Journal Issue: Volume: 26, No. 3 (2024)
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Volume
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Issue Date
2024
Journal Title
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Online ISSN: 2676-1424; Print ISSN: 2676-1319
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Articles
Correlation of diabetes self-care adherence with glycemic measures: a cross-sectional health facility-based study in Kathmandu, Nepal
(Nepal Medical College Pvt. Ltd., 2024) Silvanus, Vinutha; Maharjan, Srijana; Jha, Anushree
Abstract:
Self-care plays a key role in prevention of complications, and improvement of the quality of life of persons with diabetes (PWDs). This study has assessed adherence to self-care behavior and its correlation with glycemic measures among PWDs attending private health care facilities in Kathmandu, Nepal. A cross-sectional study was carried out using a semi-structured questionnaire. Socio-demographic information and recent fasting (FBG) and 2-hr post-prandial blood glucose (2-hr PBG) levels were recorded. Self-care inventory (SCI) 12-item version was used to assess adherence to diabetes self-care over the preceding four weeks. Self-care practice was measured in five domains: glucose monitoring; diabetes medication; diet; exercise; and preventative care. The overall adherence score was obtained by computing the average of seven items (items 1, 2, 4, 5, 6, 7, 14). Scores more than or equal to median score were considered as higher levels of self-care efficacy. Univariate linear regression analysis of the subscale scores and individual item-wise score with age, duration of diabetes (years), FBG and PPBG levels was carried out. Pearson’s coefficient (r) was reported for normally distributed variables. Among 385 PWDs, mean FBG was 146 mg/dl (±54.7), 2-hr PBG was 210 mg/dl (±82). Median score for overall adherence to diabetes self-care was 25 (IQR:21 to 29). Higher self-care efficacy was seen among 55% (n=212). Overall adherence to self-care was significantly and negatively correlated with age and glycemic measures. Self-care efficacy was mainly driven by adherence to diabetes medication. Adherence to preventative care, exercise and home monitoring of blood glucose was low. FBG was significantly and negatively correlated with glucose regulation (r=-0.16, P=0.001), diabetes medication and food regulation (r=-0.11, P=0.03), preventative care (-0.14, P=0.03) and overall adherence to treatment (-0.15, P=0.004). 2-hr PBG was significantly and negatively associated with all domains of self-care (r -0.14, P=0.04 to -0.21, P<0.0001). Elderly persons, may face difficulty with regular physical exercise, dietary recommendations and overall adherence to self-care. Continuing diabetes education is imperative to motivate PWDs and caregivers regarding importance of self-care efficacy in glycemic regulation and diabetes care.
Detection of mecA gene in staphylococcus aureus isolated from health care workers at a Tertiary care center in Kathmandu
(Nepal Medical College Pvt. Ltd., 2024) Rai, Junu Richhinbung; Suzuki, Takashi; Amatya, Ritu; Rai, Shiba Kumar
Abstract:
Staphylococcus aureus is a frequent cause of bacterial infections ranging from minor skin infections to fatal necrotizing infections and infections are on the rise particularly the hospital-acquired infections. The infections becomes more complicated when the infection are caused by drug (methicillin) resisant S. aureus. Therefore, detection of methicillin-resistant S. aureus (MRSA) becomes important. In this study, thus, we investigated the mecA gene in 53 S. aureus isolates isolated from health care workers (n= 213). Of the total 53 S. aureus isolates tested in this study, 24 (45.3%) were positive for mecA gene (533bp). Present study showed a relatively higher rate mecA gene positivity.
Pre-operative evaluation of risk factors for difficult laparoscopic cholecystectomy
(Nepal Medical College Pvt. Ltd., 2024) Sah, Chandrika; Pokharel, Nabin; Paudel, Prakash; Shrestha, Sunil; Alam, Shahid; Yadav, Aditya Prakash; Singh, Rahul
Abstract:
Cholelithiasis or the gallstone disease is the most common biliary pathology. 10-15% population of western world is estimated to be affected by gallstone disease, of which majority remains asymptomatic (>80%) and 1-2 % of these asymptomatic patients will develop symptoms needing surgery per year. In this prospective study, 77 patients years undergoing elective Laparoscopic Cholecystectomy (LC) and meeting all inclusion criteria in Department of General Surgery, Nepal Medical College and Teaching Hospital over period of 1 year. History, detailed clinical examination and laboratory investigations were performed as per the working proforma. Operative time and conversion to open cholecystectomy were recorded. The association between clinical, laboratory and sonographic factors with difficult laparoscopy were obtained. Data analysis was done using SPSS-17 version. Out of 77 patients, 63 were females. Body mass index (BMI) above 30 representing obese population were 33.2% with p value 0.0004. Also, 41.5% patients had history of acute cholecystitis while 12.9% patients had previous history of abdominal surgery and 70.1% patients had history of recurrent abdominal pain. Total of 19.4% patients had increased leucocyte count. On ultrasonography thickened GB wall of >3 mm was seen in 42.8%, distended GB was seen in 41.5%, stone size of >1 cm was seen in 70.1% patients and multiple stones were seen in 84.4%. Similarly, duration of surgery was >90 mins in 31.1% and 7.04% patients underwent conversion to open cholecystectomy both of which were considered difficult laparoscopy. Our study reveled that clinical factors like age, BMI, history of acute cholecystitis, previous history of recurrent abdominal pain and past history of abdominal surgery had significant association in prediction of difficult LC.
Antibiotic susceptibility pattern of pseudomonas aeruginosa and detection of virulence genes in a Tertiary care hospital, Kathmandu, Nepal
(Nepal Medical College Pvt. Ltd., 2024) Ojha, Tek Raj; Sah, Anil Kumar; Karn, Govind Lal; Parajuli, Pramila
Abstract:
Pseudomonas aeruginosa is one of the most common causes of hospital-acquired infections. It threatens worldwide public health because of its intrinsic antibiotic resistance and virulence. In this context, this research aimed to determine the occurrence of P. aeruginosa in a clinical setting, examine its susceptibility to antibiotics, and detect the presence of virulence genes, viz. exoY, oprL and toxA in all isolates. It was a cross-sectional study carried out from June 2022 to December 2022. A total of 1356 clinical specimens were collected and processed in the laboratory for Gram staining, culture techniques, and biochemical tests. The Kirby-Bauer disk diffusion method was applied to examine the antibiotic susceptibility pattern and conventional PCR was used to detect the virulence genes in all confirmed P. aeruginosa isolates. 40.5% of specimens showed bacterial growth, of which only 3.02% were identified as P. aeruginosa. Among them, 61.0% were multidrug resistant and 29.2% were β-lactamase producers. Aztreonam (70.7%) was the most effective antibiotic. Among all P. aeruginosa isolates, 68.3% isolates were exoY positive, 61.0% were oprL positive and 56.1% were toxA positive. Strategic interventions are required to stop the emergence and spread of antimicrobial resistance as a result of the isolation of multidrug resistant (MDR) isolates carrying these virulence genes. This study can benefit the medical staff and the entire community in building a surveillance system and enhancing infection control procedures.
Prevalence of metabolic syndrome in peri and postmenopausal women aged 40- 65 years in a Tertiary care centre
(Nepal Medical College Pvt. Ltd., 2024) Joshi, Anshumala; Dhakal, Nishchal; Giri, Amrita
Abstract:
Metabolic syndrome (MetS) is a constellation of interrelated risk factors of metabolic origin— metabolic risk factors—that appear to directly promote the development of atherosclerotic cardio-vascular disease (ASCVD). Menopausal transition with its incidental hormonal changes is considered to contribute to the development of MetS. This was a hospital based cross sectional descriptive study conducted in the Obstetrics and Gynaecology department of Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, from the 1st of September 2023 till the 29th of February 2024 after clearance from the IRC (Ref. No: 56-080/081). Convenience sampling was used among women who fulfilled the inclusion criteria. The aim of the study was to determine the prevalence of MetS among the peri and postmenopausal women and to determine which component of the diagnostic criteria of MetS was more strongly associated with MetS in our population. Women were evaluated to have MetS using both the International Diabetes Federation (IDF) and the National Cholesterol Education Program- Adult Treatment Panel III (NCEP-ATPIII criteria). The prevalence of MetS by the IDF criteria was 54% among the perimenopausal women and 61% among the postmenopausal women. Similarly, the prevalence of MetS according to NCEP-ATPIII was 53.5% among the perimenopausal and 65% among the postmenopausal women. All the MetS diagnostic markers showed a strong correlation with MetS (p<0.001). The prevalence of MetS is high in our population by both the IDF and NCEP-ATP III criteria, being higher in the postmenopausal population, though not statistically significant.