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 An unusual case of obstructive jaundice(Institute of Medicine, 2007) Sharma, P; Subedee, A; Khadka, H; Pradhan, S; Lohani, B; Joshi, BR; Paudel, SAbstract A case of hydatid cyst of liver rupturing into biliary tree causing obstructive jaundice is reported. Keywords: Obstructive jaundice, hydatid cyst ERSPPublication Benign broncho-esophageal fistula in an adult(Institute of Medicine, 2009) Singh, KN; Pradhan, S; Thapa, B; Shrestha, UK; Sayami, PAbstract Tracheoesophageal and bronchoesophageal fistulas are usually diagnosed early in life after an infant presents with difficulty in feeding or recurrent pneumonia. These conditions rarely present in adulthood. We report the case of a 65-year-old man who presented with chest discomfort and cough particularly after meals for three months. Workup including a barium esophagogram revealed bronchoesophegeal fistula. Dissection of the fistula and pedicled intercostal muscle flap repair was done.Publication Choriocarcinoma of uterine cervix with cerebral and lung metastasis(Institute of Medicine, 2009) Ansari, MA; Pokhrel, LR; Thapa, R; Shrestha, DM; Pradhan, SAbstract Abstract: Uterine cervical choriocarcinoma was diagnosed in a 22-years-old woman, admitted to the hospital with irregular vaginal bleeding, hemoptysis and intermittent fever for three months. She had undergone dilatation and curettage for incomplete abortion in the past and had a full term normal vaginal delivery. Pelvic examination revealed a tumor mass occupying the uterine cervix. Ultrasound of the abdomen and pelvis showed an ill defined heterogeneous predominantly isoechoic mass lesion arising from the cervical part of the uterus with invasion to the posterior wall of urinary bladder with bilateral ovarian cysts. Chest radiograph revealed multiple nodular soft tissue density radiopaque shadows of various sizes in lower zones of both lung fields. CT scan of the abdomen revealed heterogeneous soft tissue density mass lesion with central areas of hypodensities, arising from the cervical part of uterus. Fat plane with inferior wall of the bladder and rectum were lost. The mass shows heterogeneous enhancement after administration of contrast material. CT scan of head revealed multiple hemorrhagic lesions in the supratentorial compartment with perilesional edema. Urine pregnancy test was positive. Urine hCG in high dilution was also positive (upto I: 1024) and Serum B-hCG was 181.3(7) mUL/ml. Histopathological findings led to the diagnosis of choriocarcinoma of the cervix.Publication 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 Feasibility study of acute thrombolytic therapy for stroke in a tertiary care center in Nepal(Institute of Medicine, 2018) Pradhan, S; Shrestha, PS; Acharya, SP; Prasad, PNAbstract Introduction: Early thrombolysis is the recommended therapy for acute ischemic stroke (AIS). In a developing country like Nepal, many factors contribute to the delay in performing prompt thrombolysis. This was a feasibility study to assess the determinants of pre-hospital delay for patients diagnosed with AIS. Methods: From 16th July to 16th September 2017, patients diagnosed with AIS in the emergency department (ED) were identified and a structured interview with the patient or next of kin was performed. Various pre-hospital time intervals and possible factors resulting in delay were assessed. Results: A total of 58 AIS patients were studied. Only 12% of the total patients underwent thrombolysis. The mean delay (+/-sd) from symptom onset to first contact with a medical personnel was 6.74 (+/- 7.84) hours. The mean (+/-sd) total arrival delay to ED was 15.78 (+/-17.48) hours. The mean (+/-sd) delay in dispatch to delivery time was 9.12 (+/-15.57) hours. Ten patients (17%) arrived to our ED within 3 hours of onset of symptoms, and 14 (24%) arrived within 4.5 hours of onset of symptoms. Fifty percent of those who presented on time for thrombolysis underwent the therapy. Conclusions: This study shows that there are major obstacles before we are able to provide adequate thrombolysis services for AIS. There remain plenty of areas where the government, the hospital and public health services need immediate addressing. Key words: feasibility, ischaemic stroke, pre-hospital delay, thrombolysisPublication 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 Laparoscopic management of hydatid cyst of liver(Institute of Medicine, 2016) Pradhan, S; Ghimire, B; Kansakar, P; Singh, Bhandari R; Joshi, Lakhey P; Singh, YP; Vaidya, P; Mishra, P; Singh, KPAbstract Introduction: The surgical treatment of liver hydatid disease has evolved dramatically and laparoscopic treatment has shown encouraging results with the advantages of minimally invasive surgery. We conducted this study to determine the outcome of laparoscopic management of hydatid disease of the liver. Methods: Consecutive patients with this disease reporting to our department from July 2014 to July 2015 were offered laparoscopic management. All patients received pre- and postoperative albendazole. The laparoscopic technique consisted of aspiration of the cyst fluid, sterilization, suction and drainage of the cavity, deroofing and addition of omentoplasty. Age, sex, duration of surgery, surgical morbidity, hospital stay and evidence of hydatid cyst recurrence were measured. Results: Twenty six patients had laparoscopic treatment for hepatic hydatid cysts. Females were 18 (69.2%) and males were 8 (30.8%). Mean age of patients was 37.46 ± 15.96 years (range 17-74 years). Pain was the commonest presentation occurring in 21 (80.8%). The right lobe of the liver was most commonly involved in 20 patients (76.9%). The mean cyst size was 6.77 cm (range, 5 cm to 12 cm). Minor spillage of cyst contents occurred in 5 patients (19.23%) and major spillage occurred in 1 patient (3.8%). The mean duration of surgery was 84.81±28.93 minutes (range 50-150 minutes). Conversion was needed in 2 (7.7%). Complications included port-site infection in 2 (7.7%), bile leak in 3 (11.5%), fever in 5 (19.2%) and chest infection in 2 (7.7%) cases. Mean hospital stay is 4.58 ± 3.40 days (range 3-16). There was no mortality in the series. The average follow-up period is 7.81 ±2.57 months. There have been no recurrences to date however 1 patient was lost to follow up. Conclusion: Laparoscopic management of hydatid cysts of the liver is a safe and effective option with advantage of minimally invasive surgery in properly selected patients. Keywords: Hydatid cyst, Laparoscopy, EchinococcusPublication 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 Primary pericardial mesothelioma presenting as pericardial constriction(Institute of Medicine, 2011) Ansari, MA; Thapa, R; Pradhan, SAbstract A 48 year-old-male presented with a six month history of shortness of breath and cough with low grade fever. Chest x-ray shows enlarged cardiac size. Echocardiogram revealed pericardial effusion. ESR was raised and blood count showed lymphocytosis. Anti-tubercular treatment was started and four months after completion of treatment there was no significant improvement. Pericardial biopsy was done which revealed findings of chronic pericarditis. Echocardiogram was repeated which revealed thickened pericardium with few foci of calcification and pericardial effusion. Diagnosis of constrictive pericarditis was made. Patient was planned for pericardiactomy. During operation fleshy vascular mass was seen arising from pericardium along with nodular pericardial thickening. Biopsy was taken and closer was done. Post operatively contrast enhanced CT scan of chest was done which revealed malignant mesothelioma. Histopathological analysis showed a primary malignant mesothelioma. Post operative period was uneventful for initial 2-3 days. Patient was taken by his party against medical advice on 3rd post-operative day. Patient did not returned to the hospital again. Keywords: Pericardial mesothelioma, echocardiogram, CT scanPublication Problems regarding emergency ultrasound in Nepal(Institute of Medicine, 2008) Joshi, BR; Pradhan, S; Ansari, MAAbstract Introduction: Ultrasound plays an important role in management of emergency patients. This study was performed to define the patterns of indications and to analyze the findings. Materials and Methods: Hundred patients were analyzed for 6 months from 15th August 2003. Results: Females were 59 percent. Thirty-nine percent were of 20-29 years age group. Eleven percent presented during 8-9 PM . Provisional diagnosis and clinical history were not mentioned in some requisition forms. Normal findings were present in 18 %. Normal pregnancy was present in 11%. Acute appendicitis was present in 9%. Two were positive for ectopic pregnancy. Conclusion: Ultrasound should be used as complementary investigation and not instead of clinical examination. Keywords: Emergency, ultrasound, appendicitisPublication 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 Rectal injury attributable to enema(Institute of Medicine, 2017) Pradhan, S; Adhikari, A; Bhandari, RSAbstract Constipation is one of the most common complaints in the general population, and is associated with substantial economic cost. Postoperative ileus (POI) maybe one of the contributory factor for no passage of stool. Despite a lack of strong evidence for their clinical utility, laxatives or prokinetics have been used to treat POI in clinical practice. Many a times, patients self-medicate or take over-the-counter drugs to treat constipation and sometime end up with complications requiring urgent medical consultation. Dietary modification, laxatives are some of the first line treatment of constipation. Bowel cleansing enemas are also frequently used to relieve constipation. Though, very effective, sometimes may cause serious adverse events. Some of the common side effects are anal irritation, burning sensation, diarrhea, nausea and cramps. Bowel injuries following use of bowel cleansing enema is a rare incident. We report two cases that developed rectal injury following use of enema (glycerin 15% w/v and sodium chloride 15% w/v).