Browsing by Author "Shrestha, Asim"
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Publication Characteristics and Outcomes of COVID-19 Patients Admitted to Adult Intensive Care Unit: A Single-Center Observational Study from the Second Wave in Nepal(Institute of Medicine, 2021) Pradhan, Saurabh; Upreti, Anup R; Upadhyaya, Sarobar; Oli, Manish; Shrestha, Asim; Shrestha, YashaswiABSTRACT Introduction: There is inadequate data of critically ill COVID-19 caused by the delta variant. So, we sought to investigate the characteristics and outcomes during the second wave in Nepal. Methods: COVID-19 patients admitted to adult ICU of a single institution from April to August 2021 were included. Clinical, laboratory and radiological findings were collected. In-hospital mortality, length of ICU stay, duration of mechanical ventilation (MV) and complications during ICU stay were obtained. Results: Total 136 patients were included with a mean age of 56.24 (± 15.81) years and 52.2% males. Fifty-five percent had comorbidities. Mean fraction of inspired oxygen required was 0.8 and sequential organ failure assessment score on admission was 4.09. C-reactive protein (CRP), lactate dehydrogenase and ferritin levels were elevated to 62.5mg/L, 515 U/L and 472ng/mL respectively. The computed tomography score was 20. Thirty four (25%) required MV; 70 (52%) were managed with non-invasive ventilation; 41 (30.14%) required vasopressors; 4 (2.9%) required renal replacement therapy. In-hospital mortality was 43.4%. The median length of ICU stay and duration of MV were 6 and 3.5 days respectively. Hospital acquired infection was the commonest complication. Age (OR 1.126 (95% CI 1037-1.223, p value 0.005)) and CRP on admission (OR 1.023 (95% CI 1.000-1.047, p value 0.050) were found to be predictors of mortality. Conclusion: In this single center study from the second wave of the pandemic, majority of critically ill COVID-19 patients were elderly with co-existing illnesses. In-hospital mortality was high. Age and CRP on admission were found to be independently associated with poor outcome. Keywords: Characteristics, COVID-19, critical care, Nepal, outcomesPublication Clinical Profile of Children with Acute Febrile Encephalopathy in a Tertiary Health Care Center of Nepal(Nepal Paediatric Society (JNPS), 2015) Sharma, Poonam; Sarmah, BK; Kayastha, Pawana; Shrestha, Asim; Tiwari, DamodarAbstract: Background: Acute febrile encephalopathy is a common and severe neurological syndrome that is associated with significant morbidity and mortality in children. The etiologies differ according to geographical regions and appropriate and efficient protocols for investigations and management requires proper understanding of various potential etiologies. Methods: In this prospective observational study, 54 children of one month to 14 years presenting to the hospital with acute onset of fever with altered sensorium were clinically evaluated and investigated. Clinical examinations included temperature, pulse rate, heart rate, blood pressure, coma severity by GCS, respiratory pattern and detail systemic and CNS examination. Etiology of acute febrile encephalopathy was based on clinical history, examination and relevant laboratory investigations. Results: The incidence of acute febrile encephalopathy was 5.5% of the total hospital admissions. There were 35(64.8%) boys and 19(35.2%) girls. The maximum number of children 24(44.4%) were between one to five years of age. The most common presenting complains besides fever and altered sensorium were seizures and vomiting which was present in 59.3% and 46.3% of children respectively. Signs of meningeal irritation, hypertonia, brisk deep tendon reflexes and extensor plantar response was present in 50%, 24%, 29.6%, and 44.4% respectively. The diagnosis based on clinical findings and laboratory investigations were viral encephalitis 34(63%), bacterial meningitis 12(22.2%), cerebral malaria 4(7.4), enteric encephalopathy 3(5.6%) and hepatic encephalopathy 1(1.9%). Conclusion: Viral encephalitis and bacterial meningitis are the most common cause of acute febrile encephalopathy. Preventive strategies can be done to decrease the incidence.Publication Compliance of WHO Surgical Safety Checklist at a Pediatric Surgical Unit in a Tertiary Level Hospital: A Descriptive Cross-sectional Study Authors(Nepal Medical Association, 2021) Bajracharya, Jasmine; Shrestha, Ritesh; Karki, Deepika; Shrestha, AsimAbstract: Introduction: The Surgical safety checklist by World Health Organization has been used for the last two decades. There is every chance of unwanted expected disasters in Operating-Room in Pediatricsurgical cases. Our study is to observe the utilization of the safety checklist and evaluate occurrence of never-events in Tertiary Level Pediatric Surgery Unit in Nepal. Methods: A descriptive cross-sectional study was done at Nepal Medical College Teaching Hospital from January 2021-June 2021 with record-based data of children from 0-15 years operated in Pediatric Surgery unit from March 2017-July 2018. Ethical approval (Reference number: 049-077-078) was taken from the Institution review committee of the institute. Convenience sampling was done. Self-designed Pro-forma with demographic data along with World Health Organization-Surgical-safety-checklist used was collected and entered in Microsoft-Excel. Data were analyzed using Statistical-Package-for-the-Social-Sciences-version-25. Point estimate at 95% Confidence Interval was done along with frequency and proportion for binary data. Results: Out of 267 cases enrolled, 103 (38.6%) (35.6-41.6 at 95% Confidence Interval) were fully compliant with the checklist, 69 (25.8%) partially compliant. Among compliant cases, 148 (55.4%) Sign-in part, 128 (47.9%) cases -Time-out part and 152 (56.9%) cases Sign-out part were complete. Conclusions: Compliance with World Health Organization-Surgical-safety-checklist has a major role in preventing morbidity and mortality in Pediatric surgical cases. With proper use of the checklist, the unwanted never-events can be prevented with better surgical outcomes.Publication Psychiatric Disorders in Adolescents Attending Psychiatry Outpatient Department in a Tertiary Care Hospital: A Descriptive Cross-sectional Study(Nepal Medical Association, 2021) Joshi, Neelam; Shrestha, Asim; Karki, Deepika; Singh, Pradip ManAbstract: Introduction: Adolescence is the time when most mental illness begins most of the time these problems are overlooked leading to increased morbidity and mortality. The study is undertaken to find out the prevalence of psychiatric disorders in adolescents attending psychiatry outpatient department in a tertiary hospital. Methods: A descriptive cross-sectional study was done from 1st December 2019 to 29th November 2020 at a tertiary care centre of Kathmandu. Ethical approval (Ref No.: 012-076/077) was taken from the Institution Review Committee. A semi-structured proforma was used for the socio-demographic profile of patients and International Classification of Diseases-10 was used to make the diagnosis. Data were analyzed using Statistical Package for the Social Sciences version 16. Results: A total of 174 adolescents were included in the study. Out of the total cases 141 (81.03%) (75.1-86.8 at 95% Confidence Interval) were diagnosed with psychiatric disorders, among them 73 (51.77%) were males and 68 (48.23%) were females. The common diagnoses were anxiety disorders 63 (36.20%), mood disorders 34 (19.54%), psychotic disorders 26 (14.94%), substance use disorders 8 (4.59%), non-organic sleep disorders 5 (2.87%), behavioral and emotional disorders 3 (1.72%) and mental retardation 2 (1.149%). Conclusions: Prevalence of psychiatric illnesses is high in the adolescent population compared to the similar studies.Publication Skin Tumors among Biopsy Samples in Patients Attending Dermatological Out Patient Department in a Tertiary Care Hospital of Nepal: A Descriptive Cross-sectional Study(Nepal Medical Association, 2021) Shrestha, Shristi; Rana, Arnija; Karki, Deepika; Shrestha, AsimAbstract: Introduction: Skin tumors are on the rise in the Nepalese community. The different morphological pattern of skin tumors requires its meticulous categorization for understanding its effect on prognosis and treatment. Our study aimed at studying the prevalence of skin tumors among the skin biopsies performed in the dermatology outpatient department in a tertiary care hospital of Nepal. Methods: A descriptive cross-sectional study was done from skin biopsy samples from 1st January, 2017 to 31st December, 2019, at a tertiary care center. Ethical clearance was taken from the institutional review committee (IRC), Ref No: 056-077/078. Convenience sampling was done. A self-designed proforma containing questions on the patients' socio-demographic data and clinical details were used, and a biopsy of those clinically suspected to have skin tumors was done. Skin tumors were classified according to the World Health Organization 2018 classification of skin tumors. Data were analyzed using Statistical Package for the Social Sciences Version 16. Point estimate at 95% Confidence Interval was done, and frequency and proportion were calculated. Results: A total of 671 skin biopsies were done during this study, out of which 125 (18.63%) at 95% Confidence Interval (15.68-21.57) were diagnosed with skin tumors. Among them, 77 (61.6%) were female, and 48 (38.4%) were male. Among the diagnosed cases, 105 (84%) were benign, and 20 (16%) were malignant. Conclusions: The findings from our study show the increasing prevalence of skin tumors, and the results were comparable to other similar studies conducted in various parts of Nepal.Publication Type II Lip Pattern among Medical Students in a Medical College: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Katwal, Barshika; Karki, Deepika; Shrestha, AsimAbstract Introduction: The study of human identification is of great value in forensic medicine. Lip patterns have unique nature and individualism so can be used for human identification. The aim of this study was to find out the prevalence of Type II lip print patterns among medical students in a medical college. Methods: A descriptive cross-sectional study was conducted in a medical college from 5 March 2022 to 1 April 2022 after ethical approval from the Institution Review Committee (Reference number: 057-078/079). The lip print pattern was categorized according to Tsuchihanshi’s classification. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 100 medical students, the Type II lip pattern was seen in 26 (26%) (17.40-34.60, 95% Confidence Interval) students. The largest number of participants was seen in 21 (80.76%) from the age group of 20-25 years. Conclusions: The prevalence of Type II lip pattern among medical students was similar to other studies done in similar settings.Publication Type II Lip Pattern among Medical Students in a Medical College: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Katwal, Barshika; Karki, Deepika; Shrestha, AsimAbstract Introduction: The study of human identification is of great value in forensic medicine. Lip patterns have unique nature and individualism so can be used for human identification. The aim of this study was to find out the prevalence of Type II lip print patterns among medical students in a medical college. Methods: A descriptive cross-sectional study was conducted in a medical college from 5 March 2022 to 1 April 2022 after ethical approval from the Institution Review Committee (Reference number: 057-078/079). The lip print pattern was categorized according to Tsuchihanshi’s classification. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 100 medical students, the Type II lip pattern was seen in 26 (26%) (17.40-34.60, 95% Confidence Interval) students. The largest number of participants was seen in 21 (80.76%) from the age group of 20-25 years. Conclusions: The prevalence of Type II lip pattern among medical students was similar to other studies done in similar settings.Publication Variations of Dermatological Findings in New-Borns of a Community Hospital in Nepal(Nepal Paediatric Society (JNPS), 2017) Shrestha, Asim; Shrestha, SmritiAbstract: Introduction: Skin manifestations are common in neonates. The prevalence of skin changes and their association with neonatal and maternal factors are not adequately documented in Nepal. It is important to differentiate common benign skin lesions from infrequent skin changes that cause morbidity, requiring medical management. The objectives of this study were to determine the pattern of skin lesions in new-borns and their association with maternal and neonatal variables. Material and Methods: This was a prospective, cross-sectional study conducted in obstetric unit of the hospital from December 2016 to May 2017. Outborn babies and babies shifted to NICU were excluded. Results: A total of 935 new-borns were examined. The commonest skin lesions were Mongolian spot (66.7%), Erythema toxicum (46.6%), Milia (44.4%), Epstein pearls (26.4%) and Salmon patch (11.9%). Mothers aged 35 years or older (63.6%) had statistically significant association with Erythema toxicum (p=0.01). Erythema toxicum was more in primiparity, term pregnancy and caesarean section delivery. Milia was associated with male babies. Salmon patch was seen more in term pregnancy. Congenital melanocytic nevus, haemangioma and port-wine stain were noted in three, two and one new-borns respectively, which alter morbidity and hence are important to diagnose in time. Conclusion: We found that 93.8% of neonates had at one or more skin lesions. The majority of skin lesions were benign and transient. Erythema toxicum was seen commonly in mothers aged 35 and more. Salmon patch was seen more in term pregnancy.