Sagar Devkota | NATIONAL ACADEMY OF MEDICAL SCIENCES (original) (raw)

Papers by Sagar Devkota

Clinical Case Reports, Mar 1, 2023

Annals of Medicine & Surgery

Introduction and Importance: Multisystem inflammatory syndrome in children secondary to COVID-19 ... more Introduction and Importance: Multisystem inflammatory syndrome in children secondary to COVID-19 (MIS-C) is very common and may present with clinical features similar to Kawasaki disease but is rarely reported in neonates (MIS-N). Any history of maternal upper respiratory tract infection should raise suspicion of MIS-N secondary to COVID-19 in critically ill neonates. Case Presentation We present a term neonate with gradually progressive respiratory distress requiring mechanical ventilation with marked improvement after starting immunoglobulin and steroids after blood investigations revealed high IgG COVID-19 antibodies titers. Clinical Findings and Investigation: Admitted to the neonatal intensive care unit (NICU) as he received bag and mask ventilation for 30 seconds following delivery, he was kept under oxygen via nasal prongs; but he still had nasal flaring, subcostal retraction and tachypnea. All the blood investigations were within normal limits except for elevated C-reactive ...

Annals of Medicine & Surgery

Introduction and importance: Spontaneous uterine rupture in an unscarred uterus is very rare. It ... more Introduction and importance: Spontaneous uterine rupture in an unscarred uterus is very rare. It is found to be rarer after in-vitro fertilization. It is associated with significant morbidity and mortality if not diagnosed and treated promptly. Case presentation: Thirty three years female with twin pregnancy following in-vitro fertilization after 11 years of marriage presented to emergency department with lower abdominal pain at 36 weeks 3 days of gestation and was planned for emergency caesarean section for precious twin pregnancy in labour. Clinical findings and investigation: She was vitally stable and on palpation of abdomen, there was generalized tenderness along with guarding. All the investigations were within normal limits. Intervention and outcome: Emergency caesarean section was performed under subarachnoid block which revealed a 6×2 cm fundal uterine rupture with no active bleeding which was repaired in layers. The babies were extracted with a lower uterine segment incisi...

Journal of Clinical Gynecology and Obstetrics

Background Sinonasal anatomical variations are common and its knowledge plays an integral part in... more Background Sinonasal anatomical variations are common and its knowledge plays an integral part in the management of sinonasal disease. Although sinonasal anatomic variations have been postulated as a risk factor for sinus disease, its role in the pathogenesis of nasal polyp is still unclear. This study was done to determine the prevalence of sinonasal anatomical variations by CT imaging and examine its association with sinonasal polyposis. Methodology A descriptive cross sectional study was conducted from January, 2019 to January, 2020 at a tertiary care center in Nepal after receiving ethical approval from the Institutional Review Committee of the hospital. Patients above 17 years of age having sinonasal polyp and not responding to 3-4 weeks of medical treatment were included in the study. Convenience sampling was done. Data were collected and entered in Microsoft Excel and analyzed using Statistical Package for the Social Sciences version 24.0. Results Among 72 patients, the preva...

Nepal Journal of Obstetrics and Gynaecology

Aims: To compare the incidence of hypotension after intrathecal administration of hyperbaric bupi... more Aims: To compare the incidence of hypotension after intrathecal administration of hyperbaric bupivacaine and fentanyl in two different syringes against standard injection of mixed fentanyl with hyperbaric bupivacaine. Methods: This was a prospective comparative study conducted in 174 parturients undergoing elective caesarean section at Paropakar Maternity & Women’s Hospital. Hemodynamic effects and characteristics of block were monitored and recorded and compared between the two groups, group S (single syringe) and group D (double syringe). Results: The incidence of hypotension was almost similar in the two groups but the drop in systolic blood pressure and mean arterial pressure at 5 minutes and 7.5 minutes after subarachnoid block was significant in group S as compared to group D (p<0.005 and p<0.005 respectively). Conclusion: Hyperbaric bupivacaine with fentanyl, which when injected separately without mixing, is associated with lesser incidence of hypotension following suba...

Journal of clinical images and medical case reports, Nov 17, 2022

Clinical Case Reports, Nov 1, 2022

INTRODUCTION Deliberate self-harm (DSH) is one of the common psychiatric emergencies in medical p... more INTRODUCTION Deliberate self-harm (DSH) is one of the common psychiatric emergencies in medical practice. It has become a global health problem with rates increasing over time. Very few studies have been conducted on this important health issue in Nepal. We conducted a hospital based study to evaluate the cause, mode and psychiatric comorbidities present in patients of DSH. METHODS This cross sectional study was performed on 200 cases of deliberate self-harm in a tertiary referral centre in Eastern Nepal from April 2012 to July 2012 by the data collected from the medical records of these patients. Various sociodemographic data and psychiatric comorbidities prevalent in them were studied. RESULTS Most of the patients (77%) were below the age of 35. The female-to-male ratio was 1.35:1. 76% of the patients had received formal education. Majority (73.5%) were married. By occupation, 38% were housewives and 25.5% were students. 72.5% of cases had consumed organophosphates/-chlorides. Int...

Annals of Global Health, 2015

An estimated 424,000 fatal falls occur globally each year, making falls the second leading cause ... more An estimated 424,000 fatal falls occur globally each year, making falls the second leading cause of unintentional injury-related deaths after road traffic injuries. More than 80% of fall-related fatalities occur in low- and middle-income countries. Data from low-income South Asian countries like Nepal are lacking, particularly at the population level. The aim of this study was to provide an estimate of fall-injury prevalence and the number of fall injury-related deaths countrywide in Nepal and to describe the epidemiology of fall injuries in Nepal at the community level. A countrywide cross-sectional study was performed in 15 of the 75 districts in Nepal using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool. The SOSAS survey gathers data in 2 sections: demographic data, including the household&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s access to health care and recent deaths in the household, and assessment of a representative spectrum of surgical conditions, including injuries. Data was collected regarding an individuals&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; experience of injury including road traffic injuries, falls, penetrating trauma, and burns. Data included anatomic location, timing of injury, and whether health care was sought. If health care was not sought, the reason for barrier to care was included. Descriptive statistics were used to analyze the data. Of 2695 individuals from 1350 households interviewed, 141 reported injuries secondary to falls (5.2%; 95% confidence interval [CI], 4.4%-6.1%), with a mean age of 30.7 years; 58% were male. Falls represented 37.2% of total injuries (n = 379) reported (95% CI, 32.3%-42.3%). Twelve individuals who suffered from a fall injury were unable to access surgical care (8.5%; 95% CI, 4.5%-14.4%). Reasons for barrier to care included no money for health care (n = 3), facility/personnel not available (n = 7), and fear/no trust (n = 2). Of the 80 recent deaths reported, 7 were due to fall injury (8.8%; 95% CI, 3.6%-17.2%), and patients had a mean age of 46 years (SD 22.8). Surgical care was not delivered to those who died for the following reasons: no time (n = 4), facility/personnel not available (n = 1), fear/no trust (n = 1), and no need (n = 1). The Nepal SOSAS study provides countrywide, population-based data on fall-injury prevalence in Nepal and has identified falls as a crucial public health concern. These data highlight persistent barriers to access to care for the injured and the need to improve trauma care systems in developing countries such as Nepal.

Purpose While an estimated two billion people lack access to surgical care, little data are avail... more Purpose While an estimated two billion people lack access to surgical care, little data are available on surgical conditions for pediatric populations in low-and middleincome countries. Our study aims to assess pediatric surgical needs in Nepal. Methods A countrywide cross-sectional study was performed in 15 randomly chosen districts; 3 clusters (2 rural; 1 urban) per district were selected. The prevalence of surgical conditions, unmet surgical needs, and barriers to care were analyzed among children (0-18 years of age). Results Overall, 1,350 households and 2,695 individuals were surveyed (response rate: 97 %); 800 respondents (29.7 %, 95 % CI 27.9-31.4 %) were pediatric; 59.8 % (95 % CI 56.3-63.2 %) were male; median age was 10 years (IQR 5-15). Of them, 84 (10.5 %, 95 % CI 8.5-12.8 %) had a surgical condition; 48 (6.0 %, 95 % CI 4.5-7.9 %) reported an unmet need for surgical care. Based on this, we estimate that 706,076 (95 % CI 529,557-929,666) children live with untreated surgical conditions. Barriers to care included limited availability of services (31.3 %), funds (22.9 %), time (4.2 %), and fear/mistrust of medical services (16.7 %). Conclusion Close to 700,000 children in Nepal are estimated to need surgical consultation. Programs to address this should be developed alongside efforts by policy makers and donors to rectify the lack of care, bolster limited funds, and strengthen healthcare systems.

Clinical Case Reports, Mar 1, 2023

Annals of Medicine & Surgery

Introduction and Importance: Multisystem inflammatory syndrome in children secondary to COVID-19 ... more Introduction and Importance: Multisystem inflammatory syndrome in children secondary to COVID-19 (MIS-C) is very common and may present with clinical features similar to Kawasaki disease but is rarely reported in neonates (MIS-N). Any history of maternal upper respiratory tract infection should raise suspicion of MIS-N secondary to COVID-19 in critically ill neonates. Case Presentation We present a term neonate with gradually progressive respiratory distress requiring mechanical ventilation with marked improvement after starting immunoglobulin and steroids after blood investigations revealed high IgG COVID-19 antibodies titers. Clinical Findings and Investigation: Admitted to the neonatal intensive care unit (NICU) as he received bag and mask ventilation for 30 seconds following delivery, he was kept under oxygen via nasal prongs; but he still had nasal flaring, subcostal retraction and tachypnea. All the blood investigations were within normal limits except for elevated C-reactive ...

Annals of Medicine & Surgery

Introduction and importance: Spontaneous uterine rupture in an unscarred uterus is very rare. It ... more Introduction and importance: Spontaneous uterine rupture in an unscarred uterus is very rare. It is found to be rarer after in-vitro fertilization. It is associated with significant morbidity and mortality if not diagnosed and treated promptly. Case presentation: Thirty three years female with twin pregnancy following in-vitro fertilization after 11 years of marriage presented to emergency department with lower abdominal pain at 36 weeks 3 days of gestation and was planned for emergency caesarean section for precious twin pregnancy in labour. Clinical findings and investigation: She was vitally stable and on palpation of abdomen, there was generalized tenderness along with guarding. All the investigations were within normal limits. Intervention and outcome: Emergency caesarean section was performed under subarachnoid block which revealed a 6×2 cm fundal uterine rupture with no active bleeding which was repaired in layers. The babies were extracted with a lower uterine segment incisi...

Journal of Clinical Gynecology and Obstetrics

Background Sinonasal anatomical variations are common and its knowledge plays an integral part in... more Background Sinonasal anatomical variations are common and its knowledge plays an integral part in the management of sinonasal disease. Although sinonasal anatomic variations have been postulated as a risk factor for sinus disease, its role in the pathogenesis of nasal polyp is still unclear. This study was done to determine the prevalence of sinonasal anatomical variations by CT imaging and examine its association with sinonasal polyposis. Methodology A descriptive cross sectional study was conducted from January, 2019 to January, 2020 at a tertiary care center in Nepal after receiving ethical approval from the Institutional Review Committee of the hospital. Patients above 17 years of age having sinonasal polyp and not responding to 3-4 weeks of medical treatment were included in the study. Convenience sampling was done. Data were collected and entered in Microsoft Excel and analyzed using Statistical Package for the Social Sciences version 24.0. Results Among 72 patients, the preva...

Nepal Journal of Obstetrics and Gynaecology

Aims: To compare the incidence of hypotension after intrathecal administration of hyperbaric bupi... more Aims: To compare the incidence of hypotension after intrathecal administration of hyperbaric bupivacaine and fentanyl in two different syringes against standard injection of mixed fentanyl with hyperbaric bupivacaine. Methods: This was a prospective comparative study conducted in 174 parturients undergoing elective caesarean section at Paropakar Maternity & Women’s Hospital. Hemodynamic effects and characteristics of block were monitored and recorded and compared between the two groups, group S (single syringe) and group D (double syringe). Results: The incidence of hypotension was almost similar in the two groups but the drop in systolic blood pressure and mean arterial pressure at 5 minutes and 7.5 minutes after subarachnoid block was significant in group S as compared to group D (p<0.005 and p<0.005 respectively). Conclusion: Hyperbaric bupivacaine with fentanyl, which when injected separately without mixing, is associated with lesser incidence of hypotension following suba...

Journal of clinical images and medical case reports, Nov 17, 2022

Clinical Case Reports, Nov 1, 2022

INTRODUCTION Deliberate self-harm (DSH) is one of the common psychiatric emergencies in medical p... more INTRODUCTION Deliberate self-harm (DSH) is one of the common psychiatric emergencies in medical practice. It has become a global health problem with rates increasing over time. Very few studies have been conducted on this important health issue in Nepal. We conducted a hospital based study to evaluate the cause, mode and psychiatric comorbidities present in patients of DSH. METHODS This cross sectional study was performed on 200 cases of deliberate self-harm in a tertiary referral centre in Eastern Nepal from April 2012 to July 2012 by the data collected from the medical records of these patients. Various sociodemographic data and psychiatric comorbidities prevalent in them were studied. RESULTS Most of the patients (77%) were below the age of 35. The female-to-male ratio was 1.35:1. 76% of the patients had received formal education. Majority (73.5%) were married. By occupation, 38% were housewives and 25.5% were students. 72.5% of cases had consumed organophosphates/-chlorides. Int...

Annals of Global Health, 2015

An estimated 424,000 fatal falls occur globally each year, making falls the second leading cause ... more An estimated 424,000 fatal falls occur globally each year, making falls the second leading cause of unintentional injury-related deaths after road traffic injuries. More than 80% of fall-related fatalities occur in low- and middle-income countries. Data from low-income South Asian countries like Nepal are lacking, particularly at the population level. The aim of this study was to provide an estimate of fall-injury prevalence and the number of fall injury-related deaths countrywide in Nepal and to describe the epidemiology of fall injuries in Nepal at the community level. A countrywide cross-sectional study was performed in 15 of the 75 districts in Nepal using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool. The SOSAS survey gathers data in 2 sections: demographic data, including the household&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s access to health care and recent deaths in the household, and assessment of a representative spectrum of surgical conditions, including injuries. Data was collected regarding an individuals&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; experience of injury including road traffic injuries, falls, penetrating trauma, and burns. Data included anatomic location, timing of injury, and whether health care was sought. If health care was not sought, the reason for barrier to care was included. Descriptive statistics were used to analyze the data. Of 2695 individuals from 1350 households interviewed, 141 reported injuries secondary to falls (5.2%; 95% confidence interval [CI], 4.4%-6.1%), with a mean age of 30.7 years; 58% were male. Falls represented 37.2% of total injuries (n = 379) reported (95% CI, 32.3%-42.3%). Twelve individuals who suffered from a fall injury were unable to access surgical care (8.5%; 95% CI, 4.5%-14.4%). Reasons for barrier to care included no money for health care (n = 3), facility/personnel not available (n = 7), and fear/no trust (n = 2). Of the 80 recent deaths reported, 7 were due to fall injury (8.8%; 95% CI, 3.6%-17.2%), and patients had a mean age of 46 years (SD 22.8). Surgical care was not delivered to those who died for the following reasons: no time (n = 4), facility/personnel not available (n = 1), fear/no trust (n = 1), and no need (n = 1). The Nepal SOSAS study provides countrywide, population-based data on fall-injury prevalence in Nepal and has identified falls as a crucial public health concern. These data highlight persistent barriers to access to care for the injured and the need to improve trauma care systems in developing countries such as Nepal.

Purpose While an estimated two billion people lack access to surgical care, little data are avail... more Purpose While an estimated two billion people lack access to surgical care, little data are available on surgical conditions for pediatric populations in low-and middleincome countries. Our study aims to assess pediatric surgical needs in Nepal. Methods A countrywide cross-sectional study was performed in 15 randomly chosen districts; 3 clusters (2 rural; 1 urban) per district were selected. The prevalence of surgical conditions, unmet surgical needs, and barriers to care were analyzed among children (0-18 years of age). Results Overall, 1,350 households and 2,695 individuals were surveyed (response rate: 97 %); 800 respondents (29.7 %, 95 % CI 27.9-31.4 %) were pediatric; 59.8 % (95 % CI 56.3-63.2 %) were male; median age was 10 years (IQR 5-15). Of them, 84 (10.5 %, 95 % CI 8.5-12.8 %) had a surgical condition; 48 (6.0 %, 95 % CI 4.5-7.9 %) reported an unmet need for surgical care. Based on this, we estimate that 706,076 (95 % CI 529,557-929,666) children live with untreated surgical conditions. Barriers to care included limited availability of services (31.3 %), funds (22.9 %), time (4.2 %), and fear/mistrust of medical services (16.7 %). Conclusion Close to 700,000 children in Nepal are estimated to need surgical consultation. Programs to address this should be developed alongside efforts by policy makers and donors to rectify the lack of care, bolster limited funds, and strengthen healthcare systems.