subash sapkota

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Cilnidipine for Amlodipine Induced Pedal Edema and its Anti-hypertensive Effect in a Tertiary Care Teaching Hospital of Western Nepal

Journal of Nepal Health Research Council, 2021

BACKGROUND Hypertension is the most common cardiovascular disease. In Nepal, 27.3% populations ar... more BACKGROUND Hypertension is the most common cardiovascular disease. In Nepal, 27.3% populations are suffering from hypertension. Amlodipine is the most frequently prescribed anti-hypertensive drug. Up to 15% of patients develop pedal edema with amlodipine that may lead to discontinuation. Cilnidipine, a new calcium channel blocker, found equally effective and edema is uncommon in different studies from India. We aimed to study anti-hypertensive effect and to assess resolution of amlodipine induced Pedal edema with clinidipine. METHODS This was a prospective, single centre observational study. Study was conducted in the department of cardiology, Manipal teaching hospital from 7th May to 6th November 2020. Hypertensive Patients who were on amlodipine for at least 6 months and presented with pedal edema were enrolled for the study. RESULTS Total of 107 patients were enrolled for the study. The mean age of patients was 56.35 ± 12.84 years, ranged from 29 to 85 years and more than half(52...

Apical Variant of Hypertrophic Cardiomyopathy and Systemic Scleroderma- A Hint for Autoimmune Mechanism?

Journal of Clinical & Experimental Cardiology, 2012

We present a 75-year-old female, Ms. W, with systemic scleroderma and Hypertrophic Cardiomyopathy... more We present a 75-year-old female, Ms. W, with systemic scleroderma and Hypertrophic Cardiomyopathy (HCM) who was evaluated for one-year history of swelling in her ankles and feet. Cardiac auscultation revealed a left lower sternal border ejection systolic murmur that increased with Valsalva maneuver. ECG was consistent with Left Ventricular (LV) hypertrophy whereas transthoracic echocardiogram and cardiac MRI revealed increased LV wall thickness with asymmetric involvement of the apex and circumferential pericardial effusion. Although genetic mutations of cardiomyocyte sarcomeric proteins have been implicated in HCM, screening in several HCM cohorts have failed to identify genetic mutations in a substantial proportion of cases. A predisposition for HCM with certain human leukocyte antigen subtypes has been reported. In addition, an increased prevalence of HCM has been reported in chronic hepatitis C virus infection, a disease with multiple extra-hepatic autoimmune manifestations. Thus the occurrence of HCM in patients with autoimmune diseases such as systemic scleroderma may indicate potential autoimmune mechanism. Studies testing the hypothesis that autoimmune mechanisms are involved in producing the HCM phenotype, at least in patients with no identifiable genetic mutation affecting sarcomeric proteins, are needed.

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Bitter Gourd Poster

A study of variations in formation of superficial palmar arch in Nepalese cadavers

Journal of Gandaki Medical College-Nepal, 2021

Introduction: The superficial palmar arch (SPA) is the main source of arterial supply to the palm... more Introduction: The superficial palmar arch (SPA) is the main source of arterial supply to the palm. It is an arterial arcade formed mainly by the ulnar artery and is completed by the superficial palmar branch of the radial artery. The study was conducted with objective to study the variations in formation of superficial palmar arch in Nepalese cadaveric hands. Methodology: Two horizontal incisions were made, one at the wrist joint and another incision along the root of fingers. A vertical incision was made from the middle of the wrist to the 3rd metacarpo-phalangeal joint. The skin of the palm and the palmar aponeurosis was reflected. The surrounding adipose tissue was removed to view the superficial palmar arch and its branches. Result: In present study, out of 50 specimens of hands, 64% of superficial palmar arch was formed as normal pattern and in 36% cases it was formed by ulnar artery alone. Normal SPA pattern was seen 63% in male and 66.7% in female i.e. higher percentage in fe...

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Barraquer‐Simons syndrome in systemic lupus erythematosus: A case report

Clinical Case Reports, 2021

This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmer... more

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Perception of Problem Based Learning by Undergraduate Dental Students in Basic Medical Science

Journal of Nepal Health Research Council, 2021

BACKGROUND Problem based learning is self-directed form of learning. Problem of Diabetes Mellitus... more BACKGROUND Problem based learning is self-directed form of learning. Problem of Diabetes Mellitus was chosen. The objective was to evaluate perception of students towards Problem based learning and test their understanding. METHODS A descriptive study was conducted from November 2019 till October 2020. An online Problem based learning session of a week was conducted to second-year Bachelors of Dental Surgery students using online applications. Tutors facilitated students in a group of five to six each. Pre-post testing of evaluation questions was done. At end of session, feedback of students on Problem based learning and tutor of Problem based learning were received with 'Dolmans and Schmidt' and 'Dolmans and Ginns' questionnaire. RESULTS There was increase in correct response in nine out of 12 evaluation questions. Most students agreed to influence of discussion, content tested, course objectives, lectures, tutor and reference literature. The students agreed that tu...

A Study of Anatomical Shape of arch projected by Alveolar Process of Maxillary and Mandibular Bone

The alveolar process is that part of maxilla and mandible that forms and supports the sockets of ... more The alveolar process is that part of maxilla and mandible that forms and supports the sockets of teeth. The roots of teeth are suspended in the socket by the attachment of periodontal ligament. The joint between the alveolar socket and the root of teeth is called ‘Gomphosis’ which is fibrous joint. The alveolar bone is a projection from basal part of jaw to accommodate the roots of teeth. That is why it is called alveolar process. The curvilinear alignment of teeth confirms the anatomical shape of alveolar process which is known as ‘alveolar arch’. Anatomy of alveolar arch deals with morphology of alveolar arch in terms of shape. It is an anthropometric study as the study is exploring the distribution of anatomical form of alveolar arch in population. The basic pattern of tooth position in the arch is the alveolar arch form. The curving structures are formed by a line described by the buccal surfaces or through the central grooves of the molars and bicuspids of the teeth in their no...

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Socio-economic impacts of out migration on maize production in Rolpa district, Nepal

Azarian Journal of Agriculture, 2020

Labor migration has profound effects on agriculture production. It is increasing in the mid-hills... more Labor migration has profound effects on agriculture production. It is increasing in the mid-hills of Nepal, and it leads to labor scarcity in agriculture. This study explored the effects of outmigration on maize production. The study was conducted at Rolpa Municipality and Sunil Smriti Rural Municipality, Rolpa district, Nepal. A total of 100 households with 50 respondents from migrant households and 50 respondents from nonmigrant households were selected using a random sampling technique. Key informants interview, focus group discussion, and the household survey was used to collect data. Both descriptive and inferential statistical methods were used for the analysis. Results showed that the productivity of maize in non-migrated households was 2.93 t ha-1 which was significantly higher than that in migrated households (2.45 t ha-1). The maize income was decreased by US$ 19.41 in each individual outmigration. The 20% of remittance was used for food and clothing whereas the least share (5%) was invested in agricultural inputs. The adoption of mechanized technology was not significantly affected by remittance. The women's drudgery in the migrated households was found higher as compared to that in non-migrated households. Along with outmigration, it was observed that there was an increasing trend of land abandonment and exit from agriculture in the survey site. Therefore, the government should implement a policy which encourages people to invest remittance in agriculture specifically in the mechanized system that saves time, money, and drudgery.

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Transmission of Gastrointestinal Parasites in between Deer and Livestock Species at buffer zone located within the eastern part of Chitwan National Park, Nepal

Deer are the hoofed ruminants of the order Artiodactyla and suborder Ruminantia in which infectio... more Deer are the hoofed ruminants of the order Artiodactyla and suborder Ruminantia in which infectious disease and parasites are of major concern in their conservation. This specific research helps us to determine the transmission of gastrointestinal parasites between deer and livestock in the buffer zone. The study was conducted in the eastern part of Chitwan National Park from June 2020 to July 2020. Fecal examination for the parasitic load was carried out using Floatation and Sedimentation techniques. 96.49% of the total fecal samples tested for parasitic eggs were found to be positive for the prevalence of gastro-intestinal parasite whereas parasitic prevalence in livestock of Buffer Zone i.e. Sauraha and Bachhauli area was calculated to be 87.30% based on the examination conducted within that same period and same area by the veterinary hospital. Pramphistomum was the most prevalent one in both deer (72.72%) and livestock (52.63%). The finding of this research revealed the higher c...

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Effect of mulching materials and plant spacing on growth, sex expression and yield of bitter gourd (Momordica charantia) cv. Paalee in Chitwan, Nepal

Azarian Journal of Agriculture, 2019

The field experiment was carried out in bitter gourd cv. Paalee in Chitwan during the cropping se... more The field experiment was carried out in bitter gourd cv. Paalee in Chitwan during the cropping season of March-May, 2019. 4 × 2 Factorial Randomized Complete Block Design (RCBD) was conducted with three replications. Four different mulching materials viz. silver plastic mulch, black plastic mulch, straw mulch and a control with no mulch were assigned as first factor whereas second factor consisted of two plant spacing of 1.5m and 1m (plant-to-plant).The analysis revealed that silver plastic mulch recorded highest vine length (468.71 cm), maximum number of nodes per main vine (44.47) and maximum number of branches per main vine (31.57).Days to first male and female flowering, and sex ratio were found significantly (p<0.05) lower in silver plastic mulch as compared to other mulches. Similarly, silver plastic much had highest average fruit length (26.9cm), average fruit diameter (6.95cm), fruit number per plant (16.23), individual fruit weight (285.14g) and fruit yield (61.5 tons ha-1), soil moisture percentage (47.45) and Benefitcost Ratio (BCR) (3.08).The control treatment with no mulch had the lowest of all these parameters. The plant spacing did not significantly (p<0.05) differ for all the characters, except average individual fruit weight, average fruit yield and BCR, which were found higher (265.07g, 50.91 tons/ha and 1.9 respectively in wider spacing. The interaction effects of plant spacing and mulching materials were observed only for average fruit length and average fruit diameter. This study suggests silver plastic mulch as an effective mulching material for better growth and yield of bitter gourd cv. Paalee.

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Prevalence of wormian bones in dried adult human skulls: an osteo-morphometric study in Nepal

Anatomical Science International, 2018

The purpose of this study was to determine the incidence of wormian bones (WBs) in different head... more The purpose of this study was to determine the incidence of wormian bones (WBs) in different head shapes of Nepalese skulls along with their distribution at various sites. This study was conducted on 70 Nepalese skulls obtained from the Department of Anatomy, Nepal Medical College, and the Institute of Medicine from September 2017 to January 2018. The skulls were examined for the presence and topographic distribution of WBs. The occurrence of WBs at various sites was correlated among different head shapes. The incidence of skulls showing WBs was 88.57%. The WBs were observed at the lambdoid (61.43%), parietomastoid (41.43%), occipitomastoid (27.14%), pterion (25.71%), asterion (24.29%), lambda (11.43%), sagittal (7.14%) and coronal sutures (4.28%). The dominant head type was dolichocephalic (44.29%) and the least dominant was brachycephalic (10%). The maximum number of WBs was shown on brachycephalic (mean 8.86 ± 7.13) then hyperdolichocephalic (mean 8.33 ± 9.15), mesaticephalic (mean 5.10 ± 4.45) and dolichocephalic heads (mean 4.16 ± 5.30). Brachycephalic heads frequently exhibited WBs at the pterion (57.14%) and at different sutures: lambdoid (71.42%), parietomastoid (57.14%), sagittal (28.57%) and squamous (14.28%). Hyperdolichocephalic heads displayed more lambda (33.33%) and coronal (8.33%) WBs. Similarly, dolichocephalic and mesaticephalic heads showed WBs at the occipitomastoid (35.48%) and asterion (30%), respectively. Inca bones were only identified in three dolichocephalic skulls. Neurosurgeons, radiologists and orthopedists should be careful when doing clinical and surgical procedures on different head shapes of the Nepalese population.

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Correction to: Prevalence of wormian bones in dried adult human skulls: an osteo-morphometric study in Nepal

Anatomical Science International, 2018

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First presentation of Ebstein’s anomaly in an 80-year-old female patient and unusual occurrence of psychiatric illness in her male offsprings

Journal of Advances in Internal Medicine, 2013

An 80-year-old female Ebstein’s anomaly patient presented with palpitation and dyspnea of New Yor... more An 80-year-old female Ebstein’s anomaly patient presented with palpitation and dyspnea of New York Heart Association class III. This is probably the eldest surviving Ebstein’s anomaly patient presenting for the first time with cardiac symptoms at the age of 80 years. She had four sons and two daughters, among whom the first three sons developed psychiatric disorders after 38 years of age, with one son committing suicide because of major depressive episode. This case is unique because of the late age of initial presentation with cardiac problem and the occurrence of psychiatric illness in the male offsprings of the patient. Journal of Advances in Internal Medicine 2013;02(01):21-23 DOI: http://dx.doi.org/10.3126/jaim.v2i1.7634

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An elderly patient of formalin poisoning presenting with hematemesis

Journal of Advances in Internal Medicine, 2012

DOI: http://dx.doi.org/10.3126/jaim.v1i2.6527 Journal of Advances in Internal Medicine 2012;01(02... more

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Etiology and Adverse Outcome Predictors of Upper Gastrointestinal Bleeding in 589 Patients in Nepal

Digestive Diseases and Sciences, 2013

Upper gastrointestinal bleeding (UGIB) is a common clinical condition associated with significant... more Upper gastrointestinal bleeding (UGIB) is a common clinical condition associated with significant morbidity and mortality. The purpose of this study was to determine the etiology of UGIB and predict the adverse outcome of variceal and non-variceal UGIB by using the parameters of validated scores. This is a prospective observational study in which 589 UGIB patients underwent upper gastrointestinal endoscopy from May 2010 to April 2013 in Nepal. The variables of Glasgow-Blatchford score (GBS) and Rockall score (RS) were used to predict adverse outcomes, which were defined as transfusion, rebleeding, readmission, surgery and death within 30 days. Among UGIB patients, 33.1 % were variceal and 66.9 % were non-variceal bleeding (peptic ulcers 23.9 %, gastric erosion 16.5 % and others). The adverse outcomes of variceal and non-variceal UGIB were 77.9 % and 72.6 %, respectively. The significant predictors of adverse outcome were hemoglobin and systolic blood pressure in overall UGIB (p &amp;amp;lt; 0.001), blood urea (p = 0.002), melena (p &amp;amp;lt; 0.001) and syncope (p &amp;amp;lt; 0.001) in variceal UGIB, and heart rate, melena, syncope and malignancy in non-variceal UGIB (p &amp;amp;lt; 0.001). The area under receiver operating curve for adverse outcome in overall UGIB was 0.76, 0.80 and 0.94 using clinical RS, complete RS and GBS, respectively (p &amp;amp;lt; 0.001). Variceal bleeding was the leading cause of UGIB in Nepal followed by peptic ulcers and gastric erosion. Those variables of GBS and RS, which were significant predictors of adverse outcome for UGIB, can be utilized in determining more aggressive endoscopic management during endoscopy, or more prolonged intravenous proton pump inhibitor use, or an additional day or two of hospitalization.

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