Extrapulmonary tuberculosis: a debilitating and often neglected public health problem.

We report a case of a 33-year-old woman from Nepal who presented to a hospital with paraplegia. She was found to have pulmonary tuberculosis (TB) with lumbar spine involvement, and bilateral psoas abscesses. She had no initial symptoms attributable to pulmonary involvement.

Acute mountain sickness (AMS) in a Nepali pilgrim after rapid ascent to a sacred lake (4380 m) in the Himalayas.

A 55-year-old female Nepali pilgrim presented to the Himalayan Rescue Association Temporary Health Camp near the sacred Gosainkund Lake (4380 m) north of Kathmandu, Nepal, with a complaint of severe headache, vomiting and light-headedness. She was diagnosed with severe acute mountain sickness. Intramuscular dexamethasone was administered.

An international perspective on hospitalized patients with viral community-acquired pneumonia.

Background: Who should be tested for viruses in patients with community acquired pneumonia (CAP), prevalence and risk factors for viral CAP are still debated. We evaluated the frequency of viral testing, virus prevalence, risk factors and treatment coverage with oseltamivir in patients admitted for CAP.

Methods: Secondary analysis of GLIMP, an international, multicenter, point-prevalence study of hospitalized adults with CAP.

Changing Antimicrobial Resistance Trends in Kathmandu, Nepal: A 23-Year Retrospective Analysis of Bacteraemia.

A comprehensive longitudinal understanding of the changing epidemiology of the agents causing bacteraemia and their AMR profiles in key locations is crucial for assessing the progression and magnitude of the global AMR crisis. We performed a retrospective analysis of routine microbiological data from April 1992 to December 2014, studying the time trends of non- associated bacteraemia at a single Kathmandu healthcare facility. The distribution of aetiological agents, their antimicrobial susceptibility profiles, and the hospital ward of isolation were assessed.

Detecting past and ongoing natural selection among ethnically Tibetan women at high altitude in Nepal.

Adaptive evolution in humans has rarely been characterized for its whole set of components, i.e. selective pressure, adaptive phenotype, beneficial alleles and realized fitness differential.

Typhoid fever with isolated left lateral rectus palsy.

A 17-year-old young woman presented to Patan Hospital, Kathmandu, Nepal, with high-grade fever and headache for 4 days and non-projectile vomiting for 1 day. She also had blurred vision with dizziness on and off. There was no abnormal physical finding.

Outbreaks of Serratia marcescens and Serratia rubidaea bacteremia in a central Kathmandu hospital following the 2015 earthquakes.

Background: Human infections with Serratia spp. are generally limited to Serratia marcescens and the Serratia liquefaciens complex. There is little data regarding the infections caused by the remaining Serratia spp.

Prevalence and type-specific distribution of human papillomavirus infection among women in mid-western rural, Nepal- A population-based study.

Background: Cervical cancer is the most common cancer among women in Nepal. The prevalence of human papillomavirus (HPV) 16 and or HPV 18 among women with cervical pre-cancer and cancer is higher than the incidence of HPV in the world population. The population-based epidemiological data of HPV in the general population in most parts of the country remains unknown.

Burden of cervical neoplasia in mid-western rural Nepal: a population-based study.

Objective: To assess the burden of cervical neoplasia in mid-western rural, Nepal using cytology, visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI).

Method: A cross-sectional, population-based study was conducted. Total of 2,279 married, non-pregnant women aged 20-65 years participated in a screening clinic from May 2016 to January 2017.

Shortened Preoperative Fasting Time to Allow Oral Rehydration Solution Clear Liquid up to Two Hours before Elective Major Surgery in Adults.

Objective: To generate evidence of feasibility to allow clear liquid 2 hours before elective surgery.

Study Design: Cross-sectional observational study.

Place And Duration Of Study: The Department of Surgery, Patan Hospital, Patan Academy of Health Sciences, Nepal, from October to December 2016.

Tuberculosis in Staff and Students of Patan Hospital.

Background: There is a high risk of occupational exposure to tuberculosis among healthcare workers in endemic countries. Regular screening for tuberculosis among healthcare workers is not carried out in Nepal. Infection control measures are also not routinely implemented.

A 23-year retrospective investigation of Salmonella Typhi and Salmonella Paratyphi isolated in a tertiary Kathmandu hospital.

Background: Salmonella serovars Typhi (S. Typhi) and Paratyphi A (S. Paratyphi A), the causative agents of enteric fever, have been routinely isolated organisms from the blood of febrile patients in the Kathmandu Valley since the early 1990s.

The evolution of antimicrobial resistance in Salmonella Typhi.

Purpose Of Review: Increasing antimicrobial resistance in Salmonella Typhi is a serious public health concern, especially in industrializing countries. Here we review recent clinical and laboratory data concerning the evolution of antimicrobial resistance, with particular reference to the emergence resistance against fluoroquinolones, third generation cephalosporins, and azithromycin.

Recent Findings: The last 40 years have witnessed the sequential emergence of resistance to all first-line antimicrobials used in the treatment of S.

Caesarean Section During Second Stage of Labor in a Tertiary Centre.

Background: There is an alarming rise in caesarean section leading to increased adverse outcomes for both the mother and fetus when compared with vaginal delivery. Within this increasing caesarean section rate, there is a concerning increase in the rate of second stage caesarean section. This study highlight the feto-maternal outcome of caesarean section in second stage of labour.

Quality of Clinical Notes: Lesson Learned from Elective Surgery Patients Admitted at University Teaching Hospital.

Background: Informative relevant documentation regarding course of treatment minimizes errors, provides data for evidence based practice and legality. However, the clinical notes are often inadequate. This study aims to analyse quality of structured clinical notes in surgical patients.

Co-trimoxazole versus azithromycin for the treatment of undifferentiated febrile illness in Nepal: study protocol for a randomized controlled trial.

Background: Undifferentiated febrile illness (UFI) includes typhoid and typhus fevers and generally designates fever without any localizing signs. UFI is a great therapeutic challenge in countries like Nepal because of the lack of available point-of-care, rapid diagnostic tests. Often patients are empirically treated as presumed enteric fever.

Core competencies for scientific editors of biomedical journals: consensus statement.

Background: Scientific editors are responsible for deciding which articles to publish in their journals. However, we have not found documentation of their required knowledge, skills, and characteristics, or the existence of any formal core competencies for this role.

Methods: We describe the development of a minimum set of core competencies for scientific editors of biomedical journals.

Tubo-ovarian abscess infected by .

We report a case of a tubo-ovarian abscess infected with serotype A 19-year-old Nepalese woman presented to a hospital in Kathmandu with lower abdominal pain, constipation, fever and a non-healing, suppurative surgical wound from an emergency caesarian section performed 2 months previously at 37 weeks of pregnancy. She also had an exploratory laparotomy for an appendix perforation with peritonitis at 25 weeks of gestation. Her wound infection did not respond to cloxacillin and she had an exploratory laparotomy, and a tubo-ovarian abscess was found from which was isolated.

Ethnically Tibetan women in Nepal with low hemoglobin concentration have better reproductive outcomes.

: Tibetans have distinctively low hemoglobin concentrations at high altitudes compared with visitors and Andean highlanders. This study hypothesized that natural selection favors an unelevated hemoglobin concentration among Tibetans. It considered nonheritable sociocultural factors affecting reproductive success and tested the hypotheses that a higher percent of oxygen saturation of hemoglobin (indicating less stress) or lower hemoglobin concentration (indicating dampened response) associated with higher lifetime reproductive success.

Bilateral symmetrical synovial chondromatosis of shoulder: a case report.

Synovial chondromatosis is a benign arthropathy rarely seen in diarthrodial joints. Extra-articular bilateral symmetrical synovial chondromatosis of shoulder is the rarest variety. The diagnosis is established with the help of imaging modalities and histopathological examinations.

The use of Imatinib resistance mutation analysis to direct therapy in Philadelphia chromosome/BCR-ABL1 positive chronic myeloid leukaemia patients failing Imatinib treatment, in Patan Hospital, Nepal.

Philadelphia chromosome/BCR-ABL1 positive chronic myeloid leukaemia (CML) can be successfully treated with Glivec (Imatinib), which is available free of cost through the Glivec International Patient Assistance programme (GIPAP) to patients with proven CML without means to pay for the drug. We review the acquired mutations in the tyrosine kinase encoded by the BCR-ABL1 gene underlying Glivec failure or resistance in a cohort of 388 imatinib-treated CML patients (149 Female and 239 male) registered between February 2003 and June 2016 in Nepal. Forty-five patients (11 female 34 male) were studied; 18 different BCR-ABL1 mutations were seen in 33 patients.