BackgroundProduction of AmpC and extended spectrum beta-lactamases among urinary isolates has created a serious problem to the successful management of the urinary tract infection. The main purpose of this study was to determine the rates of the extended spectrum beta-lactamase (ESBL) production and AmpC beta-lactamase (ABL) production among urinary isolates.ResultsAmong total 564 urinary isolates, 514 (91.1%) were gram negative bacilli and 50 (8.9%) were gram positive cocci. E. coli (76.1%) was the most common bacteria isolated. Staphylococcus aureus (6.7%) was the predominant gram positive bacteria isolated. 35 (6.8%) of the 514 gram negative bacilli were ESBL producers. Similarly, 14 (2.7%) of the gram negative bacilli were ABL producers. Only one isolate was ESBL and ABL co-producer. Highest rate of susceptibility of gram negative bacteria was seen toward amikacin (97.3%) followed by imipenem (94.4%). Similarly, highest rate of susceptibility among gram positive cocci was seen toward vancomycin (100%) followed by amikacin (93.5%).ConclusionsLow rates of AmpC and extended spectrum beta-lactamases production in comparison to other previous studies were reported. On the basis of the antimicrobial susceptibility patterns of the bacteria we reported in our study, amikacin, imipenem and nitrofurantoin can be used for the preliminary treatment of urinary tract infections caused by gram negative bacteria and vancomycin and amikacin for treatment of urinary tract infections caused by gram positive bacteria.
Introduction: Neonatal sepsis is a serious problem in
Coronavirus Disease 2019 (COVID-19) burden, often underestimated by case-based incidence reports, can be accurately estimated by measuring the population that has developed antibodies following an infection. Here, we report the prevalence of COVID-19 antibodies among health workers in Kathmandu, Nepal. This seroepidemiology of COVID-19 was a longitudinal survey of hospital-based health workers working in 20 hospitals in the Kathmandu Valley. A total of 800 participants were chosen in December 2020 by a two-stage cluster-stratified random sampling method and administered a questionnaire eliciting COVID-19 related history. A blood sample was also obtained from the participants and tested for COVID-19 IgG antibodies using a Chemiluminescence Immunoassay (CLIA). We then used a probabilistic multilevel regression model with post-stratification to correct for test accuracy, the effect of hospital-based clustering, and to ensure representativeness. The final analytic sample included 800 participants; 522 (65.2%) of them were female, 372 (46%) were between ages 18-29, 287 (36%) were nurses. Of the total 800, 321 (40.1%) individuals tested positive for COVID-19 antibodies. Adjusted for test accuracy and health-worker population, the seroprevalence was 38.2% (95% Credible Interval (CrI) 29.26%–47.82%). Posterior predictive hospital-wise seroprevalence ranged between 38.1% (95% CrI 30.7.0%–44.1%) and 40.5% (95% CrI 34.7%–47.0%). Our study suggested that about two in five health workers in the Kathmandu Valley were seropositive against SARS-CoV-2 by December 2020; a substantial proportion of them did not have a documented infection.
Introduction: Thrombosis and embolism are the common causes of acute arterial occlusion. Thrombosis mostly arises from underlying cardiac disease such as a trial fibrillation while arterial occlusion by embolism. Thus, an ischemic limb can result from acute arterial occlusion. Early proper diagnosis and prompt treatment within critical time by emergency physician at the initial clinical interviewing is important in saving the affected leg and the life, thus, avoiding limb amputation and death. This paper reports a case in which the cause of acute ischemia of limb was proved with some diagnostic tests to be a trial fibrillation.
Introduction: Nearly half of people with diabetes don’t know they have it. It is often not diagnosed until complications appear. The aim of the study was to determine the prevalence of diabetes mellitus and prediabetes in patients presenting to the Emergency Department with incidental hyperglycemia, because the duration of hyperglycemia is a predictor of adverse outcomes, and there are effective interventions to prevent disease progression and to reduce complications. Methods: It was an observational cross-sectional study, 720 patients from Emergency Department of Kathmandu Medical College, Sinamangal were screened from December 2018 to March 2019 and a total of 128 patients with incidental hyperglycemia (>140mg/dl) were included. Patients with a previous diagnosis of diabetes, unstable patients and pregnant patients were excluded. Incidental hyperglycemia, fasting blood sugar, 2 hours postprandial blood sugar and HbA1c were noted, data entry was done in Microsoft Excel and analysis was done using the SPSS 24. Results: Total of 128 patients were enrolled for the study.10% of the patients had hyperglycemia and 34% among the hyperglycemic had the finding in the absence of history of diabetes. Incidental hyperglycemia ranged from 150-500 mg/dl. Among the incidental hyperglycemic, 29% and 36% had prediabetes and diabetes respectively. Incidental hyperglycemia was divided into four groups; <159, 160-179, 180-199 and >200 mg/dl, and each group was analyzed with the diagnostic criteria and the final outcome. It was found that each group correlated well with the diagnostic criteria and final outcome and was found to be statistically significant with p<0.0001 based on the Chi square test. Conclusions: Following the patients with incidental hyperglycemia in the Emergency Department, a significant number of undiagnosed diabetes or prediabetes can be diagnosed, early intervention can be started that can prevent progression from prediabetes to diabetes and risk of complications can be reduced.
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