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INTRODUCTION: Drug resistant Salmonella spp. is endemic in several Asian countries. Nalidixic acid-resistant Salmonella enterica serovar Typhi and Salmonella enterica serovar Paratyphi A show reduced susceptibility to fluoroquinolones and have resulted in a rise in treatment failures. Over the past few decades, nalidixic acid-resistant Salmonella spp have emerged in Nepal as well. MATERIAL & METHODS: This is a retrospective study that aims to provide a more recent antibiogram of S. Typhi and S. Paratyphi A isolates in Kathmandu. Between Poush, 2071 and Ashwin, 2072 (December 16,2014 to October 17,2015), 186 culture positive cases of enteric fever were diagnosed at the Civil Service Hospital. Upon isolation of S. Typhi or S. Paratyphi A, antimicrobial susceptibility testing was performed with amoxicillin, azithromycin, ceftriaxone, chloramphenicol, ciprofloxacin, cotrimoxazole, nalidixic acid, ofloxacin and tetracycline. This study shows a much higher frequency of nalidixic acid-resistance in Kathmandu than previously reported; 95.7% in Salmonella enterica serovar Paratyphi A and 86.5% in Salmonella enterica serovar Typhi. The rates of ciprofloxacin- and ofloxacin-resistance were over 50% in both serovar. CONCLUSION: In Nepal, it is necessary to reevaluate the use of fluoroquinolone therapy and introduce feasible alternatives so as to curb treatment failures. [ABSTRACT FROM AUTHOR]

Thrombosis of the dural sinus and/or cerebral veins (CVT) is an uncommon form of stroke, usually affecting young individuals. This study is done to find the clinical profile of patients with cerebral venous thrombosis admitted at Tribhuvan University Teaching Hospital (TUTH), a tertiary care hospital in Nepal for a period of one year. A retrospective study is done for patients admitted with the diagnosis of CVT over a period of one year from September 2012 to August 2013. A total of nineteen patients were admitted. CVT occurred during pregnancy or puerperium in 32% of patients. 74% of patients presented with headache as the presenting complaint and disc edema was seen in 79% of patients. Cerebral venous thrombosis is not an uncommon entity. Any young patient who presents with headache should have proper fundoscopy examination and cerebral venous thrombosis should be excluded in patients presenting with disc edema. [ABSTRACT FROM AUTHOR]

Introduction: At the time when tissue plasminogen activator and time factor is discussed in ischaemic stroke we have tried to study the level of CRP in these patients. Can it be an investigative tool for screening high-risk patients like diabetes and hypertension is still to be studied. Methods: It is a descriptive prospective exploratory research study performed among 50 ischaemic stroke patients admitted in TUTH among other investigation CRP was also done Results: CRP is raised among ischaemic stroke patients but its relation with altered lipid profi le is not so signifi cant. Conclusions: The inclusion of CRP as a risk factor for ischemic stroke or TIA would have important implications. Thus, the use of CRP values may aid in identifying a potentially large number of men and women who are at risk for cerebrovascular events. This, in turn, may lead to the development of new treatment strategies for primary stroke prevention in those individuals identifi ed as being at risk for developing cerebrovascular disease. [ABSTRACT FROM AUTHOR]

Guillain Barre syndrome (GBS) is an acute immune mediated polyradiculoneuropathy. It may be axonal or demyelinating based on electrophysiology study. The clinical profile of patients presenting with GBS differ. A retrospective escriptional study was done at TU Teaching Hospital which consisted of 36 patients admitted with the diagnosis of GBS over a period of one year. The predominant form of GBS was Acute Motor Axonal Neuropathy (AMAN). The weakness started from the lower limbs in majority of patients. Out of 36 patients, four patients (11%) had bifacial weakness and oropharyngeal weakness was present in four patients (11%). Three patients (8%) had extraocular muscle involvement. Only one patient required ventilatory support and there was no mortality. [ABSTRACT FROM AUTHOR]

Anti-N-methyl-D-aspartate receptor encephalitis is a form of autoimmune encephalitis with acute or subacute neuropsychiatric symptoms. Despite this fact, due to a couple of factors, this condition remains insufficiently acknowledged and is an under-recognised clinical scenario. We describe a case of a patient presenting with fever, headache and altered sensorium along with a history of disorientation, episodes of abnormal body movements and loss of consciousness in the later phase. She was initially thought to have Status epilepticus with tuberculous meningoencephalitis but her cognitive functions did not improve despite appropriate treatment. She displayed features away from the usual course of disease leading to suspicions of Autoimmune Encephalitis and Anti-N-methyl- D-aspartate receptor reports later confirmed the diagnosis. Methylprednisolone and Intravenous Immunoglobulin was started empirically and she was discharged in stable health with stabilised emotional and cognitive function with Azathioprine and Levetiracetam continued. Our findings suggested early diagnosis and prompt immunotherapy treatment beneficial for the outcome., Keywords: ase reports; encephalitis; immunotherapy; methylprednisolone.

Dural Venous Sinus Thrombosis is the formation of blood clot within the cerebral sinus. It is very rare case with varying clinical presentation. It has non-specific signs and symptoms ranging from headache, papilledema, seizures, focal neurological deficits and mental state changes which is caused by genetic and acquired prothrombotic states, infections, inflammatory disease and trauma. Magnetic Resonance Imaging with Magnetic Resonance Venography is the specific imaging technique for the diagnosis. We have described a case of a patient who presented with headache over the temporal and occipital region and was disoriented. The Computed Tomography, Magnetic Resonance Imaging, Magnetic Resonance Venography report revealed presence of thrombus in the transverse and sigmoid sinus with hemorrhagic infarcts. He was then treated with anticoagulants Low Molecular Weight Heparin which was further substituted by Warfarin.

Metronidazole is a widely used antibiotic against bacterial and protozoan infections. Even though the therapeutic use of the drug is high, it is associated with some severe side effects like neurotoxicity such as optic neuropathy, peripheral neuropathy, encephalopathy and cerebellar toxicity. We present a case of a 55-years male presented with dysarthria, who had positive cerebellar sign and magnetic resonance imaging findings suggestive of metronidazole induced cerebellar toxicity following metronidazole therapy for two months in a case of liver abscess. And, the symptoms resolved after cessation of metronidazole.

Tolosa-Hunt Syndrome is a rare disease characterized by painful ophthalmoplegia affecting third, fourth, and/or sixth cranial nerve caused by non-specific inflammation in the cavernous sinus or superior orbital fissure of unknown etiology. We presented a 67-year-old female with Tolosa-Hunt Syndrome. She had a right-sided headache and periorbital pain with double vision. Examination showed right-sided ptosis, right-sided trochlear and abducens nerve palsy, and partial right-sided oculomotor nerve palsy with hypoesthesia in the area of the ophthalmic division of the trigeminal nerve. Magnetic resonance imaging of head and orbit showed altered signal intensity changes in the optic nerve and lateral rectus muscle. After steroid therapy, pain and ptosis were significantly improved in 72 hours. Tolosa-Hunt Syndrome is a diagnosis of exclusion, with clinical presentation, normal investigations, magnetic resonance imaging findings, and response to steroid therapy crucial in making the diagnosis.