Browsing by Author "Mishra, SK"
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Publication An outbreak of El Tor cholera in Kavre district, Nepal(Kathmandu University, 2005) Tamang, MD; Sharma, N; Makaju, RK; Sarma, AN; Koju, R; Nepali, N; Mishra, SKOutbreak of Cholera still remains major public health problem in most of the developing countries including Nepal. A prospective study was carried out at Dhulikhel Hospital, Kathmandu University Teaching Hospital, Kavrepalanchok during 1st May 2004 to 31st October 2004. A total of 148 stool samples from patients with acute diarrhea were collected and further investigated for Cholera. The study was conducted to establish the causes of the outbreak of acute diarrheal disease, antimicrobial profiles of the stool isolates and parasitic co –infection in Cholera cases. The samples were subjected to standard recommended microbial procedures and confirmation of the isolates was done by seroagglutination using V.cholerae polyvalent O1 and 0139 antisera and monovalent Ogawa and Inaba antisera. Out of the 148 stool samples, 46 cases (31%) were found to be positive for V.cholerae serogroup O1, biotype ElTor, serotype Ogawa. Both sexes were equally affected. Young age group of less than 30 years were mostly affected. Brahmin was the most affected ethnic group. The isolates were sensitive to all the antibiotics tested except co-trimoxazole. Among the laboratory confirmed cholera cases 30% exhibited co-infection with other parasites among which Giardia lamblia and Ascaris lumbricoides were the most common. Key words: Cholera, El Tor, Ogawa, Vibrio, Co-infection, NepalPublication Biochemical nutritional indicators in children with protein energy malnutrition attending Kanti Children Hospital, Kathmandu, Nepal(Kathmandu University, 2009) Mishra, SK; Bastola, SP; Jha, BAbstract Background: Nutrition is the science of food and its relationship to health. Nutritional status is one of the key indicators of health Nutritional status of Nepal is not satisfactory. Especially Protein Energy Malnutrition (PEM) in Nepal is a very common problem in children under five years of age. There are number biochemical parameters which become altered during protein energy malnutrition. Objectives: The objectives of the study are to determine biochemical nutritional indicators among children suffering from PEM and to compare all biochemical parameters with well nourished children and also to determine the factors affecting PEM among children under five years. Materials and methods: The study design was cross sectional, descriptive study with control. Children between ages 6 to 59 months attending outpatient department (OPD) and wards of Kanti Children’s Hospital (KCH), Maharajgunj, Kathmandu, Nepal were purposively selected. The sample size was calculated by using prevalence of malnutrition in Nepalese context and allowable error of 10 %, a total of 120 cases which include 60 PEM cases and 60 controls were selected. They were grouped into two groups based on whether they are above or below the 80% of 50th percentile of weight for height based on growth chart of National Centre of Health Statistics 3 (NCHS), USA. Results: The educational status of parents of children with PEM was found to be significantly less (p<0.05) as compared to their non-PEM counterparts. Occupations of parents whose children were in PEM group include mainly housewives and labourers. Larger proportions of children in our study were born at home and exact birth weights of children were not known. Most of the children are colostrum fed. Most of the children in our study were immunized. Almost equal proportion of children belonged to nuclear family type and joint family type. The mean serum glucose, sodium, potassium, cholesterol, haemoglobin was not significantly different in both groups while mean total protein, albumin, and calcium were significantly (p<0.05) low in PEM group when compared to well nourished children (control). There was significantly (p<0.05) higher incidence of hypoproteinemia, hypoalbuminaemia, and hypocalcaemia, in PEM group when compared to control group. Conclusion: A significant proportion of children with protein energy malnutrition had altered biochemical parameters which were related to food intake and biochemical metabolism mandatory during growth and development of children less than five years of age. There was significantly higher proportion of hypoglycaemia, hypoproteinemia, hypoalbuminaemia, anaemia, hypocholesterolemia and hypocalcaemia in children with PEM when compared to normally nourished children. Key words: PEM, Biochemical nutritional indicators, anthropometryPublication Multiple drug resistance in bacterial isolates from liquid wastes generated in central hospitals of Nepal(Kathmandu University, 2010) Sharma, DR; Pradhan, B; Mishra, SKAbstract Background: Healthcare liquid wastes are the reservoirs of harmful infectious agents such as the pathogens and multiple drug resistant microorganisms. Potential infectious risks include the spread of infectious diseases and microbial resistance from health-care establishments into the environment and thereby posing risks of getting infections and antibiotic resistance in the communities. Objectives: The objectives of this study were to assess the bacterial load of healthcare liquid waste generated in central hospitals and to explore the antimicrobial resistance pattern of these bacterial isolates. Materials and methods: A descriptive study was carried out in 10 conveniently selected central hospitals of Nepal during the period of May to December 2008. Effluent specimens from each hospital were subjected to total viable count studies by spread plate method in nutrient agar plate and incubated for 24 hours at 370C using standard laboratory protocol. Similarly, all the specimens were cultured in Mac Conkey Agar media supplemented with 30 μg/ml of Chloramphenicol and 20 μg/ml of Gentamycin for the enumeration of multiple drug resistant (MDR) bacteria, which were further subjected to in-vitro antibiotic susceptibility test by modified Kirby Bauer disc diffusion technique for resistance patterns. Results: Total viable counts of hospital effluents significantly exceeded the standard heterotrophic plate count (p=0.000). Similarly, the numbers of multiple drug resistant bacteria were alarmingly high in three (more than 30% in 2 and 50% in 1) hospitals of this study. Drug resistant hospital effluent isolates showed simultaneous resistance for most of the antibiotics including Penicillin, Cephalosporin, Cotrimoxazole, Gentamycin and Quinolones. Conclusion: Healthcare liquid wastes were laden with MDR bacteria and seemed to pose a huge public health threat in the transfer of such resistance to the bacterial pathogens causing community acquired infections, thereby limiting our antibiotic pool. Key words: Healthcare liquid waste management, viable count, multiple drug resistance, hospitals, NepalPublication Nosocomial Bacterial Infection and antimicrobial Resistant Pattern in a Tertiary care Hospital in Nepal(Institute of Medicine, 2014) Sah, MK; Mishra, SK; Ohora, H; Kirikae, T; Sherchan, JB; Rijal, BP; Pokhrel, BMAbstract Introduction: Nosocomial infection is a global problem with multi facet outcomes. At present, the emergence of resistance to antimicrobial agents is a global public health problem which is well pronounced in developing countries. Methods: The aim of this study was to determine the prevalence of bacteria causing nosocomial infections and their antibiotics resistant pattern among the patients admitted at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. The study was conducted during a period of March 2011 to February 2012. Nine hundred clinical specimens which included urine, sputum, endotracheal aspirates, pus & blood were subjected for bacterial culture and their antibiotics sensitivity test at the Department of Microbiology with the use of standard method as described by American Society for Microbiology (ASM). Results: Prevalence of bacteria causing nosocomial infection was 34.4% (n=310). Out of 310 specimens, urine 122 (39.30%), sputum 78(25.2%), pus 78(25.2%), endotracheal secreation 24 (7.7%) and blood 8(2.6%). Three hundred thirty three bacteria were isolated from three hundred ten specimens. The most common isolates were Escherichia coli followed by Acinetobacter species, Klebsiella pneumonia and Staphylococcus aureus. In-vitro antibiotic susceptibility tests revealed that the Gram-negatives bacilli were only sensitive to fluroquinolones, ceftrixone, cefepime carbapenem, polymyxin B and colistin sulphate while the Gram-positive cocci were sensitive to fluroquinolones, Ceftroxone, cefepime and vancomycin. Conclusion: The findings suggested the need for constant monitoring of susceptibility of specific pathogens in different populations to commonly used anti-microbial agents to cope up this alarming situation in the hospital for the management of such patients and prevent the dissemination of such strains. Keywords: noscomical infections, bacteria and antibioticsPublication Paragonimiasis: First autochthonous case report from Nepal(Institute of Medicine, 2016) Sah, R; Khadka, S; Sherchand, JB; Parajuli, K; Shah, NP; Mishra, SK; Sharma, S; Shrestha, L; Basnet, S; Tandukar, S; Bhandari, D; Yadav, SR; Kattel, HP; Pokhrel, BM; Rijal, BNA.Publication Strongyloides stercoralis hyperinfection syndrome in patient with non- proliferative glomerulopathy(Institute of Medicine, 2017) Bhujel, R; Yadav, SK; Shrestha, K; Sah, R; Kattel, H P; Shah, NP; Sharma, S; Parajuli, K; Mishra, SK; Sherchand, JBAbstract Strongyolides stercoralis commonly causes chronic, asymptomatic infection but can cause more disastrous type of infection in immunosuppressed patient. Out of many predisposing factors for Strongyloides hyperinfection, regular intake of corticosteroids is a major risk factor. We are presenting a case of Strongyloides hyperinfection syndrome in a 66 years old male patient, a known case of non-proliferative glomerulopathy, presented at Tribhuvan University Teaching Hospital, with swollen limbs, anemia and history of self-recovered diarrhea. His condition got exacerbated and required Intensive Care Unit stay. Despite all the efforts being made for his recovery, he died after 30 days of stay in the hospital. Keywords: Hyperinfection, non-prolifertative glomerulopathy, StrongyloidesPublication The Prevalence of Diabetic Retinopathy Among Known Diabetic Population in Nepal(Kathmandu University, 2016) Mishra, SK; Pant, BP; Subedi, PABSTRACT Background The worldwide prevalence of diabetic retinopathy (DR) was found to be 34.6%. WHO estimates that DR is responsible for 4.8% of the 37 million cases of blindness throughout the world. In a study undertaken in urban population in Nepal, M.D. Bhattarai found the prevalence of diabetes among people aged 20 years and above to be 14.6% and the prevalence among people aged 40 years and above to be 19%. Studies on DR, to our knowledge, have mostly been hospital based in Nepal. Little information is available about prevalence of DR at the community level in Nepal. Objective To investigate the prevalence of diabetic retinopathy and associated risk factors among known diabetic population of Nepal. Method A descriptive cross sectional study was conducted among individuals aged 30 and more using cluster sampling method. The study sites were Kathmandu metropolitan city and Birgunj sub-metropolitan city. A sample size of 5400 was calculated assuming 5% prevalence rate with 95% confidence level, 5% worst acceptable level and 1.5 cluster sampling design effect. Study participants were interviewed, anthropometric measurements and fundus photograph was taken from participants with diabetes. Fundus photographs were used to grade retinopathy. Result Around 12% of the respondents were diabetic, mean age 55.43±11.86 years, of which slightly more than half were females (50.2%). Among these diabetic respondents 9.9% had some forms of diabetic retinopathy, mean age 54.08±10.34 years, 56.7% were male. When severe grade of retinopathy in any eye was considered as overall grade of retinopathy for the individual, prevalence of Non-proliferative Diabetic Retinopathy, Proliferative Diabetic Retinopathy and complete vision loss was found to be 9.1%, 0.5% and 0.3%. Prevalence of Diabetic Macular Edema was 5.5%. Duration of diabetes, family history of diabetes and blood pressure at the day of survey was found to be associated with having any retinopathy. Conclusion Diabetic retinopathy is emerging as a public health threat in Nepal. With increasing diabetes, DR can be expected to increase more. Existing eye care services may require upgrading to provide quality and affordable retinopathy services to address this emerging problem. KEY WORDS Diabetes, prevalence, retinopathy, riskPublication Ventilator Associated Pneumonia in Tertiary Care Hospital, Maharajgunj, Kathmandu, Nepal(Institute of Medicine, 2013) Shrestha, RK; Dahal, RK; Mishra, SK; Parajuli, K; Rijal, BP; Sherchand, JB; Kirikae, T; Ohara, H; Pokhrel, BMAbstract Introduction: Ventilator Associated Pneumonia (VAP) is the most common nosocomial infection among intensive care unit (ICU) patients and lack of much information in Nepal. So, the aim of this study was to determine prevalence and bacteriological profile of VAP with special reference to multi-drug resistant (MDR), Methicillin-resistant Staphylococcus aureus(MRSA), Metallo-β-Lactamase(MBL), Extended-Spectrum β-Lactamase(ESBL)-producing bacterial strains. Methods: A total 150 tracheal specimens were studied during June 2011 to May 2012 at Department of Microbiology, TUTH as described by American Society for Microbiology (ASM). Combination disk method was done for the detection of ESBL and MBL producing isolates. Results: Prevalence of VAP was found to be 34%. Acinetobactereal coaccticusbaumannii complex (44%) was the commonest isolate, followed by Klebsiellapneumoniae (22%), Pseudomonas aeruginosa (16%) and Staphylococcus aureus (12%). Among MDR Gram negative bacteria (GNB), 39% were MBL and 33% were ESBL-producers. All GNB (61) were sensitive to Polymyxin B and Colistinsulphate, whereas, 48% were found resistant to Carbapenems. Prevalence of MRSA was 75%, which were all sensitive to Vancomycin. Conclusion: High prevalence of VAP, MDR along with MRSA or ESBL or MBL producing strains was found in the study. Thus, suitable control measures must be adopted to cope up this alarming situation with genetic characterization. Keywords: VAP, ICU, MDR, MRSA, ESBL, MBL