Dhulikhel Hospital

About: Dhulikhel Hospital is a healthcare organization based out in Kathmandu, Nepal. It is known for research contribution in the topics: Population & Public health. The organization has 86 authors who have published 59 publications receiving 336 citations.

Study of Poisoning Cases in a Tertiary Care Hospital

Abstract: Background Poisoning is one of the leading causes of morbidity and mortality in Nepal and also a major public health problem worldwide. A thorough review of the risk factors helps to decrease the incidence and mortality. The study evaluates the cases admitted in Dhulikhel Hospital, Kavre, Various parameters like age, sex, marital status, time of ingestion, month of occurrence, agent responsible for incidence; type of poisoning, psychosocial problem, outcome and duration of treatment are analyzed. Objectives The objectives of this study are to determine the pattern and severity of poisoning cases admitted to Dhulikhel Hospital. Methods A hospital based study was carried out in the patient admitted to Dhulikhel Hospital with the history of poisoning for the period of one year between April 2011 to March 2012. Various parameters were analyzed and compared with other study. Results There were 137 cases during the one year duration and maximum case belonged to second and third decade of life. Most common manner of poisoning was suicidal and the incidence was mainly during evening hours. Organophosphorus was the most commonly abused substance. Most of the cases had arrived hospital after one hour of exposure and duration of hospital stay in many cases were less than four days. Conclusion Based on these findings preventive measures like precaution taken at various levels, restriction in free sale of the poisons and promoting Poison Information Centers along with public awareness and proper psychosocial management to decrease the incidence and mortality in poisoning cases can be suggested. DOI: http://dx.doi.org/10.3126/kumj.v10i4.10999 Kathmandu Univ Med J 2012;10(4):70-73

Bacteriological and Mycological profile of Chronic Suppurative Otitis Media among patients visiting Dhulikhel Hospital

Abstract: BACKGROUND: Chronic suppurative otitis media (CSOM) is an inflammation of the middle ear and mastoid mucosa with perforation of tympanic membrane. Mainly disease of developing countries like Nepal, CSOM results because of illiteracy, poverty and poor hygiene. Haphazard use of antibiotics and increasing use of newer one has led to persistent change in microbial flora. The aim of this study is to determine the incidence of CSOM and its causative agents. METHODS: The study included 123 samples from 105 patients attending ENT department of Dhulikhel hospital. Samples were processed in microbiology department for both bacteria and fungi using standard operating protocol. Antibiotic susceptibility testing was performed for all bacterial isolates by Kirby Bauer disc diffusion method and the result were interpreted according to clinical and laboratory standard institute (CLSI) guideline. RESULTS: Out of 105 patients, 55 were male and 50 female patients. Highest incidence of CSOM was observed between 1-10 years of age group. Of the total 123 samples taken from 105 patients, 106 showed microbial growth. Gram positive bacteria predominated and the most common bacteria isolated were S. aureus 54.55% followed by Proteus spp. 13.64% and P. aeruginosa 12.73%. Among the fungi, the most predominant was A. fumigatus 39% followed by A. niger 29%, C. albicans 26% and A. flavus 6%. Gentamycin was the most susceptible antibiotic. S. aureus were sensitive to Cloxacillin and Gentamycin, whereas Proteus spp. was most sensitive to Ceftriaxone and Norfloxacin. P. aeruginosa was 100% sensitive to Amikacin. CONCLUSION: S. aureus was the most predominant organism followed by Proteus spp. and the drug of choice was Gentamycin. DOI: http://dx.doi.org/10.3126/acclm.v1i1.12314 Ann. Clin. Chem. & Lab. Med. 1(1) 2015: 37-41

Prevalence of Sexually Transmitted Infections in a Tertiary Care Centre

Abstract: Background The burden of sexually transmitted infections is huge and is disproportionately affecting developing nations. In Nepal, recent available data on sexually transmitted infections are mostly targeted to high risk population. A prevalence study was thus done to explore the pattern of sexually transmitted infection syndromes among general population of Nepal. Objectives To highlight the prevalence and changing pattern of sexually transmitted infections among general population. Methods A retrospective study. The study was conducted among 145 patients attending Department of Dermatology and Venerology, Dhulikhel Hospital Kathmandu University Hospital, for voluntary counseling and testing from April 2010 to April 2011. Syndromic case management approach was used for the classification and treatment of the patients. Results 106 patients were suffering from Sexually Transmitted Infections and 2 patients were positive for Human Immunodeficiency Virus. The most common diagnosis was genital viral infections (41.7%). Prevalence was highest among drivers/conductors (26.9%) and migrating workers (23.1%). Age group 20 to 24 years was the maximum sufferers (37%). Unsafe sexual activity (66.7%) was the most potential exposure and majority of the patients were not consistent in using condom. Conclusions Genital viral infections constitute the major bulk of sexually transmitted infections. Majority of the patients suffering from sexually transmitted infections were in the age group 20 to 24 years and were mostly drivers, conductors or migrating workers by occupation. In the background of few available baseline data, the results are expected to assist successful target interventions in the near future. DOI: http://dx.doi.org/10.3126/kumj.v9i2.6287 Kathmandu Univ Med J 2011;9(2):44-8

Evaluation of a Rapid Point-of-Care Multiplex Immunochromatographic Assay for the Diagnosis of Enteric Fever.

Abstract: There is a critical need for an improved rapid diagnostic for enteric fever. We have previously demonstrated that serum IgA responses targeting Salmonella enterica serovar Typhi hemolysin E (HlyE) and lipopolysaccharide (LPS) are able to discriminate patients with acute typhoid from healthy controls in areas where enteric fever is endemic (healthy endemic controls) and from patients with other bacterial infections. We now have data demonstrating that IgA antibody responses against these antigens also work well for identifying patients with acute S. Paratyphi A infection. To develop a test for acute enteric fever detection, we have adapted a point-of-care immunochromatographic dual-path platform technology (DPP), which improves on the traditional lateral flow technology by using separate sample and conjugate paths and a compact, portable reader, resulting in diagnostics with higher sensitivity and multiplexing abilities. In this analysis, we have compared our standard enzyme-linked immunosorbent assay (ELISA) method to the DPP method in detecting acute phase plasma/serum anti-HlyE and anti-LPS IgA antibodies in a cohort of patients with culture-confirmed S. Typhi (n = 30) and Paratyphi A infection (n = 20), healthy endemic controls (n = 25), and febrile endemic controls (n = 25). We found that the DPP measurements highly correlated with ELISA results, and both antigens had an area under the curve (AUC) of 0.98 (sensitivity of 92%, specificity of 94%) with all controls and an AUC of 0.98 (sensitivity of 90%, specificity of 96%) with febrile endemic controls. Our results suggest that the point-of-care DPP Typhoid System has high diagnostic accuracy for the rapid detection of enteric fever and warrants further evaluation.IMPORTANCE Enteric fever remains a significant global problem, and control programs are significantly limited by the lack of an optimal assay for identifying individuals with acute infection. This is especially critical considering the recently released World Health Organization (WHO) position paper endorsing the role of the typhoid conjugate vaccine in communities where enteric fever is endemic. A reliable diagnostic test is needed to assess and evaluate typhoid intervention strategies and determine which high-burden areas may benefit most from a vaccine intervention. Our collaborative team has developed and evaluated a point-of-care serodiagnostic assay based on detection of anti-HlyE and LPS IgA. Our finding of the high diagnostic accuracy of the DPP Typhoid System for the rapid detection of enteric fever has the potential to have significant public health impact by allowing for improved surveillance and for control and prevention programs in areas with limited laboratory capacity.

Radicular cyst of the anterior maxilla: An insight into the most common inflammatory cyst of the jaws

Abstract: Radicular cyst is believed to be derived from the epithelial cell rests of Malassez. The associated tooth is nonvital, usually asymptomatic, and may result in swelling, tenderness, tooth mobility, or other problems with rare possibility of neoplastic transformation of its epithelial lining. The treatment options include endodontic procedure, extraction of offending tooth, enucleation with primary closure, and marsupialization. The present report describes the case of a radicular cyst of anterior maxillary region in a 31-year-old male patient, with a detailed description of clinical, radiographic, histopathologic features, pathogenesis, and its surgical management.