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

Browsing by Author "Shrestha, R"

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A Comparative Study on Epidemiology, Spectrum and Outcome Analysis of Physical Trauma cases Presenting to Emergency Department of Dhulikhel Hospital, Kathmandu University Hospital and its Outreach Centers in Rural Area
(Kathmandu University, 2013) Shrestha, R; Shrestha, SK; Kayastha, SR; Parajuli, N; Dhoju, D; Shrestha, D
ABSTRACT Background Physical trauma is one of the major cause of mortality and morbidity among young and active age group and its increasing trend is of main concern. There are only few studies concerning the spectrum of physical trauma in Nepal. Objective This study aims to evaluate the epidemiological spectrum, the extent, severity of the physical trauma and the outcome evaluation of patients with physical trauma over a period of one year in the emergency department of the Kathmandu University Hospital and compare the same parameters with those patients presenting to the various outreach centers of the hospital in the community. Methods Patient treatment files from the emergency department and the reports from various outreach centers were retrieved for a period of one year (May 2011 to April 2012). Epidemiological information, mode, type and anatomic location of injuries were recorded. Outcome evaluation was assessed by number of patients discharged from emergency department of the hospital or the outreach centers after the treatment, patients admitted for inpatient management and referred to other centers for further specialty management. Result In a period of one year, total 2205 (20%) of physical trauma cases presented to the emergency department and 1994 (6.12%) in the outreach centres. Most commonly involved age group in physical trauma both in Hospital set up and in Community set up were the young adults (15 to 49 years). Fall from height was the commonest mode of injury followed by road traffic accidents among the patients coming to the hospital while significant number of trauma patients coming to outreach centers were due to fall from height. In the hospital set up, 1525 (69.2%) of the cases were discharged while 537 (24.4%) needed inpatient management and 85 (3.8%) needed referral to other centers for the specialty management. In case of outreaches, half of the patients were discharged after the primary treatment and almost another half were referred to the hospital, mainly for need of further investigations. Conclusion Fall related injuries and road traffic accidents are the most common mode of trauma in the hospital set up and fall related injuries are the single most important mode of trauma seen in the outreaches. Mostly young adults in their active period of life are involved in physical trauma so appropriate preventive measures through public health approach should be included in comprehensive trauma management for reducing mortality and morbidity rates related to physical trauma. KEY WORDS Emergency department, outreach centers, physical trauma, trauma center
A Cross-Sectional Study of Medication Adherence Pattern and Factors Affecting the Adherence in Chronic Obstructive Pulmonary Disease
(Kathmandu University, 2015) Shrestha, R; Pant, A; Shakya Shrestha, S; Shrestha, B; Gurung, RB; Karmacharya, BM
ABSTRACT Background Chronic obstructive pulmonary disease (COPD) is considered as a major health problem, associated with mortality and morbidities. Various disease management strategies have been established to optimize patient’s longevity and functional status where patient adherence to the prescribed treatment plays a key role. Poor adherence to medication is common among COPD patients and is affected by number of factors like number of medicines, delivery devices and patient-related factors. Objective This study aims to investigate the adherence pattern in the management of COPD and factors affecting patient adherence to the prescribed treatment. Method This study is a cross-sectional study which was conducted in a tertiary care hospital. Those patients suffering from COPD of all age were enrolled in this study and prior informed consent was obtained from patients. The structured questionnaire was used to interview those patients. Result Total 100 patients were enrolled in this study, among which most patients (45%) were of age groups 60-70 years. Unintentional non-adherence to medication attributed for 65% of patients and the major reason was forgetfulness (52.3%). Most patients had discontinued the medication due to experience of side effects (63.3%). The result showed significant association between adherence and polypharmacy (p=0.00). However, there was no significant association between adherence and age, sex, mode of administration of drugs, technics to use delivery devices etc. Conclusion Majority of COPD patients were elderly (mean age= 68.4 years). Forgetfulness was associated with medication non-adherence. Most of the patients had discontinued medication because of side effects. Polypharmacy is one of the major factors associated with non-adherence to medication in COPD. KEY WORDS Adherence, COPD, Dhulikhel Hospital, non-adherence, polypharmacy
A Prospective Study of Commonly Prescribed Drugs in the Management of Neuropathic Pain and its Medication Adherence Pattern
(Kathmandu University, 2016) Shrestha, R; Silwal, P; Basnet, N; Shakya, Shrestha S; Shrestha, R; Pokharel, BR
ABSTRACT Background Neuropathic pain is one of the common complains of patients visiting neurology and orthopedic departments in hospitals. Management of neuropathic pain is difficult and is often symptomatic rather than being curative. Adherence to medication is necessary for pain management to be effective. However, there are various factors related to patient, physician, drug regimen and other socio-economic affecting adherence. Objective To study commonly prescribed drugs in neuropathic pain management and the medication adherence pattern including its associated factors. Method Patients already diagnosed as neuropathic pain were interviewed using structured questionnaire and data entered in Microsoft Office Excel 2007. Informed consent was taken from the patients. Result Among the 84 patients in the study, 69% were females. Majority 53.6% of patients had low back pain as cause of neuropathic pain. Anticonvulsants were mostly prescribed (75%) followed by non-steroidal anti-inflammatory drugs (52.4%) and Methylcobalamin (47.6%). More than 50% (n=49) patients were not adherent to the prescribed medication and majority (61.2%) of them were housewives. Significant association was observed between patient’s adherence to gender, occupation, polypharmacy, drug regimen, cost and availability of medicine. Conclusion Anticonvulsants were commonly prescribed drugs in patients with neuropathic pain. Neuropathic pain was seen more in females with low back pain. Majority of patients were non-adherent and forgetfulness was the major reason for missing dose in them. KEY WORDS Low back pain, medication adherence, neuropathic pain, non-adherence
A Study of Atypical Manifestations of Enteric Fever in Children
(Nepal Health Research Council, 2008) Shrestha, R; Shakya, K N; Baral, M R
A Study of the First 350 Cases Referred for EEG in Kathmandu Medical College Teaching Hospital
(Kathmandu University, 2004) Shrestha, R; Pradhan, SN; Sharma, SC; Shakya, KN; Karki, DB; Rana, BBS; Joshi, LN
Electroencephalography or EEG is a neurological test that uses an electronic monitoring device to measure and record electrical activity in the brain. Epilepsy is defined as a recurrent tendency to unprovoked seizure. About 0.5% to 2% of the population has epilepsy. Material and Methods This is a retrospective study of the first 350 odd cases referred for EEG at Kathmandu Medical College Teaching Hospital, Kathmandu during period November 2002- September 2002 (Mangsir 2058- Bhadra 2059). Results Most patients fall in the age group of 11-20 years and more than 50% referred cases fall in the prime of life, i.e., 11- 30 years. 16% of patients with the history of seizure did not use any AED and 32 % who though had no history of seizures were actually using AED. It is seen that out of 149 reported normal, 57 (38%) had history of seizure; but out of 208 reported abnormal in EEG only 92 (42%) had history of seizure. Discussion EEG is not a very sensitive or a specific tool; however, in our study it was seen to be more sensitive than specific. It is till very useful in classifying seizure types, in locating epileptic focus prior to surgery or in some confusing situation when movement disorder may simulate seizure disorder or vice versa. Conclusion Although EEG is not a very sensitive or specific investigation, it is more sensitive than specific.
Academic detailing
(Kathmandu University, 2010) Shankar, PR; Jha, N; Piryani, RM; Bajracharya, O; Shrestha, R; Thapa, HS
Abstract There are a number of sources available to prescribers to stay up to date about medicines. Prescribers in rural areas in developing countries however, may not able to access some of them. Interventions to improve prescribing can be educational, managerial, and regulatory or use a mix of strategies. Detailing by the pharmaceutical industry is widespread. Academic detailing (AD) has been classically seen as a form of continuing medical education in which a trained health professional such as a physician or pharmacist visits physicians in their offices to provide evidence-based information. Face-to-face sessions, preferably on an individual basis, clear educational and behavioural objectives, establishing credibility with respect to objectivity, stimulating physician interaction, use of concise graphic educational materials, highlighting key messages, and when possible, providing positive reinforcement of improved practices in follow-up visits can increase success of AD initiatives. AD is common in developed countries and certain examples have been cited in this review. In developing countries the authors have come across reports of AD in Pakistan, Sudan, Argentina and Uruguay, Bihar state in India, Zambia, Cuba, Indonesia and Mexico. AD had a consistent, small but potentially significant impact on prescribing practices. AD has much less resources at its command compared to the efforts by the industry. Steps have to be taken to formally start AD in Nepal and there may be specific hindering factors similar to those in other developing nations. Key words: Academic detailing, pharmaceutical industry, evidence-based information
Acetabular Fracture: Retrospective Analysis of Thirty Three Consecutive Cases with Operative Management
(Kathmandu University, 2014) Shrestha, D; Dhoju, D; Shrestha, R; Sharma, V
ABSTRACT Background With the development of better imaging modalities including 3D CT scan and availability of technical expertise, operative management is increasingly performed for acetabular fracture but many patients in developing countries like Nepal, are still being treated with prolonged skeletal traction. Objective To analyses epidemiology, types of acetabular fracture and functional and radiological outcome of patients with acetabular fracture treated with open reduction and internal fixation (ORIF). Method Inpatients hospital records of patients treated with ORIF in between June 2007 to June 2014 were evaluated. Patient’s demographic data, mode of injury, injury hospital interval, injury surgery interval, associated injuries, surgical approach, total hospital stay and peri and post-operative complications were recorded and radiological and functional outcomes were evaluated. Result Thirty three patients (Male: 24 Female: 9) with average age 39 years (range: 21 to 65 years) were operated for acetabular fracture. Twenty one patients (63%) had injury related with motor vehicle accidents and nine (24%) of them had motorbike accidents. Injury hospital interval ranges from 7 to 36 days. Average injury-surgery interval was 21 days and average hospital stay was 22 days. Bicolumnar fractures were found in 15. Nine patients had dislocation of hip and 15 had concomitant other injuries. Biculumanr fixation was performed in 15 patients, posterior column and or wall in nine with Kocher Langenbeck approach and anterior column and or wall in other nine with ilio-inguinal approach. Radiological reduction was anatomical in 18; excellent/good functional outcome was in 26 and radiological outcomes were excellent in 14. Three patients had developed Hypertopic ossification. Follow up period ranged from 6 to 48 months and 15 patients (45%) had follow up >2 years. Conclusion Acetabular fractur can be effectively managed with ORIF and have predictable and comparable functional and radiographic outcomes. Upgrading the existing facilities and training of orthopedic surgeon for acetabular fracture management is important to shorten injury-surgery interval due to lack of such facilities. KEY WORDS Acetabulum, internal fixation, open reduction
Adenomyosis at Hysterectomy: Prevalence, Patient Characteristics, Clinical Profile and Histopatholgical Findings
(Kathmandu University, 2012) Shrestha, A; Shrestha, R; Sedhai, LB; Pandit, U
ABSTRACT Background Underlying adenomyosis is often the cause of treatment failure for patients undergoing medical therapy for abnormal uterine bleeding and or chronic pelvic pain. Given the limitation of ultrasonography in diagnosing adenomyosis and MRI being unaffordable to most of the patients belonging to developing countries like us, it often remains undiagnosed before a hysterectomy. Objective To find out the clinical profile associated with adenomyosis and to determine the prevalence of adenomyosis in hysterectomy specimens; frequency distribution, as well as to correlate clinical examination with histopathological examination. Methods A total of 60 women who had undergone hysterectomy with histopathologically proven adenomyosis between April 2009 and March 2010 were included . Data were collected on indication for the intervention, age, symptoms, clinical findings, hemoglobin, menopausal status, gross and histopathological findings. Results A total of 256 women were scheduled for hysterectomy. Adenomyosis was diagnosed in 60 of 256 cases (23.4%). Menorrhagia (91.2%), dysmenorrhoea (84.2%), lower abdominal pain (84.2%) beginning later in reproductive life (mean age- 45yrs) is the classic presentation. Adenomyosis was present in 10 of 61 patients (16.3%) with fibroids; 27 of 60 (45%) with abnormal uterine bleeding; 11 of 55 (20%) with prolapse; four of 35 (11.4%) with ovarian mass; five of 25 (20%) with chronic pelvic pain; three of four (75%) with endometriosis. Conclusion Women undergoing hysterectomy with diagnosis of adenomyosis have a distinct symptomatology. The choice of therapy in adenomyosis is hysterectomy for those women who have completed family and had failed medical therapy . KEY WORDS adenomyosis, hysterectomy, prevalence
Age and Gender Differences in COVID 19 Morbidity and Mortality in Nepal
(Kathmandu University, 2020) Dhimal, ML; Rana, N; Aryal, B; Adhikari, SK; Shrestha, R; Gyanwali, P; Dhimal, M
ABSTRACT Background The global health community has emphasized the importance of reporting epidemiological data by age and sex groups in the COVID-19 pandemic. However, age and sex disaggregated data of COVID-19 cases and deaths are rarely reported. Such data are very crucial for public to make truly informed choices about their own diseases risk and also for governments for public policy response. Objective To assess age and gender difference among COVID-19 cases and deaths in Nepal. Method This is a retrospective study which uses public data on COVID-19 cases and deaths released by Ministry of Health and Population, Government of Nepal from January to November, 2020. The data analysis was carried out using SPPS software version 26. Result Nepal reported 233,452 confirmed cases and 1,566 deaths of COVID-19 from 23 January 2020 to 30 November 2020. We found statistically significant differences on COVID-19 cases by age and gender in Nepal with higher number of cases among males of economically active age groups (20-60 years). Similarly, we found significant difference in COVID-19 mortality with more death occurred among male group compared to female group and with highest number of deaths among the people of above 60 years. Furthermore, we found differences in cases and deaths among provinces. Conclusion The age and gender differences in COVID cases and deaths in Nepal indicates needs of considering age and sex groups seriously while planning for testing, case management and vaccination against COVID-19 infections in Nepal. KEY WORDS Age, COVID-19, Gender, Nepal
Analysis of Antimicrobial Drugs Usage Pattern and it’s Cost Analysis in the Pediatric Department of a Tertiary Care Hospital
(Kathmandu University, 2020) Shrestha, R; Koju, P; Silwal, S; Karmacharya, BM; Shakya Shrestha, S
ABSTRACT Background Antimicrobials agents are the most widely and often imprudently used therapeutic drugs globally. The pediatric population comprises 20-25% of the total world population, and various acute and chronic diseases are prone to this group. It is also estimated that 50% to 85% of children are prescribed with antimicrobials in developed and developing countries. The misuse of antimicrobials not only contributes not only to the development of antimicrobial resistance but also results in economic burden on the health care system. Objective To analyze the antimicrobial usage and its cost analysis in the Pediatric department of a tertiary care hospital at sub-urban area. Method A hospital based retrospective study was conducted among patient (aged 1 to 18 years) admitted in pediatric ward and intensive care unit for at least 24 hours and dispensed at least one antimicrobial drug from January 2018 to December 2019. Data were collected from electronic medical record using a structured data collection form. The data was entered and analyzed using Microsoft Excel. A descriptive analysis was presented as mean ± (standard deviation) for the continuous variables and frequencies and proportions for categorical variables. Result Among the 1,281 patients, the antimicrobials were prescribed mostly in the respiratory tract infection (39.6%), followed by sepsis (19.75%), enteric fever (11.94%), seizure (10.07%), urinary tract infection (4.29%). Penicillins (1238 times) were highly prescribed followed by Cephalosporin (733 times), Nitro-imidazole (292 times), Aminoglycosides (180 times) and Fluoroquinolones (144 times). During study period in the Pediatric Department, approximately NRs. 1,619,121.11 was spent in the antimicrobial drugs and the highest expenditure was found to be in the Cephalosporin group of antimicrobials (NRs. 530,988.6), followed by Penicillin group of drug (NRs. 3,81,842.2). Conclusion The study concludes that the Penicillin groups of drugs were the most commonly prescribed drug and the highest cost was found to be in Cephalosporin group drugs followed by Penicillin group of drugs. KEY WORDS Antimicrobial drugs, Antimicrobial usage pattern, Cost analysis, Tertiary care hospital
Analysis of Factors Associated with Thyroid Dysfunction: A Hospital Based Study
(Kathmandu University, 2019) Risal, P; Adhikari, B; Shrestha, R; Manandhar, S; Bhatt, RD; Hada, M
ABSTRACT Background Thyroid dysfunction (TD) is one of the major public health concerns in Nepal. This study intends to identify factors in association with thyroid dysfunction and its hospital based prevalence. Objective To determine hospital-based prevalence of thyroid dysfunction and to identify and analyze factors in association with thyroid dysfunction. Method A retroprospective cross-sectional study was conducted among patients attending Dhulikhel Hospital-Kathmandu University Hospital (DH,KUH) from January to December, 2015 with prospective part carried out from July to December 2015 in the patients visiting Dhulikhel hospital for health check-up and requested for Thyroid Function Tests (TFTs). Thyroid Function Tests of 1530 subjects were performed in the biochemistry laboratory and semi-structured questionnaire were introduced to 312 participants with convenient sampling method and their anthropometric measurements were taken. Chi-square test, Pearson’s correlation and student-t test were used as a measure to analyze factors. Result Out of total 1530 subjects, 35.3% were having thyroid dysfunction with the prevalence of overt hyperthyroidism, subclinical hyperthyroidism, overt hypothyroidism and subclinical hypothyroidism to be 2.5%, 2.4%, 5.6% and 24.8% respectively. The distribution of thyroid dysfunction was preponderant among females and among older age. The prevalence of thyroid dysfunction was highest among Terai/Madhesi (40.0%) and lowest among Newars (28.5%) with higher fraction of hypothyroidism in each ethnic group. There were significant correlation between Thyroid Stimulating Hormone (TSH) with waist-hip ratio (p<0.05) and weight (kg) with free thyroxine (fT4) (p<0.05). Direct pesticide exposure (p<0.05) was significantly associated with hypothyroidism. The serum fT4 was significantly different (p<0.05) among vegetarian and non-vegetarian whereas TSH and free triiodothyronine (fT3) were not significantly different. Smoking, alcoholism, dietary food habits, diabetes and hypertension were not significantly associated with thyroid dysfunction. Conclusion Thyroid dysfunction was highly prevalent among participants with higher proportion of subclinical hypothyroidism. Besides, direct pesticide exposure found to be factor in association with hypothyroidism, this study could not find significance relation with other established risk factors. KEY WORDS Hyperthyroidism, Hypothyroidism, Thyroid dysfunction, Thyroid function test
Antibiotic Usage and its Sensitivity Pattern in the NICU
(Kathmandu University, 2012) Shrestha, R; Shrestha, JM; Gurung, B
ABSTRACT Background Sepsis is a major cause of mortality and morbidity in newborns affecting both developed and developing countries accounting a quarter around one million deaths per annum. Objective This study was aimed to assess the prevalence of neonatal sepsis, culture isolates, pattern, antibiotic sensitivity and drug prescribing pattern. Methods In present prospective study, 48 neonates admitted in pediatric ward from January to March 2011 of Dhulikhel Hospital were included. The gestation age, onset of sepsis, culture isolates, antibiotic sensitivity pattern and drug prescribing pattern were studied. Environmental air sampling of NICU (Neonatal Intensive Care Unit) was done by settle plate method for microbial examination. Result Among 48 neonates, 23 (47.92%) neonates were culture positive with predominant isolates of Klebsiella oxytoca 11(47.83%), Pseudomonas spp. 4(17.39%), Methicillin Resistant Staphylococcus Aureus (MRSA) 3(13.04%) and single case of Enterobacter spp. In environmental samples, K. oxytoca and Enterobacter spp. were isolated. Amikacin, Imepeneum and Ciprofloxacin were sensitive whereas Ampicillin in combination with Cloxacillin, Ampicillin, Aztreonam were resistant for Klebsiella. oxytoca. Amikacin, Ceftazidime and Imipenuem are sensitive to Enterobacter spp. The single or combinations of resistant antibiotics were found to be prescribed. Conclusion The emerging antibiotic resistances among the culture isolates and coherence with environmental samples were observed. Hence, special measures are imperative for reducing environmental contamination and the rational usage of antibiotics for preventing the infection and emerging antibiotic resistance. The study recommends need of the antibiotic policy to curb the present scenario. KEY WORDS Antibiotic Sensitivity, Neonatal sepsis, NICU
Anxiety, Depression and Functional Impairment among Health Care Workers during COVID-19 Pandemic: A Cross- sectional Online Survey
(Kathmandu University, 2021) Shrestha, R; Khatri, B; Adhikari, S; Poudyal, P
ABSTRACT Background COVID-19 is an infectious disease caused by a newly discovered coronavirus. The number of cases and dramatic loss of human life worldwide created psychological problems among general public, including health care workers. Objective To determine the burden of anxiety, depression, and functional impairment among health care workers in the early days of lockdown during the first wave of COVID-19 outbreak in Nepal. Method A hospital-based cross-sectional study was carried out among all the employees of Hospital for Children Eye ENT and Rehabilitation Services, Bhaktapur during the COVID-19 pandemic lockdown from April 3, 2020 to May 2, 2020 using an online questionnaire. The tools used were adopted from Nepali version of Hospital Anxiety and Depression scale (HADS) and Nepali version of WHO Disability Assessment Schedule (WHODAS 2.0). Result The mean age (SD) of the participants (n=86) was 32.53 (7.92) years. Male and female participants were equal in number. The point prevalence of anxiety and depression was 25.6% and 14.0%, respectively. Females had a higher prevalence of both anxiety (39.5% vs 11.6%, p < 0.01) and depression (18.6% vs 9.3%, p=0.351). Clinical and non- clinical staff both had a higher prevalence of both anxiety (31.0% and 20.5%, p=0.265) and depression (16.7% and 11.4%, p=0.478). The mean functional impairment score (WHODAS 2.0) among all participants and participants with anxiety and depression was 19.47 (95% CI: 18.13-20.80), 21.27 (95% CI: 18.08-24.46), and 19.92 (95% CI: 15.28- 24.56), respectively. Conclusion Anxiety and depression during the first lockdown due to COVID-19 pandemic were highly prevalent in clinical and non-clinical employees. Besides controlling the outbreak, special consideration should be given to mental health. KEY WORDS Anxiety, COVID-19, Depression, Functional impairment, Health care workers, Online survey
Application of hAMRonization Tool in Investigating Anti-microbial Resistance Genes to Generate Harmonized Reports
(Kathmandu University, 2023) Katuwal, N; Tamrakar, D; Shrestha, R
ABSTRACT Background Antimicrobial resistance has become a serious threat to global public health, with the potential to cause significant morbidity and mortality. Therefore, the detection and surveillance of antimicrobial resistance genes are critical to monitor the prevalence of resistance and to guide appropriate treatment decisions. Several bioinformatics tools have been developed to facilitate the detection and investigation of antimicrobial resistance genes from sequencing data. However, these tools often require a significant amount of manual curation and provide results which can limit their intra-operability, accessibility and usability. This lack of standardization in the reporting of antimicrobial resistance genes investigation greatly hinders the comparison of results across the public health sector. Method This study focuses on the application of hAMRonize tool developed by Public Health Alliance for Genomic Epidemiology. In this study, we have implemented hAMRonization to evaluate antimicrobial resistance genes in Salmonella and compared to the results from other tools (ARIBA, RGI, amrfinderplus and abricate). Result We observed that hAMRonize was more comprehensive than other tools in predicting genes, including information on antimicrobials, drug classes, and start and end base pair of genes, among others. The hAMRonize tool also provided results in an interactive Hypertext Markup Language format. Conclusion hAMRonization is an innovative tool for investigating and sharing antimicrobial resistance data in the current field of research, where scientists use a plethora of prediction tools that provide different results and subsequent interpretations. KEY WORDS Antimicrobial resistance, Gene-prediction, hAMRonize
Arthroscopic Debridement for Mucoid Degeneration of Anterior Cruciate Ligament - A Single Institution Experience from Nepal
(Kathmandu University, 2023) Shrestha, R; Khadka, SK; Maharjan, S; Basi, A; Dahal, A; Chaudhary, A; Acharya, SP; Malla, M
ABSTRACT Background Mucoid degeneration of anterior cruciate ligament is characterized by infiltration of mucoid-like material scattered throughout the anterior cruciate ligament substance. It is an uncommon condition, but previously, underdiagnosed or often misdiagnosed as an anterior cruciate ligament tear. Objective To present our early experiences with mucoid degeneration of anterior cruciate ligament in last five years in terms of clinical presentation and the outcomes of arthroscopic management. Method This was a retrospective descriptive cross-sectional study on patient who received arthroscopic debridement for mucoid degeneration of anterior cruciate ligament in Dhulikhel Hospital over five years period (2017 May to 2022 April). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale that has been translated and validated to be used in local (Nepali) language and context was used for evaluation of outcome evaluation. Result Twenty-one patients of mean age 44.21 years, predominantly females (18), were managed in five years period. The mean Western Ontario and McMaster Universities Osteoarthritis Index score was 16.33±10.47 with a range of 0 to 36 (11.57 to 21.09 at 95% confidence interval). The mean Western Ontario and McMaster Universities Osteoarthritis Index score converted on a scale of 0 to 100 was 17. Thirteen patients had isolated Mucoid degeneration of anterior cruciate ligament whereas nine others had associated either meniscal tear or chondral lesions. Conclusion Mucoid degeneration of anterior cruciate ligament could be a cause of knee pain in middle-aged patients and arthroscopic debridement can improve the patient’s symptoms and provide a good functional outcome. KEY WORDS Anterior cruciate ligament, Arthroscopy, Debridement, Mucoid degeneration, WOMAC
Assessing Spectrum of Fractures in Elderly; Perspective on Tertiary Care Hospital of Nepal
(Kathmandu University, 2023) Parajuli, B; Sharma, R; Kayastha, SR; Thapa, J; Shrestha, R; Shrestha, D
ABSTRACT Background There is an increasing life expectancy and a surging elderly population in the last few decades, leading to a higher incidence of fractures in the elderly. The health care of the elderly in Nepal is below par and there are no studies done to evaluate the spectrum of fractures in the elderly. Objective To evaluate the demographical and epidemiological aspects of fractures in the elderly (≥ 65 years) presenting to a tertiary care hospital in Nepal in a 15 years’ timeline. Method This study was a retrospective epidemiological study conducted in the Department of Orthopedics, Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH), Nepal. The patients of age ≥ 65 years having traumatic injuries, admitted in the orthopedics ward from 2006 January to 2020 December were included. Patient demographics, site of injury, fracture incidence, mechanism of injury, hospital stay duration, and mode of treatment (surgical/ conservative) were evaluated. Result Of the 787 patients with an average age of 73.65 ± 7.5 years, 54% were females. Peritrochanteric fracture was the most common fracture (29.4%) followed by spine (18.3%). The most common mechanism of injury was fall on the labeled ground (38.6%). The incidence of fragility fractures (peri-trochanteric, proximal humerus, spine, and distal radius) was increasing with age. Conclusion Females, peritrochantric fractures, and trivial trauma are the most common occurrences for fractures in elderly. The incidence of fragility fractures is increasing with age but the overall incidence of fractures compared to other studies is low. Higher incidences of road traffic accidents (RTA) and compound fractures among the elderly are serious public health concerns that highlight the importance of primary preventive measures. KEY WORDS Elderly, Fracture, Incidence, Nepal
Assessment of Post Graduate Medical Students in Nepal: Is it time to introspect?
(Kathmandu University, 2014) Shrestha, D; Shrestha, R
NA
Assessment of Range of Motion of Temporomandibular Joint among Dental Students of Dhulikhel Hospital
(Kathmandu University, 2024) Luitel, A; Bali, H; Gautam, P; Shrestha, R; Singh, N; Gurung, K
ABSTRACT Background Restriction in mandibular range of motion (ROM) is one of the main signs of mandibular dysfunction and an important criterion for evaluation of functional state of the masticatory system. Objective The objective of this study was to evaluate the normal ROM of Temporomandibular Joint (TMJ) among dental students of tertiary care hospital at central region of Nepal. Method After ethical clearance, cross- sectional study was conducted between August to September 2022 among all dental students who gave consent. The inter-incisal opening, bilateral lateral excursion and protrusion were measured thrice using 15 cm metallic scale and an average was considered to reduce ambiguity. The data was entered in Microsoft excel and transferred to SPSS version 20 for statistical analysis. The descriptive statistics was calculated and independent t test was applied to compare the mean between genders. Result Total of 145 students (25 males and 120 females) were included with the mean age of 21.32 ± 1.29 years. The overall mean inter-incisal opening was 44.82 ± 5.80 mm, right lateral excursion was 8.23 ± 2.11 mm, left lateral excursion was 8.70 ± 1.80 mm and protrusion was 5.65 ± 1.87 mm. There was statistically significant difference in right and left lateral excursion and protrusion among genders. Conclusion The inter-incisal opening of participants in our study appeared towards lower range of normal mouth opening while lateral excursion appeared consistent with those described in the literature. The protrusive movement of our participants was decreased, compared to those recorded in the literature. KEY WORDS Inter-incisal opening, Lateral excursion, Protrusion, Temporomandibular joint
Bedside Ultrasound in the Emergency Department to Detect Hydronephrosis for the Evaluation of Suspected Ureteric Colic
(Kathmandu University, 2016) Shrestha, R; Shakya, RM; Khan, A
ABSTRACT Background Renal colic is a common emergency department presentation. Hydronephrosis is indirect sign of urinary obstruction which may be due to obstructing ureteric calculus and can be detected easily by bedside ultrasound with minimal training. Objective To compare the accuracy of detection of hydronephrosis performed by the emergency physician with that of radiologist’s in suspected renal colic cases. Method This was a prospective observational study performed over a period of 6 months. Patients >8 years with provisional diagnosis of renal colic with both the bedside ultrasound and the formal ultrasound performed were included. Presence of hydronephrosis in both ultrasounds and size and location of ureteric stone if present in formal ultrasound was recorded. The accuracy of the emergency physician detection of hydronephrosis was determined using the scan reported by the radiologists as the “gold standard” as computed tomography was unavailable. Statistical analysis was executed using SPSS 17.0. Result Among the 111 included patients, 56.7% had ureteric stone detected in formal ultrasound. The overall sensitivity, specificity, positive predictive value and negative predictive value of bedside ultrasound performed by emergency physician for detection of hydronephrosis with that of formal ultrasound performed by radiologist was 90.8%., 78.3%, 85.5% and 85.7% respectively. Bedside ultrasound and formal ultrasound both detected hydronephrosis more often in patients with larger stones and the difference was statistically significant (p=.000). Conclusion Bedside ultrasound can be potentially used as an important tool in detecting clinically significant hydronephrosis in emergency to evaluate suspected ureteric colic. Focused training in ultrasound could greatly improve the emergency management of these patients. KEY WORDS Bedside ultrasound, hematuria, hydronephrosis, nephrolithiasis, renal colic, ureteric colic
Changing Profile of Herpes Zoster in Nepal: A Hospital-Based Study
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2009) Kayastha, BMM; Shrestha, Pallem; Shrestha, R; Lama, L
Abstract NA

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