Browsing by Author "Bhattarai, P"
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Publication Emergency surgical workload in a teaching hospital(Institute of Medicine, 2010) Bhattarai, PAbstract Introduction: Emergency operations are life saving and it may account for over 50% of surgical admissions depending upon the place. Its impact on the skill development in a teaching hospital is very important. However the impact on service provision and implications for training are difficult to quantify. We analyzed ten months data of emergency operations done at Kohalpur Teaching Hospital. Methods: Data on emergency surgical operations over twelve months was collected including patient demographics, diagnosis, and operation and analyzed according to the operation performed and age-groups. Results: There were 535 emergency surgical operations over ten months; 20.7% were under 14 years of age, 48.7% were between 15-39 years of age and 30.4% patients were more than 39 years age. The commonest operations performed were from gastrointestinal cases (38.6%), orthopedic (21.4%), and wounds (20.5%). Conclusions: Children constituted one fourth of the total operations indicating peripheral hospital should have provision of a paediatric surgical team to have the optimum service. Resource planning should be based on more comprehensive, prospective data such as these. Keywords: Emergency, surgical operation, teaching hospitalPublication Guillain-Barré Syndrome in Nepalese Children(Institute of Medicine, 2008) Bhattarai, P; Shrestha, PNAbstract Background: Guillain-Barré Syndrome (GBS) is a group of autoimmune syndromes consisting ofdemyelinating and acute axonal degenerating forms of the disease. This study gives the profile of 30patients who were admitted with the diagnosis of GBS in a pediatric hospital. Methods and material: We reviewed the admitted case notes of children admitted with the diagnosisof GB syndrome from January 2005 to December 2007. The data were analyzed to find out thedemographic features, preceding illness, clinical features and CSF findings. Result: The age ranged from 3.6 years to 14 years. The mean (SD) age was 4.9 (9.7) years. The mostcommon symptoms were inability to walk after awaking in the morning.The median evolving time from the onset of illness to nadir was 12 days. The CSF protein concentrationranged from 60 to <100mg% and the CSF cell counts were less than 10/cmm in 23 patients and 11-19in 7 patients. Conclusion: We could not find any previous study done in such a large paediatric population of thiscountry. Our results show the similarity in pattern of age distribution, preceding events, and cellprotein dissociation similar to that of other studies. Keywords: Guillain-Barré Syndrome, diagnostic criteria, children, clinical profile, hospitalPublication Informed consent: Is it really understood?(Kathmandu University, 2005) Gongal, R; Bhattarai, PPre-operative counselling is an important part of the care that we give to our patients undergoing surgery. It ensures that the patients understand about their disease and the procedure that they are undergoing. This study was done with the objective of finding whether or not the patients do actually understand what has been explained to them. This is a prospective study done in the form of a survey with a set questionnaire in two hospitals in Kathmandu namely Patan hospital and Tribhuvan University Teaching Hospital. The patients surveyed were those who were admitted for elective surgery after counselling has been done and consent forms signed. The result showed that the level of understanding was poor in 11%, unsatisfactory in 33%, satisfactory in 37% and excellent in 19%. The level of understanding was affected by the education level of the patients. To conclude, the level of understanding was unsatisfactory in nearly half the patients. Only 19% had optimal understanding. This may reflect the education level of the many of our patients but it clearly points out that the medical profession needs to make more effort to make the patients understand more about their disease process. This can be said to be a reflection of our quality of care. Key words: informed consent, autonomy, understanding, and education levelPublication Paediatric clinical teaching: comparison of two medical schools(Institute of Medicine, 2005) Sharma, PR; Bhattarai, P; Sharma, MAbstract Clinical paediatric teaching in undergraduate medical education is important to impart essential skills in communicating, diagnosing and formulating management plans for common childhood illness of the country so as to reduce existing high mortality and morbidity rates. Private medical colleges are facing challenges in paediatric teaching because of the unavailability of paediatric patients with different clinical signs; both the inpatient and outpatient paediatric attendance at their teaching hospitals is very discouraging at present. At the same time, they are plagued with inadequate investigative facilities. We conducted a study to evaluate some of the clinical skills in the students during their final examination. The study showed marked differences among students in some of the essential neonatal skills and other common paediatric problems. Statistically significant differences were found in the majority OSCE stations. The mean wrong answers in one medical school were 42.2% (Std D. 30.1 %) and the other school was 24.9% (Std. D 18.3 %). In one medical school the mean of signs that were rightly performed for the essential neonatal examination were 1.4% (Std. Dev. 1.1 %) and in other schools it was 10.4% (Std. Dev 6.1%). This shows that it is necessary to standardize pediatric teaching in the country’s medical schools.Publication Paediatric practice: an approach to a child with fever(Institute of Medicine, 2005) Sharma, PR; Bhattarai, P; Sharma, MAbstract Nearly seventy percent of all children between the ages of one week and two-years-of-age are brought to Kanti Children’s Hospital for some Type of febrile episode.And 50% of these visits are for temperatures greater than or equal to 39 degrees celsius. These children may have significant bacterial infection. In 35% of these childrenn there’s no definable source for the fever on clinical examination. So the child that don’t have identifiable sources could be either bacteremic, meningitis or could have a bone or joint infection in evolution. Simple clinical observation to differentiate a well looking infant from a toxic infant helps to differentiate children who needs admisson or out patient follow-up.Publication Use of percutaneous thread loop to hold the vermiform appendix during laparoscopic appendectomy(Kathmandu University, 2007) Joshi, MR; Shrestha, SK; Thapa, PB; Koirala, U; Bhattarai, P; Dongol, UMS; Singh, DR; Sharma, SKIntroduction: Laparoscopic appendectomy, although not as widely performed as laparoscopic cholecystectomy, it has got definite advantage over the conventional open procedure. Controversy exists regarding the closure of stump. Our institute practices intracorporeal knot tying using 3 ports. Difficulties are observed in three port technique to hold the appendix during knot tying. We use a percutaneous thread loop. Advantage of the use of loop was evaluated. Patients and method: Prospective study was carried out during 18 months. Total cases were randomly divided in non-loop and with loop group. Operative procedure was same. Cases were compared in terms of operating time, post-operative hospital stay and complications. Results: Total patients were 66. Thirty two in non-loop group and 34 in with loop group. Mean age was 27.89 yrs. Most of the cases were females (62%). Mean operating time was less in loop group although statistically not significant. There was no difference in post operative hospital stay. Use of loop was not associated with added complications. Conclusion: Use of percutaneous loop to hold the appendix reduces the operating time and replaces the need of fourth port. It is safe and effective without any increased morbidity. Key words: Laparoscopic appendectomy, Intracorporeal knot, Percutaneous loop