Browsing by Author "Sharma, A"
Now showing 1 - 10 of 10
Results Per Page
Sort Options
Publication A Comparative Study of Enhanced Recovery after Surgery Versus Non-Enhanced Recovery after Surgery in Emergency Surgery for Duodenal Ulcer Perforation(Kathmandu University, 2021) Thapa, P; Sharma, A; Mahato, NABSTRACT Background Enhanced recovery after surgery is a multimodal strategy, used to attenuate the loss and improve the restoration of functional capacity after surgery. Now widely used in elective surgery, the implementation of all of its components is not feasible in emergency surgery. Therefore, its tailored protocol is likely to give better outcome. Objective To investigate the feasibility and effectiveness of enhanced recovery after surgery in emergency surgery for Duodenal Ulcer Perforation. Method Hospital based study conducted at Nepalgunj Medical College, Kohalpur from September 2018 to 2020. Hundred patients underwent emergency laparotomy with Classical Graham’s Patch Repair. Fifty patients in the enhanced recovery after surgery group were managed as per the protocol and the rest were managed conventionally. Both the groups were compared in terms of length of hospital stay, functional recovery parameters and complications. Result There were 48 (96%) males and 2 (4%) females in enhanced recovery after surgery group and 45 (90%) males and 5 (10%) females in non-enhanced recovery after surgery group. The mean length of hospital stay in enhanced recovery after surgery group was 4.9 ± 0.76 days together with early functional recovery compared to 9.06 ± 2.44 days in non-enhanced recovery after surgery group (p < 0.05). Complications as per Clavien-Dindo grading were more in the non- enhanced recovery after surgery group (p=0.03). Conclusion Enhanced recovery after surgery is feasible and effective strategy resulting in early recovery, reduced hospital stay and complications in patients undergoing emergency surgery for duodenal ulcer perforation. KEY WORDS Duodenal ulcer, Enhanced recovery after surgery, Length of hospital stayPublication An Experience of Pediatric Upper and Lower Gastrointestinal Endoscopy in a Tertiary Center(Kathmandu University, 2017) Upadhyay, S; Sharma, AABSTRACT Background Although upper gastrointestinal endoscopy and colonoscopy is considered to be a gold standard in the diagnosis of many pediatric gastrointestinal disorders, there is limited data about its utility from our country. This important diagnostic tool is underutilized. Objective The objective of this study is to report the common indications, endoscopic findings and complications of pediatric upper gastrointestinal endoscopy and colonoscopy in a tertiary center to increase awareness amongst pediatricians. Methods This descriptive cross-sectional study was conducted in children undergoing upper gastrointestinal endoscopy and colonoscopy for various indications in a tertiary center from November 2014 to October 2016 (24 months). Results We performed 192 endoscopies during this period. Upper gastrointestinal endoscopy 158 and Colonoscopy 34. Mean age of patients was 10.2 years (range 6 months to 16 years) and 140(72.9%) patients were under 10 years of age. Common indications of UGI endoscopy were recurrent abdominal pain (67%), acute abdominal pain (12.6%), recurrent vomiting (8.0%), upper GI bleed (4.4%), failure to thrive (3.1%) and caustic ingestion (2.5%). An abnormality was detected in 128(81%) patients. Antral gastritis (55%) was the most common diagnosis. Thirty two percent of children with RAP had chronic moderate to severe gastritis and were positive for H. pylori in Giemsa stain on histopathological examination. Common indications of colonoscopy were Lower GI bleed and chronic diarrhea. Out of 22 patients who underwent colonoscopy for lower GI bleed, 18(82%) patients had rectal polyp and underwent snare polypectomy. Out of 12 patients who were evaluated for chronic diarrhea, 7(20%) were diagnosed to have cow’s milk protein allergy and 5(15%) patients had inflammatory bowel disease. An abnormality was detected in 30(88%) patients. All children received sedation/ analgesia and tolerated the procedure well. Conclusion Upper gastrointestinal endoscopy and colonoscopy are safe procedure in children. The awareness about its diagnostic and therapeutic role should be raised amongst pediatricians in developing countries. There is also a need to develop training programs of pediatric gastroenterology and pediatric endoscopic suites in developing countries so that children may benefit from this state of the art diagnostic modality. KEY WORDS Colonoscopy, pediatric, upper gastrointestinal endoscopyPublication Antimicrobial susceptibility pattern and serotyping of Streptococcus pneumoniae isolated from Kanti Children Hospital in Nepal(Kathmandu University, 2010) Rijal, B; Tandukar, S; Adhikari, R; Tuladhar, NR; Sharma, PR; Pokharel, BM; Gami, FC; Shah, A; Sharma, A; Gauchan, P; Sherchand, JB; Burlakoti, T; Upreti, HC; Lalitha, MK; Thomas, K; Steinhoff, MAbstract Background: Invasive pneumococcal disease is a significant cause of morbidity and mortality worldwide and it is a major cause for childhood deaths in Nepal. Objectives: The aim of this study was to establish the antimicrobial susceptibility pattern of Streptococcus pneumoniae and perform serotype responsible for pneumococcal disease in Nepal. Materials and methods: All together 3774 children from 2 to 60 months who fulfilled the enrollment criteria for suspect of bacterial pneumonia, sepsis or meningitis were enrolled for etiologic studies of severe illness. During the study period 60 isolates of Streptococcus pneumoniae were isolated and the antimicrobial susceptibility testing and serotyping were performed. Results: The study showed that 24 (52.17%) isolates were resistant to Cotrimoxazole, 3 (6.5%) isolates were intermediately resistant to Penicillin but no Penicillin resistant strains were isolated. The 1 (2.17%) isolate was recorded as Erythromycin and Chloramphenicol resistant and only 1 (2.17%) isolate was found intermediately resistant to Cefotaxime. Of the 60 isolates, serotyping result was available only for 46 isolates. The most common serotypes were serotype 1 (27. 65%) followed by serotype 5 (19.14%) and serotype 4 (8. 5%) respectively followed by serotype 39, 23F, 7F, 19B, 12A, 14, 18F, 6B, 32, 16, 19F and 25F. Conclusions: Alarming level of Cotrimoxazole resistance demands revision of pneumonia treatment policy in Nepal and rising tendency of other drug resistance against Streptococcus pneumoniae showed use of these drugs for the treatment of meningitis, pneumonia and other serious infections needs extended research. The common serotype 1, 5 and 4 need to be incorporated in pneumococcal vaccine to immunise children in Nepal. Key words: Antimicrobial susceptibility, Streptococcus pneumoniae, Serotyping, NepalPublication Benign and malignant breast disease presenting to Bhaktapur Cancer Hospital(Kathmandu University, 2005) Sharma, A; Bandari, R; Gilbert, D; Sharma, AKObjective: In the absence of formal breast screening services in Nepal, patients must self present upon developing symptoms relating to the breast. Clinical examination and diagnostic tests are then used to differentiate benign and malignant conditions. Referral / presentation patterns are not well studied and this paper aims to investigate this. Method: Here we present the clinico-pathological diagnoses of patients presenting to Bhaktapur Cancer Hospital with breast related complaints within a six month period, and report upon their subsequent management. Results: 727 patients presented with breast related complaints, of whom 34 were diagnosed with breast cancer. These tended to present at late stage and their subsequent management is discussed. Conclusion: As the incidence of breast cancer in Nepal is likely to be under-reported and more than likely rising, patient awareness campaigns are underway in order to facilitate the earlier diagnosis of malignant disease and thus beneficially influence treatment outcomes. To this end the need for the development of dedicated breast services is highlighted.Publication Drainage versus no Drainage after Elective Laparoscopic Cholecystectomy(Kathmandu University, 2016) Sharma, A; Gupta, SNABSTRACT Background Laparoscopic cholecystectomy is the gold standard for the surgical treatment of cholelithiasis. Routine drainage after elective LC is an issue of considerable debate. Objective To evaluate the advantages and disadvantages of drainage in patients undergoing Laparoscopic cholecystectomy. Method The study was conducted at the department of surgery in Nepalgunj Medical College and Teaching Hospital, Kohalpur between March 2013 and May 2014. During the period of study, sixty patients underwent laparoscopic cholecystectomy for symptomatic gall stone. Sixty patients were randomized before surgical procedure into two groups. Group A consisted 30 patients in whom a drain was placed in subhepatic space and group B consisted 30 patients without drain. Postoperative pain was assessed using a 10-point visual analog scale. The two groups were evaluated and compared regarding postoperative pain, the time needed for surgery, length of postoperative hospital stay and the incidence of postoperative complications. Result The mean operative time in group A was 6.16 minutes longer when compared with group B (p>0.05). Although the postoperative mean pain score was same at 6 hours after surgery in both groups (7.53 vs 7.23), the postoperative pain was higher in the group A by more than two points on the average in VAS (visual analogue score) at 24 hours and 48 hours. The proportion of the patients staying in the hospital for more than two days was higher in group A, 14 (46.66%) and 8 (26.66%) in group B (p < 0.05). There was no statistical difference in the rate of wound infections, shoulder pain, nausea, vomiting, and respiratory infections between the two groups. Conclusion The routine drainage of gallbladder bed after elective laparoscopic cholecystectomy may not be justified and appears to cause more postoperative pain and more postoperative complications and prolongs the hospital stay. KEY WORDS Cholecystectomy, drain, hospital stay, laparoscopy, postoperativePublication Evaluation of Latex Agglutination Test for Rapid Identification of Staphylococcus aureus Isolated from Pyogenic Wound Infections at a Tertiary Care Hospital(Kathmandu University, 2023) Shah, P; Sah, R; Sharma, A; Khanal, B; Bhattarai, NRABSTRACT Background Staphylococcus aureus infections are increasingly reported worldwide. It is a major clinical problem and imposes significant morbidity and mortality due to widespread emergence of multidrug resistant pathogens like methicillin resistant Staphylococcus aureus. Thus, rapid and reliable identification of Staphylococcus aureus is essential for timely and effective management of patient. Objective The performance of Latex agglutination test (Staphaurex Plus) was compared to conventional method tube coagulase test which is gold standard too for the identification of Staphylococcus aureus. Method This study was conducted at B.P. Koirala Institute of Health Sciences. Following standard microbiological methods, isolation and identification was done in the Department of Microbiology. MRSA detection was performed following Clinical and Laboratory Standard Institute. All the isolates of Staphylococci were subjected for Latex agglutination test and was performed according to manufacturer’s instructions using Staphaurex Plus kit. Result Out of 377 (methicillin sensitive Staphylococcus aureus – 142; methicillin resistant Staphylococcus aureus - 233; Coagulase Negative Staphylococci –2) isolates of Staphylococci, Latex agglutination test was found to be positive in 138 (97.1%) of methicillin sensitive Staphylococcus aureus (MSSA) and 220 (94.4%) of methicillin resistant Staphylococcus aureus (MRSA). Overall sensitivity, specificity, positive predictive value and negative predictive value of Latex agglutination test was found to be 95.46%, 100%, 100%, 10.52% respectively. Conclusion In conclusion, Latex agglutination test is a rapid and reliable test for the identification of Staphylococcus aureus. KEY WORDS Latex agglutination test, Staphylococcus aureus, tube coagulase testPublication Intussusception of Small Intestine as a Result of Inflammatory Fibroid Polyp Causing Small Bowel Obstruction in an Adult Patient(Kathmandu University, 2017) Grover, AS; Kumar, M; Yadav, R; Sharma, A; Chowdhary, K; Zaman, M; Chowdhary, A; Bawa, AABSTRACT Intussusception is the telescoping of one segment of bowel into the adjacent segment. It is more commonly seen in children,however rarely encountered in adult patients. Proximal segment of bowel is called intussusceptum which is intussuscepted into the lumen of the adjacent distal segment known as intussuscipiens. There is always a lead point causing this disorder especially in adults. We presented a case of a 45 year old man who presented in emergency department of our institute with history and clinical features of acute intestinal obstruction since 10 days. Patient was resuscitated, investigated and taken for exploratory laparotomy under General anaesthesia. Segment of involved small gut was resected and well circumscribed polypoidal mass was found in intussuscepted bowel. Histopathological examination of the specimen revealed the features of inflammatory fibroid polyp. KEY WORDS Inflammatory fibroid polyp, Intussusception, Small bowel obstructionPublication Methicillin-Resistant Staphylococcus Aureus Nasal Carriers among Laboratory Technical Staff of Tertiary Hospital in Eastern Nepal(Kathmandu University, 2020) Neupane, R; Bhatt, N; Poudyal, A; Sharma, AABSTRACT Background Methicillin-resistant Staphylococcus aureus (MRSA) has been the leading cause of nosocomial and community infections worldwide. In particular, healthcare workers are at constant risk to develop MRSA carriage. There is a paucity of data regarding the epidemiology of MRSA in laboratory workers who are constantly in contact with these pathogens in almost every hospital. Objective This study was undertaken to identify the burden of MRSA nasal carriers and the antibiotic susceptibility pattern of the isolates among laboratory technical staff. Method Sterile nasal swabs were taken from 50 laboratory technical staff working in the Central and Emergency laboratory of BP Koirala Institute of Health Sciences (BPKIHS). Standard procedures were followed for isolation, identification and antibiotic sensitivity testing. Antibiotic susceptibility tests were performed using disc diffusion and growth on Oxacillin screen agar based on Clinical and Laboratory Standards Institute (CLSI) guidelines. Result Out of 50 isolates of Staphylococcus aureus, 44 (88%) were Methicillin-sensitive (MSSA) while six (12%) were Methicillin-resistant (MRSA). All 50 isolates of S. aureus were found resistant to Penicillin while all were found sensitive to Teicoplanin, Linezolid, and Levofloxacin. Only five (10%) were sensitive to Erythromycin while 49 (98%) were sensitive to both Amikacin and Gentamicin. However, none of the MRSA isolates were found sensitive to all tested antimicrobial agents. Conclusion This repertoire portrays the emergence of MRSA in laboratory workers which clearly indicates the necessity of complying with the sanitary and antibacterial guidelines and adhering to the rational use of antibiotics to prevent nosocomial infections. KEY WORDS Antibiotic resistance, Laboratory personnel, MRSA, Staphylococcus aureusPublication Role of C-reactive Protein in Acute Appendicitis(Kathmandu University, 2016) Ghimire, R; Sharma, A; Bohara, SABSTRACT Background Acute appendicitis is the common surgical emergency. This study analyzed the value of C-reactive protein as the diagnostic marker of acute appendicitis. Objective To assess the level of C-reactive protein in acute appendicitis and to relate the quantitative measurement with degree of inflammation of appendix. Method A cross sectional study was done with consecutive patients diagnosed with acute appendicitis that underwent appendectomy over six months period. Peroperative findings and histopathology report were compared and analyzed with the level of C-reactive protein. Result A total of 54 patients were enrolled in this study. 94.40% were proved as acute appendicitis in histopathology. The level of C-reactive protein was significantly raised among highly inflamed appendix. C-reactive protein showed 84.31% sensitivity, 66.66% specificity, 97.72% positive predictive value and 20% negative predictive value in diagnosing acute appendicitis. Conclusion With degree of inflammation of appendix, value of C-reactive protein was raised. Quantitative assessment can predict severity of inflammation. Raised level of C-reactive protein is an aid for diagnosing acute appendicitis. KEY WORDS Acute appendicitis, C-reactive protein, HistopathologyPublication Role of Staging Laparoscopy in Gallbladder Cancer(Kathmandu University, 2020) Sharma, A; Thapa, PABSTRACT Background Preoperative accurate staging of gallbladder cancer is still difficult. A number of patients with gallbladder cancer who undergo laparotomy for curative resection are ultimately found to have unresectable disease. The benifit of staging laparoscopy is its ability to find out the radilogical occult intraperitoneal metastasis and to spare from nontheraputic laparotomy. The role of staging laparoscopy has been extensively studied in hepatobiliary and pancreatic malignancies and found to be useful. But in recent time its utility in biliary cancers is sceptical probably because of the advent of positron emission tomography. However in gallbladder cancer it is still recommended. Objective To identify the utility of staging laparoscopy in gall bladder cancers. Method Hospital based study conducted at Nepalgunj Medical College, Nepal from October 2014 to June 2020. The patients with resectable gallbladder cancers on computed tomography were included. All patients underwent single stage staging laparoscopy. Staging laparoscopy was considered positive if the surface lesions (liver and/or peritoneal deposits) were detected. The surgery was terminated if positive. Patients with negative staging laparoscopy were proceeded with laparotomy. Result Staging laparoscopy was done in 47. The yield of staging laparoscopy was 14 (29.78%) and its accuracy was 58.33% (14/24). Out of 33 (70.21%) with negative staging laparoscopy, 10 (30.3%) had unresectable disease in laparotomy. The yield was higher in locally advanced in comparison to early disease (78.57% Vs 21.42%). Conclusion We recommend routine staging laparoscopy in gallbladder cancer, particularly when the disease is locally advanced. KEY WORDS Accuracy, Gallbladder cancer, Locally advanced disease, Staging laparoscopy, Yield