Kathmandu University medical journal (KUMJ)
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Kathmandu Univ Med J (KUMJ) · Oct 2020
Multicenter StudyRisk Factors Associated with Ninety Day Readmission in Chronic Obstructive Pulmonary Disease Exacerbation at a Tertiary Care Hospital: A retrospective cohort study.
Background Chronic obstructive pulmonary disease (COPD) exacerbation is a leading cause of frequent hospital admission. Globally, several studies have reported potential risk factors associated with COPD exacerbations which are largely unknown in Nepalese health care setting. Objective To identify the risk factors associated with hospital readmission within ninety days of discharge in acute COPD exacerbation. ⋯ Logistic regression analysis revealed preadmission domiciliary oxygen use (Odds Ratio (OR) 2.93; 95% CI 1.195- 7.202; p=0.019), admission in intensive care unit (ICU) (OR 3.060; 95% CI 1.145- 8.179; p=0.026), previous hospital admission for COPD exacerbation (OR 3.230; 95% CI 1.219-8.556; p=0.018), age (OR 0.946; 95% CI 0.905-0.988; p=0.012) and duration of hospital stay (OR 0.901; 95% CI 0.819-0.992; p=0.034) were independently associated with ninety day readmission in COPD patients. Conclusion Five clinical factors were found to be independently associated with COPD readmission in this study. Large multi-centre study at various health care levels is recommended to validate the potential risk factors in different populations and health care settings in Nepal.
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Kathmandu Univ Med J (KUMJ) · Apr 2020
Effect of Positive Airway Pressure During Preoxygenation on Safe Apnea Period: a comparison of the supine and 25° head up position.
Background Preoxygenation is performed before induction of anaesthesia which increases oxygen reserve and provides delayed onset of hypoxia during period of apnea. Several techniques such as positive airway pressure and head-up tilt during preoxygenation have shown to prolong safe apnea period compared to conventional technique. However, uniform recommendations have not yet been made. ⋯ Result The duration of safe apnea period was longer (p < 0.05) in Group H patients (405.9 ± 106.69 s) as compared to the Group C (296.9 ± 99.01s) and Group S (319.65 ± 71.54s). Although the duration of safe apnea period was longer in the Group S as compared to Group C the difference was not statistically significant. Conclusion Preoxygenation in 25° head-up position with 5 cm H2O continuous positive airway pressure significantly prolongs safe apnea period in non-obese adults compared to supine position, with or without 5 cmH2O continuous positive airway pressure.
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Kathmandu Univ Med J (KUMJ) · Jan 2020
Co-morbidities, Maternal and Fetal Outcome of Teenage Pregnancy at Tertiary Care Hospital, Nepal.
Background Teenage pregnancies constitute a serious health and social problem worldwide. World estimates in 2008 report about 16 million births to adolescent mothers, most of them occurring in low and middle income countries. Objective To assess pregnancy co-morbidities and outcome of teenage pregnancy. ⋯ Most common maternal morbidity found was urinary tract infection during pregnancy but statistically not significant. Similarly, newborn mean weight was more than 2.5 kg and neonatal death found very less. However, teenage pregnancy is significantly associated with low economic status, illiteracy status, willingness to marriage by teenagers and ethnicity.
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Kathmandu Univ Med J (KUMJ) · Jul 2019
Randomized Controlled TrialEffect of Dexmedetomidine with Ropivacaine in Supraclavicular Brachial Plexus Block.
Background Brachial plexus block is popular choice for upper limb surgeries and offers good and relatively safe anesthesia. Among various approaches supraclavicular approach is the most consistent method for anaesthesia and postoperative pain management in surgery below the elbow joint. Many drugs are used as adjuvants in brachial plexus block for faster onset, denser block and for prolongation of postoperative analgesia. ⋯ The mean duration of sensory block (838.70±164.11 min Vs 670.20±145.16 min), motor block (804.16±148.71 min Vs 594.93±53.89 min) and duration of analgesia (1193.80±223.11 min Vs 828.23±136.30 min) were significantly longer in Group RD compared to Group RS. The incidence of side effects in both groups were comparable. Conclusion From this study, it can be concluded that addition of Dexmedetomidine 0.75 mcg/ kg to 0.5% Ropivacaine results in early onset of sensory and motor blockade, prolongation of duration of sensory and motor blockade and duration of analgesia postoperatively without any significant side effects.
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Kathmandu Univ Med J (KUMJ) · Oct 2018
Randomized Controlled TrialAwake Fiberoptic Intubation in Cervical Spine Injury: A Comparison between Atomized Local Anesthesia versus Airway Nerve Blocks.
Background In cooperative patients with cervical spine injury, awake fiberoptic intubation is an excellent option for elective and semi urgent situations. It allows documentation of neurologic examination before and after intubation and surgical positioning. We have compared anesthesia of airway by nerve block and the local anesthesia atomizer undergoing awake fiberoptic intubation in cervical spine injury patients, in terms of the intubation time and discomfort. ⋯ Ease of intubation and patient comfort were significantly better in nerve block group. Demographic and hemodynamic parameters were comparable in the two groups. Conclusion The nerve blocks (bilateral superior laryngeal and transtracheal recurrent laryngeal) provides adequate airway anesthesia, lesser patient discomfort, and faster intubation to aid in awake fiberoptic intubation in patients with anticipated difficult airway as compared to topical anesthesia using atomizer.