Burden and Life Satisfaction among Caregivers of Hemodialysis Patients Residing in Kathmandu

Introduction: The patients undergoing hemodialysis need long-term care. Caregivers of hemodialysis patients can suffer from physical and psychological stress that can affect the level of burden and life satisfaction among them. The objective of the study was to assess burden and the life satisfaction among caregivers of hemodialysis patients. Methods: A cross-sectional study was conducted among 167 caregivers of hemodialysis patients in Bir Hospital and National Kidney Center from December 2019 to March 2020 by using a proportionate sampling technique. Zarit Burden Interview-22 (ZBI) was used to assess the level of caregiver burden and the Life Satisfaction Questionnaire (LiSat-11) was used to assess life satisfaction among caregivers. Data analysis was done in the Statistical Package for the Social Sciences version 16.0. Results: Out of 167 participants, 89 (53.3%) had a mild to moderate level of burden. Only 6 (3.6%) of them had a severe burden. The overall life satisfaction score was 36.89±7.03. Marital status, the number of children, and annual income had a statistically significant association with the level of burden. A negative correlation was found between burden and life satisfaction which was statistically significant (r = -0.403, p value=0.000<0.05). Conclusion: The majority of caregivers were satisfied in terms of life as a whole, leisure situation, contacts, sexual life, activities, family life, partner relationships, physical and psychological health. However, the level of burden was found to be high among caregivers of hemodialysis patients. Necessary support interventions should be carried out to improve their caring roles and coping strategies

Transaminitis among Patients with Dengue Fever Visiting a Tertiary Care Centre

Introduction: Transaminitis is a condition where serum aspartate transaminase and alanine transaminase increase indicating liver dysfunction. One such disease where liver involvement might be observed is dengue, which is a mosquito-borne viral infection. The aim of the study was to find out the prevalence of transaminitis among patients with dengue fever in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in a tertiary care centre from 1 November 2022 to 31 March 2023 after obtaining ethical approval from the Institutional Review Committee. Informed written consent was taken before collecting the data. A rapid immunochromatography test was used to confirm dengue infection. Serum aspartate transaminase and alanine transaminase were measured through routine Reitman and Frankel’s enzymatic method. Dengue-confirmed patients from the medical outpatient department, fever clinic, and medical ward of the centre were included in the study. Patients with known prior liver diseases or any other chronic diseases, pregnancy, and patients in the hospice unit were excluded. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 442 dengue infected patients, the prevalence of transaminitis was 188 (42.53%) (37.92-47.13, 95% Confidence Interval). The highest frequency of dengue positive was observed among the 18-35 years age group, which was 97 (51.59%) with male predominance 134 (71.27%). Conclusions: The prevalence of transaminitis among patients with dengue fever in a tertiary care centre was found to be lower than other studies done in similar settings

Bacteriological assessment of stethoscopes used by healthcare workers in a tertiary care centre of Nepal

Abstract Objective Stethoscope is a medical device universally used by health care workers. Stethoscope may transmit pathogens among patients and health care workers if it is not disinfected. The objective of this study was to, determine the level of stethoscope contamination used by health care workers, survey the practices of disinfecting the stethoscope, identify various microorganisms and assess their role as potential pathogens and determine the effectiveness of 70% ethanol as a disinfecting agent. Results This was a cross-sectional study conducted in the department of Microbiology, Chitwan Medical College, Bharatpur, Nepal. Stethoscopes of 122 health care workers from different departments were included in this study. Out of a total 122 diaphragms, 88 (72.1%) were colonized. Only 71 (58.1%) bells and 152 earpieces (66.2%) were contaminated. Micrococcus and coagulase negative staphylococci were predominantly isolated species. The contamination was lowest among stethoscopes cleaned after touching every patient (11.5%) and the difference is statistically significant (P < 0.0001). Significantly lower level of contamination (13.6%) were found on stethoscopes cleaned everyday (P < 0.0001). Only 8.5% stethoscope showed growth with decreased number of colonies after disinfecting the stethoscopes with 70% ethanol. Thus, demonstrating the effectiveness of disinfection

Changing Trend of Neonatal Septicemia and Antibiotic Susceptibility Pattern of Isolates in Nepal

Background. Neonatal septicemia is one of the most common leading reasons for neonatal morbidity and mortality in developing countries. Frequent monitoring on pathogens with recent updates and their antimicrobial sensitivity pattern is mandatory for the better treatment. The aim of the study was to determine the bacteriological profile of neonatal septicemia and their antibiotic susceptibility pattern. Methods. This was a cross-sectional study conducted in Outpatient Department (OPD), Neonatal Intensive Care Unit (NICU), and Pediatrics Ward of Chitwan Medical College Teaching Hospital (CMCTH), Bharatpur, Nepal. Blood cultures were performed on all suspected neonates attending to the hospital with a clinical analysis of neonatal septicemia. Isolated organism was identified by the standard microbiological protocol and antibiotic sensitivity testing was done by Kirby-Bauer disk diffusion method. Results. Out of 516 specimens, bacterial growth was obtained in 56 specimens (10.8%). Prevalence of early onset sepsis was higher 35 (62.5%) in neonates compared to late onset sepsis 21 (37.5%). Majority of neonatal septicemia were caused by gram-negative isolates 39 (69.6%). Acinetobacter species 18 (32.1%) was most commonly isolated organism followed by Staphylococcus aureus 11 (19.6%). The predominant isolate in early onset septicemia was Acinetobacter species 18 (32.1%) and Staphylococcus aureus 9 (16%) and in late onset septicemia was Staphylococcus aureus 11 (19.6%) and Acinetobacter species 5 (8.9%). Staphylococcus aureus and coagulase-negative Staphylococci displayed highest susceptibility towards vancomycin, amikacin, teicoplanin, and meropenem. Gram-negative isolates showed susceptibility towards amikacin, piperacillin/tazobactam, meropenem, ofloxacin, and gentamicin. Conclusions. Acinetobacter species and Staphylococcus aureus remain the most predominant organisms responsible for neonatal septicemia in a tertiary care setting and demonstrate a high resistance to the commonly used antibiotics. Above all, since the rate of Acinetobacter species causing sepsis is distressing, inspiring interest to control the excess burden of Acinetobacter species infection is mandatory

Prevalence of inducible clindamycin resistance in erythromycin resistant clinical isolates of Staphylococcus aureus and CONS at tertiary care hospital

Background &amp; Objectives: The objective of this study was to isolate and identify Staphylococcus species from different samples clinical samples and to determine the current trend regarding the incidence and distribution of inducible clindamycin resistance in clinical isolates of Staphylococcus aureus and CONS.Materials &amp; Methods: A total of 264 isolates of staphylococcus species were isolated from various clinical samples. Clinical samples were cultured and Staphylococcus species were identified using standard microbiological methods recommended by the American Society for Microbiology (ASM). Methicillin resistance was confirmed using cefoxitin and oxacillin disks. Inducible clindamycin resistance was identified using D-zone test.Results: Among 264 erythromycin resistant staphylococcus species, 213 (80.6%) were S. aureus and 51 (19.3%) were CONS. Out of 213 erythromycin resistant isolates of S. aureus, 140 (65.7%) were MRSA and 73 (34.2%) were MSSA whereas out of 51 erythromycin resistant isolates of CONS, 28 (54.9%) were MRCNS and 23 (45%) were MSCNS. Constitutive MLSB phenotype and Inducible MLSB phenotype was higher among both MRSA and MRCNS isolates. MS phenotype was more predominant among 11 (5.1%) MSSA and 5 (9.8%) MSCNS isolates compared to 9 (4.2%) in MRSA and 2 (3.9%) in MRCNS.Conclusion: The prevalence of constitutive &amp; inducible clindamycin resistance in staphylococcus isolates was high among both MRSA and MRCNS. Hence the implementation of D-test routinely, will reveal the iMLSB &amp; cMLSB phenotype &amp; will guide the clinicians whether to use clindamycin in staphylococcal infections when erythromycin resistance is present.</p

Dipeptidyl-Peptidase IV inhibitors and glycemic control in type 2 Diabetes Mellitus

Background &amp; Objectives: Type 2 diabetes mellitus (T2DM) is a progressive disease, characterized by insulin resistance, impaired glucose-induced insulin secretion, inappropriately elevated glucagon concentrations, and hyperglycemia. Many patients cannot obtain satisfactory glycemic control with current therapies. New and more effective agents, targeted not only at treatment, but also at prevention of the disease, its progression, and its associated complications, are, therefore, required. The dipeptidyl peptidase-4 (DPP-4) inhibitors are a newer class of oral drugs for the treatment of T2DM. They inhibit the breakdown of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) thereby increasing the incretin effect in patients with T2DM. In clinical practice they are associated with significant reductions in HbA1c, no weight gain and a low risk of hypoglycemia. Since incretin response is markedly diminished in Asian populations, these agents can be used to achieve satisfactory glycemic control in Nepalese T2DM patients.JCMS Nepal. 2016;12(1):28-32.</p

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Additional file 1. Questionnaire

Chromobacterium violaceum Isolated from a Wound Sepsis: A Case Study from Nepal

Chromobacterium violaceum is a facultative anaerobic, Gram-negative rod, prevalent in tropical and subtropical regions. It enters through the skin injury and is capable of causing severe systemic infections leading to septic shock and multiorgan failure. It has been reported by few authors across the world but this is probably the first case of Chromobacterium violaceum isolated from wound sepsis from Nepal. In this study, a pus sample from the infection of a prick injury in the left middle finger was collected from the patient admitted to the intensive care unit. Bacteriological investigations of the pus sample revealed the causative organism to be Chromobacterium violaceum. This case study indicates that Chromobacterium violaceum can act as a potential cause of wound sepsis that may lead to the septic shock and if not treated timely, the mortality rate can be high as was in this study. Although this organism is very rare, the infection caused requires prompt treatment to minimize the mortality rate. Therefore, we recommend the timely diagnosis and antimicrobial therapy of this infection to combat the consequences led