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Browsing NepMed Journals by Author "Aacharya, Ramesh P"
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Publication Mortality in Emergency Services in a University Teaching Hospital: A Retrospective Study(Institute of Medicine, 2019) Shrestha, Tirtha M; Aacharya, Ramesh P; Neupane, Ram P; Prajapati, BigyanABSTRACT Introduction Emergency services are the gateway between the community and hospital that provides 24-hour access for most needy patients in critical and emergency conditions. Mortality rate varies in emergency department across the world and even in different emergency units of the same hospital. This retrospective study was done in adult emergency services of a tertiary hospital to determine mortality rate and analyze causes of death. Methods A retrospective observational study of mortality cases to analyze mortality rate and causes of death of patients for a period of 6 months between October 2017 to March 2018 was carried out in the adult emergency services of Tribhuvan University Teaching Hospital, Kathmandu. Data required were collected from copies of death certificates. Results During the study period, a total of 128 patients died in emergency, accounting 0.5% of total patient. Male deaths (52.3%) were slightly higher compared to female deaths (47.7%). Age group 66-75 years had the highest (24.2%) of total mortalities in the emergency. The most common immediate cause of death was sepsis/septic shock (21.9%) followed by cardiopulmonary arrest, aspiration, respiratory failure, other causes of shock and poisoning. The commonest antecedent cause of death was attributed to respiratory causes. Similarly, the most common contributory cause of death was chronic obstructive pulmonary disease. Conclusion Older age group are prone to the mortality risk. Sepsis/septic shock was the most common immediate cause of death. Pneumonia was the most common antecedent causes of death. Chronic obstructive pulmonary disease was the commonest contributory cause. Keywords: Emergency Department, mortality, Nepal, sepsisPublication Public Health Ethics: Perspectives in Nepal(Central Department of Public Health, 2024) Aacharya, Ramesh PAbstract Public health ethics in Nepal involves navigating the balance between individual rights and the collective good, especially in settings with limited resources. Nepal’s distinct socio-economic conditions, cultural diversity, and unequal access to healthcare create significant ethical challenges. This review article delves into these ethical considerations, focusing on cultural sensitivity, equitable access, and the need to balance public health priorities with individual autonomy. Ethical dilemmas frequently arise when allocating scarce resources, particularly in preventive measures like vaccination campaigns, where the needs of the many may outweigh the rights of the few. Cultural beliefs and practices play a vital role in public health ethics in Nepal. Ethical dilemmas often surface when public health interventions, such as vaccination programs, conflict with deeply rooted cultural beliefs, sometimes fueled by rumors. Addressing these issues ethically requires a culturally sensitive approach that respects local traditions while advancing public health goals. The COVID-19 pandemic has amplified the ethical challenges within Nepal’s public health system. Measures like lockdowns, mandatory use of face masks, vaccination drives, and quarantine protocols raised important questions about individual freedoms versus the collective good. The ethical management of scarce resources, such as ICU beds and oxygen supplies, emerged as a critical issue, demanding transparent and equitable decision-making processes. Overall, public health ethics in Nepal is shaped by the imperative to balance individual rights with community welfare within a context of resource limitations and cultural diversity. Tackling these ethical challenges is essential for advancing public health and ensuring the well-being of the population. Keywords: Public Health, Autonomy, Collective good, Justice, EquityPublication Risk Factors for Gall Stone Diseases in Patients Presenting to General Practice Out Patient Department in a Tertiary Care Center in Nepal(Institute of Medicine, 2019) Neupane, Ram P; Shrestha, Tirtha M; Raut, Shankar; Aacharya, Ramesh PABSTRACT Introduction Gallstone disease (GSD) is a major public health problem that is associated with a number of risk factors. This study aims to analyze the risk factors of GSD in patients visiting General Practice Outpatient Department of Tribhuvan Universtiy Teaching Hospital. Methods A case-control study of 174 participants comprising 85 cases with GSD and 89 controls without GSD, as confirmed by ultrasonography of abdomen was conducted as hospital based in outpatient department of General practice, Tribhuvan University Teaching Hospital, Kathmandu from 1st February 2018 to 31st January, 2019. The participants were asked questions regarding putative risk factors for development of GSD and underwent physical and ultrasonographic examination. Risk factors included were age, sex, BMI, occupation, co-morbidities e.g. diabetes mellitus, hemolytic diseases, family history of GSD, smoking status, alcohol consumption, parity if applicable and dietary history. Data analysis was done by univariate method. Results The mean age of the case group was 47.82 years whereas mean age for the control was 46.51 years (p=0.355). 22% of cases were male and 78% were female where as in control group 29% were male (p=0.3030). Majority of the participants in both group were housewife by occupation and Hindu by religion.Mean BMI of the cases and control were 24.05 kg/m2 and 21.13kg/m2 respectively. BMI was found significant for the gall stone diseases ( p=<0.001). Similarly, Diabetes mellitus was found significant for GSD (p=0.001). 98% cases and 61% in control group were Non-vegetarians with significant p value of 0.021. Smoking (p=0.005), Non-vegetarian diet (p=0.021), family history of gall stone disease (p<0.001) and parity (p<0.001) were also found significant for the gall stone disease. Conclusion High BMI, non-vegetarian diet, family history of gall stone disease, diabetes mellitus, smoking and increased parity were associated with gall stone diseases. Keywords: Gall stone diseases, parity, risk factors, smoking, tertiary centet