Browsing by Author "Poudyal, S"
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Publication A Retrospective study of Intussusception of the bowel in adults(Institute of Medicine, 2015) Bhattarai, A; Poudyal, S; Bhandari, RS; Lakhey, PJ; Singh, KPAbstract Introduction: Intussusception is the leading cause of intestinal obstruction in children. In contrast to childhood intussusception, adult intussusception accounts for only 5% of all intussusceptions with 90% having a lead point, a well-defined pathological abnormality. Adult intussusceptions pose a further challenge as they are often presented with acute, subacute or chronic non-specific symptoms. Computed tomography is the most sensitive diagnostic modality and can distinguish between intussusception with and without a lead point. Surgery is the definitive treatment of adult intussusceptions. So the aim was to evaluate adults with intussusception in and to assess its etiology, clinical features, diagnosis and management. Methods: A retrospective review of adults aged >16 years with a diagnosis of intussusceptions between 1998- 2013 was done. Results: There were 22 cases of adult intussusceptions. Mean age was 44 years (17-86 years). Abdominal pain, nausea, vomiting and rectal bleeding were the most common symptoms. There were 2 cases of retrograde jejunogastric intussusception, 5 cases of jejunojejunal intussusceptions, 3 cases of ileoileal intussusceptions, 11 cases of ileocolic intussuscetpions and 1 case of colocolic intussusception. In seventeen cases, the lead point for intussusception was identified out of which 13 cases had benign pathology and 4 cases had malignant pathology. In five cases cause was not found. All cases were treated surgically except one case of jejunogastric intussusception which was reduced endoscopically. Mean duration of hospital stay was 13 days (5-30 days). Postoperative period was uneventful except surgical site infection in 8 cases and 1 case developed ECF which was managed conservatively. There was one mortality because of chest infection. Conclusion: Adult intussusception is an unusual and challenging condition having a well- defined pathological abnormality in most of the cases. Treatment usually requires resection of the involved bowel segment. Keywords: Adult Intussusception, Computed tomography, SurgeryPublication Comparison of Different Estimating Equations for Prediction of Glomerular Filtration Rate in Living Kidney Donors(Institute of Medicine, 2017) Poudyal, S; Pradhan, M; Chapagain, S; Luitel, BR; Chalise, PR; Sharma, UK; Gyawali, PRAbstract Introduction: Assessment of renal function is a crucial step in evaluation of living kidney donors. The standard method for determining renal function is measurement of glomerular filtration rate (GFR) using I-123 iothalamate, Tc-99m Diethylene Triamine Pentaacetic Acid (DTPA) and 51Cr-Ethylene Diamine Tetraacetic Acid. As these methods are expensive and cannot be used in all clinical settings, it is common practice to estimate GFR by creatinine-based equations. The objective of this study is to compare commonly used estimating equations for the prediction of GFR in Living Kidney Donors. Methods: In 75 healthy kidney donors, GFR estimated by Modification of Diet in Renal Disease Study equation (MDRD), Cockcroft-Gault formula(CG), Chronic Kidney Disease Epidemiology Collaboration(CKD- EPI) equation and 24 hour urinary creatinine clearance were compared to GFR measured by Tc-99m DTPA. Statistical analysis was done using Dunnett’s test and Bland-Altman plot. Similarly, accuracy, precision and bias of each equation were assessed. Results: Mean GFR calculated by DTPA clearance, CG, MDRD, CKD-EPI equations and 24 hour urine creatinine clearance were 83.35±8.59, 78.99±17.17, 93.30±17.12, 96.34±13.36 and 137.96±43.65 ml/min/1.73m2 respectively. Applying Dunnett’s test, GFR by CG equation minimally underestimated GFR measured by DTPA (p=0.612) whereas GFR estimated by MDRD (p=0.034), CKD-EPI(p=0.03) and 24 hour urine creatinine clearance(p<0.001) were statistically significant. CG equation had the highest accuracy. Using Bland-Altman plot, the precision of CKD-EPI equation was the highest among all. Conclusion: There is no single creatinine-based estimating equation to assess GFR with utmost accuracy and precision at the same time. Keywords: creatinine clearance, Diethylene Triamine Pentaacetic Acid, living kidney donorsPublication Factors affecting stone clearance in Percutaneous Nephrolithotomy(Institute of Medicine, 2018) Poudyal, S; Rai, BDK; Dhital, P; Pradhan, M; Chapagain, S; Luitel, BR; Chalise, PR; Sharma, UK; Gyawali, PRAbstract Introduction: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large and complex renal stones. It is of paramount importance to deliver the maximum clearance with minimal morbidity. There are different anatomical, stone-related and patient-related factors affecting the stone-free rate. This study is conducted to delineate the factors predicting stone clearance in PCNL. Methods: A prospectively maintained database of 114 cases, who underwent PCNL between January to October 2016 in Tribhuvan University Teaching Hospital, was analysed. Age, gender, body mass index, surgical and medical history, renal anomalies, American Society of Anesthesiologists score, tract size, type of tract dilatation, fluoroscopy time, stone density, stone location and burden, skin to stone distance, presence of hydronephrosis, and duration of surgery were correlated with the stone clearance. Stone clearance was evaluated with either X-ray or ultrasound of the kidneys, ureters and bladder up to three months of PCNL. Result: Stone clearance rate was 85.96%. Stone burden(p<0.001), stone location(p=0.03), number of calyces involved by stone(p<0.001) and presence of hydronephrosis(p=0.005) were statistically different between stone-free and stone-residue group. Multifactorial analysis showed that stone burden, location and no. of calyces involved by stone were the only factors effecting stone free rate. Area under curve for the stone burden was 0.842 (p<0.001). Conclusion: Stone burden, location and number of calyces involved by the stone are the principal factors determining the stone clearance in PCNL. Keywords: Percutaneous Nephrolithotomy, Renal calculi, Stone clearancePublication Frequency and Severity of Portal Hypertensive Gastropathy in Cirrhosis(Institute of Medicine, 2017) Poudyal, S; Sharma, S; Khadga, PK; Pathak, R; Jha, A; Shrestha, RAbstract Introduction: Portal hypertensive gastropathy (PHG) is a common endoscopic finding in patients with Cirrhosis. The pathophysiology of PHG was not clearly understood. It was thought that Portal Hypertension was an important triggering factor for the development of PHG but the other factor must be considered for its progression. It is one of the clinically important gastric mucosal lesions because it may cause acute and chronic gastrointestinal blood loss leading to anemia. The aim of our study is to determine the frequency and severity of PHG in patient with Cirrhosis. Methods: This was a Cross-sectional observational study involving 61 consecutive Cirrhotic Patients, who attended Upper GI endoscopy were enrolled in this study as per inclusion and exclusion criteria in the Department of Gastroenterology Tribhuvan University Institute of Medicine. Child-Pugh’s score and MELD score was determined at the entry to determine the severity of liver disease. Data regarding clinical and laboratory investigations were collected. Variceal size was measured endoscopically and the severity of PHG was graded according to Mac Cormack Classification. Results: Out of total 61 patients, the frequency of PHG was found to be 47.5% among them where 44.2% patients had mild PHG and 3.3% patients having severe PHG. There were 29.5% patients in child pugh A, 39.3% in child pugh B and 31.2% in child pugh C. During analysis insignificant relation was found between the PHG with Child pugh score (ρ=0.4) and MELD score (ρ=0.7).When PHG frequency was related to alcohol intake the relations were statistically not significant. There was no association found between portal hypertensive gastropathy with esophageal varices and gender of the patient. Conclusion: Our data showed that the frequency and the severity of PHG are not influenced by the Gender of the patient, etiology and severity of cirrhosis or by presence of esophageal varices. Keywords: Cirrhosis, Portal hypertensive gastropathy, esophageal varicesPublication Glue therapy for bleeding gastric varices: a single tertiary center experience in Nepal(Institute of Medicine, 2017) Jha, A; Sharma, S; Khadga, PK; Pathak, R; Poudyal, S; Hamal, RAbstract Introduction: Bleeding is a common presentation in the Department of Gastroenterology, Institute of Medicine, Tribhuvan University Teaching Hospital. Of the varied causes of upper gastrointestinal bleed, bleeding gastric varices pose a major challenge to the endoscopist and the treating physician. Endoscopic injection of N-butyl-2-cyanoacrylate is the standard of care for treating gastric varices at present. Methods: We retrospectively evaluated the efficacy and safety of cyanoacrylate in patients presenting with gastric variceal bleed. Between May 2016 to April 2017, 25 patients (14-M, 11-F) who presented to Institute of Medicine, Tribhuvan University Teaching Hospital with gastric variceal bleeding underwent endoscopic treatment with N-butyl-2-cyanoacrylate. Results: Eleven patients had cirrhosis secondary to alcohol, 9 had non-cirrhotic portal hypertension, cirrhosis due to hepatitis B-1, hepatitis C-1, NASH-1, and cryptogenic- 2. Child-Pugh score at presentation for patients was Child A-52%, Child B-36% and Child C-12. Successful hemostasis. rebleeding rate and complications were reviewed. Immediate hemostasis was observed in 100 of the cases and carly rebleeding rate of 8% was seen in 2 patients. Complications included post procedure pain 16%, fever 16% and pulmonary embolism 4%. Conclusion: N-butyl-2-cyanoacrylate is an effective, lifesaving modality for immediate hemostasis of gastric variceal bleeding with an acceptable rebleeding rate. Keywords: N-butyl-2-cyanoacrylate, endoscopic injection, gastric variceal bleedPublication Open Anderson Hynes Pyeloplasty in Ureteropelvic Junction Obstruction: An Institutional Experience(Institute of Medicine, 2015) Subedi, PP; Chapagain, S; Thakur, DK; Poudyal, S; Luitel, BR; Chalise, PR; Sharma, UK; Gyawali, PR; Shrestha, GKAbstract Introduction: Ureteropelvic junction obstruction (UPJO) is one of the common causes of hydronephros is in children and adults. The cause may be congenital or acquired. The standard management of UPJO has classically been an open Anderson-Hynes (A-H) dismembered pyeloplasty. This study is an audit of A-H pyeloplasty done for patients with UPJO presenting to our institution. Methods: A retrospective analysis was done in the Urology unit, Tribhuvan University Teaching Hospital from July 2013 to November 2014. All patients undergoing A-H pyeloplasty were included for review. Preoperative data regarding the demographics, presentation, diagnostic tools used, details of the surgery, postoperative complications, duration of hospital stay and follow up findings were reviewed. Initial follow up was scheduled at two weeks, then at three months and at one year. At 3 months, DTPA renogram was obtained to assess the function and clearance of the treated kidney. Results: The age of the patients ranged from 5 months to 69 years. Flank pain was the most common presenting complain. Most of the patients were males and left sided obstruction was common. The most common diagnostic modality used was USG and excretory urography. CT urography was done in cases of secondary UPJO. DTPA scan was used in select cases for baseline documentation of the function of the involved kidney. The average duration of surgery was 2 hours and 30 minutes. The mean duration of hospital stay was 5 days. The most common complication was urinary tract infection. Conclusion: Open A-Hpyeloplasty is the most common surgery done for UPJO at our institution. The outcome can be improved by attention to the principles of A-H pyeloplasty. Keywords: hydronephrosis, A-H pyeloplasty, ureteropelvic junction obstructionPublication Permanent Teeth Emergence Time and Sequence in Children of Kavre District, Nepal(Kathmandu University, 2016) Upadhyay, S; Shrestha, R; Shrestha, D; Poudyal, SABSTRACT Background Population specific standards on the timing and sequence of emergence of permanent teeth are essential in planning dental care for children. There is only a single study on the emergence of permanent teeth in Nepalese children. Objective To determine the standards for permanent teeth emergence time and sequence in children of Kavre district, Nepal. Method A descriptive cross sectional study was conducted in 623 children of age 5 to 14 years from six different schools of Kavre district. The number of permanent tooth erupted except third molar was recorded along with age and gender. Data were analysed using SPSS 20.0. Descriptive statistics was used to determine the number and percentage of permanent teeth emerged at different ages and the mean age of emergence of each tooth. Student ‘t’ test was used to determine the inter jaw differences in the mean age of emergence of each tooth. Result The study population constituted 50.7% boys and 49.3% girls of the total sample. The first tooth to emerge was mandibular first molar, whereas maxillary second molar tended to be the last to emerge in both the genders. Though in general, mandibular teeth tended to precede the corresponding maxillary teeth in emergence but significantly only mandibular central, lateral and second premolar emerged earlier than maxillary.( p ≤ 0.05) Conclusion This study can be used as a reference data for clinical and academic purpose especially for the children of Kavre district, Nepal. KEY WORDS Emergence sequence, emergence time, permanent teethPublication Predicting difficulties during laparoscopic cholecystectomy by preoperative ultrasound(Kathmandu University, 2007) Sharma, SK; Thapa, PB; Pandey, A; Kayastha, B; Poudyal, S; Uprety, KR; Ranjit, SBackground: The aim of this study was to determine whether the preoperative USG finding can predict the risk of conversion or difficulty during the laparoscopic cholecystectomy. Materials and methods: 200 patients undergoing Laparoscopic cholecystectomy at Kathmandu Medical College Teaching Hospital were included. Sonographic parameters like size of gall bladder, wall thickness, distance between hepaticoduodenal ligament and Hartmann’s pouch and the size of stone were taken into consideration and difficulties in terms of adhesions around gall bladder, anatomy of calot’s triangle and difficulty in peeling off gall bladder from the bed and retrieval were analyzed. Result: In 8 of 200 patients (4%), LC was converted to open procedure. In univariate analysis all the sonographic parameters we had included in this study were statically significant (p value <0.05). Conclusion: Preoperative sonographic signs can predict the difficulty in laparoscopic cholecystectomyPublication Risk factors of reflux esophagitis observed in tertiary care centre of Nepal(Institute of Medicine, 2017) Poudyal, S; Pathak, R; Hamal, R; Kafle, B; Sharma, S; Khadga, PKAbstract Introduction: Gastroesophageal reflux disease (GERD) is considered to be common disease in western countries. The prevalence of GERD is believed to be less in Asia than in Western countries. Upper GI Endoscopy is the valuable tools in the evaluation of reflux esophagitis which is a common complication of GERD. The present study aimed to determine the risk factor of Reflux Esophagitis in Nepalese with Gastroesophageal Reflux disease symptoms. Methods: It was a cross sectional observational study conducted in the department of Gastroenterology at Tribhuvan University, Institute of Medicine. Patients were recruited as per inclusion and exclusion criteria. The study involved data on 166 patients with Gastroesophageal reflux disease symptoms. After fulfilling the criteria of validated GERD questionnaire, patient were divided into two groups those having reflux esophagitis and Non erosive reflux disease according to the upper Gastrointestinal Endoscopy. Association of reflux esophagitis with different variables including patient characteristics, clinical features of GERD and endoscopic findings were tested using Chi-square test for discrete variables and continuous variables are measured as Mean SD. Multivariate analysis was performed for the association of risk factors with reflux esophagitis using logistic regression analysis. p value <0.05 was considered statistically significant. Results: Among the total of 166 patients with GERD, 63.3% were female and 36.7% were male. Mean BMI of the patient was 23.47±4.59. Of the total 7.8% had history of smoking and 12% patients were alcohol consumer. 27.7% patients were found to have reflux esophagitis. There was statistically significant difference between gender of the patients between the two group (p value=0.05). There was significant association found between current smoking and reflux esophagitis (p=0.03), also, between alcohol consumer and reflux esophagitis (p=0.021) While comparing the endoscopic findings Hiatus hernia was found significantly associated with Reflux esophagitis (p=0.004), Mean BMI and presence of peptic ulcer disease was not significantly associated with Reflux esophagitis (p=0.9) and (p=0.36). Conclusion: The frequency of Reflux esophagitis is 27.7% in our Nepalese patient. Reflux esophagitis is more common in male, predominantly in current smoker and alcoholics and those who are having hiatus hernia. Abstinence of smoking and alcohol drinking along with lifestyle modification might be important steps for prevention of Reflux esophagitis. Keywords: Gastroesophageal reflux disease, Upper GI endoscopy, Reflux esophagitisPublication Translation and Validation of Oral Health-Related Early Childhood Quality of Life Tool for Nepalese Preschool Children(Kathmandu University, 2021) Upadhyay, S; Mathur, VP; Dhillon, JK; Poudyal, SABSTRACT Background Early childhood caries (ECC) in preschool children debilitate their quality of life affecting oral function, appearance and social well-being. A tool for measuring oral health-related quality of life for preschoolers may help in making clinical decisions and assist policy makers in planning and management of health programs in the country. Objective To translate oral health-related early childhood quality of life (OH-ECQoL) tool into Nepali language and test its validity and reliability. Method OH-ECQoL was translated into Nepali language by two Nepalese professional translators which was back translated by professional English translator. This was sent to three independent advisors to see the appropriateness of translation. Pilot testing was done in 20 parents and questionnaire was finalized after needed corrections. Final version was introduced to the 118 parents of children aged 24- 71 months. Caries status was recorded for all children participating in the study. Concurrent, construct, discriminant validity and internal consistency reliability, test -retest reliability were evaluated. Result OH-ECQoL scores and perception of parents for general and oral health of their children was significant (at 0.01 level). There was significant difference in OH-ECQoL scores between no ECC and severe ECC groups and moderate and severe ECC groups (at 0.05 level). There was also a significant correlation between child impact section and family impact section (at 0.01 level). Cronbach’s alpha was 0.891 demonstrating good internal consistency. Intra class coefficient was 0.963 suggesting excellent test- retest reliability. Ninety-one (77.1%) children had severe ECC and 40(33.9%) parents were from upper middle class. Conclusion The Nepali version of OH-ECQoL is a valid and reliable tool for assessing the oral health-related early childhood quality of life in children of Nepal. KEY WORDS Early childhood caries, Oral health-related quality of life, Preschool children