Browsing by Author "Rayamajhi, A"
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Publication Heart Failure: Past, Present, Future(Kathmandu University, 2021) Karki, DB; Bhattarai, TR; Rayamajhi, AABSTRACT There are 23 million people with heart failure in the world. Heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) need to be identified before advising treatment of heart failure. Coronary artery disease, dilated cardiomyopathy, valvular heart disease, and hypertension are the common causes of heart failure. Diuretics, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and neprilysin receptor blockers have been found to reduce mortality in heart failure. Natural compensatory mechanisms such as release of various vasoconstrictors and vasodilators in heart failure come into action to improve symptoms for some time. Ultimately compensatory mechanisms fail to work and patients reach end-stage heart failure. Mechanical circulatory support devices are recommended as a bridge treatment before heart transplant. The only option at this stage is heart transplant which is not feasible easily in the low and middle-income countries. Though end-stage heart failure treatment with inotropic drugs improves symptoms for a short period, various trials have shown increased mortality with their uses. On-going research on heart failure is expected to come out with more effective treatment of heart failure in future. KEY WORDS Cardiac output, Cardiac transplant, Heart failurePublication Latex Agglutination Test for Early Detection of Causative Organism in Acute Bacterial Meningitis(Nepal Paediatric Society (JNPS), 2013) Mishra, B; Mahaseth, C; Rayamajhi, AAbstract: Introduction: Acute bacterial meningitis is one of the leading causes of mortality and morbidity in children. Identification of the causative organism is crucial to its management and outcome. The objective of this study was to see the usefulness of latex agglutination test in the early diagnosis of acute bacterial meningitis. Materials and Methods: A hospital based prospective cross-sectional study was conducted at Kanti Children’s Hospital during December 2004 to August 2005. Cerebrospinal fluid from 150 consecutive clinically suspected cases of acute bacterial meningitis between the age group of 2 months to 14 years were analyzed. Bacterial culture and latex agglutination test was done on cerebrospinal fluid obtained from all 150 suspected cases of acute bacterial meningitis. Latex agglutination test was done using the BD DirectigenTM Meningitis Combo test kit (Becton, Dickinson and company, USA) for Streptococcus pneumoniae, group B Streptococcus, Escherichia coli, Neisseria meningitidis group A,C and Y/ W135, and Hemophilus influenzae type b. Data was analysed by using SPSS Version 11.5. Results: Of the 150 Cerebrospinal fluid samples analysed bacterial culture identified only 4 meningitis cases giving an isolation rate of 1.3% whereas latex agglutination test identified 29 cases giving an isolation rate of 19.3% from 150 samples. Streptococcus pneumoniae, Hemophilus influenzae type b and Group B Streptococcus were the most common causative organism. Conclusion: Latex agglutination test has a better yield, higher sensitivity, provides microbiological diagnosis earlier than the traditional cerebrospinal fluid culture and is easy to perform.Publication Pleural Effusion in Children: How often do we suspect Tubercular origin?(Nepal Paediatric Society (JNPS), 2010) Shrestha, PN; Rayamajhi, AAbstract: Introduction: Pleural effusion is a common problem in children; mostly due to common causes like pyogenic or tubercular infections. Different studies have showed that about 30%-60% of pleural effusion have resulted into formation of empyema. Method: This was an observational study done in children aged 3 months to 14 years with a diagnosis of pleural effusion admitted at Kanti Children’s Hospital, Maharajgunj from August 2009 to March 2010. The aim of the study was done to find out different modalities of treatment for the same and their outcome. A detailed clinical history and physical examination, was done in all children. Chest x-ray, laboratory reports and treatment were recorded and all patients followed up until death or discharge. Any change of management was also noted. Pleural effusion caused by nephritic syndrome or congestive cardiac failure were excluded from the study. Results: During the study period of eight months, 64 patients were admitted with the diagnosis of pleural effusion. Boys to girls ratio was 2:1. Right-sided pleural effusions were more common than left sided pleural effusions (53% vs. 37%). Most of patients improved with parental antibiotics along with chest tube drainage (62%). One in three patients (31%) received anti-tubercular drugs. Three patients (4.6%) were referred to surgeon for decortications and one patient (1.6%) died. Conclusion: Though chest tube drainage with parental antibiotics was the mainstay of treatment of pleural effusion, however one-third of patients also received anti-tubercular drugs.Publication Relationship of Respiratory Symptoms and Signs with Hypoxemia in Infants Under 2 months of Age(Nepal Paediatric Society (JNPS), 2011) Agrawal, K; Mahaseth, C; Rayamajhi, AAbstract: Introduction: Hypoxemia is the most serious manifestation of any acute illness in infants less than two months and has shown to be a risk factor for mortality. Hypoxia can be detected using a pulse oxymeter or arterial blood gas analysis. However this facility is not available in most centers of Nepal. This study has correlated different signs and symptoms to predict hypoxia. Methodology: This hospital based prospective cross sectional study included 160 infant < 2 months, presenting to OPD or Emergency department with any acute illness A complete history was taken and weight, temperature, respiratory rate, heart rate and oxygen saturation was recorded. Presence or absence of nasal flaring, cyanosis, chest indrawing, head nodding, grunting, wheezing and crepitations on auscultation was recorded subsequently. Clinical signs of hypoxemic and non hypoxemic infants were compared and then analyzed. Results: 160 infants, 95 (59.4%) were male and 65 (40.6%) were female. Of the total population, 56(35%) were hypoxic where as 104(65%) were non hypoxic. Infants who presented with more than 3 symptoms, were lethargic, tachypneic or had chest indrawing had higher sensitivity(92.8%, 75%, 75% and 89.3 % respectively) where as infants with nasal flaring, grunting, head nodding or central cyanosis had high specificity (91.3%, 87.5%, 98% and 100%) respectively. Conclusion: Infants presenting with ≥ 3 symptoms, lethargy, respiratory rate of ≥ 70/minute or chest indrawing can be used for screening purpose to detect hypoxia and infants showing signs like grunting, head nodding, nasal flaring or central cyanosis should be considered hypoxic and treated with supplemental oxygen.Publication Rheumatic fever and rheumatic heart disease: how often we suspect infective endocarditis(Institute of Medicine, 2012) Shrestha, P N; Das, A; Rayamajhi, A; Mahaseth, CAbstract Introduction: Rheumatic fever and rheumatic heart disease is a common problem in developing countries. Rheumatic valvular heart disease is one of the important risk factor for infective endocarditis. Methods: Retrospective study was conducted among 56 children admitted in cardiology ward of Kanti children hospital with the diagnosis of rheumatic fever or rheumatic heart disease during May 2008 to M ay 2010. Results: We found male to female ratio 2: 1, median age 12 (5- 14yrs) with the most affected age group of 11- 12 years. Common symptoms were fever (66%), dyspnea (68%), joint pain (50%), palpitation (30%), cough (16%) and chest pain (12%). Only 9% of patients had positive history of sore throat. Six ty percent patients were presented with features of congestive cardiac failure (CCF). A SO positive was found in 25 (44.6%) cases. The most common valvular lesion was mitral regurgitation (M R). Moderate to severe mitral regurgitation was found in 89% of cases. Tricuspid regurgitation (T R) was found in 57% of patients and aortic regurgitation (A R) in 55% of cases. Thirty-two patients (57%} had PA H in which 8 patients has severe PAH and 24 patients had mild to moderate PAH . Infective endocarditis was diagnosed in twenty patients (35.7%). Out of 20 patients 14 (70%) had vegetation in echocardiography. The mortality was 11% in this study. Conclusion: Infective endocarditis is the major complication of rheumatic heart disease among children of Nepal and so clinical suspecian is important whenever patients with rheumatic heart disease present with fever. Keywords: dyspnea, endocarditis, rheumatic fever, rheumtic heart diseasePublication Safe Abortion Services - Need of the Day(Nepal Health Research Council, 2003) Basnet, N; Rayamajhi, A; Uprety, D