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  1. Article: Interventions to address antimicrobial resistance: an ethical analysis of key tensions and how they apply in low- income and middle-income countries.

    Pokharel, Sunil / Adhikari, Bipin / Johnson, Tess / Cheah, Phaik Yeong

    BMJ global health

    2024  Volume 9, Issue 4

    Abstract: Antimicrobial resistance (AMR) is a global health and one health problem. Efforts to mitigate the problem of AMR are challenging to implement due to unresolved ethical tensions. We present an in-depth ethical analysis of tensions that might hinder ... ...

    Abstract Antimicrobial resistance (AMR) is a global health and one health problem. Efforts to mitigate the problem of AMR are challenging to implement due to unresolved ethical tensions. We present an in-depth ethical analysis of tensions that might hinder efforts to address AMR. First, there is a tension between access and excess in the current population: addressing lack of access requires facilitating use of antimicrobials for some populations, while addressing excessive use for other populations. Second, there is a tension between personal interests and a wider, shared interest in curbing AMR. These personal interests can be viewed from the perspective of individuals seeking care and healthcare providers whose livelihoods depend on using or selling antimicrobials and who profit from the sales and use of antimicrobials. Third, there is a tension between the interests of current populations and the interests of future generations. Last, there is a tension between addressing immediate health threats such as pandemics, and AMR as a 'silent', chronic threat. For each of these tensions, we apply 'descriptive ethics' methods that draw from existing evidence and our experiences living and working in low-income and middle-income countries to highlight how these ethical tensions apply in such settings.
    MeSH term(s) Humans ; Anti-Bacterial Agents/therapeutic use ; Drug Resistance, Bacterial ; Developing Countries ; Anti-Infective Agents ; Ethical Analysis
    Chemical Substances Anti-Bacterial Agents ; Anti-Infective Agents
    Language English
    Publishing date 2024-04-03
    Publishing country England
    Document type Journal Article ; Review
    ISSN 2059-7908
    ISSN 2059-7908
    DOI 10.1136/bmjgh-2023-012874
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Juvenile sialidosis: a rare case and review of the literature.

    Pokharel, Pashupati / Dawadi, Aakriti / Baral, Biraj / Dhungana, Sunil / Baskota, Arati / Poudel, Daman Raj

    Annals of medicine and surgery (2012)

    2024  Volume 86, Issue 4, Page(s) 2248–2252

    Abstract: Background: Sialidosis is a rare variety of lysosomal storage disease that results in intracellular accumulation of sialic acid containing compounds. The authors report the first case of type II sialidosis, juvenile subtype in a 30-month-old male child ... ...

    Abstract Background: Sialidosis is a rare variety of lysosomal storage disease that results in intracellular accumulation of sialic acid containing compounds. The authors report the first case of type II sialidosis, juvenile subtype in a 30-month-old male child from Nepal.
    Case presentation: Progressive hearing loss with coarse facies, hepatomegaly, kyphoscoliosis, dysostosis multiplex were the major features in a 30-month-old child born to healthy non-consanguineous parents. With the suspicion of lysosomal storage disease, urinary oligosaccharides were tested and were positive. Whole-exome sequencing revealed a mutation in the neuraminidase gene (NEU1) and established the diagnosis of sialidosis.
    Clinical discussion: Sialidosis is a rare autosomal recessive type of lysosomal storage disease resulting due to mutation of the neuraminidase gene leading to intracellular accumulation of sialic acid compounds. Based on the presence of visual symptoms, sialidosis is classified into type I and II varieties. Our case is of type II juvenile sialidosis.
    Conclusion: Despite rare, sialidosis is a life-threatening, and disabling disease. Exploring targeted therapy is the utmost to treat this condition.
    Language English
    Publishing date 2024-02-28
    Publishing country England
    Document type Case Reports
    ZDB-ID 2745440-X
    ISSN 2049-0801
    ISSN 2049-0801
    DOI 10.1097/MS9.0000000000001768
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Readmission for Morbidities among Postpartum Women in a Tertiary Hospital of Kathmandu

    Bijay Ojha / Sunil Mani Pokharel / Ajita Silwal

    Journal of Karnali Academy of Health Sciences, Vol 6, Iss

    2023  Volume 2

    Abstract: Background: Postpartum period is a critical stage where the majority of the maternal mortality occurs. Major obstetric morbidities during this period include postpartum haemorrhage, puerperal pyrexia, and sepsis, and pregnancy induced hypertension. The ... ...

    Abstract Background: Postpartum period is a critical stage where the majority of the maternal mortality occurs. Major obstetric morbidities during this period include postpartum haemorrhage, puerperal pyrexia, and sepsis, and pregnancy induced hypertension. The objective of this study was to find out the morbidities in postpartum women readmitted following discharge from the hospital after delivery. Methods: It was conducted as a hospital-based descriptive study at Paropakar Maternity and Women’s Hospital (PMWH), Thapathali, Kathmandu. Ethical clearance was obtained from Institutional Review Board (IRB) of National Academy of Medical Sciences (NAMS). The total population enumeration technique was used to collect the data for a period of three months. A Standard Performa containing socio demographic characteristics, causes of readmission, complications during pregnancy, time interval of readmission and outcome of readmission was prepared which include relevant points according to the objective of the study. Data analysis was done using the Statistical Package for Social Sciences 16. Descriptive statistics (frequency, percent, mean, standard deviation and range) were used to analyse the data. Results: The incidence of postpartum readmission was 1.0% of total deliveries with 58 women being readmitted. More than two-fifth (29, 43.9%) were readmitted due to abdominal and perineal wound infections followed by urinary tract infections (8, 12.1%). Hypertension, puerperal pyrexia, secondary postpartum haemorrhage were other conditions requiring readmission in postpartum period. Conclusion: The study concluded that the women were readmitted during their postpartum period for multiple causes, wound infection being the most common. The quality of postnatal care including proper examination before discharge is necessary to ensure reduction in the readmission rate.
    Keywords Morbidities ; Postpartum ; Readmission ; Medicine (General) ; R5-920
    Subject code 360
    Language English
    Publishing date 2023-08-01T00:00:00Z
    Publisher Karnali Academy of Health Sciences
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Antimicrobial resistance and over the counter use of drugs in Nepal.

    Pokharel, Sunil / Adhikari, Bipin

    Journal of global health

    2020  Volume 10, Issue 1, Page(s) 10360

    MeSH term(s) Anti-Bacterial Agents/therapeutic use ; Drug Resistance, Bacterial/drug effects ; Humans ; Nepal ; Nonprescription Drugs/therapeutic use
    Chemical Substances Anti-Bacterial Agents ; Nonprescription Drugs
    Keywords covid19
    Language English
    Publishing date 2020-07-06
    Publishing country Scotland
    Document type Journal Article ; Review
    ZDB-ID 2741629-X
    ISSN 2047-2986 ; 2047-2978
    ISSN (online) 2047-2986
    ISSN 2047-2978
    DOI 10.7189/jogh.10.010360
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Anterior Cruciate Ligament Injury among Patients with Knee Injury Visiting the Out-patient Department of Orthopaedics of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

    Pokharel, Sabin / Thapa, Sunil Singh / Lamichhane, Arjun Prasad

    JNMA; journal of the Nepal Medical Association

    2022  Volume 60, Issue 254, Page(s) 853–856

    Abstract: Introduction: Anterior cruciate ligament injury diagnoses are often missed at initial presentation. Though better diagnosed by physical examinations when done by orthopaedics surgeons, proper history is also important in diagnosing it. This study aimed ... ...

    Abstract Introduction: Anterior cruciate ligament injury diagnoses are often missed at initial presentation. Though better diagnosed by physical examinations when done by orthopaedics surgeons, proper history is also important in diagnosing it. This study aimed to find the prevalence of anterior cruciate ligament injury among patients with knee injury visiting the out-patient Department of Orthopaedics of a tertiary care centre.
    Methods: This descriptive cross-sectional study was conducted on patients visiting the out-patient Department of Orthopaedics of a tertiary care centre within the study period from 31 January 2019 to 1 February 2020, after obtaining clearance from the Institutional Review Committee [Reference number: 321(6-11-E)2/075/076]. The anterior cruciate ligament injury diagnosis was made using a Magnetic Resonance Imaging scan. They were inquired about the specific history features at the time of injury: leg giving way, inability to continue the activity, massive swelling of knee joint within 6 hours, and 'pop' heard or felt. Point estimate and 95% Confidence Interval were calculated.
    Results: Among 127 cases of knee injury, anterior cruciate ligament injury was found in 109 (85.83%) (79.76-91.89, 95% Confidence Interval). History of the leg giving way, inability to continue the activity, massive swelling of the knee and 'pop' heard or felt were present in 90 (82.60%), 92 (84.40%), 91 (83.50%), and 86 (78.90%) cases of anterior cruciate ligament injury respectively. At least two history features were present in 104 (95.41%) cases.
    Conclusions: The prevalence of anterior cruciate ligament injury was found to be similar to the published studies.
    Keywords: anterior cruciate ligament; diagnosis; history; orthopaedics.
    MeSH term(s) Humans ; Anterior Cruciate Ligament Injuries/epidemiology ; Anterior Cruciate Ligament Injuries/diagnosis ; Anterior Cruciate Ligament Injuries/surgery ; Cross-Sectional Studies ; Tertiary Care Centers ; Outpatients ; Orthopedics ; Knee Joint/diagnostic imaging ; Knee Joint/surgery ; Knee Injuries/diagnosis ; Knee Injuries/surgery
    Language English
    Publishing date 2022-10-01
    Publishing country Nepal
    Document type Journal Article
    ZDB-ID 2209910-4
    ISSN 1815-672X ; 0028-2715
    ISSN (online) 1815-672X
    ISSN 0028-2715
    DOI 10.31729/jnma.7402
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Tackling antimicrobial resistance in low-income and middle-income countries.

    Pokharel, Sunil / Raut, Shristi / Adhikari, Bipin

    BMJ global health

    2019  Volume 4, Issue 6, Page(s) e002104

    Language English
    Publishing date 2019-11-10
    Publishing country England
    Document type Editorial
    ISSN 2059-7908
    ISSN 2059-7908
    DOI 10.1136/bmjgh-2019-002104
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Antimicrobial use in food animals and human health: time to implement 'One Health' approach.

    Pokharel, Sunil / Shrestha, Priyanka / Adhikari, Bipin

    Antimicrobial resistance and infection control

    2020  Volume 9, Issue 1, Page(s) 181

    Abstract: The use of antimicrobials in animals for growth promotion and infection prevention significantly contributes to the development of antimicrobial resistance (AMR), a growing public health threat. While the World Health Organization (WHO), the United ... ...

    Abstract The use of antimicrobials in animals for growth promotion and infection prevention significantly contributes to the development of antimicrobial resistance (AMR), a growing public health threat. While the World Health Organization (WHO), the United Nations (UN) and the European Union (EU) have taken steps towards reducing and restricting the use of antimicrobials in animals, initiatives are insufficient in developing countries where the demands for food animals continue to rise over the years. The inter-sectoral acknowledgment of inextricable link between animal health, human health and the environment (One Health approach) is critical. Concerted and collaborative efforts among all the stakeholders are essential to deal with this complex problem of resistance.
    MeSH term(s) Animals ; Animals, Domestic/microbiology ; Anti-Infective Agents/pharmacology ; Drug Residues ; Drug Resistance, Microbial ; Humans ; One Health ; Public Health
    Chemical Substances Anti-Infective Agents
    Language English
    Publishing date 2020-11-07
    Publishing country England
    Document type Letter
    ZDB-ID 2666706-X
    ISSN 2047-2994 ; 2047-2994
    ISSN (online) 2047-2994
    ISSN 2047-2994
    DOI 10.1186/s13756-020-00847-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Tuberculosis among Patients Admitted to the Department of Medicine of a Tertiary Care Center in Nepal: A Descriptive Cross-sectional Study.

    Thapa, Suman / Bista, Anupam / Subedi, Prashant / Adhikari, Aaradhana / Pokharel, Sunil

    JNMA; journal of the Nepal Medical Association

    2021  Volume 59, Issue 238, Page(s) 531–536

    Abstract: Introduction: Tuberculosis has high burden in developing countries like Nepal. This study aims to determine the prevalence of tuberculosis among patients admitted in the department of medicine of a tertiary hospital.: Methods: A descriptive cross- ... ...

    Abstract Introduction: Tuberculosis has high burden in developing countries like Nepal. This study aims to determine the prevalence of tuberculosis among patients admitted in the department of medicine of a tertiary hospital.
    Methods: A descriptive cross-sectional study of all the patients admitted to the tertiary care hospital from 1st January 2017 to 31st December 2019 was done. Ethical approval was obtained from Institutional Review Committee (Ref: drs2006181387). Convenience sampling method was used. A descriptive analysis of demographic, clinical and laboratory profile of patients was made using Microsoft Excel version 2016. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.
    Results: Among 6829 patients admitted to the department of medicine, 209 (3.06%) (2.65-3.47 at 95% CI) patients were diagnosed with tuberculosis. Among them, 147 (70.33%) were males and the mean age was 49.77 years. Pulmonary and extra-pulmonary tuberculosis were present in 153 (73.20%) and 56 (26.79%) patients, respectively. Bacteriological confirmation was limited to 107 (70%) of pulmonary tuberculosis and 3 (5%) of extrapulmonary tuberculosis. Fever was the commonest presentation in 166 (79.42%) followed by cough in 164 (78.46%), anorexia in 108 (51.67%), weight loss 104 (49.76%), and others.
    Conclusions: The study showed that the prevalence of tuberculosis among admitted patients was higher than national prevalence.
    MeSH term(s) Cross-Sectional Studies ; Humans ; Male ; Middle Aged ; Nepal/epidemiology ; Prevalence ; Tertiary Care Centers ; Tuberculosis/diagnosis ; Tuberculosis/epidemiology
    Language English
    Publishing date 2021-07-01
    Publishing country Nepal
    Document type Journal Article
    ZDB-ID 2209910-4
    ISSN 1815-672X ; 0028-2715
    ISSN (online) 1815-672X
    ISSN 0028-2715
    DOI 10.31729/jnma.5938
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Arterial hypertension and its covariates among nomadic Raute hunter-gatherers of Western Nepal: a mixed-method study.

    Koirala, Tapendra / B C, Udaya Bahadur / Shrestha, Carmina / Paudel, Ujjawal / Dhital, Rolina / Pokharel, Sunil / Subedi, Madhusudan

    BMJ open

    2023  Volume 13, Issue 3, Page(s) e067312

    Abstract: Objectives: To determine the prevalence of, and understand the factors associated with, hypertension among the nomadic Raute hunter-gatherers of Western Nepal.: Design: A mixed-method study.: Setting: The study was carried out at Raute temporary ... ...

    Abstract Objectives: To determine the prevalence of, and understand the factors associated with, hypertension among the nomadic Raute hunter-gatherers of Western Nepal.
    Design: A mixed-method study.
    Setting: The study was carried out at Raute temporary campsites in the Surkhet District of Karnali Province between May and September 2021.
    Participants: The questionnaire-based survey included all males and non-pregnant females of the nomadic Raute group aged 15 years and above. In-depth interviews were conducted among purposively selected 15 Raute participants and four non-Raute key informants to help explain and enrich the quantitative findings.
    Outcome measures: The prevalence of hypertension (defined as brachial artery blood pressure of systolic ≥140 mm Hg and/or diastolic ≥90 mm Hg) and its sociodemographic, anthropometric and behavioural covariates.
    Results: Of the 85 eligible participants, 81 (median age 35 years (IQR: 26-51), 46.9% female) were included in the final analysis. Hypertension was found in 10.5% of females, 48.8% of males and 30.9% of the total population. Current alcohol and tobacco use were high (91.4% and 70.4%, respectively), with concerning high rates among youths. Males, older people, current drinkers and current tobacco users were more likely to have hypertension. Our qualitative analysis suggests that the traditional forest-based Raute economy is gradually transitioning into a cash-based one that heavily relies on government incentives. Consumption of commercial foods, drinks and tobacco products is increasing as their market involvement grows.
    Conclusion: This study found a high burden of hypertension, alcohol and tobacco use among nomadic Raute hunter-gatherers facing socioeconomic and dietary transitions. Further research is needed to assess the long-term impact of these changes on their health. This study is expected to help appraise concerned policymakers of an emerging health concern and formulate context-specific and culturally sensitive interventions to limit hypertension-related morbidities and mortalities in this endangered population.
    MeSH term(s) Male ; Adolescent ; Humans ; Female ; Aged ; Adult ; Nepal/epidemiology ; Cross-Sectional Studies ; Hypertension/epidemiology ; Alcohol Drinking/epidemiology ; Tobacco Use ; Prevalence ; Risk Factors
    Language English
    Publishing date 2023-03-30
    Publishing country England
    Document type Journal Article
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2022-067312
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Coronavirus Disease 2019 Pandemic - Public Health Preparedness in Nepal and One Health Approach.

    Pokharel, Sunil / Raut, Shristi / Rijal, Komal Raj / Adhikari, Bipin

    Disaster medicine and public health preparedness

    2020  Volume 15, Issue 5, Page(s) e1–e2

    MeSH term(s) COVID-19 ; Humans ; Nepal/epidemiology ; One Health ; Pandemics/prevention & control ; Public Health ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-05-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2375268-3
    ISSN 1938-744X ; 1935-7893
    ISSN (online) 1938-744X
    ISSN 1935-7893
    DOI 10.1017/dmp.2020.172
    Database MEDical Literature Analysis and Retrieval System OnLINE

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