Browsing by Author "Vaidya, N"
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Publication Association of Allergic Biomarkers in Patients with Chronic Rhinosinusitis With or Without Asthma(Kathmandu University, 2025) Pangeni, RP; Pokharel, M; Vaidya, N; Sapkota, P; Karki, S; Bhusal, M; Basnet, D; Dhakal, A; Sapkota, B; Madhup, SABSTRACT Background Chronic rhinosinusitis and asthma are considered under unified airway diseases which describes the shared epidemiologic and pathophysiologic relationship among the chronic inflammatory diseases of the upper and lower airways Objective To assess the asthma in patients with chronic rhinosinusitis and determine the relationship of allergic biomarkers, tissue eosinophilia and radiological bone changes in patients with chronic rhinosinusitis with or without asthma. Method Prospective study involving 74 adult patients attending the Department of Otorhinolaryngology and Pulmonology at the Kathmandu University Dhulikhel Hospital for treatment of chronic rhinosinusitis and / or asthma and for functional endoscopic sinus surgery between May 2023 and May 2024. Absolute eosinophil count, total serum IgE and spirometry tests were performed. Radiological evidence of osteitis and tissue eosinophilia from surgical samples was evaluated. Correlations between allergic biomarkers,spirometry values, tissue eosinophilia, and radiological bone changes were determined in patients of chronic rhinosinusitis with or without asthma using the Mann Whitney U test, Student t test and the chi square test. Result A positive association was observed between the radiological bone score with tissue eosinophilia (p=.018), and smoking (p < 0.001) in between the two groups. Chronic eosinophilic rhinosinusitis was observed in 39 (52.7%) patients. 15 patients with Chronic rhinosinusitis had asthma ,and among these asthmatic patients 11 had eosinophilic chronic rhinosinusitis. Mild osteitis was evident in 34 (45.9%) ,moderate osteitis in 39 (52.7%) and severe in 1 (1.4%). Among 15 asthmatic patients, 10 had moderate osteitis and 5 had mild osteitis. Conclusion A rigorous exentration of osteitic bony nidus appears necessary for successful treatment outcomes in all chronic rhinosinusitis patients and to prevent acute exacerbation in the asthmatic group of chronic rhinosinusitis patients. KEY WORDS Asthma, Chronic rhinosinusitis, OsteitisPublication 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, BLABSTRACT 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 surgeryPublication Development of a Model One Stop Approach to Post-COVID-19 and other Rehabilitation Conditions(Kathmandu University, 2024) Adhikari, P; Tamrakar, D; Thakur, C; Shakya, R; Vaidya, N; Acharya, R; Shrestha, J; Byanju Shrestha, IABSTRACT Background Post-COVID-19 cases can cause severe disabling symptoms and functional disabilities. WHO recognizes the severity of the condition and publishes a standardised Case Report Form to inform clinical management and public health response. Objective To determine the post-COVID-19 case load. A multidisciplinary team including a diverse team were composed and priority intervention areas were identified through a transdisciplinary approach eventually developing a Model One Stop Approach to post-COVID-19 and other Rehabilitation Conditions. Method The COVID-19 cases recorded at Dhulikhel Hospital were monitored through phone calls to post-COVID-19 complications. Patients were then invited for additional clinical assessments. A diverse team conducted these assessments to identify the needs for expanding a post-COVID-19 clinic and devised rehabilitation services based on predefined criteria. Result A total of 550 respondents were included in the study. The proportion of males (51.7%) was slightly higher than females (48.3%) with the majority of them being Brahmin/Chettri. The primary comorbidities identified were diabetes (10.55%) and hypertension (11.4%). Of the participants, about 50.73% experienced persistent symptoms. About 17.8% reported lasting muscle-related problems, 12.1% had persistent joint pain, and 33% faced temporary cardiac issues. Less than 10% experienced enduring health problems related to vision, hearing, and sleep patterns. Conclusion After COVID-19, patients experienced cardiac and muscle-related issues, increasing morbidity, financial burdens, and pressure on healthcare systems. With the need of sustainable rehabilitation training package, Dhulikhel Hospital serves as a model for a One-Stop Approach to post-COVID-19 and other rehabilitation conditions. KEY WORDS Model, Persistent, Post-COVID-19, Rehabilitation, SymptomsPublication Diagnostic Accuracy of Drop Hydrogen Peroxide Test as a Novel Bedside Diagnostic Test to Differentiate Transudative and Exudative Pleural Effusion Against Light’s Criteria(Kathmandu University, 2022) Vaidya, N; Sapkota, P; Chaurasia, S; Thapa, B; Bhandari, N; Bhattarai, IABSTRACT Background Diagnostic evaluation of pleural fluid according to Light’s criteria to differentiate between exudative and transudative fluid takes 1 or 2 working days. For rapid clinical management, especially in critically ill patients, a simpler bedside diagnostic test can be done which has similar diagnostic accuracy as that of Light’s Criteria. Objective To determine the diagnostic accuracy of Drop Hydrogen Peroxide test to differentiate exudative and transudative pleural effusion in comparison to Light’s criteria. Method A concurrent validity test was performed using a convenient sampling technique including patients presenting to the Department of Internal Medicine from January to September 2021, who had pleural effusion. Two milliliters of tapped pleural fluid of patients who underwent aseptic thoracocentesis was collected in a test tube to which one to two drops of 20% hydrogen peroxide was added. Presence of bubbles suggested an exudative type of fluid. Rest of the tapped pleural fluid was sent to the laboratory for further evaluation by Light’s criteria, which was compared with the results by Drop Hydrogen Peroxide Test. Result There were 83 patients who had pleural effusion, of them a total of 43 patients had transudative pleural effusion while 40 patients had exudative pleural effusion based on Light’s criteria and 37 patients had transudative pleural effusion while 46 patients had exudative pleural effusion based on drop hydrogen peroxide test. Conclusion The drop hydrogen peroxide test allows cost effective and prompt evaluation of the type of pleural effusion is exudative or transudative, thereby making it a convenient diagnostic bedside test. KEY WORDS Diagnostic tests, Exudates and Transudates, Hydrogen peroxide, Pleural effusion, ThoracocentesisPublication Massive Hemoptysis and Pulmonary Thromboembolism in a Patient with Pulmonary Tuberculosis: A Therapeutic Conundrum Managed with Bronchial Artery Embolization(Kathmandu University, 2022) Vaidya, N; Karmacharya, RM; Vaidya, S; Bade, S; Bade, S; Paudel, K; Kandel, G; Thapa, P; Maharjan, R; Duwal, S; Karki, YABSTRACT Hemoptysis is a crucial entity taking into account its morbidity and mortality. Pulmonary tuberculosis is the leading cause for massive hemoptysis in our part of the world, which if left untreated may be life threatening. We present a case of a 37-year-old male patient with pulmonary tuberculosis with concurrent pulmonary thromboembolism presenting with massive hemoptysis, which was successfully managed with Bronchial Artery Embolization. This case represents that this measure can be a viable therapeutic choice for a patient with a severe life- threatening hemoptysis, particularly when other treatment options are unavailable or ineffective. KEY WORDS Bronchial arteries, Embolization, Hemoptysis, Therapeutic