The profundity of mental health during the COVID-19 pandemic

Mental health has always been stigmatised and overlooked. Since, anxiety and stress are natural responses while facing a threat of new diseases. Hence, this pandemic has shown us the importance of mental health. During this time there have been many triggers that have caused repercussions in people’s mental health. Mental health crisis is on the rise. So, it is important to be able to tackle mental health problems as effectively as physical health problems, not only now but in the future as well, once and for all.

Eosinophilic pleural effusion in an eleven-year-old boy

Pleural effusion fluid with ?10% eosinophils may be seen in 5-16% of exudative pleural effusions. Its association with helminthic infestation is reported in the literature. This patient with left-sided eosinophilic pleural effusion was a referred case from another hospital and treated initially as parapneumonic. With inadequate response to antibiotics and a markedly high IgE level praziquantel was started. This resulted in rapid disappearance of symptoms, decrease in the eosinophil count, and radiological improvement. After exclusion of parapneumonic, tuberculosis, autoimmune disease, and malignancy, a trial of antihelminthics should be considered an option. This may spare unnecessary investigations.

Feeding practices and early childhood caries among children with primary dentition

Background: Early childhood caries (ECC) is major oral health problem of young children. Risk factors for ECC are poor oral hygiene and feeding practices. Prevalence and severity of ECC is increasing with change in lifestyle and diet pattern in developing countries. Objectives: To assess the association between feeding practices and severity of early childhood caries in preschool children. Methods: An analytical cross-sectional study was conducted with convenient sample of 96 children up to six years age in Peoples Dental College from July to December 2020. Clinical examination included the recording of dental caries (dmft) using WHO criteria. The self-validated questionnaire consisting seven questions about feeding practices was asked to mothers. The Chi-square test was performed to determine association between severity of ECC and feeding pattern. Results: Mean dmft was 6.77 ± 5.91. Prevalence of severe-ECC (S-ECC) was highest in youngest age group. Caries experience was similar in breast fed, bottle fed, and mixed. There was no significant difference in non-severe ECC and ECC in relation to duration of breast or bottle feeding but frequency of night feeding was associated with S-ECC. Children given ready-made infant formula solid food had more S-ECC (13, 92%) compared to non-severe ECC (1, 7.1%) which was statistically significant. Children given homemade gram flour food were noted to have less of S-ECC (5, 27.5%) than nonsevere ECC (13, 72.5%) which was statistically significant. Conclusion: Present study revealed that multiple night feeding and weaning with readymade food are significant factors for S-ECC.

Superior subconjunctival dislocation of intraocular lens following blunt trauma: A rare case report

Subconjunctival dislocation of the intraocular lens secondary to trauma is an unusual and serious condition in the pseudophakic eye. Here, a case of 75 years old male who had traumatic superior subconjunctival dislocation of intraocular lens to his right eye with cow’s horn is reported. The patient was managed with surgical extraction of the lens and planned for secondary intraocular lens implantation. It is quite challenging to manage such a case. Despite, proper surgical management visual outcomes are always guarded in such patients with blunt trauma.

Clinical profile and outcome of children with acute bacterial meningitis in a tertiary care centre in eastern Nepal

Background: Bacterial meningitis is a severe infection of the central nervous system with varied clinical presentations. It is associated with substantial mortality and morbidity. Objectives: The objective of this study was to assess the clinical profile, including the clinical features, laboratory and radiological parameters, clinical course, treatment, response to treatment, complications, and outcome of children at discharge. Methods: A prospective observational study was conducted among 52 inpatient children of acute bacterial meningitis aged one month to 14 years over a period of six months. The patients were enrolled during admission and followed up daily till discharge. Socio-demographic, clinical, and diagnostic details and outcomes were recorded and analysed using statistical package for social sciences version 20. Results: The median age of the patients was two years with male to female ratio of 2:1. Fever (45, 87%), vomiting (37, 71%), seizure (33, 64%) and headache (22, 46%) were the most common symptoms. The cerebrospinal fluid culture was positive in three (6%) cases. Complications were seen in 20 (39%) patients including four (7.7%) deaths. Patients with prolonged fever, malnutrition, loss of consciousness, ear discharge, presence of meningeal signs, abnormal pupil, high cerebrospinal fluid protein, positive cerebrospinal fluid, and blood culture, low blood pH, and hyperlactataemia were significantly associated with complications (p <0.05). Conclusion: Factors like malnutrition, longer duration of fever, and abnormal neurological and laboratory findings were associated with higher rates of complications.

Drain or no drain in Rhomboid excision and Limberg rotational flap for pilonidal sinus

Background: Healing in Rhomboid flap for pilonidal sinus is always a problem. Different measures are applied to reduce the rate of wound infection with variable results. Objectives: To determine the effect of routine use of drain on the rate of early wound complications and additional interventions after Rhomboid flap. Methods: A retrospective chart review of all cases that underwent Rhomboid flap in five years in two tertiary care centres was done. Complication rates such as wound infection, wound disruption, and flap necrosis were evaluated. Results: A total of 38 cases of Rhomboid flap are included for analysis. Out of all cases 37 cases were done for Pilonidal sinus and one case for presacral dermoid cyst. In the first eight cases, flap was made without drain and subsequent 30 cases were done with two suction drains for five days. The rate of superficial wound infection in the group without drain was found to be significantly higher compared with flap with drain 5 (in 8) versus 2 (in 30) (62.5% versus 6.66%, p <0.5). Conclusion: Drain placement after Rhomboid flap is a good intervention to reduce wound infection.

Liver haematoma in pregnancy: A rare complication of HELLP syndrome

Liver haematoma complicating pregnancy with HELLP syndrome is a rare but life-threatening condition. Diagnosis requires a high index of suspicion. Here a case of liver haematoma is presented in a 29 years multigravida at 34 weeks of pregnancy. Initially hypertension was not revealed since she had presented in shock. She had presented with on and off epigastric pain for many days. In context of haemoperitoneum in ultrasound, emergency laparotomy was done and liver haematoma diagnosed intraoperatively. Haematoma was managed with packing and second look laparotomy was done to remove the packs. Haematoma gradually resolved over period of months.

Oral Zinc supplementation in the treatment of sepsis in Nepalese children: A double-blind randomised placebo-controlled trial

Background: Sepsis is one of the most common causes of morbidity and mortality in young children. Zinc supplementation has a preventive effect against diarrhoeal diseases and respiratory infections, but little is known about its effect on the treatment of sepsis. Objectives: To evaluate the benefit of oral Zinc supplementation along with standard antimicrobial therapy in childhood sepsis. Methods: A randomised, double-blind controlled trial was conducted on 164 septic children between 1-15 years of age from 15th April 2017 to 14th April 2018 in a eastern Nepal tertiary care centre. Block randomisation was done with four participants in each block. There were 21 and 20 blocks in the intervention and in the placebo group respectively. Each child received oral zinc (20 mg elemental zinc/day) or a placebo once a day for 14 days. Percentage was calculated for descriptive statistics and Chi-square for inferential statistics with 95% CI and p <0.05 for data analysis using SPSS v.16. Results: Of the participants, 84 (51.21%) received Zinc and 80 (48.79%) received a placebo in adjunct to the standard antimicrobial therapy. Most of the children 76 (46.34%) were under five years and were male 98 (59.75%), and 69 (42.07%) were underweight. Those receiving zinc and placebo had similar improvements at discharge; there was no reduction in the need for higher-order antibiotics or in the length of PICU/ hospital stay. Zinc supplementation in childhood sepsis had no benefit on decreasing mortality or decreasing severity (p >0.05). Conclusion: Zinc supplementation during childhood sepsis does not help in short-term clinical recovery.

Game-based learning in medical education

Not applicable.

Comparison of combined intra-articular and sub-acromial injection with intra-articular injection in adhesive capsulitis

Background: The pain and limitation of shoulder function can disrupt daily activities of patients for months to years. Adhesive capsulitis is considered a self-limiting disease but the duration remains uncertain. The brunt of the disease is focussed on the inflamed joint capsule. On this basis, use of corticosteroid injection is justified. However, injection method is not conclusive. Objectives: To compare clinical benefits of intra-articular injection alone versus combined intra-articular and subacromial injections in management of adhesive capsulitis. Methods: Fifty-nine patients with diagnostic criteria for adhesive capsulitis were included in the study from March 2019 to September 2020. Patients were divided into two groups; patients who underwent intra-articular (IA) injection alone (Group 1) and those who received both intra-articular and sub-acromial (IA+SA) injection (Group 2). The injections were landmark guided. Patients were followed up at three, six, and 12 weeks. Pain was recorded using visual analogue scale (VAS) and subjective function using Constant-Murley score. Results: Twenty-eight patients were included in Group 1 (IA) and 31 in Group 2 (IA+SA). Thirty-six patients were female (18 each in Group 1 and Group 2) and 23 patients were male (Group 1 = 13; Group 2 = 10). In the twelfth week, VAS score was reduced in both the groups. On comparing the mean value of Constant-Murley score between the two groups there is significant difference in value recorded at the sixth and twelfth week. Conclusion: The IA+SA injection provides significant reduction in pain and better function in the short term over the IA injection.