Introduction: Antimicrobial resistance is a major global public health threat, driven by inappropriate antibiotic use and associated with increased morbidity, mortality, and healthcare costs. In hospital settings, empirical antibiotic therapy is often initiated before susceptibility results are available, relying largely on conventional antibiograms. However, these provide only aggregated data and fail to reveal critical co-resistance patterns- information essential for predicting cross-resistance and optimizing treatment. To address this gap, our study applies hierarchical clustering to antimicrobial susceptibility data from a tertiary care hospital to identify clinically relevant, multidimensional resistance relationships across antibiotics, with the goal of supporting evidence-based empirical therapy and strengthening antimicrobial stewardship efforts in resource-limited settings. Methods: A retrospective observational study was conducted using microbiology laboratory data from a tertiary care hospital over a two years. Susceptibility results from clinical isolates were included. Hierarchical clustering using Ward’s linkage was applied to a Jaccard distance matrix to identify groups of antibiotics with similar resistance patterns, with analyses performed separately for each major bacterial species. Results: Bacterial growth was detected in 31.3% (12,134/38,725) of clinical specimens processed over a two-year period. Predominantly gram-negative, the most frequent isolates were Escherichia coli and Klebsiella spp., with the majority originating from urine and respiratory samples. Species-specific co-resistance patterns were identified through hierarchical clustering. In E. coli, four antibiotic clusters emerged, distinguishing agents with retained activity from commonly used oral and fluoroquinolone antibiotics that demonstrated overlapping resistance. Klebsiella spp. exhibited clustering patterns consistent with multidrug-resistant phenotypes, in which reserve agents formed independent clusters. Conclusion: Hierarchical clustering revealed distinct, clinically relevant co-resistance patterns that highlight the heterogeneity in susceptibility and limitations of conventional antibiograms. Integrating this analytical approach into AMR surveillance can optimize empirical therapy, strengthen antimicrobial stewardship, and guide AMR control strategies in similar hospital settings.
Introduction: Acute right iliac fossa (RIF) pain is a frequent clinical presentation, with acute appendicitis being the most common surgical cause. While computed tomography (CT) offers high diagnostic accuracy, its use is limited in resource-constrained settings due to cost and radiation exposure. This study aimed to evaluate the diagnostic performance of graded compression ultrasonography (USG) in patients presenting with acute RIF pain and to correlate its findings with CT and surgical/histopathological outcomes.Methods: A prospective observational study was conducted at the Department of Radiodiagnosis, Bir Hospital, Kathmandu, from January to June 2025. Sixty-eight patients with acute RIF pain underwent standardized ultrasonography, and findings were compared with CT and/or intraoperative or histopathological results. Diagnostic accuracy metrics including sensitivity, specificity, predictive values, and Cohen’s Kappa were calculated.Results: Of 68 patients, 51 (75%) were diagnosed with acute appendicitis, including 42 uncomplicated and 9 complicated cases (appendicular lump, abscess, or perforation). Other diagnoses included ileitis/colitis (n=5), renal/ureteric calculus (n=3), ileocecal malignancy (n=3), ileocecal tuberculosis (n=1), diverticulitis (n=1), lymphadenopathy (n=2), and normal findings (n=2). Ultrasonography demonstrated high diagnostic performance with a sensitivity of 96.08%, specificity of 94.12%, and a positive predictive value of 98%. Key sonographic features in appendicitis cases included the “target sign” (94.1%), appendicolith (54.9%), and free fluid (17.6%). Cohen’s Kappa coefficient was 0.885, indicating near-perfect agreement with CT/intraoperative findings.Conclusion: Graded compression ultrasonography is a highly sensitive and specific imaging modality for evaluating acute RIF pain. Beyond diagnosing appendicitis, it effectively identified other significant abdominal pathologies. Given its safety, accessibility, and diagnostic reliability, USG should be considered a primary imaging tool, particularly in resource-limited healthcare settings.
Background: Patella fractures are one of the most common types encountered by an orthopedic surgeon. It continues to pose problems being intra articular, and subjected to continuous deforming forces from muscles. It is also difficult to restore the desired anatomical continuity and congruity of the articular surfaces after reduction and thereby causing complications like osteoarthritis, stiffness of joints, non-union. Hence, this study is aimed to assess the functional outcome of minimally invasive modified tension band wiring in transverse patella fracture. Methods: This was a prospective observational study, done at a tertiary care hospital. This study included adult patients in the age group 18 to 60 years, with displaced transverse fracture of patella treated by minimally invasive modified tension band wiring. Patients with comminuted fractures, open fractures, established knee deformity, and associated ligamentous injury were excluded from this study. They were followed up at 2nd, 4th , 8th , 12th and 24th weeks post-operatively to record Reich and Rosenberg grading, pain score, range of motion and features of radiological union. Results: Total of 30 patients were enrolled in this study. The incidence was high in the age group of 31-40 years. The mechanism of injury was indirect in 21 cases and direct in 9 cases. Majority of patients 28 (93.3%) had their clinical union in less than 8 weeks and only one (3.3%) had complication with superficial wound infection. Based on the Reich and Rosenberg criteria for movement at the end of 24th weeks, our results were graded as excellent in 16 cases (53.3%), good in 8(46.7%) cases, and none had fair or poor outcome. Similarly, mean pain score at 2nd, 4th, 8th , 12th and 24th weeks of follow up is 3.04±0.54, 2.1±0.56, 0.87±0.27, 0.49±0.18 and 0.14±0.1, respectively. Mean range of motion at 2nd,4th , 8th , 12th and 24th weeks of follow ups are 65.83±7.08, 83.66 ± 9.6, 133.83 ±.64, 135.83±5.03 and 137.33±3.13 degrees, respectively with significant improvement in range of motion. A total of 93.3% (28) of patients had radiological union before 8 weeks and 6.66% (2) patients had radiological union after 8 weeks. Conclusion: Fixation of transverse patella fracture with modified tension band wiring gives good union within 2 months with low complication rates.
Background: Computed tomography (CT) plays a critical role in diagnostic imaging, but contributes substantially to cumulative radiation dose. The use of dose optimization strategies—such as Diagnostic Reference Levels (DRLs), Automatic Tube Current Modulation (ATCM), and individualized scanning protocols—is essential to minimize unnecessary exposure. Their application depends on CT technologists' knowledge, skills, and institutional environment. Despite several international studies, national-level data from Nepal are lacking. Methods: A cross-sectional survey was conducted from April to June 2025 among CT technologists across Nepal using stratified random sampling. A validated self-administered questionnaire—developed through literature review and refined via expert consultation and pilot testing—covered demographics, technical knowledge, awareness of optimization principles, training, and institutional support. Data were analyzed in SPSS version 25 using descriptive statistics and chi-square tests. Results: Of the 197 CT technologists surveyed, most were aged 25–34 years (62.4%) and held a bachelor's degree (82.7%). Awareness of Diagnostic Reference Levels (DRLs) was high (79.7%), but only 46.2% reported applying them in practice. Although 98.5% were familiar with the ALARA principle, just 40.1% routinely used shielding. Confidence in adjusting CT parameters (73.6%) and communicating radiation risks (83.2%) was commonly reported, but only 20.8% had attended dose optimization training in the past two years. Just over half (52.8%) had access to dose-monitoring software, and fewer than 40% reported routine protocol review. Most respondents adjusted scan parameters for pediatric patients (90.4%) and screened women of childbearing age for pregnancy (91.9%). No demographic or professional factors were significantly associated with adequate knowledge. Conclusion: CT technologists in Nepal understand basic radiation safety but inconsistently apply optimization strategies. The study highlights the need for targeted education, structured training, and institutional policies to enhance CT imaging safety and efficacy nationwide. Looking forward, national regulatory bodies such as the NHPC and other could play a critical role in standardizing training requirements, developing national DRLs, and enforcing institutional accountability across imaging facilities.
We report a case of a 15-year-old male presenting with persistent epigastric abdominal pain, significant weight loss, lack of appetite, and nausea over a span of 6-7 months. Clinical examination revealed pallor and splenomegaly, while laboratory investigations indicated microcytic anemia and elevated inflammatory markers. Imaging with ultrasound and contrast-enhanced computed tomography (CT) identified multiple ill-defined hypodense lesions in the liver, enlargement of the spleen, and retroperitoneal lymphadenopathy. Despite the absence of pulmonary symptoms and negative results for Acid Fast Bacilli (AFB), a diagnosis of primary hepatic miliary tuberculosis was established based on elevated serum Adenosine Deaminase levels and a positive Mantoux test. Antitubercular therapy was initiated, resulting in significant clinical improvement and normalization of laboratory values within three months. This case underscores the importance of considering extrapulmonary tuberculosis in adolescents with atypical abdominal symptoms, emphasizing the necessity for thorough evaluation and timely intervention to achieve favorable outcomes.
