An atypical case of bilateral optic neuritis after strabismus surgery under general anesthesia.

INTRODUCTION: Strabismus surgery under general anesthesia is a common procedure with rare complications in the form of hemorrhage, infection, slipped muscle, lost muscle, scleral perforation, and anterior segment ischemia. We report a unique case of bilateral optic neuritis following squint surgery under general anesthesia in a 15-year-old girl. METHODS: A 15-year-old girl presented with accommodative esotropia with V pattern. She underwent uneventful bilateral inferior oblique recession surgery under general anesthesia with Propofol 60 mg, Atracurium 30 mg, and Fentanyl 70 mcg. On the first post-operative day, the patient had an acute onset of temporal headache which was non-radiating. She responded to supportive treatment and was discharged. However, on the 7th postoperative day, she presented with a constant severe headache in the bitemporal region (left > right) for 3 days. She also experienced a painless diminution of vision for 2 days. There was no vomiting, fever, loose stools, diplopia, difficulty in breathing, peripheral sensation loss, generalized weakness, or bowel/bladder incontinence. RESULTS: The best corrected visual acuity was 6/9 in right eye, and 6/9p in left eye with a relative afferent pupillary defect (RAPD) in the left eye. Both optic discs appeared hyperemic with blurred margins. Magnetic resonance imaging (MRI) of the brain and orbit showed hyperintensity along the intraorbital and intracanalicular parts of bilateral optic nerves on T2 weighted image suggesting bilateral optic neuritis. She received intravenous methylprednisolone pulse therapy followed by oral steroids and responded to the medical treatment with improvement in vision but developed steroid-induced glaucoma requiring medical management over several weeks. DISCUSSION: Neuro-ophthalmic complication in the form of non-arteritic ischemic optic neuropathy has been reported after various ophthalmic surgeries, but bilateral optic neuritis has not been reported to date. This possibility should be kept in mind if any patient presents with similar symptoms. This report also highlights IOP monitoring in pediatric patients receiving systemic steroids to prevent loss of vision due to steroid-induced glaucoma.

Multiplex Serology for Sensitive and Specific Flavivirus IgG Detection: Addition of Envelope Protein Domain III to NS1 Increases Sensitivity for Tick-Borne Encephalitis Virus IgG Detection.

Tick-borne encephalitis is a vaccine-preventable disease of concern for public health in large parts of Europe, with EU notification rates increasing since 2018. It is caused by the orthoflavivirus tick-borne encephalitis virus (TBEV) and a diagnosis of infection is mainly based on serology due to its short viremic phase, often before symptom onset. The interpretation of TBEV serology is hampered by a history of orthoflavivirus vaccination and by previous infections with related orthoflaviviruses. Here, we sought to improve TBEV sero-diagnostics using an antigen combination of in-house expressed NS1 and EDIII in a multiplex, low-specimen-volume set-up for the detection of immune responses to TBEV and other clinically important orthoflaviviruses (i.e., West Nile virus, dengue virus, Japanese encephalitis virus, Usutu virus and Zika virus). We show that the combined use of NS1 and EDIII results in both a specific and sensitive test for the detection of TBEV IgG for patient diagnostics, vaccination responses and in seroprevalence studies. This novel approach potentially allows for a low volume-based, simultaneous analysis of IgG responses to a range of orthoflaviviruses with overlapping geographic circulations and clinical manifestations.

Anxiety, Perceived Stress and Coping Strategies among the Nepalese Nurses Working around the World During a Corona Virus Disease -19 Outbreak.

BACKGROUND: Nurses are the frontline health professional of healthcare delivery system prone to have psychosocial problems. This study aimed to explore anxiety, stress and coping strategies among the Nepalese Nurses working around the World during a corona virus disease -19 Outbreak. METHODS: A web based cross sectional study was conducted for a period of three month among 240 nurses from Nepal and working abroad. They were invited to participate via various web based networks. Anxiety Self rating scale, perceived stress Scale and coping strategies were used for data collection. Chisquare, spearman rho and Manwhitnney was used for data analysis. RESULTS: More than half 58.8% were <30 years of age,mean age was 31±7.29 ,range was 20-56 years.Only17.5%were having Mild to Extreme Anxiety and, 62.5% Nepalese nurses were having stress. Regarding coping strategies mean score is higher in positive reframing followed by acceptance.There was significant association between stress and demographic variables marital status and country.Nepalese Nurses working in Nepal were having more anxiety and stress mean score than Nepalese nurses working abroad. CONCLUSIONS: Nepalese nurses working in Nepal were having more anxiety and stress mean score than Nepalese nurses working in abroad. Mean score of coping strategies was higher in avoidant coping (Maladaptive coping) in nurses working in Nepal whereas mean score is higher in Approach coping (Adaptive coping) in Nepalese nurses working abroad.

Heterologous Immune Responses of Serum IgG and Secretory IgA Against the Spike Protein of Endemic Coronaviruses During Severe COVID-19.

Defining immune correlates of disease severity is important to better understand the immunopathogenesis in COVID-19. Here we made use of a protein microarray platform to detect IgG- and IgA-reactive antibodies in sera and saliva respectively, and assess cross-reactivity between SARS-CoV-2 and endemic coronaviruses (eCoVs). IgG responses against the full protein of spike, but not the S1 subunit, were significantly higher in convalescent sera of patients with severe disease compared to mild disease and healthy controls. In addition, we detected reactivity of secretory IgA to eCoVs in saliva of patients with severe disease, not present in patients with moderate disease or seropositive healthy controls. These heterologous immune responses are in line with non-protective cross-reactivity, and support a potential role for immune imprinting in the pathogenesis of severe COVID-19.

Internalized Stigma, Coping and Social Support with Mental Illness in Manipal Teaching Hospital, Pokhara, Nepal.

BACKGROUND: There are an increasing number of studies on the subjective experience of stigma amongst mentally ill persons but still few coming from Asian countries, and very few from Nepal. The objective of this study was to look into the experience of internalized stigma in mentally ill persons in Pokhara, Nepal and to compare this with similar studies using ISMI fromother socio-cultural contexts. METHODS: A total of 136 patients with mentally ill people attending OPD of Manipal Teaching Hospital, Nepal responded to the Internalized Stigma of Mental Illness Scale. This is a 29-item self-report questionnaire with good psychometric properties. RESULTS: Among the participant, majority 69.1% were 18-39 years age and majority 60.3% were female. Half of the participant 51.5% experienced high level of internalized Stigma. Regarding coping strategies, 86% of the participant response they does not avoid telling the health care professionals that they had a history of mental illness, Most 87.5% response they does not avoid going out with friends after receiving psychiatric treatment. Most 83.1% response they attempt to correct their friends if they hold negative views on people with mental illness. Most 65.44% were having High Social Support with Mental illness. CONCLUSIONS: Study findings show half of the participants (51.5%) experienced high level of stigma and more than half of the participant (65.44%) were having high social support with mental illness.

Lymphangiomatous Polyp Presenting as Tonsillar Mass.

A 19-year-old female presented to ENT OPD of Dhulikhel Hospital, Kathmandu University Hospital, with history of foreign body sensation in throat for 2 weeks and mass in left tonsil for 1 week. There is no history of difficulty swallowing or recurrent throat infection. Physical examination revealed a pedunculated mass arising from upper pole of left tonsil. Bilateral tonsillectomy was done under general anaesthesia. Grossly, 2.5 × 1.5 × 1 cm polypoidal mass, soft in consistency, was found to be attached to left tonsil. Histopathology report was consistent with lymphangiomatous polyp of tonsil. Postoperative period was uneventful and she was normal during her follow-up at 1 month with bilateral healthy tonsillar fossa.