Browsing by Author "Paudel, Rajan"
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Publication Emerging Antibiotic Resistance Pattern in a Neonatal Intensive Care Unit in Pokhara, Nepal(Nepal Health Research Council, 2025) Bastola, Ramchandra; Shrestha, Shree Krishna; Paudel, Rajan; Gurung, Laxmi; Sigdel, Bhawana; Neupane, Jamuna; Pradhan, Saugat; Basnet, Omkar; Subedi, NuwadattaBackground: Treating neonatal sepsis in Nepal remains difficult given the high rates of antimicrobial resistance. The objective of this study is to determine the antibiotic resistance pattern of culture-proven infections in neonates admitted to a neonatal intensive care unit. Methods: This cross-sectional prospective observational study was performed at the Neonatal Intensive Care Unit of Pokhara Academy of Health Sciences from 15th july 2022 to 15th july 2023. We included all neonates admitted with positive cultures grown from blood, cerebrospinal fluid, endotracheal tube, and pus. Demographic, clinical, and microbiologic data were collected from the medical record. We reviewed antimicrobial susceptibility testing of all isolates. Results: There were 51 culture-positive infections among 1327 neonates admitted, among which 23 cases from blood culture, 2 cases from cerebrospinal fluid, 14 cases from endotracheal tube samples, and 12 cases from pus samples. Gram-negative infections were predominant amounting to 35 (68.6%) including Pseudomonas in 12 (23.5%), and Acinetobacter species in 9 (17.6%) cases. Gram-positive infections were seen in 14 (27.4%) in which Methicillin-Resistant Staphylococcus aureus accounted for 6 (11.8%) cases. Yeast cells other than Candida albicans accounted for two (5.4%). For all Gram-negative isolates, resistance to Third-generation cephalosporin and aminoglycosides was reported in 75.0% (12 of 16 isolates tested) and 87.0% (24/31), respectively. Fluoroquinolone resistance was seen in 61% (8/13), resistance to penicillin was 59.3% (10/19), and resistance to carbapenem was in 100.0% (7/7) cases. Conclusions: There were high rates of antimicrobial resistance even with the reserved drugs among gram-negative pathogens. This alarms for the need for rationale prescribing of antimicrobials. Keywords: Antimicrobial resistance; bloodstream infection; meningitis, neonatal sepsisPublication Epidemiological and Spatial Distribution of COVID-19 Morbidity and Mortality in Nepal(Nepal Health Research Council, 2024) Poudyal, Amod Kumar; Shakya, Karuna Laxmi; Sapkota, Vishnu Prasad; Paudel, Rajan; Myia, Salau Din; Pradhan, Pranil Man Singh; Upadhyaya, Dipak Prasad; Joshi, Naresh; Shrestha, ShitalBackground: The Coronavirus (SARS-CoV-2) infection termed as COVID-19 was first detected in Wuhan, Hubei Province of China, in December 2019 and has been declared as a pandemic by the World Health Organization on January 30, 2020. The study aims to understand the time, place and person distribution of covid-19 morbidity, mortality of COVID-19 in Nepal. Methods: The analysis produces the descriptive epidemiological features of COVID-19 pandemic in Nepal. The data was analysed to produce disaggregated case rate and case fatality rate across various time, place and personal characteristics aggregated at national and subnational level Results: The study found that the observed case rate was significantly higher among males compared to females. Similarly, case rate was the highest among males of 31-40 years and females of 51- 60 years. Case fatality rate increased with age group. Above the age of 41-50 years, case fatality rate was higher among males compared to females. We observed that case fatality rate was disproportionately concentrated among the poor districts in terms of GDP Conclusions: The observed case rate is significantly higher among males compared to females, however case fatality rate increased with age group. Case rate was found the highest in the Bagmati province followed by the Gandaki Province. However, case fatality rate was found the highest in hilly and mountain districts of Province 1, Gandaki and Karnali. Case fatality rate was disproportionately concentrated among the poor districts in terms of GDP. Keywords: COVID19; morbidity; mortality; Nepal.Publication Incidence and Outcome of Acute Kidney Injury in Hospitalised Children(Nepal Paediatric Society (JNPS), 2021) Paudel, Rajan; Shah, Gauri Shankar; Chaudhary, Shipra; Dharel, Dinesh; Timilsina, AnuradhaAbstract: Introduction: Acute kidney injury (AKI) is common in hospitalised children with adverse short and long term outcomes. Detection of the incidence, etiological profile and outcome of AKI is important for starting preventive and therapeutic modalities. This study aimed to determine the incidence, etiology and short term outcome of AKI at a tertiary centre in Eastern Nepal. Methods: A prospective observational study was conducted in children from two months to 14 years of age admitted in paediatric wards and paediatric intensive care unit (PICU) of a tertiary centre of Eastern Nepal. AKI was defined according to pRIFLE criteria. Results: From May 2015 to March 2016, 942 patients enrolled in Paediatric wards and PICU were evaluated. The overall incidence of AKI was found to be 5.9% and 18.23% in patients admitted in PICU. AKI was commonest among cases having infectious etiology compromising 73.2% (n = 41), 17.85% (n = 10) due to primary renal disease, 5.35% (n = 3) secondary to congenital heart disease, and 3.57% due to other causes. Among AKI patients, 55.4% (n = 31) required inotropic support, 33.9% (n = 19) required mechanical ventilation while 5.36% (n = 3) underwent dialysis. Out of 56 AKI patients 71.4% (n = 40) had improved clinical outcome and 28.6% (n = 16) expired. Patient with AKI had significant longer duration of hospital stay as compared to non AKI (Seven days vs. three days, p < 0.001). Mortality was high among AKI patients on injury and failure stage (p = 0.003) and those requiring mechanical ventilation and inotropic support (p < 0.001). Conclusions: The incidence of AKI was found to be high in paediatric patients. Presence of AKI increased the duration of hospital stay and mortality in hospitalised children often requiring mechanical ventilation and inotropic support.Publication Intrauterine Meconium Peritonitis: An Unusual Case of Foetal Ascites(Nepal Paediatric Society (JNPS), 2021) Paudel, Rajan; Bhatta, Nisha Keshary; Shah, Rajesh; Shah, Lokraj; Poudel, AnshuAbstract Meconium peritonitis is defined as aseptic chemical inflammation caused by an intrauterine bowel perforation. Its incidence is 1 in 35,000 live births. We present a case of meconium peritonitis presented at second day of postnatal life with isolated gross fetal ascites. Exploratory laprotomy was performed, suggestive of gross ascites with fecal contamination and perforation at terminal ileum for which ileal resection with double barrel ileostomy had been done. Postoperatively patient condition had improved and discharged. We would like to highlight this rare presentation of meconium peritonitis following intrauterine bowel perforation in fetus.Publication Mental Health Literacy and Associated Factors among Secondary School Students in Bhaktapur, Nepal(Central Department of Public Health, 2024) Duwal, Sarita; Paudel, Rajan; Paudel, Mohan; Dhaubanjar, Manisha; Nepal, Jyoti; Acharya, Dilaram; Dhungana, SaraswatiAbstract Introduction: Mental health problems like depression and anxiety are the leading contributors to the global burden of disease. Mental health problems are common in adults and children in Nepal, accounting for 13.2% and 11.2% of the population while only 21% sought treatment. Evaluation of mental health literacy is important in assisting the development of intervention and policies toward preventing mental health problems. This study aimed to assess the mental health literacy among the secondary school students of Bhaktapur municipality and identify the factors associated with it. Methods: A cross-sectional descriptive study was conducted in December 2019 among 468 students of grade11 and 12. We selected the study sample using two-stage cluster sampling technique. A self-administered questionnaire was used for the data collection using a modified mental health literacy scale. Collected data were entered in EpiData 3.1 and SPSS 17.0. Descriptive analysis was done to find out the level of MHL. Variables that were found statistically significant (p<0.05) in the univariate analysis were further analysed using multiple linear regression method. Ethical approval was taken from the Institutional Review Committee of the Institute of Medicine, Nepal. Results: The participants exhibited moderate level of mental health literacy score of 110.9 8 (SD=±11.11).This study shows that age below 18 years (β= 2.13, 95% CI= 0.093to4.164), science faculty (β= 6. 41, 95% CI= 3.71to8.57), internet source for health information (β=2.31, 95% CI= 0.21to4.41), part-time job (β= -6.78, 95% CI= -9.30to -4.25) and mental distress (β= -3.37, 95% CI= -5.27to -1.47) were significantly associated with MHL in the students. Conclusions: Awareness of existing MHL levels in the secondary school students is crucial for the evaluation of targeted educational interventions and for the further development and implementation of these interventions in the future. This study also emphasizes the need for school mental health program and to include mental health literacy in the school curriculum. Keywords: Mental health literacy, Health literacy, School students