Browsing by Author "Ghimire, P"
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Publication Antibody Development Kinetics of Plasmodium falciparum Histidine Rich Protein-II (HRP-II)(Nepal Health Research Council, 2003) Mirdha, B R; Parta, A K; Panda, A K; Ghimire, P; Samantaray, J CPublication Antimicrobial Resistance Pattern of Pseudomonas aeruginosa Isolates from Tertiary Care Hospitals in Kathmandu(Kathmandu University, 2023) Shrestha, PM; Kattel, HP; Sharma, S; Bista, P; Basnet, BK; Ghimire, P; Rijal, KRABSTRACT Background Antimicrobial resistance, caused by Pseudomonas aeruginosa (P. aeruginosa), poses a global health threat, limiting treatment options and increasing morbidity and mortality rates due to its intrinsic and multidrug resistance. Objective To determine the antimicrobial resistance patterns of P. aeruginosa isolates from patients visiting or admitted to tertiary care hospitals in Kathmandu. Method A cross-sectional study was conducted at Bir Hospital and Tribhuvan University Teaching Hospital (TUTH) from December 2021 to December 2022. Isolates were identified and tested for antibiotic susceptibility following standard microbiological guidelines. Result The antimicrobial resistance of 200 P. aeruginosa isolates increased from low to high levels, as per the recommended anti-pseudomonal antibiotics by the Clinical and Laboratory Standards Institute (CLSI), from 0% to 94%. piperacillin/tazobactam exhibited significantly lower resistance at 18(9%) and while considerably higher resistance was observed with ceftazidime at 188(94%) compared to different antibiotics, followed by amikacin 34(17%), imipenem 58(29%), ciprofloxacin 42(21%), aztreonam 51(25.5%), and fosfomycin 44(22%). No resistance was observed to colistin and polymyxin B. P. aeruginosa resistant to carbapenem was accounted for 33.5% of the total, and multidrug resistance categories included multidrug resistance (MDR) at 39.0%, extensively drug resistance (XDR) at 13.5%, and P. aeruginosa difficult-to-treat (DTR PA) at 4.6%. Conclusion Most of the isolates were resistant to anti-pseudomonal antibiotics; however, colistin, polymyxin B, amikacin, doripenem, piperacillin/tazobactam, and fosfomycin were effective against MDR P. aeruginosa. Regular surveillance measures are essential to manage antimicrobial resistance. KEY WORDS Antimicrobial resistance, Difficult-to-treat Pseudomonas aeruginosa, Extensively drug resistance, Multidrug resistancePublication Association of Breast Cancer and Dyslipidemia in Nepali Women(Kathmandu University, 2025) Karki, OB; Timilsina, B; Ghimire, P; Pokharel, DABSTRACT Background Breast cancer, which is a multi-factorial disease is one of the primary causes of cancer-related mortality in women. The association of serum lipids with breast cancer is being debated. Objective To examine any possible association between fasting lipid profile and breast cancer in Nepali women. Method A case-control study was conducted among 36 breast cancer patients, 40 patients with benign breast lump and 38 apparently healthy control women from February 2022 to December 2024. Ethical clearance was obtained from institutional review committee (MEMG/IRC/500/GA) prior to study. A convenient sampling technique was used. Data entry and analysis were done using SPSS version 20. Chi-square tests and analysis of variance (ANOVA) were used for statistical comparisons of categorical and continuous data respectively. P-value of <0.05 was considered statistically significant. Result Of the 114 participants included in this study, 36 were malignant breast cancer patients, 40 were benign breast lump patients and 38 controls with the mean ages of 52.75 ± 10.39, 48.45 ± 12.78 and 45.80 ± 10.14 years respectively. The prevalence of dyslipidemia was 75%, 25% and 26.31%, among malignant breast cancer patients, benign breast lump patients and control group respectively with the mean value of triglyceride (160.01 ± 78.34, 111.75 ± 60.40 and 97.99 ± 31.34) respectively and the difference was statistically significantly (p < 0.001). In addition, the mean serum concentrations of total cholesterol were significantly different between the three groups (1588.36 ± 39.95, 132.09 ± 39.95 and 138.31 ± 45.34, p=0.020). Conclusion The overall prevalence of dyslipidemia was high in breast cancer patients in comparison to patients with benign breast lump or normal controls. KEY WORDS Breast neoplasms, Dyslipidemias, LipidsPublication Characterization of Seasonal Influenza Virus Type and Subtypes Isolated from Influenza Like Illness Cases of 2012(Kathmandu University, 2017) Upadhyay, BP; Ghimire, P; Tashiro, M; Banjara, MRABSTRACT Background Seasonal influenza is one of the increasing public health burdens in Nepal. Objective The objective of this study was to isolate and characterize the influenza virus type and subtypes of Nepal. Method A total of 1536 throat swab specimens were collected from January to December 2012. Total ribonucleic acid was extracted using Qiagen viral nucleic acid extraction kit and polymerase chain reaction assay was performed following the US; CDC Real- time PCR protocol. Ten percent of positive specimens were inoculated onto Madin- Darby Canine Kidney cells. Isolates were characterized by using reference ferret antisera. Result Of the total specimens (n=1536), influenza virus type A was detected in 196 (22%) cases; of which 194 (99%) were influenza A (H1N1) pdm09 and 2 (1 %) were influenza A/H3 subtype. Influenza B was detected in 684 (76.9%) cases. Influenza A (H1N1) pdm09, A/H3 and influenza B virus were antigenically similar to the recommended influenza virus vaccine candidate of the year 2012. Although sporadic cases of influenza were observed throughout the year, peak was observed during July to November. Conclusion Similar to other tropical countries, A (H1N1) pdm09, A/H3 and influenza B viruses were co-circulated in Nepal. KEY WORDS A (H1N1) Pdm09, influenza, real time PCRPublication Correlation between Femoral Intercondylar Notch Width and Anterior Cruciate and Posterior Cruciate Ligament Widths on MRI of Knee Joint(Kathmandu University, 2023) Ghimire, P; Kayastha, P; Suwal, S; Katwal, S; Dhakal, P; Lamichhane, S; Lohani, BABSTRACT Background Anatomic variations have been implicated as one of the intrinsic causes of injuries to the cruciate ligaments which can induce a functional deficiency to the knee. Narrow cruciate ligament widths as well as narrow femoral intercondylar notch widths can increase the risk of these ligaments rupturing. Objective To correlate the width of the femoral intercondylar notch (ICN) with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) widths on MRI of the knee joint. Method A total of 46 patients who met the inclusion criteria were evaluated. Intercondylar notch was identified on coronal T1W images while anterior cruciate ligament and posterior cruciate ligament were identified on proton density coronal images. All the widths were measured in the same plane at a mid-coronal level where anterior cruciate ligament and posterior cruciate ligament cross each other. Result Our result showed a significant correlation between the widths of intercondylar notch and anterior cruciate ligament (r = 0.68, p < 0.001) and between intercondylar notch width (INW) and posterior cruciate ligament width (r = 0.65, p < 0.001). Overall, the mean intercondylar notch width measured was 17.5 ±2.5 mm (range 11.8 to 21.8 mm), the mean anterior cruciate ligament width was 5.9 ±1.3 mm (range 3.3 to 8.6 mm), and the mean posterior cruciate ligament width was 8.9 ±1.5 mm (range 5.9 to 11.8 mm). A statistically significant difference was observed between males and females for mean widths of intercondylar notch (p < 0.001) and posterior cruciate ligament (p=0.01). However, no statistically significant difference was seen for anterior cruciate ligament width (p=0.07) between the two genders. Conclusion Measurement of the femoral intercondylar notch width can be used as an indicator of anterior cruciate ligament and posterior cruciate ligament widths which can further assist to identify the individuals who are more susceptible to cruciate ligament injuries. KEY WORDS Anterior cruciate ligament, Cruciate ligament injury, Intercondylar notch width, MRI, posterior cruciate ligamentPublication Drug resistant pulmonary tuberculosis among patients visiting national tuberculosis center, Kathmandu(Nepal Health Research Council, 2005) Bam, D S; Ghimire, P; Rijal, K R; Rijal, BPublication Enteric Parasitosis in Patients with Human Immunodeficiency Virus (HIV) Infection and Acquired Immunodeficiency Syndrome (AIDS) in Nepal(Nepal Health Research Council, 2004) Manandhar, S; Sapkota, D; Ghimire, PPublication Epidemiology of malaria in two Eastern districts of Nepal(Kathmandu University, 2010) Parajuli, K; Ghimire, PAbstract Backgrounds: Malaria is one of the major public health problems in Southeast Asia including Nepal having relatively high burden of malaria. Jhapa and Morang districts are malaria endemic plain area of South-eastern part of Nepal Objectives: The evaluate the recent epidemiology of malaria situation in Jhapa and Morang districts, which are the districts in eastern Nepal with high transmission of malaria and to assess the knowledge, attitudes and practices of the people in prevention and treatment for malaria infection. Materials and methods: This descriptive cross-sectional study was carried out with volunteer participation of suspected malaria patients seeking care at the government of Nepal managed primary health care centres located in 2 malaria endemic districts in eastern Nepal. Conventional Giemsa stained thick and thin blood smears prepared from finger prick blood were examined following standard protocols. Suspected patients’ / attendants’ knowledge on malaria, disease symptoms, prevention and control measures were assessed using a structured questionnaire. Chi square and Fisher exact test were used for statistical analysis of the data. Results: Among the total 199 malaria suspected cases studied, 32 (16.1%) cases were confirmed by microscopic findings; where, P. vivax was 12.6% (25/199) and P. falciparum in only 3.1% (6/199). The highest numbers of cases were in age group 20-29 years. Among the total positive cases 75% were male and 37.5% were labourers in occupation. Among the total cases, 32 had provided the history of recent travel to malaria endemic area in India, among them 43.8% (P<0.001) were found to be infected with the malarial parasites (P<0.001). Among the total cases, 69.7% showed some knowledge of malaria, among which fever was the most common symptom mentioned by 68.3%. Occupation (P<0.001) and education (P<0.001) were found significantly associated with the knowledge on mode of transmission. Conclusion: Jhapa district showed higher SPR than Morang, which indicated that Jhapa may be more malaria affected than Morang. Knowledge on malaria transmission and preventive measures are still lacking in deep villages, in spite of different efforts of the government. To improve the malaria morbidity in the districts, health education of the most marginalized people through audio visual methods may be beneficial. Key words: Epidemiology, Malaria, Knowledge, Practice, Eastern NepalPublication Evaluation of Hamular Notch-Incisive Papilla Plane as a Useful Reference in Establishing the Occlusal Plane(Kathmandu University, 2024) Ghimire, P; Singh, RK; Suwal, P; Rijal, AH; Basnet, BBABSTRACT Background Establishment of occlusal plane with hamular notch- incisive papilla plane as a useful reference helps to reduce the chairside time taken for jaw relation during complete denture fabrication. Objective To determine the hamular notch-incisive papilla plane (HIP) as a useful reference plane in establishing the occlusal plane. Method This cross-sectional analytical study was conducted among 100 dental students by obtaining the maxillary cast from an impression made. The data collected were entered and analyzed using SPSS version 21. Paired t-test, Independent t-test and Pearson correlation was applied for statistical analysis. Result The vertical distance from hamular notch-incisive papilla plane and occlusal plane at the level of mesio-incisal line angle of maxillary central incisor and mesio-palatal cusp tips of maxillary first molar showed statistically significant difference (p < 0.001) on both right and left sides. There was statistically significant difference (p < 0.05) between hamular notch-incisive papilla plane and occlusal plane on right and left sides, between right and left mesio-palatal cusp tips of maxillary central incisors from hamular notch-incisive papilla plane. Hamular notch-incisive papilla plane, mesio- incisal line angle of right maxillary central incisor and mesio-incisal line angle of left maxillary central incisor had mild but significant correlation with age. The parallelism between hamular notch-incisive papilla plane and occlusal plane within the range of 2 mm was 62% on right side and 75% on left side. Conclusion Hamular notch-incisive papilla plane can be used as a practical method for establishing the occlusal plane tentatively. KEY WORDS Hamular notch-incisive papilla plane, Occlusal plane, SurveyingPublication Gene Xpert based detection of drug resistant tuberculosis among retreatment patients visiting National Tuberculosis Centre, Nepal(Institute of Medicine, 2017) Khadka, DK; Bam, DS; Ghimire, P; Singh, AAbstract Introduction: Tuberculosis is still one of the major public health problems in Nepal and multi drug resistant and extensively drug resistant tuberculosis (MDR /XDRTB) additionally has become serious issue. Prompt diagnosis and effective treatment of MDR/XDRTB is urgently needed. The main objective of this study was to detect MDR TB using novel molecular techniques (rpob gene mutations) in reference with drug susceptibility test (DST). Methods: A cross sectional study was carried out identifying MDRTB among retreatment patients using Gene Xpert, culture and DST on first line drugs (FLD-DST). A total of 159 sputum samples were collected from retreatment TB patients (Female 40.3%, Male 59.7%) with median age of 30 years visiting to the DR TB treatment centres of eastern and central Nepal (via private courier and directly to National TB Reference Laboratory (NRL) at NTC from April 2013 to August 2017. Results:M. tuberculosis and rifampicin resistance were detected on all 159 (100%) samples by Gene Xpert of which, 73.3%, 21.4% and 6.3% were positive, negative and contaminated respectively by culture. FLD-DST was performed on 115 cultures positives of which, 94.78% showed MDRTB, 1.74% showed mono resistance to isoniazid or rifampicin, 0.87% to streptomycin and isoniazid and 3.47% were pan susceptible. Conclusion: One hundred fifteen of 159 cases detected rifampicin resistances (RR) by Gene Xpert were culture positive and almost 95% strains were MDRTB by FLD-DST, which was found to be higher in 15-60 years group. Sputa from retreatment TB patients required to be tested by rapid diagnostics with reference to culture and DST. Key words:Gene Xpert, Culture, Drug Susceptibility Test, Multi Drug Resistant Tuberculosis, SputaPublication Health Related Quality of Life (HRQOL) assessment using St. George's Respiratory Questionaire in patients with stable Chronic Obstructive Pulmonary Disease(Institute of Medicine, 2017) Das, SK; Bam, N; Ghimire, PAbstract Introduction: Despite being a major cause of chronic morbidity and mortality throughout the world and its relentlessly increasing incidence, Chronic Obstructive Pulmonary Disease (COPD) is an often neglected major public health problem in developing countries like Nepal. Though the health expenditure for management of COPD is gradually increasing, little attention has been given to the Quality of Life (QOL), which should be the main target for management of any chronic diseases. This study assesses the Health Related Quality of Life (HRQOL) of stable COPD patients. Methods: A descriptive observational cross-sectional study of 81 stable COPD patients (who were on regular medication for at least 3 months) was conducted in Respiratory out Patient department of Tribhuvan University Teaching Hospital (TUTH). All the subjects were assessed for their HRQOL using the St. George's Respiratory Questionnaire for COPD (SGRQ-C). Socio- demographic data regarding the patients were also recorded. Data entry and statistical analysis were performed using the SPSS software, version 18.0. Results: The mean age of COPD patients was 67 years. Out of the total 81 study cases, 46(56,8%) were female and 67(82.7%) were either current or past smokers, Patients with COPD showed significantly reduced bealth related quality of life (HRQOL) in all domains. Smoking status and baseline hypoxia showed a highly significant association with HROOL, Age, education status, occupation and gender did not affect the QOL scores in a statistically significant manner. Adding methylxanthine to the standard combination inhaler therapy did not show any significant different in term of HRQOL. Conclusion: This study showed that Nepalese COPD patients had reduced HRQOL Smoking and baseline hypoxia had significant negative impact on HRQOL. Keywords: Chronic obstructive pulmonary diseasePublication Hereditary Spherocytosis with Splenomegaly and Cholelithiasis in a Young Male of Western Region of Nepal - A Case Report(Kathmandu University, 2015) Ghimire, P; Gurung, NV; Shrestha, S; Gurung, A; Poudel, SR; Chapagain, AABSTRACT Hereditary spherocytosis is an autosomal dominant congenital hemolytic anemia due to defect in RBC membrane protein that commonly presents with intermittent jaundice, anemia, abdominal pain, splenomegaly and sometimes cholelithiasis. Due to the membrane defect, there is increased fragility, hemolytic anemia, marked splenomegaly and hyperbilirubinemia. This is a report of an 11 years old male diagnosed case of hereditary spherocytosis who presented with jaundice, splenomegaly and cholelithiasis. He underwent elective open splenectomy and cholecystectomy after prophylactic immunization for capsulated organisms and was advised lifelong oral penicillin prophylaxis post-splenectomy. KEY WORDS Cholelithiasis, hemolytic anemia, prophylaxis, splenectomy, splenomegalyPublication HIV and Hepatitis B co-infection among volunteer blood donors(Nepal Health Research Council, 2006) Tiwari, B R; Ghimire, P; Thapa, D; Rajkarnikar, MPublication Incidence of incidental carcinoma gall bladder in cases of routine cholecystectomy(Kathmandu University, 2011) Ghimire, P; Yogi, N; Shrestha, BBABSTRACT Background Carcinoma of gall bladder is the most common malignancy of the billiary tract. Most of the cases are diagnosed as an incidental case among patients undergoing cholecystectomy. Objectives To establish the rate of incidental carcinoma of gall bladder in patients undergoing routine cholecystectomy to study the demographic profile and prognosis of these patients. Methods A retrospective study was carried out in Fishtail Hospital and Research Center, Pokhara during 1998-2009. The surgical notes, hospital records and histopathology reports of 783 patients undergoing routine cholecystectomy were studied. Results Out of 783 cases, gall bladder cancer was detected in 10(1.28%) of cases and was more common in females (M:F ratio 1:2.3) and the mean age of occurrence was 63.8 years. Most of the cases diagnosed were at their early stages and none of them were in T3 and T4 stages. Six of these patients have survived till a mean follow up duration of 23.7 months. Conclusion The rate of incidental carcinoma of gall bladder is 1.28%. KEY WORDS carcinoma gallbladder, cholecystectomy, incidentalPublication Intensified Case Finding of Active Pulmonary Tuberculosis (TB) Among HIV Positive Persons in Kathmandu(Nepal Health Research Council, 2007) Sharma, S; Rijal, B P; Dhungana, G P; Ghimire, PPublication Prescription Pattern Monitoring and Off-label Use of Medicines in the Pediatric Department at Tertiary Care Teaching Hospital(Kathmandu University, 2020) Pandey, S; Yadav, CK; Ghimire, P; Shrestha, ACABSTRACT Background Off-label use means the use, concerning dosage, indication, route of administration, or age, of pharmaceutical products which are beyond the terms of the product license. For regulatory bodies and physicians, the global challenge is to achieve optimum pediatric drug therapy. Objective This prospective observational work was carried out in the paediatric department to evaluate the prescribing pattern of medicines and to identify the use of off-label drugs. Method A cross-sectional study was carried in 200 paediatric patients of ages between 0 and 12 years at the paediatric outpatient department of Universal College of Medical Sciences, Bhairahawa. Data were collected by reviewing the prescription paper and the required information was recorded using a structured data collection sheet prepared for study. The prescribing pattern was assessed by using the World Health Organization (WHO) Prescription Indicators and off-label use was assessed using the WHO Children Formulary 2010. Result Among 413 total prescriptions, only 5.56% of drugs were found to be prescribed by generic name, 16.7% of prescriptions were found to be antibiotic and 57.62% of prescribed drugs were from essential drug list. Out of 413 prescribed drugs, 16.46% of drugs were found to be off-label. The maximum extent of off-label prescribing was 51.47% in the child, followed by infants (42.6%) and neonates (5.8%). Fexofenadine; antihistaminic (23.56%), Amoxicillin+clavulanic acid; antibiotic (22.06%) had higher off-label use. Off-label dose (71.8%) was the most common cause of off-label prescribing. Conclusion Off-label prescribing among pediatric patients is common.More eminence data on the safety and efficacy of off-label medicines must be generated to rationalize paediatric pharmacotherapy. KEY WORDS Child, Neonates, Off-label drug use, Pediatric, Prescription pattern monitoring studies (PPMS)Publication Prevalence of HIV in blood donors(Nepal Health Research Council, 2008) Rajkarnikar, M; Tiwari, B R; Karki, S; Ghimire, P; Yadav, PPublication Prevalence of Intestinal Parasitosis Infection in Malnutrition among Children in Rural Community of Sarlahi, Nepal(Nepal Health Research Council, 2004) B C, R K; Malla, B; Sherchand, J B; Ghimire, P; Gauchan, PPublication Prevalence of Methicillin Resistant Staphylococcus aureus (MRSA) in Children Visiting Kanti Children's Hospital(Nepal Health Research Council, 2008) Thapa, S; Pant, D K; Ghimire, P; Thapa, P BPublication Restriction Fragment Length Polymorphism (RFLP) typing of Mycobacterium tuberculosis isolates from Nepal(Institute of Medicine, 2017) Rijal, B; Ghimire, PAbstract Introduction: Many studies to characterize Mycobacterium tuberculosis by RFLP have shown that predominance of Beijing genotype in China and many neighboring countries. Nepal is just bordering in southern part of China. We have tried to differentiate Mycobacterium tuberculosis isolates of Nepal by RFLP in first time in Nepal. Methods: A standard protocol was followed for isolation, Identification and RFLP typing of 60 strains of Mycobacterium tuberculosis of Nepal. Results: Of the 60 isolates interpretable result was found in 31 isolates. The study detected that the Beijing family 12 (38.7%), was predominant type followed by single band 12 (25.5%). Indigenous type, not reported from other part of the world was also detected in 7 strains (22.6%). Conclusion: Beijing type is the predominant RFLP type of Mycobacterium tuberculosis in Nepal and some other endogenous type also prevails which needs further study. Keywords: Mycobacterium tuberculosis, RFLP, Nepal