Browsing by Author "Pant, PR"
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Publication A retained dead fetus for eight years in a didelphys uterus(Institute of Medicine, 2007) Pant, PR; Sharma, J; Giri, K; Pradhan, N; Thapa, TPAbstract Case report: A case report of 32 years female with 3 childrens and a retained dead fetus for eight years in a didelphys uterus is discussed as a case report. Keywords: Didelphys uterus, dead fetus, coagulopathyPublication Abortions induced by inserting wooden stick(Institute of Medicine, 2007) Pant, PR; Sharma, J; Mananandher, BI; Sharma, NR; Shrestha, RAbstract Background: Nepal suffers from one of the highest maternal mortality rate in the world, and the practice of unsafe abortion is responsible for more than 50% of these maternal deaths. Before legalization of abortion in2002 though it was criminal act under any circumstances thousands of abortions were done illegally in the country by expert doctors to peon by different methods. Complications of abortions depend upon gestational age, service provider, method, place of abortion. According to a nationwide survey done by CREHPA in 1997 revealed that 20% of the women prisoners against 0.3 men prisoners were there for charge of abortion or infanticide. According to Measham maternal mortality is highest in cases when the abortion is done by foreign objects in to the uterine cavity. Keywords: Induced abortion, complications, unsafe abortionPublication An effective short duration postoperative catheterization after vaginal hysterectomy and pelvic floor repair(Institute of Medicine, 2006) Pant, PRAbstract Background: The most common postoperative problem in the female bladder is atony caused by overdistention and reluctance of the patient to initiate the voluntary phase of voiding. After anterior colporraphy, spasm, edema and tenderness of the pubo-coccygeal muscles may obstruct the process of voiding. For spontaneous voiding to occur, the para sympathetic function of the bladder detrusor must be coordinated with the voluntary motor function of the abdominal wall and elevator muscles. In the past it was customary to insert an indwelling urethral catheter for 5 or more days after vaginal hysterectomy and pelvic floor repair, but infact, in uncomplicated cases 12- 24 hours post operative bladder catheterization is sufficient. Objective: to study the urinary symptoms, like retention of urine and frequency of micturition, in patients with short duration postoperative catheterization after vaginal hysterectomy and pelvic floor repair. Study design: This is prospective descriptive study, comprised of 257 women, who underwent vaginal hysterectomy and pelvic floor repair under spinal anaesthesia in different districts of Nepal. They were catheterized for 12 to 24 hours and after removal of catheter urinary problems were studied. Results: Despite of different age, different degree of prolepses, different degree of cystocele and different duration of prolepses out of 257 patients only 8 patients developed urinary symptoms including retention of urine in 5 patients and frequency and burning maturation in 3 patients. They were catheterized for 12 to 24 hours. One of the patients who had retention required 5 days catheterization, while other 4 were re catheterized for 24 more hours. In all the cases, there was urinary tract infection. Conclusion: Long duration postoperative catheterization 48 to 72 hours is not necessary in patients after uncomplicated vaginal hysterectomy and pelvic floor repair as practiced in many gynecological centers. Age of the patients, degree of uterine prolapse, cystocele, and duration of prolapse do not play major role in development of post catheter removal urinary symptoms. Preexisting or postoperative urinary tract infections have main role in the development of these symptoms.Publication Childhood Injury Prevention in Post-epidemiological Transition in Nepal(Kathmandu University, 2016) Joshi, SK; Pant, PRNAPublication 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 Factors affecting male infertility(Institute of Medicine, 2009) Pant, PRAbstract Introduction: Infertility is commonly defined as the failure of conception after at least 12 months of unprotected intercourse. 1 Accurate assessment of the prevalence of infertility has always been difficult because of the large scale population based studies. 2 Male factor is the only cause of infertility in about 20 % of infertile couples, but it may be a contributing factor in as many as 30 % to 40 % of cases.3 Factors like diabetes, bronchiectasis, high grade fever, long term medication, urinary tract infection, sexually transmitted infection, epididymitis, testicular injury, un-descended testis,mumps, orchitis, excessive alcohol, smoking, exposure to heat and certain chemicals effect in the spermatogenesis. Impotence or erectile dysfunction remains one of the important contributors in the male infertility. Methods: This is a prospective descriptive study conducted during the health camps in Sindhupalchowk, Manang, Baitedi, Rauthat and Darchula districts of the Nepal. The objective of the study is to find out the factors contributing to male infertility. Couples who were unable to conceive after regular, unprotected coitus of at least one year were included in the study. Detail history, clinical examination and semen analysis was done. Results: There was limited facility of investigation and treatment of infertility in the health camps.The diagnosis was based only on history, examination and semen analysis. Various factors like mumps, chemical exposure like men working in carpet factory, testicular trauma and smoking were found as contributing factor of male infertility in these districts. Conclusions: Testicular trauma, mumps, smoking is common in all the districts. Exposure to chemicalssuch as dyes, used in carpet factories seems to be responsible for infertility in some men of Sindhupalchowk and Darchula. Keywords: Azospermia, oligospermia, male infertilityPublication Granulosa cell tumors(Institute of Medicine, 2008) Pant, PR; Manandhar, BL; Shrestha, S; Amatya, S; Gyawali, G; Sharma, JNA.Publication Injuries in Nepal - A Neglected Public Health Burden and Ways Forward(Kathmandu University, 2017) Joshi, SK; Pant, PR; Banstola, A; Bhatta, S; Mytton, JNAPublication Scrotal haematoma: The most common complication of no-scalpel vasectomy(Kathmandu University, 2007) Pant, PR; Sharma, J; Subba, SObjective: to study the complications of no scalpel vasectomy such as scrotal haematoma, infection, scrotal sinus, and failure, recanalization, and sperm granuloma. Materials and methods: A retrospective, descriptive study carried out in Dept. of Obs/ Gyn, Tribhuvan University Teaching Hospital Kathmandu Nepal. Result: Among 926 no scalpel vasectomy clients 5(0.53%) had scrotal haematoma, 4(0.43%) with had infection, 3(0.32%) had scrotal sinus; there were 2 cases each vasectomy failure who could not achieve azospermia and 2 with recanalization while there was only one case of sperm granuloma. Conclusion: the most common complication of no-scalpel vasectomy was scrotal haematoma and other complications are wound infection, scrotal sinus, vasectomy failure and sperm granuloma. Key words: no scalpel vasectomy, scrotal haematoma, scrotal sinus, sperm granuloma.Publication Utero-vaginal prolapse in far western region of Nepal(Institute of Medicine, 2009) Pant, PRAbstract Background: Utero-vaginal prolapse (UVP) is very common among Nepalese women. There are about 600,000 patients suffering from this gynaecological condition, amongst which 200, 00 require immediate correction.1 UVP is multifactorial and results in weakening of pelvic support, connective tissue and muscles as well as nerve damage. Methods: Prospective, descriptive study, conducted in the Far-western region vaginal hysterectomy camp from 14th to 29th April2009. Result: Of 325 women with UVP, 45.54 % were Biswakarmas, 38.08% Brahmin, 17.23% Chhetri, 5.23% Tharu and 0.92 5 from other communities. Early return to work (within 10 days of delivery) among Biswakarma and Brahmin was 95.27 % and 91.09% respectively where as smoking and chronic cough in Biswakarma and Chhetri was 92.57%, 66.22% and 78.56%, 34.4 % respectively. Conclusion: Early return to work, smoking and chronic cough are major contributors of UVP in far western Nepal which is more prevalent in the Biswakarma community. Keywords: Utero-vaginal prolapse, UVP, contributing factorsPublication Vaginal and rectal misoprostol for first trimester termination of pregnancy(Institute of Medicine, 2006) Pant, PR; Sharma, J; Shrestha, RAbstract Background: To compare the effectiveness of vaginal misoprostol with rectal misoprostol for termination of first trimester pregnancy. Prospective comparative study done on 138 women with unwanted pregnancy. Methods: This study was conducted in Vinayak hospital Kathmandu, from April 2005 to March 2006(Baisakh 2062- Chaitra 2062) i.e. one year. Atotal of 138 women with unwanted pregnancy of 6- 12 weeks, and only those who agreed to participate were included in the study after written consent. Patients with scarred uterus following previous cesarean section, myomectomy or hysterotomy, known allergic to misoprostol, diarrhea, and fever, age below 16 and above 45 were excluded from the study. Abortion was induced with 8ooµgm of mesoprostol in alternative patients vaginally in posterior fornix (group A) and per rectally (group B) Result: The age of the patients ranged from 16 -42 years and parity primi to sixth gravida. In group A54 patients out of 69( 78.2%) expelled products of conception after first dose of misoprostol within 24hours.15(21.7%) patients required repeat insertion of the drug .of these 8 expelled within the next 24 hours, whereas 7(10.1%) patients needed manual vacuum aspiration . In group B out of the 69 patients 59(85.5%) expelled product of conception within 24 hours of insertion of mesoprostol per rectally while the rest 10(14.4%) required re insertion of the drug. Out of these 10 cases 6 expelled within next 24 hours and four (5.8%) needed manual vacuum aspiration. Side effects of misoprostol: diarrhea, nausea, vomiting, headache and rigor were found to be more in rectal group than the vaginal. Conclusion: For termination of first trimester pregnancy, rectal route of mesoprostol is more effective than the vaginal route , how ever the side effects like diarrhea pyrexia, headache were more in rectal group. Keywords: misoprostol, termination of pregnancy, unwanted pregnancyPublication Vault prolapse after vaginal hysterectomy with pelvic floor repair for uterovaginal prolapse(Institute of Medicine, 2011) Pant, PRAbstract Introduction: Utero-vaginal prolapse is the most common gynaecological pathology among the Neplease women. Many women in Nepal are the unable to get the treatment of this pathology due to their poor economical conditions (1,2). However since last few years many governmental and nongovernmental organizations are organizing hysterectomy camps in rural areas of Nepal to help these poor people. Objective: To compare the incidence of vault prolapse among the women underwent vaginal hysterectomy with pelvic floor repair for different degree of utero-vaginal prolapse in hysterectomy camps. Methods: It was Prospective comparative study, done on 1646 women in different nine districts of Nepal from June 1999 to May 2009.All the Patientssubjected to the vaginal hysterectomy for different degree of utero-vaginal prolapse were grouped in to two groups selecting the patients alternatively. In first group of the patients during anterior colporraphy bladder wassupported by interrupted bladder buttressing stitches and in second group this repair was done by applying single purse string stitch including the apex of the vagina and incidence of vault prolapse was compared in two groups after two years of the surgery in follow up camps. Results: Out of 1646 operated patients 891 came for follow up. Among these women 567 were from group A (interrupted suture group) and325 patients were from the Group B (single purse string) group. From group A there were 22 cases and from group B 4cases of vault prolapse. In both the groups majority of the women were chronic smoker. And majority of them started heavy work after one month of prolapse surgery in both the groups. Conclusion: Single purse string suture seems better technique for the support of the bladder or as a whole vault during the anterior colporraphy while doing the pelvic floor repair in cases of uterovaginal prolapse, especially in the camp set up. Keywords: vault prolapse, bladder buttressing, utero-vaginal prolapse, pelvic floor repair