Browsing by Author "Joshi, Pramod"
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Publication Advancing Health and Population Research and Innovations for Achieving Sustainable Development Goals in Nepal(Nepal Health Research Council, 2024) Dhimal, Meghnath; Joshi, PramodNAPublication Anterior Cruciate Ligament Reconstruction with Semitendinosus Tendon Autograft among Paramilitary Patients Undergoing Arthroscopic Surgery in a Tertiary Care Centre(Nepal Medical Association, 2024) Shrestha, Sailendra Kumar Duwal; Nepal, Prabin; Karki, Umash; Karki, Netra; KC, Samir; Tamrakar, Rojan; Shrestha, Kumar; Joshi, PramodAbstract Introduction: In orthopaedic practice, injuries to the anterior cruciate ligaments occur almost on an epidemic scale, yet it continues to be of interest in orthopaedic surgery whether semitendinosus or gracilis hamstring autografts can be used for better anterior cruciate ligament reconstruction. This study aimed to determine the prevalence of anterior cruciate ligament reconstruction using semitendinosus tendon autografts among paramilitary patients undergoing arthroscopic surgery in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among paramilitary individuals who had knee injuries and were admitted between 6 february 2020 and 26 January 2022 for arthroscopic surgery after obtaining ethical approval from the Institutional Review Committee. Demographic details and the mode of injury were obtained from the patients. The treating orthopaedic surgeons evaluated the pre- and post-analysis Lysholm Knee Score and Lysholm Knee Scale based on the patient's response. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 166 patients, anterior cruciate ligament reconstruction using a semitendinosus tendon autograft was done in 58 (34.94%) (27.69-42.19, 95% Confidence Interval). Most of the patients in the pre-analysis had mild/periodic limp issues 52 (89.66%), followed by instability during athletics or other severe exertion 43 (74.14%). Conclusions: The prevalence of anterior cruciate ligament injuries in our study is higher than other studies done in similar settings.Publication Biofilm-Associated Multidrug-Resistant and Methicillin-Resistant Staphylococcus aureus Infections(Nepal Health Research Council, 2024) Shrestha, Shila; Basnet, Ajaya; Maharjan, Rajendra; Basnet, Bijaya; Joshi, PramodBackground: The ability of Staphylococcus aureus to form biofilms—architectural complexes that cause chronic and recalcitrant infections—along with its notorious variant, methicillin-resistant Staphylococcus aureus (MRSA), leads to multidrug-resistant (MDR) infections that are challenging to treat with antibiotics. This cross-sectional study investigated the prevalence of S. aureus infections in Kanti Children’s Hospital and characterized the antibiograms of MDR, MRSA, and biofilm-forming strains, along with their coexistence. Methods: S. aureus strains were isolated and identified from clinical samples and tested for antibiograms following standard microbiology guidelines. MDR strains were non-susceptible to at least one agent in three antimicrobial categories, whereas MRSA strains were cefoxitin-resistant. The microtiter plate method was used to detect biofilms. Statistical analyses were performed using SPSS version 17.0. Results: S. aureus was detected in 9.0% (11.4-6.6%, 95% Confidence Interval) of 543 samples, primarily from pus (79.6%, 39/49). Children aged 1 to <3 years most commonly contracted infections (30.6%, 15/49), and males (67.4%, 33/49) had twice as many infections as females (32.7%, 16/49). As high as 84.7% (83/98) of strains were penicillin-resistant, while 18.4% (27/147) were aminoglycoside-resistant. MDR accounted for 79.6% (39/49) of all S. aureus infections, while MRSA and biofilm-formers accounted for 67.6% (33/49) and 24.5% (12/49), respectively. Fluoroquinolone resistance in non-MDR-MRSA-biofilm-formers, MDR-MRSA, MDR-biofilm-formers, and MRSA-biofilm-formers was 31.3%, 46.8%, 58.3%, and 60.0%, respectively, while aminoglycoside resistance was 0%, 32.3%, 50.0%, and 45.0%, and penicillin resistance was 87.5%, 85.5%, 100.0%, and 100.0%. Conclusions: MDR-isolates and MRSA caused nearly four-fifths of S. aureus infections. Compared to MDR and MRSA strains, biofilm-formers triggered higher levels of antimicrobial resistance. Keywords: Antibiotics; biofilms; children; resistance; staphylococcus aureus.Publication Capacity Building at Nepal Health Research Council for Ethical Research(Nepal Health Research Council, 2024) Adhikari, Ramesh Kant; Ghimire, Namita; Joshi, PramodNAPublication Compliance with the Legal Provision of Tobacco Products in Nepal Authors(Nepal Health Research Council, 2024) Dhimal, Meghnath; Khatri, Bishal Dahal; Basnet, Man Bahadur; Ghimire, Sailaja; Ghimire, Namita; Acharya, Astha; Rana, Nisha; Joshi, PramodBackground: The tobacco epidemic is one of the major threats to public health, causing nearly 8 million deaths annually worldwide. In Nepal, every year, several Nepalese people die from tobacco-related diseases illnesses. Despite the implementation of several policies and strategies, tobacco use remains prevalent. This study, thus, aims to assess compliance with the legal provisions regulating tobacco products in Kathmandu Valley. Methods: A multimethod study design was adopted to explore compliance with the legal provision of tobacco products in the Kathmandu Valley. Three hundred and five public places within the Kathmandu Valley were observed using the observation checklist, and fourteen key informant interviews were conducted. The ethical approval was obtained from the Ethical Review Board of the Nepal Health Research Council. Results: Our findings show that the average adherence to the Tobacco Product Control Act in the Kathmandu Valley was merely 33.1%. Public transportation exhibited highest compliance 53.2%, whereas eateries demonstrated the lowest compliance at 15.9%. Health organizations demonstrated the highest adherence to prohibiting indoor smoking (94.7%), although the presence of “No Smoking” signage was inadequate, varying from 1.9% to 22.7% across various locations. Conclusions: In conclusion, compliance with the legal provision of tobacco products was observed owing to limited knowledge of stakeholders, inadequate multi-sectoral coordination, and lack of monitoring mechanisms in public areas. Whereas awareness initiatives through diverse communication channels are found effective in improving compliance. Keywords: Compliance; legal provision; Nepal; public places; tobacco products.Publication Dengue among Patients Visiting Department of Medicine in a Secondary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2023) Tamang, Basanta; Basnet, Ajaya; Khadka, Sudip; Joshi, Pramod; Jha, Roshan Kumar; Joshi, Rijuta; Rai, Shiba KumarAbstract Introduction: Dengue, caused by the dengue virus, has a wide range of clinical features, including fever, body ache, lethargy, nausea, and vomiting. Blood-based biomarkers in patients with dengue virus infection reflect a variety of clinical spectrums, from bleeding manifestations to liver abnormalities, and can serve as an essential tool for clinicians. This study aimed to determine the prevalence of dengue among patients visiting the Outpatient Department in a secondary care centre. Methods: A descriptive cross-sectional study was conducted among patients visiting the Outpatient Department from 16 May 2022 to 15 November 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 20790202). The socio-demographic details and biochemical and haematological findings of dengue virus-infected patients diagnosed with rapid diagnostic tests were collected. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Out of 706 individuals, the prevalence of dengue was 83 (11.76%) (9.38-14.14, 95% Confidence Interval). The median age of dengue virus-infected patients was 40 years, and the majority were males 54 (65.06%). Conclusions: The prevalence of dengue was found to be lower than in other studies done in similar settings.Publication Driving Under the Influence of Alcohol among Road Traffic Accident Patients Presenting to a Tertiary Care Centre(Nepal Medical Association, 2023) Joshi, Pramod; Karmacharya, Mahesh; Shrestha, Sailendra Kumar DuwalAbstract Introduction: Driving under the influence is one of the most significant risk factors for road traffic accidents, leading to severe and multiple orthopaedic injuries. The aim of this study was to find out the prevalence of driving under the influence of alcohol among road traffic accident patients presenting to a tertiary care centre. Methods: A descriptive cross-sectional study was conducted on patients involved in road traffic accidents presenting to a tertiary care centre. Data from 10 January 2020 to 9 December 2021 were collected between 22 July 2023 to 22 August 2023 from the hospital records after receiving ethical approval from the Institutional Review Committee. Patients who had road traffic accidents and were diagnosed with fractures were included in the study. Patients with incomplete hospital records were excluded from the study. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 2,519 patients, 307 (12.19%) (10.91-13.47, 95% Confidence Interval) were driving under the influence of alcohol when involved in a road traffic accident. Out of 307 patients, 305 (99.35%) accidents involved two-wheelers. A total of 118 (38.44%) patients suffered soft tissue injuries, while 47 (15.31%) sustained head injuries, and 28 (9.12%) sustained facial injuries. Conclusions: The prevalence of driving under the influence of alcohol among road traffic accident patients presenting to a tertiary care centre was similar to other studies done in similar settings.Publication Ensuring Integrity in Orthopaedic Research: Addressing Unethical Practices and Promoting Ethical Standards(Nepal Health Research Council, 2025) Vaishya, Raju; Bhadani, Janki Sharan; Vaish, Abhishek; Joshi, PramodThis review discusses the prevalence of these unethical behaviours, their far-reaching consequences on patient care, and the Orthopaedic field’s credibility. It highlights the need for effective strategies to promote ethical standards, emphasizing the importance of awareness among researchers and clinicians. The article outlines specific unethical practices, including data manipulation, which distorts treatment efficacy, and plagiarism, which diminishes originality and wastes peer review resources. Additionally, it addresses biased reporting and conflicts of interest, which can compromise objectivity in research findings. The review advocates for collaborative efforts among institutions and journals to foster accountability and transparency, ultimately encouraging a culture of ethical conduct within the Orthopaedic community. By ensuring rigorous standards and practices, the future of Orthopaedic research can be aligned with patient safety and trust, propelling the field toward meaningful advancements in patient care and treatment outcomes. Keywords: Conflict of interest; data fabrication; ethics; plagiarism; research; research Integrity.Publication Ethical Approval in Nepal: Barriers or Facilitators?(Nepal Health Research Council, 2024) Ghimire, Namita; Pandey, Sony; Joshi, Pramod; Adhikari, Ramesh KantAny research involving human participants requires review and approval from an authorized research ethics committee to safeguard participant's rights, dignity and welfare while ensuring the scientific validity of the research. Ethical approval is mandatory before initiating or ecruiting study participants. It is also a prerequisite for publishing research findings in scientific journals contributing to ensuring the quality of scientific knowledge. The ethical review process focuses on the assessment of potential risks to the participants as well as the research team focusing on how such risks are identified, minimized and managed. This paper provides an overview of the Nepal Health Research Council's ethical review and approval process for both national and international researchers intending to conduct health research in Nepal. Despite this, the Nepalese ethics committee and researcher face several challenges, including limited awareness of responsible conduct of research, limited training opportunities, unclear clinical trial guidelines, bureaucratic hurdles, and frequent staff turnover in research governance. This paper highlights these challenges and aims to support both researchers and the Ethics Committee in promoting the responsible conduct of health research in Nepal. Keywords: Ethical issues; ethical review and approval; Nepal and research.Publication Mapping the Health and Medical Research Excellence in Nepal: A Study of High-Cited Papers During 1994-2023(Nepal Health Research Council, 2024) Vaishya, Raju; Gupta, Brij Mohan; Mamdapur, Ghouse Modin Nabeesab; K.S., Ali; Vaish, Abhishek; Joshi, Pramod; Hamal, Pawan KumarBackground: A bibliometric analysis was performed to map the current status and development trends in medical research in Nepal. It aims to visualize research hotspots within this field and provide effective guidance for future research directions. Methods: A systematic search of the Scopus database was performed to identify high-cited papers (HCPs) on medical research in Nepal between January 1, 1994, and December 31, 2023. Bibliometrics techniques were applied to analyze the publication dates, countries, institutions, journals, authors, and research hotspots. Statistical analysis and visualization were carried output by MS-Excel and VOSviewer software. Results: A total of 326 HCPs were identified that have received 100 to 10719 citations and registered 223.05 Citations Per Paper (CPP). The 47.54% and 95.40% share of the 326 HCPs have received external funding support and are involved in international collaboration, respectively. The 15892 (417 from Nepal) authors, affiliated to 12830 (177 from Nepal) organizations and published in 138 journals participated in 326 HCPs from Nepal. USA (60.45% share) and India. (51.45% share) were the most collaborative countries, while Spain (1609.15 CPP) and Mexico (1597.08 CPP) made the largest citation impact in collaboration with Nepal. C.L. Ranabhat (n=27) and B. Sathian (n=26) were the most productive authors, while D. Acharya (3652.29 and 16.5), and S. Bhattarai (2880.11 and 13.01) registered the highest citation impact (CPP and RCI). Tribhuvan University, Kathmandu (n=72) and Nepal Health Research Council, Kathmandu (n=34) were the most productive organizations, while Kathmandu University (3652.29 and 16.5) and Nepal Academy of Science and Technology, Lalitpur (2941.67 and 13.29) registered the highest citation impact (CPP and RCI). The Lancet (n=75) and British Medical Journal (n=11) were the most productive journals, while The Lancet Neurology (1749.5 CPP), and The Lancet (1371.13 CPP) registered the highest average citations impact. B. Basnyat has the most citation as first author in health and medical research. Conclusions: The present study offers an overview of research characteristics and trends of medical research output in Nepal. It identifies main contributors, core journals, and significant subject topics. The study hopes to assist researchers and practitioners in comprehending the development and trends of medical research in Nepal and discovering potential directions for future research. Keywords: Bibliometric methods; citations; collaboration; high-cited papers; medical research.Publication Orthopaedic Fractures among Patients Attending a Tertiary Care Centre(Nepal Medical Association, 2023) Joshi, Pramod; Karmacharya, Mahesh; Shrestha, Sailendra Kumar DuwalAbstract Introduction: Orthopedic fractures caused by chronic metabolic bone disease, overuse, or road traffic accidents are among the most significant burdens on society. Furthermore, a growing number of people undergoing arthroplasty and an increase in life expectancy seem to contribute to an increase in orthopaedic fractures. However, research on orthopaedic fracture prevalence or types has been scarce in low- and middle-income countries, including Nepal. The objective of this study was to find out the prevalence of orthopaedic fractures among patients attending a tertiary care centre. Methods: A descriptive cross-sectional study among patients attending a tertiary care centre was conducted between 19 May and 18 November 2023 during which date from 1 January to 30 December 2021 were collected from the hospital records. Ethical approval was obtained from the Institutional Review Committee. A convenience sampling method was used. Point estimate was calculated at a 95% Confidence Interval. Results: Among 7609 people, 2518 (33.09%) (12.97–10.55, 95% Confidence Interval) had orthopaedic fractures. A total of 1925 (76.45%) were males. There were 339 (95.49%) fractures associated with two-wheelers and 307 (86.48%) with four-wheelers. There were 1387 (55.08%) soft tissue injuries, 198 (7.86%) skull injuries, and 116 (4.61%) facial injuries. Additionally, there were 73 (2.90%) fractures of the femur, 71 (2.82%) fractures of the phalanx, and 70 (2.78%) fractures of the clavicle. Conclusions: The prevalence of orthopaedic fractures was found to be higher than in other studies done in similar settings.