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Article ; Online: Clinical Anesthesia, South Asian Edition: A Book Review.

Hamal, Pawan Kumar

JNMA; journal of the Nepal Medical Association

2021 Volume 59, Issue 243, Page(s) 1207–1208

Abstract: Local practices, contextual issues and the therapeutic challenges of South Asian perspectives are generally overlooked in standard Clinical Anesthesia textbooks with more relevance to western scenarios. The South Asian Editors of this book, have made a ... ...

Abstract	Local practices, contextual issues and the therapeutic challenges of South Asian perspectives are generally overlooked in standard Clinical Anesthesia textbooks with more relevance to western scenarios. The South Asian Editors of this book, have made a tremendous painstaking effort to consider these issues and present the content as per the need of the local scenarios in an evidence-based manner.
MeSH term(s)	Anesthesia ; Asians ; Books ; Humans
Language	English
Publishing date	2021-11-15
Publishing country	Nepal
Document type	Journal Article
ZDB-ID	2209910-4
ISSN	1815-672X ; 0028-2715
ISSN (online)	1815-672X
ISSN	0028-2715
DOI	10.31729/jnma.7155
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Article ; Online: Clinical Anesthesia, South Asian Edition

Pawan Kumar Hamal

Journal of Nepal Medical Association, Vol 59, Iss

A Book Review

2021 Volume 243

Abstract	Local practices, contextual issues and the therapeutic challenges of South Asian perspectives are generally overlooked in standard Clinical Anesthesia textbooks with more relevance to western scenarios. The South Asian Editors of this book, have made a tremendous painstaking effort to consider these issues and present the content as per the need of the local scenarios in an evidence-based manner.
Keywords	anesthesia ; book review ; clinical ; Medicine (General) ; R5-920
Language	English
Publishing date	2021-11-01T00:00:00Z
Publisher	Nepal Medical Association
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Respiratory Morbidity and Mortality of Traumatic Cervical Spinal Injury.

Pokhrel, Nabin / Neupane, Aastha / Thapa, Nabin / Yadav, Rupesh Kumar / Hamal, Pawan Kumar / Malla, Pragya

Journal of Nepal Health Research Council

2024 Volume 21, Issue 4, Page(s) 680–683

Abstract: Background: Traumatic cervical spinal injuries can severely affect respiratory function and cause significant morbidity and mortality. The typical respiratory morbidity in cervical spine injury is Atelectasis, Ventilator-associated pneumonia, acute ... ...

Abstract	Background: Traumatic cervical spinal injuries can severely affect respiratory function and cause significant morbidity and mortality. The typical respiratory morbidity in cervical spine injury is Atelectasis, Ventilator-associated pneumonia, acute respiratory distress syndrome and delayed weaning, etc. The study aims to see the prevalence of respiratory morbidity as well as mortality associated with cervical spine injury. Methods: Cross sectional study based on retrospective data was conducted on the X Sciences with the existing hospital record during the period of 3 years to find out the prevalence respiratory morbidity like Ventilatory Associated Pneumonia, delayed weaning, ARDS, atelectasis of traumatic cervical spine injury, determine the prevalence, type, and impact of respiratory morbidity and mortality in this population. Results: Total no 76 patients data meeting the inclusion criteria included in study. Male patients were more prone to develop traumatic cervical spinal injuries (SCI). The prevalence of respiratory morbidity in term of VAP(57.89), delayed weaning(46.05) and Atelectasis(22.36) was high. Patients with Asia A Neurology has higher association for VAP and delayed weaning, while Asia E Neurology patients had no respiratory morbidity. The study found a significant positive association between respiratory morbidity with hospital stay, and ventilator days (p-value: 0.019 and 0.048). A total of 15 patients died, 28.95% were discharged on request and 40.8% leaving the hospital against medical advice. Conclusions: The prevalence of respiratory morbidity higher in cervical spine injury. Furthermore, it has associated with prolonged ICU and ventilator days and increase in mortality.
MeSH term(s)	Humans ; Male ; Cross-Sectional Studies ; Retrospective Studies ; Nepal/epidemiology ; Spinal Injuries/epidemiology ; Pulmonary Atelectasis
Language	English
Publishing date	2024-03-31
Publishing country	Nepal
Document type	Journal Article
ZDB-ID	2551251-1
ISSN	1999-6217 ; 1999-6217
ISSN (online)	1999-6217
ISSN	1999-6217
DOI	10.33314/jnhrc.v21i4.5068
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Article ; Online: Performance of custom made videolaryngoscope for endotracheal intubation: A systematic review.

Hamal, Pawan Kumar / Yadav, Rupesh Kumar / Malla, Pragya

PloS one

2022 Volume 17, Issue 1, Page(s) e0261863

Abstract: Introduction: Videolaryngoscope is regarded as the standard of care for airway management in well-resourced setups however the technology is largely inaccessible and costly in middle and low-income countries. An improvised and cost-effective form of ... ...

Abstract	Introduction: Videolaryngoscope is regarded as the standard of care for airway management in well-resourced setups however the technology is largely inaccessible and costly in middle and low-income countries. An improvised and cost-effective form of customized videolaryngoscope was proposed and studied for patient care in underprivileged areas however there were no distinct conclusions on its performances. Method: The study follows PRISMA guidelines for systematic review and the protocol in International Prospective Register for Systematic Reviews. The primary aim was to assess the first attempt success of customized videolaryngoscope for endotracheal intubation. The secondary objective was to evaluate the number of attempts, laryngoscopic view in terms of Cormack Lehane score and Percentage of glottic opening, use of external laryngeal maneuver and stylet and, the airway injuries after the endotracheal intubation. Result: Five studies were analyzed for risk of bias using the National Institute of Health Quality Assessment Tool for cross-sectional studies. Most of the studies had a poor to a fair level of evidence with only one study with a good level of evidence. Certainty of evidence was "very low" for all eligible studies when graded using the Grading of Recommendation, Assessment, Development and Evaluation approach for systematic review. Conclusions: The certainty of the evidence regarding performance of custom-made videolaryngoscope compared to conventional laryngoscope was very low and the study was performed in small numbers with fair to the poor risk of bias. It was difficult to establish and do further analysis regarding whether the customized form of videolaryngoscope will improve the first attempt success rate for tracheal intubation, reduce the number of attempts, improve the laryngoscopic view, require fewer external aids and reduce the incidences of airway injury with the given low-grade evidence. Some properly conducted randomised clinical trials will be required to further analyze the outcome and make the strong recommendations.
MeSH term(s)	Humans ; Intubation, Intratracheal/instrumentation ; Intubation, Intratracheal/methods ; Laryngoscopes ; Laryngoscopy/instrumentation ; Laryngoscopy/methods ; Video Recording
Language	English
Publishing date	2022-01-06
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0261863
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Article ; Online: Comparison of Fentanyl-Propofol and Ketamine-Propofol Combination in Induction and Maintenance with Intravenous Anesthesia for Short Surgical Procedures at Moderate Elevations.

Bhattarai, Ramesh / Hamal, Pawan Kumar

Journal of Nepal Health Research Council

2021 Volume 18, Issue 4, Page(s) 769–775

Abstract: Background: The aim of the study is to evaluate the efficacy of Ketamine-Propofol compared to Fentanyl-Propofol combination during induction and maintenance of total intravenous anesthesia for short surgical procedures at moderate elevation.: Methods!# ...

Abstract	Background: The aim of the study is to evaluate the efficacy of Ketamine-Propofol compared to Fentanyl-Propofol combination during induction and maintenance of total intravenous anesthesia for short surgical procedures at moderate elevation. Methods: A prospective pilot study was done comparing between Fentanyl (1.2 mcg/kg)- Propofol and Ketamine (0.5mg/kg)-Propofol with 30 in each group at moderate altitude of approximately 2514 meters for the requirement of positive pressure ventilation, changes in heart rate and mean arterial pressure intraoperatively, total Propofol consumption and time to attain Modified Steward Score of 6. Results: Requirement for positive pressure ventilation was significantly high in Fentanyl-Propofol group 18 (60%) compared to Ketamine-Propofol 1 (0.03%) [P = 0.00]. Fall in oxygen saturation was significant at 2 minute of Ketamine or Fentanyl [95% CI, 3.10-5.76, P = 0.00], after induction with Propofol [95% CI, 2.30-4.03, P = 0.00], 5 minute [95% CI, 1.66-3.54, P = 0.00], 10 minutes [95% CI, 0.55-2.32, P = 0.02], 15 minutes [95% CI, 0.50-2.09, P = 0.00] and 20 minutes [95% CI, 0.43-2.23, P = 0.00] respectively after study drug between the groups. Total Propofol consumption was significantly higher [95% CI, 0.19-0.43, P = 0.00] in KP (1.55±0.27mg/kg) compared to FP (1.23±0.16 mg/kg). Conclusions: At moderate elevations of 2514 meters, during the induction and maintenance of intravenous anesthesia, Ketamine-Propofol causes significantly less fall in oxygen saturation in the first 20 minutes requiring lesser need of positive pressure ventilation with comparable least fall in heart rate and mean arterial pressure with higher total Propofol consumption when compared to Fentanyl-Propofol. It took a significantly longer time to recovery with Modified steward score of maximum 6 with Ketamine-Propofol.
MeSH term(s)	Anesthesia, Intravenous ; Fentanyl ; Humans ; Ketamine ; Nepal ; Pilot Projects ; Propofol ; Prospective Studies
Chemical Substances	Ketamine (690G0D6V8H) ; Fentanyl (UF599785JZ) ; Propofol (YI7VU623SF)
Language	English
Publishing date	2021-01-22
Publishing country	Nepal
Document type	Journal Article
ZDB-ID	2551251-1
ISSN	1999-6217 ; 1999-6217
ISSN (online)	1999-6217
ISSN	1999-6217
DOI	10.33314/jnhrc.v18i4.3323
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Article ; Online: Performance of custom made videolaryngoscope for endotracheal intubation

Pawan Kumar Hamal / Rupesh Kumar Yadav / Pragya Malla

PLoS ONE, Vol 17, Iss 1, p e

A systematic review.

2022 Volume 0261863

Abstract: Introduction Videolaryngoscope is regarded as the standard of care for airway management in well-resourced setups however the technology is largely inaccessible and costly in middle and low-income countries. An improvised and cost-effective form of ... ...

Abstract	Introduction Videolaryngoscope is regarded as the standard of care for airway management in well-resourced setups however the technology is largely inaccessible and costly in middle and low-income countries. An improvised and cost-effective form of customized videolaryngoscope was proposed and studied for patient care in underprivileged areas however there were no distinct conclusions on its performances. Method The study follows PRISMA guidelines for systematic review and the protocol in International Prospective Register for Systematic Reviews. The primary aim was to assess the first attempt success of customized videolaryngoscope for endotracheal intubation. The secondary objective was to evaluate the number of attempts, laryngoscopic view in terms of Cormack Lehane score and Percentage of glottic opening, use of external laryngeal maneuver and stylet and, the airway injuries after the endotracheal intubation. Result Five studies were analyzed for risk of bias using the National Institute of Health Quality Assessment Tool for cross-sectional studies. Most of the studies had a poor to a fair level of evidence with only one study with a good level of evidence. Certainty of evidence was "very low" for all eligible studies when graded using the Grading of Recommendation, Assessment, Development and Evaluation approach for systematic review. Conclusions The certainty of the evidence regarding performance of custom-made videolaryngoscope compared to conventional laryngoscope was very low and the study was performed in small numbers with fair to the poor risk of bias. It was difficult to establish and do further analysis regarding whether the customized form of videolaryngoscope will improve the first attempt success rate for tracheal intubation, reduce the number of attempts, improve the laryngoscopic view, require fewer external aids and reduce the incidences of airway injury with the given low-grade evidence. Some properly conducted randomised clinical trials will be required to further analyze the outcome and ...
Keywords	Medicine ; R ; Science ; Q
Subject code	650
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Comparison of Fentanyl-Propofol and Ketamine-Propofol Combination in Induction and Maintenance with Intravenous Anesthesia for Short Surgical Procedures at Moderate Elevations

Ramesh Bhattarai / Pawan Kumar Hamal

Journal of Nepal Health Research Council, Vol 18, Iss

2021 Volume 4

Abstract	Background: The aim of the study is to evaluate the efficacy of Ketamine-Propofol compared to Fentanyl-Propofol combination during induction and maintenance of total intravenous anesthesia for short surgical procedures at moderate elevation. Methods: A prospective pilot study was done comparing between Fentanyl (1.2 mcg/kg)- Propofol and Ketamine (0.5mg/kg)-Propofol with 30 in each group at moderate altitude of approximately 2514 meters for the requirement of positive pressure ventilation, changes in heart rate and mean arterial pressure intraoperatively, total Propofol consumption and time to attain Modified Steward Score of 6. Results: Requirement for positive pressure ventilation was significantly high in Fentanyl-Propofol group 18 (60%) compared to Ketamine-Propofol 1 (0.03%) [P = 0.00]. Fall in oxygen saturation was significant at 2 minute of Ketamine or Fentanyl [95% CI, 3.10-5.76, P = 0.00], after induction with Propofol [95% CI, 2.30-4.03, P = 0.00], 5 minute [95% CI, 1.66-3.54, P = 0.00], 10 minutes [95% CI, 0.55-2.32, P = 0.02], 15 minutes [95% CI, 0.50-2.09, P = 0.00] and 20 minutes [95% CI, 0.43-2.23, P = 0.00] respectively after study drug between the groups. Total Propofol consumption was significantly higher [95% CI, 0.19-0.43, P = 0.00] in KP (1.55±0.27mg/kg) compared to FP (1.23±0.16 mg/kg). Conclusions: At moderate elevations of 2514 meters, during the induction and maintenance of intravenous anesthesia, Ketamine-Propofol causes significantly less fall in oxygen saturation in the first 20 minutes requiring lesser need of positive pressure ventilation with comparable least fall in heart rate and mean arterial pressure with higher total Propofol consumption when compared to Fentanyl-Propofol. It took a significantly longer time to recovery with Modified steward score of maximum 6 with Ketamine-Propofol. Keywords: Fentanyl; intravenous anesthesia; ketamine; moderate altitude; propofol
Keywords	Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Nepal Health Research Council
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Clinical Outcome for Lumbar Disc Herniation Treatment with Intradiscal Oxygen-ozone Therapy.

Yadav, Rupesh Kumar / Sherpa, Tshering / Hamal, Pawan Kumar / Pokhrel, Nabin / Thakur, Jay Prakash / Amatya, Shirish Prasad / Piya, Roshan

Journal of Nepal Health Research Council

2024 Volume 21, Issue 4, Page(s) 684–688

Abstract: Background: Low back pain due to disc herniation is a common problem causing frequent hospital visits and loss of working days with major socio-economic impact. Conservative treatments like analgesics, physiotherapy do not work in all patients. Surgical ...

Abstract	Background: Low back pain due to disc herniation is a common problem causing frequent hospital visits and loss of working days with major socio-economic impact. Conservative treatments like analgesics, physiotherapy do not work in all patients. Surgical treatment has been the mainstay of treatment when indicated but is associated with anesthetic and surgical complications. Intradiscal oxygen-ozone chemonucleolysis is a minimally invasive procedure done under local anesthesia and has promising role in shrinking the bulged disc and reducing nerve root compression and related symptoms. This retrospective study was done to see how intradiscal oxygen-ozone chemonucleolysis reduces pain severity in patients with discogenic low back pain. Methods: Retrospective data were retrieved of those patients who underwent fluoroscopy guided intradiscal oxygen-ozone chemonucleolysis with 5-6 ml of an O2-O3 mixture (concentration of 30 microgram/ml) during a period of two years in Nepal pain care and research center. Numerical pain scale (NRS) at various follow ups were compared to preprocedural NRS. Results: Preprocedural NRS was 8± 13. NRS at three hours, one week, one month, three months and six months were 2± 13 (73 percent reduction), 2± 53 (68 percent reduction), 2± 27 (72 percent reduction), 1± 08 (77 percent reduction) and 1± 67 (79 percent reduction) respectively. Conclusions: Intradiscal oxygen-ozone chemonucleolysis can be a useful modality of treatment for discogenic low back pain in patients who fail to respond to conservative management and in whom surgery is not indicated.
MeSH term(s)	Humans ; Oxygen ; Ozone/therapeutic use ; Retrospective Studies ; Intervertebral Disc Displacement/therapy ; Low Back Pain/therapy ; Nepal
Chemical Substances	Oxygen (S88TT14065) ; Ozone (66H7ZZK23N)
Language	English
Publishing date	2024-03-31
Publishing country	Nepal
Document type	Journal Article
ZDB-ID	2551251-1
ISSN	1999-6217 ; 1999-6217
ISSN (online)	1999-6217
ISSN	1999-6217
DOI	10.33314/jnhrc.v21i4.5070
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Article ; Online: Management and Leadership Development in Healthcare Professionals.

Karki, Lochan / Rijal, Badri / Hamal, Pawan Kumar / Khanal, Milan Chandra / Bhusal, Suzit

JNMA; journal of the Nepal Medical Association

2023 Volume 61, Issue 259, Page(s) 294–296

Abstract: In the healthcare system, leadership has never been more crucial. Initiatives to improve health care in underdeveloped nations frequently fail, not for lack of clinical and public health understanding, but rather for lack of management ability. However, ... ...

Abstract	In the healthcare system, leadership has never been more crucial. Initiatives to improve health care in underdeveloped nations frequently fail, not for lack of clinical and public health understanding, but rather for lack of management ability. However, there are currently few possibilities for thorough leadership development at any level of career. This short communication highlights the success of the International Public Health Management Development Program by the Nepal Medical Association in conjunction with the Indian Embassy in Nepal, financed by the Ministry of External Affairs under the Indian Technical Education Corporation. Keywords: leadership; Nepal; public health; training activities.
MeSH term(s)	Humans ; Leadership ; Health Personnel ; Delivery of Health Care ; Educational Status ; Developing Countries
Language	English
Publishing date	2023-03-01
Publishing country	Nepal
Document type	Journal Article
ZDB-ID	2209910-4
ISSN	1815-672X ; 0028-2715
ISSN (online)	1815-672X
ISSN	0028-2715
DOI	10.31729/jnma.8100
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Article ; Online: Management and Leadership Development in Healthcare Professionals

Lochan Karki / Badri Rijal / Pawan Kumar Hamal / Milan Chandra Khanal / Suzit Bhusal

Journal of Nepal Medical Association, Vol 61, Iss

2023 Volume 259

Abstract	In the healthcare system, leadership has never been more crucial. Initiatives to improve health care in underdeveloped nations frequently fail, not for lack of clinical and public health understanding, but rather for lack of management ability. However, there are currently few possibilities for thorough leadership development at any level of career. This short communication highlights the success of the International Public Health Management Development Program by the Nepal Medical Association in conjunction with the Indian Embassy in Nepal, financed by the Ministry of External Affairs under the Indian Technical Education Corporation.
Keywords	leadership ; Nepal ; public health ; training activities ; Medicine (General) ; R5-920
Language	English
Publishing date	2023-02-01T00:00:00Z
Publisher	Nepal Medical Association
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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