A Rare Case of Regorafenib-Induced ST-Elevation Myocardial Infarction.

Regorafenib is an oral multi-kinase inhibitor that is used in the treatment of chemotherapy-resistant metastatic colorectal carcinoma. However, multi-kinase inhibitors have been known to cause cardiac side effects, most notably hypertension. Myocardial ischemia is a very extraordinary adverse effect of regorafenib. Our patient was a 74-year-old gentleman with stage IVa colon cancer who underwent a right colectomy with end ileostomy and was on cycle two of regorafenib during the presentation. He came in with acute onset chest pain that was intermittent, non-exertional, and radiating to the back. His left heart catheterization did not reveal any atherosclerotic lesions, and his ST-elevation myocardial infarction (STEMI) was deemed an extremely rare adverse event from regorafenib. We are herewith reporting a case of regorafenib-induced STEMI.

Use of antimicrobials and antimicrobial resistance in Nepal: a nationwide survey.

Nepal suffers from high burden of antimicrobial resistance (AMR) due to inappropriate use of antibiotics. The main objective of this study was to explore knowledge, attitude and practices of antibiotics uses among patients, healthcare workers, laboratories, drug sellers and farmers in eight districts of Nepal. A cross-sectional survey was conducted between April and July 2017. A total of 516 individuals participated in a face-to-face interview that included clinicians, private drug dispensers, patients, laboratories, public health centers/hospitals and, livestock and poultry farmers. Out of 516 respondents, 62.8% (324/516) were patients, 16.9% (87/516) were clinicians, 6.4% (33/516) were private drug dispensers. A significant proportion of patients (42.9%; 139/324) thought that fever could be treated with antibiotics. Majority (79%; 256/324) of the patients purchased antibiotics over the counter. The knowledge of antibiotics used among patients increased proportionately with the level of education: literate only [AOR = 1.4 (95% Cl = 0.6-4.4)], versus secondary education (8-10 grade) [AOR = 1.8 (95% Cl = 1.0-3.4)]. Adult patients were more aware of antibiotic resistance. Use of antibiotics over the counter was found high in this study. Knowledge, attitude and practice related to antibiotic among respondents showed significant gaps and need an urgent effort to mitigate such practice.

Acute Acquired Methemoglobinemia Following Nitrobenzene Poisoning.

Nitrobenzene is an aromatic compound commonly used in agricultural fertilizers. It is capable of inducing methemoglobinemia when ingested in sufficient quantities. Methemoglobinemia impairs oxygen transport by dual mechanism of impaired oxygen binding and diminished oxygen unloading. We report a case of nitrobenzene poisoning accompanied by methemoglobinemia and later complicated by unconjugated hyperbilirubinemia secondary to hemolysis. Prompt treatment with intravenous methylene blue based on a clinical diagnosis in view of dropping SpO2 unresponsive to oxygen with chocolate cyanosis and paradoxically elevated PaO2 enabled favorable patient outcome. Other recommended modalities of treatment in acquired acute methemoglobinemia include vitamin C, hyperbaric oxygen and exchange transfusions. Keywords: Methemoglobinemia; methylene blue; nitrobenzene; nitroboom.

Knowledge, Attitude and Practice of healthcare workers Towards Coronavirus Disease 2019 (COVID-19) Pandemic.

BACKGROUND: The emergence of SARS-CoV 2 pandemic is the greatest public health concern of the century. Healthcare workers are the front liners of pandemic management. Their knowledge, attitudes and practices can influence the outcome of pandemic. The study aims to determine the knowledge, attitude and practices among healthcare workers. METHODS: Knowledge, attitude and practice related questionnaire based online survey through Google forms was conducted from Healthcare workers, following ethical approval from NHRC (ERB protocol registration number: 297/2020 P). Online forms were disseminated via Facebook, Instagram, Whatsapp, Viber and personal messaging. Responses containing anonymized data was collected analyzed in using SPSS-version 26, (Year: 2019). The results were interpreted in terms of percentage response, knowledge score, and practice and discussed on the possible solutions in improving the infection prevention and control practice. RESULTS: 473 HCWs responded to the questionnaire, out of which 426 responses met inclusion criteria which is 90% of the total responses. The mean score for knowledge was 3.20 + 1.15 out of maximum seven; with 45.7% correct answers. 70.4 % (300) participants felt that Nepal will be unable to contain the pandemic, 64 % of the total employed participants felt that there was inadequate institutional preparedness to protect HCWs from exposure. 91% participants reported practicing hand hygiene after every patient encounter; whereas 31.7% (77) and 22.1% (59) participants did not know how to check sealing of the N95 masks and use personal protective equipment's respectively. CONCLUSIONS: The survey findings showed deficiencies in knowledge and appropriate practice among the HCWs, in prevention of SARS-CoV-2 transmission. Attitudes towards COVID19 were a mix of both positive and negative viewpoints. Even in health care workers with access to internet, there is significant gap in universal infection prevention and control practices required for self-protection and limiting untoward transmission.

Refeeding Syndrome.

Refeeding syndrome is a potentially fatal alteration in serum electrolytes occurring in patients refed after a period of starvation. Its actual incidence is not established due to lack of universally acceptable definitions. 88 years lady presented with negligible food intake for 15 days,mild dehydration and a BMI of 16.8kg/m2. Rigorous refeeding was started and patient developed hypophosphatemia, hypomagnesemia and ventricular premature contractions. Patient was diagnosed with refeeding syndrome and treatment was started. She recovered uneventfully and was discharged with nasogastric tube in situ on day 10 of admission. Refeeding syndrome is commonly encountered but mostly overlooked diagnosis and is a significant cause of nutritional morbidity and mortality in patients with chronic malnourishment. Keywords: Hypophosphatemia; refeeding; refeeding syndrome.