Browsing by Author "Shreewastav, Rupesh Kumar"
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Publication Empagliflozin Use among Patients with Heart Failure in the Outpatient Department of Medicine in a Tertiary Care Centre(Nepal Medical Association, 2023) Ghimire, Rinku; Pokharel, Sinet; Jayshwal, Raju; Shreewastav, Rupesh KumarAbstract Introduction: Sodium-glucose co-transporter 2 inhibitors were initially used in the treatment of type 2 diabetes mellitus and subsequently, it was shown to be useful in heart failure among patients with or without diabetes mellitus. This study aimed to find out the prevalence of empagliflozin use among patients with heart failure in an outpatient department of medicine in a Tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients with heart failure attending the outpatient Department of Internal Medicine from 1 December 2022 to 30 May 2023 after obtaining ethical approval from the Institutional Review Committee. All patients with heart failure in the given study period were included. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Out of 550 patients, 188 (34.18%) (30.22-38.15, 95% Confidence Interval) received empagliflozin. The mean age was 55.11±9.99 years. A total of 124 (65.95%) were male. The mean duration of use was 104.97±63.16 days. Among the adverse effects, electrolyte imbalance was present in 14 (7.44%), hypotension in 14 (7.44%), and acute kidney injury in 12 (6.38%). Conclusions: The prevalence of empagliflozin use among patients with heart failure was found to be lower than mentioned in the guidelines.Publication Iron Profile and Status of Anemia with the Associated Factors in Chronic Kidney Disease Patients(Nepal Health Research Council, 2023) Shreewastav, Rupesh Kumar; Joshi, Bishal Raj; Yadav, Rahul; Katwal, Anup; Shrestha, ShailendraAbstract Background: One of the main complications of chronic kidney disease is anemia. Disorders of iron homeostasis seen in such patients make the management of anemia more challenging and risky. To obtain the desired result, erythropoietin and iron dose must be carefully regulated. The aim of the study is to find out the prevalence of anemia and level iron indices in patients of chronic kidney disease at a tertiary care hospital. Methods: A cross-sectional descriptive study was conducted on chronic kidney disease patients at a tertiary care center. Demographic data like age, sex, height and weight were collected with the help of using Performa. The hematological and biochemical study variables were assayed by blood sample of the patients in the clinical laboratory services. Data were analyzed by statistical package for the social sciences Version 20.0 Results: Out of 171 patients with chronic kidney disease, 162 (94.7%) were anemic, with the highest percentage 54 (31.5%) having hypertension. The median value with inter-quartile range of hemoglobin, serum iron, serum ferritin, TIBC and transferring saturation were 8.9 gm/dl (6.7-10.0), 115.0 (µg/dl) (60.0-140.0), 599.0 ng/ml (142.6-973.0), 279.0 µg/dl (250.0-342.0) and 41.0 % (22.0-53.0) respectively. Serum creatinine and eGFR were significantly correlated with hemoglobin and iron indices. Conclusions: The current study showed that anemia was more prevalent in patients of chronic kidney disease in our setting as compared to similar studies. Hypertension was the most common disease among them. The median value of parameters of iron profile except ferritin among them was within the reference limit. Keywords: Anemia; chronic kidney disease; ironPublication Subclinical Hypothyroidism among Chronic Kidney Disease Patients Admitted to Nephrology Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2023) Shreewastav, Rupesh Kumar; Ghosh, Asok Kumar; Yadav, Rahul; Katuwal, Anup; Shrestha, ShailendraAbstract Introduction: Chronic kidney disease is a condition, which worsens the quality of life in many ways including thyroid disorder in many cases. The aim of the study was to find out the prevalence of subclinical hypothyroidism among chronic kidney disease patients admitted to the Nephrology Department of a tertiary care centre. Methods: A descriptive cross-sectional study was carried out on the patients diagnosed with chronic kidney disease at a tertiary care hospital from 15 May 2022 to 10 October 2022 after getting ethical approval from the Institutional Review Committee (Reference number: 621/2022). Pre-designed proforma was used to collect demographic data like age, sex, height and weight. Blood samples of the patients were analysed for thyroid function tests (triiodothyronine, thyroxine and thyroid stimulating hormone levels) by chemiluminescence immunoassay. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of 156 study participants with chronic kidney disease, subclinical hypothyroidism was present in 34 (21.79%) (15.31-28.27, 95% Confidence Interval) patients. Conclusions: The prevalence of subclinical hypothyroidism amongst chronic kidney disease patients was found to be lower than in other similar studies conducted in similar settings.Publication The Level of Serum Enzymes and Hormones in Patients with Miscarriage(Nepal Health Research Council, 2025) Shreewastav, Rupesh Kumar; Yadav, MunzalBackground:The level of various enzymes and thyroid hormones in blood get altered during miscarriage, which can have predictive value or importance as a biomarker for the diagnosis. The aim of the present study is to validate the alteration in the level of serum enzymes and thyroid hormones in patients suffering with miscarriage in a tertiary care hospital in Nepal. Methods: A descriptive cross-sectional study was carried out on patients suffering with miscarriage and admitted for treatment in Nobel Medical College Teaching Hospital. Demographic data were recorded in a predesigned performa. The level of various enzymes and thyroid hormones were estimated from the blood sample of patients in the department of biochemistry laboratory. Data were entered in MS excel and analyzed by statistical package for the social sciences Version version 20.0 Results: The total number of patients suffering from miscarriage and enrolled in the study was 86. The mean value of serum gamma glutamyl transferase, lactate dehydrogenase and adenosine deaminase in these patients were 22.67±8.22, 289.6±126.9 and 21.3±9.9 IU/ml respectively, which were significantly higher (p=<0.0001, 0.0004, 0.0179 respectively) when compared to healthy pregnant women. Thyroid dysfunction was noted in 15 (17.44%) patients, out of that Subclinical hypothyroidism was most common and affected 8(9.3%) individuals. Conclusions:The mean value of serum gamma glutamyl transferase, lactate dehydrogenase and adenosine deaminase in case of miscarriage was found to be elevated significantly and thyroid dysfunction was also noted to small fraction of patients suffering from miscarriage with Subclinical hypothyroidism being the most common. Keywords: Enzyme; hormone; miscarriage.