Browsing by Author "Ghimire, B"
Now showing 1 - 9 of 9
Results Per Page
Sort Options
Publication Awareness and Knowledge of the Surgical Safety Checklist among Healthcare Professionals in University Teaching Hospital, Kathmandu, Nepal(Kathmandu University, 2021) Uprety, A; Kobashi, Y; Ozaki, A; Shrestha, D; Ghimire, B; Sedain, G; Sigdel, S; Higuchi, A; Tsubokura, M; Singh YPABSTRACT Background An introduction of the World Health Organization Surgical Safety Checklist (WHO SSC) is essential to promote surgical safety. Objective To obtain country-specific information regarding the checklist in a leading medical institution in Nepal. Method The present research was a cross-sectional study with a survey conducted among healthcare professionals working in the operation theatre at the Tribhuvan University Teaching Hospital (TUTH) in Kathmandu, Nepal. A questionnaire was distributed to 150 healthcare professionals working in the operating theatre. Responses to the questionnaire were analysed descriptively and regression analyses used to identify factors associated with awareness of the checklist. Result In total, 127 healthcare professionals participated in the study, of whom 118 (92.9%) had been aware of the WHO SSC. A substantial proportion of participants (108, 91.5%) were not satisfied with the prevailing practice whereby the checklist was not routinely used during surgery. Lack of appropriate training was the most prevalent barrier to the checklist use (72, 67.9%), followed by unwillingness of staff to use the checklist (54, 50.9%), and lack of experience (42, 39.7%). The mean score on the survey was 6.0 out of 10. Regarding the results of the regression model on survey scores, surgeons had higher scores compared to nurses (unadjusted coefficient 0.80, 95% CI 0.20-1.40). Conclusion Most of the healthcare professionals were aware of the WHO SSC, however multiple barriers to the checklist use were identified. It is important to establish an effective use of WHO SSC in the operation theatre. KEY WORDS Surgical safety, WHO Surgical Safety Checklist, WorkforcePublication Comparison of Subjective Global Assessment and Nutritional Risk Index on Outcome after Abdominal Surgery(Institute of Medicine, 2014) Gupta, DK; Sharma, MR; Ghimire, B; Vaidya, PAbstract Introduction: Preexisting malnutrition in surgical patients has been conclusively correlated with complications such as wound infection and myriad of other adverse outcomes during and after hospitalization. So, it is imperative to recognize and manage this status preoperatively in an effort to improve outcome. The aim of the study was to compare the Subjective Global Assessment (SGA) and Nutritional Risk Index (NRI) with outcome after abdominal surgery. Methods: This is a prospective study conducted at the Department of Surgery, Tribhuvan University Teaching Hospital, Nepal, for the period of one year. The study included a total of fifty patients undergoing abdominal surgery. Patients were assessed with two types of nutritional assessment techniques, namely, SGA and NRI. The outcome parameters included were wound infection, and chest infection, and length of hospital stay. Results: No complications occurred in 24 of the 50 patients; 13 patients had more than one complication. The frequency of malnutrition was found to be 74% and 80% as assessed by SGA and NRI respectively. Morbidity rate was significantly higher and length of hospital stay was also longer in malnourished patients assessed by SGA group. Wound infection rate was significantly higher and length of hospital stay was also longer in malnourished patients when assessed by SGA. The area under the receiver operating characteristics curve for SGA and NRI revealed that SGA was better for predicting overall morbidity as well as specific complications than the NRI. Three patients died during treatment period. Conclusions: Malnutrition is a marker of poor postoperative outcome. Subjective Global Assessment is better than Nutritional Risk Index to predict postoperative complications in patients undergoing abdominal surgery. Keywords: malnutrition, nutritional assessment techniques, nutritional risk index, subjective global assessmentPublication Ischemic Stroke as a Manifestation of Cholesterol Embolization Syndrome Following Percutaneous Coronary Intervention(Kathmandu University, 2021) Ghimire, B; Khanal, K; Bajracharya, A; Koirala, MABSTRACT Cholesterol embolization syndrome (CES) is one of the major, yet under- diagnosed cause of morbidity and mortality following invasive coronary interventions. The major risk factors are elderly, male, atherosclerotic disease, anticoagulation and femoral access route. This multisystem disease affects skin, kidney, brain, eye and gastrointestinal tract. Only few cases of cholesterol embolization syndrome manifesting as an ischemic stroke are reported. We present a case of an elderly man, admitted to our ICU after percutaneous coronary intervention (PCI) who developed neurological deficits along with skin changes and renal failure. cholesterol embolization syndrome was suspected based upon the presence of cardiovascular risk factors, invasive cardiovascular intervention and clinical signs. The diagnosis of ischemic stroke made through plain MRI brain, revealed multiple areas of lacunar infarcts. He was treated with intermittent hemodialysis, statins and anti-platelet agents. On follow up, skin lesions and renal functions were improved; but slurring of speech and paresis persisted. KEY WORDS Cholesterol embolization syndrome, Ischemic stroke, Percutaneous coronary interventionPublication Laparoscopic management of hydatid cyst of liver(Institute of Medicine, 2016) Pradhan, S; Ghimire, B; Kansakar, P; Singh, Bhandari R; Joshi, Lakhey P; Singh, YP; Vaidya, P; Mishra, P; Singh, KPAbstract Introduction: The surgical treatment of liver hydatid disease has evolved dramatically and laparoscopic treatment has shown encouraging results with the advantages of minimally invasive surgery. We conducted this study to determine the outcome of laparoscopic management of hydatid disease of the liver. Methods: Consecutive patients with this disease reporting to our department from July 2014 to July 2015 were offered laparoscopic management. All patients received pre- and postoperative albendazole. The laparoscopic technique consisted of aspiration of the cyst fluid, sterilization, suction and drainage of the cavity, deroofing and addition of omentoplasty. Age, sex, duration of surgery, surgical morbidity, hospital stay and evidence of hydatid cyst recurrence were measured. Results: Twenty six patients had laparoscopic treatment for hepatic hydatid cysts. Females were 18 (69.2%) and males were 8 (30.8%). Mean age of patients was 37.46 ± 15.96 years (range 17-74 years). Pain was the commonest presentation occurring in 21 (80.8%). The right lobe of the liver was most commonly involved in 20 patients (76.9%). The mean cyst size was 6.77 cm (range, 5 cm to 12 cm). Minor spillage of cyst contents occurred in 5 patients (19.23%) and major spillage occurred in 1 patient (3.8%). The mean duration of surgery was 84.81±28.93 minutes (range 50-150 minutes). Conversion was needed in 2 (7.7%). Complications included port-site infection in 2 (7.7%), bile leak in 3 (11.5%), fever in 5 (19.2%) and chest infection in 2 (7.7%) cases. Mean hospital stay is 4.58 ± 3.40 days (range 3-16). There was no mortality in the series. The average follow-up period is 7.81 ±2.57 months. There have been no recurrences to date however 1 patient was lost to follow up. Conclusion: Laparoscopic management of hydatid cysts of the liver is a safe and effective option with advantage of minimally invasive surgery in properly selected patients. Keywords: Hydatid cyst, Laparoscopy, EchinococcusPublication Limburg Flap Closure for Pilonidal Sinus Disease(Institute of Medicine, 2014) Ghimire, B; Singh, YPAbstract Introduction: Though Pilonidal sinus disease (PSD) is a benign disease it can be debilitating at times. Though there are many techniques for treating the disease, they have prolonged recovery and risk of recurrence. Limberg flap repair is a novel technique as it is curative with minimal incidence of recurrence and the healing is better Methods: All patients diagnosed with PSD irrespective of their age were included in the study and underwent Limberg Flap Closure under spinal anesthesia in prone position. Results: During the study period of two years, eleven patients were operated. Most of them were young males. Admission was usually for 4 days (3 to 7 days). One patient had superficial surgical site infection which healed after 10 days one patient developed seroma which was asymptomatic and three patients had hypoesthesia on the upper portion of the flap. There was no recurrence over three years follow up Conclusion: Limberg Flap Closure for Pilonidal Sinus Disease is a safe procedure with acceptable morbidity and less risk of recurrence. Keywords: Pilonidal sinus disease, Limberg flap closure, Khomboid excision, ScrumaPublication Myocardial Infarction in Non-obstructive Coronary Arteries (MINOCA) in the Perioperative Period can Epinephrine be Responsible?(Kathmandu University, 2022) Koirala, M; Shakya, BM; Parajuli, B; Ghimire, BABSTRACT Ephedrine, metaraminol, epinephrine and maneuvers like carotid sinus stimulation used during intraoperative period have been postulated to cause temporary spasm of the coronary vessels leading to decrease supply to the myocardium and precipitating myocardial infraction in non-obstructive coronary arteries (MINOCA). As an anaesthesiologists, we should be aware that even a dose as small as 25 mcg epinephrine infiltrated along with local anaesthetic in the subcutaneous plane may be responsible for coronary vessel spasm and thus myocardial infraction in non- obstructive coronary arteries. We report a case of 45 years old female with papillary carcinoma of thyroid who developed features of non-ST elevation myocardial infarction 5 minutes after the subcutaneous infiltration of 5 ml of 2% Xylocaine with 1:200000 Epinephrine. Patient was managed for acute Myocardial Infarction. Coronary angiogram done the next day revealed normal coronary arteries, hence the diagnosis Myocardial infraction in non-obstructive coronary arteries was made. KEY WORDS Acute myocardial infraction, Epinephrine, Local anaestheticsPublication Post Operative Diagnosis of Early Gastric Cancer in a Low Risk Population and the Possibility of Risk Stratified Screening(Kathmandu University, 2014) Ghimire, B; Singh, YP; Timalsina, SABSTRACT Background Gastric cancer is the second commonest cause of cancer related mortality worldwide. Though its incidence is more in Eastern Asia, it is increasing in the South Asian subcontinent. The diagnosis of early gastric cancer (EGC) confined to the mucosa or submucosa, is an important concern due to a better outcome at this stage where five year survival rates could increase by 90 percent. Though mass screening is done in few countries, it has not been applied in developing countries like Nepal. Preoperative diagnosis of EGC is rare in Nepal. The aim of this study is to analyze the clinico- pathological features of postoperative cases of gastric cancer managed in a tertiary care university hospital of Nepal. Methods All patients with histological diagnosis of gastric cancer admitted in the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal during the three year period (September 2010 to August 2013) were analyzed retrospectively. Results Ninety two patients with endoscopic diagnosis of gastric cancers were admitted during the past three years. The mean age was 60 years ranging from 28 years to 85 years with the male to female ratio of 2.8:1. Five patients were younger than 40 years and all were in advanced stage. Thirty five percent of the patients belonged to Janajatis (Hill) community though they comprise only 23% of the population and about 65% of them belonged to an area involving 25% of the country. Seventy six cases were operated. Out of 92 patients, 4 patients were diagnosed as early gastric cancer post operatively. All patients with early gastric cancer were above 50 years with CT Scan abdomen revealing focal thickening without lymphadenopathy. Conclusion Over the years, the incidence of gastric cancer is increasing in Nepal. Though 92% are advance gastric cancers, few have been diagnosed and treated early. A screening program in a country like Nepal with diverse ethnicity and difficult terrain might be helpful if it targets high risk people in high risk areas. KEY WORDS Advanced gastric cancer, early gastric cancer, ethnicity, low riskPublication Solitary skull metastasis as initial presentation of hepatocellular carcinoma(Institute of Medicine, 2017) Pradhan, S; Phuyal, S; Kumar, A; Ghimire, B; Singh, Y PAbstract Hepatocellular carcinoma (HCC) is the most common primary tumor of liver. HCC usually metastasizes to regional lymph nodes and lungs, less commonly to bone and rarely to the skull. Herein we present a case of 73 year old gentleman who presented with an occipital swelling. CT head detected mass suggestive of hemangiopericytoma with a differential of metastasis and MRI showed heterogenous signal intensity mass probably metastasis. Cytological diagnosis revealed cranial metastasis. Subsequent CECT abdomen reported a 12x11x11cm heteregenous enhancing mass suggestive of hepatocellular carcinoma. Patient was planned for craniectomy and transarterial chemoembolization to treat primary cancer but he refused further treatment inspite of extensive counseling. Primary presentation with skeletal metastases is rare in HCC and only few cases have been reported so far but it should be considered in the differential diagnosis in patients with subcutaneous scalp mass. Keywords: Hepatocellular carcinoma, Skull metastasisPublication Surgical management of extrahepatic portal vein obstruction at University Hospital(Institute of Medicine, 2017) Shah, S; Ghimire, B; Kansakar, P B S; Bhandari, R S; Lakhey, P J; Vaidya, P; Singh, Y PAbstract Introduction: Extrahepatic portal vein obstruction (EHPVO) is a second most common cause of portal hypertension which causes upper gastrointestinal (GI) bleeding. Primary management of upper GI bleeding is endoscopic therapy. However, surgery is performed as a secondary management of upper GI bleeding and if patients fail to respond endoscopic management or complications of EHPVO develops. The aim of the study was to determine the perioperative outcome of surgery done for EHPVO. Methods: This is retrospective observational study of all the patients of EHPVO, who were undergone surgical management at Tribhuvan University Teaching Hospital in between April 2015 to March 2017. Data were collected from case sheets of the patients. The demographic and clinical characteristics of the patients, and perioperative and short term outcome of the surgical management of EHPVO patients were analysed. Results: Total 34 patients were included in the study including 20 males (58.8%) and 14 (41.2%) females with median age of 17 years (4 to 45 years). Most common presentation of EHPVO were fullness in upper abdomen (34/34) upper GI bleeding (29/34). Most of the patients had anemia (33/34), splenomegaly (34/34) and hypersplenism (28/34).Shunt surgery was performed in 20 patients and modified Hassab’s procedure in 14 patients. There was no post-operative severe complication except one mortality in Hassab’s procedure. The median duration of surgery was higher in shunt surgery group compared to devascularisation group (240 minutes versus 180 minutes). There were no significant differences in intraoperative blood loss, total hospital stays and recurrent upper GI bleeding in both surgery groups. Conclusions: Surgical management for EHPVO have good perioperative and short term outcome. Keywords:Esophageal varices, Hypersplenism, Portal biliopathy,Portal vein obstruction