Browsing by Author "Sharma, M"
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Publication An Unusual Presentation of Fatal Acute Haemorrhagic Pancreatitis in a Young Adult(Kathmandu University, 2024) Naveen, A; Sahu, MR; Padhi, KS; Sharma, M; Sahu, SS; Mohanty, MKABSTRACT Acute haemorrhagic pancreatitis is a medical emergency and the most severe form of Acute Pancreatitis. It is characterized by severe epigastric pain that radiates to the back and is associated with vomiting. If not diagnosed and managed promptly, it may result in sudden, unexpected, unexplained deaths which fall within the medicolegal domain. In such cases, the role of an autopsy is of paramount importance to determine the cause of death. Here we report a young adult, who presented to the local hospital with vague abdominal discomfort and vomiting following alcohol intake and referred to our tertiary care center for further management. But he was received dead on arrival at our hospital. The diagnosis of acute haemorrhagic pancreatitis was made only after the post mortem examination. Awareness of the physicians about the unusual symptoms in acute haemorrhagic pancreatitis and the need for pancreas examination at autopsy of all sudden deaths is emphasised. KEY WORDS Acute pancreatitis, Autopsy, Autolysis, Haemorrhagic pancreatitis, Sudden death, Young adultPublication B-Lynch brace suture simple surgical technique for managing post- partum haemorrhage - Report of three cases(Kathmandu University, 2005) Saha, R; Sharma, M; Karki, C; Pande, SPost-partum haemorrhage is a major contributor to maternal morbidity and mortality. Numerous medical and surgical therapies have been used but none has been uniformly successful. Three cases which were managed successfully with brace suture following failure of medical management for post-partum haemorrhage are being presented. The ease and usefulness of this procedure as a life saving measure, its relative safety and its capacity for preserving the uterus and thus fertility is high lighted. Keywords: post-partum haemorrhage, B – Lynch Brace Suture & maternal mortality.Publication Celiac Plexus Denudation in Triangle Dissection in Pancreatico Duodenectomy: Perioperative Anesthetic Implications(Kathmandu University, 2022) Shrestha, BR; Sharma, M; Barahi Shrestha, S; Thapa, PB; Maharjan, DKABSTRACT This is a case report of inadvertent right celiac plexus denudation during triangle dissection during the surgery for carcinoma of pancreas under combined general epidural anaesthesia. Operative removal of the ganglia has its own autonomic effects, which are important to observe for anesthesiologists and perioperative critical care physicians alike. KEY WORDS Celiac plexus, Epidural, Hemodynamics, Pain, Triangle dissectionPublication Comprehensive abortion care service at Kathmandu Medical College – An experience(Kathmandu University, 2005) Pande, S; Sharma, M; Saha, R; Thapa, M; Shrestha, N; Regmi, DIntroduction: His Majesty’s Government amended the Nepal Criminal Code (Muluki Ain) – for Liberalising abortion law in the month of Chaitra 2058 (March 2002) and Royal Assent was given on 10th Asoj 2059 (27 th September 2002). Accordingly Comprehensive Abortion Care (CAC) Services was initiated in the country. Kathmandu Medical College after enlisting with Ministry of Health started this service from June 2004. Objective: This study was carried out to know- 1. Reasons for undergoing CAC service. 2. The complications after the CAC services. 3. The various contraceptive methods adopted by the client following CAC Methodology: Hospital based prospective study was carried out in Department of Obstetrics & Gynaecology at KMCTH from the period July 2004 to April 2005. Total 160 patients who asked for CAC were enrolled in the study. Counselling, history taking and general examination and per vaginal examination was carried out at the visit. CAC was performed with premedication with Doxycycline 100 mg and Ibuprofen 400 mg half an hour before the procedure. Paracervical block was also given with 1% xylocaine. MVA was performed as described in standard techniques. Patient was discharged after 1 – 2 hours of observation and with contraception opted by the clients. Results: • Main reason for performing CAC was unwanted pregnancy in 66.75%. • Complication following CAC was 1.25%. • Post CAC contraception was adopted by 93%. Most preferred method was Inj. Depoprovera Conclusion: The reason for CAC service asked by the patients was unwanted pregnancy. CAC service performed had minimal complication and also gave the opportunity for contraception. Key words: Comprehensive Abortion Care, Contraception, Safe Abortion.Publication Ectopic canine tooth: A rare cause for maxillary antral mucocoele(Kathmandu University, 2006) Sharma, V; Lavania, A; Mallick, SA; Sharma, MA 40-year-old female presented with a 10 year history of left sided facial pain and occasional purulent nasal discharge, refractory to antibiotics. Dental examination showed 3 missing teeth in left maxilla one of which had no history of extraction. X-ray paranasal sinus showed a bony opacity in the maxillary sinus but nasal endoscopy was normal. C.T. scan revealed a radio-opaque shadow arising from medial wall of left maxillary sinus with a large maxillary mucocoele. Caldwell-Luc procedure was done and an ectopic canine tooth was seen arising from the medial antral wall. Extraction of the tooth with excision of mucocoele resulted in relieving of the symptoms. Keywords: ectopic tooth, maxillary mucocoelePublication Hysterectomy: an analysis of perioperative and post operative complication(Kathmandu University, 2003) Saha, R; Sharma, M; Padhye, S; Karki, U; Pandey, S; Thapa, JObjective : To document peri operative and post operative complication observed after hysterectomy, regardless of route on the operator. Material and methods: A hospital based prospective study was carried out in department of obstetrics and gynaecology, KMCTH Sinamangal for six months. The study was carried out in patients undergoing hysterectomy who were followed from the time of admission to the time of discharge and two weeks thereafter. And followings were noted-Indication; route of hysterectomy, intraoperative and postoperative morbidities during hospital stay and after two weeks of discharge was noted. Result: Total number of hysterectomy carried out was 50. 31(62%) were Total abdominal hysterectomy, and 19(38%) were vaginal hysterectomy. Indication for total abdominal hysterectomy were fibroid uterus 12(24%), DUB 8 (16%), CIN 4(8%), chronic cervicitis 1 (2%). II U-V prolapse with previous LSCS 1 (2%), endometriosis 1(2%). Prophylactic for Ca breast 1(2%), Postmenopausal bleeding 1(2%). All cases of vaginal hysterectomy were performed for 2nd degree U-V prolapse. Intra operative complication during surgery were two cases of haemorrhage (4%) each in both total abdominal hysterectomy and vaginal hysterectomy. There was one case of bladder injury during abdominal hysterectomy. Postoperative complication noted were febrile morbidity 1(2%) in abdominal hysterectomy. Urinary tract infection remains the single most common febrile morbidity. There was one case of secondary haemorrhage in both type of hysterectomy. One was managed conservatively and other required laprotomy. There were three(6%) cases of wound infection in abdominal hysterectomy of two which were sanguineous discharge and one was frank pus which required secondary suture.