scholarly journals Complications of Percutaneous Nephrolithotomy and their Management

2016 ◽  
Vol 3 (2) ◽  
pp. 30
Author(s):  
Neeraj Thapa ◽  
Sachin Shris ◽  
Nabin Pokharel ◽  
Yeshwant Gajanan Tambay ◽  
Jayant R Kher ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Demographic Data ◽  
Descriptive Analysis ◽  
Hypovolemic Shock ◽  
College Teaching ◽  
Renal Stones ◽  
Bleeding Complications ◽  
Medical College ◽  
History Of ◽  
One Year

Introduction: Increasing global prevalence of nephrolithiasis has resulted in the development of new minimally invasive techniques and has also led to the resurgence of established methods such as percutaneous nephrolithotomy (PCNL). This procedure is now recommended as the first option for the treatment of single large or multiple renal stones and those in the inferior calyx. This study was done to assess the complications of PCNL and their management, in our centre.   Methods: Medical records of 144 patients who underwent PCNL at Lumbini Medical College Teaching Hospital, during the last one year were reviewed. The demographic data, size, tract number and location of the calculi, and intraoperative and postoperative complications were evaluated. The various parameters of the calculi were evaluated. Descriptive analysis with frequencies was done.   Results: Complications occurred in 13 (9.02%) patients. Post operative bleeding occurred in seven (4.8%) patients, out of which one patient developed pseudoaneurysms and the other developed arteriovenous fistula. One patient developed hypovolemic shock immediately after surgery. Frequent blockage of urine, excessive drainage of urine from the drain site, hemothorax and colonic perforation was seen in one  patient each. One patient had mortality due to post operative bleeding. Complications increased with the number and size of stones and number and site of the tracts.   Conclusion: Percutaneous nephrolithotomy has low complication rate in experienced hands and complications depend upon stone size, history of open stone surgery, tract number, and tract location.

scholarly journals Ultrasound Guided Percutaneous Nephrolithotomy in Mesh-Repaired Incisional Hernia

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Seyed Hassan Inanloo ◽  
Mohammad Reza Nikoobakht ◽  
Hamed Akhavizadegan ◽  
Mojgan Karbakhsh
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Percutaneous Nephrolithotomy ◽  
Demographic Data ◽  
Flank Region ◽  
Renal Stones ◽  
Prior History ◽  
Ultrasound Guided ◽  
History Of

Objectives. To describe our technique of percutaneous nephrolithotomy (PNL) in patients with mesh-repaired flank incisional hernia. Polypropylene mesh which is used for fascia strengthening in hernia repair elicits intense inflammatory reaction and the consequent fibrosis alters the characteristics of abdominal wall. Thus, prior history of flank hernia repair with mesh may result in percutaneous nephrolithotomy failure. Materials and Methods. Demographic data, renal stones characteristics, and any complication during surgery and follow-up of patients who were treated by PNL during 2011 to 2020 and had mesh in their flank region were collected. Results. Percutaneous nephrolithotomy was performed without any problem in 8 patients with guide of ultrasonography. Conclusion. Based on our experience, ultrasound-guided PNL is feasible and hypothetically superior to fluoroscopy in such circumstances.

scholarly journals Evaluation of Clinicosocial Factors Associated with Antepartum and Intrapartum Stillbirths at Kathmandu Medical College Teaching Hospital

2009 ◽  
Vol 1 (1) ◽  
pp. 14-18 ◽  
Author(s):  
RT Rayamajhi ◽  
N Shreshtha ◽  
C Karki ◽  
SM Padhye
Keyword(s):  
Risk Factors ◽  
Fetal Loss ◽  
College Teaching ◽  
Tertiary Hospital ◽  
Breech Delivery ◽  
Medical College ◽  
Fetal Movements ◽  
History Of ◽  
One Year ◽  
Cholestasis Of Pregnancy

ABSTRACT Objective To assess the prevalence and biosocial and obstetric risk factors for antepartum and intrapartum stillbirths at a tertiary hospital in Kathmandu, Nepal. Study Design A prospective hospital based study during a one year period from 1st November 2007 to 30th October 2008. Results:18 stillbirths occurred out of the 790 deliveries that took place during the study period giving an overall stillbirth rate of 22.7 per 1000 births of which 22.2% occurred in the intrapartum period. The majority(89.9%) of patients were in the low risk age group, viz. 20-35 years. 62% were overweight, 16% obese and 22% had normal BMI. More than half (56%) were either illiterate or had only primary education and 33.3% were moderate smokers. 66.6% were nullipara and there were no grand multipara in the series. 72% had regular prenatal visits but only 33% presented with a history of loss of fetal movements. 50% delivered preterm and 22.2% were post-term while 66.6% had low birth weights. Hypertensive disorders of pregnancy and IUGR were the leading causes of stillbirths, others being prolonged PROM, cholestasis of pregnancy and congenital anomalies. 11.1% were unexplained and there was one case each of gestational diabetes, antepartum hemorrhage and vaginal breech delivery. Conclusion Avoidable intrapartum stillbirths continue to be quite high where timely and appropriate intrapartum intervention must be taken to prevent fetal loss. The identified antenatal risk factors should serve as potential targets for antenatal intervention and due importance of maternal fetal movement scoring must be stressed in the at risk patient.

scholarly journals Depression and Anxiety among Patients with Type II Diabetes Mellitus in Chitwan Medical College Teaching Hospital, Nepal

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Kalpana Sharma ◽  
Govinda Dhungana ◽  
Shailendra Adhikari ◽  
Archana Bista Pandey ◽  
Muna Sharma
Keyword(s):  
Diabetes Mellitus ◽  
College Teaching ◽  
Educational Status ◽  
Current Treatment ◽  
Depression And Anxiety ◽  
Medical College ◽  
Prevalence Of Depression ◽  
Patients With Diabetes ◽  
History Of ◽  
Diabetes Patients

The prevalence of depression and anxiety disorders is common among people with diabetes mellitus. Coexistence of diabetes and depression/anxiety increases the risk of diabetes complications and reduces the overall quality of life. Hence, this study aimed to assess the depression and anxiety among patients with type 2 diabetes mellitus in Chitwan. Descriptive survey was carried out among 296 purposively selected clinically diagnosed type 2 diabetes patients admitted in the Chitwan Medical College Teaching Hospital from 15th June 2018 to 17th September 2019. Patients were interviewed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorders-7 (GAD-7). Data were analyzed using descriptive and inferential statistics. Of 296 diabetic patients, 48.6% were 60 years and above, 59.5% female and 61.5% literate; their common occupation was agriculture (38.2%) followed by household work (26.4%). Nearly two-thirds (62.8%) of diabetes patients had other chronic comorbid conditions. Depression and anxiety were observed among 57.8% and 49.7% of diabetes patients, respectively. While observing the severity, 27.4%, 19.6%, 8.4%, and 2.4% of patients had mild, moderate, moderately severe, and severe depression, respectively. Likewise, 24.7%, 20.3%, and 4.7% of patients had mild, moderate, and severe anxiety, respectively. Current living status, educational status, medicine adherence, satisfaction toward current treatment, and history of mental illness in the family were found to be significant factors associated with the anxiety of patients with diabetes. Further, educational status, smoking habit, satisfaction towards current treatment, and history of diabetes in family were the factors associated with depression. Prevalence of depression and anxiety is high among admitted patients with diabetes mellitus, and many factors are associated with it. Hence, regular screening services are essential along with diabetes management plan for timely identification and treatment of the vulnerable groups in the healthcare centers.

scholarly journals Study in the Quality of Clinical Documentation Practice in Chitwan Medical College Teaching Hospital, Nepal

2016 ◽  
Vol 12 (2) ◽  
pp. 11-16
Author(s):  
Upendra Pandit
Keyword(s):  
Teaching Hospital ◽  
Tertiary Care ◽  
College Teaching ◽  
Final Diagnosis ◽  
Pooled Analysis ◽  
Medical Documentation ◽  
Medical College ◽  
Patient Consent ◽  
One Year

Background: Primary documentation of a patient is crucial for making effective healthcare decision and improvements in the quality of care. The objective of this study was to assess the quality of current documentation practice in tertiary care hospitals. Materials and methods: This was an assessment of medical documentation practice of one year from the period of January 2010 to December 2010 in Chitwan Medical College, Teaching Hospital. Total 184 patients' discharge files were enrolled and reviewed. Documentation was reviewed in its quality such as completeness, Coherent, consistency and Legibility.Results: In overall pooled analysis, High omission rate was observed in final diagnosis, results (cure, improved, referral and death), hospital stay, and final case summary. Although, satisfactory performance was observed in complete set of forms (72.2%); Patient consent for treatment &release authorization forms (78.2%) and treatment chart (60.8%), the overall pooled performance in ten components showed50% performance gap. Study demonstrated that documentation and its legibility, coherent and consistency in all departments needs substantial improvements in the institution.JNGMC Vol. 12 No. 2 December 2014, Page: 11-16

scholarly journals Incidence of gastric cancer, its subtypes, and correlation with Helicobacter Pylori

2013 ◽  
Vol 3 (5) ◽  
pp. 403-407
Author(s):  
Shiva Raj KC ◽  
GL Amatya ◽  
A Lakhey ◽  
S Basnet ◽  
G Aryal
Keyword(s):  
Gastric Cancer ◽  
Helicobacter Pylori ◽  
Demographic Data ◽  
College Teaching ◽  
Study Data ◽  
Upper Gastrointestinal Endoscopy ◽  
Tubular Adenocarcinoma ◽  
Common Cause ◽  
Medical College ◽  
H Pylori

Background: Gastric cancer is the fourth most commonly diagnosed cancer and the second most common cause of cancer related death worldwide. It is the common cause of cancer related death in Nepal. Helicobacter Pylori has been classified as a definite carcinogen along with other factors. The aim of this study was to fi nd the incidence of gastric cancer among the patients undergoing upper gastroscopy, its various subtypes and association with Helicobacter Pylori. Materials and Methods: This is a retrospective and prospective study carried out at GRP Polyclinic and Kist Medical College Teaching Hospital. All the patients undergoing upper gastrointestinal endoscopy were included in this study. Data of all the gastric endoscopic biopsies done from June 2011 to January 2013 were collected and analyzed. All the biopsy specimens were processed routinely in histopathology laboratory. Specimens showing carcinoma were enrolled in this study and all the relevant demographic data were collected. Results: Out of 3395 biopsy cases; 49 cases (1.44%) were diagnosed as adenocarcinoma stomach. The overall mean age for carcinoma was 47.6 years with a mild male preponderance. Thirty cases (61.2%) were of intestinal type, (n=11; 22.4%) were of diffuse type and (n=8; 16.3%) were mixed type of adenocarcinoma. According to WHO classifi cation the most common subtype was tubular adenocarcinoma (n=35; 71.5%) followed by signet ring type (11 cases; 22.4%). Out of 49 cases of adenocarcinoma stomach 39 cases (79.5%) were Helicobacter Pylori positive. Conclusion: This study shows that gastric carcinoma is a male predominant neoplasm usually of old age but can occur at younger ages. It predominantly occurs in Helicobacter Pylori infected patients and H. Pylori eradication will help to decrease the incidence rate and mortality of stomach cancer. Journal of Pathology of Nepal (2013) Vol. 3, No.1, Issue 5, 403-407 DOI: http://dx.doi.org/10.3126/jpn.v3i5.7869

Tubeless Percutaneous Nephrolithotomy with Hemostatic Plug Using Surgiflo® versus Standard Percutaneous Nephrolithotomy using a Nephrostomy Tube: A Prospective Randomized Controlled Study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hisham Mohamed Fathey Elshawaf ◽  
Mohamed Ismail Shabayek ◽  
Mohamed Ahmed Saleh Ahmed
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Intraoperative Complications ◽  
Demographic Data ◽  
Renal Stones ◽  
Controlled Study ◽  
P Value ◽  
Nephrostomy Tube ◽  
Gelatin Matrix ◽  
Significant Difference ◽  
Tubeless Pcnl

Abstract Background Percutaneous Nephrolithotomy (PCNL) is the preferred technique for treating large renal stones (over 2cm in diameter). It involves keyhole surgery performed through a small skin incision overlying the kidney. Objectives Our study aimed at evaluating the safety and efficacy of local hemostatic sealant (surgiflo®) use in tubeless PCNL to enhance postoperative outcomes of PCNL. Patients and Methods We randomized our patients into two groups, Group A nephrostomy tube was used as standard PCNL, and at group B tubeless PCNL was done followed by injection of the local hemostatic flowable gelatin matrix (surgiflo®) under fluoroscopic guidance in the prone position Results There was no statistically significant difference between two groups regarding demographic data age, sex and BMI (P- value 0.280, 0.736 and 0.440 respectively), stone site and size (P- value 0.525 and 0.533 respectively), operative time (P- value 0.855), intraoperative complications as blood loss and pelvicalyceal perforation, (P- value 0.92 and P- value 0.83 respectively), postoperative complication as fever, haematuria and UTI (P- value 1.000, 0,113 and 1.000 respectivly), and Hb drop (P- value 0.735). Conclusion Tubeless PCNL with hemostatic sealant use is associated with less pain, no leakage from nephrostomy tract, less narcotic agent use, and a shorter hospital stay.

scholarly journals Percutaneous Nephrolithotomy: Challenges for a Novice Urologist

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Ashish Chaurasia
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stones ◽  
Bleeding Complications ◽  
Know How ◽  
Incomplete Removal

PCNL is the treatment of choice for large renal stones. It is a procedure of expertise. It may look simpler when done by an experienced urologist; however, for a beginner, learning each and every step is very important. He should be well-versed about the difficulties faced at every step and know how to tackle them. This article focuses mainly on the intricacies faced by a trainee during the procedure and how to troubleshoot them. Failure at any stage can lead to bleeding complications or incomplete removal of stones.

scholarly journals Comparison of KAtex, Bone Marrow Aspiration and DAT for the Diagnosis of Visceral Leishmaniasis

2019 ◽  
Vol 6 (1) ◽  
pp. 12-15
Author(s):  
Ishrat Sharmin ◽  
AKM Quamruzzaman ◽  
Rezina Parveen ◽  
M Abdulah Yusuf ◽  
Rashida Akter Khanam
Keyword(s):  
Bone Marrow ◽  
Visceral Leishmaniasis ◽  
Leishmania Donovani ◽  
Bone Marrow Aspiration ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Medical College ◽  
Kala Azar ◽  
History Of ◽  
One Year

Background: Newly developed KAtex test can be used as a non invasive tool for diagnosis of Kala-azar. Objectives: The aim of the present study was to compare KAtex, Bone marrow aspiration and DAT to diagnose VL. Methodology: This cross-sectional study was carried out in the Department of Microbiology at Dhaka Medical College, Dhaka, Bangladesh in collaboration with the Department of Parasitology, Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh for a period of one year. Clinically suspected Kala-azar (VL) cases of different age and sex attending IEDCR, Dhaka from different Kala-azar endemic areas of Bangladesh were selected for this study. Patients having fever for more than 2 weeks, with or without splenomegaly, having history of loss of body weight following onset of fever were clinically suspected as Kala-azar cases. Microscopy and culture was performed in bone marrow (BM). KAtex was performed with urine sample. Agglutination of sensitized latex indicated presence of Leishmania donovani antigen in urine and thereby visceral leishmaniasis. No agglutination indicates absence of antigen in urine. DAT was done with serums of all cases. Result: Among 130 clinically suspected VL cases, 70 (53.85%) cases were BM positive and 60(46.15%) cases were BM negative. All the 70 BM positive cases were positive by KAtex and DAT. Among 60 BM negative cases, 15 were positive by KAtex and 23 were positive by DAT. The sensitivity of KAtex was 100.0% and specificity was 75.0%. The sensitivity of DAT was 100.0% and specificity is 61.6%. Conclusion: In conclusion, KAtex test is a good diagnostic tool for the detection of VL in comparison with DAT. Bangladesh Journal of Infectious Diseases, June 2019;6(1):12-15

scholarly journals An Overview of Sexual Assault Cases in Nepal

2017 ◽  
Vol 9 (2) ◽  
pp. 43-46 ◽  
Author(s):  
Neelu Hirachan ◽  
D Limbu
Keyword(s):  
Sexual Assault ◽  
Expert Witness ◽  
Descriptive Analysis ◽  
College Teaching ◽  
Skills Training ◽  
Age Group ◽  
Institute Of Medicine ◽  
Medical College ◽  
Relationship Of ◽  
Genital Injuries

Background: Sexual assault is defined as any sexual act performed by one (or more) person(s) on another without consent. It may include the use of threat or force. In some cases, the person cannot give consent to sex because he/she is unconscious or otherwise incapacitated. A person may be raped by a stranger, an acquaintance or date or a family member.Methods: The study was a retrospective and descriptive analysis of cases of sexual assault victims examined by the author in the Forensic Medicine departments at Institute of Medicine, Maharajgunj and Gandaki Medical College Teaching Hospital, Pokhara, Nepal over a period of four years (2012 to 2016). This includes information regarding the age group of the victim at the time of sexual abuse, relationship of the victim to the perpetrator, genital and extra-genital injuries present over the victim’s body and number of cases attended as an expert witness by the author in various courts of Nepal.Results: In the four years period, a total number of 55 cases were examined as sexual assault cases. It was observed that majority were of the 13 - 15 years of age group (46%) followed by <10 years (20%), 16 - 20 years (16%), >20 years (11%) and 10 - 12 years (7%). Regarding the relationship of the victim to the alleged perpetrator, 87% cases (48 out of 55) were related to acquaintances compared to 13% due to strangers. Surprisingly, 3.6% cases (2 out of 48) were due to the biological fathers of the victims. On physical examination of the victim’s body, 36% cases showed genital injuries compared to only 15% with extra genital injuries. The author attended the court as an expert witness in 33% of these cases. Only 7% of the cases were mentally challenged.Conclusion: Young adults remain the most vulnerable group, so education related to sex, morality, humanity and different life skills training should be provided to these groups from their school years itself. The benefits of early intervention and comprehensive care of survivors with the use of standardized protocols along with shorter and lesser traumatic period of court processing to the survivors of these cases should be encouraged.Journal of Gandaki Medical College Volume, 09, Number 2, July December  2016, Page: 43-46

scholarly journals Astigmatic change after pterygium excision with autologous limbal conjunctival graft

2020 ◽  
Vol 9 (1) ◽  
pp. 25-30
Author(s):  
Dikchhya Sharma ◽  
Gunjan Prasai ◽  
Om Krishna Malla
Keyword(s):  
Age Groups ◽  
College Teaching ◽  
Corneal Astigmatism ◽  
P Value ◽  
Ocular Surgery ◽  
Medical College ◽  
Corneal Scarring ◽  
Significant Difference ◽  
History Of ◽  
Pterygium Excision

Background: Pterygium induces a significant amount of astigmatism. Pterygium excision with conjunctival limbal autograft results in significant reduction in astigmatism by inducing a reversal of pterygium induced corneal flattening thereby improving the vision. Objectives: The aim of this study was to investigate the amount of corneal astigmatism in patients with pterygium before and one month (4 weeks) after surgery.  Methodology: The prospective observational study was conducted in 31 patients who underwent pterygium excision with limbal autograft in Kathmandu Medical College Teaching Hospital during the study period of 12 months duration. Patients with recurrent pterygium, pseudopterygium, history of ocular trauma, history of ocular surgery, corneal scarring were excluded from the study. After surgery, patients were followed for four weeks. Findings were recorded in the proforma and statistical analysis was done in SPSS version 19.   Results: Pterygium was seen in all age groups with majority being in the active age range of 41-50 yrs. Females were most commonly affected. Significant difference in corneal astigmatism was noted postoperatively with a p value being 0.01. Conclusion: The technique of pterygium excision with limbal conjunctival autograft not only reduces the chances of recurrence but also helps in reducing the induced corneal astigmatism which is responsible for decreased vision in patients with pterygium.

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