Prevalence of multidrug-resistance and blaVIM and blaIMP genes among gram-negative clinical isolates in tertiary care hospital, Kathmandu, Nepal

Background and Objectives: Carbapenems have been the choice of antibiotics for the treatment of infections caused by multidrug-resistant bacteria. The main objective of this study was to determine the prevalence of carbapenemase (blaVIM and blaIMP) producing isolates among Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii. Materials and Methods: A total of 1,151 clinical samples were collected from the patients visiting Annapurna Neurological Institute and Allied Science and Annapurna Research Centre, Kathmandu, between June 2017 and January 2018. Antibiotic susceptibility testing (AST) was performed on the Enterobacteriaceae, P. aeruginosa and A. baumannii isolates using the Kirby-Bauer disk diffusion method. The modified Hodge test (MHT) was performed on the carbapenem-resistant isolates to confirm carbapenemase production. DNA was extracted and then screened for blaVIM and blaIMP genes by multiplex PCR. Results: Of the total 1,151 clinical samples, 253 (22.0%) showed positive growth. Of them, 226 (89.3%) were identified as Enterobacteriaceae, P. aeruginosa, and A. baumannii. Among the 226 isolates, 106 (46.9%) were multidrug-resistant. Out of the 106, 97 (91.5%) isolates showed resistance to at least one of the carbapenem used. Among the 97 carbapenem-resistant isolates, 67 (69.1%) showed the modified Hodge test (MHT) positive results. blaVIM and blaIMP were detected in 40 and 38 isolates respectively using multiplex PCR assay. Conclusion: This study determined a high prevalence of MDR and carbapenem resistance among Enterobacteriaceae, P. aeruginosa, and A. baumannii as detected by the presence of blaVIM and blaIMP genes. This study recommends the use of rapid and advanced diagnostic tools along with conventional phenotypic detection methods in the clinical settings for early detection and management of drug-resistant pathogens to improve treatment strategies

Electronics design and development of Near-Infrared Imager, Spectrometer and Polarimeter

NISP, a multifaceted near-infrared instrument for the upcoming 2.5m IR telescope at MIRO Gurushikhar, Mount Abu, Rajasthan, India is being developed at PRL, Ahmedabad. NISP will have wide (FOV = 10' x 10') field imaging, moderate (R=3000) spectroscopy and imaging polarimetry operating modes. It is designed based on 0.8 to 2.5 micron sensitive, 2048 X 2048 HgCdTe (MCT) array detector from Teledyne. Optical, Mechanical and Electronics subsystems are being designed and developed in-house at PRL. HAWAII-2RG (H2RG) detector will be mounted along with controlling SIDECAR ASIC inside LN2 filled cryogenic cooled Dewar. FPGA based controller for H2RG and ASIC will be mounted outside the Dewar at room temperature. Smart stepper motors will facilitate motion of filter wheels and optical components to realize different operating modes. Detector and ASIC temperatures are servo controlled using Lakeshore's Temperature Controller (TC) 336. Also, several cryogenic temperatures will be monitored by TC for health checking of the instrument. Detector, Motion and Temperature controllers onboard telescope will be interfaced to USB Hub and fiber-optic trans-receiver. Remote Host computer interface to remote end trans-receiver will be equipped with in-house developed GUI software to control all functionalities of NISP. Design and development aspects of NISP Electronics will be presented in this conference.Comment: 6 pages, 3 figures, Submitted to SPIE Conference Astronomical Telescopes + Instrumentation 202

COBRA framework to evaluate e-government services: A citizen-centric perspective

E-government services involve many stakeholders who have different objectives that can have an impact on success. Among these stakeholders, citizens are the primary stakeholders of government activities. Accordingly, their satisfaction plays an important role in e-government success. Although several models have been proposed to assess the success of e-government services through measuring users' satisfaction levels, they fail to provide a comprehensive evaluation model. This study provides an insight and critical analysis of the extant literature to identify the most critical factors and their manifested variables for user satisfaction in the provision of e-government services. The various manifested variables are then grouped into a new quantitative analysis framework consisting of four main constructs: cost; benefit; risk and opportunity (COBRA) by analogy to the well-known SWOT qualitative analysis framework. The COBRA measurement scale is developed, tested, refined and validated on a sample group of e-government service users in Turkey. A structured equation model is used to establish relationships among the identified constructs, associated variables and users' satisfaction. The results confirm that COBRA framework is a useful approach for evaluating the success of e-government services from citizens' perspective and it can be generalised to other perspectives and measurement contexts. Crown Copyright © 2014.PIAP-GA-2008-230658) from the European Union Framework Program and another grant (NPRP 09-1023-5-158) from the Qatar National Research Fund (amember of Qatar Foundation

ネパール カトマンドゥー コウガイ ノ コウリツ ショウガッコウ ニ オケル キセイチュウ カンセンショウ ノ ジッタイ

A survey on intestinal parasitosis and its pre-disposing factors was done among public primary school (1-5 classes) children (n=221 ; M : 107 and F : 114, Age : 5 to 16 years) in a suburban area of Kathmandu Valley, Nepal. Fecal samples were preserved into Cary-Blair transport media and in 10% formal. -saline. Parasites were detected by formal. -ether concentration technique. Blood hemoglobin was estimated by cyanmethemoglobin method. A questionnaire was done to reveal pre-disposing factors. The overall prevalence of parasitosis was 72.4% with significant difference in boys and girls (p<0.05). Approximately half of the infected children (46.9%) had multiple parasitic infections. Altogether eleven types of parasites were recovered. Trichuris trichiura was most frequently detected followed by Ascaris lumbricoides and Giardia lamblia. Hemoglobin level also did not differ significantly in children with and without parasitosis

Global, regional, and national burden of neurological disorders during 1990-2015 : a systematic analysis for the Global Burden of Disease Study 2015

Background Comparable data on the global and country-specific burden of neurological disorders and their trends are crucial for health-care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study provides such information but does not routinely aggregate results that are of interest to clinicians specialising in neurological conditions. In this systematic analysis, we quantified the global disease burden due to neurological disorders in 2015 and its relationship with country development level. Methods We estimated global and country-specific prevalence, mortality, disability-adjusted life-years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) for various neurological disorders that in the GBD classification have been previously spread across multiple disease groupings. The more inclusive grouping of neurological disorders included stroke, meningitis, encephalitis, tetanus, Alzheimer's disease and other dementias, Parkinson's disease, epilepsy, multiple sclerosis, motor neuron disease, migraine, tension-type headache, medication overuse headache, brain and nervous system cancers, and a residual category of other neurological disorders. We also analysed results based on the Socio-demographic Index (SDI), a compound measure of income per capita, education, and fertility, to identify patterns associated with development and how countries fare against expected outcomes relative to their level of development. Findings Neurological disorders ranked as the leading cause group of DALYs in 2015 (250.7 [95% uncertainty interval (UI) 229.1 to 274.7] million, comprising 10.2% of global DALYs) and the second-leading cause group of deaths (9.4 [9.1 to 9.7] million], comprising 16.8% of global deaths). The most prevalent neurological disorders were tensiontype headache (1505 9 [UI 1337.3 to 1681.6 million cases]), migraine (958.8 [872.1 to 1055.6] million), medication overuse headache (58.5 [50.8 to 67.4 million]), and Alzheimer's disease and other dementias (46.0 [40.2 to 52.7 million]). Between 1990 and 2015, the number of deaths from neurological disorders increased by 36.7%, and the number of DALYs by 7.4%. These increases occurred despite decreases in age-standardised rates of death and DALYs of 26.1% and 29.7%, respectively; stroke and communicable neurological disorders were responsible for most of these decreases. Communicable neurological disorders were the largest cause of DALYs in countries with low SDI. Stroke rates were highest at middle levels of SDI and lowest at the highest SDI. Most of the changes in DALY rates of neurological disorders with development were driven by changes in YLLs. Interpretation Neurological disorders are an important cause of disability and death worldwide. Globally, the burden of neurological disorders has increased substantially over the past 25 years because of expanding population numbers and ageing, despite substantial decreases in mortality rates from stroke and communicable neurological disorders. The number of patients who will need care by clinicians with expertise in neurological conditions will continue to grow in coming decades. Policy makers and health-care providers should be aware of these trends to provide adequate services.Peer reviewe

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Identifying the research, advocacy, policy and implementation needs for the prevention and management of respiratory syncytial virus lower respiratory tract infection in low- and middle-income countries

Introduction: The high burden of respiratory syncytial virus (RSV) infection in young children disproportionately occurs in low- and middle-income countries (LMICs). The PROUD (Preventing RespiratOry syncytial virUs in unDerdeveloped countries) Taskforce of 24 RSV worldwide experts assessed key needs for RSV prevention in LMICs, including vaccine and newer preventive measures. Methods: A global, survey-based study was undertaken in 2021. An online questionnaire was developed following three meetings of the Taskforce panellists wherein factors related to RSV infection, its prevention and management were identified using iterative questioning. Each factor was scored, by non-panellists interested in RSV, on a scale of zero (very-low-relevance) to 100 (very-high-relevance) within two scenarios: (1) Current and (2) Future expectations for RSV management. Results: Ninety questionnaires were completed: 70 by respondents (71.4% physicians; 27.1% researchers/scientists) from 16 LMICs and 20 from nine high-income (HI) countries (90.0% physicians; 5.0% researchers/scientists), as a reference group. Within LMICs, RSV awareness was perceived to be low, and management was not prioritised. Of the 100 factors scored, those related to improved diagnosis particularly access to affordable point-of-care diagnostics, disease burden data generation, clinical and general education, prompt access to new interventions, and engagement with policymakers/payers were identified of paramount importance. There was a strong need for clinical education and local data generation in the lowest economies, whereas upper-middle income countries were more closely aligned with HI countries in terms of current RSV service provision. Conclusion: Seven key actions for improving RSV prevention and management in LMICs are proposed

Distribution and pyrethroid resistance status of Aedes aegypti and Aedes albopictus populations and possible phylogenetic reasons for the recent invasion of Aedes aegypti in Nepal

Background: When the first systematic list of mosquitoes in Nepal was reported in 1990, there was no description of Aedes aegypti (L.), while Aedes albopictus (Skuse) has been included in the Stegomyia subgroup since the 1950s. The first record of Ae. aegypti in Nepal was reported in 2009, suggesting some coincidence between the invasion of this species and the first record of dengue fever in Nepal in 2006. Results: We performed a field survey of the distribution and insecticide susceptibility of Ae. aegypti and Ae. albopictus in Nepal in 2017 and 2018. Mosquito larvae were collected from used tires located along the streets of Kathmandu, Bharatpur and Pokhara, and a simplified bioassay was used to assess the susceptibility of the larvae to pyrethroid insecticides using d-allethrin. The presence or absence of point mutations in the voltage-gated sodium channel was also detected by direct sequencing. V1016G was detected at a high frequency and a strong correlation was observed between the frequencies of V1016G and susceptibility indices in Ae. aegypti populations. F1534C was also detected at a relatively low frequency. In Ae. albopictus populations, susceptibilities to d-allethrin were high and no point mutations were detected. Analysis of the cytochrome c oxidase subunit 1 (cox1) gene was performed for assessing genetic diversity and the existence of two strains were identified in Ae. aegypti populations. One consisted of 9 globally-distributed haplotypes while the other was derived from an African haplotype. Conclusions: The high pyrethroid resistance, high V1016G frequency, and relatively low quantity of insecticides used to control dengue vectors in Nepal may have resulted in only weak selection pressure favoring insecticide resistance and could support the hypothesis that this species has recently been introduced from neighboring Asian countries where pyrethroid resistance is relatively widespread.[Figure not available: see fulltext.