Challenges in Care of Individuals with Autism Spectrum Disorder during the Covid-19 Pandemic: A Perspective from UK, India and Nepal

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Acanthamoeba Keratitis- Camouflage Entity in Eastern Nepal: A Case Series

Acanthamoeba keratitis is a sight-threatening corneal infection and is a growing clinical problem in the world. Though Acanthamoeba keratitis is considered uncommon and rarely reported in Nepal, we encountered six cases in 2019. All patients had redness, photophobia, decreased vision, and pain with ring infiltrate. Ten percent potassium hydroxide mount revealed Acanthamoeba cyst in all cases. Non-nutrient agar overladen with Escherichia coli revealed feeding tracks and Polymerase Chain Reaction revealed T4 genotype Acanthamoeba in four cases. Amoebicidal treatment was started with chlorhexidine 0.02% eye drop half-hourly and supplementary treatment included moxifloxacin eye drop, a combination of polymyxin B sulfate, neomycin sulfate, and bacitracin eye ointment. After treatment, one patient had the best-corrected visual acuity of 6/9 while others had a visual outcome of hand movement. A high level of clinical suspicion and wet mount examination of specimen from infected corneal tissue are essential to aid in rapid diagnosis.

Outcome of Neonatal Hyperbilirubinemia from a Tertiary Care Hospital in Eastern Nepal: A Cross-sectional Study

Background: Timely detection and treatment of pathological hyperbilirubinemia in newbornscan prevent acute bilirubin encephalopathy and its consequences. We aimed to identifyitsoccurrence, presentationtime, phototherapyduration, need for exchange transfusion,and outcome. Methods: In this cross-sectional study, we enrolled all the babies admitted for pathological neonatal hyperbilirubinemia in the university hospital ofBPKIHSin a one-yearduration. Babies with life-threatening congenital malformations or conjugated bilirubin >20% of total serum bilirubin or >2 mg/dl were excluded. Obstetric profile of mothers, clinical and laboratory parameters of babies, onset time of pathological jaundice, duration of phototherapy, need for exchange transfusion or intravenous immunoglobulin were recorded. Neonatal outcome was classified as good and poor and its association with potential predictors analyzed. Results: One-hundred and fifty babiesdeveloped neonatal jaundice requiring treatment. The most common causes includedABO and Rh setting. No cause was found in 26 (18%) babies. One-hundred and eight babies (72%) were only managed withphototherapy whereas 42 (28%) required both phototherapy and double volume exchange therapy. The majority (84.5%) had good outcome without any residual neurological deficit at discharge.Babies with total serum bilirubin >20 mg/dl at presentation, duration of phototherapy >44.8 h, ABO setting, hemolysis, and out born statussignificantly developed poor outcome (p < 0.05). Conclusion: About 15% of the babies with hyperbilirubinemia had acute bilirubin encephalopathy at discharge suggestive of poor outcome. Babies with high bilirubin at presentation, longer duration of phototherapy, ABO settings, hemolysis, and out born statusdeveloped poor outcome.

Cerebral White Matter Hyperintensities in T2 Weighted Magnetic Resonance Images of Elderly Patients- Correlation with their Mental Status

Background: White matter hyperintensities (WMH), focal and/or diffuse areas of hyperintense signals on T2 weighted magnetic resonance imaging (MRI), are the most common incidental finding in elderly patients. However, their clinical significance is usually overlooked. We aimed to find out the correlation between the degree of cerebral WMH in MRI with the mental status of elderly patients, assessed by Mini-Mental Status Examination (MMSE) score. Methods: This cross-sectional study was conducted for two years on eighty eligible elderly patients (> 60 years) referred to the Department of Radiology and Imaging for MRI of the brain. Demographic variables like age and sex, MMSE score, and MRI variables like location and number of WMHs were studied. The Pearson’s correlation coefficient was used to calculate the correlation between the extent of periventricular WMHs and MMSE score. Results: A significant negative correlation (r = -0.78; p < 0.001) was found between decreased MMSE and the extent of periventricular WMH. A significant negative correlation was also found when periventricular hyperintensities were evaluated individually for frontal caps (r = -0.68; p < 0.0001), band opacities (r = -0.55; p<0.0001) and occipital cap (r = -0.59; p < 0.0001). However, subcortical WMH was not significantly corelated with MMSE score (r = +0.018, p = 0.0897). Conclusion: A significant negative correlation exists between the extent of periventricular WMH seen at brain MRI with cognitive decline in elderly subjects. However, no such correlation exists between subcortical WMH and mental status.

Awareness Regarding Health Insurance Policy Scheme of Government of Nepal among Local Residents of Dharan Sub-Metropolitan City

Background: An expensive care discourages people from using health services. The health insurance policy scheme of the government of Nepal aims to provide quality health care services without a financial burden to its citizens. We aimed to assess its awareness among local people of Dharan and also find its acceptance and association with various demographic variables. Methods: This cross-sectional study was conducted among 249 households in 5 wards of Dharan sub-metropolitan city. Using a semi-structured questionnaire, a face-to-face interview was taken either from the financial decision maker/ financial supporter of the family. The socio-demographic characteristics, awareness and perception towards the health insurance policy scheme and its acceptance were assessed. The chi-square test was used to find the association of their awareness with different demographic variables. Results: The majority (70.7%) of the families were aware of the health insurance policy scheme. The most frequent source of knowledge was their friends/ family members (43.7%) followed by insurance service providers (32.4%). Only 36.6% of the families were enrolled in the health insurance policy scheme while 34.1% were not enrolled despite their knowledge about the scheme. Elderly (> 60 years), dependent, those without formal education, or those living below the poverty line were less aware regarding the health insurance policy (p < 0.05). Conclusion: About 29% of families had no idea about health insurance policy scheme and 34.1% were not enrolled in it despite being aware of the scheme. Friends/ family members and insurance service providers were common sources of information.

Role of NT-proBNP in Detection of Left Ventricular Diastolic Dysfunction in Asymptomatic Type 2 Diabetes Patients with Preserved Ejection Fraction: A Cross-sectional Study

Background: Left ventricular diastolic dysfunction (LVDD) represents the first stage of diabetic cardiomyopathy and is initially subclinical. Early diagnosis enables earlier treatment and stops further progression of the disease. Tissue Doppler Imaging (TDI) is a new diagnostic modality with high sensitivity and specificity to know ventricular diastolic function. N-terminal pro brain natriuretic peptide (NT-proBNP) is a cardiac neurohormone that can be used to identify the changes in ventricular diastolic function. We aimed to estimate the concentration of NT-proBNP and correlate its value with TDI for LVDD in asymptomatic type 2 Diabetes Mellitus. Methods: In this comparative cross-sectional study, we enrolled 100 asymptomatic type 2 diabetic patients and 100 healthy people aged 30-60 years. In both groups, NT-proBNP levels were measured and the presence of LVDD was determined by TDI. The primary outcome parameter was the level of NT-proBNP in diabetics and healthy people. The secondary outcome parameter was the correlation of NT-proBNP level with various grades of LVDD. Results: In patients with LVDD, NT-proBNP levels [median (IQR)] were 123 (102,194) pg/ml in diabetics and 72 (67, 77) pg/ml in the control group. In patients without LVDD, NT-proBNP levels [median (IQR)] were 69 (59, 76) pg/ml in diabetics and 57 (49, 63) pg/ml in the control group. The level of NT-proBNP was significantly higher in those with LVDD (p < 0.001). NT-proBNP concentration significantly increased as grades of LVDD increased. Conclusion: NT-proBNP is a good marker for detection of preclinical LVDD in patients with uncontrolled diabetes prone to develop cardiovascular complications.

Delayed Presentation of a Penile Fracture: A Case Report

Penile fracture is a urological emergency caused by blunt trauma to an erect penis. We report a case of a 40-year-old male who presented with a complaint of a painful swelling of the penis for 4 days. On examination, a flaccid swollen tender penis with bluish discoloration over the shaft and scrotum was noted. A clinical diagnosis of delayed penile fracture was made which was managed immediately surgically under spinal anesthesia. Ourreport emphasizes that penile fracture is diagnosed solely on a reliable history and clinical examination. It has outstanding outcome despite delayed presentation if treated promptly.

Mental Health Problems in Nepalese Migrant Workers and their Families

In this cross-sectional study, we aimed to describe the mental health problems of Nepalese migrant workers and their family members at home in Nepal. Families of migrant workers left behind in Nepal from nine project districts were interviewed to assess the psychosocial problems and offered appropriate psychosocial counselling. We assessed 747 individual members. Ninety-five returned migrant workers received psychosocial counselling, 67% of whom were male. The majority (56%) of the returnees suffered from anxiety, 23% had depression and 11% had serious mental illness. The left-behind family members amounted to 653, 93% of whom were female. The majority (56%) had anxiety, 26% had depression, 7% expressed suicidal ideation or had attempted suicide, 2% had severe mental illness. We concluded that majority of returning workers and left behind family members suffered from anxiety and depression.

Knowledge Regarding Care of Low Birth Weight Babies among Nurses Working in Pediatric Wards of a University Hospital in Eastern Nepal

Background: Birth weight is the single most important factor determining a newborn’s survival chance. Recent development in neonatal care demands nurses to have updated knowledge regarding the care of low birth weight (LBW) babies. We aimed to assess the knowledge regarding care of LBW babies among nurses. Methods: In this descriptive cross-sectional study, we enrolled 54 nurses working in pediatric wards of BPKIHS. To assess their knowledge regarding the care of LBW babies, a pre-tested self- response questionnaire was administered with focus on six domains: knowledge about care of LBW babies, the kangaroo mother care, adequacy of breast feeding, vaccination, bathing of LBW babies, and prevention of infection. The chi-square test was used to examine the association between different categorical variables and their knowledge. Results: The majority (83%) had a Proficiency Certificate in nursing education, 11% had a Bachelor of Science in nursing education and only 6% had completed Bachelor in general nursing. More than half (55.6%) of the nurses had a job experience of 1-5 years. The overall knowledge score (mean ± SD) among the nurses on care of LBW babies was 86.5 ± 2.3. Nurses with Bachelor level of education had better knowledge score (85.5 ± 15.4) compared to those with proficiency level of education (75.1 ± 15.9) (p = 0.003). Conclusion: The knowledge regarding the care of LBW babies among the nurses working in pediatric wards of BPKIHS seemed excellent. Knowledge was better in nurses with higher educational level.

Serum Vitamin D Level in Patients Undergoing Coronary Artery Catheterization

Background: Vitamin D deficiency may be a risk factor for coronary artery disease (CAD). We aimed to measure the prevalence of vitamin D deficiency in CAD and its association with severity of angiographic proven CAD. Methods: This prospective, cross-sectional study included 106 consecutive patients who were admitted for typical angina and had signs of myocardial injury (ECG findings and/ or elevated troponin I or CK-MB) and who underwent coronary angiography at the university hospital of BPKIHS from August 2020 to April 2021. Patients were categorized into angiographic proven CAD group and angiographic normal coronary artery group. Serum vitamin D level was classified as normal (≥ 30 ng/ml) and deficiency (< 30 ng/ml). Results: Out of 106 patients, 78 patients (73.6%) had vitamin D deficiency and 28 (26.4%) had normal vitamin D level (p = 0.39). Vitamin D level (mean ± SD) in patients with angiographic normal coronary artery and angiographic proven CAD were 25.94 ± 11.63 ng/ml and 26.07 ± 12.90 ng/ml respectively (p = 0.97). Prevalence of vitamin D deficiency was 75.0% and 64.3% in significant CAD group and normal coronary artery group respectively (p = 0.39). Similarly, frequency of vitamin D deficiency were 68.6%, 78.3% and 88.90% in single, double, and triple vessel disease respectively (p = 0.21). The vitamin D level (mean ± SD) in single, double and triple vessel disease were 27.31 ± 14.02 ng/ml, 25.69 ± 12.72 ng/ml, 23.08 ± 9.45 ng/ml respectively. Conclusion: The prevalence of vitamin D deficiency in both angiographic normal coronary artery and angiographic proven CAD were high but comparable. There was no association of vitamin D deficiency with severity of angiographic proven CAD.