1
|
Shrestha NR, Cook S, Goy JJ. Chest Pain and Hemodynamic Instability in a Young Woman. JACC Case Rep 2021; 3:1367-1369. [PMID: 34505072 PMCID: PMC8414420 DOI: 10.1016/j.jaccas.2021.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/07/2021] [Accepted: 05/14/2021] [Indexed: 12/02/2022]
Abstract
We report the case of an 18-year-old female admitted to the hospital for severe hemodynamic instability and fatal outcome within 6 hours following admission. Significant electrocardiographic modifications were noted and are presented with diagnostic options. (Level of Difficulty: Intermediate.)
Collapse
Affiliation(s)
- Nikesh Raj Shrestha
- Department of Cardiology, Neuro Cardio, and Multispeciality Hospital, Biratnagar, Nepal
| | - Stéphane Cook
- Cardiology Department, Clinique Cecil, Lausanne, Switzerland
| | - Jean-Jacques Goy
- Cardiology Department, Clinique Cecil, Lausanne, Switzerland
- Address for correspondence: Prof. Jean-Jacques Goy, Clinique Cecil, Av. Ruchonnet 53, 1003 Lausanne, Switzerland.
| |
Collapse
|
2
|
Shrestha NR, Bruelisauer D, Uranw S, Mahato R, Sherpa K, Agrawal K, Rothenbühler M, Karki P, Pilgrim T. Mid-term outcome of children with latent rheumatic heart disease in eastern Nepal. Open Heart 2021; 8:openhrt-2021-001605. [PMID: 33820851 PMCID: PMC8030462 DOI: 10.1136/openhrt-2021-001605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/19/2021] [Accepted: 03/18/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Systematic echocardiographic screening of children in regions with an endemic pattern of rheumatic heart disease allows for the early detection of valvular lesions suggestive of subclinical rheumatic heart disease. The natural course of latent rheumatic heart disease is, however, incompletely understood at this time. Methods We performed a prospective cohort study of children detected to have echocardiographic evidence of definite or borderline rheumatic heart disease according to the World Heart Federation Criteria. Results Among 53 children found to have definite (36) or borderline (17) rheumatic heart disease, 44 (83%) children underwent follow-up at a median of 1.9 years (IQR 1.1–4.5). The median age of the children was 11 years (IQR 9–14) and 34 (64.2%) were girls. Among children with definite rheumatic heart disease, 21 (58.3%) were adherent to secondary antibiotic prophylaxis, 7 (19.4%) were not, information on adherence was missing in 2 (5.6%) children and 6 (16.7%) were lost to follow-up. Regression of disease was observed in 10 children (27.8%), whereas 20 children (55.6%) had stable disease. Among children adherent to secondary prophylaxis, seven (33.3%) showed regression of disease. Among children with borderline disease, seven (41.2%) showed regression of disease, three (17.6%) progression of disease, four (23.5%) remained stable and three (17.6%) were lost to follow-up. On univariate analysis, we identified no predictors of disease regression, and no predictors for lost to follow-up or non-adherence with secondary antibiotic prophylaxis. Conclusion Definite rheumatic heart disease showed regression in one in four children. Borderline disease was spontaneously reversible in less than half of the children and progressed to definite rheumatic heart disease in one in five children. Trial registration number NCT01550068.
Collapse
Affiliation(s)
- Nikesh Raj Shrestha
- Department of Cardiology, Neuro Cardio and Multispeciality Hospital, Biratnagar, Nepal
| | | | - Surendra Uranw
- Department of Internal Medicine and Cardiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Rajan Mahato
- Department of Internal Medicine and Cardiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Kunjang Sherpa
- Department of Internal Medicine and Cardiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Krishna Agrawal
- Department of Internal Medicine and Cardiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Prahlad Karki
- Department of Internal Medicine and Cardiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Thomas Pilgrim
- Department of Cardiology, University of Bern, Bern, Switzerland
| |
Collapse
|
3
|
Karki P, Uranw S, Bastola S, Mahato R, Shrestha NR, Sherpa K, Dhungana S, Odutayo A, Gurung K, Pandey N, Agrawal K, Shah P, Rothenbühler M, Jüni P, Pilgrim T. Effectiveness of Systematic Echocardiographic Screening for Rheumatic Heart Disease in Nepalese Schoolchildren: A Cluster Randomized Clinical Trial. JAMA Cardiol 2021; 6:420-426. [PMID: 33471029 PMCID: PMC7818193 DOI: 10.1001/jamacardio.2020.7050] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Question Is echocardiographic screening of schoolchildren in regions with an endemic pattern of rheumatic heart disease followed by secondary antibiotic prophylaxis in children with evidence of subclinical rheumatic heart disease effective in reducing the prevalence of rheumatic heart disease? Findings This cluster randomized clinical trial found a nonstatistically significant lower prevalence of definite or borderline rheumatic heart disease in schools with echocardiographic screening 4 years after intervention compared with control schools with no previous screening. An auxiliary repeated cross-sectional analysis of experimental schools found a significant reduction in the odds of definite or borderline rheumatic heart disease. Meaning A lower prevalence of rheumatic heart disease in schools with prior echocardiographic screening warrants further study of the effectiveness of early detection and timely treatment of rheumatic heart disease in children and adolescents. Importance Echocardiographic screening allows for early detection of subclinical stages of rheumatic heart disease among children in endemic regions. Objective To investigate the effectiveness of systematic echocardiographic screening in combination with secondary antibiotic prophylaxis on the prevalence of rheumatic heart disease. Design, Setting, and Participants This cluster randomized clinical trial included students 9 to 16 years of age attending public and private schools in urban and rural areas of the Sunsari district in Nepal that had been randomly selected on November 17, 2012. Echocardiographic follow-up was performed between January 7, 2016, and January 3, 2019. Interventions In the experimental group, children underwent systematic echocardiographic screening followed by secondary antibiotic prophylaxis in case they had echocardiographic evidence of latent rheumatic heart disease. In the control group, children underwent no echocardiographic screening. Main Outcomes and Measures Prevalence of the composite of definite or borderline rheumatic heart disease according to the World Heart Federation criteria in experimental and control schools as assessed 4 years after intervention. Results A total of 35 schools were randomized to the experimental group (n = 19) or the control group (n = 16). After a median of 4.3 years (interquartile range [IQR], 4.0-4.5 years), 17 of 19 schools in the experimental group (2648 children; median age at follow-up, 12.1 years; IQR, 10.3-12.5 years; 1308 [49.4%] male) and 15 of 16 schools in the control group (1325 children; median age at follow-up, 10.6 years; IQR, 10.0-12.5 years; 682 [51.5%] male) underwent echocardiographic follow-up. The prevalence of definite or borderline rheumatic heart disease was 10.8 per 1000 children (95% CI, 4.7-24.7) in the control group and 3.8 per 1000 children (95% CI, 1.5-9.8) in the experimental group (odds ratio, 0.34; 95% CI, 0.11-1.07; P = .06). The prevalence in the experimental group at baseline had been 12.9 per 1000 children (95% CI, 9.2-18.1). In the experimental group, the odds ratio of definite or borderline rheumatic heart disease at follow-up vs baseline was 0.29 (95% CI, 0.13-0.65; P = .008). Conclusions and Relevance School-based echocardiographic screening in combination with secondary antibiotic prophylaxis in children with evidence of latent rheumatic heart disease may be an effective strategy to reduce the prevalence of definite or borderline rheumatic heart disease in endemic regions. Trial Registration ClinicalTrials.gov Identifier: NCT01550068
Collapse
Affiliation(s)
- Prahlad Karki
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Surendra Uranw
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Santosh Bastola
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Rajan Mahato
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Nikesh Raj Shrestha
- Department of Cardiology, Neuro Cardio and Multispeciality Hospital, Biratnagar, Nepal
| | - Kunjang Sherpa
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sahadeb Dhungana
- Noble Medical College Teaching Hospital and Research Center, Biratnagar, Nepal
| | - Ayodele Odutayo
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Keshar Gurung
- Department of Cardiology, Neuro Cardio and Multispeciality Hospital, Biratnagar, Nepal
| | - Naveen Pandey
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Krishna Agrawal
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Prashant Shah
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| |
Collapse
|
4
|
Karki P, Agrawaal KK, Lamsal M, Shrestha NR. Predicting outcomes in acute coronary syndrome using biochemical markers. Indian Heart J 2015; 67:529-37. [PMID: 26702680 PMCID: PMC4699971 DOI: 10.1016/j.ihj.2015.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/29/2015] [Accepted: 06/29/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To assess risk prediction in patients with acute coronary syndrome (ACS) during the hospital stay, at 6 weeks and at 6 months period using high sensitivity C-reactive protein (hs-CRP), serum creatinine, cardiac troponin I, creatine kinase total, and MB levels. METHODS It was a prospective observational study. The primary outcome was taken as all-cause mortality. Patients with ACS were enrolled and followed up at 6 weeks and 6 months duration from the index event. Mortality and cause of death were recorded. The hs-CRP was estimated on admission, at 6 weeks, and at 6 months. The estimated glomerular filtration rate (eGFR) was calculated using the abbreviated modification of diet in renal disease (MDRD) formula at admission, at 6 weeks, and 6 months. RESULTS There were a total of 108 cases of ACS in the duration of 6 months who completed the follow-up. The hs-CRP level of >5mg/dl was highly significant for predicting mortality during hospital stay and at 6 weeks (p<0.001). There was 11% of in-hospital mortality (p<0.001). At 6 months, the overall mortality was 28% (p<0.001). There was a statistical significance with low eGFR (median eGFR 45ml/min/1.73m(2)) levels during the admission. CONCLUSION hs-CRP levels above 5mg/dl and the eGFR levels ≤30ml/min/1.73m(2) were significant in predicting mortality of the patients with ACS. This may provide simple assessment tools for predicting outcome in ACS in resource-poor settings if validated further.
Collapse
Affiliation(s)
- P Karki
- Prof & Head, Department of Internal Medicine & Chair, Cardiology Division, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | - K K Agrawaal
- Senior Resident, Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - M Lamsal
- Professor, Department of Biochemistry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - N R Shrestha
- Associate Professor, Department of Internal Medicine & Cardiology Division, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| |
Collapse
|
5
|
Chhetri S, Shrestha NR, Pilgrim T. Pregnancy complicated by heart disease in Nepal. Heart Asia 2014; 6:26-9. [PMID: 27326158 DOI: 10.1136/heartasia-2013-010396] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 10/23/2013] [Accepted: 01/24/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the prevalence, characteristics and maternal and perinatal outcomes of pregnancies complicated by heart disease. DESIGN Prospective single-centre registry. SETTING Tertiary care teaching hospital in eastern Nepal. PATIENTS Pregnant women presenting to the antenatal clinic and/or labour room between 1 March 2012 and 31 March 2013. MAIN OUTCOME MEASURES Prevalence, characteristics, and maternal and perinatal outcomes of pregnancies complicated by heart disease. RESULTS Fifty-three out of 9463 pregnancies (0.6%) were complicated by cardiac disease. Proportions of acquired, congenital and arrhythmic heart disease amounted to 89%, 9% and 2%, respectively. Rheumatic heart disease (RHD) was the most frequent cardiac disease complicating pregnancy (n=47). Among 45 women with RHD continuing pregnancy until delivery, 30 (67%) were primigravidae. The predominant valvular pathology was mitral stenosis (62%), followed by mitral regurgitation (21%) and aortic regurgitation (13%). Twenty women (44%) underwent elective or emergency caesarean section. Maternal and fetal/perinatal mortality of pregnancies complicated by RHD amounted to 4% and 16%, respectively. New York Heart Association (NYHA) functional class III or class IV (HR 6.0, 95% CI 1.2 to 29.1, p=0.026), pulmonary hypertension (HR 9.1, 95% CI 1.6 to 51.5, p=0.012) and severe mitral stenosis (HR 7.0, 95% CI 1.4 to 34.4, p=0.017) were identified as predictors of maternal or fetal/perinatal mortality in an univariate analysis. CONCLUSIONS Rheumatic mitral stenosis was the most frequent heart disease complicating pregnancy in a consecutive cohort from a teaching hospital in Nepal. Exercise intolerance, pulmonary hypertension and severe mitral stenosis were identified as predictors of maternal or fetal/perinatal mortality.
Collapse
Affiliation(s)
- Shailaja Chhetri
- Department of Obstetrics & Gynecology , BP Koirala Institute of Health , Dharan , Nepal
| | | | - Thomas Pilgrim
- Department of Cardiology , Bern University Hospital , Bern , Switzerland
| |
Collapse
|
6
|
Shrestha NR, Karki S, Mainali U. An unusual culprit: simple angioplasty for a complex disease. J Invasive Cardiol 2013; 25:687-689. [PMID: 24296392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We present the case of an atypical presentation of myelofibrosis presenting with acute inferior-wall ST-elevation myocardial infarction. Besides cigarette smoking, the patient had no known traditional cardiovascular risk factors like diabetes, hypertension, or a sedentary lifestyle. He, however, had a hypercoagulable state due to a myeloproliferative neoplasm. This demonstrates that the typical presentation of a common emergency condition may involve more complex underlying illness, which when identified, may change the approach to the management of the patient for a more optimal outcome.
Collapse
|
7
|
Shrestha NR, Pilgrim T, Karki P, Bhandari R, Basnet S, Tiwari S, Dhakal SS, Urban P. Rheumatic heart disease revisited. J Cardiovasc Med (Hagerstown) 2012; 13:755-9. [DOI: 10.2459/jcm.0b013e32835854b6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
8
|
Pilgrim T, Kalesan B, Karki P, Basnet A, Meier B, Urban P, Shrestha NR. Protocol for a population-based study of rheumatic heart disease prevalence and cardiovascular outcomes among schoolchildren in Nepal. BMJ Open 2012; 2:bmjopen-2012-001320. [PMID: 22685225 PMCID: PMC3371575 DOI: 10.1136/bmjopen-2012-001320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Rheumatic heart disease (RHD) remains a major contributor to morbidity and mortality in developing countries. The reported prevalence rates of RHD are highly variable and mainly attributable to differences in the sensitivity of either clinical screening to detect advanced heart disease or echocardiographic evaluation where disease is diagnosed earlier across a continuous spectrum. The clinical significance of diagnosis of subclinical RHD by echocardiographic screening and early implementation of secondary prevention has not been clearly established. METHODS AND ANALYSIS The authors designed a cross-sectional survey to determine the prevalence of RHD in children from private and public schools between the age of 5 and 15 years in urban and rural areas of Eastern Nepal using both cardiac auscultation and echocardiographic evaluation. Children with RHD will be treated with secondary prevention and enrolled in a prospective cohort study. The authors will compare the prevalence rates by cardiac auscultation and echocardiography, determine risk factors associated with diagnosis and progression of RHD, investigate social and economic barriers for receiving adequate cardiac care and assess clinical outcomes with regular medical surveillance as a function of stage of disease at the time of diagnosis. Prospective clinical studies investigating the impact of secondary prevention for subclinical RHD on long-term clinical outcome will be of central relevance for future health resource utilisation in developing countries. ETHICS AND DISSEMINATION The study was considered ethically uncritical and was given an exempt status by the ethics committee at University of Bern, Switzerland. The study has been submitted to the National Nepal Health Research Council and was registered with http://www.ClinicalTrials.gov (NCT01550068). The study findings will be reported in peer-reviewed publications. CLINICALTRIALS.GOV IDENTIFIER: NCT01550068.
Collapse
Affiliation(s)
- Thomas Pilgrim
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
| | - Bindu Kalesan
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
- Clinical Trials Unit, Department of Social and Preventive Medicine, Bern University, Bern, Switzerland
| | - Prahlad Karki
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Anil Basnet
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Bernhard Meier
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
| | - Philip Urban
- Department of Cardiology, Hôpital de la Tour, Geneva, Switzerland
| | - Nikesh Raj Shrestha
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| |
Collapse
|
9
|
Shrestha NR, Kalesan B, Karki P, Sherpa K, Basnet A, Urban P, Pilgrim T. Rheumatic heart disease: pilot study for a population-based evaluation of prevalence and cardiovascular outcomes among schoolchildren in Nepal. BMJ Open 2012; 2:bmjopen-2012-001616. [PMID: 23087010 PMCID: PMC3488717 DOI: 10.1136/bmjopen-2012-001616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To evaluate a protocol for a population-based programme targeting the prevention of rheumatic heart disease (RHD) progression by early echocardiographic diagnosis of valvular lesions and timely implementation of secondary prevention. DESIGN Observational survey with a subsequent prospective cohort study. SETTING Private boarding school in the urban area of the Sunsari district situated on the foothills of the Lower Himalayan Range in Eastern Nepal. PARTICIPANTS Fifty-four unselected school-going children 5-15 years of age, 24 girls and 30 boys. PRIMARY OUTCOME MEASURE Logistic feasibility of a large-scale population-based screening study using the echocardiographic criteria formulated by the World Heart Federation, with longitudinal follow-up of children with definite or borderline RHD in a prospective cohort study. RESULTS Standardised interview, physical examination and screening echocardiography were performed in a three-staged process and took approximately 6 min per child. Socio-economic status was assessed using surrogate markers such as the occupation of the primary caregiver, numbers of rooms at home, car, television, cell phone and internet connection. Physical examination was focused on cardiac auscultation and signs of acute rheumatic fever and targeted echocardiography was performed by an independent examiner without knowledge of the clinical findings. Two children with evidence of borderline RHD were re-examined at B.P. Koirala Institute of Health Sciences and the indication for secondary antibiotic prevention was discussed with the parents and the children. At 6 months of follow-up, echocardiographic findings were stable in both children. Implementation of secondary antibiotic prevention was challenged by impaired awareness of subclinical RHD among parents and inadequate cooperation with family physicians. CONCLUSIONS This pilot study shows that the methods outlined in the protocol can be translated into a large-scale population-based study. We learned that education and collaboration with teachers, parents and family physicians/paediatricians will be of key importance in order to establish a sustainable programme.
Collapse
Affiliation(s)
- Nikesh Raj Shrestha
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Bindu Kalesan
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
- Clinical Trials Unit, Department of Social and Preventive Medicine, Bern University, Bern, Switzerland
| | - Prahlad Karki
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Kunjang Sherpa
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Anil Basnet
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Philip Urban
- Department of Cardiology, Hôpital de la Tour, Geneva, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
| |
Collapse
|
10
|
Khattab AA, Shrestha NR, Meier B. Double-vessel coronary stenting via 5 french diagnostic catheters. Catheter Cardiovasc Interv 2011; 80:630-3. [DOI: 10.1002/ccd.23189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 03/29/2011] [Indexed: 11/06/2022]
|
11
|
Sharma SK, Ghimire A, Radhakrishnan J, Thapa L, Shrestha NR, Paudel N, Gurung K, R M, Budathoki A, Baral N, Brodie D. Prevalence of hypertension, obesity, diabetes, and metabolic syndrome in Nepal. Int J Hypertens 2011; 2011:821971. [PMID: 21629873 PMCID: PMC3095978 DOI: 10.4061/2011/821971] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 02/24/2011] [Indexed: 01/24/2023] Open
Abstract
Background. This study was carried out to establish the prevalence of cardiovascular risks such as hypertension, obesity, and diabetes in Eastern Nepal. This study also establishes the prevalence of metabolic syndrome (MS) and its relationships to these cardiovascular risk factors and lifestyle. Methods. 14,425 subjects aged 20–100 (mean 41.4 ± 15.1) were screened with a physical examination and blood tests. Both the International Diabetic Federation (IDF) and National Cholesterol Education Programme's (NCEP) definitions for MS were used and compared. Results. 34% of the participants had hypertension, and 6.3% were diabetic. 28% were overweight, and 32% were obese. 22.5% of the participants had metabolic syndrome based on IDF criteria and 20.7% according to the NCEP definition. Prevalence was higher in the less educated, people working at home, and females. There was no significant correlation between the participants' lifestyle factors and the prevalence of MS. Conclusion. The high incidence of dyslipidemia and abdominal obesity could be the major contributors to MS in Nepal. Education also appears to be related to the prevalence of MS. This study confirms the need to initiate appropriate treatment options for a condition which is highly prevalent in Eastern Nepal.
Collapse
Affiliation(s)
- Sanjib Kumar Sharma
- Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan 76500, Nepal
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Shakya VC, Agrawal CS, Shrestha NR, Dhungel K, Adhikary S. Omphalocele with Dextrocardia - A Rare Association. JNMA J Nepal Med Assoc 2009. [DOI: 10.31729/jnma.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Omphalocele is frequently associated with many other congenital malformations. In cardiacanomalies, association of omphalocele with dextrocardia has been rarely noticed before. We presenthere a child with dextrocardia and omphalocele alongwith a brief review of the literature on this rareassociation.Key Words: congenital malformations, dextrocardia, omphalocele
Collapse
|
13
|
Shakya VC, Agrawal CS, Shrestha NR, Dhungel K, Adhikary S. Omphalocele with dextrotardia-A rare association. JNMA J Nepal Med Assoc 2009; 48:249-251. [PMID: 20795468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Omphalocele is frequently associated with many other congenital malformations. In cardiac anomalies, association of omphalocele with dextrocardia has been rarely noticed before. We present here a child with dextrocardia and omphalocele alongwith a brief review of the literature on this rare association.
Collapse
Affiliation(s)
- V C Shakya
- Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | | | | | | | | |
Collapse
|
14
|
Shrestha NR, Sharma SK, Karki P, Shrestha NK, Acharya P. Echocardiographic Evaluation of Diastolic Function in Asymptomatic Type 2 Diabetes. JNMA J Nepal Med Assoc 2009. [DOI: 10.31729/jnma.185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION:Diabetes mellitus is an established risk factor for congestive cardiac failure in which the diastolic function is impaired earlier than the systolic function and majority of these patients maybe asymptomatic without signs of overt heart failure.METHODS:A cross sectional hospital based study was done which included 100 asymptomatic patients with type 2 diabetes without evidence of coronary artery disease, congestive heart failure, thyroid or overt renal disease. LVDD was evaluated by Doppler echocardiography, which included the valsalva maneuver to unmask the pseudonormal pattern of left ventricular filling. The prevalence of LVDD and the associated risk factors were assessed.RESULTS:LVDD was found in 71 subjects (71%), of whom 60 had impaired relaxation and 11 had a pseudonormal pattern of ventricular filling. Systolic function was normal in all subjects, and there was no correlation between LVDD and indexes of metabolic control. It was also found that age > or =45 years was associated with an almost three times higher risk for the development of diastolic dysfunction in type 2 diabetes. Females were at a two times higher risk of developing diastolic dysfunction than when compared to men. Duration of diabetes > or = two years was associated with a two times higher risk for developing diastolic dysfunction.CONCLUSIONS:LVDD is much more common than previously reported in subjects with well-controlled type 2 diabetes who are free of clinically detectable heart disease. The high prevalence of this phenomenon in this high-risk population suggests that screening for LVDD in type 2 diabetes should include procedures such as the valsalva maneuver to unmask a pseudonormal pattern of ventricular filling.Keywords:diabetes mellitus, diastolic dysfunction, echocardiography, impaired relaxation, pseudonormal
Collapse
|
15
|
Acharya P, Adhikari RR, Bhattarai J, Shrestha NR, Sharma SK, Karki P. Delayed presentation of acute coronary syndrome: a challenge in its early management. JNMA J Nepal Med Assoc 2009; 48:1-4. [PMID: 19529049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION The time of presentation of acute coronary syndrome from the onset of chest pain determines the treatment modality and prognosis. Delayed presentation is associated with a poor outcome. In the present study, we tried to find out the causes of late presentation of ACS in a tertiary care center in the eastern part of Nepal. METHODS It was a cross-sectional descriptive study that included 100 consecutive patients with ACS presenting to our institute over a period of 8 months. They were studied for their demographic profile, delay in presentation, the management done at the local centers and their final diagnosis. RESULTS We found that patients living within Dharan City reached BPKIHS within 20 hours of the onset of chest pain while those from outside the city who came directly reached within 63 hours. Other patients reached their respective local centers (health posts, district hospitals and private clinics) within 39 hours. The commonest cause of delay was vehicular problem followed by unnecessary delay at the local centers. The work up for chest pain was inadequate in these centers. Late presentation to our institute significantly affected the optimal management. CONCLUSIONS We found that significant number of patients with ACS from eastern Nepal presented late in our tertiary care center. In order to improve ACS outcome in this region, we advise equipping the local centers with electrocardiogram machines, improvement in ambulance services and a greater emphasis on coronary artery disease awareness programs as well as initiating preventive measures.
Collapse
Affiliation(s)
- P Acharya
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | | | | | | | | | | |
Collapse
|
16
|
Shrestha NR, Sharma SK, Karki P, Shrestha NK, Acharya P. Echocardiographic evaluation of diastolic function in asymptomatic type 2 diabetes. JNMA J Nepal Med Assoc 2009; 48:20-23. [PMID: 19529053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Diabetes mellitus is an established risk factor for congestive cardiac failure in which the diastolic function is impaired earlier than the systolic function and majority of these patients maybe asymptomatic without signs of overt heart failure. METHODS A cross sectional hospital based study was done which included 100 asymptomatic patients with type 2 diabetes without evidence of coronary artery disease, congestive heart failure, thyroid or overt renal disease. LVDD was evaluated by Doppler echocardiography, which included the valsalva maneuver to unmask the pseudonormal pattern of left ventricular filling. The prevalence of LVDD and the associated risk factors were assessed. RESULTS LVDD was found in 71 subjects (71%), of whom 60 had impaired relaxation and 11 had a pseudonormal pattern of ventricular filling. Systolic function was normal in all subjects, and there was no correlation between LVDD and indexes of metabolic control. It was also found that age > or =45 years was associated with an almost three times higher risk for the development of diastolic dysfunction in type 2 diabetes. Females were at a two times higher risk of developing diastolic dysfunction than when compared to men. Duration of diabetes > or = two years was associated with a two times higher risk for developing diastolic dysfunction. CONCLUSIONS LVDD is much more common than previously reported in subjects with well-controlled type 2 diabetes who are free of clinically detectable heart disease. The high prevalence of this phenomenon in this high-risk population suggests that screening for LVDD in type 2 diabetes should include procedures such as the valsalva maneuver to unmask a pseudonormal pattern of ventricular filling.
Collapse
Affiliation(s)
- N R Shrestha
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan Nepal.
| | | | | | | | | |
Collapse
|
17
|
Acharya P, Adhikari RR, Bhattarai J, Shrestha NR. Delayed Presentation of Acute Coronary Syndrome: A Challenge in its Early Management. JNMA J Nepal Med Assoc 2009. [DOI: 10.31729/jnma.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION:The time of presentation of acute coronary syndrome from the onset of chest pain determines the treatment modality and prognosis. Delayed presentation is associated with a poor outcome. In the present study, we tried to find out the causes of late presentation of ACS in a tertiary care center in the eastern part of Nepal.METHODS:It was a cross-sectional descriptive study that included 100 consecutive patients with ACS presenting to our institute over a period of 8 months. They were studied for their demographic profile, delay in presentation, the management done at the local centers and their final diagnosis.RESULTS:We found that patients living within Dharan City reached BPKIHS within 20 hours of the onset of chest pain while those from outside the city who came directly reached within 63 hours. Other patients reached their respective local centers (health posts, district hospitals and private clinics) within 39 hours. The commonest cause of delay was vehicular problem followed by unnecessary delay at the local centers. The work up for chest pain was inadequate in these centers. Late presentation to our institute significantly affected the optimal management.CONCLUSIONS: We found that significant number of patients with ACS from eastern Nepal presented late in our tertiary care center. In order to improve ACS outcome in this region, we advise equipping the local centers with electrocardiogram machines, improvement in ambulance services and a greater emphasis on coronary artery disease awareness programs as well as initiating preventive measures.KEY WORDS:acute coronary syndrome, chest pain, delayed presentation, electrocardiogram
Collapse
|
18
|
Shrestha NR, Conway D, Bhattarai K. Population pressure and land resources in Nepal: a revisit, twenty years later. J Dev Areas 1999; 33:245-68. [PMID: 12295539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
|
19
|
Abstract
"In Nepal, the drama of human and environmental ills is increasingly being played out in the form of peasants' ecopolitical battles over common land access and control, such as in the Tarai frontier, a region bordering the Gangetic Plain of India. This is a complex battle, pitting peasants' day-to-day survival against environmental security on one front, and against the Nepalese State and its dominant class interests on the other. This article critically dissects this raging battle to gain a clear understanding of its complexities as well as its diverse roots."
Collapse
|
20
|
Shrestha NR, Patterson JG. Population and poverty in dependent states: Latin America considered. Antipode 1990; 22:121-155. [PMID: 12283794 DOI: 10.1111/j.1467-8330.1990.tb00203.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
"Malthusians maintain that rapid population growth aggravates poverty, while Marxists contend that social formations determine its nature and extent. Each perspective is incomplete, however, since it ignores the insights of the other. Latin American states, characterized by dependent capitalism formations and dominated by ruling elites, are generally incapable of solving the problems of population and poverty. Since population growth under dependent capitalism weakens labor's bargaining position against capital, reduced population growth is emphasized as a labor empowerment strategy the poor can implement on their own to improve their socioeconomic conditions."
Collapse
|
21
|
Abstract
"Nepal has been experiencing a permanent rural-to-rural migration of households from the central hill zone to the Terai region. Migrant households, due to the structure of the Terai economy, are impelled to acquire control of land for subsistence agriculture by squatting, purchasing, or receiving a grant. A household's ability to maximize subsistence opportunities is partly a function of the means by which land is acquired and whether land is acquired at all. Factors which determine the chances of acquiring land reflect the role of institutional rigidities such as the distribution of wealth and the caste structure, state-imposed land reform policies, and such household characteristics as family size and risk aversion. A multinomial logit model is used to empirically assess the importance of these elements in the outcomes of migrant households' resource acquisition decisions."
Collapse
|
22
|
|
23
|
|
24
|
Shrestha NR. A preliminary report on population pressure and land resources in Nepal. J Dev Areas 1982; 16:197-211. [PMID: 12264247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
|