Browsing by Author "Kandel, Ramesh"
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Publication Advancing Research Excellence: Announcing the Establishment of the Journal of Rapti Academy of Health Sciences(Rapti Academy of Health Sciences (RAHS), 2024) Lamsal, Dinesh Kumar; Lamichhane, Basant; Bhandari, Hira Lal; Kandel, RameshAbstract: It is with great pleasure that we present the first edition of the Journal of Rapti Academy of Health Sciences (JRAHS). As members of the editorial board, we are committed to advancing the research activities at Rapti Academy of Health Sciences. As Mark Twain aptly stated, “The secret of making progress is to get started,” the publication of this inaugural edition of JRAHS marks a significant step forward in the realm of research and scientific writing at RAHS. This milestone is the culmination of various progressive endeavors, including the publication of numerous souvenirs, the establishment of an Institutional Review Committee (IRC), and a series of training sessions and workshops. Today, we are delighted to present the first edition of JRAHS as a testament to our collective efforts in promoting research at RAHS. As the institution continues its steady academic growth with the commencement of undergraduate programs (MBBS, BNS, BSc Nursing Programs) and postgraduate programs (MD/MS), we believe this initiative will greatly encourage all of you to engage in and explore more scientific work and research. While we must always stay abreast of evidence-based practices, our scientific writings and research papers will serve as exemplary models of effective practices in resource-limited settings like ours. In this issue, we have included valuable articles from various disciplines, ranging from original research papers to intriguing case reports. We extend our heartfelt gratitude to all authors, reviewers, and editorial staff who have dedicated their expertise to ensuring the high quality of this journal. Thank you for your contribution and readership of JRAHS. We look forward to your feedback and contributions in future editions.Publication Antimicrobial Resistance among Older Patients Attending Rapti Academy of Health Sciences: A Retrospective Study(Rapti Academy of Health Sciences (RAHS), 2025) Kandel, Ramesh; Pokhrel, Subrata; Sharma, DamodarAbstract: Introduction: Antimicrobial resistance (AMR) is an escalating global health concern, particularly in developing countries like Nepal. Older adults are disproportionately affected due to immunosenescence, frequent hospital admissions, and repeated antibiotic exposure. However, limited region-specific data exist on AMR patterns among older adults in Nepal. This study aims to evaluate the microbiological profile and antibiotic resistance patterns, including the prevalence of multidrug-resistant organisms (MDROs), in individuals aged 60 years and above in a tertiary care center in Lumbini Province. Methods: A retrospective descriptive analysis was conducted on 495 clinical culture samples obtained from patients aged ≥60 years over a one-year period. Data were retrieved from microbiology records and analyzed using SPSS version 16. Descriptive statistics were used to determine organism prevalence, sample sources, and resistance patterns. MDROs were defined as resistance to at least one antimicrobial in three or more drug classes. Results: The mean age of patients was 71.8 years(SD±8.0), with females comprising 77% of the sample. Urine was the most common specimen (94.3%). Escherichia coli(59.6%) was the predominant isolate, followed by Klebsiella spp.(8.9%) and Acinetobacter spp.(5.9%). MDROs accounted for 62% of isolates. E. coli and Klebsiella exhibited high resistance to penicillins(85–92%) and cephalosporins(70–77%). Acinetobacter demonstrated extensive resistance across multiple antibiotic classes. Conclusion: This study reveals a high burden of MDROs among older adults, highlighting the urgent need for targeted antimicrobial stewardship, infection control, and development of localized treatment protocols to combat AMR in this vulnerable population.Publication Challenges of Diagnosis and Treatment of ANCA Associated Vasculitis in COVID-19 Pandemic - A Case Report(Nepalese Respiratory Society, 2022) Sharma, Prayush; Sijapati, Milesh Jung; Gautam, Santosh; Kandel, Ramesh; Simkhada, Suman; Regmi, Sneha BandhuAbstract: As COVID-19 pandemic is spreading worldwide with high infectivity rates of various strains, it is also challenging our healthcare system with its respiratory complications, and limited availability of healthcare providers. On the other hand, a huge vaccination program against COVID-19 is being conducted throughout the world. This viral infection and vaccination program has also brought into account the controversies of some neurological and autoimmune complications. Although the exact mechanism of these complications is still unknown, some autoimmune mechanisms have been predicted. These complications may further challenge the management of this novel viral infection. One of the rare complications of COVID-19 infection and its vaccination is de novo development or flare of ANCA-associated vasculitis, which has also been found in many recent case reports.Publication Geriatric Syndromes in Older People Attending Geriatric Outpatient Department in a Tertiary Care Center in Western Nepal(Rapti Academy of Health Sciences (RAHS), 2024) Kandel, Ramesh; Gautam, Ajay Raj; Bhattarai, Bhawana; Lamichhane, BikashAbstract: Introduction: The aging population is rising globally, posing significant challenges to healthcare systems, particularly in low- and middle-income countries like Nepal. Geriatric syndromes, including falls, urinary incontinence, depression, and sensory impairments, are prevalent in older adults, often leading to reduced quality of life. However, limited research exists on the prevalence and interrelation of these syndromes in outpatient settings in Nepal. The study examined the prevalence and associated factors of geriatric syndromes among older adults attending a geriatric outpatient department (OPD) at a tertiary care hospital in western Nepal. Methods: A cross-sectional study was conducted among 160 systematically sampled individuals aged ≥60 years attending the Geriatric Medicine OPD at Rapti Academy of Health Sciences. Data were collected using semi-structured questionnaires and standardized tools, including the Geriatric Depression Scale and Mini-Cog test. Descriptive and inferential statistics were employed to analyze associations between geriatric syndromes and demographic and clinical variables. Results: The prevalence of geriatric syndromes, including falls (22.5%), urinary incontinence (31.9%), and sensory impairments (~40%), increased with age. Falls were significantly associated with morbidity, drug count, and the number of geriatric syndromes. Individuals aged ≥80 years were most vulnerable, with steeply increasing health challenges. Conclusion: Geriatric syndromes are highly prevalent among older adults in Nepal, emphasizing the need for integrated care models and targeted interventions, particularly for individuals aged ≥80 years. Findings underscore the importance of holistic approaches to improving geriatric health outcomes in Nepal’s healthcare system.Publication Unveiling the Volume and Outcomes of Upper Gastrointestinal Endoscopy at a Tertiary Care Center: A Descriptive Cross-Sectional Study(Rapti Academy of Health Sciences (RAHS), 2024) Menyangbo, Suryaman; Panthi, Janardan; Neupane, Ananda; Shahi, Dinesh; Kandel, RameshAbstract: Introduction: Endoscopy is a vital procedure for diagnosing and managing digestive diseases. The volume of upper gastrointestinal endoscopies performed at healthcare centers in Nepal is poorly documented. There is a knowledge gap regarding the volume of endoscopies performed, including whether they are overutilized or follow proper guidelines. With rising digestive disease cases in Nepal and global increases in digestive malignancies, endoscopies are crucial for accurate diagnosis and cancer detection. The aim of the study was to assess the volume of endoscopies performed and identify the spectrum of pathologies associated with these procedures. Methods: This descriptive, cross-sectional study was conducted at Rapti Academy of Health Sciences (RAHS) over a period of two years. After approval from the Institutional Review Committee of RAHS (IRC RAHS), data were collected using a structured proforma, which included variables such as age, gender, ethnicity, and visual endoscopic pathological findings. Patients under 14 years of age and those who were hospitalized were excluded from the study. Results: A total of 2,305 patients underwent upper gastrointestinal endoscopic procedures, with females comprising 68% (n=1,567). The mean age of participants was 43 years, with the majority (n=537; 23.30%) in the 30-39 age group. Gastritis was the primary finding in 1,243 (53.9%) participants, while 38 (1.64%) had significant suspicious malignant lesions. Conclusion: The volume of gastrointestinal endoscopies performed was higher compared to similar settings in other hospitals in Nepal. Gastritis was the most common finding, with a significant number of cases showing suspicious malignant lesions during endoscopy.