Appropriateness of perioperative antibiotics in thyroid surgery

Background: Most of the guidelines do not recommend routine antibiotics prophylaxis in clean head and neck surgery like thyroidectomy. In contrary to the recommendation, antibiotics are being routinely prescribed in perioperative period for various duration in many centers of Nepal. This study was aimed to find out the need of postoperative antibiotics in surgeries for thyroid related problems. Methods: Records of all patients who had undergone surgery for thyroid related problems from Jan, 2019 to Sept, 2022 were retrospectively reviewed for patterns of antibiotic use, apart from preincision antibiotic, in postoperative period which was classified as group A – no antibiotics, group B – shorter course of antibiotics (≤3 days) and group C – longer course of antibiotics (>3 days). The occurrence of surgical site infection (SSI) was recorded. Results: During the study period, 77 patients underwent surgery for thyroid related problems, out of which five were excluded (records not found in four cases and one patient was ASA III). Two out of 72 (2.77 %) patients developed superficial incisional SSI which was managed conservatively. One patient in each group A (50) and group B (8) developed SSI. Conclusion: Postoperative antibiotics can be avoided safely even in our setup in clean head and neck surgeries like thyroidectomy without increase in the risk of SSI thus reducing the cost to the patients. &nbsp

Seven incidents within a fortnight in Nepal: Is violence against healthcare professionals curbed by tougher laws?

In September 2023, a surge of violence against healthcare professionals occurred in Nepal within a two-week span, despite recent legal amendments aimed at curbing such incidents. This manuscript explores whether stricter legislation effectively deters these acts. The violence is rooted in Nepal's healthcare system's inadequacies, leading to overcrowded and understaffed hospitals, patient frustration, and healthcare professional burnout. Misinformation and rumors, particularly in rural areas, can trigger outbreaks of violence, exacerbated by media sensationalism. The lack of legal consequences for attackers is a significant factor. Perpetrators often go unpunished, emboldening others to resort to violence when dissatisfied with medical services. Political affiliations and third-party involvement for financial gain are common. The psychological toll on healthcare workers is profound, resulting in burnout, depression, and post-traumatic stress disorder, contributing to a significant brain drain of doctors from Nepal. This paper underscores the importance of enforcing existing laws to create a safe workplace and making the malpractice complaint process accessible to the public to deter resorting to violence

A Rare Case Report and Literature Review of External Auditory Canal Cholesteatoma with Circumferential Destruction of Canal Wall Exposing Facial Nerve

External auditory canal cholesteatoma (EACC) is a rare condition with an estimated incidence of 1.2 per 1000 new otological patients. It is often mistaken with keratosis obturans. We discuss an extensive primary EACC with an aural polyp in a male which was managed by modified radical mastoidectomy

Rowell syndrome secondary to anti-tubercular therapy: A case report and literature review

Rowell syndrome is a condition in which lupus erythematosus is associated with erythema multiformae-like target lesions. The authors describe the condition in a middle-aged woman with drug induced lupus erythematosus and erythema multiformae-like targetoid lesions who initially improved with systemic steroids and antimalarial but succumbed to pulmonary embolism

Primary Atypical Meningioma of the Nasal Cavity: A Case Report and Review of the Literature

Background. Meningioma is a central nervous system tumor that typically arises in proximity to meninges. Extracranial primary atypical meningioma of sinonasal tract is a rare one. Methods. We discuss the clinical, radiological, and histological presentation of an elderly female with primary atypical meningioma of the nasal cavity, which was excised via endoscopic endonasal approach. Results. There was no recurrence even up to 20 months of follow-up after endoscopic excision. Conclusion. Extracranial primary atypical meningioma should be kept in mind as one of the differential diagnoses of nasal mass. Histopathological diagnosis along with immunohistochemistry should be used for definitive diagnosis

Ecthyma gangrenosum aggravated by systemic antibiotics: A case report and literature review

Ecthyma gangrenosum is a cutaneous manifestation of systemic infection caused predominantly by Pseudomonas aeruginosa. We report a case of ecthyma gangrenosum in a child caused by P. aeruginosa who had been previously unsuccessfully treated with systemic antibiotics. A four years old boy presented with the complaints of fever and ulcers on the trunk and extremities. He had been initiated on systemic antibiotics without sending or awaiting reports of blood and skin swab culture and sensitivity. The swab samples taken from the ulcers revealed growth of P. aeruginosa. He was then started on antipseudomonal intravenous antibiotics which eventually led to full recovery. Injudicious use of systemic antibiotics can lead to colonization and infection by opportunistic organisms such as P. aeruginosa. The use of antibiotics has to be based on reports of culture and sensitivity