Browsing by Author "Bhandari, S"
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Publication Bedside Index of Severity in Acute Pancreatitis (BISAP) Score on Outcome of Patients Presenting with Acute Pancreatitis in a Tertiary Care Hospital(Kathmandu University, 2023) Gurung, RB; Jaisy, D; Sapkota, P; Bhandari, SABSTRACT Background Acute pancreatitis is a life-threatening condition characterized by inflammation of the pancreas causing intense abdominal pain and potential harm to multiple organs. The mortality rate is 1-5% and thus requires specialized and interdisciplinary care to inhibit it. Objective To describe the bedside index of severity in acute pancreatitis score on the outcome of acute pancreatitis patients in a tertiary care hospital. Method This is a hospital based observational cross-sectional study conducted in the internal medicine inpatient department of Dhulikhel Hospital from April 2018 and March 2019. This study reviewed the medical records of the department. Result The study included 70 participants with 44 (±14) years of average age and stating common cause as gallstone (45.7%). The study showed that those with bedside index of severity in acute pancreatitis score ≥ 3 during hospital admission had significantly higher rate of organ failure (p-value < 0.05), as well as had a prolonged hospital stay (mean: 20 [±7.9] days). The mean hospital stay was 12.9 days. Conclusion Patients with bedside index of severity in acute pancreatitis score greater than three at admission were found to have an increased risk of organ failure, significantly higher chances of requiring mechanical ventilation, and a longer duration of hospital stay. KEY WORDS Acute pancreatitis, Bedside index of severity in acute pancreatitis score, Organ failure, OutcomePublication Clinico-Pathological Correlation of Colorectal Diseases by Colonoscopy and Biopsy(Kathmandu University, 2017) Makaju, R; Amatya, M; Sharma, S; Dhakal, R; Bhandari, S; Shrestha, S; Gurung, R; Malla, BRABSTRACT Background Colonoscopy is a simple, safe and well tolerated procedure, the visualization of the mucosa of the entire colon and terminal ileum to detect intestinal abnormalities and obtain biopsy leads to the early detection of the pathologic process and institution of appropriate therapy. Objective To find out the correlation between clinical and histopathological diagnosis of colorectal diseases. Method A cross-sectional study was conducted at Department of Pathology, Dhulikhel Hospital, Kathmandu University Hospital from Jan. 2015 - Jan. 2016. Altogether, 95 colonoscopic biopsies were examined and recorded clinical data using pre-designed pro forma. The specimens were grossed, processed and embedded using standard procedures, stained with Hematoxylin and Eosin stain and were analyzed using light microscope. Special stains Ziehl Neelsen, and Periodic Acid-Schiff were used whenever necessary. Result Analyses of 95 cases of colonoscopic biopsies were done. The most common clinical diagnosis was polyp in 49 cases (51.57%) and the common histopathological diagnosis was non-neoplastic polyps 31(32.63%). There was no correlation in cases for suspected infectious colitis, microscopic colitis and hemorrhoids. Conclusion Colonoscopy is incomplete without biopsy and histopathology is the gold standard for the diagnosis of colorectal lesions. The clinico-pathological correlation for neoplastic lesions was excellent. However, correlation was poor in non-neoplastic lesion. KEY WORDS Colonoscopy, colorectal lesions, histopathologyPublication Correlation of Cervical Pap Smear with Biopsy in the Lesion of Cervix(Kathmandu University, 2016) Dhakal, R; Makaju, R; Sharma, S; Bhandari, S; Shrestha, S; Bastakoti, RABSTRACT Background Cervical cancer can be controlled to a greater extent by screening to improve morbidity and mortality. Pap smear is important screening method, which has proven to be highly effective in reducing the number of cases and the mortality from cervical carcinoma. Any abnormality detected in pap smear has to be confirmed with cervical biopsy, which remains the reference investigation. Objective To find the changes of cervical cytology by pap smear, to classify cervical lesions into malignant and benign groups on cytological and histopathological basis and to correlate the changes observed in cervical cytology with cervical biopsy. Method This is a prospective cross sectional study done in between July 2014 and July 2015 in Dhulikhel Hospital, Kathmandu University Hospital. During the period, all the samples requested for pap smear were studied. The cases who had undergone both pap smear and cervical biopsy were compared. Clinical data were obtained from requisition submitted along with the cytology and tissue specimens received in the department. Result During the study period, total 1922 pap smears were performed and out of them 75 patients were advised to do cervical biopsy. On cytology, out of total 1922 number of cases, 67.90% were normal, 27.90% were inflammatory smears, 3.80% were unsatisfactory (inadequate) and 0.40% were high grade intraepithelial lesions. Highest numbers of patients screened for pap smear ranged from 31 to 40 years. On histopathology, 78.70% had chronic cervicitis, 8% had normal findings, 1.30% had moderate and 6.70% had severe squamous intraepithelial lesions. The frank malignancy was found in 5.30%. The mean age ± SD for carcinoma was 52.75±6.29. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value of pap smear were 77.80%, 100%, 100% and 97% respectively considering cervical biopsy as the gold standard Conclusion This study revealed a good correlation of cervical cytology with cervical biopsy. Pap is a cost effective screening method for early detection of premalignant and malignant cervical lesions. However, biopsy is considered as the gold standard for the confirmation of abnormalities detected in cervical smear. KEY WORDS Biopsy, cervix, pap smearPublication Experience of Surgical Resection and Reconstruction of Chest Wall Tumor in Dhulikhel Hospital(Kathmandu University, 2025) Karmacharya, RM; Vaidya, S; Bhatt, S; Guragai, M; Sharma, S; Bhandari, S; Shrestha, M; Shah, B; Yadav, BABSTRACT Background Chest wall tumors are rare thoracic tumor which can be either primary or metastatic. Conventional radiography is the first line of investigation followed by further imaging like computed tomography or magnetic resonance imaging. When indicated preoperative biopsy by fine-needle aspiration need to be done. Small chest wall tumor can be surgically treated by excision and primary repair. Bigger chest wall tumor is treated by excision and chest wall reconstruction. Objective To know the features of chest wall tumor, symptoms, histopathological findings, surgical procedures performed and outcome following the surgery. Method This is the retrospective study that included chest wall tumor subjected for excision and repair during January 2018 till December 2023 in Thoracic surgical unit of Dhulikhel Hospital. Variables such as presenting complaints, size and extent of tumor, type of surgery, outcome of the surgery, hospital stay, neoadjuvant chemotherapy and post excision chemo or radiotherapy and recurrence of the tumor were included. When primary repair is not possible following wide excision, reconstruction using double prolene sandwich mesh was done. Result There were 38 cases of chest wall tumor. Mean age of the patient was 42 years (SD 15.25 years, range 20 - 68 years). Of them, 22 patients were female (57.9%) and 16 patients were male (42.1%). Chest pain was the most common symptoms (84.2%) followed by lesion in chest (81.6%). Average size of the tumor was 14.8 ± 3.6 cm (Range 5 cm to 25 cm). Most common histopathological finding was neurofibroma (31.6%) filled by schwannoma (15.8%). All the patients underwent wide local excision. In terms of repair, primary repair was possible in 68.4% while in 31.6% patients repair using double prolene and bone cement sandwich was done. Average hospital stay was 6.6 days (SD 2.3, range 3-9 days). Conclusion Chest wall tumor can have different histopathological findings. In patients where wide resection is possible, it can be repaired by either primary repair or by repair using double prolene and bone cement sandwich. KEY WORDS Chest wall tumor, Reconstruction, ResectionPublication Histopathological Changes in the Chorionic Villi and Endometrial Decidual Tissues in the Product of Conception of Spontaneous Abortion Cases(Kathmandu University, 2015) Makaju, R; Shrestha, S; Sharma, S; Dhakal, R; Bhandari, S; Shrestha, A; Tamrakar, SABSTRACT Background Spontaneous abortion refers to a pregnancy that ends spontaneously before the fetus has reached a viable gestational age or expulsion or extraction of an embryo or fetus weighing 500 g or less from its mother. The Maternal Mortality Morbidity Survey of Nepal 2008/09 reported that 7% of maternal deaths in Nepal were due to complications related to abortion. Objective The main objective of this study was to examine the histopathological changes in the chorionic villi and endometrial decidual tissue in products of conception obtained from women with spontaneous abortion. Method This is a retrospective study of 111 patients admitted in the Department of Obstetrics and Gynecology at Dhulikhel Hospital, Kathmandu University Hospital (DH-KUH) with the diagnosis of spontaneous abortion during the period of January 2013 to January 2014. Result Among 111 cases of spontaneous abortions, products of conception was seen in 73 (65.77%) and with only one cases of choriocarcinoma. Majority of cases belongs to age group 21-30 years. The most common decidual changes were inflammation (41.4%) followed by fibrin deposition 29.7%. Majority of the cases shows hydropic changes as histopathological changes in chorionic villi. In the present study, minimum age of lady was 15 years and the maximum age was 45 years and the mean age was 25.09±5.58 years at the time of abortion. Among the cases, maximum 69 (62.2%) of them belonged to age group 21-30 years. Correlating the age group with number of abortions was found to be significantly different (Chi-square= 92.35, df= 3, p < 0.001) among four different age groups. Conclusion The histopathological diagnosis of spontaneous abortion will help in further management of the patient. Further study is required to know the cause of different histopathlogical changes in villi as well as in the decidua. KEY WORDS Chorionic villi, endometrial decidual tissue, maternal mortality, product of conception, spontaneous abortionPublication Is an Elective Neck Dissection Needed in Squamous Cell Carcinoma of the Maxillary Alveolus and Hard Palate?(Kathmandu University, 2024) Bhandari, S; Michael, RC; Riju, J; Thomas, M; Irodi, A; Rani, J; Tirkey, AJ; Vidya, K; Mathew, SS; Madhavi, KABSTRACT Background Squamous cell carcinoma (SCC) of the maxillary alveolus and hard palate is a rare site for oral cavity carcinoma. Much controversy is there regarding the management of this site and elective neck dissection due to rarity and complex lymphatic drainage. Objective To estimate the prevalence of neck nodal metastasis in squamous cell carcinoma of maxillary alveolus and hard palate and the factors influencing the nodal metastasis. Method This retrospective cohort study includes patients diagnosed with squamous cell carcinoma of maxillary alveolus and hard palate and who underwent surgical intervention between March 2017 and March 2022. Result The study included 53 patients among them majority were men (73.6%). Prevalence of neck nodal metastasis was 36.6% and occult nodal metastasis was noted in 16%. On multivariate analysis, clinical nodal positivity increases the odds of pathological nodal positivity by 9.4 times compared to no nodal involvement (95% CI 2.07–42.57, p < 0.004). A depth of invasion (DOI) of more than 10 mm increases risk by 7.4 times for pathological nodal positivity compared to less than 10 mm invasion (95% CI 1.53– 35.27, p=0.013). Conclusion Squamous cell carcinoma of maxillary alveolus and hard palate has a high risk of nodal metastasis. Depth of invasion is an important predictor for nodal metastasis. Due to the high risk of nodal metastasis elective neck dissection would be recommended in advanced stages. Squamous cell carcinoma of maxillary alveolus and hard palate with nodal metastasis has a poor survival. KEY WORDS Hard palate, Lymph node metastasis, Neck dissections, Squamous cell carcinomaPublication Oral Cysticercosis Presenting as an Innocuous Lesion(Kathmandu University, 2019) Marla, V; Makaju, R; Bhandari, S; Shrestha, S; Shrestha, S; Shrestha, KS; Srii, RABSTRACT Cysticercosis is a parasitic infection with potential of causing significant morbidity especially in developing countries. The larval form of the parasite Taenia Solium, ‘Cysticercus Cellulosae’ primarily colonizes in the small intestine and has the potential to disseminate to different sites of the body. Oral presentation is rare and difficult to detect owing to its innocuous presentation. This report describes the presentation of cysticercosis involving the tongue and presenting as a submucosal mass. An incisional biopsy was performed and evaluation of the histopathological features lead to the diagnosis of oral cysticercosis. This article highlights the importance of inter-departmental collaboration for the accurate diagnosis and effective management of oral cysticercosis in order to avoid potential systemic complications. KEY WORDS Cysticercosis, Histopathology, Oral cavity, Parasite, Systemic complicationsPublication Prevalence of otitis media in school going children in Eastern Nepal(Kathmandu University, 2006) Maharjan, M; Bhandari, S; Singh, I; Mishra, SCObjectives: To find out the prevalence of otitis media in school going children from lower socio-economic strata. Material and methods: This study was carried out in a government school, Shree Naragram Secondary School in Morang district, eastern Nepal, and included 1050 children aged between 5-15 years. Results: Of the 1050 school children, 346 children were found to have various ENT related problems. Hearing assessment revealed a conductive hearing loss on one or both sides in 114 cases (87%). Various middle ear pathologies were detected in these children, out of which chronic suppurative otitis media "Tubotympanic type" was the most common, followed by otitis media with effusion. The prevalence of otitis media in these children was found to be13.2% and those with hearing loss comprised 12.47%. Prevalence of otitis media is found to be much higher in school going children as compared to adults, and is even higher amongst children belonging to the lower socio-economic strata. Conditions complicating otitis media are more common and severe in children as compared to adults. Conclusion: Primary ear care education to teachers, students and guardians can prevent these vulnerable children from developing hearing impairment. School based study could be one of the useful and cost-effective modality aimed at community oriented program. Key words: otitis media, PrevalencePublication Sensitivity and Specificity of Ankle Brachial Index for Diagnosis of Peripheral Arterial Disease in Diabetic Patients Presenting to University Hospital of Nepal(Kathmandu University, 2025) Karmacharya, RM; Vaidya, S; Yadav, B; Sharma, S; Bhatt, S; Bhandari, N; Bhandari, S; Maharjan, S; Bhusal, JABSTRACT Background Diabetes is a significant risk factor for peripheral arterial disease (PAD) that increases morbidity and mortality. Hence, early detection of peripheral arterial disease is necessary. Evidence shows Ankle Brachial Index (ABI) as a promising test to diagnose peripheral arterial disease. However, sensitivity and specificity need to be evaluated before clinical use. Objective To determine Ankle Brachial Index sensitivity and specificity for the diagnosis of peripheral arterial disease in diabetic patients. Method Diabetic patients were recruited from Dhulikhel Hospital. Doppler ultrasonography (DUS) was done in all the recruited participants and peripheral arterial disease was assessed. Based on Jager’s criteria, those with grade III and IV stenosis were diagnosed as peripheral arterial disease and underwent ankle brachial index. Ankle brachial indexscores below 0.9 and above 1.5 were considered abnormal. The diagnosis by ankle brachial index was matched against the gold standard doppler ultrasonography to determine its specificity and sensitivity. Descriptive statistics and independent t-tests were used for statistics. P-value < 0.05 was considered statistically significant. Result There were total of 237 diabetic patients of which 31.2% had peripheral arterial disease. We found high sensitivity and specificity of ankle brachial index when tested against doppler ultrasonography with the values ranging from 88.68-89.66% and 86.67-90% respectively. Conclusion Ankle brachial index can be used in clinical settings to diagnose peripheral arterial disease in individuals with diabetes mellitus. KEY WORDS Ankle brachial index, Diabetes, Peripheral arterial disease, Sensitivity, SpecificityPublication Seroprevalence of Scrub Typhus in Patients Attending Dhulikhel Hospital, Kavre(Kathmandu University, 2021) Madhup, SK; Shrestha, R; Katuwal, N; Magar, SR; Shrestha, S; Bhandari, S; Tamrakar, DABSTRACT Background Scrub typhus is a largely ignored tropical disease and a leading cause of undifferentiated febrile illness. It is caused by Orientia tsutsugamushi. Scrub Typhus is frequently observed in South Asian countries. However, clear epidemiological information of this disease is lacking in case of Nepal. Nepal has shown steady increase in cases of Scrub Typhus since 2015. The epidemiological data related to this disease would support the decision making and surveillance design for early outbreak detection and immediate responses including prevention and treatment of scrub typhus in Nepal. Objective To understand prevalence of Scrub Typhus in subjects who had visited outpatient department at Dhulikhel Hospital. Method In this study, we have studied antibody test data (n=784) for Scrub Typhus from 2019 to 2021. The tests were performed on serum samples of patients who had visited OPD at Dhulikhel Hospital with fever lasting more than 5 days. The kit used in analysis was Scrub Typhus Detect™ IgM ELISA Kit from InBios International. Result Out of the total subjects (n=784), 133 were positive (16.9%) for IgM antibody of Scrub Typhus. The positivity in female (18.6%) was higher than the male subjects (15.3%). The positivity rate was variable among the different age groups, with highest positivity for age group 0-14 years (25%). The seasonal variation was also observed among the seropositive cases. Conclusion Scrub Typhus being a neglected tropical disease has high prevalence. It can be postulated that female subjects and subjects of age group 0-14 years are vulnerable to the infection with Scrub Typhus. There is need to increase the surveillance of Scrub Typhus to add the knowledge for diagnosis and treatment. KEY WORDS ELISA, IgM, Scrub Typhus, Seroprevalence