Browsing by Author "Nepal, Richa"
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Publication Amitriptyline, Pregabalin and Duloxetine for Treatment of Painful Diabetic Peripheral Neuropathy(Nepal Health Research Council, 2024) Nepal, Richa; Bajracharya, Manil Ratna; Karki, Budda Bahadur; Mall, Dipak; Shrestha, Prajaya Shikhar; Wasti, Kushal Prasad; Bisht, AnjalBackground: Painful diabetic peripheral neuropathy is one of the frequent presenting complaints in diabetes and endocrine clinics. Our main objective was to compare effectiveness of three commonly prescribed drugs: amitriptyline, pregabalin and duloxetine for treatment of painful diabetic peripheral neuropathy. Methods: This was a comparative, prospective, observational study conducted among 99 diabetic patients with painful diabetic peripheral neuropathy having numeric rating pain scale ? 4. Thirty-three patients in each group were consecutively prescribed amitriptyline, pregabalin and duloxetine in lower dose (10mg/75mg/20mg) for first two weeks to gradually up titrate to higher dose (25mg/150mg/30mg) as per pain response for total duration of eight weeks. Results: At the end of eight weeks, 84.9% in amitriptyline, 78.7% in pregabalin and 60.6% in duloxetine group had adequate pain reduction in form of mild or no pain. Among total patients, 42.5% patients had severe pain at baseline that decreased to 5% by the end of our study. Out of three drugs, 45.5% patients in amitriptyline group had complete resolution of pain as compared to 24.2% in pregabalin and 18.2% in duloxetine group (p value 0.05). Drowsiness (42.4%), dizziness (21.2%) and dry mouth (21.2%) were the commonest side effects among total participants in our study. Conclusions: Amitriptyline, pregabalin and duloxetine were all associated with adequate pain reduction among patients of painful diabetic peripheral neuropathy in our study, however, amitriptyline had more favorable findings with tolerable side effects. Keywords: Amitriptyline; duloxetine; Nepal; painful diabetic peripheral neuropathy; pregabalin.Publication Anaemia among Patients of Heart Failure in a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study(Nepal Medical Association, 2021) Bhandari, Abhishek; Shah, Prashant; Pandey, Naveen Kumar; Nepal, Richa; Sherchand, OjasweeAbstract: Introduction: Anaemia is an important comorbidity common in patients with heart failure and is associated with poor clinical status and worse outcomes. In Nepal few studies have evaluated anaemia amongst patients suffering from heart failure. We intended to find out the prevalence of anaemia in patients with heart failure in a tertiary care centre. Methods: This is a descriptive cross-sectional study conducted among patients of heart failure presenting to tertiary care hospital in eastern Nepal from April 2017 to January 2018. Ethical approval was taken from the Institutional Review Committee of a tertiary care centre (reference number: IRC/0842/016). Using the convenience sampling method, 100 patients were enrolled in the study. Blood samples from the patients were taken for haemoglobin and serum iron studies. Data was analysed using Statistical Package for Social Sciences version 11. Point estimate at 95% Confidence Interval was calculated, with frequency and percentage. Results: Among 100 patients with heart failure, 82 (82%) (74.47-89.53 at 95% Confidence Interval) had anaemia. Mean haemoglobin level of the study population was 10.40±2.73 g/dl. Fifty four (54%) of patients had iron deficiency status irrespective of presence or absence of anaemia. Conclusions: Prevalence of anaemia among patients of heart failure in our study was found to be higher than various other homologous international studies.Publication Community-Level Screening and Referral Guidelines for Major Non-Communicable Diseases at Primary Healthcare Settings: From Development to Application at the Multi-site ‘NCDs Mega-Campaign 2024’ in Kathmandu Metropolitan City, Nepal(Nepal Medical Association, 2025) Malla, Milan; Nepal, Richa; Regmi, Sushant; Neupane, Deewash; Shrestha, Dhanendra; Bhandari, Saugat; Subedi, MadhusudanAbstract Non-communicable diseases (NCDs), mainly cardiovascular conditions like hypertension, diabetes, and chronic kidney disease (CKD) are the major causes of morbidities and mortalities worldwide, with lower- and middle-income countries (LMICs) bearing the highest burden. As the UN 25*25 targets near their final year and the Sustainable Development Goals approach their last trimester, NCD cases continue to rise, leaving a significant undiagnosed population submerged in the communities and households. In Nepal, a few initiatives have been made at the health-facility level over the past decade. However, they lack people-centric strategies and community-focused intervention with appropriate working guidelines. This article outlines the three-phase development of a community-level screening program in Kathmandu Metropolitan City, providing structured guidelines for health workers to screen and appropriately refer cases of hypertension, diabetes, and CKD, implemented during the large-scale community-based campaigns across 256 sites in Kathmandu Metropolitan in 2024.Publication Prevalence of Vitamin D Deficiency among Patients of Acute Coronary Syndrome in a Tertiary Care Center of Eastern Nepal(Nepal Medical Association, 2021) Nepal, Richa; Karki, Prahlad; Uraw, Surendra; Lamsal, MadhabAbstract: Introduction: Vitamin D deficiency is an emerging risk factor for cardiovascular diseases. Very few studies have been done to find out vitamin D deficiency status among cardiovascular patients in Nepalese setup. This research aims to find out the prevalence of vitamin D deficiency among patients of acute coronary syndrome admitted in a tertiary care center of eastern Nepal. Methods: This was a descriptive cross-sectional study conducted among patients of acute coronary syndrome admitted in a tertiary care hospital from 1st February 2018 to 31st July 2018. Ethical clearence was taken from Institutional Review Committee of B.P. Koirala Institute of Health Sciences (Reference number: 259/074/075-IRC). Convenience sampling method was used. Data was entered in Microsoft Excel and analyzed using Statistical Package for the Social Sciences version 25. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: A total of 33 (64.7%) at 95% Confidence Interval (51.58-77.82) patients of acute coronary syndrome had vitamin D deficiency in our study with 19 (37.3%) having mild deficiency and 14 (27.4%) having moderate deficiency. None of the patients had severe vitamin D deficiency in our study. The mean vitamin D levels were lower in diabetics (23.57±9.28ng/ml) as compared to non-diabetics (31.91±12.50ng/ml), in hypertensive patients (24.36±7.67ng/ml) as compared to non-hypertensive patients (30.97±13.72ng/ml), and in patients with dyslipidemia (22.86±6.44ng/ml) as compared to those without dyslipidemia (37.68±13.15ng/ml). Conclusions: Prevalence of vitamin D deficiency among patients of acute coronary syndrome in our study was comparable to various other homologous international studies.Publication Recurrent Positivity of SARS-CoV-2 RNA in a Clinically Recovered COVID-19 Patient with End Stage Renal Disease: A Case Report(Nepal Medical Association, 2020) Nepal, Richa; Sapkota, Kalyan; Gurung, Santosh; Paudel, Pramod; Neupane, Prateek; Sah, Kamlesh KumarAbstract: Recurrent or persistent positivity of SARS-CoV-2 RNA in clinically recovered COVID-19 patients have been reported worldwide. However, replication competent live viruses were not recovered beyond two to three weeks from onset of symptoms in mild to severe cases of COVID-19. End stage renal disease is characterized by uremia induced immune dysfunction that increases the risk of infectious diseases including COVID-19. The clinical implications of recurrent or persistently positive SARS-CoV-2 RNA in immunocompromised patients are difficult to be generalized to findings as in immunocompetent patients. We report a case of end stage renal disease with recent history of recovered COVID-19 pneumonia, who again presented with positive reverse transcriptase- polymerase chain reaction (RT-PCR) test for SARS-CoV-2 RNA.