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Article: Cryptococcal Neoformans and Varicella Zoster Meningitis in a Patient With Selective Innate Immunodeficiency: A Case Report.

Karki, Sophiya / Byrd, Kenneth P

2023 Volume 15, Issue 1, Page(s) e33490

Abstract: Cryptococcal neoformans (C. neoformans) and varicella-zoster (VZV) meningitis are opportunistic infections that are primarily seen in immunocompromised patients, including those with HIV, cancer, or receiving transplants. Despite treatment, infection in ... ...

Abstract	Cryptococcal neoformans (C. neoformans) and varicella-zoster (VZV) meningitis are opportunistic infections that are primarily seen in immunocompromised patients, including those with HIV, cancer, or receiving transplants. Despite treatment, infection in immunocompromised patients can be lethal, including those with T-cell dysfunction or deficiency. Whether innate immunodeficiencies also predispose to these infections remains less clear. Here, we report a case of disseminated C. neoformans and VZV meningitis in a young male with idiopathic hypereosinophilic syndrome and hypocomplementemia and no history of HIV infection, malignancy, or transplant. The patient presented with a pulsating headache, myalgia, joint pain, insomnia, night sweats, and subjective fever, along with clusters of vesicular lesions on his neck and back. A lumbar puncture and an MRI of the brain confirmed C. neoformans and VZV meningitis. Vesicular skin lesions proved to be VZV, and blood culture confirmed fungemia, suggesting disseminated disease. We investigated his medical history further to determine the underlying cause of his prior hypereosinophilia and current meningitis. The patient had idiopathic hypereosinophilia with high IgE levels, low complement levels, high rheumatoid factor levels, and an intermittent rash dating back two years, which had been treated intermittently with prednisone and hydroxyurea, with the most recent admission three weeks prior to this admission. Prior to admission, the patient had a peak absolute eosinophil count of 18.6 x10
Language	English
Publishing date	2023-01-07
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.33490
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Article ; Online: Risk Factors of Malnutrition among under Five Children Admitted in Kanti Children's Hospital in Nepal.

Karki, S / Koirala, S / Shrestha, S

Kathmandu University medical journal (KUMJ)

2022 Volume 19, Issue 76, Page(s) 486–493

Abstract: Background World Health Organization (WHO) stated that malnutrition is a major global health and social problem from which many people are suffering, particularly children. Poor feeding and care practices, insufficient nutrient intake, high rate of ... ...

Abstract	Background World Health Organization (WHO) stated that malnutrition is a major global health and social problem from which many people are suffering, particularly children. Poor feeding and care practices, insufficient nutrient intake, high rate of infection and teenage pregnancy are the immediate causes of chronic malnutrition. Objective To identify the risk factors for malnutrition among under five children. Method A case control study was carried out among the mothers having under-5 years' children who were admitted in the Kanti Children's Hospital of Nepal from 1st August 2019 to 7th September 2020. Non-probability purposive sampling technique was used to select 50 children with malnutrition and 100 children without malnutrition matched on age, sex and setting. A structured interview was used to collect data from mothers of both cases and controls. Descriptive and inferential statistics were used to analyze the data. Result Present study reveals that 58% girl got marriage before 20 years. After confounders adjusted, mother's age ≥ 20 years at marriage (OR: 2.74, 95% CI: 0.98-7.63. p=0.05), and mother's age ≥ 20 years at child birth (OR: 7.74, 95% CI: 2.37-25.27. p=0.001), were significantly associated with having malnutrition among under five children. Similarly, accessibility of health facility (OR: 3.31, 95% CI: 1-10.94. p=0.05), fathers who completed master in education (OR: 0.08, 95% CI: 0.01-0.88. p=0.04), children who lived in joint family (OR: 0.25, 95% CI: 0.07-0.86. p=0.03), child < 2.5 kg at birth (OR: 0.18, 95% CI: 0.05-0.62. p=0.01), and second and third or above in order (OR: 0.09, 95% CI: 0.01-1.04. p=0.05) had significantly less chance of having malnutrition. Children's whose birth interval was 2-3 years were significantly (OR: 9.74, 95% CI: 1.16-82.23. p=0.04) associated with the occurrence of malnutrition. Children who had suffered from multiple co-morbidities in last one year were (OR: 4.55, 95% CI: 0.48-43.03. p=0.18) more chance of having malnutrition. Likewise, the mothers who feed colostrum to their child had (OR: 2.28, 95% CI: 0.52- 9.26. p=0.29) almost two-fold less chance of having malnutrition. Mothers who had done exclusive breast feeding ≥ 4 months had (OR: 40.55, 95% CI: 3.35-1.490.92. p=0.008) significantly associated with having malnutrition. Conclusion Low education status of father, living in single family, exclusive breast feeding ≥ 4 months, lack of balance diet were significant risk factors of malnutrition. Based on finding, reliable longitudinal studies, interventions and program to educate parent for prevention of malnutrition are necessary in future.
MeSH term(s)	Infant, Newborn ; Female ; Adolescent ; Pregnancy ; Child ; Humans ; Infant ; Young Adult ; Adult ; Case-Control Studies ; Nepal/epidemiology ; Malnutrition/epidemiology ; Risk Factors ; Mothers/education ; Hospitals, Pediatric
Language	English
Publishing date	2022-10-19
Publishing country	Nepal
Document type	Journal Article
ZDB-ID	2257651-4
ISSN	1812-2078 ; 1812-2078
ISSN (online)	1812-2078
ISSN	1812-2078
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Article: Innovative methodology to guide planning of dental workforce distribution: a GIS-based study in Nepal.

Shreshtha, B / Karki, S / Kruger, E / Tennant, M

Community dental health

2022 Volume 39, Issue 1, Page(s) 27–32

Abstract: Objectives: To build a predictive model based on the distribution pattern of dentists and population in selective districts of Nepal.: Method: Cross-sectional descriptive study conducted using secondary data from the census report and available ... ...

Abstract	Objectives: To build a predictive model based on the distribution pattern of dentists and population in selective districts of Nepal. Method: Cross-sectional descriptive study conducted using secondary data from the census report and available dentist data of Nepal. Population data were obtained from the most recently available census. For dentists' data, a literature search was carried out in the databases such as PubMed, Google scholar, One Search and Medline. All data were extracted from the integrated database in the Geographic Information System (GIS), and a predictive model was built. Results: Overall, there was an uneven distribution of dentists in Nepal. When the distribution of dentists was compared with the population clusters, it was found that the slope of the population growth was below or equal to (≤) 20,000 for three provinces (2, 6, and 7), which means that lower numbers of dentists are available with respect to population density in these provinces. The slope was above 50,000 for province 3, and the number of dentists was almost half of the total nationwide. The number of dentists correlated with population clusters. Conclusion: There are substantial disparities in the distribution of dentists in Nepal. Dentists were distributed relative to higher population clusters and were unevenly distributed. The Nepal government should make necessary arrangements to address the need for the human workforce in resource-limited settings. The methods used in this study could be applied globally, as the data used are available for most countries.
MeSH term(s)	Cross-Sectional Studies ; Dentists ; Geographic Information Systems ; Humans ; Nepal ; Workforce
Language	English
Publishing date	2022-03-01
Publishing country	England
Document type	Journal Article
ZDB-ID	631156-8
ISSN	0265-539X
ISSN	0265-539X
DOI	10.1922/CDH_00024Shrestha06
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Article ; Online: FSP27 and Links to Obesity and Diabetes Mellitus.

Karki, Shakun

Current obesity reports

2019 Volume 8, Issue 3, Page(s) 255–261

Abstract: Purpose of review: Obesity is a pandemic, yet preventable healthcare problem. Insulin resistance, diabetes mellitus, dyslipidemia, and cardiovascular complications are core manifestation of obesity. While adipose tissue is a primary site of energy ... ...

Abstract	Purpose of review: Obesity is a pandemic, yet preventable healthcare problem. Insulin resistance, diabetes mellitus, dyslipidemia, and cardiovascular complications are core manifestation of obesity. While adipose tissue is a primary site of energy storage, it is also an endocrine organ, secreting a large number of adipokines and cytokines. Nonetheless in obesity, the secretion of cytokines and free fatty acids increases significantly and is associated with the degree of adiposity and insulin resistance. Fat-specific protein 27 (FSP27) has emerged as one of the major proteins that promote physiological storage of fat in adipose tissue. Recent findings: Review of number of recent findings suggests that FSP27 plays a crucial role in physiological storage of fat within the adipose tissue especially in humans. However, in disease conditions such as obesity, FSP27 may contribute to ectopic fat accumulation in non-adipose tissue. More studies are required to highlight the tissue-specific role of FSP27, especially in humans.
MeSH term(s)	Adipokines/metabolism ; Adipose Tissue/metabolism ; Animals ; Apoptosis Regulatory Proteins/genetics ; Apoptosis Regulatory Proteins/metabolism ; Diabetes Complications/metabolism ; Diabetes Mellitus/metabolism ; Humans ; Insulin Resistance ; Liver/metabolism ; Obesity/complications ; Obesity/metabolism
Chemical Substances	Adipokines ; Apoptosis Regulatory Proteins ; CIDEC protein, human
Language	English
Publishing date	2019-03-27
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2162-4968
ISSN (online)	2162-4968
DOI	10.1007/s13679-019-00343-3
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Article ; Online: Evaluation of Factors of Low Birth Weight Deliveries: A Cross Sectional Study.

Karki, Shrijana / Shakya, Vivechana

Journal of Nepal Health Research Council

2022 Volume 19, Issue 4, Page(s) 767–771

Abstract: Background: Low birth weight is the most serious challenge for infant survival, healthy growth and development. It is the major determinant of the infant morbidity, mortality and disability in childhood. Different maternal and newborn factors contribute ...

Abstract	Background: Low birth weight is the most serious challenge for infant survival, healthy growth and development. It is the major determinant of the infant morbidity, mortality and disability in childhood. Different maternal and newborn factors contribute to Low birth weight. Hence, this study aims to assess the factors of low birth weight among deliveries at a tertiary hospital. Methods: A cross sectional analytical study was conducted among 203 postnatal mothers who had delivered low birth weight babies in Patan hospital from 1st September to 30th November 2019.Purposive sampling technique was used to select the sample for the study. Interview was conducted using a self-structured questionnaire. Data were analyzed with SPSS version 20 using descriptive and independent sample t-test to identify factors of Low birth weight. Results: Increased amount of dietary intake, consumption of folic acid tablet, iron and folic acid tablet (p<0.01,CI:95%), calcium tablet(p<0.05) and hypertension during pregnancy(p<0.01) can make significant differences in the mean birth weight of the baby. Similar difference was observed with the sex of baby (p=0.05)and gestational age at birth(p<0.01). Conclusions: Less dietary intake and micronutrients supplements are largely responsible for the Low birth weight. Possible maternal factors can be eliminated in order to reduce Low birth weight deliveries. Therefore, emphasis should be given on these factors while providing antenatal care via health teaching and counseling to mothers.
MeSH term(s)	Birth Weight ; Cross-Sectional Studies ; Female ; Folic Acid ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Nepal/epidemiology ; Pregnancy
Chemical Substances	Folic Acid (935E97BOY8)
Language	English
Publishing date	2022-03-13
Publishing country	Nepal
Document type	Journal Article
ZDB-ID	2551251-1
ISSN	1999-6217 ; 1999-6217
ISSN (online)	1999-6217
ISSN	1999-6217
DOI	10.33314/jnhrc.v19i04.3775
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Article ; Online: Crystallization and low-resolution structure solution of the SALM3-PTPσ synaptic adhesion complex.

Karki, Sudeep / Kajander, Tommi

Acta crystallographica. Section F, Structural biology communications

2022 Volume 78, Issue Pt 1, Page(s) 39–44

Abstract: Synaptic adhesion molecules are major organizers of the neuronal network and play a crucial role in the regulation of synapse development and maintenance in the brain. Synaptic adhesion-like molecules (SALMs) and leukocyte common antigen-related receptor ...

Abstract	Synaptic adhesion molecules are major organizers of the neuronal network and play a crucial role in the regulation of synapse development and maintenance in the brain. Synaptic adhesion-like molecules (SALMs) and leukocyte common antigen-related receptor protein tyrosine phosphatases (LAR-PTPs) are adhesion protein families with established synaptic function. Dysfunction of several synaptic adhesion molecules has been linked to cognitive disorders such as autism spectrum disorders and schizophrenia. A recent study of the binding and complex structure of SALM3 and PTPσ using small-angle X-ray scattering revealed a 2:2 complex similar to that observed for the interaction of human SALM5 and PTPδ. However, the molecular structure of the SALM3-PTPσ complex remains to be determined beyond the small-angle X-ray scattering model. Here, the expression, purification, crystallization and initial 6.5 Å resolution structure of the mouse SALM3-PTPσ complex are reported, which further verifies the formation of a 2:2 trans-heterotetrameric complex similar to the crystal structure of human SALM5-PTPδ and validates the architecture of the previously reported small-angle scattering-based solution structure of the SALM3-PTPσ complex. Details of the protein expression and purification, crystal optimization trials, and the initial structure solution and data analysis are provided.
MeSH term(s)	Animals ; Crystallization ; Crystallography, X-Ray ; Mice ; Receptor-Like Protein Tyrosine Phosphatases, Class 2/chemistry ; Receptor-Like Protein Tyrosine Phosphatases, Class 2/genetics ; Receptor-Like Protein Tyrosine Phosphatases, Class 2/metabolism ; Synapses/metabolism
Chemical Substances	Receptor-Like Protein Tyrosine Phosphatases, Class 2 (EC 3.1.3.48)
Language	English
Publishing date	2022-01-01
Publishing country	United States
Document type	Journal Article
ISSN	2053-230X
ISSN (online)	2053-230X
DOI	10.1107/S2053230X21012905
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Article: Knowledge of point-of-care ultrasound and management of deep vein thrombosis patient in resource limited setup: A case report.

Bista, Sachhyatkar / Rajbhandari, Sabin / Karki, Saurab / Pokharel, Subashchandra / Karki, Sudesha

Annals of medicine and surgery (2012)

2022 Volume 77, Page(s) 103702

Abstract: Introduction: and importance: Deep vein thrombosis (DVT), frequently encountered in an emergency setting, if not identified and managed early, leads to pulmonary embolism that may be life threatening to the patient. The use of point-of-care ultrasound ( ... ...

Abstract	Introduction: and importance: Deep vein thrombosis (DVT), frequently encountered in an emergency setting, if not identified and managed early, leads to pulmonary embolism that may be life threatening to the patient. The use of point-of-care ultrasound (POCUS) can be used as an effective and time saving tool for diagnosis of such life threatening conditions. Case presentation: We present a case of a 53 years old male who presented to the emergency department (ED) with complaints of swelling and pain in the left lower limb for one week and redness of overlying skin for the same duration. Following a point-of-care ultrasound scan, a diagnosis of DVT was made. The condition was quickly identified and promptly treated preventing possible complications. Discussion: Use of point-of-care ultrasound to diagnose DVT has been shown to decrease the need for comprehensive scans, decrease time to diagnosis and length of stay at the emergency department. To improve medical care by increasing early detection, lowering costs, and improving overall patient care, more training of emergency physicians in ultrasound technique and standardized use of ultrasound to screen for DVT in the ED is required. Conclusion: This case report highlights how, despite the unavailability of sophisticated diagnostic procedures, a skill of using POCUS can prove to be lifesaving in a resource-limited setting.
Language	English
Publishing date	2022-04-29
Publishing country	England
Document type	Case Reports
ZDB-ID	2745440-X
ISSN	2049-0801
ISSN	2049-0801
DOI	10.1016/j.amsu.2022.103702
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Article ; Online: Mothers' Perception of Their Children's Play in Dhulikhel Hospital, Nepal.

Karki, S / Shrestha, S / Shrestha, K

Kathmandu University medical journal (KUMJ)

2021 Volume 19, Issue 74, Page(s) 230–236

Abstract: Background Play is a cherished part of childhood that offers children holistic developmental benefits and parents the opportunity to fully engage with their children. However, modern-day children are spending significantly less time in outdoor play due ... ...

Abstract	Background Play is a cherished part of childhood that offers children holistic developmental benefits and parents the opportunity to fully engage with their children. However, modern-day children are spending significantly less time in outdoor play due to a number of factors including technological advancements, more time involved in structured activities, and a greater emphasis on early cognitive learning. Objective To assess perception of mothers on their children's play. Method This was a descriptive cross-sectional study was carried out among the 228 mothers having at least one child children who attended in Paediatric OPD of Dhulikhel hospital of Nepal from 21st June, 2018 to 16th July, 2019. Ethical approval was obtained from the Institutional Review Committee (IRC) of Kathmandu University School of Medical Sciences (KUSMS). Research instrument was developed by Barnett and was adopted for this study with permission from the author. Systematic random sampling technique was used to select mothers and face to face interview was carried out to collect information. Result Perception on play of children in the mothers was varied. Most of mothers agreed on different subscales of play with mean range 2.07-3.01 in which they were agreed on freedom play with mean score 3.01±0.40, importance of play with mean score 2.93±0.37 and nearly agreed on maternal rule with mean score 2.89±0.50, play safety with mean score 2.92±0.36, child's choice with mean score 2.96±0.49 and disagreed on imaginative play with mean score 2.42±0.59 and gender typing with mean score 2.07±0.51. Conclusion Although almost all respondents had positive attitudes towards different component of the play, they disagreed on gender typing and imaginative play which is very important for developing problem solving skill of children based on their gender. So, nursing faculties, pediatricians and nurses can use the findings to develop awareness on importance of gender typing and imaginative playamong mothers.
MeSH term(s)	Child ; Cross-Sectional Studies ; Female ; Hospitals ; Humans ; Mothers ; Nepal ; Perception
Language	English
Publishing date	2021-11-24
Publishing country	Nepal
Document type	Journal Article
ZDB-ID	2257651-4
ISSN	1812-2078 ; 1812-2078
ISSN (online)	1812-2078
ISSN	1812-2078
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Article ; Online: Respiratory Failure in a Neonate with Pierre Robin Syndrome -A Challenging Proposition.

Dhakal, R / Makaju, R / Karki, S / Dhakal, B

Kathmandu University medical journal (KUMJ)

2021 Volume 19, Issue 73, Page(s) 80–84

Abstract: Background Fine needle aspiration (FNA) with radiological assisted tools such as ultrasonography (USG) and computed tomography (CT) are effective in obtaining high yield aspiration of tissues located in technically difficult places such as deep-seated. ... ...

Abstract	Background Fine needle aspiration (FNA) with radiological assisted tools such as ultrasonography (USG) and computed tomography (CT) are effective in obtaining high yield aspiration of tissues located in technically difficult places such as deep-seated. It is a simple outpatient procedure with low cost as compared to surgical biopsies. Objective To study the cytomorphological features of deep-seated lesions according to the site of occurrence, and to categorize them with respect to age, sex and behavior of lesions. Method This was a descriptive cross-sectional study of 125 patients who underwent imageguided fine needle aspiration cytology of deep-seated lesions. The study was conducted in the Department of Pathology and Department of Radiodiagnosis, Dhulikhel Hospital- Kathmandu University Hospital, between January 2017 and December 2018. Under radiological guidance, aspiration was performed under negative pressure, and adequate material was obtained. Smears were stained with Giemsa and Papanicolaou stain. The prepared slides were examined under a microscope. Result Of the 125 patients who underwent USG and CT-guided fine needle aspiration cytology (FNAC), 68(54.4%) were female and 57(45.6%) were male. The age of the patients ranged from 13 to 84 years. The maximum number of patients was above 50 years. The nature of lesions was categorized as malignant 78(62.4%), followed by 23(18.4%) inflammatory and benign 1(0.8%). Conclusion Image-guided fine needle aspiration cytology is a safe diagnostic procedure, as it provides real-time visualization of tip insertion in anatomical structures. It provides high yield and a better representation of the samples.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biopsy, Fine-Needle ; Cross-Sectional Studies ; Female ; Humans ; Infant, Newborn ; Male ; Middle Aged ; Pierre Robin Syndrome ; Respiratory Insufficiency ; Ultrasonography ; Young Adult
Language	English
Publishing date	2021-11-23
Publishing country	Nepal
Document type	Journal Article
ZDB-ID	2257651-4
ISSN	1812-2078 ; 1812-2078
ISSN (online)	1812-2078
ISSN	1812-2078
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Article ; Online: Reducing skin staining after Patent Blue V dye for sentinel lymph node biopsy using sterile lubricating jelly.

Karki, S / Lupi, M / Babu, E

Annals of the Royal College of Surgeons of England

2021 Volume 103, Issue 6, Page(s) 459–460

MeSH term(s)	Coloring Agents/adverse effects ; Extravasation of Diagnostic and Therapeutic Materials/prevention & control ; Female ; Gels ; Humans ; Injections ; Rosaniline Dyes/adverse effects ; Sentinel Lymph Node Biopsy ; Skin Pigmentation/drug effects
Chemical Substances	Coloring Agents ; Gels ; Rosaniline Dyes ; sulfan blue (FH1929ICIT)
Language	English
Publishing date	2021-05-06
Publishing country	England
Document type	Journal Article
ZDB-ID	80044-2
ISSN	1478-7083 ; 0035-8843
ISSN (online)	1478-7083
ISSN	0035-8843
DOI	10.1308/rcsann.2020.7150
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