Browsing by Author "Sherchan, JB"
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Publication Assessment of Health Systems in Relation to Interface Between Malaria Control Programs and Health System Strengthening: Comparative Study Between Nepal and Viet Nam(Institute of Medicine, 2015) Oraha, H; Sherchan, JB; Pokhrel, BM; Hirayama, T; Huy Nam, Vu; Sherchand, JBAbstract Introduction: Malaria control has been a major health issue with high priority in endemic countries and various efforts have been made with the support of foreign assistant partners. In order to implement efficient and sustainable control, integration of the control program into general health system or effective interactions between them is one of the important strategies. Methods: Studies were conducted in Nepal and Viet Nam. Information obtained from document reviews, interviews, and field surveys were analyzed from the viewpoint of interface between malaria control program and the health system in accordance with six building blocks of a health system, with special emphasis on good practices and challenges in the implementation of the malaria control program. Results: Among good practices, strong government commitment towards the control programs to strengthen facilities and capacity of health workers at the primary level, utilization of health volunteers, setting up mobile team and intensified education for residents were noteworthy. Key challenges mainly involved remote areas. Introduction of malaria due to population movement and the emergence of new endemic areas have become growing issues. While strengthening of the vertical health program appeared to have some impact on the general health system, particularly at the primary level, dissociation between the vertical control program and horizontal general health system still remains. Conclusion: It is crucial to implement an effective and equitable malaria control program that responds to these existing challenges and can create a sustainable health system. Addressing these issues will lead to further strengthening of the health system there and eventually lead to the effective implementation of various health programs. Keywords: malaria control, health system, Nepal, Veit NamPublication Clinical and epidemiological profile of bacterial pathogens isolated from infected lesions in Kathmandu University Hospital(Institute of Medicine, 2018) Sherchan, JB; Gurung, P; Bhusal, N; Pote, N; Tamrakar, SR; Malla, BR; Tamrakar, RAbstract Introduction: Treatment of thepatient with wound infected with multidrug resistantorganismis a major burden and challenge to the health care persons. This study was conducted to identify the clinical and epidemiological profile of such patients. Methods: The study was a cross-sectional study conducted between November 2017 to June 2018 in Kathmandu University Hospital. Wound swabs, pus samples collected from patients during the study period were included. Specimen collection, culture, identification tests were done following standard guidelines and patient information was collected after informed consent. Results: Total number of patients observed for wound infection was 2,763. 1,550(56.10%) were postoperative wound and 1213(43.90%) were non-post-operative wound. Pathogenic bacteria were detected in 252(9.12%) samples. 167(66.27%) were multidrug resistant. Conclusion: Since, limited data is available in Nepal,determination ofclinical and epidemiological profile ofwound infection might become a useful tool to prepare guidelines for controlling and treating infected wound in healthcare centers and community. Keywords: Clinical epidemiology profile, bacterial pathogens, drug resistant, hospitalPublication Correlation of Bacteriuria and Pyuria among the suspected cases of Urinary Tract Infection in Kathmandu University Hospital(Institute of Medicine, 2016) Sherchan, JB; Karkee, P; Wenju, SAbstract Infection of urinary tract is one of the most important infectious diseases in the world affecting all age groups across the life span. Bacteriuria and pyuria being some of the features of urinary tract infection need to be correlated. The objective of the study is to determine correlation of bacteruria with pyuria in suspected urinary tract infection. Methods: This study was conducted at Kathmandu University Hospital, Dhulikhel between September 2014 to March 2015. During this period, 272 urine samples were collected and analyzed by microscopic examination and semi-quantitative culture technique with standard microbiological methods. Results: A total of 272 urine samples were processed in which 78(28.67%) were culture positive. Among culture positive samples significant bacteriuria (i.e. ≥10 CFU/ml) was detected in 65(83.3%) of the cases whereas 13(16.7%) of the culture positive samples showed low count significant bacteriuria (i.e. 10-10 CFU/ml). Out of 58 urine samples with significant pyuria, 48(82.75%) were culture positive. Among 214 urine samples without significant pyuria, 30(14.01%) urine samples were culture positive which was significant (P value<0.05). Conclusion: The study showed that pyuria and bacteriuria had no correlation in the suspected cases of urinary tract infection. According to our findings, it is necessary to culture urine and also perform microscopic examination for the correct laboratory diagnosis of urinary tract infection Keywords: urinary tract infection, culture, bacteriuria, pyuria, microscopyPublication Detection of coliform bacteria in irrigation water and on vegetable surfaces in the Kathmandu Valley of Nepal(Institute of Medicine, 2016) Shrestha, S; Haramoto, E; Sherchan, JB; Junko, SAbstract Introduction: Consumption of vegetables irrigated using polluted water is widespread in the Kathmandu Valley of Nepal. However, studies on the microbial analysis of water and vegetable samples from this region are limited. In this study, irrigation water and vegetable samples from farmers' fields in the Kathmandu Valley were examined for the presence of Escherichia coli and total coliforms. Methods: Irrigation water (n = 8) and vegetable (n = 27) samples were collected from November to December 2015. The presence of E. coli and total coliforms in water and on vegetable surfaces was determined by the most probable number (MPN) method using Colilert reagent. In addition, information about vegetable washing and consumption was obtained through a survey to discuss changes in their microbial concentrations before selling and/or consumption. Results: E. coli was detected in 75% (6/8) of the water samples, with concentrations ranging from 8.8 * 10 ^ 3 to 5.2×107 MPN/100 ml, whereas total coliforms were detected in all the 8 water samples, with concentrations ranging from 9.7 * 10 ^ 2 | 7.9 * 10 ^ 7 * MPN / 100 * m . E. coli was similarly detected in 7% (2/27) of the vegetable samples, with concentrations ranging from 0.4 to 10.2 MPN/cm², whereas total coliforms were detected in 59% (16/27) of the vegetable samples, with concentrations ranging from 0.4 to 448 MPN/cm². Well, river, and tap were the predominant sources of water for washing vegetables before selling and/or consumption. Conclusions: Unlike water samples, vegetable samples contained low microbial contamination; however, the level of contaminants was expected to increase because of washing with polluted water. Keywords: E. coli, Kathmandu, total coliforms, vegetable contaminationPublication Enteric Opportunistic Parasitic Infections Among HIV- Seropositive Patients in Kathmandu, Nepal(Kathmandu University, 2012) Sherchan, JB; Ohara, H; Sakurada, S; Basnet, A; Tandukar, S; Sherchand, JB; Bam, D SABSTRACT Background Enteric opportunistic parasitic infections are the major source of diarrheal disease in developing countries mainly in Human Immunodeficiency virus (HIV) infected patients. Objective The study was to detect enteric parasites causing diarrhea and their association with immune status in HIV-seropositive patients. Methods The present study was conducted in Dirgh-Jeevan Health Care Research Center and Tribhuvan University Teaching Hospital, Public Health Research Laboratory, Kathmandu, Nepal between June 2010 and May 2011 involving 146 Human Immunodeficiency virus (HIV) positive patients. Serostatus from these patients were detected by Enzyme Linked Immunosorbent assay. CD4+ T cell counts were done by flow cytometry. Stool was examined for enteric parasites by microscopy with special staining methods. Results A total of 146 HIV sero-positive patients with and without diarrhea age between 20 to 45 years were included in the study. Of the 146 patients, the protozoan parasitic infection was found in 30.13% (44/146). Out of 146 patients, 78 had diarrhea in which parasitic infection was 39 (50%) and 7.35% (5/68) protozoal parasites positive cases did not have diarrhea. A significant difference (p<0.05) was observed in the level of infection of intestinal protozoan between the HIV seropositive with diarrhea and HIV-seropositive without diarrhea. Out of 43 patients whose CD4+ T cells were <200/μl, 29 (67.4%) had opportunistic parasitic infection whereas out of 103 patients whose CD4+ T cells were ≥200/μl, only 15 (14.56%) had opportunistic parasitic infection (P < 0.05). Conclusion Enteric opportunistic parasitic infections were detected in 30.1% among HIV- seropositive patients and low CD4+ T count indicated high enteric opportunistic infection. Early detection of enteric parasitic infections will help in the management and to improve the quality of life for HIV-infected individuals. KEYWORDS Diarrhea, HIV, Opportunistic parasitesPublication Leptospirosis: An Emerging Infectious Disease in Nepal(Institute of Medicine, 2016) Bhattachan, B; Bhattacharya, A; Sherchan, JB; Dhoubhadel, BG; Sherchand, JBAbstract Introduction: The aim of this study was to determine prevalence of Leptospira spp in Japanese Encephalitis negative cases, as well as its demographic and geographical picture in Nepal. Methods: The Nepal government along with World Health Organization (WHO) country office Nepal had approved this surveillance project, which conducted from 2007 to 2008 throughout 47 districts in Nepal. JE was confirmed from Cerebrospinal fluid (CSF) samples using ELIZA Method whereas Leptospiraspp was identified by using Latex Agglutination Test kit method in Nepal Public Health Laboratory (NPHL), Kathmandu, Nepal. Results: Among 2690 Acute Encephalitis Surveillance, the lumber puncture (LP) was done in 2145 patients. Among those tested, JE positive was confirmed in 771 patients. LP was not done in 381 cases. Among 993 JE negative cases, positivity rate of Leptospira spp was reported 41.8% (416/993) . There was more male preponderance 63.5% (264/416) However, it was not statistically significant (p = 0.713) . In terms of age distribution, those above 15 years of age were 64.5% (268/416) while those below 15 years of age were 35.5% (148/416), (p = 0) In eco- region, the rate of infection was highest in Terai region at 53.2% (222/416) followed by Mountain region at 45.2% (188/416) and Himalayan at 1.4% (6/416), (p = 0.005) In terms of seasonal distribution, the rate of infection in autumn was at 44.2% (188/416) followed by summer at 40.1% (167/416), spring at 9.6% (40/416) and winter at 6.1% (25/416) (p = 0) Conclusions: Nepal government cannot neglect the increasing possibility of outbreaks of Leptospira spp in different parts of the country, so this study recommends for surveillance of this infection to prevent future outbreaks in Nepal Keywords: Leptospira, Leptospirosis, JE, NepalPublication Molecular epidemiology of Rotavirus diarrhea among children in Nepal: Emergence of G12 and G9 strains(Institute of Medicine, 2013) Sherchand, JB; Tandukar, S; Sherchan, JB; Gurung, S; Dhakwa, JR; Bichha, RP; Mahaseth, CAbstract Introduction: Rotavirus is the leading cause of diarrhea and dehydration among infants in both developed and developing countries. The primary objective of this study was to find the magnitude of rotavirus disease burden and genotypic variations of rotavirus. Methodology: Questionnaires and stool samples were collected from 1003 enrolled children under 5 years of age attending tertiary care Children’s Hospital with acute watery diarrhea during January to December 2012. Rotavirus in stool samples was detected by Enzyme Immuno Assay (EIA) and strains detected from rotavirus positive samples were genotyped by Reverse-Transcription Polymerase Chain reaction (RT-PCR). Results: Among these, 356 (35.4%) cases were positive for rotavirus by EIA, among the positive cases, 344 samples underwent genotyping by RT-PCR. Rotavirus positive cases were predominant in children who were admitted to the hospital which was 37.8% (115 out of 336). Overall G12 was the most prevalent genotype (52.3%), followed by G1 (17.7%), G2 (10.17%) and G9 (8.1%). The P types identified were P[6] (55.23%), P[8] (20%), and P[4] (12.5%). Conclusion: The study reveals that rotavirus gastroenteritis accounted for more than one-third of all cases of acute diarrhea. Use of rotavirus vaccines may reduce of high burden of rotavirus diarrhea in children. Emergence of G12 and G9 strains proves the immediate need of vaccine in Nepal. Keywords: Molecular epidemiology, rotavirus, 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 Review of Collaboration between Tribhuvan University Institute of Medicine in Nepal and National Center for Global Health and Medicine in Japan on Nosocomial Infection Control and Proposal for Improvement(Institute of Medicine, 2017) Ohara, H; Sherchan, JB; Pokhrel, BMNA.Publication Streptococcus pneumoniae among children with clinical meningitis in Nepal(Institute of Medicine, 2015) Sherchan, JB; Tandukar, S; Shrestha, L; Rai, GK; Sharma, A; Gami, FC; Rijal, B; Sherchand, JB; Ohara, HAbstract Introduction: Invasive bacterial disease is a significant cause of morbidity and mortality worldwide and it is a major cause of childhood deaths in Nepal. Streptococcus pneumoniae is responsible for invasive and non-invasive pneumococcal diseases worldwide, such as pneumonia, bacteremia and meningitis. The aim of the study was to isolate, identify and determine antimicrobial susceptibility pattern of Streptococcus pneumoniae along with use of rapid immunochromatographic test “Binax NOW”, to detect antigen for diagnosis of bacterial meningitis. Methods: The study was carried out from October 2013 to September 2015 in Children’s Hospital, Teaching Hospital-Department of Child Health and Public Health Research Laboratory, Institute of Medicine, Kathmandu, Nepal. Cerebrospinal fluid sample from 339 suspected cases of meningitis from children below 15 years of age were examined for identification by Gram staining, Culture and by Binax Now test. The identification of bacteria was done following standard method recommended by American Society for Microbiology. Antibiotic sensitivity testing was done by modified Kirby- Bauer disk diffusion method. Results: Of total 339 suspected cases, 24(7.08%) bacterial meningitis was detected by Gram staining and culture methods whereas BinaxNow method detected 28(8.26%). On the basis of age, the highest numbers of the positive cases were found in the age group between 0-23 months (9.30%) followed by age group 49-60 months (8.16%) Conclusions: In conclusion, a significant rate of bacterial meningitis was found in this study prompting concern for national wide surveillance. Keywords: Children, Meningitis, S. pneumoniae, NepalPublication Study of Microorganism Growth Pattern in Nasal Pack of Patients Visiting the Department of ENT, Head and Neck Surgery(Kathmandu University, 2015) Shrestha, I; Pokharel, M; Dhakal, A; Amatya, RCM; Madhup, S; Sherchan, JBABSTRACT Background Nasal packs are utilized nearly by otorhinolaryngologists for controlling epistaxis and post nasal procedures. Complications have been reported due to them; therefore the use of antibiotics is a common practice among otorhinolaryngologists. Objective To detect microbiological flora associated with nasal packing and find evidence to support the benefit of systemic antibiotics with it. Method A prospective, analytical study was conducted on 51 patients presenting to the Department of ENT, KUSMS from June to September 2015 who required nasal packing. Approval of the local Institutional review committee (IRC) was taken. The mid part of the pack was collected in a sterile bottle under aseptic technique and sent to microbiology department. Specimen collection, culture, identification tests were done according to the guidelines by American Society for Microbiology. Data were collected using the individual patient records and Microsoft Office Excel 2007. Statistical analysis was performed with SPSS 16.0. Result Among the 51 cultures; 33 (64.7%) were positive. In 18 (35.3%) cultures no organism was grown. Statistical analysis did not show significance between duration of pack kept with microbial growth (p=0.051) or the type of pack kept (p=0.212) .It showed significance with foul smell of the pack to the growth (p=<0.001). Conclusion Microbiological flora was associated with nasal pack. Antibiotic soaked nasal packs have lesser incidence of positive bacterial growth when compared with plain nasal packs. Nasal packs kept for less than 48 hours have lesser incidence of positive bacterial growth when compared with nasal packs kept for more than 48 hours. Therefore, administering systemic antibiotics in cases when we plan to keep the pack for longer duration is recommended. KEY WORDS Epistaxis, microbiology, nasal pack