Browsing by Author "Pradhan, S"
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Publication A prospective and retrospective study of actinomycosis in last five years at Manipal Teaching Hospital, Pokhara, Nepal(Kathmandu University, 2007) Talwar, OP; Ghosh, A; Pradhan, S; Swami, RM; KC, ShivrajAbstract Objective: The study was carried out to determine the clinical and morphological presentation of actinomycosis and its association with malignancy and other opportunistic infections. Material and Methods: A prospective and retrospective study of cases was done from January 2001 to December 2006 (5 years) in the department of pathology. Result: Total 19 cases of actinomycosis were found during this period. Patients presented with discharging sinus and non-healing superficial abscess. Out of 19 cases, three cases were associated with malignancy, two cases were associated with aspergillosis while one case was clinically misdiagnosed as malignancy. All cases were diagnosed pathologically except a case of maxillary sinusitis which was initially suspected as fungal sinusitis by CT scan. Since actinomycosis is often misdiagnosed it is important to know the clinical presentation and morphological features of actinomycosis for correct management. Conclusion: The clinical features and histopathological findings of actinomycosis are important to understand for its correct diagnosis and better management of patient. Key words: Actinomycosis, fungusPublication Accuracy of ultrasonography in evaluation of level and cause of biliary obstruction: a prospective study(Kathmandu University, 2005) Ghimire, R; Lohani, B; Pradhan, SAim: To find out the accuracy of ultrasound in evaluation of level and cause of biliary obstruction. Materials and methods: Forty-five patients (26 to 86 years of age) with suspected biliary obstruction underwent Ultrasonography followed by Direct Cholangiograms (Percutaneous Transhepatic Cholangiography / Endoscopic Retrograde Cholangiography). The levels of biliary obstructions were grouped as hilar, suprapancreatic and intrapancreatic. Similarly the causes were grouped as malignant and benign. Diagnosis was confirmed either at surgery or histopathologically (USG-guided FNAC or ERC-biopsy). Results: Ultrasonography accurately identified the level of obstruction in 89 %( hilar), 91 %( suprapancreatic) and 87 %( intrapancreatic) cases. Malignancy was found in 33 patients and remaining 12 had benign diseases. USG accurately identified malignant and benign causes in 91% and 84% cases respectively. Findings were found to be statistically significant (p-value=<0.05 at 95%confidence interval). Conclusion: This study showed that USG has high accuracy in identifying the level and cause of biliary obstruction. Considering cost, availability and patient friendly nature, Ultrasound should be the first imaging modality of choice in evaluation of biliary obstruction. Key words: Ultrasound, biliary obstruction, direct cholangiogramPublication Accuracy of ultrasonography in the diagnosis of acute appendicitis(Kathmandu University, 2008) Khanal, BR; Ansari, MA; Pradhan, SAbstract Aims and Objectives: To assess the accuracy of ultrasonography in the diagnosis of acute appendicitis. Methodology: A prospective randomized study was carried in the Dept. of Radiology and Imaging, Tribhuvan University, Teaching Hospital, Maharajgunj, Kathmandu, Nepal. A total of 120 patients, who were clinically diagnosed as acute appendicitis were subjected to ultrasonography of the abdomen. A detailed ultrasonography was performed and the findings were recorded. Twenty one cases had alternate diagnosis. Ninety nine cases ultimately underwent laparotomy and the retrieved appendices were sent for histopathological examination. Intra-operative, histopathological and ultrasonographic diagnoses were then statistically analyzed. Results: Ultrasonographic, intra-operative and histopathological findings were statistically insignificant (P≥0.05). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy percentage of ultrasonography in the diagnosis of acute appendicitis was 85.7%, 100%, 100%, 6.7% and 85.9% respectively. Conclusion: Ultrasonography has a high degree of accuracy in the diagnosis of acute appendicitis. However, the diagnosis should be considered with the diameter of appendix over 6 mm. Therefore acute appendicitis with diameter of appendix having less than 6 mm should be evaluated with other diagnostic parameters. Key words: Acute Appendicitis, Ultrasonography.Publication Adrenal Ganglioneuroma(Kathmandu University, 2020) Kayastha, R; Acharya, R; Pradhan, S; Tuladhar, AS; Shrestha, AABSTRACT Adrenal ganglioneuromas are rare sympathetic differentiated tumors which originate from neural crest cells. These lesions are usually discovered incidentally on imaging and tend to be hormonally silent. Preoperative diagnosis of adrenal ganglioneuroma remains extremely challenging and the gold standard treatment is adrenalectomy. There is good prognosis after surgery without recurrence. We herein report a case of adrenal ganglioneuroma in a 15 year old female who presented with complaint of abdominal discomfort. Contrast Enhanced Computed Tomography abdomen showed a large septated hypodense right suprarenal mass which was echogenic on Ultrasonography. It showed T1 hypointense and T2 hyperintense signal on Magnetic Resonance Imaging of abdomen and pelvis. Excisional biopsy and histological examination of the mass was suggestive of adrenal ganglioneuroma. This report presents the clinical and radiological data for the rare tumor which would share some experience to facililate the diagnosis of adrenal ganglioneuroma. KEY WORDS Adrenal mass, Computed tomography, Ganglioneuroma, Magnetic resonance imaging, UltrasonographyPublication Factors Affecting the Uptake of Institutional Delivery, Antenatal and Postnatal Care in Nawalparasi District, Nepal(Kathmandu University, 2019) Pradhan, S; van Teijlingen, E; Simkhada, PP; Dhungel, A; Silwal, RC; Fanning, P; Wasti, SPABSTRACT Background Maternal deaths and complications are highly preventable with good antenatal, postnatal and skilled care during childbirth. Inadequate information on the factors affecting these services could be barrier to a reduction of maternal deaths in low- income countries. Objective To assess the uptake of antenatal, postnatal and skilled care during childbirth. Method A cross-sectional study was conducted in eight villages of Nawalparasi district in southern Nepal. A total of 447 women who had given birth within the preceding 24 months were recruited using multistage random sampling. Data were collected using a pre-tested semi-structured questionnaire. Chi-square tests were used to assess association between variables. Result Over 70% of women had gone for at least four antenatal care check-ups while only 14.3% had at least three postnatal check-ups in their last pregnancies. The proportion of institution delivery was 54%. Women’s literacy was associated with the uptake of antenatal services (p=<0.001), postnatal care (p=0.04) and institutional delivery (p=<0.001). Knowledge of antenatal (p=<0.001) and postnatal care was also associated with uptake of respective services (p=<0.001). Conclusion The uptake and knowledge of antenatal care was much better than of postnatal care. Home delivery rates were still very high. A scaling-up of education and awareness- raising interventions in this community could help improve the uptake of maternal health services. KEY WORDS Childbirth, Maternal health, Pregnancy, Service utilisation, South AsiaPublication Impalement Injury to The Heart(Kathmandu University, 2011) Pradhan, S; Sapkota, R; Shrestha, U K; Amatya, R; Koirala, BABSTRACT Cardiac impalement injury is rare and one of the most severe penetrating chest injuries, often fatal. The management of penetrating cardiac injuries is a challenging one. The success in management of impaling cardiac trauma requires stabilization of the impaling object, expeditious transfer to a facility for open heart surgery, rapid imaging, access to blood and blood products and a ready surgical team. We report a case of impalement injury to the heart by a stick, transfixing the right ventricle and its successful treatment. KEY WORDS Impalement injury, Penetrating cardiac injury, Cardiac injury, Cardiac impalementPublication Nasal glioma: A case report(Kathmandu University, 2007) Talwar, OP; Pradhan, S; Swami, R; KCSRHere we describe a rare case of nasal glioma in a 14 year old boy who presented with history of right nasal obstruction and nasal discharge since 6 months. On examination a pale mass was seen filling the right nasal cavity and extending down in the oropharynx. Clinical impression was antrochoanal polyp. Excision of the mass was carried out and sent for histopathology which showed presence of glial tissue and the diagnosis was made as nasal glioma. Key words: nasal gliomas, congenital mass, encephalocelePublication Pre-operative assessment of K-nail length in fracture shaft of femur(Kathmandu University, 2006) Lakhey, S; Pradhan, RL; Bishwakarma, M; Pradhan, S; Pradhanaga, S; Pandey, BK; Rijal, KPIntroduction: Internal fixation of diaphyseal fracture of shaft of femur in an adult by Kuntscher nail is the most common operative method of treatment in Nepal where operative facilities for the same exist. Since the complete range of K-nail sizes and length are not available in most operation theatres in Nepal, most orthopaedic surgeons assess the size and length of the K-nail pre-operatively by various methods and keep one size above and below the assessed length for the planned surgery. Materials and Methods: The following measurements were taken in five hundred people involved in the study: Measurement No. 1: Tip of the greater trochanter to lateral knee joint line minus 2cms. Measurement No. 2: Tip of the olecranon process to the tip of little finger, and Measurement No. 3: Tip of the greater trochanter to the upper pole of patella. An average of all three lengths were analysed to see if there were any differences in their mean lengths. Results: Analysis showed that there were significant differences between the mean lengths measured by the three different methods. The average length of measurement no: 2 was 3 cm longer than the average length of measurement no: 1, which is the reference pre-operative length of K.nail. Conclusion: However, in practice since measurement no:2 is more convenient to perform and can also be used when the patient has sustained bilateral fractures of femur, an accurate pre-operative K-nail length assessment can be done by subtracting 3 cm from measurement no:2, i.e. the tip of the olecranon process to the tip of the little finger.Publication Predictive value of ultrasonography in the diagnosis of palpable breast lump(Kathmandu University, 2003) Pande, AR; Lohani, B; Sayami, P; Pradhan, SA lump is the first symptom in over 80 percent of all patients with cancer of the breast. Consequently, the finding of any lump in the breast is a highly significant sign and warrants a thorough investigation. The present study was undertaken to study the predictive value of ultrasonography in the diagnosis of palpable breast lumps. Fifty-two female patients with palpable breast lumps that were unilateral underwent ultrasonography of the breast. Thirty-six of these patients who had solitary, unilateral, solid lumps were followed up with FNAC/biopsy/mammography and the findings were compared. The mean age group was seen to be 41 years. The youngest patient was 17 years old and the oldest was 80 years. The validity of USG in the diagnosis of palpable breast lumps was calculated. A sensitivity value of 95%, specificity of 94.10%, positive and negative predictive values of 95.50% and 93.75% were noted and were comparable to other similar studies. The sensitivity, specificity, positive and negative predictive values were statistically significant (p=0.0000006) and were comparable to the values obtained by different studies conducted elsewhere. Among the multiple USG parameters, shape, margins, vascularity, surrounding tissue character, sound transmission through the lump were more significant in the diagnosis of benign vs. malignant lumps. Echogenicity and echotexture were of less significance. Key words: Breast lump, Ultrasound, FNACPublication Prevalence of Gingivitis in Second Trimester of Pregnancy(Kathmandu University, 2022) Shrestha, R; Pradhan, S; Baral, GABSTRACT Background Gingivitis simply means the inflammation of gingiva. It is a reversible state but can lead to periodontitis. The final result could be the exfoliation of the tooth causing decreased masticatory function leading to a compromised quality of life. Gingivitis in the pregnant woman should be carefully assessed and treated and given special attention. There is rare documentation on the prevalence of gingivitis in pregnancy in the least developed countries. Objective To evaluate the prevalence of gingivitis in the second trimester of pregnancy and assess its relationship with age, parity, education, occupation, gravidity, oral hygiene habit and frequency of brushing. Method An observational descriptive study was conducted among 384 pregnant females in their second trimester in Kathmandu, Nepal. Demographic variables and general information including those related to oral hygiene practices and habits were collected during an interview. Plaque index and Gingival Index was recorded among the patients through full mouth examination at four sites. Result The prevalence of gingivitis in the second trimester of pregnancy was 76.3%. Statistically significant relationship was found between gingivitis and gravida and parity. A relation could not be established between gingivitis with age, education, occupation, oral hygiene habit and frequency of brushing. Conclusion The prevalence of gingivitis is found to be high in Nepalese pregnant women. Special strategies should be introduced targeting the pregnant women of least developed countries to uplift their periodontal health. KEY WORDS Gingivitis, Oral hygiene, PregnancyPublication Prevalence of Respiratory Diseases According to Spirometry Findings Among Patients Attending the Spirometry Department of Dhulikhel Hospital(Kathmandu University, 2016) Prajapati, BK; Pradhan, SABSTRACT Background Spirometry is a standard test for screening and evaluation of patients with symptoms of cough and shortness of breath. Despite its easy availability, low cost and ease of performance it has not been widely used in clinical practice in Nepal. Objective To assess the prevalence of respiratory diseases in a regional referral centre in patients referred for spirometry. Method This is a descriptive cross-sectional study including patients referred for spirometry to the spirometry unit of Dhulikhel Hospital, Kathmandu University Hospital from 2014 July to 2015 October. The spirometry findings of the patients fulfilling the criteria of American Thoracic Society/European Respitatory Society (ATS/ERS) guidelines were analyzed and categorized as normal, having obstructive lung diseases including chronic obstructive pulmonary disease (COPD) and bronchial asthma or restrictive lung disease. Data were analyzed using SPSS 20.0 software. Result Out of 821 patients, 755 patients (92%) fulfilled ATS/ERS criteria for satisfactory spirometry. The prevalence of COPD was 31.4%, bronchial asthma 24.2% and restrictive lung disease 8.1%. The mean age of patients diagnosed with COPD was 57.8±10.8 years; bronchial asthma 44.3±16.2 years; and restrictive lung disease 44.6±21.5 years. Both COPD and bronchial asthma were common in females. About twenty two percent of the COPD patients were non-smokers and 86.3% of these were females. The most common symptoms for referral was cough and shortness of breath: these symptoms were more likely to be associated with abnormal spirometry findings. Conclusion Spirometry is a crucial preliminary test for evaluation of patients with respiratory symptoms. It should be used more frequently to help stratify patients for appropriate treatment. KEY WORDS Bronchial asthma, chronic obstructive pulmonary disease, spirometryPublication Quality of Life and Associated Factors among Patients with Stroke at Tertiary Hospital, Nepal(Kathmandu University, 2024) Chaudhary, B; Devkota, N; Kafle, BR; Pradhan, S; Maharjan, PL; Adhikari, HPABSTRACT Background Stroke is the second leading cause of mortality globally, with 70% of cases occurring in low- and middle-income countries. Various risk factors for stroke have been identified as predictors of Health-Related Quality of Life (HRQoL). Objective This study aims to assess the impact of associated factors of stroke on the quality of life (QoL) of stroke patients at this tertiary hospital in Nepal. Method A descriptive cross-sectional study was conducted among 92 stroke patients at Annapurna Neurological Institute and Allied Sciences from June to December, 2022. Data were collected through a pre-designed and pre-tested SS-QoL questionnaire followed by a face-to-face interview. SPSS version 22 was employed for analysis, and Mann-Whitney U tests and Kruskal-Wallis H tests was applied to determine the association of variables at a 5% level of significance. Result About two-thirds of the participants were male, indicating a male predominance. Patients aged 45-55 exhibited higher quality of life in family roles and vision, possibly due to the adversity of stroke in older patients. Ischemic stroke was three times more prevalent than hemorrhagic stroke, and those individuals reported higher quality of life, particularly in work and productivity. However, other domains remained statistically insignificant. Among the studied comorbidities, hypertensive patients had the highest overall quality of life. Conclusion Conducting a comprehensive evaluation of the overall quality of life in individuals who have experienced a stroke can contribute to improved health outcomes, particularly in terms of their functioning and well-being in psychosocial aspects. KEY WORDS Co-morbidity, Quality of life (QoL), Stroke, Stroke specific quality of life scalePublication Self-confidence Level among Intern Dentists in Performing Endodontic Treatment Procedures in Nepal(Kathmandu University, 2021) Chakradhar, A; Humagain, M; Acharya, N; Pradhan, S; Poudel, PABSTRACT Background Endodontics is considered as one of the most difficult and stressful disciplines in dentistry. This might be due to the complex anatomical variations, recent advances in equipment, technology, materials and lack of self-confidence. Objective To determine the self-confidence level among the intern dentists in performing endodontic procedures from six different colleges of Kathmandu University, Nepal. Method A descriptive cross-sectional study was conducted among 145 intern dentists. The online questionnaire regarding confidence level (5 point Likert scale) in different endodontic procedures and difficulty level (easy, ok and difficult) with respect to teeth was distributed. For descriptive purpose, frequency and percentage for each response were calculated. Result Dental interns were confident in performing majority of the normal endodontic procedures, however, they showed less confidence in performing difficult steps like rubber dam application for anterior (74, 51%) and posterior tooth (91, 62.7%), use of electronic apex locator (89, 61.4%), using rotary files (114, 78.6%), management of flare-ups (86, 59.4%), assessment of quality of post-endodontic treatment (85, 58.5%), recall periods (75, 51.6%) and performing post and core (82, 56.6%). Likewise, upper first molars (84, 57.9%) and second molars (104, 71.7%) were found to be the most difficult teeth to treat. Conclusion It can be concluded that majority of the dental interns were confident in performing basic endodontic procedures, however, they were found to have low confidence in performing difficult steps. Further training and exposure should be incorporated to increase their confidence level. KEY WORDS Confidence level, Endodontic procedures, Intern dentists, Kathmandu UniversityPublication Treatment of Infrabony Defects by Open Flap Debridement with or without Diode Laser(Kathmandu University, 2022) Agrawal, S; Pradhan, SABSTRACT Background Periodontitis is the common oral condition which affects the periodontium of the teeth that leads to destruction of periodontal ligaments and alveolar bone. Open flap debridement is the surgical procedure which provides access and visibility of the site, application of laser as an adjunct has various advantanges. Objective To compare clinical outcomes after open flap debridement with or without diode laser. Method Patients aged 25-45 years diagnosed with infrabony defect ≥ 5 mm visiting Department of Dental Surgery, Bir Hospital. Control group sites were treated with open flap debridement alone, whereas test-groups were treated with Open flap debridement with diode laser. Various parameters like Plaque index, Gingival index, Pocket depth and Clinical attachment level were assessed and compared between groups at baseline, 3 and 6 months. Result The mean plaque and gingival scores improved in both the control and test groups at 3 and 6 months follow up as compared to baseline and was statistically non- significant between two groups. Open flap debridement with or without diode laser in the treatment of periodontal intrabony defects did not produce significant reduction in pocket depth and gain in clinical attachment level. Conclusion There was no significant differences in the clinical parameters were seen in the surgical flap debridement of infrabony pocket with and without diode laser. Diode laser can be used safely as an adjunct. However, long-term, multicentric, histologic and microbial studies are required. KEY WORDS Attachment loss, Diode laser, Gingival recession, Periodontitis, Periodontal pocketPublication Tricuspid Valve Repair: Devega’s Tricuspid Annuloplasty in Moderate Secondary Tricuspid Regurgitation(Kathmandu University, 2011) Pradhan, S; Gautam, NC; Singh, YM; Shakya, S; Timala, RB; Sharma, J; Koirala, BABSTRACT Background Moderate secondary tricuspid incompetence has variable natural history if left unattended during mitral valve surgery. Recent data suggest progression of the secondary tricuspid incompetence over time. Secondary moderate tricuspid regurgitation in rheumatic mitral valve disease may regress after mitral valve surgery without direct intervention. Objectives: The present retrospective comparative hospital based tudy was done to assess early result of DeVega tricuspid valve annuloplasty amongst those with moderate tricuspid regurgitation due to rheumatic mitral valve disease. Methods: Group I (mitral valve replacement with tricuspid repair) and Group II (mitral valve replacement only) were compared regarding functional class, heart rate, rhythm, cardiac dimensions, function and valve pathology. The two groups were followed up at three months post-operatively and evaluated for their functional class and echocardiography variables. The data was analyzed with SPSS 16.0 Results: There were 43 patients who underwent mitral valve replacement with moderate tricuspid regurgitation. Twenty three underwent mitral valve replacement with tricuspid repair group (Group 1). Most of the patients were women (28/43). The mean age was 31.4 + 14.8 and 25.13 + 9.4 years. Group I had 21(91.3%) and Group II had 17 (85%) in NYHA class III & IV. The pre-operative echocardiographic cardiac left ventricular and left atrial dimensions, left ventricular function and valve lesions were statistically similar for both groups, except PASP was higher amongst tricuspid repair (Group 1: 38.60 + 12.75mHg, Group 2: 61.52 + 19.76mmHg; p= <0.05). At three month’s review after surgery, four patients were in NYHA II amongst those without tricuspid repair (Group II), whilst the rest were in NYHA I. Left ventricular dimensions, Left Ventricular function and valve prosthetic valve function were similar between groups. Eleven (47.8%) patients in Group I and only five (25%) of Group II had trace or less TR at the follow-up (p < 0.05). There were 7 (16.2%) patients who had persistent moderate TR. Higher PASP and larger LV dimensions at three months were predictive of persistent moderate TR. Conclusion Mitral valve replacement does decrease the severity of tricuspid regurgitation amongst those with secondary moderate tricuspid regurgitation by at least one grade, but DeVega’s annuloplasty confers a better repair result. Key Words tricuspid valve, tricuspid annuloplasty; DeVega’s annuloplasty; secondary tricuspid regurgitation