Background. Bacterial contamination in intensive care units is an important risk factor associated with increasing incidences of nosocomial infections. This study was conducted to study the bacterial colonization on commonly touched objects of intensive care units and antibiotic resistance pattern of bacterial isolates. Methods. This study was conducted in different intensive care units of Manipal Teaching Hospital, Pokhara, Nepal. A total of 235 swabs were collected from surfaces of bed rails, monitors, door handles, IV stands, telephone sets, nursing stations, medicine trolleys, sphygmomanometers, wash basin taps, dressing drums, stethoscopes, pulse oximeters, ventilators, defibrillators, and stretchers. Isolation, identification, and antibiotic susceptibility tests of the bacteria were performed following standard microbiological techniques. Results. Of 235 samples, bacterial growth was observed in 152 samples. A total of 90 samples of Staphylococcus aureus were isolated from 235 samples. Most of the sampling sites included in this study were found contaminated with S. aureus. The highest number of S. aureus was cultured from the surface of bed rails. Of the total S. aureus isolates, 54.4% (49/90) were methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin resistance was detected among 8.1% MRSA isolates (4/49). Acinetobacter species were the commonest Gram-negative bacterial isolate. Conclusion. Bacterial contamination of the objects/instruments of the ICU was recorded to be high. The most common contaminating bacteria were S. aureus with a high percentage of MRSA and emergence of VRSA. Periodic microbiological surveillance, detection of contaminated sites, and effective decontamination methods would minimize the colonization by potential pathogens and their transmission.

Background: Pseudomonas spp is notoriously known to be important agent of hospital as well as community acquired infections. These organisms are resistant to many antibiotics by intrinsic and acquired mechanisms making infections difficult to treat. Regular surveillance of infection and antibiotic resistance patterns is necessary for selection of appropriate antibiotics for treatment. Methods: Non repeating Pseudomonas spp isolated from all clinical samples during the year 2017-2019 were included in the study. Identification of Isolates were done by standard conventional tests and antibiotics sensitivity test was done by Kirby-Bauer disk diffusion method following the CLSI guidelines, 2017. Results: A total of 42,545 specimens comprising of sputum, blood, pus, urine, body fluids and endotracheal tubes were processed during the entire 3 year period. There was significant increase (p-value <0.05) in yearly isolation rate of Pseudomonas spp i.e. 141(7.95%), 197(12.14%) and 303(15.69%) isolates in the year 2017, 2018, and 2019 respectively. Resistance rates of the isolates to cefoparazone sulbactam, Piperacillin Tazobactam, and Tobramycin was significantly decreasing (p-value <0.05). Overall resistance to ceftazidime (66.13%) was alarming. Decrease in MDR isolates were statistically significant over 3 years e.g. 32(22.69%), 31(15.73%) and 37(12.21%) isolates in the year 2017, 2018 and 2019 respectively (p-value <0.05). Conclusion: The rate of infection of Pseudomonas spp is significantly increasing. There was gradual decrease in number of resistant isolates and MDR isolates over the peri-od starting from 2017 to 2019 which is a favorable trend. The possible factors playing role have to be further studied, identified and promoted.

Introduction: Thyroid dysfunction is an important endocrine disorder worldwide among which hypothyroidism, is attributed to environmental deficiency of iodine. Congenital hypothyroidism is one of the most common preventable causes of intellectual disability worldwide. Hypothyroidism is easily treated and timely detection and treatment of the disorder could reduce the adverse fetal and maternal outcome. The aim of our study is to find the prevalence of thyroid illness in a tertiary health care center of Nepal. Methods: This was a descriptive, cross-sectional study carried out in the Department of Biochemistry of Shree Birendra Hospital, Chhauni, Kathmandu over a period of five months from March 2021 to July 2021. We selected 1000 patients with symptoms suggestive of thyroid disorders. Detailed history was obtained and free triiodothyronine (fT3), thyroxine (fT4) and thyroid stimulating hormone (TSH) estimation was done in Siemens CP Chemiluminescence Immunoassay analyzer. Data were entered in Microsoft Excel and managed in SPSS version 20.  Results: Most of our patients with hypothyroidism presented with puffiness of the face, hoarseness of voice, whereas weight loss and restlessness were predominant features in hyperthyroid patients. In our study, the prevalence of hypothyroidism and hyperthyroidism were 16.0% and 9.5% respectively. Conclusions: Hypothyroidism is common in the female population. We found that hypothyroidism and subclinical hypothyroidism were more prevalent in the reproductive age group.

Hospital acquired infection (HAI) in intensive care units (ICU) are responsible for high morbidities and mortalities worldwide due to emergence of resistant bacteria. In developing countries, due to lack of knowledge of proper surveillance, proper resources and proper guidance this burden was somewhat underestimated. Thus, the aim of this study was to look for the spectrum of bacteria colonizing the ETTs and to determine proper empirical antibiotic therapy. We collected endotracheal tube aspirates from 188 patients of admitted in ICU of Manipal Teaching Hospital, Pokhara. All bacteria were identified by conventional techniques. Antimicrobial sensitivity testing was performed on Mueller-Hinton agar plates with commercially available antibiotic discs using Kirby-Bauer disc diffusion techniques and interpreted as per the guidelines of CLSI. The antibiotic discs (conc.) used were: piperacillin/tazobactam (100/10mcg), ciprofloxacin (5mcg), amikacin (30mcg), imipenem (10mcg), gentamicin (10mcg), cefaperazone sulbactum(75/10mcg), for Gram negative bacteria and erythromycin (15mcg), amikacin (30mcg), gentamicin (10mcg), ciprofloxacin (5mcg), and clindamycin (2mcg) for Gram positive bacteria. A total of 188 ETTs investigated, 128(68.08%) yielded positive culture. Single type of organisms was found in 119 (63.29%) and 9 (4.7%) cases yielded mixed type of growth. Acinetobacter spp. were the most predominant organism among all gram-negative organisms, which was found to be in 71 (51.82%) cases, followed by Klebsiella pneumoniae in 27 (19.7%), Pseudomonas aeruginosa in 23 (16.78%), Escherichia coli in 5 (3.64%), Enterobacter in 2 (1.46%). Whereas, Staphylococcus aureus (4.37%) was the commonest among all gram-positive organism followed by coagulase negative Staphylococcus in 2 (1.46%) and Enterococcus in 1 (0.73%). Most of Acinetobacter spp. showed resistance to ciprofloxacin (84.5%), while 74.6% were resistant to amikacin, 73.2% to gentamicin, 71.83% to piperacillin-tazobactam and 42.2% towards imipenem. Out of the 6 strains of S. aureus, 5 (83.3%) were methicillin resistant. Due to the increasing incidence of organisms in ICUs, an early and correct diagnosis of ETT associated infections is a challenge for optimal antibiotic therapy. Therefore, the best approach to manage the respiratory infections following ETT application will be appropriate use of antibiotics with adaptation of proper infection control measures, which could help to prevent further spread of infection.

A 1 year old male child with increased frequency of urine associated with increased thirst was found to have some developmental delays. Laboratory investigations showed increased serum sodium level and serum osmolality with decreased urine osmolality. An empty sella turcica was seen in contrast brain MRI; however focal demyelinating lesion was not present. He was managed with intranasal desmopressin therapy. Developmental delays in such cases can be prevented by early referral to a tertiary health care center where laboratory and imaging facilities are available.