Browsing by Author "Shrestha, H"
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Publication Angiographic Severity of Coronary Artery Disease in Diabetic and Non-diabetic Acute STEMI Patients in a Tertiary Care Centre of Nepal(Kathmandu University, 2021) Pathak, SR; Gajurel, RM; Poudel, CM; Shrestha, H; Thapa, S; Thapa, S; Koirala, PABSTRACT Background Patients with diabetes mellitus have a higher prevalence of atherosclerotic heart disease and a higher incidence of myocardial infarction than the general population. Definitive diagnosis and precise assessment of anatomic severity of Coronary Artery Disease requires invasive diagnostic modality like coronary angiography. Objective To study angiographic characteristics and severity involving coronary arteries in patients with acute ST segment elevation Myocardial infarction and to compare the same in diabetics and non-diabetics. Method Among 150 patients with acute coronary syndrome, 75 diabetics and 75 non- diabetics admitted in Manmohan Cardiothoracic vascular and transplant Centre were selected randomly during a period of one year formed the study group. Random Blood Sugar, Fasting Blood Sugar was done in all 150 patients, HbA1c in all diabetics. All subjects with acute ST Elevation Myocardial Infarction were taken up for coronary angiography intended for primary PCI. Result In our study, 35 (46.7%) out of 75 diabetic patients had triple or multi-vessel disease compared to 10 (13.4%) out of 75 non diabetics. Non-diabetic patients had significantly higher single vessel disease (65.3%). There was a statistically significant association of duration of DM with vessels involved. The occurrence of Triple Vessel Disease/Multivessel Disease was significantly higher in the patients with DM duration > 10 years compared to patients with DM duration < 10 years (64.7% vs. 35.3%, P < 0.001), however there was no significant difference in type of vessel involved. Similarly, a significantly higher proportion of Triple vessel disease was observed in patients with poor glycemic control (HbA1c > 8.5%). 72.2% of the patients with HbA1c > 8.5% had Triple vessel disease/Multi vessel disease, whereas patients with good glycemic control (HbA1c < 7.0%) had predominantly Single vessel disease (90.0%), with no occurrence of Triple vessel disease/Multi vessel disease Conclusion Diabetic patients presenting with ST Elevation Myocardial Infarction are likely to have triple/multiple vessel disease compared to non-diabetic patients. The occurrence of Triple Vessel Disease/Multivessel Disease was significantly higher in the patients with DM duration > 10 years compared to patients with DM duration <10 years. KEY WORDS Diabetes mellitus, Acute coronary syndrome, STEMI, Coronary angiographyPublication Decrease in Mean Platelet Volume after percutaneous transvenous mitral commissurotomy in patients with Rheumatic Mitral Stenosis(Institute of Medicine, 2017) Thapa, S; Shrestha, A; Gajurel, RM; Poudel, CM; Shrestha, H; Khanal, R; Bhatta, YD; Sayami, AAbstract Introduction: Rheumatic mitral stenosis (RMS) is associated with increased thromboembolic events, especially in the presence of concomitant atrial fibrillation. Mean platelet volume (MPV) is the marker of platelet activity as larger platelets are hemostatically active and have more propensity of thrombosis. It has also been reported that percutaneous transvenous mitral commissurotomy (PTMC) attenuates platelet activity. We aimed to investigate whether PTMC decreases MPV in patients with RMS. Methods: In the present study, MPV was measured in 39 patients with RMS in sinus rhythm just before and one month after PTMC. Thirty four, sex and age-matched, apparently healthy controls were used for comparison. Mitral valve area (MVA), mean diastolic gradient across mitral valve (MDG) and pulmonary artery systolic pressure (PASP) were measured using transthoracic echocardiography and mean left atrial (LA) pressure measured during the procedure. Results: As compared to apparently healthy controls, patients with RMS had higher MPV (11.51±1.46 v. 9.6+0.75l, p<0.001). All patients with RMS underwent successful PTMC. One month after the procedure, LA diameter, MVA, MDG, PASP and LA pressures were reduced significantly (p< 0.001). The final mean platelet volume measured in patients with RMS undergoing PTMC measured after one month also had significant reduction when compared with the initial mean MPV (11.51±1.46 vs 9.55 1.11 0.001). Conclusions: As compared to apparently healthy controls, patients with RMS have higher MPV reflecting increased platelet activity, and PTMC is associated with a significant decrease in MPV one month after the procedure. Keywords: Mean platelet volume, percutaneous transvenous mitrl commissurotomy, rheumatic mitral stenosisPublication Study of Adherence Pattern of Antidepressants in Patients with Depression(Kathmandu University, 2017) Shrestha, Manandhar J; Shrestha, R; Basnet, N; Silwal, P; Shrestha, H; Risal, A; Kunwar, DABSTRACT Background Depression is one of the leading psychiatric disorders of the world affecting a person’s mood, physical health and behavior. It is not permanent and is neither a character flaw nor a lack in discipline for a person to be ashamed of. It is a disorder that is reliably diagnosed and successfully treated. Antidepressants are the standard and the most efficacious approach to treating people with depression. However, adherence to treatment is necessary for achieving effectiveness. The result of non- adherence is severe and may cause therapeutic failure resulting in poor quality of life. Objective To determine the medication adherence pattern in patients with depression and assess the factors associated with non-adherence to the prescribed antidepressant therapy. Method Patients meeting the inclusion criteria who were diagnosed with depression were taken for the study. Informed consent was taken from the patients or from their relatives in case of their incapability. They were then interviewed using structured questionnaire. Result Among the 60 patients included in the study, 78% of them were females. Most of the patients 43% (n=26) were prescribed with atypical antidepressants. Less number (37%) of the patients were adherent to the antidepressant therapy. 68% of the females were non adherent. 82% of housewives were not adherent to therapy. Forgetfulness was the main reason for missing dose in majority (50%) of the non- adherent patients. Conclusion Majority of the patients with depression were non-adherent to medication. Forgetfulness was the major reason for missing dose in these patients. KEY WORDS Adherence, Antidepressants, Depression, Non-adherence