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  • 1
    Online Resource
    Online Resource
    Challenges and Complexities of Providing Emergency Medical Services During Covid-19 Pandemic in Nepal
    Cambridge University Press (CUP) ; 2023
    In:  Prehospital and Disaster Medicine Vol. 38, No. S1 ( 2023-05), p. s172-s173
    Details
    In: Prehospital and Disaster Medicine, Cambridge University Press (CUP), Vol. 38, No. S1 ( 2023-05), p. s172-s173
    Abstract: During the Covid-19 Pandemic, the Department of Emergency Medicine is the one of most busy in Nepal. Challenges and complexities of providing emergency medical service during the waves of the Covid-19 pandemic in Nepal were analyzed. Method: Three years (2020 – 2022) of data was analyzed from Covid patients registered in Tribhuvan University Teaching Hospital (TUTH), Institute of Medicine for reference with National Data of Ministry of Health and Population, Government of Nepal. Results: On November 15, 2022, there were 5,969,338 Covid PCR tests and 1,452,639 Covid Antigen tests in Nepal with 1,000,826 (16.8%) PCR, 152,197 (10.5%) being positive. The cure rate was 98.7% (988,316 cases). There were 12,019 mortalities with 1.2% case fatality. In TUTH 2020 – 2022 records; 3,794 total severe Covid-19 patients were admitted; In the first year, only two patients (1M:1F); In the second year 2,056 patients 1.8M:1F and in the third year 1,736 with 1.1M:1F. The age groups with the first wave vs the second wave were 6.42% vs 5.47% of 0-20 years; 24.22% vs 26.84% of 21-40 years; 30.57% vs 30.87 of 41-60 years and 38.57% vs 36.87% of above 60 years. The hospital mortality rate was 751 (19.8%). Challenges were due to resource limitation, limited PPE, scarcity of oxygen, medication, and ventilators. In TUTH, all levels of emergency management and various definite care were provided 24/7 hours in the pandemic period. There are a lot of challenges in Pre-Hospital Emergency Care Service due to a limited number of designated Advance Ambulances during transportation of severe Covid patients. With these challenges and complexities, there were six deaths of their own hospital staff due to severe Covid-19. Conclusion: The challenges and complexities of providing emergency medical services during the Covid-19 pandemic in Nepal have been overcome with teamwork and activation of the emergency care system in Nepal.
    Type of Medium: Online Resource
    ISSN: 1049-023X , 1945-1938
    URL: Article
    DOI: 10.1017/S1049023X23004478
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2162069-6
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  • 2
    Online Resource
    Online Resource
    New-onset diabetes in COVID-19 and clinical outcomes: A systematic review and meta-analysis
    Baishideng Publishing Group Inc. ; 2021
    In:  World Journal of Virology Vol. 10, No. 5 ( 2021-9-25), p. 275-287
    Details
    In: World Journal of Virology, Baishideng Publishing Group Inc., Vol. 10, No. 5 ( 2021-9-25), p. 275-287
    Type of Medium: Online Resource
    ISSN: 2220-3249
    URL: Article
    DOI: 10.5501/wjv.v10.i5.275
    Language: Unknown
    Publisher: Baishideng Publishing Group Inc.
    Publication Date: 2021
    detail.hit.zdb_id: 2829019-7
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  • 3
    Online Resource
    Online Resource
    Comparative Study of Slow Infusion versus Bolus Doses of Albumin and Furosemide Infusion to Mobilize Refractory Ascites in Decompensated Chronic Liver Disease
    Nepal Health Research Council ; 2020
    In:  Journal of Nepal Health Research Council Vol. 18, No. 2 ( 2020-09-07), p. 233-237
    Details
    In: Journal of Nepal Health Research Council, Nepal Health Research Council, Vol. 18, No. 2 ( 2020-09-07), p. 233-237
    Abstract: Background: Combined use of furosemide with albumin is an approved therapy to overcome diuretic resistance in treatment of ascites in decompensated chronic liver disease. Bolus dosing of diuretics has its own limitations due to pre-existing hypotension, post diuretic sodium retention and braking phenomenon. Slow albumin and furosemide Infusion has been shown to mobilize large ascites with improved diuresis and hemodynamic stability in decompensated chronic liver disease. This study was undertaken to compare efficacy and safety of infusion therapy vs bolus therapy in term the management of refractory ascites.Methods: Decompensated chronic liver disease patients with refractory ascites were randomly assigned into two groups of 15 each - Bolus therapy (intravenous albumin and furosemide as boluses) and Infusion therapy (furosemide infusion at 2mg/hour and albumin at 2g/hour for three days). Diuresis, natriuresis, change in abdominal girth and body weight, and hemodynamic stability (change in SBP) were compared between the two groups.Results: Infusion therapy, as compared to bolus therapy, showed a significantly better diuresis (mean urinary output increment 483ml vs 243ml, p 〈 0.001), natriuresis (mean urinary sodium excretion increment 35.2 mEq/L vs 16.6 mEq/L, p = 0.004),decrease in abdominal circumference (6.1cm vs 3.0cm, p 〈 0.001) and decrease in body weight (5.53 Kg vs 2.86 Kg, p 〈 0.001). The complications of renal impairment were also lower in the Infusion group. Conclusion: Infusion of furosemide and albumin is a potential safer and effective therapeutic option in the management of refractory ascites with better natriuresis, higher urine output, and higher decrement in abdominal circumference and body weight, and lesser side effects.Keywords: Bolus dose; continuous infusion; decompensated chronic liver disease; refractory ascites.
    Type of Medium: Online Resource
    ISSN: 1999-6217 , 1727-5482
    URL: Issue
    URL: Article
    DOI: 10.33314/jnhrc.v18i2
    DOI: 10.33314/jnhrc.v18i2.2116
    Language: Unknown
    Publisher: Nepal Health Research Council
    Publication Date: 2020
    detail.hit.zdb_id: 2551251-1
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  • 4
    Online Resource
    Online Resource
    A Case Report on Deliberate Self-poisoning with Imidacloprid in a Young Female - Overview of a Newer Insecticide Poisoning
    Institute of Medicine, Nepal ; 2021
    In:  Journal of Institute of Medicine Nepal Vol. 43, No. 1 ( 2021-04-30), p. 60-62
    Details
    In: Journal of Institute of Medicine Nepal, Institute of Medicine, Nepal, Vol. 43, No. 1 ( 2021-04-30), p. 60-62
    Abstract: Imidacloprid is a newer insecticide of the group Neonicotinoids. It is safer to humans and hence considered a better alternative to organophosphorus compounds, especially in areas like Nepal with higher incidence of deliberate self-poisoning. There has been an increase in the number of reported cases of imidacloprid poisoning from South-East Asian countries, but none from Nepal. We report a case admitted in Intensive Care Unit with neurological manifestations, respiratory failure and development of Acute Kidney Injury following acute imidacloprid poisoning.
    Type of Medium: Online Resource
    ISSN: 1993-2987 , 1993-2979
    URL: Article
    DOI: 10.3126/jiom.v43i1.37476
    Language: Unknown
    Publisher: Institute of Medicine, Nepal
    Publication Date: 2021
    detail.hit.zdb_id: 2481677-2
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  • 5
    Online Resource
    Online Resource
    Use of Granulocyte Colony-Stimulating Factor Among Patients of Chronic Liver Disease in a Tertiary Hospital in Nepal: A Pilot Study
    Nepal Journals Online (JOL) ; 2019
    In:  Medical Journal of Shree Birendra Hospital Vol. 18, No. 2 ( 2019-07-12), p. 53-59
    Details
    In: Medical Journal of Shree Birendra Hospital, Nepal Journals Online (JOL), Vol. 18, No. 2 ( 2019-07-12), p. 53-59
    Abstract: Introduction: Granulocyte colony stimulating factor improves short-term survival and clinical outcomes in alcoholic hepatitis, acute-on-chronic liver failure and decompensated chronic liver disease. Our study aimed to assess survival benefit and change in Child-Turcotte-Pugh and Model For End-Stage Liver Disease scores 30 days after Granulocyte colony stimulating factor therapy in chronic liver disease patients, irrespective of their mode of presentation. Methods: This was a prospective observational study conducted in a university teaching hospital, where 25 patients with chronic liver disease were given 300 micrograms of Granulocyte colony stimulating factor subcutaneously 12 hourly plus standard medical therapy. We assessed survival until day 30. Child-Turcotte- Pugh and Model For End-Stage Liver Disease scores at enrolment and 30 days after treatment were compared. Results: 21 of 25 patients treated with Granulocyte colony stimulating factor survived at day 30. Treatment with Granulocyte colony stimulating factor reduced Child-Turcotte-Pugh score from 10.33 ± 1.24 to 8.76 ± 1.79 (p 〈 0.001) at day 30 and Model For End-Stage Liver Disease score from 22.10 ± 4.67 to 16.38 ± 5.52 (p 〈 0.001) at day 30. Conclusions: Granulocyte colony stimulating factor improves clinical outcome, Child-Turcotte-Pugh and Model For End-Stage Liver Disease scores in patients admitted with chronic liver disease for any cause. Further studies are needed to explore whether lower doses (total six doses) of Granulocyte colony stimulating factor are as effective as higher doses (total 10 doses). 
    Type of Medium: Online Resource
    ISSN: 2091-0193 , 2091-0185
    URL: Article
    DOI: 10.3126/mjsbh.v18i2.23038
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2019
    detail.hit.zdb_id: 3030595-0
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  • 6
    Online Resource
    Online Resource
    Essential Thrombocythemia among Patients with Myeloproliferative Neoplasms in Haematology Unit of a Tertiary Care Centre: A Descriptive Cross-sectional Study
    Journal of Nepal Medical Association (JNMA) ; 2022
    In:  Journal of Nepal Medical Association Vol. 60, No. 248 ( 2022-04-15), p. 369-373
    Details
    In: Journal of Nepal Medical Association, Journal of Nepal Medical Association (JNMA), Vol. 60, No. 248 ( 2022-04-15), p. 369-373
    Abstract: Introduction: Essential thrombocythemia, a myeloproliferative condition with an increased number of circulating platelets, is a rare hematological malignancy. The aim of the study is to find out the prevalence of essential thrombocythemia among patients with myeloproliferative neoplasms presenting in haematology unit of a tertiary care centre. Methods: This was a descriptive cross-sectional study at a tertiary care centre from September, 2020 to September, 2021 (Reference number: 48 (6-11) E2077/076). All the patients with a diagnosis of essential thrombocythemia and willing to give consent were included in the study while the patients with incomplete investigations were excluded. A sample size of 72 patients was taken and convenience sampling was done. Data were entered in Microsoft Excel 2010 and analysis was done by the Statistical Package for the Social Sciences Version 22.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data along with mean and standard deviation for continuous data. Results: Among 72 patients with myeloproliferative neoplasms, the prevalence of essential thrombocythemia was found to be 17 (23.61%) (13.80-33.42 at a 95% Confidence Interval). The mean age of patients was 55.41±11.20 years with a male to female ratio of 9:8. The mean hemoglobin level and platelet count in patients were found to be 11.20±2.1 g/dl and 677000±262067.70 cells/mm3. Twelve (70.58%) of total patients were under low risk of essential thrombocythemia while 3 (17.64%) of them were at high risk. Conclusions: The prevalence of essential thrombocythemia was similar to other studies done in similar settings.
    Type of Medium: Online Resource
    ISSN: 1815-672X , 0028-2715
    URL: Article
    DOI: 10.31729/jnma.7359
    Language: Unknown
    Publisher: Journal of Nepal Medical Association (JNMA)
    Publication Date: 2022
    detail.hit.zdb_id: 2209910-4
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  • 7
    Online Resource
    Online Resource
    Prevalence of Covert Hepatic Encephalopathy in A Tertiary Care Centre
    Journal of Nepal Medical Association (JNMA) ; 2020
    In:  Journal of Nepal Medical Association Vol. 58, No. 221 ( 2020-01-31)
    Details
    In: Journal of Nepal Medical Association, Journal of Nepal Medical Association (JNMA), Vol. 58, No. 221 ( 2020-01-31)
    Abstract: Introduction: Among patients with Hepatic Encephalopathy, prevalence of Minimal HE variesbetween 30-50%. Identifying patients with MHE has been shown to improve with medications anddelay development of Overt HE, however only limited clinicians screen for MHE in patients due totime consuming neuropsychological and neurophysiological tests. The Number Connection Test isan easy way to evaluate patients to diagnose MHE. The aim of this study is to find out the prevalenceof covert hepatic encephalopathy. Methods: The descriptive cross-sectional study was done to find out the prevalence of covert hepaticencephalopathy among patients with chronic liver disease. To diagnose Covert HE which includedMHE as well, NCT was used in Devanagari script. Results: The prevalence of covert hepatic encephalopathy is found to be 56 (58.3%) at 90% confidenceinterval (58.23-58.37%). A total of 96 patients (71.9% male) were diagnosed as HE, with mean age of49.6+11.8 years. The cause of CLD in 85 (88.5%) of these patients was alcohol, of which 76 (79.2%)consumed locally brewed alcohol. Of these 96 patients with HE, only 40 (41.7%) had overt HE.Among all these, maximum patients had MHE (37.5%). Conclusions: Our study showed that although the prevalence of minimal HE is quite high amongcirrhotics, they are usually missed in clinical practice due to absence of symptoms. Active screeningwith easy-to-administer tests, like Number Connection tests, can help identify patients with minimalHE and hence treat them early.
    Type of Medium: Online Resource
    ISSN: 1815-672X , 0028-2715
    URL: Article
    DOI: 10.31729/jnma.4809
    Language: Unknown
    Publisher: Journal of Nepal Medical Association (JNMA)
    Publication Date: 2020
    detail.hit.zdb_id: 2209910-4
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  • 8
    Online Resource
    Online Resource
    Ulcerative Colitis with Superior Sagittal Sinus Thrombosis: A Case Report
    Journal of Nepal Medical Association (JNMA) ; 2023
    In:  Journal of Nepal Medical Association Vol. 61, No. 263 ( 2023-07-01), p. 611-613
    Details
    In: Journal of Nepal Medical Association, Journal of Nepal Medical Association (JNMA), Vol. 61, No. 263 ( 2023-07-01), p. 611-613
    Abstract: Ulcerative colitis is a chronic inflammatory, idiopathic, condition of the mucosa of the colon. Cerebral venous thrombosis is one of the serious and rare complications of inflammatory bowel disease. We report a case of a 27-year-old female patient with complaints of loose stool 5 to 6 episodes per day mixed with blood for 10 days. The patient has severe per rectal bleed, not controlled despite adequate measures and a few days later developed altered sensorium and fits. This case highlights prompt diagnosis and early treatment managing both severe ulcerative colitis and sagittal venous thrombosis. Immediate recognition of her disease improved her condition drastically and increased her survival.
    Type of Medium: Online Resource
    ISSN: 1815-672X , 0028-2715
    URL: Article
    DOI: 10.31729/jnma.8216
    Language: Unknown
    Publisher: Journal of Nepal Medical Association (JNMA)
    Publication Date: 2023
    detail.hit.zdb_id: 2209910-4
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  • 9
    Online Resource
    Online Resource
    Extraintestinal Clostridium difficile infection: Scrotal abscess
    Elsevier BV ; 2020
    In:  Anaerobe Vol. 61 ( 2020-02), p. 102147-
    Details
    In: Anaerobe, Elsevier BV, Vol. 61 ( 2020-02), p. 102147-
    Type of Medium: Online Resource
    ISSN: 1075-9964
    URL: Article
    DOI: 10.1016/j.anaerobe.2019.102147
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 1461095-4
    SSG: 12
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  • 10
    Online Resource
    Online Resource
    Advantage of neuroeducation in managing mass psychogenic illness among rural school children in Nepal
    Elsevier BV ; 2023
    In:  IBRO Neuroscience Reports Vol. 14 ( 2023-06), p. 435-440
    Details
    In: IBRO Neuroscience Reports, Elsevier BV, Vol. 14 ( 2023-06), p. 435-440
    Type of Medium: Online Resource
    ISSN: 2667-2421
    URL: Article
    DOI: 10.1016/j.ibneur.2023.05.003
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 3061524-0
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