INTRODUCTION: Hemoptysis is usually considered as an indication of pulmonary tuberculosis, but may be associated with various other causes. Present study will draw attention towards various causes of hemoptysis other than pulmonary tuberculosis. MATERIALS AND METHODS: This prospective study was conducted between August 2008 to May 2009 in the Department of Microbiology, Sikkim Manipal Institute of Medical Sciences, Gangtok, India. Total of 61 blood stained sputum samples were collected and examined to detect various etiological agents (bacteria, fungi and parasites) by standard techniques. Brief clinical details of patients related to their illness were recorded. RESULTS: Acid fast bacilli were demonstrated in 29.5% of cases. Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pneumoniae, Aspergillus niger, Candida albicans and Candida tropicalis were isolated in 8.2%, 4.9%, 6.6%, 1.6%, 3.3%, 8.2% and 3.3% cases, respectively. Patients were clinically diagnosed as pneumonia in 6.5% cases and carcinoma of lung in 3.3% of cases. CONCLUSIONS: Although pulmonary tuberculosis is the major cause of hemoptysis, other causes of hemoptysis need to be excluded. Every case of hemoptysis, if not investigated properly may be misdiagnosed as pulmonary tuberculosis.

INTRODUCTION: Although hematogenous acute epididymo-orchitis complicating Gram negative bacteremia, tuberculosis and brucellosis have been reported in medical literature, there is paucity of report on acute epididymo-orchitis complicating Streptococcus pneumoniae bacteremia. CASE REPORT: We report the case of hematogenous acute epididymo-orchitis from S. pneumoniae bacteremia in an adult chronic cigarette smoker and alcoholic with community acquired pneumonia. CONCLUSION: We recommend that acute epididymo-orchitis should be remember as a sequel of S. pneumoniae bacteremia especially in adult males with immune suppression

INTRODUCTION: Shigellosis still remains a public health problem in developing countries because of poverty, poor sanitation, personal hygiene and poor water supply. Antimicrobial therapy for shigellosis reduces the duration and severity of the disease and can also prevent potentially lethal complications. However, over the past few decades Shigella spp. has become resistant to most of the widely used antimicrobials. This study assessed the patterns of antimicrobial susceptibility and mutations in marA and marR genes of Shigella isolates and its association. MATERIALS AND METHODS: Fifty three isolates of Shigella spp. were tested to evaluate the antimicrobial susceptibility by disc diffusion method (Kirby-Bauer) according to the Clinical Laboratory Standard Institute (CLSI) for the following antimicrobials: ciprofloxacin, norfloxacin, ampicillin, tetracycline, chloramphenicol, trimethoprim, gentamicin and streptomycin and mutation on marAR genes by using polymerase chain reaction–Single strand conformation polymorphism analysis.

INTRODUCTION: Hospital acquired infections (HAI) are serious problems in the patient care and management despite antimicrobial therapy and advances in supportive care in developing countries. Regular cleaning following institutionalized guidelines of infection control policies can minimize the possibility of contamination and prevent the HAI so that the morbidity and mortality related to HAI will be reduced. MATERIALS AND METHODS: Descriptive analysis of the culture growth of the samples from different sites of the Kathmandu Medical College Teaching Hospital (KMCTH) environment from 4th March, 2011 to 4th April, 2012 was done. The swabs were taken before and after fumigation and disinfection and number of colonies grown were used to monitor the effectiveness of the intervention. The cultures and Gram staining were performed as per standard microbiological procedures in Clinical Microbiology Laboratory, Department of Pathology, Kathmandu Medical College Teaching Hospital. RESULTS: Almost all the floors of the hospital wards swabbed were contaminated with the bacteria. The bacteria that grew from the environment ranged from 50 to 140 colonies in Medical Intensive Care Unit and Special High Care Unit respectively. Common contaminants were Staphylococci spp., Gram negative diplococcic, and Gram positive. The Staphylococci spp. contaminated air in most of the wards. The number of colonies after fumigation and disinfection were drastically decreased from no growth to 15 colonies. CONCLUSIONS: Environment was contaminated with microorganisms. Even after regular cleaning and disinfection, bacterial growth was seen. To prevent any contamination prior HAI develops, hospital needs to develop programmes for the implementation of good infection control practices.

INTRODUCTION: Although the evidences suggest that more than one third tuberculosis (TB) cases are being managed in private sector, the quality of care in private sector is major concern. However, the information regarding the private practices were lacking. Therefore the study was conducted to gain insights on current practices of TB management at private sectors. MATERIALS AND METHODS: A descriptive cross sectional study, applying quantitative method, was conducted at two cities of Kaski among all private practitioners, private pharmacies and private laboratories through self administered questionnaire and structured interview schedule. RESULTS: Nearly one fourth of the TB suspects in the district were found to have consulted private providers with about 20.0% of the total smear positive cases diagnosed in private laboratories. Beside sputum microscopy, Private Medical Practitioners (PMPs) were also found to prefer other tests like X-ray, culture for TB diagnosis. Similarly, PMPs’ varying prescription of anti TB drugs beyond National TB Programme (NTP) recommendation along with their weak recording and case holding were noteworthy, and the cost of TB treatment seemed higher in private sector. Only one third of private institution had their staff trained in TB. Except some informal linkage, no collaboration between public and private sector was noted. CONCLUSIONS: Private sector was managing many TB cases in the district. However, their practice of TB management was not much satisfactory. Therefore NTP should take effective measures for Public Private Mix and to make them aware of the standards through training and orientation in order to improve the quality of care.

NTRODUCTION: Bovine tuberculosis (bTB) is an important public health concern worldwide. This study was conducted to determine the status of bTB in animals raised by tuberculosis patients in Western Chitwan, Nepal. MATERIALS AND METHODS: This cross-sectional study was conducted from August, 2011 to January, 2012. A total of 100 bovines (cattle and buffalo) raised in 60 farms of tuberculosis patients were tested with single intradermal tuberculin test considering various animal factors. Well designed questionnaire survey was taken with 70 tuberculosis patients of same 60 families focusing knowledge, awareness and various practices related to bovine tuberculosis. RESULTS: Overall 15% bovines were positive for tuberculosis (13.6% cattle and 15.4% buffaloes).

INTRODUCTION: Due to increased demand and consumption of bottled water in Kathmandu valley, there has been a growing concern about the microbiological quality of this product. The objective of this study was to assess the microbial contamination of heterotrophs and total coliform. MATERIALS AND METHODS: This cross sectional study was done in randomly selected 30 different commercial brand of bottled water available in commercial market of Kathmandu valley, Nepal. Total coliform and heterotrophic bacteria were enumerated by the membrane filtration and spread plate technique, respectively.

Since the discovery of penicillin by Sr. Alexender Fleming in 1928, it had been instrumental in treating critically ill patients and increasing life expectancy. However the emergence of penicillin resistance in 1940s has threatened all the gains offered by it. Newer pharmaceutical companies emerged and newer antimicrobial agents were discovered and commercialized for the treatment of infections but most of them are already ineffective to treat infections due to growing antimicrobial resistance. This emergence of multi-drug (MDR), pan-drug (PDR) and extensively-drug resistant (XDR) pathogens is a global problem, the seriousness of which is evident by the fact that WHO adopted the World Health Day theme 2011 as “Combating antimicrobial resistance”. The growing resistance has posed serious effects for the health care systems in addition to the economic burden to the patients and families. Almost one third of world’s population is infected with tuberculosis and it’s a public health problem. Emergence of TB among HIV infected has worsened the scenario of both the diseases. Malaria is another disease of the poor complicating the situation. In addition to these infectious diseases of public health importance numerous bacterial, viral, protozoal and fungal agents are infecting patients in the hospitals and the community. Usually the first line antimicrobial agents cure the patients, but the treatment has to be switched to second line when they emerge as drug resistant. This second line drugs (reserve drugs) are more expensive and more toxic and are also becoming ineffective. The methicillin resistant and vancomycin resistant Staphylocccus aureus, MDR and PDR Acinetobacter baumannii, Pseudomonas aeruginosa, Citrobacter spp., Stenotrophomonas malotphila etc., metallo-betalactamase producing E. coli and Klebsiella pneumoniae, antiretroviral resistant HIV-1, MDR and XDR strains of M. tuberculosis have already emerged in the globe.1,2,3,4 Growing antimicrobial resistance has numerous effects like, prolonged hospital stay, treatment failure, spread of resistant pathogens to other patients, secondary complications and economic, social and mental problems to the patients as well as for their families. The achieved success in controlling TB will be ruined by increasing MDR and XDR strain and is a threat to the TB control programmes. Similarly, emergence of Artesunate resistance in malaria parasite will pose challenge in malaria control.5 The emergence of resistance is due to inappropriate and indiscriminate use of over the counter antimicrobial agents, irrational use, inadequate infection control practices, poor compliance, over prescription of antimicrobial agents for incentives and ineffective pharmacovigillance systems. Moreover, the emergence of resistance is intimately associated with poverty compelling patients to abort treatment against medical advice. Antimicrobial agents are also becoming popular in agriculture, veterinary and fishery. This wide use of antimicrobials has created selective pressure for human and environmental microorganisms to evolve themselves as resistant. The antimicrobial resistant microorganisms and their resistant genes are growing as an environmental pollutant in the globe. The universal success on containing antimicrobial resistance is possible through combined efforts on advocacy of rational use of antimicrobial agents, development of effective policy to address the rational use of antimicrobials and its implementation, strengthening antimicrobial surveillance network, rational use of antimicrobials in veterinary, fishery and agriculture, standardization of treatment guidelines and most importantly global commitment, adequate resources allocation and research work in this arena to generate evidence to formulate/guide the policy to address antimicrobial resistance. REFERENCES 1. Kumarasamy KK, Toleman MA, Walsh TR, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis 2012;10:597–602. 2. David L. Paterson. Resistance in Gram-negative bacteria: Enterobacteriaceae. Am J Infect Control 2006;34:S20-28 3. Louis B. Rice. Antimicrobial resistance in Gram-positive bacteria. Am J Med 2006;119:S11–S19 4. Pawlowski A, Jansson M, Sköld M, Rottenberg ME, Källenius G (2012) Tuberculosis and HIV Co-Infection. PLoS Pathog 8(2): e1002464. doi:10.1371/journal.ppat.1002464 5. Delacollette C, Bustos MD, Thimasarn K, Ortega L, Christophel EM, Ringwald P. Antimalarial and artemisinin resistance in the Greater Mekong subregion. Regional Health Forum 2011;15:131-133.