Medical students’ characteristics as predictors of career practice location: retrospective cohort study tracking graduates of Nepal’s first medical college

Objective: To determine, in one low income country (Nepal), which characteristics of medical students are associated with graduate doctors staying to practise in the country or in its rural areas. Design: Observational cohort study. Setting: Medical college registry, with internet, phone, and personal follow-up of graduates. Participants: 710 graduate doctors from the first 22 classes (1983-2004) of Nepal’s first medical college, the Institute of Medicine. Main outcome measures: Career practice location (foreign or in Nepal; in or outside of the capital city Kathmandu) compared with certain pre-graduation characteristics of medical student. Results: 710 (97.7%) of the 727 graduates were located: 193 (27.2%) were working in Nepal in districts outside the capital city Kathmandu, 261 (36.8%) were working in Kathmandu, and 256 (36.1%) were working in foreign countries. Of 256 working abroad, 188 (73%) were in the United States. Students from later graduating classes were more likely to be working in foreign countries. Those with pre-medical education as paramedics were twice as likely to be working in Nepal and 3.5 times as likely to be in rural Nepal, compared with students with a college science background. Students who were academically in the lower third of their medical school class were twice as likely to be working in rural Nepal as those from the upper third. In a regression analysis adjusting for all variables, paramedical background (odds ratio 4.4, 95% confidence interval 1.7 to 11.6) was independently associated with a doctor remaining in Nepal. Rural birthplace (odds ratio 3.8, 1.3 to 11.5) and older age at matriculation (1.1, 1.0 to 1.2) were each independently associated with a doctor working in rural Nepal. Conclusions: A cluster of medical students’ characteristics, including paramedical background, rural birthplace, and lower academic rank, was associated with a doctor remaining in Nepal and with working outside the capital city of Kathmandu. Policy makers in medical education who are committed to producing doctors for underserved areas of their country could use this evidence to revise their entrance criteria for medical school

Brief Original Article Phenotypic characterization of nosocomial isolates of Staphylococcus aureus with reference to MRSA

Background: Apart from being a major cause of mortality, nosocomial infections due to Staphylococcus aureus have been imposing a burden on patients, hospitals and health care systems. The present study was designed to determine the prevalence of methicillin resistant S. aureus (MRSA) among nosocomial isolates along with their phenotypic characterization. Methodology: MRSA and methicillin sensitive S. aureus (MSSA) were determined by performing four different tests viz: disc diffusion, oxacillin screen agar test, MRSA latex agglutination test, and MIC of oxacillin by E test. Results: Of the 149 S. aureus nosocomial isolates, 44.9 % were MRSA, which included 82.1 % of homogeneous MRSA and 17.9 % of heterogeneous MRSA. Association of MRSA infection was found to be significantly higher in skin and lower respiratory tract infections. Of the MRSA isolates, 65 were multiresistant oxacillin resistant Staphylococcus aureus (MORSA) and 2 were nonmultiresistant oxacillin resistant Staphylococcus aureus (NORSA). D tests performed on 136 isolates showed that Inducible macrolide-lincosamide-streptogramin B (MLS B) and constitutive MLS B resistance were found to be associated with MRSA. On the contrary, susceptibility to both erythromycin and clindamycin was found to be associated with MSSA. However, MS B (macrolide-streptogramin B) resistance was not found associated either with MRSA or MSSA. Furthermore, both inducible and constitutive MLS B were found to be associated with only homogenous MRSA. Conclusion: D tests may be made mandatory in all S. aureus isolates as inducible MLS B resistance cannot be detected in routine susceptibility test unless erythromycin and clindamycin are placed 15-26 mm apart

Distribution of antibody titer against <it>Salmonella enterica </it>among healthy individuals in nepal

Abstract Background Enteric fever is an endemic problem in Nepal and Widal agglutination test is widely used for its diagnosis but a normal baseline titer in healthy population and cutoff values have not been established. Methods We measured average baseline antibody titers against "O" and "H" antigens of Salmonella enterica serotype Typhi and "H" antigens of serotypes Paratyphi A and Paratyphi B among apparently healthy blood donors in Nepal. The antibody titers were measured using Standard Widal Confirmatory Quantitative Tube test. Results Among the 100 blood samples collected from healthy volunteers, 62 individuals had significant antibody titers (≥ 1:20) against one of the four antigens against S. enterica. Among 54 samples with an anti-O titer against serotype Typhi, 15 and 36 samples had titers of ≥ 1:60 and ≥ 1:40, respectively. A significant proportion (12% of all) had anti-O titer of ≥ 1:80. Similarly, among the 59 samples demonstrating anti-H titers of ≥ 1:20 to S. enterica serotype Typhi, 29 had a titer of ≥ 1:80 and 12 had 1:160. For S. enterica serotypes Paratyphi A and B, anti-H titers of ≥ 1:20 were found only in 12% and 3%, respectively, of all samples tested. Conclusion When a single Widal agglutination titer is used for the diagnosis of enteric fever, it will be more appropriate to change the currently used cutoff levels against S. enterica serotype Typhi to > 1:80 for anti-O and > 1:160 for anti-H titers for Nepal.</p