Browsing by Author "Gautam, R"
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Publication Acoustic Analysis Before and After Voice Therapy for Laryngeal Pathology(Kathmandu University, 2015) Chhetri, SS; Gautam, RABSTRACT Background Voice problems caused by pathologies in vocal folds are well known. Some types of laryngeal pathologies have certain acoustic characteristics. Objective evaluation helps characterize the voice and voice problems providing supporting evidences, severity of disorders. It helps assess the response to the treatment and measures the outcomes. Objective The objective of the study is to determine the effectiveness of the voice therapy and quantify the results objectively by voice parameters. Method Study includes 61 patients who presented with different types of laryngeal pathologies. Acoustic analyses and voice assessment was done with Dr. Speech ver 4 (Tiger DRS Inc.). Acoustic parameters including fundamental frequency, jitters, shimmers, Harmonic to noise ratio (HNR), Normalized noise energy (NNE) were analyzed before and after voice therapy. Result Bilateral vocal nodules were the most common pathologies comprising 44.26%. All acoustic parameters showed a significant difference after the therapy (p<0.05) except for NNE. Dysphonia due to vocal fold polyp showed no improvement even after voice therapy (p>0.05). Conclusion Acoustic analysis provides an objective, recordable data regarding the voice parameters and its pathologies. Though, few pathology require alternative therapy rather than voice therapy, overall it has a good effect on glottic closure. As the voice therapy can improve the different indices of voice, it can be viewed as imperative part of treatment and to monitor progression. KEY WORDS Acoustic analysis, objective evaluation, voice assessment, voice therapyPublication Assessment of Functional Status and Comorbidities among Elderly Admitted in Sub-Regional Hospital, Parsa(Institute of Medicine, 2017) Shrestha, KD; Gautam, RAbstract Introduction: Functional decline may be the first sign of changing health status and the prevalence of co morbidity is high among elderly affecting their functional ability and increases need of hospitalizations. The functional assessment is one of the trademarks of the geriatric assessment that measures the outcome of the treatment, determinant of end of life medical costs and helps to plan for further care needed for elderly. Numerous studies have shown an association between aging and higher risks of functional dependence as well as a high prevalence of functional disability in the older adult population. Hence, this study is to assess the functional status and comorbidities among elderly patient. Method: A descriptive cross- sectional study was done among elderly patient admitted in different wards of the Narayani Sub-regional Hospital, Parsa. Data was collected through census method from 121 respondents by using interview schedule through interview method. Katz Index of Independence in Activities of Daily Living was used to assess the functional status of elderly. Descriptive and inferential statistics (chi square & odds ratio) were used for analysis. Results: The study reveals more than half of the respondents (62.8%) were dependent in basic activities of daily living (BADLs). Among them, 57.9% were severely dependent followed by 42.1% moderately dependent in BADLs. Respondents were dependent in bathing (68.6%), toileting (59.5%) and transferring (43.8%). Regarding comorbidities with physical problems, each respondent has average six comorbidities with minimum two comorbidities (Mean 1.71). Among them, 8.1% respondents had chronic cough, hypertension (21.5%), diabetes (8.3%), vision problem (34.7%) and 29.8% had hearing impairment. The study also reveals that hypertension, age and BMI significantly affect the functional status of the elderly. Conclusion: More than half of the respondents were dependent in BADLs especially in bathing, toileting and transferring. Each respondent had average two comorbidities. Hypertension, age and BMI significantly affect the functional status of the elderly. Therefore, functional status and comorbidities of the elderly must be assessed in regular basis to improve the quality of life. Key words: Functional status, Comorbidities, Katz index of independence in ADLPublication Comparison of Axillary Temperature with Oral Temperature and Determination of Optimum Placement Time of Thermometer in Adults of Teaching Hospital, Nepal(Institute of Medicine, 2015) Sharma, M; Gautam, R; Neupane, BAbstract Introduction: Accurate temperature measurement is important to person, in whom suspicion of infection could result in investigations, administration of antibiotics, and even hospital admission. This study was done with the aim to determine the optimal dwell time of the thermometer in oral and axillary sites required to accurately reflect the stabilized core body temperature. Method: Cross-sectional survey of 113 adult patients was done who were admitted in Manmohan Cardio- Thoracic Vascular and Transplant Center (MCTVC) in the period between 16thJuly to August2013. Ethical approval from the Institutional Review Board (IRB) of TUIOM and permission from the respective hospital authority was taken before data collection. Conventional glass mercury thermometer were checked and brought to 95 degree of Fahrenheit before each measurement of the temperature. Two thermometers were simultaneously placed in oral cavity and in the axillary skin sites. Reading of the oral temperature was done in 1 and 3 minutes, similarly, reading of axillary temperature was done in 3 and 5 minutes. Data was analyzed in SPSS 18 by using parametric and nonparametric tests. Results: Findings revealed the mean temperature difference between 1 minute oral to 3 minute axilla was 0.92 ± 0.79 SD, and the 3 minute oral to 5 minute axilla was 0.96 ± 0.82 SD, the difference was significant (P<0.05). Further, the mean oral temperature in 1 minute was 97.75 ± 1.27 SD, and in 3 minutes was 98.69 ± 1.37 SD. Similarly, mean temperature of axilla in 3 minutes was 97.67± 1.40 SD, whereas mean in 5 minutes was 98.43 ± 1.46 SD. The mean difference was significant. Conclusion: The effective time to measure oral temperature was three minute and it was five minutes for axillary measurement. Keywords: temperature, degree of fahrenheit, oral and axillary measurementsPublication Sero prevalence of Scrub Typhus among Suspected Cases in Selected Area of Nepal(Institute of Medicine, 2018) Gautam, R; Parajuli, K; Sherchand, JBAbstract Introduction: Scrub typhus is an mite-borne acute, febrile, infectious illness that is caused by Orientia tsutsugamushi The causative organism, Orientia tsutsugamushi, is transmitted to the human beings by the bite of larval stage (chiggers) of the trombiculid mites, Leptotrombidium delience. This disease is most common in rural areas of low income countries. It is difficult to differentiate clinically from other tropical infections such as malaria, dengue, enteric fever and leptospirosis. Hence the study aim was to determine the seroprevalence of scrub typhus among the acute febrile illness patients attending in different hospitals of Chitwan district. Methods: The study was based on patients with suspected scrub typhus cases in Chitwan district from March 2017 to August 2017. Blood samples were collected from the suspected patients of scrub typhus, having acute febrile illness. IgM antibody to Orientia tsusugamushi was detected by using Scrub Typhus Detect™ Kit, In Bios International, USA. Results: A total of 451 samples, 112 (24.80%) were positive for IgM Antibodies. Multivariate analysis demonstrated that the following factors were significantly associated with the scrub typhus. 1. Females (odd ratio [OR] =2.088, P=<0.004, confidence interval [CI] =1.268-3.438) 2. House near grassland (odd ratio [OR] =10.380, P=<0.001, confidence interval [CI] =3.615-29.802), 3. Piling weeds in house (odd ratio [OR] =0.498, P=0.011, confidence interval [CI] =0.290-0.855), 4. Presence of mouse inside the house (odd ratio [OR] =2.157, P=0.003, confidence interval [CI] =1.290-3.608), 5. Working in the field (odd ratio [OR] =10.295, P=0.002, confidence interval [CI] =2.309-45.905). All cases enrolled have presented fever (100%) followed by headache (56.2%), nausea (55.4%), shortness of breath (40.2%), abdominal pain (14.3%), jaundice (8.9%), hypertension (8.9%), COPD (8.0%), tachypnoea (4.5%), diabetes (4.5%), eschar (2.7%) and seizure (1.8%). Conclusion: In the study the proportion of Scrub typhus infection was 25% among acute febrile cases. Our finding also explored the burden of scrub typhus in relation to demographic trend, risk factors, clinical characteristics and findings of different laboratory parameters. Early diagnosis, appropriate treatment along with health education and vector control measures are best way to prevent and management of scrub typhus. Key words: Scrub typhus, ELISA, Orientia tsutsugamushi, Nepal