Journal Issue: Volume: 37, No. 3 (2015) Decembe
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2015
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
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Articles
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
Stressful life events and coping strategies among patients with generalized anxiety disorders
(Institute of Medicine, 2015) Shrestha, R
Abstract
Introduction: Anxiety disorders are the most frequently occurring mental disorders resulting in psychological and physical problems. Coping is a healthy response to stress that helps in restoration to homeostasis. The aim was to identify gender and age difference on stressful life events and coping among patients with generalized anxiety disorder.
Methods: In the study, 60 subjects above 15 years of age were recruited from Psychiatric OPD of Tribhuvan University, Teaching Hospital. Subjects were assessed with Presumptive Stressful Life Events Scale and standard Coping Check List was used. Mean difference in stressful life events and coping strategy was compared by age and gender by using paired t-test. Pearson correlation coefficient was calculated for association between stressful life events and coping strategy.
Results: Female experienced significantly more stressful life events (SLE) than males (2.2±2.0). No age different in SLE was observed. Passive acceptance coping strategy was significantly higher among females than males (p=0.01). Passive coping strategy and problem focused coping strategy were most frequently adopted coping strategies.
Conclusion: Females with generalized anxiety disorder experienced more SLE than males. Coping strategies were most commonly associated with SLE among middle adults than young adults. Problem focused coping and passive acceptance coping were the mostly adopted coping strategy amongpatients with generalized anxiety disorder and were significantly correlated with males.
Keywords: Generalized anxiety disorder, coping strategy, stressful life event
Triclosan Coated Suture Inhibits colonization of Bacteria Responsible for Surgical Site Infection – An in Vitro Efficacy Study
(Institute of Medicine, 2015) Shah, NP; Shah, RK
Abstract
Introduction: Surgical site infection is one of the common healthcare associated infections, has significant impact on associated morbidity, mortality and exerts economic burden on the patient as well as on health care system. In addition to other measures, local inhibition of colonization of bacteria would provide clinical benefits. Antibacterial suture such as Triclosan coated suture prevents local growth of bacteria during critical initial stage of wound healing. At the end of 24 hrs of incubation at 37°C, 17-19 mm of zone of inhibition was seen for both S aureus and MRSA for Triclosan coated suture, while no zone was found around for non-coated suture.
Methods: The study evaluated in vitro efficacy of antibiotic coated Triclosan suture using zone of inhibition model against commonly reported organisms in SSI (Staphylococcus aureus, Methicillin resistant Staphylococcus aureus.
Results: Triclosan coated suture prevents colonization of bacteria at the surgical site, thus reduce the risk of SSI, also it would have positive financial impact such as minimizing the treatment cost and reduced hospital stay. We believe the clinical effectiveness of Triclosan coated suture in minimizing the risk of SSI would be beneficial to health care settings in Nepal.
Conclusion: The use of Triclosan coated suture for wound closure would be highly beneficial in controlling the SSI, morbidity, mortality and short hospital stay.
Abstract
Introduction: Surgical site infection is one of the common healthcare associated infections, has significant impact on associated morbidity, mortality and exerts economic burden on the patient as well as on health care system. In addition to other measures, local inhibition of colonization of bacteria would provide clinical benefits. Antibacterial suture such as Triclosan coated suture prevents local growth of bacteria during critical initial stage of wound healing. At the end of 24 hrs of incubation at 37°C, 17-19 mm of zone of inhibition was seen for both S aureus and MRSA for Triclosan coated suture, while no zone was found around for non-coated suture.
Methods: The study evaluated in vitro efficacy of antibiotic coated Triclosan suture using zone of inhibition model against commonly reported organisms in SSI (Staphylococcus aureus, Methicillin resistant Staphylococcus aureus.
Results: Triclosan coated suture prevents colonization of bacteria at the surgical site, thus reduce the risk of SSI, also it would have positive financial impact such as minimizing the treatment cost and reduced hospital stay. We believe the clinical effectiveness of Triclosan coated suture in minimizing the risk of SSI would be beneficial to health care settings in Nepal.
Conclusion: The use of Triclosan coated suture for wound closure would be highly beneficial in controlling the SSI, morbidity, mortality and short hospital stay.
Keywords: Surgical site infection, triclosan, antibacterial coated suture, bacterial colonization
Visualization of Normal Appendix in Multidetector Computed Tomography
(Institute of Medicine, 2015) Ansari, MA; Kumar, M; Subedi, K
Abstract
Introduction: Acute appendicitis is one of the most common causes of acute abdominal pain. Visualization of normal appendix is important to exclude the possibility of appendicitis. With the widespread use of multidetector computed tomography (MDCT) for evaluation of acute abdomen, the normal appearance and rate of visualization of appendix has to be defined.
Methods: This was a prospective cross sectional study involving 250 patients undergoing abdominal CT for various indications in Tribhuvan University Teaching Hospital between October 2012 and September 2013. One hundred twenty seven patients were female and 123 were male. Age ranged from 17 years to 73 years. CT scans of the patients were obtained with a 16 slice CT scanner with IV contrast. In all patients, there was no clinical suspicion of acute appendicitis or history of appendectomy. Appendix was searched in these patients by tracing caecum.
Results: Appendix was visualized in 215 patients, 111 females and 104 males. Appendix was not visualized in 35 patients, 16 females and 19 males. In total appendix was visualized in 86% of patients (87.4% females and 84.6% males).
Conclusion: MDCT is an accurate imaging modality for detection of appendix, whether normal or pathological. Visualization rate of normal appendix by CT scan is higher ranging up to 96% as shown in various studies. Thin collimation, use of contrast and multiplanar reconstruction may be the reason for increased rate of visualization of normal appendix.
Keywords: aapendix, multidetector computed tomography