Publications by authors named "Sanjib K Sharma"

12 Publications

  • Page 1 of 1

Rheumatic Heart Disease Screening Among School Children in Central Nepal.

JACC Case Rep 2019 Aug 21;1(2):218-220. Epub 2019 Aug 21.

Department of Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.

Rheumatic heart disease is the most common heart disease in developing countries. This Global Health Report uses the results of screening 28,050 school children clinically with 2-dimensional echocardiography. A total of 1,739 students had cardiac murmur, with the most dominant lesion being rheumatic mitral regurgitation. This report concluded that the burden of rheumatic heart disease is decreasing, but it is still significant in Nepal. That is why echocardiographic screening is important in early diagnosis and management. ().
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http://dx.doi.org/10.1016/j.jaccas.2019.06.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8301538PMC
August 2019

Overcoming barriers and building a strong peritoneal dialysis programme - Experience from three South Asian countries.

Perit Dial Int 2021 Jun 2:8968608211019986. Epub 2021 Jun 2.

Department of Nephrology, Teaching Hospital, Kandy, Sri Lanka.

The development of peritoneal dialysis (PD) programmes in lower-resource countries is challenging. This article describes the learning points of establishing PD programmes in three countries in South Asia (Nepal, Sri Lanka and Pakistan). The key barriers identified were government support (financial), maintaining stable supply of PD fluids, lack of nephrologist and nurse expertise, nephrology community bias against PD, lack of nephrology trainee awareness and exposure to this modality. To overcome these barriers, a well-trained PD lead nephrologist (PD champion) is needed, who can advocate for this modality at government, professional and community levels. Ongoing educational programmes for doctors, nurses and patients are needed to sustain the PD programmes. Support from well-established PD centres and international organisations (International Society of Peritoneal Dialysis (ISPD), International Society of Nephrology (ISN), International Pediatric Nephrology Association (IPNA) are essential.
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http://dx.doi.org/10.1177/08968608211019986DOI Listing
June 2021

Dialysis Care and Dialysis Funding in Asia.

Am J Kidney Dis 2020 05 5;75(5):772-781. Epub 2019 Nov 5.

The George Institute for Global Health, New Delhi, India; The George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Department of Medicine, University of New South Wales, Sydney, Australia; Manipal Academy of Higher Education, Manipal, India.

Asia is the largest and most populated continent in the world, with a high burden of kidney failure. In this Policy Forum article, we explore dialysis care and dialysis funding in 17 countries in Asia, describing conditions in both developed and developing nations across the region. In 13 of the 17 countries surveyed, diabetes is the most common cause of kidney failure. Due to great variation in gross domestic product per capita across Asian countries, disparities in the provision of kidney replacement therapy (KRT) exist both within and between countries. A number of Asian nations have satisfactory access to KRT and have comprehensive KRT registries to help inform practices, but some do not, particularly among low- and low-to-middle-income countries. Given these differences, we describe the economic status, burden of kidney failure, and cost of KRT across the different modalities to both governments and patients and how changes in health policy over time affect outcomes. Emerging trends suggest that more affluent nations and those with universal health care or access to insurance have much higher prevalent dialysis and transplantation rates, while in less affluent nations, dialysis access may be limited and when available, provided less frequently than optimal. These trends are also reflected by an association between nephrologist prevalence and individual nations' incomes and a disparity in the number of nephrologists per million population and per thousand KRT patients.
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http://dx.doi.org/10.1053/j.ajkd.2019.08.005DOI Listing
May 2020

Pattern of glomerular disease and clinicopathological correlation: A single-center study from Eastern Nepal.

Saudi J Kidney Dis Transpl 2018 Nov-Dec;29(6):1410-1416

Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.

The pattern of glomerular disease varies worldwide. In the absence of kidney disease/kidney biopsy registry in Nepal, the exact etiology of different forms of glomerular disease is primarily unknown in our country. We analyzed 175 cases of renal biopsies performed from September 2014 to August 2016 in Internal Medicine Ward at B.P. Koirala Institute of Health Sciences. The most common indication for renal biopsy was nephrotic syndrome (34.9%), followed by systemic lupus erythematosus (SLE) with suspected renal involvement (22.3%). Majority of patients were in the 30-60 years' bracket (57.2%), with the mean age of the patients being 35.37 years. The average number of glomeruli per core was 13, with inadequate sampling in 5.1%. Immunoglobulin A (IgA) nephropathy (17%) was found to be the most common primary glomerular disease, followed by membranous nephropathy (14.6%) and focal segmental glomerulosclerosis (14.6%). The most common secondary glomerular disease was lupus nephritis (LN). Complications associated with renal biopsy were pain at biopsy site in 18% of cases, hematuria in 6%, and perinephric hematoma in 4% cases. Although the most common primary glomerular disease was IgA nephropathy, significantly higher population of SLE with LN among Nepalese in comparison with other developing countries warrants further evaluation. As an initial attempt toward documentation of glomerular diseases in the national context, this study should serve as a stepping stone toward the eventual establishment of a full-fledged national registry of glomerular diseases in Nepal.
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http://dx.doi.org/10.4103/1319-2442.248302DOI Listing
October 2019

A hospital based epidemiological study of snakebite in Western Development Region, Nepal.

Toxicon 2013 Jul 24;69:98-102. Epub 2013 Apr 24.

Ministry of Health and Population, Nepal Government, District Health Office, Sindhuli, Nepal.

Snakebite is an important and serious medical problem throughout the entire terai region of Nepal. But comprehensive study of snakebite epidemiology in Western Development Region of Nepal is scarce. We described the status of snakebite situation in the region based on retrospective data retrieved from 10 snakebite treatment centers during June 2011 to February 2012. We reported six thousand and nine hundred ninety three snakebites in 2008-2010. Of all, we found 640 (9%) cases envenomed and received anti-venom therapy. We recorded the highest number of snakebites in July, August and September, which account 57% of all snakebite victims, during 15.00 and 21.00 h. People aged 11-20 years were mostly victimized by snakebite as compared to other age groups. Female suffered more than male. The average requirement of polyvalent snake anti-venom was 16 vials. Overall, case fatality rate was 13%.
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http://dx.doi.org/10.1016/j.toxicon.2013.04.002DOI Listing
July 2013

Effectiveness of rapid transport of victims and community health education on snake bite fatalities in rural Nepal.

Am J Trop Med Hyg 2013 Jul 8;89(1):145-50. Epub 2013 Apr 8.

Department of Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.

Snake bite is a major public problem in the rural tropics. In southern Nepal, most deaths caused by neurotoxic envenomation occur in the village or during transport to health centers. The effectiveness of victims' transport by motorcycle volunteers to a specialized treatment center, combined with community health education, was assessed in a non-randomized, single-arm, before-after study conducted in four villages (population = 62,127). The case-fatality rate of snake bite decreased from 10.5% in the pre-intervention period to 0.5% during the intervention (relative risk reduction = 0.949, 95% confidence interval = 0.695-0.999). The snake bite incidence decreased from 502 bites/100,000 population to 315 bites/100,000 population in the four villages (relative risk reduction = 0.373, 95% confidence interval = 0.245-0.48), but it remained constant in other villages. Simple educational messages and promotion of immediate and rapid transport of victims to a treatment center decreased the mortality rate and incidence of snake bite in southeastern Nepal. The impact of similar interventions should be assessed elsewhere.
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http://dx.doi.org/10.4269/ajtmh.12-0750DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748471PMC
July 2013

Acute peritoneal dialysis in eastern Nepal.

Perit Dial Int 2003 Dec;23 Suppl 2:S196-9

Dialysis Division, Department of Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal.

Objective: B.P. Koirala Institute of Health Sciences is the only dialysis center outside the capital city of Nepal. Although the burden of renal failure in Nepal is high, limited resources and dialysis facilities are the major constraint on management of acute renal failure (ARF) and acute dialysis in chronic renal failure (CRF). In the present study, carried out from January 2000 to June 2002, we looked into the prospect of introducing peritoneal dialysis (PD) to the district hospitals for treatment of ARF and acute dialysis in CRF.

Patients And Methods: We designed a form to evaluate the causes of renal failure and the indications for, complications of, and outcomes of dialysis. During this study, junior doctors in our hospitals completed the forms. Resident doctors were trained to do intermittent peritoneal dialysis (IPD) and were responsible for the carrying out the procedure under supervision, together with a staff nurse.

Results: A total of 120 patients underwent IPD during the study period, including 66 men and 54 women. The most common indications for acute dialysis in CRF were metabolic acidosis (56%), uremic encephalopathy (45%), and fluid overload (44%). The most common causes of ARF were acute gastroenteritis (20%), sepsis (20%), and septic abortion (16%). Fifteen patients died of sepsis and multi-organ failure.

Conclusions: Lack of dialysis facilities in the geographic periphery means that most patients present late in the course of their disease, as evidenced by severe metabolic acidosis and uremic encephalopathy. Peritoneal dialysis is a simple procedure, easily tolerated by the patient and requiring less expertise than hemodialysis does. Moreover, nursing staff, technicians, and doctors can be easily trained in the technique. Despite certain limitations, PD still has much potential and can be successfully accomplished in district hospitals and less accessible areas.
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December 2003

Protection against snake bites by sleeping under a bed net in southeastern Nepal.

Am J Trop Med Hyg 2007 Jul;77(1):197-9

Travel and Migration Medicine Unit, and Department of Community Medicine, Geneva University Hospitals, Geneva, Switzerland.

Snake bites in persons while they are asleep indoors are associated with a high risk of fatal outcome in southeastern Nepal. The preventive impact of sleeping under a bed net was assessed in four villages in a case-control study. A case was defined as a person with a history of snake bite that occurred indoors while asleep. Cases were matched with controls by village, type of household, sex, and age category. Of the 11,176 households visited, 56 cases, including 13 (23%) with a fatal outcome and 56 controls were included in the analysis. Sleeping under a bed net was a strong protective factor (odds ratio = 0.02, 95% confidence interval = 0.007-0.07, P < 0.0001), whereas the place of sleeping in the household and the use of a cot were not associated with the risk of snake bite. These findings provide further support for use of bed nets in this region.
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July 2007

Prevention programmes of progressive renal disease in developing nations.

Nephrology (Carlton) 2006 Aug;11(4):321-8

Department of Medicine and Transplantation, Ospedali Riuniti di Bergamo, Mario Negri Institute for Pharmacological Research, Bergamo, Italy.

Development of strategies for the early detection and prevention of non-communicable diseases, including kidney disease, is the only realistic strategy to avert an imminent global health and economic crisis and enhance equity in health care worldwide. In this article, we briefly examine the burden of non-communicable diseases, including diabetes, hypertension, cardiovascular disease and how chronic kidney disease (CKD) represents a key integrated element in the setting, even in developing countries. A possible explanation of the increasing number of people who have or are at risk to develop CKD in poor countries is also given. A survey of major screening and intervention programmes performed or ongoing globally is then presented, highlighting differences and hurdles of projects planned in developed or developing nations as well as in unprivileged communities in developed countries. Finally, some recommendations on future steps to implement prevention programmes in emerging worlds are provided.
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http://dx.doi.org/10.1111/j.1440-1797.2006.00587.xDOI Listing
August 2006

Impact of snake bites and determinants of fatal outcomes in southeastern Nepal.

Am J Trop Med Hyg 2004 Aug;71(2):234-8

Department of Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.

Current available data on snake bites in Nepal are based solely on hospital statistics. This community-based study aimed at evaluating the impact of snake bites and determining the risk factors associated with a fatal outcome in southeastern Nepal. A total of 1,817 households, selected by a random proportionate sampling method, were visited by trained field workers in five villages. Extensive data from snake bite victims during the 14 previous months were recorded and analyzed. One hundred forty-three snake bites including 75 bites with signs of envenoming were reported (annual incidence = 1,162/100,000 and 604/100,000, respectively), resulting in 20 deaths (annual mortality rate = 162/100,000). Characteristics of krait bites such as bites occurring inside the house, while resting, and between midnight and 6:00 am were all factors associated with an increased risk of death, as were an initial consultation with a traditional healer, a long delay before transport, and a lack of available transport. An initial transfer to a specialized treatment center and transport by motorcycle were strong protective factors. Among the 123 survivors, wounds required dressing and surgery in 30 (24%) and 10 (8%) victims, respectively, the mean working incapacity period was 15 days, and the mean out-of-pocket expense was 69 U.S. dollars. Snake bite is a major but neglected public health problem in southeastern Nepal. Public health interventions should focus on improving victims' rapid access to anti-snake venom serum by promoting immediate and fast transport to adequate treatment centers, particularly for bites occurring at night.
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August 2004

Primary amoebic meningoencephalitis in a patient with systemic lupus erythematosus.

Scand J Infect Dis 2003 ;35(8):514-6

Department of Medicine, The B.P. Koirala Institute of Health Sciences, Dharan, Nepal.

This report describes a case of primary amoebic meningoencephalitis in a patient with systemic lupus erythematosus. No specific exposure was identified. Treatment with intravenous amphotericin B was associated with marked clinical improvement, but subsequent fatal relapse while still on therapy.
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http://dx.doi.org/10.1080/00365540310009103DOI Listing
October 2003
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