Browsing by Author "Thapa, R"
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Publication A study on fine needle aspiration cytology of epididymal nodules(Institute of Medicine, 2018) Thapa, R; Gurung, P; Kafle, N; Pradhanang, S; Hirchand, S; Lakhey, M; Joshi, RAbstract Introduction: Fine needle aspiration cytology (FNAC) is a rapid and relatively inexpensive technique used extensively in the diagnosis of a large variety of neoplastic and nonneoplastic lesions in many organs.There are very few literature reports documenting the role of fine needle aspiration cytology (FNAC) in the evaluation of epididymal nodules. The aim of this study was to highlight the cytomorphologic features of FNAC in epididymal nodules. Methods: A descriptive study was carried out in all the patients presented with palpable epididymal nodules for FNAC over a period of two and half years in department of pathology, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu. FNAC was performed using 23 gauge needle with 10ml syringe. Smears were routinely stained with PAP, Giemsa stain and Special stains whenever needed. Results: A total of 31 cases of non – neoplastic lesions were identified. Age ranged from 15 to 52 years. Majority of cases were of tuberculous epididymitis accounting for 38.70%. Conclusions: FNAC serves as an important tool to screen and diagnose all palpable epididymal nodules and provides information for further management. Keywords: Fine needle aspiration cytology, epididymal nodules, neoplastic, non-neoplastic lesionsPublication Age-Related Macular Degeneration in Nepal(Kathmandu university, 2011) Thapa, R; Paudyal, G; Shrestha, MK; Gurung, R; Ruit, SABSTRACT Background The Age–related Macular Degeneration (AMD) is a common cause of visual impairment and blindness worldwide in elderly. Objective This study aimed to explore the demographic characteristics, pattern and risk factors for AMD at a tertiary referral eye centre in Nepal. Methods This is a hospital-based prospective study, conducted at Tilganga Institute of Ophthalmology, Nepal from September 2008 to May 2009. All the consecutive cases of AMD diagnosed at the institute were included. Results A total of 141 patients (266 eyes) with AMD recruited for the study. The mean age was 69.5 years (9.1SD) with three fifth males (58.9%). Housewives and occupations like agriculture comprised of 38.3% and 42.5% respectively. Three fourth (75.6%) of the patients were illiterate. The proportion of dry and wet AMD were found in 62.4% and 37.6% respectively. Bilateral involvement was seen in 88.7% of the subjects. Three fourth (71.4%) of the AMD eyes had presenting visual acuity less than 6/18. History of smoking was found in 69.9% of patients. Hypertension was the predominant systemic problem (45.4%) followed by diabetes mellitus (12.8%). Conclusion AMD is correlated with ageing in our study as well. Dry AMD is more in age groups 45-64 years and wet AMD at 65 years and older. Bilateral involvement with one eye dry and fellow eye wet AMD is more predominant (44%). Smoking and occupations like agriculture and housewife are significant risk factors for AMD. Likewise male sex, illiteracy and hypertension are other risk factors for AMD in hospital settings. KEYWORDS agriculture, dry macular degeneration, hypertension, illiterate, smoking, wet macular degenerationPublication Choriocarcinoma of uterine cervix with cerebral and lung metastasis(Institute of Medicine, 2009) Ansari, MA; Pokhrel, LR; Thapa, R; Shrestha, DM; Pradhan, SAbstract Abstract: Uterine cervical choriocarcinoma was diagnosed in a 22-years-old woman, admitted to the hospital with irregular vaginal bleeding, hemoptysis and intermittent fever for three months. She had undergone dilatation and curettage for incomplete abortion in the past and had a full term normal vaginal delivery. Pelvic examination revealed a tumor mass occupying the uterine cervix. Ultrasound of the abdomen and pelvis showed an ill defined heterogeneous predominantly isoechoic mass lesion arising from the cervical part of the uterus with invasion to the posterior wall of urinary bladder with bilateral ovarian cysts. Chest radiograph revealed multiple nodular soft tissue density radiopaque shadows of various sizes in lower zones of both lung fields. CT scan of the abdomen revealed heterogeneous soft tissue density mass lesion with central areas of hypodensities, arising from the cervical part of uterus. Fat plane with inferior wall of the bladder and rectum were lost. The mass shows heterogeneous enhancement after administration of contrast material. CT scan of head revealed multiple hemorrhagic lesions in the supratentorial compartment with perilesional edema. Urine pregnancy test was positive. Urine hCG in high dilution was also positive (upto I: 1024) and Serum B-hCG was 181.3(7) mUL/ml. Histopathological findings led to the diagnosis of choriocarcinoma of the cervix.Publication Clinico-Haematological Profile of Megaloblastic Anaemia(Institute of Medicine, 2014) Hirachand, S; Singh, R; Gurung, P; Thapa, RAbstract Introduction: Megaloblastic anaemia is one of the important causes of anaemias. It is a macrocytic anaemia resulting from abnormal maturation of hematopoietic cells due to faulty DNA synthesis. Two vitamins, cyanocobalamin (vitaminB12) and folic acid are essential for DNA biosynthesis. Deficiency of either vitamin results in abnormal nuclear maturation with normal cytoplasmic maturation, apoptosis, ineffective erythropoiesis, intramedullary haemolysis, pancytopenia and typical morphological abnormalities in blood and marrow cells. Methods: This descriptive study was carried out for two and a half years (July 2011 to December 2013) in the department of Pathology, Star hospital, Kathmandu, Nepal. Out of 885 anaemic patients 55 diagnosed as megaloblastic anaemia were included in the study. Complete blood count, reticulocyte count, peripheral smear and bone marrow examination were performed. Serum vitamin B12 and folic acid estimation was done in 32 cases. Results: Out of 55 cases of megaloblastic anaemia, 31 were female and 24 were male with a female to male ratio of 1.3:1. Age range was 18 to 80 years. Pallor was the predominant clinical finding in these cases. Twenty cases (36.36%) presented with only anaemia while others presented with pancytopenia or bicytopenia. Of the 55 cases of megaloblastic anaemia,32 had assays done for cobalamin and folate, of which 15 (46.88%) had cobalamin deficiency, 4 (12.5%) had folate deficiency and 13 (40.62%) had combined deficiency. Conclusion: Megaloblastic anaemia can present with varied clinical manifestations. Strong suspicion of megaloblastic anaemia should be entertained by clinicians to improve clinical outcome. Prompt diagnosis is important as it is a completely curable condition. Keywords: Anaemia, Cobalamin and folate deficiency, Megaloblastic anaemiaPublication Comparative Analyses of Clinical, Laboratory, and Radiological Findings between COVID-19 Deceased and Recovered Patients(Kathmandu University, 2023) Shrestha, MR; Basnet, A; Joshi, P; Bhat, DS; Maharjan, R; Thapa, R; Joshi, RD; Maharjan, R; Jha, RKABSTRACT Background Understanding the coronavirus disease 2019 (COVID-19)-specific indices has become important with increasing cases of COVID-related in-hospital mortality. Objective This case-control study compared clinical, laboratory, and radiological findings between deceased and recovered COVID-19 patients and identified the significant biomarkers associated with deceased patients. Method An analysis of clinical, laboratory, and radiological findings of COVID-19 patients admitted to the COVID-dedicated wards of Nepal Armed Police Force Hospital between March and December 2021 was performed using SPSS version 17.0, with statistical significance considered at p < 0.05. Result A total of 187 COVID-19 patients, comprising deceased [n=95, median (interquartile range, IQR) age: 66 (53–76) years, male: 61 (64.2%) (p=0.024)] and recovered [n=92, median (IQR) age: 51 (38–61) years, male: 44 (47.8%)], were included in the study. Compared to recovered COVID-19 patients, deceased patients had increased median respiratory (20 versus 29.5 breaths/minute) and pulse (83 vs. 86 beats/minute) rates; multiple co-morbidities (≥ 2) (11.9% vs. 32.6%) (p < 0.001); significantly (p < 0.05) lowered alkaline phosphatase (ALP), total protein (TP), albumin, lymphocytes, monocytes, eosinophil, hemoglobin and significantly (p < 0.05) elevated glucose, lactate dehydrogenase (LDH), alanine transaminase (ALT), aspartate aminotransferase (AST), leucocytes, neutrophils, D-dimer and C-reactive protein (CRP); and chest abnormalities including bilateral (p < 0.001), peripheral (p < 0.001) interstitial (p < 0.001) and ground glass opacity (GGO) (p=0.002). Conclusion Elderly, male sex, increased respiratory and pulse rate, presence of multiple co- morbidities, lowered levels of ALP, TP, albumin, lymphocytes, monocytes, eosinophils, hemoglobin, elevated levels of glucose, LDH, ALT, AST, leucocytes, neutrophils, D-dimer, CRP, and chest X-rays showing bilateral, peripheral interstitial and GGO abnormalities were the significant indices associated with deceased COVID-19 patients. KEY WORDS Biomarkers, Comorbidity, COVID-19, Laboratory, Radiology, Signs symptoms, VitalsPublication Comparative study of esmolol and labetalol to attenuate haemodynamic responses after electroconvulsive therapy(Kathmandu University, 2007) Shrestha, S; Shrestha, BR; Thapa, C; Pradhan, SN; Thapa, R; Adhikari, SObjective: The study was designed to evaluate the hemodynamic effects of Esmolol and labetalol in patients undergoing electroconvulsive therapy. Materials and Methods: Ninety patients undergoing electroconvulsive therapy treatment were studied according to randomized, double blind placebo controlled protocol. Ninety patients were divided into three groups with thirty patients in each group. Patients received either Esmolol (1mg/kg), Labetalol (0.25mg/kg) or Normal Saline (placebo) intravenously just after induction with propofol. The baseline heart rate and blood pressure were recorded. Hemodynamic parameters before and after drug therapy and after the ECT current application, were recorded at different time intervals. Results: It was found that Esmolol significantly attenuated the degree of tachycardia and hypertension after ECT in comparison with placebo in the first three minutes (p<0.05), whereas the rise in HR and blood pressure was significantly blunted in the labetalol group in comparison to placebo, from three minutes onward till ten minutes. (pPublication Diagnostic role of fine needle aspiration cytology in the evaluation of salivary gland lesions(Institute of Medicine, 2017) Hirachand, S; Kafle, N; Thapa, R; Gurung, PAbstract Introduction: Fine needle aspiration cytology (FNAC) is a popular method for diagnostic evaluation of salivary gland lesions due to their superficial nature and easy accessibility for the procedure. The technique is simple and cost effective. The present study was conducted to evaluate the diagnostic accuracy of fine needle aspiration cytology in various salivary gland tumors, which helps in an early diagnosis and appropriate therapeutic management. Methods: The study was conducted in the Department of Pathology in Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal from October 2014 to September 2016 (2 years). A total of 48 fine needle aspirations of salivary gland lesions were done, of which histopathological conformation of diagnosis was available in 34 cases. A standard cytological and histopathological staining were used and examined. Results: Forty eight cases of salivary gland lesions were included in the study. The age of patients ranged from 6 to 88years, with a mean age of 46years. Male: female ratio was 1.4:1 with common site being the parotid gland. Histopathological conformation of diagnosis was available in 34 cases. Pleomorphic adenoma was found to be the most common benign tumor (50%) and mucoepidermoid carcinoma (14.70%) was the commonest malignant tumor. The overall diagnostic accuracy of FNAC in diagnosing salivary gland lesions was 89.47% with a sensitivity of 77.77 and a specificity of 93.10%. Conclusion: Fine needle aspiration cytology is an important and useful diagnostic tool for diagnosing salivary gland lesions. Proper sampling of lesions and adequate cellularity of the smears are the pre- requisites for accurate diagnosis. Hence, the appropriate therapeutic management could plan earlier. Keywords: Cytology, Fine needle aspiration cytology, Salivary gland lesionsPublication Outcome of pneumatic retinopexy at a tertiary eye care centre in Nepal(Kathmandu University, 2008) Thapa, R; Shrestha, MK; Gurung, R; Ruit, S; Paudyal, GAbstract Background: Rhegmatogenous retinal detachment is one of the commonly encountered retinal problems where timely treatment could prevent irreversible vision loss. Pneumatic retinopexy (PR) is a simple and minimally invasive procedure for retinal reattachment. Aim: This study aimed to assess the outcome of pneumatic retinopexy in primary rhegmatogenous retinal detachment at our facility. Study design: This was a retrospective- prospective, interventional case series. Materials and methods: All subjects with rhegmatogenous retinal detachment who underwent pneumatic retinopexy at Tilganga Eye Centre of Nepal from January 2002 to June 2007 were included in this study. Results: A total of 32 cases were included in the study. The mean age of patients was 55.2 year (SD=11.0). The majority of cases (62.5%) presented within two weeks of symptoms with blurring of vision in 90% of cases. Pre-operatively, 56.3% (18) patients had a best corrected distance visual acuity of <6/60. Retinal detachment involving less than two quadrants consisted of 37.5% (12). A single retinal break was present in 78.1% (25) of cases and 87.5% (28) of the retinal breaks were located in the superotemporal quadrant. The macula was attached in 37.5% (12) of the cases. Sulfurhexa uoride and Per uoropropane were used in 68.8% (22) and 31.3% (10) respectively. The average follow up period was 1.02 years (range one month to four years). The retina was completely attached in 81.3% (26) of cases at the last follow up. The best corrected distance visual acuity of 6/18-6/60 was found in 40.6% (13) of subjects in the last follow up. There was a transient rise in intraocular pressure in 6.3% (2) of subjects after the procedure. Conclusion: The anatomical success rate following pneumatic retinopexy is quite high (81.3%) with good visual recovery and less morbidity translating to higher productivity for the patient. This procedure, being quicker than the alternatives, will also save surgeon’s time making PR a good choice for managing primary rhegmatogenous retinal detachment in countries like Nepal where resources are scarce. Key words: Rhegmatogenous retinal detachment, retinal break, pneumatic retinopexy, NepalPublication Prescription writing skills of preclinical medical and dental students in a medical college(Institute of Medicine, 2017) Shrestha, D; Thapa, R; Gurung, RS; Tuladhar, LR; Shrestha, LAbstract Introduction: Prescription is a clinician’s written order to dispense drugs. Prescription writing is one of the basic competencies to be learned by medical and dental students, who are more prone to make prescription errors during the early stages of their training. Methods: It was across sectional study conducted in NMCTH, Jorpati, Kathmandu. Medical and dental students in the first and second year were included in the study. Students were given common clinical conditions to write prescriptions. Prescriptions were analyzed for physician and drug related components. Results: The total number of medical and dental students that participated in this study was 326. The percentage of different physician related components in the prescriptions of first year medical students ranged from 61.4 to 100%, from 74.1 to 100% in second year medical students, from 55 to 100% in first year dental students and from 66.7 to 100% in second year dental students. The percentage of different drug related components of prescriptions was from 73.7% to 90% in first year medical students, from 79.3 to 94.8% in second year medical students, from 57.5 to 80% in first year dental students and from 74.1 to 92.6% in second year dental students. Conclusion: Prescription writing skills of preclinical medical and dental students are lacking in its various components. Evaluation of their prescription writing skill should be done frequently to find out the deficiencies which must be corrected by better training to reduce prescription errors and to increase adherence to improve rational prescribing. Keywords: prescription skills, medical students, dental studentsPublication Primary pericardial mesothelioma presenting as pericardial constriction(Institute of Medicine, 2011) Ansari, MA; Thapa, R; Pradhan, SAbstract A 48 year-old-male presented with a six month history of shortness of breath and cough with low grade fever. Chest x-ray shows enlarged cardiac size. Echocardiogram revealed pericardial effusion. ESR was raised and blood count showed lymphocytosis. Anti-tubercular treatment was started and four months after completion of treatment there was no significant improvement. Pericardial biopsy was done which revealed findings of chronic pericarditis. Echocardiogram was repeated which revealed thickened pericardium with few foci of calcification and pericardial effusion. Diagnosis of constrictive pericarditis was made. Patient was planned for pericardiactomy. During operation fleshy vascular mass was seen arising from pericardium along with nodular pericardial thickening. Biopsy was taken and closer was done. Post operatively contrast enhanced CT scan of chest was done which revealed malignant mesothelioma. Histopathological analysis showed a primary malignant mesothelioma. Post operative period was uneventful for initial 2-3 days. Patient was taken by his party against medical advice on 3rd post-operative day. Patient did not returned to the hospital again. Keywords: Pericardial mesothelioma, echocardiogram, CT scanPublication Utility of Rapid Brilliant Cresyl Blue Stain in Routine Fine Needle Aspiration Cytology(Institute of Medicine, 2017) Gurung, P; Hirachand, S; Thapa, R; Pradhanang, S; Kafle, N; Acharya, S; Sedhain, MAbstract Introduction: Rapid on-site evaluation is commonly performed by pathologists to check for cellular adequacy of fine needle aspirate smears to reduce hospital visits of patients and to make preliminary diagnosis. For rapid evaluation, laboratories use Romanowsky stain, Hematoxylin and Eosin stain, supravital stains and ultra-fast Papanicolaou stain. The aim of the study is to evaluate fine needle aspirate smears on-site for sample adequacy using supravital stain Brilliant Cresyl Blue (BCB), to make preliminary cytological diagnosis and to compare with the routine cytological Papanicolaou stain (Pap) and Giemsa stain. Methods: The study was carried out in the Department of Pathology, Kathmandu Medical College Teaching Hospital from 1st December, 2014 to 31st December, 2015. A total of 115 cases referred from OPD for FNAC were included in the study. FNA was performed under aseptic conditions with a 23-guage needle. Samples were collected for routine stains (Papanicolaou and Giemsa stain) and one air-dried slide was stained with Brilliant Cresyl Blue and examined immediately while patient was in waiting room. Results: Of the 115 cases, the age of patients ranged from 15 to 83 years in which male and female ratio was 1.5:1. There were 35 (30.4%) cases of enlarged lymph nodes, 28 (24%) cases of thyroid lesions, 20 (17.3%) cases of breast lesions, 7 (6%) cases of soft tissue lesion, 3 (3%) cases of salivary gland lesions, 1 (1%) case of lung mass, 1 (1%) case of epididymal swelling and others 20 (17.3%) cases. On rapid staining with brilliant cresyl blue, case sample adequacy was 104 (90%). Repeat aspiration was done in 11 (10%) of cases .Upon rapid staining, 92 (80%) of the cases were benign, 19 (17%) cases were malignant, 4 (3%) cases were inconclusive. After observation of papanicolaou and giemsa stains, there were 94 (82%) benign cases and 21 (18%) malignant cases. Conclusion: On-spot Brilliant Cresyl Blue staining is a good stain to check for sample adequacy and to reduce reaspirations. It is as good as the conventional stains in exhibiting cytomorphology of cells. Keywords: Brilliant Cresyl Blue, cytomorphology, fine needle aspiration cytology, Giemsa stain, Papanicolaou stainPublication Van Gogh Syndrome(Nepal Health Research Council, 2011) Roka, Y B; Thapa, R; Puri, P R; Aryal, SSelf injury is the intentional and direct injury to self that include bite, burn, ulceration and head banging. These injuries are rarely fatal and are usually not suicidal in nature. This behavior is common among adolescents, psychiatric patients and in females. Bipolar disorder, drug abuse and metabolic syndromes like LeschNyhan and Munchausen’s syndrome are often associated with this disorder. Repetitive self mutilation is termed the Van Gogh syndrome after the famous painter who cut off his ear and gave it to a prostitute. We describe two such cases of self mutilation in schizophrenic patients. Keywords: bipolar disorder, psychiatry, self mutilation, Van Gogh syndrome