Background: Invasive bacterial disease (IBD; including pneumonia, meningitis, sepsis) is a major cause of morbidity and mortality in children in low-income countries. Methods: We analyzed data from a surveillance study of suspected community-acquired IBD in children <15 years of age in Kathmandu, Nepal, from 2005 to 2013 before introduction of pneumococcal conjugate vaccines (PCV). We detailed the serotype-specific distribution of invasive pneumococcal disease (IPD) and incorporated antigen and PCR testing of cerebrospinal fluid (CSF) from children with meningitis.Results: Enhanced surveillance of IBD was undertaken during 2005-2006 and 2010-2013. During enhanced surveillance, a total of 7956 children were recruited of whom 7754 had blood or CSF culture results available for analysis, and 342 (4%) had a pathogen isolated. From 2007 to 2009, all 376 positive culture results were available, with 259 pathogens isolated (and 117 contaminants). Salmonella enterica serovar Typhi was the most prevalent pathogen isolated (167 cases, 28% of pathogens), followed by Streptococcus pneumoniae (98 cases, 16% pathogens). Approximately, 73% and 78% of pneumococcal serotypes were contained in 10-valent and 13-valent PCV, respectively. Most cases of invasive pneumococcal disease (IPD) were among children ≥5 years of age from 2008 onward. Antigen and PCR testing of CSF for pneumococci, Haemophilus influenzae type b and meningococci increased the number of these pathogens identified from 33 (culture) to 68 (culture/antigen/PCR testing). Conclusions: S. enterica serovar Typhi and S. pneumoniae accounted for 44% of pathogens isolated. Most pneumococcal isolates were of serotypes contained in PCVs. Antigen and PCR testing of CSF improves sensitivity for IBD pathogens.
Nepal is an endemic country for dengue infection with rolling of every 3 year’s clear cyclic outbreaks with exponential growth since 2019 outbreak and the virus gearing towards the non-foci temperate hill regions. However, the information regarding circulating serotype and genotype is not frequent. This research discusses on the clinical features, diagnosis, epidemiology, circulating serotype and genotype among 61 dengue suspected cases from different hospitals of Nepal during the window period 2017–2018 between the two outbreaks of 2016 and 2019. E-gene sequences from PCR positive samples were subjected to phylogenetic analysis under time to most recent common ancestor tree using Markov Chain Monte Carlo (MCMC) and BEAST v2.5.1. Both evolution and genotypes were determined based on the phylogenetic tree. Serotyping by Real-time PCR and Nested PCR showed the co-circulation of all the 3 serotypes of dengue in the year 2017 and only DENV-2 in 2018. Genotype V for DENV-1 and Cosmopolitan Genotype IVa for DENV-2 were detected. The detected Genotype V of DENV-1 in Terai was found close to Indian genotype while Cosmopolitan IVa of DENV-2 found spreading to geographically safe hilly region (now gripped to 9 districts) was close to South-East Asia. The genetic drift of DENV-2 is probably due to climate change and rapid viral evolution which could be a representative model for high altitude shift of the infection. Further, the increased primary infection indicates dengue venturing to new populations. Platelets count together with Aspartate transaminase and Aalanine transaminase could serve as important clinical markers to support clinical diagnosis. The study will support future dengue virology and epidemiology in Nepal.
Introductions: Perinatal mortality rate (PMR) of Nepal is 31 deaths per 1000 pregnancies and neonatal mortality rate (NMR) is 21 deaths per 1000 live births according to Nepal Demographic and Health Survey (NDHS) 2016. This study aims to analyse the trend of PMR and NMR of babies delivered at Patan hospital, Nepal. Methods: This was a retrospective study done in the department of Pediatrics to analyse the trend of neonatal and perinatal outcome of babies delivered during three years from April 2016 to March 2019 at Patan Hospital, Patan Academy of Health Sciences, Nepal. Data was collected from hospital records and perinatal audit. The mode of delivery (vaginal, instrumental, caesarian), birth status (sex, premature, still, live, APGAR, birth weight) and final outcome (neonatal and perinatal mortalities) were analyzed descriptively using Microsoft Excel 2010. Results: The final outcome of total 22937 deliveries during three years were PMR 4.34, corrected PMR 10.85 per 1000 total births and NMR 3.62 per 1000 live births. There were 22913 (99%) live births, 3090 (13.3%) had low birth weight, 11898 (52%) spontaneous vaginal delivery, 10700 (47%) cesarean and 339 (1.5%) instrumental deliveries. Conclusions: The overall PMR was 4.34 per 1000 total births and NMR was 3.62 per 1000 live births at Patan Hospital.
Background Globally, Tuberculosis (TB) is one of the top 10 causes of death. In Nepal, poverty and malnutrition aggravate the burden of TB. To identify Mycobacterium tuberculosis s putum is the best sample to identify the bacterium which is helpful for diagnosis. The aim of this study is to identify the situation, burden and challenges of pulmonary tuberculosis in low-middle income country like Nepal. Method A retrospective-audit with reliable-secondary-data of one year was collected (n = 4131). Descriptive-analysis was performed using frequency, percentage and analytical using chi-square-test. Level of significance was set at p < 0.05. Ethical Approval was obtained from IRC-PAHS. Result The prevalence of notified/suspected cases was highest among the patients having >60 years of age 1344(32.54%) and least among the patients with ≤15 years of age 239(5.79%). The male had 1.67 times more smear-positive pulmonary TB cases. Among the AFB-positive cases, smear 3+ was seen in most of the cases 69(38.54%) followed by smear 1+ and smear 2+ in 56(31.28%) and 54(30.16%) respectively. Conclusion The prevalence of smear-positive pulmonary TB case is higher in male. Smear 3+ is seen in most of the followed by smear 1+ and smear 2+. The Burden of Pulmonary TB is more among adult and old-age-people and its control is a challenge for developing and low-middle income countries like Nepal.
Objectives: The study was carried out to compare the inhibitory effects between commonly used antibiotics and bee honey samples, so as to correlate the inhibitory effects between bee honey alone and in combination with antibiotics. Methods: This study was carried out between December 2012 to September 2013. A total of one hundred and twenty-two clinical microbiological specimens and five different floral sourced honey samples were collected between December 2012 to September 2013. Twenty-three multi-drug resistant organisms were selected. Then, AST for commonly used antibiotics, honey alone and combination of honey-antibiotics discs was done. The difference in ZOI of antibiotic contrasting with the antibiotics containing honey were statistically analysed to define the synergism. Results: The inhibition due to honey is variable among bacteria types (F=39.17, p<0.05). From means plot, Staphylococcus and Acinetobacter were recognized as highly susceptible bacteria for honey (Χ = 21.1 ± 6.2 mm and Χ = 18.3 ± 3.3 mm respectively) but Acinetobacter species could not show synergism to honey-antibiotic combination. The tested organisms from Enterobacteriaceae family showed effective susceptibility to Chloramphenicol-honey mixture. Imipenem-honey combination and Gentamicin-honey combination showed significant effects against Pseudomonas aeruginosa. Conclusion: Thus, honey can be used in various bacteria-directed infections and found to be effective in various infections. Incorporation of honey in antibiotics like Chloramphenicol, Imipenem, and Gentamicin work better in healing various infection.
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