Objectives: Lower respiratory tract infections (LRTIs) are among the most common infectious disease. We determined the bacterial etiology of LRTIs among patients attending Nepalgunj Medical College teaching hospital in Banke, western Nepal. Materials and Methods: 426 specimens from patients with suspected LRTIs attending out-patients and in-patients departments were studied. The specimens were collected and processed according to standard methodology in the Central Laboratory of Microbiology at Nepalgunj Medical College and Teaching Hospital, Banke, Nepal during the period of January to December 2012. Results: Respiratory pathogens were recovered from 210 cases (49.3%). Bacteria were more commonly recovered from endotracheal secretions (86 cases; 41%) than in sputum (82 cases; 39%) and bronchial washing (42 cases, 20%). In168 cases, growth was monomicrobial while the rest was mixed growth. Gram-negative bacteria were isolated in 246 cases (80.9%) and Gram-positive bacteria in 58 cases (19.1%). Among the Gram-positive organisms isolated, Streptococcus pneumoniae (30, 51.7%) was the most predominant pathogen followed by Staphylococcus aureus (28, 48.3%) and in Gram-negative organisms isolated, Pseudomonas aeruginosa (116, 47.2%) was most predominant pathogen followed by Haemophilus influenzae (68, 27.6%), Klebsiella pneumoniae (36, 14.6%) and Escherichia coli (26, 10.6%). Conclusions: Respectively, Pseudomonas aeruginosa and Streptococcus pnemoniae were the most common Gram negative and Gram-positive bacterial isolates recovered from LRTIs. Close monitoring and surveillance of these pathogens is urged.

Background: There has been an increasing role of surgical intervention in managing patients with acute necrotizing lung infections and their complications, such as lung abscess and lung gangrene. Patients and Methods: In this retrospective study, conducted between 2003 and 2013, we presented patients of acute necrotizing pneumonia (ANP) and its complications, who required surgical interventions. Results: Twenty five patients required surgical management of their ANP. At the time of referral to cardiothoracic surgery all patients had evidence of ongoing sepsis despite the antibiotic therapy or have already developed complications. Patients presented with; persistent fever (n=18), cough with or without expectoration (n=25), hemoptysis (n=8), empyema (n=8), persistent air leak (n=3), severe hypoxia (n=3), septic shock (n=2), cachexia (n=6), leucocytosis (n=19), severe leuckopenia (n=3) and severe anemia (n=6). All patients were initially managed by internists, pneumologists and infectious disease teams for periods ranging from 1- 6 weeks prior to referral to cardiothoracic surgery. These patients required one or more of the following surgical procedures; anatomical lung resection (n=10), nonanatomical lung resection & debridement (n=15), and other procedures (n=10). No pneumonectomies were done in our series. There was no intra-operative mortality and only one post-operative mortality in our series. Conclusion: Surgical intervention including major or limited lung resection, for unilateral necrotizing lung infections is a safe procedure for patients with persistent sepsis who are not responding adequately to medical therapy or who have already developed complications.

Background: Many patients with transfusional iron overload are at risk of progressive organ dysfunction and early death. Poor compliance with iron chelators is believed to be a major contributing factor. Objectives: The aim of this study is to evaluate the efficacy of Deferasirox in comparison with Deferoxiamine for the treatment of transfusional iron overload in patients with β-thalassemia major. Patients and Methods: We evaluated the oncedaily Deferasirox for 48 weeks in forty patients (older than 2 years) who had β-thalassaemia major with evidence of iron overload. Some had been previously treated with chelating agents. Most patients began treatment with Deferasirox 10 mg/kg/ day and may be increased to 30 mg/kg/day. Serum ferritin level was assessed before and after beginning of Deferasirox treatment at 3 months interval for 48 weeks. Results: Deferasirox was associated with mild adverse events on most occasions. The mean serum ferritin level decreased significantly in all patients treated with Deferasirox compared to those on Deferoxiamine. Conclusions: Administration of Deferasirox as an oral drug may be preferable and more effective than the parentral iron chelating therapy with better compliance and no inconvenience of parenteral infusion regimens.

Background: Acute myocarditis can present as an ACS with elevated ST segment and elevated level of troponin mimicking myocardial infarction. Aim: To determine the potential diagnostic value of ECG-gated multidetector computed tomography (MDCT) in the setting of suspected acute myocarditis. Patients and methods: The study group consisted of 12 consecutive patients admitted for suspected acute myocarditis less than 5 days after onset of symptoms. All patients had clinical, electrocardiographic signs, and laboratory findings consistent with the diagnosis. ECGgated MDCT was performed in all patients and included a first-pass contrast-enhanced acquisition and a delayed low dose acquisition performed 5 min later without reinjection of contrast medium. 3 patients underwent cardiac MRI with injection of gadolinium. Results: The first-pass MDCT acquisition showed absence of coronary stenosis in all patients. Delayed MDCT acquisition, revealed multiple areas of sub epicardial myocardial hyperenhancement in 9 patients. This hyperhencement was confirmed in the 3 MRI examinations. Conclusion: ECG-gated MDCT could be a useful alternative non-invasive diagnostic test in the early phase of acute myocarditis, especially in the context of emergency and when MRI is unavailable.

Background: Exposure to tobacco has frequently been associated with adverse implications on many body organs and systems. Maternal smoking can influence fetal development, causing intrauterine growth restriction, preterm birth, or even fetal death and spontaneous abortion. Objectives: We investigated the effects of prenatal exposure to nicotine on the prefrontal cortex in adolescent rats. Materials and Methods: Twenty-four mature female Wistar rats were time mated and grouped according to Trimester into Control and Treated groups. Nicotine was administered intra-peritoneally to pregnant Wistar rats in the treated groups, while normal saline was given to the control groups, at each of the three Trimesters. The animals were allowed to litter and the pups were allowed to grow till postnatal day 35, when they were sacrificed and the brain removed and weighed. The prefrontal cortex was excised and either fixed in 4% paraformaldehyde for tissue histology or homogenized in sucrose solution for enzyme studies (alkaline phosphatase, lactate dehydrogenase and glucose-6-phosphate dehydrogenase). Results: Enzyme studies showed derangement in biochemical status of the prefrontal cortex of all the nicotine-exposed animals compared with their respective controls, and corresponding morphological and histological alterations, especially in animals exposed to nicotine during their 2nd and 3rd weeks of fetal life. Conclusions: The morphohistological and biochemical derangements that occur during neurodevelopment of nicotine-exposed offspring persist into adolescent life, and could underlie the neurological dysfunctions associated with such individuals.

Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial infection that causes problems in screening testing. Cefoxitin is potent selective antibiotic agent widely recommended for the detection of MRSA. The aim is to evaluate the optimum concentration of cefoxitin incorporated into mannitol salt agar (MSA) needed to select and detect MRSA. A total of 99 MRSA isolates were tested against 4 different concentrations of cefoxitin mannitol salt agar (MSC) of: 2 μg/ml (MSC-2), 4 μg/ml (MSC-4), 6 μg/ml (MSC-6) and 8 μg/ml (MSC-8). The susceptibility of MSCs were respectively as follows: 53.5%, 53.5%, 74% and 78%. Accurate and effective laboratory screening of MRSA is an important measure control of MRSA.

A 65 years old female had an ERCP whilst being managed for obstructive jaundice in her local hospital. Misplacement of the stents during cannulation occured. The stents created false track retroperitoneally. They remained silent and were not removed after being palpated during laparotomy due to the high risk relationships to important structures and to the poor prognosis of the patient condition.

Pituitary apoplexy is a rare but life-threatening medical emergency that results from either a sudden hemorrhage or infarction in a pituitary tumor. Unrecognized pituitary apoplexy can lead to serious hormonal and neuro-ophthalmic complications and even death. A major challenge in the diagnosis of pituitary apoplexy is that majority of such patients don't have a prior diagnosis of pituitary adenoma. Emergency magnetic resonance imaging of the pituitary gland is the diagnostic tool of choice for this condition. This may not be readily available in many emergency rooms. A previously healthy patient who presented with sudden severe headache and confusion and was found to have pituitary apoplexy is described and a focused review of the condition is given with emphasis on early recognition and complications of this condition

The renin angiotensin aldosterone system (RAAS) inhibitors represent an invaluable class of drugs in the management of various stages of the cardiovascular disease continuum. Both angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have unique pharmacodynamics properties. These enable them to block the RAAS system at multiple levels. The ARBs inhibit RAAS in a mechanistically distinct fashion when compared to the ACEIs. Whereas ACEIs decrease the synthesis of angiotensin II, ARBs selectively and competitively bind to the AT1 receptors hence preventing there activation by angiotensin II. The differential effects of these two groups of drugs, resulted in them playing different roles in primary and secondary cardiovascular protection. It is suggested that ACEIs tend to be more “cardioprotective” whereas ARBs may be more “cerebral-protective”. In this review article, we will attempt to enhance understanding of the role of RAAS blockers in most appropriate selection of ACEIs and ARBs according to their attributes and the needs of the clinical situation. We will initially described the role of RAAS activation in the pathophysiology of common cardiovascular disease processes. This will be followed by a review of the major clinical trials of different ACEIs and ARBs in the primary prevention and secondary prevention of cardiovascular diseases. In conclusion, the effects of ACEIs across a wide spectrum of cardiovascular diseases remain indisputable. However, ARBs showed a superior effect to ACEIs with regard to stroke, but their efficacy in certain major clinical end points seems limited.