Knowledge, Attitude and Practice on Hypertension Among Antihypertensive Medication Users.

INTRODUCTION: Hypertension is growing among the population of Nepal. We aimed to determine the current knowledge, attitude and practice of hypertension among hypertensive patients taking antihypertensive medication in the community of Central Nepal. METHODS: A cross-sectional study was conducted among the hypertensive patients in Bharatpur, Chitwan, Nepal from July 2015 to September 2015 using clustered sampling technique. Suitably designed and validated questionnaire of knowledge, attitude and practice on hypertension consisting of 27 questions were used to determine the KAP scores. The difference in the median KAP scores between sex, level of education and duration of hypertension were assessed using Mann-Whitney U test. RESULTS: A total of 200 patients met the inclusion criteria and majority of them were male (60%), had received primary education (36%) and had hypertension for ≥5 years (46.5%). The blood pressure ranged from 100-180/60-110 mmHg. The median K, A and P scores were 8 (6), 5 (1) and 6 (3) respectively. K and A were statistically associated with sex both at p<0.001 and level of education (K at p<0.001 and A at p=0.016). CONCLUSIONS: The current knowledge, attitude and practice among hypertensive patients using antihypertensive medication can be improved.

Efficacy of Combined Antithrombotic, Statins and Anti-Hypertensive Drugs in Acute Ischemic Stroke.

INTRODUCTION: Anti-thrombotic, statins and antihypertensive drugs are commonly used for the management of acute ischemic stroke in Nepal but there is no evidence regarding their efficacy in our context. This study aims to explore the efficacy of these combined medications (anti-thrombotic, statins and antihypertensive drugs) in acute ischemic stroke patients for the first time and to assess the risk factors present in those patients. METHODS: The study was conducted on 37 acute ischemic stroke patients admitted and treated at the Neurology Department of College of Medical Sciences-Teaching Hospital, Chitwan, Nepal and they were followed at three months (90±10 days). The initial stroke severity and functional disability were evaluated at admission and at 3 months using National Institute of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) respectively. The outcome parameters were functional independence (mRS≤2) and mortality at three months (mRS=6). Frequency distribution, Mann-Whitney U-test and χ2 test were performed for statistical analysis. RESULTS: Out of 37 patients, 27 (73%) were Smoker, 22 (59.5%) had hypertension and 19 (51.4%) were alcohol consumer. The stroke severity on admission was statistically significant with functional independence (P=0.003) and mortality (P=0.015) at three month. Similarly, Rankin grade on admission was statistically significant with functional independence (P=0.001) and mortality (P=0.048) at three month. At three months, 20 (69%) survived patients were independent while mortality was seen in eight (21.6%) patients. CONCLUSIONS: The management of acute ischemic stroke with combined anti-thrombotic, statins and antihypertensive drugs seems promising and efficacious in mild to moderately severe ischemic stroke.

Face-to-face Training as an Effective Approach for Teaching Rotahaler Technique in Newly Diagnosed Patients of Asthma and COPD.

INTRODUCTION: This study aimed to evaluate the effectiveness of face-to-face training for teaching rotahaler technique in newly diagnosed patients of asthma and chronic obstructive pulmonary disease (COPD). METHODS: A hospital-based study was conducted among twenty patients who were prescribed rotahaler for the first time. Patients received face-to-face training on rotahaler technique from pharmacist using GINA guidelines. The patients rotahaler technique was assessed after two weeks of training and scored one for correct and zero for incorrect steps. Descriptive statistics were performed. RESULTS: The mean age of the study population was 48.85±20.49 years. Eleven (55%) patients were females. Thirteen (65%) patient were not formally educated in school. Fourteen patients (70%) were able to perform all the steps correctly giving overall median score of eight (7-8). CONCLUSIONS: Face-to-face training seems to be effective approach for teaching rotahaler technique in asthma and COPD patients.

Status of Vitamin D and its Association with Stroke Risk Factors in Patients with Acute Ischemic Stroke in a Tertiary Care Hospital.

INTRODUCTION: Vitamin D deficiency has been associated with many neurological illnesses. The status of Vitamin D in Nepalese ischemic stroke patients is still unknown. This study aims to assess the status of vitamin D and its association with stroke risk factors in patients with acute ischemic stroke from Central Nepal. METHODS: A total of 60 patients with ischemic stroke were included in the study. Their clinical profile and Vitamin D status were assessed. Frequency distribution, Pearson χ2test and Kruskal-Wallis test were performed for statistical analysis using SPSS-IBM 20. RESULTS: The median (IQR) age of the patient was 65 (53.25, 70.75) years, ranging from 18-87 years. Thirty-four (56.7%) were males. Fourty-eight (80%) patients had hypertension and 34 (56.7%) were smoker. Previous stroke was present in six (10%) cases. Thirty-seven (61.6%) patients had low levels of Vitamin D out of which 26 (43.3%) had vitamin D insufficiency and 11 (18.3%) had vitamin D deficiency. Vitamin D level was significantly associated with previous history of stroke (P=0.043). CONCLUSIONS: Vitamin D deficiency occurs in patients with ischemic stroke. Previous episodes of stroke with low vitamin D levels could be a cause of recurrent strokes. Further studies are necessary to establish the role of vitamin D in acute ischemic stroke in Nepalese population.