Browsing by Author "Jha, A"
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Publication A comparison of radiation dose in single and split bolus multidetector computed tomography urography(Institute of Medicine, 2017) Joshi, BR; Jha, AAbstract Introduction: Routine multidetector computed tomography (MDCT) urography protocols include three phase scan with single bolus contrast material injection. To reduce the radiation dose a split bolus MDCT urography technique has been introduced. Methods: Nephrographic phase in single bolus was obtained by injecting 90 ml of Ioversol (Optiray320mgI/ml) contrast at the rate of 3ml/s during the preset time of 90 second. The excretory phase was taken at the delay of 10 minutes after the contrast injection. For split bolus only two phases (unenhanced and combined) were scanned from the diaphragm to the base of the urinary bladder. The combined phase in split bolus was performed by injecting the contrast in two bolus in which 40 ml at 2ml/s was injected in the first bolus and after a delay of 9 minutes, 60 ml at a rate of 3ml/s was injected, then the scan was obtained 90 second after the second bolus. The volume CT dose index (CTDIvol) and CT dose length product (CTDLP) were assessed in CT work station. Results: The mean effective radiation dose for single bolus MDCT urography was 40.5% more than the split bolus MDCT urography. Conclusion: Split bolus MDCT urography protocol was significantly better in effective radiation dose reduction compared with the single bolus MDCT urography protocol. Keywords: CTDIvol, DLP, MDCT urography, Radiation dosePublication Abnormal Uterine Bleeding: Comparison of Transabdominal and Transvaginal Sonography(Institute of Medicine, 2018) Solih, M; Jha, A; Joshi, BRAbstract Introduction: Transabdominal (TAS) and transvaginal sonography (TVS) are the preferred modalities for initial imaging evaluation of abnormal uterine bleeding (AUB). The main causes of such bleeding in perimenopausal patients are endometrial polyp, adenomyosis, leiomyoma and endometrial hyperplasia. The aim of this study was to evaluate the findings and compare TAS and TVS in perimenopausal and menopausal patients with AUB. Method: A prospective cohort study was performed and fifty nine perimenopausal and postmenopausal patients with AUB meeting the inclusion criteria were invited to participate in this study.TAS and TVS was done, findings recorded in proforma and analyzed. Result: Mean endometrial thickness at various uterine levels was more on TVS compared to TAS. Abnormal findings like adenomyosis and nabothian cysts were detected on TVS than TAS. On TAS 41% of patients had bulky uterus while only 2.5 % had bulky uterus on TVS. Diagnosis of intramural fibroid on TVS and TAS was comparable; however, submucosal fibroids were better visualized on TVS. Conclusion: TVS is better to diagnose endometrial polyps, submucosal fibroids, nabothian cysts and adenomyosis while TAS is superior in cases of bulky uterus. In cases with intramural fibroids and endometrial hyperplasia, both were comparable. TAS should still be used as the initial monitoring method for gynecologic abnormalities due to its greater depth penetration and thus wider field of view and should be followed by TVS. Keywords: Abnormal uterine bleeding, Transabdominal sonography, Transvaginal sonographyPublication Analgesic Efficacy of Fascia Iliaca Compartment Block for Positioning During Spinal Anesthesia in Patients with Femur Fractures(Kathmandu University, 2023) Jha, A; Khatiwada, S; Pokharel, K; Ghimire, A; Singh, SN; Prasad, JNABSTRACT Background Positioning patients with femur fractures for spinal anesthesia is associated with excruciating pain. Fascia iliaca compartment block has the potential to block all nerves supplying the femur and therefore may provide effective analgesia during positioning these patients for spinal anesthesia. Objective To assess the analgesic efficacy of Fascia iliaca compartment block, during positioning patients with femur fracture for spinal anesthesia. We also assessed the duration of analgesia and the requirement for rescue analgesics in the postoperative period. Method Seventy adult patients with fracture femurs were randomly divided into two equal groups (A and B). Patients in both groups received fentanyl one mcg/kg intravenously, 20 minutes before positioning them for spinal anesthesia. Patients of group B additionally, received ultrasound-guided Fascia iliaca compartment block with 40 ml of 0.25% Ropivacaine, immediately after intravenous fentanyl. Numerical rating score (0-10) was used for the assessment of pain at five, 10, and 20 minutes after the block and immediately after positioning patients for spinal anesthesia. Result Immediately after positioning patients for spinal anesthesia, the numerical rating score of pain was 5.06±1.5 in group A and 2.49±1.2 in group B (p<0.001). The duration of analgesia was 799.7±62.1 minutes in group B and 314.65±118.9 minutes in group A (p<0.001). One (2.8%) patient of group B and 18(51.4%) patients of group A required rescue analgesics within four to twelve hours in the postoperative period (p=0.001). In group A, seven patients were satisfied with the analgesia technique while in group B, 17 were satisfied and eight patients were strongly satisfied (p<0.001). Conclusion Ultrasound-guided Fascia iliaca compartment block is effective in reducing pain during positioning patients with femur fractures for spinal anesthesia. Patients receiving this block had a prolonged duration of analgesia, required lesser analgesics, and were more satisfied in the postoperative period as compared to patients not receiving the block. KEY WORDS Fascia Iliaca compartment block, Positioning, Postoperative analgesiaPublication Apocrine Carcinoma Developing in a Naevus Sebaceous of Scalp(Kathmandu University, 2012) Paudel, U; Jha, A; Pokhrel, DB; Gurung, D; Parajuli, S; Pant, AABSTRACT Apocrine skin carcinoma is an aggressive cutaneous tumour. We report a case of apocrine carcinoma developing in a naevus sebaceous of scalp in a 45 years old male. Malignant transformation of Naevus sebaceous is a rare complication usually found in elderly patients. Most of these tumours are basal cell carcinoma or squamous cell carcinoma. Only few cases of apocrine carcinoma on naevus sebaceous have been previously reported. This report highlights the potential of naevus sebaceous for malignant transformation. KEY WORDS Apocrine, Basal cell carcinoma, carcinoma, hamartoma, nevus, Sebaceous of Jadassohn, skin.Publication Comparison of Outcome of Borderline and Normal Amniotic Fluid Index in Term Pregnancy(Kathmandu University, 2021) Ansari, SN; Baral, J; Gurung, G; Jha, AABSTRACT Background Determination of Amniotic Fluid Index (AFI) is an important component of antepartum assessment of all normal pregnancies. Objective To compare the obstetric interventions and neonatal outcomes in term pregnancies with borderline Amniotic Fluid Index versus normal Amniotic Fluid Index. Method This hospital based prospective study was conducted at Tribhuwan University Teaching Hospital over 1 year between 2017 and 2018 in 128 women having uncomplicated term pregnancy admitted in labor ward. Of the 128 women, 64 women had borderline Amniotic Fluid Index (5.1-8 cm) and 64 normal AFI (8.1 - 24 cm). Parameters studied were induction of labor, cesarean section, instrumental delivery, intrapartum abnormal fetal heart rate, meconium staining of liquor, APGAR score at 5 and 7 minutes, birth weight, neonatal intensive care unit (NICU) admission and neonatal death. Data was analyzed using software OpenEpi. Result Statistically significant difference in result was obtained in the two groups in terms of rate of induction of labor (73.4% vs 35.9%, p = 0.0001, OR = 4.9), rate of cesarean section (42.1% vs 28 .1%, p = 0.04, OR = 1.8), tachypnea (50% vs 11.1%, p = 0.01) and low birth weight (9.1% vs 4.5%, p = 0.04). No statistical significance was found in meconium staining of liquor (33% vs 38.3%, p = 0.3) and APGAR score of <7 at 5 minutes (3.1% vs 1.5%, p = 0.06). There were no neonatal intensive care unit admissions and neonatal mortality in any of the babies. Conclusion Detection of amniotic fluid volume at term is important for timely maternal interventions to improve the overall fetal outcome. KEY WORDS Borderline amniotic fluid index, Cesarean section, Induction of labor, Meconium stained liquor, TachypnoeaPublication Frequency and Severity of Portal Hypertensive Gastropathy in Cirrhosis(Institute of Medicine, 2017) Poudyal, S; Sharma, S; Khadga, PK; Pathak, R; Jha, A; Shrestha, RAbstract Introduction: Portal hypertensive gastropathy (PHG) is a common endoscopic finding in patients with Cirrhosis. The pathophysiology of PHG was not clearly understood. It was thought that Portal Hypertension was an important triggering factor for the development of PHG but the other factor must be considered for its progression. It is one of the clinically important gastric mucosal lesions because it may cause acute and chronic gastrointestinal blood loss leading to anemia. The aim of our study is to determine the frequency and severity of PHG in patient with Cirrhosis. Methods: This was a Cross-sectional observational study involving 61 consecutive Cirrhotic Patients, who attended Upper GI endoscopy were enrolled in this study as per inclusion and exclusion criteria in the Department of Gastroenterology Tribhuvan University Institute of Medicine. Child-Pugh’s score and MELD score was determined at the entry to determine the severity of liver disease. Data regarding clinical and laboratory investigations were collected. Variceal size was measured endoscopically and the severity of PHG was graded according to Mac Cormack Classification. Results: Out of total 61 patients, the frequency of PHG was found to be 47.5% among them where 44.2% patients had mild PHG and 3.3% patients having severe PHG. There were 29.5% patients in child pugh A, 39.3% in child pugh B and 31.2% in child pugh C. During analysis insignificant relation was found between the PHG with Child pugh score (ρ=0.4) and MELD score (ρ=0.7).When PHG frequency was related to alcohol intake the relations were statistically not significant. There was no association found between portal hypertensive gastropathy with esophageal varices and gender of the patient. Conclusion: Our data showed that the frequency and the severity of PHG are not influenced by the Gender of the patient, etiology and severity of cirrhosis or by presence of esophageal varices. Keywords: Cirrhosis, Portal hypertensive gastropathy, esophageal varicesPublication Glue therapy for bleeding gastric varices: a single tertiary center experience in Nepal(Institute of Medicine, 2017) Jha, A; Sharma, S; Khadga, PK; Pathak, R; Poudyal, S; Hamal, RAbstract Introduction: Bleeding is a common presentation in the Department of Gastroenterology, Institute of Medicine, Tribhuvan University Teaching Hospital. Of the varied causes of upper gastrointestinal bleed, bleeding gastric varices pose a major challenge to the endoscopist and the treating physician. Endoscopic injection of N-butyl-2-cyanoacrylate is the standard of care for treating gastric varices at present. Methods: We retrospectively evaluated the efficacy and safety of cyanoacrylate in patients presenting with gastric variceal bleed. Between May 2016 to April 2017, 25 patients (14-M, 11-F) who presented to Institute of Medicine, Tribhuvan University Teaching Hospital with gastric variceal bleeding underwent endoscopic treatment with N-butyl-2-cyanoacrylate. Results: Eleven patients had cirrhosis secondary to alcohol, 9 had non-cirrhotic portal hypertension, cirrhosis due to hepatitis B-1, hepatitis C-1, NASH-1, and cryptogenic- 2. Child-Pugh score at presentation for patients was Child A-52%, Child B-36% and Child C-12. Successful hemostasis. rebleeding rate and complications were reviewed. Immediate hemostasis was observed in 100 of the cases and carly rebleeding rate of 8% was seen in 2 patients. Complications included post procedure pain 16%, fever 16% and pulmonary embolism 4%. Conclusion: N-butyl-2-cyanoacrylate is an effective, lifesaving modality for immediate hemostasis of gastric variceal bleeding with an acceptable rebleeding rate. Keywords: N-butyl-2-cyanoacrylate, endoscopic injection, gastric variceal bleedPublication Hymenolepis dimunata Infection in a Child of 14 month(Nepal Health Research Council, 2009-04) Thakur, N K; Mishra, S K; Neupane, G P; Jha, APublication Nevus Lipomatosus Cutaneous Superficialis of Hoffmann and Zurhelle: a rare cutaneous hamartoma(Kathmandu University, 2022) KC, S; Aryal, A; Jha, A; Karn, DABSTRACT Nevus lipomatosus cutaneous superficialis (NLCS) is a rare idiopathic cutaneous hamartoma characterized by ectopic clusters of mature adipose tissues in dermis. It is classified into two types. Classical type presenting as multiple lesions with onset at birth or within third decade of life and solitary type with onset between third to sixth decade of life. Here we present a case of 45 years female with adult onset, asymptomatic, grouped, skin colored, soft sessile growth in zosteriform pattern on left buttock. We here intend to report rare case of classical Nevus Lipomatosus Cutaneous Superficialis. KEY WORDS Hoffmann, Nevus lipomatosus cutaneous superficialis, ZurhellePublication Pyoderma gangrenosum in childhood(Institute of Medicine, 2007) Kumar, A; Gurung, D; Pokharel, DB; Budal, KP; Jha, A; Parajuli, SAbstract Pyoderma gangrenosum is a rare painful, necrolytic skin ulcer with an irregular undermined border. It is a part of the spectrum of neutrophilic dermatoses. We report a case of pyoderma gangrenosum in a twelve year old boy. The findings reported in the literature are also discussed. Keywords: pyoderma gangrenosum, neutrophilic dermatosis, skin ulcerPublication Sneddon- Wilkinson Disease in association with NonHodgkin Lymphoma(Institute of Medicine, 2008) Jha, A; Kumar, A; Gurung, D; Chaurasia, AK; Das, AK; Pokharel, DBAbstract Sneddon-Wilkinson disease is a rare condition with chronic recurrent course. It may be a part of paraneoplastic manifestation of underlying malignancy. The disease is diagnosed on the basis of its characteristic clinical features and histopathology. A case of Sneddon –Wilkinson disease associated with non-hodgkin lymphoma in a 54 years old lady is presented. Keywords: Sneddon-Wilkinson disease, Non-Hodgkin lymphoma, Paraneoplastic manifestation, DapsonePublication Sonographic Quantification of Ovarian Volume in Adults Attending General Health Checkup and General Out Patient Department in Tribhuvan University Teaching Hospital(Kathmandu University, 2020) Upadhyaya, RP; Ansari, MA; Jha, A; Kayastha, P; Paudel, SABSTRACT Background Ultrasonography is the easily available, cheap and reliable method for evaluation of ovaries. Ovarian volume is the major factor in the diagnosis of various ovarian pathologies and confusing discrepancies are found in the literature. Objective To determine the ovarian volume among individuals attending outpatient department in tertiary level hospital. Method Descriptive cross sectional study design was used; 305 patients of 16-60 years attending general outpatient department in the Tribhuvan University Teaching Hospital, Kathmandu, Nepal were included. Ovarian volume was calculated by using transabdominal ultrasonography. Data was collected in the predesigned proforma and analyzed using statistical package for the social sciences software. Result The study showed mean total ovarian volume 5.95 ± 2.44 cc (centimeter cube) with mean right ovarian volume 5.94 ± 2.70 cc and mean left ovarian volume 6.05 ± 2.79 cc. Significant decrease in ovarian volume with age was observed. Height and weight did not show significant correlation with ovarian volumes and no significant variation seen in the volumes of right and left ovaries. Periovulatory ovaries show significantly higher volumes on right side than luteal phase. Similarly, significantly higher volume of left ovary seen in mixed ethnic group than mongoloid group. Conclusion Measurement of ovarian volume is important for evaluation and management of ovarian disorders. Ultrasonography which is readily available, simple and cost effective is better suited for our environment than other imaging modality. Values of ovarian volume from this study may provide a baseline of normal ovarian volume in our community. KEY WORDS Ovary, Ultrasonography, VolumePublication The Role of Argyrophilic Nucleolar Organizer Region (AgNOR) Study in Cytological Evaluation of Fluids, Especially for Detection of Malignancy(Kathmandu University, 2012) Karki, S; Jha, A; Sayami, GABSTRACT Background Serous effusion smears reported as “suspicious for malignancy” pose problems in clinical management. Silver staining for argyrophilic nucleolar organizer regions (AgNOR) has proved useful in making a cytopathologic differential diagnosis between benign and malignant cells. Nucleolar organizer regions(NORs) are loops of DNA located in acrocentric chromosomes. These NORs are visualized by silver staining technique that recognizes these argyrophilia associated proteins which are increased in malignancy. Objective This study aimed to distinguish reactive mesothelial cells from malignant cells in serous effusions using these NORs. Methods A total of 174 serous effusions received at the Department of Pathology, TUTH, during a period of one year were included in the study. Smears were studied by conventional Papanicolaou and Giemsa stains. AgNOR counts, variation in size and dispersion of AgNOR dots in smears were graded and compared in malignant and non-malignant effusions. Results Mean AgNOR counts of 10.43±0.73 and 10.21±0.51 in malignant peritoneal and pleural effusions, respectively, were significantly (p<0.0001) greater as compared with counts of 2.12±0.54 and 2.11±0.54 in non-malignant effusions. The AgNORs were irregular in shape in malignant effusions whereas they were comparatively larger, single dots in benign effusions. AgNOR size and dispersion were of higher grade in significantly greater proportion of malignant as compared with non malignant effusions (p<0.0001). Of the cytologically suspicious samples, nine were in the malignant range and one was in the benign range. Conclusion AgNOR study appears to be clinically useful as an additional diagnostic tool for use in serous effusion when the cytologic diagnosis is difficult. KEY WORDS AgNOR , cytology, effusions