Browsing by Author "Vaidya, P"
Now showing 1 - 16 of 16
Results Per Page
Sort Options
Publication Accuracy of various diagnostic tests and antimicrobial sensitivity pattern of Helicobacter pylori infection in a tertiary care centre in Nepal(Institute of Medicine, 2015) Kansakar, P; Dongol, A; Vaidya, PAbstract Introduction: Helicobacter pylori infection is the most important cause of peptic ulcer disease as well as other gastrointestinal conditions. Most widely used diagnostic tests for detection of Helicobacter pylori include rapid urease test, histopathology, culture/sensitivity and serology. The objective of this study was to determine accuracy of standard diagnostic tests and the prevailing local antibiotic susceptibility patterns. Methods: This cross sectional study, conducted from May to October 2009 at Tribhuvan University Teaching Hospital. 3 pieces of biopsy pieces were obtained from the antral mucosa which were subsequently used for Rapid Urease Test (RUT), histopathology and culture/sensitivity. Then, 2 ml of venous blood was drawn from the antecubital vein for serological examination. Results: H. pylori positivity status was reflected as 32%, 32% and 47% by rapid urease test, culture and histology. The seroprevalence of H. pylori was 63%. A patient was considered to be positive with respect to H. pylori infection when at least two of three tests namely rapid urease test, culture and histology gave positive results. Hence, proportion of patients with positive H. pylori infection was 36%. Only 30 from 32 culture positive cases were efficiently subcultured and further processed for antibiotic susceptibility testing. Resistance to metronidazole was found to be the highest securing 53.3% and lowest to levofloxacin (0%). Conclusions: Detection of Helicobacter pylori infection using serology was the most effective among the diagnostic tests performed. More than half of the patients were resistant metronidazole while levofloxacin was sensitive in all the cases. Keywords: Helicobacter pylori, diagnostic tests, antimicrobial susceptibilityPublication Comparison of Subjective Global Assessment and Nutritional Risk Index on Outcome after Abdominal Surgery(Institute of Medicine, 2014) Gupta, DK; Sharma, MR; Ghimire, B; Vaidya, PAbstract Introduction: Preexisting malnutrition in surgical patients has been conclusively correlated with complications such as wound infection and myriad of other adverse outcomes during and after hospitalization. So, it is imperative to recognize and manage this status preoperatively in an effort to improve outcome. The aim of the study was to compare the Subjective Global Assessment (SGA) and Nutritional Risk Index (NRI) with outcome after abdominal surgery. Methods: This is a prospective study conducted at the Department of Surgery, Tribhuvan University Teaching Hospital, Nepal, for the period of one year. The study included a total of fifty patients undergoing abdominal surgery. Patients were assessed with two types of nutritional assessment techniques, namely, SGA and NRI. The outcome parameters included were wound infection, and chest infection, and length of hospital stay. Results: No complications occurred in 24 of the 50 patients; 13 patients had more than one complication. The frequency of malnutrition was found to be 74% and 80% as assessed by SGA and NRI respectively. Morbidity rate was significantly higher and length of hospital stay was also longer in malnourished patients assessed by SGA group. Wound infection rate was significantly higher and length of hospital stay was also longer in malnourished patients when assessed by SGA. The area under the receiver operating characteristics curve for SGA and NRI revealed that SGA was better for predicting overall morbidity as well as specific complications than the NRI. Three patients died during treatment period. Conclusions: Malnutrition is a marker of poor postoperative outcome. Subjective Global Assessment is better than Nutritional Risk Index to predict postoperative complications in patients undergoing abdominal surgery. Keywords: malnutrition, nutritional assessment techniques, nutritional risk index, subjective global assessmentPublication Department of Information Technology in Institute of Medicine(Institute of Medicine, 2008) Vaidya, PNA.Publication Drug sensitivity pattern of microorganisms in infected wounds at TUTH(Institute of Medicine, 2006) Singh, A; Vaidya, P; Tuladhar, NR; Maharajan, SAbstract Introduction: The spread of antibiotic resistance and the appearance of multiple antibiotic resistant pathogens have been recognized by the WHO as a serious problem that complicates medical treatment of bacterial infections. Present study is a retrospective study from 15June to to 15th December 2004, which includes 1379 pus samples. Methods: Culture and sensitivity testing for pus samples was done using standard Microbiological protocol in TUTH microbiology laboratory. Results: We found that Staphylococcus aureus is the commonest isolate (57.25) followed by E. Coli (15.61) The most effective antibiotic in-vitro for Staphylococcus aureus is Cloxacillin (87.0) followed closely by Erythromycin (81.8). In E. coli, the most effective antibiotics was Amikacin (77.88). Pseudomonas was isolated in only in (5.83) cases. The most effective antibiotic in vitro was Amikacin (47.22) and Ciprofloxacin (47.22) followed by Gentamycin (32.6). Conclusion: With rampant antibiotic use, the drugs become resistant of which the clinicians may not be aware. Similarly, the organism pattern may differ in different hospitals. So, we believe that such regular update to our clinicians will help them use appropriate antibiotics, as they will be aware of the prevalent organism and the most effective antibiotic to it.Publication Extraintestinal Gastrointestinal Stromal Tumor arising from parietal wall: A rare entity(Institute of Medicine, 2018) Jha, BK; Jha, P; Vaidya, P; Kansakar, PBS; Manandhar, SAbstract Extraintestinal gastrointestinal stromal tumors (E-GIST) are rare types of GIST most commonly involving the mesentry, omentum and retroperitoneum. Parietal wall E-GIST are very rare. Very few cases have been reported in the literature. Keywords: GIST, parietal wallPublication Focal nodular hyperplasia (FNH) of liver in children(Institute of Medicine, 2014) Bhattarai, A; Kansakar, P; Vaidya, PAbstract Introduction: Focal nodular hyperplasia (FNH) is one of the rare benign tumors of liver and second common benign tumour after the haemangioma in adult. It is mostly seen in young middle age women.The actiology of this tumour is unknown; however congenital vascular malformation or vascular injury to the hepatocytes has been suggested as the underlying mechanism for hepatocellular hyperplasia. Its relation with OCP is still controversial2. The tumor is asymptomatic most of the time and detected during routine physical examination or incidentally during radiological investigation. Large lesion presented with abdominal mass and abdominal pain due to pressure effects over surrounding tissue. Only Symptomatic lesion needs treatment. Bleeding and torsion can occur but malignant transformantion never occur in this disease. FNH is very rare in pediatric population Here we report two case of such rare case in pediatric population. Hepatic resection was undertaken in both patients with excellent outcome.Publication Giant retroperitoneal lipoma(Institute of Medicine, 2007) Kansakar, P; Ghimire, B; Rajbhandary, A; K.C., H; Singh, YP; Vaidya, PAbstract Case report: This is a case report of a retroperitoneal lipoma.The patient was admitted with complaints of abdominal distention and early satiety. Contrast enhanced CT scan of abdomen showed a large mass of fat density arising from the retroperitoneum measuring 30 x 25 x 20cm displacing the left kidney towards the midline and anteriorly. Fat plane was maintained with surrounding structures. The patient underwent exploratory laparotomy and the lipoma was excised. The lesion measured 30 x 20 cm and weighed 5.1 kgs. Since the left kidney was displaced anteriorly and towards the midline, nephropexy was performed. Histopathology revealed benign lipoma. Post operative period was uneventful. Keywords: Lipoma, retroperitoneal mass, displaced kidneyPublication Publication Publication Laparoscopic Cholecystectomy in a Private Hospital(Institute of Medicine, 2015) Shrestha, J; Vaidya, P; Khakurel, MAbstract Introduction: Laparoscopic Cholecystectomy is the gold standard for benign Gall Bladder disease. Laparoscopic Cholecystectomy has rapidly gained popularity and it is one of the commonly performed operations in Nepal. The current study was carried out in the Department of General Surgery, Hospital for Advanced Medicine and Surgery (HAMS), Kathmandu, Nepal to evaluate the result of Laparoscopic Cholecystectomy in our set up. Methods: A retrospective review of medical records was conducted on all study patients. Demographic data, indication for surgery, rate of conversion to open cholecystectomy, morbidity and mortality rates were noted. The data of all patients who underwent laparoscopic cholecystectomy from April, 2012 to April, 2014 was entered in standardized proforma and analysed on SPSS 20. Results: A total of 130 Cholecystectomy over a period of 2 years, Male: Female ratio 1:1.9. Mean Age group 41-50 years. Out of all these patients 76% patients presented with symptoms while 24% were asymptomatic. Overall conversion rate was 9.2%. The average hospital stay was 2 days. There were no complications and no mortality in this period of study. Conclusion: Our finding demonstrates that there was no difference in the outcome whether the patient was given the antibiotics post-operatively or not. Even the diabetics can be treated with prophylactic doses of antibiotics. Three port technique was safe. Complications can be avoided even without selecting cases if two surgeons perform together and early decision of conversion to open cholecystectomy is made. Keywords: cholelithiasis, laparoscopic cholecstectomy, private hospital, three port techniquePublication Peutz-Jehger’s Syndrome presenting as adult intussusception(Institute of Medicine, 2009) Athar, Z; Rajbhandari, A; Kansakar, P; Singh, YP; Vaidya, PAbstract Abstract: Peutz- Jehger’s syndrome is an autosomal dominant disorder. It is the second most common hamartomatous syndrome with hamartomatous polyp of gastrointestinal tract and cutaneous melanin deposit. Majority of patients remain relatively asymptomatic. Some present with abdominal pain secondary to obstruction or impending obstruction owing to an intussuscepted polyp with GI bleeding. We report a case of 21 year male who presented with upper central abdominal pain, distension, vomiting and blood mixed stool. He also had black colored spots on perioral region and fingers. Ultrasound revealed mass lesion with echogenic centre suggestive of intussusception. Emergency laparotomy revealed jejunojejunal intususception with gangreneous intussusceptum and two other large polyps. Resection anastomosis of jejunum and excision of polyps was done. Peutz – Jehger’s syndrome is a rare but important cause of intussusception in adults presenting with cutaneous manifestations and features of intestinal obstruction Keywords: Cutaneous melanin, Hamartomatous polyp, Intussusception, Peutz Jegher’s syndromePublication Renal cell carcinoma of a horseshoe kidney mistaken for ovarian malignancy(Institute of Medicine, 2006) Adhikari, S; Rana, A; Gurung, G; Adhikari, R; Vaidya, P; Joshi, BAbstract Background: Heterogonous complex mass suspected to be ovarian tumour preoperatively in the vicinity of both low lying kidneys in close approximation to enlarged lymph node by trans abdominal ultrasound was found to be renal cell carcinoma arising from horseshoe kidney. Case report: A rare presentation, is described herewith in a multiparous (P6), 57 year old post menopausal lady who suffered from pyrexia for 2 months and mass abdomen for 3 years.Publication Publication Responding to the need of the Society: Nepal Ambulance Service(Institute of Medicine, 2012) Gongal, R; Vaidya, PNA.Publication Surgical management of extrahepatic portal vein obstruction at University Hospital(Institute of Medicine, 2017) Shah, S; Ghimire, B; Kansakar, P B S; Bhandari, R S; Lakhey, P J; Vaidya, P; Singh, Y PAbstract Introduction: Extrahepatic portal vein obstruction (EHPVO) is a second most common cause of portal hypertension which causes upper gastrointestinal (GI) bleeding. Primary management of upper GI bleeding is endoscopic therapy. However, surgery is performed as a secondary management of upper GI bleeding and if patients fail to respond endoscopic management or complications of EHPVO develops. The aim of the study was to determine the perioperative outcome of surgery done for EHPVO. Methods: This is retrospective observational study of all the patients of EHPVO, who were undergone surgical management at Tribhuvan University Teaching Hospital in between April 2015 to March 2017. Data were collected from case sheets of the patients. The demographic and clinical characteristics of the patients, and perioperative and short term outcome of the surgical management of EHPVO patients were analysed. Results: Total 34 patients were included in the study including 20 males (58.8%) and 14 (41.2%) females with median age of 17 years (4 to 45 years). Most common presentation of EHPVO were fullness in upper abdomen (34/34) upper GI bleeding (29/34). Most of the patients had anemia (33/34), splenomegaly (34/34) and hypersplenism (28/34).Shunt surgery was performed in 20 patients and modified Hassab’s procedure in 14 patients. There was no post-operative severe complication except one mortality in Hassab’s procedure. The median duration of surgery was higher in shunt surgery group compared to devascularisation group (240 minutes versus 180 minutes). There were no significant differences in intraoperative blood loss, total hospital stays and recurrent upper GI bleeding in both surgery groups. Conclusions: Surgical management for EHPVO have good perioperative and short term outcome. Keywords:Esophageal varices, Hypersplenism, Portal biliopathy,Portal vein obstructionPublication Various presentations of Meckel’s Diverticulum(Institute of Medicine, 2005) Kumar, S; Singh, YP; Vaidya, PAbstract Background – Meckel’s diverticulum is very difficult to diagnose. The aim of this study was to study the various presentations of Meckel’s diverticulum in TUTH in one year. Methods – Retrospective study of nine patients admitted from emergency in one year data was done. Result - In acute abdomen we have to think about Meckel’s diverticulum and its complications. The diagnosis of symptomatic Meckel’s diverticulum is difficult to make, especially in adults. The diagnosis must be considered in anyone with unexplained abdominal complaints, nausea and vomiting, or intestinal bleeding.