Browsing by Author "Paudel, Rajan"
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Publication Carotid Intima-media Thickness in Patients with Non-alcoholic Fatty Liver Disease Attending a Tertiary Care Center: A Descriptive Cross-sectional Study Authors(Nepal Medical Association, 2021) BC, Bom; Jaiswal, Raj Kishwor; Gupta, Prashant Kumar; Paudel, Rajan; Subedi, Raj KumarAbstract: Introduction: Non-alcoholic fatty liver disease is fatty infiltration of the liver in the absence of other causes of steatosis. It is strongly associated with central adiposity, high body mass index, insulin resistance states, hypertension, hyperlipidemia which are features of metabolic syndrome. The objective of study is to find out the carotid intima-media thickness of non alcoholic fatty liver disease patients attending a tertiary care center. Methods: This was a descriptive cross sectional study conducted at National Academy of Medical Sciences, Bir Hospital from July 2018 to June 2019 among 70 diagnosed cases of non alcoholic fatty liver disease based on ultrasound findings. Data collection was started after receiving ethical approval from Institutional Review Board of the Institute. Convenience sampling method was used. Data were entered using Microsoft Excel. The carotid intima-media thickness of both sides were measured by ultrasound. Statistical Package for Social Sciences version 20 was used for analysis. Results: Out of 70 cases, the mean carotid intima-media thickness was 0.7140±0.1796mm on right and 0.7161±0.1828mm on left side. Among 70 cases 45 (64.3%) were Grade II non alcoholic fatty liver disease and 25 (35.7%) were Grade I. It was 0.5720±0.1275mm and 0.7929±0.1546mm in Grade I and II non alcoholic fatty liver disease cases respectively on right side whereas it was 0.5676±0.1259mm and 0.7987±0.1557mm respectively on left side. Conclusions: This study showed increased carotid intima-media thickness in non alcoholic fatty liver disease cases.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 studentsPublication Predictors of Multiple Micronutrient Powder Intake Adherence among Children Aged 6-23 Months in Rasuwa District, Nepal: A Cross-sectional Study(Institute of Medicine, 2020) Timalsina, Ashish; Paudel, Rajan; Upadhyaya, Dipak P; Bhattacharya, Sujay; Kuikel, Bihari S; Joshi, Naresh P; Adhikari, Sunil; Aung, Aye AABSTRACT Introduction: Breastfeeding would not be sufficient to meet the micronutrient requirement of children after six months and more prone to iron deficiency anemia. Micronutrient powder (MNP) can be mixed with semi-solid food to feed the children aged 6-23 months, contains 12 different micronutrients, one of the appropriate strategies. The study’s objective was to assess adherence to MNP and its predictors among children aged 6-23 months in Rasuwa district of Nepal. Methods: A cross-sectional study was conducted in the Uttargaya rural and the Kalika rural municipality of Rasuwa district among 200 mothers of children aged 6-23 months who were fed MNP. Proportionate random sampling was used to select eligible mothers for interviews, and a semi-structured questionnaire was employed for data collection. Multivariate logistic regression was used to obtain adjusted odds ratio with 95% C.I. Results: Sample mean was calculated among 155 mothers who received 60 sachets of MNPs;41.3% had adhered to 60 sachets intake of MNP. The mean age of the mother was 25. 29±5.3 years and the mean age of children was 14. 66±5.2 months. In bivariate analysis, the mother having one child less than five years (COR=0.5, 95% CI: 0.24-1.0) and MNP received from the health facility (COR=1.96, 95% CI: 1.02-3.76) were statically significant. Further, multivariate analysis, a mother who accepted the properties of MNP (AOR=2.52, 95% CI: 1.27-5.00), was associated with high adherence. Conclusion: Acceptability of MNP by the mother is the key to increase adherence to MNP. The distribution of MNP from a health facility, tailored with nutrition education is essential to improve adherence to MNP. Keywords: Adherence, children, multiple micronutrient powder, NepalPublication Prevalence of Diabetes and Dyslipidemia in Hypertensive Young Adults in a Tertiary Care Centre in Nepal, a Cross Sectional Study(Institute of Medicine, 2020) Lamsal, Kamal Sharma; Neupane, Keshab R; Acharya, Niranjan; Lamsal, Dinesh K; Karmacharya, Niraj; Paudel, Deepak; Paudel, Rajan; Sharma, Rabi PABSTRACT Introduction: Diabetes mellitus (DM) and lipid disorders (LD) in hypertensive patients are associated with increased risk of cardiovascular complications requiring close follow-up and more aggressive treatment. Hence, the present study was done to study the prevalence of diabetes and dyslipidemia in young hypertensive patients i.e. <40 years in a tertiary care hospital, Nepal. Methods: This is a hospital based cross-sectional study carried out in Civil Service Hospital, Kathmandu. Study included 165 patients of <40 years who had hypertension, either newly diagnosed or undergoing antihypertensive treatment from September 2018 to September 2019. Blood pressure was measured two times on right upper arm in sitting position at interval of 30 minutes and the aver age was taken. Fasting Lipid Profile and Fasting Blood Glucose was measured after 12 hours of fasting and the prevalence of dyslipidemia and diabetes were analyzed from the data collected. All calculations and statistical analyses are processed by the SPSS 25.0. Results: Among 165 patients included, majority of patients, 107 (64.8%) were among 31-39 years, followed by 53 (32.1%) patients among 21-30 years. In total, 98 (59.4%) were male and 67 (40.6%) female. The prevalence of diabetes was 24 (14.5%) and pre-diabetes was 49 (29.7%). The prevalence of dyslipidemia was 125 (75.6%), high triglyceride being the most common disorder followed by low HDL in 87 (52.1%). Elevated total cholesterol was found in 53 (32.1%) patients and 48 (29%) had high LDL cholesterol level. Conclusion: A high prevalence of diabetes, pre-diabetes and dyslipidemia was observed in the hypertensive patients <40 years of age. Keywords: Diabetes, dyslipidemia, hypertension, prediabetesPublication Prevalence of Stunting among 6-59 Months Children and its Association with Water, Sanitation and Hygiene Practice in Urban Slums of Kathmandu, Nepal(Institute of Medicine, 2020) Singh, Sarswoti; Dhital, Nil P; Paudel, Rajan; Sah, Dipak K; Hamal, Arjun; Shrestha, JunuABSTRACT Introduction: Childhood malnutrition is a critical public health concern in Nepal. Slums are supposed to have poor water, sanitation and hygiene practices. This study has aimed to examine association between water, sanitation and hygiene (WASH) variables and stunting among 6 to 59 months children of slums of Kathmandu metropolitan city. Methods: Descriptive cross-sectional study design was employed where 335 households were included in the study. Data were collected using standard questionnaire and observation checklist. Weight and height of children were taken using seca digital weighing scale and wooden height board of UNICEF respectively. Anthropometric analysis was done using WHO Anthro version 3.2.2 software and other statistical analysis was conducted using SPSSversion 22 software. Results: The prevalence of stunting was 23%. Four out of five household (80%) in slum used to drink water from unimproved source. Absence of handwashing station (AOR=2.109, 95% CI:1.05-3.27) and absence of water storage covering (AOR=2.46, 95% CI: 1.16–5.23) were found to be significantly contributing to stunting status. Conclusion: This study highlights the importance of good WASH practices, and the potential of WASH interventions, to contribute for the improved childhood stunting living in urban slums in Nepal. Also, the findings recommend the need of strategies on purification of water, improvement of toilets, behaviour change and awareness related activities to improve the stunting among children. Keywords: Hygiene, sanitation, slum, stunting, water