Browsing by Author "Shrestha, Gentle Sunder"
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Publication A Seven-Year Audit of Intensive Care Unit Admissions and Outcome in a Tertiary Care Hospital in Nepal(Institute of Medicine, Tribhuvan University, 2025) Sharma, Sachit; Shrestha, Gentle Sunder; Shrestha, Pramesh Sundar; Paneru, Hem Raj; Pathak, Sunil; Rijal, Divas; Acharya, Subhash PrasadAbstract: Introduction An audit is used to assess if a particular aspect of health care is in accordance with the standard practice and aims to achieve improvement in quality for the benefit of the patient. The current study is a retrospective descriptive observational audit which intends to study the patient profile and outcome of patients admitted to a level III ICU of a tertiary care hospital in Nepal over a duration of seven years. Methods A retrospective descriptive observational audit was conducted in the Tribhuvan University Teaching Hospital (TUTH) ICU from 1st Baisakh, 2074 to 31st Chaitra, 2080. Data on patient profile and outcome were recorded and statistical analysis was performed. Results A total of 6,233 patients were admitted, with 53.9% male patients over a duration of 7 years in TUTH ICU. Medical admissions accounted for 51.67% and surgical admissions 48.33%. Overall, the maximum number of cases were admitted under neurosurgical speciality. Of all patients, 64.7% improved and were shifted out of ICU while mortality was 27.4%. An average sequential organ failure assessment (SOFA) score was 6.7 during the study period. Conclusion The major finding of the study was a progressive decline in average SOFA score, average length of ICU stay and average length of Mechanical Ventilation over the last 3 years. The highest number of admission was in neurosurgery and respiratory medicine over the duration of seven years.Publication Clinical Characteristics and Outcomes of Patients Managed with Percutaneous Dilatational Tracheostomy in the Intensive Care Unit: A Retrospective Observational Study(Nepal Medical Association, 2025) Pradhan, Utsav; Karki, Bipin; Paneru, Hem Raj; Shrestha, Pramesh Sunder; Shrestha, Gentle Sunder; Acharya, Subhash PrasadAbstract Introduction: Percutaneous dilatational tracheostomy has emerged as a preferred minimally invasive alternative to surgical tracheostomy for critically ill patients requiring prolonged mechanical ventilation, though comprehensive data from Nepal remains limited. This study aimed to evaluate the practice of percutaneous dilatational tracheostomy and analyze clinical outcomes in a tertiary level ICU in Nepal. Methods: A retrospective observational study was conducted at Level III ICUs Nepal from April 14, 2021 to April 12, 2024. All patients aged 18 and older who underwent percutaneous dilatational tracheostomy during ICU stay in the study duration were included. Ethical approval for the study was obtained from the institutional review committee [Ref. 583. (6-11) E2]. Data on clinical characteristics, procedural techniques, complications, and outcomes were collected from electronic records and individual file records from hospital record department. Results: The study population comprised predominantly males 53 (63.86%) with a median age of 49 (IQR: 30-62) years. Neurological disorders, particularly intracranial haemorrhage, were the most common admission diagnosis 53 (63.86%). The mean duration from mechanical ventilation to PDT was 16 (IQR: 11-20) days and the main indication was prolonged mechanical ventilation 62 (74.7%). Grigg’s guidewire dilator forceps technique was used 77 (92.77%) of the time. Immediate complications occurred in 12 (14.46%) of cases. The hospital survival rate was 42 (50.6%) with 69 % of survivors achieving decannulation before discharge. Conclusions:Percutaneous dilatational tracheostomy safe bedside procedure for critically ill patients needing prolonged ventilation, with only minor, non-life-threatening complications observed in our tertiary care setting.Publication Perception and Willingness Regarding Organ Transplantation/donation among Medical Students of Maharajgunj Medical Campus: A Cross-sectional Study(Nepal Health Research Council, 2024) Bhattarai, Amit Sharma; Adhikari, Bidur; Joshi, Deepak Raj; Yadav, Alisha; Joshi, Pankaj; Parajuli, Bashu Dev; Koirala, Megha; Karki, Kushal Jung; Subedi, Krishna Prasad; Shrestha, Gentle Sunder; Shrestha, Anil; Singh, ShreejanaBackground: Organ transplant is the procedure of replacing a failing or damaged organ with a functioning one. Positive attitude and awareness about donation are a must for donor organs to be available. This study explored the level of knowledge, perception and willingness regarding organ donation among medical students in Nepal. Methods: A descriptive cross-sectional study was conducted with 180 medical students using a self-administered questionnaire. Descriptive statistics were used, and Pearson correlation was applied to examine the relationship between knowledge and perception of organ transplantation. Independent samples t-test and ANOVA was used to compare scores among year of study and gender. Results: Results indicated that 86.1% of participants were aware of the need for organ donation, and 83.3% knew that both living and deceased individuals could be donors. While 93.9% believed in the need for effective laws, 72.8% perceived risks for donors. However, only 74.4% were willing to donate their organs, though 91.7% expressed willingness to promote organ donation among friends and family. Participants showed a positive perception towards organ donation. Conclusions: Despite a high level of awareness and knowledge regarding organ donation, participants exhibited a lower level of willingness to donate organs. Perceived risks for donors and a lack of robust laws and regulations presented significant barriers. Nevertheless, an inclination to promote organ donation was observed. This underlines the need for enhanced education and policy reform to increase organ donation rates. Keywords: Awareness; knowledge; organ donation; organ transplantation; perception.Publication Recurrent Ischemic Stroke in a Patient with Atrial Myxoma: A Case Report(Nepal Medical Association, 2022) Shrestha, Gentle Sunder; Rimal, Ankit; Shrestha, Shubha Kalyan; Shrestha, Pramesh Sunder; Acharya, Subhash PrasadAbstract Cardiac myxoma is an infrequent but curable cause of ischemic stroke. There are no guidelines addressing the timing of surgery to excise the tumour or for the use of thrombolysis or thrombectomy. We present a case with an ischemic stroke which was diagnosed to have atrial myxoma. She was planned for surgical excision of the tumour but suffered from a second ischemic stroke while awaiting surgery. This article aims to highlight vital aspects of this rare phenomenon and discuss the prospects of the timing of surgery and neurosurgical intervention. The importance of a proper cardiac evaluation in all cases of stroke is highlighted.