Isolated abducens nerve palsy following AstraZeneca vaccine: A case report.

The corona virus disease 2019 (COVID-19) pandemic was triggered by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). SARS-CoV-2 infected millions of individuals globally. Despite the recent clearance of several medications, effective and safe COVID-19 vaccinations are still urgently needed, not only to prevent the disease from spreading but also to restore social and economic activity through mass vaccination. We present a case of a 72-year-old female who presented with sudden right abducens nerve palsy after receiving the 2nd dose of booster vaccine following the AstraZeneca COVID-19 vaccine. Because of the temporal association between vaccination and abducens nerve palsy, they assumed her vaccine caused it. The onset of symptoms, the absence of any prior medical conditions, and normal magnetic resonance imaging. This case highlights the importance of determining whether a COVID-19 vaccine could generate neurologic side effects similar to those found with the virus and previous vaccinations.

A case report on zinc phosphide ingestion resulting to acute pancreatitis.

Zinc phosphide is commonly used as a rodenticide and often abused for intentional self harm. For years, Scientist believed that, It gets converted to phosphine gas by hydrolysis in acidic circumference of the stomach upon ingestion. It is absorbed into the bloodstream and can affect cardiovascular, respiratory, hepato-biliary hematological and gastrointestinal tract. It also results into electrolyte imbalance and ultimately leads to multi organ failure. We present a case of 46 year-old-male with acute pancreatitis due to zinc phosphide ingestion that was successfully treated conservatively. Acute pancreatitis is a rare complication of zinc phosphide poisoning. It is crucial to identify zinc phosphide as the cause of acute pancreatitis and rule out other factors (like alcohol, drugs, genetics) contributing to acute pancreatitis. Interestingly, patient presents with only mild symptoms of poisoning as metabolic acidosis and abdominal discomfort, acute pancreatitis was incidentally diagnosed through lab investigations and radiographs reports after 3-4 days of ongoing conservative treatment. Management was conservative for acute pancreatitis. This article provides a comprehensive review of management of zinc phosphide poisoning induced acute pancreatitis.

Internship Experience: A Transition from Academic World to Health Care Workplace.

Internship is the training period during MBBS in which medical students will be able to learn methods/modalities to administer actual practice of medical and health care based on the knowledge gainded in their medical school. The students will get short-term supervised professional learning experience in different departments of medical and surgical specialities and have opportunity to develop professional networks within their intended career field. Internship gets your foot in the door of the real-world health care practice environment from the theoretical learning. Gaining knowledge and skills by reflecting on mistakes in practical scenario will boosts confidence and refine the practice later on. An internship can be a powerful medium for personal and professional growth as it allows the sense of responsibility towards the patients, their family and the organisation. It is indeed a great opportunity to have a hands-on learning experience prior to graduation of medical school. Keywords: internship; medical student; work.

Primary Grynfeltt Lumbar Hernia: A Case Report.

A weakening or defect in posterolateral abdominal wall can lead to development of lumbar hernia. These defects are particularly common in Petit's inferior triangle or Grynfeltt-Lesshaft superior triangle. There are very few cases of primary lumbar hernias that have been described in literature till date. As it is a rare entity, it is often misdiagnosed, leading to delay in management. We present a case of a 66-year-old male with no previous surgery who presented with a mass in left lumbar region for last ten years. The mass gradually increased in size and caused vague dragging pain. On Computed tomography, the diagnosis of Grynfeltt hernia was made. The patient underwent a laparoscopic mesh repair and had an uneventful postoperative hospital stay. Although a rare entity, there should be a high degree of suspicion of a lumbar hernia when evaluating a case of a lumbar mass. Early diagnosis by computed tomography and management with open or minimally invasive techniques can prevent complications.

Organophosphorus Poisoning among Patients Admitted to the Intensive Care Unit of the Department of Internal Medicine in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

INTRODUCTION: Organophosphates are potent cholinesterase inhibitors that when ingested in excessive amounts can be fatal. Organophosphorus poisoning has become an important clinical problem with increased mortality in the country from accidental or intentional ingestion of, or exposure to the pesticide. This study aimed to find out the prevalence of organophosphorus poisoning among patients admitted to the Intensive Care Unit of the Department of Internal Medicine in a tertiary care centre. METHODS: A descriptive cross-sectional study was conducted among patients admitted to the Intensive Care Unit of the Department of Internal Medicine of a tertiary care centre after receiving ethical approval from the Institutional Review Committee (Reference number: 2003202205). The study was conducted between 1 February 2021 and 1 February 2022 using hospital records. Convenience sampling was done among the patients who met the eligibility criteria. The diagnosis of organophosphorus poisoning was made based on the patient's history, clinical examination and the measurement of serum acetylcholinesterase levels. Point estimate and 95% Confidence Interval were calculated. RESULTS: Among 1108 patients admitted, organophosphorus poisoning was seen in 50 (4.15%) (3.29-5.73, 95% Confidence Interval). CONCLUSIONS: Our study found that the prevalence of organophosphorus poisoning was lower when compared to similar studies done in similar settings.

Mean Six Minute Walk Distance of Healthy Healthcare Workers of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: The six-minute walk test is a sub-maximal exercise test used in clinical populations to determine functional exercise capacity. It is a safe, simple, and inexpensive test. There are a number of reference equations described for estimating six-minute walk distance in healthy subjects in different countries. However, there is a lack of standard reference value for six minute walk distance in healthy Nepalese population. The aim of the study was to find the mean six minute walk distance of healthy healthcare workers of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among healthy health care workers of a tertiary care centre from 1 August 2021 to 30 November 2021 after taking ethical approval from Institutional Review Committee (Reference number: 1507202105). Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: The mean six-minute walk distance of the 162 healthy health care workers was 486.74±74.73 (475.23-498.24, 95% Confidence Interval) m. Men walked 519.61±79.19 m and women walked 474.12±75.62 m. The mean age of the participants was 29.25±8.25 years. Conclusions: The mean six-minute walk distance was found to be lower when compared to similar studies conducted in similar settings. Keywords: exercise test; health personnel; healthy volunteer; walk test.

Pneumonia in Patients with Chronic Kidney Disease Admitted to Nephrology Department of a Tertiary Care Center: A Descriptive Cross-sectional Study.

INTRODUCTION: Chronic Kidney Disease is an independent risk factor for pneumonia. The risk of hospitalization, Intensive Care Unit and ventilator requirement, in-hospital death is high in pneumonia patients with chronic kidney disease. This study aims to find the prevalence of pneumonia in patients with chronic kidney disease admitted to nephrology department of a tertiary care center. METHODS: A descriptive cross-sectional study was conducted among all the hospital records of pneumonia patients with Chronic Kidney Disease admitted to the Nephrology department between April 2019 and April 2021. Ethical clearance was obtained from the Institutional Review Committee of same institute (Reference number: 0505202106). Statistical Package for the Social Sciences version 20 was used for analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Of the total 407 patients with Chronic Kidney Disease, 78 (19.1%) (95% Confidence Interval= 15.28-22.92) had pneumonia. Among the 78 pneumonia patients, 17 (21.8%) were Stage 3, 13 (16.7%) Stage 4 and 48 (61.5%) Stage 5 of chronic kidney disease. Forty Seven (60.3%) required Intensive Care Unit (ICU), 19 (24.4%) required ventilator and 22 (28.2%) of the patient expired in hospital. The most commonly isolated organisms were Severe Acute Respiratory Syndrome Coronavirus 2 which was 13 (16.6%) followed by Strepotococcus pneumoniae which was 8 (10.2%). CONCLUSIONS: The prevalence of pneumonia in Chronic Kidney Disease was observed higher in our study compared to other studies.