDS Irritational fibroma, Mineralized deposits, Peripheral cemento-ossifying fibroma
Profile of renal diseases in Nepalese children
(Kathmandu University, 2008) Bhatta, NK; Shrestha, P; Budathoki, S; Kalakheti, BK; Poudel, P; Sinha, A; Singh, R
Abstract Aim and Objectives: To find out the profile of renal diseases in children hospitalized in the pediatric department of the tertiary care university teaching hospital in Eastern Nepal. Materials and Methods: A retrospective chart review of all the patients admitted at the department of paediatric from April 2002 to March 2007 was carried out for the presence of any renal diseases on the basis of their clinical presentation, laboratory findings and final diagnosis. Results: A total number of 10396 children were admitted during the study period out of which 651 (6.3%) children had renal disease. Among them, nephrotic syndrome seen in 222 patients (34.1%) was the commonest renal disease, followed by post streptococcal nephritis in 187(28.7%) and haemolytic uremic syndrome 66(10.1%), other renal diseases seen were acute renal failure in 25 (3.9%), lupus nephritis 24 (3.7%), urinary tract infection in 23 (3.5%) Henoch-Schönlein Purpura (HSP) nephritis 26 (4%), chronic renal failure in 27 (4.2%) and other miscellaneous causes 51 (7.8%). Conclusion: A substantial number of children are hospitilsed with renal diseases, and current trends indicate that majority of them are preventable. In near future, there is a need to develop a comprehensive service for the children with kidney diseases in Nepal. Key words: Renal Disease, Children, Nephrotic Syndrome, Poststreptococcal Glomerulonepritis, Renal Biopsy
Self-confidence Level among Intern Dentists in Performing Endodontic Treatment Procedures in Nepal
(Kathmandu University, 2021) Chakradhar, A; Humagain, M; Acharya, N; Pradhan, S; Poudel, P
ABSTRACT Background Endodontics is considered as one of the most difficult and stressful disciplines in dentistry. This might be due to the complex anatomical variations, recent advances in equipment, technology, materials and lack of self-confidence. Objective To determine the self-confidence level among the intern dentists in performing endodontic procedures from six different colleges of Kathmandu University, Nepal. Method A descriptive cross-sectional study was conducted among 145 intern dentists. The online questionnaire regarding confidence level (5 point Likert scale) in different endodontic procedures and difficulty level (easy, ok and difficult) with respect to teeth was distributed. For descriptive purpose, frequency and percentage for each response were calculated. Result Dental interns were confident in performing majority of the normal endodontic procedures, however, they showed less confidence in performing difficult steps like rubber dam application for anterior (74, 51%) and posterior tooth (91, 62.7%), use of electronic apex locator (89, 61.4%), using rotary files (114, 78.6%), management of flare-ups (86, 59.4%), assessment of quality of post-endodontic treatment (85, 58.5%), recall periods (75, 51.6%) and performing post and core (82, 56.6%). Likewise, upper first molars (84, 57.9%) and second molars (104, 71.7%) were found to be the most difficult teeth to treat. Conclusion It can be concluded that majority of the dental interns were confident in performing basic endodontic procedures, however, they were found to have low confidence in performing difficult steps. Further training and exposure should be incorporated to increase their confidence level. KEY WORDS Confidence level, Endodontic procedures, Intern dentists, Kathmandu University
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
Tetanus
(Kathmandu University, 2009) Poudel, P; Budhathoki, S; Manandhar, S
Abstract Tetanus is now a rare disease in developed world. However it remains an important cause of death worldwide and is associated with a high case fatality, particularly in the developing world. Tetanus is caused by contamination of wound by spores of Clostridium tetani. Neonatal tetanus results from contamination of the umbilical stump at or following delivery of a child born to a mother who did not possess sufficient circulatory antitoxin to protect the infant passively by transplacental transfer. It produces its clinical effects via a powerful exotoxin, tetanospasmin, which leads to uncontrolled disinhibited efferent discharges from motor neurons in the spinal cord and brainstem, causing intense muscular rigidity and spasm. Shorter incubation and onset times are associated with more severe disease and poorer prognosis. Four clinical forms of tetanus are recognised. They are generalised, localised, cephalic and neonatal tetanus. Tetanus is associated with several complications like respiratory failure, cardiovascular instability, renal failure and autonomic dysfunctions. Recovery from tetanus takes a long time. Diagnosis is established clinically. Symptomatic management, early recognition of complications, careful monitoring for dysautonomia and respiratory assistance are the anchors for successful outcome of patients. Tetanus is preventable through vaccination. Vaccination is highly safe and efficacious. Active immunisation should be instituted in all partially immunised, unimmunised persons and those recovering from tetanus. Passive immunisation is given as treatment of a case as well as prevention following high risk injury. Nepal has achieved neonatal tetanus elimination status on 2005 and is running different programs to sustain the status. Key words: Tetanus, neonatal tetanus, spasm, treatment, immunisation.
Therapeutic Drug Monitoring of Antiepileptic Drugs at a Tertiary Care Hospital of Eastern Nepal
(Kathmandu University, 2019) Mandal, NK; Rauniar, GP; Rai, DS; Pradhan, B; Poudel, P; Sapkota, N
ABSTRACT Background Therapeutic drug monitoring (TDM) is the process of measuring drug level in body fluids. It is done to maintain plasma concentration of the drug under therapy within a specific target range for maximum therapeutic efficacy without unnecessary exposure to adverse effects. Objective This study aims to evaluate necessity of therapeutic drug monitoring in Phenytoin, Carbamazepine and Lamotrigine therapy among epileptic patients. Method A prospective, cross-sectional study was conducted for a period of one year at BP Koirala Institute of Health Sciences, Dharan, Nepal. After taking detailed history, blood samples were collected from epileptic patients on monotherapy with the selected drugs. Plasma levels of these drugs were analyzed using High Performance Liquid Chromatography technique (HPLC). Out of total 42 selected patients, 21 were tested for phenytoin, 17 for carbamazepine and four for lamotrigine. The result was categorized into therapeutic, sub-therapeutic and above-therapeutic groups based on reference range. Result Out of total 21 samples tested for phenytoin, 15(71.4%) had plasma drug level within therapeutic range, 5(23.8%) had within subtherapeutic range and 1(4.8%) had above therapeutic range. Analysis of carbamazepine plasma level showed 14(82.3%) at therapeutic level, 1(5.9%) at sub-therapeutic level and 2(11.8%) at above-therapeutic level. Lamotrigine testing in four samples showed 2(50% in) both within therapeutic range and above-therapeutic range. Conclusion Therapeutic drug monitoring of phenytoin, carbamazepine and lamotrigine showed variation in plasma level irrespective of the therapeutic dose. It is suggested that dose adjustment of antiepileptic drugs should be done after establishing ‘individual therapeutic range’ following regular plasma monitoring. KEY WORDS Anti-epileptic, High performance liquid chromatography, Therapeutic drug monitoring

Browsing by Author "Poudel, P"

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