Browsing by Author "Shrestha, J"
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Publication Development of a Model One Stop Approach to Post-COVID-19 and other Rehabilitation Conditions(Kathmandu University, 2024) Adhikari, P; Tamrakar, D; Thakur, C; Shakya, R; Vaidya, N; Acharya, R; Shrestha, J; Byanju Shrestha, IABSTRACT Background Post-COVID-19 cases can cause severe disabling symptoms and functional disabilities. WHO recognizes the severity of the condition and publishes a standardised Case Report Form to inform clinical management and public health response. Objective To determine the post-COVID-19 case load. A multidisciplinary team including a diverse team were composed and priority intervention areas were identified through a transdisciplinary approach eventually developing a Model One Stop Approach to post-COVID-19 and other Rehabilitation Conditions. Method The COVID-19 cases recorded at Dhulikhel Hospital were monitored through phone calls to post-COVID-19 complications. Patients were then invited for additional clinical assessments. A diverse team conducted these assessments to identify the needs for expanding a post-COVID-19 clinic and devised rehabilitation services based on predefined criteria. Result A total of 550 respondents were included in the study. The proportion of males (51.7%) was slightly higher than females (48.3%) with the majority of them being Brahmin/Chettri. The primary comorbidities identified were diabetes (10.55%) and hypertension (11.4%). Of the participants, about 50.73% experienced persistent symptoms. About 17.8% reported lasting muscle-related problems, 12.1% had persistent joint pain, and 33% faced temporary cardiac issues. Less than 10% experienced enduring health problems related to vision, hearing, and sleep patterns. Conclusion After COVID-19, patients experienced cardiac and muscle-related issues, increasing morbidity, financial burdens, and pressure on healthcare systems. With the need of sustainable rehabilitation training package, Dhulikhel Hospital serves as a model for a One-Stop Approach to post-COVID-19 and other rehabilitation conditions. KEY WORDS Model, Persistent, Post-COVID-19, Rehabilitation, SymptomsPublication Digital Subtraction Angiography a Door Opener for Neurosurgical Residents who want to Perform Neurointerventional Procedures(Kathmandu University, 2021) Rajbhandari, P; Gurung, P; Rajbhandari, S; Shrestha, D; Acharya, S; Shrestha, R; Shrestha, P; Shrestha, J; Sharma, U; Mali, S; Rajbhandari, R; Neupane, A; Pant, BABSTRACT Digital subtraction angiography (DSA) has been a fluoroscopic golden investigative tool to know the vascular angiography of the brain and spinal cord. The technique in performing this procedure exposes residents in accessing the major vessels, branches of the arch of aorta, selective angiography and diagnosing different vascular anomalies of brain and spine. They are also exposed to the knowledge of different diagnostic catheters, its manipulation, use of dye and radiation exposure and safety. We would like to share our experience in training and disseminating the knowledge of digital subtraction angiography to the residents. KEY WORDS Digital subtraction angiography, Neurosurgical residents, NeurointerventionPublication Knowledge, Attitude, and Practices Related to COVID-19 among Healthcare Personnel in a Tertiary Care Hospital in Nepal: A Cross-sectional Survey(Kathmandu University, 2020) Basnet, S; Dahal, S; Tamrakar, D; Shakya, YR; Jacobson, C; Shrestha, J; Shrestha, SKABSTRACT Background COVID-19 is significantly affecting the healthcare system globally. As a result, healthcare workers need to be updated on the best practices for the proper management of the disease. Objective The purpose of this study was to assess the knowledge, attitude, and practices (KAP) related to COVID-19 among healthcare personnel. Method This was a cross-sectional study conducted among medical personnel at Dhulikhel Hospital Kathmandu University Hospital using a semi-structured questionnaire on KAP related to COVID-19 from May 8th to June 8th, 2020. We analyzed survey data by using descriptive statistics. Spearman rank correlation, chi-square test and binary logistic analysis were used to examine the association between sociodemographic characteristics with KAP related to COVID-19. Result Among 220 participants, the majority were nurses (60%) followed by doctors (27.7%), paramedics (10%) and technicians (2.3%). The results showed that 68.6% of healthcare personnel had a good knowledge with appropriate practices (98.5%) and negative attitude (59.3%). In the multivariate binary logistic analysis, the healthcare workers with the clinical experience level of one to five years (OR:.42, 95% CI:.19- .96) and more than 5 years (OR: .16, 95% CI: .04-.63) were significantly associated with negative attitude. The confidence score for managing COVID-19 (OR:1.16, 95% CI:1.02-1.34) was significantly associated with an optimistic attitude. Conclusion Healthcare workers are knowledgeable about COVID-19 and proactively practising to minimize the spread of infection but lack optimistic attitudes. Hence, the constantly updated educational programmes related to COVID-19 for targeted groups will contribute to improving healthcare workers’ attitude and practices. KEY WORDS Awareness, COVID-19, Infectious diseasePublication Liver Function Parameters and Validation of Health-Related Quality of Life Assessment of β-Thalassemia Cases at a Tertiary Care Hospital, Lumbini Province, Nepal(Kathmandu University, 2025) Gautam, N; Risal, P; Gupta, RT; Agrawal, KK; Chaudhary, D; Paudel, MS; Adhikari, B; Pokhrel, BR; Tamang, B; Shrestha, J; Sharma, B; Ghimire, SABSTRACT Background Individuals affected by β-thalassemia experience complications such as hepatic hemosiderosis and fibrosis due to frequent blood transfusions, which can lead to iron overload. Multiple blood transfusion burdens in thalassemia, particularly in low- income countries, impact health-related quality of life. Objective Liver function parameters and health-related quality of life were assessed using Nepali version 36 short-form survey instruments to reveal the vitality, physical, mental, emotional, pain, general health, and social functioning of β-thalassemia cases. Method In this cross-sectional study, forty β-thalassemia cases who had visited the Universal College of Medical Sciences tertiary care teaching hospital of Lumbini Province, Nepal were enrolled. The hemoglobin variant band percentage was estimated by D-10 BioRad high performance liquid chromatography (HPLC), Mentzer Index (Mean Cell Volume by Red Blood Cell count) by Beckman hematological analyzer, and serum liver parameters (Bilirubin, Total protein, Albumin, Alanine aminotransferase, Aspartate aminotransferase, Alkaline phosphatase) were estimated by using Diatron fully automated analyzer. The internal consistency of the Nepali version of 36 short- form survey instruments was checked by Cronbach`s alpha was found to be > 0.70 from the recoded value. Data are analyzed using the STATA/MP14, and ANOVA and t-test are applied to test the significance considering p-value < 0.05. Result The frequency of the β-thalassemia Trait (60%) was higher than β-thalassemia Major (30%) and 7.5% β-thalassemia Intermedia co-morbidities with Sickle cell (2.5%) and β/δ variants (2.5%). Higher frequency was found in ethnic groups Muslim (32.5%) followed by Terai indigenous-Tharu (30%) and Madheshi (27.5%). The transfusion- dependent cases have significantly higher Total, Direct, Indirect Bilirubin, and Alkaline phosphatase levels than non-transfusion dependent cases (p<0.001). The physical functioning, general health, emotional health, and vitality were significantly decreased in β-thalassemia Major as compared to β-thalassemia Trait (p<0.001), and significantly correlated with Mentzer index and HPLC patterns (HBA2/HBF) (p<0.05). Conclusion Transfusion dependent β-thalassemia Major and Intermedia had elevated Bilirubin and Alkaline phosphatase levels as compared to non-transfusion dependent β-thalassemia Trait, exacerbating health-related quality of life, emphasizing the preventable disparities for optimized transfusion protocols and psychosocial support. KEY WORDS β-thalassemia, Health-related quality of life, Liver function testsPublication Oral Solid Dosage form Modification in Community Pharmacies of Kavrepalanchok and Bhaktapur Districts of Nepal(Kathmandu University, 2022) Shrestha, J; Shrestha, A; Shrestha, B; Gamal, K; Manandhar, S; Koju, S; Koju Shrestha, RABSTRACT Background People may modify their oral solid dosage form of medicine to deal with problem faced during medicine administration. The modification of dosage form may adversely affect the quality, safety and efficacy of the medicine. Objective To investigate the causes and practices of oral solid dosage form modification among the consumers going to community pharmacies. Method A descriptive, cross-sectional study was conducted in five community pharmacies of Kavrepalanchok and Bhaktapur districts of Nepal. The consumers visiting these pharmacies for their oral solid dosage form of medicine were invited to participate in interview using structured questionnaire. Result Among 419 participants,13.6% of participants reported having problem of taking intact medicine. Most of them (12.4% of total participants) experienced difficulty swallowing the medicine. The swallowing difficulty is significantly associated with age and sex (p < 0.05). Around one third (36.8%) of participant with medicine administration problem modified the dosage form of medicines. One quarter of medicine dosage form modifications (25.0%) were inappropriate. Medicine dosage form modification is associated with age and number of daily medicine intake (p < 0.05). Among participants modifying dosage form of medicines, 66.7% were advised to do so mainly by family and friends; 33.3% were modifying on their own and 76.2% were unaware of possible effects of medicine dosage form modification. About 62.3% of total participants were never asked about any problems on taking medicines by doctor/pharmacists. Conclusion Difficulty swallowing medicines and medicine dosage form modification were prevalent in the Nepalese population. Medicine dosage form modifications also involved inappropriate modifications due to specialized design of such dosage forms. So, it seems important to provide proper counseling while dispensing such dosage forms. KEY WORDS Capsules, Dosage forms, Medication error, Oral medicine, Pharmaceutical preparations, TabletsPublication Psychosocial Problems among the Adolescent School Students of Dhulikhel Municipality(Kathmandu University, 2021) Shrestha, B; Gautam, S; Shrestha, J; Shrestha, SABSTRACT Background Adolescence is a period when an individual experiences a variety of biological, psychological and social changes. These multiple changes during the developmental period can make the adolescents vulnerable to mental health problems. Therefore early detection of psychosocial problems and addressing the need of the adolescents are crucial for promoting their mental health. Objective To assess psychosocial problems and its associated factors among school going adolescents of Dhulikhel, Nepal. Method A descriptive cross sectional study was conducted among 513 adolescents studying in grade 8 to 12 of randomly selected schools of Dhulikhel Municipality. Data were collected by using structured questionnaire and Pediatric Symptom Checklist-Youth Report (Y-PSC). Descriptive and inferential analysis was done using Statistical Package for Social Sciences version 20. Result Out of 513 adolescent students, a total of 133(25.9%) of the adolescents were found to have psychosocial problems. There was significant association between psychosocial problems and respondents’ variables like age, grade, parental education status, respondents’ living status, perceived family disputes, perceived marital problems of parents, relationship problem with family, stress of failure in study, punishment faced in home and school, experienced sexual harassment and death of loved ones. Conclusion Various family related factors and stressful life events of adolescents are associated with the psychosocial problems. Hence early intervention focusing on awareness and modification of stressful life events is required. KEY WORDS Adolescents, Pediatric symptom checklist-youth report, Psychosocial problems, StudentsPublication The Characteristic of Pain and Disability among Patients with Neck Pain in Nepal: A Study in a Tertiary Hospital(Kathmandu University, 2024) Shijagurumayum Acharya, R; Shrestha, JABSTRACT Background Neck pain is a major public health problem and found to be associated with people who have low income, low educational levels, and occupational activities that involve strenuous, manual labor work. Agriculture is the main occupation for the majority of the Nepalese population and they are potentially exposed to these risk factors. Hence, it is important to explore the characteristics of neck pain among the Nepalese population. Objective To explore characteristics of socio-demographic, pain and disability among the Nepalese population with neck pain. Method A cross-sectional study was conducted using convenience sampling in Dhulikhel Hospital from February 2019 to April 2019. Patients with neck pain, aged > 18 years were included in the study. Information on age, sex, marital status, occupation, educational status, income, and working hours were collected from the patients. Nepali versions of the Neck Disability Index and Numerical Pain Rating Scale were used to assess disability and pain intensity respectively. Result Among 120 participants, 88 patients were included in the study. The mean age of the patients was 41.38 (SD 15.26) and the majority (72%) were females. The majority were uneducated (35.2%) and unemployed (64. 8%). The mean score of pain in the past 24 hours was 6.48 (SD 1.28). The majority had a mild disability (55.7%) followed by moderate disability (43.2%). Conclusion Neck pain is common among women, the middle-aged population, and patients with a poor level of education and income. The patients reported moderate neck pain with mild to moderate disability. The results of our study highlighted the importance of implementing screening measures to enable the timely identification and treatment of neck pain, especially among high-risk individuals. This would prevent or minimize the development of disability associated with neck pain. KEY WORDS Disability, Neck disability index, Neck pain, Numerical pain rating scale, Socio- demographic characteristics