Publications by authors named "Sushan Homagain"

8 Publications

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Heterotaxy syndrome with complex congenital heart disease, facial palsy, and asplenia: A rare newborn finding.

Clin Case Rep 2021 Aug 7;9(8):e04573. Epub 2021 Aug 7.

Institute of Medicine Maharajgunj Medical Campus Kathmandu Nepal.

Heterotaxy syndrome is associated with asplenia/polysplenia and complex congenital heart disease. Facial palsy in heterotaxy is very rare. The management is still challenging with a poor prognosis. Proper counseling to the family about the disease course, treatment modalities, and outcomes is essential.
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http://dx.doi.org/10.1002/ccr3.4573DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8347632PMC
August 2021

Rebleeding in aneurysm after rectal enema: Re-emphasis on careful subarachnoid hemorrhage management.

Clin Case Rep 2021 Jul 23;9(7):e04538. Epub 2021 Jul 23.

Kathmandu Medical College and Teaching Hospital Kathmandu Nepal.

Rebleeding in an aneurysmal subarachnoid hemorrhage (SAH) is catastrophic with high mortality and grave outcome. Meticulous management of SAH patients and the prevention of activities that might increase the chances of rebleeding are life-saving.
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http://dx.doi.org/10.1002/ccr3.4538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299095PMC
July 2021

Prevalence of vancomycin-resistant enterococci in Asia-A systematic review and meta-analysis.

J Clin Pharm Ther 2021 Oct 25;46(5):1226-1237. Epub 2021 Feb 25.

Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.

What Is Known And Objective: The rise of vancomycin-resistant enterococci (VRE) has been a major health problem in most countries of the world including Asia, since its discovery. There is a paucity of data on VRE in many countries of Asia as well as limited pooled estimates. Therefore, we performed a systematic review and meta-analysis to estimate a pooled prevalence of VRE in Asia.

Methods: A literature search in electronic databases like PubMed, Embase and Google Scholar and manual searching of references and grey literature, comprising the information on the prevalence of VRE with at least two species of enterococci, conducted in different countries of Asia from January 1, 2000, to September 20, 2020, was done. The random-effect model and 95% CIs was used to calculate the pooled prevalence. Subgroup, sensitivity and meta-regression analyses were performed to address heterogeneity while Egger's test for publication bias.

Results And Discussions: We identified 39 studies, comprising a total of 11,875 enterococcal isolates. The result of the analysis showed that the pooled prevalence of VRE in Asia was 8.10% (95% CI; 7-9; I  = 93.79%; p < 0.001). Resistance to vancomycin was greater among strains of E. faecium compared to the strains of E. faecalis (22.40% vs. 3.70%). Amongst various regions of Asia, the highest prevalence of VRE was found in the Western Asian region and the lowest in the South-east Asian region. Moreover, the rate of VRE was higher than most European countries and lower than USA.

What Is New And Conclusions: With an upsurge of VRE in Asia in recent years, efficient infection control programmes, robust surveillance systems and adherence to antibiotic stewardship are paramount to halt the further rise of VRE.
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http://dx.doi.org/10.1111/jcpt.13383DOI Listing
October 2021

Portal hypertension: An uncommon presentation of Caroli's syndrome.

Clin Case Rep 2020 Dec 24;8(12):3134-3138. Epub 2020 Sep 24.

Department of Gastrointestinal Surgery Tribhuvan University Teaching Hospital Kathmandu Nepal.

Portal hypertension is not a classical presentation of Caroli's syndrome. However, some young children can present with overt signs and symptoms indicative of advanced disease state despite the improvement in imaging technology which has decreased its diagnostic age. High index of clinical suspicion can help in timely diagnosis and management.
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http://dx.doi.org/10.1002/ccr3.3374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752578PMC
December 2020

Giant cell glioblastoma in 6-year-old kid: Report of an unusual case.

Clin Case Rep 2020 Dec 14;8(12):2936-2940. Epub 2020 Sep 14.

Department of Pathology Tribhuwan University Teaching Hospital Kathmandu Nepal.

Pediatric giant cell glioblastoma, a highly malignant and lethal tumor, can only be distinguished from glioblastoma multiforme histologically. Though it is said to have a better prognosis, adequate evidence in favor is lacking. Early diagnosis with gross total resection and adjuvant chemotherapy might increase the survival period.
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http://dx.doi.org/10.1002/ccr3.3102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752560PMC
December 2020

healthy South Asians.

JGH Open 2020 Dec 12;4(6):1037-1046. Epub 2020 Oct 12.

Maharajgunj Medical Campus Tribhuvan University Institute of Medicine Kathmandu Nepal.

We aimed to estimate the pooled prevalence of among asymptomatic South Asians based on available literature and highlight the importance of screening asymptomatic individuals and implementing preventive strategies for eradicating . Electronic databases such as PubMed and Embase, a regional database of WHO South Asian Region, and gray literature sites were searched for relevant studies from 1983 to 5 May 2020. In addition, references of the included studies were thoroughly searched. The random-effect model was used to calculate the pooled prevalence with a 95% confidence interval (CI) along with subgroup analysis. Analysis of 19 studies showed a pooled prevalence of 56.5%, ranging from 10.3 to 91.7%. In subgroup analysis by country, the highest prevalence rate was reported from Bangladesh (86.3%, 95% CI: 0.806-0.921), whereas the lowest prevalence was from Sri Lanka (10.3%, 95% CI: 0.072-0.135). No differences were found between males and females. Prevalence among children and adolescents was 65.3% (95% CI: 0.529-0.777), greater than adults, 56.9% (95% CI: 0.353-0.785). The prevalence rate showed a decreasing trend upon comparison of studies conducted before and after 2000. Our analysis reveals the high prevalence of infection among asymptomatic healthy populations in South Asia, particularly in children and adolescents. Public health awareness and sanitation interventions, pure drinking water, and respective strategies on a policy level to eradicate and additional extensive multicentric cohort studies are necessary.
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http://dx.doi.org/10.1002/jgh3.12426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731813PMC
December 2020

Bilateral ovarian edema with unilateral ovarian leiomyoma and double inferior vena cava: a case report.

J Med Case Rep 2020 Jul 12;14(1):97. Epub 2020 Jul 12.

Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.

Background: Ovarian edema, ovarian leiomyoma, and double inferior vena cava are all rare clinical entities. The coexistence of all these entities has not been yet reported in the literature.

Case Presentation: We report a case of a 25-year-old nulliparous tamang woman with all these rare clinical entities, who presented with a complaint of right-sided lower abdominal pain. After examination and investigation, an ovarian tumor was suspected and laparotomy was performed during which bilateral ovarian edema with a solid tumor on the left side was identified and left salpingo-oophorectomy was done preserving her right ovary. A histopathological examination confirmed the clinical findings.

Conclusions: As ovarian edema is a rare entity, due to lack of clinical suspicion it is often overdiagnosed as a malignant tumor leading to radical surgery with subsequent loss of hormonal function and early infertility. A high degree of clinical suspicion during the intraoperative period is helpful for diagnosis to avoid unnecessary oophorectomy and infertility.
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http://dx.doi.org/10.1186/s13256-020-02418-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354687PMC
July 2020

Calvarial Tuberculosis: A Diagnostic Quandary: A Case Report.

JNMA J Nepal Med Assoc 2019 May-Jun;57(217):198-201

Department of Neurosurgery, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.

Primary Calvarial Tuberculosis, a rare entity of skull is even rarer after second decade of life in a healthy person without evidence of tuberculosis elsewhere in the body. Most of the cases are often misdiagnosed as osteomyelitis/syphilis/bony metastasis. We report a case of primary skull tuberculosis in 26-year-old male with complains of headache and swelling in the right frontal region with no history of previous tuberculosis. The patient was operated and the histopathological examination of excised tissue was suggestive of tubercular pathology. The patient is doing well after anti-tubercular therapy. Being a rare disease, tubercular osteomyelitis of skull bones is often missed and misdiagnosed due to lack of clinical suspicion and slow growth of mycobacterium cultures. Histopathological examination of biopsy material and demonstration of acid-fast bacilli in the pus are helpful for diagnosis and early management of the disease. Keywords: calvaria; Mycobacterium; osteomyelitis; tuberculosis.
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February 2020
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