1
|
Shrestha S, Adhikari S, Yadav CN, Poddar E, Bhatta S, Sapkota S, Khadayat R, Neupane G, Kunwar S, Regmi PR. Parasitic mature cystic ovarian teratoma: A rare case of autoimplantation of a twisted dermoid cyst. Clin Case Rep 2023; 11:e7764. [PMID: 37744627 PMCID: PMC10511691 DOI: 10.1002/ccr3.7764] [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: 06/15/2023] [Accepted: 07/11/2023] [Indexed: 09/26/2023] Open
Abstract
Extragonadal parasitic dermoid cysts are rare. Diagnosis of such extragonadal parasitic teratoma is often done intraoperatively during surgical exploration of abdominal mass.
Collapse
Affiliation(s)
- Suraj Shrestha
- Maharajgunj Medical CampusInstitute of MedicineKathmanduNepal
| | | | - Chandra Narayan Yadav
- Department of Obstetrics and GynecologyMadhesh Institute of Health ScienceDhanushaNepal
| | - Elisha Poddar
- Maharajgunj Medical CampusInstitute of MedicineKathmanduNepal
| | | | | | - Ramesh Khadayat
- Maharajgunj Medical CampusInstitute of MedicineKathmanduNepal
| | - Garima Neupane
- Maharajgunj Medical CampusInstitute of MedicineKathmanduNepal
| | - Simin Kunwar
- Maharajgunj Medical CampusInstitute of MedicineKathmanduNepal
| | - Pradeep Raj Regmi
- Department of RadiologyTribhuvan University Teaching HospitalKathmanduNepal
| |
Collapse
|
2
|
Kondrashov A, Sapkota S, Sharma A, Riano I, Kurzrock R, Adashek JJ. Antibody-Drug Conjugates in Solid Tumor Oncology: An Effectiveness Payday with a Targeted Payload. Pharmaceutics 2023; 15:2160. [PMID: 37631374 PMCID: PMC10459723 DOI: 10.3390/pharmaceutics15082160] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Antibody-drug conjugates (ADCs) are at the forefront of the drug development revolution occurring in oncology. Formed from three main components-an antibody, a linker molecule, and a cytotoxic agent ("payload"), ADCs have the unique ability to deliver cytotoxic agents to cells expressing a specific antigen, a great leap forward from traditional chemotherapeutic approaches that cause widespread effects without specificity. A variety of payloads can be used, including most frequently microtubular inhibitors (auristatins and maytansinoids), as well as topoisomerase inhibitors and alkylating agents. Finally, linkers play a critical role in the ADCs' effect, as cleavable moieties that serve as linkers impact site-specific activation as well as bystander killing effects, an upshot that is especially important in solid tumors that often express a variety of antigens. While ADCs were initially used in hematologic malignancies, their utility has been demonstrated in multiple solid tumor malignancies, including breast, gastrointestinal, lung, cervical, ovarian, and urothelial cancers. Currently, six ADCs are FDA-approved for the treatment of solid tumors: ado-trastuzumab emtansine and trastuzumab deruxtecan, both anti-HER2; enfortumab-vedotin, targeting nectin-4; sacituzuzmab govitecan, targeting Trop2; tisotumab vedotin, targeting tissue factor; and mirvetuximab soravtansine, targeting folate receptor-alpha. Although they demonstrate utility and tolerable safety profiles, ADCs may become ineffective as tumor cells undergo evolution to avoid expressing the specific antigen being targeted. Furthermore, the current cost of ADCs can be limiting their reach. Here, we review the structure and functions of ADCs, as well as ongoing clinical investigations into novel ADCs and their potential as treatments of solid malignancies.
Collapse
Affiliation(s)
- Aleksei Kondrashov
- Department of Internal Medicine, Saint Agnes Hospital, Baltimore, MD 21229, USA; (A.K.); (S.S.)
| | - Surendra Sapkota
- Department of Internal Medicine, Saint Agnes Hospital, Baltimore, MD 21229, USA; (A.K.); (S.S.)
| | - Aditya Sharma
- Department of Internal Medicine, Dartmouth Health, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA; (A.S.); (I.R.)
| | - Ivy Riano
- Department of Internal Medicine, Dartmouth Health, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA; (A.S.); (I.R.)
- Division of Hematology and Oncology, Dartmouth Cancer Center, Lebanon, NH 03755, USA
| | - Razelle Kurzrock
- WIN Consortium, 94550 Paris, France;
- MCW Cancer Center, Milwaukee, WI 53226, USA
- Division of Oncology and Hematology, University of Nebraska, Omaha, NE 68198, USA
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Jacob J. Adashek
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, Baltimore, MD 21287, USA
| |
Collapse
|
3
|
Sapkota S, Shrestha S, Sharma S, Sapkota S, Solis LA, Kalla A. Fusobacterium bacteremia presenting with inferior mesenteric vein thrombosis. Clin Case Rep 2023; 11:e7617. [PMID: 37397578 PMCID: PMC10310899 DOI: 10.1002/ccr3.7617] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 07/04/2023] Open
Abstract
Isolated mesenteric vein thrombosis associated with Fusobacterium is rare. Physicians should be aware regarding the association of Fusobacterium with thrombosis at various sites.
Collapse
Affiliation(s)
| | - Suraj Shrestha
- Maharajgunj Medical CampusInstitute of MedicineKathmanduNepal
| | | | | | | | | |
Collapse
|
4
|
Adhikari S, Sapkota S, Shrestha S, Karki K, Shrestha A. Eculizumab for paroxysmal nocturnal haemoglobinuria: catastrophic health expenditure in Nepalese patients. Orphanet J Rare Dis 2023; 18:172. [PMID: 37391775 DOI: 10.1186/s13023-023-02779-2] [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] [Received: 11/12/2022] [Accepted: 06/18/2023] [Indexed: 07/02/2023] Open
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) results from a mutation in the phosphatidylinositol glycan class-A gene which causes uncontrolled complement activation with resultant intravascular hemolysis and its sequelae. Eculizumab is a terminal complement inhibitor that blocks this complement activation and has revolutionized the treatment of PNH but comes with an enormous price which can have catastrophic health expenditure in low-middle income countries (LMIC) like Nepal. Here, we discuss the potential way forwards in the treatment of PNH in Nepal and other LMICs.
Collapse
Affiliation(s)
| | - Surendra Sapkota
- Department of Internal Medicine, Ascension Saint Agnes Hospital, Baltimore, MD, USA
| | - Suraj Shrestha
- Maharajgunj Medical College, Institute of Medicine, Kathmandu, Nepal.
| | - Kshitiz Karki
- Annapurna Neurological Institute and Allied Sciences, Kathmandu, Nepal
| | - Anjan Shrestha
- Department of Hematology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| |
Collapse
|
5
|
Adashek JJ, Sapkota S, de Castro Luna R, Seiwert TY. Complete response to alectinib in ALK-fusion metastatic salivary ductal carcinoma. NPJ Precis Oncol 2023; 7:36. [PMID: 37041305 PMCID: PMC10090142 DOI: 10.1038/s41698-023-00378-9] [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] [Received: 12/25/2022] [Accepted: 03/30/2023] [Indexed: 04/13/2023] Open
Abstract
The advent of next-generation sequencing (NGS) has allowed for the identification of novel therapeutic targets for patients with uncommon cancers. It is well known that fusion translocations are potent driver of cancer pathogenesis and can render tumors exquisitely sensitive to matching targeted therapies. Here we describe a patient with ALK-fusion positive widely metastatic salivary ductal carcinoma, who achieved a durable complete response from alectinib, a potent and specific ALK tyrosine kinase inhibitor. This case serves as another reminder that ALK-fusions can be targeted regardless of histology and can afford patients dramatic and durable benefit. It also emphasizes the need for insurance coverage for such beneficial therapies. While ALK fusions are exceedingly rare in salivary ductal carcinoma, the presence of multiple other targetable aberrations supports the recommendation for universal NGS testing for such tumors.
Collapse
Affiliation(s)
- Jacob J Adashek
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, Baltimore, MD, USA.
| | - Surendra Sapkota
- Department of Internal Medicine, Saint Agnes Hospital, Baltimore, MD, USA
| | - Rodrigo de Castro Luna
- Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Tanguy Y Seiwert
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, Baltimore, MD, USA.
| |
Collapse
|
6
|
Shrestha S, Poddar E, Bashyal B, Adhikari A, Pathak P, Acharya S, Sapkota S, Bhattarai A, Pant SR, Shrestha A. Bilateral central retinal vein occlusion as an initial presentation of Waldenström macroglobulinemia: a case report. J Med Case Rep 2023; 17:59. [PMID: 36804919 PMCID: PMC9940326 DOI: 10.1186/s13256-023-03778-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/16/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Waldenström macroglobulinemia is a rare hematological malignancy and is the most common diagnosis in patients with hyperviscosity syndrome. Bilateral central retinal vein occlusion as an initial presentation of hyperviscosity syndrome in Waldenström macroglobulinemia is rare. CASE PRESENTATION A 42-year-old Nepalese male presented with sudden-onset bilateral painless blurring of vision. Fundus examination revealed bilateral, diffusely dilated, tortuous retinal veins and intraretinal deep blot hemorrhages in all four quadrants of the retina in both eyes; features of bilateral central retinal vein occlusion. Serum electrophoresis showed hypoalbuminemia with an immunoglobulin M kappa monoclonal spike. Bone marrow picture and immunohistochemistry analysis were suggestive of lymphoplasmacytic lymphoma. The patient received systemic therapy for Waldenström macroglobulinemia, along with intravitreal bevacizumab. CONCLUSION Adequate hydration, plasmapheresis, and a combination of bortezomib, dexamethasone, and rituximab regimen as a systemic therapy may represent an ideal choice for patients with hyperviscosity in Waldenström macroglobulinemia.
Collapse
Affiliation(s)
- Suraj Shrestha
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal.
| | - Elisha Poddar
- grid.80817.360000 0001 2114 6728Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Bibhav Bashyal
- grid.412809.60000 0004 0635 3456Department of Internal Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Aayush Adhikari
- grid.80817.360000 0001 2114 6728Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Prabin Pathak
- grid.412809.60000 0004 0635 3456Department of Pathology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Suman Acharya
- grid.412809.60000 0004 0635 3456Department of Internal Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Surendra Sapkota
- grid.416339.a0000 0004 0436 0556Department of Internal Medicine, Saint Agnes Hospital, Maryland, USA
| | - Anjan Bhattarai
- grid.80817.360000 0001 2114 6728Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Samriddha Raj Pant
- grid.80817.360000 0001 2114 6728Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Anjan Shrestha
- grid.412809.60000 0004 0635 3456Department of Pathology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| |
Collapse
|
7
|
Sapkota S, Kuehl S, Pulluri B. Do Not Ignore Those Raccoon Eyes; They May Indicate Lethal AL Amyloidosis. Case Rep Oncol 2022; 15:1039-1048. [PMID: 36636680 PMCID: PMC9830280 DOI: 10.1159/000527169] [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: 05/20/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Light chain (AL) amyloidosis is a lethal form of systemic amyloidosis that arises from the clonal expansion of CD38+ plasma cells. Organ damage occurs when these plasma cells produce misfolded immunoglobulin light chains, which form amyloid fibrils and deposit in tissues. A minority of patients with AL amyloidosis show "raccoon eyes" caused by increased vascular fragility from accumulation of amyloid fibrils. Amyloidosis can be directly associated with bleeding diathesis due to factor X deficiency as factor X binds to amyloid fibrils primarily in the liver and spleen. A 65-year-old Caucasian male presented with random bruising in the upper chest and around the eyes for 1.5 years. Physical examination was unremarkable, except for neck bruising. Pertinent workup showed protein electrophoresis with a faint M spike, increased serum lambda light chains, a kappa to lambda ratio of 0.06, increased Bence-Jones proteins, reduced factor X activity, elevated NT-proBNP. The bone marrow biopsy was positive for Congo red stain for amyloid protein. Magnetic resonance imaging revealed diffuse enhancement of the right and left ventricle subendocardial late gadolinium, consistent with cardiac amyloidosis. The patient started systemic therapy with a regimen of daratumumab, cyclophosphamide, bortezomib, and dexamethasone. After one cycle of therapy, lambda light chains normalized with an improvement in bruising. Diagnostic delays for cardiac patients are concerning as the median survival rate among these patients, when not treated, is approximately 6 months after the onset of symptoms. Since timely treatment can prevent organ damage, clinicians should be aware of specific clinical signs such as raccoon eyes and the importance of systemic evaluation for a prompt diagnosis.
Collapse
Affiliation(s)
- Surendra Sapkota
- Department of Internal Medicine, Ascension Saint Agnes Hospital, Baltimore, Maryland, USA,*Surendra Sapkota,
| | - Sapna Kuehl
- Department of Internal Medicine, Ascension Saint Agnes Hospital, Baltimore, Maryland, USA
| | - Bhargavi Pulluri
- Ascension Saint Agnes Hospital, Cancer Institute, Baltimore, Maryland, USA
| |
Collapse
|
8
|
Sapkota S, David S, Sharma S, Shrestha S, Kalla A. Adrenal infarction secondary to methamphetamine use: a case report and review of the literature. J Med Case Rep 2022; 16:379. [PMID: 36258260 PMCID: PMC9578202 DOI: 10.1186/s13256-022-03573-7] [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: 07/16/2022] [Accepted: 08/18/2022] [Indexed: 11/23/2022] Open
Abstract
Background An acute abdomen can have a variety of causes. A commonly missed cause of abdominal pain is direct substance abuse and its sequelae. The use of methamphetamine is rising in the United States resulting in significant morbidity and mortality. There has been no reported case of methamphetamine-induced adrenal infarction based on an extensive review of available literature. Case presentation We present a case of a 34-year-old Hispanic man who presented with acute abdominal pain secondary to adrenal infarction in the setting of methamphetamine use. Left paraumbilical tenderness was present on abdominal examination. Contrast-enhanced CT of the abdomen and pelvis revealed internal hypoenhancement of the left adrenal gland, consistent with acute left adrenal infarction. The patient was managed with enoxaparin and apixaban. Conclusion Substance abuse, especially among young patients, can at times present with acute abdomen. This mandates physicians to be vigilant and take into consideration the history of substance abuse and relevant investigations. Timely diagnosis and management can prevent life-threatening complications.
Collapse
Affiliation(s)
- Surendra Sapkota
- Department of Internal Medicine, Ascension Saint Agnes Hospital, 900 S Caton Ave, Baltimore, MD, 21229, USA.
| | - Sarah David
- Ross University School of Medicine, Bridgetown, Barbados
| | | | - Suraj Shrestha
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Abhishek Kalla
- Ascension Saint Agnes Hospital, Cancer Institute, Baltimore, MD, USA
| |
Collapse
|
9
|
Sapkota S, Molitor J, Evans M, Kofoed B, Lord A, Robinson L, Crosson J. AB1384 CLINICAL SIGNIFICANCE OF DENSE FINE SPECKLED PATTERN ANA. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5294] [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: 11/03/2022]
Abstract
BackgroundThe clinical significance of Dense Fine Speckled (DFS) pattern Anti-nuclear antibodies (ANA) by indirect immunofluorescence method (IIF) is unclear and has been inversely associated with rheumatic disease 12.ObjectivesOur purpose was to determine associations between DFS pattern ANA and the disease categories of inflammatory arthritis, ANA associated rheumatic diseases (AARD), fibromyalgia/chronic pain syndrome/chronic fatigue syndrome and atopic disorder.MethodsThis retrospective study used data from patients tested for ANA by IIF between August 2017 to August 2019 at the University of Minnesota Medical Center. Comparisons between the diagnostic categories listed in objectives were made for patients with negative ANA, positive ANA (any pattern) and DFS pattern. Individual disease diagnoses belonging to the above categories were also analyzed. The inflammatory arthritis category included seropositive rheumatoid arthritis (RA), seronegative RA, RA with unknown serology, ankylosing spondylitis, and psoriatic arthritis. The disease category of AARD included systemic lupus erythematosus (SLE), systemic sclerosis, mixed connective tissue disease, idiopathic inflammatory myopathies, Sjogren’s syndrome (SS), and undifferentiated connective tissue disorder (UCTD). Atopic disorders included atopic dermatitis, allergic rhinitis, urticaria, and asthma. Frequency of Raynaud’s phenomenon (RP) was also calculated.Results13,845 patients with an ANA during the study period were identified. 9106 (65.8%) had negative ANA and 4739 (34.2%) had positive ANA by IIF (including all patterns). 640 (4.6%) had ANA positive DFS patterns. Relative risk (RR) was calculated for diagnostic categories and individual diseases. For patients with positive ANA and DFS pattern, the RR for diagnostic codes of inflammatory arthritis categories [1.35 (1.07- 1.71), p=0.02] was higher when compared to the frequency of codes in ANA negative. RR for AARD among patients with DFS pattern was also higher [1.78 (1.44- 2.2), p <0.001]. There was no significant difference in the frequency of diagnostic codes of chronic pain/fibromyalgia/chronic fatigue syndrome [1.02 (0.9- 1.2), p=0.84] atopic disorder [0.68 (0.4- 1.15), p=0.16] for DFS+ compared to the ANA group. The frequency of AARD diagnostic codes was lower for patients with DFS pattern [0.64 (0.52- 0.79), p<0.001] compared to ANA positive patients with all other patterns, consistent with published data. There was no significant difference of frequency of diagnostic codes for the rest of the disease categories when comparison was made between ANA positive DFS pattern and ANA positive with other patterns.Individual disease diagnostic codes of RA were higher among DFS+ patients when compared to ANA- patients. The frequency of diagnostic codes of SLE, SS, UCTD, fibromyalgia, Raynaud’s phenomenon, and autoimmune thyroid disease was also higher among patients with DFS pattern compared to ANA- patients. The frequency of diagnostic codes of seropositive RA was lower among patients with DFS pattern compared to ANA+ with all other patterns. The frequency of diagnostic codes of SLE, SSc, UCTD, and chronic pain was also lower among DFS+ patients, compared to those with ANA of all other patterns, consistent with prior reports.ConclusionThe frequency of diagnostic codes of RA, SS and Raynaud’s was higher among DFS pattern ANA compared to ANA negative group but was not significantly different from ANA positive with other patterns. This suggests that the presence of a DFS pattern should not be used to indiscriminately exclude the presence of a rheumatic disease.References[1]Mariz HA, Sato EI, Barbosa SH, Rodrigues SH, Dellavance A, Andrade LEC. Pattern on the antinuclear antibody-HEp-2 test is a critical parameter for discriminating antinuclear antibody-positive healthy individuals and patients with autoimmune rheumatic diseases. Arthritis Rheum. 2011;63(1):191-200. doi:10.1002/art.30084[2]Watanabe A, Kodera M, Sugiura K, et al. Anti-DFS70 Antibodies in 597 Healthy Hospital Workers. ARTHRITIS Rheum. 2004;50(3):892-900. doi:10.1002/art.20096Disclosure of InterestsNone declared
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Sapkota S, Baig S, Hess T, O'Connell AM, Menk J, Shyne M, Fazeli P, Ensrud K, Shmagel A. Vitamin D and bisphosphonate therapy in systemic lupus erythematosus patients who receive glucocorticoids: are we offering the best care? Lupus 2020; 29:263-272. [PMID: 31996109 DOI: 10.1177/0961203320903086] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to evaluate management practices for glucocorticoid (GC)-induced osteoporosis (GIOP) in systemic lupus erythematosus (SLE) patients using 2017 American College of Rheumatology guidelines as a gold standard. METHODS We conducted a retrospective cohort study using a clinical database from the years 2011 to 2016. SLE cases with >90 days continuous prednisone use at doses of ≥7.51 mg daily were identified. Osteoporosis risk factors were assessed via chart review. The Fracture Risk Assessment (FRAX) score was estimated for patients > 40 years of age. Vitamin D, bisphosphonate prescriptions, and osteoporotic (OP) fractures were ascertained through chart review. A classification tree was used to identify the key patient-related predictors of bisphosphonate prescription. RESULTS A total of 203 SLE patients met the inclusion criteria. The recommended dose of vitamin D supplement was prescribed to 58.9% of patients < 40 years of age and 61.5% of patients ≥ 40 years of age. Among patients aged ≥ 40 years, 25% were prescribed bisphosphonates compared to 36% who met indications for bisphosphonates per the ACR guidelines. Another 10% were prescribed a bisphosphonate, despite not having indication per the ACR guidelines, which was considered as overtreatment. Among patients aged ≥ 40 years, older age and a higher FRAX score for major OP fracture and hip fracture predicted bisphosphonate prescription. In a classification tree analysis, patients with FRAX scores (for major OP fracture) of ≥ 23.5% predicted bisphosphonate prescription in this SLE population. Among patients who had OP fractures in the follow-up period, nine (6.50%) were inpatients receiving appropriate GIOP care versus 12 (13.6%) who were inpatients not receiving ACR-appropriate care (p = 0.098). CONCLUSIONS In clinical practice, fewer SLE patients with or at risk for GIOP are prescribed vitamin D and bisphosphonates than recommended by the 2017 ACR guidelines. Also, in this study, another 10% were prescribed a bisphosphonate, despite not having an indication per the ACR guidelines. Patients were most likely to receive a bisphosphonate prescription if they had a major OP FRAX score of > 23.5%.
Collapse
Affiliation(s)
- S Sapkota
- Department of Medicine, University of Minnesota, Minneapolis, USA.,Division of General Internal Medicine, University of Minnesota, Minneapolis, USA
| | - S Baig
- Department of Medicine, University of Minnesota, Minneapolis, USA
| | - T Hess
- University of Minnesota Medical School, University of Minnesota, Minneapolis, USA
| | | | - J Menk
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, USA
| | - M Shyne
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, USA
| | - P Fazeli
- Department of Medicine, University of Minnesota, Minneapolis, USA.,Division of Rheumatic and Autoimmune Diseases, University of Minnesota, Minneapolis, USA
| | - K Ensrud
- Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, USA.,Center for Care Delivery and Outcome Research, Minneapolis VA Health Care System, Minneapolis, USA
| | - A Shmagel
- Department of Medicine, University of Minnesota, Minneapolis, USA.,Division of Rheumatic and Autoimmune Diseases, University of Minnesota, Minneapolis, USA
| |
Collapse
|
12
|
Adhikari S, Khadka S, Sapkota S, Sharma BR, Ghimire A, Chalise M, Gurung D, Kunwar S. Multi-drug Resistant and Extended Spectrum β-lactamase Producing Salmonella Species Isolated from Fresh Chicken Liver Samples. Kathmandu Univ Med J (KUMJ) 2020; 18:23-27. [PMID: 33582683] [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 Emergence of antibiotic resistance among microbes contaminating the fresh meat products is a global public health concern as they can be easily transmitted to humans through their consumption and contact. Objective The current study was conducted to determine the distribution of antimicrobial resistance among Salmonella species isolated from fresh chicken liver samples with special emphasis on extended spectrum beta-lactamase (ESBL) production. Method A total of 200 fresh chicken liver samples were cultivated for the isolation of Salmonella and further subcultivated to detect extended spectrum beta-lactamase production among them. Antimicrobial susceptibility testing (AST) was done by disk diffusion method using a panel of 7 antimicrobials. Result Out of 200 samples analyzed, 61 (30.5%) samples harbored Salmonella species out of which 15 (7.5%) samples showed the presence of Salmonella Typhi. A significant association was noted in the incidence of Salmonella with various factors pertaining to the butchers, such as age, sex, literacy rate, practices of washing knives and chopping board, wearing aprons and gloves and type of water used (p < 0.05). Salmonella isolates were highly sensitive to amikacin (82.0%) and least sensitive to tetracycline (3.3%). All the isolates were resistant to colistin. Sixty (98.4%) isolates were identified as multi-drug resistant (MDR). The total number of extended spectrum betalactamase producers reported among Salmonella isolates was 29 (47.5%). Conclusion The results indicate that the fresh chicken liver samples sold in Bharatpur Metropolis are reservoirs of multi-drug resistant Salmonella, including extended spectrum betalactamase producers, that could potentially be transmitted to the humans by direct contact or through inadequate cooking.
Collapse
Affiliation(s)
- S Adhikari
- Department of Microbiology, Birendra Multiple Campus, Tribhuvan University, Bharatpur, Chitwan, 44200, Nepal
| | - S Khadka
- Department of Microbiology, Birendra Multiple Campus, Tribhuvan University, Bharatpur, Chitwan, 44200, Nepal. Department of Biochemistry and Molecular Biology, School of Life Sciences, Central China Normal University, Wuhan, Hubei, 430079, P.R. China
| | - S Sapkota
- Department of Microbiology, Birendra Multiple Campus, Tribhuvan University, Bharatpur, Chitwan, 44200, Nepal. State Key Laboratory of Respiratory Disease, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou 510530, P.R. China
| | - B R Sharma
- Department of Microbiology, Birendra Multiple Campus, Tribhuvan University, Bharatpur, Chitwan, 44200, Nepal
| | - A Ghimire
- Department of Microbiology, Birendra Multiple Campus, Tribhuvan University, Bharatpur, Chitwan, 44200, Nepal
| | - M Chalise
- Department of Microbiology, Birendra Multiple Campus, Tribhuvan University, Bharatpur, Chitwan, 44200, Nepal
| | - D Gurung
- Department of Microbiology, Birendra Multiple Campus, Tribhuvan University, Bharatpur, Chitwan, 44200, Nepal
| | - S Kunwar
- Department of Microbiology, Birendra Multiple Campus, Tribhuvan University, Bharatpur, Chitwan, 44200, Nepal
| |
Collapse
|
13
|
Sapkota S, Shrestha A. Community Pharmacy Practice in Nepal- An Underexploited Healthcare Domain. Kathmandu Univ Med J (KUMJ) 2019; 17:158-159. [PMID: 33305739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
| | - A Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel. Department of Chronic Disease Epidemiology, Yale School of Public Health, USA
| |
Collapse
|
14
|
Mishra SR, Shrestha N, Poudyal IP, Malla M, Gyawali B, Shrestha AD, Pokharel S, Gyawali M, Sapkota S, Bhattarai H, Dhakal L, Soti PB, Ghimire S, Paudel R, Xia X, Beaney T, Koirala S, Olsen MH, Poulter NR, Kallestrup P, Neupane D. May Measurement Month 2017: an analysis of blood pressure screening results in Nepal-South Asia. Eur Heart J Suppl 2019; 21:D83-D85. [PMID: 31043887 PMCID: PMC6479435 DOI: 10.1093/eurheartj/suz063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2019] [Indexed: 11/18/2022]
Abstract
Hypertension is the leading risk factor of mortality in Nepal accounting for ∼33 000 deaths in 2016. However, more than 50% of the hypertensive patients are unaware of their status. We participated in the May Measurement Month 2017 (MMM17) project initiated worldwide by the International Society of Hypertension to raise the awareness on the importance of blood pressure (BP) screening. In this paper, we discuss the screening results of MMM17 in Nepal. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2017 following the standard MMM protocol. Data were collected from 18 screening sites in 7 districts covering 5 provinces. Screenings were conducted either in health facilities, public places, or participants’ homes. Trained volunteers with health science background and female community health volunteers were mobilized to take part in the screening. A total of 5972 individuals were screened and of 5968 participants, for whom a mean of the 2nd and 3rd readings was available, 1456 (24.4%) participants had hypertension; 908 (16.8%) of those not receiving treatment were hypertensive; and 248 (45.2%) of those being treated had uncontrolled BP. MMM17 is the first nationwide BP screening campaign undertaken in Nepal. Given the suboptimal treatment and control rates identified in the study, there is a strong imperative to scale up hypertension prevention, screening, and management programmes. These results suggest that opportunistic screening can identify significant numbers with hypertension. Mobilization of existing volunteer networks and support of community stakeholders, would be necessary to improve the overall impact and sustainability of future screening programmes.
Collapse
Affiliation(s)
| | - Nipun Shrestha
- Institute of Health and Sport (IHES), Victoria University, Victoria 3011, Melbourne, Australia
| | | | - Milan Malla
- Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Bishal Gyawali
- COBIN Project, Nepal Development Society, Bharatpur-10, Nepal.,Department of Public Health, Center for Global Health, Aarhus University, 8000 Aarhus C, Denmark
| | - Aamod Dhoj Shrestha
- COBIN Project, Nepal Development Society, Bharatpur-10, Nepal.,Department of Public Health, Center for Global Health, Aarhus University, 8000 Aarhus C, Denmark
| | | | - Madan Gyawali
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | | | - Liladhar Dhakal
- COBIN Project, Nepal Development Society, Bharatpur-10, Nepal
| | | | - Sagar Ghimire
- Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Rajan Paudel
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Xin Xia
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - Sweta Koirala
- COBIN Project, Nepal Development Society, Bharatpur-10, Nepal
| | - Michael Hecht Olsen
- Department of Internal Medicine, Holbaek Hospital, University of Southern Denmark, 4300 Holbæk, Denmark; and
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - Per Kallestrup
- Department of Public Health, Center for Global Health, Aarhus University, 8000 Aarhus C, Denmark
| | - Dinesh Neupane
- COBIN Project, Nepal Development Society, Bharatpur-10, Nepal.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 2120, USA
| |
Collapse
|
15
|
Shrestha BK, Ranabhat K, Pant R, Sapkota S, Shrestha S. Neuritic Leprosy; An Intriguing Re-visit to a Forbidden Ailment. Kathmandu Univ Med J (KUMJ) 2019; 17:73-76. [PMID: 31734684] [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
Leprosy is a chronic infectious disease that presents with varied manifestations. Pure neuritic leprosy is one of the rarest forms of the disease which is characterized by nerve involvement without the characteristic cutaneous stigmata. Eleven year old, healthy male presented with progressively increasing painful swelling at the medial aspect of the arm near to the right elbow joint with difficulty in extending right ring and little fingers at interphalangeal joint and numbness in the same region for last 1 year with no cutaneous abnormalities. Physical examination revealed 6x3 cm firm, tender lesion 3 cm proximal to the right elbow joint with positive tinel's sign, without signs of inflammation, along with characteristic claw hand deformity of right hand and atrophy of hypothenar and interossei muscle. Electro-diagnostic testing revealed findings consistent with a right ulnar axonal neuropathy above the elbow. Magnetic resonance imaging revealed well defined heterogeneously hyper intense linear lesion along the course of thickened ulnar nerve in the distal arm extending posterior to the medial condyle. It also showed an oval shaped lesion (2.1x1.0 cm) arising from the same segment of the nerve, without any bony or muscular involvement of that area. The patient underwent surgical exploration and ulnar nerve decompression with biopsy. Pathology revealed necrotizing granulomatous inflammatory acid fast bacilli stain negative lesion, which was histologically consistent with caseous abscess caused by tuberculoid leprosy, pathognomonic for Hansen's disease. He has been started on antibiotic therapy and is referred to leprosy center for further course of management. Pure neuritic leprosy, though rare, should be considered as differential diagnosis in cases presenting with peripheral neuropathy at leprosy-endemic areas. Prompt diagnosis and treatment is imperative to prevent permanent neurological injury.
Collapse
Affiliation(s)
- B K Shrestha
- Department of Neurosurgery, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu
| | - K Ranabhat
- Department of Radiology, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu
| | - R Pant
- Department of Pathology, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu
| | - S Sapkota
- Department of Neurosurgery, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu
| | - S Shrestha
- Department of Neurosurgery, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu
| |
Collapse
|
16
|
Sharma A, Poudyal I, Gyawali P, Chapagain S, Pokharel S, Bhandari P, Gyawali M, Malla M, Sapkota S, Mishra S. MS06.1 Preparedness To Deliver Cardiovascular Care: Access To Essential Medicines and Diagnostic Tests In Nepal. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.022] [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: 10/28/2022] Open
|
17
|
Sapkota S, Mahaseth R, Jha K. The use of olanzapine compared to aprepitant as antiemetic for prevention of chemotherapy induced nausea and vomiting in highly emetogenic chemotherapy – a randomized trial. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30623-8] [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: 10/20/2022]
|
18
|
Hage E, Mpamugo O, Ohai C, Sapkota S, Swift C, Wooldridge D, Amar CFL. Identification of six Listeria species by real-time PCR assay. Lett Appl Microbiol 2014; 58:535-40. [PMID: 24461044 DOI: 10.1111/lam.12223] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 09/25/2013] [Revised: 01/15/2014] [Accepted: 01/20/2014] [Indexed: 11/28/2022]
Abstract
UNLABELLED The Listeria genus comprises 10 recognized species. Listeria monocytogenes causes listeriosis in humans and other animals primarily via contaminated food or animal feed. Listeria ivanovii causes listeriosis in animals and on rare occasions in humans. The identification of nonpathogenic species of Listeria in foods indicates that conditions exist that support the growth of pathogenic strains and is used to facilitate the implementation of control and prevention measures. This study shows the development and evaluation of a 5'exonuclease real-time PCR assay for the rapid identification of Listeria seeligeri, Listeria welshimeri, L. monocytogenes, L. ivanovii, Listeria grayi and Listeria innocua. The assay consists of two triplexes that were evaluated using 53 cultures of Gram-positive bacteria, including 49 Listeria spp. from human, animal, food or food-processing environments. The assay was rapid, specific and reproducible and could identify each of the six species from a mixture of strains. The developed assay proved to be a powerful means of rapidly identifying Listeria species and could be usefully implemented in busy specialist reference laboratories. SIGNIFICANCE AND IMPACT OF THE STUDY The identification of species of Listeria from foods is important to monitor pathogenic strains and facilitates the implementation of control measures. This study shows the development and evaluation of a 5'exonuclease real-time PCR assay for the rapid identification of L. seeligeri, L. welshimeri, L. monocytogenes and L. ivanovii, L. grayi, L. innocua. The developed assay proved to be specific, rapid and reproducible and therefore could be implemented in busy specialist reference laboratories.
Collapse
Affiliation(s)
- E Hage
- Gastrointestinal Bacteria Reference Unit, Public Health England, London, UK
| | | | | | | | | | | | | |
Collapse
|
19
|
Thapa LJ, Twayana RS, Shilpakar R, Ghimire MR, Shrestha A, Sapkota S, Rana PVS. Clinical profile and outcome of acute encephalitis syndrome (AES) patients treated in College of Medical Sciences-Teaching Hospital. J Coll Med Sci-Nepal 2014. [DOI: 10.3126/jcmsn.v9i2.9685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
Objective: Acute encephalitis syndrome is a cause of significant morbidity and mortality in Nepal. Although Japanese encephalitis virus (JEV) was thought to be a major cause for acute encephalitis syndrome, more non-Japanese encephalitis virus cases are reported. The outcome of patients with acute encephalitis syndrome is variable. Our study was designed to study the clinical profile and outcome of patients with acute encephalitis syndrome managed in tertiary care center in central Nepal. Methods: The record of patients admitted with diagnosis of acute encephalitis syndrome,from January 2010 to December 2010 in College of Medical Sciences-Teaching Hospital (CMS-TH) was reviewed. They were classified clinically as meningitis, encephalitis and meningoencephalitis. The clinical details and reports of the patients were recorded and analyzed. Results: Total of 85 cases of meningitis and encephalitis were identified. Mean age was 19.18 years. Fifty-six (65.9%) patients were males and 29 (34.1%) were females. Sixty (70.58%) patients had meningitis, 8 (9.41%) had encephalitis, and 17 (20.0%) had meningoencephalitis. JE serology was positive in 4 patients (4.7%). Seventy-two (84.7%) patients made full recovery and were discharged from hospital. Thirteen (15.3%) patients left against medical advice (LAMA). Conclusion: Acute encephalitis syndrome is still a major public health problem in Nepal. Few of these patients have Japanese Encephalitis. There is a trend towards improved outcome because of availability of improved health services. However, financial constraint remains a challenge in management of acute encephalitis syndrome. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-2, 31-37 DOI: http://dx.doi.org/10.3126/jcmsn.v9i2.9685
Collapse
|
20
|
Gupta RK, Agrawal CS, Sah S, Sapkota S, Pathania OP, Sah PL. Bile duct injuries during open and laparoscopic cholecystectomy: management and outcome. J Nepal Health Res Counc 2013; 11:187-193. [PMID: 24362609] [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: 06/03/2023]
Abstract
BACKGROUND The widespread application of laparoscopic cholecystectomy has led to a rise in the numbers of major bile duct injuries (BDI). Perioperative management of these injuries is complex and challenging. There are few published reports locally regarding the perioperative management of BDI. Purpose of this review was to analyze our experience in diagnosis, management and prevention of BDI. METHODS This study was conducted in department of surgery at B. P. Koirala Institute of Health Sciences. From January 2001 to September 2010, a observational study of all patients with a BDI following cholecystectomy was maintained. Patients' charts were retrospectively reviewed to analyze incidence, type of injury, presentation, and perioperative management of BDI. RESULTS A total of 92 patients had BDI which occurred during cholecystectomy, were analysed retrospectively. There were 60/92 (65.5%) patients with BDI resulting from the wrong identification of the anatomy of the Calot's triangle during cholecystectomy. Abdominal ultrasonography was diagnostic for BDI in 71/90 (78.8%). Magnetic resonance cholangiography could reveal the site of injury, the length of injured bile duct and variation of bile duct tree with a diagnostic rate 22/23 (95.6%). The most common injury was Strasberg's E2 in 65/92 (70.7%). A transection or stricture of the bile duct was repaired by hepaticojejunostomy (83 cases in this series). Seventy-five (81.5%) patients were followed up. The mean follow-up time was 2.6 years (range 0.16-6). Good results were achieved in 62/75 (82.6%) of the patients. CONCLUSIONS The high success rate of bile duct repair in the present study can be attributed to the appropriate timing, meticulous technique and the tertiary care experience.
Collapse
Affiliation(s)
- R K Gupta
- Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - C S Agrawal
- Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - S Sah
- Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - S Sapkota
- Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - O P Pathania
- Department of Surgery, Lady Harding Medical College, New Delhi, India
| | - P L Sah
- Department of Radiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| |
Collapse
|
21
|
Sapkota S, Kapoor R, Aggrawal A. 60P A RANDOMIZED TRIAL COMPARING CONVENTIONAL FRACTIONATION VERSUS ACCELERATED HYPERFRACTIONATION WITH THREE DIMENSIONAL CONFORMAL RADIOTHERAPY (3D-CRT) AND CONCURRENT CHEMOTHERAPY IN UNRESECTABLE NON SMALL CELL LUNG CANCER. Lung Cancer 2013. [DOI: 10.1016/s0169-5002(13)70281-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
22
|
Gupta RK, Samalavicius NE, Sapkota S, Sah PL, Kafle SU. Colonic inflammatory myofibroblastic tumours: an institutional review. Colorectal Dis 2013; 15:e239-43. [PMID: 23350604 DOI: 10.1111/codi.12149] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 09/13/2012] [Indexed: 02/08/2023]
Abstract
AIM The aim of the study was to present the largest series of colonic inflammatory myofibroblastic tumour (C-IMFT) in the literature so far and to provide a review of this condition. METHOD A retrospective review was carried out of a consecutive series of patients diagnosed with a C-IMFT at a community-based hospital with a specialized gastrointestinal unit between 2002 and 2011. The main outcome measures were success rate and postoperative complications. Using a set of terms we searched the PubMed database for papers published on C-IMFT. We reviewed the data from these studies and case reports. RESULTS There were seven patients with a histopathologically proven C-IMFT. The patients' mean age was 39 ± 11.3 years. Four presented with clinical features of intestinal obstruction of varying severity and three with symptoms of anaemia. Complete surgical resection with end-to-end anastomosis was performed. The gross morphology included polypoidal myxoid tumours that served as a lead point for intussusception in two cases, a whorled mass in two and a circumferential infiltrative tumour in three. Microscopically, all tumours had typical features of IMFT with a variable expression of anaplastic lymphoma kinase (ALK-1) and tumour-free resection margins. All patients were well without local recurrence or metastasis at a mean follow-up of 46.8 ± 11.9 months. CONCLUSION Surgical resection is effective for this rare tumour which mostly behaves in a benign manner. Our review supports the need for patients to be followed up for long periods because of the possibility of metastasis or late recurrence.
Collapse
Affiliation(s)
- R K Gupta
- Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | | | | | | | | |
Collapse
|
23
|
Sapkota S, Sherpa M, Bhattarai B. Incidence of hypertension in patients undergoing surgery at Dhulikhel Hospital-Kathmandu University Hospital. Kathmandu Univ Med J (KUMJ) 2012; 9:40-3. [PMID: 22610867 DOI: 10.3126/kumj.v9i2.6286] [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: 11/18/2022]
Abstract
BACKGROUND Hypertension is an important public health challenge worldwide and is most important modifiable risk factor for cardiovascular, cerebrovascular and renal disease. Blood pressure determination forms an integral part of anaesthesiologist evaluation of his patient condition prior to and during surgery. Data are not available which indicate changes in blood pressure occurring preanaesthetically in hospitalized patients. There are several risks from untreated preoperative hypertension in perioperative and postoperative phase. OBJECTIVE To know the incidence of hypertension in preoperative patients undergoing major surgery. METHODS This retrospective observational study was based on the data collected from preanaesthetic checkup record book from January 2010 to December 2010. RESULTS A total of 955 patients were studied and analyzed in terms of hypertension and demographic characteristics. The total incidence of hypertension in preoperative phase was 10.16%. Among them 64.9% being male and 35.1% female. Maximum incidence was found in age group 50-59 years i.e. 26.6%. Among the case detected maximum patients i.e. 52% were patients with newly diagnosed hypertension and among those under medications 61.1% were using calcium channel blockers. CONCLUSION Knowing the incidence will help in proper preoperative optimization of the hypertensive patients and also help in decreasing the incidence of postoperative complications.
Collapse
Affiliation(s)
- S Sapkota
- Department of Anesthesia and Critical Care Medicine, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | | | | |
Collapse
|
24
|
Abstract
A study was conducted at the Institute of Agriculture and Animal Sciences (IAAS), Rampur, Chitwan from 29 August to 17 October, 2007 to compare the effects of antibiotic (chlortetracycline) and probiotic (Lactobacillus acidophilus) with three herbal growth promoters, Amala (Emblica officinalis),(EO), Tulsi (Ocimum sanctum), (OC) and Aswogandha (Withania somnifera),(WS) on growth performance, feed consumption, feed conversion efficiency, carcass characteristics, and economics of broiler production. The experiment was laid out in a completely randomized design with day-old broiler chick (192) randomly assigned to eight groups containing 8 chick in each and replicated three times. The control group received the maize-soybean based basal diet. In the treatment groups, the basal diet was supplemented with one of the following: antibiotic, probiotics, Tulsi, Amala, and Aswogandha and also in combination of herbs, forming eight treatments respectively. Results showed significantly better production in herbs. Significantly higher digestibility of all the nutrients (P<0.05) was observed in Amala+Tulsi+Aswogandha (T8) supplemented group. Highest body weight (1.440kg) was recorded in birds fed diet supplemented with Amala and Tulsi, and the lowest body weight (1.317kg) was seen in antibiotics (T2) fed birds. The highest income over expenditure (Rs.26.36) was recorded in birds fed diet supplemented with Tulsi (T6), although the difference was not significant among the treatments. Looking at the benefit cost ratio, highest B/C ratio was found in birds supplied with Tulsi (1.19) supplemented diet and minimum (1.12) was recorded in Amala supplied diet. Hence, this experiment showed that herbs as growth promoters can replace antibiotics in the diet of broiler chicken. However, it needs multilocational trials before recommendation for adoption by poultry growers.DOI: http://dx.doi.org/10.3126/njst.v12i0.6478 Nepal Journal of Science and Technology 12 (2011) 41-50
Collapse
|
25
|
Adhikari P, Pathak UN, Uprety D, Sapkota S. Profile of ascites patient admitted in Nepal Medical College Teaching Hospital. Nepal Med Coll J 2012; 14:111-113. [PMID: 23671959] [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
Ascites is one of the frequently encountered problems in internal medicine. Common causes of ascites are portal hypertension including cirrhosis of liver and congestive heart failure, hypoalbuminemia associated with nephrotic syndrome, intra-abdominal malignancy and abdominal tuberculosis. We evaluated 43 patients presented with ascites in Nepal Medical College Teaching Hospital (NMCTH). After history taking, clinical examination, imaging studies and laboratory evaluation alcoholic liver disease and abdominal tuberculosis were diagnosed in 19 and 5 patients restively. Constrictive pericarditis was diagnosed in 2 patients and 2 patients were suffering from HCV related liver disease. Present study revealed alcoholic liver disease as the commonest cause of ascites.
Collapse
Affiliation(s)
- P Adhikari
- Department of Internal Medicine, Nepal Medical College Teaching Hospital, Jorpati, Kathmandu, Nepal.
| | | | | | | |
Collapse
|
26
|
Lavé J, Yule D, Sapkota S, Basant K, Madden C, Attal M, Pandey R. Evidence for a Great Medieval Earthquake (~1100 A.D.) in the Central Himalayas, Nepal. Science 2005; 307:1302-5. [PMID: 15731452 DOI: 10.1126/science.1104804] [Citation(s) in RCA: 172] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The Himalayan orogen has produced three thrust earthquakes with moment magnitude (Mw) 7.8 to 8.5 during the past century, yet no surface ruptures associated with these great earthquakes have been documented. Here, we present paleoseismic evidence from east central Nepal that, since approximately 700 A.D., a single earthquake ruptured the Frontal Thrust fault at approximately 1100 A.D., with a surface displacement of approximately 17 (+5/-3) meters and a lateral extent and size that could have exceeded 240 kilometers and approximately Mw 8.8, respectively. Ruptures associated with Mw <8.2 events would contribute to the frontal Himalayas folding but would stop before reaching the surface. These findings could require substantial modifications to current regional seismic hazard models.
Collapse
Affiliation(s)
- J Lavé
- Laboratoire de Géodynamique des Chaînes Alpines, BP53, 38041 Grenoble, France.
| | | | | | | | | | | | | |
Collapse
|