Browsing by Author "Sapkota, Dharmendra"
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Publication Factors determining Outcomes in Hospitalized Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease(Institute of Medicine, 2023) Bam, Niraj; Sapkota, Dharmendra; Kuikel, SandipABSTRACT Introduction: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is frequently accompanied by increased local and systemic inflammation brought on by airway infection, pollution, or other airway insults. This study aimed to find the factors determining outcomes in patients hospitalized with acute exacerbation of COPD. Methods: An analytical study among diagnosed cases of AECOPD was conducted. Bivariate regression model followed by Multinomial logistic regression (MNLR) was used to contrast outcome variables. A p-value less than 0.05 was considered statistically significant in all analyses. Results: A total of 126 patients with a mean age of 72.04±9.75 years were included in the study. Most of the patients were current smokers or past smokers, cor-pulmonale was present in 34.9% of patients. The most common co-morbidity was hypertension (41.2%). Most (55.6%) patients had early discharge, 31.7% (40) patients had late discharge and 12.7% (16) patients had mortality as the outcome. After bivariate analysis, among all variables of the study qualified to be included in the multivariate MNLR model, Neutrophil Lymphocyte ratio (NLR) was found to be a significant predictor of late discharge in comparison with early discharge while Age and NLR were found to be a significant predictor of Mortality in comparison with late discharge among patients with AECOPD. Conclusion: Older age and higher NLR predicted mortality in comparison to longer hospital stay (>5days). Since NLR is a common variable in both the outcome (early vs late discharge and late discharge vs mortality), NLR can be used to predict the outcome (early discharge, late discharge, and mortality) of patients with AECOPD. Keywords: AECOPD; chronic obstructive pulmonary disease; factors; outcomes; predictorsPublication Survival in Critical Care Patients with COVID-19 Pneumonia: A Single Center Based Observational Study(Institute of Medicine, 2022) Bam, Niraj; Kuikel, Sandip; Sapkota, Dharmendra; Poudel, Sagar; Pant, Pankaj; Das, Santa KABSTRACT Introduction: The severity of COVID-19 pneumonia ranges from asymptomatic to requiring mechanical support for survival. This observational study describes the demographic, management, vaccination status and outcome in Nepalese patients with COVID-19 who were admitted to critical care settings . Methods: Single center based cross sectional study was conducted. All the patients admitted to critical care of Tribhuvan University Teaching Hospital (TUTH) were eligible subjects for this study. Demographic, clinical details and vaccination status of respective patients was obtained from interview and chart review. Data was collected in Microsoft Excel 2016 and statistical analysis was performed using statistical software SPSS 21. Results: A total of 342 patients with mean age 53.95±15.6 years were included in the study. The mean duration of stay in critical care was 6.74±4.43 days. Fever and shortness of breath was the predominant symptom present in the studied patients with all patients having shortness of breath. Out of the 342 patients, 20.2% (n=69) were intubated at least once during their critical care stay, 57.89%(n=198) received only non-invasive ventilation and 21.9% (n=75) received oxygen via other means. The overall survival rate of patients admitted to critical care of TUTH was 60.53% with very low survival rate in intubated patients. Only 8.8% of the included patients had received at least one dose of vaccine. Conclusion: Our study suggest that the prognosis of critical care COVID-19 patients is poor with highest mortality in patients receiving mechanical ventilation. Delay in intubation may contribute to this worse outcome in intubated COVID-19 patients. Keywords: Corona virus, COVID-19, critical care, SARS, survival