Browsing by Author "Shrestha, Gentle S"
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Publication Anesthetic Management of Apert Syndrome: A Case Report(Institute of Medicine, 2021) Koirala, Megha; Shrestha, Gentle S; Joshi, Pankaj; Parajuli, Bashu DABSTRACT Apert syndrome is a rare autosomal dominant disease associated with abnormalities of skull, face and limbs. These patients present for different types of surgeries. To the anesthesiologists,they pose special challenge during airway management, manifesting as difficulty in bag-mask ventilation and increased incidence of airway obstruction. Here, we report a case of a child with Apert syndrome undergoing syndactyly release under general anesthesia, in whom severe bronchospasm and a failed bag-mask ventilation occurred during the emergence of anesthesia requiring re-insertion of laryngeal mask airway. Keywords: Anesthetic management, Apert syndromePublication Knowledge of Nurses Working in Critical Care Areas Regarding Ventilator Associated Pneumonia Prevention Bundles in a Tertiary Level Cardiac Centre(Institute of Medicine, 2021) Bhandari, Sandip; Sharma, Medha; Shrestha, Gentle SABSTRACT Introduction: Prevention of ventilator associated pneumonia (VAP) is influenced by the knowledge and practices of nurses. This study was conducted to assess the knowledge of nurses working in critical care areas of a tertiary level cardiac centre regarding VAP prevention bundles. Methods: In this descriptive study, 57 nurses working in critical care areas were included, they completed a self-administered questionaire containing demographic information followed by 18 multiple response questions. With the respondents choosing one or more correct answers, the percentage of correct answer for each options was obtained. For each questions, the correct percentage for all the options were averaged and expressed as average knowledge percent. The significance of association was tested using chi-square and Fisher exact test, with level of significance established at 95%. Data analysis was done using SPSS version 21. Results: With a mean age of 26.8 years, the majority of the nurses had completed Bachelor’s degree (75.4%). Though 91.3% nurses had experience of more than a year in critical care, 87.7% of them had not obtained VAP or infection control training. The mean knowledge score of VAP was 70±7.5%, and 97.4% had satisfactory knowledge. There was no association between knowledge scores on prevention of VAP and educational qualification (p=0.26) and years of experience in intensive care unit (p=0.41). Conclusion: Almost all of the nurses working in critical care areas had satisfactory knowledge regarding VAP bundle, however, they had lower knowledge on the definition and approach to prevent VAP. This study recommends to incorporate more nurses in training related to infection and VAP prevention. Keywords: Critical care area, knowledge, nurses, ventilator-associated pneumoniaPublication Low Estimated GFR Predicts Hemorrhagic Complication in Acute Ischemic Stroke: A Meta-analysis(Institute of Medicine, 2021) Nepal, Gaurav, Gaurav; Shrestha, Gentle S; Yadav, Jayant K; Pathak, Santosh; Ojha, RajeevABSTRACT Introduction: Intracerebral hemorrhage (ICH) can occur in patients following acute ischemic stroke (AIS) and results in significant long-term morbidity and mortality. Patients with renal impairment have a higher risk of bleeding. Therefore, AIS patients with renal impairment may have a higher risk of such complications. We performed a meta-analysis of observational studies to determine the relationship between renal impairment and hemorrhagic complications in patients with AIS. Methods: This meta-analysis was conducted following the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed, Google Scholar, Web of Science and China National Knowledge Infrastructure (CNKI) were searched to identify studies published between 1995 and 2020. Relative risk estimates of all the included studies were pooled to calculate pooled OR and 95% confidence intervals. Results: Fourteen studies involving 10,033 AIS patients from Asia, Europe, and North America were included. We found that patients with renal impairment as indicated by low eGFR had a higher odds of developing any ICH (OR: 1.7; 95% CI: 1.13 to 2.57; p=0.011; I2=87.2%) following AIS. Similarly, we found that patients with renal impairment had a higher odds of developing symptomatic ICH (SICH) (OR: 1.7; 95% CI: 1.32 to 2.17; p<0.001; I2=37.3%) following AIS. Conclusion: There is an increased odds of developing any ICH and SICH in AIS patients with renal impairment. Keywords: Acute ischemic stroke, glomerular filtration rate, hemorrhagic transformation