Browsing by Author "Sharma, J"

Now showing 1 - 5 of 5
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    Comparison of single versus multiple doses of antibiotic prophylaxis in reducing post-elective Caesarean section infectious morbidity
    (Kathmandu University, 2010) Shakya, A; Sharma, J
    Abstract 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 section
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    Effects of subvalvular apparatus preservation in mitral valve replacement among rheumatic patients: early and mid term follow up
    (Institute of Medicine, 2016) Timala, RB; Joshi, D; Aryal, M; Bhandari, K; Singh, Y; Sharma, J; Sharma, J
    Abstract Introduction: Annulo-papillary continuity exerts significant impact on postoperative left ventricular function after mitral valve replacement. Methods: This is a retrospective study of patients who had undergone mitral valve replacement at one of the three units of Shahid Gangalal National Heart Center. Patients were divided into three groups, group I: total resection of subvalvular apparatus, group II: posterior mitral leaflet preservation, group III: total preservation of subvalvular apparatus. Statistical analysis was done to see the differences between three groups in regards to left ventricular dimensions in diastole, systole and ejection fraction. Results: Total of 93 patients underwent mitral valve replacement from April 14, 2011 to April 13,2012. Among group I patients, left ventricular diastolic (LVIDd) dimension decreased significantly at 3 months follow-up: group II patients left ventricular systolic dimension (LVIDs) decreased significantly at 3 months, group III patients, both LVIDd and LVIDs decreased significantly at 3 months. At the end of 3 years, the graph showed patient with group I had increasing tendency for LVIDd, whereas patients with group III had decreasing tendency for LVIDd. Similarly patients in group I showed increasing trend for LVIDs, whereas it got stabilized after 2nd year among patients in group III. The ejection fraction was most improved among the patients with group III compared to group I or II. Conclusion: Total subvalvular apparatus preservation during mitral valve replacement did have positive impact on left ventricular dimensions as well as function in early and midterm follow-up Keywords: mitral valve replacement, subvalvular apparatus preservation, left ventricular diastolic dimension,, left ventricular systolic dimension, ejection fraction
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    Scrotal haematoma: The most common complication of no-scalpel vasectomy
    (Kathmandu University, 2007) Pant, PR; Sharma, J; Subba, S
    Objective: to study the complications of no scalpel vasectomy such as scrotal haematoma, infection, scrotal sinus, and failure, recanalization, and sperm granuloma. Materials and methods: A retrospective, descriptive study carried out in Dept. of Obs/ Gyn, Tribhuvan University Teaching Hospital Kathmandu Nepal. Result: Among 926 no scalpel vasectomy clients 5(0.53%) had scrotal haematoma, 4(0.43%) with had infection, 3(0.32%) had scrotal sinus; there were 2 cases each vasectomy failure who could not achieve azospermia and 2 with recanalization while there was only one case of sperm granuloma. Conclusion: the most common complication of no-scalpel vasectomy was scrotal haematoma and other complications are wound infection, scrotal sinus, vasectomy failure and sperm granuloma. Key words: no scalpel vasectomy, scrotal haematoma, scrotal sinus, sperm granuloma.
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    Spontaneous Dissection of Right Coronary Artery and It’s Surgical Management
    (Institute of Medicine, 2017) Timala, RB; Sharma, J; Rajbhandari, R; Limbu, Y
    Abstract Primary spontaneous coronary artery dissection (SCAD) as a cause of acute myocardial infarction is rare entity with complex pathophysiology. SCAD must be considered every time that a healthy young patient presents with an onset of acute myocardial ischemic syndrome or sudden death. Mostly it appears in young women without traditional risk factors for coronary artery disease and a significant proportion of them are diagnosed during the peripartum or early postpartum period. SCAD is frequently fatal and a great number of known cases have been diagnosed at autopsy. The quick recognition of SCAD as a cause of acute myocardial ischemia in a young patient is important to establish the best medical/surgical treatment between the different therapeutic attitudes.
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    Tricuspid Valve Repair: Devega’s Tricuspid Annuloplasty in Moderate Secondary Tricuspid Regurgitation
    (Kathmandu University, 2011) Pradhan, S; Gautam, NC; Singh, YM; Shakya, S; Timala, RB; Sharma, J; Koirala, B
    ABSTRACT Background Moderate secondary tricuspid incompetence has variable natural history if left unattended during mitral valve surgery. Recent data suggest progression of the secondary tricuspid incompetence over time. Secondary moderate tricuspid regurgitation in rheumatic mitral valve disease may regress after mitral valve surgery without direct intervention. Objectives: The present retrospective comparative hospital based tudy was done to assess early result of DeVega tricuspid valve annuloplasty amongst those with moderate tricuspid regurgitation due to rheumatic mitral valve disease. Methods: Group I (mitral valve replacement with tricuspid repair) and Group II (mitral valve replacement only) were compared regarding functional class, heart rate, rhythm, cardiac dimensions, function and valve pathology. The two groups were followed up at three months post-operatively and evaluated for their functional class and echocardiography variables. The data was analyzed with SPSS 16.0 Results: There were 43 patients who underwent mitral valve replacement with moderate tricuspid regurgitation. Twenty three underwent mitral valve replacement with tricuspid repair group (Group 1). Most of the patients were women (28/43). The mean age was 31.4 + 14.8 and 25.13 + 9.4 years. Group I had 21(91.3%) and Group II had 17 (85%) in NYHA class III & IV. The pre-operative echocardiographic cardiac left ventricular and left atrial dimensions, left ventricular function and valve lesions were statistically similar for both groups, except PASP was higher amongst tricuspid repair (Group 1: 38.60 + 12.75mHg, Group 2: 61.52 + 19.76mmHg; p= <0.05). At three month’s review after surgery, four patients were in NYHA II amongst those without tricuspid repair (Group II), whilst the rest were in NYHA I. Left ventricular dimensions, Left Ventricular function and valve prosthetic valve function were similar between groups. Eleven (47.8%) patients in Group I and only five (25%) of Group II had trace or less TR at the follow-up (p < 0.05). There were 7 (16.2%) patients who had persistent moderate TR. Higher PASP and larger LV dimensions at three months were predictive of persistent moderate TR. Conclusion Mitral valve replacement does decrease the severity of tricuspid regurgitation amongst those with secondary moderate tricuspid regurgitation by at least one grade, but DeVega’s annuloplasty confers a better repair result. Key Words tricuspid valve, tricuspid annuloplasty; DeVega’s annuloplasty; secondary tricuspid regurgitation

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