NepMed Repository :: Browsing by Author "Sharma, Mohan R"

Browsing by Author "Sharma, Mohan R"

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Characteristics of Articles Published in the Journal of Institute of Medicine Nepal: A Cross-sectional Study
(Institute of Medicine, 2022) Shrestha, Lava; Singh, Yogendra P; Sharma, Mohan R
ABSTRACT Introduction: Scholarly journals publish various types of manuscripts. The objective of this study was to analyze the types of articles published in the Journal of Institute of Nepal (JIOM Nepal) from 2019 April to 2021 April and describe bibliometric characteristics. Methods: Seven issues of JIOM Nepal published from April 2019 to April 2021 were analyzed for types of study, areas of medical science, the number of authors, gender of the primary author, contributing specialty, and author’s affiliation. Results: Total articles published were 139, with a mean number of 19.8±4.4 articles per issue. More than half of the published articles were cross-sectional studies (93, 66.9%), followed by case reports (25, 17.9%). The majority of primary authors (94, 67.6%) were faculty from constituent campuses of the Institute of Medicine (IOM) Tribhuvan University. Thirty-eight (27.3%) contributing authors were females. Fifty-three (38.1%) articles published were diagnosis-related. Authors from surgical specialties were the most common article contributors [67 (48.2 %)], while basic science specialties contributed 13 (9.4%) publications. Conclusion: Cross-sectional studies were the most commonly published articles and surgical specialties published more than half of the articles. The majority of the articles were related to diagnosis. Greater efforts are needed to produce further progress of the journal. A mixture of original articles, reviews, and case reports from different medical domains will be more interesting to the readers. Keywords: Article, authors, characteristics, journal
Demography and Outcome of Pediatric Traumatic Brain Injury; Experience from a University Teaching Hospital in Nepal
(Institute of Medicine, 2022) Dahal, Sandesh; Shrestha, Dipendra K; Pradhanang, Amit B; Sedain, Gopal; Shilpakar, Sushil K; Sharma, Mohan R
ABSTRACT Introduction: Traumatic brain injury (TBI) is one of the significant causes of disability and death. It is a common cause of emergency neurosurgical consultation. Due to differences in physiology and management strategy, outcomes of pediatric TBI are different. This study purposes to describe the demography, clinical-radiological characteristics, and outcome of patients with pediatric TBI. Methods: A retrospective study of 112 children of age up to 18 years admitted to the Neurosurgical Department in Tribhuvan University Teaching Hospital following TBI from August 2021 to July 2022 was conducted. Variables analyzed were the demographics, clinical characteristics, imaging findings, management strategies, and outcome. Results: Median age was 5.5 years. The male-to-female ratio was 2.3:1. Falls followed by road accidents (RTA) were the most common mode of injury. A significant number of patients (62, 55.3%) presented after 24 hours of injury. Vomiting (67, 59.8%) was the commonest symptom followed by loss of consciousness (60, 53.6%). Post-traumatic seizure was observed in 13 (11.6%) of the children; however, had no association with the outcome. Mild, moderate, and severe TBI were seen in 80.3%, 17.8%, and 1.7% respectively. Extra-axial hematomas (40%) were the most common findings followed by skull fractures (33.9%). Intensive care was required in 13 (11.6%) and 34 (30%) required surgery. Craniotomy (30.3%) was the most common procedure. Good outcome at discharge was seen in 107 (95.5%) of patients. Conclusion: Falls and RTAs were the commonest causes of pediatric TBI. In our study, a significant number of the patients presented after 24 hours of injury. Craniotomy was the most common managment and most of the children had good outcomes at discharge. Keywords: Computed tomography, extra-axial hematoma, Glasgow outcome scale, pediatric, post-traumatic seizure, traumatic brain injury
Etiology and Demographic Profile of Medico-legal Cases in Emergency of a University Hospital in Nepal
(Institute of Medicine, 2022) Khatri, Pratima; Munikar, Anita; Pandit, Pooja; Rai, Lalita; Maharjan, Ramesh K; Sharma, Mohan R
ABSTRACT Introduction: Any injury or ailment where investigations by the law-enforcing agencies are crucial are considered as medico-legal cases. The objective of this study was to describe the profile of medico-legal cases presenting to the Emergency Room (ER) of Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. Methods: A retrospective review of medical records was done to include all medico-legal cases presented from July 2018 to June 2019. Results: Medico-legal cases comprised 1805 (3.8%) of all cases (47,289) in the study period. The category of 25- 39 years was the commonest age group involved [659 (36.5%)] followed by 15-24 years group [582 (32.2%)]. Males were almost twice (65.8%) in number compared to females (34.2%). The top three reasons for the ER visit were road traffic accidents (RTAs) [757(41.94%)], physical assaults [356 (19.72%)] and poisoning [239 (13.24%)]. Other causes were burns, falls, sexual assaults, hanging, injuries (gunshot, electrical and machinery) and drug overdose. Conclusion: There are significant numbers and wide varieties of medico-legal cases that present in the ER of TUTH. Young males are the most high-risk population and RTAs are the commonest etiology. This study will help the hospital in capacity strengthening of the ER, based on the volume of individual case types. Keywords: Emergency room, medico-legal cases, road traffic accidents, university hospital
Intraoperative Neuromonitoring in Predicting Neurological Deficits in Patients with Intramedullary Lesions in a Tertiary Care Center in Nepal
(Institute of Medicine, 2022) Bhandari, Binod Raj; Kafle, Prakash; Pradhanang, Amit B; Sedain, Gopal; Shilpakar, Sushil K; Sharma, Mohan R
ABSTRACT Introduction: Intramedullary spinal cord lesions (IMSCL) constitute 20%–30% of all spinal cord lesions. There is still uncertainty regarding the usefulness of intraoperative neuromonitoring (IONM) during spinal surgery. The purpose of this study is to determine the effectiveness of IONM in patients undergoing intramedullary spinal surgery. Methods: Twenty-three patients who underwent surgery at the Department of Neurosurgery, Tribhuvan University Teaching Hospital from January 2017 to December 2020 were included. Somatosensory evoked potential, transcranial motor evoked potentials and electromyography were recorded. Patients were divided into three groups based on IONM parameters: 1. one with no drop 2. one with a decrease and a recovery during surgery, and 3. one with a decrease but no recovery. The duration of follow-up was six months. Results: Neurological improvement was noted in 14 patients, stable in 4, and worse in 5. Out of 14 patients with clinical improvement, 9 had no decrease in IONM, while 5 had a temporary decrease. Among 4 patients whose postoperative status remained unchanged, 2 had no decrease in IONM, while one had a temporary decrease and one has a sustained decrease. Among 5 patients who deteriorated postoperatively, 1 had no decrease in IONM, and 4 had a decrease without recovery. During surgery, patients who demonstrated monitoring alterations but reverted to baseline had better neurological outcomes than those who did not (p=0.045). Conclusion: Our findings support that IONM is an effective tool for the safe resection of IMSCL. Further multi-centric larger studies are recommended to gain more insight into IONM. Keywords: Electromyography, intramedullary spinal cord lesions, intraoperative neuromonitoring, somatosensory evoked potential, transcranial motor evoked potential
Lived Experience of Breast Cancer Survivors: A Phenomenological Study
(Institute of Medicine, 2023) Lawot, Isabel; Gharti, Kamala; Singh, Shreejana; Sharma, Mohan R
ABSTRACT Introduction: Breast cancer (BrCa) is the most common cancer in women worldwide. The population who survive breast cancer is increasing; even so, they usually have to go through many problems in their life. Except for the diseased part, numerous socio-cultural factors may pose challenges for the survivors. Hence, the aim of this study was to explore the experiences of cancer survivors. Methods: A phenomenological qualitative design reseach was performed with eight BrCa survivors in Kaski district of Nepal. Data were collected through semi-structured in-depth interviews and analyzed using Colaizzi’s descriptive phenomenological method. Results: Two major themes were extracted from the in-depth interviews. One was the reaction to the diagnosis and another was fear of disease. Most participants lacked awareness of their cancer diagnosis, and nearly all of them experienced fear that persisted until death. They faced a multitude of physical issues throughout the treatment phase and subsequent years, including headaches, loss of appetite, anemia, gastritis, body pain, and swollen extremities. Additionally, they grappled with psychological challenges such as anxiety and depression, rendering them more susceptible. Financially, due to the exorbitant costs of treatment, they had to resort to borrowing money from others, with the burden primarily falling upon their families Conclusion: Most of the participants had fear regarding illness, treatments, recurrence, and death. Patients were worried about the cost of care. Therefore, it is imperative for family members and healthcare professionals to recognize the experiences of breast cancer survivors in order to optimize patient health during critical stages. Keywords: Breast cancer; fear; phenomenology
Multiple Nocardial Brain Abscesses in a Renal Transplant Recipient: A Case Report
(Institute of Medicine, 2021) Nepali, Rabin; Shah, Dibya S; Sharma, Mohan R
ABSTRACTNocardia is a rare but life-threatening opportunistic infection, especially in immunocompromised patients, including renal transplant recipients. It can cause intracranial abscess which has a mortality of more than 30%. So, when a renal transplant recipient presents with central nervous system involvement, nocardial brain abscess must be considered in the differential diagnosis. Here, we report a such case with multiple nocardial brain abscesses. This case highlights the importance of early diagnosis and treatment to get a good clinical outcome. Keywords: Brain abscess, nocardia, renal transplant
Outcome Analysis of Lipomeningomyelocele Repair in Children in a Tertiary Care Center in Nepal
(Institute of Medicine, 2019) Koirala, Puspa R; Pradhanang, Amit B; Sedain, Gopal; Sharma, Mohan R
ABSTRACT Introduction Lipomeningomyelocele (LMM) is a common neural tube defect especially prevalent in low income countries. When they get appropriate care, long term result is generally good provided the patient receives good neurosurgical, paediatric and rehabilitation care. Surgery is the mainstay of treatment. Our aim was to analyze immediate and long-term results of lipomeningomyelocele repair in symptomatic patients presenting to TU Teaching Hospital, Kathmandu, Nepal. Methods Thirteen patients admitted to Department of Neurosurgery from January 2017 to December 2018 were evaluated. All patients underwent MRI of whole spine before surgery. Surgical procedures involved total excision of lipoma and repair in 10 patients and subtotal excision and repair in 3 patients. Division of filum terminale could be done in 8 patients. Follow up varied from 6 months to 2 years. Results This study included 8(61.5 %) patients of lumbosacral LMM, 3(23%) patients of sacral LMM and 2( 15.38%) patients of thoracolumbar LMM . About 2 (15.38%) were operated before 3 months of age, 2 (15.38%) were operated between 3-6 months of age, 5 (38.46%) were operated between 6-12 months of age and 4 (30.7%) were operated after 1 year. All children except one presented with lump on back since birth and four presented with urinary incontinence, one presented with bilateral club foot. Four (30.7%) patients had weakness of one or both lower limbs. Two (15.38%) patients had improvement in urinary incontinence, two unchanged and one had developed urinary incontinence postoperatively. Four children with had weakness of lower limbs; one patient improved whereas three patients did not improve postoperatively. There was no development of postoperative hydrocephalus after LMM repair. Three (23%) patients developed wound infection who responded well with regular dressings and antibiotics. Conclusion Lipomeningomyelocele repair can be done with satisfactory outcome with total excision of lipoma and division of filum terminale. Patients with residual lipoma and undivided filum terminale should be observed closely for the development of progressive neurological deterioration. Keywords: Lipoma, lipomeningomyelocele, neurosurgery, outcome
Pediatric Ventriculoperitoneal Shunt: Outcome Analysis in a Tertiary Care Center in Nepal
(Institute of Medicine, 2020) Phuyal, Suman; Rajbhandari, Binod; Pradhanang, Amit B; Sedain, Gopal; Shilpakar, Sushil K; Sharma, Mohan R
ABSTRACT Introduction: Ventriculoperitoneal (VP) shunt is a commonly performed neurosurgical procedure in pediatric surgical practice. It results in a dramatic improvement in patient survival and neurological function but is associated with several complications requiring multiple shunt revisions throughout a patient’s lifetime. The main aim of the study was to evaluate the outcome especially complications of shunt surgery at our center. Methods: A single-institutional, retrospective observational study was conducted in 60 operated cases of congenital hydrocephalus with a minimum follow-up for up to 6 months. Parameters for analysis included demographic data, etiology of hydrocephalus, surgery time, and type of complications. Results: Out of 86 patients, 60 patients who fulfilled the inclusion criteria were enrolled in the study. The mean age of the patients at the time of VP shunt placement was 3 months, range from 8 days to 15 years with male preponderance. The majority of the patients belonged to the 0-1-year age group (76.8%). The commonest etiology of hydrocephalus was congenital aqueduct stenosis. Fifteen patients (25%) developed complications within six months follow-up period. Eight patients (13.3%) developed clinical shunt infection with four cases having culture positive. Four (6.67%) had mechanical complications in the form of shunt obstruction. Three patients had ascites, subdural collection, and shunt extrusion from the anus. The shunt related mortality was 1.67%. Conclusion: The shunt infection and obstruction still remain the most important complications. Despite inherent problems, shunt surgery is the procedure of choice until a safer effective alternative is available. Keywords: Complications congenital hydrocephalus, ventriculoperitoneal shunt
Pediatric Intensive Care Unit in a Developing Nation: Exploring Acute Neurological Illnesses and Their Clinical Course
(Institute of Medicine, 2023) Khanal, Babita; Singh, Sandeep K; Mishra, Rajnish; Kafle, Prakash; Sharma, Mohan R
ABSTRACT Introduction: The burden of neurological illnesses is high in pediatric age group. Both primary neurological illnesses and neurological complication of systemic illness are commonly seen in pediatric intensive care unit (PICU). Neurological illness prolongs the length of PICU stay and also increases the mortality and morbidity.To assess the burden and describe the spectrum of acute neurological illness in a pediatric intensive care unit and analyze the early outcome. Methods: This was a prospective observational study conducted in Department of Pediatrics intensive care unit from January 2022 to December 2022. All children from 1 months to 16 years of age with neurological illness being admitted to PICU were included in the study. Basic demographic characters, diagnosis, treatment modalities and outcome were analyzed. Results: During study period, 237 (24.89%) were admitted to PICU with neurological illness. Mean age was 66 ± 42 months and 138 (58.22%) were male. Out of 237 children, 196 (82.70%) had primary neurological illness and 41 (17.30%) neurosurgical diagnosis. In primary neurological illness, 102 (52.10%) had primary CNS infection, followed by status epilepticus (21.52%), septic encephalopathy (11.70%), neuromuscular illness (8.16%), and metabolic encephalopathy (4.08%). In neurosurgical cases, 32 (78.04%) had Traumatic Brain Injury and 9 (22%) were shifted to PICU postoperatively. Mechanical ventilation was required in 156 (65.82%) and 88 (37.13%) required inotropic support. The mortality rate in neurological cases was 24 (10.12%) as compared to overall mortality rate of 6.8% in PICU. Conclusion: Neurological disorders are common in PICU and are associated with higher mortality rate. Primary central nervous system infection, severe traumatic brain injury and status epilepticus were common cause of PICU admission in our cohort. Keywords: Mortality; neurological illness; outcome; pediatric intensive care unit
Perioperative Outcomes following Surgery of Brain Tumors: Assessment and Analysis of Risk Factors
(Institute of Medicine, 2023) Kafle, Prakash; Rufus, Phelix; Paudyal, Nabin; Joshi, Narendra P; Khanal, Babita; Jonathan, Edmond; Bhandari, Binod R; Sharma, Mohan R
ABSTRACT Introduction: Cranial neurosurgery carries significant morbidity and mortality. Hence it is imperative to combine the latest available technological equipment with surgeon’s experience to prevent or reduce perioperative complications. It is also equally important to have a preoperative general assessment of the patient with functional status in particular to predict postoperative outcomes. Methods: This is a prospective study consisting of 122 patients selected over a period of 5 years (March 2017-March 2022). The patient database was retrieved from the medical record department, Nobel Institute of Neurosciences, Nobel Medical College Teaching Hospital, Biratnagar, Nepal and the approval of Institutional review committee was obtained. Age, gender, tumor related factors (site, extent and size), preoperative Glasgow Coma Scale (GCS) score, Karnofsky Performance Status (KPS) score and Modified Rankin scale (mRS) grade and their correlation with patient’s perioperative outcome were assessed. Results: Significant correlation was found between preoperative KPS score, mRS grade and patient’s perioperative outcome (low KPS score <70 and high mRS grade was associated with adverse outcomes). There was no positive correlation between age, gender and tumor related factors with outcomes. Conclusion: Low KPS score <70 and a high Modified Rankin scale score were associated with adverse perioperative outcomes in patient’s undergoing elective craniotomy for brain tumor surgery. Keywords: Brain tumor; preoperative KPS (Karnofsky performance status score); preoperative mRS (Modified Rankin scale score)
Profile and Outcome of Adult Spine Pathologies Managed in a Neurosurgical Tertiary Care Center in Nepal
(Institute of Medicine, 2020) Sah, Hemant K; Shrestha, Dipendra K; Rajbhandari, Binod; Sedain, Gopal; Pradhanang, Amit B; Shilpakar, Sushil K; Sharma, Mohan R
ABSTRACT Introduction: Spine pathology involves a wide spectrum of diseases and needs a multidisciplinary approach including surgery, rehabilitation and psychological support. It increases the burden to the family and society. This study describes diseases related to spine and spinal cord from a neurosurgical department of a tertiary hospital in Nepal. Methods: This is a retrospective study of all spinal cases admitted between April 2019 to February 2019, in the Department of Neurosurgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. All adult patients of ≥16 years, diagnosed with various spinal diseases were included. Based on the spectrum of causative pathologies, the study population was broadly categorized into trauma, degenerative, tumor, vascular and infection. Demographics, other variables, and outcome at 1 month were assessed. Results: A total of 71 patients were included in this study. Male preponderance was observed in all categories. Twenty three patients (32.4%) had traumatic spine injury and fall from height was the most common mode of injury, accounting for two-third of the total spinal trauma patients. Cervical segment was involved in two-third patients. More than one-third of the spinal patients (36.6%) had a degenerative disorder involving lumbar (57.7%) and cervical regions (42.3%). Spinal infection was diagnosed in 11.2% of the patients with 62.5% diagnosed as Pott’s spine. Overall complications were seen in 20%. Pain improved in all patients while overall good outcome was noted in 63.2% of the patients. Conclusion: Our study demonstrated a large patient burden and a clinical profile dominated by preventable causes such as RTA and fall injury. With early treatment and rehabilitation, significant improvement can be achieved. Further large scale multicenter studies are required to generalize the findings of this study to the whole population of Nepal. Keywords: Burden, Nepal, spine trauma, spine pathology
Research and Publication from Developing Countries
(Institute of Medicine, 2020) Sharma, Mohan R
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Browsing by Author "Sharma, Mohan R"

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