Badahara Dubauliya

This research aims to compare the effects of oral anticoagulation versus no anticoagulation in patients aged 55 and older who have had recent episodes of transient atrial fibrillation triggered by stress and have additional factors that increase their risk of stroke. The study is a multinational, investigator-initiated, prospective, randomized, open-label trial evaluating the impact of non-vitamin K oral anticoagulants NOACs on preventing stroke and other serious cardiovascular events. Participants will be randomly assigned to either receive one of several NOACs, such as edoxaban, apixaban, dabigatran, or rivaroxaban, prescribed by their physician for the duration of the follow-up, or to a control group that will not receive anticoagulants unless medically indicated during the study. The choice of specific NOAC and dose adjustments are determined by the prescribing doctor. The study excludes patients with certain conditions like chronic atrial fibrillation, severe kidney or liver disease, recent cardiac surgery, or bleeding risks. During the study, participants will be monitored for up to 24 months to assess the occurrence of non-hemorrhagic stroke, systemic embolism, vascular mortality, myocardial infarction, peripheral arterial thrombosis, amputation, and venous thromboembolism. Regular follow-up will include evaluation of these outcomes to measure the effectiveness and safety of anticoagulation compared to no anticoagulation. Participants will provide informed consent and remain under medical supervision throughout the trial.

Researchers are investigating the causes of febrile illnesses in Nepal, where many patients with fever lasting 3 to 21 days are diagnosed based on symptoms alone due to limited microbiological lab support. This study aims to identify infections using advanced microbiological methods, including culture and ELISA-based tests for seven pathogens not routinely tested in Nepal. By improving diagnosis, the study seeks to reduce unnecessary antibiotic use, which can lead to resistance and added costs, and to enhance patient outcomes while aiding public health efforts to control infectious diseases. The study involves two groups one receiving the standard care evaluation by their medical team, which includes clinical assessment, basic labs, radiology, routine serologies, and microbiological tests and another group that, if no clear diagnosis emerges, will undergo additional serological and microbiological testing for infections such as Murine typhus, Bartonellosis, Q fever, Chikungunya, Zika, Japanese B encephalitis, and West Nile virus. These additional tests are meant to better identify the cause of undifferentiated febrile illness. Participants admitted to the hospital with fever lasting 3 to 21 days will be closely monitored with clinical evaluations and laboratory testing over this period. Researchers will assess the causes of fever and the effectiveness of antimicrobial treatments used. They will compare clinical diagnoses with lab results and evaluate treatment outcomes. The study lasts for the duration of the fever episode, up to 21 days, aiming to improve diagnosis and treatment practices for febrile illnesses in Nepal.

Researchers are investigating whether accelerated surgery for hip fracture patients with acute myocardial injury can reduce death rates within 90 days compared to the usual care. This international, multicenter, randomized controlled trial also evaluates secondary outcomes like walking ability, time to first mobilization, major complications including heart attacks and stroke, delirium, pain, length of hospital stay, and quality of life. The trial compares two approaches one group receives rapid medical clearance and surgery within 6 hours of meeting eligibility, while the other group undergoes hip fracture repair following standard hospital procedures. Surgery and care are performed according to institutional guidelines, with the accelerated group targeting quick operating room arrival. Participants will be monitored for 90 days after randomization. Researchers will assess survival, walking independence, major cardiovascular complications, delirium episodes, pain levels, and hospital discharge timing. This includes tracking events like myocardial infarction, heart failure, and stroke. The study aims to gather comprehensive data on safety and recovery outcomes related to timing of surgery in this patient group.