NepMed Repository :: Browsing by Author "Tamrakar, D"

Browsing by Author "Tamrakar, D"

Now showing 1 - 19 of 19

A Community Based Cross Sectional Study to Estimate the Prevalence and Associated Factors of Hypertension in Rural Nepal
(Kathmandu Unversity, 2020) Chataut, J; Jonchhe, S; Tamrakar, D
ABSTRACT Background Hypertension is a major global public health problem because of its high prevalence as it significantly increases the risk of heart attack, stroke, kidney failure and blindness. Epidemiological shift in prevalence of non-communicable diseases have been observed in Nepal and it is also evident that hypertension and related complications are major contributors to death and disability in Nepal. Objective To estimate the prevalence and explore the associated factors of hypertension in study population. Method A community based cross-sectional study was conducted in rural population of Nepal with multistage sampling design. A total of 422 participants aged 18 to 65 years of age participated in the study. The information was obtained using pretested questionnaire which included demographic information of individuals and other risk factors like alcohol and tobacco use, physical activity. Anthropometric measurements and blood pressure was recorded and hypertension was defined as per JNC VII criteria. Result The overall prevalence of hypertension was 27.7% (male: 32.7%, female: 19.8%). Mean systolic and diastolic BP were 123.79 ± 12.46 mmHg and 81.56 ± 8.32 mmHg, respectively. Age (eldest age group, AOR=4.92: CI: 1.24-19.46), participants with lower level of education (higher education, AOR=0.173: CI: 0.05-0.53), ethnicity (Janajatis, AOR=2.85: CI: 1.44-5.65) and smoking (current smokers, AOR=10.30: CI: 4.39-24.16) are found to be significantly associated with hypertension. Conclusion This study showed the prevalence of hypertension is high in study population. Increasing age, low level of education, ethnicity and smoking were independent risk factors for hypertension. KEY WORDS Hypertension, Prevalence, Risk factor
Application of hAMRonization Tool in Investigating Anti-microbial Resistance Genes to Generate Harmonized Reports
(Kathmandu University, 2023) Katuwal, N; Tamrakar, D; Shrestha, R
ABSTRACT Background Antimicrobial resistance has become a serious threat to global public health, with the potential to cause significant morbidity and mortality. Therefore, the detection and surveillance of antimicrobial resistance genes are critical to monitor the prevalence of resistance and to guide appropriate treatment decisions. Several bioinformatics tools have been developed to facilitate the detection and investigation of antimicrobial resistance genes from sequencing data. However, these tools often require a significant amount of manual curation and provide results which can limit their intra-operability, accessibility and usability. This lack of standardization in the reporting of antimicrobial resistance genes investigation greatly hinders the comparison of results across the public health sector. Method This study focuses on the application of hAMRonize tool developed by Public Health Alliance for Genomic Epidemiology. In this study, we have implemented hAMRonization to evaluate antimicrobial resistance genes in Salmonella and compared to the results from other tools (ARIBA, RGI, amrfinderplus and abricate). Result We observed that hAMRonize was more comprehensive than other tools in predicting genes, including information on antimicrobials, drug classes, and start and end base pair of genes, among others. The hAMRonize tool also provided results in an interactive Hypertext Markup Language format. Conclusion hAMRonization is an innovative tool for investigating and sharing antimicrobial resistance data in the current field of research, where scientists use a plethora of prediction tools that provide different results and subsequent interpretations. KEY WORDS Antimicrobial resistance, Gene-prediction, hAMRonize
Associated Factors and Outcome of Babies Born Through Meconium Stained Amniotic Fluid
(Kathmandu University, 2018) Shrestha, A; Singh, SD; Tamrakar, D
ABSTRACT Background Neonates born through meconium stained amniotic fluid (MSAF) are associated with significant morbidity and mortality. Objective To study the incidence, associated factors and outcome of meconium stained amniotic fluid babies born in Dhulikhel hospital. Method Prospective, cross-sectional study conducted in Obstetric ward and Neonatal Intensive Care Unit (NICU) from 15 December 2015 to 15 December 2016. All the babies born through meconium stained amniotic fluid during the period were included. Result Incidence of meconium stained amniotic fluid was 6.5%(167/2581). Meconium aspiration syndrome (MAS) developed in 9(5.4%) among all meconium stained amniotic fluid cases. Primigravidity and postdatism were observed more in Meconium aspiration syndrome group than meconium stained amniotic fluid group (77.8% VS 73.4%; 33.3% VS 26.3%). Babies delivered by caesarian section were more in meconium stained amniotic fluid group than Meconium aspiration syndrome group (47.5% VS 33.3%). All the babies with meconium stained amniotic fluid improved except one baby with Meconium aspiration syndrome who expired. Neonatal sepsis was a significant co-morbidity in Meconium aspiration syndrome group (P value= 0.008). There was increased incidence of operative delivery in thick meconium stained amniotic fluid than thin meconium stained amniotic fluid (52.6% VS 38.9%). Similarly, Neonatal Intensive Care Unit admission and neonatal complications like Meconium aspiration syndrome, perinatal asphyxia and sepsis were more commonly observed in thick meconium stained amniotic fluid group than thin meconium stained amniotic fluid group. Conclusion The progression to meconium aspiration syndrome in babies with meconium stained amniotic fluid is not associated with any maternal and neonatal factors studied. MAS babies are 10 times more likely to require NICU admission and sepsis is a significant co-morbidity. Thick meconium stained amniotic fluid is worrisome. There is increased chance of operative delivery and neonatal complications if associated with thick meconium stained amniotic fluid. KEY WORDS Meconium, Meconium aspiration syndrome, Meconium stained amniotic fluid
COVID 19 Vaccine Breakthrough Infection among Health Care Workers
(Kathmandu University, 2023) Tamrakar, D; Katuwal, N; Adhikari, P; Banjara, M; Shrestha, N; Poudel, P; Shrestha, R
ABSTRACT Background Mass vaccination is considered the primary strategy for reducing the impact of COVID-19, and it has been implemented globally. Objective To study the extent of SARS-CoV-2 infection and breakthrough infection among the HCWs who were fully vaccinated for at least 14 days and investigated the relation between neutralizing antibody response and breakthrough infection. Method This study was a retrospective cohort study among health care workers at Dhulikhel Hospital Kathmandu University Hospital from December 2021 to October 2022. The interviews with semi structured questionnaire were conducted in person or over phone. Out of 1450 participants 137 fully vaccinated HCWs without breakthrough infection were randomly selected for the prospective serological cohort. Result Out of 1079 participants’ majority (51.8%) were of age 25-34 years. Two thirds (66.7%) were females. More than half of participant (54.7%) had infection with SARS-CoV-2 at least once whereas more than one third people (35%) had reported SARS-CoV-2 infection 14 days after receiving full vaccination. Infection after vaccination had less moderate and sever/critical illness and less need for hospitalization as compared to infection before vaccination. Staffs who were directly involved in patient care had higher chance of breakthrough infection compared to those not involved directly in patient care. Those who had prior infection or booster dose had relatively higher antibody level and participants with low level of antibody had higher chance for breakthrough infection (35.3%) than participants with moderate to high level of antibody (11.9%). Conclusion Vaccinations significantly decreased severe diseases and the need for hospitalizations. Breakthrough infection was higher among the health care workers involved in direct patient care and with low level of antibody. KEY WORDS Antibody level, Breakthrough infection, COVID 19, COVID 19 vaccination
Determination of Sex from the Foramen Magnum using 3DCT: A Nepalese Study
(Kathmandu University, 2017) Singh, PK; Tamrakar, D; Karki, S; Menezes, RG
ABSTRACT Background Identification is of utmost importance in any medicolegal investigation with sex determination being one of the principle indicators of identity. Sexing of bones becomes easy when the skeletal remains are complete. However, the problem arises when the bones are fragmented. Many researchers have undertaken several studies in different populations to determine the sex with reasonable accuracy using numerous measurements of the skull including those of the foramen magnum. Objective The present study was aimed to find the sexual dimorphism of the foramen magnum in the Nepalese population by analyzing the antero-posterior length, transverse diameter and area of the foramen magnum. Method The antero-posterior length and transverse diameter of the foramen magnum were measured using three-dimensional computed tomography (3DCT) images of the head in a cohort of 100 Nepalese subjects. Radinsky’s and Teixeria’s formulae were used to calculate the area of the foramen magnum. Discriminate function analysis was used to analyze sex differences. Result Mean values of antero-posterior length and transverse diameter of the foramen magnum in males were higher than in females. The mean of the area calculated using Radinsky’s formula was smaller than that calculated by Teixeira’s formula and the areas calculated were higher in males. The measurements of the foramen magnum and the areas calculated showed significant difference (p<0.001) between males and females. Discriminate function analysis for the measurements of the foramen magnum and the areas calculated showed high predictability for both the sexes. Discriminate function analysis showed a maximum predictability of 75%. Conclusion Considering the percent of predictability of sex from the various variables related to the foramen magnum in the Nepalese population, it can be concluded that its restricted applicability in forensic investigations should be constrained to cases of fragmentary skull bases. KEY WORDS Foramen magnum, forensic anthropology, identification, sex determination, sexual dimorphism
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, I
ABSTRACT 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, Symptoms
Discrepancies between Glycated Hemoglobin and Fasting Plasma Glucose in New-onset Diabetes Mellitus
(Kathmandu University, 2023) Tamrakar, R; Tamrakar, D; Katwal, P
ABSTRACT Background Fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) are commonly used for diagnosing diabetes mellitus in Nepal. Though HbA1c criteria are convenient for diagnosis there is a discrepancy between the fasting plasma glucose and HbA1c for diagnosis. Objective To assess the comparability between fasting plasma glucose and glycated hemoglobin levels in the new-onset diabetes mellitus. Method This is a hospital-based descriptive cross-sectional study including 128 newly diagnosed diabetes mellitus conducted at Dhulikhel Hospital, Kathmandu University Hospital. New onset diabetes patients above 18 years of age who met inclusion criteria were included. The clinical characteristics and biochemical parameters were analyzed. Statistical analysis was done using student’s t-test and correlation coefficient. Result There were 128 newly diagnosed diabetes mellitus patients included in the study among which 57.0% were males with a mean age of 49.48±11.40 years. The mean fasting plasma glucose, postprandial sugar (PPBS), and glycated hemoglobin were 205.54±88.93 mg/dL, 331.08±146.61 mg/dL, and 9.59±2.70% respectively. Diabetes was diagnosed using fasting plasma glucose, and glycated hemoglobin criteria in 84.4% and 90.6% of patients. In new-onset diabetic patients, 76.56% of patients had both elevated levels of fasting plasma glucose and glycated hemoglobin. Of the diabetic patients who had fasting plasma glucose ≥126 mg/dL, 90.7% of patients had HbA1c ≥ 6.5% whereas 1.6% of new-onset diabetes had < 126 mg/dL and glycated hemoglobin < 6.5%. There was a strong correlation between fasting plasma glucose and glycated hemoglobin (r=0.723; p<0.01). Conclusion Both fasting plasma glucose and glycated hemoglobin tests have to be used together for diagnosing diabetes mellitus. KEY WORDS Blood glucose, Diabetes mellitus, Glycated hemoglobin
Estimation of Causes of Death in Suburban Nepal Using Verbal Autopsy
(Kathmandu University, 2016) Ide, N; Fitzpatrick, AL; Flaxman, AD; Koju, R; Tamrakar, D; Hernandez, B
ABSTRACT Background Nepal is in the midst of a disease transition, including a rapid increase of non- communicable diseases. In order for health policy makers and planners to make informed programmatic and funding decisions, they need up to date and accurate data regarding cause of death throughout the country. Methods of improving cause of death reporting in Nepal are urgently required. Objective We sought to validate SmartVA-Analyze, an application which computer certifies verbal autopsies, to evaluate it as a method for collecting mortality data in Nepal. Method We conducted a medical record review of mortality cases at Dhulikhel Hospital, Kathmandu University Hospital. Cases with a verifiable underlying cause of death were used as gold standard reference cases. Verbal autopsies were conducted with caregivers of 48 gold standard cases. Result Of the 66 adult gold standard mortality cases reviewed, 76% were caused by cancer, cirrhosis, cardiovascular disease, COPD or injury. When assessing concordance between cause of death from verbal autopsy vs. gold standards, we found an overall agreement (Kappa) of 0.50. Kappa based on broader ICD-10 categories was 0.69. Cause-Specific Mortality Fraction Accuracy was 0.625, and disease specific measures of concordance varied widely, with sensitivities ranging from 0-100%. Conclusion Ongoing, countrywide mortality data collection is crucial for evidence-based priority setting in Nepal. Though not valid for all causes, we found SmartVA-Analyze to provide useful general cause of death data, particularly in settings where death certification is unavailable. KEY WORDS Cause of death, death certification, Nepal, SmartVA, verbal autopsy
First Reported Death of a Postpartum Woman Due to Coronavirus Disease 2019 in Nepal: A Lesson Learnt
(Kathmandu University, 2020) Shrestha, AP; Bhushal, N; Shrestha, A; Tamrakar, D; Adhikari, P; Shrestha, P; Shrestha, A; Karmacharya, B; Basnet, S; Tamrakar, SR; Shrestha, R; Shrestha, R
ABSTRACT The first case of coronavirus disease 2019 was reported on December 31, 2019 in Wuhan, China where the average case fatality rate was 6.1 ± 2.9%. There are 453 deaths as of September 24, 2020 in Nepal. We report the first death of a 29-years-old postpartum woman due to COVID-19 in Nepal who was referred from a rural health center to Dhulikhel Hospital. On arrival, she was taken to the acute respiratory zone of the emergency department to provide immediate lifesaving procedures. Despite the repeated resuscitative measures, return of spontaneous circulation could not be achieved. The real time polymerase chain reaction test was positive. Our case report highlights the importance of early clinical suspicion, importance of “safety first” in healthcare settings, and the chain of management in such patients. We consider the fact that a postpartum woman registered as the first case of COVID-19 related death in Nepal to be an area of further study. KEY WORDS Coronavirus, Emergency department, Personal protective equipment, Postpartum death, Real time polymerase chain reaction, Resuscitation
Knowledge, Attitude and Practice Regarding Environmental Tobacco Smoke among Pregnant Women of Sunsari
(Kathmandu University, 2018) Khanal, VK; Budhathoki, SS; Nath, M; Tamrakar, D; Pokharel, HP; Shrestha, A; Pokharel, PK
ABSTRACT Background Second hand tobacco smoke or Environmental Tobacco Smoke (ETS), contains toxic substances and carcinogens that cause serious health effects in humans. Studies show that ETS exposure during pregnancy is injurious to the mother-infant pair with long term consequences. Limited studies are found in context of ETS in pregnancy in Nepal. Objective To explore the knowledge about harmful effect of ETS exposure in pregnant women and to know the behavior of avoidance from exposure to ETS during pregnancy. Method A cross sectional study was conducted among 303 pregnant women attending antenatal clinics at the District Hospital Inaruwa and BPKIHS Dharan. A pre-tested semi-structured questionnaire was used to collect data regarding socio-demographic characteristics, knowledge, attitude and practice regarding Environmental tobacco smoke. Data was entered in Excel and analyzed in SPSS 11.5. Result The mean age of the respondents was 23.86±4.68 years. The proportion of primi- gravida was 53.5% and multi-gravida was 46.5%. Among the respondents, 14% were illiterate and 91% were unemployed. A similar proportion of the husbands (12%) were illiterate. Three-fourth (75%) of the respondents lived in joint family. It was found that 86% of their husbands were smokers. There were 61% of pregnant women who had heard about ETS, mainly through television (35%) and radio (30%). There was 86% of the households who had initiated some measures to prevent smoking inside the house. Conclusion The pregnant women in this study are aware about ETS. However a significant number of them believe that ETS is not harmful compared to active smoking. There is a need for further studies to identify interventions to avoid ETS exposure among the pregnant women. KEY WORDS Knowledge attitude practice, Environmental tobacco smoke in Nepal, Pregnant women
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, SK
ABSTRACT 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 disease
Molecular Investigation of Dengue Virus Serotypes in the Dengue Outbreak of 2022 in Nepal
(Kathmandu University, 2024) Katuwal, N; Shrestha, A; Ranjitkar, U; Jakibanjar, S; Madhup, SK; Tamrakar, D; Shrestha, R
ABSTRACT Background Dengue, a viral infection highly prevalent in tropical regions, exhibits local variations in risks that are influenced by a combination of climatic, socioeconomic, and environmental factors. It is caused by four distinct, yet closely related serotypes of the dengue virus. Objective To identify the different serotypes of dengue virus responsible for the 2022 outbreak in Nepal, where dengue has been prevalent since 2006 but with limited availability of molecular information on the serotypes. Method Serum samples from suspected dengue patients visiting Dhulikhel Hospital were analyzed using Dengue Rapid Test, for the presence of IgG/IgM antibodies or NS1 Ag. The positive samples were stored at -80⁰C, and 89 samples were selected for further analysis. RNA was extracted from those positive samples and RT-PCR was performed to identify the serotypes present. Result A higher percentage of sero-positivity was observed in females(52%) compared to males. Positive cases were distributed in 14 different districts, with the highest percentage(58.4%) in Kavre. RT-PCR, of 53 out of 89 serologically positive samples, by RT-PCR revealed that DENV1 was the predominant, followed by DEN3(24.5%) and DENV2(16.9%). DENV4 was not detected in any of the samples. The average Ct-value of all serotypes was 17.6, with DENV3 having the lowest Ct-value of 16.6, indicating slightly higher viremia. Conclusion Our study, although limited in its coverage of Nepal, has provided molecular information on the serotypes responsible for the 2022 dengue outbreak. The high prevalence of DENV1 was observed, while prevalence of DENV3 was accompanied by high viral load. KEY WORDS Dengue virus, Molecular, Serotypes, Nepal
Nepali Translation and Reliability Analysis of Quantitative Androgen Deficiency in the Aging Male Questionnaire
(Kathmandu University, 2020) Risal, P; Maharjan, A; Bhatt, RD; Tamrakar, D
ABSTRACT Background Androgen deficiency is diagnosed on the basis of clinical symptoms and laboratory assessment of testosterone level. Different screening tools have been developed to evaluate the sign and symptoms. Objective In this study, we examine the validity and reliability of the Nepali version of the quantitative Androgen Deficiency in Aging Male (qADAM) questionnaire to screen androgen deficiency in Nepali male. Method English dialectal quantitative Androgen Deficiency in Aging Male questionnaire was forward translated to Nepali version and backward translated. This version was reviewed by a panel of an endocrinologist, a clinical psychiatrist, a physician, and a clinical biochemist. A final Nepali version of qADAM was developed. Thirty-one healthy male aged 31-70 years were administered with the questionnaire in two separate occasions two weeks apart. Cronbach’s alpha and test-retest reliability were calculated to identify validity and reliability, respectively. Result In the Nepali translated questionnaire, Cronbach’s alpha for internal consistency from ten items is good (0.68). The Cronbach’s alpha for internal consistency from nine items without item 7 is 0.706. Seven out of ten items had an R-value of > 0.7. In the total sample, Standard Error Mean (SEM) ranged from 0.00-0.44 for qADAM. SEM% are low for all variables (0.00-11.20%). MDC95 ranged 0.00-1.234. MDC95% ranged 0.00 – 31.05% and was < 30% for majority of variables (90%). Conclusion The final translated Nepali questionnaire seems reliable and valid. A future study measuring the Nepali questionnaire with testosterone level and another biochemical test in control and androgen deficiency patients will help validate the questionnaire. KEY WORDS Nepali translation, qADAM, Reliability analysis
Outbreak of Cholera in Tilathi VDC Saptari Nepal
(Kathmandu University, 2012) Yadav, DK; Tamrakar, D; Baral, R; Jha, P; Gautam, S; Pokharel, PK
ABSTRACT Background On 2011, Cluster of cholera cases was reported in the Tilathi VDC of Saptari, Nepal. Objective The outbreak was investigated to identify the etiological agent and possible source of infection and guiding the prevention and control measures. Methods Demographic and clinical details were collected from the suspected case-patients, and the outbreak was described by time, place, and person. Focus group discussion and Key informant interview were conducted to assess the practice of sanitation, source of drinking water and probable cause of diarrheal disease. Five stool samples and 10 water samples of tube well and ponds were collected and microbiological study was done in BPKIHS Dharan. Results A total of 111 persons suffered with diarrhea and 02 died of it (attack rate 3.05%, case fatality rate 1.8%). All age groups were affected with disease (median age 26 yrs) and males were affected more than females. Descriptive epidemiology suggested the clustering of cases were around the pond where they clean utensils, take bath and wash clothes. The Vibrio cholerae 01 El Tor, Ogawa serotype was isolated in 03 out of 05 suspected stool samples and in all three of the pond water samples. They reported that most of the houses do not have the toilet and people do not wash their hands regularly with soap and water after defecation. Conclusion Vibrio cholerae was the causative agent behind the outbreak and probable source of infection was the problematic pond water which they used for different purpose. Immediate chlorination of the pond was recommended to halt further spread of the epidemics. KEY WORDS Cholera, outbreak, tilathi, saptari
Prevalence of Metabolic Syndrome in Newly Diagnosed Type 2 Diabetes Mellitus
(Kathmandu University, 2019) Tamrakar, R; Shrestha, A; Tamrakar, D
ABSTRACT Background The clustering of risk factors in metabolic syndrome increases the risk of atherosclerotic cardiovascular disease and all-cause mortality. The prevalence of coronary heart disease is high in diabetic patients with metabolic syndrome than non diabetic patients with metabolic syndrome. Objective To determine the prevalence of metabolic syndrome in new onset Type 2 Diabetes Mellitus (T2DM) and to study the risk components of metabolic syndrome. Method This is a hospital based cross sectional study conducted in 132 newly diagnosed T2DM patients at Dhulikhel Hospital, Kathmandu University Hospital in Nepal in 2018. The socio-demographic profile, clinical characteristics, and biochemical parameters were analyzed to study the prevalence, risk factors, and concordance between various definitions of metabolic syndrome. Statistical analysis was done using Student’s t-test, Chi-square test and Kappa statistics. Result One hundred and thirty two newly diagnosed T2DM patients were included in the study. Majority of the patients (58.9%) were in the age group of 40-60 years with the mean age of 49.72±12.44 years. The prevalence of metabolic syndrome was 111 (84.1%), 106 (80.3.%), 94 (71.2%) and 82 (62.1%) using World Health Organization(WHO), Harmonized, National Cholesterol Education Program-Adult Treatment Panel III (NCEP ATP III) and International Diabetes Federation (IDF) definitions respectively. One hundred and six patients (80.3%) had 3 or more individual components of metabolic syndrome. There was substantial agreement between NCEP ATP III-Harmonized (k=0.714, p<0.001) and Harmonized-WHO (k=0.716, p<0.001) definitions for diagnosing metabolic syndrome. The increased prevalence of metabolic syndrome in females than males is due to increased prevalence of abdominal obesity (p<0.05), dyslipidemia (low HDL cholesterol (p<0.05)) and presence of diabetes. Conclusion The prevalence of metabolic syndrome in newly diagnosed T2DM is high in the Nepalese population. The central obesity and low HDL cholesterol were significant risk factors in female diabetic patients predisposing to metabolic syndrome. KEY WORDS Metabolic syndrome, Prevalence, Type 2 diabetes mellitus
Seroprevalence of Scrub Typhus in Patients Attending Dhulikhel Hospital, Kavre
(Kathmandu University, 2021) Madhup, SK; Shrestha, R; Katuwal, N; Magar, SR; Shrestha, S; Bhandari, S; Tamrakar, D
ABSTRACT Background Scrub typhus is a largely ignored tropical disease and a leading cause of undifferentiated febrile illness. It is caused by Orientia tsutsugamushi. Scrub Typhus is frequently observed in South Asian countries. However, clear epidemiological information of this disease is lacking in case of Nepal. Nepal has shown steady increase in cases of Scrub Typhus since 2015. The epidemiological data related to this disease would support the decision making and surveillance design for early outbreak detection and immediate responses including prevention and treatment of scrub typhus in Nepal. Objective To understand prevalence of Scrub Typhus in subjects who had visited outpatient department at Dhulikhel Hospital. Method In this study, we have studied antibody test data (n=784) for Scrub Typhus from 2019 to 2021. The tests were performed on serum samples of patients who had visited OPD at Dhulikhel Hospital with fever lasting more than 5 days. The kit used in analysis was Scrub Typhus Detect™ IgM ELISA Kit from InBios International. Result Out of the total subjects (n=784), 133 were positive (16.9%) for IgM antibody of Scrub Typhus. The positivity in female (18.6%) was higher than the male subjects (15.3%). The positivity rate was variable among the different age groups, with highest positivity for age group 0-14 years (25%). The seasonal variation was also observed among the seropositive cases. Conclusion Scrub Typhus being a neglected tropical disease has high prevalence. It can be postulated that female subjects and subjects of age group 0-14 years are vulnerable to the infection with Scrub Typhus. There is need to increase the surveillance of Scrub Typhus to add the knowledge for diagnosis and treatment. KEY WORDS ELISA, IgM, Scrub Typhus, Seroprevalence
Virologic Response Following a Switch to Dolutegravir-based Regimen in People Living with HIV/AIDS at a Tertiary Care Center in Nepal
(Kathmandu University, 2022) Tamrakar, R; Tamrakar, D
ABSTRACT Background The dolutegravir-based antiretroviral regimen is the preferred first-line regimen for the management of people living with human immunodeficiency virus in Nepal recently. It is considered safe to transition to a dolutegravir-based regimen for children and adults on Nevirapine and Efavirenz-based regimens. Objective To determine the virologic response following the transition to a Dolutegravir-based regimen in people living with human immunodeficiency virus previously taking Nevirapine and Efavirenz-based regimen. Method This is a retrospective cohort study including people living with human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) who were transitioned to Tenofovir/Lamivudine/Dolutegravir previously on other antiretroviral therapy regimens for at least 6 months and who had their viral load test done before transition. The medical records of patients were reviewed from records available at the antiretroviral therapy clinic of Dhulikhel Hospital. The viral load done at least 3 months after switching to the Dolutegravir-based regimen was recorded. Descriptive analysis of socio-demographic and clinical characteristics data was done. Result Fifty-seven people living with human immunodeficiency virus/ acquired immunodeficiency syndrome who transitioned to a Dolutegravir-based regimen previously on other antiretroviral therapy regimens for at least 6 months were included in this study. Tenofovir/Lamivudine/Efavirenz (47.4%), Zidovudine/ Lamivudine/Nevirapine (22.8%) and Zidovudine/Lamivudine/Efavirenz (17.5%) were the most common antiretroviral regimens before transition. The majority of the patients (86%) had suppressed viral load of fewer than 40 copies/mL before the switch. Following the transition, 96.5% of the patients had suppressed viral load of fewer than 40 copies/mL. Conclusion Dolutegravir-based antiretroviral regimen led to untransmittable viral load following a switch from Nevirapine and Efavirenz-based regimen. KEY WORDS Antiretroviral therapy, Dolutegravir, Human immunodeficiency virus, Viral load
Virological and Immunological Status of the People Living with HIV Undertaking Highly Active Antiretroviral Therapy
(Kathmandu University, 2019) Tamrakar, R; Tamrakar, D; Shrestha, S; Shrestha, A
ABSTRACT Background The major goal of antiretroviral therapy (ART) is immunological recovery and virological suppression. Immunological and virological response in People Living with HIV (PLHIV) undertaking ART has to be monitored to assess the treatment response, diagnosing treatment failure and switching antiretroviral therapy. Objective To assess the immunological and virological response to antiretroviral therapy among Human Immunodeficiency Virus (HIV) infected individuals. Method This is a cross-sectional study including people living with HIV (PLHIV) taking antiretroviral therapy for at least 6 months and was conducted in Dhulikhel Hospital in 2017. The socio-demographic profile, clinical characteristics, CD4 count and viral load were analyzed. Descriptive analysis of socio-demographic and other characteristics was done. Result Fifty-two patients undertaking antiretroviral therapy were included in the study with the mean age of 29.69±9.59 years at diagnosis. The majority of the patients were male (51.9%). Sexual transmission was the dominant mode of transmission (78.9%). The mean CD4 count at baseline was 244.08±214.32 cells/μL. Four patients (7.7%) had a virological failure. There was a discordance between immunological and virological response in patients taking antiretroviral therapy for more than 2 years’ duration with four patients with a recent CD4 count of ≤250 cells/μL had virological suppression. The mean CD4 count at treatment increased from 229.65 cells/μL to 453.33 cells/μL after 1 year of commencement of antiretroviral therapy (p<0.001). Conclusion There are optimal CD4 recovery and virological suppression as expected with antiretroviral therapy use. KEY WORDS Antiretroviral therapy, CD4, Human immunodeficiency virus, Viral load
Whole Genome Sequence Analysis to Identify SARS-CoV-2 Variant in Nepal
(Kathmandu University, 2021) Shrestha, R; Katuwal, N; Adhikari, N; Vanaerschot, M; Tamrakar, D; Dhimal, M; Gyanwali, P; Bhattarai, S; Madhup, SK; Devkota, B
ABSTRACT Background The spread of SARS-CoV-2 has become a global public health crisis. Nepal is facing the second wave of COVID-19 pandemic but, there is still a limited data on the genomic sequence of SARS-CoV-2 variants circulating in Nepal. Objective The objective of this study is to sequence the whole genome of SARS-CoV-2 in Nepal to detect possible mutation profiles and phylogenetic lineages of circulating SARS- CoV-2 variants. Method In this study, swab samples tested positive for SARS-CoV-2 were investigated. After RNA extraction, the investigation was performed through real-time PCR followed by whole genome sequencing. The consensus genome sequences were, then, analyzed with appropriate bioinformatics tools. Result Sequence analysis of two SARS-CoV-2 genomes from patient without travel history (Patient A1 and A2) were found to be of lineage B.1.1. Similarly, among other four samples from subjects returning from the United Kingdom, genomes of two samples were of lineage B.1.36, and the other two were of lineage B.1.1.7 (Alpha Variant). The mutations in the consensus genomes contained the defining mutations of the respective lineages of SARS-CoV-2. Conclusion We confirmed two genomic sequences of variant of concern VOC-202012/01 in Nepal. Our study provides the concise genomic evidence for spread of different lineages of SARS-CoV-2 – B.1.1, B.1.36 and B.1.1.7 of SARS-CoV-2 in Nepal. KEY WORDS COVID-19, Nepal, SARS-CoV-2, Variant of concern, Whole genome sequencing

Browsing by Author "Tamrakar, D"

Results Per Page

Sort Options