Browsing by Author "Jha, RK"
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Publication Comparative Analyses of Clinical, Laboratory, and Radiological Findings between COVID-19 Deceased and Recovered Patients(Kathmandu University, 2023) Shrestha, MR; Basnet, A; Joshi, P; Bhat, DS; Maharjan, R; Thapa, R; Joshi, RD; Maharjan, R; Jha, RKABSTRACT Background Understanding the coronavirus disease 2019 (COVID-19)-specific indices has become important with increasing cases of COVID-related in-hospital mortality. Objective This case-control study compared clinical, laboratory, and radiological findings between deceased and recovered COVID-19 patients and identified the significant biomarkers associated with deceased patients. Method An analysis of clinical, laboratory, and radiological findings of COVID-19 patients admitted to the COVID-dedicated wards of Nepal Armed Police Force Hospital between March and December 2021 was performed using SPSS version 17.0, with statistical significance considered at p < 0.05. Result A total of 187 COVID-19 patients, comprising deceased [n=95, median (interquartile range, IQR) age: 66 (53–76) years, male: 61 (64.2%) (p=0.024)] and recovered [n=92, median (IQR) age: 51 (38–61) years, male: 44 (47.8%)], were included in the study. Compared to recovered COVID-19 patients, deceased patients had increased median respiratory (20 versus 29.5 breaths/minute) and pulse (83 vs. 86 beats/minute) rates; multiple co-morbidities (≥ 2) (11.9% vs. 32.6%) (p < 0.001); significantly (p < 0.05) lowered alkaline phosphatase (ALP), total protein (TP), albumin, lymphocytes, monocytes, eosinophil, hemoglobin and significantly (p < 0.05) elevated glucose, lactate dehydrogenase (LDH), alanine transaminase (ALT), aspartate aminotransferase (AST), leucocytes, neutrophils, D-dimer and C-reactive protein (CRP); and chest abnormalities including bilateral (p < 0.001), peripheral (p < 0.001) interstitial (p < 0.001) and ground glass opacity (GGO) (p=0.002). Conclusion Elderly, male sex, increased respiratory and pulse rate, presence of multiple co- morbidities, lowered levels of ALP, TP, albumin, lymphocytes, monocytes, eosinophils, hemoglobin, elevated levels of glucose, LDH, ALT, AST, leucocytes, neutrophils, D-dimer, CRP, and chest X-rays showing bilateral, peripheral interstitial and GGO abnormalities were the significant indices associated with deceased COVID-19 patients. KEY WORDS Biomarkers, Comorbidity, COVID-19, Laboratory, Radiology, Signs symptoms, VitalsPublication Effects of Cold Stimulation Induced Pain on Cardiopulmonary Parameters: A Gender Based Study(Kathmandu University, 2020) Jha, RK; Amatya, SABSTRACT Background Cold pressor induced pain elicits sympathetic responses which can be monitored by measuring blood pressure, heart rate and respiratory rate after exposure to the cold stress. Objective This study was done to evaluate gender difference in acute pain induced by cold pressor test on blood pressure, heart rate and respiratory rate of healthy individuals. Method Our study was cross sectional study with the sample size of 40 including 20 male and 20 female undergraduates. Acute pain was induced by immersion of hand in cold water at 4oC. Changes in blood pressure, heart rate and respiratory rate were recorded by the digital sphygmomanometer and AD Instruments (Model: ML856, Serial: T26-4025) and analysis was done by Lab Chart 7 Pro v 7.3.3 respectively. Acute pain parameter like pain threshold was also recorded. Statistical analysis was done by using Paired “t” test and non-parametric test. Result The present study enrolled 40 participants, aged between 18 – 24 years, and body mass index from 15.78 – 36.06 kg/m2. The respiratory rate was increased in both males (17.30±3.19 to 19.0±3.21, P=0.01) and females (18.60±1.98 to 19.90±2.82, P= 0.01) however significant increase in heart rate was only found in females (77.80±8.07 to 80.70±7.80, P=0.03) after cold pressor test. The systolic as well as diastolic blood pressure did not increase significantly after cold pressor test. The pain thresholds ranged from 25.2 to 105.8 seconds (61.60±23.26, male Vs. 52.69±18.49, female, p = 0.188). Conclusion Our findings point towards autonomic adjustments suggesting more of sympathetic over activity immediately after cold pressor test. KEY WORDS Blood pressure, Cold pressor test, Heart rate, Respiratory ratePublication Galvanic Skin Response as a Simple Physiology Lab Teaching Tool- An Alternative Indicator of Sympathetic Arousal(Kathmandu University, 2018) Nepal, O; Jha, RK; Bhattarai, A; Khadka, P; Kapoor, BKABSTRACT Background Sympathetic arousal response due to rewarding emotion may not be considered threat to the well-being but such arousal response evoked by fear or punishment can be stressful. When such changes are recorded in lab as biological signals, induced with appropriate stimulus, the observed response may serve as a good indicator of homeostatic alteration. In this study, skin conductance was utilized to record sympathetic response for cognitive load, by application of simple subtraction task. Objective To detect sympathetic arousal by utilization of galvanic skin response during mental arithmetic task. Method Total of eighty two subjects, forty two female and forty male participated in the study. Twenty two subjects were provided mental task to record skin conductance. In sixty subjects, galvanic skin response, pulse rate, respiratory rate and temperature were recorded by appropriate transducers to obtain baseline and task response to detect differential recordings. Subjects performed the mental exercise of arithmetic task (MAT) with transducer placed in upper limbs. Mean of averages for respective variables were statistically calculated from obtained recordings. Result For measured galvanic skin response, 57 subjects showed increased skin conductance (rise in amplitude) whereas, 25 subjects had no rise in amplitude (“A peak”) while performing the mental arithmetic task, when compared to control recording. However, in 20 subjects, pulse rate and respiratory rate showed significant rise though, the change in the skin conductance was not significant. Conclusion Galvanic skin response is useful for demonstration of sympathetic activation induced by simple mental subtraction task, and can be utilized along with vital parameters mentioned in this study to discuss in vivo variation that exist as differential for core and superficial sympathetic outflow among individuals. KEY WORDS Arousal, Conductance, Galvanic, Mental, SympatheticPublication Skin Conductance and RR Interval for Regulated Discrete Physiological Stimuli: A Two Prong Strategy to Detect Sympathetic Activation(Kathmandu University, 2019) Nepal, O; Manandhar, L; Jha, RKABSTRACT Background Several studies have found skin conductance a good indicator for detection of sympathetic response. But, valid and reliable tool for detection of sympathetic outflow in health and disease is still a quest. Thereby, comparison of superficial and, at core sympathetic effluence induced by deliberately supplied discrete external stimuli has been attempted in this study. Objective To assess the degree of sympathetic outflow for discrete cognitive and physical stimuli through perturbations in skin conductance and variations in heart rate in healthy adults. Method Quantitative and cross-sectional study was performed in 104 healthy subjects following random sampling method. Induction of sympathetic activity was realized by providing separate time bound cognitive exercises intervened with change in posture. Recordings to detect sympathetic responses at rest and, for supplied stimuli were made by electrocardiogram and galvanic skin response. Result Cognitive performance and postural change shifts baseline effluence and increases the sympathetic outflow significantly (p=0.000). There occurs no detectable rise in sympathetic effluence at the core (p=0.362) but, eventuate significantly appreciable sympathetic outflow to sweat glands in skin (p=0.000), when compared cognitive versus physical stimuli. Conclusion Sympathetic outflow induced by cognitive challenge and physical change in posture is readily assessable through sympathetic skin response yet core sympathetic effluence for latter stimuli is steady and unwavering. Differential effluence for sympathetic response called upon by discrete stimuli is operational for maintenance of steady state in healthy subjects. KEY WORDS Galvanic skin response, Psychogalvanic reflex, Sympathetic outflow