Rojina has completed her B.Sc nursing at the age of 22 from purbanchal university and completed her Masters in Health care management from Pokhara University. She is a registered nurse of Sahid Gangalal national health centre and Assistant Manager (part time) at DI Skin health and Referral centre.
Background: Although the status of health related quality of life (HRQOL) among the post-operative patients after open-heart surgery has been assessed in many developed and developing countries, it has not yet been investigated in Nepalese population. The objective of study was to assess the level of HRQOL after mitral, aortic or both valve replacement surgery; and identify the factors affecting HRQOL of open-heart surgery patients. Methods: Cross sectional study was done among 405 adult patients of age 19 years to 65 years who had undergone aortic, mitral or both valve replacement surgery and attending the follow up visit in Shahid Gangalal National Heart Center. The study was conducted from March to August, 2017. All the eligible patients were recruited and administered the questionnaire by trained field researcher. SF-36v2 questionnaire were adopted and pre- tested prior to final survey. Informed consent was obtained prior to final data collection. Results: The respondents from the valve replacement surgery groups were dominantly female of reproductive age group (mean age: 37.84±13.25), highly literate and married. The mean PCS and MCS scores were (62.90±19.25) and (65.70±20.40) respectively, with better social and mental health including pain perception whose mean scores are (78.51 ±15.71), (87.34 ±23.11) and (79.19 ±32.16) respectively. The study revealed significant association between age, marital status, educational status, occupation, type of valve replaced as well as duration after surgery; and HRQOL (p< 0.05). However, sex of the respondents and classification of valve had no significant impact on HRQOL (p> 0.05). Conclusion and Recommendation: The majority of the patients (65.4%) had average HRQOL after valve replacement surgery. Age, educational status, marital status, major occupation, type of valve replaced and duration after valve replacement surgery had significant impact on their HRQOL (p< 0.05). Mental health was found better than physical health. The recommendations have been made to conduct further studies on HRQOL among Coronary artery bypass surgery, Fontan operation and Bentall’s surgery patients on multi-centered basis.
Currently working as a Professor in Republican Specialized Scientific and Practical Medical Center Therapy And Medical Rehabilitation, Tashkent, Uzbekistan
Purpose. Explore the dynamics of levels of brain natriuretic peptide (BNP), aldosterone (Аl) and norepinephrine (NE) in the serum in patients with II and III functional class (FC) chronic heart failure (CHF) against the background of the treatment of lozartan and lizinopril. Research methods. Were examined 46 patients with coronary heart disease (CHD) with CHF with II-III FC, according to the classification of the New York Association of cardiologists. The first group (1) was 23 patients with II FC (12) and III FC CHF (11 patients), took for 6 months against the background of the standard therapy (bisoprolol, spirinolactone) – losartan; the second group (2) - 23 patients with II FC (12) and III FC CHF (11 patients) – lizinopril, in doses, the average dose lozartan – 69.3±25.8 mg/day, lizinopril – 7.5±3.9 mg/day. All patients were carried out echocardiography, the level of Al, BNP and NE was determined by immunosorbent assay. Results. In CHF there was a significant increase the level of BNP, NE and Al in the blood plasma, correlative with a degree of disease progression, at the same time in patients with II FC is dominated by medium-high levels neurohormones, and in patients with III FC higher levels of these indicators. In patients with CHF II FC there was an increase in the content of BNP, N and Al to 187%, 30% and 36% (p<0.001) and in patients III FC to 330%, 56% and 66.3% (p<0,001), respectively, in comparison with the control group. Installed the dependence of processes remodeling of the level of neurohumoral factors (BNP, Al and NE) in patients with CHF. Revealed association of the level of neurohormones: BNP, Al and NE with the indicators remodeling heart: high inverse correlation with ejection fraction (EF) (r = 0.76, r = 0.70 and r = 0.72, respectively), direct correlation with the final diastolic volume of LV (r = 0.75, r = 0.78 and r = 0.70, respectively). Thus, in patients with CHF significant increase in neurohumoral factors: NE, BNP and Al associated with FC CHF, the degree of systolic dysfunction LV. Analysis of indicators neurohumoral factors in the dynamics of the treatment of showed a significant reduction in the level of BNP, Al and NE in both groups. 6 months treatment in patients with the first group noted reducing BNP, Al and NE in patients with II FC on 43.7%, 21.2%, 22.5%, respectively, in patients with III FC – on 31.7%, 42.6%, 9.9%, respectively, in comparison with the original indicators. 6 months treatment in patients with the 2 group noted reducing BNP, Al and NE: in patients with II FC - by 36.5%, 21.2%, 22.5%, respectively, in patients with III FC - by 35.2%, 31.2%, 8.3%, respectively, in comparison with the original indicators. Conclusion. Thus, six-month therapy by lozartan and lizinopril against the background of the standard therapy (bisoprolol, spirinolactone) allowed achieving significant decrease in BNP, Al and NE, at the same time there were no reliable comparable differences in both groups of patients.