Papers by Sanjay Shrestha
Beyond Borders, Program manager, Nepal Comparative study of treadmill test positive patients with... more Beyond Borders, Program manager, Nepal Comparative study of treadmill test positive patients with coronary artery profile on coronary angiography in patient presenting with chest pain in BPKIHS, Dharan, Nepal BACKGROUND Diagnosis of Coronary artery disease by Coronary artery angiography is limited by its availability, cost and as an invasive procedure. Treadmill test is a noninvasive and easily available test for diagnosing as well as prognosis of coronary artery disease and is most commonly performed stress test for diagnosis of coronary artery disease. Treadmill test is often used as an initial assessment of patient with suspected coronary artery disease serving as a poor man's angiogram This was a cross sectional observational study carried out over a period from 25th August 2023 to 25th November 2023 in Department of Cardiology. A total of 100 patients with positive Treadmill test underwent CAG and subsequently analyzed for the presence of CAD were enrolled in the study. TMT test was done using Bruce Protocol and results were classified as positive and negative upon ECG changes. Data about Socio demographic profiles, clinical data, major comorbidity, the presumed risk factor for CAD were entered in MS Excel and analyzed through SPSS 25. A total of 100 patients were enrolled in the study. Males were 45(45%) and females were 55(55%). The mean age of the patient was 53.38±16.7 years and 44.27±13.8 years in male and female group respectively. Smoking (82%) was the number one risk factor in male group and Hypertension (52%) in female group.. Significant CAD was seen in 33% of cases ad normal coronaries in 45%. The most common coronary artery involved having significant disease during coronary angiogram was LAD in 25% of cases There was a significant correlation between positive TMT Results and coronary artery disease in coronary angiography.
Journal of Advances in Internal Medicine, Dec 30, 2023
Holter is indicated to establish link between palpitation and arrhythmia. 2 In a study by Kurt kr... more Holter is indicated to establish link between palpitation and arrhythmia. 2 In a study by Kurt kroenke LTC et , it was found that palpitations accounted for 16% of symptoms that lead to visit general practitioner. 3
Journal of Advances in Internal Medicine
BACKGROUND Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered c... more BACKGROUND Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus referred to as SARS-CoV-2. Biomarkers has been linked with severity and appears to influence clinical outcomes among COVID-19 patients. Aims: This study aimed to describe the association of inflammatory biomarkers with clinical characteristics, severity and outcomes among COVID 19 patients in a tertiary tropical and infectious disease hospital in Nepal. METHODS This was a retrospective observational study where medical and lab records of COVID-19 inpatients (patients tested positive for SARS-CoV-2 via reverse transcriptase-polymerase chain reaction (RT-PCR)) admitted between April 2021 and September 2021 at Sukraraj Tropical and Infectious Disease Hospital, representing the second wave of COVID-19 were reviewed. Medical records of the patients were collected till discharge and inflammatory biomarkers were evaluated in relation to clinical presentations, severity and outcome am...
SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS
The risk of disseminated Histoplasmosis increases among immunocompromised HIV infected patients. ... more The risk of disseminated Histoplasmosis increases among immunocompromised HIV infected patients. It can clinically present with skin manifestation. We report a forty years HIV infected male with severe immunodeficiency clinically presenting as a disseminated Histoplasmosis with dermatological manifestation and diagnosis.
Tropical Medicine and Infectious Disease, Nov 16, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Nepal Journal of Medical Sciences
Introduction: Chronic kidney disease (CKD) patients are at increased risk of morbidity and mortal... more Introduction: Chronic kidney disease (CKD) patients are at increased risk of morbidity and mortality because of their native disease progression. Accumulation of other atherosclerotic risk factors associated with CKD multiplies their risks. This study aimed to evaluate cardiac structural and functional abnormalities in CKD patients undergoing Maintenance Hemodialysis (MHD) using Electrocardiography (ECG) and Echocardiography (Echo). Method: It was a prospective cross-sectional study containing all CKD patients undergoing MHD at Pokhara Academy of Health Sciences, Pokhara, Nepal was conducted between August 2020 to December 2020. All the relevant data were entered in Statistical Package for Social Science (SPSS) for analysis. Results: There was a total of 115 patients with a male: female ratio of 1.8:1and a mean age of 47.25 ± 15.20years. The mean duration of dialysis was 36months and hypertension was the prime risk factor. Common ECG abnormalities were left ventricular hypertrophy,...
SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS
During the time of COVID-19 outbreak there is dilemma in diagnosis of acute lung infections. This... more During the time of COVID-19 outbreak there is dilemma in diagnosis of acute lung infections. This is further hindered among immunocompromised patients due to bizarre clinical and radiological findings. We report young male severely immunocompromised HIV infected ART naïve patient presenting with acute onset of pneumonia and hypoxemia with SARS CoV-2 PCR positive.
Tropical Medicine and Infectious Disease
The long-term effects of COVID-19 among survivors is a matter of concern. This research aimed to ... more The long-term effects of COVID-19 among survivors is a matter of concern. This research aimed to study persistent symptoms in post-COVID-19 patients attending a follow-up clinic at a tertiary care hospital in Nepal. All patients, presenting to the outpatient clinic during the study duration of six weeks, with history of positive reverse transcriptase- polymerase chain reaction for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) at least two weeks prior to presentation, were included. The duration of follow-up ranged from 15 till 150 days with the mean duration of 28 days after diagnosis of COVID-19. Of 118 patients, 43 (36.4%) had a history of mild COVID-19, 15 (12.8%) had moderate, and 60 (50.8%) had severe. At the time of presentation, 97 (82.2%) patients reported that they had at least one persistent/new symptom beyond two weeks from the diagnosis of COVID-19. Dyspnea, fatigue, chest heaviness, and cough were the commonest persistent complaints in 48 (40.7%), 39 (33....
Tropical Medicine and Infectious Disease
Coronavirus Disease 2019 (COVID-19) has challenged the health system worldwide, including the low... more Coronavirus Disease 2019 (COVID-19) has challenged the health system worldwide, including the low and middle income countries like Nepal. In view of the rising number of infections and prediction of multiple waves of this disease, mortalities due to COVID-19 need to be critically analyzed so that every possible effort could be made to prevent COVID-19 related mortalities in future. Main aim of this research was to study about the mortalities due to COVID-19 at a tertiary level hospital, in Nepal. This was a retrospective, observational study that included all inpatients from Sukraraj Tropical and Infectious Disease Hospital, who were reverse transcriptase polymerase chain reaction positive for SARS-COV-2 and died during hospital stay from January 2020 till January 2021. Medical records of the patients were evaluated. Out of 860 total admissions in a year, there were 50 mortalities in the study center. Out of 50 mortalities, majority were males (76%) with male to female ratio of 3.17...
Open Forum Infectious Diseases
Background Convalescent plasma therapy (CPT) and remdesivir (REM) have been approved for investig... more Background Convalescent plasma therapy (CPT) and remdesivir (REM) have been approved for investigational use to treat coronavirus disease 2019 (COVID-19) in Nepal. Methods In this prospective, multicentered study, we evaluated the safety and outcomes of treatment with CPT and/or REM in 1315 hospitalized COVID-19 patients over 18 years in 31 hospitals across Nepal. REM was administered to patients with moderate, severe, or life-threatening infection. CPT was administered to patients with severe to life-threatening infections who were at high risk for progression or clinical worsening despite REM. Clinical findings and outcomes were recorded until discharge or death. Results Patients were classified as having moderate (24.2%), severe (64%), or life-threatening (11.7%) COVID-19 infection. The majority of CPT and CPT + REM recipients had severe to life-threatening infections (CPT 98.3%; CPT + REM 92.1%) and were admitted to the intensive care unit (ICU; CPT 91.8%; CPT + REM 94.6%) compa...
Nepal Mediciti Medical Journal
BACKGROUND: Acute upper gastrointestinal bleeding (AUGIB) is a potentially life-threatening condi... more BACKGROUND: Acute upper gastrointestinal bleeding (AUGIB) is a potentially life-threatening condition that requires rapid assessment in the emergency department. The current available scores are complex and have not been widely used in clinical practice. AIMS65 score is a simple score that can be used to risk stratify patients with AUGIB. METHODS: This was a descriptive cross-sectional study done at a single tertiary centre, NAMS, Bir Hospital among the patients presenting with AUGIB from August 2018 to January 2019. AIMS65 scores were calculated in patients presenting with acute UGIB by allotting 1 point each for albumin level < 3g/dl, INR > 1.5, alteration in mental status, systolic blood pressure ≤90 mm Hg, and age ≥65 years. Risk stratification was done during the initial 12 hours of hospital admission. RESULTS: A total of 84 patients consisting of 68 males and 16 females were enrolled in our study, with age ranging from 27 to 80 years. ICU admission, endoscopic therapy an...
Tropical Medicine and Infectious Disease, 2021
Coronavirus Disease 2019 (COVID-19) has challenged the health system worldwide, including the low... more Coronavirus Disease 2019 (COVID-19) has challenged the health system worldwide, including the low and middle income countries like Nepal. In view of the rising number of infections and prediction of multiple waves of this disease, mortalities due to COVID-19 need to be critically analyzed so that every possible effort could be made to prevent COVID-19 related mortalities in future. Main aim of this research was to study about the mortalities due to COVID-19 at a tertiary level hospital, in Nepal. This was a retrospective, observational study that included all inpatients from Sukraraj Tropical and Infectious Disease Hospital, who were reverse transcriptase polymerase chain reaction positive for SARS-COV-2 and died during hospital stay from January 2020 till January 2021. Medical records of the patients were evaluated. Out of 860 total admissions in a year, there were 50 mortalities in the study center. Out of 50 mortalities, majority were males (76%) with male to female ratio of 3.17...
Background Convalescent plasma therapy (CPT) and remdesivir (REM) have been approved for investig... more Background Convalescent plasma therapy (CPT) and remdesivir (REM) have been approved for investigational use to treat coronavirus disease 2019 (COVID-19) in Nepal. Methods In this prospective, multicentered study, we evaluated the safety and outcomes of treatment with CPT and/or REM in 1315 hospitalized COVID-19 patients over 18 years in 31 hospitals across Nepal. REM was administered to patients with moderate, severe, or life-threatening infection. CPT was administered to patients with severe to life-threatening infections who were at high risk for progression or clinical worsening despite REM. Clinical findings and outcomes were recorded until discharge or death. Results Patients were classified as having moderate (24.2%), severe (64%), or life-threatening (11.7%) COVID-19 infection. The majority of CPT and CPT + REM recipients had severe to life-threatening infections (CPT 98.3%; CPT + REM 92.1%) and were admitted to the intensive care unit (ICU; CPT 91.8%; CPT + REM 94.6%) compa...
Introduction: Hypertensive disorders in pregnancy contribute significantly to the maternal mortal... more Introduction: Hypertensive disorders in pregnancy contribute significantly to the maternal mortality, premature birth, intrauterine growth retardation and perinatal mortality. Objectives: This study is done to determine if microalbuminuria can be used as a predictive marker of pregnancy induced hypertension (PIH) and adverse pregnancy and neonatal outcomes. Materials and Methods: This study was hospital based longitudinal observational done in pregnant women attending antenatal clinic in B.P. Koirala Institute of Health Sciences for a period of 1 year from January, 2017 to January, 2019. This study involved total of 504 women of gestational age 24-28 weeks, were evaluated for microalbuminuria, defined by spot urine albumin creatinine ratio 30-300 mg/g (Kidney Disease Improving Global Outcomes guidelines) and followed till discharge after delivery. Development of PIH and both maternal and fetal outcome were recorded. Results: Of the 504 patients pregnant women enrolled in our study, ...
Journal of Advances in Internal Medicine
Background and Aims: Microalbuminuria is an early marker of diabetic nephropathy, which accounts ... more Background and Aims: Microalbuminuria is an early marker of diabetic nephropathy, which accounts for a significant reduction in life expectancy of diabetic patients. Timely detection of microalbuminuria facilitates appropriate preventive and therapeutic approaches to minimize risks. The aim of this study is to determine the prevalence and association of microalbuminuria with clinical profile and complications of type 2 diabetes mellitus. Methods: This study was a descriptive, cross sectional study involving 100 diabetic subjects between July 2018 to January 2019 at Bir Hospital. Microalbuminuria (mg/dl) was defined as spot urine albumin to creatinine ratio of 30-300 mg/g (Kidney Disease Improving Global Outcomes guidelines) in a single spot urine sample. Statistical analysis was done using Statistical package for the social sciences version 20. Results: Microalbuminuria was found in 35% of the sample and the rate was significantly higher among males (P =0.027). Microalbuminuria was ...
Tropical Medicine and Infectious Disease
The long-term effects of COVID-19 among survivors is a matter of concern. This research aimed to ... more The long-term effects of COVID-19 among survivors is a matter of concern. This research aimed to study persistent symptoms in post-COVID-19 patients attending a follow-up clinic at a tertiary care hospital in Nepal. All patients, presenting to the outpatient clinic during the study duration of six weeks, with history of positive reverse transcriptase- polymerase chain reaction for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) at least two weeks prior to presentation, were included. The duration of follow-up ranged from 15 till 150 days with the mean duration of 28 days after diagnosis of COVID-19. Of 118 patients, 43 (36.4%) had a history of mild COVID-19, 15 (12.8%) had moderate, and 60 (50.8%) had severe. At the time of presentation, 97 (82.2%) patients reported that they had at least one persistent/new symptom beyond two weeks from the diagnosis of COVID-19. Dyspnea, fatigue, chest heaviness, and cough were the commonest persistent complaints in 48 (40.7%), 39 (33....
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Papers by Sanjay Shrestha