Labial fusion: A rare cause of obstructive lower urinary tract symptoms in old age females

Lower urinary tract symptoms in females can be due to various factors. Most of the time it is due to simple urinary tract infection and lower urinary tract pathology such as urethral stricture, meatal stenosis, bladder stones, underactive detrusor, and primary bladder neck obstruction. Commonly found neurologic causes among females are detrusor–external sphincter dyssynergia, associated with various brain and spine diseases and diabetic neuropathy. Labial fusion is a rare cause of female voiding difficulty. We herein present two elderly postmenopausal diabetic female patients who had nearly total urethral occlusion due to labial fusion. After thorough history taking and local genitourinary examination, the patients were operated. Treatment included surgical correction followed by the local application of 1% estrogen ointment. Both patients were symptom-free after the procedure. Thus, with a correct diagnosis followed by simple operative procedure, we can treat such patients successfully.

Bacteria etiological agents causing lower respiratory tract infections and their resistance patterns

Lower respiratory tract infections [LTRIs] are among the most common infectious diseases with potential life-threatening complications. The study consisted of 426 patients with suspected LTRIs from mid and far western region of Nepal between September 2011 and July 2014. The specimens were collected and processed according to the standard microbiological methods at the Central Laboratory of Microbiology of Nepalgunj Medical College, Nepal. Among the isolated Gram-positive organisms, Streptococcus pneumonia [n = 30, 51.7%] was the most predominant pathogen, followed by Staphylococcus aureus [n = 28, 48.3%]. Among the isolated Gram-negative organisms, Pseudomonas aeruginosa [n = 71, 35.32%] was the most predominant pathogen, followed by Haemophilus influenzae [n = 68, 33.83%], Klebsiella pneumonia [n = 36, 17.19%], and Escherichia coli [n = 26, 12.94%]. The pattern of resistance varied regarding the bacteria species, and there were multi-resistant isolates. Also, a significant difference [P < 0.05] was observed between males and females for each type of bacterial species. Among 259 isolates, 86 [33.20%] were from children aged 1-10 years, which were statistically significant [P < 0.05] compared to the other age groups. P. aeruginosa and H. influenzae [Gram-negative] and S. pnemoniae [Gram-positive] were the most common bacterial isolates recovered from LTRIs. Age group of 1-10 years old was at a higher risk. Many isolates showed appreciable levels of antibiotic resistance due to antibiotic abuse. There is a need to increase surveillance and develop better strategies to curb the increasing prevalence of LRTI in this region of Nepal