Journal Issue: Volume: 17, No 4, Issue 68, OCT.-DEC, 2019
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Volume
Number
Issue Date
2019
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Integrating Digital Technologies in Dentistry to Enhance the Clinical Success
(Kathmandu University, 2019) Humagain M; Rokaya D
NA
Prolonged QT dispersion in Subclinical Hypothyroid Females: A Study in University Teaching Hospital in Central Nepal
(Kathmandu University, 2019) Kandel, S; Rana, BSJB; Prasad, PN; Mahotra, NB; Shrestha, TM
ABSTRACT
Background
QT dispersion is a simple index derived from 12 lead ECG; its prolongation has been
shown to be associated with increased arrhythmia risk. Increased cardiovascular
risks, particularly occurrence of the malignant arrhythmias are a common finding
in patients with subclinical hypothyroidism. This increased arrhythmia risk is found
to be higher mainly in patients with TSH level more than 10 milli international unit
per liter.
Objective
To assess QT dispersion among subclinical hypothyroid and euthyroid Nepalese
females aged 20-59 years attending general practice out patient department of
centrally located University Teaching Hospital from November 2016 to April 2017.
Method
Forty-three newly detected subclinical hypothyroid females and forty-one euthyroid
females were enrolled. Resting electrocardiogram (ECG) was performed. QT
dispersion was analyzed from ECG and corrected for heart rate using Framingham
correction formula. Independent sample t-test was applied to compare mean QT
dispersion between two groups. Pearson correlation test was used to examine the
association between QT dispersion and TSH level.
Result
Mean QT dispersion for sub-clinical hypothyroid group was 75.35 ± 43.82 whereas
mean QT dispersion for euthyroid group was 59.51 ± 22.13, with p value 0.041. A
weak association between QT dispersion and TSH level was seen with correlation
factor of 0.23.
Conclusion
The result showed prolongation of QT dispersion in sub-clinical hypothyroid group
and weak positive correlation between TSH level and QT dispersion suggesting
arrhythmia risk in subclinical hypothyroid females.
KEY WORDS
Arrhythmia risk, QT dispersion, Sub-clinical hypothyroidism
Permcath - A Vascular Access for Hemodialysis, Our Experience in Last Two Years
(Kathmandu University, 2019) Baidya, PR; Shrestha, K; Deuja, ML; Rai, A; Shrestha, N; Shrestha, A; Baidya, A
ABSTRACT
Background
The double lumen tunneled catheter (Permcath) is mostly used as an alternative
access, not as a temporary access in End Stage Renal Disease patients requiring
hemodialysis. If there is no possibility of other access modalities, failed or unable to
create native arteriovenous fistula (AVF), Permcath can be a very good alternative.
Objective
To find the indications, complications and results of Permcath insertion.
Method
We reviewed the results of 92 Permcath inserted under ultrasound guidance in two
different hospitals, 45 in Sahid Dharma Bhakta National Transplant Center (SDNTC),
Bhaktapur and 47 in Nidan Hospital Pvt. Ltd., Lalitpur from April 2016 to April 2018
retrospectively.
Result
We had inserted 55 Permcath (59.78%) in right internal jugular vein (IJV), 25 (27.17%)
in left internal jugular vein and 12(13.04%) in femoral vein. In terms of major
complications, two (2.17%) patients had profound hypotension, bradycardia and
cardiac arrest due to left internal jugular vein tear. Three patients (3.26%) died within
a week due to septicemia and 23 patients (25%) died with multiple causes within
one year. Of the cases, till now in 39 cases (42.39%) Permcath has been removed.
Major reasons of removal of Permcath are post renal transplant in 18 cases (19.57%),
Arterio Venous Fistula maturation in 13 cases (14.13%), Infection in six patients
(6.52%) and non functioning Permcath in two patients (2.17%).
Conclusion
Permcath remains a reliable method for short term vascular access, hence can be
used as a bridge to renal transplant or arteriovenous fistula maturation.
KEY WORDS
Permcath, Tunneled dialysis catheter, Vascular access
Skin Conductance and RR Interval for Regulated Discrete Physiological Stimuli: A Two Prong Strategy to Detect Sympathetic Activation
(Kathmandu University, 2019) Nepal, O; Manandhar, L; Jha, RK
ABSTRACT
Background
Several studies have found skin conductance a good indicator for detection of
sympathetic response. But, valid and reliable tool for detection of sympathetic
outflow in health and disease is still a quest. Thereby, comparison of superficial and,
at core sympathetic effluence induced by deliberately supplied discrete external
stimuli has been attempted in this study.
Objective
To assess the degree of sympathetic outflow for discrete cognitive and physical
stimuli through perturbations in skin conductance and variations in heart rate in
healthy adults.
Method
Quantitative and cross-sectional study was performed in 104 healthy subjects
following random sampling method. Induction of sympathetic activity was realized
by providing separate time bound cognitive exercises intervened with change in
posture. Recordings to detect sympathetic responses at rest and, for supplied stimuli
were made by electrocardiogram and galvanic skin response.
Result
Cognitive performance and postural change shifts baseline effluence and increases
the sympathetic outflow significantly (p=0.000). There occurs no detectable rise in
sympathetic effluence at the core (p=0.362) but, eventuate significantly appreciable
sympathetic outflow to sweat glands in skin (p=0.000), when compared cognitive
versus physical stimuli.
Conclusion
Sympathetic outflow induced by cognitive challenge and physical change in posture is
readily assessable through sympathetic skin response yet core sympathetic effluence
for latter stimuli is steady and unwavering. Differential effluence for sympathetic
response called upon by discrete stimuli is operational for maintenance of steady
state in healthy subjects.
KEY WORDS
Galvanic skin response, Psychogalvanic reflex, Sympathetic outflow
Prevalence of Metabolic Syndrome in Newly Diagnosed Type 2 Diabetes Mellitus
(Kathmandu University, 2019) Tamrakar, R; Shrestha, A; Tamrakar, D
ABSTRACT
Background
The clustering of risk factors in metabolic syndrome increases the risk of
atherosclerotic cardiovascular disease and all-cause mortality. The prevalence of
coronary heart disease is high in diabetic patients with metabolic syndrome than
non diabetic patients with metabolic syndrome.
Objective
To determine the prevalence of metabolic syndrome in new onset Type 2 Diabetes
Mellitus (T2DM) and to study the risk components of metabolic syndrome.
Method
This is a hospital based cross sectional study conducted in 132 newly diagnosed T2DM
patients at Dhulikhel Hospital, Kathmandu University Hospital in Nepal in 2018. The
socio-demographic profile, clinical characteristics, and biochemical parameters were
analyzed to study the prevalence, risk factors, and concordance between various
definitions of metabolic syndrome. Statistical analysis was done using Student’s
t-test, Chi-square test and Kappa statistics.
Result
One hundred and thirty two newly diagnosed T2DM patients were included in
the study. Majority of the patients (58.9%) were in the age group of 40-60 years
with the mean age of 49.72±12.44 years. The prevalence of metabolic syndrome
was 111 (84.1%), 106 (80.3.%), 94 (71.2%) and 82 (62.1%) using World Health
Organization(WHO), Harmonized, National Cholesterol Education Program-Adult
Treatment Panel III (NCEP ATP III) and International Diabetes Federation (IDF)
definitions respectively. One hundred and six patients (80.3%) had 3 or more
individual components of metabolic syndrome. There was substantial agreement
between NCEP ATP III-Harmonized (k=0.714, p<0.001) and Harmonized-WHO
(k=0.716, p<0.001) definitions for diagnosing metabolic syndrome. The increased
prevalence of metabolic syndrome in females than males is due to increased
prevalence of abdominal obesity (p<0.05), dyslipidemia (low HDL cholesterol
(p<0.05)) and presence of diabetes.
Conclusion
The prevalence of metabolic syndrome in newly diagnosed T2DM is high in the
Nepalese population. The central obesity and low HDL cholesterol were significant
risk factors in female diabetic patients predisposing to metabolic syndrome.
KEY WORDS
Metabolic syndrome, Prevalence, Type 2 diabetes mellitus