1
|
Joshi B, Yadav SK, Shakya Hada MS, Shrestha S, Shrestha KK, Shrestha PC, Awal BK. Post-Transplant Fecal Carriage of Antibiotic Resistant and B-Lactamases-Producing Enterobacteriales among Renal Transplant Recipients. J Nepal Health Res Counc 2024; 21:578-586. [PMID: 38616586 DOI: 10.33314/jnhrc.v21i4.4801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 03/31/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND The intestinal colonization and transmission of antibiotic-resistant Enterobacteriales to renal transplant recipients may pose a threat to them because they are profoundly immunocompromised and vulnerable to infection. Hence, it is crucial to identify these antibiotic-resistant fecal Enterobacteriales harboring high-risk populations. The objective of this study was to determine antibiotic resistance as well as β-lactamases production in fecal Enterobacteriales among renal transplant recipients. METHODS The stool samples, one collected from each transplant recipient, were processed for isolation and identification of Enterobacteriales and were tested for their antibiotic susceptibility, extended-spectrum β-lactamase, and metallo-β-lactamase production by standard methods. RESULTS A total of 103 Enterobacteriales comprising of Escherichia coli (86.4%), Klebsiella species (11.7%), and Citrobacter species (1.9%) were isolated and more than 60% of the E. coli were found resistant to ceftazidime and ciprofloxacin and around half of the Klebsiella species were resistant to ceftazidime and fluroquinolones. The extended-spectrum β-lactamase production was seen in 3.4% and 8.3% and metallo-β-lactamase production in 24.7% and 33.3% of E. coli and Klebsiella species, respectively. The high proportion of β-lactamase-producers were resistant to piperacillin-tazobactam, meropenem, gentamicin, and amikacin than β-lactamases non-producers. CONCLUSION Since the antibiotic resistance is higher in fecal Enterobacteriales, each renal transplant recipient should be screened for these highly resistant intestinal colonizers after transplantation in order to prevent infections and to reduce the rate of transplant failure due to infections.
Collapse
Affiliation(s)
- Bindira Joshi
- Department of Pathology, Shahid Dharmabhakta National Transplant Centre, Bhaktapur, Nepal
| | | | - Manju Shree Shakya Hada
- Department of Microbiology, Tri-Chandra Multiple Campus, Tribhuvan University, Kathmandu, Nepal
| | - Sabina Shrestha
- Department of Pathology, Shahid Dharmabhakta National Transplant Centre, Bhaktapur, Nepal
| | | | - Pukar Chandra Shrestha
- Department of Transplant Surgery, Shahid Dharmabhakta National Transplant Centre, Bhaktapur, Nepal
| | - Bal Krishna Awal
- Infectious Diseases Unit, National Public Health Laboratory, Kathmandu, Nepal
| |
Collapse
|
2
|
Shrestha KK, Shrestha PC, Pradhananga S, Lama S. Mean Warm Ischemia Time among Kidney Transplant Patients in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2023; 61:519-521. [PMID: 37464848 PMCID: PMC10276949 DOI: 10.31729/jnma.8190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Indexed: 07/20/2023] Open
Abstract
Introduction In renal transplantation, warm ischemia time is the interval from the removal of a procured kidney from ice storage to initiating graft reperfusion. Successful kidney transplantation depends on warm ischemia time. The study aims to find the mean warm ischemia time among kidney transplant patients in a tertiary care centre. Methods This descriptive cross-sectional study was conducted among kidney transplant patients in a tertiary care centre. Data from 15 December 2012 to 15 October 2022 were collected between 1 December 2022 to 4 January 2023 from the hospital records. Ethical approval was taken from the Nepal Health Research Council (Reference number: 1341). All first-time living-related kidney transplant recipients were included in the study. All the patients undergoing kidney transplants from brain-dead donors were excluded from the study. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results Among 230 patients, the mean warm ischemia time was 35.45±7.35 min. The mean first warm ischemia time was 4.28±2.05 min and the mean second warm ischemia time was 31.27±7.04 min. The mean age of the recipients was 35.14±10.49 years (range 14-64), of which 173 (75.20%) were male and 57 (24.80%) were female. Conclusions The mean warm ischemia time among kidney transplant patients in a tertiary care centre was similar to the studies done in similar settings. Keywords kidney transplantation; prevalence; warm ischemia.
Collapse
Affiliation(s)
- Kalpana Kumari Shrestha
- Department of Nephrology, Shahid Dharmabhakta National Transplant Center, Dudhpati, Bhaktapur, Nepal
| | - Pukar Chandra Shrestha
- Department of Transplant Surgery, Shahid Dharmabhakta National Transplant Center, Dudhpati, Bhaktapur, Nepal
| | - Swostik Pradhananga
- Department of Nephrology, Shahid Dharmabhakta National Transplant Center, Dudhpati, Bhaktapur, Nepal
| | - Suraj Lama
- Department of Nephrology, Shahid Dharmabhakta National Transplant Center, Dudhpati, Bhaktapur, Nepal
| |
Collapse
|
3
|
Paudel L, Shrestha L, Budhathoki L, Zoowa SB, Bhandari G, Shrestha KK. Maternal Health Services Utilisation in Panchkhal Municipality, Kavrepalanchok, Nepal. Kathmandu Univ Med J (KUMJ) 2023; 21:180-184. [PMID: 38628012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background Maternal Health is a priority program of Nepal. The low utilization of maternal health services is one of the major contributing factors for high maternal morbidity and mortality in developing countries like Nepal. Objective To explore various maternal health services utilized by women and identify various factors affecting the utilization of maternal health services in Panchkhal Municipality. Method A descriptive cross-sectional study was conducted among 355 reproductive-age women who have given birth in the last 2 years in Panchkhal Municipality. The data collection period was from May to July 2020. A convenient sampling method was used to select the study population. The data analysis was done by using Statistical Package for Social Sciences (version 20.0). Variables were defined by the frequency in numbers and percentages. Result The findings from the study showed that the coverage of the antenatal care (ANC) visit was 77% and among them, 25.6% visited at least 4 antenatal care visits as recommended by the government of Nepal. Out of 355 respondents, 52.4% were delivered in the health institution, and only 20% visited postnatal care after the delivery. Among various factors, lack of treatment facilities and health facilities at a far distance were the most common factors for the underutilization of maternal health services. Conclusion The coverage of maternal health services is still low despite free maternal health services with an incentive scheme. A further detailed investigation is required to find the real scenario of the Panchkhal municipality to under-utilization of maternal health services.
Collapse
Affiliation(s)
- L Paudel
- Department of Community Medicine, Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| | - L Shrestha
- Department of Community Medicine, Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| | - L Budhathoki
- Department of Community Medicine, Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| | - S B Zoowa
- Department of Community Medicine, Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| | - G Bhandari
- Department of Community Medicine, Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| | - K K Shrestha
- Department of Community Medicine, Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| |
Collapse
|
4
|
Shrestha PC, Bhandari TR, Devbhandari M, Verma RK, Shrestha KK. Kidney transplantation from brain-dead donors in Nepal: Report of first six cases. Ann Med Surg (Lond) 2022; 81:104386. [PMID: 36147109 PMCID: PMC9486551 DOI: 10.1016/j.amsu.2022.104386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction and importance: Kidney transplantation is one of the best treatment options for patients with end-stage renal disease. More than 90% of patients awaiting renal transplantation die without getting the kidney for transplantation. Brain dead donor kidney transplantation can bridge this gap proficiently. We aim to report details of the first six patients who had undergone brain-dead donor kidney transplantation in the history of transplantation in Nepal. Case presentation We conducted a descriptive analysis of clinical data of six adult recipients with kidney transplantation from three brain-dead donors. We described postoperative complications, length of stay, graft function which was documented with serum creatinine, acute rejection episode, delayed graft function, and patient/graft survival of recipient. Recipients were between 15 and 56 years old. Three patients experienced delayed graft function. Urinary tract infection was observed in two patients, both of whom were treated with antibiotics. One patient had acute graft rejection. None of our patients required reoperation. Length of hospital stay ranged from 9 to 32 days. The postoperative graft function was 100% in all patients. There was no graft loss, and no death was observed during follow-up. Clinical discussion Following the initiation of the brain-dead donor transplantation program, a lot of work needs to be done to make it a regular practice. Thus, this program needs support from all sections of society and government. This can be the only solution to decrease the huge gap between the supply and demand of organs in Nepal. Conclusion This case reports indeed revealed impressive success in initiating a brain-dead donor kidney transplantation program in a developing country that in terms of quality, meets comprehensive standard with acceptable graft function and patient/graft survival in under limited resources healthcare setting. Kidney transplantation is one of the best treatment options for patients with end-stage renal disease. More than 90% of patients awaiting renal transplantation die without getting the kidney for tranplantation. Brain dead donor kidney transplantation can bridge this gap proficiently. We reported first six patients with brain dead donor kidney transplantation in the history of transplantation in Nepal.
Collapse
|
5
|
Chandra Shrestha P, Bhandari TR, Adhikari R, Baral H, Verma RK, Shrestha KK. Living donor kidney paired exchange: An observational study. Ann Med Surg (Lond) 2022; 78:103761. [PMID: 35734678 PMCID: PMC9206995 DOI: 10.1016/j.amsu.2022.103761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/02/2022] [Accepted: 05/08/2022] [Indexed: 11/28/2022] Open
Abstract
Background Kidney transplantation is the treatment of choice for patients with end-stage renal disease (ESKD). Kidney paired donation (KPD) provides the chance to match an incompatible donor/recipient pair with another donor and recipient in a similar condition. We aimed to compare the outcomes of pair exchange kidney transplantation with traditional live donor kidney transplantation in our context. Method A review of medical records of 62 patients (31 pairs) who underwent two-way conventional living kidney pair exchange from July 2016 to June 2021 was done. The control group was considered those 62 patients who had undergone classic live donor kidney transplantation (LDKT) during the study period. The patient's demographics, intraoperative and postoperative variables including delayed graft function, length of hospital stay, graft survival, patient survival, and rejections rates were compared between the groups (KPD and LDKT). Results The majority of recipients were male (77.4 and 80.6%) while donors were female (77.4 and 69.4%) in KPD and the LDKT groups. Mean ages were 37 years (range: 19–59) and 37 years (range: 17–65) for the recipient's in KPD and the LDKT. KPD transplantation was performed in 62 recipients to avoid blood group incompatibility. There were no significant differences in outcomes comprising delayed graft function (1.6 and 3.2%), graft survival (100% in both groups), patient survival (95.2 and 96.8%), and rejections rates (1.6 and 1.6%) between KPD and LDKT group (P > 0.005). The length of stay was similar (5.9 and 5.7 days) in KPD and LDKT groups (P > 0.005). Conclusions The outcomes of KPD were comparable with classic LDKT in terms of delayed graft function, length of hospital stay, graft survival, patient survival, and rejections rates in our study. Therefore, the kidney paired donation program should be encouraged and promoted in centers where the ABO-incompatible transplant is expensive with added risk and the rate of deceased donor transplantation is very low. Kidney paired donation (KPD) provides the chance to match for an incompatible donor/recipient pair with another donor and recipient in a similar condition. The outcomes of KPD were comparable with classic live donor kidney transplantation (LDKT) in this study. KPD program should be promoted in centers where the ABO incompatible transplant is expensive with added risk and the rate of deceased donor transplantation is very low.
Collapse
Affiliation(s)
- Pukar Chandra Shrestha
- Department of Transplant Surgery, Shahid Dharmabhakta National Transplant Centre, Bhaktapur, Nepal
| | - Tika Ram Bhandari
- Department of Transplant Surgery, Shahid Dharmabhakta National Transplant Centre, Bhaktapur, Nepal
- Corresponding author. Department of Transplant Surgery, Shahid Dharmabhakta National Transplant Centre (SDNTC), Bhaktapur, Nepal.
| | - Rojan Adhikari
- Department of Urology, Shahid Dharmabhakta National Transplant Centre, Bhaktapur, Nepal
| | - Hari Baral
- Department of Urology, Shahid Dharmabhakta National Transplant Centre, Bhaktapur, Nepal
| | - Rakesh Kumar Verma
- Department of Urology, Shahid Dharmabhakta National Transplant Centre, Bhaktapur, Nepal
| | | |
Collapse
|
6
|
Bhandari TR, Shrestha KK, Shrestha PC. COVID-19 infection in renal transplant recipients in early post-renal transplantation period: report of three cases. Transpl Infect Dis 2022; 24:e13837. [PMID: 35390217 PMCID: PMC9115330 DOI: 10.1111/tid.13837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/12/2022] [Accepted: 03/17/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Tika Ram Bhandari
- Department of Transplant Surgery, Shahid Dharmabhakta National Transplant centre Bhaktapur, Bhaktapur, Nepal
| | | | - Pukar Chandra Shrestha
- Department of Transplant Surgery, Shahid Dharmabhakta National Transplant centre Bhaktapur, Bhaktapur, Nepal
| |
Collapse
|
7
|
Hammerton J, Joshi LR, Ross AB, Pariyar B, Lovett JC, Shrestha KK, Rijal B, Li H, Gasson PE. Characterisation of biomass resources in Nepal and assessment of potential for increased charcoal production. J Environ Manage 2018; 223:358-370. [PMID: 29936349 DOI: 10.1016/j.jenvman.2018.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 06/05/2018] [Accepted: 06/10/2018] [Indexed: 06/08/2023]
Abstract
Characterisation of 27 types of biomass was performed together with an assessment of regional resource availability. Charcoal was produced under two conditions from all samples and their yields were compared. Sugarcane bagasse, sal and pine produced the best charcoal with a low volatile matter and high calorific value. The amount of high-quality charcoal which can be made within Nepal from the biomass types tested is equivalent to 8,073,000 tonnes of firewood a year or 51% of the yearly demand. The areas which would benefit the most from charcoal making facilities are the Mid-hills of the Western, Central and Eastern Development Regions, as well as the Terai in the Central and Eastern Development Regions. The main potential benefit is to convert agricultural residues which are underutilised because, in their original form, produce large quantities of smoke, to cleaner burning charcoal. The conversion of agricultural residues to charcoal is also a viable alternative to anaerobic digestion in the Mid-hills.
Collapse
Affiliation(s)
- J Hammerton
- School of Chemical and Process Engineering, University of Leeds, LS2 9JT, UK.
| | - L R Joshi
- Central Department of Botany, Tribhuvan University, Kathmandu, Nepal
| | - A B Ross
- School of Chemical and Process Engineering, University of Leeds, LS2 9JT, UK
| | - B Pariyar
- School of Geography, University of Leeds, LS2 9JT, UK
| | - J C Lovett
- School of Geography, University of Leeds, LS2 9JT, UK; Royal Botanic Gardens, Kew, Richmond, TW9 3AE, UK
| | - K K Shrestha
- Central Department of Botany, Tribhuvan University, Kathmandu, Nepal
| | - B Rijal
- Central Department of Botany, Tribhuvan University, Kathmandu, Nepal
| | - H Li
- School of Chemical and Process Engineering, University of Leeds, LS2 9JT, UK
| | - P E Gasson
- Royal Botanic Gardens, Kew, Richmond, TW9 3AE, UK
| |
Collapse
|
8
|
Shrestha KK, Jha AK, Joshi RR, Rijal AS, Dhungana A, Maharjan S. Masson's Hemangioma of the Cheek: A Case Report. Indian J Otolaryngol Head Neck Surg 2018; 70:321-324. [PMID: 29977863 DOI: 10.1007/s12070-015-0886-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022] Open
Abstract
We report a rare case of intravascular papillary endothelial hyperplasia (IPEH) of the cheek. This neoplasm, known as Masson's tumor, is an unusual vascular lesion of proliferating endothelial cells. It is usually confined to the lumen of preexisting vessels or vascular malformations. The principal significance of IPEH is its resemblance to a variety of benign and malignant diseases and possible misdiagnosis as such. Achieving a correct diagnosis is essential to avoid subjecting a patient to either unnecessarily aggressive or inadequate therapy. For this reason, awareness of this lesion is very important.
Collapse
Affiliation(s)
- K K Shrestha
- Department of Otolaryngology & Head and Neck Surgery, Nepal Medical College Teaching Hospital, P O Box 13344, Attarkhel, Jorpati, Kathmandu Nepal
| | - A K Jha
- Department of Otolaryngology & Head and Neck Surgery, Nepal Medical College Teaching Hospital, P O Box 13344, Attarkhel, Jorpati, Kathmandu Nepal
| | - R R Joshi
- Department of Otolaryngology & Head and Neck Surgery, Nepal Medical College Teaching Hospital, P O Box 13344, Attarkhel, Jorpati, Kathmandu Nepal
| | - A S Rijal
- Department of Otolaryngology & Head and Neck Surgery, Nepal Medical College Teaching Hospital, P O Box 13344, Attarkhel, Jorpati, Kathmandu Nepal
| | - A Dhungana
- Department of Otolaryngology & Head and Neck Surgery, Nepal Medical College Teaching Hospital, P O Box 13344, Attarkhel, Jorpati, Kathmandu Nepal
| | - S Maharjan
- Department of Otolaryngology & Head and Neck Surgery, Nepal Medical College Teaching Hospital, P O Box 13344, Attarkhel, Jorpati, Kathmandu Nepal
| |
Collapse
|
9
|
Shrestha KK, Shah S, Malla NS, Jha AK, Joshi RR, Rijal AS, Dhungana A. The impact of hearing loss in older adults: a tertiary care hospital based study. Nepal Med Coll J 2014; 16:131-134. [PMID: 26930730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Hearing loss is the most common sensory deficit in the elderly, and is becoming a severe social and health problem. Presbycusis is the result of aging which can lead to communication problems compromising the quality of life (QoL).Since the elderly population is increasing worldwide, presbycusis is showing a similar trend. This study intended to identify the impact of hearing loss in the social life of the elderly. A total of 70 elderly patients attending Nepal Medical College Teaching Hospital who were found to have sensorineural hearing loss (SNHL) on pure tone audiometry (PTA) were recruited for this study.None of the patients had used hearing aids in the past. To assess their handicap due to hearing impairment a Hearing Handicap Inventory for the Elderly (HHIE) questionnaire was used and patients were graded as: no handicap, mild to moderate handicap and significant handicap. Pure-tone averages (PTA) were calculated for the thresholds at 0.5, 1 and 2 kHz in each ear. Patients with their PTA values between 26 to 40 dBHL were interpreted as having mild SNHL, those between 41 to 55dBHL as moderate SNHL and those above 55 dBHL as severe SNHL. Out of 70 patients, 65 had some degree of handicap ranging from mild to severe. The severity of handicap was significantly associated with the degree of hearing loss in both ears.
Collapse
|
10
|
Shakya R, Amatya R, Karki BMS, Mandal PK, Shrestha KK. Spectrum of bacterial pathogens and their antibiogram from cases of urinary tract infection among renal disorder patients. Nepal Med Coll J 2014; 16:75-79. [PMID: 25799818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Urinary tract infection (UTI) is the commonest bacterial infection occurring in renal disorder patients and is associated with significant morbidity. Resistance to antibiotics is highly prevalent in bacterial isolates and is an emerging problem in UTI. A hospital based cross sectional study was conducted from April 2011 to September 2011 to determine the frequency and bacterial profile of urinary tract infections in the patients with renal disorders visiting KIST Hospital along with their antimicrobial susceptibility pattern. Urine samples were collected from 300 clinically-suspected cases of UTI among renal disorder patients and investigated by conventional semi-quantitative culture technique, microscopy and antibiotic susceptibility test. Significant bacteriuria were detected in 34% of the total subjects, mostly from patients with Chronic Kidney Disease. Incidence of bacteriuria was found higher in females (40.40%) than in males (27.52%) and mostly occurred in elderly patients. Escherichia coli (62.75%) was the predominant isolate followed by Klebsiella pneumoniae (10.78%), Staphylococcus aureus (9.80%), Coagulase negative Staphylococcus aureus (CoNS) (5.88%), Enterococcus spp (3.92%), Klebsiella oxytoca (2.00%), Pseudomonas aeruginosa (2.00%), Proteus mirabilis (2.00%) and Proteus vulgaris (1.00%). Multidrug resistance was observed in 68.82% of the total bacterial isolates.
Collapse
|
11
|
Shrestha KK, Mohindra S, Mohindra S. How to decannulate tracheostomised severe head trauma patients: a comparison of gradual vs abrupt technique. Nepal Med Coll J 2012; 14:207-211. [PMID: 24047017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Tracheostomy is a common surgical procedure performed in patients with severe head injury to facilitate prolonged airway and ventilatory support. Decannulation is the procedure of removing the tracheostomy tube either gradually by downsizing the tube or abruptly in a single sitting. This prospective study was done to evaluate gradual vs abrupt techniques for successful decannulation in tracheostomised severe head trauma patients in Post Graduate Institute of Medical Education and Research (PGIMER), a central government tertiary centre in Chandigarh, India. A total of 118 patients, recruited over one and half years duration were arbitrarily divided into 2 groups: Gradual and Abrupt. Particulars were taken. Time since tracheostomy, timing of decannulation, Glasgow Coma Scale, amount of secretions, breath holding time, CXR and STN radiographs and cough reflex were all assessed. Follow up was done at one month to classify those who were re-tracheostomised or re-intubated as decannulation failures. Sixty-eight patients were decannulated gradually and 50 abruptly. Of the various factors assessed, only cough reflex, number of suctioning required per day, X-ray STN and use of antibiotics for more than 7 days were found to be statistically significant. One hundred and fourteen patients, 67 out of 68 in the GD group and 47 out of 50 in the AD group, had successful outcome. The study showed that success or failure of decannulation is independent of mode of decannulation.
Collapse
Affiliation(s)
- K K Shrestha
- Department of Otolaryngology, Head and Neck Surgery, Nepal Medical College, Jorpati, Kathmandu, Nepal.
| | | | | |
Collapse
|
12
|
Dong S, Lassoie J, Shrestha KK, Yan Z, Sharma E, Pariya D. Institutional development for sustainable rangeland resource and ecosystem management in mountainous areas of northern Nepal. J Environ Manage 2009; 90:994-1003. [PMID: 18433982 DOI: 10.1016/j.jenvman.2008.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Revised: 11/08/2007] [Accepted: 03/09/2008] [Indexed: 05/26/2023]
Abstract
Rangelands represent one of the most important natural resources in mountainous regions of northern Nepal. However, a poor understanding of the social dimensions of rangeland use has limited their proper management and sustainable development, which represent major challenges for Nepal's resource managers. Institutional development is thought to be a viable solution to this problem and may ultimately lead to improved rangeland management in Nepal. Based on this hypothesis, a study was conduced in the Rasuwa district of northern Nepal to examine the effectiveness of institutional development at the local and national levels in mitigating the problems facing sustainable rangeland management by using an institutional analysis and development (IAD) framework. The information and data were mainly collected from different stakeholders, farmers, professionals and practitioners using a toolkit of participatory rural appraisal (PRA), workshops and literature review. It can be concluded from this case study that a number of institutional development efforts are needed to promote sustainable rangeland management in this region. First, local herders represent a repository of rich indigenous knowledge essential to sustaining sound rangeland management practices; hence, indigenous practices need to be integrated into modern technologies. Second, public services and technical support are currently unavailable or inaccessible to local herders; hence, research, development and extension interventions need to be initiated for marginalized pastoral communities. Third, rangeland institutions are incomplete and ill-organized, so institutional development of various organizations is necessary for promoting sustainable rangeland management. Fourth, the policies and governance necessary for promoting rangeland management are not well-designed; hence, governance reform and policy development need to be formulated through internal and external agencies and organizations.
Collapse
Affiliation(s)
- Shikui Dong
- State Key Laboratory of Water Environmental Simulation, Environmental School, Beijing Normal University, Beijing, China.
| | | | | | | | | | | |
Collapse
|
13
|
Shrestha AK, Duncan B, Taren D, Canfield LM, Greivenkamp JE, Shrestha N, Shrestha KK. A new, simple, inexpensive means of testing functional vitamin A status: the night vision threshold test (NVTT). A preliminary field-test report. J Trop Pediatr 2000; 46:352-6. [PMID: 11191147 DOI: 10.1093/tropej/46.6.352] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Vitamin A deficiency is the leading cause of preventable childhood blindness in developing countries. Each year, an estimated 13.5 million children world-wide are unable to adapt to the dark and half a million children progress to complete blindness annually from lack of vitamin A. Most of the currently available methods for assessing vitamin A status are expensive, require sophisticated instrumentation and are not efficacious in field conditions. A simple, inexpensive method was developed to identify children with defective dark-adaptability, thereby providing a reflection of marginal vitamin A stores. The purpose of this preliminary study was to test the field-efficacy of the Night Vision Threshold Tester (NVTT). Thirty-nine middle-school children with a mean age of 13.5 +/- 1.37 years were initially tested for their ability to adapt to the dark using the
Collapse
Affiliation(s)
- A K Shrestha
- The University of Arizona, College of Public Health, USA
| | | | | | | | | | | | | |
Collapse
|