Browsing by Author "Sharma, VK"
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Publication 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 Does serum magnesium analysis need to be a part of routine dyselectrolytemia investigation?(Institute of Medicine, 2017) Tuladhar, ET; Pant, V; Aryal, B; Tumbapo, A; Ghimire, S; Sharma, VK; Bhattarai, A; Raut, M; Yadav, BKAbstract Introduction: The fourth most abundant cation in the body and the second most prevalent intracellular cation, magnesium (Mg) is a co-factor for over 300 enzymes. Though magnesium abnormalities frequently accompany other electrolytes abnormalities, during electrolyte investigation, magnesium estimation is often overlooked. This study aims to investigate the occurrence of magnesium abnormalities in serum samples sent, for routine electrolyte measurement like sodium, potassium, calcium and phosphorus, to the biochemistry laboratory of Tribhuvan University teaching hospital. Methods: Serum magnesium measurement was done in 799 serum samples ordered for various electrolyte estimation. Magnesium, Calcium and phosphorus present in sample was analyzed by BT 3500 machine spectrophotometrically. Sodium and potassium ions were analyzed by direct ion selective electrode method. Results: Only 14(1.75%) samples were requested by physician for magnesium estimation out of total 799 samples sent for various electrolyte estimation. When all 799 samples were analyzed for magnesium level, magnesium abnormalities were identified in 76(9.5%), out of which hypermagnesemia was found in 22 (2.75%) and hypomagnesemia in 54 (6.76%) samples. Conclusion: Since, significant numbers of patient's serum sample, sent for estimation of various electrolytes, are found to have magnesium abnormalities, we recommend routine measurement of this analyte along with other electrolytes. Keywords: Magnesium, Sodium, Potassium, Calcium, Phosphorus, DyselectrolytemiaPublication Results of typhoid perforation management: Our experience in Bir Hospital, Nepal(Kathmandu University, 2006) Karmacharya, B; Sharma, VKObjective: To determine the demographic characteristics, clinical features, operative findings and postoperative complications in patients operated for typhoid enteric perforation. Methods: A retrospective study was carried out in the Department of General Surgery, Bir Hospital since 2002 to April 2004. Among 189 patients who underwent laparotomy for hollow viscus perforation in two years, ileal perforation was found in 102 patients. Results: The sex ratio of the patients was 4.66:1, in favor of male, with age range of 14-78 years and mean age 28.35 years. Most of the patients (80.39 %) presented with history of fever for two weeks. Half of the patients presented within 24 hours of onset of generalized abdominal pain. Majority (65.67%) had a solitary perforation on the antimeseteric border of terminal ileum. Eighty one percent of patients had trimming of the ulcer margins and primary closure. Complications included wound infection (35.3%), wound dehiscence (17.6%), fecal fistula (7.84%) and hospital mortality (6.86%). Conclusion: Typhoid ulcer perforation is common among developing nations, including Nepal. Postoperative complications following surgical management of perforation are high and increases mortality. Key words: Typhoid perforation, wound dehiscence, hospital mortality