Browsing by Author "Thapa, S"
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Publication Angiographic Severity of Coronary Artery Disease in Diabetic and Non-diabetic Acute STEMI Patients in a Tertiary Care Centre of Nepal(Kathmandu University, 2021) Pathak, SR; Gajurel, RM; Poudel, CM; Shrestha, H; Thapa, S; Thapa, S; Koirala, PABSTRACT Background Patients with diabetes mellitus have a higher prevalence of atherosclerotic heart disease and a higher incidence of myocardial infarction than the general population. Definitive diagnosis and precise assessment of anatomic severity of Coronary Artery Disease requires invasive diagnostic modality like coronary angiography. Objective To study angiographic characteristics and severity involving coronary arteries in patients with acute ST segment elevation Myocardial infarction and to compare the same in diabetics and non-diabetics. Method Among 150 patients with acute coronary syndrome, 75 diabetics and 75 non- diabetics admitted in Manmohan Cardiothoracic vascular and transplant Centre were selected randomly during a period of one year formed the study group. Random Blood Sugar, Fasting Blood Sugar was done in all 150 patients, HbA1c in all diabetics. All subjects with acute ST Elevation Myocardial Infarction were taken up for coronary angiography intended for primary PCI. Result In our study, 35 (46.7%) out of 75 diabetic patients had triple or multi-vessel disease compared to 10 (13.4%) out of 75 non diabetics. Non-diabetic patients had significantly higher single vessel disease (65.3%). There was a statistically significant association of duration of DM with vessels involved. The occurrence of Triple Vessel Disease/Multivessel Disease was significantly higher in the patients with DM duration > 10 years compared to patients with DM duration < 10 years (64.7% vs. 35.3%, P < 0.001), however there was no significant difference in type of vessel involved. Similarly, a significantly higher proportion of Triple vessel disease was observed in patients with poor glycemic control (HbA1c > 8.5%). 72.2% of the patients with HbA1c > 8.5% had Triple vessel disease/Multi vessel disease, whereas patients with good glycemic control (HbA1c < 7.0%) had predominantly Single vessel disease (90.0%), with no occurrence of Triple vessel disease/Multi vessel disease Conclusion Diabetic patients presenting with ST Elevation Myocardial Infarction are likely to have triple/multiple vessel disease compared to non-diabetic patients. The occurrence of Triple Vessel Disease/Multivessel Disease was significantly higher in the patients with DM duration > 10 years compared to patients with DM duration <10 years. KEY WORDS Diabetes mellitus, Acute coronary syndrome, STEMI, Coronary angiographyPublication Assessment of Symptomatic Dry Eye Disease among Postgraduate Medical Students of KIST Medical College and Teaching Hospital using an Ocular Surface Disease Index Questionnaire(Kathmandu University, 2024) Basnet, A; Thapa, S; Ghising, K; Shah, SK; Pathak, SB; Pradhan, PABSTRACT Background Symptomatic dry eye disease is a growing public health challenge especially among those who are visual display unit users and other long-time near activity workers. Increased screen time, prolonged use of face mask and shortage of sleep among resident doctors increases the risk of developing dry eye disease that can affect their learning and social abilities. Data is insufficient on the prevalence of dry eye disease among postgraduate medical students in Nepal. Objective To find out the prevalence of symptomatic dry eye disease using an ocular surface disease index questionnaire among postgraduate medical students of KIST Medical College and Teaching Hospital. Method A cross-sectional study was conducted among three batches postgraduate medical students until 2023 of KIST Medical College and Teaching Hospital, Imadol, Lalitpur. A single validated symptom-based questionnaire with 12 questions was used to assess symptomatic dry eye disease. Result Total of 110 post-graduate medical students with mean age of 30.4 years, 67 males and 43 females were enrolled. Among them, 68 (61.8%) had dry eye disease. Severe dry eye was the commonest followed by mild dry eye. There was statistically significant association between dry eye disease with the increased screen time and suboptimal durations of sleep. Conclusion About half of postgraduate students faced symptomatic dry eye disease. It is advisable for residents to have optimum sleep as possible, limit screen time and establish regular break time along their exposure. KEY WORDS Ocular surface disease index questionnaire, Postgraduate medical students, Symptomatic dry eye diseasePublication Awareness of Burn First Aid Management among Undergraduate Medical Students at a Medical College Teaching Hospital(Kathmandu University, 2024) Thapa, S; Thapa, B; Shrestha, SABSTRACT Background First aid training, educational degree of health sector employee is linked to greater levels of knowledge, awareness and positive outcome in burn injury and its management but studies have shown insufficient level of awareness with unsatisfactory skills not only among professional healthcare workers but also in medical students. Objective To assess the knowledge and confidence of our medical students towards basic burn first aid and management. Method Cross sectional observational study was done using a structured, self-reported 16 multiple choice questionnaire with total marks of 30. Students was graded accordingly: more than 25 points: good, 16-25 points: satisfactory and less than 16 points: poor level of awareness about burn first aid management. Confidence in management of burn related victims, information on receiving of prior formal training in burns and sources of knowledge in students were also evaluated. Result Only a satisfactory level of awareness is seen in medical students 62.1%, 98.2% had not received any kind of formal training and the medical college curriculum was the main source of information (69.2%) followed by journals (47.1%) and internet (26%). 78.4% students felt that the curriculum provided to them was inadequate and only 5.3% students were confident in managing burn first aid. Conclusion There was inadequacy in the knowledge of burn first aid amongst undergraduate students therefore clinical course in managing burns into the undergraduate curriculum is vital. KEY WORDS Awareness, Burns, First aid management, Medical students, PerceptionPublication Clinical Outcome following Intra-articular Triamcinolone Injection in Osteoarthritic Knee at the Community: A Randomized Double Blind Placebo Controlled Trial(Kathmandu University, 2018) Shrestha, R; Shrestha, R; Thapa, S; Khadka, SK; Shrestha, DABSTRACT Background Knee pain is one of the common complaints patients present with in any community based health camps and Osteoarthritis of knee is a usual diagnosis. Injecting a long acting steroid is a common practice to alleviate the symptoms of osteoarthritic knee. Objective To evaluate the clinical outcome of injecting Triamcinolone acetenoid in osteoarthritis of knee in a community set up over a randomized double-blind placebo control trial. Method A prospective, randomized, double blind, placebo control trial was carried out in community after obtaining the ethical clearance from the IRC. Patients with clinically diagnosed osteoarthritis of knee were injected either Triamcinolone or Placebo after recording the baseline scores of the knee by Knee injury and Osteoarthritis Outcome Score (KOOS) – Physical Function Short form (KOOS-PS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analogue Scale (VAS). The same tools were used at two, six and at twelve weeks post injection to evaluate the functional outcome and pain. Result One hundred and seventeen patients were available for analysis among which, 55(48.7%) patients received Triamcinolone and 58(51.3%) received placebo. The baseline status of knees of two groups was comparable at the start of study. There was significant pain relief in the group receiving Triamcinolone at two and six week but not in twelve weeks. Group receiving placebo had pain relief only for first two weeks. Functional outcome was significantly improved compared to baseline in both the groups until six weeks however, in the triamcinolone group, it was significant until twelve weeks. No major complications were noted. Conclusion Intra-articular injection of Triamcinolone acetenoid is effective in symptoms control and improving functional outcome in clinically diagnosed osteoarthritis of knees in community set up during health camps. KEY WORDS Community, Health camps, Intra-articular injection, Knee, KOOS-PS, Osteoarthritis, WOMACPublication Complex Regional Pain Syndrome(Kathmandu University, 2024) Shakya, S; Amatya, S; Thapa, S; Thapa, P; Pokharel, SABSTRACT Complex regional pain syndrome is chronic pain condition involving hyperalgesia and allodynia of extremities. The pathophysiology of CRPS is thought to be combination of different factors that take place at the time of initial injury. Sixty two years female presented to us with severe leg pain after intravenous cannulation during her spine surgery and associated with hyperalgesia and allodynia. On examination, there was shinny skin and nail changes on right leg and significant surface temperature difference between two legs. Patients were managed conservatively with patient education, physical therapy, pharmacological management, and psychological therapy with diagnosis of complex regional pain syndrome. Diagnosis is a clinical finding based on the Budapest diagnostic criteria. Early treatment with multidisciplinary approach to pain management is necessary to achieve complete recovery and prevent damage. Complex regional pain syndrome is life altering condition but understanding the etiological factors helps us to an early diagnosis and a better implementation of treatment. KEY WORDS Allodynia, Budapest criteria, Complex reginal pain syndrome, HyperalgesiaPublication Demographic and Clinical Profiles of Patients with Traumatic Brain Injury Managed in a District Hospital in Nepal(Kathmandu University, 2023) Thapa, S; Baral, A; Lal, V; Bajracharya, K; Sharma, MRABSTRACT Background Traumatic brain injury (TBI) is a significant cause of disability and mortality globally. Information regarding clinical presentation and management of TBI patients in the district hospital settings is inadequate, especially in low- and middle-income countries. Objective This study aims to describe the demographic and clinical profiles of traumatic brain injury patients in a district hospital setting in Nepal. Method This study was done at Chautara Hospital in Sindhupalchowk district from December 2021 to June 2022. Sixty-one patients were included using non-probability sampling. The age and sex of patients, cause of injury, distance from the hospital, the severity of the injury based on the Glasgow Coma Scale, site of trauma on the head, and disposition of patients were analyzed. Result Sixty-one patients met the inclusion criteria out of which 29 were males and 32 were females. The mean age of the patients was 42.5 years. The most frequent cause was fall from height (23), and the most common injury site was the frontal region of the head (29). Most patients had a mild injury (52) followed by severe (five). Only two patients had moderate injury. Forty-two patients sustained injury within 5 kilometres of the hospital. Thirty patients were referred to higher centres for further treatment. Conclusion Falls from height is the most common cause of traumatic brain injury followed by road traffic accidents. As most of the cases are mild in severity, the availability of trained human resources and telemedicine consultation in district hospitals can substantially decrease referral to higher centres and therefore decrease the burden of traumatic brain injury patients in the higher centres. KEY WORDS Glasgow coma scale, Imaging, Referral, Traumatic brain injuryPublication Histopathological Analysis of Non-Neoplastic Superficial Lymphadenopathies(Kathmandu University, 2017) Thapa, S; Ghosh, A; Ghartimagar, D; Narasimhan, R; Prasad, T; Talwar, OPABSTRACT Background Lymphadenopathies are the clinical manifestation of enlargement of lymph nodes which are a common occurrence and are processes of lymph nodes in response to a variety of exogenous and endogenous stimulants. The vast majority of enlarged lymph nodes are non-neoplastic. Objective The objective of the study is to analyze the spectrum of non-neoplastic lesions of superficial lymphadenopathies with their histomorphological features. Method This was a retrospective hospital based study done in the department of Pathology. All cases of superficial lymph node biopsies received during a period of 7 years were retrieved and divided into 2 broad categories: neoplastic and non-neoplastic. The latter group is the material for the present study. The diagnosis was made on morphological basis. Result Of all the 268 superficial lymph node biopsies, 25.4% (68 cases) were neoplastic and 74.6% (200 cases) were non-neoplastic. The non-neoplastic cases were further categorized into non-infectious 60.5% (121 cases) and infectious 39.5% (79 cases). Neck node (70%) was the most common site of involvement. There were 102 male and 98 female patients with male to female ratio 1.04:1. The age range of the patients was 2 years to 83 years with a mean of 27.16 years and most common being 11-20 years 29% (58 cases). Majority of the cases were non-specific reactive lymphadenitis 84.3% (102 cases) followed by tuberculosis 36.5% (73 cases). Conclusion The major cause for the superficial lymphadenopathy was found to be non- neoplastic etiology with slight male predominance. Reactive lymphadenitis was the leading cause unlike the studies done in other Asian and Tropical countries where tuberculosis was more common. KEY WORDS Lymphadenopathies, non-neoplastic, reactive lymphadenitis, tuberculosisPublication Improving Knowledge, Skill and Confidence of Novice Medical Doctors in Trauma Management with Principles of ABCDE(Kathmandu University, 2018) Shrestha, R; Khadka, SK; Thapa, S; Shrestha, B; Shrestha, SK; Ranjit, S; Pradhan, BB; Shakya, YR; Lama, D; Shrestha JABSTRACT Background Trauma is one of the major public health concerns clamming about five million death annually worldwide. Experience and confidence of a doctor in the management of trauma patients have big impact on the overall outcome. Objective This study aims to evaluate the outcome of a trauma course in improving the knowledge, skill and confidence of novice doctors in managing trauma victims. Method A pre/post test analytical study was carried out among novice medical doctors from Kathmandu University School of Medical Science (KUSMS) who participated in a standard two and a half day trauma course, that utilizes the principles of ABCDE, as a part of their regular training. Pre-course knowledge and skill were compared with immediate post-course scores on the same guidelines. Objective structured and subjective written feedbacks from the participants were analyzed qualitatively to identify the perceptions of candidates. Result Sixty-eight males and twenty-nine females completed the course. The average pre- test scores in knowledge and skill were 8.3(33.2%) and 19.6(78.5%) respectively. Similarly the post-test scores were 16.04(64.2%) and 22.45 (89.5%) respectively, showing statistically significant improvements (P 0.000). The mean percentage improvement in knowledge was 48.8% and that in skill was 160.9%. The feedback analysis showed majority of the participants were satisfied with the course and they perceived improved “self-confident” in handling trauma cases. Conclusion All the novice doctors should participate in a standard trauma course hence their knowledge, skill and confidence in handling a trauma can be improved. KEY WORDS Emergency room trauma course (ERTC), Interns, Knowledge and skill, Principles of ABCDE, Simulation, Skill stations, Trauma, Trauma coursePublication Meniscal Tear at Knee: Repair or Resect? An Early Experience from a University Hospital in Nepal(Kathmandu University, 2022) Shrestha, R; Khadka, SK; Basi, A; Malla, M; Thapa, S; Tripathi, A; Kulshrestha RABSTRACT Background The meniscus plays an important role in maintaining healthy articular cartilage. Meniscus tear, one of the common intra-articular knee lesions, is treated by either debridement or repair. Objective This study aims at identifying the early outcome of meniscus tears treated by debridement or repair. This study also elaborates on the spectrum of meniscal injuries presented in a tertiary care hospital in Nepal. Method A retrospective descriptive cross-sectional study was conducted at Orthopedic Department of Dhulikhel Hospital from February 2018 until January 2020 among patients who underwent knee arthroscopies for meniscal tears treated either by debridement or repair. Patients having intra articular fractures, osteochondral injuries and multi-ligament injuries were excluded. The meniscal tears were classified according to location and type of tear. Those patients who had at least one-year of follow up were evaluated with Lysholm score for functional outcome. Data were compiled and analyzed with Microsoft Excel 2011. Result One hundred and ten cases of meniscal tears were managed over the study period. Ninty-three cases could be traced for outcome evaluation, which included 50 cases of meniscal debridement and 43 cases of meniscal repair. The mean Lysholm score of the patients who received debridement was 81.5 (SD 10.4) and those who received meniscal repair was 84.9 (SD 9.1) (p=0.105). The population distribution was found to be similar in both the groups according to age and sex distribution and associated ligamentous injuries. Conclusion Good functional outcome was seen for meniscal tears managed with debridement or repair in at least one year follow up and could not establish one modality of management better than the other. KEY WORDS Arthroscopy, Debridement, Meniscus, RepairPublication Ovarian Tumors: Pattern of Histomorphological Types- A 10 Years Study in a Tertiary Referral Center and Review of Literature(Kathmandu University, 2016) Ghosh, A; Ghartimagar, D; Thapa, S; Sathian, B; Narasimhan, R; Talwar, OPABSTRACT Background Ovarian cancer accounts for 6% of all cancers in females. Among cancers of female genital tract, the incidence of ovarian cancers ranks below only carcinoma of the cervix and the endometrium. Objective To find the frequency of different types of histomorphological types and their association with age, side and size distribution. Method This study is a hospital based retrospective study carried out in the Department of Pathology, Manipal Teaching Hospital over a time period from Jan. 2006 to Sep. 2015. Specimens were received from the Manipal Teaching Hospital and other hospitals within the Himalayan valley of Pokhara. All the clinical and histolpathological data were retrieved from the departmental data bank and were analyzed. Result A total of 409 cases of ovarian tumors have been reported in the same period. Among them, 215 cases were of surface epithelial origin including 172 benign, 07 borderline and 36 malignant cases. Among the surface epithelial tumors, the commonest was serous cystadenoma (119 cases) followed by mucinous cyst adenoma (40 cases). There were 176 cases of tumors with germ cell origin which included 170 cases of teratoma, four dysgerminoma and one each case of choriocarcinoma and yolk sac tumor. Among seven metastatic tumors, one case was of Krukenberg tumor. Age range was 12 to 90 years and the size range from 3 to 36 cm. Conclusion In our study, we analyzed all the spectrum of ovarian tumors diagnosed on morphological bases and most of the findings were similar to other national & international studies. However, we have reported increased percentage of mucinous tumors and less sex cord stromal tumors. KEY WORDS Germ cell tumor, metastatic, mucinous, ovarian tumor, serousPublication Surgical abortion in second trimester: Initial experiences in Nepal(Kathmandu University, 2010) Shrivastava, V; Bajracharya, L; Thapa, SAbstract Introduction: In spite of legalising abortion and making safe abortion available at affordable price at accessible distance to almost everyone, unsafe abortion especially second trimester abortion is still a big health problem in Nepal. Objective: The objective of the study is to find the demographic profile, reasons for seeking abortion and to see the effectiveness of Misoprostol in preparing the cervix. Materials and methods: A prospective study was done in the two second trimester abortion trainings conducted in Maternity hospital, Kathmandu. Total 57 clients had second trimester abortion performed. Information was collected from structured questionnaire and then data was analysed. Results: Commonest reason for seeking abortion was, multiparity (61.4%). Common reasons for second trimester abortion were, completed family size with unwanted pregnancy (61.4%), unwanted pregnancy in married (10.52%) unwanted pregnancy in unmarried (5.26%). Conclusions: Second trimester abortion is one of the most common procedures performed in reproductive-aged women and when performed by a skilled provider in the appropriate setting, it is one of the safest surgeries, if it is well supported by change in policy of the country and acceptability of the people. Key words: Maternal death, Safe abortion, Second trimester abortionPublication Women Having Abortion in Urban Nepal: 2005 and 2010 Compared(Kathmandu University, 2012) Thapa, S; Neupane, S; Basnett, I; Read, EABSTRACT Background The use of abortion services at the Maternity Hospital clinic, the largest public sector abortion clinic in Nepal, has risen over the years. Whether the profile of the clients, reasons for abortion, and contraceptive use have changed are not known and need to be investigated. Objectives This paper evaluates changes between 2005 and 2010 in the socio-demographic profile of abortion users, reasons for seeking abortion, and contraceptive use of two cohorts of women who had first-trimester abortion at the Maternity Hospital. Methods We used data from two similar surveys conducted in 2005 and 2010 among 672 and 392 women, respectively, who obtained first-trimester surgical abortion in a large public sector clinic. We analyzed trend data in service utilization and carried out a cost analysis. Results The number of women having abortions has steadily increased over the years, and cumulatively about 19,800 women have received services. The profile of the clients at this clinic has remained essentially the same between 2005 and 2010. The typical users of abortion services at the clinic were 27 years old with two living children, mostly married, with the majority not wanting to have more children. About half of them used a contraceptive method—mostly condoms, withdrawal, the pill and rhythm—in the month of unintended pregnancy, suggesting failures with these methods. Health concerns, dislike of available methods, and perceived low risk of pregnancy were common reasons for not using a contraceptive method. Conclusion Despite increases in the number of clients, the socio-demographic profile of the abortion clients has remained similar over the years. The linkage between the abortion and family planning clinics needs to be strengthened. KEY WORDS Abortion, client characteristics, family planning, Nepal