Browsing by Author "Shakya, A"
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Publication Acute appendicitis: Analysis of 518 histopathologically diagnosed cases at the Kathmandu University Hospital, Nepal(Kathmandu University, 2010) Makaju, R; Mohammad, A; Shakya, AAbstract Background: Appendicitis is important as it is a common surgical emergency. There is no medical treatment for it, timely surgery is mandatory to prevent morbidity and mortality. Objectives: The objective of this study was to analyse the pathologic findings, the demographics, and, look for the existence of the so called aetiopathogenetic factors in the context of current prevailing beliefs regarding acute appendicitis, the most common current reason for emergency abdominal surgery. Materials and methods: This was a retrospective study. It was carried out at the Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. All histopathologically diagnosed cases of acute appendicitis during the period January 1, 2004 to April 30, 2010 were included. Their macrospcopic and light microscopic examination findings were analyzed. Results: A total of 518 histopathologically diagnosed cases of acute appendicitis were found. Age distribution of these cases was between 6 to 84 years. Mean age was 30. 94+ 15.75 years. Sex distribution consisted of 313 (60.42%) cases in males and 205 (39.58%) cases in females. Fecalith in the appendiceal lumen was seen only in 8 (1.54%) of cases. Granuloma and carcinoid was seen in 3 (0.58%) and 1 (0.19%) cases respectively. Perforation was seen in 11 (2.12%) cases. Foreign bodies, gallstones, strictures, helminthic infection, carcinoma or any other obvious/apparent aetiologic/ pathogenetic lesions/findings were not seen in any of the cases. Histopathologically staged distribution revealed that 180 (34.75%) cases were of early acute appendicitis, 250 (48.26%) cases were of acute suppurative appendicitis, and 88 (16.99%) cases were of acute gangrenous appendicitis. Conclusion: This study did not confirm the existing popular notion that luminal obstruction is the pathogenetic hallmark for acute appendicitis. Therefore, further research on this common surgical emergency is surely warranted. Key words: Acute appendicitis, fecalith, gangrenousPublication Comparison of single versus multiple doses of antibiotic prophylaxis in reducing post-elective Caesarean section infectious morbidity(Kathmandu University, 2010) Shakya, A; Sharma, JAbstract Background: Puerperal sepsis is frequently in Caesarean section. Antibiotic prophylaxis may have significant impact in reduction of infections and thus the need to study its role in sepsis prevention systematically. Objective: The aim of this study is to compare the efficacy of single dose versus multiple doses of a first generation cephalosporin (with Metronidazole), to reduce postoperative infectious morbidity in elective caesarean section. Materials and methods: It was prospective clinical trial of hundred women undergoing elective caesarean section who received either a single prophylactic dose of Cefazolin with Metronidazole post-cord clamping, or multiple postoperative doses of antibiotics based on the standard protocol of the hospital. Duration of the study was seven months and twenty- two days (11 th November 2004 to 30 th June 2005).Women were compared on the basis of development of postoperative febrile morbidity, endometritis, urinary tract infection, wound infection and other infections. Results: There were no significant differences among the patients in single and multiple dose groups in terms of their age distribution, gravida, period of gestation, smoking status, body mass index, indications for elective caesarean section or operation characteristics. There were 4% and 6% febrile morbidity, 2 (4%) and 0 (0%) urinary tract infection, in the single dose and multiple dose groups respectively. But none of the differences were statistically significant. Conclusion: A single prophylactic dose of Cefazolin plus Metronidazole given post-umbilical cord clamping gives as much protection as multiple postoperative doses of Cefazolin/Cefalexin plus Metronidazole in preventing postoperative infectious morbidity in elective caesarean section. Key words: Antibiotic prophylaxis, Caesarean sectionPublication Darier White disease(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2010) Amatya, A; Karn, D; Aryal, E; Makaju, R; Shakya, A; Priyadarshinee, AAbstract Darier’s disease was described inependently by Darier and White in 1989 AD. Reported prevalence varies from 1/100,000 in Denmark to 1 in 30- 35,000 in northern England and Scotland.1 Darier’s disease has been reported from other parts of the world, however,there has been no reported cases in Nepal. It is an inherited autosomal dominat disease characterized by dark crusty lesions over the seborrheic areas of the skin. We are reporting a case of Darier’s disease in a Nepalese patient who developed skin leison’s over his face and body at the age of 12 years. We took skin punch biopsy from the leisons, which showed findings suggestive of Darier’s disease. Our case was treated with isotrerenoin and topical keratolytics. He responded with the given treatment within two weeks of therapy.