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Adhikari SP, Pathak BD, Ghimire B, Baniya S, Joshi P, Kafle P, Adhikari P, Rana A, Regmi L, Dhakal B, Simkhada N, Tandon OP, Pathak ID, Rawal NM. Prevalence of pre-operative anxiety and associated risk factors among patients awaiting elective surgery in a tertiary care hospital. F1000Res 2023; 12:1207. [PMID: 38318155 PMCID: PMC10839854 DOI: 10.12688/f1000research.136320.2] [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] [Accepted: 12/11/2023] [Indexed: 02/07/2024] Open
Abstract
Background Patients undergoing surgery have a fear of anesthesia and surgical procedures that results in anxiety. The global incidence of pre-operative anxiety is estimated at 60-92%. Age, gender, education, marital status, type of family, type of anesthesia and surgery, and history of surgery are the contributing factors. High levels of anxiety during the pre-operative period has negative impacts on surgical outcomes. The main objective of this study was to find out the prevalence of pre-operative anxiety and associated risk factors in a hospital setting of a developing country. Methods This was a single center, analytical, cross-sectional study conducted among the admitted patients scheduled for elective surgeries in a tertiary care hospital. Non-probability convenience sampling was adopted and a total of 205 cases were included. The researchers themselves collected the data on the day before surgery using questionnaires comprised of two parts: semi-structured questionnaires prepared via literature review and Amsterdam Pre-operative Anxiety and Information Scale (APAIS). Data were analyzed in SPSS version 23. Bivariate and multivariate analyses were performed appropriately. Results The prevalence of pre-operative anxiety was 25.85%. The median anaesthesia related, surgery related, and total anxiety scores were 4.00, 5.00 and 9.00 respectively. Likewise, the median score of information desired component scale was 5.00. Different anxiety scores were positively correlated with the information desire component score. The patients living in a nuclear family (adjusted OR, 2.480; 95% CI, 1.272-4.837, p = 0.008) and those without past history of surgery (adjusted OR, 2.451; 95% CI, 1.107-5.424, p = 0.027) had approximately 2.5 times higher risk of having pre-operative anxiety compared to those from a joint family and those having past history of surgery respectively. Those receiving spinal anesthesia had approximately two times lower risk of anxiety (adjusted OR, 0.511; 95% CI, 0.265-0.985, p = 0.045). Conclusions One fourth of the patients had pre-operative anxiety. Type of family, type of anesthesia and past history of surgery were found to be the independent predictors of anxiety.
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Affiliation(s)
- Suman Prasad Adhikari
- Department of Neuropsychiatry, Nepalese Army Institute of Health Sciences, Kathmandu, Bagmati province, 10160, Nepal
| | - Bishnu Deep Pathak
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Bagmati Province, 10160, Nepal
| | - Bhuwan Ghimire
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Bagmati Province, 10160, Nepal
| | - Sunil Baniya
- Department of Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Lalitpur, Bagmati Province, 26500, Nepal
| | - Prabhas Joshi
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Bagmati Province, 10160, Nepal
| | - Pooja Kafle
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Bagmati Province, 10160, Nepal
| | - Prawesh Adhikari
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Bagmati Province, 10160, Nepal
| | - Aakanksha Rana
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Bagmati Province, 10160, Nepal
| | - Laxmi Regmi
- Karnali Province Hospital, Birendranagar, Surkhet, 21700, Nepal
| | - Bishal Dhakal
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Bagmati Province, 10160, Nepal
| | - Nabin Simkhada
- Department of Internal Medicine, Kathmandu University School of Medical Sciences, Kavrepalanchok, Bagmati Province, 45200, Nepal
| | - Om Prakash Tandon
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Bagmati Province, 10160, Nepal
| | - Indra Dev Pathak
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Bagmati Province, 10160, Nepal
| | - Namrata Mahara Rawal
- Department of Neuropsychiatry, Nepalese Army Institute of Health Sciences, Kathmandu, Bagmati province, 10160, Nepal
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Koirala M, Shakya BM, Parajuli B, Ghimire B. Myocardial Infarction in Non-obstructive Coronary Arteries (MINOCA) in the Perioperative Period can Epinephrine be Responsible? Kathmandu Univ Med J (KUMJ) 2022; 20:535-537. [PMID: 37795740] [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
Ephedrine, metaraminol, epinephrine and maneuvers like carotid sinus stimulation used during intraoperative period have been postulated to cause temporary spasm of the coronary vessels leading to decrease supply to the myocardium and precipitating myocardial infraction in non-obstructive coronary arteries (MINOCA). As an anaesthesiologists, we should be aware that even a dose as small as 25 mcg epinephrine infiltrated along with local anaesthetic in the subcutaneous plane may be responsible for coronary vessel spasm and thus myocardial infraction in nonobstructive coronary arteries. We report a case of 45 years old female with papillary carcinoma of thyroid who developed features of non-ST elevation myocardial infarction 5 minutes after the subcutaneous infiltration of 5 ml of 2% Xylocaine with 1:200000 Epinephrine. Patient was managed for acute Myocardial Infarction. Coronary angiogram done the next day revealed normal coronary arteries, hence the diagnosis Myocardial infraction in non-obstructive coronary arteries was made.
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Affiliation(s)
- M Koirala
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - B M Shakya
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - B Parajuli
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - B Ghimire
- Department of Cardiothoracic and Vascular Anaesthesiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
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Ainasoja O, Hurskainen M, Ghimire B, Lahtela J, Syrjälä S, Lemström K. Spatial Transcriptomic Analysis of Acute Heart Rejection Model. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.746] [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] [Indexed: 11/30/2022] Open
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Lundin K, Sepponen K, Väyrynen P, Liu X, Yohannes DA, Survila M, Ghimire B, Känsäkoski J, Katayama S, Partanen J, Vuoristo S, Paloviita P, Rahman N, Raivio T, Luiro K, Huhtaniemi I, Varjosalo M, Tuuri T, Tapanainen JS. OUP accepted manuscript. Mol Hum Reprod 2022; 28:6574364. [PMID: 35471239 PMCID: PMC9308958 DOI: 10.1093/molehr/gaac012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/11/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Lundin
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - K Sepponen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P Väyrynen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - X Liu
- Molecular Systems Biology Research Group, Institute of Biotechnology & HiLIFE, University of Helsinki, Helsinki, Finland
- Proteomics Unit, Institute of Biotechnology & HiLIFE, University of Helsinki, Helsinki, Finland
| | - D A Yohannes
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Translational Immunology & Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
| | - M Survila
- Molecular and Integrative Biosciences Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - B Ghimire
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - J Känsäkoski
- Department of Physiology, University of Helsinki, Helsinki, Finland
| | - S Katayama
- Folkhälsan Research Center, Helsinki, Finland
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
- Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - J Partanen
- Molecular and Integrative Biosciences Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - S Vuoristo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P Paloviita
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - N Rahman
- Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Reproduction and Gynecological Endocrinology, Medical University of Bialystok, Bialystok, Poland
| | - T Raivio
- Department of Physiology, University of Helsinki, Helsinki, Finland
- Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- New Children's Hospital, Pediatric Research Center, Helsinki University Hospital, HUH, Helsinki, Finland
| | - K Luiro
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - I Huhtaniemi
- Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Metabolism, Endocrinology and Reproduction, Faculty of Medicine, Hammersmith Campus, Imperial College London, London, UK
| | - M Varjosalo
- Molecular Systems Biology Research Group, Institute of Biotechnology & HiLIFE, University of Helsinki, Helsinki, Finland
- Proteomics Unit, Institute of Biotechnology & HiLIFE, University of Helsinki, Helsinki, Finland
| | - T Tuuri
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J S Tapanainen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Obstetrics and Gynecology, University Hospital of Oulu, University of Oulu, Medical Research Center Oulu and PEDEGO Research Unit, Oulu, Finland
- Corresponding author. Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO Box 140, 00029 Helsinki, Finland. Tel: +358-94711; E-mail:
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Uprety A, Kobashi Y, Ozaki A, Shrestha D, Ghimire B, Sedain G, Sigdel S, Higuchi A, Tsubokura M, Singh YP. Displaced Intra-Articular Calcaneal Fractures: Evaluation of Clinical and Radiological Outcome Following Open Reduction and Internal Fixation with Locking Branched Calcaneal Plate. Kathmandu Univ Med J (KUMJ) 2021; 19:29-34. [PMID: 34812154] [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 An introduction of the World Health Organization Surgical Safety Checklist (WHO SSC) is essential to promote surgical safety. Objective To obtain country-specific information regarding the checklist in a leading medical institution in Nepal. Method The present research was a cross-sectional study with a survey conducted among healthcare professionals working in the operation theatre at the Tribhuvan University Teaching Hospital (TUTH) in Kathmandu, Nepal. A questionnaire was distributed to 150 healthcare professionals working in the operating theatre. Responses to the questionnaire were analysed descriptively and regression analyses used to identify factors associated with awareness of the checklist. Result In total, 127 healthcare professionals participated in the study, of whom 118 (92.9%) had been aware of the WHO SSC. A substantial proportion of participants (108, 91.5%) were not satisfied with the prevailing practice whereby the checklist was not routinely used during surgery. Lack of appropriate training was the most prevalent barrier to the checklist use (72, 67.9%), followed by unwillingness of staff to use the checklist (54, 50.9%), and lack of experience (42, 39.7%). The mean score on the survey was 6.0 out of 10. Regarding the results of the regression model on survey scores, surgeons had higher scores compared to nurses (unadjusted coefficient 0.80, 95% CI 0.20-1.40). Conclusion Most of the healthcare professionals were aware of the WHO SSC, however multiple barriers to the checklist use were identified. It is important to establish an effective use of WHO SSC in the operation theatre.
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Affiliation(s)
- A Uprety
- Department of Anesthesiology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Y Kobashi
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima 960-1295, Japan. Department of Anesthesia, Jyoban Hospital of Tokiwa Foundation. Iwaki City, Fukushima, 972-8322, Japan. Medical Governance Research Institute, Minato-ku, Tokyo, 108-0074, Japan
| | - A Ozaki
- Medical Governance Research Institute, Minato-ku, Tokyo, 108-0074, Japan. Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki City, Fukushima, 972-8322, Japan
| | - D Shrestha
- Department of Neonatology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - B Ghimire
- Department of GI and General Surgery, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - G Sedain
- Department of Neurosurgery, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - S Sigdel
- Department of Cardiothoracic and Vascular Anesthesiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - A Higuchi
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima 960-1295, Japan. Medical Governance Research Institute, Minato-ku, Tokyo, 108-0074, Japan
| | - M Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima 960-1295, Japan. Medical Governance Research Institute, Minato-ku, Tokyo, 108-0074, Japan
| | - Y P Singh
- Department of Gastrointestinal and General Surgery, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Ghimire B, Khanal K, Bajracharya A, Koirala M. Ischemic Stroke as a Manifestation of Cholesterol Embolization Syndrome Following Percutaneous Coronary Intervention. Kathmandu Univ Med J (KUMJ) 2021; 19:143-145. [PMID: 34812174] [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
Cholesterol embolization syndrome (CES) is one of the major, yet underdiagnosed cause of morbidity and mortality following invasive coronary interventions. The major risk factors are elderly, male, atherosclerotic disease, anticoagulation and femoral access route. This multisystem disease affects skin, kidney, brain, eye and gastrointestinal tract. Only few cases of cholesterol embolization syndrome manifesting as an ischemic stroke are reported. We present a case of an elderly man, admitted to our ICU after percutaneous coronary intervention (PCI) who developed neurological deficits along with skin changes and renal failure. cholesterol embolization syndrome was suspected based upon the presence of cardiovascular risk factors, invasive cardiovascular intervention and clinical signs. The diagnosis of ischemic stroke made through plain MRI brain, revealed multiple areas of lacunar infarcts. He was treated with intermittent hemodialysis, statins and anti-platelet agents. On follow up, skin lesions and renal functions were improved; but slurring of speech and paresis persisted.
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Affiliation(s)
- B Ghimire
- Nepal Mediciti Hospital, Nakhu, Lalitpur, Nepal
| | - K Khanal
- Nepal Mediciti Hospital, Nakhu, Lalitpur, Nepal
| | | | - M Koirala
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Gurung B, Shrestha R, Shrestha S, Singh M, Koirala A, Chataut S, Tuladhar S, Shrestha S, Ghimire B, Shrestha M, Gautam M, Dhakal H. P3.09-09 “Prevalence of Epidermal Growth Factor Receptor Mutation in Non-Small Cell Carcinoma Lungs at a Cancer Center in Nepal”. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1778] [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] [Indexed: 10/28/2022]
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Ruparel M, Quaife S, Ghimire B, Dickson J, Horst C, Tisi S, Bhowmik A, Navani N, Baldwin D, Duffy S, Waller J, Janes S. P2.11-29 Impact of an Information-Film to Promote Informed Decision-Making in Individuals Taking Part in a Lung Cancer Screening Demonstration Pilot. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1376] [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] [Indexed: 11/17/2022]
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Thakur DK, Ghimire B, Singh YP. Trend in Gastric Outlet Obstruction at Patients Attending Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Birat J Health Sci 2017. [DOI: 10.3126/bjhs.v2i2.18531] [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
IntroductionGastric outlet obstruction (GOO) involves obstruc_on in the antro-pyloric region or bulb of duodenum. Malignancy is common cause of GOO in adults but many patients with GOO have benign causes. Despite the improvement in medical management, about 5% patients with complicated duodenal ulcer disease and 1%-2% with complicated gastric ulcer disease respectively develop this problem.ObjectiveThe purpose of this study was to find the etiologies of GOO, their management options and outcome in Tribhuvan University Teaching Hospital.MethodologyIn this retrospective study, the records of 44 patients admited with diagnosis of GOO from September 2007 to August 2010 in the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal were retrieved. Patients' demography, etiologies of GOO, treatment given and their outcome were analysed.ResultsThirty two patients (73%) were male and 12 (27%) were female with M:F ratio of 2.7:1. The mean age of patients was 57.40 years and duration of symptoms 2.68 months. Carcinoma of stomach, 28 cases (64%) was most common ecology of GOO followed by PUD, 9 (21%), duodenal malignancy,3 (7%), corrosive stricture, 2 (5%), advanced gallbladder carcinoma, 1 (2%) and chronic pancreatis, 1 (2%). Seventeen (39%) patients were treated by gastrojejunostomy, 14 (32%) by subtotal gastrectomy and gastrojejunostomy, 5 (11%) by truncal vagotomy and gastrojejunostomy, 4 (9%) by medical management, 2 (4.5%) by feeding jejunostomy, and 2 (4.5%) were discharged on request. Complications occurred in 7 (16%) patients and mortality in 1 (2%). Twenty three (52%) patients were candidates for chemotherapy either in an adjuvant or palliative seting.ConclusionGastric malignancy was the most common cause of gastric outlet obstruction. Most of the patients in our setup presented with advanced disease and were candidates of palliative treatment only. Birat Journal of Health Sciences Vol.2/No.1/Issue 2/ Jan - April 2017, Page: 219-221
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Sapkota R, Ghimire B, Lakhey PJ, Ghimire RK, Shrestha UK. Visceral artery aneurysms: an institutional review. J Soc Surg Nepal 2017. [DOI: 10.3126/jssn.v17i2.17140] [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
Methods: It is a retrospective review of prospectively kept data of patients treated for visceral artery aneurysms in Tribhuvan University Teaching Hospital and Manmohan Cardiothoracic Vascular and Transplant Center from 1997 to 2009.Results: Fifteen patients were diagnosed with 16 visceral artery aneurysms. These consisted of 7 splenic (in 6 patients), 4 hepatic, 2 superior mesenteric, 1 gastroduodenal, and 1 renal artery aneurysms. There were 14 symptomatic patients including 4 who presented with rupture. Commonest presenting symptom was pain abdomen (14/15), followed by gastrointestinal bleed (6/15) and mass abdomen (5/15). The diagnosis was made with the help of CECT of abdomen in 13 patients, which was confirmed by conventional angiography in three patients. In two patients with obscure GI bleeding, diagnosis was clinched by conventional angiogram. Eight patients were treated only surgically, with three mortality. Transcatheter embolization alone was used in 5 patients. Two patients were treated with combination of surgical and endovascular therapy. One patient with superior mesenteric artery aneurysm in whom nothing could be done during laparotomy died six months later. Average follow up duration was one year.Conclusion: Splenic artery remains the most commonly afflicted vessel among the visceral artery aneurysms. The VAAs can be treated surgically or with endovascular means with fair success, although the best mode of treatment needs to be individualized.Journal of Society of Surgeons of NepalVol. 17, No. 2, 2014, Page: 3-6
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KC R, Ghimire B, Singh YP. Annular pancreas presenting as gastric outlet obstruction in an adult: a case report. J Soc Surg Nepal 2017. [DOI: 10.3126/jssn.v17i2.17146] [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
Annular pancreas is a rare congenital abnormality which arises in the embryo by persistence of pancreatic tissue in the track which the ventral pancreatic bud follows in its rotation round the duodenum. A 21 years old male was admitted because of a non bilious vomiting and epigastric fullness after intake of food. Diagnosis was confirmed with contrast enhanced CT scan of the abdomen. He successfully underwent laparoscopic gastrojejunostomy with uneventful postoperative recovery. Though rare, annular pancreas should be considered as differential diagnosis in patient presenting as gastric outlet obstruction after excluding common causes.Journal of Society of Surgeons of NepalVol. 17, No. 2, 2014, Page: 35-36
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Ghimire B, Singh YP, Timalsina S. Post operative diagnosis of early gastric cancer in a low risk population and the possibility of risk stratified screening. Kathmandu Univ Med J (KUMJ) 2015; 12:32-7. [PMID: 25219991 DOI: 10.3126/kumj.v12i1.13630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Gastric cancer is the second commonest cause of cancer related mortality worldwide. Though its incidence is more in Eastern Asia, it is increasing in the South Asian subcontinent. The diagnosis of early gastric cancer (EGC) confined to the mucosa or submucosa, is an important concern due to a better outcome at this stage where five year survival rates could increase by 90 percent. Though mass screening is done in few countries, it has not been applied in developing countries like Nepal. Preoperative diagnosis of EGC is rare in Nepal. The aim of this study is to analyze the clinicopathological features of postoperative cases of gastric cancer managed in a tertiary care university hospital of Nepal. METHODS All patients with histological diagnosis of gastric cancer admitted in the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal during the three year period (September 2010 to August 2013) were analyzed retrospectively. RESULTS Ninety two patients with endoscopic diagnosis of gastric cancers were admitted during the past three years. The mean age was 60 years ranging from 28 years to 85 years with the male to female ratio of 2.8:1. Five patients were younger than 40 years and all were in advanced stage. Thirty five percent of the patients belonged to Janajatis (Hill) community though they comprise only 23% of the population and about 65% of them belonged to an area involving 25% of the country. Seventy six cases were operated. Out of 92 patients, 4 patients were diagnosed as early gastric cancer postoperatively. All patients with early gastric cancer were above 50 years with CT Scan abdomen revealing focal thickening without lymphadenopathy. CONCLUSION Over the years, the incidence of gastric cancer is increasing in Nepal. Though 92% are advance gastric cancers, few have been diagnosed and treated early. A screening program in a country like Nepal with diverse ethnicity and difficult terrain might be helpful if it targets high risk people in high risk areas.
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Affiliation(s)
- B Ghimire
- Department of Surgery, Institute of Medicine Tribhuvan University Teaching Hospital Kathmandu, Nepal
| | - Y P Singh
- Department of Surgery, Institute of Medicine Tribhuvan University Teaching Hospital Kathmandu, Nepal
| | - S Timalsina
- Department of Biochemistry, Institute of Medicine Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Ghimire B, Khan MI, Bibhusal T, Singh Y, Sayami P. Accuracy of triple test score in the diagnosis of palpable breast lump. JNMA J Nepal Med Assoc 2008; 47:189-192. [PMID: 19079392] [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: 05/27/2023] Open
Abstract
Breast lump is a very sensitive issue for the patient so a reliable, non invasive and prompt diagnosis helps to lessen the associated anxiety and leads to early definitive treatment. The aim of this study was to evaluate the accuracy of Triple Test Score (TTS) as a clinical tool for the diagnosis of a palpable breast lump. This diagnostic test study was carried out in the Department of Surgery of Tribhuvan University Teaching Hospital. Of the 117 patients admitted with breast diseases from the breast clinic over thirteen months, 87 had breast lump. Fifty patients underwent Triple Test Score ( physical examination, mammography and fine needle aspiration cytology) and were categorized into benign, suspicious and malignant. This was later correlated with the histopathological findings. Nineteen patients with breast lumps interpreted by TTS as benign correlated with the histopathological findings whereas of 31 malignant lumps, 30 turned out to be malignant and one benign. This gives TTS an over all accuracy of 98% with 100% sensitivity, 95.2% specificity and positive predictive value of 96.7%. Carcinoma was seen in 29 (58%) cases in the age group of 35 to 70 years. The mean age at diagnosis of benign and malignant disease was 41.8 and 45.1 years respectively. In conclusion, TTS is an accurate and least invasive diagnostic test based on which definitive treatment can be initiated.
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Affiliation(s)
- B Ghimire
- Department of Surgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
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