Aerococcus urinae is a rare cause of urinary tract infection (UTI) seen in elderly males with multimorbidity. Incidence is estimated between 0.15 and 0.8%. This organism is frequently misidentified for other grampositive species. Missed or delayed diagnosis of A. urinae UTI can lead to systemic infection with high morbidity and potential mortality. We present a classic case of A. urinae UTI in a 91-year-old male with multiple comorbidities, including heart failure, diabetes mellitus, and metastatic prostate carcinoma. Empiric therapy with nitrofurantoin was unsuccessful, but intravenous ceftriaxone and bladder catheterization resulted in rapid symptomatic improvement. Variable antimicrobial sensitivities and resistance have been reported for A. urinae. Therefore, antimicrobial resistance testing should be performed for all patients with A. urinae infections.

Background : There is abundance of evidence regarding various aspects of mortality in emergency department from different parts of world but there is limited number of studies on mortality in context of western Nepal. The objectives of this analysis were to review the demographical pattern of mortalities and define the cause and frequency of death in the Emergency Department (ED) of our institute within 24 hours of treatment process.Material and Methods : A retrospective study was carried out evaluating all patients who died during the treatment process in the Emergency Department of Lumbini Medical College in a three and half year of period from January 2014 to June 2017.Results : A total of 33,472 patients attended to ED with mortality rate of 36.4%, 33.6% and 28.2% on consecutive three years in which 110 deaths occurred. There were 66 (60%) male and 44 (40%) female. The highest mortality was seen after age of 60 years (range 2 month to 90 year). Non-communicable causes & stroke deaths were found to be higher in number. Most of our patient n=52 (47.3%) death occurred within 6-12 hours of admission in ED.Conclusion : Mortality within 24 hours of presentation at ED remains high. Well organized emergency setup, transport, development of protocol as well as new guideline will definitely help in reducing hospital mortalities.Journal of Nobel Medical CollegeVolume 6, Number 2, Issue 11 (July-December, 2017) Page:48-52

Paget-Schroetter syndrome (PSS) is a rare form of spontaneous upper extremity deep vein thrombosis associated with vigorous activity of the upper extremities. We present a rare case of a young swimmer who presented with a painful right upper extremity swelling, with compression ultrasound (CUS) revealing extensive venous clots in the basilic, axillary, and subclavian veins. Venous duplex revealed extrinsic compression of the subclavian vein, and catheter-based contrast venography confirmed our diagnosis of PSS. The patient was started on a therapeutic dose of subcutaneous enoxaparin and referred to a higher center for further intervention.

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Leptomeningeal carcinomatosis is a rare complication of metastatic systemic malignancy, with lung cancer being the most common cause. We present a case of a 75-year-old man with a past medical history of right non-small cell lung carcinoma and ischemic stroke who presented with a persistent headache and swallowing difficulties. On evaluation, the patient was initially diagnosed with a subacute infarct of the right posterior frontal lobe following magnetic resonance imaging (MRI). The patient’s headache and dysphagia worsened, increasing the possibility of brain metastasis. The patient underwent cerebrospinal fluid analysis including cytology and multiple MRI studies with no obvious explanation for the symptoms. The patient eventually developed multiple cranial nerve palsies, and a diagnosis of leptomeningeal carcinomatosis was made with neuroradiology consultation for the MRI.