Journal of National Heart and Lung Society Nepal

Advancements in Precision Medicine: Transforming the Landscape of Healthcare

Shankar Laudari — Fri, 30 Jun 2023 00:00:00 +0000

Precision medicine has emerged as a revolutionary approach to patient care, tailoring treatment strategies based on individual traits, including genetic, environmental, and lifestyle factors. This editorial aims to highlight how advancements in precision medicine have the potential to transform the healthcare landscape, leading to more personalized and effective therapies.

Metabolic Syndrome as a Cardiovascular Risk Factor: A Reality or Just a Multiplex of Risk Factors? A Study on Association Between Endothelial Dysfunction And Metabolic Syndrome as a Cardiovascular Risk Factor

Mani Prasad Gautam, Samir Gautam, Subramanyam Gangapatnam, Sogunuru Guruprasad — Fri, 30 Jun 2023 00:00:00 +0000

Background:Metabolic syndrome is a constellation of various cardiovascular risk factors with a potential to double the risk of coronary artery disease. However, in real world scenario, this is just a combination of multiple CV risk factors and its separate existence is somehow regarded as a myth in endothelial function assessment. Endothelial dysfunction is regarded as a precursor and a surrogate marker of atherosclerosis and coronary artery disease. Therefore a study was designed to evaluate the role of metabolic syndrome as a cardiovascular risk factor by assessing endothelial function in subjects with it.

Methods: One hundred subjects with various cardiovascular risk factors were selected and endothelial dysfunction was assessed by measuring flow-mediated dilation of brachial artery. The rates of endothelial dysfunction was compared between subjects with and without metabolic syndrome. Similarly the rates of metabolic syndrome was calculated in subjects with and without endothelial dys-function in this cohorts of cardiovascular risk factors.

Results: Out of 100 subjects with cardiovascular risk factors, mean age 46.75 (9.95) years and mean number of risk factors 2.81 (1.17), similarly, there was no significant difference in the rates of metabolic syndrome among subjects with and without endothelial dysfunction (84.85% vs 79.10% respectively; p=0.67). Only age and hypertension were associated with endothelial dysfunction.

Conclusion: The association between metabolic syndrome and endothelial dys-function was not significantly different than the association between multiplex of risk factors and endothelial dysfunction. Therefore its putative role as a separate cardiovascular risk factors, rather than just a multiplex still remains under scrutiny if not a myth. Further well-designed study should be conducted to establish the role of metabolic syndrome as a separate cardiovascular risk factor other than just a multiplex.

Challenges in Managing Acute ST Myocardial Infarction in Community Heart Hospital

Fri, 30 Jun 2023 00:00:00 +0000

Background:The financial issue can cause pre-hospital delay, choosing reperfu-sion therapy and delay in door to balloon or door to needle time during early management of STMI. The objective of this research is to study the in-hospital cost for STMI patients in community hospital.

Methods: This cross sectional observational study was done for two years from September 2019 to August 2021. Total in hospital host (in Nepalese rupees) dur-ing managing STMI was calculated.

Results: The mean in-hospital cost of managing STMI (intervention or medical management) was 78,585±71167. For Intervention the total mean cost was 1,73,884±137551 of which PPCI with one stent 1,80,972±25547 and Percutane-ous old balloon angioplasty (POBA) 1,37,551 ±34824. For medical manage-ment, the total mean cost was 32,001 ±19442 of which thrombolysis 36069±24188 while conservative management was 31488±18765.

Conclusion: The in hospital cost was more for intervention management com-pared to medical therapy. The mortality was more for the medical therapy com-pared to intervention. Cost of life saving procedures like reperfusion therapy in STMI need to be make more affordable. Patient education for early use of nearby available cardiac facilities including Cath lab need to be promoted.

Hypertension Control in Patients Attending Outpatient Department: A Hospital Based Study from Lumbini Province Nepal

Fri, 30 Jun 2023 00:00:00 +0000

Background: Systemic hypertension is major public health problem. It is easy to diagnose and initiate treatment. But still it remains under detected, undertreated and less well controlled throughout the world. We wanted to know control of hypertension in patients attending outpatient department in a cardiac center.

Methods: This is a cross-sectional observational study conducted at Gautam Buddha Community Heart Hospital. One hundred newly detected hypertensive patients attending outpatient department were evaluated in this study.

Results: Distribution of patients was males 56% and females 44%. Most patients (55%) were in the age group 45 to 65 years. Headache (42%) and dizziness (39%) were common symptoms at presentation. Majority of hypertensive pa-tients had blood pressure range 140 to 160 SBP (49%) and 90 to 100 DBP (56%). Hypertension control target reached in 69% for SBP and 90% for DBP at one month. Target blood pressure was present in 82% for SBP and 84% for DBP at three months follow up.

Conclusion: Hypertension management in short term appears promising but long term control is more important to prevent complications. So long term fol-low up study or national registry database is important.

Measurement of Erect and Supine Waist Circumference among Healthy Adults

Pukar Ghimire, Bikram Prasad Gajurel, Kanshi Ram B.K., Gajendra Duwal — Fri, 30 Jun 2023 00:00:00 +0000

Background: Erect waist circumference is a key marker of obesity. However, it is not possible to measure erect waist circumference in all patients. This study aims to formulate an equation to calculate erect waist circumference from supine waist circumference for both males and females in our population.

Methods: Thirty female and thirty male volunteers were recruited. Erect and supine waist circumference measurements were taken as per WHO STEPS protocol. The measurements were made at the approximate midpoint between the lower margin of the last palpable rib and the top of the iliac crest at the end of a normal expiration.

Results: Erect waist circumference was found to be greater than supine waist circumference with the mean difference in overall participants being 2.6 + 1.4 cm. The difference between erect and supine waist circumference was significantly higher in females (Mean difference 3.1 + 1.6 cm) than in males (Mean difference 2.2 + 0.9 cm). A simple correction formula was derived as corrected erect waist circumference = -2.757 + 0.9 x Gender + 1.048 x Supine waist circumference.

Conclusion: This formula which has been derived can be used in situations where only supine waist circumference measurement is possible.

Lateral Approach to Thyroid Surgery: An Alternative Open Thyroidectomy Technique

Ramesh Bhandari, Bivek Aryal, Anika Sapkota, Damodar Kandel, Sona Sharma — Fri, 30 Jun 2023 00:00:00 +0000

Background: Thyroidectomy is one of the common surgical procedures for thyroid related various pathology. Midline approach is the classical and common in which thyroid gland is approached after splitting the strap muscles in midline. The objective of this research is to elaborate the surgical technique of lateral thyroid approach for hemi-thyroidectomy, also to measure the efficacy in preserving the important anatomical structures and to assess the complications.

Materials: A cross-sectional study was conducted in the department of ENT-Head and Neck Surgery of Bharatpur Hospital, Chitwan, Nepal during January 2019 to March 2021. Benign thyroid diseases that required hemi-thyroidectomy were included in this study. Surgical technique was discussed with special focus for access of superior pedicle and preservation of important anatomical structures.

Results: Among 36 cases most of those 16(44.4%) were operated after 1 year of disease occurrence. Not a single case was undergone strap muscle cutting or sacrifice of superior belly of omohyoid muscle. Recurrent laryngeal nerve was found in 94.4% (33 cases). External branch of superior laryngeal nerve (EBSLN) was in 91.7 %( 33) cases. Superior parathyroid glands were found in majority of the cases but not found in 8.3 %( 3). Inferior parathyroid glands were found in all cases. Post-operative drainage was 38 ml(mean).

Conclusion: Vital structures were preserved in more than 90% cases and major complication occurred in none of the cases. We conclude that this approach is good, safe and comfortable to the surgeon.

Radiation Dose Measurement during CT Abdomen Examination of Adult Patients: A Cross-Sectional Study

Subhash Chandra Yadav, Saraswati Banstola, Sadhan Mukhi, Anjan Palikhey — Fri, 30 Jun 2023 00:00:00 +0000

Background: Computed tomography (CT) has become a routine imaging modality for many clinical applications due to its wide availability, minimally invasiveness, short scan time, excellent anatomical resolution, and high diagnostic value. The radiation dose to patients from CT examinations is the highest contributor to diagnostic medical exposure, which is a growing public concern. The aim of this study was to measure radiation doses for abdominal CT examinations in adult patients and compared them to international standard dose values.

Methods: A cross-sectional study was conducted on 92 adult patients with abdomen CT scans using a 16-slice computed tomography scanner at the department of Radiodiagnosis & Medical Imaging, UCMS-TH, Bhairahawa, Nepal from August 2018 to January 2019. The radiation doses were measured by convenient techniques: volumetric computed tomography dose index (CTDIvol), dose length product (DLP) & effective dose (ED) and data were analyzed using SPSS version 20.

Results: The mean BMI of the study participants was 23.92±4.29 kg/m². The mean values of contrast-enhanced scan CTDIvol, DLP, and an ED in our study were 7.31 mGy, 421.46 mGy.cm and 6.31 mSv respectively which is very low as compared to European Guidelines (EG) & International Atomic Energy Agency (IAEA). There was a statistically significant association between patient BMI with CTDIvol, DLP and ED during non-contrast, contrast-enhanced and delayed scans.

Conclusion: The CTDIvol, DLP, and ED were lower than the European guidelines and IAEA standards. Toward preventing health effects from ionizing radiation, our study follows public concerns and minimizes radiation doses.

Knowledge Regarding Ebola Virus Disease among Nursing Students

Mina Adhikari, Susmita Shrestha, Hari Prasad Upadhyay — Fri, 30 Jun 2023 00:00:00 +0000

Background: Ebola virus disease (EVD) is an acute, viral and fatal illness among humans and other primates. It can be transmitted from wild animals to human and could spread from human to human. The objective of the study was to assess the knowledge regarding Ebola Virus Disease among the nursing students.

Method: A cross sectional analytical study design was conducted among the nursing students to assess the knowledge regarding Ebola Virus Disease among the nursing students of Bharatpur, Chitwan. A total of 138 nursing students were selected by using the enumerative sampling method. Data were collected by using semi structured self-administered questionnaire. Data was entered and analyzed by using SPSS-20.

Result: In the study, out of 138 respondents, majority of respondents were in age group of 21-25 years (51.4%) and while least 0.7% were in age group of 26-30years. Regarding ethnicity, highest percentage of the respondents were Brahmin/Chhetri covering 67.4%. Regarding the level of knowledge on Ebola virus disease, 77.5% had poor knowledge and 22.5% had good knowledge. There was statistically significant relationship between the level of knowledge regarding Ebola virus disease and types of family (p<0.031).

Conclusion: Based on the finding of the study, it is concluded that majority of the respondents had poor level of knowledge regarding Ebola Virus disease. So, the study recommends the need of effective awareness programme for the nursing students that could bring more awareness as a whole in good level.

Knowledge and Practice Regarding Prevention of Myocardial Infarction among People above 40 Years of Age

Fri, 30 Jun 2023 00:00:00 +0000

Background: : This study entitled " Knowledge and Practice Regarding Prevention of Myocardial Infarction Among People Above 40 Years of Age" was carried out to identify the knowledge and practice regarding prevention of myocardial infarction among people above 40 years of age attending in community people.

Methodology: Simple descriptive cross sectional study design was used for the study conducted in the Siddharthanagar Municipality,-09 no-ward with a sample of 138 and were selected by Non-probability purposive sampling technique using semi-structured questionnaire.

Result: The study revealed that majority (61.6%) were age 40-50 years, majority (60.9%) were male. Majority (81.9%) of Hindu were found. Majority were literate (60.9%); out of them, highest number (30.4%) had secondary level education. Majority of (60.1%) were farmer depending upon Agriculture. The majority (100%) Heard about Heart attack (MI) and mostly (50.0%) received information through Media\TV. (30.4) participants believed that MI is curable and controllable. However, (95.7%) were unknown about anyone who had heart attack before and majority (79.7%) hadn't ever received any information related MI. Majority (70.3%) Sudden pain or discomfortable in the chest and (64.5%) had chest pain through Identify and characteristics Symptoms of MI. Majority believed (47.1%) risk factor were smoking. (100%) believed that it requires a prompt treatment, (71.0%) take them hospital immediate. Highest number (77.5%) believed that lack of exercise is major factor and (81.9) heart disease, (91.3) hypertension were risk for MI. (87.7%) believed that less fat more fruits and vegetables should be consumed on daily basis whereas (100%) had no stress and (52.9%) were stay happy.

Conclusion: The study found that 61.9% of respondents were literate, while 39.1% were illiterate but the majority (100%) were aware of heart attack (MI), which is curable and controllable. Nepal needs to conduct awareness programmes for MI and prevent life-threatening diseases.

Nirmasi (Delphinium) poisoning with salvoes of malignant ventricular arrhythmias in central Nepal: A case report

Shankar Laudari, Shahid Murtuza, Santosh Sharma Bhusal, Rachit Yadav — Fri, 30 Jun 2023 00:00:00 +0000

Nirmasi is a commonly used herb in Nepal especially in hilly and Himalayan regions. It is known as Delphinium species herb. Nirmasi has been used in Nepalese and Indian rural communities since ages for treatment of chronic illnesses like headache, epilepsy, mania, paralysis, rheumatism, toothache, and various types of pain. However, many species of Nirmasi (Delphinium) are poisonous and look quite similar in morphology to the beneficial ones. As a result, unintentional poisoning is common. Poisoning due to these plant products results in various symptoms attributed to gastric irritation, competitive neuromuscular blockade, and cardiotoxicity caused by various alkaloids present in them. We report here a case of poisoning due to Nirmasi herb ingestion presenting as epigastric pain, vomiting, profuse sweating, syncopal attack, hypotension and malignant ventricular arrhythmias managed successfully with antiarrhythmics and supportive treatment.

Marfan’s syndrome with rhegmatogenous retinal detachment: a case report and literature review

Kumudini Subedi; Prachi Dulal, Sangita Pradhan; Raghunandan Byanju — Fri, 30 Jun 2023 00:00:00 +0000

Background: Marfan’s syndrome is known to be a rare, multisystem disorder of connective tissue typically affecting cardiac, skeletal and ocular system. The only definitive diagnosis is by gene testing for autosomal dominant mutation of FBN1 gene encoding the regulation of fibrillin 1 located on chromosome 15q.3.Ocular manifestations appear early in life with most of the abnormalities being sight threatening. These incude ectopia lentis, high myopia, rhegmatogenous retinal detachment , open angle glaucoma etc. Ophthalmological examination plays vital role in early diagnosis and visual preservation.

Case report: A 16 year old male presented with chief complaints of curtain like shadow in temporal visual field with present glasses for past 7 days. He had bilateral ectopia lentis with rhegmatogenous retinal detachment sparing the macula in the left eye. General examination of patient revealed physical features suggestive of Marfan’s syndrome. Although genetic testing was not possible, all features were suggestive of Marfan’s syndrome according to revised Ghent criteria. Pars plana vitrectomy with lens extraction with silicone oil injection was the treatment of choice. After an eventful post-operative period with silicone oil induced rise in intraocular pressure and 360 degrees peripheral anterior synechiae, early removal of silicone oil led to a good final visual outcome. Thus, with early detection and prompt treatment we were able to restore his visual quality of life.

Conclusion: Although serious and vision threatening manifestations may occur in the eye in cases of Marfan’s syndrome, early diagnosis and prompt treatment may be able to salvage vision. It is necessary to keep patients on regular follow up and inform them of possible vision threatening ocular manifestations in the eye for early diagnosis and prompt management.