Use of Continuous Positive Airway Pressure (CPAP) in an Infant with COVID-19 patients in a tertiary care center of Gandaki Pradesh, Nepal

COVID-19 in infancy is a rare disease among all COVID-19 patients. Here we report a case of 2 months old male child who was brought by parents with the complain of fever and running nose for 2 days. He was being treated with antibiotics and antipyretics from local pharmacy without improvement and was admitted in hospital for intravenous antibiotics. On 5th day of admission baby developed grunting and respiratory distress so referred to tertiary center for possible covid-19 infection. Further investigations led to the positivity of COVID-19 in PCR test. He was treated with antibiotics, steroids and kept in CPAP during respiratory distress for 40 hours and then to high flow oxygen therapy via hood box. CPAP during respiratory distress responded to the treatment dramatically. COVID-19 infection among infant though rare, it is important to consider CPAP and oxygen therapy via hood box as an important treatment modality in COVID-19 patients

FORMULATION AND IN-VITRO EVALUATION OF SUSTAINED RELEASE MATRIX TABLETS OF GLIPIZIDE

Diabetes mellitus is a metabolic disorder caused by insufficient production of endogenous insulin, with or without resistance to insulin action, resulting in hyperglycaemia. In type 1 diabetes mellitus, there is a failure in production of insulin as a result of destruction of the cells of the pancreas, and patients require treatment with insulin whereas type 2 diabetes can be characterised by defects in both insulin action (i.e. insulin resistance) and insulin secretion, and is associated with elevated basal hepatic glucose production.  Glipizide is a second-generation sulfonylurea that can acutely lower the blood glucose level in humans by stimulating the release of insulin from the pancreas and is typically prescribed to treat type II diabetes. Different formulations were prepared by varying the concentration of HPMC used as polymers. The effect of varying concentration of hydrophilic polymers (HPMC 5cps and 15 cps) was studied on the release pattern of glipizide. Sustained release glipizide matrix tablets were prepared by wet granulation and compression of hydroxypropylmethyl cellulose (5 cps and 15 cps), drug and other excipients mixture. The promising formulation was compared with the marketed sample of suatained release glynase in terms of release pattern. The release rate of a glipizide from matrix tablet was decreased with increasing the concentration as well as viscosity polymer. This might be probably due to increased swelling and reduced erosion rate of matrix tablet. The formulation 13 (F13) showed the similar result as marketed sample of sustained release glynase tablets in terms of release rate.Key Words: Glipizide, Hydroxy propyl methyl cellulose (HPMC), Viscosity grade

Depressive Symptoms among People Living with HIV Attending ART Centers of Lumbini Province, Nepal: A Cross-Sectional Study

Background. Depression is a common mental disorder and is a leading cause of disability globally. Depressive symptoms among people living with HIV can be a significant barrier to ART initiation and thus lead to poor ART adherence. Global studies have found the prevalence of depressive symptoms among people living with HIV ranges from 12 to 63%. The real scenario of Nepal still needs to be explored. Thus, this study aimed to identify the prevalence and predictors of depression in individuals with HIV. Methods. An institutional-based cross-sectional study was carried out from August to December 2020 among 406 people living with HIV attending ART centers in Lumbini province. Participants were selected using a systematic random sampling technique and surveyed with a structured questionnaire consisting of sociodemographic variables, HIV AIDS-related variables, and 21 items Beck Depression Inventory tool. The odds ratio was used as the ultimate measure of association, with a 95% confidence interval computed to establish statistical significance. A multivariate regression analysis was carried out to identify the final predictors of depressive symptoms. Results. The study found that 26.8% of the respondents had depressive symptoms. Those who were literate (AOR = 0.24, 95% CI: 0.10–0.61), in the poorest wealth quintile (AOR = 7.28, 95% CI: 2.22-23.87), initiated ART within 12 months (AOR = 1.88, 95% CI: 1.03–3.42), had CD4 cell counts below 200 (AOR = 2.50, 95% CI: 1.54–4.06), and had a time difference of 3 months or less between HIV diagnosis and ART initiation (AOR = 0.50, 95% CI: 0.29–0.86) were independently associated with depressive symptoms. Conclusion. Routine screening for depressive symptoms should be integrated into national HIV prevention and control programs for people living with HIV. An enabling environment should be created to facilitate the rapid enrollment of individuals newly diagnosed with HIV in ART services, thereby reducing the time gap between HIV diagnosis and ART initiation

Clinical profile and drug resistance patterns of typhoid fever in children: A prospective hospital-based study

Background: Salmonella typhi and Salmonella paratyphi are important causes of bacteremia in children, especially those from the developing world. The present study is undertaken to study the pattern of antimicrobial resistance of S. typhi in culture positive cases of enteric fever. Materials and Methods: This prospective non-randomized study was conducted in the Department of Pharmacology, J. N. Medical College, AMU, Aligarh, in association with the Department of Paediatrics and Department of Microbiology, J. N. Medical College, on pediatric patients attending the Outpatient/Inpatient Department of Paediatrics, over a period of 1 year and 11 months from September 2005 to August 2006. For all patients with suspected enteric fever, the following investigations were sent for complete hemogram, blood culture, and sensitivity test and Widal test. Results: About 114 randomly selected children having clinical features strongly suggestive of uncomplicated enteric fever with either culture positive or serology positive or both were entered in the study. Fever was the most common clinical presentation and was present in 94.7%. Only 25% of patients attended the hospital within the 1st week of illness, while maximum (54.6%) patients came to the hospital in the 2nd week of illness. Hepatomegaly was more common (43.8%) as compared to splenomegaly (27.1%). The characteristic rose spots of enteric fever were a rare finding in children. Conclusion: Burden of typhoid fever in endemic areas of India underscores the importance of evidence on disease burden in making policy decisions about interventions to control this disease. Our antimicrobial susceptibility data suggest that quinolones and third-generation cefalosporins should be used as first-line antimicrobials in enteric fever. A careful consideration should be given before deciding the antibiotic for treatment to prevent the emergence of antibiotic resistance. Key words: ,,,&nbsp

Prosthetic Rehabilitation of Maxillectomy Patient with Post-Surgical Obturator: A Case Report

Case description: A 60 year old female patient presented to Department of Prosthodontics, CODS, BPKIHS, Dharan with a chief complain of loose obturator. History revealed that patient had undergone partial maxillectomy for squamous cell carcinoma 7 years back. The patient also has been wearing obturator which was loose when the patient reported to the department. On examination, the site of surgery was the maxillary right buccal sulcus area and a part of the hard palate including teeth number 11, 12, 13, 14, 15, 16, 17. The presented defect situation corresponded to a Class I situation (resection performed along the palatalmidline) according to the Aramany classification of defects. The surgical site showed complete healing. A hollow-bulb obturator was fabricated for rehabilitation of the defect. Conclusion: The extensive surgical procedures necessary to eradicate cancer of the head and neck and to prevent local recurrence or regional metastasis often leave extremely large physical defects which present almost insurmountable surgical difficulties in restoring acceptable function or esthetics. The prosthesis rehabilitated the patient in terms of function by providing better masticatory efficiency, phonetics by adding resonance to the voice, hence improving the clarity of speech and also improved the esthetics of the patient. DOI: http://dx.doi.org/10.3126/jcmsn.v10i4.12976 JCMS Nepal 2014; 10(4):32-36</p

The use of Fourier Transform Infrared (FTIR) spectroscopy in skin cancer research:a systematic review

Abstract Skin cancers are one of the most frequently occurring diseases in humans that pose severe health issues. Fourier Transform Infrared (FTIR) spectroscopy in cancer research has gained considerable attention because of its ability to provide biochemical information in addition to being compatible with traditional histopathology. With this review, we aim to identify all skin cancer studies which have been conducted using FTIR spectroscopy and depict different methodologies that have been used to analyze FTIR spectroscopic data of skin cancers. We conducted the systematic review following PRISMA guidelines for which three databases, Scopus, PubMed and Web of Science, were searched from commencement to 16 January 2019. All the studies which used FTIR spectroscopy for skin cancer research were included in the review. A total of 35 studies were found eligible to be included in the review. Of these, 21 studies were based on melanoma, 6 studies on BCC, 2 studies on SCC, and 2 on lymphocytes. The remaining 4 studies aimed to differentiate between various skin cancer types. The potential of FTIR spectroscopy for many relevant aspects of skin cancer research has already been demonstrated, but more work is needed to establish FTIR spectroscopy as a routine method in the field

Comparative study of pattern of infections in adult patients presenting as Acute Japanese Encephalitis and Acute Non Japanese Viral Encephalitis in tertiary care centre in Eastern Uttar Pradesh

Introduction : Acute encephalitis syndrome (AES) caused by Japanese encephalitis (JE) virus is a major health problem in Eastern Uttar Pradesh in India since 1978. In last 10 years a change in pattern of AES has been noticed, with two distinct patterns. One group has AES with extrapyramidal involvement and higher JE virus positivity, while the other has concomitant systemic involvement, mimicking enterovirus infection with low JE virus positivity. Aim&amp; objectives :To compare the pattern of infections in adult patients presenting as Acute JE and Acute Non JE in a tertiary care centre in Eastern Uttar Pradesh.Methods : Fifty eight patients of JE were compared with the 115 patients with Non JE viral encephalitis for demography, clinical features, investigations, complications and outcome. It was a prospective study with one month follow up. Results &amp; Conclusion : Cases of JE came mostly from August to October, while cases of Non JE came throughout the year. Abdominal pain, loose stools, swelling of body and breathlessness were more common in Non JE patients. Hepatomegaly, icterus, ascitis and raised JVP were more common in Non JE patients. Non JE cases have multisystem involvement like renal, hepatic and cardiac. Cerebellar signs, extrapyramidal signs, brisk DTR, hypertonia and hemiparesis were predominant in JE.Full recovery was achieved in 68.96% in JE and 74.78% in Non JE. Partial recovery with sequelae was seen in 13.79% in JE and 11.30% in Non JE. The case fatality rate was 13.79% in JE and 10.43% in Non JE

Inter-organisational systems and peace processes: restoring the local dimension (introduction)

Peacebuilding is nowadays characterised by its polymorphism, with a variety of ostensibly complementary actors involved in the political, socio-economic and military domains. Instead of focusing on institutional discourses or designs that often prevail in academic literature, this special issue returns to concrete interventions. It addresses mechanisms of inter-organisational cooperation in the making. Based on the study of various local settings (Somalia, Liberia, Burundi and Kosovo), the three articles offer new insights into on-the-ground workings of cooperation. They show a discrepancy between the high-value international actors – first and foremost, international organisations – attach to cooperation and the frequently lacklustre results and occasional reverses thereof. On top of that, this special issue relies on several sociological tools and methods that are helpful to understand the complex interactions involved in inter-organisational cooperation in peace processes

Antibiotic resistance among Escherichia coli isolates from stool samples of children aged 3 to 14 years from Ujjain, India

Background: Antibiotic resistance is a major global public health concern, particularly in settings where few treatment options are available. Limited research has been done on antibiotic resistance in Escherichia coli of Indian children at community level. Therefore we studied antibiotic resistance patterns in E. coli isolates from stool samples of children aged 3-14 years from Ujjain, Central India, to investigate associations of resistance with demographic variables. Methods: Children, 3-14 years of age, were included from 30 randomly selected villages of Palwa demographic surveillance site, Ujjain, India. Parents were interviewed using a questionnaire, and stool samples were collected from participating children. E. coli were isolated from stool samples (n = 529), and susceptibility testing to 18 different antibiotics was done using standard methods. Results: The proportions of isolates resistant to various antibiotics were, nalidixic acid, (45%), tetracycline (37%), ampicillin (37%), sulfamethoxazole/trimethoprim (29%) and amoxicillin/clavulanic acid (29%). No isolates were resistant to imipenem. Overall, 72% of isolates were resistant to at least one antibiotic and 33% were multi-drug resistant. High rates of cross-resistance were seen for 15 (83%) of the antibiotics studied. E. coli isolates from children with literate mothers were more resistant to penicillins and fluoroquinolones. ESBL-producers comprised 9% of the isolates. Conclusion: Antibiotic resistance and cross-resistance were common in E. coli from stools of children. Resistance rates were associated with maternal literacy