Browsing by Author "Thapa, BB"
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Publication 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 Essential Drugs Concept : its application in Nepal(Institute of Medicine, 1998) Thapa, BB; Prasad, RR; Shrestha, BM; Bhuju, GB; Rajbhandari, VAbstract Essential drugs are those that satisfy the healthcare needs of the majority of the population; they should therefore be available at all times in adequate amount and in the appropriate dosage forms. Various factors need to be considered for the selection of such drugs, though the model list published by WHO serves as valuable guidelines. National List of Essential Drugs, Nepal (EDL) was published in 1986, which was first revised in 1992 and then in 1997. Implementation of it helps to provide health care to a large population in relatively less resources. We have made an effort in this paper to analyze the situation after implementing EDL in Nepal and suggest the ways and means for more effective implementation so that the goal of 'health for all' could be achieved. Keywords: Essential drugs, Nepal