Browsing by Author "Dhungana, SP"
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Publication Thyroid Hormone Abnormalities and Associated Risk Factors among Acute Coronary Syndrome Patients at a Tertiary Care Hospital(Kathmandu University, 2023) Shreewastav, RK; Dhungana, SP; Pokhrel, S; Jayshwal, R; Pandey, HABSTRACT Background Thyroid dysfunction and associated factors like age, sex, diabetes mellitus, hypertension, smoking, family history of coronary artery disease and dyslipidemia contributes the risk for acute coronary syndrome. Objective To find out the prevalence of thyroid dysfunction and associated risk factors among acute coronary syndrome patients at this tertiary care hospital in eastern Nepal. Method A descriptive cross-sectional study was carried out prospectively among acute coronary syndrome patients at a tertiary care Hospital. Diagnosis of acute coronary syndrome was made based on the medical history, Electrocardiogram abnormalities, and cardiac markers. Thyroid function test and estimation of other blood parameters were done in the blood of the patients. Other relevant information and medical history of the patients were collected by using proforma. Result Out of 186 total acute coronary syndrome patients, 127 (68.28%) were male and mean age of all patients was 60.0 ± 13.7 years. Thyroid dysfunction was observed in 52 (27.95%) patients, out of that subclinical hypothyroidism was mostly seen in 30 (16.12%) patients followed by hypothyroidism in 13 (6.98%). The number of patients with hyperthyroidism and subclinical hyperthyroidism was 6 (3.23%) and 3 (1.62%) respectively. Associated factors like hypertension, diabetes mellitus, smoking, family history of coronary artery disease and dyslipidemia was observed in 80 (43.01%), 42 (22.58%), 83 (44.62%), 11 (5.91%) and 79 (42.47%) patients. Conclusion Acute coronary syndrome was predominantly seen in male and subclinical hypothyroidism was a major thyroid dysfunction observed among the patients. Hypertension, dyslipidemia, diabetes mellitus and smoking was found to be associated in a proportion of patients with acute coronary syndrome. KEY WORDS Acute coronary syndrome, Diabetes mellitus, Hypertension, Risk factors, Thyroid function testPublication Time in Therapeutic Range and Adverse Outcomes among Patients Receiving Warfarin Therapy at Tertiary Care Hospital(Kathmandu University, 2023) Ghimire, R; Dhungana, SPABSTRACT Background Warfarin has a narrow therapeutic index and needs regular international normalized ratio monitoring and dose adjustment. Poor quality of warfarin dosing can lead to an increased risk of adverse events. Objective To find out the overall quality of the international normalized ratio expressed in terms of time in therapeutic range and adverse outcomes associated with the use of warfarin. Method A descriptive cross-sectional study among 150 patients attending a tertiary care center receiving warfarin therapy from December 2022 to June 2023. Patients receiving warfarin at least for 6 months and with at least three international normalized ratio values were enrolled. Indications, average daily dosing, international normalized ratio, and adverse effects were recorded using convenient sampling. Data were analyzed by using SPSS, version 20. Result The mean age was 46.41±13.96 years. Indications for warfarin were valvular and nonvalvular atrial fibrillation in 104 (69.33%), deep vein thrombosis 21 (14%), and pulmonary embolism 6 (4%). The majority of patients 100 (66.6%) received 5 to 10mg of warfarin per day. The mean duration of warfarin use was 18.11±21.93 months. The mean time in the therapeutic range (%) was 62.43±27.52. Sixty patients (40%) had time in the therapeutic range below 60%. Among the adverse effects, minor bleeding was present in 25 (16.66%). The ischemic event was present in 7 (4.7%). Conclusion Our patients had lower time in the therapeutic range than recommended in the guidelines. They had a longer time in the sub-therapeutic range. KEY WORDS Atrial fibrillation, International normalized ratio, Treatment outcome, Warfarin