Study of parasitic infection among children of Sukumbasi Basti in Kathmandu valley.

Keeping in view of heavy burden of intestinal parasitosis, present study was done to find out the prevalence of intestinal parasitic infection in children (aged <16 years) of Sukumbasi (people living without land ownership) Basti (community) in Kathmandu Valley. A total of 279 stool samples collected in clean, dry and screw capped plastic container were firstly examined for the presence of adult worm and/or segments of worms. Samples fixed in 10% formal-saline were then examined microscopically after concentration by formal-ether sedimentation technique. Overall parasite positive rate was 43.3% (121/279) with no significant difference in two genders (Boys: 48.3%, 73/151; Girls: 37.5%, 48/128) (p=0.07). Altogether 11 species of parasites were detected. Of them Giardia lamblia was most common followed by Entamoeba histolytica, Trichuris trichiura and others. Positive rate was higher in Tibeto-Burman (55.0%, 77/140) and the least in Indo-Aryan (25.4%, 27/ 106) (p=0.01) ethnic groups. Children taking anti-parasitic drug in last six months had significantly low positive rate (25.4%, 15/59) than others (48.2%, 106/220) (p=0.002). Results of this study suggestive of periodic administration of anti-parastic drugs and need for improvement of sanitary/hygienic practice.

Clinical profiling and use of loop-mediated isothermal amplification assay for rapid detection of Mycobacterium tuberculosis from sputum.

BACKGROUND: Tuberculosis is a global health problem and the situation is worsening with newer incidences of drug resistance and HIV association. Diagnosis of tuberculosis can be done by many methods and test, culture of sputum being the ideal one. Nucleic acid amplification (NAA) assay are more time efficient one, that amplify and detect specific nucleic acid sequences allows rapid, sensitive and specific detection of M. tuberculosis in sputum samples. OBJECTIVES: The present study intends to compile the clinical presentations of the pulmonary tuberculosis (PTB) patients and to evaluate the efficacy of in-house loop-mediated isothermal amplification (LAMP) in detecting Mycobacterium tuberculosis in sputum samples by comparing with microscopy and culture. MATERIALS AND METHODS: Two hundred two sputum samples were collected from 202 patients at National Tuberculosis Center, Bhaktapur, Nepal. Complete clinical profiling, epidemiological data and record on BCG vaccination were noted and the samples were subjected for microscopy, culture and in-house LAMP with six primers specific for 16S RNA gene of Mycobacterium tuberculosis. RESULT: Of the 176 cases of clinical profiling, productive cough was most common symptom in 147 (83.52%), followed by chest pain 136 (77.27%), fever 133 (75.56%) and haemoptysis 61 (34.66%). There was a statistically significant association between BCG vaccination and development of TB (chi(2)=5.33, P=0.02). Of 202 cases, 115 (56.93%) were chest X-ray positive, 101(50%) were direct smear-positive and 100 (49.51%) were culture positive. LAMP had a sensitivity of 97% and specificity of 94.12% while comparing with culture. In addition, its sensitivity and specificity were 91.09% and 89.11% respectively with reference to microscopy. CONCLUSION: As in our previous study, overall, the result of present study further confirms that the in-house LAMP is a simple, rapid, sensitive and specific DNA amplification technique for PTB diagnosis. Because of rapidity of microscopy and specificity of culture, in-house LAMP assay can be used as a very powerful and useful supplementary tool with complete clinical profiling of the patients for rapid diagnosis of TB in both AFB-positive and negative cases who are suspected as PTB in disease endemic country like Nepal.

Etiological agents of bacteraemia and antibiotic susceptibility pattern in Kathmandu Model Hospital.

The presence of bacteria in blood is simply known as bacteraemia. The main aim of this study is to determine the bacteraemia in patients visiting Kathmandu Model Hospital and antibiotic susceptibility pattern of isolates with special interest on ciprofloxacin. This prospective study was carried out in microbiology laboratory, Kathmandu Model Hospital from April 2005 to June 2005. Standard procedure was followed for blood sample collection. The bacteria were isolated and identified by standard microbiological procedure. Further, antibiotic susceptibility test was determined by NCCLS recommended Kirby-Bauer disc diffusion method. Out of 532 culture requests, 123 samples showed evidential microbial growth. The number of isolate of Salmonella typhi, Salmonella paratyphi A and Escherichia coli were 78, 44 and one respectively. The antibiotic susceptibility test demonstrated that chloramphenicol was the foremost drug of choice among the tested antibiotics with its sensitive rate of 98.4%. All the isolates of Salmonella typhi were susceptible to ceftriaxone and all isolates of Salmonella paratyphi A were susceptible to chloramphenicol, cotrimoxazole and amoxycillin. Ciprofloxacin resistant serotype of Salmonella was not isolated but out of 16 isolated serovar of Typhi and 10 serovar of Paratyphi A screened with nalidixic acid, 10 serovar of Typhi and all serovar of Paratyphi A were found to be resistant. Three isolates of Salmonella typhi were found as multidrug resistant (MDR) whereas no MDR was found in Salmonella paratyphi A. From this it can be concluded that Salmonella bacteraemia is more than other. Although nalidixic acid resistant serovars were isolated, ciprofloxacin resistant serovar were not present.

Total spinal anaesthesia in association with insertion of a paravertebral catheter.

An association between intercostal nerve block and the development of a total spinal is rare. Usually, subarachnoid injection is considered to have followed intraneural placement or inadvertent entrance into a dural cuff extending beyond an intervertebral foramen. We report a patient that followed injection of local anaesthetic into a paravertebral catheter sited at surgery in the thoracic paravertebral space of a patient undergoing thoracotomy. This was a life-threatening event that occurred on two occasions before the definitive diagnosis was made. It is considered likely that the paravertebral catheter entered an intervertebral foramen and the tip perforated the dura.

Prophylactic oral ephedrine reduces the incidence of hypotension after subarachnoid block.

The purpose of this study was to demonstrate the efficacy of oral ephedrine in preventing hypotension following subarachnoid block. Two hundred women, ASA physical status I or II, undergoing lower abdominal surgery were randomly divided into two groups (n = 100 each). All patients were given routine oral premedication consisting of diazepam 10 mg and ranitidine 150 mg at bed time and at 90 min before surgery. In addition, Group I patients received ephedrine 30 mg, orally, 30 min before subarachnoid block was administered. Group II received only routine premedication. After starting an iv line and preloading with 10 ml.kg-1 crystalloid, patients were given 0.5% heavy bupivacaine 3.2 to 3.6 ml, depending on body weight, intrathecally. Patients with decreases in blood pressure of 20% were given ephedrine i.v., in increments, in addition to crystalloids. Despite a similar level of block (T3-T4) and i.v. fluids, the total dose of ephedrine supplement in Group I was 4.3 +/- 4.8 mg compared with 11.6 +/- 9.4 mg in Group II (P < 0.01). Also, 55 patients in Group I required intraoperative inotrope supplement compared with 83 in Group II (P < 0.01). We conclude that oral ephedrine premedication is a simple and effective way of reducing the incidence of hypotension in patients undergoing lower abdominal surgery under subarachnoid block.

A modification of the Bain system for ambient air-oxygen inhalation.

In developing countries like Nepal, anaesthetic compressed gases, especially nitrous oxide, are expensive and in short supply and anaesthetic techniques must equally use oxygen and volatile anaesthetics sparingly. We have designed a non-rebreathing anaesthetic system which meets these requirements. An Ambu-E anaesthetic valve and self-inflating Ambu bag connected to a Bain system form a non-rebreathing system which uses ambient air to supplement a mixture of low flow oxygen and halothane. Over 100 patients have been anaesthetised with this system using a balanced anaesthetic technique. The oxygen flow was 2 l.min-1 and the average halothane consumption was 8 ml.h-1. The average inspired oxygen concentration was 34%, and the air:oxygen dilution ratio was 5:1. A graphical analysis of gas flow predicts that the system is almost 100% efficient, in that almost all of the oxygen and halothane will enter the alveoli. Our experience confirms that this is a safe, simple and economical method for inhalation anaesthesia. We recommend it for locations where anaesthetic machines and mechanical ventilators are lacking, and where medical oxygen is in short supply.

Fresh gas flow and carbon dioxide rebreathing in a low pressure semi-open anaesthesia system.

We have constructed a simple system for field anaesthesia by using a Farman entrainer and a semi-open circuit to convert a draw-over apparatus to a continuous flow air/O2 system. Compressed O2 was the driving gas for the entrainer; fresh gas (FG) delivered to the semi-open circuit was a mixture of O2, entrained air and anaesthetic vapour. The purpose of this study was to examine FG flow rate and CO2 rebreathing during intermittent positive pressure ventilation (IPPV). A non-rebreathing inflation valve (Laerdal) placed at the end of the expiratory (efferent) limb of the circuit vented both expiratory gas and excess FG. Ambient air IPPV was applied through the Laerdal valve from a self-inflating bag or ventilator. Since this circuit is functionally similar to a T-piece, the gas from the efferent limb (340 ml, containing FG) entered the lungs first. If tidal volume was larger than 340 ml the balance was ambient air. Minute ventilation of the lungs with efferent limb gas was defined as Veff. Respiratory gas was sampled at the endotracheal tube and the CO2 tension was measured with a NIHON-KOHDEN CO2 analyzer. Thirty-seven adult patients having intra-abdominal or pelvic surgery under general tracheal anaesthesia were studied. Four FG flow rates (5.7, 8.0, 9.3, and 10.4 L.min-1), corresponding to driving gas pressures of 40, 60, 80, and 100 mmHg, were introduced in random order. Although inspired CO2 was detected at FG flow rates of 5.7-9.3 L.min-1, there were no differences in PETCO2 among the four groups.(ABSTRACT TRUNCATED AT 250 WORDS)