Browsing by Author "Shrestha, A"
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Publication A National Equity Initiative to Address Noncommunicable Diseases and Injuries: Findings and Recommendation from the Nepal NCDI Poverty Commission(Kathmandu University, 2022) Koirala, B; Adhikari, SR; Shrestha, A; Vaidya, A; Aryal, KK; Kalaunee, SP; Shrestha, A; Mishra, SR; Sharma SK; Karki, A; Maharjan, B; Singh, S; Schwarz, D; Gupta, N; Bukhman, G; Karmacharya, BMABSTRACT We aimed to assess the burden of NCDIs across socioeconomic groups, their economic impact, existing health service readiness and availability, current policy frameworks and national investment, and planned programmatic initiatives in Nepal through a comprehensive literature review. Secondary data from Global Burden of Disease estimates from GBD 2015 and National Living Standard Survey 2011 were used to estimate the burden of NCDI and present the relationship of NCDI burden with socioeconomic status. The Commission used these data to define priority NCDI conditions and recommend potential cost-effective, poverty-averting, and equity-promoting health system interventions. NCDIs disproportionately affect the health and well-being of poorer populations in Nepal and cause significant impoverishment. The Commission found a high diversity of NCDIs in Nepal, with approximately 60% of the morbidity and mortality caused by NCDIs without primary quantified behavioral or metabolic risk factors, and nearly half of all NCDI-related DALYs occurring in Nepalese younger than 40 years. The Commission prioritized an expanded set of twenty-five NCDI conditions and recommended introduction or scale-up of twenty-three evidence-based health sector interventions. Implementation of these interventions would avert an estimated 9680 premature deaths per annum by 2030 and would cost approximately $8.76 per capita. The Commission modelled potential financing mechanisms, including increased excise taxation on tobacco, alcohol, and sugar-sweetened beverages, which would provide significant revenue for NCDI-related expenditures. Overall, the Commission’s conclusions are expected to be a valuable contribution to equitable NCDI planning in Nepal and similar resource-constrained settings globally. KEY WORDS NCDI Poverty Commission, Noncommunicable diseases and injuriesPublication A Randomized Trial of Hospital Vs Home Self Administration of Vaginal Misoprostol for Medical Abortion(Kathmandu University, 2014) Shrestha, A; Sedhai, LBABSTRACT Background A combination of mifepristone followed after 24 hrs by misoprostol has proved a safe and effective abortifacient for termination of early pregnancy. Home use of misoprostol for medical abortion is still controversial in many countries including ours where women’s literacy rate is low. Particularly in developing countries, this method markedly decreased the hospital visit which would be beneficial to patients and hospital staff. Objective To see whether the home self administration of vaginal misoprostol was equally effective as administered by trained staff in terms of successful termination of early pregnancy. Secondary outcomes were bleeding and pain duration during medical abortion, side effects, reason for termination of pregnancy and women’s acceptability of the procedure. Method One hundred and eighty eight women requesting medical abortion with pregnancy less than 63 days gestation were randomized into two groups either self administration of vaginal misoprostol (800 mcg) at home or hospital administration 24 hours after oral 200 mg mifepristone. Ultrasound was performed after 14 days to confirm complete abortion. Result The overall success rate was similar in two groups: 89.13% on home group Vs 86.9% in hospital group. Eleven out of 18 women (61.1%) having incomplete abortion had successful termination after 2nd dose misoprostol( 400 mcg). None of the women had continued pregnancy. Multigravida had slightly higher risk of failure (R.R: 1.04). Conclusion Home self administration of vaginal misoprostol was safe and effective for early termination of medical abortion and was acceptable. Use of extra dose of misoprostol has advantage of higher completion rate of abortion. KEY WORDS Medical abortion, mifepristone, misoprostolPublication 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 A Rare Case of Large Left Lateral Wall Vaginal Myoma(Kathmandu University, 2021) Shrestha, A; Mudbari, J; Tamrakar, SR; Pradhan, N; Makaju, R; Karki, SABSTRACT Vaginal leiomyomas are rare, they are uncommon benign tumor with variable clinical presentation. They usually present as a mass per vaginum or dyspareunia or pressure symptoms on the neighbouring structures. We present a case of 47 years lady with mass per vaginum and difficulty in walking and chronic pelvic pain. Her clinical findings suggested a large mass in the left vaginal wall, the mass was approximately 12 x 10 cm in size hindering the visualization of the cervix. Her ultrasonography showed bulky uterus with mass occupying the cervix. This finding was not correlating with the clinical findings. Magnetic resonance imaging (MRI) was done and it was reported as mass lesion in pelvis separate from the cervix abutting the rectum posteriorly. Ultrasonography (USG) guided biopsy was done which was reported as Leiomyoma. She underwent vaginal myomectomy and was confirmed in histopathology as Leiomyoma. A leiomyoma is a smooth muscle tumor that arises from the muscular part of the uterus and rarely seen in the vaginal wall. KEY WORDS Chronic pelvic pain, Leiomyoma, Mass per vaginumPublication A Study on Obstetric Intensive Care in Dhulikhel Hospital, Kathmandu University Hospital(Kathmandu University, 2017) Shrestha, A; Kayastha, B; Kayastha, SABSTRACT Background Maternal mortality ratio in developing countries is high, depending upon the country and region. Many programmes have been launched in different parts of the world like “Safe motherhood Initiatives” under the WHO guidance. An alternative indicator of obstetric health care is obstetric transfer to an intensive care unit. Very few have been reported from developing countries in South East Asia. Objective To determine the intensive care unit (ICU) utilization by critically ill obstetric patients and to see the spectrum and outcome of disease. Method A prospective study performed on obstetric patients admitted to the intensive care unit of Kathmandu university hospital during a five year period (1st January 2010- 31st December 2015). A total of 56 patients were studied. Result The main cause of admission was hypertensive disorder in pregnancy (22 patients), bleeding disorders in pregnancy (18 patients), sepsis (8 patients), heart disease complicating the pregnancy (4 patients) and 4 others with respiratory problems encountered during delivery. These are the important causes of maternal mortality and morbidity. Conclusion In this study obstetric patients form a small percentage of the total patients admitted to ICU and majority of them were with preventable aetiology. In order to decrease the maternal mortality in developing countries better primary health care and efficient referral system is recommended. KEY WORDS Developing countries, Intensive care unit, Maternal morbidity, Maternal mortality, Obstetric patientsPublication A Study on Variations of Branching Pattern of Hepatic Arteries with its Clinical Significance(Kathmandu University, 2020) Mansur, DI; Karki, S; Shrestha, A; KC, BABSTRACT Background Variation of hepatic artery is very frequent and may predispose the patients to inadvertent injury to the vessels during hepato-billiary surgery. With the advancement of new diagnostic, therapeutic and operative techniques for abdomen, the sound knowledge of variations of hepatic arterial system have become increasingly important for dealing clinicians, surgeons and interventional radiologists. Objective To study the variations of hepatic artery and to evaluate the possible clinical significances. Method A total of 104 images of abdominal computed tomography scans were used for this study. The origin and branching patterns of hepatic artery were recorded. After collecting the data, statistical analysis was done. Result The present study concluded that normal branching pattern of hepatic artery was seen in 86.54% cases, whereas 13.46% cases showed different types of variations. Among them, type II and IV pattern were seen in 0.96% in each, type VI in 1.93%, type VII in 2.87% and the most common variation type IX was seen in 3.85%. There were not a single case of type III, V, VIII and X recorded in this study. Addition to these, one of the variants was common hepatic artery originating from abdominal aorta, was seen in 1.93% of cases while the other variant is unnamed artery arising from superior mesenteric artery, was seen in 0.96% of cases. Conclusion The knowledge of the branching pattern of hepatic artery might be helpful for clinicians to the better understanding of the arterial supply of the liver and may reduce the risk of complications. KEY WORDS Hepatic artery, Hepatic artery proper, Left hepatic artery, Right hepatic arteryPublication A Study on Variations of Branching Pattern of Renal Artery with its Clinical Significance(Kathmandu University, 2019) Mansur, DI; Karki, S; Mehta, DK; Shrestha, A; Dhungana, AABSTRACT Background The kidneys are supplied by a single renal artery originating from abdominal aorta. However, recent literature reports great variations in renal blood supply. Hence, it becomes mandatory for the clinicians to understand the abnormality and variations in the renal vasculature. Objective To evaluate the branching pattern of renal artery and its variations. Method The study consisted of Computed Topographic images of 206 kidneys. Numbers and branching pattern of renal artery were recorded. The data was analyzed for presence or absence, source of origin and type of accessory renal artery. Result The present study revealed that 73.79% of kidneys were supplied by a single renal artery, 25.72% by double renal artery and 0.49% by triple renal artery. The hillar branching pattern was recorded in 38.83% and early branching pattern was in 34.95%. The presence of accessory renal artery was recorded in 26.21%. They were originated from abdominal aorta in 22.81% and 3.40% from main renal artery. The prevalence of superior polar artery was found in 6.79%, hilar in 10.19% and inferior polar in 9.22%. Conclusion The knowledge of variations of renal artery becomes essential for the clinician to plan the adequate surgical procedures and to avoid any vascular complication. KEY WORDS Abdominal aorta, Accessory renal artery, Renal arteryPublication Acceptance of Family Planning Amongst Patients Attending Dhulikhel Hospital Obstetrics and Gynecology Department(Kathmandu University, 2014) Shrestha, A; Kayastha, B; Manandhar, S; Chawla, CDABSTRACT Background Knowledge of contraceptive methods is an important factor for an individual to use or not use of family planning methods. In Nepal, at least one modern method of family planning is universal amongst both men and women. Objectives To assess the knowledge, attitude regarding various family planning methods and practice of contraceptives amongst couples attending Dhulikhel Hospital Obstetrics and Gynecology Department. Methods Five hundred and fifteen couples were interviewed. Their knowledge, attitude and practice of contraception were evaluated with the help of pre-evaluated questionnaire. The other variable used were the age of the couple, parity, educational status and economic status having effect on the contraceptive acceptance were taken into consideration. Descriptive analysis was conducted to obtain percentages. Results We observed that 74.98% of women were in the age group of 20-29 years and 59.22% of men were within the age group of 20-29 years. Teen age mothers were 17.86% and teen age fathers were 1.35%. In our study, we observed that higher the educational level better was the acceptance for family planning methods. The higher income group had less number of children compared to lesser income group. In our study, we noticed that all the couples knew about different methods of family planning, main sources of information were television, pamphlets and healthworkers. Only 16 males had undergone vasectomy and 32 women had undergone tubectomy. Fewer number of vasectomy was due to the belief that undergoing vasectomy will make the male partner weak physically. 13.20% of women preferred Depot medroxy progesterone as a temporary method of family planning, 13% of males preferred condom as a temporary method of family planning. Conclusion We conclude that education plays a vital role in the acceptance of family planning. As couples who have higher education level tend to have higher income and they have lesser number of children. They are more receptive towards counseling and agree upon the various methods of family planning. The easy accessibility to the various media like radio, television tend to make people aware of various methods of family planning. KEY WORDS Acceptance, education, family planning.Publication Accuracy of Transvaginal Ultrasound Parameters and Bishop Score as Predictors of Successful Induction of Labor in Term High-Risk Pregnancy(Kathmandu University, 2024) Shakya, S; Shrestha, AABSTRACT Background Induction is one of the most common interventions in obstetrics practice, accounting for 1.4-35%. Cervical favorability is crucial for successful induction. The Bishop score is simple and assesses preinduction cervical favorability based on five components. However, it has high inter- and intra-observer variability. Alternative objective methods are transvaginal ultrasound parameters (e.g., cervical length, width, and funneling). Objective To assess and compare the predictive value of transvaginal ultrasound and bishop score for vaginal delivery. In addition, the time interval from induction to delivery in women undergoing induction of labor. Method This prospective cross-sectional study included 342 pregnant women, in whom induction of labor was performed at 38-42 weeks of gestation. Cervical length, funneling, and width from transvaginal sonography and bishop scores by digital examination are assessed prior to induction in high-risk cases according to standard protocol. Result In our study, both transvaginal cervical length and bishop score showed similar predictors of successful labor induction, i.e., vaginal delivery. The ROC curve for cervical length showed an optimal cut-off value of ≤ 32 mm, corresponding to a sensitivity of 64.2% and a specificity of 60.0%, whereas the optimal cut-off value for Bishop score was ≥ 5, with a sensitivity of 65.1% and a specificity of 62.0%. However, cervical width and the presence of cervical funneling did not correlate. Both cervical length and Bishop score had a significant correlation as predictors of successful induction, with an OR of 0.93 (95% CI 0.91-0.96), an AOR of 0.96 (955 CI 0.9-0.99), and an OR of 1.41 (95% CI 1.2-1.6) and an AOR 1.2 (95% CI 1.1-1.5), respectively. Conclusion Cervical length and bishop score are both good and equally predict of successful induction of labor. KEY WORDS Bishop score, Cervical length measurement, Labor induction, Obstetric deliveryPublication Acute Kidney Injury Secondary to Rhabdomyolysis Due to Wasp Bite(Kathmandu University, 2023) Chapagain, S; Sah, SP; Chhetri Budhathoki, A; Shrestha, AABSTRACT Wasp and bee bites have been well known to cause effects in the human body ranging from minor local skin reactions to deadly anaphylactic reactions. They have also been known to disrupt kidney functions or cause liver injury. The kidney injury associated with wasp bite is a well-known phenomenon, but it is still very rare. We report a case of a 74-year-old man who developed rhabdomyolysis and acute kidney injury, three days after he was bitten by wasp. His symptoms improved after nine days of hospital admission, where he received fluid resuscitation and hemodialysis sessions. This report aims to educate clinicians about the diverse effects of wasp bite for timely diagnosis and management. KEY WORDS Acute kidney injury, Rhabdomyolysis, Wasp bitePublication Adenomyosis at Hysterectomy: Prevalence, Patient Characteristics, Clinical Profile and Histopatholgical Findings(Kathmandu University, 2012) Shrestha, A; Shrestha, R; Sedhai, LB; Pandit, UABSTRACT Background Underlying adenomyosis is often the cause of treatment failure for patients undergoing medical therapy for abnormal uterine bleeding and or chronic pelvic pain. Given the limitation of ultrasonography in diagnosing adenomyosis and MRI being unaffordable to most of the patients belonging to developing countries like us, it often remains undiagnosed before a hysterectomy. Objective To find out the clinical profile associated with adenomyosis and to determine the prevalence of adenomyosis in hysterectomy specimens; frequency distribution, as well as to correlate clinical examination with histopathological examination. Methods A total of 60 women who had undergone hysterectomy with histopathologically proven adenomyosis between April 2009 and March 2010 were included . Data were collected on indication for the intervention, age, symptoms, clinical findings, hemoglobin, menopausal status, gross and histopathological findings. Results A total of 256 women were scheduled for hysterectomy. Adenomyosis was diagnosed in 60 of 256 cases (23.4%). Menorrhagia (91.2%), dysmenorrhoea (84.2%), lower abdominal pain (84.2%) beginning later in reproductive life (mean age- 45yrs) is the classic presentation. Adenomyosis was present in 10 of 61 patients (16.3%) with fibroids; 27 of 60 (45%) with abnormal uterine bleeding; 11 of 55 (20%) with prolapse; four of 35 (11.4%) with ovarian mass; five of 25 (20%) with chronic pelvic pain; three of four (75%) with endometriosis. Conclusion Women undergoing hysterectomy with diagnosis of adenomyosis have a distinct symptomatology. The choice of therapy in adenomyosis is hysterectomy for those women who have completed family and had failed medical therapy . KEY WORDS adenomyosis, hysterectomy, prevalencePublication Adrenal Ganglioneuroma(Kathmandu University, 2020) Kayastha, R; Acharya, R; Pradhan, S; Tuladhar, AS; Shrestha, AABSTRACT Adrenal ganglioneuromas are rare sympathetic differentiated tumors which originate from neural crest cells. These lesions are usually discovered incidentally on imaging and tend to be hormonally silent. Preoperative diagnosis of adrenal ganglioneuroma remains extremely challenging and the gold standard treatment is adrenalectomy. There is good prognosis after surgery without recurrence. We herein report a case of adrenal ganglioneuroma in a 15 year old female who presented with complaint of abdominal discomfort. Contrast Enhanced Computed Tomography abdomen showed a large septated hypodense right suprarenal mass which was echogenic on Ultrasonography. It showed T1 hypointense and T2 hyperintense signal on Magnetic Resonance Imaging of abdomen and pelvis. Excisional biopsy and histological examination of the mass was suggestive of adrenal ganglioneuroma. This report presents the clinical and radiological data for the rare tumor which would share some experience to facililate the diagnosis of adrenal ganglioneuroma. KEY WORDS Adrenal mass, Computed tomography, Ganglioneuroma, Magnetic resonance imaging, UltrasonographyPublication An Anatomical Variation of Median Artery of Forearm and Palm: Cadaveric Study into its Origin and Course(Kathmandu University, 2022) Khan, GA; Shrestha, AABSTRACT Background The median artery (transitory artery) represents the forearm’s embryonic arterial axis. At 8th week of gestation retreats into a little canal that supplies the median nerve. Later, ulnar and radial arteries take its place. Adults may still have it in either a palmar or an antebrachial pattern. The persistent median arteries are a long, angular arterial that extends to the hand’s palmar surface. The median artery only partially recedes in the antebrachial type. Objective To identify the median artery distribution in the adult Nepalese population. Method Twenty-five adult human cadavers’ left and right upper limbs undergone to descriptive research. The persistent median artery was exposed according to the Cunningham’s Manual of Practical Anatomy. Result The forearm and hand arteries in each of the fifty upper limbs from the twenty- five formalin-embalmed human cadavers were studied. Among fifty upper limbs, persistent median arteries were found in six (twelve percent) of them. One percent of a cadaver’s right and left limbs had bilateral persisting median arteries (ante brachial). Persistent median artery of the ante brachial type that arises from the anterior interosseous artery in a right upper limb. Persistent median artery emerging from the posterior interosseous arteries were visible in one right upper limb. Conclusion The study showed persistent median artery of ante brachial type. The posterior interosseus artery is the source of the majority of antebrachial type. A median artery piercing the median nerve was discovered. KEY WORDS Ante brachial, Carpal tunnel variation, Median nerve, Palmar, Persistent median arteryPublication Assessment of Health Service Delivery to Address Cardiovascular Diseases in Nepal(Kathmandu University, 2021) Suwal, PS; Prajapati, D; Bajracharya, S; Shrestha, A; Maharjan, R; Shrestha, S; Jha, N; Koju, RP; Vaidya, AABSTRACT Background A health care delivery system is the organization of people, institutions, and resources designed to deliver health services. A comprehensive study to explore cardiovascular health service delivery in Nepal is lacking. Objective This study attempted to assess Nepal’s health system gap on organization and delivery of cardiovascular disease prevention and management services. Method This mixed-method study used the six building blocks of the World Health Organization health system framework: organization; access; coverage, utilization and demand; equity; quality of services; and outcomes. We conducted the desk reviews of national and international documents, performed several key informant interviews, calculated the relevant indicators, and assessed the Strengths, Weaknesses, Opportunities, and Threats of the cardiovascular health service delivery. Result We found that most of the cardiovascular services are concentrated in urban areas, and suffer from poor access, quality, utilization, and coverage in most of the areas resulting in poor health outcomes. Though the services have recently improved due to increased primary care interventions, there is scope for the development of competent human resources, advancement of technologies, development of national protocols, and improved monitoring and supervision. Improved disease system including the medical recording and reporting mechanism to incorporate and reflect the true burden of CVD in Nepal is lacking. Conclusion Despite having health facilities from grassroots to the central level, availability, access, and quality of cardiovascular health services are poor. Further improvement and equitable expansion of promotive, preventive, diagnostic, referral, and rehabilitative cardiovascular services are needed to ensure universal health coverage. KEY WORDS CVDs, Health-service delivery, Infrastructure, Needs-assessment, NepalPublication Associated Factors and Outcome of Babies Born Through Meconium Stained Amniotic Fluid(Kathmandu University, 2018) Shrestha, A; Singh, SD; Tamrakar, DABSTRACT Background Neonates born through meconium stained amniotic fluid (MSAF) are associated with significant morbidity and mortality. Objective To study the incidence, associated factors and outcome of meconium stained amniotic fluid babies born in Dhulikhel hospital. Method Prospective, cross-sectional study conducted in Obstetric ward and Neonatal Intensive Care Unit (NICU) from 15 December 2015 to 15 December 2016. All the babies born through meconium stained amniotic fluid during the period were included. Result Incidence of meconium stained amniotic fluid was 6.5%(167/2581). Meconium aspiration syndrome (MAS) developed in 9(5.4%) among all meconium stained amniotic fluid cases. Primigravidity and postdatism were observed more in Meconium aspiration syndrome group than meconium stained amniotic fluid group (77.8% VS 73.4%; 33.3% VS 26.3%). Babies delivered by caesarian section were more in meconium stained amniotic fluid group than Meconium aspiration syndrome group (47.5% VS 33.3%). All the babies with meconium stained amniotic fluid improved except one baby with Meconium aspiration syndrome who expired. Neonatal sepsis was a significant co-morbidity in Meconium aspiration syndrome group (P value= 0.008). There was increased incidence of operative delivery in thick meconium stained amniotic fluid than thin meconium stained amniotic fluid (52.6% VS 38.9%). Similarly, Neonatal Intensive Care Unit admission and neonatal complications like Meconium aspiration syndrome, perinatal asphyxia and sepsis were more commonly observed in thick meconium stained amniotic fluid group than thin meconium stained amniotic fluid group. Conclusion The progression to meconium aspiration syndrome in babies with meconium stained amniotic fluid is not associated with any maternal and neonatal factors studied. MAS babies are 10 times more likely to require NICU admission and sepsis is a significant co-morbidity. Thick meconium stained amniotic fluid is worrisome. There is increased chance of operative delivery and neonatal complications if associated with thick meconium stained amniotic fluid. KEY WORDS Meconium, Meconium aspiration syndrome, Meconium stained amniotic fluidPublication Association between Dental Prosthesis and Periodontal Disease among Patients Visiting a Tertiary Dental Care Centre in Eastern Nepal(Kathmandu University, 2015) Mansuri, M; Shrestha, AABSTRACT Background Dental caries and Periodontal diseases are the most prevalent oral health problems present globally. The distribution and severity of such oral health problems varies in different parts of the world and even in different regions of the same country. Nepal is one of the country with higher prevalence rate of these problems. These problems arise in association with multiple factors. Objective This study was carried out to describe the periodontal status and to analyse the association of periodontal disease with the wearing of fixed or removable partial dentures in a Nepalese population reporting to the College of Dental Surgery, B P Koirala Institute of Health Sciences, Dharan, Nepal. Method This study comprised of a sample of 200 adult individuals. All data were collected by performing clinical examinations in accordance with the World Health Organization Oral Health Surveys Basic Methods Criteria. It included the Community Periodontal Index and dental prosthesis examination. Result A descriptive analysis was performed and odds ratio (1.048) and 95% confidence interval (1.001; 1.096) was found out. The mean age of the population participated in the study was 41.82 ± 14.80 years. A total of 93 (46.5%) males and 107 (53.5%) females participated in the study. Among these subjects, 100% presented some periodontal problems. The statistical analysis indicated that the probability of periodontal disease with regards to wearing partial dentures was not significant as suggested by the odds ratio (1.048). Conclusion There is no association of the wearing of dental prosthesis (RPD and/or FPD) with the periodontal disease and suggests a need for populations based oral health education programs, plaque control programs to reduce the incidence of periodontal disease. KEY WORDS Community periodontal index, dental prosthesis, oral health, periodontal disease.Publication Association of Waist Circumference and Body Mass Index among the Students of a Medical College(Kathmandu University, 2023) Sharma, K; Mansur, DI; Shakya, R; Maskey, S; Shrestha, A; Nepal, OABSTRACT Background Obesity and overweight have emerged as significant public health concerns on a global scale. In the pursuit of evaluating body composition and identifying potential health risks, two widely utilized measures are Body Mass Index and waist circumference. These anthropometric indicators are considered economical, practical, and also crucial for screening, monitoring the individual’s nutritional status, and anticipating future disease risk. Objective To explore the correlation between waist circumference and Body Mass Index and find out its significance as indicators of health and nutritional status in young adults. Method The study comprises 260 healthy young adults, aged 18-25 years from pre-clinical sciences, Kathmandu University School of Medical Sciences (KUSMS). Anthropometric measurements of height (m), weight (kg), and waist circumference (cm) were recorded. Body Mass Index was calculated by using the formula as body weight (kg) divided by the square of body height (m2). Demographic factors such as age, sex, obesity, and life style factors like smoking, alcohol consumption, and physical activity were noted. Result The study found a positive correlation between Body Mass Index, waist circumference (WC) and weight. However, no association was found between waist circumference and height. The findings also indicated a notably high percentage of 17.69% participants, who were categorized as overweight, while a 9.23% fell into the underweight category. The study confirms that 83.08% of the students have moderate physical activity whereas 14.62% have insufficient and 2.31% have heavy physical activity. Conclusion The study shows a positive correlation between body mass index (BMI) and waist circumference (WC) in young adults aged 18-25 years. KEY WORDS Anthropometric measurement, Body mass index , Obesity, Waist circumferencePublication Awareness and Knowledge of Glaucoma and their Associated Factors among People Visiting a Tertiary Level Hospital in Central Nepal(Kathmandu University, 2022) Shrestha, A; Shrestha, P; Shrestha, T; Shrestha, RM; Sujakhu, D; Dhakal, K; Thapa, G; Adhikari, S; Karki, S; Adhikari, BABSTRACT Background Glaucoma is one of the major causes of irreversible blindness globally. Almost 60 million people globally are affected by glaucoma making it the second leading cause of blindness worldwide. Diagnosis of glaucoma early on is vital for timely management and prevention of blindness. However, it is challenging to diagnose it early because it is asymptomatic in the initial stage, and there is also the dearth of appropriate screening tools. Awareness, knowledge, and beliefs are believed to influence the treatment-seeking behavior of people as well as their uptake of services. Objective To assess the awareness and knowledge about glaucoma among general patients and patient attendants visiting Dhulikhel Hospital. Method We conducted a cross sectional quantitative study among general patients visiting Dhulikhel Hospital. We collected data using face-to-face interviews with semi- structured questionnaires. We analyzed data in R version 4.0.3 (2020-10-10). We presented numerical variables as mean and standard deviation whereas categorical variables as frequency and percentage. We determined factors associated with awareness and knowledge of glaucoma using logistic regression analysis and estimated adjusted odds ratio (AOR) with 95% confidence interval. Result Of 379 participants, a total of 214 (56.5%) participants had heard about glaucoma. Out of the participants who heard about glaucoma, the mean knowledge score was 48.3±21.7 and 53.3% had good knowledge on glaucoma. The odds of having heard about glaucoma were two percent lower (AOR=0.98; 95%CI: 0.97-0.99; p-value 0.036) in the older participants compared to one year younger participant, 1.98 (95%CI:1.01-3.86; p-value 0.046) times higher among literates and 2.79 (95%CI: 1.76- 4.41; p-value < 0.001) times among participants with previous ocular examination. The odds of having good knowledge was 1.94 (95%CI: 1.10-3.42; p value 0.021) times among participants with previous ocular examinations. Conclusion The knowledge and awareness regarding glaucoma in a hospital-visiting population in central Nepal was low. Half of the participants were unaware of the disease glaucoma and half of the participants who heard of the glaucoma had poor knowledge on glaucoma. KEY WORDS Awareness, Glaucoma, KnowledgePublication Awareness and Knowledge of Glaucoma and their Associated Factors among Staffs in a Tertiary-level Hospital in Central Nepal(Kathmandu University, 2022) Shrestha, A; Shrestha, P; Shrestha, T; Shrestha, RM; Sujakhu, D; Dhakal, K; Thapa, G; Adhikari, S; Karki, S; Poudel, LABSTRACT Background Since glaucoma-related blindness may only be prevented with early identification and treatment, finding asymptomatic individuals in the target population is critical. It is thus important to determine the awareness and knowledge on glaucoma. Objective To determine the knowledge and awareness on glaucoma among the staff of a tertiary level hospital in central Nepal. Method This was a cross sectional study among the staffs of Dhulikhel Hospital who participated voluntarily in the study. The data was collected through the administration of semi-structured questionnaires. R version 4.0.3 (2020-10-10) was used for the data analysis. Categorical variables are presented as frequency (percentages) and the numerical ones are presented as mean (standard deviation). Adjusted odds ratio (AOR) with 95% confidence interval were estimated through logistic regression analysis for determining factors associated with awareness and knowledge of glaucoma. Result A total of 107 (89.2%) participants had heard about glaucoma of which 93 (86.9%) had good knowledge and 14(13.1%) had poor knowledge on glaucoma. The mean score of knowledge was 64.1±16.9. Only 47.7% of the participants said that glaucoma also has an asymptomatic course. We could not find an association of awareness and knowledge of glaucoma with any of the selected sociodemographic variables. Conclusion Although there was a fairly good glaucoma related awareness and knowledge among hospital staff, we found lack of understanding on some critical issues on glaucoma, mainly related to its asymptomatic nature. There is thus room for improvement in educating about glaucoma even in healthcare settings. Given the necessity of expanding glaucoma awareness in the public, hospital staff might potentially serve as messengers to the communities KEY WORDS Awareness, Glaucoma, Hospital Staffs, Knowledge, PracticePublication Awareness Regarding Preventive Measures of Avian Influ- enza Among the Adult People of Thimi Municipality, Nepal(Kathmandu University, 2013) Manandhar, K; Chataut, J; Khanal, K; Shrestha, A; Shrestha, S; Shrestha, SABSTRACT Background Avian influenza is considered as a threat to global public health. Prevention and control depends on the awareness of the general population as well as high risk- groups. The avian influenza should be viewed more seriously because it may lead to pandemic influenza when the virus mutates its strain with the common human influenza. Thus, this study aims to explore the awareness regarding preventive measures of avian influenza among the adult population of Thimi Municipality. Objective The objective of this study was to explore awareness regarding preventive measures of avian influenza among the adult population of Thimi Municipality. Methods It is a cross-sectional, population based study. It was carried out in Thimi Municipality from May 15 to June 15, 2012. Pre tested structured questionnaire was used for face to face interview with randomly selected 250 subjects. Results Out of 250 subjects, 123 (49.2 %) were males. The mean age of subjects was 36 ± 11.8 year. Among total subjects, 94.4 percent had heard about avian influenza. The main source of information was television (94.1%). Majority of subjects (84.9 %) thought that keeping infected birds and poultry as the mode of transmission followed by eating not well cooked poultry meat (82.8 %). Out of total study subjects, 165 (66.0 percent) mentioned fever and 138 (55.2 percent) thought fatigue as the signs and symptoms. As for knowledge about preventive measures, majority (85.6%) stated that cleaning the surfaces that had come in contact with the poultry could prevent the disease and 83.2 % had knowledge that the infection could be prevented by washing hands with soap and water after poultry handling. Awareness regarding preventive measures was found significantly low in females, middle adults, illiterates, and house wives. Conclusion The awareness regarding avian influenza was quite satisfactory among the adult people of Thimi Municipality. However level of awareness was seen lower in female, illiterate and middle adult. So that along with large scale mass education, there should be specific health education program for the specific group of population. KEY WORDS Awareness, avian influenza, preventive measures