Browsing by Author "Thapa, M"
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Publication Comprehensive abortion care service at Kathmandu Medical College – An experience(Kathmandu University, 2005) Pande, S; Sharma, M; Saha, R; Thapa, M; Shrestha, N; Regmi, DIntroduction: His Majesty’s Government amended the Nepal Criminal Code (Muluki Ain) – for Liberalising abortion law in the month of Chaitra 2058 (March 2002) and Royal Assent was given on 10th Asoj 2059 (27 th September 2002). Accordingly Comprehensive Abortion Care (CAC) Services was initiated in the country. Kathmandu Medical College after enlisting with Ministry of Health started this service from June 2004. Objective: This study was carried out to know- 1. Reasons for undergoing CAC service. 2. The complications after the CAC services. 3. The various contraceptive methods adopted by the client following CAC Methodology: Hospital based prospective study was carried out in Department of Obstetrics & Gynaecology at KMCTH from the period July 2004 to April 2005. Total 160 patients who asked for CAC were enrolled in the study. Counselling, history taking and general examination and per vaginal examination was carried out at the visit. CAC was performed with premedication with Doxycycline 100 mg and Ibuprofen 400 mg half an hour before the procedure. Paracervical block was also given with 1% xylocaine. MVA was performed as described in standard techniques. Patient was discharged after 1 – 2 hours of observation and with contraception opted by the clients. Results: • Main reason for performing CAC was unwanted pregnancy in 66.75%. • Complication following CAC was 1.25%. • Post CAC contraception was adopted by 93%. Most preferred method was Inj. Depoprovera Conclusion: The reason for CAC service asked by the patients was unwanted pregnancy. CAC service performed had minimal complication and also gave the opportunity for contraception. Key words: Comprehensive Abortion Care, Contraception, Safe Abortion.Publication Correlation of cervical cytology with cervical histology(Kathmandu University, 2005) Saha, R; Thapa, MObjective: To correlate cervical cytology with Cervical histology. Methodology: A hospital based prospective study was carried out in consecutive total forty-three patient attending oncology clinic of Kathmandu Medical College Teaching Hospital, Sinamangal, Nepal from 1st Bhadra 2061 to end of Falgun 2061 (18 th August 2004 - 12 th February 2005) during authors posting in this clinic. All patients who underwent cervical biopsy on either indication of clinically suspected lesions or abnormal cytology were correlated with Pap smear report. Pap smear was carried out in conventional technique using Ayre’s spatula. Cervical biopsy was carried out with help of punch biopsy forceps in operation Theatre without the guidance of colposcopy. All pertinent information regarding patient profile in terms of their age, parity, age at marriage, age at 1 st child birth, smoking habit, contraceptive use, and symptom of vaginal discharge was taken. Reports of Pap smear and cervical biopsy of these patients were collected from oncology clinic during their follow up visit and all these information and finding were entered in structured questionnaire. The reporting of Pap smear was done in Bethesda system. The average duration between performing Pap smear and biopsy was of one month. Statistical analysis was carried out by EPI – INFOS6 system. Result: Of forty three patients who underwent cervical cytology 22 cases were of Benign lesion, 8 cases of LSIL, 9 cases of HSIL, 3 cases of invasive carcinoma and 1 of ASCUS. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and p-value in benign grade was 76%, 83.3%, 86.4%, 71.4%, 79.1%, 0.0004 respectively. Similarly sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and p-value in LSIL was 60%, 93.9%, 75%, 88.6%, 86%,0 .0008 respectively. For HSIL it was 100%, 89.5%, 55.6%, 100%, 90.7 0.0001 respectively. Respectively for carcinoma it was 100% for sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy p-value was0 .00008. Conclusion: Pap smear significantly correlated with cervical histology. Key Words: Pap Smear, Histology, Correlation.Publication High risk nonmetastatic persistent gestational trophoblastic tumour following an abortion(Kathmandu University, 2007) Pandey, S; Shrestha, NS; Thapa, MLocally invasive non-metastatic persistent gestational trophoblastic tumours (PGTT) following a non-molar pregnancy occur very rarely. Non-metastatic tumours usually falls in low risk group in WHO scoring system based on prognostic factors. We report a case of high risk non-metastatic PGTT which followed a spontaneous first trimester abortion. Complete remission of the tumour was achieved by chemotherapy EMA-CO regimen. Key words: Persistent gestational trophoblastic tumour, Abortion, ChemotherapyPublication Outcome of Patients with Meningitis and Encephalitis at Tertiary Care Hospital in Eastern Nepal(Kathmandu University, 2017) Kafle, DR; Subedi, M; Thapa, MABSTRACT Background There are several etiologies of meningitis and encephalitis which must be considered in any patient presenting with fever, headache, neck stiffness and vomiting. Bacterial meningitis and viral encephalitis are medical emergencies and need urgent attention and treatment. Any delay in diagnosis and treatment has been shown to increase morbidity and mortality. Some of the survivors also have neurological sequel with a need for long term physical and occupational rehabilitation. Objective To find out common causes of meningitis, encephalitis, predictors of outcome, early and late complications of meningitis and encephalitis at Tertiary Care Hospital in Eastern Nepal. Method It is a prospective study which was conducted at Nobel Medical College Teaching Hospital from April 2015 to March 2016. Result A total of 52 patients participated in the study. Bacterial meningitis was the most common type of neuroinfection (40.4%) followed by tubercular meningitis (27%), viral encephalitis (17.3%) and viral meningitis (15.4%). Pneumococcus was the most common identified cause of meningitis accounting for 28.9% of bacterial meningitis. Japanese encephalitis was the most common identifiable cause of encephalitis accounting for 33% of cases. Low Glasgow Coma Scale at admission was significantly associated with worse neurological outcome (P<0.001).Similarly, high white blood cell count in blood was associated with worse neurological outcome (P=0.001). Conclusion Meningitis and encephalitis are neurological emergency. Prompt diagnosis and treatment is needed to improve survival. Neurological sequel is common after those infections which require long term rehabilitation. KEY WORDS Bacterial meningitis, tubercular meningitis, viral encephalitisPublication The challenge of grandmultiparity in obstetric practice(Kathmandu University, 2006) Rayamajhi, R; Thapa, M; Pande, SIntroduction: Traditionally grandmultiparity has been considered to be an obstetric hazard both to the mother and foetus. Compounding factors are low socioeconomic status, poor female literacy and social deprivation. In developed populations with improved and optimal obstetric services, parity per se is no longer considered a significant risk for adverse obstetric and perinatal outcome. Objectives: To compare the obstetric and perinatal outcome between grandmultiparas and second gravidas with previous one delivery as well as analyse certain socio demographic features in the two groups. Methodology: Case records from Maternity Hospital, Kathmandu, an inner city tertiary care centre were retrospectively studied. 106 cases of grandmultiparous patients were compared with 110 cases of second gravidas who had previously delivered once which was taken as the control group. Biosocial features as well as obstetric and perinatal outcome were analyzed. Results: Rural residents comprised 60.4% of the grandmultiparous group versus 27.7% of the control group. A predominance of early marriage as well as an older age profile was noted in the grandmultipara. ANC attendance was documented to be much lower among grandmultipara with 26.4% having absolutely no antenatal care. A higher frequency of hypertensive disorders in pregnancy, preterm birth, anaemia, malpresentations, multiple pregnancy and premature rupture of membranes, postpartum haemorrhage and retained placenta was noted in the grandmultipara which also had a slightly higher caesarean delivery rate. The salient adverse perinatal outcome was found to be intrauterine foetal death, preterm birth and neonatal sepsis. Conclusion: In our set up grandmultiparity continues to challenge our obstetric practice with its associated increased likelihood of maternal and perinatal complications. Concerted effort should be directed to reducing high parity in the community through effective family planning initiatives and specialized antepartum and intrapartum supervision of this group should be available.