Browsing by Author "Sharma, R"
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Publication Assessing Spectrum of Fractures in Elderly; Perspective on Tertiary Care Hospital of Nepal(Kathmandu University, 2023) Parajuli, B; Sharma, R; Kayastha, SR; Thapa, J; Shrestha, R; Shrestha, DABSTRACT Background There is an increasing life expectancy and a surging elderly population in the last few decades, leading to a higher incidence of fractures in the elderly. The health care of the elderly in Nepal is below par and there are no studies done to evaluate the spectrum of fractures in the elderly. Objective To evaluate the demographical and epidemiological aspects of fractures in the elderly (≥ 65 years) presenting to a tertiary care hospital in Nepal in a 15 years’ timeline. Method This study was a retrospective epidemiological study conducted in the Department of Orthopedics, Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH), Nepal. The patients of age ≥ 65 years having traumatic injuries, admitted in the orthopedics ward from 2006 January to 2020 December were included. Patient demographics, site of injury, fracture incidence, mechanism of injury, hospital stay duration, and mode of treatment (surgical/ conservative) were evaluated. Result Of the 787 patients with an average age of 73.65 ± 7.5 years, 54% were females. Peritrochanteric fracture was the most common fracture (29.4%) followed by spine (18.3%). The most common mechanism of injury was fall on the labeled ground (38.6%). The incidence of fragility fractures (peri-trochanteric, proximal humerus, spine, and distal radius) was increasing with age. Conclusion Females, peritrochantric fractures, and trivial trauma are the most common occurrences for fractures in elderly. The incidence of fragility fractures is increasing with age but the overall incidence of fractures compared to other studies is low. Higher incidences of road traffic accidents (RTA) and compound fractures among the elderly are serious public health concerns that highlight the importance of primary preventive measures. KEY WORDS Elderly, Fracture, Incidence, NepalPublication Chronic Spontaneous Urticaria: Clinical Profile, Autologous Serum Skin Test Positivity and Associated Impairment in Quality of Life in Nepalese Patients(Kathmandu University, 2022) Paudel, S; Parajuli, N; Sharma, R; Parajuli, SABSTRACT Background Chronic Spontaneous Urticaria is considered to be an autoimmune phenomenon in half of the total cases. Autologous serum skin test is a simple screening test for the presence of auto-antibodies in chronic urticaria. Significant impairment in quality of life have been observed in autologous serum skin test positive cases. There are limited literatures on chronic spontaneous urticaria, autologous serum skin test and associated Dermatology Life Quality Index in Nepal till date. Objective To find the proportion of autologous serum skin test positive cases in chronic urticaria and impairment in quality of life in such patients. Method This was a retrospective review of outpatient records of patients diagnosed with chronic spontaneous urticaria, from January 2018 to December 2019, from a tertiary care hospital in Kathmandu, Nepal. Details of the patients, autologous serum skin test and dermatology life quality index scores were analyzed and presented. Result Among the total 114 cases positive autologous serum skin test was seen in 48.2% of cases. The mean total Dermatology Life Quality Index score was 8.06±6.64. A significantly higher quality of life impairment was observed in in patients with positive autologous serum skin test as compared to the negative ones. The odds of finding a positive autologous serum skin test in patients with angioedema was 2.1, however the difference was not statistically significant. Conclusion Chronic spontaneous urticaria was more common in females as compared to males. A positive autologous serum skin test was present in half of the patients which was in turn associated with a greater impairment of quality of life. KEY WORDS Autologous serum skin test, Chronic urticaria, Dermatology life quality index, Quality of lifePublication Clinico-epidemiological Profile of Extra Hepatic Portal Vein Obstruction: A Tertiary Care Hospital Based Retrospective Study(Kathmandu University, 2019) Sharma, R; Pradhan, B; Karki, P; Bartaula, BABSTRACT Background Extra hepatic portal vein obstruction (EHPVO) is a common cause of portal hypertension in the developing countries (up to 30% of all variceal bleeders) and is second to cirrhosis in the West (up to 5-10%). Our understanding of the disease is poor compared with other illnesses. Objective To undertake a retrospective study of the clinicoepidemiological profile of Extra hepatic portal vein obstruction in a tertiary care hospital in eastern Nepal. Method All consecutive adult patients whose features were consistent with the diagnosis of extra hepatic portal vein obstruction from June 2014 to June 2016 were retrospectively analyzed to explore the various clinico-epidemiological parameters. Result A total of 58 patients were enrolled in the study with a median age of 24 years (20.5- 40). Portal vein thrombosis was the most common cause of extrahepatic portal vein obstruction. Hematemesis followed by melena were the most common presenting symptoms. All patients had splenomegaly on examination. None of the patients had clinical, biochemical or radiological evidence of chronic liver disease. Conclusion The diagnosis of extra hepatic portal venous obstruction and differentiation from cirrhosis can be easily made by characteristic clinical features, normal liver function tests and doppler ultrasound. Portal vein thrombosis (PVT) is the predominant cause of extra hepatic portal vein obstruction in Nepali patients, as seen at this tertiary care hospital in Nepal. KEY WORDS Cirrhosis, Extra hepatic portal vein obstruction, ThrombosisPublication Common pathogens isolated in diabetic foot infection in Bir Hospital(Kathmandu University, 2006) Sharma, VK; Khadka, PB; Joshi, A; Sharma, RAim: Foot ulcers are a frequent complication of patients suffering with diabetes mellitus, accounting for up to 20% of diabetes-related hospital admission6. Secondary infection of these ulcers is by far the leading cause of amputation of feet and legs and the polymicrobial nature of diabetic foot infection has been well documented in the literature. The present study sought to reveal the bacterial etiology of diabetic foot ulcer in patients presenting to Bir Hospital. Method: A 1 year retrospective study was carried out to analyse the bacterial isolates of all patients admitted with diabetic foot infection presented with Wagner grade 2 -5 ulcers. Bacteriological diagnosis and antibiotic sensitivity profiles were carried out and analysed using standard procedures. Results: Diabetic polyneuropathy was found to be common in (51.1%) and gram positive bacteria were isolated more often than gram-negative ones in the patients screened. The most frequent bacterial isolate were Staphylococcus aureus (38.4%), Pseudomonas aeruginosa (17.5%), and Proteus (14%). Imipenem was the most effective agent against gram-negative organisms. Vancomycine was found to be most effective against gram- positive organisms. 13 Conclusion: Staph aureus and Pseodomonas aeruginosa were the most common causes of diabetic foot infections in Bir Hospital. Theses wounds require use of combined antimicrobial therapy for initial management, repeated dressing and wound debridements were done.Publication Comparative Study between the Use of Pigtail Catheters and Traditional Chest Tube Drain in Cases with Pneumothorax(Kathmandu University, 2022) Vaidya, S; Karmacharya, RM; Shrestha, B; Adhikari, MM; Sharma, R; Khadka, S; Bhandar, N; Hada, GABSTRACT Background Pneumothorax is a condition in which air or other gas is present in the pleural cavity. Mainstay of management of pneumothorax is to remove the air from the pleural space usually done by chest tube insertion. There is still uncertainty whether minimal invasive management with pigtail catheter is sufficient for the management of pneumothorax. Objective To find the effectiveness, safety, tolerability, efficacy of pigtail catheters and large bore chest tubes. Method Prospective comparative study was done in Dhulikhel Hospital between August 2019 till August 2021. Chest tube insertion used to be the only available treatment modality till December 2020 (15 months). Following January 2021 after obtaining ethical clearance for use of pigtail insertion for pneumothorax, this treatment modality was done (8 months). Result Among 76 patients, 52(68.4%) underwent a large bore chest tube and 24 (34.6%) pigtail catheter patients. Mean age of the patients was 48 years (SD 18.01). Duration of hospital stay and length of hospital stay was more in large bore catheters and less in pigtail catheters. Eight hours post tube placement of the expansion of the lungs was present in pigtail and was statistically significant. Pain killer used in pigtail catheters was limited to Non-steroidal anti-inflammatory drugs, for large bore catheter opioids were added and were statistically significant. Conclusion Pigtail catheter is nearly effective as compared to traditional wide bore catheters. KEY WORDS Large bore chest tube, Painkillers, Pigtail, Pleural space, PneumothoraxPublication Effect of preloading on haemodynamic of the patient undergoing surgery under spinal anaesthesia(Kathmandu University, 2010) Singh, J; Ranjit, S; Shrestha, S; Sharma, R; Marahatta, SBAbstract Background: Hypotension and bradycardia after conduction of spinal anaesthesia are common side effects because of sympathetic blockade. Efforts to prevent these complications have been attempted like preloading with crystalloids, colloids or use of vasopressors. The role of volume preloading to prevent haemodynamic changes associated with spinal anaesthesia has been recently questioned. Objective: The objective of the study was to investigate the effects of volume preload on changes of patient’s hemodynamic. Materials and methods: A Quasi- experimental design was used to conduct the study. Taking written informed consent, 40 patients of age group 18-45 years and ASA grade I and II undergoing surgery under spinal anaesthesia in operation theatre of Dhulikhel Hospital were selected as the sample of the study and allocated randomly to 2 groups. Group I did not receive volume preload and Group II received preload of 1000 ml of Ringer’s lactate solution within 30 minutes immediately before giving the spinal anaesthesia. An observational checklist was used to collect demographic, intra- operative and post-operative records of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR). Results: The findings revealed that the haemodynamic changes occurred in all patients. The decrease in SBP, MBP and DBP from baseline was statistically significant at all points of time (p=0.000). The decrease in HR from baseline was not statistically significant at all points of time (p>0.05). The overall incidence of hypotension was 50%, among which 9 (45%) were from without preload group and 11 (55%) were from with preload group. The incidence of hypotension was similar in groups, sexes and surgical conditions (General Surgery, Gynae/Obs and Orthopaedics). There were no signifi cant differences in haemodynamic changes among groups. Conclusion: On the basis of findings, it is concluded that volume preloading had no effect on the incidence of hypotension and bradycardia after spinal anaesthesia. Key words: Preload, Haemodynamics, Spinal Anaesthesia, CrystalloidPublication Incidence of Simian Crease in Normal Nepalese Children(Kathmandu University, 2010) Malla, T; Malla, KK; Gauchan, E; Brijesh, S; Sharma, RABSTRACT Backgroud Simian crease is usually associated with some chromosomal anomalies and syndromes but it is also seen in some populations without any chromosomal defects. Objective To see the incidence of simian crease in children without chromosomal anomalies and to detect the Ethnic group variations. Methods A prospective study in children attending the paediatric outpatient department of Manipal Teaching Hospital, Pokhara. –2,067 children were screened randomly from the 1st June 2007 to the 31st December 2007. Palm crease and axial triradius angle were detected in every child. Axial Triradius angle was compared between those who have simian crease to those who do not simian crease.Children who were found with simian crease underwent IQ testing. The exclusion criteria were children with Down syndrome, other chromosomal and minor anomalies, plus or any other chronic disease condition. Results 2,067children (1,084 boys & 983 girls) were screened. Among them four were cases of Down syndrome so were excluded from the study. Finally total of 2,063 (1,082 boys & 981 girls) were the study group. There were a total 14 ethnic groups who attended the outpatient department of Manipal Hospital during a seven months period. Among the seven ethnic groups Brahaman, Gurung, Tamang, Lama, Newar, Chettri and Dalit had single palmar crease. The incidence of simian crease was14.6%.This incidence was highly significant (p<0001) in Lama population (71.2%). In these seven ethnic groups axial triradius angle was compared between those who had simian crease and with those who did not have simian crease. Comparisons were made statistically and found to be significant. Conclusion Incidence of simian crease in Nepalese children was 14.6% and was observed only in certain ethnic groups. It was significantly high in the Lama population (71.2%0. Key Words Simian crease, single palmer crease, incidence, Down syndrome, ATD anglePublication Knowledge, Attitude and Practice in Recurrent Shoulder Dislocation: an analysis of patients presenting at a tertiary referral centre(Kathmandu University, 2023) Joshi, A; Gurung, S; Basukala, B; Rijal, N; Sharma, R; Bista, R; Singh, N; Pradhan, IABSTRACT Background Early diagnosis and treatment of recurrent shoulder dislocation are crucial to avoid complications associated with multiple dislocations. Little is known about knowledge, attitude, and practice of recurrent shoulder dislocation among patients. Objective To assess the knowledge, attitude, and practice among patients regarding recurrent shoulder dislocation. Method A retrospective study of prospectively collected data from December 2019 to November 2022 among patients seeking treatment for recurrent shoulder dislocation at a tertiary care centre was conducted. A 16-item questionnaire, including 5 items regarding patients’ knowledge, 2 items regarding attitude, and 2 items regarding practice on recurrent shoulder dislocation, was devised and responses were recorded. Continuous data were reported as mean ± standard deviation and categorical data were reported as number (percentage). Comparative analysis was done using student t-test. Result A total of 220 patients completed the questionnaire. Out of 220, 159 (72.27%) were not informed about recurrence after first dislocation, 146 (66.36%) felt that they were not properly counselled regarding treatment, and 172 (78.18%) responded that they did not know that recurrent shoulder dislocation can be treated. Among 220 patients, 171 (77.73%) responded that their quality of life was affected by recurrent shoulder dislocation, and first dislocation was relocated by doctors in 116 (52.73%), self in 78 (35.45%), and relatives in 26 (11.82%). The number of dislocations was significantly higher among patients who did not visit the hospital after their first dislocation. Conclusion Majority of the patients have positive attitude, but poor knowledge and practice regarding recurrent shoulder dislocation. The findings would be useful for planning strategies to improve patients counselling regarding recurrent shoulder dislocation. KEY WORDS Knowledge gap, Practice gap, Recurrent shoulder dislocationPublication Osteosynthesis of Neck of Femur Fracture below 65 years of Age: does timing of surgery influence osteonecrosis, non- union and functional outcome?(Kathmandu University, 2021) Thapa, J; Shrestha, D; Kayastha, SR; Dhoju, D; Shrestha, R; Sharma, R; Regmi, RABSTRACT Background Influence of timing of injury surgery interval in outcome of osteosynthesis of neck of femur has always been a matter of debate. Patients in our set up have been surgically treated for neck of femur fracture with wide range of injury surgery interval which could have resulted in varied functional outcome and radiological outcome. Objective To evaluate the difference in functional outcome, femoral head osteonecrosis and non-union in fracture neck of femur fixed within and after twenty-four hours. Method All patients, who had undergone osteosynthesis for the neck of femur fractures via open or closed technique from 2010 to 2018 were analyzed retrospectively. The cases were examined and evaluated in terms of injury surgery interval, fracture union, functional status using Modified Harris Hip Score, complications like femoral head osteonecrosis and non-union. Result Fifty patients with an average injury surgery interval of 34±28 hours were evaluated. Twenty three (46%) cases were included in early surgery group (< 24 hours) and 27 (54%) patients were included in delayed (> 24 hours) surgery group. Incidence of femoral head osteonecrosis was reported in two (4%) cases, both being in delayed fixation group (p=0.49). Non-union was reported in four (8%) patients, one in early fixation group and three in delayed fixation group (p=0.61). The average Modified Harris Hip Score in early fixation group was 87 and in delayed fixation group was 84 (p=0.1). Forty two (84%) cases had a good quality of reduction and eight (16%) had a poor reduction. Non-union and functional outcome significantly differed between the good and poor reduction group (p=0.001 and 0.004 respectively). Conclusion There is no significant difference in the functional and radiological outcome of cases operated before and after 24 hours for osteosynthesis of neck of femur fractures in patients 16 to 65 years age group. However, poor reduction is significantly associated with the increased rate of non-union and poor functional outcome. KEY WORDS Femur neck, Non-union, Osteonecrosis, OsteosynthesisPublication Pachydermoperiostosis ('Touraine-Solente-Gole' Syndrome)(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2013) Sharma, R; Pandey, S; Choudhary, D; Pokhrel, DBNo Abstract Keywords: Pachydermia, primary hypertrophic osteoarthropathy, clubbingPublication Prevalence of Intestinal Parasitosis Among School Children in Baglung District of Western Nepal(Kathmandu University, 2012) Shrestha, A; KC, Narayan; Sharma, RABSTRACT Background This study was carried out to estimate the prevalence of intestinal parasites among school-going children of the Baglung municipality from December 2010 to January 2011. Objective To find out prevalence of parasitosis among school aged children and to make necessary recommendations for preventive measures. Method A total of 260 stool samples were collected. A structured questionnaire was used to collect data on predisposing factors. Nails were observed without prior information to the subjects so as to find their hygienic practice. The stool samples were examined by direct wet mount and formal ether concentration technique. Results The total prevalence of the intestinal parasitosis was found to be 21.05%. The prevalence for individual parasites was as follows: Entamoeba histolytica (9.23%), Giardia lamblia (5.76%), Trichuris trichuria (5%), Ancylostoma duodenale (2.65%) and Ascaris lumbricoides (2.3%). Nail hygiene and level of education were significantly associated with intestinal parasitosis. The gender and age of the children, sanitary habits including toilet use, hand washing practice, and the use of the antihelminthic drug (albendazole) were not significantly associated with intestinal parasitosis. Higher prevalence was seen in boys, children belonging to age group 10-14 years, lower secondary students, among those who reported gastrointestinal problems within last six months, children from agriculture-based families and children with untrimmed nail. Conclusion Major contributors for the prevalence of parasites were found to be poor personal hygiene and educational level of the children. Health education and mass treatment are recommended as a preventive measures. KEY WORDS Hygiene, parasites, prevalence, school childrenPublication Refractive Errors and Visual Anomalies in Schoolchildren in the Kavrepalanchowk District(Kathmandu University, 2010) Marasini, S; Sharma, R; Sthapit, PR; Sharma, D; Koju, U; Thapa, G; Nepal, BPABSTRACT Background Schoolchildren form an important target group for a nation, as any ocular morbidity in this age group has huge physical, psychological and socio-economical implications. Childhood eye disorders can contribute to the burden of blindness in any society. This study aims to highlight the prevalence of ocular morbidity in governmental schools in a sub-urbanised area of Nepal, in relation to ethnic variation. Methods A descriptive study, and the study population used were schoolchildren who were examined in their schools and afterwards referred to the hospital if required. Presenting and best corrected visual acuity, refraction, binocularity assessment, anterior and posterior segment evaluation was carried out. Data was analysed statistically using SPSS software, version 14. Results We examined 1,802 school children. The mean age was 10.78±3.61 years. Ocular abnormality was detected in 11.7%. Low vision and blindness was rare (0.11% and 0.05%). Ocular morbidities were more common in Newar communities (3.71%) followed by Brahamans (3.38%). Lid abnormalities were the most common (3.55%), and morbidities in each ethnicity were followed by refractive errors (3%), conjunctival abnormalities (1.10%), strabismus (0.88%) and amblyopia (0.33%). Refractive errors were most common among Newar communities (1.16%) at almost twice as many Brahamans (0.61%) followed by Mongolians (0.49%). Convergence insufficiency was detected in 2.49% (p<0.01). Conclusions Ocular morbidities are common in children in Kavhrepalanchowk District with lid abnormalities being the most common issue, probably due to a lack of hygienic practice. Ethnic variation of ocular morbidities is an important observation mostly for refractive error and strabismus. Key Words blepharitis, blindness, ethnicity, oculo-visual, visual acuityPublication Round Block Technique in Management of Breast Lesions(Kathmandu University, 2019) Khanal, S; Singh, YP; Sharma, R; Pandit, KABSTRACT The basic tenets of oncoplastic surgery essentially includes volume displacement and volume replacement. The round block technique, so-called donut mastopexy or Benelli mastopexy, is frequently used as a volume displacement technique in breast conserving surgery for benign multicentric fibroadenomas and early breast cancers. Such techniques are still underused in Nepal. In this article we present on four cases managed with original round block technique and followed prospectively with their outcome. KEY WORDS Breast cancer, Fibroadenoma, Oncoplasty, Sentinel lymph nodePublication Tubercular scleritis(Kathmandu University, 2010) Sharma, R; Marasini, S; Nepal, BPABSTRACT Scleritis is a severe painful inflammatory process centred in the sclera. A scleritis may be a harbinger of many systemic diseases so that it is important to exclude multisystem disease. We describe a case of unilateral tubercular anterior nodular non-necrotizing scleritis. Anterior nodular non-necrotizing scleritis is relatively an uncommon manifestation of tuberculosis. It may be difficult to diagnose and manage the disease. However, good history, detail clinical evaluation, appropriate and timely management shows a good response to the disease. Key Words mantoux test, nodular scleritis, ocular tuberculosis