Browsing by Author "B, Karmacharya"
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Publication Results of typhoid perforation management: Our experience in Bir Hospital, Nepal(Kathmandu University, 2006) B, Karmacharya; VK, SharmaObjective: To determine the demographic characteristics, clinical features, operative findings and postoperative complications in patients operated for typhoid enteric perforation. Methods: A retrospective study was carried out in the Department of General Surgery, Bir Hospital since 2002 to April 2004. Among 189 patients who underwent laparotomy for hollow viscus perforation in two years, ileal perforation was found in 102 patients. Results: The sex ratio of the patients was 4.66:1, in favor of male, with age range of 14-78 years and mean age 28.35 years. Most of the patients (80.39 %) presented with history of fever for two weeks. Half of the patients presented within 24 hours of onset of generalized abdominal pain. Majority (65.67%) had a solitary perforation on the antimeseteric border of terminal ileum. Eighty one percent of patients had trimming of the ulcer margins and primary closure. Complications included wound infection (35.3%), wound dehiscence (17.6%), fecal fistula (7.84%) and hospital mortality (6.86%). Conclusion: Typhoid ulcer perforation is common among developing nations, including Nepal. Postoperative complications following surgical management of perforation are high and increases mortality. Key words: Typhoid perforation, wound dehiscence, hospital mortalityPublication Typhoid fever in Dhulikhel hospital, Nepal(Kathmandu University, 2004) N, Sharma; R, Koju; B, Karmacharya; MD, Tamang; R, Makaju; N, Nepali; P, Shrestha; D, AdhikariOne hundred and twelve cases of typhoid fever presenting in outpatient and emergency department of Dhulikhel Hospital in Nepal were studied. In this study, it was found that 71% typhoid fever cases were less than 30 years of age group with male to female ratio of 3:1. Fever over 5 days followed by headache and chills were major presenting symptoms. Widal test and blood culture for Salmonella typhi were positive in 59% and 49% cases respectively. Two third of our study population had total leucocyte count of normal range. The fever clearance time was significantly better with ofloxacin compared to ciprofloxacin (p<0.05) and ceftriaxone compared to chloramphenicol (p<0.05). The release from treatment was significantly shorter with ceftriaxone compared to ofloxacin, ciprofloxacin and chloramphenicol (p<0.01). Ceftriaxone was found to be 100% sensitive to salmonella typhi. Amoxicillin was only 52.1% sensitive to Salmonella typhi. Early diagnosis and institution of appropriate antibiotic therapy is of paramount importance in the management of typhoid patients. Key words: Typhoid fever, salmonella typhi, fever clearance time, release from treatment