Background Escherichia coli has found to be the predominant uropathogen (50–90%) in uncomplicated, community acquired urinary tract infection (UTI). Uropathogenic Escherichia coli (UPEC) express a multitude of virulence factors, which enable the bacteria to establish UTI. The objective of this study was to evaluate the presence of different phenotypic virulence markers in UPEC isolates and determine their correlation with antibiotic resistance pattern. Results Out of 105 patients, 56 (53%) were females and 49 (47%) were males. The age of the patients in the study ranged from 18 years to 87 years and majority of the patients belonged to the age group 20–29 years. Virulence factor was observed in 65% (n = 69) of UPEC and 20% (n = 22) of control isolates (P = 0.0001). Haemolysin production was observed in 34(32.3%) of uroisolates and 12 (11.4%) of control strain. Similarly, 62% of UPEC and 1% of control produced biofilm (P = 0.0001). The expression of Mannose-resistant hemagglutinin (MRHA) and mannose-sensitive hemagglutinin (MSHA) in uroisolates were 52.3% (n = 55) and 5.7% (n = 6) respectively, whereas in faecal isolates, 8.5% (n = 9) expressed MRHA and none produced MSHA. Antimicrobial resistance showed a high degree of resistance towards ampicillin, cotrimoxazole and norfloxacin. The resistance was observed in significant higher degree in biofilm formers as compared to non-formers. MDR and ESBL was observed in 51 and 46% of test strains and 9 and 7.6% of control strains (P = 0.0001). Conclusion A significant association between virulence factors of UPEC and antimicrobial resistance in UPEC was present. Routine testing of these factors and co-relation with AMR is recommended. These findings will certainly help understand the pathogenicity and proper management of UTI patients, thus decreasing the improper use of antibiotics.

Introduction:Stroke is the second most common cause of mortality worldwide. Data regarding the predictors of mortality of acute ischemic stroke are widely discordant. Identifying the predictors and providing the utmost care to a high-risk patient is still an unmet need in middle- to low-income countries. We did this study to identify the predictor of in-hospital mortality of acute ischemic stroke.Materials and Methods:We conducted a retrospective study of patients with acute ischemic stroke presented to the tertiary care center in eastern Nepal from January 2012 to December 2016. We enrolled patients of age 18 years and older with acute ischemic stroke in this study. The primary outcome of the study was in-hospital mortality of enrolled patients. Predictors of mortality were analyzed by comparing the patients with acute ischemic stroke who had mortality with those who survived.Results:The mean age of enrolled patients was 66 years. Among 257, the in-hospital mortality rate was 20.5%. The patients with in-hospital mortality had lower Glasgow coma scale (GCS) score (9 vs. 12, P < 0.001) compared to those who survived. During admission, a patient with in-hospital mortality had significantly lower arterial oxygen saturation (92 vs. 95, P < 0.001), higher pulse rate (91 vs. 83, P = 0.009), and higher respiratory rate (24 vs. 21, P < 0.001) than those patients with acute ischemic stroke who survived.Conclusion:Lower GCS score, baseline higher pulse rate, higher respiratory rate, and lower arterial oxygen saturation are the predictors of in-hospital mortality of adult with acute ischemic stroke.

No abstract

No abstract

Background and Aims: Tetanus is a cause of thousands of death and disability annually in developing countries. Nepal is a low-income country and has achieved maternal-neonatal transmission elimination status. However, the literature regarding the status of generalized tetanus in adult populations is limited. This study was conducted to determine the clinical profile and outcome of patients with generalized tetanus. Methods: This was a retrospective study conducted among adult patients with generalized tetanus admitted at the Department of Internal Medicine or Department of Anesthesiology and Critical Care at B.P. Koirala Institute of Health Sciences, Dharan, Nepal from January 2012 to December 2016. Results: Of 40 patients with generalized tetanus, the mean age was 47 } 16 years. Most of the patients were male (95%) and were not vaccinated with tetanus toxoid (67.5%). The most common wound type was skin puncture. Tracheostomy was done in 30 patients (75%). Twenty-nine patients (72.5%) were discharged after completion of treatment, seven patients (17.5%) took leave against medical advice, and three patients (7.5%) died at the hospital during treatment. Conclusions: Generalized tetanus is still a public health concern in Nepal. It is more common in males and at ages above 40 years. Perforative skin wounds sustained from the wood sticks or needles were a frequent cause. Most of the patients with generalized tetanus needed a tracheostomy and mechanical ventilation. The in-hospital mortality rate of generalized tetanus was 7.5%.