Browsing by Author "Shrestha, PM"
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Publication 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 Comparison between Simple and Classical Techniques to Create Closed Pneumoperitoneum(Kathmandu University, 2021) Gharti, BB; Shrestha, PM; Shrestha, A; Basnet, RB; Shah, C; Adhikari, BABSTRACT Background Closed method of pneumoperitoneum using Veress needle is an established technique. Classical closed technique is popular. Simple technique is a modified closed technique. Objective To compare the classical and simple techniques of closed pneumoperitoneum. Method This study was conducted in the department of urology, Bir hospital from August 1st 2019 to March 30th 2021. Total 114 patients were randomized into simple and classical technique of creating closed pneumoperitoneum. Time taken for creation of pneumoperitoneum, complications and failure of creating pneumoperitoneum in each group noted and analyzed. Chi square test, Fischer exact test and student t test were used and p < 0.05 considered significant. Result Among 114 patients, 61 in simple and 53 in classical technique allocated. In simple technique, mean age was 42.98±18.21 years, BMI was 21.84±2.57 kg/m2, mean time for pneumoperitoneum creation was 108.07±21.14 seconds. In classical technique, mean age was 40.15±17.58 years, BMI was 21.94±2.54 (kg/m2), mean time for pneumoperitoneum creation was 189.70±32.21 seconds. Mean time was less in simple technique than classical technique (p < 0.001). Complication rate observed was 6% in each technique (p=0.797) with cumulative rate of 10%. Omental injury was seen in 3.2% in simple technique and 5.6% in classical technique (p=0.662). Retroperitoneal insufflation was seen in 6.5% in simple technique and 5.6% in classical technique (p=0.842). No failed pneumoperitoneum was observed in both groups. Conclusion Simple technique is as effective, reproducible and safe method as classical technique of creating closed pneumoperitoneum. KEY WORDS Classical technique, Pneumoperitoneum, Veress needlePublication En Bloc Versus Conventional Resection of Primary Bladder Tumor(Kathmandu University, 2025) Thapa, BB; Shah, AK; Adhikari, B; Mishra, U; Dahal, R; Rasali, N; Basnet, RB; Shrestha, PM; Shrestha, AABSTRACT Background Transurethral resection of bladder tumor (TURBT) is the crucial and standard approach in the diagnosis and management of urinary bladder cancer. Objective To compares conventional piecemeal and en bloc resection techniques in terms of detrusor muscle presence in resected specimens, surgical safety, and feasibility. Method A prospective comparative study conducted from April 2024 to March 2025 included patients with up to three bladder tumors, measuring ≤ 3 cm, who were alternately assigned to undergo either conventional piecemeal resection or en bloc resection. The primary outcome was the presence of detrusor muscle in the resected specimen. Secondary outcomes included operative time duration, bladder perforation, and obturator reflex. The quality of tissue was assessed by pathologists using a Likert scale. Result Eighty-seven patients were included, 43 in the conventional and 44 in the en bloc group. The baseline characteristics and tumor size were comparable. Presence of detrusor muscle in specimens was higher in en bloc group (97.7% vs 83.7%; p = 0.030). Operative duration was shorter in the en bloc group (35.55 minutes vs 43.42 minutes; p = 0.001). A case of bladder perforation was observed in the conventional group. Pathologists observed better specimen orientation and architecture in the en bloc group. Presence of tumor in re-TURBT was 16.0% in the en bloc group and 28.6% in the conventional group (p=0.497). Conclusion En bloc resection yielded a higher presence of detrusor muscle and shorter operative duration with better specimen quality compared to conventional piecemeal resection for tumor ≤ 3 cm. KEY WORDS Detrusor muscle, En bloc resection, Transurethral resection of bladder tumorPublication Feasibility, Safety and Acceptance of Buccal Mucosa Harvest Under Local Anesthesia for Substitution Urethroplasty: Prospective Observational Study in a Tertiary Centre(Kathmandu University, 2024) Pandey, A; Shrestha, PM; Shrestha, A; Basnet, RB; Adhikari, B; Shah, AK; Mishra, UABSTRACT Background Urethral stricture is a challenging condition with significant socioeconomic impacts, often requiring surgical intervention such as urethroplasty. Buccal mucosa grafts (BMG) are a popular choice for substitution urethroplasty due to their favorable outcomes. This study evaluates the feasibility, safety, and acceptance of harvesting buccal mucosa grafts under local anesthesia. Objective To assess feasibility, safety and acceptance of Buccal mucosa harvest under local anesthesia. Method A prospective observational hospital based study to evaluate outcomes of substitution urethroplasty using buccal mucosa grafts (BMG) under local anesthesia. Result Of the 40 patients, 28 had unilateral graft harvests, while 12 had bilateral procedures. The mean graft length obtained was 5.65 cm. Postoperatively, patients experienced a quick recovery, with full mouth opening achieved within an average of 2.78 days and resumption of normal eating within 2.6 days. Minor complications included oral swelling in 15% of cases and food residue in 12.5%. Although 87.5% of patients reported pain at the perineal wound site, the overall pain score averaged 3.58, indicating manageable discomfort. Importantly, 92.5% of patients expressed a willingness to undergo the procedure again if necessary. Conclusion These findings suggest that buccal mucosa graft harvest under local anesthesia is both feasible and well-tolerated. The procedure appears to be a safe alternative to regional or general anesthesia, with minimal complications and a high level of patient acceptance. Future randomized controlled trials comparing local anesthesia to regional or general anesthesia could provide additional insights and further validate these findings. This study contributes to the growing body of evidence supporting the use of local anesthesia in urethral stricture surgery, offering a practical approach to managing this condition effectively. KEY WORDS Buccal mucosa graft, Feasibility study, Local anesthesia, Substitution urethroplasty, Urethral stricturePublication Minimally Invasive Plate Osteosynthesis with Locking Compression Plate for Distal Diametaphyseal Tibia Fracture(Kathmandu University, 2011) Shrestha, D; Acharya, BM; Shrestha, PMABSTRACT Background Distal diametaphyseal tibia fracture though requires operative treatment is difficult to manage. Conventional osteosynthesis is not suitable because distal tibia is subcutaneous bone with poor vascularity. Closed reduction and minimally invasive plate osteosynthesis (MIPO) with locking compression plate (LCP) has emerged as an alternative treatment option because it respects biology of distal tibia and fracture hematoma and also provides biomechanicaly stable construct. Objectives To find out suitability of MIPO with LCP for distal diametaphyseal tibia fracture including union time and complicatios and compare wih other available management options in literature. Methods Twenty patients with closed distal diametaphyseal tibia fracture with or without intra articular extension (AO classification: 12 type 43A1, 4 type 43A2, 2 type 43A3 and 2 type 43B1) treated with MIPO with LCP were prospectively followed for average duration of 18.45 months (range 5-30 months). Results Average duration of injury-hospital and injury-surgery interval was 12.8 hrs (range 2-44 hrs) and 4.45 days (range 1-10 days) respectively. All fractures got united with an average duration of 18.5 weeks (range14-28weeks) except one case of delayed union which was managed with percutaneous bone marrow injection. Two patients had union with valgus angulation < 5 degees but no nonunion was found. There were two superficial and one deep post operative wound infection. All infections healed with extended period of intravenous antibiotics besides repeated debridemet for deep infection. Implants were removed in eight patients among whom six (30%) had malleolar skin irritation and pain due to prominent hardware. Conclusion The present case series shows that MIPO with LCP is an effective treatment method in terms of union time and complications rate for distal diametaphyseal tibia fracture. Malleolar skin irritation is common problem because of prominent hardware. Key Words Distal diametaphyseal tibia fracture; LCP, MIPOPublication Outcome of Transurethral Vaporisation of Prostate in Small Volume Prostate: A prospective observational study(Kathmandu University, 2024) Dahal, R; Adhikari, B; Mishra, U; Shah, AK; Basnet, RB; Shrestha, A; Shrestha, PMABSTRACT Background Benign Enlargement of Prostate is common in aging men. Transurethral vaporisation of prostate is one modality of minimal invasive management of benign enlargement of prostate. This study assesses the efficacy and safety of transurethral vaporisation of prostate in small volume prostate. Objective To assess the efficacy and safety of bipolar plasma vaporisation of small volume prostate (Prostate Volume less than 40 grams). Method A total of 40 patients with prostate volume less than 40 grams and indications for operative management of benign enlargement of prostate were included. Patients with prior prostate surgery, urethral stricture surgery, presence of vesical calculus, urethral stricture and neurogenic bladder were excluded. Preoperative prostate size was assessed by transrectal ultrasonography. Comparison of preoperative and postoperative hemoglobin, sodium, international prostate symptom score and maximum flow rate was done. Perioperative complications were documented. Result The mean age of patients was 66.88 ± 9.09 years and the mean size of prostate was 32.52 ± 4.66 grams. Significant improvement in IPSS (preoperative 22, postoperative 9) and Qmax (preoperative 8.4 ml/min, postoperative 18.5 ml/min) was noted. There was significant drop in hemoglobin (p < 0.001) but no patients required blood transfusion. There was significant drop in sodium (p < 0.001) but no patients developed transurethral resection syndrome. Most complications were Clavien grade I. Two patients required recatheterization and all were catheter free on follow up. Two patients developed urethral stricture. Conclusion Bipolar transurethral vaporisation of Prostate is effective and safe treatment option for prostate volume less than 40 grams. KEY WORDS Bipolar plasma vaporisation, Lower urinary tract symptoms, Prostate symptoms