Browsing by Author "Bhandari, Subarna"
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Publication Clinical Outcome of Patients Admitted to Critical Care Unit in Karnali Province(Nepal Health Research Council, 2025) Paudel, Khechar Nath; Khanal, Mahesh Kumar; Bhandari, SubarnaAbstract: Background: Life-threatening illnesses are rising globally, disproportionately affecting patients from developing countries. The outcome of such illness depends on the critical care services provided to the patients. Constrained resources may impact the quality and outcome of critical care. This study aims to assess the outcomes of critically ill patients admitted to the Intensive Care Unit (ICU) of a hospital in remote Karnali Province of Nepal Methods: This retrospective observational study reviewed data of ICU patients admitted from July 2021 to July 2022 in Province Hospital, Karnali, Nepal. Analysis included data on socio-demographic information, clinical diagnosis, duration of stay in ICU, use of mechanical ventilator, and outcomes of patient admitted to the ICU. Results: A total of 745 patients were admitted within the specified time period. The most common diagnoses were chronic obstructive pulmonary disease (COPD), poisoning, and acute coronary syndrome(ACS). Non-communicable diseases accounted for 60% of admissions. Overall, 17% of patients received support via mechanical ventilation. 50% of patients admitted in the ICU were recovered. The ICU mortality rate was 22 %, whereas 23% left the ICU against the medical advice. Age (p<0.001), ventilator use (p<0.001), and source of admission(p<0.001) were significantly associated with death in the ICU. Though the mortality rate varied significantly across diagnoses, septic shock and COPD attributed to the highest mortality. Conclusions: Non-communicable diseases were the most common cause of admission to the ICU of the hospital. Half of the ICU patients had poor outcomes, with one out of four succumbing to death. Factors like suboptimal speciality services and equipments, poor infrastructure development, and poor human resources might have contributed to poor outcomes in such settings. Keywords: Critical care; intensive care; mortality; prognosis; pulmonary disease chronic obstructive.Publication Prevalance of Elevated D-dimer Levels in Confirmed COVID-19 Cases in Intensive Care Unit of a Tertiary Care Centre of Western Nepal(Nepal Medical Association, 2021) Khatri, Prabin; Agrawal, Krishna Kumar; Chhetri, Pradip; Sharma, Dipesh; Neupane, Aryan; Piryani, Rano Mal; Baral, Pawan Puspa; Sapkota, Suman Raj; Banjade, Ashish; Chhetri, Ashmita; Bhandari, Subarna; Bharali, SwarajAbstract: Introduction: D-dimer is currently the best available marker for COVID-19 associated hemostatic abnormalities. This study aims to find out the prevelance of elevated D-dimer levels in confirmed COVID-19 cases in intensive care unit of a tertiary care hospital of western Nepal. Methods: This descriptive cross-sectional study was conducted among 95 patients admitted to COVID Intensive Care Unit of a teriary care centre from August 2020 to January 2021 after taking ethical clearence from Institutional Review Committee in order to determine the D-dimer levels in confirmed COVID-19 cases. D-dimer value was measured at the admission and the highest D-dimer value was recorded during the course of hospital stay with the risk of mortality in confirmed COVID-19 cases. The normal range of D-dimer was taken as <0.35 mg/dl as per our hospital laboratory standards. Convenience sampling method was used. Data entry and descriptive analysis were done in Statistical Package for the Social Sciences version 25.0, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of total 95 cases of COVID-19 included in this study, 25 (89.3%) patients with age ≥65 years and 42 (62.69%) patients aged <65 years had elevated D-dimer on admission. Data showed that 29 (67.4%) patients having elevated D-dimer at admission had mortality. Conclusions: Elevated D-dimer levels was frequently seen in patients admitted in Intensive Care Unit with COVID-19. Our study suggested that measurement of D-dimer may guide in clinical decision making.