Successful management of delayed presentation of massive paracetamol overdose in a resource-limited setting: A case report from Nepal.

We present a case of self-poisoning with a massive dose of paracetamol by a young Nepalese female patient who presented late to our emergency department. This report highlights the successful management of the patient with the extended use of N-acetylcysteine over 4 days and continuous supportive therapy as required. The case is an example of the management of delayed presentation of a massive paracetamol poisoning in a resource-limited setting, where intensive care units and hemodialysis facilities are not easily available. However, when available, massive poisoning should always be managed in continuous monitoring units under the expertise of a toxicologist.

Adverse Events following Immunization with COVID-19 Vaccines: A Narrative Review.

Numerous COVID-19 vaccines are being administered to people around the world. Adverse events following immunization (AEFI) with COVID-19 vaccines have been reported by health care workers as well as surveillance bodies. A wealth of information on the efficacy and safety of vaccines exists in the literature, and the knowledge in this sector is growing exponentially. A narrative literature review was conducted on sources accessed from PubMed, Google Scholar, and Cochrane Review from March 2021 to July 2021. This review is aimed at describing AEFI associated with currently available COVID-19 vaccines, with an emphasis on narrating probable AEFI, and at assisting in a better understanding of the COVID-19 vaccines.

Adverse Events Following the First Dose of Immunization of COVID-19 Vaccine.

BACKGROUND: The COVID-19 pandemic has challenged the entire globe and the need for a vaccine is supreme. Since many vaccines along with Covishield have been granted emergency use authorization, the evaluation and monitoring of safety are crucial. Covishield was rolled out in Nepal on January 27, 2021. So through this study, we aim to identify the prevalence of Adverse Events Following Immunization in general with the first dose of Covishield vaccine, compare Adverse Events Following Immunization in prior COVID-19 positive cases and Adverse Events Following Immunization in co-morbid individuals. METHODS: This was a descriptive cross-sectional study conducted in 440 sample from May 2021 till July 2021 in a provincial government hospital of western Nepal. Ethical approval was received from Ethical Review Board, Nepal Health Research Council (Registration no: 279/2021 P). Simple random sampling was used. Point estimate was done at 95% confidence interval and descriptive analysis was done to identify the prevalence of Adverse Events Following Immunization within one week after Covishield vaccination in the studied population. RESULTS: 79.77% of the study population complaint at least one or more Adverse Events Following Immunization. Fever, myalgia, headache, pain at the injection site, arthralgia, chills, and fever are the most common Adverse Events Following Immunization. 42.73% of the study population self-medicated to manage Adverse Events Following Immunization, 7.89% took leave from work while 0.28% needed medical attention. No major Adverse Events Following Immunization relevance with prior-COVID history or co-morbidity was seen. CONCLUSIONS: Majority of the vaccinated participants had minor adverse effects on the first-day post-vaccination while most of the Adverse Events Following Immunization subsided within seven days.

Prevalence of rheumatic heart disease in South Asia: A systematic review and meta-analysis.

INTRODUCTION: Most countries in South Asia are endemic for rheumatic heart disease (RHD). We aimed to estimate the pooled prevalence of RHD in South Asia from population-based screening studies. METHODS: A systematic strategy was developed and used to search online databases for articles which described the prevalence of RHD in the South Asia region. Articles published in the English language between 1991 and 2021 were included in the review after fulfilling eligibility criteria. RESULTS: The pooled prevalence of RHD in South Asia was 2.79 per 1000 (95% Confidence interval (CI): 1.30-4.83) according to studies using auscultation followed by echocardiography of suspected cases and 18.28 per 1000 (95% CI: 11.59-26.44) for studies using echocardiography screening of all participants. The highest prevalence of 8.0 per 1000 (95% CI: 0.71-22.74) was observed in Pakistan, whereas the lowest prevalence of 0.32 per 1000 (95% CI: 0.18-0.48) was observed in Bangladesh. The prevalence of RHD has decreased to 2.30 per 1000 from 3.06 per 1000 by 24.84% in 30 years (1991-2021). The prevalence is more than twice higher using WHF criteria compared to WHO criteria. We observed no sex-related differences in prevalence (p = 0.16). CONCLUSIONS: The prevalence of RHD is still high in the South Asian population. Recent studies utilizing echocardiographic screening have identified subclinical cases of RHD, reflecting the significant burden of the disease in this region. More population-based echocardiography screening studies in every country in South Asia are required to estimate the accurate prevalence of the disease.

Potential Drug-drug Interactions among Hospital Discharge Prescriptions in a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: In our setup, potential drug-drug interactions are overlooked in routine clinical practice. In general, most of the discharges are handwritten in the developing world, and the discharge prescriptions are not checked with the database for potential drug-drug interactions checker. This study aimed to determine the prevalence of potential drug-drug interactions in the prescribed drugs in clinical practice in a tertiary care centre of Nepal. METHODS: A descriptive cross-sectional study was conducted in a tertiary care center from October 2019 to December 2019. Ethical approval was taken from the Institutional Review Committee (Reference number: 394(6-11)E2/075/76). Through simple random sampling, the data about drug prescription was collected from the patient discharge records of the Department of Internal Medicine. The potential drug interactions were checked by using Lexicomp® drug interactions. Data was analysed using Statistical Package for the Social Sciences version 20.0. Point estimate at 95% Confidence Interval was calculated along with frequency, percentage, mean, standard deviation and mode. RESULTS: Among 382 discharge prescriptions, the prevalence of potential drug-drug interactions was 299 (78.3%) (74.1-82.4 at 95% Confidence Interval). A total of 1519 drug interactions with a mean of 5.08±3.89 drug interactions per prescription was identified. The major, moderate and minor drug-drug interactions according to the severity were found to be 163 (10.7%), 1162 (76.5%), and 178 (11.7%) respectively. CONCLUSIONS: The prevalence of potential drug-drug interactions is high among the patients on discharge compared to similar studies. Use of drug-drug interactions checker databases before discharge with computer-based discharge prescriptions is recommended.

Counterfeit Healthcare Products: Nepal at a Vulnerable Position.

Nepal stands in a vulnerable position when it comes to counterfeit medicines as two of its major trade partners countries are leading producers of falsified healthcare products. The impacts that it can lead to are a lower standard of healthcare delivery to the public, increased cost of treatment, antibiotic resistance, and even fatality. The time of crisis as the Coronavirus disease 2019 pandemic is often seen as an opportunity to endorse substandard products in greater amounts. The people's doubt over the medicine is another issue generated by this malpractice that can lead to problems like vaccine hesitancy which can have scary outcomes so forth in a pandemic situation like this. Stronger national policies and vigilant authorities are prime to overcoming flourishing counterfeit culture as it is a peak time when we can not put public health at stake. Keywords: counterfeit medicines; Nepal; patient safety; substandard medicines.

Blood Lead Levels in Rag-Pickers of Kathmandu and its Association with Hematological and Biochemical Parameters.

INTRODUCTION: Lead poisoning is a common health problem in Nepal and there are a limited number of studies on blood lead levels in various population groups. Rag-pickers are those people who visit from house to house to collect the materials that can be recycled and thus earn their livelihood. The present study was designed to evaluate blood lead level (BLL) and its relationship between hematological and biochemical parameters in rag-pickers working in Kathmandu. METHODS: An observational cross-sectional study among 50 ragpickers working in the selected area of Kathmandu was done in May 2019 after obtaining ethical approval from the Nepal health research council. Capillary and venous blood was drawn from each participant after written consent to measure the BLL, aspartate aminotransferase, alanine aminotransferase, total bilirubin, creatinine, glucose and to test for a complete blood count. Whole blood was also screened for the presence of hemoglobin variants in cases with abnormal red blood cell indices. Data was analyzed using SPSS (Version 20.0). RESULT: All rag pickers were men with mean age of 32.56 ± 12.51 years. The mean BLL among ragpickers was 11.6 ± 7.23 µg/dL. High eosinophil count was found (8.27 ± 5.49 %) in 27 cases (54%) having no significant association with BLL. The mean BLL was higher (12.89 µg/dL) in a cohort of workers who pick and recycle electronic waste. Beta-Thalassemia trait was seen in four cases, all of them had high BLL. No significant association of BLL with the number of years worked by rag picker was found. Similarly, no significant association of BLL with hematological and biochemical parameters was found. CONCLUSION: Rag-pickers working in Kathmandu are at increased risk of lead toxicity. The use of protective gloves, masks, shoes and clothes along with a regular medical examination of this vulnerable group is recommended.

Insulin autoimmune syndrome as a cause of recurrent hypoglycemia in a carbimazole user: a case report from Nepal.

Insulin autoimmune syndrome (IAS) is a rare cause of nondiabetic hypoglycemia characterized by hyperinsulinemia and autoantibodies to endogenous insulin without prior exposure to exogenous insulin. We report a drug-induced case of IAS in a 59-year-old Nepalese female. She had been taking carbimazole for Graves' disease and later presented with recurrent episodes of hypoglycemia, with laboratory findings of low blood glucose, increased molar ratio of insulin to C-peptide, and elevated autoantibodies to insulin. IAS should be considered while evaluating hypoglycemia to prevent unwarranted invasive procedures and surgical interventions.