Browsing by Author "Joshi, Deepak Raj"
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Publication Analysis of Homocysteine Level in Patient with Acute Kidney Injury(Nepal Health Research Council, 2025) Aryal, Saroj Babu; Joshi, Deepak RajAbstract: Background: Homocysteine (Hcy) contributes to oxidative stress and renal injury by generating reactive oxygen species and reducing heme oxygenase-1 levels. Elevated Hcy (Hhcy) may worsen outcomes after acute renal failure(ARF), promoting fibrosis and progression to chronic kidney disease (CKD). This study investigates the association between Hcy levels and ARF in patients at Tribhuvan University Teaching Hospital. Methods: This study was an analytical cross sectional single center study that was carried out in Tribhuvan University Teaching Hospital. Specimens were processed as per the guidelines of Standard Operating Procedure (SOP) of Biochemistry laboratory of Tribhuvan University Teaching Hospital. Results: Participants had a mean age of 54.2 years. Mean homocysteine was (13.7±10.36) µmol/L and creatinine was (148.7±18.03) µmol/L. Homocysteine levels showed no significant association with age, sex, residence, or disease type. A weak but significant positive correlation was found between homocysteine and creatinine(r = 0.186, p = 0.029). Potassium correlated moderately with creatinine (r = 0.383, p< 0.001). Conclusions: Homocysteine levels showed no significant association with age, gender, residence, or comorbid conditions. A weak but significant correlation was observed between homocysteine and creatinine, suggesting a potential link with renal function.Publication Clinico-Histopathological Consistency in Dermatological Disorders in a Tertiary Care Hospital of Kathmandu(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2024) Shrestha, Akankshya; Gurung, Tsering Dolma; Joshi, Deepak Raj; Shrestha, Dwarika PrasadAbstract Introduction: A skin biopsy for histopathological examination is one of the most reliable investigations for confirming clinical diagnosis. When there is alignment of clinical and histopathological diagnosis, it demonstrates clinico-histopathological consistency. There is limited reported data on clinico-histopathological concordance in the context of Nepal. Objectives: To determine the consistency of clinical and histopathological diagnosis of dermatological disorders. Materials and Methods: A retrospective study was conducted on 551 patients who underwent skin biopsy at the Department of Dermatology and Venereology, Tribhuvan University Teaching Hospital, for a period of 1 year. Both inpatients and outpatients who had undergone a skin biopsy were included in the study. Demographic data, clinical and histopathological diagnoses were noted on a proforma sheet. Histopathological diagnoses, both definitive and descriptive, were deemed consistent when they aligned with the clinical diagnoses. Conversely, if either definitive or descriptive histopathological diagnoses were not concordant with the clinical diagnoses, they were categorized as inconsistent. Results: The mean age of patients was 41.42 (±18.42) years. The male to female ratio was 1:1.5. Out of 551 cases who underwent skin biopsy, clinico-histopathological consistency was found in 64.43% of cases (355), whereas clinico-histopathological inconsistency was present in 35.57% (196). The maximum concordance was present in eczematous disorders (58.06%), followed by immunobullous disorders (47.22%), and vasculitis (45.45%). Conclusion: The overall clinico-histopathological consistency was 64.43%. Both experienced dermatologists and pathologists need to assist each other in providing a better understanding of the diagnostic process. This study emphasizes need for this cooperation and will aid in evaluating clinico-histopathological consistency.Publication Dentoalveolar Heights in Skeletal Malocclusion: A Dual Plane Study(Institute of Medicine, Tribhuvan University, 2025) Yadav, Rajiv; Joshi, Deepak Raj; Yadav, Neelam; Yadav, AnilAbstract: Introduction Skeletal malocclusions are manifested in sagittal, vertical and transverse discrepancies. Aim of this study was to determine the relationship of dentoalveolar heights among skeletal malocclusion with different growth patterns. Methods In this cross-sectional study, traced cephalometric X-rays were grouped into skeletal Class I, Class II, Class III based on Steiner’s ANB angle and growth patterns based on Steiner’s SN-GoGn Angle and Tweeds FMA angle. A Total of 180 samples were proportionally divided in nine groups based on growth pattern and malocclusion classification. ANOVA was applied for data analysis using SPSS V21. Results Upper anterior dental height (UADH) showed significance differences in all three planes, (Class I: p=0.041, Class II: p=0.043, Class III: p=0.013), Lower anterior dental height (LADH) showed no statistically significant differences across any class of malocclusion (all p > 0.1). In UADH, Class I and III exhibited lower values in horizontal compared to normal, while Class I and II showed lower UADH in vertical compared to horizontal. For UPDH, Class III showed lower values in vertical compared to normal, whereas Class II and III showed lower UPDH in vertical compared to horizontal. In LPDH, a significant reduction was found in Class III individuals with vertical patterns compared to horizontal. Conclusion Significant differences were mainly observed between horizontal and vertical growth patterns in Class II and III. In class I, differences were notable between normal to horizontal and horizontal to vertical growth patterns.Publication Interrater Variability among Anaesthesiologists Using American Society of Anesthesiologists Physical Status Classification System(Nepal Health Research Council, 2023) Bhattarai, Amit Sharma; Bista, Navindra Raj; Basnet, Madindra Bahadur; Joshi, Deepak Raj; Shrestha, AnilAbstract Background: The American Society of Anaesthesiologists Physical Status classification is deployed by the anaesthesiologists worldwide to classify operative surgical patients. Many studies have found moderate degree of interrater variability among anaesthesiologists. The general objective of the study was to find out interrater variability among Nepalese anesthesiologists using this classification system in Nepal. The specific objectives of the study were to find out the correctness of assignment and inter-rater variability among anaesthesiologists based on their experience. Methods: Ten clinical cases were distributed among 130 registered anaesthesiologist practitioners of Nepal after validation with the experts. Respondents were asked to assign each of ten cases to a specific physical status class. Anaesthesiologists were classified to two classes based on clinical experience as having more or less than five years of experience. Results: We found substantial agreement among < 5 year’s (0.66) and > 5 year’s experience group (0.753) and among all raters (0.736). The mean score of the group with less than 5 years of experience was more. There was no significant difference between the mean score (p = 0.595). Overall mean score for the both groups was 5.66 with SD 1.66. There was no significant difference between the groups. Conclusions: The study shows that there is very less variation among registered practising anaesthesiologists of Nepal using American Society of Anesthesiologists Physical Status classification system. Keywords: ASA-PS; interrater; variability.Publication Knowledge and Attitude on Ethical Conduct of Clinical Research Among Nurses Working in the University Hospital of Nepal(Nepal Health Research Council, 2026) Singh, Shreejana; Joshi, Deepak Raj; Maharjan, Ajanta; Khatri, Pratima; Shahi, Bhibhooti; Chapagai, Manisha; Parajuli, Bimala; Sharma, Mohan RajAbstract: Background: Nurses are pivotal in primary healthcare and often serve as the first point of patient contact. Delivering evidence-based care is essential for ensuring high-quality services. Clinical research in hospital settings provides the evidence base that supports such care. This study aimed to assess nurses’ knowledge of clinical research ethics and their attitudes toward conducting research at a university hospital. Methods: A pretested semi-structured questionnaire, developed from literature and expert input, was used to collect data on demographics, research knowledge, and attitudes toward ethical conduct of clinical research among 279 nurses at the University Hospital. Ethical approval was obtained from the Institutional Review Committee, and data were analyzed using descriptive and inferential statistics (t-test and ANOVA) in SPSS version 26. Results: Most respondents were aged 26–30 years, held bachelor’s degrees, and lacked formal research training, though over half had prior research experience. Knowledge of clinical research, particularly ethics and trial procedures, was high, and attitudes were largely positive. Misconceptions persisted regarding vulnerable populations, the use of placebos, and blinding. Knowledge and attitude scores were significantly associated with education and research experience, while nearly all nurses acknowledged the necessity of clinical trials (98.9%) and ethical guidelines (93.5%). Conclusions: Nurses demonstrated strong knowledge of research ethics and positive attitudes toward clinical research, though gaps in specific ethical concepts highlight the need for enhanced formal training to strengthen their confidence and readiness for ethical research engagement. Keywords: Attitude; clinical research; ethics; knowledge; Nepal; nurses. Author Biography Manisha Chapagai , Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, NepalPublication Knowledge and Preventive Practices of Dengue Fever among Adolescents in a Terai District of Nepal: A Cross- Sectional Study(Perinatal Society of Nepal (PESON), 2024) Singh, Shreejana; Joshi, Deepak Raj; Yadav, Alisha; Lawot, Isabel; Sharma, Mohan RajAbstract Introduction Dengue fever spreads by mosquito bites. Preventive measures are the most effective way to decrease the incidence of dengue. This study aims to find out the knowledge and preventive practices of Dengue fever among adolescents in Nepal. Methods This descriptive cross-sectional study was conducted among 450 students studying in grades 9 and 10 of selected community and private schools in the Dhanusha district of Nepal. The total enumeration method was used with self-administered semi-structured questionnaires for data collections. Results Among 450 respondents, the mean age of the students was 16±1.72 years. Regarding awareness of dengue symptoms, (420)92.7% responded to restlessness, as the symptoms of dengue while only 84 (18.5%) attributed bleeding from the gums or nose to the disease. Regarding preventive practices, 424 (93.6%)) participants acknowledged the importance of covering the water tank, while 175 (38.6%) considered spraying insecticide as a useful preventive measure. Education alone is significantly associated with the levels of knowledge (p-value = 0.046) and preventive practice (p-value = 0.000). The correlation analysis between knowledge and practice scores revealed a weak positive correlation (r=0.20, p-value<0.001). Conclusion: The study revealed inadequate knowledge and insufficient preventive practices concerning the prevention of dengue fever among adolescents in Nepal.Publication Knowledge and Preventive Practices of Dengue Fever among Adolescents in a Terai District of Nepal: A Cross- Sectional Study(Perinatal Society of Nepal (PESON), 2024) Singh, Shreejana; Joshi, Deepak Raj; Yadav, Alisha; Lawot, Isabel; Sharma, Mohan RajAbstract: Introduction Dengue fever spreads by mosquito bites. Preventive measures are the most effective way to decrease the incidence of dengue. This study aims to find out the knowledge and preventive practices of Dengue fever among adolescents in Nepal. Methods This descriptive cross-sectional study was conducted among 450 students studying in grades 9 and 10 of selected community and private schools in the Dhanusha district of Nepal. The total enumeration method was used with self-administered semi-structured questionnaires for data collections. Results Among 450 respondents, the mean age of the students was 16±1.72 years. Regarding awareness of dengue symptoms, (420)92.7% responded to restlessness, as the symptoms of dengue while only 84 (18.5%) attributed bleeding from the gums or nose to the disease. Regarding preventive practices, 424 (93.6%)) participants acknowledged the importance of covering the water tank, while 175 (38.6%) considered spraying insecticide as a useful preventive measure. Education alone is significantly associated with the levels of knowledge (p-value = 0.046) and preventive practice (p-value = 0.000). The correlation analysis between knowledge and practice scores revealed a weak positive correlation (r=0.20, p-value<0.001). Conclusion: The study revealed inadequate knowledge and insufficient preventive practices concerning the prevention of dengue fever among adolescents in Nepal.Publication Knowledge, Attitude and Practice Regarding Menstrual Hygiene Among Girls of Government School(Nepal Paediatric Society (JNPS), 2022) Shahi, Bibhooti; Singh, Shreejana; Joshi, Deepak Raj; Maharjan, AjantaAbstract: Introduction: Menstruation is a natural phenomenon unique to women and menstrual hygiene is fundamental to the wellbeing of women and girls. Menstruation is the process of periodic discharge from the female genital tract due to hormonal influence and takes place within the interval of 28 days. The objective of the study was to find out knowledge, attitude and practice regarding menstrual hygiene among adolescent girls of the Government school. Methods: A descriptive study was carried out among 100 adolescent girls attending selected schools of Birgunj, Nepal using pretested self-administered questionnaires. Proportional Stratified Sampling was used. During data collection privacy and confidentiality was ensured. The data were analyzed using SPSS version 16 through descriptive statistical methods and inferential statistical methods. Results: This study revealed that majority of the girls (32%) have good knowledge, 93% have good attitude and 23% girls have good practice. There was significant association (p < 0.05) between the level of practice and age of menarche but there was no any significant association (p < 0.05) between level of knowledge and attitude with selected variables regarding menstrual hygiene. Conclusions: This study concludes that though the majority of the girls have, good attitude, many have poor knowledge and practice about menstrual hygiene.Publication Nutritional Status and Its Associated Factors among Under-Five Children in Bidur Municipality, Nuwakot District, Nepal: A Secondary Data Analysis(Central Department of Public Health, 2024) Pradhan, Pranil Man Singh; Pant, Smriti; Shrestha, Gambhir; Karki, Namrata; Mikrani, Tanweer Ahmad; Joshi, Deepak Raj; Shrestha, Sushan Man; Basel, Prem; Karki, Khem B.Abstract Background: Undernutrition among under-five children is a major public health problem in Nepal. The study's main objective was to assess the nutritional status and its associated factors among under-5 children of Bidur Municipality, Nuwakot district using secondary data analysis. Methods: We analyzed the data of 667 under-five children from 3183 households collected from the Community Health Diagnosis 2023 program database stored in the Kobo toolbox. Nutritional status indicators were measured by using the WHO classification. The chi-square test was applied to find out the association of nutritional status with independent variables such as maternal age at marriage, age at first child, antenatal, delivery, and post-natal care, exclusive breastfeeding, complementary feeding practices, and immunization status. Results: Nearly 32% (95%CI: 28.3-35.8) of the children were stunted, 12.1% (95%CI: 9.7-14.7) wasted, and 13.9% (95%CI: 11.4-16.6) were underweight. Early age at marriage, less than four ANC visits by the mother, history of substance use during pregnancy, and not exclusively breastfeeding were significantly associated with different forms of undernutrition. Conclusion: Promotion of exclusive breastfeeding and a higher number of ANC visits and discouraging early-age marriage and substance use during pregnancy are necessary to prevent undernutrition in under-five children. Keywords: Malnutrition, Nepal, under-five childrenPublication Perception and Willingness Regarding Organ Transplantation/donation among Medical Students of Maharajgunj Medical Campus: A Cross-sectional Study(Nepal Health Research Council, 2024) Bhattarai, Amit Sharma; Adhikari, Bidur; Joshi, Deepak Raj; Yadav, Alisha; Joshi, Pankaj; Parajuli, Bashu Dev; Koirala, Megha; Karki, Kushal Jung; Subedi, Krishna Prasad; Shrestha, Gentle Sunder; Shrestha, Anil; Singh, ShreejanaBackground: Organ transplant is the procedure of replacing a failing or damaged organ with a functioning one. Positive attitude and awareness about donation are a must for donor organs to be available. This study explored the level of knowledge, perception and willingness regarding organ donation among medical students in Nepal. Methods: A descriptive cross-sectional study was conducted with 180 medical students using a self-administered questionnaire. Descriptive statistics were used, and Pearson correlation was applied to examine the relationship between knowledge and perception of organ transplantation. Independent samples t-test and ANOVA was used to compare scores among year of study and gender. Results: Results indicated that 86.1% of participants were aware of the need for organ donation, and 83.3% knew that both living and deceased individuals could be donors. While 93.9% believed in the need for effective laws, 72.8% perceived risks for donors. However, only 74.4% were willing to donate their organs, though 91.7% expressed willingness to promote organ donation among friends and family. Participants showed a positive perception towards organ donation. Conclusions: Despite a high level of awareness and knowledge regarding organ donation, participants exhibited a lower level of willingness to donate organs. Perceived risks for donors and a lack of robust laws and regulations presented significant barriers. Nevertheless, an inclination to promote organ donation was observed. This underlines the need for enhanced education and policy reform to increase organ donation rates. Keywords: Awareness; knowledge; organ donation; organ transplantation; perception.Publication Why Traditional Statistical Methods Need to Evolve in the Age of Artificial Intelligence: A Biostatistical Perspective(Central Department of Public Health, 2025) Joshi, Deepak RajTraditional statistical methods, basically the frequentist approach, must evolve to remain relevant in the age of Artificial Intelligence (AI). While Conventional statistical methods work under theoretical assumptions, they struggle to handle the complexities of modern biomedical data, including high dimensionality, non-linearity, and violations of key assumptions However, this is not a problem for the newer machine learning models like support vector machines. There are new techniques like regularization (ridge, lasso) to handle many of the assumptions in traditional statistical methods, which can be implemented and automated using software like R and Python. Machine learning as a part of AI offers solutions by handling large-scale complex datasets, uncovering hidden patterns, and improving prediction power. They are based on the foundation models where statistics and mathematics meet. So, just talking about the limitations of the statistical methods is half true. The viewpoint tries to explain why to integrate AI with traditional biostatistics, creating hybrid models that combine statistical rigor with AI flexibility. Integration can enhance data analysis, causal inference, and decision-making, ultimately advancing personalized medicine and public health, ethically and transparently.