Browsing by Author "Adhikari, R"
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Publication Antimicrobial susceptibility pattern and serotyping of Streptococcus pneumoniae isolated from Kanti Children Hospital in Nepal(Kathmandu University, 2010) Rijal, B; Tandukar, S; Adhikari, R; Tuladhar, NR; Sharma, PR; Pokharel, BM; Gami, FC; Shah, A; Sharma, A; Gauchan, P; Sherchand, JB; Burlakoti, T; Upreti, HC; Lalitha, MK; Thomas, K; Steinhoff, MAbstract Background: Invasive pneumococcal disease is a significant cause of morbidity and mortality worldwide and it is a major cause for childhood deaths in Nepal. Objectives: The aim of this study was to establish the antimicrobial susceptibility pattern of Streptococcus pneumoniae and perform serotype responsible for pneumococcal disease in Nepal. Materials and methods: All together 3774 children from 2 to 60 months who fulfilled the enrollment criteria for suspect of bacterial pneumonia, sepsis or meningitis were enrolled for etiologic studies of severe illness. During the study period 60 isolates of Streptococcus pneumoniae were isolated and the antimicrobial susceptibility testing and serotyping were performed. Results: The study showed that 24 (52.17%) isolates were resistant to Cotrimoxazole, 3 (6.5%) isolates were intermediately resistant to Penicillin but no Penicillin resistant strains were isolated. The 1 (2.17%) isolate was recorded as Erythromycin and Chloramphenicol resistant and only 1 (2.17%) isolate was found intermediately resistant to Cefotaxime. Of the 60 isolates, serotyping result was available only for 46 isolates. The most common serotypes were serotype 1 (27. 65%) followed by serotype 5 (19.14%) and serotype 4 (8. 5%) respectively followed by serotype 39, 23F, 7F, 19B, 12A, 14, 18F, 6B, 32, 16, 19F and 25F. Conclusions: Alarming level of Cotrimoxazole resistance demands revision of pneumonia treatment policy in Nepal and rising tendency of other drug resistance against Streptococcus pneumoniae showed use of these drugs for the treatment of meningitis, pneumonia and other serious infections needs extended research. The common serotype 1, 5 and 4 need to be incorporated in pneumococcal vaccine to immunise children in Nepal. Key words: Antimicrobial susceptibility, Streptococcus pneumoniae, Serotyping, NepalPublication Association of Different Biochemical and Hemodynamic Characteristic with Type 2 Diabetes Mellitus and Hypertension in Nephrolithiasis Patients(Kathmandu University, 2023) Katwal, BM; Gautam, N; Shrestha, S; Adhikari, R; Baral, H; Jha, SK; Jha, GABSTRACT Background Although Nephrolithiasis is a common condition caused by a wide variety of metabolic or environmental disturbances, its being one of the major factor of morbidity. Incidence of kidney stone disease (KSD) is highly affected by metabolic disorders and change in blood pressure and glucose. Objective To find out association of different biochemical and hemodynamic parameters with various glycemic status and hypertension in kidney stone disease. Method A cross sectional study was conducted in patients diagnosed as nephrolithiasis by using re¬nal ultrasonography and underwent nephrectomy between January 2019 to January 2021 in Shahid Dharmabhakta National Transplant Centre (SDNTC). A total of 100 subjects with 60 male and 40 females were enrolled. Glycemic status was categorized based on criteria of American Diabetes Association (ADA) and hypertension was defined as BP ≥ 140/90 mm Hg in right arm supine position. All biochemical and hemodynamic profile was carried out following standard protocol. Result Out of 100 patients enrolled, pre-diabetes accounted for 31% followed by diabetes (4%). However, hypertension comprised of 66% in total subjects. Serum urea, cholesterol and triglyceride level were found to be increased by 84.6%, 67.7% and 64.7% respectively in diabetes followed by increase of 3.9%, 19.5% and 3.1% respectively in prediabetes when compared to normal glycemic condition in nephrolithiasis subjects. Serum fasting blood glucose, creatinine and uric acid level was observed significantly higher (p=0.003, p=0.004, p < 0.001 respectively) in hypertensive patients. Duration of hospital stay was also seen positively correlated with hypertension. Conclusion Not only diabetes, prediabetes also manifests the increased risk of kidney stone disease along with hypertension. There is significant impairment in renal function and lipid profile based on diabetes mellitus and hypertension. Early identifying these systemic diseases, different biochemical and hemodynamic parameters and proper treatment accordingly may minimize risk and prevent serious complication in these patients. KEY WORDS Diabetes mellitus, Hypertension, NephrolithiasisPublication Rectal Misoprostol versus Intramuscular Oxytocin for Prevention of Post Partum Hemorrhage(Kathmandu University, 2011) Shrestha, A; Dongol, A; Chawla, CD; Adhikari, RABSTRACT Background Postpartum hemorrhage (PPH) is an important cause of maternal morbidity and mortality especially in the developing countries.,Compared to expectant management, active management decreases the incidence of PPH. Objective To compare the effectiveness of rectal misoprostol with intramuscular oxytocin in the prevention of postpartum hemorrhage. Methods This is a prospective, randomized and analytical study from 1stSeptember 2009 to 28th February 2010 at Department of Obstetrics and Gynecology, Dhulkhel Hospital - Kathmandu University Hospital, Dhulikhel, Nepal. A total of 200 women were included to receive either 1000 micrograms rectal misoprostol tablets or 10 units of oxytocin intramuscularly. Primary outcome measures were the incidence of postpartum hemorrhage or a change in hematocrit or hemoglobin from admission to day two post delivery. Secondary outcome measures including severe postpartum hemorrhage and the duration of the third stage of labor were noted. Also the side effects of both misoprostol and oxytocin were recorded. Results The frequency of postpartum hemorrhage was 4% in the misoprostol subjects and 6% in the control subjects (P=0.886) There were no significant difference among the groups in the drop of hematocrit (P>0.05). Secondary outcome measures including severe postpartum hemorrhage and the duration of the third stage of labor were similar in both groups. Similarly, the side effects between the misoprostol and oxytocin group within 6 hours was statistically significant (p=0.003) whereas the side effects within 24hours was statistically not significant (p=0.106). Conclusion Rectal misoprostol is as effective as intravenous oxytocin in preventing postpartum hemorrhage with the similar incidence of side effects and is worthwhile to be used as a uterotonic agent for the routine management of third stage of labor. KEY WORDS misoprostol, oxytocin, postpartum hemorrhage