Magnesium sulphate therapy in eclampsia and pre-eclampsia

Background: Maternal and perinatal mortality and morbidity remains high during pregnancy in the presence of eclampsia, it can have severe adverse effects on mother and the fetus. So, its management should be a top priority. The objective of the present research was to study the effect of magnesium sulphate in control of imminent eclampsia and eclampsia.Methods: 19 cases of eclampsia and 185 cases of imminent eclampsia were treated with standardized magnesium sulphate. The outcome measures in terms of recurrence of convulsions, maternal and neonatal outcome, etc. were seen.Results: Most common age group in both the groups were 21-30 years (i.e. 78.9% with eclampsia and 75.7% with imminent eclampsia). In both the groups, majority of the women were primigravidae. In eclampsia group, 9 (47.4%) women had 1 episode of convulsion, 8 (42.1%) women had two episodes of convulsions, 1 (5.3%) women each had 3 and 4 episodes of convulsions, while there were no convulsions in imminent eclampsia women (‘t’ value = 28.558, df=202, p=0.000). Vomiting and headache (94.7%) were the most common premonitory symptoms in eclampsia group, followed by edema in 68.4% women, while in imminent eclampsia 64.9% women had headache, 57.8% women had edema and 43.2% had vomiting. Recurrence of convulsions were seen in 4 (21.1%) women of the eclampsia group even after giving maintenance dose and additional dose of magnesium sulphate. 1 (5.3%) death was seen in eclampsia group and none in the imminent eclampsia group. Neonatal mortality in eclampsia group (47.4%) was higher than imminent eclampsia group (11.7%), which was statistically significant (Z value = 3.05, p=0.002).Conclusions: Magnesium sulphate regimen was effective in control of convulsions in eclampsia and as prophylaxis in imminent eclampsia

Head and Neck Myxoma Presenting as Isolated Laryngeal Polyp

Myxoma is a benign tumour with a propensity for local infiltration and recurrence. Laryngeal myxoma presents as a submucosal polyp. Being an uncommon tumour and mimicking vocal cord polyp, only anecdotal evidence is available in the literature. The literature was reviewed from 1986 onwards using the keywords “myxoma” and “larynx.” The databases used were PubMed, Google Scholar, Scopus, and Web of Science. Along with this, we also report our case of vocal fold myxoma. We found a total of 19 studies reporting laryngeal myxoma. Laryngeal myxoma typically affects males in the 6th decade with a history of smoking. Unlike myxomas originating outside the larynx, recurrence is not widely described, and microlaryngeal surgery will usually suffice. Laryngeal myxomas should definitely be kept in the list of differential diagnosis when dealing with a benign-looking vocal fold lesion

Recurrent Mucoepidermoid Carcinoma of Parotid with Facial Tics - Report of an unusual case

We report an interesting case of a 21 year old male who presented with recurrent mucoepidermoid carcinoma of parotid with facial nerve involvement as facial tics. Intraoperatively, the tumour was noted to be firm, irregular and adherent to the underlying structures. The patient underwent extended total parotidectomy, division of buccal branch of facial nerve, selective neck dissection with cervical local rotational flap repair and post-operative radiotherapy. This presentation of Mucoepidermoid carcinoma with involvement of facial nerve as facial tics is one of the rare unique reported cases

Umbrella Partnership: a case study on capacity building and bringing synergy between local and national NGOs in an emergency

Nepal’s 9th & 10th 5-year plan had identified Non-Governmental Organization as vital partners in contributing to reducing poverty. On the other hand same local NGO working at district and provincial level lack the capacity; specifically not having defined roles and responsibilities in responding to the specific needs of poor and disadvantaged communities (Badu, 2002). Chand (2001) has identified that local NGOs which are working and advocating in the sector like drinking water and sanitation requires robust organizational technical and management capacity. Due to the lack of capacity of local NGOs, INGOs and donors preferably work with other INGOs or civic groups formed by donors and communities (ADB, 2005). This situation leads to a vicious cycle where a local NGO having low organizational capacity is left behind without having an opportunity to partner with INGOs. This ultimately leads to limiting the prospects of having access to learning and sharing opportunities for their overall organizational growth and development. This paper intends to share the learning of partnership experience while working in COVID-19 Pandemic

Association of various factors related to mastoid buffer and middle ear ventilation in etiopathogenesis of squamous chronic otitis media—a cross-sectional study

Abstract Background Active squamous chronic otitis media (COM) is an entity with a deep retraction pocket of the pars tensa or flaccida that has retained debris of squamous epithelial where the fundus cannot be visualized involving the pars flaccida or pars tensa, associated with cholesteatoma. Eustachian tube dysfunction (ETD) is a known etiological factor for squamous COM, based on Wittmack’s theory; however, there are very few recent studies in this regard. Contracted mastoid pneumatisation (diploic or primary sclerosis) and presence of Korner’s septum have also been implicated to be associated with middle ear pathology, with conflicting results. Hence, the present study was undertaken to find out the association of three important factors, namely eustachian tube dysfunction, type of mastoid pneumatisation, and Korner’s septum related to mastoid buffer and middle ear ventilation in etiopathogenesis of active squamous chronic otitis media. The study also attempted to identify various conditions of nose and nasopharynx associated with ETD. This would enable us in appropriate surgical decision making with long term benefits in term of hearing and disease outcomes. Results Out of the total 37 patients, with active squamous chronic otitis media, it was observed that Eustachian tube dysfunction was found to be associated with 23 (62.16%). The majority of patients had a diploic/primary sclerosed mastoid pneumatization pattern which is 32 (86.48%) of patients. Korner’s septum was found to be associated with 13 (35.13%) patients of the total 37 patients with active squamous chronic otitis media. All these findings were found to be statistically significant. Conclusion In this study, we found that there was a statistically significant positive association of all etiological factors namely Eustachian tube dysfunction, contracted mastoid (diploic/primary sclerotic mastoid), and the presence of Korner’s septum with causation of active squamous otitis media. Out of these factors, occurrence of diploic mastoid seemed to be the most constant association. Eustachian tube dysfunction of mechanical type, associated with various nasal pathologies, most common was, deviated nasal septum

Crohn disease in Nepal: true rarity or gross underdiagnosis?

Gross and histopathological examination of a resected segment of ileum in a 72-year-old man with the preoperative diagnosis of small intestinal perforation peritonitis revealed the first-ever diagnosed case of Crohn Disease (CD) at the B P Koirala Institute of Health Sciences, Dharan, Nepal. In view of the recent reports on rising incidence of CD in neighbouring Asian countries, it was decided to perform an exhaustive literature search to find out the documented prevalence of CD in Nepal. It was surprising to find only a single case of CD from Nepal, occurring in the year 1980, to be documented in English literature. Further, the index case of CD presenting with acute abdomen is of interest since only about 100 cases of CD with small intestinal perforation have been so far reported worldwide