Browsing by Author "Adhikari, RK"
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Publication Comparison of Pain Response to Venepuncture Versus Heel Lance Blood Sampling in Term Neonates(Nepal Paediatric Society (JNPS), 2012) Shrestha, M; Adhikari, RKAbstract: Introduction: Pain in neonates is largely underestimated and neglected. Pain experience can alter clinical outcome, brain development and subsequent behavior in newborns. Numerous newborns undergo blood sampling routinely in nurseries/NICUs and these procedures are often done without pain relieving measures. Heel lancing and venepuncture are two common procedures for blood sampling in neonates. The objective of this study was to compare pain response to venepuncture versus heel lance in full term neonates. Materials and Methods: A comparative observational study was conducted among 200 term neonates who were undergoing blood sampling for bilirubin or glucose estimation. Neonates were randomly assigned to heel lance (HL) and venepuncture (VP) groups with 100 babies in each group. During the procedure, pain was assessed by Neonatal/Infant pain Scale (NIPS). Heart rate (HR) and oxygen saturation (SpO2) were continuously monitored 5 minutes prior to procedure and upto 5 minutes after the procedure. Results: The median NIPS score in HL and VP were 7 and 3.5 respectively which showed statistically significant (p= 0.0001) higher level of pain experience in HL than in VP. During the procedure, both the groups (HL and VP) showed significant changes in heart rate and oxygen saturation i.e., increase in HR (p= 0.0001) and decrease in SpO2 (p= 0.0001), however the increase in heart rate and decrease in oxygen saturation were significantly more in HL than in VP (p= 0.0001). Conclusion: Neonates perceive pain as demonstrated by Neonatal Pain Scale and venepuncture is the less painful procedure than heel lancing for blood sampling in neonates.Publication Publication Evaluation of non-HDL-c and total cholesterol: HDL-c Ratio as Cumulative Marker of Cardiovascular Risk in Diabetes Mellitus(Kathmandu University, 2010) Aryal, M; Poudel, A; Satyal, B; Gyawali, P; Pokheral, BR; Raut, BK; Adhikari, RK; Koju, RABSTRACT Background Cardiovascular disease (CVD), is the primary cause of morbidity and mortality in patients with diabetes and have approximately - two to four times higher CVD rate than adult without diabetes. Low density lipoprotein cholesterol (LDL-C) is primarily used as the marker of cardiovascular risk in diabetes despite its several limitations. Although several newer markers of CVD are emerging, no marker has been established in Nepal. Objectives The study was designed to evaluate the non-high-density-lipoprotein- cholesterol(Non- HDL-C) and Total Cholesterol to High density lipoprotein cholesterol (TC:HDL-C ratio) as CVD risk marker in diabetes mellitus. Methods The study was conducted in the Department of Bbiochemistry, Kathmandu University School of Medical Sciences. The study comprised of 76 diabetic subjects and 60 non- diabetic subjects. The anthropometric and biochemical parameters were measured. The Non-HDL-C and TC:HDL-C ratio were also calculated employing their respective formula. Results Body mass index (BMI), waist circumference (WC), blood pressure and lipid parameters were significantly different between diabetic subjects and non-diabetic subjects. There was increased non-HDL-C and TC:HDL-C ratio in subjects with diabetes mellitus. Furthermore, statistically significant correlations of non-HDL-C and TC:HDL-C ratio were obtained with BMI, WC, total cholesterol, HDL-C and LDL-C in diabetic subjects. Conclusions The present study observation revealed that the Non-HDL-C and TC: HDL-C strongly correlate with established independent risk factors such as obesity(WC), elevated blood pressure, HDL-C and LDL-C in diabetes. Thus, the evaluation of Non-HDL-C and TC: HDL-C ratio can be used as the simple, cost-effective and cumulative marker of cardiovascular risk in diabetes mellitus. Key Words cardiovascular risk, diabetes mellitus, Hypertension, lipid profile, Obesity, Non-HDL- cholesterolPublication Publication Pattern of Organophosphorous Poisoning: A Retrospective Community Based Study(Kathmandu University, 2011) Chataut, J; Adhikari, RK; Sinha, NP; Marahatta, SBABSTRACT Background Pesticide poisoning is very common in Nepal. Hospital based studies from various parts of Nepal have shown that poisoning with organophosphorus compounds is the most common type of poisoning. Current study is undertaken to see the pattern of organophosphorus poisoning and to identify the common risk factors among the cases. If the risk factors are modifiable, attempts in addressing the risk factors and decreasing the likelihood of poisoning will certainly be fruitful in reducing the morbidity and mortality associated with organophosphorus poisoning. Objectives To assess the risk factors of organophosphorus poisoning which is major public health problem in Nepal. Methods A community based retrospective study of 75 cases of organophosphate poisoning who were brought to the emergency department of Dhulikhel hospital over the period of 3 years. Basic information was collected from hospital records and home visits were made to study the risk factors. Data were collected through interviews of the study population and their family members using a pre-designed questionnaire. Results In this study 75 cases and their families were interviewed of which there were 59% males and 42% females (M/F ratio of 1:1.4). The majority (40%) of the poisoning cases were in the age group 25-34 years. Lower literacy level showed positive association with the incidence of poisoning. Occupation wise vast majority (80%) of the cases were engaged in agricultural work. Suicidal attempts by ingesting organophosphate compounds were high in farmers and females. Conclusion In this study, majority of the poisoning were attempts of intentional self harm. Agriculture workers and females are high risk groups and may be associated with the fact that they have easy access to the poison. Interventions directed towards health education, counseling, and enforcement of laws restricting the availability and use of harmful pesticides may help in reducing such events in future. KEY WORDS Organophosphorus, Pesticides.Publication Prevalence and Risk Factors for Hypertension in Adults Living in Central Development Region of Nepal(Kathmandu University, 2011) Chataut, J; Adhikari, RK; Sinha, NPABSTRACT Background Hypertension is the commonest cardiovascular disorder and now regarded as major public health problem. It is a precursor to major diseases like myocardial infarction, stroke, renal failure etc. There are very limited community based data on hypertension in Nepal, so, information on the prevalence of hypertension in the population is desirable. Objectives To estimate the prevalence of hypertension and to explore the risk factors associated with hypertension. Methods In a cross sectional study , a total of 527 subjects (males n=214 and females n=313) participated in our study (age ≥18 years). The participants underwent anthropometric measurement and blood pressure and answered a pretested questionnaire. Hypertension was defined as per JNC VII criteria. Results Overall prevalence of hypertension was 22.4% (males: 32.7% and female: 15.3%). Age specific prevalence of hypertension showed significant progressive increase in blood pressure ranging from 8% to 35%. Almost 40% of hypertensives did not know about their status. Bivariate analysis showed significant relationship of hypertension with gender, age, literacy, physical inactivity, body mass index (BMI), smoking and alcohol consumption. Multivariate analysis excluded literacy but all other risk factors continued to show positive association with hypertension. Conclusion Being elderly, less physical activity, obese/overweight, smoking and alcohol consumption are significant risk factors of hypertension. Therefore, intervention measures are warranted emphasizing on modifiable risk factors such as smoking, alcohol consumption, physical activity and obesity to prevent hypertension. KEY WORDS cross-sectional study, hypertension, JNC VII criteria, prevalence, risk factorsPublication Prospective evaluation of contracted sockets(Kathmandu University, 2007) Adhikari, RK; Khazai, H; Usha, KDAims: To establish a correct method of evaluation and management of contracted sockets Results: Anopthalmic socket were frequently seen in orbit and Oculoplasty clinic of Aravind Eye Hospital, Madurai, South India. Prospective evaluation of Anophthalmic Sockets was done in this study. Anophthalmic Socket which can not support prosthetic eye is called contracted socket.4,5,14 . These sockets were graded as congenital and acquired, which were managed using single, combined and multiple procedures. Surgical outcome of each case were analyzed. Key words: Anophthalmos, contracted sockets, prosthesis, conformer, volume deficit,Publication Quality of life of people living with lymphoedema: A cross sectional community based study in selected districts of Nepal(Institute of Medicine, 2014) Adhikari, RK; Sherchand, JB; Mishra, SR; Ranabhat, K; Wagle, RRAbstract Introduction: Lymphatic Filariasis (LF) is the second most common cause of physical disability worldwide with 40 million people chronically disabled by the disease and about twice that number suffering from covert lymphatic changes or kidney diseases. The most common chronic manifestations of the disease are lymphoedema and hydrocele. The objective of this study is to evaluate the quality of life (QOL) of lymphoedema patients in Nepal. Methods: We sought the help of female community health volunteers, health workers working in peripheral health centers in selected sentinel surveillance sites in listing out the names of patients with lymphoedema. The researcher obtained details of 205 cases of lymphoedema (49 cases of Elephantiasis and 156 cases of hydrocele) in three districts (Dhading 74, Kapilbastu 78, Kailali 53). A total of 205 healthy individuals were selected from the same locality (Dhading 68, Kapilbastu 66, Kailali 71) for comparison. World Health Organization Quality of Life questionnaire brief version (WHO QOL-BREF) was used for data collection. Results: The mean age of the respondents was 45.95 years with a standard deviation of 17.96 years. In four domains, the physical domain scored highest (14.28±2.52) and the environmental domain scored lowest (12.19±1.69). Patients with lymphoedema had significantly low QOL scores in physical (p<0.001), psychological (p<0.001), social relationship (p<0.001), and environmental (p<0.001) compared to their healthy counterparts. Similarly, the overall QOL score was lower in patients with lymphoedema than in healthy control, and it was statistically significant (p<0.001). Conclusion: This study reports significantly low QOL scores in all four domains in patient with lymphoedema denoting low quality of life compared to their healthy counterparts. It is recommended that the current Lymphatic Filariasis elimination program of Nepal should focus to initiate morbidity management program specifically to patients with lymphoedema and hydrocele. Keywords: Lymphoedema, filariasis, quality of life, cross sectional studies, NepalPublication Research during COVID-19 Pandemic: Perspectives from the Ethics Committees of a Lower Middle Income Country(Kathmandu University, 2020) Ghimire, N; Panthee, A; Sharma, MR; Adhikari, RK; Gyanwali, PABSTRACT The pandemic of Coronavirus Disease 2019 (COVID-19) has created paradoxically a good opportunity globally to conduct research in the field of health and social science, and a Lower Middle-Income Country (LMIC) like Nepal is not an exception in this regard. During this ongoing pandemic, the Ethical Review Board (ERB) of Nepal Health Research Council (NHRC) has received numerous research proposals regarding COVID-19. As its main responsibility is to ensure participants’ safety, at the same time maintaining the scientific standard of research, the ERB has meticulously gone through all the proposals received so far. During this situation of a health emergency, the ERB of NHRC has had a different experience compared to the usual time. Its strength, weakness, opportunities, and threats have been like never before. KEY WORDS Coronavirus disease 2019, Ethical review board, Ethics, Research