Background: Acinetobacter species has emerged as a significant hospital pathogen, and are becoming        increasingly drug resistance. They cause outbreaks in intensive care units and health care units. Methods: A cross-sectional study was conducted to determine the prevalence and antibiotic susceptibility pattern of Acinetobacter spp isolated from various clinical samples collected from patients admitted in various wards and intensive care units of the hospital over a period of one year (March 2018 to Feb 2019).   Results: Out of 2,623 samples, 1,201(45.78%) yielded significant growth and out of these positive cultures, 138(11.49%) Acinetobacter spp were isolated. Majority of isolates 24(17.39%) were isolated from General intensive care unit (GICU). Maximum sensitivity of Acinetobacter spp was seen towards polymyxin B 138(100%) and colistin 138(100%), followed by tigecycline 127(92.02%). Hundred and one (80.43%) isolates were found to be multidrug resistant.   Conclusions: Acinetobacter isolates showed multidrug resistant pattern mostly in inpatients. To avoid resistance, antibiotics should be used judiciously. There is also an urgent need for emphasizing the       importance of hand washing and use of disinfectants in prevention of transmission of infection in health care setup. Keywords: Acinetobacter spp; prevalence; antibiotic resistance; intensive care units; multidrug           resistance.

Introduction: Wound infections are significant group of infections in the hospitals worldwide. The wide spread uses of antimicrobial agents lead to emergence of resistant pathogens contributing to increased morbidity and mortality. Accurate and prompt antimicrobial therapy is required to reduce the complications. This study was aimed to investigate pyogenic bacterial pathogens and their susceptibility patterns. Methods: A cross sectional study was carried out at Gandaki Medical College Teaching Hospital from July to December 2018. Wound specimens obtained from adult patients were inoculated onto appropriate media and pathogens were identified using standard microbiological methods. Antimicrobial susceptibility patterns were determined by Kirby-Bauer disc diffusion method following the guidelines of Clinical and Laboratory Standard Institute (CLSI). Results: A total of 264 specimens were included in the study of which 167 (63.3%) were positive for bacterial growth. Of these, polymicrobial growth was observed in two specimens. Gram positive bacteria (119, 70.4%) were the leading cause of infections, Staphylococcus aureus (102, 85.7%) being the most dominant. Among the Gram negative pathogens (50, 29.6%), Escherichia coli (31,62%) was found to be the predominant followed by Pseudomonas aeurogenosa (10, 20%). Overall, the isolates were resistance to Ampicillin (90.7%), Amoxycillin (64.9%), Cloxacillin (68%), Ofloxacin (61.5%) and Cotrimoxazole (55.6%). Lesser rates of resistance were observed to Doxycycline, Erythromycin, Amikacin, Gentamicin and Imipenem. Conclusion: This study revealed the most common pathogens causing pyogenic wound infections in our setting. Again, these pathogens are resistance to commonly used antibiotics. Therefore, this study could be helpful to develop proper guidelines of antibiotics to be used for prophylactic and empiric treatment.

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Introduction: Foodborne illnesses are caused by consumption of contaminated foods. The risk of food getting contaminated depends largely on the health status of the food handlers, their personal hygiene, knowledge and practice of food hygiene. Hence, this study aimed to assess the proportion of Salmonella among food handlers working in the cafeteria of Gandaki Medical College Teaching Hospital, Pokhara, Nepal. Methods: An institutional based cross-sectional analytical study was conducted from March 2018 to February 2019. A structured questionnaire was used to collect the sociodemographic characteristics, the knowledge and the risk factors of the participants. A total of 62 stool samples were collected and processed according to the standard microbiological procedures. All the Salmonella isolates were identified by biochemical tests. Additionally, antimicrobial susceptibility tests were performed according to Clinical and Laboratory Standards Institute guidelines 2017, using Kirby-Baur disk diffusion method. Data were analyzed by Statistical Package for Social Service for window version 21.0. Descriptive statistics were computed and chi-square test was applied at 5% level of significance. P-value <0.05 was considered to be statistically significant. Results: Total of 62 food handlers were included in the study. Majority of the cafeteria workers 46(74.2%) were not aware of proper hand washing technique. Of the 62 food handlers working in the cafeteria, Salmonella were isolated from 12(19.4%) stool specimens. All the Salmonella isolates were sensitive to amikacin (100%), followed by imipenem (91.7%) and cefotaxime (91.7%). However, the highest rate of antibiotic resistance among Salmonella isolates was noted for amoxicillin (58.3%). Conclusions: This study showed increased proportion of Salmonella carriers among the food handlers of cafeteria. Salmonella carriage among food handlers is of great concern as they can be the source of foodborne illness. Therefore, educating the food handlers of cafeteria about personnel hygiene may play a pivotal role in minimizing the incidence of foodborne illness and the associated morbidity

Mature cystic teratoma often referred to as dermoid cysts have been diagnosed using all imaging modalities. Dermoid cysts present various and complex ultrasonographic aspects. At times diagnosis may be diffi cult and lead to confusion due to its complex solid and cystic nature. The specifi city for diagnosis of fat and calcifi cation makes computed tomography (CT) scan the modality of choice. But CT scan is high technique equipment, expensive and may not be affordable or available at all places. Advances in the quality of USG machines, better experiences of ultrasound operators and thorough analysis of all ultrasound features that characterise dermoid cysts have resulted in an increased accuracy of exact ultrasonographic diagnosis of dermoid cysts in the vast majority of the cases and now used as the fi rst preoperative work-up method of choice for the assessment of adnexal masses in clinical practices.

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Primary testicular germ cell tumors (PGCT) can be classified as seminomatous and non-seminomatous germ-cell tumor (NSGCT) types. Mixed germ cell tumors (MGCT), a subtype of NSGCT, contain more than one germ cell components. Here, we present a rare case of a MGCT composed of yolk sack tumor and teratoma which had a continuous large abdominal and retroperitoneal extension. A 43 years old male presented with complaints of discomfort and swelling over the right inguinoscrotal region. Ultrasonography (USG) showed a large ill-defined heteroechoic mass in the right inguinoscrotal region with vascularity and without separate visualization of right testis. Subsequent contrast enhanced Computed Tomography (CT) showed large enhancing mass in the right scrotal sac which was continuous with large abdominopelvic and retroperitoneal mass through the right inguinal canal. Tru-Cut biopsy of the scrotal mass showed MGCT with yolk sac and teratoma component. Patient underwent 6 cycles of chemotherapy followed by Right Radical Inguinal Orchidectomy.

Introduction: Scrub typhus is an acute febrile illness caused by obligate intracellular bacteria of the family Rickettsia after an incubation period of 6-21 days. The disease may lead to several complications such as acute hepatitis, sepsis, myocarditis, respiratory distress and disseminated vasculitis if not treated properly. The aim of the study was to find out the prevalence of scrub typhus among febrile patients admitted to the Department of Medicine in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among febrile patients admitted to the Department of Medicine in a tertiary care centre from 12 November 2020 to 11 May 2023 after obtaining ethical approval from the Institutional Review Committee (Reference number: 26/076-077). All patients with acute febrile illness from 17 years to 70 years were included. Patients with an acute febrile illness diagnosed with other infections such as dengue, leptospirosis, typhoid, brucellosis, malaria, and COVID-19 were excluded. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 640 patients presenting with acute febrile illness, 38 (5.94%) (4.11-7.77, 95% Confidence Interval) patients were diagnosed to have scrub typhus. Among 38 patients, 2 (5.26%) patients suffered from acute hepatitis, and 1 (2.63%) each suffered from sepsis, myocarditis, disseminated vasculitis and respiratory distress. Conclusions: The prevalence of scrub typhus among patients admitted to the Department of Medicine was found to be slightly higher than in other studies done in similar settings.