1
|
Karki D, LaPointe AT, Isom C, Thomas M, Sokoloski KJ. Mechanistic insights into Sindbis virus infection: noncapped genomic RNAs enhance the translation of capped genomic RNAs to promote viral infectivity. Nucleic Acids Res 2024:gkae1230. [PMID: 39660624 DOI: 10.1093/nar/gkae1230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 11/15/2024] [Accepted: 11/29/2024] [Indexed: 12/12/2024] Open
Abstract
Alphaviruses are globally distributed, vector-borne RNA viruses with high outbreak potential and no clinical interventions, posing a significant global health threat. Previously, the production and packaging of both viral capped and noncapped genomic RNAs (cgRNA and ncgRNA) during infection was reported. Studies have linked ncgRNA production to viral infectivity and pathogenesis, but its precise role remains unclear. To define the benefits of ncgRNAs, pure populations of capped and noncapped Sindbis virus (SINV) gRNAs were synthesized and transfected into host cells. The data showed that mixtures of cgRNAs and ncgRNAs had higher infectivity compared to pure cgRNAs, with mixtures containing low cgRNA proportions exceeding linear infectivity expectations. This enhancement depended on co-delivery of cgRNAs and ncgRNAs to the same cell and required the noncapped RNAs to be viral in origin. Contrary to the initial hypothesis that the ncgRNAs serve as replication templates, the cgRNAs were preferentially replicated. Further analysis revealed that viral gene expression, viral RNA (vRNA) synthesis and particle production were enhanced in the presence of ncgRNAs, which function to promote cgRNA translation early in infection. Our findings highlight the importance of ncgRNAs in alphaviral infection, showing they enhance cgRNA functions and significantly contribute to viral infectivity.
Collapse
|
2
|
Samdyan R, Karki D, Chakrabarti S, Sharma T, Karki D. Serum lactate and base deficit as prognostic markers in acute burns patients. ANNALS OF BURNS AND FIRE DISASTERS 2024; 37:287-293. [PMID: 39741774 PMCID: PMC11649161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/07/2023] [Indexed: 01/03/2025]
Abstract
Resuscitation of burns remains a fundamental problem in burn care. Traditional endpoints such as mean arterial pressure and urine output guide fluid therapy for optimal resuscitation, but an ideal marker remains controversial. Base deficit and serum lactate are markers of global tissue acidosis and inadequate oxygenation. The aim of this study was to determine whether serum lactate and base deficit together can be used as prognostic markers in acute burns and their association with sepsis and mortality. A prospective observational study with a sample size of 250 was conducted over 18 months, which included patients with 20-60% total body surface area (TBSA) having thermal burns or scald. Resuscitation was done according to hospital protocol and fluid administration was adapted according to clinical parameters. Serum lactate and base deficit values were analysed at the time of admission, then on day one, two, three and finally on day seven after admission. The two parameters were compared among survivors and non survivors. Patients were followed up till discharge, death or 30th post burn day. Baseline serum lactate levels are high and base deficit levels low in the patients sustaining burns and the levels normalised over seven days with adequate resuscitation in survivors. Persistently high serum lactate and low base deficit are associated with sepsis and increased mortality. This study indicates that serum lactate and base deficit are useful parameters to predict mortality and promising predictive tools for assessing resuscitation and development of sepsis. Using these tools to guide fluid resuscitation may help mortality and improve overall outcomes.
Collapse
|
3
|
Landers VD, Thomas M, Isom CM, Karki D, Sokoloski KJ. Capsid protein mediated evasion of IRAK1-dependent signalling is essential to Sindbis virus neuroinvasion and virulence in mice. Emerg Microbes Infect 2024; 13:2300452. [PMID: 38164715 PMCID: PMC10773654 DOI: 10.1080/22221751.2023.2300452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
ABSTRACTAlphaviruses are arthropod-borne, single-stranded positive-sense RNA viruses that are recognized as rapidly emerging pathogens. Despite being exquisitely sensitive to the effects of the innate immune response alphaviruses can readily replicate, disseminate, and induce pathogenesis in immunologically competent hosts. Nonetheless, how alphaviruses evade the induction of an innate immune response prior to viral gene expression, or in non-permissive infections, is unknown. Previously we reported the identification of a novel host/pathogen interaction between the viral Capsid (CP) protein and the host IRAK1 protein. The CP/IRAK1 interaction was determined to negatively impact IRAK1-dependent PAMP detection in vitro, however, the precise importance of the CP/IRAK1 interaction to alphaviral infection remained unknown. Here we detail the identification of the CP/IRAK1 interaction determinants of the Sindbis virus (SINV) CP protein and examine the importance of the interaction to alphaviral infection and pathogenesis in vivo using an interaction deficient mutant of the model neurotropic strain of SINV. Importantly, these interaction determinants are highly conserved across multiple Old-World alphaviruses, including Ross River virus (RRV), Mayaro virus (MAYV), Chikungunya virus (CHIKV), and Semliki Forest virus (SFV). In the absence of a functional CP/IRAK1 interaction, SINV replication is significantly restricted and fails to disseminate from the primary site of inoculation due to the induction of a robust type-I Interferon response. Altogether these data indicate that the evasion of IRAK1-dependent signalling is critical to overcoming the host innate immune response and the in vivo data presented here demonstrate the importance of the CP/IRAK1 interaction to neurovirulence and pathogenesis.
Collapse
|
4
|
Acharya M, Ghimire RH, Karki D, Poudel S. Psychiatric Comorbidity among Type 2 Diabetes Mellitus Patients. Kathmandu Univ Med J (KUMJ) 2024; 22:171-174. [PMID: 39328106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
Background The co-occurrence of psychiatric conditions and diabetes mellitus is frequently observed. This coexistence manifests in various ways, leading to a diminished quality of life, heightened healthcare expenses, reduced treatment compliance, suboptimal blood sugar control, and an upsurge in visits to the emergency room. Objective To evaluate the prevalence of psychiatric comorbidity in patients with type 2 diabetes at a specialized medical center. Method We conducted a cross-sectional study, enrolling eligible type 2 diabetes patients who sought outpatient services. To evaluate the cognitive and emotional aspects of their illness, we employed the Mini International Neuropsychiatric Interview and ICD-10 guidelines. Convenience sampling method was used and 200 patients were included in the study. Their socio-demographic profile, presence of depression, and other psychiatric illnesses were studied. Result Among the total screened type 2 diabetes patients, 200 eligible individuals were included in the study. Depression emerged as the most prevalent psychiatric comorbid condition, affecting 30.5% of the patients. Notably, depression rates were slightly higher in female patients and those over 50 years of age. Furthermore, individuals with longer diabetes durations displayed a greater prevalence of depressive episodes, followed by other psychiatric illnesses. Conclusion A noteworthy proportion of diabetic patients exhibited comorbid psychiatric conditions. Depression was the most common among diabetics followed by other psychiatric illnesses. The presence of neuropsychiatric illness was commonly seen in diabetics at a later age of life, peaking after 6th decade.
Collapse
|
5
|
Karki D, Khadka D, Kunwar RM, Aryal PC, Paudel HR, Bhatta S, Shi S. Ethnomedicinal plants in Champadevi rural municipality, Okhaldhunga district, Nepal. JOURNAL OF ETHNOBIOLOGY AND ETHNOMEDICINE 2023; 19:58. [PMID: 38072922 PMCID: PMC10712033 DOI: 10.1186/s13002-023-00627-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Okhaldhunga is a hilly district with fragile socioeconomic conditions, limited access to health care, social stigma, and poor resource management, where most people rely on medicinal plants for primary health care. The use of medicinal plants for primary health care varies with socioeconomic attributes. Following the intra-cultural analysis, we documented and tested the hypothesis that use of medicinal plants in Champadevi, Okhaldhunga, Nepal, depends on socioeconomic variables. METHODS We interviewed 224 respondents, 53.12% female and 46.88% male, including 31 Brahmin, 157 Chhetri, 13 Dalit, and 23 Janajati, and conducted three focused group discussions and seven key informant interviews to record the ethnomedicinal plants used in Champadevi rural municipality, Okhaldhunga District. The relative frequency of citation (RFC) was computed to know the importance of the species. A generalized linear model (GLM) was used to see the relationship between medicinal plants reported with the sociocultural variables, which include age, gender, occupation, education, ethnicity, and religion. RESULTS We documented 149 medicinal plants, including 69 herbs, 22 shrubs, nine climbers, 48 trees, and one parasitic plant, belonging to 68 families and 130 genera, and used to treat 48 distinct diseases and ailments. Plant parts, leaf, and digestive disorders were frequently treated during healing. Curcuma angustifolia was the most cited species with RFC 0.9554. The respondents' knowledge of medicinal plant use varied significantly with age (p = 0.0001) and occupation (p = 0.003). Changes in land use, population decline of medicinal plant species, and unsustainable harvesting practices constituted the local threats to medicinal plants and associated knowledge. Elders died without passing on their knowledge to the younger generations during sociocultural transformation, and youth disinterest coupled with the free availability of allopathic medicine led to knowledge erosion. CONCLUSIONS The use of medicinal plants in Champadevi, Okhaldhunga, was significantly depended on two socioeconomic variables age and occupation. Ethnomedicinal plants are essential in the primary healthcare system in Nepal; however, their availability and practices are declining. Thus, plans regulating land use change and human migration, acknowledging traditional healthcare practices, and raising awareness of the significance of traditional medical practices as complementary healthcare practices should be strengthened.
Collapse
|
6
|
Westcott CE, Isom CM, Karki D, Sokoloski KJ. Dancing with the Devil: A Review of the Importance of Host RNA-Binding Proteins to Alphaviral RNAs during Infection. Viruses 2023; 15:164. [PMID: 36680204 PMCID: PMC9865062 DOI: 10.3390/v15010164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/02/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Alphaviruses are arthropod-borne, single-stranded positive sense RNA viruses that rely on the engagement of host RNA-binding proteins to efficiently complete the viral lifecycle. Because of this reliance on host proteins, the identification of host/pathogen interactions and the subsequent characterization of their importance to viral infection has been an intensive area of study for several decades. Many of these host protein interaction studies have evaluated the Protein:Protein interactions of viral proteins during infection and a significant number of host proteins identified by these discovery efforts have been RNA Binding Proteins (RBPs). Considering this recognition, the field has shifted towards discovery efforts involving the direct identification of host factors that engage viral RNAs during infection using innovative discovery approaches. Collectively, these efforts have led to significant advancements in the understanding of alphaviral molecular biology; however, the precise extent and means by which many RBPs influence viral infection is unclear as their specific contributions to infection, as per any RNA:Protein interaction, have often been overlooked. The purpose of this review is to summarize the discovery of host/pathogen interactions during alphaviral infection with a specific emphasis on RBPs, to use new ontological analyses to reveal potential functional commonalities across alphaviral RBP interactants, and to identify host RBPs that have, and have yet to be, evaluated in their native context as RNA:Protein interactors.
Collapse
|
7
|
Karki D, Dawson L, Muthukumar V, Aggarwal N. Blood Indices In Adult Acute Burn: A Window Into Milieu Interieur - The Future Biomarkers? ANNALS OF BURNS AND FIRE DISASTERS 2022; 35:46-54. [PMID: 35582086 PMCID: PMC9020846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/23/2021] [Indexed: 06/15/2023]
Abstract
Optimal treatment of sepsis in burned patients depends on early diagnosis and includes prompt administration of antimicrobials as well as management of hemodynamic alterations and other organ dysfunctions. The role of red blood cell distribution width (RDW) and platelet indices in prognosticating and identifying sepsis in acute burn patients is studied. This study was done as a prospective study over 18 months, including patients in the age group >18 or <60 years, with burns >20% and <70% TBSA, burn time to resuscitation time 24 hours or less and with thermal and scald burns. Data of 157 patients were analyzed and the following observations were made. The mean age of the study population was 31.36 years (18-59 years). RDW values were higher in the non-survivor group. Platelet count and plateletcrit were higher in the survivor group and the no sepsis group. Positive rising trends of platelet count and plateletcrit were seen in the survivor group. Day 1, 3, 7 values of RDW, platelet count and plateletcrit were significant in determining the outcome of the patient on mortality and sepsis related morbidity of the patient. RDW, platelet count and plateletcrit in combination can predict mortality and sepsis as early as the third day, thus giving a clinical advantage of initiating targeted treatment to the at-risk burn population before sepsis is detected clinically. This could better the outcomes in treatment of burn patients.
Collapse
|
8
|
Bhandari S, Adhikari S, Karki D, Chand AB, Sapkota S, Dhungel B, Banjara MR, Joshi P, Lekhak B, Rijal KR. Antibiotic Resistance, Biofilm Formation and Detection of mexA/mexB Efflux-Pump Genes Among Clinical Isolates of Pseudomonas aeruginosa in a Tertiary Care Hospital, Nepal. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2021.810863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Efflux-pump system and biofilm formation are two important mechanisms Pseudomonas aeruginosa deploys to escape the effects of antibiotics. The current study was undertaken from September 2019 to March 2020 at a tertiary-care hospital in Kathmandu in order to ascertain the burden of P. aeruginosa in clinical specimens, examine their biofilm-forming ability and determine their antibiotic susceptibility pattern along with the possession of two efflux-pump genes-mexA and mexB. Altogether 2820 clinical specimens were collected aseptically from the patients attending the hospital and processed according to standard microbiological procedures. Identification of P. aeruginosa was done by Gram stain microscopy and an array of biochemical tests. All the P. aeruginosa isolates were subjected to in vitro antibiotic susceptibility testing and their biofilm-forming ability was also examined. Presence of mexA and mexB efflux-pump genes was analyzed by Polymerase Chain Reaction (PCR) using specific primers. Out of 603 culture positive isolates, 31 (5.14%) were found to be P. aeruginosa, of which 55% were multi-drug resistant (MDR). Out of 13 commonly used antibiotics tested by Kirby-Bauer disc diffusion method, greatest resistance was shown against piperacillin-tazobactam 15 (48.4%) and ceftazidime 15 (48.4%), and least against meropenem 6 (19.4%) and ofloxacin 5 (16.2%). Of all 17 MDR isolates subjected to biofilm detection, strong biofilm formation was exhibited by 11 (65%) and 14 (82%) isolates with microtiter plate method and tube method respectively. Out of 17 isolates tested, 12 (70.6%) isolates possessed mexA and mexB genes indicating the presence of active efflux-pump system. Higher number of the isolates recovered from sputum 7 (58.3%) and pus 5 (41.7%) possessed mexA/mexB genes while the genes were not detected at all in the isolates recovered from the urine (p<0.05). This study assessed no significant association between biofilm production and multi-drug resistance (p>0.05). Adoption of stern measures by the concerned authorities to curb the incidence of multi-drug resistant and biofilm-forming isolates is recommended to prevent their dissemination in the hospital settings.
Collapse
|
9
|
Niraula A, Gelal B, Lamsal M, Karki D, Chhetri R. Biochemical Parameters in Confirmed Covid-19 Patients: A Hospital Based Study from Eastern Nepal. Kathmandu Univ Med J (KUMJ) 2021; 19:415-419. [PMID: 36259181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background COVID-19 has posed a global threat to almost every part of the world. The disease has varied form of presentation and the modern medicine has still not been able to provide definite treatment for the disease. Objective To assess the biochemical parameters in confirmed patients of COVID-19 admitted at B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. Method This is a retrospective hospital based cross-sectional study conducted in the Department of Biochemistry, B.P. Koirala Institute of Health Sciences, Dharan from October to December, 2020. Convenient sampling technique was used to enroll the data of the patients for whom the biochemical parameters were requested by the clinicians. Routine biochemical tests were performed in Cobas c311 autoanalyzer. Result A total of 202 patients with confirmed COVID-19 infections and admitted at COVID Hospital, BPKIHS were enrolled. The findings depict an elevated liver enzyme (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma glutamyl transpeptidase and cardiac enzymes (creatine kinase-total and creatine kinase- MB) in the study population. Increased serum ferritin (1026.08±220.53), hs CRP (41.52±5.22) and lactate dehydrogenase 360 [303.50-526.75] was found in the patients. Also, majority of the patients (> 50%) had abnormal biochemical findings. Conclusion Biomarkers like C-reactive protein, lactate dehydrogenase and ferritin have shown significant clinical implications in effective management, monitoring, and assessment of the severity of disease in COVID- 19 patients. Simple and cost-effective markers like CRP, LDH, HbA1c could be used for monitoring the severity of COVID-19 infection.
Collapse
|
10
|
Karki D, Dhungel B, Bhandari S, Kunwar A, Joshi PR, Shrestha B, Rijal KR, Ghimire P, Banjara MR. Antibiotic resistance and detection of plasmid mediated colistin resistance mcr-1 gene among Escherichia coli and Klebsiella pneumoniae isolated from clinical samples. Gut Pathog 2021; 13:45. [PMID: 34225805 PMCID: PMC8256586 DOI: 10.1186/s13099-021-00441-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/30/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The prevalence of antimicrobial resistance (AMR) among Gram-negative bacteria is alarmingly high. Reintroduction of colistin as last resort treatment in the infections caused by drug-resistant Gram-negative bacteria has led to the emergence and spread of colistin resistance. This study was designed to determine the prevalence of drug-resistance among beta-lactamase-producing strains of Escherichia coli and Klebsiella pneumoniae, isolated from the clinical specimens received at a tertiary care centre of Kathmandu, Nepal during the period of March to August, 2019. METHODS A total of 3216 different clinical samples were processed in the Microbiology laboratory of Kathmandu Model Hospital. Gram-negative isolates (E. coli and K. pneumoniae) were processed for antimicrobial susceptibility test (AST) by using modified Kirby-Bauer disc diffusion method. Drug-resistant isolates were further screened for extended-spectrum beta-lactamase (ESBL), metallo-beta-lactamase (MBL), carbapenemase and K. pneumoniae carbapenemase (KPC) production tests. All the suspected enzyme producers were processed for phenotypic confirmatory tests. Colistin resistance was determined by minimum inhibitory concentration (MIC) using agar dilution method. Colistin resistant strains were further screened for plasmid-mediated mcr-1 gene using conventional polymerase chain reaction (PCR). RESULTS Among the total samples processed, 16.4% (529/3216) samples had bacterial growth. A total of 583 bacterial isolates were recovered from 529 clinical samples. Among the total isolates, 78.0% (455/583) isolates were Gram-negative bacteria. The most predominant isolate among Gram-negatives was E. coli (66.4%; 302/455) and K. pneumoniae isolates were 9% (41/455). In AST, colistin, polymyxin B and tigecycline were the most effective antibiotics. The overall prevalence of multidrug-resistance (MDR) among both of the isolates was 58.0% (199/343). In the ESBL testing, 41.1% (n = 141) isolates were confirmed as ESBL-producers. The prevalence of ESBL-producing E. coli was 43% (130/302) whereas that of K. pneumoniae was 26.8% (11/41). Similarly, 12.5% (43/343) of the total isolates, 10.9% (33/302) of E. coli and 24.3% of (10/41) K. pneumoniae were resistant to carbapenem. Among 43 carbapenem resistant isolates, 30.2% (13/43) and 60.5% (26/43) were KPC and MBL-producers respectively. KPC-producers isolates of E. coli and K. pneumoniae were 33.3% (11/33) and 20% (2/10) respectively. Similarly, 63.6% (21/33) of the E. coli and 50% (5/10) of the K. pneumoniae were MBL-producers. In MIC assay, 2.2% (4/179) of E. coli and 10% (2/20) of K. pneumoniae isolates were confirmed as colistin resistant (MIC ≥ 4 µg/ml). Overall, the prevalence of colistin resistance was 3.1% (6/199) and acquisition of mcr-1 was 16.6% (3/18) among the E. coli isolates. CONCLUSION High prevalence of drug-resistance in our study is indicative of a deteriorating situation of AMR. Moreover, significant prevalence of resistant enzymes in our study reinforces their roles in the emergence of drug resistance. Resistance to last resort drug (colistin) and the isolation of mcr-1 indicate further urgency in infection management. Therefore, extensive surveillance, formulation and implementation of effective policies, augmentation of diagnostic facilities and incorporation of antibiotic stewardship programs can be some remedies to cope with this global crisis.
Collapse
|
11
|
Gautam B, Piya B, Karki D. Study of Dexmedetomidine in Caudal Block for Children Undergoing Inguino-scrotal Surgery. Kathmandu Univ Med J (KUMJ) 2020; 18:68-73. [PMID: 33582692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background Caudal block is the most common anaesthetic technique employed in children for managing perioperative pain of inguino-scrotal surgery. However, despite using longacting local anaesthetics, caudal analgesia lasts relatively shorter. Dexmedetomidine, an alpha-2 agonist, augments local anaesthetic action. Objective To assess the analgesic effect of caudal Dexmedetomidine. Method This is a randomized, double-blinded study conducted on otherwise healthy children (one to five years) undergoing elective inguino-scrotal surgery. General anaesthesia was administered and a laryngeal mask airway was inserted for assisting ventilation. The caudal block was applied using 0.8 milliliters/kilogram drug volume comprising either two milligrams/kilogram Bupivacaine in group A (n=42) or two milligrams/ kilogram Bupivacaine mixed with 0.75 micrograms/kilogram Dexmedetomidine in group B (n=42). Intraoperatively, inhaled Halothane, intravenous Fentanyl, fluids, and ventilation were titrated to maintain monitored hemodynamic variables within 15% from baseline values. The primary endpoint comprised the duration of analgesia, defined by a time when postoperative pain score (face, legs, activity, cry, consolability; FLACC scale) reached four out of ten. Perioperative events were studied for 24 hours. Student's t-test and Chi-square test were used for analysis, with p-value less than 0.05 considered as significant. Result Demographic, surgical, and anaesthetic characteristics were similar between the groups. Duration of analgesia was significantly prolonged in group B (group B, 413±101 minutes; group A, 204±40 minutes). The intraoperative requirement for supplement Fentanyl was significantly reduced in group B. Adverse events were comparable between the groups. Conclusion Dexmedetomidine prolongs the duration of analgesia when mixed with caudal Bupivacaine, without increasing adverse events.
Collapse
|
12
|
Karki S, Karki D. Tonsillar tuberculosis : A case report. JOURNAL OF PATHOLOGY OF NEPAL 2016. [DOI: 10.3126/jpn.v6i12.16264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Tuberculosis of the oral cavity which is an uncommon occurrence can be primary or secondary. In the absence of active pulmonary tuberculosis, isolated tonsillar tuberculosis is rare. Herein, we report two cases of bilateral tonsillar tuberculosis who presented as recurrent sore throat for which tonsillectomy was done. No active primary pulmonary lesion was found in these cases. Histopathological examination revealed caseating epithelioid granulomas with Langhans giant cells. Ziehl Neelson stain for acid fast bacilli was positive in one case. Tonsillar tuberculosis, though a rare entity, should be considered in the clinical differential diagnosis of tonsillar lesions. Histopathological examination with Ziehl Neelson stain should be performed for definite diagnosis.
Collapse
|
13
|
Karki D, Tamang T, Maharjan D, Thapa P, Shrestha S. Comparison of BISAP score with Ranson’s score in predicting severe acute pancreatitis. JOURNAL OF SOCIETY OF SURGEONS OF NEPAL 2016. [DOI: 10.3126/jssn.v18i3.15306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives: To compare BISAP score with Ranson’s scoring in predicting severity of acute pancreatitisMethods: Extensive demographic, radiographic, and laboratory data from consecutive patients with AP admitted to our institution was collected between March 2014 to March 2015. Ranson’s and BISAP score was calculated. Severity of pancreatitis was defined according to Atlanta classification. Sensitivity, Specificity, PPV, NPV of both the scoring system was calculated and compared.Results: A total of 42 patients with diagnosis of acute pancreatitis were included during the study period. 21(50%) were male and 21(50%) were female. Mean age is 49.52 ± 17.37.Most common etiology was biliary (45%) followed by alcohol (31%). 20 (48%) patients were categorized as severe pancreatitis according to Atlanta classification. 21 (50%) patients had a Ranson’s score of ≥3 and 19 (45.24%) patients had a BISAP score of ≥3. Both Ranson’s and BISAP scoring system was statistically significant in determining SAP ( p-value = 0.002). Sensitivity, specificity, PPV and NPV of Ranson’s and BISAP score was calculated to be 75%, 72.72%, 71.43%, 76.19% and 70%, 77.27%, 73.68%, 73.91%. respectively. The AUC for SAP by Ranson’s score is 0.7386 ; 95%CI (0.602 - 0.874) and BISAP score is 0.7364 ; 95% CI ( 0.599 - 0.872).Conclusions: Both Ranson’s and BISAP scoring system is similar in predicting SAP. However BISAP has the advantage due to its simplicity.
Collapse
|
14
|
Joshi MR, Bohara TP, Rupakheti S, Parajuli A, Shrestha DK, Karki D, Laudari U. Pre-operative Prediction of Difficult Laparoscopic Cholecystectomy. JNMA J Nepal Med Assoc 2015; 53:221-226. [PMID: 27746459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
INTRODUCTION Laparoscopic cholecystectomy is one of the most common operation performed. Though LC have become safer and easier at times it can be difficult. Difficult cases can result in prolonged operative time, bleeding, bile spillage, conversion to open technique and bile duct injury resulting in unplanned prolonged hospital stay, increase in estimated cost to the patients and for the surgeon it leads to increased stress during operation and time pressure to complete the operative list. . Identification of difficult cases has potential advantages for surgeons, patients and their relatives. We aim to develop and validate a scoring system to predict difficult LC preoperatively. METHODS Prospective study. History, physical examination, abdominal ultrasound and biochemical parameters were included to develop a scoring system. Hundred patients undergoing LC were included and preoperative scores were calculated preoperatively to predict difficult LC which was compared with operative assessment. RESULTS Sensitivity and specificity of the preoperative scoring for difficult case was 53.8 % and 89.2 % respectively with PPV of 63.64 % and NPV of 84.62%. Only three parameters (history of acute cholecystitis, gall bladder wall thickness and contracted gall bladder) were statistically significant to predict difficult LC individually. Area under ROC curve was 0.779 (95 % CI, 0.657-0.883). CONCLUSIONS Preoperative scoring system can be used to predict difficult LC. Surgeons can plan operation based on predicted difficulty. Patients and relatives can be counselled preoperatively for the possibility of difficult operation, prolonged hospital stay and increased cost in predicted difficult case.
Collapse
|
15
|
Ghimire R, Thapa AS, Karki D, Shrestha DK. Routine Measurement of Serum Amylase in Acute Abdomen. JNMA J Nepal Med Assoc 2014; 52:982-985. [PMID: 26982896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Acute abdominal pain is a common condition presenting to both the emergency department (ED) and surgical admission unit. Increase in serum amylase levels are found in much gastrointestinal pathology. Serum amylase level is consistently high in acute pancreatitis though high values are not pathognomonic of pancreatitis .The aim of this study to assess the level of serum amylase in various diseases presenting with acute abdominal pain and to evaluate the role of routine measurement of serum amylase in the screening of patient with acute abdominal pain for the diagnosis of acute pancreatitis in a prospective series. METHODS A prospective observational study was performed from 15th May 2014 - 15th Nov 2014 (6 months) at Department of Surgery of Kathmandu medical College Teaching Hospital; Kathmandu. All consecutive patients presented at emergency department and required admissions in surgical ward were included. A multivariate analysis was performed to assess the level of serum amylase in various diseases presenting with acute abdominal pain including acute pancreatitis. RESULTS Overall, 318 patients were included during a period of 6 months among them 48 patients were excluded. 34 cases (12.6 %) were diagnosed of acute pancreatitis. three cases (1.1%) of non pancreatic pathology with raised serum amylase level (> 1000 U\L). CONCLUSIONS Routine assessment of serum amylase is helpful in excluding differential diagnosis of patient presenting with acute abdomen and this study identified serum amylase as a good screening tool if done in cases with clinical suspicion.
Collapse
|
16
|
Schmidt SK, Lynch RC, King AJ, Karki D, Robeson MS, Nagy L, Williams MW, Mitter MS, Freeman KR. Phylogeography of microbial phototrophs in the dry valleys of the high Himalayas and Antarctica. Proc Biol Sci 2010; 278:702-8. [PMID: 20826485 DOI: 10.1098/rspb.2010.1254] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
High-elevation valleys in dry areas of the Himalayas are among the most extreme, yet least explored environments on Earth. These barren, rocky valleys are subjected to year-round temperature fluctuations across the freezing point and very low availability of water and nutrients, causing previous workers to hypothesize that no photoautotrophic life (primary producers) exists in these locations. However, there has been no work using modern biogeochemical or culture-independent molecular methods to test the hypothesis that photoautotrophs are absent from high Himalayan soil systems. Here, we show that although microbial biomass levels are as low as those of the Dry Valleys of Antarctica, there are abundant microbial photoautotrophs, displaying unexpected phylogenetic diversity, in barren soils from just below the permanent ice line of the central Himalayas. Furthermore, we discovered that one of the dominant algal clades from the high Himalayas also contains the dominant algae in culture-independent surveys of both soil and ice samples from the Dry Valleys of Antarctica, revealing an unexpected link between these environmentally similar but geographically very distant systems. Phylogenetic and biogeographic analyses demonstrated that although this algal clade is globally distributed to other high-altitude and high-latitude soils, it shows significant genetic isolation by geographical distance patterns, indicating local adaptation and perhaps speciation in each region. Our results are the first to demonstrate the remarkable similarities of microbial life of arid soils of Antarctica and the high Himalayas. Our findings are a starting point for future comparative studies of the dry valleys of the Himalayas and Antarctica that will yield new insights into the cold and dry limits to life on Earth.
Collapse
|