NepMed Repository :: Browsing by Author "Shrestha, P"

Browsing by Author "Shrestha, P"

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A Hospital Based Study of Pterygium in Tertiary Care Hospital of Nepal
(Kathmandu University, 2016) Shrestha, P; Kaiti, R
ABSTRACT 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-factors
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, D
ABSTRACT 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.
Clinicohistopathological Correlation in Leprosy
(Kathmandu University, 2011) Mathur, MC; Ghimire, RBK; Shrestha, P; Kedia, SK
ABSTRACT 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, histopathology
Cutaneous leishmaniasis: a case report
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2009) Kayastha, BMM; Shrestha, P; Shrestha, R; Jahan, R
Abstract 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 leishmaniasis
Dermatologic Manifestations In Chronic Kidney Disease Patients On Hemodialysis
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2014) Shrestha, P; Mathur, M
Abstract: 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, Hemodialysis
Ocular Morbidity among Earthquake Survivors in a Community Based Hospital in Nepal
(Kathmandu University, 2017) Shrestha, P; Sthapit, PR
ABSTRACT Background Nepal suffered a massive loss of lives and property following devastating earthquake on Saturday 25 April, 2015 and 12 May, 2015. Though Nepal is prone to natural disasters and ocular trauma being important cause of visual morbidity, the impact of ocular trauma in disaster setting has rarely been studied. Objective The aim of this study was to report the spectrum of ocular morbidities among the earthquake survivors who presented to a tertiary care Hospital which lies close to major earthquake hit districts of Nepal. Method This is a hospital based retrospective study where details of all the cases with ocular injury or ocular diseases during first three weeks of earthquake were extracted from the record books of Ophthalmology and Emergency department. Detail ophthalmic examination findings and treatment received by the patients were also noted from the records, tabulated and analyzed. Result There were total 3679 earthquake survivors, majority from Kavrepalanchowk district, visiting our Hospital during first three weeks of earthquake among which 92 patients had ocular problems. Among the 117 affected eyes, 75% had unilateral involvement. Males and females were equally affected. Children and adolescents of age group 11-20 years was the most commonly affected age group. Spectrum of ocular injuries ranged from lid lacerations, conjunctival inflammation to sixth nerve palsy and traumatic optic neuropathy. Conclusion Ocular morbidity either in the form of ocular injuries or diseases were common in polytrauma cases among the earthquake survivors. Though most of them had eyelid injuries and conjunctival inflammations, vision threatening conditions were also observed which needed expert opinion and meticulous treatment. KEY WORDS Earthquake, ocular trauma, ocular morbidity
Pattern and Prevalence of Refractive Error and Secondary Visual Impairment in Patients Attending a Tertiary Hospital in Dhulikhel, Nepal
(Kathmandu University, 2018) Kaiti, R; Pradhan, A; Dahal, HN; Shrestha, P
ABSTRACT Background Uncorrected refractive error is one of the most important causes of visual impairment worldwide. Objective To ascertain the pattern and prevalence of refractive error and secondary visual impairment in subjects attending Ophthalmology department. Method A prospective hospital-based study was designed where presenting visual acuity, age of presentation, refractive status, best corrected visual acuity and status of visual impairment were assessed in participants, ages ranging from 3-39 years presenting to the Ophthalmology department of Dhulikhel Hospital, Kathmandu University Hospital. History of use of spectacle was noted and participants were categorized into different visual impairment categories as per their presenting visual acuity. Result Out of a total of 4500 total clients examined during the study period, 388 (8.62%) had refractive error where 219 (56.44%) were females and 169 (43.56%) were males. Mean age at presentation was 22.70±7.69 years (range, 3-39 years). Astigmatism was the most common subtype seen in 373 eyes (48.06%), followed by myopia (366 eyes, 47.16%) and hypermetropia (31 eyes, 4.0%). Only 40.50% subjects who required refractive correction were using spectacle. 62.37% (242 clients) had some of visual impairment during their presentation. There was statistically significant improvement in visual acuity after refractive correction (p=0.00). Conclusion Uncorrected refractive error is one of the most important causes of visual impairment. Lack of awareness, infrequent ocular examination and lack of community or preschool vision screening were the main causes for the late presentation and significant visual impairment associated with the condition. Social stigma, economical limitation and negative counseling and attitudes about spectacle wear were primary factors behind the unsatisfactory spectacle use. KEY WORDS Astigmatism, Refractive correction, Refractive error, Visual impairment
Pemphigus herpetiformis : A rare clinical variant of pemphigus
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2015) Shrestha, P; Tajhya, R B; Pokharel, A
Abstract: Pemphigus herpetiformis is an autoimmune blistering disease. We report a case of pemphigus herpetiformis, a generalized form, manifested as pruritic grouped vesicles at extremities and trunk, in a seventy years old man. Neutrophil dominant inflammatory substrate was seen in histopathology. Direct immunofluorescene revealed IgG reactivity in net like pattern at upper epidermis, confirming pemphigus. The patient responded well to prednisolone and colchicine combination initially and maintained remission later on colchicine alone. Colchicine has anti-mitotic, anti-inflammatory and immunosuppressive mechanism of actions and proven benefits in neutrophilic dermatoses. Therefore we recommend colchicine as mono therapy or in combination with immunosuppressive, for the treatment of pemphigus herpetiformis where neutrophil is predominant inflammatory infiltrate histologically. Keywords: Pemphigus, Herpetiform, Pruritic, Vesicles
Perceptions and Attitudes towards Evidence Based Practice among Nurses and Nursing Students in Nepal
(Kathmandu University, 2015) Karki, S; Acharya, R; Budhwani, H; Shrestha, P; Chalise, P; Shrestha, U; Gautam, K; Wilson, L
ABSTRACT Background As the evidence based practice (EBP) movement expands, there is a need for health leaders and educators in each country to assess the extent to which health professional students and practitioners are prepared to locate, evaluate, and apply evidence to guide their practice. Objective The study objective was to explore nurses’ and nursing students’ perceptions and attitudes towards EBP. Method This was a descriptive cross-sectional survey administered to all 273 nurses and nursing students from Nepal who attended an EBP conference. The survey instrument that was used by Majid in Singapore was adapted for use in this study with permission from the author. Result In total, 121 nurses participated in the study. The majority (93%) of respondents reported that they had no previous training in EBP. The respondents’ perceptions of their EBP knowledge and skills were variable, but most of them demonstrated positive attitudes toward EBP. Respondents identified a number of barriers that limit the implementation of EBP in Nepal. The greatest barriers were lack of time and resources, difficulty understanding research articles and translating the findings to practice, and limited autonomy to change practice based on evidence. Conclusion Although respondents had positive attitudes towards EBP, their knowledge and skills were limited and barriers to implementation existed. Nursing faculty can use the findings to guide implementation of EBP into curricula, and nursing administrators and clinicians can use the findings to guide practice to promote EBP. KEY WORDS Evidence-based nursing, evidence-based practice, nursing research
Profile of renal diseases in Nepalese children
(Kathmandu University, 2008) Bhatta, NK; Shrestha, P; Budathoki, S; Kalakheti, BK; Poudel, P; Sinha, A; Singh, R
Abstract Aim and Objectives: To find out the profile of renal diseases in children hospitalized in the pediatric department of the tertiary care university teaching hospital in Eastern Nepal. Materials and Methods: A retrospective chart review of all the patients admitted at the department of paediatric from April 2002 to March 2007 was carried out for the presence of any renal diseases on the basis of their clinical presentation, laboratory findings and final diagnosis. Results: A total number of 10396 children were admitted during the study period out of which 651 (6.3%) children had renal disease. Among them, nephrotic syndrome seen in 222 patients (34.1%) was the commonest renal disease, followed by post streptococcal nephritis in 187(28.7%) and haemolytic uremic syndrome 66(10.1%), other renal diseases seen were acute renal failure in 25 (3.9%), lupus nephritis 24 (3.7%), urinary tract infection in 23 (3.5%) Henoch-Schönlein Purpura (HSP) nephritis 26 (4%), chronic renal failure in 27 (4.2%) and other miscellaneous causes 51 (7.8%). Conclusion: A substantial number of children are hospitilsed with renal diseases, and current trends indicate that majority of them are preventable. In near future, there is a need to develop a comprehensive service for the children with kidney diseases in Nepal. Key words: Renal Disease, Children, Nephrotic Syndrome, Poststreptococcal Glomerulonepritis, Renal Biopsy
Study of clinical profile and antibiotic sensitivity pattern in culture positive typhoid fever cases
(Kathmandu University, 2005) K.C., Mathura; Chaudhary, D; Simkhada, R; Pradhan, M; Shrestha, P; Gurubacharya, DL
Objectives: The present study was designed to analyze the clinical profile and antibiotic sensitivity pattern in the cases of culture positive typhoid fever. Method: The study was conducted over a period of 1year. Total of 46 culture positive cases of Typhoid fever were included in the study. The sensitivity pattern of isolates from blood culture was recorded. The modes of presentation, clinical course, lab investigation reports were also recorded. Results: Out of 46 cases, 33 (71.7%) were males and 13 (28.3%) were females. Average age of presentation was 26.17 years. Fever was present in all patients. Resistance of S .typhi to amoxycillin, chloramphenicol and co- trimoxazole were significantly high. Ciprofloxacin showed resistance in 2 (4.3%) cases. Sensitivity to ceftriaxone was 100% in our study. Conclusion: Typhoid fever is one of the most common health problem in Nepal. Various drugs are being used in the treatment of typhoid fever, in the mean time resistance to many of them are emerging. An appropriate antibiotic has to be initiated only after culture sensitivity in typhoid fever. Keywords: Typhoid fever, S. typhi, Sensitivity, Drug resistance
Sweet's Syndrome: a case report
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2009) Kayastha, BMM; Lama, L; Shrestha, P; Shrestha, R; Karki, A
Abstract Sweet's syndrome is a disorder characterized by fever and painful skin lesions. The condition starts suddenly with the appearance of red, slightly raised tender plaques, usually on the back, arms, face or neck. Women are most at risk of Sweet's syndrome, predominantly between 30-50 years of age who have recently had an upper respiratory tract infection. Here we present a 70 years old lady who came with fever and tender erythematous plaques on trunk and limbs. On investigation, leucocytosis with raised ESR was found and the skin biopsy was consistent with Sweet's syndrome. There was dramatic improvement with systemic corticosteroid. Keywords: Sweet's Syndrome
Typhoid fever in Dhulikhel hospital, Nepal
(Kathmandu University, 2004) Sharma, N; Koju, R; Karmacharya, B; Tamang, MD; Makaju, R; Nepali, N; Shrestha, P; Adhikari, D
One hundred and twelve cases of typhoid fever presenting in outpatient and emergency department of Dhulikhel Hospital in Nepal were studied. In this study, it was found that 71% typhoid fever cases were less than 30 years of age group with male to female ratio of 3:1. Fever over 5 days followed by headache and chills were major presenting symptoms. Widal test and blood culture for Salmonella typhi were positive in 59% and 49% cases respectively. Two third of our study population had total leucocyte count of normal range. The fever clearance time was significantly better with ofloxacin compared to ciprofloxacin (p<0.05) and ceftriaxone compared to chloramphenicol (p<0.05). The release from treatment was significantly shorter with ceftriaxone compared to ofloxacin, ciprofloxacin and chloramphenicol (p<0.01). Ceftriaxone was found to be 100% sensitive to salmonella typhi. Amoxicillin was only 52.1% sensitive to Salmonella typhi. Early diagnosis and institution of appropriate antibiotic therapy is of paramount importance in the management of typhoid patients. Key words: Typhoid fever, salmonella typhi, fever clearance time, release from treatment

Browsing by Author "Shrestha, P"

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