Browsing by Author "Ranabhat, K"
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Publication Effect of preload reduction by haemodialysis on doppler indices of diastolic function in patients with end-stage renal disease(Kathmandu University, 2008) Acharya, P; Ranabhat, K; Trikhatri, Y; Manandhar, DN; Sharma, SK; Karki, PAbstract Objective: To assess the influence of preload reduction by haemodialysis on Doppler echocardiographic indices of cardiac diastolic function. Methodology: Parameters of left ventricular diastolic function were measured in patients with end-stage renal disease before and after a single session of haemodialysis. Patients with valvular heart disease, coronary artery disease, cardiomyopathies, pericardial disease and those not in sinus rhythm were excluded from the study. Results: Seventeen subjects (12 males and 5 females, mean age 48 ± 16 years) were studied. Over the duration of 3.7 ± 0.6 hours of haemodialysis, 2.6 ± 1.3 litres of ultrafiltrate was removed. The comparison of pre and post haemodialysis peak mitral E and A velocities showed a decrease in E velocity (p < 0.01) whereas the change in A velocity was not significant. The E/A ratio decreased significantly (p < 0.05).The decrease in E velocity correlated well with the amount of ultrafiltrate (r = 0.653, p < 0.01). There was a significant increase in isovolumetric relaxation time (p< 0.05) whereas deceleration time did not change (p =0.3). Conclusion: Ultrafiltration during haemodialysis causes a rapid reduction in preload. It results in decreased early left ventricular diastolic filling without a change in the atrial phase of filling, hence causing a decrease in calculated E/A ratio. Key words: Doppler indices, echocardiography, diastolic function, end-stage renal disease, BPKIHSPublication Genetic variability of the human filarial parasite, Wuchereria bancrofti in Southern parts of Nepal(Institute of Medicine, 2015) Adhikari, RK; Sherchand, JB; Hoti, SL; Vishal, LA; Mishra, SR; Weber, EJW; Khanal, PR; Joshi, G; Dumre, SP; Adhikari, R; Nazeer, S; Ranabhat, K; Wagle, RRAbstract Introduction: Lymphatic filariasis (LF) is a neglected tropical disease, caused by Wuchereria bancrofti parasite and pose potential risk to about 1.4 billion people in 73 countries. In Nepal, 60 out of 75 districts are endemic and nearly 90% of the population is at risk and mass drug administration (MDA) has beenin place since 2003. Yet, information about the genetic diversity of W. bancrofti is largely lacking. Methods: The genetic variability of the parasites in two localities Kailali and Kapilbastu from south- western parts of Nepal were studied. Blood samples were collected at night and stained with Giemsa stain and positive archived slides were taken for the study. W. Bancrofti was individually picked under microscope and gDNA was isolated from the pooled (100 mf) samples. Short Tandem 29bp Repeats (STR) from the intronic region of Abundant Larval Transcript-2 (ALT-2) gene and haplotype mapping of the Internal Transcribed Spacer (ITS-1) region were studied. The phylogenetic trees were constructed and analyzed. Results: The analyses of STR, haplotypes and the phylogenetic trees indicated the presence of at least two genetically distinct clusters among the W. Bancrofti parasite populations in two areas. Conclusion: The study identified two genetically distinct clusters of mf in the populations. The finding of two genetic “variants” of W. bancrofti in the present study has important implications for filariasis epidemiology and control/elimination program. Keywords: Genetic variability, Lymphatic filariasis, Nepal, Wuchereria bancroftiPublication Neuritic Leprosy; An Intriguing Re-visit to a Forbidden Ailment(Kathmandu University, 2019) Shrestha, BK; Ranabhat, K; Pant, R; Sapkota, S; Shrestha, SABSTRACT Leprosy is a chronic infectious disease that presents with varied manifestations. Pure neuritic leprosy is one of the rarest forms of the disease which is characterized by nerve involvement without the characteristic cutaneous stigmata. Eleven year old, healthy male presented with progressively increasing painful swelling at the medial aspect of the arm near to the right elbow joint with difficulty in extending right ring and little fingers at interphalangeal joint and numbness in the same region for last 1 year with no cutaneous abnormalities. Physical examination revealed 6x3 cm firm, tender lesion 3 cm proximal to the right elbow joint with positive tinel’s sign, without signs of inflammation, along with characteristic claw hand deformity of right hand and atrophy of hypothenar and interossei muscle. Electro-diagnostic testing revealed findings consistent with a right ulnar axonal neuropathy above the elbow. Magnetic resonance imaging revealed well defined heterogeneously hyper intense linear lesion along the course of thickened ulnar nerve in the distal arm extending posterior to the medial condyle. It also showed an oval shaped lesion (2.1x1.0 cm) arising from the same segment of the nerve, without any bony or muscular involvement of that area. The patient underwent surgical exploration and ulnar nerve decompression with biopsy. Pathology revealed necrotizing granulomatous inflammatory acid fast bacilli stain negative lesion, which was histologically consistent with caseous abscess caused by tuberculoid leprosy, pathognomonic for Hansen’s disease. He has been started on antibiotic therapy and is referred to leprosy center for further course of management. Pure neuritic leprosy, though rare, should be considered as differential diagnosis in cases presenting with peripheral neuropathy at leprosy-endemic areas. Prompt diagnosis and treatment is imperative to prevent permanent neurological injury. KEY WORDS Leprosy, Neuropathy, Ulnar nervePublication Outcome of Surgical Resection of Craniopharyngioma: Single Center 12 Years’ Experience(Kathmandu University, 2018) Bishokarma, S; Shrestha, S; Ranabhat, K; Koirala, S; Shrestha, D; Panth, R; Gongal, DNABSTRACT Background Craniopharyngiomas (CPs) are rare epithelial tumors arising from the Rathke’s pouch remnant located along the path of the craniopharyngeal duct accounting for 1.2-4% of all primary intracranial brain tumors, the primary treatment of which is surgery. Objective Whether radical surgical resection or partial resection followed by radiotherapy is a topic of debate. We presented our 12 years single center experience on surgical resection of craniopharyngioma. Method This was a descriptive cross-sectional study conducted among forty-five patients who underwent transcranial resection of craniopharyngioma during a period of 12 years. Data were collected from medical record archives. Glassgow outcome score (GOS), electrolyte imbalance and visual complications were assessed as outcome measure. GOS > 3 was considered favorable while score ≤ 3 was considered unfavorable. Recurrence of tumors were analyzed. Result Out of 45 patients, 28 patients were male with male to female ration of 1.64. Mean age was 32.22±16.42 years. Supra-sellar craniopharyngioma were the most common location. Gross total resection was accomplished in 32 patients (71.1%) while subtotal resection among 13 patients (28.9%). Post-operative Diabetes Insipidus was developed among 35 patients (77.7%). Adamantinomatous craniopharyngioma was the most common histopathological type. Postoperative MRI with contrast was repeated to ascertain the completeness of resection. All patient with subtotal resection received radiotherapy. Follow up period ranged from 3 months to 8 years with mean of 4.2 years. Favorable outcome (GOS>3) was seen among 41 patients while unfavorable among 4 patients. Recurrence seen among 4 patients (8.9%). Overall mortality was 4 (8.8%). Conclusion Gross total excision of craniopharyngioma has a favorable outcome with acceptable morbidity. KEY WORDS Adamantinomatous, Craniopharyngioma, Pterional craniotomy, Radiation therapyPublication Public Awareness and Attitude towards COVID-19 Infection and Vaccines: A cross-sectional national survey in Nepal(Kathmandu University, 2023) Pant, S; Bhattarai, S; Ranabhat, K; Dumre, SP; Rajbhandari, B; Mudvari, A; Bista, B; Bhandari, R; Adhikari, SK; Dhimal, M; Gyanwali, PABSTRACT Background To combat COVID-19, high vaccination rates are essential. However, challenges such as vaccine denial, lack of knowledge, and negative attitudes hinder progress. Assessing public understanding of vaccination is crucial to promote acceptance and reducing reluctance. Objective To understand people’s awareness and attitude regarding COVID-19 infection and vaccines in Nepal. Method A cross-sectional web-based survey was conducted among the Nepali population of age 18 years and above in April 2021 during the early phase of vaccination deployment. A structured questionnaire was used to collect awareness data, and a five-point Likert scale was employed to assess participants’ attitudes. The survey categorized participants into two groups based on whether their awareness level or attitude score was above or below the mean. The secondary outcome was the association between socio-demographic factors and COVID-19 awareness or attitude. Result Of 475 eligible participants, 46% had a low level of awareness on COVID-19 infection whereas 56% had low awareness on COVID-19 vaccines. Every six out of ten participants had a positive attitude towards the national COVID-19 vaccination program. Most of the participants had high awareness of COVID-19 symptoms and preventive measures (hand hygiene, physical distancing, mask), but two-thirds had a false perception of vaccine safety and contraindications. People’s education status, occupation, province, and current/prior COVID-19 infection status were found to be significantly associated with their awareness regarding COVID-19 disease or vaccines. Conclusion The study revealed limited COVID-19 awareness among the Nepali population but a positive attitude toward the national vaccination program. Regular updates on COVID-19 and vaccines are important as new variants and vaccines emerge. KEY WORDS Attitude, COVID-19 virus, Public awareness, VaccinationPublication Quality of life of people living with lymphoedema: A cross sectional community based study in selected districts of Nepal(Institute of Medicine, 2014) Adhikari, RK; Sherchand, JB; Mishra, SR; Ranabhat, K; Wagle, RRAbstract Introduction: Lymphatic Filariasis (LF) is the second most common cause of physical disability worldwide with 40 million people chronically disabled by the disease and about twice that number suffering from covert lymphatic changes or kidney diseases. The most common chronic manifestations of the disease are lymphoedema and hydrocele. The objective of this study is to evaluate the quality of life (QOL) of lymphoedema patients in Nepal. Methods: We sought the help of female community health volunteers, health workers working in peripheral health centers in selected sentinel surveillance sites in listing out the names of patients with lymphoedema. The researcher obtained details of 205 cases of lymphoedema (49 cases of Elephantiasis and 156 cases of hydrocele) in three districts (Dhading 74, Kapilbastu 78, Kailali 53). A total of 205 healthy individuals were selected from the same locality (Dhading 68, Kapilbastu 66, Kailali 71) for comparison. World Health Organization Quality of Life questionnaire brief version (WHO QOL-BREF) was used for data collection. Results: The mean age of the respondents was 45.95 years with a standard deviation of 17.96 years. In four domains, the physical domain scored highest (14.28±2.52) and the environmental domain scored lowest (12.19±1.69). Patients with lymphoedema had significantly low QOL scores in physical (p<0.001), psychological (p<0.001), social relationship (p<0.001), and environmental (p<0.001) compared to their healthy counterparts. Similarly, the overall QOL score was lower in patients with lymphoedema than in healthy control, and it was statistically significant (p<0.001). Conclusion: This study reports significantly low QOL scores in all four domains in patient with lymphoedema denoting low quality of life compared to their healthy counterparts. It is recommended that the current Lymphatic Filariasis elimination program of Nepal should focus to initiate morbidity management program specifically to patients with lymphoedema and hydrocele. Keywords: Lymphoedema, filariasis, quality of life, cross sectional studies, Nepal