International Journal of medicine & biomedical sciences

Vol.2 Issue.1


Antibiotic Susceptibility Pattern of Urinary Isolates from a Tertiary Care Hospital in Kathmandu

Gyanendra Ghimire1,3*, Sabita Bhatta1, Raina Chaudhary1, Binita Adhikari1,  Manoj Pradhan1,  Jayendra Bajracharya2 & Y Ibotomba Singh1

1 Department of Microbiology, Nepalese Army Institute of Health Sciences, College of Medicine, Kathmandu, Nepal
2 Department of Biochemistry, Nepalese Army Institute of Health Sciences, College of Medicine, Kathmandu, Nepal
3 Singhaniya University, Pacheribari, Jhunjhunu, Rajasthan, India

Urinary tract infection (UTI) is the commonest clinical condition encountered by the clinicians worldwide. The present research was conducted to find out bacterial pathogens responsible for UTI and their antimicrobial susceptibility patterns. The study was done in the Department of Microbiology, Nepalese Army Institute of Health Sciences (NAIHS), Kathmandu, Nepal. Total 450 clean catched midstream urine (MSU) samples were collected, processed, identified and their susceptibility patterns to commonly used antimicrobial agents were recorded according to the CLSI (Clinical Laboratory Standard Institute) guidelines. Out of 450 samples, 108 (24.0%) showed bacterial growth in which UTI occurred more in female with 84 isolates (77.8%) than in male 24 (22.2%). Escherichia coli was the predominant bacterial isolate and accounted for 80 (74.1%) of the total UTI cases followed by Klebsiella pneumoniae 11 (10.2%), Proteus mirabilis 5 (4.6%), Pseudomonas aeruginosa 4 (3.7%), Staphylococcus aureus 4 (3.7%), Staphylococcus saprophyticus 2 (1.9%), and Enterococcus species 2 (1.9%). The isolates were more sensitive to cefotaxim, amikacin, ofloxacin and norfloxacin. Most of the strains isolated were resistant to ampicillin, nalidixic acid, nitrofurantoin, cotrimoxazole followed by ciprofloxacin and gentamycin. The resistant patterns of urinary isolates with 3rd generation cephalosporin are increasing due to irrational and empirical use of antibiotics.

Vol.2 Issue.1


Use of Pleural Fluid C- Reactive Protein and comparison with Light’s criteria to differentiate Exudative from Transudative Pleural Effusions in Nepalese population

Jiwan Thapa1, Amal Basnet1, Kalyan Sapkota2, Anuja Bhandari Thapa3

1 Department of Medicine, National Academy of Medical Sciences, Bir Hospital, Nepal

2 Department of Medicine, Bharatpur Hospital, Nepal

3 Department of Pathology, Institute of Medicine, Kathmandu

Pleural effusion is a common medical problem with diagnostic dilemma, this study was conducted to determine if C- Reactive Protein level in pleural fluid is a better diagnostic tool in differentiating exudative and transudative pleural effusion, to compare with parameters of modified Light’s criteria and its application in Nepalese population. This was an Analytical, Cross-Sectional, Hospital Based Observational study of patients admitted at Department of Medicine, Bir Hospital during period of one year (January 2014-december 2015). A total of 86 patients with Unilateral Pleural effusion whose cause was unknown were enrolled. Diagnosis of pleural effusion was established by a detailed history, physical examination, chest radiograph, ultrasonography and CT scan in few cases. Demographic profiles like age, sex, location, occupation was recorded. Pleural fluid analysis was done for total leukocyte count, differential counts, total protein, LDH and CRP level along with simultaneous serum sample for total protein, albumin, LDH. Cases with Bilateral pleural effusions and who didn’t give consent were excluded from study. Younger age groups (17-25yrs) and females were more affected. Out of 86 samples examine half of them were smokers and smoking had more association with females (58%). Poor appetite and chest pain were the most common presenting symptoms 65(75%) cases. Cut-off values of pleural fluid CRP level ≥ 10 mg/dl showed sensitivity of 87.60% where as in case of clinically identified transudates, 1 transudates out of 13 were misclassified as exudates. The specificity is 92.30%, the positive predictive value and negative predictive values were 98.14%, and 37.50% with a significant p value of <0.001. All transudates were classified correctly as transudates by CRP level > 30 mg/dl, whereas 44 exudates were misclassified as transudates. This criterion had a sensitivity, specificity, positive predictive value and negative predictive values of 100%, 36.23%, 27.87% and 100% respectively with a significant p value of <0.001. On evaluating the individual parameters of Light’s Criteria; Pleural fluid LDH level > 2/3rd of LDH level of normal serum classified 64(74.41%) cases of pleural effusion as exudates, this criteria had a sensitivity of 86.30%, specificity of 92.30%, positive predictive value of 98.43 % and a negative predictive value of 54.55 % with a significant p value of< 0.001and Kappa value is 0.77.While on pleural fluid to serum LDH ratio >0.6, 59 (81.94%) exudates were correctly classified as exudates whereas 13 (18.05%) exudates were classified falsely as transudates. This criterion had a sensitivity, specificity, positive predictive value and negative predictive value of 81.94%, 92.31%, 98.36% and 48% respectively with a significant p value of <0. 001. The test result has similar sensitivity, specificity, positive predictive value and negative predictive value compared with Parameters of Light’s criteria, hence could be applicable to our population as well, however multi centric studies with larger sample size are necessary.

Vol.2 Issue.1


Portal Vein Diameter by Ultrasonography as a non-Invasive Predictor of Esophageal Varices

Amal Basnet1, Jiwan Thapa1, Kalyan Sapkota2, Anjana KC1

 

1 Department of Medicine, National Academy of Medical Sciences, Bir Hospital, Nepal

2 Department of Medicine, Bharatpur Hospital, Nepal

Esophageal varices are one of the most serious consequence of portal hypertension in patients with liver diseases If undetected or left untreated, it can result in massive upper gastrointestinal bleed and can be fatal. Therefore, a timely detection and management of the varices in cirrhotic patient is a must. Several studies have evaluated possible noninvasive markers of esophageal varices to reduce the number of unnecessary endoscopies in patients with cirrhosis but without varices. Endoscopic surveillance of esophageal varices in patients with liver cirrhosis is expensive for the health system and uncomfortable for the patients. Recently, non-invasive ultrasound-based parameters seem to offer valuable information about the status of esophageal varices and thus challenge the need for repetitive endoscopic monitoring.  In this study, our aim was to develop a predictive model using an independent risk factor for the presence of varices in the enrolled patients.

This is a cross-sectional study. The study analyzed 50 patients with liver diseases from February 2014 to January 2015. All the patients with cirrhosis of either gender except those with hepatocellular carcinoma and previous surgical or medical intervention for portal hypertension were enrolled in the study. Ultrasound of the abdomen was done in all cases to note the portal vein diameter. The varices visualized were graded endoscopically. Data entry was done in SPSS version 20 and statistical analysis was done with Chi Square test. Total 50 patients were enrolled in the test. Varices was present in 47 (96%) of the patients. Small varices were present in 13 (26%) and large varices was present in 34 (68%) of patients. For the patients with small varices, the mean portal vein diameter was 13.23 mm and for those with large varices, the mean portal vein diameter was 16.83 mm. The above results signify that the presence of varices was associated with the mean portal vein diameter of 13.23 mm or more and the result was statistically significant with the p value of 0.024 Measurement of portal vein diameter by ultrasonography can be used as a non-invasive predictive indicator of the development of gastro-esophageal varices in patients with portal hypertension.

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