Antibiotic resistance among uropathogens is emerging public health problem. This study was done for assessing antibiotic and multidrug resistance (MDR) patterns of Escherichia coli at Bir Hospital, Kathmandu, among suspected urinary tract infection (UTI) patients from January to March, 2011. Altogether, 739 urine samples were analysed by semi-quantitative culture method and uropathogens were identified by conventional methods. E. coli was tested (109 samples) for antimicrobial susceptibility by Kirby Bauer disc diffusion method as per Clinical and Laboratory Standard Institute (CLSI) guidelines. Out of 739 samples, 27.3% gave significant growth while 3.1% and 29.2% samples gave mixed and non-significant growth respectively. E. coli was found to be most predominant isolate (54.0%) followed by coagulase negative Staphylococci (CoNS) (21.3%) and Enterococcus spp. (7.3%). Nitrofurantoin was found to be the most effective antibiotic followed by ciprofloxacin and ofloxacin while cephalexin was least effective. Out of 109 E. coli isolates, 90.8% were MDR strains and most of the isolates had a very high multiple antibiotic resistance (MAR) index, suggesting the origin of the isolates to be of high antibiotic usage. E. coli showed higher rate of resistance towards commonly used oral antibiotics. However, nitrofurantoin is still active against organisms. Thus, nitrofurantoin could be the choice for empirical therapy of UTI.

Summaryobjective To evaluate the repeatability and reproducibility of the serological direct agglutination test (DAT) for visceral leishmaniasis (VL) with aqueous antigen in a multi-centre study in VL-endemic areas in Sudan, Kenya and Nepal.methods Repeatability within each centre and reproducibility between the centres' results and an external reference laboratory (Belgium) was assessed on 1596 triplicate plain blood samples collected on filter paper.results High kappa values (range 0.86-0.97) indicated excellent DAT repeatability within the centres. The means of the titre differences between the reference laboratory and the centres in Sudan, Kenya and Nepal (2.3, 2.4 and 1.1, respectively, all significantly different from 0) showed weak reproducibility across centres. 95% of the titre differences between the reference laboratory and the respective centres were accounted for by large intervals: 0.6-9 fold titre variation for Sudan, 0.7-8 fold for Kenya and 0.26-4 fold for Nepal.conclusion High repeatability of DAT confirms its potential, but reproducibility problems remain an obstacle to its routine use in the field. Reproducibility was hindered by alteration of the antigen through temperature and shaking, especially in Kenya and Sudan, and by nonstandardization of the test reading. DAT handling procedures and antigen quality must be carefully standardized and monitored when introducing this test into routine practice. keywords reproducibility, direct agglutination test, visceral leishmaniasis, diagnosis, repeatability, agreement

The ecology of Anopheles mosquitoes in relation to malaria transmission was studied at sprayed and unsprayed villages and two unsprayed cattle sheds in the inner terai of Sindhuli District, Central Region, and at two unsprayed villages and one cattle shed in Kanchanpur, Far Western Region of Nepal, from August 1987 to August 1989. Anopheles maculatus was the most abundant of 26 anopheline species collected in Sindhuli District; however, An. fluviatilis was collected most frequently at human bait and was infected most frequently with malaria sporozoites. Residual house spray controlled the indoor resting abundance of the endophilic resting species and protected the population from malaria during midsummer, but had less effect on exophilic resting species and those abundant after and before spray application during the fall and spring, respectively. Malaria at the unsprayed village was detected predominantly in adults of both sexes, perhaps because young children retired early and frequently slept indoors under bed nets during the early evening period of elevated anopheline host-seeking activity. Malaria transmission was verified by the collection of sporozoite infected An. fluviatilis and An. maculatus during spring at cattle sheds in the forested Churia Hills and during the summer monsoon season within the unsprayed village. An. culicifacies was the most abundant of 12 anopheline species collected in Kanchanpur District. Few females of all species were collected at human bait positioned in or out of houses or had human positive blood meals; none were infected with sporozoites. Malaria incidence was higher in the study village positioned along the forest-rice field ecotone than in the cleared rice growing area.

Introduction: Upper gastro-intestinal endoscopy remains the gold standard for screening for esophageal varices but it has its own limitations. It is an invasive, expensive and uncomfortable procedure and needs clinical expertise. Accordingly, this study was conducted to establish the role of non-invasive markers for prediction of esophageal varices in liver cirrhosis. Methods: A hospital based descriptive cross-sectional study was carried out in Liver unit of National Academy of Medical Sciences, Bir Hospital, from October 2016 to September 2017. Complete blood count, liver function test, liver ultrasound and upper gastro-intestinal endoscopy were done for all patients to detect esophageal varices and to correlate with different non-invasive markers. Results: Total 191 patients of liver cirrhosis were studied after exclusion. Platelet count of 92082.00±43435.83/mm3 and spleen size of 144.21±10.71 mm was found to be good predictors of presence of EV (P≤0.001). Significant association between Child-Turcotte-Pugh class and presence of varices was observed (P≤0.001). AST/ALT ratio with cutoff value of 1.415 showed sensitivity of 82.4% and specificity of 36.4%. APRI at a cutoff value of 1.3 showed a sensitivity of 83.2% and specificity of 50%. Conclusions: Platelet count, spleen size and Child-Turcotte-Pugh class are good predictors of presence of esophageal varices in patients with liver cirrhosis. AST/ALT ratio and APRI score are not good substitutes for upper gastro-intestinal endoscopy.   Keywords:  esophageal varices; liver cirrhosis; non-invasive markers; portal hypertension; upper gastro-intestinal.

Introduction: Βeta haemolytic streptococcal infections have a worldwide distribution among children and it poses an important health problem globally. So, a five months study was conducted to know the prevalence of beta haemolytic streptococci (BHS) in the throat of school children. Materials and Methods: Throat swabs from 200 school children of Kirtipur were collected, transported to the laboratory and were processed for BHS following standard microbiological procedures. Group A Streptococci (GAS) were identified by beta haemolytic colonies, bacitracin sensitivity and catalase negativity test. ASO test was also performed from serum samples. Result: Altogether 18 (9%) BHS isolates were identified from 200 samples, out of which 11 (5.5%) isolates were from males and 7 (3.5%) were from females. Among the 18 BHS isolates, 10 were identified as GAS isolates. The number of GAS presented only 5% of total sample. There was no significant sex difference in colonization of GAS (p> 0.05). Majority of cases were asymptomatic. All GABHS isolates were sensitive to Penicillin. In Serological examination, i.e. Antistreptolysin O (ASO) titre, all serum samples showed less than 200 IU ASO titre. Conclusion: This result highlights the current situation of GABHS throat infection in school children of Kirtipur.