samir lamichhane | Tribhuvan University (original) (raw)

Papers by samir lamichhane

Infection and Drug Resistance, Apr 1, 2021

Inappropriate use of broad-spectrum antibiotics contributes to the emergence of multidrug-resista... more Inappropriate use of broad-spectrum antibiotics contributes to the emergence of multidrug-resistant (MDR) bacteria. Finding novel antimicrobial agents and strategies based on synergistic combinations are essential to combat MDR infections. This study was designed to determine in vitro synergy of different antimicrobials against extensively drugresistant (XDR) Gram-negative clinical isolates. Methods: A descriptive, cross-sectional study was conducted at Human Organ Transplant Center, Nepal, for five months. Clinical isolates were checked for their drug-resistance properties including extended-spectrum beta-lactamase-(ESBL-) and metallo-betalactamase-(MBL-) production. The XDR isolates were further tested for antimicrobial synergy, and the results were interpreted as synergistic, additive, indifferent or antagonistic determining fractional inhibitory concentration of the antibiotics. Results: Out of total 1155 clinical samples, 308 showed significant growth. Escherichia coli was the most common isolate (n=142) followed by Klebsiella pneumoniae, Acinetobacter calcoaceticus baumannii (Acb) complex, Pseudomonas aeruginosa and miscellaneous bacteria. Out of the culture positive isolates, 21.4% were MDR and 10.06% were XDR. The XDR population comprised K. pneumoniae (18.42%), E. coli (9.86%), Acb complex (7.41%) and P. aeruginosa (4.17%). Among the culture positive isolates, 4.5% and 5.8% were ESBLand MBL-producers, respectively. Colistin, polymyxin B, and tigecycline were the antibiotics effective in majority of MDR isolates as compared to carbapenems. The combination of antibiotics-meropenem and colistin showed the highest proportion of "synergy" among all XDR E. coli whereas the combination of amikacin and colistin showed synergistic effect in XDR K. pneumoniae. Conclusion: A significant proportion of isolates were MDR among which a large fraction was XDR. The combination of meropenem, amikacin and colistin with one another in pair showed beneficial activity in vitro. Such combinations can be utilized as effective therapy for XDR infections. Further studies are required to confirm these findings, and accordingly treatment protocols should be developed in the management of such infections.

International journal of basic and clinical pharmacology, Jan 28, 2017

Background: Immunosuppression has been detrimental for graft survival in renal transplant recipie... more Background: Immunosuppression has been detrimental for graft survival in renal transplant recipients (RTRs). Now that acute rejection is less of a concern, the main problem with kidney transplantation is the long term adverse effects of immunosuppression; dyslipidemia and subsequent atherosclerosis leading to cardiovascular diseases being one of them. The objective of the study was to determine the association of lipid profile with immunosuppressive therapy in RTRs. Methods: A descriptive qualitative study was conducted in 120 live RTRs following up at the post-renal transplant clinic in 1 year duration. Means of baseline lipid profiles were compared to those of all follow ups and means of all lipid profiles done at different intervals were compared among different subgroups of patients grouped according to different variables including the individual immunosuppressants and the immunosuppressive therapy. Results: There was a significant increase in TC levels at 6 and 12 months. HDL-C levels were significantly higher at all follow ups and TG levels done at all follow ups were significantly higher as compared to baseline. LDL-C(12) was significantly higher in the group with higher tacrolimus dose. LDL-C(6), LDL-C(24), TC(24) were significantly different among different prednisolone groups reflecting a relation of prednisolone with alteration in lipid profiles. None of the two regimens was found to be superior over the other regarding lipid profile. Conclusions: This study has shown a significant alteration of lipid profile in patients after renal transplantation as compared to pre-transplant status and immunosuppressive therapy seems to be one among the various contributors to it.

Journal of Medical Case Reports, Aug 28, 2017

Background: Breast cancer is one of the commonest sources of ocular metastasis. Patients with ocu... more Background: Breast cancer is one of the commonest sources of ocular metastasis. Patients with ocular metastatic disease can present with a variable clinical picture. Patients with a history of breast cancer presenting with any eye symptom should be evaluated with consideration of ocular metastasis. Case presentation: We report a case of ocular metastasis in a 46-year-old Brahmin woman presenting with right eye pain. She had been treated for stage IIIc left-sided breast cancer 2 years ago with six cycles of chemotherapy with docetaxel, adriamycin, and cyclophosphamide after undergoing modified radical mastectomy. An ophthalmic examination revealed a tender subconjunctival swelling superotemporally on retracting right upper eyelid. This finding alone indicated anterior scleritis. On examining fundus under mydriasis, an amelanotic subretinal mass could be visualized in the posterior pole superotemporal to macula. An orbital magnetic resonance imaging revealed a mass of 2 × 1 cm in size in the subretinal space of her right eye. Computed tomography of her chest was then done and showed multiple metastases in both lungs. Conclusion: This case report highlights the fact that any unusual ocular presentation, even one simulating anterior scleritis, in a patient with a history of breast cancer should raise suspicion of metastasis.

European journal of medical case reports, 2017

Background: Linezolid like many other systemic drugs can cause reversible sight threatening adver... more Background: Linezolid like many other systemic drugs can cause reversible sight threatening adverse reaction. A proper causality assessment tool can aid a decision to discontinue a drug when an adverse event is suspected. Case presentation: We describe a case of progressive visual loss in a 28-year-old lady undergoing long term linezolid for extensively drug resistant tuberculosis. A marked improvement in vision was seen on discontinuation of linezolid. Conclusion: A knowledge of visual monitoring in patients undergoing long-term linezolid therapy among physicians and ophthalmologists is important, especially in developing countries where infectious disease is still a problem and use of antimicrobials is hardly monitored.

Journal of Nepal Health Research Council, Nov 13, 2019

Background: Drug Promotional Literatures are usually relied upon for drug promotion, however stud... more Background: Drug Promotional Literatures are usually relied upon for drug promotion, however studies have shown them to contain several pitfalls. World Health Organization has time and often revised the guideline to address the issue and World Health Organization Ethical Criteria for Medicinal Drug Promotion was established. Based on this guideline, several regional as well as national guidelines have been formulated. Though laws to regulate drug promotion is existent, studies have shown problems with drug promotional literatures in Nepal also. This study was carried out to analyse the drug promotional literatures distributed by pharmaceutical companies in Nepal as per World Health Organization Ethical Criteria for Medicinal Drug Promotion.Methods: A cross-sectional study over a period of one year was conducted at our department. Pharmaceutical companies registered in Department of Drug Administration, Kathmandu and consenting for the study were requested to provide ten unique drug promotional literatures of their products. Collected drug promotional literatures were analysed for inclusion of essential information as per World Health Organization Ethical Criteria for Medicinal Drug Promotion, level of biasness. Different drug promotional literatures were also classified and compared for these aspects. Results: A total of 48 pharmaceutical companies were included in the study. Drug promotional literatures (n = 372) were analysed during the study. Adherence to criteria concerned with positive attributes of the promoted medicine was found to be higher, most of the drug promotional literatures adhered to 5-8 criteria of World Health Organization Ethical Criteria for Medicinal Drug Promotion and were categorised into grade B. Difference in adherence as well as number of biased drug promotional literatures was also seen when drug promotional literatures were compared on different basis. Conclusions: Adherence to World Health Organization Ethical Criteria for Medicinal Drug Promotion was found to vary when drug promotional literatures were classified as per pharmaceutical company, type of formulation being promoted, type of drug promotional literatures.Keywords: Drug act Nepal 1978; drug promotional literatures; WHO-ethical drug criteria for medicinal drug promotion.

International Journal of Health Sciences and Research, 2015

Background: A variety of newer drugs are available in market for hypertension, the quality of lif... more Background: A variety of newer drugs are available in market for hypertension, the quality of life for these patients has been altered for the better. Not many studies are conducted in Nepal regarding drug utilization of antihypertensive in remote villages and hence this study was planned. Method: A pilot study was conducted in a private polyclinic located in village named Bhimad, which is located in Tanhun district of Nepal. One hundred patients with hypertension were chosen randomly and the prescription was analyzed. Specialized pro forma was designed for the data collection where the variables such as age, sex, drugs used and also regarding the names of drugs used(generic or trade) were included. The data was analyzed using descriptive statistics. Result: One hundred patients were recruited for the study. We found trade name more commonly being used then generic name (81% vs. 19%). Data showed that 54% were females and 46% were males. Beta blocker was used most frequently (43%) f...

Infection and Drug Resistance, 2021

Purpose Inappropriate use of broad-spectrum antibiotics contributes to the emergence of multidrug... more Purpose Inappropriate use of broad-spectrum antibiotics contributes to the emergence of multidrug-resistant (MDR) bacteria. Finding novel antimicrobial agents and strategies based on synergistic combinations are essential to combat MDR infections. This study was designed to determine in vitro synergy of different antimicrobials against extensively drug-resistant (XDR) Gram-negative clinical isolates. Methods A descriptive, cross-sectional study was conducted at Human Organ Transplant Center, Nepal, for five months. Clinical isolates were checked for their drug-resistance properties including extended-spectrum beta-lactamase- (ESBL-) and metallo-beta-lactamase- (MBL-) production. The XDR isolates were further tested for antimicrobial synergy, and the results were interpreted as synergistic, additive, indifferent or antagonistic determining fractional inhibitory concentration of the antibiotics. Results Out of total 1155 clinical samples, 308 showed significant growth. Escherichia col...

Journal of Nepal Health Research Council

Journal of Chitwan Medical College

Implementation of food extract for target medicinal purpose is a genre in medical science called ... more Implementation of food extract for target medicinal purpose is a genre in medical science called Nutraceutical which is vast and much of it is yet to be explored. Nowadays general population are aware of the importance of exercise in terms of health benefits but the fatigue and delayed onset muscle soreness (DOMS) are limitations that are to be overcome to continue extensive exercises. For this article, the role of Branched chain amino acids (BCAA) for the purpose is studied from various scientific journal. DOMS is due to direct muscle damage following exercise whereas central fatigue is the sensation of fatigue due to neurochemical changes in brain following exercise. In various studies, DOMS and central fatigue were minimized in terms of duration when given to animals and human volunteers. Further research has to be done regarding dosing regimen of BCAA supplementation and also to uncover any adverse effect of the supplements.