Browsing by Author "Dhungana, SP"
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Publication Antithrombotic agents and Risk Profile of Patients with Atrial Fibrillation from Rural Part of Nepal(Institute of Medicine, 2015) Dhungana, SP; Sherpa, KAbstract Introduction: Atrial fibrillation (AF) is an atrial tachyarrhythmia characterized by uncoordinated activation of atria with subsequent impairment of atrial mechanical function. Anticoagulation with warfarin decreases the ischemic stroke risk associated with AF. Although the trends of anticoagulation use and risk profiles of AF is available from different countries, but, there is scarcity of data from Nepal. Hence, the study was carried out to determine the current practices of antithrombotic use in rural Nepal. Methods: A total of 240 patients from January 2012 to September 2014 with and without admitted but diagnosis of atrial fibrillation (AF) were enrolled from Lumbini Medical College, Palpa. Demographic information, clinical history, co-morbid conditions, use of anticoagulants and risk factors for stroke were obtained from questionnaire designated. Clinical examinations were performed along with electrocardiography and echocardiography from each patient. Results: A total of 240 patients, diagnosis with atrial fibrillation (AF) from outpatient or admitted, the mean ranged was 63.3 years (20 to 90). Male: female ratio was 0.84. Majority of patients (60%) were of age >60 years. Mean heart rate was 98 bpm. Among risk factors for AF, hypertension, rheumatic heart disease, systolic and diastolic heart failure, dilated cardiomyopathy, ischemic heart diseases were common underlying problems. Ninety percent of patients had dilated left atrium (>40mm). Among patients with non-valvular AF. 39.1% had CHADS2 score of ≥ 2 who were eligible for oralanticoagulants and 18.9 % patients received it. Out of 44 with rheumatic heart disease and AF, 10(22.7%) patients obtained oral anticoagulants, Conclusions: The findings highlight the need for improved treatments of underlying risk factors to prevent the onset of AF and adequate use of OACs to prevent stroke risk. Keywords: Atrial fibrillation, clinical characteristics, risk factorsPublication 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