Browsing by Author "Shrestha, JK"
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Publication An Unusual Presentation of Giant Cell tumour (osteoclastoma)(Kathmandu University, 2003) Pradhan, E; Shrestha, JK; Karmacharya, PCKThe number of well-documented true giant cell tumours arising in any of the craniofacial bones is small, but they do exist. A 19 year old female, Ms. KS, presented with complain of progressive enlargement of facial bones especially jaw bones, then orbit symmetrically since the age of 7. There was bilateral gross enlargement of mandible, maxilla, orbital walls, causing displacement of eye medially and upwards. The visual acuity of both eyes were 6/36 and 6/18 with best correction. Extra ocular movements were restricted because of bony growth and conjunctiva over inferior fornix were keratinized due to exposure. Fine needle aspiration (FNAC) from the side of bony growth showed plenty of osteoclasts with multinucleated giant cells. The level of serum alkaline phosphatase were highly increased. She underwent orbitotomy and a part of tissue was sent for biopsy which revealed multiples of mononucleargiant cells and tumour cells. Key Words: osteoclastoma, craniofacial bones, visual acuity, orbitotomy.Publication Association of HBA1c and Plasma Glucose Levels with Diabetic Retinopathy(Kathmandu University, 2025) Shrestha, P; Chaudhary, A; Shrestha, JKABSTRACT Background Diabetic retinopathy is one of the leading causes of blindness worldwide. The relationship between glucose level and development of diabetic retinopathy has always been an area of interest and constantly evolving. Objective To determine the association of glycosylated hemoglobin and plasma glucose levels with different grades of diabetic retinopathy. Method A hospital based cross sectional study was conducted among 504 patients with type II diabetes mellitus attending the Department of Ophthalmology in a University Hospital for one year duration. Relevant history regarding diabetes mellitus was recorded for all patients. The status of diabetic retinopathy in each patient was diagnosed by detailed ophthalmological examination and classified according to International Classification of Diabetic Retinopathy Scale. All the patients were evaluated for their glycosylated hemoglobin, fasting and post prandial blood glucose levels. Bivariate analysis using t-tests and chi-square tests was used to measure the strength of association between the different variables. An Analysis of Variance (ANOVA) test was used to evaluate the association between the means of different variables. Result Total 504 patients constituted of 254 males (50.39%) and 250 (49.60 %) females. Almost half of the study population had poor glycemic control and deranged fasting and post prandial blood sugar levels. Diabetic retinopathy was observed in 124 (24.60%) patients and diabetic macular edema was observed in 42 (8.33%) patients. Poor control of glycosylated hemoglobin (> 7.6) was seen in 88 (70.96%) cases of diabetic retinopathy and 34 (80.95%) cases of diabetic macular edema. Uncontrolled fasting and postprandial blood sugar levels were associated with a significant number of cases of diabetic retinopathy and of diabetic macular edema respectively. A statistically significant association was observed between increasing grades of diabetic retinopathy and higher glycosylated hemoglobin and plasma glucose levels. Conclusion Higher the level of glycosylated hemoglobin and plasma glucose levels, more severe is the grade of diabetic retinopathy. KEY WORDS Diabetic retinopathy (DR), Fasting blood sugar, Glycosylated hemoglobin (HBA1c), Non-proliferative diabetic retinopathy (NPDR), Proliferative diabetic retinopathy (PDR)Publication Association of primary glaucomas with retinal vein occlusion(Kathmandu University, 2008) Sherpa, D; Shakya, S; Shrestha, JKAbstract Aims and Objectives: To determine the association of Primary glaucoma with retinal vein occlusion. Methodology: A prospective cross-sectional study was carried out in B.P. Koirala Lions Centre for Ophthalmic Studies from April 2002-July 2003. All diagnosed cases of retinal vein occlusion were evaluated in detail for the presence of primary glaucoma. Detailed history was taken. Best corrected visual acuity was recorded, slit-lamp evaluation of anterior segment was performed, intraocular pressure was assessed with the help of applanation tonometer, gonioscopy was done and fundus evaluation was done under full mydriasis. Results: Out of 50 patients, 19 (38%) were central retinal vein occlusion and 31(62%) were branch retinal vein occlusion. Majority of the retinal vein occlusion patients were in the age group of (61-70years) 12 out of 50 patients (24%). There were 12 patients of primary glaucoma in 50 patients of retinal vein occlusion. Out of which 11 patients had primary open angle glaucoma and 1 patient had primary angle closure glaucoma. Conclusion: This study shows association of primary glaucoma as a risk factor of retinal vein occlusion. Evaluation of retinal vein occlusion patients for primary glaucoma would be worthwhile for early detection and prevention of blindness. Keywords: Primary open angel glaucoma (POAG), Primary angle closure glaucoma (PACG), Central retinal vein occlusion (CRVO), Branch retinal vein occlusion (BRVO).Publication Clinical Characteristics of Cataract Patients and Outcome of Cataract Surgery in Tertiary Care Hospital in Central Nepal(Kathmandu University, 2022) Shrestha, A; Shrestha, P; Shrestha, T; Makaju Shrestha, R; Shrestha, B; Poudel, L; Shrestha, JKABSTRACT Background Cataract remains the leading cause of avoidable blindness in low-income countries such as Nepal. Despite the availability of surgical interventions for cataract in leading institutions, still a large number of patients from remote areas delay or have difficulty in getting treatment, present late or with complications. Objective To determine the clinical characteristics and visual outcome of patients undergoing cataract surgery in Tertiary Care Hospital in Central Nepal. Method We retrospectively reviewed the medical records of 138 patients who underwent cataract surgery at a tertiary care hospital from January 2018 to September 2022. R version 4.0.3 was used for the data analysis. Categorical variables are presented as frequency (percentages) and the numerical ones are presented as mean (standard deviation). Result During follow-up visits between one to three weeks, 91.9% out of 135 patients had normal/near normal presenting visual acuity and with best correction it was 96.9% out of 131 patients. About 1.6% out of 124 operated eyes still had moderate visual impairment after best correction when they visited for follow-up at 12 weeks. Conclusion The study findings underline the ongoing gap in increasing access to cataract treatment, given the large proportion of individuals who still presented extremely late. KEY WORDS Cataract, Complication, Characteristics, Outcome, SurgeryPublication Demographics and Awareness of Diabetic Retinopathy among Diabetic Patients Attending Department of Ophthalmology at Dhulikhel Hospital(Kathmandu University, 2022) Shrestha, RM; Shrestha, N; Shrestha, P; Shrestha, JKABSTRACT Background Diabetes mellitus is considered as a major public health concern globally. Poor management of diabetes may lead to several serious complications including end- stage renal disease, diabetic retinopathy, diabetic neuropathy, and cardiovascular complications. Among them diabetic retinopathy is one of the leading causes of visual impairment and blindness in Nepal. Objective To assess the demographics and level of awareness among individuals with diabetes about diabetic retinopathy during their visit to Department of Ophthalmology at Dhulikhel Hospital. Method A descriptive cross-sectional study was conducted involving all consecutive cases of diabetes mellitus who attended eye clinic with the principal investigator and co-investigator from March 2021 to August 2021. Detailed demographics of the participants, their level of awareness regarding diabetic retinopathy and associated complications were documented. This was followed by a detailed ocular examination intending to screen for the presence of features of diabetic retinopathy. Result A total of 260 patients with a mean age of 54 years ± 12.20 (range of 24 - 85 years) were included. The male to female ratio was 2.2:1. Among them, 65.4% of the patients had diabetes mellitus for less than 5 years duration. Diabetic retinopathy was found in 18.46% of the cases. Awareness of diabetic ocular complications was significantly higher among literate population (p = 0.054), among those who have positive family history of diabetes mellitus (p = 0.529) and those who had undergone prior fundus evaluation (p = 0.000). Conclusion From result of this study, we can emphasize that there is a necessity for health education in order to increase the awareness and knowledge about diabetic retinopathy to lower the burden of sight threatening complications related with the issue. KEY WORDS Awareness, Demographics, Diabetic retinopathyPublication Retinal Haemorrhage in Newborns in Tertiary Care Hospital(Kathmandu University, 2022) Makaju Shrestha, R; Shrestha, S; Sharma, S; Joshi, A; Shrestha, P; Shrestha, JKABSTRACT Background Retinal haemorrhage in new-born is a clinically common neonatal fundus condition. Although, it usually does not affect the development of visual function, entities like macular haemorrhages may lead to amblyopia causing deterioration of visual function. Such scenario leads to downgrade in quality of life of the affected child. Objective To explore the underlying clinical factors associated with retinal haemorrhage in term new-borns. Method A cross sectional study was conducted involving 136 term neonates admitted in the neonatal intensive care unit of Dhulikhel Hospital. Fundus examination was performed within 2 weeks of delivery. Retinal haemorrhage was graded according to their location in three retinal zones. Result Out of 136 cases examined, 44 (32.35%) of the cases had one of the eyes with retinal haemorrhage. Where grade 1 retinal haemorrhage was accounted in majority of the cases. Birth weight, gestational age, mode of delivery, poor Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) Score in 1 and 5 minutes, birth asphyxia, neonatal sepsis and heavy work in antenatal period had statistically significant correlation with occurrence of retinal haemorrhage. Conclusion Our results suggest that spontaneous vaginal delivery, larger birth weight, higher gestational age, birth asphyxia, low Appearance, Pulse, Grimace, Activity, and Respiration score, are risk factors for occurrence of neonatal retinal haemorrhage. It is recommended that in neonates with above high-risk factors should undergo targeted fundus screening for early identification and needful interventions. KEY WORDS Asphyxia, New-born, Retinal haemorrhage