The use of telecommunication in the field of medicine is very limited in Nepal. Despite huge potential of improving access of the sub-urban and rural communities with the urban-based health care professionals for expert consultation, the use of the telecommunication technology remains largely unexplored. In light of the facts, a comparative study was conducted at a rural community in Makwanpur. In total 40 patients (20 in each group) were selected for the study with an objective to test the feasibility and effectiveness of telemedicine in improving the quality of diabetes care in an experimental group and control group in Makwanpur district. In the intervention group, diabetes care was provided with tele-consultation for diabetes care mediated via local doctor. The outcome was compared with a control group based in an urban community with treatment as usual in their community. The study results showed that the use of telemedicine is a feasible alternative to provide diabetes care in rural Nepal. Overall fasting blood sugar was better controlled in the control group whereas there was significant improvements in micro albumin were observed in the interventional group. Similarly, the knowledge of the respondents on various aspects of the disease was also found to be better in the interventional group than in the control group. Majority of the respondents (90%) felt telemedicine service is less expensive than the service they had taken before.

No abstract

Background

Background Moderate secondary tricuspid incompetence has variable natural history if left unattended during mitral valve surgery. Recent data suggest progression of the secondary tricuspid incompetence over time. Secondary moderate tricuspid regurgitation in rheumatic mitral valve disease may regress after mitral valve surgery without direct intervention. Objectives: The present retrospective comparative hospital based tudy was done to assess early result of DeVega tricuspid valve annuloplasty amongst those with moderate tricuspid regurgitation due to rheumatic mitral valve disease. Methods: Group I (mitral valve replacement with tricuspid repair) and Group II (mitral valve replacement only) were compared regarding functional class, heart rate, rhythm, cardiac dimensions, function and valve pathology. The two groups were followed up at three months post-operatively and evaluated for their functional class and echocardiography variables. The data was analyzed with SPSS 16.0 Results: There were 43 patients who underwent mitral valve replacement with moderate tricuspid regurgitation. Twenty three underwent mitral valve replacement with tricuspid repair group (Group 1). Most of the patients were women (28/43). The mean age was 31.4 + 14.8 and 25.13 + 9.4 years. Group I had 21(91.3%) and Group II had 17 (85%) in NYHA class III & IV. The pre-operative echocardiographic cardiac left ventricular and left atrial dimensions, left ventricular function and valve lesions were statistically similar for both groups, except PASP was higher amongst tricuspid repair (Group 1: 38.60 + 12.75mHg, Group 2: 61.52 + 19.76mmHg; p= <0.05). At three month’s review after surgery, four patients were in NYHA II amongst those without tricuspid repair (Group II), whilst the rest were in NYHA I. Left ventricular dimensions, Left Ventricular function and valve prosthetic valve function were similar between groups. Eleven (47.8%) patients in Group I and only five (25%) of Group II had trace or less TR at the follow-up (p < 0.05). There were 7 (16.2%) patients who had persistent moderate TR. Higher PASP and larger LV dimensions at three months were predictive of persistent moderate TR. Conclusion Mitral valve replacement does decrease the severity of tricuspid regurgitation amongst those with secondary moderate tricuspid regurgitation by at least one grade, but DeVega’s annuloplasty confers a better repair result. http://dx.doi.org/10.3126/kumj.v9i1.6266 Kathmandu Univ Med J 2011;9(1):64-8

Background