Journal Issue: Vol. 21 No. 01 (2023): Issue 58 Jan-Mar
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1999-6217
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Free Basic Healthcare in Nepal: Can the Dream be Turned into Reality in the Pursuit of Universal Health Coverage?
(Nepal Health Research Council, 2003) Aryal, Krishna K
NA
Incidence and Predictors of Delirium After Cardiac Surgery
(Nepal Health Research Council, 2023) Bajracharya, Smriti Mahaju; Baidya, Rabin; Bhandari, Sandip; Amatya, Ashish G
Abstract
Background: The overall purpose of this study was to determine the incidence and perioperative factors that predispose to cause delirium in postoperative cardiac surgery patients in our Intensive Care Unit.
Methods: We performed a prospective, observational study. Following institutional review board approval, this study included 234 patients above the age of 18 years meeting the inclusion criteria for cardiac surgery in Shahid Gangalal National Heart Center from July 2018 to December 2018. Preoperative, intraoperative and postoperative data for possible risk factors were obtained. Daily assessment of delirium was done during Intensive Care Unit stay of the patient. Collected data were analysed by means of statistical software SPSS-21.
Results: The incidence of delirium was 15.6% (35/224) in our study. Delirium was seen in 14 out of 58 (24.1%) patients with age >60 years which was found to be statistically significant. Preoperative risk factor for developing delirium were carotid artery disease and Hemoglobin level <10gm/dl. Intraoperative risk factor for developing delirium were blood transfusion, longer cardiopulmonary bypass time. Post-operative factors for developing delirium included longer Intensive Care Unit stay, mechanical ventilation time ,duration on inotropes , blood transfusion, use of non-invasive ventilation, sleep deprivation, use of intra-aortic balloon pump, Pao2<70.
Conclusions: As shown in our study, delirium is a frequent occurrence in the cardiac surgical population. The incidence of delirium after cardiac surgery was 15.6%. Several risk factors pre-operatively like age>60 years, carotid artery disease, Hb<10gm/dl, intra-operative factors like longer cardiopulmonary bypass time, blood transfusion and post-operatively longer duration of Mechanical ventilation, Intensive Care Unit stay, blood transfusion, use of intra-aortic balloon pump and Non-invasive ventilation were found to be predictors of delirium.
Keywords: Keywords: Cardiac surgery; delirium; risk factors
Incidence and Predictors of Delirium After Cardiac Surgery
(Nepal Health Research Council, 2023) Bajracharya, Smriti Mahaju; Baidya, Rabin; Bhandari, Sandip; Amatya, Ashish G
Abstract
Background: The overall purpose of this study was to determine the incidence and perioperative factors that predispose to cause delirium in postoperative cardiac surgery patients in our Intensive Care Unit.
Methods: We performed a prospective, observational study. Following institutional review board approval, this study included 234 patients above the age of 18 years meeting the inclusion criteria for cardiac surgery in Shahid Gangalal National Heart Center from July 2018 to December 2018. Preoperative, intraoperative and postoperative data for possible risk factors were obtained. Daily assessment of delirium was done during Intensive Care Unit stay of the patient. Collected data were analysed by means of statistical software SPSS-21.
Results: The incidence of delirium was 15.6% (35/224) in our study. Delirium was seen in 14 out of 58 (24.1%) patients with age >60 years which was found to be statistically significant. Preoperative risk factor for developing delirium were carotid artery disease and Hemoglobin level <10gm/dl. Intraoperative risk factor for developing delirium were blood transfusion, longer cardiopulmonary bypass time. Post-operative factors for developing delirium included longer Intensive Care Unit stay, mechanical ventilation time ,duration on inotropes , blood transfusion, use of non-invasive ventilation, sleep deprivation, use of intra-aortic balloon pump, Pao2<70.
Conclusions: As shown in our study, delirium is a frequent occurrence in the cardiac surgical population. The incidence of delirium after cardiac surgery was 15.6%. Several risk factors pre-operatively like age>60 years, carotid artery disease, Hb<10gm/dl, intra-operative factors like longer cardiopulmonary bypass time, blood transfusion and post-operatively longer duration of Mechanical ventilation, Intensive Care Unit stay, blood transfusion, use of intra-aortic balloon pump and Non-invasive ventilation were found to be predictors of delirium.
Keywords: Keywords: Cardiac surgery; delirium; risk factors
Functional and Radiological Outcome of Short Same Segment Instrumentation in Thoracolumbar Burst fracture
(Nepal Health Research Council, 2023) Thapa, Bishnu Babu; Shah, Rajesh Pratap
Abstract
Background: Thoracolumbar region is important biomechanics transition zone in which rigid thoracic and flexible lumbar spine meet. This area is highly vulnerable to traumatic spinal fracture.Among all spine fracture, compression type is most common and managed conservatively. Thoracolumbar spine fracture can be associated with neurological deficit, spinal instability. The optimal treatment for these injuries is still controversy and subject for research.
Methods: This retrospective study included 30 patients with single level thoracolumbar fracture.All the patients clinical and radiological parameters were evaluated preoperative, post-operative and 1 year follow up. Clinical parameters were included Visual analogue score, Oswestry disability index. Radiologic measurement were regional kyphotic angle by cobb’s method and anterior vertebral body height loss (Mumford’ santerior body compression equation method) in X-ray. All the data were analysed in SPSS version 20.
Results: A total of 30 patients were included in this study,19 were male.The mean age of the patients were 40.8±13.The main cause of injury was fall from height,26 patients. The most common level of fracture vertebra was L1,11 patients.The mean difference of preop and postop kyphosis was 11.70±50 with P<0.05.The mean difference of preop Oswestry disability index and postop Oswestry disability index score was 30.7±7.6 with T score 22(P<0.05).The preop and postop Visual analogue score score also improved ,mean difference was 2.8±1(P<0.05).
Conclusions: Short segment instrumentation with placement of pedicle screw at fracture vertebra is one option in the treatment of thoracolumbar burst fracture.
Keywords: Burst; instability; kyphosis; neurological; thoracolumbar
Evaluation of Quality Parameters of Light Sensitive Drugs Marketed in Nepal
(Nepal Health Research Council, 2023) Maharjan, Sajan; Dhungel, Subhash Kumar
Abstract
Background: Photosensitivity is the response of drug or drug product to the exposure of solar, UV and visible light in the solid, semisolid, or liquid state that leads to a physical or chemical change. Exposure to light is a concern with numerous medications due to the potential for photo degradation or other chemical reactions that affect drug stability.
Methods: Out of all the registered brands in Department of Drug Administration, 9 brands of Rabeprazole tablets, 5 brands of Promethazine tablets and 5 brands of methylcobalamin tablets were selected and were subjected for testing and analysis for various quality parameters as per pharmacopoeia. The labels of the collected medicine were analyzed. The obtained data were entered and analyzed in Microsoft office excel 2019.
Results: Eleven products did not comply with the existing regulatory requirement on labeling system of medicine as per Regulation of Standard of drugs. There was no uniformity in mentioning the self-life. Similarly, large variation was seen on price of same generic drugs. Information regarding storage conditions, direction for use and category of the drug were lacking in the label of some brands of medicines.Upon Laboratory analysis, two brands of promethazine tablets and three brands of Rabeprazole tablets were found substandard. Drug content of all the brands of Methylcobalamin was found to contain overage.
Conclusions: The result of this study indicates that substandard medicines are abundant in Nepalese market. There is weak regulation monitoring which have resulted in no uniformity in similar pharmaceutical products too. Hence, stringent regulatory monitoring is required to assessthe quality of pharmaceutical products in the Nepalese market.
Keywords: Light sensitive drugs; substandard drugs; quality of drugs