Browsing by Author "Jha, R"
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Publication Abortion legalized: Challenges ahead(Kathmandu University, 2007) Singh, M; Jha, RObjective: To see whether advocacy for abortion law and comprehensive abortion care (CAC) sites after legalization of abortion in Nepal is adequate among educated people (above school leaving certificate). Method: 150 participants were assigned randomly who agreed to be in the survey and were given structured questionnaires to find out their perception of abortion and CAC sites. Result: Majority know abortion is legalized and majority have positive attitude about legalization of abortion, however majority are not aware of abortion service in CAC sites and none knew the cost of abortion service Conclusion: Proper and adequate advocacy of the new abortion law and CAC service is essential. Key words: Abortion law, CAC site, AdvocacyPublication Conservatively managed puerperal retroperitoneal haematoma(Institute of Medicine, 1999) Rana, A; Singh, M; Jha, R; Verma, SAbstract Puerperal haematoma occurs in 1/300 to 1/1500 deliveries. A characteristic presentation of post-delivery collapse with signs of internal haemorrhage and clinically palpable left-sided pelvic mass causing gross hydronephrosis on ipsilateral side was confirmed as a case of retroperitoneal haematoma on ultrasound, which resolved completely on conservative management. Keywords: puerperal haematoma, retroperitoneal haematoma, post-delivery collapsePublication Difficulties in the diagnosis of soft tissue sarcomas(Institute of Medicine, 2010) Jha, RAbstract Introduction: Soft tissue tumors represent diagnostic challenge to general practicing pathologists because of overlap in morphologic features. The usual approach is to diagnose by presumed cell lineage. A major utility of immunohistochemistry is to identify a tumor being mesenchymal or nonmesenchymal and once mesenchymal lineage has been confirmed, histologic sub typing according to specific lineage may be achieved with help of lineage specific markers. Methods: The objective of this study was to analyse different types of soft tissue malignancies according to their type, site and age distribution, discuss the difficulties faced during morphologic examination and review the literature for role of ancillary techniques, particularly immunohistochemistry in diagnosing soft tissue sarcomas.All soft tissue malignancies reported from Tribhuvan University Teaching Hospital in three years period from April 2008 to March 2010 were included in the study. Results: Total 87 soft tissue malignancies were reported during study period. Most of these patients (58.6%) were male and the rest were female. These malignancies were found in all age groups. Youngest patient was newborn who was born with tongue mass and biopsy was performed on 13th day of life. However maximum numbers of tumors (41.4%) were seen in first two decades of life. Head and neck was the most common site .Rhabdomyosarcoma was the most common diagnosis. In 20 cases (23%) a definite opinion was not possible and vague terms like sarcoma, small round cell tumor, spindle cell malignancy, vascular tumor “likely” were used. Immunohistochemistry was advised in these cases. Conclusions: Only light microscopic examination of hematoxylin and eosin stained slide not sufficient at all times because there is morphologic overlap of soft tissue sarcomas with each other and with carcinomas and melanomas. Though immunohistochemistry is not a substitute for skilled interpretation of routinely stained slides but prove helpful to reach a more definite diagnosis. Keywords: Immunohistichemistry, sarcoma, soft tissuePublication Evaluation of urinary fistula after Radical hysterectomy(Institute of Medicine, 2011) Jha, M; Jha, R; Pant, PR; Ojha, N; Koirala, P; Shrestha, VAbstract Rate of lower urinary tract complications after radical hysterectomy has been reported with variable rates. It has been found that up to one half of patients will experience at least one urinary tract symptom that develops after radical hysterectomy. Various retrospective studies have examined lower urinary tract dysfunction and injuries as fistula after radical hysterectomy. Compication could be simple as a transient urinary dysfunction to severe as urinary fistula However before diagnosing severe complication of urinary fistula, we should do simple test as examination of urea and creatine level of client’s serum, fluid and urine. These simple test can help to prove that it is not a severe complication as urinary fitula. Like our case though it looked like VVF in the post operative period, however it was daignosed to be just a transient problem after doing simple test as examination of urea and creatine level of client’s serum, fluid and urine. Keywords: Radical hysterectomy, urinary fistula, simple test, daignosisPublication Impact of Elective Abortion in pregnancy with Cardiac problems(Institute of Medicine, 2011) Shrestha, B; Dali, B; Paudel, P; Jha, R; Rana, A; Gurung, G; Baral, GAbstract Introduction: Pregnant women with heart diseases advance either to preterm/term delivery. Some of the pregnancies end in abortions, which however are spontaneous or are terminated for medical reasons. Method: Retrospective study done in the Department of Obstetrics and Gynecology at Tribhuvan University Teaching Hospital from April 2010 to March 2011 (Baisakh 2067 to Chaitra 2067); Source of data was Operation Theater Register and Admission files. Results: MTP were done for altogether 18 cases of heart diseasesin pregnancy. Primigravida (6) and multigravida (12) were seen in age groups 20-30 (13); 30-40 (5) at gestational weeks of 6-8 (n=10); 9-10 (n=6); 11-12 (n=1); >12 (n=1). The heart diseases were {CHD (1); rest 17 RHD: Majority being done following post valve replacement surgery 11[AVR (1); DVR (3) & MVR (7)]}. Latter mandated a tedious process of anticoagulation, switching from heparin to warfarin and vice versa demanding prolonged hospitalization (up to 12 days) as co- morbidity. Mainly because repeat MVA was needed for incomplete abortion as complication in one case, subsequent procedures were done under USG guidance. Conclusion: It is simpler and safer to avoid pregnancy in heart diseases; especially in those women with post valve replacement surgery rather than imposing MTP, the procedure concerned are not without associated risk, beyond doubt. Keywords: Medical termination of pregnancy (MTP), anticoagulation, valve replacement surgeryPublication Limitations of Clinico-histopathological correlation of Skin Biopsies in Leprosy(Nepal Health Research Council, 2010) Karki, S; Jha, RBackground: Skin biopsies play an important role in diagnosing and classifying different types of leprosy. The aim of this study was to analyse different histologic types of leprosy, to correlate histopathological diagnosis with clinical diagnosis, to study the uniformity of clinical and histological findings in the diagnosis of leprosy and to evaluate difficulties faced during clinicopathological correlation according to Ridley- Jopling classification due to inadequacy of data provided. Methods: This is a retrospective study of all skin biopsies reported from Department of Pathology of Tribhuvan University Teaching Hospital from 14 April 2007 to 13 April 2009, for which leprosy was the diagnosis or was strongly suspected on histopathology. Results: Out of 40 cases included, 33 were males and seven were females.           Tuberculoid leprosy was the most common type comprising 23/40 cases (57.5%). In 18/40 cases (45%), clinical diagnosis was leprosy. Only in three, leprosy was classified according to Ridley-Jopling criteria clinically. Thus clinicopathological correlation according to Ridley-Jopling criteria could not be done. Histopathological reporting lacked uniformity too. In 13/40 reports (32.5%), exact location of granuloma, presence or absence of Grenz zone and encroachment of epidermis by granuloma was  not mentioned. None mentioned the number and distribution of lymphocytes or relative proportion of  epithelioid cells and foamy histiocytes. Results: Out of 40 cases included, 33 were males and seven were females. Tuberculoid leprosy was the most common type comprising 23 /40 cases (57.5%). In 18/ 40 cases (45%), clinical diagnosis was leprosy. Only in three, leprosy was classified according to Ridley-Jopling criteria clinically. Thus clinicopathological correlation according to Ridley-Jopling criteria could not be done. Histopathological reporting lacked uniformity too. In 13/40 reports (32.5%), exact location of granuloma, presence or absence of Grenz zone and enroachment of epidermis by granuloma was not mentioned. None mentioned the number and distribution of lymphocytes or relative proportion of epithelioid cells and foamy histiocytes. Conclusions: Histopathological diagnosis of leprosy did not correlated with clinical diagnosis significantly. Uniformity was not seen in the clinical or histopathological informations provided making it difficult to conduct retrospective clinic pathological correlation. Key words: granuloma, histopathology, leprosy, Ridley-Jopling classification, tuberculoidPublication Study of effusion cytology in patients with simultaneous malignancy and ascites(Kathmandu University, 2006) Jha, R; Shrestha, HG; Sayami, G; Pradhan, SBObjective: To evaluate sensitivity of effusion cytology in detecting malignancy Materials and methods: Effusion cytology was studied from 37 malignancy associated and 28 non malignancy associated ascitic fluid samples. Results: Out of 65 cases, 44 (67.7%) effusions were reported negative, 15 (23.1%) were positive and 6 (9.2%) were suspicious for malignancy. Thus total 21 effusions (32.3%) were tumour cell positive. All 21 (100%) were true positive, none (0%) was false positive, 28 (63.6%) were true negative and 16 (36.4%) were false negative. Thus ascitic fluid cytology had sensitivity of 56.7% and specificity of 100%. Predictive value of positive test and negative test was 100% and 63.6% respectively. Stomach was the most common primary site of malignancy associated with ascites (11 /37 i.e. 29.7%) where as adenocarcinoma was the most common type of malignancy (11/15 i.e.73.3%) in ascitic fluid cytology. Conclusion: Ascitic fluid cytology is a simple and useful procedure with sensitivity of 56.7% and should be routinely requested. Key words: Ascitic fluid, Effusion cytologyPublication Surgical Management of Spinal Dysraphism: Five -year Experience in a Central Hospital(Nepal Paediatric Society (JNPS), 2014) Banskota, N; Jha, R; Khadka, N; Sharma, GR; Bista, P; Kumar, PAbstract: Introduction: Spinal dysraphism is a heterogeneous group of congenital spinal anomalies resulting from defective closure of the neural tube early in fetal life and anomalous development of the caudal cell mass. Meningomyelocele is common among Neural tube defects. Patients with myelomeningocele present with a spectrum of impairments, including primary functional deficits like are lower limb paralysis, sensory loss, bladderbowel dysfunction and cognitive dysfunction. Medical, surgical management and rehabilitation have helped patients with neural tube defects to participate and be productive in mainstream society. The aims of this study were to review the clinical presentation, surgical management and their outcome in the patient with spinal dysraphism. Materials and Methods: This is a retrospective study of Forty-one cases of spinal dysraphism managed during a period of five years from January 2008 to December 2012 in Department of Neurosurgery, National Academy of Medical Sciences (NAMS), Bir Hospital. Demographic profiles, clinical presentation of patients with spinal dysraphism, associated hydocephalus, surgical management and outcome were studied. Results: Out of total 41 cases studied, male patients outnumbered female with 58.5% to 41.5%. Age ranged from 5 days to 29 years and mean age was 2.71 years whereas. Lump (97%) and paraparesis (88%) were frequent mode of presentation. Lumbar lesion (65%) was commonest followed by lumbosacral (29%). Hydrocephalus was present in 51% of cases and in 24% cases developed hydrocephalus later after repair. Total 75.6% of cases were treated with VP shunt. Conclusion: Spinal dysraphism is debilitating entity and management is challenging. Lump on back and weakness of limb are major factor for children and their parents seek medical service. Lesion in low back (lumbar and lumbosacral) were most common location. Besides repair, majority of them needed CSF diversion surgery for hydocephalus. Aim of surgical management was to prevent further deterioration, control of hydrocephalus or leak.Publication Urine culture pattern in Norvic International Hospital(Institute of Medicine, 2007) Jha, R; Sijapati, K; Pant, ADAbstract Background: Urinary tract infections are responsible for considerable morbidity particularly in sexually active women. The aim of this study was to study the distribution of age and sex for significant growths isolated in urine specimens, the microorganisms associated and their sensitivity pattern to antibiotics Methods: Data on age, sex, organism isolated and sensitivity pattern was collected for all (total 103) culture positive urine samples sent between Baisakh 2064 to Bhadra 2064. Results: Majority of patients were females and most were between 20-39 years of age. E. coli was the most common organism isolated ( 81.6%) followed by Proteus (16.5%). E coli showed sensitivity to cefotaxime, ceftriaxone and cefexime in most cases. Conclusion: Females in sexually active age group show significant bacterial growth in urine more frequently than males . E coli are the commonest pathogen isolated. Keywords: Antibiotic sensitivity, urine culture, urinary tract infectionPublication Visual inspection using acetic acid and pap smear as a method of cervical cancer screening(Institute of Medicine, 2006) Vadehra, K; Jha, RAbstract Introduction: The objective of this study was to study the of comparison of visual inspection using acetic acid and pap smear as a method of cervical cancer screening. The specific objectives were to determine the proportion of women screened positive with VIA and proportion of women screened positive with pap smear. Another specific objective was to determine total number of cervical intraepithelial neoplasia and carcinoma cervix in the study population. Method: This was a comparative study.Atotal of 500 women presenting to the outpatient gynecologic clinic, T.U. Teaching Hospital from 23rd February 2004 to 22nd February 2005, who met the inclusion criteria were examined by both conventional cytology and visual inspection using 5% acetic acid. Distinct acetowhite areas touching the transformation zone were categorized as VIA positive cases. ASCUS or worse lesions by cytology were considered as positive smears. Those women who showed positive test result with either VIA or pap smear or both tests were further subjected to colposcopy directed biopsy and histology was taken as gold standard to compare the performance of VIA and cytology. Those for whom histology revealed no pathology or reactive/reparative change or inflammation were considered as false positives. Results: On VIA, 37 out of 500 women screened had acetowhite lesions. On pap smear, 27 out of the 500 women had ASCUS or worse lesions. The proportion of women screened positive with VIA was 7.4 % and the proportion of women screened positive with pap smear was 5.4 %. Of the 500 enrolled women, 20 were positive on both VIA and cytology; 17 were positive on VIA only; and 7 were positive on cytology only. So 44 patients had cervical biopsies performed on them. Histological diagnosis of CIN/cancer was made in 28 out of the total 44 patients who underwent biopsy. Incidence of CIN/ cancer cervix in the study population was found to be 5.6 %. Pap smear picked up 20 out of the 28 biopsy-proven cases. The 8 lesions missed by cytology included 5 low grade, 2 high grade and 1 cancer. VIA could identify 27 out of the 28 CIN/carcinoma cervices; the only lesion being missed was LSIL. But VIA had higher number of false positives as compared to cytology. VIAwas more sensitive (96.4 %) than pap smear (71.4%), which was statistically significant. However, the specificity of VIAwas lower (37.5 %) than that of cytology (56.3 %). The PPV of VIA was 73% versus 71.4 % for pap smear. The NPV of VIA was 85.7 % versus 52.9 % for cytology. Overall, VIA demonstrated an accuracy of 75 % as compared to 65.9 % for cytology. Conclusion: In women undergoing screening for pre-invasive and cancer cervix, visual inspection using 5 % acetic acid was found to be more sensitive and has a higher accuracy as compared to pap smear. VIA is less specific than cytology, resulting in high false-positive and hence unnecessary referral for colposcopy/biopsy. Although the present study is small, other larger comparative studies have evaluated the validity of VIA as a method of cervical cancer screening and concluded the same. Another important feature of VIA is its high Negative Predictive Value, which means that when the test result is negative, the woman can go home assured that she is not likely to have a neoplastic cervical lesion. Visual inspection is a simple, accurate, cost effective method of rapidly differentiating between a potentially diseased cervix and a healthy one and therefore its use can be recommended as primary screening method.