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

Browsing by Author "Shrestha, BL"

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A Comprehensive Approach to Juvenile Angiofibroma: Diagnosis, Staging, and Surgical Management
(Kathmandu University, 2024) Shrestha, BL; Shrestha, P
ABSTRACT 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, Surgery
Addressing Pediatric Hearing Impairment in Nepal: A Critical Public Health Concern
(Kathmandu University, 2024) Shrestha, BL
NA
Analysis of Ear, Nose and Throat Foreign Bodies in Dhulikhel Hospital
(Kathmandu University, 2012) Shrestha, I; Shrestha, BL; Amatya, RCM
ABSTRACT Background Foreign body in ear nose and throat are commonly encountered by otolaryngologists, pediatricians and primary care physicians. Objective The aim of this study is to analyze different types of foreign bodies and socio- demographic correlates of self-inflicted foreign body insertion in ear–nose–throat. Method This was a two year hospital based cross sectional descriptive study performed in the Department of ear nose and throat (ENT), Dhulikhel Hospital - Kathmandu University from June 2009 to June 2011 after verification from the Institutional Review Committee. Using a predesigned questionnaire, socio-demographic data was collected prospectively by examining clinically all patients attending with foreign body and interviewing the caregivers of pediatric patients after removal of foreign body. The data collected from 312 patients was entered and analyzed by using descriptive and analytical statistical methods using SPSS version 16.0. Results The mean age was 21.26 years with majority between 0-10 years (50.6%). Male predominance was noted (58.97%). Most patients or caregivers were illiterate (35.1%) or literacy up to primary level(21.12%).Foreign body of the ear was found to be most frequent ( 47.4%) and mostly they were non-living (96.1%). Most patients presented late (80%) and had history of prior attempted removal (67%). Pearsons chi square test between education level and duration of time was significant (p value- 0.0000). One way ANOVA test between type of foreign body and age was significant (p value- 0.001). Conclusion Foreign bodies are common in adult and pediatric ear, nose and throat. They can potentially be associated with significant complications if not taken care of immediately. KEY WORDS Foreign body, inorganic, living, non- living, organic
Analysis of tracheobronchial foreign bodies
(Institute of Medicine, 2007) Adhikari, P; Shrestha, BL; Sinha, BK; Baskota, DK; Sharma, NR
Abstract Background: To analyze the type and site of tracheo-bronchial foreign bodies in patients admitted in the department of ENT-Head and Neck surgery (ENT-HNS) of TU Teaching Hospital. Methods: Medical records of 41 cases admitted in the department of ENT-HNS, TU Teaching Hospital, Kathmandu between April 2004 to October 2006 for the management of suspected foreign bodies in tracheobronchial tree were analysed retrospectively. It was found that rigid bronchoscopy was performed in all 41 cases and foreign bodies were removed from 36 cases. In the five cases where foreign body was not found, were excluded from the study. Results: There were 83.3% children and 16.6% adults. Most common type of foreign body found in children were vegetative (63.3%) where as in adults beetle nut (50.0%) and metallic foreign bodies (50.0%) were found. Majority of foreign body was found to be lodged in the right main bronchus (56.7%) in children. Whereas, in adults foreign bodies (66.7%) were found in the left main bronchus. Radiological confirmation of the foreign body could be made only in 8 cases (22.2%). All patients had an uneventful postoperative period except two (5.5%) who died during postoperative period after removal of foreign bodies from trachea. Conclusion: In children, foreign body is more common in right bronchus where as in adults it is more common in left bronchus. Only 22.2% foreign bodies could be seen in plain X-ray. In unresolved pneumonia high index of suspicion of foreign body in tracheobronchial tree must be made and diagnostic bronchoscopy should be performed. Keywords: Vegetative foreign body, metallic foreign body, rigid bronchoscopy
Angiomyolipoma of Nasal Cavity - A rare clinical entity
(Kathmandu University, 2024) Shrestha, KS; Shrestha, BL; Sapkota, B; Ghimire, SB; Shrestha, P
ABSTRACT 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, Histopathology
Artificial Intelligence in Medical Practice: The Promise and the Challenges
(Kathmandu University, 2023) Shrestha, BL
NA
Audiological Outcome of Endoscopic Stapedotomy in Nepalese population
(Kathmandu University, 2024) Subba Rai, S; Shrestha, BL; Pradhan, A
ABSTRACT Background Otosclerosis is a complex disease of otic capsule that mainly affects the stapes footplate causing conductive hearing loss, sometimes mixed hearing loss. Microscope stapes surgery was used traditionally but endoscopic stapedectomy has ushered a new revelation. Objective To report the audiological outcome of solely endoscopic trans canal stapedotomy surgery for otosclerosis in Nepalese population. Method This retrospective case series study analysed pre and post operative pure tone average of air conduction (AC) and bone conduction (BC) threshold and air bone gap (ABG) at 0.5, 1, 2 and 4 kHz. Postoperative ABG ≤ 10 dBHL (decibels hearing level) and ABG ≤ 20 dBHL was used to consider surgical success and improvement respectively. Paired t-test was used to test the significance of the audiological outcome of the study group pre and post operatively. Result The study included 9 patients, 10 operated ears with male to female ratio of 1:2. Mean age was 37.60 ± 9.28 years and mean postoperative air bone gap was 19.00 (± 5.89) and gain in air bone gap 18.75 (± 8.70) which was found to be statistically significant (p < 0.000). Audiological outcome in each of the four frequencies, 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz was also found to be statistically significant. Conclusion This limited series study concludes that because of its favourable audiological gain and closure of the air bone gap postoperatively and better intraoperative view, it can uplift other surgeons to choose this as preferred technique. KEY WORDS Audiological outcome, Endoscopic stapedotomy, Otosclerosis, Stapes surgery
Blood Splashes Risk During Otorhinolaryngology Surgery: A Tertiary Care Hospital Based Study
(Kathmandu University, 2018) Shrestha, BL; Dhakal, A; Karmacharya, S
ABSTRACT Background ENT (Ear, Nose and Throat) surgeons are particularly at high risk of exposure with blood and body fluid related infections both in Outpatient and during surgical procedures. They do take precaution to avoid the needle stick injuries but few pay attention on blood or body fluid splashes into eye. Objective To find out the risk of blood splashes to both surgeon and assistant during otorhinolaryngology surgeries. Method This was an descriptive study and data were collected prospectively in Department of Ear, Nose and Throat-Head and Neck Surgery of Dhulikhel Hospital, Kathmandu University Hospital in 1 year period from 1st January 2017 to 1st January 2018. All the surgical cases were included in the study. The surgeon and assistant wore the glass and mask during the surgery. At the end of the surgery, the glass, mask and gown were inspected for any blood splashes and information was recorded. Result There were total 272 patients with male 119 and female 153. The amount of blood splatter in glass, mask and gown is most common in modified radical mastoidectomy surgery. Likewise, the blood splatter is most common in tonsillectomy in throat surgery and in head and neck surgery, the blood splatter is common in all head and neck surgery. Conclusion The blood splashes is high in various Ear, Nose and Throat surgeries. So it is important to take precaution by surgeon and assistant, like protective mask and glass worn during surgeries to protect from various blood-borne infection transmissions. KEY WORDS Blood splashes, Glass, Gown, Mask, Surgery
Clinical Profile and Diagnosis of Obstructive Sleep Apnea Syndrome using Overnight Polysomnography in a Tertiary Care Hospital
(Kathmandu University, 2021) Pokharel, M; Shrestha, BL; Dhakal, A; Rajbhandari, P; Shrestha, KS; KC, AK; Bhattarai, A; Karki, DR
ABSTRACT Background Obstructive sleep apnea is a highly prevalent yet largely under-diagnosed disease that poses a significant burden on the healthcare system. Objective To determine the role of predictors for Obstructive sleep apnea syndrome and its severity in Nepalese population. Method Prospective and analytical study conducted in the Department of Otorhinolaryngology and Head and Neck surgery at Kathmandu University Hospital between March 2018 and June 2020. A total of 85 adult patients with Obstructive sleep apnea with an Epworth sleepiness score greater than 10 were included. Overnight polysomnography was done and scoring of sleep associated events were done according to the American Academy of Sleep Medicine criteria. Participants were classified as simple snoring and mild, moderate or severe Obstructive sleep apnea syndrome groups depending on the Apnea Hypopnea Index values. Relationship of Apnea hypopnea index was analyzed with age, neck circumference, body mass index and Epworth Sleepiness score. Result Simple snoring was seen in 18(21.17%) patients, 14(16.47%) had mild Obstructive sleep apnea, 13(15.29%) had moderate Obstructive sleep apnea, whereas the severe group consisted of 40(47.05%) patients. The minimum Epworth Sleepiness Score was 10 and the maximum was 25. The Apnea hypopnea index correlated positively with Body mass index (p=.010) and Epworth sleepiness score (p<.001). However, Apnea hypopnea index had no association with age (p=.437) and neck circumference (p=.118). Conclusion Health professionals need to be extremely vigilant while examining patients presenting with Obstructive Sleep Apnea. Polysomnography is the investigation of choice in the early identification of this treatable disease. KEY WORDS Apnea hypopnea index, Obstructive sleep apnea, Polysomnography
Clinicoradiologic Evaluation of Eagle’s Syndrome and its Management
(Kathmandu University, 2013) Pokharel, M; Karki, S; Shrestha, I; Shrestha, BL; Khanal, K; Amatya, RCM
ABSTRACT Background Eagle’s syndrome (Elongated styloid process) is often misdiagnosed due to its vague symptomatology. The diagnosis relies on detail history taking, palpation of styloid process in tonsillar fossa and imaging modalities. Objective To assess the length and medial angulation of elongated styloid process with the help of three dimensional computed tomography (3D CT) scan and to describe our clinical and surgical experience with patients suffering from Eagle’s syndrome. Method Prospective, analytical study conducted from August 2011 to August 2012 among 39 patients with Eagle’s syndrome. Detailed history taking, clinical examination and 3D CT scan was performed. Length and medial angulation was calculated. Patients with styloid process length longer than 2.50 cm underwent surgical excision via intraoral approach. Medial angulation of styloid process on both sides was correlated with each other using rank correlation coefficient. Wilcoxon Signed Rank test was applied to test significant difference between pre-operative and post- operative symptoms scores. Result Significant positive correlation was found between the medial angulation of styloid process on right side and left side (ρ =0.81, p<0.001). Significant difference was also observed between pre and post-operative symptoms scores (z=-5.16, p<0.001) . Conclusion Possibility of Eagle’s syndrome should always be considered while examining patients with vague neck pain. 3D CT reconstruction is a gold standard investigation which helps in studying the relation of styloid process with surrounding structures along with accurate measurement of its length and medial angulation. KEY WORDS Eagle’s syndrome, elongated styloid process, three dimensional computed tomography
Comparison of clinical presentation between Chronic Otitis Media Mucosal with Squamous.
(Kathmandu University, 2010) Shrestha, BL; Shrestha, I; Amatya, RC
ABSTRACT Background Chronic otitis media is a chronic inflammatory disease of the middle ear cleft which is manifested as deafness and ear discharge. It is a common condition affecting 0.5 – 30% of any community worldwide, and most common in developing countries. The prevalence mainly depends on age, low socio-economic status, overcrowding and limited medical facilities. Objective To compare the clinical presentation between chronic otitis media mucosal with squamous types. Methods A prospective, longitudinal and analytical study performed among 200 patients who have features of chronic otitis media and were attended to in the ear, nose and throat outpatient department of Dhulikhel Hospital - Kathmandu University Hospital, Dhulikhel, Nepal from January 2010 to January 2011. Patients who had already undergone surgery and came back to the hospital, with inadequate information were excluded from the study. Results The results showed that, out of 200 cases, 120 (60%) were chronic otitis media- mucosal and 80 (40%) were chronic otitis media – squamous. Patients < 30 years were affected in both groups. The male to female ratio in chronic otitis media mucosal was 1.14:1, whereas in chronic otitis media squamous, it was 1.96:1. Similarly in etiological factors, oil and water exposure (76%) was the most common cause in chronic otitis media mucosal, whereas in chronic otitis media squamous, oil and water exposure (62.5%) and recurrent upper respiratory tract infection (62.5%) were the most common causes. Of all the clinical features, ear discharge was the leading feature in both chronic otitis media mucosal (98%) and squamous (100%) cases. The complications were mainly seen in the chronic otitis media squamous and the most common complication was mastoid abscess (5%). Conclusions The frequency of chronic otitis media is higher in the younger age group and those lacking in health education. As a result, it is important to disseminate the health education regarding the ear disease which will help in decreasing the frequency of the disease in developing countries like ours. Key Words chronic otitis media, mastoid abscess, upper respiratory tract infection
Comparison of Hearing Result and Graft Uptake Rate between Temporalis Fascia and Tragal Cartilage in Endoscopic Myringoplasty
(Kathmandu University, 2022) Shrestha, BL; Shakya, S; Pradhan, A; Dhakal, A; KC, AK; Shrestha, KS; Pokharel, M
ABSTRACT Background There are different methods to repair the perforation of the tympanic membrane. Recently cartilage has been used for the repair and results are comparable to temporalis fascia. For surgical procedure endoscope had added good assistance in middle ear surgery. Though the one hand technique the image quality and results are on par with the use of a microscope. Objective To compare the graft uptake rate and hearing results between temporalis fascia and tragal cartilage in endoscopic myringoplasty. Method This is a prospective, longitudinal study conducted among 50 patients who underwent endoscopic myringoplasty using temporalis fascia and tragal cartilage with 25 patients in each group. The hearing was assessed by comparing pre with post-operative ABG (Air bone gap) and ABG closure in speech frequencies (500Hz, 1 KHz, 2 KHz, 4 KHz). The status of graft and hearing results was evaluated on 6 months of follow up in both the groups. Result Out of total 25 patients enrolled for study in both (temporalis fascia and cartilage) groups, 23 (92%) patients in each group had graft uptaken. The audiological gain in the temporalis fascia group was 11.37±0.32 dB whereas in the tragal cartilage group it was 14.56±1.22dB. The audiological gain between the two groups did not show any statistically significant (p = 0.765). However, the pre and post-operative hearing difference was statistically significant in both temporalis fascia and tragal cartilage group. Conclusion Tragal cartilage has similar graft uptake rate and hearing gain when compared with temporalis fascia in endoscopic myringoplasty. Hence, tragal cartilage can be used for myringoplasty whenever required without any fear of deterioration in hearing. KEY WORDS Air bone gap, Endoscopic myringoplasty, Temporalis fascia, Tragal cartilage
Comparison of hearing results between the averages of three and four speech frequencies in Type 3 Tympanoplasty
(Institute of Medicine, 2011) Shrestha, BL; Gurung, U; Bhattarai, H
Abstract Introduction: Hearing assessment after tympanoplasty is done by taking pure tone average. This study was performed to compare the hearing results obtained from the averages of three and four speech frequencies namely 0.5, 1,2KHz and 0.5,1,2,4 KHz in type III tympanoplasty. Methods: This study was conducted in Tribhuwan university teaching hospital and Kathmandu university hospital, Dhulikhel from October 2006 to November 2009. The pure tone audiogram was performed by Hugson and Westlake method. The audiometry results were reported as per American Academy of Otolaryngology – Head and Neck surgery guidelines. The comparison between the averages of 3 and 4 speech frequencies that are 0.5, 1,2KHz and 0.5,1,2,4 KHz were performed with regard to bone conduction threshold(BCT), air conduction threshold(ACT),air bone gap (ABG) and air bone gap closure. Data analysis was performed using SPSS 13 software. Results: Comparison between the averages of 3 and 4 speech frequencies between the preoperative BCT and ACT showed difference of 1.5dB and 0.8dB which were statistically significant whereas the difference in ABG was 1dB which was statistically not significant. Similarly post-operative BCT, ACT, ABG showed the difference of 0.3dB, 0.5dB and 0.2dB respectively which were also statistically not significant. Conclusions: The difference between 3 and 4 speech frequencies averages are small and are statistically not significant but it is still worth to include 4 KHz as this is a high frequency which is likely to be affected by tympanoplsty. Keywords: tympanoplasty, bone conduction threshold, air conduction threshold, air bone gap
Comparison of Ketamine, Fentanyl and Clonidine as an Adjuvant During Bupivacaine Caudal Anaesthesia in Paediatric Patients
(Kathmandu University, 2012) Singh, J; Shah, RS; Vaidya, N; Mahato, PK; Shrestha, S; Shrestha, BL
ABSTRACT Background Caudal epidural analgesia with bupivacaine is very popular in paediatric anaesthesia for providing intra- and postoperative analgesia. Several adjuvants have been used to prolong the action of bupivacaine. Objectives To compare the efficacy of ketamine, fentanyl and clonidine in terms of quality and duration of analgesia they produce when added with caudal bupivacaine by single shot technique in children. Methods Eighty children, age one to ten years, undergoing sub-umbilical surgery, were prospectively randomized to one of four groups: caudal analgesia with 0.75 ml/ kg of 0.25% bupivacaine in normal saline (Group B) or caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine with 1 μg/kg of clonidine in normal saline (Group BC) or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with ketamine 0.5mg/kg (Group BK) or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with fentanyl 1mcg/kg (Group BF). Post-operative pain was assessed for 24 hours using the FLACC scale. Results The mean duration of analgesia was significantly longer in Group BC (629.06 ± 286.32 min) than other three groups P < 0.05. The pain score assessed using FLACC scale was compared between the four groups, and children in Group BC had lower pain scores, which was statistically significant. The requirement of rescue medicine was lesser in Group BC. Clonidine in a dose of 1 μg/kg added to 0.25% bupivacaine for caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia of bupivacaine, without any side effects in compare to fentanyl or ketamine. Conclusion We conclude that clonidine in a dose of 1 μg/kg, added to 0.25% bupivacaine for caudal analgesia and administered as a 0.75 ml/kg mixture in children, for sub- umbilical surgery, significantly prolongs the duration of post-operative analgesia when compared to 0.75 ml/kg of 0.25% bupivacaine in normal saline than 0.75 ml/kg of 0.25% bupivacaine with ketamine 0.5 mg/kg or 0.75 ml/kg of 0.25% bupivacaine with fentanyl 1 mcg/kg or 0.75 ml/kg of 0.25% bupivacaine alone, without any side effects. KEY WORDS Bupivacaine, caudal analgesia, clonidine, fentanyl, ketamine, post-operative analgesia, sub-umbilical surgery
Comparison of Surgical Outcome of Bipolar Scissors with Conventional Cold Dissection Tonsillectomy
(Kathmandu University, 2023) Shrestha, BL; Khadka, L; KC, AK; Dhakal, A; Shrestha, KS; Pokharel, M
ABSTRACT Background The tonsillectomy is the most common Ear, Nose, and Throat (ENT) surgical procedure. Different methods have been used to improve the outcome of the surgery. One such method is tonsillectomy performed with bipolar scissors. In our scenario, the comparison of bipolar scissors tonsillectomy with conventional cold dissection has not been done. Objective To compare the surgical outcomes of bipolar scissors tonsillectomy and conventional cold dissection tonsillectomy. Method A prospective randomized study was conducted in 40 patients who underwent tonsillectomy on one side using bipolar scissors and on the other side using conventional cold dissection. Intraoperative blood loss, operation time, postoperative pain, and postoperative hemorrhage were all analyzed in both surgical techniques. Result The median operative time was 10 minutes for bipolar scissors compared with 12 minutes for conventional cold dissection, with a p-value of 0.390 which was not statistically significant. The median blood loss was 48 mL on the bipolar scissors side and 60 mL on the conventional cold dissection side, with a p-value of 0.232 which was also not statistically significant. The overall postoperative hemorrhage rate was 12.5%. Of these, 4 (10%) occurred on the bipolar scissors side (left side mainly) and 1 (2.5%) on the conventional cold dissection side (also left side), with a p-value of 0.002 which was statistically significant. There was no statistically significant difference in the pain scores between the two methods in both rest and swallowing (p > 0.05). Conclusion The bipolar scissors did not show any benefit over conventional cold dissection in terms of surgical time, intraoperative blood loss, or postoperative pain. However, postoperative hemorrhage was more common with bipolar scissors. Therefore, conventional cold dissection remains a safe technique for tonsillectomy in adult patients. KEY WORDS Intraoperative blood loss, Operation time, Postoperative hemorrhage, Postoperative pain
Correlations Between Symptoms, Nasal Endoscopy Computed Tomography and Surgical Findings in Patients with Chronic Rhinosinusitis
(Kathmandu University, 2013) Pokharel, M; Karki, S; Shrestha, BL; Shrestha, I; Amatya, RCM
ABSTRACT Background Although Chronic rhinosinusitis (CRS) is increasing in prevalence and incidence, its diagnosis and treatment still pose a challenge. The Task Force on rhinosinusitis (TFR) advocates the use of symptom based criteria. However, many otorhinolaryngologists depend on diagnostic nasal endoscopy and computed tomography(CT) of paranasal sinuses for diagnosis of CRS. Computed tomography has been extensively relied upon in confirming the presence of CRS, in assessing severity of disease, surgical planning and management decisions. Despite its widespread use, several studies have failed to correlate findings on CT with symptom severity. Objective To determine the correlations between symptoms described at presentation, radiological findings, endoscopy and extensiveness of surgery. Methods Longitudinal, prospective, analytical study conducted from August 2011 to August 2012 among 87 patients diagnosed as CRS according to the TFR criteria. Symptom, endoscopic, radiological and surgical scoring was done by using Lund and Mackay staging system. Pearson correlation coefficients between scores for symptoms, endoscopy, sinus CT and surgery was determined. Results When overall symptom score was correlated with radiological score and endoscopy score, it was found to be statistically significant (p= <0.01). However, no significant relationship was found between Lund and Mackay symptom and surgery score. Conclusion The symptom criteria used by TFR for CRS diagnosis are not very specific for sinus disease. A detail assessment of the subjective and objective criteria (CT and endoscopy) is necessary for tailoring surgical plan but should not be relied upon for determining the extensiveness of surgical intervention. KEY WORDS Chronic rhinosinusitis, lund and mackay staging system, task force on rhinosinusitis
Dhulikhel Hospital Checklist Protocol for Temporal Bone Computed Tomography Scan Analysis: How We Do It?
(Kathmandu University, 2022) Shrestha, BL; KC, AK; Karmacharya, S
ABSTRACT The temporal bone is very complicated anatomical structure. Any disease process within this structure mandates thorough anatomical knowledge of the corresponding structure. The High resolution computed tomography (HRCT) temporal bone is the best way to look inside this complex bone. The importance of knowledge about how to read and look inside the CT scan temporal bone lead us develop the Dhulikhel Hospital Check list protocol. This protocol will help aspiring otologist and otolaryngologist to read and know details about the underlying structures. KEY WORDS High resolution computed tomography, Otologist, Temporal bone
Does the Preoperative Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio Associate with Clinic-pathological Characteristics in Papillary Carcinoma of Thyroid
(Kathmandu University, 2021) Shrestha, BL; KC, AK; Rajbhandari, P; Dhakal, A; Shrestha, KS
ABSTRACT Background Thyroid cancer is associated with local and systemic inflammatory activities. Many systemic inflammatory markers including the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) had shown credible and independent prognostic biomarkers in different malignant conditions. These markers are easy to reproduce, measure and inexpensive also. So, the preoperative evaluation of NLR and PLR is helpful in evaluating tumor growth and prognosis of papillary carcinoma of thyroid. Objective To evaluate the association of pre-operative NLR and PLR with clinic-pathological characteristic in papillary carcinoma of thyroid. Method This was a retrospective study performed in thirty one patients with the diagnosis of papillary carcinoma of thyroid. Preoperative NLR and PLR values were correlated with the clinical parameters like age, gender, lymph node metastasis, tumor size and pathological features (e.g., multifocality, bilaterality, extrathyroidal spread). Result There were thirty one patients, amongst which 13 were male and 18 were female. Similarly, the age distribution ranges from 27-68 years. The value of NLR was 2.37±1.09, and the value of PLR was 96.69±49.53.The increase in NLR was associated with increase in tumor size with statistically significant results. Similarly, increase in PLR was associated with increase in tumor size and multifocality with statistically significant results. Conclusion Increase NLR and PLR is associated with lymph node metastasis, extra thyroidal extension, multifocality of tumor and also bilaterality, so the risk can be stratified beforehand with measurement of NLR and PLR. KEY WORDS Lymph node metastasis, Neutrophil-to-lymphocyte ratio, Papillary carcinoma of thyroid, Platelet-to-lymphocyte ratio
Efficacy of Budesonide Nasal Irrigation in Comparison to Normal Saline Irrigation in Post-Operative Management of Functional Endoscopic Sinus Surgery
(Kathmandu University, 2025) Shrestha, BL; Sijapati, D; Dhakal, A
ABSTRACT Background Nasal irrigation with normal saline and topical steroid spray forms the mainstay of treatment in post endoscopic sinus surgery patients. However nasal sprays may not deliver optimum dosage of drug to the paranasal sinus mucosa. Budesonide nasal irrigation solves this problem by delivering drugs in a high-volume high-pressure system. Objective The main objectiveof this study will provide insight into the efficacy of budesonide nasal irrigation following functional endoscopic sinus surgery (FESS) surgery and will help to establish new protocols in future. Method Forty-four patients were included and divided into 2 groups of 22 each. One arm received normal saline nasal irrigation and the other arm received budesonide nasal irrigation (1 mg in 500 ml) twice daily. Patients were followed up at 1st post-operative week and 10th post-operative week and on each visit Sino-Nasal Outcome Test (SNOT) 22 and Lund Kennedy Endoscopic scores (LKES) were assessed. Result The mean scores in the first visit was SNOT 22 : 15.73 + 8.897 vs 12.73 + 16.110 (p < 0.05) and LKES : 2.82 + 1.097 vs 1.77 + 1.52 (p > 0.05) in the saline and budesonide groups respectively. The mean scores in the second visit was SNOT 22 : 7.09+3.87 vs 3.73 + 8.70 (p < 0.05) and LKES : 1.64 + 0.790 vs 0.18 + 0.501 (p < 0.05) in the saline and budesonide groups respectively. Thus the budesonide arm had statistically significantly better scores when compared to the normal saline group. Conclusion Budesonide nasal irrigation with a positive pressure high volume device was found to have better efficacy when compared to normal saline irrigation. Budesonide nasal irrigation may be used in the post-operative management of endoscopic sinus surgery patients. KEY WORDS Budesonide, Endoscopic surgical procedure, LKES, Nasal irrigation, SNOT 22
Endoscopic Ear Surgery in Dhulikhel Hospital: A decade of Experience
(Kathmandu University, 2022) Shrestha, BL
ABSTRACT Endoscopic ear surgery is one of the most commonly performed surgeries in Dhulikhel hospital. In the past eleven years, there have been different endoscopic ear surgeries performed with a very good outcome. The main benefit of endoscopic ear surgery is; to let the surgeon see better, proceed with the surgery through the trans-canal, teaching and training of the students. There are some drawbacks of endoscopic ear surgery like the one-handed technique and learning curve. With repeated practice and the help of motion parallax, the trainee can overcome the drawback of the procedure. KEY WORDS Endoscopic ear surgery, Motion parallax, Teaching and training

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