Browsing by Author "Shrestha, M"
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Publication A Case of Precocious Puberty in a Setting with Limited Resources(Kathmandu University, 2011) Paudel, KP; Giri, S; Shrestha, PS; Shrestha, L; Thapa, SB; Shrestha, MABSTRACT Precocious puberty is a rare condition characterized by the development of secondary sexual characteristics before the median age for the sex. It is either gonadotropin dependent also called as central or gonadotropin independent also known as peripheral type. Hypothalamamic Hamartoma is a common cause of the central or precocious puberty due to organic brain lesion. Here we present a two year male who presented us with precocious puberty due to a hypothalamic Hamartoma. KEY WORDS hypothalamic hamartoma, precociuos pubertyPublication An ultrasonographic evaluation of solitary muscular and soft tissue cysticercosis(Kathmandu University, 2010) Sharma, P; Neupane, S; Shrestha, M; Dwivedi, R; Paudel, KAbstract Background: Cysticercosis in humans is infection with the larval form (cysticercus cellulosae) of the pork tapeworm T. solium. Encystment of larvae can occur in almost any tissue. The location of cysts in order of frequency is the central nervous system, subcutaneous tissue and striated muscle, vitreous humour of the eye and, rarely, other tissues. High resolution ultrasound can be used in the diagnosis of muscular and soft tissue cysticercosis. Objective: The aim of this study is to evaluate the ultrasonographic findings in cases of muscular and soft tissue cysticercosis. Materials and methods: It was a retrospective review of the cases of muscular and soft tissue cysticercosis which were diagnosed by ultrasound during June 2007 to May 2009 in the department of Radiology and Imaging, Nepalgunj Medical College Teaching Hospital. A total of six patients were evaluated. Result: There were four males and two females. Age of the patient ranged from 18 to 50 years. All of the patients presented with a swelling with pain in five of them. There was a wide variation in the location of the cysts. In all cases ultrasound revealed a cystic lesion with an echogenic eccentric pedunculated nodule attached to the wall. The mean diameter of the cyst was 6mm. Smooth wall was present in five cases whereas one of the cysts revealed irregular wall. Pericystic inflammatory changes were seen in the adjacent muscles. Conclusion: Ultrasound is a safe and non-invasive method that can be used in the diagnosis of muscular and soft tissue cysticercosis. Key words: Muscular and soft tissue cysticercosis, ultrasound.Publication Association between Thyroid Dysfunction and Common Mental Disorders (Anxiety and Depression): A university hospital-based cross-sectional study(Kathmandu University, 2025) Shrestha, B; Upadhaya, SK; Shrestha, M; Regmi, S; Kunwar, D; Risal, AABSTRACT Background Anxiety and depression have been frequently reported to be associated with thyroid dysfunctions. Many symptoms of anxiety and depression overlap with thyroid disorders sometimes masking the diagnosis. Objective To look for association between thyroid diseases and newly diagnosed case of anxiety or depression in out-patient department. Method It was a hospital based descriptive, cross-sectional study conducted in a period of six months after ethical approval from institutional review committee with participants aged 18-65 years, who wished to give consent for the study and investigations. Cases of anxiety and depression was diagnosed as per the International Classification of Diseases-10, clinical description and diagnostic guideline and self-administered proforma was used for demographic profile. Sample analysis and comparison of different groups in the study was done using chi-square test; p-value < 0.05 was considered for statistical significance. Result Anxiety disorders was higher in individuals with normal thyroid function (54.5%), and depression appeared to be more common among individuals with abnormal thyroid function (60.9%); it did not have any statistical significance. Conclusion Depressive disorders were common among thyroid disorder patients. Further study is needed to examine the relationship between thyroid disorder and common mental disorders to help improve mental health outcomes. KEY WORDS Anxiety, Common mental disorders, Depression, Thyroid diseasesPublication Bacterial Isolates and its Antibiotic Susceptibility Pattern in NICU(Kathmandu university, 2013) Shrestha, S; Shrestha, NC; Dongol Singh, S; Shrestha, RPB; Kayestha, S; Shrestha, M; Thakur, NKABSTRACT Background Neonatal sepsis is one of the major causes of morbidity and mortality among the newborns in the developing world. Objectives To determine the common bacterial isolates causing sepsis in neonatal intensive care unit and its antibiotic susceptibility pattern. Methods A one year discriptive prospective study was conducted in neonatal intensive care unit to analyse the results of blood culture and to look into the sensitivity of the commonly used antibiotics. Results The blood culture yield by conventional method was 44.13% with nosocomial sepsis accounting for 10.79%. 84.08% were culture proven early onset sepsis and 15.95% were late onset sepsis. Klebsiella infection was the commonest organism isolated in early, late and nosocomial sepsis but statistically not significant. Gram positive organisms were 39.36% in which Staphylococcus aureus was the leading microorganism followed by coagulase negative staphylococcus areus. Gram negative organisms were 60.64% amongst them Klebsiella was the most often encountered followed by Pseudomonas. The most common organism Klebsiella was 87.5% and 78.3% resistance to ampicillin and gentamycin respectively. Among gram negative isolates 87.5% and 77.2% were resistance to ampicillin and gentamycin respectively. Among gram positive isolates 58.5% and 31.5% resistance were noted to ampicillin and gentamycin respectively. Resistance to cefotaxim to gram negative and gram positive isolates were 87.34% and 59.35% respectively. Conclusion Klebsiella is most common organism which is almost resistance to first line antibiotics. Resistance to both gram negative and gram positive isolates among firstline antibiotics and even with cefotaxim is emerging and is a major concern in neonatal intensive care unit. KEY WORDS Antibiotic susceptibility, bacterial isolates, neonatesPublication Better Social-emotional Behavior in Young Nepali Children is Associated with Household Wealth, Child Age, and Family Participation in a Community Development Intervention(Kathmandu University, 2023) Miller, LC; Neupane, S; Shrestha, M; Joshi, N; Lohani, M; Thorne-Lyman, AABSTRACT Background Mental health and behavior problems are under-recognized in low- and middle- income countries, especially in young children. Early identification of these problems could encourage governments to address the shortages of child mental health professionals and promote early intervention programs to help children achieve their full developmental potential. Objective Describe the social-emotional development of young rural Nepali children; explore risk factors for poor development. Method The study was embedded in a longitudinal intervention trial comparing control households with those who received training in family nutrition+livestock management (Partial Package) or family nutrition+livestock management+community mobilization (Full Package). At midline, enumerators completed a 145-item household questionnaire, child anthropometry, and Administered the Ages and Stages Questionnaire-Social-Emotional (ASQ-SE) to all enrolled children age 33-47 months (n=310). Bivariate and regression analyses examined the relationship of child and household risk factors to administered the Ages and Stages Questionnaire- Social-Emotional scores. Result Administered the Ages and Stages Questionnaire-Social-Emotional scores were below age cutoffs in 24% of children, suggesting worse social-emotional development. In bivariate analyses and the adjusted linear regression model, older child age, greater household wealth, and Full Package Intervention status were all associated with better social-emotional development scores. Partial Package Intervention status was associated with worse scores. Conclusion The Administered the Ages and Stages Questionnaire-Social-Emotional is a potential tool to assess child social-emotional development in the context of household and community level interventions. Further work is necessary to validate the administered the Ages and Stages Questionnaire-Social-Emotional and similar tools in Nepal, and to better understand the prevalence of challenges to optimal social- emotional development in young children in order to use this information to design and monitor needed interventions. KEY WORDS Child development, Community, Developing countries, Social behaviorPublication Difficult Journey from Delivery to Discharge, Case of Congenital Diaphragmatic Hernia(Kathmandu University, 2014) Karmacharya, RM; Dangol, S; Shrestha, M; Koju, RABSTRACT We report a case of congenital diaphragmatic hernia which was diagnosed prenatally for which surgical correction was done on second day of life. The child was discharged in 17 days and has resulted in good post repair condition of patient. KEY WORDS Bochdalek, congenital diaphragmatic hernia, hemithoraxPublication Experience of Surgical Resection and Reconstruction of Chest Wall Tumor in Dhulikhel Hospital(Kathmandu University, 2025) Karmacharya, RM; Vaidya, S; Bhatt, S; Guragai, M; Sharma, S; Bhandari, S; Shrestha, M; Shah, B; Yadav, BABSTRACT Background Chest wall tumors are rare thoracic tumor which can be either primary or metastatic. Conventional radiography is the first line of investigation followed by further imaging like computed tomography or magnetic resonance imaging. When indicated preoperative biopsy by fine-needle aspiration need to be done. Small chest wall tumor can be surgically treated by excision and primary repair. Bigger chest wall tumor is treated by excision and chest wall reconstruction. Objective To know the features of chest wall tumor, symptoms, histopathological findings, surgical procedures performed and outcome following the surgery. Method This is the retrospective study that included chest wall tumor subjected for excision and repair during January 2018 till December 2023 in Thoracic surgical unit of Dhulikhel Hospital. Variables such as presenting complaints, size and extent of tumor, type of surgery, outcome of the surgery, hospital stay, neoadjuvant chemotherapy and post excision chemo or radiotherapy and recurrence of the tumor were included. When primary repair is not possible following wide excision, reconstruction using double prolene sandwich mesh was done. Result There were 38 cases of chest wall tumor. Mean age of the patient was 42 years (SD 15.25 years, range 20 - 68 years). Of them, 22 patients were female (57.9%) and 16 patients were male (42.1%). Chest pain was the most common symptoms (84.2%) followed by lesion in chest (81.6%). Average size of the tumor was 14.8 ± 3.6 cm (Range 5 cm to 25 cm). Most common histopathological finding was neurofibroma (31.6%) filled by schwannoma (15.8%). All the patients underwent wide local excision. In terms of repair, primary repair was possible in 68.4% while in 31.6% patients repair using double prolene and bone cement sandwich was done. Average hospital stay was 6.6 days (SD 2.3, range 3-9 days). Conclusion Chest wall tumor can have different histopathological findings. In patients where wide resection is possible, it can be repaired by either primary repair or by repair using double prolene and bone cement sandwich. KEY WORDS Chest wall tumor, Reconstruction, ResectionPublication Morbidity pattern of children with asthma: A prospective study(Kathmandu University, 2006) Manandhar, K; Bajracharya, BL; Dhakal, S; Shrestha, MObjectives: To determine the morbidity pattern of asthma in children attending the paediatric asthma follow-up clinic. Materials and methods: Longitudinal prospective follow up of hundred and four patients, diagnosed as asthma, over a period of 2 years was done. Regular follow up by the same person during each visit and proper supervision of standard treatment along with parental education regarding the asthma, was done. Results: The mean age of children presenting with asthma was 6.7 years. Majority of children 49 (47.5%) were graded as mild persistent asthma. Fifty nine (56.7%) children were missing school more than 7 days per month. Family history was present in forty one percent of the children. Fifty seven (54.8%) children were taking significant amount of junk food and were undernourished. Significant reduction in school-missing days and Emergency Room visits was noted in these children during the follow up period. Conclusion: Awareness of disease is an important aspect of asthma management. Proper treatment and follow up with emotional support and education of the care taker, about the asthma, can reduce the morbidity pattern of asthma in children. Key words: Prospective study, longitudinal study, AsthmaPublication Occurrence of soil-transmitted helminths in women at the Himalayan region of Nepal(Kathmandu University, 2006) Kunwar, CB; Chapagain, RH; Subba, B; Shrestha, M; Jha, B; Subedi, J; Blangero, J; Williams-Blangero, S; Towne, BObjective: to find the occurrence pattern and prevalence of the soil transmitted helminths in women of child bearing age group. Methods and Materials: The study was conducted in Jiri , an area of Dolakha district at the altitude of 2100 meter from sea level. The faecal sample of 478 women of childbearing age (15 to 45 years) were taken randomly and examined for the ova of soil transmitted helianthus. Result: The occurrence pattern was 53.0%, 20.0% and 2.7% for Hookworms, Ascaries lumbricoids and Trichuris Trichuria respectively. Both Ascaries and Hookworm prevalence rates noticeably increased with increasing age, with the highest infection rate between the age of 36 - 45 years while trichuris infection reached the highest in women of 15-25 years of age. Conclusion: There is a high prevalence of hookworm and ascaries in women of childbearing age and necessary intervention is needed according to WHO guidelines. Key words: soil-transmitted helminth, stool sample, women, himalayanPublication Prevalence of Breast Lump and Risk Factors of Breast Cancer among Reproduvtive Aged Women of Jabalpur VDC of Sunsari District, Nepal(Nepal Health Research Council, 2004) Shrestha, M; Shah, TPublication Prevalence of Fibularis Tertius: Insights from a Surface Anatomical Study(Kathmandu University, 2025) Shrestha, S; Mansur, DI; Shrestha, P; Maskey, S; Shrestha, M; Kunwar, A; Poudel, B; Dahal, P; Gautam, BABSTRACT Background The fibularis tertius muscle, a variant muscle in the crural compartment of the leg, is thought to have evolved in humans in response to the development of bipedalism. Acting as both an ankle dorsiflexor and foot everter, it plays a crucial role in enabling efficient terrestrial locomotion, especially in mid-foot biomechanical stabilization. The origin and insertion of this muscle have been reported to exhibit significant variation. Objective The aim is to determine the prevalence of this muscle by conducting a surface anatomical examination of the foot among pre-clinical sciences students at Kathmandu University School of Medical Sciences. Method Each participant’s fibularis tertius muscle (FTM) was assessed on both feet using a standardized surface palpation technique based on protocols that Tixa and Kendall had validated. To ensure accuracy, each foot was subjected to two separate evaluations by qualified evaluators that lasted 120 seconds each. During dorsiflexion and eversion, muscles were identified using sequential palpation techniques. Visibility was categorized into three graded responses (G1–G3) according to muscle activation. SPSS version 23 was used to analyze the data. While the Chi-square test evaluated sex-based associations, with statistical significance set at p < 0.05, descriptive statistics summarized prevalence. Result A total of 226 students (54.42% males, 45.58% females; mean age 20.8 ± 1.88 years) participated in the study. The fibularis tertius muscle had a prevalence of 95.58%, with a similar gender distribution. It was bilateral in 187 participants and unilateral in 29, mostly on the right foot. Multivariable logistic regression revealed no significant association between fibularis tertius presence and body mass index, with both crude and adjusted odds ratios (0.83 and 0.89, respectively) and p-values exceeding 0.05. Conclusion The fibularis tertius muscle is essential for ankle stability, reducing injury risk and aiding recovery during high-impact activities. Its absence increases instability and recurrent sprains. Understanding the anatomy of fibularis tertius muscle is crucial for surgical planning, tendon repair, and rehabilitation, influencing diagnosis, treatment, and injury prevention. KEY WORDS Anatomy, Bilateral traits, Fibularis tertius, Muscle anatomy, Prevalence, Unilateral traitsPublication Quality of care provided to newborns by nursing personnel at BP Koirala Institute of Health Sciences(Kathmandu University, 2009) Shrestha, M; Singh, R; Upreti, DAbstract Background: Birth is a major challenge for the newborn to negotiate successfully from intrauterine to extra uterine life. The first few hours since birth is the most crucial period in the life of an infant for further growth and development, which is largely determined by the quality of care that the newborn receives. Objective: The aim of this study is to assess the quality of care provided by nursing personnel to newborn in the labour room. Materials and methods: This study was conducted in BP Koirala Institute of Health Science. Cross sectional, non participatory observational research design was adopted for the study. Care provided by nursing personnel to 814 normal newborns was observed. Samples were chosen by non probability purposive sampling technique. Data was collected through observational method by trained nursing personnel, using 46 items pre-tested, validated and self developed observational checklist. Care provided to newborns was observed from birth to two hours and categorised as good, average and poor based on scores obtained. Data was entered and analysed using SPSS-10. Descriptive statistics- [Mean, percentage, frequencies and standard deviation] was used to describe the quality of care provided to the newborn babies. Results: Overall quality of care was good in 42.36%, average in 57.64% and none of them received poor care. Overall mean score for quality of care was 34.75/46 (75.54 %). Regarding subscales quality of care was good in majority of newborns in areas such as Preparation to receive the baby (76.1%), Initiation of breathing (100%), Maintaining thermoregulation (77.3%), Physical assessment (90.9%), and other aspects of care (95.2%). However the quality of care was poor in majority of newborns in establishment of breast feeding (58.23%) and average in prevention of infection (76.9%). Conclusion: Study findings highlight the need for focus in establishment of breast feeding and prevention of infection. Key words: Quality of care, newborns, nursing personnel, breast feeding, prevention of infection and assessment of newborn.Publication Two year audit of perinatal mortality at Kathmandu Medical College Teaching Hospital(Kathmandu University, 2006) Shrestha, M; Manandhar, DS; Dhakal, S; Nepal, NIntroduction: Perinatal mortality rate is a sensitive indicator of quality of care provided to women in pregnancy, at and after child birth and to the newborns in the first week of life. Regular perinatal audit would help in identifying all the factors that play a role in causing perinatal deaths and thus help in appropriate interventions to reduce avoidable perinatal deaths. Aims and objectives: This study was carried out to determine perinatal mortality rate (PMR) and the factors responsible for perinatal deaths at KMCTH in the two year period from November 2003 to October 2005 (Kartik 2060 B.S. to Ashoj 2062). Methodology: This is a prospective study of all the still births and early neonatal deaths in KMCTH during the two year period from November 2003 to October 2005. Details of each perinatal death were filled in the standard perinatal death audit forms of the Department of Pediatrics, KMCTH. Perinatal deaths were analyzed according to maternal characteristics like maternal age, parity, type of delivery and fetal characteristics like sex, birth weight and gestational age and classify neonatal deaths according to Wigglesworth’s classification and comparison made with earlier similar study. Results: Out of the 1517 total births in the two year period, 22 were still births (SB) and 10 were early neonatal deaths (ENND). Out of the 22 SB, two were of < 1 kg in weight and out of 10 ENND, one was of <1 kg. Thus, perinatal mortality rate during the study period was 19.1 and extended perinatal mortality rate was 21.1 per 1000 births. The important causes of perinatal deaths were extreme prematurity, birth asphyxia, congenital anomalies and associated maternal factors like antepartum hemorrhage and most babies were of very low birth weight. According to Wigglesworth’s classification, 43.8% of perinatal deaths were in Group I, 12.5% in Group II, 28.1% in Group III, 12.5% in Group IV and 12.5% in Group V. Discussion: The perinatal death audit done in KMCTH for 1 year period from September 2002 to August 2003 showed perinatal mortality rate of 30.7 and extended perinatal mortality rate of 47.9 per 1000 births. There has been a significant reduction in the perinatal mortality rate in the last 2 years at KMCTH. Main reasons for improvement in perinatal mortality rate were improvement in care of both the mothers and the newborns and the number of births have also increased significantly in the last 2 years without appropriate increase in perinatal deaths. Conclusion: Good and regular antenatal care, good care at the time of birth including appropriate and timely intervention and proper care of the sick neonates are important in reducing perinatal deaths. Prevention of preterm births, better care and monitoring during the intranatal period and intensive care of low birth weight babies would help in further reducing perinatal deaths. Key words: Perinatal mortality rate (PMR), still births, early neonatal death (ENND), Total perinatal death (PND)