Browsing by Author "Pandey, A"
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Publication A Point Prevalence Study of the Use of Antibiotics in Six Tertiary Care Hospitals in the Kathmandu Valley, Nepal(Kathmandu University, 2022) Jha, N; Thapa, B; Pathak, SB; Pandey, A; Pokhrel, S; Shankar, PR; Bhandary, S; Mudvari, A; Dangal, GABSTRACT Background Point prevalence survey (PPS) on antibiotic use developed by the WHO has already been used in many hospitals globally. Objective To obtain information on antibiotic prescribtion using point prevalence survey methodology in six private hospitals in the Kathmandu valley. Method This descriptive cross-sectional study was completed during 20th July to 28th July 2021 using point prevalence survey methodology. The study was conducted among inpatients admitted at or before 8:00 AM on the day of survey in various wards. Data was presented as frequencies and percentages. Result Maximum number of patients were above 60 years [34 (18.7%)]. Number of male and female participants were equal [91 (50%)]. Only one antibiotic was used in 81 patients (44.5%) followed by two antibiotics in 71 (39%) patients. Duration of prophylactic antibiotic use was one day in 66 (63.7%) patients. Blood, urine, sputum, and wound swabs were the common samples for culture. Cultures were positive for 17 (24.7%) samples. The common organisms isolated were E. Coli, Pseudomonas aeruginosa and Klebsiella pneumoniae. Ceftriaxone was the most used antibiotic. Drug and therapeutics, infection control committee and pharmacovigilance activities were present in 3/6 (50%) study sites. Antimicrobial stewardship was present in 3/6 (50%) and microbiological services was present in all hospitals. Antibiotic formulary and antibiotic guideline were present in 4/6 sites and facilities to audit or review surgical antibiotic prophylaxis choice in 2/6 (33.3%) sites, facility to monitor antibiotic use in 4/6 (66.6%) and cumulative antibiotic susceptibility reports in 2/6 (33.3%) study sites. Conclusion Ceftriaxone was the most used antibiotic. E. Coli, Pseudomonas aeruginosa and Klebsiella pneumonia were the commonly isolated organisms. Not all parameters for infrastructure, policy and practice and monitoring and feedback were present at the study sites. KEY WORDS Antibiotics, Point prevalence survey, Private hospitals, Tertiary care centersPublication Acute Subperiosteal Hematoma of the Orbit with Visual Impairment: An Unconventional Presentation(Kathmandu University, 2016) Maithani, T; Singh, VP; Pandey, AABSTRACT Acute subperiosteal hematoma of orbit is a rare condition and its presentation with rapid severe diminution of vision is even rarest. Urgent intervention is required for these patients presenting with visual compromise. Needle aspiration is safe and simple procedure for management of such hematoma provided the patient presents early and does not have any associated complications. We present one such rare case highlighting the importance of timely diagnosis and urgent management to overcome functional complications in acute subperiosteal hematoma. To best of our knowledge this is the first pediatric case presenting with acute subperiosteal hematoma accompanied by severely diminished vision within few hours of trauma. KEY WORDS Needle aspiration, subperiosteal hematoma, visual acuityPublication Epidemiological Characteristics of the Spine Tumors in a Single Tertiary Centre of Nepal(Kathmandu University, 2025) Kayastha, SR; Pandey, A; Lamichhane, S; Thapa, J; Parajuli, B; Shrestha, DABSTRACT Background Spine tumors can be primary or secondary, depending on their origin. Metastasis compromises the majority of spine tumors. Primary tumors of the spine are rare and mostly asymptomatic; consequently, their real incidence cannot be investigated. Primary malignancies of the spine are even rarer. Most epidemiological data for spine tumors comes from registries in developed countries. Objective To provide epidemiological data on spine tumors in a single tertiary hospital in Nepal. Method This is a descriptive cross-sectional study done at the department of orthopaedics at Dhulikhel Hospital. The study was done using retrospective hospital records from January 2010 to December 2024. The data related to all the spine tumors admitted under the department of orthopedics during the study’s duration were included. Records without complete, relevant information were excluded. We took data from 135 patients admitted for spine tumors. The information related to the demography, site of tumors, types of tumors, and histological diagnosis was entered in Google Sheets and exported for descriptive analysis in Statistical Package for Social Sciences (SPSS) version 20. Result Among the 135 patients, the most common site of spine tumor was thoracic (42.22%). Primary benign neoplasms were the most common (n=68), and among the 61 malignancies, 36 were secondary and 25 were primary malignancies. Schwannomas were the most common benign tumors in the spine (n=23). The most common site for secondaries in the spine was the lungs (n=11). Conclusion This study’s results represent data on the epidemiology of spinal tumors from a single institute. Although this data is far too small to represent the whole country, in the absence of registries or other large multicentric databases, it can shed some light on the less studied spine tumors in Nepal. KEY WORDS Epidemiology, Metastasis, Spine tumorsPublication Feasibility, Safety and Acceptance of Buccal Mucosa Harvest Under Local Anesthesia for Substitution Urethroplasty: Prospective Observational Study in a Tertiary Centre(Kathmandu University, 2024) Pandey, A; Shrestha, PM; Shrestha, A; Basnet, RB; Adhikari, B; Shah, AK; Mishra, UABSTRACT Background Urethral stricture is a challenging condition with significant socioeconomic impacts, often requiring surgical intervention such as urethroplasty. Buccal mucosa grafts (BMG) are a popular choice for substitution urethroplasty due to their favorable outcomes. This study evaluates the feasibility, safety, and acceptance of harvesting buccal mucosa grafts under local anesthesia. Objective To assess feasibility, safety and acceptance of Buccal mucosa harvest under local anesthesia. Method A prospective observational hospital based study to evaluate outcomes of substitution urethroplasty using buccal mucosa grafts (BMG) under local anesthesia. Result Of the 40 patients, 28 had unilateral graft harvests, while 12 had bilateral procedures. The mean graft length obtained was 5.65 cm. Postoperatively, patients experienced a quick recovery, with full mouth opening achieved within an average of 2.78 days and resumption of normal eating within 2.6 days. Minor complications included oral swelling in 15% of cases and food residue in 12.5%. Although 87.5% of patients reported pain at the perineal wound site, the overall pain score averaged 3.58, indicating manageable discomfort. Importantly, 92.5% of patients expressed a willingness to undergo the procedure again if necessary. Conclusion These findings suggest that buccal mucosa graft harvest under local anesthesia is both feasible and well-tolerated. The procedure appears to be a safe alternative to regional or general anesthesia, with minimal complications and a high level of patient acceptance. Future randomized controlled trials comparing local anesthesia to regional or general anesthesia could provide additional insights and further validate these findings. This study contributes to the growing body of evidence supporting the use of local anesthesia in urethral stricture surgery, offering a practical approach to managing this condition effectively. KEY WORDS Buccal mucosa graft, Feasibility study, Local anesthesia, Substitution urethroplasty, Urethral stricturePublication Knowledge and Practices of Child Protection among the School Health Nurses of Nepal(Kathmandu University, 2021) Chapgain, RH; Adhikari, S; Pandey, A; Sharma, S; Pokhrel, S; Devkota, N; Shrestha, NJ; Upadhaya, D; Acharay, J; Dharel, MABSTRACT Background Child protection is burning issues in developing countries including Nepal. Child protection is one of the key works of the school health nurses. Objective To find out about the existing knowledge and practices of child protection among the school health nurses. Method This descriptive cross-sectional study was conducted among 130 school health nurses working in different schools throughout Nepal. The participants were selected using purposive sampling technique and were invited to participate via various online networks. Self-administered questionnaire was used to collect data. Duration of data collection was 20 December 2020 to 10 February 2021. Descriptive statistics was used to analyze and interpret the data. Result Among the 130 Participants, 88.5% belonged to less than 29 years age group and 67.7% had Proficiency Certificate Level in Nursing education. None of them has received training related to child protection recognition and response and 90.8% had work experience of less than 5 years. Eighty percent and 96.9% participants had knowledge regarding the meaning of child right and child abuse respectively. But 45.4% had knowledge on meaning of child neglect; 53.1% and 72.3% had the knowledge of physical abuse and noncontact sexual abuse respectively. Majority (86.9%) of the participants reported as relatives were the abuser and 63.8% replied as home is the common place for abuse. Similarly, 85.4% had received the information regarding child protection via television radio and newspaper. Only 36.1% has already been involved in child protection. The participants who went to local government (Palika), police and Non-government Organizations for coordination for child right issues were 9(19.1%), 7(14.8%) and 8(17.0%) respectively. Conclusion Most of the school health nurses are young without having experience of childhood abuse and received any child protection training before joining the job. They have good knowledge of child right, physical, sexual abuse except child neglect and existing legal arrangements. There is gap in knowledge and practice. KEY WORDS Child abuse, Knowledge, Practice, School health nursesPublication Knowledge, Attitude and Practice Towards Antimicrobial Resistance and Antimicrobial Adherence among Female Community Health Volunteers Before and After an Educational Intervention(Kathmandu University, 2025) Jha, N; Kafle, S; Joshi, M; Pandey, A; Koirala, P; Bhandary, S; Shankar, PRABSTRACT Background Antimicrobial resistance is a serious problem in Nepal. Knowledge, attitude, practice and adherence of female community healthcare volunteers of an intervention area about antimicrobials before and immediately after a workshop conducted on 24th February 2024 was measured. Objective To compare the knowledge, attitude and practice towards antimicrobial resistance and antimicrobial adherence among female community health volunteers. Method A questionnaire containing four sections related to various themes of antimicrobials was developed. Knowledge, Attitude and Practice questions were analyzed using two sample proportion tests. Feedback regarding the educational intervention was also obtained using a 7-item tool and open responses. Result All Female Community Health care Volunteers from Mahalaxmi municipality participated. Most participants were aged between 41-50 years [19 (42.2%)] and [25 (55.6%)] had working experience greater than 10 years. The scores for statements antimicrobial resistance are a serious problem worldwide, [84.4% vs 60% (p=0.004)] and antibiotics are used to inhibit the growth of bacteria improved post- intervention [100% vs 77.8% (p ≤ 0.001)]. Scores for attitude statements like, taking antibiotics without consulting a physician [91.1% vs 60% (p ≤ 0.001)], missing a dose or two of antibiotic treatment contribution to antibiotic resistance, [75.5% vs 46.6% (p = 0.002)] among others improved. The scores for certain practice statements also improved post-intervention. The median scores for attitude scale, [31 vs 26 (p ≤ 0.001)] and practice scale, [31 vs 34 (p = 0.011)] were different before and after the workshop. Participant feedback on the workshop was positive. Conclusion The session was effective in increasing participants’ practice scores and may lead to more rational use of antimicrobials. The attitude, practice and total scores were different before and after the workshop. KEY WORDS Antimicrobial resistance, Educational intervention, Feedback, Female community healthcare volunteersPublication Nail Changes Following Valproate Therapy(Kathmandu University, 2024) Shrestha, S; Pandey, A; Pathak, RABSTRACT Valproic acid is a widely prescribed medication for seizure disorders, mood disorders, and migraines. The adverse effects involving nails following the use of sodium valproate are rare. The nail changes reported so far include onycholysis, onychomadesis, the roughness of the nail, brownish-yellow discoloration, and a transverse yellow band. These changes are independent of the age of the patients, dose, and duration of medication. The nail changes are reversible following the discontinuation of the medication. KEY WORDS Onycholysis, Onychomadesis, Nail discoloration, Valproic acidPublication Nonsyndromic Complete Second Branchial Cleft Fistulas: A Clinicosurgical Experience(Kathmandu University, 2025) Ghimire, SB; Dhakal, A; Pandey, A; Vaidya, SABSTRACT Branchial cleft anomalies are congenital malformations resulting from the abnormal persistence of branchial clefts during embryogenesis, often presenting as cysts, sinuses, or fistulae. These anomalies account for approximately 20% of pediatric head and neck masses, with bilateral cases being particularly rare. This report discusses a case of an 11-year-old boy with complete bilateral second branchial cleft fistulae, characterized by intermittent mucopurulent discharge and recurrent inflammation, primarily following upper respiratory infections. Diagnostic imaging, including CT scans, confirmed the presence of bilateral fistulous tracts. Surgical management involved a combined transoral and transcervical approach, including bilateral tonsillectomy and complete excision of the fistulous tracts. The procedure resulted in successful removal of the anomalies without postoperative complications. This case emphasizes the importance of thorough diagnostic evaluation and the effectiveness of complete surgical excision in managing bilateral branchial cleft anomalies to prevent recurrence and improve patient outcomes. Further research is warranted to optimize surgical techniques and postoperative results. KEY WORDS Congenital neck mass, Excision, Second branchial cleft fistulaPublication Outcome of Titanium Elastic Intramedullary Nail in the Treatment of Shaft of Femur Fracture in Children(Kathmandu University, 2015) Khan, JA; Singh, GP; Pandey, AABSTRACT Background Femoral-shaft fractures are among the most common fractures of the lower extremity in children. There are several different options for treating femoral-shaft fractures in children. Elastic stable intramedullary nailing (ESIN) has become the standard treatment for fractures of shaft of femur in children for reasons including mini-invasive surgery, no need for casting, early mobilization and discharge as well as growing concerns toward cost-effectiveness. Objective To demonstrate the effectiveness of intramedullary fixation of fracture shaft of femur in skeletally immature children using the titanium elastic intramedullary nails. Method Forty children who underwent fixation with titanium intramedullary nails because of fracture of shaft of femur (Winquist and Hansen type 1 and 2) were reviewed. There were 60% male and 40% female patients and mean follow-up was six months. Time of union, deformity at fracture site, limb length discrepancy, knee range of motion and complications were assessed. Result Average age of the patients was 5.17 years (range 3 to 10). All patients achieved complete healing at a mean 12.8 weeks (range 10 to 20 weeks). Average limb length discrepancy was -0.16 cm (range -1.0 to 1.1 cm) average knee range of motion was 137.55 degrees (range 118 to 152 degrees). Complications were recorded in 13 (31.7%) patients and included: Five malunion which did not show any deformity or functional impairment and eight superficial wound infections which were healed after removal of nail. All patients were active as their pre injury levels at six months follow up. Conclusion Elastic stable intramedullary nailing is the method of choice for the simple pediatrics fracture shaft of femur, as it is minimally invasive and shows good functional and cosmetic results. It allows short hospital stay and quick recovery from pain and is cast-free. KEY WORDS Children, fracture shaft of femur, titanium elastic nail (TEN)Publication Predicting difficulties during laparoscopic cholecystectomy by preoperative ultrasound(Kathmandu University, 2007) Sharma, SK; Thapa, PB; Pandey, A; Kayastha, B; Poudyal, S; Uprety, KR; Ranjit, SBackground: The aim of this study was to determine whether the preoperative USG finding can predict the risk of conversion or difficulty during the laparoscopic cholecystectomy. Materials and methods: 200 patients undergoing Laparoscopic cholecystectomy at Kathmandu Medical College Teaching Hospital were included. Sonographic parameters like size of gall bladder, wall thickness, distance between hepaticoduodenal ligament and Hartmann’s pouch and the size of stone were taken into consideration and difficulties in terms of adhesions around gall bladder, anatomy of calot’s triangle and difficulty in peeling off gall bladder from the bed and retrieval were analyzed. Result: In 8 of 200 patients (4%), LC was converted to open procedure. In univariate analysis all the sonographic parameters we had included in this study were statically significant (p value <0.05). Conclusion: Preoperative sonographic signs can predict the difficulty in laparoscopic cholecystectomyPublication Self-Reported Emotional and Behavioural Problems among Adolescents, Kathmandu(Kathmandu University, 2023) Pandey, A; Adhikari, K; Dhakal, K; Pandey, AR; Upadhyay, R; Devkota, NABSTRACT Background Adolescents are highly vulnerable to different types of behavioural problems that can affect their academic and social lives. If left untreated, serious mental illness can develop. Objective The objective of this study was to find out emotional and behavioural problems among adolescents. Method A descriptive cross-sectional study was conducted among 275 adolescents studying in grades 7-11 at five private schools in Kathmandu. A non-probability convenience sampling technique was used to select required sample. The self-reported Strengths and Difficulties Questionnaire was used to collect data. Ethical approval was obtained from the Institutional Review Committee at the Institute of Medicine, Tribhuvan University. Descriptive statistics were used to analyse the data. The chi-square test was used to measure the association between behavioural problems and selected variables at a 95.0% confidence level. Result The mean age of the adolescents was 13.66 (SD ± 1.13) years, and 53.1% were female. In total, 7.3% and 13.8% of adolescents had abnormal and borderline levels of behavioural problems (total difficulties), respectively. Across different domains of difficulty levels, 5.0%, 12.0%, 3.3%, 5.5%, and 1.5% of adolescents had abnormal levels of emotional problems, conduct problems, hyperactivity/ inattention problems, peer relationship problems, and pro-social behaviours, respectively. Fathers’ occupation was significantly associated with behavioural problems among adolescents (p=0.020), and 15.3% of adolescents had a significant impact on their daily life, such as at home, with friends, in the classroom, or during leisure activities, due to emotional and behavioural difficulties. Conclusion Emotional and behavioural problems are quite prevalent among adolescents and have a significant adverse impact on their daily lives. KEY WORDS Adolescents, Behavioural and emotional problems, Self-report, Strengths and difficulties questionnaire