Knowledge, Attitude and Practice of Health Care Professionals towards Antimicrobial Resistance and its stewardship at tertiary care teaching Hospital

Background: Irrational antibiotic use leads to resistance, a serious problem which is increasing tremendously and requires urgent response. The goal of this study is to evaluate knowledge, attitude, and practice of health care professionals (HCPs) regarding antimicrobial resistance (AMR) and its stewardship. Methods: This questionnaire based prospective cross-sectional study was conducted in 216 HCPs of Universal College of Medical Sciences (UCMS). Chi-square analysis was used to see the association of knowledge, attitude, and practice (KAP) with other demographic variables. Pearson correlation was done to analyze the correlation between knowledge and attitude, knowledge and practice, and attitude and practice. Results: Among all participants, 33% had good knowledge, majority of them (78.2%) had positive attitude and 43.5% had good practice related to antimicrobial resistance and its stewardship. There was no significant correlation between knowledge and practice, as well as between practice and attitude. However, a weak positive correlation was found between knowledge and attitude (r=0.186; p=0.006). Conclusion: The majority of health care professionals showed a positive attitude towards antibiotic resistance and its stewardship. However, in spite of positive attitude of HCPs, the level of knowledge and practice were found to be poor

Accuracy of Glucose Meter Among Adults in a Semi-urban Area in Kathmandu, Nepal

Introduction: Glucose meters are gaining popularity in monitoring of blood glucose at household levels and in health care set-ups due to their portability, affordability and convenience of use over the laboratory based reference methods. Still they are not free of limitations. Operator’s technique, extreme temperatures, humidity, patients’ medication, hematocrit values can affect the reliability of glucose meter results. Hence, the accuracy of glucose meter has been the topic of concern since years. Therefore, present study aims to evaluate the analytical and clinical accuracy of glucose meter using International Organization for Standardization 15197 guideline. Methods: A community based descriptive cross-sectional study was conducted in Kapan, Kathmandu, Nepal in April 2018. Glucose levels were measured using glucose meter and reference laboratory method simultaneously among 203 adults ≥20 years, after an overnight fasting and two hours of ingestion of 75 grams glucose. Modified Bland-Altman plots were created by incorporating ISO 15197 guidelines to check the analytical accuracy and Park error grid was used to evaluate the clinical accuracy of the device. Results: Modified Bland-Altman plots showed>95% of the test results were beyond the acceptable analytical criteria of ISO 15197:2003 and 2013. Park Error Grid-Analysis showed 99% of the data within zones A and B of the consensus error grid. Conclusions: Glucose meter readings were within clinically acceptable parameters despite discrepancies on analytical merit. Possible sources of interferences must be avoided during the measurement to minimize the disparities and the values should be interpreted with caution.

LC-MS based metabolite profiling, in-vitro antioxidant and in-vivo antihyperlipidemic activity of Nigella sativa extract

The aim of this study was to identify the bioactive phytoconstituents present in the aqueous extract of Nigella sativa and also, to evaluate the antioxidant and antihyperlipidemic activity in Wistar rats. The LC-MS/MS analysis was assessed for the determination of different bioactive compounds present in N. sativa extract. Total phenolic and flavonoid content were determined by using validated Folin-Ciocalteu and Aluminum chloride colorimetric methods, respectively. The in-vitro antioxidant and in-vivo antihyperlipidemic activity in Wistar rats were also evaluated. Preliminary phytochemical screening of the extract showed the presence of alkaloids, flavonoids, phenols, glycosides, and amino acids in the aqueous extract. The bioactive compounds of the aqueous extract were identified through LC-MS/MS analysis. The in-vitro antioxidant activity of N. sativa showed the highest free radical scavenging capacity in DPPH, H2O2, and OH radical scavenging assays with IC50 values 11.916 ± 2.828, 30.294 ± 13.790, and 12.048 ± 2.828 µg/mL, respectively. Evaluation of antihyperlipidemic activity of extract in Wistar rats showed that a high dose (800 mg/kg) of extract significantly decreased total cholesterol (TC) 71.76 ± 6.91 mg/dL, TG 83.6 ± 8.09 mg/dL, low-density lipoproteins (LDL-c) 33.86 ± 6.05 mg/dL, very low-density lipoproteins (VLDL-c) 16.72 ± 1.61 mg/dL level in blood. However, the HDL-C level was significantly improved (21.18 ± 1.80 mg/dL) as compared to HFD-induced control rats (11.76 ± 1.14 mg/dL) after 28 days of treatment. Also, at the same dose, animal body weight was also decreased to 162.6 ± 16.40 g compared with control 184.4 ± 10.24 g. The aqueous extract of N. sativa was found to be an effective natural source of antioxidant and hypolipidemic agents. This activity was attributed to the presence of diverse bioactive compounds in it

Hypovitaminosis D among Blood Samples of Patients Presenting to the Department of Biochemistry of a Tertiary Care Center

Introduction: Hypovitaminosis D is a global public health problem affecting approximately one billion people, with a particularly high prevalence in South Asia. Several hospital-based studies from Nepal show a high prevalence of hypovitaminosis D. However, large-scale community-based studies are lacking. The aim of the study was to find out the prevalence of hypovitaminosis D among blood samples of patients presenting to the Department of Biochemistry of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among blood samples of patients presenting to the Department of Biochemistry of a tertiary care centre from 3 November 2022 to 30 April 2023 after obtaining ethical approval from the Institutional Review Committee (Reference number: 136/22). Patients of all age groups and genders who were sent for the evaluation of Vitamin D at the laboratory were included. A convenience sampling technique was used. The point estimate was calculated at a 95% Confidence Interval. Results: Out of 376 patients, hypovitaminosis was seen in 274 (72.87%) (68.38-77.36, 95% Confidence Interval). Vitamin D insufficiency was present in 252 (91.97%) and vitamin D deficiency was present in 22 (8.03%) participants. Conclusions: The prevalence of hypovitaminosis D was found to be higher than other studies done in similar settings.

Depression, malnutrition, and health-related quality of life among Nepali older patients

Abstract Background Little is known about the health, nutrition, and quality of life of the aging population in Nepal. Consequently, we aimed to assess the nutritional status, depression and health-related quality of life (HRQOL) of Nepali older patients and evaluate the associated factors. Furthermore, a secondary aim was to investigate the proposed mediation-moderation models between depression, nutrition, and HRQOL. Methods A cross-sectional survey was conducted from January–April of 2017 among 289 Nepali older patients in an outpatient clinic at Nepal Medical College in Kathmandu. Nutritional status, depression and HRQOL were assessed using a mini nutritional assessment, geriatric depression scales, and the European quality of life tool, respectively. Linear regression models were used to find the factors associated with nutritional status, depression, and HRQOL. The potential mediating and moderating role of nutritional status on the relationship between depression and HRQOL was explored; likewise, for depression on the relationship between nutritional status and HRQOL. Results The prevalence of malnutrition and depression was 10% and 57.4% respectively; depression-malnutrition comorbidity was 7%. After adjusting for age and gender, nutritional score (β = 2.87; BCa 95%CI = 2.12, 3.62) was positively associated and depression score (β = − 1.23; BCa 95%CI = − 1.72, − 0.72) was negatively associated with HRQOL. After controlling for covariates, nutritional status mediated 41% of the total effect of depression on HRQOL, while depression mediated 6.0% of the total effect of the nutrition on HRQOL. Conclusions A sizeable proportion of older patients had malnutrition and depression. Given that nutritional status had a significant direct (independently) and indirect (as a mediator) effect on HRQOL, we believe that nutritional screening and optimal nutrition among the older patients can make a significant contribution to the health and well-being of Nepali older patients. Nonetheless, these findings should be replicated in prospective studies before generalization

Cardiovascular Risk Assessment in Hemodialysis Patients

Cardiovascular diseases are the leading cause of death in hemodialysis patients. We aimed to evaluate non-traditional cardiovascular risk factors: homocysteine, high sensitive C-reactive protein, oxidized LDL antibodies, phosphate, and red cell distribution width in chronic kidney disease patients under maintenance hemodialysis along with traditional cardiovascular risk factors like age, hypertension, diabetes mellitus, among others. A total of 78 diagnosed chronic kidney disease patients under maintenance hemodialysis visiting a tertiary care center were included in the study, of which 59% were male. Hyperhomocysteinemia was present in 79.5% of the participants, with the median homocysteine level being 28.43 µmol/L. The median hsCRP level was 4.74 mg/L, and 59% and 24.4% of the total participants were at high and moderate cardiovascular risk respectively. The median oxidized LDL antibody level was 4235 U/mL, which is within the reference range. The median red cell distribution width was 14.05%, which is within the normal range. Left ventricular hypertrophy, a common cardiovascular disease in such patients, was found in 55.13% of the participants. Serum homocysteine level was significantly higher in patients with left ventricular hypertrophy, whereas serum C- reactive protein level was significantly lower in patients with left ventricular hypertrophy. The mean serum phosphate was 6.23 mg/dL (i.e. higher than normal) and hyperphosphatemia was seen among 76.9% of the patients. The mean age of the patients was 47.5 years, which is distinctly lower when compared to the hemodialysis patients in the Western population. The prevalence of hypertension, diabetes mellitus, and anemia were 95%, 18.25%, and 92.3%, respectively

CLINICAL PROFILE OF MINERAL BONE DISORDERS (RENAL OSTEODYSTROPHY) IN CHRONIC KIDNEY DISEASE PATIENTS

Objective: The objective of the study was to evaluate the clinical profile of mineral bone disorders (renal osteodystrophy) in chronic kidney disease (CKD) patients. Methods: A retrospective study was performed involving 100 patients above 15 years of age with previously diagnosed chronic renal failure. A series of tests such as biochemical, radiological, and arterial calcifications were monitored. The mean age of subjects in our study was 52.54 years. Results: Biochemical tests revealed that hypocalcemia was present in 54% of the patients, and hyperphosphatemia was seen in 84% of the participants, while only 22% of the participants had high alkaline phosphate (ALP) levels. Radiological tests revealed that 39 patients had aortic calcification, 42 patients had radial artery calcification, and 27 patients had both. Subperiosteal resorption was seen on 29 participants. The majority of the vascular calcification and subperiosteal resorption was seen in patients with CKD Stage 5, and both aortic and radial artery calcifications were significantly associated with subperiosteal bone resorption. Conclusion: The results point toward a high prevalence of derangement in the mineral, vascular and valvular calcifications. Serum total ALP can serve as a biochemical marker to identify a pattern of bone turnover where intact parathyroid hormone is not available. The results highlight that serum phosphorus and Ca × P product levels were significantly associated with both aortic and radial artery calcifications. There was no significant association of these calcifications with serum calcium and ALP levels