Browsing by Author "Tripathi, P"
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Publication Changes in Clinical Practice amongst Nepalese Otolaryngologists during COVID-19 Pandemic(Kathmandu University, 2022) Tripathi, P; Gurung, U; Baidya, S; Thapa, NABSTRACT Background COVID-19 pandemic changed clinical practices more so for otolaryngologists due to inevitable risk of exposure. Objective To assess the changes in the clinical practice among Nepalese otolaryngologists during this pandemic. Method It was an observational study conducted as an online survey in the first two weeks of December 2020. A questionnaire pertaining to changes in clinical practice was mailed to 190 registered otolaryngologists working in various provinces of Nepal. Data were entered in Microsoft Excel 2007 and analysed in percentages. Result Out of the 77 (40.5%) who responded, nearly 50% resumed clinical practice after a month of national lockdown restarting everyday consultation by 64.9% mostly in hospital setting (81.8%) after screening patients via fever clinic by 87%. Modifications in clinical examinations was mostly done for neck (85.7%), oral cavity (44.2%) and nose (29.8%) examination with least with for ear examination (3.9%) Regular endoscopic evaluation was avoided by 19.4%. Only around 57% used adequate personal protective equipment. There was 93.5% reduction in elective operations. Mandatory COVID test was done by 89.6% mostly with reverse transcriptase polymerase chain reaction (95.9%) prior to semi-urgent case. Conclusion Changes in clinical practice were adapted to mitigate viral transmission. The changes were evident in the outpatient department where most patients were screened for fever and modifications made in the clinical examinations. Personal protective equipments were worn when available. Operative lists were limited to semi-urgent and urgent cases with covid testing customarily done for semi-urgent cases. KEY WORDS Aerosols, COVID-19, Otolaryngologists, PandemicPublication Comparison of Outcomes of Conventional Septoplasty Versus Endoscopic Septoplasty using Freer’s Incision in Symptomatic Deviated Nasal Septum(Kathmandu University, 2021) Khadgi, S; Gurung, U; Pradhan, B; Tripathi, PABSTRACT Background Septoplasty techniques have evolved over the years with endoscopic septoplasty gaining popularity in the recent times. Objective To compare the outcomes of conventional septoplasty with endoscopic septoplasty using Freer’s incision in symptomatic deviated nasal septum. Method It was a prospective, randomized and comparative study done at Department of ENT- Head and Neck Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from July 2018 to August 2019. A total of 70 patients with symptomatic deviated nasal septum were allocated randomly into two groups. Group A underwent conventional septoplasty whilst Group B underwent endoscopic septoplasty using Freer’s incision. Sino-nasal outcome test (SNOT-10) score was recorded pre-operatively and post -operatively between four to six weeks of surgery. Paired and independent ‘t’ test for mean was used as a statistical tool. Result Out of 70 patients, 57(81.43%) were males and 13(18.57%) females. The age group mostly affected was in the third and fourth decades with total 47 patients (67.14%). In the conventional group, the pre-op mean SNOT-10 score was 11.46 (SD±3.6) while post-op mean SNOT-10 score was 2.60 (SD±1.9), the difference being statistically significant (p value 0.00001). Similarly, in the endoscopic group, pre-op mean SNOT- 10 score was 12.06 (SD±4.88) and post-op mean SNOT- 10 score was 3.37 (SD±2.71) with the difference being statistically significant (p value 0.00001). Comparison of post-operative mean SNOT-10 score between two techniques was not statistically significant (p value 0.17). Conclusion Both conventional and endoscopic septoplasty techniques using Freer’s incision were equally effective in improving symptoms due to deviated nasal septum. KEY WORDS Conventional septoplasty, Deviated nasal septum, Endoscopic septoplasty, Freer’s incisionPublication Extended Spectrum β-lactamase (ESBL) Producing Multi Drug Resistant (MDR) Urinary Pathogens in a Children Hospital from Nepal(Kathmandu University, 2018) Sharma, KR; Bhandari, P; Adhikari, N; Tripathi, P; Khanal, S; Tiwari, BRABSTRACT Background Multidrug resistant in clinical bacterial isolates has increasingly been reported through out the world and is associated with high morbidity, mortality and increased health care costs. It is important to determine the status of multidrug resistance pattern to understand the current resistance trend so that appropriate antibiotics can be used in practice. Objective To determine the antibiotic resistant profile and prevalence of extended spectrum β-lactamase producing multidrug resistant strains in pediatric patients of Kanti Children’s Hospital, Kathmandu, Nepal. Method Urine sample was cultured by standard microbiological techniques and bacterial isolates were identified using different biochemical tests. Antibiotic susceptibility testing was performed by Kirby Bauer disc diffusion method and extended spectrum β-lactamase detection was carried out using combined disc method as recommended by Clinical Laboratory Standard Institute guidelines. Result All together 65 different bacteria were isolated and subsequently identified. E. coli was the most common isolate with 46 (71%) isolates 63% of these isolates were multidrug resistant. Gram negative isolates were most resistant to nalidixic acid (81.97%) followed by ampicillin (69.35%) and co-trimoxazole (69.35%). The extended spectrum β-lactamase producing isolates were 43% among total isolates. Conclusion Higher rate of Extended Spectrum β-lactamase production among multidrug resistant isolates suggested routine extended spectrum β-lactamase testing in clinical isolates. KEY WORDS Antimicrobial, Multidrug resistant, Urinary tract infectionPublication Pregnancy Outcomes in Patients with Hypothyroidism(Kathmandu University, 2019) Shrestha, A; Tripathi, P; Dongol, AABSTRACT Background Pregnancy is an important event in reproductive years of women life. It has a reversible effect on the thyroid gland and its functions. The role of thyroid gland function and conception has been known for a long time. The most common thyroid gland dysfunction in pregnancy is hypothyroidism. It is estimated that the prevalence is 1.5-4.4% of pregnant women. It is known to cause complications during pregnancy leading to adverse pregnancy outcomes. Objective To observe the pregnancy outcomes in patients with hypothyroidism. Method This is a retrospective study conducted from January 2015 to December 2018. Two hundred and thirty nine patients with hypothyroidism were included. They were investigated for thyroid stimulating hormone (TSH), free tri iodothyronin (FT3), free thyroxine (FT4) levels and for auto-antibodies against thyroperoxidase (anti TPO). All these patients after the detection of hypothyroidism were under thyroxine hormone replacement. Result Amongst 239 ladies with hypothyroidism 97.5% came from hilly region. Seventy seven (32%)of them had history of abortions. Twenty three (9.8%) of them had antepartum hemorrhage. Eleven (4.6%) had preeclampsia during this pregnancy. Seven (2.9%) had fetuses with intrauterine growth restriction (IUGR). Seven (2.9%) had fetuses with preterm delivery. Twenty seven (11.3%) of fetuses had APGAR Score of < 6. Conclusion Of 239 women with hypothyroidism, many had history of recurrent abortions and also complications during antenatal period like preeclampsia, abruption placenta, IUGR and preterm delivery. After thyroxine replacement, risk is much lowered and it has a positive outcome. KEY WORDS Abruptio placenta, APGAR score, hypothyroidism, preeclampsia, thyroxine