Browsing by Author "Shrestha, MK"
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Publication Age-Related Macular Degeneration in Nepal(Kathmandu university, 2011) Thapa, R; Paudyal, G; Shrestha, MK; Gurung, R; Ruit, SABSTRACT Background The Age–related Macular Degeneration (AMD) is a common cause of visual impairment and blindness worldwide in elderly. Objective This study aimed to explore the demographic characteristics, pattern and risk factors for AMD at a tertiary referral eye centre in Nepal. Methods This is a hospital-based prospective study, conducted at Tilganga Institute of Ophthalmology, Nepal from September 2008 to May 2009. All the consecutive cases of AMD diagnosed at the institute were included. Results A total of 141 patients (266 eyes) with AMD recruited for the study. The mean age was 69.5 years (9.1SD) with three fifth males (58.9%). Housewives and occupations like agriculture comprised of 38.3% and 42.5% respectively. Three fourth (75.6%) of the patients were illiterate. The proportion of dry and wet AMD were found in 62.4% and 37.6% respectively. Bilateral involvement was seen in 88.7% of the subjects. Three fourth (71.4%) of the AMD eyes had presenting visual acuity less than 6/18. History of smoking was found in 69.9% of patients. Hypertension was the predominant systemic problem (45.4%) followed by diabetes mellitus (12.8%). Conclusion AMD is correlated with ageing in our study as well. Dry AMD is more in age groups 45-64 years and wet AMD at 65 years and older. Bilateral involvement with one eye dry and fellow eye wet AMD is more predominant (44%). Smoking and occupations like agriculture and housewife are significant risk factors for AMD. Likewise male sex, illiteracy and hypertension are other risk factors for AMD in hospital settings. KEYWORDS agriculture, dry macular degeneration, hypertension, illiterate, smoking, wet macular degenerationPublication Bleeding Meckel's Diverticulum in an Infant - A Case Report(Nepal Paediatric Society (JNPS), 2014) Shrestha, MK; Gurubacharya, RL; Devkota, K; Agarwal, NAbstract: Meckel’s diverticulum is a congenital diverticulum. Mostly it is asymptomatic. In children the commonest complication is lower GI bleeding. High index of suspicion is required for its diagnosis. Technetium-99m pertechnetate scan is useful to detect ectopic gastric mucosa. Surgical treatment of symptomatic Meckel’s diverticulum is diverticulectomy or ileal resection.Publication Bruckner Red Light Reflex Test in a Hospital Setting(Kathmandu university, 2012) Saiju, R; Yun, S; Yoon, PD; Shrestha, MK; Shrestha, UDABSTRACT Background Childhood blindness is a major problem in developing world including Nepal that needs to be addressed. Objective The objective of study was to measure the effectiveness of the Bruckner red reflex test for screening of posterior segment opacities in children. Methods Patients aged less than five years who came to the Tilganga Institute of Ophthalmology, Kathmandu from March to August, 2009 were recruited in this cross-sectional descriptive study. Children were screened with the Bruckner red light reflex test in a dark room. Patients with abnormal Bruckner tests had their eyes dilated for further investigations. Abnormalities were recorded. The number of patients with an abnormal Bruckner test was recorded and correlated with their potential pathology. Results A total of 172 patients with 97 boys and 75 girls were included. Twenty-three had abnormal Bruckner test results in either one or both eyes. Four of these twenty- three patients had no pathology diagnosed; hence the sensitivity of the Bruckner screen to diagnose significant pathology was calculated at 82.6%. Of the 153 patients with normal results, two patients were found to have pathology detected, which included cataract and strabismus. Hence, the specificity of this test was 98.7%. The screening test had a positive predictive value of 90.5% and a negative predictive value of 97.4%. Conclusion Bruckner test screening is a sensitive and specific marker for detecting the posterior segment opacities in children. We recommend utilizing the test to evaluate these problems where other technologies are rare. KEY WORDS Nepal, Red flex test, Retinoblastoma, ScreeningPublication Clinical Profile of Paediatric Cataract and Surgery in a Tertiary Eye Care Centre, Nepal(Nepal Paediatric Society (JNPS), 2012) Shrestha, UD; Shrestha, MKAbstract: Introduction: Paediatric cataract is the opacification of lens and its capsule in children below 14 years of age. The management of paediatric cataract is lens aspiration with or without anterior vitrectomy, with or without intra-ocular lens implantation. The objective was to present the profile of pediatric cataract of operated eyes in children ≤14 years. Materials and Methods: This was a descriptive study in a hospital setting. A review of pediatric cataract cases operated between November 2007 and June 2009 in Tilganga Institute of Ophthalmology (TIO), a tertiary eye care centre in Nepal was carried out. The personal profile, preoperative and intra-operative details were noted. In the statistical analysis p value less than 0.05 is considered as significant. Results: A total of 175 eyes of 132 children had presented during study. The sex ratio was 1.6 male per female with mean age of 6.7 years (SD ±4.3). About one-third (32%) presented within the age of three years where as more than two-fifths (46%) presented at the age eight years and above. Seventy two cases were collected through door to door enumeration and screening clinics for children. The proportion of cataract was higher in males than in females (P>0.05). Visual acuity ranged from 6/18 to follows light. Conclusion: Nearly half of the paediatric cataract had presented after the age of eight years mainly from hilly region through the screening program. Most of the pediatric cataract cases presented with the whitish pupillary reflex with more than two-thirds of visual acuity of less than 3/60. The most common type of the cataract surgery performed was lens aspiration with anterior vitrectomy with lens implantation. The earlier the surgery better is the visual prognoses. Hence, community screening through as door to door screening and one day screening clinics will help for early referral and earlier surgery to reduce visual disabilities due to paediatric cataract.Publication Early Experience With Single-Stage Transanal Endorectal Pull Through For Rectosigmoid Hirschsprung’s Disease(Nepal Paediatric Society (JNPS), 2014) Shrestha, MK; Sherchan, M; Dhoubhadel, BK; Basnet, RBAbstract: On 24th August 2015, the spelling of the third author's name was changed from Dhaubhadel TO Dhoubhadel - Editor. Introduction: Recent trends in surgery for Hirschsprung’s disease (HD) have been towards earlier operation and fewer surgical stages. A single-stage transanal endorectal pull through (TEPT) is the latest development and minimally invasive technique for HD. This observational prospective study was designed to evaluate the safety and efficacy of single-stage TEPT technique in the management of rectosigmoid HD. Materials and Methods: Infants and children with biopsy-proved aganglionosis and barium enema (BE) documented rectosigmoid HD were included for single stage TEPT. Twenty children aged 22 days to 7 years (17 boys and 3 girls) underwent one stage TEPT over 5 year period. Median follow up was 18 months (range 6-36 months). These patients were evaluated with regard to age, sex, intraoperative details, postoperative functional outcome and complications and need for secondary surgical procedure. Results: The operating time was 105-180 minutes (mean 120 minutes). The length of resected bowel was 18-30 cm (mean 25 cm). Intraoperative blood loss was 5-40 ml, less in infants compared to older children. Blood transfusion was needed in none out of 12 infants and 2 out of 8 older children. Transient perianal excoriation occurred in 16 patients. Postoperative enterocolitis occurred in one patient. One patient developed constipation with encopresis following anastomotic stricture. None had adhesive obstruction and prolapse of pulled through colon, one required colostomy for anastomotic leakage and peritonitis while another had retained aganglionic segment and re-do pull through was required. Conclusion: Single-stage TEPT can be performed successfully in all age of children. The technique is safe, easily learned and has good clinical results.Publication Outcome of pneumatic retinopexy at a tertiary eye care centre in Nepal(Kathmandu University, 2008) Thapa, R; Shrestha, MK; Gurung, R; Ruit, S; Paudyal, GAbstract Background: Rhegmatogenous retinal detachment is one of the commonly encountered retinal problems where timely treatment could prevent irreversible vision loss. Pneumatic retinopexy (PR) is a simple and minimally invasive procedure for retinal reattachment. Aim: This study aimed to assess the outcome of pneumatic retinopexy in primary rhegmatogenous retinal detachment at our facility. Study design: This was a retrospective- prospective, interventional case series. Materials and methods: All subjects with rhegmatogenous retinal detachment who underwent pneumatic retinopexy at Tilganga Eye Centre of Nepal from January 2002 to June 2007 were included in this study. Results: A total of 32 cases were included in the study. The mean age of patients was 55.2 year (SD=11.0). The majority of cases (62.5%) presented within two weeks of symptoms with blurring of vision in 90% of cases. Pre-operatively, 56.3% (18) patients had a best corrected distance visual acuity of <6/60. Retinal detachment involving less than two quadrants consisted of 37.5% (12). A single retinal break was present in 78.1% (25) of cases and 87.5% (28) of the retinal breaks were located in the superotemporal quadrant. The macula was attached in 37.5% (12) of the cases. Sulfurhexa uoride and Per uoropropane were used in 68.8% (22) and 31.3% (10) respectively. The average follow up period was 1.02 years (range one month to four years). The retina was completely attached in 81.3% (26) of cases at the last follow up. The best corrected distance visual acuity of 6/18-6/60 was found in 40.6% (13) of subjects in the last follow up. There was a transient rise in intraocular pressure in 6.3% (2) of subjects after the procedure. Conclusion: The anatomical success rate following pneumatic retinopexy is quite high (81.3%) with good visual recovery and less morbidity translating to higher productivity for the patient. This procedure, being quicker than the alternatives, will also save surgeon’s time making PR a good choice for managing primary rhegmatogenous retinal detachment in countries like Nepal where resources are scarce. Key words: Rhegmatogenous retinal detachment, retinal break, pneumatic retinopexy, NepalPublication Prevalence of Nonalcoholic Fatty Liver Disease in a Tertiary Care Teaching Hospital: A Cross Sectional Study in Province 4 of Nepal(Kathmandu University, 2019) Shrestha, MK; Ghartimagar, D; Jhunjhunwala, AK; Thapa, MABSTRACT Background Nonalcoholic fatty liver disease (NAFLD) is collection of lipids in hepatic tissues excluding other hepatic diseases and chronic alcohol intake. It may advance to nonalcoholic steatohepatitis or cirrhosis. Ultrasonography has high sensitivity and specificity for detecting nonalcoholic fatty liver disease. Objective Lack of sufficient information in this region on sonological prevalence of nonalcoholic fatty liver disease, lead us to design the survey and may also serve as reference for further researches. Method This is a cross sectional study with 600 participants, conducted at Gandaki Medical College Teaching Hospital, Province 4 of Nepal, from September to October 2017. Ethical approval is taken from the Institutional review board. The study group includes the participants referred for abdominal sonography from outpatient department. Result In present survey, 367 (61.2%) are female and 233 (38.8%) are male participants. The mean age is 41.6 years and median age is 38 years. The prevalence of nonalcoholic fatty liver in our observation is 229 cases (38.2%) of which, 102 cases (44.5%) are male and 127 cases (55.4%) are female participants. Normal liver was seen in 61.8%, Grade one fatty liver was discovered in 24.8%, Grade one in 12.6% and Grade three in 0.6%. The mean liver size in those with fatty liver was 14.1 cm. Conclusion Province 4 of Nepal is not exempt from the growing epidemic of nonalcoholic fatty liver disease with prevalence of 38.2%. The study shows that with higher grades of fatty liver, the size of liver is also increased and the mean age of the participants involved is also in the higher side of the spectrum. KEY WORDS Fatty liver, Nonalcoholic, Prevalence, Ultrasonography