Browsing by Author "Karki, P"
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Publication Association of cardiovascular events with glycosylated haemoglobin in diabetic patients(Kathmandu University, 2008) Deo, RK; Karki, P; Sharma, SK; Acharya, PAbstract Background: In persons with diabetes, chronic hyperglycemia (assessed by glycosylated hemoglobin level) is related to the development of microvascular disease; however, the relation of glycosylated hemoglobin (HbA1c) to macrovascular disease is less clear. Objective: To study the association of cardiovascular events (CVE) with glycosylated haemoglobin in diabetic patients. Design: Case control study Setting: B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal Materials and methods: Fifty diabetic patients with recent cardiovascular events: myocardial infarction (MI) or stroke was included in the study. There were 25 patients of myocardial infarction and 25 patients of stroke. Fifty diabetic patients without cardiovascular events were taken as control. Results: After adjustment for age, smoking, body mass index, systolic blood pressure and total cholesterol at baseline, level of HbA1c was statistically signi cant (p = 0.017) among patients with CVE. For MI, level of HbA1c was statistically signi cant (p = 0.018) while for stroke, level of HbA1c was not signi cant (p = 0.694). Mean blood glucose also predicted CVE and MI but not stroke in this study (p values = 0.006, 0.006 and 0.670 respectively). Fasting and postprandial plasma glucose was statistically signi cant in CVE (p values = 0.024 and 0.019 respectively). Urine protein was statistically signi cant for CVE, MI and stroke (p values = 0.000, 0.032, 0.032 and OR 4.571 (95% CI: 1.963- 10.646), 2.667 (95% CI: 1.043-6.815), 2.667 (95% CI: 1.043-6.815) respectively. Limitations: Sample size was limited due to time constraint and limited resources. Cases with peripheral artery disease were not included in the study. Conclusion: Glycosylated haemoglobin is associated with cardiovascular events and myocardial infarction but not stroke. Key words: Glycosylated Haemoglobin, Cardiovascular event, Myocardial infarction, StrokePublication Association of obesity and physical activity in adult males of Dharan, Nepal(kathmandu University, 2006) Vaidya, A; Pokharel, PK; Nagesh, S; Karki, P; Kumar, S; Majhi, SObjectives: Obesity is one of the most apparent-yet most neglected public health problems. Physical activity is a crucial element in the development of obesity but still its importance in the occurrence of obesity varies in different populations. This paper aims to study the burden of obesity and its association with physical activity was carried out in a rapidly urbanizing town. Methods: A cross-sectional study to investigate the prevalence of obesity and its association with physical activity was carried out in one thousand adult males of Dharan municipality. Tools of data collection included interview and physical measurements such as blood pressure, height and weight measurements, and waist and hip circumferences. Odds ratios (ORs) and their 95% confidence intervals for obesity were computed across various demographic and other variables without adjusting and then adjusting for physical activity. Results: The prevalence of overweight and obesity in the population was 32.9% and 7.2% respectively. The study showed that physical inactivity is more importantly associated with obesity in the older population. The trend of young being more obese is reversed after adjusting for physical activity so that those in the older age were more obese than the younger ones. Similarly, those in to the business, vocational and clerical works, those who were more literate and those in the higher socio-economic status were significantly associated with obesity even after correcting for physical activity. Conclusion: The prevalence of overweight and obesity is high in the males of Dharan. The value and effect of physical activity seem to vary across different age-groups and socio-economic status and occupations. The young, the technical persons or businessmen and the more prosperous ones probably need to bring down their calorie intake along with emphasis on physical activity in order to bring down their weight and cardiovascular risk.Publication Effect of haemodynamic and metabolic predictors on echocardiographic left ventricular mass in non-diabetic hypertensive patients(Kathmandu University, 2010) Gupta, N; Karki, P; Sharma, S; Shrestha, N; Acharya, PAbstract Background: Left ventricular hypertrophy is a forerunner of coronary heart disease, congestive cardiac failure, stroke and may also lead to sudden death. Estimation of left ventricular mass by echocardiography offers prognostic information better than the evaluation of traditional cardiovascular risk factors. Objective: The aim of this study was to determine the relative contributions of haemodynamic and metabolic factors affecting left ventricular mass in non-diabetic patients with essential hypertension. Material and methods: 100 non-diabetic hypertensive patients were taken. The association between age, gender, smoking, alcohol, height, weight, heart rate, clinic blood pressure, fasting blood glucose, lipid profile, haemoglobin, body mass index and stroke volume with LV mass was studied. Left ventricular mass was measured by using standard M-mode echocardiography measurement obtained by way of standard recommended by the American Society of Echocardiography. Results: Left ventricular mass was analyzed as a continuous variable. In males body mass index (r=.35, p<.004) and stroke volume(r=-.26, p<.039) were significantly correlated with LV mass. In females body weight was significantly related to left ventricular mass(r=.36, p<.02). The independent association between significant factors and left ventricular mass was assessed by stepwise multivariate logistic regression. Body mass index and systolic blood pressure came as independent determinants of left ventricular mass in all patients. A maximum of 13% of left ventricular mass variability could be explained by these two factors. Conclusion: In untreated patients with hypertension patient’s body mass index and systolic blood pressure are independent predictors of left ventricular mass after adjustment for other haemodynamic and metabolic factors. They explain a maximum of 13% of left ventricular mass variability. More knowledge is needed about factors that may alter cardiac morphology in the evolution of hypertensive patients. Key words: Echocardiography, Haemodynamic, Metabolic Factors, Left Ventricular Mass, Non-diabetic, HypertensivePublication Exploring the iceberg of hypertension: A community based study in an eastern Nepal town(Kathmandu University, 2007) Vaidya, A; Pokharel, PK; Karki, P; Nagesh, SObjectives: Hypertension is an important public health challenge in the developing and the developed world alike. However, community-based studies on cardiovascular diseases including hypertension in a developing country like Nepal have been limited. The primary aim of this study is to measure the prevalence of hypertension in the Dharan town of Eastern Nepal and to explore the ‘iceberg phenomenon’ of hypertension in the study population. Methods: A population-based cross-sectional analytical study was undertaken in the Dharan municipality in 2004-5 with one thousand males aged 35 years and above as participants. The subjects were recruited by simple random sampling of the households in each ward. Results: The overall prevalence of hypertension in the study population was 22.7% which was comparable to the studies from Northern and Western India. The comparison between the population with normal and high blood pressure at time of study shows significant differences in terms of age, religion, current job status, occupation, socio- economic status, physical activity and tobacco use. Conclusion: The study shows that while a vast majority of the hypertensive population was not aware of their high blood pressure status, at the same time, a large fraction of the population with increased blood pressure did not have their blood pressure under control. A surveillance system to detect population with high blood pressure, follow up the detected cases of hypertension, as well as motivate and/or counsel the ‘hard-to-treat’ cases for regular follow-up should be valuable. Key words: hypertension, community-based, iceberg, Eastern NepalPublication Left ventricular hypertrophy in hypertension: Correlation between electrocardiography and echocardiography(Kathmandu University, 2009) Prakash, O; Karki, P; Sharma, SKAbstract Background: Hypertension is an important modifiable cardiovascular risk factor. Left ventricular hypertrophy – the marker of hypertension, has emerged as an independent risk factor that can be detected by electrocardiography (ECG) and echocardiography (ECHO). Objective: Correlation of electrocardiography and echocardiographically detected left ventricular hypertrophy in hypertensive patients. Materials and methods: Hundred patients with hypertension were studied for left ventricular hypertrophy by the help of electrocardiography and echocardiography. Left ventricular hypertrophy on ECG was assessed by the help of Sokolow- Lyon Voltage Criteria (SLV) and Romhilt – Estes Point Score (R/E). Results: Among 100 patients, 60 were males and 40 were females. Mean age for male was 54.82 + 12.10 years and 52.95 + 11.63 years for female. The mean systolic blood pressure for male was 150.47 + 20 mmHg and for female 148.60 + 16.95 mmHg; where as Diastolic blood pressure for male was 93.67 + 11.13 mmHg and for female it was 96.05 + 12.47 mmHg. Echocardiography detected left ventricular hypertrophy in 64% patients. Electrocardiography detected Left Ventricular Hypertrophy by R/E and SLV criteria 13% and 34% respectively. Conclusion: In developing and under developed country ECG is a useful tool for detection of LVH where the facilities of echocardiography and trained echocardiographer are still not in a common man’s reach. Key words: Left ventricular hypertrophy, HypertensionPublication Neurocysticercosis- a review(Kathmandu University, 2003) Ansari, JA; Karki, P; Dwivedi, S; Ghotekar, LH; Rauniyar, RK; Rijal, SNA.