Browsing by Author "Vaidya, Pradeep"
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Publication Public Health Approach to Developing Palliative Care(Nepal Medical Association, 2022) Baral, Kedar Prasad; Bista, Kiweta; Lama, Chiniya; Acharya, Paras Kumar; Vaidya, Pradeep; Gongal, Rajesh NathAbstract Nepal has witnessed demographic and epidemiological transition resulting in the shift from infectious diseases to non-communicable diseases as the major disease burden. Around 60% of mortalities and morbidities are attributable to non-communicable diseases of which the majority end with the need for palliative care services. The current palliative care services in Nepal are in the infancy stage compared with other services. Undignified dying is a challenging public health problem and as such requires a public health approach to address it with the involvement of all stakeholders. Recognizing the need for the end spectrum of non-communicable diseases patients, the Ministry of Health, Nepal recently introduced the policy to address the unmet need through the community-based palliative care program, a laudable initiation.Publication Risk Score for Prediction of Severe Postoperative Complications After Pancreaticoduodenectomy(Institute of Medicine, 2021) Shah, Surendra; Bhandari, Ramesh S; Vaidya, Pradeep; Singh, Yogendra P; Lakhey, Paleswan JoshiABSTRACT Introduction: Morbidity after pancreaticoduodenectomy (PD) still remains high. Postoperative pancreatic fistula (POPF) is the most common cause of increased morbidity after PD. Assessment of predictability of risk score for severe postoperative complications was the objective of this study. Methods: This was a retrospective observational study. Patients undergoing pancreaticoduodenectomy at Tribhuvan University Teaching Hospital (TUTH) between January 2017 to December 2017 were included in the study. Variables were recorded from case sheets of the patients. The “Risk Score” was calculated using the pancreatic duct diameter and body mass index (BMI). Association of risk score and severe postoperative complications were analyzed. Results: A total number of patients were 43, including 23 (53.5%) males and 20 (46.5%) females. The mean age was 57.09 ± 11.85 years ranges from 29 years to 76 years. The POPF and delayed gastric emptying (DGE) was 23.3% (10/43); and post-pancreaticoduodenectomy hemorrhage (PPH) was 11.6% (5/43). Severe postoperative complications were present in 13.9% (6/43) patients. In univariate analysis, pancreatic duct diameter (p=0.045) and Risk Score (p=0.02) were significantly associated with severe postoperative complications after PD. However none of them were significant in multivariate analysis. Conclusion: Risk score failed to predict severe postoperative complication after pancreaticoduodenectomy. Keywords: Pancreaticoduodenectomy, postoperative pancreatic fistula, severe postoperative complicationsPublication Role of Preoperative CEA, CA 19-9, NLR and PLR as Predictors of Adverse Prognostic Pathological Features of Gastric Carcinoma Patients in a Tertiary Centre of Nepal(Institute of Medicine, 2019) Mandal, Rajesh K; Bhandari, Ramesh S; Lakhey, Paleswan J; Singh, Yogendra P; Vaidya, Pradeep; Kansakar, Prasan BS; Ghimire, Bikal; Kandel, Bishnu PABSTRACT Introduction According to GLOBOCAN 2018, gastric carcinoma is the fifth most common cancer (5.7%) and third most common cause of cancer related death (8.2%) worldwide. Delayed presentation and advanced disease at diagnosis, owing to the overlapping symptoms, can be attributed to its high mortality. Gastrectomy is one of the most commonly performed surgery at our centre. This study aims to study the role of pre-operative serum carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) as predictors of adverse prognostic pathological features of gastric carcinoma patients who were considered for surgery at our centre. Methods This is a retrospective analysis of prospectively maintained database of all operated gastric carcinoma patients since June 2016 to January 2019. Various pre-operative variables including serum CEA level, serum CA 19-9 level, NLR and PLR were collected. Intra-operative surgical procedures performed and post-operative pathologic variables like tumor size, stage, grade, lymph node ratio (LNR), lymphovascular invasion (LVI) and perineural invasion (PNI) were collected. Results A total 60 patients were planned for surgical intervention over this duration. Mean age of the population was 56.8±12.5 years with slight male predominance (i.e. 55%). Mean CEA level was 6.17 ng/ml and CA 19-9 level was 72.1 U/ml. The mean NLR and PLR of the study population was 3.4 and 200 respectively. Fifty four patients had distal tumors and six had proximal tumors. Curative surgery was performed in 40 patients out of which 37 underwent subtotal gastrectomy and three underwent total gastrectomy. D2 gastrectomy was performed in 55% patients treated with curative intention. Advanced disease (T2 and above) was seen in 86.7% of patients. Preoperative CEA, CA 19-9, NLR, PLR were evaluated for association with pathologic features like tumor size, T stage, grade of tumor, LNR, LVI, and PNI but statistical analysis failed to show any significant association. Conclusion Advanced disease at presentation is common in gastric carcinoma. Preoperative clinical parameters including tumor markers CEA, CA 19-9, NLR and PLR may not be useful to diagnose the advanced disease in gastric carcinoma patients. Keywords: Gastric carcinoma, gastrectomy, CEA, CA 19-9, NLR, PLR