Browsing by Author "Upreti, Anup R"
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Publication Characteristics and Outcomes of COVID-19 Patients Admitted to Adult Intensive Care Unit: A Single-Center Observational Study from the Second Wave in Nepal(Institute of Medicine, 2021) Pradhan, Saurabh; Upreti, Anup R; Upadhyaya, Sarobar; Oli, Manish; Shrestha, Asim; Shrestha, YashaswiABSTRACT Introduction: There is inadequate data of critically ill COVID-19 caused by the delta variant. So, we sought to investigate the characteristics and outcomes during the second wave in Nepal. Methods: COVID-19 patients admitted to adult ICU of a single institution from April to August 2021 were included. Clinical, laboratory and radiological findings were collected. In-hospital mortality, length of ICU stay, duration of mechanical ventilation (MV) and complications during ICU stay were obtained. Results: Total 136 patients were included with a mean age of 56.24 (± 15.81) years and 52.2% males. Fifty-five percent had comorbidities. Mean fraction of inspired oxygen required was 0.8 and sequential organ failure assessment score on admission was 4.09. C-reactive protein (CRP), lactate dehydrogenase and ferritin levels were elevated to 62.5mg/L, 515 U/L and 472ng/mL respectively. The computed tomography score was 20. Thirty four (25%) required MV; 70 (52%) were managed with non-invasive ventilation; 41 (30.14%) required vasopressors; 4 (2.9%) required renal replacement therapy. In-hospital mortality was 43.4%. The median length of ICU stay and duration of MV were 6 and 3.5 days respectively. Hospital acquired infection was the commonest complication. Age (OR 1.126 (95% CI 1037-1.223, p value 0.005)) and CRP on admission (OR 1.023 (95% CI 1.000-1.047, p value 0.050) were found to be predictors of mortality. Conclusion: In this single center study from the second wave of the pandemic, majority of critically ill COVID-19 patients were elderly with co-existing illnesses. In-hospital mortality was high. Age and CRP on admission were found to be independently associated with poor outcome. Keywords: Characteristics, COVID-19, critical care, Nepal, outcomesPublication Topical Corticosteroids Utilisation and Cost Variation in Dermatology Outpatient of a Tertiary Hospital in Kathmandu(Institute of Medicine, 2021) Shrestha, Deepti; Joshi, Smita; Gurung, Rashmi Shakya; Poudel, Rekha; Upreti, Anup RABSTRACT Introduction: Topical corticosteroids (TCs) are one of the important drugs prescribed in skin diseases. Cost is an important factor for compliance to treatment. Cost analysis provides the variation of costs which helps in economic benefit in the use of drugs. Thus the aim of the study was to assess the TC utilisation in Dermatology department and study its cost variation. Methods: A descriptive cross-sectional study was conducted in the out-patient of Department of Dermatology, Nepal Medical College Teaching Hospital. Patient demographic, disease, name of topical steroid, vehicle, strength, single or combination, cost of the different brands of TCs were analysed. Results: Out of 216 patients, 109 (50.5%) were females and 67 (31%) were of 21-30 years age group . Dermatitis was the most common skin condition encountered (106, 49.1%). Most common TC prescribed as single therapy was mometasone furoate 0.1%, (51, 23.6%) and betamethasone valerate 0.1% with fusidic acid, (48, 22.2%) as combination therapy. Mometasone furoate 0.1% cream, (15 gm) showed the maximum cost variation (94.7%) in single drug product while clobetasol propionate 0.05% with salicylic acid ointment (20 gm) showed the maximum cost variation (95.55%) in a combination product. Conclusion: The commonest indication of TCs use in Dermatology outpatient during our study was dermatitis, with commonest TCs prescribed being mometasone furoate. Cream was the most favoured vehicle. Cost variation was as high as 95% . Reduction in this cost variation would ease the financial burden on patients which will help in improving the patient compliance in a resource limited population. Keywords: Cost analysis, cost variation, dermatology, topical corticosteroids