Publications

2024

1. Synthesizing environmental, epidemiological and vector and parasite genetic data to assist decision making for disease elimination

   Himal Shrestha, Karen McCulloch, Rebecca H. Chisholm, and 7 more authors

   Molecular Ecology, Apr 2024

   Abs DOI

   Abstract We present a framework for identifying when conditions are favourable for transmission of vector‐borne diseases between communities by incorporating predicted disease prevalence mapping with landscape analysis of sociological, environmental and host/parasite genetic data. We explored the relationship between environmental features and gene flow of a filarial parasite of humans, Onchocerca volvulus , and its vector, blackflies in the genus Simulium . We generated a baseline microfilarial prevalence map from point estimates from 47 locations in the ecological transition separating the savannah and forest in Ghana, where transmission of O. volvulus persists despite onchocerciasis control efforts. We generated movement suitability maps based on environmental correlates with mitochondrial population structure of 164 parasites from 15 communities and 93 vectors from only four sampling sites, and compared these to the baseline prevalence map. Parasite genetic distance between sampling locations was significantly associated with elevation ( r  = .793, p  = .005) and soil moisture ( r  = .507, p  = .002), while vector genetic distance was associated with soil moisture ( r  = .788, p  = .0417) and precipitation ( r  = .835, p  = .0417). The correlation between baseline prevalence and parasite resistance surface maps was stronger than that between prevalence and vector resistance surface maps. The centre of the study area had high prevalence and suitability for parasite and vector gene flow, potentially contributing to persistent transmission and suggesting the importance of re‐evaluating transmission zone boundaries. With suitably dense sampling, this framework can help delineate transmission zones for onchocerciasis and would be translatable to other vector‐borne diseases.

2022

1. Consumer acceptance and preference for brown rice—A mixed‐method qualitative study from Nepal

   Pratiksha Gyawali, Dipesh Tamrakar, Abha Shrestha, and 8 more authors

   Food Science & Nutrition, Mar 2022

   DOI
2. Geospatial modeling of pre-intervention nodule prevalence of Onchocerca volvulus in Ethiopia as an aid to onchocerciasis elimination

   Himal Shrestha, Karen McCulloch, Shannon M. Hedtke, and 1 more author

   PLOS Neglected Tropical Diseases, Jul 2022

   Abs DOI

   Background Onchocerciasis is a neglected tropical filarial disease transmitted by the bites of blackflies, causing blindness and severe skin lesions. The change in focus for onchocerciasis management from control to elimination requires thorough mapping of pre-control endemicity to identify areas requiring interventions and to monitor progress. Onchocerca volvulus nodule prevalence in sub-Saharan Africa is spatially continuous and heterogeneous, and highly endemic areas may contribute to transmission in areas of low endemicity or vice-versa. Ethiopia is one such onchocerciasis-endemic country with heterogeneous O . volvulus nodule prevalence, and many districts are still unmapped despite their potential for onchocerciasis transmission. Methodology/Principle findings A Bayesian geostatistical model was fitted for retrospective pre-intervention nodule prevalence data collected from 916 unique sites and 35,077 people across Ethiopia. We used multiple environmental, socio-demographic, and climate variables to estimate the pre-intervention prevalence of O . volvulus nodules across Ethiopia and to explore their relationship with prevalence. Prevalence was high in southern and northwestern Ethiopia and low in Ethiopia’s central and eastern parts. Distance to the nearest river (RR: 0.9850, 95% BCI: 0.9751–0.995), precipitation seasonality (RR: 0.9837, 95% BCI: 0.9681–0.9995), and flow accumulation (RR: 0.9586, 95% BCI: 0.9321–0.9816) were negatively associated with O . volvulus nodule prevalence, while soil moisture (RR: 1.0218, 95% BCI: 1.0135–1.0302) was positively associated. The model estimated the number of pre-intervention cases of O . volvulus nodules in Ethiopia to be around 6.48 million (95% BCI: 3.53–13.04 million). Conclusions/Significance Nodule prevalence distribution was correlated with habitat suitability for vector breeding and associated biting behavior. The modeled pre-intervention prevalence can be used as a guide for determining priorities for elimination mapping in regions of Ethiopia that are currently unmapped, most of which have comparatively low infection prevalence.

2021

1. C-reactive Protein to Albumin Ratio among Patients Admitted to Intensive Care Unit of a Tertiary Care Hospital: A Descriptive Crosssectional Study

   Pratiksha Gyawali, Himal Shrestha, Vivek Pant, and 2 more authors

   Journal of Nepal Medical Association, Dec 2021

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   Introduction: Sepsis is the most common cause of mortality among patients admitted to intensive care unit. There is emerging evidence on the role of C-reactive protein to albumin ratio (C-reactive protein/Albumin) in predicting outcomes in patients with critical illness and sepsis, admitted to intensive care unit. We aimed to find out the median value of C-reactive protein/Albumin ratio among patients admitted to intensive care unit of a tertiary care hospital. Methods: We conducted a descriptive cross-sectional study of 110 critically ill patients (\textgreater18 years old) admitted to intensive care unit of Dhulikhel Hospital from April, 2014 to June, 2016. The ethical approval (Reference number.51/16) was obtained from Institutional Review Committee at Kathmandu University School of Medical Sciences. C-reactive protein/albumin ratio was calculated from records of patients admitted to the intensive care unit. Convenience sampling was done. Data were entered into Microsoft Excel and analysed using Statistical Package for Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequencies and percentages for binary data. Results: Among 110 patients admitted to the intensive care unit, the median value of C-reactive protein/Albumin ratio was found to be 3.4 (Interquartile range: 3.1-4.5). Out of these patients, 44 (39.5%) patients were septic and their median C-reactive protein/albumin ratio was 3.4 (Interquartile range: 3.1-4.5). Conclusions: Our study showed higher median C-reactive protein /Albumin similar to other studies. Sepsis is a common finding among patients admitted to intensive care unit. Monitoring of C-reactive protein/albumin level in a patient admitted to intensive care unit could be useful for stratifying patients with a high risk of developing sepsis.

2017

1. Adverse Effects of Oral Hypoglycemic Agents and Adherence to them among Patients with Type 2 Diabetes Mellitus in Nepal

   Jyoti Tara Manandhar Shrestha, Himal Shrestha, Miyasha Prajapati, and 2 more authors

   Journal of Lumbini Medical College, Jul 2017

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   Introduction: Oral hypoglycemic agents (OHAs) are the most common drugs used in Type 2 Diabetes Mellitus. There are various established adverse effects related to their use including hypoglycemia, weight gain, gastrointestinal disturbance, lactic acidosis, and fluid retention. However, the pattern of adverse effects related to OHAs in Nepalese patients still needs to be explored. Our study aims to determine the pattern of adverse effects resulting from the use of OHAs among Type 2 Diabetes mellitus patients and their adherence to the medication. Methods: All diabetic patients who met the inclusion criteria were enrolled in the study. After informed consent, patients were interviewed and evaluated as per the designed proforma. They were mainly studied for common drug used, adverse effects of the drugs, occurrence of hypoglycemia, and adherence to treatment. Results: The study comprised of 183 patients with mean age of 58.73 years (SD = 12.95). Fifty-six (30.6%) patients said that they developed adverse effects of drugs but only 21 (11.5%) of them reported to their treating physician. Most common adverse effect were related to central nervous system such as tingling sensation of hands and feet, dizziness, drowsiness, etc. Though 91 (49.7%) patients had developed symptoms suggestive of hypoglycemia, only 31 (16.9%) knew that it was due to hypoglycemia. Majority of the patients (n = 143, 78.1%) administered the drugs as prescribed by the physician. Among the defaulters, the most important reasons for failure to properly administer the drugs was forgetfulness in 82.5% (n = 33, N = 40) of cases. Among the study variables family history of chronic illness (p = 0.046) and information about adverse effects from physician (p = 0.001) had a significant relationship with incidence of adverse effects. Whereas none of them had a significant relationship with adherence to hypoglycemic medication. Conclusion: The incidence of adverse effects was high with hypoglycemia occurring in 49.7% of the cases, though only one-third of them recognized it to be due to hypoglycemia, in the patients with Type 2 Diabetes Mellitus. Family history of chronic illness and information about adverse effects from the physician had significant relationship with the incidence of adverse effects of hypoglycemic treatment. Journal of Lumbini Medical College Vol 5, No 1, Jan-June 2017, page: 34-40DOI: https://doi.org/10.22502/jlmc.v5i1.126

2. Experimental Study of Atmospheric Pressure Argon Plasma Jet−Induced Strand Breakage in Large DNA Molecules

   Rajendra Shrestha, Deepak P. Subedi, Sandeep Adhikari, and 3 more authors

   Plasma Medicine, Jul 2017

   DOI
3. Study of Adherence Pattern of Antidepressants in Patients with Depression

   J. Shrestha Manandhar, R. Shrestha, N. Basnet, and 4 more authors

   Kathmandu University medical journal (KUMJ), Mar 2017

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   Background Depression is one of the leading psychiatric disorders of the world affecting a person’s mood, physical health and behavior. It is not permanent and is neither a character flaw nor a lack in discipline for a person to be ashamed of. It is a disorder that is reliably diagnosed and successfully treated. Antidepressants are the standard and the most efficacious approach to treating people with depression. However, adherence to treatment is necessary for achieving effectiveness. The result of nonadherence is severe and may cause therapeutic failure resulting in poor quality of life. Objective To determine the medication adherence pattern in patients with depression and assess the factors associated with non-adherence to the prescribed antidepressant therapy. Method Patients meeting the inclusion criteria who were diagnosed with depression were taken for the study. Informed consent was taken from the patients or from their relatives in case of their incapability. They were then interviewed using structured questionnaire. Result Among the 60 patients included in the study, 78% of them were females. Most of the patients 43% (n=26) were prescribed with atypical antidepressants. Less number (37%) of the patients were adherent to the antidepressant therapy. 68% of the females were non adherent. 82% of housewives were not adherent to therapy. Forgetfulness was the main reason for missing dose in majority (50%) of the nonadherent patients. Conclusion Majority of the patients with depression were non-adherent to medication. Forgetfulness was the major reason for missing dose in these patients.