NepMed Repository :: Browsing by Author "Karmacharya, RM"

Browsing by Author "Karmacharya, RM"

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A Study Looking at the Teaching of Peripheral Arterial Disease to Medical Personnel in Nepal: How well are we doing and how might we be able to improve?
(Kathmandu University, 2021) Krueger, E; Karmacharya, RM; Klinger, D
ABSTRACT Background There is currently no data showing the prevalence of peripheral arterial disease in Nepal, although they have a high incidence of risk factors in their population such as diabetes, hypertension, and high volume of smoke inhalation. Objective To quantify a gap in medical education curriculum in Nepal as it pertains to medical trainees that have a lack of exposure to peripheral arterial disease (PAD) in a clinical setting as well as improve lecture quality on peripheral arterial disease. Method A survey was sent out to 615 medical trainees in Nepal with a survey completion rate of 44%. The results indicate that both medical students and intern doctors feel most confident in their ability to diagnose peripheral arterial disease and comfortable ordering a workup for peripheral arterial disease when their education includes both a dedicated lecture and care of a patient. Result The self-reported ability to diagnose peripheral arterial disease increased in medical students from 21.9% in the lecture only group to 44.4% in the group who had both lecture and cared for a patient. The current curriculum at the Kathmandu University School of Medical Sciences only allows two hours in the medical school to cover all vascular topics and is taught with a traditional PowerPoint method. Conclusion To improve this area of curriculum, we recommend increasing the allotted time for lectures as well as demonstrate on live patients the evaluation for peripheral arterial disease. KEY WORDS Medical education, Peripheral arterial disease, Peripheral vascular disease
Abnormal Venous Dilatation other than Typical Varicose Vein, Rare Encounters
(Kathmandu University, 2018) Karmacharya, RM; Shrestha, B; Shrestha, BK; Devbhandari, M; Tuladhar, SM; Hodde, A; Thermann, F
ABSTRACT Varicose vein, one of the common vascular illnesses is usually a disease in lower limb. This is due to reflux of blood from deep venous system to superficial venous system. Rarely, this disease can also happen in veins in different location. Four such rare encounters are mentioned in this case series. KEY WORDS Superficial veins, Unconventional sites, Varicose vein
Analysis of Consecutive Open Surgeries for Varicose Vein at Dhulikhel Hospital
(Kathmandu University, 2014) Karmacharya, RM; Shakya, YR; Shrestha, B
ABSTRACT Background Varicose veins are prominent dilated veins in the lower limb primarily due to disease in the junction between superficial and deep venous system. Operative treatment of such condition significantly improves quality of life and also demonstrably decreases the potential complications. We present with analysis of fifty one consecutive open surgeries for varicose vein at Dhulikhel Hospital. Objective To analyze consecutive open surgeries for varicose vein in terms of gender, age, presenting complaints, findings and post operative outcomes. Method All the cases posted for open surgeries for varicose vein at Dhulikhel Hospital during September 2012 – July 2013 were included. If great saphenous vein in thigh was more than 3 mm, segmental stripping was done. The collected data was analyzed using SPSS version 13.0. Result There were 51 cases with 47%male and 53% female. Mean age was 48.9 years. Prominent dilated vein was the most common presenting complaints. Incompetent saphenofemoral junction was present in 68.6% cases. Segmental stripping was done in 51% cases. Mean days of admission was 2.6 days. Mean pain free day was on 3.2 days. In an average, patient were able to walk normally in 4.1 days. Analysis of hospital admission days, ability to walk normally and pain free day attained in between stripping required and stripping not required group showed significant difference with higher values in stripping required group. Conclusion Although conventional stripping surgery has long been performed for varicose vein, this is associated with prolonged hospital admission, prolonged time required for ability to walk normally, and prolonged time taken for pain free status. Hence newer modalities of treatment like radiofrequency ablation is warranted in our setup too. KEY WORDS Saphenofemoral junction, stripping surgery, varicose vein
Analysis of Lung Cancer Cases Presenting in Outpatient Department of University Hospital of Nepal
(Kathmandu University, 2022) Karmacharya, RM; Singh, AK; Vaidya, S; Tuladhar, SM; Devbhandari, M; Lama, B; Kharel, BB; Basnet, S
ABSTRACT Background Lung cancer is one of the leading cause of cancer related death. Most common histopathology of lung cancer is non-small cell carcinoma of which adenocarcinoma is the most common. There are limited number of studies done in Nepal to know different aspects of lung cancer. Objective To know demographic parameters of patients diagnosed as lung cancer in a university hospital. The study also aims to know the different histopathological diagnosis of lung cancer. Method All the patients presenting to outpatient department (Cardio Thoracic and Vascular unit) of Dhulikhel Hospital, if are diagnosed as cancer of lung/bronchus will be included in the study. The duration of the study was January 2017 to December 2021. The details on age, gender, presenting symptoms, histopathology of lung cancer, operability will be included in database and will be analyzed. Result There were total of 127 patients diagnosed as lung cancer. Male:female ratio was 1.7:1. Overall mean age was 63.23 years (SD 13.5 years, Range 19-89 years). Non small cell carcinoma was the most common type of lung cancer with 83.7%. In non small cell carcinoma, most common type was Squamous cell carcinoma followed by undifferentiated and Adenocarcinoma. Only five (3.93%) cases were in operable stage. Conclusion Despite the fact that lung cancer is one of the most common cancer, patients usually present late and moslty are not in operable stage. This study shows that squamous cell carcinoma is the most common histopathology in lung cancer cases. KEY WORDS Lung Cancer, Smoker, Thoracotomy
C-ARM Guided Angiogram/Angioplasty for Selected Failed Arterio Venous Fistula. A Report of a Procedure at University Hospital of Nepal
(Kathmandu University, 2021) Vaidya, S; Karmacharya, RM; Singh, AK; Vaidya, PR; Malinowski, M; Dhakal, A
ABSTRACT End Stage Renal Disease is a last stage of Chronic Kidney Disease which is characterized by Glomerular Filtration rate of less than 15 ml/min/1.73 m2. Hemodialysis is the most commonly used modality for treatment of Chronic Kidney disease. Among the access for hemodialysis arteriovenous fistula is the most common modality. However most common problems of fistula are significant stenosis of more than 50% which is characterized by limb swelling, pigmentation, tortuous veins, and difficulty maintaining flow during dialysis from AV fistula. These can be managed either by minimal intervention or with surgical intervention. Very few hospitals in Nepal and other countries have an angiographic suite to perform minimal intervention include angiogram with angioplasty. So in this case we try to address the use of C-Arm to perform angiogram or fistulogram and even angioplasty for the management of significant stenosis or complications of arteriovenous fistula. KEY WORDS Angiogram/Angioplasty, Arterio venous fistula, C-arm
Chest Trauma Requiring Admission: Differences in Earthquake Victims and other Modes of Injury
(Kathmandu University, 2018) Karmacharya, RM; Devbhandari, M; Tuladhar, S; Shrestha, B; Acharya, P
ABSTRACT Background The April 25, 2015 Nepal earthquake (7.8 Richter scale) followed by May 12, 2015 major aftershock (7.3 Richter scale) killed more than 9,000 people and injured more than 23,000 people. Dhulikhel Hospital situated at Kavre district of Nepal encountered major bulk of Earthquake victims residing at Sindhuplanchowk, Kavre and Dolakha districts during subsequent earthquake events. Objective To distinguish any significant differences in hospital admitted Earthquake and non- Earthquake chest trauma cases. Method Retrospective study was done comparing earthquake with non-earthquake chest trauma cases admitted in Dhulikhel Hospital. Study included parameters like mode of injury, time taken to reach health center, symptoms at presentation, involvement of chest area, presence and site of rib fracture, presence of hemothorax or pneumothorax, spectrum of treatment required, hospital admission days. Result There were total 23 earthquake victims of which 14 (61%) were female and rest of 9(39%) were male whereas out of total 95 non earthquake cases 23(24%) were female and 72 (76%) were male (p< 0.01). Mean age in earthquake victims was 53.73 (SD 18.33, range 19-84) while non earthquake cases was 46.83(SD 16.53, range 11-90), (p >0.05). Major mode of injuries in earthquake victims was hit by objects (82.60%) followed by fall (17.4 %). Incidence of rib fractures was 69.56% in earthquake victims and 85.26 % in non earthquake cases with average of 2-3 ribs in both cases (p>0.05). There was higher rates of pneumothorax in earthquake victims (52.17%) compared to non earthquake cases (30.52%), (p<0.05). There wasn’t evidently major differences in incidence of pulmonary contusion, hemothorax and surgical emphysema. The mean duration of hospital admission days in earthquake victims was 7.78 days while non earthquake cases was 5.04 days (p >0.05). The total number of patients requiring chest tube insertion in earthquake victims was 16(69.56%) while that was 29(30.52 %) in non earthquake patients (p <0.01). Conclusion There was preponderance of female gender in earthquake related cases compared to non earthquake cases. Incidence of rib fracture was higher in earthquake victims. In earthquake victims, higher proportion of patient required chest tube drainage compared to non earthquake cases. KEY WORDS Chest trauma, Earthquake, Pneumothorax, Rib fracture
Clinical Profile of Patients Presenting with Gallstone Disease in University Hospital of Nepal
(Kathmandu University, 2020) Joshi, HN; Singh, AK; Shrestha, D; Shrestha, I; Karmacharya, RM
ABSTRACT Background Gallstone disease is one of the most common surgical problem throughout the world. The rise in gallstone disease burden and its wide spectrum of non-specific presentation makes the disease more challenging. Objective To know the various modes of presentation, socio-demographic details of the patients with gallstone disease, any associated factors and its treatment options. Method This is a prospective descriptive study in the patients presenting to Dhulikhel Hospital Kathmandu University Hospital diagnosed with gallstone during May 2018 to April 2020. After receiving ethical clearance from institutional Review committee, the informed consent was taken from all patient involved in the study. The presence of gallstone was confirmed by abdominal ultrasonography (USG). This study included total of 202 patients with gallstone disease. Result A total of 202 individuals with gallstone were included in the study; 48 males (24%) and 154 females (76%). The disease condition was common in age group 31-40 years (26.24%). Majority of the study population consumed mixed diet (92.57%). Out of 202 patients; 52 patients (25.74%) were overweight. In this study series 185 patients (91.58%) were symptomatic. Pain abdomen was one of the commonest symptoms (97.84%) followed by Nausea (28.11%), Dyspepsia (28.11%), Vomiting (18.38%), Fever (1.62) and Jaundice (1.08%). All cases were planned for laparoscopic cholecystectomy however 4 cases had to be converted to open surgery for completion. Conclusion Gallstone disease is a common surgical problem in Female population that presents most commonly with pain abdomen. Laparoscopic cholecystectomy can be easily performed in all cases of gallstone disease. KEY WORDS Cholecystolithiasis, Cholecystectomy, Gallstone disease, Laparoscopic cholecystectomy
Comparative Study between the Use of Pigtail Catheters and Traditional Chest Tube Drain in Cases with Pneumothorax
(Kathmandu University, 2022) Vaidya, S; Karmacharya, RM; Shrestha, B; Adhikari, MM; Sharma, R; Khadka, S; Bhandar, N; Hada, G
ABSTRACT Background Pneumothorax is a condition in which air or other gas is present in the pleural cavity. Mainstay of management of pneumothorax is to remove the air from the pleural space usually done by chest tube insertion. There is still uncertainty whether minimal invasive management with pigtail catheter is sufficient for the management of pneumothorax. Objective To find the effectiveness, safety, tolerability, efficacy of pigtail catheters and large bore chest tubes. Method Prospective comparative study was done in Dhulikhel Hospital between August 2019 till August 2021. Chest tube insertion used to be the only available treatment modality till December 2020 (15 months). Following January 2021 after obtaining ethical clearance for use of pigtail insertion for pneumothorax, this treatment modality was done (8 months). Result Among 76 patients, 52(68.4%) underwent a large bore chest tube and 24 (34.6%) pigtail catheter patients. Mean age of the patients was 48 years (SD 18.01). Duration of hospital stay and length of hospital stay was more in large bore catheters and less in pigtail catheters. Eight hours post tube placement of the expansion of the lungs was present in pigtail and was statistically significant. Pain killer used in pigtail catheters was limited to Non-steroidal anti-inflammatory drugs, for large bore catheter opioids were added and were statistically significant. Conclusion Pigtail catheter is nearly effective as compared to traditional wide bore catheters. KEY WORDS Large bore chest tube, Painkillers, Pigtail, Pleural space, Pneumothorax
Crural Bypass Surgery in Case of Critical Ischemia: Technical Aspects and Results
(Kathmandu University, 2018) Thermann, F; Karmacharya, RM
ABSTRACT Background Crural bypass surgery is one of the last options to salvage the leg. Compared to arterial reconstructions of more proximal localization patency rates are generally less good. The aim of this retrospective study was to answer the question if crural bypass surgery is justified. For that we focused on different technicalities, bypass material, recipient vessel and anticoagulation regimes. Objective To know outcome of crural bypass in terms of patency rates, survival rates, amputation. The difference in outcome is compared in different stages of peripheral arterial disease and various bypass materials and sites. Method Between 07/2013 and 06/2018 we performed 102 crural bypasses (27 female, 75 male; age 44-90 (70) years). Reasons for the bypasses were a critical peripheral arterial diseases (PAD) (stage III [pain at rest] and IV [necrosis/gangrene] according to Fontaine). End point of the study was major amputation or death. All patients were operated on in the same department by two experienced vascular surgeons. Result Amputation-free time was 78% after sixmonths and 70% after 24 and 60 months. Six, 12 and 40 months survival was 83%, 78% and 59%, respectively. Patency rates were affected by the severity of the disease (stage III vs. stage IV) and so was major amputation. Autologous bypasses were not associated with a better patency rate. Minor amputation or the anticoagulation scheme did not influence the long term results. Conclusion The long term survival after crural bypass is good and amputation rates are low, independent of the vessel of the lower leg used as recipient outflow. Accordingly, if a bypass is technically feasible, there is no limitation regarding the choice of the recipient vessel. If possible, autologous vein should be used, but a graft prosthesis can lead to equally good results. As patients with stage III PAD have better outcomes, early intervention is recommended in order to avoid deterioration to stage IV. KEY WORDS Anticoagulation, Crural bypass, Limb salvage, Recipient vessel
Diabetic Foot Ulcer and its Associated Risk Factors in Diabetic Patients with Peripheral Arterial Disease Presenting in the University Hospital of Nepal
(Kathmandu University, 2024) Karmacharya, RM; Maharjan, S; Vaidya, S; Bhatt, S; Sharma, S; Timalsina, G; Kunwar, K; Joshi, HN
ABSTRACT Background Diabetic foot ulcers (DFUs) are a common complication in diabetic patients especially in those with peripheral arterial disease (PAD). However, it can be prevented if its risk factors can be identified and adjusted. Objective To investigate the frequency of diabetic foot ulcers and their associated risk factors in diabetic patients with peripheral artery disease. Method Diabetic patients under medication with known peripheral arterial disease diagnosed with Doppler ultrasonography were recruited from the outpatient department of the cardiothoracic and vascular unit, at Dhulikhel Hospital. The patients were interviewed about their demographic details, presenting clinical symptoms, and the risk factors such as smoking, hypertension, cardiovascular diseases, duration of diabetes, and hyperlipidemia. Also, the patients were assessed for any ulcers in their feet. Descriptive statistics and chi-square tests were used to analyze the data. Result The analysis demonstrated diabetic foot ulcers in 24.1% of the total 54 diabetic patients with peripheral arterial disease. The risk factors such as smoking (24.1%), increasing age (68.5%), hypertension (31.5%), and duration of diabetes (72.2%) were found in the majority of the patients. Out of these risk factors, smoking (Odds ratio: 6.81) and increasing age (Odds ratio: 0.28) were significantly associated with diabetic foot ulcers. (p < 0.05) Conclusion Diabetic foot ulcers affected about a quarter of diabetic patients with peripheral arterial disease and were found to be associated with increasing age and smoking. KEY WORDS Complication, Diabetes, Foot ulcers, Peripheral arterial disease, Risk factors
Difficult Journey from Delivery to Discharge, Case of Congenital Diaphragmatic Hernia
(Kathmandu University, 2014) Karmacharya, RM; Dangol, S; Shrestha, M; Koju, R
ABSTRACT We report a case of congenital diaphragmatic hernia which was diagnosed prenatally for which surgical correction was done on second day of life. The child was discharged in 17 days and has resulted in good post repair condition of patient. KEY WORDS Bochdalek, congenital diaphragmatic hernia, hemithorax
Factors Affecting Recanalisation after Optimal Management of Deep Vein Thrombosis; A single institution based study
(Kathmandu University, 2019) Karmacharya, RM; Shrestha, B; Devbhandari, M; Tuladhar, SM; Pradhan, A
ABSTRACT Background Presence of recanalisation will favour for better physiological recovery after medical management of Deep Vein Thrombosis (DVT) along with lesser chances of post thrombotic syndrome. Rate of recanalisation is varied and can range from 43-57% and the factors that affect recanalisation are still a dilemma. Objective To know the factors for recanalisation following Deep Vein Thrombosis. Method This is a single institution based retrospective-prospective analytical study encompassing all ultrasonologically diagnosed cases of Deep Vein Thrombosis in adults from January 2015 to November 2017. All the cases were admitted with oral warfarin bridged by Heparin/ Enoxaparin and were discharged once International Normalization Ratio was in therapeutic range. The patients were followed up for three months with minimal of three outpatient followup. Best finding in the doppler ultrasonography (done by Acuson P500, Seimens) in relation to recanalisation was taken for the study. Result There were 67 cases of Deep Vein Thrombosis. Of these cases male to female ratio was 0.91. The mean age was 48.07. Most common extent was up to common femoral vein (47.8%) followed by upto popliteal vein (40.3%). Remaining 11.9% had extension upto iliac veins. There was no recanalisation in 2 cases (3%). Partial recanalisation was seen in 23 cases (34.3%) while complete recanalisation was seen in 42 cases (62.7%). Recanalisation is more in DVT involving popliteal vein while it decreases as the extension goes up. In contrast to 79.4% complete recanalisation in popliteal vein, that in common femoral vein is 62.5% while in iliac vein is only 37.5%. Mean age in no recanalisation group is much younger than partial or complete recanalisation groups. Conclusion Recanalisation following Deep Vein Thrombosis distal to popliteal vein is more than that in proximal Deep Vein Thrombosis. The information on recanalization can be considered to use to decide upon the duration of medical management of Deep Vein Thrombosis. KEY WORDS Deep vein thrombosis, Doppler ultrasonography, Recanalisation
Incidence and Associated Risk Factors of Postoperative Sore Throat in Tertiary Care Hospital
(Kathmandu University, 2017) Shrestha, S; Maharjan, B; Karmacharya, RM
ABSTRACT Background Postoperative sore throat is a relatively minor complaint but a frequent postoperative complication of anesthesia. The incidence of postoperative sore throat varies from 0-50% in most research studies, but some report the incidence is as high as 51-100% following general anesthesia. Objective The aim of this study was to obtain the incidence and determine the associated risk factors of postoperative sore throat in tertiary care hospital. Method Three hundred and seventy six patients who underwent various surgeries under general anesthesia in Dhulikhel Hospital during a four month period were included. Using a predesigned questionnaire with follow up after 24-30 hours after extubation, data was collected. Sore throat was identified using a four point scale (0-3). Result Overall incidence of postoperative sore throat was 50.8%. Patient with airway device endotracheal tubes had the highest incidence (52.2%, 176 of 337), and patient with i-gel had a lower incidence of sore throat (33.3%, 7 of 21). Female patients reported more sore throat than male, more common with older age group and duration of anesthesia more than two hours. Increased incidence of postoperative sore throat was not associated with the type of surgery, number of intubation attempts, category of personnel performing airway managementr and use of oropharyngeal airway. Conclusion Postoperative sore throat is a common complication of airway instrumentation in general anesthesia that can lead to discomfort. The overall incidence of postoperative sore throat in this study was 50.8%. Endotracheal tube, female patients and increased duration of anesthesia were associated with increased postoperative sore throat rates. KEY WORDS Airway device, anesthesia, complication, postoperative, sore throat
Incidence and Risk Factors of Surgical Site Infections in Kathmandu University Hospital, Kavre, Nepal
(Kathmandu University, 2016) Shrestha, S; Wenju, P; Shrestha, R; Karmacharya, RM
ABSTRACT Background Surgical site infections (SSI) are the common nosocomial infection in surgical patients, and are a significant source of postoperative morbidity resulting in increased hospital stay, morbidity and cost. Objective The objective of this study was to obtain the incidence of SSI and determine various risks factors influencing the SSI rate with special reference to the National Nosocomial Infections Surveillance System risk index in Kathmandu University Hospital, Kavre, Nepal. Method Six hundred and thirty eight patients who underwent various surgeries in Dhulikhel Hospital, Kathmandu University Hospital during a three-month period were included. Using a pre designed questionnaire with follow up to 30 days and in orthopedic cases, where metal implants were used as internal fixation devices, with follow up to 90 days data were collected. Infected cases were identified using Centre for Disease Control and Prevention definition for surgical site infections. Swabs were obtained from wounds and were processed without delay using standard microbiological methods. Result Overall SSI rate was 2.6%. The most common pathogen isolated was Escherichia coli (5 isolates, 29.4 %). The SSI rate was 0.0% for clean wounds, 2.9%, 15.3% and 18.7% for clean-contaminated, contaminated and dirty wounds respectively. Increased incidence of surgical site infections were associated with higher grades of wound, emergency surgeries, American Society of Anesthesiologists score >2 and increased in National Nosocomial Infections Surveillance System risk index. Conclusion The incidence of SSI in this study meets the standard of center for disease prevention and control. Increases in surgical wound class, National Nosocomial Infections Surveillance System risk index, American Society of Anesthesiologist score >2 and emergency surgeries were associated with increased SSI rates. KEY WORDS National Nosocomial Infections Surveillance System (NNIS) risk index, Surgical site infection, wound class
Influence of Body Mass Index (BMI), Age and Gender on Stages of Varicose Vein in Newly Diagnosed Cases Following Screening Doppler in Outpatient Clinic
(Kathmandu University, 2020) Shrestha, B; Karmacharya, RM
ABSTRACT Background Varicose vein is one of the most common venous diseases which affect superficial veins especially of lower limb. This disease is characterized by prominent dilated veins, feeling of heaviness, itchiness, pigmentation, ulceration depending upon the stage of the disease. Objective This study was conducted to know how Body Mass Index, Age and Gender influence staging of varicose veins in our context. Method This is a cross sectional hospital based study conducted at Dhulikhel Hospital, Kathmandu University Hospital from April 2018 to March 2019. Patients with signs and symptoms of varicose vein were included in the study. Informed consent was taken from each patient and data collection done by filling the proforma. Result This study comprised 135 lower limbs with varicose vein from 108 patients. Male:Female ratio was 1.4:1. Mean age of patients was 44.47±12.65 (17-81) years. Significant correlation was found between increasing age and progression in Clinical staging of Varicose vein according to Clinical classification (p<0.05). Mean Great Saphenous Vein diameter at knee was found significantly higher in patients with more than five years of symptoms Mean Body Mass Index was not very different in different Clinical stage of Varicose veins. Conclusion This study showed that the Clinical Staging of Clinical Etiological Anatomical and Pathophysiological classification of varicose vein is significantly related to age. The mean diameter of Great Saphenous Vein at the level of Knee is significantly related to the duration of symptoms. However, the influence of Body Mass Index and gender on stages of varicose vein could not be established. KEY WORDS Age, Body mass index, Doppler, Gender, Varicose veins
Initial Experience of Complex Peripheral Bypass Surgery at Dhulikhel Hospital, Kathmandu University Hospital
(Kathmandu University, 2017) Karmacharya, RM; Shrestha, B; Devbhandari, M; Tuladhar, SM; Hodde, A; Thermann, F
ABSTRACT Peripheral arterial disease is seemingly silent yet is a major pubic health problem with limb threatening and life threatening consequences. This condition can initially be asymptomatic and gradually may progress to intermittent claudication and finally to critical ischemia. When conservative management is not sufficient and there is option of surgical management, peripheral bypass surgery is an established modality of treatment of peripheral arterial disease. We present our initial cases of peripheral arterial bypass surgery all of which are technically demanding surgeries. All the cases have resulted into limb salvage until current follow-up. KEY WORDS Claudication, critical ischemia, peripheral arterial bypass, peripheral arterial disease
Management of Different Types of Pneumothorax at Dhulikhel Hospital, Kathmandu University Hospital
(Kathmandu University, 2020) Shrestha, B; Karmacharya, RM; Pant, S
ABSTRACT Background Pneumothorax is defined as the presence of air in the pleural cavity. Pneumothorax can be classified as Spontaneous and Traumatic according to the etiology. Spontaneous pneumothorax is further classified as Primary and Secondary. Objective This study was conducted to know the management of different types of pneumothorax at Dhulikhel Hospital, Kathmandu University Hospital. Method This was a hospital based retrospective study conducted at Dhulikhel Hospital, Kathmandu University Hospital. Patients admitted in Surgery Ward with diagnosis of Pneumothorax from January 2018 to December 2019 were included in this study. Result This study included 144 patients with pneumothorax age ranging from 14 years to 94 years. Most of the patients were male with male:female ratio of 3.8:1. Eighty-four (58.03%) patients had Traumatic pneumothorax followed by Secondary spontaneous pneumothorax in 53(36.08%) patients and Primary spontaneous pneumothorax in seven (4.86%) patients. Among 144 patients, chest tube drain was required in 135 patients and nine patients were managed conservatively. One patient underwent Video Assisted Thoracoscopic Surgery (VATS) with Bullectomy and mechanical pleurodesis. Sixteen patients had persistent pneumothorax, among which six patients required chemical pleurodesis, two patients required negative suction therapy and five patients required both chemical pleurodesis and negative suction therapy. Conclusion This study showed pneumothorax to be more common in male population. Traumatic pneumothorax was the most common type followed by Secondary spontaneous pneumothorax and Primary spontaneous pneumothorax. KEY WORDS Chest tube drainage, Pleurodesis, Pneumothorax, Video assisted thoracoscopic surgery
Management of Proximal Ureteric Stones: Extracorporeal Shock Wave Lithotripsy (ESWL) Versus Ureterorenoscopic Lithotripsy (URSL)
(Kathmandu University, 2017) Joshi, HN; Shrestha, B; Karmacharya, RM; Makaju, S; Koju, R; Gyawali, D
ABSTRACT Background Urolithiasis is the third most common disease of the urinary tract after urinary tract infections and pathologic conditions of prostate. Debate is ongoing regarding the effectiveness of Extracorporeal Shock Wave Lithotripsy (ESWL) and ureterorenoscopic lithotripsy (URSL) in the management of ureteral stones. Objective We aim to compare the efficacy of Extracorporeal Shock Wave Lithotripsy and Ureterorenoscopic Lithotripsy in the management of upper ureteric stones in terms of stone clearance. Method This prospective hospital based study included patients with upper ureteric calculus managed with Ureterorenoscopic Lithortripsy with Double J stenting or Extracorporeal Shock Wave Lithotripsy at Dhulikhel Hospital, Kathmandu University Hospital from August 2014 to July 2015. Stone size, stone clearance, number of sittings, complications and need of other procedure were recorded. Result There were 90 patients with upper ureteric calculus. Among these patients, 45 patients underwent Extracorporeal Shock Wave Lithotripsy and 45 patients underwent Ureterorenoscopic Lithotripsy. There was no difference in male/female ratio, age and stone diameter between two groups (p>0.05). Total stone-free ratio was 88.9% (40/45) for Extracorporeal Shock Wave Lithotripsy and 82.2% (37/45) for URSL, partial fragmentation requiring shift of modality of treatment was 8.88% (4/45) for Extracorporeal Shock Wave Lithotripsy and 13.33% (6/45) for Ureterorenoscopic Lithotripsy. Failure of procedure was noted in 11.1% in Extracorporeal Shock Wave Lithotripsy group and 17.8% in URSL group In the Extracorporeal Shock Wave Lithotripsy group, 8.89% (4 out of 45) patients required Ureterorenoscopic Lithotripsy for complete stone clearance. Complete stone clearance could not be achieved in 2.23% (1 out of 45) patient with both Extracorporeal Shock Wave Lithotripsy and Ureterorenoscopic Lithotripsy and had to undergo open ureterolithotomy. Conclusion Both Extracorporeal Shock Wave Lithotripsy and Ureterorenoscopic Lithotripsy are equally effective in the management of upper ureteric calculus with no significant difference in age, male/female ratio, stone diameter and stone free ratio. KEY WORDS Extracorporeal shock wave lithotripsy, Ureterorenoscopic lithotripsy, Ureteric stone
Massive Hemoptysis and Pulmonary Thromboembolism in a Patient with Pulmonary Tuberculosis: A Therapeutic Conundrum Managed with Bronchial Artery Embolization
(Kathmandu University, 2022) Vaidya, N; Karmacharya, RM; Vaidya, S; Bade, S; Bade, S; Paudel, K; Kandel, G; Thapa, P; Maharjan, R; Duwal, S; Karki, Y
ABSTRACT Hemoptysis is a crucial entity taking into account its morbidity and mortality. Pulmonary tuberculosis is the leading cause for massive hemoptysis in our part of the world, which if left untreated may be life threatening. We present a case of a 37-year-old male patient with pulmonary tuberculosis with concurrent pulmonary thromboembolism presenting with massive hemoptysis, which was successfully managed with Bronchial Artery Embolization. This case represents that this measure can be a viable therapeutic choice for a patient with a severe life- threatening hemoptysis, particularly when other treatment options are unavailable or ineffective. KEY WORDS Bronchial arteries, Embolization, Hemoptysis, Therapeutic
National Needs Assessment of Health Information System to Address Cardiovascular Diseases in Nepal: A Mixed Method Study
(Kathmandu University, 2021) Karmacharya, RM; Shestha, AP; Shrestha, A; Bajracharya, S; Maharjan, R; Shrestha, S; Jha, N; Pyakurel, P
ABSTRACT Background Health information system is an integral component of a country’s capacity to integrate, process, report, and use information in improving health services. Objective This study aims to assess the infrastructure and capacity of the national Health information system to address cardiovascular diseases in Nepal. Method We adopted the United States Agency for International Development manual “The Health System Assessment Approach: A How-To Manual”, Version 2.0. Three topical areas: input, process and output, were identified. Stepwise approach for Health information system assessment was done. A desk review and key informant interview was performed. Audio recordings were transcribed in Nepali language and intercoder reliability was checked. Result The upgraded District Health Information Software 2.3 provides a comprehensive online data management solution. Sustainable funding to upgrade the system exists. Annual report provides performance of all the components of the health care delivery system. Data were reviewed quarterly. However, no dedicated section for cardiovascular diseases in the Health information system is present. Private health facilities are poorly represented. Strategic planning, management, and evaluation of the Health information system are lacking. Inadequacy of timeliness, completeness, and periodicity of the reporting still exist. Conclusion A separate section of cardiovascular diseases in the Health information system is required. Better reporting of private sectors and its inclusion in databases is of utmost importance. Adaptation in the recently introduced federal structure is key for development of Health information system in the country. KEY WORDS CVDs, Health information management system, needs assessment, indicators, Nepal

Browsing by Author "Karmacharya, RM"

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