Chronic Lithium Toxicity in Old Age Patients Taking Angiotensin Receptor Blocker: A Case Report.

Chronic lithium toxicity is a potentially serious side effect on patients taking lithium for a prolonged period with the diagnosis of mood disorders. The toxicity is even higher in patients taking drugs that interfere with the metabolism of lithium like angiotensin receptor blockers and in older patients with reduced kidney function. In this report, we present the case of a 62-year-old woman who presented to the emergency department with symptoms including loose stools, generalised body weakness, slurred speech, coarse hand tremors, and dystonia persisting for fifteen days. She had been under lithium therapy for bipolar type 1 disorder for 15 years before experiencing these symptoms, which emerged shortly after the addition of telmisartan (angiotensinogen receptor blocker) for hypertension. Keywords: angiotensin receptor blocker; bipolar disorder; case reports; lithium; telmisartan.

Mesorrhine Type of Nose among Medical Students of a Medical College.

Introduction: The nose is an attraction point in our face and one of the important sense organs of our body. The knowledge of the type of nose is essential for surgeons undertaking esthetic repair and reconstruction of noses The aim of this study was to find out the prevalence of the mesorhine type of nose among medical students of a medical college. Methods: A descriptive cross-sectional study was done among medical students of medical college after obtaining ethical approval from the Institutional Review Committee. Students of age groups 16-25 years from different religions with various castes/ethnicities were included. Those with craniofacial abnormalities, nasal deviation and a history of nasal trauma were excluded. All the nasal parameters were measured with the help of vernier's calliper and the nasal index was calculated. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 215 medical students, the prevalence of mesorrhine type of nose was 130 (60.46%) (53.92-67, 95% Confidence Interval). Conclusions: The prevalence of mesorrhine type of nose among medical students was similar to other studies done in similar settings. Keywords: medical students; nose; prevalence; sexual dimorphism.

Immature Teratoma in Pregnancy: A Case Report.

Immature teratoma is one of the rare malignant germ cell tumours presented in pregnancy. Here, we present 26-year-old pregnant women who had an incidental finding of left adnexal mass in an anomaly scan at 19 weeks of pregnancy. Laparotomy with peritoneal fluid cytology, left salpingo-oophorectomy and omental biopsy at 20 weeks of pregnancy revealed immature teratoma stage 1A, grade 2 in the histopathology report. However, she followed up with the metastatic mass in the pouch of Douglas at 30 weeks of pregnancy in magnetic resonance imaging despite being counselled for possible chemotherapy and surveillance. A baby with a good Apgar score and grade 3 immature teratoma in the metastatic mass was revealed following the exploratory laparotomy and cesarean section at 36 weeks of pregnancy. Fertility-sparing surgery with chemotherapy during pregnancy for high-grade tumours may result in a good prognosis. Keywords: case reports; chemotherapy; immature teratoma; pregnancy; surgery.

Factors Influencing Health Seeking Behaviour among Persons with Diabetes Attending Urban Health Care Settings.

BACKGROUND: Health seeking behaviour can influence outcomes in chronic diseases such as diabetes. As diabetes burden is higher in urban areas and under half receive adequate diabetes care and support in Nepal, this study aimed to assess factors influencing health behaviour among persons with diabetes attending urban health care settings. METHODS: A cross-sectional study was conducted at two private healthcare settings with a pretested semi-structured questionnaire to assess health behaviour in particular with gender and regular diabetes follow-up. Bivariate analysis alongwith univariate and multivariate logistic regression was used to assess factors that influence HSB (P<0.05). Adjusted odds were reported within 95% confidence intervals. RESULTS: Among 385 PWDs (42.3% women) with a median diabetes duration of 7 years (IQR: 3 to 14 years), three fourths (75.1%, 95% CL: 70.5 to 79.1%) reported regular follow-up for diabetes care. After adjusting for confounders, the odds of regular follow-up were higher for those with a family history of diabetes (AOR: 1.82, 95% CI: 1.11 to 3.00) and non-smokers (AOR: 2.08, 95% CI: 1.34 to 3.61). The odds of follow-up were lower among the elderly (? 60 years) (AOR: 0.59, 95% CI: 0.35 to 0.97) and those with a family income below 35,000 Nepali rupees (AOR:0.39, 95% CI: 0.23 to 0.67). CONCLUSIONS: A plurality of health seeking behaviours such as regular follow-up care, taking glucose lowering medications and diabetes information seeking was observed among persons with diabetes attending private urban heath care settings during the COVID-19 pandemic period. Older age, family history of diabetes, non-smoking status and low family income were found to influence regular follow-up. In particular, psychosocial mechanisms that influence behavior among persons who smoke may need exploration.

Dermatomyositis in an Elderly with Respiratory Presentation: A Case Report.

Dermatomyositis is an idiopathic inflammatory disease that affects the skin and proximal skeletal muscles. To our best knowledge, there are very few cases of Dermatomyositis reported in Nepal and almost none with respiratory manifestation. We present to you the case of dermatomyositis complicated with interstitial lung disease of a 74 years old male patient with a three-week history of generalized weakness, weight loss, Gottron's papule, and heliotrope rash, with features of interstitial lung disease such as shortness of breath, fever, and productive cough, later confirmed by high-resolution computed tomography. We monitored his serum creatine kinase/creatine phosphokinase level for two consecutive days which showed a progressive increase (281 U/L to 290 U/L). His antinuclear antibody test was positive. He was managed with standard treatment of dermatomyositis. This report might help understand the presentation of disease in our setting which can help in early diagnosis and early initiation of treatment. Keywords: case reports; dermatomyositis; interstitial; lung diseases; Nepal.

Adherence to Anti- Hypertensive Medications among Patients in Selected Health Facilities of Nepal.

BACKGROUND: Hypertension is a non-communicable disease and one of the most prominent modifiable risk factors for cardiovascular diseases. 7.6 million premature deaths are attributed to high blood pressure around the world. Better adherence with antihypertensive medications improves quality and length of life. This research focuses on the extent of adherence towards prescribed antihypertensive treatment, and identify factors influencing non-adherence. METHODS: Descriptive cross-sectional study design was undertaken in various health care centers (2 primary health care center and 3 hospitals) of Nepal. A total of 348 individuals (age above 30) who suffered from hypertension visiting health institutes were included in the study. Adherence was calculated using Morisky Medication Adherence scale. RESULTS: Adherence level to the antihypertensive medication as per the morisky adherence scale, 38.8% had medium level of adherence, 37.4% had a low adherence level, and 23.9% had a high adherence level among 348 participants. From the total participants, 89 admitted to be irregular in medication use. 56% of them claimed to do so because of forgetfulness, 12.4 % because of consistent exercise and low-salt diet, 10.1% due to the lack of affordability. CONCLUSIONS: Our study had concluded that the majority of participants had medium to low levels of adherence to anti-hypertensive drugs. Forgetfulness was major cause for irregular medication. Patient education and counseling, family support also seem to be important for proper adherence to drugs. Thus, health care providers should allocate ample time in educating, counseling clients and family.