Browsing by Author "Kansakar, P"
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Publication Accuracy of various diagnostic tests and antimicrobial sensitivity pattern of Helicobacter pylori infection in a tertiary care centre in Nepal(Institute of Medicine, 2015) Kansakar, P; Dongol, A; Vaidya, PAbstract Introduction: Helicobacter pylori infection is the most important cause of peptic ulcer disease as well as other gastrointestinal conditions. Most widely used diagnostic tests for detection of Helicobacter pylori include rapid urease test, histopathology, culture/sensitivity and serology. The objective of this study was to determine accuracy of standard diagnostic tests and the prevailing local antibiotic susceptibility patterns. Methods: This cross sectional study, conducted from May to October 2009 at Tribhuvan University Teaching Hospital. 3 pieces of biopsy pieces were obtained from the antral mucosa which were subsequently used for Rapid Urease Test (RUT), histopathology and culture/sensitivity. Then, 2 ml of venous blood was drawn from the antecubital vein for serological examination. Results: H. pylori positivity status was reflected as 32%, 32% and 47% by rapid urease test, culture and histology. The seroprevalence of H. pylori was 63%. A patient was considered to be positive with respect to H. pylori infection when at least two of three tests namely rapid urease test, culture and histology gave positive results. Hence, proportion of patients with positive H. pylori infection was 36%. Only 30 from 32 culture positive cases were efficiently subcultured and further processed for antibiotic susceptibility testing. Resistance to metronidazole was found to be the highest securing 53.3% and lowest to levofloxacin (0%). Conclusions: Detection of Helicobacter pylori infection using serology was the most effective among the diagnostic tests performed. More than half of the patients were resistant metronidazole while levofloxacin was sensitive in all the cases. Keywords: Helicobacter pylori, diagnostic tests, antimicrobial susceptibilityPublication Focal nodular hyperplasia (FNH) of liver in children(Institute of Medicine, 2014) Bhattarai, A; Kansakar, P; Vaidya, PAbstract Introduction: Focal nodular hyperplasia (FNH) is one of the rare benign tumors of liver and second common benign tumour after the haemangioma in adult. It is mostly seen in young middle age women.The actiology of this tumour is unknown; however congenital vascular malformation or vascular injury to the hepatocytes has been suggested as the underlying mechanism for hepatocellular hyperplasia. Its relation with OCP is still controversial2. The tumor is asymptomatic most of the time and detected during routine physical examination or incidentally during radiological investigation. Large lesion presented with abdominal mass and abdominal pain due to pressure effects over surrounding tissue. Only Symptomatic lesion needs treatment. Bleeding and torsion can occur but malignant transformantion never occur in this disease. FNH is very rare in pediatric population Here we report two case of such rare case in pediatric population. Hepatic resection was undertaken in both patients with excellent outcome.Publication Giant retroperitoneal lipoma(Institute of Medicine, 2007) Kansakar, P; Ghimire, B; Rajbhandary, A; K.C., H; Singh, YP; Vaidya, PAbstract Case report: This is a case report of a retroperitoneal lipoma.The patient was admitted with complaints of abdominal distention and early satiety. Contrast enhanced CT scan of abdomen showed a large mass of fat density arising from the retroperitoneum measuring 30 x 25 x 20cm displacing the left kidney towards the midline and anteriorly. Fat plane was maintained with surrounding structures. The patient underwent exploratory laparotomy and the lipoma was excised. The lesion measured 30 x 20 cm and weighed 5.1 kgs. Since the left kidney was displaced anteriorly and towards the midline, nephropexy was performed. Histopathology revealed benign lipoma. Post operative period was uneventful. Keywords: Lipoma, retroperitoneal mass, displaced kidneyPublication 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 Peutz-Jehger’s Syndrome presenting as adult intussusception(Institute of Medicine, 2009) Athar, Z; Rajbhandari, A; Kansakar, P; Singh, YP; Vaidya, PAbstract Abstract: Peutz- Jehger’s syndrome is an autosomal dominant disorder. It is the second most common hamartomatous syndrome with hamartomatous polyp of gastrointestinal tract and cutaneous melanin deposit. Majority of patients remain relatively asymptomatic. Some present with abdominal pain secondary to obstruction or impending obstruction owing to an intussuscepted polyp with GI bleeding. We report a case of 21 year male who presented with upper central abdominal pain, distension, vomiting and blood mixed stool. He also had black colored spots on perioral region and fingers. Ultrasound revealed mass lesion with echogenic centre suggestive of intussusception. Emergency laparotomy revealed jejunojejunal intususception with gangreneous intussusceptum and two other large polyps. Resection anastomosis of jejunum and excision of polyps was done. Peutz – Jehger’s syndrome is a rare but important cause of intussusception in adults presenting with cutaneous manifestations and features of intestinal obstruction Keywords: Cutaneous melanin, Hamartomatous polyp, Intussusception, Peutz Jegher’s syndromePublication Shigella isolates of Nepal: Changes in the incidence of shigella subgroups and trends of antimicrobial susceptibility pattern(Kathmandu University, 2007) Kansakar, P; Malla, S; Ghimire, GRObjectives: Shigellosis is an important cause of bloody diarrhoea in all age groups, especially in children. A retrospective study was done to analyse the pattern of shigella isolates and the antimicrobial susceptibility trend of these shigella isolated at different hospitals of Nepal from Jan, 2003- Dec, 2005. Materials and methods: A total of 118 Shigella species isolated at nine different hospital laboratories of Nepal were reported to National Public Health Laboratory during January, 2003- December 2005 .The isolates were tested for the confirmation of identification and antimicrobial susceptibility pattern by standard bacteriological techniques. Results: Of the 118 Shigella isolates reported, Shigella flexneri 51 (43.22%) was the predominant of the four species followed by Shigella dysenteriae 49(41.52 %) , Shigella boydii (7.62%) and Shigella sonnei (7.62%).But the yearly distribution of the Shigella isolates in 2003 and 2004 showed that Shigella dysenteriae was the most common of the four species. In 2005, a shift in the species was noted as Sh flexneri replaced Sh dysenteriae and became the most prevalent species. The percentage of Shigella dysenteriae type-1 among all Shigella dysenteriae were 66.66 % in 2003, 44.44 % in 2004 and 60 % in 2005. Individual or multiple resistances to Ampicillin, Nalidixic acid, and/or Cotrimoxazole was seen in all the four species of Shigella. 33% of the total Shigella isolates reported were multi drug resistant (showing resistance to 3 or more antibiotics at a time). Shigella dysenteriae type-1(Sd 1) isolates resistant to ciprofloxacin were also encountered in the present study .Of the total 25 Shigella dysenteriae type 1 isolates reported, 18(72%) were ciprofloxacin resistant . All the Shigella isolates were however sensitive to Ceftriaxone and Azithromycin. Conclusion: Distribution of different species of Shigella and their antibiotic susceptibility profile may vary from one geographical location to another and may also change with time. Systematic monitoring of the species and serotypes of Shigellae and their antimicrobial susceptibility can help to guide therapy and reveal periodic epidemics due to Sd 1, which may have acquired resistance to antibiotics that have previously been effective. Key words: Dysentery, Shigella, Shigella dysenteriae type-1, Antimicrobial resistance.