D. Khanal, S. Chapagain, Soni Kc, Sadikshya Neupanae
Background: Oral Anti-coagulant is widely used for the prevention and treatment of cardiac and thromboembolic diseases. As oral anticoagulant is a narrow therapeutic index medicine, it requires close monitoring to achieve effectiveness of anticoagulants therapy. Therefore, this study was conducted to assess adherence to anticoagulant therapy and its awareness among cardiac patients attending cardiac OPD of Chitwan Medical College Teaching Hospital, Chitwan. Methods: A descriptive cross-sectional study design was carried out among 91 cardiac patients attending cardiac OPD of Chitwan Medical College Teaching Hospital sample was selected by using Consecutive sampling technique. Data was collected using structured interview schedule. General medication adherence scale and self-prepared structured questionnaire of awareness of anticoagulant therapy was used. Data was analyzed in SPSS version 20 by using descriptive and inferential statistics. Results: Out of 91 respondents 42.9% of the respondents had partial adherence while 33.0% had good adherence. Only 6% of the respondents had high adherence, 7.7% and 9.9% of the respondents had poor and low respectively. Regarding awareness of anticoagulant therapy 63.7% of the respondents had inadequate level of awareness. There was statistically significant relationship between level of awareness with educational status (0.02), having insurance (0.05) and drug duration (0.05). Conclusions: Based on this finding respondent’s awareness was found to be low on the risk effects of alcohol intake, drugs and food interaction and self-limiting of injurious activities and most identified reason for non-adherence is discontinue due to feeling well, adverse effect and progression of disease. So, clinician and nurse should design an effective instructional program about anticoagulant therapy by highlighting those limited area thus to enhance adherence and prevent life threatening complications.
背景:口服抗凝剂广泛应用于心脏和血栓栓塞性疾病的预防和治疗。口服抗凝药是一种治疗指标较窄的药物，需要密切监测才能达到抗凝治疗的效果。因此，本研究旨在评估Chitwan医学院附属医院心内科急诊科心脏病患者抗凝治疗依从性及抗凝治疗意识。方法:采用描述性横断面研究设计，采用连续抽样方法对在奇旺医学院附属医院心内科门诊就诊的91例心脏病患者进行抽样调查。数据收集采用结构化访谈计划。采用一般药物依从性量表和自行编制的结构化抗凝治疗认知问卷。数据在SPSS version 20中进行分析，采用描述统计和推理统计。结果:91名应答者中，42.9%的应答者部分依从，33.0%的应答者良好依从。只有6%的受访者依从性高，7.7%的受访者依从性差，9.9%的受访者依从性低。在抗凝治疗知晓率方面，63.7%的被调查者对抗凝治疗知晓率不高。知晓率与受教育程度(0.02)、是否有保险(0.05)、用药时间(0.05)有统计学意义。结论:基于这一发现，受访者对酒精摄入、药物和食物相互作用以及自我限制有害活动的风险影响的认识较低，大多数确定的不坚持的原因是由于感觉良好、不良反应和疾病进展而停止。因此，临床医生和护士应设计有效的抗凝治疗指导方案，突出这些局限性，从而提高依从性，预防危及生命的并发症。
{"title":"ADHERENCE TO ANTICOAGULANT THERAPY AND ITS AWARENESS AMONG CARDIAC PATIENTS ATTENDING CARDIAC OPD OF CHITWAN MEDICAL COLLEGE TEACHING HOSPITAL, CHITWAN","authors":"D. Khanal, S. Chapagain, Soni Kc, Sadikshya Neupanae","doi":"10.54530/jcmc.1193","DOIUrl":"https://doi.org/10.54530/jcmc.1193","url":null,"abstract":"Background: Oral Anti-coagulant is widely used for the prevention and treatment of cardiac and thromboembolic diseases. As oral anticoagulant is a narrow therapeutic index medicine, it requires close monitoring to achieve effectiveness of anticoagulants therapy. Therefore, this study was conducted to assess adherence to anticoagulant therapy and its awareness among cardiac patients attending cardiac OPD of Chitwan Medical College Teaching Hospital, Chitwan.\u0000Methods: A descriptive cross-sectional study design was carried out among 91 cardiac patients attending cardiac OPD of Chitwan Medical College Teaching Hospital sample was selected by using Consecutive sampling technique. Data was collected using structured interview schedule. General medication adherence scale and self-prepared structured questionnaire of awareness of anticoagulant therapy was used. Data was analyzed in SPSS version 20 by using descriptive and inferential statistics.\u0000Results: Out of 91 respondents 42.9% of the respondents had partial adherence while 33.0% had good adherence. Only 6% of the respondents had high adherence, 7.7% and 9.9% of the respondents had poor and low respectively. Regarding awareness of anticoagulant therapy 63.7% of the respondents had inadequate level of awareness. There was statistically significant relationship between level of awareness with educational status (0.02), having insurance (0.05) and drug duration (0.05).\u0000Conclusions: Based on this finding respondent’s awareness was found to be low on the risk effects of alcohol intake, drugs and food interaction and self-limiting of injurious activities and most identified reason for non-adherence is discontinue due to feeling well, adverse effect and progression of disease. So, clinician and nurse should design an effective instructional program about anticoagulant therapy by highlighting those limited area thus to enhance adherence and prevent life threatening complications.","PeriodicalId":265624,"journal":{"name":"Journal of Chitwan Medical College","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121412720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Adhikari, D. Tiwari, B. Sharma, Amrit Ghimire, G. Dhakal, G. Khanal, Fuleshwar Manadal
Background: There is rising prevalence of non-communicable diseases (NCDs) and associated mortality in developing and moderately developed countries. Nepal is currently moving in a transition from infectious diseases to NCDs. In Nepal, NCDs are the leading causes of death with two thirds (66%) of death attributable to NCDs. The aim of the study was to assess the effects of the health educational intervention on knowledge towards NCDs and its’ risk factors among school students. Methods: This study is quasi experimental pre-test-post-test design conducted among the plus-two students of a selected school of Chitwan. All the plus-two students studying at Sunrise school were enrolled for the study. Complete enumeration technique was used for selecting study units. A “one-hour educational intervention package” was administered by researcher themselves with NCDs and NCD risk factors related information. Pretested, self-constructed, structured questionnaire was administered 20-minute prior the intervention and immediately after the intervention. Both descriptive and inferential statistics were computed at 5% level of significance Results: Median knowledge score was 9 out of total 25 in pretest and it increased to 19 after intervention. The change in the score was significantly different in pre and posttest (p<0.001). Pre-test and post test scores were almost similar in both male and female except in pre-test in total knowledge score. Conclusions: One-hour educational class room package was found effective to improve the NCD related knowledge of plus two students in study area.
{"title":"EFFECTS OF HEALTH EDUCATIONAL INTERVENTION ON KNOWLEDGE TOWARDS NON-COMMUNICABLE DISEASES AND ITS RISK FACTORS AMONG STUDENTS OF A SELECTED SCHOOL OF CHITWAN","authors":"K. Adhikari, D. Tiwari, B. Sharma, Amrit Ghimire, G. Dhakal, G. Khanal, Fuleshwar Manadal","doi":"10.54530/jcmc.1223","DOIUrl":"https://doi.org/10.54530/jcmc.1223","url":null,"abstract":"Background: There is rising prevalence of non-communicable diseases (NCDs) and associated mortality in developing and moderately developed countries. Nepal is currently moving in a transition from infectious diseases to NCDs. In Nepal, NCDs are the leading causes of death with two thirds (66%) of death attributable to NCDs. The aim of the study was to assess the effects of the health educational intervention on knowledge towards NCDs and its’ risk factors among school students.\u0000Methods: This study is quasi experimental pre-test-post-test design conducted among the plus-two students of a selected school of Chitwan. All the plus-two students studying at Sunrise school were enrolled for the study. Complete enumeration technique was used for selecting study units. A “one-hour educational intervention package” was administered by researcher themselves with NCDs and NCD risk factors related information. Pretested, self-constructed, structured questionnaire was administered 20-minute prior the intervention and immediately after the intervention. Both descriptive and inferential statistics were computed at 5% level of significance\u0000Results: Median knowledge score was 9 out of total 25 in pretest and it increased to 19 after intervention. The change in the score was significantly different in pre and posttest (p<0.001). Pre-test and post test scores were almost similar in both male and female except in pre-test in total knowledge score.\u0000Conclusions: One-hour educational class room package was found effective to improve the NCD related knowledge of plus two students in study area.","PeriodicalId":265624,"journal":{"name":"Journal of Chitwan Medical College","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132495621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ramesh Subba, H. Subba, Sarita Nepal, Amrit Ghimire
Background: The family member is an important support system in the care of patient with chronic mental illness. The caregivers experience from a number of significant stresses and burden and need concern from the mental health professionals. The objective of the study was to assess the extent of burden and coping strategies among caregivers of mentally-ill patients. Methods: Descriptive cross-sectional study design was used among 102 caregivers of mentally ill patients admitted in Psychiatric ward of Chitwan Medical College, Teaching Hospital. Non-probability consecutive sampling technique was used to select the sample. Ethical approval was taken from the Institutional Review Committee. Data were collected from 27 January 2020 to 29 May 2020 using a structured interview schedule and record review. Data was analyzed using Statistical Package for Social Sciences version 20 and analyzed by using descriptive statistics and inferential statistics. Results: Among 102 caregivers, it was found that 47.1% caregivers perceived moderate to severe burden, 41.2% of the caregivers experienced mild to moderate and 11.8% experienced minimal burden. The highest median percentage of caregivers reported financial burden (50%) where 41.66% reported burden in the relationship. The most frequently used strategies were use of informational support (62.5%), venting (62.5%), positive reframing (62.5%), acceptance (62.5%), and religion (62.5%). Conclusions: The highest percentage of caregivers experienced moderate to severe burden. So, mental health professionals should develop training programs that include counseling to support both patients and family caregivers to reduce the family burden and improving coping skills.
背景:家庭成员是慢性精神疾病患者护理的重要支持系统。照顾者承受着许多重大的压力和负担，需要精神卫生专业人员的关注。本研究的目的是评估精神病患照护者的负担程度及因应策略。方法:采用描述性横断面研究设计，对奇旺医学院附属教学医院精神科102例精神病患者的护理人员进行调查。采用非概率连续抽样技术选择样本。伦理批准由机构审查委员会。数据收集于2020年1月27日至2020年5月29日，采用结构化访谈时间表和记录审查。使用Statistical Package for Social Sciences version 20对数据进行分析，并使用描述性统计和推理统计进行分析。结果:102名照护者中，47.1%的照护者有中度至重度负担，41.2%的照护者有轻度至中度负担，11.8%的照护者有轻度负担。照顾者报告经济负担的中位数百分比最高(50%)，其中41.66%报告了关系中的负担。最常用的策略是使用信息支持(62.5%)、发泄(62.5%)、积极重构(62.5%)、接受(62.5%)和宗教(62.5%)。结论:护理人员有中度至重度负担的比例最高。因此，心理健康专业人员应该制定培训计划，包括为患者和家庭照顾者提供咨询，以减轻家庭负担，提高应对技能。
{"title":"BURDEN AND COPING STRATEGIES AMONG CAREGIVERS OF MENTALLY ILL PATIENTS ADMITTED IN TEACHING HOSPITAL","authors":"Ramesh Subba, H. Subba, Sarita Nepal, Amrit Ghimire","doi":"10.54530/jcmc.1211","DOIUrl":"https://doi.org/10.54530/jcmc.1211","url":null,"abstract":"Background: The family member is an important support system in the care of patient with chronic mental illness. The caregivers experience from a number of significant stresses and burden and need concern from the mental health professionals. The objective of the study was to assess the extent of burden and coping strategies among caregivers of mentally-ill patients.\u0000Methods: Descriptive cross-sectional study design was used among 102 caregivers of mentally ill patients admitted in Psychiatric ward of Chitwan Medical College, Teaching Hospital. Non-probability consecutive sampling technique was used to select the sample. Ethical approval was taken from the Institutional Review Committee. Data were collected from 27 January 2020 to 29 May 2020 using a structured interview schedule and record review. Data was analyzed using Statistical Package for Social Sciences version 20 and analyzed by using descriptive statistics and inferential statistics.\u0000Results: Among 102 caregivers, it was found that 47.1% caregivers perceived moderate to severe burden, 41.2% of the caregivers experienced mild to moderate and 11.8% experienced minimal burden. The highest median percentage of caregivers reported financial burden (50%) where 41.66% reported burden in the relationship. The most frequently used strategies were use of informational support (62.5%), venting (62.5%), positive reframing (62.5%), acceptance (62.5%), and religion (62.5%).\u0000Conclusions: The highest percentage of caregivers experienced moderate to severe burden. So, mental health professionals should develop training programs that include counseling to support both patients and family caregivers to reduce the family burden and improving coping skills.","PeriodicalId":265624,"journal":{"name":"Journal of Chitwan Medical College","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131627600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Ghimire, Sundar Pandey, Deepak Aryal, Pooja Shah, Binita Soti, S. Thapa, S. Shrestha
Background: Metformin for type 2 diabetes mellitus has more beneficial effect with few side effects like vitamin B12 deficiency. So, this study aimed to determine the level of vitamin B12 in patients with type 2 diabetes mellitus using metformin and its association with dose and duration of metformin use. Methods: This was descriptive, cross-sectional, hospital-based study. A total of 128 diabetic patients using metformin for more than 6 months were enrolled. After taking informed consent, considering exclusion criteria, level of serum B12 were quantified by chemiluminescent enzyme immunoassay. Vitamin B12 level <300pg/dl as inadequate and ≥300pg/dl as adequate; metformin 1000mg as low dose; more than 1000mg as high dose were considered. Also, metformin used 1000mg /day taken as constant and comparing it with duration of > 10 years with duration of > 10 years. Data were entered in Microsoft Excel 2013 and analyzed on SPSS V25. Results: Our study results 62.5% had adequate (>300pmol/l) and 37.5% had inadequate (≤300pmol/l) vitamin B12 level in patients with type 2 diabetes using metformin. Level of vitamin B12 deficiency was statistically associated with increasing dose of metformin used (p<0.001) and long term used of metformin used (p<019). Conclusions: This study concluded that there is prevalence of deficiency of Vit B12 level in type 2 diabetes mellitus patients using metformin. Also, this deficiency level depends on use of dose of metformin.
{"title":"EVALUATION OF SERUM VITAMIN B12 LEVELS IN TYPE 2 DIABETES MELLITUS PATIENT ON METFORMIN THERAPY ATTENDING A TERTIARY CARE HOSPITAL","authors":"M. Ghimire, Sundar Pandey, Deepak Aryal, Pooja Shah, Binita Soti, S. Thapa, S. Shrestha","doi":"10.54530/jcmc.1148","DOIUrl":"https://doi.org/10.54530/jcmc.1148","url":null,"abstract":"Background: Metformin for type 2 diabetes mellitus has more beneficial effect with few side effects like vitamin B12 deficiency. So, this study aimed to determine the level of vitamin B12 in patients with type 2 diabetes mellitus using metformin and its association with dose and duration of metformin use.\u0000Methods: This was descriptive, cross-sectional, hospital-based study. A total of 128 diabetic patients using metformin for more than 6 months were enrolled. After taking informed consent, considering exclusion criteria, level of serum B12 were quantified by chemiluminescent enzyme immunoassay. Vitamin B12 level <300pg/dl as inadequate and ≥300pg/dl as adequate; metformin 1000mg as low dose; more than 1000mg as high dose were considered. Also, metformin used 1000mg /day taken as constant and comparing it with duration of > 10 years with duration of > 10 years. Data were entered in Microsoft Excel 2013 and analyzed on SPSS V25.\u0000Results: Our study results 62.5% had adequate (>300pmol/l) and 37.5% had inadequate (≤300pmol/l) vitamin B12 level in patients with type 2 diabetes using metformin. Level of vitamin B12 deficiency was statistically associated with increasing dose of metformin used (p<0.001) and long term used of metformin used (p<019).\u0000Conclusions: This study concluded that there is prevalence of deficiency of Vit B12 level in type 2 diabetes mellitus patients using metformin. Also, this deficiency level depends on use of dose of metformin.","PeriodicalId":265624,"journal":{"name":"Journal of Chitwan Medical College","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129019185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Hussain, Shyan Raj Regmi, B. Dhital, S. Thapa, Tirth Dhungana, S. Shrestha
Cardiovascular events are less commonly described in glomerular disease. However, thromboembolic events are quite commonly reported in glomerular disease with nephrotic range proteinuria. Here, we report a case of a 29 years old male with IgA nephropathy present with central chest pain radiating to the jaw. He was under mycophenolate, prednisolone and losartan with remission of proteinuria for two months. ECG showed extensive ST segment elevation in V1- V6 leads. His cardiac troponins were elevated. Coronary angiography showed complete thrombotic occlusion of mid left anterior descending artery which was successfully recanalized after primary percutaneous intervention. Though less commonly reported in literature, such incidence of coronary events in IgA nephropathy can rarely present with acute myocardial infarction.
{"title":"ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION IN A YOUNG PATIENT WITH IGA NEPHROPATHY: A RARE CASE REPORT","authors":"A. Hussain, Shyan Raj Regmi, B. Dhital, S. Thapa, Tirth Dhungana, S. Shrestha","doi":"10.54530/jcmc.1228","DOIUrl":"https://doi.org/10.54530/jcmc.1228","url":null,"abstract":" \u0000 Cardiovascular events are less commonly described in glomerular disease. However, thromboembolic events are quite commonly reported in glomerular disease with nephrotic range proteinuria. Here, we report a case of a 29 years old male with IgA nephropathy present with central chest pain radiating to the jaw. He was under mycophenolate, prednisolone and losartan with remission of proteinuria for two months. ECG showed extensive ST segment elevation in V1- V6 leads. His cardiac troponins were elevated. Coronary angiography showed complete thrombotic occlusion of mid left anterior descending artery which was successfully recanalized after primary percutaneous intervention. Though less commonly reported in literature, such incidence of coronary events in IgA nephropathy can rarely present with acute myocardial infarction.","PeriodicalId":265624,"journal":{"name":"Journal of Chitwan Medical College","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130395296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Police work is one of the highly stressful job as police personnel continuously face stressful situation at work. This study intended to assess the stress and coping strategies among police personnel in the selected police stations of Kathmandu Valley. Methods: A descriptive, cross-sectional study was conducted in selected police stations of Kathmandu valley from 28th July 2019 AD to 24th August 2019 AD. Non-probability consecutive sampling technique was adopted for selecting 198 police personnel. Structured self-administered questionnaire, Police Stress Questionnaire and Brief COPE scale were used as to measure stress and coping strategies. Descriptive statistics was used to analyse collected data. Chi- square test was used to determine the association between variables. Results: Among 198 police personnel, 56.1% had high level of operational stress and 45.0% had high level of organizational stress. There was significant association between age and organizational stress (p =.003). Duration of work was significantly associated with levels of operational and organizational stress (p=< .001). Positive reframing coping strategies are the most rated coping strategy (72.66%). Conclusions: Study concluded that more than half of police officers experience significant levels of organizational and operational stress. They employ problem-focused coping techniques more frequently than other coping mechanisms. There is a strong correlation between stress and coping mechanisms. Therefore, the appointing authority must prioritize the mental health of police officers and encourage the adoption of problem-focused coping mechanisms.
{"title":"STRESS AND COPING STRATEGIES AMONG POLICE PERSONNEL AT SELECTED POLICE STATIONS IN KATHMANDU VALLEY","authors":"Sagun Lohala, Mamata Sharma","doi":"10.54530/jcmc.1154","DOIUrl":"https://doi.org/10.54530/jcmc.1154","url":null,"abstract":"Background: Police work is one of the highly stressful job as police personnel continuously face stressful situation at work. This study intended to assess the stress and coping strategies among police personnel in the selected police stations of Kathmandu Valley.\u0000Methods: A descriptive, cross-sectional study was conducted in selected police stations of Kathmandu valley from 28th July 2019 AD to 24th August 2019 AD. Non-probability consecutive sampling technique was adopted for selecting 198 police personnel. Structured self-administered questionnaire, Police Stress Questionnaire and Brief COPE scale were used as to measure stress and coping strategies. Descriptive statistics was used to analyse collected data. Chi- square test was used to determine the association between variables.\u0000Results: Among 198 police personnel, 56.1% had high level of operational stress and 45.0% had high level of organizational stress. There was significant association between age and organizational stress (p =.003). Duration of work was significantly associated with levels of operational and organizational stress (p=< .001). Positive reframing coping strategies are the most rated coping strategy (72.66%).\u0000Conclusions: Study concluded that more than half of police officers experience significant levels of organizational and operational stress. They employ problem-focused coping techniques more frequently than other coping mechanisms. There is a strong correlation between stress and coping mechanisms. Therefore, the appointing authority must prioritize the mental health of police officers and encourage the adoption of problem-focused coping mechanisms.","PeriodicalId":265624,"journal":{"name":"Journal of Chitwan Medical College","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122706553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ismail Ejaz Ali, S. Adhikari, B. P. Manandhar, A. Jha
COVID-19 disease is caused by a novel coronavirus SARS-CoV-2 and typically causes respiratory symptoms. However, with increasing cases SARS-CoV-2 infection has been shown to be associated with dysregulated and persistent inflammatory reactions and production of some antibodies hence multi organ involvement is seen. We present a 12-year-old boy who had no pulmonary symptoms and presented with the complaints of fever and behavioral changes with examination and investigation findings suggestive of Covid 19 infection with probable Anti-NMDAR encephalitis with MIS-C.
{"title":"SARS-COV-2 WITH PROBABLE ANTI-NMDA RECEPTOR ENCEPHALITIS WITH MIS-C: A CASE REPORT","authors":"Ismail Ejaz Ali, S. Adhikari, B. P. Manandhar, A. Jha","doi":"10.54530/jcmc.706","DOIUrl":"https://doi.org/10.54530/jcmc.706","url":null,"abstract":"COVID-19 disease is caused by a novel coronavirus SARS-CoV-2 and typically causes respiratory symptoms. However, with increasing cases SARS-CoV-2 infection has been shown to be associated with dysregulated and persistent inflammatory reactions and production of some antibodies hence multi organ involvement is seen. We present a 12-year-old boy who had no pulmonary symptoms and presented with the complaints of fever and behavioral changes with examination and investigation findings suggestive of Covid 19 infection with probable Anti-NMDAR encephalitis with MIS-C.","PeriodicalId":265624,"journal":{"name":"Journal of Chitwan Medical College","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122751161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Murtuza, S. Regmi, B. Dhital, S. Thapa, P. Gurung, A. Khan, Sagar Thapa
Background: The prevalence of right bundle branch block (RBBB) is estimated in 0.2 to 1.3% of healthy people. RBBB had independent association with decreased right ventricle (RV) function, which is considered as predictor of adverse cardiovascular outcomes. The aim of this study is to evaluate RV structure and function in patients with isolated RBBB (without structural heart disease) using two-dimensional echocardiography. Methods: A cross-sectional study conducted at Chitwan Medical College, Bharatpur from 1st January 2022 to 30th June 2022. Consecutive adult patients aged ≥18 years with isolated RBBB classified into complete RBBB (CRBBB) and Incomplete RBBB (IRBBB) based on electrocardiographic findings. The echocardiographic evaluation was done to assess RV dimension and function. Results: A total of 52 patients with isolated RBBB were included with mean age of the study population was 45.3 ± 9.3 years, (28 ,53.8%) had CRBBB, whereas the remaining (24, 46.2%) had IRBBB. Among the parameters used to assess RV function; mean RV-Fractional area change (P<0.001), Tricuspid annular plane systolic excursion(P<0.02) and Pulsed Doppler peak velocity at the lateral annulus RV(P<0.001) were significantly lower, while Pulsed Doppler myocardial performance index(P<0.001) was significantly high in CRBBB group as compared to IRBBB group. Similarly, Right atrium and RV dimensional parameters were significant higher in CRBBB compared to IRBBB group. Conclusions: Isolated RBBB is not as benign as it was considered and has deteriorating effect on RV morphology and function. Therefore, patients with Isolated RBBB need follow-up with passing age and more attention toward RV structural and functional analysis.
背景:右束支传导阻滞(RBBB)的患病率估计为0.2%至1.3%的健康人。RBBB与右心室(RV)功能下降有独立的相关性，这被认为是不良心血管结局的预测因子。本研究的目的是利用二维超声心动图评估孤立性RBBB(无结构性心脏病)患者的右心室结构和功能。方法:一项横断面研究于2022年1月1日至2022年6月30日在Chitwan Medical College, Bharatpur进行。年龄≥18岁孤立性RBBB的连续成人患者根据心电图表现分为完全RBBB (CRBBB)和不完全RBBB (IRBBB)。超声心动图评价右心室的尺寸和功能。结果:共纳入52例孤立性RBBB患者，研究人群平均年龄为45.3±9.3岁，其中CRBBB (28.53.8%)， IRBBB(24.46.2%)。在评价RV功能的参数中;CRBBB组的平均心室面积变化(P<0.001)、三尖瓣环平面收缩偏移(P<0.02)和左心室外侧环脉冲多普勒峰值速度(P<0.001)显著低于IRBBB组，而脉冲多普勒心肌功能指数(P<0.001)显著高于IRBBB组。与IRBBB组相比，CRBBB组右心房和右心室尺寸参数明显升高。结论:离体RBBB不像想象的那样是良性的，对右心室形态和功能的影响越来越差。因此，孤立性RBBB患者需要随着年龄的增长进行随访，并更多地关注右心室的结构和功能分析。
{"title":"MORPHOLOGIC CHARACTERISTICS AND FUNCTION OF RIGHT VENTRICLE IN PATIENTS WITH ISOLATED RIGHT BUNDLE BRANCH BLOCK","authors":"S. Murtuza, S. Regmi, B. Dhital, S. Thapa, P. Gurung, A. Khan, Sagar Thapa","doi":"10.54530/jcmc.1153","DOIUrl":"https://doi.org/10.54530/jcmc.1153","url":null,"abstract":"Background: The prevalence of right bundle branch block (RBBB) is estimated in 0.2 to 1.3% of healthy people. RBBB had independent association with decreased right ventricle (RV) function, which is considered as predictor of adverse cardiovascular outcomes. The aim of this study is to evaluate RV structure and function in patients with isolated RBBB (without structural heart disease) using two-dimensional echocardiography.\u0000Methods: A cross-sectional study conducted at Chitwan Medical College, Bharatpur from 1st January 2022 to 30th June 2022. Consecutive adult patients aged ≥18 years with isolated RBBB classified into complete RBBB (CRBBB) and Incomplete RBBB (IRBBB) based on electrocardiographic findings. The echocardiographic evaluation was done to assess RV dimension and function.\u0000Results: A total of 52 patients with isolated RBBB were included with mean age of the study population was 45.3 ± 9.3 years, (28 ,53.8%) had CRBBB, whereas the remaining (24, 46.2%) had IRBBB. Among the parameters used to assess RV function; mean RV-Fractional area change (P<0.001), Tricuspid annular plane systolic excursion(P<0.02) and Pulsed Doppler peak velocity at the lateral annulus RV(P<0.001) were significantly lower, while Pulsed Doppler myocardial performance index(P<0.001) was significantly high in CRBBB group as compared to IRBBB group. Similarly, Right atrium and RV dimensional parameters were significant higher in CRBBB compared to IRBBB group.\u0000Conclusions: Isolated RBBB is not as benign as it was considered and has deteriorating effect on RV morphology and function. Therefore, patients with Isolated RBBB need follow-up with passing age and more attention toward RV structural and functional analysis.","PeriodicalId":265624,"journal":{"name":"Journal of Chitwan Medical College","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114858652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Lama, K. Amgain, Niresh Thapa, Bishal Pokhrel, P. P. Panta, Pratima Neupane, Sushma Kafle, Shreejana K.C., S. Budhathoki
Background: The Human Coronaviruses (HCoVs), the neglected inconsequential pathogens have emerged from animal to man and man to man as a global epidemic with alarming morbidity and mortality in 21st century and Nepal did not remain sacred. It was important to rapidly assess the knowledge, attitude, practice and stigma regarding COVID-19 among people of Karnali Province where large number of labor migrants and villagers have entered the district during pandemic. Methods: An analytical cross-sectional study was done using structured questionnaire among 500 participants from Jumla and Mugu districts of Karnali Province. Descriptive and inferential statistical analysis were done. Ethical principles were followed throughout the study. Results: Among 500 participants, only 46.4% had good knowledge, 50.0% had positive attitude and 33.2% had good preventive practices regarding COVID-19. About one third (30%) participants sensed discriminatory behavior in community. Knowledge and attitude had statistically significant association with preventive practices against pandemic. Conclusions: More than half of the people of Karnali Province had poor knowledge, negative attitude and poor preventive practices regarding COVID-19. The determining factors for this situation were age, marital status, ethnicity, education, occupation and travel history. Hence, it is crucial to improve knowledge and attitude which will ultimately enhance preventive practices. Likewise, it is of utmost importance to address social stigma related to such epidemic, a serious public health issue prevalent in Karnali Province.
{"title":"KNOWLEDGE, ATTITUDE, PRACTICE AND STIGMA REGARDING COVID-19 AMONG PEOPLE OF KARNALI PROVINCE, NEPAL","authors":"N. Lama, K. Amgain, Niresh Thapa, Bishal Pokhrel, P. P. Panta, Pratima Neupane, Sushma Kafle, Shreejana K.C., S. Budhathoki","doi":"10.54530/jcmc.1168","DOIUrl":"https://doi.org/10.54530/jcmc.1168","url":null,"abstract":"Background: The Human Coronaviruses (HCoVs), the neglected inconsequential pathogens have emerged from animal to man and man to man as a global epidemic with alarming morbidity and mortality in 21st century and Nepal did not remain sacred. It was important to rapidly assess the knowledge, attitude, practice and stigma regarding COVID-19 among people of Karnali Province where large number of labor migrants and villagers have entered the district during pandemic.\u0000Methods: An analytical cross-sectional study was done using structured questionnaire among 500 participants from Jumla and Mugu districts of Karnali Province. Descriptive and inferential statistical analysis were done. Ethical principles were followed throughout the study.\u0000Results: Among 500 participants, only 46.4% had good knowledge, 50.0% had positive attitude and 33.2% had good preventive practices regarding COVID-19. About one third (30%) participants sensed discriminatory behavior in community. Knowledge and attitude had statistically significant association with preventive practices against pandemic.\u0000Conclusions: More than half of the people of Karnali Province had poor knowledge, negative attitude and poor preventive practices regarding COVID-19. The determining factors for this situation were age, marital status, ethnicity, education, occupation and travel history. Hence, it is crucial to improve knowledge and attitude which will ultimately enhance preventive practices. Likewise, it is of utmost importance to address social stigma related to such epidemic, a serious public health issue prevalent in Karnali Province.","PeriodicalId":265624,"journal":{"name":"Journal of Chitwan Medical College","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126573344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Niraj Puri, S. Adhikari, S. Gurung, S. Patel, P. Wagley, B. Thakur, M. Devkota
Background: Fiberoptic Bronchoscopy is a valuable tool in current respiratory medicine. This study was aimed to evaluate the diagnostic yield of Fiberoptic Bronchoscopy using a wider diameter bronchoscope. Methods: This was a hospital based cross-sectional study carried out in BP Koirala Memorial Cancer Hospital from January 2021 to March 2021. Consecutive sampling technique was used where 150 patients were enrolled in the study. Data entry and descriptive analysis were done in IBM SPSS version 20.0. Point estimate at 95% confidence interval was calculated along with frequency and descriptive statistics. Results: The overall yield from the wider Fiberoptic Bronchoscope was 70.07% which was slightly higher compared to literature results from conventional bronchoscopy. Lung mass on CT scan was the most common indication for bronchoscopy and upper lobe bronchus was the most common site for biopsy. Bronchial wash yield was highest for Squamous cell carcinoma with 22.78% followed by Pulmonary Tuberculosis with 21.5%. Endobronchial biopsy yield was highest for Squamous cell carcinoma with 41.21% followed by Adenocarcinoma with 31.42%. Temporary hypoxia and mild bleeding were common but life-threatening complications were rare. Conclusions: Overall findings of our study confirm that the diagnostic yield of Fiberoptic Bronchoscopy is high, particularly when a larger diameter bronchoscope is used which can facilitate wider biopsy forceps for larger tissue sampling.
{"title":"DIAGNOSTIC YIELD OF FIBEROPTIC BRONCHOSCOPY IN A TERTIARY CENTER","authors":"Niraj Puri, S. Adhikari, S. Gurung, S. Patel, P. Wagley, B. Thakur, M. Devkota","doi":"10.54530/jcmc.667","DOIUrl":"https://doi.org/10.54530/jcmc.667","url":null,"abstract":"Background: Fiberoptic Bronchoscopy is a valuable tool in current respiratory medicine. This study was aimed to evaluate the diagnostic yield of Fiberoptic Bronchoscopy using a wider diameter bronchoscope.\u0000Methods: This was a hospital based cross-sectional study carried out in BP Koirala Memorial Cancer Hospital from January 2021 to March 2021. Consecutive sampling technique was used where 150 patients were enrolled in the study. Data entry and descriptive analysis were done in IBM SPSS version 20.0. Point estimate at 95% confidence interval was calculated along with frequency and descriptive statistics.\u0000Results: The overall yield from the wider Fiberoptic Bronchoscope was 70.07% which was slightly higher compared to literature results from conventional bronchoscopy. Lung mass on CT scan was the most common indication for bronchoscopy and upper lobe bronchus was the most common site for biopsy. Bronchial wash yield was highest for Squamous cell carcinoma with 22.78% followed by Pulmonary Tuberculosis with 21.5%. Endobronchial biopsy yield was highest for Squamous cell carcinoma with 41.21% followed by Adenocarcinoma with 31.42%. Temporary hypoxia and mild bleeding were common but life-threatening complications were rare.\u0000Conclusions: Overall findings of our study confirm that the diagnostic yield of Fiberoptic Bronchoscopy is high, particularly when a larger diameter bronchoscope is used which can facilitate wider biopsy forceps for larger tissue sampling.","PeriodicalId":265624,"journal":{"name":"Journal of Chitwan Medical College","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124934684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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