Browsing by Author "Dhakal, Ajaya Kumar"
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Publication Abdominal Wall Dyskinesia in a Child Presenting as Belly Dancers’ Syndrome: A Case Report(Nepal Medical Association, 2023) KC, Divya; Dhakal, Ajaya Kumar; Shrestha, Devendra; Acharya, Samyukta; Neupane, NischalAbstract Belly dancer’s dyskinesia or syndrome is a rare condition characterized by involuntary, undulating, infrequent diaphragm movements. The etiologies for this disorder include nervous system disorders (peripheral or central), drug-induced, psychological, or idiopathic. This article describes a 10-year-old boy with an underlying psychological stressor who suddenly experienced involuntary abdominal wall movements after salbutamol nebulization. After a detailed history, physical examination, and abdominal ultrasound that revealed rapid rhythmic diaphragm movements, the child was diagnosed with salbutamol-induced belly dancer's dyskinesia with an underlying psychological problem. These movements subsided with medical and psychological therapy for two weeks. Belly dancer’s dyskinesia is a complex disorder that is difficult to diagnose but can be managed with medical treatment and psychological counseling alone in a few patients. In contrast, in other cases, surgical intervention may be required.Publication Clinical Laboratory Profile of Blood Culture Proven Enteric Fever in Children(Nepal Paediatric Society (JNPS), 2018) Shah, Subhash Chandra; Neupane, Prashank Shree; Guragain, Anusmriti; Dhakal, Ajaya KumarAbstract: Introduction: Enteric fever has diverse clinical presentations and laboratory findings and blood culture is gold standard for diagnosis in the children. This study was done to analyse clinical profile and laboratory findings in culture proven enteric fever. Material and Methods: The study was descriptive observational study carried out in the patient aged 14 years of age or less admitted with culture proven enteric fever admitted in a Paediatric ward of a tertiary medical centre in Lalitpur, Nepal from April 2009 to February 2018. Results: Forty children with blood culture proven were enrolled in the study. All children had fever with the mean duration of 5.3 days (1-14). The most common associated symptoms were gastrointestinal which included anorexia (47.5%), pain abdomen (37.5%), vomiting (37.5%), diarrhoea (15%) and constipation (5 %). Splenomegaly (25%) and hepatomegaly (17.5%) were the commonest signs. The majority of children (80%) had normal total leucocyte count and 32.5% of them had anaemia. There were no children with thrombocytopenia. Salmonella typhi and Salmonella paratyphi A were isolated in 70% and 30% of children respectively. None of the isolates showed drug resistance against ceftriaxone, chloramphenicol, cotrimoxazole, gentamicin, norfloxacin and ofloxacin. There was no mortality. Conclusions: Enteric fever should be suspected in all the children with fever for more than five days along with anorexia, gastrointestinal associated symptoms and normal white blood counts.Publication Colostrum Feeding among Newborns Visiting the Outpatient Department of Pediatrics of a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2023) Acharya, Sharda; Thapa, Bibechan; Dhakal, Ajaya Kumar; Singh, Saurav KumarAbstract Introduction: Colostrum is the thick yellowish breast milk that is produced during the first 3-5 days of childbirth. Feeding colostrum protects the newborn from various diseases, thus promoting the overall well-being of the newborn. The objective of this study was to find out the prevalence of colostrum feeding among newborns visiting the Department of Pediatrics in a tertiary care centre. Methods: A descriptive cross-sectional study was done among infants presenting to the Department of Pediatrics in a tertiary care centre. Ethical approval was taken from the Institutional Review Committee (Reference number: 2078/079/107). The duration of study was six month from 12 February 2022 to 12 August 2022. A pre-designed questionnaire was used for face-to-face interviews. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 350 newborns, colostrum was fed to 305 (87.14%) (83.63-90.65, 95% Confidence Interval) newborns. A total of 180 (59.02%) were breastfed within 1 hour of delivery. Conclusions: The prevalence of colostrum feeding was higher in our study than in other studies done in similar settings.Publication Faculty Development Program in Nepalese Medical Schools: Past, Present, and Future Perspectives(Nepal Health Research Council, 2023) Dhakal, Ajaya Kumar; Adhikari, Ramesh KantAbstract Teaching medical students is an art that requires expertise in the core content of the subject and specialized teaching techniques. Learning to teach medical students and teachers learning from those teachings themselves is a lifelong process. Short medical teacher training courses in various specialized teaching techniques lay the foundation for a positive teaching experience that can substantially impact medical education. The Faculty Development Program is one such training course for medical teachers, designed to be an essential step toward becoming a student-centered facilitator. This article sheds light on the current status and significance of the faculty development program in Nepalese medical education. It also offers suggestions and critical strategies to improve the program in the future with available resources and to integrate it further into medical education. Keywords: Faculty development program; medical education; Nepal; teacher trainingPublication Identifying Barriers and Areas of Focus to Improve the Publication Practices among Paediatricians in Nepal(Nepal Health Research Council, 2025) Dhakal, Ajaya Kumar; Neopane, Arun Kumar; Thapa, Moon; Singh, Neeti; Shrestha, DevendraBackground: Medical research publications in Nepal have remained relatively uncommon over the last decade. However, recent growing research interest among clinicians in Nepal has emphasised the need to identify and address key barriers to strengthen the research-publication process. This study aimed to identify these barriers and focus areas for improving publication practices among paediatricians in Nepal. Methods: A cross-sectional study was conducted among Nepali paediatricians from 15 January to 15 May 2024 using a semi-structured questionnaire distributed via Google Forms. The survey included Likert-scale, open-ended, and closed-ended questions on research-publication barriers, research practices, motivation, and recommendations for improvement. Results: A total of 293 participants (male: 60.1%) responded to the survey. Of these, 35.2% worked in government hospitals, 38.6% were subspecialists, and 54.9% had additional responsibilities beyond their paediatric work. Furthermore, 77.5% of paediatricians had publications, with 78% and 95.15% as principal authors and co-authors, respectively. Systematic reviews and meta-analyses were deemed to be the most challenging, whereas cross-sectional studies were the easiest to conduct. Academic recognition (73.7%) was the primary motivation for publishing, whereas the most significant barrier was being overwhelmed by clinical work (64.5%). Time management (96.1%) and clinical work responsibilities (93.2%) were the main challenges in the manuscript preparation. Ghost authorship (14%) and gift authorship (32.6%) were the most common issues related to authorship. Most participants (80.5%) believed that training in manuscript writing and research methodology could improve the quality and quantity of the research publications. Conclusions: Paediatricians in Nepal face several publication barriers, which can be addressed through increased funding, improved resources, and enhanced research training. Keywords: Barriers; Nepal; paediatrician; publication; research.Publication Neonatal Outcome of Macrosomia(Nepal Paediatric Society (JNPS), 2020) Subhash Chandra Shah,; Anusmriti, Guragain; Pandey, Shreejana; Dhakal, Ajaya KumarAbstract: Introduction: Macrosomia is an emerging public health problem, both in the developed as well as in the developing countries. This study was aimed to examine the maternal and neonatal risk factors associated with macrosomia and compare adverse neonatal outcome between appropriate for gestational age (AGA) and macrosomia. Methods: Records of all live singleton AGA and macrosomic babies delivered at a tertiary care teaching hospital in Lalitpur, Nepal, between 14th April 2013 and 13th April 2014 were retrospectively reviewed. Results: Of the 769 deliveries, 684 neonates were eligible of which 93 were born macrosomic with an incidence of 12.1%. We observed the most significant neonatal outcome to be neonatal sepsis (14%; p = 0.005) compared to AGA babies (5.9%). Macrosomia was found to be associated with increasing maternal age and parity (p = 0.007) relative to mothers of AGA babies, most of whom underwent caesarean section (55.9%) whilst the same outcome was fewer for mothers of AGA babies (29.9%). A higher incidence of pregnancy induced hypertension (PIH) as maternal comorbidity (5.4%) was associated with macrosomia contrasted with mothers of AGA babies (4.4%). Conclusion: Macrosomic birth was found to be associated with relatively higher adverse neonatal outcome, warranting prolonged hospital admission than AGA births.Publication Scar among Bacillus Calmette-Guérin Vaccinated Children Presenting to an Immunisation Clinic at a Tertiary Hospital in Nepal: An Observational Study(Nepal Medical Association, 2025) Dhakal, Ajaya Kumar; KC, Divya; Shrestha, Barsha; Shrestha, Devendra; Neupane, Nischal; Acharya, Sharda; Shrestha, SauravAbstract Introduction: Bacillus Calmette-Guérin vaccination is associated with the development of scarring at the vaccination site in most children within 12 weeks of vaccination. However, due to various factors, some children do not develop scars. The aim of the study was to determine the prevalence of scar failure and the differences in clinical characteristics between scar-positive and scar-negative children. Methods: This observational cross-section study was conducted between 12 September 2022 and 15 April 2024 on children attending a vaccination clinic at a tertiary care hospital for 12 or 15-month vaccination. A purposive sampling method was used, and 386 children were enrolled in the study. During medical history, information was collected on Bacillus Clamettte-Guérin vaccination, child and maternal clinical profiles, and hospitalisations for respiratory tract infections in children. Results: Among 386 infants, prevalence of BCG scar was 341 (88.34%; 95% CI: 91.81%-91.37%). Vaccination was confirmed in 94.82% by history and card. The median scar size was 4mm (IQR: 2,5 mm) transversely and 3 mm (IQR: 2,5) vertically. Thirty-two (8.30%) infants required hospital admission for respiratory infections; none received anti-tubercular treatment. Conclusions: The BCG scar formation was higher compare to the scar failure. The scar failure was comparable to other studies.Publication Stunting among Children Aged 6 to 59 Months Visiting the Outpatient Department of Pediatrics in a Tertiary Care Centre(Nepal Medical Association, 2023) Acharya, Sharda; Thapa, Bibechan; Kansakar, Rochak; Shakya, Henish; Dhakal, Ajaya Kumar; KC, DivyaAbstract Introduction: Stunting refers to low height for age, resulting from chronic undernutrition, often linked to poor socio-economic conditions, maternal health, infant care, and nutrition. It hinders children's physical and cognitive development. In Nepal, over half of children under five suffer from malnutrition. Despite efforts, stunting remains high but has decreased from 57% in 1996 to 25% in 2022. The aim of the study was to find out the prevalence of stunting among children aged 6 to 59 months visiting the outpatient Department of Pediatrics in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among children aged 6 to 59 months visiting the outpatient Department of Pediatrics in a tertiary care centre after obtaining ethical approval from the Institutional Review Committee from 27 April 2023 to 15 July 2023. Anthropometric measurements were taken. World health organization standard growth charts for Z score was used appropriately for the completed age in months and gender of the child. A pre-designed questionnaire was used for face-to-face interviews. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 320 children, 46 (14.38%) (10.54-18.22, 95% Confidence Interval) children had stunting. Among those 46 children with stunting, 20 (43.47%) had severe stunting. Conclusions: The prevalence of stunting among children aged 6 to 59 months was found to be lower than other studies done in similar settings.