Browsing by Author "Subedi, Nuwadatta"
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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 Pattern of Injury and Computed Tomography Findings in Patients with Cranio-Cerebral Trauma(Rapti Academy of Health Sciences (RAHS), 2024) Bagale, Deepak; Pangeni, Roshan; Baral, Santosh; Subedi, NuwadattaAbstract: Introduction: Traumatic brain injury (TBI) is the leading cause of fatalities from trauma and the main cause of disability under the age of 40 years. The estimated incidence of TBI in Nepal slightly surpasses the global average of 369 per 100,000. This study aims to identify the types of head trauma and patterns of CT scan findings, which will be beneficial in managing the patients and modifying the treatment protocol accordingly. Methods: The study was conducted in the department of Radiology of Western Regional Hospital, Pokhara Academy of Health Sciences, from March to August 2024. This was a descriptive cross-sectional study conducted with 220 patients of all age groups coming for a CT scan of the head due to trauma to assess the causes and pattern of injuries. Results: The mean age of the patients was 37.29±21.75 years and males were twice in number compared to females. More than 50% of patients had head injuries from road traffic accidents and 48.18% had fall injuries. The CT scan findings demonstrated that scalp hematoma was seen in 61.36% and skull fracture in 29% of patients. Amongst intracranial findings, contusion was seen in 6.82% of patients, subdural haemorrhage in 5.91%, epidural haemorrhage in 3.64%, and subarachnoid haemorrhage in 2.73%. Conclusion: Almost 74% of people with head injuries who underwent a CT scan had some type of abnormal findings, where extra-cranial hematoma was more common than intracranial hematoma. Preventive strategies should be developed to minimize head injuries, and effective treatment planning is essential.Publication Perception and Attitude of Second-year Medical and Dental Students regarding the Use of a Problem-based Learning(Nepal Health Research Council, 2024) Bista, Soni; Paudel, Sabita; Shrestha, Bijayata; Subedi, Nuwadatta; Basnyat, Rupesh Shingh; Chettri, PradipBackgrounds: Problem-based learning (PBL) is a learner-centered pedagogical approach in which a person learns about a subject by working in groups to solve an open-ended problem. The objective of the present study was to assess students' perceptions and attitudes toward Problem-based learning and the role of tutors in Problem-based learning. Methods: This quantitative study was conducted among second-year medical and dental undergraduate students from November 2022 to November 2023. The students were divided into eight groups, and each group was facilitated by tutors. A Problem-based learning tutor guide, with a case on the topic of diarrhea/dysentery, was designed as a module with six triggers and given to the groups. At the end of nine days of PBL sessions, feedback from students on the process of Problem-based learning and tutors was received using the 'Dolmans and Schmidt' and 'Dolmans and Ginns' questionnaires, respectively. The level of attitude of the students based on their feedback toward the Problem-based learning process and the tutors were also assessed. The data were entered into Microsoft Excel, and descriptive analysis was performed using the Statistical Package for Social Sciences (SPSS), version 21. Results: Among the 79 responses received, 72 (92.4%) students gave a good rating of the process of Problem-based learning, indicating a favorable attitude. The participants agreed with the themes based on the influence of discussion, content tested, course objectives, lectures, tutors, and reference literature. Similarly, 63 (81%) students gave a good rating of the tutorials’ performance, suggesting a favorable attitude. They agreed that tutors facilitated active, self-directed, contextual, and collaborative learning. Conclusions: This study revealed the positive perceptions and attitudes of medical and dental undergraduate students regarding the PBL process and the role of tutors in Problem-based learning. The outcomes of this study have provided a foundation for implementing Problem-based learning in Nepal's medical and dental undergraduate curricula. Keywords: Dental education; diarrhea; dysentery; medical education; problem-based learning.Publication Unnatural Deaths among Autopsy Cases Brought at Tertiary Care Hospital of Western Nepal during COVID-19 Pandemic Period: A Descriptive Cross-sectional Study(Nepal Medical Association, 2021) Koirala, Santosh; Subedi, Krishna; Subedi, NuwadattaAbstract: Introduction: The outbreak of COVID-19 as changed patterns of mortality in different setups. The rate of suicide has increased in some countries during the pandemic while the overall death rates have decreased. The study was conducted with objective to find out the prevalence of unnatural deaths among the autopsy cases brought at tertiary care hospital during COVID-19 pandemic period. Methods: This is a descriptive cross-sectional study using the records of the medico legal autopsies conducted from 24th March 2020 to 23rd August 2020 during the COVID-19 pandemic in Pokhara Academy of Health Sciences. Ethical approval was taken from Institutional Review Committee of Pokhara Academy of Health Sciences (Reference number 28.2077/78). Whole sampling method was used. Records which were available were included in the study whereas those cases whose complete records were not available were excluded. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Results: Out of 188 deaths studied at the autopsy during the COVID-19 pandemic period, the prevalence of unnatural deaths was 147 (78.19%) (71.04-85.33 at 95% Confidence Interval). Among these deaths, 109 (74.14%) were males and 38 (25.85%) were females. Suicide was the most common manner attributing to 78 (53.06%) of the unnatural deaths. Conclusions: The prevalence of suicide was more than those demonstrated by earlier observations in similar settings before the pandemic period. Suicidal deaths were more common during the COVID 19 pandemic. This is an indicator of frustration of the people and necessary steps have to be taken to decrease such deaths in similar conditions to come.