Our Unit at Patan Hospital has continued to work hard as a team and produce useful articles which have impacted therapy especially in the treatment of enteric fever. Specifically earlier this year we were able to show (Lancet Infect Dis. 2016 May;16(5):535-45; Elife. 2016 Mar 11;5:e14003) that fluroquinolones should not be used in the treatment of enteric fever in South Asia. We documented the fact that clinically and microbiologically (including sequencing resistant typhoid strains) typhoid fever patients on fluroquinolones (which in some countries in this region is the drug of choice in treating enteric fever) fared badly. Through public engagement campaign we are attempting to bring this important issue to the attention of the health policy makers in the region (South Asia) so that this finding is incorporated in the treatment guideline of enteric fever here.
Post-earthquake Nepal, we humbly recommended (Lancet Glob Health. 2015 Dec;3(12):e731-2) to the government of Nepal to include vaccines for some common prevalent diseases and offered some other innovative ideas for the earthquake- ravaged districts and for those living in temporary shelters. Post earthquake Nepal there were outbreaks of scrub typhus that were mistakenly diagnosed as typhoid fever and we commented (Lancet Glob Health. 2016 Aug;4(8):e516-7) on how to deal with this common situation so that proper treatment can be administered. We went to various districts outside of Kathmandu valley with the Epidemiology and Disease Control Division (EDCD) of the Nepali government giving talks on scrub typhus and typhoid fever.
In addition our Unit has continued to take on more studies especially regarding AMR (antimicrobial resistance). Together with GARP (Global Antibiotic Resistance) Nepal we have been able to publish a Situation Analysis with recommendations for AMR control in Nepal (J Nepal Health Res Counc. 2015 May-Aug;13(30):102-11) . And we continue to be actively involved with helping clinicians with microbiological data in the day to day treatment of patients at Patan Hospital. Importantly we carried out the first extensive spatiotemporal investigation of water pollution in an area of typhoid endimicity (Kathmandu Nepal) and showed with DNA analysis widespread presence of enteric fever organisms in the municipal drinking water, in all likelihood the main source of typhoid fever in Kathmandu (PLoS Negl Trop Dis. 2016 Jan 6;10(1):e0004346).
Finally in an unrelated subject (compared to enteric fever) one of us (BB) has been involved with writing a paper on drug use and misuse in the mountains with suitable recommendations (High Alt Med Biol. 2016 Sep;17(3):157-184) and also carrying out an epidemiological survey on older Himalayan trekkers to the Everest region of Nepal and how the demographics have changed over the year (J Travel Med. 2016 Aug 8;23(6).
Our Unit at Patan Hospital has been conducting journal club on a weekly basis for the benefit of the doctors and students for many years. For example On Sept 14th 2014 the topic for discussion was:
Typhoid Fever: A Massive, Single–Point Source, Multidrug-Resistant Outbreak in Nepal published in Clinical Infectious Diseases 2005; 40:554–6. This is much appreciated by the hospital staff.
In addition, we have also been involved for almost a year in the live streaming of medicine updates at Patan Hospital for Nepali health professionals. The updates are from the Royal College of Physicians in Edinburgh, Scotland. The last one (on Sept 12th) was on renal medicine.