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Search Results: 1 - 10 of 53769 matches for " David Shrestha "
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A Novel Surgical Approach to Traumatic Intracranial Epidural Hematoma  [PDF]
David Shrestha, Liang Feng
Open Access Library Journal (OALib Journal) , 2017, DOI: 10.4236/oalib.1103820
Objective: Traumatic intracranial epidural hematoma is considered to be the serious complication of head injury requiring appropriate evaluation and surgical intervention. Although craniotomy provides an effective evacuation of the hematoma, there is an insufficient data to support one particular surgical treatment method. The objective of this study is to address the effectiveness of Urokinase instillation via single burr hole in different time interval. Method: Forty two patients with traumatic epidural hematoma, ranging between 15 and 71 years who meet the inclusion criteria were selected for the retrospective study. All the patients were surgically treated in the First Affiliated Hospital of Liaoning Medical University from January 2013 to June 2015. Result: The common complication encountered in this study was headache, dizziness, fever and re-bleeding. In Group-A, 4 (19%) patients complained of headache, 5 (23.8%) dizziness, 1 (4.7%) fever and re-bleeding occurred in 2 (9.5%) patients. In Group-B, 2 (9.5%) patients complained of headache, 1 (4.7%) dizziness, 1 (4.7%) fever and 1 (4.7%) re-bleeding. Out of forty two patients, 3 (7.1%) patients encountered re-bleeding and received craniotomy. In this study, Group B demonstrates better outcome than Group A (P < 0.028). Conclusion: Single burr hole with Urokinase instillation is safe, feasible and effective technique in the treatment of traumatic epidural hematoma in selected cases where close regular clinical and radiological monitoring is possible.
Olfactory Groove Meningioma Extension to Paranasal Sinus and Nasal Cavity: Combined Approach by Unilateral Subfrontal and Endoscopic Endonasal  [PDF]
David Shrestha, Feng Liang, Bibek Gyanwali
Open Access Library Journal (OALib Journal) , 2015, DOI: 10.4236/oalib.1102218
Abstract: The local extension of olfactory groove meningioma into the paranasal sinuses and nasal cavity eroding underlying bone in young patients is considered as an unusual and extremely rare event. We report the case of a 25-year-old female of primary growth of olfactory groove meningioma extension to left ethmoidal sinus and nasal cavity, presented with sudden onset of seizure after delivering a baby. Although olfactory groove meningioma can grow to extreme size with unnoticed symptoms, frequent nasal obstruction, unilateral headache and gradual loss of smell are described. Head image revealed large mass into the anterior cranial fossa extending into the paranasal sinus and left nasal cavity containing cancellous bone. Considering the possibility of postoperative morbidity and mortality, complete removal of large tumor and the dura tail that extends beyond its attachment at skull base becomes challenging. The combined unilateral subfrontal and endoscopic endonasal approach is applied to achieve the Simpson grade-I removal.
Comparative prevalence of MRSA in two Nepalese tertiary care hospitals  [PDF]
Bidya Shrestha
Open Journal of Clinical Diagnostics (OJCD) , 2013, DOI: 10.4236/ojcd.2013.32013
Abstract: This comparative study has been focused on the prevalence of MRSA types and their antibiotic resistance in two tertiary care hospitals of Nepal. During November 2007 to June 2009, clinical samples from patients with nosocomial infection from two Nepali hospitals, Kathmandu Based Hospital (KBH) and Lalitpur Based Hospital (LBH) were cultured and antibiotic susceptibility tests done following standard methodology in Microbiology laboratory, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Occurrence of MRSA (52.9% of 304 Staphylococcus aureus isolates) in KBH and that of MSSA (62% of 100 S. aureus isolates) in LBH were significant. No association of age was observed with MRSA or MSSA. Among MSSA from both hospitals, the highest resistance was found against penicillin. KBH urinary isolates were resistant to norfloxacin (51.4%), while isolates from other sites were resistant to ciprofloxacin (30.6%), erythromycin (12%), gentamicin (10.3%). LBH isolates were resistant to co-trimoxazole (22.6%), erythromycin (17.2%), ciprofloxacin (13.8%), gentamicin (12.9%). Among MRSA, most of the isolates from both hospitals were resistant to a wide array of antibiotics. A majority of the MSSA and MRSA isolates were susceptible to rifampicin and chloramphenicol. Most of KBH MRSA were homogeneous MRSA, 80.5% (significant), of which, 99.2% were multiresistant oxacillin resistant S. aureus (MORSA). And among the heterogeneous MRSA isolates from KBH, 71% were MORSA. On the other hand, among LBH MRSA isolates, 52.6% were homogeneous MRSA, cent percent of which were MORSA while 47.4% were heterogeneous MRSA of which 44.5% were MORSA. Since almost all of the homogeneous MRSA and most of the heterogeneous MRSA from both hospitals were MORSA, there is a possibility that a hospital acquired S. aureus could be MORSA. Hence, every infected patient should be considered as a potential source of MORSA.
A Probabilistic Fragment-Based Protein Structure Prediction Algorithm
David Simoncini, Francois Berenger, Rojan Shrestha, Kam Y. J. Zhang
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0038799
Abstract: Conformational sampling is one of the bottlenecks in fragment-based protein structure prediction approaches. They generally start with a coarse-grained optimization where mainchain atoms and centroids of side chains are considered, followed by a fine-grained optimization with an all-atom representation of proteins. It is during this coarse-grained phase that fragment-based methods sample intensely the conformational space. If the native-like region is sampled more, the accuracy of the final all-atom predictions may be improved accordingly. In this work we present EdaFold, a new method for fragment-based protein structure prediction based on an Estimation of Distribution Algorithm. Fragment-based approaches build protein models by assembling short fragments from known protein structures. Whereas the probability mass functions over the fragment libraries are uniform in the usual case, we propose an algorithm that learns from previously generated decoys and steers the search toward native-like regions. A comparison with Rosetta AbInitio protocol shows that EdaFold is able to generate models with lower energies and to enhance the percentage of near-native coarse-grained decoys on a benchmark of proteins. The best coarse-grained models produced by both methods were refined into all-atom models and used in molecular replacement. All atom decoys produced out of EdaFold’s decoy set reach high enough accuracy to solve the crystallographic phase problem by molecular replacement for some test proteins. EdaFold showed a higher success rate in molecular replacement when compared to Rosetta. Our study suggests that improving low resolution coarse-grained decoys allows computational methods to avoid subsequent sampling issues during all-atom refinement and to produce better all-atom models. EdaFold can be downloaded from http://www.riken.jp/zhangiru/software/.
Magnitude of Construction Cost and Schedule Overruns in Public Work Projects
Pramen P. Shrestha,Leslie A. Burns,David R. Shields
Journal of Construction Engineering , 2013, DOI: 10.1155/2013/935978
Abstract: This study analyzed 363 Clark County Department of Public Works (CCDPW) projects to determine construction cost and schedule overruns in various types and sizes of the projects. The sample projects were constructed from 1991 to 2008, with a total construction cost of $1.85 billion, equivalent to 2012 cost. A one-factor ANOVA test was conducted to determine whether construction cost and schedule overruns significantly varied based on types and sizes of the projects. The study showed that large, long-duration projects had significantly higher cost and schedule overruns than smaller, short-duration projects. 1. Introduction Consistent cost and time overruns of public works projects are not the best use of taxpayer money. In the current economic downturn where tax revenues are lagging, they are particularly detrimental. In the public sector, money spent on project change orders and increased construction time reduces the number and size of the projects that can be completed during any given fiscal year. Various reasons for construction cost and schedule overruns in any project include design error, inadequate scope, weather, project changes, and underestimating the time needed to complete the project. Items omitted from the engineer’s estimate of the projects due to design errors or inadequate scope frequently result in change orders, which increase cost as well as the time of delivery. Underestimating the construction time is detrimental because another important project may be delayed from going to bid until the current project is completed. Many public projects are extensions of a previous project, and inaccuracies in estimating project cost and construction time can result in improper sequencing of related projects or phasing within projects, thus delaying much needed improvements. Decisions on which projects are to put out for bids are based both on the need for improvement in a current facility or construction of a new facility, which is certainly the most important consideration, and on the engineer’s estimated cost and construction time. Underestimating a project’s cost and time is not in the public’s best interest, particularly in an urban area with a rate of growth such as the one recently experienced in Clark County, Nevada. Therefore, this study determined the magnitude of construction cost and schedule overruns in public projects of Clark County, Nevada, so that necessary actions can be taken to control these overruns in future projects. Further, the study investigated whether the magnitude of construction cost and schedule overruns varies
Long Lead-Time Streamflow Forecasting Using Oceanic-Atmospheric Oscillation Indices  [PDF]
Niroj Kumar Shrestha
Journal of Water Resource and Protection (JWARP) , 2014, DOI: 10.4236/jwarp.2014.66062

Climatic variability influences the hydrological cycle that subsequently affects the discharge in the stream. The variability in the climate can be represented by the ocean-atmospheric oscillations which provide the forecast opportunity for the streamflow. Prediction of future water availability accurately and reliably is a key step for successful water resource management in the arid regions. Four popular ocean-atmospheric indices were used in this study for annual streamflow volume prediction. They were Pacific Decadal Oscillation (PDO), El-Nino Southern Oscillation (ENSO), Atlantic Multidecadal Oscillation (AMO), and North Atlantic Oscillation (NAO). Multivariate Relevance Vector Machine (MVRVM), a data driven model based on Bayesian learning approach was used as a prediction model. The model was applied to four unimpaired stream gages in Utah that spatially covers the state from north to south. Different models were developed based on the combinations of oscillation indices in the input. A total of 60 years (1950-2009) of data were used for the analysis. The model was trained on 50 years of data (1950-1999) and tested on 10 years of data (2000-2009). The best combination of oscillation indices and the lead-time were identified for each gage which was used to develop the prediction model. The predicted flow had reasonable agreement with the actual annual flow volume. The sensitivity analysis shows that the PDO and ENSO have relatively stronger effect compared to other oscillation indices in Utah. The prediction results from the MVRVM were compared with the Support Vector Machine (SVM) and the Artificial Neural Network (ANN) where MVRVM performed relatively better.

Mortality and Morbidity Pattern of Preterm Babies at a Tertiary Level Hospital in Nepal
Laxman Shrestha,Prabina Shrestha
Journal of Nepal Paediatric Society , 2013, DOI: 10.3126/jnps.v33i3.9200
Abstract: Introduction: Preterm birth is a major determinant of neonatal mortality and morbidity and has long-term adverse consequences for health. The objectives of this study were to find the demographic characteristics and clinical course of preterm babies admitted at Neonatal Unit of TU Teaching Hospital. Materials and Methods: A retrospective study was done by collecting data from labour room, NICU and by reviewing medical records of all preterm babies admitted to NICU in 2011. Results: There were total of 266 preterm deliveries in TUTH in the year 2011. About 45% of them required NICU admission. Ninety five babies were included in the study. Most common cause of premature delivery was maternal pregnancy induced hypertension (26%). Other causes were preterm premature rupture of membrane (24%) and in 25% of cases the cause was unknown. There were 10 (10.5%) severe preterm babies with mean weight 1.4 ± 0.3 kg, 27 (28.5 %) moderate preterm babies with mean weight 1.8 ± 0.4 kg and 58 (61%) late preterm babies with mean weight 2.2 ± 0.5 kg. Respiratory distress syndrome (RDS) was seen in 32% babies, hyperbilirubinemia in 40% babies, sepsis occurred in 37% and NEC in 4%. Hypothermia was seen in 10.5% and hypoglycemia in 5% babies. Apnea of prematurity was seen in 7% babies. Mechanical ventilation was required in 7% babies. The overall mortality was 12%. The main causes of death were respiratory distress syndrome and sepsis. The mean duration of stay was 10.2±8.8days. The survival rate of severe preterm babies was 80%, moderate preterm babies was 78% while that of late preterm was 95%. Conclusion: The main causes of morbidities in preterm babies were respiratory distress, hyperbilirubinemia and sepsis. Respiratory distress syndrome and sepsis were the predominant causes of mortality in these babies. DOI: http://dx.doi.org/10.3126/jnps.v33i3.9200 J. Nepal Paediatr. Soc. 2013;33(3):201-205
Clinical Profile of Paediatric Cataract and Surgery in a Tertiary Eye Care Centre, Nepal
UD Shrestha,MK Shrestha
Journal of Nepal Paediatric Society , 2012, DOI: 10.3126/jnps.v32i1.5378
Abstract: Introduction: Paediatric cataract is the opacification of lens and its capsule in children below 14 years of age. The management of paediatric cataract is lens aspiration with or without anterior vitrectomy, with or without intra-ocular lens implantation. The objective was to present the profile of pediatric cataract of operated eyes in children ≤14 years.
Ultrasonographically detected renal fusion anomalies in Western Region of Nepal
OK Shrestha,GL Shrestha
Journal of Chitwan Medical College , 2014, DOI: 10.3126/jcmc.v4i2.10857
Abstract: To establish the incidence and patterns of renal fusion anomalies based on Ultrasonography (USG) in Western region of Nepal. In 2 years period, patients undergoing abdominal USG at Gandaki Medical College between 2010 and 2012 were screened for renal fusion anomalies. After identification, incidence and male:female ratio were stratified for total renal fu-sion anomalies, horseshoe kidney, crossed fused ectopia and fused pelvic kidney. Out of 31498 patients who underwent abdominal USG, there were 71(1:444) cases of renal fusion anomalies, 61 (1:516) of horseshoe kidneys, 9 (1:3500) of crossed-fused ectopia and 1 (1:31498) of fused pelvic kidney. Male:Female ratio was 1:2 for horseshoe kidney and 1.25:1 for crossed fused ectopia. Renal fusion anomalies are rare congenital malformation. USG is a sensitive and reliable modality for its detection. Horseshoe kidney is the most common renal fusion anomaly followed by crossed fused ectopia. Our ultrasonograhic evaluation for incidence of renal fusion anomalies closely matches past autopsy and radiographic data. DOI: http://dx.doi.org/10.3126/jcmc.v4i2.10857 Journal of Chitwan Medical College 2014; 4(2): 25-28
Visceral fat versus subcutaneous fat: comparison of their association with type 2 diabetes mellitus
OK Shrestha,GL Shrestha
Journal of Chitwan Medical College , 2014, DOI: 10.3126/jcmc.v4i2.10853
Abstract: To compare abdominal visceral fat with subcutaneous fat in relation to their association with type 2 diabetes. Abdominal fat distribution was measured using Computed Tomography in 60 subjects (30 diabetics and 30 non-diabetics). Computed tomography images obtained at two intervertebral locations L2-L3 and L4-L5 were used to measure areas of total fat, visceral fat and subcutaneous fat using slice thickness of 5mm and attenuation range of -190 to -30 Hounsfield units. Data were analyzed using logistic regression. At L2-L3 level, taking visceral fat and subcutaneous fat as predictor variables, diabetes was correctly classified at 78.0% and 66.10% respectively. At L4-L5 level, taking visceral fat and subcutaneous fat as predictor variables, diabetes was correctly classified at 72.88% and 67.80% respectively. Regardless of the measurement site, visceral fat has significantly stronger association with diabetes, compared to subcutaneous fat. Visceral fat at L2-L3 level alone may be a better predictor of diabetes. Abdominal fat distribution, visceral fat, subcutaneous fat, type 2 diabetes. DOI: http://dx.doi.org/10.3126/jcmc.v4i2.10853 Journal of Chitwan Medical College 2014; 4(2): 9-12
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