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Browsing by Author "Paudel, BH"

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    Heart rate variability: Response to graded head up tilt in healthy men
    (Kathmandu University, 2009) Sharma, P; Paudel, BH; Singh, PN; Limbu, P
    Abstract Background: Heart rate variability is actually a misnomer for R to R variability in cardiac cycle. Variation in successive cycle length is called the heart rate variability (HRV). Head-up tilt is a model of studying cardiovascular haemodynamics, which reflects in heart rate variability (HRV). Objectives: To study the effect of 10° and 70° head-up tilt on HRV. Materials and methods: The study was done in the Department of Physiology using graded head up tilt (passive orthostatism). HRV measurement was done at 10° and 70° tilt and compared with supine using standardised methods on 30 consenting healthy males (age 25.37±3.89 years). The HRV variables across postures were compared by ANOVA and Bonferroni test. Results: The heart rate increased at 70° compared to 10° and supine (70.48±8.17 Vs 70.22±8.67 and 88.51±12.84 bpm, p<0.001). The 70° tilt decreased vagal HRV indicators compared to 10° and supine: SDNN (31.13±8.12 Vs 38.07±11.29 and 38.13±10.89 ms, p<0.05), RMSSD (20.06 ±8.47 Vs 34.23±14.22 and 36.16±12.22 ms, p<0.001), NN50 count (13.03±20.58 Vs 45.07±44.44 and 55.27±44.10, p<0.01), pNN50 (3.28±6.08 Vs 14.06±15.65 and 16.65±14.23, p<0.01), HF power (197.20±143.76 Vs 218.17±155.85 and 216.87±150.98 Hz, p<0.05), HFnu unit (24.28±14.16 Vs 45.48±16.34 and 47.67±19.89, p<0.001). The 70° tilt increased LF power% (197.20±143.76 Vs 218.17±155.85 and 216.87±150.98, p<0.001). LFnu unit (75.72±14.76 Vs 54.52±16.34 and 52.32±19.89, p<0.001), LF: HF (4.96±4.08 Vs 1.53±1.138 and 1.69±1.67, p<0.001) compared to 10° and supine. Conclusion: At 70° tilt, HRV measures, reflecting vagal contribution to cardiac-cycle length, decreased with reciprocal increase in sympathetic activity compared to 10° or supine leading to increase in sympathetic predominance. A 10° tilt, which is almost equivalent to lying down with pillow, did not change HRV from supine. Key words: Cardiac cycle, cardiovascular haemodynamics, head-up-tilt, heart rate variability, sympathetic activity, parasympathetic activity
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    Nerve Conduction study in healthy individuals a preliminary age based study
    (Kathmandu University, 2010) Thakur, D; Paudel, BH; Jha, CB
    ABSTRACT Background Nerve conduction study assesses peripheral nerve functions and has clinical implication. Objectives To study the effect of age on nerve conduction study variables in healthy adults. Methods Cross sectional study was done from Jan 2006 to Dec 2006 in department of Physiology, BP Koirala Institute of Health Sciences, Dharan, Nepal. The study was done in 34 (younger, n= 18, 17 to 29 years; older, n= 16, 30 to 57 years) consenting healthy adults of either sex. The compound muscle action potential and sensory nerve action potential were recorded using standard technique. Due to the non-normal distribution of data, the effect of age on nerve conduction study variables was analyzed using Mann Whitney U test. Results Younger vs. older individuals: older had lower Compound Muscle action potential amplitude (mV) in all motor nerves except radial and left ulnar nerves. Compound Muscle action potential duration (ms) was shorter in older (p<0.05) in ulnar, tibial, right median and left common peroneal motor nerves than the younger: right median (6.92±1.3 vs. 8.5±1.88), right ulnar (7.09±1.54vs. 8.2±1.31), left ulnar (10.56±1.44 vs. 12.06±1.5), right tibial (6.28±0.81vs. 7.28±1.12), and left tibial (9.58±1.52vs.10.78±1.71). Sensory nerve actional potential amplitude (μV) was smaller in older as compared to younger: right median (19.01±7.83 vs. 26.97±10.63), right ulnar (10.9±3.44 vs.16.09±5.85) and right radial (14.31±4.34 vs.19.72±6.47). SNAP duration (ms) was longer in older: right ulnar (1.34±0.17 vs.1.26± 0.18), left ulnar (1.46±0.14 vs. 1.29±0.26), and left median (1.11± 0.14 vs. 1± 0.14). Conclusions Age has definite effects on amplitude and duration of motor and sensory nerves. Different nerves have different timing of aging. Without adjustment for age, the sensitivity and specificity of nerve conduction study will decrease whenusing the same reference data in patients with different age. Key Words age, compound muscle action potential, nerve conduction study, sensory nerve action potential
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    Preparing tutors for problem-based learning: An experience from B. P. Koirala Institute of Health Sciences, Nepal
    (Kathmandu University, 2010) Baral, N; Paudel, BH; Das, BKL; Aryal, M; Gautam, A; Lamsal. M
    Abstract Background: Problem based learning (PBL) has made major impact on curricular designing and practice in medical education for the last forty years. Incorporation of PBL approach in medical education has been a challenge and opportunity for both educationists on how to impart change and medical teachers on how to internalise the change. Objectives: This paper aimed to investigate experiences, achievement and responses of medical teachers at B. P. Koirala Institute of Health Sciences (BPKIHS), Nepal. Materials and methods: There were 25 heterogeneous groups of teachers, majority of them were entry level. Pre- and Post- test question were taken from various topics relevant to PBL such as learning strategy and principles of adult learning, PBL practice at BPKIHS, tutorial session and role of a tutor, making resource session interactive, designing PBL problems, planning educational objectives in PBL, formulation of problem for PBL. In addition to it participants’ perception on development and dissemination of PBL manual and effectiveness of workshop were also included in the questionnaire. Results: There was significant gain in knowledge following the workshop (p<0.001). The perception of the teacher found quite relevant and useful for adopting new role as tutor. The respondent teachers noted that skills they learned during the training will be applicable to their job situation. They stressed for an additional training for reinforcement and update with new trends and tools in PBL. Conclusion: Therefore, such trainings for faculty development would be highly beneficial to inculcate new competencies in PBL. Key words: BPKIHS, Faculty Development, Problem Based Learning

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