Tag: pubmed

Adv Respir Med. 2022 Feb 24. doi: 10.5603/ARM.a2022.0028. Online ahead of print.

ABSTRACT

INTRODUCTION: The classification of the severity of obstructive sleep apnea (OSA) based on the Apnea/Hypopnea Index (AHI) does not reflect the heterogeneity and prognosis of the disease. The Baveno classification proposes a new assessment system that includes symptoms and comorbidities. The aim of our study was to evaluate the application of the Baveno classification in clinical practice and to explore its association with sleep indices, adherence to therapy and symptoms over a 6-months period.

MATERIAL AND METHODS: Prospective study including patients diagnosed with OSA between January and July 2021 was conducted. Patients were divided into 4 groups (A-D) according to the Baveno classification. The adherence to PAP treatment and Epworth Sleepiness Scale (ESS) values were obtained 6 months after initiation of therapy.

RESULTS: A total of 91 patients (84% male, 58 ± 13 years) were included in the study. The median ESS score was 10 (6-15), mean AHI was 28.4 ± 22.2 events/hour and the time with SpO₂ < 90% (T90) was 9.7 ± 14.9%. At diagnosis, patients were classified into Baveno groups: A: 30%; B: 35%; C: 17%, D: 19%. There were no statistical differences in AHI between the different groups. On the other hand, T90 had higher values in patients with comorbidities (C, D). Regarding the treatment, the prescription of PAP was higher in patients with comorbidities (C, D), and adherence to this treatment at 6 months was higher in group D. Among patients under PAP therapy, there was a statistically significant decrease in daytime sleepiness at 6 months in groups B and D.

CONCLUSIONS: The Baveno classification distributes patients with OSA evenly across the different phenotypes, regardless of the AHI value. The treatment decision was linked to the comorbidities (C, D) were the ones who had the greatest adherence to treatment at 6 months were in group D. ESS improved with greater emphasis in the most symptomatic (B, D), while the AHI is essential for the diagnosis of OSA, the Baveno classification may guide physicians better in their treatment decision.

PMID:35199843 | DOI:10.5603/ARM.a2022.0028

Pacing Clin Electrophysiol. 2022 Feb 24. doi: 10.1111/pace.14471. Online ahead of print.

ABSTRACT

BACKGROUND: Thromboembolic (TE) events are among the most common and devastating adverse events in patients with continuous-flow left ventricular assist device (cf-LVAD). Given the high burden of AF among cf-LVAD patients, we sought to evaluate the effect of concomitant surgical LAAO in patients receiving cf-LVAD.

METHODS: A systematic search using electronic databases was performed using the keywords: “left atrial appendage occlusion” and “left ventricular assist device.” Statistical analysis was performed using meta-package for R version 4.0 and Rstudio version 1.2. Mantel-Haenszel risk ratio (RR) random-effects model was used to summarize data between two groups. The primary outcomes included: (a) stroke; (b) LVAD pump thrombosis; (c) all-cause mortality RESULTS: : Three studies with a total of 305 patients (LAAO=68 and No-LAAO=237) were included in the analysis. HeartMate II (39%) and Heartware (27.5%) were the two most common cf-LVADs utilized, while only 5% received HeartMate III. At a mean follow up of 1.47 years, LAAO group had a lower risk of stroke (8.8% vs 15.2%, RR 0.64; 95% CI 0.28 – 1.49), LVAD pump thrombosis (1.5% vs 3.8%, RR 0.28; 95% CI 0.05 – 1.55) and all-cause mortality (5.9% vs 20.2%, RR 0.69; 95% CI 0.19 – 2.52) when compared with no-LAAO group, but the difference did not reach statistical significance.

CONCLUSION: Concomitant surgical LAAO at the time of cf-LVAD implantation demonstrated a trend towards positive outcomes and was not associated with adverse outcomes during the follow-up period, though the results were not statistically significant This article is protected by copyright. All rights reserved.

PMID:35199863 | DOI:10.1111/pace.14471

JNMA J Nepal Med Assoc. 2021 Dec 11;59(244):1272-1276. doi: 10.31729/jnma.5307.

ABSTRACT

INTRODUCTION: Dengue fever, a mosquito-borne disease, is one of the emerging tropical diseases that appear primarily in rainy seasons. The number of dengue cases was increased in recent years in Nepal. Chitwan is one of the risky areas of dengue. This aim of the study is to find out the prevalence of hospital admission among the dengue positive cases.

METHODS: The descriptive cross-sectional study was carried out among 323 serologically confirmed dengue fever positive patient admitted in Medicine Inpatients Department of Chitwan Medical College Teaching Hospital. Ethical approval was taken from the Institutional Review Committee (Reference number. 076/077-121 dated August 30, 2019). Data were collected from 1st September 2019 to 31st December 2019 using a structured interview schedule and record review. Convenience sampling was done. Data was analysed using Statistical Package for Social Sciences version 11. Point estimate at 95% Confidence Interval was calculated, with frequency and percentage.

RESULTS: Among 1206 patient with dengue fever, 323 (26.78%) (24.29-29.27 at 95% confidence Interval) were admitted in the tertiary care hospital. Study findings revealed that out of 323 admitted patients with dengue fever, 182 (56.3%) patients were between 20-40 years of age and 179 (55.4%) were males. The highest number of patients were admitted in the months of September 192 (59.4%) and October 101 (31.2%).

CONCLUSIONS: Admission rate among dengue positive cases are comparable to other studies of the similar settings. Dengue fever is common among community people especially in young adult and males. Hence, screening of dengue fever in febrile illness is necessary for the early diagnosis and prompt treatment.

PMID:35199799 | DOI:10.31729/jnma.5307

Adv Respir Med. 2022 Feb 24. doi: 10.5603/ARM.a2022.0025. Online ahead of print.

ABSTRACT

INTRODUCTION: Noninvasive positive-pressure ventilation (NPPV) is applied to facilitate weaning process and decrease complications associated with prolonged intubation. Interest has emerged in using Intelligent Volume Assured Pressure Support (iVAPS) to facilitate earlier removal of an endotracheal tube.

MATERIAL AND METHODS: This study was conducted to compare the effectiveness of iVAPS versus standard Spontaneous/timed (S/T) mode in facilitating weaning process of mechanically ventilated chronic obstructive pulmonary disease (COPD) in acute exacerbation. In a prospective randomized study, 80 invasively ventilated COPD patients in acute exacerbations were extubated then immediate applicationof NPPV using either S/T mode (Group I) or iVAPS mode (Group II) was done. Clinical parameters (heart rate, respiratory rate, and arterial blood gas parameters at selected time intervals of treatment were recorded for both groups and analyzed.

RESULTS: No significant differences were found between both groups regarding age, sex, mMRC dyspnea scale, CAT score and APACHE II score. Heart rate and mean arterial blood pressure in the two groups decreased with time, but no significant differences were found between the two groups. Likewise, there was no significant difference in RR between S/T and iVAPS groups. Regarding arterial blood gas analysis, there were no detectable differences in PaCO₂ level, PaO₂ level or oxygen saturation. The successful outcome was achieved in (82.5%) in the S/T group vs (80%) in the iVAPS group. The two modes achieved comparable levels of comfort as assessed by VAS and the total Mask Fitness Score. There was no statistically significant difference in reintubation, the duration of NPPV, duration of ICU stay or in mortality rate.

CONCLUSION: iVAPS mode is as effective as fixed-pressure S/T mode in facilitating weaning of hypercapnic COPD patients.

PMID:35199841 | DOI:10.5603/ARM.a2022.0025

JNMA J Nepal Med Assoc. 2021 Dec 11;59(244):1239-1242. doi: 10.31729/jnma.6318.

ABSTRACT

INTRODUCTION: Hematologic abnormalities are among the most common complications of infection with Human Immunodeficiency Virus. These abnormalities are due to: impaired hematopoiesis, immune mediated cytopenias and altered coagulation mechanisms. Anemia is the most frequent,however, leukopenia, lymphopenia, and thrombocytopenia have also been observed. The aim of the study was to find the prevalence of anemia in patients attending anti-retroviral therapy at a tertiary care center of Nepal.

METHODS: The study was a descriptive cross-sectional study conducted from August 2018 to August 2019 in patients attending anti-retroviral therapy at a tertiary care hospital. Ethical approval was obtained from the Institutional Review Board of National Academy of Medical Sciences before starting the study (Reference number 267). Convenient sampling was used for this study. Data were analysed using the Statistical package for Social Sciences version 20. Point estimate at 90% confidence interval was calculated along with frequency and proportion for the binary data.

RESULTS: The prevalence of anemia among patients attending anti-retroviral therapy centers in our study was found in 29 (58%) (46.55-69.45 at 90% Confidence Interval). Out of those patients, 20 (63%) were male and 9 (50%) were female. The mean hemoglobin value was 11.946±2.51g/dl.

CONCLUSIONS: The prevalence of anemia among patients attending antiretroviral therapy in our study was found to be high which is consistent with the findings of other similar international studies. These patients should be routinely monitored and treated for the occurrence of hematological abnormalities.

PMID:35199795 | DOI:10.31729/jnma.6318

JNMA J Nepal Med Assoc. 2021 Dec 11;59(244):1209-1214. doi: 10.31729/jnma.6392.

ABSTRACT

INTRODUCTION: Pregnancy Induced Hypertension is a major health issue with limited studies conducted so far in Chitwan, Nepal regarding adverse perinatal outcomes in obstetric population. This study aimed to find prevalence of pregnancy induced hypertension among pregnant women delivering in a tertiary care hospital.

METHODS: A descriptive cross-sectional study was conducted in a teaching hospital of Chitwan, Nepal during the study period of six months from 15th Jan 2019- 16th July 2019 after getting ethical approval from Chitwan Medical College-Institutional Review Committee (Reference number-2075/076042). Women were selected via convenience sampling technique. Face to face interview was conducted to collect socio-demographic and obstetric data whereas, data related to the fetomaternal outcomes were obtained from patient charts and delivery record books. Statistical Package for Social Sciences version 20 was used for data analysis. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data.

RESULTS: The prevalence of pregnancy induced hypertension was found to be 91 (6.43%) (3.83-9.03 at 95% Confidence Interval) representing 71 (78.1%), 12 (13.2%), and 8 (8.7%) as gestational hypertension, preeclampsia and eclampsia respectively.

CONCLUSIONS: The burden of pregnancy induced hypertension was found quite higher as compared to other similar studies done in Nepal. Gestational hypertension was most common type.

PMID:35199794 | DOI:10.31729/jnma.6392

JNMA J Nepal Med Assoc. 2021 Dec 11;59(244):1234-1238. doi: 10.31729/jnma.6652.

ABSTRACT

INTRODUCTION: Performing the total knee arthroplasty in moderate to severe fixed flexion deformity, appropriate resection of bone from distal femur along with proper ligament balancing is mandatory in order to get the reasonable intraoperative correction. The aim of our study is to find out the prevalence of total knee arthroplasty among knees with moderate to severe fixed flexion deformity in a tertiary care center.

METHODS: This is a descriptive cross-sectional study conducted from hospital records of 2013 to 2019 in elderly patients with moderate to severe fixed flexion deformity in a Tertiary Care Hospital. Ethical clearance (14/2020) was taken from Institutional Review Board. Convenience sampling was used and statistical analyses were performed using the Statistical Package for the Social Sciences software (version 16.0). Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data.

RESULTS: Out of 400 knees with moderate to severe fixed flexion deformity, the prevalence of total knee arthroplasty was found to be 80 knees (20%) (16.08-23.92 at 95% Confidence Interval).

CONCLUSIONS: The prevalence of total knee arthroplasty is comparable to other study. In our study total knee arthroplasty can be performed successfully with excellent functional outcomes in patients with moderate to severe fixed flexion deformity of knee joint provided the joint stability is maintained by appropriate ligamentous balancing.

PMID:35199789 | DOI:10.31729/jnma.6652

JNMA J Nepal Med Assoc. 2021 Dec 11;59(244):1297-1301. doi: 10.31729/jnma.6627.

ABSTRACT

INTRODUCTION: Acute Pancreatitis is a common disease, diagnosed in about 3% of cases presenting with abdominal pain. Severe disease with multiple systemic complications develops in 10-20% of the cases which require intensive care in specialized centres. Harmless acute pancreatitis score is a simple and economical score predicting the non-severe course of disease within 30 minutes of admission. The aim of our study was to find the prevalence of harmless (harmless acute pancreatitis) among cases of acute pancreatitis in a tertiary care centre.

METHODS: A descriptive cross-sectional study was conducted after obtaining the ethical approval (Reference no. 344/2076/77). The study was carried out from September 2019 to February 2020 taking 50 patients with the first attack of acute pancreatitis. Convenient sampling was done. Harmless acute pancreatitis score prediction of severe disease and final outcome as severe or non-severe was noted with predefined severity criteria. Data were entered in Microsoft Excel and Statistical Package for the Social Sciences and results represented in tables and charts. Point estimate at 95% was done and frequency and percentage were calculated.

RESULTS: Out of 50 patients with first attack of acute pancreatitis, using the harmless acute pancreatitis score, the prevalence of harmless acute pancreatitis was 22 (56%) (44.45-67.5 at 90% Confidence Interval).

CONCLUSIONS: The harmless acute pancreatitis score is an easy, less expensive, quick and promising early scoring system for prediction of non-severe courses of acute pancreatitis. The prevalence of harmless (harmless acute pancreatitis) among cases of acute pancreatitis was found to be similar to other studies.

PMID:35199790 | DOI:10.31729/jnma.6627

JNMA J Nepal Med Assoc. 2021 Dec 11;59(244):1252-1255. doi: 10.31729/jnma.6879.

ABSTRACT

INTRODUCTION: Ureteric calculi are lying at any point of ureter from the pelvic ureteric junction to the vesicoureteral junction. If left untreated, ureteropelvic junction obstruction can lead to hydronephrosis. With the improved availability of computed tomography and ultrasound scanning, hydronephrosis is being diagnosed more frequently. The main aim of this study is to find out the prevalence of moderate Hydronephrosis among ureteral calculus on ultrasonography imaging in a tertiary care center of Nepal.

METHODS: A descriptive cross-sectional study was conducted among 110 acute ureteral calculus cases at Radiodiagnosis and Imaging Department of Chitwan Medical College and Teaching Hospital, Bharatpur from 15th August 2020 to 15th May 2021. The ethical approval was taken from the Institutional Review Committee of same institution. Convenient sampling technique was used to select the participant. The collected data was entered in excel 16 and analysed in Statistical Package for Social Sciences. Point estimate at 95% Confidence Interval was done and frequency and percentage were calculated.

RESULTS: Out of the 110 cases of acute ureteral calculus, 31 (28.2%) (19.79-36.60 at 95% Confidence Interval) has moderate hydronephrosis in the ultrasonographic imaging. The mean age of participants was 31.61±8.51 years and male to female ratio was 1.97:1. Vesicoureteric junction was the most common site for ureteric calculus 39 (35.5%).

CONCLUSIONS: The ultrasound is an easy method to be applied, and a fast one to help and diagnose obstructive hydronephrosis. The main causes of hydronephrosis are kidney stones, followed by ureteral stones, with a moderate degree of hydronephrosis.

PMID:35199787 | DOI:10.31729/jnma.6879

JNMA J Nepal Med Assoc. 2021 Dec 11;59(244):1256-1261. doi: 10.31729/jnma.7045.

ABSTRACT

INTRODUCTION: The Surgical safety checklist by World Health Organization has been used for the last two decades. There is every chance of unwanted expected disasters in Operating-Room in Pediatricsurgical cases. Our study is to observe the utilization of the safety checklist and evaluate occurrence of never-events in Tertiary Level Pediatric Surgery Unit in Nepal.

METHODS: A descriptive cross-sectional study was done at Nepal Medical College Teaching Hospital from January 2021-June 2021 with record-based data of children from 0-15 years operated in Pediatric Surgery unit from March 2017-July 2018. Ethical approval (Reference number: 049-077-078) was taken from the Institution review committee of the institute. Convenience sampling was done. Self-designed Pro-forma with demographic data along with World Health Organization-Surgical-safety-checklist used was collected and entered in Microsoft-Excel. Data were analyzed using Statistical-Package-for-the-Social-Sciences-version-25.Point estimate at 95% Confidence Interval was done along with frequency and proportion for binary data.

RESULTS: Out of 267 cases enrolled, 103 (38.6%) (35.6-41.6 at 95% Confidence Interval) were fully compliant with the checklist, 69 (25.8%) partially compliant. Among compliant cases, 148 (55.4%) Sign-in part, 128 (47.9%) cases -Time-out part and 152 (56.9%) cases Sign-out part were complete.

CONCLUSIONS: Compliance with World Health Organization-Surgical-safety-checklist has a major role in preventing morbidity and mortality in Pediatric surgical cases. With proper use of the checklist, the unwanted never-events can be prevented with better surgical outcomes.

PMID:35199784 | DOI:10.31729/jnma.7045