Browsing by Author "Sharma, Mohan Raj"
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Publication Applications of Generative Artificial Intelligence in Medicine: Opportunities and Ethical Considerations(Institute of Medicine, Tribhuvan University, 2024) Sharma, Mohan RajAbstract: Generative Artificial Intelligence (AI) has emerged as a transformative tool in various domains, including medical sector. Generative AI models like ChatGPT offer unparalleled potential in diagnostics, prognostications, and research assistance. However, their integration necessitates careful scrutiny of risks, including privacy violations and the propagation of inaccuracies. Establishing clear guidelines for their use in academic medicine and research is imperative for the responsible use of these tools. This article explores the foundational concepts of generative AI, highlights its applications in medicine, research, and academia, and addresses ethical and practical concerns.Publication Clinical Characteristics and Outcome of Patients with Distal Anterior Cerebral Artery Aneurysms(Nepal Health Research Council, 2024) Bohara, Sandeep; Pradhanang, Amit Bahadur; Sedain, Gopal; Sharma, Mohan RajBackground: Distal anterior cerebral artery aneurysms account for 3% to 7% of intracranial aneurysms. They have increased risk of premature rupture during surgery and tend to have a higher morbidity. We aim to determine the clinical characteristics, management strategies and outcomes of patients with these aneurysms who underwent microsurgical clipping at a major university hospital in Nepal. Methods: This is a retrospective study of patients with distal anterior cerebral artery aneurysms who underwent microsurgical clipping between 2012-2022. Demographic data and clinical-radiological factors like Hunt and Hess grade, aneurysm location, and modified Rankin scale score at three, six, and 12 months were collected. Results: A total of 26 aneurysms were microsurgically clipped in 20 patients in ten years. Most patients presented with Hunt and Hess grade II. Of the 26 aneurysms, 16 (62%) were in A3 segment. Six patients had associated anterior communicating artery aneurysm, two patients had middle cerebral artery aneurysm and two patients had associated arteriovenous malformation. Sixteen patients (80%) had a favorable outcome (modified Rankin scale ?2) at 12 months follow-up. Conclusions: Aneurysms in the distal anterior cerebral artery locations are a challenging subset of aneurysms to treat. The majority of the patients had aneurysms in A3 segment and 80% patients had a favourable outcome at 12 months follow up period. Keywords: Aneurysm; distal anterior cerebral artery; outcome; subarachnoid haemorrhage.Publication Early Experience of Minimally Invasive Tubular Lumbar Microdiscectomy at a Tertiary Care Centre in Nepal(Institute of Medicine, Tribhuvan University, 2024) Pradhanang, Amit; Sedain, Gopal; Karki, Anjan Singh; Bohara, Sandeep; Shrestha, Dipendra Kumar; Sharma, Mohan Raj; Shilpakar, Sushil Krishna; Jha, PrabhatAbstract: Introduction Lumbar disc herniation is a leading cause of low back pain and radiculopathy. Open microdiscectomy, though effective, involves muscle dissection and longer recovery. Minimally invasive tubular microdiscectomy aims to reduce these drawbacks. This study evaluates its early outcomes in Nepal. Methods Our observational study included patients who underwent MIS tubular lumbar microdiscectomy at our hospital from August 2023 to July 2024. Data on operative duration, blood loss, and return to work time were collected. Functional outcomes were assessed at three months using the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for spinal and radicular pain. Results A total of 22 patients were included. The mean operative duration was 121.5 ± 31.67 minutes, and mean intraoperative blood loss was 60 ± 20.17 mL. The mean return to work time was 1.86 ± 0.2 weeks. At three months, the mean ODI score significantly improved from 54.36 ± 8.8 to 0.91 ± 1.47 (p < 0.001). VAS scores for spinal pain decreased from 3.05 ± 0.84 to 1.5 ± 0.3 (p < 0.001), and radicular pain from 4.91 ± 0.86 to 1.36 ± 0.65 (p < 0.001). No major complications occurred, and 5% of patients had transient paresthesia, which resolved spontaneously. Conclusion MIS tubular lumbar microdiscectomy is an alternative procedure for lumbar disc herniation, offering short-term functional improvement. Long-term comparative studies are needed to assess its durability against open microdiscectomy.Publication Knowledge and Perception Regarding Adolescent Sexual and Reproductive Health Services among Adolescents attending a Tertiary Level Hospital(Nepal Paediatric Society (JNPS), 2022) Singh, Shreejana; Sharma, Saraswati; Tandukar, Bimala; Silwal, Pratibha; Sharma, Mohan RajAbstract: Introduction: Adolescence is the transitional phase of growth and development between childhood and adulthood with ages ranging from 10 to 19 years. Adolescent sexual and reproductive health (ASRH) services are the centers where adolescents can get access to their queries regarding health of both physical as well as psychological aspect. The objective of the study was to find out the knowledge and perception regarding ASRH services among adolescents attending a tertiary level hospital. Methods: A descriptive study was carried out among 112 adolescents attending adolescent clinic using a pretested structured interview schedule. Non probability purposive sampling technique was used. The data were analyzed using SPSS version 16 through descriptive statistical method and Inferential statistical methods. Results: The study revealed majority (58.0%) of respondents had moderate level of knowledge regarding ASRH (Mean value 68.89 ± 14.59 S. D). Respondent’s had high perception towards programmatic domain. Almost all (97.3%) of the respondents had positive perception towards ASRH services. There was no statistical significance between the level of knowledge and perception, level of knowledge and sociodemographic variables at 95% confidence level. Conclusions: The study concludes that adolescents have moderate level of knowledge regarding ASRH. Adolescents have an overall positive perception towards the ASRH services but they have negative perception towards the facility of ASRH services in comparison to programmatic domain.Publication Knowledge and Preventive Practices of Dengue Fever among Adolescents in a Terai District of Nepal: A Cross- Sectional Study(Perinatal Society of Nepal (PESON), 2024) Singh, Shreejana; Joshi, Deepak Raj; Yadav, Alisha; Lawot, Isabel; Sharma, Mohan RajAbstract: Introduction Dengue fever spreads by mosquito bites. Preventive measures are the most effective way to decrease the incidence of dengue. This study aims to find out the knowledge and preventive practices of Dengue fever among adolescents in Nepal. Methods This descriptive cross-sectional study was conducted among 450 students studying in grades 9 and 10 of selected community and private schools in the Dhanusha district of Nepal. The total enumeration method was used with self-administered semi-structured questionnaires for data collections. Results Among 450 respondents, the mean age of the students was 16±1.72 years. Regarding awareness of dengue symptoms, (420)92.7% responded to restlessness, as the symptoms of dengue while only 84 (18.5%) attributed bleeding from the gums or nose to the disease. Regarding preventive practices, 424 (93.6%)) participants acknowledged the importance of covering the water tank, while 175 (38.6%) considered spraying insecticide as a useful preventive measure. Education alone is significantly associated with the levels of knowledge (p-value = 0.046) and preventive practice (p-value = 0.000). The correlation analysis between knowledge and practice scores revealed a weak positive correlation (r=0.20, p-value<0.001). Conclusion: The study revealed inadequate knowledge and insufficient preventive practices concerning the prevention of dengue fever among adolescents in Nepal.Publication Knowledge and Preventive Practices of Dengue Fever among Adolescents in a Terai District of Nepal: A Cross- Sectional Study(Perinatal Society of Nepal (PESON), 2024) Singh, Shreejana; Joshi, Deepak Raj; Yadav, Alisha; Lawot, Isabel; Sharma, Mohan RajAbstract Introduction Dengue fever spreads by mosquito bites. Preventive measures are the most effective way to decrease the incidence of dengue. This study aims to find out the knowledge and preventive practices of Dengue fever among adolescents in Nepal. Methods This descriptive cross-sectional study was conducted among 450 students studying in grades 9 and 10 of selected community and private schools in the Dhanusha district of Nepal. The total enumeration method was used with self-administered semi-structured questionnaires for data collections. Results Among 450 respondents, the mean age of the students was 16±1.72 years. Regarding awareness of dengue symptoms, (420)92.7% responded to restlessness, as the symptoms of dengue while only 84 (18.5%) attributed bleeding from the gums or nose to the disease. Regarding preventive practices, 424 (93.6%)) participants acknowledged the importance of covering the water tank, while 175 (38.6%) considered spraying insecticide as a useful preventive measure. Education alone is significantly associated with the levels of knowledge (p-value = 0.046) and preventive practice (p-value = 0.000). The correlation analysis between knowledge and practice scores revealed a weak positive correlation (r=0.20, p-value<0.001). Conclusion: The study revealed inadequate knowledge and insufficient preventive practices concerning the prevention of dengue fever among adolescents in Nepal.Publication Nature of Research Proposals Submitted to Institute of Medicine Institutional Review Committee: A Retrospective Review(Nepal Health Research Council, 2025) Tiwari, Ashish; Sharma, Mohan Raj; Shrestha, Lava; Bali, Kanchana; Bhatta, Om PrakashAbstract Background : Efficient evaluation of research proposals is crucial for ensuring ethical standards and scientific rigor in healthcare. This study aims to analyze the proposals submitted to the Institutional Review Committee (IRC) of the Institute of Medicine (IOM) to determine the trends in health-related research conducted in a major institute. Methods: This is a retrospective review of research proposals submitted to the IRC of IOM from May 2019 to April 2021. The analysis focused on the institutional/departmental affiliation of investigators, gender of the principal investigator (PI), funding sources, ethical issues, types of proposals, and research design. Results: Out of 769 proposals submitted, seven were rejected (acceptance rate of 99.1%). There was a steady increase in the number of submissions over the study period. Descriptive cross-sectional studies were the most frequent 630 (82.6%) followed by randomized controlled trials. More than half [403, 52.9%] proposals were related to health promotion. The clinical departments contributed 443 (58.1%) submissions. Males outnumbered females (54.2% vs 45.8%) and only 53 (7.0%) were funded. Conclusions: Cross-sectional studies with a focus on health promotion were the most common submissions for ethical approval at the IOM. Policymakers in our institute and other institutions can use this research to set priorities for promoting research. Keywords: Ethical review, Institutional Review Board, Researchers, research proposalPublication Outcomes of Patients with Traumatic Brain Injury between Two-Wheeler and Non-Two-Wheeler Vehicles: A Cohort Study(Institute of Medicine, Tribhuvan University, 2025) Shrestha, Bishwash; Sharma, Mohan Raj; Shilpakar, Sushil Krishna; Sedain, Gopal; Pradhanang, Amit; Jha, PrabhatAbstract: Introduction Traumatic brain injury (TBI) is growing public health concern and one of the most devastating types of injury. Pattern of injuries and outcome in two-wheeler and non-two-wheeler vehicular accidents should be evaluated and addressed separately. This study aimed to determine the outcome between two wheeler and Non two-wheeler vehicular Traumatic brain injury (TBI) patients. Methodology This was a retrospective cohort study which include the data from October 2020 to December 2022, of patients with vehicular traumatic brain injuries, admitted in Department of Neurosurgery, Tribhuvan University Teaching Hospital, Nepal. Primary data was collected from emergency records, in-patient files, operative notes and post-operative discharge. Patients were followed up via phone calls and at follow up visits. Results A total of 75 patients with mean age of 39.39 ± 18.3 years and male to female ratio of 3.6:1 were enrolled in the study. 63 patients and 12 patients were included in two-wheeler and non-two-wheeler TBI patients. Among two wheeler patients, 39.68% used helmet whereas 16.6% of non two-wheeler patients used seatbelts. Alcohol consumption was high in 2 wheelers (52.38%) than in non two-wheelers (25%). Majority of the patients had mild head injury,73% among two wheelers and 83.3% in non 2-wheelers. Favourable Extended Glasgow Coma score (4-8) was seen in 98.4% of two-wheeler TBI patients and among all of non two-wheeler TBI patients. Conclusion There are differences in outcomes between TBI of two-wheelers and non-two-wheelers. Favourable outcomes in terms of Extended Glasgow coma score was seen in non-two-wheelers as compared to two-wheelers in our study.Publication Pre-hospital care, pre-hospital delay, and in-hospital delay in patients with traumatic brain injury in getting neurosurgical care in a tertiary care center: A Cross-Sectional study.(Nepal Medical Association, 2024) Regmi, Milan; Bhatta, Om Prakash; Sharma, Mohan RajAbstract Introduction: Timely institution of pre-hospital therapies aimed at damage control and the appropriately timed decision of transfer to higher centers for definitive neurosurgical management are crucial in determining the outcome of patients following traumatic brain injury. This study aimed to evaluate the factors determining pre-hospital care and delay in patients with traumatic brain injury. Methods: This was a descriptive cross-sectional study conducted in a tertiary care center after obtaining ethical approval from the Institutional Review Board (approval number 392 (6-11) E2). All patients with traumatic brain injury who presented to the emergency department from 1 July, 2018 to 15 June, 2019 were enrolled. Data related to patient demographics, the primary cause of the incident, grading of traumatic brain injury on admission, pre-hospital care, and variables that cause pre-hospital delay were collected. Results: In this study of 144 patients with traumatic brain injury, we found that 70 (48.61%) experienced transfer delays exceeding one hour. There were 71 (49.31%) patients aged 15-44 years, and 100 (69.44%) were males , with falls being the primary cause of 119 (82.64%). Most patients had mild traumatic brain injury 80 (55.56%). Out of 144, 20 (13.89%) received prehospital care, and 28 (19.44%) underwent a computed tomography scan of the head before arrival. Conclusions: Our study highlights the challenges in pre-hospital care and delays in reaching for neurosurgical care in patients with traumatic brain injury. Falls, road accidents, and physical assaults were the leading causes.Publication Publication Status of Theses among Post-graduate Students in Nursing from Institute of Medicine(Nepal Health Research Council, 2024) Khatri, Pratima; Chapagain, Bigya; Sharma, Mohan RajBackground: Publication of the research work done during the master’s program is highly desirable. However, there is a paucity of data on the number of publications, especially from low-income countries. The objective was to find out the status of the publication of the theses of post-graduate students in Nursing from the Institute of Medicine, Tribhuvan University, Nepal from 2015-2019. Methods: Cross-sectional analytical design with a structured interview via telephone was done for data collection. Independent variables were age, marital status, current work status, current working organization, type of research, year of graduation, and facilitators and barriers to publication, whereas dependent was the publication status of the thesis. Results: Two hundred five (76.2%) out of 269 participated in the study. The age group ranged from 27 to 50 years (mean ± SD = 36.6±4.8). The majority 89.3% were married. Currently working in academic institutions was 51.7%. One hundred ninety-eight (96.6%) respondents performed a cross-sectional descriptive study. Only 2.9% of studies were cross-sectional analytical and 0.5% were qualitative. Seventy-five (36.6%) respondents published their theses. Twenty-seven (36.0%) were published in PubMed-indexed journals. The most common facilitator for publication was academic satisfaction [59 out of 75(78.7%)] followed by encouragement from supervisors 52.0% and peers 40.0%, whereas the commonest barrier to publication was lack of interest [80 out of 124 (64.5%)] followed by lack of confidence 51.6%. Conclusions: Based on the results, more than one-third of the participants published their theses in national and international journals including those indexed in PubMed. Provision of university research grants, development of publication culture among post-graduate students, and making a provision of academic publication before degree awards should be encouraged for more academic publication. Keywords: Journals; Nepal; nursing; publication status; thesis.Publication Publication Status of Theses among Post-graduate Students in Nursing from Institute of Medicine(Nepal Health Research Council, 2024) Khatri, Pratima; Chapagain, Bigya; Sharma, Mohan RajBackground: Publication of the research work done during the master’s program is highly desirable. However, there is a paucity of data on the number of publications, especially from low-income countries. The objective was to find out the status of the publication of the theses of post-graduate students in Nursing from the Institute of Medicine, Tribhuvan University, Nepal from 2015-2019. Methods: Cross-sectional analytical design with a structured interview via telephone was done for data collection. Independent variables were age, marital status, current work status, current working organization, type of research, year of graduation, and facilitators and barriers to publication, whereas dependent was the publication status of the thesis. Results: Two hundred five (76.2%) out of 269 participated in the study. The age group ranged from 27 to 50 years (mean ± SD = 36.6±4.8). The majority 89.3% were married. Currently working in academic institutions was 51.7%. One hundred ninety-eight (96.6%) respondents performed a cross-sectional descriptive study. Only 2.9% of studies were cross-sectional analytical and 0.5% were qualitative. Seventy-five (36.6%) respondents published their theses. Twenty-seven (36.0%) were published in PubMed-indexed journals. The most common facilitator for publication was academic satisfaction [59 out of 75(78.7%)] followed by encouragement from supervisors 52.0% and peers 40.0%, whereas the commonest barrier to publication was lack of interest [80 out of 124 (64.5%)] followed by lack of confidence 51.6%. Conclusions: Based on the results, more than one-third of the participants published their theses in national and international journals including those indexed in PubMed. Provision of university research grants, development of publication culture among post-graduate students, and making a provision of academic publication before degree awards should be encouraged for more academic publication. Keywords: Journals; Nepal; nursing; publication status; thesis.Publication Status of Research Funding in Nepal: A Scoping Review(Nepal Medical Association, 2024) Sharma, Mohan Raj; Tuladhar, Sugat Rana; Adhikari, Abhishek; Khadga, Akriti; Singh, Shreejana; Ghimire, NamitaAbstract With the rapid advancement of health delivery, there has been a renewed interest in conducting research among healthcare professionals in Nepal. However, concern is there regarding availability of funds and mechanisms of awarding. The purpose of this scoping review is to map the available evidence regarding the evolution and current status of health research funding in Nepal and to highlight gaps and areas for future research. We searched three databases for empirical papers and several gray literature. Our search, conducted between March and April 2024 yielded 76 documents of which 30 that met the selection criteria were included in the scoping review. Almost all studies identified lack of funding as a deterrent to research. We found a paucity of research focusing on the role of researchers in funding decision-making. Our findings revealed that there are 12 national and four international organizations providing funds for research. University Grant Commission is the largest funder from Nepal whereas the Research Council of Norway is the biggest international funder. There were certain barriers and facilitators for obtaining funds identified by this scoping review. Further efforts are needed to increase the amount and availability of funds in Nepal to enable high-quality research.Publication Traumatic Injury among Patients Presenting to the Department of Emergency Medicine of a Tertiary Care Centre(Nepal Medical Association, 2024) Rijal, Suraj; House, Darlene Rose; Joshi, Nishant; Thapa, Barsha; Shrestha, Kriti; Sharma, Mohan RajAbstract Introduction: The majority of trauma-related deaths occur in low- and middle-income countries; however, limited data exists in these settings related to injury types and severity. The prevalence of trauma similar to our setting was less estimated. This study aimed to find the prevalence of traumatic injury among patients presented to the department of emergency medicine of a tertiary care centre. Methods: This is a descriptive cross-sectional study conducted among patients presented to the Department of Emergency Medicine from 15 September 2021 to 14 September 2022. Ethical approval was taken from the Institutional Review Committee. World Health Organization trauma minimum data set, injury mechanism, types and patient disposition data were collected and injury severity scores were calculated. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 47,825 patients, 1,524 (3.19%) (3.03-3.34, 95% Confidence Interval) patients presented with a traumatic injury. A total of 967 (63.45%) were males and had a median age of 30 years (Interquartile range: 25). Most injuries were caused by falls 650 (42.65%), followed by road traffic accidents 411 (26.97%). A majority had minor Injury Severity Scores 1280 (83.99%). Conclusions: The prevalence of traumatic injury among patients presenting to emergency was found to be lower than other studies done in similar settings.Publication World Health Organization Tool for Benchmarking Ethics Oversight of Health-Related Research with Human Participants(Nepal Medical Association, 2024) Ghimire, Namita; Basnet, Rojina; Acharya, Richa; Adhikari, Santoshi; Verma,Shashi; Sharma, Mohan RajAbstract Benchmarking ethics oversight is a process of aligning comparing and evaluating the strengths and room for improvement of ethical review and approval process across different institutions or the country. The World Health Organization tool for benchmarking ethics oversight is designed to help countries assess and improve their systems for ethically overseeing health-related research involving human participants. It identifies gaps in legal frameworks, committee structures, resources, accountability and transparency while promoting best practices and policy alignment. Nepal has made progress through the research regulations body like the Nepal Health Research Council , but challenges such as inconsistent implementation, oversight of the implementation and resource limitations remain. The tool offers an opportunity to strengthen Nepal’s health research governance and regulation but it must be adapted to fit local contexts, emphasizing accountability, transparency, capacity-building, and improved communication.