NepMed Repository :: Browsing by Author "SK, Sharma"

Browsing by Author "SK, Sharma"

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Ancient cystic pelvic schwannoma presenting as a right iliac fossa mass
(Kathmandu University, 2005) BR, Rai; D, Chaudhary; P, Thapa; MR, Joshi; UMS, Dongol; DR, Singh; SK, Sharma
Schwannoma is rare in pelvis. Ancient schwannoma is rarer histological subtype of schwannoma. We report a very rare case of pelvic schwannoma presenting with right sciatica and right iliac fossa pain. Clinical and imaging findings were suggestive of Peritoneal Hydatid cyst. The tumour was resected completely with marked clinical improvement. Histopathological examination showed Ancient cystic schwannoma. Key words: Benign pelvic Schwannoma, Benign retroperitoneal tumour, Giant ancient Schwannoma, Presacral Cystic Schwannoma
Antimicrobial utilization pattern in out patient services of ENT department of tertiary care hospital of Eastern Nepal
(Kathmandu University, 2005) BP, Das; A, Sethi; GP, Rauniar; SK, Sharma
Objective The objective of this study was to monitor the antimicrobial utilization in ENT out patient services in a tertiary care hospital of Nepal. Materials & Methods A total of 191 prescriptions were randomly audited at varying time interval from the department of ENT in the year2003. The data was collected in customized Performa in the form of antibacterial audit questionnaires. It also contained Patient particulars, diagnosis, investigations, drug details and information from the prescriber regarding the indication for prescribing antimicrobial agent, suspecting organism underlying infection, duration of therapy and details of any concomitant medications. Results The incidence of use of antimicrobial agents (AMA) in 191 prescriptions was analyzed from the enrolled prescriptions, a total of 218 antimicrobials i.e.1.4 antimicrobial agent per patient were prescribed. .The AMAs were indicated therapeutically in 73.29% of patients & 19.37% patients for prophylaxis. The AMAs were advised for more than 72 hours for prophylaxis in 86.48%. In the concomitant medications antihistaminic were prescribed in 32.62% and NSAIDS in 21.98% cases. Most of patients reported with upper respiratory tract infections (URTI- 32.56%), Chronic Suppurative otitis Media (CSOM-18.3%), sinusitis (6.28%), tonsillitis (5.75%),. Pharyngitis (3.66%), Acute Suppurative Otitis Media (ASOM-2.61%) and others. The diagnosis was established clinically in 42.40% and confirmative in 35.60%. In 21.46% the diagnosis was not disclosed. Out of 191 patients, culture sensitivity tests were performed for only 31 patients and 13 patients depicted a positive culture sensitivity tests. The common microbes isolated from the culture were staphylococcus aureus (69.2%). Streptococcus (7.7%), Enterobacteriacae (7.7%), Pseudomonas auroginosa (7.7%) & psendomanas mirabilis (7.7%). Clinically suspected organism were mentioned in only 32 prescriptions and most prescriber presumed the infections due to staphylococci & pseudomonas (43.75%), streptococci (21.8%),Gram negative organisms (12.5%) and H influenza (9.3%).The use of a single drug was abundant (89.52%), two drugs (9.94%), and three drugs (0.52% )prescriptions. Ciprofloxacin (23.85%) was preferred, followed by amoxycillin (20.06%), combination of ampicillin + cloxacillin( 9.17%), doxycyclin (5.96%). Erythromycin (4.58%) and cotimoxazole (4.58%). Expensive drugs i.e azithromycin (2.75%), roxithromycin (1.37%) and cephalosporins (3.21%) were also prescribed. The causative microbes were sensitive to amoxycillin (53.84%), cloxacillin (53.84%) ciprofloxacin (46.15%), gentamicin (46.15%), and cephalosporin (46.15%). But resistant to erythromycin, tetracycline, cotrimoxazole and norfloxacin) Conclusions-Majority of patients were prescribed drugs irrationally with misleading indications without confirming the bacteriological culture and sensitivity. Keywords: AMAs (Antimicrobial Agents), URTI (upper respiratory tract infection), Drug utilization
Intra-abdominal abscess presenting as a thigh abscess
(Kathmandu University, 2004) D, Chaudhary; A, Magar; P, Thapa; DR, Singh; SK, Sharma
Secondary thigh abscesses are rare, and their cause is often obscure. We report a case of an elderly diabetic who presented with thigh abscess secondary to tuberculous sacroilitis. Key words: Secondary thigh abscess, retroperitoneal abscess, tuberculous sacroilitis
Omental torsion: a case report
(Kathmandu University, 2005) D, Chaudhary; R, Rajkarnikar; MR, Joshi; P, Thapa; DR, Singh; SK, Sharma
Omental torsion is a rare cause of acute abdomen. Most often it presents with sign and symptoms of acute appendicitis. It is seldom considered in the differential diagnosis preoperatively based on clinical findings and the diagnosis is only established during surgery. We present a case of omental torsion in a middle aged male patient who presented with findings suggestive of appendicular perforation and underwent emergency laparotomy. Key words: acute abdomen, omentum, torsion, appendicitis
Predicting difficulties during laparoscopic cholecystectomy by preoperative ultrasound
(Kathmandu University, 2007) SK, Sharma; PB, Thapa; A, Pandey; B, Kayastha; S, Poudyal; KR, Uprety; S, Ranjit
Background: The aim of this study was to determine whether the preoperative USG finding can predict the risk of conversion or difficulty during the laparoscopic cholecystectomy. Materials and methods: 200 patients undergoing Laparoscopic cholecystectomy at Kathmandu Medical College Teaching Hospital were included. Sonographic parameters like size of gall bladder, wall thickness, distance between hepaticoduodenal ligament and Hartmann’s pouch and the size of stone were taken into consideration and difficulties in terms of adhesions around gall bladder, anatomy of calot’s triangle and difficulty in peeling off gall bladder from the bed and retrieval were analyzed. Result: In 8 of 200 patients (4%), LC was converted to open procedure. In univariate analysis all the sonographic parameters we had included in this study were statically significant (p value <0.05). Conclusion: Preoperative sonographic signs can predict the difficulty in laparoscopic cholecystectomy
Removal of central venous catheter fragment embolus in a young male
(Kathmandu University, 2006) PB, Thapa; R, Shrestha; DR, Singh; SK, Sharma
A 22 years male admitted with severe pancreatitis with central venous catheter implanted for central venous pressure monitoring and for providing total parental nutrition developed catheter fragment embolus due to accidental fracture of the same while manipulating it. Non surgical retrieval of the same was done by radiological intervention without any complication. Key words: intravascular catheter fragments, transfemoral venous approach, interventional procedures
Risk factors, associated health problems, reasons for admission and knowledge profile of diabetes patients admitted in BPKIHS
(Kathmandu University, 2006) RS, Mehta; P, Karki; SK, Sharma
Objectives: The objective of the study was to find out the demographic profile, identify the known risk factors, assess the associated health problems, find out the reasons for admission and explore the knowledge profile of the patients admitted with diabetes in medical units of BPKIHS. Methods: It was hospital based exploratory study conducted among the admitted DM patients during the period of 1-3-2003 to 29-2-2004 in medical units using simple random sampling, which included 35 samples. The data was analysed using Excel and SPSS programme. Results: About 54% subjects were of age group between 40-60 yr., Hindu 85.7%, married 92.9%, and non- vegetarian 75.9 %. About 50% of subjects were on Insulin. About 60.7 % subject had hypertension, 39.3 % had ocular problem, and 25 % had renal problems. Majority of subject (82.1 %) had knowledge about the disease, they were suffering but limited subject had the knowledge about, causes, curability, treatment modalities, diet, and other aspects. Conclusions: As the knowledge regarding various aspects of DM is very low, there is need for information booklet in Nepali and health education programme among public will be very beneficial. Key Words: Risk Factors, Associated Health problems, Knowledge profile, Diabetes.
Total thyroidectomy: the treatment of choice in differentiated thyroid carcinoma
(Kathmandu University, 2005) SK, Shrestha; MR, Joshi; SK, Sharma
Introduction: Clinically detectable thyroid carcinoma constitutes less than 1% of human cancers. Ninety percent of all thyroid malignancies are differentiated papillary and follicular carcinoma. Surgery plays a key role in differentiated thyroid carcinoma as it carries excellent prognosis, lower recurrence rate and low mortality rate but controversy persists for extent of surgery and optimal surgical management of lymph node metastasis. Patient and Method: A retrospective analysis was done for the cases that underwent total thyroidectomy with lymph node dissection for differentiated carcinoma of thyroid in Kathmandu Medical College during two year periods (Oct 2001 to Oct 2003). Result: In our experience with 18 cases of Differentiated Thyroid Carcinoma (DTC) treated with total thyroidectomies and lymph node dissection, papillary carcinoma was predominant with 83% incidence. Disease was prevalent in 50 to 60year age group. Except two cases of transient hypocalcaemia and few wound related complications, there have been no other complications. Conclusion: Total thyroidectomy with lymph node dissection is safe and effective, so, the treatment of choice in cases of differentiated thyroid carcinoma.
Use of percutaneous thread loop to hold the vermiform appendix during laparoscopic appendectomy
(Kathmandu University, 2007) MR, Joshi; SK, Shrestha; PB, Thapa; U, Koirala; P, Bhattarai; UMS, Dongol; DR, Singh; SK, Sharma
Introduction: Laparoscopic appendectomy, although not as widely performed as laparoscopic cholecystectomy, it has got definite advantage over the conventional open procedure. Controversy exists regarding the closure of stump. Our institute practices intracorporeal knot tying using 3 ports. Difficulties are observed in three port technique to hold the appendix during knot tying. We use a percutaneous thread loop. Advantage of the use of loop was evaluated. Patients and method: Prospective study was carried out during 18 months. Total cases were randomly divided in non-loop and with loop group. Operative procedure was same. Cases were compared in terms of operating time, post-operative hospital stay and complications. Results: Total patients were 66. Thirty two in non-loop group and 34 in with loop group. Mean age was 27.89 yrs. Most of the cases were females (62%). Mean operating time was less in loop group although statistically not significant. There was no difference in post operative hospital stay. Use of loop was not associated with added complications. Conclusion: Use of percutaneous loop to hold the appendix reduces the operating time and replaces the need of fourth port. It is safe and effective without any increased morbidity. Key words: Laparoscopic appendectomy, Intracorporeal knot, Percutaneous loop

Browsing by Author "SK, Sharma"

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