Browsing by Author "Chhetri, Surendra Bahadur"
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Publication Clinical and Laboratory Characteristics of Patients with Mono and Coinfection of Dengue and Scrub typhus(Nepal Health Research Council, 2023) Banstola, Hemanta; Shrestha, Tirtha Man; Bhattarai, Dipesh; Ghimire, Manoj; Chhetri, Surendra BahadurAbstract Background: Dengue is a neglected tropical disease, and Scrub typhus is an emerging tropical illness in Nepal. Coinfection between them is found in literature and clinical practice. The objective of this study is to describe and compare the demographic, clinical, and laboratory characteristics of patients with mono and coinfection of Dengue and Scrub typhus. Methods: This was a single-center hospital-based retrospective study, performed at Beni District Hospital, Nepal. The patient who was diagnosed with mono and coinfection of Dengue and Scrub typhus from 1st January 2020 to 16th September 2020 were included. Data regarding demographic characteristics, symptoms, signs, and laboratory parameters were collected and analyzed. Results: In 53 patients who fall under the inclusion criteria of our study, 12 patients had coinfection with dengue and Scrub typhus with headache being the most common symptom regardless of mono or coinfection followed by myalgia and arthralgia. Total platelet counts at the time of admission were lower in the coinfection group with increasing thrombocytopenia during the disease course in comparison to mono-infection. The maximum temperature recorded, elevation in hepatic enzymes, and duration of defervescence were more in the coinfection group in comparison to dengue and scrub mono-infection. Conclusions: Mono and coinfection of Dengue, Scrub typhus present with common clinical symptoms, laboratory findings. With limited resources for screening and diagnosis, clinical prediction based on symptoms alone or together with lab parameters is difficult which is further difficult in the presence of Co-infection. Keywords: Clinical; coinfection; dengue; laboratory parameter; scrub typhusPublication Clinical Correlation between Symptoms and Risk Factors with Cardiac Arrhythmias on 24-Hour Holter Monitoring(Institute of Medicine, Tribhuvan University, 2025) Shrestha, Hemant; Chhetri, Surendra Bahadur; Bashyal, Bibhav; Bastakoti, Sudip; Gajurel, Ratna ManiAbstract: Introduction Ambulatory ECG Holter monitoring is necessary for the diagnosis of intermittent arrhythmias. The study aimed to study the clinical profile of symptomatic patients and association between symptoms and risk factors with specific arrhythmia. Methods This was a prospective observational study conducted to study the clinical profile of symptomatic patients who presented with unexplained palpitation, dizziness, syncope, or unexplained neurological events and who underwent 24-hour Holter monitoring for suspected cardiac arrhythmias. Results Overall, 265 patients were enrolled, of which 127 (47.9%) were male and 138 (52.1%) were female. The mean age of the study population was 55.5 ± 16.7. The most common indication was palpitation (58.5%), followed by dizziness (20%), unexplained neurological events (10.2%), and syncope (9.1%). The most common finding was Ventrical premature contractions (VPCs) seen in 195 (73.6%), followed by Atrial premature contractions (APCs) in 176 (66.4%), Supravenricular tachycardias (SVTs) in 33 (12.5%), and ventricular arrhythmias in 7 (2.6%). Sinus bradycardia was seen in 6 (2.3%), while sinus pause was seen in 10 (3.8%) patients. SVTs significatntly presented with palpitation (p-0.008) while sinus pause and sinus bradycardia presented with syncope (p-<0.001). Sinus pause was exclusively associated with syncope in all 10 patients (100 %). Conclusion Increasing age, smoking, hypertension, and pre-existing cardiac disease were significantly associated with abnormal Holter reports. Syncope was the only symptom that was associated with a higher prevalence of clinically significant arrhythmias. Only supraventricular tachycardias, sinus bradycardia, and sinus pause were associated with specific symptoms.