Browsing by Author "S, Sharma"
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Publication Acute sacrococcygeal dislocation (anterior type): A case report(Kathmandu University, 2004) KP, Rijal; RL, Pradhan; S, Sharma; S, Lakhey; BK, PandeySacrococcygeal dislocation is a rare injury. A twenty-nine year old male presented to us with pain over the lowest part of spine of 5 days duration. He fell down on stairs with his buttock landing directly over the edge of the stairs. On examination, a step was felt in the continuity of sacrum and coccyx. The tip of the coccyx was not palpable. Per rectal examination revealed a small bump on running the finger along the sacrococcygeal curvature. On plain radiographs of sacro-coccygeal region, lateral view revealed anterior dislocation of the coccyx over the sacrum. On antero-posterior view, the injury could not be identified. Under general anaesthesia, an attempt to reduce the dislocation per rectally was tried, but failed. The patient was treated conservatively with analgesics. He refused surgery, as he was relieved of pain with analgesics. Key Words: - Sacrococcygeal dislocation, coccydynia, conservative treatment.Publication B-Lynch Brace suture for conservative surgical management for placenta increta.(Kathmandu University, 2004) P, Chaudhary; S, Sharma; R, Yadav; P, DhaubhadelPlacenta accreta is defined as “an abnormal adherence, either in whole or in part, of the afterbirth to the underlying uterine wall”. Placenta increta occurs when the placenta invades deeply into the myometrium.1 . Placenta increta is a life threatening condition. We report a case of placenta increta managed by unilateral uterine artery and ovarian artery ligation followed by B- Lynch Brace suturing of the uterus to control bleeding from the placental bed. Key words: Placenta increta, PPH, B-Lynch suturePublication HIV and AIDS: the global perspectives and the challenges for Nepal(Kathmandu University, 2004) S, SharmaNAPublication Hormone Replacement Therapy in menopause: current concerns and considerations(Kathmandu University, 2003) S, SharmaIt has been estimated that one third of postmenopausal women in the U.S. use Hormone Replacement Therapy (HRT) to treat symptoms of menopause and prevent chronic conditions. In developing countries HRT use is not so common but there is an increasing trend in its use. It has been seen that women with better socio-economic status, higher education and urban population use HRT. It is important that benefits and harms of HRT based on scientific evidence should be considered when prescribing HRT. The health care workers should prepare themselves for a better dialogue with women including information about alternative treatment. Objective: To review the available evidence on benefits and harms of HRT. Methodology: A Medline search was done for papers published in English language between 1990 to 2003, with abstracts available. The limitations set were original articles and reviews. The key words used were Menopause, Hormone Replacement, HRT, and ERT. The local libraries were searched and email requests were sent for full text articles. 10 full text articles were available, mostly review and large studies, which were studied in more detail. Some textbooks and reference books for gynaecology were also reviewed. Results: Beneficial effects of HRT on vasomotor symptoms have been supported by various studies, but HRT to treat negative mood is not recommended. A systematic review of Cochran database showed little evidence regarding the effect of hormone replacement therapy or oestrogen replacement therapy on overall cognitive function in healthy postmenopausal women. Oestrogens and androgens have significant beneficial effects on skin collagen, but do not prevent the effect of aging on elastic tissue and have limited use in the prevention and treatment of skin changes of menopause. Short-term benefits have been shown for urogenital atrophy. Recent evidences suggest that benefits of HRT include prevention of osteoporotic fractures, and colorectal cancer while prevention of dementia is uncertain. Harms include Coronary Heart Disease (CHD), stroke, thromboembolic events, breast cancer, with 5 or more years of use, and cholecystitis. It is recommended that the regimen should not be initiated or continued for primary prevention of coronary heart disease. In women with CHD, it should not be used for secondary prevention of CHD events. Active living, alternative therapies and consumption of food rich in phyto-oestrogens are some areas, which need to be explored in more detail. Conclusion: Patient preferences as well as evidence are important to initiate and/or continue HRT. Benefits and harms need to be re-addressed periodically to apply newly published evidence and to reassess emerging risk, co-morbidities and need of individuals.Publication Publication Publication Measuring life skills of adolescents in a secondary school of Kathmandu: an experience(Kathmandu University, 2003) S, SharmaObjective: The objective of this study was to develop a scale to measure life skills and to assess the levels of life skills in adolescents of a secondary school at Kathmandu. Methodology: a descriptive, cross sectional survey of adolescents from class VIII, IX, and X of a public co-educational secondary school of Kathmandu was done with the help of self-administered questionnaires prepared in English and translated into Nepali. Focus Group Discussions consisting of boys only, girls only and a mixed group comprising of one student from each section of each class were conducted to confirm the results of the study. All the data obtained from the questionnaire survey were edited, coded and entered into EPI info Version 6. Results: A total of 347 adolescents participating in the study. 176 adolescents (51%) had life skill scores above the mean, and was termed as having “high level” of life skills and 171(49%) , had “low level” of life skills scores. Mother’s education was significantly associated with increased level of life skills in adolescents (P=.001). Conclusion: Most of the teachers were not aware of the concept of life skills. Maternal education was significantly associated with higher life skill levels in adolescents. Connectedness and family support were other important factors influencing the level of life skills in the adolescents. Keywords: Life skill, adolescence, scale measuring life skillPublication Post legalisation challenge: minimizing complications of abortion(Kathmandu University, 2004) N Ojha; S, Sharma; J, PaudelAbortion has been legalized in Nepal since September 2002 by 11th amendment to the Muluki Ain. The present study was conducted in Paropakar Shree Panch Indra Rajya Laxmi Devi Maternity Hospital to assess the magnitude of induced abortion, its causes and the types of complications, in the post legalization phase. Prospective descriptive analyses of the patients who were admitted with history of induced abortion from 16 th Dec 2003 to 13th March 2004 was carried out. A total of 305 cases of abortion complications were admitted during the three-month study period, which is 39.7% of the total gynaecological admissions (768). Of these 31 (10.25%) patients had history of induced abortion. Half of the induced abortion cases (52%) were of age group 21-29 yrs and 42% had three or more children. 39% of the cases had history of induced abortion at more than 12 weeks and almost half of the cases (48%) had history of family planning. The most common reason for seeking abortion was too many children (59%) followed by illegitimate pregnancy (16%). Twenty-one patients gave history of abortion being performed by doctors and the most common method used was D&C (75%). 77% of cases presented as incomplete abortion and one case presented with uterine perforation, bowel injury and peritonitis. Twenty patients had evacuation under sedation while five had manual vacuum aspiration (MVA); one patient required laparatomy. In two third of the patients intravenous fluid and antibiotics were used. Four patients required blood transfusion. Abortion complications constitute almost 40% of the total gynaecological admissions. Ten percent of the abortion cases had history of induced abortion. Medical persons, mainly doctors, performed most of the cases of induced abortion and D&C was the most commonly used method. However the patients had faced various types of complications. Untrained provider, resulting in serious life threatening injuries, performed more than a third of the cases of induced abortion at more than twelve weeks gestation. This points to the need for improved monitoring of the quality of services provided, and adherence to the criteria set by the procedural order.Publication Reproductive Rights of Nepalese Women: Current Status and Future Directions(Kathmandu University, 2004) S, SharmaNAPublication Tuberculosis and other clinical presentation of HIV/AIDS in patients with or without undergoing antiretroviral therapy in Kathmandu(Kathmandu University, 2007) GP, Dhungana; P, Ghimire; S, Sharma; BP, RijalObjectives: To screen tuberculosis (TB) and examine the clinical presentation of AIDS in HIV sero-positive persons. Methods: A Cross-sectional study was designed. One hundred HIV infected persons were randomly selected from different parts of the country visiting Tribhuvan University, Teaching Hospital, Kathmandu and different HIV/AIDS care centres. After taking informed consent, questionnaires were filled and three sputum specimens from each person were collected to investigate tuberculosis by Ziehl-Neelsen staining and culture. Data generated were entered into SPSS 11.5 and relevant statistical tools were applied. Results: Among 100 HIV infected cases, 66 (66%) were males and 34 (34%) were females. Sixty percent of the cases were in the age group of 21-30 years. Majority of them were Smokers (41%), alcoholics (34%), illiterates (54%) and unemployed (59%). Heterosexual activity (51%) was found to be the major risk factor for HIV infection. Of the 100 HIV cases, 23 (23%) were co-infected with tuberculosis of which 18(78%) were sputum smear negative tuberculosis, mostly developed in late stage of HIV infection. Weight loss (54%) and diarrhoea (43%) were the major clinical presentations of AIDS. Antiretro-viral therapy non-receiver were more likely to suffer with various clinical disorders/TB as compared to ARV therapy receiver but the values were statistically insignificant, χ2 values ranging from 0.003 to 2.24, p>0.05. Conclusion: Prevalence of tuberculosis was still high in HIV/AIDS patients, and specifically, sputum smear negative tuberculosis cases constituted the significant proportion, particularly in late stage of HIV infection. Weight loss and diarrhoea were found to be the major clinical presentation of AIDS. Illiterate and unemployed young adults involved in unsafe sexual practice and drug addiction were high risk of acquiring HIV infection. Key words: Clinical features, HIV/AIDS, Kathmandu; Smear Negative Tuberculosis