Browsing by Author "Poudel, R"
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Publication A Rare Case of Large Hydatidiform Mole Mimicking a Term Pregnancy(Kathmandu University, 2022) Shrestha, A; Bastakoti, R; Pandey, N; Poudel, R; Ranjit, S; Makaju, RABSTRACT Molar pregnancy is a type of abnormal pregnancy that usually presents with amenorrhea, vaginal bleeding and elevated serum ß-hCG levels. We report a rare case of complete hydatidiform mole occurring in a 46-year-old P2L2 lady who presented with a term size uterus and elevated serum ß-hCG level (> 15,00,000 per deciliter, anemia (hemoglobin: 8.1 g/dL), difficulty in breathing and minimal vaginal bleeding. During the course of her evaluation, she had profuse vaginal bleeding, she underwent suction and evacuation, but bleeding was not controlled despite measures to control it. She was given uterotonics and antifibrinolytic agents and uterine artery ligation. But was proceeded with emergency hysterectomy for uncontrolled hemorrhage. The content of suction and evacuation was vesicles with blood clots and histopathology was reported as complete hydatidiform mole. The patient received a total of 4 units of packed red blood cells. She was discharged from hospital on 5th postoperative day and was followed up serial serum ß-hCG level. Therefore, complete mole can present with enlarged uterus, vaginal bleeding and anemia. It is also important to note that intractable bleeding following suction and evacuation not being controlled with uterotonics and antifibrinolytic agents and uterine artery ligation may require hysterectomy to save the patient’s life. KEY WORDS Elevated serum ß-hCG level, Suction and evacuation, Term size uterus, Vaginal bleedingPublication Clinical Profile and Knowledge, Attitude and Practice of Patients Presenting with Headache(Kathmandu University, 2023) Ghimire, MR; Thapa, M; Shrestha, AM; Bhattrai, S; Ghimire, S; Sharma, N; Soti, B; Dutta, Ashish; Shrestha, S; Pokharel, M; Poudel, R; Thapa, LJABSTRACT Background Headache disorders are among the most prevalent and disabling conditions worldwide. People, however, do not seek early advice in developing countries. Objective To study clinical profile of patients with headache and their existing knowledge, attitude, and practice regarding primary headaches. Method Descriptive cross-sectional study conducted among 196 patients. Patients were selected using purposive sampling technique fulfilling inclusion criteria. Patients were interviewed based on semi-structural headache questionnaire and data was collected from 4th October to 21st December 2021. Descriptive statistics was used for analysis and interpretation. Result Among 196 participants, 74% were females, 29.6% of patients were between (31 to 40) years of age. The majority were Hindu and belongs to province 3; 36.7% were homemakers, and 32.2% were literate. Migraine headache was the most common type with 14.3% reporting aura. Most reported headache within 1 to 5 years. The commonest triggers were sunlight 64.8%, crowd 54.7%, stress 39.8%, fasting state 31.7%, cold 26.3%. Almost 39% believed that headache could be a chronic neurologic disorder. Majority had knowledge of the causes, triggers, and the relieving factors. Fifty-five percent seek help of a doctor for first time, and the rest seek help of a pharmacist or self-medication. Only 19% tried to manage the headache triggers; 66.8% felt that lifestyle modification is the best treatment for headache comparing drugs. Conclusion Migraine headache was the commonest headache occurring at middle age group with sunlight being the most common trigger factor. Lifestyle modification was perceived to be the best for headache management. KEY WORDS Attitude, Clinical profile, Headache, Knowledge, PracticePublication Correlation between Preoperative High Resolution Computed Tomography (CT) Findings with Surgical Findings in Chronic Otitis Media (COM) Squamosal Type(Kathmandu University, 2017) Karki, S; Pokharel, M; Suwal, S; Poudel, RABSTRACT Background The exact role of High resolution computed tomography (HRCT) temporal bone in preoperative assessment of Chronic suppurative otitis media atticoantral disease still remains controversial. Objective To evaluate the role of high resolution computed tomography temporal bone in Chronic suppurative otitis media atticoantral disease and to compare preoperative computed tomographic findings with intra-operative findings. Method Prospective, analytical study conducted among 65 patients with chronic suppurative otitis media atticoantral disease in Department of Radiodiagnosis, Kathmandu University Dhulikhel Hospital between January 2015 to July 2016. The operative findings were compared with results of imaging. The parameters of comparison were erosion of ossicles, scutum, facial canal, lateral semicircular canal, sigmoid and tegmen plate along with extension of disease to sinus tympani and facial recess. Sensitivity, specificity, negative predictive value, positive predictive values were calculated. Result High resolution computed tomography temporal bone offered sensitivity (Se) and specificity (Sp) of 100% for visualization of sigmoid and tegmen plate erosion. The performance of HRCT in detecting malleus (Se=100%, Sp=95.23%), incus (Se=100%,Sp=80.48%) and stapes (Se=96.55%, Sp=71.42%) erosion was excellent. It offered precise information about facial canal erosion (Se=100%, Sp=75%), scutum erosion (Se=100%, Sp=96.87%) and extension of disease to facial recess and sinus tympani (Se=83.33%,Sp=100%). high resolution computed tomography showed specificity of 100% for lateral semicircular canal erosion (Sp=100%) but with low sensitivity (Se=53.84%). Conclusion The findings of high resolution computed tomography and intra-operative findings were well comparable except for lateral semicircular canal erosion. high resolution computed tomography temporal bone acts as a road map for surgeon to identify the extent of disease, plan for appropriate procedure that is required and prepare for potential complications that can be encountered during surgery. KEY WORDS Cholesteastoma, high resolution computed tomography, temporal bonePublication Imaging in Infertile Female Patients Who Underwent Hysterosalpingography Investigation at Dhulikhel Hospital(Kathmandu University, 2016) Karki, S; Suwal, S; Tamrakar, SR; Poudel, RABSTRACT Background Fallopian tube and uterine abnormalities are the most common cause of female infertility, accounting for 30% of cases. Hysterosalpingography is the safe, minimal invasive radiographic technique for evaluation of uterine cavity and fallopian tubes defects. The purpose of the study was to assess the various uterine and tubal abnormalities leading to infertility Objective To assess the abnormalities in uterus and fallopian tubes detected on Hysterosalpingography (as causative factors of infertility in a tertiary care centre for proper decision making in treatment. Method This is the prospective cross sectional study done in department of radiology Dhulikhel hospital, Kathmandu University Hospital between January 2015 to January 2016 with complain of infertility. Hysterosalpingography was performed using ionic contrast medium (10-20 ml of 76% urograffin) under digital fluoroscopy. Radiographic films were obtained and analyzed. Demographic data and radiological findings were reviewed and the obtained data analyzed with SPSS version 16. Result Out of the total 100 patient, 75 had primary infertility while 25 had secondary infertility. The age ranged from 19 to 43 years with mean age of 27.75 years. Normal Hysterosalpingography findings were seen in 37% cases. Tubal abnormalities were seen in 34%, uterine abnormalities in 23% and both tubal and uterine abnormalities in 6% patients. The most common tubal abnormality detected on Hysterosalpingography was tubal block 75%. Out of the 30 patients who had tubal block, unilateral block was noted in 76.7% patients whereas bilateral block was noted in 23.3%. Hydrosalphinx was seen in 25% cases with tubal abnormality. Among the 29 cases with various uterine abnormalities, bicornuate uterus 9% was the most common abnormality Conclusion Hysterosalpingography is an easily available radiographic procedure that can demonstrate a wide variety of uterine and tubal abnormalities for the initial assessment of infertility which can avoid unnecessary and sometimes more aggressive procedures. KEY WORDS Hysterosalpingography, hydrosaphyinx, infertility, tubal blockPublication Investigating the Efficacy of Triple Drug Therapy and Sequential Drug Therapy in the Eradication of Helicobacter Pylori with Respect to Antigen Stool test: A Pilot Study(Kathmandu University, 2020) Shrestha, R; Poudel, R; Shakya, S; Gurung, RB; Makaju, R; Koju, PABSTRACT Background Helicobacter pylori is one of the most prevalent infectious disease worldwide. The treatment regimens involve mainly two therapies: Standard Triple drug therapy and Sequential drug therapy. Several studies have shown that the sequential therapy has higher eradication rates of H. pylori than the standard triple drug therapy and since proper study on sequential drug therapy and standard triple drug therapy is still lacking in Nepal, this study is attempted to compare efficacy of Sequential Drug Therapy in the eradication of H. pylori in gastritis with respect to the Standard triple drug therapy. Objective To investigate the efficacy of Triple Drug Therapy and Sequential Drug Therapy in the eradication of Helicobacter pylori with respect to Antigen Stool test. Method This study was the prospective study conducted in 62 patients attending the Department of Gastroenterology, Dhulikhel Hospital, meeting the inclusion criteria who were confirmed as H. pylori positive by histopathology and stool antigen test. Patients were randomized into two groups. One group prescribed with Standard triple drug regimen and another group with Sequential drug regimen. Eradication of H. pylori infection was confirmed by repeating the stool antigen test at least five weeks after the completion of the regimen. Result Among the 62 participants included in this study, 54.5% of them were males. Among the study population, the eradication achieved by standard triple drug therapy was 87.8% and 89.6% with Sequential drug therapy. Higher numbers (82.3%) of patients were compliant to the prescribed medication. Forgetfulness was the main reason for missing the dose (91%) of the non-compliant patients. Conclusion The study revealed an equal efficacy of both Standard Triple drug regimen and Sequential drug regimen in the eradication of H. pylori infection. Further, Stool antigen test can be preferred as a non-invasive test, for diagnosis of H. pylori infection, monitoring the response to treatment and in epidemiological studies. KEY WORDS Helicobacter pylori, Sequential drug therapy, Stool antigen test, Triple drug therapyPublication Lightning induced atrial fibrillation(Kathmandu University, 2008) Dronacharya, L; Poudel, RAbstract Atrial fibrillation (AF) is a common arrhythmia that occurs in paroxysmal and persistent forms. It occurs in varied situations but lightning induced AF is extremely rare. Here is a case which reverted to sinus rhythm spontaneously. This 37-year-old man without any underlying heart disease had new onset AF after being struck by a lightning. Oral Metoprolol alone was given to control ventricular rate. Spontaneous reversion to sinus rhythm within 36 hours is in favor of new onset lightning induced AF. Key words: Lightning injuries, atrial fibrillation, ECG changesPublication Mucinous Cystic Borderline Tumor of the Mesentery: A Case Report(Kathmandu University, 2015) Poudel, R; Acharya, A; Pokhrel, S; Adhikari, SKABSTRACT Mucinous cystic neoplasms are rare tumors of uncertain histogenesis. They arise from the ovaries, pancreas, and other intra-abdominal sites but more unusually from the mesentery. They can present with abdominal pain, distension, or a palpable mass but are commonly an incidental finding. We present a case of a 33 year old female who presented with complain of pain abdomen for one-year duration. On Physical examination there was a palpable lump in right lumbar region extending to right iliac fossa. CT scan of abdomen and pelvis suggested the mass to be a Mesenteric Cyst. Enucleation of the cyst was done and histopathology report revealed Mucinous Cystic borderline tumor of the Mesentery. KEYWORDS Borderline, cystic, mesentery, mucinous.Publication Prevalence of Anatomical Variations of the Sinonasal Region and their Relationship with Chronic Rhinosinusitis(Kathmandu University, 2016) Karki, S; Pokharel, M; Suwal, S; Poudel, RABSTRACT Background Precise knowledge of anatomic variations of nose and paranasal sinus complex is essential for achieving best surgical results during endoscopic sinus surgery. Computed tomography is the gold standard investigation for evaluation of paranasal sinuses and adjacent structures. Objective To study prevalence of anatomical variations of nose, paranasal sinuses and osteomeatal complex and to identify a probable association between anatomical variations and chronic rhinosinusitis. Method Prospective, analytical study conducted in 218 patients with Chronic rhinosinusitis in Department of Radiology, Dhulikhel Hospital, Kathmandu University Hospital between January 2015 to January 2016. Volumetric axial CT scan was done in 128 slice CT scanner in 3mm thickness from frontal sinus to floor of maxillary sinus with thin multiplanar reconstruction. Radiological findings were reviewed and obtained data analyzed with SPSS version 16. Pearson chi square test and Pearson correlation coefficient were used for statistical analysis. Result The most common anatomical variation was pneumatized agger nasi cells followed by concha bullosa and deviated nasal septum respectively. Statistical significance were seen between ipsilateral agger nasi cell and frontal sinusitis (p< 0.001), ipsilateral haller cell and concha bullosa with maxillary sinusitis (p<0.001) and onodi cell with sphenoid sinusitis (p<0.001), However, no obvious statistical correlation was noted between deviated nasal septum with ipsilateral maxillary sinusitis. Conclusion Precise knowledge of anatomic variations of the paranasal sinuses is important in chronic rhinosinusitis to prevent possible complications during surgery. Computed tomography is the modality of choice in evaluation of paranasal sinuses and adjacent structures. KEY WORDS Chronic rhinosinusitis, computed tomography, osteomeatal complexPublication The Impact of COVID-19 on Women’s Health in Nepal(Kathmandu University, 2020) Poudel, R; Dangal, G; Caagbay, DABSTRACT COVID-19 has significantly impacted the world and Nepal is no exception. The pandemic has caused a reduction in health service delivery, especially for women’s health conditions, resulting in an increase in challenges for an already vulnerable group. Maternity care, reproductive health services, preventive interventions, nutritional advice and mental health care are not being addressed and with an increase in domestic violence, the health and wellbeing of women in Nepal is precarious and needs to be addressed immediately. KEY WORDS Covid-19, Mental health, Reproductive health