Unexpected Effect of Propranolol and Prednisolone on Infantile Facial Rhabdomyosarcoma.

A 14-month-old Nepalese infant had developed a rapidly growing facial tumor originating from a dark spot on her upper eyelid. A cavernous hemangioma was suspected and treated with high doses of propranolol and prednisolone. Remission was dramatic. Histology confirmed alveolar rhabdomyosarcoma. Chemotherapy was planned but not carried out due to complicated logistics. The girl died at the age of 3. We present this case for discussion as to whether propranolol and prednisolone might be effective in rapidly growing rhabdomyosarcomas.

Infection-associated hemophagocytic lymphohistiocytosis: a case report.

Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a rare hyperinflammatory disorder characterized by fever, cytopenia, splenomegaly, and hemophagocytosis. Without prompt treatment, HLH can rapidly progress to life-threatening multiorgan failure. The authors present a case of occult HLH with severe bicytopenia and organ dysfunction requiring intensive care. Case presentation: A 20-year-old male presented with fever, cough, and constitutional symptoms. He developed hypoxia, elevated transaminases, and bicytopenia. Despite transfusions, platelet counts remained critically low. With high suspicion for HLH, head computed tomography and bone marrow biopsy was although panned but couldn't be performed due to resource less settings. And with suspicion for HLH treatment with high-dose dexamethasone was initiated as counts improved. Clinical course: The patient required mechanical ventilation for pulmonary infiltrates. He exhibited seizure activity and epistaxis related to coagulopathy. On hospital day 9, he was successfully extubated as counts normalized. He was discharged from the intensive care unit once stable. Conclusion: This case illustrates a delayed diagnosis of HLH masquerading as a fever of unknown origin. HLH should be urgently considered in patients with unexplained cytopenia, organ dysfunction, and systemic inflammation. Early treatment with immunotherapy can be lifesaving, whereas delays may precipitate irreversible end-organ damage.

Perception and Practice among Community People and Health Service Providers on Care and Management of Burn Injuries in Nepal: A Qualitative Study.

BACKGROUND: According to WHO, burns are a serious public health problem and the second most common cause for injury in rural Nepal, accounting for 5% of disabilities. The overall objective of the study is to assess the prevailing perception and practice among community people and health service providers on care and management of burn injuries in Nepal. METHODS: This was a qualitative study conducted in 2016 representing all eco-development regions. A total of 40 key informants interviews with health personnel and 18 focus group discussions with the community people were conducted. RESULTS: There are very limited dedicated burn care facilities in Nepal. During discussion, the service providers and community people mentioned that a burn injury can affect any one irrespective of their age and socioeconomic status. The study showed that females are at higher risk for burn injury which is associated mostly with wood fire cooking.The burn cases in the hospitals were more during winter than insummer season. Among all the ethnic groups, Dalit and indigenous population were found more vulnerable towards burn injuries. Intentional burn injuries such as self-inflicted burns/suicidal attemptwere found to occur more in females.The community people had a good practice of taking the majority ofpatients having burn injury immediately to the hospital,if not, they at least provided them with a first aid treatment. CONCLUSIONS: Majority of burn injured cases are getting first aid treatment at the incident places and taking hospital immediately. Main reasons, who reached late, are unaware about seeking services and financial constraint. Overall, the community people are partially aware about the burn injury.

Perception of Community and Hospital Personnel on Burn Treatment and Outcome in Nepal.

INTRODUCTION: Globally, eleven million people sustain burn injuries every year enough to require medical attention. WHO has estimated Disability associated limited years of 84,000 per year just due to deformities and 2100 people die every year due to burn injuries in Nepal. The overall objective of the study is to explore the effectiveness of burn injuries treatment and management approach of hospitals. METHODS: This qualitative study approached to 40 Health Personnel for Key Informants Interviews and 18 Focus Group Discussions with community people at the ten referral hospitals of eight district from May-June 2016. Qualitative data were analyzed using AtLas.ti software. RESULTS: Female burn victims are brought late to the hospital compared to male patients and false reporting about incident is usually done by her attendants. More than three-fourth (80%) of the hospitals and about one-third male and female from FGD reported that the community people seek home remedy first rather than medical treatment. Majority of the medical doctors and nursing chiefs reported that first degree cases accounts for 50% of the total burn cases with a success rate of 80%. Medical and Nursing staff reported that deformities like hypertrophic scar, keloids, joint stiffness and compartment syndrome are mostly observed during the treatment. Hypothermia and sepsis were the major causes of death in most of the burn patients. CONCLUSIONS: Usually, people who engaged in house and agriculture works, have visited public health posts/hospitals more frequently due to financial constraints and transportation issues where quality of burn care services are unavailable.