Annals of Clinical Chemistry and Laboratory Medicine

Changing trends in antibiotic susceptibility pattern among clinical isolates of Pseudomonas species in a tertiary care hospital in Nepal

Fri, 31 Dec 2021 00:00:00 +0000

Background: Pseudomonas spp is notoriously known to be important agent of hospital as well as community acquired infections. These organisms are resistant to many antibiotics by intrinsic and acquired mechanisms making infections difficult to treat. Regular surveillance of infection and antibiotic resistance patterns is necessary for selection of appropriate antibiotics for treatment.

Methods: Non repeating Pseudomonas spp isolated from all clinical samples during the year 2017-2019 were included in the study. Identification of Isolates were done by standard conventional tests and antibiotics sensitivity test was done by Kirby-Bauer disk diffusion method following the CLSI guidelines, 2017.

Results: A total of 42,545 specimens comprising of sputum, blood, pus, urine, body fluids and endotracheal tubes were processed during the entire 3 year period. There was significant increase (p-value <0.05) in yearly isolation rate of Pseudomonas spp i.e. 141(7.95%), 197(12.14%) and 303(15.69%) isolates in the year 2017, 2018, and 2019 respectively. Resistance rates of the isolates to cefoparazone sulbactam, Piperacillin Tazobactam, and Tobramycin was significantly decreasing (p-value <0.05). Overall resistance to ceftazidime (66.13%) was alarming. Decrease in MDR isolates were statistically significant over 3 years e.g. 32(22.69%), 31(15.73%) and 37(12.21%) isolates in the year 2017, 2018 and 2019 respectively (p-value <0.05).

Conclusion: The rate of infection of Pseudomonas spp is significantly increasing. There was gradual decrease in number of resistant isolates and MDR isolates over the peri-od starting from 2017 to 2019 which is a favorable trend. The possible factors playing role have to be further studied, identified and promoted.

Prevalence of pathogenic bacteria in meat products and their antimicrobial resistance pattern

Fri, 31 Dec 2021 00:00:00 +0000

Background: There is increase in consumption of antimicrobial agents with misuse and/or overuse of antimicrobial agents in animals and resulting to rise in antimicrobial resistance. The controlled use of antimicrobials is important for national and international policymakers to draw guidelines on its use. Assessing AMR in meat-producing industry is essential to track emerging resistant pathogens that are common between animals and humans. In this study, we have aimed to investigate the prevalence of bacteria in meat products and the antimicrobial resistance pattern in those isolates.

Methods: This study is a quantitative, observational study, where we collected meat samples (n=118) from shops, in Banepa and Dhulikhel Municipality. The samples were cultured in appropriate media for isolation of bacteria. Subsequently, AMR pattern was studied through antibiotic susceptibility test using Kirby Bauer Disc Diffusion method.

Results: In our study, only two sites, out of 48, did not have any pathogenic bacteria. There were total of 113 iso-lates from 118 samples. E. coli (62.8%), Enterococcus (14.1%), Klebsiella pneumoniae (11.5%), were the most prevalent bacteria in processed samples including MRSA (4%). Additionally, 81.6% of the isolated E. coli were resistant to Ampicillin and 60.5% to Ciprofloxacin and 35% to Gentamycin. 43.6% of all isolated E. coli, 100% of all Klebsiella, 100% of all Enterobacter and 25% of all Citrobacter were multi-drug resistant. The resistance was mostly observed against Ampicillin (83.3%), followed by resistance against Ciprofloxacin (64.4%), Gentamycin (58.8%), Ceftazidime (38.8%), with the lowest resistance against Sulbactam/Cefoperazone (3.3%).

Conclusion: E. coli was the most prevalent organism in meat samples. Multi-drug resistance was also most common in E. coli with resistance against Ampicillin, Ciprofloxacin and Gentamycin. Therefore, we recommend for more controlled use of antibiotics in animal rearing industry and more hygienic environment at meat vendors.

Pathological changes in placentas of pregnant females with Gestational hypertension

Binod Dhakal, VK Singh, Raghavan Narasimhan, OP Talwar — Fri, 31 Dec 2021 00:00:00 +0000

Background: Hypertensive disorders complicating pregnancy are common and contribute greatly to maternal and fetal morbidity and mortality. The complications of hyper-tensive disorders in pregnancy have been attributed to abnormalities in the placenta. This study aims to observe the clinical, gross and microscopical (morphology) effects of pregnancy induced hypertension, preeclampsia and Eclampsia.

Methods: It was a prospective study conducted in 30 placentas of hypertensive disorder of pregnancy and 20 placentas of normal pregnancy. The placentas with hypertensive disorders of pregnancy were compared with the placentas of normal pregnancy.

Results: The mean age of mother at delivery was 28.1 years, 25.04 years and 25.04 years in pregnancy induced hypertension, preeclampsia and normal pregnancy respectively. The mean birth weight of new born babies, the mean placental weight and volume were found to be much lower than the control group. The risk for prematurity along with gross and histological abnormalities such as the presence of necrosis, villous hypermaturity, lymphohistiocytic villitis, avascular villi, perivillous fibrin deposits, hyalinization, stromal fibrosis, calcification and vessel wall thickening were observed significantly more often in the placentas of hypertensive mothers.

Conclusion: There is a significant Gross and microscopic changes observed in placentas of hypertensive mothers than the normal mothers. Similarly placental weight and volume were found to be much lower.

Association between serum albumin and cardiovascular diseases among adult population of Kaski district, Nepal

Fri, 31 Dec 2021 00:00:00 +0000

Background: Serum albumin is an abundant circulatory protein. Several studies were reported that a low level of serum albumin associated with a high risk of cardiovascular diseases (CVDs) mortality. Therefore, the present study aimed to investigate serum albumin levels and find out the association between serum albumin and CVDs and their correlation with cardiovascular risk factors.

Methods: This was a cross-sectional study. Patients with confirmed CVDs were enrolled in this study while patients with CVDs plus acute or chronic liver and intestinal diseases were excluded in this study. Data were collected and analyzed by using SPSS version 21. P-value (two-tailed) < 0.05 was considered statistically significant.

Results: A total of 400 subjects were enrolled, out of which 200 healthy control (male 125 and female 75) and 200 patients with CVDs (male 130 and female 70). The mean level of total protein, albumin, globulin, and HDL-C were statistically (p<0.005) lower while TC, TG, and FBS were statistically (p<0.005) higher in CVDs sub-jects in compared to healthy control. The serum albumin was lower in 35 (17.5%) of patients with CVDs, out of which 19 (9.5%) were male and 16 (8.0%) were female. Serum albumin showed a statistically significant negative correlation with age (p=0.000) and a positive correlation with TC (p=0.000). In multinomial logistic regression analysis, model-I, II, and III showed a statistically significant (p<0.05) association between serum albumin with CVDs.

Conclusion: This study concluded, low serum albumin was found in patients with CVDs and it was significantly associated with CVDs. Therefore, measurement of serum albumin can be performed routinely in patients with CVDs.

Urinalysis: Extract the Relevant Information Before Throwing it into the Drain

Madhab Lamsal — Fri, 31 Dec 2021 00:00:00 +0000

From ancient time urine has been considered as a substance of importance and examination for physical wellbeing. Evidences from the ancient civilizations including the Egyptian, Sumerian, Babylonian and Eastern Civilizations such as Vedic cultures support the use of urine as an index of physical and mental well-being. Classified as coloured, black, frothy, cloudy and sweet, urine used to be correlated with different disease conditions such as jaundice, kidney diseases, diabetes etc. These practices have been carried on even by the alchemists and have now formed as an integral constituent of clinical laboratory diagnostics.

Modern approach to urinalysis can be credited to Dr. Richard Bright, MD, who in 1827 by performing urine examinations related to vol-ume, colour, pH, protein (but not cast) corre-lated his findings to several diseases and clini-cal picture including edema, proteinuria etc.

Urinalysis combines the expertise from vari-ous disciplines including biochemistry, pa-thology, microbiology, cytology etc. Urinalysis may be used for screening, diagnosis, monitoring and prognosis due to the ease of collection in any settings. Modern day tech-niques such as molecular biology, immunolo-gy, and mass spectrometry with high resolu-tion microscopy have taken up urinalysis to explore the genetic predisposition to inherited diseases and tumor studies besides the routine diagnostics. So, variation occurs in urinalysis from the simple routine analysis, microscopic examination to highly sophisticated and ad-vanced automated analytical techniques. Uri-nalysis therefore, forms a key component of personalized medicine also integrating with proteomics, genomics, metabolomics approaches.

Heaviness in the chest and Hodgkin Lymphoma: An unusual presentation

Sujan Sharma, Ramesh Chokhani, Pankaj Deo, Sanat Chalise — Fri, 31 Dec 2021 00:00:00 +0000

Hodgkin lymphoma (HL) usually presents as nodal disease and may involve extranodal sites during the progression of the disease. Here we report a unusual case of Hodgkin’s lymphoma (HL) in an otherwise healthy 26 year old young male who came to the Pulmonology OPD with heaviness in the chest . An ultrasound shows mediastinal enlargement. The diagnosis of Hodgkin’s lymphoma was made on a trucut biopsy of mediastinal swelling.