Browsing by Author "Sharma, P"
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Publication Alveolar Bone Biology in Extrusion Splint Technique(Kathmandu University, 2012) Sharma, P; Shankar, TPABSTRACT The moment after the tooth avulsion, blood supply to the pulp is interrupted and the periodontal ligament cells are exposed to injury from the external environment. Complete healing is possible if the tooth can be immediately replanted and favorable environment is created .A case of report of intruded and mobile upper left central incisor due to Road Traffic Accident of a twenty-two-year-old patient is presented here. In which, intentional extrusion traumatized tooth and then flexible acrylic wire splinting was done to stabilize it. Previously there was no periapical bone support but with nine months maintenance follow up bone has shown a significant improvement towards healing. KEY WORDS Traumatized tooth, extrusion, intrusion splint, acrylic wire splintPublication An ultrasonographic evaluation of solitary muscular and soft tissue cysticercosis(Kathmandu University, 2010) Sharma, P; Neupane, S; Shrestha, M; Dwivedi, R; Paudel, KAbstract Background: Cysticercosis in humans is infection with the larval form (cysticercus cellulosae) of the pork tapeworm T. solium. Encystment of larvae can occur in almost any tissue. The location of cysts in order of frequency is the central nervous system, subcutaneous tissue and striated muscle, vitreous humour of the eye and, rarely, other tissues. High resolution ultrasound can be used in the diagnosis of muscular and soft tissue cysticercosis. Objective: The aim of this study is to evaluate the ultrasonographic findings in cases of muscular and soft tissue cysticercosis. Materials and methods: It was a retrospective review of the cases of muscular and soft tissue cysticercosis which were diagnosed by ultrasound during June 2007 to May 2009 in the department of Radiology and Imaging, Nepalgunj Medical College Teaching Hospital. A total of six patients were evaluated. Result: There were four males and two females. Age of the patient ranged from 18 to 50 years. All of the patients presented with a swelling with pain in five of them. There was a wide variation in the location of the cysts. In all cases ultrasound revealed a cystic lesion with an echogenic eccentric pedunculated nodule attached to the wall. The mean diameter of the cyst was 6mm. Smooth wall was present in five cases whereas one of the cysts revealed irregular wall. Pericystic inflammatory changes were seen in the adjacent muscles. Conclusion: Ultrasound is a safe and non-invasive method that can be used in the diagnosis of muscular and soft tissue cysticercosis. Key words: Muscular and soft tissue cysticercosis, ultrasound.Publication Delirium in Critically ill Patients in a Tertiary Care Centre in Western Region of Nepal(Kathmandu University, 2014) Thapa, P; Chakraborty, PK; Khattri, JB; Ramesh, K; Sharma, PABSTRACT Background Delirium affects a significant proportion of critically ill patients admitted in hospital. It is associated with various adverse outcomes. Despite its enormous prognostic significance it tends to be underdiagnosed. There is a dearth of studies on risk factors of delirium in our setting. Objectives The main objectives of this study was to find out the prevalence, rate of non recognition and risk factors associated with delirium in hospitalized critically ill patients. Methods A hospital based cross-sectional study was carried out. Data was collected using a predesigned semi-structured proforma and Intensive care delirium screening checklist was used to screen for delirium in patients admitted in various wards of Manipal teaching hospital, Pokhara, Nepal. Results Ninety five cases were included in the analysis. The mean age of study group was 58.9 ± 19.1 years. Delirium was present in 15/95 cases and it was not recognized by treating physician in about one third of cases. Odds ratio (OR) was statistically significantly increased in patients with history of stroke (OR=4.484 95% CI=1.0896;18.459), alcohol use (OR=10.792 95% CI=2.906;40.072), smoking (OR= 4.836 95% CI= 1.411;16.576), use of restraint (OR=17.143 95% CI=4.401;66.766), nasogastric tube placement (OR= 7.731 95% CI=2.348;25.452) and use of Foley’s catheter (OR=12.000 95% CI= 3.072;46.877). Conclusion About 16% of critically ill patients were found to be delirious. In about one third of the cases delirium was not recognized. Both patient related and iatrogenic factors may increase the risk of delirium in hospitalized critically ill patients. KEY WORDS Critical care, delirium, non-recognitionPublication Heart rate variability: Response to graded head up tilt in healthy men(Kathmandu University, 2009) Sharma, P; Paudel, BH; Singh, PN; Limbu, PAbstract Background: Heart rate variability is actually a misnomer for R to R variability in cardiac cycle. Variation in successive cycle length is called the heart rate variability (HRV). Head-up tilt is a model of studying cardiovascular haemodynamics, which reflects in heart rate variability (HRV). Objectives: To study the effect of 10° and 70° head-up tilt on HRV. Materials and methods: The study was done in the Department of Physiology using graded head up tilt (passive orthostatism). HRV measurement was done at 10° and 70° tilt and compared with supine using standardised methods on 30 consenting healthy males (age 25.37±3.89 years). The HRV variables across postures were compared by ANOVA and Bonferroni test. Results: The heart rate increased at 70° compared to 10° and supine (70.48±8.17 Vs 70.22±8.67 and 88.51±12.84 bpm, p<0.001). The 70° tilt decreased vagal HRV indicators compared to 10° and supine: SDNN (31.13±8.12 Vs 38.07±11.29 and 38.13±10.89 ms, p<0.05), RMSSD (20.06 ±8.47 Vs 34.23±14.22 and 36.16±12.22 ms, p<0.001), NN50 count (13.03±20.58 Vs 45.07±44.44 and 55.27±44.10, p<0.01), pNN50 (3.28±6.08 Vs 14.06±15.65 and 16.65±14.23, p<0.01), HF power (197.20±143.76 Vs 218.17±155.85 and 216.87±150.98 Hz, p<0.05), HFnu unit (24.28±14.16 Vs 45.48±16.34 and 47.67±19.89, p<0.001). The 70° tilt increased LF power% (197.20±143.76 Vs 218.17±155.85 and 216.87±150.98, p<0.001). LFnu unit (75.72±14.76 Vs 54.52±16.34 and 52.32±19.89, p<0.001), LF: HF (4.96±4.08 Vs 1.53±1.138 and 1.69±1.67, p<0.001) compared to 10° and supine. Conclusion: At 70° tilt, HRV measures, reflecting vagal contribution to cardiac-cycle length, decreased with reciprocal increase in sympathetic activity compared to 10° or supine leading to increase in sympathetic predominance. A 10° tilt, which is almost equivalent to lying down with pillow, did not change HRV from supine. Key words: Cardiac cycle, cardiovascular haemodynamics, head-up-tilt, heart rate variability, sympathetic activity, parasympathetic activity