Dyslipidemia among Pilots visiting a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Dyslipidemia is the imbalance of various lipids in our body like cholesterol, low-density lipoprotein cholesterol, triglycerides, and high-density lipoprotein. It has been established as a major factor associated with cardiovascular disease. The aim of our study was to find out the prevalence of dyslipidemia among pilots visiting a tertiary care centre. Methods: This descriptive cross-sectional study was conducted in the family medicine department of Grande International Hospital, Dhapasi, Kathmandu from 1 May 2022 to 30 July 2022 (Reference number: 08/2022). Seventy pilots were included in this study. Lipid profiles like total cholesterol, triglycerides, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol were measured. Results: Among 70 pilots, only 2 (2.85%) (0-6.12, 90% Confidence Interval) had dyslipidemia with an increased level of triglycerides. Dyslipidemia was seen among pilots 41 to 60 years. Conclusions: Dyslipidemia among pilots was lower than in other studies done in similar settings. Keywords: dyslipidemia; lipids; pilot.

Role of Biofilm in Bacterial Infection and Antimicrobial Resistance.

Biofilm refers to the complex, sessile communities of microbes found either attached to a surface or buried firmly in an extracellular matrix as aggregates. Microbial flora which produces biofilm manifests an altered growth rate and transcribes genes that provide them resistance to antimicrobial and host immune systems. Biofilms protect the invading bacteria against the immune system of the host via impaired activation of phagocytes and the complement system. Biofilm-producing isolates showed greater multidrug resistance than non-biofilm producers. Biofilm causes antibiotic resistance through processes like chromosomally encoded resistant genes, restriction of antibiotics, reduction of growth rate, and host immunity. Biofilm formation is responsible for the development of superbugs like methicillin-resistant Staphylococcus aureus, vancomycin-resistant Staphylococcus aureus, and metallo-beta-lactamase producing Pseudomonas aeruginosa. Regular monitoring of antimicrobial resistance and maintaining hygiene, especially in hospitalized patients are required to control biofilm-related infections in order to prevent antimicrobial resistance.

Prevalence of COVID-19 Positive Cases Diagnosed by Real time Polymerase Chain Reaction in a Tertiary Care Hospital of Nepal.

INTRODUCTION: The virus that causes COVID-19 is known as severe acute respiratory syndrome Coronavirus-2. This new variant of Corona Virus introduced in China has urged the massive health system resources to focus on its screening and management of sick patients worldwide. We aimed to find the prevalence of COVID-19 positive cases diagnosed by Real-time polymerase chain reaction in a tertiary care hospital of Nepal. METHODS: This is a descriptive cross-sectional study that was conducted from 11th of November to 15th December 2020. Nasopharyngeal and Oropharyngeal swabs were collected, and confirmation of cases of COVID-19 was done based on the detection of viral ribonucleic acid by nucleic acid amplification tests such as real-time reverse transcriptase-polymerase chain reactions. The viral genes targeted include the E, N, and ORF. RESULTS: A total of 15247 samples have been processed, of which s (14.81%) positive cases were included in this study. There were 1427 (63.19%) male and 831 (36.68%) females. The majority of the cases were asymptomatic 1386 (61.38%). The most common age group infected was between 15 to 40 years, 841 (58.93%) male and 542 (65.22%) females. The most common presenting symptoms were cough 315 (13.95%) and fever 306 (13.55%). CONCLUSIONS: Most of the individuals reported for real-time polymerase chain reaction were asymptomatic patients who might be contagious and have the potential to transmit infection. Among symptomatic cases, common symptoms were cough and fever.

Side Effects after Second Dose of Covishield Vaccine among Health Care Workers: A Descriptive Cross Sectional Study.

INTRODUCTION: COVID 19 vaccination will protect us from getting COVID-19. Some side effects are common which are signs that our body is building protection. This side effects will go away in a few days. The aim of this study is to find out side effects seen among health care workers after second dose of covishield vaccination. METHODS: This was a descriptive cross-sectional study conducted at Kathmandu medical college and Teaching Hospital from 22nd April 2021 till 30th April 2021. Ethical approval was revceived from Institutional Commitee of Institiute. Convienient sampling was done. The second dose of covishield vaccine was administered 12 weeks after its first dose. The vaccine was administered intramuscularly (IM) into deltoid muscle. Statistical Package for the Social Sciences were used for analysis. RESULTS: Out of 220 cases taken, 135 were male and 85 were female. In our study 178 (80.90%) complaint of pain at injection site after second dose of covishield vaccine followed by 97 (44.09%) complaint of fatigue, 43 (19.54%) complaint of headache, 18 (8.18%) complaint of chills, 11 (5.00%)complaint of fever, 6 (2.72%) complaint of dizziness and 5 (2.27%) complaint of nausea. CONCLUSIONS: Pain at injection site, fatigue and headache were common side effects seen after second dose of Covishield vaccination.

Antibiotic Resistance to Escherichia coli among Urine Culture-Positive Patients in a Tertiary Care Hospital in Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Urinary tract infection is treated by the antibiotic sensitivity pattern of uropathogens in our population. Present infection cases have been showing an increase in resistance to the current first-line of antibiotics. The objective of this study is to determine the resistance of antibiotics in Escherichia coli in a tertiary care center. METHODS: This is a descriptive cross-sectional study done in Kathmandu Medical College Teaching Hospital from October 2018 to February 2019. The sample size was calculated, and convenient sampling was done. Patients with urine culture positive (i.e., Colony-forming unit >105) were included in the study. All positive samples were tested for antibiotics sensitivity and resistance. The resistance to the antibiotics was recorded using Statistical Package for Social Sciences version 20. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 100 samples, the highest number of organisms isolated was Escherichia coli, 71 (71%). Escherichia coli showed the highest resistance to drugs like Norfloxacin, 37 (52.11%), AmoxicillinClavulanic acid 37 (52.11%), followed by Co-trimoxazole 32 (45.1%), Ceftriaxone, 24 (33.8%), and Ciprofloxacin 23 (32.3%). CONCLUSIONS: Escherichia coli showed the highest resistance to commonly used antibiotics like Norfloxacin, Amoxicillin-Clavulanic acid, Co-trimoxazole, Ceftriaxone, and Ciprofloxacin.

Standard Operating Procedure for Specimen Collection, Packaging and Transport for Diagnosis of SARS-COV-2.

Coronavirus disease-19 is caused by severe acute respiratory syndrome coronavirus-2 (SARSCoV-2). Specimen quality, and proper transportation is vital for accurate diagnosis. This standard operating procedure is designed to educate the clinicians, nurses, paramedics, and laboratory personnel regarding proper methods of sample collection, packaging, and transportation. Nasopharyngeal swabs and/or oropharyngeal swabs should be collected for real-time quantitative polymerase chain reaction to detect SARS-CoV-2. The sample should be collected wearing proper personal protective equipment, packed in a triple packaging system, and transported maintaining cold chain.

Prevalence of Pseudomonas Aeruginosa and its Antibiotic Sensitivity Pattern.

BACKGROUND: Pseudomonas aeruginosa is an opportunistic pathogen which causes most of the chronic infection in humans. This study was undertaken to determine the prevalence rate of Pseudomonas aeruginosa that is isolated from various clinical specimens along with its antibiotic susceptibility pattern. METHODS: This descriptive cross sectional study was conducted in Kathmandu Medical College and Teaching Hospital (KMCTH) from February to May 2018. Pseudomonas aeruginosa isolated from various clinical specimens were processed in clinical laboratory, Department of Microbiology, KMCTH. Isolation, identification and sensitivity of Pseudomonas aeruginosa to antibiotics were measured. RESULTS: A total of 7527 samples were been processed of which 46 isolates of Pseudomonas aeruginosa were obtained. Pseudomonas aeruginosa was isolated mainly from Pus, Wound swab, Sputum and Tracheal aspirate. Here 63.04% Pseudomonas aeruginosa isolates were resistant to Ceftazidime, 65.21% to Cefixime, 56.52% to Ceftriaxone and Cefotaxime followed by 56.52% to Piperacillin. Furthermore, the current study reveals antibiotics like Imipenem, Meropenem, Piperacillin/Tazobactam, Ciprofloxacin, Gentamicin, Amikacin and Tobramycin were found to be good choice for the treatment of infection caused by this organism. CONCLUSIONS: Continuous monitoring of antibiotic susceptibility pattern of Pseudomonas aeruginosa is essential and rational treatment regimens prescription by the clinicians is required to limit the spread of antimicrobial resistance.

Resistance Pattern of Carbapenem on Enterobacteriaceae.

INTRODUCTION: Gram negative bacilli are the important causes of common clinical infections. Carbapenem resistant Enterobacteriaceae are considered as important public health threat and is classified as urgent by the Centers of Disease Control and Prevention because of their progressive geographic dissemination and limited therapeutic alternatives. This study was done to find out the resistance pattern of Carbapenem among Enterobacteriaceae. METHODS: The descriptive cross-sectional study was carried out in Clinical Microbiology laboratory from February 2018 to May 2018 after ethical approval. Organism was identified on the basis of its microscopic observation by performing Gram's stain and by identification of morphology after its growth in culture media followed by its biochemical reactions. Antibiotic sensitivity test of isolated pathogens was done using Muller Hinton Agar by the standard disk diffusion technique of Kirby-Bauer method. RESULTS: In our study, total 1055 sample belongs to the family Enterobacteriaceae. From the family Enterobactericeae, 348 (27%) of the bacilli were found to be Carbapenem resistant. Among which most common bacteria was Klebsiella pneumoniae followed by Escherichia coli. All strains of Carbapenem resistant Enterobacteriaceae were sensitive to Colistin, Polymyxin B and Tigecycline. CONCLUSIONS: Among Enterobacteriaceae, around one-third of the bacterial isolates were Carbapenem resistant. However, to reduce drug resistance antimicrobial stewardship programme and proper infection control measures is required.

Incidence of metallo-beta-lactamase producing clinical isolates of Escherichia coli and Klebsiella pneumoniae in central Nepal.

BACKGROUND: The increasing and rapid spread of metallo-beta-lactamase (MBL) producing Enterobacteriaceae, particularly Escherichia coli and Klebsiella pneumoniae represents an emerging public health threat. However, limited data is available on MBL production in clinical isolates of E. coli and K. pneumoniae from Nepal. We have therefore undertaken this study to ascertain the incidence of MBL production in clinical isolates of E. coli and K. pneumoniae at a tertiary care teaching hospital in central Nepal. METHODS: A total of 401 consecutive, non-duplicate isolates of E. coli (n = 216) and K. pneumoniae (n = 185) were recovered from various clinical samples between July and December, 2012. These isolates were screened for the detection of carbapenemase production on the basis of their reduced susceptibility to meropenem or ertapenem by the disc diffusion method. The screened isolates were further phenotypically studied for carbapenemase production by modified Hodge test (MHT). MBL production was detected by performing combined disc test by using imipenem discs with and without ethylenediaminetetraacetic acid (EDTA), which chelates zinc required for MBL activity. RESULTS: Out of 216 E. coli isolates, a total of 41 isolates (18.98%) and out of 185 K. pneumoniae isolates, a total of 39 isolates (21.08%) were suspected to be carbapenemase- producers on the basis of their reduced susceptibility to meropenem or ertapenem. Interestingly, all the initially suspected isolates of E. coli and K. pneumoniae for carbapenemase production were found to be positive in both MHT and combined disc test. However, few weakly positive reactions were observed in MHT. All the MBL producing isolates were multidrug-resistant (MDR). In addition, 75.60% E. coli and 71.79% of K. pneumoniae isolates producing MBL were found to be "pandrug- resistant". CONCLUSIONS: Our findings showed MBL production in a considerable number of E. coli and K. pneumoniae isolates with MDR and pandrug-resistant phenotypes. Combined disc method can provide a sensible choice for phenotypic detection of MBL production in clinical microbiology laboratories as detection of MBL in bacterial isolates is indispensable for establishing the effective antibiotic policies and infection control strategies in the hospital setting.