BackgroundNeonatal sepsis, one of the leading causes of mortality in neonatal intensive care units (NICU) of developing countries like Nepal, is often not extensively studied. In order to decrease the morbidity and mortality associated with neonatal sepsis, neonatologists should have a keen knowledge of the existing bacteriological flora and their antibiotic susceptibility pattern. In this study, we aim to determine the bacteriological profile and antibiotic susceptibility pattern of culture positive neonatal sepsis in the NICU of a tertiary teaching hospital in Nepal.MethodsThis was a retrospective cross-sectional study of all blood culture positive sepsis cases among neonates admitted to the neonatal intensive care unit of Patan Hospital, Nepal between April 15, 2014 and April 15, 2017. All neonates with a clinical suspicion of sepsis with a positive blood culture were identified. Patient demographics, clinical details, maternal risk factors, and laboratory data including bacteriological profiles and antimicrobial susceptibilities were recorded and analyzed.ResultsOf the 336 neonates admitted in the NICU, 69 (20.5%) had culture-positive sepsis. The majority were early-onset sepsis (n = 54, 78.3%) and were among the preterm babies (n = 47, 68.1%). Most bacterial isolates were gram-negative, predominantly the Klebsiella species (n = 23, 33.3%). Klebsiella showed high resistance to commonly used antibiotics such as; Cefotaxime (90.5%), Gentamicin (75%), Ciprofloxacin (76.2%), Ofloxacin (72.2%) and Chloramphenicol (65%). However, they showed good susceptibility to Carbapenems (100%), Colistin (88.8%) and Tigecycline (81.8%). Among cultures with gram-positive species, Coagulase-negative Staphylococci (CONS) (n = 14, 20.3%) predominated. CONS showed high resistance to Oxacillin (80%), Cefotaxime (66.7%) and Meropenem (80%) but good susceptibility (100%) to Vancomycin and Linezolid. Prevalence of multidrug-resistant strain was 73.9%.ConclusionsKlebsiella species and CONS were the most common causes of neonatal sepsis in our study. A significant proportion of the isolates were multidrug resistant strains, which pose a great threat to neonatal survival, and thereby, warrant modification of existing empirical therapy. Implementation of effective preventive strategies to combat the emergence of antibiotic resistance is urgently needed. We recommend a combination of Piperacillin-Tazobactam and Ofloxacin as the first line therapy and combination of Vancomycin and Meropenem as the second line empirical therapy in our NICU.

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The present study had been planned to determine the pattern of drug utilization of analgesics (non-opioid and opioid analgesics) in dental outpatients in a referral hospital in western Nepal. A total of 1820 prescriptions of dental patients attending the dental outpatient at Manipal Teaching Hospital (MTH), Fulbari, Pokhara, Nepal were collected by a random once-weekly survey between March 2001 and February 2002. The analgesic-containing prescriptions (n = 1346) were separated from the total prescriptions collected. This information was compiled, scored and analyzed in consultation with dentists using WHO guidelines. There were more female patients (56%) than male patients (44%) in this study. The dental disorders most frequently reported in our study were diseases of pulp and periapical tissue (36.5%), gingivitis and periodontal diseases (28.5%) and dental caries (16%) etc. In total, 74% prescriptions contained analgesics which are the second-most commonly prescribed drugs after anti-microbials (44.9%) in dental OPD. The total analgesics prescribed were 1358 that account for 36.7% of total drugs prescribed. Only 5 and 37.8% of analgesics were prescribed generically and from the essential drug list of WHO respectively. All the analgesics were administered orally which included 89.7 and 10.3% of non-opioid analgesics and opioid analgesics (propoxyphene and dextropopoxyphene) respectively. The average duration of analgesic use was 3.5 +/- 0.3 days. The most commonly prescribed non-opioid analgesic was ibuprofen (41%) followed by nimesulide (22%). A total of 38.9% analgesics were fixed-dose combinations (FDCs) of two drugs and the most common analgesic combination used was ibuprofen + paracetamol and paracetamol + opioid analgesics. All opioid analgesics were prescribed in combination with paracetamol (10.3%) only. In total, 1.6% analgesics were prescribed concomitantly with gastroprotective agents. All gastroprotective agents (n = 22) were prescribed concomitantly with opioid analgesics only. No gastroprotective was used when NSAIDs were prescribed alone or in combination with paracetamol. Our present study indicate that all the analgesics were prescribed in oral dosage forms but analgesics prescribed in generic name (5%) and from essential drug lists (37.8%) were very less. There was an inclination to prescribe the older non-opioid analgesics. Selection of analgesics was quite rational in our study but some lacunae were observed. A total of 38.9% analgesics were FDCs and most common FDC analgesics were ibuprofen + paracetamol. Avoiding unnecessary FDCs may help in reducing prescribing costs because FDCs usually cost more than single ingredient preparations. It is best to avoid combination therapy with more than one non-opioid analgesic; there is little evidence of extra benefit to the patient and the incidence of side effects generally is additive. Prescribing generic names aids in avoiding confusion and minimizing the costs. In the present study, coprescription of gastroprotective agents with analgesic use was lo...

Introduction: Malocclusion is the improper relationship of maxillary and mandibular teeth. The prevalence of malocclusion varies in different populations of the world.Objective: To study the prevalence of malocclusion in western part of Nepal and to evaluate the gender variation in occurrence of malocclusion.Materials & Method: A total of 1284 subjects were studied. Out of them 656 were male and 628 were female. Intra-oral examination was carried out to assess occlusal types of Class I, II, III according to Angle’s classification of malocclusion, and various occlusal characteristics like crowding, spacing, cross-bite, open-bite and deep bite were recorded. Gender variation in malocclusion characteristics were tested using chi-square test (p<0.05).Result: The present study showed that Class I occlusion type with malocclusion was more prevalent than Class II and Class III malocclusions. Class I was seen in 71.5% , Class II div 1 in 20.7%, Class II div 2 in 3.9% cases and Class III in 4.1% cases. Among the occlusal characteristics; crowding (61.3%), deep bite (29.5%) and spacing (10.5%) were most prevalent.Conclusion: Class I malocclusion was most prevalent type of malocclusion in western Nepalese subjects. There was no significant gender dimorphism between male and female in prevalence of various malocclusion characteristics.