The increasing trend of gut colonization by extended-spectrum β-lactamase (ESBL) producing Enterobacterales has been observed in conventional farm animals and their owners. Still, such colonization among domesticated organically fed livestock has not been well studied. This study aimed to determine the gut colonization rate of ESBL-producing Enterobacteriaceae and carbapenemase-producing Enterobacteriaceae (CPE) among rural subsistence farming communities of the Kaski district in Nepal. Rectal swabs collected by systematic random sampling from 128 households of subsistence farming communities were screened for ESBL-producing Enterobacteriaceae and CPE by phenotypic and molecular methods. A total of 357 (57%) ESBL-producing Enterobacteriaceae isolates were obtained from 626 specimens, which included 97 ESBL-producing Enterobacteriaceae (75.8%) from 128 adult humans, 101 (79.5%) from 127 of their children, 51 (47.7%) from 107 cattle, 26 (51%) from 51 goats, 30 (34.9%) from 86 poultry and 52 (42%) from 127 environmental samples. No CPE was isolated from any of the samples. blaCTX-M-15 was the most predominant gene found in animal (86.8%) and human (80.5%) isolates. Out of 308 Escherichia coli isolates, 16 human and two poultry isolates were positive for ST131 and were of clade C. Among non-cephalosporin antibiotics, the resistance rates were observed slightly higher in tetracycline and ciprofloxacin among all study subjects. This is the first one-health study in Nepal, demonstrating the high rate of CTX-M-15 type ESBL-producing Enterobacteriaceae among gut flora of subsistence-based farming communities. Gut colonization by E. coli ST131 clade C among healthy farmers and poultry birds is a consequential public health concern.

Introduction Mucocele is a slow growing, benign but locally aggressive cystic structure lined by true epithelium. It often results due to obstructed sinus outflow or obstruction of gland-like mucous retention cyst. It can cause bony destruction and might result in orbital symptoms like diplopia, orbital displacement, visual disturbances. Other clinical features are facial numbness, dental problems, etc. Radiological evaluation is the preferred diagnostic modality. Surgical removal is the treatment of choice both endoscopic and open (could well luc) approach or combined approach are preferred. Here we report a very typical case of maxillary mucocele who presented with subtle symptoms of nasal obstruction. The study was done in compliance with SCARE guidelines.[1] Case presentation We present a very unique case of 24 years man with complaints of nasal obstruction and swelling over the right cheek for 2 years. He had a history of facial trauma two years back. Diagnosis was made on the basis of radiological examination CT (Computed Tomography) scan. He underwent enucleation via Cold well Luc's approach with good postoperative results. Conclusion Maxillary mucoceles are slow growing benign lesions. However, they are locally aggressive and cause bony destruction resulting into orbital and dental symptoms. Thus early recognistion with regular folllowr up and planning for surgical intervention can help avoid complications.

<p class="abstract"><strong>Background:</strong> Ear, nose and throat (ENT) problems are more common in children than adults. The objective of this study was to know the occurrence of various ENT disorders among children reporting to the out-patient department of a tertiary care center and to see their associations with three age-groups.</p><p class="abstract"><strong>Methods:</strong> A prospective cross-sectional study was conducted in the Out-Patient Department of Ear, Nose and Throat from 2016 to 2017. All the patients of age group 0-16yrs were included in the study. Informed consent or ascent from the patients and permission from their parents were taken. Detailed history taking, clinical examinations and appropriate investigations were performed and recorded in a pre-formed proforma. Data were entered into Microsoft Excel format 2013 and statistical analysis was done with SPSS 20 version.  </p><p class="abstract"><strong>Results:</strong> A total of 968 patients were examined, males 633(65.4%) and females 335(34.6%). The spectrum of ENT disorders reported were chronic suppurative otitis media (CSOM) 126 (13.0%), Otitis media with effusion (OME) 113 (11.7%), acute otitis media (AOM) 98 (10.1%), otomycosis with otitis externa 59 (6.1%), wax 36 (3.7%), foreign body ear (FB ear) 11 (1.1%), acute mastoiditis 22 (2.3%), acute rhinitis 35(3.6%), chronic sinusitis 33(3.4%), deviated nasal septum (DNS) 34 (3.5%), FB nose 21 (2.2%), vestibulitis with epistaxis 20 (2.1%), injury/trauma 11 (1.1%), tonsillitis 89 (9.2%), adenoid hypertrophy 71 (7.3%), acute pharyngitis 52 (5.4%), chronic pharyngitis 46 (4.7%), cervical lymphadenitis 37 (3.8%), FB esophagus 8 (0.8%) and laryngitis 12 (1.2%). CSOM was significantly associated with the age-groups 5-9 yrs whereas, AOM with 0-4 yrs. Adenoid hypertrophy was significantly associated with 0-4 yrs whereas, pharyngitis with 10-16 yrs.</p><p><strong>Conclusions:</strong> Most common ENT disorders reported were ear disorders and second most common throat disorders. Significant associations were found between disorders and age-groups.</p>

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Objectives: To correlate the hearing loss with duration of the disease, stage of the disease, ototoxic drugs use, co-morbidity and biochemical parameters in patients with chronic kidney disease (CKD).Material and Methods: This prospective study of 50 CKD patients was conducted in the department of ototolaryngology head and neck surgery and department of internal medicine, B. P. Koirala Institute of Health Sciences, Dharan, between December 2008 to November 2009. The blood investigation report of the patients were noted. Otological examination was carried out including tunning fork test and pure tone audiometry. Middle ear pathology and conductive hearing loss were excluded. Data was collected and analyzed.Results : Sensory neural hearing loss was higher in patients with; end stage renal disease (stage-5), co-morbidity, haemoglobin level less than 8.5, duration of CKD greater than 2 years, and ototoxic drug administration, but not statistically significant (P-value >0.05). Hearing loss in patients with CKD was not influenced by fasting blood sugar, serum urea, creatinine, sodium, potassium, calcium and serum phosphorus. (P-value >0.05)Conclusion: The hearing loss in patients with chronic kidney disease was not significantly related with stage of CKD, co-morbidity, ototoxic drug use, fasting blood sugar, serum urea, creatinine, sodium, potassium, calcium and serum phosphorus (P-value >0.05). The sensory neural hearing loss in these patients may be due to the advanced age and possible accelerated presbyacusis by the disease.

In the era of growing antimicrobial resistance, there is a concern about the effectiveness of first-line antibiotics such as ampicillin in children hospitalized with community-acquired pneumonia. In this study, we describe antibiotic use and treatment outcomes among under-five children with community-acquired pneumonia admitted to a tertiary care public hospital in Nepal from 2017 to 2019. In this cross-sectional study involving secondary analysis of hospital data, there were 659 patients and 30% of them had a history of prehospital antibiotic use. Irrespective of prehospital antibiotic use, ampicillin monotherapy (70%) was the most common first-line treatment provided during hospitalization followed by ceftriaxone monotherapy (12%). The remaining children (18%) were treated with various other antibiotics alone or in combination as first-line treatment. Broad-spectrum antibiotics such as linezolid, vancomycin, and meropenem were used in less than 1% of patients. Overall, 66 (10%) children were required to switch to second-line treatment and only 7 (1%) children were required to switch to third-line treatment. Almost all (99%) children recovered without any sequelae. This study highlights the effectiveness of ampicillin monotherapy in the treatment of community-acquired pneumonia in hospitalized children in a non-intensive care unit setting.

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