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> en-US (Dr. Shankar Laudari) (Sioux Cumming) Sun, 31 Dec 2023 08:18:53 +0000 OJS 60 Transradial Approach to Coronary Interventions in Central Nepal <p><strong>Background</strong></p> <p>The transradial approach (TRA) has gained popularity worldwide and it is the preferred access in many cardiac centers in Nepal. The aim of this study is to document single operator experience with TRA and its complications.</p> <p><strong>Results</strong></p> <p>A total of 214 patients were included with 114(53.27%) males and 100(46.73%) females. The mean age was (62.51 ± 12.47) years. The total transradial success rate was 88.78% for Coronary interventions. The crossover rate from radial to femoral access was 11.22%. The primary causes for crossover were severe tortuosity of the aorta and brachiocephalic trunk, radial artery spasm, puncture failure, and radial loop.</p> <p><strong>Conclusions</strong></p> <p>TRA is safe and can be applied in the majority of cases. The routine assessment of dual hand circulation before TRA might not be necessary.</p> <p> </p> Shankar Laudari, Puran Gurung, Kushal Gurung, Abiona Dhakal, Hari Prasad Upadhyay Copyright (c) 2023 shankar laudari Sun, 31 Dec 2023 00:00:00 +0000 Trends and Predictors of Readmission among Coronary Artery Disease Patients in a Community Heart Hospital in Nepal <p><strong>Background</strong>: Patients of Coronary artery disease after index hospitalization gets readmitted to the same or different hospital for cardiac or noncardiac causes. The objective of this study if to find the trends of readmission pattern and different factors determining readmission .<br /><strong>Methods</strong>: The study is retrospective hospital based study for one year. Eligible patients were patients having documentation of coronary artery disease and readmission in time frame of one year in 2079 BS.<br /><strong>Results</strong>: Out of 749 admitted patient with coronary artery disease, 143 (19%) patients were readmitted. Mean age was 63.3 ± 13.4. There were 88 (61.5%) male and 55(38.5%) female. Readmission rate for 30 days was 2.9% and 1 year 11.2%. Forty (38%) of readmitted patients had been admitted more than one time. Common presentations were chest pain 60 (42%), shortness of breath 42(29.4%), fever 11 (7.7%), epigastric pain 9 (6.3%), hemiparesis 8(5.6%), dizziness 4 (2.8%), hematemesis 2(1.4%) and hempoptysis 2 (1.4%). Top factors determining readmission were enlisted were presence of wall motion abnormalities 96(67.1%), anemia 83 (58%), diagnostic invasive procedure in past 80 (55.9%), hypertension 76(52.4%), low systolic function 75 (52.4%), angina 60(43%), diabetes 59(41.3%), heart failure 50 (35%), revascularization( PCI) 50 (35%), infarction 39(27.3 ), COPD 32(22.4%), infections 29(20.3%),acute kidney injury 25 (17.5), hypothyroidism 16(11.2%), dyslipidemia 15(10.5), CKD 14(9.8), CVA 13(9.1), APD 12 (8.4), arrhythmia 10 (7%) h/o CABG, 10 (7%) and UGI bleeding 10 (7%).<br /><strong>Conclusion</strong>: Readmission forms nineteen percentage of total admissions and readmission rate calculated within 30 days of admission as 2.9%.</p> Sachin Dhungel, Samir Gautam, Bishal KC, Mazhar Khan, Rajesh Panjiyar, Abhishesh Shakya, Manisha Yadav, Prayatna Bhattarai, Laxmi Dhawal, Subash Baral Copyright (c) 2023 Sachin Dhungel, Samir Gautam, Samir Gautam, Bishal KC, Mazhar Khan, Rajesh Panjiyar, Abhishesh Shakya, Manisha Yadav, Prayatna Bhattarai, Lakshmidhawal Dhawal, Subash Baral Sun, 31 Dec 2023 00:00:00 +0000 Diagnostic Utility of NT-Pro BNP in Elderly Patients Presenting With Acute Dyspnea in Emergency Department <p>ABSTRACT</p> <p>BACKGROUND:&nbsp; Acute dyspnea may be related to lungs pathology or cardiac pathology or due to involvement of both. Rapid diagnosis of the cause of dyspnea in emergency can help in early start of treatment preventing further progress of the symptoms, prolong hospital stay, need of more invasive medical procedures like intubation and ventilation thereby decrease the morbidity and mortality of the patients.</p> <p>METHODOLOGY: The study was conducted for three months i.e, from 16th May 2023 till 17th August 2023. 150 patients fulfilling inclusion criteria were taken. Clinical diagnosis in these patients was established based on medical history as well as echo and chest X-ray. Based on their clinical diagnosis, the patients were divided into three groups: group A diagnosed with pulmonary dyspnea (PD), group B diagnosed with congestive heart failure (CHF), and group C diagnosed with combined dyspnea (CHF+PD). NT-proBNP level in these patients was measured and compared.</p> <p>RESULTS: The study population constituted 60% males and 40% female with mean age of 68.9±10.99. Out of 150 patients presenting with acute dyspnea in emergency department, 65 patients were diagnosed with congestive heart failure, 55 patients were diagnosed with pulmonary dyspnea and 30 patients diagnosed with combined dyspnea. Average NT-proBNP among group A patients was (1300±175) ng/l, among group B patients was (275±70) ng/l and among group C patients was (1276±165) ng/l.</p> <p>CONCLUSION: NT-proBNP is the reliable marker to differentiate the cardiac and pulmonary causes of acute dyspnea among elderly patients presenting to emergency.</p> <p>&nbsp;</p> <p>KEY WORDS: N-terminal pro-B-type natriuretic peptide (NT-proBNP), emergency, elderly patients, dyspnea, biomarker</p> Manoj Shrestha, Pramod Bhusal Copyright (c) 2023 Manoj Shrestha Sun, 31 Dec 2023 00:00:00 +0000 Cardiac Arrhythmias in Ischemic Stroke Patients Admitted in a Tertiary Medical College of Central Nepal <p><strong>Background:</strong> Cardiac arrhythmias are known etiological agent for ischemic stroke and are also common after acute ischemic stroke. The objective of this research is to study various cardiac arrhythmias and find incidence of atrial fibrillation in acute ischemic stroke.</p> <p><strong>Methods:</strong> This hospital based cross sectional study conducted at COMS - teaching Hospital included 100 patients with diagnosis of acute ischemic stroke from October 2015 to October 2016. Arrhythmias was classified as atrial ectopic beats, atrial fibrillation, premature ventricular complex, sinus bradycardia, sinus tachycardia, sinus arrhythmias, sick sinus syndrome, atrial tachycardia and ventricular tachycardia on basis of ECG monitoring for 24 hours.</p> <p><strong>Results:</strong> Among total 56% (n=56) had abnormal rhythm. Total incidence of atrial fibrillation was 20%. Other arrhythmias observed were sinus tachycardia in 9% (n=9), premature ventricular complex in 8% (n=8), ventricular tachycardia in 5% (n=5), sinus bradycardia in 4% (n=4), sinus arrhythmias in 4% (n=4), atrial ectopic beats in 3% (n=3), sick sinus syndrome in 2% (n=2) and atrial tachycardia in 1%(n=1). Right cerebral hemisphere was more involved than left in both normal and abnormal rhythm (p =0.714). Mortality observed was 4.5% (n=2) in normal rhythm and 8.9% (n=5) in arryhthmias (p=0.461).</p> <p><strong>Conclusion:</strong> Cardiac arrhythmias are frequent in acute ischemic stroke. Atrial fibrillation is most commonly observed arrhythmia in acute ischemic stroke and mortality is higher in patient with rhythm abnormalities than with normal rhythm.</p> Bikash Nepal, Rajeev Mishra, Avatar Verma, Prativa Chapagain, Prabin Chapagain, Khush Raj Dewan, Ganapati Mishra, PVS Rana Copyright (c) 2023 shankar laudari Sun, 31 Dec 2023 00:00:00 +0000 Clinical Profile of Patients with Pleural Effusion Admitted to Bharatpur Hospital <p><span style="font-weight: 400;">ABSTRACT</span></p> <p><strong>Background</strong><span style="font-weight: 400;">: Pleural effusion occurs when there is disequilibrium between the quantity of fluid entering and leaving the pleural space. The objective of the study was to investigate the association between pleural effusion and underlying medical conditions as heart failure, pneumonia, malignancies of clinical presentations and laboratory findings of all those patients admitted to Bharatpur Hospital during the period of last 1year.</span></p> <p><strong>Methods</strong><span style="font-weight: 400;">: Retrospective data from September 2022 to September 2023 from all the cases diagnosed with pleural effusion will be taken. Altogether 120 cases diagnosed with pleural effusion studied. The collected data was re-checked, reviewed, organized, entered and analyzed in statistical package for social sciences (SPSS) version 20.0.</span></p> <p><strong>Results:</strong><span style="font-weight: 400;"> From the findings of the study, 56.7% were male and 60.0% were from outside Chitwan District. Among the various causes of pleural effusion the most common cause was tubercular effusion (30.8%) followed by para-pneumonic effusion (19.2%). Tubercular effusion is Shortness of breath was present in 13.5%, cough in 10.8%. Tubercular pleural effusion is common in the age group 41–50 years and Patients with para-pneumonia, is 97 had lymphocyte and 23 had neutrophil. &gt;3 gm/dl was observed in patients with tubercular effusion and Mean value of ADA for tubercular effusion was 45.8 U/L.</span></p> <p><strong>Conclusions</strong><span style="font-weight: 400;">: Our study concluded that shortness of breath, cough, and Pleural fluid analysis is the diagnostic method to distinguish exudative from transudative pleural effusion. Lymphocyte rich exudative effusion occurs in case of Tubercular effusion and neutrophil rich effusion occurs in para-pneumonic effusion.</span></p> <p><span style="font-weight: 400;">Key words: pleural effusion, exudative, transudative.</span></p> Mahendra Agrahari, Kalyan Sapkota, Ranjita Singh, Prajawal Dahal, Joon Kumar Shrestha Copyright (c) 2023 Mahendra Agrahari Sun, 31 Dec 2023 00:00:00 +0000 Diagnostic Value of Bronchoalveolar Lavage in Sputum-Smear Negative Pulmonary Tuberculosis <p>Introduction: Bronchoalveolar lavage has a high diagnostic utility for cytology and bacteriology. The aim of this study was to assess the diagnostic value of bronchoalveolar lavage (BAL) which underwent routine bronchoscopy for evaluation of lung disease. Materials and Methods: This is a hospital based descriptive study done from July 1, 2022, to June 30, 2023. Eighty bronchoalveolar lavage (BAL) cases were analyzed for differential count, cytological evaluation and bacteriological examination. All cases were included which were sent as BAL specimen to the laboratory department. Bronchoscopy was done as an outpatient procedure and lavage fluid obtained was analyzed. Result: Out of 80 cases, 51 were male and 29 were female. The age ranged from 10 to 80 years. The prevalence of tuberculosis in sputum smear negative cases was found to be 29%. Among 80 cases, eight cases were unsatisfactory, twenty-three cases were of tuberculosis, one case was of fungal infection, two cases were of malignancy, forty cases were of small airway infection and six cases were satisfactory but with no diagnostic value. Conclusion Bronchoalveolar lavage is valuable in diagnosis of tuberculosis, infections and malignancies.</p> Apar Pokharel, Chhanya Bhandari, Bibek Sharma, Ramesh Bhandari, Yubraj Paudel Copyright (c) 2023 Apar Pokharel, Chhanya Bhandari, Bibek Sharma Sun, 31 Dec 2023 00:00:00 +0000 Influence of Antihypertensive Drugs on Left Ventricular Hypertrophy Regression in Hypertensive Patients <p><strong>Background</strong>: Hypertension and its effect on heart in the form of left ventricular hypertrophy are the important predictors of heart failure. Hypertension treatment and left ventricular hypertrophy regression is crucial in the prevention of cardiovascular disease. However, the impact of antihypertensive treatment on left ventricular hypertrophy is less studied and which particular class of antihypertensive medicine is more effective is largely unexplored in our population. We designed this study to explore this issue in subjects taking treatment by evaluation initial and after six months echocardiography findings. <br /><strong>Methods</strong>: One hundred fifty subjects aged 25-75 years, taking antihypertensive medicine were enrolled in the study. Along with basic demographic and epidemiological data, initial and after 6 months echocardiographic findings were analyzed for the presence of LV hypertrophy regression. Choice of medicine and necessary changes for the achievement of blood pressure targets were done on treating physician’s discretion.<br /><strong>Results</strong>: Out of 150 subjects, data for 130 subjects were available for final analysis. Mean age was 54.4 years with standard deviation of 12.3 years. Apart from age, smoking, overweight and obesity, dyslipidemia, and diabetes were the important risk factors with a prevalence of 28%, 26%, 22% and 20% respectively. Although the decrease in rates of LV hypertrophy over the duration of 6 months were not significant in overall and in subjects treated with various antihypertensive medicines, the reductions in LV mass index (108.76+/-11.3 to 98.46+/-11.23) in overall and in different antihypertensives were significant (p&lt;0.001). The decrease in LV mass index was statistically significant in subjects taking angiotensin converting enzyme inhibitors or angiotensin receptor blockers when compared to subjects taking calcium channel blockers (p&lt;0.05). This decrease in LV mass index was not significant when compared between CCBs and mixed drugs.<br /><strong>Conclusion</strong>: There was regression in LV hypertrophy among subjects taking antihypertensive treatment. It was more obvious in subjects taking angiotensin converting enzyme inhibitors/angiotensin receptor blockers when compared with subjects taking calcium channel blockers or both.</p> Mani Prasad Gautam, Sabina Sedhain , Puran Gurung , Sophiya Paudel , Govinda Kandel , Prakash Khatiwada Copyright (c) 2023 Hari Prasad, Mani Prasad Gautam, Sabina Sedhain , Puran Gurung , Sophiya Paudel , Govinda Kandel , Prakash Khatiwada Sun, 31 Dec 2023 00:00:00 +0000 Emergence Agitation: Comparison of Paracetamol and Tramadol in Elective Surgery Patients <p><strong>Background</strong>: Post-operative emergence agitation is frequent and self-limiting but at times may present with violent behavior and may result in harm to both patients and caregivers. The objective of this research is to find the incidence of emergence agitation and to compare the effects of paracetamol and tramadol on emergence agitation.<br /><strong>Methods</strong>: A quasi experimental study was conducted in the Department of Anesthesiology, College of Medical Sciences, Bharatpur, Chitwan, Nepal over a period of three months. One hundred fifty ASA I and II patients aged 18 – 45 years old, posted for elective surgery under general anesthesia were included. Patients were assigned into two equal groups of 75 patients (n=75). At the end of the surgery, group A received inj. tramadol 1mg/kg, just when the surgeon starts skin closure and group B received 15 mg/kg Paracetamol. Time taken for extubation, shivering, Richmond agitation sedation scale (RASS) and sedation and Visual analogue scale (VAS) and need of rescue analgesics were recorded. <br /><strong>Results</strong>: In paracetamol group, reversal to extubation time was 8.75±3.0 minutes which was higher compared to 6.21±1.84 minutes in tramadol group. Prevalence of shivering was higher in paracetamol group. VAS score in paracetamol group was 5.28±1.03 compared to 4.33±0.82 in tramadol group. Frequency of need of rescue analgesia was higher in paracetamol group. In the immediate postoperative period, agitation was more common. <br /><strong>Conclusion</strong>: Use of tramadol before extubation reduces the incidence of postoperative emergence agitation, immediate postoperative pain and shivering.</p> Ajay Singh Thapa, Rakesh Shah, Rajesh Kumar Yadav, Ram Shrestha Copyright (c) 2023 Ajay Singh Thapa Sun, 31 Dec 2023 00:00:00 +0000 Association of Hemoglobin Variability with Mortality in Dialysis Patients in Tertiary Hospital Nepal <p><strong>Background</strong>: Rising number of End Stage Renal Disease patients is a great economic burden because of its high cost and lifelong treatment need. Target hemoglobin in dialysis patients is maintained through iron supplement, Erythropoietin stimulating agents, Blood products transfusions and treatment of other correctable causes. Large Hemoglobin fluctuation in such patients is related to decreased survival. The aim of this study was to relate hemoglobin variability with mortality in dialysis patients.</p> <p><strong>Methods</strong>: This is a cross sectional observational study carried out in 104 patients undergoing dialysis for a duration of one year from March 2019 to February 2020. Area Under Curve (AUC) method was used to calculate hemoglobin variability. Hb data were collected using Hospital based software.</p> <p><strong>Results</strong>: Mean age of study population was 50.15±14.1 yrs and 68.14% were male. Calculated hemoglobin variability was more in &lt;15T (patients receiving less than fifteen blood transfusions per year) than &gt;15T (patients receiving more than fifteen blood transfusions per year) group. Death to survival ratio was 0.73 in &lt;15T and 0.41 in &gt;15T.</p> <p><strong>Conclusion</strong>: This study showed that lesser the hemoglobin variability, better the survival in ESRD population receiving maintenance hemodialysis.</p> Gobinda Kandel, Kabindra Sedhain, Pitambar Thakur, Pradeep Sapkota, Kalyan Sapkota Copyright (c) 2023 Gobinda Kandel, Kabindra Sedhain, Pitambar Thakur, Pradeep Sapkota, Kalyan Sapkota Sun, 31 Dec 2023 00:00:00 +0000 Clinical Profile and Etiology of Patients with Pericardial Effusion <p><strong>Background</strong>: Pericardial effusion are one of the common cardiac problems in our part of the world and is associated with high risk of morbidity and mortality if not diagnosed and treated. The aim of this study was to determine etiological spectrum and clinical presentation of moderate to large pericardial effusion.<br /><strong>Methods</strong>: A descriptive cross-sectional study was conducted from February 2023 to July 2023 at Department of Cardiology, NMC-TH. Fifty patients were included in the study who visited to NMC-TH; OPD, ward and emergency department. Apart from routine investigations, ECG, chest X-ray and echocardiography were performed in all patients. Pericardiocentesis was done in 37 patients (74%). Specific investigations for the suspected etiological diagnosis were done.</p> <p><strong>Results</strong>: A total of 50 patients (30 Male, 20 Female) were included in the study with age ranging from 11 to 76 years. The most common clinical presentations were dry cough (86%) followed by shortness of breath (70%) and fever (66%). In this study, the most common etiology of pericardial effusion was tuberculosis (n-22; 44%) followed by malignancy 6(12%), idiopathic 6(12%), and Hypothyroidism 4(8%). Among malignancies, carcinoma of lung was the commonest 3(50%). Tuberculosis was the most common cause in patients presenting with tamponade 8(61.5%) followed by malignancy 2(15.3%).<br /><strong>Conclusion</strong>: This study shows tuberculosis is the most common cause of pericardial effusion followed by malignancy. </p> Madhu Gupta, Maheshwar Prasad, Achutanand Lal, Jeetendra Mishra, Imran Ali, Parash Bhatta, Salina Khadka Copyright (c) 2023 Hari Prasad, Madhu Gupta, Maheshwar Prasad, Achutanand Lal, Jeetendra Mishra, Imran Ali, Parash Bhatta, Salina Khadka Sun, 31 Dec 2023 00:00:00 +0000 Effectiveness of Structured Teaching Programme on Knowledge Regarding Arterial Blood Gas Analysis among Nursing Students <p><strong>Background</strong>: Arterial blood gas (ABG) analysis measures blood pH, oxygen (O2), and carbon dioxide (CO2) levels. Normal pH is 7.35-7.45, PaO2 ranges from 70-100 mm Hg, PaCO2 is 35-45 mm Hg, and SaO2 is 93-98%. HCO3 normal value is 22-26 meq/l. This study assesses the effectiveness of a structured teaching program on arterial blood gas analysis knowledge among nursing students. <br /><strong>Methods</strong>: A pre-experimental study with a one-group pretest-posttest design evaluated the effectiveness of a structured teaching program on Arterial Blood Gas analysis knowledge among nursing students from two Purbanchal University-affiliated colleges. Narayani Samudayik Nursing College was chosen using a probability-based simple random sampling lottery method. Enumerative sampling was employed to select respondents for the study. <br /><strong>Results</strong>: The study found that 87% of respondents initially had an average knowledge level of arterial blood gas analysis, with 13% having adequate knowledge. After intervention, 82.6% demonstrated adequate knowledge, and 17.4% maintained an average level. Mean knowledge scores significantly increased from 67.15 to 87.7 in pretest and posttest, respectively (p&lt;0.001). The results affirm the intervention's effectiveness in improving participants' understanding of arterial blood gas analysis..<br /><strong>Conclusion</strong>: Most respondents had average knowledge of ABG analysis. Following the structured teaching program, the majority achieved adequate knowledge, demonstrating its significant positive impact in enhancing nursing students' unde standing of ABG analysis.</p> Babita Ghimire, Anjana Acharya, Hari Prasad Upadhyay Copyright (c) 2023 Babita Ghimire Sun, 31 Dec 2023 00:00:00 +0000 Prevalence and Associated Risk Factors of Depression among Elderly People Admitted in a Tertiary Health Care Centre of Nepal <p><strong>Background</strong>: Ageing is associated with various physiological and pathological changes including Mental Health. Mental health is a neglected health problem in Nepal which is underdiagnosed and undertreated, especially among elderly population. However, Depression among elderly people is the most common mental health problem worldwide and in Nepal, Limited research has been conducted. Thus, study aimed to assess the prevalence and associated factors of depression among elderly admitted in tertiary level hospital, Nepal. <br /><strong>Methods</strong>: Descriptive cross-sectional study design was used where 330 patients aged 60 years and over and admitted in geriatric ward were purposively selected as sample of the study. Data were collected from September 2021 to March 2022 semi structured face to face interview schedule questionnaire to identify sociodemographic characteristics as well as factors associated with depression and Geriatric depression scale item 15 (GDS 15) to measure prevalence of depression. Data were entered in SPSS, analyzed using descriptive and inferential statistics and presented in tables. <br /><strong>Results</strong>: This study had prevalence of depression 65.8%. Male had higher prevalence rate of depression than female. Prevalence of depression was significantly associated with gender, education status, financial support from family (P-value=0.010, 0.042 and 0.00) at 95% of confidence interval.<br /><strong>Conclusion</strong>: The prevalence of depression among older adult was found to be high. This emphasizes the need for screening of depression among elderly, to initiate early intervention measures.</p> Bijaya Dhakal, Rama Kumari Lamichhane, Kalyan Sapkota, Aasha Thapa Copyright (c) 2023 Bijaya Dhakal, Rama Kumari Lamichhane, Kalyan Sapkota, aasha Thapa Sun, 31 Dec 2023 00:00:00 +0000 Acute Pulmonary Embolism Following Hemorrhagic Stroke <p><strong>Background</strong>: Venous thromboembolism results from extended immobilization following intracerebral hemorrhage. Massive pulmonary embolism in association with right heart failure is a life-threatening condition and requires treatment with anticoagulants or thrombolytic agents. There are no guidelines for treatment of pulmonary embolism with recent hemorrhagic stroke and these medicines are contraindicated, as they may induce farther hemorrhage.</p> Madhu Gupta, Maheshwar Prasad, Achutanand Lal, Jeetendra Mishra, Imran Ali, Parash Bhatta, Salina Khadka Copyright (c) 2023 shankar laudari Sun, 31 Dec 2023 00:00:00 +0000