Janaki Medical College Journal of Medical Science

Antibiotic Susceptibility Patterns and Extended Spectrum Beta-Lactamase (ESBL) production in Enterobactericeae Isolated from Stool Samples of HIV and AIDS Patients in Ibadan, Nigeria

2021-07-08T18:12:43+00:00

Background and Objectives: Abuse and indiscriminate use of antibiotics, prolong hospital admission, travel history, organ transplants, immunocompromised conditions and age are parts of the factors that contribute to development of antibiotic resistance and intestinal carriage of Extended Spectrum Beta-Lactamases (ESBL) Enterobacteriaceae. These bacteria affect the course and outcome of an infection and continue to pose a challenge to infection management worldwide. This study was carried out to determine the antimicrobial susceptibility patterns and prevalence of ESBL-producing Enterobacteriaceae isolated from stool samples of HIV and AIDS patients in Ibadan, Nigeria.

Materials and Methods: One hundred stool samples were collected from consenting HIV and AIDS patients accessing care in Antiretroviral (ARV) Clinic in a secondary and a tertiary health care facility in Ibadan, Nigeria. Gram-negative bacteria were isolated and identified using conventional methods. Antimicrobial susceptibility test was carried out using the Kirby Bauer disc diffusion technique. Phenotypic detection of ESBL-producing isolates was carried out using Double Disc Synergy Test (DDST).

Results: A total of 240 Gram-negative bacteria were isolated comprising 100 (41.6%) Escherichia coli, 33(13.8%) Klebsiella pneumonia, 27(11.3%) Serratia marcescens, 20(8.3%) Salmonella enterica, 9(3.8%) Proteus vulgaris, 13(5.4%) Proteus mirabilis, 21(8.8%) Citrobacter freundii and 17(7.1%) Enterobacter aerogenes. Out these, 56 (23.3%) were ESBL-producers; comprising 23(41.0%) Escherichia coli, 9(16.0%) Klebsiella pneumonia, 6(10.7%) Serratia marcescens, 5(8.9%) Salmonella enterica, 3(5.3%) Proteus vulgaris, 5(8.9%) Proteus mirabilis, 2(3.6%) Citrobacter freundii and 3(5.4%) Enterobacter aerogenes. Among the ESBL producers, 45 (80.3%) and 38 (67.8%) showed resistance to trimethoprim/sulfamethoxazole and aztreonam while 3 (3.5%) showed resistance to ertapenem. Also, 96.4% (54/56) of the ESBL producers were multidrug resistant.

Conclusion: This study showed that HIV and AIDS patients are reservoirs of ESBL-producing Enterobacteriaceae through faecal carriage, presenting them as likely source of dissemination of ESBL producer in community and hospital settings.

Otorhinolaryngological diseases of Geriatric visiting Tertiary Care Hospital in Nepal: An Overview of neglected and underrated field

2021-07-08T18:12:46+00:00

Background and Objectives: In Nepal, person aged 60 years and above is considered elderly. The population of Nepal is approximately 30 million, and people aged 60 years and above makes about one tenth of the total population. This study aims to report the main complaints and prevalence of otorhinolaryngological diseases in patients aged 60 years and above, who visited outpatient otolaryngology department of Manmohan Memorial College and Teaching Hospital, Kathmandu, Nepal during study period.

Material and Methods: It is a prospective descriptive cross-sectional study done in Manmohan Memorial College and Teaching Hospital, Kathmandu, Nepal for the duration of a year. All patients aged 60 years and above attending to Ear, Nose and throat (ENT) Outpatient Department were included in the study. The information including demographic data, ENT Complaints and physical examination were noted. Analysis of data was done and report was prepared.

Results: Total of six hundred and ninety three patients were enrolled over the period of one year for the study. Number of Male and female patients in the study were almost equal. The otological problems had the highest prevalence constituting 51.7% of the study population. More than Twenty eight (28.3 %) percent had oral and oropharyngeal pathologies. Nasal complaints constituted 10.8% of the study population and 9.2% had pathologies related to neck and others.

Conclusion: Hearing loss is the most common diagnosis among all the otological pathologies and epistaxis the most common nasal problem. Head and Neck malignancy is also increasing among the geriatric population.

Polypharmacy and potential drug-drug interactions among medications prescribed to chronic kidney disease patients

2021-07-08T18:12:47+00:00

Background and Objectives: Chronic kidney disease is a major systemic condition. Presence of comorbid conditions with the deteriorating renal function, lead them to use multiple drugs. Polypharmacy is common among chronic kidney disease. The possibility of drug interaction rises when a patients concurrently receive more than one drug and the chances increase with the number of drugs taken, which may be associated with increased morbidity, mortality, length of hospital stay and health-care cost. The aim of this study was to assess the polypharmacy and pattern of drug- drug interactions in chronic kidney disease patients attending OPD and ward of nephrology unit in Kathmandu Medical College teaching hospital.

Material and Methods: This was a prospective cross sectional study conducted among 143 chronic kidney disease diagnosed patients in Kathmandu Medical College Teaching Hospital. The Lexi-comp database was used to evaluate patient’s medications for potential drug-drug interactions.

Results: Chronic kidney disease was predominant among male (65.7%) than the female (34.3%). The most common age group was 41-60yrs followed by 61-80 yrs. The mean age of the patients was 54.38 ± 16.43 years. Chronic kidney disease was associated with multiple co-morbid conditions. The most common comorbid conditions were hypertension 52 (36. 4%) and hypertension and diabetes both in 42 (29.4%). A total of 143 prescriptions were included in this study. Average number of drugs per prescription was 6.1. Almost 5-8 medicines per prescription were observed among 95(65.73%) patients. A total of 837 medicines were prescribed. A total number of 206 potential drug-drug interactions were observed among 143 patients. Depending upon the risk rating categorize, the most common were, risk rating C 178( 86.4%) and the most frequent drug interaction was between amlodipine and calcium carbonate 65 (45.45%) .

Conclusion: The prevalence of potential drug-drug interaction is high among chronic kidney disease patients. About 63% of interactions have moderate severity. The safest approach to avoid potentials drug-drug interaction is the implementation of appropriate guidelines, detailed and rationalize knowledge of drugs and to utilize available drug-drug interaction software to avoid harmful drug-drug interaction among chronic kidney disease patients.

Awareness of Oral Cancer in a Community of Tarahara, Sunsari, Nepal

2021-07-08T18:12:49+00:00

Background and Objectives: Oral cancer is one of the highly prevalent cancers worldwide and a leading cause of mortality in certain regions like South-Central Asia and a major public health problem. According to National Health Policy, oral cancer is the most common form of cancer in men and the third most common cancer in females in Nepal. Several studies have shown that public is not well aware of risk factors associated with oral cancer. The objective of this study was to assess the awareness of oral cancer among people of Tarahara-20.

Material and Methods: A cross-sectional descriptive study was conducted among people of age group 18-65 years in 2019. Data were collected from 128 respondents through face to face interview using Semi – structured interview schedule with non-probability purposive sampling method. Data entry and analysis was done in SPSS version 17. Descriptive statistics i.e. frequency, percentage, mean and standard deviation was used to assess the level of knowledge and inferential statistics i.e. chi square was used to find the association between awareness of oral cancer and selected demographic variables.

Results: Total findings of the study showed that More than half (52.3%) of respondents were known about treatment modalities of Oral cancer whereas two third, 78.9% of respondents stated out movement is best for physical rehabilitation. Likewise, more than half (65.6%) had moderate level of awareness and 28.1% of the respondents had inadequate level of awareness regarding oral cancer. The result showed there was no association between level of awareness of oral cancer and selected demographic variables.

Conclusion: The study concluded that awareness regarding oral cancer is moderate among community people of Tarhara. It reflects that efforts should be made to increase the awareness regarding oral cancer. Health education regarding oral cancer and its risk factors with periodic reinforcement will play an important role in creating awareness.

Prescription pattern of anti-hypertensive drugs in Chitwan Medical College Hospital

2021-07-08T18:12:51+00:00

Background and Objectives: Hypertension is a crucial health issue globally. Cardiovascular and kidney disease is one of the results of hypertension which remarkably confer to overall mortality. Thus, the aim of this study is to investigate the prescribing pattern of anti-hypertensive drugs to hypertensive patients and also to establish the current trend of prescribing pattern of anti-hypertensive drugs at Chitwan Medical College (CMC).

Material and Methods: A descriptive cross-sectional study was conducted among 290 patients to assess the prescribing pattern of anti-hypertensive drugs from hypertensive patients visiting medicine OPD of CMC during study period and fulfilling the inclusion criteria. A standard proforma was used to collect information about patient’s socio-demographic details and anti-hypertensive drugs used for them. Data was collected, compiled and analyzed by using Statistical Package of Social Science (SPSS) version 16.

Results: Out of 290 prescriptions, 201 (69.3%) patients received monotherapy while only 89 (30.7%) patients received combination therapy. In monotherapy, calcium channel blockers (CCBs) and Angiotensin receptor blockers (ARBs) were most commonly prescribed, while angiotensin receptor blockers (ARBs) + diuretics were the most commonly prescribed combination therapy.

Conclusion: In the present study, it was found that CCBs and ARBs were the most commonly prescribed anti-hypertensive drug in monotherapy.

Knowledge, attitude, and practice regarding COVID-19 among doctors of Janakpur, Nepal

2021-07-08T18:12:52+00:00

Background and Objectives: COVID-19 is a global pandemic. Practicing hand and respiratory hygiene is important at all times and is the best way to protect others and oneself from COVID-19. People’s behavior plays important role in control of any infectious disease. Knowledge, attitude and practices (KAP) of a person determines the adherence to the control measures. As doctors are the frontline warriors in this pandemic, an online survey as conducted among the doctors of Janakpur for the assessment of their knowledge, attitude and practice regarding COVID-19.

Material and Methods: This study is a cross-sectional online survey using self-administered Questionnaire designed after proper literature survey. The survey was conducted from 4th August, 2020 to 20th August, 2020.

Results: Overall knowledge about the various aspects of COVID-19 among the doctors of Janakpur was 81.25%. A positive attitude was noted among 78.12% of the respondents. However, majority (90.6%) of the doctors thought that the country is not prepared to handle the pandemic. Good practice to prevent and treat COVID-19 was shown by 84.37% of the doctors.

Conclusion: Doctors of Janakpur show good knowledge, a positive attitude and good practice on various aspects of COVID-19. A significant positive correlation exists between knowledge, attitude and practice among them.

PBL session conducted for second year undergraduate students of medicine and dentistry at Universal College of Medical Sciences Nepal: Perception of the participants

2021-07-08T18:12:54+00:00

Background and Objectives: Problem-based-learning (PBL) is generally recognized as a student centered instructional approach. Universal College of Medical Sciences Nepal introduced PBL to second year MBBS and BDS students in July 2019.This study assessed the perceptions of students of second year MBBS and BDS who participated in PBL session.

Material and Methods: This was a cross-sectional questionnaire-based study assessing perceptions of the participant students. The validated questionnaire was used for the collection of data at the end of PBL session. The questionnaire comprised of two parts; Part I- Students’ perceptions and attitude towards PBL (9 statements) and Part II Students’ perceptions about the role of tutor in PBL(11 statements).Data were analyzed using SPSS version 21. The frequency, mean and standard deviation were computed and t test was used for the comparison of responses on statements of MBBS and BDS groups.

Results: The mean scores on7 out of 9 statements on students’ perceptions and attitude towards PBL was higher than fourat Likert scale 1-5 (5=strongly agree, 4=agree, 3=to some extent agree, 2=disagree, 1=strongly disagree) and on 2 statements was higher than 3.5. The mean scores on all the statements with regard to students’ perception about the role of tutor in PBL were higher than four. The mean scores of both MBBS and BDS groups of students on all statements were compared; the significant differences were obtained only on 2 statements out of 20.

Conclusion: The perceptions and attitude of students towards PBL and perceptions about the role of tutor were positive.

Under nutrition among Chepang children of Chitwan, Nepal

2021-07-08T18:12:55+00:00

Background and Objectives: Under nutrition, which includes wasting (low weight-for-height), stunting (low height-for-age) and underweight (low weight-for-age) makes children in particular much more vulnerable to disease and death. This research analyzes the nutrition status of the Chepang children (an indigenous Tibeto-Burman ethnic group of the Mahabharat mountain range of central Nepal living semi-nomadic life) and the associated demographic factors affecting it.

Material and Methods: This study is carried out in children of chepang community living in Kalika municipality, Chitwan, Nepal. The children were interviewed together with their parents/ teachers after which their anthropometric measurements were taken. Information regarding socio – demographic information, physical activities and diet intake were recorded. Food frequency questionnaire was utilized to know the frequency of food per week. Face-to-face interview technique with a structured questionnaire was used to collect data from the respondents.

Results: Out of the 145 children, 72.3% of children were found to be underweight and 86.9% stunted whereas comparatively lower amount of children were found to be wasted (6.2%). Nearly half of the children (43.5%) under 5 years of age were found to be at a risk for acute malnutrition.

Conclusions: Majority of the children were underweight. More than half of the total children were found to be stunted and underweight where as few numbers of the children were found to be wasted.

Management of resistant congenital clubfeet by the new operative procedure (Hussain's procedure): An experience of a fellowship program

2021-07-08T18:12:57+00:00

Background and Objectives: Pakistan Society for Rehabilitation of the Disabled Orthopedic Hospital is renowned for the correction of orthopedic deformities including foot and ankle deformities. Consultant orthopedic surgeon Afzal Hussain, pioneers the treatment of orthopedic deformities and has developed a new operative technique for congenital clubfoot. This research was planned to report the success of Hussain's Procedure in detecting and managing the anomalous structures.

Material and Methods: This research was mixed retrospective and prospective research carried out during fellowship of first author in which, operative procedure of the resistant congenital clubfoot associated with anomalous structures viz. anomalous muscles and tarsal coalitions, were performed with the new operative procedure by Dr. Hussain, were assisted by the first author and a minimum of 5 years of follow up of the cases was done by the senior author (Afzal Hussain). Cumming’s modification of Laavag and Ponseti score was applied for the calculation of the results at the follow-ups.

Results: During the fellowship, 10 cases of clubfeet with muscle anomalies were managed. Similarly 7 clubfeet with tarsal coalitions were managed. There was full correction of the clubfoot deformity. The cases were followed up by the senior author (Afzal Hussain) for at least 5 years. During the minimum of 5 years followup post completion of treatment, Cumming’s modification of Laavag and Ponseti scores of the operated clubfeet were found to be excellent.

Conclusion: The resistance to management of congenital clubfoot by casting may be because of anomalous structures. New operative procedure by Consultant Afzal Hussain names as Hussain's Procedure was helpful in detecting and managing the anomalous structures.

Fluctuations of ‘mind stuff’ in respect to self (individual) and the external world: Review of a book - 'Concept of Mind and Cognition in Yoga Sutra of Patanjali (YSP)'

2021-07-08T18:12:45+00:00

No abstract available.

ACE2 and RAAS: Therapeutic intervention point for COVID-19

2021-07-08T18:12:42+00:00

COVID-19 has caused widespread mortality and morbidity and significant economic disruption. Several potential therapeutic and/ or preventive approaches to address the pandemic are being worked out, a few effective vaccines are under clinical trials and few vaccines has been approved but still the expected result has not been achieved. Some Spiritual Leader claims it to be natural process and can be protected by chant of Mantra 'Pujya Anakarananta Nirakar niranjan shivajyoti mahamanav pita'.

Renin-Angiotensin-Aldosterone System (RAAS) is no more a mere research area in cardio-pulmonary and renal physiology alone but has gained focus as an infection and therapeutic point for COVID-19. This article discusses about ACE2 receptor as a centre point of infection of SARS-CoV-2 and also suggests it as the therapeutic intervention point for COVID-19.