NepMed Repository :: Browsing by Author "Thapa, P"

Browsing by Author "Thapa, P"

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Ancient cystic pelvic schwannoma presenting as a right iliac fossa mass
(Kathmandu University, 2005) Rai, BR; Chaudhary, D; Thapa, P; Joshi, MR; Dongol, UMS; Singh, DR; Sharma, SK
Schwannoma is rare in pelvis. Ancient schwannoma is rarer histological subtype of schwannoma. We report a very rare case of pelvic schwannoma presenting with right sciatica and right iliac fossa pain. Clinical and imaging findings were suggestive of Peritoneal Hydatid cyst. The tumour was resected completely with marked clinical improvement. Histopathological examination showed Ancient cystic schwannoma. Key words: Benign pelvic Schwannoma, Benign retroperitoneal tumour, Giant ancient Schwannoma, Presacral Cystic Schwannoma
Comparison of Initial Response of Nebulized Salbutamol and Adrenaline in Infants and young Children Admitted with Acute Bronchiolitis
(Kathmandu University, 2016) Adhikari, S; Thapa, P; Rao, KS; BK, G
ABSTRACT Background Acute bronchiolitis is common cause of hospitalization in infants and young children. There are widespread variations in the diagnosis and management. Despite the use of bronchodilators for decades, there is lack of consensus for the benefit of one above another. Objective To compare initial response of nebulized adrenaline and salbutamol. Method Children aged two months to two years admitted with acute bronchiolitis in the department of Paediatrics of Manipal teaching hospital, Pokhara, Nepal, from 1st March 2014 to 28th February 2015 were enrolled. Patients fulfilling inclusion criteria received either adrenaline or salbutamol nebulization. Data were collected in a predesigned proforma. Respiratory distress assessment instrument (RDAI) scores were considered primary outcome measure and respiratory rate at 48 hours, duration of hospital stay, requirement of supplemental oxygen and intravenous fluid were considered secondary outcome measure. Result A total of 40 patients were enrolled in each study group. Mean RDAI scores at admission was in 9.75 with (CI- 9.01, 10.49) in adrenaline and 9.77 (CI- 9.05, 10.50) in salbutamol group. There was gradual decline in mean RDAI scores in both the groups over 48 hours to 4.15 (CI- 3.57,4.73) and 4.13 (CI- 3.69,4.56) in adrenaline and salbutamol group respectively. Hospital stay was 5.32 days in adrenaline and 5.68 days in salbutamol group. Patients nebulized with adrenaline required oxygen for 33.30 hours compared with 36.45 hours in salbutamol. Intravenous fluid duration was also less in adrenaline group compared to salbutamol group (33.15 vs 37.80 hours). Conclusion Patients of acute bronchiolitis nebulized with either salbutamol or adrenaline experienced similar decline in RDAI scores in the first 48 hours. Duration of supplementary oxygen and intravenous fluid was less in adrenaline group compared with salbutamol group. KEY WORDS Acute bronchiolitis, adrenaline nebulization, salbutamol nebulization
Compliance and its Determinants Regarding Iron and Folic Acid Supplementation during Pregnancy in Kathmandu, Nepal
(Kathmandu University, 2016) Rai, SS; Ratanasiri, T; Arkaravichien, T; Thapa, P; Koju, R
ABSTRACT Background Iron deficiency anemia is one of the major public health problems mostly affecting pregnant women of developing countries like Nepal. Kathmandu, the capital city of Nepal, has considerably high prevalence of anemia, which is attributed to inadequate dietary iron and problems of compliance to iron and folic acid supplementation. Objective This descriptive study aimed to identify the levels of and determinants associated with compliance regarding Iron and folic acid supplementation among pregnant women in Kathmandu, Nepal. Method The study was conducted in Paropakar Maternity and Women’s Hospital in Kathmandu. Systematic random sampling was done to select a total of 406 samples that were either handed questionnaire for self-administration or interviewed. The χ2 test and multiple linear regressions were used for statistical analysis. Result The findings showed 73.2% of the respondents had high compliance, 12.8% moderate compliance, and 14% low compliance to iron and folic acid supplementation. More than half of the respondents had insufficient knowledge regarding anemia, iron deficiency and iron and folic acid supplementation. Multiple linear regression revealed that perceived severity, perceived barriers and social support were determinants of compliance to iron and folic acid supplementation (p<0.05). Conclusion This study infers that there is a lack of knowledge and awareness regarding anemia, iron deficiency, and iron and folic acid supplementation among pregnant women, and improvement in social support and perception of severity of the disease, and minimization of associated barriers may lead to better outcome in terms of compliance to iron and folic acid supplementation among pregnant women. KEY WORDS Anemia, compliance, iron, pregnant women, supplementation
Delirium in Critically ill Patients in a Tertiary Care Centre in Western Region of Nepal
(Kathmandu University, 2014) Thapa, P; Chakraborty, PK; Khattri, JB; Ramesh, K; Sharma, P
ABSTRACT Background Delirium affects a significant proportion of critically ill patients admitted in hospital. It is associated with various adverse outcomes. Despite its enormous prognostic significance it tends to be underdiagnosed. There is a dearth of studies on risk factors of delirium in our setting. Objectives The main objectives of this study was to find out the prevalence, rate of non recognition and risk factors associated with delirium in hospitalized critically ill patients. Methods A hospital based cross-sectional study was carried out. Data was collected using a predesigned semi-structured proforma and Intensive care delirium screening checklist was used to screen for delirium in patients admitted in various wards of Manipal teaching hospital, Pokhara, Nepal. Results Ninety five cases were included in the analysis. The mean age of study group was 58.9 ± 19.1 years. Delirium was present in 15/95 cases and it was not recognized by treating physician in about one third of cases. Odds ratio (OR) was statistically significantly increased in patients with history of stroke (OR=4.484 95% CI=1.0896;18.459), alcohol use (OR=10.792 95% CI=2.906;40.072), smoking (OR= 4.836 95% CI= 1.411;16.576), use of restraint (OR=17.143 95% CI=4.401;66.766), nasogastric tube placement (OR= 7.731 95% CI=2.348;25.452) and use of Foley’s catheter (OR=12.000 95% CI= 3.072;46.877). Conclusion About 16% of critically ill patients were found to be delirious. In about one third of the cases delirium was not recognized. Both patient related and iatrogenic factors may increase the risk of delirium in hospitalized critically ill patients. KEY WORDS Critical care, delirium, non-recognition
Empyema thoracis
(Kathmandu University, 2007) Singh, DR; Joshi, MR; Thapa, P; Nath, S
Abstract Objective: To review the management of Empyema Thoracis in the surgical department of Kathmandu Medical College Teaching Hospital. Methods: Thirteen cases with Empyema thoraces treated in the surgical department of the hospital with different modalities of treatment was taken for study and analyzed for morbidity, mortality, and hospital stay. Results: there was a single mortality in the thoracotomy group. Video assisted thoracic surgery or VATS debridement or deloculation was successful in the eight of the patients with shorter stay in the hospital. One patient who refused surgery was treated with streptokinase with good result. Conclusion: Streptokinase may be effective in the treatment of empyemas. Video assisted thoracic surgery or VATS has definite advantage over traditional surgery in terms decreased morbidity, mortality, earlier hospital discharge and cosmesis in the treatment of empyema. Keywords: Empyema thoracis, VATS, Decortications, Streptokinase
Intra-abdominal abscess presenting as a thigh abscess
(Kathmandu University, 2004) Chaudhary, D; Magar, A; Thapa, P; Singh, DR; Sharma, SK
Secondary thigh abscesses are rare, and their cause is often obscure. We report a case of an elderly diabetic who presented with thigh abscess secondary to tuberculous sacroilitis. Key words: Secondary thigh abscess, retroperitoneal abscess, tuberculous sacroilitis
Medication Adherence to Oral Hypoglycemic Agents Among Type II Diabetic Patients and Their Clinical Outcomes with Special Reference to Fasting Blood Glucose and Glycosylated Hemoglobin Levels
(Kathmandu University, 2013) Shrestha, SS; Shakya, R; Karmacharya, BM; Thapa, P
ABSTRACT Background Oral hypoglycemic agents (OHAs) are the major treatment for people with type 2 diabetes mellitus (DM2). However, non-adherence to OHAs remains as one of the main reasons for poor glycemic control. Objectives To assess the adherence pattern to OHAs and clinical outcomes with special reference to fasting blood glucose (FBG) level and glycosylated hemoglobin (HbA1c) levels. Methods Informed consent was obtained from patients fulfilling the criteria and from the patient party in case of incapacitated patients. Information was obtained by interviewing them and filled in the appropriate questionnaire. All the medical information of the patients was obtained from the medical case records and laboratory reports. Results OHAs had been discontinued by 25% of patients. Overall 38% had ever discontinued and/ or often missed OHAs. Intentional discontinuation of OHAs attributed for 72% of the patients, followed by forgetfulness (42.9%), carelessness (30.6%), and hypoglycemia, (24%). There were 50.50% patients who had uncontrolled FBG (>130 mg/dl) level and 39% had uncontrolled HbA1c (≥ 7%) level. Taking reference age group 51-60 years, control of FBG level was found to be statistically associated with the decreasing age group (p = 0.006, OR = 4.8) as well as increasing age group (p = 0.008, OR = 4.034). There was significant association between controlled HbA1c level and patients’ knowledge about the precautions to be taken while using OHAs (p = 0.044, OR = 4). However, there was no significant association between glycemic control and OHAs adherence. Conclusion Majority of the patients who had missed OHAs attributed it to forgetfulness. Hypoglycemia may also be one of the contributing factors for poor adherence to OHAs. However no association was found between adherence and various other factors like age groups, treatment complexity, health literacy and social or family support. KEY WORDS Adherence, diabetes, HbA1c, hypoglycemia, non-adherence
Omental torsion: a case report
(Kathmandu University, 2005) Chaudhary, D; Rajkarnikar, R; Joshi, MR; Thapa, P; Singh, DR; Sharma, SK
Omental torsion is a rare cause of acute abdomen. Most often it presents with sign and symptoms of acute appendicitis. It is seldom considered in the differential diagnosis preoperatively based on clinical findings and the diagnosis is only established during surgery. We present a case of omental torsion in a middle aged male patient who presented with findings suggestive of appendicular perforation and underwent emergency laparotomy. Key words: acute abdomen, omentum, torsion, appendicitis
Postoperative Analgesic Effect of Morphine Added to Bupivacaine for Transversus Abdominis Plane (TAP) Block in Appendectomy
(Kathmandu University, 2017) Ghimire, A; Bhattarai, B; Prasad, JN; Subedi, A; Thapa, P; Limbu, PM; Adhikari, S
ABSTRACT Background Transversus abdominis plane (TAP) block with local anaesthetics produces effective pain relief following lower abdominal surgeries. Although opioids have been found to have effects through peripheral receptors also, reports on their effect when used as additive to local anaesthetics for TAP block are lacking. Objective To assess the analgesic effect of peripherally administered morphine with bupivacaine for ipsilateral TAP block in patients undergoing emergency appendectomy under general anaesthesia. Method Sixty patients undergoing appendectomy were randomized to undergo ipsilateral TAP with 20 ml of 0.5% bupivacaine plus 2 ml of NS (total 22 ml) and 2 ml of intravenous (IV) saline (Group TB) or with 20ml of 0.5% bupivacaine plus 2 mg (2 ml) of morphine (total 22 ml) and 2 ml of NS IV (Group TBM) or with 20 ml of 0.5% bupivacaine plus 2 ml of NS (total 22 ml) and 2 mg (2 ml) IV morphine (Group TB-IVM). Pain severity was measured using Visual Analogue Scale (VAS) preoperatively (Baseline) and at 30 min, 6h, 12 h and 24 h postoperatively. Inj. tramadol 50 mg IV was used as rescue analgesic when postoperative VAS was 4 or more. The duration of analgesia (time to first analgesic) and the postoperative 24 h tramadol requirement was recorded. Result The mean duration of analgesia in Group TBM was significantly longer (801.50 ± 74.92 min, p=0.002) than in Group TB (720.00 ± 42.17 min) and Group TB-IVM (712.70 ± 40.94 min). The mean postoperative 24 h tramadol requirement was also less in Group TBM (69.23 ± 25.31mg) than in Groups TB (100.00 ± 38.34 mg) and TB-IVM (95.00 ± 39.40 mg) but did not reach the level of statistical significance (p=0.057). Significantly less ondansetron was required in Group TBM (3.80 ± 2.04 mg) than in Group TB (6.80 ± 2.93 mg) and TB-IVM (6.00 ± 2.75 mg) (p=0.002). Conclusion Morphine added to bupivacaine effectively prolongs the analgesic duration of TAP block in appendectomy. KEY WORDS Morphine, postoperative analgesia, transversus abdominis plane block, USG guided
Relation of Sociodemographics and Personal Hygiene on Different Childhood Dermatoses
(Kathmandu University, 2015) Gauchan, E; Kumar, A; BK, G; Thapa, P; Pun, J
ABSTRACT Background Skin diseases in children contribute to significant morbidity and psychological distress. Infective dermatoses are one of the major dermatoses in children. Low socioeconomic status, overcrowding and poor personal hygiene has been linked to skin diseases. Objective To find out the prevalence of infectious skin disease in children, rate of transmissible skin disease and association of sociodemographic factors and personal hygiene on infective childhood dermatoses. Method This was a cross-sectional study conducted in the Pediatric and Dermatology Department, Manipal Teaching Hospital, Pokhara, Nepal. A total of 226 patients were examined over a period of one year. Relation of sociodemographics, crowding and personal hygiene on skin disease were assessed. Result The most common category was Infections and Infestations (51.3%) followed by Dermatitis (27.9%) . Transmissible skin disease was seen in 49.6%. Low socioeconomic status and overcrowding were associated with increased risk for infective dermatoses. Conclusion Skin disease in children constitutes a public health problem. Improving the socioeconomic status and personal hygiene can help to reduce the incidence of skin disease in children. KEY WORDS Infections and infestations, personal hygiene, sociodemographics
Toxic epidermal necrolysis masquerading as scald burn
(Kathmandu University, 2007) Mahat, B; Pandit, N; Shrestha, R; Rupakheti, S; Thapa, P; Neopane, A; Joshi, KD
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Browsing by Author "Thapa, P"

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