Browsing by Author "Maharjan, Ramesh Kumar"
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Publication Admission Rate of Patients Visiting Emergency Department in a Tertiary Care Center in Kathmandu: A Descriptive Cross-sectional Study(Nepal Medical Association, 2024) Tiwari, Sanjeeb; Tiwari, Jyotshna Sharma; Jha, Jay Bhushan; Regmi, Sushant; Yadav, Dhirendra; Kafle, Ravi; Khanal, Inesh; Shrestha, Aakripa Rani; Shrestha, Shubham; Shakya, Yagya Laxmi; Maharjan, Ramesh Kumar; Gupta, Sanjaya KumarAbstract Introduction: Emergency departments serve as the initial point of contact for patients with a wide range of conditions. Not all patients visiting get admitted to the hospital. The admission rate varies from 20% in the United States to 40.83% in Nepal. Given the variability in these results across different regions, there is a need to better understand the admission rates from the Emergency Department. Methods: A descriptive cross-sectional study was conducted after obtaining ethical approval( Reference Number: 58 (6-11)E2 081/082) in the Emergency Department of a tertiary health care center. Retrospective data was collected from the data register. The data from April 2023 to April 2024 was collected. A sample size of 222 was calculated and convenience sampling was done. Demographic details like age, sex, and data regarding admission status were collected. Data was collected in MS Excel and was analyzed using JASP software. Results: Out of 222 patients that presented to the emergency department, 53 (23.87%)(18.26-29.47,95 % Confidence Interval) were admitted to the ward or intensive care unit of the hospital, whereas 167 (75.23) got discharged, 1 (0.45%) was brought dead and 1 (0.45%) expired. The median age of patients was 43 (IQR: 26-62). The admission rate of females was 20 (17.24%), whereas for males it was 33 (31.13%). Conclusions: The prevalence of admission of patients visiting the emergency department was higher than similar US based studies. There was a higher percentage of female patients presenting to theemergency department, while those being admitted were mostly males.Publication Emergency Department Presentations of Chronic Kidney Disease in a Tertiary Hospital of Nepal: A Cross-sectional study(Nepal Medical Association, 2025) Neupane, Ram Prasad; Maharjan, Ramesh Kumar; Shrestha, Bipsana; Poudel, Bibek; Dandekhya, Rasmila; Shrestha, Tirtha Man; Chitrakar, Shasank; Dulal, Anga Raj; Malla, Arju; Silwal, Amisha; Karki, Sagun; Pokhrel, Manju; Thakur, Shubham Kumar; Panthee, Abhinandan; Jha, Sagar Kumar; Sah, Anish; Bhujel, BishnuAbstract Introduction: Progressive chronic kidney disease is associated with complications like hypertension, anemia, mineral bone disorder, metabolic acidosis and electrolyte disorders which lead to higher morbidity, mortality and poorer quality of life. Available estimates of chronic kidney disease cases and those receiving treatment suggests an existing gap in care. Therefore, this study aims to estimate the prevalence of chronic kidney disease and its complications in the emergency department of Tribhuvan University Teaching Hospital. Methods: A cross-sectional descriptive study was done. The participants were chronic kidney disease patients with complications visiting the Emergency Department of Maharajgunj Medical Campus. Census sampling technique was used to enroll all chronic kidney disease patients with complications meeting inclusion criteria, visiting the Emergency Department from 11th October 2023 to 19th September 2024. Ethical approval was obtained from the institutional review committee of the Institute of Medicine, Maharajgunj with the reference number 509(6-11)E2/081/082. Distribution check and descriptive analysis was done using STATA. Results: The prevalence of chronic kidney disease was found to be 2.5%. The most common complications were anemia 399 (53.69%) and hypertensive crisis 396 (53.29%). Least common complications among CKD patients was sepsis 8 (1.08%). Several other complications like arrhythmia, nephropathy, hypoglycemia, obstructive uropathy, pericardial effusion, urinary tract infection, effusion, pneumonia were observed in 50 (6.73%) of the CKD patients. Death as an outcome was reported in 9 (1.2%) of total patients. Conclusions: Chronic kidney disease proportion in emergency departments is high, with anemia and hypertension being common complications. Targeted interventions might include establishing hemodialysis units and increasing staff awareness.Publication Epidemiological Study of Stroke Cases Presenting to the Emergency Department of a Tertiary Hospital: An Observational Study(Nepal Medical Association, 2025) Rajbhandari, Bibek; Man Shakya, Yogendra; Maharjan, Ramesh Kumar; Shakya, Yagya Laxmi; Aryal, Shiva Sharma; Bhandari, Pratiksha; Shilpakar, Olita; Neupane, Ram Prasad; Nakarmi, Rajan Narayan; Shrestha, CimonaIntroduction: Stroke remains a major global health burden, ranking as the second leading cause of death and third leading cause of disability worldwide. Low- and middle-income countries, including Nepal, face a disproportionate share of this burden, characterized by delayed treatment and limited healthcare infrastructure. This study aimed to determine the epidemiological profile of stroke cases presenting to the emergency department of a tertiary hospital in Nepal. Methods: A cross-sectional study was conducted using medical records of stroke patients presenting to the General Practice and Emergency Department from August 2022 to September 2023. Data on demographics, stroke type, clinical outcomes, and management were collected and analyzed descriptively using STATA version 17. Results: Of 39,702 emergency department visits, 1,174 (2.96%) were stroke cases. Ischemic stroke occurred in 896 (76.34%) patients, hemorrhagic stroke in 175 (14.89%), and transient ischemic attack in 103 (8.82%). The mean age was 61.79 ± 15.76 years, and 704 (60.00%) patients were male. Admission to the general ward occurred in 1,011 (86.10%) patients, and 43 (3.65%) patients were admitted to the ICU. Thrombolysis was administered to 22 (1.87%) patients, and 11 (0.93%) were referred for thrombectomy. A total of 151 (12.90%) patients arrived within 4.5 hours of symptom onset. Conclusions: The study highlights the predominance of ischemic stroke, delayed hospital presentations, and limited use of thrombolysis among stroke patients in a high-volume ED in Nepal.