Browsing by Author "Subedi, K"
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Publication A Study of Diagnostic Yield, Efficacy and Complications of Ultrasound Guided Renal Biopsy in Different Renal Pathologies(Institute of Medicine, 2014) Chataut, D; Subedi, K; Lohani, BAbstract Introduction: Renal biopsy is an integral part of modern nephrology practice, being indicated in renal diseases in both native and transplanted kidneys. The purpose of this study was to automated biopsy gun. Methods: This was a prospective cross-sectional study involving 184 patients including renal transplant recipients. These patients, with new onset renal symptoms or deteriorating renal function post-transplant, underwent freehand real time ultrasound guided renal biopsy with 18 gauge automated biopsy gun. The diagnostic yield, pathological and immunohistochemistry diagnosis and complications of the procedure were analyzed. Results: 184 patients underwent the ultrasound guided biopsy, 17 were renal transplant recipients. Male and female ratio was almost equal (51.1% and 48.9%, respectively). Most patients were in the age group of 20-40 years. Most cases presented clinically with nephrotic syndrome (38.04%), followed by an equal number of lupus nephritis and nonnephrotic range proteinuria. The average number of glomeruli in the biopsy tissue was 11.8 per specimen. The average length of biopsy tissue was 1.15 cm in native kidneys and 0.9 cm in transplant kidneys. Renal biopsy yielded a pathological diagnosis in 97.2% of cases, with adequate sample for diagnosis in 98.9% of cases. Major life threatening complication was noted in a single patient. Rest of the patients showed minor or no complications. Conclusion: Ultrasound guided percutaneous biopsy with automated biopsy gun is modality of choice for renal biopsy since it has the greatest yield, highest efficacy and least serious complication rates. Keywords: glomeruli, nephrotic syndrome, renal biopsy, ultrasoundPublication Assessment of normal splenic volume by Computed Tomography in Nepalese population(Institute of Medicine, 2015) Suwal, S; Subedi, K; Gurung, GAbstract Introduction: The purpose of this study was to assess the normal splenic volume in Nepalese population by Computed Tomography and its variability with age, sex and body habitus. Methods: This was a cross sectional observational study involving 264 patients undergoing CT abdomen examination for pathologies not pertaining to spleen, in Department of Radiology, Tribhuvan University Teaching Hospital. The spleen volume was obtained by adding cross-sectional area of spleen from 10 mm contiguous CT slices in axial CT images and multiplying them with the slice thickness. The relationships between spleen volume and age, sex and body habitus were also derived. Results: The mean splenic volume was 151.20 cm3 ± 59.62 cm3, ranging from 25.95 cm3 to 331.66 cm3. Weak negative correlation of spleen volume with age (r = -0.173, p <0.01) and body habitus (r = -0.132, p <0.05) were also noted. No significant correlation of spleen volume with gender was noted. Conclusion: The finding provided defining the criteria for splenomegaly. The mean splenic size in Nepalese population is similar and/or larger compared to Asian population, and smaller compared to western population. However a larger sample size is required for corroboration of our findings. Keywords: Computed Tomography, Normal, Spleen, VolumePublication Correlation Of Linear Measurements Of Spleen With Splenic Volume in Computed Tomography(Institute of Medicine, 2018) Suwal, S; Subedi, K; Gurung, GAbstract Introduction: The purpose of this study was to assess the normal linear measurements of spleen in Nepalese adults by Computed Tomography (CT) and their correlation with splenic volume. Methods: This was a prospective cross sectional observational study done in 264 peoples undergoing abdominal CT examination for various clinical indications not pertaining to spleen, in Department of Radiology & Imaging, Tribhuvan University Teaching Hospital (TUTH). Four linear measurements of spleen were obtained in axial plane. Craniocaudal length of the spleen was also obtained. The volume was obtained by adding cross-sectional area of spleen from 10 mm contiguous axial images and multiplying them with the slice thickness. The relationships between various linear measurements of spleen with spleenic volume were derived. Results: The mean length of spleen along long axis was 9.3 +/-1.3 cm, and the mean length along the craniocaudal axis was 7.6+/-1.5 cm. The mean width, maximum thickness, and thickness at hilum of the spleen were 9.3 +/- 1.7 cm, 5.1+/-1.2 and 3.2+/-0.6 cm respectively. The mean splenic volume was 151.20 cm3 ± 59.62 cm3. Significant positive correlations were noted between linear measurements and volume, the strongest being the width followed by the craniocaudal length. Conclusion: Linear measurements of the spleen in CT show stong correlation with volume and hence can replace the splenic volume measurements while defining splenomegaly. Key words: Computed Tomography, Spleen, Linear measurement, VolumePublication Falcine Meningioma with Massive Calvarial Hyperostosis(Institute of Medicine, 2014) Subedi, K; Suwal, S; Chataut, D; Paudel, SAbstract Meningiomas are neoplasms of meningeal origin. Hyperostosis is a peculiar but common sign of meningioma. Though common in skull base meningiomas, massive calvarial hyperostosis is rare in the vertex, with only few reported cases. We report a rare case of massive calvarial hyperostosis due to falcine meningioma, illustrated with multimodality imaging. Keywords: CT Scan, Hyperostosis, Meningioma, MRI, X-rayPublication Impact of Community Diagnosis Programme on Undergraduate Students at BP Koirala Institute of Health Sciences(Kathmandu University, 2019) Singh, A; Subedi, K; Shrestha, A; Bhagat, T; Pyakurel, P; Agrawal, SKABSTRACT Background Community Diagnosis Programme (CDP) aims to demonstrate the importance of teamwork in health care to understand the comprehensive health needs of the rural people and conceive about the research. Objective To assess the impact of community diagnosis program on undergraduate students of BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. Method A cross sectional study with mixed design (quantitative and qualitative) was conducted among the undergraduate students of batch 2017 participating in community diagnosis programme of BP Koirala Institute of Health Sciences, Dharan, Nepal. Eight questions assessed the students’ perceptions regarding their abilities about community diagnosis program using six point Likert Scale and four open ended questions were used to know the students’ experience and perception of community diagnosis programme. Result Overall mean ± SD score for pre-exposure response was 30.47 ± 6.18 and for the post- exposure response was 40.49 ± 5.16. The overall mean ± SD score of the students categorized according to streams showed similar results in both pre-exposure response and post-exposure responses. Qualitative analysis revealed the themes like “Research, a reflection of community and new method of learning to medical students”; “method of developing confidence and good communication skills”, “learning to work as a team” and “exposure to rural area”; “Research an adjunct to medical profession”. Conclusion Community diagnosis programme had a positive impact on the students about basic survey process, learnt to communicate with rural people, understood the type of data and were willing to participate in similar projects in future. Qualitative analysis showed most of the students had positive experience with some negative experience of community diagnosis programme. KEY WORDS BPKIHS, Community Diagnosis Programme, Undergraduate StudentsPublication Manual Vaginal Reversion of Acute Puerperal Uterine Inversion: Learning by Doing(Institute of Medicine, 2016) Katuwal, N; Pokharel, M; Subedi, K; Baniya, J; Sherchan, K; Rawal, S; Baral, J; Gurung, G; Rana, AAbstract Uterine inversion is the folding of the fundus into the uterine cavity in varying degrees. Acute uterine inversion is a rare and unpredictable obstetric emergency. Here we report a case of a woman who had vaginal delivery complicated by postpartum hemorrhage. Diagnosed as acute puerperal uterine inversion; reposition was tried in the labor room which failed ensuing shock. Simultaneous fluid resuscitation and manual vaginal reversion under general anesthesia was done in Operation Theater, also needing blood transfusion, 5 units in total. Therefore, this case is described herein to illustrate the importance of early recognition and prompt reversion of inverted uterus vaginally,as delay can render replacement progressively more difficult and also increase the risk of hemorrhage.Publication MRI Pattern of Lumbosacral Degeneration in Tribhuvan University Teaching Hospital, Nepal(Institute of Medicine, 2015) Ansari, MA; Subedi, K; Panta, OB; Suwal, SAbstract Introduction: The economical and social burden of degenerative disc disease remains unclear in Nepal due to lack of systematic data. However, considering the large volumes of spinal magnetic resonance imaging (MRI) performed for low back pain and/or radiculopathy, this has become the prime problems in all spinal care facilities in Nepal. Spinal MRIs constitute approximately sixty percent of the MRI performed in the Tribhuvan University Teaching Hospital (TUTH). This study is being conducted to review the pattern of degeneration of lumbosacral spine in patients referred for MRI at TUTH. Methods: A retrospective study was conducted at TUTH. Patients with low back pain and or radiculopathy undergoing MRI in the previous 5 months were included in the study. Patients with trauma and or conditions other than degenerative processes were excluded in the study. The findings were recorded and analyzed using SPSS. Results: A total of 301 patients were included in the study. Age ranged from 16 to 83 years, mean age being 42 years. Highest number of patients were in the 30-40 years age group (26.2%). Male to female ratio was 1.22. Disc bulge was the most common finding, seen in 77.7% followed by protrusion (58.5%), extrusion (3.9%) and sequestration (0.3%). Foraminal stenosis (68.4%) was the most common complication followed by central canal stenosis (51.8%) and nerve root compression (37.8%). Disc protrusion was the most significant (p<0.05) predictor of complications (nerve root compression, foraminal stenosis and central canal stenosis). Conclusion: The study shows that degenerative disc diseases remain the cause of morbidity in the most productive years of life (30-40 years of age). Large volumes of MRIs performed for this condition represent significant economic and healthcare burden in a developing country like Nepal as well. Keywords: disc degeneration, lumbosacral spine, MRIPublication Paediatric Stroke: A Rare Presentation of Iron Deficiency Anemia in a Four Year Old Child(Kathmandu University, 2016) Subedi, K; Koirala, S; Basnet, R; Poudel, AABSTRACT Paediatric stroke is an uncommon syndrome with even lesser annual incidence rates of arterial ischemic stroke in infants and children. In children the diagnosis of stroke is frequently delayed or missed. This is due to subtle and nonspecific clinical presentations, a complicated differential diagnosis and a lack of awareness by physicians and also delay in the seeking of medical attention as in our case. We report you a rare case of a four year old child from remote Nepal who presented to our Out Patient Department after a long gap of around four months after the sudden onset of loss of consciousness and decreased movement of right limbs who after detailed history examination and lab investigations and imaging revealed ischemic stroke due to iron deficiency anemia. KEY WORDS Anemia, iron deficiency, pediatric strokePublication Pompe Disease: Cyanosed Hypotonic Infant with Normal Respiratory Rate(Kathmandu University, 2015) Koirala, S; Poudel, A; Basnet, R; Subedi, KABSTRACT Infantile hypotonia or floppy infant is a diagnostic challenge when it presents with other presenting complaints such as fever, cough or diarrhea. Many times the hypotonia goes unnoticed when other symptom covers the hypotonia and child continues to receive the treatment for other symptoms. We report a rare case from Nepal of infantile Pompe disease who presented with the history of fever and cough in the recent earthquake disaster camp at remote part of Sindhupalchowk, Nepal. He was being treated as a case of pneumonia. Pompe disease can be diagnosed clinically by taking detailed history and correlating the clinical findings during the presentation with other symptoms. In our case the normal respiratory rate, reduced Spo2 and presence of crackles dominated the hypotonia and was mistreated as pneumonia. High index of suspicion is necessary in diagnosing Pompe disease. KEY WORDS Developmental delay, hypertrophic cardiomyopathy, hypotonia, normal respiratory rate, pompe diseasePublication Radiation Hazards and Protection: are Nepalese Radiologists Up to Date?(Institute of Medicine, 2014) Subedi, K; Suwal, S; Pant, OBAbstract Introduction: Radiation safety is a major concern in this modern era of diagnostic and therapeutic radiology. Institutions in Nepal still lack the adequate standards to maintain radiation safety. This study was conducted to assess the status of update on radiation hazards and methods of protection among radiologists in Kathmandu. Methods: A questionnaire survey was performed during continuing medical education program at Tribhuvan University Teaching Hospital, Kathmandu before and after a lecture session on radiation hazards and protection. Results: A total of 28 participants volunteered to answer the questionnaire. The mean pretest score was 57.8±29.7, which increased to 83.5± 16.8 after the lecture session. Twelve (42.86%) participants scored less than 50%, which increased significantly comparable to the rest (scoring more than 50%) in posttest score. Mean score was least in ionizing radiation questions. Conclusion: The update on radiation hazards and methods of protection is inadequate among radiologists in Kathmandu. Continuing medical education programs pertinent to the topic must be regularly conducted to keep the radiologists up to date. Keywords: knowledge, radiation hazards, radiation protection, radiologistsPublication Spectrum of MRCP findings: An Initial Experience with 3.0 Tesla Magnetic Resonance Imaging System in Nepal(Institute of Medicine, 2015) Gurung, GS; Subedi, K; Karki, DBAbstract Introduction: Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive magnetic resonance imaging (MRI) examination used in the evaluation of hepatobiliary and pancreatic tree. It is a non-invasive alternative to endoscopic retrograde cholangiopancreatography (ERCP). Here we attempted to summarize the spectrum of MRCP findings in a cohort of patients undergoing MRCP examination in a 3.0 Tesla MRI system, the first of its kind in Nepal. Methods: The study was carried among patients undergoing MRCP in a 3.0 Tesla MRI system from November 24, 2014 to June 29, 2015. 167 patients (73 male and 94 female, age range, 1-87 years, mean age, 49.8years) were identified who underwent MRCP. MRCP was performed on a 3.0 Tesla MR scanner (Ingenia, Philips Medical System) using a sixteen-element quadrature phased array body coil over the liver. The MRCP findings were reviewed and various imaging findings were recorded. The findings were analyzed using SPSS. Results: MRCP was normal in 44(26.2%) patients. Various findings were found in the biliary ducts, liver, gall bladder, pancreas and outside the pancreas and liver. Commonest biliary duct pathology was choledocholithiasis (25.7%). Commonest liver pathology was chronic liver disease (3%). Commonest pancreatic parenchymal pathology was acute pancreatitis (4.2%). Commonest pancreatic duct pathology was dilated pancreatic duct (5.4%). Gall bladder was seen in 37 (22%) patients, and 30 patients were status post cholecystectomy (17.9%). Extra pancreaticobiliary findings included pleural effusion, ascites, splenomegaly, juxtapapillary duodenal diverticulum etc. Conclusion: MRCP is the choice of investigation for the non-invasive diagnosis of pancreaticobiliary disorders. In the current review, we have summarized the spectrum of MRCP findings and shared an early experience with 3.0 Tesla MRCP system in Nepal. The findings are comparable to the existing literature in the subject. Keywords: Bile ducts, Gall bladder, Magnetic resonance cholangiopancreatography (MRCP)Publication Visualization of Normal Appendix in Multidetector Computed Tomography(Institute of Medicine, 2015) Ansari, MA; Kumar, M; Subedi, KAbstract Introduction: Acute appendicitis is one of the most common causes of acute abdominal pain. Visualization of normal appendix is important to exclude the possibility of appendicitis. With the widespread use of multidetector computed tomography (MDCT) for evaluation of acute abdomen, the normal appearance and rate of visualization of appendix has to be defined. Methods: This was a prospective cross sectional study involving 250 patients undergoing abdominal CT for various indications in Tribhuvan University Teaching Hospital between October 2012 and September 2013. One hundred twenty seven patients were female and 123 were male. Age ranged from 17 years to 73 years. CT scans of the patients were obtained with a 16 slice CT scanner with IV contrast. In all patients, there was no clinical suspicion of acute appendicitis or history of appendectomy. Appendix was searched in these patients by tracing caecum. Results: Appendix was visualized in 215 patients, 111 females and 104 males. Appendix was not visualized in 35 patients, 16 females and 19 males. In total appendix was visualized in 86% of patients (87.4% females and 84.6% males). Conclusion: MDCT is an accurate imaging modality for detection of appendix, whether normal or pathological. Visualization rate of normal appendix by CT scan is higher ranging up to 96% as shown in various studies. Thin collimation, use of contrast and multiplanar reconstruction may be the reason for increased rate of visualization of normal appendix. Keywords: aapendix, multidetector computed tomography