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Pérez Lugo MI, Salas ML, Shrestha A, Ramalingam L. Fish Oil Improves Offspring Metabolic Health of Paternal Obese Mice by Targeting Adipose Tissue. Biomolecules 2024; 14:418. [PMID: 38672435 PMCID: PMC11048145 DOI: 10.3390/biom14040418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Obesity is a fast-growing epidemic affecting more than 40% of the US population and leads to co-morbidities such as type 2 diabetes and cancer. More importantly, there is a rapid increase in childhood obesity associated with obesity in parents. Further, offspring are encoded with approximately half of their genetic information from the paternal side. Obesity in fathers at the preconceptional period likely influences the intergenerational development of obesity. This study focuses on the role of fish oil supplementation as a non-pharmacological intervention in fathers and its impact on childhood obesity using animal models. Male mice were fed a low-fat diet or high-fat diet with or without fish oil for 10 weeks and mated with female mice on a chow diet. Offspring were then continued on a chow diet until 8 or 16 weeks. In vivo insulin tolerance was tested to assess the metabolic health of offspring. Further, adipose tissue was harvested upon sacrifice, and genetic markers of inflammation and lipid metabolism in the tissue were analyzed. Offspring of males supplemented with fish oil showed lower body weight, improved insulin tolerance, and altered inflammatory markers. Markers of fatty acid oxidation were higher, while markers of fatty acid synthesis were lower in offspring of fathers fed fish oil. This supports fish oil as an accessible intervention to improve offspring metabolic health.
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Affiliation(s)
| | | | | | - Latha Ramalingam
- Department of Nutrition and Food Studies, Syracuse University, Syracuse, NY 13244, USA (M.L.S.); (A.S.)
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Shrestha A, Dellett SK, Yang J, Sharma U, Ramalingam L. Effects of Fish Oil Supplementation on Reducing the Effects of Paternal Obesity and Preventing Fatty Liver in Offspring. Nutrients 2023; 15:5038. [PMID: 38140297 PMCID: PMC10745816 DOI: 10.3390/nu15245038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/30/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a serious public health concern, which calls for appropriate diet/nutrition intervention. Fish oil (FO) has several benefits in reducing obesity, but its intergenerational role in reducing the effects of paternal obesity has not been established. Hence, we hypothesized that FO supplementation to an obese father during the pre-conceptional period could improve the metabolic health of the offspring, specifically in the liver. Three groups of male mice were fed with a low-fat (LF), high-fat (HF), or high-fat diet supplemented with FO (HF-FO) for 10 weeks and were then allowed to mate with female mice fed a chow diet. Offspring were sacrificed at 16 weeks. The liver tissue was harvested for genomic and histological analyses. The offspring of HF and HF-FO fathers were heavier compared to that of the LF mice during 9-16 weeks. The glucose tolerance of the offspring of HF-FO fathers were significantly improved as compared to the offspring of HF fathers. Paternal FO supplementation significantly lowered inflammation and fatty acid synthesis biomarkers and increased fatty acid oxidation biomarkers in the offspring liver. In summary, FO supplementation in fathers shows the potential to reduce metabolic and cardiovascular diseases through genetic means in offspring.
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Affiliation(s)
- Akriti Shrestha
- Department of Nutrition and Food Studies, Syracuse University, Syracuse, NY 13244, USA; (A.S.); (S.K.D.); (J.Y.)
| | - Sarah Katherine Dellett
- Department of Nutrition and Food Studies, Syracuse University, Syracuse, NY 13244, USA; (A.S.); (S.K.D.); (J.Y.)
| | - Junhui Yang
- Department of Nutrition and Food Studies, Syracuse University, Syracuse, NY 13244, USA; (A.S.); (S.K.D.); (J.Y.)
| | - Upasna Sharma
- Department of Molecular, Cell and Developmental Biology, University of California Santa Cruz, Santa Cruz, CA 95064, USA;
| | - Latha Ramalingam
- Department of Nutrition and Food Studies, Syracuse University, Syracuse, NY 13244, USA; (A.S.); (S.K.D.); (J.Y.)
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Hamid M, Bird J, Yeo J, Shrestha A, Carter M, Kudhail K, Akingboye A, Sellahewa C. Paradigm shift towards emergency cholecystectomy: one site experience of the Chole-QuiC process. Ann R Coll Surg Engl 2023. [PMID: 38037953 DOI: 10.1308/rcsann.2023.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Substantial evidence exists for the superiority of emergency over delayed cholecystectomy for gallstone disease during primary admission. Despite this, emergency surgery rates in the UK remain low compared with other developed countries, with great variation in care across the nation. We aimed to describe the local paradigm shift towards emergency surgery and investigate outcomes. METHODS This is a prospective observational study examining patients enrolled onto an emergency cholecystectomy pathway, following the hospital's subscription to the Royal College of Surgeons of England's Cholecystectomy Quality Improvement Collaborative (Chole-QuIC), between 1 December 2021 and 31 January 2023. Multivariate logistical regression models were used to identify patient and hospital factors associated with postoperative outcomes. RESULTS Of the 307 suitable acute admissions, 261 (85%) had an emergency cholecystectomy, compared with 5% preceding the Chole-QuIC interventions. Waiting time dropped from 67 to 5 days. A total of 208 (79.7%) patients were primary presentations, 92 (35.2%) were classed Tokyo grade 2 and 142 (54.4%) were obese. A total of 23 (8.8%) patients underwent preoperative endoscopic retrograde cholangiopancreatography, and 26 (10%) patients had a subtotal cholecystectomy. Favourable outcomes (Clavien Dindo ≥3) were observed in first presentations (odds ratio (OR) 0.35; p=0.042) and for operation times within 7 days (OR 0.32; p=0.037), with worse outcomes in BMI ≥35 (OR 3.32; p=0.005) and operation time >7 days (OR 3.11; p=0.037). CONCLUSION A paradigm shift towards emergency cholecystectomy benefits both the patient and the service. Positive outcomes are apparent for early operation in patients presenting for the first time and recurrent attendees, with early operation (<7 days) providing the most favourable outcome in a select patient group.
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Affiliation(s)
- M Hamid
- Dudley Group NHS Foundation Trust, UK
| | - J Bird
- Dudley Group NHS Foundation Trust, UK
| | - J Yeo
- Dudley Group NHS Foundation Trust, UK
| | | | - M Carter
- Dudley Group NHS Foundation Trust, UK
| | - K Kudhail
- Dudley Group NHS Foundation Trust, UK
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Emiliani E, Sanz-Gómez I, Somani B, Tailly T, Castellani D, Traxer O, Yuen-Chun Teoh J, Chew B, Ong Lay Keat W, Chai CA, Bin-Hamri S, Shrestha A, Soehabali B, Angerri O, Gauhar V. Does gender influence retrograde intrarenal surgery (RIRS) outcomes? Data from the Flexible Ureteroscopy Outcomes Registry (FLEXOR). Actas Urol Esp 2023; 47:581-587. [PMID: 37369300 DOI: 10.1016/j.acuroe.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION AND OBJECTIVES As well established flexible ureteroscopy (RIRS). There is still no evidence if gender can have any influence on the outcomes and complication when performing. This study aims to evaluate the role that gender has in performing flexible ureteroscopy from a large series of patients. METHODS This study retrospectively analyzed patients who underwent RIRS for renal stones from January 2018 to August 2021 within the multicentric FLEXOR registry. Demographics, stone characteristics, perioperative findings, results and complications were analyzed and compared between gender groups. RESULTS A total of 6669 patients were included, 66.1% were male and 33.9% were female. Stone characteristics was comparable between groups. Female patients had significant higher fever and positive urine culture rates (12% vs. 8% and 37% vs. 34%). Also, females had a slight longer hospital stay (3.8 vs. 3.5 days; P < 0.001) and more residual fragments after the procedure (23.03% vs. 20.97 (P = 0.032). Overall complications were slightly significantly higher in women (15.74% vs. 14% (P = 0.042)) mainly at the expense of fever rates (6.9% vs. 5.7%) whereas the risk of sepsis was similar in both groups. A multivariate analysis showed that larger stone size, multiple and lower pole stones seem to have a negative impact in the incidence of residual stones and complications. CONCLUSION Our real life global study reflects that female gender may have a correlation with a slightly increased residual fragment rate and overall low grade complications. However, women can safely be treated with RIRS with no increased the rate of sepsis with appropriate care.
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Affiliation(s)
- E Emiliani
- Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - I Sanz-Gómez
- Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - B Somani
- Servicio de Urología, Hospital Universitario de Southampton, NHS Trust, Southampton, United Kingdom
| | - T Tailly
- Servicio de Urología, Hospital Universitario de Gante, Gante, Belgium
| | - D Castellani
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - O Traxer
- Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), París, France
| | - J Yuen-Chun Teoh
- Servicio de Cirugía, Clínica de Urología S.H. Ho, Facultad de Medicina, Universidad China de Hong Kong, Hong Kong, China
| | - B Chew
- Departamento de Urología, Universidad de British Columbia, Vancouver, Canada
| | - W Ong Lay Keat
- Servicio de Urología, Hospital General de Penang, Georgetown, Malaysia
| | - C A Chai
- Departamento de Urología, Universidad de Malaya, Kuala Lumpur, Malaysia
| | - Saeed Bin-Hamri
- Servicio de Urología, King Abdulaziz National Guard Medical City, Riad, Saudi Arabia
| | - A Shrestha
- Servicio de Urología, Hospital Bir, Academia Nacional de Ciencias Médicas, Katmandú, Nepal
| | - B Soehabali
- Departamento de Urología, Facultad de Medicina, Universidad de Mulawarman, Hospital Abdul Wahab Sjahranie, Samarinda, Indonesia
| | - O Angerri
- Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - V Gauhar
- Servicio de Urología, Hospital General Ng Teng Fong, Singapur, Singapore
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Shrestha A, Hagemeier T. Solyx Minisling Surgery for Stress Urinary Incontinence: Dhulikhel Hospital Initiative. Kathmandu Univ Med J (KUMJ) 2023; 21:227-229. [PMID: 38628019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Solyx mini-sling surgery is a single-incision procedure that is used to treat stress urinary incontinence (SUI) in women. SUI is a common medical condition characterized by the involuntary leakage of urine with activity such as laughing, coughing, and sneezing. It affects 35% of adult women worldwide. The Solyx sling is a minimally invasive procedure that can be performed through a single vaginal incision. It is a safe and effective treatment for SUI, with a high success rate. The mini-sling is inserted through a small, single incision in the vagina. This makes the procedure less invasive than traditional sling surgery, which requires a larger incision in the abdomen or groin. The Solyx mini sling is also adjustable, which means that the surgeon can make adjustments to the tension of the sling after it is inserted. This helps to ensure that the sling is properly positioned and that the patient experiences optimal results. We have performed Solyx minisling surgery in 182 women and we found it very effective. 96% of women had no leakage of urine while coughing, sneezing after one week of surgery. We have performed this surgery in rural areas of Nepal where there is no facility of cystoscopy.
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Affiliation(s)
- A Shrestha
- Department of Obstetrics and Gynecology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - T Hagemeier
- MVZ SRH Poliklinik Suhl GmbH, Facharzt für Frauenheilkunde und Geburtshilfe
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Sanz I, Gauhar V, Somani B, Tailly T, Castellani D, Traxer O, Teoh J, Chew B, Lay Keat W, Ann C, Bin Hamri S, Shrestha A, Soehabali B, Angerri O, Emiliani E. Does gender have any influence on RIRS outcomes? Data from the FLEXible ureteroscopy Outcomes Registry (FLEXOR). Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01247-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Tanidir Y, Sekerci C, Castellani D, Ferretti S, Gatti C, Campobasso D, Bujons A, Quiroz Y, Teoh J, Pietropaolo A, Ragoori D, Bhatia T, Vaddi C, Shrestha A, Lim E, Fong K, Sinha M, Griffin S, Sarica K, Somani B, Traxer O, Gauhar V. The utility and safety of ureteral access sheath during retrograde intrarenal surgery in children. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00632-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Chu Ann C, Somani B, Yuen-Chun Teoh J, Tailly T, Emiliani E, Inoue T, Tanidir Y, Gadzhiev N, Bin Hamri S, Lay Keat W, Shrestha A, Ragoori D, Lakmichi M, Gorelov D, Soebhali B, Vaddi C, Bhatia T, Desai D, Durai P, Heng C, Chew B, Castellani D, Traxer O, Gauhar V. Comparing Retrograde Intrarenal Surgery (RIRS) outcomes between pre-stented vs non-stented patients Inferences from 6679 patients of the global FLEXible ureteroscopy Outcomes Registry (FLEXOR). Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Shrestha A, Bhattarai S, Madhup SK. Pyrexia in Pregnancy and its Maternal and Fetal Outcome. Kathmandu Univ Med J (KUMJ) 2023; 21:7-12. [PMID: 37800418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Background Contemporary obstetrics has witnessed improved maternal and fetal outcomes, owing to several advances. Any source of maternal hyperthermia that results in significant core temperature increase (> 38°C), could potentially affect the fetus. Fetus being an integral part of the feto-maternal unit and pregnancy involving numerous physiological changes and adaptations, pyrexia during the pregnancy affects both the mother and her fetus adversely. Objective To find the etiology and prevalence of fever in pregnancy and to know the effect of fever on maternal and fetal outcome. Method Pregnant ladies with fever > 38°C, presenting to Obstetrics and Gynecology, Department of Dhulikhel Hospital were enrolled in the study. A detailed clinical history, thorough general and physical examinations were done. All risk factors were asked and recorded including all baseline investigations and cases were followed up till delivery. Maternal and fetal outcomes were recorded. Data were recorded in Excel and calculated using SPSS 26. Result Eighty patients presented with complaints of fever were included in this study. The mean age of the patient was 25.49± 4.50 years. Out of 80 patients, 46 (57.50%) presented with fever in the third trimester. The most common etiology of fever being urinary tract infection in 21 (26%) cases followed by respiratory tract infection in 20 (25.1%) cases. Twenty two newborns had low birth weight among which 12 (15%) neonates had IUGR. About 14 (17.5%) neonates were admitted in NICU due to various complications and perinatal mortality was in 9 (11.25%) cases. The most common antepartum complication was preterm labor in 16 (20%) cases. Conclusion Fever in pregnancy is still a challenge to obstetrician and the society at large due its problems related to its prevention, diagnosis, management and its feto-maternal outcome. Hence, an evaluation of the effect and outcomes of fever in pregnancy, provides definite knowledge of clinical epidemiology, and facilitates optimum prioritization of efforts and resources.
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Affiliation(s)
- A Shrestha
- Department of Obstetrics and Gynecology, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Bhattarai
- Department of Obstetrics and Gynecology, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S K Madhup
- Department of Microbiology, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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Prajapati D, Bhandari N, Gautam P, Dhital R, Shrestha A. Coronary Artery Disease in Nepal: Current Perspective, Challenges, Need for National Practice Guidelines, and Potential Solutions. Kathmandu Univ Med J (KUMJ) 2022; 20:505-513. [PMID: 37795733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
South Asians are estimated to have a 40% increased risk for coronary artery disease as compared to populations from other regions. Nepal, as a South Asian country, should also analyze the burden of coronary artery disease and its risk factors to minimize cardiovascular morbidity and mortality. We reviewed the barriers to cardiovascular care and its services in low- and middle-income countries, including Nepal. The identified barriers included coronary artery disease risk factors, access, cost, adherence to cardiovascular care, awareness, knowledge gaps, and socioeconomic and health system challenges. The possible strategies to reduce coronary artery disease included national, regional, and local perspectives. It also highlighted the involvement of community workers and local leaders, education, patient-centered intervention, easy access to drugs and treatments, rehabilitation and public health measures, innovation within the health care system, and multi-sectoral involvement. This review provides insights into the current situation of coronary artery disease and its possible solutions.
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Affiliation(s)
- D Prajapati
- Department of Cardiology, Shahid Gangalal National Heart Center, Bansbari, Kathmandu, Nepal. And National Academy of Medical Sciences, Kathmandu, Nepal
| | - N Bhandari
- Institute for Implementation Science and Health, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Authentic Leadership Institute Nepal, Kathmandu, Nepal
| | - P Gautam
- Harvard T.H. Chan School of Public Health, Global Health and Population, Boston, MA, US
| | - R Dhital
- Health Action and Research, Kathmandu, Nepal
| | - A Shrestha
- Institute for Implementation Science and Health, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Khan GA, Shrestha A. An Anatomical Variation of Median Artery of Forearm and Palm: Cadaveric Study into its Origin and Course. Kathmandu Univ Med J (KUMJ) 2022; 20:443-447. [PMID: 37795721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Background The median artery (transitory artery) represents the forearm's embryonic arterial axis. At 8th week of gestation retreats into a little canal that supplies the median nerve. Later, ulnar and radial arteries take its place. Adults may still have it in either a palmar or an antebrachial pattern. The persistent median arteries are a long, angular arterial that extends to the hand's palmar surface. The median artery only partially recedes in the antebrachial type. Objective To identify the median artery distribution in the adult Nepalese population. Method Twenty-five adult human cadavers' left and right upper limbs undergone to descriptive research. The persistent median artery was exposed according to the Cunningham's Manual of Practical Anatomy. Result The forearm and hand arteries in each of the fifty upper limbs from the twentyfive formalin-embalmed human cadavers were studied. Among fifty upper limbs, persistent median arteries were found in six (twelve percent) of them. One percent of a cadaver's right and left limbs had bilateral persisting median arteries (ante brachial). Persistent median artery of the ante brachial type that arises from the anterior interosseous artery in a right upper limb. Persistent median artery emerging from the posterior interosseous arteries were visible in one right upper limb. Conclusion The study showed persistent median artery of ante brachial type. The posterior interosseus artery is the source of the majority of antebrachial type. A median artery piercing the median nerve was discovered.
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Affiliation(s)
- G A Khan
- Department of Anatomy, Chitwan Medical College, Bharatpur, Chitwan, Nepal
| | - A Shrestha
- Department of Anatomy, Chitwan Medical College, Bharatpur, Chitwan, Nepal
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Shrestha A, Shrestha P, Shrestha T, Makaju Shrestha R, Shrestha B, Poudel L, Shrestha JK. Clinical Characteristics of Cataract Patients and Outcome of Cataract Surgery in Tertiary Care Hospital in Central Nepal. Kathmandu Univ Med J (KUMJ) 2022; 20:401-405. [PMID: 37795712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Background Cataract remains the leading cause of avoidable blindness in low-income countries such as Nepal. Despite the availability of surgical interventions for cataract in leading institutions, still a large number of patients from remote areas delay or have difficulty in getting treatment, present late or with complications. Objective To determine the clinical characteristics and visual outcome of patients undergoing cataract surgery in Tertiary Care Hospital in Central Nepal. Method We retrospectively reviewed the medical records of 138 patients who underwent cataract surgery at a tertiary care hospital from January 2018 to September 2022. R version 4.0.3 was used for the data analysis. Categorical variables are presented as frequency (percentages) and the numerical ones are presented as mean (standard deviation). Result During follow-up visits between one to three weeks, 91.9% out of 135 patients had normal/near normal presenting visual acuity and with best correction it was 96.9% out of 131 patients. About 1.6% out of 124 operated eyes still had moderate visual impairment after best correction when they visited for follow-up at 12 weeks. Conclusion The study findings underline the ongoing gap in increasing access to cataract treatment, given the large proportion of individuals who still presented extremely late.
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Affiliation(s)
- A Shrestha
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - P Shrestha
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - T Shrestha
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - R Makaju Shrestha
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - B Shrestha
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - L Poudel
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - J K Shrestha
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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Lau A, Aseem R, Shrestha A. 175 Rare Complications and Management of Port Site Hernias (PSH) Following Robotic-Assisted Radical Prostatectomy (RARP). Br J Surg 2022. [DOI: 10.1093/bjs/znac269.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Robot-assisted surgery has become increasingly prevalent in surgical practice and is very commonly performed in urological cancers especially of the prostate gland. Robotic surgical techniques are safe and reproducible; however, they have their associated complications. Risk factors such as the nature of cancer, learning curve of the surgery, experience of the surgeon and patient characteristics have been implicated for potential complications. Complications can range from bleeding, infection, bowel injury, ureteric and nerve damage. Port site hernias (PSH) are an infrequent complication with a reported incidence varying from 0.2–4.8%. Although uncommon, they can result in high morbidity due to bowel incarceration and strangulation.
We report two cases of PSH from our large district general hospital, both at the supraumbilical port site after robotic assisted radical prostatectomy (RARP). The first case presented with complete evisceration and strangulation of a segment of small bowel and the second with bowel incarceration and small bowel obstruction. Our cases highlight potentially rare but severe complications of RARP that should be promptly recognised and urgently treated to prevent significant patient morbidity and mortality.
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Affiliation(s)
- A Lau
- William Harvey Hospital , Ashford , United Kingdom
| | - R Aseem
- William Harvey Hospital , Ashford , United Kingdom
- East Kent Hospitals University NHS Foundation Trust , Kent , United Kingdom
| | - A Shrestha
- William Harvey Hospital , Ashford , United Kingdom
- East Kent Hospitals University NHS Foundation Trust , Ashford , United Kingdom
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Tanwar A, Gurung C, Pangeni A, Shrestha A, Basnyat P. 509 Splenosis, an Important Differential for Peritoneal Metastases. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Splenosis is defined as the auto-transplantation of splenic tissues in other sites of the body. It is a rare benign condition and can be an incidental finding. However, early diagnosis is essential as the differential diagnosis of splenosis includes peritoneal metastases.
Early identification relies on recognising relevant past medical history including splenic injury and or splenectomy. Splenosis can be confirmed through the usage of a technetium-99m colloid scan. By using nuclear medicine scans, repeated invasive investigations such as biopsy and diagnostic laparoscopies can be avoided.
We present here a case of a 51-year-old woman who was extensively investigated by the gynaecology department and general surgery department, even undergoing a diagnostic laparoscopy following repeated presentations to primary and secondary care with chronic abdominal and pelvic pain. She had a splenectomy 28 years earlier for traumatic splenic injury. CT scan of abdomen and pelvis showed features suspicious of multiple peritoneal metastases and hence she was urgently referred to a colorectal cancer multidisciplinary meeting. A subsequent technetium-99m colloid scan confirmed multiple splenic nodules in the peritoneal cavity. The patient was reassured and discharged.
In conclusion, in a patient with a known history of splenic trauma, splenosis is an important differential diagnosis. A careful past medical history and appropriate investigations will avoid unnecessary referral and invasive investigations.
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Affiliation(s)
- A Tanwar
- William Harvey Hospital , Ashford , United Kingdom
| | - C Gurung
- William Harvey Hospital , Ashford , United Kingdom
| | - A Pangeni
- William Harvey Hospital , Ashford , United Kingdom
| | - A Shrestha
- William Harvey Hospital , Ashford , United Kingdom
| | - P Basnyat
- William Harvey Hospital , Ashford , United Kingdom
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Shrestha AD, Andersen JG, Gyawali B, Shrestha A, Shrestha S, Neupane D, Ghimire S, Campbell C, Kallestrup P. Cervical cancer screening utilization, and associated factors, in Nepal: a systematic review and meta-analysis. Public Health 2022; 210:16-25. [PMID: 35863158 DOI: 10.1016/j.puhe.2022.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 05/23/2022] [Accepted: 06/11/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To systematically appraise the existing published literature on cervical cancer screening utilization, and associated barriers and facilitators, in Nepal. STUDY DESIGN Systematic literature review and meta-analysis. METHODS PubMed/MEDLINE, CINAHL, Scopus, Embase, and, Google Scholar were systematically searched using Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. All quantitative and qualitative studies reporting cervical cancer screening (using the Pap smear test or visual inspection with acetic acid or human papillomavirus test) utilization, barriers, and facilitators for screening were identified. A meta-analysis was performed to estimate Nepal's pooled cervical cancer screening utilization proportion. RESULTS The search yielded 97 records, of which 17 studies were included. Fifteen studies were quantitative and two were qualitative. Of the 17 studies, six were hospital-based and six were community-based. The pooled cervical cancer screening utilization proportion (using Pap smear test) among Nepalese women was 17% from the studies in the hospital settings, and 16% in the community. Six studies reported barriers to cervical cancer screening, of which four reported embarrassments related to the gynecological examination and a low level of knowledge on cervical cancer. Three (of four) studies reported health personnel, and two studies reported screening services-related facilitators for cervical cancer screening. CONCLUSION Our review reported that cervical cancer screening utilization (16%) is more than four times lower than the national target (70%) in Nepal. Multiple barriers such as low levels of knowledge and embarrassment are associated with cervical cancer screening utilization. Health personnel's gender, counseling, and privacy of screening services were commonly reported facilitators. These findings could help to inform future research, and policy efforts to increase cervical cancer screening utilization in Nepal.
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Affiliation(s)
- A D Shrestha
- Center for Global Health, Department of Public Health, Aarhus University, Denmark; COBIN, Nepal Development Society, Bharatpur, Nepal.
| | - J G Andersen
- Center for Global Health, Department of Public Health, Aarhus University, Denmark
| | - B Gyawali
- Global Health Section, Department of Public Health, University of Copenhagen, Denmark
| | - A Shrestha
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA; Institute for Implementation Science, Kathmandu, Nepal
| | - S Shrestha
- School of Public Health, University of Alabama, Birmingham, AL, USA
| | - D Neupane
- COBIN, Nepal Development Society, Bharatpur, Nepal; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - S Ghimire
- Nepal Cancer Care Foundation, Lalitpur, Nepal
| | - C Campbell
- Usher Institute, University of Edinburgh, EH8 9AG, United Kingdom
| | - P Kallestrup
- Center for Global Health, Department of Public Health, Aarhus University, Denmark
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Haziza S, Hernandez V, Carvajal J, Ocksrider J, Zieminski C, Rosenberg C, Shrestha A, Lebwohl N. A Discussion on The Utility of Discharge Location Prediction Models for Total Joint Arthroplasty Surgery. Muscles Ligaments Tendons J 2022. [DOI: 10.32098/mltj.03.2022.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Koirala B, Adhikari SR, Shrestha A, Vaidya A, Aryal KK, Kalaunee SP, Shrestha A, Mishra SR, Sharma SK, Karki A, Maharjan B, Singh S, Schwarz D, Gupta N, Bukhman G, Karmacharya BM. A National Equity Initiative to Address Noncommunicable Diseases and Injuries: Findings and Recommendation from the Nepal NCDI Poverty Commission. Kathmandu Univ Med J (KUMJ) 2022; 20:376-383. [PMID: 37042383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
We aimed to assess the burden of NCDIs across socioeconomic groups, their economic impact, existing health service readiness and availability, current policy frameworks and national investment, and planned programmatic initiatives in Nepal through a comprehensive literature review. Secondary data from Global Burden of Disease estimates from GBD 2015 and National Living Standard Survey 2011 were used to estimate the burden of NCDI and present the relationship of NCDI burden with socioeconomic status. The Commission used these data to define priority NCDI conditions and recommend potential cost-effective, poverty-averting, and equity-promoting health system interventions. NCDIs disproportionately affect the health and well-being of poorer populations in Nepal and cause significant impoverishment. The Commission found a high diversity of NCDIs in Nepal, with approximately 60% of the morbidity and mortality caused by NCDIs without primary quantified behavioral or metabolic risk factors, and nearly half of all NCDI-related DALYs occurring in Nepalese younger than 40 years. The Commission prioritized an expanded set of twenty-five NCDI conditions and recommended introduction or scale-up of twenty-three evidence-based health sector interventions. Implementation of these interventions would avert an estimated 9680 premature deaths per annum by 2030 and would cost approximately $8.76 per capita. The Commission modelled potential financing mechanisms, including increased excise taxation on tobacco, alcohol, and sugar-sweetened beverages, which would provide significant revenue for NCDI-related expenditures. Overall, the Commission's conclusions are expected to be a valuable contribution to equitable NCDI planning in Nepal and similar resource-constrained settings globally.
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Affiliation(s)
- B Koirala
- Tribhuvan University, Institute of Medicine, Department of Cardiothoracic and Vascular Surgery,Maharajgunj, Kathmandu. and Kathmandu Institute of Child Health, Budhanilkantha, Kathmandu
| | - S R Adhikari
- Tribhuvan University Faculty of Humanities and Social Sciences, Central Department of Economics, Kritipur, Kathmandu
| | - A Shrestha
- Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre
| | - A Vaidya
- Kathmandu Medical College and Teaching Hospital, Department of Community Medicine, Sinamangal, Kathmandu
| | - K K Aryal
- Bergen Center for Ethics and Priority Setting in Health, Department of Global Public Health and Primary Care, University of Bergen
| | | | - A Shrestha
- Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre
| | - S R Mishra
- Nepal Development Society, Chitwan, Nepal
| | - S K Sharma
- B.P. Koirala Institute of Health Sciences, Dharan
| | - A Karki
- School of Health, Medical and Applied Sciences, Central Queensland University
| | - B Maharjan
- Kathmandu Institute of Child Health, Budhanilkantha, Kathmandu
| | - S Singh
- Kathmandu Institute of Child Health, Budhanilkantha, Kathmandu
| | - D Schwarz
- Brigham and Women's Hospital, Division of Global Health Equity; Harvard Medical School, Department of Medicine
| | - N Gupta
- Center for Integration Science, Brigham and Women's Hospital; Program in Global NCDs and Social Change, Harvard Medical School; NCD Synergies Project, Partners In Health; NCDI Poverty Network, Boston, USA
| | - G Bukhman
- Center for Integration Science, Brigham and Women's Hospital; Program in Global NCDs and Social Change, Harvard Medical School; NCD Synergies Project, Partners In Health; NCDI Poverty Network, Boston, USA
| | - B M Karmacharya
- Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre
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Grimley M, Kent M, Asnani M, Shrestha A, Felker S, Lutzko C, Arumugam P, Witting S, Knight-Madden J, Niss O, Quinn C, Lo C, Little C, Dong A, Malik P. P1453: STABLE TRANSDUCTION OF FETAL HEMOGLOBIN IN PATIENTS WITH SICKLE CELL DISEASE IN THE PHASE 1/2 MOMENTUM STUDY OF ARU-1801 GENE THERAPY AND REDUCED INTENSITY CONDITIONING. Hemasphere 2022. [PMCID: PMC9429142 DOI: 10.1097/01.hs9.0000848668.22824.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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19
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Thapa B, Sharma S, Shrestha A, Maharjan R, Jha N, Bajracharya S, Shrestha S, Neupane T, Sapkota BP, Koju RP, Oli N. Human Resources for Cardiovascular Disease Management in Nepal: A National Need Assessment. Kathmandu Univ Med J (KUMJ) 2022; 19:3-10. [PMID: 35526131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background Human resources are the mainstay of the healthcare system. Higher numbers of health workers have better healthcare coverage and outcomes. Availability of trained human resources to address the exponential rise in cardiovascular disease in Nepal is a national concern. Objective To assess the need of human resources for cardiovascular disease management in Nepal. Method We conducted an exploratory sequential mixed-method study. We developed a task force and organized a national workshop to engage stakeholders and collect feedback on the research process. We did a desk review and conducted 24 key informant interviews. We did thematic analysis from the codes generated. Result There is no clear definition and required estimation of health workers for cardiovascular disease management. There is a shortage of health workers with 8.9 doctors, 20.8 nurses, 0.05 cardiologist/cardiac surgeon, 4.2 pharmacist, 10.2 laboratory technicians per 10,000 population. There is a comprehensive human resource plan but it does not provide details of human resources for cardiovascular disease management. There is a lack of public private collaboration for human resource management. However, there is production of human resources for cardiovascular disease management through pre-service specialized courses and inservice training. Conclusion A clear definition and estimation of health workers with stringent human resource plan for cardiovascular disease management is essential. The government can still address these gaps by establishing a well-equipped central health workforce unit and expanding collaboration with private sectors.
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Affiliation(s)
- B Thapa
- Department of Nursing, Tribhuvan University, Institute of Medicine, Nepalgunj Nursing Campus, Banke, Nepal. and Fellow, TREIN Nepal, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Sharma
- Fellow, TREIN Nepal, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. Department of Nursing, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal. and Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - A Shrestha
- Department of Public Health and Community Programs, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. and Institute for Implementation Science and Health, Kathmandu, Nepal
| | - R Maharjan
- Fellow, TREIN Nepal, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. and Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. Kathmandu, Nepal
| | - N Jha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Bajracharya
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - T Neupane
- Nepal Health Research Council, Kathmandu, Nepal
| | - B P Sapkota
- Health Coordination Division, Ministry of Health and Population, Kathmandu Nepal. and CIH-LMU Center for International Health, University Hospital, LMU Munich, Germany
| | - R P Koju
- Dean, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre. and Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre
| | - N Oli
- Department of Community Medicine, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
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20
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Sapkota S, Shrestha S, Bista D, Shrestha A, Maharjan R, Bajracharya S, Jha N, Koju RP, Shrestha R. Medical Products for Cardiovascular Disease Management in Nepal: a needs assessment study. Kathmandu Univ Med J (KUMJ) 2022; 19:18-29. [PMID: 35526133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background Medical Products and Technologies is a key component of the health system. Quality medicines and efficient management of the medical products can secure effective cardiovascular diseases management. Objective To collate information and identify strengths, weaknesses, opportunities and threats (SWOT) associated with medical products and technology component for cardiovascular disease management in Nepal. Method This study is a part of a larger rapid assessment of Nepal's health system for cardiovascular disease management and based on The Health System Assessment Approach: A How-To Manual (USAID). The authors conducted a desk review of documents related to the WHO "medical product and technology" building block component and key informant interviews using a pre-tested interview protocol. The first eight interviews were transcribed verbatim and analysed inductively to generate a codebook; and the remaining, transcribed and deductively coded based on the codebook. Findings were categorised into relevant topical area and SWOT components. Result Nepal has laws and provisions for medicine regulation, pharmacovigilance, post marketing surveillance, registration and licensing provisions for pharmacy industries/ outlets, essential medicine lists and national formulary. These provisions also apply to medicines used for cardiovascular diseases. The challenge however, is the lack of effective implementation and monitoring, due to shortages of technical workforce and state of art information and technologies. Information on pharmaceutical expenditures for cardiovascular disease management is scarce; there are no standard national level guidelines that are consistently used to manage cardiovascular diseases in health facilities. Conclusion There are limited provisions and information on medical products for cardiovascular disease management in Nepal, and a need to strengthen existing provisions for medicine regulations and surveillance.
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Affiliation(s)
- S Sapkota
- Research Division, Manmohan Memorial Institute of Health Sciences, Soalteemod, Kathmandu, Nepal. Department of Pharmacy, Manmohan Memorial Institute of Health Sciences, Soalteemode, Kathmandu, Nepal. and Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Shrestha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - D Bista
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Department of Pharmacy, Kathmandu University, Dhulikhel, Kavrepalanchowk, Nepal
| | - A Shrestha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal. Department of Public Health, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Nepal. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. Institute for Implementation Science and Health, Kathmandu, Nepal
| | - R Maharjan
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal. and Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Bajracharya
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - N Jha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - R P Koju
- Dean, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Nepal. and Department of Internal Medicine, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - R Shrestha
- Department of Pharmacology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Pharmacovigilance Unit/Research and Development Division, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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21
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Suwal PS, Prajapati D, Bajracharya S, Shrestha A, Maharjan R, Shrestha S, Jha N, Koju RP, Vaidya A. Assessment of Health Service Delivery to Address Cardiovascular Diseases in Nepal. Kathmandu Univ Med J (KUMJ) 2022; 19:40-50. [PMID: 35526135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background A health care delivery system is the organization of people, institutions, and resources designed to deliver health services. A comprehensive study to explore cardiovascular health service delivery in Nepal is lacking. Objective This study attempted to assess Nepal's health system gap on organization and delivery of cardiovascular disease prevention and management services. Method This mixed-method study used the six building blocks of the World Health Organization health system framework: organization; access; coverage, utilization and demand; equity; quality of services; and outcomes. We conducted the desk reviews of national and international documents, performed several key informant interviews, calculated the relevant indicators, and assessed the Strengths, Weaknesses, Opportunities, and Threats of the cardiovascular health service delivery. Result We found that most of the cardiovascular services are concentrated in urban areas, and suffer from poor access, quality, utilization, and coverage in most of the areas resulting in poor health outcomes. Though the services have recently improved due to increased primary care interventions, there is scope for the development of competent human resources, advancement of technologies, development of national protocols, and improved monitoring and supervision. Improved disease system including the medical recording and reporting mechanism to incorporate and reflect the true burden of CVD in Nepal is lacking. Conclusion Despite having health facilities from grassroots to the central level, availability, access, and quality of cardiovascular health services are poor. Further improvement and equitable expansion of promotive, preventive, diagnostic, referral, and rehabilitative cardiovascular services are needed to ensure universal health coverage.
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Affiliation(s)
- P S Suwal
- Nepal Institute of Health Sciences, Jorpati Kathmandu, Nepal. and Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - D Prajapati
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Shahid Gangalal National Heart Centre, and National Academy of Medical Sciences, Kathmandu, Nepal
| | - S Bajracharya
- Department of Community Programs, Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - A Shrestha
- Department of Community Programs, Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchowk, Nepal. Department of Public Health, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Nepal. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. and Institute for Implementation Science and Health, Kathmandu, Nepal
| | - R Maharjan
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. Department of Community Programs, Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchowk, Nepal. and Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA
| | - S Shrestha
- Department of Community Programs, Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - N Jha
- Department of Community Programs, Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - R P Koju
- Dean, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Nepal. and Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - A Vaidya
- Department of Community Medicine, Kathmandu Medical College Public Limited, Kathmandu, Nepal
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Pradhan PM, Bhatt RD, Pandit R, Shrestha A, Maharjan R, Jha N, Bajracharya S, Shrestha S, Koju RP, Karmacharya BM. Needs Assessment of Leadership and Governance in Cardiovascular Health in Nepal. Kathmandu Univ Med J (KUMJ) 2022; 19:30-39. [PMID: 35526134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background Good governance and leadership are essential to improve healthy life expectancy particularly in low and middle-income countries (LMICs). This study aimed to epitomize the challenges and opportunities for leadership and good governance for the health system to address non-communicable diseases particularly cardiovascular diseases (CVD) in Nepal. Objective The objective of this study was to understand and document CVD programs and policy formulation processes and to identify the government capacity to engage stakeholders for planning and implementation purposes. Method A national-level task force was formed to coordinate and steer the overall need assessment process. A qualitative study design was adopted using "The Health System Assessment Approach". Eighteen indicators under six topical areas in leadership and governance in cardiovascular health were assessed using desk review and key informant interviews. Result Voice and accountability exist in planning for health from the local level. The government has shown a strong willingness and has a strategy to work together with the private and non-government sectors in health however, the coordination has not been effective. There are strong rules in place for regulatory quality, control of corruption, and maintaining financial transparency. The government frequently relies on evidence generated from large-scale surveys for health policy formulation and planning but research in cardiovascular health has been minimum. There is a scarcity of cardiovascular disease-specific protocols. Conclusion Despite plenty of opportunities, much homework is needed to improve leadership and governance in cardiovascular health in Nepal. The government needs to designate a workforce for specific programs to help monitor the enforcement of health sector regulations, allocate enough funding to encourage CVD research, and work towards developing CVD-specific guidelines, protocols, and capacity building. KEY WORDS Cardiovascular diseases, Governance, Leadership, Needs assessment, Nepal.
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Affiliation(s)
- P Ms Pradhan
- Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Nepal. Nepalese Society of Community Medicine. and Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R D Bhatt
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. Wuhan University, Faculty of Medical Sciences, School of Health Sciences, Wuhan, China. and Department of Biochemistry, Kathmandu University School of Medical Sciences, Nepal
| | - R Pandit
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Department of Physiology, Nepal Medical College and Teaching Hospital, Nepal
| | - A Shrestha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal. Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. and Institute for Implementation Science and Health, Kathmandu, Nepal
| | - R Maharjan
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal. and Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - N Jha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - S Bajracharya
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal
| | - S Shrestha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal
| | - R P Koju
- Dean, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre. and Department of Internal Medicine, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Kavre
| | - B M Karmacharya
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal. and Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
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Shrestha A, Parajuli SB, Aryal A, Shrestha A, Maharjan R, Jha N, Bajracharya S, Shrestha S, Neupane T, Poudel U, Karmacharya BM, Koju RP, Dhimal M. National Needs Assessment of Health Information System to Address Cardiovascular Diseases in Nepal: A Mixed Method Study. Kathmandu Univ Med J (KUMJ) 2022; 19:58-67. [PMID: 35526137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background Health financing is a major domain of health system building blocks. With the epidemiological transition and increasing trend of Cardiovascular diseases (CVDs), it is crucial to assess the status of health financing to address the gap of prevention, control, and treatment of CVDs in Nepal. Objective This paper aims to assess the situation of healthcare financing on Cardiovascular diseases in Nepal. We framed three key functions of health system financing: (a) revenue collection, (b) pooling of resources, and (c) purchasing of services for this study. Method We used sequential explanatory mixed-method research design. We conducted desk reviews, analyzed secondary data on health financing followed by Key-Informant Interviews with five relevant policymakers and experts between February and September 2019. We obtained the Ethical clearance from the Nepal Health Research Council. Result Out of pocket (OOP) expenditure remains the highest source (52%) of total health care expenditure in Nepal, and two third of it is made for NCDs. Out of total current health expenditure on outpatient and inpatient services for fiscal year 2015/16, only 7% of total NCDs was spent on CVDs. Hypertension is the third-most utilized insurance service out of 36 CVD related services provided by the Health Insurance Board. The existing health related social service schemes covers the high costs associated with treatment, and streamlining these services including provider payment mechanisms with the health insurance program could open up opportunities to expand quality CVD services and make it accessible to the marginalized population. Conclusion Health Financing is the integral part of the health system. With the rising burden of cardiovascular diseases and its impact on impoverishment due to high OOP, integrated health care services, budget specification based on the evidence-based burden of disease such as CVD needs to be prioritized by the government.
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Affiliation(s)
- A Shrestha
- Department of Community Medicine, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S B Parajuli
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Department of Community Medicine, Birat Medical College Teaching Hospital, Biratnagar, Nepal
| | - A Aryal
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Nyaya Health Nepal, Kathmandu, Nepal
| | - A Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. and Institute for Implementation Science and Health, Kathmandu, Nepal
| | - R Maharjan
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. and Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - N Jha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Bajracharya
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - T Neupane
- Nepal Health Research Council, Kathmandu, Nepal
| | - U Poudel
- Nepal Health Research Council, Kathmandu, Nepal
| | - B M Karmacharya
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - R P Koju
- Dean, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - M Dhimal
- Nepal Health Research Council, Kathmandu, Nepal
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Pyakurel M, Bhattarai S, Joshi B, Koju RP, Shrestha A. Burden of Stroke in Nepal: Findings from Global Burden of Disease Dataset 2017. Kathmandu Univ Med J (KUMJ) 2022; 19:11-17. [PMID: 35526132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background Stroke is the second leading cause of death and disability worldwide including Asian countries, surpassing ischemic heart disease. Stroke accounts for 10% of global death, of which more than three fourth occur in low- and middle-income countries. An exact estimate of the burden of stroke in Nepal is not available. Objective To assess the burden of stroke including disability and death over time in Nepal and compare it with other South Asian countries. Method We retrieved data from the Institute of Health Metrics and Evaluation's Global Burden of Diseases database of 2017 on stroke deaths, disability-adjusted life years, incidence, and prevalence rates, for both genders from Nepal, Bangladesh, Pakistan, Bhutan, and India by year. We assessed the trend of deaths and Disability-Adjusted Life Years (DALYs) due to stroke from 1990 to 2017; and the contribution of major risk factors to stroke burden in 2017. Result Stroke contributed 7.6% of total deaths and 3.5% of total DALYs in Nepal, with a higher burden among the male and old age population. Intracerebral hemorrhage was the dominant type of stroke in Nepal with the highest proportion of deaths and DALYs. Among the South Asian countries, incidence, prevalence, and burden of stroke were highest in Bangladesh. Intracerebral hemorrhage contributed the highest DALYs in South Asian countries. High systolic blood pressure was contributing the maximum DALYs due to stroke in Nepal. Conclusion Hemorrhagic stroke causes high mortality and DALYs in Nepal. Most of the burden of stroke is attributed to high blood pressure in Nepal.
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Affiliation(s)
- M Pyakurel
- Inclusive Partnership Against Violence (InPAV)Project, Green Tara Nepal, Baluwatar, Nepal. and Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Bhattarai
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - B Joshi
- University of Bordeaux, Inserm, Research Institute for development (IRD), France. and Center for Research Innovation and Development (CRID), Lalitpur, Nepal
| | - R P Koju
- Dean, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - A Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. and Institute for Implementation Science and Health, Kathmandu, Nepal
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Karmacharya RM, Shestha AP, Shrestha A, Bajracharya S, Maharjan R, Shrestha S, Jha N, Pyakurel P. National Needs Assessment of Health Information System to Address Cardiovascular Diseases in Nepal: A Mixed Method Study. Kathmandu Univ Med J (KUMJ) 2022; 19:51-57. [PMID: 35526136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background Health information system is an integral component of a country's capacity to integrate, process, report, and use information in improving health services. Objective This study aims to assess the infrastructure and capacity of the national Health information system to address cardiovascular diseases in Nepal. Method We adopted the United States Agency for International Development manual "The Health System Assessment Approach: A How-To Manual", Version 2.0. Three topical areas: input, process and output, were identified. Stepwise approach for Health information system assessment was done. A desk review and key informant interview was performed. Audio recordings were transcribed in Nepali language and intercoder reliability was checked. Result The upgraded District Health Information Software 2.3 provides a comprehensive online data management solution. Sustainable funding to upgrade the system exists. Annual report provides performance of all the components of the health care delivery system. Data were reviewed quarterly. However, no dedicated section for cardiovascular diseases in the Health information system is present. Private health facilities are poorly represented. Strategic planning, management, and evaluation of the Health information system are lacking. Inadequacy of timeliness, completeness, and periodicity of the reporting still exist. Conclusion A separate section of cardiovascular diseases in the Health information system is required. Better reporting of private sectors and its inclusion in databases is of utmost importance. Adaptation in the recently introduced federal structure is key for development of Health information system in the country.
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Affiliation(s)
- R M Karmacharya
- Department of Surgery (Cardio Thoracic and Vascular Surgery Unit), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. and Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - A P Shestha
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal
| | - A Shrestha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal. Department of Public Health, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Nepal. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. and Institute for Implementation Science and Health, Kathmandu, Nepal
| | - S Bajracharya
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - R Maharjan
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal. Nepal. Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Shrestha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - N Jha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - P Pyakurel
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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Shrestha A. W087 Seroprevalence of influenza a virus (H1N1) IGM in patients attending CMC-TH and its association with liver function test. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shrestha A. High Risk Pregnancy Detection and Management: Need of Present Day Obstetric Care. Kathmandu Univ Med J (KUMJ) 2022; 20:122-123. [PMID: 37017152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- A Shrestha
- Department of Obstetrics and Gynecology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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Shrestha A, Shrestha P, Shrestha T, Shrestha RM, Sujakhu D, Dhakal K, Thapa G, Adhikari S, Karki S, Poudel L. Awareness and Knowledge of Glaucoma and their Associated Factors among Staffs in a Tertiary-level Hospital in Central Nepal. Kathmandu Univ Med J (KUMJ) 2022; 20:161-165. [PMID: 37017159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Background Since glaucoma-related blindness may only be prevented with early identification and treatment, finding asymptomatic individuals in the target population is critical. It is thus important to determine the awareness and knowledge on glaucoma. Objective To determine the knowledge and awareness on glaucoma among the staff of a tertiary level hospital in central Nepal. Method This was a cross sectional study among the staffs of Dhulikhel Hospital who participated voluntarily in the study. The data was collected through the administration of semi-structured questionnaires. R version 4.0.3 (2020-10-10) was used for the data analysis. Categorical variables are presented as frequency (percentages) and the numerical ones are presented as mean (standard deviation). Adjusted odds ratio (AOR) with 95% confidence interval were estimated through logistic regression analysis for determining factors associated with awareness and knowledge of glaucoma. Result A total of 107 (89.2%) participants had heard about glaucoma of which 93 (86.9%) had good knowledge and 14(13.1%) had poor knowledge on glaucoma. The mean score of knowledge was 64.1±16.9. Only 47.7% of the participants said that glaucoma also has an asymptomatic course. We could not find an association of awareness and knowledge of glaucoma with any of the selected sociodemographic variables. Conclusion Although there was a fairly good glaucoma related awareness and knowledge among hospital staff, we found lack of understanding on some critical issues on glaucoma, mainly related to its asymptomatic nature. There is thus room for improvement in educating about glaucoma even in healthcare settings. Given the necessity of expanding glaucoma awareness in the public, hospital staff might potentially serve as messengers to the communities.
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Affiliation(s)
- A Shrestha
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - P Shrestha
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - T Shrestha
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - R M Shrestha
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - D Sujakhu
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - K Dhakal
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - G Thapa
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Adhikari
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Karki
- Department of Public Health and Community, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - L Poudel
- Department of Public Health and Community, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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Shrestha A, Bastakoti R, Pandey N, Poudel R, Ranjit S, Makaju R. A Rare Case of Large Hydatidiform Mole Mimicking a Term Pregnancy. Kathmandu Univ Med J (KUMJ) 2022; 20:243-245. [PMID: 37017175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Molar pregnancy is a type of abnormal pregnancy that usually presents with amenorrhea, vaginal bleeding and elevated serum ß-hCG levels. We report a rare case of complete hydatidiform mole occurring in a 46-year-old P2L2 lady who presented with a term size uterus and elevated serum ß-hCG level (> 15,00,000 per deciliter, anemia (hemoglobin: 8.1 g/dL), difficulty in breathing and minimal vaginal bleeding. During the course of her evaluation, she had profuse vaginal bleeding, she underwent suction and evacuation, but bleeding was not controlled despite measures to control it. She was given uterotonics and antifibrinolytic agents and uterine artery ligation. But was proceeded with emergency hysterectomy for uncontrolled hemorrhage. The content of suction and evacuation was vesicles with blood clots and histopathology was reported as complete hydatidiform mole. The patient received a total of 4 units of packed red blood cells. She was discharged from hospital on 5th postoperative day and was followed up serial serum ß-hCG level. Therefore, complete mole can present with enlarged uterus, vaginal bleeding and anemia. It is also important to note that intractable bleeding following suction and evacuation not being controlled with uterotonics and antifibrinolytic agents and uterine artery ligation may require hysterectomy to save the patient's life.
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Affiliation(s)
- A Shrestha
- Department of Obstetrics and Gynecology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - R Bastakoti
- Department of Obstetrics and Gynecology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - N Pandey
- Department of Obstetrics and Gynecology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - R Poudel
- Department of Radiology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Ranjit
- Department of Anesthesia, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - R Makaju
- Department of Pathology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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Oli N, Pradhan PM, Sagtani RA, Shrestha A, Jaacks LM, Karmacharya BM, Danaei G, Vaidya A. Research Capacity for Prevention and Control of Non-communicable Diseases and their Risk Factors in Nepal: Findings of a Needs Assessment Study. Kathmandu Univ Med J (KUMJ) 2022; 20:147-154. [PMID: 37017157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Background Despite a high burden, there are limited trainings in non-communicable disease research in Nepal. Objective We conducted a needs assessment to assess existing research training capacity in academic health institutions of Nepal for the prevention and control of noncommunicable diseases, identify gaps in research, and explore the feasibility of developing research training program in Nepal targeting non-communicable diseases. Method We did mixed-method research and reviewed academic institution curricula and scientific articles authored by Nepali researchers. We conducted 14 Focus Group Discussions with bachelor and masters level students of public health and community medicine; 25 In-depth Interviews with department heads and faculties, and government stakeholders. We surveyed medical and public health students on their research knowledge and skills development. Result Research methodology component was addressed differently across academic programs. One-third (33.7%) of students expressed lack of skills for analysis and interpretation of data. They felt that there is a wide scope and career-interest in non-communicable diseases research in Nepal. However, specific objectives in the curriculum and practical aspects regarding non-communicable diseases were lacking. Most of the non-communicable diseases research in Nepal are prevalence studies. Lack of funding, conflicting priorities with curative services, and inadequate training for advanced research tools were reported as major barriers. Conclusion Nepal must strengthen the whole spectrum of research capacity: epidemiological skills, research management, and fund development. Generation of a critical mass of non-communicable disease researchers must go together with improved funding from the government, non-governmental, and external funding organizations.
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Affiliation(s)
- N Oli
- Department of Community Medicine, Kathmandu Medical College Public Limited, Sinamangal, Kathmandu, Nepal
| | - P Ms Pradhan
- Department of Community Medicine, Institute of Medicine, Maharajganj, Kathmandu, Nepal
| | - R A Sagtani
- Department of Community Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - A Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - L M Jaacks
- Global Academy of Agriculture and Food Security, The University of Edinburgh, Midlothian, UK
| | - B M Karmacharya
- Department of Community Medicine, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - G Danaei
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - A Vaidya
- Department of Community Medicine, Kathmandu Medical College Public Limited, Sinamangal, Kathmandu, Nepal
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Lim E, Traxer O, Madarriaga Y, Castellani D, Fong K, Chan VS, Tur A, Pietropaolo A, Ragoori D, Shrestha A, Vaddi C, Bhatia T, Mani M, Juliebø-Jones P, Griffin S, Rojo E, Corrales M, Sekerci C, Tanidir Y, Teoh JC, Gauhar V, Somani B. Outcomes from practice of Retrograde Intrarenal Surgery (RIRS) in a paediatric setting of various age groups: A global study across 8 centres. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00857-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Shrestha A, Shrestha P, Shrestha T, Shrestha RM, Sujakhu D, Dhakal K, Thapa G, Adhikari S, Karki S, Adhikari B. Awareness and Knowledge of Glaucoma and their Associated Factors among People Visiting a Tertiary Level Hospital in Central Nepal. Kathmandu Univ Med J (KUMJ) 2022; 20:56-60. [PMID: 36273292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Glaucoma is one of the major causes of irreversible blindness globally. Almost 60 million people globally are affected by glaucoma making it the second leading cause of blindness worldwide. Diagnosis of glaucoma early on is vital for timely management and prevention of blindness. However, it is challenging to diagnose it early because it is asymptomatic in the initial stage, and there is also the dearth of appropriate screening tools. Awareness, knowledge, and beliefs are believed to influence the treatment-seeking behavior of people as well as their uptake of services. Objective To assess the awareness and knowledge about glaucoma among general patients and patient attendants visiting Dhulikhel Hospital. Method We conducted a cross sectional quantitative study among general patients visiting Dhulikhel Hospital. We collected data using face-to-face interviews with semistructured questionnaires. We analyzed data in R version 4.0.3 (2020-10-10). We presented numerical variables as mean and standard deviation whereas categorical variables as frequency and percentage. We determined factors associated with awareness and knowledge of glaucoma using logistic regression analysis and estimated adjusted odds ratio (AOR) with 95% confidence interval. Result Of 379 participants, a total of 214 (56.5%) participants had heard about glaucoma. Out of the participants who heard about glaucoma, the mean knowledge score was 48.3±21.7 and 53.3% had good knowledge on glaucoma. The odds of having heard about glaucoma were two percent lower (AOR=0.98; 95%CI: 0.97-0.99; p-value 0.036) in the older participants compared to one year younger participant, 1.98 (95%CI:1.01-3.86; p-value 0.046) times higher among literates and 2.79 (95%CI: 1.76- 4.41; p-value < 0.001) times among participants with previous ocular examination. The odds of having good knowledge was 1.94 (95%CI: 1.10-3.42; p value 0.021) times among participants with previous ocular examinations. Conclusion The knowledge and awareness regarding glaucoma in a hospital-visiting population in central Nepal was low. Half of the participants were unaware of the disease glaucoma and half of the participants who heard of the glaucoma had poor knowledge on glaucoma.
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Affiliation(s)
- A Shrestha
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - P Shrestha
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - T Shrestha
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - R M Shrestha
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - D Sujakhu
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - K Dhakal
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - G Thapa
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Adhikari
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Karki
- Department of Public Health and Community, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - B Adhikari
- Department of Public Health and Community, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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Shrestha J, Shrestha A, Shrestha B, Gamal K, Manandhar S, Koju S, Koju Shrestha R. Oral Solid Dosage form Modification in Community Pharmacies of Kavrepalanchok and Bhaktapur Districts of Nepal. Kathmandu Univ Med J (KUMJ) 2022; 20:29-37. [PMID: 36273287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background People may modify their oral solid dosage form of medicine to deal with problem faced during medicine administration. The modification of dosage form may adversely affect the quality, safety and efficacy of the medicine. Objective To investigate the causes and practices of oral solid dosage form modification among the consumers going to community pharmacies. Method A descriptive, cross-sectional study was conducted in five community pharmacies of Kavrepalanchok and Bhaktapur districts of Nepal. The consumers visiting these pharmacies for their oral solid dosage form of medicine were invited to participate in interview using structured questionnaire. Result Among 419 participants,13.6% of participants reported having problem of taking intact medicine. Most of them (12.4% of total participants) experienced difficulty swallowing the medicine. The swallowing difficulty is significantly associated with age and sex (p < 0.05). Around one third (36.8%) of participant with medicine administration problem modified the dosage form of medicines. One quarter of medicine dosage form modifications (25.0%) were inappropriate. Medicine dosage form modification is associated with age and number of daily medicine intake (p < 0.05). Among participants modifying dosage form of medicines, 66.7% were advised to do so mainly by family and friends; 33.3% were modifying on their own and 76.2% were unaware of possible effects of medicine dosage form modification. About 62.3% of total participants were never asked about any problems on taking medicines by doctor/pharmacists. Conclusion Difficulty swallowing medicines and medicine dosage form modification were prevalent in the Nepalese population. Medicine dosage form modifications also involved inappropriate modifications due to specialized design of such dosage forms. So, it seems important to provide proper counseling while dispensing such dosage forms.
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Affiliation(s)
- J Shrestha
- Department of Pharmacy, Kathmandu University, Dhulikhel, Kavre, Nepal
| | - A Shrestha
- Dirghayu Medical, Banepa, Kavrepalanchowk, Nepal
| | - B Shrestha
- Seer Imaging and Diagnostic Center, Banepa, Kavrepalanchowk, Nepal
| | - K Gamal
- Curex Pharmaceutical Pvt. Ltd., Sanga, Kavrepalanchowk, Nepal
| | - S Manandhar
- Bhomi Hospital, Banepa, Kavrepalanchowk, Nepal
| | - S Koju
- Arrow Pharmaceuticals Pvt. Ltd. Changunarayan, Bhaktapur, Nepal
| | - R Koju Shrestha
- Department of Pharmacy, Kathmandu University, Dhulikhel, Kavre, Nepal
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Shrestha U, Shakya Shrestha S, Shrestha A, Poudel U, Manandhar Shrestha JT. Drug Utilization Study in Outpatient Department of Ophthalmology in Tertiary Care Hospital. Kathmandu Univ Med J (KUMJ) 2022; 20:43-46. [PMID: 36273289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background The advancement in drug development and availability of newer drugs has improved overall health services including decrease in mortality and hospital stay. Along, it has brought negative impacts such as polypharmacy and associated adverse drug reactions and antimicrobial resistance. Drug utilization research is an essential approach to understand the drug use pattern, identify the early signs of such irrational drug use and to improve quality of drug use. Objective To study the drug utilization pattern in the Ophthalmology Outpatient department (OPD) of Dhulikhel Hospital, Kathmandu University Hospital (DH-KUH). Method A descriptive, cross sectional study was conducted from March 2019 to August 2019 in patients attending OPD of Ophthalmology in Dhulikhel Hospital, Kathmandu University Hospital. Prescriptions of 311 patients were analyzed using World Health Organization (WHO) International Network of Rational Use of Drug (INRUD) and additional other indices. The descriptive data was presented in mean and standard deviation. Result The average number of drugs per prescription was 2.10±1.35. Out of total 311 prescriptions, drugs prescribed in generic name were 152 (23.30%). Total antibiotics encountered were 247 (37.90%) and total drugs prescribed from National Essential Medicine List (NEML) were 371 (56.90%). Antibiotics 247 (37.90%) were the most commonly prescribed drugs followed by lubricants 146 (22.40%). Conclusion Practice of polypharmacy was very high. Most of the drugs were prescribed in brand names and antibiotics were the most frequently used drugs.
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Affiliation(s)
- U Shrestha
- Department of Pharmacology, School of Medical Sciences, Kathmandu University, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Shakya Shrestha
- Department of Pharmacology, School of Medical Sciences, Kathmandu University, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - A Shrestha
- Department of Opthalmology, School of Medical Sciences, Kathmandu University, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - U Poudel
- Department of Pharmacology, School of Medical Sciences, Kathmandu University, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - J T Manandhar Shrestha
- Department of Pharmacology, School of Medical Sciences, Kathmandu University, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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Shaladi A, Shrestha A, Basnyat P. 1354 A Rare Case of Gallstone Ileus Due to Cholecystocolonic Fistula. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Gallstone Ileus (GI) is an uncommon but potentially lethal complication of cholelithiasis. 50 to 70% of gallstones obstruct in the ileum, the narrowest point of the intestine. More uncommonly the gallstone can travel into the large bowel via an incompetent ileo-caecal valve and impact in the colon at a recto sigmoid junction. GI involving the sigmoid colon is extremely rare cause of large bowel obstruction. The gallstone often enters the large bowel through a fistula formation between the gallbladder and colon, and impacts at a point of narrowing, causing large bowel obstruction.
Case Report
We describe the case of a 72-year-old man who presented with features of bowel obstruction. CT of abdomen pelvis (CTAP) showed a large 5x5cm intraluminal gallstone obstructing at the rectosigmoid area. It showed presence of pneumobilia and incidental finding of abdominal aortic aneurysm (AAA). An emergency laparotomy revealed a cholecystocolonic fistula. The stone was extracted after milking the stone proximally and loop colostomy formed at colotomy site. The patient made an uneventful recovery. Reversal of stoma was postponed pending endovascular repair of enlarging AAA.
Discussion
Presenting symptoms of GI are often non-specific, frequently leading to a delay in diagnosis and treatment. Although no fistula was identified in this patient by imaging, the most common cause of GI in most patients is formation of a cholecystoduodenal fistula.
Conclusions
Compared with biliary enteric fistulae, the occurrence of cholecystocolonic fistulae is remarkably rare. Temporary colostomies can be considered for treating these cases alongside one-stage operations
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Affiliation(s)
- A Shaladi
- William Harvey Hospital, Kent, United Kingdom
| | - A Shrestha
- William Harvey Hospital, Kent, United Kingdom
| | - P Basnyat
- William Harvey Hospital, Kent, United Kingdom
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Davis H, Mishra S, Balakumar C, Shrestha A. 1470 Consenting for a Bedside Procedure: A Prospective Observational Analysis of Consenting Practice in the Surgical Emergency Admissions Unit of a District General Hospital. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
Consent is necessary to enable patient autonomy, and it is vital that it is voluntary, informed and, where possible, the patient has valid mental capacity to give consent. Recent case law has grown around consent and practice guidance has evolved.
This was a prospective observational study investigating the quality of consenting practice for incision and drainage procedures performed within the surgical emergency admissions unit (SEAU) at a district general hospital.
Method
A prospective study was conducted on consent documentation for a study period from August to September 2020, for patients undergoing bedside incision and drainage (I&D) procedures within the SEAU. Documentation was reviewed and data collected for quality of consent. Further data into the quality of this documentation was also collected; including legibility, risk and benefit discussions, local anaesthetic used, operation note documentation and discussion of the procedure. This was compared against GMC standards.
Results
Of 20 cases (n = 20), 1 case had written consent and 15 cases had verbal consent documented. 4 cases had no documentation of consent. No cases had benefit documentation, and 4 out of the 20 cases had risks documented. 4 cases had documentation of procedure discussion. 13 cases had an operation note included.
Conclusions
This study highlights a deviation from recommended practice, and results have been communicated at a departmental level. Recommendations have been offered in an attempt to improve compliance, including the display of posters in the SEAU. We shall re-audit practice within the coming months after these changes have been implemented.
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Affiliation(s)
- H Davis
- William Harvey Hospital, Kent, United Kingdom
| | - S Mishra
- William Harvey Hospital, Kent, United Kingdom
| | - C Balakumar
- Maidstone and Tunbridge Wells NHS trust, Kent, United Kingdom
| | - A Shrestha
- William Harvey Hospital, Kent, United Kingdom
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Davis H, Mishra S, Adams L, Culmer C, Shrestha A. 1487 The Pied-Piper, How Gastroenteritis Led Us Astray. Fibromuscular Dysplasia: A Surgical Perspective of a Rare Vascular Disorder. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A 73-year-old female was admitted for abdominal pain after eating an out-of-date pie. She was treated for gastroenteritis for 48hours, after which she became unexpectedly haemodynamically unstable. Computerised Tomography (CT) suggested mesocolic arterial bleed with a large mesenteric haematoma. CT angiography confirmed false aneurysms of the middle colic artery and multiple beading of coeliac branches, small mesenteric vessels and the inferior mesenteric artery. Opinion was sought from multiple specialties, pseudoaneurysm embolisation was undertaken and steroids commenced for presumed vasculitis. Vasculitis screen was negative, and PET CT scan showed no metabolically active vasculitis. It was felt a diagnosis of fibromuscular dysplasia (FMD) was likely. Steroids have been weaned and the patient is under active observation.
Background
FMD is a rare idiopathic condition of abnormal cellular growth in medium/large arterial vessel walls. It has a frequency of approximately 0.02%, predominantly affecting middle-aged Caucasian women. It manifests mostly in renal and cerebrovascular arteries and can present as hypertension or stroke. Complications include aneurysms, stenosis and dissections. Characteristic angiographical finding is a “beads on a string” appearance. There is no current cure, but surgical or interventional involvement by angioplasty and stenting may play a role treatment.
Conclusions
This case elegantly highlights the ambiguity in diagnosis of abdominal pain in a general surgical setting; with a wide variety of differentials spanning multiple specialties, it emphasises the importance to consider rare presentations of equally rare pathologies. It is a celebration of the merits of a multi-disciplinary approach to solve complex clinical questions.
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Affiliation(s)
- H Davis
- William Harvey Hospital, Kent, United Kingdom
| | - S Mishra
- William Harvey Hospital, Kent, United Kingdom
| | - L Adams
- Lewisham University Hospital, London, United Kingdom
| | - C Culmer
- Queen Elizabeth Hospital Woolwich, London, United Kingdom
| | - A Shrestha
- William Harvey Hospital, Kent, United Kingdom
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Shrestha A, Shrestha P, Shrestha T, Makaju Shrestha R, Sujakhu D, Dhakal K, Thapa G, Paneru D. Prevalence of Refractive Error and Ocular Pathologies among School Children: Finding from the School Eye Program of Dhulikhel Hospital. Kathmandu Univ Med J (KUMJ) 2021; 19:436-441. [PMID: 36259185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Childhood blindness and visual impairments could lead to the onset of blindness among children and adolescents. New cases appear particularly between the ages of 6-15 years and if uncorrected, runs a risk of developing Amblyopia, strabismus. There exists a mounting need to strengthen and modify established school eye health programs in Nepal as per the local needs and conditions. Objective To determine the prevalence of refractive error and ocular pathologies among school children in rural Nepal. Method This cross-sectional study was conducted in nine schools of Kavrepalanchowk and Bhaktapur district with 953 students screened from December 2018 to February 2020. The team of optometrist, ophthalmic assistants and ophthalmologist applied a standard protocol for screening of refractive error as a part of the school eye program of Dhulikhel Hospital. Other standard eye examinations were performed to note the ocular pathologies. The association of socio-demographic factors of students having refractive errors with that in emmetropes was identified using logistic regression analysis. Result A total of 953 students were screened in nine study sites, age ranged from 5-19 years. There were 183 students (19.2%) with refractive errors. Blurred vision was the common complaint reported by 2.5% of students. Multivariate logistic regression analysis showed higher age group children (aOR=2.93; 95% CI: 1.62-5.29; P=0.01) and urban area children (aOR=4.37; 95% CI: 0.87-21.98; P=0.07) to have higher odds of refractive error. Conclusion Refractive error is the major eye problem among school children. Despite its high prevalence, there is still a major gap in timely diagnosis and treatment. Regular vision screening and timely treatment is required for better addressing refractive error among school-going children.
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Affiliation(s)
- A Shrestha
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - P Shrestha
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - T Shrestha
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - R Makaju Shrestha
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - D Sujakhu
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - K Dhakal
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - G Thapa
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - D Paneru
- Department of Ophthalmology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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Morgan JL, Shrestha A, Reed MWR, Herbert E, Bradburn M, Walters SJ, Martin C, Collins K, Ward S, Holmes G, Burton M, Lifford K, Edwards A, Ring A, Robinson T, Chater T, Pemberton K, Brennan A, Cheung KL, Todd A, Audisio R, Wright J, Simcock R, Thomson AM, Gosney M, Hatton M, Green T, Revill D, Gath J, Horgan K, Holcombe C, Winter MC, Naik J, Parmeschwar R, Wyld L. Bridging the age gap in breast cancer: impact of omission of breast cancer surgery in older women with oestrogen receptor-positive early breast cancer on quality-of-life outcomes. Br J Surg 2021; 108:315-325. [PMID: 33760065 PMCID: PMC10364859 DOI: 10.1093/bjs/znaa125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/15/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Primary endocrine therapy may be an alternative treatment for less fit women with oestrogen receptor (ER)-positive breast cancer. This study compared quality-of-life (QoL) outcomes in older women treated with surgery or primary endocrine therapy. METHODS This was a multicentre, prospective, observational cohort study of surgery or primary endocrine therapy in women aged over 70 years with operable breast cancer. QoL was assessed using European Organisation for Research and Treatment of cancer QoL questionnaires QLQ-C30, -BR23, and -ELD14, and the EuroQol Five Dimensions 5L score at baseline, 6 weeks, and 6, 12, 18, and 24 months. Propensity score matching was used to adjust for baseline variation in health, fitness, and tumour stage. RESULTS The study recruited 3416 women (median age 77 (range 69-102) years) from 56 breast units. Of these, 2979 (87.2 per cent) had ER-positive breast cancer; 2354 women had surgery and 500 received primary endocrine therapy (125 were excluded from analysis due to inadequate data or non-standard therapy). Median follow-up was 52 months. The primary endocrine therapy group was older and less fit. Baseline QoL differed between the groups; the mean(s.d.) QLQ-C30 global health status score was 66.2(21.1) in patients who received primary endocrine therapy versus 77.1(17.8) among those who had surgery plus endocrine therapy. In the unmatched analysis, changes in QoL between 6 weeks and baseline were noted in several domains, but by 24 months most scores had returned to baseline levels. In the matched analysis, major surgery (mastectomy or axillary clearance) had a more pronounced adverse impact than primary endocrine therapy in several domains. CONCLUSION Adverse effects on QoL are seen in the first few months after surgery, but by 24 months these have largely resolved. Women considering surgery should be informed of these effects.
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Affiliation(s)
- J L Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - A Shrestha
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - M W R Reed
- Brighton and Sussex Medical School, Brighton, UK
| | - E Herbert
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - M Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - S J Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - C Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - K Collins
- Faculty of Health and Wellbeing, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - S Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - G Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - M Burton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - K Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - A Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - A Ring
- Department of Medical Oncology, Royal Marsden Hospital, London, UK
| | - T Robinson
- Department of Cardiovascular Sciences and National Institute for Health Research Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, Glenfield General Hospital, Leicester, UK
| | - T Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - K Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Brennan
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - K L Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - A Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - R Audisio
- Department of Surgery, University of Gothenberg, Sahlgrenska Universitetssjukhuset, Gothenberg, Sweden
| | - J Wright
- Brighton and Sussex Medical School, Brighton, UK
| | - R Simcock
- Brighton and Sussex Medical School, Brighton, UK
| | - A M Thomson
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - M Gosney
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - M Hatton
- Sheffield Teaching Hospitals NHS Foundation Trust, Weston Park Hospital, Sheffield, UK
| | - T Green
- North Trent Cancer Research Network Consumer Research Panel, Sheffield, UK
| | - D Revill
- North Trent Cancer Research Network Consumer Research Panel, Sheffield, UK
| | - J Gath
- North Trent Cancer Research Network Consumer Research Panel, Sheffield, UK
| | - K Horgan
- Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK
| | - C Holcombe
- Department of Breast Surgery, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - M C Winter
- Sheffield Teaching Hospitals NHS Foundation Trust, Weston Park Hospital, Sheffield, UK
| | - J Naik
- Department of General Surgery, Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - R Parmeschwar
- Department of Breast Surgery, University Hospitals of Morecambe Bay, Lancaster, UK
| | - L Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
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Shrestha A, Prowak M, Berlandi-Short VM, Garay J, Ramalingam L. Maternal Obesity: A Focus on Maternal Interventions to Improve Health of Offspring. Front Cardiovasc Med 2021; 8:696812. [PMID: 34368253 PMCID: PMC8333710 DOI: 10.3389/fcvm.2021.696812] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022] Open
Abstract
Maternal obesity has many implications for offspring health that persist throughout their lifespan that include obesity and cardiovascular complications. Several different factors contribute to obesity and they encompass interplay between genetics and environment. In the prenatal period, untreated obesity establishes a foundation for a myriad of symptoms and negative delivery experiences, including gestational hypertensive disorders, gestational diabetes, macrosomia, and labor complications. However, data across human and animal studies show promise that nutritional interventions and physical activity may rescue much of the adverse effects of obesity on offspring metabolic health. Further, these maternal interventions improve the health of the offspring by reducing weight gain, cardiovascular disorders, and improving glucose tolerance. Mechanisms from animal studies have also been proposed to elucidate the signaling pathways that regulate inflammation, lipid metabolism, and oxidative capacity of the tissue, ultimately providing potential specific courses of treatment. This review aims to pinpoint the risks of maternal obesity and provide plausible intervention strategies. We delve into recent research involving both animal and human studies with maternal interventions. With the increasing concerning of obesity rates witnessed in the United States, it is imperative to acknowledge the long-term effects posed on future generations and specifically modify maternal nutrition and care to mitigate these adverse outcomes.
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Affiliation(s)
- Akriti Shrestha
- Department of Nutrition and Food Studies, Syracuse University, Syracuse, NY, United States
| | - Madison Prowak
- Department of Nutrition and Food Studies, Syracuse University, Syracuse, NY, United States
| | | | - Jessica Garay
- Department of Nutrition and Food Studies, Syracuse University, Syracuse, NY, United States
| | - Latha Ramalingam
- Department of Nutrition and Food Studies, Syracuse University, Syracuse, NY, United States
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Gharti BB, Shrestha PM, Shrestha A, Basnet RB, Shah C, Adhikari B. Comparison between Simple and Classical Techniques to Create Closed Pneumoperitoneum. Kathmandu Univ Med J (KUMJ) 2021; 19:309-313. [PMID: 36254415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Closed method of pneumoperitoneum using Veress needle is an established technique. Classical closed technique is popular. Simple technique is a modified closed technique. Objective To compare the classical and simple techniques of closed pneumoperitoneum. Method This study was conducted in the department of urology, Bir hospital from August 1st 2019 to March 30th 2021. Total 114 patients were randomized into simple and classical technique of creating closed pneumoperitoneum. Time taken for creation of pneumoperitoneum, complications and failure of creating pneumoperitoneum in each group noted and analyzed. Chi square test, Fischer exact test and student t test were used and p < 0.05 considered significant. Result Among 114 patients, 61 in simple and 53 in classical technique allocated. In simple technique, mean age was 42.98±18.21 years, BMI was 21.84±2.57 kg/m2 , mean time for pneumoperitoneum creation was 108.07±21.14 seconds. In classical technique, mean age was 40.15±17.58 years, BMI was 21.94±2.54 (kg/m2 ), mean time for pneumoperitoneum creation was 189.70±32.21 seconds. Mean time was less in simple technique than classical technique (p < 0.001). Complication rate observed was 6% in each technique (p=0.797) with cumulative rate of 10%. Omental injury was seen in 3.2% in simple technique and 5.6% in classical technique (p=0.662). Retroperitoneal insufflation was seen in 6.5% in simple technique and 5.6% in classical technique (p=0.842). No failed pneumoperitoneum was observed in both groups. Conclusion Simple technique is as effective, reproducible and safe method as classical technique of creating closed pneumoperitoneum.
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Affiliation(s)
- B B Gharti
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - P M Shrestha
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - A Shrestha
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - R B Basnet
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - C Shah
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - B Adhikari
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
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Shrestha A, Mudbari J, Tamrakar SR, Pradhan N, Makaju R, Karki S. A Rare Case of Large Left Lateral Wall Vaginal Myoma. Kathmandu Univ Med J (KUMJ) 2021; 19:396-398. [PMID: 36254433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Vaginal leiomyomas are rare, they are uncommon benign tumor with variable clinical presentation. They usually present as a mass per vaginum or dyspareunia or pressure symptoms on the neighbouring structures. We present a case of 47 years lady with mass per vaginum and difficulty in walking and chronic pelvic pain. Her clinical findings suggested a large mass in the left vaginal wall, the mass was approximately 12 x 10 cm in size hindering the visualization of the cervix. Her ultrasonography showed bulky uterus with mass occupying the cervix. This finding was not correlating with the clinical findings. Magnetic resonance imaging (MRI) was done and it was reported as mass lesion in pelvis separate from the cervix abutting the rectum posteriorly. Ultrasonography (USG) guided biopsy was done which was reported as Leiomyoma. She underwent vaginal myomectomy and was confirmed in histopathology as Leiomyoma. A leiomyoma is a smooth muscle tumor that arises from the muscular part of the uterus and rarely seen in the vaginal wall.
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Affiliation(s)
- A Shrestha
- Department of Obstetrics and Gynecology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - J Mudbari
- Department of Obstetrics and Gynecology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S R Tamrakar
- Department of Obstetrics and Gynecology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - N Pradhan
- Department of Obstetrics and Gynecology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R Makaju
- Department of Pathology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Karki
- Department of Radiology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Acharya Pandey R, Chalise HN, Shrestha A, Ranjit A. Quality of Life of Patients with Chronic Obstructive Pulmonary Disease Attending a Tertiary Care Hospital, Kavre, Nepal. Kathmandu Univ Med J (KUMJ) 2021; 19:180-185. [PMID: 34819432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background Chronic Obstructive Pulmonary Disease (COPD) is one of the most common chronic health conditions and is increasingly becoming a major public health problem among the elderly population. As the chronic obstructive pulmonary disease is not curable, evaluation of and methods to improve quality of life among such patients is of utmost importance. Objective The objective of the study was to assess the quality of life among patients living with chronic obstructive pulmonary disease. Method This is a cross-sectional carried out in Dhulikhel Hospital, Kathmandu University Hospital, Nepal in 2017-2018. A total of 274 patients aged 40 years and above were selected for this study. The quality of life of participants was assessed through the widely used shorter version ST George's Respiratory Questionnaire (SGRQ-C). Result The mean age of the participants was 68.19 (SD ± 10.36) years, with the age range of 40-94 years. More than half (55.5%) of respondents were females, 55% were from rural areas, 42.7% were illiterate and 53.3% were from joint families. Agriculture (35.4%) and homemakers (32.5%) were the most prevalent occupation. The mean total score for all domains of quality of life was 68.06 (±18.87). The mean quality of life scores for symptom, activity, and impact domains was 70.11 (±22.33), 67.59 (±20.41), 67.64 (±20.41) respectively which suggested marked impairments in quality of life in all SGRQ-C domains. The symptoms and impact domains were most affected during the activity. Among socio-demographic variables, educational status, ethnicity, number of family members, type of family and economic status had a statistically significant effect on the quality of life. Initial health condition, smoking habit, number of cigarettes smoked, and years of smoking had statistically significant effects on quality of life. Conclusion Patients with chronic obstructive pulmonary disease have a low quality of life in three components of symptom, activity, and impact domains. Major factors associated with poor quality of life were low educational status, large family size, poor health condition, and smoking.
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Affiliation(s)
- R Acharya Pandey
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - H N Chalise
- Population Association of Nepal, Kathmandu, Nepal
| | - A Shrestha
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - A Ranjit
- Howard University Hospital, Washington, DC, USA
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Shrestha A, Marla V, Lamsal M, Sarraf DP, Rao N. Evaluation of Nicotine Dependence in Adult Population of Eastern Nepal. Kathmandu Univ Med J (KUMJ) 2021; 19:210-215. [PMID: 34819438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background Tobacco consumption is a leading cause of premature death in the world. Tobaccorelated deaths are associated with cardiovascular diseases, pulmonary diseases, oral potentially malignant disorders, cancer, others. Moreover there is also associated nicotine dependence which might result to numerous tobacco-associated diseases. Objective This study was conducted to analyze the degree of nicotine dependence considering its potential health risk, in the Eastern region of Nepal. Method A descriptive questionnaire based study was conducted among current tobacco users of six districts of Eastern Nepal. Fagerstrom Test for Nicotine Dependence (FTND) and Fagerstrom Test for Nicotine Dependency for Smokeless Tobacco (FTNDST) questionnaire were used for tobacco smokers and chewers, respectively. Result Of the total participants, 836 were males and 359 females, among whom 736 were active tobacco smokers and 432 chewers, 34.8% had tried to stop consuming tobacco and 306 (25.6%) had oral lesions in white or red forms. Very low nicotine dependence was found among 244 (31.47%) tobacco smokers and 37 (8.56%) chewers whereas 36 (4.71%) smokers and 103 (23.84%) chewers had very high nicotine dependence. The mean score for FTND was 3.73±2.37 and 5.74±2.12 for FTND-ST. A significant difference in duration and age group with FTND score was observed, however not with FTND-ST. Conclusion The information regarding degree of nicotine dependence can be used as baseline information for planning of preventive strategies and implementation of tobacco cessation and control programs.
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Affiliation(s)
- A Shrestha
- Department of Oral Pathology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - V Marla
- Department of Oral Pathology, Panang International Dental College, Malaysia
| | - M Lamsal
- Department of Biochemistry, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - D P Sarraf
- Department of Clinical Pharmacology and Therapeutics, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - N Rao
- Boston University, Hendry M Goldman School of Dental Medicine, USA
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Shrestha A. Vaccination Against COVID-19 in Pregnant and Lactating Women. Kathmandu Univ Med J (KUMJ) 2021; 19:158-159. [PMID: 34819427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- A Shrestha
- Department of Obstetrics and Gynecology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Wyld L, Reed MWR, Collins K, Burton M, Lifford K, Edwards A, Ward S, Holmes G, Morgan J, Bradburn M, Walters SJ, Ring A, Robinson TG, Martin C, Chater T, Pemberton K, Shrestha A, Nettleship A, Murray C, Brown M, Richards P, Cheung KL, Todd A, Harder H, Brain K, Audisio RA, Wright J, Simcock R, Armitage F, Bursnall M, Green T, Revell D, Gath J, Horgan K, Holcombe C, Winter M, Naik J, Parmeshwar R, Gosney M, Hatton M, Thompson AM. Bridging the age gap in breast cancer: cluster randomized trial of two decision support interventions for older women with operable breast cancer on quality of life, survival, decision quality, and treatment choices. Br J Surg 2021; 108:499-510. [PMID: 33760077 PMCID: PMC10364907 DOI: 10.1093/bjs/znab005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/04/2020] [Accepted: 12/28/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Rates of surgery and adjuvant therapy for breast cancer vary widely between breast units. This may contribute to differences in survival. This cluster RCT evaluated the impact of decision support interventions (DESIs) for older women with breast cancer, to ascertain whether DESIs influenced quality of life, survival, decision quality, and treatment choice. METHODS A multicentre cluster RCT compared the use of two DESIs against usual care in treatment decision-making in older women (aged at least ≥70 years) with breast cancer. Each DESI comprised an online algorithm, booklet, and brief decision aid to inform choices between surgery plus adjuvant endocrine therapy versus primary endocrine therapy, and adjuvant chemotherapy versus no chemotherapy. The primary outcome was quality of life. Secondary outcomes included decision quality measures, survival, and treatment choice. RESULTS A total of 46 breast units were randomized (21 intervention, 25 usual care), recruiting 1339 women (670 intervention, 669 usual care). There was no significant difference in global quality of life at 6 months after the baseline assessment on intention-to-treat analysis (difference -0.20, 95 per cent confidence interval (C.I.) -2.69 to 2.29; P = 0.900). In women offered a choice of primary endocrine therapy versus surgery plus endocrine therapy, knowledge about treatments was greater in the intervention arm (94 versus 74 per cent; P = 0.003). Treatment choice was altered, with a primary endocrine therapy rate among women with oestrogen receptor-positive disease of 21.0 per cent in the intervention versus 15.4 per cent in usual-care sites (difference 5.5 (95 per cent C.I. 1.1 to 10.0) per cent; P = 0.029). The chemotherapy rate was 10.3 per cent at intervention versus 14.8 per cent at usual-care sites (difference -4.5 (C.I. -8.0 to 0) per cent; P = 0.013). Survival was similar in both arms. CONCLUSION The use of DESIs in older women increases knowledge of breast cancer treatment options, facilitates shared decision-making, and alters treatment selection. Trial registration numbers: EudraCT 2015-004220-61 (https://eudract.ema.europa.eu/), ISRCTN46099296 (http://www.controlled-trials.com).
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Affiliation(s)
- L Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - M W R Reed
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - K Collins
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - M Burton
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - K Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - A Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - S Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - G Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - J Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - M Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - S J Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Ring
- Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - T G Robinson
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, Glenfield General Hospital, Leicester, UK
| | - C Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - T Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - K Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Shrestha
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - A Nettleship
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - C Murray
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - M Brown
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - P Richards
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - K L Cheung
- University of Nottingham, Royal Derby Hospital, Derby, UK
| | - A Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - H Harder
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - K Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - R A Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, Gothenberg, Sweden
| | - J Wright
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - R Simcock
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | | | - M Bursnall
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - T Green
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - D Revell
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - J Gath
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - K Horgan
- Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK
| | - C Holcombe
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - M Winter
- Weston Park Hospital, Sheffield, UK
| | - J Naik
- Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - R Parmeshwar
- University Hospitals of Morecambe Bay, Lancaster, UK
| | - M Gosney
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - M Hatton
- Weston Park Hospital, Sheffield, UK
| | - A M Thompson
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
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Dunnell L, Shrestha A, Li E, Khan Z, Hashemi N. 81 Integrating A Front Door Frailty Service in the Emergency Department: Results of A Pilot Study. Age Ageing 2021. [DOI: 10.1093/ageing/afab030.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Increasing old age and frailty is putting pressure on health services with 5–10% of patients attending the emergency department (ED) and 30% of patients in acute medical units classified as older and frail. National Health Service improvement mandates that by 2020 hospital trusts with type one EDs provide at least 70 hours of acute frailty service each week.
Methodology
A two-week pilot (Monday–Friday 8 am-5 pm) was undertaken, with a “Front Door Frailty Team” comprising a consultant, junior doctor, specialist nurse and pharmacist, with therapy input from the existing ED team. They were based in the ED seeing patients on arrival, referrals from the ED team and patients in the ED observation ward—opposed to the usual pathway of referral from the ED team to medical team. Data was captured using “Cerner” electronic healthcare records. A plan, do, study, act methodology was used throughout with daily debrief and huddle sessions.
Results
95 patients were seen over two weeks. In the over 65 s, average time to be seen was 50 minutes quicker than the ED team over the same period, with reduced admission rate (25.7% vs 46.5%). The wait between decision to admit and departure was shortened by 119 minutes. Overall, this led to patients spending on average 133 minutes less in the ED. 64 patients were discharged, of which 44 had community follow-up (including 37.5% of 64 referred to acute elderly clinic and 25% to rapid response). 47 medications were stopped across 25 patients.
Conclusion
The pilot shows that introduction of an early comprehensive geriatric assessment in the ED can lead to patients being seen sooner, with more timely decisions over their care and reduction in hospital admissions. It allowed for greater provision of acute clinics and community services as well as prompt medication review and real time medication changes.
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Affiliation(s)
| | | | - E Li
- Croydon University Hopsital
| | - Z Khan
- Croydon University Hopsital
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Shrestha AP, Bhushal N, Shrestha A, Tamrakar D, Adhikari P, Shrestha P, Shrestha A, Karmacharya BM, Basnet S, Tamrakar SR, Shrestha R, Shrestha R. First Reported Death of a Postpartum Woman Due to Coronavirus Disease 2019 in Nepal: A Lesson Learnt. Kathmandu Univ Med J (KUMJ) 2021; 18:117-119. [PMID: 33605254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The first case of coronavirus disease 2019 was reported on December 31, 2019 in Wuhan, China where the average case fatality rate was 6.1 ± 2.9%. There are 453 deaths as of September 24, 2020 in Nepal. We report the first death of a 29-years-old postpartum woman due to COVID-19 in Nepal who was referred from a rural health center to Dhulikhel Hospital. On arrival, she was taken to the acute respiratory zone of the emergency department to provide immediate lifesaving procedures. Despite the repeated resuscitative measures, return of spontaneous circulation could not be achieved. The real time polymerase chain reaction test was positive. Our case report highlights the importance of early clinical suspicion, importance of "safety first" in healthcare settings, and the chain of management in such patients. We consider the fact that a postpartum woman registered as the first case of COVID-19 related death in Nepal to be an area of further study.
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Affiliation(s)
- A P Shrestha
- Department of General Practice and Emergency Medicine, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - N Bhushal
- Department of Microbiology, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - A Shrestha
- Department of Community Medicine, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - D Tamrakar
- Department of Community Medicine, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - P Adhikari
- Department of Public Health and Community Program, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - P Shrestha
- Department of Public Health and Community Program, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - A Shrestha
- Department of Public Health and Community Program, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - B M Karmacharya
- Department of Public Health and Community Program, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Basnet
- Department of General Practice and Emergency Medicine, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S R Tamrakar
- Department of Obstetrics and Gynecology, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R Shrestha
- Department of Pharmacology, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R Shrestha
- Department of Pharmacology, Pharmacovigilance Unit/Research and Development Division, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Shrestha B, Neupane AK, Pant S, Shrestha A, Bastola A, Rajbhandari B, Thapa A, Singh A. Sensitivity and Specificity of Lateral Flow Antigen Test Kits for COVID-19 in Asymptomatic Population of Quarantine Centre of Province 3. Kathmandu Univ Med J (KUMJ) 2021; 18:36-39. [PMID: 33605236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background Nearly after 6 months of the spread of Corona Virus Disease 19, along with the world Nepal is still trying to control the spread and prevent general population from acquiring it. With limited resources in manpower, technology and evidence it has been a difficult battle. But with time and more understanding of the virus new technology to detect the virus are coming up. It is a major breakthrough in the diagnostic field as this helps us in not only detecting the virus but also helps us to mobilize our human resources. This comes in a time where the cases are increasing at an alarming rate. Although numbers of Polymerase Chain Reaction testing have increased but due to the time consuming and the cost wise, we need a faster and equally reliable alternative. Antigen test approved by different countries can be used for point of care, screening and surveillance depending upon the requirements after calculating its sensitivity, specificity and accuracy. Objective To find out sensitivity and specificity of the Antigen test kit for COVID-19. Method Antigen tests were compared with Reverse Transcription Polymerase Chain Reaction as a reference standard in calculated sample size of 113 subjects in a high risk population. Both Reverse Transcription Polymerase Chain Reaction and antigen test were performed in a same subject with in maximum of 2 days' interval. Convenience sampling technique was used to select the subjects. Ethical approval was taken from Nepal Health Research Council before data collection. Study was done from August to September 2020 from Quarantine center of Province 3. Result There were total of 113 test carried out, among those 47 were positive and 66 were negative in Reverse Transcription Polymerase Chain Reaction. After preparing two by two table, Sensitivity and specificity of the tested was calculated which came out to be 85% and 100% respectively, with accuracy of 93.80%. Conclusion Even though the sensitivity and specificity came to be higher, this test should be interpreted cautiously depending upon the prevalence of Corona Virus Disease 19 in that particular community and the clinical and epidemiological context of the person who has been tested. When in doubt by clinical correlation should be confirmed with Reverse Transcription Polymerase Chain Reaction.
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Affiliation(s)
- B Shrestha
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - A K Neupane
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - S Pant
- Nepal Health Research Council, Kathmandu, Nepal
| | - A Shrestha
- Patan Academy of Health Science, Lalitpur, Patan, Nepal
| | - A Bastola
- Shukraraaj Tropical and Infectious Disease Hospital, Kathmandu, Nepal
| | | | - A Thapa
- Nepal Armed Police Force Hospital, Kathmandu, Nepal
| | - A Singh
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
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50
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Shrestha A, Shrestha A, Cissé G. Dietary Patterns Measured by Principal Component Analysis and its Association with Stunting among Nepalese Schoolchildren in Nepal. Kathmandu Univ Med J (KUMJ) 2021; 19:9-16. [PMID: 34812151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background There is a gap of knowledge on the link of major dietary patterns with stunting among schoolchildren in Nepal. Objective To identify dietary patterns in rural Nepalese households in two districts and assess their association with stunting among schoolchildren. Method This cross-sectional study gathered data from 708 schoolchildren aged 8-16 years participating in the baseline survey in the Districts of Dolakha and Ramechhap, Nepal. We derived major dietary patterns from a principal component analysis of reported intake from a food frequency questionnaire completed through interviews with the caregivers. Statistical analysis was conducted using mixed logistic regression with random intercepts at the level of schools adjusting for socio-demographic and behavioural indicators. Result The diet of surveyed schoolchildren was mainly comprised of starchy staples and legumes. Five dietary patterns score were derived: mixed food, vegetables and lentils, milk and beverages, salty snacks, and processed food. The vegetables and lentils pattern scores were negatively associated with stunting (aOR 0.84; 95% CI: 0.66-1.08, p=0.17) after adjusting for regional differences, demographic and behavioural risk factors. Conclusion Our results suggest that adherence to dietary patterns high in vegetables and animal protein might be associated with reduced odds of being stunted among schoolchildren. Therefore, the promotion of dietary diversification strategies to improve schoolchildren's food consumption is required in the study area.
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Affiliation(s)
- A Shrestha
- Department of Public Helath, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - A Shrestha
- Harvard TH Chan School of Public Health, Boston, USA
| | - G Cissé
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
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