Journal Issue: Volume: 20, No 4 Issue 84, OCTOBER - DECEMBER, 2023
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Volume
Number
Issue Date
2023
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Time in Therapeutic Range and Adverse Outcomes among Patients Receiving Warfarin Therapy at Tertiary Care Hospital
(Kathmandu University, 2023) Ghimire, R; Dhungana, SP
ABSTRACT
Background
Warfarin has a narrow therapeutic index and needs regular international normalized
ratio monitoring and dose adjustment. Poor quality of warfarin dosing can lead to an
increased risk of adverse events.
Objective
To find out the overall quality of the international normalized ratio expressed in
terms of time in therapeutic range and adverse outcomes associated with the use
of warfarin.
Method
A descriptive cross-sectional study among 150 patients attending a tertiary care center
receiving warfarin therapy from December 2022 to June 2023. Patients receiving
warfarin at least for 6 months and with at least three international normalized ratio
values were enrolled. Indications, average daily dosing, international normalized
ratio, and adverse effects were recorded using convenient sampling. Data were
analyzed by using SPSS, version 20.
Result
The mean age was 46.41±13.96 years. Indications for warfarin were valvular and
nonvalvular atrial fibrillation in 104 (69.33%), deep vein thrombosis 21 (14%), and
pulmonary embolism 6 (4%). The majority of patients 100 (66.6%) received 5 to 10mg
of warfarin per day. The mean duration of warfarin use was 18.11±21.93 months. The
mean time in the therapeutic range (%) was 62.43±27.52. Sixty patients (40%) had
time in the therapeutic range below 60%. Among the adverse effects, minor bleeding
was present in 25 (16.66%). The ischemic event was present in 7 (4.7%).
Conclusion
Our patients had lower time in the therapeutic range than recommended in the
guidelines. They had a longer time in the sub-therapeutic range.
KEY WORDS
Atrial fibrillation, International normalized ratio, Treatment outcome, Warfarin
Outcomes of Laparoscopic Cholecystectomy in a Tertiary Hospital in Nepal
(Kathmandu University, 2023) Shakya, YR; Manandhar, A; Laudari, U; Patel, JN; Karmacharya, RM; Sah, S; Malla, B; Shrestha, B; Maharjan, S; Dahal, A
ABSTRACT
Background
Laparoscopic Cholecystectomy (LC) is the gold-standard surgery for symptomatic
cholelithiasis with low mortality and morbidity.
Objective
The main objective of this study is to study the outcomes of laparoscopic
cholecystectomy in Dhulikhel Hospital over the period of seven years.
Method
The records of all the patients who underwent laparoscopic cholecystectomy in
Dhulikhel Hospital from January 1, 2015, to December 31, 2021 were reviewed.
Patient demographics, indication of surgery, hospital stay, and number of conversions
to open cholecystectomy were collected. The percentage, mean and median were
calculated for socio-demographic information and Chi-square test was performed
to measure the association between socio-demographic characteristics, duration of
hospital stay, and operative procedure.
Result
Out of 2106 patients who underwent laparoscopic cholecystectomy from January
1, 2015, to December 31, 2021, 584 (27.73%) were male, and 1522 (72.27%) were
female. The female-to-male ratio was 2.6:1. The median age of the patients was
40 years (IQR=52-30). Most common indications for surgery were symptomatic
cholelithiasis in 1740 (82.62%) patients along with chronic cholecystitis in 268
(12.73%) patients, and Post ERCP Cholecystectomy in 92 (4.37%) patients. Median
hospital stay was three days. Out of 2106 cases, 24 cases were converted to open
cholecystectomy.
Conclusion
Laparoscopic cholecystectomy is the gold standard treatment for benign diseases of
the gallbladder and can be performed safely as day care surgery to reduce the cost,
length of hospital stay, and long waiting list in low and middle-income countries.
KEY WORDS
Cholecystectomy, Cholecystitis, Gallstone, Laparoscopy, Post-ERCP
Vitamin D Deficiency and Acute Otitis Media among Children Visiting a Tertiary Care Centre in Eastern Nepal
(Kathmandu University, 2023) Dahal, R; Shah, SP; Mishra, S; Baaniya, B
ABSTRACT
Background
There have been various studies to draw out the association between acute otitis
media (AOM) and vitamin D deficiency but the results are conflicting.
Objective
To explore the relationship between vitamin D deficiency and acute otitis media.
Method
The comparative cross-sectional study was conducted in which children aged five to
fifteen years were included. Sixty children diagnosed with acute otitis media were
kept in group A while 60 children diagnosed with conditions other than acute otitis
media were included in Group B. Then the Vitamin D level was sent in both the
groups and compared.
Result
Fifty-four participants in group A had an insufficient level of Vitamin D while six
participants had a sufficient level of Vitamin D and none had an excess level of
Vitamin D while in Group B, fiftywo participants had an insufficient level of Vitamin
D while eight participants had a sufficient level of Vitamin D. The mean vitamin D of
the cases was 22.12 ±7.896 ng/ml, and that of the controls was 22.58 ±7.056 ng/ml
for the controls (p = 0.737).
Conclusion
Both the children with acute otitis media and without acute otitis media had lower
levels of Vitamin D in similar proportions. Therefore, we can conclude that there is
no association between Vitamin D level and acute otitis media.
KEY WORDS
Acute otitis media, Children, Vitamin D
Intraurethral Instillation of Ketamine and Lidocaine versus Lidocaine for Male Rigid Cystoscopy: A Prospective Randomized Controlled Trial
(Kathmandu University, 2023) Pradhan, U; Chalise, PR; Luitel, BR; Kriti, S; Devkota, S
ABSTRACT
Background
Male rigid cystoscopy is one of the most common outpatient procedures in urology
because of it lower cost, better optical area and better orientation compared with
flexible devices. However, performing rigid cystoscopy is not only painful but equally
apprehensive in awake male patients.
Objective
The study was conducted to evaluate the efficacy of lidocaine gel and ketamine
solution together compared with lidocaine gel alone during male rigid cystoscopy.
Method
A total of 76 male patients who visited the hospital for rigid cystoscopy were
randomized into two groups before undergoing cystoscopy. The experimental group
received 15 ml lidocaine with 2 ml (100 mg) Ketamine solution while the control
group received 15 ml lidocaine gel with 2 ml Normal saline. Patient’s heart rate and
mean arterial pressure were recorded in five minutes interval till twenty minutes
after completion of the procedure. The level of pain perception of all the patients
was measured with Visual analogue scale (VAS) score, at the beginning, during and
after cystoscopy. Independent sample t-test was used to compare outcome measures
and p value of < 0.05 was considered statistically significant.
Result
Out of the total 70 patients analyzed at the end of study with 35 patients in each group,
the VAS score in each stage were lower in lidocaine plus ketamine group compared to
lidocaine gel alone. The difference was significant at the commencement and middle
of the procedure (p < 0.05).
Conclusion
Intraurethral instillation of ketamine and lidocaine is more effective in reducing mean
pain score during cystoscopy as compared to lidocaine alone.
KEY WORDS
Cystoscopy, Ketamine, Lidocaine, Visual analogue scale score