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

Browsing by Author "Shrestha, D"

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A Comparative Study on Epidemiology, Spectrum and Outcome Analysis of Physical Trauma cases Presenting to Emergency Department of Dhulikhel Hospital, Kathmandu University Hospital and its Outreach Centers in Rural Area
(Kathmandu University, 2013) Shrestha, R; Shrestha, SK; Kayastha, SR; Parajuli, N; Dhoju, D; Shrestha, D
ABSTRACT Background Physical trauma is one of the major cause of mortality and morbidity among young and active age group and its increasing trend is of main concern. There are only few studies concerning the spectrum of physical trauma in Nepal. Objective This study aims to evaluate the epidemiological spectrum, the extent, severity of the physical trauma and the outcome evaluation of patients with physical trauma over a period of one year in the emergency department of the Kathmandu University Hospital and compare the same parameters with those patients presenting to the various outreach centers of the hospital in the community. Methods Patient treatment files from the emergency department and the reports from various outreach centers were retrieved for a period of one year (May 2011 to April 2012). Epidemiological information, mode, type and anatomic location of injuries were recorded. Outcome evaluation was assessed by number of patients discharged from emergency department of the hospital or the outreach centers after the treatment, patients admitted for inpatient management and referred to other centers for further specialty management. Result In a period of one year, total 2205 (20%) of physical trauma cases presented to the emergency department and 1994 (6.12%) in the outreach centres. Most commonly involved age group in physical trauma both in Hospital set up and in Community set up were the young adults (15 to 49 years). Fall from height was the commonest mode of injury followed by road traffic accidents among the patients coming to the hospital while significant number of trauma patients coming to outreach centers were due to fall from height. In the hospital set up, 1525 (69.2%) of the cases were discharged while 537 (24.4%) needed inpatient management and 85 (3.8%) needed referral to other centers for the specialty management. In case of outreaches, half of the patients were discharged after the primary treatment and almost another half were referred to the hospital, mainly for need of further investigations. Conclusion Fall related injuries and road traffic accidents are the most common mode of trauma in the hospital set up and fall related injuries are the single most important mode of trauma seen in the outreaches. Mostly young adults in their active period of life are involved in physical trauma so appropriate preventive measures through public health approach should be included in comprehensive trauma management for reducing mortality and morbidity rates related to physical trauma. KEY WORDS Emergency department, outreach centers, physical trauma, trauma center
Acetabular Fracture: Retrospective Analysis of Thirty Three Consecutive Cases with Operative Management
(Kathmandu University, 2014) Shrestha, D; Dhoju, D; Shrestha, R; Sharma, V
ABSTRACT Background With the development of better imaging modalities including 3D CT scan and availability of technical expertise, operative management is increasingly performed for acetabular fracture but many patients in developing countries like Nepal, are still being treated with prolonged skeletal traction. Objective To analyses epidemiology, types of acetabular fracture and functional and radiological outcome of patients with acetabular fracture treated with open reduction and internal fixation (ORIF). Method Inpatients hospital records of patients treated with ORIF in between June 2007 to June 2014 were evaluated. Patient’s demographic data, mode of injury, injury hospital interval, injury surgery interval, associated injuries, surgical approach, total hospital stay and peri and post-operative complications were recorded and radiological and functional outcomes were evaluated. Result Thirty three patients (Male: 24 Female: 9) with average age 39 years (range: 21 to 65 years) were operated for acetabular fracture. Twenty one patients (63%) had injury related with motor vehicle accidents and nine (24%) of them had motorbike accidents. Injury hospital interval ranges from 7 to 36 days. Average injury-surgery interval was 21 days and average hospital stay was 22 days. Bicolumnar fractures were found in 15. Nine patients had dislocation of hip and 15 had concomitant other injuries. Biculumanr fixation was performed in 15 patients, posterior column and or wall in nine with Kocher Langenbeck approach and anterior column and or wall in other nine with ilio-inguinal approach. Radiological reduction was anatomical in 18; excellent/good functional outcome was in 26 and radiological outcomes were excellent in 14. Three patients had developed Hypertopic ossification. Follow up period ranged from 6 to 48 months and 15 patients (45%) had follow up >2 years. Conclusion Acetabular fractur can be effectively managed with ORIF and have predictable and comparable functional and radiographic outcomes. Upgrading the existing facilities and training of orthopedic surgeon for acetabular fracture management is important to shorten injury-surgery interval due to lack of such facilities. KEY WORDS Acetabulum, internal fixation, open reduction
Antibacterial activities of medicinal plants of Nepal
(Institute of Medicine, 2008) Pokharel, K; Dhungana, BR; Tiwari, KB; Shahi, RB; Yadav, BK; Sharma, M; Shrestha, RK; Shrestha, D; Paudel, BH
Abstract Background: Medicinal plants of Nepal are still remaining to be assessed for their antimicrobial properties, which may lead to discovery of broad-spectrum antimicrobial compounds. Methods: Various parts of medicinal plants, viz. Acorus calamus, Curcuma longa, Emblica officinalis, Glycyrrhiza glabra (a non-indigenous to Nepal), Justicia adhatoda and Xanthoxylum armatum, were collected from hilly regions of Nepal. The plant parts were chopped into fine pieces, air-dried at 37°C for several hours, surface sterilized and grinded to powder. The antibacterial compounds were extracted by Soxhlet Reflux method and tested against common bacterial pathogens by agar well diffusion test. Result: All the crude extracts were found to be effective against Salmonella typhi, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus. Among tested ones E. officinalis was found to the best antibacterial plant. Minimum inhibitory concentration (MIC) and Minimum bactericidal concentration (MBC) values of the crude extract of E. officinalis were found to be 8mg/ml and 16mg/ml respectively. Similarly, MIC value of A. calamus was 128mg/ml. Conclusion: Being highly effective against both Gram-positive and Gram-negative common bacterial pathogens, the antibacterial compounds from the plants can be exploited to commercial values provided in vivo assessment of the compounds are studied. Keywords: Antibacterial agents, medicinal plants, minimum inhibitory concentration, Nepal
Assessing Spectrum of Fractures in Elderly; Perspective on Tertiary Care Hospital of Nepal
(Kathmandu University, 2023) Parajuli, B; Sharma, R; Kayastha, SR; Thapa, J; Shrestha, R; Shrestha, D
ABSTRACT Background There is an increasing life expectancy and a surging elderly population in the last few decades, leading to a higher incidence of fractures in the elderly. The health care of the elderly in Nepal is below par and there are no studies done to evaluate the spectrum of fractures in the elderly. Objective To evaluate the demographical and epidemiological aspects of fractures in the elderly (≥ 65 years) presenting to a tertiary care hospital in Nepal in a 15 years’ timeline. Method This study was a retrospective epidemiological study conducted in the Department of Orthopedics, Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH), Nepal. The patients of age ≥ 65 years having traumatic injuries, admitted in the orthopedics ward from 2006 January to 2020 December were included. Patient demographics, site of injury, fracture incidence, mechanism of injury, hospital stay duration, and mode of treatment (surgical/ conservative) were evaluated. Result Of the 787 patients with an average age of 73.65 ± 7.5 years, 54% were females. Peritrochanteric fracture was the most common fracture (29.4%) followed by spine (18.3%). The most common mechanism of injury was fall on the labeled ground (38.6%). The incidence of fragility fractures (peri-trochanteric, proximal humerus, spine, and distal radius) was increasing with age. Conclusion Females, peritrochantric fractures, and trivial trauma are the most common occurrences for fractures in elderly. The incidence of fragility fractures is increasing with age but the overall incidence of fractures compared to other studies is low. Higher incidences of road traffic accidents (RTA) and compound fractures among the elderly are serious public health concerns that highlight the importance of primary preventive measures. KEY WORDS Elderly, Fracture, Incidence, Nepal
Assessment of Knowledge Regarding Oral Hygiene among Parents of Pre-School Children Attending Pediatric Out Patient Department in Dhulikhel Hospital
(Kathmandu University, 2015) Khanal, K; Shrestha, D; Ghimire, N; Younjan, R; Sanjel, S
ABSTRACT Background Level of knowledge regarding oral hygiene among the parents of pre-school children plays an important role on maintaining the good oral hygiene of their children. In Nepal, sufficient research has not been carried out on this area. Objective Objective of this study is to assess the level of knowledge on oral hygiene of pre- school children’s parents attending pediatric outpatient department in Dhulikhel Hospital. Method A descriptive study was conducted from November 2012 to January 2013 among one hundred parents of preschool children visiting pediatrics outpatient department of Dhulikhel Hospital. Paper and pencil based semi structured questionnaire was used for collecting data. Questions related to demographic information and knowledge were asked. Thirty questions were used for assessing knowledge level. Knowledge score was calculated by allocating one point for each correct answer and zero point for each wrong answer. Analyzed data were presented in terms of numbers and percentages. Total knowledge scores were categorized based on percentage. Knowledge score was categorized on four group - exclusive intervals - namely-poor (0-40%), moderate (40-60%), good (60-80%) and excellent (80-100%). Mann-Whitney U test and Kruskal-Wallis test were applied to check significance difference and chi- square test was used to check association among different background characteristic. Result It was found that 81% had moderate knowledge, 15% had poor knowledge and 4% had good knowledge about oral hygiene. Median knowledge score was found to be 15 with range 10 to 21. Following variables were found to be significant difference on knowledge category: Education status (p<0.001), education level (p= 0.041), past experience about oral health problem (p = 0.008), Further significant association was found between knowledge category and educational status (p < 0.001) and between knowledge category and past experience (p < 0.001). Conclusion Knowledge regarding oral hygiene was found satisfactory among the parents of preschool children visiting pediatric OPD of Dhulikhel Hospital. KEY WORDS Knowledge, oral health, parents, pre-school children
Assessment of Post Graduate Medical Students in Nepal: Is it time to introspect?
(Kathmandu University, 2014) Shrestha, D; Shrestha, R
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Awareness and Knowledge of the Surgical Safety Checklist among Healthcare Professionals in University Teaching Hospital, Kathmandu, Nepal
(Kathmandu University, 2021) Uprety, A; Kobashi, Y; Ozaki, A; Shrestha, D; Ghimire, B; Sedain, G; Sigdel, S; Higuchi, A; Tsubokura, M; Singh YP
ABSTRACT Background An introduction of the World Health Organization Surgical Safety Checklist (WHO SSC) is essential to promote surgical safety. Objective To obtain country-specific information regarding the checklist in a leading medical institution in Nepal. Method The present research was a cross-sectional study with a survey conducted among healthcare professionals working in the operation theatre at the Tribhuvan University Teaching Hospital (TUTH) in Kathmandu, Nepal. A questionnaire was distributed to 150 healthcare professionals working in the operating theatre. Responses to the questionnaire were analysed descriptively and regression analyses used to identify factors associated with awareness of the checklist. Result In total, 127 healthcare professionals participated in the study, of whom 118 (92.9%) had been aware of the WHO SSC. A substantial proportion of participants (108, 91.5%) were not satisfied with the prevailing practice whereby the checklist was not routinely used during surgery. Lack of appropriate training was the most prevalent barrier to the checklist use (72, 67.9%), followed by unwillingness of staff to use the checklist (54, 50.9%), and lack of experience (42, 39.7%). The mean score on the survey was 6.0 out of 10. Regarding the results of the regression model on survey scores, surgeons had higher scores compared to nurses (unadjusted coefficient 0.80, 95% CI 0.20-1.40). Conclusion Most of the healthcare professionals were aware of the WHO SSC, however multiple barriers to the checklist use were identified. It is important to establish an effective use of WHO SSC in the operation theatre. KEY WORDS Surgical safety, WHO Surgical Safety Checklist, Workforce
Bacterial Flora and Antibiotics Sensitivity Pattern in Chronic Rhinosinusitis Outpatient Cases in Tertiary Care Hospital
(Kathmandu University, 2022) Shrestha, D
ABSTRACT Background Chronic rhinosinusitis is a disease that afflicts a significant percentage of the population and causes considerable long-term morbidity. The initial treatment is clinical evaluation followed by starting empirical antibiotics. With the use of empirical antibiotics there is a possibility of aggravating the disease and leading to the persistence of chronic sinusitis. In order to start a protocol for rational use of antibiotics, we need to have the bacteriological profile in cases of chronic rhinosinusitis along with the sensitive group of antibiotics. Objective To determine the bacterial flora in nasal swab of patients with chronic rhinosinusitis and identify the sensitive antibiotics for the bacterial isolate. Method A prospective, cross-sectional study was conducted in ENT Head and Neck Department of tertiary care hospital. The study population was the patients with clinical diagnosis of chronic rhinosinusitis whose nasal swabs were taken during nasal endoscopy and sent for culture and sensitivity. The data were entered in Microsoft Excel and analyzed using statistical computer program Statistical Package for the Social Sciences (SPSS). The ethical approval for the study was taken from Ethical Committee of Kathmandu Medical College. Result There were 60 (87%) bacterial isolate growths out of 69 samples of which 49 (82%) were gram positive and 11 (18%) were gram negative. The most common bacteria isolated was S aureus (42%) followed by Cogaulase neagative Staphylococcus (25%). Conclusion Among gram positive isolates, amoxycillin was the most sensitive antibiotic and among gram negative isolates, ceftriaxone, levofloxacin, imipenem, meropenem and piperacillin were most sensitive antibiotics. In this study, we have determined the bacterial flora from endoscopic nasal swab of the sinuses in chronic rhinosinusitis patients and identified the sensitive antibiotics. This study would help us prescribe rational antibiotics in cases of chronic rhinosinusitis. KEY WORDS Antibiotics, Bacteria, Chronic rhinosinusitis, Sensitivity
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.
Childhood Neurological Illness in Nepal
(Nepal Health Research Council, 2010) Mishra, N; Belbase, M; Shrestha, D; Poudel, R; Mishra, P
The commonly encountered neurological disorders in Nepalese children are febrile encephalopathies, neurocysticercosis, and epilepsy,and neonatal encephalopathy,neuro-psychiatric and neuromuscular disease. Also, these childrenin Nepal remain one of the most vulnerable andmarginalized groups in the community. Due to the lack of proper facilities some preventable and treatable neurological conditions continue to paralyze thechildrenâ€™s physical and mental health. The alarmingly high prevalence of theseneurological illnessesÂ has high mortality and morbidity in children ultimately adding financial burden to the family, society and the country asa whole. The paucity of data and difficultiesin proper collection of reliable facts furtherÂ Â hampers to understand the actual magnitude of thisproblem.Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Key words: epilepsy,neonatal encephalopathy, neurocysticercosis
Clinical Outcome following Intra-articular Triamcinolone Injection in Osteoarthritic Knee at the Community: A Randomized Double Blind Placebo Controlled Trial
(Kathmandu University, 2018) Shrestha, R; Shrestha, R; Thapa, S; Khadka, SK; Shrestha, D
ABSTRACT Background Knee pain is one of the common complaints patients present with in any community based health camps and Osteoarthritis of knee is a usual diagnosis. Injecting a long acting steroid is a common practice to alleviate the symptoms of osteoarthritic knee. Objective To evaluate the clinical outcome of injecting Triamcinolone acetenoid in osteoarthritis of knee in a community set up over a randomized double-blind placebo control trial. Method A prospective, randomized, double blind, placebo control trial was carried out in community after obtaining the ethical clearance from the IRC. Patients with clinically diagnosed osteoarthritis of knee were injected either Triamcinolone or Placebo after recording the baseline scores of the knee by Knee injury and Osteoarthritis Outcome Score (KOOS) – Physical Function Short form (KOOS-PS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analogue Scale (VAS). The same tools were used at two, six and at twelve weeks post injection to evaluate the functional outcome and pain. Result One hundred and seventeen patients were available for analysis among which, 55(48.7%) patients received Triamcinolone and 58(51.3%) received placebo. The baseline status of knees of two groups was comparable at the start of study. There was significant pain relief in the group receiving Triamcinolone at two and six week but not in twelve weeks. Group receiving placebo had pain relief only for first two weeks. Functional outcome was significantly improved compared to baseline in both the groups until six weeks however, in the triamcinolone group, it was significant until twelve weeks. No major complications were noted. Conclusion Intra-articular injection of Triamcinolone acetenoid is effective in symptoms control and improving functional outcome in clinically diagnosed osteoarthritis of knees in community set up during health camps. KEY WORDS Community, Health camps, Intra-articular injection, Knee, KOOS-PS, Osteoarthritis, WOMAC
Clinical Profile of Acute Poisoning in Children at a Teaching Hospital in Lalitpur
(Nepal Paediatric Society (JNPS), 2014) Dhakal, Ajaya Kumar; Shrestha, D; Shakya, A; Shah, SC; Shakya, H
Abstract: Introduction: Acute poisonings are one of the common cause of emergency visits and hospital admissions and is potentially preventable cause of childhood mortality and morbidity. The objectives of this study were to identify the common type of poisoning in children, to determine types of poisoning according to age and to find out the common age group in which the incidence of poisoning was high. Materials and Methods: It was a descriptive observational study done in a teaching hospital in Lalitpur, Nepal in patients aged 1 month to 18 years who visited the emergency department and were admitted to hospital with history of alleged poisoning from 2009 July to 2014 January. Results: Fifty patients were included. Drugs, kerosene and organophosphorus were most common cause of poisoning. Drugs and kerosene below 10 years of age and organophosphorus and drugs above 10 years of age were common types of poisoning. Maximum numbers (50%) of children with poisoning cases were below five year of age. Mean duration of hospital stay was 2.1days and mean age of poisoning was 7.8 years with a male(54%) predominance. Majority of poisoning occurred at home (84%) and 68% of patients were symptomatic at presentation to hospital with 84% of patients presenting to hospital within six hours. Conclusion: This study showed that drugs, kerosene and organophosphorus were most common forms of poisoning. Young children were most vulnerable for acute poisoning.
Clinical Profile of Patients Presenting with Gallstone Disease in University Hospital of Nepal
(Kathmandu University, 2020) Joshi, HN; Singh, AK; Shrestha, D; Shrestha, I; Karmacharya, RM
ABSTRACT Background Gallstone disease is one of the most common surgical problem throughout the world. The rise in gallstone disease burden and its wide spectrum of non-specific presentation makes the disease more challenging. Objective To know the various modes of presentation, socio-demographic details of the patients with gallstone disease, any associated factors and its treatment options. Method This is a prospective descriptive study in the patients presenting to Dhulikhel Hospital Kathmandu University Hospital diagnosed with gallstone during May 2018 to April 2020. After receiving ethical clearance from institutional Review committee, the informed consent was taken from all patient involved in the study. The presence of gallstone was confirmed by abdominal ultrasonography (USG). This study included total of 202 patients with gallstone disease. Result A total of 202 individuals with gallstone were included in the study; 48 males (24%) and 154 females (76%). The disease condition was common in age group 31-40 years (26.24%). Majority of the study population consumed mixed diet (92.57%). Out of 202 patients; 52 patients (25.74%) were overweight. In this study series 185 patients (91.58%) were symptomatic. Pain abdomen was one of the commonest symptoms (97.84%) followed by Nausea (28.11%), Dyspepsia (28.11%), Vomiting (18.38%), Fever (1.62) and Jaundice (1.08%). All cases were planned for laparoscopic cholecystectomy however 4 cases had to be converted to open surgery for completion. Conclusion Gallstone disease is a common surgical problem in Female population that presents most commonly with pain abdomen. Laparoscopic cholecystectomy can be easily performed in all cases of gallstone disease. KEY WORDS Cholecystolithiasis, Cholecystectomy, Gallstone disease, Laparoscopic cholecystectomy
Co-infection of COVID-19 with Malaria and Dengue -A Hospital based Study in Kathmandu, Nepal
(Kathmandu University, 2024) Bajracharya, B; Shrestha, P; Shrestha, D; Karna, AK; Mahato, RK; Shrestha, S; Baral,B; Bhandari, P; Sah, P; Bastola, A; Pandey, BD
ABSTRACT Background In tropical countries like Nepal, the COVID-19 pandemic unfolded within a population already grappling with various tropical infectious diseases. Co-infection with malaria and dengue holds clinical significance when managing COVID-19 patients in regions endemic to these diseases. Objective To identify malaria and dengue infections in febrile or symptomatic patients suspected of COVID-19 at the Sukraraj Tropical and Infectious Disease Hospital, Kathmandu. Method Over two months, a prospective study was conducted on febrile or symptomatic patients suspected of COVID-19 visiting Sukraraj Tropical and Infectious Disease Hospital, Kathmandu. One hundred and twenty-three patients suspected of COVID-19 were tested for SARS-CoV-2 through RT-PCR as well as for malaria and dengue infection using rapid diagnostic test kits. Result Out of 123 patients suspected of COVID-19, 64 were confirmed to have COVID-19. No evidence of SARS-CoV-2 and malaria co-infection was found among the 123 tested patients. However, two patients admitted for COVID-19 tested positive for dengue virus infection. The patients with co-infections with dengue or scrub typhus were likely to have a longer hospital stays (OR 2.5; 95% CI: 0.22-29.26), though lacking a significant association. Conclusion The two patients diagnosed with dengue virus and SARS-CoV-2 were identified during their hospital visit and both recovered after receiving treatment. Given that COVID-19 patients manifest symptoms resembling many tropical infectious diseases, the study underscores the clinical importance of testing for multiple circulating infections in patients from endemic areas. This approach ensures appropriate and timely management reducing the risk of severity or mortality. KEY WORDS Co-infection, COVID-19, Dengue, Malaria, Nepal
ComparisonofBloodCultureandSingleSlideAgglutinationWidalTestfortheDiagnosisofEntericFever
(Institute of Medicine, 2014) Shrestha, D; Kalakheti, U; Shrestha, M; Shrestha, S; Shrestha, P; Acharya, J
Abstract Introduction: Enteric fever is a leading cause of mortality and morbidity in the developing world. Unawareness of public concerning the sanitation & hygiene led to the high prevalence of the disease. Methods: Blood sample of patients suspecting enteric fever attending STIDH of all age group were collected & simultaneously data on pre-disposing factors associated with systemic febrile illness were collected according to the questionnaire designated. The collected blood samples were brought immediately to the laboratory. Upon arrival, the blood samples were processed for blood culture and single slide agglutination Widal test according to the standard laboratory methods. Results: Of the total 237 cases, 13 (5.48%) were confirmed as enteric fever by blood culture with 5 (38.46%) Salmonella enterica serovar Typhi and 8 (61.54%) Salmonella enterica serovar Paratyphi A. Out of the total cases, 7 (2.95%) were positive for blood culture as well as Widal test. At the serum titre of 1:80, Widal test showed the sensitivity of 28.57% and specificity of 73.56% for O antigen whereas sensitivity of 71.42% and specificity of 61.36% for H antigen. PPVs for the test were quite low with 8% for O antigen, 12.82% for H antigen and 12.5% for AH antigen. NPVs were 92.75% for O antigen, 96.42% for H antigen and 95.08% for AH antigen. Most of the culture confirmed cases, 9 (69.23%) were positive in the 1st week of onset of fever and most of the widal positive cases, 49(51.57%) were positive in the 2nd week of onset of fever. Conclusion: Single slide Widal test of titre value ≥ 1:160 was found to be useful tool for diagnosis of enteric fever but the results should be corelated with clinical findings. Keywords: blood culture, enteric fever, Salmonella, Widal test
Digital Subtraction Angiography a Door Opener for Neurosurgical Residents who want to Perform Neurointerventional Procedures
(Kathmandu University, 2021) Rajbhandari, P; Gurung, P; Rajbhandari, S; Shrestha, D; Acharya, S; Shrestha, R; Shrestha, P; Shrestha, J; Sharma, U; Mali, S; Rajbhandari, R; Neupane, A; Pant, B
ABSTRACT Digital subtraction angiography (DSA) has been a fluoroscopic golden investigative tool to know the vascular angiography of the brain and spinal cord. The technique in performing this procedure exposes residents in accessing the major vessels, branches of the arch of aorta, selective angiography and diagnosing different vascular anomalies of brain and spine. They are also exposed to the knowledge of different diagnostic catheters, its manipulation, use of dye and radiation exposure and safety. We would like to share our experience in training and disseminating the knowledge of digital subtraction angiography to the residents. KEY WORDS Digital subtraction angiography, Neurosurgical residents, Neurointervention
Displaced Intra-Articular Calcaneal Fractures: Evaluation of Clinical and Radiological Outcome Following Open Reduction and Internal Fixation with Locking Branched Calcaneal Plate
(Kathmandu University, 2017) Shrestha, R; Shrestha, D; Kayastha, SR; Winker, H
ABSTRACT Background Calcaneal fractures are common, but are difficult to manage. Immediate concern is soft tissue problems, while long term concern is pain as a sequelae of subtalar arthritis. A consensus has not been reached in the management of calcaneal fractures. Objective This study aims to evaluate clinical and radiological outcomes of the patients managed with open reduction and internal fixation with Calcaneal Locking Plates for the displaced intra-articular calcaneal fractures presenting in Dhulikhel Hospital, Kathmandu University Hospital. Method This was a prospective study, conducted on displaced intra articular calcaneal fractures from January 2014 through December 2016. The patients underwent open reduction and internal fixation with Locking Branched Calcaneal Plates through the extensile lateral approach. Post-operatively, ankle was mobilized after two weeks. Weight bearing was started after 12 weeks. Patients were evaluated clinically with Maryland foot score and radiologically with measurements of Boehler’s and Gissane angle. Result Twenty-two cases of calcaneal fractures managed with open reduction and internal fixation with Locking Branched Calcaneal Plates were available for final evaluation. Seventeen of the enrolled patients were males in their third decade of life. On average, calcaneal fractures were operated on seven days after the injury. Sanders Type II were seen in 68.2% of the cases and Sanders Type III were in 31.8%. Mean follow-up duration was 21.5 months. The average Maryland foot score was 77.27. Seventeen cases (77.13%) had good, four cases (18.2%) had fair, and one case (5.5%) had poor outcome score. There was statistically significant improvement in Boehler’s and Gissane angle across all enrolled patients. Conclusion Displaced intra-articular calcaneal fractures treated operatively with open reduction and internal fixation with Locking Branched Calcaneal Plates through the extended lateral approach, with proper planning of operation and surgical techniques in soft tissue handling, results in good clinical as well as radiological outcomes. KEY WORDS Boehler’s angle, calcaneum, calcaneal locking plates, maryland foot score, ORIF
Distally Based Sural Faciocutaneous and Fascial (Adipofascial) Flap for Reconstruction of Distal Leg, Ankle and Foot Defects
(Kathmandu University, 2014) Parajuli, NP; Shrestha, D; Panse, N
ABSTRACT Background Any soft tissue defect in distal leg, ankle and hind foot is still a challenging problem. There are various options for coverage of such defects, but the distally based sural neurocutaneous and neurofascial flap based on the sural nerve and superficial sural artery has been an important option. Objective To evaluate the efficacy of distally based sural flap in reconstruction of the distal leg, ankle and hind foot soft tissue defects. Method Seventeen patients with soft tissue defects over distal leg, ankle and hind foot were included in this study. All patients were treated with distally based sural flap. Most of the cases were due to trauma (16 cases) which compromised tendon and bone. One case was of malignant melanoma of sole of hind foot which required wide excision and soft tissue reconstruction with sural flap. Result In all cases defects were successfully covered. Three showed venous congestion and partial necrosis. One developed secondary infection. One flap failed completely. Mean follow up of patients was 20 months (6 – 36 months). Conclusion Sural flap is a good option for reconstruction of distal leg, ankle and foot defects. KEY WORDS Ankle defect, distally based sural flap, heel defect, leg defect, lower limb reconstruction.
Diversity of Root Canal Morphology in Mandibular First Premolar
(Kathmandu University, 2019) Shrestha, R; Srii, R; Shrestha, D
ABSTRACT Background Mandibular first premolars have been reported to have complex anatomical aberration making them one of the most difficult teeth to manage endodontically. Objective To determine the root canal anatomy of mandibular first premolar in a Nepalese population using decalcification and clearing technique. Method One hundred and fifty extracted mandibular first premolars were collected from Nepalese population. Access cavities were prepared on the occlusal surface of each tooth. Teeth were decalcified by immerging in 5% nitric acid, dehydrated in ethyl alcohol and made transparent using methyl salicylate. Methylene blue dye was injected through access cavity and canal anatomy were observed and classified according to Vertucci’s classification. Result The average length of mandibular first premolar was 20.43mm. One rooted teeth were 96% and two rooted were 4%. Vertucci’s type I canal configuration was most prevalent (72%) followed by type V (18.6%), type III (3.3%), type II (2.6%) and type IV (2.6%). An unusual configuration was found in one tooth. Isthmus and apical deltas were found in 8.6%) and 14.6% of the cases respectively. Conclusion Type I canal configuration were the most frequently observed root canal configuration in mandibular first premolar followed by type V configuration. Such variation in root canal anatomy should be taken into consideration to ensure successful endodontic therapy of these teeth. KEY WORDS Decalcification and clearing, Mandibular first premolar, Nepalese, Root canal morphology
Egg Allergy in infancy
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2010) Shrestha, R; Shrestha, D; Poudyal, R; Mishra, N
Abstract Egg allergies are one of the most common allergies of childhood and the reactions may vary from mild to severe. A family history of egg allergy or atopy is a risk factor for egg allergy. Most food-induced allergic reactions occur on first known oral exposure, especially in the case of eggs and peanuts. We report a case of nine months old infant who developed egg allery (contact dermatitis) after contact with egg white, with a positive family history of atopy and egg allergy. Keywords Egg allergy; contact dermatitis; infancy.

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