Study of Microorganism Growth Pattern in Nasal Pack of Patients Visiting the Department of ENT, Head and Neck Surgery.

Background Nasal packs are utilized nearly by otorhinolaryngologists for controlling epistaxis and post nasal procedures. Complications have been reported due to them; therefore the use of antibiotics is a common practice among otorhinolaryngologists. Objective To detect microbiological flora associated with nasal packing and find evidence to support the benefit of systemic antibiotics with it. Method A prospective, analytical study was conducted on 51 patients presenting to the Department of ENT, KUSMS from June to September 2015 who required nasal packing. Approval of the local Institutional review committee (IRC) was taken. The mid part of the pack was collected in a sterile bottle under aseptic technique and sent to microbiology department. Specimen collection, culture, identification tests were done according to the guidelines by American Society for Microbiology. Data were collected using the individual patient records and Microsoft Office Excel 2007. Statistical analysis was performed with SPSS 16.0. Result Among the 51 cultures; 33 (64.7%) were positive. In 18 (35.3%) cultures no organism was grown. Statistical analysis did not show significance between duration of pack kept with microbial growth (p=0.051) or the type of pack kept (p=0.212) .It showed significance with foul smell of the pack to the growth (p <0.001). Conclusion Microbiological flora was associated with nasal pack. Antibiotic soaked nasal packs have lesser incidence of positive bacterial growth when compared with plain nasal packs. Nasal packs kept for less than 48 hours have lesser incidence of positive bacterial growth when compared with nasal packs kept for more than 48 hours. Therefore, administering systemic antibiotics in cases when we plan to keep the pack for longer duration is recommended.

Enteric opportunistic parasitic infections among HIV seropositive patients in Kathmandu, Nepal.

BACKGROUND: Enteric opportunistic parasitic infections are the major source of diarrheal disease in developing countries mainly in Human Immunodeficiency virus (HIV) infected patients. OBJECTIVE: The study was to detect enteric parasites causing diarrhea and their association with immune status in HIV-seropositive patients. METHODS: The present study was conducted in Dirgh-Jeevan Health Care Research Center and Tribhuvan University Teaching Hospital, Public Health Research Laboratory, Kathmandu, Nepal between June 2010 and May 2011 involving 146 Human Immunodeficiency virus (HIV) positive patients. Serostatus from these patients were detected by Enzyme Linked Immunosorbent assay. CD4+ T cell counts were done by flow cytometry. Stool was examined for enteric parasites by microscopy with special staining methods. RESULTS: A total of 146 HIV sero-positive patients with and without diarrhea age between 20 to 45 years were included in the study. Of the 146 patients, the protozoan parasitic infection was found in 30.13% (44/146). Out of 146 patients, 78 had diarrhea in which parasitic infection was 39 (50%) and 7.35% (5/68) protozoal parasites positive cases did not have diarrhea. A significant difference (p less than 0.05) was observed in the level of infection of intestinal protozoan between the HIV seropositive with diarrhea and HIV-seropositive without diarrhea. Out of 43 patients whose CD4+ T cells were less than 200/µl, 29 (67.4%) had opportunistic parasitic infection whereas out of 103 patients whose CD4+ T cells were =200/mcl, only 15 (14.56%) had opportunistic parasitic infection (P less than 0.05). CONCLUSION: Enteric opportunistic parasitic infections were detected in 30.1% among HIV-seropositive patients and low CD4+ T count indicated high enteric opportunistic infection. Early detection of enteric parasitic infections will help in the management and to improve the quality of life for HIV-infected individuals.

Microbiological and Clinical Profile of Uropathogenic Escherichia coli Isolates in Kathmandu University Hospital.

BACKGROUND: Treatment of patients infected by multidrug resistant bacteria is a major challenge. Immunocompromised status, prolonged hospital stay, malignancy, diabetes are some of the risk factors for emergence of multidrug resistance. Our study focused on microbiological and clinical profile of multidrug resistant uropathogenic Escherichia coli. METHODS: This was a cross-sectional study conducted between June 2014-May 2015 in Kathmandu University Hospital. Urine sample from outpatients and inpatients from which Escherichia coli isolated was included. Specimen collection, culture, identification tests were done following guidelines given by American Society for Microbiology. RESULTS: Total number of urine samples received during the study were 3,554. Escherichia coli isolates were 645(18.14%) and 245(37.98%) were Extended Spectrum Beta-Lactamase producer. Extended Spectrum Beta-Lactamase producers were found more among inpatients 148(60.41%) [p<0.001], patients with underlying urological abnormalities 38 (15.51%) [p=0.0039], pregnant ladies 46(18.77%) [p=0.0028], diabetic patients 27 (11.02%) [p=0.0084], patients who received prior antibiotic therapy 155 (63.26%) [p=0.0043] than Extended Spectrum Beta-Lactamase non-producer. Malignancy was seen more among Extended Spectrum Beta-Lactamase producer having patients 5 (2.04%) [p=0.031] and all these isolates were more resistant to fluoroquinolones 168(68.57%), Trimethoprim-sulfamethoxazole 239 (97.55%) [p=0.0633], aminoglycosides [p=0.0001] but only 2(0.80%) were resistant to carbapenems. CONCLUSIONS: Diabetes, pregnancy, malignancy, prior antibiotic therapy, underlying urological abnormalities were found associated with emergence of Extended Spectrum Beta-Lactamase producer in urine samples. Proper antibiotic usage may help to overcome the problem of emergence of antibiotic resistance.

Hospital-based study in children with rotavirus gastroenteritis and other enteropathogens.

BACKGROUND: Rotavirus is the most common cause of life threatening gastroenteritis in infants and young children in the world. The objective of the study is to find out current trends and incidents of rotavirus, including other enteropathogens related with children diarrhoea and lastly identify the most common rotavirus serotypes that circulate in Nepal. METHODS: A total of 1721 stool samples from less than 5 years of children were collected. Rotavirus in the stool samples were detected by Enzyme Immuno Assay (EIA) and strains were genotyped by Reverse-Transcription Polymerase Chain Reaction (RT-PCR). Bacteria and parasites were detected by following standard microbiological procedures. RESULTS: In between 2009 to 2010, of the total 1721, the prevalence of rotavirus was 24.7%. Of them, 906 (52.6%) were collected in the year 2009 and 815(47.5%) in the year 2010. Rotavirus was frequently detected in inpatients (31.6%) than outpatient (16.8%). Rotavirus detection was higher in female (26.4%) than male (23.7%). The prevalence was seen higher in age group 0-23 months in both years. Among six different bacterial isolates, Escherichia coli was most frequently isolated (6.5%). Similarly, Giardia lamblia (1.3%) was most common among six different parasites detected. A total of rotavirus positive 425 stool samples were detected over 2 years (2009-230, and 2010-195), G12P6 was the predominant strain circulating in both (45% in 2009 and 28% in 2010) years. G9P6 emerged in 2010 (6%). There were significant numbers of mixed infections (14.0% in 2009 and 29.8% in 2010). Thirty five samples were partially typed and 15 were completely untyped over the two year period. CONCLUSIONS: The study helps comprehend the prevalence of rotavirus along with other intestinal pathogens including bacteria and parasites. Major genotypes of rotavirus are also introduced in the study.