Browsing by Author "Sharma, J"
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Publication A retained dead fetus for eight years in a didelphys uterus(Institute of Medicine, 2007) Pant, PR; Sharma, J; Giri, K; Pradhan, N; Thapa, TPAbstract Case report: A case report of 32 years female with 3 childrens and a retained dead fetus for eight years in a didelphys uterus is discussed as a case report. Keywords: Didelphys uterus, dead fetus, coagulopathyPublication Abortions induced by inserting wooden stick(Institute of Medicine, 2007) Pant, PR; Sharma, J; Mananandher, BI; Sharma, NR; Shrestha, RAbstract Background: Nepal suffers from one of the highest maternal mortality rate in the world, and the practice of unsafe abortion is responsible for more than 50% of these maternal deaths. Before legalization of abortion in2002 though it was criminal act under any circumstances thousands of abortions were done illegally in the country by expert doctors to peon by different methods. Complications of abortions depend upon gestational age, service provider, method, place of abortion. According to a nationwide survey done by CREHPA in 1997 revealed that 20% of the women prisoners against 0.3 men prisoners were there for charge of abortion or infanticide. According to Measham maternal mortality is highest in cases when the abortion is done by foreign objects in to the uterine cavity. Keywords: Induced abortion, complications, unsafe abortionPublication Bacterial vaginosis in Tribhuvan University Teaching Hospital(Institute of Medicine, 2005) Manandhar, R; Sharma, J; Pokharel, BM; Shrestha, B; Pradhan, NAbstract Five hundred women of reproductive age group were screened for bacterial vaginosis (BV) using Amsel’s criteria from January 2004 to July 2004 at gynaecological out patient department of Tribhuvan University Teaching Hospital (TUTH). Bacterial vaginosis was found in 2.5%. Among all BV positive patients, 67.3% were symptomatic and 32.7% were asymptomatic. Brahmans were significantly least infected caste. Highly educated women were also significantly least infected group. Sexual exposure has significant association with BV. Smokers and people using alcohol suffered much from bacterial vaginosis but were not statistically significant.Publication Bacteriological Profile of Heart Valves Resected from Infective Endocarditis Patients(Nepal Health Research Council, 2009-10) Koirala, B; Manandhar, S; Basnyat, S; Sharma, J; Pokhrel, B MPublication Carcinoma of vulva occurs not only during old age: A Series of six cases(Institute of Medicine, 2013) Pant, P R; Sharma, J; Manandhar, B L; Joshi, AAbstract Squamous cell carcinoma of the vulva is predominantly a disease of postmenopausal women; it accounts for 5% of all female genital malignant neoplasms. Postoperative recovery in two among the five operated patient was late as their vulval wound underwent dehiscence. Other three patients had an uneventful post operative period. Histopathology report showed Squamous cell carcinoma in all the cases. Lymphnodes was negative for malignant cells in all the cases.Publication 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 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, JAbstract 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 fractionPublication Granulosa cell tumors(Institute of Medicine, 2008) Pant, PR; Manandhar, BL; Shrestha, S; Amatya, S; Gyawali, G; Sharma, JNA.Publication Scrotal haematoma: The most common complication of no-scalpel vasectomy(Kathmandu University, 2007) Pant, PR; Sharma, J; Subba, SObjective: 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.Publication Spontaneous Dissection of Right Coronary Artery and It’s Surgical Management(Institute of Medicine, 2017) Timala, RB; Sharma, J; Rajbhandari, R; Limbu, YAbstract 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.Publication Spontaneous preterm delivery and risk factors at Tribhuvan University Teaching Hospital(Institute of Medicine, 2006) Manandhar, BL; Sharma, J; Gurung, CKAbstract Background: Preterm delivery is one of the major health problems in both, developing and developed countries because it is associated with increased perinatal morbidity and mortality. Methods: This was an unmatched hospital based case control study. The cases were the postpartum women, who delivered after 22 weeks and before 37 completed weeks of gestation and the controls were those postpartum women, who delivered after 37 completed weeks of gestation. The estimated sample size for preterm delivery (case) were 64 and for term delivery (control) were 128, with case to control ratio being 1:2. Results: There total number of deliveries during the study period was 1192. Of the total deliveries, 64 spontaneous preterm deliveries and 128 term deliveries were enrolled for the study, giving the prevalence of spontaneous preterm delivery = 5.5%. The previous preterm delivery, urinary tract infections in the index pregnancy and heavy physical activity during pregnancy showed strong independent risk for preterm delivery. The adjusted odds ratio for previous preterm delivery was 13.13, 95% CI 2.48-69.8 and P-value = .003. Similarly, adjusted odds ratio for urinary tract infection was 7.6, 95% CI 1.2-47.3 and p = .028. The farmers carried highest adjusted odds ratio of 14.8, 95% CI 2.8 – 78.2 and p = .001 and the adjusted odd ratio for small- scale business- women was 8.0, 95% CI 2.18 – 29.4 and p = .002. Conclusion: The study concluded that previous preterm delivery, urinary tract infection and heavy physical activity during pregnancy were independent risk factors for preterm delivery. Keywords: Preterm delivery, urinary tract infection, physical activity, pregnancyPublication 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, BABSTRACT 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 regurgitationPublication Vaginal and rectal misoprostol for first trimester termination of pregnancy(Institute of Medicine, 2006) Pant, PR; Sharma, J; Shrestha, RAbstract Background: To compare the effectiveness of vaginal misoprostol with rectal misoprostol for termination of first trimester pregnancy. Prospective comparative study done on 138 women with unwanted pregnancy. Methods: This study was conducted in Vinayak hospital Kathmandu, from April 2005 to March 2006(Baisakh 2062- Chaitra 2062) i.e. one year. Atotal of 138 women with unwanted pregnancy of 6- 12 weeks, and only those who agreed to participate were included in the study after written consent. Patients with scarred uterus following previous cesarean section, myomectomy or hysterotomy, known allergic to misoprostol, diarrhea, and fever, age below 16 and above 45 were excluded from the study. Abortion was induced with 8ooµgm of mesoprostol in alternative patients vaginally in posterior fornix (group A) and per rectally (group B) Result: The age of the patients ranged from 16 -42 years and parity primi to sixth gravida. In group A54 patients out of 69( 78.2%) expelled products of conception after first dose of misoprostol within 24hours.15(21.7%) patients required repeat insertion of the drug .of these 8 expelled within the next 24 hours, whereas 7(10.1%) patients needed manual vacuum aspiration . In group B out of the 69 patients 59(85.5%) expelled product of conception within 24 hours of insertion of mesoprostol per rectally while the rest 10(14.4%) required re insertion of the drug. Out of these 10 cases 6 expelled within next 24 hours and four (5.8%) needed manual vacuum aspiration. Side effects of misoprostol: diarrhea, nausea, vomiting, headache and rigor were found to be more in rectal group than the vaginal. Conclusion: For termination of first trimester pregnancy, rectal route of mesoprostol is more effective than the vaginal route , how ever the side effects like diarrhea pyrexia, headache were more in rectal group. Keywords: misoprostol, termination of pregnancy, unwanted pregnancy