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  • 1
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    Clinical profile of 103 patients with abdominal tuberculosis in Nepal
    Nepal Journals Online (JOL) ; 2017
    In:  Journal of Advances in Internal Medicine Vol. 4, No. 2 ( 2017-03-05), p. 51-56
    Details
    In: Journal of Advances in Internal Medicine, Nepal Journals Online (JOL), Vol. 4, No. 2 ( 2017-03-05), p. 51-56
    Abstract: Background and aims: The nonspecific clinical features of abdominal tuberculosis (TB) have made its diagnosis difficult, which can lead to the poor outcome in patients who are not able to receive early treatment. Hence, the aim of our study was to determine the clinical profile of abdominal TB in the patients of Nepal.Methods: This is a prospective observational study in which 103 patients with abdominal TB were analyzed for clinical profiles from May 2010 to April 2015. All diagnosed patients received anti-tubercular treatment (ATT) and were followed up at 1 and 6 months of ATT.Results: Among 103 patients of abdominal TB [males 48 (46.6%), females 55 (53.4%); mean age 33.1 years (±12.9)], 47.6% had histopathological examination (HPE) confirmation, 27.2% had high ascitic adenosine deaminase (ADA) value and another 25.2% had suggestive imaging findings. The common symptoms were abdominal pain (84.5%), weight loss (75.7%), anorexia (63.1%), chronic diarrhea (56.3%) and fever (52.4%). The mean weight was 〈 50 Kg, hemoglobin 〈 11 gm/dl and Erythrocyte Sedimentation Rate 〉 40 mm/first hour. The sites involved were ileo-cecal (35.9%), peritoneal (27.2%), ileal (15.5%), colonic (15.5%), lymph nodal (3.9%) and gastroduodenal (1.9%). The sensitivity of HPE for diagnosis of abdominal TB was 47.6% (95% confidence interval 37.6% to 57.6%). All patients of abdominal TB had a good clinical response after ATT.Conclusion: The common symptoms of abdominal TB were abdominal pain, weight loss, anorexia, chronic diarrhea and fever. Since the diagnosis of abdominal TB by HPE may not always be positive, other parameters such as ascitic ADA value, imaging findings and associated supportive clinical features have to be considered, and a therapeutic trial of ATT may be indicated so that all patients of abdominal TB can be treated early in the course of disease.  
    Type of Medium: Online Resource
    ISSN: 2091-1440 , 2091-1432
    URL: Article
    DOI: 10.3126/jaim.v4i2.16896
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2017
    detail.hit.zdb_id: 2895109-8
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  • 2
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    Informing Design of a Smart Phone Mobile Application to Improve Cancer Pain Management: A Survey of Cancer Care Institutions in Nepal (RP510)
    Elsevier BV ; 2020
    In:  Journal of Pain and Symptom Management Vol. 60, No. 1 ( 2020-07), p. 234-235
    Details
    In: Journal of Pain and Symptom Management, Elsevier BV, Vol. 60, No. 1 ( 2020-07), p. 234-235
    Type of Medium: Online Resource
    ISSN: 0885-3924
    URL: Article
    DOI: 10.1016/j.jpainsymman.2020.04.102
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 639142-4
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  • 3
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    Association between Body Mass Index and Gastroesophageal Reflux Symptoms in Nepalese Adult Population. A Single Centered Hospital Based Study
    Nepal Journals Online (JOL) ; 2015
    In:  Journal of College of Medical Sciences-Nepal Vol. 11, No. 2 ( 2015-11-12), p. 23-26
    Details
    In: Journal of College of Medical Sciences-Nepal, Nepal Journals Online (JOL), Vol. 11, No. 2 ( 2015-11-12), p. 23-26
    Abstract: Background & Objectives: Gastroesophageal reflux disease (GERD) is a common disorder, and studies have reported inconsistent association between high BMI and its elevated risk of GERD symptoms. The aim of the present study was to estimate the strength of the association between body mass index and reflux symptoms in Nepalese adults.Materials & Methods: This was a cross-sectional study conducted at National Academy of Medical Science, Bir Hospital, Kathmandu, Nepal. All patients of age 18 years or above who underwent endoscopy and diagnosed to have esophagitis were recruited for the analysis. Symptoms were identified by using a self-administered validated questionnaire regarding GERD that identify the onset for GERD symptoms and grade the frequency and severity of symptoms experienced over a period of one year. BMI data, the cut off points were based on the WHO classification of overweight and obesity. A BMI value ?25–30 represents overweight and BMI 〉 30 indicates obesity. A BMI value 〈 25 is considered as normal. Severity of erosive esophagitis was graded according to the Los Angeles classification.Results: The Among 127 enrolled esophagitis subjects, about 43% were under 20 BMI, 43% overweight and about 24% were obese. Obesity measured by BMI revealed no significant association among age, sex, smoker, alcoholics, hernia and severity grade of esophagitis (p 〉 0.05). Ages with various categories (18-40, 〉 40-60, 〉 60) were significantly associated with the GERD symptoms (P=0.021). We categorize BMI in three categories. A BMI value 〈 25 (normal), ?25–30 (overweight), and BMI 〉 30 (obesity). Categorical analysis of BMI with GERD symptoms confirmed the absence of any tendency towards an association (p 〉 0.05).Conclusion: The tendency of reflux symptoms towards BMI is null, and weight reduction may not be the adequate justifiable for the symptoms therapy.JCMS Nepal. 2015; 11(2):23-26
    Type of Medium: Online Resource
    ISSN: 2091-0673 , 2091-0657
    URL: Article
    DOI: 10.3126/jcmsn.v11i2.13672
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2015
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  • 4
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    Outcome of Pneumatic Balloon Dilatation in Achalasia Cardia
    Nepal Journals Online (JOL) ; 2021
    In:  Journal of Advances in Internal Medicine Vol. 10, No. 1 ( 2021-05-14), p. 8-13
    Details
    In: Journal of Advances in Internal Medicine, Nepal Journals Online (JOL), Vol. 10, No. 1 ( 2021-05-14), p. 8-13
    Abstract: Background: Achalasia Cardia is a rare esophageal motility disorder. Among various treatment options, Pneumatic Dilatation (PD) is the most widely used and cost effective modality till date. This is the first observational study aiming to evaluate the short term response and complications of PD for Achalasia Cardia in Nepal. Methods: This prospective observational study was conducted between 28th Jan 2020 to 27th Jan 2021. It included 39 patients with Achalasia Cardia diagnosed by clinical presentation, esophagoscopy, barium esophagogram and high resolution manometry. Two patients of Type III achalasia were excluded from study. Thirty seven patients underwent pneumatic dilatation with 30 mm Rigiflex balloon (Boston Scientific, USA) for a duration of 1 minute. Response was assessed by Eckardts score at 3 and 6 months. Result: Among 39 cases (mean age= 39.03±15.017 years, 59% men), commonest was Type II Achalasia (71.8%) followed by Type I (23.1%) and Type III (5.1%). Dysphagia was present in all patients (100%), followed by weight loss (84.6%), regurgitation (79.5%) and chest pain (35.9%). Mean basal Eckardts score and Lower Esophageal Sphincter pressure of the study population was 7.81±1.24 and 24.40±6.83 respectively. Response to pneumatic dilatation was 89.2%. Eckardts score changed significantly from7.81±1.24 to 1.03±1.82 at 6 months (p 〈 0.001). None of the patients had major complications. Younger age (23±6.377 years) had poor response to treatment, while predilatation Lower Esophageal Sphincter pressure, gender and type of achalasia did not affect the treatment outcome. Conclusion: PD is safe and effective treatment modality for Achalasia. Younger patients have poor response to treatment with Pneumatic Dilatation.  
    Type of Medium: Online Resource
    ISSN: 2091-1440 , 2091-1432
    URL: Article
    DOI: 10.3126/jaim.v10i1.37083
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2021
    detail.hit.zdb_id: 2895109-8
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  • 5
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    Predictors of hepatorenal syndrome in patient with decompensated liver cirrhosis
    General Practice and Emergency Medicine Association of Nepal (GPEMAN) ; 2021
    In:  Journal of General Practice and Emergency Medicine of Nepal Vol. 8, No. 11 ( 2021-08-16), p. 27-31
    Details
    In: Journal of General Practice and Emergency Medicine of Nepal, General Practice and Emergency Medicine Association of Nepal (GPEMAN), Vol. 8, No. 11 ( 2021-08-16), p. 27-31
    Abstract: Introduction: Hepatorenal syndrome (HRS) is one of the severe complications of decompensated liver cirrhosis which has poor outcome. Predictive models are important aspect in assessment of high risk patient. Method: This prospective analytical study was conducted in Gastroenterology unit of Bir hospital from December 2018 to April 2020. Seventy patient of liver cirrhosis with ascites (CTP score 7 or more) were followed for a period of three months. The outcome of study was hepatorenal syndrome. Predictors were assessed from baseline variables. Result: Total 65 patients completed the study. The mean age of study population was 47.38 ±11.38 years and 52(80%) were male. The most common aetiology was alcohol 55(84 %). Eight (12.5%) developed HRS. Hepatorenal syndrome was precipitated by spontaneous bacterial peritonitis 5(62.5%), upper gastrointestinal bleeding 2(25%) and unknown 1(12.5%). In Bivariate analysis total leucocyte count, Serum sodium, Model for End-stage Liver Disease – Sodium (MELD- Na), serum bilirubin and use of rifaximin were predictors of HRS. Only use of rifaximin was the predictor in multivariate analysis. Conclusion: Serum sodium, bilirubin and MELD Na are important predictors of the hepatorenal syndrome. Rifaximin use may be preventive for HRS. Keywords:  Decompensation, hepatorenal syndrome, liver cirrhosis, predictors
    Type of Medium: Online Resource
    ISSN: 2362-1168 , 2091-279X
    URL: Article
    DOI: 10.59284/jgpeman64
    Language: Unknown
    Publisher: General Practice and Emergency Medicine Association of Nepal (GPEMAN)
    Publication Date: 2021
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  • 6
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    Prevalence of Organic Colonic Lesions by Colonoscopy in Patients Fulfilling ROME IV Criteria of Irritable Bowel Syndrome
    Journal of Nepal Medical Association (JNMA) ; 2018
    In:  Journal of Nepal Medical Association Vol. 56, No. 209 ( 2018-02-28), p. 487-492
    Details
    In: Journal of Nepal Medical Association, Journal of Nepal Medical Association (JNMA), Vol. 56, No. 209 ( 2018-02-28), p. 487-492
    Abstract: Introduction: Irritable bowel syndrome occurs as recurrent abdominal pain that is related to defecation and associated with change in frequency and/or form of stool. Few Patients with IBS may have organic lesions detectable at colonoscopy. Methods: A cross sectional study was carried out in 140 consecutive patients of IBS fulfilling the ROME IV criteria. The study was conducted in Gastroenterology unit, Department of Medicine, Bir hospital, Kathmandu from July 2016 to September 2017. All patients underwent full colonoscopy along with biopsy from sigmoid colon and any visibly abnormal areas. Results: The average age of patients was 37.5 years with 76 (52.8%) males. Forty-two (30%) had IBS-D, 36 (26%) had IBS-C, 31 (22%) had IBS-M and 31 (22%) had IBS-U. Dyspepsia was seen in 16 (11.4%) and fear of TB/Malignancy/IBD was seen in 27 (19.2%). Organic lesions were seen in 39 (27.85%) patients. Nonspecific colitis was seen in 10 (7.1%) followed by ileal erosions in 7 (5%), polyps in 8 (5.7%), hemorrhoids in 6 (4.2%) and diverticula in 3 (2.1%). Only one (0.71%) patient had microscopic colitis and one (0.71%) had malignant lesion seen at histopathological examination. Females with IBS-D had more organic findings than males (P=0.03, RR=4.13, 95% CI=1.21-15.71). Conclusions: The prevalence of organic lesions in patients with IBS fulfilling ROME IV criteria is 27%. Dyspepsia is the most common comorbidity and fear of TB/malignancy/IBD is the most common reason for seeking health care. Females with IBS-D have a higher risk of detecting organic lesions by colonoscopy and histopathology examination.
    Type of Medium: Online Resource
    ISSN: 1815-672X , 0028-2715
    URL: Article
    DOI: 10.31729/jnma.3367
    Language: Unknown
    Publisher: Journal of Nepal Medical Association (JNMA)
    Publication Date: 2018
    detail.hit.zdb_id: 2209910-4
    detail.hit.zdb_id: 138059-X
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  • 7
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    Relationship between Nonalcoholic Fatty Liver Disease and Vitamin D in Nepal
    Nepal Journals Online (JOL) ; 2021
    In:  Nepal Mediciti Medical Journal Vol. 2, No. 1 ( 2021-05-21), p. 22-25
    Details
    In: Nepal Mediciti Medical Journal, Nepal Journals Online (JOL), Vol. 2, No. 1 ( 2021-05-21), p. 22-25
    Abstract: Background and Aims: Vitamin D deficiency has been frequently reported in many causes of chronic liver disease and has been associated with the development and evolution of non-alcoholic fatty liver disease (NAFLD).The study was done to explore associations between serum vitamin D concentrations among obesity, diabetes mellitus, hypothyroidism, and metabolic syndrome and its effects on liver fibrosis by ultra-sonogram and 2 d shear wave elastography in patients with non-alcoholic fatty liver disease (NAFLD). Methods: A hospital based prospective observational study was conducted from May 2019 for twelve months period in Gastroenterology Unit, NAMS, Nepal. Seventy patients with known fatty liver identified by Ultrasonogram criteria were enrolled. All patients were evaluated by different fibrosis scores (NAFLD Fibrosis, FIB4, APRI, AST/ALT ratio) and 2d shear wave score. Patients were evaluated for Vitamin D level and its effects on obesity, diabetes mellitus, thyroid related disease, dyslipidemias and NAFLD. Results: Among 70 patients, 39 (55.7%) were male and 31 (44.3%) were female with mean age of 44.3 years. Most of the patients were overweight with mean BMI of 28.2 kg/m2; among them 51 (72.9%) were more than 25.kg/m2. About 41.4% had diabetes mellitus, 77.1% had hypertension, 30% had hypothyroidism and 25.9% had metabolic syndrome. Majority of patients on ultrasound grading were mild with 64.28%; 25.72% were moderate and only 10 % were in severe groups. A study of 2 d shear wave elastography showed mean fibrosis of 7.07 kpa for mild grade, 8.22 kpa for moderate grade and 18.16 kpa for severe grade. The mean value of vitamin D was 22.61iu/ml for mild grade, 24.89 iu/ml for moderate grade and 17.4 iu/ml for severe grade. Conclusion: The results of this study showed high prevalence of serum 25(OH) vitamin D inadequacy in individuals with obesity, diabetes mellitus, hypothyroidism and metabolic syndrome which worsens as the stage of liver disease progresses.  
    Type of Medium: Online Resource
    ISSN: 2773-7810
    URL: Article
    DOI: 10.3126/nmmj.v2i1.37217
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2021
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  • 8
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    Etiology of isolated terminal ileal ulcers in symptomatic patients
    Nepal Journals Online (JOL) ; 2019
    In:  Nepal Journal of Medical Sciences Vol. 4, No. 2 ( 2019-09-05), p. 2-9
    Details
    In: Nepal Journal of Medical Sciences, Nepal Journals Online (JOL), Vol. 4, No. 2 ( 2019-09-05), p. 2-9
    Abstract: Introduction: Isolated terminal ileal ulcers (ITIUs) are being frequently encountered by the clinicians with the increasing numbers of ileal intubation during colonoscopies. This study was aimed at finding the etiologies of these ulcers in symptomatic patients and their association with various clinical features. Methods: This was a hospital based prospective, observational, descriptive study performed on all consecutive patients who underwent ileocolonoscopy for various gastrointestinal symptoms between 1 July 2018 and 30 June 2019. Clinical, endoscopic and histopathological findings were analyzed to determine the etiology of ITIUs in symptomatic patients. Statistical analysis was done by SPSS 20. Results: Among 60 (7.67%) of 782 symptomatic patients who had ITIUs on ileocolonoscopy, specific etiologies were established in 28 (46.67%) of them. Intestinal TB was the most common specific diagnosis, which was seen in 18 (30%) patients. Chronic abdominal pain with or without chronic diarrhea was the most common indication for ileocolonoscopy. Conclusions: Specific etiologies like tuberculosis, Crohn’s disease, NSAID-induced ulcer and intestinal spirochetosis were seen in 28 (46.67%) of patients with isolated terminal ileal ulcers. The most common clinical features were chronic abdominal pain (65%) and abdominal pain with diarrhea (16.7%). No clinical presentation was significantly associated with any specific etiology, thus emphasizing the need for routine ileal intubation and tissue sampling for histopathological examination in all symptomatic patients undergoing colonoscopy.
    Type of Medium: Online Resource
    ISSN: 2091-1459 , 2091-1424
    URL: Article
    DOI: 10.3126/njms.v4i2.25471
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2019
    detail.hit.zdb_id: 2682352-4
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  • 9
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    Intravenous Ringers lactate versus normal saline for predominantly mild acute pancreatitis in a Nepalese Tertiary Hospital
    Public Library of Science (PLoS) ; 2022
    In:  PLOS ONE Vol. 17, No. 1 ( 2022-1-28), p. e0263221-
    Details
    In: PLOS ONE, Public Library of Science (PLoS), Vol. 17, No. 1 ( 2022-1-28), p. e0263221-
    Abstract: Acute pancreatitis (AP) is a common presentation in patients admitted with acute abdomen. Whether Ringers lactate (RL) or Normal Saline (NS) as a resuscitation fluid is better still remains unclear. The aim of this study is to compare the efficacy of RL and NS in terms of control of systemic inflammation by measuring indirect markers specifically Systemic Inflammation Response Syndrome (SIRS) scores and C- Reactive Protein (CRP) level. Methods This was an open label randomized trial conducted in a tertiary level hospital of Nepal. Ethical approval was obtained prior to the study. Patients with acute pancreatitis were randomized to either RL or NS group for the fluid resuscitation. The fluid was given as per the study protocol for three days for hydration. Baseline SIRS and CRP were recorded on admission and subsequently as defined. All the data were analyzed using SPSS ver 20.0 software. Results Total 51 patients were enrolled, 26 in RL and 25 in NS group. The commonest etiology of AP was alcohol (84.31%). SIRS was present in 46.2% and 64.0% of patients in RL and NS group respectively (p = 0.20) on admission. At least one SIRS criteria was still present in 44.0% of patients in the NS group compared to only 15.4% in the RL group after 24 hours (p = 0.025). The baseline CRP were comparable in both the groups. However after 72 hours, the increment of CRP was more in the NS group compared to the RL group; median value of 14.2 mg/dl (12.15, 16.45) and 22.2 mg/dl (18.20, 30.60) in RL and NS group respectively (p 〈 0.001). Conclusions Ringers lactate was associated with a reduction in systemic inflammation compared to normal saline in patients with acute pancreatitis. Incidence of SIRS at 72 hours and occurrence of local complications were however similar in both the groups.
    Type of Medium: Online Resource
    ISSN: 1932-6203
    URL: Article
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    DOI: 10.1371/journal.pone.0263221
    DOI: 10.1371/journal.pone.0263221.g001
    DOI: 10.1371/journal.pone.0263221.g002
    DOI: 10.1371/journal.pone.0263221.g003
    DOI: 10.1371/journal.pone.0263221.g004
    DOI: 10.1371/journal.pone.0263221.t001
    DOI: 10.1371/journal.pone.0263221.t002
    DOI: 10.1371/journal.pone.0263221.s001
    DOI: 10.1371/journal.pone.0263221.s002
    DOI: 10.1371/journal.pone.0263221.s003
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2022
    detail.hit.zdb_id: 2267670-3
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  • 10
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    Accuracy of bedside index for severity in acute pancreatitis ‘BISAP’ score in predicting outcome of acute pancreatitis
    Nepal Journals Online (JOL) ; 2020
    In:  Journal of Patan Academy of Health Sciences Vol. 7, No. 2 ( 2020-08-30), p. 70-76
    Details
    In: Journal of Patan Academy of Health Sciences, Nepal Journals Online (JOL), Vol. 7, No. 2 ( 2020-08-30), p. 70-76
    Abstract: Introduction: Early identification of severe acute pancreatitis is of paramount importance in the management and for improving outcomes. Bedside index for severity in acute pancreatitis (BISAP) is a simple and accurate score for stratification in acute pancreatitis. This study was conducted to find out the accuracy of BISAP score in predicting outcomes of acute pancreatitis in local population. Method: We prospectively analyzed 96 patients with acute pancreatitis from February 2019 to December 2019. Revised Atlanta classification was used to stratify mild, moderately severe and severe pancreatitis. BISAP score was calculated within 24 hours of admission. Accuracy was measured by area under receiver operating curve (AUC). Result: Out of 96 patients, alcohol related acute pancreatitis accounted for 74.7%. There were 63.2% of mild AP, 37.3% of moderately severe AP, 9.4% of severe AP and 15.8 % of pancreatic necrosis. The AUC for moderately severe AP, severe AP and pancreatic necrosis were 0.77 (CI 0.68-0.87), 0.95 (CI 0.90-0.99) and 0.87 (CI 0.79-0.96) respectively. The statistically significant BISAP cut off for diagnosing sever AP was≥3, and ≥2 for moderately sever AP and pancreatic necrosis. There was positive correlation between revised Atlanta severity of acute pancreatitis and length of hospital stay (r=0.41). Mortality was 3.3 % which was seen in BISAP score 3 or above. Conclusion: BISAP is a simple predictive model in identifying patient at a risk of developing different severity of pancreatitis and its outcome in our population.
    Type of Medium: Online Resource
    ISSN: 2091-2757 , 2091-2749
    URL: Article
    DOI: 10.3126/jpahs.v7i2.31117
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2020
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