Pancreaticopleural fistula causing pleural effusion: a case report and review of the literature.

BACKGROUND: Pancreaticopleural fistula is a rare complication of pancreatitis and poses diagnostic and therapeutic challenges. This case report sheds light on the unique challenges posed by pancreaticopleural fistula as a rare complication of pancreatitis. The aim is to contribute valuable insights to the scientific literature by presenting a case involving a middle-aged man with acute necrotizing pancreatitis and associated pleural effusion. CASE PRESENTATION: A 41-year-old Asian male with a history of pancreatitis and chronic alcohol use presented with severe dyspnea, chest pain, and left-sided pleural effusion. Elevated serum amylase lipase levels and imaging confirmed acute necrotizing pancreatitis with a computed tomography severity index of 8/10. Magnetic resonance cholangiopancreatography revealed pancreatic necrosis and pseudocyst formation and findings suggestive of pancreaticopleural fistula. The patient was then treated with octreotide therapy. CONCLUSION: The management of pancreaticopleural fistula demands a comprehensive and individualized approach. Recognition guided by high clinical suspicion coupled with appropriate investigations and a careful balance between medical, endoscopic, and surgical interventions is crucial for achieving favorable outcomes. This case report adds to the scientific literature by providing insights into the complexities of pancreaticopleural fistula and emphasizing the importance of personalized strategies in its management.

Seroprevalence of SARS-CoV-2 infection in the general population of Nepal during the first and second generalized waves of the COVID-19 pandemic-2020-2021.

Few seroprevalence studies have been conducted on coronavirus disease (COVID-19) in Nepal. Here, we aimed to estimate seroprevalence and assess risk factors for infection in the general population of Nepal by conducting two rounds of sampling. The first round was in October 2020, at the peak of the first generalized wave of COVID-19, and the second round in July-August 2021, following the peak of the wave caused by the delta variant of SARS-CoV-2. We used cross-sectional probability-to-size (PPS)-based multistage cluster sampling to estimate the seroprevalence in the general population of Nepal at the national and provincial levels. We tested for anti-SARS-CoV-2 total antibody using the WANTAI SARS-CoV-2 Ab ELISA kit. In Round 1, the overall national seroprevalence was 14.4%, with provincial estimates ranging from 5.3% in Sudurpaschim to 27.3% in Madhesh Province. In Round 2, the estimated national seroprevalence was 70.7%, with the highest in the Madhesh Province (84.8%) and the lowest in the Gandaki Province (62.9%). Seroprevalence was comparable between males and females (Round 1, 15.8% vs. 12.2% and Round 2, 72.3% vs. 68.7%). The seroprevalence in the ecozones-Terai, hills, and mountains-was 76.3%, 65.3%, and 60.5% in Round 2 and 17.7%, 11.7%, and 4.6% in Round 1, respectively. In Nepal, COVID-19 vaccination was introduced in January 2021. At the peak of the first generalized wave of COVID-19, most of the population of Nepal remained unexposed to SARS-CoV-2. Towards the end of the second generalized wave in April 2021, two thirds of the population was exposed.

A rare case of Behcet's disease in Nepal: multisystem manifestations and diagnostic challenges.

Behcet's disease (BD) is a chronic inflammatory disorder characterized by a relapsing and remitting course and multisystem involvement. The authors present a case report of a 20-year-old male who presented with bilateral knee joint pain, oral and genital ulcers, and papulopustular skin lesions. The patient's clinical history, physical examination, laboratory findings, and biopsy results were consistent with the diagnosis of BD. The patient tested positive for the HLA-B51 allele, confirming a genetic predisposition. The diagnosis was supported by a positive pathergy test and a skin biopsy showing vasculitis. The diagnostic criteria established by the international study group and the International Criteria for Behcet's Disease were fulfilled. Treatment consisted of colchicine, azathioprine, and topical corticosteroids. This case highlights the importance of recognizing the varied clinical presentations of BD and the need for a multidisciplinary approach to diagnosis and management. Early and accurate diagnosis is crucial to prevent severe complications and improve patient outcomes.

A case of acute encephalitis syndrome and cranial nerve palsy secondary to scrub typhus: A rare presentation from Western Nepal.

Key Clinical Message: This case report highlights the importance of considering scrub typhus as a differential diagnosis for acute encephalitis with cranial nerve palsy in the region of the tsutsugamushi triangle. Abstract: Scrub typhus is a zoonotic rickettsiosis caused by the bacterium Orientia tsutsugamushi. This disease is endemic to a region called the tsutsugamushi triangle that extends from Southeast Asia to the Pacific Ocean. We report a 17-year-old girl from western Nepal who presented with fever, headache, vomiting, and altered sensorium, as well as bilateral lateral rectus palsy, dysphagia, regurgitation of food, dysarthria, and left-sided upper motor neuron type facial palsy. Following laboratory and imaging tests, the patient was diagnosed with scrub typhus and was treated successfully with high-dose dexamethasone and doxycycline. This case highlights the importance of considering scrub typhus in the differential diagnosis of encephalitis with cranial nerve palsy, especially in the region of the tsutsugamushi triangle. It also emphasizes the need for timely diagnosis and treatment of scrub typhus to prevent the development of various complications and ensure earlier recovery of patients.

COVID-19 Amongst Travelers at Points of Entry in Nepal: Screening, Testing, Diagnosis and Isolation Practices.

WHO recommends surveillance for COVID-19 among travelers at Points of Entry (POE) to countries. At 13 selected POE at the Nepal-India border, between March 2021 and July 2021, we describe the screening, testing, diagnosis and isolation practices of COVID-19 amongst travelers. Those who stayed in India or elsewhere for > one day and those who did not have a negative RT-PCR result within the last 72 h of travel were tested for COVID-19 with rapid antigen diagnostic tests. Daily surveillance reports maintained at POE were used for analysis. Of 337,338 travelers screened, 69,886 (21%) were tested and 3907 (6%) were diagnosed with COVID-19. The proportions tested averaged 15% during April-May when screened numbers were high and increased to 35% in July when screened numbers had decreased. The proportions diagnosed positive peaked at 10% in April-May, but decreased to below 1% in June and July. Testing coverage varied from 0−99% in the different POE. Most COVID-19 cases were Nepalese, male, <60 years of age, migrant workers and presented with fever. Of COVID-19 cases, 32% had home-based isolation, 64% underwent community-based isolation and the remainder either went to hospital or returned to India. In conclusion, about one fifth of travelers overall were tested, with coverage varying considerably over time and among different POE. Strengthening surveillance processes at POE is needed.

Childhood Tuberculosis: An Under Prioritized Disease in Nepal.

Globally, childhood tuberculosis constitutes up to 10% of overall tuberculosis cases. In Nepal, childhood tuberculosis has remained around 5.5% of overall tuberculosis cases and has remained stagnant over the years. Moreover, our health system is focused on adult tuberculosis. Childhood tuberculosis has recently got its attention both at the national and international levels. National Tuberculosis Program has been a successful program; however, more has to be done to track childhood tuberculosis progress. In this viewpoint, we discuss current initiatives taken by the government and the way forward for case detection and management of childhood tuberculosis in Nepal.

Burden of tobacco in Nepal: a systematic analysis from the Global Burden of Disease Study 1990-2017.

OBJECTIVE: This study systematically reviews the data extracted from the Global Burden of Disease Study and sets out to assess the age-specific and sex-specific mortality and disability attributable to different forms of tobacco from 1990 to 2017, for Nepal. DESIGN: This cross-sectional study extracted data from the Institute for Health Metrics and Evaluation's Global Burden of Disease database, then was quantitatively analysed to show the trends and patterns of prevalence of tobacco use, deaths and disability-adjusted life-years (DALYs) attributable to tobacco use from different diseases from the year 1990 to 2017 in Nepal. SETTING: Nepal. RESULTS: In between 1990 and 2015, the age-standardised prevalence of daily tobacco smoking decreased by 33% in males, 48% in females and 28% in both. By 2017, the age-standardised mortality rate and DALYs attributable to tobacco use, including any form, decreased by 34% and 41%, respectively, with tobacco smoking having the most contribution. However, the absolute number of deaths and DALYs increased by 39% and 3%, respectively. An increasing rate of deaths and DALYs attributable to tobacco was noted with an increase in age. Non-communicable diseases were responsible for most deaths and disabilities attributable to tobacco use. CONCLUSION: The prevalence of smoking along with the age-standardised mortality rate and DALYs shows a decreasing trend. However, attention should be made to implement a strong plan to control all forms of tobacco including secondhand exposure.

Pulmonary Tuberculosis among Male Inmates in the Largest Prison of Eastern Nepal.

INTRODUCTION: The prevalence of Pulmonary Tuberculosis (PTB) is much higher in the prison population than in the general population. This study aims to find out the prevalence of PTB and its associated factors among inmates in eastern Nepal. METHODS: This cross-sectional study was conducted in Jhumka Regional Prison, the largest male prison of Eastern Nepal from September 2014 to August 2015. Semi-structured questionnaires were used to identify individuals with a cough more than one-week duration among 434 randomly selected inmates. Screening of PTB was done by sputum smear test and/or GeneXpert test. Prevalence of TB was defined as the number of cases detected during the study period divided by the total number of inmates screened during that period. Fisher's exact test was used to find out the association of PTB with related variables. RESULTS: A total of 434 inmates were screened for PTB with mean age 35.7 years and body mass index 22.7 kg/m2. A total of 68 inmates had a productive cough of more than a week and two patients were already on anti-tuberculosis therapy at the time of screening. Sixty sputum samples were considered for sputum smear/GeneXpert test and 6 of them (10%) had positive results. The prevalence of TB in the Prison was 1843/100,000 population. Chest pain and abnormal chest auscultation findings were found to be significantly associated with PTB. CONCLUSIONS: This study showed that there was a high rate of PTB among inmates in Nepal. The results suggest a need for effective screening of PTB and strategies to improve management including reduction of PTB transmission in the prison.

The goal to end TB- strategy: Public private partnership. Is it only private sector to blame?

National Strategic Plan for tuberculosis care and control, Nepal ( 2016-2021) envisions ambitious target of decreasing TB incidence by 20% by 2021.In achieving so it has to identify and manage 20,000 more cases by 2021 compared to 2015. Contribution of private sector which roughly accounts to 25% of all the burden of tuberculosis cases in Nepal will be vitally important along with effective public private partnership. In this review we discuss why blaming the private sector alone is not sufficient and much effective PPP collaboration needs to be done stepping on the positive results shown by the earlier collaboration.

Respiratory Disorders among Dust Exposed Workers.

INTRODUCTION: Exposure to dusts and hard physical work is common in developing industrialized countries. Acute and chronic respiratory illnesses are highly been reported from jute and textile industry. This study was undertaken to explore status of respiratory health among the workers of jute and textile industries. METHODS: This descriptive cross-sectional study enrolled 315 workers from each of textile and jute industry of Eastern Nepal. Almost all the workers were selected from the textile industry whereas those from dust prone areas of jute industry. Workers were interviewed using pre-tested questionnaires. Measurement of height, weight and peak expiratory flow rate was done. RESULTS: Majority were non-smokers in both the industries 230 (73%) in Jute vs. 223 (70.8%) in Textile. Most of the workers had the working experience of less than five years; jute 134 (42.5%) vs. textile 180 (57.1%). Upper respiratory disorder was found in more than 1/5 of workers (68) in jute vs. 1/20 of workers (18) in textile industry. One and two workers suffered from chronic bronchitis in the jute and the textile industry respectively. Chest tightness was reported among 4 (1.3%) in jute vs. 17 (5.4%) in textile workers, cough symptoms among 86 (27.3%) in jute vs. 26 (8.3%) in textile industry. Low practice of personal protective measure was seen in both industries. The mean score of PEFR of workers in jute mill was lower than the workers in textile industry. CONCLUSIONS: Workers with acute respiratory disorders were more in the jute industry while chest tightness was more in the textile industry. Chronic respiratory problems did not appear to be alarming in both the industries. Use of personal protective measures should be promoted among the dust exposed workers.

Respiratory Problems among Workers of Udayapur Cement Factory in Eastern Nepal.

BACKGROUND: There have been very limited studies regarding health of the cement factory workers in Nepal. This study aimed to find out the prevalence of health problems and the factors associated with respiratory symptoms among the workers of Udayapur cement factory. METHODS: This is a cross-sectional study conducted from March to August 2015 in Udayapur cement factory in eastern Nepal. All the workers working in the factory more than a year were included in the study. Thedata was collected by using a semi-structured questionnaire consisting of socio-demographic characteristics,type of work, reported health problems, use of personal protective measures.Chi-square test was used to determine the association of respiratory symptoms with related variables. RESULTS: A total of 295 workers were included in this study with mean age of 45.9 years (SD=7.7). Majority 279 (94.6%) were males. The most common health problems were musculoskeletal pain (55.6%) followed by eye problems (33.2%). Among them, 17(21.1%) reported that they had at least one respiratory problem and chest tightness while running/climbing and wheeze were the most common. A total of 233 participants (79%) used at least one form of personal protective equipment. Low education, longer duration of work and smoking were found to be positively associated with respiratory symptoms. CONCLUSIONS: Respiratory problems were high among the workers of the cement factory. Proper use of PPEs and dust control measures should be promoted among the workers.

Facilitators and barriers to healthy eating in a worksite cafeteria: a qualitative study from Nepal.

OBJECTIVE: Worksite interventions can serve as a potential platform for translating existing knowledge of diabetes prevention and facilitate healthy food choices. The study explored perceptions about healthy eating as well as potential facilitators and barriers to healthy eating among employees in a wire manufacturing factory in Nepal. METHODS AND MATERIALS: We conducted a cross-sectional exploratory qualitative study in a wire manufacturing industry in eastern Nepal. We conducted three focus group discussions (FGDs) with a total of 26 employees and four in-depth interviews (IDIs) with cafeteria operators/managers from a wire manufacturing factory in eastern Nepal. FGDs and IDIs were audio-recorded, transcribed verbatim and analysed using the thematic method. RESULTS: Most employees defined healthy eating as the consumption of food prepared and maintained using hygienic practices and fresh foods in general. Major barriers to healthy eating included unavailability of healthy foods, difficulty in changing eating habits, the preference for fried foods in Nepali culture and the high costs of some healthy foods. The most commonly reported facilitator of healthy eating was the availability of affordable healthy food options in worksite cafeterias. CONCLUSION: Availability of healthy food options at an affordable price could lead to healthier food choices in the worksite.