Browsing by Author "Gupta, DK"
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Publication Comparative study of three antimicrobial drugs protocol (Ceftriaxone, Gentamicin/Amikacin and Metronidazole) versus two antimicrobial drugs protocol (Ceftriaxone and Metronidazole) in cases of intra-abdominal sepsis(Kathmandu University, 2005) Khan, S; Gupta, DK; Khan, DNBackground: Treatment of intra-abdominal sepsis with antibacterial drugs should be initiated as soon as possible diagnosis is made before surgery and continued in the post operative period, unless required to be changed (when there is no satisfactory clinical response). The ideal agent (s) and duration of therapy remains somewhat controversial. However, early experimental and subsequent clinical studies have indicated that the spectrum of chosen antibacterial activity must encompass both colonic aerobes and anaerobes including B. fragilis. There are a number of multi drug protocols that are used to treat intra-abdominal septic conditions. Empiric use of these protocols not only adds toxicity to already ill patient but therapy becomes costly and utilizes human resource, unnecessarily. Aim of study: To study the clinical efficacy of the treatment of intra-abdominal sepsis with protocol –A (Ceftriaxone, Metronidazole and aminoglycoside) versus protocol –B. (Ceftriaxone and Metronidazole). Material and methods: This is a prospective randomized study conducted at NGMC, Nepalgunj, Nepal (2003- 2004) on the patient attending for the treatment of intra -abdominal sepsis. Patients included in this study were of inflammation, obstruction with or without gangrene and perforation of appendix, small bowel and large bowel with localized or generalized peritonitis. These patients were managed surgically by- appendicectomy, closure of perforation, resection and anastomosis (R&A) and resection and proximal colostomy. Patients of large bowel obstruction without gangrene and small bowel gangrene were managed by R&A. These patients had significant faecal spillage at the surgical site as well as in the peritoneum. At the end of operation peritoneum and surgical site of all cases were washed with saline and povidone-iodine solution. They were put on one of the two protocols for post-operative treatment. A total 59 patients were included in this study. 32 cases were treated with protocol- A and rest 27 cases were treated with protocol- B. These cases were selected randomly for this study. Their outcome was compiled and compared under following headings: postoperative recovery, postoperative pyrexia, wound infection and dehiscence, anastomotic leak, residual abscess and cost of therapy. Statistical analysis: Statistical analysis was done with the help of Chi square test. Result: Of the 59 patients, 32 were randomized to group I, 27 to group II. These groups were comparable in age, weight, sex and duration of therapy. Uneventful recovery was noted in 87.5 % (28/32) in -group I where as in 70.37% (19 /27) in-group II. Complications were observed in 12.5% in-group I where as 29.63 % in-group II. 10 patients in-group I where as 7 patients in -group II had surgical site infections (SSIs). All of these had superficial wound infection with/or without dehiscence of small portion of wound. A single case of residual abscess and anastomotic leak was observed. Postoperative pyrexia was noted in 8 patients in-group I where as in 6 patients in-group II. In pyrexia, temperature ranged from 99-104 0F. Finally except one case, rest of the cases recovered. On follow up after 3weeks, the cases recovered were doing well. Conclusion: At least three conclusions can be drawn from this study. Firstly protocol A is equally effective as protocol B. Secondly; it appears that combining aminoglycoside with Ceftriaxone therapeutically has no significant (P=0.09) benefit over Ceftriaxone alone. Finally protocol A is less expensive in terms of total therapy than protocol B and can be used without fear even in subnormal functioning kidney. Key Words: Comparative Study, Antimicrobial Drugs, Protocol, Intra-abdominal SepsisPublication Pattern of Renal Cell Carcinoma – A Single Center Experience in Nepal(Kathmandu University, 2011) Sidharth; Luitel, BR; Gupta, DK; Maskey, P; Chalise, PR; Sharma, UK; Gyawali, PR; Shrestha, GK; Sayami, G; Joshi, BRABSTRACT Background Renal tumor is the 13th most common malignancy in the world and more than 90% of renal tumors are renal cell carcinomas. As there is no data available on renal cell carcinoma in Nepal, hence this study was undertaken to analyze the patterns of renal cell carcinoma in patients with renal mass at a tertiary level hospital in Nepal. Objectives To analyze the patterns of renal cell carcinoma in patients with renal mass at a tertiary level hospital in Nepal. Methods The case records of 50 consecutive patients with renal cell carcinoma presenting at the Tribhuvan University Teaching Hospital, Kathmandu from July 2006 to June 2011 were retrospectively evaluated for presenting symptoms, physical finding, investigation and histopathology report. Results Out of 50 patients, 64% were male and 36% were female. The age ranged between 11 to 78 years (mean ± SD: 55 ± 15 years). Fifty four percent of patients were smokers. Incidentally tumor was detected in 40% cases by ultrasonography and the typical triad was present in only 4%. The tumor was occupying upper pole in 40% of cases. The tumor size ranged from 3 to 15 cm (mean ± SD: 7.3 ± 2.9 cm). Histopathologically, 76% of the patient had organ confined renal cell carcinoma (T1- 2 N0 M0). Clear cell was the most common type seen in 86%. Fuhrman’s nuclear grade 2 was found in 50%. Conclusion Many of the renal cell carcinoma are detected incidentally, at an early stage and are of clear cell subtype. KEY WORDS Incidental renal tumor, Nepal, Renal cell carcinoma.Publication Phaeochromocytoma in Nepal – A Single Centre Experience(Kathmandu University, 2012) Maskey, P; Shrestha, GK; Luitel, BR; Gupta, DK; Sidarth; Chalise, PR; Sharma, UK; Gyawali, PR; Joshi, BRABSTRACT Background Phaeochromocytomas are rare tumors of chromaffin cells of neural crest that classically present with symptoms of catecholamine excess such as palpitations, headache and sweating. They are diagnosed by measuring plasma or urinary levels of catecholamines or their metabolites. Anatomic localization is done by computed tomographic scan or magnetic resonance imaging, or meta-iodobenzyl guanidine scan in certain cases. Adequate preoperative catecholamine blockade prevents perioperative hemodynamic instability. Objectives To study the clinical spectrum and management of phaeochromocytomas in a tertiary care centre, Tribhuvan University Teaching Hospital, in Nepal. Methods Retrospective review of case records of histologically proven cases of phaeochromocytomas from 2008 -2011 was done, and data collected on clinical spectrum, diagnostic modalities, perioperative management and follow-up. Results Tweleve cases of phaeochromocytomas were operated. The mean age was 36.41±14.07 years. There were 2 bilateral phaeochromocytomas and 1 extra- adrenal paraganglioma. Apart from the common symptoms of catecholamine excess, patients had atypical presentations like psychiatric manifestations and blurred vision. A combination of urinary Vanillyl Mandelic Acid and computed tomographic scan was used for diagnosis, and open surgery was done in all cases. Pre-operative blood pressure control was achieved by prazocin or calcium channel blockers. Ten patients had intraoperative surge in blood pressure. There were no major morbidity or mortality. Three patients had high blood pressure post- operatively, but were effectively managed with antihypertensives. Conclusion Phaeochromocytomas can have variable presentation. Good preoperative preparation and perioperative management can result in an excellent outcome. KEY WORDS Hypertension, Paraganglioma, Phaeochromocytoma, Prazocin, Vanillyl Mandelic AcidPublication Risk-based Management of Non-muscle Invasive Bladder Cancer: Experience from Tribhuvan University Teaching Hospital(Kathmandu University, 2016) Luitel, BR; Chalise, PR; Sidharth; Gupta, DK; Subedi, P; Chapagain, S; Sharma, UK; Gyawali, PR; Shrestha, GK; Joshi, BRABSTRACT Background Most of the recent evidences suggest for risk-based management of non muscle invasive bladder cancer (NMIBC) to reduce the risk of recurrence and progression. Objective This study was conducted to assess the recurrence and progression of non muscle invasive bladder cancer in Nepalese patients using European Organization for Research and Treatment of Cancer (EORTC) risk tables and to assess the effectiveness of intravesical therapy to reduce the risk of recurrence. Method A prospective observational single centre study was conducted at Tribhuvan University Teaching Hospital from January 2010- December 2012. Forty six patients with non muscle invasive bladder cancer who underwent transurethral resection of bladder tumor and completed two years follow up were included. According to the European Organization for Research and Treatment of Cancer (EORTC) risk table, the patients were divided into low, intermediate and high risk groups. The patients received postoperative adjuvant therapy and surveillance as per the European Association of Urology guidelines. Result Among the 46 patients, the overall two year recurrence and progression rate was 8 (17%) and 1 (2%) respectively. Out of seven patients in low risk category, none of them developed recurrence or progression of disease. Out of 15 patients in intermediate risk category the one year and two year recurrence rate was 13% and 20% respectively. Out of 24 patients in high risk category the one and two year recurrence rate was 17% and 21% respectively. The risk reduction by use of intravesical Bacillus Calmette Guerin (BCG) for recurrence in high risk category was 58% and 60% in first and second year respectively. In our study, the overall and individual risk group, the one and two year recurrence rate was lower than that predicted by European Organization for Research and Treatment of Cancer risk table. Conclusion Risk-based management of non muscle invasive bladder cancer by using the European Organization for Research and Treatment of Cancer risk table is a useful method of management, though its prediction rates are lower in Nepalese population. KEY WORDS EORTC, intravesical therapy, NMIBC, progression, recurrence, risk table