Browsing by Author "Khanal, R"
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Publication Bacteriological Profile of Neonatal Sepsis in a Tertiary Level Hospital of Nepal(Nepal Paediatric Society (JNPS), 2014) Khanal, R; Manandhar, S; Acharya, GPAbstract: Introduction: Neonatal sepsis is one of the most common reasons for admission to neonatal units in developing countries. It is also a major cause of mortality in both developed and developing countries. This study was done to determine the bacterial profile causing neonatal sepsis and to assess their susceptibility pattern to various antimicrobial agents. Materials and Methods: A cross-sectional prospective study was conducted in Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal among 340 neonates suspected of neonatal sepsis. Blood culture was performed and organisms were identified with Gram staining and conventional biochemical methods. Antimicrobial susceptibility testing was performed by Kirby-Bauer disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI). Results: The prevalence rate of neonatal sepsis was 20.3%. Among 340 neonates, 52.17% were males and 47.82% were females. Gram positive cocci were the most predominant isolates (88.40%). Among Gram positive cocci Staphylococcus epidermidis was the most common isolates (72.46%) followed by Staphylococcus aureus (7.24%), Staphylococcus saprophyticus (4.34%) and Enterococcus fecalis (4.34%). Gram negative bacilli were found in 11.60% of the growth positive samples of which E.coli and Klebsiella spp were found in 10.14% and 1.44% respectively. Sensitivity to Amikacin was highest among all types of organisms isolated. Vancomycin and Gentamycin sensitivity was highest for Gram positive and Gram negative organisms respectively. Ampicillin resistance was highest among isolates. Among the 69 isolates 48 were Multiple drug resistant. Conclusion: The predominance of Gram positive cocci particularly Coagulase negative Staphylococci is shown. Empirical antibiotic therapy should be reviewed for Multiple drug resistant strains.Publication Decrease in Mean Platelet Volume after percutaneous transvenous mitral commissurotomy in patients with Rheumatic Mitral Stenosis(Institute of Medicine, 2017) Thapa, S; Shrestha, A; Gajurel, RM; Poudel, CM; Shrestha, H; Khanal, R; Bhatta, YD; Sayami, AAbstract Introduction: Rheumatic mitral stenosis (RMS) is associated with increased thromboembolic events, especially in the presence of concomitant atrial fibrillation. Mean platelet volume (MPV) is the marker of platelet activity as larger platelets are hemostatically active and have more propensity of thrombosis. It has also been reported that percutaneous transvenous mitral commissurotomy (PTMC) attenuates platelet activity. We aimed to investigate whether PTMC decreases MPV in patients with RMS. Methods: In the present study, MPV was measured in 39 patients with RMS in sinus rhythm just before and one month after PTMC. Thirty four, sex and age-matched, apparently healthy controls were used for comparison. Mitral valve area (MVA), mean diastolic gradient across mitral valve (MDG) and pulmonary artery systolic pressure (PASP) were measured using transthoracic echocardiography and mean left atrial (LA) pressure measured during the procedure. Results: As compared to apparently healthy controls, patients with RMS had higher MPV (11.51±1.46 v. 9.6+0.75l, p<0.001). All patients with RMS underwent successful PTMC. One month after the procedure, LA diameter, MVA, MDG, PASP and LA pressures were reduced significantly (p< 0.001). The final mean platelet volume measured in patients with RMS undergoing PTMC measured after one month also had significant reduction when compared with the initial mean MPV (11.51±1.46 vs 9.55 1.11 0.001). Conclusions: As compared to apparently healthy controls, patients with RMS have higher MPV reflecting increased platelet activity, and PTMC is associated with a significant decrease in MPV one month after the procedure. Keywords: Mean platelet volume, percutaneous transvenous mitrl commissurotomy, rheumatic mitral stenosis