Background. Extended-spectrum β-lactamase (ESBL)- and AmpC-β-lactamase-producing Enterobacteriaceae have recently emerged as a public threat in the treatment of nosocomial as well as community-acquired infections. Very little information is currently available about its existence in Nepal. We, therefore, aim to determine the prevalence of ESBL and AmpC-β-lactamase-producing Enterobacteriaceae and also to determine their drug resistance pattern. Methods. During a 6-month period (November 2014–April 2015), a total of 190 stool specimens from 190 participants were obtained from different population. Of the total 260 fecal isolates, 152 from outpatient department (OPD) and 108 from healthy volunteer were collected. Stool specimens were cultured and enterobacterial isolates were subjected to antimicrobial susceptibility tests according to the standard microbiologic guidelines. ESBL was screened using ceftazidime (CAZ, 30 μg) and cefotaxime (CTX, 30 μg) disks and confirmed by double-disk synergy test. AmpC-β-lactamase enzyme production was detected by the aminophenylboronic acid inhibitor-based detection method. Antibiotic susceptibility test was performed for ESBL-positive isolates as per the Kirby-Bauer disk diffusion method, and interpretation was done according to CLSI (Clinical and Laboratory Standard Institute). Results. The prevalence of ESBL, AmpC-β-lactamases, and coproducer (ESBL + AmpC-β-lactamase) producing Enterobacteriaceae in OPD participants were 30.92%, 18.4%, and 13.81%, respectively, while 25%, 6.4%, and 1.8% in healthy population. ESBL-producing E. coli was 70.2% followed by K. pneumoniae (12.7%), and among AmpC-β-lactamase producer, E. coli were detected in half of the isolates (14/28, 50.0%) among OPD patients. Similarly, E. coli remained the most frequent ESBL producers 21/27 (77.8%) followed by K. pneumoniae 4/27 (14.21%) in healthy participants, and K. pneumoniae 5/7 (71.42%) and C. freundii 2/7 (28.57%) were detected highest among AmpC-β-lactamase-producing isolates. All isolates were highly sensitive (100%) to imipenem in both OPD and healthy participants. Conclusion. Our study revealed a high prevalence of ESBL- and AmpC-β-lactamase-producing enteric pathogen in Nepalese OPD and healthy population. The significant increase of these isolates and increased rate of drug resistance indicates a serious threat that stress the need to implement the surveillance system and a proper control measure so as to limit the spread of ESBL-producing Enterobacteriaceae (ESBL-PE) in both OPD as well as in community. Therefore, healthcare providers need to be aware that ESBL- and AmpC-β-lactamase-producing strains are not only circulating in hospital environments but also in the community and should be dealt with accordingly.

Background: Anemia is the commonest hematological complications in HIV patients, and has a significant impact on quality of life, morbidity, and mortality. However, little is known about the epidemiology of anemia in this population in a Nepalese setting. Therefore, the present study aimed at assessing the prevalence of anemia in patients living with HIV and further to determine the independent predictors associated with it. Methods: This cross-sectional study was conducted in patients diagnosed with HIV at Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu from November 2016 to August 2017. Anemia was considered a core variable, and covariates used for analysis were age, sex, CD4 count, antiretroviral therapy regimen, history of intravenous drug use, marital status, religion, geography, employment status, hypertension, and diabetes mellitus. Prevalence of anemia and its independent predictors were evaluated. Fisher's exact and χ 2 tests were performed to determine the significance of differences among categorical variables and t-tests for continuous variables. Binary logistic regression was modeled to assess predictors associated with anemia. Results: Of the total 210 patients analyzed, median age was 37.50±10.57 years, and 110 (52.6%) were male. The estimated prevalence of anemia overall was 66.7% (95% CI 60.64%-73.35%): mild anemia 14.3% (95% CI 8.25%-19.74%), moderate anemia 40.5% (95% CI 31.88%-48.11%), and severe anemia 11.9% (95% CI 6.61%-17.30%). Prevalence of anemia increased significantly with decreasing CD4 count: 5.71%, 12.85%, and 48.09% among patients with CD4 counts >500, 200-499, and <200 cells/mm 3 , respectively (P=0.019). Severity of anemia was significantly associated with immunostatus (<200, 200-499, and >500; P=0.048). Female sex was significantly associated with increased odds of anemia (OR 2.27, P=0.007). Conclusion:The present study demonstrated a high rate of anemia in a substantial number of HIV individuals. Therefore, early detection and timely management of anemia, especially in females and those with decreased immunostatus, are crucial to prevent anemia progression and improve quality of life.

Background. Early detection of the SARS-CoV-2 is crucial for both the improvement of turnaround time and limiting the spread of the virus in the community. Thus, this study aims to establish rapid antigen tests as an effective diagnostic tool to improve the testing strategies of COVID-19 diagnosis. Methods. A laboratory based cross-sectional study was performed on the patients that visited Sukraraj Tropical and Infectious Disease Hospital (STIDH) in Kathmandu, Nepal, from November 2020 to January 2021. A total of 213 nasopharyngeal swabs were collected from both symptomatic and asymptomatic patients for rapid antigen test, followed by RT-PCR assay as reference test for confirmation of COVID-19. A standard questionnaire was administered to collect other information from patients. Data were collected and analyzed using SPSS version 20. Results. Out of 213 individuals, 75 tested positive in Ag-RDT test, while 118 tested positive for SARS-CoV-2 RNA genome via Real time PCR assay. The overall diagnostic performance of Ag-RDT showed 63.6% sensitivity and 97.9% specificity. The diagnostic accuracy of Ag- RDT was 78.9% with κ value 0.590, showing moderate agreement with RT-PCR. Significant difference ( p value <0.001) was observed between Ag- RDT+ and Ag- RDT− results when compared to Cq values obtained from RT- PCR. Conclusion. The promising performance of Ag-RDT renders it useful as screening tool alongside RT-PCR to reduce transmission via improving contact tracing, implementation of local mitigation strategies, and refining existing testing protocol for diagnosis of COVID-19.