Browsing by Author "Uprety, S"
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Publication Diagnosis of Pancreatic Adenocarcinoma in a Case of 25-year-old Female from Nepal(Kathmandu University, 2024) Bhattarai, K; Bhandari, A; Acharya, A; Uprety, SABSTRACT Pancreatic adenocarcinoma is one of the lethal form of malignant change involving the pancreas. The median age of diagnosis is 71 years and is uncommon below 40 years. Here we intend to report an uncommon case of a 25-year-old woman who presented to our institution with complaints of fever, severe abdominal pain. The laboratory workup showed bicytopenia with USG abdomen revealing a bulky pancreas. The Contrast Enhanced Computed Tomography and Magnetic Resonance Cholangiopancreatography suggested malignancy followed by Fine Needle Aspiration Cytology (FNAC) which confirmed the diagnosis of adenocarcinoma. Pancreatic adenocarcinoma is the 14th most common cancer and 7th most common cause of cancer death. Computed tomography is most useful modality of investigation used to diagnose and stage the cancer. This is supported by FNAC and CA19-9 tumor marker. The management includes surgical resection and chemotherapy. Although pancreatic adenocarcinoma is uncommon among the young population, it requires early management protocols. KEY WORDS CA 19-9 antigen, Case report, Nepal, Pancreatic cancer, Risk factorsPublication Functional Outcome in Patients with Chronic Plantar Fasciitis Treated with Plantar Fascia Stetching vs Tendoachilles Stretching Exercises(Institute of Medicine, 2013) Jha, R K; Uprety, S; Shah, L LAbstract Introduction: Approximately ten percentage of patients with plantar fasciitis have development of persistent and often disabling symptoms. A poor response to treatment may be due, in part, to inappropriate and nonspecific stretching techniques. We hypothesized that patients with chromic plantar fasciitis who are managed with the structure-specific planter fascia-stretching program for eight weeks have a better functional outcome than do patients managed with a standard Achilles tendon-stretching protocol. Methods: Sixty five patients who had chronic proximal planter fasciitis for duration of at least ten months were randomized into one of two treatment groups. All patients received prefabricated soft insoles and a three-week course of naproxen. The patients received instructions for either a plantar fascia tissue-stretching program (Group A) or an Achilles tendon-stretching program (Group B). All patients completed the pain subscale of the Foot Function Index and a subject-relevant outcome survey that incorporated generic and condition-specific outcome measures related to pain, function, and satisfaction with treatment outcome. The patients were reevaluated after eight weeks. Results: sixty one patients returned for follow-up evaluation (78 total feet). Covariates for baseline measures revealed no significant differences between the groups. The pain subscale scores of the Foot Function Index showed significantly better results for the patients managed with the plantar fascia stretching program with respect to item 1 (worst pain; p = 0.002), item 2 (first steps in the morning; p=0.018) and combined items 1 to 7(p=0.033). Analysis of the response rates to the outcome measures also revealed significant differences with respect to pain, activity limitations, and patient satisfaction, with greater improvement seen in the group managed with the plantar fascia-stretching program. Conclusions: A program of non-weight-bearing stretching exercises specific to the planter fascia is superior to the standard program of weight-bearing Achilles tendon-stretching exercises for the treatment of symptoms of proximal planter fasciitis. These findings provide an alternative option to the present standard of care in the non-operative treatment of patients with chronic, disabling plantar heel pain. Keywords: Plantar fasciitis, plantar fascia stretching, Tendoachilles stretchingPublication Lived Experience of Mothers with Duchenne Muscular Dystrophy Children, Kathmandu(Institute of Medicine, 2015) Prasai, S; Uprety, SAbstract Introduction: Duchenne Muscular Dystrophy (DMD) is a genetic neuromuscular disorder with functional disability. In Nepal, eight hundred cases have been registered in Muscular Dystrophy Foundation (MDF). The Survival age of child with Duchene Muscular Dystrophy (DMD) is not more than twenty four years of life. (MDF-Nepal). The purpose of this study was to explore the lived experiences of mothers who are taking care of children with muscular dystrophy. Methods: Using a phenomenological design, nine mothers having DMD children were selected. Data was gathered using In-depth interview method. Respondent’s verbal as well as nonverbal clues were recorded during observation. Two to three in-depth interviews were carried out with each respondent along with audio tape recording and field notes. Results: Almost all of the respondents perceived DMD as a progressive fatal form of neuromuscular disease making the child unable to walk by 7-8 years of age. Majority of the respondents had suffered from psychosocial problems as well. The initial reaction of mothers regarding children’s diagnosis was a feeling of mixed emotion. Majority of the mothers relieved their anxiety to some extent by sharing their feelings with others, assuring themselves and accepting their reality of their child’s illness. Clusters of themes were identified: perception regarding disease, treatment modality, physical mobility of child, and coping mechanisms. Conclusion: Mothers of DMD children are facing a huge array of problems which has decreases the quality of life of mothers. It is recommended to provide, social security, free supply of medicine, health facility and Palliative care for DMD child so that parents may face fewer problems. Keywords: Duchenne Muscular Dystrophy, child, Physical disabilityPublication Modified Altissimi and Mancini technique for carpal tunnel decompression(Institute of Medicine, 2012) Sigdel, A; Uprety, S; K.C., GovindAbstract Introduction: Carpal tunnel syndrome is the commonest compressive peripheral nerve neuropathy; open carpal tunnel decompression still remains the preferred method as a day case procedure using local anaesthesia. The local anaesthetic is commonly administered by subcutaneous infiltration alone (the Gale technique) or by infiltration of the local anaesthetic into the carpal tunnel in addition to the subcutaneous infiltration (the Altissimi and Mancini technique). The purpose of this study was to evaluate the efficacy of the modified Altissimi and Mancini technique of local anesthesia. Methods: Fourteen hands of twelve patients age ranged from 26 to 55 years, two patients with bilateral involvements were recruited. Most involved hand was operated first with the modified Altissimi and Mancini technique of local anaesthesia. Results: Intra-operative pain was evaluated using visual analog score. Patients experienced no to very little intra-operative pain VAS 0- 2. Only one patient experienced tourniquet discomfort which subsided after release. There was neither any intra-operative nor during follow up, the signs of iatrogenic median nerve injury. Conclusion: We concluded that open carpal tunnel decompression using modified Altissimi and Mancini technique under local anaesthesia and with tourniquet control is a safe, effective and acceptable novel technique.Publication Pulled Elbow: Is X-ray Evaluation Really Required?(Institute of Medicine, 2017) Uprety, S; Bhandari, PSAbstract Introduction: Pulled elbow is a unique condition affecting paediatric population. The mechanism of injury is well stated by the child's patents. The condition is benign and passes uneventfully following a simple reduction manoeuvre in outpatient department. The condition is detected and treated easily by experts hands but to an unwary clinician may suspect it to be a bony injury and patient may be subjected to x-ray evaluation. The study was conducted to address the need to clinically identifying the condition and treating it without subjecting the patient to x-ray Distribution Users & Roles. Methods: This was prospective study carried out in the department of orthopaedics and trauma surgery Tribhuvan university teaching hospital A total of 20 patients with 21 of total limb were included in the study. Age of the children ranged from 2-6 years of age. The reduction of elbow was done by hyperpronation technique and confirmed by feeling the click at radial head with improvement of symptoms. Result: Among 21 elbows click of reduction was felt in 19. In two elbows no click of reduction was felt and these patients were subjected to x-ray evaluation. The elbow radiographs were normal and patient improved subsequently. Conclusion: A careful history taking with good clinical examination is all that is required for diagnosis and prompt treatment of the condition. An x-ray evaluation is not necessary with proper history is taken and when reduction click is felt and the child shows improvement the child can safely be discharged. Keywords: Pulled elbow, Hyperpronation manocurve, x-ray evaluationPublication Radiographic evaluation of acute scaphoid fractures(Institute of Medicine, 2015) Parajuli, B; Uprety, S; KC, GAbstract Introduction: Scaphoid fracture is the commonest carpal bone fracture. Various radiographic views have been proposed for diagnosing it. This study was conducted to determine which radiographic view/s among five different views showed scaphoid fracture consistently. Methods: This prospective study was carried out in Department of Orthopedics, IOM, TUTH from February 2012 to June 2013. Twenty-six patients with scaphoid fracture were included in the study who had five scaphoid views done viz. postero-anterior, ulnar deviated PA, pronation oblique, supination oblique and lateral. Each view was assessed with respect to demonstrating a fracture and the clarity of demonstration. Statistical analysis of data obtained was done using SPSS 17.0 version. Results: This study included 26 patients, 18 to 54 years of age (27.5±9.5 years). Average duration after injury was 6.73± 8.64 days. Out of five different views, pronation oblique showed fracture in 69.2% of patients followed by ulnar deviated PA in 61.5% patients. Pronation oblique showed fracture in all patients who had demonstrated fracture in supination oblique and lateral views also. Pronation oblique and ulnar deviated PA were the only views to show fracture in 5 patients each. Fracture in middle 1/3rd of the scaphoid was present in 53.8% patients while no patients had proximal 1/3rd fracture. Conclusion: Pronation oblique and ulnar deviated PA are the most important views among the other views of scaphoid series. Supination oblique and lateral views are the least important views to detect a scaphoid fracture. Keywords: Pronation oblique, Scaphoid fracture, Scaphoid series, Ulnarly deviated PAPublication Risk factors for redisplacement in pediatric distal radius fractures after closed reduction and cast immobilisation(Institute of Medicine, 2016) Ghimire, N; Uprety, S; Lamichhane, AAbstract Introducation: Pediatric distal radius fractures are one of the most common fractures that we see in our practice. The primary modality of treatment of the displaced fractures of distal radius in children is closed reduction and immobilization in cast. Loss of alignment in cast after an acceptable reduction is common. Twenty one to fifty percent rates of redisplacement in cast after acceptable initial reduction have been reported in literature. Methods: This prospective study included 58 fractures of distal radius and distal third shaft of radius in 57 children with radiologically open physis. Age, gender, initial displacement, associated fracture of the ulna, adequacy of reduction, cast index and gap index were evaluated as possible risk factors for redisplacement in cast. Results: A redisplacement rate of 34.48%was found in distal radius fractures of children after acceptable initial closed reduction and immobilization in cast. Initial complete displacement, degree of initial translation in coronal and sagittal plane, degree of initial angulation in the coronal plane, associated fracture of the ulna, non anatomical initial reduction and cast index were found to be significant risk factors for redisplacement. Age, gender, initial angulation in the sagittal plane and gap index were insignificant risk factors. Conclusion: Distal radius fractures in children have high rate of redisplacement in cast. Fractures with initial complete displacement, fractures with associated fracture of ulna and non-anatomically reduced fractures should either be treated by primary closed reduction and percutaneous pinning or must be followed very carefully in cast treatment. Cast index rather than gap index is a better predictor of loss of reduction in cast. Keywords: Pediatrc, Distal radius fracture, Close reduction, RedisplacementPublication The Prognostic Value of the Fracture Level in the Treatment of Displaced Supracondylar Humeral Fractures in Children(Kathmandu University, 2020) Gaihre, SK; Uprety, S; Thapa, SSABSTRACT Background Supracondylar fractures are subclassified as high and low type depending on whether they are above or below the isthmus of the distal humerus and it play an important role in determining outcome. Objective To compare the clinical and radiological outcomes of patients with fractures above and below the distal humeral isthmus treated with closed reduction and percutaneous pinning. Method This is a prospective non-randomized analytical study of 40 patients with displaced extension type supracondylar fracture of distal humerus treated by closed reduction and percutaneous pinning. Radiological and functional outcomes was followed up to 6 months postoperatively. The significance of differences between means (baumann angle, carrying angle and time to recovery) were calculated using the independent t-test. Result Twenty-four (60%) patients were high type and 16 (40%) patients were low type. According to Flynn grading, there was no statistical significance between the high type and low type (p = 0.601). The time to recovery for the high type was 15.58 ± 2.95 weeks and for low type was 18.75 ± 2.18 weeks. Hence, the time to recovery for the low type was longer than high type and it was statistically significant (p = 0.001). Conclusion Low type supracondylar fractures require a longer period for the gain of elbow range of motion. However, in long term the prognosis of low type is comparable with that of high type fracture. Hence, the prognostic value of fracture level in the treatment of displaced supracondylar fractures is not statistically significant. KEY WORDS Flynn’s grading, Fracture level, Supracondylar humeral fracturePublication Tibial plateau fractures: four years review at B&B Hospital(Kathmandu University, 2004) Shrestha, BK; Bijukachhe, B; Rajbhandary, T; Uprety, S; Banskota, AKBackground: Tibial plateau fractures involve the articular surface of the tibia resulting from a combination of axial loading with varus or valgus stress. Inadequate and inappropriate treatment may result in significant functional loss. Objective: The purpose of this study was to determine the outcome of our treatment modalities and to compare with the results of comparable studies. Methods: The results of treatment of 81 knees were reviewed over the period of five years (1997 to 2002). There were 62 men and 18 women, with an average age of 37 years (15 years to 75 years) at the time of initial evaluation. One patient had bilateral involvement. Fractures were classified according to Schatzker. Seven patients were treated conservatively. Sixteen patients (17 knees, one had bilateral involvement) were operated with closed reduction and percutaneous cannulated screws fixation. Thirty one patients' required open reduction and internal fixation with cannulated screws. Fifteen fractures were plated, and in eleven cases, external fixators were used. Follow up period ranged from six months to three years. Results: Results were graded as excellent, good, fair and poor on the basis of functional outcome. Forty- three (54%) patients (44 knees) had excellent, twenty-two (26%) had good, five (6%) had fair and ten (14%) had poor results. Poor results were associated with high energy fractures, late presentation, and inadequate physiotherapy follow up. Eight patients (10%) had complications. One had common peroneal nerve palsy, six had wound infection and one patient demonstrated early arthritic changes. Conclusion: Tibial plateau fracture is a challenging fracture to manage. Restoration of articular congruity and early range of motion should be the primary goal. Proper and adequate preoperative planning is mandatory. Well maintained articular congruity with stable fixation helps early mobilization and better functional outcome. Key Words: Plateau, Axial load, Varus, Valgus, Articular congruity, Functional outcome