Journal of Nepal Health Research Council最新文献

Background: Acinetobacter baumannii has emerged as a problematic pathogen due to its ability to become resistant to antibiotics and form biofilms. The aim of this study was to explore antibiotic resistance and biofilm formation, and examine any correlation between these in Acinetobacter baumannii isolates.

Methods: This was a cross-sectional study conducted at the 750-bed Tribhuvan University Teaching Hospital in Nepal. Identification and antibiotic sensitivity of Acinetobacter baumannii isolates were performed following American Society for Microbiology guidelines. Different β-lactamases were detected by standard phenotypic tests. The microtiter plate method was used to screen strains of their ability to form biofilms.  Results: Out of total 18,343 clinical samples processed, 4,249 (23.1%) showed bacterial growth. A. baumannii comprised of 4.7% of the total bacterial growth. Multidrug-resistant (MDR) was exhibited by 97.5% of Acinetobacter baumannii isolates. All multidrug-resistant Acinetobacter baumannii isolates were resistant to cephalosporins and carbapenems; however, they were sensitive to polymyxins. Only few isolates showed sensitivity to sulbactam-containing antibiotics (15.4-29.2%), fluoroquinolones (1.0-7.2%), aminoglycosides (2.6-5.6%), and cotrimoxazole (4.1%). Extended-spectrum-beta-lactamase (ESBL), metallo-beta-lactamase (MBL), Klebsiella pneumoniae carbapenemase (KPC) and AmpC production were found in 54.9%, 73.3%, 41.5% and 14.9% isolates, respectively. Among all tested isolates, 192 were able to produce biofilms, with 83.1% being classified as strong biofilm producers. Those strains that were resistant to gentamicin were more likely to produce biofilms (P<0.05). ESBL, MBL, KPC and AmpC were seen in 51.8%, 71.6%, 43.8% and 16.0% of strong biofilm producers respectively.

Conclusions:   Only polymyxins were effective against Acinetobacter baumannii. Carbapenemase producers were generally strong biofilm producers, and gentamicin resistant strains were more likely to produce biofilms. The findings of this study may help to understand antibiotic-resistance mechanisms and provide valuable information in the treatment of MDR Acinetobacter baumannii infections.

Background: The burden of hypertension is high in our context. Poor adherence contributes to poor hypertension control. This pilot study aims to study the effect of structured counseling programs on antihypertensive therapy adherence and blood pressure control.

Methods: This is an effectiveness-implementation hybrid design type I- Quasi-experimental feasibility study. We recruited newly diagnosed hypertensive patients under antihypertensives with 50 each in the intervention and control group. We adapted existing guidelines to devise a structured counseling program. The intervention group underwent the counseling program. We called both groups after one month to assess the adherence and blood pressure control.

Results: We recruited 100 newly diagnosed hypertensive patients. Twenty-two participants dropped out in the one-month follow-up visit. Among the remaining 78 individuals, 73 (94%) demonstrated good adherence. The post-intervention median (IQR) of medication adherence scores assessed with the Medication Adherence and Report Scale (MARS) in the intervention and control groups after one month was 50 (48-50) and 48 (43.5-50) respectively (p=0.015). The immediate knowledge score increased significantly in the intervention group after the structured counseling. Nevertheless, there was no significant change in systolic and diastolic pressure recordings in the intervention group one-month post-intervention when compared to that of the control group.

Conclusions: The findings of this pilot study suggest that the structured counseling program should be tailored to local needs and should be compounded with regular follow-ups for reinforcement, drug reminders, and family and peer support along with a collaborative effort to ensure adherence and control.

Eccrine porocarcinoma is a tumor of the sweat gland that mostly develops from an existing benign eccrine poroma. It is a rare cutaneous malignancy with a high risk of metastasis and recurrence. Known to affect the elderly population in general with no gender discrepancy, it presents as an ulcerative mass commonly in the trunk or head/neck region. Definitive diagnosis is made by histopathological findings of peculiar pleomorphic cells with nuclear hyperchromasia and mitotic activity, surrounded by ductal lumen. The standard treatment is complete surgical excision with appropriate surgical margins; adequate work-ups to look for metastasis and timely follow ups for chances of recurrence. Here we report a case of an 82-year-old patient who presented at our department with a long-standing exophytic lesion in the head that rapidly started growing in the past few weeks. After excisional biopsy and histopathology, the diagnosis of Eccrine porocarcinoma was made. Keywords: Cutaneous; eccrine porocarcinoma; malignancy; rare.

Background: This study aimed to assess skin carotenoid measurement among children in the Hill region of Nepal.

Methods: School children between 3 to 7 years old from six schools were enrolled in the study. Skin carotenoid levels were assessed using the Veggie Meter® (Longevity Link Corporation, Salt Lake City, Utah, USA). Detailed eye evaluations were conducted in subjects with low skin carotenoid scores (<150 Reflectance Units(RU)) and/or those with a history of night blindness.

Results: A total of 324 school children were enrolled in the study with mean age of 5.12±1.33 years. The mean skin carotenoid score was 163±71 RU, ranging from 1 to 363 RU. The skin carotenoid level was <150 RU in 46.9% of children and between 150 and 200 RU in 23.5% of children. Low skin carotenoid scores (<150 RU) were found in 17% of 3 year olds, 28.3% each of 4 and 5 year olds, 20.4% of 6 year olds, and 11.2% of 7 year olds. In multivariate analysis, age was significantly associated with low skin carotenoid scores (p=0.003; OR; 2.02; 95% CI: 1.28- 3.19). Odds of having <150 RU was 2.02 times more among the children up to five years old as compared to those over five years of age.

Conclusions: Nearly half of the school children had low skin carotenoid scores. Skin carotenoid score was significantly lower among the lower age group. These findings emphasize the need to enhance awareness to consume plenty of green leafy vegetables and fruits in the diet.

Background: Multi-ligament injuries of the knee are rare injuries that can cause significant impairment of the knee function. There is controversy in the treatment regarding staged versus single-stage surgery. This study was performed to assess the outcome of the single-staged reconstruction of the multi-ligament injury of the knee.

Methods: This prospective observational study was done from January 15, 2022 to January 14, 2023. The outcome was analyzed by comparing the preoperative and 12-month postoperative Visual Analog Scale score, Lysholm Score, and International Knee Documentation Committee Score.

Results: The mean age of the patients was 28.35 years. among 12 patients 9 were male and 3 were female. Single-staged multi-ligament reconstruction was done in all the cases. The Lysholm score was improved from preoperatively 36.42 ± 1.46 to 95.36 ± 2.84, IKDC score was improved from 24.38 ± 1.64 to 93.86 ± 3.14, VAS score 8.14 ± 1.44 to 0.40 ± 0.60 at 12 months postoperative follow-up which all came to be clinically significant with p-value < 0.001.

Conclusions: Single-stage multi-ligament reconstruction of the knee is an effective method of treatment and has excellent outcomes.

Background: More than 10 % of colorectal carcinoma occur in patients less than 50 years. Progression of a colorectal polyp to carcinoma may take 5 to 20 years. Implementing screening guidelines and removing such polyps would reduce the progression into carcinoma. The aim of the study was to find the prevalence, distribution and histological analysis of polyps in patients under 50 years undergoing colonoscopy.

Methods: Single-center cross-sectional study of 254 consecutive patients less than 50 years who underwent colonoscopy were included in the study. Patients with prior diagnosis of inflammatory bowel disease, colonic polyp(s) or colorectal carcinoma were excluded. Basic demographic data (age, gender), history of smoking and alcohol consumption were recorded. Prevalence of polyps, their location, size and histological type were estimated. Categorical data were expressed as frequencies and percentages.

Results: Among 254 patients who underwent colonoscopy, 63 had colorectal polyps. 39 (61.9 %) patients with polyp were males and 33 (52.38 %) patients were of 40-49 years age. Recto-sigmoid polyps were seen in 47 (74.6 %) patients. Regular heavy alcohol consumers and active smokers had higher odds of having polyps. Adenomatous polyps and adenocarcinoma were detected in 12 and 10 patients respectively. Ulcerated or excavated appearance strongly suggested carcinomatous histology (OR: 363.8, (CI: 16.04 - 8250.90). Similarly, polyp size 5 mm or more favored adenomatous polyp or carcinoma [(OR: 177.35, CI: 9.7 - 3229)].

Conclusions: Prevalence of polyps in patients below 50 years age was 24.8 %. Most of the polyps were benign, diminutive (< 5 mm) and located in recto-sigmoid colon. One-third of the polyps were adenoma or adenocarcinoma.

Background: Proper nutrition counselling on healthy food habit to all pregnant women can be a strong weapon to achieve good health of mothers as well as healthy offspring. The main objective of this research was to assess the effectiveness of nutritional counseling on dietary intake and nutritional status of pregnant women.

Methods: Quasi-experimental research design was used to evaluate the effectiveness of nutritional counselling on dietary intake and nutritional status of pregnant women. The study area was chosen based on nonprobability purposive sampling technique and 110 participants who were pregnant before 20 weeks of gestation were included in the study who attended district hospital Lamahi and health post of Sisahaniya, Dang. Risults: Mid Upper Arm Circumference (MUAC) measurement of pregnant women showed that 11.8% pregnant women were malnourished (MUAC <22cm) before intervention. The proportion of MUAC measurement improved after nutritional counseling (4.5%). Almost all participants consumed rice, and roti as main foods. Frequency of consuming dal, green vegetables, fruits, milk and milk products, meat, fish, and egg increased after nutrition counseling. The result indicated that the consumption of carbohydrate, protein, fat and energy increased after nutrition counseling (Carbohydrate-226 vs 289g, protein- 65 vs 77g, fat- 43 vs 50g, energy- 1648 vs 2041kcal).

Conclusions: Maternal nutrition during pregnancy is crucial for achieving healthy maternal and fetal outcomes. Nutrition counselling showed positive effects on nutritional status of pregnant women. Thus, nutrition counselling is essential for all pregnant women. It should be a major part of Antenatal care service to all pregnant women in Nepal.

Background: Diabetes Mellitus (DM) requires continuous self-care practices to prevent acute and chronic complications. With the possibility of several physical and psychological complications alongside affecting the social aspect of life, improving self-care is highly important in patients with DM. The aim of this study was to measure self-care practices among patients with DM and factors associated with inadequate self-care.

Methods: Information on self-care practices was collected using the summary of Diabetes Self-care Activities (SDSCA) in a hospital based cross-sectional study among 345 participants selected through sequential sampling. Data was analysed using descriptive and inferential statistics and results were presented with proportions and odds ratios with a 95% confidence interval (CI).

Results: We found that 30.7% of the participants had adequate self-care practices across all domains. A fairly substantial proportion had adequate self-care in diet and exercise related care with 87.5% and 65.5%, respectively. However, with foot care and blood sugar monitoring related care only a small to negligible proportion had an adequate level of self-care. Multivariate analysis showed that participants aged 65 years and above had higher odds of having inadequate self-care practices (aOR:5.20; 95%CI: 2.20-12.33); and those with diabetes for more than five years had twice the odds (aOR:2.10; 95%CI: 1.15-3.83) of having inadequate self-care.

Conclusions: A large proportion of the participants had inadequate self-care practices, and this was even poorer in domains of foot care and blood sugar monitoring. Age of the participants, marital status and duration of illness were factors independently associated with inadequate self-care. Targeted behavior change interventions for patients visiting hospitals and health care centers in Nepal could improve self- care practices among patients with DM.

Cutaneous larva migrans is a tropical dermatosis acquired through the helminthic infection. It is caused by penetration of animal hookworm larva in patient with history of walking barefoot on soil or beaches or with history of travel to tropical areas. It usually presents clinically as a pruritic serpiginous lesion with a trailing. Here, we report three cases who presented as asymptomatic to pruritic thread like serpiginous lesion on cutaneous examination. Cutaneous larva migrans was diagnosed clinically and proper treatment was done with complete regression of manifestations within a week. Although the condition is self-limiting, it is an under-diagnosed entity leading to delay in treatment and exacerbation of clinical manifestations including rare pulmonary manifestation called Loefflers syndrome. Keywords: Creeping eruption; ivermectin; larva migrans; skin-NTDs.

Any research involving human participants requires review and approval from an authorized research ethics committee to safeguard participant's rights, dignity and welfare while ensuring the scientific validity of the research. Ethical approval is mandatory before initiating or ecruiting study participants. It is also a prerequisite for publishing research findings in scientific journals contributing to ensuring the quality of scientific knowledge. The ethical review process focuses on the assessment of potential risks to the participants as well as the research team focusing on how such risks are identified, minimized and managed. This paper provides an overview of the Nepal Health Research Council's ethical review and approval process for both national and international researchers intending to conduct health research in Nepal. Despite this, the Nepalese ethics committee and researcher face several challenges, including limited awareness of responsible conduct of research, limited training opportunities, unclear clinical trial guidelines, bureaucratic hurdles, and frequent staff turnover in research governance. This paper highlights these challenges and aims to support both researchers and the Ethics Committee in promoting the responsible conduct of health research in Nepal. Keywords: Ethical issues; ethical review and approval; Nepal and research.