Incidence of Impacted Mandibular Third Molars with Their Pattern and Associated Complications in Nepalese Population

INTRODUCTION: Impaction may be defined as the failure of complete eruption into a normal functional position of one tooth within normal time due to lack of space in the dental arch, caused by obstruction by another tooth or development in an abnormal position.MATERIAL AND METHODS: A cross sectional descriptive study was conducted on 945 patients (males=591, females=354) aged between 18- 50 years of age who had mandibular third molars impacted. The difficulty index for mandibular third molar for angulation and depth was based on Winter’s classification (1926).RESULTS: The most common type of impaction seen was Mesio- angular with (32%) followed by horizontal 264 (27.8%), then followed by other types. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 23.0CONCLUSION: Impacted third molars are a common observation in routine dental practice. The impaction rate of third molars is higher as compared to other teeth in the dentition. The high prevalence found in the present study, with more than half of these Nepalese adult patients having at least one impacted third molar

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Detection of Mutations in pncA in Mycobacterium tuberculosis Clinical Isolates from Nepal in Association with Pyrazinamide Resistance

Without the proper information on pyrazinamide (PZA) susceptibility of Mycobacterium tuberculosis (MTB), PZA is inappropriately recommended for the treatment of both susceptible and multidrug-resistant tuberculosis (MDR-TB) in Nepal. This study aimed to collect information regarding PZA susceptibility in MTB isolates from Nepal by analyzing pncA and its upstream regulatory region (URR). A total of 211 MTB isolates were included in this study. Sequence analysis of pncA and its URR was performed to assess PZA resistance. First-line drug susceptibility testing, spoligotyping, and sequence analysis of rpoB, katG, the inhA regulatory region, gyrA, gyrB, and rrs were performed to assess their association with pncA mutation. Sequencing results reveal that 125 (59.2%) isolates harbored alterations in pncA and its URR. A total of 57 different mutation types (46 reported and 11 novel) were scattered throughout the whole length of the pncA gene. Eighty-seven isolates (41.2%) harbored mutations in pncA, causing PZA resistance in MTB. There was a more significant association of pncA alterations in MDR/pre-extensively drug-resistant (Pre-XDR) TB than in mono-resistant/pan-susceptible TB (p < 0.005). This first report on the increasing level of PZA resistance in DR-TB in Nepal highlights the importance of PZA susceptibility testing before DR-TB treatment

Antibiogram of bacterial species causing skin wound infections

Wounds occur when the integrity of any tissues is compromised. Infection causes significant increase in costs, morbidity, and potential mortality. This study was conducted during the period from July, 2015 to January, 2016 with the aims of identifying the etiological agents causing skin wound infections, and their antibiotic susceptibility profile among patients visiting International Friendship Children’s Hospital (IFCH), Maharajgunj, Kathmandu, Nepal. Specimens were processed by conventional culture technique and antibiogram of isolates were done by modified Kirby-Bauer disc-diffusion method. Out of 219 skin pus samples, 132 (60.3%) were reported to be bacterial culture positive. Eight different bacterial species were identified as; S. aureus 75 (56.8%), Coagulase negative S. aureus (CONS) 20 (15.2%), Escherichia coli 13 (9.8%), Citrobacter spp. 7 (5.3%), Pseudomonas aeruginosa 5 (3.7%), Klebsiella spp. 5 (3.7%), Proteus spp. 5 (3.7%) and Enterobacter spp. 2 (1.5%), all were isolated from culture positive specimens. Antibiotic susceptibility test (AST) of all Gram-negative isolates showed that Colistin and Imepenum were the most effective antibacterial drugs. Out of total 75 S. aureus isolates, all were reported to be susceptible to Vancomycin, whereas, 23 (30.7%) were resistant to methicillin. This study reported that S. aureus strains were the predominant isolates. Prevalence of multi-drug resistant strains of S. aureus is increasing. Current results demonstrated that antibiotic resistance in Gram-positive and Gram-negative bacteria is increasing in alarming trends that lead to failure of treatment

Molecular analysis of streptomycin-resistance associating genes in Mycobacterium tuberculosis isolates from Nepal

Mutation in rpsL (encoding ribosomal protein S12), rrs (encoding 16S ribosomal RNA) and gidB (encoding 7-methylguanosine methyltransferase) are associated with resistance to streptomycin (STR), which is used for the treatment of multi-drug resistant tuberculosis (MDR-TB) in Nepal. The aim of our study is to analyze the correlation between mutations in the target genes and STR-resistance in 197 Mycobacterium tuberculosis (MTB) isolates from Nepal. Mutations in rpsL was harbored by 65.9% of isolates, in which the most common mutation in rpsL is caused by K43R (58.8%) and were significantly associated with Beijing genotype (P < 0.001). About 13.2% of isolates harbored mutations in two highly mutable regions of rrs, the 530 loop and the 912 region. About 13.2% of gidB mutants do not show any mutation in rpsL and rrs, which might suggest the role of gidB mutations in STR-resistance in MTB. In addition, 5.6% of isolates do not show any mutations in three genes examined, suggesting the involvement of other mechanism in STR-resistance in MTB. Our findings can be implemented for the establishment of molecular STR-susceptibility testing, in which tuberculosis can be treated with appropriate drugs and can improve control strategies for DR-TB

Characterization of embB mutations involved in ethambutol resistance in multi-drug resistant Mycobacterium tuberculosis isolates in Zambia

Background: Ethambutol (EMB) is an important anti-tuberculosis drug used in the management of multi-drug resistant tuberculosis (MDR-TB). Mutations in embB are the major mechanism of resistance. This study investigated embB mutations among MDR-TB isolates and analyzed their correlations with phenotypic drug susceptibility testing (DST) in Zambia. Method: A total of 132 MDR-TB isolates were collected from January 2014 to April 2017 and characterized using MGIT 960 systems, embB sequencing, and spoligotyping. Results: Out of 61 phenotypically EMB resistant isolates, 53 had mutations in embB. Among the 71 EMB susceptible isolates, 47 had embB mutations. Sensitivity of embB mutations was 86.9% while specificity was 33.8%. CAS1_Kili (SIT21) had high odds of having embB mutations, particularly, G918A (Met306eIl) (Odds ratio 16.7, p < 0.0001). Conclusion: Molecular EMB resistance testing by DNA sequencing can improve detection of EMB resistance among MDR-TB patients in Zambia. Additionally, CAS1_Kili was associated with embB amino acid substitution Met306Ile suggesting transmission. A detailed investigation to track and determine transmission hotspot area for MDR-TB could help optimize control strategies