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Suryabanshi A, Timilsina B, Shakya S, Khanal S, Yadav V, Joshi A. Left Atrial Enlargement as a Predictor of Atrial Fibrillation in Rheumatic Mitral Valve Disease: An Echocardiography-based Retrospective Cross-sectional Study. J Nepal Health Res Counc 2024; 21:593-598. [PMID: 38616588 DOI: 10.33314/jnhrc.v21i4.4811] [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] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 03/31/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Rheumatic heart disease is a major cause of cardiovascular morbidity and mortality in developing nations and is a leading cause of hospital admission due to cardiac problems in our country. This study will evaluate the association between left atrial size and the occurrence of atrial fibrillation and describe the clinical characteristics along with complications related to Rheumatic Mitral valve disease. METHODS A retrospective cross-sectional study was conducted at a tertiary care center from January 2018 to December 2019. Reports of 207 patients admitted to medical and/or surgical wards with echocardiographic diagnosis of rheumatic mitral valve disease with or without atrial fibrillation were reviewed. Data were collected, entered, and analyzed using the Statistical Package for the Social Science version 25.0. RESULTS Among 207 patients, atrial fibrillation was present in 90 (43.5%) patients. Atrial fibrillation was higher in patients with mixed mitral valvular lesions compared to isolated mitral stenosis or mitral regurgitation. Univariate and multivariate analysis revealed left atrial size [aOR=1.067, 95% CI: 1.023 - 1.113, P= 0.002] and age [aOR = 1.073, 95% CI: 1.042 - 1.105, P<0.001] as an independent predictor of atrial fibrillation. CONCLUSIONS Larger left atrium was an independent predictor of atrial fibrillation. Besides this, atrial fibrillation was associated with increasing age, mixed mitral valvular lesion, and moderately reduced left ventricular ejection fraction, but not associated with gender and mitral stenosis severity. Left atrial clot was significantly higher in patients with atrial fibrillation than in sinus rhythm.
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Affiliation(s)
- Anil Suryabanshi
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Binita Timilsina
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Smriti Shakya
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Centre, Maharajgunj, Kathmandu, Nepal
| | - Shambhu Khanal
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Vijay Yadav
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Centre, Maharajgunj, Kathmandu, Nepal
| | - Amir Joshi
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
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2
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Kashyap A, Pokhrel B, Bhatta A, Aryal S, Khanal S. Vasculitis, an Early Unusual Presentation of Rheumatoid Arthritis: A Case Report. Cureus 2024; 16:e52845. [PMID: 38406040 PMCID: PMC10884621 DOI: 10.7759/cureus.52845] [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] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease, with rheumatoid vasculitis (RV) being its most threatening complication. We report a case of a 70-year-old female presenting with gangrene of the tips of fingers and toes early in the course of RA, which is a rare manifestation. The skin is the most commonly affected organ in RV, followed by the peripheral nerves. However, almost every organ system can get implicated. The management of RV is mostly empirical, with high-dose glucocorticoids and cyclophosphamide. Early diagnosis and optimum management are essential in preventing severe complications of the disease.
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Affiliation(s)
- Ashutosh Kashyap
- Department of Internal Medicine, Tribhuvan University Institute of Medicine, Kathmandu, NPL
| | - Biraj Pokhrel
- Department of Internal Medicine, Tribhuvan University Institute of Medicine, Kathmandu, NPL
| | - Aaraju Bhatta
- Department of Internal Medicine, Patan Academy of Health Sciences, Kathmandu, NPL
| | - Savita Aryal
- Department of Emergency Medicine, Lumbini Provincial Hospital, Kathmandu, NPL
| | - Shambhu Khanal
- Department of Internal Medicine, Lumbini Provincial Hospital, Kathmandu, NPL
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3
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Khanal S, Kafle A, Bhandari S, Kayastha P. A rare extrapulmonary presentation of tuberculosis: Breast tuberculosis. Clin Case Rep 2023; 11:e7728. [PMID: 37492072 PMCID: PMC10363816 DOI: 10.1002/ccr3.7728] [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: 01/12/2023] [Revised: 07/04/2023] [Accepted: 07/08/2023] [Indexed: 07/27/2023] Open
Abstract
Key Clinical Message Breast abscess of long duration can be tubercular origin in both developing and developed countries despite its rarity. Abstract A 34-year-old lady presented with painful lump on her breast for 2 months, which was diagnosed with mammary tuberculosis on basis of aspiration cytology and successfully treated with antitubercular drugs. Breast abscess of long duration may be tubercular etiology in both developing and developed nations.
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Affiliation(s)
- Shambhu Khanal
- Department of Internal MedicineTribhuvan University Institute of MedicineKathmanduNepal
| | - Anil Kafle
- Department of PathologyBP Koirala Institute of Health SciencesDharanNepal
| | | | - Priyanka Kayastha
- Department of PathologyNational Academy of Medical SciencesKathmanduNepal
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4
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Regmi B, Shrestha B, Khanal S, Moktan S, Byanju R. Alarm Fatigue among Nurses Working in Critical Care Setting in a Tertiary Hospital, Nepal. Kathmandu Univ Med J (KUMJ) 2023; 21:28-32. [PMID: 37800422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Background Alarm fatigue is a well-recognized patient safety concern in critical care settings. It occurs when nurses become overwhelmed by the total number of alarm signals which can result in alarm desensitization and eventually contributes to missing of serious and important changes in a patient's condition, thus failing to respond properly. Objective To find out alarm fatigue and its associated factors among nurses working in critical care setting. Method A cross-sectional study design with convenient sampling technique was used to select 56 nurses working at different critical care settings in Dhulikhel Hospital. A selfconstructed semi structured questionnaire and nurses alarm fatigue questionnaire was used for the survey. Frequency, percentage, mean and standard deviation were used for descriptive statistics whereas Independent t-test and One-way ANOVA were used for inferential statistics. Result The result shows that more than half of the nurses were less than 25 years, single and more than two-third of the participants worked in Adult Intensive Care Unit. Out of total obtainable score 44, the overall mean score of the Alarm Fatigue was 28.03±12.813. The result showed that there was no significant difference between alarm fatigue and selected socio-demographic and work related characteristics. Conclusion The alarm fatigue among nurses working in critical care settings was found to be higher in this study. Since alarm fatigue is directly related to patients' safety, the effective management of medical device alarms can reduce alarm fatigue and prevent potentially dangerous outcomes.
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Affiliation(s)
- B Regmi
- Department of Nursing and Midwifery Program, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - B Shrestha
- Department of Nursing and Midwifery Program, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Khanal
- Department of Orthopedics and Traumatology, National Academy of Health Sciences, Bir Hospital, Kathmandu, Nepal
| | - S Moktan
- Department of Nursing and Midwifery Program, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R Byanju
- Department of Nursing and Midwifery Program, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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5
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Velagapudi S, Sharma B, Hussain K, Sana MK, Kannayiram S, Murthi M, Khanal S, Gomez J. Speckle tracking echocardiography in patients with systemic sclerosis: a meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.032] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Myocardial dysfunction is well established in systemic sclerosis (SSc). The utility of standard echocardiography is limited to detect the onset of myocardial dysfunction. Speckle tracking echocardiography (STE) and strain imaging has emerged as a useful technique to quantify left ventricle hemodynamics and myocardial function in early stages of myocardial dysfunction. We aimed to systematically analyze the existing literature on the application of STE and strain analysis in identifying SSc associated myocardial dysfunction
Methods
PubMed, Cochrane, and Google Scholar were queried for studies from the inception of the databases to 2022. Case control studies that used 2D STE for assessment of strain in SSc patients and controls, were included for the analysis. PRISMA guidelines were followed for selections of studies. Two independent reviewers extracted data. Analysis was done using Cochrane Review Manager 5.0.
Results
Total of 19 studies were included in the analysis that compared strain analysis in SSc patient's vs healthy controls. Of the 16 studies that reported left ventricular (LV) global longitudinal strain, we found significantly lower LV global longitudinal strain in SSc patients (mean difference 1.92; 95% CI 0.98–2.87). Six studies reported LV circumferential strain which was noted to be lower in SSc patients compared to healthy controls (mean difference 3.55; 95% CI 1.60–5.51). Five studies reported LV global radial strain with a similar decrease in radial strain among SSc patients compared to controls (mean difference 4.39; 95% CI −6.95 to −1.83). 10 studies reported right ventricular longitudinal strain with a decrease in longitudinal strain in SSc patient's vs controls (mean difference 2.57; 95% CI 2.03–3.12).
Conclusions
SSc patients have lower strain values compared to controls, which is suggestive of an impaired myocardial function in left and right ventricle. Strain analysis by STE could help with early detection of myocardial dysfunction.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Velagapudi
- John H. Stroger Jr. Hospital of Cook County , Chicago , United States of America
| | - B Sharma
- John H. Stroger Jr. Hospital of Cook County , Chicago , United States of America
| | - K Hussain
- NorthShore University Health System , Chicago , United States of America
| | - M K Sana
- John H. Stroger Jr. Hospital of Cook County , Chicago , United States of America
| | - S Kannayiram
- John H. Stroger Jr. Hospital of Cook County , Chicago , United States of America
| | - M Murthi
- John H. Stroger Jr. Hospital of Cook County , Chicago , United States of America
| | - S Khanal
- John H. Stroger Jr. Hospital of Cook County , Chicago , United States of America
| | - J Gomez
- John H. Stroger Jr. Hospital of Cook County , Chicago , United States of America
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6
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Kannayiram S, Velagapudi S, Kang CY, Sami FL, Romero-Noboa ME, Murthi M, Alsahoury J, Krishnaraju E, Khanal S. Takotsubo's cardiomyopathy in patients with pre-existing autoimmune diseases: a national inpatient sample analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2650] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recent research has suggested a potential role of autoimmunity and inflammation in Takotsubo's cardiomyopathy (TC) [1]. There have been few reports of TC occurring in patients with pre-existing autoimmune diseases (AID). It has also been hypothesised that the low prevalence of TC in patients with AID might be due to attenuating effect on the inflammatory response to catecholamine excess in TC by immunosuppressive medications used in AID patients [2]. On a population-based level, the prevalence of AID in TC patients and its implications remain unknown.
Purpose
Using a large national database, we aimed to describe the prevalence of AID in TC patients and its impact on in-hospital outcomes of TC patients.
Methods
We performed a retrospective analysis using the 2016–2019 National inpatient sample database in the United States, covering over 7 million admissions per year. Using ICD-10 codes, we identified patients with TC and a concomitant diagnosis of any of the AID† depicted in Table 1. We compared TC patients with (AID+) and without AID (AID−) for patient characteristics and in-hospital outcomes. Our primary outcome of interest was mortality. Secondary outcomes are listed in Table 2. Linear regression and multivariate logistic regression analysis were done using STATA 17 to adjust for confounders.
Results
158,230 patients were admitted with TC and of those, 2880 (1.8%) had concomitant AID. Systemic lupus erythematosus (n=1515, 54.1%) was the most common AID followed by Sjogren's syndrome (n=645, 23.02%) Systemic sclerosis (n=440, 14%) and Rheumatoid Arthritis (n=200, 7.1%) in TC population. Compared to TC patients without AID, AID+ patients were relatively younger (mean age of 63 vs 67 years, p<0.0001) and more likely to be females (95% vs 83%, p<0.0001*). 200 (7.1%) and 9459 (6.08%) TC patients with and without AID died during hospitalisation,respectively. TC patients with AID had lower odds of developing acute decompensated heart failure [ADHF] (aOR=0.69 95% CI: 0.56–0.85, p=0.001*) and acute stroke (aOR=0.60, 95% CI: 0.43–0.85, p=0.005*) There was no statistical significance in mortality, rates of acute respiratory failure, cardiogenic shock and healthcare utilisation (Table 2).
Conclusion
Our study notes a substantially higher number of TC patients with pre-existing AID than previously reported in the literature. In addition, these patients have lower odds of developing acute stroke and ADHF, while there was no significant difference for cardiogenic shock and mortality. Further studies are required to decipher the potential link between AID and TC and explore the possible role of immunosuppressants in TC therapy, as suggested in prior studies.
*P-value <0.05 was considered statistically significant. aOR = Adjusted Odds Ratio. †AID included in the study are mentioned in Table 1.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Kannayiram
- John H. Stroger Jr. Hospital of Cook County , Chicago , United States of America
| | - S Velagapudi
- John H. Stroger Jr. Hospital of Cook County , Chicago , United States of America
| | - C Y Kang
- John H. Stroger Jr. Hospital of Cook County , Chicago , United States of America
| | - F L Sami
- John H. Stroger Jr. Hospital of Cook County , Chicago , United States of America
| | - M E Romero-Noboa
- John H. Stroger Jr. Hospital of Cook County , Chicago , United States of America
| | - M Murthi
- John H. Stroger Jr. Hospital of Cook County , Chicago , United States of America
| | - J Alsahoury
- John H. Stroger Jr. Hospital of Cook County , Chicago , United States of America
| | - E Krishnaraju
- John H. Stroger Jr. Hospital of Cook County , Chicago , United States of America
| | - S Khanal
- John H. Stroger Jr. Hospital of Cook County , Chicago , United States of America
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7
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Ayala A, Yin H, Khanal S, Niu N, Nunez M, Chupp G, Laguna T, Britto C. 117 Interleukin-6 and short-palate lung and nasal epithelium clone 1 fluctuations as sex-specific markers of acute cystic fibrosis exacerbation. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00808-6] [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: 11/06/2022]
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8
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Rayamajhi A, Pokhrel B, Khanal S, Shrestha A. Undiagnosed polycythemia, an uncommon cause of Wallenberg syndrome: A case report. Clin Case Rep 2022; 10:e05752. [PMID: 35474990 PMCID: PMC9020440 DOI: 10.1002/ccr3.5752] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/23/2022] [Accepted: 04/02/2022] [Indexed: 11/30/2022] Open
Abstract
A 26‐year‐old man presented with difficulty swallowing, dizziness, hiccups, and Horner's syndrome. Clinical and neuroimaging collaboration confirmed lateral medullary syndrome. Polycythemia was identified as the only attributable risk factor. However, the cause of polycythemia could not be assessed further. Polycythemia was managed with phlebotomy.
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Affiliation(s)
- Aadesh Rayamajhi
- Department of Internal Medicine Tribhuvan University Teaching Hospital Kathmandu Nepal
| | - Biraj Pokhrel
- Department of Internal Medicine Tribhuvan University Teaching Hospital Kathmandu Nepal
| | - Shambhu Khanal
- Department of Internal Medicine Tribhuvan University Teaching Hospital Kathmandu Nepal
| | - Anjan Shrestha
- Department of Hemato‐oncology Tribhuvan University Teaching Hospital Kathmandu Nepal
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Khanal S, Pokhrel B, Pokhrel M, Thapa R, Nepali R. Anuria, an Atypical Presentation of Leptospirosis: A Case Report. JNMA J Nepal Med Assoc 2022; 60:83-85. [PMID: 35199683 PMCID: PMC9157668 DOI: 10.31729/jnma.6240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 01/17/2022] [Indexed: 11/18/2022] Open
Abstract
Leptospirosis, an underreported disease, is a highly prevalent spirochaetal zoonotic disease in both tropical and temperate climates. Symptoms can range from mild illness to potentially life-threatening infection. Laboratory tests are nonspecific. Microbiological confirmation is not widely available in endemic developing countries like Nepal. We need to rely on the serologic test, which has its own pitfalls in the initial days of illness. Here, we report a case of 56 years old female from the western region of Nepal who presented with fever, jaundice and anuria. She initially tested negative for leptospirosis but was later found to be positive in the second week of illness. Unlike the usual non-oliguric renal failure in leptospirosis, she presented with anuria requiring haemodialysis and subsequently had a good recovery with treatment. We highlight the importance of clinical suspicion and logical interpretation of serologic tests based on its timing from the onset of illness.
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Affiliation(s)
- Shambhu Khanal
- Department of Internal Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Biraj Pokhrel
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
- Correspondence: Mr. Biraj Pokhrel, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal. , Phone: +977-9857046753
| | - Madalasha Pokhrel
- Department of Internal Medicine, Manipal College of Medical Sciences, Pokhara, Nepal
| | - Rukshar Thapa
- Department of Internal Medicine, Manipal College of Medical Sciences, Pokhara, Nepal
| | - Rabin Nepali
- Department of Nephrology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
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10
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Chapagain P, Khanal S, Ojha R, Gautam N, Sayami M, Bhandari R. Extensive bilateral intracranial calcifications and seizure in iatrogenic hypoparathyroidism: A case report. Clin Case Rep 2021; 9:e05076. [PMID: 34804532 PMCID: PMC8587699 DOI: 10.1002/ccr3.5076] [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: 06/18/2021] [Revised: 09/30/2021] [Accepted: 10/29/2021] [Indexed: 11/18/2022] Open
Abstract
Postoperative permanent hypoparathyroidism can exhibit extensive intracranial calcifications involving basal ganglia, thalamus, cerebellum, and cerebral cortex.
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Affiliation(s)
- Parikshit Chapagain
- Department of Internal MedicineTribhuvan University Teaching HospitalKathmanduNepal
| | - Shambhu Khanal
- Department of Internal MedicineTribhuvan University Teaching HospitalKathmanduNepal
| | - Rajeev Ojha
- Department of NeurologyTribhuvan University Teaching HospitalKathmanduNepal
| | - Niraj Gautam
- Department of NeurologyTribhuvan University Teaching HospitalKathmanduNepal
| | - Matina Sayami
- Department of EndocrinologyTribhuvan University Teaching HospitalKathmanduNepal
| | - Roshan Bhandari
- Department of EndocrinologyTribhuvan University Teaching HospitalKathmanduNepal
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11
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Mishra A, Giri S, Rauniyar R, Poudel S, Nepal AS, Chaudhary G, Khanal S, Paudel S. Endogenous endophthalmitis and multifocal brain abscess-An interesting case. Clin Case Rep 2021; 9:e04913. [PMID: 34631092 PMCID: PMC8493369 DOI: 10.1002/ccr3.4913] [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: 07/08/2021] [Revised: 07/12/2021] [Accepted: 09/24/2021] [Indexed: 11/13/2022] Open
Abstract
We present an unusual case that staphylococcal brain abscess can present in an immunocompetent with endogenous endophthalmitis secondary to a septic foci and early prevention of dissemination with appropriate management to prevent its complications.
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Affiliation(s)
- Aman Mishra
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Subarna Giri
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Robin Rauniyar
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Sagar Poudel
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Amit Sharma Nepal
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Gajendra Chaudhary
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Shambhu Khanal
- Department of Internal MedicineMaharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Sunanda Paudel
- Department of NeurologyMaharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
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12
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Pokhrel B, Khanal S, Chapagain P, Sedain G. Pituitary Apoplexy Complicated by Cerebral Infarction: A Case Report. JNMA J Nepal Med Assoc 2021; 59:723-726. [PMID: 34508512 PMCID: PMC9107860 DOI: 10.31729/jnma.6120] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 07/17/2021] [Indexed: 11/14/2022] Open
Abstract
Cerebral infarction is a rare complication of pituitary apoplexy, which can result in significant morbidity if not treated on time. Pituitary apoplexy mostly occurs in pre-existing adenoma, which can remain undiagnosed until symptoms arise. Here, we present a case of a 26-year-old man with undiagnosed acromegaly who presented with left retro-orbital pain, diminished vision of the left eye, and right hemiparesis. Neuroimaging revealed large hemorrhagic sellar mass and ischemic infarction in the left middle cerebral artery territory. Emergency transcranial tumor excision was done, which resulted in significant neurological recovery.
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Affiliation(s)
- Biraj Pokhrel
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Shambhu Khanal
- Department of Internal Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Parikshit Chapagain
- Department of Internal Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Gopal Sedain
- Department of Neurosurgery, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
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13
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Pokhrel B, Gautam S, Khanal S, Pokhrel NB, Shrestha A. A Rare and Misdiagnosed Entity Paroxysmal Nocturnal Hemoglobinuria: A Case Report. Cureus 2021; 13:e14902. [PMID: 34109088 PMCID: PMC8183308 DOI: 10.7759/cureus.14902] [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] [Indexed: 11/17/2022] Open
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired stem cell disorder manifesting as non-immunological hemolytic anemia, hemoglobinuria, unusual thrombosis, and renal impairment due to deficiency of glycosylphosphatidylinositol (GPI) linked proteins in red blood cells. Patients present with features of chronic non-immune intravascular hemolysis, unexplained anemia, and thrombosis at unusual sites. It is often misdiagnosed and treated as anemia due to a low degree of suspicion. In resource-limited settings, the low degree of suspicion and paucity of investigations are the major diagnostic challenges. The even bigger challenge remains in the affordability of definitive treatment after a diagnosis has been made. Herein, we present a case of PNH in a 26-year man from rural Nepal who went undetected during the initial presentation of hemolytic anemia and later presented to us with hemolytic anemia and gastrointestinal symptoms. We made the provisional diagnosis based on the clinical presentations. However, we faced challenges in reaching the final diagnosis and providing the definitive treatment due to financial constraints and limited resources. Any patient presenting with features of chronic non-immune intravascular hemolysis, unexplained anemia, and unusual thrombosis should prompt the consideration of PNH.
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Affiliation(s)
- Biraj Pokhrel
- Internal Medicine, Tribhuvan University, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, NPL
| | - Sandesh Gautam
- Internal Medicine, Tribhuvan University, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, NPL
| | - Shambhu Khanal
- Internal Medicine, Tribhuvan University, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, NPL
| | - Nishan B Pokhrel
- Internal Medicine, Tribhuvan University, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, NPL
| | - Anjan Shrestha
- Internal Medicine, Tribhuvan University, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, NPL
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14
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Gyawali S, Joshi U, Kharel Z, Khanal S, Shrestha A. Tuberculosis with Evans syndrome: A case report. Clin Case Rep 2021; 9:e04113. [PMID: 34026153 PMCID: PMC8122135 DOI: 10.1002/ccr3.4113] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/16/2021] [Indexed: 11/20/2022] Open
Abstract
Evans syndrome and tuberculosis could be predisposing factors for one another, or there may be a common pathophysiological denominator for the co-occurrence. Further research is needed for a better understanding of pathophysiology and treatment.
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Affiliation(s)
- Sagar Gyawali
- Department of Internal MedicineInstitute of MedicineTribhuvan University Teaching HospitalKathmanduNepal
| | - Utsav Joshi
- Department of Internal MedicineRochester General HospitalRochesterNYUSA
| | - Zeni Kharel
- Department of Internal MedicineRochester General HospitalRochesterNYUSA
| | - Shambhu Khanal
- Department of Internal MedicineInstitute of MedicineTribhuvan University Teaching HospitalKathmanduNepal
| | - Anjan Shrestha
- Department of Internal MedicineInstitute of MedicineTribhuvan University Teaching HospitalKathmanduNepal
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Aboseria M, Swikehardt M, Provancha I, Khanal S, Grewal T, Lavian J, Patel S, Walsh J. Abstract No. 564 Identifying racial disparity in treatment of uterine fibroids. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.374] [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: 10/21/2022] Open
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16
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Pokhrel NB, Khanal S, Chapagain P, Pokhrel B, Shrestha A. Hemochromatosis in a β-thalassemia minor patient with H63D homozygous mutation: A case report. Clin Case Rep 2020; 8:2341-2345. [PMID: 33363736 PMCID: PMC7752352 DOI: 10.1002/ccr3.3096] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/12/2020] [Accepted: 06/21/2020] [Indexed: 01/04/2023] Open
Abstract
β-thalassemia heterozygosity can cause significant iron overload when accompanied by HFE gene mutations and inappropriate iron supplementation.
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Affiliation(s)
- Nishan Babu Pokhrel
- Department of Internal MedicineTribhuvan University Institute of MedicineKathmanduNepal
| | - Shambhu Khanal
- Department of Internal MedicineTribhuvan University Institute of MedicineKathmanduNepal
| | - Parikshit Chapagain
- Department of Internal MedicineTribhuvan University Institute of MedicineKathmanduNepal
| | - Biraj Pokhrel
- Department of Internal MedicineTribhuvan University Institute of MedicineKathmanduNepal
| | - Anjan Shrestha
- Department of Hemato‐OncologyTribhuvan University Institute of MedicineKathmanduNepal
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Abstract
Fluoride has a preventive effect on dental caries. However, excessive/insufficient ingestion of fluoride can lead to the development of dental fluorosis/increased risk for dental caries respectively. The objective of this study was to estimate fluoride concentration in drinking water of Kathmandu valley. It was a community based cross-sectional study in which drinking water samples were collected from municipal water supply and bottled water. Municipal water supply was collected according to eight water schemes in Kathmandu valley and as for bottled water, 35 samples were randomly collected according to different brand names available in the commercial market. The samples were analyzed for fluoride content by SPADNS colorimetric method as per standard procedure set by American Public Health Association (APHA 2012).The results revealed that the fluoride content in drinking water samples was below the permissible limit (<0.5 ppm) as per Nepal’s drinking water quality standards and WHO guidelines. Hence, implementation of water fluoridation program can be initiated for municipal water supply and bottled water for prevention of dental caries to optimize the oral health of people.
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Boeckmann M, Noor M, Zahid R, Firoze F, Shresthra P, Khanal S, Regmi S, Baral S, Elsey H. Lessons from the field: Gender roles and researcher reflexivity in smoking cessation in South Asia. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.749] [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: 11/13/2022] Open
Abstract
Abstract
Background
In South Asia, dual epidemics of smoking and tuberculosis (TB) have contributed to a high burden of lung disease. To address these health risks, the TB & Tobacco study uses the TB diagnosis as a teachable moment and implements a behaviour support counselling intervention, conducted by TB health workers, for patients in Bangladesh, Nepal and Pakistan. In this region, smoking tobacco is perceived as problematic for women, and being confronted with questions on smoking from a health professional may be uncomfortable for men and women. Anticipating these challenges, we incorporated gender sensitivity into training of health workers.
Methods
During implementation of the cessation support in routine TB care, a process evaluation assessed interactions between participants and the intervention through interviews with health workers and patients with TB participating in the cessation program. This presentation focusses on a retrospective self-reflection on how we conceptualized gender roles based on prior research, and how research findings partially challenged these assumptions.
Findings
While parts of our interview findings point towards smoking as a stigmatized practice for women and some men in South Asia as expected, several male and female respondents across socio-economic and geographical spheres contradicted this assumption. We discovered that health workers’ self-efficacy and perceived smoking stigma among health workers influenced whether they discussed smoking with women or minors. Many patients, on the other hand, told us that they were interested in receiving help to cure their TB and were willing to talk to about smoking with their health workers and their family members.
Conclusions
Patients in this study were more open to talking about smoking than anticipated. When including gender sensitivity into the standard training for health workers, we should be careful not to increase doubts in health workers about addressing smoking with women.
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Affiliation(s)
- M Boeckmann
- Department of Environment and Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany
- Department of Health Sciences, University of York, York, UK
| | - M Noor
- The Inititative, Islamabad, Pakistan
| | - R Zahid
- The Inititative, Islamabad, Pakistan
| | - F Firoze
- ARK Foundation, Dhaka, Bangladesh
| | | | | | - S Regmi
- HERD International, Kathmandu, Nepal
| | - S Baral
- HERD International, Kathmandu, Nepal
| | - H Elsey
- Department of Health Sciences, University of York, York, UK
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Redfern J, Enright G, Hyun K, Raadsma S, Allman-Farinell M, Innes-Hughes C, Khanal S, Lukeis S, Rissel C, Chai HC, Gyani A. 4225Effectiveness of a behavioural incentive scheme linked to goal achievement in overweight children: a multicenter cluster randomized controlled trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0132] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The prevalence of childhood overweight and obesity is becoming an increasing concern worldwide and management is vital for primary prevention of cardiovascular disease. Studies in adults have shown that provision of incentives may facilitate behaviour change but there are no similar studies targeting weight management in children.
Purpose
To determine effectiveness of a structured goal setting incentive scheme, delivered within a community program, on health outcomes (with a focus on cardiovascular risk factors) in overweight children at 6 and 18 months.
Methods
Single-blind, multicenter, cluster randomized controlled trial with 10 weeks, 6 and 18 month follow-up. Eligible sites had to be delivering the standard children's weight management program and enrol at least 10 children per term. Eligible children had to be 7–13 years and have a body mass index (BMI) >85th percentile. Recruited sites were randomized to (i) standard weight management program plus incentive scheme (intervention) or (ii) standard program alone (control). The intervention group participated in the standard program plus received milestone based incentives for achievement of goals. Incentives were practical, and healthy in nature such as fun vegetable slicers, sports store vouchers, sport equipment and family zoo passes. Primary outcome was mean BMIz score at 18 months. Secondary outcomes included anthropometric (body weight, waist circumference), behavioural (physical activity, nutrition) and self-esteem (Physical Activity Enjoyment Scale, Rosenberg Self Esteem Scale) measures.
Results
A total of 37 sites (33 urban and 4 regional) and 512 children were recruited. There were no significant differences between the control and intervention groups at any follow-up time-points. There were significantly more participants in the intervention than control group who completed 10 sessions of the weight management program (23% v 13%, p=0.015). Compared to baseline, at 18 month follow-up, the total cohort achieved significant reductions in the mean BMIz score (1.7 v 1.0, p<0.001), median screen time (16.5 v 15.8 hours/week p=0.0414), median number of fast food meals per week (1.0 v 0.7, p<0.001) and significant increases in physical activity (6.0 v 10.0 hours/week, p<0.001) and self-esteem score (20.7 v 22.0, p<0.002).
Conclusions
The incentive scheme, delivered in addition to a standard community weight management program, did not have a significant impact on health outcomes in overweight children. However, the intervention increased program attendance and overall cohort achieved sustained improvements in clinical and lifestyle outcomes. The results of this study suggest that extrinsic rewards may not provide added value to current community weight management programs however, participation in such programs is likely to support primary prevention of cardiovascular disease.
Acknowledgement/Funding
This work was supported by National Heart Foundation (Australia) pilot funding as part of JR's Future Leader Fellowship, in-kind contributions from th
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Affiliation(s)
- J Redfern
- University of Sydney, Sydney, Australia
| | - G Enright
- University of Sydney, Sydney, Australia
| | - K Hyun
- University of Sydney, Sydney, Australia
| | | | | | | | - S Khanal
- NSW Government, Sydney, Australia
| | - S Lukeis
- Better Health Company, Sydney, Australia
| | - C Rissel
- NSW Government, Sydney, Australia
| | - H C Chai
- NSW Government, Sydney, Australia
| | - A Gyani
- NSW Government, Sydney, Australia
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Khanal S, Singh YP, Sharma R, Pandit K. Round Block Technique in Management of Breast Lesions. Kathmandu Univ Med J (KUMJ) 2019; 17:248-250. [PMID: 33305757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The basic tenets of oncoplastic surgery essentially includes volume displacement and volume replacement. The round block technique, so-called donut mastopexy or Benelli mastopexy, is frequently used as a volume displacement technique in breast conserving surgery for benign multicentric fibroadenomas and early breast cancers. Such techniques are still underused in Nepal. In this article we present on four cases managed with original round block technique and followed prospectively with their outcome.
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Affiliation(s)
- S Khanal
- Breast and Thyroid Unit, Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Y P Singh
- Breast and Thyroid Unit, Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - R Sharma
- Department of Dermatology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - K Pandit
- Medical Officer, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Binod G, Sapkota R, Rayamajhee B, Poudel P, Thapa S, Lekhak S, Khanal S. Detection of blaNDM-1 gene among the carbapenem resistant Escherichia coli and Klebsiella pneumoniae isolates. N Biotechnol 2018. [DOI: 10.1016/j.nbt.2018.05.1038] [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: 11/25/2022]
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22
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Sharma KR, Bhandari P, Adhikari N, Tripathi P, Khanal S, Tiwari BR. Extended Spectrum β-lactamase (ESBL) Producing Multi Drug Resistant (MDR) Urinary Pathogens in a Children Hospital from Nepal. Kathmandu Univ Med J (KUMJ) 2018; 16:151-155. [PMID: 30636756] [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: 06/09/2023]
Abstract
Background Multidrug resistant in clinical bacterial isolates has increasingly been reported through out the world and is associated with high morbidity, mortality and increased health care costs. It is important to determine the status of multidrug resistance pattern to understand the current resistance trend so that appropriate antibiotics can be used in practice. Objective To determine the antibiotic resistant profile and prevalence of extended spectrum β-lactamase producing multidrug resistant strains in pediatric patients of Kanti Children's Hospital, Kathmandu, Nepal. Method Urine sample was cultured by standard microbiological techniques and bacterial isolates were identified using different biochemical tests. Antibiotic susceptibility testing was performed by Kirby Bauer disc diffusion method and extended spectrum β-lactamase detection was carried out using combined disc method as recommended by Clinical Laboratory Standard Institute guidelines. Result All together 65 different bacteria were isolated and subsequently identified. E. coli was the most common isolate with 46 (71%) isolates 63% of these isolates were multidrug resistant. Gram negative isolates were most resistant to nalidixic acid (81.97%) followed by ampicillin (69.35%) and co-trimoxazole (69.35%). The extended spectrum β-lactamase producing isolates were 43% among total isolates. Conclusion Higher rate of Extended Spectrum β-lactamase production among multidrug resistant isolates suggested routine extended spectrum β-lactamase testing in clinical isolates.
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Affiliation(s)
- K R Sharma
- Department of Microbiology, Kantipur College of Medical Sciences, Kathmandu, Nepal
| | - P Bhandari
- Department of Microbiology, National College (NIST), Kathmandu, Nepal
| | - N Adhikari
- Department of Microbiology, Kantipur College of Medical Sciences, Kathmandu, Nepal
| | - P Tripathi
- Department of Pathology Laboratory, Kanti Children's Hospital, Kathmandu, Nepal
| | - S Khanal
- Department of Microbiology, National College (NIST), Kathmandu, Nepal
| | - B R Tiwari
- School of Health and Allied Sciences, Pokhara University, Pokhara, Nepal
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Humagain M, Dixit S, Bhandari B, Khanal S, Singh PK. Self-Perception of Halitosis among Undergraduate Students of Kathmandu University School of Medical Sciences - A Questionnaire Based Study. Kathmandu Univ Med J (KUMJ) 2018; 16:89-93. [PMID: 30631025] [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: 06/09/2023]
Abstract
Background Halitosis is a frequently reported oral health problem worldwide with a prevalence rate of 10-30% in the general population. It is defined as the disagreeable or foul smelling breath originating consistently from a person's oral cavity. It not only effects the normal daily life activities of the patient but also bring humiliation, reduced self- esteem, ultimately resulting into decreased quality of life. Objective To determine the self-perception of halitosis among undergraduate students of different medical branches of Kathmandu University School of Medical Sciences (KUSMS); Kavre, Nepal. Method A descriptive cross-sectional epidemiological survey was conducted among undergraduate students of Physiotherapy, B.Sc Nursing, Bachelor of Nursing Sciences (BNS), MBBS and BDS program of Kathmandu University School of Medical Sciences, Dhulikhel. A self-administered questionnaire was developed and were distributed among 500 undergraduate students. Result Out of total 500 distributed questionnaires, 406 were completely filled and returned giving an overall response of 81.2%, in which 70 (89.7%) male and 280 (85.4%) female students from different medical branches were aware of the term halitosis. Among them 29 (7.14%) of students think that they suffer from halitosis. Similarly 178 (43.84%) students had severe impact of halitosis on their social life while 153 (37.68%) and 62 (15.27%) students had moderate and mild impact respectively. Conclusion Due to the multifactorial complexity of halitosis, further longitudinal studies including objective assessment of malodor are required to determine its prevalence and to further investigate the association of this problem with other etiological factors in the context of Nepal. Also, curriculum of different fields should be modified to include this simple but very necessary topic.
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Affiliation(s)
- M Humagain
- Department of Periodontology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Dixit
- Department of Oral Medicine and Radiology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - B Bhandari
- Department of Periodontology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Khanal
- Department of Periodontology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - P K Singh
- Department of Forensic Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Khanal S, Welsby D, Lloyd B, Innes-Hughes C, Lukeis S, Rissel C. Effectiveness of a once per week delivery of a family-based childhood obesity intervention: a cluster randomised controlled trial. Pediatr Obes 2016; 11:475-483. [PMID: 26695932 DOI: 10.1111/ijpo.12089] [Citation(s) in RCA: 8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 11/01/2015] [Accepted: 11/02/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The effectiveness of once per week (OPW) delivery of a family-based childhood obesity programme was compared with twice per week (TPW) delivery in achieving health and behavioural outcomes at a population level and in improving programme attendance. Both programmes were delivered over 10-weeks, and the contact hours in the OPW and TPW programmes were 20 and 35-h, respectively. METHODS A cluster-randomised controlled trial with stratification by local health district was conducted. Height, weight and global self esteem of participants and parent-reported diet and physical activity were measured at programme commencement and completion and at 6-month follow-up. Attendance was defined as the proportion of total sessions attended. RESULTS There were no differences between the OPW and TPW arms in changes from pre-programme baseline for body mass index (BMI) z-score and other health and behaviourial measures at programme completion and at follow-up, except for the increase in physical activity outside of the programme at programme completion (OPW, 3.5 h/week; TPW, 1.9 h/week; p = 0.03). OPW and TPW participants attended 71.2% and 69.2% of the total sessions, respectively. Attendance was the only contributing factor to a positive BMI z-score outcome (β = -2.45, p < 0.01) with no effects of child age and gender, language spoken at home or highest qualification of mother. CONCLUSIONS A family-based childhood obesity programme can be delivered OPW with no compromise to health or behavioural outcomes compared with TPW. Higher attendance, as a proportion of available sessions, leads to better outcomes for children.
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Affiliation(s)
- S Khanal
- NSW Office of Preventive Health, Liverpool, New South Wales, Australia
| | - D Welsby
- NSW Office of Preventive Health, Liverpool, New South Wales, Australia
| | - B Lloyd
- NSW Office of Preventive Health, Liverpool, New South Wales, Australia
| | - C Innes-Hughes
- NSW Office of Preventive Health, Liverpool, New South Wales, Australia
| | - S Lukeis
- Better Health Company, Ashwood, Victoria, Australia
| | - C Rissel
- NSW Office of Preventive Health, Liverpool, New South Wales, Australia
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Khanal S, Baral S, Shrestha P, Puri M, Kandel S, Lamichanne B, Elsey H, Brouwer M, Goel S, Chinnakali P. Yield of intensified tuberculosis case-finding activities using Xpert(®) MTB/RIF among risk groups in Nepal. Public Health Action 2016; 6:136-41. [PMID: 27358808 DOI: 10.5588/pha.16.0015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/12/2016] [Indexed: 11/10/2022] Open
Abstract
SETTING Twenty-two districts of Nepal, where intensified case-finding (ICF) activities for tuberculosis (TB) were implemented among risk groups under the TB REACH initiative in collaboration with the National TB Programme from July 2013 to November 2015. OBJECTIVES To assess the yield of TB screening using an algorithm with smear microscopy followed by Xpert(®) MTB/RIF. DESIGN A descriptive study using routinely collected data. RESULTS Of 145 679 individuals screened, 28 574 (19.6%) had presumptive TB; 1239 (4.3%) of these were diagnosed with TB and 1195 (96%) were initiated on anti-tuberculosis treatment. The yield of screening was highest among people living with the human immunodeficiency virus (PLHIV) (6.1%), followed by household contacts (3.5%) and urban slum dwellers (0.5%). Among other risk groups, such as prisoners, factory workers, refugees and individuals with diabetes, the yield was less than 0.5%. The number needed to screen to diagnose an active TB case was 17 for PLHIV, 29 for household contacts and 197 for urban slum dwellers. Of 11 525 patients from ICF and the routine programme, 112 (1%) were diagnosed with multidrug-resistant TB. CONCLUSION There was a substantial yield of TB cases among risk groups such as PLHIV and household contacts. Although the yield in urban slum dwellers was found to be moderate, some intervention should nonetheless be targeted because of the large population and poor access to care in this group.
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Affiliation(s)
- S Khanal
- Health Research and Social Development Forum (HERD), Kathmandu, Nepal
| | - S Baral
- Health Research and Social Development Forum (HERD), Kathmandu, Nepal
| | - P Shrestha
- Health Research and Social Development Forum (HERD), Kathmandu, Nepal
| | - M Puri
- Health Research and Social Development Forum (HERD), Kathmandu, Nepal
| | - S Kandel
- Health Research and Social Development Forum (HERD), Kathmandu, Nepal
| | - B Lamichanne
- National Tuberculosis Centre, Thimi, Bhaktapur, Nepal
| | - H Elsey
- Nuffield Centre for International Health and Development, Leeds Institute of Health Science, Leeds, UK
| | - M Brouwer
- PHTB Consult, Tilburg, The Netherlands
| | - S Goel
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P Chinnakali
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Gibbard G, Shang C, Khanal S. SU-F-T-77: A Novel Test for Coincidence Between Light Fields and Electron Radiation Fields. Med Phys 2016. [DOI: 10.1118/1.4956213] [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: 11/07/2022] Open
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Shang C, Gibbard G, Cole J, Schramm A, Leventouri T, Khanal S. SU-F-T-556: A Potential Real Time AQA for Cyberknife Cones and MLC Based Treatments. Med Phys 2016. [DOI: 10.1118/1.4956741] [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: 11/07/2022] Open
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Perez C, Amsbaugh M, Claudino W, Yusuf M, Wu X, Rai S, Roberts T, Wilson L, Hall Volz L, Khanal S, Jenson A, Cash E, Bumpous J, Silverman C, Tennant P, Dunlap N, Redman R. High-Dose Versus Weekly Cisplatin Definitive Chemoradiation Therapy for Human Papillomavirus–Related Oropharyngeal Squamous Cell Carcinoma of the Head and Neck. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2015.12.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Shumway B, Khanal S, Trainor P, Zahin M, Ghim S, Joh J, Rai S, Jenson A. Histologic Variation in High-Grade Oral Epithelial Dysplasia When Associated With High-risk Human Papillomavirus. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2015.12.277] [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: 10/22/2022]
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Anderson S, Daly G, O'Sullivan C, Subish P, MI MI, Mishra P, Alam K, Poudel A, Khanal S, Norris R, Lee SG, Galbraith K, Kong DCM. Letters to the Editor. Journal of Pharmacy Practice and Research 2015. [DOI: 10.1002/j.2055-2335.2008.tb00400.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - P Subish
- Department of Hospital and Clinical Pharmacy/Pharmacology, Manipal Teaching Hospital/Manipal College of Medical Sciences
| | - Mohamed Izham MI
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences; Universiti Sains Malaysia
| | - P Mishra
- Department of Hospital and Clinical Pharmacy/Pharmacology
| | - K Alam
- Department of Hospital and Clinical Pharmacy/Pharmacology
| | - A Poudel
- Department of Hospital and Clinical Pharmacy, Manipal Teaching Hospital/Manipal College of Medical Sciences; Pokhara Nepal
| | - S Khanal
- Department of Hospital and Clinical Pharmacy, Manipal Teaching Hospital/Manipal College of Medical Sciences; Pokhara Nepal
| | - Ross Norris
- Australian Centre for Paediatric Pharmacokinetics & Therapeutic Advisory Service, Mater Pharmacy Services; South Brisbane Qld 4101
| | - Su-Gil Lee
- Occupational Hygienist & Laboratory Manager OEH Consulting, Discipline of Public Health School of Population Health & Clinical Practice; University of Adelaide; Thebarton SA 5031
| | - Kirstie Galbraith
- Department of Pharmacy Practice; Monash University, and Senior Pharmacist, Research and Education, Royal Melbourne Hospital; Parkville Vic. 3050
| | - David CM Kong
- Department of Pharmacy Practice, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences; Monash University; Parkville Vic. 3052
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Thomas JS, Koo M, Shakib S, Wu J, Khanal S. Impact of a compulsory final year medical student curriculum on junior doctor prescribing. Intern Med J 2015; 44:156-60. [PMID: 24528813 DOI: 10.1111/imj.12316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 06/18/2013] [Accepted: 10/09/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Attendance at face-to-face sessions and completion of online components of the National Prescribing Curriculum was made compulsory for final year medical students at the University of Adelaide in 2010. AIMS To determine the impact of a compulsory prescribing curriculum for final year medical students on their prescribing competencies at the start of clinical practice. Graduates' attitudes to their medical school training in prescribing were also surveyed. METHODS Two cohorts of medical graduates from the University of Adelaide who commenced medical practice in 2010 and 2011 were required to complete a prescribing task using the National Inpatient Medication Chart (NIMC) at orientation and after 6 months of clinical practice. The main outcome measure was a performance in a scenario-based prescribing test, as determined by test scores and overall safety of prescriptions at orientation and 6 months of clinical practice. RESULTS There was a small difference in the average total score for the prescribing task between the 2010 and 2011 cohorts at orientation (P = 0.0007). The 2011 cohort had a higher number of safer charts at commencement of practice. We found no difference between the 2010 and 2011 cohorts in attitudes towards their undergraduate pharmacology education, and new graduates feel poorly prepared. CONCLUSION Medical graduates who are required to complete a practically oriented prescribing curriculum in final year perform slightly better on a prescribing assessment at commencement of practice. More work on preparing graduates for this complex task before graduation is needed.
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Affiliation(s)
- J S Thomas
- Clinical Education, University of Adelaide, Adelaide, South Australia, Australia
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Khanal S, Gurung SB, Pant KK, Chaudhary P, Dangol D. Ecosystem Services and Stakeholder Analysis in Bishajari Lake and Associated Wetland Areas, Chitwan, Nepal. ACTA ACUST UNITED AC 2014. [DOI: 10.3126/ijasbt.v2i4.11552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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
Wetlands as other ecosystems deliver goods and services of enormous value to the human society and are regarded as one of the most productive ecosystems. We assessed the ecosystem services delivered by Bishajari Lake and its associated wetland areas of Chitwan district during June to August, 2012. A household survey consisting 110 households, interviews with key informants, group discussions and stakeholder analysis were carried out for this purpose to document the overall status of ecosystem services, evaluate the provisional services generated by the lakes, understand potentials for payment to ecosystem services, and identify stakeholders involved and their roles and responsibilities. A total of 12 fish species, 17 wild and domestic fruits, 12 timber species, 15 fodder species, 20 wild vegetables species and 31 medicinal plant species were recorded. Moreover 65.5% of respondents were found receiving some sort of income from the wetland area. The majority of respondents felt that the ecosystem is being changed mostly on provisional services. So far with little support from government, the local people have practiced some adaptive responses like biogas plant, afforestation, electric fencing, contract fisheries, ecotourism and other climate-smart measures. It suggest that raising awareness and sharing information among the locals should be done more frequently and effectively to continuously cope with ecosystem change. DOI: http://dx.doi.org/10.3126/ijasbt.v2i4.11552 Int J Appl Sci Biotechnol, Vol. 2(4): 563-569
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Khanal S, Acharya J. Dental caries status and oral health practice among 12-15 year old children in Jorpati, Kathmandu. Nepal Med Coll J 2014; 16:84-87. [PMID: 25799820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Oral health is an essential component of health throughout life. There has been a decline in dental caries and periodontal disease in developed countries which can be attributed to the implementation of preventive programmes but in developing countries dental diseases are still on the rise. Therefore this cross sectional study was carried out to assess the prevalence of dental caries and oral hygiene practices among 12 to 15 years old children. Self administered close ended questionnaires were used to assess the oral hygiene practice. The overall dental caries prevalence was 58.3% and the mean DMFT score was 1.2 (± 1.79) and the deft score was 0.6 (± 1.24). Majority of the children (84.1%) presented with the practice of brushing their teeth once everyday using tooth brush and toothpaste. Regular dental check up was very poor (5.6%) but 77.4% reported that they visited a dentist in case of pain or presence of stains in the teeth. Females (63.4%) and children studying in higher secondary class (74.2%) showed a "good" level of oral hygiene practice than males and children in secondary class respectively. Children having "good" practice presented with "low" dental caries severity. The utilization of dental services was poor in the children, therefore highlighting the necessity to implement preventive programmes is important which would help in reducing the incidence of the dental caries as well as aiding in prompt treatment of dental caries at its initial stages.
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Aryal RR, Shrestha HL, Khanal S. Using Landsat data for assessing forest cover change and fragmentation in Laljhadi corridor of Kanchanpur district, Nepal. ACTA ACUST UNITED AC 2013. [DOI: 10.3126/banko.v21i2.9142] [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]
Abstract
The study, carried out at Laljhadi corridor in Kanchanpur district of Nepal, aimed at assessing forest cover change and fragmentation using multi-temporal Landsat data. Post classifi cation change detection was applied on temporal forest cover class datasets obtained by supervised classifi cation technique with maximum likelihood algorithm. The overall change analysis indicated a decreasing trend in forest cover. Statistics on selected landscape metrics were generated to quantify the change in spatial structure resulting from fragmentation. The analysis of the landscape metrics depicted increase in fragmentation over the analysis time period along with progression of deforestation.DOI: http://dx.doi.org/10.3126/banko.v21i2.9142Banko Janakari Vol. 21, No. 2, 2011 Page: 40-44 Uploaded date: November 11, 2013
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Thapa M, Shrestha GB, Sharma AK, Karki S, Khanal S. Recurrence of uveal malignant melanoma: a case report. Nepal J Ophthalmol 2013; 5:275-8. [PMID: 24172570 DOI: 10.3126/nepjoph.v5i2.8744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Malignant melanoma of uveal tract is a rare ocular malignancy. It is one of the significant causes of ocular morbidity and mortality which is less commonly seen in children. CASE We report an unusual case of orbital recurrence of malignant melanoma in a 14-year old boy who had previously undergone enucleation of the left painful blind eye 8 months ago. He was diagnosed to have uveal malignant melanoma elsewhere which was confirmed by histopathology. Orbital recurrence was managed with modified exenteration with adjuvant chemotherapy and radiotherapy. CONCLUSION In all treated cases of uveal melanoma, close follow up examination and monitoring is necessary for early diagnosis of the recurrence and to plan for further management.
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Abstract
Introduction: The Bhaktapur Glaucoma Study is a population-based, cross-sectional and longitudinal study undertaken in one of the districts of Nepal. Objectives: To determine the prevalence of glaucoma in Bhaktapur district, Nepal. Materials and methods: Thirty clusters were randomly selected and a door-to-door census was conducted to identify citizens 40 years of age and older. Four thousand eight hundred individuals fulfilling the eligibility criteria were referred to the base hospital in Kathmandu for a detailed clinical examination. The diagnosis of glaucoma was based upon criteria described by the International Society for Geographic and Epidemiological Ophthalmology (ISGEO). Results: Complete data was available on 3991 subjects (response rate 83.15 %). The mean IOP was 13.3 mm Hg (97.5th and 99.5th percentiles, 18 and 20 mm Hg, respectively) and mean VCDR 0.26 (97.5th and 99.5th percentiles, 0.6 and 0.8 mm Hg, respectively). Seventy-five subjects had glaucoma, an age-sex-standardized prevalence of 1.80 (95 % confidence interval (CI), 1.68 - 1.92). The age-and sex-standardized prevalence of POAG was 1.24 % (CI, 1.14 - 1.34), PACG 0.39 % (CI, 0.34 - 0.45) and secondary glaucoma 0.15 % (CI, 0.07-0.36). The prevalence of glaucoma increased with increase in age and there was no significant difference in gender. Nine eyes were blind and two subjects bilaterally blind from glaucoma. Conclusion: The overall prevalence of glaucoma was 1.9 %. POAG was the most common form of glaucoma. Visual morbidity from PACG, however, was higher. A large majority of the subjects with POAG had not been previously diagnosed and had intraocular pressure within the normal range. Nepal J Ophthalmol 2013; 5(9):81-93 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7832
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Kc A, Thapa K, Pradhan YV, Kc NP, Upreti SR, Adhikari RK, Khadka N, Acharya B, Dhakwa JR, Aryal DR, Aryal S, Starbuck E, Paudel D, Khanal S, Devkota MD. Developing community-based intervention strategies and package to save newborns in Nepal. J Nepal Health Res Counc 2011; 9:107-118. [PMID: 22929839] [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
In Nepal, the proportion of under 5 deaths that are neonatal (0-28 days) has been increasing in the last decade, due to faster declines in infant and child mortality than in neonatal mortality. This trend is likely due to a focus on maternal and child survival programs that did not adequately address newborn health needs. Policy and actions to save newborn lives resulted from increased attention to newborn deaths in 2001, culminating in the endorsement of the National Neonatal Health Strategy in 2004, a milestone that established newborn health and survival as a national priority. Operationalization of the National Neonatal Health Strategy took place in 2007 with the development of the Community-Based Newborn Care Package (CB-NCP). This paper describes how national stakeholders used global, regional and in-country research and policies to develop the CB-NCP, thus outlining key ingredients to make newborn health programming a reality in Nepal. A technical working group was constituted to review existing evidence on interventions to improve newborn survival, develop a tool to prioritize neonatal interventions, and conduct program learning visits to identify key components appropriate to the Nepal context that should be included in the Community Based Integrated Newborn Care Package. The group identified interventions based on the evidence of impact on newborn survival, potential mechanisms within the existing health system to deliver the interventions, and linkages with existing programs and different tiers of the health system. Not only was Nepal one of the first countries in south-east Asia where government adopted a national strategy to reduce neonatal deaths, but it was also one of the first to endorse a package of neonatal interventions for pilot testing and scaling up through existing community-based health systems that provide basic health services throughout the country. CB-NCP was designed to be gradually scaled up throughout the country by integration with Safe Motherhood and Child survival programs that are currently operating at scale. Under Ministry of health and Population leadership, a network of academia, professional bodies and partners developed a common vision for improving newborn health and survival, and launched district-level pilot programs to demonstrate and learn how newborn health interventions could be effectively and efficiently delivered and scaled up in Nepal.
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Affiliation(s)
- A Kc
- Save the Children Nepal, Kathmandu, Nepal.
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Pradhan YV, Upreti SR, Kc NP, Thapa K, Shrestha PR, Shedain PR, Dhakwa JR, Aryal DR, Aryal S, Paudel DC, Paudel D, Khanal S, Bhandari A, Kc A. Fitting Community Based Newborn Care Package into the health systems of Nepal. J Nepal Health Res Counc 2011; 9:119-128. [PMID: 22929840] [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
Community-based strategies for delivering effective newborn interventions are an essential step to avert newborn death, in settings where the health facilities are unable to effectively deliver the interventions and reach their population. Effective implementation of community-based interventions as a large scale program and within the existing health system depends on the appropriate design and planning, monitoring and support systems. This article provides an overview of implementation design of Community-Based Newborn Care Package (CB-NCP) program, its setup within the health system, and early results of the implementation from one of the pilot districts. The evaluation of CB-NCP in one of the pilot districts shows significant improvement in antenatal, intrapartum and post natal care. The implementation design of the CB-NCP has six different health system management functions: i) district planning and orientation, ii) training/human resource development, iii) monitoring and evaluation, iv) logistics and supply chain management, v) communication strategy, and vi) pay for performance. The CB-NCP program embraced the existing system of monitoring with some additional components for the pilot phase to test implementation feasibility, and aligns with existing safe motherhood and child health programs. Though CB-NCP interventions are proven independently in different local and global contexts, they are piloted in 10 districts as a "package" within the national health system settings of Nepal.
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Affiliation(s)
- Y V Pradhan
- Department of Health Service, Ministry of Health and Population, Government of Nepal
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Khanal S, GC VS, Dawson P, Houston R. Verbal autopsy to ascertain causes of neonatal deaths in a community setting: A study from Morang, Nepal. JNMA J Nepal Med Assoc 2011. [DOI: 10.31729/jnma.34] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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
Introduction: Clinical registration of the cause of death is available for less than one-third of the global newborn deaths, but the need for good quality data on causes of death for public health planning has renewed the interest in the Verbal Autopsy (VA). We aimed to determine the cause of neonatal deaths by VA in Morang district of Nepal.
Methods: Caretakers of the deceased were interviewed using a semi-structured VA questionnaire by female community health volunteers. The cause of death was assigned by two senior pediatricians independently and disagreements in ascertaining the proximate cause of death were resolved by consensus.
Results: The proximate causes of deaths were infections (41 %), birth asphyxia (37.2 %), prematurity (11.5 %), and low birth weight related causes (6.9 %). There was no signifi cant statistical difference in deaths due to infection seen in non-institutional deliveries (43.5 %) than institutional deliveries (34.6 %). More than half of the deaths (58.5 %) occurred within the fi rst three days of life where the predominant cause of death was birth asphyxia (60.7 %).
Conclusions: Analysis of verbal autopsies demonstrates that the major causes of death still are infections and birth asphyxia. The timing of deaths suggests that neonatal interventions should be aimed at the fi rst week of life. There is no comparative advantage between institutional deliveries at below district level institutions and non-institutional deliveries to prevent neonatal infection. Thus, further study on the quality of care at institutes below the district level should be conducted. Disparities still occur in deaths, with most deaths in Morang occurring in non-institutional deliveries and in disadvantaged groups.
Keywords: neonatal deaths, Nepal, newborn, verbal autopsy.
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Abstract
The purpose of this study was to compare tear physiology characteristics of chronic GVHD (cGVHD)-associated dry eye to dry eye caused by Sjogren's syndrome (SS), a extreme form of aqueous-deficient dry eye, and meibomian gland dysfunction (MGD), the major cause of evaporative dry eye. Tear turnover rate, evaporation and osmolarity along with meibomian gland dropout and lipid layer interferometric patterns were assessed in the right eyes of 12 patients with dry eye associated with cGVHD, 12 age-matched patients with SS and 12 age-sex matched subjects with MGD. In cGVHD, the decrease in tear turnover rate was similar (P=0.33), but the number of non-functioning meibomian glands was significantly higher (P<0.01) than in SS. Tear evaporation rate in cGVHD dry eye was found to be similar to that in MGD (P=0.36) and significantly higher than in SS (P<0.01). The lipid layer was most unstable in cGVHD compared with other groups. There was no variation in tear volume across all groups. Although statistical significance was not detected, the mean tear osmolarity (333.51±14.67mOsm/L) was highest in cGVHD. Major aspects of tear physiology were severely impaired in cGVHD-associated dry eye.
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Affiliation(s)
- S Khanal
- School of Natural Sciences, University of Western Sydney, Sydney, Australia.
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Abstract
We present a multichannel coincidence-counting module for use in quantum optics experiments. The circuit takes up to four transistor-transistor logic pulse inputs and counts either twofold, threefold, or fourfold coincidences, within a user-selected coincidence-time window as short as 12 ns. The module can accurately count eight sets of multichannel coincidences, for input rates of up to 84 MHz. Due to their low cost and small size, multiple modules can easily be combined to count arbitrary M-order coincidences among N inputs.
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Affiliation(s)
- D Branning
- Department of Physics, Trinity College, Hartford, Connecticut 06106, USA
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Khanal S, Gc VS, Dawson P, Houston R. Verbal autopsy to ascertain causes of neonatal deaths in a community setting: a study from Morang, Nepal. JNMA J Nepal Med Assoc 2011; 51:21-27. [PMID: 22335091] [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: 05/31/2023] Open
Abstract
INTRODUCTION Clinical registration of the cause of death is available for less than one-third of the global newborn deaths, but the need for good quality data on causes of death for public health planning has renewed the interest in the Verbal Autopsy (VA). We aimed to determine the cause of neonatal deaths by VA in Morang district of Nepal. METHODS Caretakers of the deceased were interviewed using a semi-structured VA questionnaire by female community health volunteers. The cause of death was assigned by two senior pediatricians independently and disagreements in ascertaining the proximate cause of death were resolved by consensus. RESULTS The proximate causes of deaths were infections (41%), birth asphyxia (37.2%), prematurity (11.5%), and low birth weight related causes (6.9%). There was no significant statistical difference in deaths due to infection seen in non-institutional deliveries (43.5%) than institutional deliveries (34.6%). More than half of the deaths (58.5%) occurred within the first three days of life where the predominant cause of death was birth asphyxia (60.7%). CONCLUSIONS Analysis of verbal autopsies demonstrates that the major causes of death still are infections and birth asphyxia. The timing of deaths suggests that neonatal interventions should be aimed at the first week of life. There is no comparative advantage between institutional deliveries at below district level institutions and non-institutional deliveries to prevent neonatal infection. Thus, further study on the quality of care at institutes below the district level should be conducted. Disparities still occur in deaths, with most deaths in Morang occurring in non-institutional deliveries and in disadvantaged groups.
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Affiliation(s)
- S Khanal
- Morang Innovative Neonatal Intervention/John Snow Inc. Research and Training Institute, Kathmandu, Nepal.
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Abstract
DOI: 10.3126/kumj.v7i4.2776 Kathmandu University Medical Journal (2009) Vol.7, No.4 Issue 28, 470
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Affiliation(s)
- S Khanal
- Department of Pharmacology, Nepalgunj Medical College, Chisapani, Nepal.
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Khanal S, Zhang W, Shrestha NR, Dahal GR. A comparative study of outcome of preterm neonate with and without history of preterm premature rupture of membrane. Nepal Med Coll J 2009; 11:99-103. [PMID: 19968148] [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: 05/28/2023]
Abstract
The aim of the study was to find out the neonatal outcome of infants born with history of preterm premature rupture of membrane (PPROM) and to compare with infants born without history of PPROM. It was a retrospective study that included 187 preterm newborn with history of PPROM admitted in neonatal intensive care unit of the third affiliated hospital of Zhengzhou University from January 2008 to December 2008. Another 150 preterm newborns from same department during same period were taken as control. Patient demographics, patient's problem, investigation, management and outcome were recorded from medical record department and compared. Chi square and t test were used for statistical analysis. There was no statistical difference of gestational age, mode of delivery, birth weight and gender between case and control group. Respiratory system related problems like birth asphyxia, respiratory distress syndrome, apnea and pneumonia were common in both group but not statistical significant (p>0.05). However, need of oxygen supply and mechanical ventilation was significantly more (p<0.05) in case group. Neonatal death was more in case group (5.3%) than in control group (0.7%) and was statistically significant (p<0.001). The morbidity of preterm neonate does not entirely depend on history of PPROM than prematurity itself. However severity of disease and death is more with history of PPROM.
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Affiliation(s)
- S Khanal
- Department of Epidemiology, College of Public Health, Zhengzhou University, Henan, China.
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Abstract
Retinal vasculitis is an idiopathic inflammatory venous occlusion primarily affecting the peripheral retina of otherwise healthy young adults. Eales' disease is recognized as primary vasculitis of unknown etiology occurring in young adults. This article aims at the overall review of the etiopathogenesis, clinical presentations, pathology, management and prognosis of retinal vasculitis.
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Affiliation(s)
- J K Shrestha
- Department of Ophthalmology, Institute of Medicine, BPKLCOS, Kathmandu, Nepal
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Adhikari P, Pramanik T, Pokharel R, Khanal S. Relationship between blood group and epistaxis among Nepalese. Nepal Med Coll J 2008; 10:264-265. [PMID: 19558068] [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: 05/28/2023]
Abstract
The relationship between blood group and epistaxis among the patients coming to Tribhuvan University Teaching Hospital, Kathmandu with idiopathic epistaxis was studied. A total of 235 patients coming to the Emergency Department or Department of Otorhinolaryngology with active nose bleeding in were included. ABO blood group was performed. Nearly half (45.5%) of the patients belonged to O-group followed by A-group others. O-group people were also had longer bleeding time compared to other blood groups.
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Affiliation(s)
- P Adhikari
- Department of ENT, TU Teaching Hospital, Kathmandu, Nepal.
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Choi DS, Park J, Kim S, Gracias DH, Cho MK, Kim YK, Fung A, Lee SE, Chen Y, Khanal S, Baral S, Kim JH. Hyperthermia with magnetic nanowires for inactivating living cells. J Nanosci Nanotechnol 2008; 8:2323-2327. [PMID: 18572644 DOI: 10.1166/jnn.2008.273] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We describe a method to induce hyperthermia in cells, in-vitro, by remotely heating Ni nanowires (NWs) with radio frequency (RF) electromagnetic fields. Ni NWs were internalized by human embryonic kidney cells (HEK-293). Only cells proximal to NWs or with internalized NWs changed shape on exposure to RF fields indicative of cell death. The cell death occurs as a result of hyperthermia, since the RF field remotely heats the NWs as a result of magnetic hysteresis. This is the first demonstration of hyperthermia induced by NWs; since the NWs have anisotropic and strong magnetic moments, our experiments suggest the possibility of performing hyperthermia at lower field strengths in order to minimize damage to untargeted cells in applications such as the treatment of cancer.
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Affiliation(s)
- D S Choi
- Department of Materials Science and Engineering, University of Idaho, Moscow, ID 83844, USA
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Khanal S, Sainju RK, Adhikari P, Thapa R. Eliciting knee jerk--a new method of reinforcement. Nepal Med Coll J 2007; 9:278-280. [PMID: 18298021] [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: 05/26/2023]
Abstract
This study was designed to detect the sensitivity of different methods of eliciting knee jerks and to compare the conventional methods with the newly purposed maneuver. Knee jerk (a deep tendon reflex) was elicited in 123 apparently normal population (77 males and 46 females) with three different methods (1) without applying reinforcement, (2) applying Jendrassik maneuver (strong voluntary contraction of upper limbs) and (3) using the new method of reinforcement--that is by dorsiflexion of ankle joint of the same foot voluntarily as strong as possible on which the jerk would be elicitated. The sensitivity of the method without reinforcement was found to be is 87.8%; that with Jendrassik maneuver was 93.5%, whereas the sensitivity of newly proposed maneuver was 99.2%. Results of the present study have served to demonstrate that elicitation of knee jerk with newly proposed reinforcement maneuver is the best among all three methods.
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Affiliation(s)
- S Khanal
- Dept. of Ophthalmology, B P Koirala Lions Centre for Ophthalmic Studies, TU Teaching Hospital, Nepal.
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Abstract
The term ‘five-star doctor’ has been promoted to denote the model physician for today's society, who should be able to respond to the needs of both individual patients and their community. The B.P. Koirala Institute of Health Sciences (BPKIHS) has adopted integrated, partially problem-based, organ system and community-oriented curriculum for medical graduates. The various field programmes related to community diagnosis, health care delivery system, family health exercise, epidemiology for health management, managerial skills for health services, and learning in fields are incorporated in the MBBS curriculum. Five-month postings during internships in zonal and district hospitals and one month in district public health offices and primary health centres are unique programmes to make it more socially accountable. Such exposure for MBBS students makes them to attain five-star status, that is, caregiver, decision maker, communicator, community leader and manager. Thus, BPKIHS is working as a pioneer in an endeavour to create five-star doctors for the 21st century.
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Affiliation(s)
| | | | | | | | - L.B. Thapa
- Nilambar Jha, K.C. Premarajan, S. Nagesh, S. Kharal and L.B. Thapa are at the Department of Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan 56701, Nepal.( Jha)
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Czerska B, Oren R, Bohm M, Sadowsky J, Van Bakel A, Abraham W, Wasler A, Cabuay B, Khanal S, Bartus K, Zile M, Konstam M. Clinical results with the Orqis® medical cancion® CRS therapy. J Heart Lung Transplant 2005. [DOI: 10.1016/j.healun.2004.11.101] [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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