Browsing by Author "Singh, M"
Now showing 1 - 10 of 10
Results Per Page
Sort Options
Publication Abortion legalized: Challenges ahead(Kathmandu University, 2007) Singh, M; Jha, RObjective: To see whether advocacy for abortion law and comprehensive abortion care (CAC) sites after legalization of abortion in Nepal is adequate among educated people (above school leaving certificate). Method: 150 participants were assigned randomly who agreed to be in the survey and were given structured questionnaires to find out their perception of abortion and CAC sites. Result: Majority know abortion is legalized and majority have positive attitude about legalization of abortion, however majority are not aware of abortion service in CAC sites and none knew the cost of abortion service Conclusion: Proper and adequate advocacy of the new abortion law and CAC service is essential. Key words: Abortion law, CAC site, AdvocacyPublication Comparison of oral misoprostol with intravenous oxytocin for induction of labour in premature rupture of membranes(Institute of Medicine, 2013) Maskey, S; Singh, M; Rawal, SAbstract Introduction: To compare the effectiveness of oral misoprostol with intravenous oxytocin for induction of labor in premature rupture of membranes (PROM) at term. Methods: This randomized comparative study was carried out in 100 women who were at or beyond 37 weeks of gestation with cephalic presentation, had PROM more than 12 hours with bishop’s score less than six. Out of 100 women 50 were induced with 50 μg of oral misoprostol 4 hours apart (max 6 doses) and other 50 received intravenous oxytocin infusion (max 3 pints). Results: The parity, mean bishop’s score of two groups were comparable. Both misoprostol and oxytocin group showed similar induction to delivery interval (8.68 hrs ± 3.22hours vs. 7.61hours ± 2.84hours, P value was 0.08). Maximum number (52%) of patient’s responded to single dose of misoprostol in misoprostol group. Whereas in oxytocin group 40% of primigravidae required 10 units and 47% of multigravidae required 2.5 units of oxytocin. Majority of women in both the groups delivered vaginally but oxytocin group had slightly increased number of LSCS and one instrumental delivery. Meconium stained liquor was seen more in oxytocin group than misoprostol. Neonatal outcome was comparable in both groups. Conclusion: Oral misoprostol was as effective as oxytocin in induction of labour in term PROM with low bishop’s score. Keywords: premature rupture of membrane, induction of labor, misoprostol, oxytocinPublication Conservatively managed puerperal retroperitoneal haematoma(Institute of Medicine, 1999) Rana, A; Singh, M; Jha, R; Verma, SAbstract Puerperal haematoma occurs in 1/300 to 1/1500 deliveries. A characteristic presentation of post-delivery collapse with signs of internal haemorrhage and clinically palpable left-sided pelvic mass causing gross hydronephrosis on ipsilateral side was confirmed as a case of retroperitoneal haematoma on ultrasound, which resolved completely on conservative management. Keywords: puerperal haematoma, retroperitoneal haematoma, post-delivery collapsePublication Delayed management of ruptured ectopic pregnancy: an observation of concern(Institute of Medicine, 1999) Rana, A; Gurung, G; Singh, M; Pradhan, NAbstract There were 82 cases of ruptured ectopic pregnancies during a 6-year period, (2049- 2054) April 1992-1998. Associated high risk factors were proven PID (3), infertility (10), sterilization (4), previous ectopic (6), IUCD (1). One of the cases had clomiphen citrate and the other was an OCP for cystic ovary. Atypical presentations were malaena (2) and intestinal obstruction (1). Symptoms and admission interval varied from 1 hour to more than a month in 8 cases. Surgical intervention was undertaken at an earliest in 2 hours and delayed beyond 1-2 weeks in 7 cases. Surgical management was delayed beyond 6 hours (69.5%) and 12 hours (56%) respectively. This delay was mainly due to misdiagnosis (45%) as the symptoms of PID (3), DUB (1), and pelvic abscess (1) overlapped with ectopic. Improper and inadequate referral due to inexpert opinion at admission was another cause for delay. Forty-two point six percent had significant haemoperitoneum, of which 39.4 needed blood transfusion. Two cases had tubal reconstruction and two underwent hysterectomy. We emphasize to overcome the diagnostic dilemma by adopting sensitive BhCG using monoclonal antibodies, TVS and laparoscopy whenever necessary along with active surgical team to cut short the delay in operative management of ruptured ectopic. Keywords: Ruptured ectopic, Risk factor, Delayed managementPublication Heterotopic pregnancy with spontaneous intrauterine conception: A rare clinical entity with diagnostic dilemma(Kathmandu University, 2008) Rawal, S; Koirala, P; Singh, M; Rana, AAbstract Twenty-one years old primigravida presented to emergency with amenorrhoea for 2 months and complaints of severe abdominal pain for few hours. The pain was associated with 2 episodes of fainting attacks in emergency during the period of observation. Viable intrauterine pregnancy of 8-9 weeks along with collection of fluid in the Pouch of Douglas was detected by ultrasound examination and on laparotomy ectopic pregnancy was confirmed with haemoperitoneum of 2 litres with 500gms of clots. Histopathology report confirmed the tubal ectopic pregnancy and postlaparotomy, transvaginal sonography confirmed the salvage of the intrauterine pregnancy. Despite massive haemoperitoneum, the pregnancy continued till 40+6 weeks with uneventful antenatal period. She underwent emergency caesarean section for meconium stained liquor with foetal distress and delivered of an alive healthy female of 2.5 kg with good Apgar score. Key words: Ectopic, Heterotopic pregnancyPublication Immune thrombocytopenic purpuera in pregnant women(Institute of Medicine, 2007) Rawal, S; Sigdel, MR; Singh, M; Baral, JAbstract Case report: Immune Thrombocytopenic Purpuera (ITP) is the commonest autoimmune disorder occurring in pregnancy. This is a case of asymptomatic ITP diagnosed in a 21 years primigravida by doing platelet count during routine antenatal investigation at 27th week, who remained refractory to treatment with steroid and platelet transfusion, had to undergo emergency LSCS for low lying placenta, but both the intrapartum and the postpartum period remained uneventful. The baby was assumed to have neonatal alloimmune thrombocytopenia (NAIT) due to low platelet count of 10,000/ cumm and with clinical evidence of petechia on the trunk and hard palate, was later treated with platelet transfusion, intravenous immunoglobulin (IVIG) and steroids. Both the baby and the mother had an uneventful recovery following a multidisciplinary approach with the obstetrician, physician, neonatologist and the anaesthesiologist and both were discharged on steroids on the 10th post operative day. Keywords: Platelets, Pregnancy, ITPPublication Introducing Clinical Pathology Course to Fourth Year Medical Students as a Bridge between Pre-clinical and Clinical Medical Sciences(Kathmandu University, 2022) Upadhyaya Kafle, S; Singh, M; Kafle, N; Sinha, A; Guragain, P; Rimal, HSABSTRACT There isn’t any vertical integration of pre-clinical and clinical sciences subjects in the existing Kathmandu University MBBS curriculum. Many of the graduates are not able to correlate the clinico-pathological aspects of various diseases as a result the rational use of investigations for diagnosing various diseases is compromised. There are few published examples of implementation of pathology instruction courses during the clinical years of medical training but it is not universally practiced. This lack of exposure to pathology may lead to poor understanding of laboratory testing and the role of pathologists in patient care. To set and implement an exemplary vertical integration of pre-clinical science with clinical science. A 12 credit hours clinical pathology education course comprising clinical hematology, cytopathology and histopathology was developed. Students belonging from the ongoing fourth year MBBS course of Birat Medical College were enrolled in the course. All of the interactive lecture sessions were delivered via an e-learning interface, using the Zoom platform as the main teaching methods. Evaluation of students’ achievement of learning objectives was conducted through distributing pre and post-test online multiple-choice questionnaires. Chi-square tests were used to compare the variables between pre-test and post-test questionnaire responses. Results suggested that the designed clinical pathology course is valuable. The pre- test and post-test questionnaire responses revealed the positive impact regarding the importance of introducing clinical pathology courses within the clinical year of MBBS undergraduate curriculum. Response rate to the online session was 100%. The point of agreement between the pre-test and post-test questionnaire responses were highly achieved after intervention of the clinical pathology course. A statistically significant result (p < 0.05) between all of the pre-test and post-test questionnaire responses was noted. There was a strong positive recommendation for incorporating clinical laboratory medicine courses within the MBBS clinical science curriculum. The improvement observed among fourth-year MBBS students on learning the importance of clinical pathology courses was encouraging. This experience thus contributed to set and implement an exemplary vertical integration of pre-clinical science with clinical science. KEY WORDS Clinical pathology, Clinical sciences, Pre-clinical sciences, Vertical integrationPublication Maternal cardiac diseases complicating pregnancy: a review of 105 cases(Institute of Medicine, 2001) Rana, A; Singh, M; Manandhar, B; Pradhan, N; Gurung, G; Dali, B; Koirala, B; Koirala, RRAbstract The outcome of pregnancies in 105 patients with heart diseases in TUTH, Kathmandu, Nepal between April 1995 and May 2001 was reviewed. The incidence of heart disease was 0.55% of the total 19038 deliveries. Rheumatic (79), congenital (17) and miscellaneous groups (9) complicated the pregnancy. Significant number (53) had their diagnosis made at the index pregnancy. Patients who developed cardiac failure (17) mostly did during antenatal period (20-42 weeks); the majority had cardiac failure (14) at third trimester. Two of the cases that had cardiac failure at 33 weeks ultimately had stillbirths later at term. Induction of labour for such cases, which was discouraged earlier, should be considered. In our hospital labour analgesia with epidural anaesthesia, pethidine or morphine is not a routine practice. Injection Methergin is also generally withheld. Save one or two, most Cesaerean sections had obstetrical indication. Prophylactic forceps or ventouse were barely used. There were two maternal deaths. One of them had pregnancy complication as eclampsia and presented with SVT and MI at 34 weeks. The other case died within 48 hours of Caesarean delivery for critical mitral stenosis with pulmonary hypertension. The perinatal losses were 7. This article strongly emphasizes the need for routine cardiac evaluation of patients at their very first antenatal check up so that patie nts with cardiac disease can benefit from shared co-operation between cardiologist, cardiothoracic surgeon, anaesthelogist and obstetrician. Keywords: Heart disease, pregnancy, cardiac failure, obstretic analgesia, induction of labourPublication Single visit approach for Cervical Cancer Prevention in a mobile screening clinic(Institute of Medicine, 2016) Singh, M; Shrestha, S B; Manandhar, A; Ranjit, R; Pradhan, R; Shah, A; Verma, S; Malla, KAbstract Introduction: Cervical cancer is the third most common cancer in women worldwide, but the most preventable cancer. The objectives was to determine the feasibility and acceptability of immediately treating VIA positive women with thermocoagulation in a single-visit approach (SVA) in preventing cervical cancer. Method: This was a community-based programme organized in collaboration with Nepal Australian Cervical Cancer Foundation and Thermocoagulation unit donated by Tropical Health and Education Trust in a mobile screening camp set up in five different underserved areas in Gorkha, Nepal. Total women were 1071 aged 30-60 yearrs in 5 days in December, 2016, had come for cervical cancer screening. Women who were VIA positive had thermocoaculation for treatment. Results: Total screened women were 1071, the rate of VIA positive was 115(10.7%). 100% percent of positive result accepted treatment. All VIA positive patients except for one woman who was suspected of having invasive cervical cancer had treatment with thermocoagulation. Of all treated women only 5(4.38%) had minor side effect. Conclusion: For cervical cancer screening, the single-visit program was feasible and the degree of acceptability was 100% in this underserved population. Single visit programs provide an opportunity to increase the rate of immediate treatment of lesions with minimal side effect compared with delayed treatment after obtaining colposcopy guided biopsy report in later visit. Keywords: cervical cancer, mobile screening, VIA, SVA, thermocoagulationPublication Young teenagers and child birth(Institute of Medicine, 2000) Pradhan, N; Rana, A; Singh, M; Gurung, G; Manandhar, BAbstract In a retrospective analysis done at TU Teaching Hospital between 15 Aug 1997 and 14 Aug 1998, 57 teenage mothers (13-17 years) represented twenty per thousand deliveries (total deliveries, 2799). The usual documented complications like prematurity and low-birthweight were seen in 16% and 24.5% respectively. Pregnancy complication such as eclampsia was seen in one case that delivered a low birthweight baby with poor apgar. Most of these young mothers had vaginal deliveries (86%). The caesarean section rate was 14%, which could have been further lowered, if there were no complications like foetal distress (3) and abnormal presentation (2). Excepting a case of pregnancy that occurred in a 13-year old girl due to sexual abuse, all the other pregnancies followed marriage. This indicates that adolescent reproductive health is a neglected arena requiring some change. Hence full attention has yet to be focused on adolescent reproductive health, particularly directed towards preventing early marriage and early child bearing which is detrimental to adolescent reproductive health. Keywords: Teenage pregnancy, early marriage, adolescent reproductive health