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My experience as an exchange student at Linkping
S Shrestha
Kathmandu University Medical Journal , 2009, DOI: 10.3126/kumj.v7i2.2719
Abstract: DOI: 10.3126/kumj.v7i2.2719 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 185-187
Antibiotic susceptibility pattern of resistant Escherichia Coli from poultry waste
S Shrestha
BIBECHANA , 2013, DOI: 10.3126/bibechana.v9i0.7188
Abstract: The study was conducted in Kathmandu valley to investigate the relationship between the use of antibiotic and the development of the resistant form of Escherichia coli (E.coli), which were isolated from faecal waste of poultry farm. Out of 30 samples investigated, 20 samples were found to be E.coli positive. It was further investigated that the resistance pattern for the isolates of E.coli from poultry farm was tetracycline (100%), penicillin (100%), erythromycin (100%), amoxicillin (90%) and chloramphenicol (60%).
Gastric pH in patients premedicated with Esomeprazole or Famotidine undergoing routine surgery under general anaesthesia
BR Shrestha,S Shrestha,S Moktan,OS Shrestha
Journal of Kathmandu Medical College , 2012, DOI: 10.3126/jkmc.v1i2.8141
Abstract: Background: Stress and anxiety in patients planned for surgery under anaesthesia may change pH of gastric secretion. Premedication of surgical patients with pH altering drugs may modify the pH favourably. With the advent of newer agents, premedication has been carried out with different agents. Most of the time choice of drug is made by the perioperative physician on his/her own. Objective: To study gastric pH in patients premedicated either with Esomeprazole or Famotidine. Methods: This is a randomized controlled double blind prospective study conducted in 150 patients of American Society of Anesthesiologists grade I and II posted for elective surgery under general anaesthesia. The patients enrolled in the study were randomly assigned to three groups having 50 patients in each. Group I (control group) did not receive any pH altering drug, Group II (Famotidine Group) received 40 mg of Famotidine and Group III (Esomeprazole Group) received 40 mg of Esomeprazole the night before surgery. The observer was totally blind about the groups or drugs given to the patients. On the day of surgery, after induction of anaesthesia gastric juice was obtained via nasogastric tube and was checked for pH using pH indicator paper. Results: The pH raised by Esomeprazole was statistically significant (p<0.001) when compared to that of control group or Famotidine group. The mean pH value in control group was less than 2.5 whereas the pH value was higher than 2.5 in patients premedicated with either Famotidine or Esomeprazole. Conclusions: Gastric pH is raised by Famotidine or Esomeprazole premedication prior to routine surgery, Esomeprazole being superior to Famotidine, p<0.001. Patients (84%) not premedicated with either of the drugs had pH less than 2.5. DOI: http://dx.doi.org/10.3126/jkmc.v1i2.8141 Journal of Kathmandu Medical College, Vol. 1, No. 2, Oct.-Dec., 2012: 71-76
Trends in Perinatal Mortality in Tribhuvan University Teaching Hospital: 13 Years Review
M Shrestha,L Shrestha,S Basnet,PS Shrestha
Journal of Nepal Paediatric Society , 2012, DOI: 10.3126/jnps.v32i2.6898
Abstract: Introduction : The perinatal mortality rate (PMR) in Nepal is still very high. In major hospitals of Nepal, it is still ranging from 20-30 per thousand births. This study was carried out with the objective to review PMR and classifying it according to Wigglesworth classification to identify the causes of perinatal deaths at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal over the past 13 years and assess need for improvement in care. Material and Methods: It was a retrospective study carried out in TUTH. Data of all stillbirths from 28 weeks of pregnancy and neonatal deaths within first seven days of life in the hospital was taken from monthly perinatal audit and annual mortality review. All the perinatal deaths were then classified according to Wigglesworth classification. Results: Over a 13 year period, there were total 42,746 births and 921 perinatal deaths giving a perinatal mortality of 21.5 per thousand births. Over this period PMR has decreased from 31 to 18 per thousand births. Still births contributed almost 50% of the perinatal deaths; deaths related to prematurity show an increasing trend and have increased by almost 70% in past 5 years. Deaths due to perinatal asphyxia were static. Conclusion: PMR over the years has shown declining trend at TUTH. There is need to improve antenatal, obstetric as well as intrapartum services to further reduce the still birth as well as deaths due to prematurity and perinatal asphyxia. J. Nepal Paediatr. Soc. 32(2) 2012 150-153 doi: http://dx.doi.org/10.3126/jnps.v32i2.6898
Intraoral cysticercosis of the masseter muscle- A rare finding; correlation of histopathology with MRI and USG
M Shrestha,P Shakya,S Shrestha
Journal of Chitwan Medical College , 2014, DOI: 10.3126/jcmc.v4i2.10864
Abstract: Cysticercosis refers to infection of tissues after exposure of eggs of pork tapeworm Taenia solium. The authors report a rare case of a solitary intraoral cysticercosis in a thirty-four year female who presented with a mass in the left buccal mucosa of two months duration. The attending dentist could not have an impression of the lesion and sent for ultrasonography. The ultrasonographic report described a well defined hypoechoic lesion with central hypoechoic mural nodular area in left buc-cal region with muscle plane along with posterior enhancement suggestive of cystic nature. The impression was of benign cystic lesion in left buccal region (muscle plane). The MRI report revealed a 12 mm diameter T2 high signal intensity area noted in the anterior aspect of the left masseter muscle that showed iso to low signal in T1 weighted images. An ill margin-ated T2 high signal intensity was seen in left masseter muscle which also showed slight enlargement. The impression was of cystic lesion in left masticator space with edema in surrounding soft tissue plane. The lesion was enucleated and the histological findings revealed a cystic lesion containing parasitic larva. The cystic cavity was surrounded by a collagenous capsule of multinucleated foreign body giant cells with admixture of lymphocytes, plasma cells and histiocytes. The para-sitic larva showed thick integument with projections and a myxomatous inner stroma. Thus a definitive diagnosis of “oral cysticercosis” was given. Oral cysticercosis rarely involves the oral cavity. This case reports a rare involvement of cysticer-cosis involving the masseteric space. DOI: http://dx.doi.org/10.3126/jcmc.v4i2.10864 Journal of Chitwan Medical College 2014; 4(2): 44-47
Neurocysticercosis in Children at GMC, Charak Hospital, Pokhara
SP Shrestha,S Dhungana,AK Shrestha
Journal of Chitwan Medical College , 2013, DOI: 10.3126/jcmc.v3i2.8437
Abstract: Neurocysticercosis (NCC) is a common cause of seizure and major cause of neurological illness globally. It is one of the major causes of epilepsy in children. Fewer studies were done in the past regarding NCC in Nepal. However study on NCC in children in Gandaki Medical College (GMC), Charak Hospital is the first of its kind. 23 children with CT scanning of head that were consistent with NCC over a period of 18 months at GMC, Charak Hospital were included as study subjects. Although there are so many diagnostic tools including MRI, immunological and serological tests for the detection of NCC, CT scanning of the head was used for its diagnosis in this study. 17.3% of the study subjects were found to have suffered from NCC. Girls (60%) outnumbered boys (40%); it was more commonly seen in 10-15 years age group (47.83%). Three main clinical presentations were Seizure (100%), Headache (73.91%) and Vomiting (30.43%). Most of the cases had ring en-hancing lesion at colloidal stage. All patients were treated with albendazole, dexamethasone and antiepileptic drugs (AED) and advised strongly to continue for the period of at least 2 years without failure. NCC should be considered and CT/MRI head must be performed in all children above 5 years of age presented as seizure, headache or vomiting where Taenia solium (TS) infestations are found endemic. DOI: http://dx.doi.org/10.3126/jcmc.v3i2.8437 Journal of Chitwan Medical College Vol.3(2) 2013 20-23
Prevalence of Pulmonary Tuberculosis among the suspected patients visiting tertiary care hospital in Birgunj, Nepal
S Shrestha,B Shakya,P Shrestha
Janaki Medical College Journal of Medical Science , 2013, DOI: 10.3126/jmcjms.v1i1.7886
Abstract: Background and Objectives : Mycobacterial disease continues to cause high morbidity and mortality and is a major public health problem in Nepal. Bacteriological examination of sputum is the cornerstone in the diagnosis of pulmonary tuberculosis in the developing world. This prospective study was carried out with an objective to evaluate the prevalence of pulmonary tuberculosis among the patients visiting National Medical College Teaching Hospital by Ziehl- Neelsen (Zn) staining microscopy. Material and Methods: The study was cross-sectional study. Three consecutive early morning sputum collected from 626 patients were subjected to Zn staining and observed under oil immersion. Results: Among 626 patients, 85 (13.57%) were found to be Acid fast positive by Zn staining microscopy. Of total suspected patients,16.0% of male and 8.7% of female were infected, common among 41-60 years group (17.2%) followed by 21-40 years (12.6%) and multibacillary cases was 71.8%. Conclusion: The prevalence of pulmonary tuberculosis among National medical college teaching hospital was found to be higher than the Nation pulmonary tuberculosis detection rate, most commonly infecting males. DOI: http://dx.doi.org/10.3126/jmcjms.v1i1.7886 Janaki Medical College Journal of Medical Sciences (2013) Vol. 1 (1):48-52
An interesting case report of Morvan′s syndrome from the Indian subcontinent
Bajaj B,Shrestha S
Neurology India , 2007,
Abstract: The French physician Augustine Marie Morvan first used the term ′la chorιe fibrillare′ to describe a syndrome characterized by peripheral nerve hyperexcitability, dysautonomia, insomnia and fluctuating delirium. There are no published reports of the condition from the Indian subcontinent. We report the first such case from the region. Our patient, a 24-year-old male, presented with easy fatigability and stiffness in both the calves for 18 months; continuous twitching of muscles of all four limbs and jaw for two months; hyperhydrosis, palpitations, urinary symptoms, burning dysesthesia in hands, insomnia and abnormal sleep behavior for about a month. Patient had bilateral hyper-reflexia with extensor plantar on the right and equivocal response on the left. Electromyography revealed continuous muscle fiber activity. Thyroid function test, electroencephalography, computerized tomography scan (head) and routine cerebrospinal fluid analysis were normal. The patient showed marked clinical and electrophysiological improvement on prednisolone along with symptomatic therapy over the next two months.
Polycystic Ovarian Syndrome
S Mishra,A Shrestha
Journal of Universal College of Medical Sciences , 2013, DOI: 10.3126/jucms.v1i1.8423
Abstract: DOI: http://dx.doi.org/10.3126/jucms.v1i1.8423 Journal of Universal College of Medical Sciences Vol.1(1) 2013: 39-41
Intraperitoneal and periportal injection of bupivacaine for pain after laparoscopic cholecystectomy
SK Maharjan,S Shrestha
Kathmandu University Medical Journal , 2009, DOI: 10.3126/kumj.v7i1.1765
Abstract: Purpose: to study the analgesic efficacy of intraperitoneal and periportal injection of bupivacaine following laparoscopic cholecystectomy. Materials and methods: 40 patients undergoing laparoscopic cholecystectomy were randomized into two groups of 20 each. Group A (study group) received 40 ml of intraperitoneal injection of 0.25% bupivacaine and 20 ml of same concentration in 4 ports, 5 ml each at the end of surgery. Group B (control) received no treatment. Post operative patient monitoring and pain assessment was done by another doctor blinded to the procedure using VAS score at 1,2,3,6,9 and 24 hours after surgery. Pethidine 50 mg intramuscular was given as rescue analgesic when demanded by patient within first 24 hours. Results: when VAS score was analyzed in the two groups, the study group had less scores compared to control group though it was statistically not significant (p > 0.05). The rescue analgesic requirement was significantly less in study group (p Conclusion: Intraperitoneal and periportal injection of bupivacaine is effective in decreasing pain after laparoscopic cholecystectomy. Key words: Laparoscopic surgery, intraperitoneal bupivacaine, analgesia, VAS score ??? doi: 10.3126/kumj.v7i1.1765 ? ? ? Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 50-53 ????????
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