Browsing by Author "Karki, M"
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Publication Asymptomatic throat carriage rate and antimicrobial resistance pattern of Streptococcus pyogenes in Nepalese school children(Kathmandu University, 2009) Dumre, SP; Sapkota, K; Adhikari, N; Acharya, D; Karki, M; Bista, S; Basnyat, SR; Joshi, SKAbstract Background: Streptococcus pyogenes or Group A streptococcus (GAS) causes several suppurative and non suppurative infections. In addition to pharyngitis and skin infections, GAS are also the causative agent of post-streptococcal infection syndromes such as acute rheumatic fever (ARF) and post-streptococcal glumerulonephritis (PSG). GAS frequently colonises in the throat of an asymptomatic person. Pharyngeal carriage rates of GAS among healthy school children vary with geographical location and seasons. Objectives: We carried out this preliminary study to determine the throat carriage rate and antimicrobial resistance trend of Streptococcus pyogenes or Group A streptococcus (GAS) among the Nepalese school children. Materials and methods: Four schools situated at different locations of Kathmandu valley were included in the study. Throat swabs from 350 students of age group 5-15 years were collected, immediately transported to the laboratory and were processed for S. pyogenes following standard microbiological procedures. Antimicrobial susceptibility testing of the isolates was performed by Kirby Bauer disc diffusion method following CLSI guidelines. Results: S. pyogenes was isolated from 10.9% (38/350) of the screened children. The GAS colonisation rate was statistically insignificant (P>0.05) with sex and age sub-groups, although the rate was slightly higher among girls and age sub-group 9-12 years. No significant difference in carrier rate was observed among different schools (P>0.05). All isolates were susceptible to azithromycin. No resistance was detected for penicillin and its derivative antibiotic ampicillin. Highest resistance rate was observed for cotrimoxazole (71.0%) followed by chloramphenicol (7.8%), ciprofloxacin (5.2%) and erythromycin (5.2%). Conclusion: Antibiotic resistant GAS isolated from asymptomatic Nepalese school children is a public health concern. When screened and appropriately treated with antibiotics, carriers can be prevented from spreading of streptococcal infections in the school environment and the community. Preventing cross infections would ultimately reduce the incidence of life-threatening sequelae which are debilitating and difficult to treat. It is recommended to conduct regular screening and GAS surveillance in schools, and maintain rational use of antibiotics to minimise GAS carriage/infections and resistance. Key words: Streptococcus pyogenes, Antibiotics Resistance, Throat carriage, Children, Nepal.Publication Effect of Sildenafil Citrate on Pulmonary Arterial Systolic Pressure and Sub-maximal Exercise Capacity in Chronic Obstructive Pulmonary Disease(Kathmandu University, 2017) Shrestha, SK; Srivastava, B; Karki, M; Khatri, DB; Pradhan, RMABSTRACT Background Pulmonary hypertension (PH) often complicates Chronic Obstructive Pulmonary Disease (COPD). Sildenafil reduces pulmonary arterial pressure associated with multitude of diseases. Objective To evaluate the use of Sildenafil in Pulmonary Hypertension associated with COPD. Method This randomized control study enrolled 72 patients: 61 completed the study. Thirty- patients with COPD received Sildenafil 25 mg thrice daily and 31 patients with COPD received optimal medical therapy for four weeks. Symptom assessment and dyspnoea grading was done with modified Borg scale and Modified Medical Research Council (MMRC) grade. The functional assessment was done with WHO functional classification. The estimation of pulmonary arterial systolic pressure and six minute walking distance was done before and after four weeks of the administration of therapy in both groups. Adverse reaction profiling was done for Sildenafil. The primary outcomes were the changes in pulmonary arterial systolic pressure and six minute walk test. The secondary outcomes were change in modified Borg scale for dyspnoea, MMRC grading and WHO functional class. Result The mean decrease in pulmonary arterial systolic pressure in Sildenafil group was significant as compared to controls (9.87+7.84 mmHg Vs 5.93+7.44 mmHg, P=0.048). The mean increase in six minute walk distance was significantly more in cases as compared to controls (48.13+25.79 m Vs 32.59+32.96 m,P=0.047). The changes in modified Borg scale was not significant (1.20+1.92 to 1.55+1.23; P=0.401). There was significant changes in MMRC grade (p=0.037). There was no significant change in WHO functional class after four weeks (p=0.071). Conclusion Sildenafil marginally decreased pulmonary arterial systolic pressure and increased six minute walk distance in COPD patients. It improved MMRC grading without affecting modified Borg’s Scale and WHO functional class. KEY WORDS Chronic obstructive pulmonary disease, Pulmonary hypertension, Sildenafil, Six minute walk distancePublication Refractive error profile – a clinical study(Kathmandu University, 2004) Karki, KJD; Karki, MAim: To study the distribution of refractive error in different ethnic groups of Nepal. Methods: A total of 1276 new eye patients between 5-35 years of age were included in this study after a thorough eye examination consisting of vision test, anterior and posterior segment eye examination including the investigative procedures whenever needed to rule out any systemic and ocular diseases. Thereafter, the patients were subjected to rigorous streak retinoscopic refraction. Results: Out of 1276 eye patients examined 51.33 % patients are males and 48.66 % are females. The ethnic distribution of refractive error shows that there are 32.44% Newars; 27.50% Brahmins; 21.63% Chhetriyas; 12.14% Gurungs, Magars, Rais, Limbus, Tamangs, Sunuwars; and 6.26% Madhesias. Out of 414 Newar patients, 14.00% patients are myopic; 29.71% hyperopic; and 56.28% astigmatic. In 351 Brahmin patients, 14.81% patients are myopic; 49.85% hyperopic; and 35.32% astigmatic. In 276 Chhetry patients, 13.40% patients are myopic; 48.18% hyperopic; and 38.40% astigmatic. Out of 155 Gurungs, Magars, Rais patients, 11.61% are myopic; 52.90% hyperopic; and 35.48% astigmatism. Out of 80 Madhesias patients, 11.25% are myopic; 37.50% hyperopic; and 51.25 % astigmatic. Conclusion: Thus, a refractive error profile is drawn up in Nepalese population. Key words: refractive error, distribution, Nepalese populationPublication Throat carriage rate and antimicrobial resistance trend of Streptococcus pyogenes among the asymptomatic Nepalese school children(Kathmandu University, 2009) Dumre, SP; Sapkota, K; Adhikari, N; Acharya, D; Karki, M; Basnyat, SR; Joshi, SKAbstract Background: Streptococcus pyogenes or Group A streptococcus (GAS) causes several suppurative and non suppurative infections. Since the 1980s there has been re-emergence in the incidence of invasive S. pyogenes infections and rheumatic heart disease all over the world and hence throat carriage has assumed of great importance. Objectives: We carried out this preliminary study to determine the throat carriage rate and antimicrobial resistance trend of Streptococcus pyogenes or Group A streptococcus (GAS) among the Nepalese school children. Materials and methods: Four schools situated at different locations of Kathmandu valley were included in the study. Throat swabs from 350 students of age group 5-15 years were collected, immediately transported to the laboratory and were processed for S. pyogenes following standard microbiological procedures. Antimicrobial susceptibility testing of the isolates was performed by Kirby Bauer disc diffusion method following CLSI guidelines. Results: S. pyogenes was isolated from 10.9% (38/350) of the screened children. The GAS colonisation rate was statistically insignificant (P>0.05) with sex and age subgroups, although the rate was slightly higher among girls and age subgroup 9-12 years. No significant difference in carrier rate was observed among different schools (P>0.05). Highest resistance rate was observed for Cotrimoxazole (71.05%) followed by Chloramphenicol (7.8%), Ciprofloxacin (5.2%) and Erythromycin (5.2%). All isolates were susceptible to Azithromycin. No resistance was detected for penicillin and its derivative and Azithromycin. Conclusion: Antibiotic resistant GAS isolated from asymptomatic Nepalese children is a concern. When screened and appropriately treated with antibiotics, carriers can be prevented from spreading of streptococcal infections in the community. This would ultimately reduce the incidence of life-threatening sequelae which are debilitating and difficult to treat. It is recommended to conduct regular screening programs and GAS surveillance, and maintain rational use of antibiotics to keep GAS carriage/ infections and resistance in check. Key words: Streptococcus pyogenes, Antibiotics Resistance, Children, Throat carriage, Nepal