NepMed Repository :: Browsing by Author "Karki, P"

Browsing by Author "Karki, P"

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Association of cardiovascular events with glycosylated haemoglobin in diabetic patients
(Kathmandu University, 2008) Deo, RK; Karki, P; Sharma, SK; Acharya, P
Abstract 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, Stroke
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, S
Objectives: 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.
Cervical necrotizing fasciitis in an uncontrolled type II diabetic patient
(Kathmandu University, 2006) Singh, RK; Bhandary, S; Wakode, PT; Karki, P
We report a case of cervical necrotizing fasciitis (CNF) in a female having uncontrolled type II diabetes mellitus. The patient was presented to us after 20 days of preliminary symptoms. The aetiology of microbial inoculation in subdermal tissue was not known. The isolate was Staphylococcus aureus. In spite of the delay in presentation, the patient was successfully treated with combined antimicrobial and surgical intervention. Key words: Necrotizing fasciitis, head and neck, cervical, diabetes mellitus.
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, P
Abstract 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, Hypertensive
Effect of preload reduction by haemodialysis on doppler indices of diastolic function in patients with end-stage renal disease
(Kathmandu University, 2008) Acharya, P; Ranabhat, K; Trikhatri, Y; Manandhar, DN; Sharma, SK; Karki, P
Abstract Objective: To assess the influence of preload reduction by haemodialysis on Doppler echocardiographic indices of cardiac diastolic function. Methodology: Parameters of left ventricular diastolic function were measured in patients with end-stage renal disease before and after a single session of haemodialysis. Patients with valvular heart disease, coronary artery disease, cardiomyopathies, pericardial disease and those not in sinus rhythm were excluded from the study. Results: Seventeen subjects (12 males and 5 females, mean age 48 ± 16 years) were studied. Over the duration of 3.7 ± 0.6 hours of haemodialysis, 2.6 ± 1.3 litres of ultrafiltrate was removed. The comparison of pre and post haemodialysis peak mitral E and A velocities showed a decrease in E velocity (p < 0.01) whereas the change in A velocity was not significant. The E/A ratio decreased significantly (p < 0.05).The decrease in E velocity correlated well with the amount of ultrafiltrate (r = 0.653, p < 0.01). There was a significant increase in isovolumetric relaxation time (p< 0.05) whereas deceleration time did not change (p =0.3). Conclusion: Ultrafiltration during haemodialysis causes a rapid reduction in preload. It results in decreased early left ventricular diastolic filling without a change in the atrial phase of filling, hence causing a decrease in calculated E/A ratio. Key words: Doppler indices, echocardiography, diastolic function, end-stage renal disease, BPKIHS
Exploring the iceberg of hypertension: A community based study in an eastern Nepal town
(Kathmandu University, 2007) Vaidya, A; Pokharel, PK; Karki, P; Nagesh, S
Objectives: 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 Nepal
Left ventricular hypertrophy in hypertension: Correlation between electrocardiography and echocardiography
(Kathmandu University, 2009) Prakash, O; Karki, P; Sharma, SK
Abstract 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, Hypertension
Neurocysticercosis- a review
(Kathmandu University, 2003) Ansari, JA; Karki, P; Dwivedi, S; Ghotekar, LH; Rauniyar, RK; Rijal, S
NA.
Risk factors, associated health problems, reasons for admission and knowledge profile of diabetes patients admitted in BPKIHS
(Kathmandu University, 2006) Mehta, RS; Karki, P; Sharma, SK
Objectives: The objective of the study was to find out the demographic profile, identify the known risk factors, assess the associated health problems, find out the reasons for admission and explore the knowledge profile of the patients admitted with diabetes in medical units of BPKIHS. Methods: It was hospital based exploratory study conducted among the admitted DM patients during the period of 1-3-2003 to 29-2-2004 in medical units using simple random sampling, which included 35 samples. The data was analysed using Excel and SPSS programme. Results: About 54% subjects were of age group between 40-60 yr., Hindu 85.7%, married 92.9%, and non- vegetarian 75.9 %. About 50% of subjects were on Insulin. About 60.7 % subject had hypertension, 39.3 % had ocular problem, and 25 % had renal problems. Majority of subject (82.1 %) had knowledge about the disease, they were suffering but limited subject had the knowledge about, causes, curability, treatment modalities, diet, and other aspects. Conclusions: As the knowledge regarding various aspects of DM is very low, there is need for information booklet in Nepali and health education programme among public will be very beneficial. Key Words: Risk Factors, Associated Health problems, Knowledge profile, Diabetes.
Sinonasal inverted papilloma in eastern part of Nepal
(Kathmandu University, 2006) Bhandary, S; Singh, RK; Shrestha, S; Sinha, AK; Badhu, BP; Karki, P
Objective: To evaluate the clinicopathological profile of sinonasal inverted papilloma in a tertiary referral center in eastern part of Nepal. Methods: A prospective study consisting of total 28 histologically proven cases of sinonasal inverted papilloma was conducted in the ENT department of the center. The study period was from April 2002 to November 2005. Result: Out of 28 cases studied, 21 were males and 7 were females with male to female ratio of 3:1. The highest incidence was seen in the 5 th and 6 th decades of life. The duration of symptoms varied from 5 months to 20 years with mean duration of 3.9 years. The lateral nasal wall and nasal cavity involvement was seen in all 28 cases. Maxillary sinus was involved in 27(96.4%) subjects followed by ethmoid (20), sphenoid (10) and the frontal sinus (7). The principle presenting symptom was nasal obstruction seen in 96.4% of the patients. Twenty two cases were treated by lateral rhinotomy with medial maxillectomy while, orbital exenteration was done in two cases. Associated carcinoma was noticed in 10.15% of all the subjects studied. Conclusion: Sinonasal papilloma mostly presented in fifth to six decades of life mainly affecting the male patients. Majority of the patients were treated by lateral Rhinotomy with medial maxillectomy surgery. Early presentation would have given chances for endoscopic surgery. Key words: Sinonasal inverted papilloma, lateral Rhinotomy, medial maxillectomy.
Social health insurance: A knowledge-do gap in eastern Nepal
(Kathmandu University, 2007) Jha, N; Karki, P; Das, BP; Chapagain, N
Health care costs, and those for inpatient care in particular, pose a barrier to seeking health care, and cost be a major cause of indebtedness and impoverishment, particularly among the poor. The Ministry of Health in Nepal intends to initiate alternative financing schemes such as community and social health insurance schemes as a means to supplement the government health sector financing source. Social Health Insurance (SHI) is a mechanism for financing and purchasing / delivering health care to workers in the formal sector regulated by the government. Considering all these facts BP Koirala Institute of Health Sciences (BPKIHS) has introduced SHI scheme in 2000 as an alternative health care financing mechanism to the community people of Sunsari and Morang districts. In the beginning small area was elected as a pilot project to launch the scheme. A major objective of SHI is to reduce poverty caused by paying for health care and to prevent already vulnerable families from falling into deeper poverty when facing health problems. A total of 26 organizations with 19799 populations are at present in SHI scheme. Sixteen rural based organizations with 14,047 populations and 10 urban based organizations with 5752 people are the beneficiaries in this scheme. BPKIHS SHI Scheme is the outcome of the visionary thinking on social solidarity and as an alternative health care financing mechanism to the community. BPKIHS is mobilizing people's organizations and is offering health services through its health insurance scheme at subsidized expenses. This has helped people to avail with health facilities who otherwise would have been left vulnerable because of their penetrating health needs. There is huge gap between premium collection and expenditures. The expenditures are more and this may be due to knowledge – do gap in the program. If conditions are unsuitable, SHI can lead to higher costs of care, inefficient allocation of health care resources, inequitable provision and dissatisfied patients. It can also be more difficult to realize the potential advantages of SHI in future. The future challenges confronting the scheme are to give the continuity and sustainability of the program to its catchments areas. This might entail a shift in its program operation mechanism. People's active involvement is required, which will further provide a sense of ownership in the scheme amongst the people.
Spontaneous bacterial peritonitis (SBP) in cirrhotic ascites: A prospective study in a tertiary care hospital, Nepal
(Kathmandu University, 2007) Syed, VA; Ansari, JA; Karki, P; Regmi, M; Khanal, B
Background: Spontaneous bacterial peritonitis (SBP) is one of the potentially lethal complications of cirrhosis and is defined as infected ascites in the absence of any recognizable secondary cause of infection. Objective was to study the occurrence of SBP, clinical and laboratory characteristics and the response to antibiotics. Methods: We had prospectively evaluated 81 cirrhotic patients with ascites during one-year period. All SBP patients were treated with cefotaxime, 2gm IV, every 12h for 5days. Results: Of these 81 patients, 24.67% of patients (n=20) had SBP and its variants (classical SBP n= 4, CNNA n=13 and bacterascites n=3). There were thirteen males and 7 females in the study.85% of the cases had Child`s class C cirrhosis. UGI bleeding and abdominal pain were the most common presenting symptoms of SBP. Culture positives were 35% (n=7). The most frequent organisms were Escherichia coli (n=3) and Streptococcus pneumoniae (n=2). 94% of the patients responded to therapy after 48 hours of treatment. Total resolution after 5 days of therapy was 73% and in-hospital mortality was 15% (n=3). Conclusion: SBP, if diagnosed early can be treated with very good success rate up to 73%. Appropriate treatment of SBP with cefotaxime can help in reducing mortality and morbidity in patients with chronic liver disease. Key words: SBP, CNNA, Cirrhotic patients and Cefotaxime

Browsing by Author "Karki, P"

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