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 Anesthetic Management of a Patient with Myasthenia Gravis for Meningioma Surgery - A Case Report(Kathmandu University, 2015) Srivastava, VK; Agrawal, S; Ahmed, M; Sharma, SABSTRACT Myasthenia gravis is a disease of great challenge to the anesthesiologist, because it affects the neuromuscular junction. Anesthetic management involves either muscle relaxant or non-muscle relaxant techniques. This case report documents the safe use of fentanyl, propofol and sevoflurane combination guided by bispectral index, without the use of muscle relaxants in a patient with myasthenia gravis who presented for meningioma surgery. KEY WORDS Fentanyl, myasthenia gravis, propofol, sevofluranePublication Antimicrobial Resistance Pattern of Pseudomonas aeruginosa Isolates from Tertiary Care Hospitals in Kathmandu(Kathmandu University, 2023) Shrestha, PM; Kattel, HP; Sharma, S; Bista, P; Basnet, BK; Ghimire, P; Rijal, KRABSTRACT Background Antimicrobial resistance, caused by Pseudomonas aeruginosa (P. aeruginosa), poses a global health threat, limiting treatment options and increasing morbidity and mortality rates due to its intrinsic and multidrug resistance. Objective To determine the antimicrobial resistance patterns of P. aeruginosa isolates from patients visiting or admitted to tertiary care hospitals in Kathmandu. Method A cross-sectional study was conducted at Bir Hospital and Tribhuvan University Teaching Hospital (TUTH) from December 2021 to December 2022. Isolates were identified and tested for antibiotic susceptibility following standard microbiological guidelines. Result The antimicrobial resistance of 200 P. aeruginosa isolates increased from low to high levels, as per the recommended anti-pseudomonal antibiotics by the Clinical and Laboratory Standards Institute (CLSI), from 0% to 94%. piperacillin/tazobactam exhibited significantly lower resistance at 18(9%) and while considerably higher resistance was observed with ceftazidime at 188(94%) compared to different antibiotics, followed by amikacin 34(17%), imipenem 58(29%), ciprofloxacin 42(21%), aztreonam 51(25.5%), and fosfomycin 44(22%). No resistance was observed to colistin and polymyxin B. P. aeruginosa resistant to carbapenem was accounted for 33.5% of the total, and multidrug resistance categories included multidrug resistance (MDR) at 39.0%, extensively drug resistance (XDR) at 13.5%, and P. aeruginosa difficult-to-treat (DTR PA) at 4.6%. Conclusion Most of the isolates were resistant to anti-pseudomonal antibiotics; however, colistin, polymyxin B, amikacin, doripenem, piperacillin/tazobactam, and fosfomycin were effective against MDR P. aeruginosa. Regular surveillance measures are essential to manage antimicrobial resistance. KEY WORDS Antimicrobial resistance, Difficult-to-treat Pseudomonas aeruginosa, Extensively drug resistance, Multidrug resistancePublication 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 Clinico-Pathological Correlation of Colorectal Diseases by Colonoscopy and Biopsy(Kathmandu University, 2017) Makaju, R; Amatya, M; Sharma, S; Dhakal, R; Bhandari, S; Shrestha, S; Gurung, R; Malla, BRABSTRACT Background Colonoscopy is a simple, safe and well tolerated procedure, the visualization of the mucosa of the entire colon and terminal ileum to detect intestinal abnormalities and obtain biopsy leads to the early detection of the pathologic process and institution of appropriate therapy. Objective To find out the correlation between clinical and histopathological diagnosis of colorectal diseases. Method A cross-sectional study was conducted at Department of Pathology, Dhulikhel Hospital, Kathmandu University Hospital from Jan. 2015 - Jan. 2016. Altogether, 95 colonoscopic biopsies were examined and recorded clinical data using pre-designed pro forma. The specimens were grossed, processed and embedded using standard procedures, stained with Hematoxylin and Eosin stain and were analyzed using light microscope. Special stains Ziehl Neelsen, and Periodic Acid-Schiff were used whenever necessary. Result Analyses of 95 cases of colonoscopic biopsies were done. The most common clinical diagnosis was polyp in 49 cases (51.57%) and the common histopathological diagnosis was non-neoplastic polyps 31(32.63%). There was no correlation in cases for suspected infectious colitis, microscopic colitis and hemorrhoids. Conclusion Colonoscopy is incomplete without biopsy and histopathology is the gold standard for the diagnosis of colorectal lesions. The clinico-pathological correlation for neoplastic lesions was excellent. However, correlation was poor in non-neoplastic lesion. KEY WORDS Colonoscopy, colorectal lesions, histopathologyPublication Correlation between Endoscopic and Histopathological Findings in Gastric Lesions(Kathmandu University, 2015) Sharma, S; Makaju, R; Dhakal, R; Purbey, B; Gurung, RB; Shrestha, RABSTRACT Background Stomach is a common site for wide variety of lesions. The visualisation of the site with biopsy leads to the early detection of the pathologic process and appropriate therapy. Objectives The objective of this study is to correlate the histopathological pattern of endoscopic biopsies with distribution of gastric lesions according to age and sex. Method The retrospective study was carried out among 50 cases with endoscopic biopsies and histopathological assessment, received at Department of Pathology, Dhulikhel Hospital- Kathmandu University Hospital. Result Out of 50 cases majority of cases were of male gender with male: female ratio was 1.3:1. Our study showed a poor correlation between endoscopic and histopathological evidence of inflammation in the stomach. Two cases were diagnosed as intestinal metaplasia which were diagnosed as ulcer and erosion endoscopically. Out of 32% of cases diagnosed endoscopically as ulcer, only one case was confirmed histopathologically. Our study showed good correlation in the cases of carcinoma. Out of 17 cases diagnosed endoscopically as gastric carcinoma correlated histopathologically as gastric adenocarcinoma. Majority of carcinoma cases showed ulcerating fungating growth followed by ulcero-proliferative growth. Conclusion Endoscopy is incomplete without biopsy and histopathology is the gold standard for the diagnosis of endoscopically detected lesions. Endoscopic examination and histopathological examination of suspected gastric lesions should go parallel and neither should be a substitute of each other. KEY WORDS Carcinoma, endoscopy, helicobacterpylori, histopathology.Publication Correlation of Cervical Pap Smear with Biopsy in the Lesion of Cervix(Kathmandu University, 2016) Dhakal, R; Makaju, R; Sharma, S; Bhandari, S; Shrestha, S; Bastakoti, RABSTRACT Background Cervical cancer can be controlled to a greater extent by screening to improve morbidity and mortality. Pap smear is important screening method, which has proven to be highly effective in reducing the number of cases and the mortality from cervical carcinoma. Any abnormality detected in pap smear has to be confirmed with cervical biopsy, which remains the reference investigation. Objective To find the changes of cervical cytology by pap smear, to classify cervical lesions into malignant and benign groups on cytological and histopathological basis and to correlate the changes observed in cervical cytology with cervical biopsy. Method This is a prospective cross sectional study done in between July 2014 and July 2015 in Dhulikhel Hospital, Kathmandu University Hospital. During the period, all the samples requested for pap smear were studied. The cases who had undergone both pap smear and cervical biopsy were compared. Clinical data were obtained from requisition submitted along with the cytology and tissue specimens received in the department. Result During the study period, total 1922 pap smears were performed and out of them 75 patients were advised to do cervical biopsy. On cytology, out of total 1922 number of cases, 67.90% were normal, 27.90% were inflammatory smears, 3.80% were unsatisfactory (inadequate) and 0.40% were high grade intraepithelial lesions. Highest numbers of patients screened for pap smear ranged from 31 to 40 years. On histopathology, 78.70% had chronic cervicitis, 8% had normal findings, 1.30% had moderate and 6.70% had severe squamous intraepithelial lesions. The frank malignancy was found in 5.30%. The mean age ± SD for carcinoma was 52.75±6.29. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value of pap smear were 77.80%, 100%, 100% and 97% respectively considering cervical biopsy as the gold standard Conclusion This study revealed a good correlation of cervical cytology with cervical biopsy. Pap is a cost effective screening method for early detection of premalignant and malignant cervical lesions. However, biopsy is considered as the gold standard for the confirmation of abnormalities detected in cervical smear. KEY WORDS Biopsy, cervix, pap smearPublication Deployment of COVID-19 Vaccines for Refugees and Migrants in Nepal(Kathmandu University, 2025) Karmacharya, BM; Joshi, A; Marasini, S; Rai, P; Sharma, S; Kunwar, S; Kampalath, VN; Czapka, EA; Benavente, P; Zan, ML; Tran, NT; Hosseinalipour, SM; Blanchet, KABSTRACT Background The needs and determinants of COVID-19 vaccination uptake and coverage among refugees, migrants in regular situations (MIRS), and migrants in irregular situations (MIIS) remain undocumented. This hinders advocacy toward inclusive vaccination policies and ultimately undermines effective vaccine rollout. Objective To estimate vaccination coverage and produce evidence on the barriers and facilitators to COVID-19 vaccination for refugees and migrants in Nepal. Method Mixed-method study was conducted in Koshi, Bagmati and Gandaki provinces of Nepal. In total, 210 household surveys were conducted among the refugees and migrants, and eight key informant interviews were conducted locally among Nepal’s major stakeholders of COVID-19 vaccination. Result A total of 210 participants were included in this study: 101 refugees, 66 MIRS, and 43 MIIS. Among them, 52.9% (111/210) were fully vaccinated with two or more COVID-19 doses, 43.3% (91/210) were partially vaccinated with one dose, and 3.8% (8/210) were unvaccinated. Inclusive vaccination policies were an enabling factor for wide access to COVID-19 vaccines among refugees and migrants. The availability of vaccines free of cost, timely information on vaccinations, and multiple vaccination centers facilitated COVID-19 vaccine uptake. However, barriers like requirement of identity documents, safety misconceptions, fear of side effects, and language challenges hindered access. Conclusion This study highlights the overlooked issue of vaccination uptake among refugees and migrants, emphasizing the lack of data on their needs and determinants. This gap hinders inclusive vaccination policies and rollout effectiveness. Tailored strategies are crucial to address their specific needs, alongside ongoing research and advocacy for inclusive policies and targeted interventions to overcome barriers. KEY WORDS COVID-19, Immunization, Migrants, Nepal, Refugees, VaccinesPublication Diabetic Foot Ulcer and its Associated Risk Factors in Diabetic Patients with Peripheral Arterial Disease Presenting in the University Hospital of Nepal(Kathmandu University, 2024) Karmacharya, RM; Maharjan, S; Vaidya, S; Bhatt, S; Sharma, S; Timalsina, G; Kunwar, K; Joshi, HNABSTRACT Background Diabetic foot ulcers (DFUs) are a common complication in diabetic patients especially in those with peripheral arterial disease (PAD). However, it can be prevented if its risk factors can be identified and adjusted. Objective To investigate the frequency of diabetic foot ulcers and their associated risk factors in diabetic patients with peripheral artery disease. Method Diabetic patients under medication with known peripheral arterial disease diagnosed with Doppler ultrasonography were recruited from the outpatient department of the cardiothoracic and vascular unit, at Dhulikhel Hospital. The patients were interviewed about their demographic details, presenting clinical symptoms, and the risk factors such as smoking, hypertension, cardiovascular diseases, duration of diabetes, and hyperlipidemia. Also, the patients were assessed for any ulcers in their feet. Descriptive statistics and chi-square tests were used to analyze the data. Result The analysis demonstrated diabetic foot ulcers in 24.1% of the total 54 diabetic patients with peripheral arterial disease. The risk factors such as smoking (24.1%), increasing age (68.5%), hypertension (31.5%), and duration of diabetes (72.2%) were found in the majority of the patients. Out of these risk factors, smoking (Odds ratio: 6.81) and increasing age (Odds ratio: 0.28) were significantly associated with diabetic foot ulcers. (p < 0.05) Conclusion Diabetic foot ulcers affected about a quarter of diabetic patients with peripheral arterial disease and were found to be associated with increasing age and smoking. KEY WORDS Complication, Diabetes, Foot ulcers, Peripheral arterial disease, Risk factorsPublication Differentiation of Crohn’s disease from intestinal Tuberculosis and Ulcerative Colitis: a single tertiary centre experience in Nepal(Institute of Medicine, 2018) Hamal, R; Pathak, R; Kafle, B; Khadga, PK; Sharma, SAbstract Introduction: Differentiating intestinal luminal tuberculosis from Crohn’s disease (CD) is an important clinical challenge of considerable therapeutic significance. Likewise differentiating ulcerative colitis from Crohn’s disease with colonic or ileocolonic involvement is difficult. The aim of this study was to investigate the clinical, endoscopic, radiologic and histological features that will help to differentiate Crohn’s disease from intestinal luminal tuberculosis as well as from ulcerative colitis. Methods: A total of 40 patients diagnosed with Crohn’s disease, Intestinal luminal TB and Ulcerative colitis who were admitted under the Gastroenterology Department TUTH from July 2017 to February 2018 were included in this retrospective study. Clinical, endoscopic, radiologic, histopathologic and microbiologic features as well as response to treatment of these patients were studied in detail. Results: Among 40 patients, Intestinal TB was diagnosed in 52.5% patients, ulcerative colitis in 32.5% patients and Crohn’s disease in 15% patients. There was a higher incidence of fever, night sweats, lung involvement and ascites in Intestinal TB whereas diarrhea, perianal disease, hematochezia and extraintestinal were predictive for Crohn’s disease. Similarly on colonoscopy involvement of IC valve, patulous IC valve and transverse ulcers favored a diagnosis of intestinal TB in contrast to Crohn’s disease where longitudinal ulcers, aphthous ulcers, cobblestone appearance and rectal involvement were seen.Similarly the diagnosis of Ulcerative colitis was favored by rectal involvement and contiguous involvement whereas patients with Crohn’s disease had significantly more deep ulcers, cobblestoning, skip areas and ileal involvement. Conclusions: Crohn’s disease must be differentiated from Intestinal luminal TB and Ulcerative colitis before treatment. According to our study, a combination of clinical, endoscopic, serologic, radiologic, histopathologic and microbiologic features can be utilized in order to reliably predict and distinguish Crohn’s disease from Intestinal luminal TB and from Ulcerative colitis. In complicated cases deep enteroscopy and surgery may be needed before a confident diagnosis is reached.Publication Effect of Breastfeeding on Relieving Pain during Immunization in Infant(Kathmandu University, 2020) Bhurtel, R; Yadav, U; Chaudhary, R; Shah, S; Poudel, P; Pokhrel, RP; Sharma, SABSTRACT Background Advantages due to immunization are numerous and cannot be avoided but at the same time pain inflicted on babies needs to be addressed when possible. Pain associated with immunization injections has often been overlooked when remedies are available. Objective To find out the effect of breastfeeding on relieving pain during immunization injection in infants. Method An experimental study was conducted at Immunization clinic of B.P. Koirala Institute of Health Sciences (BPKIHS). Total 124 subjects were divided randomly into two groups. Experimental subjects were allowed to breastfeed for 5-10 minutes before immunization while control group was immunized without breastfeeding. Interview Questionnaire was used to obtain demographic variables and measurements were obtained. Measures of pain was recorded using duration of cry and Modified Behavior Pain Scale, by Taddio et al. Data was analyzed by using SPSS 20.0 where variables were assessed with frequency tables, Pearson’s Chi-Square test, independent t test and Mann Whitney U test. Result The mean pain score in experimental group was 7.10 and in control group 7.56 which was statistically significant (p=0.001). The median duration of cry was significantly shorter in experimental group i.e. 25 seconds (IQR: 20-30) than control group 42.5 seconds (IQR: 30-61.5) (p < 0.001). Conclusion Breastfeeding before immunization is effective in reducing pain in infants. KEY WORDS Breastfeeding, Immunization, Infants, PainPublication Effect of Dexmedetomidine with Ropivacaine in Supraclavicular Brachial Plexus Block(Kathmandu University, 2019) Sharma, S; Shrestha, A; Koirala, MABSTRACT Background Brachial plexus block is popular choice for upper limb surgeries and offers good and relatively safe anesthesia. Among various approaches supraclavicular approach is the most consistent method for anaesthesia and postoperative pain management in surgery below the elbow joint. Many drugs are used as adjuvants in brachial plexus block for faster onset, denser block and for prolongation of postoperative analgesia. Dexmedetomidine also has been shown to prolong the sensory and motor duration when added as an adjuvant to local anaesthetic in nerve blocks. Objective To assess the effect of adding dexmedetomidine to ropivacaine in brachial block. Method Sixty patients, planned for upper limb surgeries under ultrasound guided brachial block were randomly allocated into two groups. Group RS (n=30) received 30 ml of 0.5% Ropivacaine + 1 ml Normal Saline and Group RD (n=30) received 30 ml of 0.5% Ropivacaine + 0.75 mcg/kg Dexmedetomidine diluted to 1 ml solution. The onset time to sensory and motor blockade were recorded. The duration of sensory and motor block and duration of analgesia were recorded. Result The mean time to onset of sensory block (12.60±2.67 min Vs 22.17±2.81 min) and motor block (14.20±3.22 min Vs 22.53±3.97) in Group RD was significantly faster in Group RD than Group RS. The mean duration of sensory block (838.70±164.11 min Vs 670.20±145.16 min), motor block (804.16±148.71 min Vs 594.93±53.89 min) and duration of analgesia (1193.80±223.11 min Vs 828.23±136.30 min) were significantly longer in Group RD compared to Group RS. The incidence of side effects in both groups were comparable. Conclusion From this study, it can be concluded that addition of Dexmedetomidine 0.75 mcg/ kg to 0.5% Ropivacaine results in early onset of sensory and motor blockade, prolongation of duration of sensory and motor blockade and duration of analgesia postoperatively without any significant side effects. KEY WORDS Analgesia, Brachial plexus block, Dexmedetomidine, Motor block, Ropivacaine, Sensory blockPublication 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 Epidemiological study of hand injury in a tertiary care centre in Nepal(Institute of Medicine, 2018) Sharma, S; Shrestha, JM; Rayamajhi, S; Manandhar, K; Lohani, IAbstract Introduction: The epidemiology and pattern of hand injury may vary from one region to the other. Due to the lack of systematic documentation, not much is known regarding the epidemiology of hand injury in Nepal. The purpose of this study was to determine the patterns of hand injury in a tertiary care centre in a developing country like Nepal. Methods: A cross-sectional descriptive study was carried out in the Department of Plastic Surgery and Burns, Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. The study included 174 patients presenting with hand injury in the emergency room and the outpatient department. Results: There were 129 (74.1%) males and 45 (25.9%) female patients, the mean age of all patients being 30.3 years. The top four occupations concerned with hand injuries were carpenters, students, manual labourers and factory workers. Most injuries occurred in furniture and wood workshops. Electrically powered saw belt and grinding machinery were the culprits for majority of crush/avulsion injuries whereas broken glass was the commonest cause of sharp cut injury. Tendon injury was the most common diagnosis followed by fractures and fingertip injuries. Accordingly, tendon repair followed by fixation of fractures were the commonly carried out treatment procedures. Conclusion: Hand injuries are very common among young male furniture and wood factory workers as well as manual labourers having occupational exposure to different machines. Formulating safety protocols in the furniture and industrial settings and other machinery related workplaces would play a significant role in reducing the incidence of hand injuries. Keywords: Hand, hand injuries, occupational exposurePublication Evaluation of Anterolateral Plating of Distal Third Tibial Fractures(Kathmandu University, 2017) Pandey, BK; Rijal, KP; Prasai, T; Pradhan, RL; Lakhey, S; Manandhar, RR; Sharma, SABSTRACT Background Distal one-third tibial fractures with or without articular involvement can be difficult to manage. Variety of treatment methods have been suggested for these injuries, including conservative treatment, external fixation with or without limited internal fixation, intramedullary nailing, plate fixation (medial or anterolateral) and more recently minimally invasive plate osteosynthesis (MIPO). All of these techniques have advantages and disadvantages. None of these techniques can be considered the “gold standard” for these injuries. Objective The objective of this prospective study was to evaluate the results of anterolateral plating of these fractures. Method Forty-five fractures of distal third of tibia were treated with open reduction and internal fixation with anterolateral tibial plate from December 2011 to December 2016. All the patients were followed up at least for nine months for the study. Radiological union was finally assessed in nine months. Result All the fractures united within nine months of plating without angulation in sagittal or coronal plane. One patient (2%) had limb length shortening of more than one cm. Full range of motion of ankle and knee joint was achieved compared to the normal side by nine months follow up. 17 (38%) patients developed marginal skin necrosis. Three (7%) patients developed superficial wound infection. These complications were seen more in patients in whom posterior below knee slab was used for pre- operative splintage (as compared to calcaneal traction). Conclusion Hence distal one-third tibial fractures with or without articular involvement can be treated with anterolateral tibial plate. KEY WORDS Anterolateral, Distal, Fracture, Plating, TibiaPublication Experience of Surgical Resection and Reconstruction of Chest Wall Tumor in Dhulikhel Hospital(Kathmandu University, 2025) Karmacharya, RM; Vaidya, S; Bhatt, S; Guragai, M; Sharma, S; Bhandari, S; Shrestha, M; Shah, B; Yadav, BABSTRACT Background Chest wall tumors are rare thoracic tumor which can be either primary or metastatic. Conventional radiography is the first line of investigation followed by further imaging like computed tomography or magnetic resonance imaging. When indicated preoperative biopsy by fine-needle aspiration need to be done. Small chest wall tumor can be surgically treated by excision and primary repair. Bigger chest wall tumor is treated by excision and chest wall reconstruction. Objective To know the features of chest wall tumor, symptoms, histopathological findings, surgical procedures performed and outcome following the surgery. Method This is the retrospective study that included chest wall tumor subjected for excision and repair during January 2018 till December 2023 in Thoracic surgical unit of Dhulikhel Hospital. Variables such as presenting complaints, size and extent of tumor, type of surgery, outcome of the surgery, hospital stay, neoadjuvant chemotherapy and post excision chemo or radiotherapy and recurrence of the tumor were included. When primary repair is not possible following wide excision, reconstruction using double prolene sandwich mesh was done. Result There were 38 cases of chest wall tumor. Mean age of the patient was 42 years (SD 15.25 years, range 20 - 68 years). Of them, 22 patients were female (57.9%) and 16 patients were male (42.1%). Chest pain was the most common symptoms (84.2%) followed by lesion in chest (81.6%). Average size of the tumor was 14.8 ± 3.6 cm (Range 5 cm to 25 cm). Most common histopathological finding was neurofibroma (31.6%) filled by schwannoma (15.8%). All the patients underwent wide local excision. In terms of repair, primary repair was possible in 68.4% while in 31.6% patients repair using double prolene and bone cement sandwich was done. Average hospital stay was 6.6 days (SD 2.3, range 3-9 days). Conclusion Chest wall tumor can have different histopathological findings. In patients where wide resection is possible, it can be repaired by either primary repair or by repair using double prolene and bone cement sandwich. KEY WORDS Chest wall tumor, Reconstruction, ResectionPublication 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 Factors Influencing Male Participation in Maternal Health Care among Married Couples in Nepal: A Population-based Cross-sectional Study(Kathmandu University, 2020) Sharma, S; Aryal, UR; Shrestha, AABSTRACT Background The male involvement in maternal health care is essential to reduce obstetric complications. However, there is little known about factors contributing to male participation in maternal health in Nepal. Objective To assess predisposing, enabling and reinforcing factors contributing male participation in maternal health care in Nepal. Method A population based cross-sectional study was conducted among 374 married couples. Ethical approval was obtained from Institutional Review Board of Kathmandu Medical College Teaching Hospital. The data was collected, using modified Safe Motherhood and Partnership Family Approach Model. Multivariable logistic regression was applied to account associated paternal factors. Concentration curve and concentration index were computed to measure equity gap between lowest and highest quintiles. Result While four out of ten husbands reported high level of their involvement in maternal health care practices, wives reported relatively less involvement of their husbands. Logistic regression showed that husband having low family income, knows about immunization, contact with family planning providers were more likely to participate. In contrary, according to wives, husbands’ who have ever been to health facility, discuss family planning with others, contact with family planning providers and who knows about exclusive breast feeding were less likely to participate. The study also showed that socio-economic factors play a significant role. Conclusion Male involvement in maternal health care practices is low. Predisposing, enabling and reinforcing factors play a significant role; however, some contradictions among husbands’ and wives’ perspectives provide strong evidence on significance of communication within partners on maternal health care issues. KEY WORDS Disparity, Male participation, Reproductive health, Sexual health, Women’s healthPublication 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.