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NepMed is a Nepal MEDLINE(Medical Literature Analysis and Retrieval System Online) by Nepal Health Research Council(NHRC). It includes bibliographic information for articles from academic biomedical journals covering medicine, dentistry, nursing, pharmacy, dentistry veterinary medicine, and allied health sciences.

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Article

Incarcerated inguinal hernia with adhered ileal loop: a case report

(Nepal Medical College Pvt. Ltd., 2025) Silwal, Mahesh

Abstract: About one-tenths of inguinal hernias become incarcerated, mainly secondary to benign causes. Incarcerated hernias are irreducible with intact blood supply to the contained part but might develop strangulation if not timely managed. Traditionally, open technique has been used to repair incarcerated or strangulated inguinal hernias, as it is probably the safest and the most expedient approach. A case of incarcerated inguinal hernia with adhered ileal loop, which is a rare finding, is reported in this article.

Article

Study on blakpc gene among klebsiella pneumoniae from the clinical specimens in a tertiary care hospital, Kathmandu, Nepal

(Nepal Medical College Pvt. Ltd., 2025) Khadka, Shusila; Adhikari, Ram Prasad; Khanal, Laxmi Kant; Pandey, Ritu; Sah, Anil Kumar; Sapkota, Jyotshna

Abstract: Multidrug resistance (MDR) among Klebsiella pneumoniae: a common nosocomial pathogen, has been a great concern for managing its infections effectively worldwide. Production of KPCs (Klebsiella pneumoniae carbapenemases) is one of the most important mechanisms in this bacterium, making it resistant to carbapenems: the most commonly used antibiotics for treating MDR organisms. This study was done to detect KPC genotypes (blaKPC-1, blaKPC-2, blaKPC-3) among K. pneumoniae isolates and to determine their antimicrobial susceptibility patterns.A descriptive cross-sectional study was conducted from September 2023 to February 2024 in a total of 82 non-repetitive clinical isolates of K. pneumoniae at Clinical Microbiology Laboratory of Nepal Medical College Teaching Hospital (NMCTH), Nepal. More than one-third (30/82; 36.58%) of the isolates were MDR. Out of the total isolates, 18 (21.95%) were resistant to carbapenems. Of these, 14 (77.77%) isolates possessed blaKPC-2 gene. All isolates were susceptible to Polymyxin and Colistin sulphate. Almost half of the isolates were resistant to Cephalophorins (Cefixime- 43.90%, Ceftriaxone-41.0% and Ceftazidime-43.9%). Presence of KPC producing K. pneumoniae isolates in our set-up, with higher level of resistance to multiple antibiotics highlights the need for continuous monitoring and endorsement of control strategies to tackle the challenges created by this bacterial pathogen.

Article

Secondary bacterial infection in clinically suspected cases of pulmonary tuberculosis and their antibiotic sensitivity pattern

(Nepal Medical College Pvt. Ltd., 2025) Shrestha, Rajani; Nayak, Niranjan; Jwarchan, Bishnu; Gauchan, Eva; Gokhale, Shishir

Abstract: Secondary bacterial infection has become one of the most important complications in patients suffering with pulmonary tuberculosis (PTB). The suppression of immunity, which can occur due to T-lymphocyte deficiency during active PTB disease, could be the main reason for the bacterial superadded infections. This aimed to evaluate tuberculosis (TB) status and secondary bacterial infections among them. A total of 400 sputum samples were collected and examined using Ziehl-Neelsen staining method as per revised national tuberculosis control program guidelines and GeneXpert following the WHO guidelines. Those sputum samples were also processed for routine bacterial culture and bacteria were identified by conventional techniques. Antimicrobial sensitivity testing was performed on Mueller-Hinton agar plates with commercially available antibiotic discs using Kirby-Bauer disc diffusion techniques and interpreted as per the guidelines of Clinical and Laboratory Standards Institute (CLSI). A total of 44 (11.0%) samples out of 400 yielded tuberculosis by GeneXpert assay and maximum positivity was noted among the age group 46-60 years (20.4%). The present study showed GeneXpert positivity for the MTB detected rate remained to be 11.0 % (44/400) detected as against smear positivity in only 7.5% (30/400) and this difference was found to be statistically significant (p<0.001). Overall, 220 (55.0%) secondary bacterial pathogens were isolated. Gram negative bacterial infection was most common. Of them, Klebsiella pneumoniae (33.63%; 74/220) was the commonest organism followed by Acinetobacter spp. (30%;66/220) and Pseudomonas aeruginosa (18%; 40/220). Streptococcus pneumoniae (6.36%; 14/220) was the commonest among the gram-positive bacteria. Majority (54.0%) of Klebsiella spp. showed resistance to Ciprofloxacin, while 29.7% Imipenem, 32.4% to Gentamicin, 35.13% to Piperacillin/Tazobactum, 37.8% to Amikacin. However, (70.0%) of Acinetobacter spp. showed resistance to Ciprofloxacin, while 75.7% were resistant to Ceftazimine, 54.5% Imipenem, 48.4% to Gentamicin, 31.0% to Amikacin. Interestingly, 44 of these 400 (11.0%) were found to positive be MTB by GeneXpert test and 220/400 (55.0%) bacterial infection and coinfection 22/44 (50.0%) among clinically suspected PTB cases. Tuberculosis remains a global threat despite effort to eradicate the disease and PTB co-infection with secondary bacterial infection may complicate the infection and treatment.

Article

Anatomical variations of the biceps brachii muscle in the Nepalese population: a cadaveric study

(Nepal Medical College Pvt. Ltd., 2025) Jha, Anuja; Chalise, Usha; Lama, Chhiring Palmu; Dhungel, Aryan

Abstract: The biceps brachii is the primary muscle in the anterior compartment of the arm, typically consists of two heads: the long head and the short head. It often presents with anatomical variations, including additional heads, differences in its insertion and nerve supply. The present study aimed to assess these variations in the Nepali population, with a focus on additional heads, insertional variations and nerve connections. The study was conducted on 40 dissected upper limbs from 20 cadavers (18 male and 2 female) in the Department of Human Anatomy at Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal, from November 2024 to April 2025. The present study observed anatomical variations in 12.5% of the cases, specifically additional heads of the biceps brachii. One rare bilateral variation (2.5%) displayed four heads on one side and three on the other. The four-headed variant included two additional heads originating from the pectoralis major muscle, while the three-headed variant was of the inferomedial humeral type. The inferomedial humeral variation was the most common, found in 10.0% of limbs, with three occurring on the right side. These findings emphasize the inferomedial humeral variation as the most prevalent biceps brachii anomaly. In conclusion, this study revealed additional heads and a communicating branch between the musculocutaneous and median nerves. These anatomical variations can affect function, complicate diagnosis and provide options for reconstructive surgery.

Article

Antimicrobial resistance among pseudomonas aeruginosa isolated at a tertiary care hospital, nepal: a descriptive cross-sectional study

(Nepal Medical College Pvt. Ltd., 2025) Adhikari, Ram Prasad; Khadka, Shusila; Rai, Shiba Kumar

Abstract: Pseudomonas aeruginosa is one of the common isolates from various clinical samples. Infections by it, are usually difficult to treat due to its emerging acquisition of drug resistance, limiting the therapeutic options. This study was done to determine the prevalence of P. aeruginosa and its antibiotic susceptibility patterns in our setup. A descriptive cross-sectional study was conducted over a year from April 2019 to March 2020 in the Microbiology Laboratory of Nepal Medical College Teaching Hospital, Kathmandu, Nepal in 121 non-repetitive clinical isolates of P. aeruginosa. Identification of the isolates and performance of antimicrobial susceptibility testing were done by using standard microbiological procedures. The prevalence rate of P. aeruginosa was 5.98% (n=121) among the total bacterial isolates (n=2021) and 1.02% among the total clinical specimens processed (n=11,880). Of the total 121 isolates, 84 (69.42%) were from inpatients and 37 (30.58%) from outpatient clinical samples. The prevalence of MDR and ESBL-producing P. aeruginosa was 53.71% (n=65) and 20.60% (n=25), respectively. Except, for carbapenems and piperacillin-tazobactam, the susceptibility of the isolates towards other commonly prescribed and tested antibiotics like piperacillin, tobramycin, ceftazidime, ciprofloxacin and ofloxacin were around 50.00%. The presence of MDR and ESBL producing P. aeruginosa and their resistance against most of the commonly used antibiotics in our set-up necessitates urgent and coordinated efforts to implement effective antimicrobial stewardship, strengthen infection control practices and enhance surveillance system. Addressing these issues are essential to preserve the efficacy of existing antibiotics and safeguard public health.

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