Browsing by Author "Shrestha, Tirtha Man"
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Publication Clinical and Laboratory Characteristics of Patients with Mono and Coinfection of Dengue and Scrub typhus(Nepal Health Research Council, 2023) Banstola, Hemanta; Shrestha, Tirtha Man; Bhattarai, Dipesh; Ghimire, Manoj; Chhetri, Surendra BahadurAbstract Background: Dengue is a neglected tropical disease, and Scrub typhus is an emerging tropical illness in Nepal. Coinfection between them is found in literature and clinical practice. The objective of this study is to describe and compare the demographic, clinical, and laboratory characteristics of patients with mono and coinfection of Dengue and Scrub typhus. Methods: This was a single-center hospital-based retrospective study, performed at Beni District Hospital, Nepal. The patient who was diagnosed with mono and coinfection of Dengue and Scrub typhus from 1st January 2020 to 16th September 2020 were included. Data regarding demographic characteristics, symptoms, signs, and laboratory parameters were collected and analyzed. Results: In 53 patients who fall under the inclusion criteria of our study, 12 patients had coinfection with dengue and Scrub typhus with headache being the most common symptom regardless of mono or coinfection followed by myalgia and arthralgia. Total platelet counts at the time of admission were lower in the coinfection group with increasing thrombocytopenia during the disease course in comparison to mono-infection. The maximum temperature recorded, elevation in hepatic enzymes, and duration of defervescence were more in the coinfection group in comparison to dengue and scrub mono-infection. Conclusions: Mono and coinfection of Dengue, Scrub typhus present with common clinical symptoms, laboratory findings. With limited resources for screening and diagnosis, clinical prediction based on symptoms alone or together with lab parameters is difficult which is further difficult in the presence of Co-infection. Keywords: Clinical; coinfection; dengue; laboratory parameter; scrub typhusPublication Emergency Department Presentations of Chronic Kidney Disease in a Tertiary Hospital of Nepal: A Cross-sectional study(Nepal Medical Association, 2025) Neupane, Ram Prasad; Maharjan, Ramesh Kumar; Shrestha, Bipsana; Poudel, Bibek; Dandekhya, Rasmila; Shrestha, Tirtha Man; Chitrakar, Shasank; Dulal, Anga Raj; Malla, Arju; Silwal, Amisha; Karki, Sagun; Pokhrel, Manju; Thakur, Shubham Kumar; Panthee, Abhinandan; Jha, Sagar Kumar; Sah, Anish; Bhujel, BishnuAbstract Introduction: Progressive chronic kidney disease is associated with complications like hypertension, anemia, mineral bone disorder, metabolic acidosis and electrolyte disorders which lead to higher morbidity, mortality and poorer quality of life. Available estimates of chronic kidney disease cases and those receiving treatment suggests an existing gap in care. Therefore, this study aims to estimate the prevalence of chronic kidney disease and its complications in the emergency department of Tribhuvan University Teaching Hospital. Methods: A cross-sectional descriptive study was done. The participants were chronic kidney disease patients with complications visiting the Emergency Department of Maharajgunj Medical Campus. Census sampling technique was used to enroll all chronic kidney disease patients with complications meeting inclusion criteria, visiting the Emergency Department from 11th October 2023 to 19th September 2024. Ethical approval was obtained from the institutional review committee of the Institute of Medicine, Maharajgunj with the reference number 509(6-11)E2/081/082. Distribution check and descriptive analysis was done using STATA. Results: The prevalence of chronic kidney disease was found to be 2.5%. The most common complications were anemia 399 (53.69%) and hypertensive crisis 396 (53.29%). Least common complications among CKD patients was sepsis 8 (1.08%). Several other complications like arrhythmia, nephropathy, hypoglycemia, obstructive uropathy, pericardial effusion, urinary tract infection, effusion, pneumonia were observed in 50 (6.73%) of the CKD patients. Death as an outcome was reported in 9 (1.2%) of total patients. Conclusions: Chronic kidney disease proportion in emergency departments is high, with anemia and hypertension being common complications. Targeted interventions might include establishing hemodialysis units and increasing staff awareness.Publication Postpartum Cavernous Sinus Thrombosis Associated with Eclampsia and Gestational Diabetes Mellitus: A Case Report(Nepal Medical Association, 2025) Chitrakar, Shasank; Aryal, Saroj Babu; Shrestha, Tirtha ManAbstract Pregnancy is the pro-thrombotic state. The objective of this report is to highlight the rare occurance of postpartum cavernous sinus thrombosis associated with eclampsia and gestational diabetes mellitus, emphasizing its clinical presentation. A 25-year-old Muslim female came with the complaint of headache,post auricular and right parietal region on 8th day post-partum. She had a history of postpartum eclampsia and Gestational Diabetes Mellitus for which she was treated with magnesium sulfate and oral hypoglycaemic agents respectively. MRV showed a filling defect in right transverse sinus, sigmoid sinus, and internal jugular vein. She was then admitted to the ward and was treated with heparin and antibiotics. She was then discharged on oral rivaroxaban. As pregnancy is itself a state of hyper-coagulable state, there seems to be a significant thrombosis risk. Hence clinicians should be aware of the possible thrombotic disorder in the background of this vignette.