Browsing by Author "Koirala, P"
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Publication A case report and overview of organophosphate (OP) poisoning(Kathmandu University, 2006) Bhattarai, MD; Singh, DL; Chalise, BS; Koirala, PA case of organophosphate (OP) poisoning who recovered after requiring almost 1000 mg of atropine, 10 gm of PAM and ventilatory support for 7 days is presented here. The overview of organophosphate poisoning and its management is given. With the approach adopted, the mortality reported in the general medicine unit in the central hospital in Nepal is 7.4%. The two important aspects of the management are vigilance of the atropine drip, especially at night, and other physical and psychological support care of the patients. Key words: Organophosphate poisoning, atropine drip, counselling, Nepal.Publication Angiographic Severity of Coronary Artery Disease in Diabetic and Non-diabetic Acute STEMI Patients in a Tertiary Care Centre of Nepal(Kathmandu University, 2021) Pathak, SR; Gajurel, RM; Poudel, CM; Shrestha, H; Thapa, S; Thapa, S; Koirala, PABSTRACT Background Patients with diabetes mellitus have a higher prevalence of atherosclerotic heart disease and a higher incidence of myocardial infarction than the general population. Definitive diagnosis and precise assessment of anatomic severity of Coronary Artery Disease requires invasive diagnostic modality like coronary angiography. Objective To study angiographic characteristics and severity involving coronary arteries in patients with acute ST segment elevation Myocardial infarction and to compare the same in diabetics and non-diabetics. Method Among 150 patients with acute coronary syndrome, 75 diabetics and 75 non- diabetics admitted in Manmohan Cardiothoracic vascular and transplant Centre were selected randomly during a period of one year formed the study group. Random Blood Sugar, Fasting Blood Sugar was done in all 150 patients, HbA1c in all diabetics. All subjects with acute ST Elevation Myocardial Infarction were taken up for coronary angiography intended for primary PCI. Result In our study, 35 (46.7%) out of 75 diabetic patients had triple or multi-vessel disease compared to 10 (13.4%) out of 75 non diabetics. Non-diabetic patients had significantly higher single vessel disease (65.3%). There was a statistically significant association of duration of DM with vessels involved. The occurrence of Triple Vessel Disease/Multivessel Disease was significantly higher in the patients with DM duration > 10 years compared to patients with DM duration < 10 years (64.7% vs. 35.3%, P < 0.001), however there was no significant difference in type of vessel involved. Similarly, a significantly higher proportion of Triple vessel disease was observed in patients with poor glycemic control (HbA1c > 8.5%). 72.2% of the patients with HbA1c > 8.5% had Triple vessel disease/Multi vessel disease, whereas patients with good glycemic control (HbA1c < 7.0%) had predominantly Single vessel disease (90.0%), with no occurrence of Triple vessel disease/Multi vessel disease Conclusion Diabetic patients presenting with ST Elevation Myocardial Infarction are likely to have triple/multiple vessel disease compared to non-diabetic patients. The occurrence of Triple Vessel Disease/Multivessel Disease was significantly higher in the patients with DM duration > 10 years compared to patients with DM duration <10 years. KEY WORDS Diabetes mellitus, Acute coronary syndrome, STEMI, Coronary angiographyPublication Coxsackie B Virus Infection as a Rare Cause of Acute Renal Failure and Hepatitis(Kathmandu University, 2018) Thapa, J; Koirala, P; Gupta, TNABSTRACT We report a 37 year female patient, admitted with complains of fever, jaundice and myalgia of seven days. There was no history of trauma, drug abuse, seizure or vigorous exercise nor history of renal and musculoskeletal disease. Here we have discussed the clinical features, biochemical derangements, diagnosis of coxsackie B virus, multi organ involvement and need of urgent hemodialysis for appropriate management of the case. KEY WORDS Acute renal failure, Coxsackie B, Hemodialysis, HepatitisPublication Functional Status of Senior Citizens of a Metropolitan City in Morang(Kathmandu University, 2022) Koirala, P; Shrestha, S; Koirala, MABSTRACT Background Functional abilities start to decelerate after the age of 70 and causes need for assistance to do their basic activities of daily living (BADL) as well as instrumental activities of daily living (IADL). Objective To find out the functional status of senior citizens of a Metropolitan city in Morang. Method A descriptive cross-sectional study was carried out at Biratnagar Metropolitan City among 254 senior citizens receiving old age allowance using cluster sampling technique. Data were collected through face to face interview and measuring height and weight by researcher herself for the period of four weeks. Basic activities of daily living and instrumental activities of daily living were assessed using Katz Index of Basic Activities of Daily Living and Lawton Instrumental Activities of Daily Living tool with some modifications. Chi square test was used to assess the association between variables. Result About 48.4% and 90.6% of senior citizens had dependency in Basic Activities of Daily Living and Lawton Instrumental Activities of Daily Living respectively. The most common dependency for Basic Activities of Daily Living and Instrumental Activities of Daily Living was control of urination and defecation (31.9%) and using telephones (75.2%) respectively. Basic activities of daily living was significantly associated with age (p=0.0017), sex (p=0.013), literacy status (p=0.001), years of smoking (p=0.0029), social participation (0.0029) and history of fall within 1 year (p=0.038). Likewise Instrumental Activities of Daily Living was significantly associated with age (p=0.03), sex (p=0.035), literacy status (p=0.002), exercise (p=0.033) and social participation (p= 0.001). Conclusion It is concluded that about half of the senior citizens are dependent in Basic Activities of Daily Living and almost all of them are dependent in Instrumental Activities of Daily Living. So senior citizen clubs/ groups are suggested to be strengthened which may be effective in promoting independence, extending an active and healthy ageing. KEY WORDS Basic activities of daily living , Functional status, Instrumental activities of daily living, Senior citizensPublication Heterotopic pregnancy with spontaneous intrauterine conception: A rare clinical entity with diagnostic dilemma(Kathmandu University, 2008) Rawal, S; Koirala, P; Singh, M; Rana, AAbstract Twenty-one years old primigravida presented to emergency with amenorrhoea for 2 months and complaints of severe abdominal pain for few hours. The pain was associated with 2 episodes of fainting attacks in emergency during the period of observation. Viable intrauterine pregnancy of 8-9 weeks along with collection of fluid in the Pouch of Douglas was detected by ultrasound examination and on laparotomy ectopic pregnancy was confirmed with haemoperitoneum of 2 litres with 500gms of clots. Histopathology report confirmed the tubal ectopic pregnancy and postlaparotomy, transvaginal sonography confirmed the salvage of the intrauterine pregnancy. Despite massive haemoperitoneum, the pregnancy continued till 40+6 weeks with uneventful antenatal period. She underwent emergency caesarean section for meconium stained liquor with foetal distress and delivered of an alive healthy female of 2.5 kg with good Apgar score. Key words: Ectopic, Heterotopic pregnancyPublication Outcome Analysis of Termination of Pregnancy in Second Trimester(Kathmandu University, 2023) Rijal, H; Koirala, PABSTRACT Background Second-trimester abortions, constitute 10-15% of global annual abortions, leading to two-thirds of major abortion-related complications. Recognizing the elevated risk, the WHO recommends diverse methods for safe termination. Surgical and medical approaches, particularly using drugs like Mifepristone and Misoprostol, show promising success rates. Objective To analyze the outcomes of second-trimester termination using Mifepristone or PG analogues alone or in combination. Method This is a one-year retrospective study at Tribhuvan University Teaching Hospital analyzing second-trimester terminations, collecting data on demographics, medical history, period of gestation, doses of abotificient drugs, complications, and management. Result In a study of 66 second-trimester abortions, mean age was 28.8±4.96 years, gestational age 20.07±4.3 weeks. Mifepristone and Misoprostol combination succeeded in 66.7% of cases, while 42.2% required repeated Mifepristone doses. Misoprostol use was significantly higher in patients without medical comorbidities (p=0.018), but Mifepristone requirement didn’t differ significantly based on medical conditions. Combined Mifepristone and Misoprostol were used more for fetal indications. Notably, the use of Mifepristone and Misoprostol didn’t significantly differ for live and intrauterine fetal death cases. Conclusion Mifepristone and Misoprostol effectively terminate second-trimester pregnancies. In high-risk cases, cautious Prostaglandin use is crucial and Mifepristone alone, in divided doses, reduces complications with high success. KEY WORDS Abortion, Mifepristone, Misoprostrol, Second trimester, TerminationPublication Perceived Health Promoting Education Needs of Middle-aged Population in Dhulikhel Municipality of Nepal(Kathmandu University, 2017) Karki, S; Koirala, PABSTRACT Background Health promoting education need assessment is of utter importance while conducting health promoting education programs. However little efforts have been put on this by the policy level authorities and there are no studies to assess the perceived health promoting education needs of the middle aged population of Nepal till date. Objective The objective of this study was to assess the perceived health promoting education needs of middle-aged population in Dhulikhel municipality. Method A descriptive cross-sectional study was conducted among 300 respondents using two staged cluster and systematic technique. Face to face interview technique was used for data collection. T-test was used for comparison of dependent variables with independent variables. Result The study revealed that the mean education need score was 66.66±16.09 (in a score of minimum 25 and maximum 125). Cancer prevention was perceived as the topic of highest education need and retirement planning as the topic of least education need. There was statistically significant difference in the mean perceived education need score between male and female (p=0.048), respondents with exposure and non-exposure to health related programs on mass-media (p=0.020) and mental component summary score <50 and mental component summary scores >=50 (p=0.048). Conclusion This study suggested that the community people have perceived moderate level of health promoting education need. Since cancer prevention was the highest rated topic followed by chronic illness prevention and dementia, it is recommended to focus on these topics while organizing any health promoting education programs in the community. KEY WORDS Health promotion, health promoting education, perceived needs