Browsing by Author "Prasad, PN"
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Publication 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 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 hypothyroidism