Author: "Hem Raj Paneru" - Searchworks@Jio Institute Digital Library Search Results

30 results on '"Hem Raj Paneru"'

1. Early Outcomes Of Living Donor Liver Transplant Recipients In A University Teaching Hospital Of Nepal

Author: Sumita Pradhan, Narendra Maharjan, Deepak Sharma, Bishnu Kandel, Rabin Hamal, Amit Sharma Bhattarai, Pankaj Joshi, Pramesh Sunder Shrestha, Hem Raj Paneru, Subhash P Acharya, Ajit Thapa, Dinesh Chataut, Sharma Paudel, Paleswan Joshi Lakhey, and Ramesh Singh Bhandari
Subjects: Early outcomes, liver transplantation, Living donor liver transplantation, recipient, Surgery, RD1-811
Abstract: Introduction: The burden of chronic liver disease (CLD) is on the rise and liver transplantation remains the best treatment modality for the end stage liver disease (ESLD). Tribhuvan University Teaching Hospital has started doing living donor liver transplantation (LDLT) and we aim to report our experience and early postoperative outcomes of the first 10 living donor liver transplants performed in our institute. Methods: This is a retrospective review and included all patients who were operated for LDLT from the year 2019 to 2023 for various indications. Demographic data, Model for End-Stage Liver Disease score, Child score, etiology of CLD, liver graft type, graft-to-recipient weight ratio, operative time, blood transfusion and complications were analysed. Results: From 2019 to 2023, in total, 10 patients underwent LDLT, including one paediatric transplant. The most common etiology was alcohol (50%) and right lobe was the preferred graft. The average operative time was 7.9 ± 2.56 hours. There were no re exploration or re transplantation. The mean duration of hospital stay was around 21.37 ± 6.43 days. All patients were followed for one to five years. Four recipients had Clavien Dindo Grade II and above complications, including bile leak and post-operative bleeding. One mortality occurred on 27th post-operative day due to covid infection. Conclusions: Living donor liver transplantation is a feasible option for patients with end stage liver disease and is safe to be performed in low volume centre with the help of expertise and good team work.
Published: 2024
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2. Critical care services in Bagmati province of Nepal: A cross sectional survey [version 2; peer review: 2 approved]

Author: Subekshya Luitel, Sushila Paudel, Diptesh Aryal, Janaki Pandey, Hem Raj Paneru, Roshni Shakya, Prashant Acharya, Isha Amatya, Rashan Haniffa, Suman Pant, Abi Beane, and Pradip Gyanwali
Subjects: intensive care unit (ICU), high dependency unit, critical care services, critical care resources, critical care structure, critical care staffing, eng, Medicine, Science
Abstract: Background This study aimed to assess the current status of critical care services in 13 districts of Bagmati Province in Nepal, with a focus on access, infrastructure, human resources, and intensive care unit (ICU) services. Methods A cross-sectional survey was conducted among healthcare workers employed in 87 hospitals having medical/surgical ICUs across Bagmati Province. Data were collected through structured questionnaires administered via face-to-face and telephone interviews. Descriptive analysis was used for data analysis, involving frequencies and percentages. Results From 87 hospitals, a total of 123 ICUs were identified in the province, providing 1167 beds and 615 functioning ventilators. The average ICU bed availability per 100,000 population was 19, ranging from 3.6 in Makwanpur to 33.9 in Kathmandu. Out of 13 districts, 95% of beds were concentrated in just four districts, while six had no ICU facilities. Of the available facilities, 69.9% were owned by private entities. One-to-one nurse-to-ventilated bed ratio was maintained by 63.4% of ICUs during daytime, and 62.6% at nighttime. Furthermore, 74.8% of ICUs had consultants trained in critical care medicine. While essential equipment availability was higher in Bagmati province, gaps existed in the availability of oxygen plants and isolation rooms. Similarly, many ICUs offered continuous medical education and cardiopulmonary resuscitation (CPR) training, but improvements were necessary in clinical audits, antibiotic stewardship programs, and research engagement. Conclusions Disparities in critical care resources were evident across districts in Bagmati Province, highlighting the need for a balanced and decentralized approach to ensure equitable access to care. Although there were disparities, numerous ICUs were effectively carrying out multiple critical care procedures. This study suggests conducting a nationwide mapping of ICU resources, prioritizing infrastructure development, optimizing resource allocation, and establishing national protocols.
Published: 2024
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3. Point-prevalence survey of antimicrobial use in intensive care units in Nepal

Author: Sabin Koirala, Agnimshwor Dahal, Hem Raj Paneru, Astha Thapa, Surendra Bhusal, Roshni Shakya, Subekshya Luitel, Kanchan Koirala, and Diptesh Aryal
Subjects: Infectious and parasitic diseases, RC109-216, Public aspects of medicine, RA1-1270
Abstract: Abstract Objective: This study aimed to investigate the prevalence and practices of antibiotic use in intensive care units (ICUs) in Nepal and to identify potential areas for implementing antimicrobial stewardship programs. Design: A point prevalence survey was conducted to characterize and quantify the antimicrobial utilization in level III ICUs of Nepal. Methods: Data on antibiotic prescription rates, reasons for prescribing antibiotics, and prescribing practices were collected and analyzed. The prevalence of antimicrobial resistance was also assessed. Results: The antibiotic prescribing rate was found to be very high, with 92.85% of patients in ICU on antibiotics. Prolonged surgical prophylaxis was the most common reason for prescribing antibiotics. Empirical therapy accounted for 67.5% of all antibiotic prescriptions. Prescribing practices were poor, with low adherence to guidelines and best practices. Broad-spectrum antibiotics were commonly used even for surgical prophylaxis or community-acquired infections. High resistance was observed against commonly used antibiotics. Conclusions: The study underscores the urgent need for effective antimicrobial stewardship programs in ICUs of Nepal. Implementing robust stewardship programs could help optimize antibiotic utilization, improve patient outcomes, and combat the global threat of antimicrobial resistance. The findings serve as a stepping stone toward understanding and improving antibiotic prescribing practices in ICUs of Nepal.
Published: 2024
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4. A comparison of clinical profile and outcomes among different age groups of critically ill elderly patients in a tertiary level hospital in Nepal: A retrospective study

Author: Sabin Bhandari, Subhash Prasad Acharya, Gentle Sunder Shrestha, Pramesh Sunder Shrestha, and Hem Raj Paneru
Subjects: acute physiology and chronic health evaluation ii score, clinical characteristics, elderly, intensive care unit, outcomes, Medicine
Abstract: Background: Ageing population has increased the rate of hospitalizations and demand for critical care services. The data on the clinical profile and outcomes of different groups of elderly admitted to the intensive care units (ICU) are however sparse. Aims and Objectives: The aim of this study was to evaluate and compare the clinical profile and outcomes among different age groups of critically ill elderly patients admitted to the ICU of a tertiary level hospital. Materials and Methods: This retrospective and observational study reviewed all the elderly patients aged 60 years and above, admitted to the ICU of a tertiary hospital over a period of 1 year. The patients were divided into three groups, 60–69 years, 70–79 years, and 80 years and above. Non-probability sampling was done. Kruskal–Wallis H test was performed to compare the median values of the variables between the three groups. Results: Among 173 patients analyzed, the three groups did not differ in clinical characteristics, requirement of renal replacement therapy and cardiovascular support, length of stay (LOS) in ICU, LOS in mechanical ventilator, and patients who improved and transferred out of ICU. Acute physiology and chronic health evaluation II (APACHE) II score was significantly higher in 70–79 years compared to the other two groups (P=0.01) as was the in-hospital mortality (P=0.03). Conclusion: APACHE II score rather than age is a good predictor of adverse outcomes in ICU. Age should not be used to preclude the utilization of resources in ICU.
Published: 2023
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5. Combination of convalescent plasma therapy and repurposed drugs to treat severe COVID‐19 patient with multimorbidity

Author: Santa Kumar Das, Kamal Ranabhat, Suraj Bhattarai, Khem Bahadur Karki, Pradip Gyanwali, Hem Raj Paneru, Bipin Nepal, Shyam Prakash Dumre, and Subhash Prasad Acharya
Subjects: convalescent plasma therapy, COVID‐19 infection, multimorbidity, Nepal, Medicine, Medicine (General), R5-920
Abstract: Abstract Combination of convalescent plasma therapy and repurposed drugs such as dexamethasone and remdesivir could be beneficial for severe COVID‐19 patients with obesity and chronic diseases such as diabetes and hypertension.
Published: 2021
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6. Factors associated with extubation failure in the intensive care unit patients after spontaneous breathing trial

Author: Niraj Kumar Keyal, Roshana Amatya, Gentle Sunder Shrestha, Saurabh Pradhan, Krishna Kumar Agrawal, and Hem Raj Paneru
Subjects: chronic obstructive airway disease, extubation, spontaneous breathing trial, Medicine, Nursing, RT1-120
Abstract: Introduction: Extubation failure is associated with high mortality and poor outcome of patients. Aims: This study was conducted to assess the factors associated with extubation failure in the intensive care unit (ICU) patients planned for extubation. Settings and Design: It was a prospective observation study conducted in all patients aged >18 years admitted in the ICU of a tertiary care hospital. Subjects and Methods: It was done on 108 patients who were planned for extubation. Patients were assessed by an intensivist clinically and decided whether a patient can be extubated on clinical grounds. Spontaneous breathing trial (SBT) was done for 2 h by T-piece in patients who met clinical and objective criteria. Arterial blood gas (ABG) was done in all patients who successfully completed SBT. Patients with successful SBT and acceptable ABG were extubated. Patients were observed for 48 h for extubation failure, and the reason for reintubation was recorded. Statistical Analysis Used: Independent Student's t-test and Chi-square test were used for data analysis. Results: Of 108 patients who passed the SBT, 96 (88.88%) patients had acceptable ABG and were extubated. 85 (88%) underwent successful extubation and 11 (12%) underwent unsuccessful extubation. Duration of mechanical ventilation (MV) and chronic obstructive airway disease was a risk factor associated with extubation failure. Conclusion: Duration of MV of >2 days and chronic obstructive pulmonary disease were identified as independent risk factors for extubation failure.
Published: 2020
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7. Precision medicine for COVID-19: a call for better clinical trials

Author: Gentle Sunder Shrestha, Hem Raj Paneru, and Jean-Louis Vincent
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Published: 2020
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8. Operationalisation of the Randomized Embedded Multifactorial Adaptive Platform for COVID-19 trials in a low and lower-middle income critical care learning health system. [version 1; peer review: 2 approved]

Author: Diptesh Aryal, Abi Beane, Arjen M. Dondorp, Cameron Green, Rashan Haniffa, Madiha Hashmi, Devachandran Jayakumar, John C. Marshall, Colin J. McArthur, Srinivas Murthy, Steven A. Webb, Subhash P. Acharya, Pramodya G. P. Ishani, Issrah Jawad, Sushil Khanal, Kanchan Koirala, Subekshya Luitel, Upulee Pabasara, Hem Raj Paneru, Ashok Kumar, Shoaib Siddiq Patel, Nagarajan Ramakrishnan, Nawal Salahuddin, Mohiuddin Shaikh, Timo Tolppa, Ishara Udayanga, and Zulfiqar Umrani
Subjects: Medicine, Science
Abstract: The Randomized Embedded Multifactorial Adaptive Platform (REMAP-CAP) adapted for COVID-19) trial is a global adaptive platform trial of hospitalised patients with COVID-19. We describe implementation in three countries under the umbrella of the Wellcome supported Low and Middle Income Country (LMIC) critical care network: Collaboration for Research, Implementation and Training in Asia (CCA). The collaboration sought to overcome known barriers to multi centre-clinical trials in resource-limited settings. Methods described focused on six aspects of implementation: i, Strengthening an existing community of practice; ii, Remote study site recruitment, training and support; iii, Harmonising the REMAP CAP- COVID trial with existing care processes; iv, Embedding REMAP CAP- COVID case report form into the existing CCA registry platform, v, Context specific adaptation and data management; vi, Alignment with existing pandemic and critical care research in the CCA. Methods described here may enable other LMIC sites to participate as equal partners in international critical care trials of urgent public health importance, both during this pandemic and beyond.
Published: 2021
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9. Preparedness for Coronavirus Disease in Hospitals of Nepal: A Nationwide Survey

Author: Gentle Sunder Shrestha, Hem Raj Paneru, Subhash Prasad Acharya, Sanjeet Krishna Shrestha, Mahesh Raj Sigdel, Sanjeeb Tiwari, Bharat Kumar Yadav, Badri Rijal, Lochan Karki, Yogesh Neupane, Narmaya Thapa, and Sanjay Lakhey
Subjects: COVID-19, hospital preparedness, Nepal., Medicine (General), R5-920
Abstract: Introduction: Coronavirus disease pandemic has affected large number of people globally and has continued to spread. Preparedness of individual nations and the hospitals is important to effectively deal with the surge of cases. We aimed to obtain nation wide data from Nepal, about hospital preparedness for COVID-19. Methods: Online questionnaire was prepared in accordance with the Center for Disease Control recommendations to assess preparedness of hospitals for COVID-19. The questionnaire was circulated to the over 800 doctors across the nation, who are the life members of six medical societies. Results: We obtained 131 completed responses from all seven provinces. Majority of respondents had anaesthesiology as the primary specialty. Only 52 (39.7%) participants mentioned that their hospital had policy to receive suspected or proven cases with COVID-19. Presence of isolation ward was mentioned by 83 (63.4%) respondents, with only 9 (6.9%)mentioning the presence of airborne isolation. Supply of personal protective equipment (PPE) was inadequate as per 124 (94.7%) respondents. Critical care services for COVID-19 patients were possible only in hospitals of 42 (32.1%)respondents. RT-polymerase chain reaction could be performed only in the hospital of 6 (4.6%) respondents. Conclusions: It is apparent that most of the hospitals are not well prepared for management of patients with COVID-19. Resource allocation and policy making should be aimed to enhance national preparedness for the pandemic.
Published: 2020
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10. A Case Study of Stevens–Johnson Syndrome-Toxic Epidermal Necrolysis (SJS-TEN) Overlap in Mycoplasma pneumoniae-Associated Tracheobronchitis

Author: Ranjit Sah, Samikshya Neupane, Shusila Khadka, Sagar Poudyal, Hem Raj Paneru, Ranjana Sah, Sanjit Sah, and Vivek Pant
Subjects: Infectious and parasitic diseases, RC109-216
Abstract: Stevens–Johnson syndrome is a medical emergency which is characterized by skin and mucosal reaction to the use of certain drugs. Atypical Steven–Johnson syndrome can occur due to various microorganisms and Mycoplasma pneumoniae being one of them. We present a clinical course, diagnosis, and successful management of Steven–Johnson syndrome-toxic epidermal necrolysis (SJS-TEN) overlap due to Mycoplasma pneumoniae in a 17-year-old Nepalese female. In the resource-limiting country and hospitals where serology and PCR for M. pneumoniae is not easily accessible, a simple bedside cold agglutination test can be done to increase the suspicion of infectious cause (most common M. pneumoniae ) of SJS-TEN overlap. M. pneumoniae infection should be considered in all cases of mucositis, especially in patients having preceding respiratory tract infections (tracheobronchitis).
Published: 2019
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11. Higher dose corticosteroids in patients admitted to hospital with COVID-19 who are hypoxic but not requiring ventilatory support (RECOVERY)

Author: Obbina Abani, Ali Abbas, Fatima Abbas, Joshua Abbas, Kasim Abbas, Mustafa Abbas, Sadia Abbasi, Hakam Abbass, Alfie Abbott, Alison Abbott, Nabeel Abdallah, Ammar Abdelaziz, Ashraf Abdelaziz, Mohamed Abdelfattah, Bushra Abdelqader, Audrey Abdul, Basir Abdul, Siddiqui Abdul, Althaf Abdul Rasheed, Ajibode Abdulakeem, Rezan Abdul-Kadir, Abdullah Abdullah, Abdulfatahi Abdulmumeen, Rasheed Abdul-Raheem, Niyaz Abdulshukkoor, Kula Abdusamad, Yazeed Abed El Khaleq, Mai Abedalla, Abeer Abeer Ul Amna, Lynn Abel, Katrina Abernethy, Movin Abeywickrema, Chandra Abhinaya, Affyarsyah Abidin, Adebanke Aboaba, Abigail Aboagye-Odei, Christopher Aboah, Heba Aboelela, Hani Abo-Leyah, Karim Abouelela, Ahmed Abou-Haggar, Mahmoud Abouibrahim, Ahmed Abousamra, Mona Abouzaid, Miriam Abraham, Tizzy Abraham, Abraheem Abraheem, Judith Abrams, Rebecca Abrams, Hyacinth-John Abu, Ahmed Abu-Arafeh, Syed M Abubacker, Akata Abung, Yousuf Abusamra, Yaa Aceampong, Amaka Achara, Devikumar Acharya, Faustina Acheampong, Prince Acheampong, Sarah Acheampong, Janet Acheson, Shiella Achieng, Andres Acosta, Rebecca Acquah, Catherine Acton, Jacqueline Adabie-Ankrah, Paul Adair, Fiona Adam, Matthew Adam, Huzaifa Adamali, Marta Adamczyk, Carol Adams, Charlotte Adams, Daniel Adams, Kate Adams, Laura Adams, Nikkita Adams, Richard Adams, Tim Adams, Laura Adamu-Ikeme, Krishma Adatia, Kirsty Adcock, Lawrence Addai-Boampong, Afua Addo, Oluwatobi Adeagbo, Ade Adebiyi, Ogunlana Adedeji, Yewande Adegeye, Ken Adegoke, Vicki Adell, Sherna Adenwalla, Femi W Adeoye, Oluwasegun A Adesemoye, Emmanuel O Adewunmi, Adedamola Adeyanju, Joyce Adeyemi, Tenifayo Adeyemo, Binay Adhikari, Shanti A Adhikari, Rina Adhikary, Adhikarla Aditya, Patience Adjepong, Gabrielle Adkins, Adnan Adnan, Marguerite Adriaanse, John Aeron-Thomas, Debbie Affleck, Carmel Afnan, Muhammad Afridi, Patricia Afrim, Felicia Akua Afriyie, Zainab A Aftab, Meenakshi Agarwal, Rachel Agbeko, Chris Agbo, Sunil Aggarwal, Arameh Aghababaie, Laura Aguilar Jimenez, Jacqueline Afrakomah Agyekum, Kwame Agyen, Shafana Ahamed Sadiq, Mohamed H Ahammed Nazeer, Mohammad Ahmad, Syed Ahmad, Afshan Ahmed, Ashar Ahmed, Asim Ahmed, Basheer A R Ahmed, Bilal Ahmed, Forizuddin Ahmed, Hamze Ahmed, Hanad Ahmed, Irshad Ahmed, Khaled Ahmed, Khalil Ahmed, Liban Ahmed, Mahin Ahmed, Maria C Ahmed, Muhammad S Ahmed, Naseer Ahmed, Nausheen Ahmed, Osama Ahmed, Rajia A Ahmed, Rawya Ahmed, Rizwan Ahmed, Saif Ahmed, Sammiya Ahmed, Sana G Ahmed, Syed Ahmed, Syed H Ahmed, Roa Ahmed Ali, Bilal Ahmed Mohamud, Sana Ahmed, Sana Ahmer, Augustine Ahonia, Christine Aiken, Dhiraj Ail, Mark Ainsworth, Myriam Aissa, Lindianne Aitken, Bini Ajay, Abdulakeem Ajibode, Ayesha Ajmi, Nasim Akhtar, Nauman Akhtar, Suha Akili, Bolutito Akinbiyi, Oludoyinsola Akindolie, Yinka Akinfenwa, Olugbenga Akinkugbe, Ibrahim Akinpelu, Mohammad Akram, Olugbenro Aktinade, Uzayr Akudi, Ahmad S A R Al Aaraj, Asma Al Balushi, Majd Al Dakhola, Aladdin Al Swaifi, Eslam Al-Abadi, Adegoke Alabi, Narendra Aladangady, Mohamed Alafifi, Ayaz Alam, Sajid Alam, Abbas Al-Asadi, Kyriaki Alatzoglou, Paul Albert, Albertus Albertus, Lorraine Albon, Angela Alcala, Gemma Alcorn, Stephen Alcorn, Aggie Aldana, David Alderdice, Abdullah Aldesouki, Rayan Aldouri, Jonathan Aldridge, Nicolas Aldridge, Ram Maya Ale, Ana Alegria, Alison Alexander, Courtney Alexander, John Alexander, Peter D G Alexander, Julyan Al-fori, Laith Alghazawi, Osama Alhabsha, Bahij Al-Hakim, Rafil Alhameed, Mohammed Al-Hayali, Shams Al-Hity, Ali Ali, Amanda Ali, Asad Ali, Fawzia R Ali, Jawad Ali, Mariam Ali, Mohamed Ali, Mohammad Ali, Muhammad S Ali, Nayab Ali, Oudai Ali, Ramla Ali, Sakina Ali, Syed Ali, Emilio Aliberti, Jade Alin, Abid Alina, Analyn Alipustain, Bachti Alisjahbana, Fine Aliyuda, Katrin Alizadeh, Maithem Al-Jibury, Saba Al-Juboori, Majid Al-Khalil, Abdullah Alkhudhayri, Moutaz Alkhusheh, Fiona Allan, Nataliya Allan, Alison Allanson, Robert Allcock, Eireann Allen, Jade Allen, Kerry Allen, Louise Allen, Poppy Allen, Rebecca Allen, Sam Allen, Sharon Allen, Simon Allen, Tania Allen, Abiola Alli, Kathryn Allison, Bethan Allman, Helen K Allsop, Lynne Allsop, David Allsup, Amal F T Almahroos, Hassan Al-Moasseb, Magda Al-Obaidi, Lina Alomari, Akram Al-Rabahi, Bahar Al-Ramadhani, Zayneb Al-Saadi, Riyam Al-Sammarraie, Inji Alshaer, Rustam Al-Shahi Salman, Warkaq Al-Shamkhani, Fadia Alsheikh, Bashar Al-Sheklly, Sara Altaf, Amanda Alty, Mary Alvarez, Maria Alvarez Corral, Edward Alveyn, Maysaa Alzetani, Susan Amamou, Noor Amar, Sakkarai Ambalavanan, Robert Ambrogetti, Chris Ambrose, Amir Ameen, Amel Amelia Ganefianty, Katharine Ames, Maria R Amezaga, Allison Amin, Amina Amin, Kanish Amin, Syed Amin, Tara Amin, Badshah Amit, Amjad Amjad, Neelma Amjad, James Amoah-Dankwa, Victoria Amosun, Muhammad Amsal, Khaled Amsha, John Amuasi, Noelia Amutio Martin, Pugh Amy, Ann Anada, Atul Anand, Samantha Anandappa, Satya D Anantapatnaikuni, Ellen Anderson, Julie Anderson, Laura Anderson, Marina Anderson, Michelle Anderson, Nicola Anderson, Rachel Anderson, Rebecca Anderson, Rory Anderson, Samantha Anderson, Wendy Anderson, Prematie Andreou, Angela Andrews, Antonette Andrews, Jill Andrews, Joyann Andrews, Kanayochukwu Aneke, Andrew Ang, Wan Wei Ang, Tammy Angel, Aramburo Angela, Paola Angelini, Lazarus Anguvaa, Oleg Anichtchik, Millicent Anim-Somuah, Krishnan Aniruddhan, Jessica Annett, Louise Anning, Maldwyn Ansah, Patrick J Anstey, Rebekah Anstey, Alpha Anthony, Aaron Anthony-Pillai, Philip Antill, Zhelyazkova Antonina, Varghese Anu, Muhammad Anwar, Elena Apetri, Aristeidis Apostolopoulos, Sarah Appleby, Diane Appleyard, Maia F Aquino, Bianca Araba, Samuel Aransiola, Mariana Araujo, Ann Archer, Denise Archer, Samuel Archer, Simon Archer, Daniele Arcoria, Christian Ardley, Ana-Maria Arias, Oluwatoyin Aribike, Ryoki Arimoto, Charlotte Arkley, Charlotte Armah, Ilianna Armata, Jennifer Armistead, Adam Armitage, Ceri Armstrong, Maureen Armstrong, Sonia Armstrong, Wendy Armstrong, Philippa Armtrong, Heike Arndt, Clare Arnison-Newgass, David Arnold, Rachael Arnold, Andrew Arnott, Dhawal Arora, Kavan Arora, Pardeep Arora, Rishi Arora, Arslam Arter, Armena Arumaithurai, Ayush Arya, Rita Arya, Diptesh Aryal, Denisa Asandei, Adeeba Asghar, Malik Asghar, Arif Ashab, Catherine Ashbrook-Raby, Helen Ashby, Jan Ashcroft, John Ashcroft, Samuel Ashcroft, Georgia Asher, Zakariya Ashfak, Ayesha Ashfaq, Abdul Ashish, Dawn Ashley, Sally Ashman-Flavell, Sundar Ashok, Abd-El-Aziz Ashour, Muhammad Z Ashraf, Saima Ashraf, Mohammad B Ashraq, Deborah Ashton, Susan Ashton, Andrew Ashworth, Fiona J Ashworth, Rebecca Ashworth, Arshia Aslam, I Aslam, Suhail Aslam, Laura Aslett, Harshini Asogan, Atif Asrar, Omar Assaf, Raine Astin-Chamberlain, Deborah Athorne, Billie Atkins, Christopher Atkins, Stacey Atkins, John Atkinson, Vicki Atkinson, Abolaji Atomode, Brygitta Atraskiewicz, Abdul A Attia, Eva Attubato, Marie Attwood, Paula Aubrey, Zoltan Auer, Avinash Aujayeb, Aye Chan Thar Aung, Hnin Aung, Hnin Wint Wint Aung, Ko Ko Aung, Kyaw Thu Aung, Nwe Aung, Yin Aung, Zaw Myo Aung, Emily Austin, Karen Austin, Abdusshakur Auwal, Malcolm Avari, Miriam Avery, Nicholas Aveyard, Joanne Avis, Georgina Aviss, Cristina Avram, Paula Avram, Abuzar Awadelkareem, Gabriel Awadzi, Mahmoud Awaly, Atia Awan, Aszad Aya, Eman Ayaz, John Maximilian Ayerh, Amanda Ayers, Jawwad Azam, Ahmed Azeem, Mohammed Azharuddin, Ammar Aziz, Ghazala Aziz, Imran Aziz, N Aziz, Ali Azkoul, Ashaari Azman Shah, Giada Azzopardi, Hocine Azzoug, Fiyinfoluwa Babatunde, Melvin Babi, Babiker Babiker, Gayna Babington, Matthew Babirecki, Marta Babores, Adetona O Babs-Osibodu, Sammy Bacciarelli, Roudi Bachar, Michel-Elie Bachour, Alisjahbana Bachti, Gina Bacon, Jenny Bacon, Bibi Badal, Aysha Badat, Maryuma Bader, Gurpreet R Badhan, Shreya Badhrinarayanan, Joseph P Bae, Alice Baggaley, Amy Baggott, Graham Bagley, Dinesh Bagmane, Lynsey Bagshaw, Kasra Bahadori, Angela Bailey, James Bailey, Katie Bailey, Lindsey Bailey, Liz Bailey, Lucy Bailey, Maria A Bailey, Morgan Bailey, Pippa Bailey, Sarah Bailey, Hamish Baillie, J Kenneth Baillie, Jennifer Bain, Vikram Bains, David Baird, Eilidh Baird, Kevin Baird, Susan Baird, Tracy Baird, Yolanda Baird, Aiysha Bajandouh, Danielle C Baker, Evelyn Baker, Johanne Baker, Josephine Baker, Kenneth Baker, Mark Baker, Rebecca Baker, Terri-Anne Baker, Victoria Baker, Hugh Bakere, Nawar Bakerly, Michelle Baker-Moffatt, Ameet Bakhai, Nauman Bakhtiar, Panos Bakoulas, Dhanalakshmi Bakthavatsalam, Niranjan Balachandran, Andrea Balan, Prasath Balasingam, Theodosios Balaskas, Madhu Balasubramaniam, Nicola Balatoni, Alison Balcombe, Alexander Baldwin, Ashley Baldwin, Caron Baldwin, Danielle Baldwin, Fiona Baldwin, Rebekah Baldwin-Jones, Nichola Bale, James Balfour, Matthew Ball, Robert Ball, K Ballard, Ismael Balluz, Craig Balmforth, Emese Balogh, Abeir Baltmr, Amir Baluwala, Gabby Bambridge, Alasdair Bamford, Amy Bamford, Peter Bamford, Adefunke Bamgboye, Elizabeth Bancroft, Hollie Bancroft, Joyce Banda, Krishna Bandaru, Srini Bandi, Nageswar Bandla, Somaditya Bandyopadhyam, Amit Banerjee, Ritwik Banerjee, Santosh Baniya, Omar Bani-Saad, Harrison Banks, Luke Banks, Paul Banks, Claudia Bann, Helen Bannister, Oliver Bannister, Laura Banton, Tran Bao, Mariamma Baptist, Tanya Baqai, Ananya M Baral, Sharad Chandra Baral, Desislava Baramova, Russel Barber, Emma Barbon, Monica Barbosa, Jamie Barbour, Alexander Barclay, Amanda Barclay, Claire Barclay, George Bardsley, Stephanie Bareford, Shahedal Bari, Morris Barimbing, Amy Barker, Debbie Barker, Erandi Barker, Helen Barker, Joseph Barker, Leon Barker, Lesley Barker, Oliver Barker, Kerry Barker-Williams, Sinha Barkha, Juliana Barla, Gavin Barlow, Richard Barlow, Valerie Barlow, James Barnacle, Alex Barnard, Debi Barnes, Nicky Barnes, Rory Barnes, Theresa Barnes, Calum Barnetson, Amy Barnett, Ashton Barnett-Vanes, Prince Gyenti Barning, William Barnsley, Andrew Barr, David Barr, James Barr, Charlotte Barr, Nina Barratt, Shaney Barratt, Manuella Barrera, Amy Barrett, Fiona Barrett, Jessica Barrett, Sue Barrett, Esther Barrow, Jazz Bartholomew, Claire Bartlett, Georgina Bartlett, James Bartlett, Louise Bartlett, Shauna Bartley, Sandra Bartolmeu-Pires, Anna Barton, Greg Barton, Jill Barton, Lorna Barton, Rachael Barton, Rosaleen Baruah, Sonia Baryschpolec, Hannah Bashir, Archana Bashyal, Betsy Basker, Sudha Basnet, Buddha Basnyat, Ayten Basoglu, Alexander Basran, John Bassett, G Bassett, Chris Bassford, Bengisu Bassoy, Victoria Bastion, Anup Bastola, Anupam Basumatary, Precious Basvi, Jireh A Batac, Vipula R Bataduwaarachchi, Tristan Bate, Harry J Bateman, Kathryn Bateman, Vhairi Bateman, Eleanor Bates, Hayley Bates, Michelle Bates, Simon Bates, Sally Batham, Ana Batista, Amit Batla, Dushyant Batra, Harry Batty, Thomas Batty, Alice Batty, Miranda Baum, Rachel Baumber, Carina Bautista, Fareha Bawa, Tanveer Bawa, Fatima S Bawani, Simon Bax, Matt Baxter, Nicola Baxter, Zachary Baxter, Hannah Bayes, Lee-Ann Bayo, Farid Bazari, Rohit Bazaz, Ahmad Bazli, Laura Beacham, Wendy Beadles, Kirsten Beadon, Philip Beak, Andy Beale, Kathy Beard, Jack Bearpark, Alanna Beasley, Sandee Beattie, Karen Beaumont, Dawn Beaumont-Jewell, Theresa Beaver, Sarah Beavis, Christy Beazley, Sarah Beck, Virginia Beckett, Rosie Beckitt, Sarah Beckley, Heidi Beddall, Seonaid Beddows, Deborah Beeby, Sophia Beeby, Gail Beech, Michelle Beecroft, Nigel Beer, Sally Beer, Jane Beety, Gabriela Bega, Alison Begg, Susan Begg, Sara Beghini, Ayesha Begum, Salman Begum, Selina Begum, Teresa Behan, Roya Behrouzi, Jon Beishon, Claire Beith, James Belcher, Holly Belfield, Katherine Belfield, Ajay Belgaumkar, Dina Bell, Gareth Bell, Gillian Bell, Jessica Bell, Lauren Bell, Louise Bell, Nicholas Bell, Pippa Bell, Stephanie Bell, Jennifer Bellamu, Mary Bellamy, Tammy Bellamy, Arianna Bellini, Amanda Bellis, Fionn Bellis, Lesley Bendall, Naveena Benesh, Nicola Benetti, Leonie Benham, Guy Benison-Horner, Sarah Benkenstein, Tracey Benn, Ann 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Flanagan, Charles Flanders, Nikolaos Flaris, Gail Fleming, Julie Fleming, Lucy Fleming, Paul Fleming, William Flesher, Alison Fletcher, Anna Fletcher, Jonathan Fletcher, Lucy Fletcher, Simon Fletcher, Sophie Fletcher, Fiona Flett, Karen Flewitt, Sarah Flockhart, Christopher Flood, Ian Floodgate, Jonathan Flor, Vincent Florence, Mary Flowerdew, Sharon Floyd, Margaret J Flynn, Rachel Flynn, Claire Foden, Adama Fofana, Georgina Fogarty, Paul Foley, Linda Folkes, Tracey Fong, Daniela M Font, Aiwyne Foo, Jane Foo, Andrew Foot, Helen R Foot, Jayne Foot, Jane Forbes, Amber Ford, Jamie Ford, Imogen Fordham, Jennifer Foreman, Matthew Forester, Mohammad Forkan, Caroline Fornolles, Adam Forrest, Ellie Forsey, Miranda Forsey, Thomas Forshall, Elliot Forster, Abigail Forsyth, Julian Forton, Conrad Foster, Emily Foster, Joseph Foster, Rachel A Foster, Tracy Foster, Angela Foulds, Ian Foulds, Folakemi Fowe, Natasha Fowkes, Emily Fowler, Robert Fowler, Stephen Fowler, Amy Fox, Claire Fox, Heather Fox, 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Giokanini-Royal, Anna Gipson, Barbie Giri, Joanna Girling, Rhian Gisby, Angelena Gkioni, Aikaterini Gkoritsa, Effrossyni Gkrania-Klotsas, Amy Gladwell, James Glanville, Jessica Glasgow, Susannah Glasgow, Jon Glass, Lynn Glass, Sharon Glaysher, Lisa Gledhill, Eleanor Glenday, Ana Glennon, Jodie Glossop, John Glover, Kyle Glover, Michelle Glover, Jan Glover Bengtsson, Deborah Glowski, Sharon Glynn, Chevanthy Gnanalingam, Julie Goddard, Wendy Goddard, Emily Godden, Jo Godden, Sarah Godlee, Emma Godson, Gillian Godwin, Sukanya Gogoi, Aiky Goh, Manjinder Gohel, Rebeca Goiriz, Sriya Gokaraju, Raphael Goldacre, Arthur Goldsmith, Portia Goldsmith, Darren Gomersall, Lucia Gomez, Raquel Gomez-Marcos, Ali Gondal, Celia Gonzalez, Jack Goodall, Vicky Goodall, Bob Goodenough, Anna Goodfellow, Laura Goodfellow, James Goodlife, Camelia Goodwin, Elizabeth Goodwin, Jayne Goodwin, Paula Goodyear, Rajiv Gooentilleke, Michelle Goonasekara, Sheila Gooseman, Shameer Gopal, Chris Gordon, Sally Gordon, Robin 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Hale, Jennie Hale, Carmel Halevy, Paul Halford, William Halford, Alaina Halim, Alistair Hall, Anthony Hall, Claire Hall, Elizabeth Hall, Fiona Hall, Helen Hall, Jennifer Hall, Kathryn Hall, Laura Hall, Jan Hallas, Kyle Hallas, Charles Hallett, Jackie Halliday, Akmal Hallman, Heather Halls, Maryam Hamdollah-Zadeh, Ifedadepo A Hamed-Adekale, Bilal Hameed, Mohammed Hameed, Raph L Hamers, Imran Hamid, Mohamad Hamie, Raymond Hamill, Bethany Hamilton, Fergus Hamilton, Gus Hamilton, Leigh Hamilton, Melanie Hamilton, Nicola Hamilton, Sara Hamilton, Ruth Hamlin, Eleanor Hamlyn, Beatrice Hammans, Shirley Hammersley, Kate Hammerton, Bev Hammond, Emily Hammond, Leah Hammond, Sally Hammond, Fiona Hammonds, Ibrahim Hamoodi, Karen Hampshire, James A Hampson, Jude Hampson, Lucy Hampson, Lisa Hamzah, Jenny Han, Ozan Hanci, Sadiyah Hand, Lala Handayani, Jasmine Handford, Soran Handrean, Nina K Handzewniak, Sarah Haney, Vu Thi Kim Hang, Sheharyar Hanif, E Hanison, Esther Hanison, Jennifer Hannah, Amy 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Ruth Hartley, Tom Hartley, William Hartrey, Phillipa Hartridge, Stuart Hartshorn, Alice Harvey, Angela Harvey, Anna Harvey, Max Harvey, Catherine Harwood, Helen Harwood, Zoe Harzeli, Brigitte Haselden, Kazi Hashem, Mohammed Hashimm, Tadaaki Hashimoto, Imranullah Hashmi, Jack Haslam, Zena Haslam, Grace Hasnip, Adil Hassan, Ali Hassan, Amro Hassan, Awab Hassan, Zeinab Hassan, Sapna Hassasing, Jane Hassell, Philip Hassell, Alex Hastings, Bethany Hastings, Janice Hastings, Sarah Hathaway-Lees, Jonathan Hatton, Jennifer Hau, May Havinden-Williams, Stefan Havlik, Daniel B Hawcutt, Kadean Hawes, Liz Hawes, Nicola Hawes, Lydia Hawker, Annie Hawkins, Joe Hawkins, Nancy Hawkins, W John Hawkins, Dan Hawley, Ed Hawley-Jones, Edward Haworth, Alasdair W Hay, Cathy Hay, Amna Hayat, Jamal Hayat, Mohamed-Riyal Hayathu, Anne Hayes, Jonas Hayes, Kate Hayes, Melony Hayes, Fiona Hayes, Patrick Hayle, Chloe Haylett, Antara Hayman, Melanie Hayman, Matthew Haynes, Richard Haynes, Rachel Hayre, Carole Hays, Sarah Haysom, James Hayward, Patrick Haywood, Hazel Haywood Hasford, Tracy Hazelton, Phoebe Hazenberg, Zhengmai He, Elizabeth Headon, Carrie Heal, Brendan Healy, Jessica L Healy, Amy Hearn, David Heasman, Angela Heath, Debbie Heath, Rowan Heath, Diane Heaton, Adam Heavens, Kerry Hebbron, Catherine Heckman, Gemma Hector, Sadie Heddon, Andy Hedges, Katrine Hedges, Cheryl Heeley, Elaine Heeney, Richard Heinink, Rajdeep Heire, Ingvild Helgesen, Joanne Hemingway, Ulla Hemmila, Beth Hemmings, Scott Hemphill, Deborah Hemsley, Abigail Henderson, Eilidh Henderson, Jennifer Henderson, Steven Henderson, Joanne Henry, Karol Henry, Lavinia Henry, Margo Henry, Natalie Henry, David Henshall, Gillian Herdman, Rosaleen Herdman-Grant, Morag Herkes, Lucas E Hermans, Fe Marie Hernandez, Emma Heron, Lisa Heron, William Herrington, Emilia Heselden, Peta Heslop, Tracey Heslop, Simon Hester, Emily Hetherington, Joseph Hetherington, Chamila Hettiarachchi, Pramodh Hettiarachchi, Hayley Hewer, John Hewertson, Anna Hewetson, Sue Hewins, Nicola Hewitson, Claire Hewitt, Davina Hewitt, Richard Hewitt, Samuel Hey, Robert S Heyderman, Mathis Heydtmann, Joseph Heys, Jonathan Heywood, Meg Hibbert, John Hickey, Naomi Hickey, Peter Hickey, Nicky Hickman, Alex Hicks, Jenny Hicks, Scott R Hicks, Phan Thi Thu Hien, Daniel Higbee, Lucy Higgins, Andrew Higham, Martin Highcock, Judith Highgate, Mondy Hikmat, Amanda Hill, Helen Hill, Joanne Hill, Lisa Hill, Lucy Hill, Phoebe Hill, Uta Hill, Annette Hilldrith, Catherine Hillman-Cooper, Jon Hilton, Zoe Hilton, Sarah Hinch, Andrew Hindle, Esther Hindley, Alice Hindmarsh, Paul Hine, Kim Hinshaw, Clare Hird, Claire Hirst, Lindsay Hirst, Jemma Hives, Htet M Hlaing, Benson Ho, David K K Ho, Rosemary Ho, Michaela Hoare, David Hobden, Gill Hobden, Maria Hobrok, Simon Hobson, Christopher Hodge, Simon Hodge, Lesley Hodgen, George Hodgetts, Holly Hodgkins, Sally Hodgkinson, David Hodgson, Helen Hodgson, Luke Hodgson, Sheila Hodgson, Gemma Hodkinson, Kenneth Hodson, 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Elizabeth Horsley, Sarah Horton, Jane Hosea, Toby Hoskins, Muhammad S Hossain, Rashed Hossain, Maxine Hough, Sarah Hough, Catherine Houghton, Kathryn Houghton, Rebecca Houlihan, Kay Housely, Hamish Houston, Roseanna Hovvels, Lee How, Laura Howaniec, Joanne Howard, Kate Howard, Laura Howard, Linda Howard, Lucy Howard, Megan Howard, Sarah Howard, Stuart Howard, Richard Howard-Griffin, Louise Howard-Sandy, Serena Howe, Alice Howell, Mark Howells, Lyn Howie, Kerry Howlett, Sophie Howlett, Ruth Howman, Josh Hrycaiczuk, Hein Htet, Naing Z Htoon, Su Htwe, Ying Hu, Chiang O H Huah, Sylvia Huang, Kelly Hubbard, Abby Huckle, Shahzya Huda, Alison Hudak, Lisa Hudig, Heather Hudson, Suzanne Hudson, Oli Hudson, Alison Hufton, Connor Huggins, Alistair Hughes, Caitlin Hughes, Emma Hughes, Gareth Hughes, Heather Hughes, Luke Hughes, Martin Hughes, Rachel Hughes, Rebecca Hughes, Samantha Hughes, Stephen Hughes, Vikki Hughes, Wesley Hughes, Lukas Huhn, Ching Hui, Ruth Hulbert, Diana Hull, Grace Hull, Robert Hull, Amanda Hulme, Peter Hulme, Wendy Hulse, George Hulston, Ryan Hum, Megan Hume, Charlotte Humphrey, Alasdair Humphries, Amy Humphries, Joanne Humphries, Charlotte Hunt, Fiona Hunt, Jane Hunt, Jonquil Hunt, Kristen Hunt, Luke Hunt, Molly Hunt, Sophie Hunt, Alexandra Hunter, Catherine Hunter, Ewan Hunter, Karl Hunter, Neil Hunter, Ross Hunter, Sophie Hunter, George Huntington, Fuad Huq, Elizabeth Hurditch, Judith Hurdman, Cian Hurley, Katrina Hurley, Mohammed A Husain, Syeda Y Husaini, Coralie Huson, Afreen Hussain, Chreif Hussain, Ibraar Hussain, Ifza Hussain, Mohammad Hussain, Mohammed Hussain, Muhammad Hussain, Reda Hussain, Rizwana Hussain, Samia Hussain, Sanniah Hussain, Yasmin Hussain, Mohammed Hussam El-Din, Samahir F E M Hussein, Ziad Hussein, Rebecca Hussey, Adiel Haqiq Hussien, Anja Hutchinson, Camille Hutchinson, Dorothy Hutchinson, Elizabeth Hutchinson, John Hutchinson, Claire Hutsby, Paula Hutton, Nguyen Quang Huy, Thuong Huyen, Tran Bang Huyen, Nguyen Thi Huyen Thuong, Hieu Huynh, Daniella Hydes, Jamie Hyde-Wyatt, Niamh Hynes, Megan Hyslop, Angeliki Iakovou, Katherine Ibison, Mazen Ibraheim, Abdalla Ibrahim, Ahmed Ibrahim, Asil Ibrahim, Javed Ibrahim, Mamoun Ibrahim, Mohamed Ibrahim, Wadah Ibrahim, Becky Icke, Adetokunbo Idowu Idowu, Muhammad Idrees, Nauman Idrees, Hina Iftikhar, Mawara Iftikhar, Chukwuemeka Igwe, Ogechukwu Igwe, Mohammad Ijaz, Amaju Ikomi, Clare Iles, Stamatina Iliodromiti, Mary Ilsley, Lorna Ilves, Fatima Mariam Ilyas, La'ali Imam-Gutierrez, Mohamed Iman, Christopher Imray, Haider Imtiaz, Jack Ingham, Jo Ingham, Julie Ingham, Rory Ingham, Tejas Ingle, Jennifer Inglis, Samantha Inglis-Hawkes, Anne Ingram, Luke Ingram, Tanya Ingram, Nicholas Innes, Peter Inns, Vithusha Inpadhas, Ken Inweregbu, Andreea A Ionescu, Ana Ionita, Ilian Petkov Iordanov, Anil Ipe, Javaid Iqbal, Madiha Iqbal, Mishal Iqbal, Mohammed Iqbal, Faisal Iqbal Sait, Iziegbe Irabor, Jane Ireland, Jamie Irisari, Robert Irons, Mohannad Irshad, Muhammad S Irshad, 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Jennings, Jacqui Jennings, Louise Jennings, Virginia Jennings, Ellen Jerome, Douglas Jerry, Greame Jervis, Ellen Jessup-Dunton, Jorge A Jesus Silva, Champa Jetha, Kishan Jethwa, Roshan Kumar Jha, Shaman Jhanji, Khoo Jian, Zhixin Jiao, Laura Jimenez, Ana Jimenez Gil, Jithin Jith, Teishel Joefield, Navraj Johal, Simran Johal, Karine Johannessen, Aisyah Johari, Annie John, Anu John, Maya John, Navin John, Emma Johns, Margaret Johns, Antoinette Johnson, Emma Johnson, Gillian Johnson, Kathryn Johnson, Katie Johnson, Luke Johnson, Mark Johnson, Nelsonseelan Johnson, Oliver Johnson, Rachel Johnson, Brogan Johnston, Claire Johnston, Janet Johnston, Susan Johnston, Victoria Johnston, Dawn Johnstone, Ed Johnstone, Janet Johnstone, Manohar Joishy, Adam Jones, Alistair Jones, Amy Jones, Angela Jones, Annabel Jones, Ben Jones, Bryony Jones, Carys Jones, Ceri Jones, Charlotte Jones, Christine E Jones, Debra Jones, Emily Jones, Gareth Jones, Geraldine Jones, Jac Jones, James Jones, Jonathon Jones, Julie Jones, Kate E Jones, Kimberly Jones, Laura Jones, Laura M Jones, Louise Jones, Mathew Jones, Nancy Jones, Nicola Jones, Olivia Jones, Paul Jones, Philip H Jones, Rhianna Jones, Ruth E Jones, Samantha Jones, Sophie Jones, Stefanie Jones, Steve Jones, Susan Jones, Taya Jones, Thomas Jones, Tim Jones, Tracey Jones, Ramya Jonnalagadda, Rebecca Jordache, Michele Jordan, Sarah Jordan, Abi Jose, Litty Jose, Louise Jose, Sanal Jose, Anna Joseph, Gigee Joseph, P Aiden Joseph, Rosane Joseph, Sibet Joseph, Dhaara Joshi, Mehul Joshi, Pratichi Joshi, Tushar Joshi, Benz Josiah, Lijo Joy, Tiffany Joyce, Hong Ju, Adriel Ju Wen Kwek, Andrew Judd, Edward Jude, Parminder Judge, Jessica Juhl, Sirisha Jujjavarapu, Mark Juniper, Edmund Juszczak, Deepthi Jyothish, Kasamu Kabiru Dawa, Mark Kacar, Nikhil Kadam, Nicole Kader, Ajai Kailey, Matthew Kain, Gail Kakoullis, Azad Kala Bhushan, Richard J K Kalayi, Roobala Kaliannan Periyasami, Efthymia Kallistrou, Thomas Kalmus Eliasz, Seika Kalsoom, Elisa Kam, 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Younes Ibrahim, Eoin Young, Gail Young, Louise Young, Asfand Yousafzar, Sajeda Youssouf, Ahmed Yousuf, Hartantri Yovita, Chrissie Yu, Jack S J Yuan, Nindya Yufaniaputri, Bernard Yung, Daniel Yusef, Said Yusef, Intekhab Yusuf, Anna-Sophia Zafar, Silvia Zagalo, Su Zaher, Aqsa Zahoor, Mahrukh Zainab, Thornton Zak, Kareem Zaki, Nabhan Zakir, Kasia Zalewska, Ane Zamalloa, Mohsin Zaman, Shakir Zaman, Julie Zamikula, Louise Zammit, Marie Zammit-Mangion, Marcelina Zawadzka, Mohammed Zayed, Esther Zebracki, Daniel Zehnder, Lisa Zeidan, Darius Zeinali, Jing Zhang, Xiaobei Zhao, Dongling Zheng, Doreen Zhu, Madiha Zia, Omar Zibdeh, Rabia Zill-E-Huma, Ei Thankt Zin, Eva Zincone, Garikai Zindoga, Eleanor Zinkin, Vivian Zinyemba, Christos Zipitis, Letizia Zitter, Arkadiusz Zmierczak, Garazi Zubikarai, Azam Zubir, Naz Zuhra, Rasha Zulaikha, Sabrina Zulfikar, Carol Zullo, Ana Zuriaga-Alvaro, University of St Andrews. Infection and Global Health Division, University of St Andrews. School of Medicine, and Group, RECOVERY Collaborative
Subjects: Adult, Male, Hypoxia/etiology, SARS-CoV-2, COVID-19, 3rd-DAS, General Medicine, Adrenal Cortex Hormones/therapeutic use, AC, Dexamethasone/therapeutic use, Hospitals, Oxygen, Treatment Outcome, SDG 3 - Good Health and Well-being, MCP, Humans, Female
Abstract: Background Low-dose corticosteroids have been shown to reduce mortality for patients with COVID-19 requiring oxygen or ventilatory support (non-invasive mechanical ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation). We evaluated the use of a higher dose of corticosteroids in this patient group. Methods This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing multiple possible treatments in patients hospitalised for COVID-19. Eligible and consenting adult patients with clinical evidence of hypoxia (ie, receiving oxygen or with oxygen saturation Findings Between May 25, 2021, and May 13, 2022, 1272 patients with COVID-19 and hypoxia receiving no oxygen (eight [1%]) or simple oxygen only (1264 [99%]) were randomly allocated to receive usual care plus higher dose corticosteroids (659 patients) versus usual care alone (613 patients, of whom 87% received low-dose corticosteroids during the follow-up period). Of those randomly assigned, 745 (59%) were in Asia, 512 (40%) in the UK, and 15 (1%) in Africa. 248 (19%) had diabetes and 769 (60%) were male. Overall, 123 (19%) of 659 patients allocated to higher dose corticosteroids versus 75 (12%) of 613 patients allocated to usual care died within 28 days (rate ratio 1·59 [95% CI 1·20–2·10]; p=0·0012). There was also an excess of pneumonia reported to be due to non-COVID infection (64 cases [10%] vs 37 cases [6%]; absolute difference 3·7% [95% CI 0·7–6·6]) and an increase in hyperglycaemia requiring increased insulin dose (142 [22%] vs 87 [14%]; absolute difference 7·4% [95% CI 3·2–11·5]). Interpretation In patients hospitalised for COVID-19 with clinical hypoxia who required either no oxygen or simple oxygen only, higher dose corticosteroids significantly increased the risk of death compared with usual care, which included low-dose corticosteroids. The RECOVERY trial continues to assess the effects of higher dose corticosteroids in patients hospitalised with COVID-19 who require non-invasive ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation. Funding UK Research and Innovation (Medical Research Council), National Institute of Health and Care Research, and Wellcome Trust.
Published: 2023
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12. A comparison of clinical profile and outcomes among different age groups of critically ill elderly patients in a tertiary level hospital in Nepal: A retrospective study

Author: null Sabin Bhandari, null Subhash Prasad Acharya, null Gentle Sunder Shrestha, null Pramesh Sunder Shrestha, and null Hem Raj Paneru
Subjects: General Agricultural and Biological Sciences
Abstract: Background: Ageing population has increased the rate of hospitalizations and demand for critical care services. The data on the clinical profile and outcomes of different groups of elderly admitted to the intensive care units (ICU) are however sparse. Aims and Objectives: The aim of this study was to evaluate and compare the clinical profile and outcomes among different age groups of critically ill elderly patients admitted to the ICU of a tertiary level hospital. Materials and Methods: This retrospective and observational study reviewed all the elderly patients aged 60 years and above, admitted to the ICU of a tertiary hospital over a period of 1 year. The patients were divided into three groups, 60–69 years, 70–79 years, and 80 years and above. Non-probability sampling was done. Kruskal–Wallis H test was performed to compare the median values of the variables between the three groups. Results: Among 173 patients analyzed, the three groups did not differ in clinical characteristics, requirement of renal replacement therapy and cardiovascular support, length of stay (LOS) in ICU, LOS in mechanical ventilator, and patients who improved and transferred out of ICU. Acute physiology and chronic health evaluation II (APACHE) II score was significantly higher in 70–79 years compared to the other two groups (P=0.01) as was the in-hospital mortality (P=0.03). Conclusion: APACHE II score rather than age is a good predictor of adverse outcomes in ICU. Age should not be used to preclude the utilization of resources in ICU.
Published: 2023
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13. Comparison of airway pressure release ventilation with low tidal volume ventilation in patients with acute respiratory failure

Author: Hem Raj Paneru, Subhash Prasad Acharya, and Moda Nath Marhatta
Abstract: Background and aims:Acute respiratory failure (ARF) frequently requires invasive mechanical ventilation. Though low tidal volume ventilation has improved outcome of these patients, mortality is still high. We aimed to assess whether the use of Airway Pressure Release Ventilation (APRV) results in better oxygenation compared to Low Tidal Volume (LTV) ventilation in patients with ARF. Methods: Patients with ARF requiring mechanical ventilation were randomized into either APRV or LTV ventilation. PaO2 and PaO2/FiO2 ratio were recorded and compared between the groups for the assessment of effect on oxygenation. Results: Two hundred and two patients were included in the study with 101 patients in each group. Baseline oxygenation status, APACHE II scores, and demographic parameters were similar in both the groups. PaO2 values at the time of admission (73.73 ± 22.23 mmHg in APRV group and 75.13 ± 20.43 mmHg in LTV group; p = 0.643), at 24 hours (176.21 ± 50.70 vs 180.62 ± 53.19 mmHg; p = 0.547) and at 72 hours (208.17 ± 61.20 vs 211.36 ± 50.89 mmHg; p = 0.688) were similar between the groups. The mean values of PaO2/FiO2 ratio at 0, 24, and 72 hours were 178.67 ± 55.51 vs 186.09 ± 53.34, 285.87 ± 69.08 vs 290.95 ± 63.56, and 288.95 ± 71.51 vs 283.78 ± 59.13 mmHg respectively in APRV and LTV groups. Conclusion: Both APRV and LTV modes improved oxygenation and had similar effects on oxygenation in patients with ARF.
Published: 2023
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14. Sildenafil induced seizures in a patient treated for pulmonary hypertension: A case report

Author: Sunti Barahi and Hem Raj Paneru
Abstract: Sildenafil is one of the common drugs used to treat pulmonary hypertension. We report a rare case of a life-threatening adverse effect of Sildenafil. The patient was admitted to our intensive care unit for the management of urosepsis with obesity hypoventilation syndrome with pulmonary hypertension. After administration of the first dosage of Sildenafil, the patient developed generalized tonic-clonic seizure. She had no previous history of seizure disorder. She was investigated for the possible cause of seizure, but none were conclusive. Sildenafil was discontinued and she remained seizure free after discontinuation of it. Sildenafil can increase the effects mediated by nitric oxide and can thus affect the seizure threshold. Though rare, seizure as an adverse effect of Sildenafil should be considered before initiating this drug.
Published: 2023
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15. Combination of convalescent plasma therapy and repurposed drugs to treat severe COVID‐19 patient with multimorbidity

Author: Bipin Nepal, Suraj Bhattarai, S. K. Das, Pradip Gyanwali, Khem Bahadur Karki, Kamal Ranabhat, Subhash Prasad Acharya, Hem Raj Paneru, and Shyam Prakash Dumre
Subjects: medicine.medical_specialty, 2019-20 coronavirus outbreak, Medicine (General), Convalescent plasma, Coronavirus disease 2019 (COVID-19), multimorbidity, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), convalescent plasma therapy, Case Report, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, R5-920, Nepal, Internal medicine, Diabetes mellitus, medicine, Dexamethasone, business.industry, General Medicine, medicine.disease, COVID‐19 infection, 030220 oncology & carcinogenesis, Medicine, business, medicine.drug
Abstract: Combination of convalescent plasma therapy and repurposed drugs such as dexamethasone and remdesivir could be beneficial for severe COVID‐19 patients with obesity and chronic diseases such as diabetes and hypertension., Combination of convalescent plasma therapy and repurposed drugs such as dexamethasone and remdesivir could be beneficial for severe COVID‐19 patients with obesity and chronic diseases such as diabetes and hypertension
Published: 2021

16. Epidemiology of critically ill patients in intensive care units in Nepal: a retrospective observational study

Author: Diptesh Aryal, Anand Thakur, Basanta Gauli, Hem Raj Paneru, Kanchan Koirala, Kishor Khanal, Lalit Kumar Rajbanshi, Niroj Hirachan, Pramesh Sunder Shrestha, Pradip Tiwari, Raju Shrestha, Riju Dhakal, Rupesh Gami, Sabin Koirala, Sanjay Lakhey, Shital Adhikari, Subekshya Luitel, Subha Kalyan Shrestha, Subhash Prasad Acharya, Sushil Khanal, Tamanna Bajracharya, Tiffany E Gooden, Fathima Fazla, Abi Beane, and Rashan Haniffa
Subjects: Medicine (miscellaneous), General Biochemistry, Genetics and Molecular Biology
Abstract: Background: Epidemiological data on critically ill patients is crucial for understanding resource utilisation, gaps in quality of care and for supporting surveillance of endemic or emerging diseases. We report the epidemiology of critically ill patients from 17 intensive care units (ICUs) in Nepal using an established and standardised ICU registry. Methods: The ICU registry data is collected prospectively and includes data on case mix, severity, organ support and outcomes. We conducted a retrospective observational study with all adult (≥18 years) critically ill patients admitted to 17 ICUs in Nepal between September 2019 and September 2022. We report on case mix, treatment received, severity of illness, standardised mortality rates (SMR), discharge outcomes and ICU service activity. Descriptive statistics were used to report the findings. Results: Of the 18603 unique admissions, 14% were operative, with 35% emergency surgeries. Patients’ median age was 57 (IQR 40-71) and 59% were male. Hypertension and diabetes were common comorbidities and pneumonia accounted for 26% of all admissions. During the ICU stay, 39% of patients received mechanical ventilation, 29% received vasoactive medication and 10% received renal replacement therapy. The median predicted risk of death was 0.1 (IQR 0.1-0.3) using APACHE II and 0.2 (IQR 0.1-0.4) using eTropICS. The median SMR was 0.7 (IQR 0.5-0.8) and 0.8 (IQR 0.6-1.4) using eTropICS and APACHE II, respectively. Median length of stay was 4 days (IQR 2-7). Eighteen percent died in the ICU; of those alive at discharge, 12% went home, 84% went to another department and 3% went to another hospital. COVID-19 was the most common notifiable disease reported (12% of all admissions). Median ICU turnover was 9% (IQR 6-14) with bed capacity ranging from 43-278. Conclusions: These findings should guide forecasting and service planning to ensure ICUs can optimally care for critically ill patients in Nepal.
Published: 2023
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17. Incidence, risk and impact of ICU readmission on patient outcomes and resource utilisation in tertiary level ICUs in Nepal: A cohort study

Author: Diptesh Aryal, Hem Raj Paneru, Sabin Koirala, Sushil Khanal, Subhash Prasad Acharya, Arjun Karki, Dilanthi Gamaga Dona, Rashan Haniffa, Abi Beane, and Jorge I F Salluh
Subjects: Medicine (miscellaneous), General Biochemistry, Genetics and Molecular Biology
Abstract: Background: Readmissions to Intensive Care Units (ICUs) result in increased morbidity, mortality, and ICU resource utilisation (e.g. prolonged mechanical ventilation), and as such, is a widely utilised metric of quality of critical care. Most of the evidence on incidence, characteristics, associated risk factors and attributable outcomes of unplanned readmission to ICU are from studies performed in high-income countries This study explores the determinants of risk attributable to unplanned ICU readmission in four ICUs in Kathmandu, Nepal. Methods: The registry-embedded eCRF reported data on case mix, severity of illness, in-ICU interventions (including organ support), ICU outcome, and readmission characteristics. Data were captured in all adult patients admitted between September 2019 and February 2021. Population and ICU encounter characteristics were compared between those with and without readmission. Independent risk factors for readmission were assessed using univariate analysis. Results: In total 2955 patients were included in the study. Absolute unplanned ICU readmission rate was 5.69 % (n=168) for all four ICUs. Median time from ICU discharge to readmission was 3 days (IQR=8,1). Of those readmitted, 29.17% (n=49) were discharged at night following their index admission. ICU mortality was higher following readmission to ICU(p=0.016) and mortality was increased further in patients whose primary index discharge was at night(p= 0.019). Primary diagnosis, age, and use of organ support in the first 24hrs of index admission were all independently attributable risk factors for readmission. Conclusions: Unplanned ICU readmission rates were adversely associated with significantly poorer outcomes, increased ICU resource utilisation. Clinical and organisational characteristics influenced risk of readmission and outcome.
Published: 2023
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18. Mixed methods study protocol for combining stakeholder-led rapid evaluation with near real-time continuous registry data to facilitate evaluations of quality of care in intensive care units

Author: Aasiyah Rashan, Wangari Waweru-Siika, Swagata Tripathy, Catherine Thwaites, Arjen M Dondorp, Mohd Basri Mat Nor, David Thomson, Luigi Pisani, Timo Tolppa, Rashan Haniffa, Hem Raj Paneru, Madiha Hashmi, Jorge Salluh, Tiffany Gooden, Snehal Pinto Pereira, Ishara Udayanga, Dilanthi Priyadarshani Gamage Dona, Maryam Shamal Ghalib, Diptesh Aryal, Aniruddha Ghose, Abigail Beane, and Bharath Kumar Tirupakuzhi Vijayaraghavan
Subjects: Medicine (miscellaneous), General Biochemistry, Genetics and Molecular Biology
Abstract: Background: Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous prevention of avoidable harms associated with the illness and the treatment interventions. Therefore, successful design and implementation of improvement interventions requires understanding of the behavioural, organisational, and external factors that determine care delivery and the likelihood of achieving sustained improvement. We aim to identify care processes that contribute to suboptimal clinical outcomes in ICUs located in LMICs and to establish barriers and enablers for improving the care processes. Methods: Using rapid evaluation methods, we will use four data collection methods: 1) registry embedded indicators to assess quality of care processes and their associated outcomes; 2) process mapping to provide a preliminary framework to understand gaps between current and desired care practices; 3) structured observations of processes of interest identified from the process mapping and; 4) focus group discussions with stakeholders to identify barriers and enablers influencing the gap between current and desired care practices. We will also collect self-assessments of readiness for quality improvement. Data collection and analysis will be performed in parallel and through an iterative process across eight countries: Kenya, India, Malaysia, Nepal, Pakistan, South Africa, Uganda and Vietnam. Conclusions: The results of our study will provide essential information on where and how care processes can be improved to facilitate better quality of care to critically ill patients in LMICs; thus, reduce preventable mortality and morbidity in ICUs. Furthermore, understanding the rapid evaluation methods that will be used for this study will allow other researchers and healthcare professionals to carry out similar research in ICUs and other health services.
Published: 2023
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19. Incidence, risk and impact of unplanned ICU readmission on patient outcomes and resource utilisation in tertiary level ICUs in Nepal: A cohort study

Author: Diptesh Aryal, Hem Raj Paneru, Sabin Koirala, Sushil Khanal, Subhash Prasad Acharya, Arjun Karki, Dilanthi Gamaga Dona, Rashan Haniffa, Abi Beane, and Jorge I F Salluh
Subjects: Medicine (miscellaneous), General Biochemistry, Genetics and Molecular Biology
Abstract: Background: Unplanned readmissions to Intensive Care Units (ICUs) result in increased morbidity, mortality, and ICU resource utilisation (e.g. prolonged mechanical ventilation), and as such, is a widely utilised metric of quality of critical care. Most of the evidence on incidence, characteristics, associated risk factors and attributable outcomes of unplanned readmission to ICU are from studies performed in high-income countries This study explores the determinants of risk attributable to unplanned ICU readmission in four ICUs in Kathmandu, Nepal. Methods: The registry-embedded eCRF reported data on case mix, severity of illness, in-ICU interventions (including organ support), ICU outcome, and readmission characteristics. Data were captured in all adult patients admitted between September 2019 and February 2021. Population and ICU encounter characteristics were compared between those with and without readmission. Independent risk factors for readmission were assessed using univariate analysis. Results: In total 2948 patients were included in the study. Absolute unplanned ICU readmission rate was 5.60 % (n=165) for all four ICUs. Median time from ICU discharge to readmission was 3 days (IQR=8,1). Of those readmitted, 29.7% (n=49) were discharged at night following their index admission. ICU mortality was higher following readmission to ICU(p=0.016) and mortality was increased further in patients whose primary index discharge was at night(p= 0.019). Primary diagnosis, age, and use of organ support in the first 24hrs of index admission were all independently attributable risk factors for readmission. Conclusions: Unplanned ICU readmission rates were adversely associated with significantly poorer outcomes, increased ICU resource utilisation. Clinical and organisational characteristics influenced risk of readmission and outcome.
Published: 2022
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20. Precision medicine for COVID-19: a call for better clinical trials

Author: Jean Louis Vincent, Gentle Sunder Shrestha, and Hem Raj Paneru
Subjects: 2019-20 coronavirus outbreak, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Pneumonia, Viral, MEDLINE, Critical Care and Intensive Care Medicine, Pandemic, medicine, Humans, Precision Medicine, Intensive care medicine, Pandemics, Clinical Trials as Topic, Viral Epidemiology, business.industry, lcsh:Medical emergencies. Critical care. Intensive care. First aid, COVID-19, lcsh:RC86-88.9, Sciences bio-médicales et agricoles, Coronavirus Infections -- epidemiology -- therapy, Precision medicine, medicine.disease, Clinical trial, Pneumonia, Viral -- epidemiology -- therapy, Pneumonia, Editorial, Clinical Trials as Topic -- standards, business, Coronavirus Infections
Abstract: info:eu-repo/semantics/published
Published: 2020
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21. Point-of-care ultrasonography: training, applications and barriers. A survey study

Author: Gentle Sunder Shrestha, Sandip Bhandari, Diptesh Aryal, Saurabh Pradhan, Sabin Koirala, Navindra Raj Bista, Hem Raj Paneru, Niraj Kumar Keyal, Shailendra Sigdel, Amit S Bhattarai, Ashish Amatya, Bashu Dev Parajuli, Sharma Paudel, Ninadini Shrestha, Anand Thakur, Bigen Man Shakya, Megha Koirala, Bibhush Shrestha, Pragya Acharya, Tamanna Bajracharya, Benu Lohani, Pramesh Sunder Shrestha, Arjun Gurung, Bindu L. Shah, Subhash Prasad Acharya, and Achyut Sharma
Subjects: medicine.medical_specialty, business.industry, education, Medicine, Survey research, Medical physics, Point of care ultrasonography, business, Training (civil)
Abstract: Background and Aims: Use of point-of-care ultrasound (POCUS) in acute care setting has rapidly increased and has potentials to guide patient management. This survey study aims to explore the usefulness of a one-day workshop and to elicit the perceived barriers for effective use of POCUS. Methods: A total of 169 doctors who had attended one day Acute Care Ultrasound workshop were approached through email. Online link to access the survey created using Google forms was sent. The survey contained questions related to the details about the participants, feedback about the workshop, whether the workshop has helped to change the practice of the participants, availability of ultrasound machine during the daily practice and the perceived barriers for use of POCUS. Results: A total of 41 responses were obtained. Majority of the participants had anaesthesiology as the base specialty followed by general practice. Most of them had ICU as their predominant working place, followed by emergency room and operating room. The workshop was found to be helpful by most of the participants. Majority of the participants (20 participants; 49%) had ultrasound machine sometimes available during their daily practice. Only 20% (8 participants) had ultrasound machine always available during their clinical practice. Similarly, 46% (19 participants) considered lack of access to ultrasound machine as a barrier for application of POCUS. Significant number of participants considered lack of supervision and guidance (18 participants; 44%) and lack of knowledge and skills (13 participants; 32%) as the barriers. Conclusions: Majority of the participants found the one-day workshop helpful. Doctors from various specialty, working in acute care setting had participated in the survey. Limited access to ultrasound machine, together with lack of adequate knowledge and skills were perceived as major barriers for effective use of point-of-care ultrasound.
Published: 2019
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22. Clinical Profile of Critically Ill Patients Presenting to Emergency Department of Tertiary Level Hospital of Nepal

Author: Bishwas Pradhan, Yogendra M Shakya, Hem Raj Paneru, and Shubha K Shrestha
Subjects: COPD, medicine.medical_specialty, Exacerbation, business.industry, Critically ill, Mortality rate, Emergency department, medicine.disease, Pneumonia, Emergency medicine, medicine, business, Prospective cohort study, Kidney disease
Abstract: Introduction: Among critically ill patients presenting to Emergency Room (ER) of Tribhuwan University Teaching Hospital (TUTH), a number of patients have to either remain in ER or have to be referred outside due to unavailability of critical care beds. Studies have shown significant association between delayed admission and mortality rates along with increased length of stay and higher cost. This study aimed to present an audit of critically ill patients presenting to ER of TUTH. Methods: This was a prospective study conducted over a period of one month. All patients presenting to ER of TUTH were triaged and critically ill patients were shifted to Red area of the ER. All patients ≥16 years of age shifted to Red area during the study period were enrolled in our study. Results: Out of 3718 patients presenting to ER during the study period, the number of critically ill patients ≥16 years of age was 526 i.e. 14.14% of total patients. Among them, the common diagnosis were Cerebrovascular Accidents (CVA) followed by Intoxication, Acute Exacerbation(AE) of Chronic Obstructive Pulmonary Disease(COPD), Pneumonia and Chronic Kidney Disease(CKD) respectively. Almost 20% of these patients were admitted, 31% were referred and 40% were shifted for observation. The median length of ER stay was 6 hours (Mean: 8.5 hrs; Range: 20 min to 70 hr 15 min). Conclusion: Among critically ill patients presenting to our ER, almost 1/5thof the patients were admitted whereas more than 2/3rd were either referred or remained in our ER. This data highlights the need for solutions to provide optimal care for the acute phase management of the critically ill patients. Keywords: Critically ill patients, Monitoring beds, Red area
Published: 2019
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23. Characteristics and Outcome of Patients with COVID-19 Undergoing Invasive Mechanical Ventilation for Respiratory Failure in a Tertiary Level Hospital in Nepal

Author: Sachit, Sharma, Hem Raj, Paneru, Gentle Sunder, Shrestha, Pramesh Sunder, Shrestha, and Subhash Prasad, Acharya
Subjects: Tertiary Care Centers, Diabetes Mellitus, Type 2, Nepal, SARS-CoV-2, COVID-19, Humans, Respiratory Insufficiency, Respiration, Artificial, Retrospective Studies
Abstract: Corona virus disease 2019 has become a global health issue. The goal of this study was to investigate the characteristics and outcomes of patients with corona virus disease 2019 undergoing invasive mechanical ventilation and identify factors associated with mortality.Ninety four consecutive critically ill patients with confirmed corona virus disease 2019 undergoing invasive mechanical ventilation were included in this retrospective, single-center, observational study. The outcome variable was mortality of patients undergoing invasive mechanical ventilation and factors associated with it during intensive care unit stay.Seventy nine (84%) out of 94 patients with confirmed corona virus disease 2019 who underwent invasive mechanical ventilation didn't survive. Ninety four percent of patients who had Type 2 Diabetes Mellitus did not survive in comparison to 72 percent of patients who didn't have Type 2 Diabetes Mellitus. Similarly, 48 (94.1%) out of 51 patients with a positive C-reactive protein value didn't survive in comparison to 31 (72%) out of 43 patients with a negative C-reactive protein.The presence of Type 2 Diabetes Mellitus and a positive C-reactive protein value were strongly associated with mortality. Patients with a Sequential organ failure assessment score of more than eight at intensive care unit admission and peak D-dimer level of more than or equal to two during intensive care unit stay didn't show significant association with mortality. These findings need further exploration through larger prospective studies.
Published: 2021

24. Preparedness for Coronavirus Disease in Hospitals of Nepal: A Nationwide Survey

Author: Bharat Kumar Yadav, Badri Rijal, Narmaya Thapa, Yogesh Neupane, Gentle Sunder Shrestha, Sanjay Lakhey, Subhash Prasad Acharya, Hem Raj Paneru, Mahesh Raj Sigdel, Lochan Karki, Sanjeeb Tiwari, and Sanjeet Krishna Shrestha
Subjects: medicine.medical_specialty, Civil defense, Isolation (health care), Pneumonia, Viral, Specialty, Computer-assisted web interviewing, 01 natural sciences, 03 medical and health sciences, Betacoronavirus, 0302 clinical medicine, Nepal, Surveys and Questionnaires, Pandemic, medicine, Humans, 030212 general & internal medicine, 0101 mathematics, Personal protective equipment, Pandemics, Personal Protective Equipment, hospital preparedness, lcsh:R5-920, business.industry, SARS-CoV-2, 010102 general mathematics, COVID-19, Civil Defense, General Medicine, Isolation ward, Coronavirus, Family medicine, Preparedness, Original Article, Emergencies, lcsh:Medicine (General), business, Coronavirus Infections, Emergency Service, Hospital
Abstract: Introduction: Coronavirus disease pandemic has affected large number of peopleglobally and has continued to spread. Preparedness of individual nations and the hospitals isimportant to effectively deal with the surge of cases. We aimed to obtain nation wide data fromNepal, about hospital preparedness for COVID-19. Methods: Online questionnaire was prepared in accordance with the Center for Disease Controlrecommendations to assess preparedness of hospitals for COVID-19. The questionnaire wascirculated to the over 800 doctors across the nation, who are the life members of six medical societies. Results: We obtained 131 completed responses from all seven provinces. Majority of respondentshad anaesthesiology as the primary specialty. Only 52 (39.7%) participants mentioned that theirhospital had policy to receive suspected or proven cases with COVID-19. Presence of isolationward was mentioned by 83 (63.4%) respondents, with only 9 (6.9%)mentioning the presenceof airborne isolation. Supply of personal protective equipment (PPE) was inadequate as per 124(94.7%) respondents. Critical care services for COVID-19 patients were possible only in hospitals of42 (32.1%)respondents. RT-polymerase chain reaction could be performed only in the hospital of 6(4.6%) respondents. Conclusions: It is apparent that most of the hospitals are not well prepared for management ofpatients with COVID-19. Resource allocation and policy making should be aimed to enhance nationalpreparedness for the pandemic.
Published: 2020

25. A clinical audit of newly established intensive care unit in the Far Western Region of Nepal

Author: Subhash Prasad Acharya, Sher Bahadur Kamar, Hem Raj Paneru, Moda Nath Marhatta, and Padam Prakash Dev Sharma
Subjects: Clinical audit, business.industry, law, Medicine, Medical emergency, business, medicine.disease, Intensive care unit, law.invention
Abstract: available on the PDF.
Published: 2017
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26. Operationalisation of the Randomized Embedded Multifactorial Adaptive Platform for COVID-19 trials in a low and lower-middle income critical care learning health system

Author: Issrah Jawad, Srinivas Murthy, Ishara Udayanga, Nagarajan Ramakrishnan, Devachandran Jayakumar, Upulee Pabasara, Ashok Kumar, Arjen M. Dondorp, Rashan Haniffa, Subekshya Luitel, Kanchan Koirala, Colin McArthur, Steven A R Webb, Madiha Hashmi, Pramodya G. P. Ishani, Subhash Prasad Acharya, Shoaib Siddiq Patel, Timo Tolppa, Cameron Green, John C. Marshall, Abi Beane, Nawal Salahuddin, Diptesh Aryal, Zulfiqar Umrani, Mohiuddin Shaikh, Hem Raj Paneru, Sushil Khanal, and Intensive Care Medicine
Subjects: medicine.medical_specialty, Process management, Computer science, Data management, 030231 tropical medicine, Research network, Capacity building, Medicine (miscellaneous), General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, Clinical trials, 0302 clinical medicine, Community of practice, Pandemic, medicine, capacity building, 030212 general & internal medicine, Adaptation (computer science), Case report form, business.industry, Public health, Articles, LMICS, Clinical trial, Registry platform, Open Letter, business
Abstract: The Randomized Embedded Multifactorial Adaptive Platform (REMAP-CAP) adapted for COVID-19) trial is a global adaptive platform trial of hospitalised patients with COVID-19. We describe implementation in three countries under the umbrella of the Wellcome supported Low and Middle Income Country (LMIC) critical care network: Collaboration for Research, Implementation and Training in Asia (CCA). The collaboration sought to overcome known barriers to multi centre-clinical trials in resource-limited settings. Methods described focused on six aspects of implementation: i, Strengthening an existing community of practice; ii, Remote study site recruitment, training and support; iii, Harmonising the REMAP CAP- COVID trial with existing care processes; iv, Embedding REMAP CAP- COVID case report form into the existing CCA registry platform, v, Context specific adaptation and data management; vi, Alignment with existing pandemic and critical care research in the CCA. Methods described here may enable other LMIC sites to participate as equal partners in international critical care trials of urgent public health importance, both during this pandemic and beyond.
Published: 2021
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27. Factors associated with extubation failure in the intensive care unit patients after spontaneous breathing trial

Author: Roshana Amatya, Gentle Sunder Shrestha, Krishna Kumar Agrawal, Niraj Kumar Keyal, Hem Raj Paneru, and Saurabh Pradhan
Subjects: lcsh:RT1-120, Mechanical ventilation, extubation, Extubation failure, lcsh:Nursing, business.industry, medicine.medical_treatment, lcsh:R, lcsh:Medicine, Intensivist, General Medicine, chronic obstructive airway disease, Intensive care unit, law.invention, Spontaneous breathing trial, spontaneous breathing trial, law, Anesthesia, medicine, Arterial blood, In patient, Risk factor, business
Abstract: Introduction: Extubation failure is associated with high mortality and poor outcome of patients. Aims: This study was conducted to assess the factors associated with extubation failure in the intensive care unit (ICU) patients planned for extubation. Settings and Design: It was a prospective observation study conducted in all patients aged >18 years admitted in the ICU of a tertiary care hospital. Subjects and Methods: It was done on 108 patients who were planned for extubation. Patients were assessed by an intensivist clinically and decided whether a patient can be extubated on clinical grounds. Spontaneous breathing trial (SBT) was done for 2 h by T-piece in patients who met clinical and objective criteria. Arterial blood gas (ABG) was done in all patients who successfully completed SBT. Patients with successful SBT and acceptable ABG were extubated. Patients were observed for 48 h for extubation failure, and the reason for reintubation was recorded. Statistical Analysis Used: Independent Student's t-test and Chi-square test were used for data analysis. Results: Of 108 patients who passed the SBT, 96 (88.88%) patients had acceptable ABG and were extubated. 85 (88%) underwent successful extubation and 11 (12%) underwent unsuccessful extubation. Duration of mechanical ventilation (MV) and chronic obstructive airway disease was a risk factor associated with extubation failure. Conclusion: Duration of MV of >2 days and chronic obstructive pulmonary disease were identified as independent risk factors for extubation failure.
Published: 2020
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28. Colistin and tigecycline for management of external ventricular device-related ventriculitis due to multidrug-resistant Acinetobacter baumannii

Author: Pramesh Sunder Shrestha, Gentle Sunder Shrestha, Niraj Kumar Keyal, Hem Raj Paneru, Subhash Prasad Acharya, Sushil Tamang, Sushil Krishna Shilpakar, and Moda Nath Marhatta
Subjects: Acinetobacter baumannii, medicine.medical_specialty, Case Report, Tigecycline, lcsh:RC321-571, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, medicine, Ventriculitis, ventriculitis, colistin, Intensive care medicine, lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry, intraventricular, biology, business.industry, General Neuroscience, multidrug resistant, Acinetobacter, biology.organism_classification, medicine.disease, Multiple drug resistance, Colistin, Neurology (clinical), tigecycline, business, Multidrug resistant Acinetobacter baumannii, 030217 neurology & neurosurgery, medicine.drug
Abstract: Acinetobacter baumannii is an important cause of nosocomial ventriculitis associated with external ventricular device (EVD). It is frequently multidrug resistant (MDR), carries a poor outcome, and is difficult to treat. We report a case of MDR Acinetobacter ventriculitis treated with intravenous and intraventricular colistin together with intravenous tigecycline. The patient developed nephrotoxicity and poor neurological outcome despite microbiological cure. Careful implementation of bundle of measures to minimize EVD-associated ventriculitis is valuable.
Published: 2016

29. Successful lumbar puncture with Taylor′s approach for the diagnostic workup of meningitis in a patient with Ankylosing spondylitis

Author: Subhash Prasad Acharya, Gentle Sunder Shrestha, Niraj Kumar Keyal, Hem Raj Paneru, and Pramesh Sunder Shrestha
Subjects: medicine.medical_specialty, Ankylosing spondylitis, medicine.diagnostic_test, Ossification, Lumbar puncture, business.industry, meningitis, Case Report, difficult lumbar puncture, Critical Care and Intensive Care Medicine, medicine.disease, Surgery, Cerebrospinal fluid, medicine, In patient, Taylor's approach, medicine.symptom, business, Meningitis, Encephalitis
Abstract: Meningitis and encephalitis are the neurological emergencies. As the clinical findings lack specificity, once suspected, cerebrospinal fluid (CSF) analysis should be performed and parenteral antimicrobials should be administered without delay. Lumbar puncture can be technically challenging in patients with ankylosing spondylitis due to ossification of ligaments and obliteration of interspinous spaces. Here, we present a case of ankylosing spondylitis where attempts for lumbar puncture by conventional approach failed. CSF sample was successfully obtained by Taylor's approach.
Published: 2015
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30. Transient leucopenia in acute zinc phosphide poisoning

Author: Gentle Sundar Shrestha, Niraj Kumar Keyal, Hem Raj Paneru, and Roshana Amatya
Subjects: 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, business.industry, Internal medicine, Medicine, Zinc phosphide poisoning, 030208 emergency & critical care medicine, 030212 general & internal medicine, Transient (oscillation), business, Gastroenterology
Abstract: Zinc phosphide is easily available, cheap, and highly effective household rodenticide. Self poisoning with this rodenticide is commonly encountered in our clinical practice and causes lethal poisoning by liberation of phosphine which in turn causes inhibition of cytochrome oxidase C thereby leading to cellular hypoxia. We report a case of such poisoning which had an unusual presentation in the form of transient leucopenia.
Published: 2017
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30 results on '"Hem Raj Paneru"'

1. Early Outcomes Of Living Donor Liver Transplant Recipients In A University Teaching Hospital Of Nepal

2. Critical care services in Bagmati province of Nepal: A cross sectional survey [version 2; peer review: 2 approved]

3. Point-prevalence survey of antimicrobial use in intensive care units in Nepal

4. A comparison of clinical profile and outcomes among different age groups of critically ill elderly patients in a tertiary level hospital in Nepal: A retrospective study

5. Combination of convalescent plasma therapy and repurposed drugs to treat severe COVID‐19 patient with multimorbidity

6. Factors associated with extubation failure in the intensive care unit patients after spontaneous breathing trial

7. Precision medicine for COVID-19: a call for better clinical trials

8. Operationalisation of the Randomized Embedded Multifactorial Adaptive Platform for COVID-19 trials in a low and lower-middle income critical care learning health system. [version 1; peer review: 2 approved]

9. Preparedness for Coronavirus Disease in Hospitals of Nepal: A Nationwide Survey

10. A Case Study of Stevens–Johnson Syndrome-Toxic Epidermal Necrolysis (SJS-TEN) Overlap in Mycoplasma pneumoniae-Associated Tracheobronchitis

11. Higher dose corticosteroids in patients admitted to hospital with COVID-19 who are hypoxic but not requiring ventilatory support (RECOVERY)

12. A comparison of clinical profile and outcomes among different age groups of critically ill elderly patients in a tertiary level hospital in Nepal: A retrospective study

13. Comparison of airway pressure release ventilation with low tidal volume ventilation in patients with acute respiratory failure

14. Sildenafil induced seizures in a patient treated for pulmonary hypertension: A case report

15. Combination of convalescent plasma therapy and repurposed drugs to treat severe COVID‐19 patient with multimorbidity

16. Epidemiology of critically ill patients in intensive care units in Nepal: a retrospective observational study

17. Incidence, risk and impact of ICU readmission on patient outcomes and resource utilisation in tertiary level ICUs in Nepal: A cohort study

18. Mixed methods study protocol for combining stakeholder-led rapid evaluation with near real-time continuous registry data to facilitate evaluations of quality of care in intensive care units

19. Incidence, risk and impact of unplanned ICU readmission on patient outcomes and resource utilisation in tertiary level ICUs in Nepal: A cohort study

20. Precision medicine for COVID-19: a call for better clinical trials

21. Point-of-care ultrasonography: training, applications and barriers. A survey study

22. Clinical Profile of Critically Ill Patients Presenting to Emergency Department of Tertiary Level Hospital of Nepal

23. Characteristics and Outcome of Patients with COVID-19 Undergoing Invasive Mechanical Ventilation for Respiratory Failure in a Tertiary Level Hospital in Nepal

24. Preparedness for Coronavirus Disease in Hospitals of Nepal: A Nationwide Survey

25. A clinical audit of newly established intensive care unit in the Far Western Region of Nepal

26. Operationalisation of the Randomized Embedded Multifactorial Adaptive Platform for COVID-19 trials in a low and lower-middle income critical care learning health system

27. Factors associated with extubation failure in the intensive care unit patients after spontaneous breathing trial

28. Colistin and tigecycline for management of external ventricular device-related ventriculitis due to multidrug-resistant Acinetobacter baumannii

29. Successful lumbar puncture with Taylor′s approach for the diagnostic workup of meningitis in a patient with Ankylosing spondylitis

30. Transient leucopenia in acute zinc phosphide poisoning

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30 results on '"Hem Raj Paneru"'

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