Browsing by Author "Pokhrel, Anil"
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Publication Contrast-induced Nephropathy among Patients Administered with Contrast Material at a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2023) Pokhrel, Anil; Sharma, Anubhav; Khatiwada, Dikshya; Lamsal, Jagdish; Adhikary, LaxmanAbstract Introduction: Administration of an intravenous contrast medium, which is used in various routine hospital procedures, can lead to the development of nephropathy in some patients. This contrast-induced nephropathy is one of the most common reasons for hospital-acquired acute kidney injury. This study aimed to find out the prevalence of contrast-induced nephropathy among patients administered with contrast material at a tertiary care centre. Methods: This descriptive cross-sectional study was conducted from 4 March 2022 to 23 May 2022 at a tertiary care centre after taking ethical approval from the Institutional Review Committee (Reference number: 0812202106). Patients administered with an intravenous contrast medium for diagnostic imaging were included in the study. Data including sociodemographic variables and renal function test results were collected. A convenience sampling method was used. Point estimate was done and 95% Confidence Interval was calculated. Results: Among 174 participants, contrast-induced nephropathy was found in 86 (48.31%) (48.24-48.39, 95% Confidence Interval). Conclusions: The study showed that the prevalence of contrast-induced nephropathy was higher than findings from other studies done in a similar setting.Publication Detection of blaoxa-23 Gene from Carbapenem-resistant Acinetobacter Baumannii(Nepal Health Research Council, 2022) Neupane, Laxmi; Sah, Anil Kumar; Rayamajhee, Binod; Pokhrel, Anil; Singh, AnjanaAbstract Background: Antibiotic resistance is a great concern for public health and Acinetobacter baumannii-associated infections are increasing in many parts of the world, including Nepal. However, limited data is available on the prevalence of A. baumannii harboring blaOXA-23 from Nepal. Methods: A hospital-based cross-sectional study was designed to detect the blaOXA-23 gene from carbapenem-resistant A. baumannii isolates in Nepal. A total of 380 clinical specimens were collected and processed following standard microbiological procedures. Antibiotic susceptibility test was performed as per the protocol of the Kirby-Bauer disk diffusion technique and the CLSI guidelines, while screening of carbapenemase production was assessed by the Modified Hodge Test using meropenem (10µg) disc. The presence of the blaOXA-23 gene in carbapenemase-positive A. baumannii was confirmed by PCR. Results: Among 380 specimens analyzed, 210 (55.3%) samples were positive for bacterial growth, where 33(15.7% of total growth) of the isolates were A. baumannii, and most of them were isolated from the ICU patients (20/33, 60.6%) and sputum (16/33, 48.5%). Thirty-two isolates (97%) were colistin sensitive, while only four (12.1%) isolates were sensitive to meropenem and imipenem. Twenty-three (69.7%) of A. baumannii were carbapenemase positive as revealed by the Modified Hodge Test test, and 19 of them (57.6% of total A. baumannii) harbored the blaOXA-23 gene. Conclusions: A high prevalence of the blaOXA-23 gene among carbapenem-resistant A. baumannii isolates were found. Systematic network surveillance should be established to check the spread of such isolates, especially in the intensive care units of tertiary care hospitals in Nepal. Keywords: Acinetobacter baumannii; antibiotic-resistant; blaOXA-23; carbapenemase; NepalPublication Detection of blaoxa-23 Gene from Carbapenem-resistant Acinetobacter Baumannii(Nepal Health Research Council, 2022) Neupane, Laxmi; Sah, Anil Kumar; Rayamajhee, Binod; Pokhrel, Anil; Singh, AnjanaAbstract Background: Antibiotic resistance is a great concern for public health and Acinetobacter baumannii-associated infections are increasing in many parts of the world, including Nepal. However, limited data is available on the prevalence of A. baumannii harboring blaOXA-23 from Nepal. Methods: A hospital-based cross-sectional study was designed to detect the blaOXA-23 gene from carbapenem-resistant A. baumannii isolates in Nepal. A total of 380 clinical specimens were collected and processed following standard microbiological procedures. Antibiotic susceptibility test was performed as per the protocol of the Kirby-Bauer disk diffusion technique and the CLSI guidelines, while screening of carbapenemase production was assessed by the Modified Hodge Test using meropenem (10µg) disc. The presence of the blaOXA-23 gene in carbapenemase-positive A. baumannii was confirmed by PCR. Results: Among 380 specimens analyzed, 210 (55.3%) samples were positive for bacterial growth, where 33(15.7% of total growth) of the isolates were A. baumannii, and most of them were isolated from the ICU patients (20/33, 60.6%) and sputum (16/33, 48.5%). Thirty-two isolates (97%) were colistin sensitive, while only four (12.1%) isolates were sensitive to meropenem and imipenem. Twenty-three (69.7%) of A. baumannii were carbapenemase positive as revealed by the Modified Hodge Test test, and 19 of them (57.6% of total A. baumannii) harbored the blaOXA-23 gene. Conclusions: A high prevalence of the blaOXA-23 gene among carbapenem-resistant A. baumannii isolates were found. Systematic network surveillance should be established to check the spread of such isolates, especially in the intensive care units of tertiary care hospitals in Nepal. Keywords: Acinetobacter baumannii; antibiotic-resistant; blaOXA-23; carbapenemase; NepalPublication Distribution of MecA and Erm Genes among Methicillin-resistant Staphylococcus Aureus with Inducible Resistance to Clindamycin(Nepal Health Research Council, 2023) Thakuri, Dudha Raj Malla; Pokhrel, Anil; Amatya, Ritu; Bashyal, Narayan Sharma; Neupane, Mary; KC, Sudeep; Joshi, Dev Raj; Khanal, SantoshAbstract Background: The emergence of Methicillin-resistant Staphylococcus aureus and its ability to confer cross-resistance to macrolide-lincosamide-streptogramin B has complicated the treatment against it. Gene-based studies among phenotypic methicillin-resistant isolates with inducible resistance to clindamycin are less available in Nepal. This work was undertaken to detect the mecA and erm genes among such phenotypes isolated from clinical samples. Methods: S. aureus isolated from different clinical samples was identified by standard microbiological procedures (Gram-staining, colony morphology, and different biochemical tests). Methicillin-resistant and inducible resistant to clindamycin phenotypes were detected by using cefoxitin disc (30 µg) and a double disk diffusion test according to the Clinical and Laboratory Standards Institute guidelines and mecA and erm genes were detected by polymerase chain reaction. Results: Among 120 S. aureus isolates, 51.67% (n=62) were MRSA, and the prevalence of inducibly-resistant, constitutively-resistant and Macrolide-Streptogramin phenotypes were 15.83% (n=19), 28.33% (n=34) and 15.83% (n=19) respectively. While 35.84% (n=43) of isolates showed sensitivity to both antibiotics, erythromycin and clindamycin. Out of 14 inducibly-resistant phenotypes, 57.14% (n=8) were found carrying ermC and 28.57% (n=4) phenotypes contained both ermA and ermC. All phenotypes were positive for the mecA gene. Conclusions: Macrolides-Lincosamide-Streptogramin B resistance was predominant among methicillin-resistant S. aureus. While all isolates with inducible clindamycin resistance harbored mecA gene, most of them also harbored ermC gene. The higher prevalence of inducible-resistant to clindamycin indicated the need for rational use of antimicrobial agents. Keywords: Erm gene; iMLSB resistance; mecA; methicillin-resistance; MRSAPublication Remarkable Recovery in a Patient with Lethal Dose Paraquat Poisoning: A Case Report(Nepal Medical Association, 2023) Adhikari, Nishob; Chapagain, Nibedita; Acharya, Rajat; Pokhrel, Anil; Niroula, AliskaAbstract Paraquat emerges as a formidable medical dilemma in Southeast Asia, its toxic effects attributed to the generation of free radicals and oxidative stress, with a specific predilection for diverse tissues, most notably the lungs. The scarcity of effective treatment modalities in resource-constrained settings magnifies the magnitude of the paraquat poisoning predicament. This report outlines the successful management of a 25-year-old man who ingested a lethal dose of paraquat. The patient presented solely with dysphagia devoid of accompanying symptoms, regardless of ingesting a fatal quantity of paraquat. The diagnosis was made based on history and a thorough clinical examination. Early, aggressive treatment with pulse therapy of steroids and antioxidants led to unexpected and quirky recovery. The case stresses the importance of prompt management and highlights the need for more research and public education to prevent future cases.