Browsing by Author "Basnet, Ajaya"
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Publication Biofilm-Associated Multidrug-Resistant and Methicillin-Resistant Staphylococcus aureus Infections(Nepal Health Research Council, 2024) Shrestha, Shila; Basnet, Ajaya; Maharjan, Rajendra; Basnet, Bijaya; Joshi, PramodBackground: The ability of Staphylococcus aureus to form biofilms—architectural complexes that cause chronic and recalcitrant infections—along with its notorious variant, methicillin-resistant Staphylococcus aureus (MRSA), leads to multidrug-resistant (MDR) infections that are challenging to treat with antibiotics. This cross-sectional study investigated the prevalence of S. aureus infections in Kanti Children’s Hospital and characterized the antibiograms of MDR, MRSA, and biofilm-forming strains, along with their coexistence. Methods: S. aureus strains were isolated and identified from clinical samples and tested for antibiograms following standard microbiology guidelines. MDR strains were non-susceptible to at least one agent in three antimicrobial categories, whereas MRSA strains were cefoxitin-resistant. The microtiter plate method was used to detect biofilms. Statistical analyses were performed using SPSS version 17.0. Results: S. aureus was detected in 9.0% (11.4-6.6%, 95% Confidence Interval) of 543 samples, primarily from pus (79.6%, 39/49). Children aged 1 to <3 years most commonly contracted infections (30.6%, 15/49), and males (67.4%, 33/49) had twice as many infections as females (32.7%, 16/49). As high as 84.7% (83/98) of strains were penicillin-resistant, while 18.4% (27/147) were aminoglycoside-resistant. MDR accounted for 79.6% (39/49) of all S. aureus infections, while MRSA and biofilm-formers accounted for 67.6% (33/49) and 24.5% (12/49), respectively. Fluoroquinolone resistance in non-MDR-MRSA-biofilm-formers, MDR-MRSA, MDR-biofilm-formers, and MRSA-biofilm-formers was 31.3%, 46.8%, 58.3%, and 60.0%, respectively, while aminoglycoside resistance was 0%, 32.3%, 50.0%, and 45.0%, and penicillin resistance was 87.5%, 85.5%, 100.0%, and 100.0%. Conclusions: MDR-isolates and MRSA caused nearly four-fifths of S. aureus infections. Compared to MDR and MRSA strains, biofilm-formers triggered higher levels of antimicrobial resistance. Keywords: Antibiotics; biofilms; children; resistance; staphylococcus aureus.Publication Co-infection of Uropathogenic Escherichia coli among COVID-19 Patients Admitted to a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Basnet, Ajaya; Chand, Arun Bahadur; Shrestha, Lok Bahadur; Pokhrel, Nayanum; Karki, Lochan; Shrestha, Sailendra Kumar Duwal; Tamang, Basanta; Shrestha, Mahendra Raj; Dulal, Maina; Rai, Junu RichhinbungAbstract: Introduction: Simultaneous infection of antibiotic-resistant uropathogens in patients with COVID-19 has necessitated the revision of the prescription of broad-spectrum antibiotics on the grounds of evidence-based studies and antimicrobial stewardship principles. The objective of this study was to find out the prevalence of uropathogenic Escherichia coli co-infection among hospital-admitted COVID-19 patients of a tertiary care centre. Methods: This descriptive cross-sectional study was conducted in urinary tract infection suspected COVID-19 patients admitted to a tertiary care hospital, from 25th June to 24th December 2021 after ethical clearance from the Institutional Review Committee with registration number 207707860. Convenience sampling was used. Serum procalcitonin levels were also measured. Data analysis was performed using the Statistical Package for the Social Sciences software version 17.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data, and mean and standard deviation for continuous data. Results: Among the 49 hospital-admitted COVID-19 patients, 3 (6.12%) (0.59-12.83 at 95% Confidence Interval) were co-infected with uropathogenic Escherichia coli. Absolute non-susceptibility of Escherichia coli to antibiotics such as ceftriaxone, cotrimoxazole, nalidixic acid, gentamicin, and ampicillin was observed. All isolates were multidrug-resistant. All co-infected patients were female and had a median age of 35 years. Mean±SD value for procalcitonin in patients with co-infection (6.13±7.88 ng/ml) was six times higher than for the patients without co-infection (0.95±1.11 ng/ml). Conclusions: Escherichia coli co-infection in hospitalised COVID-19 patients was less frequent as compared to published literature. The serum procalcitonin value in patients with co-infection was substantially higher than that of patients without co-infection.Publication COVID-19 among Patients Visiting the Department of Emergency of a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2023) Shrestha, Mahendra Raj; Basnet, Ajaya; Maharjan, Rajendra; Chand, Arun Bahadur; Karki, Lochan; Singh, Subash; Ghimire, Sagar; Maharjan, RupakAbstract Introduction: Because of the unbridled transmissibility of the SARS-CoV-2 worldwide, researchers and healthcare professionals have set a common goal for timely diagnosis and future prevention of the disease. The aim of this study was to find out the prevalence of COVID-19 among patients visiting the Department of Emergency of a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among the individuals suspected COVID-19 who had visited the Department of Emergency of a tertiary care centre between 11 January 2021 and 29 December 2021. Ethical approval was taken from Ethical Review Board (Reference number: 2768). Socio-demographic details, clinical symptoms, and two nasopharyngeal swab samples (one in viral transport medium to run RT-PCR and the other for Ag-RDT) were collected from each individual. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among the 232 patients, COVID-19 was detected in 108 (46.55%) (40.13-52.97, 95% CI) by Ag-RDT. A total of 44 (39.63%) of age groups 31-40 years were predominantly infected with SARS-CoV-2. The mean age was 32.13±10.80 years and was mostly males 73 (65.77%). Fever was present in 57 (51.35%) and dry cough was present in 50 (45.05%) COVID-19 patients. Conclusions: The prevalence of COVID-19 among hospitalized individuals in this study was higher than in previous studies conducted in similar settings.Publication Dengue among Patients Visiting Department of Medicine in a Secondary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2023) Tamang, Basanta; Basnet, Ajaya; Khadka, Sudip; Joshi, Pramod; Jha, Roshan Kumar; Joshi, Rijuta; Rai, Shiba KumarAbstract Introduction: Dengue, caused by the dengue virus, has a wide range of clinical features, including fever, body ache, lethargy, nausea, and vomiting. Blood-based biomarkers in patients with dengue virus infection reflect a variety of clinical spectrums, from bleeding manifestations to liver abnormalities, and can serve as an essential tool for clinicians. This study aimed to determine the prevalence of dengue among patients visiting the Outpatient Department in a secondary care centre. Methods: A descriptive cross-sectional study was conducted among patients visiting the Outpatient Department from 16 May 2022 to 15 November 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 20790202). The socio-demographic details and biochemical and haematological findings of dengue virus-infected patients diagnosed with rapid diagnostic tests were collected. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Out of 706 individuals, the prevalence of dengue was 83 (11.76%) (9.38-14.14, 95% Confidence Interval). The median age of dengue virus-infected patients was 40 years, and the majority were males 54 (65.06%). Conclusions: The prevalence of dengue was found to be lower than in other studies done in similar settings.Publication Human Papillomavirus among Women Undergoing Papanicolaou Smear Test in the Department of Gynaecologic Oncology of a Tertiary Care Centre(Nepal Medical Association, 2023) Shrestha, Mahendra Raj; Basnet, Ajaya; Maharjan, Rajendra; Ghimire, Sagar; Khatri, Nisha; Shrestha, Arju; Karki, Lochan; Karmacharya. SaujanyaAbstract Introduction: In invasive cervical specimens or precursors, high-risk human papillomavirus Deoxyribonucleic acid may be detected to identify females at risk of developing cervical cancer. This study aimed to find out the prevalence of human papillomavirus among women undergoing Papanicolaou smear tests in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among women undergoing the Papanicolaou smear test in the Department of Gynaecologic Oncology, Nepal Armed Police Force Hospital, between 1 June 2022 and 15 November 2022. Ethical approval was obtained from the Ethical Review Board. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among the 199 women, 6 (3.02%) (0.64-5.40, 95% Confidence Interval) had human papillomavirus infection. The mean age of the infected females was 31.17±5.57 years. Human papillomavirus DNA for 16 and 18 were detected in 4 (66.67%) and 2 (33.33%) females, respectively. Conclusions: The prevalence of human papillomavirus in females was found to be lower than other studies done in similar settings.Publication Role of Tocilizumab in the Treatment of COVID-19 Patients with Cytokine Storm: A Case Series(Nepal Medical Association, 2022) Basnet, Ajaya; Shrestha, Mahendra Raj; Thapa, Rossu; Tamang, Basanta; Shrestha, Apurba; Rawal, Prabhat; Shrestha, Sailendra Kumar Duwal; Karki, Lochan; Rai, Shiba KumarAbstract The in-hospital mortality in patients with COVID-19 could be correlated with severe acute respiratory syndrome coronavirus-2 induced hyper-inflammation, which is attributed to an unconstrained inflammatory cytokine storm. The pro-inflammatory cytokine, specifically, interleukin-6 plays a prominent role in the cytokine storm and may result in alveolar-capillary blood-gas exchange dysfunction. Therefore, the method to block the signal transduction pathway of interleukin-6 could be a potential treatment for severe COVID-19 patients. In this case series of three patients with severe COVID-19, we focus on the rationale for utilization of tocilizumab, an anti-interleukin-6 receptor antibody, which could block the signal transduction pathway of interleukin-6. The observations from this study allowed us to hypothesize that the infusions of tocilizumab may not reduce the elevated level of interleukin-6, and hence may not be a significant therapeutic for reducing in-hospital mortality associated with COVID-19. Additionally, it could also be speculated that interleukin-6 may not be a potentially actionable target cytokine to treat COVID-19-associated cytokine storms.Publication Stress Fractures among Paramilitary Trainee Visiting a Paramilitary Hospital of Nepal: A Descriptive Cross-sectional Study Authors(Nepal Medical Association, 2022) Shrestha, Sailendra Kumar Duwal; Basnet, Ajaya; Karki, Netra Bahadur; Nepal, Prabin; Karki, Umash; KC, Samir; Shrestha, Kumar; Tamang, Basanta; Shrestha, Mahendra RajAbstract: Introduction: Young paramilitary recruits, who undergo strenuous exercise during basic training, are often presented with stress fractures, which could be due to an inadequate vitamin D (25-hydroxyvitamin D) intake. This study aimed to find the prevalence of stress fracture among young paramilitary trainees visiting the orthopedic outpatient department of a paramilitary hospital. Methods: This was a descriptive cross-sectional study done among paramilitary trainees in a paramilitary Hospital of Nepal between April 2019 to April 2021. The study was approved by the Ethical Review Board (Reference number: 1003) of the Nepal Health Research Council. Convenience sampling was used. Anthropometric variables, serum 25-hydroxyvitamin D level, and bone mineral density of spine and hip were determined. Data analysis was performed using the Statistical Package for the Social Sciences software version 17.0. Point estimate at 95% Confidence Interval was calculated along with frequency, proportion for binary data and mean, standard deviation for continuous data. Results: Among 417 young paramilitary trainees, 24 (5.76%) (3.52-7.99 at 95% Confidence Interval) were found to have a stress fracture. The stress fracture patients had a serum 25-hydroxyvitamin D level of 21.47ng/mL±6.98. Similarly, the bone mineral density value of the spine and hip among the patients was -1.34g/cm2±1.37 and 0.36g/cm2±1.24, respectively. Conclusions: The prevalence of stress fracture among young paramilitary trainee was high compared to previous studies. Additionally, average Vitamin D and the bone mineral density value of the spine and the total hip among stressed fractured patients were also low.Publication Vitamin D Deficiency among Patients Visiting Outpatient Departments in a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Chand, Arun Bahadur; Singh, Samir; Bhatt, Lok Raj; Sen, Bindu; Joshi, Yadav Prasad; Joshi, Pramod; Shrestha, Lok Bahadur; Shrestha, Sailendra Kumar Duwal; Basnet, AjayaAbstract Introduction: Vitamin D deficiency is a global health issue affecting billions of people. Its deficiency results in abnormal homeostasis of calcium and phosphorous levels in an individual and results in reduced bone mineral density, which further makes them more prone to develop osteogenic disorders, such as fractures. The aim of this study is to find out the prevalence of vitamin D deficiency among patients visiting the outpatient departments in a tertiary care centre. Methods: This was a descriptive cross-sectional study done among 582 patients visiting outpatient departments in a tertiary care centre between January 1, 2019 and July 31, 2020. The study was approved by the Institutional Review Committee (Reference number: 076/077/17) of a tertiary care centre. A convenience sampling method was used. Patients’ demographic detail and serum vitamin D level were determined. Data were collected retrospectively from hospital records and analysis was performed using the Statistical Package for the Social Sciences software version 17.0. Point estimate at 95% Confidence Interval was calculated along with frequency, the proportion for binary data, and mean with standard deviation for continuous data. Results: Among 582 patients enrolled in this study, 328 (56.35%) (52.32-60.38 at 95% Confidence Interval) patients were vitamin D deficient. Vitamin D deficiency was found in 238 (72.56%) females and 257 (78.35%) aged 16 to 59 years. Finally, there were 102 (31.09%) cases of vitamin D deficiency over the winter season. Conclusions: The prevalence of serum vitamin D deficiency in the current study was lower when compared to similar studies done in similar settings and similar to the prevalence from international literature.Publication Vitamin D Deficiency among Patients Visiting Outpatient Departments in a Tertiary Care Centre: A Descriptive Cross-sectional Study Authors(Nepal Medical Association, 2022) Chand, Arun Bahadur; Singh, Samir; Bhatt, Lok Raj; Sen, Bindu; Joshi, Yadav Prasad; Joshi, Pramod; Shrestha, Lok Bahadur; Shrestha, Sailendra Kumar Duwal; Basnet, AjayaAbstract: Introduction: Vitamin D deficiency is a global health issue affecting billions of people. Its deficiency results in abnormal homeostasis of calcium and phosphorous levels in an individual and results in reduced bone mineral density, which further makes them more prone to develop osteogenic disorders, such as fractures. The aim of this study is to find out the prevalence of vitamin D deficiency among patients visiting the outpatient departments in a tertiary care centre. Methods: This was a descriptive cross-sectional study done among 582 patients visiting outpatient departments in a tertiary care centre between January 1, 2019 and July 31, 2020. The study was approved by the Institutional Review Committee (Reference number: 076/077/17) of a tertiary care centre. A convenience sampling method was used. Patients’ demographic detail and serum vitamin D level were determined. Data were collected retrospectively from hospital records and analysis was performed using the Statistical Package for the Social Sciences software version 17.0. Point estimate at 95% Confidence Interval was calculated along with frequency, the proportion for binary data, and mean with standard deviation for continuous data. Results: Among 582 patients enrolled in this study, 328 (56.35%) (52.32-60.38 at 95% Confidence Interval) patients were vitamin D deficient. Vitamin D deficiency was found in 238 (72.56%) females and 257 (78.35%) aged 16 to 59 years. Finally, there were 102 (31.09%) cases of vitamin D deficiency over the winter season. Conclusions: The prevalence of serum vitamin D deficiency in the current study was lower when compared to similar studies done in similar settings and similar to the prevalence from international literature.