Browsing by Author "Agrawal, CS"
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Publication A comparative study of early vs. delayed laparoscopic cholecystectomy in acute cholecystitis(Kathmandu University, 2009) Yadav, RP; Adhikary, S; Agrawal, CS; Bhattarai, B; Gupta, RK; Ghimire, ANAPublication Abdominal Cocoon in an Adolescent Male(Kathmandu University, 2012) Shakya, VC; Agrawal, CS; Rajbanshi, SK; Pradhan, A; Khaniya, S; Adhikary, SABSTRACT Abdominal cocoon is an uncommon peritoneal condition characterized by partial or complete encasement of small bowel by a thick rind of fibrous tissue and adhesions. Only few cases of this disease have been reported in world literature. The etiology of this condition is unknown, and most often it is found in adolescent girls from tropical or subtropical countries, and usually diagnosed incidentally on exploration. Surgery (membrane dissection and extensive adhesiolysis) is the treatment of choice. Here, we report a case of abdominal cocoon in a 20-year-old male patient, with a brief review of the literature. KEYWORDS Abdominal cocoon; adhesiolysis; intestinal obstructionPublication Examination of Relationships of Scores Obtained in Grades 10 and 12 with the Entry and Success in Undergraduate Medical Education(Kathmandu University, 2012) Gautam, A P; Paudel, BH; Agrawal, CS; Niraula, SR; Van Dalen, JABSTRACT Background Entrance examination (admission test) is the most important and widely accepted method of student selection for admission into medical schools in Nepal. For many schools it is the only criterion of student selection. Objectives To examine relationships of scores obtained in schooling (grade 10 and 12), medical entrance and MBBS professional examinations in a cohort to identify predictive strength for entry into medical school and success in medical education. Methods Exam scores from grade 10 to medical entrance and professional exams of undergraduate medical education of a total of 118 medical students who entered medical school between 1994 and 1998 only through the merit of open competitive medical entrance examination at the BP Koirala Institute of Health Sciences (BPKIHS) were assessed. Results Student selection for admission in MBBS course at BPKIHS and their subsequent success were not determined by difference in outcomes of public & private management of schools at grade 10 (selection p= 0.80 & success p= 0.32 ) and grade 12 (selection p= 0.59 & success p= 0.55). Grade 12 averaged scores had no relationship in getting these students selected for admission into medical course (r= 0.08, p= 0.37), but did show correlation with the overall success in medical education (r= 0.32, p= 0.00). Scores in physics at grade 12 retained predictive strength in success in medical education (r= 0.19, p= 0.04). Conclusion The present student selection criteria for medical education are not appropriate and need to incorporate other attributes of candidates along with cognitive aspects. KEY WORDS admission test, medical education, medical students, performance, predictions, selection criteriaPublication Iliopsoas abscess: Analysis and perspectives from an endemic region of Eastern Nepal(Kathmandu University, 2007) Yadav, RP; Agrawal, CS; Adhikary, S; Kumar, M; Regmi, R; Amatya, R; Gupta, RKAbstract Objective: To evaluate the clinical profile and outcome in patients with iliopsoas abscess. Methods: A descriptive study was carried out in B.P. Koirala Institute of Health Science, Dharan, Nepal from February 2005 to March 2006. The medical records of all thirty six patients admitted in surgery ward with diagnosis of iliopsoas abscess during the study period were analyzed. Results: Thirty six patients were included the study. There were 22 (61.1%) males and 14 (38.9%) females with a mean age of 24.33 ±19.19 years. Demographic distribution of the patients revealed the highest number 13 (36.1%) from Sunsari district, eastern part of the country. Right sided unilateral involvement was the most common presentation and only 2 cases had bilateral involvement. In none of our patients the dorsolumbar spine radiograph revealed any involvement of the bone. The most common complaints were pain in lower abdomen and lump in iliac fossa with flexion deformity at hip joint. All the patients underwent open surgical drainage and their outcomes were analyzed in term of cure, morbidity and mortality. Staphylococcus aureus was the most common organism 24 (61.5%) isolated. Twenty two (91.66%) of Staphylococcus aureus samples were sensitive to ciprofloxacin. There was one mortality in the group who died of septicaemia secondary to necrotizing fascitis. Six patients had wound infection, which were cured by regular dressing. Conclusion: On the basis of our experience and review of available relevant literature, we can conclude that a high index of suspicion and awareness of the varying clinical picture are required to diagnose this condition properly. Ultrasonography should still be the preferred imaging modality as it is cheap, safe, cost effective and readily available. Ciprofloxacin should be used as a first line drug. Image guided aspiration may be practical in selected cases having little pus and traditional open drainage should be considered without hesitation. Key words: Psoas abscess, ultrasound abdomen, bacteriology, operative interventionPublication Postoperative intussusception following transverse colostomy: A case report with its pathogenesis(Kathmandu University, 2009) Shakya, VC; Agrawal, CS; Koirala, R; Khaniya, S; Shrestha, AB; Adhikary, SAbstract Postoperative idiopathic intussusception is considered to be a distinct entity, and has been reported following different operations. We present a 45-year-old female with postoperative ileoileal intussusception following a transverse loop colostomy for sigmoid volvulus, in which there was a kinked loop of bowel forming the lead point. The pathogenesis and literature review of this disorder is discussed. Key words: postoperative intussusception, lead point, kink, motility disorderPublication Retrospective analysis of management of patients presenting with acute urinary retention due to benign prostatic hyperplasia: A hospital based study(Kathmandu University, 2008) Pandit, RK; Agrawal, CS; Chalise, PR; Sapkota, GAbstract Objectives: To analyze current practice of management of acute urinary retention (AUR) in men above 40 years of age at B.P.Koirala Institute of Health Sciences, Nepal. Materials and methods: A total of 68 patients (aged 50-91 years) presenting with indwelling catheter for AUR were included in the study. Because of lack of clear guideline and limited health care facility in our setup trial without catheter (TWOC) was given selectively depending mainly on preexisting symptoms. AUR presumed to be due to urinary tract infection received only antibiotic and others diagnosed of benign prostatic hyperplasia (BPH) received alfa1 blocker prior to TWOC. TWOC was given 3-15 days after such treatment. Those satis ed without catheter for at least a week were considered successful TWOC. Results: The data was available for 68 patients (mean age 66.1 years). Of 15 patients treated with antibiotic alone, 11 (73.3 %) had successful TWOC. Of 57 with presumptive diagnosis of BPH, 68.9% (31 of 45) had successful TWOC. Mean age, symptom score and prostate volume were higher for patients with unsuccessful TWOC. Conclusion: Selective TWOC may be imperative to minimize unnecessary suffering from AUR in less easily accessible health care facilities like ours. It may also reduce total cost of treatment. Key words: Acute urinary retention, benign prostatic hyperplasia, trial without catheterPublication Splenic Epidermoid Cyst(Kathmandu University, 2007) Maskey, P; Rupakheti, S; Regmi, R; Adhikary, S; Agrawal, CSSplenic epidermoid cyst is a rare cystic disease affecting the spleen. We report a young male who presented with a painless abdominal lump. Ultrasonography and CT scan of abdomen showed a huge cystic lesion of obscure origin. At laparotomy a huge cyst was found to be arising from the superior pole of the spleen, and its removal necessitated splenectomy. Histopathological findings were consistent with splenic epidermoid cyst. The aetiopathology and different treatment modalities of splenic cysts are discussed. Key words: splenic cyst, epidermoid cyst, pseudocyst, splenectomyPublication Validating breast self examination as screening modalities for breast cancer in eastern region of Nepal: A population based study(Kathmandu University, 2008) Tara, S; Agrawal, CS; Agrawal, AAbstract Breast cancer is one of the most common causes of death in many developed countries amongst middle-aged women and is becoming common in developing countries as well. Aims and Objectives: The objective of this study was to evaluate the performance of Breast Self Examination (BSE) against examination conducted by the trained health personnel. Methodology: A descriptive evaluative study was conducted among women aged 15 to 60 years undertaken in urban and rural areas. It was a population-based study and non-probability sampling method was used for data collection. Respondents conducted Breast Self Examination on their own, and then investigators did clinical examination of breasts of the respondents to verify their findings. Results: Mean age of the respondents was 34.54 ± 9.12 years. Nearly half (44.8%) of the respondents were illiterate. On comparison of each variable of breast self- examination with the physical examination of breast, it was observed that size of the breasts and lump found in the breast had significant relation to performance during examination (P<0.1). The result of Kappa test showed 68% agreement between findings of examinations done by the experts and respondents. Conclusion: Breast Self Examination can be used as an important tool for primary prevention of breast cancer in Nepal, where sophisticated method like screening mammography for general public cannot afford.