Browsing by Author "Paudel, P"
Now showing 1 - 8 of 8
Results Per Page
Sort Options
Publication Brain tumours in children(Kathmandu University, 2008) Shah, GS; Paudel, P; Srivastav, M; Sagar, K; Manandhar, S; Singh, MKAbstract A 10 years old, female patient presented with symptoms of abnormal movement of the body for 5 years, deviation of mouth to left side for 12 days and difficulty in walking for 12 days. We report a very rare case of Brain Stem gliomas. Clinical and imaging findings were suggestive of Brain Stem gliomas. Key words: Brain tumours, Intracranial space occupying lesion.Publication Evaluation of Mannheim Peritonitis Index for Predicting Outcome in Emergency Exploratory Laparotomy for acute peritonitis(Institute of Medicine, 2014) Paudel, P; Tiwari, A; Pradhan, GBN; Shrestha, S; Bhattachan, CLAbstract Introduction: Exploratory laparotomy is one of the commonest emergency procedure performed by general surgeons in daily practice. Due to heterogenisity of conditions required in exploratory laparotomy, the outcome is to variable. It is often difficult to predict outcome of such patients server scoring system are available to predict outcome to patients undergoing exploratory laparotomy for acute peritonitis. The aim of this study is to evaluate the role of Mannheim Peritonitis Index (MPI) score is predicting the outcome to patience you need exploratory laparotomy for acute peritonitis. Methods: This is our prospective analysis of 86 patients who underwent emergency exploratory laparotomy over past 2 years. The mean age of patient was 41 years and 29 (33.7%) were female. All the patients had presented to the emergency with features of peritonitis. Two patient presented with shock. Hollow viscus perforation was present in 37 patients, intestinal obstruction in 31 patients and 18 patients had various other pathologies. There were total 29 complication including 10 mortalities. The mean MPI score was 21.2 ± 8(4 – 39). There was significant correlation of MPI with mortality (p<0.05). Conclusion: the MPI score can provide simple and objective means to predict the outcome of patients with peritonitis. Keywords: Exploratory Laparotomy, MPI score, Outcome, PeritonitisPublication Glomerular Diseases in Children - A Review of 27 Cases Recorded at a Single Centre in Eastern Nepal(Nepal Paediatric Society (JNPS), 2009) Shrestha, P; Bhatta, NK; Tiwari, A; Singh, R; Kalakhetti, BK; Majhi, S; Paudel, P; Sinha, AAbstract: Glomerular disease remains an important cause of renal disease in children. We retrospectively assessed the clinical features and histopathological diagnoses in kidney biopsy specimens in children (n=27). The medical records and histopathological diagnoses between 2003 and 2006 were reviewed. In each patient, clinical presentation, age at onset of disease, gender, presence of nephrotic range proteinuria, hematuria, hypertension and histopathological diagnoses were evaluated. SLE nephritis (n=8) and membranoproliferative glomerulonephritis (MPGN) (n=8) were the most frequent glomerular diseases and nephrotic syndrome (n=21) was the frequent clinical manifestation.Publication Impact of Elective Abortion in pregnancy with Cardiac problems(Institute of Medicine, 2011) Shrestha, B; Dali, B; Paudel, P; Jha, R; Rana, A; Gurung, G; Baral, GAbstract Introduction: Pregnant women with heart diseases advance either to preterm/term delivery. Some of the pregnancies end in abortions, which however are spontaneous or are terminated for medical reasons. Method: Retrospective study done in the Department of Obstetrics and Gynecology at Tribhuvan University Teaching Hospital from April 2010 to March 2011 (Baisakh 2067 to Chaitra 2067); Source of data was Operation Theater Register and Admission files. Results: MTP were done for altogether 18 cases of heart diseasesin pregnancy. Primigravida (6) and multigravida (12) were seen in age groups 20-30 (13); 30-40 (5) at gestational weeks of 6-8 (n=10); 9-10 (n=6); 11-12 (n=1); >12 (n=1). The heart diseases were {CHD (1); rest 17 RHD: Majority being done following post valve replacement surgery 11[AVR (1); DVR (3) & MVR (7)]}. Latter mandated a tedious process of anticoagulation, switching from heparin to warfarin and vice versa demanding prolonged hospitalization (up to 12 days) as co- morbidity. Mainly because repeat MVA was needed for incomplete abortion as complication in one case, subsequent procedures were done under USG guidance. Conclusion: It is simpler and safer to avoid pregnancy in heart diseases; especially in those women with post valve replacement surgery rather than imposing MTP, the procedure concerned are not without associated risk, beyond doubt. Keywords: Medical termination of pregnancy (MTP), anticoagulation, valve replacement surgeryPublication Nutritional risk assessment in patient undergoing major gastrointestinal surgeries(Institute of Medicine, 2017) Paudel, P; Ghimire, S; Rai, S; Pradhan, GBN; Shrestha, S; Bhattachan, CLAbstract Introduction: Malnutrition is prevalent in surgical patients in the range of 20–50%, depending on the population studied and method employed to determine nutritional status. Malnutrition is associated with adverse clinical outcomes, slow healing, increase in infection and longer hospital stay. There are several methods to assess the nutritional status of surgical patients. However, none has been universally accepted and there is no consensus on the best system. The Nutritional Risk Screening score (NRS 2002) was developed based on the presupposition that the severity of malnutrition indicates increased nutritional requirements and need for nutritional support. It has received approval from the European Society for Parenteral and Enteral Nutrition for use in the hospital setting. It is easy to administer in daily clinical practice and offers satisfactory reliability and reproducibility. The aim of the present study was to identify nutritional risk in patients undergoing major gastrointestinal surgeries using NRS2002 and to determine possible associations with postoperative complications. Methods: This is a prospective study carried out in department of surgery, Nepal Medical College and Teaching Hospital from 1st August 2016 to 30th July 2017. All the major gastrointestinal surgeries performed during this period were included. The nutritional assessment was done by BMI, Serum protein /albumin and nutritional risk screening score (NRS 2002). Results: Sixty three patients who underwent major gastrointestinal surgery were included in this study. Sixty percent patients (n=38) were male, 68.8% had BMI within ideal range (18.5-25.9 kg/m2), 71.4% (n=45) patients underwent elective surgery and 68.2% (n=43) had malignancy. A total of 44.4% (n=28) of the patients were classified as being “at nutritional risk” and 47.6% (n=30) had postoperative complications. The mean NRS score was significantly higher among the patients who had complications compared to those who did not have complication (3.7± 1.2 vs 3± 1, p=0.016). Low serum albumin, BMI and absolute lymphocyte count correlated with presence of nutritional risk assessed by NRS 2002 and complications. Conclusions: NRS 2002 is simple and easy to apply in routine clinical practice for nutritional assessment. It correlates with postoperative complications. Serum albumin, BMI and absolute lymphocyte count are also simple tools for nutritional assessment of surgical patients and can be used in supplementation with NRS 2002 for better accuracy. Keywords: Albumin, Complications, Gastrointestinal surgery, Malnutrition, Nutritional risk screeningPublication Nutritional risk assessment in patient undergoing major gastrointestinal surgeries(Institute of Medicine, 2017) Paudel, P; Ghimire, S; Rai, S; Pradhan, GBN; Shrestha, S; Bhattachan, CLAbstract Introduction: Malnutrition is prevalent in surgical patients in the range of 20–50%, depending on the population studied and method employed to determine nutritional status. Malnutrition is associated with adverse clinical outcomes, slow healing, increase in infection and longer hospital stay. There are several methods to assess the nutritional status of surgical patients. However, none has been universally accepted and there is no consensus on the best system. The Nutritional Risk Screening score (NRS 2002) was developed based on the presupposition that the severity of malnutrition indicates increased nutritional requirements and need for nutritional support. It has received approval from the European Society for Parenteral and Enteral Nutrition for use in the hospital setting. It is easy to administer in daily clinical practice and offers satisfactory reliability and reproducibility. The aim of the present study was to identify nutritional risk in patients undergoing major gastrointestinal surgeries using NRS2002 and to determine possible associations with postoperative complications. Methods: This is a prospective study carried out in department of surgery, Nepal Medical College and Teaching Hospital from 1st August 2016 to 30th July 2017. All the major gastrointestinal surgeries performed during this period were included. The nutritional assessment was done by BMI, Serum protein /albumin and nutritional risk screening score (NRS 2002). Results: Sixty three patients who underwent major gastrointestinal surgery were included in this study. Sixty percent patients (n=38) were male, 68.8% had BMI within ideal range (18.5-25.9 kg/m2), 71.4% (n=45) patients underwent elective surgery and 68.2% (n=43) had malignancy. A total of 44.4% (n=28) of the patients were classified as being “at nutritional risk” and 47.6% (n=30) had postoperative complications. The mean NRS score was significantly higher among the patients who had complications compared to those who did not have complication (3.7± 1.2 vs 3± 1, p=0.016). Low serum albumin, BMI and absolute lymphocyte count correlated with presence of nutritional risk assessed by NRS 2002 and complications. Conclusions: NRS 2002 is simple and easy to apply in routine clinical practice for nutritional assessment. It correlates with postoperative complications. Serum albumin, BMI and absolute lymphocyte count are also simple tools for nutritional assessment of surgical patients and can be used in supplementation with NRS 2002 for better accuracy. Keywords: albumin, complicationnns, Gastrointesstinal surgery, malnutrition, nutritional risk screeningPublication Scenario of Health Camps in Nepal(Nepal Health Research Council, 2011) Pandey, A; Paudel, P; Paudel, LIt has become a rising trend in Nepal to conduct health camps. This article tries to give an overview about the direction to which this aspect of community based service is going to and also points out a few pros and cons related to this. A couple of issues has also been raised like; ethical issues, lack of governing bodies and a lack of national policy, unavailability of data upon health camps and so forth. Above all, this article tries to clarify the importance of conducting health camps in a country like ours and if properly conducted this has a balanced benifit to all. Keywords: health camp, community based servicePublication Treatment of Anisometropic Amblyopia in children with refractive correction(Institute of Medicine, 2009) Kaphle, D; Shrestha, JB; Paudel, PAbstract Background: The main purpose of the study is to determine the effectiveness of spectacles alone in the treatment of anisometropia in paediatric population. Methods: A hospital based prospective study was conducted on twenty children (involving twentysix eyes) with freshly diagnosed anisometropic amblyopia of mild to moderate grade. Optimal refractive correction was provided with spectacles alone and was followed at every 3 weeks until amblyopia resolved. Results: The mean line of improvement in visual acuity in 3 weeks was 0.85 ± 0.65 snellen lines. The mean line improvement in second follow up was 0.80 ± 0.70 lines. There was statistically significant (p=0.04) decrease in inter-ocular acuity (IOD) for anisometropia of 1 to 2.0D. The IOD improvement was associated with age (1.53 snellen lines in more than 8 years) in first follow up (p=0.001). IOD also decreased in children of more than 8 yrs. Conclusions: As in nearly half of the participants, especially who has minimal interocular acuity difference, anisometropic amblyopia resolved to normal acuity within first three weeks, we can conclud that the early improvement of visual acuity is related to lesser amount of anisometropia, age and sex. Keywords: Anisometropic amblyopia, amblyopia resolution, inter-ocular difference (IOD), refractive correction