Browsing by Author "Pokharel, B"
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Publication Alcohol use among physicians in a medical school in Nepal(Kathmandu University, 2006) Kumar, S; Pokharel, B; Nagesh, S; Yadav, BKObjective: The objective of the study was to know about the use of alcohol among physicians and factors that were related to it. Methods: This was a cross sectional study conducted among the physicians in a medical school of eastern Nepal. A semi structured questionnaire was used to collect information. Results: There were 55 subjects in the study. Half of them were between 35-45 years age group and one fourth among them were female. There were more than 88% physicians consuming alcohol for more than 10 years. One third used to preferred whisky as their favorites drink. Use of alcohol among them was due to peer pressure and to become a social human being. Most of them drink alcohol occasionally with an average amount 30-60ml in a sitting and usually in the evening. Most of the time, they use alcohol either in parties or at home. Conclusion: Alcohol use in Nepal is very much prevalent. The use of alcohol is socially accepted in many communities. Uses of alcohol by physicians have direct effect on their health as well as the health of many people because they are role model for many people. They are also in direct contact with the patients. Steps to council the physicians may reduce the consumption of alcohol. Key words: Alcohol, Nepal, Physicians, Dependence, AbusePublication Per-operative Instrument Failure in Lumbar Spine Surgery(Institute of Medicine, 2013) Pokharel, R K; Lakhey, R B; Kafle, D; Pokharel, B; Dhakal, R K; Sigdel, A; Lalit, T; Shah, L L; Kafle, DAbstract Breakage of hardware is not an uncommon complication in spine surgery practice. Pedicle screw breakage is the commonest instrument failure encountered in spine surgery, and different relatively simple, techniques have been recommended to retrieve the threaded part of it. Per-operative breakage of an instrument like pedicle seeker and jaw of disc forceps is unpredictable and removal of an unthreaded smooth implant is difficult. We experienced breakage of the pedicle seeker while putting a pedicle screw in a case of spondylolisthesis and breakage of the mobile jaw of a disc forceps in another case of prolapsed intervertebral disc. Here we present an innovative technique of removal of the broken instrument through the pedicle. Regular maintenance and replacement of al old instrument is recommended. Keywords: per-operative instrument breakage, spine surgeryPublication Role of tiotropium in chronic obstructive pulmonarydisease exacerbation(Institute of Medicine, 2010) Pant, P; Yadav, B; Khan, G M; Koju, R; Gurung, R; Pokharel, B; Bedi, T R S; Adkhari, R KAbstract Introduction: Chronic obstructive pulmonary disease (COPD) remains a major public health problem. Many patients suffering from chronic obstructive lungs diseases are of poor economic status, mostly illiterate, therefore has a direct bearing on patient compliance. Tiotropium is a new anticholinergic therapy for chronic obstructive pulmonary disease that differs from ipratropium by its functional relative selectively for musarinic receptor subtypes and which allows single dosing a day. This study presents a cost-effectiveness, efficacy, and side-effects of Ipratropium bromide and Tiotropium in COPD. Methods: Prospective study was conducted In Kathmandu University Teaching Hospital, between the year 2008 and 2009 in terms of cost-effectiveness, efficacy, and side-effects of Tiotropium and Ipratropium amongst COPD patients. Results: Tiotropium and Ipratropium were prescribed in total of 57 patients (30 in ipratropium bromide and 27 in tiotropium bromide) for the management of COPD among outpatients. There were no significant differences in age, height, weight and baseline lung function parameters (FEV1 and PEF) between the two drugs i.e. ipratropium bromide and tiotropium bromide. Significant improvement in lung function parameters were found in each respective group of drugs after bronchodilator therapy. Tiotropium results in significant reduction of Chronic Obstructive Pulmonary disease exacerbations and significant improvement in quality of life, lung function, and dyspnoea compared to ipratropium. The additional cost to achieve these favorable outcomes was cheaper than Ipratropium bromide. (Nepalese Rs. 7.03 per day for tiotropium as compared to Rs. 9.06 for Ipratropium) Conclusions: Tiotropium results in significant reduction of chronic obstructive pulmonary disease exacerbations and significant improvement in quality of life, lung function and dyspnoea compared to Ipratropium. Keywords: Chronic obstructive pulmonary disease, ipratropium, tiotropium