NepMed Repository :: Browsing by Author "Rijal, BP"

Browsing by Author "Rijal, BP"

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Clinical features of HIV/AIDS and various opportunistic infections in relation to antiretroviral status among HIV seropositive individuals from Central Nepal
(Kathmandu University, 2009) Sharma, S; Dhungana, GP; Pokherel, BM; Rijal, BP
Abstract Background: So far, antiretroviral therapy is the only effective treatment available to HIV/AIDS patients. Provision of combined package of treatment, care and support service as well as regular assessment of the therapy increases its effectiveness. Objective: The aim of this study was to establish the relationship between antiretroviral therapy status and clinical features/opportunistic infections among HIV seropositive individuals. Materials and methods: This is a cross-sectional study. Study was carried out between October 2007 and May 2008 in 150 HIV patients of Kathmandu, Central Nepal. After taking informed consent pre-structured questionnaire was filled to assess clinical features and specimen were collected to investigate major OIs as per standard microbiological procedure. All the information were entered into SPSS 11.5 system and analysed. Result: Of the 150 patients, 100 (66.7%) were males and 50 (33.3%) were females. The age group 21-30 years was predominant followed by 31-40 years (42%). Significant relationship could be established between intake of ART and cardinal symptoms of HIV/AIDS (χ2 value ranging from 4.11 to 9.34). However, no significant relationship could be established between the intake of ART and distribution of different OIs (χ2 values ranging from 0.15 to 1.6). Conclusion: Antiretroviral therapy was found to effective enough to reduce the clinical features of AIDS. Diagnosis and treatment of opportunistic infections should be routinely done for both groups of patients. Key words: Antiretroviral therapy, CD4 count, HIV/AIDS, Nepal
Co-existence of aminoglycosides and β-lactam-resistant Escherichia coli phenotypes in a Tertiary care center of Nepal
(Institute of Medicine, 2015) Shrestha, B; Tada, T; Shrestha, S; Katte, HPl; Ohara, H; Kirikae, T; Rijal, BP; Sherchand, JB; Pokhrel, BM
Abstract Introduction: Multidrug-resistant Escherichia coli isolates conferring simultaneous resistance to both aminoglycosides and β-lactam drugs have serious implications for clinicians worldwide. This study was designed to evaluate the co-existence of various β-lactamases in aminoglycoside- resistant Escherichia coli amongst hospitalized subjects in a tertiary care center of Kathmandu, Nepal, between December 2013 and December 2014. Methods: Standard microbiological techniques were used for isolation and identification of the isolates. The antimicrobial susceptibility of bacterial isolates was determined following Clinical and Laboratory Standard Institute recommended Kirby-Bauer Disc Diffusion method. The defining criterion in this study for an isolate to be MDR, resistance to at least one agent in three or more than three different structural classes was taken. Results: Among 302 MDR E. coli isolates, 174 (58.0 %) were resistance to gentamicin and 138 (46.0 %) were resistance to amikacin. Maximum aminoglycoside-resistant 9/11(82.0%) strains were isolated from body fluids followed by 7/10 (70.0%) from bile, 6/9 (67.0%) from blood and 2/3 (67.0%) from tissue. Out of 174 aminoglycosides-resistant E. coli isolates, the simultaneous occurrence of Extended-spectrum- b- lactamase (ESBL) and AmpC β–lactamaseswas noted in 13.0 % isolates and Metallo-β-lactamase (MBL) and AmpC β–lactamasesin 8.0 % isolates. None E. coli isolates were positive for all 3 types of β–lactamases in combinations. In amikacin- resistant isolates, ESBL+ AmpC observed in 12% and MBL+AmpC seen in 10% isolates. Conclusion: Our results show a high frequency of aminoglycoside- resistance phenotypes. Strict application for appropriate use of antimicrobials in medical settings should be essential to minimize the emergence of multidrug-resistance among E. coli in hospitalized patients. Keywords: Aminoglycoside-resistant E. coli, Amp C β–lactamases, Metallo-β-lactamase, MDR E.coli
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, BM
Abstract 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 antibiotics
Phenotypic characterization of multidrug-resistant Acinetobacter baumannii with special reference to metallo-β-lactamase production from the hospitalized patients in a tertiary care hospital in Nepal
(Institute of Medicine, 2015) Shrestha, S; Tada, T; Shrestha, B; Ohara, H; Kirikae, T; Rijal, BP; Pokhrel, BM; Sherchand, JB
Abstract Introduction: Acinetobacter baumanniiis an important cause of nosocomial infection and has been associated with a wide variety of illnesses in hospitalized patients, especially patients in the intensive care units. The emergence of carbapenem-resistant clones of A. baumannii has been the most serious problem worldwide. After the carbapenem resistant clones have emerged, leaving the hope of treatment of A. baumannii infection is by the last resort of antibiotics such as tigecycline, polymyxin-B and colistin. The purpose of this study is to determine the antibiotic resistance patterns of A. baumannil isolates, prevalence of multidrug resistance, extended spectrum beta lactamase production and metallo-beta lactamase production. Methods: This is a prospective study conducted at the department of Clinical Microbiology. Tribhuvan University Teaching Hospital, from December 2013 to September 2014. Ethical approval was taken from the Institutional Review Board of Institute of Medicine. Two hundred and forty six Acinetobacterisolates were identified by standard microbiological testing. Antimicrobial susceptibility testing was performed by Kirby Bauer method as per the CLSI guidelines. Multidrug resistance was determined. ESBL production was detected by combination disc method and confirmed by Clinical and Laboratory Standerd Institute confirmatory test. MBL production was detected by using imipenem and imipenem/EDTA disc. Result: All 122 Multidrug-resistant A. baumannii isolateswere resistant to majority of the drugs used. All the isolates were completely sensitive to polymyxin B, colistin and tigecycline only. Fifteen (12.29%) isolates of A. baumannii were extended spectrum beta-lactamase producers and 50 (40.98%) were metallo-beta-lactamase producers. Multidrug resistance was common in A. baumannii Conclusion: Multidrug resistance in A. baumannii is becoming more common ESBL and MBL production should be promptly detected and reported to control the spread of resistant phenotypes to other individuals. Keywords: Acinetobacter baumannii, ESBL, MBL, multidrug-resistance
Seasonality of tuberculosis among suspect patients visiting National Medical College, Teaching Hospital, Birgunj, Nepal
(Institute of Medicine, 2014) Shidiki, A; Pandit, BR; Bhargava, D; Mondal, S; Rijal, BP
Abstract Introduction: Seasonal variations of tuberculosis have been demonstrated in a number of studies with reported peaks in late winter and early spring or summer. The study was to analyze effect of seasonal variation on tuberculosis suspects across the calendar year. Methods: The research work was conducted in National Medical College & Teaching Hospital from January to December 2012. The sputum samples were collected and processed for acid fast bacilli from suspected tuberculosis patients. Results: Among 1403 suspected tuberculosis patients, 57.0% were male and 43.0% were females. 11.3% male and 4.0% female were present among the suspected cases of tuberculosis. The highest number of cases was in the age group 51-60.There was no any significant difference in between positive cases and age group (P=0.637). The positive cases of tuberculosis were found in 8.7% Muslim and 8.1% Hindu significant difference was not found in religion and tuberculosis (P=0.780%). The highest cases of tuberculosis was detected in June (14.9%) and to decline from august (13.2%) through December (4.4%). There was significant relation for cases and month (P=0.00001). More severe (3+) cases were found more (10.6%) in June, 2+ (4.4%) in July and 1+ (9.7%) in August which was statistically significant (P=0.00001). Conclusion: The seasonal variability of tuberculosis case detection showing mostly a peak in numbers in early spring and summer months. Keywords: Seasonal variation, Tuberculosis, Religion, severity
Tuberculosis and other clinical presentation of HIV/AIDS in patients with or without undergoing antiretroviral therapy in Kathmandu
(Kathmandu University, 2007) Dhungana, GP; Ghimire, P; Sharma, S; Rijal, BP
Objectives: To screen tuberculosis (TB) and examine the clinical presentation of AIDS in HIV sero-positive persons. Methods: A Cross-sectional study was designed. One hundred HIV infected persons were randomly selected from different parts of the country visiting Tribhuvan University, Teaching Hospital, Kathmandu and different HIV/AIDS care centres. After taking informed consent, questionnaires were filled and three sputum specimens from each person were collected to investigate tuberculosis by Ziehl-Neelsen staining and culture. Data generated were entered into SPSS 11.5 and relevant statistical tools were applied. Results: Among 100 HIV infected cases, 66 (66%) were males and 34 (34%) were females. Sixty percent of the cases were in the age group of 21-30 years. Majority of them were Smokers (41%), alcoholics (34%), illiterates (54%) and unemployed (59%). Heterosexual activity (51%) was found to be the major risk factor for HIV infection. Of the 100 HIV cases, 23 (23%) were co-infected with tuberculosis of which 18(78%) were sputum smear negative tuberculosis, mostly developed in late stage of HIV infection. Weight loss (54%) and diarrhoea (43%) were the major clinical presentations of AIDS. Antiretro-viral therapy non-receiver were more likely to suffer with various clinical disorders/TB as compared to ARV therapy receiver but the values were statistically insignificant, χ2 values ranging from 0.003 to 2.24, p>0.05. Conclusion: Prevalence of tuberculosis was still high in HIV/AIDS patients, and specifically, sputum smear negative tuberculosis cases constituted the significant proportion, particularly in late stage of HIV infection. Weight loss and diarrhoea were found to be the major clinical presentation of AIDS. Illiterate and unemployed young adults involved in unsafe sexual practice and drug addiction were high risk of acquiring HIV infection. Key words: Clinical features, HIV/AIDS, Kathmandu; Smear Negative Tuberculosis
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, BM
Abstract 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

Browsing by Author "Rijal, BP"

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