governing body report 2017.pdfdeepak bohara hon. minister for health members mr. ishwor pokharel...

GOVERNING BODY

chairmanMR. DEEPAK BOHARA

HON. MINISTER FOR HEALTH

membersMR. ISHWOR POKHAREL

HON. MEMBER OF PARLIAMENT

PROF. DR. GEETA BHAKTA JOSHI HON. MEMBER, NATIONAL PLANNING COMMISSION

DR. PUSHPA CHAUDHARY SECRETARY, MINISTRY OF HEALTH

MR. GANESH PRASAD PANDEY

JOINT SECRETARY, MINISTRY OF FINANCE

DR. ABANI BHUSAN UPADHYAYA SR. CONSULTANT CARDIOLOGIST

DR. MAN BAHADUR K.C. SR. CONSULTANT CARDIOLOGIST

DR. RAAMESH RAJ KOIRALA SR. CONSULTANT CARDIAC SURGEON

DR. YAHUN CHANDRA SIWAKOTI DEAN, NAMS, BIR HOSPITAL

MS. SHANTI BASNET ADHIKARI WOMEN REPRESENTATIVE

MS. AASMI RANASOCIAL WORKER

member secretaryDR. JYOTINDRA SHARMAEXECUTIVE DIRECTOR

EDITORIAL TEAM

editor in chiefDR. CHANDRA MANI ADHIKARI

membersDR. DIPANKER PRAJAPATI

DR. DIKSHYA JOSHI

DR. REEJU MANANDHAR

DR. SHAILI THAPA

MR. MAHERNDR LAMSAL

EDITORIALYear 2017 was a milestone year for SGNHC in serving patients. And we could not be

more excited to have made to this point. Giving back to its community whatever and

whenever it can be the essence of SGNHC. SGNHC has been providing free services to

children of fifteen years and below through ‘Children Assisted Program’ scheme, senior

citizens above seventy-five years, and aid of Rupees one lakh to every patient undergoing

treatment at our centre through ‘Bipanna scheme’. Moving one step further in 2017, we

saw the emergence of a new scheme called ‘Rheumatic Heart Scheme’, where we provide

free valve surgeries to patients with rheumatic heart disease. We are honored to share

the work of so many committed and thoughtful people who joined hands together to make

this scheme possible. This initiative is part of our commitment to offer very best in care

to the patients and families we serve.

Also within this year, we participated and presented papers and articles both nationally

and internationally, and we continued to shine, bashing in the glow of various awards that

we received. We are passionately interested in the new advances, researches, education

and training the new generation, to achieve excellence in quality healthcare for the

benefit of humanity. We are proud to be a part of multinational, multicentre ‘Invictus

Trial’. In addition, SGNHC STEMI Registry has just started at our centre. This registry

has received grant from Nepal Health Research Council. Our ever-growing network

of patients continued to expand and we had opportunities to serve new communities.

We thrive for excellence and quality care. We are about to reach 30,000 coronary

angiograms , 10,000 percutaneous coronary interventions. Device Closure intervention

is also gaining attention at our centre. We will soon be reaching 500 ASD device closure

and 250 PDA device closure.

Cardiac CT Imaging, which has always been in the strategy of SGNHC, is soon going

to be accessible which will unquestionably make a difference for patient quality care.

SGNHC has come a long journey. Everyday it has new frontier and new challenges to

face. We will always be grateful to these magnified blessings and support that we have

received. We will forever remain humble to all our well wishers and everyone who have

supported us in this journey. We wish SGNHC, may your future always shine.

ANNUAL REPORT2017

TABLE OF CONTENTqm=;+= lzif{s k]h g+=

1 sfo{sf/L lgb]{zssf] jflif{s k|ltj]bg 1-32 cf=j= )&#÷&$ sf] jflif{s sfo{qmdsf] k|ult tyf cfoJoo ljj/0f 4-63 Department of Cardiovascular Surgery 7-94 Department of Anesthesiology 10-125 Non-Invasive Cardiology and OPD Services 13-166 Pediatric Cardiology Service 17-197 Acute Coronary Syndrome 20-218 Medical Intensive Care Unit (MICU) 22-239 Interventional Cardiology Services 24-2510 Cardiac Electrophysiology and Device Implantation 26-2711 Emergency Services 28-2912 Medical Ward 30-3113 Department of Cardiac Rehabilitation & Health Promotiion 32-3414 Pathology/Clinical Laboratories Services 35-3615 Radiology Services 37-3816 Pharmacy Unit 39-4017 Physiotherapy Services 41-4318 Annual Mortality : 2017 44-4619 Perfusion Technology Unit 47-4820 Institutional Review Committee 49-5121 Diabetic retinopathy and hypertensive retinopathy screening service at

Gangalal National Heart Center 52-53

22 FRAGILE LIFE 5423 ;dk{0f gl;{Ëdf 5524 Photographs 56-6325 Staff List 64-75

Annual Report 2017

Shahid Gangalal National Heart Centre, Bansbari, Kathmandu

sfo{sf/L lgb]{zssf] k|ltj]bg

8f= Hof]tLGb| zdf{sfo{sf/L lgb]{zs

:yfkgfsfnb]lv 5f]6f] ;dodf g} x[bo/f]usf] lgbfg, prf/ tyf /f]syfdsf] If]qdf pNn]-vgLo of]ubfg k'¥ofpg ;kmn o; zxLb u+ufnfn /fli6«o x[bo s]Gb|sf] afO;f}+ jflif{sf]]-T;jsf] cj;/df sfo{sf/L lgb]{zssf] x}l;otn] jflif{s k|ltj]bg k|:t't ug{ kfpFbf uf}/jflGjt ePsf] 5' .

g]kfndf lbg k|ltlbg j[l4 x'F+b} uO/x]sf] d'6'/f]usf] /f]syfd, lgbfg, pkrf/ tyf Xbo/f]uLx?sf] k'g:yf{kgfsf] nflu cfjZos pRr:t/Lo :jf:Yo ;]jf ;j{;'ne?kdf :jb]zdf g} k|bfg u/L Xbo/f]uLx?nfO{ dfgjf]lrt hLjgofkg ug{ ;Ifd t'Nofpg tyf x[bo/f]u;DaGwL pRr:t/Lo cWoog / cg';Gwfgsf nflu cfjZos bIf hgzlQm tof/ ug]{ d"n p2]Zo lnO{ g]kfn ;/sf/n] zxLb u+ufnfn >]i7sf] gfddf ;dlk{t u/L o; s]Gb|sf] :yfkgf u/]sf] xf] . lj= ;+= @)%@ ;fn sf=d=g=kf= #, af+;af/Ldf :yflkt o; s]Gb||n] ( z}ofaf6 cfˆgf] ;]jf ;'? u/]sf]df xfn @)) z}Øof Ifdtfdf lj:tf/ eO{ ;+rfngdf /x]sf]5. k|f/Dedf d'6'/f]u ;DaGwL ;fdfGo pkrf/jf6 ;]jf z'? u/]sf] o; c:ktfnn] ;dosf] cGt/- fn;Fu} d'6'/f]u;DjGwL ljleGg lsl;dsf] ljz]-if1 pkrf/ ;]jfx? pknJw u/fpFb} cfO/x]-sf] 5 . l;ldt >f]t / ;fwgaf6 z'? ePsf] o; s]Gb| xfn j}1flgs k|ljlw, bIf hgzlQm tyf cTofw'lgs cf}hf/n] ;';lHht /fli6«o:t/sf] c:ktfnsf] ?kdf cfkm"nfO{ :yflkt ug{ ;kmn ePsf] 5 . :yfkgfsfnb]lvsf ;+rfns ;ldltx¿, :jf:Yo

dGqfno, s]Gb|df sfo{/t ;Dk"0f{ sd{rf/Lx?, g]kfn ;/sf/sf ;/f]sf/jfnf lgsfox?sf] lg/Gt/ d]x]gt / ;xof]u Pj+ cfdhgtf tyf lj/fdLx?sf] c6'6 ljZjf; / ;b\efjsf sf/0f of] s]Gb| cfhsf] :j?kdf cfOk'Ug ;kmn ePsf] xf] .

ljutsf @@ jif{df s]Gb|n] y'k|} pknlAwx¿ xfl;n u/]sf] 5 . lj=;+= @)%% kf}if !% ut] alx/+u ;]jf z'¿ ePb]lv xfn;Dd sl/a !$ nfv $) xhf/ lj/fdLx?sf] alx/+u ;]jfdfkm{t\ :jf:Yo kl/If0f ul/Psf] 5 . xfn;Dd sl/a %^ xhf/ lj/fdLx?sf] ljleGgvfnsf Cath Procedures tyf sl/a @) xhf/ lj/fdLsf] d'6'sf] zNolqmofx? ePsf 5g\ . utjif{ cyf{t\ ;g\ @)!& df dfq !,%#,$^@ hgf lj/fdLx¿sf] alx/+u ;]jfdfkm{t\ :jf:Yo kl/-If0f ePsf] 5 . oxL jif{ Electrocardiogram (ECG): %(#$#, Echocardiogram: ^@$#$, X-ray: ^)^^*, TMT: !#!!&, Fetal Echo: ^^#, Carotid Doppler: ^&% sf ;fy} cGo ljleGgvfn] Non–Invasive k/LIf0fx? pNn]-Vo ;+Vofdf ePsf 5g\ . ;fy} &*@$ Cath Procedures ul/Psf] 5 h;df Coronary Angiogram (CAG): $!$%, Coronary Angioplasty (PTCA): !%&!, PTMC: $$%, EPS/RFA: #^@, Device closures: @*#, Pacemaker: ^#) k|Tof/f]k0f ul/Psf] 5 . To;}u/L utjif{ !&*@ j6f ljleGg vfnsf d'6'sf] zNolqmof ;DkGg ul/Psf] 5 . xfn;Dd !$ xhf/eGbf a9L cf]kg xf6{ ;h/L s]Gb|df ;DkGg

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sfo{sf/L lgb]{zssf] jflif{s k|ltj]bg===

Annual Report 2017


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5f}+ . o;} cf=j=b]lv ljkGg cfsl:ds pkrf/sf] nflu ?= ! s/f]8 ljlgof]hg ul/Psf] 5 . ;du|df g]kfn ;/sf/åf/f 3f]lift ;fdflhs ;'/Iff sfo{qmd cGtu{t ?= #! s/f]8 ̂ % nfv rfn' cf=j=sf] nflu ljlgof]hg ul/Psf] 5 . o;sf cltl/Qm æljkGg tyf c;xfoÆ lj/fdLx?sf] nflu uDeL/ k|s[ltsf d'6'/f]usf] pkrf/fy{ k|lt la/fdL ?= ! nfv;Dd cg'bfg g]kfn ;/sf/n] k|bfg u/]sf] 5 . ut cfly{s jif{df @@$$ hgf la/fdLsf] ljkGg sfo{qmd cGtu{t pkrf/ jfkt @! s/f]8 ^* nfv & xhf/ &) /sd vr{ ePsf] 5 . oL ;a} sfo{qmdx? s]Gb|åf/f cToGt} k|efjsf/L 9+un] sfof{Gjog ul//x]sf] 5 .

dfly pNn]lvt ;/sf/L /fxt sfo{qmdx?sf cltl/Qm hoGtL d]df]l/on 6«i6, g]kfn x[bo/f]u lgjf/0f k|lti7fg s]lGb|o sfof{no, g]kfn x[bo/f]u lgjf/0f k|lti7fg nlntk'/ zfvf, eujtL b]jL ;+}h' cIfo sf]if, u]bf{ Osf] lxdfn Rofl/6L kmfd]{;L, l;tf–s]bf/ rfln;] 6«i6, ofs P08 olt /]i6'/]G6 leogf, >L ;To ;fO{ s]Gb|, >LdtL ld/f l;+x -:j= ch'{g axfb'/ l;+xsf] ;Demgfdf_, Milal Heart Foundation Nepal, ;+sNk g]kfn, nufotsf ljleGg ;xof]uL ;+3 ;+:yf tyf JolQmx?n] klg u/La tyf c;xfo lj/fdLsf] pkrf/df oyf;Sbf] cfly{s tyf ef}lts ;xof]u ul//x]sf 5g\ .

d'6'/f]u pkrf/ dx+uf] x'g'sf;fy} hl6n 5 . d'6'/f]usf] pkrf/sf ;fy} /f]syfddf klg o; s]Gb|n] pNn]vgLo e"ldsf v]Nb} cfPsf] 5 . d'6'/f]u /f]syfddf ;dod} Wofg lbPdf of] ;:tf] / k|efjsf/L x'g;S5 . To;}n] of] s]Gb| d'6'/f]uLx?sf] pkrf/df /ftf]lbg tlNng eP/ klg d'6'/f]usf] /f]syfd / o;;DaGwL hgr]tgf clej[l4 ug]{ sfo{df klg lg/Gt/ nflu k/]sf] s'/f hfgsf/L u/fpg rfxG5' . s]Gb|n] ljutsf jif{x?df em}+ ut cfly{s jif{df klg b]zsf !@ lhNnfx? -tgx'F, wg'iff, k;f{ eQmk'/, DofUbL, dsjfgk'/, :ofËhf-@_, wflbË, u'NdL, ;f]n'v'Da' / d':tfË_ df ljz]if1 lrlsT;sx?sf] 6f]nLn] lgMz'Ns d'6'/f]u :jf:Yo lzlj/x? ;+rfng u/]sf]df tL lzlj/x?af6 ^,()% hgf lj/fdLx?n] k|ToIf?kdf ;]jf lnPsf lyP . h;dWo] @*%@ hgfsf] Ol;lh / @&!) hgfsf] Osf]sfl8{of]u|fd ul/Psf] lyof] . oL sfo{s|dsf] nfe / k|efjsfl/tfsf] hg:t/af6 lgs} k|z+;f a6'Ng s]Gb| ;kmn ePsf] 5 . o:tf] sfo{nfO{ cfufdL lbgdf klg s]Gb|n] k|fyldstfsf;fy lg/Gt/tf lbg]5 .

eO;s]sf] 5 . s]Gb|df ;g\ @)!& df egf{ eO{ pkrf/ u/fpg] lj/fdLx? (In-patient) sf] ;+Vof !#,$%( /x]sf] 5 . ut jif{b]lv # j6f cTofw'lgs Modular Operation Theater tyf @^ z}Øofsf] Surgical ICU ;+rfngdf cfPkZrft zNolqmofsf] ;+Vofdf pNn]vgLo j[l4 ePsf] 5 . x[bo3ft eP/ t'?Gt} c:ktfn cfOk'Ug] la/fdLx?nfO{ @$;} 306f Primary Angioplasty sf] ;]jf s]Gb|n] k|bfg ul//x]-sf] 5 . ;fy} s]Gb|df d'6'sf] rfn u8\a8L ePsf la/fdLnfO{ cTofw'lgs “3D Mapping” k4ltaf6 ut jif{b]lv ;]jf k|bfg ug{ yfn]kl5 h:tf];'s} d'6'sf] rfn u8\a8L;DaGwL /f]usf] lgbfg tyf pkrf/ ;+ej ePsf] 5. s]Gb|n] d'6' sdhf]/ ePsf la/fdLnfO{ ljz]if k|sf/-sf] k]zd]s/ (CRT/CRTD) ut aif{b]lv s]-Gb|s} lrlsT;sx?af6 ;kmntfk"j{s k|Tof/f]k0f ub}{ cfPsf] 5 . d'6'sf] hGdhft Kjfn ePsf, eNe ;fF3'/f] ePsf lj/fdLnfO{ lgoldt?kdf ck|]zg gu/L Device Closure k4ltaf6 ;]jf k|bfg ul//x]sf] 5. o;} aif{b]lv ;fgf] 3fp dfq agfP/ ul/g] zNolqmof (Minimal Invasive Surgery) z'? ug{ cf}hf/x? v/Lb ul/;lsPsf] 5 . s]Gb|n] k|bfg ug]{ ;]jf u'0f:t/Lo, e/- kbf]{ / k|efjsf/L agfpgsf] nflu ut cf=j=df cTofjZos pks/0f Pj+ cf}hf/x? s]Gb|sf ljleGg ljefusf dfu cg';f/ v/Lb ul/Psf] 5 . o;} cf=a=df cTofw'lgs ^$) :nfO;sf] sfl8{ofs ;L=6L= :Sofg d]zLg v/Lb u/L h8fg x'g] k|s[ofdf /x]sf] 5 . o; cfwf/df ljutsf jif{x?df h:t} of] jif{df klg s]Gb|n] cfˆgf] sfd st{Jo ;Gtf]ifhgs ?kdf ;DkGg u/]sf] 5 .

d'6'/f]usf] pkrf/df g]kfn ;/sf/n] cToGt} dxTj lbPsf] 5 . ljut s]xL jif{b]lv g]kfn ;/sf/n] !% jif{d"lgsf afnaflnsf tyf &% jif{dflysf h]i7 gfu/Lsx?nfO{ o; s]Gb|df lgMz'Ns pkrf/ ug]{ Joj:yfsf] nflu ah]6 k|bfg u/]sf] 5 . rfn' cfly{s jif{df klg ;f]xL k|of]hgsf] nflu g]kfn ;/sf/n] ?= !# s/f]8 ljlgof]hg u/]sf] 5 . ;fy} ljgf ck|]zg d'6'sf] ;fF3'l/Psf] eNe vf]Ng] k|ljlw (PTMC) sf] nflu ?= ! s/f]8 &% nfv ljlgof]hg u/]sf] 5 . ut cf=j= @)&#.)&$ sf] kmfu'g dlxgfb]lv afy d'6'/f]uLx?sf] ;+k"0f{ zNolqmof lgMz'Ns ug]{ g]kfn ;/sf/sf] lg0f{okZrft\ %(^ hgf lj/fdLsf] lgMz'Ns zNolqmof eO;s]sf] 5 . pQm sfo{qmd ;+rfngsf] nflu rfn' cf=a=df g]kfn ;/sf/n] !% s/f]8 () nfv ljlgof]hg u/]sf] 5 . o; cGtu{t s/La ^ ;o afy d'6'/f]uLx?sf] lgMz'Ns zNolqmof ug]{ nIo /fv]sf

Annual Report 2017


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s]Gb|nfO{ cfTdlge{/ agfpg hgzlQm tyf k|ljlwsf] ljsf; / lj:tf/df s]Gb| uDeL/ eP/ nfu]sf] 5 . ljleGg lzIf0f tyf tfnLd;DaGwL sfo{qmdx? s]Gb|df z'¿ eO;s]sf 5g\ . lrlsT;f lj1fg /fli6«o k|lti7fg (NAMS) ;Fu ;xsfo{ u/L d'6'/f]usf] If]qdf pRr lzIffsf] cWofkg hf/L 5 . s]Gb|sf ljz]if1x?nfO{ tflndsf] nflu ljb]zsf pTs[i6 ;+:yfdf k7fpg] tyf o"/f]k, cd]/Lsfsf ljz]if1x?nfO{ s]Gb|df af]nfP/ tfnLd pknAw u/fpg] k|s[of ;'rf? 5 . ;fy} d'6' pkrf/nfO{ ljs]Gb|Ls/0f ug'{k5{ eGg] s]Gb|sf] dfGotf cg'?k ljleGg ;/sf/L tyf lghL c:ktfnsf lrlsT;s, g;{ tyf k/\ˆo"hgsf sd{rf/LnfO{ tfnLd k|bfg u/]sf] 5 . s]Gb|df olt w]/} u'0f:t/Lo sfd x'Fbf x'Fb} klg Ps]8]lds k|lti7fg gePsf] sf/0fn] b]zsf] cfjZostf cg';f/sf] hgzlQm pTkfbg tyf z}lIfs sfo{qmd ;+rfng ug{ ;lsPsf] 5}g . s]-Gb|sf] ;+rfns ;ldltaf6 kfl/t eO{ o;;DaGwL Joj:yf x'g :jf:Yo dGqfnodf k7fO;lsPtf klg b]zdf ljBdfg ljleGg sf/0fjz of] k"/f x'g ;s]sf] 5}g . pkTosf aflx/ s]Gb|sf] ;]jf lj:tf/ u/L d'6';DaGwL u'0f:t/Lo ;]jf k|bfg ug]{ p2]Zon] g]kfnu~hsf] e]/L c~rn c:ktfn tyf hgsk'/sf] hgsk'/ c~rn c:ktfn;Fu ;Demf}tf u/L cfjZos sfo{ cl3 al9;s]sf]5 . e]/L c~rn c:ktfnsf lrlsT;s, g;{ tyf cGo Kof/fd]l8S; hgzlQmnfO{ tflnd k|bfg ug'{sf ;fy} pQm c:ktfnsf] nflu cTofw'lgs Cath-Lab Machine g]kfn ;/sf/sf] ;xof]-udf s]Gb|n] v/Lb u/L h8fg x'g] k|s[ofdf /x]sf] 5 . hgsk'/ c~rn c:ktfndf o; s]-Gb|sf] zfvf vf]Ng ah]6 lalgof]hg eO{ :ynut cWoogsf] l/kf]6{adf]lhd sfo{ cl3 al9;s]sf] 5 . oL b'O{ :yfgafx]s k|To]s k|b]zdf g]kfn ;/sf/sf] ;xof]uaf6 s]Gb|n] sDtLdf Ps zfvf lj:tf/ ug]{ nIf lnPsf] 5 .

cfly{s cg'zf;g tyf cfly{s sf/f]af/df kf/blz{tf s]Gb|sf] g}lts an xf] . o; s]Gb|sf ;Dk"0f{ v/Lb k|lqmof cgnfO{g -O–6]08/_ dfkm{t ;kmntfk"j{s ul/Fb} cfPsf] 5 . ljut cfly{s jif{x?df h:t} cf=j= @)&@.)&# sf] n]vf k/LIf0fdf s]Gb|sf] a]?h' z'Go /x]sf] 5 .

o; s]Gb|n] ljutsf @@ jif{df cfkm"nfO{ cu|0fL ;+:yfsf] ?kdf :yflkt ug{ ;s]tfklg ljleGg

r'gf}tLx? ljBdfg 5g\ . s]Gb| cToGt Jo:t x'Fbf tyf bIf hgzlQmsf] cefjsf sf/0f o;sf ;]jfx?nfO{ b]zsf cGo efudf ;f]r]h:tf] lj:tfl/t tyf ljs]lGb|t ug{ ;lsPsf] 5}g . s]Gb|nfO{ k|lti7fgsf] ?kdf kl/0ft ug{ ;s] of] ;d:ofsf] xn ug{ ;lsg] b]lvG5 . ;fy} s]Gb|sf] ljBdfg ;]jf ;'ljwfsf] u'0f:t/nfO{ sfod /f- Vb} ;dofg's'n :t/f]Gglt ug'{ csf]{ d"Vo r"gf}lt xf] . s]Gb|df cfly{s?kn] ;DkGg lj/fdLnfO{ cfsif{0f ug{sf] nflu s]Gb|df cltl/Qm ;dodf ;+rflnt Paying Clinic nfO{ cem k|efjsf/L / Jojl:yt agfpg' kg]{5. xfn ;+rfng eO/x]sf] Paying Clinic af6 c:ktfnnfO{ jflif{s s/La * s/f]8 yk cfDbfgL eO/x]sf] 5 . o;n] s]Gb|nfO{ cfTdlge{/ agfpg yk d2t k'u]sf] 5 . la/f- dLsf] rfk lbgfg'lbg al9/x]sf] cj:yfdf alx/+u ;]jf tyf Odh]{G;L ;]jf k|jfx ug]{ :yfgsf] sdL ePsf]n] s]Gb|df cTofw'lgs ;'ljwfo'Qm gofF alx/+u ;]jf tyf Odh]{G;L ejg lgdf{0f ut jif{ z'? ul/Psf] 5 . pQm lgdf{0f x'g] ejgdf Paying Clinic sf] nflu klg 5'§} :yfgsf] Joj:yf ul/Psf] 5 . gofF ejg lgdf{0fsf] sfo{ b|'t ultdf cl3 al9/x]sf] 5 . lgwf{l/t ;do cufj} ejg lgdf{0f ;DkGg u/L x:tfGt/0f ug{ ejg ljefu tyf lgdf{0f Joj;foLnfO{ cg'/f]w ul/Psf] 5 . ejg lgdf{0f ;DkGg gx'Fbf;Ddsf nflu alx/+u tyf cfsl:ds ;]jf k|bfg ug]{ :yfgsf] s]xL xb;Dd cK7]/f] kg{ hfg]5 .

cGTodf, s]Gb|sf] ljsf;, lj:tf/ tyf :yfoLTjsf] nflu lg/Gt/ nflu/xg' ePsf s]Gb|df sfo{/t ;Dk"0f{ sd{rf/Lx?, :jf:Yo dGqfno, g]kfn ;/sf/sf ;/f]sf/jfnf lgsfox?, s]Gb|sf jt{dfg Pj+ k"j{ ;+rfns ;ldltsf ;b:oHo"x?, k"j{ sfo{sf/L lgb]{zsHo"x?, /Qmbftfx?, rGbfbftfx?, u}/–;/sf/L ;+:yfsf k|ltgLlwx¿, kqsf/x?, lj/fdL tyf pxfFx?sf cfkmGtx? Pj+ ;Dk"0f{ z'e]R5's hgdfg;df xflb{s wGoafb JoQm ug{ rfxG5'.

–––––––––––––––––8f= Hof]tLGb| zdf{sfo{sf/L lgb]{zs

@)&$ df3 !% ut] .

Annual Report 2017


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cf=j=2073÷074 sf] aflif{s sfo{s|dsf] k|utL tyf cfo Aoo laa/)f

o; s]Gb|n] cf=j=2073÷74 df d"Vo 8 j^f sfo{s|d ;+rfng ug]{ nIo /flvPsf] / ;f] sfo{s|d ;+rfngsf nfuL g]kfn ;/sf/sf] tkm{af^ %oxQ/ s/f]* ;f&L nfv,:jf:Yo s/sf]ifsf] tkm{af^ gf} s/f]* / cfGt/Ls >f]taf^ pgfgAa] s/f]* lqof;L nfv Aoxf]g]{ ul/ s'n /sd Ps c/j krxQ/ s/f]* lqrfnL; nfv ah]^sf] Joj:yf ul/Psf]df o; cfly{s aif{df d"Vo 8 j^f sfo{s|d ;DkGg e} Ps c/j rf}xQ/ s/f]* a};¶L nfv pgG;Q/L xhf/ vr{ e} pQm /sdaf^ pNn]vLt sfo{s|dx? ;+rfng ePsf]% .

1= d"^"/f]uLx?sf] kl/If)f ;]jfM

o; cf=j=2073÷74 df hDdf s"n 120,000 hgf lj/fdLx?nfO{ alx/+u ;]-jf dfkm{t ;]jf k"-ofpg] nIo /fv]sf]df 147,405 hgf la/fdLx?sf] alx/+u ;]jf dfkm{t d"^"sf] kl/If)f ul/Psf]% . o;/L aflif{s nIosf] cfwf/df 122=83% ef}lts k|ult b]lvPsf]% .

2= d"^"sf] zNols|of ;]jfM

cf=j=2073÷74 df hDdf 1400 hgf la/fdLsf] d"^"sf] zNols|of ug]{ sfo{s|d /flvPsf]df 1683 hgf la/fdLx?sf] laleGg vfn] d"^"sf] zNols|of ul/Psf]% . o;/L jflif{s nIosf] cfwf/df 120% k|ltzt ef}lts k|ult b]lvPsf]% .

3= PGhLof]u|fkmL÷Knfi^L kl/If)f ;]jfM

cf=j=2073÷74 df SofyNofa ;]jf dfkm{t hDdf 7,715 hgf la/fdLx?sf] PGhLof]u|fkmL÷Knfi^L nufotsf laleGg /f]ux?sf] kl/If)f tyf lgbfg ul/Psf]% .

4= k|ltsf/fTds ;]jf M

cf=j=2073÷74 df o; s]Gb|n] d'Vo d'Vo 8 :yfgdf d'^'/f]u ;DaGwL lzla/ ;+rfng ug]{ nIf /fv]sf]df b]zsf]

laleGg 12 :yfgdf d'^'/f]u ;DaGwL lgMz'Ns :jf:Yo lzlj/ ;+rfng u/L hDdf 6905 hgf la/fdLsf] :jf:Yo kl/If)f ul/Psf] lyof] h;dWo] O;LhL ug]{ la/fdL 2852 tyf Osf] ug]{ la/fdLsf] ;Vof 2710 /x]sf]% . h;dWo]==

• bdf}nLdf lgMz'Ns :jf:Yo lzlj/ ;+rfng ul/ ^^! hgf la/fdLsf] :jf:Yo kl/If)f ul/Psf] .

• wg'iffdf lgMz'Ns :jf:Yo lzlj/ ;+rfng ul/ @^# hgf la/fdLsf] :jf:Yo kl/If)f ul/Psf] .

• kif{fdf lgMz'Ns :jf:Yo lzlj/ ;+rfng ul/ #@@ hgf la/fdLsf] :jf:Yo kl/If)f ul/Psf] .

• eQmk'/df lgMz'Ns :jf:Yo lzlj/ ;+rfng ul/ @$% hgf la/fdLsf] :jf:Yo kl/If)f ul/Psf] .

• DofUbLdf lgMz'Ns :jf:Yo lzlj/ ;+rfng ul/ ^@* hgf la/fdLsf] :jf:Yo kl/If)f ul/Psf] .

• X]6f}8fdf lgMz'Ns :jf:Yo lzlj/ ;+rfng ul/ (%( hgf la/fdLsf] :jf:Yo kl/If)f ul/Psf] .

• :oféhf, la3f{df lgMz'Ns :jf:Yo lzlj/ ;+rfng ul/ $!^ hgf la/fdLsf] :jf:Yo kl/If)f ul/Psf] .

• :oféhf,s]nfbL3f6df lgMz'Ns :jf:Yo lzlj/ ;+rfng ul/ #*& hgf la/f dLsf] :jf:Yo kl/If)f ul/Psf] .

• wflbªdf lgMz'Ns :jf:Yo lzlj/ ;+rfng ul/ #^% hgf la/fdLsf] :jf:Yo kl/If)f ul/Psf] .

jflif{s sfo{qmdsf] k|utL tyf cfo Joo ljj/0f===

dgf]h s"df/ lji^, g/]z lrkfn" lg? bfxfn, laa]s yfkf, ;+ho dxh{g

Annual Report 2017


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• u'NdL tD3f; / afems6]/Ldf lgMz'Ns :jf:Yo lzlj/ ;+rfng ul/ !%** hgf la/fdLsf] :jf:Yo kl/If)f ul/Psf] .

• ;f]n'v"Da'df lgMz'Ns :jf:Yo lzlj/ ;+rfng ul/ !%^ hgf la/fdLsf] :jf:Yo kl/If)f ul/Psf] .

• Hff]d;f]ddf lgMz'Ns :jf:Yo lzlj/

;+rfng ul/ (!% hgf la/fdLsf] :jf:Yo kl/If)f ul/Psf] .

5= d"^"sf] eNe /fxt sfo{s|dM

cf=j= 2073÷74 df g]kfn ;/sf/$f/f z"Ns ltg{ g;Sg] d"^"sf ul/a la/f- dLx?sf nfuL #f]ifLt /fxt sfo{s|d cg";f/ 200 j^f d"^"sf eNex? vl/b ug{ ?=1 s/f]* 20 nfv /sd lalgof]lht e} cfPsf]df pQm /sdjf^ 200 j^f d"^"sf eNex? vl/b sfo{ ;DkGg e}xfn pQm 200 j^f eNex? k|lsof k"/f u/L la/fdLx?nfO{ lat/)f u/L k|Tof/f]k)f ul/Psf] % . ;fy} 2073 kmfu"g 01 ut] b]lv ;+k')f{ jfy/f]uLx?sf] zNolqmof lgMz"Ns ug]{ #f]if)ff kZrft 291 hgf la/fdLx?sf] lgMz"Ns zNolqmof ul/Psf] % ..

6= 15 jif{ d"gLsf tyf 75 jif{ dflysf la/fdLx?sf] lgz"Ns :jf:Yo ;]jf sfo{s|dM

cf=j= 2073÷74 df g]kfn ;/sf/$f/f z"Ns ltg{ g;Sg] 15 jif{ d"gLsf tyf 75 jif{ dflysf d"^"sf ul/a la/fdLx?sf nfuL #f]ifLt /fxt sfo{s|d cg";f/ 15 jif{ d"gLsf 600 hgf / 75 jif{ dflysf 300 hgfsf] zNolqmof tyf pkrf/ ug]{ nIo /flvPsf]df 15 jif{ d"gLsf 787 hgf ul/a la/fdLx?sf] laleGg ls;Ldsf zNols|ofx? ;DkGg ul/Psf] % eg] 75 jif{ dflysf 465 hgf ul/a la/fdLx?sf] pkrf/ ul/Psf]% . o;/L jflif{s nIosf] cfwf/df qmdzM 131% / 155% ef}lts k|ult b]lvPsf]% .

7= lk=^L=Pd=;L= ug]{ la/fdLx?sf] lgMz"Ns :jf:Yo ;]jf sfo{s|dM

cf=j=2073÷74 df g]kfn ;/sf/$f/f z"Ns ltg{ g;Sg] d"^"sf] eNe ;f+u"l/Psf] la/fdLx?sf] pkrf/sf nfuL #f]lift /fxt sfo{s|d cg";f/ 300 hgfsf] pkrf/ ug]{ nIo /flvPsf]df 461 hgf ul/a la/fdLx?sf] lk=^L=Pd=;L=;DkGg ul/Psf]% . o;/L jflif{s nIosf] cfwf/df 153% ef}lts k|ult b]lvPsf]% .

8= k'jf{wf/ lgdf{)f tyf lasf; sfo{s|dM

cf=j= 2073÷74 lgDg pNn]lvt k'jf{wf/ lasf; tyf lgdf{)fsf sfo{s|d /flvPsf]]% .

• xfn ;+rfngdf cfPsf] gof+ ejgdf 3 j^f ck/]zg lyo^/ tyf 50 ;}of yk u/L ;]jf ;+rfng .

• gof alx/+u ;]jf ejg lgdf{)f sfo{sf] 50 k|ltzt sfo{ ;DkGg .

• cTofw"lgs Cardiac CT scann Machine v/Lb .

• e]/L c+rn c:ktfnsf nflu gof SofyNofj pks/)f v/Lb .

• s]Gb| xftf leq /x]sf] ejgx?df /+u/f]ug,la/fdLx?sf] nflu ;]* tyf laleGg dd{t ;+ef/ ul/Psf] .

• s]Gb|sf] nflu cfaZos pks/)fx?sf] Aoj:yf ul/Psf] .

lgisif{M

o; s]Gb|n] rfn" cf=j= 2073÷74 sf] aflif{s sfo{s|d ;+rfngsf nflu d"Vo u/L 8 j^f sfo{s|d to u/L ;f]xL adf]hLd jh]^sf] Joj:yf u/]sf]df jflif{s nIosf] cfwf/df 100 k|ltzt ef}lts k|ult b]lvPsf] % eg] lalQo tkm{ jflif{s nIosf] cfwf/df 99=50 k|ltzt k|ult b]lvPsf] % .


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Shahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 6


Annual Report 2017


DEPARTMENT OF CARDIOVASCULAR SURGERY

We must become the change we want to see

In 2017, the department of cardiac surgery grew exponentially. Over the course of a long surgical journey, we had the opportunity to perform a variety of surgical interventions and treatments to our patients. Respecting its integrity to the community and its patients has been SGNHC’s ideal since the hospital’s founding. This has never been truer than it was past year. This issue of Smarika celebrates one of the many programs that make us proud to be in SGNHC. The support from the government of Nepal and the incessant efforts from the heart team have made the Rheumatic Heart Valve scheme possible, where we provide free valve surgeries for patients with rheumatic heart disease. This has created the healing spaces that put patients and families at ease. Our institute is giving renewed hope to patients and families. As

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Cardiovascular Surgery Report

many as 426 families have benefited from this program until now. We will continue to provide the scheme to innumerable families in the upcoming days. Through this issue of Smarika, we would like to acknowledge and give our sincere thanks to every personnel who were involved in making the scheme possible.

Annual Report 2017


many as 426 families have benefited from this program until now. We will continue to provide the scheme to innumerable families in the upcoming days. Through this issue of Smarika, we would like to acknowledge and give our sincere thanks to every personnel who were involved in making the scheme possible.

Dr Bijoy G. Rajbanshi attended the European Association of cardiothoracic society, in Austria, Vienna. Dr. Bijoy Rajbanshi presented paper at the European Association of cardiothoracic society in ‘Primary Surgical Repair of Coarctation of Aorta in Adolescents and Adults: Intermediate results and consequence of hypertension, congenital.’ Dr Bijoy G. Rajbanshi became the Vice President in the Asia Pacific Society of Cardiology, Singapore. He also presented a paper titled ‘Coarctaion of Aorta in Adults’ in ATCSA, Bangladesh. Dr Bishwo Pokhrel and Dr Nivesh Rajbhandari attended the IACTS

in Bangalore. Dr. Sidhartha Pradhan and Dr. Anil Acharya visited Dayanand Medical College for off pump conorary bypass grafting by Dr Sanju Ralhan. Dr Anil Acharya presented paper titled ‘Does Anterior Pericardiectomy suffices for postinfective constrictive pericarditis? Short and intermediate term outcome’ in ATCSA, Bangladesh. Dr Dikshya Joshi presented a paper on ‘Prevalence of coronary artery disease in rheumatic patients undergoing valve surgeries: retrospective analysis in

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Research, the quest for in-depth knowledge and wisdom about this rapidly developing field of cardiac surgery is what we are driven by at SGNHC. To meet the changing needs of our patients, we can never over-emphasize research and development, and how keeping up-to-date with the recent technologies can bring us to the frontier. Hence, we had some participation in the international conferences and training workshops. Dr. Jyotindra Sharma and

The scope and quality of surgical care provided has continued to increase. In 2016-2017, the department conducted 1778 surgeries. We still witness the increase flow of patients with coronary heart disease over the past few years, and the number of CABG is on the rise and accounts to 290 surgeries. This year valvular heart surgeries accounted for the largest volume of procedures performed at our centre, numbering 641 surgeries. We had 498 congenital heart surgeries. There were total of 11 vascular procedures, 41 closed heart surgeries, 51 arteriovenous fistula creation and 61 other procedures.

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Shahid Gangalal National Heart Centre, Bansbari, KathmanduPage 9


a tertiary care cardiac centre’ in the XV International congress of management of cardiovascular disease’, and received the best abstract award.

This year we were graced with some of the most notable visitors who spent their time and expertise with us. Prof. S. Bhattacharya from Mumbai visited us and guided us about his techniques in off pump coronary bypass grafting. Team of doctors lead by Dr. Fredrick Grover from University of Colorado, Denver, USA also visited us. We appreciate Dr. John Calhoon spending time with us and sharing his expertise. Dr Devagorou from AIIMS visited us for Mitral Valve Repair Workshop. Also the

team from Mayo Clinic visited us like every year which was very refreshing for us.

With growing volume of patients and cardiovascular diseases, the department of Cardiovascular Surgery at our centre will have a lot of challenges to face in the upcoming days. There exist limitless opportunities and a vast area for us to grow. With adequate resources, devoted, well qualified and skilled workforce, we are confident that we can make full use of the opportunities that come our way and explore, experiment and express ourselves better so that we can give better outcome to our patients whom we value the most.

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DEPARTMENT OF ANESTHESIOLOGY

Cardiac anesthesiology at the Shahid Gangalal National Heart Center provides perioperative cardiovascular care including Pre- operative assessment and preparation of all patients prior to surgery, intraoperative management of patients undergoing complex operations, which encompasses

the use of invasive monitoring techniques, advanced hemodynamic management, reading and interpreting intraoperative transesophageal echocardiograms, post-surgical intensive care management and the control of postoperative pain. The department also provide anesthesia services

Dr Jejeu Nath Pokharel, Dr Ashish Govinda Amatya, Dr Battu kumar Shrestha, Dr Smriti Mahaju Bajracharya, Dr Santosh Parajuli, Dr Santosh Khatri, Dr Parbesh Kumar Gyawali, Dr Rabin Vaidhay

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Anesthesiology Report

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in the cath lab and respiratory care support to the mechanically ventilated patients in the coronary care unit and medical intensive care unit. Beside this the department actively takes part in ongoing educational and research program and conduct various CME.

In the year 2017, 2025 patients required anesthesia service. Among those 1687 patient were from operation theater and 338 patients from Cath lab. According to the type of procedure in Operation Theater, maximum number of procedure was open heart procedures which included surgeries of valvular heart disease, surgery for repair of congenital heart lesions followed by coronary artery bypass surgery. Other surgery include vascular surgery, pericardial surgery, cardiac tumors and others.

In catheterization laboratory, 338 patients required anesthesia service. Among them right heart catheterization for cyanotic and acyanotic congenital heart diseases were 67, Balloon Pulmonary Valvotomy (BPV) and BAV 26, device closure for ASD, VSD and PDA were 141 and percutaneous coronary intervention PCI were 102.

ACADEMIC ACTIVITIES

The goal of our departments is to insure quality care for the patient in the hospital, critical care, cath lab and develop the subspeciality training in cardiac anesthesia by fostering the research activities.

Our department is conducting CPR training regularly for all the hospital staff currently. From this year we are also conducting regular classes presented by faculty doctors and resident doctors every Thursday. We are also planning to start fellowship program on cardiovascular anesthesia from this year.

Educational participation includes residency rotations for the National Academy of Medical Sciences (NAMS), B P Koirala Instutute of Health Science (BKIHS), Nepalgunj Medical College (NMC), Nobel Medical College and Lumbini Medical College (LMC). Cardiac surgical program are assisted in Kathmandu University of Medical Sciences (KUMS), Dhulikhel Hospital and Chitwan Medical College (CMC), Chitwan as resource personal. CME program of the hospital is being conducted in regular basis.

CONFERENCE and RESEARCH ACTIVITIES

• Dr Ashish Amatya has rejoined SGNHC after successful completion of Fellowship in Cardiac Anesthesia in IJN, National Health Institute, Malaysia.

• Dr Jeju Nath Pokherl and Dr Battu Kumar Shrestha attended ISACON in Calcutta, India in the month of December 2016.

• Dr Battu Kumar Shrestha attended workshop “ Noscomial Infection Control “, Nagoya ; Japan in the month of January.


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• Dr Santosh Parajuli published research on “Ultrasoud-guided internal jugular catheterization in paediatric cardiac surgical patients: a prospective observational study.” in The Egyptian Journal of Cardiothoracic Anesthesia.

• Dr Battu Kumar Shrestha published research on “Difference in Return of Spontaneous Circulation in Early vs Late Endotracheal Intubation among witnessed in Hospital Cardiac Arrest” in The Journal of Nepal health Research Council.

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Non Invasive Cardiology Report

NON–INVASIVE CARDIOLOGY AND OPD SERVICES

INTRODUCTIONNon-Invasive Cardiology, a branch of cardiology, includes non-invasive testing for outpatients and inpatients, utilizing tests to diagnose and treat cardiac diseases. With the establishment of Shahid Gangalal National Heart Centre (SGNHC) in 1995, the tertiary center for cardiovascular disease in Nepal, there has been significant increase in the quantity as well as quality of non-invasive tests. Nepalese people all over the country as well as foreigners have been benefitted from the services available in this institution.

Non-invasive services are an integral part of this institution in the form of services provided to the patients and as a major source of revenue. Every year new services are being added to this list. Advanced non-invasive cardiology imaging and technologies have dramatically improved early detection and treatment of cardiovascular diseases.

SERVICES PROVIDEDServices provided by the noninvasive cardiac unit include Adult and Pediatric echocardiography, Stress echocardiography, Trans-esophageal echocardiography (TEE), Fetal echocardiography, 3D Echocardiography, Treadmill test, Ambulatory blood pressure (ABP) monitoring, Holter monitoring, Electrocardiogram (ECG), X-ray, Ultrasonography, Doppler study including carotid and venous doppler, Enhanced External Counter Pulsation (EECP) and Benzathine penicillin injections.

Currently, the non-invasive unit in our institution is equipped with eight functioning Echo machines (one high end 3D echo and TEE, two high-end and two medium range with two new Philip echo machines added this year), 4 treadmill machines: 2 functioning, 18 functioning Holter monitoring devices and three wireless Holter devices and seven ABP

Dr Amrit Bogati, Dr Pragya Silwal

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devices. Portable echo machine has greatly enhanced ability of early diagnosis and management of cardiovascular diseases in emergency conditions. Services like Ultrasonogram (USG) and Venous Doppler which have helped in diagnosing peripheral vascular and other non-cardiac conditions have been continued this year.

Each year there have been significant increase in the number of patients who attended the outpatient department. In the year 2016, there were total of 140,093 patients attending the outpatient department, whereas in the year 2017, total no. of patients has increased to 153462 making it the highest number of patients attending outpatient department till date.

Number of Patients Receiving Non-invasive Services in 2017

Investigations Male Female TotalElectrocardiogram 31941 27402 59343Echocardiogram 33734 28700 62434Echo Screening 621 708 1329De Stress Echo 37 25 62Fetal Echo 663 663TMT 8177 4940 13117Holter 1836 1647 3483ABP 1078 681 1759TEE 299 590 889X-Ray 31565 29103 60668Doppler 451 224 675USG 664 627 1291Penidure Injection 1635 2222 3857Immunization 112 114 226OPD Patients 80878 72584 153462

Graphs below show a comparison in the number of patients receiving non-invasive services since the beginning of the service at the OPD:

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Pediatric Cardiology Report

PEDIATRIC CARDIOLOGY SERVICE

INTRODUCTIONShahid Gangalal National Heart Centre is one of the very few hospitals in Nepal providing cardiac health services to the pediatric population. It is a major referral center from all over Nepal and neighboring country where children suffering from heart disease are appropriately diagnosed and managed. SERVICES PROVIDEDPediatric Cardiology unit of SGNHC has increased its services by leaps and bounds since its establishment in 2004 A.D. With only thrice a week out patient services in its early days, the services have expanded to daily OPD, congenital echocardiography, inpatient, noninvasive and invasive services on all working days. Pediatric Cardiology unit deals with all types of cardiac illnesses, however the majority of the children are those with rheumatic heart disease and

structural/congenital abnormality.

Most of the patients attending the pediatric OPD of SGNHC are from the remote areas of Nepal due to lack of cardiology services for children outside Kathmandu. Despite the geographical difficulties there is an increasing number of attendants visiting the pediatric clinic each year with the total number reaching 10,265 in the year 2017. Among them, 5813 (56.6%) were male and 4452 (43.4%) were female. Fig 1 shows this increasing trend of OPD visits since 2008 and Fig 2 shows gender-wise distribution of patients visiting to Pediatric OPD in 2017.

Fig. 1: Number of OPD patients as per year

Dr. Urmila Shakya, Dr. Manish Shrestha, Dr. Poonam Sharma, Dr. Shilpa Aryal, Dr. Anjana Thapa Magar, Dr. Swastika Sedhai

Annual Report 2017



get referrals for echocardiography from different departments in the hospital mainly for structural (congenital) heart diseases. A total of 8703 patient had undergone trans thoracic echocardiography by the pediatric department. Among them 59.9% (n=5220) were male and 40.1% (n=3483) were female. The mean age of children undergoing echocardiography was 7 years (S.D= 4.65) with minimum age being 1 day of life and maximum of 25 years of age. Figure 3 shows the age distribution of children undergoing echocardiography with the most common age group being one to five years of age.

Fig. 3. Age Distribution of patients undergoing Trans Thoracic Echocardiography

Abnormal finding in echocardiogram was seen in 73.4% (n=6390) of patients with the most common finding being Acyanotic Congenital Heart Disease which was present in 44% (n=3220) of children. The percentage of other abnormal findings classified as Cyanotic CHD, Rheumatic Heart Disease, post intervention procedures, post-surgical procedures, Complex heart and miscellaneous diseases is shown in figure 4. Similarly Figure 5 compares the transthoracic echocardiographic results over a period of three years.

Fig.4: Echocardiography Findings

Fig. 5. Comparison of Echocardiography findings in

Figure. 2: Sex-wise distribution of OPD Patients

Fig. 2. Gender wise distribution of OPD patients

Since last six years inpatient services to pediatric patients have been provided by four bed allocated for medical management of children with cardiac disease. Pediatric cardiology unit is also looking after chil-dren admitted in surgical wards and pediat-ric ICU both pre and post operatively. Total of 108 patients were admitted in pediatric ward this year with majority of children be-ing admitted for some cardiac intervention. This shows the increasing number of in-tervention in children, both diagnostic and therapeutic, in SGNHC. Heart failure was the second commonest cause for admission followed by pericardial effusion. Diagnosis No. Of

PatientsHeart Failure 25Rheumatic Heart Disease 4Infective Endocarditis 17Acute Rheumatic Activity 10

S/P Intervention 35Arrythmia 2

Pericardial Effusion/ post Pericar-diocentesis

10

Miscellaneous 5

Total 108

(NB: Some children undergoing catheterization pro-cedure had been admitted in other wards due to unavailability of beds in Pediatric ward causing dis-parity in numbers.)PEDIATRIC ECHOCARDIOGRAPHY Transthoracic Echocardiography services have expanded according to the expansion of OPD services to all working days since 2013 which has increased the total number of echocardiography performed. Along with our own OPD patients we

Annual Report 2017



consecutive three years.

MINIMAL INVASIVE PROCEDURES PERFORMED IN CHILDREN AT SGNHCBoth diagnostic as well as therapeutic cardiac catheterization procedures are being performed in children by the Pediatric Cardiology Unit of SGNHC. Since the availability of Children Assistance Programme (CAP) by the government where the intervention procedure are given free of charge to the children, there has been a sharp increase in the number of children seeking treatment. Therapeutic intervention like Balloon Valvuloplasty, transcatheter closure of ASD and PDA and balloon atrial septostomy are being regularly performed by the pediatric unit with the beginning of more complex procedures such as VSD device closure, coronary artery fistula occlusion and PDA stenting.

Table 2: Distribution of patients undergoing intervention

Procedures No. of Patients

RHC/LHC 67BPV(Balloon Pulmonary Valvu-loplasty) 18

BAV(Ballon Aortic Valvuloplasty) 8Percutaneous transatrial mitral comissurotomy (PTMC) 12

ASD Device Closure 41PDA Device Closure 94PDA Stenting 1Balloon Atrial Septostomy (BAS)/static balloon dilatation 8

Coil Embolization 2TOTAL 250

Diagnostic catheterisation continues to be the gold standard tool in complex heart disease and those with severe pulmonary hypertension for accurate hemodynamic assessment of pulmonary artery pressure. Thus the diagnostic catheterization done in SGNHC has shown our improvement in the quality and accuracy

of surgical and post surgical management of such patients. There has been a dramatic increment in therapeutic intervention mainly PDA and ASD device closure in 2017 with significant improvement in the quality of life without the neccesity of open heart surgery in these children. Similarly we have also started performing relatively complex procedure such as VSD device closure, Coil embolisation and PDA stenting. Our skill and confidence has had a major boost because of the knowledge and guidance shared by various renowned doctors from India such as Dr. Bharat Dalvi (Glenmark Hospital, Mumbai), Dr. Shiva Kumar(Madras Medical Mission,Chennai), Dr Jay Rangnath, Dr. Ravi Ranjan Tripathi(CHL Hospital, Indore) and Dr. Neeraj Awasthi (Mac Hospital, New Delhi). We are ever grateful for sharing their knowledge and experience with us. Figure 6 compares the number of invasive procedures performed by the pediatric unit over three years.HUMAN RESOURCESPediatric Cardiology unit is a unit comprising of one consultant pediatric cardiologist, one pediatric cardiologist, two registrars and two medical officers. Despite its small size and inadequate manpower we are trying our best to provide the best possible treatment to the ever increasing number of children with cardiac problems. We hope to add further on it to cope with the load in future.We are also providing basic training in Pediatric Cardiology including echocardiography to interested candidates from different institutes. Pediatric residents from Institute of Medicine, Tribhuvan University Teaching Hospital and Lumbini Medical College were also posted with us as a part of their training in pediatrics. In addition pediatric cardiology unit is also performing fetal echocardiography in collaboration with the department of Radiology for intrapartum diagnosis of congenital heart disease. Similarly there are multiple researches going on within the unit with some being published in national and international journals.

CONCLUSIONDue to increased awareness of heart disease in Nepal, there has been steady increase in the number of patients attending Pediatric Cardiology OPD. With limited resources we are continually trying to give quality services and will leave no stone unturned for betterment of pediatric cardiology service in the future.

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ACS Report

ACUTE CORONARY SYNDROME AT SGNHCINTRODUCTIONCoronary artery disease(CAD) continues to be the leading cause of mortality and morbidity worldwide. Although CAD mortality rates worldwide have declined over the past four decades, CAD remains responsible for about one-third or more of all deaths in individuals over age 35.It places a large economic burden on health care system as CAD is one of the most frequent reason for hospital admission. The incidence of CAD has decreased over time in developed countries but it is increasing in developing countries like Nepal. At the turn of the century, it was reported that coronary heart disease mortality was expected to increase approximately 29 percent in women and 48 percent in men in developed countries between 1990 and 2020. The corresponding estimated increases in developing countries were 120 percent in women and 137 percent in men.

CAD results from atherosclerotic changes within the walls of the coronary arteries that obstruct the normal blood flow to the cardiac muscles leading to myocardial ischemia and, in severe cases, infarction. There are specific risk factors related to each of the 2 phases—atherogenic and thrombogenic—of the pathogenesis of CAD. Atherogenic risk factors can be classified into 3 subgroups: upstream, behavioral, and physiological risk factors. Upstream factors are those that provide a favorable environment for individuals to acquire the behavioral and physiological risk factors and include population level factors such as urbanization, globalization, public policies, trade agreements, socioeconomic status, and education. Behavioral risk factors include unhealthy diet, smoking, psychosocial

factors, and sedentary lifestyle. Physiological risk factors include hyperlipidemia, obesity, hypertension, and diabetes. The thrombotic risk factors for CAD include high fibrinogen levels, abnormal platelet size and function, decreased endogenous fibrinolytic activity, and elevated levels of lipoprotein A.

Acute coronary syndrome (ACS) refers to a spectrum of clinical presentations ranging from those for ST-segment elevation myocardial infarction (STEMI) to presentations found in non–ST-segment elevation myocardial infarction (NSTEMI) or in unstable angina. It is almost always associated with rupture of an atherosclerotic plaque and partial or complete thrombosis of the infarct-related artery. Chest Pain, which is usually described as pressure, squeezing, or a burning sensation across the precordium and may radiate to the neck, shoulder, jaw, back, upper abdomen, or either arm is the most common symtom. ECG findings differentiates between STEMI and NSTEMI and cardiac enzymes needed to differentiate between NSTEMI and Unstable Angina. STEMI are usually managed initially with antiplatelets and revascularization either with thrombolytic therapy or with primary percutaneous intervention and other ACS initially managed with anticogulants, antiplatelets and other supportive treatments.

SERVICE PROVIDED

A coronary care unit (CCU) is a hospital ward specialized in the care of patients with Myocardial Infraction , unstable angina, cardiac dysrhythmia and various other cardiac conditions that require continuous monitoring and treatment. We have a specially designed,

Dr. Reeju Manandhar, Dr. Pragya Silwal, Dr. Rabindra Pandey

Annual Report 2017


ACS Report

well equiped 12 beded unit with comprehensive central monitoring, central oxygen supply, 24 hr portable x-ray, portable echocardiography, defribrillator, mechanical ventilator and IABP supports. CCU has round the clock duty of medical officers with on call cardiologist 24 hrs available with well trained nursing staffs and other health professionals along with the support from anesthesia department.

The acute coronary cases were predominantly admitted through emergency department.ECG was taken within10 minutes on patients arrival. Patients with STEMI were managed with primary PCI or thrombolysed according to duration of chest pain and affordability of patient.Rescue PCI was also rendered whenever necessary. Patients with STEMI, NSTEMI and high risk UA almost all admitted in CCU. However patients with low to moderate risk UA were admitted in CCU if beds were available,otherwise in general ward.

DEMOGRAPHIC FEATURES

In this year 2017, Total 1197 patients got admitted in CCU with diagnosis of ACS. Among them 963( 81%) were STEMI, 133( 11% ) were NSTEMI and 101( 8% )were of UA. ACS showed male predominance with total of 864(72.1%) patients.

THROMBOLYSIS VS PRIMARY PCI

Among 963 STEMI cases 230 ( 23.88%)(last year 18.64%) underwent PPCI, 8( 0.83%) rescue PCI and 114(11.83%)(last year 14.20%) received thrombolysis.

MORTALITY

Overall mortality of ACS was 90(7.51%)(last year 5.1%).The mortality in anterior wall MI, inferior wall MI and Inferior wall MI with RV infraction were 11.58%, 5.32% and 16% respectively.

MI Total Male Female PPCI Rescue PCI STK TNK MortalityAWMI/ASWMI 385 276 109 87 03 43 00 35IWMI 263 197 66 60 01 33 01 14EAWMI 107 78 29 26 03 15 03 22INF POS/INF LAT 151 116 35 42 00 16 00 15IWMI+ RV INFRAC-TION

25 16 09 07 01 03 00 04

LAT/POST MI 32 24 08 08 00 00 00 00TOTAL 963 707 256 230 08 110 04 90

Table 1: ACS Admission Pattern in SGNHC

ACS Male Female TotalSTEMI 707 256 963NSTEMI 95 38 133UA 62 39 101TOTAL 864 333 1197

Annual Report 2017


MICU Report

MEDICAL INTENSIVE CARE UNIT (MICU)

INTRODUCTIONMedical ICU was established at our centre on August 2002. Since its establishment, the primary aim of this unit was to care for patients with cardiac failure of various etiologies. It also takes care of critically ill cardiac patients with comorbid medical conditions like chronic renal failure, stroke and sepsis with the support from anesthesia department. Medical ICU has round the clock duty of medical officer and on call registrar and efficient staffs trained in critical care.

SERVICES PROVIDEDThis year a total of 598 patients were admitted in the MICU, out of which the total female patients were 271 (45%) and male were 327(55%). The mean age of admitted patients was 59 yrs with the youngest patient admitted was 12 yrs old. The eldest patient admitted was 92 yrs old.

The pattern of diseases with which the patient were admitted ranged from acute myocardial infarction to chronic illnesses like COPD, chronic renal failure, Cardiomyopathies

and Rheumatic Heart Disease (RHD). The most common cause of admission was acute coronary syndrome with or without intervention (52.8%) that required intensive monitoring and supportive care. Dilated cardiomyopathies with various etiologies (idiopathic, ischemic, peripartumetc) was another leading cause of MICU admissions with almost (13.4%) of the total MICU admissions. These cases were mostly admitted following the episodes of acute decompensated heart failure and had to be managed with aggressive diuresis, inotropic support and if required ventillatory support. RHD including post Mitral valve replacement (MVR), Aortic valve replacement (AVR) and stuck valve was another common presenting illness at

Dr Chirag Subedi, Dr. Yudhir Khadka,Dr. Parag Karki, Dr. Deepak Limbu

Fig. 1: Sex distribution of patients in MICU

Annual Report 2017


MICU Report

the Medical ICU (11%). Non rheumatic valvular heart disease (7.2%) and Arrhythmias including Heart Block (4.2%) were also fairly common admissions. Admissions due to other diseases (11.4%) included heart failure, congenital heart disease, pulmonary embolism,pericardial diseases, ischemic heart diseases, sepsis and primary respiratory illness with acute exacerbation of COPD, asthma, pneumonia.

We have our primary physicians as well as well-trained cardiologists and DM fellows to make decisions regarding management in such situation. We also have facility to take frequent bedside superspecialityconsultations (Nephrology, Neurology, Endocrinology, Neurosurgery etc) for better patient care. We have been giving frequent bedside hemodialysis with the help of team from National Kidney Centre to the patients requiring temporary dialysis services in acute settings. We also have facility of inter hospital referrals as and when required for better patient care and management. Our Medical ICU services also give opportunity for poor patients who require prolonged ICU management in form of charity fund and drugs which are supplied from the Jayanti trust and Bridging the gap project.

MORTALITYTotal MICU mortality was 115 (19.23%) out of which 55 were male and 60 were female which were 16.81 % and 22.14 % of respective admissions. Major cause of MICU mortality was Heart Failure 44 patients (38.26%) followed by cardiogenic shock 28 patients (24.34%). Other common causes of death were Sepsis in 15 patients (13.04%) and cardiac arrhythmias like VT and VF in 8 patients (6.95 %). Cardiac rupture occurred in 6 patients which

amounts to 5.21% of total mortality. Other various causes of death like respiratory failure, pulmonary embolism, aspiration pneumonia, heart block, acute kidney injury etc were listed in 12.17%of deaths.

CONCLUSIONWith this year’s challenge been done, Medical ICU has and will be working with the same spirit in the patient management. In the upcoming years, the institute is planning to further expand the unit and the number of beds available seeing the rising trend of various heart failure admissions as well as multisystem illness that get admitted in our hospital.

Annual Report 2017


Interventional Cardiology Report

INTERVENTIONAL CARDIOLOGY SERVICES

INTRODUCTIONCardiac catheterization is a special branch of cardiology which has contributed a lot in management of cardiovascular disease .Cardiac catheterization and angiogram are used both for diagnostic as well as management purposes. Subsets of this technique are mainly coronary catheterization, catheterization of cardiac chambers and valves of cardiac system. The clinical application of cardiac catheterization begins with Werner Forssman in the 1930s,and since then many experts has contributed a lot in field on interventional cardiology to revolutionize in the diagnosis and management of cardiovascular disease.

SERVICES PROVIDEDOur centre is the first national heart center and the only tertiary level cardiac centre in Nepal pioneered in handling complex cardiac cases and emergencies.

The interventional unit under the center takes pride of running a 24 hour running cath lab services with the dedicated primary operators as interventional cardiologist, well trained nursing staffs and radiographers providing both diagnostic and therapeutic interventional procedures. The Interventional cardiology branch was established at this center in the year 2058

Dr Satish K. Singh, Dr. Kunjang Sherpa, Dr. Shipra Shrestha, Dr. Swostika Sedhai

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Interventional Cardiology Report

B.S. and since then the number of elective as well as emergency cardiac interventions are increasing every year with better expertise. Different coronary interventions including PTCA, FFR ,IVS to valvular intervention like BPV,BAV,PTMC and pacemaker insertion are being done every year with increasing numbers.

With the new technologies and expertise with dedicated electrophysiologists, there has been marked rise in the number of complex EP studies and ablation done at the centre. The cath has also started usingIVS( intravascular ultrasound) in selected cases whenever needed which is upto the latest standards in managing complex percutaneous coronary interventions. There has been significant increase in the number of diagnostic and therapeutic structural interventions this year like ASD/PDA/VSD device closure. AV fistula closure etc. The different cardiac interventional procedures performed from Jan 2017 to Dec 2017 are shown in Table and figure as below.

SN Procedure Total1. Coronary Angiography (CAG) 41452. Percutaneous Transluminal Coronary Angioplasty (PTCA) 15713. PercuataneousTransluminal Coronary Angioplasty(PTMC) 4454. Electrophysiology Study /Radiofrequency Ablation (EPS/RFA) 3625. Permanent Pacemaker Implantation 3416. Temporary Pacemaker Implantation 2897. Device Closure (ASD/PDA/VSD) 2838. Primary Percutaneous Coronary Intervention (PPCI) 1709. Right Heart Catheterization 103

10. Pericardiocentesis 6011. Ballon Pulmonary Valvuloplasty/Ballon Aortic Valvuloplasty (BPV/BAV) 4212. Peripheral Angiography/Angioplasty 7

13. FFR (fractional flow reserve)/ IVS (intravascular ultrasound) 4

Total 7822

CONCLUSIONSahid Gangalal National Heart Centre has been established as the best tertiary care center for cardiac catheterization in Nepal. Both diagnostic and therapeutic interventional procedures are performed routinely in this centre. The services provided by a dedicated cathlabteam in this centre are expanding and has established a reputation of respect in the medical community in the whole nation. We will continue to serve the nation as the ace institute in management of most cardiac interventional cases and maintain the pride with hard work and dedication.

Annual Report 2017


Cardiac Electrophysiology Report

CARDIAC ELECTROPHYSIOLOGY AND DEVICE IMPLANTATION

SAfter its establishment in 2004 AD, the unit of Electrophysiology is providing the services to the patients to its fullest. With recent advances in the technologies and the fully dedicated team of enthusiastic and energetic doctors and paramedics, the department is marching ahead in its services. Now the department has 3D mapping system which is operated on last Friday of every month.

EP Study and Ablation

An overview of the number of clinical cases is as follows:

Total of 147 cases of AVNRT underwent EPS + RFA of which 98% were of typical type.

Fig-1: AVRT cases in EPS Lab

AVRT Pathways as found in the EPS Lab

Fig 2: AVRT Pathways in Patients Undergone EPS + RFA in EP lab in SGNHC

Dr. Mukund Sharma, Dr. Samir Poudel, Dr. Jyoti Baskota

Annual Report 2017


Cardiac Electrophysiology Report

Other types of tachycardia found in patients in EP lab are as follows

Fig 3: Other types of Tachycardia in EP Study

Fourteen patients underwent EP Study with attempted ablation and seven patients were re-ablated.

This year there has been 36 cases who have had 3D mapping for Ep Study and Radiofrequency Ablation. The distribution of numbers as per the type of pathology is as follows:

Fig-4: 3D EP Study and ablation in SGNHC

Permanent Pacemaker Implantation

Pacemaker implantation is also a regular procedure in SGNHC. It is done twice a week- Tuesday and Friday. Total of 302 cases of pacemaker implantation were there in the last year. The number as per sex and type is as below.

SINGLE CHAMBER DUAL CHAMBERMALE FEMALE MALE FEMALE

164 106 21 11270 32

Table-1: PPI Cases in last fiscal year

Indications of PPI

Fig-5: PPI Indications as per the pathology

Other devices, in addition to pacemakers, are also implanted in our cath-lab.

Fig-6: Number of CRT and AICD implantation as per sex

CRT: Cardiac resynchronization therapy & AICD: Automated Intracardiac Cardioverter Defibrillator

After putting the devices,followings were the re-do procedures

Fig-7: Number of Re-do Procedures in patients with

device implantation

CONCLUSIONWith the advent of new technologies and procedures, patients with arrhythmia are being benefitted with device implantation and ablation therapy. It has a significant impact on morbidity and mortality of cardiac patients with rhythm disturbances.

Annual Report 2017


Emergency Services Report

EMERGENCY SERVICES

INTRODUCTIONEmergency services are critical for high-quality healthcare service provision to support acute illness, trauma and disaster response. Shahid Gangalal National Heart Centre (SGNHC), popularly known as Gangalal, has been the leading and trusted institution for cardiac emergencies since its birth. It is actually a matter of pride to all of us that,due to the quality of healthcare we provide, every cardiac patient from every corner of the country wishes to be treated at Gangalal. Because of this popularity among the general public, our emergency room is one of the busiest places within the premises round the clock.

SERVICE PROVIDEDAThe emergency room is well equipped to deal with any sort of cardiac emergency. The hard working, dedicated and well trained team of doctors, nurses and paramedics are all the time prepared to provide quality healthcare to the patients as per the latest guidelines set by ACC/AHA.

ECG, ECHO and relevant blood

investigations as per the symptoms are done to all the patients who present to ER. As a patient present to ER, after a brief history ECG is obtained and is immediately interpreted by the cardiologist on duty. ECHO screening is done to every patient who present with cardiac related complaints.

Acute Coronary Syndromes and life threatening arrhythmias are dealt speedily. Acute ST elevation MI patients are immediately given the options for thrombolysis or Primary PCI if they have presented within the specific time. Those who opt for PCI are immediately transferred to Cath lab to maintain a door to balloon time of 90 minutes. And those opting for thrombolysis and without contraindications are immediately thrombolysed maintaining door to needle time of less than 30 minutes. After immediate management and stabilization, the patients are then transferred to CCU for further treatment.

Patient with life threatening arrhythmia are managed as per the guidelines. Hemodynamically stable patients are managed medically initially. Those hemodynamically unstable are electrically

Dr Sanjay Singh K.C., Dr. Jagat Adhikari, Dr. Anubhab Sharma, Dr. Smita Adhikari, Dr. Grishma Upreti

Annual Report 2017


Emergency Services Report

cardioverted. Temporary Pacemaker are inserted on emergency basis as per need in life threatening bradyarrhythmias and admitted for permanent pacemaker electively.

We, at Gangalal ER, have to deal with many non-cardiac Emergencies like CVS, Respiratory emergencies, GI bleeds among many others. Such cases after initial acute management and thorough counselling are referred to respective centers for specialist care without delay.

Emergency Room Census – 2017Because of the popularity and the immense faith we have gathered in these years, the number of patients attending Gangalal has been increasing year after year. The ER attendance in the year 2015, 2016 and 2017 are 11631, 13854 and 17046 respectively.

Table 1: ER attendance

TOTAL 17046MALES 9139FEMALES 7313ADMISSION 5491DISCHARGED 9948REFERRED 2337LAMA 151MORTALITY 40DOA 39

Table 2: Provisional diagnosis

PROVISIONAL DIAGNOSIS NUMBERHYPERTENSION 3230CORONARY ARTERY DISEASE 3012RHD/VHD 1628COPD/RTI 1158CARDIOMYOPATHY 1263ARRYTHMIA 1007APD 1051ANXIETY DISORDER 533CVA 278CHD 206PERICARDIAL DISEASES 197VASCULAR DISEASES 113OTHERS 2381

Table 3: Presenting complaints

Annual Report 2017


Medical Ward Report

MEDICAL WARD

INTRODUCTIONIn order to cope with the incremental inflow of patients the medical ward has been continuously being extended. Currently Medical Ward has a capacity of 107 beds ( 18 in General Ward, 16 in New Medical Ward, 18 in Annex, 14 in Chest Pain Observation Ward,10 in Pre Cath, 11 in Double Cabin, 20 in Single Cabin).The hospital, being the national referral cardiac center, is constantly upgrading facilities to provide highest quality services to patients.

Medical Wards receive patients via direct admissions (from OPD), Emergency and Pre-cath and also serves as a step-down unit from critical care units (CCU and MICU). Medical Ward services are covered by a 24-hour on duty resident doctor.

DISEASE DISTRIBUTION For analysis, the patients admitted in Medical Wards were categorized having either Coronary Artery Disease (CAD),

Valvular Heart Disease, Rheumatic Heart disease, Arrhythmias, Hypertension, Congenital Heart Disease(CHD), Dilated Cardiomyopathy(DCM), Chronic Obstructive Pulmonary Disease(COPD), Pericardial Effusion, Infective Endocarditis (IE), Non-specific Chest Pain and others. The disease prevalence among patients admitted to Medical Ward are shown in Table below.

CONCLUSIONAs the table illustrates, CAD was the most prevalent disease amongst the patients admitted to the medical ward (43%), followed by HTN (12%), DCM (8%), arrhythmias (9%) and valvular heart diseases. The trends in 2017 showed similar pattern as in 2016, as illustrated in the bar chart below, although the cumulative number of cases have increased. Considering the increasing trend of patient inflow, we are likely to continue expansion of Medical Ward in years to come.

Dr. ReejuManandhar, Dr. Shaneez Najmy, Dr. Shruti Pokharel, Dr. SantoshKarki, Dr. Nripesh Man Shrestha

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Medical Ward Report

NUMBER OF CASES %MALE FEMALE TOTAL

CAD 2711 1325 4036 43.26HYPERTENSION 740 381 1121 12.02DILATED CARDIOMYOPATHY 427 337 764 8.19ARRHYTHMIAS 340 469 809 8.67VALVULAR HEART DISEASE 149 291 440 4.72RHEUMATIC HEART DISEASE 289 477 766 8.21CONGENITAL HEART DISEASE 76 100 176 1.89PERICARDIAL EFFUSION 94 106 200 2.14COPD 87 48 135 1.45INFECTIVE ENDOCARDITIS 38 40 78 0.84NON-SPECIFIC CHEST PAIN 147 107 254 2.72OTHERS 290 261 551 5.91

Annual Report 2017


CRAHP Department Report

DEPARTMENT OF CARDIAC REHABILITATION AND HEALTH

PROMOTION

INTRODUCTIONDCardiac Rehabilitation and Health Promotion (CRAHP) department is one of the very important department at Shahid Gangalal National Heart Center, performing a vital role in primary and secondary prevention of cardiovascular diseases. The goal of cardiac rehabilitation is to reduce the risk of a future cardiac event by stabilizing, slowing, or even reversing the progression of cardiovascular disease. Cardiac rehabilitation is designed to improve health among patients recovering from a heart attack and other forms of heart disease or surgery for various forms of heart disease. Cardiac rehabilitation services are available across a continuum that includes inpatient, outpatient and ongoing

prevention approaches.

Cardiac rehabilitation programs consist of primary prevention and secondary prevention after manifestation of cardiac disease. We conduct free cardiac camps, community awareness programs, school health programs and distribution of health education materials for primary prevention of cardiovascular diseases. In other hand we also provide regular counseling service to the patients indoor and outdoor about the disease process, planned intervention and life style modification. Moreover, we have been conducting structured education program for patients who are suffering from coronary artery diseases and other people who are interested to know about cardiovascular diseases and its risk factors.

Pushpa Neupane, Binita Tamrakar

Annual Report 2017



PROGRESS REPORT

FREE CARDIAC CAMPSSN

PLACE CAMP DATE TOTAL PAR-TICI-PANTS

TO-TAL ECG

TO-TAL ECHO

1 MYAGDI ( DARBANG)

30TH JANUARY 2017

628 206 183

2 HETUADA 4TH FEBRUARY 2017

959 397 281

3 SYANGJA( BIRGHA)

18TH FEBRUARY 2017

416 111 124

4 SYANGJA ( KELADHIGHAT)

387 147 103

5 DHADING 4TH MARCH 2017

365 87 113

6 GULMI ( TAMGHAS )

18TH MARCH 2017

988 611 400

7 GULMI ( BHAJHKETRI)

20TH MARCH 2017

600 129 278

8 SOLUKHUMBU 20TH APRIL 2017

156 38 55

9 JOMSOM 4THAND 5TH JUNE 2017

915 500 675

10 KATHMANDU 31TH JULY 2017

144 98 144

11 MYAGDI ( TATOPANI)

23RD DECEMBER 2017

400 237 157

TOTAL 5958 2381 2513

In the year 2017 we had conducted eleven free cardiac camps for the purpose of screening cardiac diseases in different districts of Nepal. During these screening programs we had received 5958 participants who were directly benefited by these camps. There were total 2381 Electrocardiography and 2513 Echocardiography done.

INDOOR COUNSELING Counseling service is one of the regular services in our hospital that is provided to the admitted patients especially focused on pre discharged patients. During counseling we noted their queries and counseled about

disease condition, life style modification and carry out regular exercise according to their health condition. In the year 2017 we counseled 4554 Patients and their visitors individually. And also encouraged the patients to join the structured education program for more detailed education.

OUTDOOR COUNSELINGThis department hasalso continuing outdoor counseling services from 2011. It targets for educating patients and visitors who are attended outpatient department as well as indoor patients. Hypertension and Diabetes are the most common topic we counsel for, followed by Heart Attack and its risk factors, Valvular Heart Diseases, Congenital heart diseases, Heart failure, etc. In the year 2017, we counseled 7265 patients and their family members.

STRUCTURED EDUCATION PROGRAM (SEP)Structured Education Program is our ongoing weekly awareness program. It is designed for patient with coronary artery disease (CAD), its risk factors and Rheumatic Fever/Rheumatic Heart Disease. Its objective is to prevent and manage CAD and its risk factors. It can also help patients who are recovering from a heart attack, as

Annual Report 2017



well as those who recently had heart surgery. Benefits of a this cardiac rehabilitation program can include reduced cardiac symptoms, better long-term survival, weight loss, improved cholesterol levels, improved blood pressure, lower blood sugar levels in diabetics and reduced stress. One cycle of program consists of eight different classes. We have been running 34th cycle till last of December 2017. In this program total number of 1984 participants directly benefited.

HEALTH EDUCATION MATERIAL PRODUCTIONOur department has been serving as a resource center for health education materials. We have produced plenty of brochures, posters, pamphlets and power point presentations. It provides free access of these materials for patients, health care providers and other institutions.CELEBRATIONS OF SPECIAL DAYSEvery year we celebrate World Hypertension Day and World Heart Day. In World Hypertension Day, we conducted free blood pressure screening and counseling service done in Shahid Gangalal National Heart Centre premises. We had screened around 350 participants.

COMMUNITY AWARENESS PROGRAMIt is a community based awareness program. In 2017we had conducted 2 programs, one in Pharping and another in Tokha.

RADIO PROGRAMThere is regularly broadcasting of Public Service Announcement (PSA) about hypertension, heart attack, rheumatic heart disease and seven rules of healthy heart in Radio Sagarmatha.

HUMAN RESOURCE

DR YUB RAJ LIMBU

HEAD OF THE DEPART-MENT/ SR. CONSULTANT CARDIOLOGIST

DR SHAILI THAPA

SR.PHYSIOTHERAPIST

PUSHPA NEUPANE

SR.STAFF NURSE

BINITA TAMRAKAR

SR.STAFF NURSE

YASHODA LUITEL

SR. ASSISTANT PHYSI-OTHERAPIST

RAJIV KU-MAR YADAV

ASSISTANT PHYSI-OTHERAPIST

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Page 35

Pathology Services Report

PATHOLOGY/CLINICAL LABORATORY SERVICES

INTRODUCTIONLaboratories in Nepal today face increasing pressure to automate their system as they are challenged by an increase in workload and need to reduce experienced technical staff. The implementations of a laboratory automation system in the clinical labs rely on minimizing laboratory errors, staff satisfaction and the outcome of the end result. Considerable efforts are needed to overcome the initial difficulties associated with adjusting to a new system

new software and new working procedure.

PRESENT SCENARIOWWith the increasing charm in automation at present department is equipped with following equipments:1.Automated Five Parts and Three Parts Differential Cell Counter.2.Fully automation biochemistry machine.3.Fully automated coagulation machine.

4.Separate Blood bank.

OVERVIEWTThe following details of the responsibilities of clinical laboratory:• Hematology works with whole blood counts and blood films as well as many other specialized tests.• Coagulation requires citrated blood sample to analyze blood clotting times and coagulation factors.• Clinical Biochemistry usually receives serum or plasma. They test the serum for chemicals present in blood. These include a wide array of substance, such as serum lipids, blood sugar, enzyme, and hormones.• Microbiology receives clinical specimen including swabs, faeces, urine, blood, sputum, cerebrospinal fluid, synovial fluid, as well as possible infected tissue. The work here is mainly concerned with cultures, to look for suspected pathogens

Mr. Bindeshwor Yadav

Annual Report 2017


Pathology Services Report

which, if found, are further identified based on biochemical test. Also, sensitive testing is carried out to determine whether the pathogens are sensitive or resistant to a suggested medicine. Results are reported with the identified organisms and the type and amount of drugs that should be prescribed for the patient.• Parasitology is a microbiology unit that investigates parasite. However, blood, urine, sputum, and other samples may also contain parasite.• Immunology/Serology uses the concept of antigen-antibody interaction as a diagnostic tool.• Blood bank determines blood groups, and performs compatibility testing on donor blood and recipients. It also prepares blood component, derivatives, and products for transfusion.

HUMAN RESOURCEWe have well trained technical manpower in our department with the following professionals:

• Two medical lab technologist• five sr. lab technician• 13 lab technician

MORE ACHIEVEMENTS NO• Automation upgraded in biochemistry.• Quality control analysis in biochemistry.• Quality control analysis in Hematology.• Quality control analysis in Coagulation.• Quality control to all the analyzers.• Conducted blood donation programme

with acquisition of local youth club which minimizes the problem for the patient to manage the blood components.

• Able to manage and minimize the rush of phlebotomy section by providing prompt reports and quality services.

NO OF TEST DONE• Biochemistry 486256 test• Haematology 207093 test• Microbiology 4611 test• Coagulation 36391 test• Serology 52454 test• Blood donation 7269 test• Special test 12157 test

FUTURE PLAN

• Introducing Laboratory information system to the hospital information system along with electronic reporting system.

• Automation in the microbiology in detection and isolation.

• Automation in blood bank.

Annual Report 2017


Radiology Services Report

RADIOLOGY SERVICESRRadiology is the science that uses medical maging to diagnose and sometimes treat disease within the body. Radiology is now the key diagnostic tool for many disease and has an important role in monitoring treatment and predicting outcome. It is an integral part of the health care delivery system. The radiology department of Shahid Gangalal National Heart Centre has been proving services since its establishment.

SERVICES PROVIDEDThis year total 60668 patient were radiographed. Now a days, about 170 patients are radiographed per day in OPD radiology unit and about 60 cases receive bedside radiographic services from IPD radiology unit. The radiology unit provides imaging services 24X7 days and reports are proved in shortest time possible. We performed all kinds of general radiography with particular emphasis on chest radiography and bedside radiography in all wards such as ASICU, PSICU, MICU,

CCU, and GW. We have three state of the art Cath Lab(Two Philips Integris, one Siemens Germany).Radiographer are providing services in Cath-lab in both diagnostic and therapeutic interventional procedures such as CAG,PTCA,PTMC,BPV,BAV,DEVICE CLOSURE,TPI,PPI, EPS and RHC.

The radiology department is going to be equipped with sophisticated Multi-slice Cardiac CT which will greatly enhance ability of diagnosis of CAD and other cardio vascular abnormalities.

EQUIPMENT Now-a-days, about 150 OPD patients are raWe recognize the importance of staying on top of the latest medical advancement and use the very latest radiologyequipment. The department is equipped with various recent and hi-tech radio diagnostic modalities and includes:

1.One set DDR System(Prognosys Medical

Annual Report 2017


Radiology Services Report

system)

2.Three CR reader units(Konica Minolta, Japan)

3.Three Dry Laser Imagers (Konica Minolta and Fuji, Japan)

4.One fixed 500 mA X ray machine (Quantum medical imaging USA)

5.Three mobile X-ray machine(100 mA,300 mA and 400mA)

6.One state of the art USG machine (Philips medical System)

7.One MDCT Toshiba Japan-under installation process.

HUMAN RESOURCEThe radiology unit of SGNHC is staffed by well-trained board certified manpower. We have one radiologist, one Sr.Radiography-technologist, three Technologist, four Sr.Radiographer and seven Radiographer .We provide the complete range of medical imaging procedure in general radiology(OPD ,IPD),USG and in Cath-Lab.

RADIATION SAFTY MEASURES

We strive to create the safest environment for our patient by implementing technology that significantly reduces radiation exposure to patient as well as staffs. All the means of radiation protection especially in Call- Lab and During Portable radiography are practiced. The general principle of radiation protection i.e Optimization, justification of practice and ALARA as well as Cardinal principle of radiation protection i.e. TDS (time of exposure as short as possible , distance as far as possible and Proper shielding)are always been followed. All the radiation workers are provided with TLD (Thermo-luminescence Dosimeter) that are periodically processed and dose are evaluated with Dose limit recommended by ICRP (International Commission on radiation Protection).

CONCLUSIONRadiology services here are fully dedicated to provide quality radiographic and ultra-sonographic service, however further training regarding advancement in technology and new modalities such as FFR, IVUS, OCT, CT are required to enhance the knowledge and performance of radiographers.

Annual Report 2017


Pharmacy Report

PHARMACY UNITHospital Pharmacy is a department which caters the need of physician, nurses, technicians and other staff members of hospital. It also provides drug information and drug monitoring services. Hospital Pharmacy exerts a great deal of influence on the professional stature of the hospital as well as upon the economics of the total operational cost of the institution because of its inter-relation with and the inter-dependency of other services upon it. Apart from these, the practice of pharmacy in hospital setting also includes broad responsibility for safe and appropriate use of drugs in patients, including rational drug selection, monitoring, dosing and control of patient’s overall drug-therapy.

Shahid Gangalal National Heart Centre has its own hospital pharmacy. All most every medicine and surgical products required in hospital are available in the pharmacy. It has indoor, ward supply and outdoor pharmacy dispensing unit for the servicing facility to indoor and outdoor patients where medicines are dispensed with sufficient counseling. Medicines are dispensed to patients by registered pharmacists and pharmacy assistants in accordance with prescriptions.

HUMAN RESOURCE

One pharmacist, One Sr.pharmacy assistants, six pharmacy assistants, One Sr. health assistant and three health assistant.

WORKING HOURIndoor Pharmacy: 24 hours

Outdoor pharmacy: 12 hours

Store and ward supply pharmacy: 8 hours

ACTIVITIES PERFORMEDa) Purchasing – contracting, ordering and receiving

b) Ware housing- storage and restocking

c) Housekeeping:

1)Inventory management

2) Rotation, return and recall

d) Distribution

e) Dispensing and drug counseling

Aatmaram Timalsina Pharmacy Incharge

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Page 40

Pharmacy Report

1. PHARMACY REPORTThe Transaction from hospital Pharmacy is increasing every year. So, hospital is in benefit from the

Pharmacy. As compared to previous years, the transaction has increased as shown in the diagram below. (Transaction has been mentioned in amount)

FUTURE PLANa) Initiate therapeutic monitoring of drugs having narrow therapeutic index and inter-pharmacokinetic variables.

b) Establishment of drug information centre.

c) Initiate drug and cost related research activities.

d) Drug counseling.

e) Floor stock system.

f) Initiate drug interaction surveillance and program implementation to reduce harms associated with it.

g) Participate in Antibiotics Stewardship Program and Infection Prevention Control

Annual Report 2017


Physiotherapy Services Report

PHYSIOTHERAPY SERVICES

INTRODUCTIONPPhysiotherapy is a well established branch of medical science being practiced globally. It is a scientific physical procedure used in the treatment of patients with a disease, injury or disability to achieve and maintain functional rehabilitation and to prevent malfunction or deformity. Physiotherapy treatments are designed to minimize residual physical disability, to hasten convalescence, and to contribute to the patient’s comfort and well-being.

Physiotherapy unit being an integral part of Cardiac Rehabilitation and Health Promotion Department has completed its seventeen years of service in Shahid Gangalal National Heart Centrex (SGNHC) by providing high quality physiotherapy services. Physiotherapy unit is spacious, and has three well equipped big rooms with a fitness and rehabilitation center within it and is located on the ground floor room no.34.

It gives immense pleasure to inform you all that, SGNHC is the only national heart center which is running cardiac rehabilitation exercise program in physiotherapy unit.

HUMAN RESOURCE Senior Physiotherapist- 1

Senior Physiotherapy Assistant-1

Physiotherapy Assistant-1

SERVICE PROVIDEDPPhysiotherapy unit at SGNHC, provides its services to both in-patient as well as outpatient regularly six days a week. This unit has been running almost all phases of cardiac rehabilitation exercise program where it gives exercise prescription to the patients with cardiac diseases. The unit provides physiotherapy services for all the general medical and surgical conditions which require physiotherapy treatment however the unit at SGNHC mostly deals

Dr. Shaili Thapa Budhathoki( PT) , Yashoda Luitel Shrestha, Rajeev Kumar Yadav

Annual Report 2017



with the function of the cardio-pulmonary and vascular system. It has also been running various programs like fitness program for staff, fitness program for patients with hypertension, obesity, dyslipidemia and diabetes mellitus via cardiac rehabilitation program.

OTHER ACTIVITIESPhysiotherapy unit have been conducting the Tuesday classes about the importance and benefits of the exercises for the patients and their visitors under Structured education program (SEP) for coronary artery disease regularly since 2012 under cardiac rehabilitation program, which have been a very useful and knowledgeable.

MONTHSNO. OF IN-PA-

TIENTS

NO. OF PATIENT ENROLL IN CAR-

DIAC REHABILITA-TION

NO. OF OUT PATIENTS

JANUARY-2017(POUSH-MAGH 2073) 768 193 99FEBURARY-2017(MAGH-FALGUN 2073) 585 129 124MARCH-2017(FALGUN-CHAITRA 2073) 656 51 129APRIL-2017(CHAITRA-BAISAKH2073/74) 858 17 75MAY-2017(BAISAKH-JESTHA 2074) 740 14 108JUNE-2017(JESTHA-ASHAD 2074) 825 45 90JULY-2017(ASHAD-SHRAWN 2074) 739 31 64AUGUST-2017(SHRAWN-BHADRA 2074) 797 16 23SEPTEMBER-2017(BHADRA-ASHOJ 2074) 506 5 16OCTOBER-2017(ASHOJ-KARTIK 2074) 340 7 11NOVEMBER-2017(KARTIK-MANGSIR 2074) 746 2 35DECEMBER-2017(MANGSIR-POUSH 2074) 643 3 31

STATISTICAL DATA OF THE YEAR 2017 (2073/ 2074 B.S):

IN-PATIENT

OUT-PATIENT

CARDIAC REHABILI-TATION

GRAND TOTAL

8203 805 513 9521

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FUTURE PLAN• To provide safe and reliable

physiotherapy service to the hospital.

• To make an effective cardiac rehabilitation team.

• To deliver community exercises programs via camps organized by SGNHC.

• Exercise tolerance test and exercise prescription for patients.

• Research activities on effectiveness of various exercise protocol.

CONCLUSIONPhysiotherapy unit being an integral part of Cardiac Rehabilitation and Health Promotion Department at SGNHC gives the major contribution in prevention and management of cardiac diseases. Hence we would like to thank all the departments, units and the staffs for their constant support and encouragement. We also hope to get the more referrals in upcoming days. We would also like to thank our patients and their relatives for their cooperation and believing on us.

Annual Report 2017


Annual Mortality Report

ANNUAL MORTALITY: 2017

INTRODUCTIONLike many low- and middle-income countries (LMICs), Nepal is battling a double burden of disease, communicable and non-communicable diseases (NCDs), with cardiovascular diseases (CVDs) being the most common among the latter. CVDs have been recognized as a major public health issue in Nepal. The disease burden is projected to rise in parallel with increase in prevalent risk factors, life expectancy, and socio-economic transitions.

Shahid Gangalal National Heart Center (SGNHC) is a national referral center for cardiology and cardiac surgery, and has been playing a major role in minimizing the burden of heart disease in the country.

Annual mortality reports are part of self-audit as part of robust quality management and improvement system. The mortality findings facilitate retrospective reflections and assessment of hospital performance, for quality improvement efforts.

RESULTSA A total of 25,487 patients were managed under adult cardiology services at this hospital and out of which 327 (1.28%, male-191, female-136) patients died. Patterns of mortality in the admitted population are influenced by a number of important factors as follows:

Age: The relationship between age and mortality demonstrated the expected trend: the youngest age groups had the lowest rates of death and the mortality rate increased with age. As shown in Figure

Dr. Madhu Roka, Dr. Shaneez Najmy, Dr.Ashutosh Rayamajhi, Dr. Shreya Bhandari, Dr. Garima Aryal

1, the most number of deaths was noted in 6-8th decade. This finding is consistent

Annual Report 2017



Double Cabin (0.39%), GWA (0.24%)and NMW (0.60%). Emergency, a place where patients undergo triage and immediate care and transfer to appropriate ward, had mortality of 0.26% (Table 1). Table 2 shows the number of deaths and their antecedent cause at various levels of care.

Table 1: Mortality percentage at various level of care

Ward Total Deaths % MortalityMICU 537 100 18.62CCU 1510 150 9.93CPOW 1096 8 0.73Single Cabin 824 5 0.61NMW 1324 8 0.60Annex 1097 5 0.46Double Cabin 778 3 0.39Emergency 17046 45 0.26

GWA 1273 3 0.24

with previous year’s mortality rate by age data.

Gender: Mortality by gender closely resembled the gender distribution of the admitted population.

Level of care: There are substantial differences in mortality between the different levels of care. Mortality rates are highest for critically ill patients in intensive care units such as CCU (9.93%), MICU (18%), and as expected, the mortality rates are lower in patients admitted in Single Cabin (0.61%), Annex (0.46%),

Table 2: Mortalities and conditions leading to deaths in various levels of care

CCU MICU CPOW NMW GWA An-nex

DC SC ER

AMI Cardiogenic Shock 45 15 2 2 0 1 0 0 11AMI Heart Failure 28 10 0 3 2 2 0 0 4AMI Arrhythmia 15 6 1 0 0 0 0 0 3AMI Cardiac rupture 8 4 1 0 1 0 0 0 2Post MI VSR 4 0 0 0 0 0 0 0 2RHD: Heart failure 11 9 2 1 0 1 0 0 3RHD: IE 3 4 0 1 0 0 0 0 0RHD: Arrhythmia 3 0 0 0 0 0 0 0 0VHD: Heart failure 4 2 0 0 0 0 0 1 1DCM: Heart Failure 7 17 2 1 0 1 2 1 7DCM: Arrhythmia 2 0 0 0 0 0 0 1 2COPD/pneumonia/respiratory failure 6 9 0 0 0 0 1 2 6

Pulmonary edema 4 5 0 0 0 0 0 0 0Septic shock 3 8 0 0 0 0 0 0 2Arrhythmias 3 3 0 0 0 0 0 0 2Myocarditis 2 2 0 0 0 0 0 0 0Pulmonary embolism 0 4 0 0 0 0 0 0 0CHD: HF 2 2 0 0 0 0 0 0 0

Annual Report 2017



Cause specific mortality: The causes of death are noted in Table 3. Acute Myocardial Infarction complicated with - Cardiogenic Shock / heart failure or arrhythmias was the leading cause of mortality.Dilated Cardiomyopathy and RHD with Heart Failure, Septic Shock and MODS, Acute Myocardial Infarction –Heart failure and Arrhythmias were also among the leading causes of death in the year 2017 AD.

Table 3: Causes of death

Causes Cases %

AMI Cardiogenic Shock 76 23.24AMI Heart Failure 49 14.98DCM: Heart failure 38 11.62RHD: Heart failure 27 8.26AMI Arrhythmia 25 7.65COPD/pneumonia/respiratory failure

24 7.34

AMI Cardiac rupture 16 4.89Septic shock / MODS 13 3.98Pulmonary edema 9 2.75Arrhythmias 8 2.45VHD: Heart failure 8 2.45RHD: IE 8 2.45Post MI VSR 6 1.83DCM: Arrhythmia 5 1.53CHD: Heart Failure 4 1.22Myocarditis 4 1.22Pulmonary embolism 4 1.22RHD: Arrhythmia 3 0.92

CONCLUSIONIn conclusion, trends in mortality are influenced by a number of important factors. Rates of mortality show a linear correlation with advancing age: the youngest age groups have the lowest rates of death and the mortality rate increases with age, highest in 6-8th decade of life. There are substantial gender differences in absolute number of mortality with higher percentage of mortality among the male gender. The leading cause of death was Acute Myocardial Infarction - Cardiogenic Shock.

Absolute deaths in the year 2017 reflects the increase in patient volume, where as the mortality rate (1.28% in 2017 vs 1.4% in 2016)has been declining and we anticipate further decline with appropriate action and strategic planning to further improve the mortality indices of our institute.

Annual Report 2017


Perfusion Technology Report

PERFUSION TECHNOLOGY UNIT

INTRODUCTIONPerfusion unit is one of the most vital unit of the department of cardiovascular surgery .What is Perfusion ? Perfusion is the delivery of blood to capillary bed in tissue .A person who perfuse blood is called a perfusionist .A perfusionist can run Heart lung machine (Cardiopulmonary bypass machine),Intra aortic balloon pump (IABP)machine, Extra-corporial membrane oxygenation (ECMO)machine and Ventricular assist device (VAD)machine. Perfusionist helps surgeon in every open and sometimes in close heart surgery. Cardiopulmonary bypass (CPB) by extracorporeal circulation promotes surgeons to empty the heart of blood, stop its beat as necessarily, open any desired chamber and safely carry out reparative procedure or even total replacement in an unhurried manner.

Figure of Heart-lung machine and IABP machine:

The first successful open heart surgery done in Shahid Gangalal National Heart Centre was in September 2, 2001. The case was ASD secondum. In 2017, we have done 1569 cases using heartlung machine. Among them 858 were male and 711 were female. The number of cases was increased by 19.77% from last year. The cases were categorized as congential, valve, CABG and others and their number were showed in figure. In others;cases are Modified Bentall’s procedure, pericardial effusion, constructive pericarditis, aortic aneurysm, myxoma, rupture sinus of valsalva and pulmonary embolism.

Mr. Mahendra Bhatt, Mr. Umesh Khan, Ms. Lalita Shakya, Mr. Ram Bharosh Yadav, Mrs. Laxmi Shrestha, Mr. Sujan Shrestha and Mr. Ashok Karki

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Perfusion Technology Report

The perfusion unit is run by 7 members, 2 are in study leave and 2 are in training phase. Train-ing is given in OT and CME program of the hospital is conducted in regular basis. This unit provides services to cardiac patients six days a week and in emergency need also.

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INSTITUTIONAL REVIEW COMMITTEE

BACKGROUNDIt’s been two year since the establishment of Institutional Review Committee(IRC) of Shahid Gangalal National Heart Centre (SGNHC). There had been a flurry of research proposals from our centre and outside as well. There were five international research proposals till date. The research are better coordinated and taking place in a proper environment after establishment of IRC. All the proposals are discussed in the monthly meeting and those who require modifications are asked to do so. Utmost importance is given to ethics. Record of each and every document is filed and stored properly, a hard copy ad well as electronic version. E mail correspondence is well maintained by our office secretary. Online applications are also accepted although the applicants are asked to submit the hard copy as well. The researchers are required to submit their completed work i.e. thesis, paper etc to the office. IRC conducted introductory statistical class for the SGNHC staffs on 5th and 6th May 2017. Nepal Research Council also conducted an introductory workshop on 8th and 9th september 2017. Presentation of our work including research approval was done by our member secretary. Internationally

acclaimed INVICTUS trial is undergoing in Shahid Gangalal National Heart Centre as well monitored by IRC. •

MEMBERSChairman: Dr. Deewakar Sharma (Prof/Senior Consultant Cardiologist, Cardiology – HOD)

Member Secretary: Dr. Sujeeb Rajbhandari (Senior Consultant Cardiologist)

Member: Dr. Siddhartha Pradhan (Consultant Surgeon, Cardiac Surgery – HOD)

Member: Ms. Krishna Kumari Subedi (Chief of Nursing Supervisor / Matron)

Member: Dr. Chandra Mani Adhikari (Cardiologist)

Member: Dr. Dipanker Prajapati (Cardiologist)

Member: Mr. Bidur Khadka (Public Representative)

Office Secretary: Ms. Binita Tamrakar Khadka

Dr. Sujeeb Rajbhandari, Binita Tamrakar

Institutional Review Committee

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List of the research proposals from 2016 to 2017SN RESEARCH TOPIC1 CLINICAL PROFILE MANAGEMENT

AND OUTCOMES OF PULMONARY EMBOLISM. : SGNHC

2 PATIENT'S SATISFACTION WITH THE HEALTH SERVICES PROVIDED BY HOSPITAL IN INPATIENTS UNITS AT SHAHID GANGALAL NATIONAL HEART CENTRE : SGNHC

3 QUALITY OF LIFE AFTER OPEN HEART SURGERY AND THE POTEN-TIAL RISK FACTORS FOR UNIM-PROVED QUALITY OF LIFE AMONG THE POST OPERATIVE ATTENDING SHAHID GANGALAL NATIONAL HEART CENTRE. : SGNHC

3 KNOWLEDGE REGARDING PAIN MANAGEMENT AMONG NURSES IN SHAHID GANGALAL NATIONAL HEART CENTRE. : SGNHC

4 INCIDENCE OF PHLEBITIS IN PA-TIENTS WITH PERIPHERAL INTRA-VENOUS CANULA IN SHAHID GAN-GALAL NATIONAL HEART CENTRE: SGNHC

5 CLINICAL PROFILE AND MANAGE-MENT TRENDS OF STUCK PROS-THETIC VALVE THROMBOSIS IN TER-TIARY CARDIAC CENTRE OF NEPAL: NAMS

6 ASSESSMENT OF NURSES KNOWL-EDGE REGARDING LEGAL ISSUES RE-LATED TO NURSING AMONG STAFF NURSE WORKING IN SHAHID GAN-GALAL NATIONAL HEART CENTRE: SGNHC

7 ANTITHROMBOTIC PRESCRIBING PATTERNS AMONG PATIENTS DIAG-NOSED WITH ATRIAL FIBRILLATION IN TERTIARY CARE HOSPITAL OF NE-PAL: KATHMANDU UNIVERSITY

8 TACKLING THE AORTIC ARCH – OUR EXPERIENCE: SGNHC


9 AORTIC ROOT SURGERY – MEDIUM TERM OUTCOME: SGNHC

10 ANXIETY , DEPRESSION AND RESIL-IENCE AMONG PATIENTS WITH CORONARY ARTERY DISEASE AT-TENDING AT CARDIAC CARE CENT-ER , KATHMANDU: CHITWAN MEDI-CAL COLLEGE

11 RHEUMATIC HEART DISEASE AND CONGENITAL HEART DISEASE AMONG SCHOOL CHILDREN IN HILLY REGION OF NEPAL :- CAMP BASED STUDY : SGNHC

12 HYPERTENSION AND OTHER CAR-DIOVASCULAR RISK FACTORS AMONG THE RESIDENT OF HILLY RE-GION OF NEPAL; CAMP BASED STUDY : SGNHC

13 FACTORS ASSOCIATION MEDICA-TION ERROR : SGNHC

14 COMPARISON OF PDA SIZE ON TTE AND ANGIOGRAM. : SGNHC

15 DOOR TO BALLOON TIME IN PRIMA-RY PCI IN ST_ELEVATION INFRAC-TION IN SHAHID GANGALAL NATIONAL HEART CENTRE: COLLEGE OF MEDI-CAL SCIENCES

16 NURSES KNOWLEDGE REGARDING CARE OF PATIENT WITH PERCUTA-NEOUS TRANSLUMILNAL MITRAL COMMISUROTOMY AT SGNHC: NA-GARAKI COLLEGE OF HEALTH SCI-ENCE

17 KNOWLEDGE REGARDING POST PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY MAN-AGEMENT AMONG NURSING STAFF IN SGNHC .: NAGARAKI COLLEGE OF HEALTH SCIENCE

18 NURSES KNOWLEDGE REGARDING POSTOPERATIVE MANAGEMENT AMONG PATIENT UNDERGONE CARDIOVASCULAR SURGERY: NOR-VIC COLLEGE

19 KNOWLEDGE REGARDING SELFF – CARE AMONG PATIENT WITH CAR-DIAC FAILURE ATTENDING SPECIAL-IZED CARDIAC CENTRE, KATHMANDU .: NORVIC COLLEGE

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Contact Address and Office locationInstitutional Review Committee (IRC)

2nd Floor, Academic Block (South Wing) of Shahid Gangalal National Heart Cen-

treBansbari, Kathmandu, Nepal

P.O. Box: 11360Tel: 977 – 1 – 431322 / 4370622 / 4371374

(Ext.: 620)e mail: [email protected]

For form collection and submission please contact office secretary between 2:00 PM to 3:00 PM (Except Saturdays)

20 PATIENT’S SATISFACTION ON PAIN MANAGEMENT IN ICU PATIENTS UNDERGONE CARDIOVASCULAR SURGERY OF SELECTED HOSPITALS IN KATHMANDU VALLEY , 2017.: NORVIC COLLEGE

21 NURSES KNOWLEDGE ON OXYGEN THERAPY.: SGNHC

22 THE BURDEN OF CARE AMONG MOTHERS HAVING CHILDREN WITH CONGENITAL HEART DISEASE AT-TENDING REFERRAL HOSPITAL KATHMANDU.: TU/IOM

23 DIFFERENCE IN RETURN OF SPON-TANEOUS CIRCULATION IN EARLY VS LATE ENDOTRACHEAL INTUBA-TION AMONG PATIENTS WITH WITNESSED IN HOSPITAL CARDIAC ARREST.: SGNHC

24 HEALTH RELATED QUALITY OF LIFE OF CHILDREN WITH CONGENITAL HEART DISEASE ATTENDING AT TERTIARY LEVEL HOSPITAL.: TUTH

25 AWARENESS ON ADVANCE CARDIAC LIFE SUPPORT AMONG THE NURSES IN NEPAL AND PROTUGAL. ; ESCOLA SUPERIOR DE SAUDE DE SANTAREM

26 HIGH ALTITUDE INDUCE ADAPTA-TION FOR ARTERIOSCLEROSIS AND PULMONARY HYPERTENSION IN EN-DEMIC ANIMALS OF NEPAL .: SGNHC

27 KNOWLEDGE AND PRACTICE RE-GARDING ET CARE AMONG HEALTH PROFESSIONALS .: NORVIC COLLEGE

28 KNOWLEDGE REGARDING CARE OF WATER SEAL DRAINAGE AMONG THE NURSES OF CRITICAL CARE UNIT FROM SELECTED HOSPITAL OF KATHMANDU.: NORVIC COLLEGE

29 SHAHID GANGALAL CONGENITAL HEART DISEASE INTERVENTION REGISTRY. : SGNHC

30 TRANSCATHER CLOSURE OF PATENT DUCTUS ARTERIOUS AT SHAHID GANGALAL NATIONAL HEART CEN-TRE. : SGNHC

31 PREVALENCE OF NEEDLE PRICK IN-JURY AND THEIR POST EXPOSURE RESPONSE IN HEALTH CARE PER-SONNEL OF SHAHID GANGALAL NA-TIONAL HEART CENTRE.: SGHNC

32 RISK FACTORS AND OUTCOME AC-CORDING TO ETHNICITY INPATIENT WITH CORONARY DISEASE IN A TER-TIARY LEVEL CARDIAC CENTRE OF NEPAL. : SOUTH EAST UNIVERSITY

33 MANAGEMENT AND OUTCOME OF PROSTHETIC VALVE THROMBOSIS IN TERTIARY CARDIAC CENTER OF NE-PAL : AN OBSERVATIONAL STUDY : SGNHC

34 ATRIAL SEPTAL DEFECT RIMS IN TRANSEOPEGEAL ECHOCARDIO-GRAM : SGNHC

35 COMPARISON OF INTRAOPERATIVE AND POSTOPERATIVE OUTCOME BETWEEN CONVENTIONAL AND MINIMAL INVASIVE AORTIC VALVE REPLACEMENT


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DIABETIC RETINOPATHY AND HYPERTENSIVE RETINOPATHY

SCREENING SERVICE AT GANGALAL NATIONAL HEART

CENTER

Diabetes mellitus and hypertension are among the major non-communicable diseases, increasing as a public health problem in Nepal. Diabetic retinopathy is one of the most common complication of diabetes mellitus and is the fifth leading cause of global blindness despite being a preventable cause. More than 90% of blindness from diabetic retinopathy occurs from low and mid income countries on timely detection and treatment. Patients have no symptoms until the advanced stage of diabetic retinopathy. When patients develop symptoms the disease is already in advanced stage where good visual recovery is not possible. Timely detection of vision threatening retinopathy and treatment with retinal laser therapy helps to save the vision from its complication of diabetic retinopathy. In Nepal, there is lack of awareness on diabetic retinopathy among the person with diabetes and there is limited diabetic retinopathy screening services. Patients present late in the hospital for eye check up where good visual recovery is not possible. Early detection of diabetic retinopathy is possible if diabetic retinopathy screening is integrated as comprehensive diabetes management. Retina evaluation at the time of diagnosis and at least retina check up once in a year is required for early detection of diabetic retinopathy. Those with poor control of blood sugar, longer duration of diabetes, concurrent hypertension, hyperlipidaemia,

anaemia, kidney problems, pregnant women and smokers are high risk for developing the diabetic retinopathy. At 20 years of diabetes duration, almost all of the people with diabetes have diabetic retinopathy while almost 80% of type 2 diabetes has diabetic retinopathy.

Hypertension related retinal problems are also one of the leading causes of blindness in Nepal. Like in diabetic retinopathy, majority of patients have no symptoms on until the advanced stages. Regular eye check up focused on retina at the time of diagnosis of hypertension and at least yearly check up could help detect these blinding complications resulting from high blood pressure.

Among the various modalities of diabetic and hypertensive retinopathy screening, fundus photography are widely accepted, easy methods for detection of these retinal diseases.

The diabetic retinopathy screening services are available in Gangalal National Heart center since 2014 in collaboration with Tilganga Institue of Ophthalmology and supported by The Fred Hollows Foundation and World Diabetes Foundation. 476 patients with diabetes were screened in 2014, 647 patients with diabetes were screened in 2015, 568 patients with diabetes were screened in 2016 and 1213 patients with diabetes were screened in 2017. Now

Meena Kc SSN, Niru Ratyal HA

Annual Report 2017


hypertensive retinopathy screening services has also been started since 2017 for those with hypertension. Almost 15% of these screened patients were found that need urgent referral to eye hospital for further treatment. Majority of the referring patients were benefitted at Tilganga Institute of Ophthalmology for their treatment.

This service has helped for raising awareness on diabetic and hypertensive retinopathy among the people with diabetes and hypertension. Moreover, early identification of diabetic retinopathy and hypertension related problems have been possible for timely treatment of these conditions in large number of patients.

Page 53

This integrated retinopathy screening program has been very useful to reduce blindness from diabetic retinopathy, hypertension related retinal problems, including other retinal and optic nerve problems among patients with diabetes and hypertension in a large scale in Nepal. Patients are very happy getting this service at Gangalal National Heart Center with early identification of diseases.

Finally, we request for utilization of this service by all persons with diabetes and hypertension to save their vision.

Annual Report 2017


FRAGILE LIFE

-Pabitra Pandey(PSICU)

Page 54

Working as a nurse for a number of years, I feel a truth of being said with these lines-“When you are a nurse, you know that eve-ry day you will touch a life or a life will touch yours.”It’s a feeling that you never can express in words when you get a chance to cherish the moments of miracle happening to a dying child. You can see the tears of happiness in parents. At this time you feel you have achieved big thing in life. But things always don’t happen the way you want or wish. Sometime the Almighty God become so harsh, he can’t see you being delighted and satisfied. He has got something atypical plan in one’s life. So you come to experi-ence lot of things in this life.

I have witnessed bundle of beautiful mo-ments and celebrated with them but I have been also forced so hard to witness all those unpleasant moments where you could hard-ly stop crying. It’s like losing your breath

and never catching it again and no matter what you try to do you continue to lose your mind.

The very heartbreaking situation has hap-pened few days back in the ward where I have been working. It so happened that parents of that particular ill child gave up their hope and decided ending up every-thing. They want him go back to the nature. This decision really made me speechless and the worst part is that you were a media-tor for letting him go. At a time baby was opening his beautiful eyes but within a few second ‘he has left his soul’. This is the situation where you feel guilty for not be-ing able to make him alive. It was hard for me to accept the truth that child was no longer in this world and I thought deeply how cruel the nature can be and how “FRAGILE THE LIFE IS.”

Annual Report 2017


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Annual Report 2017


photographs

Annual Report 2017


DEPARTMENT OF CARDIOLOGY


Annual Report 2017



DEPARTMENT OF CARDIAC REHABILITATION AND HEALTH PROMOTION

Annual Report 2017


Page 59

DEPARTMENT OF PEDIATRIC CARDIOLOGY

DEPARTMENT OF NURSING

Annual Report 2017


DEPARTMENT OF ADMINISTRATION

TRANSPORTATION UNIT

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PHARMACY UNIT

PATHOLOGY UNIT

Annual Report 2017


RADIOLOGY UNIT

PERFUSION TECHNOLOGY UNIT

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MAINTENANCE UNIT

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staff list

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Annual Report 2017


SN NAME DESIGNATION1 Dr. Anil Acharya Cardiac Surgeon2 Dr. Apurba Thakur Resident Doctor3 Dr. Ashok Kumar Rokaya Resident Doctor4 Dr. Avash Karki Registrar Surgery5 Dr. Bishow Pokhrel Registrar Surgery6 Dr. Dikshya Joshi Registrar Surgery7 Dr. Jyotindra Sharma Sr. Consultant Cardiac Surgeon & E.D.8 Dr. Navin Chandra Gautam Consultant Cardiac Surgeon9 Dr. Nirmal Panthee Registrar Surgery

10 Dr. Nivesh Rajbhandari Registrar Surgery11 Dr. Rabindra Bhakta Timala Consultant Cardiac Surgeon12 Dr. Ramesh Raj Koirala Sr. Consultant Cardiac Surgeon13 Dr. Rheecha Joshi Resident Doctor14 Dr. Rubina Rayamajhi Resident Doctor15 Dr. Ruby Shrestha Resident Doctor16 Dr. Rupak Pradhan Resident Doctor17 Dr. Sanjeen K.c Resident Doctor18 Dr. Sidhartha Pradhan Consultant Cardiac Surgeon & HOD19 Dr. Trilok S.J.B. Rana Resident Doctor20 Dr. Yogeshor Man Singh Registrar Surgery21 Lalita Shakya Perfusion Assistant22 Laxmi Shrestha (Bhattarai) Perfusion Assistant

23 Ram Bharosh Yadav Perfusion Assistant

24 Umesh Khan Perfusionist

SN NAME DESIGNATION1 Dr. Amrit Bogati Registrar, Cardiology2 Dr. Anjana Thapa Magar Resident Doctor3 Dr. Anubhav Sharma Resident Doctor

4 Dr. Arun Maskey Sr. Consultant Cardiologist

5 Dr. Ashutosh Jung Rayamajhi Resident Doctor6 Dr. Binay Kumar Rauniyar Cardiologist7 Dr. Chandramani Adhikari Cardiologist8 Dr. Chirag Subedi Resident Doctor

9 Dr. Deepak Limbu Registrar, Cardiology

10 Dr. Deewakar Sharma Sr. Consultant Cardiologist & HOD11 Dr. Dharma Nath Yadav Cardiologist12 Dr. Dipanker Prajapati Cardiologist13 Dr. Garima Aryal Resident Doctor


DEPARTMENT OF CARDIOLOGY

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Annual Report 2017


SN NAME DESIGNATION14 Dr. Gayatri Yadav Resident Doctor15 Dr. Grishma Uprety Resident Doctor16 Dr. Himamshu Nepal Consultant Cardiologist17 Dr. Jagat Adhikari Resident Doctor18 Dr. Laxeshwar Pradhan Sah Resident Doctor19 Dr. Madhu Roka Registrar, Cardiology20 Dr. Man Bahadur K C Sr. Consultant Cardiologist21 Dr. Manish Shrestha Peaditric Cardiologist22 Dr. Mukunda Sharma Registrar, Cardiology23 Dr. Murari Dhungana Cardiologist24 Dr. Nripesh Man Shrestha Resident Doctor25 Dr. Poonam Sharma Registrar, Pediatric Cardiology26 Dr. Rabi Malla Sr. Consultant Cardiologist27 Dr. Rabindra Pandey Registrar, Cardiology28 Dr. Rabindra Simkhada Cardiologist29 Dr. Rajeeb Rajbhandari Consultant Cardiologist30 Dr. Rayana Shrestha Resident Doctor31 Dr. Reeju Manandhar Registrar, Cardiology32 Dr. Rikesh Tamrakar Cardiologist33 Dr. Roshan Raut Consultant Cardiologist34 Dr. Roshani Shahi Resident Doctor35 Dr. Sanjay Singh K.C. Registrar, Cardiology36 Dr. Santosh Karki Resident Doctor37 Dr. Satish Kumar Singh Registrar, Cardiology38 Dr. Shilpa Aryal Registrar, Peaditric Cardiology39 Dr. Shipra Shrestha Resident Doctor40 Dr. Shreya Bhandari Resident Doctor41 Dr. Shruti Pokharel Resident Doctor42 Dr. Smita Adhukari Resident Doctor43 Dr. Subodh Kansakar Consultant Cardiologist44 Dr. Sujeeb Rajbhandari Sr. Consultant Cardiologist45 Dr. Sushan Bogati Resident Doctor46 Dr. Swastika Sedhai Resident Doctor47 Dr. Urmila Shakya Consultant Pediatric Cardiologist48 Dr. Yubaraj Limbu Consultant Cardiologist49 Dr. Yudheer Khadka Resident Doctor

SN NAME DESIGNATION1 Dr. Ashish Amatya Anesthesiologist2 Dr. Battu Kumar Shrestha Registrar Anesthesiologist3 Dr. Jejunath Pokharel Sr. Consultant Anesthesiologist &

HOD4 Dr. Parbesh Kumar Gyawali Registrar Anesthesiologist


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DEPARTMENT OF CARDIAC REHABILATION & HEALTH PROMOTION

SN NAME DESIGNATION1 Aleena Khanal Staff Nurse2 Ambika Shrestha Staff Nurse3 Amita Joshi Staff Nurse4 Amita Singh Staff Nurse5 Amrita Singh Tamang Staff Nurse6 Anisha Ghimire Staff Nurse7 Anita Dewan Nursing Supervisor8 Anita Gupta Staff Nurse9 Anita Sharma Paudel Staff Nurse10 Anjana Koirala Sister11 Anusha Acharya Staff Nurse12 Apeksha Ghale Staff Nurse13 Apsara Bhandari Staff Nurse14 Apurwa Sawad Staff Nurse15 Arzoo Neupane Staff Nurse16 Asha Kumari Jha Staff Nurse17 Ashmita Shrestha Staff Nurse18 Ashmita Silwal Staff Nurse19 Asmin Tamang Staff Nurse20 Asmita Bisowkarma Staff Nurse21 Asmita Karki Staff Nurse22 Asmita Lamichhane Staff Nurse23 Astha Baniya Sr. Staff Nurse24 Bal Kumari Chaudhary Staff Nurse25 Bandana Bogati Staff Nurse26 Bandana Sankhi Staff Nurse27 Barsha Bhandari Staff Nurse

DEPARTMENT OF NURSING

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SN NAME DESIGNATION1 Binita Tamrakar Sr. Staff Nurse2 Dr. Shaili Thapa Sr. Physiotherapist3 Dr. Yubaraj Limbu Consultant Cardiologist & HOD4 Pushpa Neupane Sr. Staff Nurse5 Rajeev Kumar Yadav Physiotherapy Assistant

6 Yashoda Luitel Sr. Physiotherapy Assistant

SN NAME DESIGNATION5 Dr. Rabin Baidya Registrar Anesthesiologist6 Dr. Rajendra Kumar Yadav Resident Doctor7 Dr. Santosh Khatri Registrar Anesthesiologist8 Dr. Santosh Sharma Parajuli Registrar Anesthesiologist

Annual Report 2017


SN NAME DESIGNATION28 Basanta Sharma Staff Nurse29 Bidhya Malla Staff Nurse30 Bijaya Aryal Staff Nurse31 Bimala Chand Staff Nurse32 Bina Paneru Sr. Staff Nurse33 Bina Sherpa Staff Nurse34 Bina Shrestha Staff Nurse35 Bindiya Shrestha Staff Nurse36 Bindu Adhikari Staff Nurse37 Binita Sapkota Staff Nurse38 Binita Tamrakar Sr. Staff Nurse39 Binita Thapa Staff Nurse40 Bishnu Pandey Sister41 Chahana Singh Staff Nurse42 Chandani Singh Nakarmi Staff Nurse43 Chandika Gwachha Staff Nurse44 Chunam Khadka Staff Nurse45 Deepa Bajracharya Staff Nurse46 Deepa Devkota Staff Nurse47 Deepa Kumari Baral Staff Nurse48 Deepika Mudhbhari Staff Nurse49 Deepika Shrestha Staff Nurse50 Deoki Saru Sister51 Dibyashori Khati Sr. Staff Nurse -II52 Gita Tamang Staff Nurse53 Hemu Pun Staff Nurse54 Hira Adhikari Staff Nurse55 Isha Lama Staff Nurse56 Ishwori Gautam Staff Nurse57 Jamuna Khanal Staff Nurse58 Janaki Ayer Staff Nurse59 Januka Khadka Staff Nurse60 Jenisha Shrestha Staff Nurse61 Jina KC Staff Nurse62 Jyoti Shrestha Staff Nurse63 Kabita Baniya Staff Nurse64 Kalpana Thapa Staff Nurse65 Kalpana Timilsina Sister66 Kamala Poudel Staff Nurse67 Kamana Paudel Staff Nurse68 Kanchan Kusatha Staff Nurse69 Kiran Subedi Dahal Staff Nurse70 Kopila Luitel Nursing Supervisor71 Krishna Kumari Subedi Matron/Chief Nursing Superviser72 Krishna Shwari Gwachha Sr. Staff Nurse

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Annual Report 2017


SN NAME DESIGNATION73 Kunti Khanal Sister74 Kusum Thapa Staff Nurse75 Lalita Maharjan Sister76 Lalita Poudel Sr. Staff Nurse77 Laxmi Aryal Staff Nurse78 Laxmi Bista Staff Nurse79 Leela Khanal Staff Nurse80 Leela Rana KC Sr. Staff Nurse-II81 Madhuri Thapa Staff Nurse82 Madhushree Khanal Staff Nurse83 Mahima Shrestha Staff Nurse84 Mamata Ojha Staff Nurse85 Man Kumari Shris Thapa Staff Nurse86 Mandira Khadka Staff Nurse87 Manika Tamang Staff Nurse88 Manisha Bohara Staff Nurse89 Manisha Pudasaini Staff Nurse90 Manju Acharya Staff Nurse91 Manju Khadka Staff Nurse92 Manju Poudel Staff Nurse93 Manju Pyakurel Staff Nurse94 Manju Timilsina Sister95 Mausam Rai Staff Nurse96 Mausami Paudyal Staff Nurse97 Menuka Silwal Staff Nurse98 Mikita Baniya Staff Nurse99 Mina KC Sr. Staff Nurse100 Mukta Shrestha Staff Nurse101 Nabina Karki Staff Nurse102 Namrata Rawal Staff Nurse103 Neelam Pradhan Staff Nurse104 Nilima Joshi Staff Nurse105 Nira Shrestha Staff Nurse106 Nirjala Khanal Staff Nurse107 Nirmala BudaMagar Staff Nurse108 Nisha Thapa Staff Nurse109 Nita Dangol Chief Nursing Superviser110 Pabitra Pandey Staff Nurse111 Pinky Shrestha Staff Nurse112 Pooja Poddar Staff Nurse113 Pooja Subedi Staff Nurse114 Poonam Gurung Staff Nurse115 Prabha K.C. Staff Nurse116 Prabha Paudel Staff Nurse117 Pragya K.c Staff Nurse

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Annual Report 2017


SN NAME DESIGNATION118 Prajita Shrestha Staff Nurse119 Pramila Subedi Staff Nurse120 Prashansa Bhetwal Staff Nurse121 Prati Badan Dangol Nursing Supervisor122 Pratikshya Shrestha Staff Nurse123 Pratima Acharya Staff Nurse124 Pratima Dhakal Staff Nurse125 Pratima Niraula Staff Nurse126 Pratistha Bhattarai Staff Nurse127 Puja Kafle Staff Nurse128 Puja Satyal Staff Nurse129 Punam Shrestha Staff Nurse130 Purnima Sedain Staff Nurse131 Pushpa Neupane Sr. Staff Nurse132 Pushpa Sharma Staff Nurse133 Puspa Karmacharya Staff Nurse134 Puspa Kumari Gurung Staff Nurse135 Puspa Mahara Staff Nurse136 Puspa Marasini Staff Nurse137 Radhika Mudbhari Staff Nurse138 Raj Kumari Shrestha Staff Nurse139 Rajani Shrestha Staff Nurse140 Rajyalaxmi Bhele Sr. Staff Nurse141 Rameswori Duwal Staff Nurse142 Ramita Pandey Staff Nurse143 Ranjana Pandey Staff Nurse144 Rashmi Basnet Staff Nurse145 Rashmi Karki(A) Staff Nurse146 Rashmi Karki(B) Staff Nurse147 Rashmi Regmi Staff Nurse148 Rashmila Manandhar Staff Nurse149 Ratna Devekota Staff Nurse150 Rekha Karki Staff Nurse151 Rekha Kumari Staff Nurse152 Rephika Maharjan Staff Nurse

153 Reshma Thapa Sr. Staff Nurse154 Richa Bista Staff Nurse155 Roji Shakya Sister156 Rojina Bhujel Staff Nurse157 Rojina Guragain Staff Nurse158 Rojina Rayamajhi Staff Nurse159 Romy Twayana Staff Nurse160 Roshani Manandhar Staff Nurse161 Rumina Dhakal Staff Nurse162 Rupisha Karki Staff Nurse

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Annual Report 2017


SN NAME DESIGNATION163 Sabina Baral Staff Nurse164 Sabina Shrestha Staff Nurse165 Sabina Thimi Staff Nurse166 Sabina Tiwari Staff Nurse167 Sabina Tulsibakhyo Staff Nurse168 Sabita Bhusal Staff Nurse169 Sabita Karki Staff Nurse170 Sabita Khanal Staff Nurse171 Safala Subedi Staff Nurse172 Sagun Sharma Staff Nurse173 Sakuntala Karki Staff Nurse174 Salina Tamang Staff Nurse175 Samiksha Karki Staff Nurse176 Samita Thapa Magar Staff Nurse177 Samjana Mishra Staff Nurse178 Samjhana Karki Staff Nurse179 Samjhana Pandey Staff Nurse180 Samriddhi Timalsina Staff Nurse181 Sandhya Rijal Staff Nurse182 Sandhya Thapa Staff Nurse

183 Sangeeta Gyawali Staff Nurse184 Sangita Baskota Staff Nurse185 Sangita Kafle Staff Nurse186 Sanjita Dhakal Staff Nurse187 Sanju Shah Staff Nurse188 Sapana Maharjan Sr. Staff Nurse189 Sarala Malla Staff Nurse190 Sarala Shrestha Staff Nurse191 Sarita Maharjan Staff Nurse192 Sashi Lama Staff Nurse193 Season Bista Staff Nurse194 Shailee Karanjit Staff Nurse195 Shakuntala Mahat Staff Nurse196 Shama Singh Kunwar Staff Nurse197 Shanta Singh Thakuri Staff Nurse198 Shanti Gurung Staff Nurse199 Sharad Rayamajhi Staff Nurse200 Sharmila Dhukuchhu Staff Nurse201 Sharmila Neupane Staff Nurse202 Sharmila Thapa Staff Nurse203 Shila Shrestha Staff Nurse204 Shilpa Shrestha(A) Staff Nurse205 Shova Shrestha Staff Nurse206 Shovana Shrestha Sr. Staff Nurse207 Shovna Shrestha Staff Nurse

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Annual Report 2017


SN NAME DESIGNATION1 Bibek Thapa Account Assistant2 Bimal Kumar Upreti Chief of Financial Administration3 Krishna Bahadur Kumal Account Sub- Assistant4 Manoj Kumar Bista Dy. Chief of Financial Administration5 Naresh Chipalu Finance Officer

FINANCE

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SN NAME DESIGNATION208 Shreejana Gautam Staff Nurse209 Shristi Maharjan Staff Nurse210 Shushma Tamang Staff Nurse211 Shusma Malla Staff Nurse212 Siba Laxmi Shrestha Staff Nurse213 Sirjana Adhikari Staff Nurse214 Sirjana Paudel Staff Nurse215 Sisira Rajthala Staff Nurse216 Sitasnu Dahal Staff Nurse217 Srijana Bhattarai Staff Nurse218 Srijana Bhele Staff Nurse219 Srijana Dhital Staff Nurse220 Srijana Gurung Staff Nurse221 Srijana Thapa Staff Nurse222 Sujan G.C. Staff Nurse223 Sujata Adhikari Staff Nurse224 Sujata Ghimire Staff Nurse225 Sujata K.c Staff Nurse226 Sumitra Thapa Staff Nurse227 Sunaina Shakya Staff Nurse228 Sunita Khadka Sister229 Sunita Pandey Staff Nurse230 Suraksha Dhungana Staff Nurse231 Sushila Ghimire Staff Nurse232 Sushila Khanal Staff Nurse233 Sushma Basnet Staff Nurse234 Sushmita Bista Staff Nurse235 Sushmita Kaldan Staff Nurse236 Susmita Pun Staff Nurse237 Tripti Singh Staff Nurse238 Tulasa KC Nursing Supervisor239 Urmila Maharjan Staff Nurse240 Usha Paudel Staff Nurse241 Ushna Shrestha Sr. Staff Nurse242 Vidhya Koirala Nursing Supervisor243 Yogina Maharjan Staff Nurse

Annual Report 2017


SN NAME DESIGNATION1 Bhagawati Gaire Administrative Assistant2 Bhupal Acharya Administrative Officer

3 Bikash Khaniya Administrative Assistant

4 Bimala Aryal Sr. Administrative Officer5 Bimala Sapkota Administrative Assistant-II 6 Chunam Lama Sr. Administrative Assistant7 Dipendra Khadka Chief of Administration8 Dr. Jyotindra Sharma Executive Director9 Kabita Koirala Khatiwada Administrative Assistant

10 Mahendra Lamsal Sr. Administrative Assistant11 Mandira Khadka Administrative Sub- Assistant12 Pratima Malla Thakuri Administrative Assistant13 Ram Acharya Sr. Administrative Officer14 Ram Babu Raut Sr. Medical Record Assistant15 Sudha Sigdel Administrative Sub- Assistant16 Uva Raj Timilsina Sr. Administrative Assistant

RADIOLOGY

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ADMINISTRATION

SN NAME DESIGNATION1 Anup Rimal Radiographer2 Baidh Nath Yadav Radiography Technologist3 Bijaya Shrestha Sr. Radiographer4 Dr. Pragati Shrestha Registar Radiologist5 Indesh Thakur Sr. Radiography Technologist6 Laxminarayan Singh Radiographer7 Mahesh Khadka Radiographer8 Prakash Timalsina Radiographer9 Pramod Khatri Sr. Radiographer

10 Ramesh Thapa Dark Room Assistant - II11 Saroj Chhetry Radiographer12 Sebika Baniya Pandit Radiographer13 Seema Gyawali Radiographer14 Shulav Paudel Radiography Technologist15 Shyam Kumar Adhikari Sr. Radiographer16 Shyam Thakur Sr. Radiographer17 Sunita Khawaju Radiographer

SN NAME DESIGNATION6 Neeru Dahal Sr. Account Assistant7 Sabin Manandhar Sr. Account Assistant8 Sanjay Maharjan Account Assistant

Annual Report 2017


SN NAME DESIGNATION1 Atmaram Timalsina Sr. Pharmacy Assistant2 Devendra Yadav Health Assistant3 Indrajit Yadav Sr. Health Assistant4 Jaykishor Shah Health Assistant5 Kamal Bahadur Rana Pharmacy Assistant6 Madhu Giri Sr. Pharmacist7 Manoj Kumar Yadav Health Assistant8 Nabina Thapa Pharmacy Assistant9 Niru Ratyal Health Assistant

10 Prem Raj K.C. Pharmacy Assistant11 Rajendra Khatiwada Pharmacy Assistant12 Rita Chapain Pharmacy Assistant13 Upama Parajuli Pharmacy Assistant

PHARMACY

SN NAME DESIGNATION1 Arya Tara Shilpakar Sr. Lab Technician2 Bijaya Kumar Thakur Lab Technician3 Bikash Bhusal Sr. Lab Technician4 Bindeshwar Yadav Medical Lab Technologist5 Binod Kumar Yadav Medical Lab Technologist6 Daltan Dahal Lab Technician7 Dipendra Khadka Lab Technician8 Karna B.K Lab Technician9 Kripa Bhattarai Lab Technician

10 Narendra Shrestha Lan Technician -II11 Nawal Kishor Yadav Lab Technician12 Pradeep Khanal Lab Technician13 Pranila Chitrakar Lab Technician14 Prasamsha Adhikari Lab Technician15 Rajnarayan Mishra Sr. Lab Technician16 Renu Shakya Sr. Lab Technician17 Sarala Koirala Lan TechnicianII-II 18 Sugrib Shrestha Lab Technician19 Suresh Kumar Gupta Lab Technician20 Sushila Shrestha Lab Technician

PATHOLOGY

Annual Report 2017


SN NAME DESIGNATION1 Bhagawan Karki Overseer2 Bhogendra Narayan Shah Sub- Overseer3 Bishwa Ram Adhikari Plumber-II 4 Dinesh Maharjan Plumber5 Kedar Raj Khadka Plumber-II 6 Nawaraj Roka Sub- Overseer7 Pradip Kumar Yadav Engineer8 Shamsher Bahadur Basnet Plumber-II

MAINTENANCE UNIT

TRANSPORTATION UNIT

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SN NAME DESIGNATION1 Bhai Narayan Maharjan Driver-II2 Bharat Bahadur Khadka Driver-II

3 Bhej Bahadur Moktan Driver-II

4 Gyan Kaji Maharjan Driver-II

5 Krishna Bahadur Budhathoki Driver-III

6 Pitambar Bhujel Driver-II

7 Rup Bahadur Thapa Driver-II

8 Sadhuram Pandit Driver-II

9 Yagya Bahadur Khulal Driver-II

OFFICE HELPER

SN NAME DESIGNATION1 Biju Kuwar Chhetri Office Helper2 Gauri Devi Sharma Office Helper-III

3 Kalpana Bhattarai Office Helper-II

4 Kamala Gautam Office Helper-II

5 Madhav Thapa Office Helper-III

6 Shanti KC Office Helper-III7 Sharada Khanal Office Helper-III8 Sushila Bista Office Helper-II

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