Browsing by Author "Maharjan, Rajendra"
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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 Clinico-demographic, Thyroid, and Lipid Biomarkers in Patients with and without Type 2 Diabetes Mellitus in a Paramilitary Hospital, Nepal(Nepal APF Hospital, 2025) Shrestha, Mahendra Raj; Shrestha, Apurba; Bhat, Dinesh Singh; Maharjan, RajendraAbstract Introduction: Diabetes disrupts the hypothalamic regulation of thyroid-releasing hormone and impacts the synthesis of triiodothyronine (T3) and thyroxine (T4), leading to disrupted lipid biomarker levels. This study was aimed how HbA1c correlates with body mass index (BMI), thyroid and lipid biomarkers in patients with and without type 2 diabetes mellitus (T2DM). Methods: This case-control study was conducted at the Tertiary Care Paramilitary Hospital between July 2023 and June 2024, along with 202 T2DM patients and 211 controls. Ethical approval was taken from Ethical Review Board (Reference number:3795). Data on clinico-demographic and anthropometric variables were collected. Fasting venous blood samples were analyzed for HbA1c, thyroid, and lipid profiles. Correlational analyses were conducted using Statistical Package for the Social Sciences (SPSS) version 17 with significance set at p<0.05. Results: The prevalence of T2DM among hospital visitors was 8.12% (202/2,488) [males: 60.40% (122/202); ageMedian: 51 years; BMIMedian: 25.68 kg/m2]. Among T2DM patients, 18.81% (38/202) had dysthyroidism, predominantly hypothyroidism (17.82%, 36/202), especially in females (100.00%, 11/11) and those who were overweight. Additionally, 54.95% (111/202) of T2DM patients had dyslipidemia, with hypertriglyceridemia (50.99%, 103/202) being the most common, particularly among males (94.52%, 69/73) and overweight patients. T2DM patients had significantly higher BMI, triglycerides, and thyroid-stimulating hormone (TSH) levels compared to non-T2DM patients. HbA1c was positively correlated with total cholesterol (p=0.041) and triglycerides (p=0.004), HDL with T3 (p=0.005), and BMI with age (p=0.048). Conclusions: T2DM affected less than one-tenth of hospital-visiting patients, primarily males and those aged 50–59. Dyslipidemia was common among T2DM patients, with dyslipidemia and hypothyroidism being most prevalent in overweight males and females, respectively. Regular testing of triglycerides, TSH, and T4 in T2DM patients can help reduce morbidity.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 Histopathological Findings in Cholecystectomy Specimens of Gallbladder in a Tertiary Care Hospital in Kathmandu: A Descriptive Cross-Sectional Study(Nepal APF Hospital, 2025) Maharjan, Rajendra; Khadka, RajyaAbstract: Introduction: The gallbladder is one of the most frequently resected organs which is examined in a surgical pathology practice. It presents with a wide spectrum of lesion on histopathology. Gallbladder is among the most common organs where incidental gallbladder carcinoma occurs. The study was aimed to find the prevalence of various histopathological spectrum of gallbladder among cholecystectomy specimens in a tertiary care hospital in Kathmandu. Methods: A descriptive cross-sectional study was conducted in the Department of pathology, of a tertiary care hospital from January 1, 2023 to December 30, 2024. Ethical approval was taken from the Institutional Review Committee (Reference number: NAPFH-037/2024). All the patients who had undergone cholecystectomy for gallbladder diseases were enrolled in the study. Enumeration sampling technique was done. Basic statistics and Microsoft Excel were used for data analysis. Results: Out of 400 cholecystectomy specimens, Chronic cholecystitis with specific finding was the most common finding with 270 (67.50%) cases. 11 (2.75%) cases of dysplasia and one (0.25%) case of gallbladder adenocarcinoma was observed. There were 125 (31.25%) males and 275 (68.75%) females with a male to female ratio of 1:2.2. Age ranged from 15 to 83 years with a mean age of 44.32±13.55 years. Gallbladder lesions were observed maximum in age group 30-39 years with 136 (34.00%) cases. Conclusions: The prevalence of histopathological spectrum of gallbladder is similar to other studies done in similar settings. Female predominance was noted in gallbladder lesions.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.