Browsing by Author "Prasad, PN"
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Publication Body mass index and its relation with hypertension, diabetes mellitus and ischemic heart disease in a general health clinic in Nepal(Institute of Medicine, 2006) Acharya, RP; Prasad, PN; Gupta, MPAbstract Background: Obesity is increasing rapidly in both developed and developing countries and the new generations are at increased risk. Similarly, the prevalence of non-communicable diseases are also increasing. In this context, attempt has been made to correlate the situation. Objective: To find out the Body Mass Index (BMI) in patient suffering from three common noncommunicable diseases - hypertension, diabetes mellitus and ischemic heart disease (IHD). Material and Methods: Aretrospective study was carried out in the clients attending General Health Check up Clinic at Tribhuvan University Teaching Hospital, Katmandu during a period of six months. Those suffering from Hypertension, Diabetes Mellitus and Ischaemic Heart Disease were included and BMI was analysed. Results: In this study, a total of 464 records were analyzed. Analysis of BMI revealed 5.8% to be underweight (<18.5), 52.2% to be normal (18.5-25.0), 37.9% to be overweight (25.1-30.0) and 4.1% to be obese (>30.0). Out of 19 obese cases, 73.7% had hypertension, 10.5% had diabetes mellitus and 5.3% had IHD. Similarly, out of 176 overweight cases 46.0% had hypertension, 6.8% had diabetes mellitus and 3.4% had IHD. The cases with normal weight or underweight had significantly lower incidence of these diseases. Out of 242 normal cases, 21.1% had hypertension, 5.4% had diabetes mellitus and 2.9% had IHD. Out of 27 underweight cases, 3.7% had hypertension, 3.7% had diabetes mellitus and none had IHD. Conclusion: This study showed that overweight and obesity is not uncommon in Nepali population; and is related with the higher incidence of hypertension, diabetes mellitus and IHD.Publication Empirical use of antibiotics in Emergency Department of Tribhuvan University Teaching Hospital and Treatment Success Rate in Discharged Patients(Institute of Medicine, 2014) Joshi, D; Bhandari, S; Upreti, AR; Banjara, MR; Regmi, BM; Prasad, PNAbstract Introduction: Infectious diseases are the common presentation in emergency department, which require treatment within minutes. As a result, the empirical antibiotics are started prompt in emergency department before the bacteriological results are available. Therefore, the aim of this study was to explore the use of antibiotics at emergency room and to determine the success rate in discharged patients. Methods: A descriptive, exploratory, non-interventional study was conducted during 8 weeks among the discharged patients from emergency department who received the antibiotic therapy and culture/ sensitivity test was asked. Patients were followed from emergency room and adequate information was taken from emergency records and also at the time of outpatient department visit. Results: Out of 297 patients, only 179 patients were studied. We found that 75.1% of empirically prescribed antibiotics were oral. The most commonly administered intravenous and oral antibiotics were ceftriaxone (20.4%) and cefixime (17.0%). The most common isolate leading to emergency department visit was Escherichia coli (29 patients, 16.2%). In vitro sensitive test for gram positive and gram negative isolates, amoxicillin-clavulanate combination and ciprofloxacin were most effective and cefixime was the least effective antibiotic. The treatment success rate was found to be 147(82.1%) of the patients, as the medication prescribed at emergency room was continued by outpatient department physician. Conclusion: Quinolones and cephalosporins groups of antibiotics are rising as the determinant antibiotics at emergency room. The rate of appropriate use of antibiotics and treatment success rate were found to be higher. Keywords: antibiotics, emergency department, emperical theoryPublication Factors determining self-harm(Institute of Medicine, 2010) Shakya, YL; Acharya, R; Gupta, MP; Banjara, MR; Prasad, PNAbstract Introduction: Self-harm forms a significant proportion of patient attending in emergency departments, typically 10-30 per 100000 people commit suicide annually. The objective of this study was to find out the factors responsible for self harm. Methods: This is a cross-sectional study of 100 patients of self-harm coming to Emergency Department of Tribhuvan University Teaching Hospital from from 1st October 2007 to 31st March, 2008. Questionnaire about demographic information of patient along with details about cause of self-harm, and any other illnesses associated was filled. Information about duration of arrival in emergency department, place of self-harm was gathered. Patients were clinically examined and hematological and biochemical tests including liver function test and the type of poison used and its level in blood were examined. Results: Total number of patients with self-harm was 100 (female - 71%; male- 29%). Among female,16-30 years age group to be the largest (76%). Mean duration of arrival in emergency department was3.08 hour. Metacid ingestion (29%) was found to be the most common cause for self-harm. There is no difference of self-harm for suicide and threat cause. Only 5% of patient with self-harm has psychiatry illness in the past. Conclusions: Self harm forms a significant proportion of patient attending the Emergency department and the most common form of self-harm used was metacid ingestion. There is compelling evidence for the need to improve delivery of care for patients who inflict self-harm. Keywords: Cause, emergency department, self harmPublication Feasibility study of acute thrombolytic therapy for stroke in a tertiary care center in Nepal(Institute of Medicine, 2018) Pradhan, S; Shrestha, PS; Acharya, SP; Prasad, PNAbstract Introduction: Early thrombolysis is the recommended therapy for acute ischemic stroke (AIS). In a developing country like Nepal, many factors contribute to the delay in performing prompt thrombolysis. This was a feasibility study to assess the determinants of pre-hospital delay for patients diagnosed with AIS. Methods: From 16th July to 16th September 2017, patients diagnosed with AIS in the emergency department (ED) were identified and a structured interview with the patient or next of kin was performed. Various pre-hospital time intervals and possible factors resulting in delay were assessed. Results: A total of 58 AIS patients were studied. Only 12% of the total patients underwent thrombolysis. The mean delay (+/-sd) from symptom onset to first contact with a medical personnel was 6.74 (+/- 7.84) hours. The mean (+/-sd) total arrival delay to ED was 15.78 (+/-17.48) hours. The mean (+/-sd) delay in dispatch to delivery time was 9.12 (+/-15.57) hours. Ten patients (17%) arrived to our ED within 3 hours of onset of symptoms, and 14 (24%) arrived within 4.5 hours of onset of symptoms. Fifty percent of those who presented on time for thrombolysis underwent the therapy. Conclusions: This study shows that there are major obstacles before we are able to provide adequate thrombolysis services for AIS. There remain plenty of areas where the government, the hospital and public health services need immediate addressing. Key words: feasibility, ischaemic stroke, pre-hospital delay, thrombolysisPublication Impact of duration of Prolong Manual Bag ventilated patients in the Emergency Service(Institute of Medicine, 2014) Maharjan, PK; Aacharya, RP; Prasad, PNAbstract Introduction: There are increasing numbers of critically ill patients who need urgent emergency intubation in Emergency Service. Due to limited number of ventilators and even lack of portable ventilators in emergency room, we need to continue prolong manual bag ventilation of those patients after emergency intubation. Therefore, the aim was to analyse the impact of duration of prolong manual bag ventilated patients in the Emergency Service, Tribhuvan University Teaching Hospital in Nepal. Methods: This was a prospective non-interventional cross-sectional study conducted from August 2012 to July 2013 (one year). This study included those Emergency Intubation cases with written informed consent from patient's party/guardian/legal representative to enroll in this study and excluding otherwise. Results: 172 (0.4% of 45000 emergency room patients) patients were enrolled and divided in to Group I: Manual Bag Ventilation without Mechanical Ventilation (MBV-MV)-56 (32.6%) and Group II. MBV with MV (MBV+MV) 116 (67.4%) with accounting the incidence of such critically ill rarely found cases. The age ranges from 11 to 94 years with mean 49+-19. There were 33 Alive and 139 Death (p 0.006), M:F=1.32:1, MBV duration was with median 540 min (p0.02), 22.7% had <180 minutes MBV with survival rate 28.25% (OR 1.98, p 0.162 comparing with >181 minutes), 58.2% cases were only MBV in ER with 100% mortality. 41.2% had mechanical ventilation after MBV with median 3 days, mean 5.0+-SD 4.9 days in ICUs with 71.5% crude ill-defined mortality (p 0.042, ROC0.704). The probability of survival after emergency intubation varies with duration of MIBV as 0.8 in 1hr (7.1% mortality) and 0.02 after 24hrs (92.3% mortality) with underlying causes and availability of present treatment. Conclusion: Irrespective of underlying causes, due to prolong manual bag ventilation without mechanical ventilation; there was increase chance of mortality and even 100% mortality as ill-defined crude mortality. Keywords: Emergency Room, Emergency Intubation, Manual Bag Ventilation, Mechanical VentilationPublication Knowledge, Attitude and Practice regarding Diabetes among Diabetes Patients at a Tertiary Teaching Hospital in Nepal(Institute of Medicine, 2018) Gupta, SK; Yadav, RS; Gupta, RK; Shrestha, S; Shakya, YL; Prasad, PNAbstract Introduction: Diabetes is a chronic metabolic disease which is prevalent all over the world. Its burden has immensely increased in the last two decades. The problem in young people is equally worrisome. Its number in Nepal is estimated to reach 6,38,000 by the year 2025. Many lifestyle and environmental factors have contributed to its rapid rise. It has several microvascular and macrovascular along with systemic complications. There is lack of public awareness on diabetes in our communities. This study aims to assess knowledge, attitude and practice about diabetes among diabetic patients. Methods: This study was conducted in Tribhuvan University Teaching Hospital General Practice OPD. All the diabetic cases attending to OPD were taken for a sample size of 120. Diabetic cases were followed and informed written consent was taken from each patient. All statistical tests were performed using 0.05 as level of significance. Results: Among 120 study patients, 59.16% were male and 40.83% were female. Majority of cases belonged to 41-60 years. More male (40.83%) were literate than female (10%). Knowledge regarding dryness of mouth, urinary frequency, kidney failure as complication, effect of high blood pressure, blood pressure measurement, foot care and exercise was 36.67%, 19.17%, 47.5%, 73.33%, 85%, 19.17% and 43.33% respectively. Practice of diet plan was found in 56.67%. Practice of blood pressure monitoring and eye checkup at an interval of one month was 30% and 20% respectively whereas 41.67% had never had their eye checkup. Compliance to antidiabetic medicines was found in 71.66%. Knowledge on exercise among age group (P=0.032), knowledge on effects of high blood pressure among male and female (P=0.009) as well as literacy among male and female (P=<0.001) were found statistically significant. Conclusion: This study shows that patient’s knowledge about foot care and practice of diet plan was not appreciable. Patient’s attitude and practice about diabetes was also not significant. Diabetes health knowledge need to be improved for better health promotion. Key words: Diabetes; diet; foot care; KAPPublication Outcome of Severe Pneumonia with Adjunct Corticosteroid Therapy at a Tertiary Care Teaching Hospital in Nepal(Institute of Medicine, 2018) Sthapit, R; Maharjan, RK; Pant, P; Prasad, PNAbstract Introduction: Severe pneumonia is a major cause of Emergency Room (ER) admission and morbidity and mortality worldwide. Early identification and adequate resuscitation in the initial hours after severe pneumonia is the challenge today for a better outcome. It is not clear whether corticosteroid (CS) as adjunct therapy in severe pneumonia improves the outcome. Therefore, this study was done to assess the benefit of adjunct CS therapy in the treatment of severe community acquired pneumonia (CAP). Methods: This was a prospective, randomized controlled trial (RCT) conducted from May 2017 to April 2018 (12 months) in the ER, Intensive Care Unit (ICU), Intensive Critical Care Unit (ICCU), and Medical Intensive Care Unit (MICU) of Tribhuvan University Teaching hospital (TUTH) in patients with severe CAP {(Pneumonia Severity Index (PSI) grade IV and V)} in two groups of patients (with and without steroid as adjunct therapy). Results: Clinical cure at 5 days in the steroid and no steroid group was 43.2% and 54.1% respectively (P =0.696); clinical cure at 28 days in the steroid and no steroid group was 75.9% and 79.3% (P = 0.753) respectively. Treatment failure was comparable in the steroid and no steroid group (45.9 % Vs 37.8 %; P = 0.696). Overall mortality in steroid and no steroid group was 32.5% and 27.5% respectively (Chi square = 0.238, p=0.626).There was no statistically significant difference in the time to clinical stability (ttcs) between steroid and no steroid group (mean ttcs: 5.22 days Vs 5.78 days, SD: 3.106 Vs 3.671, pvalue: 0.521). The mean length of stay (LOS) in hospital for steroid group: 10.26 days, mean LOS for no steroid group: 11.26 days; p value: 0.438). Conclusion: Among patients with severe pneumonia, adjunct corticosteroid therapy did not result in lower 48 hours, 5 days, and 28-days mortality. Hence, it was found that adjunct corticosteroid therapy is not beneficial in patients with severe pneumonia. Keywords: severe pneumonia, corticosteroid, outcomePublication Prolonged QT dispersion in Subclinical Hypothyroid Females: A Study in University Teaching Hospital in Central Nepal(Kathmandu University, 2019) Kandel, S; Rana, BSJB; Prasad, PN; Mahotra, NB; Shrestha, TMABSTRACT Background QT dispersion is a simple index derived from 12 lead ECG; its prolongation has been shown to be associated with increased arrhythmia risk. Increased cardiovascular risks, particularly occurrence of the malignant arrhythmias are a common finding in patients with subclinical hypothyroidism. This increased arrhythmia risk is found to be higher mainly in patients with TSH level more than 10 milli international unit per liter. Objective To assess QT dispersion among subclinical hypothyroid and euthyroid Nepalese females aged 20-59 years attending general practice out patient department of centrally located University Teaching Hospital from November 2016 to April 2017. Method Forty-three newly detected subclinical hypothyroid females and forty-one euthyroid females were enrolled. Resting electrocardiogram (ECG) was performed. QT dispersion was analyzed from ECG and corrected for heart rate using Framingham correction formula. Independent sample t-test was applied to compare mean QT dispersion between two groups. Pearson correlation test was used to examine the association between QT dispersion and TSH level. Result Mean QT dispersion for sub-clinical hypothyroid group was 75.35 ± 43.82 whereas mean QT dispersion for euthyroid group was 59.51 ± 22.13, with p value 0.041. A weak association between QT dispersion and TSH level was seen with correlation factor of 0.23. Conclusion The result showed prolongation of QT dispersion in sub-clinical hypothyroid group and weak positive correlation between TSH level and QT dispersion suggesting arrhythmia risk in subclinical hypothyroid females. KEY WORDS Arrhythmia risk, QT dispersion, Sub-clinical hypothyroidismPublication Prophylactic leg wrapping in elective cesarean section under bupivacain spinal anesthesia(Institute of Medicine, 2006) Sharma, SA; Prasad, PN; Marhatha, MN; Gupta, MPAbstract Background: Hypotension is the most frequent and serious complication associated with spinal anesthesia in obstetrics. Over the years many interventions have been tried to prevent the hypotension. Preloading with fluid, prophylactic vasopressors and leg wrapping have been seen as effective interventions. Leg wrapping, a noninvasive and a nonpharmacologic method, has consistently been seen as an easy and effective intervention. Various studies using Esmarch bandage, graduated compression bandage and inflatable boots are found in the literature. Till now no study has been done using Elastic leukocrepe bandage, which is cheap and widely available. This study was thus carried out with the aim of finding out if wrapping with elastic leukocrepe would have a similar effect. Methods: In a randomized controlled study, 30 patients (15 in each group) had either their legs wrapped or no wrapping prior to spinal anesthesia before cesarean section. Systolic blood pressure and rescue mephentermine use were recorded. Result: The mean systolic blood pressure, SBP, at different time intervals was compared. The leg wrapped group had consistently higher SBP. Overall, 12 out of 15 patients in the leg wrapped group and all 15 patients in the control group experienced hypotensive episodes requiring rescue dose of mephentermine. The number of patients who had more than one hypotensive episodes during the surgery was also analyzed. 5 out of 15 cases compared to 14 out of 15 controls had more than one hypotensive episodes requiring supplemental mephentermine. Conclusion: The findings of my study suggest that the wrapping of lower limbs with Leukocrepe elastic bandage (like other methods of wrapping) decreases the incidence of hypotensive episodes to a significant degree however it does not eliminate the incidence of hypotension in spinal anesthesia given to elective cesarean section patients. Keywords: prophylactic leg wrapping, elective CS, spinal anesthesia