Colistin Resistance among Human Clinical Isolates from a Tertiary Care Hospital in Nepal.

Background Colistin is increasingly being used for treatment of multidrug resistant (MDR) bacterial infections in human. The plasmid mediated mcr-1 gene was detected recently among the poultry in Nepal. Plasmid mediated colistin resistance among human isolates would severely compromise the treatment of MDR bacterial infections. Objective To find out the prevalence of colistin resistance among the gram-negative bacteria isolated from clinical specimen. Method A descriptive cross-sectional study was conducted in a tertiary care hospital in Kathmandu. Colistin resistance among all the gram negative bacilli (GNB), isolated in a year, from all clinical specimen subjected for aerobic bacterial isolation, was detected by disc diffusion and agar dilution methods. Those with a minimum inhibitory concentration (MIC) > 2 mcg/ml were subjected to polymerase chain reaction for detection of mcr-1 gene. Result A total of 1993 aerobic GNB were isolated from clinical samples received from February 2018 to January 2019. By the agar dilution screening method, 2.1% of the GNBs isolated had MIC of colistin > 2 mcg/ml. None of these possessed the mcr-1 gene. Conclusion Given the occurrence of increased MIC of colistin in the clinical isolates in our set up, nationwide active surveillance would generate data for Nepal. The study for the presence of other genes (chromosomal or plasmid mediated) responsible for the increased MIC of colistin would further guide the control measures.

Cheiro-Oral Syndrome.

Cheiro-Oral Syndrome (COS) is a very rare neurological syndrome associated with varied etiology. We report a 53-year-old man presented with left sided perioral and ipsilateral hand/fingers burning sensation for a one-month duration. On examination, he had hypesthesia over left perioral and distal palmar aspect of all five fingers. MRI revealed subacute infarct in the posterior limb of right internal capsule adjacent to and minimally involving thalamus. He was diagnosed as CheiroOral Syndrome as a result of ischemic stroke and managed.

Inducible clindamycin and methicillin resistant Staphylococcus aureus in a tertiary care hospital, Kathmandu, Nepal.

BACKGROUND: Staphylococcus aureus, an important nosocomial pathogen, is frequently associated with infections in human. The management of the infections by it especially methicillin resistant ones is often difficult because methicillin resistant S. aureus is usually resistant to multiple antibiotics. Macrolide-lincosamide streptogramin B family of antibiotics is commonly used to treat such infections as an alternative to vancomycin. METHODS: This study was conducted over the period of one and half year from November 2013-April 2015 in Microbiology laboratory of Nepal Medical College and Teaching Hospital, Kathmandu, Nepal to find the incidence of different phenotypes of MLSB resistance among S. aureus from clinical samples and their association with methicillin resistance. Two hundred seventy isolates of S. aureus were included in the study. Methicillin resistance was detected by cefoxitin disc diffusion method and inducible clindamycin resistance by erythromycin and clindamycin disc approximation test (D-test). RESULTS: Of the 270 clinical isolates of S. aureus, 25.1% (68/270) were MRSA. Erythromycin and clindamycin resistance was seen in 54.4% (147/270) and 41.8% (113/270) isolates respectively. Resistance to erythromycin and clindamycin were higher in MRSA as compared to MSSA (erythromycin-resistance: 88.2% Vs 39.1% and clindamycin-resistance: 79.4% Vs 41.8%). The overall prevalence of iMLSB and cMLSB phenotype was 11.48% (31/270) and 29.25% (79/270) respectively. Both iMLSB and cMLSB phenotypes predominated in MRSA strains. CONCLUSIONS: Detection rate of MRSA in our study shows the necessity to improve in healthcare practices and to formulate new policy for the control of MRSA infections. Clindamycin resistance in the form of iMLSB and cMLSB especially among MRSA emphasizes the need of D-test to be performed routinely in our set up while using clindamycin as an alternative choice to anti-staphylococcal antibiotics like vancomycin and linezolid in the treatment of staphylococcal infections.

Awareness and Knowledge of Oral Cancer among Medical Students in Kathmandu University School of Medical Sciences.

Background Oral cancer is a major public health problem worldwide. It has high mortality rates and chances of survival is relatively superior when detected early. Lack of knowledge and awareness about oral cancer among medical students may contribute to delay in diagnosis and treatment. Objective To assess awareness and knowledge of oral cancer among medical students. Method A cross-sectional study conducted among 286 students by Department of Otorhinolaryngology and Head & Neck surgery, Kathmandu University School of Medical sciences between July to August 2016. A questionnaire with questions on socio-demographic profile, awareness and knowledge of oral cancer was used. Independent sample t test and Pearson Chi-square tests were used for statistical analysis. Result Out of 329 students approached, 286 participated in the study yielding a response rate of 86.9%. Symptoms of oral cancer as reported were ulceration in mouth (92.3%), oral bleeding (85.0%),whitish or reddish patch (84.3%), halitosis (75.5%) and swelling in neck (74.5%), trismus (69.2%), numbness (67.1%), loosening of teeth (49.3%) and tooth sensitivity (41.6%). The perceived risk factors were smoking (97.2%), tobacco chewing (96.5%), chronic irritation (86.7%), immunodeficiency (83.9%), poor oral hygiene (88.5%), human papilloma virus infection (82.5%), dietary factors (81.1%), alcohol (79.4%), ill-fitting dentures (72.4%), hot spicy food (65.4%) and hot beverages (58.0%). Significant differences were found between pre-clinical and clinical students for knowledge of risk factors, signs and symptoms of oral cancer (p<0.001). Conclusion There is deficiency of knowledge among medical students about some aspects of oral cancer. Active involvement while examining patients and taking biopsies of malignant and premalignant lesions may help in improving students' knowledge about oral cancer.

Reflux Symptom Index and Reflux Finding Score in Diagnosis of Laryngopharyngeal Reflux.

Background Although laryngopharyngeal reflux is a common condition encountered in otolaryngological practice, its diagnosis is not very easy because of its indistinct symptoms Objective To assess the efficacy of proton pump inhibitors versus proton pump inhibitors with lifestyle modification in patients with laryngopharyngeal reflux. Method Prospective, analytical study conducted in Department of Otorhinolaryngology and Head and Neck Surgery at Dhulikhel Hospital, Kathmandu University Hospital between January 2015 to January 2016. Eighty two patients with laryngopharyngeal reflux having Reflux symptom index > 13 and Reflux finding score > 7 were included. Patients were divided into 2 groups. Group A comprised of patients treated with proton pump inhibitors alone and Group B with Proton pump inhibitors with lifestyle modification. Pre and post therapeutic reflux finding score and reflux symptom index were compared. Result The mean reflux symptom index score difference before and after treatment in group A was 16.70 and group B was 14.58. Similarly, mean reflux finding score difference before and after treatment in group A was 8.68 and group B was 9.92. Comparison of reflux finding score and reflux symptom index scores before and after treatment revealed improvement in both groups and the difference was statistically significant (p<0.001). However, comparison of pre and post therapeutic and scores between group A and B, showed no statistical significance. Conclusion The extent of symptomatic improvement correlated positively with both proton pump inhibitor therapy alone as well as with proton pump inhibitor therapy along with lifestyle modification. Although addition of lifestyle modification offered incremental benefit for treating laryngopharyngeal reflux, it was not found to be statistically significant.

Thyroid Isthmus Agenesis in a Patient with Papillary Carcinoma of Thyroid.

Thyroid gland is the largest of all endocrine glands. It is composed of two lobes. These two lobes are joined by an isthmus and this resemble the letter "H". A wide range of morphological variations and developmental anomalies of the thyroid gland like hypoplasia, ectopy, hemiagenesis, and agenesis have been reported in literature. Out of these, the incidence of agenesis of the thyroid isthmus is rare, and very few cases have been reported. In our report, 28 year old male patient was found with agenesis of thyroid isthmus with papillary carcinoma in the right lobe of thyroid. During the operation it was seen that the right and left thyroid lobes were independent from each other and isthmus was absent. We will present a case of thyroid isthmus agenesis and discuss the clinical importance and the incidence of this case.

Socio Demographic Predictors in Delayed Presentation of Head and Neck Cancer.

Background Head and neck cancer is a major public health problem worldwide. In spite of the increase in incidence, there has been paucity of research on socio demographic factors influencing head and neck cancer. Objective To study the influence of various socio demographic factors on late presentation of head and neck cancer. Method Prospective, analytical study conducted in 69 patients with Head and neck malignancies in Department of Otorhinolaryngology and Head and Neck surgery, Kathmandu University School of Medical sciences between January 2015 to January 2016. Collected data were entered and analyzed using IBM SPSS statistical software 21.0. All the socio demographic variables were compared between the early and late presentation groups of patient using Chi-square test. A 'p' value of < 0.05 was considered statistically significant. Result Forty eight were male and 21 were female. The age of patients ranged from 34 to 70 years (mean age 52.03). Twenty patients were diagnosed in stage I, 13 in stage II, 20 in stage III and 16 in stage IV. Significant association was seen between stage of head and neck cancer and duration of illness (p=0.007), educational status of patient (p=0.003) and educational status of patient's care taker (p=0.005). However, no statistical association was seen between stage at diagnosis of head and neck cancer and gender, type of family, previous consultation, systems of alternative medicine adopted before diagnosis, smoking habit, alcohol intake, tobacco chewing habit and occupation. Conclusion The results of this study suggest that educational status may influence the presentation of head and neck cancer.

Evaluation of Etiology of Epistaxis and its Management in Dhulikhel Hospital.

BACKGROUND: Epistaxis is one of the most common and most difficult emergencies presenting in 7-14% of the general population each year. Although its lifetime incidence is about 60%, only 6% require formal medical intervention but they can be serious and even life threatening. OBJECTIVE: The main objectives are to study different etiology, types, modality of treatment of epistaxis. Specific objective is also to find out if the modality of treatment is associated with age, site, amount of bleeding and etiology. METHOD: It is a prospective, cross sectional, longitudinal, analytical study done in Department of ENT, Dhulikhel hospital, Kathmandu University School of Medical Sciences (KUSMS) from Aug. 2010 to Aug. 2013. Data was collected. This study was cleared through institutional review committee of hospital. Statistical analysis was done using SPSS 16.0. RESULT: 487 patients were studied during the period. There was significant association between age group with type of treatment (p value 0.002); and with admission (p value < 0.001). Significance in the study was also shown in the correlation between site of bleeding and the type of treatment and also with alcohol intake with site of bleeding (p value < 0.001).However there was no significance between hypertension and the type of treatment methods chosen (p value > 0.01). CONCLUSION: Management of epistaxis is challenging. Most are managed by non surgical means whereas some by surgical treatment. Non surgical treatment is still useful, safe and cost effective. Type of treatment and need for hospital stay is related to age and site of bleeding.

Study to Compare and Evaluate Traditional vs. Endoscopic Septoplasty.

BACKGROUND: Surgery on a deviated septum has seen several modifications since its inception starting from radical septal resection to preservation of the possible septal framework. OBJECTIVE: To compare the efficacies of "Endoscope Septoplasty" over "Traditional Septoplasty" in treating pathological septum and turbinates, in terms of their outcome. METHOD: Prospective descriptive study conducted on 60 patients who presented to the Department of ENT, Kathmandu University School of Medical sciences during a period of two years. The severity of the symptoms of the patients was scored using a visual analogue scale which was compared post operatively to subjectively evaluate the efficacy of either surgery. Objective assessment was done by nasal endoscopy. P value in case of subjective and objective evaluation was done by applying Z- test. RESULT: The mean age ± SD was 29.5±1.2 .Maximum patients fell into age group of 21-30 with 31.7 % followed by 11-20 with 28.3% and then 31-40 with 25%. There were total 35 males (58.3%) and 25 females (41.7%). Among the symptoms, nasal obstruction seems to be dominating with total of 83.3%, followed by postnasal drip with 66.6% and then headache with 60%. The types of dislocation was compared, there were 66.7% cases with DNS and Spur whereas only 10 % with isolated spur. C shaped deformity was seen in 30% and S shaped in 26.6 % cases. Significance in Z test, is seen in subjective assessment post surgery for nasal obstruction, headache and rhinorrhea and for objective assessment post surgery for persistent contact with turbinates. (p value set to 0.01). CONCLUSION: Endoscopic surgery is an evolutionary step towards solving the problems related to deviated nasal septum. It is safe, effective and conservative alternative to conventional septal surgery.

Study of Microorganism Growth Pattern in Nasal Pack of Patients Visiting the Department of ENT, Head and Neck Surgery.

Background Nasal packs are utilized nearly by otorhinolaryngologists for controlling epistaxis and post nasal procedures. Complications have been reported due to them; therefore the use of antibiotics is a common practice among otorhinolaryngologists. Objective To detect microbiological flora associated with nasal packing and find evidence to support the benefit of systemic antibiotics with it. Method A prospective, analytical study was conducted on 51 patients presenting to the Department of ENT, KUSMS from June to September 2015 who required nasal packing. Approval of the local Institutional review committee (IRC) was taken. The mid part of the pack was collected in a sterile bottle under aseptic technique and sent to microbiology department. Specimen collection, culture, identification tests were done according to the guidelines by American Society for Microbiology. Data were collected using the individual patient records and Microsoft Office Excel 2007. Statistical analysis was performed with SPSS 16.0. Result Among the 51 cultures; 33 (64.7%) were positive. In 18 (35.3%) cultures no organism was grown. Statistical analysis did not show significance between duration of pack kept with microbial growth (p=0.051) or the type of pack kept (p=0.212) .It showed significance with foul smell of the pack to the growth (p <0.001). Conclusion Microbiological flora was associated with nasal pack. Antibiotic soaked nasal packs have lesser incidence of positive bacterial growth when compared with plain nasal packs. Nasal packs kept for less than 48 hours have lesser incidence of positive bacterial growth when compared with nasal packs kept for more than 48 hours. Therefore, administering systemic antibiotics in cases when we plan to keep the pack for longer duration is recommended.

Prevalence of high level gentamicin and vancomycin resistance among clinical isolates of enterococci from a tertiary care hospital in central Nepal.

High level aminoglycoside resistance is an established phenomenon in enterococci. With the increasing use of broad spectrum cephalosporins and glycopeptides, vancomycin resistant enterococci are being increasingly reported from different parts of the world. The objective of our study was to determine the prevalence of high level gentamicin resistant (HLAR) enterococci among the clinical isolates in our hospital and to find the minimum inhibitory concentration (MIC) of vancomycin against these isolates. The enterococci isolated over a year (n = 41) were subjected to HLAR screening by disc diffusion and MIC of vancomycin by agar dilution method. HLAR prevalence was 63%. MIC of vancomycin showed none in the resistant range. However, 4 (9.7%) isolates were in the intermediate range heralding the eminent emergence of VRE if adequate control measures are not implemented in time.

Growing Resistance to Vancomycin among Methicillin Resistant Staphylococcus Aureus Isolates from Different Clinical Samples.

INTRODUCTION: Methicillin resistant Staphylococcus aureus (MRSA), majorly associated with nosocomial and community infections worldwide, are emerging as resistant strains to many antibiotics narrowing down the efficacy of antimicrobial therapy. In order to investigate the changing resistant pattern of MRSA to empirical drugs, the study was carried out at KIST Medical College and Hospital, Nepal. It also aims to determine the minimum inhibitory concentration (MIC) of vancomycin among MRSA. METHODS: Altogether 3500 clinical samples including 1303 blood, 1489 urine and 708 body fluids were collected and processed. Isolated S. aureus were further screened for methicillin resistance by Kirby-Bauer disk diffusion technique using cefoxitin (30µg) disk. All MRSA were subjected to in vitro determination of MIC of vancomycin by agar dilution method as recommended by CLSI guidelines. RESULTS: Total 287 S. aureus were isolated from the different clinical samples. Altogether 248 (86.41%) were found to be multidrug resistance (MDR) while 42 (14.63%) of the isolates were methicillin resistance with the highest prevalence in the age group of 16-30. All 42 (100%) MRSA isolates were resistant to ampicillin and penicillin followed by 41 (97.62%), 32 (76.19%), 31(73.81%), 29 (69.05%), 9 (21.43%) and seven (16.67%) to cefotaxime, gentamycin, cotrimoxazole, erythromycin, tetracycline and ciprofloxacin respectively. Although all MRSA strains were sensitive to vancomycin on disc diffusion, four isolates were intermediates in vitro determination of MIC of vancomycin. The break point for vancomycin was found to be 15mm. CONCLUSIONS: The increment in vancomycin MIC among MRSA is alarming. Strict control measures to prevent MRSA spread and a routine surveillance for VRSA must be incorporated in hospitals.

Reduced susceptibility to vancomycin in methicillin resistant staphylococcus aureus: a time for action.

Infections by Methicillin resistant Staphylococcus aureus (MRSA) is an often encountered therapeutic challenge. The problem is accentuated by the emergence of MRSA strains which are resistant to Vancomycin, the recommended agent for the treatment of MRSA infections. We therefore carried out this study to determine the MIC values ofvancomycin for the MRSA isolated from different clinical specimens in Nepal Medical College. MICs were determined by agar dilution method. Out of the 82 MRSA isolates tested, 18 showed MIC of 2 µg/ml and 29 isolates had MIC of 1 µg/ml and 35 isolates had MIC of 0.5 µg/ml. Although none had a MIC in the intermediate or resistant zone, 18 (2.9%) had MIC in the upper limit of the sensitive zone which is a matter of concern and calls for prompt preventive actions.

Spectrum of bacterial pathogens and their antibiogram from cases of urinary tract infection among renal disorder patients.

Urinary tract infection (UTI) is the commonest bacterial infection occurring in renal disorder patients and is associated with significant morbidity. Resistance to antibiotics is highly prevalent in bacterial isolates and is an emerging problem in UTI. A hospital based cross sectional study was conducted from April 2011 to September 2011 to determine the frequency and bacterial profile of urinary tract infections in the patients with renal disorders visiting KIST Hospital along with their antimicrobial susceptibility pattern. Urine samples were collected from 300 clinically-suspected cases of UTI among renal disorder patients and investigated by conventional semi-quantitative culture technique, microscopy and antibiotic susceptibility test. Significant bacteriuria were detected in 34% of the total subjects, mostly from patients with Chronic Kidney Disease. Incidence of bacteriuria was found higher in females (40.40%) than in males (27.52%) and mostly occurred in elderly patients. Escherichia coli (62.75%) was the predominant isolate followed by Klebsiella pneumoniae (10.78%), Staphylococcus aureus (9.80%), Coagulase negative Staphylococcus aureus (CoNS) (5.88%), Enterococcus spp (3.92%), Klebsiella oxytoca (2.00%), Pseudomonas aeruginosa (2.00%), Proteus mirabilis (2.00%) and Proteus vulgaris (1.00%). Multidrug resistance was observed in 68.82% of the total bacterial isolates.

Correlations between symptoms, nasal endoscopy computed tomography and surgical findings in patients with chronic rhinosinusitis.

BACKGROUND: Although chronic rhinosinusitis (CRS) is increasing in prevalence and incidence, its diagnosis and treatment still pose a challenge. The Task Force on rhinosinusitis (TFR) advocates the use of symptom based criteria. However, many otorhinolaryngologists depend on diagnostic nasal endoscopy and computed tomography (CT) of paranasal sinuses for diagnosis of CRS. Computed tomography has been extensively relied upon in confirming the presence of CRS, in assessing severity of disease, surgical planning and management decisions. Despite its widespread use, several studies have failed to correlate findings on CT with symptom severity. OBJECTIVE: To determine the correlations between symptoms described at presentation, radiological findings, endoscopy and extensiveness of surgery. METHODS: Longitudinal, prospective, analytical study conducted from August 2011 to August 2012 among 87 patients diagnosed as CRS according to the TFR criteria. Symptom, endoscopic, radiological and surgical scoring was done by using Lund and Mackay staging system. Pearson correlation coefficients between scores for symptoms, endoscopy, sinus CT and surgery was determined. RESULTS: When overall symptom score was correlated with radiological score and endoscopy score, it was found to be statistically significant (p= <0.01). However, no significant relationship was found between Lund and Mackay symptom and surgery score. CONCLUSION: The symptom criteria used by TFR for CRS diagnosis are not very specific for sinus disease. A detail assessment of the subjective and objective criteria (CT and endoscopy) is necessary for tailoring surgical plan but should not be relied upon for determining the extensiveness of surgical intervention.

Urinary tract infection in vaginitis: a condition often overlooked.

Despite the differences between the organisms that cause vaginitis and urinary tract infections (UTI), it is possible that women with vaginitis develop UTI. The main objective of the study was to find the association of the common types of infectious vaginitis with UTI. Cross sectional study was conducted for six months in a referral hospital at Lalitpur, Nepal. Three hundred and sixmid-stream urine samples and high vaginal swabs (HVS) collected from non pregnant women were investigated by standard microbiological techniques. Among the women with bacterial vaginosis (BV), 75% also had UTI. Similarly, 46% and 13% of those with vaginal candidiasis and trichomoniasis respectively had concurrent UTI. Considering this strong association of UTI and vaginitis, women with either of these conditions should be tested for the other.

Clinicoradiologic evaluation of Eagle's syndrome and its management.

BACKGROUND: Eagle's syndrome (Elongated styloid process) is often misdiagnosed due to its vague symptomatology. The diagnosis relies on detail history taking, palpation of styloid process in tonsillar fossa and imaging modalities. OBJECTIVE: To assess the length and medial angulation of elongated styloid process with the help of three dimensional computed tomography (3D CT) scan and to describe our clinical and surgical experience with patients suffering from Eagle's syndrome. METHOD: Prospective, analytical study conducted from August 2011 to August 2012 among 39 patients with Eagle's syndrome. Detailed history taking, clinical examination and 3D CT scan was performed. Length and medial angulation was calculated. Patients with styloid process length longer than 2.50 cm underwent surgical excision via intraoral approach. Medial angulation of styloid process on both sides was correlated with each other using rank correlation coefficient. Wilcoxon Signed Rank test was applied to test significant difference between pre-operative and postoperative symptoms scores. RESULT: Significant positive correlation was found between the medial angulation of styloid process on right side and left side (? =0.81, p<0.001). Significant difference was also observed between pre and post-operative symptoms scores (z=-5.16, p<0.001) . CONCLUSION: Possibility of Eagle's syndrome should always be considered while examining patients with vague neck pain. 3D CT reconstruction is a gold standard investigation which helps in studying the relation of styloid process with surrounding structures along with accurate measurement of its length and medial angulation.

Tobacco and alcohol: the relation to pulmonary tuberculosis in household contacts.

Tuberculosis is transmitted commonly by droplet nuclei and facilitated by weak immune system. Lowered immunity may be associated with cigarette smoking, tobacco chewing and alcohol consumption. The co-relationship between these all factors to TB should be explored. This study aims to detect the hidden household contacts (HC) cases early and to examine the relative contribution of tobacco and alcohol use to the risk of TB. Across-sectional study was in Dharan among HCs. From June 2009 to May 2010, 184 index cases with sputum smear positive for AFB and their 802 HCs were included. Three sputum specimens were collected from each HCs and examined microscopically for AFB detection. AFB were detected in sputum of 13 (1.6%) HCs. The association between habits (alcohol user and smoking) and TB was found except with chewing tobacco user (P > 0.05). The risk of contact TB was 4 and 8 times greater in smoker (OR = 3.94 95% CI = 1.26-12.26, P < 0.05) and alcoholic (OR = 8.23 95% CI = 2.71-24.98, P < 0.05) HCs respectively. This study has revealed smoking and alcohols as the risk factors for tuberculosis. Effective campaign to discourage use of alcohol and tobacco, and awareness programme about the mode of transmission of TB are needed in community.

Analysis of ear, nose and throat foreign bodies in dhulikhel hospital.

BACKGROUND: Foreign body in ear nose and throat are commonly encountered by otolaryngologists, pediatricians and primary care physicians. OBJECTIVE: The aim of this study is to analyze different types of foreign bodies and sociodemographic correlates of self inflicted foreign body insertion in ear, nose, throat. METHOD: This was a two year hospital based cross sectional descriptive study performed in the Department of ear nose and throat (ENT), Dhulikhel Hospital - Kathmandu University from June 2009 to June 2011 after verification from the Institutional Review Committee. Using a predesigned questionnaire, socio-demographic data was collected prospectively by examining clinically all patients attending with foreign body and interviewing the caregivers of pediatric patients after removal of foreign body. The data collected from 312 patients was entered and analyzed by using descriptive and analytical statistical methods using SPSS version 16.0. RESULTS: The mean age was 21.26 years with majority between 0-10 years (50.6%). Male predominance was noted (58.97%). Most patients or caregivers were illiterate (35.1%) or literacy up to primary level(21.12%).Foreign body of the ear was found to be most frequent ( 47.4%) and mostly they were non-living (96.1%). Most patients presented late (80%) and had history of prior attempted removal (67%). Pearsons chi square test between education level and duration of time was significant (p value- 0.0000). One way ANOVA test between type of foreign body and age was significant (p value- 0.001). CONCLUSION: Foreign bodies are common in adult and pediatric ear, nose and throat. They can potentially be associated with significant complications if not taken care of immediately.

Cesarean section without urethral catheterization: a randomized control trial.

BACKGROUND: Urethral catheterization is done as a routine procedure in cesarean section. It is associated with high incidence of urinary tract infections, discomfort, delayed ambulation and longer hospital stay. OBJECTIVE: To determine the feasibility and safety of cesarean section without urethral catheterization. METHODS: A prospective, randomized controlled trial was carried out from April 2008 to March 2009, in the Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences. Among 150 patients who had undergone cesarean section 75 were catheterized and 75 were uncatheterized. RESULTS: First void discomfort was significantly associated with the use of indwelling catheter (OR 6.95, CI 95 %, 3.74 to 12.95; P less than 0.001).Significant number of patients with indwelling catheter had signs and symptoms of urinary tract infection (OR 6,CI 95%, 2.59 to 13. 86; P less than 0.001). Positive urinalysis for urinary tract infection was high in catheterized group (P less than 0.001). Hospital stay was shorter in patients without catheter (p less than 0.05). None of the patients had bladder injury. There were no significant differences in duration of surgery and ambulation time between two groups of patients. CONCLUSIONS: Cesarean section can be done safely without urethral catheterization with reduced morbidities.