Browsing by Author "Madhup, SK"

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    A study of Deep Neck Space Infections at Kathmandu University Dhulikhel Hospital
    (Kathmandu University, 2021) Pokharel, M; Dhakal, A; Rajbhandari, P; Madhup, SK; Khadka, L
    ABSTRACT Background Deep neck infections are severe infections in potential spaces and fascial planes of the neck. Despite antibiotic therapy, these infections continue to cause significant morbidity and mortality. Objective To determine the clinical features, predisposing factors, socio demographic factors and complications associated with deep neck infections. Method Prospective study conducted in the Department of Otorhinolaryngology, Kathmandu University Dhulikhel Hospital between March 2018 and June 2020. Seventy-five patients with deep neck infections were enrolled. Result Submandibular abscess was most frequently observed (41.3%), followed by submental abscess (25.3%), parotid abscess(9.3%), ludwig’s angina (6.7%), posterior triangle of neck abscess (4%), retropharyngeal abscess (2.7%), parapharyngeal space abscess (2.7%), and multiple space infections (8%). Staphylococcus aureus was the most common organism (53.3%), followed by Beta hemolytic Streptococcus (12%) and methicillin-resistant Staphylococcus aureus (12%). A negative culture was seen in 22.7%. Sixty-eight percent of patients underwent incision and drainage. Incision and drainage with dental extraction was done in 26.7%, four percent underwent incision and drainage with debridement and dental extraction, whereas 1.3% underwent incision and drainage with tracheostomy. Eight percent patients required Intensive care unit admission. Seven patients had descending mediastinitis, four out of which developed sepsis. When age and duration of hospital stay were correlated by using Pearson correlation coefficient, a remarkable correlation was observed (p=.020). Noteworthy relationship was not observed between different locations of deep neck infections and duration of hospital stay (p=.202). Conclusion Early identification of deep neck infections is often challenging. Proper knowledge and extreme vigilance is necessary when dealing with these complex entities to avoid life-threatening complications. KEY WORDS Abscess, Complications, Deep neck infections, Tracheostomy
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    Clinical Profile and Antibiotics Sensitivity in Childhood Urinary Tract Infection at Dhulikhel Hospital
    (Kathmandu University, 2013) Singh, SD; Madhup, SK
    ABSTRACT Background Urinary Tract Infection implies presence of actively multiplying organisms in the urinary tract. Although it is infrequently associated with mortality, it is still a significant cause of morbidity. Early diagnosis is critical to preserve renal function of growing kidney. Objective Our purpose was to determine the clinical, microbiologic profile and antibiotic sensitivity of such infections in pediatric Urinary Tract Infection (UTI) patients at Dhulikhel Hospital. Methods A hospital based prospective descriptive study of 135 children from 2 months to 16 years, with clinical diagnosis of urinary tract infection who visited the pediatric department of Dhulikhel Hospital over the period of 15 months were enrolled in the study. All patients underwent routine urine analysis and culture. Children with recurrent UTI underwent micturating cystourethrogram (MCUG). Children with recurrent UTI of more than two years and with feature of pyelonephritis underwent USG abdomen as well. Complications and response of the treatment was observed in all cases of UTI. All data were entered in Epidata and data analysis was done using spss 16 version. Results Among 135 children, 32.5% were male and 67.4% were female. Fever was the most common presenting symptom in 74.80% of patients followed by dysuria in 54.1%. Among these children 95.6% had significant pyuria and 45% had culture positive infection. Children who showed positive for bacteriuria, Escherichia coli (78.7%) was the most common organism and are more than 80% sensitive to Amikacin, Gentamicin, Ceftriaxone, Ofloxacin, Nalidixic acid, Imipenem and Vancomycin. Co-trimoxazole was the most common drug used for treatment with a mean drug respond time of (mean±S.D) of 2.21±.78 days. 2±±. Children who had recurrent UTI were more prone to develop culture positive UTI (p=0.0001). Conclusion Urinary Tract Infection in female was almost twice more common than in male. Co- trimoxazole was the most common drug used for treatment, sensitivity of this drug was less than 50% for all organisms. KEY WORDS Bacteriuria, pyuria
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    Comparision of Clinical and Laboratory Parameters in Culture Proven and Unproven Early Onset Sepsis in NICU
    (Kathmandu University, 2013) Shrestha, S; Dongol Singh, S; Shrestha, NC; Shrestha, RPB; Madhup, SK
    ABSTRACT Backgroud Early onset sepsis remains a major cause for neonatal morbidity and mortality. Objectives The aim of this study was to describe and compare the clinical and laboratory characteristics of neonates in neonatal intensive care unit with culture positive and negative early onset sepsis and verify if there were any differences between the groups. Methods A one year comparative prospective study was conducted from January 2011 to January 2012 in neonatal intensive care unit (NICU), Dhulikhel Hospital, Kathmandu University Hospital (KUH). Results Out of 215 cases of suspected neonatal sepsis, 192 (89.30%) cases of early onset sepsis were admitted in neonatal intensive care unit. Out of which 82 cases (42.7%) had blood culture positive and 110( 57.3%) had culture negative but compatible with features of clinical sepsis. There were no cases of culture proven meningitis and urinary tract infections. The clinical characteristic did not show any statistical differences between the study groups except for seizure which was found to be high in culture positive cases (p= 0.041). The hospital stay in neonatal intensive care unit was significantly longer (p=0.02) in culture positive cases. As for the laboratory test there were no differences found between the two study groups except cases of meningitis was more in culture proven early onset sepsis (p=0.00). The overall mortality in early onset sepsis was 36.95%. The higher mortality of 64.7% was seen in culture positive cases but statistically not significant. Conclusion Clinical manifestation and laboratory test were insufficient to distinguish between neonatal infection with blood culture positive and negative sepsis, hence both culture positive and negative cases should be treated promptly and equally. KEY WORD Culture proven early onset sepsis, neonates
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    Mobile Phone: A Possible Vector of Bacterial Transmission in Hospital Setting
    (Kathmandu University, 2017) Karkee, P; Madhup, SK; Humagain, P; Thaku, N; Timilsina, B
    ABSTRACT Background Mobile phones of Health Care Workers (HCWs) are capable of harbouring microorganisms that can potentially cause nosocomial infections. Frequent movement of hospital staff inside and outside the hospital can augment bacterial transmission inside hospital and even to the community. Objective To screen the mobile phones of Health Care Workers for potential pathogens and perform microbiological study of the isolates. Methods A cross sectional study was conducted in 124 Health Care Workers of different departments of tertiary care hospital. Swabs were taken from their mobile phones, processed immediately and identified and their antibiotic suceptibility pattern was studied. Results This study revealed that bacterial growth was positive for pathogenic organisms in 89 out of 124 (71.8%) mobile phones out of which 33 (82.5%) were of male and 56 (66.7%) of female. However, there was no significant association between gender and isolation of pathogens. Single pathogen was isolated in 74 (59.7%) of mobile phones and multiple pathogens were isolated in 15(12.1%). Amongst them, most common pathogen isolated was Coagulase Negative Staphylococcus (CoNS) (56.7%) followed by Micrococcus spp., Escherichia. coli, Enterobacter spp., Acinetobacter spp., Staphylococcus. aureus, Klebsiella spp. and Enterococcus spp. Most of the Gram Positive Cocci (GPC) were sensitive to Vancomycin (81.9%) and Ciprofloxacin (88%) while were resistant to Penicillin(83.1%). For Gram negative bacteria sensitivity to ciprofloxacin ranged from 83.33% to 100% . Conclusion Mobile phones are possible vectors of bacterial transmission and therefore are constant threat to the lives of already seriously ill patients as well as healthy individuals visiting the hospital. So it is recommended to make infection control guidelines which target the use of suitable disinfectants to avoid mobile phone contamination. KEY WORDS Antibiotics, Health care workers, Mobile phones, Nosocomial infection
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    Whole Genome Sequence Analysis to Identify SARS-CoV-2 Variant in Nepal
    (Kathmandu University, 2021) Shrestha, R; Katuwal, N; Adhikari, N; Vanaerschot, M; Tamrakar, D; Dhimal, M; Gyanwali, P; Bhattarai, S; Madhup, SK; Devkota, B
    ABSTRACT Background The spread of SARS-CoV-2 has become a global public health crisis. Nepal is facing the second wave of COVID-19 pandemic but, there is still a limited data on the genomic sequence of SARS-CoV-2 variants circulating in Nepal. Objective The objective of this study is to sequence the whole genome of SARS-CoV-2 in Nepal to detect possible mutation profiles and phylogenetic lineages of circulating SARS- CoV-2 variants. Method In this study, swab samples tested positive for SARS-CoV-2 were investigated. After RNA extraction, the investigation was performed through real-time PCR followed by whole genome sequencing. The consensus genome sequences were, then, analyzed with appropriate bioinformatics tools. Result Sequence analysis of two SARS-CoV-2 genomes from patient without travel history (Patient A1 and A2) were found to be of lineage B.1.1. Similarly, among other four samples from subjects returning from the United Kingdom, genomes of two samples were of lineage B.1.36, and the other two were of lineage B.1.1.7 (Alpha Variant). The mutations in the consensus genomes contained the defining mutations of the respective lineages of SARS-CoV-2. Conclusion We confirmed two genomic sequences of variant of concern VOC-202012/01 in Nepal. Our study provides the concise genomic evidence for spread of different lineages of SARS-CoV-2 – B.1.1, B.1.36 and B.1.1.7 of SARS-CoV-2 in Nepal. KEY WORDS COVID-19, Nepal, SARS-CoV-2, Variant of concern, Whole genome sequencing

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