bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of furosemide and high-dosage pimobendan administration on the renin-angiotensin-aldosterone system in dogs
Authors: Ames Marisa K. , Atkins Clarke E. , Lantis Andrea C. , Werre Stephen R.
Published: July 2013

Objective—To determine whether a high dosage of pimobendan, when administered concurrently with moderate-dosage furosemide to healthy dogs, would activate the renin-angiotensin-aldosterone system (RAAS) more than furosemide alone.

Animals—12 healthy dogs.

Procedures—6 dogs received furosemide (2.0 mg/kg, PO, q 12 h) only, as an RAAS activator, for 10 days. The other 6 dogs received furosemide (2.0 mg/kg, PO, q 12 h) and pimobendan (0.6 mg/kg, PO, q 12 h) for 10 days. The effect of these drugs on the RAAS was determined by measurement of the aldosterone-to-creatinine ratio (A:C) in urine collected in the morning and evening of study days −2, −1, 1, 5, and 10.

Results—Although there was an increase in the urine A:C during the study period in both groups, it was significant only for dogs that received both drugs. The urine A:C only differed significantly between groups on day 1, at which time A:C was greater in the group that received both drugs.

Conclusions and Clinical Relevance—High-dosage pimobendan administration neither substantially suppressed nor potentiated the RAAS when administered with furosemide in healthy dogs.
Comparison of concentrations of γ-aminobutyric acid and glutamate in cerebrospinal fluid of dogs with idiopathic epilepsy with and without seizure-related magnetic resonance imaging hyperintense areas in the limbic system
Authors: Creevy Kate E. , Gagnepain John F. , Platt Simon R. , Edwards Gaylen L. , Kent Marc
Published: July 2013

Objective—To investigate differences in CSF concentrations of excitatory and inhibitory neurotransmitters in dogs with and without T2-weighted (T2W) MRI hyperintense areas in the limbic system.

Sample—Archived CSF samples and stored brain MRI images of 5 healthy research dogs (group 1), 8 dogs with idiopathic epilepsy (IE) with no abnormal MRI findings (group 2), and 4 dogs with IE with hyperintense areas in the limbic system detected by means of T2W MRI (group 3).

Procedures—Archived CSF samples and stored MRI images obtained from all dogs were evaluated. Dogs in groups 2 and 3 were matched on the basis of age and breed. High-performance liquid chromatography was used to evaluate glutamate and γ-aminobutyric acid (GABA) concentrations in CSF samples.

Results—Glutamate concentrations were higher in CSF of both groups of dogs with IE than in healthy dogs. However, glutamate concentrations in CSF were not significantly higher in dogs with IE and with hyperintense areas than in dogs with IE but no abnormal MRI findings. Concentrations of GABA in CSF were higher in group 3 than in group 2 and in group 2 than in group 1.

Conclusions and Clinical Relevance—No significant difference was evident between glutamate concentrations in CSF of dogs with IE and with and without hyperintense areas detected by means of T2W MRI. However, glutamate concentrations typically were higher in CSF of dogs with IE and MRI hyperintense areas. Future studies with larger sample sizes should be conducted to confirm this finding and to determine the clinical importance of high glutamate concentrations in CSF of dogs with IE.
Effects of peribulbar anesthesia (sub-Tenon injection of a local anesthetic) on akinesia of extraocular muscles, mydriasis, and intraoperative and postoperative analgesia in dogs undergoing phacoemulsification
Authors: Ahn Jaesang , Jeong Manbok , Lee Euiri , Kim Soohyun , Park Sangwan , Park Sungwon , Kang Sunmi , Lee Inhyung , Seo Kangmoon
Published: July 2013

Objective—To evaluate the effects of peribulbar anesthesia (sub-Tenon injection of lidocaine hydrochloride) on akinesia of extraocular muscles, mydriasis, and intraoperative and postoperative analgesia in dogs undergoing phacoemulsification.

Animals—14 Beagles with ophthalmically normal eyes.

Procedures—A blinded randomized controlled trial was performed. Dogs were anesthetized and assigned to 2 treatments: concurrent sub-Tenon injection of 2% lidocaine hydrochloride solution (2 mL) and IV injection of saline (0.9% NaCl) solution (0.02 mL/kg; lidocaine group [n = 7]) or concurrent sub-Tenon injection of saline solution (2 mL) and IV injection of 0.2 mg of atracurium/kg (0.02 mL/kg; control group [7]). Pupils were dilated by topical application of a combined tropicamide and phenylephrine ophthalmic solution. Ten minutes after the injections, pupil diameter was measured and phacoemulsification was performed. End-tidal isoflurane concentration was used to evaluate intraoperative pain. Subjective pain scores were recorded during the postoperative period.

Results—Akinesia was induced and maintained throughout the surgery in all eyes. Mean ± SD pupil diameter was significantly greater in the lidocaine group (13.7 ± 0.7 mm) than in the control group (12.2 ± 0.8 mm). Isoflurane requirements were significantly lower in the lidocaine group than the control group. However, postoperative pain scores were not significantly different between the groups.

Conclusions and Clinical Relevance—Sub-Tenon injection of lidocaine was an effective method for inducing akinesia of extraocular muscles, mydriasis, and intraoperative analgesia for phacoemulsification in dogs. Therefore, this could be another option for surgical field exposure and pain management during phacoemulsification in dogs.
Effect of hydroxyethyl starch 130/0.4 and 200/0.5 solutions on canine platelet function in vitro
Authors: McBride Duana , Hosgood Giselle L. , Mansfield Caroline S. , Smart Lisa
Published: July 2013

Objective—To determine whether dilution of blood samples from healthy dogs with 2 hydroxyethyl starch (HES) solutions, HES 130/0.4 and HES 200/0.5, would result in platelet dysfunction as measured by closure time (Ct) beyond a dilutional effect.

Sample—Citrated blood samples from 10 healthy dogs with a Ct within reference limits (52 to 86 seconds).

Procedures—Blood samples were diluted 1:9 and 1:3 with 6% HES 130/0.4 and 10% HES 200/0.5 solutions and saline (0.9% NaCl) solution. Dilutions at 1:9 and 1:3 mimicked 10 mL/kg and 30 mL/kg doses, respectively, ignoring in vivo redistribution. Closure time was measured with a platelet function analyzer and compared among dilutions.

Results—A dilutional effect on Ct was evident for the 1:3 dilution, compared with the 1:9 dilution, but only HES 200/0.5 increased the Ct beyond the dilutional effect at the 1:3 dilution, to a median Ct of 125 seconds (interquartile range, 117.5 to 139.5 seconds). No effect of HES or dilution on Ct was identified at the 1:9 dilution.

Conclusions and Clinical Relevance—1:3 dilution of blood samples from healthy dogs with HES 200/0.5 but not HES 130/0.4 significantly increased Ct beyond the dilutional effect, suggesting that IV administration of HES 200/0.5 in dogs might cause platelet dysfunction.
Combination therapy for visceral leishmaniasis
Authors: Banjara MR
Published: July 2013

DOI: http://dx.doi.org/10.3126/ijim.v2i2.8318Int J Infect Microbiol 2013;2(2):32-33
Direct Nitrate Reductase Assay for detection of drug resistance in Mycobacterium tuberculosis: rapid, simple and inexpensive method for low resource laboratories
Authors: Lamsal A , Thapa B , Timilshina M , Verma SC , Ghimire GR , Gautam A
Published: July 2013

INTRODUCTION: The most common method for detection of drug-resistant-Tuberculosis (DR-TB) in resource-limited settings (RLSs) is indirect susceptibility testing on Lowenstein-Jensen (LJ) medium with results available only after 2-3 months. Rapid detection of drug resistance by direct Nitatre Reductase Assay (NRA) expedites Tuberculosis patient management. The objective of the study is to access the feasibility and performance of Direct NRA for detection of DR-TB in National Tuberculosis Center under the National Tuberculosis Control Programme (NTP). MATERIALS AND METHODS: Out of 416 previously treated and new pulmonary TB suspect cases; a total of 117 (28.1%) smear-positive sputa with a positivity score of 1+ or more were used in the study. The NRA results were compared with the gold standard LJ proportion method for 110 (94%) specimens while 7 were either contaminated or culture negative. RESULTS: In comparison with LJ proportion method, the respective sensitivities, specificities, NPV, PPV and kappa agreement were 97.2% (95% CI, 86-100), 95.9%(95% CI, 89-99), 92.1% (95% CI, 78-99) 98.6% (95% CI, 92-100), and 0.92 for INH, 100% (95%CI, 90-100), 98.7% (95% CI, 93- 100), 97.1% (95% CI, 85-100), 100% (95% CI, 95- 100) and 0.98 for RFM, 97.1% (95% CI, 85-100) ,96.1% (95%, 89-99), 91.7% (95% CI, 78-98), 98.7% ((95% CI, 93-100) and 0.92 for SM and 100% (95% CI, 88-100), 97.7% (95% CI, 91-100), 93.3% (95% CI, 78-99), 100% (95% CI, 95- 100)and 0.93 for EMB. CONCLUSIONS: The results obtained by direct NRA demonstrated excellent concordance for all drugs. Direct NRA is an assay which detects DR-TB directly from sputum rapidly and has the potential to become an alternative to existing methods particularly in resource-poor settings.DOI: http://dx.doi.org/10.3126/ijim.v2i2.8319   Int J Infect Microbiol 2013;2(2):34-39
Hematological profile in visceral leishmaniasis
Authors: Agrawal Y , Sinha AK , Upadhyaya P , Kafle SU , Rijal S , Khanal B
Published: July 2013

INTRODUCTION: Visceral Leishmaniasis is the most severe form of leishmaniasis and can be fatal in the absence of treatment. Nepal, India, Bangladesh, Brazil and Sudan constitute five countries of the world where more than 90% of visceral leishmaniasis occurs. The aim of this study is to evaluate haematological profile with available clinical data in visceral leishmaniasis patients and to detect LD bodies among them. MATERIALS AND METHODS: It is a hospital based cross sectional study conducted in the Department of Pathology, BPKIHS, Dharan, for the period of one year. LD bodies were calculated in bone marrow aspirate of forty clinically suspected cases by counting the number of parasites per 100 consecutive oil immersion fields. RESULTS: The age ranged from 2-60 years. Pyerxia was the most common sign (100%) followed by splenomegaly (82.5%), hepatomegaly (65%), and pallor (75%). Anemia was present in 90%, leucopenia in 67.5% and thrombocytopenia in 72.5% cases. Bicytopenia and pancytopenia were observed in 40% and 25% cases, respectively. On peripheral examination RBCs were predominantly normocytic normochromic. On bone marrow examination normocellular marrow and megaloblastic features were predominant findings followed by increased plasma cells. Low, moderate and high grade LD bodies were present in 7.5%, 37.5% and 55% of the cases respectively. Hepatomegaly, anemia, neutropenia and lymphocytosis were statistically significant to parasite load (p-value <0.05). CONCLUSIONS: Besides LD bodies in bone marrow aspirates, dyserythroblastic changes and increase plasma cells are common findings in leishmaniasis. Patient from endemic area with positive clinical history and findings should be examined for LD bodies in marrow if dyserythroblastic and increase plasma cell picture is found.  DOI: http://dx.doi.org/10.3126/ijim.v2i2.8320   Int J Infect Microbiol 2013;2(2):39-44
First line anti-tubercular drug resistance among patients visiting German Nepal Tuberculosis Project, Nepal
Authors: Regmi S , Shrestha B , Katuwal A
Published: July 2013

INTRODUCTION: Tuberculosis is one of the commonest causes of death in the world. It remains a major public health problem in developing countries including Nepal. Despite the reduction in incidence of tuberculosis by the implementation of anti-tuberculosis drugs regimen, TB remains pandemic due to emergence of drug resistant strain of M. tuberculosis. The aim of this study was to evaluate the first line anti-tubercular drug resistance among patients visiting German Nepal Tuberculosis Project, Nepal. MATERIALS AND METHODS: Anti-tubercular drug susceptibility test for first line drugs (Rifampicin, Isonizid, Ethambutol, and Streptomycin) was performed by proportion method (n=141) for new sputum smear positive patients attending German Nepal Tuberculosis Project, Kathmandu, Nepal. RESULTS: 78.1% (n=110.) were sensitive to all 4 drugs. Eight isolates (5.6%), 4(2.8%), 10(7.1%) and 31(21.9%) were resistant to any 4, 3, 2 and 1 drug respectively. Proportion of drug resistant (PDR) to one drug was 12.6%, two drugs 7.6%, three drugs (6.3%) and four drugs was 5.6%. Our result indicates the PDR to the first line drug was 21.9% and multidrug resistant (MDR) was 12 (8.5%). CONCLUSIONS: Drugs resistant cases of tuberculosis in increasing. Surveillance and monitoring of the drug resistant tuberculosis is necessary to prevent emergence of MDR, extensively drug resistant and so-called totally drug resistant tuberculosis.  DOI: http://dx.doi.org/10.3126/ijim.v2i2.8321   Int J Infect Microbiol 2013;2(2):45-48
Assessment of sub-clinical mastitis and its associated risk factors in dairy livestock of Lamjung, Nepal
Authors: Khanal T , Pandit A
Published: July 2013

INTRODUCTION: Mastitis is one among the top three threats faced by dairy farmers. The study was carried out to assess sub-clinical mastitis, management practices and associated risk factors for mastitis. MATERIALS AND METHODS: A cross sectional study was conducted in Chandreshwor and Archalbot VDCs of Lamjung district taking 63 dairy livestock randomly each from a herd along with questionnaire survey to respective owner. Tem ml of milk sample from each quarter was taken in a sterilized syringe for further laboratory investigation. California Mastitis Test (CMT) was performed at farmer’s shed. Organisms were identified based on colony characteristics, Gram's staining and various biochemical tests. RESULTS: On CMT, subclinical mastitis was 46.1% (n=29) and 30.15% (n=76) on animal and quarter basis respectively, however, culture showed, 28.6% and 24.2%. Streptococcal mastitis was the commonest (11.1%) followed by coliform (9.5%) and staphylococcal (7.9%). Mastitis was highest in left fore quarter (34.92%) followed by left hind (31.76%), right hind (28.57%) and right fore (25.39%). Coliform & Staphylococcal mastitis was highest in left fore and right hind quarter respectively. Most of dairy animals (86%) were on zero grazing, 30% (n=19) of the farmers had forage trees and only 29% (n=18) had known about subclinical mastitis. The average milk production was 3.5 ±1.47 liters. Subclinical mastitis was associated significantly (p<0.01) with livestock yielding more than 3 lt per lactation. CONCLUSIONS: There was high prevalence of subclinical mastitis in dairy livestock at Lamjung due to poor management, unhygienic shed, and little knowledge on subclinical mastitis.  DOI: http://dx.doi.org/10.3126/ijim.v2i2.8322 Int J Infect Microbiol 2013;2(2):49-54
Measurement of transverse and sagittal diameter of the lumbar vertebral canal in people from Western region of Nepal
Authors: Shrestha B , Dhungana S
Published: July 2013

INTRODUCTION: Size of the canal diameter is one among several factors responsible for lumbar canal stenosis. The study aims to measure the transverse and sagittal diameter of the lumbar vertebral canal in people from Western region of Nepal and compare with the published results. MATERIALS AND METHODS: Fifty young patients (24 males and 26 females) complaining of LBP were done X-ray of lumbar spine in Antero- Posterior (AP)/ Lateral in supine views. From the images, midsagittal (AP) dimensions, transverse (interpedicular) distances and width of vertebral body were measured at each level with the help of electronic calipers. RESULTS: The mean transverse diameter of lumbar canal ranged from 24.8 mm at L1 to 33.25 mm at L5. This gradual increase in the transverse diameter from L1 to L5 was statistically significant. Measurement of lumbar vertebral width ranged from 41.37 mm at L1 and 52.96 mm at L5. There was gradual increase in the size from L1 to L5. But the measurement of AP distance showed a gradual decrease in diameter from L 1 to L 5. The decrease in the AP diameter from L 1 to L2 and Canal body ratio was not constant at all levels. CONCLUSIONS: Our hospital based data showed that the patients from western region of Nepal have smaller canal size. Therefore, the patients from western region of Nepal may be more prone to develop spinal canal stenosis.  DOI: http://dx.doi.org/10.3126/ijim.v2i2.8323   Int J Infect Microbiol 2013;2(2):55-58
Refractive Error Profile in a Tertiary Centre in Western Nepal
Authors: Taludhar S , Dhakal S
Published: July 2013

INTRODUCTION: Refractive error is one of the causes of avoidable blindness. Myopia, hypermetropia and astigmatism are the common types of refractive error. Not many studies are done to detect pattern of refractive error in Western Nepal. So, the study will determine the prevalence and distribution of refractive errors. MATERIALS AND METHODS: A prospective study of all consecutive patients of age less than 40 years who visited eye department, Gandaki Medical College, between May 2010 and May 2011 was conducted. Visual acuity, naked eye and pin hole examination was done by ophthalmic assistant with cycloplegic refraction when needed. Those who did not turn up for refraction were excluded from the study. RESULTS: A total of 601 patients were seen within the study period. Mean age of male patients was 22.4 years }0.6 (95% CI, 21.2-23.6 years) and mean age of female patients was 24.2 years }0.5 (95% CI, 23.2-25.2 years). Majority of the patients were in age group 11-20 years (39.3%). Myopia was the most common refractive error (43.3%) followed by simple myopic astigmatism (23.8%). Refractive errors were more common in females. CONCLUSIONS: Myopia was the commonest refractive compared to hypermetropia. Refractive error was more common in females than in males. Such studies help to know the picture of refractive errors in community and such reports are helpful in planning programme to prevent avoidable blindness.DOI: http://dx.doi.org/10.3126/ijim.v2i2.8324 Int J Infect Microbiol 2013;2(2):59-63
Histoid leprosy on scrotal skin: an unusual case
Authors: Paudyal P , Shrestha S , Agarwal M , Kafle SU , Karki S , Upadhyaya P , Agarwal S , Pradhan A
Published: July 2013

INTRODUCTION: Although no part of the skin is immune from invasion by mycobacterium leprae it is commonly seen over cooler parts of the body and very rarely found over external genitalia because of their warm temperature. Histoid leprosy is rare but a well-defined entity with specific clinical, histopathological, and bacteriological features. CASE REPORT: A Punch biopsy measuring 3x3 cm of a 73 year old male having an erythematous plaque over scrotum since 2 months was received for histopathologic examination with the clinical differentials of pilomatrixoma and steatocystoma multiplex. Histopathologic and special stain slides revealed a feature of histoid leprosy. CONCLUSION: Although rare, leprosy lesions may occur on the male genitalia and therefore in all male patients, history taking and examination of external genitalia should not be neglected.  DOI: http://dx.doi.org/10.3126/ijim.v2i2.8325   Int J Infect Microbiol 2013;2(2):64-67
Errata: J Infect Microbiol 2013;2(1):7-11
Authors: Thapa Bhadri
Published: July 2013

DOI: http://dx.doi.org/10.3126/ijim.v2i2.8326 Int J Infect Microbiol 2013;2(2):68
The Deadly Epidemic of Cardiovascular Disease
Authors: Bhatt YKD
Published: July 2013

DOI: http://dx.doi.org/10.3126/njh.v8i1.8327 Nepalese Heart Journal Vol.8(1) 2011 pp.1-2
Prediction of Cardiovascular Disease in suburban population of 3 municipalities in Nepal
Authors: Koju R , Gurung R , Pant P , Humagain S , Yogol CM , Koju A , Manandhar K , Karmacharya B , Bedi TRS
Published: July 2013

Background Cardiovascular disease (CVD) is a major cause of morbidity and mortality throughout the world including Nepal. The assessment of risk factors responsible for CVD can predict 10 year risk of CVD. World Health Organization (WHO) risk assessment chart, specially designed for South East Asia Sub-region D can predict the risk of CVD in Nepal. Method and Materials A total 532 study population from Panauti, Banepa and Dhulikhel were calculated their 10 year risk of CVD using WHO/ISH risk prediction chart on the basis of risk factors: age, gender, smoking status, diabetes, systolic blood pressure and total cholesterol. Result Ten year risk of developing cardiovascular disease is less than 10% among the population less than 50 years, irrespective of gender. 5% of male population had more than 10% chance of developing cardiovascular events in next ten years. One third of 60 – 69 years people had more than 10% chance of developing cardiovascular disease whereas it increased to 50% among 70 years and older group. Conclusion The assessment of risk factors is quite easy and cheap tool to predict the cardiovascular event, which support to practice the good clinical management to prevent the cardiovascular morbidity and mortality.  DOI: http://dx.doi.org/10.3126/njh.v8i1.8328 Nepalese Heart Journal Vol.8(1) 2011 pp.3-7
Primary Cardiac Tumours: Our Experience
Authors: Sharma J , Sherchan S , Pradhan S , Rajbanshi B , Koirala R , Tamala R , Pokharel J , Uprety MR , Koirala B
Published: July 2013

Introduction Primary cardiac tumours are rare with autopsy incidence of less than 0.1 percent. We present our experience on surgical treatment of such tumours. Methods Since 2001, fifteen patients underwent surgical intervention for primary cardiac tumour at our centre. Mean age was 46.5 ± 17.5 years (range 20 to 73 years). There were eight female patients. Thirteen patients had atrial myxoma and the remaining two had primary malignant tumours. Surgical excision of the tumour was done under cardiopulmonary bypass and cardioplegic cardiac arrest. Results Complete excision was possible in all benign cardiac tumours where as excision was possible in only one of the two malignant tumours. One patient with suspected angiosarcoma had biopsy taken from the heart. There was no operative mortality. All the patients with atrial myxoma were symptom free and free of recurrence on follow-up echocardiography. The patient with suspected angiosarcoma (histopathology was reported as hemangioma only) presented with disseminated disease and metastasis to thoracic spine with paraplegia three months postoperatively. The other patient with rhabdomyosarcoma who had complete excision of tumour followed by repair of the defect is currently on adjuvant chemotherapy. Conclusion Surgical excision of primary benign cardiac tumours is possible with excellent surgical outcome where as outcome is guarded in primary malignant cardiac tumours. DOI: http://dx.doi.org/10.3126/njh.v8i1.8329 Nepalese Heart Journal Vol.8(1) 2011 pp.8-11
Electrocardiographic changes in Chronic Obstructive Pulmonary Disease patients with elevated Pulmonary Artery Systolic Pressure
Authors: Humagain S , Keshari S , Gurung R , Pant P , Pokharel B , Koju R , Bedi TRS
Published: July 2013

Background Chronic Obstructive Pulmonary Disease (COPD) is a common global problem and most common medical problem in Nepal having significant morbidity and mortality. One of the pathogenesis of COPD in long run is the elevation of Pulmonary Artery Systolic Pressure (PASP) leading to right heart failure. A simple investigation - an Electrocardiograph (ECG) is assessed to co-relate with elevated PASP measured by Echocardiography in COPD patients of Dhulikhel Hospital. Methods and Materials A retrospective case control study of 342 COPD patients was done with assessment of ECG to co-relate with elevated PASP and with normal PASP. Data were analyzed using SPSS 17. Result There was significant difference in mean age, P amplitude in Lead II, III and aVF, QRS axis and R wave in V1 and S in V6 between two groups. Conclusion ECG changes are fairly sensitive and specific for elevation of PASP. DOI: http://dx.doi.org/10.3126/njh.v8i1.8330 Nepalese Heart Journal Vol.8(1) 2011 pp.12-15
Allergic reaction to long – term Benzathine penicillin injection for secondary prevention of acute rheumatic fever and recommendations for skin testing
Authors: Regmi PR , Upadhyaya AB
Published: July 2013

Background Rheumatic Fever (RF) causes 25-40% of all cardio vascular disease in developing countries. Long term benzathine penicillin injection is being used for secondary prophylaxis of RF / RHD. Although allergic reaction to penicillin is rare skin testing is performed routinely before each and every penicillin injection delivery in most of the hospitals in Nepal. Objectives Objectives of this study was to evaluate safety of long term benzathine penicillin injection and establish recommendations for penicillin skin testing. Methods Data from the registers of National RF/RHD prevention and control programme from 32 hospitals of Nepal were collected and analyzed in a retrospective study. Results 65 patients (1.4%) among 77300 injections of benzathine penicillin given to 4712 patients, had allergic reactions. 5 had anaphylaxis, an incidence of 0.1% (0.7/10000 injections), 60 had minor allergy, an incidence of 1.3%. Conclusions Life-threatening allergic reactions are very rare in patients on long-term intramuscular benzathine penicillin for secondary prevention of RF. With these rare complications, regular skin test before each and every benzathine penicillin injection delivery has no significant role. Nevertheless Skin testing is recommended before 1st injection and patients having different batch number and or brand name. DOI: http://dx.doi.org/10.3126/njh.v8i1.8331 Nepalese Heart Journal Vol.8(1) 2011 pp.16-18
Radio Frequency Ablation of right sided accessory pathway - 8 years experience at SGNHC
Authors: Raut R , KC MB , Rajbhandari S , Dhungana M , Shah R , Shah KB
Published: July 2013

Background Radiofrequency ablation has been established as the curative treatment for most of supraventricular tachycardia since 1987. In SGNHC, ablation has been done routinely since 2003. In our experience, right sided accessory pathway (AP) has been technically difficult and challenging with low success rate as mentioned in literature outside. So, the objective of this article was to analyze the demographic characteristics, success and recurrence rate and complication of right sided AP ablation in our centre. Methods and Materials From 13th Oct 2003 to 9th Sept. 2011, altogether 768 patients who underwent ablation were analyzed. Result Among 768 patients, 416(54.2%) were accessory pathways out of which 72(17.3%) were right sided AP. Majority of right sided accessory pathway were manifest (WPW) comprising 77.1%, significantly higher compare to left sided pathway where manifest AP was only 44.1 % (p< 0.001). Among all attempted ablation of right sided AP, 11 ablations failed so that the success rate was 84.7% lower than that of left sided pathway where success rate was 98.4% (p<0.001). Among 61 successful ablations, 2 relapsed during follow up period, recurrence rate being 3.3%. Although there were few complications in the ablation of other tachyarrhythmia, there was no complication noted during the ablation of 72 right sided AP. Conclusion Right sided pathway are mostly manifest. The success rate of right sided pathway is lower in comparison to left sided pathway. Our success rate is comparable to the result in the literature which indicates that ablation of right sided accessory pathway in our centre is reasonably good. DOI: http://dx.doi.org/10.3126/njh.v8i1.8332 Nepalese Heart Journal Vol.8(1) 2011 pp.19-22
Current Scenario of Heart Diseases in Nepal: At a glance
Authors: Shakya S , Sharma D , Bhatta YD
Published: July 2013

Background Cardiovascular disease no more remains as a disease of developed countries. It is affecting developing countries as well. In addition, developing countries have big challenge to deal with these because of lack of resources and lack of studies related to it. This study is an attempt to portrait a picture of cardiovascular problems in Nepal on the basis of records obtained in various cardiac camps conducted by Shahid Gangalal National Heart Center in September 2008 to July 2011. Methods and materials The reports of 19 cardiac camps were analyzed. Result The proportion of congenital heart disease in cardiac camps ranges from 0.35% (Dolakha) to 5.04% (Dhangadi). The proportion of RHD ranges from 3.25% (Bhaktapur) to 30.67% (Dhangadi). The proportion of hypertension ranges from 5.11% (Dolakha) to 39.41% (Baglung). The proportion of CAD ranges from 0.56% (Tikapur) to 15.12% (Birgunj). Conclusion The proportion of CHD and RHD were found the highest in Dhangadi. The lowest proportion of hypertension was found in Dolakha, the study was conducted in Singati, which is the most remote area among the areas included in this study. The highest proportion of hypertension was found in Baglung. The highest proportion of Coronary artery disease was found in Birgunj. In every camp, the hypertension claims the major proportion of cardiovascular problem. It reflects, Nepal is in a rising epidemic of coronary artery disease. Preventive programs should be emphasized sooner as possible to prevent catastrophic effect of Cardiovascular Disease in Nepal. DOI: http://dx.doi.org/10.3126/njh.v8i1.8333 Nepalese Heart Journal Vol.8(1) 2011 pp.23-26
Angioplasty Outcomes in the Elderly Nepalese Patients: an eight years experience in Norvic International Hospital
Authors: Chirag G , Rawat B , Rajbhandari S , Bhatta Y , Jaiswal JP , Vaidya A
Published: July 2013

Background The aim of the study is to evaluate and compare the outcomes of percutaneous transluminal coronary angioplasty (PTCA) between the elderly (>70 yrs) and the non-elderly (70 yrs and younger) Nepalese patients who had been admitted to Norvic International Hospital between early 2002 and April 2010. Methods Data of a total of 92 elderly and 604 non-elderly patients were retrospectively analyzed after they had been admitted in the Hospital for the interventional treatment of acute coronary syndrome. Results There were 64 (69.6%) male patients and 28 (30.4%) female patients in the elderly group. Elderly population had lesser smokers. Diabetic population was similar in both the age groups. The elderly patients slightly less success rate compared to the non-elderly (95.7% vs. 99.3%). There was no significant difference in bleeding complication and groin haematoma. In hospital death was 3.33% in elderly and 0.5% in non elderly. Conclusion Though the outcome in the elderly is poorer in comparison to the younger patients, it is an expected result when compared to even the biggest centres worldwide. DOI: http://dx.doi.org/10.3126/njh.v8i1.8334 Nepalese Heart Journal Vol.8(1) 2011 pp.27-29
Acute ST segment elevation MI with Normal Coronaries
Authors: Barakoti M , Jha SC , Acharya SM , Paudel CM
Published: July 2013

A 45 year-old man with no history of cardiac disease presented to the emergency department with typical angina chest pain of >24 hours duration. He was not thormbolyzed due to late presentation. Having elevated troponin and CK-MB levels and an electrocardiogram demonstrating anterolateral ST segment elevation and persistent of angina pain prompted coronary angiography which could be done only after 3 weeks of symptom onset due to financial constraint; which revealed coronary vessels free of significant disease. An echocardiogram showed dilatation of all cardiac chambers with hypokinesia of anterior wall and mid-septum and akinesia of apex. There was moderate mitral regurgitation and moderate tricuspid regurgitation and moderate systolic dysfunction. A number of conditions can lead to ST segment elevation MI with normal epicardial coronary anatomy. We report a case possibly due to autothrombolysis. Treatment to such cases would be symptomatic drug therapy with reassurance and risk factor reduction. DOI: http://dx.doi.org/10.3126/njh.v8i1.8335 Nepalese Heart Journal Vol.8(1) 2011 pp.33-36
Is he the culprit?
Authors: Prabhan BB , Shrestha S
Published: July 2013

The peripartum cardiomyopathy (PPCM) generally occurs in the last trimester of pregnancy or within 6 months of delivery. The disease generally occurs in multiparous female more than 30 years of age. The prognosis depends upon whether the heart returns to normal size after the first episode of CHF. If heart remains enlarged or the ejection fraction remains depressed after 6 months, the prognosis is poor. We present a case of 27 years female who gave birth to her fourth child and presented peripartum cardiomyopathy 11 months after the child birth. She was admitted, evaluated and managed with diuretics in the initial period and when stabilized placed on ACE inhibitor and alpha beta blocker. She improved significantly and was discharged. She was on regular follow up and showed a significant improvement in heart size, ejection fraction and valvular function when re-evaluated after 7 months. DOI: http://dx.doi.org/10.3126/njh.v8i1.8336 Nepalese Heart Journal Vol.8(1) 2011 pp.37-39
Abstracts Presented at the Conquering Heart Disease in the Himalayan Region International Conference 16-17 October 2011
Authors: Editor The
Published: July 2013

DOI: http://dx.doi.org/10.3126/njh.v8i1.8337 Nepalese Heart Journal Vol.8(1) 2011 pp.43-52
Cardiovascular Professionals for Services Provision in Nepal
Authors: Koju R
Published: July 2013

DOI: http://dx.doi.org/10.3126/njh.v9i1.8338 Nepalese Heart Journal Vol.9(1) 2012 pp.1-2
Normal Echocardiographic Parameters of Healthy Adult Individuals working in National Heart Centre
Authors: Prajapati D , Sharma D , Baidya SG , Shakya U , Shrestha N
Published: July 2013

Background Studies evaluating potential differences in normal cardiac dimensions and body mass indices of various ethnic populations using 2D echocardiography have reported variations based on gender and ethnicity. Currently, accepted echocardiographic reference values are from US studies, and the limited information is available on Nepalese population. The purpose of this study was to derive population-based reference values for two-dimensional (2D) guided M-mode echocardiographic dimensions and left ventricular mass of adult Nepalese that can be applied in epidemiologic studies, clinical trials and clinical practice. Methods 97 individuals were randomly selected, out of 502 staffs working in our hospital, who were over 18 years of age and were free of cardiovascular disease. Subjects underwent M-mode and 2D echocardiogram with color Doppler study. Reference values were derived for end-diastolic and end-systolic left ventricular internal dimensions, left ventricular wall thickness, left atrial dimension, aorta, LV mass. Measurements were described by mean, standard deviation and 95% reference range. Results Echocardiographic measurements were within standard normal limits. The measurements of aorta, left atrium, inter-ventricular septum, left ventricle in systole and diastole, left posterior wall and left ventricular mass, adjusted or not for body surface area, were significantly higher in males. Several echocardiographic measurements, adjusted or not for anthropometric measurements, had different mean and range than the reference limits in US-based studies. Conclusion The means and range for the measurements of left atrium volume, left ventricular diastolic dimension and left ventricular mass found in this survey were lower than those indicated by the international literature and accepted as normal limits. The results of this study strongly indicate the need for a larger scale study to further establish ethnic-specific and gender-specific echocardiographic reference values for the Nepalese population. DOI: http://dx.doi.org/10.3126/njh.v9i1.8339 Nepalese Heart Journal Vol.9(1) 2012 pp.3-6
Balloon Pulmonary Valvuloplasty in patients with Congenital Valvular Pulmonary Stenosis
Authors: Sharma R , Rajbhandari R , Limbu Y , Singh S , Bhatt YKD , KC MB
Published: July 2013

Background Congenital valvular pulmonary stenosis (PS) accounts for most of the etiology of PS, and constitutes about 5 to 10% of all congenital heart disease. Balloon Pulmonary Valvuloplasty has become the choice of treatment for valvular PS since the first series reported by Kan et al in 19824 and has almost replaced surgical valvotomy in pediatric patients. The purpose of this study was to investigate the immediate results of balloon valvuloplasty in patients with congenital valvular pulmonary stenosis. Method We analyzed hemodynamic data of 122 patients who underwent balloon pulmonary valvuloplasty (ages14days- 50 years mean 25 years). Single-balloon technique was used. Right ventricle systolic pressure and pulmonary valve Peak-to-peak systolic pressure gradient were recorded before and after balloon dilatation of pulmonary valve. Result Right ventricle systolic pressure decreased from 128±44.9 to 60±24.9 mmHg (p <0.001) and pulmonary valve peak-to-peak systolic pressure gradient decreased from 89±38.6 to 45 ± 22.4 mmHg (p <0.001). No major complication or mortality was noted. Conclusion Balloon pulmonary valvuloplasty is a safe and effective treatment for patients with congenital valvular PS. DOI: http://dx.doi.org/10.3126/njh.v9i1.8340 Nepalese Heart Journal Vol.9(1) 2012 pp.7-9ca
Predictors of poor cardiac recovery pattern after aortic declamping in consecutive cardiac surgery cases
Authors: Karmacharya RM , Xigang G , Jianjie G , Haichen W , Yang Y , Yongxin L
Published: July 2013

Background Poor Cardiac recovery following aortic declamping in cardiac surgery is associated with increased morbidity and mortality. This study aims to identify the predictors of poor cardiac recovery pattern after aortic declamping in consecutive cardiac surgery cases. Methods A prospective study was conducted from February 2011 to November 2011in elective cardiac surgical cases in First Affiliated Hospital of Medical College of Xi’an Jiaotong University. Single factor and subsequent logistic regression analysis was performed to identify the predictors of poor cardiac recovery pattern after aortic declamping. Results Of the 150 patients enrolled in the study, 38% had good cardiac recovery while 62% had poor cardiac recovery after aortic declamping. Of the studied variables, those associated with significant outcome (P value <0.05) in all the subgroups were NYHA (New York Heart Association) classification (1 or 2 vs. 3 or 4), Control group vs. blood cold cardioplegia, Route of cardioplegia, Age, Cardiopulmonary Bypass time groups, aortic clamping duration, ejection fraction and presence of pulmonary hypertension. From multivariate logistic regression analysis for predictors of cardiac recovery pattern, it was found that Age more than 40 years, NYHA category 3 or 4, ejection fraction less than 55%, aortic clamping time 60-120 minutes were significantly associated with poor cardiac recovery pattern. Cardiopulmonary bypass time however was not significantly associated as independent predictors of poor cardiac recovery pattern after aortic declamping. Conclusion Age more than 40 years, NYHA category 3 or 4, ejection fraction less than 55%, aortic clamping time 60-120 minutes are independent predictors of poor cardiac recovery pattern after aortic declamping. DOI: http://dx.doi.org/10.3126/njh.v9i1.8341 Nepalese Heart Journal Vol.9(1) 2012 pp.10-15
Pattern of Valvular Involvement and Demographic Features of Patients on Injection Benzathine Penicillin at Dhulikhel Hospital
Authors: Humagain S , Gurung R , Pant P , Koju R , Bedi TRS
Published: July 2013

Background Rheumatic heart disease (RHD) is the most common cardiovascular disease in children and young adults. Though declined and almost non-existent in developed nations, RHD is still one of the leading cause for premature death and disability in developing countries. Prevalence of RHD is high in both rural as well as urban area of Nepal. Present study is designed to look at the pattern of valvular involvement and demographic features in RHD. Methods 326 Patients indicated for inj. Benzathine penicillin were selected and echocardiograph performed to see the pattern of vavular involvement. Data analysis was done using SPSS 17. Result The most common type of lesion was mixed type with mitral valve involvement. MR was the most common isolated lesion. MS was more commonly seen in females whereas AS was more common in males. Secondary prophylaxis was more common than primary prophylaxis. Conclusion RHD still being a major problem and a preventable disease so extensive screening program is required to identify them early and prevent the complication. DOI: http://dx.doi.org/10.3126/njh.v9i1.8342 Nepalese Heart Journal Vol.9(1) 2012 pp.16-19
Efficacy of Enhanced External Counterpulsation (EECP) in Nepalese chronic stable Angina patient: a single centre prospective study at Shahid Gangalal National Heart Center (SGNHC)
Authors: Adhikari CM , Prajapati D , Thapa S , KC MB
Published: July 2013

Background Enhanced External Counterpulsation (EECP) is a novel; FDA approved; non-invasive; outpatient treatment offered to patients with refractory angina pectoris. It uses sequentially inflated pneumatic cuffs on the lower extremities to enhance coronary diastolic flow. We studied its effect in twenty one patients with refractory angina pectoris. Methods All patients (n=21) who were referred for Enhanced External Counterpulsation to Shahid Gangalal National Heart Center Enhanced External Counterpulsation Llb who completed a treatment course (one hour per day for 35 days) of EECP and underwent 6-minute walk test before and after treatment were included. Demographic data, coronary artery disease risk factors and baseline angiographic data were collected. Distance covered in six minute walk test before and after the treatment was compared. Results All the patients who had undergone Enhanced External Counterpulsation had a positive clinical response. Distance covered in six minute walk test improved in all patients after the treatment. Decrease in anginal severity, frequency and the use of sublingual nitrates, with improvement in quality of life was observed after the treatment. During the treatment some patients complained of leg pain, one patient developed blister and one ecchymosis but the treatment was not discontinued. Conclusion The results from this study suggest that Enhanced External Counterpulsation is an effective, safe and well tolerated treatment option for the patients with refractory angina pectoris. DOI: http://dx.doi.org/10.3126/njh.v9i1.8343 Nepalese Heart Journal Vol.9(1) 2012 pp.20-24
Study of the Side effects profile of different antihypertensive drugs among the Hypertensive patient
Authors: Shrestha RK , Khan GM , Thapa P , Koju R
Published: July 2013

Background Hypertension is the leading cause of morbidity and mortality worldwide. Because hypertension is usually asymptomatic yet requires long term therapy, consideration of potential of undesirable effects of drugs used for its treatment is important for making the appropriate choice. In this context, a precise understanding typical adverse reaction profile of the different drugs is essential. Objective This study was done to assess the side effects profile of different antihypertensive drugs (calcium channel blocker, beta blocker, ACE inhibitor) among the hypertensive patient. Methods A mixed retrospective & prospective cross sectional study of 61 patients was done at Medical Out Patient Department of Dhulikhel Hospital KUTH were included in the study. Result Dry cough was experienced by most of the patients (66.7%) and both dry cough and dizziness was reported by only one patient (6.7%) taking enalapril. In case of atenolol, bradycardia, dizziness and insomnia were experienced by same number of patients (14.3%) separately. Among amlodipine users, side effects experienced were peripheral edema (23%), flushing (2.6%), dyspnoea (2.6%), headache (5.1%), dizziness (2.6%), palpitation (2.6%) and insomnia (2.6%).Patients on enalapril had significantly more complaints regarding side effects (73.3%) compared to those taking amlodipine (41%) (OR=4, p=0.033) and atenolol (42.9%).There was no significant difference in the occurrence of side effects between enalapril- atenolol (p >0.05) and amlodipine- atenolol (p >0.05). Conclusion Although all three drugs were well tolerated, more side effects were seen in case of enalapril. Enalapril has 4 times higher rate of side effects than amlodipine. DOI: http://dx.doi.org/10.3126/njh.v9i1.8344 Nepalese Heart Journal Vol.9(1) 2012 pp.25-29
Prevalence of Sydenham’s chorea in patients with Acute Rheumatic fever in Nepal
Authors: Regmi PR , Shrestha A , Khanal HH , Nepal BP , Chapagain P
Published: July 2013

Background Sydenham’s Chorea (SC) is a major manifestation of acute rheumatic fever (ARF) and is the only evidence of ARF in approximately 20% of cases. There are no published reports on prevalence of SC in patients with ARF in Nepal. Objectives This retrospective study was done to find out the prevalence of SC in patients with ARF in Nepal. Methods Four years data of 672 patients with ARF from the RF/RHD registry of National RF/RHD prevention & control programme launched by Ministry of Health and Population & Nepal Heart Foundation in 32 hospitals throughout Nepal were analyzed. Results Prevalence of SC as a major manifestation of ARF in Nepalese patients was found to be 3.87%. Females were mostly affected with a female-to-male ratio of 3:1. Patients of age group 10-15 years were affected the most. SC was the third most common manifestation of ARF after Arthritis and Carditis. DOI: http://dx.doi.org/10.3126/njh.v9i1.8345 Nepalese Heart Journal Vol.9(1) 2012 pp.30-32
Hypertension among Young Adults in the Shopping Malls of Kathmandu
Authors: Shakya S , Timilsina M , Timilsina K , Lamsal M , Dhakal S , Neupane P
Published: July 2013

Background Hypertension is a major public health challenge in the world. Developing countries share the major burden of it. Unlike thought before, hypertension is increasing among poor, young and women. Methods It was a cross sectional study carried out in The Hypertension Screening and Awareness Program conducted in the shopping malls at the heart of Kathmandu on the occasion of World Hypertension Day 2012 by Shahid Gangalal National Heart Center, Kathmandu. The blood pressure was measured according to World Heart Organization’s guideline by registered nurses. There were total 486 participants with the mean age of 29.51±10.77years. Majority of the participants were male (67.1%). Most of the participants were less or equal to 40 years (84.6%). Mean systolic blood pressure was 112.3±14.69mmHg and mean diastolic blood pressure was 75.09±11.89 mmHg. Average mean blood pressure was 87.41±12.28mmHg in the study population. Results Despite majority of participants were at young age, prevalence of hypertension was 23.7%, pre-hypertension was 30% and 46.3% had ideal blood pressure according to JNC-7 Classification. Prevalence of hypertension was higher among male (30.39% vs. 10%). Almost two third of the hypertensive subjects were less or equal to 40 years (64.35%). Awareness, treatment and control of hypertension were 39.13%, 18.26% and 7.38% respectively. Conclusion In conclusion, Hypertension is an emerging public health challenge in urban areas of Nepal. Most importantly, it may be increasing among young population. Moreover, awareness, treatment and control rates are not satisfactory. DOI: http://dx.doi.org/10.3126/njh.v9i1.8346 Nepalese Heart Journal Vol.9(1) 2012 pp.33-36