NepMed Repository :: Browsing by Author "Shrestha, U"

Browsing by Author "Shrestha, U"

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A comparative study of pregnancy outcome between teenage pregnancy and older reproductive age group in a rural University Teaching Hospital of Nepal
(Institute of Medicine, 2018) Aryal, B; Shrestha, U
Abstract Introduction: Teenage pregnancy is a common public health problem worldwide and is considered as high-risk pregnancy in terms of health of both mother and child. The objective of this study was to find the incidence and outcome of teenage pregnancy in comparison to older women who delivered in Karnali Academy of Health Sciences Teaching Hospital. Methods: This is a hospital based cross-sectional comparative study conducted in Labor Unit of Karnali Academy of Health Sciences, Jumla over a period of one year from July 2016 to June 2017. The hospital data was retrieved and divided into two groups i.e. teenagers and older age and was compared in terms of incidence and maternal and fetal outcome of pregnancy. The data were analyzed using software package SPSS 16. Results: This study showed that incidence of teenage pregnancy was 24.14%. Maternal and fetal complication like eclampsia/preeclampsia (7.63% vs. 0.44%), cesarean section (44.44% vs. 7.96%) preterm delivery (15.97 % vs. 1.10%), small for gestational age (29.86% vs. 3.31%) and intrauterine fetal death (9.72% vs. 0.66%) occurred more frequently in teenagers in comparison to older age. Similarly, there was increased incidence of congenital anomalies (5.55% vs. 0.44%) among the neonates born to teenage mothers. Conclusion: Incidence of teenage pregnancy in rural and resource-limited part of the country is high, which predispose them into increased risk of maternal and fetal complications like increased incidence of eclapsia/preeclampsia, cesarean section rate, prematurity and its complications, small for gestational age, congenital anomalies and intrauterine fetal death. Key words: teenage pregnancy, maternal outcome, fetal outcome, rural
A rare case of pseudocyesis in a grand multiparous woman in Karnali Academy of Health Sciences: a case report
(Institute of Medicine, 2017) Aryal, B; Shrestha, U
Abstract Pseudocyesis, sometimes called phantom or false pregnancy is a rare medical condition in which women has false believe of being pregnant. She experiences many signs and symptoms of pregnancy but there is absence of fetus. The etiology of this condition could be the interplay and combination of various psychological, sociocultural and endocrine factors. A case of this rare condition is described in the case report that represents the sociocultural belief of need of specific sex (male) child in the family and believe in traditional healers in rural Nepalese society. Key words: pseudocyesis, grand multipara, sociocultural belief
Bilateral Congenital Cataract Associated with Multiple Epiphyseal Dysplasia: A case Report
(Nepal Paediatric Society (JNPS), 2012) Adhikari, S; Shrestha, U; Nepal, P; Singh, JL
Abstract: Cataract in children has varied etiology. It may be associated with systemic diseases including skeletal dysplasias. However cataract in Multiple Epiphyseal Dysplasia is a rare association. A child presented with bilateral dense posterior sub capsular cataract and multiple bony abnormalities. Clinical and radiographic findings suggested the disease to be Multiple Epiphyseal Dysplasia. The aim of presenting this case is to report a case of congenital cataract having a rare association with the Multipe Epiphyseal Dyspalsia.
Cross – sectional study of respiratory pathogens and their antibiotic susceptibility pattern in Tribhuvan University Teaching Hospital
(Institute of Medicine, 2006) Shrestha, U; Singh, A; Pokharel, BM
Abstract Background: Lower respiratory tract infection (LRTI) comprises an array of diseases ranging from bronchitis to pneumonia; its asperity can sway from non-pneumonic LRTI to pneumonia or chronic obstructive pulmonary disease (COPD). The HMG/WHO review in 1994 estimated the overall acute respiratory infections in Nepal to be 2.1%. Methods: In brief, all total 132 sputum samples of patients suspected of LRTI those visiting Tribhuvan University Teaching Hospital during March to May 2005 were investigated with the use of standard microbiological methods and the bacterial isolates were subjected for antibiotic sensitivity test. Results: Of the total, 31.0% sputum samples showed significant positive. Among them 75.6% were gram-negative bacteria (GNB) and 24.40% gram-positive bacteria (GPB). Eight different types of bacteria were isolated. Haemophilus influenzae (19.51%), Klebsiella pnemoniae (19.51%), Pseudomonas aeruginosa(19.51%), were the most common isolates followed by Streptococcus pneumoniae (12.19%), Staphylococcus aureus (12.19%), Escherichia coli (9.75 %), Citrobacter fruendii (4.87%), Acinetobacter calcoaceticus (2.43%). Antibiotic susceptibility test showed that, more than 50% of GPB were resistant to Erythromycin, Cephalexin and Ciprofloxacin whereas majority of GNB were resistant to Ciprofloxacin, Gentamycin,Ampicillin. Conclusion: This study needs to be conducted round the year to acquire more information regarding seasonal variation. Keywords: LRTI, Antibiotic susceptibility pattern, Sputum, GPB, GNB
Cytogenetic analysis of children with suspected genetic disorder
(Kathmandu University, 2009) Shrestha, U; Bhattacharya, S; Bhatta, NK; Jha, CB
Abstract Objectives: To analyze chromosomes in children with suspected genetic disorder and to categorize the chromosomal basis of genetic disorder Materials and methods: Thirty children were selected from the patients attending genetic clinic, Department of Pediatrics, B.P. Koirala Institute of Health Sciences presenting with dysmorphic feature, mental retardation, short stature, congenital malformations and ambiguous genitalia with age between 0-15 years. Cytogenetic analysis was carried using standard peripheral blood lymphocyte culture method and G-banding technique in Cytogenetic laboratory of Department of Anatomy, B.P. Koirala Institute of Health Sciences. Results: Chromosomal disorders were identified in 33.34% (10) of children. The most common chromosomal abnormality was Down syndrome (26.67%) followed by Turner syndrome (6.67%). Conclusion: The cytogenetic analysis of children with suspected chromosomal aberration is important to uncover the contribution of chromosomal disorder in genesis of dysmorphisms, mental retardation, short stature, sexual ambiguity and congenital malformation in children and prevent further potentially unpleasant investigation being undertaken. Key words: Chromosome, suspected genetic disorder, dysmorphic feature, mental retardation, short stature, congenital malformations, ambiguous genitalia
Drug Utilization Study in Outpatient Department of Ophthalmology in Tertiary Care Hospital
(Kathmandu University, 2022) Shrestha, U; Shakya Shrestha, S; Shrestha, A; Poudel, U; Manandhar Shrestha, JT
ABSTRACT Background The advancement in drug development and availability of newer drugs has improved overall health services including decrease in mortality and hospital stay. Along, it has brought negative impacts such as polypharmacy and associated adverse drug reactions and antimicrobial resistance. Drug utilization research is an essential approach to understand the drug use pattern, identify the early signs of such irrational drug use and to improve quality of drug use. Objective To study the drug utilization pattern in the Ophthalmology Outpatient department (OPD) of Dhulikhel Hospital, Kathmandu University Hospital (DH-KUH). Method A descriptive, cross sectional study was conducted from March 2019 to August 2019 in patients attending OPD of Ophthalmology in Dhulikhel Hospital, Kathmandu University Hospital. Prescriptions of 311 patients were analyzed using World Health Organization (WHO) International Network of Rational Use of Drug (INRUD) and additional other indices. The descriptive data was presented in mean and standard deviation. Result The average number of drugs per prescription was 2.10±1.35. Out of total 311 prescriptions, drugs prescribed in generic name were 152 (23.30%). Total antibiotics encountered were 247 (37.90%) and total drugs prescribed from National Essential Medicine List (NEML) were 371 (56.90%). Antibiotics 247 (37.90%) were the most commonly prescribed drugs followed by lubricants 146 (22.40%). Conclusion Practice of polypharmacy was very high. Most of the drugs were prescribed in brand names and antibiotics were the most frequently used drugs. KEY WORDS Drug utilization, Ophthalmology OPD, Rational drug use, WHO-INRUD
Indications of Cesarean Section in a rural referral Hospital
(Institute of Medicine, 2018) Aryal, B; Shrestha, U
Abstract Introduction: There is a huge difference in cesarean section rate between rural (3.5%) and urban (15%) areas of Nepal. The national CS rate is around 5% whereas global CS rate is 26%. The objective of this study is to find out the delivery profile and rate and indications of CS in a rural university hospital. Methods: This is a three -year’s retrospective cross-sectional study done from January 2016 to January 2019 (Magh 2072 to Poush 2075) at Karnali Academy of Health Sciences, Jumla. The data was retrieved from hospital birth profile records and analyzed using SPSS 20. Permission was taken from Institutional review committee (IRC) to conduct the study. Results: Total number of delivery during this period was 1841 out of which 172 were Cesarean delivery giving a CS rate of 9.3%. The most common indication of CS were fetal distress (33.7%), previous CS (9.3%), failed induction of labor (9.3%). Non progress of Labor (8.1%) and post term pregnancy (8.1%). Majority of the CS were done as an emergency procedure. Conclusion: The CS rate at KAHS teaching hospital was within WHO recommendation of between 5-15% and was very low in comparison to other centers situated in urban areas of the country. The indications of CS was also similar to the other national and international statistics. Key words: Cesarean section, Indications, Nepal, Maternal health, rural area, Global trends
Is computer assisted teaching effective on improving knowledge of preconception care? A hospital based study
(Institute of Medicine, 2017) Shrestha, U; Jacob, J
Abstract Introduction: Preconception care is any intervention provided to women and couples of childbearing age to improve health outcomes of women, newborns and children. Computer Assisted Teaching has been used for more than five decades for educational purposes. This study was done to assess the effectiveness of computer assisted teaching to improve knowledge of preconception care among married women in selected hospital at Bangalore. Methods: An evaluative approach with pre-experimental, one group pretest posttest design was selected and a judgmental sampling technique was used to select the samples for preconception care for married women in Seventh Day Adventist Multi Specialty Hospital, Bangalore. Pretest was done using structured knowledge questionnaire on knowledge of preconception care. After the pretest, computer assisted teaching was administered, and on the 8th day post test was conducted using the same questionnaire. The duration of study was one month. Results: The study revealed that, among 40 married women, during pretest, majority ie. 70% (28) were having inadequate knowledge and 27.5% (11) were having moderately adequate knowledge regarding preconception care. After administering computer assisted teaching on knowledge of preconception care, the post test result showed that majority of 97.5% (39) women gained adequate level of knowledge and no one had inadequate knowledge. Conclusion: The study concluded that there was overall 96.21% mean percentage knowledge regarding preconception care after administration of computer assisted teaching. This indicates that, computer assisted teaching is an effective teaching strategy in the education system, because this technique make study more interesting and easy to comprehend. Keywords: Preconception care, married women, computer, teaching, reproductive service clinic
Knowledge and Attitude of Undergraduate Students on Use of Topical Corticosteroids in a Medical School in Nepal: A cross-sectional study
(Kathmandu University, 2025) Shrestha, U; Shakya Shrestha, S; Shrestha Manandhar, JT; Shrestha, R
ABSTRACT Background Topical corticosteroids are widely used for their anti-inflammatory and immunosuppressive properties. However, proper knowledge of health professionals is key to appropriate and rational use of such topical corticosteroids to minimize multitude of their adverse effects. Objective To study knowledge and attitude of medical students regarding use of topical corticosteroid use. Method A cross-sectional study was conducted from September 2024 - November 2024, among the undergraduate students of Kathmandu University, School of Medical Sciences. A total of 387 students were included in the study. The students were surveyed using a structured questionnaire. Statistical analysis was performed using Statistical Package for Social Science version 21. Result Among 387 participants 217 (44.2%) were male and 171 (55.8%) were female. The mean (± SD) age of the patients was 21.73 years (± 2.06). The highest number of participants - 258 (66.7%) - were aware about atopic dermatitis as the most common indication of topical corticosteroids. Majority of the participants - 350 (90.4%) agreed that topical corticosteroids can cause cutaneous adverse effects. Similarly most of the participants 324 (83.7%) agreed that topical corticosteroids can produce systemic adverse effects as well. Likewise, most of the participants, 287 (74.2%), were aware of the fact that treatment with topical corticosteroids should not be stopped abruptly or without medical guidance. Conclusion Majority of the students had reasonable knowledge and attitude towards the use of Topical corticosteroids. However more than half were unaware of some topical adverse effects of Topical corticosteroids. Adequate educational training should be provided to future doctors regarding proper prescribing and usage of topical corticosteroids. KEY WORDS Adverse effects, Attitude, Knowledge, Medical students, Topical corticosteroids
Multiple arterial anomalies in upper limb
(Kathmandu University, 2009) Baral, P; Vijayabhaskar, P; Roy, S; Kumar, S; Ghimire, S; Shrestha, U
Abstract An isolated neurovascular variation is common but multiple vascular anomalies on same upper limb is a very rare case. We observed an unusual variations in right upper limb during routine dissection of a Nepali cadaver . The variations were observed in Axilla, Forearm and Palm. In axilla, first part of axillary artery did not give any branch, the second part of axillary artery gave off only two branches - (a) thoracoacromial artery and (b) a large common trunk which later gave off lateral thoracic, thoracodorsal, subscapular, posterior circumflex scapular and then continued as posterior circumflex humeral artery. The third part of axillary artery gave off only anterior circumflex humeral artery. In forearm, the ulnar artery runs downward superficial to flexor muscles. Here, radial artery gave off common interosseous artery. In palm radial artery did not give any contribution to superficial palmar arch which is solely formed by the continuation of ulnar artery. This type of anomalies are very rare and is not reported in Nepalese cadaver at all. These anomalies are described in detail and their clinical relevance is highlighted. Key words : Axillary artery, Brachial artery, Radial artery, Ulnar artery, Palmar arch, Variations
Perceptions and Attitudes towards Evidence Based Practice among Nurses and Nursing Students in Nepal
(Kathmandu University, 2015) Karki, S; Acharya, R; Budhwani, H; Shrestha, P; Chalise, P; Shrestha, U; Gautam, K; Wilson, L
ABSTRACT Background As the evidence based practice (EBP) movement expands, there is a need for health leaders and educators in each country to assess the extent to which health professional students and practitioners are prepared to locate, evaluate, and apply evidence to guide their practice. Objective The study objective was to explore nurses’ and nursing students’ perceptions and attitudes towards EBP. Method This was a descriptive cross-sectional survey administered to all 273 nurses and nursing students from Nepal who attended an EBP conference. The survey instrument that was used by Majid in Singapore was adapted for use in this study with permission from the author. Result In total, 121 nurses participated in the study. The majority (93%) of respondents reported that they had no previous training in EBP. The respondents’ perceptions of their EBP knowledge and skills were variable, but most of them demonstrated positive attitudes toward EBP. Respondents identified a number of barriers that limit the implementation of EBP in Nepal. The greatest barriers were lack of time and resources, difficulty understanding research articles and translating the findings to practice, and limited autonomy to change practice based on evidence. Conclusion Although respondents had positive attitudes towards EBP, their knowledge and skills were limited and barriers to implementation existed. Nursing faculty can use the findings to guide implementation of EBP into curricula, and nursing administrators and clinicians can use the findings to guide practice to promote EBP. KEY WORDS Evidence-based nursing, evidence-based practice, nursing research
Problems faced by clients and factors affecting post-operative recovery after open-heart surgery in selected hospitals in Kathmandu
(Institute of Medicine, 2017) Shrestha, U; Adhikary, GP
Abstract Introduction: Open-heart surgery is a stressfulcondition and people suffer from various physical, psychological, social and economic stress after open-heart surgery. These factors also affect the recovery and survival after the surgery. This is adescriptive purposive study among adult clients of two tertiary hospitals of Kathmandu with the objective of finding the problems faced by the clients and factors affecting post-operative recovery after open-heart surgery. Method: Population consisted of 50 clients who had already undergone open-heart surgery. A purposive sampling was done information collected on physical, psychological, social and economic problems using pre-tested structure questionnaire through interview method. The data was analyzed by descriptive and inferential statistics toidentify the association between research variables. Results: Fatigue and discomfort were the most frequently experienced physical complaints. The clients with less than 12 months post-operative period mainly suffered physical problems. Female clients mainly sufferedfrom psychological problems like sadness, anxiety, loss of interest and irritability. Inadequate interpersonal interaction, social and religious participation and the family support were major social tribulations that were significantly higher among female clients. Likewise, decreased follow-up frequency, family disputes and marital disharmony were chief problems due to financial constraints. Conclusion: This study concludes that clients suffer from a variety of problems associated to physical, psychological, social and economic aspects after open-heart surgery. For this reason, study strongly indicates the need for regular provision of educational sessions and proper counseling services to all clients including their families about these problems so that possible complications and the sufferings are less. Key words: open-heart surgery, client’s perception, post-operative recovery
Study on Patient’s Perception on Medication Counseling at Community Pharmacy in Sub-urban Area of Nepal
(Kathmandu University, 2022) Shrestha, U; Koju Shrestha, R; Biswokarma, AK; Koju, P; Shrestha, S; Shakya Shrestha, S
ABSTRACT Background Community pharmacists are the primary contact point in a healthcare system who provide medication information to the patients and enable them to make appropriate decision regarding their therapy. Hence, this study explored patients’ perception of community pharmacist based on medication counseling. Objective To study patient’s perception on medication counseling by community pharmacist at Manohara Municipality, Kathmandu, Nepal Method A cross sectional study was conducted from November 2020 to April 2021 in population visiting pharmacies of Kageshwori Manohara Municipality of Kathmandu valley. A total of 384 participants included in the study were surveyed using a structured questionnaire exploring the content of medication counseling, level of satisfaction on counseling and use of various means of counseling. Descriptive data were presented in frequencies and percentages using EXCEL 2016. Result This study enrolled 384 participants out of which 354, 92.19% received medication counseling. The main reason of pharmacy visit was to obtain over the counter medicines, 262, 68.23%. Majority of the participants rated satisfied with informations provided on use of medication 218, 56.77%, duration of therapy 261, 67.97%, about side effects 211, 54.95% and on action to be taken following side effects 246, 64.06%. Most of the participants rated satisfied with counseling on storage 189, 49.22% and for referral 250, 65.10% while 201, 52.34% participants rated highly satisfied with advice on lifestyle and dietary changes required. Conclusion This study concludes that the patients’ perception regarding the medication counseling by community pharmacist was acceptable. Thus pharmacists should be encouraged to support patients with their medication to promote patient care. KEY WORDS Community pharmacy, Medication counseling, Patient perception
Ultrasound Guided Stellate Ganglion Block with Dexmedetomidine as an Adjuvant in Complex Regional Pain Syndrome (CRPS)
(Kathmandu University, 2021) Shrestha, BR; Lama, S; Shrestha, U
ABSTRACT This is a case report of successful use of ultrasound for stellate ganglion (SG) blocks in CRPS I in 11 patients using local anesthetic bupivacaine with injection dexmedetomidine as an adjunct. Ultrasound helped us to deposit Local anesthetics in target area without any noticeable side effects and trauma to adjacent structures. KEY WORDS Block, Complex regional pain syndrome, Dexmedetomidine, Stellate ganglion, Ultrasound
Utilization and Completeness of World Health Organization Surgical Safety Checklist in a Tertiary Hospital in Nepal
(Kathmandu University, 2025) Shrestha, U; Ghimire, P; Khatri, G
ABSTRACT Background The World Health Organization Surgical Safety Checklist (WHO-SSC) reduces surgical complications and morbidity; however, its utilization remains low in low- and middle- income countries. Objective To assess the utilization and completeness of a modified WHO Surgical Safety Checklist at a tertiary hospital in Nepal. Method A descriptive, observational cross-sectional study was conducted in 300 surgeries at Kathmandu Medical College Teaching Hospital (February to May 2024) following ethical clearance. Utilization and completeness of the modified WHO Surgical Safety Checklist (Pre-procedure check, Sign-in, Time-out, Sign-out) were observed passively. Data were analyzed using Microsoft Excel and SPSS v 20. Data were presented in numbers and percentages and Chi-square/ Fisher’s exact test used for categorical variables. A p-value of < 0.05 was considered significant. Result WHO Surgical Safety Checklist was utilized in 48.7% of cases, with full compliance in only 8.7%. Utilization rate was seen to be 63% in the Pre-procedure check, while Sign-out was the least performed (29.3%). Highest utilization was seen in the General Surgery department, while the highest completion rate was seen in Neurosurgery (100%). Verbal confirmation (70.2%) was done more than written documentation. Conclusion Despite proven benefits, adherence to WHO Surgical Safety Checklist remains suboptimal. Targeted training and regular audits are essential to improve compliance and patient safety in resource-limited settings. KEY WORDS Completeness, Compliance, Utilization, WHO surgical safety checklist

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