Hydatid cyst submandibular gland, an unusal presentation: A case report

This is a case report of a sixteen years old female presented in the Otolaryngology and Head & Neck Surgery with left submandibular region which did not recovered by medical treatment. She underwent excision of left submandibular gland and hispathological examination confirmed the diagnosis as hydatid cyst of left submandibular gland.Health Renaissance 2015;13(3): 188-190

Family presence in emergency: Attitude and belief among emergency health professionals in a Tertiary Care Hospital of Nepal

Background: The emergency department of B.P Koirala Institute of Health Sciences, Dharan, a 700 bedded tertiary care centre provides all medical and surgical services, with easy access to patients by their family members during most of the resuscitation procedures. Complete privacy hence is not ideally maintained. Coping with emotional stress among the family members can be a gruesome experience and reactions from them can be unpredictable. Hence, health professionals are usually exposed to various emotions of the family members of these sick patients.Methods: It is a descriptive cross sectional study among the health professionals working in the emergency department. A sample size of 80 is taken over a period of 3 months. A semi-structured questionnaire leaflet was distributed and collected by the researcher. The attitude and belief was evaluated by 12 questions on the 5 point Liker scale and cutoff value being 3. Points less than 36 were given as negative attitude towards the family presence and more being positive.Results: Out of 80samples, 75 completed with a response rate of about 94%. The majority belonged to age group 20-29 years (70.7%) age, among profession Nurses respondents were about 56%. Male and Female respondent were about equal in numbers, qualification with undergraduate level was higher (73.3%), with an experience of less than 1year being 40%. Amongst the responders there is a positive attitude with increasing age, experience and qualification.Conclusion: The health professionals had a negative attitude towards the presence of family members during the resuscitation or invasive procedures. Hence with the ethnicity and cultural aspect of family their presence is well accepted. Health Renaissance 2015;13 (3): 152-160

Drug ampoules in rectum: Lucky co-incidental finding in emergency department of eastern Nepal

Background: Rectal foreign body is uncommon in emergency usually presenting after failure to remove the object manually or with other complications.Case: Twenty two years male in emergency department presented with rectal leeding following a manual attempt to remove drug ampoules from rectum.Conclusion: In an unexplained rectal bleed, foreign bodies could be a pitfall.Health Renaissance 2015;13(3): 185-187

Indications for destructive eye surgeries at tertiary care hospital, eastern Nepal: A five years experience

Background: Destructive surgery is the management option offered to patients when further retention of the globe is unlikely and can affect ocular and general morbidity.Objective: To determine the frequency and indications for destructive eye surgeries in patients attending a tertiary hospital, Eastern Nepal.Methods: A retrospective analysis of clinical records of all the tructive eye surgeries from April 2008 to March 2013 at a tertiary hospital, Eastern Nepal was carried out. Patients' history, demographic characteristics and indications for the procedure were studied.Results: A total of 88 eyes of 88 patients, who had undergone destructive eye surgery, were reviewed. The mean age of the patient was 22.89 ± 23.49 years, median 9.5 years, with a range of 1.5 months to 80 years. Male: Female ratio was 1:1.04. Enucleation was the most common surgery performed in 46 eyes (52.3%), followed by evisceration in 30 eyes (34.1%) and exenteration in 12 eyes (13.6%). The destructive eye surgery in our study accounted for 51% neoplasms, 17% ocular trauma, 15.9% ocular infection, 10.2% anterior staphyloma and 5.7% painful blind eye. The most common indication for destructive eye surgery was enucleation (60.8%) for retinoblastoma followed by evisceration (46.6%) for open globe injury and exentration (33.3%) for sebaceous gland carcinoma.Conclusions: Enucleation was the most common destructive eye surgery performed. Retinoblastoma, ocular trauma and sebaceous gland carcinoma were the most common indications for destructive eye surgery.Health Renaissance 2015;13 (3): 161-168

Convulsions in pregnancy-not always eclampsia role of neuro-imaging in diagnostic dilemma

Background: Convulsions in pregnancy is always considered and treated as Eclampsia unless otherwise proved. Eclampsia is associated with increased risk of maternal death varying from 1.8 % to 14 % in developed countries. Despite availability of Intensive care units and improved antenatal care, some women still die from Eclampsia. Cerebral complications are the major cause of death in eclampsia patients. Hypercoagulopathy of pregnancy is a high risk factor for these patients in respect to development of cerebro vascular thrombosis and ischaemic strokes. Eclampsia patients who are refractory to the routine treatment have been found to have various Central Nervous System pathological conditions amenable to the medical treatment.Objective: To study the neuro pathophysiology behind a seizure in pregnancy and to reduce the morbidity associated with it. To study the role of neuro-imaging in patients with convulsions in pregnancy not responding to treatment with magnesium sulphate (MgSo4).Methods: It was a prospective study design which included 50 antenatal mothers. All patients were admitted in the eclampsia room with history of convulsions and all of them were put on MgSo4 therapy and Antihyperertensives. The patients who were refractory to the treatment such as having recurrent convulsions despite therapy with MgSo4 were selected for neuro- imaging with Computed Tomography scan. Neuro-imaging was done using Phillips Tomoscan CT scanner where slices of 10-mm thickness were taken through the entire brain in the trans-axial plane. Abdomen shielding was done with lead shield to prevent radiation hazard in the antenatal period.The results were documented and analysed using appropriate statistical method.Results: The CT scanning report revealed: Cerebral oedema (30/50), Encephalopathy (10/50), Intra Cranial Haemorrhage (02/50) Cerebral infarction (01/50), Cortical venous sinus thrombosis (01/50), Tuberculomas (01/50), Neurocysticercosis (01/50) and Hydrocephalus (01/50). Three patients out of 50 had normal CT scan report. Conclusion: Patients with convulsions in pregnancy who were refractory to the treatment with MgSo4 and Antihypertensives have been found to have very significant and morbid CNS pathological conditions. Neuro imaging in these patients have done a pivotal role in identifying the abnormality and rectifying it with medical means which had definitely improved patients conditions and have reduced morbidity and mortality. Health Renaissance 2015;13 (3): 144-151

A case of abdominal tuberculosis diagnosed by fine needle aspiration cytology (FNAC) of mesenteric lymph node

Background: The modes of presentation of abdominal tuberculosis can be vague resulting in diagnostic dilemma.Objective: To report a case of abdominal tuberculosis diagnosed by FNAC of a mesenteric lymphnode.Case: A 17-year-old boy presented in General out Patient department complaining of abdominal pain, abdominal distension, and low grade fever, anorexia and weight loss for 2 months. The examination revealed pallor, low body weight, doughing of abdomen and multiple palpable painless, slightly mobile abdominal lymph nodes. The ultrasonography (USG) guided fine needle aspiration cytology (FNAC) of a mesenteric lymphnode showed caseating necrosis suggestive of tuberculosis. The erythrocytes sedimentation rate (ESR) was raised.Conclusion: The abdominal tuberculosis can present with abdominal pain and abdominal distension associated with low grade fever, anorexia and weight loss. The diagnosis of abdominal tuberculosis can be confirmed by FNAC of the lymphnodes. Health Renaissance 2015;13(3): 177-180

Diffuse parenchymal neurocysticercosis

Neurocysticercosis is the commonest parasitic manifestation of brain and the leading cause of seizure in the developing world. It is caused by the ingestion of Taenia solium eggs through contaminated food and especially pork meat. Computed tomography and magnetic resonance imaging are the modality of choice for diagnosis of neurocysticercosis. We report a case of 65 years old male presented with complaint of seizure, which was diagnosed as diffuse parenchymal neurocysticercosis on computed tomography scan of brain. Health Renaissance 2015;13(3): 177-180

Screening and management of hypertension in a General Practice Outpatient Department of a tertiary level teaching hospital in eastern region of Nepal

Background: Hypertension is a common disease affecting about 20% of the adult population, both in developed and developing world (WHO 2002). It is one of the serious public health problems. Timely detection, compliance with lifestyle modification and use of drugs are important for effective management of this condition. Objective: To find out the prevalence of systemic hypertension in the general outpatient department and to study the effect of drugs and lifestyle education on the blood pressure over time. Methods: This was an interventional series of cases involving diagnosis and management of patients with BP higher than 140/90 or with known hypertension. All the subjects included were given life style education to see the effect of change of life style on blood pressure over time. Results: A total of 258 subjects were screened and 145 (56%) were diagnosed as hypertensive. Of the total, 75 (29%) had a blood pressure level in pre- hypertensive range. Whereas, 42 (16.3%) had hypertension of stage 1, and 28 (11%) had hypertension of stage 2. Forty- nine patients came for first follow up, 40 patients for second and 10 patients for the third follow up. Blood pressure started to decrease with second follow up. Conclusion: This study demonstrated that the prevalence of hypertension is 56% in the general outpatient department. The lifestyle education can have positive impact on blood pressure control.Health Renaissance 2015;13 (1): 58-67

Laparoscopic management of liver echinococcal cyst at B.P.Koirala Institute of Health Sciences Dharan, Nepal an institutional review

Background: Hydatid disease is an endemic disease in several parts of the world. Surgeons and physicians in the non-endemic areas may encounter the disease. Surgery remains the mainstay of therapy. Recently, laparoscopic treatment of hepatic hydatid disease has been increasingly popular and has undergone a revolutionary parallel to the progress in laparoscopic surgery. It is a new and encouraging approach with minimum morbidity and mortality.Objective: To assess the outcome of laparoscopic management of hydatid cyst.Methods: A retrospective & prospective case series study included all patients of hydatid liver cysts who were managed laparoscopically from 1st January 2008- 31st June 2013 (five & half yrs). Patients with deep intraparenchymal location of the cyst, more than 3 cysts and cysts with calcified walls were excluded.Results: Thirty two patients were included in this study to know the results of the laparoscopic management of hepatic hydatid cyst disease. Majority of patients in the age group of 21-40 years. The mean age was of 38± 5.25 with range being 19-65 years. The commonest presentation of dull aching pain in right upper quadrant was seen in 21(62.5%) patients followed by hepatomegaly in 12 (37.5%) patients & right upper abdominal lump in 8 (25%) patients. Twenty seven (84.3%) patients had single cyst & 5 (15.6%) patients had two cysts. The mean diameter of the cyst was 9.2±2.72 cm in size. The mean operative time was (65.42±12.67min) with range being 45-125 mins.Conclusion: The laparoscopic approach is safe & feasible in selected patients. The treatment choices of hydatid disease of the liver have increased in the last 2 decades including medical treatment, percutaneous drainage, or a combination.Health Renaissance 2015;13 (1): 86-94

Impact of educational intervention on knowledge regarding safe handling of cytotoxic drugs among the nursing personnel working in BPKIHS

Introduction: Cytotoxic drugs are toxic compounds and are known to have carcinogenic, mutagenic and/or teratogenic potential. It is also considered as hazardous drugs. With direct contact they may cause irritation to the skin, eyes, and mucous membranes, and ulceration and necrosis of tissue. Safe handling refers to the process in which health care workers adhere to evidence-based practices (EBP) set forth by national organizations that have been designed to eliminate or significantly reduce occupational exposure. The key to safe handling is to protect the health care worker throughout the three phases of contact with the hazardous drugs. These phases are drug preparation, administration and disposal.Objective: To assess the effectiveness of education in enhancing the knowledge regarding safe handling of cytotoxic drugs among nursing personnel working at BPKIHS.Methods: Fifty nurses were taken as sample from selected ward of BPKIHS. One group pretest post test design was used by using population enumeration methods.Results: The overall mean score of knowledge on safe handling cytotoxic drugs of the respondents were 35.3 in the pre-test which increased to 83.7 in the post-test after an educational intervention. The difference was significant (p<0.001).Conclusion: Thus, the study's findings highlighted that there was a significant improvement in knowledge of the staffs after educational intervention. The educational intervention was very effective to improve the knowledge of the staffs. Health Renaissance 2015;13 (1):