Avinash Chandra - Academia.edu (original) (raw)

Papers by Avinash Chandra

Journal of Neurology and Neurophysiology, Nov 16, 2013

Life Science Journal

To date there is very few clinical studies published on the cognitive characteristics in patients... more To date there is very few clinical studies published on the cognitive characteristics in patients with SCA3 in China, we sought to evaluate the cognitive function in a cohort of clinically diagnosed and molecularly confirmed patients with SCA3 in China. The neuropsychological tests that were used to evaluate the cognitive function consisted of the Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), Digit Cancellation Test (DC), Digit Symbol Substitution Test (DSST), Stroop Color-Word Test (SCWT), Trial-Making Test (TMT), Verbal Fluency Test (VFT), and Wechsler Intelligence Scale-Digit Span Test (WISC-DST). The psychiatric symptoms were assessed by the Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD). The severity of motor symptoms was evaluated by the Scale for the Assessment and Rating of Ataxia (SARA). 15 patients with genetically confirmed SCA3 and 15 normal control subjects were enrolled in the study. There was no significant difference in age, gend...

Life Science Journal

Objective: On the basis of current evidence, treatment delay is minimal if patients contact the e... more Objective: On the basis of current evidence, treatment delay is minimal if patients contact the emergency medical services（EMS） or attend an emergency department (ED) immediately after minor stroke or high-risk transient ischemic attack (TIA). Little is known about the factors that can influence these actions in China.. Methods: Data were collected from university affiliated hospital records from March 2010 to March 2012, and a questionnaire was administered that included questions about socio-demographics, self-reported risk factors and hospital arrival. Potential impact factors of utilizing EMS or attending ED were analyzed by both univariate and multivariate logistical regression. Results: Of 4247 patients who sought medical attention within 24 hours, 61.05%(2593) used EMS or attended ED after minor stroke or high-risk TIA. Multivariate analysis demonstrated that consciousness dysfunction(OR 3.129, 95% CI 2.397 to 4.084) at symptom onset, a higher income (≥2001 Yuan/month) (OR 2....

Annapurna journal of health sciences, Feb 21, 2023

Annapurna Journal of Health Sciences

This case reports depicts the effect of scapular stabilization regimen for managing clinical symp... more This case reports depicts the effect of scapular stabilization regimen for managing clinical symptoms of scapular dyskinesis presenting with crepitus during shoulder movement. A 35 old banker with history of peri scapular, shoulder and coracoid area pain with auditory joint noise visited our department. Scapular stabilization exercise regimen with emphasis on normalizing anatomical symmetry, scapular motor control was done for 40 mins, three times a week for 8 weeks. Follow up was maintained once a month after that or as per the need. Measurements included scapular deviations, muscle strength, pain intensity, quality of life and global rate of change. These changes were assessed at the beginning before the intervention, 8 weeks after treatment and during 1 year follow-up. Data shows favourable improvement on pain, strength , scapular symmetry and quality of life. Thus, it can be concluded that the scapular stabilization exercise is helpful in alleviating symptoms related to scapular...

Annapurna Journal of Health Sciences

Introduction: Azathioprine is used as an off - label drug for the treatment of multiple sclerosis... more Introduction: Azathioprine is used as an off - label drug for the treatment of multiple sclerosis. It is one of the oldest and most widely used immunosuppressants that targets T and B lymphocytes and thus reduces the relapse and slows down the disease progression with the almost same efficacy as the other disease modifying drugs for multiple sclerosis. But due to its side effect profile it isn’t used as a standard choice of treatment. However, its cost effectiveness and oral route of administration makes it a drug of choice in a low socioeconomic country. This paper highlights the diagnosis of Multiple Sclerosis based on McDonald’s criteria and treatment with Azathioprine. Methods: It is a retrospective analysis was conducted among 32 patients suffering from Multiple sclerosis and treated with Azathioprine at tertiary neurological institue.Patients outcome was also documented reaching them individually. Results: Among 19 patients all were female with highest prevalence among age gro...

Clinical Case Reports, 2022

Cerebral Venous Thrombosis is a rare extra‐intestinal manifestation of ulcerative colitis. Ulcera... more Cerebral Venous Thrombosis is a rare extra‐intestinal manifestation of ulcerative colitis. Ulcerative colitis is a hypercoagulable state and, if poorly managed, can predispose to thrombosis, including thrombosis of the cerebral veins.

Asian Journal of Neurosurgery

"I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, na... more "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.

Journal of Stroke and Cerebrovascular Diseases, 2021

Background: Stroke related studies in Nepal are primarily hospital-based and mainly from the capi... more Background: Stroke related studies in Nepal are primarily hospital-based and mainly from the capital city. We aimed to estimate the prevalence of stroke and stroke risk factors in the SouthWestern community of Nepal. Methods: A cross-sectional study was conducted from May to August 2018 among 549 randomly selected Nepalese participants from diverse ethnicity, aged ≥15 years, in a region with the availability of neurological support facilities. Data were collected using a stroke questionnaire designed for the purpose. Stroke was identified by enumerators using the Balance-Eyes-Face-Arms-Speech-Time (BEFAST) scale, and a senior neurologist confirmed it. We assessed the presence of major risk factors associated with stroke. Results: The crude and age-standardised prevalence of stroke were 2368 and 2967 per 100,000 respectively. Of all the surveyed participants, 61% (n=335) reported consumption of full-fat dairy products >3 days per week, 87.6% (n=481) reported a high intake of salt (>5g/day), 83.6% (n=459) with a low intake of fruits and vegetables (<400g/day), 45.2% (n=248) with perceived stress related to work or home, 51.6% (n=283) with financial stress (283, 51.6%), 86.7% (n=457) with low high-density lipoprotein (HDL), 96.2% (n=507) with high blood urea nitrogen, 47.1% (n=356) were either overweight or obese 20.4% (n=112) with hypertension and 6.2% (n=34) with diabetes. Conclusion: The prevalence of stroke in the community of the SouthWestern part of Nepal is relatively higher than that estimated in South-Asia and global context. Our findings suggest an urgent community intervention, particularly with healthy lifestyles changes for future stroke prevention in the high-risk group.

Background A periodic state of rest accompanied by varying degree of unconsciousness and relative... more Background A periodic state of rest accompanied by varying degree of unconsciousness and relative inactivity, the sleep is vital to human health, insufficiency of which can lead to serious problem with physical and mental health consequences. Because of COVID-19 Pandemic, Nepal is under a total lockdown, with total restrictions on the movement of individual in the entire nation, forcing people to home confinement. People are extremely worried about their and families’ health as well as lost or verge of losing jobs. The daily news of increasing COVID-19 cases inside nation and all around the globe is adding to the fear that leads to anger, anxiety, frustration, and stress that directly affects the quality of sleep. Objectives The study aimed to assess the quality of sleep before and after COVID-19 pandemic among Nepalese residents. Method: A cross-sectional study was conducted that recruited 206 Nepalese residents. The participants completed an anonymous, self-administered questionna...

Biomedical Journal of Scientific and Technical Research, 2020

The rapid spread of infection has devastated the already weak health care system of Low-Middle -I... more The rapid spread of infection has devastated the already weak health care system of Low-Middle -Income Countries (LMICs) and...

Journal of College of Medical Sciences-Nepal, 2021

Introduction: The co-existence of anxiety disorders in patients with neurological and neurosurgic... more Introduction: The co-existence of anxiety disorders in patients with neurological and neurosurgical disease is in association with barriers to treatment and worsening medical outcomes. This study aims to identify the prevalence and correlation of anxiety in a tertiary neurological center in Kathmandu, Nepal. Methods: This was a hospital-based cross-sectional study conducted at a tertiary neurological center in Kathmandu in patients undergoing major neurosurgical procedure. A semi-structured questionnaire including socio-demographic characteristics and medical history were used to collect data. Nepali translated Hospital Anxiety Scale, AUDIT, and Fragesterum Questionnaire were used to assess the anxiety level, alcohol dependence and tobacco dependence among the participants respectively. Chi-square tests and multiple logistic regression were used to test the association of anxiety with independent variables. Results: A total of 260 patients participated in this study with the mean a...

Nepal Journal of Neuroscience, 2016

Central Pontine Demyelination is a neurological disease caused by rapidly fl uctuating serum osmo... more Central Pontine Demyelination is a neurological disease caused by rapidly fl uctuating serum osmolality resulting in severe damage of the myelin sheath of nerve cells in the brainstem, more precisely in the area of pons. This condition is associated with electrolyte disorders, especially severe hyponatremia and its rapid correction. Its clinical course is characterized by alterations in the mental status to debilitating neurological status i.e. coma. Chronic hyponatremia and its correction, with or without evaluating safe limit could result in pontine demyelination. Demyelination might also occur with normal sodium levels, and even if serum sodium levels are corrected within safe limits. The objective of this case report is to give a broad perspective on Central Pontine Demyelination and to discuss about the different factors contributing to the demyelination and the various causes, pathophysiology and the management of this condition. Nepal Journal of Neuroscience. Vol. 13, No. 2, ...

Case reports in oncology, 2013

For a long time, head injury has been considered as a possible causative factor for later develop... more For a long time, head injury has been considered as a possible causative factor for later development of brain tumors. However, the actual role of previous head trauma in the pathogenesis of intracranial tumors is still a matter of debate, also due to the possible medico-legal implications. Some authors have suggested several criteria for establishing a possible causal relationship between the aforementioned factors. We report a case of a left posterior paraventricular high-grade glioma which developed 20 years after a posttraumatic hematoma occurring in the same area. This case is reported in detail and the relevant literature is reviewed.

Life Research, 2020

Background: Recently, there has been a surge in research worldwide on vitamin D. based on interna... more Background: Recently, there has been a surge in research worldwide on vitamin D. based on international level, Vit. D has shown positive correlation with cardio-cerebrovascular disorders. Regarding possible role of vitamin D there is paucity of research in low-and middle-income nations that are nearer to the equatorial area. Despite of abundant sunlight exposure, Asian people are developing hypovitaminosis D need a special consideration to avoid excessive and unnecessary usage of it. This study aims to detect the situation of vitamin D in Nepalese population and secondly to find out the suitable normalized reference range for serum vitamin D in multi-ethnic Nepalese population. Methods: A hospital based prospective study was conducted using purposive sampling technique to select 107 subjects. In-vivo and in vitro bio-physiological method was used to collect serum vitamin D level. Result: The present study showed that 32% of participants had deficit (< 15 ng/mL), 48% of subjects had insufficient (15 to < 30 ng/mL) and 20% of participants had sufficient serum level of Vitamin-D (> 30 ng/mL). Study showed that there is a lower degree of positive relationship of body mass index (r = 0.162, P = 0.094) and significant association of history of chronic illness (χ 2 = 0.10, P = 0.03), timing of occurrence of stroke (χ 2 = 11.41, P = 0.017) and diagnosis (χ 2 = 21.19, P = 0.011) with serum vitamin-D level at P < 0.05. Conclusion: There is a direct significant association of serum vitamin D with socio-demographic variables when international unit is considered. Neurological disorder showed positive association with serum vitamin D level.

Postgraduate Medical Journal, 1981

Central pontine myelinolysis was found histologically in a young man who died with Hodgkin's lymp... more Central pontine myelinolysis was found histologically in a young man who died with Hodgkin's lymphoma. Clinically he had developed a progressive peripheral sensory deficit, ataxia, quadriparesis, dysarthria, incontinence and drowsiness. This is the fifth case reported in the British literature. The pathogenesis and aetiology of this primary demyelinating disease are considered.

Veins and Lymphatics, 2017

Increased collateral facial vein (FV) flow may be associated with structural damage in patients w... more Increased collateral facial vein (FV) flow may be associated with structural damage in patients with multiple sclerosis (MS). The objective was to assess differences in FV flow and magnetic resonance imaging (MRI)-derived outcomes in MS. The study included 136 MS patients who underwent neck and head vascular system examination by echo-color Doppler. Inflammatory MRI markers were assessed on a 3T MRI using a semi-automated edge detection and contouring/ thresholding technique. MRI volumetric outcomes of whole brain (WB), gray matter (GM), white matter (WM), cortex, ventricular cerebrospinal fluid (vCSF), deep gray matter (DGM), thalamus, caudate nucleus (CN), putamen, globus pallidus (GP), and hippocampus were calculated. Independent t-test and ANCOVA, adjusted for age, were used to compare groups based on FV flow quartiles. Thirty-four MS patients with FV flow ≤327.8 mL/min (lowest quartile) had significantly lower WB (P<0.001), WM (P<0.001), thalamus (P=0.004), cortex (P=0.00...

Nepal Journal of Neuroscience, 2016

Chiari Malformation-I is a congenital disorder characterized by the anatomical defect of the base... more Chiari Malformation-I is a congenital disorder characterized by the anatomical defect of the base of skull with tonsillar herniation (≥5 mm) below the foramen magnum, which is detected on MRI. It has a diverse range of symptoms with non-specific presentation leading to the chances of misdiagnosis and untimely recognition of the disorder. Syringomyelia is the most common result of Chiari-I. The selection of surgical or non-surgical management depends upon the patient symptoms and the presence of absence of Syringomyelia. The objective of this case report is to give a broad perspective on Chiari Malformation-I from the symptoms and clinical findings obtained in a patient with Syringomyelia associated with Chiari Malformation-I and to discuss about the different surgical options as well as the psychological support required for the management of the condition.Nepal Journal of Neuroscience. Vol. 13, No. 2, 2016, Page: 105-108

Nepal Journal of Neuroscience, 2018

Cerebral Venous Thrombosis (CVT) is a rare form of Stroke characterized by thrombus formation in ... more Cerebral Venous Thrombosis (CVT) is a rare form of Stroke characterized by thrombus formation in the cerebral veins. CVT is a result of various reasons among which the hyperthyroidism is not so frequently encountered. This is probably the first case report published from Nepal. The aim of this case report is to give the message that persistent severe headache in patient with hyperthyroidism can be the red flag and needs to be investigated further. We present a case of a 35 years old female who presented with complaints of severe headache and persistent in nature associated with vomiting since 5 days. She was a diagnosed subacute thryroiditis and under medicine from 1 month before presenting to us. Her Magnetic Resonance Venography (MRV) brain showed venous thrombosis within superior saggital sinus, left transverse sinus and sigmoid sinus. Her thyroid function test showed pretreatment T3 of 2.98 ng/ml T4 of 1.02 mg/ ml and TSH of 0.12 μIU/L. She was kept on anticoagulants and other s...

BMC Neurology, 2019

Background: No longitudinal, long-term, follow-up studies have explored the association between p... more Background: No longitudinal, long-term, follow-up studies have explored the association between presence and severity of variations in extracranial venous anatomy, and clinical outcomes in patients with multiple sclerosis (MS). Objective: This prospective 5-year follow-up study assessed the relationship of variations in extracranial venous anatomy, indicative of chronic cerebrospinal venous insufficiency (CCSVI) on Doppler sonography, according to the International Society for Neurovascular Disease (ISNVD) proposed consensus criteria, with clinical outcomes and disease progression in MS patients. Methods: 90 MS patients (52 relapsing-remitting, RRMS and 38 secondary-progressive, SPMS) and 38 age-and sexmatched HIs were prospectively followed for 5.5 years. Extracranial and transcranial Doppler-based venous hemodynamic assessment was conducted at baseline and follow-up to determine the extent of variations in extracranial venous anatomy. Change in Expanded Disability Status Scale (ΔEDSS), development of disability progression (DP) and annualized relapse rate (ARR) were assessed. Results: No significant differences were observed in MS patients, based on their presence of variations in extracranial venous anatomy at baseline or at the follow-up, in ΔEDSS, development of DP or ARR. While more MS patients had ISNVD CCSVI criteria fulfilled at baseline compared to HIs (58% vs. 37%, p = 0.03), no differences were found at the 5-year follow-up (61% vs. 56%, p = 0.486). Discussion: This is the longest follow-up study assessing the longitudinal relationship between the presence of variations in extracranial venous anatomy and clinical outcomes in MS patients. Conclusion: The presence of variations in extracranial venous anatomy does not influence clinical outcomes over the 5-year follow-up in MS patients.

Journal of Neurology and Neurophysiology, Nov 16, 2013

Life Science Journal

To date there is very few clinical studies published on the cognitive characteristics in patients... more To date there is very few clinical studies published on the cognitive characteristics in patients with SCA3 in China, we sought to evaluate the cognitive function in a cohort of clinically diagnosed and molecularly confirmed patients with SCA3 in China. The neuropsychological tests that were used to evaluate the cognitive function consisted of the Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), Digit Cancellation Test (DC), Digit Symbol Substitution Test (DSST), Stroop Color-Word Test (SCWT), Trial-Making Test (TMT), Verbal Fluency Test (VFT), and Wechsler Intelligence Scale-Digit Span Test (WISC-DST). The psychiatric symptoms were assessed by the Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD). The severity of motor symptoms was evaluated by the Scale for the Assessment and Rating of Ataxia (SARA). 15 patients with genetically confirmed SCA3 and 15 normal control subjects were enrolled in the study. There was no significant difference in age, gend...

Life Science Journal

Objective: On the basis of current evidence, treatment delay is minimal if patients contact the e... more Objective: On the basis of current evidence, treatment delay is minimal if patients contact the emergency medical services（EMS） or attend an emergency department (ED) immediately after minor stroke or high-risk transient ischemic attack (TIA). Little is known about the factors that can influence these actions in China.. Methods: Data were collected from university affiliated hospital records from March 2010 to March 2012, and a questionnaire was administered that included questions about socio-demographics, self-reported risk factors and hospital arrival. Potential impact factors of utilizing EMS or attending ED were analyzed by both univariate and multivariate logistical regression. Results: Of 4247 patients who sought medical attention within 24 hours, 61.05%(2593) used EMS or attended ED after minor stroke or high-risk TIA. Multivariate analysis demonstrated that consciousness dysfunction(OR 3.129, 95% CI 2.397 to 4.084) at symptom onset, a higher income (≥2001 Yuan/month) (OR 2....

Annapurna journal of health sciences, Feb 21, 2023

Annapurna Journal of Health Sciences

This case reports depicts the effect of scapular stabilization regimen for managing clinical symp... more This case reports depicts the effect of scapular stabilization regimen for managing clinical symptoms of scapular dyskinesis presenting with crepitus during shoulder movement. A 35 old banker with history of peri scapular, shoulder and coracoid area pain with auditory joint noise visited our department. Scapular stabilization exercise regimen with emphasis on normalizing anatomical symmetry, scapular motor control was done for 40 mins, three times a week for 8 weeks. Follow up was maintained once a month after that or as per the need. Measurements included scapular deviations, muscle strength, pain intensity, quality of life and global rate of change. These changes were assessed at the beginning before the intervention, 8 weeks after treatment and during 1 year follow-up. Data shows favourable improvement on pain, strength , scapular symmetry and quality of life. Thus, it can be concluded that the scapular stabilization exercise is helpful in alleviating symptoms related to scapular...

Annapurna Journal of Health Sciences

Introduction: Azathioprine is used as an off - label drug for the treatment of multiple sclerosis... more Introduction: Azathioprine is used as an off - label drug for the treatment of multiple sclerosis. It is one of the oldest and most widely used immunosuppressants that targets T and B lymphocytes and thus reduces the relapse and slows down the disease progression with the almost same efficacy as the other disease modifying drugs for multiple sclerosis. But due to its side effect profile it isn’t used as a standard choice of treatment. However, its cost effectiveness and oral route of administration makes it a drug of choice in a low socioeconomic country. This paper highlights the diagnosis of Multiple Sclerosis based on McDonald’s criteria and treatment with Azathioprine. Methods: It is a retrospective analysis was conducted among 32 patients suffering from Multiple sclerosis and treated with Azathioprine at tertiary neurological institue.Patients outcome was also documented reaching them individually. Results: Among 19 patients all were female with highest prevalence among age gro...

Clinical Case Reports, 2022

Cerebral Venous Thrombosis is a rare extra‐intestinal manifestation of ulcerative colitis. Ulcera... more Cerebral Venous Thrombosis is a rare extra‐intestinal manifestation of ulcerative colitis. Ulcerative colitis is a hypercoagulable state and, if poorly managed, can predispose to thrombosis, including thrombosis of the cerebral veins.

Asian Journal of Neurosurgery

"I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, na... more "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.

Journal of Stroke and Cerebrovascular Diseases, 2021

Background: Stroke related studies in Nepal are primarily hospital-based and mainly from the capi... more Background: Stroke related studies in Nepal are primarily hospital-based and mainly from the capital city. We aimed to estimate the prevalence of stroke and stroke risk factors in the SouthWestern community of Nepal. Methods: A cross-sectional study was conducted from May to August 2018 among 549 randomly selected Nepalese participants from diverse ethnicity, aged ≥15 years, in a region with the availability of neurological support facilities. Data were collected using a stroke questionnaire designed for the purpose. Stroke was identified by enumerators using the Balance-Eyes-Face-Arms-Speech-Time (BEFAST) scale, and a senior neurologist confirmed it. We assessed the presence of major risk factors associated with stroke. Results: The crude and age-standardised prevalence of stroke were 2368 and 2967 per 100,000 respectively. Of all the surveyed participants, 61% (n=335) reported consumption of full-fat dairy products >3 days per week, 87.6% (n=481) reported a high intake of salt (>5g/day), 83.6% (n=459) with a low intake of fruits and vegetables (<400g/day), 45.2% (n=248) with perceived stress related to work or home, 51.6% (n=283) with financial stress (283, 51.6%), 86.7% (n=457) with low high-density lipoprotein (HDL), 96.2% (n=507) with high blood urea nitrogen, 47.1% (n=356) were either overweight or obese 20.4% (n=112) with hypertension and 6.2% (n=34) with diabetes. Conclusion: The prevalence of stroke in the community of the SouthWestern part of Nepal is relatively higher than that estimated in South-Asia and global context. Our findings suggest an urgent community intervention, particularly with healthy lifestyles changes for future stroke prevention in the high-risk group.

Background A periodic state of rest accompanied by varying degree of unconsciousness and relative... more Background A periodic state of rest accompanied by varying degree of unconsciousness and relative inactivity, the sleep is vital to human health, insufficiency of which can lead to serious problem with physical and mental health consequences. Because of COVID-19 Pandemic, Nepal is under a total lockdown, with total restrictions on the movement of individual in the entire nation, forcing people to home confinement. People are extremely worried about their and families’ health as well as lost or verge of losing jobs. The daily news of increasing COVID-19 cases inside nation and all around the globe is adding to the fear that leads to anger, anxiety, frustration, and stress that directly affects the quality of sleep. Objectives The study aimed to assess the quality of sleep before and after COVID-19 pandemic among Nepalese residents. Method: A cross-sectional study was conducted that recruited 206 Nepalese residents. The participants completed an anonymous, self-administered questionna...

Biomedical Journal of Scientific and Technical Research, 2020

The rapid spread of infection has devastated the already weak health care system of Low-Middle -I... more The rapid spread of infection has devastated the already weak health care system of Low-Middle -Income Countries (LMICs) and...

Journal of College of Medical Sciences-Nepal, 2021

Introduction: The co-existence of anxiety disorders in patients with neurological and neurosurgic... more Introduction: The co-existence of anxiety disorders in patients with neurological and neurosurgical disease is in association with barriers to treatment and worsening medical outcomes. This study aims to identify the prevalence and correlation of anxiety in a tertiary neurological center in Kathmandu, Nepal. Methods: This was a hospital-based cross-sectional study conducted at a tertiary neurological center in Kathmandu in patients undergoing major neurosurgical procedure. A semi-structured questionnaire including socio-demographic characteristics and medical history were used to collect data. Nepali translated Hospital Anxiety Scale, AUDIT, and Fragesterum Questionnaire were used to assess the anxiety level, alcohol dependence and tobacco dependence among the participants respectively. Chi-square tests and multiple logistic regression were used to test the association of anxiety with independent variables. Results: A total of 260 patients participated in this study with the mean a...

Nepal Journal of Neuroscience, 2016

Central Pontine Demyelination is a neurological disease caused by rapidly fl uctuating serum osmo... more Central Pontine Demyelination is a neurological disease caused by rapidly fl uctuating serum osmolality resulting in severe damage of the myelin sheath of nerve cells in the brainstem, more precisely in the area of pons. This condition is associated with electrolyte disorders, especially severe hyponatremia and its rapid correction. Its clinical course is characterized by alterations in the mental status to debilitating neurological status i.e. coma. Chronic hyponatremia and its correction, with or without evaluating safe limit could result in pontine demyelination. Demyelination might also occur with normal sodium levels, and even if serum sodium levels are corrected within safe limits. The objective of this case report is to give a broad perspective on Central Pontine Demyelination and to discuss about the different factors contributing to the demyelination and the various causes, pathophysiology and the management of this condition. Nepal Journal of Neuroscience. Vol. 13, No. 2, ...

Case reports in oncology, 2013

For a long time, head injury has been considered as a possible causative factor for later develop... more For a long time, head injury has been considered as a possible causative factor for later development of brain tumors. However, the actual role of previous head trauma in the pathogenesis of intracranial tumors is still a matter of debate, also due to the possible medico-legal implications. Some authors have suggested several criteria for establishing a possible causal relationship between the aforementioned factors. We report a case of a left posterior paraventricular high-grade glioma which developed 20 years after a posttraumatic hematoma occurring in the same area. This case is reported in detail and the relevant literature is reviewed.

Life Research, 2020

Background: Recently, there has been a surge in research worldwide on vitamin D. based on interna... more Background: Recently, there has been a surge in research worldwide on vitamin D. based on international level, Vit. D has shown positive correlation with cardio-cerebrovascular disorders. Regarding possible role of vitamin D there is paucity of research in low-and middle-income nations that are nearer to the equatorial area. Despite of abundant sunlight exposure, Asian people are developing hypovitaminosis D need a special consideration to avoid excessive and unnecessary usage of it. This study aims to detect the situation of vitamin D in Nepalese population and secondly to find out the suitable normalized reference range for serum vitamin D in multi-ethnic Nepalese population. Methods: A hospital based prospective study was conducted using purposive sampling technique to select 107 subjects. In-vivo and in vitro bio-physiological method was used to collect serum vitamin D level. Result: The present study showed that 32% of participants had deficit (< 15 ng/mL), 48% of subjects had insufficient (15 to < 30 ng/mL) and 20% of participants had sufficient serum level of Vitamin-D (> 30 ng/mL). Study showed that there is a lower degree of positive relationship of body mass index (r = 0.162, P = 0.094) and significant association of history of chronic illness (χ 2 = 0.10, P = 0.03), timing of occurrence of stroke (χ 2 = 11.41, P = 0.017) and diagnosis (χ 2 = 21.19, P = 0.011) with serum vitamin-D level at P < 0.05. Conclusion: There is a direct significant association of serum vitamin D with socio-demographic variables when international unit is considered. Neurological disorder showed positive association with serum vitamin D level.

Postgraduate Medical Journal, 1981

Central pontine myelinolysis was found histologically in a young man who died with Hodgkin's lymp... more Central pontine myelinolysis was found histologically in a young man who died with Hodgkin's lymphoma. Clinically he had developed a progressive peripheral sensory deficit, ataxia, quadriparesis, dysarthria, incontinence and drowsiness. This is the fifth case reported in the British literature. The pathogenesis and aetiology of this primary demyelinating disease are considered.

Veins and Lymphatics, 2017

Increased collateral facial vein (FV) flow may be associated with structural damage in patients w... more Increased collateral facial vein (FV) flow may be associated with structural damage in patients with multiple sclerosis (MS). The objective was to assess differences in FV flow and magnetic resonance imaging (MRI)-derived outcomes in MS. The study included 136 MS patients who underwent neck and head vascular system examination by echo-color Doppler. Inflammatory MRI markers were assessed on a 3T MRI using a semi-automated edge detection and contouring/ thresholding technique. MRI volumetric outcomes of whole brain (WB), gray matter (GM), white matter (WM), cortex, ventricular cerebrospinal fluid (vCSF), deep gray matter (DGM), thalamus, caudate nucleus (CN), putamen, globus pallidus (GP), and hippocampus were calculated. Independent t-test and ANCOVA, adjusted for age, were used to compare groups based on FV flow quartiles. Thirty-four MS patients with FV flow ≤327.8 mL/min (lowest quartile) had significantly lower WB (P<0.001), WM (P<0.001), thalamus (P=0.004), cortex (P=0.00...

Nepal Journal of Neuroscience, 2016

Chiari Malformation-I is a congenital disorder characterized by the anatomical defect of the base... more Chiari Malformation-I is a congenital disorder characterized by the anatomical defect of the base of skull with tonsillar herniation (≥5 mm) below the foramen magnum, which is detected on MRI. It has a diverse range of symptoms with non-specific presentation leading to the chances of misdiagnosis and untimely recognition of the disorder. Syringomyelia is the most common result of Chiari-I. The selection of surgical or non-surgical management depends upon the patient symptoms and the presence of absence of Syringomyelia. The objective of this case report is to give a broad perspective on Chiari Malformation-I from the symptoms and clinical findings obtained in a patient with Syringomyelia associated with Chiari Malformation-I and to discuss about the different surgical options as well as the psychological support required for the management of the condition.Nepal Journal of Neuroscience. Vol. 13, No. 2, 2016, Page: 105-108

Nepal Journal of Neuroscience, 2018

Cerebral Venous Thrombosis (CVT) is a rare form of Stroke characterized by thrombus formation in ... more Cerebral Venous Thrombosis (CVT) is a rare form of Stroke characterized by thrombus formation in the cerebral veins. CVT is a result of various reasons among which the hyperthyroidism is not so frequently encountered. This is probably the first case report published from Nepal. The aim of this case report is to give the message that persistent severe headache in patient with hyperthyroidism can be the red flag and needs to be investigated further. We present a case of a 35 years old female who presented with complaints of severe headache and persistent in nature associated with vomiting since 5 days. She was a diagnosed subacute thryroiditis and under medicine from 1 month before presenting to us. Her Magnetic Resonance Venography (MRV) brain showed venous thrombosis within superior saggital sinus, left transverse sinus and sigmoid sinus. Her thyroid function test showed pretreatment T3 of 2.98 ng/ml T4 of 1.02 mg/ ml and TSH of 0.12 μIU/L. She was kept on anticoagulants and other s...

BMC Neurology, 2019

Background: No longitudinal, long-term, follow-up studies have explored the association between p... more Background: No longitudinal, long-term, follow-up studies have explored the association between presence and severity of variations in extracranial venous anatomy, and clinical outcomes in patients with multiple sclerosis (MS). Objective: This prospective 5-year follow-up study assessed the relationship of variations in extracranial venous anatomy, indicative of chronic cerebrospinal venous insufficiency (CCSVI) on Doppler sonography, according to the International Society for Neurovascular Disease (ISNVD) proposed consensus criteria, with clinical outcomes and disease progression in MS patients. Methods: 90 MS patients (52 relapsing-remitting, RRMS and 38 secondary-progressive, SPMS) and 38 age-and sexmatched HIs were prospectively followed for 5.5 years. Extracranial and transcranial Doppler-based venous hemodynamic assessment was conducted at baseline and follow-up to determine the extent of variations in extracranial venous anatomy. Change in Expanded Disability Status Scale (ΔEDSS), development of disability progression (DP) and annualized relapse rate (ARR) were assessed. Results: No significant differences were observed in MS patients, based on their presence of variations in extracranial venous anatomy at baseline or at the follow-up, in ΔEDSS, development of DP or ARR. While more MS patients had ISNVD CCSVI criteria fulfilled at baseline compared to HIs (58% vs. 37%, p = 0.03), no differences were found at the 5-year follow-up (61% vs. 56%, p = 0.486). Discussion: This is the longest follow-up study assessing the longitudinal relationship between the presence of variations in extracranial venous anatomy and clinical outcomes in MS patients. Conclusion: The presence of variations in extracranial venous anatomy does not influence clinical outcomes over the 5-year follow-up in MS patients.