Search

Objective: In the present modern era of time, poor and frantic lifestyle has led to an enumerate increase in the number of people with obesity and metabolic syndrome (MS). Epidemiological studies have shown the incidence of chronic kidney disease (CKD) risk factors in individuals with obesity and MS; despite the nonclear evidence on the existing potential risk factors, it became important to reassess existing potential risk factors that are involved in disease progression and its further complications. The strongest risk factor of CKD, albumin-to-creatinine ratio (ACR) recognized as a marker of MS and obesity. This study was carried out to identify the association of obesity (body mass index [BMI]) as a risk factor for albuminuria and to observe the dependence and association with albuminuria of each critical and basic factor of MS. Design: We conducted the potential risk factor analysis on 913 subjects, including 398 females and 515 males, from various diabetic hospitals of Vijayawada, Andhra Pradesh from early 2013 to June 2015. The medical records of the patients followed up; the anthropometric measurements and clinical parameters were retrospectively collected. The total subjects were categorized as subjects with and without MS as per National Cholesterol Education Program Adult Treatment Panel (NCEP-ATPIII) and the subjects with BMI more than 30 kg/m2 were defined as obese according to WHO classification. Results: Student’s t test analysis indicates a significant difference for ACR with mean values of 39.5 ± 44.8 and 18.4 ± 24.3 (P < 0.0001) in subjects with MS and without MS, 43.4 ± 48.3 and 36.7 ± 42.5 (P < 0.02) in obese and nonobese subjects, respectively. Chi-square analysis showed a significant association (P < 0.05) between MS and ACR and correlation analysis manifested significant association (P < 0.01) between ACR and FBS, TG, B.P, and Age in subjects with MS. The subjects with high prevalence of albuminuria exhibited significant association with an odds ratio (OR) of 1 (referent) 1.9 (95% CI, 1.34–2.58, P = 0.0002), 1.5 (95% CI, 1.11–1.96, P = 0.0082) for FBS >110 mg/dL, and TG > 150 mg/dL, respectively. Although the subjects with obesity showed no correlation with albuminuria, the risk for albuminuria was 1.5 times (95%CI 1.03–2.40, P = 0.03) higher among obese male subjects compared to obese female subjects. Conclusion: Our study strongly supports that albuminuria is highly prevalent among the subjects, with MS showing a significant positive association between obesity (BMI) with albuminuria in males only.

Background: Antibiotic resistance in healthcare system is a widespread and inevitable problem which is mainly due to their inappropriate and indiscriminate prescribing or use. The misuse of antibiotics which is having substantial detrimental consequences is under the influence of clinicians’ education, existing beliefs, incentives offered by the pharmaceutical manufacturers, hospital’s sales profit and usual trend among the prescribers to use antimicrobials haphazardly. Objectives: The objective of the study was to determine the pattern of bacterial culture sensitivity and antimicrobials prescribing. Material and Methods: The study was a retrospective cross-sectional analysis of culture sensitivity reports for duration of 5 months (May to September 2010) at the laboratory of department of microbiology, Nobel Medical College and Research Centre, Biratnagar Nepal. Data was collected through a self designed and pre-piloted questionnaire. The questionnaire contained information on patient’s particulars, diagnosis, specimen, culture sensitivity and antimicrobials prescribed before performing culture sensitivity tests. Patient’s names and hospital Identification number were noted from the register and their respective prescriptions were investigated from medical record department of the hospital. The prescriptions were analyzed for the antimicrobials prescribed before carrying out culture sensitivity tests. The data was coded, verified, entered and analyzed using Statistical Package for Social Sciences version 11.5 Chicago, Inc. Results: Majority (71%) of the patients were below the age of 30 years. Diagnosis of the disease was not mentioned in majority (88%) of the reports. Staphylococcus aureus and Escherichia coli were the most commonly occurring bacteria (78%). Treating infectious complications with single antimicrobial agent was predominant (68%). Furthermore, third generation cephalosporins (47%) particularly ceftriaxone and cefotaxime were the most commonly prescribed agents, but culture sensitivity was not performed against them. There was a striking practice of prescribing antimicrobials against the bacteria which were either resistant or culture sensitivity was not performed. Conclusion: Bacterial resistance and inappropriate prescribing of antimicrobials are important issues at Nobel teaching hospital which entails expanding antimicrobial susceptibility testing to commonly used or prescribed antimicrobials

Introduction: Mushroom poisoning is not new to Nepal. Undocumented and unrecorded mushroom poisoning is more common than the published one. We evaluated the pattern and outcomes following toxic mushroom ingestions., Methods: We did a retrospective analysis of patients admitted with mushroom poisoning in BPKIHS, a tertiary care hospital in Nepal, from 2002 to 2006. The diagnosis of mushroom poisoning was based on history and clinical presentation., Results: Twenty seven patients, aged between 7-83 years were studied. Fourteen (51.86%) were male and 13 (48.14%) were female. All (100%) patients had consumed wild mushroom unintentionally. Twelve patients developed symptoms within first hour and 11 patients within one to six hours. The average delay in presenting to our hospital was 23.1 (2-96) hours. In 10 cases, other family members were affected, out of which in two cases the family members had died in other hospitals. Reported symptoms were nausea 27 (100%), vomiting 24 (88.88%), abdominal cramping 8 (29.6%), jaundice 3 (11.1%), diarrhea 17 (62.96%) and altered sensorium in 8 patients (29.65%). All patients were treated conservatively. Three patients with severe hepatitis were admitted in ICU, out of which two recovered without liver transplant. One eight year old boy developed acute liver failure and expired within 24 hours of hospitalization., Conclusions: Most of the mushroom poisoning was acute, unintentional and by consumption of wild mushroom. Community based awareness programs will help prevent the instances of poisoning.

Background: Spontaneous bacterial peritonitis (SBP) is one of the potentially lethal complications of cirrhosis and is defined as infected ascites in the absence of any recognizable secondary cause of infection. Objective was to study the occurrence of SBP, clinical and laboratory characteristics and the response to antibiotics., Methods: We had prospectively evaluated 81 cirrhotic patients with ascites during one-year period. All SBP patients were treated with cefotaxime, 2gm IV, every 12h for 5days., Results: Of these 81 patients, 24.67% of patients (n=20) had SBP and its variants (classical SBP n= 4, CNNA n=13 and bacterascites n=3). There were thirteen males and 7 females in the study.85% of the cases had Child;s class C cirrhosis. UGI bleeding and abdominal pain were the most common presenting symptoms of SBP. Culture positives were 35% (n=7). The most frequent organisms were Escherichia coli (n=3) and Streptococcus pneumoniae (n=2). 94% of the patients responded to therapy after 48 hours of treatment. Total resolution after 5 days of therapy was 73% and in-hospital mortality was 15% (n=3)., Conclusion: SBP, if diagnosed early can be treated with very good success rate up to 73%. Appropriate treatment of SBP with cefotaxime can help in reducing mortality and morbidity in patients with chronic liver disease.