Browsing by Author "Sharma, SK"
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Publication Ancient cystic pelvic schwannoma presenting as a right iliac fossa mass(Kathmandu University, 2005) Rai, BR; Chaudhary, D; Thapa, P; Joshi, MR; Dongol, UMS; Singh, DR; Sharma, SKSchwannoma is rare in pelvis. Ancient schwannoma is rarer histological subtype of schwannoma. We report a very rare case of pelvic schwannoma presenting with right sciatica and right iliac fossa pain. Clinical and imaging findings were suggestive of Peritoneal Hydatid cyst. The tumour was resected completely with marked clinical improvement. Histopathological examination showed Ancient cystic schwannoma. Key words: Benign pelvic Schwannoma, Benign retroperitoneal tumour, Giant ancient Schwannoma, Presacral Cystic SchwannomaPublication Antimicrobial utilization pattern in out patient services of ENT department of tertiary care hospital of Eastern Nepal(Kathmandu University, 2005) Das, BP; Sethi, A; Rauniar, GP; Sharma, SKObjective The objective of this study was to monitor the antimicrobial utilization in ENT out patient services in a tertiary care hospital of Nepal. Materials & Methods A total of 191 prescriptions were randomly audited at varying time interval from the department of ENT in the year2003. The data was collected in customized Performa in the form of antibacterial audit questionnaires. It also contained Patient particulars, diagnosis, investigations, drug details and information from the prescriber regarding the indication for prescribing antimicrobial agent, suspecting organism underlying infection, duration of therapy and details of any concomitant medications. Results The incidence of use of antimicrobial agents (AMA) in 191 prescriptions was analyzed from the enrolled prescriptions, a total of 218 antimicrobials i.e.1.4 antimicrobial agent per patient were prescribed. .The AMAs were indicated therapeutically in 73.29% of patients & 19.37% patients for prophylaxis. The AMAs were advised for more than 72 hours for prophylaxis in 86.48%. In the concomitant medications antihistaminic were prescribed in 32.62% and NSAIDS in 21.98% cases. Most of patients reported with upper respiratory tract infections (URTI- 32.56%), Chronic Suppurative otitis Media (CSOM-18.3%), sinusitis (6.28%), tonsillitis (5.75%),. Pharyngitis (3.66%), Acute Suppurative Otitis Media (ASOM-2.61%) and others. The diagnosis was established clinically in 42.40% and confirmative in 35.60%. In 21.46% the diagnosis was not disclosed. Out of 191 patients, culture sensitivity tests were performed for only 31 patients and 13 patients depicted a positive culture sensitivity tests. The common microbes isolated from the culture were staphylococcus aureus (69.2%). Streptococcus (7.7%), Enterobacteriacae (7.7%), Pseudomonas auroginosa (7.7%) & psendomanas mirabilis (7.7%). Clinically suspected organism were mentioned in only 32 prescriptions and most prescriber presumed the infections due to staphylococci & pseudomonas (43.75%), streptococci (21.8%),Gram negative organisms (12.5%) and H influenza (9.3%).The use of a single drug was abundant (89.52%), two drugs (9.94%), and three drugs (0.52% )prescriptions. Ciprofloxacin (23.85%) was preferred, followed by amoxycillin (20.06%), combination of ampicillin + cloxacillin( 9.17%), doxycyclin (5.96%). Erythromycin (4.58%) and cotimoxazole (4.58%). Expensive drugs i.e azithromycin (2.75%), roxithromycin (1.37%) and cephalosporins (3.21%) were also prescribed. The causative microbes were sensitive to amoxycillin (53.84%), cloxacillin (53.84%) ciprofloxacin (46.15%), gentamicin (46.15%), and cephalosporin (46.15%). But resistant to erythromycin, tetracycline, cotrimoxazole and norfloxacin) Conclusions-Majority of patients were prescribed drugs irrationally with misleading indications without confirming the bacteriological culture and sensitivity. Keywords: AMAs (Antimicrobial Agents), URTI (upper respiratory tract infection), Drug utilizationPublication Association of cardiovascular events with glycosylated haemoglobin in diabetic patients(Kathmandu University, 2008) Deo, RK; Karki, P; Sharma, SK; Acharya, PAbstract Background: In persons with diabetes, chronic hyperglycemia (assessed by glycosylated hemoglobin level) is related to the development of microvascular disease; however, the relation of glycosylated hemoglobin (HbA1c) to macrovascular disease is less clear. Objective: To study the association of cardiovascular events (CVE) with glycosylated haemoglobin in diabetic patients. Design: Case control study Setting: B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal Materials and methods: Fifty diabetic patients with recent cardiovascular events: myocardial infarction (MI) or stroke was included in the study. There were 25 patients of myocardial infarction and 25 patients of stroke. Fifty diabetic patients without cardiovascular events were taken as control. Results: After adjustment for age, smoking, body mass index, systolic blood pressure and total cholesterol at baseline, level of HbA1c was statistically signi cant (p = 0.017) among patients with CVE. For MI, level of HbA1c was statistically signi cant (p = 0.018) while for stroke, level of HbA1c was not signi cant (p = 0.694). Mean blood glucose also predicted CVE and MI but not stroke in this study (p values = 0.006, 0.006 and 0.670 respectively). Fasting and postprandial plasma glucose was statistically signi cant in CVE (p values = 0.024 and 0.019 respectively). Urine protein was statistically signi cant for CVE, MI and stroke (p values = 0.000, 0.032, 0.032 and OR 4.571 (95% CI: 1.963- 10.646), 2.667 (95% CI: 1.043-6.815), 2.667 (95% CI: 1.043-6.815) respectively. Limitations: Sample size was limited due to time constraint and limited resources. Cases with peripheral artery disease were not included in the study. Conclusion: Glycosylated haemoglobin is associated with cardiovascular events and myocardial infarction but not stroke. Key words: Glycosylated Haemoglobin, Cardiovascular event, Myocardial infarction, StrokePublication Effect of preload reduction by haemodialysis on doppler indices of diastolic function in patients with end-stage renal disease(Kathmandu University, 2008) Acharya, P; Ranabhat, K; Trikhatri, Y; Manandhar, DN; Sharma, SK; Karki, PAbstract Objective: To assess the influence of preload reduction by haemodialysis on Doppler echocardiographic indices of cardiac diastolic function. Methodology: Parameters of left ventricular diastolic function were measured in patients with end-stage renal disease before and after a single session of haemodialysis. Patients with valvular heart disease, coronary artery disease, cardiomyopathies, pericardial disease and those not in sinus rhythm were excluded from the study. Results: Seventeen subjects (12 males and 5 females, mean age 48 ± 16 years) were studied. Over the duration of 3.7 ± 0.6 hours of haemodialysis, 2.6 ± 1.3 litres of ultrafiltrate was removed. The comparison of pre and post haemodialysis peak mitral E and A velocities showed a decrease in E velocity (p < 0.01) whereas the change in A velocity was not significant. The E/A ratio decreased significantly (p < 0.05).The decrease in E velocity correlated well with the amount of ultrafiltrate (r = 0.653, p < 0.01). There was a significant increase in isovolumetric relaxation time (p< 0.05) whereas deceleration time did not change (p =0.3). Conclusion: Ultrafiltration during haemodialysis causes a rapid reduction in preload. It results in decreased early left ventricular diastolic filling without a change in the atrial phase of filling, hence causing a decrease in calculated E/A ratio. Key words: Doppler indices, echocardiography, diastolic function, end-stage renal disease, BPKIHSPublication Publication Helicobacter pylori infection, glandular atrophy, intestinal metaplasia and topography of chronic active gastritis in the Nepalese and Japanese population: The age, gender and endoscopic diagnosis matched study(Kathmandu University, 2007) Matsuhisa, T; Miki, M; Yamada, N; Sharma, SK; Shrestha, BMBackground: The incidence and mortality from gastric cancer is high in Japanese but extremely low in Thailand. It is different among Asian countries. The aim of this study is to investigate the difference of peptic ulcer disease, glandular atrophy, intestinal metaplasia and topography of chronic active gastritis between the Nepalese and Japanese population. Materials and methods: Nepalese patients were paired with Japanese patients by age, gender and endoscopic diagnosis in order to compare the prevalence of H. pylori infection (N=309) and the difference of H. pylori related peptic ulcer disease (N=48). Glandular atrophy and intestinal metaplasia scores were also compared between the Nepalese and Japanese population in H. pylori positive cases (N=152) and negative cases (N=145) using paired cases by age, gender and endoscopic diagnosis. Paired H. pylori-positive Nepalese and Japanese population were also used to compare the ratio of corpus gastritis to antrum gastritis (C/A ratio) (N=152). Results: Among peptic ulcer diseases, gastric ulcer was frequent in Japanese and duodenal ulcer was frequent in Nepalese. The prevalence of H. pylori infection in the Nepalese and Japanese population were similar. Glandular atrophy and intestinal metaplasia scores in the H. pylori positive Japanese were significantly higher than those of Nepalese in all positions according to triple site biopsy. Furthermore, there were significant differences in glandular atrophy and intestinal metaplasia scores between in the H. pylori-negative Nepalese and Japanese population except intestinal metaplasia score in the greater curvature of the upper corpus. Japanese C/A ratio was significantly higher than that of Nepalese. Corpus predominant gastritis (C/A ratio>1.00) was characteristic in the elderly Japanese. Nepalese was antrum predominant (C/A ratio<1.00) in every age group. Conclusions. Gastric ulcer was a common disease in Japanese, in contrast duodenal ulcer was common in Nepalese. H. pylori infected Japanese patients showed severe atrophic and metaplastic gastritis in comparison with Nepalese. These results may be associated with the high incidence of gastric cancer in Japanese. Corpus predominant gastritis was found in the elderly Japanese and antrum predominant gastritis was found in every age Nepalese. Key words: H. pylori, atrophy, metaplasia, corpus-predominant gastritis, NepalPublication Increasing Access to Safe Abortion Services Through Auxiliary Nurse Midwives Trained as Skilled Birth Attendants(Kathmandu University, 2011) KC, NP; Basnett, I; Sharma, SK; Bhusal, CL; Parajuli, RR; Andersen, KLABSTRACT Background The use of medical abortion methods was approved by Department of Health Services in 2009 and introduced in hospitals and a few primary health centres (PHCs). Access would increase if services were available at health post level and provided by auxiliary nurse midwives trained as skilled birth attendants. Evidence from South Africa, Bangladesh, Nepal and Vietnam show that mid-level health workers can provide medical abortion safely. Objectives To determine the best way to implement the new strategies of medical abortion into the existing health system of Nepal; and to facilitateits full-scale implementation, monitoring and evaluation. Methods An implementation research involving a baseline study, implementation phase and end line study was done in ten districts covering five development regions from July 2010 to June 2011. Both qualitative and quantitative methods were used. Results Of 1,799 medical abortion clients who received service, 46% were disadvantaged Janjati, 14% were Dalit, 42% were upper caste groups and rest were advantaged Janjati (7%), Muslim (1%) and others. 14% were referred by female community health volunteers and 56% were referred by others. Complication rate of 0.3% was well below acceptable levels. Condom use increased from 8% to 28% by the end of study. Use of Pills, Depo, intra uterine devices and Implants also increased, but use of long acting family planning methods was negligible. Conclusions This model should be replicated nationwide at health posts and sub-health posts where auxiliary nurse milwifes are available 24 hours/day. Focus should be given first to those areas where access is difficult, time consuming and costly. KEY WORD medical abortions, safe abortion services, skilled birth attendantPublication Influence of duration of symptoms over perioperative outcomes during emergency laparoscopic cholecystectomy(Kathmandu University, 2009) Sharma, SK; Thapa, PB; Maharjan, DK; Dhakal, A; Baral, NAbstract Background: Laparoscopic cholecystectomy is a gold standard treatment for gall stone diseases. Early surgical intervention in acute calculus cholecystitis is feasible and duration of onset of symptoms does not influence the conversion rate. Objective: To compare the safety and feasibility between urgent and delayed laparoscopic cholecystectomy in patients with acute calculus cholecystitis. Materials and methods: This is a comparative study conducted in Department of Surgery, Kathmandu Medical College, during the period of January 2006 to January 2008. Alltogether, 436 patients were analysed out of which 55 were selected as urgent laparoscopic cholecystectomy and were included in the study. Among 55 patients presented with acute calculus cholecystitis were divided into two groups. Group 1 underwent laparoscopic cholecystectomy within 72 hours of onset of pain abdomen and Group 2 after 72 hours of onset of pain abdomen. Results: Conversion rate in Group 1 was 19.44% whereas it was 263% in Group 2 (p = .693). There was no statistically significant difference in mean operating time (p = .412), total hospital stay (p = .626), bile duct injury and postoperative complications. Conclusion: Urgent laparoscopic cholecystectomy is safe and duration of onset of pain abdomen does not influence conversion rate. Key words: Urgent laparoscopic cholecystectomy, Conversion rate, acute calculus cholecystitisPublication Intra-abdominal abscess presenting as a thigh abscess(Kathmandu University, 2004) Chaudhary, D; Magar, A; Thapa, P; Singh, DR; Sharma, SKSecondary thigh abscesses are rare, and their cause is often obscure. We report a case of an elderly diabetic who presented with thigh abscess secondary to tuberculous sacroilitis. Key words: Secondary thigh abscess, retroperitoneal abscess, tuberculous sacroilitisPublication Left ventricular hypertrophy in hypertension: Correlation between electrocardiography and echocardiography(Kathmandu University, 2009) Prakash, O; Karki, P; Sharma, SKAbstract Background: Hypertension is an important modifiable cardiovascular risk factor. Left ventricular hypertrophy – the marker of hypertension, has emerged as an independent risk factor that can be detected by electrocardiography (ECG) and echocardiography (ECHO). Objective: Correlation of electrocardiography and echocardiographically detected left ventricular hypertrophy in hypertensive patients. Materials and methods: Hundred patients with hypertension were studied for left ventricular hypertrophy by the help of electrocardiography and echocardiography. Left ventricular hypertrophy on ECG was assessed by the help of Sokolow- Lyon Voltage Criteria (SLV) and Romhilt – Estes Point Score (R/E). Results: Among 100 patients, 60 were males and 40 were females. Mean age for male was 54.82 + 12.10 years and 52.95 + 11.63 years for female. The mean systolic blood pressure for male was 150.47 + 20 mmHg and for female 148.60 + 16.95 mmHg; where as Diastolic blood pressure for male was 93.67 + 11.13 mmHg and for female it was 96.05 + 12.47 mmHg. Echocardiography detected left ventricular hypertrophy in 64% patients. Electrocardiography detected Left Ventricular Hypertrophy by R/E and SLV criteria 13% and 34% respectively. Conclusion: In developing and under developed country ECG is a useful tool for detection of LVH where the facilities of echocardiography and trained echocardiographer are still not in a common man’s reach. Key words: Left ventricular hypertrophy, HypertensionPublication Omental torsion: a case report(Kathmandu University, 2005) Chaudhary, D; Rajkarnikar, R; Joshi, MR; Thapa, P; Singh, DR; Sharma, SKOmental torsion is a rare cause of acute abdomen. Most often it presents with sign and symptoms of acute appendicitis. It is seldom considered in the differential diagnosis preoperatively based on clinical findings and the diagnosis is only established during surgery. We present a case of omental torsion in a middle aged male patient who presented with findings suggestive of appendicular perforation and underwent emergency laparotomy. Key words: acute abdomen, omentum, torsion, appendicitisPublication Perceptions and Care Seeking Behavior of Obstetric Complication in Thailand(Kathmandu University, 2012) Sharma, SK; Vong-Ek, PABSTRACT Background Importance of maternal health has been recognized over the last decade, however information about the perception of illness and healthcare behavior of obstetric complication is lacking. Objective This study assesses women’s knowledge, perception, and experience of obstetric complication and care-seeking behavior and explores the factors associated with the morbidity and the constraints hindering them from seeking timely care. Methods Twenty one in-depth interviews on the perceptions, experience and care seeking behavior related to pregnancy and delivery of Women at Kanchanaburi Demographic Surveillance site of Thailand were conducted. A structured guideline was first prepared in English and translated into Thai language. An interpreter was hired to interview women at the Thai-Myanmar border to translate Thai into local language. A moderator note-taker, and interpreter were present throughout the interview period and tape recorded the conversation. Results In-depth interview revealed that even though quality maternal health care was accessible to most of the women, obstetric complication was prevalent and they were not seeking appropriate care specifically in highland. Too early and too late marriage, frequent child bearing, poverty, hard work, poor nutrition and traditional practices were the reasons for complications. Poor transportation, lack of health insurance, inadequate training of health personnel, poor health facilities and the perception that the complications are normal for pregnant women were the main reasons for not seeking appropriate care. Conclusions Perceived reasons for complications among women living in Kanchanaburi, Thailand were early marriage, frequent childbearing, hard work, poor nutrition and traditional practices. The constraints hindering them from seeking care for the complications were perceived to be the lack of access to health personnel, health facilities, and proper transportation. These issues seemed to be related to poverty. KEY WORD Care-Seeking, Complication, Obstetric, Perception, ThailandPublication Predicting difficulties during laparoscopic cholecystectomy by preoperative ultrasound(Kathmandu University, 2007) Sharma, SK; Thapa, PB; Pandey, A; Kayastha, B; Poudyal, S; Uprety, KR; Ranjit, SBackground: The aim of this study was to determine whether the preoperative USG finding can predict the risk of conversion or difficulty during the laparoscopic cholecystectomy. Materials and methods: 200 patients undergoing Laparoscopic cholecystectomy at Kathmandu Medical College Teaching Hospital were included. Sonographic parameters like size of gall bladder, wall thickness, distance between hepaticoduodenal ligament and Hartmann’s pouch and the size of stone were taken into consideration and difficulties in terms of adhesions around gall bladder, anatomy of calot’s triangle and difficulty in peeling off gall bladder from the bed and retrieval were analyzed. Result: In 8 of 200 patients (4%), LC was converted to open procedure. In univariate analysis all the sonographic parameters we had included in this study were statically significant (p value <0.05). Conclusion: Preoperative sonographic signs can predict the difficulty in laparoscopic cholecystectomyPublication Removal of central venous catheter fragment embolus in a young male(Kathmandu University, 2006) Thapa, PB; Shrestha, R; Singh, DR; Sharma, SKA 22 years male admitted with severe pancreatitis with central venous catheter implanted for central venous pressure monitoring and for providing total parental nutrition developed catheter fragment embolus due to accidental fracture of the same while manipulating it. Non surgical retrieval of the same was done by radiological intervention without any complication. Key words: intravascular catheter fragments, transfemoral venous approach, interventional proceduresPublication Risk factors, associated health problems, reasons for admission and knowledge profile of diabetes patients admitted in BPKIHS(Kathmandu University, 2006) Mehta, RS; Karki, P; Sharma, SKObjectives: The objective of the study was to find out the demographic profile, identify the known risk factors, assess the associated health problems, find out the reasons for admission and explore the knowledge profile of the patients admitted with diabetes in medical units of BPKIHS. Methods: It was hospital based exploratory study conducted among the admitted DM patients during the period of 1-3-2003 to 29-2-2004 in medical units using simple random sampling, which included 35 samples. The data was analysed using Excel and SPSS programme. Results: About 54% subjects were of age group between 40-60 yr., Hindu 85.7%, married 92.9%, and non- vegetarian 75.9 %. About 50% of subjects were on Insulin. About 60.7 % subject had hypertension, 39.3 % had ocular problem, and 25 % had renal problems. Majority of subject (82.1 %) had knowledge about the disease, they were suffering but limited subject had the knowledge about, causes, curability, treatment modalities, diet, and other aspects. Conclusions: As the knowledge regarding various aspects of DM is very low, there is need for information booklet in Nepali and health education programme among public will be very beneficial. Key Words: Risk Factors, Associated Health problems, Knowledge profile, Diabetes.Publication Total thyroidectomy: the treatment of choice in differentiated thyroid carcinoma(Kathmandu University, 2005) Shrestha, SK; Joshi, MR; Sharma, SKIntroduction: Clinically detectable thyroid carcinoma constitutes less than 1% of human cancers. Ninety percent of all thyroid malignancies are differentiated papillary and follicular carcinoma. Surgery plays a key role in differentiated thyroid carcinoma as it carries excellent prognosis, lower recurrence rate and low mortality rate but controversy persists for extent of surgery and optimal surgical management of lymph node metastasis. Patient and Method: A retrospective analysis was done for the cases that underwent total thyroidectomy with lymph node dissection for differentiated carcinoma of thyroid in Kathmandu Medical College during two year periods (Oct 2001 to Oct 2003). Result: In our experience with 18 cases of Differentiated Thyroid Carcinoma (DTC) treated with total thyroidectomies and lymph node dissection, papillary carcinoma was predominant with 83% incidence. Disease was prevalent in 50 to 60year age group. Except two cases of transient hypocalcaemia and few wound related complications, there have been no other complications. Conclusion: Total thyroidectomy with lymph node dissection is safe and effective, so, the treatment of choice in cases of differentiated thyroid carcinoma.Publication Use of percutaneous thread loop to hold the vermiform appendix during laparoscopic appendectomy(Kathmandu University, 2007) Joshi, MR; Shrestha, SK; Thapa, PB; Koirala, U; Bhattarai, P; Dongol, UMS; Singh, DR; Sharma, SKIntroduction: Laparoscopic appendectomy, although not as widely performed as laparoscopic cholecystectomy, it has got definite advantage over the conventional open procedure. Controversy exists regarding the closure of stump. Our institute practices intracorporeal knot tying using 3 ports. Difficulties are observed in three port technique to hold the appendix during knot tying. We use a percutaneous thread loop. Advantage of the use of loop was evaluated. Patients and method: Prospective study was carried out during 18 months. Total cases were randomly divided in non-loop and with loop group. Operative procedure was same. Cases were compared in terms of operating time, post-operative hospital stay and complications. Results: Total patients were 66. Thirty two in non-loop group and 34 in with loop group. Mean age was 27.89 yrs. Most of the cases were females (62%). Mean operating time was less in loop group although statistically not significant. There was no difference in post operative hospital stay. Use of loop was not associated with added complications. Conclusion: Use of percutaneous loop to hold the appendix reduces the operating time and replaces the need of fourth port. It is safe and effective without any increased morbidity. Key words: Laparoscopic appendectomy, Intracorporeal knot, Percutaneous loop