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Maskay SS, Shrestha N, Bastola P, Pradhan B, Shrestha A. Ultrasonography Imaging versus Waveform Capnography in Detecting Endotracheal Tube Placement during Intubation at a Tertiary Hospital. J Med Ultrasound 2024; 32:70-75. [PMID: 38665336 PMCID: PMC11040478 DOI: 10.4103/jmu.jmu_98_22] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/01/2023] [Accepted: 03/08/2023] [Indexed: 04/28/2024] Open
Abstract
Background There is continued research to find new faster, highly accurate, easily accessible, and portable methods of confirming endotracheal tube position during intubation. A newer modality for visualizing endotracheal tube location is transtracheal or transcricothyroid ultrasonography. The aim of this study was to see if ultrasound machine can also be routinely used for the confirmation of endotracheal tube position in operating theaters along with capnograph. Methods The study was observational and prospective, conducted from January 2017 to July 2017. Study locations were at the Tribhuvan University Teaching Hospital and Manmohan Cardiothoracic Vascular and Transplant Center operating rooms. Sample size taken was 95. Results In the study, 11 patients had esophageal intubation out of the 95. The accuracy of both ultrasonography and capnography was found to be 96.84%. For ultrasonography, the sensitivity, specificity, along with positive predictive value and negative predictive value were 97.62%, 90.91%, 98.80%, and 83.33%, respectively, while that for capnography were found to be 96.43%, 100%, 100%, and 78.57%, respectively. The kappa value was calculated to be 0.749, which suggested the degree of agreement of result between the methods to be good. Compared to capnography, ultrasonography was found to be significantly faster for the confirmation of endotracheal tube location by 16.36 s (15.70-17.02) (P = 0.011). Conclusion Both waveform capnography and ultrasonography were found to be accurate and reliable in confirming endotracheal tube location. The use of ultrasound during intubation can help confirm endotracheal tube location faster and also aid in precision when used along with capnography. Manual bag ventilations are not necessary when confirming endotracheal tube position by ultrasonography and thus may help in preventing aspiration of gastric contents into the lungs of the patient.
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Affiliation(s)
- Shirish Shakti Maskay
- Department of Anesthesiology, Indira Gandhi Memorial Hospital, Male, Maldives
- Department of Anesthesiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Ninadini Shrestha
- Department of Anesthesiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Priska Bastola
- Department of Cardiothoracic and Vascular Anesthesiology, Manmohan Cardiothoracic Transplant and Vascular Centre, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Bishwas Pradhan
- Department of Cardiothoracic and Vascular Anesthesiology, Manmohan Cardiothoracic Transplant and Vascular Centre, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Anil Shrestha
- Department of Anesthesiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Pradhan B, Panda D, Bishi SK, Chakraborty K, Muthusamy SK, Lenka SK. Progress and prospects of C 4 trait engineering in plants. Plant Biol (Stuttg) 2022; 24:920-931. [PMID: 35727191 DOI: 10.1111/plb.13446] [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] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
Incorporating C4 photosynthetic traits into C3 crops is a rational approach for sustaining future demands for crop productivity. Using classical plant breeding, engineering this complex trait is unlikely to achieve its target. Therefore, it is critical and timely to implement novel biotechnological crop improvement strategies to accomplish this goal. However, a fundamental understanding of C3 , C4 , and C3 -C4 intermediate metabolism is crucial for the targeted use of biotechnological tools. This review assesses recent progress towards engineering C4 photosynthetic traits in C3 crops. We also discuss lessons learned from successes and failures of recent genetic engineering attempts in C3 crops, highlighting the pros and cons of using rice as a model plant for short-, medium- and long-term goals of genetic engineering. This review provides an integrated approach towards engineering improved photosynthetic efficiency in C3 crops for sustaining food, fibre and fuel production around the globe.
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Affiliation(s)
- B Pradhan
- Department of Agricultural Biotechnology, Faculty Centre for Integrated Rural Development and Management, Ramakrishna Mission Vivekananda Educational and Research Institute, Kolkata, India
| | - D Panda
- Department of Biodiversity & Conservation of Natural Resources, Central University of Odisha, Koraput, India
| | - S K Bishi
- School of Genomics and Molecular Breeding, ICAR-Indian Institute of Agricultural Biotechnology, Ranchi, India
| | - K Chakraborty
- Department of Plant Physiology, ICAR-National Rice Research Institute, Cuttack, India
| | - S K Muthusamy
- Division of Crop Improvement, ICAR-Central Tuber Crops Research Institute, Thiruvananthapuram, India
| | - S K Lenka
- Department of Plant Biotechnology, Gujarat Biotechnology University, Gujarat, India
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Das S, Satpathy P, Dash SK, Mohanty A, Sarkar S, Pradhan B, Sahu GS, Tripathy PK. Genotypic variation in auxin-induced rooting response of detached tomato leaves: an innovative approach for indirect evaluation of yielding ability in tomato (Solanum lycopersicum L.). CURR SCI INDIA 2022. [DOI: 10.18520/cs/v123/i4/568-573] [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: 11/15/2022]
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Joshi P, Sigdel S, Sharma Bhattarai A, Pradhan B. Hemodynamic Responses to laryngoscopy and intubation: Comparison between Macintosh and McCoy laryngoscope. Med J Shree Birendra Hosp 2022. [DOI: 10.3126/mjsbh.v21i1.42382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Laryngoscopy causes exaggerated hemodynamics as tachycardia, hypertension, arrhythmias and may have deleterious respiratory, neurological, and cardiovascular effects. A very few studies have compared the effects of various types of laryngoscope blades on hemodynamic response to laryngoscopy and intubation.
Methodology: A prospective randomized study was done to compare the hemodynamic response to using McCoy and Macintosh laryngoscope. A hundred patients, belonging to ASA grade I and II, between 15-65 years, requiring general anesthesia with intubation were included. A standard anesthesia technique was used. Both groups(n=50) were matched demographically. Mallampati grading, laryngoscopy and intubation time, laryngeal visualization grades, and hemodynamic variables at baseline were comparable.
Result: Following laryngoscopy there was significant rise in heart rate, systolic, diastolic and mean arterial pressure. The maximum change in HR compared to baseline was 20.45±9.29 vs 12.36± 7.28 (p<0.001) in Macintosh and McCoy groups. As compared to baseline maximum change in SBP (mean) was 7.92±10.53 vs 2.80± 6.73 (p= 0.005), the maximum change in DBP (mean) was 9.28±14.74 vs 5.72±7.37 (p= 0.130), the maximum percentage change in MAP (mean) was 8.62±12.07 vs 4.36±7.83 (p=0.039) in Macintosh and McCoy group respectively. Compared to variables just before insertion of the laryngoscope, maximum percentage rise in mean HR was 22.74±10.88 vs 16.40±7.43 (p=0.001), maximum percentage rise in SBP (mean) was 28.31± 13.22 vs 19.41±6.82 (p<0.001), maximum percentage rise in DBP (mean) was 30.00±15.25 vs 24.64±12.21 (p=0.003), maximum percentage rise in MAP (mean) was 28.89±11.55 vs 22.31±11.34 (p=0.05) in Macintosh and McCoy group respectively.
Conclusion: The hemodynamic response to laryngoscopy and intubation with McCoy laryngoscope was significantly less than with Macintosh laryngoscope.
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Mahaseth R, Gurung U, Pradhan B. Conchopexy Suture versus Bolgerization in preventing middle turbinate lateralisation following FESS. RHINOL 2021. [DOI: 10.4193/rhinol/21.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Middle turbinate lateralisation is the most common minor post-operative complication following functional endoscopic sinus surgery. This study aimed to compare the outcome between Conchopexy suture and Bolgerization method in preventing middle turbinate lateralisation. Methodology: This was a prospective, comparative and interventional study conducted from May 2018 to November 2019 at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. A total of 68 patients were divided equally into two groups. Following functional endoscopic sinus surgery, the middle turbinate was medialised either by Conchopexy suture or Bolgerization technique. Postoperative assessment was done on the second and 12th week of surgery, where the position of the middle turbinate and status of the sinus cavity were assessed using perioperative sinus endoscopic (POSE) score. Chi-square test and unpaired t test were used for comparison of postoperative results between two groups taking p value of < 0.05 as statistically significant. Results: Lateralised middle turbinate and mean POSE score was 5/34 (14.8%) and 2.1±1.25, respectively, in Conchopexy group whilst in Bolgerization group it was 6/34 (17.6%) and 2.5±1.46. However, the observed differences were not statistically significant. Conclusion: Conchopexy suture and Bolgerization techniques were equally effective in preventing middle turbinate lateralisation. Hence, either of these techniques could be used as an adjunct to FESS to avoid middle turbinate lateralisation.
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Khadgi S, Gurung U, Pradhan B, Tripathi P. Comparison of Outcomes of Conventional Septoplasty Versus Endoscopic Septoplasty using Freer's Incision in Symptomatic Deviated Nasal Septum. Kathmandu Univ Med J (KUMJ) 2021; 19:339-344. [PMID: 36254421] [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 Septoplasty techniques have evolved over the years with endoscopic septoplasty gaining popularity in the recent times. Objective To compare the outcomes of conventional septoplasty with endoscopic septoplasty using Freer's incision in symptomatic deviated nasal septum. Method It was a prospective, randomized and comparative study done at Department of ENTHead and Neck Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from July 2018 to August 2019. A total of 70 patients with symptomatic deviated nasal septum were allocated randomly into two groups. Group A underwent conventional septoplasty whilst Group B underwent endoscopic septoplasty using Freer's incision. Sino-nasal outcome test (SNOT-10) score was recorded pre-operatively and post -operatively between four to six weeks of surgery. Paired and independent 't' test for mean was used as a statistical tool. Result Out of 70 patients, 57(81.43%) were males and 13(18.57%) females. The age group mostly affected was in the third and fourth decades with total 47 patients (67.14%). In the conventional group, the pre-op mean SNOT-10 score was 11.46 (SD±3.6) while post-op mean SNOT-10 score was 2.60 (SD±1.9), the difference being statistically significant (p value 0.00001). Similarly, in the endoscopic group, pre-op mean SNOT10 score was 12.06 (SD±4.88) and post-op mean SNOT- 10 score was 3.37 (SD±2.71) with the difference being statistically significant (p value 0.00001). Comparison of post-operative mean SNOT-10 score between two techniques was not statistically significant (p value 0.17). Conclusion Both conventional and endoscopic septoplasty techniques using Freer's incision were equally effective in improving symptoms due to deviated nasal septum.
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Affiliation(s)
- S Khadgi
- Department of Head and Neck Oncology, B.P. Koirala Memorial Cancer Hospital, Bharatpur, Chitwan, Nepal
| | - U Gurung
- Department of ENT-Head and Neck Surgery, Tribhuvan University Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - B Pradhan
- Department of ENT-Head and Neck Surgery, Tribhuvan University Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - P Tripathi
- Department of ENT-Head and Neck Surgery, Tribhuvan University Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
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Abstract
During the COVID-19 pandemic, there has been a global shift toward online distance learning due to travel limitations and physical distancing requirements as well as medical school and university closures. In low- and middle-income countries like Nepal, where medical education faces a range of challenges-such as lack of infrastructure, well-trained educators, and advanced technologies-the abrupt changes in methodologies without adequate preparation are more challenging than in higher-income countries. In this article, the authors discuss the COVID-19-related changes and challenges in Nepal that may have a drastic impact on the career progression of current medical students. Outside the major cities, Nepal lacks dependable Internet services to support medical education, which frequently requires access to and transmission of large files and audiovisual material. Thus, students who are poor, who are physically disadvantaged, and who do not have a home situation conducive to online study may be affected disproportionately. Further, the majority of teachers and students do not have sufficient logistical experience and knowledge to conduct or participate in online classes. Moreover, students and teachers are unsatisfied with the digital methodologies, which will ultimately hamper the quality of education. Students' clinical skills development, research activities, and live and intimate interactions with other individuals are being affected. Even though Nepal's medical education system is struggling to adapt to the transformation of teaching methodologies in the wake of the pandemic, it is important not to postpone the education of current medical students and future physicians during this crisis. Looking ahead, medical schools in Nepal should ensure that mechanisms are proactively put into place to embrace new educational opportunities and technologies to guarantee a regular supply of high-quality physicians capable of both responding effectively to any future pandemic and satisfying the nation's future health care needs.
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Affiliation(s)
- Shailendra Sigdel
- S. Sigdel is assistant professor, Department of Cardiothoracic and Vascular Anesthesiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Maharajgunj, Kathmandu, Nepal; ORCID: https://orcid.org/0000-0001-5357-1083
| | - Akihiko Ozaki
- A. Ozaki is attending physician, Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Rachana Dhakal
- R. Dhakal is assistant professor, Department of Pathology, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Bishwas Pradhan
- B. Pradhan is professor, Department of Cardiothoracic and Vascular Anesthesiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - Tetsuya Tanimoto
- T. Tanimoto is researcher, Medical Governance Research Institute, Shinagawa, Tokyo, Japan
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Moktan Lama PB, Khakural P, Sigdel S, Raj Bhatta M, Sah Teli R, Baral RK, Bhattarai A, Pradhan B, Koirala B. Del Nido Cardioplegia in Coronary Artery Bypass Grafting Surgery: A safe, efficacious and economic alternative to St. Thomas solution; an experience from a developing nation. Perfusion 2021; 36:470-475. [PMID: 33509043 DOI: 10.1177/0267659121991033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/17/2022]
Abstract
INTRODUCTION del Nido cardioplegia is a newer solution getting popular worldwide, whereas in Nepal, St. Thomas cardioplegia solution is conventionally used. There is no national recommendation on cardioplegia solutions supported by evidences from Nepalese studies. This study aimed to evaluate and compare the efficacy of these solutions in Nepalese patients undergoing coronary artery bypass grafting. METHODS Patients undergoing coronary revascularization, from May 2018 to December 2019, were randomized into St. Thomas and del Nido groups based on the cardioplegia administered, with 45 patients in each group. Preoperative, intraoperative, and postoperative parameters and cost of cardioplegia preparation in the two groups were compared. RESULTS The cardiopulmonary bypass time (106.13 ± 24.65 minutes vs 107.62 ± 18.69 minutes, p = 0.02), aortic cross clamp time (66.22 ± 15.40 minutes vs 72.07 ± 12.23 minutes, p = 0.04), volume (1059.22 ± 100.30 ml vs 1526.67 ± 271.81 ml, p < 0.001) and number of cardioplegia doses (1.00 ± 0.00 vs 2.51 ± 0.66, p < 0.001) were significantly lower with del Nido cardioplegia. A lower CPK-MB at second post-operative (59.91 ± 31.62 vs 73.82 ± 37.25, p = 0.03) and a higher left ventricle ejection fraction at discharge (56.33 ± 8.94% vs 50.45 ± 8.55%, p < 0.001) was observed in del Nido group. There was one death in St. Thomas group. ICU and hospital stay were similar in both groups. St. Thomas solution was found to be costlier than del Nido solution (USD 5.40 ± 0.96 vs USD 3.50 ± 0.34, p < 0.001). CONCLUSION The del Nido cardioplegia was found to be efficacious, safe and more economical alternative to St. Thomas solution.
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Affiliation(s)
- Purna Bahadur Moktan Lama
- Department of Cardiothoracic Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Prabhat Khakural
- Department of Cardiothoracic Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Shailendra Sigdel
- Department of Cardiothoracic and Vascular Anesthesiology, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Mahendra Raj Bhatta
- Department of Cardiothoracic Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Rabindra Sah Teli
- Department of Cardiothoracic Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Ravi Kumar Baral
- Department of Cardiothoracic Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Anil Bhattarai
- Department of Cardiothoracic Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Bishwas Pradhan
- Department of Cardiothoracic and Vascular Anesthesiology, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Bhagawan Koirala
- Department of Cardiothoracic Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
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Sigdel S, Ozaki A, Basnet M, Kobashi Y, Pradhan B, Higuchi A, Uprety A. Anxiety evaluation in Nepalese adult patients awaiting cardiac surgery: A prospective observational study. Medicine (Baltimore) 2020; 99:e19302. [PMID: 32118748 PMCID: PMC7478669 DOI: 10.1097/md.0000000000019302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Perioperative anxiety could negatively affect surgery outcomes, and cardiac diseases have long been known to be an independent risk factor for anxiety development. However, little is known about preoperative anxiety in Nepalese adult cardiac patients waiting for surgery. The primary objectives of this study were to: (1) clarify the levels of preoperative anxiety in Nepalese adult cardiac patients waiting for open heart surgery; (2) identify factors associated with preoperative anxiety; and (3) evaluate any possible factors associated with patients' desire to obtain information related to their heart surgery.This is a prospective observational study for patients already scheduled for cardiac surgery at a core medical institution in Kathmandu, Nepal. We collected sociodemographic and clinical characteristics of the patients from their medical charts, and assessed their preoperative anxiety using the Amsterdam Preoperative Anxiety and Information Scale. We performed descriptive analyses of the collected data. Further, we employed regression models to assess to the objectives of the study.In total, 140 patients participated, and data of 123 (87.9%) were used for analysis. 58.5% of the participants had preoperative anxiety. Female gender (OR 0.31, 95% CI 0.15-0.65, P < .001) and past anesthesia exposure (OR 2.38, 95% CI 1.01-5.62, P < .05) were identified as risk factors for developing anxiety before cardiac surgery. Further, female gender (IRR 0.80, 95% CI 0.67-0.94, P < .001), higher education levels (IRR 1.18, 95% CI 1.01-1.40, P < .05), and higher preoperative anxiety (IRR 1.44, 95% CI 1.21-1.73, P < .001) could lead to higher levels of desire to acquire information related to the procedure.The study concluded that more than a half of the cardiac surgery patients experiences preoperative anxiety; female gender and having past anesthesia exposure are the risk factors. Anxious patients have more desire to acquire knowledge about the procedure. Thus, the evaluation and adequate management of preoperative anxiety should be proposed in high-risk groups.
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Affiliation(s)
- Shailendra Sigdel
- Department of Cardiothoracic and Vascular Anesthesiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Akihiko Ozaki
- Department of Breast Cancer, Jyoban Hospital of Tokiwa Foundation, Iwaki
- Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma
| | - Madindra Basnet
- Department of Cardiothoracic and Vascular Anesthesiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Yurie Kobashi
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima
- Department of Anesthesia, Jyoban Hospital of Tokiwa Foundation, Iwaki
| | - Bishwas Pradhan
- Department of Cardiothoracic and Vascular Anesthesiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Asaka Higuchi
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima
- Medical Governance Research Institute, Tokyo, Japan
| | - Anup Uprety
- Department of Anesthesiology, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
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Gyawali BR, Pradhan B, Thapa N. Comparison of outcomes of triamcinolone versus normal saline soaked polyvinyl alcohol pack following bilateral endoscopic sinus surgery. Rhinology 2019; 57:287-292. [PMID: 31129684 DOI: 10.4193/rhin19.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Steroids have been proven to be beneficial in improving post-operative outcomes following sinus surgery. The ideal mode of delivery is to increase local concentration in the sinuses with minimal systemic side effects. In this study, we used triamcinolone soaked polyvinyl alcohol packs immediately following sinus surgery, and assessed the effects on post-operative outcomes. METHODOLOGY This was a prospective, interventional, and comparative study. Following endoscopic sinus surgery, a polyvinyl alcohol pack was placed in both nasal cavities and 4 ml triamcinolone was infiltrated in one side and 4 ml of normal saline was infiltrated in the other. The pack was removed on the second post-operative day and nasal cavities and paranasal sinuses were evaluated using a flexible endoscope in the third post-operative week using Lund-Kennedy and Peri-operative sinus endoscopic scores. RESULTS There was a reduction in the average Lund-Kennedy score and Peri-operative sinus endoscopy score in the treatment site compared to the control site which was statistically significant. There was a greater reduction in crusting, oedema and scarring in the treatment site compared to the control site. However, only the reduction in oedema was statistically significant. CONCLUSIONS Triamcinolone soaked polyvinyl alcohol pack following endoscopic sinus surgery improves post-operative outcomes.
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Affiliation(s)
- B R Gyawali
- Department of ENT-HNS, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - B Pradhan
- Department of ENT-HNS, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - N Thapa
- Department of ENT-HNS, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Mandal NK, Rauniar GP, Rai DS, Pradhan B, Poudel P, Sapkota N. Therapeutic Drug Monitoring of Antiepileptic Drugs at a Tertiary Care Hospital of Eastern Nepal. Kathmandu Univ Med J (KUMJ) 2019; 17:160-165. [PMID: 33305740] [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 Therapeutic drug monitoring (TDM) is the process of measuring drug level in body fluids. It is done to maintain plasma concentration of the drug under therapy within a specific target range for maximum therapeutic efficacy without unnecessary exposure to adverse effects. Objective This study aims to evaluate necessity of therapeutic drug monitoring in Phenytoin, Carbamazepine and Lamotrigine therapy among epileptic patients. Method A prospective, cross-sectional study was conducted for a period of one year at BP Koirala Institute of Health Sciences, Dharan, Nepal. After taking detailed history, blood samples were collected from epileptic patients on monotherapy with the selected drugs. Plasma levels of these drugs were analyzed using High Performance Liquid Chromatography technique (HPLC). Out of total 42 selected patients, 21 were tested for phenytoin, 17 for carbamazepine and four for lamotrigine. The result was categorized into therapeutic, sub-therapeutic and above-therapeutic groups based on reference range. Result Out of total 21 samples tested for phenytoin, 15(71.4%) had plasma drug level within therapeutic range, 5(23.8%) had within subtherapeutic range and 1(4.8%) had above therapeutic range. Analysis of carbamazepine plasma level showed 14(82.3%) at therapeutic level, 1(5.9%) at sub-therapeutic level and 2(11.8%) at above-therapeutic level. Lamotrigine testing in four samples showed 2(50% in) both within therapeutic range and above-therapeutic range. Conclusion Therapeutic drug monitoring of phenytoin, carbamazepine and lamotrigine showed variation in plasma level irrespective of the therapeutic dose. It is suggested that dose adjustment of antiepileptic drugs should be done after establishing 'individual therapeutic range' following regular plasma monitoring.
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Affiliation(s)
- N K Mandal
- Department of Clinical Pharmacology and Therapeutics, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - G P Rauniar
- Department of Clinical Pharmacology and Therapeutics, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - D S Rai
- Department of Clinical Pharmacology and Therapeutics, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - B Pradhan
- Department of Internal Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - P Poudel
- Department of Pediatrics and Adolescent Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - N Sapkota
- Department of Psychiatry, BP Koirala Institute of Health Sciences, Dharan, Nepal
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Sharma R, Pradhan B, Karki P, Bartaula B. Clinico-epidemiological Profile of Extra Hepatic Portal Vein Obstruction: A Tertiary Care Hospital Based Retrospective Study. Kathmandu Univ Med J (KUMJ) 2019; 17:30-34. [PMID: 31734675] [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: 06/10/2023]
Abstract
Background Extra hepatic portal vein obstruction (EHPVO) is a common cause of portal hypertension in the developing countries (up to 30% of all variceal bleeders) and is second to cirrhosis in the West (up to 5-10%). Our understanding of the disease is poor compared with other illnesses. Objective To undertake a retrospective study of the clinicoepidemiological profile of Extra hepatic portal vein obstruction in a tertiary care hospital in eastern Nepal. Method All consecutive adult patients whose features were consistent with the diagnosis of extra hepatic portal vein obstruction from June 2014 to June 2016 were retrospectively analyzed to explore the various clinico-epidemiological parameters. Result A total of 58 patients were enrolled in the study with a median age of 24 years (20.5- 40). Portal vein thrombosis was the most common cause of extrahepatic portal vein obstruction. Hematemesis followed by melena were the most common presenting symptoms. All patients had splenomegaly on examination. None of the patients had clinical, biochemical or radiological evidence of chronic liver disease. Conclusion The diagnosis of extra hepatic portal venous obstruction and differentiation from cirrhosis can be easily made by characteristic clinical features, normal liver function tests and doppler ultrasound. Portal vein thrombosis (PVT) is the predominant cause of extra hepatic portal vein obstruction in Nepali patients, as seen at this tertiary care hospital in Nepal.
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Affiliation(s)
- R Sharma
- Division of Gastroenterology and Internal Medicine, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - B Pradhan
- Division of Gastroenterology and Internal Medicine, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - P Karki
- Department of Internal Medicine, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - B Bartaula
- Department of Internal Medicine, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
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Pradhan B, Zhang K, Badge R, Kauppi L. PO-318 De novolong interspersed element (LINE-1) insertions in high-grade serous ovarian carcinoma. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.348] [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] Open
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Gyawali B, Pradhan B. Sphenoidal mucopyocele with visual impairment: case report of a rare disease and literature review. RHINOL 2018. [DOI: 10.4193/rhinol/18.022] [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: 11/08/2022] Open
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Shrestha R, Shrestha SD, Malla AP, Pradhan R, Pradhan B, RC L. Acute Total Uterine Inversion: A Life Threatening Obstetrics Emergency. Nepal j obstet gynaecol 2018. [DOI: 10.3126/njog.v12i1.18987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Acute total uterine inversion is a rare and life threatening obstetric emergency. Prompt diagnosis and aggressive management reduces maternal mortality and morbidity .We report a case of 28 year old primi, who had total uterine inversion immediately after normal delivery of full term baby weighing 3150gm. Immediate manual repositioning was done by Johnson’s maneuver under general anesthesia. She recovered well and was discharged after 5 days.
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Amatya BR, Acharya B, Pradhan B, Marhattha MN. Effect of Glycopyrolate on Nausea, Vomiting and Neonatal Outcome During Spinal Anaesthesia for Elective Caesarean Section. Med J Shree Birendra Hosp 2016. [DOI: 10.3126/mjsbh.v15i1.15188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Glycopyrrolate has better antisialagogue effect and does not cross placental barrier; thereby when given immediately before subarachnoid block for elective caesarean section might reduce incidence and severity of nausea and vomiting without affecting neonatal outcome. Methods: In a prospective randomized double blind placebo controlled study, sixty ASA PS I and II patients undergoing elective caesarean section at term were assigned to receive 1 ml of Inj Normal Saline IV or 1 ml (0.2 mg) of Inj Glycopyrrolate. After subarachnoid block, nausea score was assessed every 5 min during intraoperative period (before and after cord clamping), every 30 min for initial 4 hour and every 6 hour till 24 hr after surgery. Vomiting was assessed as mild (<2 episodes) and severe (>2 episodes). Apgar scores were recorded 1 min and 5 min after birth. Results:The severity of nausea was less in glycopyrrolate group than in normal saline group during intraoperative period (p value ≤ 0.001) and postoperative period (p value 0.31). During intraoperative and postoperative period, the severity of vomiting was mild in normal saline group where as in glycopyrrolate group there was no vomiting. The incidence of nausea was low in the parturient who received IV glycopyrrolate than those who received normal saline 3.33% vs. 60% (p value <0.001) during intraoperative period particularly after cord clamping 0 vs. 53.33% (p value <0.001). There was also reduced incidence of vomiting 0 vs. 13.33% (p value 0.03) during intraoperative period after cord clamping. All neonates born to the mother participating in the study had satisfactory Apgar score. Conclusions: Injection Glycopyrrolate when given as an IV premedication during spinal anaesthesia for elective caesarean section could reduce both the severity and incidence of nausea and vomiting during intraoperative period particularly after cord clamping without affecting neonatal outcome and causing side effects.
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Sah RB, Pradhan B, Subedi L, Karki P, Jha N. Epidemiological Study of Tobacco Smoking Behaviour amongst Residents of the Hill Region of Nepal. Kathmandu Univ Med J (KUMJ) 2016; 14:215-220. [PMID: 28814681] [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: 06/07/2023]
Abstract
Background Tobacco use is still a serious public health problem in the world and represents a major cause of morbidity and mortality in most parts of the world. Objective To measure the prevalence of tobacco use and to identify the factors associated with tobacco use among the residents of Dhankuta Municipality. Method The cross-sectional study was conducted among the residents of the Dhankuta Municipality where 205 households were taken as subjects. Pretested semistructured questionnaire was used for data collection and face to face interview was conducted. Univariate and multivariate logistic regression was used to see the association between various factors and tobacco use and identify the predictor variables. Result Overall prevalence of tobacco consumption in Dhankuta Municipality was found to be 57.1%. Prevalence of tobacco consumption among the male was significantly higher (67%) than female (47.1%) (p<0.05). Most of the respondents (56.4%) started consuming tobacco due to peer pressure and for recreation (24.8%). The multivariate logistic regression showed that the people with illiterate have higher chances of consuming tobacco than above School Leaving Certificate (OR 38.395, 95% CI=3.209- 459.417). The respondents below poverty line (<1.25 US$) was consuming tobacco more than above poverty line (> 1.25 US $) (OR 6.814, 95% CI= 1.255-36.986). Conclusion The aims of this study was to measure the prevalence of tobacco use and to identify the factors associated with tobacco use among the residents of the Dhankuta Municipality. We conclude that the prevalence rate of tobacco consumption in the Dhankuta Municipality was found to be moderately high. Factors like male in gender, Brahmin/Chhetri in ethnicity, lack of education, poor occupation like farmer and housewife, poor economic status were associated with tobacco use.
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Affiliation(s)
- R B Sah
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - B Pradhan
- Department of Internal Medicine, Koirala Institute of Health Sciences, Dharan, Nepal
| | - L Subedi
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - P Karki
- Department of Internal Medicine, Koirala Institute of Health Sciences, Dharan, Nepal
| | - N Jha
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
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Pradhan B. European Score for Cardiac Operative Risk Evaluation (EuroSCORE) in cardiac valvular surgeries in Nepal. J Cardiothorac Vasc Anesth 2016. [DOI: 10.1053/j.jvca.2016.03.028] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pokharel S, Upadhyaya P, Karki S, Paudyal P, Pradhan B, Poudel P. Megakaryocytic alterations in thrombocytopenia: A bone marrow aspiration study. J Pathol Nep 2016. [DOI: 10.3126/jpn.v6i11.15673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Megakaryocyte morphology plays an important role in thrombopoiesis. A defect in any stage of megakaryocytopoiesis can lead to dysmegakaryocytopoiesis and thrombocytopenia. This study was conducted to understand megakaryocytic alterations and their contribution in the diagnosis of cases of thrombocytopenia.Materials and Methods: This was a cross-sectional study was conducted on all consecutive cases of bone marrow aspirates of thrombocytopenia over a duration of one year in BPKIHS. Megakaryocyte morphology was studied with a 100X objective. Data were entered into Microsoft excel 10 and analysed with SPSS version 11.5. Descriptive statistics charted and Chi-square tests were done for inferential statistics to find any association at 95% Confidence Interval.Results: Among the 38 subjects, megakaryocytic thrombocytopenia (44.7%) was the most common cause of thrombocytopenia. Hypolobated megakaryocytes (63.2%), bare megakaryocytic nuclei (57.9%) were the common morphological changes in megakaryocytes. Odds of increased megakaryocyte count in megakaryocytic thrombocytopenia was found to be 12.5 times than for other causes of thrombocytopenia and the presence of bare megakaryocytic nuclei in MTP was statistically significant. (p –value<0.05)Conclusion: Many similarities were observed in megakaryocytic morphology among different hematological diseases. However, increased megakaryocyte count and presence of bare megakaryocytic nuclei, hypolobated forms were significant in megakaryocytic thrombocytopenia.
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Abstract
Journal of Society of Anesthesiologists of Nepal 2015; 2(2): 39-40
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Abstract
Aims: This study was done to find out morbidity related with puerperal pyrexia/sepsis and its risk factors. Methods: This was retrospective study conducted from January 2011 to December 2012 at Department of Obstetrics and Gynaecology, Patan Hospital, Kathmandu, Nepal. All women who delivered in this hospital within 42 days of delivery with puerperal pyrexia/sepsis diagnosed on clinical examination and relevant investigations were included in the study. Women with malaria, typhoid fever and ??other fever were excluded. The data was recorded in predesigned proforma and analyzed. Results: During this period, there were 122 cases of puerperal pyrexia. Puerperal pyrexia accounted for 6.28% of 1945 admissions. Most of the women were aged between 20-29 years, primiparous and booked cases with absent membranes. The causes of puerperal pyrexia in our study were urinary tract infection (47.5%), wound infection (20.5%), endometritis (19.7%) retained product of conception (8.2%), pyoperitoneum (2.5%) and septicemia (1.6%). Conclusions: Puerperal pyrexia/sepsis is one of the causes of preventable maternal morbidity and mortality though in our study it was not proved to be very high in number. Optimal aseptic measures during labour can prevent most of the cases.
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Parajuli BD, Shrestha GS, Pradhan B, Amatya R. Comparison of acute physiology and chronic health evaluation II and acute physiology and chronic health evaluation IV to predict intensive care unit mortality. Indian J Crit Care Med 2015; 19:87-91. [PMID: 25722550 PMCID: PMC4339910 DOI: 10.4103/0972-5229.151016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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] [Indexed: 11/04/2022] Open
Abstract
Context: Clinical assessment of severity of illness is an essential component of medical practice to predict the outcome of critically ill-patient. Acute Physiology and Chronic Health Evaluation (APACHE) model is one of the widely used scoring systems. Aims: This study was designed to evaluate the Performance of APACHE II and IV scoring systems in our Intensive Care Unit (ICU). Settings and Design: A prospective study in 6 bedded ICU, including 76 patients all above 15 years. Subjects and Methods: APACHE II and APACHE IV scores were calculated based on the worst values in the first 24 h of admission. All enrolled patients were followed, and outcome was recorded as survivors or nonsurvivors. Statistical Analysis Used: SPSS version 17. Results: The mean APACHE score was significantly higher among nonsurvivors than survivors (P < 0.005). Discrimination for APACHE II and APACHE IV was fair with area under receiver operating characteristic curve of 0.73 and 0.79 respectively. The cut-off point with best Youden index for APACHE II was 17 and for APACHE IV was 85. Above cut-off point, mortality was higher for both models (P < 0.005). Hosmer–Lemeshow Chi-square coefficient test showed better calibration for APACHE II than APACHE IV. A positive correlation was seen between the models with Spearman's correlation coefficient of 0.748 (P < 0.01). Conclusions: Discrimination was better for APACHE IV than APACHE II model however Calibration was better for APACHE II than APACHE IV model in our study. There was good correlation between the two models observed in our study.
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Affiliation(s)
- Bashu Dev Parajuli
- Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Gentle S Shrestha
- Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Bishwas Pradhan
- Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Roshana Amatya
- Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
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Bhattarai S, Agrawal S, Rijal A, Majhi S, Pradhan B, Dhakal SS. The Study of Prevalence of Helicobacter Pylori in Patients with Acne Rosacea. ACTA ACUST UNITED AC 2014; 10:49-52. [DOI: 10.3126/kumj.v10i4.10995] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Acne rosacea is an inflammatory disease affecting the central part of the face characterized by erythema, papules, papulo pustules and telangiectasias of unknown etiology. More recently numerous studies have described an association with Helicobacter pylori (Hp) and the extra gastric symptoms of cutaneous origin. Objectives To establish the prevalence of Helicobacter pylori (Hp) infection in the stomach in patients with rosacea based on standard Hp serological test. Methods All patients with the clinical staging of 2, 3 and 4 rosacea attending the Dermatology Out Patient Department from May 2009 – April 2010 were included in the study. Quantitative serological test using the SERION ELISA classic Helicobacter pylori IgG was done. Result A total of 26 patients were enrolled in the study with the age ranging from 26- 82 years. There were 14 males and 12 females and the male: female ratio was 1.6:1. Three (11.53%) patients presented with Grade IV rosacea, a severe clinical presentation and symptoms suggestive of acid peptic diseases were found in 14/26 (53.8%) patients. A positive serology to H. pylori was found in 17/26 (65.4%) of patients. A statistically significant correlation was found when association of H.pylori positivity in patients of rosacea compared with the seropositivity in controls. However correlation in the seropositivity was not found amongst the patients having gastritis and rosacea. Conclusion There still proves to find a correlation of Hp infection with patients with rosacea but it can still be hypothesised as a cutaneous manifestation of an internal peptic ulcer disease . DOI: http://dx.doi.org/10.3126/kumj.v10i4.10995 Kathmandu Univ Med J 2012;10(4):49-52
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Regmi H, Gurung R, Sharma S, Pradhan B, Bhattacharya S. Pulmonary tuberculosis among diabetic patients in Dharan Municipality, Eastern Nepal. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.1050] [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: 10/25/2022] Open
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Pradhan B, Barakoty M, Rijal S, Shyangwa P, Dhakal S. Occurrence of Cysticerci serology and risk factors for neurocysticercosis in Eastern Nepal. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.750] [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] Open
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Aman SNA, Latif ZA, Pradhan B. Spatial probabilistic approach on landslide susceptibility assessment from high resolution sensors derived parameters. IOP Conf Ser : Earth Environ Sci 2014; 18:012057. [DOI: 10.1088/1755-1315/18/1/012057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Paudel R, Pradhan B, Wagle RR, Pahari DP, Onta SR. Risk factors for stunting among children: a community based case control study in Nepal. Kathmandu Univ Med J (KUMJ) 2013; 10:18-24. [PMID: 23434956 DOI: 10.3126/kumj.v10i3.8012] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Stunting, a chronic condition, is an underlying cause of child morbidity and mortality in Nepal. This study intends to identify the factors causing stunting among children that will help to prioritize the strategies at the district level. OBJECTIVE The objective of the study was to identify the risk factors for stunting among children of age between 6 to 59 months. METHODS The study was based on community-based case control design in the mid-west, Surkhet Nepal from August to September 2010. The cases were stunted children and controls were the children without stunting. Data was collected by interviewing those children's mothers and measured length/height of 118 children as cases and 236 children as controls. Logistic regression analysis was performed to identify the best model of factors leading to stunting. Odds ratio and 95% confidence interval were used as a measure of association. RESULTS Socio-economic risk factors for stunting comprised mothers without earning (OR=3.11, 95% CI 1.26-7.65), food deficit families (OR=4.26, 95% CI 1.73-10.45) and care taker of the children other than mother (OR=3.02, 95% CI 1.19-7.70). Environmental risk factors for stunting consisted of kitchen without ventilation and children exposed to pesticide. Inappropriate exclusive breast feeding (OR=6.90, 95% CI 2.81-16.97), complementary feeding less than four times a day (OR=3.60, 95% CI 1.32-9.95) and dietary diversity below WHO standard (OR=4.06, 95% CI 1.70-9.67) were factors of stunted children. Diarrhea was found significantly associated with stunting (OR=7.46, 95% CI 2.98-18.65). CONCLUSIONS Stunting was found to be as a result of multiple factors such as socio-economic, environmental and inappropriate feeding practices.
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Affiliation(s)
- R Paudel
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Nepal.
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Abstract
Chondrosarcoma is a rare non-epithelial tumor comprising of 10-20% of primary bone tumor. The nasal septum is a rare site for its occurrence. We present one such case of chondrosarcoma of the nasal septum who was treated with endoscopic removal followed by post operative radiotherapy and discuss the relevant clinical presentation, diagnosis and treatment and review the literature also.
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Affiliation(s)
- U Gurung
- Ganesh Man Singh Memorial Academy of ENT and Head & Neck Studies, Tribhuwan University Teaching Hospital, Kathmandu, Nepal.
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Chaurasia RK, Pradhan B, Chaudhary S, Jha SM. Child-Turcotte-Pugh versus model for end stage liver disease score for predicting survival in hospitalized patients with decompensated cirrhosis. J Nepal Health Res Counc 2013; 11:9-16. [PMID: 23787518] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Short term and medium term survival predictive value of the Child-Turcotte-Pugh (CTP) and Model for End Stage Liver Disease (MELD) score has been established but their usefulness in predicting survival of hospitalized patients with decompensated cirrhosis is lacking. We compared the survival predictive value of these scoring systems in hospitalized patients of decompensated cirrhosis and other associated factors. METHODS A prospective, observational study in 216 consecutive cases of decompensated cirrhosis admitted in medical ward, were enrolled if the inclusion criteria were fulfilled. All cases were investigated and treated as per standard guidelines and clinician's judgment. CTP and MELD score were calculated for each case at the time of admission and followed throughout the hospital stay till discharge/death. The accuracy of the different score systems for predicting survival was evaluated through the area under ROC curve. RESULTS CTP and MELD score were higher (12.44 ± 1.07, 31.91 ± 4.92) in expired cases than who improved and discharged (11.32 ± 1.28, 23.97 ± 5.36) respectively with significant p-value (<0.001). Area under ROC curve for serum creatinine, MELD score, blood urea and CTP score for predicting hospital survival were 0.887, 0.864, 0.836 and 0.738 respectively. CONCLUSIONS MELD score is superior to CTP score in predicting survival at the time of discharge in hospitalized patients with decompensated cirrhosis. Renal failure in patients with decompensated cirrhosis carries poor prognosis and has a good outcome prognostic value, even superior to MELD/CTP scoring.
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Affiliation(s)
- R K Chaurasia
- Department of Nephrology, Bir Hospital, Kathmandu, Nepal. happyrkc@ gmail.com
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Abstract
Introduction: Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Recent epidemiological studies indicate that hospitalizations for DKA in the U.S. are increasing. Epidemiological studies from India are limited. We undertook this observational study to analyse the clinical profiles of DKA in adults in south India.Methods: This study was conducted in at a tertiary care center in Andhra Pradesh for one year from Aug 2010 to July 2011. Diagnosis of DKA was made by the presence of (1) Plasma glucose level of 250mg/dl or higher (2) Serum bicarbonate level of 15mEq/lt or lower (3) Arterial blood pH of 7.3 or lower or a venous blood pH of 7.25 or lower (4) Presence of moderate or large urine ketones. All the patients were treated with institutional treatment protocol.Results: Of 27 patients, 22(81%) had type2 diabetes and 5(19%) had type 1 DM .10 were females and 17 males. Age of the patients ranged between 18 to 70 years, with an average of 45.3 years. Precipitating factors were present in 60% of the admissions. Non-compliance or discontinuation of drug therapy was seen in fifty per cent of patients. Average length of hospital stay was slightly longer in type 1 than type 2 DM patientsConclusion: A significant proportion of DKA occurs in patients with type 2 diabetes and many of these cases can be prevented with proper patient education and effective communication with a health care provider during an inter-current illness.DOI: http://dx.doi.org/10.3126/hren.v10i2.6569 Health Renaissance 2012; Vol 10 (No.2); 80-86
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Shakya S, Pradhan B, Smith L, Shrestha J, Tuladhar S. Isolation and characterization of aerobic culturable arsenic-resistant bacteria from surfacewater and groundwater of Rautahat District, Nepal. J Environ Manage 2012; 95 Suppl:S250-S255. [PMID: 21868146 DOI: 10.1016/j.jenvman.2011.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 06/29/2011] [Accepted: 08/01/2011] [Indexed: 05/31/2023]
Abstract
Arsenic (As) contamination of groundwater is a serious Environmental Health Management issue of drinking water sources especially in Terai region of Nepal. Many studies have reported that due to natural abundance of arsenic in the environment, various bacteria have developed different resistance mechanisms for arsenic compound. In this study, the culturable arsenic-resistant bacteria indigenous to surfacewater as well as groundwater from Rautahat District of Nepal were randomly isolated by standard plate count method on the basis of viable growth on plate count agar amended with arsenate ranging from 0, 0.5, 10, 40, 80 to 160 milligram per liter (mg/l). With respect to the morphological and biochemical tests, nine morphologically distinct potent arsenate tolerant bacteria showed relatedness with Micrococcus varians, Micrococcus roseus, Micrococcus luteus, Pseudomonas maltophilia, Pseudomonas sp., Vibrio parahaemolyticus, Bacillus cereus, Bacillus smithii 1 and Bacillus smithii 2. The isolates were capable of tolerating more than 1000 mg/l of arsenate and 749 mg/l of arsenite. Likewise, bioaccumulation capability was highest with M. roseus (85.61%) and the least with B. smithii (47.88%) indicating the potential of the organisms in arsenic resistance and most probably in bioremediation.
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Affiliation(s)
- S Shakya
- Department of Biotechnology, Kathmandu University, Dhulikhel, Kavre, P.O. Box 6250, Kathmandu, Nepal.
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Thapa N, Pradhan B. Postoperative complications of septal quilting and BIPP packing following septoplasty. J Nepal Health Res Counc 2011; 9:186-188. [PMID: 22929851] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Septoplasty is one of the most common surgeries in otorhinolaryngology. After septal surgery nasal packing is usually done to prevent complications like haemorrhage, septal haematoma. However it is associated with many postoperative complications such as pain, hypoxia, dryness in throat, headache, epiphora, vestibular stenosis, crusting, synaechiae, secondary infection etc. In order to prevent these complications quilting has been developed. No study has been done in our country to compare the postoperative complications after septoplasty. METHODS This study was carried out to compare postoperative crusting, oedema, synaechia and infection in patients who underwent septal quilting and BIPP packing following septoplasty from August 2008 to July 2011 in the Department of ENT-Head and Neck Surgery, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal. RESULTS There were 44 patients in quilting and 41 patients in BIPP packing group. Out of 44 patients of quilting group, crusting occurred in 3 patients, oedema in 4 patients, synechia in 1 patient and infection in 3 patients. Out of 41 patients of BIPP packing group, 9 patients had crusting, oedema was present in 7 patients, 6 patients had synaechia and 5 patients had infection. Crusting and synaechia was found to be statistically significant while oedema and infection was not significant between two groups. CONCLUSIONS Complications like excessive crusting, oedema, synaechia and infection can be minimized by quilting suture following septoplasty.
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Affiliation(s)
- N Thapa
- Department of ENT-Head and Neck Surgery, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
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Sharma DR, Pradhan B, Mishra SK. Multiple drug resistance in bacterial isolates from liquid wastes generated in central hospitals of Nepal. Kathmandu Univ Med J (KUMJ) 2011; 8:40-4. [PMID: 21209506 DOI: 10.3126/kumj.v8i1.3220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Healthcare liquid wastes are the reservoirs of harmful infectious agents such as the pathogens and multiple drug resistant microorganisms. Potential infectious risks include the spread of infectious diseases and microbial resistance from health-care establishments into the environment and thereby posing risks of getting infections and antibiotic resistance in the communities. OBJECTIVES The objectives of this study were to assess the bacterial load of healthcare liquid waste generated in central hospitals and to explore the antimicrobial resistance pattern of these bacterial isolates. MATERIALS AND METHODS A descriptive study was carried out in 10 conveniently selected central hospitals of Nepal during the period of May to December 2008. Effluent specimens from each hospital were subjected to total viable count studies by spread plate method in nutrient agar plate and incubated for 24 hours at 37 °C using standard laboratory protocol. Similarly, all the specimens were cultured in Mac Conkey Agar media supplemented with 30 μg/ml of Chloramphenicol and 20 μg/ml of Gentamycin for the enumeration of multiple drug resistant (MDR) bacteria, which were further subjected to in-vitro antibiotic susceptibility test by modified Kirby Bauer disc diffusion technique for resistance patterns. RESULTS Total viable counts of hospital effluents significantly exceeded the standard heterotrophic plate count (p=0.000). Similarly, the numbers of multiple drug resistant bacteria were alarmingly high in three (more than 30% in 2 and 50% in 1) hospitals of this study. Drug resistant hospital effluent isolates showed simultaneous resistance for most of the antibiotics including Penicillin, Cephalosporin, Cotrimoxazole, Gentamycin and Quinolones. CONCLUSION Healthcare liquid wastes were laden with MDR bacteria and seemed to pose a huge public health threat in the transfer of such resistance to the bacterial pathogens causing community acquired infections, thereby limiting our antibiotic pool.
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Affiliation(s)
- D R Sharma
- Department of Public Health, Yeti Health Science Academy, Kathmandu, Nepal.
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Paudel R, Pradhan B. Health care waste management practice in a hospital. J Nepal Health Res Counc 2010; 8:86-90. [PMID: 21876569] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Health-care waste is a by-product of health care. Its poor management exposes health-care workers, waste handlers and the community to infections, toxic effects and injuries including damage of the environment. It also creates opportunities for the collection of disposable medical equipment, its re-sale and potential re-use without sterilization, which causes an important burden of disease worldwide. The purpose of this study was to find out health care waste management practice in hospital. METHODS A cross-sectional study was conducted in Narayani Sub-Regional Hospital, Birgunj from May to October 2006 using both qualitative and quantitative methods. Study population was four different departments of the hospital (Medical/Paediatric, Surgical/Ortho, Gynae/Obstetric and Emergency), Medical Superintendent, In-charges of four different departments and all sweepers. Data was collected using interview, group discussion, observation and measurement by weight and volume. RESULTS Total health-care waste generated was 128.4 kg per day while 0.8 kg per patient per day. The composition of health care waste was found to be 96.8 kg (75.4%) general waste, 24.1 kg (8.8%) hazardous waste and 7.5 kg (5.8%) sharps per day by weight. Health staffs and sweepers were not practicing the waste segregation. Occupational health and safety was not given due attention. Majority of the sweepers were unaware of waste management and need of safety measures to protect their own health. CONCLUSIONS Health care waste management practice in the hospital was unsatisfactory because of the lack of waste management plan and carelessness of patients, visitors and staffs. Therefore the hospital should develop the waste management plan and strictly follow the National Health Care Waste Management Guideline.
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Affiliation(s)
- R Paudel
- Community Medicine and Family Health Department, Maharajgunj Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal.
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Agrawal KK, Dhakal SS, Bhatta N, Pradhan B, Chaurasia RK, Rijal S, Karki P. Chronic Cough in Thymoma. JNMA J Nepal Med Assoc 2010. [DOI: 10.31729/jnma.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Cough is one of the most common symptom for which patients seek medical attention from primary care physicians and pulmonologists. Although tuberculosis and other lung infections are common throughout the developing world, they are not among the most common causes of chronic cough. We report a case of a 23 years old male who presenting to the outpatient clinic with chronic cough not responding to regular and symptomatic treatment that was diagnosed to have thymoma. After all the common causes for chronic cough have been ruled out, unusual causes should also be considered in the differential diagnosis.
KEYWORDS: Chronic cough, Thymoma, Anterior Mediastinum.
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Agrawaal KK, Dhakal SS, Bhatta N, Pradhan B, Chaurasia RK, Rijal S, Karki P. Chronic cough in thymoma. JNMA J Nepal Med Assoc 2010; 49:164-166. [PMID: 21485607] [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: 05/30/2023] Open
Abstract
Cough is one of the most common symptom for which patients seek medical attention from primary care physicians and pulmonologists. Although tuberculosis and other lung infections are common throughout the developing world, they are not among the most common causes of chronic cough. We report a case of a 23 years old male who presenting to the outpatient clinic with chronic cough not responding to regular and symptomatic treatment that was diagnosed to have thymoma. After all the common causes for chronic cough have been ruled out, unusual causes should also be considered in the differential diagnosis.
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Affiliation(s)
- K K Agrawaal
- Department of Internal Medicine, BPKIHS, Dharan, Nepal.
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Sharma DR, Pradhan B, Pathak RP, Shrestha SC. Healthcare liquid waste management. J Nepal Health Res Counc 2010; 8:23-26. [PMID: 21879009] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The management of healthcare liquid waste is an overlooked problem in Nepal with stern repercussions in terms of damaging the environment and affecting the health of people. This study was carried out to explore the healthcare liquid waste management practices in Kathmandu based central hospitals of Nepal. METHODS A descriptive prospective study was conducted in 10 central hospitals of Kathmandu during the period of May to December 2008. Primary data were collected through interview, observation and microbiology laboratory works and secondary data were collected by records review. For microbiological laboratory works,waste water specimens cultured for the enumeration of total viable counts using standard protocols. RESULTS Evidence of waste management guidelines and committees for the management of healthcare liquid wastes could not be found in any of the studied hospitals. Similarly, total viable counts heavily exceeded the standard heterotrophic plate count (p=0.000) with no significant difference in such counts in hospitals with and without treatment plants (p=0.232). CONCLUSIONS Healthcare liquid waste management practice was not found to be satisfactory. Installation of effluent treatment plants and the development of standards for environmental indicators with effective monitoring, evaluation and strict control via relevant legal frameworks were realized.
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Affiliation(s)
- D R Sharma
- Department of Public Health, Yeti Health Science Academy, Kathmandu, Nepal.
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Pradhan B. Spinal anesthesia for cesarean section: comparison of 5.0% lignocaine and 0.5% bupivacaine. Nepal Med Coll J 2010; 12:30-33. [PMID: 20677606] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Objective of the study was to compare the effect of the drugs, intraoperative hemodynamic variables (heart rate, blood pressure) and associated complications (hypotension, nausea, shivering etc) between the bupivacaine and lignocaine group, when administered intrathecally in patients undergoing caesarean section. This is a randomized prospective study where the haemodynamic changes and the complications following sub arachnoid block either with 5.0% lignocaine or with 0.5% bupivacaine in 52 patients undergoing caeserian section were compared. The patients were randomly divided in two groups, group X (lignocaine group, n=26) or group B (bupivacaine group, n=26), either to receive 5.0% lignocaine 75 mg or 0.5% bupivacaine 12.5 mg. Intraoperatively heart rate, blood pressure (systolic (SBP), diastolic (DBP) and mean (MAP)), oxygen saturation were monitored. Any rescue drugs e.g. mephentermine, crystalloid 200 ml bolus, pethidine, diazepam etc given were noted with the dose and time. Urine output and total amount of fluid given was noted at the end of the surgery. Oxytocin 10 U in infusion was given after the baby was delivered in all the cases. Intraoperative blood pressures, total amount of fluid given, rescue vasopressor (mephentermine) given were compared in both the groups. Groups were also compared with respect to the patients' age, height of sensory block, motor block, duration of surgery, Apgar score and weight of the baby and duration of postoperative analgesia. It was concluded that the drugs were similar with respect to their sensory and motor effects, intraoperative hemodynamic changes like hypotension and bradycardia, and other complications like shivering and can be used interchangeably as spinal anesthetic agent for caesarean section deliveries.
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Affiliation(s)
- B Pradhan
- Department of Anesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
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Gurung R, Bhattacharya SK, Pradhan B, Gurung S, Singh YI. Phenotypic characterisation and drug sensitivity testing of mycobacteria isolated from extra-pulmonary tuberculosis. Kathmandu Univ Med J (KUMJ) 2010; 8:57-61. [PMID: 21209509 DOI: 10.3126/kumj.v8i1.3223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Tuberculosis (TB) is a major cause of morbidity and mortality globally, with most cases occurring in developing countries. The importance of extra pulmonary tuberculosis (EPTB) among all forms of tuberculosis has not yet been ascertained in developing countries. OBJECTIVE To identify and perform phenotypic characterization of clinically important mycobacterium isolates from extra-pulmonary sites along with drug susceptibility testing. MATERIALS AND METHODS A total of 513 specimens from patients of (EPTB) with varied presentation were studied. Speciation and characterization of isolates were done on the basis of growth and biochemical characteristics. Drug susceptibility testing for mycobacterium isolates was done by proportion method. RESULTS Fifty four patients clinically suspected to have extra-pulmonary tuberculosis were culture positive for mycobacteria. On characterization 48 of the 54 isolates were identified as M. tuberculosis, 4 as M. bovis and 2 were M. avium/intracelulare. Drug susceptibility testing was done for the both M. tuberculosis as well as M. bovis. In single drug resistance, Streptomycin was highest followed by Isoniazid, Ethambutol and Refampicin. Multi drug resistance (MDR) was found in 6 isolates and it was observed only in group I cases. CONCLUSION EPTB accounts for 10-15 percent of all cases of tuberculosis. Mycobacterium was present in 10.5 percent samples. 48 isolates out of 54 samples were found to be M. tuberculosis. The maximum numbers of M. tuberculosis were isolated from lymph node aspiration.
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Affiliation(s)
- R Gurung
- Department of Microbiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
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Syed VA, Lakshmi R, Karki P, Pradhan B, Maskey R. Scenario of mushroom poisoning in a tertiary care hospital. JNMA J Nepal Med Assoc 2009; 48:296-300. [PMID: 21105553] [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: 05/30/2023] Open
Abstract
INTRODUCTION Mushroom poisoning is not new to Nepal. Undocumented and unrecorded mushroom poisoning is more common than the published one. We evaluated the pattern and outcomes following toxic mushroom ingestions. METHODS We did a retrospective analysis of patients admitted with mushroom poisoning in BPKIHS, a tertiary care hospital in Nepal, from 2002 to 2006. The diagnosis of mushroom poisoning was based on history and clinical presentation. RESULTS Twenty seven patients, aged between 7-83 years were studied. Fourteen (51.86%) were male and 13 (48.14%) were female. All (100%) patients had consumed wild mushroom unintentionally. Twelve patients developed symptoms within first hour and 11 patients within one to six hours. The average delay in presenting to our hospital was 23.1 (2-96) hours. In 10 cases, other family members were affected, out of which in two cases the family members had died in other hospitals. Reported symptoms were nausea 27 (100%), vomiting 24 (88.88%), abdominal cramping 8 (29.6%), jaundice 3 (11.1%), diarrhea 17 (62.96%) and altered sensorium in 8 patients (29.65%). All patients were treated conservatively. Three patients with severe hepatitis were admitted in ICU, out of which two recovered without liver transplant. One eight year old boy developed acute liver failure and expired within 24 hours of hospitalization. CONCLUSIONS Most of the mushroom poisoning was acute, unintentional and by consumption of wild mushroom. Community based awareness programs will help prevent the instances of poisoning.
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Affiliation(s)
- V A Syed
- Department of Internal Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
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Karki P, Lakshmi R, Karki P, Pradhan B, Maskey R. Scenario of Mushroom Poisoning in a Tertiary Care Hospital. JNMA J Nepal Med Assoc 2009. [DOI: 10.31729/jnma.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Abstract
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Pradhan B, Thapa N. Juvenile angiofibroma and its management. Nepal Med Coll J 2009; 11:186-188. [PMID: 20334067] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This prospective longitudinal study was done to determine extent of tumor and to highlight the importance of lateral rhinotomy approach for nasopharyngeal angiofibroma. Patients with a diagnosis of nasopharyngeal angiofibroma who underwent surgery in Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu from April, 2004 to Jan 2009 were included in the study. Extent of tumour and surgical approaches were noted in a special form prepared for the study. Fisch Staging system was followed for the extent of tumor. A total number of patients were 23 and all of them were male. Age ranged from 15-30 years with mean age of 18.25 years. All the patients underwent contrast enhanced CTScan. Two patients had stage I tumor, 9 patients had stage II disease, other 12 patients had stage III tumor. Twenty patients were operated by lateral rhinotomy approach. In one patient with the tumour hanging in the oropharynx with a pedical attached to the lateral wall of nasopharynx was removed by peroral route and in another patient with tumour confined to nasopharynx and posterior part of nose was removed by transpalatal approach. One patient who had tumour extention into infratemporal fossa were operated by lateral rhinotomy with inferior sublabial extetention approach. Eleven patients underwent preoperative embolization with gelfoam 48 hours prior to surgery. Most of them had stage III disease and were managed surgically by lateral rhinotomy approach. Lateral rhinotomy approach with or without extention of incision can be used to remove tumours in majority of patients.
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Affiliation(s)
- B Pradhan
- Department of ENT and Head and Neck Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
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Vaidya A, Pradhan B. Community participation in health: a brief review and the experience of Kathmandu Medical College with the Duwakot community. Kathmandu Univ Med J (KUMJ) 2009; 6:526-32. [PMID: 19483440 DOI: 10.3126/kumj.v6i4.1750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
One of the principles of Primary Health Care (PHC), Community Participation is a process through which the stakeholders influence and share control over development initiatives and the decisions and resources which affect them. It is a complex issue that has been studied widely and continues to be of great interest among community health workers. This paper presents a brief review of various aspects of community participation. It then illustrates how it is practiced at Duwakot Community Hospital, Kathmandu Medical College, Duwakot, Bhaktapur, Nepal in collaboration with the local community.
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Affiliation(s)
- A Vaidya
- Department of Community Medicine, Duwakot Community Hospital, Kathmandu Medical College, Duwakot, Bhaktapur, Nepal.
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Medhi B, Prakash O, Jose VM, Pradhan B, Chakrabarty S, Pandhi P. Seasonal variation in plasma levels of lithium in the Indian population: is there a need to modify the dose? Singapore Med J 2008; 49:724-727. [PMID: 18830549] [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: 05/26/2023]
Abstract
INTRODUCTION Lithium still remains an important choice in the therapy of manic-depressive psychosis (MDP), and though there are reports of seasonal variation in lithium levels from a few countries, such studies have not been conducted in India. Variability in the lithium level can lead to lack of efficacy or toxicity, making seasonal variation clinically relevant. METHODS A retrospective case sheet audit was performed for 101 MDP patients for recording plasma lithium level, oral lithium dose, age and gender for one year. The overall average oral lithium dose and level were recorded; the monthly average to which it most closely matched was noted as the control month, and values of other months were compared with this control month by Friedman's test followed by Dunn's test. RESULTS The mean age of patients was 38.22 (standard deviation 12.07) years, and 72 out of 101 patients were male. The mean lithium dose in November (938.61 +/- 243.40 mg/day), which was the closest to the overall mean dose (938.24 +/- 241.78 mg/day) was taken as the control month, which when compared with other monthly values, did not show any significant difference. The June (0.54 +/- 0.23 meq/L), July (0.55 +/- 0.24 meq/L) and August (0.55 +/- 0.24 meq/L) mean plasma lithium values were significantly high when compared to the October value (0.45 +/- 0.22 meq/L) as control. High-low variability between the plasma lithium values of different months was found to be 25 percent. CONCLUSION The present study showed a significant high variability of lithium levels in different months of the year, therefore frequent plasma level monitoring and oral lithium dose adjustment to prevent situations of toxicity and lack of efficacy in MDP.
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Affiliation(s)
- B Medhi
- Department of Pharmacology, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
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Pradhan B, Bajracharya GR. Midazolam for caudal analgesia in children: comparison with caudal bupivacaine. Kathmandu Univ Med J (KUMJ) 2008; 6:166-172. [PMID: 18769080] [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: 05/26/2023]
Abstract
BACKGROUND Caudal analgesia is the most popular and commonly used regional anaesthesia technique for post operative analgesia in children undergoing lower limb, anoperineal and abdominal surgical procedures. It is commonly applied in all the paediatric patients undergoing the above mentioned surgery, as the goal of balanced anaesthesia is not only limited to intraoperative period but also good analgesia in post operative period. Many drugs like morphine, Pethidine, Neostigmine etc have been used as analgesic agent via the caudal route but not without their side effects. So Midazolam was used as an alternative drug as it may not be associated with the side effects encountered with the other drugs. AIMS AND OBJECTIVES The objective of the study was to see the analgesic efficacy of caudal administration of Midazolam with comparison to Bupivacaine for post operative analgesia, and to observe for side effects if any. MATERIALS AND METHODS This was a single blinded prospective observational study in children of age 1 to 6 years of ASA grade I undergoing elective hernia or hydrocoele surgery. The patients were allocated randomly into two groups (n=25) to receive caudal injection of either 0.25% Bupivacaine 1 ml/kg (group A) or Midazolam 50 microg/kg with normal saline 1 ml/kg (group B). In the post operative period heart rate, blood pressure, pain score, recovery to first analgesic time, total number of analgesics required in 24 hours and side effects if any were noted and analysed. RESULTS There were no significant differences in quality of pain relief, postoperative behaviour or analgesic requirements between the Midazolam group and the Bupivacaine group. Recovery to first analgesic time though was longer in the Bupivacaine group (9.65 hr) than Midazolam group (7.32 hr); it was statistically not significant (P= 0.9). Any of the side effects such as motor weakness, urinary retention, and respiratory depression were not observed in both the groups. However in both the groups, few of the patients had post operative vomiting. CONCLUSION We conclude that caudal Midazolam in a dose of 50 microg/kg provides equivalent analgesia to Bupivacaine 0.25%, when administered in a volume of 1 ml/kg for children undergoing unilateral inguinal herniotomy for hernia or high ligation of processus vaginalis for hydrocoele.
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Affiliation(s)
- B Pradhan
- Department of Anesthesiology, Institute of Medicine, Kathmandu, Nepal.
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Acharya SP, Pradhan B, Marhatta MN. Application of "the Sequential Organ Failure Assessment (SOFA) score" in predicting outcome in ICU patients with SIRS. Kathmandu Univ Med J (KUMJ) 2007; 5:475-483. [PMID: 18604078] [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: 05/26/2023]
Abstract
BACKGROUND Various scoring systems have been developed to prioritize patient admission and management in ICU. The objective of this prospective, observational cohort study was to evaluate application of one such system, the Sequential Organ Failure Assessment (SOFA) Score in predicting outcome in ICU patients with SIRS. PATIENTS AND METHODS Fifty patients admitted to a six bed multidisciplinary ICU with SIRS were consecutively enrolled in the study and SOFA scores were calculated at zero hour, after 48 hrs, and after 96 hrs and patients followed till discharge from hospital. RESULTS When compared to outcome, the non survivors had high initial, mean and highest SOFA scores as compared to survivors. (p value = 0.002, <0.001, <0.001 respectively). Delta SOFA was not significantly associated with outcome. (p value= 0.117). The initial SOFA score > 11 predicted a mortality of 90%. (OR 23.72, 95%CI2.68-209.78, p=0.004). Similarly, mean SOFA score of > 7 predicted a mortality of 73.9% (OR 22.7, 95%CI 5.0 - 103.5, p<0.001) and high SOFA score > 11 predicted a mortality of 87.5% (OR 32.66, 95%CI 5.82-183.179, p< 0.001). Area under receiver operating characteristic (ROC) curve for mean SOFA was 0.825, for high SOFA was 0.817 and for initial SOFA was 0.708. Thus mean, high and initial SOFA scores were helpful in predicting between the survivors and the non survivors. CONCLUSION The SOFA scoring system is useful in predicting outcomes in ICU and thus help in proper utilization of ICU resources.
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Affiliation(s)
- S P Acharya
- Department of Anesthesiology, Tribhuban University Teaching Hospital, Maharajgunj, Nepal.
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