Empagliflozin Use among Patients with Heart Failure in the Outpatient Department of Medicine in a Tertiary Care Centre.

Introduction: Sodium-glucose co-transporter 2 inhibitors were initially used in the treatment of type 2 diabetes mellitus and subsequently, it was shown to be useful in heart failure among patients with or without diabetes mellitus. This study aimed to find out the prevalence of empagliflozin use among patients with heart failure in an outpatient department of medicine in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients with heart failure attending the outpatient Department of Internal Medicine from 1 December 2022 to 30 May 2023 after obtaining ethical approval from the Institutional Review Committee. All patients with heart failure in the given study period were included. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Out of 550 patients, 188 (34.18%) (30.22-38.15, 95% Confidence Interval) received empagliflozin. The mean age was 55.11±9.99 years. A total of 124 (65.95%) were male. The mean duration of use was 104.97±63.16 days. Among the adverse effects, electrolyte imbalance was present in 14 (7.44%), hypotension in 14 (7.44%), and acute kidney injury in 12 (6.38%). Conclusions: The prevalence of empagliflozin use among patients with heart failure was found to be lower than mentioned in the guidelines. Keywords: heart failure; outpatient care; patient safety; SGLT-2 inhibitors.

Iron Profile and Status of Anemia with the Associated Factors in Chronic Kidney Disease Patients.

BACKGROUND: One of the main complications of chronic kidney disease is anemia. Disorders of iron homeostasis seen in such patients make the management of anemia more challenging and risky. To obtain the desired result, erythropoietin and iron dose must be carefully regulated. The aim of the study is to find out the prevalence of anemia and level iron indices in patients of chronic kidney disease at a tertiary care hospital. METHODS: A cross-sectional descriptive study was conducted on chronic kidney disease patients at a tertiary care center. Demographic data like age, sex, height and weight were collected with the help of using Performa. The hematological and biochemical study variables were assayed by blood sample of the patients in the clinical laboratory services. Data were analyzed by statistical package for the social sciences Version 20.0 Results: Out of 171 patients with chronic kidney disease, 162 (94.7%) were anemic, with the highest percentage 54 (31.5%) having hypertension. The median value with inter-quartile range of hemoglobin, serum iron, serum ferritin, TIBC and transferring saturation were 8.9 gm/dl (6.7-10.0), 115.0 (µg/dl) (60.0-140.0), 599.0 ng/ml (142.6-973.0), 279.0 µg/dl (250.0-342.0) and 41.0 % (22.0-53.0) respectively. Serum creatinine and eGFR were significantly correlated with hemoglobin and iron indices. CONCLUSIONS: The current study showed that anemia was more prevalent in patients of chronic kidney disease in our setting as compared to similar studies. Hypertension was the most common disease among them. The median value of parameters of iron profile except ferritin among them was within the reference limit.

Subclinical Hypothyroidism among Chronic Kidney Disease Patients Admitted to Nephrology Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Chronic kidney disease is a condition, which worsens the quality of life in many ways including thyroid disorder in many cases. The aim of the study was to find out the prevalence of subclinical hypothyroidism among chronic kidney disease patients admitted to the Nephrology Department of a tertiary care centre. Methods: A descriptive cross-sectional study was carried out on the patients diagnosed with chronic kidney disease at a tertiary care hospital from 15 May 2022 to 10 October 2022 after getting ethical approval from the Institutional Review Committee (Reference number: 621/2022). Pre-designed proforma was used to collect demographic data like age, sex, height and weight. Blood samples of the patients were analysed for thyroid function tests (triiodothyronine, thyroxine and thyroid stimulating hormone levels) by chemiluminescence immunoassay. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of 156 study participants with chronic kidney disease, subclinical hypothyroidism was present in 34 (21.79%) (15.31-28.27, 95% Confidence Interval) patients. Conclusions: The prevalence of subclinical hypothyroidism amongst chronic kidney disease patients was found to be lower than in other similar studies conducted in similar settings. Keywords: chronic kidney disease; thyroid stimulating hormone; thyroxine; triiodothyronine.

Cell-mediated immune response to epitopic MAP (multiple antigen peptide) construct of LcrV antigen of Yersinia pestis in murine model.

Yersinia pestis is the causative agent of plague. Cellular immunity seems to play an important role in defense against this disease. The subunit vaccine based on V (Lcr V) antigen has been proved to be immunogenic in animals and in humans. The multiple antigen peptide (MAP), incorporating all the relevant B and T cell epitopes is highly immunogenic in mice through intranasal route of immunization in PLGA particles containing CpG-ODN as an immunoadjuvant inducing humoral and mucosal immune response. In the present study, cell-mediated immune response using same MAP was studied in murine model. Primary and memory T cell responses were studied in outbred and inbred mice immunized intranasally with MAP in the presence of two immunoadjuvants (Murabutide and CpG-ODN). All the three compartments (Spleen, Lamina propria and Peyer's patches) of the lymphoid system showed increased lymphoproliferative response. Highest lymphoproliferative response was observed especially with CpG-ODN. Cytokine profile in the culture supernatant showed highest Th(1) and Th(17) levels. FACS analysis showed expansion of both CD4(+) and CD8(+) T cells producing gamma-interferon, perforin and granzyme-B with major contribution from CD4(+) T cells.

Seropositivity among Blood Samples Drawn from Suspected Dengue Cases at a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: The cases of dengue fever have been reported more frequently in Nepal these days. The aim of this study was to find the prevalence of seropositivity among blood samples drawn from suspected dengue cases at a tertiary care centre of Nepal. METHODS: A descriptive cross-sectional study was conducted at a tertiary care hospital from 1st June 2017 to 31st October 2018 after getting approval from the Institutional Review Committee (Reference number: 23/2016). A total of 537 suspected dengue patients were selected for the study using convenience sampling. These dengue positive sera were assayed for their reactivity with Immunoglobulin M and Immunoglobulin G present in sera and synthetic peptides of dengue virus by enzyme linked immunosorbent assay. Data was entered and analysed in Microsoft Excel 2016. Point estimate at 95% Confidence Interval was calculated along with frequency, percentage, mean and standard deviation. RESULTS: Among 537 suspected dengue cases, the seropositivity for dengue was found in 124 (23.09%) (19.52-26.65 at 95% Confidence Interval) of the serum. CONCLUSIONS: The present study revealed that dengue was more prevalent in our setting compared to similar studies. All the synthetic peptides showed reactivity with dengue-positive sera with maximum reactivity shown by RR2 peptide. In dengue-positive sera, RR2 peptide of dengue virus identified more Immunoglobulin M than Immunoglobulin G.

Diarrhoea among Children Under Five Years of Age Residing in a Village Development Committee: A Descriptive Cross-sectional Study.

Introduction: Diarrhoea is an important cause of morbidity and mortality among young children. It is reported that a large number of under five-year children still die of diarrhoea in Nepal. Nepal is striving for reducing childhood mortality by two thirds. The aim of this study is to find out the prevalence of diarrhoea among children under five years of age in a village development committee. Methods: This was a descriptive cross-sectional study performed among 356 children below 5 years of age residing in the Village Development Committee between January, 2018 and December, 2018 after getting ethical approval from the Institutional Review Committee (Reference number: 209/2017). A semi-structured questionnaire was used to collect the demographic data and other pertinent information. Convenience sampling was done. The data were entered into Microsoft Excel version 16.0 and analyzed using the Statistical Package for the Social Sciences version 23.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data and mean with standard deviation for continuous data. Results: Out of 356 children less than five years of age, diarrhoea was prevalent in 156 (43.82%) (38.67-48.97 at 95% Confidence Interval). Eighty-six (55.12%) were males and 70 (44.87%) were females. Conclusions: The prevalence of diarrhoea in our study was higher when compared to similar studies conducted in similar settings. Keywords: children; hygiene; prevalence; sanitation; water.

Scenario of Sepsis in Intensive Care Unit in a Tertiary Care Hospital.

BACKGROUND: Sepsis has been defined as life-threatening organ dysfunction caused by dysregulated host response to infection. Sepsis is an important cause of mortality in intensive care unit worldwide. The study aims to identify the outcome of sepsis patient admitted at tertiary care hospital. METHODS: This is a descriptive cross-sectional hospital based study on 76 adult patients admitted at intensive care unit of Nobel Medical College with diagnosis of sepsis with an objective of estimating mortality of sepsis and identifying associated symptoms with it. Baseline demographics, clinical and laboratory data were collected and analyzed. RESULTS: Out of 76 patients with sepsis, mean age of the patients was 50.07±18.15 years. Majority of patients 31.6% with sepsis were above age groups >60 years. The most common symptoms among the patients were fever, which was seen in 69 (90.8%) patients. The most common source of infection in those patients was found to be unknown, which was seen in 36.8% of patients. While analyzing the outcome, it was noted that 25 patients with sepsis (32.9%) died during treatment. CONCLUSIONS: Sepsis is related with high mortality. Elderly patients are at more risk. Fever is the commonest presentation and source is not identified in majority of cases.

Selected Risk Factors and Pattern of Semen Abnormality in Male Partners of Infertile Couples in Eastern Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Semen analysis is an initial basic step in evaluating and diagnosing male infertility. Multiple risks factors in combination or alone are responsible for abnormal semen parameters. The present study aimed to study certain risk factors and semen parameters of infertile male. METHODS: It was a descriptive cross-sectional study. We consecutively enrolled 186 male partners of infertile couple who underwent certain risk factors evaluation and semen analysis according to WHO guideline. RESULTS: Multiple risk factors were present like Gulf country migration, smoking, chemical exposure and heat exposure in infertile male partners. Forty six percent of our patients were gulf workers. Eleven percent patients had azoospermia, 27% had abnormal sperm morphology and 23% had <25% motile spermatozoa. CONCLUSIONS: Surprisingly 46% of our patients were Gulf country workers and abnormal semen analysis is very important factor for infertility. Large prospective studies need to be carried out involving Gulf migrant workers only.

Clinical Profile and Outcome of Adult Patients with Scrub Typhus in a Tertiary Care Centre of Eastern Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Scrub typhus is an under-diagnosed and undertreated zoonotic human infection. There are no data related to profile of adult patients in Nepal. We conducted this study to report socio-demographic, clinical profile and complications of scrub typhus in our scenario. METHODS: This was a descriptive cross-sectional study carried out in Nobel Medical College Teaching Hospital, eastern Nepal. The sample enrollment process was consecutively who were admitted under medical ward and intensive care unit. Diagnosis was established serologically with positive test of IgM antibodies against scrub typhus using immuno-chromatography. Operational definitions for organ system dysfunction were based upon simple available clinic laboratory profiles and imaging. Collected data were entered in Microsoft Excel 2007 and converted it into Statistical Package for Social Science 11.5 Version for statistical analysis. RESULTS: A total of 47 patients were analyzed during this study. Diagnosis of scrub typhus was more common 17 (36.17%) in age group of (40-60 years) with female predominance 32 (68.08%). Most patients (70.15%) were of above 40 years. Fever 47 (100%), asthenia 40 (85.10%), generalized body-ache 41 (87.23%), anorexia 46 (97.87%) and headache 39 (82.97%) were present in most of our patients at sometime during their illness. Respiratory dysfunction was the commonest 37 (78.72%) system dysfunction followed by renal 30 (63.82%) and hepatic 20 (42.55%) impairment. Fortunately no deaths occurred. CONCLUSIONS: Scrub typhus occurred more commonly in elderly female patients. Early empirical treatment may prevent mortality. Large studies involving whole country is needed to see real scenario of disease in this setting.

Clinical Profile and Outcome of Adult Patients with Scrub Typhus in a Tertiary Care Centre of Eastern Nepal.

INTRODUCTION: Scrub typhus is an under-diagnosed and undertreated zoonotic human infection. There are no data related to profile of adult patients in Nepal. We conducted this study to report socio-demographic, clinical profile and complications of scrub typhus in our scenario. METHODS: This was a descriptive cross-sectional study carried out in Nobel Medical College Teaching Hospital, eastern Nepal. The sample enrollment process was consecutively who were admitted under medical ward and intensive care unit. Diagnosis was established serologically with positive test of IgM antibodies against scrub typhus using immuno-chromatography. Operational definitions for organ system dysfunction were based upon simple available clinic laboratory profiles and imaging. Collected data were entered in Microsoft Excel 2007 and converted it into Statistical Package for Social Science 11.5 Version for statistical analysis. RESULTS: A total of 47 patients were analyzed during this study. Diagnosis of scrub typhus was more common 17 (36.17%) in age group of (40-60 years) with female predominance 32 (68.08%). Most patients (70.15%) were of above 40 years. Fever 47 (100%), asthenia 40 (85.10%), generalized body-ache 41 (87.23%), anorexia 46 (97.87%) and headache 39 (82.97%) were present in most of our patients at sometime during their illness. Respiratory dysfunction was the commonest 37 (78.72%) system dysfunction followed by renal 30 (63.82%) and hepatic 20 (42.55%) impairment. Fortunately no deaths occurred. CONCLUSIONS: Scrub typhus occurred more commonly in elderly female patients. Early empirical treatment may prevent mortality. Large studies involving whole country is needed to see real scenario of disease in this setting.

Prevalence of Dyslipidemia in Patients with Acute Coronary Syndrome Admitted at Tertiary Care Hospital in Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Dyslipidemia is one of the major risk factors for acute coronary syndrome. Dyslipidemia with an increase in total cholesterol, low-density lipoprotein cholesterol, triglycerides and decrease in high-density lipoprotein cholesterol is one of the major risk factors for the acute coronary syndrome and alone account for more than 50% of population attributable risk. This study was conducted to find out the prevalence of dyslipidemia. METHODS: This descriptive cross-sectional study was conducted in 105 patients admitted at the tertiary care center with a diagnosis of acute coronary syndrome from July 2018 to March 2019 after approval from the institutional review committee (Ref no. 205/2018). Fasting serum lipid profile was obtained within 24 hours of hospitalization with the convenient sampling method. Data were analyzed with the help of the Statistical Package for Social Sciences version 20. Point estimation at 95% Confidence interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 105 people, dyslipidemia was present in 51 (48.6%). The mean age of the participants was 59.19±12.69 years. The majority 81 (77.1%) were male. The mean total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were 183.43±35.9 mg/dl, 140.59±46.83 mg/dl, 109.9±26.38 mg/dl and 41.17±4.78 mg/dl respectively. High total cholesterol and triglyceride were found in 34 (32.4%) each, low high-density lipoprotein in 31 (29.5%) and high low-density lipoprotein in 22 (21%). CONCLUSIONS: Dyslipidemia is a significant risk factor in patients with acute coronary syndrome and commonly associated with other risk factors. Careful attention to its management may help to reduce further events.

Study of Acid-Base Disorders and Biochemical Findings of Patients in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Acid base disorder is a condition characterized by alteration in blood pH by the imbalance between the components of blood leading to a life threatening situation. The main aim of this study was to find the prevalence of acid-base disorders and biochemical findings of such disorders in patients in a tertairy care hospital. METHODS: This descriptive cross-sectional study was conducted in Nobel Medical College Teaching Hospital from 1st September, 2018 to 31st August, 2019. Ethical apporoval was taken from Institutional Review Committee. All the patients presented to emergency department, intensive care units and wards were included during the study period. Data were entered and calculations were done in Microsoft Excel, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of arterial blood gas analysis of 1144 patients, the prevalence of acid base disorders was 718 (62.76%) at 95% Confidence Interval (59.96-65.56%). Simple and mixed acid base disorders were observed in 332 (46.24%) and 386 (53.76%) patients respectively. Respiratory alkalosis was most common among 134 (40.36%) cases in simple acid base disorder whereas metabolic acidosis and respiratory alkalosis was most common among 204 (52.85%) in mixed acid base disorder. All types of disorders were observed more in elderly people (41-60 and >60 age group) than other age groups. CONCLUSIONS: Acid base disorder was found to be more common in very ill patients in emergency and intensive care units. Mixed acid base disorder was the most common with male and elderly patients in predominance.