Browsing by Author "Bhandari, N"
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Publication Coronary Artery Disease in Nepal: Current Perspective, Challenges, Need for National Practice Guidelines, and Potential Solutions(Kathmandu University, 2022) Prajapati, D; Bhandari, N; Gautam, P; Dhital, R; Shrestha, AABSTRACT South Asians are estimated to have a 40% increased risk for coronary artery disease as compared to populations from other regions. Nepal, as a South Asian country, should also analyze the burden of coronary artery disease and its risk factors to minimize cardiovascular morbidity and mortality. We reviewed the barriers to cardiovascular care and its services in low- and middle-income countries, including Nepal. The identified barriers included coronary artery disease risk factors, access, cost, adherence to cardiovascular care, awareness, knowledge gaps, and socioeconomic and health system challenges. The possible strategies to reduce coronary artery disease included national, regional, and local perspectives. It also highlighted the involvement of community workers and local leaders, education, patient-centered intervention, easy access to drugs and treatments, rehabilitation and public health measures, innovation within the health care system, and multi-sectoral involvement. This review provides insights into the current situation of coronary artery disease and its possible solutions. KEY WORDS Coronary artery disease, Disease burden, Nepal, Risk factors, South AsiaPublication Diagnostic Accuracy of Drop Hydrogen Peroxide Test as a Novel Bedside Diagnostic Test to Differentiate Transudative and Exudative Pleural Effusion Against Light’s Criteria(Kathmandu University, 2022) Vaidya, N; Sapkota, P; Chaurasia, S; Thapa, B; Bhandari, N; Bhattarai, IABSTRACT Background Diagnostic evaluation of pleural fluid according to Light’s criteria to differentiate between exudative and transudative fluid takes 1 or 2 working days. For rapid clinical management, especially in critically ill patients, a simpler bedside diagnostic test can be done which has similar diagnostic accuracy as that of Light’s Criteria. Objective To determine the diagnostic accuracy of Drop Hydrogen Peroxide test to differentiate exudative and transudative pleural effusion in comparison to Light’s criteria. Method A concurrent validity test was performed using a convenient sampling technique including patients presenting to the Department of Internal Medicine from January to September 2021, who had pleural effusion. Two milliliters of tapped pleural fluid of patients who underwent aseptic thoracocentesis was collected in a test tube to which one to two drops of 20% hydrogen peroxide was added. Presence of bubbles suggested an exudative type of fluid. Rest of the tapped pleural fluid was sent to the laboratory for further evaluation by Light’s criteria, which was compared with the results by Drop Hydrogen Peroxide Test. Result There were 83 patients who had pleural effusion, of them a total of 43 patients had transudative pleural effusion while 40 patients had exudative pleural effusion based on Light’s criteria and 37 patients had transudative pleural effusion while 46 patients had exudative pleural effusion based on drop hydrogen peroxide test. Conclusion The drop hydrogen peroxide test allows cost effective and prompt evaluation of the type of pleural effusion is exudative or transudative, thereby making it a convenient diagnostic bedside test. KEY WORDS Diagnostic tests, Exudates and Transudates, Hydrogen peroxide, Pleural effusion, ThoracocentesisPublication Factors Associated with Urinary Tract Infection among Children Aged Less than 5 Years Visiting Department of Pediatrics of Dhulikhel Hospital(Kathmandu University, 2024) Siluwal, N; Bhandari, N; Prajapati, R; Timalsena, DABSTRACT Background Urinary tract infection (UTI) constitutes a significant cause of morbidity, especially among children under five years old. Early diagnosis and management are essential to minimize acute morbidity and prevent the long-term complications associated with urinary tract infections. Objective To identify factors associated with urinary tract infections among children under five years old. Method A quantitative cross-sectional study was conducted at Dhulikhel Hospital, Kathmandu University Hospital in Nepal, involving face-to-face interviews with 105 parents of children under 5 years with suspected or culture-positive Urinary tract infections. Data collection occurred from July 2022 to December 2022, covering both outpatient (OPD) and inpatient cases. Logistic regression was employed to identify factors associated with urinary tract infections. Result The Urinary tract infection prevalence among children under five was 27.12%, with over half (55.2%) were female. Females had a seven times higher urinary tract infection risk than males (95% CI: 1.64 - 30.18; p = 0.009). Children with congenital anomalies faced a 22.8 times higher urinary tract infection risk (95% CI: 1.70 - 286.56, p = 0.01). Diaper changes exceeding 6 hours elevated the risk by 20.09 times (95% CI: 1.14 - 353.95; p = 0.04). Escherichia coli presence in urine culture correlated with a 9.43 times higher urinary tract infection risk (95% CI: 1.34 - 66.16, P = 0.02). Conclusion Implementing preventive measures, including maintaining personal hygiene and changing diapers frequently, can significantly reduce the incidence of urinary tract infections in children, ultimately minimizing medical costs. KEY WORDS Children, Cleaning, Risk factors, Urinary tract infectionPublication Open Surgical Management of Abdominal Aortic Aneurysm at a Community Based University Hospital in Nepal(Kathmandu University, 2020) Bhandari, N; Karmacharya, RM; Devbhandari, M; Shrestha, B; Singh, AK; Ranjit, S; Shrestha, KRABSTRACT Aortic aneurysms are abnormal dilatation of aorta. The risk factors include male sex, age > 65, smoking, coronary artery disease and hypertension. Here we report a case of infra-renal abdominal aortic aneurysm (AAA) of diameter 6 cm. The patient sucessfully underwent aorto-biiliac bypass surgery using Dacron Y graft. During abdominal aortic aneurysm surgery anesthetic challenge is also of paramount importance and should be considered. KEY WORDS Abdominal aortic aneurysm, Aorto-biiliac bypass, Dacron graft, Vascular surgeryPublication Perception Regarding Care of Attempted Suicide Patients among Nursing Students in Kathmandu University School of Medical Sciences(Kathmandu University, 2020) Bajracharya, J; Bhandari, N; Chalise, P; Tiwari, DABSTRACT Background Suicide is an act of deliberately killing oneself. It is a global health problem and is the second leading cause of death in 15 to 29 years. Thus, studying nursing students’ perception towards suicide attempters has paramount importance in understanding and addressing the existing gaps in healthcare delivery system. Objective To assess the nursing students’ perception towards attempted suicide and to find out the association between perception and selected variables. Method A descriptive, cross sectional design was carried out to assess the nursing students’ perception towards suicide attempters in Kathmandu University School of Medical Sciences. The respondents were 193 nursing students. A structured questionnaire was used in order to collect data. Descriptive statistics including frequency, percentage, mean and standard deviation were calculated to summarize the data and inferential statistics, Mann Whitney-U test was used for the association between perception and selected variables. Result A total 193 nursing students participated in this study. The scores between 1 and 2.4 were considered ‘positive’, ‘unsure’ or ‘uncertain’, between 2.5 and 3.4 and negative for 3.5 and above’ over all nurses showed relatively negative perception towards suicide attempters. According to results from eight domains of perception, those who did not attend the courses on psychiatry nursing presented higher score, which was found to have significant association with permissiveness, unpredictability and incomprehensibility. A younger nursing student shows significant association with incomprehensibility. Younger nursing student showed statistically significant association with duration of suicide process. Conclusion Nursing students are frequently encountered with attempted suicide patients. Therefore, they must be aware of their attitudes toward this group of patients as part of their professional and therapeutic role. Thus a nurse’s positive perception towards attempted suicide can play a key role in communicating and preventing a future suicide attempt. KEY WORDS Nursing student, Perception, Suicide attemptersPublication Prevalence and Associated Factors of Low Birth Weight among Newborns in a Tertiary Level Hospital in Nepal(Kathmandu University, 2018) Prajapati, R; Shrestha, S; Bhandari, NABSTRACT Background A United Nations Children’s Fund reported that the global low birth weight was 15.5%, more than 95.6% of them being from developing countries. Low Birth Weight is a major factor associated with neonatal deaths in developing countries. Also, birth weight is one of the major factor in determining child survival, growth and development. Objective The objective of the study was to identify the prevalence and associated factors of low birth weight among newborns delivered in Dhulikhel Hospital. Method A cross sectional research design was carried out among all newborns delivered at the maternity ward of Dhulikhel Hospital within a period of one year. Data were collected using delivery record register as well as its electronic version which was available in the ward. The collected data were entered and analyzed using software SPSS 20 version with descriptive and inferential statistics. Result Total 2,798 numbers of newborns delivered in the hospital during the period of one year met the inclusion criteria for the study. Among them, 21.6% had low birth weight. We found that low birth weight of newborns was significantly affected by younger age of the mother and lesser weeks of gestation at birth. There were no significantly affected by antenatal clinic visit, parity, sex of the baby, type of delivery. Conclusion The study found that more than one fifth of babies had Low Birth Weight. The study findings suggest that special emphasis should be given to minimize early pregnancy to avoid low birth weight babies. KEY WORDS Delivery, Hospital, Low birth weight, NewbornPublication Prevalence of Exclusive Breast Feeding and its Associated Factors among Mothers(Kathmandu University, 2018) Bhandari, N; Prajapati, RABSTRACT Background Breast feeding is the priceless gift given by mother to her newborn. It also has benefits to both mothers and baby. Prevalence of exclusive breast feeding varies from 26.4% in one study to that of 82.2% in another study. Objective To assess the factors associated with exclusive breast feeding among mothers. Method A prospective cross-sectional study using systematic random sampling method, was carried out in Dhulikhel Municipality for two months in November and December 2017 after taking permission from KUSMS IRC and from Dhulikhel Municipality. The study sample was 218 mothers whose infants between 6 months to 1 year were included in the study. A structured and semi-structured interview schedule was used in order to collect the information. Descriptive statistics including frequency and percentage was calculated to summarize mothers’ socio-demographic information. Chi-square test was used for non-parametric categorical data in order to find out the association between variables. P-value less than 0.05 were considered significant. Result The prevalence of exclusive breast feeding was 75.7% in the present study. Maternal age found to be varied from 17 years to 40 years. Maternal age, parity of mother and types of family found to be significantly associated with the practice of exclusive breast feeding (p < 0.05). Mothers’ occupation and education level was not associated with the practice of exclusive breast feeding. Conclusion Majority of the mothers practice exclusive breast feeding (75.7%). Finding of this study i.e. the factors influencing the practice of exclusive breast feeding will help the health care workers to plan the community awareness program on it. KEY WORDS Exclusive breast feed, Infants, MothersPublication Sensitivity and Specificity of Ankle Brachial Index for Diagnosis of Peripheral Arterial Disease in Diabetic Patients Presenting to University Hospital of Nepal(Kathmandu University, 2025) Karmacharya, RM; Vaidya, S; Yadav, B; Sharma, S; Bhatt, S; Bhandari, N; Bhandari, S; Maharjan, S; Bhusal, JABSTRACT Background Diabetes is a significant risk factor for peripheral arterial disease (PAD) that increases morbidity and mortality. Hence, early detection of peripheral arterial disease is necessary. Evidence shows Ankle Brachial Index (ABI) as a promising test to diagnose peripheral arterial disease. However, sensitivity and specificity need to be evaluated before clinical use. Objective To determine Ankle Brachial Index sensitivity and specificity for the diagnosis of peripheral arterial disease in diabetic patients. Method Diabetic patients were recruited from Dhulikhel Hospital. Doppler ultrasonography (DUS) was done in all the recruited participants and peripheral arterial disease was assessed. Based on Jager’s criteria, those with grade III and IV stenosis were diagnosed as peripheral arterial disease and underwent ankle brachial index. Ankle brachial indexscores below 0.9 and above 1.5 were considered abnormal. The diagnosis by ankle brachial index was matched against the gold standard doppler ultrasonography to determine its specificity and sensitivity. Descriptive statistics and independent t-tests were used for statistics. P-value < 0.05 was considered statistically significant. Result There were total of 237 diabetic patients of which 31.2% had peripheral arterial disease. We found high sensitivity and specificity of ankle brachial index when tested against doppler ultrasonography with the values ranging from 88.68-89.66% and 86.67-90% respectively. Conclusion Ankle brachial index can be used in clinical settings to diagnose peripheral arterial disease in individuals with diabetes mellitus. KEY WORDS Ankle brachial index, Diabetes, Peripheral arterial disease, Sensitivity, SpecificityPublication Stress and Coping Strategies among Mothers of Neonates in Neonatal Intensive Care Unit(Kathmandu University, 2025) Bhandari, N; Shrestha, S; Bajracharya, J; Siluwal, NABSTRACT Background The birth of a baby is a happy moment for parents. When a newborn is admitted to Neonatal Intensive Care Unit due to morbidities, stress provoking for the parents. To overcome stress, parents, especially mothers adopt different types of coping strategies. Objective To assess the stressor and coping strategies adopted by mothers of neonates in Neonatal Intensive Care Unit. Method This is a cross-sectional, analytical study design conducted in mothers whose neonates were admitted 72 hours prior to data collection in the Neonatal Intensive Care Unit. The study was conducted after the approval received from the Institutional Review Committee-Kathmandu University School of Medical Sciences. Consecutive sampling methods was used to select the mothers. Data was collected using Parent Stressor Scale (PSS: NICU) for stress and BRIEF Coping Orientation to Problems Experiences (COPE) Inventory for coping strategies. Four points Likert scale was used to collect data. Data was analyzed using descriptive analysis, independent t-test and pearson correlation was used to see the correlation between independent and dependent variables. Result Overall stress among mothers is 111.4 ± 9.82 and among which most stressful events is neonates, looks and behaviour 54.4 ± 6.56 followed by parental role 34.10 ± 2.50 and sight and sounds of Neonatal Intensive Care Unit 23.06 ± 2.85 respectively. The direction of the relationship is positive between stress and coping strategies in neonates mothers (p < 0.001) in Neonatal Intensive Care Unit. Conclusion Understanding the stress of mothers and their coping strategies when their neonates admitted in Neonatal Intensive Care Unit will help the nurses to plan care for admitted neonates. KEY WORDS Coping strategies, Mothers, Neonates, Neonatal intensive care unit, Stress