Browsing by Author "Nepal, Rajesh"
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Publication Coronary Artery Bypass Grafting among Patients Undergoing Cardiac Surgery in a Tertiary Care Hospital: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Sharma, Praman; Yadav, Lokesh; Nepal, Rajesh; Khanal, Sunil Babu; Agrawal, Subhadra; Kattel, VivekAbstract: Introduction: Among all cardiac surgeries, coronary artery bypass graft is frequently performed and is expected to improve the quality of life in patients with coronary artery disease. This study aimed to look at the prevalence of the patients undergoing coronary artery bypass grafting among cardiac surgery cases at a tertiary care hospital. Methods: This was a descriptive cross-sectional study conducted at the Cardio-Thoracic and Vascular Surgery department of a tertiary care hospital among 92 patients who underwent cardiac surgery. Participants were enrolled after the ethical clearance from the Institutional Review Committee (Reference number: 574/2019). Epidemiological characters, functional New York Heart Association classification, and left ventricular function were evaluated. Data were entered in Microsoft Excel 2010 and analyzed using Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: The prevalence of coronary artery bypass graft in patients undergoing cardiac surgery was 49 (53.2%) (43.0-63.4 at 95% Confidence Interval). The mean age of 49 patients was 58.87 years. Hypertension 43 (88%), Dyslipidemia 34 (69%) and Type 2 Diabetes Mellitus 25 (51%) were major comorbidities. The mean preoperative and postoperative ejection fraction was 48.2±10.5% and 52.6±6.0% respectively. The preoperative median New York Heart Association class was 3 whereas the post-operative class was 1. Mortality was seen in one (2.04%) patient. Conclusions: The prevalence of coronary artery bypass graft in the patient undergoing cardiac surgery was lower than noted in other studies.Publication Patterns of Rheumatic Heart Disease and Treatment Practices at Tertiary Care Center in Nepal: A Descriptive Cross-sectional Study(Nepal Medical Association, 2020) Nepal, Rajesh; Bista, Madhab; Dhungana, Sahadeb PrasadAbstract: Introduction: Rheumatic heart disease is a sequel of rheumatic fever which causes heart valve damage. This study was conducted to look at the pattern of valve lesions and treatment practices in patients with rheumatic heart disease. Methods: A cross-sectional study conducted at the tertiary care center with a diagnosis of rheumatic heart disease from July 2018 to January 2020 by convenient sampling. Ethical clearance was obtained from the Institutional Review Committee (ref no. 55/2018). Data were analyzed by using Statistical package for social sciences version 20. Results: Out of 600 patients, 428 (71.3%) were female. The mean age was 44.24±14.24 years. The isolated mitral valve was affected in 280 (46.6%). Dual involvement of mitral and aortic valve was present in 294 (49%). Only 14 (2.3%) had involvement of isolated aortic valve involvement. Overall, mitral stenosis was the most common abnormality 508 (84.6%) followed by mitral regurgitation 418 (69.6%), aortic regurgitation 320 (53.3%), and aortic stenosis 63 (10.5%). Assessment of the severity of lesions showed that 247 (41.2%) patients had severe mitral stenosis, 119 (19.8%) severe mitral regurgitation, 14 (2.3%) severe aortic stenosis, and 11 (1.8%) severe aortic regurgitation. Majority 493 (82.2%) were treated with medical therapies. Surgical procedures were performed in 51 (8.5%). The use of anticoagulation was in 212 (35.3%) of eligible patients. Conclusions: Mitral valve was affected commonly both in isolation and combination. The majority of patients who were eligible for cardiac interventions were treated medically with suboptimal use of anticoagulation and secondary prophylaxis.