Journal of National Heart and Lung Society Nepal <p>The Journal of National Heart and Lung Society Nepal is published by the National Heart &amp; Lung Society Nepal, Kathmandu-15, Dallu Awash, Nepal. This journal is focused on research related to health. The main intension of this journal is to enhance the knowledge and research finding sharing platforms for academic and professional growth.</p> National Heart & Lung Society Nepal en-US Journal of National Heart and Lung Society Nepal 2976-1468 Coronary Artery Protection with Chimney Stent in High-Risk Case of Coronary Occlusion in Transcatheter Aortic Valve Implantation <p>Transcatheter aortic valve implantation (TAVI) has rapidly evolved in the last decade to become the treatment of choice for most patients with severe aortic stenosis. Acute coronary occlusion during TAVI is a rare and life-threatening complication with high morbidity and mortality rates. If coronary occlusion is considered highly likely to occur, a risk reassessment could favor surgical aortic valve replacement. An excessive surgical risk that mandates continuing with the transcatheter strategy requires coronary protection techniques. Coronary protection techniques include; Coronary wire protection, Chimney/snorkel stent technique, “Bioprosthetic Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction,” (BASILICA) technique, Splitting devices, and UNICORN procedure. In this case report we present our first experience of the “Chimney/Snorkel stent technique” for coronary protection in a case where coronary occlusion risk was high due to low coronary height, small sinus of Valsalva, and use of balloon-expandable valve.</p> Chandra Mani Adhikari Amrit Bogati Birat Timalsena Sajjad Safi Sushant Khanal Pratik Thapa Vijay Ghimire Rahul Yadav Dipanker Prajapati Copyright (c) 2024 The Author(s) 2024-06-10 2024-06-10 3 1 39 43 10.3126/jnhls.v3i1.66388 Deep Vein Thrombosis While Still on NOAC <p>Novel oral anticoagulation treatment has been extensively used for thromboprophylaxis in atrial fibrillation and other clinical conditions because of predicable pharmacokinetic profile and safety. However, rarely plasma drug level variation can occur that can lead to thrombotic and bleeding events. We describe a case of deep vein thrombosis in a compliant patient still on apixaban. Anticoagulation failure with NOAC is concerning and obviously there is growing need of assay in these subsets showing the activity of NOAC. Till the availability of such methods, switching back to conventional therapy with Vitamin K antagonist with accurate monitoring could be appropriate strategy.</p> Murari Prasad Barakoti Copyright (c) 2024 The Author(s) 2024-06-10 2024-06-10 3 1 44 48 10.3126/jnhls.v3i1.66391 Adrenal Insufficiency Presenting as Pulseless Ventricular Tachycardia <p>Adrenal insufficiency (AI) is a severe sickness induced by adrenal gland or hypothalamic-pituitary-adrenal (HPA) axis dysfunction. It can induce a variety of symptoms, the most serious of which are potentially fatal adrenal crises. This case report describes a clinical scenario involving a 42-year-old male patient who had previously had brain tumor surgery. The patient had presented with fever and gastrointestinal symptoms. He developed pulseless ventricular tachycardia on day two of admission. Patient was promptly treated with electrical cardioversion. Workup revealed QT prolongation on ECG and adrenal insufficiency. Both the patient’s arrhythmias and QT prolongation on ECG responded to intravenous hydrocortisone. </p> Asraf Hussain Copyright (c) 2024 The Author(s) 2024-06-10 2024-06-10 3 1 49 52 10.3126/jnhls.v3i1.63818 Insight into The Status of Cardiothoracic and Vascular Surgery Training in Nepal <p>Cardiothoracic and Vascular Surgery is at a developing stage in Nepal. In Nepal, training of CTV surgeons started in the beginning of the 21st century. Nevertheless, there is already a decrease in trainee’s interest in this specialization leading CTVS training to a gasping state at its very neonatal age. Globally, training of medical professionals, in particular CTV surgeons, has been under continuous evolution since its inception. Analogously, in Nepal, the duration of the CTVS training and academic curriculum needs upgrading to meet international standards. Introduction of new concepts, learning advanced diagnostic and therapeutic techniques is important for CTV surgeons in Nepal, to become a competent member of the multidisciplinary Heart Team. </p> Kaushal Kishore Tiwari Copyright (c) 2024 The Author(s) 2024-06-10 2024-06-10 3 1 53 58 10.3126/jnhls.v3i1.66421 Transcatheter Aortic Valve Implantation (TAVI) In Small Island Nation- Maldives, Leading Cardiac Care to A Higher Standard <p><strong>Background</strong>: Surgical aortic valve replacement is still considered the preferred treatment option for patients with severe aortic valve stenosis, and it is known to improve the survival of the patients. However, about 30-50% of patients are not operated on due to several reasons including old age, high risk and other comorbidities. Transcatheter Aortic Valve Implantation (TAVI) is emerging as an alternative treatment option for elderly patients with high surgical risk.</p> <p><strong>Methods</strong>: In our study, four patients have undergone TAVI from February 2022 till May 2023 using Medtronic Transcatheter Aortic Valve, Core valve Evolut R (Medtronic Inc., Minneapolis, MN, USA) bioprosthesis.</p> <p><strong>Results</strong>: All the patients were discharged early. Follow-up Echocardiography showed decreased transaortic gradient with improved quality of life.</p> <p><strong>Conclusion</strong>: We conclude, implementation and use of this emerging technology in small Island Nations like Maldives would help to treat many patients, mostly elderly and high-risk as well as patients with intermediate risk requiring aortic valve surgery with less morbidity and comparable mortality in comparison to SAVR.</p> Kaushal Kishore Tiwari Mohamed Shafiu Murari Barakoti Ashish Kumar Nema Athul Suresh Kumar Dusooma Abdul Razzag Diwas Manandhar Satish Sai Copyright (c) 2024 The Author(s) 2024-06-10 2024-06-10 3 1 1 6 10.3126/jnhls.v3i1.63620 Prevalence of Systemic Hypertension and Hypertensive Crises among Adult Outpatients in a Cardiac Hospital in Central Nepal <p><strong>Background</strong>: The prevalence of systemic hypertension is a significant global health concern, affecting a large population worldwide. The objective of the study was to determine the prevalence of systemic hypertension and hypertensive crises among adult outpatients in a cardiac hospital in central Nepal.</p> <p><strong>Methods</strong>: This is a hospital based cross-sectional observational study conducted at outpatient department of Cardiology in central Nepal. Consecutive 487 patients were included in the study. All the patients had undergone proper blood pressure measurements as per the standard protocol with Aneroid Sphygmomanometer.</p> <p><strong>Results</strong>: Out of 487 participants in the study, 199 were diagnosed as hypertensives. The prevalence of hypertension was 40.86%, out of whom 56.28% were males and 43.72% were females with male: female ratio of 1:1.28. Mean age of the patients was 54.97 years with SD(±14.18 years). The highest number of patients with hypertension was in 51 to 60 years (25.6%) followed by 41-50 years (21.60%), 31(15.60%) of the patients presented with Hypertensive crises.</p> <p><strong>Conclusion</strong>: The prevalence of systemic hypertension was considerably high in our study. Newer and multifaceted approaches along with other effective preventive strategies have to be implemented to raise awareness among the publics regarding risk factors for systemic hypertension and its control. Early detection and proper management of Hypertension including therapeutic lifestyle modifications is the key to success.</p> Shankar Laudari Madhu Gupta Abiona Dhakal Raghuvendar Yadav Hari Prasad Upadhyay Copyright (c) 2024 The Author(s) 2024-06-10 2024-06-10 3 1 7 11 10.3126/jnhls.v3i1.65258 Prevalence of Alcohol Consumption and its Impact on Morbidity Among Patients Admitted to the Department of Medicine <p><strong>Background</strong>: Alcohol consumption is a prevalent societal issue with significant implications for public health. This study aims to investigate the prevalence of alcohol consumption and its impact on morbidity and outcomes among patients admitted to medicine department.</p> <p><strong>Methods</strong>: A prospective observational study was conducted using a proforma containing demographic and clinical data. Data of four hundred subjects admitted to Bharatpur Hospital in the department of medicine over the year 2023 were randomly collected. Data on alcohol consumption, demographic characteristics, medical history, and morbidity outcomes were collected and analyzed using descriptive statistics and chi-square tests.</p> <p><strong>Results</strong>: Among the study subjects (n=400), 22% reported alcohol consumption. The prevalence of alcohol consumption varied across demographic groups, with higher rates (30.9% and 33.1%) observed among males and middle age groups (36 - 55 years) respectively. Patients with a history of alcohol consumption had a significantly higher incidence of morbidity outcomes, including longer hospital stays (8.2 vs 5.1 days, p &lt;0.0001)), increased need for intensive care or referrals (10.71% vs 5.2%, p &lt;0.05), and higher mortality rates (8.03% vs 3.1%, p &lt;0.05) compared to non-drinkers.</p> <p><strong>Conclusion</strong>: This study highlights the relatively high prevalence of alcohol consumption among patients admitted to medical wards and its association with adverse morbidity outcomes. These findings underscore the importance of targeted interventions and comprehensive healthcare strategies aimed at addressing alcohol-related morbidity in hospitalized patients.</p> Mani Prasad Gautam Prakash Khatiwada Narad Thapaliya Gobinda Kandel Pramod Paudel Mahendra Kumar Agraharil Sophiya Paudel Copyright (c) 2024 The Author(s) 2024-06-10 2024-06-10 3 1 12 17 10.3126/jnhls.v3i1.66390 Clinical Profile, Pacemaker Parameters and Early Outcome of Permanent Pacemaker Implantation in Lumbini Province Nepal <p><strong>Background</strong>: Pacemaker implantation was started for the first time in Lumbini province Nepal at Gautam Buddha Community Heart Hospital. The objective of this research is to evaluate clinical parameters and compare with established centers in Nepal. </p> <p><strong>Methods</strong>: Patient and pacemaker parameters noted in proforma after getting consent from the patients. This is simple observational study. Calculation of parameters done using SPSS 17 version.</p> <p><strong>Results</strong>: Total 224 patients were evaluated over the duration of 3 years. Majority (60.3%) were female and 39.7% were male. 51.3% were of age group 65 to 80 years. 21% were above age 80 years, 22.8% were 45 to 65 years and 4.9% were below 45 years. 96.4% were Single chamber and 3.6 % were Dual chamber pacemaker. 97.8% were implanted on left side and 2.2% were implanted on right side. Impedance more than 1000 ohm noted in 3.6%. Threshold more than 1 mV noted in 7.6% and R wave amplitude less than 10 noted in 28.1%. Dislodgement was in 2.6% and Infection in 1.3%. No procedural death.</p> <p><strong>Conclusion</strong>: Single chamber implantation was far more common than dual chamber. Pacemaker parameters were similar at our hospital to other hospitals in Nepal.</p> Samir Gautam Sachin Dhungel Bishal KC Majhar Khan Abhishesh Shakya Rajesh Panjiyar Deepanjali Sharma Copyright (c) 2024 The Author(s) 2024-06-10 2024-06-10 3 1 18 21 10.3126/jnhls.v3i1.64141 Femoral artery Pseudo-aneurysm: Presentation, Causation and Outcome in Cardiothoracic Vascular and Transplant Centre of a Tertiary Level Hospital in Nepal <p><strong>Background</strong>: Peripheral arterial pseudo-aneurysms are of varied etiology and are quite common presenting from simple swelling to life threatening hemorrhage and sepsis. Our study aimed at evaluating our Institute’s experience with femoral artery pseudo-aneurysm over a span of 2 years with particular focus on the various range of presentations, causative factors and management outcomes.</p> <p><strong>Methods</strong>: Retrospective analysis of medical records of patients with diagnosis of femoral arterial pseudo-aneurysm who underwent surgery was done. Data was collected retrospectively from Anesthesia and vascular surgery records as well as administrative records.</p> <p><strong>Results</strong>: Over the duration of 2 years we found a total of 135 cases of femoral artery pseudo-aneurysm treated in our center. Intravenous drug abuse (112) followed by catheter induced (11) was the commonest etiology. Demographics showed a propensity towards the youth with most cases in the 20-30 age group (78, 58%) followed by 30-40 (35, 25%). A painful swelling with tenderness (91) was the commonest presentation. All patients underwent surgical treatment with 62 (45 %) patients undergoing ligation and the same numbers undergoing pseudo-aneurysm repair, 62 (45%). 78 (58%) patients had an uneventful recovery. However 18 cases had to undergo limb amputation and 7 patients lost their lives due to various complications.</p> <p><strong>Conclusion</strong>: Our study found that femoral artery pseudo-aneurysms present with various etiology and presentation, poses a huge challenge to the clinicians for surgery and management of its complications.</p> Bibhush Shrestha Shiva Prasad Paudyal Anil Bhattarai Copyright (c) 2024 The Author(s) 2024-06-10 2024-06-10 3 1 22 25 10.3126/jnhls.v3i1.64604 Computed Tomography Findings in Acute Stroke Patients in a Tertiary center <p><strong>Background</strong>: Stroke, or "cerebrovascular accident," is a medical disorder in which the brain's cells die due to insufficient blood flow. Successful stroke treatment varies according to the type of stroke, whether an infarct or a bleed, and it can be lethal without brain damage. The study aim was to compare clinical stroke diagnosis with computed tomography (CT) scan findings to determine stroke type (hemorrhagic or Ischemic).</p> <p><strong>Methods</strong>: This is a descriptive cross-sectional type of study conducted at the Department of Radiology &amp; Imaging in a diagnostic center at central Nepal from December 2023 to February 2024. A total of 120 patients from the inclusion criteria were taken for the study purpose. Data of clinical diagnosis were compared individually with CT findings.</p> <p><strong>Results</strong>: Out of 120 patients, 76 were males and 44 were females and they were in the age range of 40 to &gt;70 years. Clinically 59 patients were suspected to have Inermediate (hemorrhagic) infarct, 44 acute cerebral infarct and 17 Intra cerebral hemorrhage. CT scan of the brain showed 58 acute cerebral infarct, 36 Hemorrhagic infarct, 15 Intra cerebral hemorrhage and 7 Space occupying lesion.</p> <p><strong>Conclusion</strong>: The study found that CT should be the first thing to do when a person has a stroke because it's easy, quick, and accurate at figuring out infarct and hemorrhage which decides the treatment at a glance.</p> Mahendra Kumar Agrahari Ranjita Singh Kamlesh Kumar Shah Joon Kumar Shrestha Bibek Kadel Copyright (c) 2024 The Author(s) 2024-06-10 2024-06-10 3 1 26 29 10.3126/jnhls.v3i1.64322 Spectrum of Glomerular Diseases in Biopsy Proven Nephrotic Syndrome in Adults in Tertiary Center of Nepal <p><strong>Background</strong>: Glomerulonephritis (GN) is the important cause of chronic renal disease and had been reported as first common cause of CKD in Nepal after Diabetes and Hypertension. Correct diagnosis of glomerulonephritis requires renal biopsy and correlation with clinical and biochemical parameters.</p> <p><strong>Methods</strong>: This was an observational study conducted in Department of Nephrology, Bir Hospital Kathmandu, during the period of one year. A total of 88 patients were enrolled. Nephrotic syndrome was established by a detailed history, physical examination and investigations including kidney biopsy..</p> <p><strong>Results</strong>: Among the enrolled patients.51.2% were male and 48.8% were female. Almost all patients had hyperlipidemia. IgA Nephropathy was found to be the first commonest cause in 22.8% , second Lupus Nephritis in 9.3%, third Focal Segmental Glomerulosclerosis (FSGS) in 18.2% fourth was Membranous Nephropathy (MN) in 13.6%, Minimal Change Disease (MCD) in 11.4%, 9.1% Diffuse Proliferative Glomerulonephritis (DPGN), 3.4%, Membranous Proliferative Glomerulonephritis (MPGN) in which one was HBsAg positive, 1.1% PSGN,and 1.1% C3 glomerulopathy. Hypertension (HTN) was found in 26%, renal impairment in 28%, hematuria in 16% anemia and oedema in 12%, and 30 % respectively.</p> <p><strong>Conclusion</strong>: According to this study, IgA Nephropathy was the commonest cause 22.7% of Glomerulonephritis among total patients enrolled, whereas lupus nephritis was the second commonest 19.3% followed by focal segmental glomerulonephritis 18.1% and Membranous Nephropathy in 13.6%.</p> Dineshowri Shrestha Rajendra Kumar Agrawal Rajani Hada Anil Baral Copyright (c) 2024 The Author(s) 2024-06-10 2024-06-10 3 1 30 35 10.3126/jnhls.v3i1.66493 Clinico Microbiological Study of Infection In Burn Patients at BPKIHS Teaching Hospital <p><strong>Background</strong>: Each year around 2,00,000 peoples globally are injured by burn and 1,00,000 of these seek medical attention out of which 10,000 lose their lives. prevention is better in burns. The exact data about burns patient in Nepal is not known.</p> <p><strong>Methods</strong>: Prospective observational study carried out at surgical ward of BPKIHS Teaching Hospital between 15 May 2001 to 14 May, 2002 i.e. one year altogether.</p> <p><strong>Results</strong>: There were total 95 cases of burn patients admitted and managed by BPKIHS Teaching Hospital during that periods. Males were 40% (38) and Females were 60% (57). Accidental burns injury was 90.55% (86) and flame burns were 83% (79). Mixed infection in 36%, Acinobacter in 32% and pseudomonas in 14.4% found in wound swab cultures. Ofloxacin was found sensitive in 91.6%. 27% (26) patients expired in our study.</p> <p><strong>Conclusion</strong>: Mortality is high in our study because of Major burn patients came late in our Teaching Hospital for treatment.</p> Narad Prasad Thapaliya Copyright (c) 2024 The Author(s) 2024-06-10 2024-06-10 3 1 36 38 10.3126/jnhls.v3i1.66585