Browsing by Author "Shrestha, P"
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Publication A Comprehensive Approach to Juvenile Angiofibroma: Diagnosis, Staging, and Surgical Management(Kathmandu University, 2024) Shrestha, BL; Shrestha, PABSTRACT Juvenile angiofibroma of nasopharynx is a benign but locally aggressive tumor predominantly affecting adolescent males, characterized by hypervascular growth in the nasopharynx. Early diagnosis and appropriate management are crucial to prevent complications. Symptoms typically include nasal obstruction, epistaxis, and hearing loss. Imaging techniques, such as contrast-enhanced CT and MRI, play a pivotal role in assessing tumor size, vascularity, and involvement of surrounding structures. Angiography, followed by embolization, is commonly used to reduce intraoperative bleeding risk. The treatment of choice is surgical resection, which can be performed via an endonasal, transpalatal, or combined approach, depending on tumor extent. In cases of inoperable tumors or recurrence, radiation therapy may be considered. Although nasopharyngeal juvenile angiofibroma has a favorable prognosis when treated early, close monitoring for recurrence is necessary, as it can reappear even years after surgery. Multidisciplinary management involving otolaryngologists, radiologists, and oncologists is essential for optimal outcomes. KEY WORDS Diagnosis, Embolization, Juvenile angiofibroma, Nasopharynx, SurgeryPublication A Hospital Based Study of Pterygium in Tertiary Care Hospital of Nepal(Kathmandu University, 2016) Shrestha, P; Kaiti, RABSTRACT Background Pterygium, a triangular fibrovascular subepithelial growth of degenerative bulbar conjunctival tissue over the limbus onto the cornea, is one of the common ocular conditions that may result in discomfort, tearing, photophobia and significant visual impairment. Little is known about its epidemiology in Nepalese context. Objective The current study aims to analyze the epidemiology of pterygium in a hospital-based population in Kavre District, a mid hilly region of central Nepal. Method This was a prospective hospital based study carried out in the Department of Ophthalmology in Dhulikhel Hospital, Kathmandu University Hospital for a period of one year from January to December 2013. All the patients with pterygium, aged 21 years and above attending the outpatients department were included into the study. The epidemiological data was collected using a standard questionnaire and complete ocular examination was performed by the Ophthalmologist. Result A total of 7925 patients were seen in the Ophthalmology outpatient department during a one year period, out of which 5622 patients (age range 20-80 years) were eligible for the study. A total of 137 patients, 43(31.4%) males and 94 females (68.6%) had different grades of pterygium with mean age of 48.6± 12.8 years. The overall prevalence of pterygium was 2.4 %. Majority of the patients with pterygium were between 41-60 years. Fifty-eight percent of pterygium were of grade I followed by 41% of grade II. Unilateral and nasal pterygia were common. Conclusion The prevalence of pterygium is low in this hospital based population, majority of cases affecting females and old age population. KEY WORDS Prevalence, pterygium, risk-factorsPublication Angiomyolipoma of Nasal Cavity - A rare clinical entity(Kathmandu University, 2024) Shrestha, KS; Shrestha, BL; Sapkota, B; Ghimire, SB; Shrestha, PABSTRACT Angiomyolipomas (AML) are benign mesenchymal tumour with varying proportion of matured fat cells, thick walled vessels and smooth muscle cells. Nasal angiomyolipomas are exceedingly rare and usually present as small tumour in middle aged and old men. This is a case of 86 years old male who presented in the ENT OPD with the swelling in the right nasolabial fold for 2 months. He underwent excision of the mass under general anesthesia and the histopathological examination proved to be angiomyolipoma of nose. KEY WORDS Angiomyolipoma, Hamartoma, HistopathologyPublication Antimicrobial resistance pattern of bacterial isolates causing urinary tract infection(Nepal Health Research Council, 2007) Lamichhane, S; Shrestha, P; Malla, S; Basnyat, S; Dumre, S; Upadhaya, BPublication 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 Awareness and Knowledge of Glaucoma and their Associated Factors among People Visiting a Tertiary Level Hospital in Central Nepal(Kathmandu University, 2022) Shrestha, A; Shrestha, P; Shrestha, T; Shrestha, RM; Sujakhu, D; Dhakal, K; Thapa, G; Adhikari, S; Karki, S; Adhikari, BABSTRACT Background Glaucoma is one of the major causes of irreversible blindness globally. Almost 60 million people globally are affected by glaucoma making it the second leading cause of blindness worldwide. Diagnosis of glaucoma early on is vital for timely management and prevention of blindness. However, it is challenging to diagnose it early because it is asymptomatic in the initial stage, and there is also the dearth of appropriate screening tools. Awareness, knowledge, and beliefs are believed to influence the treatment-seeking behavior of people as well as their uptake of services. Objective To assess the awareness and knowledge about glaucoma among general patients and patient attendants visiting Dhulikhel Hospital. Method We conducted a cross sectional quantitative study among general patients visiting Dhulikhel Hospital. We collected data using face-to-face interviews with semi- structured questionnaires. We analyzed data in R version 4.0.3 (2020-10-10). We presented numerical variables as mean and standard deviation whereas categorical variables as frequency and percentage. We determined factors associated with awareness and knowledge of glaucoma using logistic regression analysis and estimated adjusted odds ratio (AOR) with 95% confidence interval. Result Of 379 participants, a total of 214 (56.5%) participants had heard about glaucoma. Out of the participants who heard about glaucoma, the mean knowledge score was 48.3±21.7 and 53.3% had good knowledge on glaucoma. The odds of having heard about glaucoma were two percent lower (AOR=0.98; 95%CI: 0.97-0.99; p-value 0.036) in the older participants compared to one year younger participant, 1.98 (95%CI:1.01-3.86; p-value 0.046) times higher among literates and 2.79 (95%CI: 1.76- 4.41; p-value < 0.001) times among participants with previous ocular examination. The odds of having good knowledge was 1.94 (95%CI: 1.10-3.42; p value 0.021) times among participants with previous ocular examinations. Conclusion The knowledge and awareness regarding glaucoma in a hospital-visiting population in central Nepal was low. Half of the participants were unaware of the disease glaucoma and half of the participants who heard of the glaucoma had poor knowledge on glaucoma. KEY WORDS Awareness, Glaucoma, KnowledgePublication Awareness and Knowledge of Glaucoma and their Associated Factors among Staffs in a Tertiary-level Hospital in Central Nepal(Kathmandu University, 2022) Shrestha, A; Shrestha, P; Shrestha, T; Shrestha, RM; Sujakhu, D; Dhakal, K; Thapa, G; Adhikari, S; Karki, S; Poudel, LABSTRACT Background Since glaucoma-related blindness may only be prevented with early identification and treatment, finding asymptomatic individuals in the target population is critical. It is thus important to determine the awareness and knowledge on glaucoma. Objective To determine the knowledge and awareness on glaucoma among the staff of a tertiary level hospital in central Nepal. Method This was a cross sectional study among the staffs of Dhulikhel Hospital who participated voluntarily in the study. The data was collected through the administration of semi-structured questionnaires. R version 4.0.3 (2020-10-10) was used for the data analysis. Categorical variables are presented as frequency (percentages) and the numerical ones are presented as mean (standard deviation). Adjusted odds ratio (AOR) with 95% confidence interval were estimated through logistic regression analysis for determining factors associated with awareness and knowledge of glaucoma. Result A total of 107 (89.2%) participants had heard about glaucoma of which 93 (86.9%) had good knowledge and 14(13.1%) had poor knowledge on glaucoma. The mean score of knowledge was 64.1±16.9. Only 47.7% of the participants said that glaucoma also has an asymptomatic course. We could not find an association of awareness and knowledge of glaucoma with any of the selected sociodemographic variables. Conclusion Although there was a fairly good glaucoma related awareness and knowledge among hospital staff, we found lack of understanding on some critical issues on glaucoma, mainly related to its asymptomatic nature. There is thus room for improvement in educating about glaucoma even in healthcare settings. Given the necessity of expanding glaucoma awareness in the public, hospital staff might potentially serve as messengers to the communities KEY WORDS Awareness, Glaucoma, Hospital Staffs, Knowledge, PracticePublication Can Laparoscopic Cholecystectomy be a Feasible Standard in a Rural set up too? - An Experience of 348 cases from a Peripheral set up of Western Nepal(Kathmandu University, 2015) Shrestha, AL; Shrestha, P; Brown, DABSTRACT Background Gall stone disease is a common reason for admissions in both acute and elective situations and bears significant morbidity in the rural population of western Nepal. The earlier conventional open method of treatment for the same seems to have been largely seeded by the laparoscopic approach owing to its numerous benefits. Objective To study the clinical profile of patients with symptomatic gall stones with respect to demography and to assess the feasibility of using Laparoscopic cholecystectomy as the next standard in this set up too as guided by the outcome in terms of complications, conversion rates and potential impact it bears on the health and socioeconomic status in this group. Method A retrospective analysis of all the patients undergoing an attempted laparoscopic cholecystectomy from 1st Jestha 2068 to 30th Jestha 2070 was done. Relevant medical records were reviewed to study demography, various indications for operations, intra operative events including conversions and complications. Result Of 348 patients 293(84.19%) were females and 55(15.80%) were males. The mean age was 38.46 years (range 15-76 years). Most of the patients belonged to the Palpa district of Lumbini zone and many were from other surrounding areas. Gall stone disease was commonest in people of Brahmin ethnicity. The operating time was <2 hours for most and most had an uneventful recovery with a mean hospital stay of 3.8 days. The rate of conversion to open cholecystectomy was 6.9% (24 out of 348 patients). Post operative complications were noted in 5 patients (1.42%). Of these 1 sustained a major bile duct injury (0.28%) requiring immediate conversion and repair, 3 had post operative bilioma and 1 had diffuse bleeding from the gall bladder fossa all requiring re explorations. There was no mortality in this study. Conclusion Laparoscopic cholecystectomy is a safe, reliable and a promising option even in the rural peripheral set up. Due to its well known advantages and superiority over the open conventional method and considering the impact that it holds on the overall outcome, morbidity, health and socioeconomic status of the rural population, it can be recommended as an acceptable feasible standard in rural peripheral set up. KEY WORDS Complications, conversions, laparoscopic cholecystectomy.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 Clinical Dilemma of Diabetic Ketoacidosis and COVID-19 Infection(Kathmandu University, 2021) Sapkota, P; Chalise, S; Shrestha, PABSTRACT The COVID-19 Pneumonia with diabetic ketoacidosis is a dreadful health condition. Diabetic ketoacidosis is one of the severe metabolic complications and it can be precipitated by infection. We presented a case of 48 years female with no known comorbidities who presented with COVID-19 symptoms and with Diabetic Ketoacidosis. The case presented with elevated inflammatory markers, high anion gap metabolic acidosis with type I respiratory failure. During admission, the oxygen saturation had marked drop, later her improvement was steady followed by gradual tapering of the oxygenation. Marked improvement was noticed in the subsequent follow-up. COVID-19 infection can be precipitated by preexisting diabetes or newly diagnosed diabetes and the severity of COVID-19 infection is more pronounced in patients with diabetes mellitus, thus should be managed timely and accordingly. The scarce studies among the COVID-19 cases with diabetic ketoacidosis reflect the need for further studies for the availability of a wider range of information. KEY WORDS Diabetic ketoacidosis, Metabolic complications, Severe COVID-19 pneumoniaPublication Clinicohistopathological Correlation in Leprosy(Kathmandu University, 2011) Mathur, MC; Ghimire, RBK; Shrestha, P; Kedia, SKABSTRACT Background Leprosy is a chronic, infectious disease caused by Mycobacterium leprae. It is classified into five groups based on clinical, histological, microbiological and immunological criteria (Ridley & Jopling Classification) . However, a great variation has been observed in the interpretation of histopathological examination ok skin biopsies and clinical presentation of the disease. Objective To correlate clinical diagnosis with histopathological diagnosis of leprosy patients in Nepal. Methods A retrospective hospital-based study was conducted among patients with all clinical types of leprosy, classified as per the Ridley-Jopling classification. Skin biopsies were taken from active lesions in all patients and were stained with Hematoxylin & Eosin stain and modified Fite-Ferraco stain for identification of Mycobacterium leprae. The histopathological findings were compared with clinical diagnoses. Results A total 156 patients were studied, out of which 84 (53.8%) males and 72 (46.1%) females between 8 and 86 years of age. The majority of patients 33 (23.57%) were in the age group of 21-30 years and least affected was children below 10 years 1(0.007%).Overall coincidence of clinical and histopathological diagnoses of classification was seen in 115 cases (80.4%). The maximum correlation (95.2%) was noted in LL patients (p value 0.000049) followed by BT(89.74%), TT (73.2%),BL(72.4%), BB(64.7%). Conclusion Leprosy still continues to be one of the common infectious disease in Nepal and skin biopsy is a useful tool in confirming the clinical diagnosis of leprosy as well as for the therapeutic guide. KEY WORDS Mycobacterium leprae, Leprosy, histopathologyPublication Co-infection of COVID-19 with Malaria and Dengue -A Hospital based Study in Kathmandu, Nepal(Kathmandu University, 2024) Bajracharya, B; Shrestha, P; Shrestha, D; Karna, AK; Mahato, RK; Shrestha, S; Baral,B; Bhandari, P; Sah, P; Bastola, A; Pandey, BDABSTRACT Background In tropical countries like Nepal, the COVID-19 pandemic unfolded within a population already grappling with various tropical infectious diseases. Co-infection with malaria and dengue holds clinical significance when managing COVID-19 patients in regions endemic to these diseases. Objective To identify malaria and dengue infections in febrile or symptomatic patients suspected of COVID-19 at the Sukraraj Tropical and Infectious Disease Hospital, Kathmandu. Method Over two months, a prospective study was conducted on febrile or symptomatic patients suspected of COVID-19 visiting Sukraraj Tropical and Infectious Disease Hospital, Kathmandu. One hundred and twenty-three patients suspected of COVID-19 were tested for SARS-CoV-2 through RT-PCR as well as for malaria and dengue infection using rapid diagnostic test kits. Result Out of 123 patients suspected of COVID-19, 64 were confirmed to have COVID-19. No evidence of SARS-CoV-2 and malaria co-infection was found among the 123 tested patients. However, two patients admitted for COVID-19 tested positive for dengue virus infection. The patients with co-infections with dengue or scrub typhus were likely to have a longer hospital stays (OR 2.5; 95% CI: 0.22-29.26), though lacking a significant association. Conclusion The two patients diagnosed with dengue virus and SARS-CoV-2 were identified during their hospital visit and both recovered after receiving treatment. Given that COVID-19 patients manifest symptoms resembling many tropical infectious diseases, the study underscores the clinical importance of testing for multiple circulating infections in patients from endemic areas. This approach ensures appropriate and timely management reducing the risk of severity or mortality. KEY WORDS Co-infection, COVID-19, Dengue, Malaria, NepalPublication Correlation between Invasive Intracranial Pressure Monitoring and Optic Nerve Sheath Diameter in Patients with Traumatic Brain Injury(Kathmandu University, 2021) Shrestha, B; Shrestha, P; Ghale, P; Lakshmipathy, GABSTRACT Background In management of patients with traumatic brain injury, intracranial pressure holds an important place. Any untoward rise in intracranial pressure portends dreaded complications. Hence, any delay in detecting the issue is considered unacceptable. Objective This study focuses on analyzing the correlation between ultrasound derived optic nerve sheath diameter and intracranial pressure values derived from invasive intracranial pressure monitoring system in a neurosurgical patient with severe traumatic brain injury. Method A prospective observational study was performed using a convenience sample technique including all adult patients with traumatic brain injury who had invasive intracranial monitors placed as part of their clinical care. Ocular ultrasound was performed with 5 - 7.5 MHz linear probe of ACUSON X300 ultrasound system while simultaneous intracranial pressure readings were obtained directly from an invasive intracranial pressure monitoring system. The association between optic nerve sheath diameter and invasive intracranial pressure reading was assessed with the Pearson’s correlation coefficient and a receiver operator characteristic curve was created to determine the optimal optic nerve sheath diameter cutoff to detect intracranial pressure > 15 mm of Hg. Result One hundred and fifteen ocular ultrasounds were performed on 30 individual patients. The mean age of the population involved in this study is 42.13 years ± 1.89 with male preponderance in the ratio of 6:1. Pearson’s correlation coefficient of optic nerve sheath diameter and intracranial pressure was found to be 0.844 (p < 0.000) demonstrating a significant positive correlation. The area under the receiver operating characteristic curve was found to be 0.961 (95% confidence interval = 0.93 to 0.99). Based on analysis of the receiver operating characteristic curve, optic nerve sheath diameter > 4.85 mm performed best to detect intracranial pressure > 15 mm of Hg. with a sensitivity of 93.5% and specificity of 83%. Conclusion Optic nerve sheath diameter is a dependable screening tool to evaluate for elevated intracranial pressure among patients with traumatic nerve injury. KEY WORDS Intracranial pressure, Optic nerve sheath diameter, ScreeningPublication Cutaneous leishmaniasis: a case report(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2009) Kayastha, BMM; Shrestha, P; Shrestha, R; Jahan, RAbstract Cutaneous Leishmaniasis (CL) is a vector-borne protozoal infection of the skin. It is endemic in the tropics and neotropics. Several species of Leishmania cause this disease in the Old World. It is manifested as chronic nodular to ulcerative lesions of the skin, which last for many months and may be disfiguring. Despite its increasing worldwide incidence, it is infrequently reported from Nepal. We are reporting a case of CL in a man who acquired the disease while working in Saudi Arabia and who was successfully treated with Sodium Stibogluconate injections. Keywords: Cutaneous leishmaniasisPublication Deep Brain Stimulation in Parkinsons Disease in Nepal(Kathmandu University, 2018) Shrestha, R; Taira, T; Shrestha, P; Rajbhandari, P; Acharya, S; Pant, BABSTRACT Background Parkinsons disease is a central nervous system degenerative disorder affecting motor system and characterized by progressive tremor, rigidity, gait abnormalities. Surgical treatment of Parkinsons disease is based on the changes in the basal ganglio- thalamocortical circuits which is altered in Parkinsons disease. Currently pallidotomy and Deep Brain Stimulation are available modes of surgical treatment of Parkinsons disease. Objective To know efficacy of deep brain stimulation in Parkinsons Disease in Nepal. Method All patients of idiopathic Parkinsons disease who underwent Deep Brain Stimulation in Annapurna Neurological Institute and Allied sciences since 2014 were included. The standard functional coordinates for Subthalamic nucleus and Globus pallidus internus was used. We used Zamarano-Dujovny (ZD) Fisher Frame with its software. Patients’ Unified Parkinsons disease rating score, Modified Hoehn and Yahr Staging and Schwab and England Activities of daily living Scale were evaluated preoperatively as well as postoperatively. Result Ten patients underwent Deep Brain Stimulation. The male is to female ratio was 2:1. The mean age was 55.4±8.9 years and duration of illness was 5.5±2 years. There was a significant improvement in the scores for the main motor manifestations of the disease between the preoperative off-dopa and postoperative off-dopa/on-stim conditions. There was a significant improvement in Schwab and England Activities of daily living scale scores in the off-dopa condition between the preoperative score and the postoperative M6 score. Conclusion Our result of Deep Brain Stimulation is quite promising. However, it is very expensive and requires frequent follow-up for neuromodulation. KEY WORDS Deep brain stimulation, Parkinsons disease, Unified parkinsons disease rating scorePublication 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 Dermatologic Manifestations In Chronic Kidney Disease Patients On Hemodialysis(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2014) Shrestha, P; Mathur, MAbstract: Introduction: Dermatologic changes are frequently seen in chronic kidney disease (CKD) patients. Early identification of these manifestations helps timely institution of treatment and prevention of progression of CKD. Objectives: The aim of this study was to evaluate the frequency and pattern of dermatologic problems among CKD patients who are on maintenance hemodialysis in our population. Material and Methods: A hospital based cross sectional comparative study was conducted. Fifty patients with CKD on hemodialysis were compared with the same number of non CKD patients. All the patients were clinically examined. Complementary diagnostic measures such as skin biopsy, gram stain, potassium hydroxide mounting and culture sensitivity of the lesions were carried out when necessary. Results: At least one dermatologic manifestation was present in 86% of the patients and changes were seen commonly in CKD patients who had GFR <15ml/min (83.8%). Cutaneous manifestations were significantly associated with CKD patients than control (p<0.001) but not with the duration of CKD and duration of hemodialysis. Thirty seven patients (74%) were having cutaneous lesions, commonest being xerosis (52%) followed by pruritus (40%) and hyperpigmentation (32%). Nail, mucous membrane and hair changes were present in 56%, 22% and 12% respectively, commonest being white nail (30%), furred tongue (18%), telogen effluvium (10%) respectively. Conclusion: In our study, dermatologic manifestations were common in CKD patients with GFR <15ml/min. Cutaneous and nail changes were seen in 74% and 56% of the CKD patients undergoing hemodialysis, commonest changes being xerosis and white nail respectively. Keywords: Dermatologic manifestations, CKD, HemodialysisPublication Digital Subtraction Angiography a Door Opener for Neurosurgical Residents who want to Perform Neurointerventional Procedures(Kathmandu University, 2021) Rajbhandari, P; Gurung, P; Rajbhandari, S; Shrestha, D; Acharya, S; Shrestha, R; Shrestha, P; Shrestha, J; Sharma, U; Mali, S; Rajbhandari, R; Neupane, A; Pant, BABSTRACT Digital subtraction angiography (DSA) has been a fluoroscopic golden investigative tool to know the vascular angiography of the brain and spinal cord. The technique in performing this procedure exposes residents in accessing the major vessels, branches of the arch of aorta, selective angiography and diagnosing different vascular anomalies of brain and spine. They are also exposed to the knowledge of different diagnostic catheters, its manipulation, use of dye and radiation exposure and safety. We would like to share our experience in training and disseminating the knowledge of digital subtraction angiography to the residents. KEY WORDS Digital subtraction angiography, Neurosurgical residents, NeurointerventionPublication First Reported Death of a Postpartum Woman Due to Coronavirus Disease 2019 in Nepal: A Lesson Learnt(Kathmandu University, 2020) Shrestha, AP; Bhushal, N; Shrestha, A; Tamrakar, D; Adhikari, P; Shrestha, P; Shrestha, A; Karmacharya, B; Basnet, S; Tamrakar, SR; Shrestha, R; Shrestha, RABSTRACT The first case of coronavirus disease 2019 was reported on December 31, 2019 in Wuhan, China where the average case fatality rate was 6.1 ± 2.9%. There are 453 deaths as of September 24, 2020 in Nepal. We report the first death of a 29-years-old postpartum woman due to COVID-19 in Nepal who was referred from a rural health center to Dhulikhel Hospital. On arrival, she was taken to the acute respiratory zone of the emergency department to provide immediate lifesaving procedures. Despite the repeated resuscitative measures, return of spontaneous circulation could not be achieved. The real time polymerase chain reaction test was positive. Our case report highlights the importance of early clinical suspicion, importance of “safety first” in healthcare settings, and the chain of management in such patients. We consider the fact that a postpartum woman registered as the first case of COVID-19 related death in Nepal to be an area of further study. KEY WORDS Coronavirus, Emergency department, Personal protective equipment, Postpartum death, Real time polymerase chain reaction, ResuscitationPublication Knowledge, Attitude and Practice towards COVID-19 among Private School Teachers of Chitwan, Nepal(Kathmandu University, 2021) Dhakal, RD; Paudel, D; Shrestha, P; Adhikari, PABSTRACT Background The coronavirus disease (COVID-19) pandemic has brought life to a standstill across the world, with nearly 178 countries reporting school closures. As the schools have started reopening slowly, precautions are utmost necessary to prevent the potential spread of COVID-19 in school and community settings. Objective To assess knowledge, attitude and practice towards COVID-19 among private school teachers. Method A web based cross-sectional analytical study design was undertaken. Currently working private school teachers of Chitwan District were included as a unit of analysis. The snowball sampling technique was employed to identify the eligible participant. Collected data was entered in SPSS version 20 and analyzed using the Chi-square test, Pearson correlation, and binary logistic regression. Result Of 344 participants, the majority were male (52.9%), most of the participants were from age group 26-30 years (38.4%). Regarding knowledge, attitude and practice, 57% had good knowledge, 53.2% had favorable attitude and 51.7% had good practice towards COVID-19. Logistic regression analysis demonstrated gender (OR 0.475, 95% CI: 0.256-0.818) and COVID-19 training (OR 25.687, 95% CI 5.354-123.226) were significant with good knowledge. Conclusion Knowledge about COVID-19 among private schools teacher was good, attitudes have been mostly favorable, and the practices were mostly adequate. However, good knowledge is not the only factor for better attitude and good practices. It is necessary to implement massive education campaigns, trainings and information via school authorities and health authorities by developing and adopting appropriate guidelines on COVID-19. KEY WORDS Attitude-practice, COVID-19, Knowledge, School teacher