Background COVID-19 pandemic has created unprecedented health and economic impact. Psychological stress, anxiety and depression are affecting not only COVID-19 patients but also health professionals, and general population. Fear of contracting COVID-19, forced restrictive social measures, and economic hardship are causing mental trauma. Nepal is a developing country from South Asia where the COVID-19 pandemic is still evolving. This online survey has been carried out to understand impact of COVID- 19 on mental health of Nepalese community dwellers. Methods The COVID-19 Peritraumatic Distress Index (CPDI) questionnaire adapted from the Shanghai Mental Health Centre was used for online data collection from 11 April-17 May 2020. Collected data were extracted to Microsoft excel-13 and imported and analyzed using SPSS (Statistical Package for Social Sciences) version-22. An initial univariate analysis was conducted for all variables to assess the distribution. Logistic regression analyses were done to estimate the odds ratios of relevant predicting variables. Results A total of 410 participants completed the self-rated questionnaires. Mean age of study participants was 34.8 ± 11.7 years with male preponderance. 88.5% of the respondents were not in distress (score less than 28) while, 11% had mild to moderate distress and 0.5% had severe distress. The prevalence of distress is higher among age group > 45 years, female gender, and post-secondary education group. Health professional were more likely to get distressed. Respondents with post-secondary education had higher odds (OR = 3.32; p = 0.020) of developing distress as compared to respondents with secondary education or lower. Conclusion There is lower rate of psychological distress in city dwellers and people with low education. Adequate intervention and evaluation into mental health awareness, and psychosocial support focused primarily on health care workers, female and elderly individuals is necessary.

Background: Apart from being a major cause of mortality, nosocomial infections due to Staphylococcus aureus have been imposing a burden on patients, hospitals and health care systems. The present study was designed to determine the prevalence of methicillin resistant S. aureus (MRSA) among nosocomial isolates along with their phenotypic characterization. Methodology: MRSA and methicillin sensitive S. aureus (MSSA) were determined by performing four different tests viz: disc diffusion, oxacillin screen agar test, MRSA latex agglutination test, and MIC of oxacillin by E test. Results: Of the 149 S. aureus nosocomial isolates, 44.9% were MRSA, which included 82.1% of homogeneous MRSA and 17.9% of heterogeneous MRSA. Association of MRSA infection was found to be significantly higher in skin and lower respiratory tract infections. Of the MRSA isolates, 65 were multiresistant oxacillin resistant Staphylococcus aureus (MORSA) and 2 were nonmultiresistant oxacillin resistant Staphylococcus aureus (NORSA). D tests performed on 136 isolates showed that Inducible macrolide-lincosamide-streptogramin B (MLS B ) and constitutive MLS B resistance were found to be associated with MRSA. On the contrary, susceptibility to both erythromycin and clindamycin was found to be associated with MSSA. However, MS B (macrolide-streptogramin B) resistance was not found associated either with MRSA or MSSA. Furthermore, both inducible and constitutive MLS B were found to be associated with only homogenous MRSA. Conclusion: D tests may be made mandatory in all S. aureus isolates as inducible MLS B resistance cannot be detected in routine susceptibility test unless erythromycin and clindamycin are placed 15-26 mm apart.

Caffeine citrate is one of the most prescribed drug in the present day NICU for apnea. Its efficacy, tolerability, wide therapeutic index and safety margin has made it the drug of choice among the methylxanthines. Its therapeutic uses in apnea of prematurity, mechanical ventilation, bronchopulmonary dysplasia has made it a "silver bullet" in neonatology. However, there are still controversies surrounding this drug. This review is aimed to update the reader about the basic pharmacology, current therapeutic uses, adverse effects, controversies as well as present and future research of caffeine.

Methicillin-resistant Staphylococcus aureus (MRSA) carrying the important virulence determinant, Panton-Valentine leukocidin (PVL), is an emerging infectious pathogen associated with skin and soft tissue infections as well as life-threatening invasive diseases. In carrying out the first PVL prevalence study in Nepal, we screened 73 nosocomial isolates of S. aureus from 2 tertiary care Nepali hospitals and obtained an overall PVL-positivity rate of 35.6% among the hospital isolates: 26.1% of MRSA and 51.9% of methicillin sensitive S. aureus (MSSA) isolates were found to be positive for the PVL genes. PVL prevalence was not associated with a specific (i) infection site, (ii) age group, or (iii) hospital of origin. It was found to be positively associated with heterogeneous MRSA (73.3%) compared to homogeneous MRSA (3.2%) and MSSA (51.9%); negatively associated with multiresistant MRSA (22%) compared to nonmultiresistant MRSA (60%) and MSSA (51.9%); and positively associated with macrolide-streptogramin B resistance (93.8%) compared to macrolide-lincosamide-streptogramin B resistance (0%) and no-resistance (45.8%) types. Macrolide-streptogramin B resistance was confirmed by the presence of msr(A) gene. Restriction pattern analyses provided evidence to support the circulation of a limited number of clones of PVL-positive MRSA, arguing for the adaptability of these isolates to a hospital setting.