Browsing by Author "Singh, AK"
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Publication Analysis of Lung Cancer Cases Presenting in Outpatient Department of University Hospital of Nepal(Kathmandu University, 2022) Karmacharya, RM; Singh, AK; Vaidya, S; Tuladhar, SM; Devbhandari, M; Lama, B; Kharel, BB; Basnet, SABSTRACT Background Lung cancer is one of the leading cause of cancer related death. Most common histopathology of lung cancer is non-small cell carcinoma of which adenocarcinoma is the most common. There are limited number of studies done in Nepal to know different aspects of lung cancer. Objective To know demographic parameters of patients diagnosed as lung cancer in a university hospital. The study also aims to know the different histopathological diagnosis of lung cancer. Method All the patients presenting to outpatient department (Cardio Thoracic and Vascular unit) of Dhulikhel Hospital, if are diagnosed as cancer of lung/bronchus will be included in the study. The duration of the study was January 2017 to December 2021. The details on age, gender, presenting symptoms, histopathology of lung cancer, operability will be included in database and will be analyzed. Result There were total of 127 patients diagnosed as lung cancer. Male:female ratio was 1.7:1. Overall mean age was 63.23 years (SD 13.5 years, Range 19-89 years). Non small cell carcinoma was the most common type of lung cancer with 83.7%. In non small cell carcinoma, most common type was Squamous cell carcinoma followed by undifferentiated and Adenocarcinoma. Only five (3.93%) cases were in operable stage. Conclusion Despite the fact that lung cancer is one of the most common cancer, patients usually present late and moslty are not in operable stage. This study shows that squamous cell carcinoma is the most common histopathology in lung cancer cases. KEY WORDS Lung Cancer, Smoker, ThoracotomyPublication C-ARM Guided Angiogram/Angioplasty for Selected Failed Arterio Venous Fistula. A Report of a Procedure at University Hospital of Nepal(Kathmandu University, 2021) Vaidya, S; Karmacharya, RM; Singh, AK; Vaidya, PR; Malinowski, M; Dhakal, AABSTRACT End Stage Renal Disease is a last stage of Chronic Kidney Disease which is characterized by Glomerular Filtration rate of less than 15 ml/min/1.73 m2. Hemodialysis is the most commonly used modality for treatment of Chronic Kidney disease. Among the access for hemodialysis arteriovenous fistula is the most common modality. However most common problems of fistula are significant stenosis of more than 50% which is characterized by limb swelling, pigmentation, tortuous veins, and difficulty maintaining flow during dialysis from AV fistula. These can be managed either by minimal intervention or with surgical intervention. Very few hospitals in Nepal and other countries have an angiographic suite to perform minimal intervention include angiogram with angioplasty. So in this case we try to address the use of C-Arm to perform angiogram or fistulogram and even angioplasty for the management of significant stenosis or complications of arteriovenous fistula. KEY WORDS Angiogram/Angioplasty, Arterio venous fistula, C-armPublication Clinical Profile of Patients Presenting with Gallstone Disease in University Hospital of Nepal(Kathmandu University, 2020) Joshi, HN; Singh, AK; Shrestha, D; Shrestha, I; Karmacharya, RMABSTRACT Background Gallstone disease is one of the most common surgical problem throughout the world. The rise in gallstone disease burden and its wide spectrum of non-specific presentation makes the disease more challenging. Objective To know the various modes of presentation, socio-demographic details of the patients with gallstone disease, any associated factors and its treatment options. Method This is a prospective descriptive study in the patients presenting to Dhulikhel Hospital Kathmandu University Hospital diagnosed with gallstone during May 2018 to April 2020. After receiving ethical clearance from institutional Review committee, the informed consent was taken from all patient involved in the study. The presence of gallstone was confirmed by abdominal ultrasonography (USG). This study included total of 202 patients with gallstone disease. Result A total of 202 individuals with gallstone were included in the study; 48 males (24%) and 154 females (76%). The disease condition was common in age group 31-40 years (26.24%). Majority of the study population consumed mixed diet (92.57%). Out of 202 patients; 52 patients (25.74%) were overweight. In this study series 185 patients (91.58%) were symptomatic. Pain abdomen was one of the commonest symptoms (97.84%) followed by Nausea (28.11%), Dyspepsia (28.11%), Vomiting (18.38%), Fever (1.62) and Jaundice (1.08%). All cases were planned for laparoscopic cholecystectomy however 4 cases had to be converted to open surgery for completion. Conclusion Gallstone disease is a common surgical problem in Female population that presents most commonly with pain abdomen. Laparoscopic cholecystectomy can be easily performed in all cases of gallstone disease. KEY WORDS Cholecystolithiasis, Cholecystectomy, Gallstone disease, Laparoscopic cholecystectomyPublication Dysnatremia in Traumatic Brain Injury and its Association with Outcome(Kathmandu University, 2022) Bishokarma, S; Thapa, U; Thapa, M; Singh, AK; Gurung, S; Aryal, B; Maharjan, AMS; Lakshmipathy, GABSTRACT Background Traumatic brain injury on its own results in significant mortality and morbidity but it also contributes to complications that manifest as dysnatremia in the majority of cases. Objective The objective of this study is to assess the association of hyponatremia and hypernatremia with the severity of traumatic brain injury and its impact on mortality. Method This is a retrospective, descriptive, and analytic study conducted during a 1-year period from March 2018 to March 2019. The study population was selected from the patients presenting to the emergency department with TBI in the Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal. All the patients that fulfilled the inclusion criteria of age were enrolled in the study. Patients with known renal disease due to the higher incidence of electrolyte disbalance were excluded. Association of outcome with hyponatremia and hypernatremia were sought using chi-square, fisher exact test and independent t test using SPSS ver 20. Result Over a period of 1 year, 367 patients with traumatic brain injuries were treated in our hospital. Hyponatremia was seen among 55 patients (14.9%) and hypernatremia was seen among 22 patients (5.99%). The age range of patients included in the study was 16 to 87 with a mean age of 37.96 ± 16.512 years. The male to female ratio was calculated as 3.2:1. Mild, moderate, and severe head injuries were 286 (77.9%), 37 (10.1%), and 44 (12%) respectively. Surgical intervention was performed among 77(21%) individuals. Our series showed an association between the severity of traumatic brain injury and hyponatremia however didn’t show an association between the severity of traumatic brain injury and the development of hypernatremia. Conclusion We concluded that the severity of head injury is associated with severity of hyponatremia but not with severity of hypernatremia. Similarly, a strong association existed between the severity of hypernatremia and outcome of patients. However, such association was not seen with hyponatremia. KEY WORDS Hypernatremia, Hyponatremia, Mortality, Severity, Traumatic head injuryPublication Knowledge, Attitude and Practice Regarding COVID-19 and its Impact on Dentistry: A Cross-sectional Survey among Nepalese Dentists(Kathmandu University, 2020) Khanal, N; Singh, AKABSTRACT Background Coronavirus Disease, 2019 (COVID-19) is a highly infectious respiratory disease with high transmissibility. Dentists are at inherent risk because of aerosol generating procedures exposing dentists to the respiratory and oral secretions of the patients. Objective To assess the knowledge, awareness, and practice (KAP) of the Dentists to combat the pandemic which could help shape future guidelines and policies to be implemented in dental settings. Method This cross-sectional descriptive study included series of multiple-choice questions distributed online, assessing dentists’ KAP towards COVID-19, its impact on dentistry and their psychological well-being. Statistical analysis was performed using SPSS (Statistical Package for Social Sciences) version 20 for mac Operating System (OS). Descriptive statistics was performed, and frequencies of responses were reported in proportion. Non-parametric tests of independence and Chi-square test were performed to see the association between the categorical variables. Result Around 84% of the respondents accurately answered mode of transmission, 68% inquired about the travel history while only 49% measured the body temperature. Also, only 42% were receiving salary. A statistically significant difference concerning impact and practice during the COVID-19 was observed between general practitioner and specialist working at different work places. Conclusion Majority of Dentists have good knowledge and awareness but there were certain pitfalls in attitude and practice level calling out for more efficient training programs, precise guidelines, and treatment protocols to put into practice. Also, the mental distress and the financial impact subjected upon dentist require to be further explored determining the association between their mental health during and post COVID-19 outbreak. KEY WORDS Aawareness, Behavior, COVID 19, Dental care professionals, KnowledgePublication Open Surgical Management of Abdominal Aortic Aneurysm at a Community Based University Hospital in Nepal(Kathmandu University, 2020) Bhandari, N; Karmacharya, RM; Devbhandari, M; Shrestha, B; Singh, AK; Ranjit, S; Shrestha, KRABSTRACT Aortic aneurysms are abnormal dilatation of aorta. The risk factors include male sex, age > 65, smoking, coronary artery disease and hypertension. Here we report a case of infra-renal abdominal aortic aneurysm (AAA) of diameter 6 cm. The patient sucessfully underwent aorto-biiliac bypass surgery using Dacron Y graft. During abdominal aortic aneurysm surgery anesthetic challenge is also of paramount importance and should be considered. KEY WORDS Abdominal aortic aneurysm, Aorto-biiliac bypass, Dacron graft, Vascular surgeryPublication Outcome of Uretero Renoscopic Lithotripsy (URSL) with Holmium LASER Vs Pneumatic Lithotripter for Lower Ureteric Stones, Experience from University Hospital of Nepal(Kathmandu University, 2020) Joshi, HN; Singh, AK; Koirala, N; Karmacharya, RMABSTRACT Background There are various methods of endoluminal ureteral stone fragmentation. Among various modalities Laser lithotripsy and Pneumatic lithotripsy are commonly used and have shown comparable outcomes. Objective To compare the efficacy and outcome of laser and pneumatic lithotripsy in a patient with lower ureteric calculi. The comparison will be done in stone free rate, migration of stone and complication of the procedure. Method This is a prospective comparative study in a cohort of patients at University Hospital with Lower Ureteric stone. Ninety patients were randomized in to two groups (Laser Lithotripsy Vs Pneumatic Lithotripsy) during the study period. The purpose of this study was to measure the immediate stone free rate, intra-operative complications, mean operative time, post-operative complication and if any stone retention after six weeks follow up. Result Both the groups were similar in Age and Gender. Immediate stone free rate was slightly higher in Laser lithotripsy group (97.77%) in comparison to Pneumatic lithotripter group (84.44%) with p=0.507 which is not statistically significant. There was statistical difference in terms of stone migration rate, mean operation time in favor of Laser Lithotripsy group (p<0.01, in both parameters). There were no immediate complications in both the group however there were three cases of short segment ureteric strictures (6.66%) in case of Pneumatic lithotripsy on six weeks follow up which was managed conservatively. Conclusion Both LASER lithotripter and Pneumatic lithotripter are equally efficacious modality of endoluminal URSL in lower ureteric stone with similar Stone Free Rate. Laser lithotripsy showed lower frequency of stone migration and had shorter procedure time. KEY WORDS Laser lithotripsy, Lower ureteric calculus, Pneumatic lithotripsyPublication Smoking women and their lung function tests(Kathmandu University, 2004) Prasad, BK; Sahay, AP; Singh, AKSmoking amongst women has become significant as the number of smoking women is increasing gradually in this developing society. It affects the lungs to produce Chronic Obstructive Pulmonary Disease (COPD). Present study was conducted over 100 smoker's women and 100 non-smoker women in the age group of 30-40 Years. Three Lung Function Tests – FEVI, FVC and PEFR were employed to all smoking and non-smoking women. It was observed that all the above mentioned three parameters of lung function tests were reduced significantly among smoker women as compared to non-smoker women. These reduced parameters of lung function test among heavy smokers are suggestive of chronic obstructive lung diseases. Key Words: Smoking, FEV1, FVC, PEFR, COPD.Publication The Cut-off Value of Great Saphenous Vein Diameter at the Level of Femoral Condyle to Predict the Sapheno-Femoral Junction Incompetence(Kathmandu University, 2022) Singh, AK; Karmacharya, RM; Vaidya, S; Shrestha, I; Siwakoti, SABSTRACT Background Varicose vein is one of the commonest problems that patients visit to a vascular out patient services (OPD). It causes a great deal of morbidity in today’s population. Objective To see the correlation between the size of great saphenous and Saphenofemoral junction incompetence. Method From January 2019 till January 2020, 396 patients with symptomatic or clinically diagnosed varicose veins were screened for Saphenofemoral junction reflux. The diameter of the saphenous vein was measured with B-mode imaging, and reflux was quantified based on valve closure time using Doppler spectral measurements. Best saphenous vein diameter cutoff for predicting reflux was determined using receiver operating characteristics curve analysis. Result Out of 792 limbs, the Great Saphenous Venous System was involved in 452 limbs, the Short Saphenous Venous System was involved in 151 limbs and significant perforators were present in 240 limbs. Mean great Saphenous Vein diameter of diseased limb (Reflux Positive) was 5.68 mm and 4.0 mm in control group (Reflux Negative). Mean Saphenofemoral junction diameter was 8.23 mm in diseased limbs and 6.16 mm in control limbs. Receiver operating characteristics curve showed great saphenous vein diameter at femoral condyle of 4.5 mm as best cut-off value for diagnosis of sapheno femoral junction reflux. Conclusion Great Saphenous Vein diameter at femoral condyle of 4.5 mm is the best cut-off value for diagnosis Saphenofemoral junction reflux. The Sensitivity and specificity of this cut off value is 81.8% and 71% respectively. KEY WORDS Doppler, Great-saphenous veins, Radio-frequency ablation, Varicose veinsPublication Types of Renal Stones and its Variation with Age and Gender in a University Hospital of Nepal(Kathmandu University, 2020) Joshi, HN; Singh, AK; Karmacharya, RMABSTRACT Background Types of renal stones have profoundly changed in the last half-century, parallel to the change in lifestyle and dietary habit, with an increase of calcium stones. Among many lithogenic factors age and gender are considered to be associated with the types of renal stones. Studies evaluating the influence of age and gender on the distribution of the types of urinary calculi are scarce in Nepal. Objective To explore the influence of age and gender on different types of urolithiasis. Method This is a single center prospective study encompassing urolithiasis during a study period of 18 months. All the stone retrieved from the patients after surgery were sent for biochemical analysis of the stone. The result was then compared with the age and gender of the study population. Result Calculi from a total of 107 patients wereanalyzed (62 from malesand 45 from females). Mixed stones consisting of calcium oxalate and calcium phosphate werethe predominant constituent in 74.16% of stones, followed by uric acid, struvite and cystine stones. We found predominance of Calcium stones in males(47.66%) vs 36.44% in females and predominance of struvite stonesin females (7.47%) vs 3.73% in males. Age group of 21-40 years has the main burden of stone. Conclusion Being aware and having better knowledge of risk factors, composition and correlation with age and gender can provide personalized guidance to prevention and avoid recurrence of urolithiasis. KEY WORDS Renal stones, Urolithiasis, Urinary CalculiPublication Where is the Perforation ? Rare Complication of Endoscopic Retrograde Cholangio Pancreatography(Kathmandu University, 2019) Singh, AK; Malla, BR; Gurung, RBABSTRACT Perforation is one of the most feared complications of Endoscopic Retrograde Cholangio Pancreatography (ERCP). ERCP has become important method for treating biliary-pancreatic diseases. Perforation related with Endoscopic Retrograde Cholangio Pancreatography is an infrequent, but if happens is a severe complication. Reported incidence of Edoscopic Retrograde Cholangio Pancreatography related perforation is 0.3-6%. Its mortality is as high as 37.5%. In our hospital since 2010 AD, There were 6 Perforations related to Endoscopic Retrograde Cholangio Pancreatography done in 4787 cases. This is a case of Endoscopic Retrograde Cholangio Pancreatography related perforation with no site of perforation recognized during surgical management. KEY WORDS Edoscopic Retrograde Cholangio Pancreatography, Negative Laparotomy, Perforations, Rare Complication