Browsing by Author "Kumar, P"
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Publication Effectiveness of addition of neostigmine or dexamethasone to local anaesthetic in providing perioperative analgesia for brachial plexus block: A prospective, randomized, double blinded, controlled study(Kathmandu University, 2008) Yadav, RK; Sah, BP; Kumar, P; Singh, SNAbstract Background: Various local anaesthetic agents are used for brachial plexus block.We compared effectiveness of addition of Dexamethasone versus Neostigmine to Lignocaine, adrenaline admixtures for Brachial plexus block in providing perioperative analgesia. Methods: Ninety patients were randomized in three groups and were received 24ml of study drugs. The groupA [Lignocaine with adrenaline (1.5%)], groupB [Lignocaine with adrenaline (1.5%)] +500μg Neostigmine, and group C (Lignocaine with adrenaline (1.5%) +4mg Dexamethasone) for brachial plexus block through supraclavicular approach. The observed parameters were onset of analgesia, completion of sensory and motor blockade, Duration of analgesia, Surgeon’s score, side effects, number of supplemental analgesics doses and Visual analogue scale (VAS) score for pain in 12 hour of post-operative period. Results: Mean onset of analgesia 4.6±1.1 , 4.4 ±0.8 , 3.8±1.8 mins in group A,B and C respectively and the Mean onset of motor blockade were 7.7± 2.0, 7.0±1.8, 6.0 ± 2.1mins in group A,B and C respectively. Similarly Mean Complete sensory block in 10.6 ±3, 10.4±2.5, and 8.9±2.2mins and Mean complete motor block in 17.3±4.3, 17.2 ±4.0 and 14.7±3.5 mins in group A, B and C respectively were achieved. Duration of analgesia was 176.5±53.5, 225.7±53.3 and 454.2±110.7 mins in group A, B and C respectively. Duration of analgesia in group C was statistically signi cant in comparison with other groups. The number of mean analgesic requirement by group C (0.9±0.4) was signi cantly (p- 0.005) lower. The mean VAS was signi cantly lower in groupC in 12 hours post-operatively. Conclusion: The onsets of action, duration of analgesia were better in dexamethasone group and also need less number of rescue analgesics requirement.Publication Post Kala Azar Dermal Leishmaniasis (PKDL) Presenting with Ulcerated Chronic Paronychia Like Lesion(Kathmandu University, 2012) Jha, AK; Anand, V; Mallik, SK; Kumar, PABSTRACT A 50-year-old lady, resident of urban Bihar, presented with inflamed proximal nail fold of a single digit for one and half months. The lesion on distal finger was remarkable for ulceration. Mucocutaneous examination revealed multiple hypopigmented macules and patches, notable for absence of scaling. The presence of ulceration was not consistent with chronic paronychia, hence, she was asked for biopsy. She declined and opted for trial of antibiotic and anti-fungal treatment. At two weeks of follow up, no improvement was noted at all. At the same time, she developed multiple juicy papules in perioral area and on neck. She tested positive by rK 39 tests. Histopathology from periungual area showed LD body. She was diagnosed as Post Kala-azar dermal leishmaniasis and was treated with miltefosine 50 mg twice daily for three months, resulting in complete resolution of all lesions. KEYWORDS Post Kala azar dermal leishmaniasis, kala-azar, paronychia, ulceration, miltefosinePublication Predicting cubitus varus in supracondylar fractures of the humerus by Baumann’s angles in post reduction X-rays(Kathmandu University, 2006) Dahal, M; Kumar, P; Singh, GK; Arora, SS; Singh, MPObjectives: The present study presents the technique to predict cubitus varus by post reduction Affected Side and Normal Side Baumann’s angle difference (ASBA and NSBA) respectively. It intends to correlate the Baumann’s angle to the final carrying angle of the injured elbow and presents the relevant mathematical clinical rule along with its prediction test characteristics. Material and Methods: Total 57 patients of 6.5±1.67yrs, 22 were males and 8 females with 19/30 having left side injury. Isolated closed supracondylar fractures of humerus up to 5 days duration included and previous trauma, pathological fracture, other injury, elbow disease were excluded .30/57 completed >1 year follow-up. Results: The Mean NSBA was 74.4±4.14º. The mean normal side carrying angles (NSCA) were 9.56 ± 2.2º. The NSCA IQR (Inter Quartile Range) was 8.8-10º. The ASBA was 79.9±9.1º and affected side carrying angles (ASCA) was 0.20±8.7º. The ASCA was best predicted by the difference between ASBA-NSBA (ASCA=3.87-0.65(ASBA- NSBA; F=15.91). At a cut off of 8.8º (the lower limit of IQR for NSCA), a value >0º for ASBA- NSBA was 80% predictive of cubitus varus. With pre test probability of varus at 70%, sensitivity was 0.94 and specificity 0.42. Discussion: A prediction rule to predict the final carrying angle from ASBA NSBA difference is presented with a positive predictive value 0.80, specificity of 0.42, and sensitivity of 0.94 at a pre test probability of 0.70.When the diagnosis of cubitus varus is ASCA<8.8º (Lower limit of the IQR for NSCA). Conclusion: If affected side Baumann’s Angle – Normal Side Baumann’s Angle is equal to or greater than 0 then there was 80% probability of having cubitus varus. Key words: Supracondylar fractures of humerus, Baumann’s angle, Complications, Carrying angle, Cubitus Varus.Publication Treatment of grade IIIB opens tibial fracture by ilizarov hybrid external fixator(Kathmandu Unviversity, 2007) Kumar, P; Singh, GK; Bajracharya, SObjective: We evaluated the results of patients who were treated with Ilizarov hybrid external fixator for type IIIB open tibial fractures. Materials and methods: 35 Gustilo grade IIIB tibial fractures of age between 18 to 42 years (22 male and 13 female) in which 12 distal fourth tibia (D/4) of C1.1 (6), C1.3 (6), 12 upper fourth Tibia (U/4) of A2 (8) and A3 (4) according to AO classification and 11 Tibial plateau fractures of Schatzker type VI (5) , V(5), IV(1) . All tibial plateau, proximal fourth fractures and lower fourth fractures of tibia and fibula (Reversed Hybrid), treated with Ilizarov hybrid fixator using two Ilizarov 5/8 rings and AO External fixator were followed up to 12-52 months. Results: D/4 fractures were united at 31.1667±8.3046 wks, U/4 at 24.00±5.2915 and Tibial plateau at 15.545±4.160 weeks (p-0.00). ROM in tibial plateau type IV 130°±00, type V 124°±8.94° , type VI 125°±7.0711°, D/4 of type C1.1 (50°±0.00), type C1.3 (43° ±5.7755) whereas full ROM in U/4 fractures. Pin tract infection occurred in 21% of cases. Pain on walking in 20% of cases of type VI tibial plateau fractures and 80% of cases of type IV and V. Problem free in rest of parameter of function of VI and 100% problem in IV and V. Pain at rest observed in 20% of cases in type V. In 66.67% U/4 fractures had pain on walking but no other functions were compromised. In 33% D/4 fractures of C1.1 type had pain on walking only and had 1cm of shortening. Conclusion: On the basis of our experience, we suggest adopting this method for functional limb salvage after extensive complex high-energy injuries. This fixator is safe and versatile, effective in providing stability and allowing early rehabilitation, although the indications for its use are very relatively specific. Key words: Ilizarov hybrid external fixator, tibial plateau, upper fourth and distal fourth fractures, Clinical and Functional outcome.