Browsing by Author "Ghimire, R"
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Publication Accuracy of ultrasonography in evaluation of level and cause of biliary obstruction: a prospective study(Kathmandu University, 2005) Ghimire, R; Lohani, B; Pradhan, SAim: To find out the accuracy of ultrasound in evaluation of level and cause of biliary obstruction. Materials and methods: Forty-five patients (26 to 86 years of age) with suspected biliary obstruction underwent Ultrasonography followed by Direct Cholangiograms (Percutaneous Transhepatic Cholangiography / Endoscopic Retrograde Cholangiography). The levels of biliary obstructions were grouped as hilar, suprapancreatic and intrapancreatic. Similarly the causes were grouped as malignant and benign. Diagnosis was confirmed either at surgery or histopathologically (USG-guided FNAC or ERC-biopsy). Results: Ultrasonography accurately identified the level of obstruction in 89 %( hilar), 91 %( suprapancreatic) and 87 %( intrapancreatic) cases. Malignancy was found in 33 patients and remaining 12 had benign diseases. USG accurately identified malignant and benign causes in 91% and 84% cases respectively. Findings were found to be statistically significant (p-value=<0.05 at 95%confidence interval). Conclusion: This study showed that USG has high accuracy in identifying the level and cause of biliary obstruction. Considering cost, availability and patient friendly nature, Ultrasound should be the first imaging modality of choice in evaluation of biliary obstruction. Key words: Ultrasound, biliary obstruction, direct cholangiogramPublication Correlation of serum free prostate-specific antigen level with histological findings in patients with prostatic disease(Kathmandu University, 2010) Lakhey, M; Ghimire, R; Shrestha, R; Bhatta, ADAbstract Background: Prostate Specific Antigen (PSA) has been widely used in the diagnosis and management of patients with prostate cancer. It may be elevated in other prostatic diseases and surgical procedures. PSA exists in two forms, a major bound form (cPSA) and a free form (fPSA). Objectives: The objective of the study was to determine the relationship between serum fPSA levels and histologic findings in biopsy specimens of men with prostatic disease. Material and methods: This study includes 91 patients planned for transurethral resection of prostate (TURP). Blood samples were collected before TURP and tested for fPSA. Histology of the tissue samples collected after TURP were studied and the relationship with fPSA analysed using SPSS 11.5. Results: The median values for benign, premalignant and malignant lesions were 1.8ng/ml, 4.5ng/ml and 13.20ng/ml respectively (p<0.001). Most cases of benign prostatic hyperplasia(BPH) without inflammation had fPSA levels <2ng/ ml, while most with active inflammation had levels >5ng/ml. Low grade prostatic intraepithelial neoplasia (LGPIN) saw levels <5ng/ml while high grade intraepithelial neoplasia (HGPIN) and prostate cancer (PCa) had levels > 5ng/mL (p<0.05). For detection of high grade lesions (HGPIN and PCa), the sensitivity and specificity of fPSA level > 5ng/ml was found to be 88.8% and 90.2% respectively. Conclusions: Serum fPSA is elevated marginally in patients with BPH without inflammation. Active inflammation and high grade lesions are associated with fPSA level more than 5 ng/ml. Key words: Benign prostatic hyperplasia, fPSA, prostate cancer, prostatic intraepithelial neoplasia.Publication Histoid leprosy with ENL reaction(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2013) Pokhrel, K; Ghimire, R; Subedi, SNo Abstract Keywords: Histoid leprosy, ENLPublication Modified Limberg Flap for Pilonidal Sinus(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2017) Thapa, Prabin Bikram; Maharjan, DK; Ghimire, R; Shrestha, SKAbstract: Background: Pilonidal sinus disease is a common condition usually seen in young adults. Although several methods of treatment have been described, but all have been associated with high recurrence rates. This study was carried out to evaluate the advantages and results of rhomboid excision and Limberg flap reconstruction in the management of pilonidal sinus disease. Objective: To evaluate the advantages and results of rhomboid excision and Limberg flap reconstruction in the management of pilonidal sinus disease Material and Methods: This was prospective descriptive study conducted in Unit III, Department of Surgery, Kathmandu Medical College Teaching Hospital from August 2013 to August 2015. First 50 patients with diagnosis of pilonidal sinus were included .Exclusion criteria was patients with pilonidal abscess. Results: Total 50 patient were included in 2 years time. Mean age was 23.48 ± 3.9 years with all male patients only. Median duration of surgery was 32 ± 4.4 minutes .Median time for normal activities was 21± 3.9 days and median follow up time was 18±8.5 months. No recurrence was noted till then. Post surgery, patient applied hair removal cream: 44%, hair shaving: 34% and laser therapy for hair follicles: 22%. Conclusion: Modified Limberg flap is better option for pilonidal sinus with least recurrence. However, post surgical counseling for hair removal is very important in order to prevent recurrence and should be multidisciplinary approach along with dermatologist colleagues. Keywords: pilonidal sinus, modified limberg flap, hair removalPublication Role of C-reactive Protein in Acute Appendicitis(Kathmandu University, 2016) Ghimire, R; Sharma, A; Bohara, SABSTRACT Background Acute appendicitis is the common surgical emergency. This study analyzed the value of C-reactive protein as the diagnostic marker of acute appendicitis. Objective To assess the level of C-reactive protein in acute appendicitis and to relate the quantitative measurement with degree of inflammation of appendix. Method A cross sectional study was done with consecutive patients diagnosed with acute appendicitis that underwent appendectomy over six months period. Peroperative findings and histopathology report were compared and analyzed with the level of C-reactive protein. Result A total of 54 patients were enrolled in this study. 94.40% were proved as acute appendicitis in histopathology. The level of C-reactive protein was significantly raised among highly inflamed appendix. C-reactive protein showed 84.31% sensitivity, 66.66% specificity, 97.72% positive predictive value and 20% negative predictive value in diagnosing acute appendicitis. Conclusion With degree of inflammation of appendix, value of C-reactive protein was raised. Quantitative assessment can predict severity of inflammation. Raised level of C-reactive protein is an aid for diagnosing acute appendicitis. KEY WORDS Acute appendicitis, C-reactive protein, HistopathologyPublication Role of Intraoperative Cholangiogram in Major Liver Resection and Complex Bilio-enteric Bypass Surgery(Kathmandu University, 2024) Ghimire, R; Pandey, P; Acharya, BPABSTRACT Background Advances in surgery have decreased postoperative morbidities but bile leak is still a major issue. Intraoperative cholangiogram (IOC) is considered better in identifying bile leaks and anatomical delineation making its expanded use in hepato-biliary surgeries. Objective To assess the role of intraoperative cholangiogram in major hepatectomy and complex bilio-enteric bypass surgery. Method A single-centered, descriptive cross-sectional study between March 2022 to February 2023 among conveniently sampled 32 patients undergoing Hepato-biliary surgeries. One ampoule of meglumine diatrizoate was instilled into the biliary tract and intraoperative pictures were taken via C-arm to visualize the biliary tree and pre- operative and intra-operative pictures were compared. Result A total of 32 patients were included in the study with a median age of 42 years and a male-female ratio of 1:1.67. During the bilio-enteric anastomosis, no intraoperative anastomotic leaks were detected. Two patients experienced postoperative bile leakage that was managed conservatively and eight cases had intraoperative bile leakage which was addressed during surgery. The average duration of hospital stay was 5 days. Conclusion An intraoperative cholangiogram is useful to delineate the biliary tract anatomy, reassure anastomosis, and identify bile leaks in difficult bilio-enteric anastomosis and from liver resection margins intraoperatively. KEY WORDS Complex hepatobiliary surgery, Intraoperative cholangiogram, Liver resectionPublication Stress Anxiety and Depression among Adolescents of Schools in Godawari Municipality, Lalitpur(Kathmandu University, 2024) Ghimire, R; Adhikari Mishra, T; Sharma, PABSTRACT Background Adolescence is a critical phase of life marked by various physical, emotional, and intellectual changes. Emotional aspects of adolescents are often undetected, unaddressed, and untreated. Objective To find out the level and factors associated with stress, anxiety, and depression among adolescent students. Method A descriptive cross-sectional study among 513 adolescents from grades 9 and 10 in the Public Secondary Schools of Godawari Municipality was carried out using cluster sampling techniques. The participants were administered a validated Nepali version of the Depression, Anxiety, and Stress Scale 21. Descriptive statistics was used to assess the level of stress, anxiety, and depression, while binary logistic regression was used to identify predictors of these conditions among adolescent students. Result Findings revealed that mild level of stress (10.1%), moderate level of anxiety (21.2%) and mild level of depression (19.5%) were more prevalent among adolescent students. In a multivariate model, it was found that female adolescents were more likely to have symptoms of stress, anxiety, and depression. Similarly, witnessing domestic violence and experiencing abuse ever were significantly associated with stress; family health problems and witnessing domestic violence were significantly associated with anxiety and passed in previous examination, family history of mental illness, experiencing abuse ever and bedtime use of electronic devices were significantly associated with depression in adolescent students. Conclusion The severity of stress, anxiety and depression are increasing among adolescent students. Hence routine mental health screening, adolescent mental health awareness programs and counselling sessions should be conducted in schools. KEY WORDS Adolescents, Anxiety, Depression, StressPublication Time in Therapeutic Range and Adverse Outcomes among Patients Receiving Warfarin Therapy at Tertiary Care Hospital(Kathmandu University, 2023) Ghimire, R; Dhungana, SPABSTRACT Background Warfarin has a narrow therapeutic index and needs regular international normalized ratio monitoring and dose adjustment. Poor quality of warfarin dosing can lead to an increased risk of adverse events. Objective To find out the overall quality of the international normalized ratio expressed in terms of time in therapeutic range and adverse outcomes associated with the use of warfarin. Method A descriptive cross-sectional study among 150 patients attending a tertiary care center receiving warfarin therapy from December 2022 to June 2023. Patients receiving warfarin at least for 6 months and with at least three international normalized ratio values were enrolled. Indications, average daily dosing, international normalized ratio, and adverse effects were recorded using convenient sampling. Data were analyzed by using SPSS, version 20. Result The mean age was 46.41±13.96 years. Indications for warfarin were valvular and nonvalvular atrial fibrillation in 104 (69.33%), deep vein thrombosis 21 (14%), and pulmonary embolism 6 (4%). The majority of patients 100 (66.6%) received 5 to 10mg of warfarin per day. The mean duration of warfarin use was 18.11±21.93 months. The mean time in the therapeutic range (%) was 62.43±27.52. Sixty patients (40%) had time in the therapeutic range below 60%. Among the adverse effects, minor bleeding was present in 25 (16.66%). The ischemic event was present in 7 (4.7%). Conclusion Our patients had lower time in the therapeutic range than recommended in the guidelines. They had a longer time in the sub-therapeutic range. KEY WORDS Atrial fibrillation, International normalized ratio, Treatment outcome, Warfarin