Anti-SARS-CoV-2 Antibody Level among Renal Transplant Recipients: A Case Report from Nepal.

Globally, SARS-CoV-2 has caused significant public health burden, mainly in patients with underlying comorbidities including both communicable and noncommunicable diseases. Solid organ transplant recipients under immunesupressive medication are also amongst the high risk group. There is only sparse data on immunity against SARS-CoV-2 infection among renal transplant recipients. In this case report, we present the level of anti-SARS-CoV-2 antibody of three kidney transplant recipients after vaccination against COVID-19 virus. All three cases had received two doses of Oxford-AstraZeneca COVID-19 vaccine AZD1222 (ChAdOx1). Serological analysis showed protective level of circulating antibodies in the blood of all three cases. Although two out of three patients in the study acquired COVID-19 infection after immunization, they recovered with mild clinical course. Hence, we conclude that despite immune-suppressed status of transplant recipients, COVID-19 vaccination could protect them against severe illness

A rare case of recurrent urinary tract infection due to Trichosporon species in an immune-competent diabetic female patient

Trichosporonosis is a disease caused by Trichosporon spp. which are ubiquitous anamorphic yeast that commonly inhabit the soil. In human they are found in the skin, gastrointestinal tract and respiratory tract. Globally, Trichosporon spp. infection is rare and remains scantily reported in urinary tract infections and disseminated invasive infection amongst immunocompromised and cancer patients with neutropenia. Trichosporon asahii is the most commonly reported species. Virulence factors like proteinases, lipases, and phospholipases may be responsible for disease manifestation. We report a case of recurrent urinary tract infection due to Trichosporon spp. in a 62-year-old immunocompetent diabetic female which remained misdiagnosed for a long period of time. The patient was subsequently treated successfully by oral fluconazole drug

Methicillin-Resistant and Biofilm-Producing Staphylococcus aureus in Nasal Carriage among Health Care Workers and Medical Students

Antimicrobial resistance (AMR) is a global threat. It has been portrayed as a slow tsunami. Multidrug resistance and extensive drug resistance exacerbate the already-existing AMR problem. The aim of the study was to access the colonization of methicillin-resistant and biofilm-producing Staphylococcus aureus among healthcare workers (HCWs) and medical students (MSs). A cross-sectional study was designed. A total of 352 participants (176 were HCWs and 176 were MSs) were enrolled from different hospitals and medical colleges in Kathmandu, Nepal. Nasal cavity swab samples were collected and inoculated on Mannitol salt agar at standard in-vitro environmental conditions. Isolates were identified based on colony characteristics, staining properties, and biochemical tests. Identified isolates were tested for antibiotic susceptibility and biofilm production. Out of 352 participants, 65.3% were S. aureus carriers; among the carriers, 52.2% were HCWs and 47.8% were MSs. Of the total isolates, 47.4% isolates were methicillin-resistant S. aureus (MRSA) and 73.9% isolates were multidrug-resistant (MDR). Among MDR isolates, out of 109 MRSA isolates, 86.2% were MDR and out of 121 MSSA isolates, 62.8% were MDR where isolates were mainly resistant to erythromycin. In addition, 68.7% isolates were biofilm-forming; the results were similar in both MRSA and MSSA. Variables such as profession and educational level showed statistical significance (p < 0.05) with MRSA, MSSA, and biofilm producers. In conclusion, asymptomatic colonization of healthcare workers by drug-resistant S. aureus is increasing at alarming rates. This reflects the lack of proper hygiene practice as well as improper disinfection of workplace of study population

Utilization of Antenatal Care Services in Dalit Communities in Gorkha, Nepal: A Cross-Sectional Study

Background and Objective. Antenatal care (ANC) is one of the main components of maternal health. Utilization of safe motherhood is deprived in women who belong to low-caste groups like Dalit of Nepal. Low socioeconomic status, poor knowledge and awareness on obstetric complications, lack of decision-making autonomy, and limited health care options lead to underutilization of existing maternal health care service. The aim of this study was to ascertain the utilization of antenatal care services in terms of ANC visits with health personnel, receiving recommended period of iron tablets, consumption of antihelminthes and number of Tetanus Toxoid (TT) vaccines taken among child bearing women in Dalit community. Materials and Methods. Descriptive cross-sectional research design was used to conduct the study of 150 child bearing women of reproductive age (15-49 years) having at least one child up to three years of age in a Dalit community of Gorkha from March 2015 to March 2016. The data was collected from each mother by conducting face to face interview with each household by using a questionnaire. Result. The study revealed that mean age at marriage of respondents was 17.7 years and mean age at first pregnancy was 18 years. 44.6% of respondents experienced complication during last pregnancy, labour, and postpartum period in their last pregnancy. 59.3% of respondents stated that neighbors, relatives, and traditional healers were the best first contact person during health problem of women. 76.0% of respondents had attended antepartum visit during their last pregnancy whereas 24.0% of respondents did not attend any antepartum clinic. 68.3% of the mothers had consumed Iron/Folates within 45 days after delivery. Only 30.0% of respondents received antihelminthes (albendazole) while 70.0% of respondents had received TT Vaccines during their last pregnancy. Age, type of family, and education of the mothers were significantly associated with utilization of antenatal care services. Conclusion. Even though there is reasonable good utilization rate of antenatal service, the study revealed that low education and awareness among mothers, low socioeconomic condition, early marriage and pregnancy, inappropriate antenatal health check-up, and cultural taboos were significant factors affecting the satisfactory utilization of services among the Dalit community. Hence, there is a need to emphasize on raising awareness of Dalit mothers for receiving available prenatal services

Fungal Infection among Diabetic and Nondiabetic Individuals in Nepal

Background. Low immunity, comorbid clinical conditions, and metabolic disorders may be the underlying factors that determine the severity of infection. Diabetes increases the risk of infection and multiple organ damage. In Nepal, the actual burden of fungal infections has not been estimated or is in a limited progress. This study aimed to investigate the status of fungal infection in diabetic and nondiabetic individuals in Bhaktapur, Nepal. Materials and Methods. A total of 670 samples were collected from 134 participants. From each participant, five samples were collected from different sites like an oral wash, toe swab, midstream urine, hair shaft, and nail scrapings. All samples were cultured on Sabouraud dextrose agar. Gram stain was used to observe yeast cells and lactophenol cotton blue stain was used for hyphae. Chlamydospore production by Candida species was observed in cornmeal agar medium by Dalmau Plate method. Candida species isolated were characterized by germ-tube test and differentiated using CHROM agar Candida medium. Candida species isolates were tested for antibiotic susceptibility. Results. Overall, 19.4% of the samples showed fungal growth. The prevalence of fungal infection was higher in diabetic (34.0%) than nondiabetic individuals (4.7%). Fungal growth was found to be higher in oral wash followed by toe, urine, hair, and nail samples. Predominant fungi were Candida species (57.5%), Aspergillus species (28.4%), and Trichophyton species (10.7%). Oral wash, toe, and urine samples in diabetics had a significantly higher fungal prevalence when compared between both groups, p value < 0.05. In Candida isolates, higher resistance was seen against fluconazole 36.8% and ketoconazole 28.9%, whereas other drugs showed low resistance. Conclusion. Diabetic participants are more susceptible to fungal infection than the nondiabetics. Overall, Candida species and Aspergillus species are highly predominant fungi. Candida species are highly resistant to fluconazole and ketoconazole

Epidemiology of COVID‐19 mortality in Nepal: An analysis of the National Health Emergency Operation Center data

Abstract Introduction COVID‐19 had caused nearly 12,000 deaths in Nepal by March 2023. In this study, we compare COVID‐19‐associated mortality in the first (September 15 to November 30, 2020) and second (April 15 to June 30, 2021) waves of the pandemic in Nepal and investigate the associated epidemiological factors. Methods We disaggregated the COVID‐19‐related deaths between the first and second waves of the pandemic using the national COVID‐19 database and evaluated the association of independent variables with the deaths in the first versus second waves. Results Out of 8133 deaths, 25% died in the first wave and 75% in the second. Overall, 33.5% of the deceased were female, and 52% of the deaths were in those 60 years or older. A vast majority (92%) of deaths occurred in hospitals. Geographically, the middle “Hill” region (58.3%) witnessed the most significant number of deaths. About two thirds (64%) had at least one comorbid condition. Multivariable logistic regression showed a difference in the reported deaths by province (state) and geography (ecological region) between the first and second waves. Those in the age groups “19–39 years” and “40–59 years” were more likely to die in the second wave than in the first wave compared to the younger age group. Conclusions Overall, deaths were concentrated among older age groups, males, in the Hill regions, in the western provinces, and those with comorbidities. Therefore, the country must focus on these areas to ensure an efficient and effective pandemic response in the future

Knowledge, Attitudes, and Practices Concerning COVID-19 in Nepal

Background: Coronavirus disease-2019 (COVID-19) severely affects patients with chronic diseases. Adequate knowledge, attitudes, and practice related to COVID-19 is associated with decrease morbidity and mortality. Therefore, this aimed to assess knowledge, attitudes, and practice toward COVID-19 disease among chronic diseases patients visiting tertiary hospitals in Kathmandu. Methods: A cross-sectional study was conducted among chronic disease patients who visited Tribhuvan University Teaching Hospital and Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu. Structured questionnaire was used to collect patients’ socio-demographic data and perspectives on COVID-19. Results: Four hundred chronic disease patients participated in the study, with 53.2% female and 46.8% male, and 56.8% of age ≥50 years. Overall, 55.5% of the participants had good knowledge, 56.2% had good practice, and 30.7% had positive attitude towards COVID-19. Younger patients, 18-34 years, were found to have higher odds of having good knowledge compared to other age groups (aOR: 2.5; 95% CI: 1.3-6.0). The patients with less than average family income and those unable to read and write had lower odds of having positive attitude towards COVID-19 (aOR: 0.6; 95% CI: 0.4-0.9 and aOR: 0.4; 95%CI: 0.2-0.9, respectively). A statistically significant correlation was found between the patients’ knowledge and practice, knowledge and attitude, and attitude and practice (p <0.001). Conclusions: Nearly half of the chronic disease patients in Nepal had poor knowledge and practice whereas more than two-third had negative attitude towards COVID-19 disease. Older age of the patient was significantly associated with poor knowledge and practice. Keywords: Attitudes; chronic diseases; COVID-19; knowledge; practic