Browsing by Author "Neupane, Ram P"
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Publication Airway Management Skills in Emergency Services(Institute of Medicine, 2021) Shrestha, Jukel; Shakya, Yogendra M; Maharjan, Ramesh K; Neupane, Ram P; Shakya, Yagya L; Prasad, Pratap NABSTRACT Introduction: Endotracheal intubation in critically ill and injured patients is a high-risk procedure in an Emergency Room (ER). The risk of complications increases with repeated or prolonged attempts, making first attempt success primary goal for airway management in these patients. The primary objectives were to compare first pass success during intubation among various specialties with different level of airway management training and education. Methods: This was a quantitative, observational, cross-sectional study conducted at Tribhuvan University Teaching Hospital for one year. The intubators completed an intubation data collecting form post intubation. After a failed first attempt, alternative methods such as using experienced intubators for subsequent intubation attempts were performed. Results: In the emergency room, 265 attempts of endotracheal intubation were made on total 224 patients. Most common causes for intubation were stroke (49 [21.8 %]), sepsis (39 [17.20 %]), COPD (28 [12.20 %]), and head traumas (24 [10.90 %]). During endotracheal intubation, 185 (82.58%) patients had a successful first-attempt success, and 39 (17.41 %) patients required ≥2 attempts. First pass success was least among medical officers (13/20 (65%)), compared to other senior specialties (p=0.01). Conclusion: With more training and education on the airway, first-pass success during endotracheal intubation increased. All front-line workers should consider it an ethical commitment to stay updated through lifelong learning, an obligation that should be made easier by governing bodies enforcing a thorough airway management training programs. Keywords: Airway, complications, emergency physicians, emergency intubation, first attempt success, techniquePublication Mortality in Emergency Services in a University Teaching Hospital: A Retrospective Study(Institute of Medicine, 2019) Shrestha, Tirtha M; Aacharya, Ramesh P; Neupane, Ram P; Prajapati, BigyanABSTRACT Introduction Emergency services are the gateway between the community and hospital that provides 24-hour access for most needy patients in critical and emergency conditions. Mortality rate varies in emergency department across the world and even in different emergency units of the same hospital. This retrospective study was done in adult emergency services of a tertiary hospital to determine mortality rate and analyze causes of death. Methods A retrospective observational study of mortality cases to analyze mortality rate and causes of death of patients for a period of 6 months between October 2017 to March 2018 was carried out in the adult emergency services of Tribhuvan University Teaching Hospital, Kathmandu. Data required were collected from copies of death certificates. Results During the study period, a total of 128 patients died in emergency, accounting 0.5% of total patient. Male deaths (52.3%) were slightly higher compared to female deaths (47.7%). Age group 66-75 years had the highest (24.2%) of total mortalities in the emergency. The most common immediate cause of death was sepsis/septic shock (21.9%) followed by cardiopulmonary arrest, aspiration, respiratory failure, other causes of shock and poisoning. The commonest antecedent cause of death was attributed to respiratory causes. Similarly, the most common contributory cause of death was chronic obstructive pulmonary disease. Conclusion Older age group are prone to the mortality risk. Sepsis/septic shock was the most common immediate cause of death. Pneumonia was the most common antecedent causes of death. Chronic obstructive pulmonary disease was the commonest contributory cause. Keywords: Emergency Department, mortality, Nepal, sepsisPublication Nebulized Magnesium Sulphate Versus Saline as an Adjuvant in Acute Exacerbation of Chronic Obstructive Pulmonary Disease in a Tertiary Centre of Nepal: A Randomized Control Study(Institute of Medicine, 2021) Bajracharya, Manjita; Acharya, Ramesh P; Neupane, Ram P; Sthapit, Rekha; Tamrakar, Apurva RABSTRACT Introduction: Magnesium has been shown to have bronchodilator properties in asthma and chronic obstructive pulmonary disease (COPD). Therapeutic benefits of nebulized magnesium in asthma has been seen. The purpose of this study was to compare therapeutic benefits of nebulised magnesium sulphate as an adjuvant with normal saline in patients with COPD exacerbation. Methods: It was a randomized single blind interventional study of 172 cases of acute exacerbation of COPD presenting (AECOPD) with a peak expiratory flow rate (PEFR) <300 L/min measured 20 min after initial management. Patients received 5 mg salbutamol mixed with 3 ml isotonic magnesium sulphate or 3 ml normal saline on three occasions at 30 min intervals via nebulizer. The primary outcome measured was PEFR at 90 min and hospital admission, noninvasive or invasive ventilation and mortality were taken as secondary outcomes. Results: The mean PEFR were 86.3±11.9 l/min, 97.6±19.1 l/min and 99.6±15.2 l/min after nebulization with magnesium sulphate and 79.17±14.11 l/min, 90.17±18.27 l/min and 93.17±20.63 l/min at 30, 60 and 90 minutes respectively in normal saline group which were statistically significant differences. Total 91.9% were admitted in ward and 8.1% got admitted in Medical and intermediate intensive care units from magnesium group and 81.7% were admitted in ward and 18.3% required ICU admissions in saline group. Differences in ventilation and mortality were insignificant. Conclusion: Nebulized magnesium sulphate as an adjuvant to salbutamol treatment in the setting of AECOPD has therapeutic benefit on PEFR but no effect in terms of hospital admission, requirement of invasive or non-invasive ventilation and mortality. Keywords: Chronic obstructive pulmonary disease, magnesium sulphate, peak expiratory flow ratePublication Prevalence of Metabolic Syndrome among Subjects attending General Health Checkup of a Tertiary Center of Kathmandu, Nepal(Institute of Medicine, 2021) Shakya, Yagya L; Raut, Shankar; Shrestha, Tirtha M; Neupane, Ram PABSTRACT Introduction: Metabolic syndrome is one of the major concerns of modern health causing morbidity and mortality. The metabolic syndrome is the constellation of metabolic disorders - insulin resistance; obesity, dyslipidemia and hypertension that are interrelated which lead to higher risk of cardiovascular disease, diabetes, stroke, atherosclerosis and serious health condition. The study focused on the prevalence of all the metabolic syndrome cases that came to general health checkup (GHC) of Tribhuvan University Teaching Hospital. Methods: The study was a cross-sectional retrospective study of all cases that came to GHC from July 2019 to October 2019. GHC records files of all patients that came for their general health check-up were used to obtain data that included demographic details and the criteria for metabolic syndrome. Waist circumference, weight, height and blood investigations were sent as a routine examination of the general health checkup. Data analysis was done in Microsoft Excel 2019 and SPSS 20. Results: Among 311 cases enrolled in our study, 99 (31.8%) met the revised National Cholesterol Education Program, Adult Treatment Panel III (NCEP ATP III) criteria for metabolic syndrome. Among those with metabolic syndrome, males were 52 (52.53%) and females were 47 (47.47%). Also, 81 (81.81%) out of 99 cases had decreased HDL (<1.03 mmol/L for males and <1.30 mmol/L for females), which was the most common component of metabolic syndrome in the study. Conclusion: Metabolic syndrome is present in almost one third of the studied apparently healthy patients coming for general health checkup and it emphasizes on awareness regarding screening for metabolic syndrome. Keywords: General health checkup, metabolic syndromePublication Risk Factors for Gall Stone Diseases in Patients Presenting to General Practice Out Patient Department in a Tertiary Care Center in Nepal(Institute of Medicine, 2019) Neupane, Ram P; Shrestha, Tirtha M; Raut, Shankar; Aacharya, Ramesh PABSTRACT Introduction Gallstone disease (GSD) is a major public health problem that is associated with a number of risk factors. This study aims to analyze the risk factors of GSD in patients visiting General Practice Outpatient Department of Tribhuvan Universtiy Teaching Hospital. Methods A case-control study of 174 participants comprising 85 cases with GSD and 89 controls without GSD, as confirmed by ultrasonography of abdomen was conducted as hospital based in outpatient department of General practice, Tribhuvan University Teaching Hospital, Kathmandu from 1st February 2018 to 31st January, 2019. The participants were asked questions regarding putative risk factors for development of GSD and underwent physical and ultrasonographic examination. Risk factors included were age, sex, BMI, occupation, co-morbidities e.g. diabetes mellitus, hemolytic diseases, family history of GSD, smoking status, alcohol consumption, parity if applicable and dietary history. Data analysis was done by univariate method. Results The mean age of the case group was 47.82 years whereas mean age for the control was 46.51 years (p=0.355). 22% of cases were male and 78% were female where as in control group 29% were male (p=0.3030). Majority of the participants in both group were housewife by occupation and Hindu by religion.Mean BMI of the cases and control were 24.05 kg/m2 and 21.13kg/m2 respectively. BMI was found significant for the gall stone diseases ( p=<0.001). Similarly, Diabetes mellitus was found significant for GSD (p=0.001). 98% cases and 61% in control group were Non-vegetarians with significant p value of 0.021. Smoking (p=0.005), Non-vegetarian diet (p=0.021), family history of gall stone disease (p<0.001) and parity (p<0.001) were also found significant for the gall stone disease. Conclusion High BMI, non-vegetarian diet, family history of gall stone disease, diabetes mellitus, smoking and increased parity were associated with gall stone diseases. Keywords: Gall stone diseases, parity, risk factors, smoking, tertiary centet