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Lacey H, Jain N, Sugimoto M, Shimato M, Zhou SJ, Pirags V, Shakya R, Karmacharya RM, Baral PP. Advancing diabetes primary care education and knowledge in Nepal: A scoping review and case study discussion. Prim Care Diabetes 2024; 18:25-36. [PMID: 38061968 DOI: 10.1016/j.pcd.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/21/2023] [Accepted: 11/30/2023] [Indexed: 02/12/2024]
Abstract
AIMS Diabetes mellitus (DM) is a chronic disorder of insulin and glucose metabolism. It affects more than 463 million people worldwide and is expected to reach 700 million by 2045. In the Southeast Asian region, the prevalence of DM has tripled to 115 million due to rapid urbanization, unhealthy diet, sedentary lifestyles, and genetic factors. In Nepal, a developing country, DM affects 8.5% of adults, with an alarming increase in recent years. Lack of diabetes education and limited populational adoption of behavioural changes further hamper care. METHODS In the present study, we performed a scoping review to determine the status of awareness, attitudes, and knowledge about diabetes in the Nepalese population with a focus on the educational initiatives that have been implemented. We also conducted a two-week international case study discussion among medical students to brainstorm viable intervention strategies. RESULTS Our findings indicate that limited data is available on the level of education or initiatives to improve knowledge and practice among healthcare professionals and community members. Targeted studies of people with diabetes also present heterogeneous results due to differences in the sample population, geographic location, education, age, and gender. Accordingly, we propose five interrelated education-based strategies that leverage existing networks to expand community outreach and engagement, improve system resilience, and improve health outcomes. CONCLUSIONS Effective education for healthcare professionals, community, and patients with diabetes is vital in improving diabetes outcomes in Nepal and South Asia. Collaboration, funding, and evaluation are key areas needing reform.
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Affiliation(s)
- Hester Lacey
- Faculty of Medicine, Brighton and Sussex Medical School, 94 N - S Rd, Falmer, Brighton BN1 9PX, United Kingdom.
| | - Nityanand Jain
- Faculty of Medicine, Riga Stradinš University, 16 Dzirciema Street, Riga LV-1007, Latvia
| | - Mai Sugimoto
- Faculty of Medicine, Queen Mary University of London, Mile End Rd, Bethnal Green, London E1 4NS, United Kingdom
| | - Masako Shimato
- Faculty of Medicine, University College London, Gower St, London WC1E 6BT, United Kingdom
| | - Shi Jia Zhou
- Faculty of Medicine, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe City, Hyogo 650-0017, Japan
| | - Valdis Pirags
- Faculty of Medicine, University of Latvia, 3 Jelgavas Street, Riga LV-1004, Latvia; Department of Endocrinology and Rheumatology, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, Riga LV-1002, Latvia
| | - Rajani Shakya
- Research & Development Division, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel 45200, Nepal
| | - Robin Man Karmacharya
- Department of Surgery, Kathmandu University School of Medical Sciences, B.P.Highway, Panauti 45209, Nepal
| | - Phanindra Prasad Baral
- Non-Communicable Disease and Mental Health Section, Epidemiology and Disease Control Division (EDCD), Department of Health Services (DoHS), Ministry of Health and Population (MoHP), Government of Nepal, Kathmandu, Nepal
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Shrestha P, Karmacharya RM, Dhakal P, Bade S, Dahal S, Bhandari N, Bade S. Predicting factors of patient satisfaction after varicose vein surgery at a university hospital in Nepal. J Vasc Nurs 2023; 41:180-185. [PMID: 38072570 DOI: 10.1016/j.jvn.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 06/09/2023] [Accepted: 06/27/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Varicose veins are a common vascular problem with a high prevalence, yet they are often neglected. The main objective of this study was to explore the patient satisfaction after varicose vein surgery, along with its predicting factors. To our knowledge, no similar study has been conducted in Nepal to date. METHODOLOGY This retrospective cross-sectional study included patients who underwent varicose vein surgery at Dhulikhel Hospital from September 2019 to February 2020. The satisfaction level after the surgery was assessed using a 10-point Likert scale questionnaire during a telephone interview with their verbal consent. Descriptive statistics and linear regression were performed to identify the predicting factors of patient satisfaction. RESULTS Among a total of 84 patients interviewed, 53.6% were male. The mean age of the participants was 43.13 ± 13.62 years. The mean patient satisfaction score was 42 ± 5.5, with nursing service, discharge teaching and hospital service being the highest scoring items in terms of patient satisfaction. Linear regression revealed age ≤40 years as a predictor of higher patient satisfaction (β=0.258, p=0.015) while early stage of varicose veins (β=-0.233, p=0.026) and duration of post-operative follow-up (β=-0.25, p=0.021) were negative predictors of patient satisfaction. This means that patients with C2-C3 venous disease and longer duration of postoperative follow-up tended to have lower satisfaction scores. CONCLUSION The overall patient satisfaction following varicose vein surgery was very good, and the major predictors of better satisfaction were age ≤40 years, C4-C6 clinical classification of venous disease and the shorter duration of follow-up after surgery.
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Affiliation(s)
- P Shrestha
- Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Dhulikhel, Nepal.
| | - R M Karmacharya
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Dhulikhel, Bagmati Province, Nepal.
| | - P Dhakal
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Dhulikhel, Bagmati Province, Nepal
| | - S Bade
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Dhulikhel, Bagmati Province, Nepal
| | - S Dahal
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Dhulikhel, Bagmati Province, Nepal
| | - N Bhandari
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Dhulikhel, Bagmati Province, Nepal
| | - S Bade
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Dhulikhel, Bagmati Province, Nepal
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Yadav B, Sapkota A, Sharma S, Karmacharya RM, Vaidya S. Treating upper limb claudication in a patient with Takayasu's arteritis with carotid-to-subclavian bypass: A case report. Int J Surg Case Rep 2023; 109:108566. [PMID: 37549437 PMCID: PMC10425891 DOI: 10.1016/j.ijscr.2023.108566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Takayasu's Arteritis (TA) is a rare form of large vessel vasculitis often being apparent late in its progression with features of artery occlusion. Studies comparing endovascular approach with bypass surgeries reveal surgery to be a better option with lesser rates of postoperative restenosis. CLINICAL PRESENTATION A 25-year-old female patient presented with dizziness, headache, claudication and paresthesias in the right arm. Her right radial pulse couldn't be appreciated and BP on the right brachial artery was unrecordable. BP on her left brachial artery was 160/110 mmHg. CT angiogram demonstrated stenosis in the right subclavian, coeliac and left renal artery. After adequate control of hypertension and ruling out the active phase of TA, she underwent right carotid to subclavian bypass with Polytetrafluoroethylene(PTFE) graft. At 1 year follow up there was significant improvement in her right arm claudication. DISCUSSION Symptomatic cases of TA need either endovascular angioplasty or surgical intervention to establish reperfusion. Surgery must be done only in the inactive phase of the disease because of the risk of reocclusion. The remission of TA is difficult to predict with clinical findings and ESR values. Oftentimes biopsies taken from the arteries of patients who underwent surgery showed features of active inflammation. CONCLUSION We recommend all cases of TA to be treated with a course of steroids before planning for surgery irrespective of symptomatology and ESR values. Bypass surgeries with PTFE graft along with preoperative or postoperative steroid therapy result in resolution of ischemic symptoms.
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Affiliation(s)
- Binay Yadav
- Department of Cardiothoracic and Vascular Surgery, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal.
| | - Anugya Sapkota
- Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Sanjay Sharma
- Department of Cardiothoracic and Vascular Surgery, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Robin Man Karmacharya
- Department of Cardiothoracic and Vascular Surgery, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Satish Vaidya
- Department of Cardiothoracic and Vascular Surgery, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
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Vaidya S, Karmacharya RM, Khadka S, Pokharel S, Yadav B, Sharma S, Kunwar K, Bhatt S. Ewing's sarcoma arising from the right sided chest wall: a case report. Ann Med Surg (Lond) 2023; 85:3709-3713. [PMID: 37427176 PMCID: PMC10328691 DOI: 10.1097/ms9.0000000000000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 06/10/2023] [Indexed: 07/11/2023] Open
Abstract
Ewing sarcoma (ES) is a malignant tumour prevalent in young adults with a reported 5-year survival ranging between 40 and 60% in most studies. Majority of the patients with ES are usually diagnosed late with significant chest wall mass, chest pain or respiratory distress. Case presentation Here, the authors present a case of a 21-year-old female with a diagnosis of right sided chest wall ES treated with neoadjuvant chemotherapy followed by surgical resection of the mass. Clinical findings and investigations The patient presented to the Surgical OPD with shortness of breath for 6 months associated with chest pain on the right side. Radiological investigations including chest X-ray and multi-detector row computed tomography chest was done. Additionally, diagnosis of ES was confirmed with histopathological examination of the mass obtained from fine needle aspiration cytology. Interventions and outcome She was planned for safe maximal resection of tumour with chest wall reconstruction using double prolene mesh with bone cement and the defect was sutured with adjacent ribs. Good outcome was noted on postoperative period with resolution of symptoms. Relevance and impact This procedure is now commonly used and is considered as an effective treatment for chest wall tumours, which was also noted in our case and the procedure is also well tolerated.
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Affiliation(s)
- Satish Vaidya
- Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences
| | - Robin Man Karmacharya
- Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences
| | - Saurav Khadka
- Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences
| | - Selene Pokharel
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Nepal
| | - Binay Yadav
- Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences
| | - Sanjay Sharma
- Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences
| | - Kajol Kunwar
- Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences
| | - Swechha Bhatt
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Nepal
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Chaudhary A, Acharya S, Pradhan SK, Gurung K, Karmacharya RM, Vaidya S, Mahat C, Kunwar K, Bhatt S. Accidental gunshot injury with left-sided lung injury and D11 burst fracture: a case report. Ann Med Surg (Lond) 2023; 85:1897-1901. [DOI: 10.1097/ms9.0000000000000343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/01/2023] [Indexed: 04/05/2023] Open
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Bhandari N, Chaudhary A, Acharya S, Acharya SS, Paudel K, Karmacharya RM, Vaidya S, Kunwar K, Bhatt S. Supraventricular tachycardia and deep vein thrombosis following Moderna vaccination: A case series. Clin Case Rep 2023; 11:e7065. [PMID: 36968349 PMCID: PMC10030682 DOI: 10.1002/ccr3.7065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 03/24/2023] Open
Abstract
There have been reports of deep vein thrombosis and supraventricular tachycardia following the Moderna vaccination. The timing of SVT and DVT just after vaccination in our case series could suggest possible temporal relationships to the vaccination. But further studies are needed to establish such evidence.
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Affiliation(s)
- Niroj Bhandari
- Department of SurgeryKathmandu University School of Medical SciencesDhulikhelNepal
| | - Aashutosh Chaudhary
- Kathmandu University School of Medical SciencesDhulikhel HospitalDhulikhelNepal
| | - Suyash Acharya
- Kathmandu University School of Medical SciencesDhulikhel HospitalDhulikhelNepal
| | | | - Kusum Paudel
- Department of MedicineKathmandu University School of Medical SciencesDhulikhelNepal
| | - Robin Man Karmacharya
- Cardio‐Thoracic and Vascular Surgery Unit, Department of SurgeryKathmandu University School of Medical SciencesDhulikhelNepal
| | - Satish Vaidya
- Cardio‐Thoracic and Vascular Surgery Unit, Department of SurgeryKathmandu University School of Medical SciencesDhulikhelNepal
| | - Kajol Kunwar
- Kathmandu University School of Medical SciencesDhulikhel HospitalDhulikhelNepal
| | - Swechha Bhatt
- Kathmandu University School of Medical SciencesDhulikhel HospitalDhulikhelNepal
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Gyawali P, Bhatt RD, Karmacharya RM, Pant V, Khadka A. High Burden of Vitamin B12 Deficiency among Adults and Elderly. J Nepal Health Res Counc 2023; 20:702-707. [PMID: 36974860 DOI: 10.33314/jnhrc.v20i3.4407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Deficiency of vitamin-B12 is widespread. Adults and the elderly are particularly susceptible to vitamin-B12 deficiency. This study investigated the burden of vitamin-B12 deficiency and insufficiency among adults and the elderly attending a tertiary care hospital in Nepal. METHODS This is a retrospective chart review conducted at Dhulikhel hospital. We reviewed records of 1615 patients investigating Vitamin-B12 level (pmol/L) at the clinical biochemistry laboratory from laboratory management database MIDAS between June 2020 and December 2021. Vitamin-B12 level was measured using enzyme immunoassay in Abbott Architect i1000SR analyzer. The categorical variables are presented as frequency and percentage; and numerical variables as means and standard deviations, or median and Interquartile range. Pearson Chi-square test was used to determine association between categorical variables. Mann Whitney test and Kruskal Wallis H test were used to compare Vitamin-B12 level by categories. RESULTS There were 1454 participants of which 33.5% of the patients were deficient, 27.9% were borderline deficient, while 38.7% had adequate vitamin B12 levels. Young adults(170.4 pmol/L) had a lower median vitamin B12 level than middle-aged adults (183.7pmol/L) and the elderly population (247.9pmol/L) (P<0.001). Compared to females (186.7 pmol/L), males(171.9 pmol/L) had lower vitamin B12 level (P <0.05). CONCLUSIONS The study revealed that a significant proportion of young adults, middle aged adults and elderly population visiting a tertiary care hospital of Nepal are having vitamin B12 deficiency and borderline deficiency of public health concern. Keywords: Adults; deficiency; elderly, vitamin B12.
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Affiliation(s)
- Pratiksha Gyawali
- Department of Biochemistry, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal
| | - Rajendra Dev Bhatt
- Department of Biochemistry, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal
| | - Robin Man Karmacharya
- Department of Cardiothoracic Vascular Surgery(CTVS), Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal
| | - Vivek Pant
- Department of Clinical Biochemistry, Samyak Diagnostic Pvt. Ltd, Kathmandu, Nepal
| | - Ayesha Khadka
- Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
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Basnet S, Pradhan A, Bade S, Sharma G, Giri L, Shakya YR, Karmacharya RM, Dahal S, Shrestha SK. Hemoperitoneum among Pediatric Abdominal Trauma Patients Visiting in Emergency Department of a Tertiary Care Centre: A Descriptive Cross-sectional study. JNMA J Nepal Med Assoc 2023; 61:59-63. [DOI: 10.31729/jnma.7520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 11/21/2022] [Indexed: 01/03/2023] Open
Abstract
Introduction: Pediatric abdominal trauma presents a major challenge for first-line responders in the Emergency Department for assessment and management. The Focused assessment sonography for trauma is a readily available, easy-to-use, and affordable tool for detecting hemoperitoneum during the initial assessment of trauma in the Emergency Department for adult traumatic patients. The aim of this study was to find the prevalence of hemoperitoneum among pediatric abdominal trauma patients visiting the Emergency Department of tertiary care centre through Focused assessment with sonography for trauma examination technique.
Methods: This was a descriptive cross-sectional study conducted in the Emergency Department of a tertiary care hospital from 7 April 2019 to 7 April 2020. Among 413 pediatric trauma patients, 93 children (1 to 17 years) admitted to the Emergency Department who underwent focused assessment with sonography for trauma examination were included in the study. Ethical approval was obtained from the Institutional Review Committee (Approval number: 111/19). Convenience sampling was used. Point estimate and 90% Confidence Interval were calculated.
Results: Among 93 children receiving focused assessment with sonography for trauma imaging in the Emergency Department with a history of blunt abdominal trauma, the prevalence of hemoperitoneum was 18 (19.34%) (12.61-26.09, 90% Confidence Interval).
Conclusions: The prevalence of hemoperitoneum was similar to other studies conducted in a similar setting.
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Sapkota P, Tamang A, Bhandari S, Singh Y, Shrestha RB, Karmacharya RM, Vaidya S, Bhatt S. Anticoagulation failure in pulmonary thromboembolism in COVID-19 pneumonia despite prolonged anticoagulation: A case series. Ann Med Surg (Lond) 2022; 84:104929. [PMID: 36439890 PMCID: PMC9675080 DOI: 10.1016/j.amsu.2022.104929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/09/2022] [Accepted: 11/13/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Moderate to severely ill patients diagnosed with Coronavirus disease 2019 (COVID-19) pneumonia develop a series of complications and less frequently, we might witness cases of Pulmonary Thromboembolism (PE)-refractory to the standard treatment with Low Molecular Weight Heparin (LMWH). The aim of this case series is to report the presentation and management of pulmonary thromboembolism secondary to COVID-19 pneumonia. Method We report a case series of seven cases aged 40–70 who were presented in Dhulikhel Hospital with COVID-19 symptoms in different stages. The case details were extracted from their medical reports of the hospital. The written informed ethical consents were obtained from all the cases and their voluntary participation was assured. Outcome The cases in the case series admitted with COVID-19 pneumonia, after diagnostic investigation (Chest x-ray, HRCT, CTPA) were suggestive of COVID-19 Pneumonia with ARDS and pulmonary thromboembolism. The cases received rivaroxaban, a newer anticoagulant-15 mg twice daily for 21 days and after discharge, they were asked to continue once daily doses for 9 weeks. Significant improvement was witnessed, with the presence of additional intervention including rehabilitative chest exercises. Conclusion Pulmonary thromboembolism secondary to COVID-19 pneumonia is a life-threatening condition. Rivaroxaban is seen to be very effective in the management of this condition when an anticoagulation failure occurs even after the therapeutic dose of low molecular weight heparin. Future studies may require more scientific investigations to prevent complications even in the early stages of COVID-19.
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Affiliation(s)
- Prakash Sapkota
- Department of Internal Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Ashish Tamang
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
- Corresponding author.
| | - Sadikshya Bhandari
- Department of Internal Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Yadvinder Singh
- Department of Internal Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Rohit Bhasink Shrestha
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Robin Man Karmacharya
- Cardiothoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Satish Vaidya
- Cardiothoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Swechha Bhatt
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
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Karmacharya RM, Vaidya S, Yadav B, Joshi S, Karkee D, Marasini S, Khadka S, Bhatt S. Klippel Trenaunay syndrome in a 3-year-old: A case report. Int J Surg Case Rep 2022; 99:107673. [PMID: 36170793 PMCID: PMC9568750 DOI: 10.1016/j.ijscr.2022.107673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 01/19/2023] Open
Abstract
Introduction and importance Klippel-Trenaunay syndrome (KTS) is characterized by a triad of port-wine stain, varicose veins and soft tissue or bony hypertrophy of lower limb. Varicose veins in Klippel Trenaunay syndrome are mostly distributed in the lateral aspect of the lower limb. The exact etiology of KTS is not known, and the treatment usually starts with conservative management- limb elevation, compression stockings and physiotherapy. However, some cases are severe enough to warrant surgical management. Case presentation Here we present a case of a 3-year-old male child with clinical features suggestive of Klippel Trenaunay Syndrome managed successfully with sclerotherapy of persistent lateral marginal vein of servelle. At one month follow-up the vein was sclerosed and there was a significant reduction in varicosities of leg. Clinical discussion Starting treatment of varicose veins in Klippel Trenaunay Syndrome in children is effective in preventing long-term complications in adults. Thus, treating venous malformation with sclerotherapy is warranted in early childhood to prevent venous hypertension and chronic venous insufficiency. Conclusion Varicose veins in KT syndrome can be managed successfully by sclerotherapy of lateral marginal vein of servelle resulting in significant reduction in varicosities of leg. Klippel-Trenaunay Syndrome is a combined vascular malformation usually having a persistent lateral marginal vein of Servelle. Diagnosis in early childhood is rare; therefore, the disease is under-evaluated until the patient is symptomatic. Ultrasonography can be done to see underlying venous malformation. Treatment with two to four sessions intravenous sclerotherapy yields a good clinical outcome.
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Affiliation(s)
- Robin Man Karmacharya
- Cardiothoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Satish Vaidya
- Cardiothoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Binay Yadav
- Cardiothoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.
| | - Sahasra Joshi
- Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Diwas Karkee
- Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Sujita Marasini
- Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Sadiksha Khadka
- Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Swechha Bhatt
- Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Vaidya N, Karmacharya RM, Vaidya S, Bade S, Bade S, Paudel K, Kandel G, Thapa P, Maharjan R, Duwal S, Karki Y. Massive Hemoptysis and Pulmonary Thromboembolism in a Patient with Pulmonary Tuberculosis: A Therapeutic Conundrum Managed with Bronchial Artery Embolization. Kathmandu Univ Med J (KUMJ) 2022; 20:522-525. [PMID: 37795736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Hemoptysis is a crucial entity taking into account its morbidity and mortality. Pulmonary tuberculosis is the leading cause for massive hemoptysis in our part of the world, which if left untreated may be life threatening. We present a case of a 37-year-old male patient with pulmonary tuberculosis with concurrent pulmonary thromboembolism presenting with massive hemoptysis, which was successfully managed with Bronchial Artery Embolization. This case represents that this measure can be a viable therapeutic choice for a patient with a severe lifethreatening hemoptysis, particularly when other treatment options are unavailable or ineffective.
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Affiliation(s)
- N Vaidya
- Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R M Karmacharya
- Department of General Surgery (Cardiothoracic and Vascular), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Vaidya
- Department of General Surgery (Cardiothoracic and Vascular), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Bade
- Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Bade
- Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - K Paudel
- Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - G Kandel
- Department of General Surgery (Cardiothoracic and Vascular), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - P Thapa
- Interventional Radiology Department, Grande International Hospital, Kathmandu, Nepal
| | - R Maharjan
- Catheterization Laboratory, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Duwal
- Catheterization Laboratory, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Y Karki
- Catheterization Laboratory, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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Karmacharya RM, Singh AK, Vaidya S, Tuladhar SM, Devbhandari M, Lama B, Kharel BB, Basnet S. Analysis of Lung Cancer Cases Presenting in Outpatient Department of University Hospital of Nepal. Kathmandu Univ Med J (KUMJ) 2022; 20:452-455. [PMID: 37795723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Background Lung cancer is one of the leading cause of cancer related death. Most common histopathology of lung cancer is non-small cell carcinoma of which adenocarcinoma is the most common. There are limited number of studies done in Nepal to know different aspects of lung cancer. Objective To know demographic parameters of patients diagnosed as lung cancer in a university hospital. The study also aims to know the different histopathological diagnosis of lung cancer. Method All the patients presenting to outpatient department (Cardio Thoracic and Vascular unit) of Dhulikhel Hospital, if are diagnosed as cancer of lung/bronchus will be included in the study. The duration of the study was January 2017 to December 2021. The details on age, gender, presenting symptoms, histopathology of lung cancer, operability will be included in database and will be analyzed. Result There were total of 127 patients diagnosed as lung cancer. Male:female ratio was 1.7:1. Overall mean age was 63.23 years (SD 13.5 years, Range 19-89 years). Non small cell carcinoma was the most common type of lung cancer with 83.7%. In non small cell carcinoma, most common type was Squamous cell carcinoma followed by undifferentiated and Adenocarcinoma. Only five (3.93%) cases were in operable stage. Conclusion Despite the fact that lung cancer is one of the most common cancer, patients usually present late and moslty are not in operable stage. This study shows that squamous cell carcinoma is the most common histopathology in lung cancer cases.
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Affiliation(s)
- R M Karmacharya
- Department of Surgery (Cardio Thoracic and Vascular Surgery Unit), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - A K Singh
- Department of Surgery (Cardio Thoracic and Vascular Surgery Unit), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Vaidya
- Department of Surgery (Cardio Thoracic and Vascular Surgery Unit), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S M Tuladhar
- Department of Surgery (Cardio Thoracic and Vascular Surgery Unit), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - M Devbhandari
- Department of Surgery (Cardio Thoracic and Vascular Surgery Unit), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - B Lama
- Department of Surgery (Cardio Thoracic and Vascular Surgery Unit), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - B B Kharel
- Department of Surgery (Cardio Thoracic and Vascular Surgery Unit), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Basnet
- Department of Surgery (Cardio Thoracic and Vascular Surgery Unit), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Chaudhary A, Acharya S, Karmacharya RM, Lamsal A, Pokharel S, Bhatt S. Venous pseudoaneurysm of left brachiocephalic fistula treated by excision and aneurysmorrhaphy: A case report. Int J Surg Case Rep 2022; 98:107496. [PMID: 36027828 PMCID: PMC9424355 DOI: 10.1016/j.ijscr.2022.107496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/07/2022] [Accepted: 08/07/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction and importance Brachiocephalic fistula, an arteriovenous fistula approach for hemodialysis in Chronic Kidney Disease patients, can cause various complications. Pseudoaneurysm in the venous end of the arteriovenous fistula is one of those unusual presentations, and can lead to the failure of vascular access. Case presentation We present a case of a 38-year-old female with pseudoaneurysm in the venous end of the left brachiocephalic fistula presenting as painless swelling for one month. Surgical management was done with excision followed by aneurysmorrhaphy. Clinical discussion The repair is associated with risks of arteriovenous fistula failure, thromboembolism, bleeding manifestation and graft rupture. Surgical correction should be done as early as possible with consideration of size, location, and available resources. Conclusion Venous pseudoaneurysm in a brachiocephalic fistula is an unusual complication which requires prompt surgical correction. Pseudoaneurysm in the venous end of the brachiocephalic fistula is an unusual presentation. Surgical repair of pseudoaneurysm is associated with more complications. Case of successful surgical management of pseudoaneurysm by excision and aneurysmorrhaphy
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Shrestha B, Man Karmacharya R, Shalike N. Prediction of Quality of Life by Helsinki CT Scoring System in Patients with Traumatic Brain Injury. Nep J Neurosci 2022. [DOI: 10.3126/njn.v19i2.42293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Traumatic brain injury (TBI) is an alteration in normally maintained homeostasis and function of the brain owing to any external forces. It is one of the major causes leading to increased disability and morbidity among patients suffering trauma. Hence, we aim to study the association between Helsinki computed tomography CT score on admission to patient’s Quality of Life (QoL) following traumatic brain injury in Dhulikhel Hospital, Nepal.
Methods and Materials
A prospective observational study was conducted among 44 patients who suffered traumatic brain injury. Eligible patients over 18 years of age diagnosed with traumatic brain injury which is confirmed with a computed tomography scan on admission were included. Outcomes were assessed using the quality of life scale “Project for the Epidemiological Analysis of Critical Care Patients scale (PAEEC)”.
Results: Among 44 participants suffering from TBI owing to various modes of injury, male to female ratio was 2.3:1. The mean age among participants was 41.07 years with standard deviation of ± 20.13 (Range 18 – 90 years). Correlation analysis showed that QoL, up to 6 months post-TBI, was significantly associated with Helsinki CT classification. Group 1 and group 2 encompassed subjects who sustained TBI and are in their scheduled 3 monthly and 6 monthly follow up. And significant correlation was noted between two variables r1 = 0.536, p-value = 0.027 and r2 = 0.565, p-value = 0.001 respectively.
Conclusion: The present study showed that patients with TBI experience significant quality of life deterioration up to 3-6 months post-TBI. And such deterioration can be predicted by use of Helsinki CT score on admission.
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Singh AK, Karmacharya RM, Vaidya S, Shrestha I, Siwakoti S. The Cut-off Value of Great Saphenous Vein Diameter at the Level of Femoral Condyle to Predict the Sapheno-Femoral Junction Incompetence. Kathmandu Univ Med J (KUMJ) 2022; 20:280-283. [PMID: 37042366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Background Varicose vein is one of the commonest problems that patients visit to a vascular out patient services (OPD). It causes a great deal of morbidity in today's population. Objective To see the correlation between the size of great saphenous and Saphenofemoral junction incompetence. Method From January 2019 till January 2020, 396 patients with symptomatic or clinically diagnosed varicose veins were screened for Saphenofemoral junction reflux. The diameter of the saphenous vein was measured with B-mode imaging, and reflux was quantified based on valve closure time using Doppler spectral measurements. Best saphenous vein diameter cutoff for predicting reflux was determined using receiver operating characteristics curve analysis. Result Out of 792 limbs, the Great Saphenous Venous System was involved in 452 limbs, the Short Saphenous Venous System was involved in 151 limbs and significant perforators were present in 240 limbs. Mean great Saphenous Vein diameter of diseased limb (Reflux Positive) was 5.68 mm and 4.0 mm in control group (Reflux Negative). Mean Saphenofemoral junction diameter was 8.23 mm in diseased limbs and 6.16 mm in control limbs. Receiver operating characteristics curve showed great saphenous vein diameter at femoral condyle of 4.5 mm as best cut-off value for diagnosis of sapheno femoral junction reflux. Conclusion Great Saphenous Vein diameter at femoral condyle of 4.5 mm is the best cut-off value for diagnosis Saphenofemoral junction reflux. The Sensitivity and specificity of this cut off value is 81.8% and 71% respectively.
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Affiliation(s)
- A K Singh
- National Consultant, WHO, Kathmandu, Nepal
| | - R M Karmacharya
- Department of Department of General Surgery (CTVS Unit), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Vaidya
- Department of Department of General Surgery (CTVS Unit), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - I Shrestha
- Department of Department of General Surgery (CTVS Unit), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Siwakoti
- Department of Department of General Surgery (CTVS Unit), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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Karmacharya RM, Singh A, Devbhandari M, Napit D, Ghimire K, Mahat C, Vaidya S. Solving the Mystery of Giant Intrathoracic Mass. Kathmandu Univ Med J (KUMJ) 2022; 20:396-398. [PMID: 37042387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Intrathoracic schwannoma are highly vascular nerve sheath benign tumors arising from neural crest derived schwann cells of the intercostal nerves. Common clinical presentation is palpable mass but in our case patient presented with shortness of breath which is rare presentation in Schwannoma. Imaging studies of the patient showed the lesion in left lung, however surgical finding showed mass to arise from chest wall and it was confirmed to be schwannoma by histopathological examination.
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Affiliation(s)
- R M Karmacharya
- Department of Surgery (CardioThoracic and Vascular), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhek, Kavre, Nepal
| | - A Singh
- Department of Surgery (CardioThoracic and Vascular), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhek, Kavre, Nepal
| | - M Devbhandari
- Department of Surgery (CardioThoracic and Vascular), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhek, Kavre, Nepal
| | - D Napit
- Department of Surgery (CardioThoracic and Vascular), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhek, Kavre, Nepal
| | - K Ghimire
- Department of Surgery (CardioThoracic and Vascular), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhek, Kavre, Nepal
| | - C Mahat
- Department of Surgery (CardioThoracic and Vascular), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhek, Kavre, Nepal
| | - S Vaidya
- Department of Surgery (CardioThoracic and Vascular), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhek, Kavre, Nepal
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Karmacharya RM, Vaidya S, Bhatt S, Tamang A, Shrestha RB, Bhandari N, Paudel B, Shah M, Nepal G. Klippel-Trenaunay Syndrome: Case series from a university hospital of Nepal. Ann Med Surg (Lond) 2022; 78:103732. [PMID: 35600200 PMCID: PMC9114462 DOI: 10.1016/j.amsu.2022.103732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 01/19/2023] Open
Abstract
Introduction Klippel Trenaunay Syndrome (KTS) is a rare congenital malformation with capillary and venous malformations and soft tissue/bony overgrowth with or without lymphatic malformation. Cutaneous vascular stain, varicosities and tissue hypertrophy represent its main clinical features. Besides, the patient can develop thromboembolic pathologies, recurrent bouts of infection, stasis eczema, limb length discrepancy and intolerable pain typical of intraosseous involvement. Methods Here, we report a case series of seven patients aged 10–45 who presented to our centre with clinical features suggestive of KTS. Out of them, six patients had involvement of unilateral lower limb, while only one had involvement of bilateral lower limb. They all had typical cutaneous vascular stains and underlying venous malformation, while one patient had developed complications with multiple ulcer formation. Outcomes An interdisciplinary team of vascular surgeons, dermatologists, interventional radiologists, orthopaedics, and physiotherapists managed the cases. We performed an individualized treatment as per the patient's presentation, which included a combination of supportive, medical, interventional radiologic, and surgical interventions. The follow-up outcomes of all the patients revealed significant resolution of symptoms. Conclusion Patients with KTS can have diverse presentations. Therefore, clinicians should ensure an individualized treatment with the involvement of a multidisciplinary team for proper management and prevention of complications. Compilation of eight cases of lower limb Klippel-Trenaunay Syndrome (KTS) successfully managed by a multidisciplinary approach. Primary complaints include pain, geographic vascular stain and, prominent dilated veins. Demonstration of individualized management algorithm, which yields a good outcome.
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Affiliation(s)
- Robin Man Karmacharya
- Unit Chief, Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, 45210, Nepal
| | - Satish Vaidya
- Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, 45210, Nepal
| | - Swechha Bhatt
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
- Corresponding author.
| | - Ashish Tamang
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| | - Rohit Bhasink Shrestha
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| | - Niroj Bhandari
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| | - Bijaya Paudel
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| | - Manish Shah
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| | - Gaurav Nepal
- Institute of Medicine (IOM), Kathmandu, 44600, Nepal
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Acharya SS, Karmacharya RM, Vaidya S, Adhikari MM, Upadhyay G, Bhandari N, Bhatt S. Traumatic gastric laceration with injury of splenic and celiac vessel following intentional self-harm by crashing of motor vehicle: A case report. Ann Med Surg (Lond) 2022; 78:103827. [PMID: 35734650 PMCID: PMC9207041 DOI: 10.1016/j.amsu.2022.103827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022] Open
Abstract
Intra-abdominal injury due to blunt trauma accounts for 5–10% of all traumatic cases. It usually occurs secondary to motor vehicle collision, pedestrian injury, and falls. Typically these result in injury to solid abdominal organs–liver and spleen, hollow visceral organs, and rarely the abdominal vasculature. Blunt abdominal trauma causing concurrent injury to the hepatic branch of the celiac artery and the associated vein along with gastric laceration is a rare presentation and has a high mortality rate, thereby warranting prompt evaluation. While the initial stabilization should follow Advanced Trauma Life Support guidelines, the adherence to nonoperative management or operative care depends upon the severity of the injury and the patient's clinical status. Here, we present an unusual case of gastric and splenic laceration with damage to the hepatic branch of celiac artery, splenic artery, and the associated vein following blunt abdominal trauma in a 12-year-old child following intentional self-harm by crashing a self-inflicted motor vehicle. Despite the negative preoperative radiological finding, the case was managed successfully with the laparotomic correction of the damaged stomach segment, splenectomy, and repair of the damaged artery, and ligation of the transected vein to control hemorrhage. Traumatic gastric and splenic laceration with injury to the hepatic branch of the celiac artery. Exploratory laparotomy reveals a concealed rent in the hepatic branch of the celiac artery causing a source of continuous blood flow. Surgical repair of the damaged viscera and artery, splenectomy, and ligation of the transected vein.
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Affiliation(s)
- Shiwani Sharma Acharya
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
- Corresponding author.
| | - Robin Man Karmacharya
- Cardio-Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, 45210, Nepal
| | - Satish Vaidya
- Cardio-Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, 45210, Nepal
| | - Mahesh Mani Adhikari
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| | - Gaurav Upadhyay
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| | - Niroj Bhandari
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| | - Swechha Bhatt
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
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Karmacharya RM, Shestha AP, Shrestha A, Bajracharya S, Maharjan R, Shrestha S, Jha N, Pyakurel P. National Needs Assessment of Health Information System to Address Cardiovascular Diseases in Nepal: A Mixed Method Study. Kathmandu Univ Med J (KUMJ) 2022; 19:51-57. [PMID: 35526136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background Health information system is an integral component of a country's capacity to integrate, process, report, and use information in improving health services. Objective This study aims to assess the infrastructure and capacity of the national Health information system to address cardiovascular diseases in Nepal. Method We adopted the United States Agency for International Development manual "The Health System Assessment Approach: A How-To Manual", Version 2.0. Three topical areas: input, process and output, were identified. Stepwise approach for Health information system assessment was done. A desk review and key informant interview was performed. Audio recordings were transcribed in Nepali language and intercoder reliability was checked. Result The upgraded District Health Information Software 2.3 provides a comprehensive online data management solution. Sustainable funding to upgrade the system exists. Annual report provides performance of all the components of the health care delivery system. Data were reviewed quarterly. However, no dedicated section for cardiovascular diseases in the Health information system is present. Private health facilities are poorly represented. Strategic planning, management, and evaluation of the Health information system are lacking. Inadequacy of timeliness, completeness, and periodicity of the reporting still exist. Conclusion A separate section of cardiovascular diseases in the Health information system is required. Better reporting of private sectors and its inclusion in databases is of utmost importance. Adaptation in the recently introduced federal structure is key for development of Health information system in the country.
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Affiliation(s)
- R M Karmacharya
- Department of Surgery (Cardio Thoracic and Vascular Surgery Unit), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. and Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - A P Shestha
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal
| | - A Shrestha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal. Department of Public Health, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Nepal. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. and Institute for Implementation Science and Health, Kathmandu, Nepal
| | - S Bajracharya
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - R Maharjan
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal. Nepal. Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Shrestha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - N Jha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - P Pyakurel
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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Dahal S, Karmacharya RM, Vaidya S, Gautam K, Bhatt S, Bhandari N. A rare case of persistent lateral marginal vein of Servelle in Klippel Trenaunay Syndrome: A successful surgical management. Int J Surg Case Rep 2022; 94:107052. [PMID: 35405516 PMCID: PMC9006318 DOI: 10.1016/j.ijscr.2022.107052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 01/19/2023] Open
Abstract
Introduction and importance Klippel-Trenaunay Syndrome (KTS) is a rare congenital vascular disorder characterized by capillary malformation, varicosities, and tissue overgrowth. It usually affects the unilateral lower extremities manifesting commonly as pain, localized rise of temperature, and venous tortuosity. However, in severe cases, ulceration, cellulitis, and chronic lymphatic malformation may be present. Management is mostly supportive and involves the use of compression stockings. Case presentation Here, we report a case of KTS with a persistent lateral marginal vein of Servelle managed with radiofrequency ablation along with sclerotherapy of selected perforators. On a two-year follow-up, the symptoms had resolved and Doppler ultrasonography revealed resolution of the defective vein along with the absence of incompetent perforators. Clinical discussion In cases with venous malformation with the persistence of embryonic avalvular venous structures, like the lateral marginal vein of Servelle, surgical intervention is warranted especially at a younger age to reduce the risk of future thromboembolic events and recurrence. Conclusion Varicosities of the lateral marginal vein of Servelle can be managed successfully by radiofrequency ablation and adjunct sclerotherapy in selected cases. Klippel-Trenaunay Syndrome (KTS) is a congenital vascular disorder which usually affects the unilateral lower extremities. Endovenous treatment of the greater saphenous vein is gradually becoming popular in the treatment of KTS. This case is managed by radiofrequency ablation of lateral marginal vein of Servelle.
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Affiliation(s)
- S Dahal
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Nepal.
| | - R M Karmacharya
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Nepal
| | - S Vaidya
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Nepal
| | - K Gautam
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Nepal
| | - S Bhatt
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Nepal
| | - N Bhandari
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Nepal
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Karmacharya RM, Vaidya S, Bhatt S, Gyawali K, Milan J, Karkee D, Gyawali G, Marasini S. Combined vascular malformation of neck: A case report. Ann Med Surg (Lond) 2022; 76:103531. [PMID: 35495388 PMCID: PMC9052240 DOI: 10.1016/j.amsu.2022.103531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/11/2022] [Accepted: 03/26/2022] [Indexed: 11/23/2022] Open
Abstract
Vascular malformations are developmental anomalies occurring due to defective vasculogenesis. Depending on the number of vessels involved, they are subgrouped into simple or combined types. Combined vascular malformations are a rare clinical entity with two or more vascular malformations (capillary, venous, arteriovenous, lymphatic) present in one lesion. Due to the complexity of these lesions, clinicians should employ an interdisciplinary approach with multi-staged treatment for the proper management. Here, we report a case of a lady with a combined vascular malformation in the right side of the neck who presented to our department with a complaint of progressively increasing swelling for three months. A multidisciplinary team of vascular surgeons, interventional radiologists and physiotherapists were involved in its treatment. Initially, Doppler ultrasonography was performed, which revealed a vascular lesion with arterial and venous components and a flow void region suggestive of lymphatic malformation, further confirmed by magnetic resonance imaging (MRI). A multistage treatment modality was employed where intralesional steroid was initially administered in the lesion area to shrink the vessel's size. Next, venous malformation targeted sclerotherapy was performed preoperatively, followed by intraoperative ligation of the feeding vessel and excision of remaining malformation. Postoperatively the patient had no wound site complication and was discharged on the fourth postoperative day with advice to follow rehabilitative neck exercises. One month follow-up revealed complete resolution of the malformation. Thus, in the case of combined vascular malformation, multistage treatment modalities with a multidisciplinary team should be employed for proper treatment. A rare case of combined arterio-lymphatico-venous malformation on the right side of the neck. Successful multimodal treatment by intralesional steroid injection, ligation of feeding vessel, resection of malformation, and sclerotherapy.
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Affiliation(s)
- Robin Man Karmacharya
- Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, 45210, Nepal
| | - Satish Vaidya
- Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, 45210, Nepal
| | - Swechha Bhatt
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
- Corresponding author.
| | - Kamana Gyawali
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| | - J.N. Milan
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| | - Diwas Karkee
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| | - Garima Gyawali
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| | - Sujita Marasini
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
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Vaidya S, Karmacharya RM, Bhatt S, Bhandari N, Duwal S, Karki YD, Maharjan R. Placement of cuffed tunnelled permanent hemodialysis catheter in patients with end stage renal disease: A cross sectional study. Ann Med Surg (Lond) 2022; 76:103452. [PMID: 35308430 PMCID: PMC8927791 DOI: 10.1016/j.amsu.2022.103452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/26/2022] Open
Abstract
Background End-Stage Renal Disease (ESRD) is a significantly increasing condition warranting renal replacement therapy. Gaining vascular access for catheter placement for this procedure is of paramount importance. These can be done by temporary and permanent cuffed tunnelled catheters. The present study aims to analyze the outcome of permanent hemodialysis catheters and their efficacy in the case of patients suffering from end-stage renal disease. Materials and methods A cross-sectional study was conducted on 32 patients who underwent permanent tunnelled catheter intervention along with details of follow-up from January 1st, 2021 till December 31st, 2021. Results Among 32 patients, the mean age of the patient was 50.25 ± 18.10 years with 62.5% females. The site of insertion was right 27(84.37%) and left internal jugular vein in 4 (12.50%) and 1 patient (3.12%) in the left common femoral vein. Bleeding the peri-catheter site was observed in 4 (12.5%), infection was found among 2 patients (6.25%), thrombosis in the catheter in 7 (21.87%) patients. Indication for the procedure was due to failure of arteriovenous fistula in 21 (65.62%), lack of maturation of the AVF in 9 (28.12%) and patients awaiting transplantation in 2 (6.25%). The mean months of follow-up of the patients were 5.9 months (SD 4.4 months, range 1 month–12 months). Total 25 (78.1%) of the catheters were patent till the time of follow-up. Seven (21.9%) of the patients required manipulation once after which they also had functioning permanent catheters. The mean month on which manipulation was required was 4.1 months (SD 2.3months, range one month to seven months). Conclusion Permanent cuffed tunnelled catheter has good patency and can be an alternative to an arteriovenous fistula. Experience of cuffed tunnelled permanent hemodialysis catheter and details on manipulation. Details on denovo catheter insertion and exchange with a previous internal jugular catheter. Study on patency of cuffed tunnelled permanent hemodialysis catheter.
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23
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Silwal P, Karmacharya RM, Vaidya S, Shrestha S, Adhikari MM. Spontaneous Common Femoral Artery Pseudoaneurysm: A Case Report. JNMA J Nepal Med Assoc 2022; 60:310-313. [PMID: 35633270 PMCID: PMC9226735 DOI: 10.31729/jnma.6948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 03/11/2022] [Indexed: 11/26/2022] Open
Abstract
Spontaneous femoral artery pseudoaneurysm in a young person with no comorbidity is a rare occurrence. A 30 years old gentleman presented to our hospital with complaints of painful swelling of spontaneous onset in the right inguinal region for 15 days. He had undergone incision and drainage of the contents of the swelling five days back but he suffered from a recurrence of the painful right inguinal swelling and persistent bleeding from the incision site for four days. Computed tomography showed a pseudoaneurysm of the right common femoral artery. It was treated surgically by emergency exploration, hematoma evacuation, removal of pseudoaneurysm, and repair of the defect in the right common femoral artery. In this case, we were fortunate that inadvertent incision of the pseudoaneurysm didn't result in a massive haemorrhage. This serves as a reminder that the possibility of a femoral artery pseudoaneurysm should be considered when evaluating a swelling of the inguinal region.
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Affiliation(s)
- Prabhat Silwal
- Cardio-thoracic and Vascular Unit, Department of Surgery, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
- Correspondence: Dr Prabhat Silwal, Cardio-Thoracic and Vascular Unit, Department of Surgery, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal. , Phone: +977-9840065038
| | - Robin Man Karmacharya
- Cardio-thoracic and Vascular Unit, Department of Surgery, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Satish Vaidya
- Cardio-thoracic and Vascular Unit, Department of Surgery, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Shashank Shrestha
- General and Gastrointestinal Unit, Department of Surgery, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Mahesh Mani Adhikari
- Cardio-thoracic and Vascular Unit, Department of Surgery, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
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24
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Vaidya S, Karmacharya RM, Bhatt S, Paudel B, Neupane M. Vascular Injury to the Neck by a Bamboo Stick: A Case Report. JNMA J Nepal Med Assoc 2022; 60:90-92. [PMID: 35199668 PMCID: PMC9157659 DOI: 10.31729/jnma.7180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/17/2022] [Indexed: 11/01/2022] Open
Abstract
Penetrating neck injuries causing rupture of sternocleidomastoid muscle along with transection of major vessels of the neck have significant morbidity and mortality due to the risk of severe hemorrhage and cerebral infarction. However, there are no universal guidelines for the management of penetrating neck injuries. Here, we report a case of a 67-year-old female with a lacerated wound on the left side of the neck with a complete transection of the left sternocleidomastoid muscle along with transection of internal jugular vein and two superficial branches of internal carotid artery following penetrating injury to the neck by a bamboo stick. It was managed by emergency wound exploration with ligation of the injured vessels with repair of sternocleidomastoid muscle. Post-operatively the hemorrhage was controlled and the patient was discharged on the fourth postoperative day. Thus, in a case of penetrating injury to the neck, prompt surgical wound exploration is beneficial.
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Affiliation(s)
- Satish Vaidya
- Department of Surgery, Kathmandu University School of Medical Sciences, Dhuiikhei Hospital, Dhuiikhei, Kavre, Nepal
| | - Robin Man Karmacharya
- Department of Surgery, Kathmandu University School of Medical Sciences, Dhuiikhei Hospital, Dhuiikhei, Kavre, Nepal
| | - Swechha Bhatt
- Kathmandu University Schooi of Medicai Sciences, Dhuiikhei Hospitai, Dhuiikhei, Kavre, Nepai.
- Correspondence: Ms. Swechha Bhatt, Kathmandu University Schooi of Medicai Sciences, Dhuiikhei Hospitai, Dhuiikhei, Kavre, Nepai. , Phone: +977-9840727936
| | - Bijaya Paudel
- Department of Surgery, Kathmandu University School of Medical Sciences, Dhuiikhei Hospital, Dhuiikhei, Kavre, Nepal
| | - Manish Neupane
- Department of Surgery, Kathmandu University School of Medical Sciences, Dhuiikhei Hospital, Dhuiikhei, Kavre, Nepal
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25
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Dahal S, Karmacharya RM, Singh AK, Vaidya S, Dhakal P, Thapa P, Shrestha P, Bhandari N, Bade S, Bade S. Peripheral Vascular Trauma among Vascular Surgery Cases Operated in a Tertiary Care Hospital: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:12-16. [PMID: 35199678 PMCID: PMC9157658 DOI: 10.31729/jnma.6764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/17/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: Peripheral vascular trauma can result in limb or life-threatening injuries. Early surgical intervention leads to a better outcome. Diagnosis is made clinically, by non-invasive and invasive imaging modalities. Our aim in this study is to find out the prevalence of peripheral vascular trauma among vascular surgery cases operated in a tertiary care centre of Nepal. Methods: This is a descriptive cross-sectional study of peripheral vascular injuries that underwent operative management in a tertiary care hospital of Nepal from January 2018 to May 2020. Ethical approval was taken from the Institutional Review Committee of Kathmandu University School of Medical Sciences (Registration Number 79/20). Convenience sampling technique was used. Data for the study was retrieved from operation records of the patients along with their treatment summaries and entered and analyzed in the Statistical Package for Social Sciences version 20.0. All cases with complete records were included. Conservatively managed cases and cases that underwent primary amputation were not included in the study. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 624 vascular surgery patients, 40 (6.41%) (4.48-8.33 at 95% Confidence Interval) patients had presented with peripheral vascular trauma during the study period. There were 26 (65%) cases where the upper limb was involved. Conclusions: The prevalence of vascular surgery for peripheral vascular trauma among vascular surgeries operated in our study was similar to other studies done in similar settings. Vascular injury needs urgent intervention and appropriate management will result in a high chance of limb salvage and survival.
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Affiliation(s)
- Sushil Dahal
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
- Correspondence: Dr. Sushil Dahal, Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. , Phone: +977-9860479043
| | - Robin Man Karmacharya
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Amit Kumar Singh
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Satish Vaidya
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Prasesh Dhakal
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Pratima Thapa
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Prabha Shrestha
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Niroj Bhandari
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Sohail Bade
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Sahil Bade
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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26
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Vaidya S, Karmacharya RM, Shrestha B, Adhikari MM, Sharma R, Khadka S, Bhandari N, Hada G. Comparative Study between the Use of Pigtail Catheters and Traditional Chest Tube Drain in Cases with Pneumothorax. Kathmandu Univ Med J (KUMJ) 2022; 20:24-28. [PMID: 36273286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Pneumothorax is a condition in which air or other gas is present in the pleural cavity. Mainstay of management of pneumothorax is to remove the air from the pleural space usually done by chest tube insertion. There is still uncertainty whether minimal invasive management with pigtail catheter is sufficient for the management of pneumothorax. Objective To find the effectiveness, safety, tolerability, efficacy of pigtail catheters and large bore chest tubes. Method Prospective comparative study was done in Dhulikhel Hospital between August 2019 till August 2021. Chest tube insertion used to be the only available treatment modality till December 2020 (15 months). Following January 2021 after obtaining ethical clearance for use of pigtail insertion for pneumothorax, this treatment modality was done (8 months). Result Among 76 patients, 52(68.4%) underwent a large bore chest tube and 24 (34.6%) pigtail catheter patients. Mean age of the patients was 48 years (SD 18.01). Duration of hospital stay and length of hospital stay was more in large bore catheters and less in pigtail catheters. Eight hours post tube placement of the expansion of the lungs was present in pigtail and was statistically significant. Pain killer used in pigtail catheters was limited to Non-steroidal anti-inflammatory drugs, for large bore catheter opioids were added and were statistically significant. Conclusion Pigtail catheter is nearly effective as compared to traditional wide bore catheters.
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Affiliation(s)
- S Vaidya
- Department of Surgery, Cardio Thoracic and Vascular Surgery Unit, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - R M Karmacharya
- Department of Surgery, Cardio Thoracic and Vascular Surgery Unit, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - B Shrestha
- Department of Surgery, Cardio Thoracic and Vascular Surgery Unit, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - M M Adhikari
- Department of Surgery, Cardio Thoracic and Vascular Surgery Unit, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - R Sharma
- Department of Surgery, Cardio Thoracic and Vascular Surgery Unit, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Khadka
- Department of Surgery, Cardio Thoracic and Vascular Surgery Unit, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - N Bhandari
- Department of Surgery, Cardio Thoracic and Vascular Surgery Unit, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - G Hada
- Department of Surgery, Cardio Thoracic and Vascular Surgery Unit, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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27
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Yadav AK, Shrestha S, Shrestha SR, Karmacharya RM, Vaidya S. Cervical rib, case series from a university hospital of Nepal. Ann Med Surg (Lond) 2021; 72:103061. [PMID: 34888041 PMCID: PMC8636984 DOI: 10.1016/j.amsu.2021.103061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
Cervical rib is a rare anatomical anomaly with an incidence of 0.2%-1% and is an important cause of thoracic outlet syndrome. We present a case series of five female patients with a mean age of 20.6 (15-26) years, symptoms present were neck pain, neck mass, tingling sensation and weakness in the affected side. Symptoms develop in adolescence probably due to sagging of the shoulders and a disproportion between chest and neck growth at this age. X-rays of cervical spine was a common mode of diagnosis and showed bilateral cervical rib in three cases and unilateral in two cases. They were managed by performing surgeries under supraclavicular approach with resection of cervical rib of affected side. There was improvement of symptoms with restoration of limb function with a mean time of recovery of 9 weeks. Early diagnosis is important as differential diagnosis of such symptoms may be cervical stenosis and myelopathy which differ in management and have a greater risk of morbidity. In absence of intervention, cervical ribs can lead to compression of neurovascular structures leading to worsening of symptoms, thrombosis of subclavian artery or cerebral emboli.
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Affiliation(s)
| | - Sneha Shrestha
- Kathmandu University School of Medical Sciences, Dhulikhel, 45210, Nepal
| | | | - Robin Man Karmacharya
- Unit Chief, Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, 45210, Nepal
| | - Satish Vaidya
- Unit Chief, Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, 45210, Nepal
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28
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Krueger E, Karmacharya RM, Klinger D. A Study Looking at the Teaching of Peripheral Arterial Disease to Medical Personnel in Nepal: How well are we doing and how might we be able to improve? Kathmandu Univ Med J (KUMJ) 2021; 19:503-506. [PMID: 36259196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background There is currently no data showing the prevalence of peripheral arterial disease in Nepal, although they have a high incidence of risk factors in their population such as diabetes, hypertension, and high volume of smoke inhalation. Objective To quantify a gap in medical education curriculum in Nepal as it pertains to medical trainees that have a lack of exposure to peripheral arterial disease (PAD) in a clinical setting as well as improve lecture quality on peripheral arterial disease. Method A survey was sent out to 615 medical trainees in Nepal with a survey completion rate of 44%. The results indicate that both medical students and intern doctors feel most confident in their ability to diagnose peripheral arterial disease and comfortable ordering a workup for peripheral arterial disease when their education includes both a dedicated lecture and care of a patient. Result The self-reported ability to diagnose peripheral arterial disease increased in medical students from 21.9% in the lecture only group to 44.4% in the group who had both lecture and cared for a patient. The current curriculum at the Kathmandu University School of Medical Sciences only allows two hours in the medical school to cover all vascular topics and is taught with a traditional PowerPoint method. Conclusion To improve this area of curriculum, we recommend increasing the allotted time for lectures as well as demonstrate on live patients the evaluation for peripheral arterial disease.
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Affiliation(s)
- E Krueger
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI USA
| | - R M Karmacharya
- Department of Surgery (Cardiac Thoracic and Vascular), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - D Klinger
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI USA
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29
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Shrestha A, Maharjan R, Karmacharya BM, Bajracharya S, Jha N, Shrestha S, Aryal A, Baral PP, Bhatt RD, Bhattarai S, Bista D, Citrin D, Dhimal M, Fitzpatrick AL, Jha AK, Karmacharya RM, Mali S, Neupane T, Oli N, Pandit R, Parajuli SB, Pradhan PMS, Prajapati D, Pyakurel M, Pyakurel P, Rai BK, Sapkota BP, Sapkota S, Shrestha A, Shrestha AP, Shrestha R, Sharma GN, Sharma S, Spiegelman D, Suwal PS, Thapa B, Vaidya A, Xu D, Yan LL, Koju R. Health system gaps in cardiovascular disease prevention and management in Nepal. BMC Health Serv Res 2021; 21:655. [PMID: 34225714 PMCID: PMC8258928 DOI: 10.1186/s12913-021-06681-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/31/2021] [Indexed: 01/19/2023] Open
Abstract
Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. Conclusion Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06681-0.
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Affiliation(s)
- Archana Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. .,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. .,Institute for Implementation Science and Health, Kathmandu, Nepal. .,Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.
| | - Rashmi Maharjan
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.,Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Biraj Man Karmacharya
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.,Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Swornim Bajracharya
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Niharika Jha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Soniya Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Anu Aryal
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.,Nyaya Health Nepal, Kathmandu, Nepal
| | - Phanindra Prasad Baral
- Department of Health Services, Non Communicable Diseases and Mental Health Section, Epidemiology and Disease Control Division, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Rajendra Dev Bhatt
- Department of Biochemistry, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.,Faculty of Medical Sciences, School of Health Sciences, Wuhan University, Wuhan, China
| | - Sanju Bhattarai
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Durga Bista
- Department of Pharmacy, Kathmandu University, Dhulikhel, Kavre, Nepal
| | - David Citrin
- Possible, New York, NY, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Anthropology, University of Washington, Seattle, WA, USA.,Medic, Seattle, WA, USA.,Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA
| | - Meghnath Dhimal
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | - Annette L Fitzpatrick
- Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, Seattle, USA
| | | | - Robin Man Karmacharya
- Department of Surgery (Cardio Thoracic and Vascular unit), Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Sushmita Mali
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Tamanna Neupane
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | - Natalia Oli
- Department of Community Medicine, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Rajan Pandit
- Department of Physiology, Nepal Medical College and Teaching Hospital, Attarkhel, Kathmandu, Nepal
| | - Surya Bahadur Parajuli
- Department of Community Medicine, Birat Medical College and Teaching Hospital, Biratnagar, Morang, Nepal
| | - Pranil Man Singh Pradhan
- Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Dipanker Prajapati
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal.,Department of Cardiology, National Academy of Health Sciences, Bir Hospital, Mahaboudha, Kathmandu, Nepal
| | - Manita Pyakurel
- School of Public Health, Central University of Nicaragua, Managua, Nicaragua
| | - Prajjwal Pyakurel
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Binuka Kulung Rai
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Bhim Prasad Sapkota
- Health Coordination Division, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal.,Teaching & Training Unit, Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU, Munich, Germany.,Center for International Health (CIH), Ludwig-Maximilians-Universität, Munich, Germany
| | - Sujata Sapkota
- Department of Pharmacy, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Abha Shrestha
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Anmol Purna Shrestha
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Rajeev Shrestha
- Department of Pharmacology, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.,Pharmacovigilance unit/ Research and Development Division, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Guna Nidhi Sharma
- Policy, Planning and Monitoring Division, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Sumitra Sharma
- Department of Nursing, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Donna Spiegelman
- Center for Methods in Implementation and Preventive Science and Department of Biostatistics, Yale School of Public Health, New Haven, USA
| | - Punya Shori Suwal
- Department of Public Health, Nepal Institute of Health Sciences, Stupa Health Care Center Cooperative Limited, Jorpati, Kathmandu, Nepal
| | - Bobby Thapa
- Department of Nursing, Nepalgunj Nursing Campus, Institute of Medicine, Tribhuvan University, Banke, Nepalgunj, Nepal
| | - Abhinav Vaidya
- Department of Community Medicine, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Dong Xu
- Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, China.,Peking University School of Global Health and Development, Beijing, China
| | - Rajendra Koju
- Dean, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.,Department of Medicine (Cardiology), Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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30
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Vaidya S, Karmacharya RM, Singh AK, Vaidya PR, Malinowski M, Dhakal A. C-ARM Guided Angiogram/Angioplasty for Selected Failed Arterio Venous Fistula. A Report of a Procedure at University Hospital of Nepal. Kathmandu Univ Med J (KUMJ) 2021; 19:399-401. [PMID: 36254434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
End Stage Renal Disease is a last stage of Chronic Kidney Disease which is characterized by Glomerular Filtration rate of less than 15 ml/min/1.73 m2 . Hemodialysis is the most commonly used modality for treatment of Chronic Kidney disease. Among the access for hemodialysis arteriovenous fistula is the most common modality. However most common problems of fistula are significant stenosis of more than 50% which is characterized by limb swelling, pigmentation, tortuous veins, and difficulty maintaining flow during dialysis from AV fistula. These can be managed either by minimal intervention or with surgical intervention. Very few hospitals in Nepal and other countries have an angiographic suite to perform minimal intervention include angiogram with angioplasty. So in this case we try to address the use of C-Arm to perform angiogram or fistulogram and even angioplasty for the management of significant stenosis or complications of arteriovenous fistula.
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Affiliation(s)
- S Vaidya
- Department of Surgery (Cardio Thoracic and Vascular Surgery), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - R M Karmacharya
- Department of Surgery (Cardio Thoracic and Vascular Surgery), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - A K Singh
- Department of Surgery (Cardio Thoracic and Vascular Surgery), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - P R Vaidya
- Consultant (Cardio and Vascular Surgery), KIST Medical College Teaching Hospital, Gwarko, Lalitpur
| | - M Malinowski
- Consultant (Medical College of Wisconsin), Wisconsin, USA
| | - A Dhakal
- Department of Surgery (Cardio Thoracic and Vascular Surgery), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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Shrestha P, Karmacharya RM, Dahal S, Dhakal P, Bhandari N, Bade S. Patient literacy on varicose veins in cases presenting at university hospital of Nepal subjected for surgical management of varicose veins. J Vasc Nurs 2021; 39:2-5. [PMID: 33894950 DOI: 10.1016/j.jvn.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 01/05/2021] [Accepted: 01/09/2021] [Indexed: 11/19/2022]
Abstract
Varicose veins are prominent dilated veins usually present in the lower limbs leading to complications if not managed well. Knowledge regarding varicose vein among the patients in Nepal is not yet known. We aim to examine the knowledge regarding varicose vein diagnosis and treatment among patients to better understand the barriers to care. This is a descriptive cross-sectional study adopting census sampling method. We collected data from the surgical ward where patients were admitted for surgery of varicose veins. Self-developed tool "Dhulikhel Hospital Patient Perception Questionnaire on Varicose Vein" was used for data collection after validation (Kuder-Richardson Reliability Coefficient was 0.75). Collected data were analyzed using software SPSS 23.0. Descriptive statistics was performed to present sociodemographic variables and varicose veins literacy scores. Independent sample t-test was performed for dichotomous variables and one-way ANOVA with post hoc analysis were performed for variables with multiple groups. Total 80 participants were included in the study of which 60% were men. The mean age was 45.66 years with SD 13.27. Varicose veins literacy score was high among 52.4% (more than 50% score) and low (less than 50% score) among 47.6%. There was significant mean difference (P < .01) among male and female sex, different educational groups, and different occupational groups. Patients admitted for varicose vein surgery had less than 50% knowledge in different components of varicose vein. Regular educational intervention is recommended to ensure better care of these patients.
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Affiliation(s)
- Prabha Shrestha
- Department of Nursing, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchowk, Nepal
| | - Robin Man Karmacharya
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchowk, Nepal.
| | - Sushil Dahal
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchowk, Nepal
| | - Prasesh Dhakal
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchowk, Nepal
| | - Niroj Bhandari
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchowk, Nepal
| | - Sohail Bade
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchowk, Nepal
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Singh AK, Karmacharya RM, Vaidya S, Thapa P. Quantification of Superficial Venous Reflux by Duplex Ultrasound - Role of Peak Reflux Velocity and Reflux Time in the Assessment of Varicose Vein. J Nepal Health Res Counc 2020; 18:442-447. [PMID: 33210638 DOI: 10.33314/jnhrc.v18i3.2558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 11/14/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The study compared the peak reflux velocity and reflux time in cases of varicose veins and non-varicose veins with a focus on quantifying the reflux parameters. METHODS This is a hospital based observational comparative study. The limbs with CEAP Clinical classification of C2 or more were taken as diseased limbs and contra-lateral limbs with no symptoms or disease were taken as control limbs. RESULTS Altogether 792 limbs (452 diseased limbs and 340 control limbs) were evaluated with color duplex. Mean Great Saphenous Vein diameter was 5.68 ± 2.07 mm and 4.00 ± 1.34mmin diseased limbs and control limbs respectively (p=0.0001). Mean sapheno-femoral junction diameter was 8.23 ± 2.64 mm and 6.16 ± 1.93 mm in diseased limbs and control limbs respectively (p=0.0001). Mean peak reflux velocity in diseased limbs was significantly higher than control limbs (77.38 cm/sec vs 7.95 cm/sec; p=0.0001). Similarly mean reflux time was significantly longer in diseased limbs than non-diseased limb (406.58ms and 67.28 ms respectively; p=0.0001). An optimal cut-off point of 27.4 cm/s for peak reflux velocity and 250 ms for the reflux time at Sapheno-Femoral junction had a discriminatory power between the two groups. CONCLUSION The quantification of peak reflux velocity seems to be more consistent than reflux time in determining the superficial venous reflux. An optimal peak reflux velocity cut off point of 27.4 cm/sec has the discriminatory power between diseased and non-diseased limb.
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Affiliation(s)
- Amit Kumar Singh
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Nepal
| | | | - Satish Vaidya
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Nepal
| | - Pratima Thapa
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Nepal
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Malla BR, Rajbhandari N, Karmacharya RM. Management of Bile Duct Injury Following Cholecystectomy. J Nepal Health Res Counc 2020; 18:214-218. [PMID: 32969380 DOI: 10.33314/jnhrc.v18i2.1579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/07/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy is responsible for 80-85% of the bileduct injury, and twice as frequentcompared to open cholecystectomy.Injury affects the quality of life and overall survival of the patient. The management of these injuries is complex and challenging. There are few locally published reports regarding management of bile duct injury. The objective of this study is to evaluate the management of bile duct injury and its outcome Methods: This retrospective study includes patients bile duct injury following cholecystectomy who were managed at Dhulikhel Hospital, Nepal, during January 2014 to December 2016. The clinical features, type of injuries(Strasberg classification) management, outcome (as per McDonald and colleague grading system) and follow up were analyzed descriptively. RESULTS Out of 35 bile duct injuries,only 3 (8.57%)occurred following open cholecystectomy. Three (8.7%) cases of bile duct injury were diagnosed intraoperatively and had primary biliary anastomosis over T-tube. Five (14.28%) were diagnosed postoperatively and underwent Roux-en-y hepatojejunostomy 6 weeks after index surgery. And, 27(77.14%) with type A injuries were treated by endoscopic retrograde cholangio-pancreatography and stenting. After surgical repair, 1 (2.85%) had transient biliary leak. One patient had grade B outcome. During 18 months follow up, no stricture or cholangitis were observed. CONCLUSIONS Bile duct injury with intact continuity of the duct can be successfully managed with endoscopic stenting of the biliary tree. Intraoperative diagnosis of bile duct injury and immediate surgical management has good outcome.
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Affiliation(s)
- Bala Ram Malla
- Department of Surgery, Dhulikhel Hospital, Banepa, Kavre, Nepal
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Joshi HN, Singh AK, Shrestha D, Shrestha I, Karmacharya RM. Clinical Profile of Patients Presenting with Gallstone Disease in University Hospital of Nepal. Kathmandu Univ Med J (KUMJ) 2020; 18:256-259. [PMID: 34158432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background Gallstone disease is one of the most common surgical problem throughout the world. The rise in gallstone disease burden and its wide spectrum of non-specific presentation makes the disease more challenging. Objective To know the various modes of presentation, socio-demographic details of the patients with gallstone disease, any associated factors and its treatment options. Method This is a prospective descriptive study in the patients presenting to Dhulikhel Hospital Kathmandu University Hospital diagnosed with gallstone during May 2018 to April 2020. After receiving ethical clearance from institutional Review committee, the informed consent was taken from all patient involved in the study. The presence of gallstone was confirmed by abdominal ultrasonography (USG). This study included total of 202 patients with gallstone disease. Result A total of 202 individuals with gallstone were included in the study; 48 males (24%) and 154 females (76%). The disease condition was common in age group 31-40 years (26.24%). Majority of the study population consumed mixed diet (92.57%). Out of 202 patients; 52 patients (25.74%) were overweight. In this study series 185 patients (91.58%) were symptomatic. Pain abdomen was one of the commonest symptoms (97.84%) followed by Nausea (28.11%), Dyspepsia (28.11%), Vomiting (18.38%), Fever (1.62) and Jaundice (1.08%). All cases were planned for laparoscopic cholecystectomy however 4 cases had to be converted to open surgery for completion. Conclusion Gallstone disease is a common surgical problem in Female population that presents most commonly with pain abdomen. Laparoscopic cholecystectomy can be easily performed in all cases of gallstone disease.
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Affiliation(s)
- H N Joshi
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - A K Singh
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - D Shrestha
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - I Shrestha
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R M Karmacharya
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Shrestha B, Karmacharya RM, Pant S. Management of Different Types of Pneumothorax at Dhulikhel Hospital, Kathmandu University Hospital. Kathmandu Univ Med J (KUMJ) 2020; 18:271-274. [PMID: 34158435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background Pneumothorax is defined as the presence of air in the pleural cavity. Pneumothorax can be classified as Spontaneous and Traumatic according to the etiology. Spontaneous pneumothorax is further classified as Primary and Secondary. Objective This study was conducted to know the management of different types of pneumothorax at Dhulikhel Hospital, Kathmandu University Hospital. Method This was a hospital based retrospective study conducted at Dhulikhel Hospital, Kathmandu University Hospital. Patients admitted in Surgery Ward with diagnosis of Pneumothorax from January 2018 to December 2019 were included in this study. Result This study included 144 patients with pneumothorax age ranging from 14 years to 94 years. Most of the patients were male with male:female ratio of 3.8:1. Eighty-four (58.03%) patients had Traumatic pneumothorax followed by Secondary spontaneous pneumothorax in 53(36.08%) patients and Primary spontaneous pneumothorax in seven (4.86%) patients. Among 144 patients, chest tube drain was required in 135 patients and nine patients were managed conservatively. One patient underwent Video Assisted Thoracoscopic Surgery (VATS) with Bullectomy and mechanical pleurodesis. Sixteen patients had persistent pneumothorax, among which six patients required chemical pleurodesis, two patients required negative suction therapy and five patients required both chemical pleurodesis and negative suction therapy. Conclusion This study showed pneumothorax to be more common in male population. Traumatic pneumothorax was the most common type followed by Secondary spontaneous pneumothorax and Primary spontaneous pneumothorax.
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Affiliation(s)
- B Shrestha
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R M Karmacharya
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Pant
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Karmacharya RM, Vaidya S, Singh AK, Dahal S, Dhakal P, Bhandari N, Bade S, Shrestha P, Thapa P. Study of Arteriovenous Fistula Cases in a Tertiary Care Hospital: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2020; 58:324-327. [PMID: 32538927 PMCID: PMC7654469 DOI: 10.31729/jnma.4957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Arteriovenous fistulas are a preferred choice for hemodialysis access in chronic kidney disease patients. There is increased adoption of arteriovenous fistula creation in Nepal. Our objective is to study various arteriovenous fistulas that have been created in our center. METHODS This is a descriptive cross-sectional study conducted in a tertiary care hospital including all cases of arteriovenous fistula creation from January 2018 to December 2019. We obtained the ethical clearance from the institutional review committee of Kathmandu University School of Medical sciences. Convenient sampling method was used. Detailed vascular mapping and color doppler ultrasonography was done in the bilateral upper limb as preoperative preparation and to choose a site for arteriovenous fistula creation. Data were entered into the Statistical Package for the Social Sciences version 20 for analysis. RESULTS Among 50 patients, the most common location was brachiobasilic 20 (40%) patients followed by brachiocephalic 18 (36%), radiocephalic 11 (22%), and arteriovenous graft between the brachial artery and axillary vein 1 (2%). The mean duration of hospital stay was 1.44 days. Three (6%) patients required re-intervention, all within 24 hours. Two (4%) patients had a failure of arteriovenous fistula requiring the creation of a new arteriovenous fistula. CONCLUSIONS Brachiobasilic was the most common location for arteriovenous fistula creation. Reintervention was not common.
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Affiliation(s)
- Robin Man Karmacharya
- Department of Surgery, Kathmandu University Teaching Hospital, Dhulikhel, Kathmandu, Nepa
| | - Satish Vaidya
- Department of Surgery, Kathmandu University Teaching Hospital, Dhulikhel, Kathmandu, Nepa
| | - Amit Kumar Singh
- Department of Surgery, Kathmandu University Teaching Hospital, Dhulikhel, Kathmandu, Nepa
| | - Sushil Dahal
- Department of Surgery, Kathmandu University Teaching Hospital, Dhulikhel, Kathmandu, Nepa
| | - Prasesh Dhakal
- Department of Surgery, Kathmandu University Teaching Hospital, Dhulikhel, Kathmandu, Nepa
| | - Niroj Bhandari
- Department of Surgery, Kathmandu University Teaching Hospital, Dhulikhel, Kathmandu, Nepa
| | - Sohail Bade
- Department of Surgery, Kathmandu University Teaching Hospital, Dhulikhel, Kathmandu, Nepa
| | - Prabha Shrestha
- Department of Surgery, Kathmandu University Teaching Hospital, Dhulikhel, Kathmandu, Nepa
| | - Pratima Thapa
- Department of Surgery, Kathmandu University Teaching Hospital, Dhulikhel, Kathmandu, Nepa
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Shrestha S, Shrestha R, Karmacharya RM, Ranjit S. Knowledge on American Heart Association Guidelines Update for Cardiopulmonary Resuscitation among the Nurses Working at University Hospital, Kavre. Kathmandu Univ Med J (KUMJ) 2020; 18:117-121. [PMID: 33594016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background Cardiopulmonary resuscitation is the foundational technique for the emergency treatment of cardiac arrest and the standardized training of it has been emphasized more than ever. Competence of the nurses in this lifesaving procedure is a critical factor in patient outcome from cardiac arrest and can largely prevent sudden death. Objective Many evidences suggest lack of knowledge on proper cardiopulmonary resuscitation among nurses so the aim of this study was to assess the knowledge on 2015 American Heart Association guidelines update for cardiopulmonary resuscitation among nurses working at University hospital and to identify the relationship between the level of knowledge and selected variables. Method Two hundred and sixty nurses working in Dhulikhel hospital participated in the study. A cross-sectional descriptive study was conducted using a predesigned questionnaire based on 2015 guidelines updates for cardiopulmonary resuscitation that incorporated total of 20 questions. Result Total 260 participated in the study and all were female. Only one third of the nurses had good knowledge regarding 2015 guidelines update for cardiopulmonary resuscitation. No significant results existed between the knowledge score and age of the nurses, duration of work experience. However, significant results existed between the knowledge score and qualification, designation of the nurses and previous training on cardiopulmonary resuscitation. Conclusion One third of the nurses had good knowledge regarding 2015 guidelines update for cardiopulmonary resuscitation in this study. Thus, knowledge and practical approach has to be updated with current guidelines in cardiopulmonary resuscitation in order to improve the safety and effectiveness of patient care.
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Affiliation(s)
- S Shrestha
- Department of Nursing, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R Shrestha
- Department of Nursing, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R M Karmacharya
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Ranjit
- Department of Anesthesiology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Joshi HN, Singh AK, Karmacharya RM. Types of Renal Stones and its Variation with Age and Gender in a University Hospital of Nepal. Kathmandu Univ Med J (KUMJ) 2020; 18:193-196. [PMID: 33594029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background Types of renal stones have profoundly changed in the last half-century, parallel to the change in lifestyle and dietary habit, with an increase of calcium stones. Among many lithogenic factors age and gender are considered to be associated with the types of renal stones. Studies evaluating the influence of age and gender on the distribution of the types of urinary calculi are scarce in Nepal. Objective To explore the influence of age and gender on different types of urolithiasis. Method This is a single center prospective study encompassing urolithiasis during a study period of 18 months. All the stone retrieved from the patients after surgery were sent for biochemical analysis of the stone. The result was then compared with the age and gender of the study population. Result Calculi from a total of 107 patients wereanalyzed (62 from malesand 45 from females). Mixed stones consisting of calcium oxalate and calcium phosphate werethe predominant constituent in 74.16% of stones, followed by uric acid, struvite and cystine stones. We found predominance of Calcium stones in males(47.66%) vs 36.44% in females and predominance of struvite stonesin females (7.47%) vs 3.73% in males. Age group of 21-40 years has the main burden of stone. Conclusion Being aware and having better knowledge of risk factors, composition and correlation with age and gender can provide personalized guidance to prevention and avoid recurrence of urolithiasis.
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Affiliation(s)
- H N Joshi
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - A K Singh
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R M Karmacharya
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Karmacharya RM, Shakya R, Singh AK, Baidya S, Dahal S, Dhakal P, Shrestha P, Bhandari N. Recovery Pattern in Different Surgical Approaches on Thoracic Enhanced Recovery based Fourteen-Step Protocol in Patients Undergoing Cardio-thoracic Surgery at University Hospital of Nepal. Kathmandu Univ Med J (KUMJ) 2020; 18:181-185. [PMID: 33594027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background Cardio-thoracic surgery involves open and minimally invasive techniques. Enhanced recovery after surgery is used for early recovery from surgery. Enhanced recovery after surgery decreases hospital stay duration. Patients undergoing Enhanced recovery after surgery after video assisted thoracic surgery use less pain killers and have less hospital cost. There has not been any study on outcomes on patient who follow physiotherapy protocol designed in our setting. Objective To find the physiotherapy outcomes in patients undergoing thoracic enhanced recovery after surgery (T-ERAS) based 14 step protocol locally designed at Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH). Method This is a retrospective cross sectional observational study. All the cases who underwent cardiothoracic surgery were classified based on the approach of chest surgery performed into groups Sternotomy, Thoracotomy and Video Assisted Thoracic Surgery (VATS) groups. Patients were advised for Thoracic Enhanced recovery after surgery based on the protocol that has been devised at Dhulikhel Hospital. The recovery of patients based on activities they could perform was noted and analyzed. Result Both ICU stay and hospital stay in number of days were highest in thoracotomy (6.04 days) group while that was lowest in video assisted thoracic surgery group (1.67 days). There is a similar recovery until step 5, i.e. 2 days and rapid progression in further steps in video assisted thoracic surgery group while it is much slower in both sternotomy and thoracotomy groups. Conclusion Postoperative mobilization and physiotherapy enhance early healing and decrease hospital stay. Mean hospital stay and ICU stay were shorter for video assisted thoracic surgery cases compared to Thoracotomy and Sternotomy groups and the mean days to achieve different steps varied within the protocol between groups compared.
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Affiliation(s)
- R M Karmacharya
- Department of Surgery (Cardio Thoracic and Vascular), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R Shakya
- Department of Physiotherapy, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - A K Singh
- Department of Surgery (Cardio Thoracic and Vascular), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Baidya
- Department of Physiotherapy, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Dahal
- Department of Surgery (Cardio Thoracic and Vascular), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - P Dhakal
- Department of Surgery (Cardio Thoracic and Vascular), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - P Shrestha
- Department of Surgery (Cardio Thoracic and Vascular), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - N Bhandari
- Department of Surgery (Cardio Thoracic and Vascular), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Shakya R, Karmacharya RM, Shrestha R, Shrestha A. Varicose veins and its risk factors among nurses at Dhulikhel hospital: a cross sectional study. BMC Nurs 2020; 19:8. [PMID: 32042263 PMCID: PMC6998362 DOI: 10.1186/s12912-020-0401-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/28/2020] [Indexed: 11/18/2022] Open
Abstract
Background Women in nursing professions are at high risk for developing varicose veins as it requires physical work and prolonged standing. The aim of the study is to estimate the current prevalence of varicose veins among nurses at Dhulikhel Hospital and assess its risk factors. Methods A cross sectional study was carried out among 181 female nurses from different clinical settings of Dhulikhel Hospital. A structured questionnaire was administered to gather the demographic, work related and medical history information. The participants underwent Doppler ultrasound for varicose veins confirmation. Varicose veins was defined as Doppler finding of reflux or vein diameter equal or greater than 5 mm. Results A total of 181 nurses participated in this study and 83 (46%) had varicose veins. The mean standing time was 4.28 (0.8) hours /day, mean sitting time was 1.28 (0.6) hours/day, mean walking time was 2.37 (0.8) hours/day. In the adjusted model the odds of having varicose veins was 27 times greater with every 1 hour increase in standing time per day (adjusted OR: 27.44; 95% CI 4.09–180.77; p-value <0.00). Conclusions Varicose veins was prevalent among nurses’ at Dhulikhel Hospital. Prolonged standing was found to be a significant factor for varicose veins.
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Affiliation(s)
- Regan Shakya
- 1Department of Physiotherapy, Kathmandu University School of Medical Sciences/Dhulikhel Hospital, Kavre, Dhulikhel, Nepal
| | - Robin Man Karmacharya
- 2Department of Cardiovascular Surgery, Kathmandu University School of Medical Sciences/Dhulikhel Hospital, Kavre, Dhulikhel, Nepal
| | - Rojina Shrestha
- 1Department of Physiotherapy, Kathmandu University School of Medical Sciences/Dhulikhel Hospital, Kavre, Dhulikhel, Nepal
| | - Archana Shrestha
- 3Department of Community Programs, Kathmandu University School of Medical Sciences/Dhulikhel Hospital, Kavre, Dhulikhel, Nepal
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Joshi HN, Singh AK, Koirala NP, Karmacharya RM. Outcome of Uretero Renoscopic Lithotripsy (URSL) with Holmium LASER Vs Pneumatic Lithotripter for Lower Ureteric Stones, Experience from University Hospital of Nepal. Kathmandu Univ Med J (KUMJ) 2020; 18:49-53. [PMID: 33582688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background There are various methods of endoluminal ureteral stone fragmentation. Among various modalities Laser lithotripsy and Pneumatic lithotripsy are commonly used and have shown comparable outcomes. Objective To compare the efficacy and outcome of laser and pneumatic lithotripsy in a patient with lower ureteric calculi. The comparison will be done in stone free rate, migration of stone and complication of the procedure. Method This is a prospective comparative study in a cohort of patients at University Hospital with Lower Ureteric stone. Ninety patients were randomized in to two groups (Laser Lithotripsy Vs Pneumatic Lithotripsy) during the study period. The purpose of this study was to measure the immediate stone free rate, intra-operative complications, mean operative time, post-operative complication and if any stone retention after six weeks follow up. Result Both the groups were similar in Age and Gender. Immediate stone free rate was slightly higher in Laser lithotripsy group (97.77%) in comparison to Pneumatic lithotripter group (84.44%) with p=0.507 which is not statistically significant. There was statistical difference in terms of stone migration rate, mean operation time in favor of Laser Lithotripsy group (p<0.01, in both parameters). There were no immediate complications in both the group however there were three cases of short segment ureteric strictures (6.66%) in case of Pneumatic lithotripsy on six weeks follow up which was managed conservatively. Conclusion Both LASER lithotripter and Pneumatic lithotripter are equally efficacious modality of endoluminal URSL in lower ureteric stone with similar Stone Free Rate. Laser lithotripsy showed lower frequency of stone migration and had shorter procedure time.
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Affiliation(s)
- H N Joshi
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - A K Singh
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - N P Koirala
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - R M Karmacharya
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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Bhandari N, Karmacharya RM, Devbhandari M, Shrestha B, Singh AK, Ranjit S, Shrestha KR. Open Surgical Management of Abdominal Aortic Aneurysm at a Community Based University Hospital in Nepal. Kathmandu Univ Med J (KUMJ) 2020; 18:96-98. [PMID: 33582697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Aortic aneurysms are abnormal dilatation of aorta. The risk factors include male sex, age > 65, smoking, coronary artery disease and hypertension. Here we report a case of infra-renal abdominal aortic aneurysm (AAA) of diameter 6 cm. The patient sucessfully underwent aorto-biiliac bypass surgery using Dacron Y graft. During abdominal aortic aneurysm surgery anesthetic challenge is also of paramount importance and should be considered.
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Affiliation(s)
- N Bhandari
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - R M Karmacharya
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - M Devbhandari
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - B Shrestha
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - A K Singh
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Ranjit
- Department of Anesthesia, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - K R Shrestha
- Department of Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj, Kathmandu, Nepal
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Shrestha B, Karmacharya RM. Influence of Body Mass Index (BMI), Age and Gender on Stages of Varicose Vein in Newly Diagnosed Cases Following Screening Doppler in Outpatient Clinic. Kathmandu Univ Med J (KUMJ) 2020; 18:28-31. [PMID: 33582684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background Varicose vein is one of the most common venous diseases which affect superficial veins especially of lower limb. This disease is characterized by prominent dilated veins, feeling of heaviness, itchiness, pigmentation, ulceration depending upon the stage of the disease. Objective This study was conducted to know how Body Mass Index, Age and Gender influence staging of varicose veins in our context. Method This is a cross sectional hospital based study conducted at Dhulikhel Hospital, Kathmandu University Hospital from April 2018 to March 2019. Patients with signs and symptoms of varicose vein were included in the study. Informed consent was taken from each patient and data collection done by filling the proforma. Result This study comprised 135 lower limbs with varicose vein from 108 patients. Male:Female ratio was 1.4:1. Mean age of patients was 44.47±12.65 (17-81) years. Significant correlation was found between increasing age and progression in Clinical staging of Varicose vein according to Clinical classification (p<0.05). Mean Great Saphenous Vein diameter at knee was found significantly higher in patients with more than five years of symptoms Mean Body Mass Index was not very different in different Clinical stage of Varicose veins. Conclusion This study showed that the Clinical Staging of Clinical Etiological Anatomical and Pathophysiological classification of varicose vein is significantly related to age. The mean diameter of Great Saphenous Vein at the level of Knee is significantly related to the duration of symptoms. However, the influence of Body Mass Index and gender on stages of varicose vein could not be established.
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Affiliation(s)
- B Shrestha
- Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R M Karmacharya
- Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Dahal S, Bhandari N, Dhakal P, Karmacharya RM, Singh AK, Tuladhar SM, Devbhandari M. A case of thymoma in myasthenia gravis: Successful outcome after thymectomy. Int J Surg Case Rep 2019; 65:229-232. [PMID: 31734473 PMCID: PMC6864328 DOI: 10.1016/j.ijscr.2019.10.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Thymic abnormalities occur as hyperplasia and thymoma. Myasthenia gravis is commonly present in thymoma. Thymectomy possesses risk due to anatomical proximity with vital thoracic structures and myasthenia crisis. PRESENTATION OF CASE Forty five years female with complaints of difficulty swallowing and weakness of upper limb muscles upon investigation showed mass in mediastinum and antibody test for myasthenia gravis positive. Medical management was done for a month followed by thymectomy. There were no intra and postoperative complications. Medical management was stopped one month after surgery and she is symptom free. DISCUSSION Thymectomy is the standard of care where median sternotomy is the mainstay approach to surgery. Various other surgical approaches and complications revolving around surgery has been discussed. CONCLUSION Surgical removal of thymoma cured myasthenia gravis in our case. We focused on proper preoperative optimization of myasthenia gravis symptoms before thymectomy.
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Affiliation(s)
- S Dahal
- Kathmandu University School of Medical Sciences, Department of Surgery, Dhulikhel, 3, Nepal.
| | - N Bhandari
- Kathmandu University School of Medical Sciences, Department of Surgery, Dhulikhel, 3, Nepal
| | - P Dhakal
- Kathmandu University School of Medical Sciences, Department of Surgery, Dhulikhel, 3, Nepal
| | - R M Karmacharya
- Kathmandu University School of Medical Sciences, Department of Surgery, Dhulikhel, 3, Nepal
| | - A K Singh
- Kathmandu University School of Medical Sciences, Department of Surgery, Dhulikhel, 3, Nepal
| | - S M Tuladhar
- Kathmandu University School of Medical Sciences, Department of Surgery, Dhulikhel, 3, Nepal
| | - M Devbhandari
- Kathmandu University School of Medical Sciences, Department of Surgery, Dhulikhel, 3, Nepal
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Karmacharya RM, Shrestha BK, Shrestha B, Singh AK, Bhandari N, Dhakal P, Dahal S. <p>Varicose vein invasive intervention at university hospital of Nepal, our experience in the last six years</p>. OAS 2019. [DOI: 10.2147/oas.s214962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Karmacharya RM, Shrestha B, Devbhandari M, Tuladhar SM, Pradhan A. Factors Affecting Recanalisation after Optimal Management of Deep Vein Thrombosis; A single institution based study. Kathmandu Univ Med J (KUMJ) 2019; 17:174-177. [PMID: 33305743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background Presence of recanalisation will favour for better physiological recovery after medical management of Deep Vein Thrombosis (DVT) along with lesser chances of post thrombotic syndrome. Rate of recanalisation is varied and can range from 43-57% and the factors that affect recanalisation are still a dilemma. Objective To know the factors for recanalisation following Deep Vein Thrombosis. Method This is a single institution based retrospective-prospective analytical study encompassing all ultrasonologically diagnosed cases of Deep Vein Thrombosis in adults from January 2015 to November 2017. All the cases were admitted with oral warfarin bridged by Heparin/ Enoxaparin and were discharged once International Normalization Ratio was in therapeutic range. The patients were followed up for three months with minimal of three outpatient followup. Best finding in the doppler ultrasonography (done by Acuson P500, Seimens) in relation to recanalisation was taken for the study. Result There were 67 cases of Deep Vein Thrombosis. Of these cases male to female ratio was 0.91. The mean age was 48.07. Most common extent was up to common femoral vein (47.8%) followed by upto popliteal vein (40.3%). Remaining 11.9% had extension upto iliac veins. There was no recanalisation in 2 cases (3%). Partial recanalisation was seen in 23 cases (34.3%) while complete recanalisation was seen in 42 cases (62.7%). Recanalisation is more in DVT involving popliteal vein while it decreases as the extension goes up. In contrast to 79.4% complete recanalisation in popliteal vein, that in common femoral vein is 62.5% while in iliac vein is only 37.5%. Mean age in no recanalisation group is much younger than partial or complete recanalisation groups. Conclusion Recanalisation following Deep Vein Thrombosis distal to popliteal vein is more than that in proximal Deep Vein Thrombosis. The information on recanalization can be considered to use to decide upon the duration of medical management of Deep Vein Thrombosis.
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Affiliation(s)
- R M Karmacharya
- Department of Surgery, Cardiothoracic and Vascular Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - B Shrestha
- Department of Surgery, Cardiothoracic and Vascular Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - M Devbhandari
- Department of Surgery, Cardiothoracic and Vascular Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S M Tuladhar
- Department of Surgery, Cardiothoracic and Vascular Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - A Pradhan
- Department of Surgery, Cardiothoracic and Vascular Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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Karmacharya RM, Devbhandari M, Tuladhar S, Shrestha B, Acharya P. Chest Trauma Requiring Admission: Differences in Earthquake Victims and other Modes of Injury. Kathmandu Univ Med J (KUMJ) 2018; 16:237-239. [PMID: 31719313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background The April 25, 2015 Nepal earthquake (7.8 Richter scale) followed by May 12, 2015 major aftershock (7.3 Richter scale) killed more than 9,000 people and injured more than 23,000 people. Dhulikhel Hospital situated at Kavre district of Nepal encountered major bulk of Earthquake victims residing at Sindhuplanchowk, Kavre and Dolakha districts during subsequent earthquake events. Objective To distinguish any significant differences in hospital admitted Earthquake and nonEarthquake chest trauma cases. Method Retrospective study was done comparing earthquake with non-earthquake chest trauma cases admitted in Dhulikhel Hospital. Study included parameters like mode of injury, time taken to reach health center, symptoms at presentation, involvement of chest area, presence and site of rib fracture, presence of hemothorax or pneumothorax, spectrum of treatment required, hospital admission days. Result There were total 23 earthquake victims of which 14 (61%) were female and rest of 9(39%) were male whereas out of total 95 non earthquake cases 23(24%) were female and 72 (76%) were male (p< 0.01). Mean age in earthquake victims was 53.73 (SD 18.33, range 19-84) while non earthquake cases was 46.83(SD 16.53, range 11-90), (p >0.05). Major mode of injuries in earthquake victims was hit by objects (82.60%) followed by fall (17.4 %). Incidence of rib fractures was 69.56% in earthquake victims and 85.26 % in non earthquake cases with average of 2-3 ribs in both cases (p>0.05). There was higher rates of pneumothorax in earthquake victims (52.17%) compared to non earthquake cases (30.52%), (p<0.05). There wasn't evidently major differences in incidence of pulmonary contusion, hemothorax and surgical emphysema. The mean duration of hospital admission days in earthquake victims was 7.78 days while non earthquake cases was 5.04 days (p >0.05). The total number of patients requiring chest tube insertion in earthquake victims was 16(69.56%) while that was 29(30.52 %) in non earthquake patients (p <0.01). Conclusion There was preponderance of female gender in earthquake related cases compared to non earthquake cases. Incidence of rib fracture was higher in earthquake victims. In earthquake victims, higher proportion of patient required chest tube drainage compared to non earthquake cases.
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Affiliation(s)
- R M Karmacharya
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - M Devbhandari
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Tuladhar
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - B Shrestha
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - P Acharya
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Thermann F, Karmacharya RM. Crural Bypass Surgery in Case of Critical Ischemia: Technical Aspects and Results. Kathmandu Univ Med J (KUMJ) 2018; 16:109-113. [PMID: 30636749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background Crural bypass surgery is one of the last options to salvage the leg. Compared to arterial reconstructions of more proximal localization patency rates are generally less good. The aim of this retrospective study was to answer the question if crural bypass surgery is justified. For that we focused on different technicalities, bypass material, recipient vessel and anticoagulation regimes. Objective To know outcome of crural bypass in terms of patency rates, survival rates, amputation. The difference in outcome is compared in different stages of peripheral arterial disease and various bypass materials and sites. Method Between 07/2013 and 06/2018 we performed 102 crural bypasses (27 female, 75 male; age 44-90 (70) years). Reasons for the bypasses were a critical peripheral arterial diseases (PAD) (stage III [pain at rest] and IV [necrosis/gangrene] according to Fontaine). End point of the study was major amputation or death. All patients were operated on in the same department by two experienced vascular surgeons. Result Amputation-free time was 78% after sixmonths and 70% after 24 and 60 months. Six, 12 and 40 months survival was 83%, 78% and 59%, respectively. Patency rates were affected by the severity of the disease (stage III vs. stage IV) and so was major amputation. Autologous bypasses were not associated with a better patency rate. Minor amputation or the anticoagulation scheme did not influence the long term results. Conclusion The long term survival after crural bypass is good and amputation rates are low, independent of the vessel of the lower leg used as recipient outflow. Accordingly, if a bypass is technically feasible, there is no limitation regarding the choice of the recipient vessel. If possible, autologous vein should be used, but a graft prosthesis can lead to equally good results. As patients with stage III PAD have better outcomes, early intervention is recommended in order to avoid deterioration to stage IV.
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Affiliation(s)
- F Thermann
- Department of Vascular Surgery, Hospital Carl-von-Basedow, Merseburg, University teaching Hospital (University of Halle), Weiße Mauer 52, 06217 Merseburg, Germany
| | - R M Karmacharya
- Department of CardioThoracic and Vascular Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Karmacharya RM, Shrestha B, Shrestha BK, Devbhandari M, Tuladhar SM, Hodde A, Thermann F. Abnormal Venous Dilatation other than Typical Varicose Vein, Rare Encounters. Kathmandu Univ Med J (KUMJ) 2018; 16:103-105. [PMID: 30631029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Varicose vein, one of the common vascular illnesses is usually a disease in lower limb. This is due to reflux of blood from deep venous system to superficial venous system. Rarely, this disease can also happen in veins in different location. Four such rare encounters are mentioned in this case series.
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Affiliation(s)
- R M Karmacharya
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital Dhulikhel, Kavre, Nepal
| | - B Shrestha
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital Dhulikhel, Kavre, Nepal
| | - B K Shrestha
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital Dhulikhel, Kavre, Nepal
| | - M Devbhandari
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital Dhulikhel, Kavre, Nepal
| | - S M Tuladhar
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital Dhulikhel, Kavre, Nepal
| | - A Hodde
- Department of Vascular Surgery, University Medical Center, Groningen, Holland
| | - F Thermann
- Department of Vascular Surgery, Carl von Basedow Klinikum, Merseberg, Germany
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Joshi HN, Shrestha B, Karmacharya RM, Makaju S, Koju R, Gyawali D. Management of Proximal Ureteric Stones: Extracorporeal Shock Wave Lithotripsy (ESWL) Versus Ureterorenoscopic Lithotripsy (URSL). Kathmandu Univ Med J (KUMJ) 2017; 15:343-346. [PMID: 30580354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background Urolithiasis is the third most common disease of the urinary tract after urinary tract infections and pathologic conditions of prostate. Debate is ongoing regarding the effectiveness of Extracorporeal Shock Wave Lithotripsy (ESWL) and ureterorenoscopic lithotripsy (URSL) in the management of ureteral stones. Objective We aim to compare the efficacy of Extracorporeal Shock Wave Lithotripsy and Ureterorenoscopic Lithotripsy in the management of upper ureteric stones in terms of stone clearance. Method This prospective hospital based study included patients with upper ureteric calculus managed with Ureterorenoscopic Lithortripsy with Double J stenting or Extracorporeal Shock Wave Lithotripsy at Dhulikhel Hospital, Kathmandu University Hospital from August 2014 to July 2015. Stone size, stone clearance, number of sittings, complications and need of other procedure were recorded. Result There were 90 patients with upper ureteric calculus. Among these patients, 45 patients underwent Extracorporeal Shock Wave Lithotripsy and 45 patients underwent Ureterorenoscopic Lithotripsy. There was no difference in male/female ratio, age and stone diameter between two groups (p>0.05). Total stone-free ratio was 88.9% (40/45) for Extracorporeal Shock Wave Lithotripsy and 82.2% (37/45) for URSL, partial fragmentation requiring shift of modality of treatment was 8.88% (4/45) for Extracorporeal Shock Wave Lithotripsy and 13.33% (6/45) for Ureterorenoscopic Lithotripsy. Failure of procedure was noted in 11.1% in Extracorporeal Shock Wave Lithotripsy group and 17.8% in URSL group In the Extracorporeal Shock Wave Lithotripsy group, 8.89% (4 out of 45) patients required Ureterorenoscopic Lithotripsy for complete stone clearance. Complete stone clearance could not be achieved in 2.23% (1 out of 45) patient with both Extracorporeal Shock Wave Lithotripsy and Ureterorenoscopic Lithotripsy and had to undergo open ureterolithotomy. Conclusion Both Extracorporeal Shock Wave Lithotripsy and Ureterorenoscopic Lithotripsy are equally effective in the management of upper ureteric calculus with no significant difference in age, male/female ratio, stone diameter and stone free ratio.
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Affiliation(s)
- H N Joshi
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - B Shrestha
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - R M Karmacharya
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Makaju
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - R Koju
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - D Gyawali
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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