Diptesh Aryal

Diptesh Aryal
Nepal Intensive Care Research Foundation

Doctor of Medicine

About

41
Publications
8,812
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1,271
Citations
Introduction
Working as Principal Investigator for Nepal REMAP-CAP project. https://www.remapcap.org/

Publications

Publications (41)
Article
Full-text available
This White Paper has been formally accepted for support by the International Federation for Emergency Medicine (IFEM) and by the World Federation of Intensive and Critical Care (WFICC), put forth by a multi-specialty group of intensivists and emergency medicine providers from low- and low-middle-income countries (LMICs) and high-income countries (H...
Article
Importance: The evidence for benefit of convalescent plasma for critically ill patients with COVID-19 is inconclusive. Objective: To determine whether convalescent plasma would improve outcomes for critically ill adults with COVID-19. Design, setting, and participants: The ongoing Randomized, Embedded, Multifactorial, Adaptive Platform Trial f...
Article
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Background: The value of medical registries strongly depends on the quality of the data collected. This must be objectively measured before large clinical databases can be promoted for observational research, quality improvement, and clinical trials. We aimed to evaluate the quality of a multinational intensive care unit (ICU) network of registries...
Preprint
Full-text available
Background Globally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients can be overlooked in health systems. Essential and Emergency Care (EECC) has been devised as the care that should be provided to all critically ill patients...
Article
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Background: Thrombosis and inflammation may contribute to morbidity and mortality among patients with coronavirus disease 2019 (Covid-19). We hypothesized that therapeutic-dose anticoagulation would improve outcomes in critically ill patients with Covid-19. Methods: In an open-label, adaptive, multiplatform, randomized clinical trial, critically...
Article
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Background Convalescent plasma therapy (CPT) and remdesivir (REM) have been approved for investigational use to treat coronavirus disease 2019 (COVID-19) in Nepal. Methods In this prospective, multicentered study, we evaluated the safety and outcomes of treatment with CPT and/or REM in 1315 hospitalized COVID-19 patients over 18 years in 31 hospit...
Preprint
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Objective We aimed to evaluate the quality of a multinational intensive care unit (ICU) network of registries of critically ill patients established in seven Asian low and middle income countries (LMICs). Methods The Critical Care Asia federated registry platform enables ICUs to collect clinical, outcome and process data for aggregate and unit-leve...
Article
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PurposeTo study the efficacy of lopinavir-ritonavir and hydroxychloroquine in critically ill patients with coronavirus disease 2019 (COVID-19).Methods Critically ill adults with COVID-19 were randomized to receive lopinavir-ritonavir, hydroxychloroquine, combination therapy of lopinavir-ritonavir and hydroxychloroquine or no antiviral therapy (cont...
Preprint
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Coronavirus Disease 2019 (COVID-19) burden is often underestimated when relying on case-based incidence reports. Seroprevalence studies accurately estimate infectious disease burden by estimating the population that has developed antibodies following an infection. Sero-Epidemiology of COVID-19 in the Kathmandu valley (SEVID-KaV) is a longitudinal s...
Preprint
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Background Thrombo-inflammation may contribute to morbidity and mortality in Covid-19. We hypothesized that therapeutic-dose anticoagulation may improve outcomes in non-critically ill patients hospitalized for Covid-19. Methods In an open-label adaptive multiplatform randomized controlled trial, non-critically ill patients hospitalized for Covid-19...
Preprint
Full-text available
Background Globally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients can be overlooked in health systems. Essential and Emergency Care (EECC) has been devised as the care that should be provided to all critically ill patients...
Article
Background The efficacy of interleukin-6 receptor antagonists in critically ill patients with coronavirus disease 2019 (Covid-19) is unclear. Methods We evaluated tocilizumab and sarilumab in an ongoing international, multifactorial, adaptive platform trial. Adult patients with Covid-19, within 24 hours after starting organ support in the intensiv...
Article
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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...
Preprint
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Dislodgement of tracheostomy tubes are critical incidents in ICU leading to increased morbidity and mortality. This article describes our quality improvement initiative to decrease the chances of tracheostomy tube displacement.
Article
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The ongoing novel coronavirus disease (COVID-19) pandemic is threatening the global human population, including in countries with resource-limited health facilities. Severe bilateral pneumonia is the main feature of severe COVID-19, and adequate ventilatory support is crucial for patient survival. Although our knowledge of the disease is still rapi...
Article
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Background Resistance to antimicrobial agents of pathogenic bacteria has become a major problem in routine medical practices. Carbapenem resistance has long been increasing. The production of carbapenem- hydrolysing β-lactamases (carbapenamases), which include NDM, KPC, OXA-48, IMP-1 and VIM is the most common mechanism. Case presentation A 56 yea...
Article
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Background Resistance to antimicrobial agents of pathogenic bacteria has become a major problem in routine medical practices. Carbapenem resistance has long been increasing. The production of carbapenem- hydrolysing β-lactamases (carbapenamases), which include NDM, KPC, OXA-48, IMP-1 and VIM is the most common mechanism. Case presentation A 56 yea...
Article
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Dilated cardiomyopathy is a primary myocardial disease charac­terized by left ventricular or biventricular dilation and impaired contractility. The anesthetic management of a patient with dilat­ed cardiomyopathy undergoing a non-cardiac surgery is always challenging and may be associated with high mortality. Further­more, perioperative morbidity be...
Article
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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 Acut...
Article
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Background Aluminum phosphide is a very common suicide agent in developing countries like Nepal. Due to the unavailability of a specific antidote, mortality is very high because the phosphine molecule that is formed leads to inhibition of the cytochrome oxidase enzyme system in mitochondria. Extracorporeal membrane oxygenation provides life-saving...
Article
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Background: Intravenous immunoglobulin is one of the most common modalities of treatment for Guillain-Barré syndrome. Although minor complications are easily preventable with pre-medications, rare complications like hemolysis occur at unexpected times and carry risks of repeated transfusions. A complication like difficulties in cross-matching bloo...
Article
Study objective: Online educational resources such as blogs are increasingly used for education by emergency medicine clinicians. The Social Media Index was developed to quantify their relative impact. The Medical Education Translational Resources: Indicators of Quality (METRIQ) study was conducted in part to determine the association between the...
Article
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p> Background & Objectives: Gabapentin has been used successfully as a non-opioid analgesic adjuvant for postoperative pain management. We hypothesized that the preoperative use of gabapentin prolonged the analgesic effect of epidural morphine without an increase in adverse effects of morphine. Materials & Methods: In a randomized, double blind st...
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The efficacy of early goal directed therapy in improving outcomes has been questioned in few recent studies. But, does that hold true for low and middle income countries like Nepal? This editorial expresses the views of the editors on the usual care of sepsis patients and early goal directed therapy in resource limited settings.
Article
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p> Background: Hepatobiliary diseases account for significant proportion of admission in our intensive care unit, a semi-closed, 11 bedded mixed medical-surgical unit. This study was conducted to study the profile of patients with various hepatobiliary diseases who required intensive care unit admissions with the aim of identifying the need for a h...
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p>Gastrointestinal infestation with Ascaris lumbricoides is common in the tropical countries. A wide range of clinical presentations are reported for gastrintestinal ascariasis in both adults and children. We report a case of diarrhea causing malnutrition in ICU due to Ascaris infestation. Bangladesh Crit Care J March 2017; 5(1): 70-71</p
Article
Study objective: Open educational resources such as blogs are increasingly used for medical education. Gestalt is generally the evaluation method used for these resources; however, little information has been published on it. We aim to evaluate the reliability of gestalt in the assessment of emergency medicine blogs. Methods: We identified 60 En...
Article
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With the publication of the 2016 September issue, Journal of Society of Anesthesiologists of Nepal (JSAN) has published its revised instruction to authors. The editorial board of JSAN has taken all possible steps to ensure the quality of the material published in the journal remains high and advise the authors to use the minimum set of items needed...
Article
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Spontaneous cervical cerebrospinal fluid leak is a rare entity and occurs because of tear in cervical dural layer. Management has been conservative in the past but here we present this case that was managed successfully with cervical epidural blood patch. A 36-year-old man presented to neurology outpatient clinic with headache in occipito-frontal r...
Article
Purpose of review: Resource-challenged environments of low and middle-income countries face a significant burden of neurocritical illness. This review attempts to elaborate on the multiple barriers to delivering neurocritical care in these settings and the possible solutions to overcome such barriers. Recent findings: Epidemiology of neurocritic...
Article
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An elderly female presented to Intensive Care Unit with generalized weakness and altered sensorium with past history of adenocarcinoma of larynx. She was managed with Radiation Therapy and Chemotherapy in the past. Current admission to the intensive care unit was for aspiration pneumonitis and respiratory failure requiring mechanical ventilation. S...
Article
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Apnea testing is a key component in the clinical diagnosis of brain death. Patients with poor baseline oxygenation may not tolerate the standard 8-10 min apnea testing with oxygen insufflation through tracheal tube. No studies have assessed the safety and feasibility of other methods of oxygenation during apnea testing in these types of patients. H...