NepMed Repository :: Browsing by Author "Maharjan, S"

Browsing by Author "Maharjan, S"

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Arthroscopic Debridement for Mucoid Degeneration of Anterior Cruciate Ligament - A Single Institution Experience from Nepal
(Kathmandu University, 2023) Shrestha, R; Khadka, SK; Maharjan, S; Basi, A; Dahal, A; Chaudhary, A; Acharya, SP; Malla, M
ABSTRACT Background Mucoid degeneration of anterior cruciate ligament is characterized by infiltration of mucoid-like material scattered throughout the anterior cruciate ligament substance. It is an uncommon condition, but previously, underdiagnosed or often misdiagnosed as an anterior cruciate ligament tear. Objective To present our early experiences with mucoid degeneration of anterior cruciate ligament in last five years in terms of clinical presentation and the outcomes of arthroscopic management. Method This was a retrospective descriptive cross-sectional study on patient who received arthroscopic debridement for mucoid degeneration of anterior cruciate ligament in Dhulikhel Hospital over five years period (2017 May to 2022 April). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale that has been translated and validated to be used in local (Nepali) language and context was used for evaluation of outcome evaluation. Result Twenty-one patients of mean age 44.21 years, predominantly females (18), were managed in five years period. The mean Western Ontario and McMaster Universities Osteoarthritis Index score was 16.33±10.47 with a range of 0 to 36 (11.57 to 21.09 at 95% confidence interval). The mean Western Ontario and McMaster Universities Osteoarthritis Index score converted on a scale of 0 to 100 was 17. Thirteen patients had isolated Mucoid degeneration of anterior cruciate ligament whereas nine others had associated either meniscal tear or chondral lesions. Conclusion Mucoid degeneration of anterior cruciate ligament could be a cause of knee pain in middle-aged patients and arthroscopic debridement can improve the patient’s symptoms and provide a good functional outcome. KEY WORDS Anterior cruciate ligament, Arthroscopy, Debridement, Mucoid degeneration, WOMAC
Awareness Regarding Diabetes Mellitus among General Population of Banepa Municipality
(Kathmandu University, 2021) Manandhar, S; Buddhacharya, M; Maharjan, S
ABSTRACT Background Diabetes is a silent disease and many people with diabetes may become aware of it only after life-threatening complications. The presence of knowledge of diabetes could contribute in early diagnosis and minimize the occurrence of complications. Hence, healthcare and public policy makers are putting extensive efforts to aware them on diabetes. Objective To assess the level of diabetes knowledge and its risk among the general public of Banepa municipality. Method A Cross sectional study was conducted to assess the awareness about diabetes among the general public of Banepa municipality. During the period of November 2019 to January 2020, 273 respondents of Banepa municipality were included with informed consent. Data was collected using a pre-tested structured questionnaire through one-to-one interviews. Indian Diabetes risk score (IDRS) was used to identify the risk of diabetes among them that consists of four elements i.e. age, abdominal obesity, physical activity, and family history. Data entry and analysis was done using SPSS version 20. Result It was found that 61.9% had a higher level of knowledge of diabetes. IDRS score shows more than half percent (53.5%) of respondents were in high risk, 39.2% were in medium risk and 7.3% were in low risk. Conclusion This study implies that there was good knowledge about diabetes among people. However, the majority of them are at risk for developing diabetes in future which may be due to lack of practical implication of knowledge. It reflects the necessity to educate and reinforce the public regarding prevention of diabetes which further postpones its complications. KEY WORDS Awareness, Diabetes, IDRS, Knowledge, Risk factors
Cheiro-Oral Syndrome
(Kathmandu University, 2018) Thapa, L; Amatya, R; Maharjan, S; Gaurishankar, N; Shrestha, AM; Bhattarai, S; Singh, SN; Gongal, DN; Devkota, UP
ABSTRACT Cheiro-Oral Syndrome (COS) is a very rare neurological syndrome associated with varied etiology. We report a 53-year-old man presented with left sided perioral and ipsilateral hand/fingers burning sensation for a one-month duration. On examination, he had hypesthesia over left perioral and distal palmar aspect of all five fingers. MRI revealed subacute infarct in the posterior limb of right internal capsule adjacent to and minimally involving thalamus. He was diagnosed as Cheiro- Oral Syndrome as a result of ischemic stroke and managed. KEY WORDS Cheiro-oral syndrome, Stroke, Internal capsule, Perioral hypesthesia
Comparison of the Mean Cross-sectional Area of the Median Nerve between Pregnant and Non-Pregnant Women Using Ultrasonography in a Tertiary Level Hospital, Nepal
(Kathmandu University, 2023) Adhikari, G; Regmi, PR; Paudel, S; Lamichhane, B; Kayastha, P; Maharjan, S; Amatya, I
ABSTRACT Background The median nerve is subjected to compression in the carpal tunnel giving rise to a constellation of symptoms known as carpal tunnel syndrome. It is the most frequent form of peripheral entrapment neuropathies and is most prevalent in the middle age females. The most common cause of this syndrome is idiopathic. One of the known secondary causes is pregnancy. Objective To compare the mean cross sectional area of median nerve using ultrasound in pregnant and non-pregnant females at carpal tunnel inlet and its variations with different trimesters. Method The study was conducted during a period of one year (October 2014 to September 2015). A total of 204 participants were evaluated among which 102 were nonpregnant and 102 were pregnant. Among the 102 pregnant participants, 34 females each were in the first, second, and third trimesters. A convenience sampling technique was used for the selection of the participants. The mean cross-sectional area of the median nerve was calculated in both of these groups in both hands by using the direct method. The mean cross-sectional area of non-pregnant female was used as the reference value to which that of pregnant female were compared. Data obtained were compiled and analyzed using Statistical Package for Social Sciences Version 16. Result The overall mean cross-sectional area of the median nerve in non-pregnant females was 6.76 ± 1.05 mm2 and in pregnant females was 6.84 ± 1.09 mm. No statistically significant difference was noted in the mean cross-sectional area of the median nerve in either hand in both pregnant and non-pregnant females. No statistically significant difference was noted in the overall mean cross-sectional area between the non-pregnant and pregnant females. There was no significant difference in the mean cross-sectional area within the different trimesters in both hands on intergroup comparisons. Conclusion Ultrasound examination of the median nerve and measurement of its cross- sectional area is a useful diagnostic tool in the evaluation of carpal tunnel syndrome. Ultrasound has the advantage of easy availability, low cost, quick scan time, able to scan a long segment of nerve and examine the structures in both static and dynamic states. Besides, it also helps in the identification of various anatomic variants and pathologies within or adjacent to carpal tunnel. KEY WORDS Carpal tunnel, Mean cross sectional area, Median nerve, Ultrasonography
COVID-19 Pandemic: An Experience of OBGYN Residents at Kathmandu Model Hospital
(Kathmandu University, 2020) Bharati, S; Bajracharya, N; Tiwari, KD; Maharjan, O; Maharjan, S
ABSTRACT COVID-19, a novel corona virus has affected the life of each and every individual worldwide. Nepal being the neighborhood country of china, though, we had a late case detection. But, since the month of July this virus has spread in an alarming manner in Nepal. Nepal being one of the developing countries, we lack in equipments, manpower resources and also in treatment centers. Looking into the devastating scenario of Covid 19 in China, Italy, New York, Brazil and our neighboring countries like India, Pakistan and Bangladesh is scary. We wondered how we were going to handle this pandemic if similar circumstances happened in our country too. At the same time being OBGYN residents, we all know pregnancy is very crucial and our patients have faced much difficulties to receive the maternal health services. In this manuscript, we have shared our experience regarding preparedness for COVID-19, management of positive cases and its effect in OBGYN trainee. KEY WORDS COVID-19, Effect, Maternal health, OBGYN residents
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
Entry knowledge and situational feedback of MBBS students
(Kathmandu University, 2005) Sharma, SC; Maharjan, S
Introduction: A need has been felt to acquire knowledge of students at Kathmandu Medical College (KMC) who have decided to take up a medical career and have enrolled at KMC after completing two years of basic sciences. Objective: The intent was to (i) find out the entering status with regard to general knowledge, (ii) get feedback from the students about the facilities provided by the management both at basic sciences complex at Duwakot and clinical sciences at Sinamangal and (iii) get feedback regarding the teaching learning activities provided by various departments in KMC. This attempt at getting their point of view was for trying to improve upon the facilities by taking up their suggestions and doing away with the weaknesses. Preference was given to hostel students as they would be able to comment on living conditions. Methodology: A total of 150 students from three consecutive batches from basic and clinical sciences were included in the study. Survey questionnaires were distributed and all the forms were returned. The obtained data was analyzed using SPSS 11.5 version for Windows. Results: It was found that the entry knowledge on general issue was better in 6 th batch of students (87.08±17.41) than 5 th batch (82.19±17.43) and 7 th batch (78.93±20.60), but not significant (p=0.164>0.05). The students in different batches differed in their rating of various facilities provided by KMCTH. The most liked departments in terms of teaching learning activities were departments of Anatomy and Pathology. Discussion: Entry knowledge of the students of three batches was found to differ but not significant, correlating with the amount of teaching and learning received at KMC. The facilities provided by KMC were perceived as more satisfactory by the students who enrolled at KMC in later years. The earlier students had to cope with more difficulties as KMC was trying to improve on various facilities it provided to its students. Conclusion: Level of entry knowledge got better as the students attained more and more years of teaching and learning activities. It was also seen that the student’s perception of the quality of facilities provided by KMC got better overtime. Key words: Student, Knowledge, Aptitude, facilities, KMC, feedback, course
Inter pleural catheter technique for perioperative pain management
(Kathmandu University, 2003) Shrestha, BR; Tabadar, S; Maharjan, S; Amatya, SR
NA.
Intramedullary Nailing System in Unstable Both Bone Diaphyseal Fractures in Children
(Kathmandu University, 2017) KC, BB; Lamichhane, N; Parajuli, SP; Maharjan, S
ABSTRACT Background Forearm fractures in pediatric population is usually managed conservatively. Unstable fractures need operative intervention like closed or open intramedullary nailing or open reduction and internal fixation with plates and screws. However, there is no consensus regarding the method of treatment according to age group. Objective To standardize the use of elastic nailing system as effective form of treatment in terms of function, cost and lower complications as compared to widely used titanium nails in developed countries. Method Sixty eight pediatric patients with both bone forearm diaphyseal fractures were managed with closed reduction and intramedullary fixation with rush nail or k-wire and followed at least for 6 months for evaluation of radiological and functional outcome. Result Patients were divided into two age groups, Group A for age of 5 to 9 years (26 patients) and Group B for age of 10-15 years (42 patients). The mean time for union for Group A patient was 7.31 weeks which was significantly lower than that of Group B patients of 9.33 weeks (p-value <0.05). All the patients in Group A had excellent outcome and 36 (85.7%) patients had excellent outcome and 6 (14.3%) had good outcome in Group B. 5 out of 68 cases (7.35 %) had minor complications (2 in Group A and 3 in Group B). The mean time for implant removal was 17.9 weeks in Group A and 22.9 in Group B. Conclusion Intramedullary fixation for unstable diaphyseal both bone fractures of forearm is safe and cost effective method of treatment with good to excellent functional outcome with union time being significantly lower in younger age group. KEY WORDS Children, diaphyseal forearm fracture, intramedullary nail
MBBS student selection: search for proper criteria
(Kathmandu University, 2004) Maharjan, S; Dixit, H
It is accepted that selecting students for the MBBS course is fairly difficult and not totally effective. This article documents the process undertaken at Kathmandu Medical College (KMC) with reference to previous attempts and suggestions for the future. Keywords: Admission process, medical students, selection, KUMET, Interview, criteria
Misleading Diagnosis of Dysgerminoma in a Young Asymptomatic Patient
(Kathmandu University, 2020) Maharjan, O; Bajracharya, N; Dangal, G; Karki, A; Pradhan, HK; Shrestha, R; Bhattachan, K; Tiwari, K; Bharati, S; Maharjan, S
ABSTRACT Dysgerminomas account for approximately one third of all malignant ovarian germ cell tumors (tumors arising from ovarian germinal elements) and are the most common ovarian malignancy detected during pregnancy. They are the only germ cell malignancy with a significant rate of bilateral ovarian involvement that is 15-20 percent. They have a variable gross appearance, but in general are solid, pink to tan to cream colored lobulated masses. They have the best prognosis of all malignant ovarian germ cell tumor variants. Two thirds are stage I at diagnosis, and prognosis is excellent even for those with advanced disease due to exquisite tumor chemosensitivity. The 5 year disease specific survival rate approximates 99 percent. This is a case report of a huge ovarian dysgerminoma in a young unmarried lady that was quite asymptomatic. She underwent laparotomy with right ovarian cystectomy. KEY WORDS Dysgerminoma, Germ cell tumor, Malignant, Pvarian malignancies
Outcomes of Laparoscopic Cholecystectomy in a Tertiary Hospital in Nepal
(Kathmandu University, 2023) Shakya, YR; Manandhar, A; Laudari, U; Patel, JN; Karmacharya, RM; Sah, S; Malla, B; Shrestha, B; Maharjan, S; Dahal, A
ABSTRACT Background Laparoscopic Cholecystectomy (LC) is the gold-standard surgery for symptomatic cholelithiasis with low mortality and morbidity. Objective The main objective of this study is to study the outcomes of laparoscopic cholecystectomy in Dhulikhel Hospital over the period of seven years. Method The records of all the patients who underwent laparoscopic cholecystectomy in Dhulikhel Hospital from January 1, 2015, to December 31, 2021 were reviewed. Patient demographics, indication of surgery, hospital stay, and number of conversions to open cholecystectomy were collected. The percentage, mean and median were calculated for socio-demographic information and Chi-square test was performed to measure the association between socio-demographic characteristics, duration of hospital stay, and operative procedure. Result Out of 2106 patients who underwent laparoscopic cholecystectomy from January 1, 2015, to December 31, 2021, 584 (27.73%) were male, and 1522 (72.27%) were female. The female-to-male ratio was 2.6:1. The median age of the patients was 40 years (IQR=52-30). Most common indications for surgery were symptomatic cholelithiasis in 1740 (82.62%) patients along with chronic cholecystitis in 268 (12.73%) patients, and Post ERCP Cholecystectomy in 92 (4.37%) patients. Median hospital stay was three days. Out of 2106 cases, 24 cases were converted to open cholecystectomy. Conclusion Laparoscopic cholecystectomy is the gold standard treatment for benign diseases of the gallbladder and can be performed safely as day care surgery to reduce the cost, length of hospital stay, and long waiting list in low and middle-income countries. KEY WORDS Cholecystectomy, Cholecystitis, Gallstone, Laparoscopy, Post-ERCP
Pregnancy Complicated by Acute Pancreatitis with Ascariasis
(Kathmandu University, 2020) Thakur, SK; Dangal, G; Karki, A; Pradhan, H; Shrestha, R; Bhattachan, K; Bajracharya, N; Tiwari, K; Bharati, S; Maharjan, O; Maharjan, S
ABSTRACT Ascariasis lumbricoides infections are common in tropical and sub-tropical countries. As it is one of the common causes for common bile duct obstruction. But in pregnancy is a rare entity. It may present with complications like acute pancreatitis. Here we present a case of 24 year female gravida 2 para 1 at 34 weeks of pregnancy presented with chief complain of pain over epigastric region radiating to back and associated with two episodes of vomiting, non bilious, not mixed with blood. Ultrasonography showed long tubular hyperechoic structure in gallbladder lumen most likely ascariasis and then she was diagnosed as a case of acute pancreatitis with alive ascariasis. KEY WORDS Acute pancreatitis, Ascariasis lumbricoides, Pregnancy, Ultrasonography
Review of Admission of MBBS Students at KMC
(Kathmandu University, 2003) Dixit, H; Maharjan, S
This is an account regarding the intake of the 7 th batch of MBBS students at Kathmandu Medical College (KMC) for the academic session 2003-2004. A total of 257 admission forms had been issued to Nepali students. Of these, 252 admission forms were filled up and were submitted to KMC together with the completed questionnaire by the Nepali students. Seven students (approximately 2.7%) did not attend interview. After the interview, out of the 245 interviewed students, the names of only 50 were brought out in the 1 st list for admission. The paper presents the system for admission of MBBS students and has made recommendations for future action. Keywords: Admission process, medical students, KUMET.
Sellar Tuberculosis Mimicking Pituitary Adenoma
(Kathmandu University, 2022) Maharjan, S; Satyal, B; Baidya, R
ABSTRACT Tuberculosis of central nervous system accounts for only 1% of tuberculosis cases worldwide, of which pituitary is an extremely unusual site. We report a case of pituitary tuberculosis in a 29-year-old female presenting with complains of headache and diminished vision on right eye. It was misdiagnosed as pituitary adenoma on radiology. Biopsy showed epithelioid granulomas, langhans giant cells and caseous necrosis. Ziehl nelseen stain showed presence of acid fast bacilli confirming the tubercular etiology. Therefore, histology remains the mainstay for diagnosis of these lesions. Early diagnosis and prompt use of antitubercular drugs results in good outcome. KEY WORDS Pituitary adenoma, Sellar, Tuberculosis
Surgery for recurrent lower lip carcinoma
(Kathmandu University, 2008) Maharjan, S; Bista, M; KC, Toran; Joshi, KD
Abstract A 38 year old gentleman presented with recurrent Squamos cell carcinoma of lower lip. He had earlier undergone previous surgeries and radiotherapy. At the time that he presented in KMCTH his lower lip area was much scarred and the tongue was shrunk and unavailable for vermilion reconstruction. This case report is an account of the various treatment carried out to reconstruct the lip. It was done with co-operation of the ENT department. Key words: Recurrent squamous cell carcinoma, Gillies fan ap, Deltopectoral ap, Delay of aps
Vaginal Atresia with Cervical Agenesis, a Rare Congenital Malformation
(Kathmandu University, 2021) Regmi, DR; Dangal, G; Karki, A; Pradhan, HK; Shrestha, R; Bhattachan, K; Tiwari, KD; Bharati, S; Manandhar, P; Maharjan, S
ABSTRACT Congenital vaginal atresia and cervical agenesis is a rare congenital abnormality of the female genital tract. Here we report a case of 15-year old girl with primary amenorrhea with hematometra, presented with lower abdominal mass. She was symptomatic since 5 months and visited local hospital after 4 months of onset of her symptoms when it became severe, where diagnostic laparotomy was performed for suspected Adnexal mass. Intraoperatively adnexal mass was adhered with and extended up to the uterus with 16 weeks size of uterus. Abdomen was closed without any further intervention and was referred to higher center for needful. When she presented to Kathmandu Model Hospital, she was asymptomatic on her 5th post-operative day of laparotomy. We planned for surgical intervention after examination and investigation. Drainage with vaginoplasty with amnion graft with placement of mould was done. KEY WORDS Congenital cervical agenesis, Hematometra, Vaginal atresia, Vaginoplasty

Browsing by Author "Maharjan, S"

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