Browsing by Author "Shrestha, Lava"
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Publication Blood Groups and their Association with Academic Performance among Medical Students in a Nepalese Medical College(Institute of Medicine, 2019) Mahat, Barun; Shrestha, Lava; Adhikari, Shailesh; Thapa, Bikalp; Limbu, Prakesh; Banstola, Dinesh; Dhungel, SunilABSTRACT Introduction Knowing a person’s blood type is not only important in transfusion medicine and forensic medicine but is also useful for predicting a person’s characteristics including intelligence, knowledge, skill and behavior. It is recognized that intelligence, knowledge and skill are assessed by performance in examination. The objective of this study was to determine distribution of blood groups among students and its association with their academic performance. Methods This was an analytical study that was conducted among the medical students of Nepalese Army Institutes of Health Sciences (NAIHS) in Department of Clinical Physiology from June 2014 to April 2019. This study was conducted among 738 students by using convenient sampling method. Blood group was determined on the basis of agglutination reaction. Academic performance of students was assessed by the marks obtained by them in annual final examination. Results Blood group O was the most prevalent at 33.5%, followed by B at 29.5%, A at 29% and AB at 8%. Distribution of Rh positive and Rh negative were 96.6% and 3.4% respectively. The mean scores obtained in final university examination were highest in blood group A (62.9%) and lowest in blood group AB (60.3%) but the difference between different blood groups was not statistically significant. Conclusion Blood group O was the most common blood group. Rh positive was present in 96.6%. Though mean score was highest in blood group A, significant association between blood groups and academic performance was not seen in our study. Keywords: ABO, academic performance, blood groups, medical college, Nepal, RhPublication Characteristics of Articles Published in the Journal of Institute of Medicine Nepal: A Cross-sectional Study(Institute of Medicine, 2022) Shrestha, Lava; Singh, Yogendra P; Sharma, Mohan RABSTRACT Introduction: Scholarly journals publish various types of manuscripts. The objective of this study was to analyze the types of articles published in the Journal of Institute of Nepal (JIOM Nepal) from 2019 April to 2021 April and describe bibliometric characteristics. Methods: Seven issues of JIOM Nepal published from April 2019 to April 2021 were analyzed for types of study, areas of medical science, the number of authors, gender of the primary author, contributing specialty, and author’s affiliation. Results: Total articles published were 139, with a mean number of 19.8±4.4 articles per issue. More than half of the published articles were cross-sectional studies (93, 66.9%), followed by case reports (25, 17.9%). The majority of primary authors (94, 67.6%) were faculty from constituent campuses of the Institute of Medicine (IOM) Tribhuvan University. Thirty-eight (27.3%) contributing authors were females. Fifty-three (38.1%) articles published were diagnosis-related. Authors from surgical specialties were the most common article contributors [67 (48.2 %)], while basic science specialties contributed 13 (9.4%) publications. Conclusion: Cross-sectional studies were the most commonly published articles and surgical specialties published more than half of the articles. The majority of the articles were related to diagnosis. Greater efforts are needed to produce further progress of the journal. A mixture of original articles, reviews, and case reports from different medical domains will be more interesting to the readers. Keywords: Article, authors, characteristics, journalPublication Comparison of Spirometric Parameters in different Postures among Young Healthy Volunteers(Nepal Health Research Council, 2023) Mahotra, Narayan B; Shrestha, Lava; Kandel, Sabita; Chaudhary, SonamAbstract Background: Spirometry is the most common pulmonary function tests that specifically measures volume and flow of air during respiration. It helps to identify obstructive and restrictive diseases of the lungs. The alterations of the results in spirometry can happen even in normal health due to change in body postures that alter lung volumes and muscle biomechanics. So, the objective of this study is to determine the effects of change of postures mainly supine, sitting and standing on pulmonary parameters of young healthy volunteers. Methods: A cross-sectional analytical study was conducted among young medical students of Maharajgunj Medical Campus in the department of Clinical Physiology. A total of 31 students were selected by convenient sampling technique. Pulmonary parameters: Forced Vital Capacity (FVC), Forced Expiratory Volume in 1st second (FEV1), FEV1/FVC, Peak Expiratory Flow(PEF), EF2575 were collected from spirometry. The spirometry was done in supine, sitting and standing postures and the best value of each posture was selected for the comparison and obtained data were analyzed using repeated measures ANOVA with confidence interval of 95%. Results: The pulmonary parameters recorded in different postures showed that the mean of these variables comparatively increased in standing posture than others with mean FVC 3.98±0.66 L, mean FEV1 3.53±0.55L, mean FEV1/FVC 89.23±5.60%, mean PEF 8.60±1.62L/s and mean PEF2575 4.46±1.08 L/s. The mean comparisons of these pulmonary parameters in supine, sitting and standing postures showed statistically significant differences with P value < 0.05. Conclusions: The pulmonary parameters are affected by body postures. Those parameters are recorded highest during standing posture and lowest during supine posture. Keywords: Postures; pulmonary parameters; spirometryPublication Correlation of Body Mass Index with Handgrip Strength and Endurance of Dominant Hand in Medical Students(Institute of Medicine, 2020) Shrestha, Lava; Gurung, Sanyukta; Bhat, Neeti; Mahotra, Narayan B; Bajimaya, Mahesh M; Malla, Neha; Kandel, Sabita; Shakya, Aman; Aryal, Vibina; Gyawali, Bigyan R; Rayamajhi, Nirmala; Pradhan, SaitABSTRACT Introduction: Hand grip strength is used in evaluation of muscle strength and is also increasingly being used as an indicator for nutritional status. The maximum force applied voluntarily by the subject is called maximum handgrip strength, which is measured in kilograms. Muscular endurance is the ability of a muscle or muscle group to perform against a load for an extended period of time, measured in seconds. This study aims to correlate body mass index with handgrip strength and handgrip endurance in medical students. Methods:This is a cross sectional, observational study which included 74 undergraduate students of Maharajgunj Medical Campus by convenient sampling method. Body mass index was calculated by Quetelet’s formula. Camry digital hand dynamometer was used to measure handgrip strength in the dominant hand in kilograms. Participants were instructed to hold dynamometer with maintained pressure of 30% of maximum handgrip strength for as long as possible to determine the handgrip endurance. Statistical analyses were performed with SPSS Statistics software. Results: The handgrip strength was more in males than females with a mean of 43.09±3.72 kg, while handgrip endurance was more in females with a mean of 123.60±50.65 sec. Positive correlation was seen between body mass index and handgrip strength (r=0.23 and p=0.045). Body mass index and handgrip endurance also showed positive correlation (r=0.34 and p=0.003). Conclusion: Significant correlation of body mass index with handgrip strength and handgrip endurance was seen in medical students. Keywords: Body mass index, correlation, handgrip endurance, handgrip strength, medical studentsPublication Electro-physiological Changes in the Central Nervous System by Visual Evoked Potential in Diabetic Patients(Nepal Health Research Council, 2022) Malla, Neha; Mahotra, Narayan B; Shrestha, Lava; Joshi, Sajun Narayan; Gurung, SanyuktaAbstract Background: Increasing sedentary lifestyle in today’s world has increased the prevalence of Diabetes Mellitus. Loss of vision due to diabetic retinopathy is a major public health burden. Visual evoked potential identifies the neuronal degenerative changes in chronic metabolic disorders specially Diabetes Mellitus. The study aimed at evaluating changes in visual evoked potential waves in diabetic patients. Methods: This is a cross sectional comparative study consisting of 90 participants, out of which 60 were diabetic patients and 30 were non-diabetic control group. Among diabetic patients, 30 were without retinopathy, 10 with mild non-proliferative retinopathy, 10 with moderate non-proliferative retinopathy and 10 with severe non-proliferative retinopathy. Visually evoked potential latencies and amplitudes were compared among diabetic patients and the control group and also among individuals with different grades of retinopathy. Results: Delay in P100 latency and decrease in its amplitude were statistically significant in diabetic patients. The changes in P100 latency, P100 amplitude and N75 latency were also significant in different grades of retinopathy. Conclusions: There are statistically significant changes in visually evoked potential in diabetes patients. Visual evoked potential is a useful, non-invasive investigation which can establish the central nervous system neuropathy in diabetes at an early stage of the disease. So Diabetic retinopathy can be prevented due to early detection of neuropathy by visual evoked potential test Keywords: Diabetes mellitus; diabetic retinopathy; visual evoked potentialPublication Microbiological Profile and Drug Sensitivity Pattern in Persistently Discharging Ears: A Tertiary Level Hospital Based Retrospective Study(Institute of Medicine, 2020) Gyawali, Bigyan R; Pradhanaga, Rabindra B; Rayamjhi, Pabina; Dongol, Kripa; Gupta, Mudit; Shrestha, Lava; Acharya, KunjanABSTRACT Introduction: Antimicrobial resistance is an emerging issue resulting from the misuse of antibiotics in today’s world. As an effect of it, cases with persistent ear discharge not responding to the conventional oral antibiotics prescribed in ear pathologies are seen increasing in our day to-day practice. This study aims to review the microbiological growth and the pattern of their antibiotic sensitivity in this group of population. Methods: This was a retrospective study which was conducted at the Department of ENT-HNS of Tribhuvan University Teaching Hospital. Record files of all cases who presented with persistently discharging ear for more than 2 weeks and not responding to oral antibiotics, between January 2017 to March 2020 were assessed. Cases of chronic otitis media (COM) squamous with persistent discharge were excluded as most of the times it is the disease process rather than type of organism which causes the persistence of ear discharge despite the use of antibiotics. Results: COM mucosal and cavity infection following modified radical mastoidectomy (MRM) were the commonest pathologies. Pseudomonas aeruginosa (PA) and Coagulase negative Staphylococcus (CoNS) were the commonest bacterial isolates. Pseudomonas aeruginosa showed a good sensitivity to antibiotics like Tazobactam and Piperacillin and resistance to conventionally used antibiotics like Ciprofloxacin and Levofloxacin. Similarly, CoNS had good sensitivity to antibiotics like Oxacillin and Levofloxacin and resistance to conventionally used antibiotics like Amoxicillin. Conclusion: COM mucosal and post MRM cavity infection are the commonest pathologies presenting with persistent ear discharge with PA and CoNS as the predominant isolates. Pseudomonas aeruginosa holds a good sensitivity to drugs like Tazobactam and Piperacillin; and CoNS to drugs like Oxacillin and Levofloxacin. Keywords: Drug sensitivity, ear discharge, microbiological, persistentPublication Nature of Research Proposals Submitted to Institute of Medicine Institutional Review Committee: A Retrospective Review(Nepal Health Research Council, 2025) Tiwari, Ashish; Sharma, Mohan Raj; Shrestha, Lava; Bali, Kanchana; Bhatta, Om PrakashAbstract Background : Efficient evaluation of research proposals is crucial for ensuring ethical standards and scientific rigor in healthcare. This study aims to analyze the proposals submitted to the Institutional Review Committee (IRC) of the Institute of Medicine (IOM) to determine the trends in health-related research conducted in a major institute. Methods: This is a retrospective review of research proposals submitted to the IRC of IOM from May 2019 to April 2021. The analysis focused on the institutional/departmental affiliation of investigators, gender of the principal investigator (PI), funding sources, ethical issues, types of proposals, and research design. Results: Out of 769 proposals submitted, seven were rejected (acceptance rate of 99.1%). There was a steady increase in the number of submissions over the study period. Descriptive cross-sectional studies were the most frequent 630 (82.6%) followed by randomized controlled trials. More than half [403, 52.9%] proposals were related to health promotion. The clinical departments contributed 443 (58.1%) submissions. Males outnumbered females (54.2% vs 45.8%) and only 53 (7.0%) were funded. Conclusions: Cross-sectional studies with a focus on health promotion were the most common submissions for ethical approval at the IOM. Policymakers in our institute and other institutions can use this research to set priorities for promoting research. Keywords: Ethical review, Institutional Review Board, Researchers, research proposalPublication Outcomes of Children Presenting with Button Battery in Esophagus: A Retrospective Review(Institute of Medicine, 2020) Gyawali, Bigyan R; Guragain, Rajendra P Sharma; Neupane, Yogesh; Dutta, Heempali; Shrestha, Lava; Pradhananga, Rabindra BABSTRACT Introduction: Foreign body in esophagus is a common ENT emergency. Button batteries tend to have more grievous outcomes due to caustic mucosal injury to the esophagus. The objective of our study was to review the clinical profile and outcomes of the paediatric population in our center who presented with button battery in esophagus following accidental ingestion. Methods: This was a retrospective study conducted in Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Hospital records of all the patients who presented with button battery esophagus and underwent rigid oesophagoscopic removal from January 2013 to January 2019 were reviewed and analyzed for patient demographics, time interval between ingestion and presentation, site of impaction, status of oesophageal mucosa at the time of rigid oesophagoscopic removal of the battery, early post-operative complications, outcomes at the time of discharge and on follow-up. Results: Our final sample size was 11 and all cases were <15 years. The average duration from time of ingestion to presentation to our hospital ranged from 1 day to 2 months. Variable oesophageal mucosal findings such as superficial mucosal erosion, superficial ulcer with slough and granulations with deep discrete ulcer were seen at the site of impaction of the button battery. One case was diagnosed with bilateral abductor palsy on 10th post-operative day following rigid oesophagoscopic removal of the battery. All other cases didn’t develop any significant complications. Conclusion: Button battery in esophagus results in oesophageal ulceration and thus warrants an early endoscopic removal. Delayed removal can also cause bilateral abductor palsy from the caustic damage to recurrent laryngeal nerve. Keywords: Alkaline button battery, esophagus, rigid oesophagoscopyPublication Pattern of Blood Products Consumption in a Teaching Hospital(Nepal Health Research Council, 2024) Shrestha, Lava; Gurung, Numaya; Mahotra, Narayan Bahadur; Pradhan, Sait; Ghimire, Ananda; Pokhrel, Kailash Mani; Khanal, Kapil; Dhungana, Reechashree; Gautam, Naveen; Kandel, Sabita; Chaudhary, SonamBackground: Blood transfusions are lifesaving, but resource limitations and inadequate utilization patterns pose challenges in low- and middle-income countries. In Nepal, detailed analyses of blood use practices, are needed to inform resource allocation and policy decisions. The objective of this study was to study the overall and component-specific use, explore temporal trends in utilization of blood and blood products. Methods: We conducted an observational study analyzing data from Blood Bank of Tribhuvan University Teaching Hospital (TUTH), a tertiary hospital (January 1st - December 31st, 2019). Data included patient demographics, blood groups, blood products requested and transfused, and facility type. Data analysis was conducted with SPSS v20. Results: Patients from TUTH had substantially higher blood product requests, requesting 25,716 units compared to only 1855 units across other centers combined. Blood groups A positive (8089, 31.4%) and and O positive (7851, 30.6%) were the most requested blood groups. Whole blood (11358, 44.2%) and packed red blood cells (9565, 37.2%) were most frequently requested. We observed monthly fluctuations in demand with peak of 2742 requests in December with a trough in June (1947 units). Notably, only approximately 46% of blood products requested from patients admitted to TUTH were ultimately transfused. Conclusions: Whole blood and packed red blood cells were the most frequently requested blood products. Eventhough whole blood was the most frequently requested blood product, the most transfused one was packed red cells. Peak demand was observed in December. Our study provides valuable insights into blood utilization patterns, underscoring the need for specific strategies to improve blood transfusion management practices. Keywords: Blood banking; blood transfusion; blood utilization; LMICs. Nepal.Publication Trend of Antihypertensive Use and Blood Pressure Control Among Hypertensive Patients in a Tertiary Care Hospital of Kathmandu(Institute of Medicine, 2022) Shrestha, Deepti; Shrestha, Shirish L; Poudel, Rekha; Gurung, Rashmi Shakya; Yadav, Radhay Shyam; Shrestha, Lava35ABSTRACT Introduction: Hypertension is a global burden and prevalence of hypertension increases with age. Various antihypertensive drugs are available for the management of hypertension. The aim of this study is to assess the trend of antihypertensive drugs used and blood pressure (BP) control among patients with hypertension. Methods: A cross sectional study was conducted among patients with hypertension prescribed with antihypertensive drugs in Department of Medicine, Nepal Medical College Teaching Hospital. Antihypertensive drugs, number of antihypertensive drugs prescribed in each individual and BP were analyzed. Results: Out of 218 patients, 61.5% were female and 38.5% were male. Common age group range from 51-60 years in 28.4% of patients. Diabetes mellitus (23.4%) was the most common comorbid condition. Dual therapy (47.6%) followed by monotherapy (45.9%) was the most common therapy prescribed for patients with hypertension. Most commonly prescribed antihypertensive as monotherapy was Calcium Channel Blockers (CCBs), 29.4% and in dual therapy, CCBs and Angiotensin Receptor Blockers (ARBs), 38.6% were the most commonly prescribed medications. Fixed dose combination of antihypertensive drugs were prescribed in 81.4% patients receiving multiple therapy. Good BP control was observed in 61.2% of patients with hypertension. Conclusion: Dual therapy followed by monotherapy was the most common therapy prescribed for the management of hypertension. Calcium channel blockers as monotherapy and CCBs and ARBs as combination therapy were the most common antihypertensive drugs prescribed for hypertension. More than half the patients had controlled BP. A therapeutic audit with more parameters of analysis to provide regular feedback to researchers and prescribers may encourage rational prescribing in hypertension. Keywords: Antihypertensives, blood pressure, hypertensionPublication Use of Complementary and Alternatives Medicine among Cancer Patients(Institute of Medicine, 2024) Neupane, Suchita; Gautam, Roshani; Sharma, Sujan; Shrestha, LavaABSTRACT Introduction: Complementary and alternative medicine (CAM) use is common among cancer patients with the hope to manage symptoms arising from the cancer related treatment or to improve the quality of life. In this study, we aimed to describe various CAM practices among cancer patients. Methods: A descriptive cross-sectional study was conducted in Bhaktapur Cancer Hospital. Convenient sampling technique was used to select the participants. Data was collected from cancer patients attending in out-patient department of Bhaktapur Cancer Hospital with a structured questionnaire. The collected data and analyzed using Statistical Package for the Social Sciences (SPSS) version 16. Results: The use of CAM was found in 40.7% (37/91) of the studied cancer patients. Among them, Ayurveda 18 (56.2%) was the most common type of CAM used. Among CAM users, the most common reason for using CAM was to reduce side effects of cancer related treatment (22, 59.4%). The majority of the respondents 33 (89.1%) were satisfied with CAM use. Only 14 (37.8%) of respondents consulted with their doctor about the initiation of CAM use. Gynecological cancer 38 (41.7%) was the most common site of cancer seen among the respondents followed by respiratory 18 (19.7%) and gastro-intestinal 17 (18.6%) respectively. Twenty eight (30.8%) of the respondents were in the third stage of cancer. Conclusion: Less than half of the cancer patients were using CAM, Ayurvedic medicine being the most common form. Majority of the users were satisfied with CAM use. Further studies on potential risk and benefits associated with CAM therapy is needed as its use has been increasing. Keywords: Cancer patient, complementary medicine, alternative medicine