Journal Issue: Volume: 10, No 2, Issue 38, APR-JUN, 2012
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Volume
Number
Issue Date
2012
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
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 S
ABSTRACT
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 parasites
Cesarean Section without Urethral Catheterization: A Randomized Control Trial
(Kathmandu university, 2012) Acharya, S; Uprety, DK; Pokharel, HP; Amatya, R; Rai, R
ABSTRACT
Background
Urethral catheterization is done as a routine procedure in cesarean section. It is
associated with high incidence of urinary tract infections, discomfort, delayed
ambulation and longer hospital stay
Objective
To determine the feasibility and safety of cesarean section without urethral
catheterization.
Methods
A prospective, randomized controlled trial was carried out from April 2008 to
March 2009, in the Department of Obstetrics and Gynecology, B. P. Koirala Institute
of Health Sciences. Among 150 patients who had undergone cesarean section 75
were catheterized and 75 were uncatheterized.
Results
First void discomfort was significantly associated with the use of indwelling
catheter (OR 6.95, CI 95 %, 3.74 to 12.95; P< 0.001).Significant number of patients
with indwelling catheter had signs and symptoms of urinary tract infection (OR
6,CI 95%, 2.59 to 13. 86; P < 0.001). Positive urinalysis for urinary tract infection
was high in catheterized group (P <0.001). Hospital stay was shorter in patients
without catheter (p < 0.05). None of the patients had bladder injury. There were
no significant differences in duration of surgery and ambulation time between two
groups of patients.
Conclusions
Cesarean section can be done safely without urethral catheterization with reduced
morbidities.
KEY WORDS
Cesarean section, urethral catheterization, Urinary tract infection
Bruckner Red Light Reflex Test in a Hospital Setting
(Kathmandu university, 2012) Saiju, R; Yun, S; Yoon, PD; Shrestha, MK; Shrestha, UD
ABSTRACT
Background
Childhood blindness is a major problem in developing world including Nepal that
needs to be addressed.
Objective
The objective of study was to measure the effectiveness of the Bruckner red reflex
test for screening of posterior segment opacities in children.
Methods
Patients aged less than five years who came to the Tilganga Institute of
Ophthalmology, Kathmandu from March to August, 2009 were recruited in this
cross-sectional descriptive study. Children were screened with the Bruckner red
light reflex test in a dark room. Patients with abnormal Bruckner tests had their
eyes dilated for further investigations. Abnormalities were recorded. The number
of patients with an abnormal Bruckner test was recorded and correlated with their
potential pathology.
Results
A total of 172 patients with 97 boys and 75 girls were included. Twenty-three had
abnormal Bruckner test results in either one or both eyes. Four of these twenty-
three patients had no pathology diagnosed; hence the sensitivity of the Bruckner
screen to diagnose significant pathology was calculated at 82.6%. Of the 153
patients with normal results, two patients were found to have pathology detected,
which included cataract and strabismus. Hence, the specificity of this test was
98.7%. The screening test had a positive predictive value of 90.5% and a negative
predictive value of 97.4%.
Conclusion
Bruckner test screening is a sensitive and specific marker for detecting the posterior
segment opacities in children. We recommend utilizing the test to evaluate these
problems where other technologies are rare.
KEY WORDS
Nepal, Red flex test, Retinoblastoma, Screening
Antibiotic Usage and its Sensitivity Pattern in the NICU
(Kathmandu University, 2012) Shrestha, R; Shrestha, JM; Gurung, B
ABSTRACT
Background
Sepsis is a major cause of mortality and morbidity in newborns affecting both
developed and developing countries accounting a quarter around one million
deaths per annum.
Objective
This study was aimed to assess the prevalence of neonatal sepsis, culture isolates,
pattern, antibiotic sensitivity and drug prescribing pattern.
Methods
In present prospective study, 48 neonates admitted in pediatric ward from January
to March 2011 of Dhulikhel Hospital were included. The gestation age, onset of
sepsis, culture isolates, antibiotic sensitivity pattern and drug prescribing pattern
were studied. Environmental air sampling of NICU (Neonatal Intensive Care Unit)
was done by settle plate method for microbial examination.
Result
Among 48 neonates, 23 (47.92%) neonates were culture positive with predominant
isolates of Klebsiella oxytoca 11(47.83%), Pseudomonas spp. 4(17.39%), Methicillin
Resistant Staphylococcus Aureus (MRSA) 3(13.04%) and single case of Enterobacter
spp. In environmental samples, K. oxytoca and Enterobacter spp. were isolated.
Amikacin, Imepeneum and Ciprofloxacin were sensitive whereas Ampicillin in
combination with Cloxacillin, Ampicillin, Aztreonam were resistant for Klebsiella.
oxytoca. Amikacin, Ceftazidime and Imipenuem are sensitive to Enterobacter spp.
The single or combinations of resistant antibiotics were found to be prescribed.
Conclusion
The emerging antibiotic resistances among the culture isolates and coherence with
environmental samples were observed. Hence, special measures are imperative
for reducing environmental contamination and the rational usage of antibiotics for
preventing the infection and emerging antibiotic resistance. The study recommends
need of the antibiotic policy to curb the present scenario.
KEY WORDS
Antibiotic Sensitivity, Neonatal sepsis, NICU