Drug-resistant Mycobacterium tuberculosis among Nepalese patients at a tuberculosis referral center.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB), characterized by isoniazid and rifampicin resistance, is caused by chromosomal mutations that restrict treatment options and complicate tuberculosis management. This study sought to investigate the prevalence of pre-extensively drug-resistant (pre-XDR) and extensively drug-resistant (XDR) tuberculosis, as well as mutation pattern, in Nepalese patients with MDR/rifampicin-resistant (RR)-TB strains. METHODS: A cross-sectional study was conducted on MDR/RR-TB patients at the German Nepal Tuberculosis Project from June 2017 to June 2018. The MTBDRsl line probe assay identified pre-XDR-TB and XDR-TB. Pre-XDR-TB included MDR/RR-TB with resistance to any fluoroquinolone (FLQ), while XDR-TB included MDR/RR-TB with resistance to any FLQ and at least one additional group A drug. Mutation status was determined by comparing bands on reaction zones [gyrA and gyrB for FLQ resistance, rrs for SILD resistance, and eis for low-level kanamycin resistance, according to the GenoType MTBDRsl VER 2.0, Hain Lifescience GmbH, Nehren, Germany definition of pre-XDR and XDR] to the evaluation sheet. SPSS version 17.0 was used for data analysis. RESULTS: Out of a total of 171 patients with MDR/RR-TB, 160 had (93.57%) had MTBC, of whom 57 (35.63%) had pre-XDR-TB and 10 (6.25%) had XDR-TB. Among the pre-XDR-TB strains, 56 (98.25%) were FLQ resistant, while 1 (1.75%) was SLID resistant. The most frequent mutations were found at codons MUT3C (57.14%, 32/56) and MUT1 (23.21%, 13/56) of the gyrA gene. One patient had SLID resistant genotype at the MUT1 codon of the rrs gene (100%, 1/1). XDR-TB mutation bands were mostly detected on MUT1 (30%, 3/10) of the gyrA and rrs, MUT3C (30%, 3/10) of the gyrA, and MUT1 (30%, 3/10) of the rrs. CONCLUSIONS: Pre-XDR-TB had a significantly higher likelihood than XDR-TB, with different specific mutation bands present in gyrA and rrs genes.

Analysis of altered level of blood-based biomarkers in prognosis of COVID-19 patients.

INTRODUCTION: Immune and inflammatory responses developed by the patients with Coronavirus Disease 2019 (COVID-19) during rapid disease progression result in an altered level of biomarkers. Therefore, this study aimed to analyze levels of blood-based biomarkers that are significantly altered in patients with COVID-19. METHODS: A cross-sectional study was conducted among COVID-19 diagnosed patients admitted to the tertiary care hospital. Several biomarkers-biochemical, hematological, inflammatory, cardiac, and coagulatory-were analyzed and subsequently tested for statistical significance at P<0.01 by using SPSS version 17.0. RESULTS: A total of 1,780 samples were analyzed from 1,232 COVID-19 patients (median age 45 years [IQR 33-57]; 788 [63.96%] male). The COVID-19 patients had significantly (99% Confidence Interval, P<0.01) elevated levels of glucose, urea, alanine transaminase (ALT), aspartate aminotransaminase (AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), white blood cell (WBC), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), ferritin, D-Dimer, and creatinine phosphokinase-MB (CPK-MB) compared to the control group. However, the levels of total protein, albumin, and platelets were significantly (P<0.01) lowered in COVID-19 patients compared to the control group. The elevated levels of glucose, urea, WBC, CRP, D-Dimer, and LDH were significantly (P<0.01) associated with in-hospital mortality in COVID-19 patients. CONCLUSIONS: Assessing and monitoring the elevated levels of glucose, urea, ALT, AST, ALP, WBC, CRP, PCT, IL-6, ferritin, LDH, D-Dimer, and CPK-MB and the lowered levels of total protein, albumin, and platelet could provide a basis for evaluation of improved prognosis and effective treatment in patients with COVID-19.

COVID-19 among Patients Visiting the Department of Emergency of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Because of the unbridled transmissibility of the SARS-CoV-2 worldwide, researchers and healthcare professionals have set a common goal for timely diagnosis and future prevention of the disease. The aim of this study was to find out the prevalence of COVID-19 among patients visiting the Department of Emergency of a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among the individuals suspected COVID-19 who had visited the Department of Emergency of a tertiary care centre between 11 January 2021 and 29 December 2021. Ethical approval was taken from Ethical Review Board (Reference number: 2768). Socio-demographic details, clinical symptoms, and two nasopharyngeal swab samples (one in viral transport medium to run RT-PCR and the other for Ag-RDT) were collected from each individual. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among the 232 patients, COVID-19 was detected in 108 (46.55%) (40.13-52.97, 95% CI) by Ag-RDT. A total of 44 (39.63%) of age groups 31-40 years were predominantly infected with SARS-CoV-2. The mean age was 32.13±10.80 years and was mostly males 73 (65.77%). Fever was present in 57 (51.35%) and dry cough was present in 50 (45.05%) COVID-19 patients. Conclusions: The prevalence of COVID-19 among hospitalized individuals in this study was higher than in previous studies conducted in similar settings. Keywords: COVID-19; Nepal; prevalence; SARS-CoV-2.

Antimicrobial Susceptibility Pattern in Opportunistic Pathogens Isolated from Immunocompromised Patients.

BACKGROUND:  Brought with the advancements in transplantation science and the development of immunosuppressive agents, immunocompromised patients characterized with defective immunity have increased throughout the world with increased risk for opportunistic infections. This study provides an overview of the antimicrobial susceptibility pattern among opportunistic pathogens isolated from immunocompromised patients.  Methods: Clinical and laboratory records of immunocompromised patients [patients with chronic kidney disease neutropenia, diabetes, rheumatic heart disease acquired immune deficiency syndrome hepatitis B, hepatitis C, who were subjected to microbiological culture analysis in the Department of Clinical Microbiology, KIST Medical College and Teaching Hospital, for 2 years (January 2019 and December 2020) were analyzed. RESULTS:  Out of 8,402 immunocompromised patients, 954 (11.4%) patients were subjected to microbiological culture analysis. Among 954 patients, 253 (26.5%) patients [median(interquartile range) age: 52(31-67) years; male 138 (54.5%)] were infected. A total of 295 pathogens were isolated from 1,331 cultured samples. Infections due to Escherichia coli (n=71, 24.1%), Klebsiella spp. (n=55, 18.6%), Acinetobacter calcoaceticus-baumannii complex (n=35, 11.9%), Candida albicans (n=30, 10.2%), and Staphylococcus aureus (n=28, 9.5%) were frequently observed. Among the bacterial isolates (n=239), 81.6% (n=195) of bacteria were ß-lactamase producers, 51.0% (n=122) were multi-drug resistant, 9.2% (n=195) were extensively-drug resistant, 0.8% (n=195) were pan-drug resistant, and 35.7% (n=10) of S. aureus were methicillin-resistant Staphylococcus aureus. CONCLUSIONS:  The majority of infection in immunocompromised patients is caused by Gram-negative bacteria, and is often associated with a higher number of ß-lactamase producers and multi-drug resistant organisms. Prescriptions of antibiotics on the grounds of antimicrobial stewardship might help to reduce the burden of antimicrobial resistance.

Significance of Hematological Biomarkers in Association to Syphilitic Patients.

BACKGROUND: Venereal syphilis is a sexually transmitted disease, involving pathological activities mediating tissue destruction by extensive tissue necrosis. As such, the goal amongst researchers has been set to the identification of effective laboratory biomarkers that can reflect the broad spectrum of disease and ultimately aid in timely diagnosis and effective treatment of syphilis. This research aimed to study the applications of hematological biomarkers associated with syphilitic patients visiting a tertiary care hospital. METHODS: A retrospective cross-sectional study was conducted in the syphilitic patients attending KIST Medical College and Teaching Hospital, Lalitpur, Nepal. A total of 25 syphilitic patients and 41 non-syphilitic participants were included. The rapid plasma reagin test and Treponema pallidum hemagglutination assay were used for the screening and confirmation of syphilis respectively. The hematological investigation was performed using a hematology analyzer. Statistical Package for Social Science version 17.0 was used for data analysis. A P value <0.05 was considered significant. RESULTS: Syphilitic patients showed significantly elevated levels of lymphocytes (39.8±11.5) (p=0.025), monocyte (1.9±0.8) (p=0.002), mean corpuscular volume (MCV) (92.6±12.9) (p=0.005), and mean corpuscular hemoglobin (MCH) (31.9±4.6) (p=0.008) and lowered levels of red blood cell (RBC) (4.2±0.3) (p=0.005) and platelets (237.2±628.6) (p=0.048) as compared to the lymphocytes (32.9±11.9), monocyte (0.6±1.2), MCV (83.9±8.8), MCH (34.3±1.5), RBC (4.6±0.7), and platelets (280.9±113.3) of the non-syphilitic participants. CONCLUSIONS: The results showed that the elevated levels of lymphocyte, monocyte, MCV, and MCH and lowered levels of RBC and platelets are highly specific hematological biomarkers for the diagnosis of patients with syphilis.

Status of Intestinal Parasitic Infections in a Tertiary Care Center.

BACKGROUND: Intestinal parasitic infections (IPIs) are diseases of serious public health concern in low- and middle-income countries, including Nepal. Such infections can cause growth retardation and increased susceptibility to other parasitic infections. Hence, this study aims to assess the prevalence of IPIs among the patients attending a tertiary care hospital in central Nepal. METHODS: Clinical and laboratory records of patients, whose stool samples were collected and transported to the Department of Clinical Microbiology, KIST Medical College and Teaching Hospital, during 2 years (January 2019 and December 2020) were examined for parasitological findings, by conventional microscopy using normal saline and iodine preparation. RESULTS: Out of 3,146 patients included in the study, 411 (13.1%) patients (median age[IQR]: 27[12-45]) were infected with the intestinal parasites. Patients of different age groups, such as 20-30 years (16.1%), 10-20 years (14.1%), and 30-40 years (13.3%) were mostly infected. Infection was more common in females (221/1572, 14.1%) than males (190/1574, 12.1%). There were 373 (90.8%) cases of IPIs due to Entamoeba histolytica, 34 (8.3%) cases due to Giardia lamblia, and 4 (0.9%) cases due to helminths. The prevalence of IPI in the first and second years was 14.5% (260/1794) and 11.2% (151/1352), respectively. IPIs were more common in summer (n=87, 12.8%) and spring(n=81, 10.8%). CONCLUSIONS: Present study showed a declined prevalence of helminth infection. However, a higher rate of protozoan infection indicated the water source contamination with fecal matters and therefore urgencies for awareness among the public about hygienic practices.

Vitamin D Deficiency among Patients Visiting Outpatient Departments in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Vitamin D deficiency is a global health issue affecting billions of people. Its deficiency results in abnormal homeostasis of calcium and phosphorous levels in an individual and results in reduced bone mineral density, which further makes them more prone to develop osteogenic disorders, such as fractures. The aim of this study is to find out the prevalence of vitamin D deficiency among patients visiting the outpatient departments in a tertiary care centre. Methods: This was a descriptive cross-sectional study done among 582 patients visiting outpatient departments in a tertiary care centre between January 1, 2019 and July 31, 2020. The study was approved by the Institutional Review Committee (Reference number: 076/077/17) of a tertiary care centre. A convenience sampling method was used. Patients' demographic detail and serum vitamin D level were determined. Data were collected retrospectively from hospital records and analysis was performed using the Statistical Package for the Social Sciences software version 17.0. Point estimate at 95% Confidence Interval was calculated along with frequency, the proportion for binary data, and mean with standard deviation for continuous data. Results: Among 582 patients enrolled in this study, 328 (56.35%) (52.32-60.38 at 95% Confidence Interval) patients were vitamin D deficient. Vitamin D deficiency was found in 238 (72.56%) females and 257 (78.35%) aged 16 to 59 years. Finally, there were 102 (31.09%) cases of vitamin D deficiency over the winter season. Conclusions: The prevalence of serum vitamin D deficiency in the current study was lower when compared to similar studies done in similar settings and similar to the prevalence from international literature. Keywords: deficient; prevalence; vitamin D.

Co-infection of Uropathogenic Escherichia coli among COVID-19 Patients Admitted to a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Simultaneous infection of antibiotic-resistant uropathogens in patients with COVID-19 has necessitated the revision of the prescription of broad-spectrum antibiotics on the grounds of evidence-based studies and antimicrobial stewardship principles. The objective of this study was to find out the prevalence of uropathogenic Escherichia coli co-infection among hospital-admitted COVID-19 patients of a tertiary care centre. Methods: This descriptive cross-sectional study was conducted in urinary tract infection suspected COVID-19 patients admitted to a tertiary care hospital, from 25th June to 24th December 2021 after ethical clearance from the Institutional Review Committee with registration number 207707860. Convenience sampling was used. Serum procalcitonin levels were also measured. Data analysis was performed using the Statistical Package for the Social Sciences software version 17.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data, and mean and standard deviation for continuous data. Results: Among the 49 hospital-admitted COVID-19 patients, 3 (6.12%) (0.59-12.83 at 95% Confidence Interval) were co-infected with uropathogenic Escherichia coli. Absolute non-susceptibility of Escherichia coli to antibiotics such as ceftriaxone, cotrimoxazole, nalidixic acid, gentamicin, and ampicillin was observed. All isolates were multidrug-resistant. All co-infected patients were female and had a median age of 35 years. Mean±SD value for procalcitonin in patients with co-infection (6.13±7.88 ng/ml) was six times higher than for the patients without co-infection (0.95±1.11 ng/ml). Conclusions: Escherichia coli co-infection in hospitalised COVID-19 patients was less frequent as compared to published literature. The serum procalcitonin value in patients with co-infection was substantially higher than that of patients without co-infection. Keywords: antimicrobial drug resistance; co-infection; COVID-19; Escherichia coli; procalcitonin.

Methicillin-resistant Staphylococcus aureus in Nepal.

Staphylococcus aureus is both a frequent commensal and a leading cause of endocarditis, bacteremia, osteomyelitis and skin and soft tissue infections and device-related infections. We performed this minireview to summarize the prevalence of Staphylococcus aureus among clinical samples and estimate the proportion of methicillin-resistant Staphylococcus aureus. The prevalence of Staphylococcus aureus among clinical isolates in Nepal is 34.5%. On average, the proportion of multi-drug resistance in Staphylococcus aureus is 57.1%. Methicillin-resistant Staphylococcus aureus accounts for a total of 41.7%. Inducible clindamycin resistance was detected in about 35% of the isolates. A regular antimicrobial resistance surveillance mechanism is necessary to mitigate the development of resistance among organisms and further spread of superbugs like methicillin-resistance Staphylococcus aureus.