135 results on '"Rajbhandari, R."'
Search Results
2. Update on a Two-Part, International, Real-World, Observational Registry of Subjects with Aromatic L-Amino Acid Decarboxylase Deficiency (AADCd) ± Eladocagene Exuparvovec Treatment.
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Roubertie, A., Leuzzi, V., Pearl, P. L., Ezgü, F., Lupo, P., Rajbhandari, R., Sierra, J. R., Grünert, J., and Giugliani, R.
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ACIDS ,NEURAL development ,EVERYDAY life - Abstract
This article provides an update on a two-part international observational registry called AADCAware, which focuses on individuals with aromatic L-amino acid decarboxylase deficiency (AADCd). AADCd is a rare neurodevelopmental disorder that causes severe impairment. Part A of the registry examines the natural history of AADCd in patients receiving standard care, while Part B assesses the long-term safety and efficacy of a specific treatment called eladocagene exuparvovec on motor function. The study found that the majority of subjects failed to achieve major motor milestones, indicating a significant need for daily life support. [Extracted from the article]
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- 2023
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3. Impact of telemedicine among Parkinson’s disease patients during COVID-19 pandemic in Nepal
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Ojha, R., Karn, R., Gajurel, B.P., Rajbhandari, R., Gautam, N., Shrestha, A., Yadav, J.K., Joshi, P., and Nepal, G.
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- 2023
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4. Novel on-site follow-up and enhancement program (FEP) improves knowledge, clinical skills and enabling environment of skilled birth attendants in Nepal.
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Thapa, R., Nikolli, K., McMahon, D., Blakemore, S., Tamang, S., Bhatta, S., Gautam, P., Shrestha, R., and Rajbhandari, R.
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CLINICAL competence ,MIDWIVES ,HEALTH facilities ,HOSPITAL administration ,WORK environment - Abstract
Introduction: Although great strides have been made in maternal and newborn health in Nepal, the maternal mortality ratio (MMR) is still high at 186 per 100,000 births. Many maternal deaths are preventable if there is access to a skilled birth attendant (SBA). The Ministry of Health and Population of Nepal launched the in-service SBA training program in 2007 and has trained over 10,000 SBAs to date. Evidence shows that one episode of training is not enough to retain skills. Therefore, the Nick Simons Institute (NSI) in collaboration with National Health Training Center (NHTC) devised a Follow-Up and Enhancement Program (FEP) in 2011 where the knowledge, clinical skills, and working environment of SBA graduates were assessed directly at their worksites. FEP allows on-site coaching and feedback so that graduates may continue to improve upon any gaps in their knowledge, skills, and working environment. This study aims to assess the effectiveness of FEP. Methods: We used a mixed-methods research design. A total of 73 SBAs who had a pre-FEP assessment in 2016 were followed up for a post-FEP assessment in 2017. We also collected data from 3 additional districts (115 SBAs) that had not previously had FEP, to compare SBAs in FEP versus non-FEP districts. Qualitative data was collected from 16 health facilities on the perceptions, motivation, and satisfaction of stakeholders. Results: Of the total 188 SBAs that were sampled, a one-time FEP increased knowledge scores by 9%, clinical skills scores by 29%, and enabling environment scores by 7%. The number of deliveries conducted improved with a one-time FEP, although this increase was not statistically significant. We found a trickle-down effect of working in a facility that has had prior FEP, with SBAs that have never had FEP improving their clinical skills. FEP was found to be a highly accepted program and is beneficial to SBAs, trainers, and the Hospital Management Committee (HFOMC). However, a one-time FEP is not sufficient in retaining clinical skills and knowledge. Conclusion: FEP is a highly effective program by both quantitative and qualitative evaluation. Our study suggests that FEP should be frequent and continuous to retain the knowledge and clinical skills of SBAs, motivate them through on-site coaching, and improve their working environment through direct feedback to the Ministry of Health and Population. [ABSTRACT FROM AUTHOR]
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- 2023
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5. Discontinuity of care for mothers with chronic hepatitis B diagnosed during pregnancy
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Rajbhandari, R., Barton, K., Juncadella, A. C., Rubin, A. K., Ajayi, T., Wu, Y., Ananthakrishnan, A. N., and Chung, R. T.
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- 2016
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6. P197 Pulmonary function in patients with Duchenne muscular dystrophy from the STRIDE registry and CINRG natural history study: a matched cohort analysis
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Tulinius, M., Buccella, F., Desguerre, I., Kirschner, J., Mercuri, E., Muntoni, F., Osorio, A Nascimento, de Resende, M., Morgenroth, L., Gordish-Dressman, H., Johnson, S., Werner, C., Anbu, B., Liu, E., Rajbhandari, R., Trifillis, P., and McDonald, C.
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- 2023
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7. P198 Updated demographics and safety data from patients with nonsense mutation Duchenne muscular dystrophy receiving ataluren in the STRIDE registry
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Muntoni, F., Buccella, F., Desguerre, I., Kirschner, J., Osorio, A Nascimento, Tulinius, M., de Resende, M., Johnson, S., Werner, C., Anbu, B., Liu, E., Rajbhandari, R., Trifillis, P., and Mercuri, E.
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- 2023
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8. P196 Age at loss of ambulation in patients with DMD from the STRIDE registry and the CINRG natural history study: a matched cohort analysis
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Mercuri, E., Muntoni, F., Buccella, F., Desguerre, I., Kirschner, J., Osorio, A Nascimento, Tulinius, M., de Resende, M., Morgenroth, L., Gordish-Dressman, H., Johnson, S., Werner, C., Anbu, B., Liu, E., Rajbhandari, R., Trifillis, P., and McDonald, C.
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- 2023
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9. HBV infection is associated with greater mortality in hospitalised patients compared to HCV infection or alcoholic liver disease
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Rajbhandari, R., Danford, C. J., Chung, R. T., and Ananthakrishnan, A. N.
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- 2015
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10. Impact of ANXA7 I1 Expression on PDGFRA and MET Endosomal Trafficking in Glioblastoma
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White, Z.B., II, Dates, C., Rajbhandari, R., Nair, S., Nozell, S., and Bredel, M.
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- 2019
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11. HBV/ HIV coinfection is associated with poorer outcomes in hospitalized patients with HBV or HIV.
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Rajbhandari, R., Jun, T., Khalili, H., Chung, R. T., and Ananthakrishnan, A. N.
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HIV infections , *PORTAL hypertension , *HOSPITAL admission & discharge , *LOGISTIC regression analysis , *HOSPITAL care - Abstract
We examined the impact of HBV/ HIV coinfection on outcomes in hospitalized patients compared to those with HBV or HIV monoinfection. Using the 2011 US Nationwide Inpatient Sample, we identified patients who had been hospitalized with HBV or HIV monoinfection or HBV/ HIV coinfection using ICD-9- CM codes. We compared liver-related admissions between the three groups. Multivariable logistic regression was performed to identify independent predictors of in-hospital mortality, length of stay and total charges. A total of 72 584 discharges with HBV monoinfection, 133 880 discharges with HIV monoinfection and 8156 discharges with HBV/ HIV coinfection were included. HBV/ HIV coinfection was associated with higher mortality compared to HBV monoinfection ( OR 1.67, 95% CI 1.30-2.15) but not when compared to HIV monoinfection ( OR 1.22, 95% CI 0.96-1.54). However, the presence of HBV along with cirrhosis or complications of portal hypertension was associated with three times greater in-hospital mortality in patients with HIV compared to those without these complications ( OR 3.00, 95% CI 1.80-5.02). Length of stay and total hospitalization charges were greater in the HBV-/ HIV-coinfected group compared to the HBV monoinfection group (+1.53 days, P < 0.001; $17595, P < 0.001) and the HIV monoinfection group (+0.62 days, P = 0.034; $8840, P = 0.005). In conclusion, HBV/ HIV coinfection is a risk factor for in-hospital mortality, particularly in liver-related admissions, compared to HBV monoinfection. Overall healthcare utilization from HBV/ HIV coinfection is also higher than for either infection alone and higher than the national average for all hospitalizations, thus emphasizing the healthcare burden from these illnesses. [ABSTRACT FROM AUTHOR]
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- 2016
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12. Projected changes in climate over the Indus river basin using a high resolution regional climate model (PRECIS).
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Rajbhandari, R., Shrestha, A., Kulkarni, A., Patwardhan, S., and Bajracharya, S.
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CLIMATE change , *ATMOSPHERIC models , *PREDICTION models , *METEOROLOGICAL precipitation - Abstract
A regional climate modelling system, the Providing REgional Climates for Impacts Studies developed by the Hadley Centre for Climate Prediction and Research, has been used to study future climate change scenarios over Indus basin for the impact assessment. In this paper we have examined the three Quantifying Uncertainty in Model Predictions simulations selected from 17-member perturbed physics ensemble generated using Hadley Centre Coupled Module. The climate projections based on IPCC SRES A1B scenario are analysed over three time slices, near future (2011-2040), middle of the twenty first century (2041-2070), and distant future (2071-2098). The baseline simulation (1961-1990) was evaluated with observed data for seasonal and spatial patterns and biases. The model was able to resolve features on finer spatial scales and depict seasonal variations reasonably well, although there were quantitative biases. The model simulations suggest a non-uniform change in precipitation overall, with an increase in precipitation over the upper Indus basin and decrease over the lower Indus basin, and little change in the border area between the upper and lower Indus basins. A decrease in winter precipitation is projected, particularly over the southern part of the basin. Projections indicate greater warming in the upper than the lower Indus, and greater warming in winter than in the other seasons. The simulations suggest an overall increase in the number of rainy days over the basin, but a decrease in the number of rainy days accompanied by an increase in rainfall intensity in the border area between the upper and lower basins, where the rainfall amount is highest. [ABSTRACT FROM AUTHOR]
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- 2015
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13. The National Institute of Health Stroke Scale Score and Outcome in Acute Ischemic Stroke.
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Gajurel, B. P., Dhungana, K., Parajuli, P., Karn, R., Rajbhandari, R., Kafle, D., and Oli, K. K.
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STROKE ,ISCHEMIA ,CENTRAL nervous system ,HEALTH outcome assessment ,COMPUTED tomography ,PATIENTS - Abstract
Introduction: Stroke is a focal neurological deficit of sudden onset which lasts for more than 24 hours and has a vascular cause. Various prognostic indices derived from clinical features or patient characteristics and ancillary tests have been used to predict the prognosis of patients with acute ischemic stroke. The aim of this study was to find out the significance of the National Institute of Health Stroke Scale (NIHSS) score on admission in predicting the prognosis of patients with acute ischemic stroke. Method: This is a prospective observational study done in a tertiary care hospital with two hundred patients with acute ischemic stroke Result: Themean NIHSS score in patients with better outcome was 4.6 (? 2.2) and the mean NIHSS score in patients with poor outcome was 14.16(? 7.96). The difference was statistically significant (p=0.000). Conclusion: The baseline neurological status as measured by the National Institute of Health Stroke Scale score predicts the functional status at one month after acute ischemic stroke. [ABSTRACT FROM AUTHOR]
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- 2014
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14. Outcome of percutaneous balloon mitral valvotomy in Shahid Gangalal National Heart Centre, Kathmandu, Nepal
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Shrestha, N., Bhatta, Y.K.D., Maskey, A., Malla, R., Rajbhandari, R., Kansakar, S., Sharma, R., Yadav, D.N., Adhikari, C.M., Prajapati, D., Kesavan, S., and Shrestha, S.
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- 2014
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15. COMPARISION OF TRANSTHORACIC AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR THE DETECTION OF LEFT ATRIAL THROMBUS IN RHEUMATIC MITRAL VALVULAR DISEASE.
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Sharma, D., Maskey, A., KC, M. B., Rajbhandari, S., Rajbhandari, R., Limbu, Y. R., Malla, R., Regmi, S. R., Pradhan, B., and Shrestha, N. K.
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Transesophageal echocardiography (TEE) was performed in 114 patients with rheumatic mitral valvular disease and its results were compared with those of transthoracic echocardiography (TTE). Of 114 patients, LA thrombus was detected in 32 patients by TEE whereas TTE could detect LA thrombus in only 4 of them. Out of 32 cases, thrombus was located in left atrial appendage (LAA) in 20 (62%). TTE could detect LAA thrombus in only one patient. The procedure of TEE was well tolerated and there was no complication. We conclude that TEE is superior to TTE in detection of LA cavity and LA appendage thrombus. Hence, TEE should be a routine procedure to detect LA thrombus in patients with rheumatic mitral valvular disease prior to any surgical intervention. [ABSTRACT FROM AUTHOR]
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- 2004
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16. Segmental resection with primary reconstruction using patient- specific implant for odontogenic fibromyxoma: An illustrative rare case from Nepal.
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Ghimire B, Miya N, Rajbhandari R, and Verma L
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Introduction: Odontogenic fibromyxoma (OFM) is a round and locally invasive neoplasm predominantly seen in the mandible. Though radiographic appearance is variable, definitive diagnosis is based on correlation with histopathological examination. Surgical approach is the treatment of choice. For reconstruction, patient-specific implant (PSI) has lately been developed as a crucial help., Case Presentation: This case report presents a 19 year old female patient with odontogenic fibromyxoma highlighting its clinical, radiographic, histopathological features along with rehabilitation using patient specific implants reducing the complexity and related morbidities of reconstructive procedures., Discussion: Surgical repair and reconstruction of defects in cranio-maxillofacial region is challenging. The described treatment eliminates the need for bone grafting, shows optimal results owing to the shorter rehabilitation time and more accurate fits., Conclusion: This report introduces a novel technique whereby patient-specific implants are employed as the primary method of reconstruction following segmental resection., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interest or personal relationship that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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17. Changes in the Prevalence, Incidence, and Disability-Adjusted Life Years of Non-alcoholic Fatty Liver Disease in the United States Between 1990 and 2019.
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Jaroenlapnopparat A, Mettler SK, Guillen H, Chayanupatkul M, and Rajbhandari R
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- United States epidemiology, Humans, Child, Middle Aged, Child, Preschool, Adolescent, Young Adult, Adult, Disability-Adjusted Life Years, Prevalence, Incidence, Massachusetts, Quality-Adjusted Life Years, Global Health, Non-alcoholic Fatty Liver Disease diagnosis, Non-alcoholic Fatty Liver Disease epidemiology
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Introduction: This study aimed to determine trends in the prevalence, incidence, and disability-adjusted life years (DALYs) of Non-alcoholic Fatty Liver Disease (NAFLD) in the US across different states and age groups between 1990 and 2019., Methods: Using the Global Burden of Disease database, this study analyzed the prevalence, incidence, and DALYs of NAFLD in the US between 1990 and 2019. We computed relative percentage changes, performed Joinpoint regression analyses of trends, and compared these between states and age groups (5-19, 20-55, and more than 55 years old)., Results: In the United States, the prevalence of NAFLD increased more than the global average over the study period (+ 30.7% vs. + 24.5%), especially in the 5-19-year-old age group. Among all states, Kansas, Washington, and California had the highest increase in prevalence and the District of Columbia followed by Massachusetts and North Carolina had the lowest increase in prevalence. The increase in incidence was greater in the US than the global average (+ 37.18% vs. + 7.28%). West Virginia, Ohio, and Kentucky had the highest increase in incidence. The increase in DALYs was greater in the US compared to the global average (+ 57.15% vs. + 12.65%). Alaska, West Virginia, and Kentucky had the highest increase in DALYs. The increased incidence and DALYs were found in all states except in the District of Columbia., Conclusion: The prevalence of NAFLD in the US has increased more rapidly than the global average, especially in the pediatric population. South and Midwest states have the highest increase in prevalence, incidence, and DALYs of NAFLD. The District of Columbia was the only state that has decreased incidence and DALYs., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2024
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18. Shared infections at the wildlife-livestock interface and their impact on public health, economy, and biodiversity.
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Karmacharya D, Herrero-García G, Luitel B, Rajbhandari R, and Balseiro A
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- 2024
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19. SOFA and APACHE II scoring systems for predicting outcome of neurological patients admitted in a tertiary hospital intensive care unit.
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Shahi S, Paneru H, Ojha R, Karn R, Rajbhandari R, and Gajurel BP
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Background: The field of neurology encompasses the study and treatment of disorders that affect the nervous system, and patients with neurological conditions often require specialized care, particularly in the ICU. Predictive scoring systems are measures of disease severity used to predict patient outcomes. The aim of this study was to compare the discriminative power of commonly used scoring systems, namely the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE II) in the ICU of a tertiary care hospital., Methods: This retrospective study included patients with neurological disorders in the ICUs of Tribhuvan University Teaching Hospital from 1 January 2022 to 31 December 2022., Results: A total of 153 patients were included. The mean age of the patients was 54.76 ± 17.32 years with higher male predominance (60.78%). Ischaemic stroke was the most common neurological disorder. There were 58 patients (37.9%) who required mechanical ventilation and all-cause mortality was 20.9%. The mean SOFA score was significantly higher ( P =0.002) in survivors, whereas the mean APACHE II did not show a significant difference ( P =0.238). Receiver operating characteristic (ROC) analysis showed the area of curve (AUC) of SOFA score was 0.765 and of APACHE II was 0.722., Conclusions: SOFA score had comparatively higher discriminative power than APACHE II. Assessment of the performance of scoring systems in a specific ICU setting improves the sensitivity and applicability of the model to these settings., Competing Interests: There are no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2024
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20. Dyslipidemia and Obesity in Ischemic Stroke.
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Gajurel BP, Gurung A, Ojha R, Rajbhandari R, and Karn R
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Background Dyslipidemia and obesity are both important risk factors for the first and recurrent ischemic strokes. Dyslipidemia is highly prevalent among Asian populations, and the prevalence of obesity is also noted to be progressively increasing in this population. This study was carried out to determine the prevalence of dyslipidemia and central obesity and their association with each other and various cardiovascular risk factors among patients who presented with an acute ischemic stroke to a tertiary care university hospital in Nepal. Methods This study is a secondary analysis done on data from a prospective observational study that was carried out on patients who were either acutely admitted to or visited the outpatient department of the hospital with a diagnosis of ischemic stroke. Dyslipidemia was defined according to the third report of the National Cholesterol Education Program expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Obesity was defined as central obesity by measuring waist circumference. Data were collected by convenience sampling and analyzed by IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. Significant variables were compared with logistic regression analysis. Other data were expressed as frequencies and percentages. Results Out of 145 patients, 77 were male (53.1%). The mean age of the patients was 60.15 years. Dyslipidemia and central obesity were present in 96.6% and 57.9% of the patients, respectively. The most common lipid abnormality was low-density lipoprotein cholesterol, present in 82.8% of the patients, followed by high triglycerides, present in 21.4% of them. Dyslipidemia was not associated with any vascular risk factors. Central obesity was significantly associated with female gender, diabetes, and low-density lipoprotein cholesterol in univariate analysis. However, in multivariate logistic regression analysis, it was significantly associated with only female gender (p=0.003) and diabetes (p=0.012). Conclusion Dyslipidemia and central obesity are very common in patients with ischemic stroke. Dyslipidemia is not associated with any vascular risk factors. However, central obesity is significantly associated with the female gender and diabetes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Gajurel et al.)
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- 2023
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21. Haploinsufficiency of NFKBIA reshapes the epigenome antipodal to the IDH mutation and imparts disease fate in diffuse gliomas.
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Bredel M, Espinosa L, Kim H, Scholtens DM, McElroy JP, Rajbhandari R, Meng W, Kollmeyer TM, Malta TM, Quezada MA, Harsh GR, Lobo-Jarne T, Solé L, Merati A, Nagaraja S, Nair S, White JJ, Thudi NK, Fleming JL, Webb A, Natsume A, Ogawa S, Weber RG, Bertran J, Haque SJ, Hentschel B, Miller CR, Furnari FB, Chan TA, Grosu AL, Weller M, Barnholtz-Sloan JS, Monje M, Noushmehr H, Jenkins RB, Rogers CL, MacDonald DR, Pugh SL, and Chakravarti A
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- Child, Humans, Epigenome, Haploinsufficiency genetics, Mutation genetics, NF-KappaB Inhibitor alpha genetics, Isocitrate Dehydrogenase, Brain Neoplasms genetics, Glioma genetics, Glioma pathology
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Genetic alterations help predict the clinical behavior of diffuse gliomas, but some variability remains uncorrelated. Here, we demonstrate that haploinsufficient deletions of chromatin-bound tumor suppressor NFKB inhibitor alpha (NFKBIA) display distinct patterns of occurrence in relation to other genetic markers and are disproportionately present at recurrence. NFKBIA haploinsufficiency is associated with unfavorable patient outcomes, independent of genetic and clinicopathologic predictors. NFKBIA deletions reshape the DNA and histone methylome antipodal to the IDH mutation and induce a transcriptome landscape partly reminiscent of H3K27M mutant pediatric gliomas. In IDH mutant gliomas, NFKBIA deletions are common in tumors with a clinical course similar to that of IDH wild-type tumors. An externally validated nomogram model for estimating individual patient survival in IDH mutant gliomas confirms that NFKBIA deletions predict comparatively brief survival. Thus, NFKBIA haploinsufficiency aligns with distinct epigenome changes, portends a poor prognosis, and should be incorporated into models predicting the disease fate of diffuse gliomas., Competing Interests: Declaration of interests M.B.: NIH/NINDS grant R01NS117641, advisory board membership and grant (Varian Medical Systems), consulting (MRIMath). L.E.: Instituto de Salud Carlos III grant PI22/00069. T.L.-J.: an Asociación Española Contra el Cáncer grant. G.R.H.: NIH/NIBIB grant (P41-EB032840-01). J.S.B.-S.: NIH/NCI grants to Case Western Reserve University School of Medicine. J.P.M.: MOU between OSU Radiation Oncology and OSU Center for Biostatistics. R.B.J.: NIH grants. A.W.: MOU between OSU Radiation Oncology and OSU Biomedical Informatics. T.A.C.: grants (PGDX, Pfizer, AstraZeneca, Illumina, NysnoBio); royalties (PGDX); consulting (Illumina, NysnoBio, Pfizer, BMS, Merck, LG Chem); patents (TMB as predictor of immunotherapy response); stock (Griststone Bio, Nysno Bio). A.N.: consulting (Daiichi-Sankyo, NGK, SparkPlug) to his institution; $2,000 as honoraria. M.W.: grants (Apogenix, Merck, Sharp & Dohme, Merck [EMD], Philogen, Quercis); consulting (Adastra, Medac, Merck [EMD], Nerviano Medical Sciences, Novartis); honoraria (Bristol Meyer Squibb, Medac, Merck, Sharp & Dohme); Data Safety Monitoring Board or Advisory Board (Orbus and Philogen); leadership (EORTC). R.G.W.: grant 70-3163-Wi 3 (German Cancer Aid). S.O.: grant (Cordia Therapeutics, Dainippon-Sumitomo, Pharmaceuticals, Otsuka Assay Inc.); royalties (ASAHI Genomics, Qiagen); consulting (Cordia Therapeutics, Kan Research Institute, Novartis Pharmaceuticals); honoraria (MSD Japan, Kyowa Hakko Kirin, Pfizer); stocks (ASAHI Genomics, Cordia Therapeutics, Rebirthell). M.M.: NIH grants (R01NS092597, DP1NS111132, P50CA165962), grants from Kleberg Foundation Cancer Research, Ludwig Fund for Cancer Research; consulting (Cygnal Therapeutics); honoraria for lectures. C.R.M. and F.B.F.: NIH grant (R01CA258248). F.B.F.: NIH grant (R01NS080939). D.R.M.: clinical trials support (INTELLANCE-1 study [M13-813], CCTG CE.8 [EORTC-1709-BTG], INDIGO study [AG-881], Abbvie, Celgene, Agios [now Servier])., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2023
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22. Stroke patterns and outcomes during the second wave of COVID-19 pandemic: a cross-sectional study.
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Gajurel BP, Giri S, Tamrakar P, Pandeya A, Gautam N, Shrestha A, Karn R, Rajbhandari R, and Ojha R
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The coronavirus disease 2019 (COVID-19) pandemic has affected the number of stroke activations, admission of patients with various types of strokes, the rate and timely administration of reperfusion therapy, and all types of time-based stroke-related quality assessment metrics. In this study, we describe the different types of strokes, different delays in seeking and completing treatment occurring during the second wave of the COVID-19 pandemic, and predictors of outcome at 3 months follow-up., Materials and Methods: This is a single-centered prospective cross-sectional study carried out from May 2021 to November 2021, enrolling patients with stroke. Data collected were demographic characteristics, stroke types and their outcomes, and different types of prehospital delays., Results: A total of 64 participants were included in the study with a mean age of 60.25±15.31 years. Ischemic stroke was more common than hemorrhagic stroke. The median time of arrival to the emergency room of our center was 24 h. The most common cause of prehospital delay was found to be delays in arranging vehicles. The median duration of hospital stays [odds ratio (OR)=0.72, P <0.05] and baseline NIHSS (National Institute of Health Stroke Scale) score (OR=0.72, P <0.05) were found to be a predictor of good outcomes at 3 months follow-up on binary logistic regression., Conclusion: The factors that cause the delayed transfer to the hospital and onset of treatment should be addressed. Patient counseling about the likely prognosis can be done after evaluating the probable outcome based on the NIHSS score and median duration of hospital stay. Nevertheless, mechanisms should be developed to reduce the prehospital delay at the ground level as well as at the policy level., Competing Interests: No potential conflicts of interest relevant to this article exists., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2023
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23. Painful tonic spasms in a patient with neuromyelitis optica spectrum disorder: A case report.
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Aryal R, Homagian S, Shrestha S, Gajurel BP, Karn R, Rajbhandari R, Gautam N, Shrestha A, Shahi S, and Ojha R
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Painful tonic spasms initially described in association with multiple sclerosis are actually more common in patients with neuromyelitis optica spectrum disorder. Characterized by fierce pain and tonic posture of limbs, painful tonic spasms are common in patients during the recovery phase after the first episode of myelitis. A 68-year-old man presented with painful tonic spasm after 2 months of diagnosis of neuromyelitis optica spectrum disorder. Eventual use of eslicarbazepine resulted in significant control of spasms. Early recognition of painful tonic spasms and appropriate therapeutic medications can significantly decrease the impact it can have on the quality of life among neuromyelitis optica spectrum disorder patients., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)
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- 2023
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24. Crohn's Disease Among the Poorest Billion: Burden of Crohn's Disease in Low- and Lower-Middle-Income Countries.
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Rajbhandari R, Blakemore S, Gupta N, Mannan S, Nikolli K, Yih A, Drown L, and Bukhman G
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- Humans, Cross-Sectional Studies, Developing Countries, Crohn Disease diagnosis, Crohn Disease epidemiology, Crohn Disease therapy, Inflammatory Bowel Diseases epidemiology, Colitis, Ulcerative epidemiology
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Background: To establish the epidemiology and patterns of care of Crohn's Disease in low- and lower-middle-income countries., Methods: A cross-sectional survey of gastroenterology providers in countries where the world's poorest billion live was conducted to learn more about the state of diagnostic and treatment capacity for Crohn's. Quantitative data were analyzed in R and Excel., Results: A total of 46 survey responses from 15 countries were received, giving a response rate of 54.8%. All responses collected were from providers practicing in Africa and South Asia. The mean number of patients with Crohn's cared for in the last year was 89.5 overall but ranged from 0 reported at one facility in Rwanda to 1000 reported at two different facilities in India. Overall, Crohn's disease made up 20.6% of the inflammatory bowel disease diagnoses reported by survey respondents, with Africa exhibiting a larger proportion of Crohn's compared to ulcerative colitis than Asia. Most providers reported that patients with Crohn's have symptoms for 6-24 months prior to diagnosis and that 26-50% of their patients live in rural areas. The most reported diagnostic challenges are differentiating between Crohn's and intestinal tuberculosis, poor disease awareness, and lack of trained pathologists. The most widely reported challenge in managing Crohn's disease is patients' inability to afford biologics, reported by 65% of providers., Conclusion: Our study suggests there may be a greater burden of Crohn's disease in low- and lower-middle-income countries than is indicated in prior literature. Respondents reported many challenges in diagnosing and treating Crohn's disease., (© 2022. The Author(s).)
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- 2023
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25. Wallerian degeneration in the brain after organophosphorus poisoning: a case report.
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Gajurel BP, Giri S, Poudel N, Kharel S, Karn R, Rajbhandari R, Ojha R, Gautam N, and Shrestha A
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The type, quantity, and potency of the organophosphorus compound (OPC) taken determine the symptoms of OPC poisoning as well as their severity. The exact etiology for organophosphorus (OP) poisoning delay neuropathy regulating Wallerian degeneration is still unknown., Case Presentation: We report here a rare case of a 25-year-old lady with Wallerian degeneration in the brain found in an MRI in a patient after OPC ingestion. MRI of the brain, in our case, shows Wallerian degeneration of the corona radiata, internal capsule, and midbrain., Clinical Discussion: Some OPCs can lead to OP-induced delayed neuropathy, a form of delayed neurotoxicity in humans (OPIDN). The distal axonopathy's (in OPIDN) morphological pattern resembles Wallerian degeneration, which happens in vitro following nerve damage. Although delayed Wallerian degeneration from organophosphate poisoning often affects the peripheral nervous system, it can also affect the central nervous system. Rehabilitation therapy combined with appropriate nursing care has been demonstrated to improve the disease., Conclusion: Central nervous system involvement after OP poisoning is rare, and MRI of the brain and spinal cord can document evidence of Wallerian degeneration after OP poisoning., Competing Interests: The authors report no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2023
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26. MRI of the brain mimicking autoimmune encephalitis in Sjögren syndrome with chorea: a case report.
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Gajurel BP, Giri S, Poudel N, Kharel S, Jha S, Karn R, Rajbhandari R, Ojha R, Gautam N, and Shrestha A
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Neurologic manifestations in primary Sjögren syndrome (SS) range in prevalence from 8 to 49%, and most of the studies suggest a prevalence of 20%. The incidence of SS patients developing movement disorders is about 2%., Case Presentation: The authors herein report a case of a 40-year-old lady with MRI of the brain mimicking autoimmune encephalitis in SS who presented with chorea. Her MRI findings revealed T2 and FLAIR (fluid-attenuated inversion recovery) high signal intensity areas in bilateral middle cerebellar peduncles, dorsal pons, dorsal midbrain, hypothalami, and medial temporal lobes., Clinical Discussion: There is still no evidence to support the definite use of MRI in characterizing the central nervous system involvement in primary SS, especially due to overlapping findings with age and cerebrovascular disease. Multiple areas of increased signal intensity in periventricular and subcortical white matter in FLAIR and T2-weighted image is commonly seen in primary SS patients., Conclusion: It is crucial to consider autoimmune diseases like SS as a cause of chorea in adults, even in those whose imaging findings are suggestive of autoimmune encephalitis., Competing Interests: The authors report no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2023
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27. Pathways to effective surgical coverage in a lower-middle-income country: A multiple methods study of the family physician-led generalist surgical team in rural Nepal.
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Ross O, Shakya R, Shrestha R, Shah S, Pradhan A, Shrestha R, Bhandari P, Paris B, Shah K, Shrestha A, Zimmerman M, Henrikson H, Tamang S, and Rajbhandari R
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The Lancet Commission on Global Surgery (LCoGS) recommends using specialist surgical workforce density as one of 6 core indicators for monitoring universal access to safe, affordable surgical and anaesthesia care. Using Nepal as a case study, we explored the capacity of a generalist workforce (led by a family physician or MD general practitioner and non-physician anaesthetist) to enable effective surgical delivery through task-shifting. Using a multiple-methods approach, we retrospectively mapped essential surgical care and the enabling environment for surgery in 39 hospitals in 25 remote districts in Nepal and compared it with LCoGS indicators. All 25 districts performed surgery, 21 performed Caesarean section (CS), and 5 met at least 50% of district CS needs. Generalist surgical teams performed CS, the essential major operation at the district level, and very few laparotomies, but no operative orthopaedics. The density of specialist Surgeon/Anaesthesiologist/Obstetrician (SAO) was 0·4/100,000; that of Generalist teams (gSAO) led by a family physician (MD General Practitioners-MDGP) supported by non-physician anaesthetists was eight times higher at 3·1/100,000. gSAO presence was positively associated with a two-fold increase in CS availability. All surgical rates were well below LCoGS targets. 46% of hospitals had adequate enabling environments for surgery, 28% had functioning anaesthesia machines, and 75% had blood transfusion services. Despite very low SAO density, and often inadequate enabling environment, surgery can be done in remote districts. gSAO teams led by family physicians are providing essential surgery, with CS the commonest major operation. gSAO density is eight times higher than specialists and they can undertake more complex operations than just CS alone. These family physician-led functional teams are providing a pathway to effective surgical coverage in remote Nepal., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ross et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2023
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28. Stiff person syndrome in a Nepalese man with uncontrolled diabetes mellitus and ketonuria: A rare case report.
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Kharel S, Ojha R, Bhandari S, Sharma A, Parajuli N, Karn R, Gajurel BP, Rajbhandari R, Gautam N, and Shrestha A
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Stiff Person Syndrome (SPS), a progressive Central Nervous System disorder is accompanied by progressive muscle rigidity, hyperreflexia, and spasms mainly in truncal and proximal leg muscles mainly associated with autoimmune disorders. Here, we report a rare case of SPS in a middle-aged Nepalese man with uncontrolled diabetes mellitus and ketonuria., Competing Interests: The authors have no conflicts of interest to declare., (© 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)
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- 2023
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29. Epidemiological and clinical characteristics of central nervous system infections in a tertiary center: A retrospective study.
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Gajurel BP, Giri S, Rayamajhi S, Khanal N, Bishowkarma S, Mishra A, Karn R, Rajbhandari R, and Ojha R
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Background and Aims: Central nervous system (CNS) infection is one of the most common causes of morbidity, mortality, and hospital admission worldwide. The natural history of CNS infection is quite fatal. Early diagnosis and treatment have been proven to have a crucial role in patients' survival. The aim of this study was to identify the epidemiological and clinical patterns of patients diagnosed with CNS infections., Methods: This study is a retrospective study conducted in a tertiary level hospital in Nepal in which patient diagnosed with CNS infections (September 2019 to 2021) were included. Data were collected and analyzed in SPSS., Results: The mean age of the 95 patients included in the study was 45.18 ± 19.56. Meningoencephalitis ( n = 44, 46.30%) was the most common infection diagnosed. Patients belonging to the age group 30-60 years had a higher frequency of focal neurological deficit, and other classical clinical features. All the patients who died during the treatment had associated comorbidities but no concurrent infections. Altered sensorium, fever, and headache were the common presenting symptoms in all the recovered patients., Conclusion: To ensure optimum disease outcome, early diagnosis and prompt management are crucial. For this, recognizing the local disease patterns in terms of disease distribution, commonly implicated aetiologies, presenting symptoms, and prognostic factors is of utmost importance., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)
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- 2023
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30. Cerebral venous thrombosis in a patient with adenomyosis: A case report.
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Yadav JK, Thapa A, Bhattarai A, Kc A, Budhathoki SJ, Chandra A, and Rajbhandari R
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Cerebral venous thrombosis can be caused by different conditions such as infectious, structural, hypercoagulable states, hematological, hormonal, collagen, vascular diseases, and oral contraceptive pills among other causes. Adenomyosis has been rarely associated with Cerebral venous thrombosis (CVT). Increased CA-125 and iron deficiency anemia in adenomyosis may predispose to CVT., Competing Interests: None of the authors has any conflict of interest to disclose., (© 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)
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- 2022
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31. Chorea hyperglycemia basal ganglia syndrome: A case report from Nepal.
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Bhandari SK, Kharel H, Gajurel BP, Karn R, Rajbhandari R, Gautam N, Shrestha A, and Ojha R
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A rare case of chorea hyperglycemic basal ganglia syndrome in a 56-year-old woman who presented with left-sided hemichorea in the setting of uncontrolled, non-ketotic, type II diabetes mellitus is reported. Early blood glucose control could lead to complete resolution of symptoms. Despite an excellent prognosis, delayed recognition and management can lead to prolong disability due to movement disorder., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)
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- 2022
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32. Phyllanthus emblica Seed-Derived Hierarchically Porous Carbon Materials for High-Performance Supercapacitor Applications.
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Shrestha LK, Shahi S, Gnawali CL, Adhikari MP, Rajbhandari R, Pokharel BP, Ma R, Shrestha RG, and Ariga K
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The electrical double-layer supercapacitance performance of the nanoporous carbons prepared from the Phyllanthus emblica (Amala) seed by chemical activation using the potassium hydroxide (KOH) activator is reported. KOH activation was carried out at different temperatures (700-1000 °C) under nitrogen gas atmosphere, and in a three-electrode cell set-up the electrochemical measurements were performed in an aqueous 1 M sulfuric acid (H
2 SO4 ) solution. Because of the hierarchical pore structures with well-defined micro- and mesopores, Phyllanthus emblica seed-derived carbon materials exhibit high specific surface areas in the range of 1360 to 1946 m2 g-1 , and the total pore volumes range from 0.664 to 1.328 cm3 g-1 . The sample with the best surface area performed admirably as the supercapacitor electrode-material, achieving a high specific capacitance of 272 F g-1 at 1 A g-1 . Furthermore, it sustained 60% capacitance at a high current density of 50 A g-1 , followed by a remarkably long cycle-life of 98% after 10,000 subsequent charging/discharging cycles, demonstrating the electrode's excellent rate-capability. These results show that the Phyllanthus emblica seed would have significant possibilities as a sustainable carbon-source for the preparing high-surface-area activated-carbons desired in high-energy-storage supercapacitors.- Published
- 2022
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33. Occurrence of osmotic demyelination syndrome in diabetes mellitus: A case report and literature review of various etiologies for osmotic demyelination syndrome.
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Yadav SK, Ojha R, Parajuli N, Karki S, Pant S, Karn R, Gajurel BP, Rajbhandari R, Gautam N, Shrestha A, and Jha A
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Osmotic demyelination syndrome is a rare condition reported mainly in the case of rapid correction of hyponatremia, but it can occur even in the case of complicated diabetes mellitus either during rapid correction of hyperglycemia or anytime during the complicated diabetes mellitus. We report a case of complicated diabetes mellitus developing osmotic demyelination syndrome. The patient had presented with altered sensorium and seizure, which was initially diagnosed as hyperglycemia, but during his treatment, the magnetic resonance imaging of brain revealed central pontine myelinolysis. Our search on the causes of osmotic demyelination syndrome other than rapid correction of hyponatremia has revealed several other causes like autoimmune liver disease, Sjogren's syndrome and non-Hodgkin's lymphoma in addition to diabetes mellitus., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© The Author(s) 2022.)
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- 2022
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34. Guillain-Barre Syndrome following lower segment caesarean section under spinal anesthesia: A case report.
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Luitel P, Upadhyay D, Neupane N, Paudel S, Gyawali P, Gajurel BP, Karn R, Rajbhandari R, Gautam N, Shrestha A, and Ojha R
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Symptoms of Guillain-Barre Syndrome (GBS) may be mistaken for typical puerperal changes, delaying diagnosis. Surgery and anesthesia may be triggers for GBS with an overall increase in pro-inflammatory cytokines in the postpartum period. We report a unique case of GBS in the postpartum period who made a good recovery with supportive measures., Competing Interests: The authors declare they have no conflicts of interest., (© 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)
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- 2022
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35. Venture of a Tertiary Care Neurosurgical Center in Course of COVID-19 Lockdown without RT-PCR.
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Rajbhandari P, Gurung P, Shrestha R, Dhakal S, Shrestha J, Sharma U, Shrestha D, Nepal G, Shrestha B, Sah K, Acharya S, Shrestha P, Rajbhandari R, Chandra A, Mali S, Dabadi S, Dhungel RR, Shrestha J, Palikhe A, Karki SB, and Pant B
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"I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient." Obliged by the aforementioned oath, no medical practitioner shall sit in a moral judgment on any patient but will treat their illness to the best of their ability whatever the circumstances. A clear concord was yet to be authorized after the World Health Organization (WHO) declared the global pandemic of severe acute respiratory syndrome coronavirus 2infection. As a diagnostic modality, WHO recommended real-time reverse transcription-polymerase chain reaction (RT-PCR) as a reliable test; however, its availability in a deprived nation like ours became a major restraining factor. Despite an asset of having high specificity, RT-PCR for coronavirus disease 2019has its own liability of having low sensitivity. Henceforth, as time passed by, the validity of the rapid diagnostic tests was put into question. In later months, a few centers around our periphery started conducting RT-PCR, but the time taken to obtain the result was long-drawn-out process and the patient who needed urgent neurosurgical intervention at Annapurna Neurological Institute and Allied Sciences had to wait. We would like to share our expedition through peaks and valleys of managing 215 patients during the vicious circle of lockdown and global pandemic., Competing Interests: Conflict of Interest None declared., (Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)
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- 2022
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36. Thyrotoxic periodic paralysis in a patient with Graves' disease: A case report.
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Kharel S, Ojha R, Parajuli N, Bhattarai S, Parajulee G, Karn R, Gajurel BP, Rajbhandari R, Gautam N, and Shrestha A
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Introduction and Importance: Thyrotoxic periodic paralysis (TPP) is a rare and often misdiagnosed, hypokalemic periodic paralysis with features of mainly recurrent acute limb weakness with good treatment outcome if diagnosed early., Case Presentation: We here report a case of a 25-year-old male with a history of recurrent bilateral upper and lower limbs weakness resolved by potassium infusion later found to have Thyrotoxicosis (Graves' disease). MRI scans of the brain had no abnormal finding while thyroid scintigraphy showed diffuse toxic goiter., Clinical Discussion: Graves' disease shares a majority of TPP while, other causes like toxic adenoma, thyroiditis, toxic multinodular goiter, amiodarone induced thyrotoxicosis, levothyroxine intoxication and thyrotropin (TSH) producing pituitary adenoma are also associated with TPP. The management of thyrotoxicosis by medical therapy, surgery or radioactive iodine therapy is the mainstay of treatment of TPP patients. For the treatment of acute attacks, potassium administration is necessary keeping in mind the problem of hyperkalemia because of excess doses of potassium as it shifts to extracellular space., Conclusion: TPP should be considered as a differential in the cases of limb weakness and the secondary causes especially Thyrotoxicosis and precipitating factors should be identified., Competing Interests: None., (© 2022 The Authors.)
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- 2022
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37. Creutzfeldt-Jakob disease: A case report and differential diagnoses.
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Raut A, Thapa A, Shrestha A, Saud K, Rajbhandari R, and Katwal S
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Although sporadic Creutzfeldt-Jakob disease is a rare neurodegenerative disease and often difficult to diagnose at the earliest onset, meticulous clinical examination, electroencephalography, and neuroimaging findings will help in diagnosis., Competing Interests: None., (© 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)
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- 2022
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38. Delayed myelopathy after organophosphate intoxication: A case report.
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Gautam S, Sapkota S, Ojha R, Jha A, Karn R, Gajurel BP, Rajbhandari R, Paudel S, Gautam N, and Shrestha A
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Organophosphate-induced delayed neuropathy, a central-distal axonopathy, passes through latent, progressive, static and improvement phases. During the improvement phase, the peripheral nerves regenerate unmasking the spinal cord lesion with myelopathic features. We report a case of a 16-year-old male who developed myelopathy 6 weeks following chlorpyrifos poisoning. He had a motor weakness of 4/5 in bilateral hips and 3/5 in bilateral knees and ankles. Spasticity and exaggerated reflexes with ankle clonus were present in the lower limbs. Sensory and the upper limb motor examinations were all normal. Pertinent blood, cerebrospinal fluid and nerve conduction tests were normal. Magnetic resonance imaging of the spine showed features of cord atrophy. Three months following physiotherapy, his power improved to 5/5 in bilateral knee and hip joints and 4/5 in bilateral ankles with spasticity. Organophosphate-induced delayed neuropathy can present as earlier as 6 weeks with myelopathy. Previous history of organophosphorous exposure is important in myelopathy or peripheral neuropathy., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© The Author(s) 2022.)
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- 2022
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39. Guillain-Barré syndrome following coronavirus disease vaccine: First report from Nepal.
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Luitel P, Poudel B, Upadhyay D, Paudel S, Tiwari N, Gajurel BP, Karn R, Rajbhandari R, Shrestha A, Gautam N, and Ojha R
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ChAdOx1 nCoV-19 is an effective and well-tolerated coronavirus disease 2019 vaccine. However, rare cases of serious adverse events have been reported with it. We report a patient who did not have active or prior coronavirus disease 2019 infection, who developed Guillain-Barré syndrome 7 days following the first dose of ChAdOx1 nCoV-19 vaccination. He was treated with intravenous immunoglobulin, with stabilization of the disease. Proper monitoring and prompt reporting of such cases are required to ensure the safety of the vaccine., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)
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- 2022
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40. Utility of fertility procedures and prenatal tests to estimate gestational age for live-births and stillbirths in electronic health plan databases.
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Taylor LG, Bird ST, Stojanovic D, Toh S, Maro JC, Fazio-Eynullayeva E, Petrone AB, Rajbhandari R, Andrade SE, Haynes K, McMahill-Walraven CN, Shinde M, and Lyons JG
- Subjects
- Electronics, Female, Fertility, Gestational Age, Humans, Pregnancy, Live Birth epidemiology, Stillbirth epidemiology
- Abstract
Purpose: Current algorithms to evaluate gestational age (GA) during pregnancy rely on hospital coding at delivery and are not applicable to non-live births. We developed an algorithm using fertility procedures and fertility tests, without relying on delivery coding, to develop a novel GA algorithm in live-births and stillbirths., Methods: Three pregnancy cohorts were identified from 16 health-plans in the Sentinel System: 1) hospital admissions for live-birth, 2) hospital admissions for stillbirth, and 3) medical chart-confirmed stillbirths. Fertility procedures and prenatal tests, recommended within specific GA windows were evaluated for inclusion in our GA algorithm. Our GA algorithm was developed against a validated delivery-based GA algorithm in live-births, implemented within a sample of chart-confirmed stillbirths, and compared to national estimates of GA at stillbirth., Results: Our algorithm, including fertility procedures and 11 prenatal tests, assigned a GA at delivery to 97.9% of live-births and 92.6% of stillbirths. For live-births (n = 4 701 207), it estimated GA within 2 weeks of a reference delivery-based GA algorithm in 82.5% of pregnancies, with a mean difference of 3.7 days. In chart-confirmed stillbirths (n = 49), it estimated GA within 2 weeks of the clinically recorded GA at delivery for 80% of pregnancies, with a mean difference of 11.1 days. Implementation of the algorithm in a cohort of stillbirths (n = 40 484) had an increased percentage of deliveries after 36 weeks compared to national estimates., Conclusions: In a population of primarily commercially-insured pregnant women, fertility procedures and prenatal tests can estimate GA with sufficient sensitivity and accuracy for utility in pregnancy studies., (© 2022 John Wiley & Sons Ltd. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)
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- 2022
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41. Evaluating cognitive outcomes in adult patients with acute encephalitis syndrome: a prospective study from a tertiary care center in Nepal.
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Rayamajhi P, Nepal G, Ojha R, Rajbhandari R, Gajurel BP, and Karn R
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Purpose: Although cognitive impairment is a known complication of acute encephalitis syndrome (AES), few studies have evaluated cognitive outcomes in patients with encephalitis. The primary objective of this study was to assess the cognitive profiles of patients diagnosed with AES, which is pivotal for improving rehabilitation strategies and prognostic measures., Methods: This study was conducted at the Tribhuvan University Teaching Hospital. Adult patients with AES who met inclusion criteria were enrolled. The Montreal Cognitive Assessment (MoCA) tool was used to assess cognitive function at admission, discharge, and 3-month follow-up., Results: Thirty-six patients were enrolled in our study. The mean age of the participants was 43 ± 18 years. Fourteen patients (38.9%) were female, and 22 (61.1%) were male. Tuberculous (TB) meningoencephalitis was present in 14 cases (38.9%), with herpes simplex virus (HSV) encephalitis in 14 (38.9%), bacterial meningoencephalitis in 4 (11.1%), autoimmune encephalitis in 2 (5.6%), and Japanese encephalitis in 2 (5.6%). Patients with bacterial meningoencephalitis had the highest MoCA scores at admission, whereas those with HSV encephalitis had the highest scores at discharge and follow-up. Compared with the scores at admission, the scores at discharge and follow-up increased significantly in patients with TB meningoencephalitis and HSV encephalitis. The MoCA score at discharge was established as a significant predictor of cognitive function at follow-up., Conclusion: We found that active treatment can improve the outcomes of AES patients with cognitive impairment. Although infectious etiologies are most common in low-income countries such as Nepal, autoimmune etiologies should not be overlooked., Competing Interests: Conflicts of Interest No potential conflict of interest relevant to this article is reported., (Copyright © 2022 Korean Encephalitis and Neuroinflammation Society.)
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- 2022
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42. Delayed Visual Loss in a Patient with Snake Bite: Case Report of an Unusual Neuro-Ophthalmic Presentation.
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Kuikel S, Rimal S, Ojha R, Sitaula S, Karn R, Gajurel B, Rajbhandari R, Gautam N, Paudel S, and Shrestha A
- Abstract
Neurotoxin-related optic neuritis (ON) after snake bite is uncommon. Here, we present a case of a 70-year-old female who developed bilateral painless loss of vision after she received treatment with anti-snake venom (ASV). She had only perception of light on assessment of visual acuity on admission which then improved drastically after administration of intravenous methylprednisolone (MP) after making the provisional diagnosis of ON on the basis of history and clinical findings of the patient. Imaging and visual-evoked potential could not be done initially, and they were done after the administration of intravenous MP which had normal findings. ASV, though being a lifesaving treatment, has been sometimes associated with ON., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2022 by S. Karger AG, Basel.)
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- 2022
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43. Guillain-Barré syndrome associated with Coronavirus disease 2019: A case from Nepal.
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Aryal R, Karki S, Rajbhandari S, Gajurel BP, Karn R, Rajbhandari R, Paudel S, Gautam N, Shrestha A, and Ojha R
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Coronavirus disease 2019 (COVID-19) has now spread widely after the outbreak since December 31, 2019. Guillain-Barré syndrome is an immunological postinfectious neuropathy, which has been reported to be a rare but possible complication COVID-19. We report a case of Guillain-Barré syndrome associated with COVID-19 in Nepal., Competing Interests: The authors declare that there are no conflicts of interest., (© 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)
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- 2022
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44. Effect of deploying biomedical equipment technician on the functionality of medical equipment in the government hospitals of rural Nepal.
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Thapa R, Yih A, Chauhan A, Poudel S, Singh S, Shrestha S, Tamang S, Shrestha R, and Rajbhandari R
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- Government, Hospitals, Public, Humans, Nepal, Workforce, Maintenance and Engineering, Hospital
- Abstract
Background: Medical equipment plays a crucial role in the provision of quality healthcare services, despite this more than 50% of equipment in developing countries are non-functioning due to a lack of appropriate human resources to maintain. To address this problem some government hospitals of Nepal have deployed a mid-level technical cadre called 'Biomedical Equipment Technician' (BMET). This study aims to evaluate the effectiveness of deploying a BMET on the functionality of medical equipment in government hospitals of rural Nepal., Methods: We used a mixed-methods approach with a comparative research design. A comprehensive range of 2189 pieces of medical equipment at 22 hospitals with and without BMET were observed to assess their functional status. Medical equipment were stratified into 6 categories based on department and T tests were conducted. We collected qualitative data from 9 BMETs, 22 medical superintendents, and 22 health staff using semi-structured interviews and focus-group discussions. Thematic content analysis was conducted to explore how the BMET's work was perceived., Findings: The quantity of non-functional devices in hospitals without BMETs was double that of hospitals with BMETs (14% and 7% respectively, p < 0.005). Results were similar across all departments including General (16% versus 3%, p = 0.056), Lab (15% versus 7%, p < 0.005) and Operation Theater (14% versus 5%, p < 0.005). Hospitals with BMETs had fewer overall non-functional devices requiring simple or advanced repair compared to hospitals without BMETs [3% versus 7% (p < 0.005) simple; 4% versus 6% (p < 0.005) advanced]. In our qualitative analysis, we found that BMETs were highly appreciated by hospital staff. Hospital workers perceived that having a BMET on staff, rather than twice-yearly visits from central-level maintenance technicians, is an effective way to keep medical equipment functional. However, without a favorable working environment, the BMET alone cannot perform optimally., Conclusions: Having a BMET at a rural government hospital has a substantial positive effect on the functional status of medical devices at the hospital. BMETs should be deployed at all rural hospitals to increase the functionality of medical devices, thereby improving the working environment and quality of health services provided., (© 2022. The Author(s).)
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- 2022
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45. Clinical spectrum and management of dystonia in patients with Japanese encephalitis: A systematic review.
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Aryal R, Shrestha S, Homagain S, Chhetri S, Shrestha K, Kharel S, Karn R, Rajbhandari R, Gajurel BP, and Ojha R
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- Humans, Quality of Life, Dystonia complications, Dystonia therapy, Dystonic Disorders therapy, Encephalitis, Japanese complications, Encephalitis, Japanese diagnosis, Encephalitis, Japanese therapy, Movement Disorders complications
- Abstract
Background: Japanese encephalitis (JE) is a potentially fatal viral infection with a wide range of manifestations and can also present with a variety of movement disorders (MD) including dystonia. Dystonic features in JE are uncommon. Here, we have tried to summarize the clinical features and management of dystonia among JE patients with a comprehensive literature search., Methods: Various databases, including PubMed, Embase, and Google Scholar, were searched against the predefined criteria using suitable keywords combination and boolean operations. Relevant information from observational and case studies was extracted according to the author, dystonic features, radiological changes in the brain scans, treatment options, and outcome wherever provided., Result: We identified 19 studies with a total of 1547 JE patients, the diagnosis of which was confirmed by IgM detection in serum and/or cerebrospinal fluid in the majority of the patients (88.62%). 234 (15.13%) of JE patients had dystonia with several types of focal dystonia being present in 131 (55.98%) either alone or in combination. Neuroimaging showed predominant involvement of thalami, basal ganglia, and brainstem. Oral medications including anticholinergics, GABA agonists, and benzodiazepines followed by botulinum toxin were the most common treatment modalities., Conclusion: Dystonia can be a disabling consequence of JE, and various available medical therapies can significantly improve the quality of life. Owing to insufficient studies on the assessment of dystonia associated with JE, longitudinal studies with a larger number of patients are warranted to further clarify the clinical course, treatment, and outcome of dystonia., (© 2022 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)
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- 2022
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46. Magnetic resonance imaging abnormalities in encephalomyelitis due to paralytic rabies: A case report.
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Gajurel BP, Gautam N, Shrestha A, Bogati N, Bista M, Ojha R, Rajbhandari R, and Karn R
- Abstract
The diagnosis of rabies, a potentially fatal neuroinfectious disease, should be strongly considered in all patients who develop encephalitis following an infected animal bite even when they have received post-exposure prophylaxis. In the absence of confirmatory tests, typical magnetic resonance imaging findings help confirm the clinical diagnosis of rabies., Competing Interests: The authors do not have any conflicts of interests., (© 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)
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- 2022
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47. Maternity Waiting Home Interventions as a Strategy for Improving Birth Outcomes: A Scoping Review and Meta-Analysis.
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Smith S, Henrikson H, Thapa R, Tamang S, and Rajbhandari R
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- Delivery, Obstetric, Female, Health Services Accessibility, Humans, Male, Observational Studies as Topic, Parturition, Pregnancy, Prenatal Care, Maternal Health Services
- Abstract
Background and Objective: Over 300 000 women worldwide die due to pregnancy-related complications annually, with most occurring in developing countries where access to skilled obstetric care is limited. Maternity waiting homes (MWHs) are one intervention designed to increase access to skilled prenatal care in resource-limited settings. MWHs are defined as accommodations at or near a health facility where pregnant women can stay in the final weeks of their pregnancy so they can be easily transferred to the health facility to give birth. While MWHs have existed for decades, evidence regarding their effectiveness in reducing adverse birth outcomes has been mixed. The objective of this study is to comprehensively assess all available MWH research reporting quantitative maternal and childbirth data to determine whether MWHs are an effective maternal health strategy in resource-limited settings., Methodology: We conducted a scoping review and meta-analysis of existing literature on MWHs according to PRISMA guidelines. Descriptive statistics and odds ratios were calculated for the following birth outcomes: maternal mortality, perinatal mortality, and caesarian section. Quantitative analysis was conducted in RStudio and Stata Version 16., Results: One hundred seventy-one records were retrieved from our initial database search, of which 66 were identified as relevant. Only 15 of these records reported quantitative data on the health outcomes of interest and therefore met inclusion criteria for our meta-analysis. All studies reporting maternal mortality demonstrated a protective effect of MWHs (aggregate OR: 0.19 [0.10, 0.40]), as did all studies reporting perinatal mortality (aggregate OR: 0.29 [0.16, 0.53]). Studies reporting caesarian section were more varied and indicated less of a protective effect (aggregate OR: 1.80 [1.18, 2.75])., Conclusions: There is some indication that MWHs are an effective strategy for reducing maternal and perinatal mortality in resource-limited settings. However, our analysis was constrained by the observational design of most prior MWH studies. More rigorous MWH evaluations, ideally in the form of randomized-control trials, are needed to better determine MWH effectiveness., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2022 The Author(s).)
- Published
- 2022
- Full Text
- View/download PDF
48. Cerebral venous sinus thrombosis with concomitant subdural hemorrhage and subarachnoid hemorrhages involving cerebral convexity and perimesenchephalic regions: A case report.
- Author
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Gajurel BP, Shrestha A, Gautam N, Rajbhandari R, Ojha R, and Karn R
- Abstract
We should suspect cerebral venous sinus thrombosis in patients with subacute onset progressive headaches with brain imaging evidence of localized cerebral edema with superimposed parenchymal, convexity subarachnoid as well as subdural hemorrhages., Competing Interests: The authors do not have any conflicts of interests., (© 2021 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)
- Published
- 2021
- Full Text
- View/download PDF
49. Paraparetic Guillain-Barre syndrome: An uncommon diagnosis of acute flaccid paralysis of the lower limbs.
- Author
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Luitel P, Neupane N, Adhikari N, Paudel S, Gajurel BP, Karn R, Rajbhandari R, Gautam N, Shrestha A, and Ojha R
- Abstract
Apart from the usual differentials of transverse myelitis and cord compression, paraparetic GBS should be considered when sudden, flaccid paralysis of the lower limbs occurs, as prompt diagnosis and management can minimize sequel and unnecessary procedures. We do report a case wherein we managed a similar situation without the use of an immunomodulatory therapy., Competing Interests: The authors declare they have no conflicts of interest., (© 2021 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)
- Published
- 2021
- Full Text
- View/download PDF
50. Recurrent Bilateral Optic Neuritis Associated with Myelin Oligodendrocyte Glycoprotein Antibody: A Case Report from Nepal.
- Author
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Shah S, Ojha R, Sitaula S, Regmi D, Karn R, Gajurel BP, Rajbhandari R, Gautam N, Paudel S, and Shrestha A
- Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an immune-mediated inflammatory condition involving spinal cord and optic nerves. Diagnosis of NMOSD is done by aquaporin-4 antibody (AQP4) in patients with optic neuritis. Myelin oligodendrocyte glycoprotein (MOG) expressed on the oligodendrocyte cell surface and on the outermost cell surface of the myelin sheath may also be present in patients with NMOSD bilateral optic neuritis. Here, we describe a case of a thirty-nine-year-old-female with recurrent bilateral optic neuritis with positive anti-MOG antibody, and anti-MOG syndrome has not previously been reported from Nepal., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Sangam Shah et al.)
- Published
- 2021
- Full Text
- View/download PDF
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