BackgroundStaphylococcus aureus (S. aureus), a normal flora of nasal cavity, can cause minor to life threatening invasive diseases and nosocomial infections. Methicillin resistant strains of S. aureus are causing a great challenge for treatment options. Therefore, the purpose of this study was to assess the nasal carriage rate of S. aureus, its methicillin resistant strains and risk factors in medical students prior to clinical exposure.MethodsThe bacterial growth of S. aureus from nasal swab culture was identified by using standard microbiological methods recommended by American Society for Microbiology. Modified Kirby–Bauer disk diffusion method was used for antibiotic susceptibility testing and methicillin resistance was confirmed using cefoxitin and oxacillin disks. D-zone test method was used to determine the inducible clindamycin resistance.ResultsAmong 200 participants, nasal carriage of S. aureus was detected from 30 (15 %) subjects. Upper respiratory tract infections significantly (P < 0.05) contributed the carriage of S. aureus and their methicillin resistant strains. All of the isolates were reported to be susceptible to vancomycin and teicoplanin. S. aureus strains detected from 8 (4 %) students were confirmed to be methicillin resistant.ConclusionsThe result of our study demands for strict policy to screen all the students for nasal carriage of S. aureus and its MRSA strains to minimize the transmission of this organism from community to hospital settings.

Introduction. Children are among the most vulnerable population groups to contract illnesses. The varying microbiological pattern of septicemia warrants the need for an ongoing review of the causative organisms and their antimicrobial susceptibility pattern. Therefore, the objective of this study was to document the bacterial etiology of childhood septicemia and its antibiotic susceptibility profile. Methods. Cross-sectional type of study in 1630 suspected patients was conducted at CMCTH from January 2012 to December 2013. Blood samples were collected aseptically for culture. The organisms grown were identified by standard microbiological methods recommended by American Society for Microbiology (ASM) and subjected to antibiotic susceptibility testing by modified Kirby-Bauer disk diffusion method. Methicillin resistance was confirmed using cefoxitin and oxacillin disks methods. Results. Septicemia was detected in 172 (10.6%) cases. Among Gram-positive organisms, coagulase negative staphylococci (CoNS) were leading pathogen and Acinetobacter spp. were leading pathogen among Gram-negative isolates. Vancomycin, teicoplanin, and clindamycin were the most effective antibiotics against Gram-positive isolates while amikacin was effective against Gram-positive as well as Gram-negative isolates. Methicillin resistance was detected in 44.4% of Staphylococcus aureus. Conclusions. This study has highlighted the burden of bacterial etiology for septicemia among children in a tertiary care center of central Nepal.

A one-day workshop on proposal writing for research for health care professionals was organized by Hospital Research Board (HRB), Nepal Cancer Hospital and Research Center Pvt. Ltd, Harisiddhi, Lalitpur, Nepal on 2nd March 2019. The main aim of this workshop was to identify, motivate and prepare health care professionals for conducting research in their respective professional institution in collaboration. The workshop was facilitated by international and national resource persons. The deliberations of the workshop were focused on seven topics: “Turning research into impact, Essentials of the research protocol, Why proposals are rejected?, Plagiarism in medical research, Research with medical records, Grant writing workshop, Manuscript writing workshop” based on a presentation by the different resource persons. Ninety-nine persons participated in the workshop including physicians, medical oncologists, pharmacists, nurses and other allied health professionals. The interactive teaching-learning methods were utilized in all sessions of the workshop. The feedback of the participants was taken on semi-structured feedback format. Overall evaluations from the feedback forms showed that majority (90%) of the participants agreed that the workshop achieved its objectives with a major recommendation as to the allocation of short duration for the workshop and timely organize of research activities regarding scientific writing. In conclusion, the workshop on research proposal writing for health care professionals was successfully organized and the participants are looking forward for future ones.

The various indices and waveforms of TCD can be useful in assessing the cerebral blood flow dynamics in patients with various traumatic and non-traumatic ailments in the peri-agonal period; and hence help in their management as well as in the confirmation of brainstem death.

Introduction: Accurate assessment of fluid status in hemodialysis patients presents a significant challenge. Nephrologists have long relied on dry weight estimation based solely on clinical parameters to decide the ultrafiltration volume for patients with end-stage kidney disease on dialysis. However, this method is far from accurate and many patients recurrently suffer from signs and symptoms of fluid overload or circulatory collapse from overaggressive ultrafiltration. Invasive methods such as measurement of central venous pressure cannot be used routinely. We evaluated the usefulness of inferior vena cava (IVC) diameter measured by handheld ultrasound in the estimation of fluid status in patients before and after hemodialysis. Materials and Methods: Clinical assessment included patients’ symptoms, weight, blood pressure, heart rate, and presence of edema before and after dialysis session. Dry weight was assessed based on the above parameters. Each patient underwent measurement of inferior vena cava before and after hemodialysis. The anteroposterior IVC diameter (IVCD) was measured 1.5 cm below the diaphragm in the hepatic segment in supine position during normal inspiration and expiration.Results:  Thirty hemodialysis patients (mean age 51.6±18.03 years) were evaluated in outpatient dialysis unit. Following hemodialysis mean IVCe (IVC diameter in expiration) decreased from 1.40±0.38 to 0.91±0.30 cm (p<0.001). Similarly, mean IVCi (IVC diameter in inspiration) decreased from 0.67±0.34 to 0.35±0.19 cm (p<0.001). Changes in IVCD were significantly correlated with alterations in body weight following dialysis (p<0.0001). The IVC collapsibility index (IVC-CI, per cent of change in IVC diameter in expiration vs. inspiration) increased significantly from 0.53±0.18 to 0.68±0.18 after dialysis (p=0.002). IVC diameter and IVC-CI clearly reflected alterations in fluid status. Regarding the clinical parameters of fluid status, following hemodialysis, mean heart rate increased from 81.17±5.21 beats per minute to 86.50±7.99, (p=0.003), systolic blood pressure increased from 148.67±26.36 mmHg to 155.00±28.50, (p=0.05), and diastolic blood pressure increased from 78.62±12.74 mmHg to 84.83±14.55, (p<0.001).Conclusions:  Our findings support the applicability of IVCD measurement and IVC-CI in the estimation of fluid status in end stage kidney disease patients on hemodialysis. The clinical parameters of fluid status including heart rate, systolic blood pressure, and diastolic blood pressure suggest that significant numbers of patients underwent excess ultrafiltration based on their traditional dry weight calculation. Thus, using IVC parameters before and during hemodialysis might give a better estimation of fluid status of the patient and guide the amount of ultrafiltration to be done.

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Aims: To examine the association between maternal hemoglobin with birth weight.Methods: Cross sectional study of obstetrics database at Paropakar Maternity and Women’s Hospital. Hospital delivery of over 18 years of age women tested for Pearson correlation using SPSS-17.Results: Total of 2085 cases analyzed. There was mean hemoglobin value of 12.05 ± 1.30 (95% CI=11.992-12.103) g/dL and no any significant impact on mode of delivery (p=0.15) and neonatal death (p=0.736). There was a small but a significant correlation (p<0.01) of maternal age with hemoglobin (r = 0.106) and birth weight (r = 0.093); but a very small negative correlation between maternal hemoglobin and birth weight.Conclusions: Optimal maternal hemoglobin during labor rules out any strong correlation with birth weight.

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