Chitwan Medical College Teaching Hospital Research Articles

Effect of self-management intervention on patients with chronic obstructive pulmonary diseases, Chitwan, Nepal.

Self-management skills are important for patients with Chronic Obstructive Pulmonary Disease (COPD) who are responsible for their day to day care. Poor self-management behaviours have a significant influence on symptoms, functional impairments and quality of life. Evidence has shown that self-management interventions support patients to respond to changing symptoms and thereby make appropriate decisions regarding their self-management. This study aimed to find out the effect of self-management interventions in patients with COPD in terms of self-management practice, inhaler practice, COPD symptoms burden, functional ability, self-perceived dyspnoea and emotional symptoms. Quasi-experimental pre-test post-test design was carried out among patients with COPD attending respiratory units of Chitwan Medical College Teaching Hospital (CMC-TH), Nepal. Convenience sampling technique was used to select the 70 patients with COPD for the study. Baseline data was collected from the participants using (i) Semi-structured interview schedule for socio-demographic and clinical variables, (ii) COPD Self-Management Practice Questionnaire, (iii) Borg Dyspnoea Scale, and (iv) Six Minute Walking Distance (6MWD) Test (v) Pulmonary Function Test (PFT) and (vi) Observation Checklist. Self-management Intervention given was 2 ½ hour sessions per week for 6 weeks along with information booklets distribution. Participants were re-evaluated after 3 months of intervention using same tools. Data analysis was performed using IBMSPSS version 20.0 for window. Wilcoxon signed-rank test was performed to find the effectiveness of the self-management interventions on outcome parameters. Self-management interventions (2 ½ hour session per week for 6 weeks) elicited a statistically significant change on self-management practice (z = -7.215, p<0.001), inhaler practice (DPI practice z = -6.731, p<0.001, MDI practice, z = -1.816, p = 0.005), functional ability (z = -4.243, p<0.001), self-perceived dyspnoea (z = -4.443, p<0.001), COPD symptom burden (z = -7.009, p<0.001) and emotional symptoms (depression, z = -6.856, p<0.001, anxiety, z = -6.675, p<0.001) of patients with COPD. Self-management intervention acts as powerful equipment to improve self-management practice, COPD symptoms burden, functional ability, self-perceived dyspnoea and emotional symptoms of patients with COPD. Hence, clinician and policy maker need to plan and intervene the rehabilitation program for the patients with COPD to enhance the effectiveness of therapy, self-management practice and general longevity.

Depressive disorder among the end-stage renal disease patients undergoing maintenance hemodialysis at Chitwan medical college

Background: Patients with End stage renal disease (ESRD) suffer from a variety of losses, including renal function, family role, work role, sexual function, as well as time and mobility, all of which have a substantial influence on their lives. Physical manifestation of the End-Stage Renal Disease patients receiving dialysis treatment may be obvious but studies have found that they are also at increased risk of clinical and subclinical Depressive Disorder for a variety of reasons; which might be overlooked in our routine clinical assessment. Depressive Disorder has been associated with impaired recovery and increased mortality in many diseases including End-Stage Renal Disease patients. Objectives: To assess the magnitude of depressive disorder among the patients undergoing hemodialysis of duration &gt;3 months at Chitwan Medical College Teaching Hospital (CMCTH) and to determine the association between explanatory variables with depressive disorder. Methods: Patients undergoing maintenance hemodialysis at CMCTH after meeting inclusion criteria were enrolled by consecutive sampling technique. Diagnoses were assessed on the basis of the ICD-10 Classification of Mental and Behavioral Disorders- Diagnostic Criteria for Research (ICD-10 DCR). To stratify the severity of the Depression into mild, moderate and severe categories, we used Hamilton Depressive Disorder rating scale. Seventy-four (74) patients undergoing maintenance hemodialysis were assessed. Interviews with patients and informants were taken and filled in a self-designed demographic datasheet. Obtained data were analyzed by using descriptive and inferential statistics. Results: The prevalence of the depressive disorder among patients undergoing maintenance hemodialysis was 75.70%. Positive correlations were found between depressive disorder and gender, age group and occupation(p&lt;0.05). Conclusion: The present study showed that the prevalence of depressive disorder was higher in ESRD patients compared to study done in Nepal where prevalence of depressive disorder in ESRD patients was 51.8%.

ANTIMICROBIAL PROPHYLAXIS IN SURGERY: A CROSS-SECTIONAL STUDY IN THE SURGICAL WARD OF A TERTIARY CARE CENTRE IN CENTRAL NEPAL

Background: Surgical Antimicrobial Prophylaxis is administration of a short course of antimicrobial agent prior to surgery. It has long been recommended for routine use in preventing occurrence of surgical site infections. The choice of drug, dosage, route, duration and timing of antimicrobial prophylaxis has been specified in the clinical practice guideline issued by American Society of Health-System Pharmacists. In the present study, we aim to seek the practice of antibiotic prophylaxis at a tertiary care centre in central Nepal and report the adherence to American and National Antimicrobial Treatment Guideline where applicable. Methods: This hospital-based cross-sectional study was conducted between January to June 2023 among 232 patients undergoing surgery at Chitwan Medical College Teaching Hospital. Data collection tool prepared with slight modification from previous studies recorded the demographic details, surgical data, surgical antimicrobial prophylaxis usage data and assessment of Prophylaxis data. Data analysis was done using SPSS-20. Results: We observed compliance to selection of drug, route of administration, dosage of antimicrobial prophylaxis with American guideline. All (100%) prophylaxis was administered parenterally for more than 72 hours in over 40% cases. Choice of drug was appropriate in over 84% of cases and dosage adequacy was observed in over 61% cases. Surgical antimicrobial prophylaxis was administered most frequently 30 minutes before surgery (52.59%). Conclusions: All the surgical patients were found to receive surgical antimicrobial prophylaxis. Ceftriaxone was the most commonly administered drug followed by combination of piperacillin and tazobactam. The duration of treatment post-surgery was found to be unnecessarily broader than recommended guideline.

PREVALENCE OF THYROID EYE DISEASE IN PATIENTS WITH THYROID DYSFUNCTION IN A TERTIARY CARE HOSPITAL OF CENTRAL NEPAL

Background: Thyroid eye disease is the most common extra thyroidal manifestation of Graves’ disease. The pattern and prevalence of thyroid eye disease vary widely from a mild disorder characterized by dry eye symptoms and ocular irritation to a severe disfiguring form of orbitopathy. Thyroid eye disease is a frequently encountered Ophthalmological morbidity in Nepal and across the globe. The aim of this study was to ascertain the prevalence of thyroid eye disease in subjects with thyroid dysfunction in a tertiary care hospital in central Nepal.. Methods: This was a prospective cross-sectional study, conducted in Chitwan medical college Teaching hospital (CMCTH), department of Ophthalmology. Subjects presenting to Ophthalmology department or referred patients from different departments with thyroid dysfunction were enrolled in the study. The data thus collected was analyzed using SPSS version 26 and the data was presented as frequency and percentage. Results: Among 320 subjects screened for Thyroid eye disease prevalence, 106 (33.3%) were hyperthyroid, 207 (64.7%) were hypothyroid whereas, 7 (2.2%) were euthyroid. The prevalence of Thyroid eye disease was 40% and this was more prevalent among hypothyroid. Among the 320 patients with thyroid eye disease, 126 (39.4%), 95 (29.7%), 53 (16.6%), 24 (7.5%), 15 (4.7%), 5 (1.6%) and 2 (0.6%) had CAS score of 1,2,3,4,5,6 and 7 respectively. Similarly, NOSPECS score (American Thyroid Association) 243 (75.9%), 57 (17.8%), 1 (0.3%), 7 (2.2%), 8 (2.5%), 3(0.9%) and 1 (0.3%) were graded from 0-6 accordingly respectively. Conclusions: Thyroid eye disease was more prevalent in hypothyroid middle-aged females and the overall prevalence of Thyroid Eye disease was more in hypothyroid patients. Though sight threatening complications didn’t exist in our study, close workup by endocrinologist and ophthalmologist can decrease ocular morbidity.

AWARENESS ON STROKE AMONG HYPERTENSIVE PATIENTS ATTENDING AT TEACHING HOSPITAL, BHARATPUR, CHITWAN, NEPAL

Background: Hypertensive patients are at the risk of developing stroke. Awareness regarding stroke is essential for the prevention and initiation of immediate effective treatment of stroke. This study aimed to find out the awareness regarding stroke among hypertensive patients attending a teaching hospital. Methods: A cross-sectional survey was carried out among hypertensive patients attending Medicine Out-patient Department of Chitwan Medical College Teaching Hospital, Bharatpur, Chitwan. A total 95 patients were selected using convenience sampling technique. Data were collected using structured interview schedule. Obtained data were analyzed in SPSS version 20 for window using descriptive and inferential statistics. Results: Result of this study revealed that out of 95 hypertensive patients, 91.6% were above age group 40 years. More than half (51.6%) of the patients had good knowledge, 32.6% had fair knowledge and 15.8% had poor knowledge regarding stroke .Overall Level of knowledge on stroke was significantly associated with sex (p=0.012) and educational status (p=0.001) of the patients. Conclusions: The awareness of stroke among hypertensive patients attending at teaching hospital of Chitwan seems to be insufficient at present. Hence, there is need for the awareness program for the hypertensive patients on stroke to prevent potential complication associated with it.

Diabetes Self-Management Practices among Diabetic Patients Attending Chitwan Medical College Teaching Hospital

Introduction: Diabetes is a new health issue that affects many people around the world. The majority of the diabetic population lives in low-and middle-income countries. Diabetes has badly affected individuals, families, and countries. This problem can be minimized and managed through effective self-management practices. Objective: The present study aims to identify the level of self-management practices among type 2 diabetes mellitus patients. Methods: A descriptive and analytical cross-sectional study design was used to assess diabetes self-management practices. A standard ‘Summary of Diabetes Self-Care Activity’ tool was adopted with few modifications after pretesting. This study was carried out among 191 samples with diabetes type-2 patients attending the outpatient department of Chitwan Medical College Teaching Hospital. The non-probability consecutive sampling method was adopted for data collection. Ethical principles were addressed during the study. Results: Among the total participants, 51.8% had unsatisfactory diabetes self-management practices. Age, education, place of residence, religion, occupation, family history, comorbidity, duration of diagnosis, alcohol drinking, and smoking were associated with diabetes self-management practice. There were 55.5% male participants. The majority, 42.4% belonged to the age group 60 and above. The minimum age was 30, the maximum age was 94, and the mean age was 56.9 years. The majority (77%) of participants were literate. Conclusions: This study revealed an unsatisfactory level of diabetes self-management practices. This finding implies that diabetes self- management practice-related education programs should be created and implemented for people who are impacted, as well as for those who provide care at home.

PREVALENCE AND ASSOCIATED FACTORS OF OLDER ADULTS MISTREATMENT IN BHARATPUR, CHITWAN

Background: Older adults mistreatment is an important public health issue in both developed and developing countries. It has a significant impact on the physical and mental health of the older population. Hence, this study aimed to find out the prevalence and associated factors of older adults mistreatment in Bharatpur, Chitwan. Methods: A cross-sectional study was used among 160 older adults aged 60 years and above admitted in medical and surgical wards of Chitwan Medical College Teaching Hospital. A non-probability purposive sampling technique was used to select the desired sample. The data were collected using a structured interview schedule. The collected data were analyzed using IBM SPSS version 23 and interpreted in terms of descriptive statistics (frequency, percentage, and median) and inferential statistics (chi-square test). Results: Findings revealed that the median age of the older adult was 70 years where 57.5% were male, Brahmin (45%), and Hindu (79.4%). The prevalence of older adults mistreatment was 41.3%; among them, the most common types of self-reported mistreatment were psychological mistreatment (74.2%), financial mistreatment (59.1%), and neglect (59.1%), respectively. Educational status, occupation, depression, dependency level, old age allowance, chronic illness, and hearing abuse had statistically significant association with older adults mistreatment. Conclusions: This study shows that older adults mistreatment is quite high, with psychological, neglect, and financial mistreatment being the most common. Thus, an awareness program for the elderly and caregivers is necessary for the prevention and management of older adults mistreatment and the wellbeing of the elderly by concerned authorities.

CLINICAL PROFILE OF PATIENTS WITH POISONING ADMITTED TO TERTIARY CARE CENTRE OF NEPAL

Background: Acute poisoning is one of major medical emergencies and a common cause of admission and death in hospitals in Nepal. In our country, agrochemicals including pesticides like Organophosphorus, organochlorine, zinc and aluminium phosphide are most common causative agents used for intentional or accidental poisoning. The study was aimed to assess clinical profile of patients with poisoning admitted to tertiary care centre of Nepal. Methods: This retrospective study was conducted to see clinical profile of patients diagnosed with poisoning in Chitwan Medical College Teaching Hospital for 1 year period from February, 2022 to January, 2023. Data were collected from hospital medical records and Midas software. Data analysis was performed using Statistical package for Social Sciences version 21 and data are presented as frequency and percentage. Results: A total of 150 cases of poisoning presented to our hospital during the one-year period. Among them, 42% patients were males and 58% females (1.38:1). Most of them (34%) belonged to age group of 21-30 years. Majority of the cases were suicidal (86%). Organophosphorus was the most common poison (36.66%), followed by rat poison-(12.66%). About 44% patients went on Leave Against Medical Advice, 28% on Discharge On Request, 23% patients were discharged with full recovery, whereas mortality with treatment was 5%. Conclusions: Poisoning is more prevalent in females and younger age group. The most common agent is Organophosphorus followed by rat poison. Self-poisoning with suicidal intent is the most common mode of poisoning. Mortality in this study was 5.33% which was more among Organophosphorus poisoning.

Study of Adverse Drug Reaction of Anti-Depressants in Adult Patients: A Nepalese Perspective

Background of the study: Depression is a prevalent mental disorder characterized by various symptoms, including low mood, lack of pleasure, changes in appetite and sleep, and difficulty concentrating. Antidepressants are commonly used to manage depression as well as other related disorders, such as anxiety and somatoform disorders. This study aimed to investigate the adverse drug effects experienced by adult patients who were using antidepressants at Chitwan Medical College Teaching Hospital in Nepal. Methods: This study was a retro-prospective, observational study consisting of 117 adult patients under antidepressant medication. The adverse drug profile for the patients was collected using an antidepressant side effect checklist developed by the NHS foundation trust. Statistical analysis was performed using SPSS version 20. Result: The study group consisted of adult patients using antidepressants at Chitwan Medical College Teaching Hospital, Chitwan, Nepal. The mean age of the group was 40.9 ± 12.8, with 63.2% females and 36.7% males. The most common conditions for which antidepressants were prescribed were depression (49.5%), anxiety disorder (31.6%), and somatoform disorder (13.6%). Amitriptyline was the most commonly used medication in monotherapy (64.1%), followed by escitalopram and sertraline. Dry mouth, weight gain, drowsiness, blurred vision, problems with sexual function, and an increase in appetite were the most commonly reported adverse effects. The incidence of certain adverse effects was higher in the multiple therapy group than in the monotherapy group (p &lt; 0.05). Conclusion: The incidence of adverse drug effects is high in patients taking antidepressants, especially those receiving multiple medications. Educating patients about common side effects and prescribing monotherapy whenever possible are crucial in reducing the incidence.

Job Satisfaction Among Healthcare Workers Working During COVID-19 Pandemic at a Private Teaching Hospital in Nepal.

Background: COVID-19 pandemic has created many serious challenges to the frontline workers in their day-to-day job activities. Job satisfaction among healthcare workers is most predominant component to smooth functioning of institutional activities and to improve the quality of patient care. Objective: To find out job satisfaction among frontline healthcare workers during COVID-19 pandemic. Methods: A cross-sectional study was conducted among 228 healthcare workers (doctors and nurses) working in Chitwan Medical College Teaching Hospital (CMC-TH) during the COVID-19 pandemic. A simple random sampling technique was used to select the sample and a self-administered structured questionnaire with a job satisfaction scale was used to collect the data. Obtained data were analyzed in SPSS version 20 for Windows using descriptive and inferential statistics. Results: The majority (71.1%) of the healthcare workers were ambivalent whereas few (18%) were satisfied, and 11.0% were dissatisfied with their job during the COVID-19 pandemic. Healthcare workers' median percentage satisfaction score was higher on the domains of coworkers (70.8%), nature of work (70.8%), and supervision (70.8%) whereas lower on fringe benefits (54.2%), and contingent rewards (54.2%) other domains. There was a statistically significant association between job satisfaction level with age (p=0.037), marital status (p= &lt;0.001) and experience (p=0.016) of the doctors and nurses. Conclusions: Job satisfaction is very low among healthcare workers in a teaching hospital. Hence, appropriate strategies are needed to be implemented considering the identified domains of satisfaction to enhance the healthcare workers’ job satisfaction and quality patients’ care.

PROFILE OF LAPAROSCOPIC CHOLECYSTECTOMY: A CROSS-SECTIONAL STUDY FROM TERTIARY CENTRE OF CENTRAL NEPAL

Background: Laparoscopic cholecystectomy (LC) is the gold standard method for the treatment of cholelithiasis as it causes less patient discomfort, shorter postoperative hospital stay, early return to work, better cosmesis, and less financial burden. The objective of this study was to evaluate the outcome of LC in Chitwan Medical College Teaching Hospital, Nepal. Methods: This was the descriptive cross-sectional study carried out in the Department of General Surgery from May 2022 to December 2022 after taking ethical approval from Institutional Review Committee. A convenience sampling technique was used and the data was analyzed using Statistical Package for the Social Sciences version 21. Point estimate and 95% confidence interval was calculated. Results: Out of 270 patients, the ratio of female to male was 4.18:1 with a mean age of 47.13±14.95. Most common indication was symptomatic cholelithiasis 207 (76.7%). The overall mean operative duration was 64.72±29.03 minutes with a conversion rate to open cholecystectomy (OC) was 9 (3.33%) (1.20-5.46, 95% CI), primarily due to unclear anatomy with dense adhesion and a single case of bile duct injury accounting for a prevalence of 0.37% (-0.35 to 1.9, 95% CI). The post-operative complication was 9 (3.33%) and the mean duration of postoperative hospital stay was 2.18±1.05 days with no mortality. Conclusions: The current study shows that LC is safe and effective method of treatment for cholelithiasis, and the results are comparable to those from different parts of world.

THICKNESS MAPPING OF NEPALESE CALVARIA USING COMPUTERIZED TOMOGRAPHY

Background: The bony skeleton of the head is termed skull. Skull composed of cranial vault and base. Cranial vault is known as Calvaria. Cranial vault (Calvaria) is the superior view of skull (Norma Verticalis). Calvarium consists of frontal, parietal, temporal and occipital bones. Total thickness of calvarial bones includes outer table, diploe and inner table. Diploe is made up of spongy bone. Outer and inner table made up of compact bone. This study aims to measure the image assisted measurement of thickness of Calvaria and to observe the variation in thickness with age, gender and ethnicity. Methods: This was a descriptive cross-sectional study conducted at Department of Radiology, Chitwan Medical College Teaching Hospital Bharatpur-13, Chitwan. Patient of age 15 to 50 years with normal CT finding were included in the study. Using the axial view of brain CT, the thickness of Calvaria was measured and recorded in millimeter. Results: Hundred calvarial thickness was measured using computerized tomography scan. Thickness of frontal bone; parietal bone and occipital bone ranges from 0.37 mm to 0.97mm with mean value 0.6991±0.311mm;0.36mm to 0.99 with mean 0.6772±0.15058 mm and 0.30 to 0.95mm with mean 0.68±0.15236 respectively. No significant correlation between thickness of frontal, parietal and occipital bone is observed using Pearson coefficient. Conclusions: There is slight variation of calvarial thickness of frontal, parietal and occipital bone. The frontal, parietal and occipital bone thickness are not significantly correlated with each other.

Metabolic syndrome and life style factors among diabetes patients attending in a teaching hospital, Chitwan.

Metabolic syndrome (MetS) is associated with an increased incidence of chronic complications and mortality of diabetes patients. Prevention and treatment of MetS is important means of lowering the risk of cardiovascular diseases and mortality. This study aimed to find out metabolic syndrome and life style factors among diabetes patients. A cross-sectional survey was carried out among 296 patients with type 2 diabetes mellitus attending Chitwan Medical College Teaching Hospital. Consecutive sampling technique was used to select sample. Data were collected from 15th December 2021 to 15th March, 2022 using Interview Schedule, bio-physiological measurement and record review. Obtained data were analysed in SPSS version 20 for window using descriptive and inferential statistics. Chi-square test was applied to measure the association between the variables. Logistic regression analysis was performed to identify the factors associated with metabolic syndrome. Findings revealed that the prevalence of MetS was 66.2% and 58.4% in patients according to International Diabetes Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria respectively. The most common MetS parameters were raised fasting plasma glucose (94.6%) and abnormal waist circumference (78.4% in IDF criteria) while the least prevalent parameter was reduced HDL level (43.2%). Majorities of the patients were non-vegetarian (85.5%), had poor dietary compliance (poor-46.3%, very poor-32.1%), overweight/obese (65.5%), and suffered from moderate stress (90.1%). Bivariate analysis showed that MetS as per NCEP ATP criteria was significantly associated with gender (p = 0.006), occupation (p = 0.007), presence of other co-morbid condition (<0.001) and sleep problem (p = <0.001). However, MetS as per IDF criteria was significantly associated with age (p = <0.028), duration of diabetes (p = <0.001), follow-up visit (p = <0.030), blood sugar monitoring (p = <0.009) and physical activity of diabetes patients (p = <0.001). Further logistic regression analysis revealed that sleep problem (AOR = 21.812;95%CI = 8.512,55.894) and presence of other comorbidities (AOR = 4.024;95%CI = 2.220,7.295) were the significant factors of metabolic syndrome. Metabolic syndrome is high in patients with type 2 diabetes mellitus. Therefore, treating physicians and other health workers need to monitor MetS parameters regularly to reduce the risk of cardiovascular diseases, stroke and premature death.

OUTCOMES AND SAFETY OF RETROGRADE INTRA RENAL SURGERY FOR RENAL STONES

Background: Renal stones are one of the most common urological problems requiring surgical interventions. Retrograde intra-renal surgery is a minimally invasive surgical technique with minimal complications and a good stone-free rate. In the present study we aimed to assess the outcomes and safety of retrograde intrarenal surgery. Methods: A retrospective study was performed at Chitwan Medical College Teaching Hospital in the span of two years from Dec 2019 to Nov 2021. Patient demographics; stone burden, stone density, and location were collected from the medical records and evaluated. The data was collected in a proforma which was then entered into SPSS version 20. The data was presented in form of frequency and percentage. Results: One hundred and seventy patients were subjected to retrograde intrarenal surgery, out of which 32 were converted to mini- percutaneous nephrolithotripsy, 12 were presented and total of 126 were subjected to retrograde intrarenal surgery. The major complications were pyrexia in 21(16.67%) patients followed by hematuria in 4(3.17%) patients, and sepsis in 2(1.58%) patients. The stone-free rate was 94.4%. 2 (1.58%) patients underwent mini- percutaneous nephrolithotripsy and5 (3.96%) of them showed stones of varying size 2-6mm, non-obstructive with none of cases planned for staged retrograde intrarenal surgery. Conclusions: Primary Retrograde intrarenal surgery is the safe and effective treatment for the intrarenal stones.

Anxiety, Depression and Self-Care Management among Hypothyroidism Patients Attending Chitwan Medical College Teaching Hospital, Chitwan

Background: Thyroid dysfunctions have been recognized to cause significant manifestations in physical health as well as mental health. A descriptive cross-sectional research design was used to assess anxiety, depression and self-care management among hypothyroidism attending Chitwan Medical College Teaching Hospital (CMC-TH). &#x0D; Methods: A total of 258 patients diagnosed with hypothyroidism were selected by convenience sampling. Data was collected from the date June 6, 2021 to November 17, 2021 using face to face interview schedule. The data was analyzed in SPSS version 20 using descriptive and inferential statistics was used to analyze the data. &#x0D; Result: Out of 258 respondents females constituted 64% of the sample. A total of 72.1% of the respondents had different level of anxiety based on GAD-7 among them 43.8% of the respondents had mild anxiety and 9.3% severe level of anxiety. Regarding depression 60.1 % of the respondents had different level of depression based on PHQ-9. Among them 27.1% had mild level of depression whereas 4.7% severe level of anxiety. More than fifty percentages of the respondents (54.3%) had inadequate level of self-care management. Anxiety was significantly associated with sex (0.044), marital status (0.000) and family history of mental illness (0.009) whereas depression was significantly associated with educational status (0.009) and duration of illness (0.002). &#x0D; Conclusion: It is concluded that anxiety and depression was more prevalent among hypothyroidism patients so, routine screening of hypothyroidism patients for psychiatric disorder and treating by both an endocrinologist and a psychiatrist in liaison with each other is very important to optimize their management and improve quality of life.

ADHERENCE TO ANTICOAGULANT THERAPY AND ITS AWARENESS AMONG CARDIAC PATIENTS ATTENDING CARDIAC OPD OF CHITWAN MEDICAL COLLEGE TEACHING HOSPITAL, CHITWAN

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.

Study of Point of Care Lung Ultrasound in Patients with Acute Respiratory Failure

Introduction: An acute dyspnea has been a common cause of hospital admission throughout history. When formulating a treatment plan based on limited clinical information, a rapid diagnosis is important. Bedside maneuvers and tests that deliver rapid and reliable results represent a cornerstone of diagnostics medicine. Methods: This was a one-year cross-sectional research conducted at Chitwan Medical College Teaching Hospital. Consecutive patients with acute dyspnea whom were admitted for ≤ 6 hours were included in the study. A 5MHz micro-convex probe was used as the optimal single probe. 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 statics. Results: Pneumonia was the most common overall ultrasound diagnosis with combined frequency of 47%. With a Positive Predictive Value of 94.11% and Negative Predictive Value of 97.01%, anterior pneumonia exhibited a sensitivity of 94.11% and specificity of 97.11%. Similarly, Posterior Lateral Alveolar Points (PLAPS) pneumonia had a sensitivity of 94.11% and specificity of 98.08%, with a PPV of 94.11% and NPV of 98.80% respectively. The clinical accuracy for pulmonary edema was the greatest with 96.77%. while COPD/asthma had least accuracy with 81.25%. Conclusions: POCUS of the lung, has a high sensitivity and specificity, especially for evaluation of acute causes of dyspnea such pulmonary edema and pneumonia. It is more sensitive than Chest X ray alone and should be integrated while making clinical diagnosis.

Assessment of Serum Electrolyte in Hypothyroid Patients Attending Chitwan Medical College

INTRODUCTION: Hypothyroidism is a clinical condition resulting from inadequate synthesis of the thyroid hormones. Thyroid hormone has an influence on renal hemodynamics, glomerular filtration, as well as the renin angiotensin aldosterone system and renal electrolyte handling. The aim of present study was to find out the serum concentration of electrolytes sodium and potassium in hypothyroid patients attending a tertiary care hospital. MATERIALS AND METHODS: A hospital-based descriptive cross-sectional study was conducted from 24th July 2019 to November 30th 2019 at Chitwan Medical College Teaching Hospital. A venous blood sample was collected and T3, T4 and TSH levels were measured by using chemiluminescence technology. Sodium and potassium levels in blood were investigated by ion selective electrode (ISE) method. Data were analyzed using IBM SPSS 21 software. RESULTS: In our study parameters (T3, T4 &amp; TSH and Na+) were significant (P&lt;0.05) in hypothyroidism subjects (group II) as compared to control subjects (group I) except for electrolyte potassium which was non-significant at P&lt;0.05. T3 and T4 were found significantly decreased whereas TSH was found elevated in subjects of hypothyroidism (group II) as compared to controls. The level of potassium was within the normal range but it was found not significant as compared to healthy controls. CONCLUSIONS: The study concluded that there was increase in TSH with decrease in T3 and T4 in hypothyroid subjects but the electrolyte sodium was found to be statistically significant.

CLINICAL COURSE AND OUTCOME OF PATIENTS WITH SOLID ORGAN INJURY IN BLUNT ABDOMINAL TRAUMA

Background: Blunt abdominal trauma, one of the most common injuries caused by road traffic accident are usually not obvious hence often missed unless repeatedly looked for. In view of this, the study was aimed to diagnose the solid organ injury and its incidence, mode, age, sex distribution, time of presentation, clinical course, management, time interval between injury and surgery, postoperative complications and outcomes. Methods: This prospective observational study was conducted in the department of General surgery, Chitwan Medical College Teaching Hospital, from August 2020 to July 2021. Data were collected with clinical history/examination, injury assessment, appropriate investigations, modes and patterns. Documentation with identification, history, clinical findings, diagnosis, management, complications and outcomes were done and analyzed with SPSS version 16. Results: Among 83 patients, most of them aged between 16-30 years (57.8%). Male to female ratio was 1.96:1. The most common mode was road traffic accidents (55.5%). Commonly injured organ was spleen (51%) and liver (30%) with associated other organs (65%). Conservative management was done in 62% and operative in 38%. Majority of patients were operated after 4-6 hours of initial presentation. The more the time interval between injury and surgery, the more the complications, duration of hospital stay and mortality. Post-operative complications were noted in 38.5% and mortality in7.22%. Conclusions: Blunt abdominal trauma was common and mainly associated with road traffic accidents. Associated abdominal and extra abdominal injury, delay presentation, diagnosis and intervention significantly predict high mortality and poor outcomes.

Antibiotic Resistance among Gram Negative Bacilli Isolated from the ICU Admitted Patients Attending Chitwan Medical College Teaching Hospital

INTRODUCTION: Antimicrobial therapy is the main stone in treatment. Gram negative bacilli are common cause of sepsis, pneumonia and urinary tract infections in ICU patients. Their treatment becomes more challenging due to the evolution of multiple drug resistant strains. The findings of this study would be useful in the formation of effective diagnostic approaches and policy of antimicrobial therapy for the treatment of infections in a similar intensive care hospital setting. MATERIALS AND METHODS: A Laboratory based descriptive cross-sectional study was conducted at the department of clinical microbiology of the Chitwan Medical College Teaching Hospital based on the reports of 129 bacterial isolated of various clinical specimens from different ICUs of hospital between April 2018 to September 2018. RESULTS: Among the 129-gram bacilli isolated mono bacterial growth were 116(89.92%) while remaining 13(10.08%) had poly bacterial or mixed organisms isolated. The most frequently isolated organisms were Acinetobacter spp. 51(39.55%), Escherichia coli 25(19.37%), Klebsiella spp. 27(20.93%), Pseudomonas aeruginosa 17(13.95%) and Enterobacter spp. 8(6.2%). Antibiotic resistance was observed in many organisms with multidrug resistance 97(75.2%) among them. High level of resistance was observed to Cefotaxime (98.04%), Ceftriaxone (96.08%), Imipenem (80.39%), Ampicillin/sulbactam (72.55%) and Amikacin (70.59%). Ciprofloxacin (68.63%), Levofloxacin (27.45%) and Meropenem (28.21%) were found to be relatively effective against Acinetobacter spp. Isolated. CONCLUSIONS: Most of the frequently isolated organisms are multi drug resistant.