Browsing by Author "Shrestha, Bipsana"
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Publication Comparative Outcomes of Doxorubicin and Cyclophosphamide with Sequential versus Concurrent Paclitaxel in the Adjuvant Treatment of Non-Metastatic Breast Cancer: A Cross-Sectional Analytical Study(Nepal Medical Association, 2025) Paudel, Bishal; Paudel, Bishnudutta; Shrestha, Rakshya; Panthi, Bishal; Shilpakar, Ramila; Dulal, Soniya; Kharel, Sanjeev; Dhunagana, Reechashree; Singh, Yogendra Prasad; Shrestha, BipsanaAbstract Introduction: Studies have compared the efficacy and toxicities of doxorubicin and cyclophosphamide every three weeks for four cycles followed by four cycles of paclitaxel every three weeks (AC/T); with paclitaxel, doxorubicin, and cyclophosphamide (TAC) every three weeks for six cycles for adjuvant treatment of breast cancer in western countries. Genetic and environmental disparities in Nepalese population warrant the need for similar studies in Nepal. This study compares the toxicity patterns and compliance of AC/T versus TAC in the adjuvant treatment of non-metastatic breast cancer in Nepalese women. Methods: A hospital-based cross-sectional analytic study was conducted at Bir Hospital, Kathmand after obtaining the ethical approval (Reference number: 931/076/077). Sixty women who completed either AC/T or TAC regimens were evaluated. Confounding was minimized by strict inclusion/ exclusion criteria (restriction), group matching, and random sampling. Primary outcome was grade 3–4 hematological toxicity; secondary outcomes included other adverse effects and compliance. Results: Although hematological toxicities were higher in the TAC group, differences were not statistically significant. Non-hematological toxicities (fatigue, nausea, vomiting, pain, nail changes) were significantly higher in the TAC group. Edema was more prevalent in the AC/T group (p=0.04). Compliance without modification favored AC/T (64.5% vs. 34.5%; p=0.038). Conclusions: Sequential AC/T demonstrated superior tolerability and compliance. Confounder control through study design and statistical methods strengthens the validity of these findings, though larger studies are warranted.Publication Emergency Department Presentations of Chronic Kidney Disease in a Tertiary Hospital of Nepal: A Cross-sectional study(Nepal Medical Association, 2025) Neupane, Ram Prasad; Maharjan, Ramesh Kumar; Shrestha, Bipsana; Poudel, Bibek; Dandekhya, Rasmila; Shrestha, Tirtha Man; Chitrakar, Shasank; Dulal, Anga Raj; Malla, Arju; Silwal, Amisha; Karki, Sagun; Pokhrel, Manju; Thakur, Shubham Kumar; Panthee, Abhinandan; Jha, Sagar Kumar; Sah, Anish; Bhujel, BishnuAbstract Introduction: Progressive chronic kidney disease is associated with complications like hypertension, anemia, mineral bone disorder, metabolic acidosis and electrolyte disorders which lead to higher morbidity, mortality and poorer quality of life. Available estimates of chronic kidney disease cases and those receiving treatment suggests an existing gap in care. Therefore, this study aims to estimate the prevalence of chronic kidney disease and its complications in the emergency department of Tribhuvan University Teaching Hospital. Methods: A cross-sectional descriptive study was done. The participants were chronic kidney disease patients with complications visiting the Emergency Department of Maharajgunj Medical Campus. Census sampling technique was used to enroll all chronic kidney disease patients with complications meeting inclusion criteria, visiting the Emergency Department from 11th October 2023 to 19th September 2024. Ethical approval was obtained from the institutional review committee of the Institute of Medicine, Maharajgunj with the reference number 509(6-11)E2/081/082. Distribution check and descriptive analysis was done using STATA. Results: The prevalence of chronic kidney disease was found to be 2.5%. The most common complications were anemia 399 (53.69%) and hypertensive crisis 396 (53.29%). Least common complications among CKD patients was sepsis 8 (1.08%). Several other complications like arrhythmia, nephropathy, hypoglycemia, obstructive uropathy, pericardial effusion, urinary tract infection, effusion, pneumonia were observed in 50 (6.73%) of the CKD patients. Death as an outcome was reported in 9 (1.2%) of total patients. Conclusions: Chronic kidney disease proportion in emergency departments is high, with anemia and hypertension being common complications. Targeted interventions might include establishing hemodialysis units and increasing staff awareness.