Browsing by Author "Bhandary, S"
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Publication A Point Prevalence Study of the Use of Antibiotics in Six Tertiary Care Hospitals in the Kathmandu Valley, Nepal(Kathmandu University, 2022) Jha, N; Thapa, B; Pathak, SB; Pandey, A; Pokhrel, S; Shankar, PR; Bhandary, S; Mudvari, A; Dangal, GABSTRACT Background Point prevalence survey (PPS) on antibiotic use developed by the WHO has already been used in many hospitals globally. Objective To obtain information on antibiotic prescribtion using point prevalence survey methodology in six private hospitals in the Kathmandu valley. Method This descriptive cross-sectional study was completed during 20th July to 28th July 2021 using point prevalence survey methodology. The study was conducted among inpatients admitted at or before 8:00 AM on the day of survey in various wards. Data was presented as frequencies and percentages. Result Maximum number of patients were above 60 years [34 (18.7%)]. Number of male and female participants were equal [91 (50%)]. Only one antibiotic was used in 81 patients (44.5%) followed by two antibiotics in 71 (39%) patients. Duration of prophylactic antibiotic use was one day in 66 (63.7%) patients. Blood, urine, sputum, and wound swabs were the common samples for culture. Cultures were positive for 17 (24.7%) samples. The common organisms isolated were E. Coli, Pseudomonas aeruginosa and Klebsiella pneumoniae. Ceftriaxone was the most used antibiotic. Drug and therapeutics, infection control committee and pharmacovigilance activities were present in 3/6 (50%) study sites. Antimicrobial stewardship was present in 3/6 (50%) and microbiological services was present in all hospitals. Antibiotic formulary and antibiotic guideline were present in 4/6 sites and facilities to audit or review surgical antibiotic prophylaxis choice in 2/6 (33.3%) sites, facility to monitor antibiotic use in 4/6 (66.6%) and cumulative antibiotic susceptibility reports in 2/6 (33.3%) study sites. Conclusion Ceftriaxone was the most used antibiotic. E. Coli, Pseudomonas aeruginosa and Klebsiella pneumonia were the commonly isolated organisms. Not all parameters for infrastructure, policy and practice and monitoring and feedback were present at the study sites. KEY WORDS Antibiotics, Point prevalence survey, Private hospitals, Tertiary care centersPublication Appropriate body mass index cut-off point in relation to type 2 diabetes mellitus in the population of Kavre district(Kathmandu University, 2008) Shah, A; Bhandary, S; Malik, SLAbstract Objective: The objective of the present study was to find out the appropriate BMI cut-off point in relation to type 2 Diabetes Mellitus (DM) in the population of Kavre district of Nepal. Materials and methods: Thirty-five “known type 2 diabetic” and Thirty-five “self-reported non-diabetic” subjects above thirty years of age were included in the present study. Height and weight were recorded for every subject. BMI was calculated by the standard formula. The data was analyzed using SPSS Version 11.5. Results: Our results showed that the reference BMI range for both diabetic male (23.26 ± 6.88 kg/m2) and diabetic female (22.51 ± 6.28 kg/m2) subjects were within normal BMI range according to WHO. Odds ratio showed an irregular pattern at different BMI ranges indicating the risk of having diabetes did not increase constantly. Comparison of number and percentage of both diabetic and non-diabetic male and female subjects according to various recommended normal BMI categories showed gradual reduction in percentage of both diabetic and non-diabetic male and female subjects that were within normal ranges from BMI category 18.5-24.9 kg/m2 to BMI category 18.5-21.9 kg/m2 .The BMI cut-off point was found 22 kg/m2 using Receiver Operating Characteristic (ROC) curves. Conclusion: The appropriate BMI cut-off point for both men and women was found 22 kg/m2 in the population of Kavre district of Nepal. Key words: BMI cut-off points, Type 2 DM, Kavre districtPublication Cervical necrotizing fasciitis in an uncontrolled type II diabetic patient(Kathmandu University, 2006) Singh, RK; Bhandary, S; Wakode, PT; Karki, PWe report a case of cervical necrotizing fasciitis (CNF) in a female having uncontrolled type II diabetes mellitus. The patient was presented to us after 20 days of preliminary symptoms. The aetiology of microbial inoculation in subdermal tissue was not known. The isolate was Staphylococcus aureus. In spite of the delay in presentation, the patient was successfully treated with combined antimicrobial and surgical intervention. Key words: Necrotizing fasciitis, head and neck, cervical, diabetes mellitus.Publication Developing tool and Measuring Integration Characteristics of Basic Science Curriculum to Improve Curriculum Integration(Kathmandu University, 2018) Maharjan, BR; Bhandary, S; Upadhyay, S; Ghimire, S; Shrestha, I; Joshi, M; Vaidya, S; Pradhan, PABSTRACT Background Integrated curriculum enhances students’ learning and the retention of knowledge. At Patan Academy of Health Sciences, integrated organ system based curriculum is used with Problem Based Learning as the principle teaching learning method to foster students’ learning. In addition, other approaches of integration were under taken such as integrated assessment; logical arrangement teaching learning methods (lectures and practicals); joint effort of faculty in curriculum planning and delivery; conducive environment to foster hidden curriculum. This study describes the perception of faculty and students on integration characteristics of Basic Science curriculum. Objective To measure the integration characteristics of Basic Science Curriculum. Method Tool was developed to measure integration characteristics of Basic Science Curriculum and ensure whether such planned integration has been achieved. Mixed method was used to measure the perception of the integration characteristics i) quantitatively by questionnaire survey to faculty and students ii) qualitatively by in-depth interview of students. Result Both faculty and students perceived that all the blocks in Basic Science was well integrated in the quantitative questionnaire survey. But, in the in-depth interview, students perceived integration of curriculum in organ system blocks were better integrated compared to Principle of Human Biology blocks where fundamentals of basic science disciplines were delivered. Students reflected that Problem Based Learning not only integrated Basic Science disciplines but also with clinical sciences and the social context. But, students perceived that Community Health Sciences curriculum was not so well integrated with Basic Science subjects. Conclusion Overall, this study showed that planned integration in Basic Science curriculum was successfully executed during curriculum implementation. KEY WORDS Basic Science, Integration characteristic, Integrated curriculum, PBLPublication Fungal Maxillary sinusitis: A prospective study in a tertiary care hospital of eastern Nepal(Kathmandu University, 2007) Joshi, RR; Bhandary, S; Khanal, B; Singh, RKIntroduction: The incidence of mycotic infections and the diversity of pathogenic fungi have increased dramatically in recent years. Fungal sinusitis should be considered in all the patients with chronic maxillary sinusitis (CMS), especially in association with certain clinical features that serve as clue to the diagnosis. Aspergillus is the most common fungal pathogen in maxillary sinus. Methodology: A total of 100 patients those who fulfilled the diagnostic criteria (Lanza and Kennedy3 , 1992) for chronic rhinosinusitis were eligible for this open level and randomized prospective study. Only those above 14 years of age were included. Results: Fungal maxillary sinusitis was seen in 14% of all cases of chronic maxillary sinusitis in eastern part of Nepal. We identified Acremonium and Candida species as commonest fungi involved in fungal maxillary sinusitis (FMS). To the best of our knowledge this is the first such study conducted in eastern Nepal. Key words: Fungus, Sinusitis, MaxillaryPublication In response to the article entitled “Surgery for recurrent lower lip carcinoma” by Maharjan S et al, published in KUMJ, 2008 Vol. 6, No. 3, Issue 23, 375-378.(Kathmandu University, 2009) Bhandary, SNAPublication Knowledge, Attitude and Practice Towards Antimicrobial Resistance and Antimicrobial Adherence among Female Community Health Volunteers Before and After an Educational Intervention(Kathmandu University, 2025) Jha, N; Kafle, S; Joshi, M; Pandey, A; Koirala, P; Bhandary, S; Shankar, PRABSTRACT Background Antimicrobial resistance is a serious problem in Nepal. Knowledge, attitude, practice and adherence of female community healthcare volunteers of an intervention area about antimicrobials before and immediately after a workshop conducted on 24th February 2024 was measured. Objective To compare the knowledge, attitude and practice towards antimicrobial resistance and antimicrobial adherence among female community health volunteers. Method A questionnaire containing four sections related to various themes of antimicrobials was developed. Knowledge, Attitude and Practice questions were analyzed using two sample proportion tests. Feedback regarding the educational intervention was also obtained using a 7-item tool and open responses. Result All Female Community Health care Volunteers from Mahalaxmi municipality participated. Most participants were aged between 41-50 years [19 (42.2%)] and [25 (55.6%)] had working experience greater than 10 years. The scores for statements antimicrobial resistance are a serious problem worldwide, [84.4% vs 60% (p=0.004)] and antibiotics are used to inhibit the growth of bacteria improved post- intervention [100% vs 77.8% (p ≤ 0.001)]. Scores for attitude statements like, taking antibiotics without consulting a physician [91.1% vs 60% (p ≤ 0.001)], missing a dose or two of antibiotic treatment contribution to antibiotic resistance, [75.5% vs 46.6% (p = 0.002)] among others improved. The scores for certain practice statements also improved post-intervention. The median scores for attitude scale, [31 vs 26 (p ≤ 0.001)] and practice scale, [31 vs 34 (p = 0.011)] were different before and after the workshop. Participant feedback on the workshop was positive. Conclusion The session was effective in increasing participants’ practice scores and may lead to more rational use of antimicrobials. The attitude, practice and total scores were different before and after the workshop. KEY WORDS Antimicrobial resistance, Educational intervention, Feedback, Female community healthcare volunteersPublication Nutritional status and morbidity pattern among governmental primary school children in the Eastern Nepal(Kathmandu University, 2004) Shakya, SR; Bhandary, S; Pokharel, PKObjective: To assess the nutritional status and morbidity pattern of primary school children. Methods: Descriptive, cross-sectional study was administered in the five governmental schools located in Dhankuta town (Dhankuta district) and Ineruwa town (Sunsari district). The schools were selected using simple random sampling technique. From these selected schools, a total number of 818 students studying from Grade I to V were enumerated in the study using census survey method. Results: Among 818 students, 61% of the students were found to be malnourished. The students were more stunted (21.5%) than wasted (10.4%). Only 5.4 % of the students were found to be both wasted and stunted. The collected blood and stool samples from the students revealed parasitic infestation of 65.8% and anaemia of 58%. The most common diseases in those schools were: skin diseases (20%), dental caries (19.8%), and lymphodenopathy (10.5%). Among skin diseases, pediculosis was more common among girls while ringworms and scabies were common among boys. Conclusion: The study revealed that high percentage of primary school students was malnourished. It was found that there was a high prevalence of parasitic infestation and anaemia. The study result revealed the urgent need for initiation of school health program with specific emphasis on prevention of diseases, improvement of personal hygiene and nutritional status with the collaboration of governmental and non-governmental institutions. Key Words: Nepal, school health, nutritional status, malnutrition, anaemia, pediculosis.Publication Oxygen Saturation of Hemoglobin in Healthy Children of 2- 14 Years at High Altitude in Nepal(Kathmandu University, 2012) Shrestha, S; Shrestha, S; Shrestha, L; Bhandary, SABSTRACT Background Individuals residing at higher altitude may have oxygen saturation of hemoglobin different to those living at lower altitude. Objectives To find out the baseline value of SpO2 in healthy Nepali children (2-14 years) living permanently at high altitude using pulse oximeter and also to study the relation of SpO2 with age, sex and ethnicity Methods A descriptive observational study was conducted at 4 different altitudes ranging from 2700 to 3800 m in Mustang district. The mean pulse oximery values at different altitudes were calculated and compared. Results One hundred six children were enrolled with the median age of 10 years. The mean SpO2 value of children permanently residing at altitude 2700m was 95.18%, at 2800m was 94.82%, at 3550m was 94.1% and 3800m was 93.1%.The difference in the SpO2 values at different altitude was statistically significant. No sex or age wise differences were noted on the mean SpO2 values in the study group. Conclusions The mean SpO2 values were higher than several other studies done in the altitude above 2500 meters. Enrollment of older children and the different ethnic background could be the contributing factors for the differences. KEY WORDS children, high altitude, Nepal, pulse oximetryPublication Peripheral intravenous catheter related phlebitis and its contributing factors among adult population at KU Teaching Hospital(Kathmandu University, 2008) Singh, R; Bhandary, S; Pun, KDAbstract Background: Peripheral intravenous catheter-related phlebitis is a common and signi cant problem in clinical practice. This study was carried out to determine the occurrence of peripheral intravenous catheter related phlebitis and to de ne the possible factors associated to its development. Materials and methods: Prospective observational study was carried out on 230 clients who were under rst time peripheral infusion therapy during two months period: September – October, 2007. Peripheral infusion site was examined for signs of phlebitis once a day. Jackson Standard visual phlebitis scale was used to measure the severity of the phlebitis. SPSS software was used to enter, edit and analyze the data and t-test, chi-square test, binary logistic regression and ROC curve were used to draw the statistical inferences. Results: Phlebitis developed in 136/230 clients (59.1%). It was very mild in most cases. Increased incidence rates of infusion related phlebitis were associated with male sex, small catheter size (20 gauge), insertion at the sites of forearm, IV drug administration and blood product transfusions. The incidence rate of phlebitis rose sharply after 36 hours of catheter insertion. Conclusion: Peripheral Intravenous therapy related phlebitis at KUTH, Dhulikhel Hospital is a signi cant problem. Related risk factors as found in the present study were insertion site (forearm), size of catheter (20G) and dwell time (>= 36 hours). There were higher incident of phlebitis among the client with Intra venous drug administration and especially between ages 21 - 40 years. Therefore more attention and care are needed in these areas by the care provider. Key words: Phlebitis, Intravenous Therapy, Catheter, Risk Factors, KUTH, Nepal.Publication Regarding “Tonsillar microbial flora: A comparison of infected and non-infected tonsils”(Kathmandu University, 2006) Bhandary, S; Singh, RK; Shrestha, SNAPublication Sex Preferences Among Mothers Delivering at Patan Hospital(Kathmandu University, 2011) Chhetri, UD; Ansari, I; Bhandary, S; Adhikari, NABSTRACT Background High sex ratios at birth (SRB) are seen in China, Taiwan, South Korea, parts of India and Vietnam. The imbalance is the result of son preference, accentuated by declining fertility. Prenatal sex determination and female feticides are common in many countries. It is reflected in sex ratio Objective To determine reasons for the preferences for different sex; to find out whether there is altered sex ratio at birth and to find out whether female feticide are common among women who had abortion. Method It is a prospective study. Women who had previous history of abortion and had delivered at Patan Hospital in the year 2066 were interviewed as per questionnaires. Results Among 560 women with total live births of 965, (462 male and 503 female) during their life time the overall sex ratio was 92 male per 100 female birth; total abortions were 663. Preferences for male were 10%, female 15.4% and either was for 74%. The reason for male preference was to continue family lineage, to bring honor, old age security, and performing funeral rites while the reasons for daughter preferences were that they understand mother’s pain, help in household work. The sex ratio of the babies born during the study period was 113 male per 100 female births. The Sex ratio at birth from 1st to 6th deliveries was 61, 79, 101, 210, 286 and 1100 male per 100 female birth respectively. Prenatal sex selection was 8% (by USG) but none had sex selected abortion. Conclusion Sex ratio of those delivered during the study period was skewed (136 boys per 100 girls) towards male. There was shift in SRB in 4th and subsequent pregnancies in favor of boys. As the male sex ratio increased the number of induced abortion decreased in subsequent pregnancies. KEY WORDS Feticide, Induced abortion, Sex preferences, Sex ratioPublication Sinonasal inverted papilloma in eastern part of Nepal(Kathmandu University, 2006) Bhandary, S; Singh, RK; Shrestha, S; Sinha, AK; Badhu, BP; Karki, PObjective: To evaluate the clinicopathological profile of sinonasal inverted papilloma in a tertiary referral center in eastern part of Nepal. Methods: A prospective study consisting of total 28 histologically proven cases of sinonasal inverted papilloma was conducted in the ENT department of the center. The study period was from April 2002 to November 2005. Result: Out of 28 cases studied, 21 were males and 7 were females with male to female ratio of 3:1. The highest incidence was seen in the 5 th and 6 th decades of life. The duration of symptoms varied from 5 months to 20 years with mean duration of 3.9 years. The lateral nasal wall and nasal cavity involvement was seen in all 28 cases. Maxillary sinus was involved in 27(96.4%) subjects followed by ethmoid (20), sphenoid (10) and the frontal sinus (7). The principle presenting symptom was nasal obstruction seen in 96.4% of the patients. Twenty two cases were treated by lateral rhinotomy with medial maxillectomy while, orbital exenteration was done in two cases. Associated carcinoma was noticed in 10.15% of all the subjects studied. Conclusion: Sinonasal papilloma mostly presented in fifth to six decades of life mainly affecting the male patients. Majority of the patients were treated by lateral Rhinotomy with medial maxillectomy surgery. Early presentation would have given chances for endoscopic surgery. Key words: Sinonasal inverted papilloma, lateral Rhinotomy, medial maxillectomy.