Loss of Consciousness and Cardiac Arrest as an Atypical Presentation of Tubercular Meningitis: A Case Report

Tubercular meningitis is a devastating presentation of extra pulmonary tuberculosis, with fatality in each case without treatment. A 39 years male, a regular consumer of alcohol and a known case of major depressive disorder, presented with the alleged history of using an electric heater in a closed room, and presented to emergency with unconsciousness and cardiac arrest. As his neurological status didn’t improve over 72 hrs, a magnetic resonance imaging brain was done which was non-conclusive. Electroencephalogram revealed diffuse right fronto-parietal seizure activity ceasing with midazolam injection, hence levetiracetam was started. Lumbar puncture revealed increased adenosine deaminase and nil white blood cells. Repeat lumbar puncture showed lymphocytic–predominant pleocytosis, elevated protein and low glucose. The patient was started on anti-tubercular therapy and an injection of dexamethasone was added. Repeat electroencephalogram didn’t show any seizure-like activity. It is important to be aware of variety of presentations of tubercular meningitis. Delay in treatment leads to irreversible neurological damage and even death.</jats:p

Loss of Consciousness and Cardiac Arrest as an Atypical Presentation of Tubercular Meningitis: A Case Report

Tubercular meningitis is a devastating presentation of extra pulmonary tuberculosis, with fatality in each case without treatment. A 39 years male, a regular consumer of alcohol and a known case of major depressive disorder, presented with the alleged history of using an electric heater in a closed room, and presented to emergency with unconsciousness and cardiac arrest. As his neurological status didn’t improve over 72 hrs, a magnetic resonance imaging brain was done which was non-conclusive. Electroencephalogram revealed diffuse right fronto-parietal seizure activity ceasing with midazolam injection, hence levetiracetam was started. Lumbar puncture revealed increased adenosine deaminase and nil white blood cells. Repeat lumbar puncture showed lymphocytic–predominant pleocytosis, elevated protein and low glucose. The patient was started on anti-tubercular therapy and an injection of dexamethasone was added. Repeat electroencephalogram didn’t show any seizure-like activity. It is important to be aware of variety of presentations of tubercular meningitis. Delay in treatment leads to irreversible neurological damage and even death

Case Report: Paraquat poisoning

Paraquat (1, 1′-dimethyl-4,4′-bipyridinium) is a commonly used herbicide that is highly toxic when ingested. Ingestion of toxic doses of paraquat has serious complications on the lungs, gastrointestinal tract, kidney, liver, and other organs. Due to its inherent toxicity and the lack of a specific antidote, it has a high case fatality rate. Despite being restricted to commercially licensed users in Nepal, it is a common herbicide causing both intentional and accidental poisoning. Although there have been numerous anecdotal cases of paraquat poisoning in Nepal, no reports have been published in the literature. . We report a case of a 30-year old female, who developed gastrointestinal symptoms like vomiting, diarrhoea and odynophagia, renal and liver injury after accidental ingestion of 10ml of 20% paraquat. Symptoms and organ involvement subsided with timely and appropriate supportive management.</ns3:p

Nimesulide-induced Erythema Multiforme Major: A Case Report

Erythema Multiforme Major (EMM) is a rare hypersensitivity reaction that primarily affects the skin and mucosa, typically self-limiting. This case discusses a patient who developed severe EMM lesions after consuming nimesulide, a non-steroidal anti-inflammatory drug (NSAID), for abdominal discomfort. Patient was admitted to the hospital, the drug was discontinued, and supportive measures such as pain management and fluid replacement were initiated. This case, being the first to identify nimesulide as a possible trigger for EMM, aims to contribute to the growing body of knowledge on this topic. It emphasizes the need for vigilance and swift intervention for unusual drug reactions

Job Satisfaction among Medical Doctors in Nepal: A Descriptive Cross-sectional Study

Introduction: Job satisfaction is an attitudinal variable representing the extent to which people like or dislike their jobs. It is a critical factor influencing healthcare quality, patient outcomes, and overall well-being in medical professionals. This study aimed to determine Job Satisfaction among medical doctors in Nepal. Methods: A descriptive cross-sectional study was conducted among medical doctors of Nepal between June 2023 and August 2023 after obtaining ethical approval from the Ethical Review Board of Nepal Health Research Council. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 380 participants, 63 (16.58%) (12.84-20.32 at 95% Confidence Interval) expressed satisfaction. The number of satisfied participants above 40 years were 10 (16%) and less than 40 years were 53 (84%). Out of 63, 46 (73.02%) were male and 17 (26.98%) were females. Conclusions: Job satisfaction among doctors practicing in Nepal was found to be lower than the studies conducted in similar settings