Browsing by Author "Pradhan, N"
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Publication A Rare Case of Large Left Lateral Wall Vaginal Myoma(Kathmandu University, 2021) Shrestha, A; Mudbari, J; Tamrakar, SR; Pradhan, N; Makaju, R; Karki, SABSTRACT Vaginal leiomyomas are rare, they are uncommon benign tumor with variable clinical presentation. They usually present as a mass per vaginum or dyspareunia or pressure symptoms on the neighbouring structures. We present a case of 47 years lady with mass per vaginum and difficulty in walking and chronic pelvic pain. Her clinical findings suggested a large mass in the left vaginal wall, the mass was approximately 12 x 10 cm in size hindering the visualization of the cervix. Her ultrasonography showed bulky uterus with mass occupying the cervix. This finding was not correlating with the clinical findings. Magnetic resonance imaging (MRI) was done and it was reported as mass lesion in pelvis separate from the cervix abutting the rectum posteriorly. Ultrasonography (USG) guided biopsy was done which was reported as Leiomyoma. She underwent vaginal myomectomy and was confirmed in histopathology as Leiomyoma. A leiomyoma is a smooth muscle tumor that arises from the muscular part of the uterus and rarely seen in the vaginal wall. KEY WORDS Chronic pelvic pain, Leiomyoma, Mass per vaginumPublication 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 Bacterial vaginosis in Tribhuvan University Teaching Hospital(Institute of Medicine, 2005) Manandhar, R; Sharma, J; Pokharel, BM; Shrestha, B; Pradhan, NAbstract Five hundred women of reproductive age group were screened for bacterial vaginosis (BV) using Amsel’s criteria from January 2004 to July 2004 at gynaecological out patient department of Tribhuvan University Teaching Hospital (TUTH). Bacterial vaginosis was found in 2.5%. Among all BV positive patients, 67.3% were symptomatic and 32.7% were asymptomatic. Brahmans were significantly least infected caste. Highly educated women were also significantly least infected group. Sexual exposure has significant association with BV. Smokers and people using alcohol suffered much from bacterial vaginosis but were not statistically significant.Publication Complications of warfarin in post operative heart valve surgery(Institute of Medicine, 2013) Pradhan, N; Bhandari, NR; Bharati, LAbstract Introduction: Thromboembolic complications and bleeding are the major complications of warfarin. The aim of the study was to focus on the complication of warfarin and monitoring post-valve surgery. Methods: A combined retrospective and prospective study was done in post mechanical heart valve surgery patients at Manmohan Cardiothoracic Vascular and Transplant Center. The study was carried out for 4 months by interviewing patients with self-administered structured questionnaire about any complications during their follow up in OPD and monitoring for their INR values. Results: The majority of patients studied wer male 42 and 56 were female. 55 patients underwent mitral valve replacement, 22 underwent double valve replacement and 46 underwent aortic valve replacement. There were a total of 59 cases of bleeding complications. Hemoptysis was the most common bleeding event .Pericardial bleeding was the most common major bleeding complication with 3.1%. In patients taking warfarin major bleeding complication was 10.2% and minor bleeding was 50%. Out of total INR reading 47% were out of the target INR range, with 19.5% above range and 27.5% below range. Conclusion: Minor bleeding was the most common type of bleeding. A system for proper monitoring of warfarin can bring improvement in better dose adjustment to achieve more appropriate INR values and eventually minimizing warfarin related complications. Introducing pharmacist monitored anticoagulant clinic can reduce the work load of physicians and overcome the time barrier. Keywords: Minor bleeding, Major bleeding, INR, ThromboembolismPublication Delayed management of ruptured ectopic pregnancy: an observation of concern(Institute of Medicine, 1999) Rana, A; Gurung, G; Singh, M; Pradhan, NAbstract There were 82 cases of ruptured ectopic pregnancies during a 6-year period, (2049- 2054) April 1992-1998. Associated high risk factors were proven PID (3), infertility (10), sterilization (4), previous ectopic (6), IUCD (1). One of the cases had clomiphen citrate and the other was an OCP for cystic ovary. Atypical presentations were malaena (2) and intestinal obstruction (1). Symptoms and admission interval varied from 1 hour to more than a month in 8 cases. Surgical intervention was undertaken at an earliest in 2 hours and delayed beyond 1-2 weeks in 7 cases. Surgical management was delayed beyond 6 hours (69.5%) and 12 hours (56%) respectively. This delay was mainly due to misdiagnosis (45%) as the symptoms of PID (3), DUB (1), and pelvic abscess (1) overlapped with ectopic. Improper and inadequate referral due to inexpert opinion at admission was another cause for delay. Forty-two point six percent had significant haemoperitoneum, of which 39.4 needed blood transfusion. Two cases had tubal reconstruction and two underwent hysterectomy. We emphasize to overcome the diagnostic dilemma by adopting sensitive BhCG using monoclonal antibodies, TVS and laparoscopy whenever necessary along with active surgical team to cut short the delay in operative management of ruptured ectopic. Keywords: Ruptured ectopic, Risk factor, Delayed managementPublication Knowledge, attitude and practice of contraception among women seeking: abortion care services(Institute of Medicine, 2013) Bista, KDB; Pradhan, N; Manandhar, RAbstract Introduction: Women coming for abortion are those in whom contraceptive use is most needed. This study was therefore done to assess the knowledge, attitude and practice of family planning measures among the women who came for safe abortion services at TU Teaching Hospital Methods: A prospective, study done for a period of 9 months (17 April 2009 to 14 Jan 2010) in the Family Planning and Comprehensive Abortion Care Centre, Tribhuvan University Teaching Hospital among the women who came to seek abortion services. The women were interviewed before the procedure and then at follow up at 1 month and at 3 months. Results: A total of 125 women were interviewed. Most women belonged to age between 20- 29 yrs (57%). Of them 19% were > P3. Only 3 women had not heard about family planning methods, while >50% knew all the methods. Maximum source of information was media (65.6%). Ninety five percent women approved of practicing family planning and 81% intended to use it after the abortion. 81% needed approval from husband for using a contraceptive. Eighty percent of women had used some sort of contraceptives in the past while less than 50% of husband had ever used contraceptives in the past. Fifty seven percent women came for termination of pregnancy because of completed family. Seventy nine percent of women accepted different methods of family planning while 68% were found to continue using them at 3 months follow up. Conclusion: Long acting contraceptives were less likely to be discontinued. Husbands had an important role in giving permission and deciding the contraceptive method. Keywords: contraception, knowledge, attitude and practisePublication Maternal cardiac diseases complicating pregnancy: a review of 105 cases(Institute of Medicine, 2001) Rana, A; Singh, M; Manandhar, B; Pradhan, N; Gurung, G; Dali, B; Koirala, B; Koirala, RRAbstract The outcome of pregnancies in 105 patients with heart diseases in TUTH, Kathmandu, Nepal between April 1995 and May 2001 was reviewed. The incidence of heart disease was 0.55% of the total 19038 deliveries. Rheumatic (79), congenital (17) and miscellaneous groups (9) complicated the pregnancy. Significant number (53) had their diagnosis made at the index pregnancy. Patients who developed cardiac failure (17) mostly did during antenatal period (20-42 weeks); the majority had cardiac failure (14) at third trimester. Two of the cases that had cardiac failure at 33 weeks ultimately had stillbirths later at term. Induction of labour for such cases, which was discouraged earlier, should be considered. In our hospital labour analgesia with epidural anaesthesia, pethidine or morphine is not a routine practice. Injection Methergin is also generally withheld. Save one or two, most Cesaerean sections had obstetrical indication. Prophylactic forceps or ventouse were barely used. There were two maternal deaths. One of them had pregnancy complication as eclampsia and presented with SVT and MI at 34 weeks. The other case died within 48 hours of Caesarean delivery for critical mitral stenosis with pulmonary hypertension. The perinatal losses were 7. This article strongly emphasizes the need for routine cardiac evaluation of patients at their very first antenatal check up so that patie nts with cardiac disease can benefit from shared co-operation between cardiologist, cardiothoracic surgeon, anaesthelogist and obstetrician. Keywords: Heart disease, pregnancy, cardiac failure, obstretic analgesia, induction of labourPublication Pyoperitoneum associated with uterovaginal prolapse in two elderly women(Institute of Medicine, 2007) Pradhan, N; Rana, A; Gurung, G; Zaffar, SAbstract Case report: Incarcerated uterovaginal prolapse due to pelvic and peritoneal abscess (pyoperitoneum) which at initial laparotomy was insufficiently dealt due to plastered peritoneum and dense pelvic adhesion, just by means of peritoneal lavage alone in one case and subtotal hysterectomy in the other and were wisely operated at a later date, removing uterus and bilateral adnexal mass at abdominal hysterectomy and bilateral salphingo-oophorectomy or removal of prolapsed cervix, that included the safety of surgical procedure is highlighted. Keywords: Pyoperitoneum, pelvic abscess, peritoneal lavagePublication Reproductive Risk Factors in Uterovaginal Prolapse: A Case Control Study(Institute of Medicine, 2015) Paudyal, P; Pradhan, N; Ojha, NAbstract Introduction: Uterovaginal prolapse (UVP) is a major women’s health concern throughout the world and contributes a major bulk of reproductive health morbidity in Nepal. The cause of this disorder is likely to be multifactorial. The aim of this study was to analyze the reproductive risk factors associated with UVP. Methods: This was a hospital-based case control study, carried out in the Gynaecology Department of TUTH over one year from 1 st Baisakh 2068 to 30 th Chaitra 2068 (13th April 2011 to 12th April 2012). Cases comprised of 116 women with UVP, second degree or more and controls were women without prolapse of the same age group (± 5 years) admitted subsequently after the cases. The variables studied were; age at first childbirth, number of vaginal births, birth spacing and rest during puerperal period. P value and Odds Ratio (OR) for each risk factor were calculated. Multivariate analysis was done for those risk factors found to be significant from the univariate analysis. Results: Age at first childbirth, number of vaginal births and rest during puerperium were found to be significant risk factors from univariate analysis. Only two risk factors i.e. age at first childbirth<20years; OR 2.24(95% CI 1.18-4.25) and rest during puerperium<15 days; OR 3.87(95% CI 1.9-7.93), were found to be significant by the multivariate analysis. Conclusion: Preventing early marriage and childbirth at a young age along with imparting awareness about the importance of adequate rest during the puerperium could go a long way in reducing morbidity due to prolapse. Keywords: reproductive risk factor, uterovaginal prolapsePublication Young teenagers and child birth(Institute of Medicine, 2000) Pradhan, N; Rana, A; Singh, M; Gurung, G; Manandhar, BAbstract In a retrospective analysis done at TU Teaching Hospital between 15 Aug 1997 and 14 Aug 1998, 57 teenage mothers (13-17 years) represented twenty per thousand deliveries (total deliveries, 2799). The usual documented complications like prematurity and low-birthweight were seen in 16% and 24.5% respectively. Pregnancy complication such as eclampsia was seen in one case that delivered a low birthweight baby with poor apgar. Most of these young mothers had vaginal deliveries (86%). The caesarean section rate was 14%, which could have been further lowered, if there were no complications like foetal distress (3) and abnormal presentation (2). Excepting a case of pregnancy that occurred in a 13-year old girl due to sexual abuse, all the other pregnancies followed marriage. This indicates that adolescent reproductive health is a neglected arena requiring some change. Hence full attention has yet to be focused on adolescent reproductive health, particularly directed towards preventing early marriage and early child bearing which is detrimental to adolescent reproductive health. Keywords: Teenage pregnancy, early marriage, adolescent reproductive health