NepMed Repository :: Browsing by Author "Shrestha, B"

Browsing by Author "Shrestha, B"

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A Cross-Sectional Study of Medication Adherence Pattern and Factors Affecting the Adherence in Chronic Obstructive Pulmonary Disease
(Kathmandu University, 2015) Shrestha, R; Pant, A; Shakya Shrestha, S; Shrestha, B; Gurung, RB; Karmacharya, BM
ABSTRACT Background Chronic obstructive pulmonary disease (COPD) is considered as a major health problem, associated with mortality and morbidities. Various disease management strategies have been established to optimize patient’s longevity and functional status where patient adherence to the prescribed treatment plays a key role. Poor adherence to medication is common among COPD patients and is affected by number of factors like number of medicines, delivery devices and patient-related factors. Objective This study aims to investigate the adherence pattern in the management of COPD and factors affecting patient adherence to the prescribed treatment. Method This study is a cross-sectional study which was conducted in a tertiary care hospital. Those patients suffering from COPD of all age were enrolled in this study and prior informed consent was obtained from patients. The structured questionnaire was used to interview those patients. Result Total 100 patients were enrolled in this study, among which most patients (45%) were of age groups 60-70 years. Unintentional non-adherence to medication attributed for 65% of patients and the major reason was forgetfulness (52.3%). Most patients had discontinued the medication due to experience of side effects (63.3%). The result showed significant association between adherence and polypharmacy (p=0.00). However, there was no significant association between adherence and age, sex, mode of administration of drugs, technics to use delivery devices etc. Conclusion Majority of COPD patients were elderly (mean age= 68.4 years). Forgetfulness was associated with medication non-adherence. Most of the patients had discontinued medication because of side effects. Polypharmacy is one of the major factors associated with non-adherence to medication in COPD. KEY WORDS Adherence, COPD, Dhulikhel Hospital, non-adherence, polypharmacy
Abnormal Venous Dilatation other than Typical Varicose Vein, Rare Encounters
(Kathmandu University, 2018) Karmacharya, RM; Shrestha, B; Shrestha, BK; Devbhandari, M; Tuladhar, SM; Hodde, A; Thermann, F
ABSTRACT Varicose vein, one of the common vascular illnesses is usually a disease in lower limb. This is due to reflux of blood from deep venous system to superficial venous system. Rarely, this disease can also happen in veins in different location. Four such rare encounters are mentioned in this case series. KEY WORDS Superficial veins, Unconventional sites, Varicose vein
Analysis of Consecutive Open Surgeries for Varicose Vein at Dhulikhel Hospital
(Kathmandu University, 2014) Karmacharya, RM; Shakya, YR; Shrestha, B
ABSTRACT Background Varicose veins are prominent dilated veins in the lower limb primarily due to disease in the junction between superficial and deep venous system. Operative treatment of such condition significantly improves quality of life and also demonstrably decreases the potential complications. We present with analysis of fifty one consecutive open surgeries for varicose vein at Dhulikhel Hospital. Objective To analyze consecutive open surgeries for varicose vein in terms of gender, age, presenting complaints, findings and post operative outcomes. Method All the cases posted for open surgeries for varicose vein at Dhulikhel Hospital during September 2012 – July 2013 were included. If great saphenous vein in thigh was more than 3 mm, segmental stripping was done. The collected data was analyzed using SPSS version 13.0. Result There were 51 cases with 47%male and 53% female. Mean age was 48.9 years. Prominent dilated vein was the most common presenting complaints. Incompetent saphenofemoral junction was present in 68.6% cases. Segmental stripping was done in 51% cases. Mean days of admission was 2.6 days. Mean pain free day was on 3.2 days. In an average, patient were able to walk normally in 4.1 days. Analysis of hospital admission days, ability to walk normally and pain free day attained in between stripping required and stripping not required group showed significant difference with higher values in stripping required group. Conclusion Although conventional stripping surgery has long been performed for varicose vein, this is associated with prolonged hospital admission, prolonged time required for ability to walk normally, and prolonged time taken for pain free status. Hence newer modalities of treatment like radiofrequency ablation is warranted in our setup too. KEY WORDS Saphenofemoral junction, stripping surgery, varicose vein
Anthropometrically Determined Undernutrition among the Adolescent Girls in Kathmandu Valley
(Kathmandu University, 2015) Shrestha, B
ABSTRACT Background No information exists regarding the health of the adolescent girls residing in Kathmandu valley in urban setup. Objective To evaluate the prevalence of undernutrition among the adolescent girls living in Kathmandu valley. It also aims to know the distribution of weight, height and body mass index of adolescent girls in relation to the different adolescent age groups. Method A cross sectional study was conducted in one government and two private schools in Kathmandu valley from 16th April to 15th September 2010. Anthropometric measurements were recorded using standardized methodology as recommended by World Health Organization (WHO). Standard operational definitions like percentiles, mean, standard deviation and proportions were used for analysis. Result Four hundred adolescent girls were enrolled randomly, out of which 111 girls (27.8%) were from government school and 289 girls (72.2 %) were from private schools. Maximum were of 16 years of age and the least were of 19 years of age, mean age being 15.4 years of age. Of them, early, mid and late adolescents were 41%, 35% and 24% respectively. Around one third of the study population were stunted (32%), one fourth were underweight (24%) and one tenth of them were thin (9.5%) based on National Center for Health Statistics (NCHS )standard. Both underweight and stunted girls were significantly more during the late adolescence period (P<0.001). However, thinness was not significant in any of the three adolescent age groups. Conclusion A high prevalence of undernutrition in terms of stunting, underweight and thinness exists among the adolescent girls in Kathmandu valley. KEY WORDS Adolescent girls, Kathmandu valley, undernutrition
Causes of stillbirths and neonatal deaths in Dhanusha district, Nepal: A verbal autopsy study
(Kathmandu University, 2010) Manandhar, SR; Ojha, A; Manandhar, DS; Shrestha, B; Shrestha, D; Saville, N; Costello, AM; Osrin, D
Abstract Background: Perinatal (stillbirths and first week neonatal deaths) and neonatal (deaths in the first 4 weeks) mortality rates remain high in developing countries like Nepal. As most births and deaths occur in the community, an option to ascertain causes of death is to conduct verbal autopsy. Objective: The objective of this study was to classify and review the causes of stillbirths and neonatal deaths in Dhanusha district, Nepal. Materials and Methods: Births and neonatal deaths were identified prospectively in 60 village development committees of Dhanusha district. Families were interviewed at six weeks after delivery, using a structured questionnaire. Cause of death was assigned independently by two pediatricians according to a predefined algorithm; disagreement was resolved in discussion with a consultant neonatologist. Results: There were 25,982 deliveries in the 2 years from September 2006 to August 2008. Verbal autopsies were available for 601/813 stillbirths and 671/954 neonatal deaths. The perinatal mortality rate was 60 per 1000 births and the neonatal mortality rate 38 per 1000 live births. 84% of stillbirths were fresh and obstetric complications were the leading cause (67%). The three leading causes of neonatal death were birth asphyxia (37%), severe infection (30%) and prematurity or low birth weight (15%). Most infants were delivered at home (65%), 28% by relatives. Half of women received an injection (presumably an oxytocic) during home delivery to augment labour. Description of symptoms commensurate with birth asphyxia was commoner in the group of infants who died (41%) than in the surviving group (14%). Conclusion: The current high rates of stillbirth and neonatal death in Dhanusha suggest that the quality of care provided during pregnancy and delivery remains sub-optimal. The high rates of stillbirth and asphyxial mortality imply that, while efforts to improve hygiene need to continue, intrapartum care is a priority. A second area for consideration is the need to reduce the uncontrolled use of oxytocic for augmentation of labour. Key words: Stillbirth, neonatal death, verbal autopsy, Nepal.
Fulminant Hepatic Failure Due to Dengue
(Kathmandu University, 2011) Sedhain, A; Adhikari, S; Regmi, S; Chaudhari, SK; Shah, M; Shrestha, B
ABSTRACT: Dengue Fever (DF) is only rarely considered as a cause of acute liver failure even globally and only a few case reports of acute hepatic failure and encephalopathy occurring in DF in adults are available. We report a case of Acute Liver Failure due to Dengue during a major outbreak in 2010 in Chitwan. A 20 year old previously healthy female presented to the emergency department of Chitwan Medical College with fever, jaundice and altered sensorium. She was tested positive for Dengue IgM. Her biochemical and clinical parameters were suggestive of acute liver failure with total billirubin of 10.1 mg/dL, direct billirubin of 5.2 mg/ dL, ALT 5760 IU, AST 14100 IU, alkaline phosphatase of 1250 IU, PT INR of 1.76 and platelet count of 30,000 /mm3. Other causes for acute hepatic failure like acute viral hepatitis, leptospirosis, malaria, Reye’s syndrome were ruled out. The patient was admitted and managed in the ICU with supportive care and platelet transfusion. With treatment she made a significant clinical and biochemical improvement with AST of 105 IU, ALT of 120 IU and platelet count of 150,000/mm3. She was discharged after 11 days of hospital stay. KEY WORDS Dengue, Dengue Hemorrhagic Fever, Fuminant Hepatic failure
Improving Knowledge, Skill and Confidence of Novice Medical Doctors in Trauma Management with Principles of ABCDE
(Kathmandu University, 2018) Shrestha, R; Khadka, SK; Thapa, S; Shrestha, B; Shrestha, SK; Ranjit, S; Pradhan, BB; Shakya, YR; Lama, D; Shrestha J
ABSTRACT Background Trauma is one of the major public health concerns clamming about five million death annually worldwide. Experience and confidence of a doctor in the management of trauma patients have big impact on the overall outcome. Objective This study aims to evaluate the outcome of a trauma course in improving the knowledge, skill and confidence of novice doctors in managing trauma victims. Method A pre/post test analytical study was carried out among novice medical doctors from Kathmandu University School of Medical Science (KUSMS) who participated in a standard two and a half day trauma course, that utilizes the principles of ABCDE, as a part of their regular training. Pre-course knowledge and skill were compared with immediate post-course scores on the same guidelines. Objective structured and subjective written feedbacks from the participants were analyzed qualitatively to identify the perceptions of candidates. Result Sixty-eight males and twenty-nine females completed the course. The average pre- test scores in knowledge and skill were 8.3(33.2%) and 19.6(78.5%) respectively. Similarly the post-test scores were 16.04(64.2%) and 22.45 (89.5%) respectively, showing statistically significant improvements (P 0.000). The mean percentage improvement in knowledge was 48.8% and that in skill was 160.9%. The feedback analysis showed majority of the participants were satisfied with the course and they perceived improved “self-confident” in handling trauma cases. Conclusion All the novice doctors should participate in a standard trauma course hence their knowledge, skill and confidence in handling a trauma can be improved. KEY WORDS Emergency room trauma course (ERTC), Interns, Knowledge and skill, Principles of ABCDE, Simulation, Skill stations, Trauma, Trauma course
Incidence and Risk Factors of Surgical Site Infection Following Cesarean Section at Dhulikhel Hospital
(Kathmandu University, 2014) Shrestha, S; Shrestha, R; Shrestha, B; Dongol, A
ABSTRACT Background Cesarean Section (CS) is one of the most commonly performed surgical procedures in obstetrical and gynecological department. Surgical site infection (SSI) after a cesarean section increases maternal morbidity prolongs hospital stay and medical costs. Objective The aim of this study was to find out the incidence and associated risk factors of surgical site infection among cesarean section cases. Method A prospective, descriptive study was conducted at Dhulikhel Hospital, department of Obstetrics and Gynaecology from July 2013 to June 2014. Total of 648 women who underwent surgical procedure for delivery during study period were included in the study. Data was collected from patient using structred pro forma and examination of wound till discharge was done. Data was compared in terms of presence of surgical site infection and study variables. Wound was evaluated for the development of SSI on third day, and fifth post-operative day, and on the day of discharge. Results Total of 648 cases were studied. The mean age was 24±4.18. Among the studied cases 92% were literate and 8% were illiterate. Antenatal clinic was attended by 97.7%. The incidence rate of surgical site infection was 82 (12.6%). SSI was found to be common in women who had rupture of membrane before surgery (p=0.020), who underwent emergency surgery (p=0.0004), and the women who had vertical skin incision (p=0.0001) and interrupted skin suturing (p=0.0001) during surgery. Conclusion Surgical site infection following caesarean section is common. Various modifiable risk factors were observed in this study. Development of SSI is related to multi- factorial rather than one factor. Development and strict implementation of protocol by all the health care professionals could be effective to minimize and prevent the infection rate after caesarean section. KEY WORDS Caesarean section, maternal infection, surgical site infection
Initial Experience of Complex Peripheral Bypass Surgery at Dhulikhel Hospital, Kathmandu University Hospital
(Kathmandu University, 2017) Karmacharya, RM; Shrestha, B; Devbhandari, M; Tuladhar, SM; Hodde, A; Thermann, F
ABSTRACT Peripheral arterial disease is seemingly silent yet is a major pubic health problem with limb threatening and life threatening consequences. This condition can initially be asymptomatic and gradually may progress to intermittent claudication and finally to critical ischemia. When conservative management is not sufficient and there is option of surgical management, peripheral bypass surgery is an established modality of treatment of peripheral arterial disease. We present our initial cases of peripheral arterial bypass surgery all of which are technically demanding surgeries. All the cases have resulted into limb salvage until current follow-up. KEY WORDS Claudication, critical ischemia, peripheral arterial bypass, peripheral arterial disease
Malignant teratoid medulloepithelioma in eye
(2003) Pradhan, SB; Adhikari, RC; Shrestha, B; Sayami, G; Dali, S; Shrestha, HG
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Management of antitubercular drugs-induced hepatotoxicity and therapy reintroduction strategy in a TB clinic of Nepal
(Kathmandu University, 2005) Shakya, R; Rao, BS; Shrestha, B
Background: PZA, INH and R have potential for hepatotoxic side effects. Although anti-tuberculosis drug-induced hepatotoxicity is well known, there is no agreement on the clinical approach for cases in whom hepatotoxicity has developed. Objective: To study the management of anti-TB-drugs induced hepatotoxicity and the standard anti-TB drugs therapy reintroduction procedure. Design: In prospective cohort analysis, 4 patients with active TB infection had developed anti-TB drugs induced hepatotoxicity. Retreatment of therapy was done on the basis of severity of hepatitis. If damage is mild, all the drugs were reintroduced at once in a tapering dose and if patient’s condition is worse, INH and E is introduced in lower dose, later increasing the dose and the number of drugs. Results: All the patients tolerated anti-TB drugs well after reintroduction. There was no incidence of recurrence. All the patients completed their 8 months treatment regimen and all are cured. Conclusion: Timely detection and temporary withdrawal of the offending agent can completely cure anti-TB drugs-induced hepatotoxicity. The recurrence of hepatotoxicity is rare if reintroduction in done in a well planned manner.
Management of Proximal Ureteric Stones: Extracorporeal Shock Wave Lithotripsy (ESWL) Versus Ureterorenoscopic Lithotripsy (URSL)
(Kathmandu University, 2017) Joshi, HN; Shrestha, B; Karmacharya, RM; Makaju, S; Koju, R; Gyawali, D
ABSTRACT Background Urolithiasis is the third most common disease of the urinary tract after urinary tract infections and pathologic conditions of prostate. Debate is ongoing regarding the effectiveness of Extracorporeal Shock Wave Lithotripsy (ESWL) and ureterorenoscopic lithotripsy (URSL) in the management of ureteral stones. Objective We aim to compare the efficacy of Extracorporeal Shock Wave Lithotripsy and Ureterorenoscopic Lithotripsy in the management of upper ureteric stones in terms of stone clearance. Method This prospective hospital based study included patients with upper ureteric calculus managed with Ureterorenoscopic Lithortripsy with Double J stenting or Extracorporeal Shock Wave Lithotripsy at Dhulikhel Hospital, Kathmandu University Hospital from August 2014 to July 2015. Stone size, stone clearance, number of sittings, complications and need of other procedure were recorded. Result There were 90 patients with upper ureteric calculus. Among these patients, 45 patients underwent Extracorporeal Shock Wave Lithotripsy and 45 patients underwent Ureterorenoscopic Lithotripsy. There was no difference in male/female ratio, age and stone diameter between two groups (p>0.05). Total stone-free ratio was 88.9% (40/45) for Extracorporeal Shock Wave Lithotripsy and 82.2% (37/45) for URSL, partial fragmentation requiring shift of modality of treatment was 8.88% (4/45) for Extracorporeal Shock Wave Lithotripsy and 13.33% (6/45) for Ureterorenoscopic Lithotripsy. Failure of procedure was noted in 11.1% in Extracorporeal Shock Wave Lithotripsy group and 17.8% in URSL group In the Extracorporeal Shock Wave Lithotripsy group, 8.89% (4 out of 45) patients required Ureterorenoscopic Lithotripsy for complete stone clearance. Complete stone clearance could not be achieved in 2.23% (1 out of 45) patient with both Extracorporeal Shock Wave Lithotripsy and Ureterorenoscopic Lithotripsy and had to undergo open ureterolithotomy. Conclusion Both Extracorporeal Shock Wave Lithotripsy and Ureterorenoscopic Lithotripsy are equally effective in the management of upper ureteric calculus with no significant difference in age, male/female ratio, stone diameter and stone free ratio. KEY WORDS Extracorporeal shock wave lithotripsy, Ureterorenoscopic lithotripsy, Ureteric stone
Morbidity and early outcome of transurethral resection of prostate: A prospective single-institute evaluation of 100 patients
(Kathmandu Unversity, 2010) Shrestha, B; Baidya, JL
Abstract Background: Transurethral resection of the prostate underwent significant technical improvements during the last decades, with major impact on the incidence of intra and postoperative complications. Objectives: teh objective of teh study was to analyse the early complications and to predict immediate outcomes of transurethral resection of prostate (TURP) in a single tertiary care institute. Materials and methods: We prospectively evaluated 100 patients undergoing transurethral resection of prostate at B and B Hospital, Gwarko, Lalitpur, Nepal, from August 2008 till April 2009. Case records containing 32 variables concerning preoperative status, operative details, complications and immediate outcome were recorded for each patient. Results: The cumulative short-term postoperative significant morbidity was 10% and the peroperative morbidity was 6%. The most relevant postoperative complication was failure to void (24%). Among significant postoperative morbidities, surgical revision had to be performed in two patients (2%), open prostatectomy in one patient, transurethral resection (TUR) syndrome in 5% and significant urinary tract infection in 2%. Among significant intra operative morbidity, we had one case with bladder perforation, significant cardiac arrhythmia requiring prompt attention in 4% and TUR syndrome during resection in 1%. We did not have any mortality related to the procedure during the study period. The resected tissue averaged 25.67gm. Incidental carcinoma of the prostate was diagnosed by histological examination in 4% of patients. Urine peak flow rate (Q-max) increased to 12.88ml per second from 9.24ml per second and average flow rate increased to 7.36 ml per second from 5.03 ml per second. The postoperative mean residual urine measured by ultrasound decreased to 28.46ml from preoperative 86.59 ml. Conclusions: TURP has, for decades, been the standard surgical therapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia though significant morbidities can be associated with the procedure. Meticulous preoperative workup and proper selection of the patients for the procedure significantly improve the outcome after transurethral resection of the prostate. Key words: TURP ( Transurethral resection of prostate), LUTS ( Lower urinary tract symptoms), BOO (Bladder outlet obstruction)
Outcomes of Extra Corporeal Shock Wave Lithotripsy in Renal and Ureteral Calculi
(Kathmandu University, 2014) Joshi, HN; Karmacharya, RM; Shrestha, R; Shrestha, B; de Jong, IJ; Shrestha, RKM
ABSTRACT Background Since the introduction in early 1980s, Extracorporeal Shockwave Lithotripsy (ESWL) became the accepted first line treatment modality for renal and upper ureteric stones. It is simple, safe and effective noninvasive procedure which can be performed without anaesthesia in outpatient basis. The objective of this study was to determine the efficacy of ESWL to achieve complete stone clearance in the patients with different sizes of renal and upper ureteric stones. Objective The aim of this study was to assess the outcome, efficacy and complications of ESWL in the treatment for renal and ureteric stones in terms of the site and the size of the stone in the patients presented at Dhulikhel Hospital Kathmandu University Hospital. Method In this prospective study a total of 430 (214 renal and 216 ureteric) cases of urinary stone disease in 257 male and 173 female patients treated by ESWL at Dhulikhel Hospital, Kathmandu University Teaching Hospital during time period of May 2010 to June 2012 were included. Data of patients with renal and ureteric stones were evaluated for stone site, size, and number of sessions. Data were analyzed using spss 13.0. Result Out of 430 cases, the overall stone free rate in after 1st session was 341 (79.3%) at one month and in three months follow up (3 sessions) it was increased up to 414 (96.3%). In 16 (3.7%) patients treatment was failed. Average size of the stone was 12.24 (SD± 3.65) mm. Stone free rate was 154 (72%) in the case of renal and 187 (86.6%) in the case of ureteric stones in first session. In three months follow up (three sessions) it was 204 (95.4%) and 210 (97.2%) respectively for renal and ureteric stones. In relation to size the stone free rate in <10mm, 10-15mm and > 15mm was 97%, 97% and 90%. Conclusion ESWL is the first line preferred choice for renal and upper ureteric stones which provides the maximum stone free rate in the case of stone size smaller than 1.5cm. KEY WORDS ESWL, outcome, renal stones, ureteric stones, urinary stone disease, urolithiasis
Outcomes of Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia Comparing Prostate Size of more than 80 Grams to Prostate Size less than 80 Grams
(Kathmandu University, 2014) Joshi, HN; de Jong, IJ; Karmacharya, RM; Shrestha, B; Shrestha, R
ABSTRACT Background Benign prostatic hyperplasia is a condition occurring in elderly men in which the prostate gland is enlarged, hence the condition also known as benign enlargement of prostate. Benign hyperplasia can lead to both obstructive and irritative symptoms. Transurethral resection of prostate (TURP) still remains the gold standard modality of surgical treatment of obstructive lower urinary tract symptoms due to Benign hyperplasia. Objectives The objective of this study was to evaluate the outcomes of TURP in large prostate (>80 grams) in comparison to small prostate (<80 grams) in terms of efficacy, safety and complications. Methods A total of 65 cases included in this prospective study, which were operated by a single surgeon with conventional monopolar TURP using standard technique. Intra -operative and post-operative complications, pre and post- operative quality of life (QoL) and international prostate symptom score (IPSS), operative time, time to removal of catheter and hospital stay were evaluated between small and large prostate gland volumes. Results Out of 65 cases, 30 were with large prostate size i.e. 80 grams or more (group 1), and 35 cases were with small prostate size than 80 grams size (group 2). Mean age was 71.8 SD ± 6.9 years in group 1 and 68.2 SD ± 12.7 years in group 2. The mean preoperative volume of prostate was 88.8 grams (range 80-115 grams) in group 1 and 40.3 (range 20-65 grams) in group 2. The mean preoperative post void residual volume of urine (PVRU) was 244 ml SD ± 190.8 ml in group 1 and 117 ml ± 70.3 ml in group 2. Mean resection time in group 1 was 110 (range 90-130) minutes and in group 2 it was 90 minutes (range 55-115) minutes. There were quite satisfactory improvements in IPSS and QoL. No significant complications were observed except TUR syndrome in 2 cases from group 2, which were managed well in postoperative period. Conclusion With meticulous resection and intra-operative haemostasis using continuous out flow resectoscope, conventional monopolar TURP is equally safe and effective in large size prostate as compare in small size. KEY WORDS Benign prostatic hyperplasia, obstructive lower urinary tract, prostate, transurethral resection of prostate.
Study of Pre-disposing Factors of Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Antibiotic Prescribing Pattern with Reference to Antibiotic Sensitivity Test
(Kathmandu University, 2015) Shrestha, R; Shrestha, B; Shakya Shrestha, S; Pant, A; Prajapati, B; Karmacharya, BM
ABSTRACT Background Chronic Obstructive Pulmonary Disease (COPD) affects about 329 million people worldwide, which is nearly 5% of the entire global population. In the context of Nepal, COPD accounts for 43% of the non-communicable disease burden and 2.56% of hospitalizations. Various pre-disposing factors like bacterial, viral, fungal, smoking, occupational exposures and genetic factors have been proposed to precipitate COPD and its exacerbation though, the definitive pre-disposing factors and factors related to acute exacerbation have not been determined in the context of Nepal. Objective To find out the pre-disposing factors and the related causative agents for COPD. Method A cross sectional study was conducted in a tertiary care hospital. Patients of all age group who were diagnosed as COPD and admitted in the hospital were included in this study. Patients were interviewed using structured questionnaire. The socio- demographic data including personal and medical history were recorded from those participants. In addition, sputum from those patients was sent for culture to investigate the possible responsible pathogens as well as its antibiotic sensitivity pattern. Result A total of 150 patients having Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) who have admitted from either emergency or out-patient department of the hospital were included in this study. Among the total number of patients, more than half of them were female (n=82). In addition, analysis of occupations shows that most of them were either farmer (36.0%) or housewife (30.7%). In total studied patients (n=150), most of them were using traditional firewood (83%) for cooking purpose and majority of patients (91%) were smokers. Most of the sputum samples show growth of gram-positive cocci (26.7%) and gram negative bacilli (27.5%). Considering the overall sensitivity pattern, the higher sensitivity was recorded for Co-trimoxazole and Ciprofloxacin while higher rate of resistance was noted for Penicillin group of drugs. The most widely used antibiotics were found to be Cephalosporin group of drugs (68%). Conclusion The present study revealed that the case of COPD is more in female and the commonest pre-disposing factor is found to be smoke/firewood. Cephalosporin group of drugs is the most commonly prescribed drug. KEY WORDS AECOPD, firewood, pre-disposing factor and therapy of COPD
The Correlation Between Fine Needle Aspiration Cytology and Histopathology of Head and Neck Lesions in Kathmandu University Hospital
(Kathmandu University, 2013) Rajbhandari, M; Dhakal, P; Shrestha, S; Sharma, S; Shrestha, S; Pokharel, M; Shrestha, I; Shrestha, B; Makaju, R
ABSTRACT Background Fine needle aspiration cytology (FNAC) with it’s minimally invasiveness has been a well accepted procedure in the initial diagnosis of various swellings. With time and experience high sensitivity and specificity of FNAC over conventional open biopsy has lead to the wide acceptance of this procedure. Objective To evaluate the utility of aspiration cytology as a first-line diagnostic tool in palpable head and neck masses and correlate with histologic results for evaluating diagnostic accuracy. Methods A hospital based prospective, comparative study was conducted among patients with various swellings at Head and Neck regions in the Department of Pathology, Dhulikhel Hospital between July 2011 to June 2012. FNAC were done from the palpable masses of head and neck regions and were compared with biopsy findings of the same lesions. Data entry and analysis performed using SPSS version 16. The sensitivity, specificity and accuracy rates were calculated. Results A total 64 patients were subjected to both FNAC and histopathological examination (HPE). Total 39 (61 %) were females and 25 (39 %) were males with M: F ratio of 1:1.6. The age group ranged from 9 to 80 years. Twenty five percent of patients were in the age group below 20 years. The highest number of cases included lymph nodes 29 (45%) followed by thyroid 24(37.5 %), salivary glands 10(16%) and 1 case (1.6%) was a soft tissue swelling over the occipital region. Highest sensitivity, specificity and accuracy rate for diagnosis by FNAC were observed in thyroid. The overall sensitivity and specificity of FNAC were 86% and 97% respectively in determining the various pathologies. The overall accuracy of FNAC in present study was 87.4%. Conclusion FNAC is a minimally invasive first line investigation with a high sensitivity and specificity for the diagnosis of various head and neck lesions KEY WORDS FNAC, lymph nodes, salivary Glands, thyroid
The outcome of pneumatic lithotripsy for the management of ureteric calculi
(Kathmandu University, 2008) Shrestha, B; Karki, DV; Baidya, JL
Abstract Background: Various methods have been adopted for the removal of ureteric calculi around the world. Ureteroscopic pneumatic lithotripsy has been used to treat ureteric calculi for more than a decade. Owing to its low price and high degree of effectiveness, it has become the most popular ureteroscopic device amongst many others. Moreover, ureteroscopy has become the method of choice for the quickest way of rendering patients stone-free. Objectives: To determine successful stone fragmentation by ureteroscopic pneumatic lithotripsy in the management of ureteric calculi as well as intra-operative and post-operative complications related to it. Study design: A prospective and descriptive study. The study was conducted in Section of Urology, Department of Surgery, B&B Teaching Hospital, Kathmandu University. The data was collected from April 2005 to April 2006. Materials and methods: Ninety-two consecutive patients having ninety- ve ureteric stones were treated with intracorporeal pneumatic lithotripsy over a period of one year. The size, side, number and site of stones along with the results of preoperative routine investigations were noted in the patients. The pneumatic lithotripter was introduced through a 10 or 8 Fr rigid ureteroscope (Karl Storz) to break the stone/s. Successful stone fragmentation, lithotripsy time, intra-operative and post-operative complications and duration of hospital stay were recorded. Results: Complete stone fragmentation was achieved in about 80 % of cases. The mean lithotripsy time was 17.66 minutes. About 76% of patients were stone-free at one week follow-up after the procedure, 92% by the end of eight weeks while 100% stone-free status was achieved by the end of 12 weeks. The mean hospital stay was 1.82 days and complications (both signi cant and minor) occurred in 51 % of cases. However, majority of them were minor and successfully managed. Conclusion: Intra-operative pneumatic lithotripsy is a minimally invasive, effective and rapid procedure for the management of ureteric calculi. Though it can give rise to considerable complications, they are mainly minor. Moreover, both complications and failure rates can be reduced if patients with ureteric calculi are properly selected. It seems to be a good alternative in patients where extracorporeal shockwave lithotripsy is unsuccessful or not indicated and in patients who need early stone removal. Key words: SIRS- Systemic In ammatory Response Syndrome, ESWL- Extra corporeal shockwave lithotripsy, JJ stent: Double J stent, URS: Ureterorenoscope, Steinstrasse.
Unresolved abdominal mass
(Kathmandu University, 2009) Shrestha, B; Baidya, JL
Abstract A case of huge enhancing solid mass in the abdomen observed in 30 years old gentlemen is reported. Patient was worked up and managed conservatively outside valley with the provisional diagnosis of an appendicular lump. When examined, he was found to have huge intra abdominal mass. Interestingly when the genitalia was examined he was found to have underdeveloped empty scrotum without testes in it which he was yet not bothered. This simple examination gave us a straight clue to come up with the diagnosis of malignancy in undescended testes. Laparotomy was performed and the mass was excised. After 6 weeks postoperatively he was subjected for the chemotherapy. After3 cycles of chemotherapy CT scan showed complete disappearance of retroperitoneal lymphadenopathy and serum tumor markers have come down to normal level. Key words: Germ cell tumor (GCT), Seminoma, Non seminomatous germ cell tumor, (NSGCT), Cryptorchidism, Alpha fetoprotein (AFP), Beta human chorionic gonadotrophin (BHCG), Lactate dehydrogenase (LDH)
Urinary Bladder Carcinoma: Impact of Smoking, Age and its Clinico-Pathological Spectrum
(Kathmandu University, 2013) Joshi, HN; Makaju, R; Karmacharya, A; Karmacharya, RM; Shrestha, B; Shrestha, R; de Jong, IJ; Shrestha, RKM
ABSTRACT Background Urinary bladder carcinoma is common urological malignancy. Although epidemiological evidence favors role of occupational exposure to chemical carcinogen as the aetiological factor of bladder carcinoma, many cases arise with no obvious occupational exposure to chemical carcinogen. Tobacco and cigarette smoking is common in both rural and urban areas of Nepal. Objective The objective of this study was to determine the impact of smoking and age in urinary bladder carcinoma with related clinicopathological correlations. Method A total of 56 (44 males and 12 females) cases of urinary bladder cancer treated at Dhulikhel Hospital, Kathmandu University Teaching Hospital during time period of January 2004 to December 2013 were included in the study. Data of patients with Urinary bladder cancer were obtained from hospital records and evaluated for age, sex, history of smoking, clinical presentations, cystoscopic findings and histopathological characteristics. Results Out of 56 cases, 51 (91.1%) of the patients had hematuria. History of smoking was found in 44 patients. Smoking was found much higher in males (88%) than females (41.66%). Transitional cell carcinoma (TCC) was the most common histological variety, which was seen in 51 (91.07%) patients. The significant impact of smoking was found in terms of grade of TCC. Conclusion The incidence of bladder carcinoma is higher in male and TCC is the most common variety of Urinary bladder malignancy. History of smoking correlated with grade. KEY WORDS Bladder cancer, bladder carcinoma, smoking, transitional cell carcinoma

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