Browsing by Author "Thapa, Pramila"
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Publication Fever among COVID-19 Patients in a Tertiary Care Hospital of Western Nepal: A Descriptive Cross-sectional Study(Nepal Medical Association, 2021) Khatri, Prabin; Neupane, Aryan; Banjade, Ashish; Chhetri, Ashmita; Sharma, Dipesh; Chhetri, Pradip; Thapa, Pramila; Khadka, Nasatya; Karki, Saugat; Neupane, SrijanaAbstract: Introduction: COVID-19 has a wide spectrum of clinical presentation ranging from asymptomatic infection to acute respiratory distress syndrome and multi organ dysfunction. Data regarding this is scarce in our setting. This study aims to study the prevalence of fever in confirmed COVID-19 cases in a tertiary care hospital of western Nepal. Methods: We conducted a descriptive cross-sectional study among patients admitted to COVID-19 wards and intensive care units of a tertiary care hospital. We enrolled patients from August 2020 to January 2021 and the study proposal was approved by the Institutional Review Committee (reference number: 069/20). Convenience sampling method was used. Data entry and descriptive analysis were done in Statistical Package for the Social Sciences version 16.0. Point estimate at 95% Confidence Interval was calculated along with frequency and descriptive statistics. Results: Among 206 cases of COVID-19, the most common symptom was fever 136 (66.1%) (95% Confidence Interval= 58.14.63-74.05). Sixty-seven (49.3%) of those with fever required intensive care units admission whereas 27 (19.9%) of patients with fever had mortality. Most common comorbidities in the patient having fever is Diabetes mellitus 41 (66.1%) followed by hypertension 20 (62.5%). Conclusions: Fever was the most common presenting complaint with high prevalence as compared to similar studies done in similar settings. We stress the importance of considering the presence of COVID-19 even in the absence of fever as many patients presented without fever.Publication Pure Autonomic Failure: A Case Report of Recurrent Orthostatic Hypotension(Nepal Medical Association, 2021) Khatri, Prabin; Panth, Himal; Khadka, Sabina; Thapa, Pramila; Regmi, Rajshree; Shah, Sunil; Gami, Sumit; Upadhyaya, Ashutosh; Alam, Mohammad Rizwan; Sharma, SrijanaAbstract: Pure autonomic failure is a neurodegenerative disorder affecting the autonomic nervous system which clinically presents with orthostatic hypotension. It is a diagnosis of exclusion after detailed clinical examinations and relevant investigations. Here, we discuss a case of 68 years old male who had complaints of multiple episodes of loss of consciousness on standing from a sitting position for the last 3 years. The diagnosis was considered by clinical examinations revealing autonomic dysfunctions with normal appropriate investigations. The patient was treated successfully with midodrine, fludrocortisone, and other non-pharmacological interventions. We focused on doing various autonomic dysfunction tests in the evaluation of a patient with recurrent orthostatic hypotension. We suspect that pure autonomic failure might not have been considered in the differential diagnosis of recurrent orthostatic hypotension and suggest that it is to be kept as a differential in such a scenario. Midodrine has an effective role in syncope due to sympathetic vasoconstrictor failure.