Browsing by Author "Yadav, Dhirendra"
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Publication Admission Rate of Patients Visiting Emergency Department in a Tertiary Care Center in Kathmandu: A Descriptive Cross-sectional Study(Nepal Medical Association, 2024) Tiwari, Sanjeeb; Tiwari, Jyotshna Sharma; Jha, Jay Bhushan; Regmi, Sushant; Yadav, Dhirendra; Kafle, Ravi; Khanal, Inesh; Shrestha, Aakripa Rani; Shrestha, Shubham; Shakya, Yagya Laxmi; Maharjan, Ramesh Kumar; Gupta, Sanjaya KumarAbstract Introduction: Emergency departments serve as the initial point of contact for patients with a wide range of conditions. Not all patients visiting get admitted to the hospital. The admission rate varies from 20% in the United States to 40.83% in Nepal. Given the variability in these results across different regions, there is a need to better understand the admission rates from the Emergency Department. Methods: A descriptive cross-sectional study was conducted after obtaining ethical approval( Reference Number: 58 (6-11)E2 081/082) in the Emergency Department of a tertiary health care center. Retrospective data was collected from the data register. The data from April 2023 to April 2024 was collected. A sample size of 222 was calculated and convenience sampling was done. Demographic details like age, sex, and data regarding admission status were collected. Data was collected in MS Excel and was analyzed using JASP software. Results: Out of 222 patients that presented to the emergency department, 53 (23.87%)(18.26-29.47,95 % Confidence Interval) were admitted to the ward or intensive care unit of the hospital, whereas 167 (75.23) got discharged, 1 (0.45%) was brought dead and 1 (0.45%) expired. The median age of patients was 43 (IQR: 26-62). The admission rate of females was 20 (17.24%), whereas for males it was 33 (31.13%). Conclusions: The prevalence of admission of patients visiting the emergency department was higher than similar US based studies. There was a higher percentage of female patients presenting to theemergency department, while those being admitted were mostly males.Publication Intracranial Calcification and Seizure with Down Syndrome: A Case Report(Nepal Medical Association, 2022) Rai, Nilshan; Thapa, Monika; Pokharel, Merina; Acharya, Jinee; Yadav, DhirendraAbstract Down syndrome is a genetic disorder caused by an extra copy of chromosome number 21. New onset of seizure in adults with Down syndrome is rare. The exact pathogenesis of intracranial calcification and seizure in Down syndrome is unknown, however, a possible association between hypocalcemia and vitamin D deficiency in Down syndrome was reported. An 18-year-old girl with nasal bridge, mongoloid slants, clinodactyly and saddle gap of toes, and prominent Downs phenotypes was present with a low level of parathyroid hormone, calcium, and vitamin D. Due to a higher prevalence of intracranial calcification in people with Down syndrome, there is an increased possibility of hypocalcemia and vitamin D deficiency. Hence, serum levels of calcium and vitamin D should always be checked before starting treatment with anti-epileptic drugs.Publication Intracranial Calcification and Seizure with Down Syndrome: A Case Report(Nepal Medical Association, 2022) Rai, Nilshan; Thapa, Monika; Pokharel, Merina; Acharya, Jinee; Yadav, DhirendraAbstract Down syndrome is a genetic disorder caused by an extra copy of chromosome number 21. New onset of seizure in adults with Down syndrome is rare. The exact pathogenesis of intracranial calcification and seizure in Down syndrome is unknown, however, a possible association between hypocalcemia and vitamin D deficiency in Down syndrome was reported. An 18-year-old girl with nasal bridge, mongoloid slants, clinodactyly and saddle gap of toes, and prominent Downs phenotypes was present with a low level of parathyroid hormone, calcium, and vitamin D. Due to a higher prevalence of intracranial calcification in people with Down syndrome, there is an increased possibility of hypocalcemia and vitamin D deficiency. Hence, serum levels of calcium and vitamin D should always be checked before starting treatment with anti-epileptic drugs.Publication Localization of a Bullet in a Firearm Injury Victim Using X-ray Imaging During Autopsy: A Case Report(Nepal Medical Association, 2024) Shrestha, Kaschev; Shrestha, Nishana; Yadav, Salmalee; Yadav, DhirendraAbstract Firearm injuries can result in varying degrees of trauma, depending on factors such as the type of firearm, range, and wound location. This case report presents the role of X-ray imaging in detecting a projectile causing fatal penetrating abdominal trauma in a 45-year-old male. The patient was found with a gunshot wound in his abdomen, and despite medical interventions, he succumbed to his injuries. X-ray imaging revealed a hyper-dense area resembling a bullet lodged in the abdominal cavity. Autopsy confirmed a close-range gunshot with significant internal damage to the peritoneum, mesentery, liver, and the bullet lodged near the L1 vertebra. This case underscores the value of radiological imaging in identifying projectile trajectory and injury severity, particularly in resource-limited settings. X-rays assist in distinguishing between penetrating and perforating wounds, aiding both forensic investigation and legal procedures. The integration of imaging in forensic autopsies improves the accuracy of injury assessment, especially in cases involving gunshot wounds.Publication Nasal Myiasis in a Female with Christ–Siemens–Touraine Syndrome: A Case Report(Nepal Medical Association, 2024) Maharjan, Leison; Shah, Anju; Yadav, Dhirendra; Shrestha, NamitaAbstract Ectodermal dysplasia is a rare disease that belongs to a diverse group of inherited monogenic disorders involving defects in one or more ectodermally or mesodermally derived tissues. Hypohidrotic ectodermal dysplasia, also known as Christ-Siemens-Touraine syndrome is a type of ectodermal dysplasia characterized by a triad of anhidrosis, dysodontia, and hypotrichiasis. The most prevalent method of transmission is X-linked recessive, manifesting fully in men and only partially in female carrier heterozygotes. Atrophic rhinitis and nasal myiasis are rare characteristics of this condition. We hereby report a case of a 52-year-old female with atrophic rhinitis and nasal myiasis who was managed conservatively.Publication Touch of Medical Ethics at the Beginning of Medical School(Nepal Medical Association, 2024) Ghimire, Nova; Yadav, DhirendraAbstract There comes a great responsibility to make patients feel better with the title of doctor. Often we meet certain moral and ethical dilemmas that cannot be solved by our medical textbook alone. It requires a certain assistance which can only be provided by medical ethics. Medical ethics is the guiding moral that guides Health Care Workers to provide a holistic approach while treating a patient. Medical ethics is the soul that can not only prevent future dilemmas but can overall make a healthcare worker ‘feel’ and have empathy for the patient. From the story of Paul and the true life stories of patients we encountered during our visit to the Leprosy center, we got a sense of empathy. Ethical practice and empathy are the pillars that can play a vital role in the rapidly increasing level of violence against the Health care professionals. So it is an emerging need to have medical ethics as a part of the curriculum among medical students.Publication Undermined Skin Lesion Emerged as Tubercular Meningitis: A Case Report(Nepal Medical Association, 2023) Yadav, Dhirendra; Khan, Javed AhmadAbstract Cutaneous tuberculosis is a rare type of extrapulmonary tuberculosis and it is uncommon even in places where tuberculosis is widespread. A 32-year-old female presented with fever and headache along with prior history of an ulcer in her leg which was treated as cellulitis at another centre. The neck rigidity, and the Kernig and Budzinski sign were also positive. There were also features of increased intracranial pressure. The non-contrast computed tomography showed bilateral hydrocephalus and hypodense areas. She was managed for increased intracranial pressure and anti-tubercular therapy for disseminated tuberculosis. Biopsy of non-healing wounds should be checked for lupus vulgaris.