Browsing by Author "Dhungana, Ashesh"
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Publication Clinical Profile and Complications Experienced by Chronic Kidney Disease Patients undergoing Hemodialysis in a Tertiary Hospital of Nepal: An Observational Study(Nepal Medical Association, 2025) Sah, Bimala; Khan, Imran; Dhungana, AsheshAbstract Introduction: Chronic kidney disease is emerging public health problems globally. Hemodialysis is the commonest treatment modality but it causes some complications and fluctuation in parameters. This study aimed to assess the clinical profile and complications experienced by chronic kidney disease patients undergoing hemodialysis. Methods: This was an observational study conducted from December, 2023 to February, 2024 Patients aged 20 and above, receiving hemodialysis more than three months were included in the study. Descriptive analysis was done. Results: Among 110 CKD patients undergoing hemodialysis, 62 (56.36%) were 50 years of age or younger, with a mean 48.76±13.365. The study population included 66 (60%) male and mean age of the patients was 48.76±13.36. In this study group 90 (81.82%) had two session of dialysis per week. Mean Pre-HD systolic blood pressure was 150.64±23.95 mmHg and Post-HD was 147.64±24.38 mmHg. In this study the mean hemoglobin was 9.38±1.85 gm/dl, glucose was 110.85±46.62 mg/ dl, urea 91.81±37.73 mg/dl and creatinine 7.94±2.68 mg/dl. In the patient population undergoing dialysis oliguria was observed in 106 (96.36%), weakness 98 (89.09%) and insomnia was observed in 87 (79.09%). Conclusions: In this study, more than half of the patient were in the age group of less than or equal to 50 years. Common symptoms included reduced urine output, weakness, and insomnia. Hypertension was the most common underlying condition, often occurring with diabetes.Publication Lived Experiences of Chronic Kidney Disease Patients undergoing Haemodialysis in a Tertiary Hospital of Nepal(Nepal Health Research Council, 2024) Sah, Bimala Kumari; Khan, Imran; Dhungana, Ashesh; Subedi, Madhusudan; Dhital, RolinaBackground: Chronic kidney disease (CKD) poses significant global health challenges, including in Nepal, where the increasing need for hemodialysis are influencing patient’s daily life. This study aimed to explore lived experiences of CKD patients undergoing hemodialysis. Methods: A qualitative, phenomenological research design was employed. In-depth interviews were conducted with 13 hemodialysis patients at Bir Hospital from December, 2023 to January, 2024. Analysis followed Colaizzi’s method, ensuring data quality through established credibility and transferability measures. Results: Four major themes emerged: (i) Journey to receive hemodialysis (ii) Financial Constraints (iii) Psychosocial support (iv) Seeking for special health services. Patients perceived hemodialysis as a hope for existence but faced financial troubles and inadequate special and psychosocial support. Conclusions: The lived experiences of the patients reflected both hope and challenges highlighting the need for improved health services and counseling in hemodialysis wards, along with enhanced governance in the healthcare system. Keywords: Chronic kidney disease; hemodialysis; lived experience; pilot; qualitative.Publication Role of Fractional Exhaled Nitric Oxide for Monitoring Bronchial Asthma(Nepal Health Research Council, 2024) Lamichhane, Buddhi Sagar; Dhungana, Ashesh; Shrestha, Prajowl; Thapa, Kamal Raj; Shrestha, Deepa KumariBackground: Monitoring during treatment of asthma is usually done by various clinical tools, spirometry, sputum eosinophils and fractional exhaled nitric oxide. Fractional exhaled nitric oxide is a simple and noninvasive tool and has a good agreement with asthma control test score. This study aims to correlate fractional exhaled nitric oxide with asthma control test score. Methods: This cross-sectional study was conducted at National Academy of Medical Sciences, Bir hospital, Chest unit, Department of Medicine, over a duration of six months. Patients aged more than 18 years with bronchial asthma diagnosed at least three months prior were included into the study. Those with recent severe exacerbations, known other chronic respiratory disease and smokers were excluded. Asthma control test score was obtained at baseline. All included patients underwent fractional exhaled nitric oxide measurement followed by measurement of Forced vital capacity(FVC) Forced expiratory volume in one second (FEV1) and FEV1/FVC ratio. Results: Forty patients with a mean age of 40.5±11.1 years were included in the study. Majority were females (65%) and the median duration of symptoms was 24 months (Interquartile range= 18-60). Mean fractional exhaled nitric oxide level was 27.8 (±16.0) parts per billion (ppb) and asthma control test score was 19.3 (±4.7). Mean fractional exhaled nitric oxide levels were significantly different across different severity (well controlled, partially controlled and poorly controlled) of asthma (p=0.013). The mean fractional exhaled nitric oxide values and total asthma control test score shows statistically significant negative correlation (Pearson correlation coefficient (r) = -0.462, p=0.003). Asthma control test and FeNO values guided the change of inhaled steroid dose in 17 of the 40 patients. Conclusion: Fractional exhaled nitric oxide can be used when available, along with asthma control test for monitoring control and adjusting the inhaled steroid dose in asthma. Keywords: Asthma control test (ACT); bronchial asthma; Fractional exhaled nitric oxide (FeNO).