Introduction: Skin tumors are not uncommon in the Nepalese community. Accurate diagnosis and categorization of these into different types is important because of its effect on prognosis and management. We conducted this study to find out the frequency of different histological types of skin tumors, correlate with their clinicopathologic profile and to determine the stage of malignant tumors.Methods: This is a descriptive cross-sectional study of skin tumors during the period February 2015 to January 2017. All the patients who were subjected to skin biopsy for skin tumors were included in this study. The biopsies taken were fixed in 10% formalin and then processed. Four microns thick sections were taken and stained with Haematoxylin and Eosin stain (H&E). Results: Total of 108 cases of skin tumors were included of which 68 (62.97%) cases were histologically diagnosed as benign and 40 (37.03%) cases were diagnosed as malignant tumors. Keratinocytic tumors were predominant among both benign and malignant skin tumors.Conclusions: Histopathological examination is the gold standard for accurate diagnosis and prognostic assessment of the patient. Staging of the malignant tumors in excision biopsy specimen needs to be emphasized since it is a predictor of prognosis.

Background: Upper gastrointestinal tract disorders are one of the most commonly encountered problems in the clinical practice. A variety of disorders can affect the upper gastrointestinal tract. Endoscopy, in combination with biopsy, plays an important role in the exact diagnosis for further management.Objectives: To determine the spectrum of histopathological lesions of upper gastrointestinal tract.Methods: A prospective study was conducted in the Department of Pathology, Kathmandu Medical College and Teaching Hospital, Nepal from January 2015 to December 2016 (2 years).Results: A total 243 endoscopic biopsies were evaluated. Out of which, 219 cases were from gastric, 15 were from esophagus and 9 were from duodenum. Among the gastric biopsies, 77 cases (35.16%) were chronic active gastritis and 27 cases (12.33%) were malignant. The most common malignancy was adenocarcinoma. Among the 15 oesophageal biopsies, 12 cases (80%) were of non-neoplastic and 3 cases (20%) were of neoplastic nature. The most common malignancy was squamous cell carcinoma. Among 9 cases of duodenum biopsies, all were non-neoplastic, of which chronic non-specific duodenitis (66.66%) was the commonest.Conclusion: Endoscopy is incomplete without histopathological examination of biopsy and so, the combinations of methods play an important role in diagnosis and management of upper gastrointestinal tract disorders.Journal of BP Koirala Institute of Health Sciences, Vol. 1, No. 1, 2018, Page: 67-74

Isolation of multidrug resistant bacteria such as extended spectrum beta-lactamase (ESBL), metallo beta–lactamase (MBL) producing and Methicillin resistant Staphylococcus aureus (MRSA) causing lower respiratory tract infection (LRTI) is associated with various risk factors and a major challenge in treatment. So, the study determined bacterial etiology of lower respiratory tract infection and antibiotic sensitivity pattern with special reference to ESBL, MBL, and MRSA strains along with risk factors associated with such strains. A total of 120 specimens were collected from patients with lower respiratory tract infection along with clinical details. Combination disk method was done for the detection of ESBL and MBL producing isolates and oxacillin disc was used to detect MRSA. Out of 120 specimens, 87.5% was monomicrobial while 12.5% was polymicrobial infection. Pseudomonas aeruginosa (36.19%) was the predominant followed by Acinetobacter baumannii (28.57%), Klebsiella pneumoniae (20.95%), Escherichia coli (8.57%) and Staphylococcus aureus (5.72%). Total 33 (31.43%) out of 105 monomicrobial isolate were MDR. All MDR E. coli, K. pneumoniae, P. aeruginosa were ESBL producers and (6, 20%) out of total A. baumannii isolated produced MBL and was not found to produce ESBL. All MDR S. aureus isolates were found to be resistant to methicillin. Carbapenems followed by amikacin were found to be the most effective antibiotic for Gram negative bacilli causing LRTI. Vancomycin, Teicoplanin & Linezolid were found to be the most effective antibiotics for MRSA. 28 out of 33 MDR isolate possessing patients had comorbid illness. Isolation of MRSA, ESBL and MBL producing bacteria in LRTI are increasing in number. Increased prevalence of MDR bacterial strains form patients with comorbid illness is a major problem in healthcare centers. Nepal Journal of Science and Technology Vol. 13, No. 1 (2012) 157-163 DOI: http://dx.doi.org/10.3126/njst.v13i1.7454

Background: Wound infection with multidrug resistant bacteria along with risk factors is a major burden and challenge to the health care persons. This study focuses on antibiotic susceptibility pattern of bacterial isolates and risk factors of patients with infected wounds.Methods: This was a cross-sectional study conducted between November 2017 to June 2018 in Kathmandu University Hospital. Pus sample and wound swabs collected from patients during the study period were included. All microbiological processing were done following standard guidelines and patient’s information was collected following ethical guidelines.Results: Total number of patients observed for wound infection was 2,763. Pathogenic bacteria were detected in 252(9.12%) samples. 167(66.27%) were multidrug resistant. 118(46.82%) had risk factors. Among risk factors 14 had malignancy, 12 had diabetes, 32 were above age 60 without other risk factors, 45 received prior antibiotics and had critical illness and 15 were renal failure patients. Multidrug resistant bacteria was detected more among patients with risk factors 101(85.59%) in comparison to patients without risk factor 66(49.25%). When p value was calculated it was found significant. (p=<0.05).Conclusions: Significant amount of multidrug resistant bacteria were found in wounds of patients with risk factors. Prevention of wound infection by taking care of postoperative wounds, controlling and treating the risk factors, avoiding misuse of antibiotics and early microbiological analysis of infected wound might help to reduce the burden in healthcare centers.Keywords: Extended spectrum beta-lactamase; methicillin resistant staphylococcus aureus; multidrug resistant.

Oral keratotic white lesions are a common problem that is encountered on routine clinical examination. Clinical appearance of the lesion may belie the true nature of the lesion. So a biopsy followed by histopathological diagnosis is the gold standard in evaluating these lesions for malignant potential or dysplasias. Objective: The aim of the present study is to evaluate the clinicopathologic findings of oral keratotic lesions. Materials and Methods: Oral biopsies of 61 cases of oral keratotic white lesions during the period from January 2006 to July 2009 were studied retrospectively at the Department of Pathology, Kasturba Medical College, Manipal by microscopy. Clinical details and records were obtained from the medical records department. Results: In 61 cases of oral keratotic white lesions the age distribution ranged from 29 to 86 years. 66% were males while 34% were females and most lesions occurred between 31 and 70 years. The buccal mucosa was the most common site of lesion in 35% patients. Only 15 cases had some personal habits and 8/15 cases (53%) showed dysplasia. 12/ 54 cases (22%) of homogenous leukoplakia displayed dysplasia, of which 11 cases (92%) showed mild dysplasia and 1 case (8%) showed moderate dysplasia. Of the 4 cases of speckled leukoplakia, 75% showed dysplasia- mild, moderate and severe. 2/3 cases (66%) of verrucous leukoplakia displayed dysplasia- moderate and severe. There were 41 cases consistent with leukoplakia (67%), of which 22% showed epithelial hyperplasia and hyperkeratosis, 12 cases showed mild dysplasia, 3 cases moderate dysplasia and 2 cases showed severe dysplasia. Benign keratosis formed the largest group (35%) among the 61 cases. Of the 61 cases 17 (27%) showed dysplasia of which 19% was mild dysplasia, 5% was moderate dysplasia and 3% was severe dysplasia. Most frequent histomorphological feature seen in this study was nuclear pleomorphism in 21/ 27 cases (78%). There were 12 cases (71%) of dysplasia in males and 5 cases (28%) of dysplasia in females. There was 1 case of Progressive verrucous leukoplakia   in an 86 year old female patient. There were 3 cases (5%) each of oral lichen planus, lichenoid dysplasia and lichenoid keratosis in the present study. 6 cases (9%) of candidiasis was seen among the 61 biopsies. In the study there was 1 case (2%) each of verrucous  carcinoma, squamous cell carcinoma and micro-invasive squamous cell carcinoma. Conclusions: Oral keratotic white lesions demonstrate a wide spectrum of histopathological features from benign lesions to dysplastic lesions to carcinoma in situ to invasive ones. Scientific World, Vol. 10, No. 10, July 2012 p70-76 DOI: http://dx.doi.org/10.3126/sw.v10i10.6866