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Bhandari TR, Wong JLH, Ahmad J, Akbari K, Menon V. Bouveret's syndrome: An old diagnosis. A modern multimodality approach (endoscopic and robotic surgical) of gastric outlet obstruction: Report of two cases. Int J Surg Case Rep 2024; 114:109134. [PMID: 38113565 PMCID: PMC10772237 DOI: 10.1016/j.ijscr.2023.109134] [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: 10/20/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Bouveret's syndrome is an uncommon condition characterized by the impaction of a gallstone in the pylorus or duodenum via a cholecysto-enteric fistula causing gastric outlet obstruction. We report two unusual cases of Bouveret's syndrome causing gastric outlet obstruction in two elderly patients. CASE PRESENTATION Two elderly female patients presented to the surgical assessment unit with features of gastric outlet obstruction. In both cases, an urgent computed tomography (CT) of the abdomen showed pneumobilia, gastric distension, and gallstones impaction at the duodenal bulb. In Patient 1, endoscopic removal of the impacted gallstones was done successfully. She was discharged three days following an uneventful recovery. In Patient 2, an endoscopic removal of a single large gallstone was attempted, which was unsuccessful. She underwent robotic gastrotomy with extraction of the large gallstone with primary repair. She was discharged on 8th postoperative day. CLINICAL DISCUSSION Treatment options for Bouveret's syndrome include endoscopic management and surgery. The selection of treatment options depends upon factors like the degree of obstruction, the impaction site, number, type or size of gallstones, patient co-morbidities and clinical parameters at presentation, as well as expertise available, both endoscopic and surgical. CONCLUSIONS Bouveret's syndrome is one of the rare complications of gallstone. Endoscopic management can be effective at removing the impacted gallstones, which is particularly helpful for those elderly patients who have multiple medical co-morbidities, as in our first patient. Surgical management like minimal invasive surgery (robotic) can be beneficial in failed endoscopic attempt of removal of stone like in the second patient.
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Affiliation(s)
- Tika Ram Bhandari
- Department of Upper Gastrointestinal and Bariatric Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom.
| | - John Lin Hieng Wong
- Department of Gastroenterology and Endoscopy, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Jawad Ahmad
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Khalid Akbari
- Department of Upper Gastrointestinal and Bariatric Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Vinod Menon
- Department of Upper Gastrointestinal and Bariatric Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Shrestha PC, Bhandari TR, Devbhandari M, Verma RK, Shrestha KK. Kidney transplantation from brain-dead donors in Nepal: Report of first six cases. Ann Med Surg (Lond) 2022; 81:104386. [PMID: 36147109 PMCID: PMC9486551 DOI: 10.1016/j.amsu.2022.104386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction and importance: Kidney transplantation is one of the best treatment options for patients with end-stage renal disease. More than 90% of patients awaiting renal transplantation die without getting the kidney for transplantation. Brain dead donor kidney transplantation can bridge this gap proficiently. We aim to report details of the first six patients who had undergone brain-dead donor kidney transplantation in the history of transplantation in Nepal. Case presentation We conducted a descriptive analysis of clinical data of six adult recipients with kidney transplantation from three brain-dead donors. We described postoperative complications, length of stay, graft function which was documented with serum creatinine, acute rejection episode, delayed graft function, and patient/graft survival of recipient. Recipients were between 15 and 56 years old. Three patients experienced delayed graft function. Urinary tract infection was observed in two patients, both of whom were treated with antibiotics. One patient had acute graft rejection. None of our patients required reoperation. Length of hospital stay ranged from 9 to 32 days. The postoperative graft function was 100% in all patients. There was no graft loss, and no death was observed during follow-up. Clinical discussion Following the initiation of the brain-dead donor transplantation program, a lot of work needs to be done to make it a regular practice. Thus, this program needs support from all sections of society and government. This can be the only solution to decrease the huge gap between the supply and demand of organs in Nepal. Conclusion This case reports indeed revealed impressive success in initiating a brain-dead donor kidney transplantation program in a developing country that in terms of quality, meets comprehensive standard with acceptable graft function and patient/graft survival in under limited resources healthcare setting. Kidney transplantation is one of the best treatment options for patients with end-stage renal disease. More than 90% of patients awaiting renal transplantation die without getting the kidney for tranplantation. Brain dead donor kidney transplantation can bridge this gap proficiently. We reported first six patients with brain dead donor kidney transplantation in the history of transplantation in Nepal.
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Chandra Shrestha P, Bhandari TR, Adhikari R, Baral H, Verma RK, Shrestha KK. Living donor kidney paired exchange: An observational study. Ann Med Surg (Lond) 2022; 78:103761. [PMID: 35734678 PMCID: PMC9206995 DOI: 10.1016/j.amsu.2022.103761] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/02/2022] [Accepted: 05/08/2022] [Indexed: 11/28/2022] Open
Abstract
Background Kidney transplantation is the treatment of choice for patients with end-stage renal disease (ESKD). Kidney paired donation (KPD) provides the chance to match an incompatible donor/recipient pair with another donor and recipient in a similar condition. We aimed to compare the outcomes of pair exchange kidney transplantation with traditional live donor kidney transplantation in our context. Method A review of medical records of 62 patients (31 pairs) who underwent two-way conventional living kidney pair exchange from July 2016 to June 2021 was done. The control group was considered those 62 patients who had undergone classic live donor kidney transplantation (LDKT) during the study period. The patient's demographics, intraoperative and postoperative variables including delayed graft function, length of hospital stay, graft survival, patient survival, and rejections rates were compared between the groups (KPD and LDKT). Results The majority of recipients were male (77.4 and 80.6%) while donors were female (77.4 and 69.4%) in KPD and the LDKT groups. Mean ages were 37 years (range: 19–59) and 37 years (range: 17–65) for the recipient's in KPD and the LDKT. KPD transplantation was performed in 62 recipients to avoid blood group incompatibility. There were no significant differences in outcomes comprising delayed graft function (1.6 and 3.2%), graft survival (100% in both groups), patient survival (95.2 and 96.8%), and rejections rates (1.6 and 1.6%) between KPD and LDKT group (P > 0.005). The length of stay was similar (5.9 and 5.7 days) in KPD and LDKT groups (P > 0.005). Conclusions The outcomes of KPD were comparable with classic LDKT in terms of delayed graft function, length of hospital stay, graft survival, patient survival, and rejections rates in our study. Therefore, the kidney paired donation program should be encouraged and promoted in centers where the ABO-incompatible transplant is expensive with added risk and the rate of deceased donor transplantation is very low. Kidney paired donation (KPD) provides the chance to match for an incompatible donor/recipient pair with another donor and recipient in a similar condition. The outcomes of KPD were comparable with classic live donor kidney transplantation (LDKT) in this study. KPD program should be promoted in centers where the ABO incompatible transplant is expensive with added risk and the rate of deceased donor transplantation is very low.
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Affiliation(s)
- Pukar Chandra Shrestha
- Department of Transplant Surgery, Shahid Dharmabhakta National Transplant Centre, Bhaktapur, Nepal
| | - Tika Ram Bhandari
- Department of Transplant Surgery, Shahid Dharmabhakta National Transplant Centre, Bhaktapur, Nepal
- Corresponding author. Department of Transplant Surgery, Shahid Dharmabhakta National Transplant Centre (SDNTC), Bhaktapur, Nepal.
| | - Rojan Adhikari
- Department of Urology, Shahid Dharmabhakta National Transplant Centre, Bhaktapur, Nepal
| | - Hari Baral
- Department of Urology, Shahid Dharmabhakta National Transplant Centre, Bhaktapur, Nepal
| | - Rakesh Kumar Verma
- Department of Urology, Shahid Dharmabhakta National Transplant Centre, Bhaktapur, Nepal
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Bhandari TR, Shrestha KK, Shrestha PC. COVID-19 infection in renal transplant recipients in early post-renal transplantation period: report of three cases. Transpl Infect Dis 2022; 24:e13837. [PMID: 35390217 PMCID: PMC9115330 DOI: 10.1111/tid.13837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/12/2022] [Accepted: 03/17/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Tika Ram Bhandari
- Department of Transplant Surgery, Shahid Dharmabhakta National Transplant centre Bhaktapur, Bhaktapur, Nepal
| | | | - Pukar Chandra Shrestha
- Department of Transplant Surgery, Shahid Dharmabhakta National Transplant centre Bhaktapur, Bhaktapur, Nepal
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Shahi S, Paudel DR, Bhandari TR. Burnout among resident doctors: An observational study. Ann Med Surg (Lond) 2022; 76:103437. [PMID: 35308433 PMCID: PMC8927790 DOI: 10.1016/j.amsu.2022.103437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background Burnout is a syndrome of emotional exhaustion and depersonalization that reduces efficiency at work. No studies have been reported focusing only on residency burnout and risk factors from our country until now. This study aimed to find out the impact and the association of specific demographic and practice characteristics with burnout among resident doctors. Methods A prospective cross-sectional survey of all resident doctors under training at that point of time in 2019 in the National Academy of Medical Sciences, Nepal in different specialties was done. We evaluated demographic variables, practice characteristics, and assessed burnout through validated Maslach burnout inventory (MBI) tools, and data were analyzed. Results A total 347 among 410 resident doctors (227 male) responded to the survey. Median age was 30 years (range 25–44). Overall, 147 (42.4%) of responding residents were burned out with high emotional exhaustion in 58 (16.6%), high depersonalization in 55 (15.9%), and low personal achievement in 34 (9.8). In regression analysis, out of independent variables gender, marital status, having children, specialty, hours of work per week and year of residency, specialties (general surgery odds ratio [OR]; 12.595, confidence interval [CI],[ 1.037–152.9], P; 0.047), obstetrics, and gynecology (odds ratio [OR]; 13.977, confidence interval [CI]; [1.324–147.5], P; 0.028), and anesthesiology (odds ratio [OR]; 11.54, confidence interval [CI]; [1.014–131.4], P; 0.049)) and hours of work per week (≥80 h) (odds ratio [OR]; 2.511, confidence interval [CI]; [1.128–5.589], P; 0.024), were significantly associated with high burnout. Conclusions Burnout is common among trainee resident doctors which is possibly preventable. Thus, the concern should be to prepare strategies to identify and minimize burnout from the individual, institutional, and societal sides. It is essential to preserve and promote the mental health of trainee residents to prevent serious consequences in the personal lives of resident doctors and as well as on patient outcomes. Burnout amongst resident doctors is extremely predominant which may be caused due to various reasons. We describe the impact of burnout among resident doctors and focus on identifying different risk factors for burnout. Preservation of mental health of resident doctors is essential to prevent serious consequences in their lives as well as on patient care.
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Affiliation(s)
- Sudha Shahi
- Otorhinolaryngology Head and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
- Corresponding author.
| | - Dhundi Raj Paudel
- Otorhinolaryngology Head and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Tika Ram Bhandari
- General Surgery, People's Dental College and Hospital, Kathmandu, Nepal
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Bhandari TR, Khan SA, Jha JL. Prediction of difficult laparoscopic cholecystectomy: An observational study. Ann Med Surg (Lond) 2021; 72:103060. [PMID: 34815866 PMCID: PMC8591467 DOI: 10.1016/j.amsu.2021.103060] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023] Open
Abstract
Background Laparoscopic cholecystectomy (LC) is a gold standard treatment of symptomatic gallstone disease. Meanwhile, it is also a challenging procedure demanding excellent expertise for the best outcomes. Many times, difficult laparoscopic cholecystectomy is a nerve-wracking situation for surgeons. It endangers patients by causing potential injury to vital structures. Thus, we aimed to identify predictors for difficult LC. Methods A retrospective cross-sectional review of surgical records was done. Patients who underwent laparoscopic cholecystectomy on an elective basis from July 2017 to June 2021 were included in the study. We divided our patients into two groups based on operative findings of difficult LC; difficult LC group and non-difficult LC group. We compared patient's demographics, predictors, and perioperative details and analyzed the data. Results A total of 338 patients (82 males) with a median age of 47 years were studied. Total difficult LC was found in 52 patients (15.4%). The overall conversion rate was 8.9%. Logistic multivariable regression analysis revealed that; male gender (odds ratio (OR); 0.171, confidence interval (CI),(0.043-0.675), P; 0.012), past history of acute cholecystitis (OR; 0.038, CI; (0.005-0.309), P; 0.002), gall bladder wall thickness (≥4-5 mm) (OR; 0.074, CI; (0.008-0.666), P; 0.020), fibrotic gallbladder (OR; 166.6, CI; (7.946-3492), P; 0.001), and adhesion at Calot's triangle (OR; 0.021, CI (0.001-0.311), P; 0.005) were independent predictors of difficult LC. Conclusions Gender (male), past history of acute cholecystitis, gallbladder wall thickness (≥4-5 mm), fibrotic gallbladder, and adhesion at Calot's triangle are significant predictors for difficult LC. Moreover, an awareness about reliable predictors for difficult LC would be helpful for an appropriate treatment plan and application of the resources to anticipate difficult LC.
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Affiliation(s)
- Tika Ram Bhandari
- Department of General Surgery, People's Dental College and Hospital, Kathmandu, Nepal
| | - Sarfaraz Alam Khan
- Department of General Surgery, People's Dental College and Hospital, Kathmandu, Nepal
| | - Jiuneshwar Lal Jha
- Department of General Surgery, People's Dental College and Hospital, Kathmandu, Nepal
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Bhandari TR, Khan SA, Jha JL, Sah JK. A rare case report of enteric fever causing gallbladder perforation. Int J Surg Case Rep 2021; 88:106553. [PMID: 34741857 PMCID: PMC8577125 DOI: 10.1016/j.ijscr.2021.106553] [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: 09/24/2021] [Revised: 10/19/2021] [Accepted: 10/27/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction and importance Enteric fever is one of the major public health problems mainly in developing countries. Gallbladder perforation is very unusual. Enteric fever rarely causes gallbladder perforation. We report a case of gallbladder perforation due to enteric fever in an adult patient. Case presentation A 50-year-old female without any medical illness presented with a history of intermittent fever for two weeks and three days duration of severe abdominal pain. Upper abdominal tenderness and guarding were found in the abdominal examination. Ultrasonography showed thickening of the gallbladder wall and pericholecystic fluid collection. Magnetic resonance cholangiopancreatography revealed a distended gallbladder with sludge, diffuse wall thickening, and contained perforation with a mild amount of free fluid seen in the abdomen. With the diagnosis of type II gallbladder perforation, percutaneous ultrasonography-guided drainage was done. The culture of bile revealed positivity for Salmonella Typhi. Intra-venous antibiotic (ceftriaxone and gentamicin) was administered for 14 days. Four weeks later, cholecystectomy with peritoneal lavage was done. She was discharged on the 8th postoperative day. Clinical discussion Preoperative diagnosing of gallbladder perforation is challenging. The accurate treatment and precise timing of the surgery remain important. In most cases, cholecystectomy and abdominal lavage are adequate to treat gallbladder perforation. Conclusions Gallbladder perforation is a life-threatening surgical problem. The clinician should have a high index of awareness about this unusual surgical entity due to enteric fever and early diagnosis with prompt surgical intervention is necessary to improve patient outcomes. Enteric fever is one of the major public health problems mainly in developing countries. Gallbladder perforation is a very uncommon complication of enteric fever. Awareness of this rare entity due to enteric fever is important for prompt timely management for better patient outcomes.
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Affiliation(s)
- Tika Ram Bhandari
- Department of General Surgery, People's Dental College and Hospital, Kathmandu, Nepal.
| | - Sarfaraz Alam Khan
- Department of General Surgery, People's Dental College and Hospital, Kathmandu, Nepal
| | - Jiuneshwar Lal Jha
- Department of General Surgery, People's Dental College and Hospital, Kathmandu, Nepal
| | - Jayant Kumar Sah
- Department of General Surgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Bhandari TR, Dangal G. COVID-19 Pandemic and Neonatal Health: What We Know so Far? Kathmandu Univ Med J (KUMJ) 2021; 18:94-98. [PMID: 33605246] [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
COVID-19 first time appeared in December 2019 in Wuhan, China. The number of cases increased rapidly in china and outside and the World Health Organization declared a pandemic on 11th March 2020. The pregnant and postpartum women, child, and neonatal populations are vulnerable to this disease due to immunological and physiological changes. This paper analyzed the published evidence for assessing the effect of COVID-19 on neonatal health and health care. Online published literature was searched from PubMed, Google Scholar, and other official webpages using keywords: "coronavirus/COVID-19/new coronavirus 2019"/SARS-CoV-2 and neonatal health/care/outcomes" and reviewed to prepare this article. COVID-19 is the potential to transmit either mother to fetus or mother/caregiver to neonates. However, neonates born from infected mothers did not show significant clinical features. Pharyngeal-swab, amniotic-fluid, cord-blood, and breast-milk test results were not found positive. Health facility-based vaginal/caesarian delivery was considered a low risk of transmission. However, recommended to separate neonates with infected mothers/caregivers and test immediately after birth to avoid the possible transmission. Mothers/caregivers should take routine preventive measures such as washing hands frequently and avoiding contact with infected people. If neonates suffered from the server acute respiratory distress requires intensive care urgently. Despite the possibility of the intrauterine transmission of COVID-19 direct evidence is still lacking so it needs more studies for further confirmation. The International Pediatric Association suggested preventive programs, curative care, vaccination, and telemedicine care as the minimum services and called on its members to address these cares during the pandemic.
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Affiliation(s)
- T R Bhandari
- Department of Public Health, School of Health and Allied Sciences, Pokhara University, Nepal
| | - G Dangal
- Kathmandu Model Hospital, Bagbazzar, Kathmandu, Nepal
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Shahi S, Bhandari TR, Thapa PB, Shrestha D, Shrestha K. Foreign body esophagus: Six years of silence. SAGE Open Med Case Rep 2020; 8:2050313X20944322. [PMID: 32754336 PMCID: PMC7378705 DOI: 10.1177/2050313x20944322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/09/2020] [Accepted: 06/29/2020] [Indexed: 11/15/2022] Open
Abstract
Foreign body esophagus remains one of the common medical emergencies which may lead to
significant morbidity and mortality. Sharp objects, batteries, and elderly with foreign
body esophagus should be treated with emergent removal owing to the complications that
might ensue. Endoscopic removal is the preferred choice of treatment but for large foreign
body, sharp foreign body, and so on, rigid esophagoscopic removal might be more
preferable. Foreign body esophagus though an obvious situation might at times be missed.
It is important to make an early definitive diagnosis. We report a unique case of missed
foreign body (denture) esophagus despite the obvious signs and symptoms. Definitive
diagnosis was made only after 6 years due to the lack of definitive diagnostic procedures
and expertise. The foreign body was impacted in the mucosal wall of the esophagus
requiring Gastric resection and anastomosis (with McKeown procedure). With this we have
tried to highlight the pitfalls in the diagnosis and management of foreign body esophagus.
We report a case of a 55-year-old female who presented to the Emergency Room with history
of progressive dysphagia and odynophagia for 6 years which was aggravated for the past
6 months. A radiological diagnosis was made. It was followed by a failed attempt of
endoscopic removal which warranted the surgical removal of the foreign body.
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Affiliation(s)
- Sudha Shahi
- Department of Otorhinolaryngology Head and Neck Surgery, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Tika Ram Bhandari
- Department of General Surgery, People's Dental College and Hospital, Kathmandu, Nepal
| | - Prakash Bahadur Thapa
- Department of Otorhinolaryngology Head and Neck Surgery, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Deependra Shrestha
- Department of Otorhinolaryngology Head and Neck Surgery, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Kiran Shrestha
- Department of Cardiothoracic and Vascular Surgery, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal
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Shahi S, Bhandari TR, Pantha T, Gautam D. A rare coexistence of papillary carcinoma and anaplastic carcinoma of thyroid in multinodular goitre: Case report and literature review. Ann Med Surg (Lond) 2020; 56:161-164. [PMID: 32637093 PMCID: PMC7330161 DOI: 10.1016/j.amsu.2020.06.024] [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: 06/11/2020] [Revised: 06/21/2020] [Accepted: 06/21/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction Multinodular goiter is defined as multiple discrete nodules in the thyroid gland. The incidence of Papillary carcinoma thyroid was found to be highest out of total Multinodular Goiter cases while that of Anaplastic carcinoma was the least. We report a rare coexistence of Papillary carcinoma and Anaplastic carcinoma in adult patient with a long-standing Multinodular Goiter. Case presentation Here we present a case of 54 years male with huge anterior neck swelling for 20 years with a gradual increase in size. Computerized tomography of neck revealed solidocystic mass lesion without any significant lymphadenopathy, features suggesting Multinodular goiter with differential diagnosis of Carcinoma Thyroid. Cytological examination showed Papillary thyroid Carcinoma. He underwent total thyroidectomy with central neck dissection. Postoperative period was uneventful. Histopathological report revealed features suggestive of mixed tumor of Papillary thyroid Carcinoma and Anaplastic Carcinoma thyroid TNM Staging T3 N0 M0, Stage IVA. After the final reports patient was sent for adjuvant therapy three weeks later where he received megavoltage external beam radiation and he was followed up till 12th week. He was assessed radiologically which showed no signs of physical progression of the disease. However, he was lost to follow up after that visit. Discussion Long-standing benign conditions of thyroid can transform into malignant forms in the undefined duration of time. Conclusion Regular follow up and early management of multinodular goiter at the right time can save a patient from undue stress and complication like the conversion into malignancy.
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Affiliation(s)
- Sudha Shahi
- Otorhinolaryngology Head and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Tika Ram Bhandari
- General Surgery, People's Dental College and Hospital, Kathmandu, Nepal
| | - Tridip Pantha
- Otorhinolaryngology Head and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Dipendra Gautam
- Otorhinolaryngology Head and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
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Shahi S, Bhandari TR, Pantha T. Verrucous Carcinoma in a Giant Cutaneous Horn: A Case Report and Literature Review. Case Rep Otolaryngol 2020; 2020:7134789. [PMID: 32082671 PMCID: PMC7013305 DOI: 10.1155/2020/7134789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/09/2019] [Accepted: 01/09/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A cutaneous horn is a common clinical entity which usually presents as a cutaneous lesion. Because of its subtle nature, patients usually tend to present late unless the lesion is big or complications develop. Because of its resemblance to animal horn, it has been given the term "horn." Cutaneous horn seems to have a remarkable history. Though cutaneous horn is benign most of the times, chances of malignancy (20-25%) should be kept in mind. Old age, giant cutaneous horn carries more chances of transformation into malignancy like in our case. Thus, early diagnosis and treatment is required in all cases. Case Presentation. We report a case of a 74-year-old farmer with a cutaneous projection measuring ∼8 × 5 × 3 cm3 over the medial surface of the right pinna for 1 year. It started as a small projection which was progressively enlarging. The primary reason behind him presenting to us was cosmetic reason since it resembled an animal horn. The projection was not associated with pain or similar lesions anywhere else in body. Understanding the malignancy risks and the cosmetic benefits, he was planned for excision biopsy of the horn. He had no systemic signs of malignancy. Histopathological reports were consistent with malignancy. CONCLUSIONS Cutaneous horns are usually benign lesions and mostly found in the head and neck region. Because of the chances of malignancy, cutaneous horns should undergo surgical removal and biopsy for early and definitive diagnosis and management.
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Affiliation(s)
- Sudha Shahi
- Otorhinolaryngology Head and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Tika Ram Bhandari
- General Surgery, People's Dental College and Hospital, Kathmandu, Nepal
| | - Tridip Pantha
- Otorhinolaryngology Head and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
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Shahi S, Bhandari TR, Thapa PB, Shrestha D. Buccal oncocytoma: Report of a case and literature review. Ann Med Surg (Lond) 2019; 43:82-84. [PMID: 31245002 PMCID: PMC6581872 DOI: 10.1016/j.amsu.2019.05.016] [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: 04/08/2019] [Revised: 05/21/2019] [Accepted: 05/27/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction More common in major salivary glands, oncocytomas are very rare tumors. They commonly occur in the parotid gland and are painless slow growing predominantly benign tumors. The term “oncocytoma” was introduced by Jaffe to designate those tumors of the salivary glands that consist predominantly of oncocytic cells lining the salivary ducts (1) Similalry, Meza- Chavez had proposed the name “oxyphilic granular cell adenoma. (2) Oncocytomas are extremely rare, benign and slow growing in nature. Here we present a rare case of buccal oncocytoma which is to our knowledge the 19th case of intraoral minor salivary gland tumor and the 7th reported case of buccal oncocytoma. Case presentation Here we present an exceedingly rare case of buccal oncocytoma in a 14 years boy who presented to the department of ENT with right buccal swelling for 6 months. He was posed the diagnosis of buccal cyst after cytological examination supported by CT scan. He then underwent an excisional biopsy where the final diagnosis was made as Buccal Oncocytoma. Conclusions Though very rare in the picture, conditions like salivary gland oncocytomas still are reported on and off in the literature. The treatment of which is complete surgical excision. Buccal oncocytoma is one of the rare entities salivary gland oncocytoma. So far only 6 cases of buccal oncocytoma has been mentioned in literature. The definitive treatment is surgical excision.
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Affiliation(s)
- Sudha Shahi
- Department of Otorhinolaryngology Head and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Tika Ram Bhandari
- Department of General Surgery, People's Dental College and Hospital, Kathmandu, Nepal
| | - Prakash Bahadur Thapa
- Department of Otorhinolaryngology Head and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Deependra Shrestha
- Department of Otorhinolaryngology Head and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
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Bhandari TR, Shahi S. Volvulus of sigmoid colon in a challenged adolescent: An unusual case report. Ann Med Surg (Lond) 2019; 44:26-28. [PMID: 31297192 PMCID: PMC6598602 DOI: 10.1016/j.amsu.2019.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 02/27/2019] [Revised: 06/03/2019] [Accepted: 06/11/2019] [Indexed: 12/29/2022] Open
Abstract
Sigmoid volvulus is very uncommon cause of intestinal obstruction in pediatrics population withhigh rate of mortality. To date, few cases of sigmoid volvulus in children and association with several condition has been reported in literature, of them very few cases are with mental disability. We report a challenged (mentally disabled) 14-year old adolescent boy presented asan emergency with feature of complete bowel obstruction. Abdominal X-rays shows dilated loop of large bowel with inverted U shaped. Volvulus of sigmoid colon was found during laparotomy and successfully managed with resection of a redundant colon with colocolic end to end anastomosis. Sigmoid volvulus is relatively uncommon in children as compared to adults. Surgeons should be attentive of this rare entity, cause of large bowel obstruction to allow for early diagnosis and to enable better patient outcomes by reducing the morbidity and mortality.
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Affiliation(s)
- Tika Ram Bhandari
- Department of General Surgery, People's Dental College and Hospital, Kathmandu, Nepal.,Formerly Department of General Surgery, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Sudha Shahi
- Department of ENT Head and Neck Surgery, National Academy of Medical Sciences, Kathmandu, Nepal
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Affiliation(s)
- Sudha Shahi
- Department of Otorhinolaryngology Head, and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Sonika Dhari Shrestha
- Department of Otorhinolaryngology Head, and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Mauroofa Abdul Latheef
- Department of Otorhinolaryngology Head, and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Tika Ram Bhandari
- Department of General Surgery, People's Dental College and Hospital, Kathmandu, Nepal
| | - Deependra Shrestha
- Department of Otorhinolaryngology Head and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
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Bhandari TR, Shahi S, Mahaseth N. Massive encrustations as a consequence of longterm indwelling urethral catheter: A rare case report. Ann Med Surg (Lond) 2018; 34:14-16. [PMID: 30186600 PMCID: PMC6123059 DOI: 10.1016/j.amsu.2018.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/08/2017] [Revised: 05/21/2018] [Accepted: 08/08/2018] [Indexed: 11/30/2022] Open
Abstract
Longterm indwelling urethral catheter can cause several complications such as lower urinary tract infections, tissue damage, pain, hemorrhage and encrustation of catheter leading to blockage. A 55- year old male presented with suprapubic pain for three months owing to poorly draining Foley catheter. He had undergone surgery for bladder calculi two and half a years back. He had been discharged with Foley catheter. He did not show up at the hospital for two and half years. The catheter was never changed during this period. Plain X-ray abdomen revealed a large encrustation with radiopacity surrounding the foley's bulb. Open suprapubic cystostomy was performed. The intact Foley catheter with encrusted bulb was removed. His postoperative period was uneventful. Surgical removal is the only treatment of choice for unusual massive encrustations in long-term indwelling urethral catheter. Minimally invasive technique is getting popularity, however we performed open cystostomy and removal due to the lack of expertise and instruments in our hospital setting. Catheterization under aseptic condition, frequent catheter change, early treatment of urinary infection and proper patient education on catheter hygiene are few methods that can reduce the complications of longterm indwelling urinary catheter.
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Affiliation(s)
- Tika Ram Bhandari
- Department of General Surgery, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Sudha Shahi
- Department of ENT, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Naveen Mahaseth
- Department of General Surgery, Universal College of Medical Sciences, Bhairahawa, Nepal
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Bhandari TR, Shahi S, Gautam M, Pandey S. A rare case report of patent vitellointestinal duct causing bowel obstruction in an adult. Int J Surg Case Rep 2017; 39:231-234. [PMID: 28858741 PMCID: PMC5581374 DOI: 10.1016/j.ijscr.2017.08.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 05/30/2017] [Revised: 08/12/2017] [Accepted: 08/13/2017] [Indexed: 11/17/2022] Open
Abstract
Patent vitellointestinal duct is very rare congenital condition. We report an unusual case of patent vitellointestinal duct causing intestinal obstruction in adult patient. Awareness of this a rare cause of bowel obstruction is important for appropriate management.
Introduction Patent vitellointestinal duct occurs in about 2% of the population which unusually leads to small intestinal obstruction associated with high morbidity and mortality. Here we are reporting an unusual case of patent vitellointestinal duct causing small intestinal obstruction in an adult patient. Presentation of case A 22-year-old male without any medical illness presented as an emergency with a 3 day hystory of abdominal pain, multiple episode of vomiting and abdominal distention. Distended abdomen and sign of peritonitis were found on abdominal examination. Abdominal X-rays revealed multiple small intestinal air-fluid levels. A patent vitellointestinal duct extending from distal ileum to the posterior wall of the umbilicus was found causing closed loop ileal obstruction during laparotomy. Resection of a vitellointestinal duct along with gangrenous distal ileum and cecum with ileocolostomy was performed. He was discharged on the 8 th postoperative day. Discussion Diagnosing and management of cause of intestinal obstruction in patients without history of abdominal surgery is very challenging. Early resuscitation and timely surgical intervention of intestinal obstruction due to a rare patent vitellointestinal duct can be life-saving measure. Conclusion The patent vitellointestinal duct is an uncommon entity in adults and moreover this disorder leading to intestinal obstruction is very rare. Surgeons should be aware of this infrequent cause of small bowel obstruction to allow for early diagnosis and to facilitate better patient outcomes.
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Affiliation(s)
- Tika Ram Bhandari
- Department of General Surgery, Universal College of Medical Sciences, Bhairahawa 32900, Nepal.
| | - Sudha Shahi
- Department of ENT, National Academy of Medical Sciences, Kathmandu 44600, Nepal.
| | - Manish Gautam
- Department of General Surgery, Universal College of Medical Sciences, Bhairahawa 32900, Nepal.
| | - Sanjay Pandey
- Department of General Surgery, Universal College of Medical Sciences, Bhairahawa 32900, Nepal.
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Abstract
Introduction: Appendicitis is one of the most common causes of acute abdomen in children. Patients who are diagnosed early and undergo an appendectomy before perforation have a good outcome. However, it is difficult to diagnose in young children because its clinical manifestations may be atypical. The aim of this study was to determine the risk factors for complications in acute appendicitis in paediatric population.
Methods: We performed a cross sectional study on children (age ≤18 years) who underwent appendectomy for suspected appendicitis from January 2014 to December 2015. Medical records of patients who met inclusion criteria were reviewed. Preoperative, operative and post-operative data were analyzed. The main outcome measure was intraoperative confirmation of gangrenous or perforated appendicitis. Multivariate logistic regression analysis was performed, and the main predictors of interest were patient’s age, duration of pain and total leucocyte count.
Results: Total 73 paediatric patients (46 males) with mean age 13±3.8 were studied. In multivariate logistic regression analysis, patients having pain duration more than 72 hours and patients with leucocyte count >15000/mm3 were more likely to have complicated appendicitis [(OR:14.6), (95% CI= 2.40 – 89.77), (P= 0.004)] and [(OR=16.38), (95% CI = 1.836-146), (P = 0.012)] respectively. However, the age of the patient is not independently associated with complicated appendicitis.
Conclusions: Increase in total leucocyte count and duration of the presentation can be a good marker of complicated appendicitis.
Keywords: appendicitis; complicated; gangrenous; pediatric; perforated; risk factors.
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Poudel R, Bhandari TR. Risk Factors for Complications in Acute Appendicitis among Paediatric Population. JNMA J Nepal Med Assoc 2017; 56:145-148. [PMID: 28598452] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION Appendicitis is one of the most common causes of acute abdomen in children. Patients who are diagnosed early and undergo an appendectomy before perforation have a good outcome. However, it is difficult to diagnose in young children because its clinical manifestations may be atypical. The aim of this study was to determine the risk factors for complications in acute appendicitis in paediatric population. METHODS We performed a cross sectional study on children (age ≤18 years) who underwent appendectomy for suspected appendicitis from January 2014 to December 2015. Medical records of patients who met inclusion criteria were reviewed. Preoperative, operative and post-operative data were analyzed. The main outcome measure was intraoperative confirmation of gangrenous or perforated appendicitis. Multivariate logistic regression analysis was performed, and the main predictors of interest were patient's age, duration of pain and total leucocyte count. RESULTS Total 73 paediatric patients (46 males) with mean age 13±3.8 were studied. In multivariate logistic regression analysis, patients having pain duration more than 72 hours and patients with leucocyte count >15000/mm3 were more likely to have complicated appendicitis [(OR:14.6), (95% CI= 2.40 - 89.77), (P= 0.004)] and [(OR=16.38), (95% CI = 1.836-146), (P = 0.012)] respectively. However, the age of the patient is not independently associated with complicated appendicitis. CONCLUSIONS Increase in total leucocyte count and duration of the presentation can be a good marker of complicated appendicitis.
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Affiliation(s)
- R Poudel
- Department of Surgery, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - T R Bhandari
- Department of Surgery, Universal College of Medical Sciences, Bhairahawa, Nepal
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Bhandari TR, Shahi S, Bhandari RS, Lakhey PJ. Preoperative serum albumin level as a predictor of perioperative outcome in patient undergoing major gastrointestinal surgery. J Soc Surg Nepal 2016. [DOI: 10.3126/jssn.v19i2.24544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: Hypoalbuminemia, as a marker of malnutrition and disease, is associated with higher risk of poor postoperative outcomes. However, no study has been reported from our country until now. Our aim was to identify the relationship between preoperative hypoalbuminemia and the development of complications after major gastrointestinal surgery.
Methods: A prospective study of 106 patients who underwent major elective gastrointestinal surgery between July 2012 to June 2013 in Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal were considered for the study. Serum albumin was determined preoperatively in all patients. Hypoalbuminemia was defined as albumin less than 35 mg/dl. Thirty-day postoperative complications were analyzed.
Results: The patients were 70 males (66 %) and 36 females (34%) with a mean age of 50 years (23-81). Thirty-six patients (34%) had hypoalbuminemia. Overall complication rate was 32%. Hypoalbuminemic patients had a significantly higher rate of postoperative complications (26.4 and 5.6%; P<0.05). In multivariate analysis, age (>50 year), BMI (<18 kg/m2), duration of surgery (>3 hours) and hypoalbuminemia (<35 mg/dl) were the significant risk factors for postoperative complications (P<0.05).
Conclusion: Preoperative hypoalbuminemia is an independent predictor of postoperative outcomes in patients with elective major gastrointestinal surgery. Identification and optimization of nutritional status prior to surgery may improve surgical outcomes.
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Dangal G, Bhandari TR. Updates on Maternal and Child Health. Kathmandu Univ Med J (KUMJ) 2016; 14:94-95. [PMID: 28166061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- G Dangal
- Kathmandu Model Hospital, Kathmandu, Nepal
| | - T R Bhandari
- School of Health and Allied Sciences, Pokhara University, Kaski, Nepal
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Parajuli K, Chhetry MR, Bhandari TR, Paneru DP, Shrestha N, Tamrakar A, Dahal PK. Choices, Shift and Continuation of Temporary Contraceptive Methods among Women of Reproductive age in Western Development Region of Nepal. Nepal j obstet gynaecol 2016. [DOI: 10.3126/njog.v10i2.14344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
Aims: Global family planning programs have been in existence in the developing world. Modern techniques of temporary contraceptives have been proved to be useful tool for limiting births. This study is intended to identify the use pattern, associated factors with the choice, shift and continuity of temporary methods of contraception.Methods: This is descriptive cross-sectional study, incorporating qualitative aspects. Out of sixteen districts six were selected proportionately by using simple random methods from each ecological zone of the Western Development Regions, Nepal. Focus group discussion was accomplished among the different level family planning service providers.Results: User of Depo-Provera and pills were seen more in comparison to other temporary contraceptive. There are different reasons behind choosing of temporary contraceptive method such as Pills make regularity in menstruation, Norplant is useful for prolonged period, Depo-Provera is useful for three months and confidently used for a long time without any risk, motivation by friends/relatives. Reasons in changing the contraceptives includes associated side effects, lack of availability, irregularity in menstruation, choosing the another best method, excessive bleeding, difficult to use, pressure from family and husband to give birth, misunderstanding and stress in the family, traditional belief and lack of education.Conclusions: For proper choice of modern contraceptive methods promotion, education and knowledge about associated factors related to use of these method is needed. Continuous information on contraceptives focusing particularly on the side effects and trained health care providers are essential.
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Bhandari TR, Dangal G. Abortion Practices in Nepal: What does Evidence Show? Nepal j obstet gynaecol 2015. [DOI: 10.3126/njog.v10i1.13186] [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
Twenty-five years have passed since the global community agreed in Nairobi to address the high maternal mortality by implementing the Safe Motherhood Initiative. However, every year around 22 million women seek unsafe abortion in developing countries. Globally, the unsafe abortion accounts for 13% maternal deaths. Out of the total aborted women, around five million women were admitted to hospitals as a result of unsafe abortion. Similarly, more than three million women suffer from severe complications from unsafe abortion every year. In 2002, responding to the public voices and high attribution of unsafe abortion on maternal mortality, Nepal granted legal access to safe abortion introducing safe abortion act. Women can seek abortion up to 12 weeks of gestation for any indication. However, sex selective pregnancy termination is prohibited in Nepal. This study aimed to assess the results of various studies on abortion practices in Nepal. Literature published in PubMed, Lancet, Medline, WHO and Google Scholar web pages from 1990 to 2014 were used to prepare this paper. From 2004 to 2014, more than half a million women sought safe abortion care in Nepal. Despite the considerable progress, unsafe abortion is still a major issue in Nepal as it has been estimated that it constitutes half of all abortions undertaken every year. Published literature further showed that still an unmet need of safe abortion services exists in Nepal. However, the overall awareness of legal abortion was found to be high among Nepalese women. We found negative attitude of most people towards women who sought abortion care. Similarly, a large number of unmarried women were found at risk for seeking abortion care due to socio-cultural norms, values and stigmas in Nepal.
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Poudel RS, Thapa L, Shrestha S, Khatiwada D, Upadhyay N, Bhandari TR, Shrestha A. Efficacy of Combined Antithrombotic, Statins and Anti-Hypertensive Drugs in Acute Ischemic Stroke. JNMA J Nepal Med Assoc 2015; 53:5-11. [PMID: 26983040] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Anti-thrombotic, statins and antihypertensive drugs are commonly used for the management of acute ischemic stroke in Nepal but there is no evidence regarding their efficacy in our context. This study aims to explore the efficacy of these combined medications (anti-thrombotic, statins and antihypertensive drugs) in acute ischemic stroke patients for the first time and to assess the risk factors present in those patients. METHODS The study was conducted on 37 acute ischemic stroke patients admitted and treated at the Neurology Department of College of Medical Sciences-Teaching Hospital, Chitwan, Nepal and they were followed at three months (90±10 days). The initial stroke severity and functional disability were evaluated at admission and at 3 months using National Institute of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) respectively. The outcome parameters were functional independence (mRS≤2) and mortality at three months (mRS=6). Frequency distribution, Mann-Whitney U-test and χ2 test were performed for statistical analysis. RESULTS Out of 37 patients, 27 (73%) were Smoker, 22 (59.5%) had hypertension and 19 (51.4%) were alcohol consumer. The stroke severity on admission was statistically significant with functional independence (P=0.003) and mortality (P=0.015) at three month. Similarly, Rankin grade on admission was statistically significant with functional independence (P=0.001) and mortality (P=0.048) at three month. At three months, 20 (69%) survived patients were independent while mortality was seen in eight (21.6%) patients. CONCLUSIONS The management of acute ischemic stroke with combined anti-thrombotic, statins and antihypertensive drugs seems promising and efficacious in mild to moderately severe ischemic stroke.
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Affiliation(s)
- R S Poudel
- Department of Pharmacy, National Model College for Advance Learning, Kathmandu, Nepal
| | - L Thapa
- Department of Neurology, College of Medical Sciences Teaching Hospital, Chitwan, Nepal
| | - S Shrestha
- Department of Pharmacy, Shree Medical and Technical College, Chitwan, Nepal
| | - D Khatiwada
- Department of Community Medicine, College of Medical Sciences Teaching Hospital, Chitwan, Nepal
| | - N Upadhyay
- Department of Pharmacy, National Model College for Advance Learning, Kathmandu, Nepal
| | | | - A Shrestha
- Khairenitar Primary Health Centre, Nuwakot, Nepal
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Abstract
Twenty-five years have passed since the global community agreed in Nairobi to address the high maternal mortality by implementing the Safe Motherhood Initiative. However, every year nearly three million women die due to pregnancy related causes. This tragedy is avoidable if women have timely access to required emergency obstetric care. Emergency obstetric care refers to life-saving services for maternal and neonatal complications provided by skilled health workers. Since the beginning of the 1980’s, several efforts have been intensified to improve maternal and child health status and reducing the high morbidity and mortality. There was built on a worldwide consensus to provide improved maternal and child health care for addressing the high morbidity and mortality. All participant countries agreed to integrate emergency obstetric care services in their national health care system. Emergency obstetric care is one of the strategies for reducing the maternal mortality as pregnancy related complications are unpredictable. However, many women in developing countries do not have access to essential health care services including emergency obstetric care. Basic emergency obstetric care by skilled birth attendants or timely referral for further comprehensive emergency obstetric care can reduce maternal deaths and disabilities significantly. This paper is based on the results published in PubMed, Medline, Lancet, WHO and Google Scholar web pages from 1990 to 2013. DOI: http://dx.doi.org/10.3126/njog.v9i1.11179 NJOG 2014 Jan-Jun; 2(1):8-16
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Thapa L, Shrestha A, Pradhan M, Bhandari TR, Shrestha S, Poudel RS, Poudel R, Pokhrel B. Status of Vitamin D and its Association with Stroke Risk Factors in Patients with Acute Ischemic Stroke in a Tertiary Care Hospital. JNMA J Nepal Med Assoc 2014; 52:935-939. [PMID: 26982669] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Vitamin D deficiency has been associated with many neurological illnesses. The status of Vitamin D in Nepalese ischemic stroke patients is still unknown. This study aims to assess the status of vitamin D and its association with stroke risk factors in patients with acute ischemic stroke from Central Nepal. METHODS A total of 60 patients with ischemic stroke were included in the study. Their clinical profile and Vitamin D status were assessed. Frequency distribution, Pearson χ2test and Kruskal-Wallis test were performed for statistical analysis using SPSS-IBM 20. RESULTS The median (IQR) age of the patient was 65 (53.25, 70.75) years, ranging from 18-87 years. Thirty-four (56.7%) were males. Fourty-eight (80%) patients had hypertension and 34 (56.7%) were smoker. Previous stroke was present in six (10%) cases. Thirty-seven (61.6%) patients had low levels of Vitamin D out of which 26 (43.3%) had vitamin D insufficiency and 11 (18.3%) had vitamin D deficiency. Vitamin D level was significantly associated with previous history of stroke (P=0.043). CONCLUSIONS Vitamin D deficiency occurs in patients with ischemic stroke. Previous episodes of stroke with low vitamin D levels could be a cause of recurrent strokes. Further studies are necessary to establish the role of vitamin D in acute ischemic stroke in Nepalese population.
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Affiliation(s)
- L Thapa
- National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal
| | - A Shrestha
- Khairanitar Primary Health Center, Nuwakot, Nepal
| | - M Pradhan
- College of Medical Sciences-Teaching Hospital, Chitwan, Nepal
| | | | - S Shrestha
- Shree Medical and Technical College, Chitwan, Nepal
| | - R S Poudel
- Chitwan Medical College Teaching Hospital, Chitwan, Nepal
| | - R Poudel
- Grande International Hospital, Dhapasi, Kathmandu, Nepal
| | - B Pokhrel
- Kathmandu University Medical College, Dhulikhel, Nepal
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Bhandari TR, Dangal G, Sarma PS, Kutty VR. Construction and Validation of a Women's Autonomy Measurement Scale with Reference to Utilization of Maternal Health Care Services in Nepal. JNMA J Nepal Med Assoc 2014; 52:925-934. [PMID: 26982668] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Women's autonomy is one of the predictors of maternal health care service utilization. This study aimed to construct and validate a scale for measuring women's autonomy with relevance to developing countries. METHODS We conducted a study for construction and validation of a scale in Rupandehi and further validated in Kapilvastu districts of Nepal. Initially, we administered a 24-item preliminary scale and finalized a 23-item scale using psychometric tests. After defining the construct of women's autonomy, we pooled 194 items and selected 24 items to develop a preliminary scale. The scale development process followed different steps i.e. definition of construct, generation of items pool, pretesting, analysis of psychometric test and further validation. RESULTS The new scale was strongly supported by Cronbach's Alpha value (0.84), test-retest Pearson correlation (0.87), average content validity ratio (0.8) and overall agreement- Kappa value of the items (0.83) whereas all values were found satisfactory. From factor analysis, we selected 23 items for the final scale which show good convergent and discriminant validity. From preliminary draft, we removed one item; the remaining 23 items were loaded in five factors. All five factors had single loading items by suppressing absolute coefficient value less than 0.45 and average coefficient was more than 0.60 of each factor. Similarly, the factors and loaded items had good convergent and discriminant validity which further showed strong measurement capacity of the scale. CONCLUSIONS The new scale is a reliable tool for assessing women's autonomy in developing countries. We recommend for further use and validation of the scale for ensuring the measurement capacity.
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Affiliation(s)
- T R Bhandari
- Department of Public Health, School of Health and Allied Sciences, Pokhara University, Kaski, Nepal. and Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - G Dangal
- Department of Obstetrics and Gynaecology, Kathmandu Model Hospital, Kathmandu, Nepal
| | - P S Sarma
- Department of Obstetrics and Gynaecology, Kathmandu Model Hospital, Kathmandu, Nepal
| | - V R Kutty
- Department of Biology, Faculty of Natural and Life Sciences, Djillali Liabes University, Sidi-bel-Abbes, Algeria
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