Posterior Reversible Encepalopathy Syndrome in A Child With Post Streptococcal Glomerulonephritis- A Rare Case Report

Posterior reversible encephalopathy syndrome is a condition occurring in majority of case of hypertensive encephalopathy mainly due to vasogenic edema in parieto occipital region in neuroimaging. It is reversible if timely treatment is done .Here we are reporting a 11 year old female child with acute post streptococal glomerulonephrtitis leading to typical clinical and radiological features of posterior reversible encephalopathy syndrome

Knowledge, Attitude and Practices of Pharmacovigilance among Doctors at a Tertiary Care Teaching Hospital Birgunj, Nepal

Introduction: Pharmacovigilance helps in the detection and prevention of adverse effects of drugs. For the effectiveness of this program, health care professionals should report adverse drug reactions (ADRs) considering it as their moral and professional obligation. The objective of the study was to assess the knowledge, attitude, and practices (KAP) of the doctors towards ADRs and pharmacovigilance in National Medical College Teaching Hospital (NMCTH), a tertiary care teaching hospital situated in the Narayani zone. Materials and Methods: A cross-sectional study was carried out using a self-administered questionnaire consisting of four parts; first part included a demographic profile of participants, the second part consisted of ten questions for the assessment of the knowledge about pharmacovigilance, third part comprised of six questions on attitude and fourth part consisted of five questions on practice. The results were depicted in the form of percentages for each KAPs questionnaire. Results: The response rate of participants was 85.16%. Pharmacovigilance was correctly defined by 52%. Department of drug administration was responsible for monitoring ADRs in Nepal was correctly given by 80%. Only 8% had reported ADRs, although 62% had encountered an ADR in their clinical practice. Conclusion: The doctors at NMCTH had a poor KAP towards pharmacovigilance and educational intervention is needed for the proper functioning of this program.

Efficacy of Tamsulosin and Alfuzosin in Management of Distal Ureteral Stones

Introduction: Urinary tract calculi are the most frequent condition in urology clinics worldwide. The overall prevalence is about 5 % and lower urinary tract stones account for 70% among them. Medical expulsive therapy has been used to treat distal ureteric stone as it reduces symptoms and facilitates stone expulsion. The aim of this study is to evaluate and compare the efficacy of tamsulosin and alfuzosin as medical therapy in ureteric stones. Materials and Methods: A total of 87 patients with distal ureteral stones of size ≤10 mm were randomly divided into 3 groups. Group A patients (n-30) received 0.4 mg of tamsulosin daily, group B patients (n-29) received 10 mg of alfuzosin daily and group C patients (n-28) received 75 mg of diclofenac sodium. Patients in all groups received diclofenac sodium for one week and then as required. Follow-up was done on a weekly basis for 4 weeks. The stone expulsion rate, time for stone expulsion, and side-effects were recorded in each group. Results: The mean stone size (5.66, 5.79, 5.67) mm and age (29.1, 30.31, 29.4) were comparable in each group. The stone expulsion rate was 83.3%, 79.3%, and 50% in groups A, B, and C respectively. It showed that both the study groups (Group A and Group B) were effective than the control group (p-value 0.006 and 0.02 respectively) but there was no difference between tamsulosin and alfuzosin (p-value 0.69). The duration of stone expulsion was 11.5 days, 11.8 days, and 17.3 days for Group A, B, and C respectively. The drugs related side effects reported by patients were mild and transient. Conclusion: The use of tamsulosin and alfuzosin for the medical treatment of ureteric stones proved to be safe and effective and neither did have any significant benefits over the other.

Establishment and Management Of COVID-19 Testing Molecular Laboratory in Minimal Resource Setting, Challenges and Issues Reported From Birgunj, Nepal – An Experience of Pathologist

The Coronavirus pandemic is recording numerous deaths worldwide. The temporal distribution and burden of the disease varies from setting to setting based on economic status, demography and geographic location. Nepal reported the first COVID-19 case on January 23, 2020. A rapid increase in the number of COVID-19 cases was being reported in Nepal as of June 2020. Limited molecular laboratory capacity in resource limited settings is a challenge in the diagnosis of the ever-increasing cases and the overall management of the disease. In this article, we share the experience, challenges and prospects in the rapid establishment of COVID-19 testing laboratory in Birgunj from available resources. We provide empirical evidence from Parsa district, as this is one of the SARS-CoV-2 transmission hotspots in Nepal and it is likely generalizable to other similar settings in the country. The first step in establishing the COVID-19 molecular testing laboratory were i) identifying a suitable space ii) renovating it and iii) mobilizing materials including consumables, mainly from the hospital store and administration. A chain of experimental design was set up with distinct laboratories to standardize the extraction of samples, preparation of the master mix and detection. At the commencement of sample reception and testing, laboratory contamination was among the primary challenges faced. The source of the contamination was identified in the master mix room and resolved. In summary, the established COVID-19 testing lab (Narayani PCR Lab) has tested more than 40,000 samples (January 2021) and is now the preferred setting for CoVID-19 testing. The lessons learnt may benefit the further establishment of testing laboratories for COVID-19 and/or other epidemic/pandemic diseases in resource-limited settings.

Clinical Profile, Precipitating Factors and Outcome of Hepatic Encephalopathy in Patients with Liver Cirrhosis

Introduction: Hepatic encephalopathy (HE) is characterized by reversible neuropsychological features and is observed with advanced and decompensated cirrhosis of the liver. Patients outcomes and survival depends on clinical presentation, identification of the precipitating factor, early management, and treatment of complications. This study aims to find out the clinical profile of cirrhotic patients with hepatic encephalopathy, their precipitating factors, and clinical outcomes in patients admitted at a tertiary care Teaching Hospital in Gandaki province, Nepal. Materials and Methods: An observational, cross-sectional, hospital-based prospective study comprising of 140 cirrhotic patients with encephalopathy was conducted over a study period of 18 months. Their clinical profile, precipitating factors, and outcomes during hospitalization including mortality were studied. The data analysis was done using SPSS version 20 and a P-value of ≤0.05 was considered significant. Results: Majority (36.5%) of the patients presented with Grade II HE. Upper gastrointestinal (GI) bleeding and spontaneous bacterial peritonitis were the most common precipitating factors. Inpatient mortality was 22.9%. The increased mortality rate was observed in patients with Child class C and with higher grading (Grade III and IV) of hepatic encephalopathy and in presence of more than two precipitating factors Conclusion: Most of the patients presented with Grade II HE. Upper gastrointestinal bleed and infections were the most common precipitating factors. Patients with Hepatic encephalopathy of Grades III and IV, those with CTP Child class C, and in presence of more than two precipitating factors have high mortality.

Carotid Plaques Among Different Ethinic Patients with Ischemic Stroke

Introduction: Sonographic evaluation of the carotid artery is commonly used for risk assessment in stroke. In Nepal, there are few studies regarding morphological changes in the carotid artery including the percentage of stenosis, types of plaque, sites of plaque. These changes quite vary in relation to age, sex, and ethnicity, and other risk factors. The primary objective of the study was to find the prevalence of carotid plaques in different ethnic groups with ischemic stroke. Materials and Methods: The study was an observational, cross-sectional descriptive study conducted in the Neuromedicine department of the National Academy of Medical Sciences. The study included a consecutive sampling of the patients diagnosed with ischemic stroke admitted in the neuro/medicine ward or those visiting neuro/medicine OPD of Bir hospital. Results: Out of the 80 study patients,26.3% patients were Brahmans/Chhetri,11.3% were Madhesi,10 % were Dalits,25% were Newars and 27.5% were Janajati. In descending order, the presence of carotid plaque in Janajati (20%) was followed by Newars (18.8), Brahmans (17.5%), Madhesi group (8.8%), and Dalit (7.5%). The mean number of plaque was higher in Brahman/Chhetri group 3.33 with S.D 3.28 and lowest in Janajati group 2.20 with S.D 3.16. It was found that around 24% of the cases had unilateral carotid plaques and 49% had bilateral carotid plaques. Janajati group had a maximum proportion of bilateral plaques while Dalit had the least proportion (15% vs 2.5%). However, the difference among the ethnic groups was not significant. Conclusion: The prevalence of carotid plaques, the maximum number of plaques, and the number of bilateral plaques, all were highest in the Janajati group. However, the mean number of the carotid plaque was highest among the Dalit group. Further larger studies are required to study the association of the Nepalese ethnicity with carotid morphological changes.

Quality of Life Among Medical Students in Nepal: A Comparative Study

Introduction: Medical education increases mental stress and affects the quality of life in medical students. Tough competition, academic performances, psychological distress, and unhealthy lifestyle add extra burden to the student. The study aimed to compare the quality of life among students of first and final year students. Materials and Methods: This was a cross-sectional study among first and final-year students of Bachelor in Medicine and Bachelor in Surgery (MBBS) degree at National Medical College at Birgunj, Nepal. Pre-designed socio-demographic proforma along with the Kuppuswamy scale was administered to the student. Another scale used was the English version of (World Health Organization Quality of Life-Brief version) WHOQoL-Bref scale. Result: Eighty-one students participated in this study, where 54 students were from the first year and 27 students from an internship. 43.2% of them belonged to the upper socioeconomic class as per the Kuppuswamy scale. The quality of life of interns was higher and better in all domains but was statistically significant in general (0.002), psychological (0.006), environmental (0.002), and overall (0.008) domains. Conclusion: The quality of life of medical students is lower than the general population. It is poorer for the first-year student than the final year interns.

Excess Screen Time - Impact on Childhood Development and Management: A Review

In recent years children are immersed in both traditional and new forms of digital media around the globe. Screen time is now embedded in the daily lives of young children beginning from infancy. Pre-schoolers exposed to screen and interactive media may benefit in many ways but excessive and inappropriate screen exposure could potentially lead to several health and developmental risks. Environmental factors such as parents, siblings, peers have a profound influence on a child’s development. Despite challenges of screen media parenting practices and those posed by lockdown (work from home, online schooling) during this pandemic, parents hold the key to navigate these challenges by serving as role models to ensure positive developmental outcomes in their children.

A Comparison of Incidence of Post Dural Puncture Headache Using 25G Quincke and 25G Whitacre Needle in Obstetric Patients Undergoing Caesarean Section under Spinal Anesthesia

Introduction: Spinal anesthesia has offered a new armamentarium for the anesthesiologists and has been widely used in the Cesarean section in the field of obstetrics, an alternative to general anesthesia. However, Post Dural Puncture Headache remains an inevitable complication of spinal anesthesia and can be minimized its incidence by reducing the size of the needle and changing the design of the needle tip. The objective of the study was to find the incidence of post-dural puncture headache undergoing subarachnoid block for CS using 25G Quincke and 25G Whitacre needles. Materials and methods: This study was conducted from August 2020 to January 2021 enrolling 72 parturients and were allocated in two groups of 36 each. Group A and B parturients received spinal anesthesia via. 25G Quincke and 25G Whitacre in sitting position respectively. All the patients were evaluated based on incidence, onset, duration, and severity of headache postoperatively for 72 hours after the subarachnoid block. Results: The incidence of post-dural puncture headache in the study was 7.2% in Group A and 3.15% in Group B which was statistically significant (P-value = 0.011), while there were no significant differences between these two groups in the onset, severity, and duration of post-dural puncture headache. Conclusion: Despite no significant differences were found for the onset, severity, and duration of post-dural puncture headache, the use of 25G Whitacre is associated with a reduced incidence of post-dural puncture headache compare to 25G Quincke.

Coexistence of Stump Appendicitis and Ovarian Fibro-Thecoma in a Young Women with Recurrent Right Iliac Fossa Pain During Pregnancy; A Rare Case Report

Ovarian Fibro-thecoma is a rare, benign, sex cord-stromal neoplasm, with a typically unilateral location in the ovary, characterized by mixed features of both fibroma and thecoma. Ovarian Fibro-thecoma is Uncommon tumor of gonadal stromal cell origin accounting for 3-4% of all ovarian tumors. We describe a rare case of Fibro-thecoma in a 27- year women with a history of recurrent right iliac fossa pain during pregnancy associated with fever and vomiting with previous history of laparotomy for appendicular abscess 10 years back. She presented to us during pregnancy with this complain for which she was managed conservatively. She did not maintain her follow up regularly at our hospital and visited again after delivery of her baby with a still birth outcome with a newly diagnosed complex bilateral ovarian cyst demonstrated on ultrasound and computed tomography showed inflammatory Right sided tubo-ovarian mass along with inflammatory thickening of ileum in right lower quadrant adjacent to right ovarian mass lesion. The patient underwent laparotomy for this with the removal of mass along with the removal of appendicular stump for appendicular stump appendicitis which was diagnosed intraoperatively. The finding from histopathological examination of the mass was consistent with the diagnosis of Fibro-thecoma.