Browsing by Author "Bhattacharya, A"
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Publication Breathing comfort associated with different modes of ventilation: A comparative study in non-intubated healthy Nepalese volunteers(Kathmandu University, 2007) Baral, PR; Bhattarai, B; Pande, R; Bhadani, U; Bhattacharya, A; Tripathi, MObjective: To compare subjective experience of comfort associated with various commonly used supportive modes of mechanical ventilation for weaning in the intensive care unit (ICU). Subjects and Methods: The study was carried out in general ICU of a community-based teaching hospital in 30 healthy adult Nepalese volunteers of either sex and 19-37 years of age. The subjects were randomly made to experience breathing via anatomical facemask through ventilator circuit with synchronized intermittent mandatory ventilation (SIMV), assisted spontaneous breathing (ASB), biphasic positive airway pressure (BiPAP), and continuous positive airway pressure (CPAP) modes of ventilation with parameters set at intermediate level of respiratory support. Subjective comfort of breathing was noted using a 10cm visual analogue scale (VAS) with no discomfort at one end and maximum imaginable discomfort at the other. Inspiratory and expiratory experience of discomfort was also noted using a four point ranking scale (0-no discomfort, 1-mild discomfort, 2-moderate discomfort and 3-severe discomfort). In addition, presence or absence of feeling of breathlessness and inflation was also noted. Results: BiPAP was the most comfortable mode of ventilation (p<0.01) on visual analogue scale. SIMV and CPAP modes were associated with higher discomfort than other modes during inspiratory and expiratory phases respectively. Breathlessness and inflation were least felt in BiPAP and SIMV modes respectively. Conclusion: Perception of breathing comfort can vary widely with various supportive modes of ventilation in the ICU. Hence, no single supportive mode should be used in all patients during weaning from mechanical ventilation. Key words: assisted spontaneous breathing; biphasic positive airway pressure; breathing comfort; continuous positive airway pressure; mechanical ventilation; supportive modes synchronized intermittent mandatory ventilation; weaningPublication Leptospirosis: An Emerging Infectious Disease in Nepal(Institute of Medicine, 2016) Bhattachan, B; Bhattacharya, A; Sherchan, JB; Dhoubhadel, BG; Sherchand, JBAbstract Introduction: The aim of this study was to determine prevalence of Leptospira spp in Japanese Encephalitis negative cases, as well as its demographic and geographical picture in Nepal. Methods: The Nepal government along with World Health Organization (WHO) country office Nepal had approved this surveillance project, which conducted from 2007 to 2008 throughout 47 districts in Nepal. JE was confirmed from Cerebrospinal fluid (CSF) samples using ELIZA Method whereas Leptospiraspp was identified by using Latex Agglutination Test kit method in Nepal Public Health Laboratory (NPHL), Kathmandu, Nepal. Results: Among 2690 Acute Encephalitis Surveillance, the lumber puncture (LP) was done in 2145 patients. Among those tested, JE positive was confirmed in 771 patients. LP was not done in 381 cases. Among 993 JE negative cases, positivity rate of Leptospira spp was reported 41.8% (416/993) . There was more male preponderance 63.5% (264/416) However, it was not statistically significant (p = 0.713) . In terms of age distribution, those above 15 years of age were 64.5% (268/416) while those below 15 years of age were 35.5% (148/416), (p = 0) In eco- region, the rate of infection was highest in Terai region at 53.2% (222/416) followed by Mountain region at 45.2% (188/416) and Himalayan at 1.4% (6/416), (p = 0.005) In terms of seasonal distribution, the rate of infection in autumn was at 44.2% (188/416) followed by summer at 40.1% (167/416), spring at 9.6% (40/416) and winter at 6.1% (25/416) (p = 0) Conclusions: Nepal government cannot neglect the increasing possibility of outbreaks of Leptospira spp in different parts of the country, so this study recommends for surveillance of this infection to prevent future outbreaks in Nepal Keywords: Leptospira, Leptospirosis, JE, Nepal