Browsing by Author "Shrestha, K"
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Publication Are we really in safe hands? How safe is safe?(Kathmandu University, 2008) Pradhan, R; Shrestha, K; Gurung, SNAPublication Dental Biofilm Accumulation and Gingival Health of Teeth with Fixed Single Prosthesis Fabricated by Various Prosthetic Materials(Kathmandu University, 2024) Pradhan, A; Shrestha, K; Aryal, S; Shrestha, SABSTRACT Background Periodontal health plays an important role in maintaining the health of natural teeth as well as in the success of all dental procedures. Fixed single prosthesis (dental crown) can be fabricated with different types of prosthetic restorative materials like Metal, Ceramic, Ceramic fused to metal. These different materials have different affinity for plaque accumulation leading to the development of gingival inflammation and periodontal disease. Objective To determine the amount of Plaque accumulation and gingival health of teeth with a fixed single prosthesis fabricated by various Prosthetic materials. Method This quantitative cross-sectional study was carried out from July 2021 to March 2022. The patients who visited the hospital after six months of use of the prosthesis enrolled and were categorized into three groups according to the material used for the prosthesis metal, ceramic, and metal-ceramic. The periodontal condition was assessed using the plaque index and gingival index. Result A total of 136 patients (78 female and 58 male) were enrolled in the study, with a mean age of 39.44 ± 16.23 years (Range 19 – 70 years). There were 47 patients with ceramic crowns, 39 patients with metallic, and 50 patients with metal ceramic crowns. The mean plaque index of metal, ceramic, and metal-ceramic crowns was found 1.15 ± 0.546, 0.86 ± 0.479, and 0.93 ± 0.498 respectively. Similarly, the mean gingival index of metal, ceramic, and metal-ceramic crown were 1.22 ± 0.56, 0.91 ± 0.48, and 1.09 ± 0.55 respectively. Conclusion The dental biofilm (plaque) accumulation and hence gingival inflammation is less in ceramic crowns than in metal and metal-ceramic crowns. KEY WORDS Dental crown, Dental plaque index, Gingival indexPublication Evolving Experience in The Management of Empyema Thoracis(Kathmandu University, 2011) Shrestha, K; Shah, S; Shrestha, S; Thulung, S; Karki, B; Pokhrel, DPABSTRACT Background Empyema thoracis a disease of significant morbidity and mortality, especially in the developing world. However, the optimal management of empyema thoracis remains controversial. Objective To analyse evolving experience in clinical presentation, management, outcome and factors contributing to adverse morbidity in empyema thoracis. Methods This is hospital based retrospective study of patients who were diagnosed with empyema thoracis in cardiothoracic and vascular surgery (CTVS) unit, Bir Hospital, Kathmandu, Nepal over a period of one year (July 2009 to June 2010). A total of forty-six adult cases were categorized into two treatment groups: (i) thoracotomy for decortication (ii) segmentectomy, lobectomy and redo-thoracotomy for pneumonectomy. The median duration of illness prior to hospital admission was compared. The presence of loculated pleural fluid determined the need for thoracotomy. Results Out of forty-six cases, twenty- nine (63.04%) who had early thoracotomy (<22 days) had prompt symptomatic recovery. Forteen out of seventeen (82.35%) of the patients who were initially treated with thoracocentesis or tube thoracostomy eventually needed thoracotomy. There was a positive shift in management towards early thoracotomy resulting in prompt symptomatic recovery. Significant complications were noted in eight patients who had delayed thoracotomy. Complications included recurrent empyema with lung abscess (n = 3), restrictive lung disease (n = 3), bronchopleural fistula (n = 1) and scoliosis (n=1). Conclusion Early thoracotomy and decortication was found to be an excellent surgical procedure with good functional results and high patient satisfaction rate. KEY WORDS empyema, thoracotomy, complicationsPublication Factors Influencing Brain Drain among Nepalese Nurses(Kathmandu University, 2017) Thapa, B; Shrestha, KABSTRACT Background Brain drain means migration of technically skilled people from one country to another country. Migration of health workers including nurses are the result of interplay of many push and pull factors. Push factors are those conditions that influence the nurses’ decision to leave their own country. Conversely, pull factors are those conditions in a given country that attract nurses, influencing their movement to that country. Objective The objective of this study was to identify push and pull factors of brain drain among the Nepalese nurses. Method Descriptive cross sectional study was done among 228 Nepalese nurses working in five different countries in 2016 by using quota sampling technique. A self administered questionnaire consisting of structured four-point Likert scale was designed to collect information on push and pull factors of brain drain. Descriptive and inferential statistics were computed using SPSS version 16. Result Many of brain drained nurses had ranked very important push factor was personal ambition (72.8%) and very important pull factor was better job and career opportunity (77.2%). Majority of nurses working in Nepal had ranked very important push factor was lack of job and career opportunity (86.0%) and pull factor was better job and career opportunity (85.1%). All push and pull factors were significantly associated with brain drain. Conclusion Most of the Nepalese nurses were forced to go abroad due to personal ambition, followed by low salary, and lack of job and career opportunity. Nurse migration out of Nepal is likely to persist and even increase if underlying factors aren’t properly resolved. KEY WORDS Brain drain, nurses, pull factors, push factorsPublication Health Promoting Lifestyle during Covid-19 Pandemic among Residents of Gandaki Province, Nepal(Kathmandu University, 2022) Shrestha, K; Acharya, S; Poudel, SABSTRACT Background Lifestyle is an important factor to individual’s health and quality of life. Although, the emergence of Corona virus disease 2019 (COVID-19) has forced billions of people to change their lifestyle overnight. Objective To identify health promoting lifestyle during COVID-19 pandemic among the residents of Gandaki Province, Nepal. Method Descriptive cross sectional web based study was conducted among 386 respondents from Gandaki Province. Adults from 18 years and above, who could fill the form online were included using purposive and snowball sampling technique. Data were collected using Health Promoting Lifestyle Profile II (HPLP II) scale and analysed using descriptive (frequency, percentage, median) and inferential statistics (Mann Whitney U test and Kruskal Wallis test). Result Only 18.7% of the respondents had an excellent health promoting lifestyle followed by good health promoting lifestyle among 60.4%. Highest median score was observed in spiritual 27(10-36), and interpersonal relationship subscale 27(9-36). Whereas, the lowest was observed in physical activity 21(8-32) followed by stress management 24(10-32). Statistically significant difference was observed in age and perception of own health status with spirituality; gender, chronic illness and perception of own health status with interpersonal subscale and age, gender, marital status, occupation and perception of own health status with physical subscale. Conclusion The study concludes the need of health education and awareness to promote healthy lifestyle behaviours with a particular emphasis on indoor physical activities and stress management skills with specific consideration to female and elderly. KEY WORDS Adult, COVID-19, Health promoting lifestyle/behaviour, NepalPublication Health Related Quality of Life of Diabetic Patients(Kathmandu University, 2019) Shrestha, K; Tamrakar, NABSTRACT Background Diabetes mellitus is a common and serious global health problem. In Nepal, it is a major expanding non communicable disease that has a number of chronic effects, accompanied by marked reduction in the health related quality of life (HRQOL). Assessment of health related quality of life mainly focuses on the effect of illness and impact of treatment on health. Objective The objective of this study was to identify the health related quality of life of diabetic patients. Method A descriptive cross sectional study was conducted among 116 diabetic patients attending Diabetes, Thyroid and Endocrinology Care Center, Pokhara. Non probability purposive sampling technique was used. Data was collected using World Health Organization Quality Of Life - BREF tool and analysed using descriptive and inferential statistics such as frequency, percentage, mean, standard deviation, median, interquartile range, Mann Whitney U test, Kruskal Wallis test and Spearman’s correlation coefficient test. Result The median score of HRQOL was 244 (225-275). Statistically significant difference was observed in age (p<0.001), sex (p=0.043), living status (p=0.012), education (p=0.001), duration of illness (p=0.038) and co-morbidity (p<0.001) with overall health related quality of life. Physical domain had strongest correlation (p<0.000) with overall quality of life. Conclusion Diabetic patients have higher health related quality of life in the physical and social domain. Young adults, male, literate, living with spouse, duration of diabetes for less than 10 years and those without comorbidity have higher health related quality of life. Integration of routine counselling programme will be helpful in promoting health related quality of life of diabetic patients. KEY WORDS Diabetes, Diabetic patients, Health related quality of lifePublication Mothers’ Perception of Their Children’s Play in Dhulikhel Hospital, Nepal(Kathmandu university, 2021) Karki, S; Shrestha, S; Shrestha, KABSTRACT Background Play is a cherished part of childhood that offers children holistic developmental benefits and parents the opportunity to fully engage with their children. However, modern-day children are spending significantly less time in outdoor play due to a number of factors including technological advancements, more time involved in structured activities, and a greater emphasis on early cognitive learning. Objective To assess perception of mothers on their children’s play. Method This was a descriptive cross-sectional study was carried out among the 228 mothers having at least one child children who attended in Paediatric OPD of Dhulikhel hospital of Nepal from 21st June, 2018 to 16th July, 2019. Ethical approval was obtained from the Institutional Review Committee (IRC) of Kathmandu University School of Medical Sciences (KUSMS). Research instrument was developed by Barnett and was adopted for this study with permission from the author. Systematic random sampling technique was used to select mothers and face to face interview was carried out to collect information. Result Perception on play of children in the mothers was varied. Most of mothers agreed on different sub scales of play with mean range 2.07-3.01 in which they were agreed on freedom play with mean score 3.01±0.40, importance of play with mean score 2.93±0.37 and nearly agreed on maternal rule with mean score 2.89±0.50, play safety with mean score 2.92±0.36, child’s choice with mean score 2.96±0.49 and disagreed on imaginative play with mean score 2.42±0.59 and gender typing with mean score 2.07±0.51. Conclusion Although almost all respondents had positive attitudes towards different component of the play, they disagreed on gender typing and imaginative play which is very important for developing problem solving skill of children based on their gender. So, nursing faculties, pediatricians and nurses can use the findings to develop awareness on importance of gender typing and imaginative play among mothers. KEY WORDS Children, Mothers, Play, PerceptionPublication Permcath - A Vascular Access for Hemodialysis, Our Experience in Last Two Years(Kathmandu University, 2019) Baidya, PR; Shrestha, K; Deuja, ML; Rai, A; Shrestha, N; Shrestha, A; Baidya, AABSTRACT Background The double lumen tunneled catheter (Permcath) is mostly used as an alternative access, not as a temporary access in End Stage Renal Disease patients requiring hemodialysis. If there is no possibility of other access modalities, failed or unable to create native arteriovenous fistula (AVF), Permcath can be a very good alternative. Objective To find the indications, complications and results of Permcath insertion. Method We reviewed the results of 92 Permcath inserted under ultrasound guidance in two different hospitals, 45 in Sahid Dharma Bhakta National Transplant Center (SDNTC), Bhaktapur and 47 in Nidan Hospital Pvt. Ltd., Lalitpur from April 2016 to April 2018 retrospectively. Result We had inserted 55 Permcath (59.78%) in right internal jugular vein (IJV), 25 (27.17%) in left internal jugular vein and 12(13.04%) in femoral vein. In terms of major complications, two (2.17%) patients had profound hypotension, bradycardia and cardiac arrest due to left internal jugular vein tear. Three patients (3.26%) died within a week due to septicemia and 23 patients (25%) died with multiple causes within one year. Of the cases, till now in 39 cases (42.39%) Permcath has been removed. Major reasons of removal of Permcath are post renal transplant in 18 cases (19.57%), Arterio Venous Fistula maturation in 13 cases (14.13%), Infection in six patients (6.52%) and non functioning Permcath in two patients (2.17%). Conclusion Permcath remains a reliable method for short term vascular access, hence can be used as a bridge to renal transplant or arteriovenous fistula maturation. KEY WORDS Permcath, Tunneled dialysis catheter, Vascular accessPublication Predicting Complicated Appendicitis Based on Neutrophil to Lymphocyte Ratio, A Study in University Hospital of Nepal(Kathmandu University, 2023) Shrestha, B; Koju, R; Makaju Shrestha, S; Shrestha, K; Hada, G; Shakya, YR; Karmacharya, RM; Malla, BRABSTRACT Background Acute appendicitis is one of the most common causes of acute abdomen requiring surgical treatment. Accurately diagnosing appendicitis and identifying complicated appendicitis can be difficult at times. Objective To evaluate the ability of the neutrophil-to-lymphocyte ratio (NLR) to differentiate between uncomplicated and complicated appendicitis. Method This was a prospective hospital-based observational study conducted at the Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital from July 2021 to December 2022. Patients with the clinical diagnosis of acute appendicitis who had undergone emergency appendectomy were included in the study. Informed consent was taken from each patient and data collection was done by filling the proforma. Result A total of 218 patients were included in the study. Male: female ratio was 1.18:1. Mean age of patients was 28.58 ± 16.65 (3-78) years. A significant correlation was found between increasing neutrophil count and neutrophil-to-lymphocyte ratio with complicated appendicitis. However, no significant correlation was found between White Blood Cell counts and complicated appendicitis. Neutrophil-to-lymphocyte ratio > 12.6 was found to be associated with complicated appendicitis. Conclusion A simple, cost-effective, and yet perfect test is not available for identifying complicated appendicitis. Increased Neutrophil count and neutrophil-to-lymphocyte ratio can indicate complicated appendicitis. Elevated WBC counts alone has no role in differentiating complicated appendicitis. According to the results of our study, an neutrophil-to-lymphocyte ratio of 12.6 can help to differentiate complicated from uncomplicated appendicitis. KEY WORDS Appendectomy, Appendicitis, Lymphocyte count, Neutrophils, Receiver operating characteristic curvePublication Predictors of Stone Free Rate and Application of the Size, Topography, Obstruction, Number and Evaluation of Hounsfield Units (S.T.O.N.E) Scoring System in Predicting the Outcome in Patients Undergoing Semi-rigid Ureteroscopic Lithotripsy for Ureteric Calculi at a University Hospital of Nepal(Kathmandu University, 2024) Shrestha, B; Koju, R; Makaju Shrestha, S; Shrestha, K; Karmacharya, RMABSTRACT Background Ureteric colic is common urological emergency in patients with urinary stone disease. Semi rigid ureteroscopic lithotripsy is a widely acceptable treatment modality for ureteric calculi. Objective To evaluate the predicting factors of stone free rate (SFR) and application of the Size, Topography, Obstruction, Number and Evaluation of Hounsfield units (S.T.O.N.E) scoring system in predicting success rate of ureteroscopiclithotrisy (URSL) for ureteric calculi. Method This was a prospective hospital based observational study conducted at the Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital from October 2021 to September 2022. Patients undergoing ureteroscopiclithotripsy using laser and/or pneumatic lithotripsy for ureteric calculi were included in the study. Informed consent was taken from each patient and data collection was done by filling the proforma. Result A total of 82 patients were included in the study. Mean age of patients was 35.89 ± 11.51 years. Overall stone free rate was 80.5%. Stone free rate were 96.67% and 71.15% in moderate (6-9) and high (10-13) S.T.O.N.E score groups respectively. Stone size and S.T.N.O.E score were found to be significantly high in patients with retained stone following ureteroscopiclithotrisy (p value < 0.05). Duration of surgery was significantly high in high S.T.O.N.E score group (p<0.05). However no significant correlation was found between patient characters like age, sex, Body mass index and Hounsfield units of stone with stone free rate in this study. The area under the curve of the receiver operating characteristic curve for the S.T.O.N.E score and stone size were 0.693 and 0.660 respectively in this study. Conclusion Stone size and S.T.O.N.E score can be used as predictors of success following semi- rigid ureteroscopic lithotripsy. The value of S.T.N.O.E score has good predictive value for SFR and duration of surgery. There was no significant impact of patient’s age, sex, Body mass index and Hounsfield units of stone in stone free rate following ureteroscopic lithotrisyin this study. KEY WORDS Body mass index, Lithotripsy, Receiver operating characteristic curve, Ureteroscopy