Browsing by Author "Sharma, S"
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Publication Acute sacrococcygeal dislocation (anterior type): A case report(Kathmandu University, 2004) Rijal, KP; Pradhan, RL; Sharma, S; Lakhey, S; Pandey, BKSacrococcygeal dislocation is a rare injury. A twenty-nine year old male presented to us with pain over the lowest part of spine of 5 days duration. He fell down on stairs with his buttock landing directly over the edge of the stairs. On examination, a step was felt in the continuity of sacrum and coccyx. The tip of the coccyx was not palpable. Per rectal examination revealed a small bump on running the finger along the sacrococcygeal curvature. On plain radiographs of sacro-coccygeal region, lateral view revealed anterior dislocation of the coccyx over the sacrum. On antero-posterior view, the injury could not be identified. Under general anaesthesia, an attempt to reduce the dislocation per rectally was tried, but failed. The patient was treated conservatively with analgesics. He refused surgery, as he was relieved of pain with analgesics. Key Words: - Sacrococcygeal dislocation, coccydynia, conservative treatment.Publication B-Lynch Brace suture for conservative surgical management for placenta increta.(Kathmandu University, 2004) Chaudhary, P; Sharma, S; Yadav, R; Dhaubhadel, PPlacenta accreta is defined as “an abnormal adherence, either in whole or in part, of the afterbirth to the underlying uterine wall”. Placenta increta occurs when the placenta invades deeply into the myometrium.1 . Placenta increta is a life threatening condition. We report a case of placenta increta managed by unilateral uterine artery and ovarian artery ligation followed by B- Lynch Brace suturing of the uterus to control bleeding from the placental bed. Key words: Placenta increta, PPH, B-Lynch suturePublication Clinical features of HIV/AIDS and various opportunistic infections in relation to antiretroviral status among HIV seropositive individuals from Central Nepal(Kathmandu University, 2009) Sharma, S; Dhungana, GP; Pokherel, BM; Rijal, BPAbstract Background: So far, antiretroviral therapy is the only effective treatment available to HIV/AIDS patients. Provision of combined package of treatment, care and support service as well as regular assessment of the therapy increases its effectiveness. Objective: The aim of this study was to establish the relationship between antiretroviral therapy status and clinical features/opportunistic infections among HIV seropositive individuals. Materials and methods: This is a cross-sectional study. Study was carried out between October 2007 and May 2008 in 150 HIV patients of Kathmandu, Central Nepal. After taking informed consent pre-structured questionnaire was filled to assess clinical features and specimen were collected to investigate major OIs as per standard microbiological procedure. All the information were entered into SPSS 11.5 system and analysed. Result: Of the 150 patients, 100 (66.7%) were males and 50 (33.3%) were females. The age group 21-30 years was predominant followed by 31-40 years (42%). Significant relationship could be established between intake of ART and cardinal symptoms of HIV/AIDS (χ2 value ranging from 4.11 to 9.34). However, no significant relationship could be established between the intake of ART and distribution of different OIs (χ2 values ranging from 0.15 to 1.6). Conclusion: Antiretroviral therapy was found to effective enough to reduce the clinical features of AIDS. Diagnosis and treatment of opportunistic infections should be routinely done for both groups of patients. Key words: Antiretroviral therapy, CD4 count, HIV/AIDS, NepalPublication Effect of haemodynamic and metabolic predictors on echocardiographic left ventricular mass in non-diabetic hypertensive patients(Kathmandu University, 2010) Gupta, N; Karki, P; Sharma, S; Shrestha, N; Acharya, PAbstract Background: Left ventricular hypertrophy is a forerunner of coronary heart disease, congestive cardiac failure, stroke and may also lead to sudden death. Estimation of left ventricular mass by echocardiography offers prognostic information better than the evaluation of traditional cardiovascular risk factors. Objective: The aim of this study was to determine the relative contributions of haemodynamic and metabolic factors affecting left ventricular mass in non-diabetic patients with essential hypertension. Material and methods: 100 non-diabetic hypertensive patients were taken. The association between age, gender, smoking, alcohol, height, weight, heart rate, clinic blood pressure, fasting blood glucose, lipid profile, haemoglobin, body mass index and stroke volume with LV mass was studied. Left ventricular mass was measured by using standard M-mode echocardiography measurement obtained by way of standard recommended by the American Society of Echocardiography. Results: Left ventricular mass was analyzed as a continuous variable. In males body mass index (r=.35, p<.004) and stroke volume(r=-.26, p<.039) were significantly correlated with LV mass. In females body weight was significantly related to left ventricular mass(r=.36, p<.02). The independent association between significant factors and left ventricular mass was assessed by stepwise multivariate logistic regression. Body mass index and systolic blood pressure came as independent determinants of left ventricular mass in all patients. A maximum of 13% of left ventricular mass variability could be explained by these two factors. Conclusion: In untreated patients with hypertension patient’s body mass index and systolic blood pressure are independent predictors of left ventricular mass after adjustment for other haemodynamic and metabolic factors. They explain a maximum of 13% of left ventricular mass variability. More knowledge is needed about factors that may alter cardiac morphology in the evolution of hypertensive patients. Key words: Echocardiography, Haemodynamic, Metabolic Factors, Left Ventricular Mass, Non-diabetic, HypertensivePublication External and internal fixation for comminuted intra-articular fractures of distal radius(Kathmandu University, 2009) Pradhan, RL; Lakhey, S; Pandey, BK; Manandhar, RR; Rijal, KP; Sharma, SAbstract Background: Distal radius fractures are a common injury and without proper treatment leads to high functional impairment and frequent complications. Objective: The aim of this study was to see the functional outcome in patients with comminuted distal radius fractures treated with combined external fixation and open reduction with volar plating. Materials and methods: All comminuted distal radius fractures classified as type C in AO/OTA classification were enrolled for the study from 2005 till 2008. The clinical scoring chart modified by Cooney was used to evaluate the functional outcome. Results: There were twenty-two patients with the average age of 42.18 years (range 19-60) with 15 male and 7 females. The follow-up period was from 14 to 46 months. Accordingly, there were 11 (50%) excellent, 7 (31%) good, 2 (9%) fair and 2 (9%) poor results. There were very few complications in our series. In three patients additional K-wire supplementation was necessary along with external and open internal fixation. Conclusions: Comminuted intra-articular fractures of distal radius should be treated by open reduction and combined internal and external fixation to achieve a high rate of patient satisfaction and satisfactory functional outcome. Key words: distal radius fractures, volar plating, external fixationPublication Functional outcome of operatively treated displaced intra-articular calcaneal fractures using two parallel contoured reconstruction plates(Kathmandu University, 2010) Lakhey, S; Manandhar, RR; Pradhan, RL; Pandey, BK; Sharma, S; Rijal, KPAbstract Introduction: The treatment of displaced intra-articular calcaneal fracture is controversial. Conventionally, they were treated non-operatively. However, some surgeons are now operatively treating these fractures because of continuing dissatisfaction with the outcome of conservative treatment of these fractures and improvements that have occurred in surgical techniques and complication rates. Objective: The aim of this study was to determine the functional outcome of operatively treated displaced intra-articular calcaneal fractures using two parallel contoured reconstruction plates. Materials and methods: 12 patients with 14 displaced intra-articular calcaneal fractures involving the subtalar joint were included in the study conducted between July 2005 and December 2008. The fracture site was exposed using extended lateral approach. Internal fixation was done by two nearly parallel 3.5mm reconstruction plates and screws contoured to form a gentle curve in all cases with the first plate fixed just below the articular surface. At the end of follow up, the patients' foot function was assessed by Calcaneal Fracture Scoring System of Kerr et al. Patients were also enquired about their satisfaction with their treatment outcome. Results: The patients were followed up for duration of 12 to 24 months (mean 15.64 months). The outcome score as measured by Calcaneal Fracture Scoring System ranged from 48 to 94 (mean 83.64). 11 of 12 patients (91.6 %) were satisfied with the treatment. Conclusion: Displaced intra-articular fractures treated by open reduction and internal fixation, using two nearly parallel, contoured reconstruction plates through an extensile lateral approach and following the principles of treatment of intra- articular fractures, have good functional results with high patient satisfaction rate. Key words: displaced intra-articular calcaneal fractures, operative treatment.Publication Fungal Infection Mimicking Metastasis in Lung Carcinoma(Kathmandu University, 2011) Sharma, S; Shrestha, S; Rawal, K BABSTRACT: In our investigation, we found out that the lung infections can be due to fungus which can make the treatment to cancer a bit confusing for medical therapy. People with weakened immune systems are susceptible to infections by opportunistic fungi and can invade the lungs. Here, one patient was diagnosed with squamous cell carcinoma of left lung but later on his right lung was found to show multiple cannon ball opacities which were reported to be metastasis by chest X-ray and CT Scan reports. However, it was not the exact case because when treated with anti- fungal drugs, the cannon balls disappeared within two weeks.Publication Histopathological Findings of Endometrial Samples and its Correlation Between the Premenopausal and Postmenopausal Women in Abnormal Uterine Bleeding(Kathmandu University, 2014) Sharma, S; Makaju, R; Shrestha, S; Shrestha, AABSTRACT Background Abnormal uterine bleeding is considered as one of the most common problems among women. The therapy is incomplete without knowing the underlying pathology. Objectives To determine the types and frequency of endometrial pathologies in patients presenting with abnormal uterine bleeding at Dhulikhel Hospital Kathmandu university Hospital. Methods This is retrospective study total 100 cases were included over a period of one year of Abnormal Uterine bleeding. Results Out of 100 cases of Abnormal uterine bleeding, 61% were due to non-organic cause with a commonest histopathological findings proliferative endometrium. 27% cases were due to organic cause with pregnancy related condition as most common finding. 12% were reported as inadequate. The rate of postmenopausal bleeding declined with increasing age in the postmenopausal period and endometritis was the predominant finding. Conclusion There is an age specific association of Abnormal uterine bleeding with increased incidence in perimenopausal age group. Postmenopausal bleeding declined with increasing with endometritis the most common finding. Dilation and curettage is helpful to exclude other organic pathology. It is useful for diagnosis and to know pathological incidence of organic lesions in cases of Abnormal uterine bleeding prior to surgery. KEY WORDS Abnormal uterine bleeding, histopathologyPublication Hospital based analytic study of peptic ulcer disease in patients with dyspeptic symptoms(Kathmandu University, 2009) Sharma, S; Maharjan, DK; Thapa, PBAbstract Background: Peptic ulcer disease is one of the most common diseases prevalent in developing country like Nepal and with availability of endoscopy there have been increase in diagnosis and therapeutic use of endoscopy. Objective: The aim of this study is to investigate the prevalence of peptic ulcer disease in patient who came for upper gastrointestinal endoscopy in Kathmandu Medical College Teaching Hospital. Materials and methods: All patients who were referred to department of endoscopy from outpatient department (OPD) and inpatient department with symptoms like dyspepsia, upper GI bleeding were included from August 2004 to August 2008. Results: A total of 2761 patient were evaluated, with mean age group of 40.57 years (range 8- 95 years) and with sex distribution of male 1353 (49%) and female 1408 (51%) and racial difference into Aryan 2050 (74.2%) and Mongoloid 771 (25.8%). There were 983 patients (35.60%) with peptic disease which includes erosive gastritis, non erosive gastritis, duodenitis and gastroduodenitis without obvious ulcer. The prevalence of peptic disease with or without ulcer was more common in age group of 20- 49 years (n= 764, 27.67 %) with 70 patient with gastric ulcer (2.5%) and 50 patient with duodenal ulcer (1.8%). There was no significant racial difference among incidence of peptic ulcer (P value= 0.527). Conclusions: Peptic ulcer disease is a significant cause of morbidity in urban population of Nepal with more prevalent of erosive diseases in productive age group (20-49 years). However both male and female have equal incidence of peptic ulcer disease and there was no significant racial difference in its incidence. Key words: Peptic ulcer diseases, Oesophago-gastroduodenoscopy, H. pyloriPublication Medication Adherence to Antiretroviral Therapy Among Patients Visiting Antiretroviral Therapy Center at Tribhuvan University Teaching Hospital, Kathmandu, Nepal(Kathmandu University, 2013) Sharma, S; Khadga, P; Dhungana, GP; Chitrakar, UABSTRACT Background Although antiretroviral therapy has limited efficiency, patients should take multiple drugs in combination in prescribed time for lifelong and they should also require specific food and fluid restriction. Due to these and other factors patients may discontinue their medication and therefore face significant challenges in adherence. Objectives To assess factors associated with non-adherence among people living with HIV receiving the antiretroviral therapy. Methods Between July 2011 to January 2012, a cross sectional survey was conducted among patients visiting HIV/AIDS unit, Tribhuvan University Teaching Hospital for therapy. After taking informed consent, a pre-structured questionnaire was filled up and data were entered into SPSS 11.5 system and analyzed. Results Of the 100 studied subjects, 61 (61.0%) were male and 39 (39%) were female. Adherence was found to be 79%. The major barrier to adherence was reported to be simply forgetfulness (33.3% of those non adherents). Non adherence was significantly associated with types of family (X2 value, 7.11), smoking (X2 value, 5.44) and alcoholic habit (X2 value, 5.69) but not with gender (X2 value, 2.57). Besides this, poor economic status, and attendance to religious ceremony were reported to be major obstacles to adherence. Conclusion Adherence at this center was found to be only satisfactory. Forgetfulness was reported to be the major cause of non adherence. Persons living in joint family and those with alcoholic and /or smoking habit were more likely to miss the pills. It can be recommended that effective counseling, moral/financial support for HIV/AIDS patients may increase their adherence. KEY WORDS Adherence, HIV/AIDS, KathmanduPublication Osteosynthesis of intercondylar humerus fracture using bryan and morrey approach(Kathmandu University, 2010) Lakhey, S; Sharma, S; Pradhan, RL; Pandey, BK; Manandhar, RR; Rijal, KPAbstract Background: The olecranon approach has been the gold standard for surgical approaches to fracture fixation of distal articular surface of humerus. Although it provides a good exposure, it also has disadvantages of delayed union, non- union and implant related complications at the osteotomy site. Objective: The aim of this study was to determine the functional outcome of displaced intra-articular distal humerus fracture fixation using an alternative approach: the Bryan and Morrey approach. Materials and methods: Twenty patients with twenty AO type C1 and C2 intercondylar fractures of the distal humerus had bicolumnar fixation of the distal humerus with two contoured reconstruction plates and screws on the dorsal surface or various combinations of a single reconstruction plate, screws and K-wires using a Bryan and Morrey approach. Twelve of the patients were male and eight were female. The average age of the patients was 44.8 years. Eleven patients had sustained the injury as result of fall and nine of the patients had sustained it in road traffic accidents. Right elbow was involved in fifteen patients and left in five. All patients were followed up for 12 months post operatively. Results: All twenty fractures had united at 4 months follow-up. The mean fixed flexion deformity was 9.0º (range 0º- 15º) and the mean arc of motion was 115.0º (range 85º- 130º). All patients had grade 4 triceps strength and stable elbows at the end of 12 months follow up. One patient had deep seated wound infection resulting in necrosis of the triceps tendon requiring a second operative procedure. Conclusions: Bryan and Morrey approach is a simpler, easier and better approach as compared to the other posterior approaches to the elbow joint, and therefore, can be used as the approach of choice for fixation of fractures of the distal articular surface of humerus. Key words: Fracture, Intercondylar Humerus, OsteosynthesisPublication Post legalisation challenge: minimizing complications of abortion(Kathmandu University, 2004) Ojha, N; Sharma, S; Paudel, JAbortion has been legalized in Nepal since September 2002 by 11th amendment to the Muluki Ain. The present study was conducted in Paropakar Shree Panch Indra Rajya Laxmi Devi Maternity Hospital to assess the magnitude of induced abortion, its causes and the types of complications, in the post legalization phase. Prospective descriptive analyses of the patients who were admitted with history of induced abortion from 16 th Dec 2003 to 13th March 2004 was carried out. A total of 305 cases of abortion complications were admitted during the three-month study period, which is 39.7% of the total gynaecological admissions (768). Of these 31 (10.25%) patients had history of induced abortion. Half of the induced abortion cases (52%) were of age group 21-29 yrs and 42% had three or more children. 39% of the cases had history of induced abortion at more than 12 weeks and almost half of the cases (48%) had history of family planning. The most common reason for seeking abortion was too many children (59%) followed by illegitimate pregnancy (16%). Twenty-one patients gave history of abortion being performed by doctors and the most common method used was D&C (75%). 77% of cases presented as incomplete abortion and one case presented with uterine perforation, bowel injury and peritonitis. Twenty patients had evacuation under sedation while five had manual vacuum aspiration (MVA); one patient required laparatomy. In two third of the patients intravenous fluid and antibiotics were used. Four patients required blood transfusion. Abortion complications constitute almost 40% of the total gynaecological admissions. Ten percent of the abortion cases had history of induced abortion. Medical persons, mainly doctors, performed most of the cases of induced abortion and D&C was the most commonly used method. However the patients had faced various types of complications. Untrained provider, resulting in serious life threatening injuries, performed more than a third of the cases of induced abortion at more than twelve weeks gestation. This points to the need for improved monitoring of the quality of services provided, and adherence to the criteria set by the procedural order.Publication The Correlation Between Fine Needle Aspiration Cytology and Histopathology of Head and Neck Lesions in Kathmandu University Hospital(Kathmandu University, 2013) Rajbhandari, M; Dhakal, P; Shrestha, S; Sharma, S; Shrestha, S; Pokharel, M; Shrestha, I; Shrestha, B; Makaju, RABSTRACT Background Fine needle aspiration cytology (FNAC) with it’s minimally invasiveness has been a well accepted procedure in the initial diagnosis of various swellings. With time and experience high sensitivity and specificity of FNAC over conventional open biopsy has lead to the wide acceptance of this procedure. Objective To evaluate the utility of aspiration cytology as a first-line diagnostic tool in palpable head and neck masses and correlate with histologic results for evaluating diagnostic accuracy. Methods A hospital based prospective, comparative study was conducted among patients with various swellings at Head and Neck regions in the Department of Pathology, Dhulikhel Hospital between July 2011 to June 2012. FNAC were done from the palpable masses of head and neck regions and were compared with biopsy findings of the same lesions. Data entry and analysis performed using SPSS version 16. The sensitivity, specificity and accuracy rates were calculated. Results A total 64 patients were subjected to both FNAC and histopathological examination (HPE). Total 39 (61 %) were females and 25 (39 %) were males with M: F ratio of 1:1.6. The age group ranged from 9 to 80 years. Twenty five percent of patients were in the age group below 20 years. The highest number of cases included lymph nodes 29 (45%) followed by thyroid 24(37.5 %), salivary glands 10(16%) and 1 case (1.6%) was a soft tissue swelling over the occipital region. Highest sensitivity, specificity and accuracy rate for diagnosis by FNAC were observed in thyroid. The overall sensitivity and specificity of FNAC were 86% and 97% respectively in determining the various pathologies. The overall accuracy of FNAC in present study was 87.4%. Conclusion FNAC is a minimally invasive first line investigation with a high sensitivity and specificity for the diagnosis of various head and neck lesions KEY WORDS FNAC, lymph nodes, salivary Glands, thyroidPublication Tuberculosis and other clinical presentation of HIV/AIDS in patients with or without undergoing antiretroviral therapy in Kathmandu(Kathmandu University, 2007) Dhungana, GP; Ghimire, P; Sharma, S; Rijal, BPObjectives: To screen tuberculosis (TB) and examine the clinical presentation of AIDS in HIV sero-positive persons. Methods: A Cross-sectional study was designed. One hundred HIV infected persons were randomly selected from different parts of the country visiting Tribhuvan University, Teaching Hospital, Kathmandu and different HIV/AIDS care centres. After taking informed consent, questionnaires were filled and three sputum specimens from each person were collected to investigate tuberculosis by Ziehl-Neelsen staining and culture. Data generated were entered into SPSS 11.5 and relevant statistical tools were applied. Results: Among 100 HIV infected cases, 66 (66%) were males and 34 (34%) were females. Sixty percent of the cases were in the age group of 21-30 years. Majority of them were Smokers (41%), alcoholics (34%), illiterates (54%) and unemployed (59%). Heterosexual activity (51%) was found to be the major risk factor for HIV infection. Of the 100 HIV cases, 23 (23%) were co-infected with tuberculosis of which 18(78%) were sputum smear negative tuberculosis, mostly developed in late stage of HIV infection. Weight loss (54%) and diarrhoea (43%) were the major clinical presentations of AIDS. Antiretro-viral therapy non-receiver were more likely to suffer with various clinical disorders/TB as compared to ARV therapy receiver but the values were statistically insignificant, χ2 values ranging from 0.003 to 2.24, p>0.05. Conclusion: Prevalence of tuberculosis was still high in HIV/AIDS patients, and specifically, sputum smear negative tuberculosis cases constituted the significant proportion, particularly in late stage of HIV infection. Weight loss and diarrhoea were found to be the major clinical presentation of AIDS. Illiterate and unemployed young adults involved in unsafe sexual practice and drug addiction were high risk of acquiring HIV infection. Key words: Clinical features, HIV/AIDS, Kathmandu; Smear Negative Tuberculosis