Browsing by Author "Joshi, D"
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Publication Effects of subvalvular apparatus preservation in mitral valve replacement among rheumatic patients: early and mid term follow up(Institute of Medicine, 2016) Timala, RB; Joshi, D; Aryal, M; Bhandari, K; Singh, Y; Sharma, J; Sharma, JAbstract Introduction: Annulo-papillary continuity exerts significant impact on postoperative left ventricular function after mitral valve replacement. Methods: This is a retrospective study of patients who had undergone mitral valve replacement at one of the three units of Shahid Gangalal National Heart Center. Patients were divided into three groups, group I: total resection of subvalvular apparatus, group II: posterior mitral leaflet preservation, group III: total preservation of subvalvular apparatus. Statistical analysis was done to see the differences between three groups in regards to left ventricular dimensions in diastole, systole and ejection fraction. Results: Total of 93 patients underwent mitral valve replacement from April 14, 2011 to April 13,2012. Among group I patients, left ventricular diastolic (LVIDd) dimension decreased significantly at 3 months follow-up: group II patients left ventricular systolic dimension (LVIDs) decreased significantly at 3 months, group III patients, both LVIDd and LVIDs decreased significantly at 3 months. At the end of 3 years, the graph showed patient with group I had increasing tendency for LVIDd, whereas patients with group III had decreasing tendency for LVIDd. Similarly patients in group I showed increasing trend for LVIDs, whereas it got stabilized after 2nd year among patients in group III. The ejection fraction was most improved among the patients with group III compared to group I or II. Conclusion: Total subvalvular apparatus preservation during mitral valve replacement did have positive impact on left ventricular dimensions as well as function in early and midterm follow-up Keywords: mitral valve replacement, subvalvular apparatus preservation, left ventricular diastolic dimension,, left ventricular systolic dimension, ejection fractionPublication Empirical use of antibiotics in Emergency Department of Tribhuvan University Teaching Hospital and Treatment Success Rate in Discharged Patients(Institute of Medicine, 2014) Joshi, D; Bhandari, S; Upreti, AR; Banjara, MR; Regmi, BM; Prasad, PNAbstract Introduction: Infectious diseases are the common presentation in emergency department, which require treatment within minutes. As a result, the empirical antibiotics are started prompt in emergency department before the bacteriological results are available. Therefore, the aim of this study was to explore the use of antibiotics at emergency room and to determine the success rate in discharged patients. Methods: A descriptive, exploratory, non-interventional study was conducted during 8 weeks among the discharged patients from emergency department who received the antibiotic therapy and culture/ sensitivity test was asked. Patients were followed from emergency room and adequate information was taken from emergency records and also at the time of outpatient department visit. Results: Out of 297 patients, only 179 patients were studied. We found that 75.1% of empirically prescribed antibiotics were oral. The most commonly administered intravenous and oral antibiotics were ceftriaxone (20.4%) and cefixime (17.0%). The most common isolate leading to emergency department visit was Escherichia coli (29 patients, 16.2%). In vitro sensitive test for gram positive and gram negative isolates, amoxicillin-clavulanate combination and ciprofloxacin were most effective and cefixime was the least effective antibiotic. The treatment success rate was found to be 147(82.1%) of the patients, as the medication prescribed at emergency room was continued by outpatient department physician. Conclusion: Quinolones and cephalosporins groups of antibiotics are rising as the determinant antibiotics at emergency room. The rate of appropriate use of antibiotics and treatment success rate were found to be higher. Keywords: antibiotics, emergency department, emperical theory