Browsing by Author "Shrestha, Ashish"
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Publication A case report of a COPD patient presented in severe metabolic alkalosis Authors(Nepalese Respiratory Society, 2022) Shrestha, Ashish; Gurung, Naresh; Karthak, Ashish; Bhattarai, Sanjeet; Lama, Rakesh; Shrestha, Utsav Kumar; Khanal, Kishor; Ghimire, Anup; Regmi, Ashim; Shrestha, Sanjeet KrishnaAbstract: Chronic Obstructive Pulmonary Disease (COPD) patients generally present with respiratory acidosis and type 2 respiratory failure. Here we present a case of 65 years old female, who is a known case of COPD and presented in our emergency department with severe metabolic alkalosis (pH 7.730, HCO3- greater than 99.9mmol/l). She was referred from other center after the development of seizure. Urinary sodium was sent which indicated the cause of metabolic alkalosis was contraction alkalosis; we then treated the patient with IV fluids, antibiotics and Mechanical Ventilator. Arterial Blood gas analysis was initially done every 4 hours till the pH was corrected. After pH was corrected the patient was extubated to intermitted Non Invasive Ventilation (NIV) for type 2 respiratory failure. With pulmonary rehabilitation we could discharge the patient with inhalers; without the need for NIV or supplementary oxygen. This is one of the rare cases where the patient presented with a very high bicarbonate level, high partial pressure of carbon dioxide in arterial blood, and high pH. The patient was successfully managed with IV fluids and mechanical ventilation.Publication ARDS as a presenting feature in sarcoidosis: an uncommon occurrence(Nepalese Respiratory Society, 2022) Shrestha, Sanjeet K; Malla, Jonas; Bhusal, Yuvaraj; Bhattarai, Sanjeet; Lama, Rakesh; Rayamajhi, Sulav; Gurung, Naresh; Shrestha, Ashish; Karthik, Ashish; Pradhan, Pratistha; Rana, Reena; Khetan, KhusbooAbstract: Sarcoidosis though a chronic multi-system granulomatous disease, predominantly involves respiratory system. Often asymptomatic, patients can present with lymphadenopathy, prolonged fever and shortness of breath. Acute respiratory distress syndrome (ARDS) is relatively uncommon presenting feature of the disease. Here we present a case of a 19 years old female presenting in acute respiratory distress syndrome, eventually being diagnosed as Sarcoidosis. Although different diagnostic criteria have been developed for early diagnosis of sarcoidosis, atypical presentations can always pose significant challenge and lag for the diagnosis.Publication Asymptomatic Pulmonary Cryptococcosis And Tuberculosis Co-infection in an immunocompetent Host: A case report(Nepalese Respiratory Society, 2023) Giri, Rashmi; Khetaan, Khusboo; Aryal, Gopi; Karthik, Ashish; Shrestha, Ashish; Gurung, Naresh; Shrestha, Sanjeet K.Abstract: Pulmonary Cryptococcosis is a rare fungal infection that mostly occurs in immunocompromised host. However, with advancement in diagnostic approach like tissue biopsy, cryptococcal infections are now increasingly being recognised.In immunocompetent host, cryptococcal infection is often asymptomatic and rarely becomes disseminated. Symptom development in immunocompetent host largely depends on burden and virulence of pathogen. Due to similarities in clinical, radiological and pathological findings in Cryptococcosis, Tuberculosis and other fungal infections like Blastomycocosis, it is important to have a tissue biospy to confirm the diagnosis. The aim of this case report is to highlight the investigation necessary to diagnose both fungal infection and Tuberculosis due to similar clinical, radiological features in both. We report a case of Gene Xpert positive Tuberculosis and histopathology proven Pulmonary Cryptococcos in same patient.Publication Cronkhite-Canada Syndrome: A Case Report(Nepal Medical Association, 2022) Sapkota, Prakash; Gurung, Ram Bahadur; Shrestha, Ashish; Paudel, Isha; Shrestha, PramitaAbstract Cronkhite-Canada Syndrome is a rare disease characterised by diffuse gastrointestinal polyposis, abdominal pain, diarrhoea, cutaneous and mucosal hyperpigmentation, alopecia, and onychodystrophy. Here we report a case of a 40-year-old female with Cronkhite-Canada Syndrome, who presented with the complaints of diffuse abdominal pain, blood mixed stools, and diarrhoea associated with tenesmus. She had nausea and reduced appetite and lost 10 kgs in 3 months. She had hair fall (alopecia), atrophic changes of nails (onychodystrophy), and hyperpigmentation of the skin in fingers, tongues, and lips. Histopathological biopsy of the gastric and colonic biopsy revealed polypoid edematous mucosa and the colonic biopsies showed scattered dilated glands with inflammatory exudate and mucin. She got Entamoeba histolytica and COVID-19. She received respective antibiotics and protein diets that helped relieve the symptoms. After 4 weeks of steroids, her symptoms improved drastically. Corticosteroids, treating co-infection along with nutritional counselling can be helpful to relieve the symptoms.Publication Endoscopic Drainage of Pancreatic Pseudocysts: Clinical Profile and Outcome Analysis(Nepal Health Research Council, 2024) Gurung, Ram Bahadur; Sharma, Pasand; Sapkota, Prakash; Shrestha, Ashish; Shrestha, PramitaBackground: Pancreatic pseudocyst is a complication of acute and chronic pancreatitis. Although surgery considered the gold standard, there is a rapid shift towards endoscopic treatment owing to its therapeutic outcome and minimal invasive involvement. This study aims to present the clinical profile and outcome analysis of the endoscopic drainage of pancreatic pseudocysts in Dhulikhel Hospital. Methods: This is a retrospective review of all patients who were diagnosed with pancreatic pseudocyst between January 2015 and December 2018 in Dhulikhel Hospital. The retrospective data were on patient characteristics, etiology, location of the cyst, other clinical characteristics. Results: The study included 51 patients and the average age of the patients in this study was 39 years and among them 62.7% were female. The mean size of pseudocyst was 7.89 cm, and the average days of hospital stay was 13.64. The most common etiology was idiopathic and more than half of the patient’s cyst was in head and/or body, 15 and 36 underwent conservative and therapeutic management respectively. The technical success rate was at 94% and reported increased pancreatic pseudocyst in Dhulikhel Hospital from 2015-18. Conclusions: The study findings highlight the increased trend of pancreatitis pseudocyst as a complication of acute or chronic pancreatitis. Endoscopic drainage of pseudocyst with plastic stent is an established method of managing it. However, pancreatic pseudocyst even larger than 6 cm can undergo spontaneous resolution.Hence, conservative management should be considered first. Keywords: Endoscopic ultrasound; endoscopic drainage; pancreatitis; pancreatic pseudocyst.Publication Hydrocele among Patients undergoing Surgery in the Department of Surgery in a Tertiary Care Center: A Descriptive Cross-sectional Study(Nepal Medical Association, 2024) Deo, Kishor; Chaudhary, Arun Kumar; Shrestha, Reshika; Chaudhary, Aashutosh; Adhikari, Bindira; Bista, Apeksha; Jha, Devesh; Shakya, Niliza; Maharjan, Suresh; Shrestha, Manisha; Shrestha, Ashish; Dahal, Isha; Sutihar, AnshuAbstract Introduction: Hydrocele, an accumulation of serous fluid within the remnant of the processus vaginalis, is a common cause of painless scrotal enlargement. While prevalent, few studies have been conducted to assess the extent and risk factors of hydrocele in Nepal. This study aimed to assess the prevalence and associated factors of hydrocele among patients undergoing the surgery department at a tertiary care center in Nepal. Methods: This descriptive cross-sectional study was conducted at a tertiary care center. Data were retrospectively collected from medical records over one year (2021 July to 2022 June), including all patients undergoing surgery in the general surgery department. Ethical Approval was received from the Institutional Review Committee of the same institute (Reference number: 820/2080/81) Cases of hydrocele surgery were identified, and relevant data were extracted using a structured proforma. Descriptive analyses were performed using Microsoft Excel 2016. Results: Out of 1812 surgeries, 95 (9.72%) were hydrocele surgeries. Of these, 94 (98.95%) were non-communicating hydroceles, 79 (83.16%) were unilateral, and 90 (94.74%) showed positive transillumination tests. The mean age of patients was 50.84 ± 17.02 years, with the highest number of cases in the 46-55 age group (20%). Postoperative complications occurred in 19 (20%) patients, with seroma and surgical site infection being the most common (31.58% each). Conclusions: Hydrocele surgeries comprised a significant portion (5.24%) of surgical cases at the tertiary care center, with the majority being non-communicating and unilateral types.Publication Impact of Pictorial Health Warnings on Cigarette Packs among Current Smokers of Sub-Metropolitan City of Nepal: A Descriptive Cross-sectional Study(Nepal Medical Association, 2024) Shrestha, Ashish; Bhagat, Tarakant; Agrawal, Santosh Kumari; Limbu, BinitaAbstract Introduction: Pictorial health warning on cigarette packs is one of the strategies undertaken by Nepal Government as per the directive of World Health Organization Framework Convention on Tobacco Control to control smoking. It has been more than a decade since the introduction of pictorial health warnings on cigarette packs in Nepal. The objective of this study was to assess the impact of the pictorial warnings among current smokers of Dharan, Nepal. Methods: A descriptive cross-sectional study was conducted among current smokers visiting local shops located near ward offices of Dharan after obtaining ethical approval from Institutional Review Committee (Reference number: 204/080/01 -IRC). A structured and validated Nepali questionnaire was used to interview the smokers about the impact of the pictorial warnings based on their noticeability, behavioural and cognitive responses. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 20.0. The responses of the participants were tabulated in frequencies and percentages. Results: The pictorial warnings were noticed by 277 (98.93%) participants in past one month out of which 11 (3.93%) smokers had always read or looked closely at them. Smoking less frequently was the behaviour change reported by 70 (25%) participants and smoking less around others was reported by and 56 (20%) participants. In total, 189 (67.50%) smokers had thought about the harms of smoking and 160 (57.14%) had intention to quit smoking due to the pictorial warnings. Conclusions: The pictorial health warnings were not so effective in bringing about changes in smoking behaviour of smokers.Publication Non-resolving long term Mucormycosis in Post-COVID-19 Patient: A Case Report Authors(Nepalese Respiratory Society, 2022) Bhattarai, Sanjeet; Karthak, Ashish; Gurung, Naresh; Shrestha, Ashish; Lama, Rakesh; Bhusal, Yuvaraj; Giri, Bijay; Chhetri, Sujan; Shrestha, Sanjeet KrishnaAbstract: With the second wave of COVID-19, there was a surge of cases of mucormycosis co-infection in our health center. We would like to present a case of a 53 years old man with COVID-19 positive status who later developed mucormycosis, with invasion of Maxillary sinus, jugular vein, digastric recess in MRI. He was managed with Amphotericin –B injection along with insulin therapy in sliding scale and Posaconazole thereafter for six months. Debridement of the lesion was done along with removal of inferior alveolar process of maxillary process and 3 molar teeth and a premolar tooth of upper left side.Publication Peripheral Ameloblastoma of Acanthomatous Variant: A Case Report(Nepal Medical Association, 2022) Singh, Ripu; Shrestha, Sajeev; Acharya, Pujan; Shrestha, AshishAbstract Ameloblastoma is an uncommon benign epithelial neoplasm of odontogenic origin that accounts for about 18% of the odontogenic tumour. It is a slow-growing, locally invasive but rarely metastatic tumour. Extraosseously occurring peripheral ameloblastoma is a rare variant that comprises about 2-10% of all ameloblastoma. We report a case of peripheral ameloblastoma in a 43-years old male patient affecting the mandibular canine-premolar region with a histopathological diagnosis of acanthomatous ameloblastoma. This case report emphasises the clinical, radiographic, and histological features of a rare variant that distinguishes it from the other similar appearing lesion on gingiva along with its various treatment modalities.Publication Prevalence of Cleft Lip and Palate in the Developing Countries of Asia and Africa: A Review Authors(Nepal Paediatric Society (JNPS), 2022) Shrestha, Ashish; Hoang, Ha; Gardner, Sue; Pradhan, Archana; Crocombe, LeonardAbstract: Introduction: The objective of this paper is to review the literature on the incidence of cleft lip and palate (CLP) in the developing countries of Asia and Africa. The existing literature tends to focus on developed countries and there is lack of research in developing countries. Methods: The studies that met the inclusion criteria were reviewed and data extracted. There were 20 studies done in Asian and African countries which were included. Results: The incidence of CLP in Asian countries is markedly greater than in African countries. Most studies report a male predominance in CLPs and a female predominance in cleft palates. The male dominance is seen more than other developing countries which is consistent with other Asian countries and the same has been found in African countries. In the Nepalese study, females were slightly more affected than males among all clefts. The incidence or prevalence in the frequency and types of malformations of CLP in developing countries has been provided. Conclusions: The review underlines the need for an aggressive approach to prevent and control CLP in patients in developing countries.Publication Pulmonary Mucormycosis secondary to Severe Acute Respiratory Illness due to Covid 19 Infection: A Case Report Authors(Nepalese Respiratory Society, 2022) Karthak, Ashish; Shrestha, Ashish; Gurung, Naresh; Bhusal, Yuvaraj; Lama, Rakesh; Rayamajhi, Sulav; Bhattarai, Sanjeet; Regmi, Asim; Ghimire, Anup; Khanal, Kishor; Shrestha, Sanjeet KAbstract: Patients diagnosed and hospitalized with SARS COV-2 are managed with corticosteroids due to its known benefits for the prevention of airway inflammation secondary to acute respiratory distress syndrome seen commonly in viral pneumonia. However, these patients carry a high risk of developing secondary bacterial and fungal infection. We present a case of 60-year-old male with COVID-19 pneumonia. The patient was diagnosed with pulmonary mucormycosis 18 days following admission. The patient was treated with broad-spectrum antibiotics, remdesivir and corticosteroids along with antifungals including voriconazole and amphotericin B with no significant improvement. However, even after extensive medical management patient was eventually intubated and succumbed to its complications. Mucormycosis although an uncommon infection should be considered due to extensive use of glucocorticoid therapy and concurrent comorbidities present among COVID-19 patients.