Global incidence of caesarean deliveries on maternal request: a systematic review and meta-regression.

BACKGROUND: Caesarean delivery on maternal request (CDMR) is considered a significant contributor to the unprecedented increase in caesarean deliveries (CDs) for nonclinical reasons. Current literature lacks a reliable assessment of the rate of CDMR, which hinders the planning and delivery of appropriate interventions for reducing CDMR rates. OBJECTIVES: To conduct a systematic review of the literature and meta-regression to explore the global incidence of CDMR. SEARCH STRATEGY: PubMed, Embase, CINAHL, Medline, Google scholar and grey literature were searched from January 1985 to May 2019. SELECTION CRITERIA: Observational studies that report CDMR data were included. We excluded non-English articles, case notes, editorial reviews and articles reporting elective CDs from pregnancy risk factors. DATA COLLECTION AND ANALYSIS: Two reviewers independently conducted the screening and quality appraisal using a validated tool. The weighted average of CDMR over total deliveries (absolute proportion) and by total CDs (relative proportion) were generated. Quality-effects meta-regression was used to explain the variability of the CDMR estimates by moderators, including study methodology and demography of study participants. MAIN RESULTS: We identified 31 articles from 14 countries that include 5 million total births. The absolute proportion of CDMR varies between 0.2 and 42.0%, with significant variations across studies and subgroups. The economic status of the country and study year together explained 84% of the absolute and 76% of the relative proportion of CDMR variation. CONCLUSIONS: An appropriate reporting of CDMR should be a key priority in maternal health policies and practices. TWEETABLE ABSTRACT: Globally, the proportion of maternal requested caesarean delivery has mostly been influenced by the economic status of the country.

Adaptation strategies of yak to seasonally driven environmental temperatures in its natural habitat.

The gradual increase of ambient temperature (TA) at high altitude can cause heat stress as an effect of climate change and may shift the traditional habitat of yak to further higher altitude. Therefore, an attempt has been made in this study to evaluate the thermo-adaptability of yaks to different seasons at high altitude. The adaptive capabilities of yaks were assessed based on different heat tolerance tests in relation to changes in rectal temperature (RT; °F), respiration rate (RR; breaths/min), pulse rate (PR; beats/min), and plasma heat shock protein (HSP) profile. The experiment was conducted in 24 yaks, divided into three groups based on age as calf (n = 8), adult (n = 8), and lactating cow (n = 8). Thermal adaptability was determined by temperature humidity index (THI), dairy search index (DSI), and Benezra's thermal comfort index (BTCI) along with HSP70 profile. The THI was higher (P < 0.01) in summer than winter which increased from lowest (40.87) to highest (61.03) in summer by 20 points, where yaks were under heat load beyond THI 52. The RT (100.09 ± 0.18 °F), RR (21.76 ± 0.18), and PR (59.78 ± 0.32) increased by 23-35%, and this was correlated to the higher values of DSI exceeding 1 in calves (1.35 ± 0.03), lactating cows (1.29 ± 0.04), and adults (1.23 ± 0.32) during summer in comparison to winter (0.98 ± 0.02). The BTCI also showed values greater (P < 0.01) than 2 in calves (3.47 ± 0.27), lactating cows (3.23 ± 0.28), and adults (2.98 ± 0.29) which reflected 49-75% increase in rectal temperature and respiration rate during summer. Further, heat stress was substantiated by threefold higher (P < 0.01) level of plasma HSP70 in calves (189.61 ± 3.90 pg/ml) followed by lactating cows (168.62 ± 3.03 pg/ml) and adults (155.33 ± 2.30 pg/ml) against the winter average of 87.92 ± 3.19 pg/ml. Present results revealed that yaks were experiencing heat stress in summer at an altitude of 3000 m above sea level and calves were more prone to heat stress followed by lactating cows and adults.

Overweight and obesity among children and adolescents in Bangladesh: a systematic review and meta-analysis.

OBJECTIVES: The increasing prevalence of overweight and obesity among children (0-12 years) and adolescents (13-19 years) has emerged as a major public health threat in Bangladesh. Unfortunately, there is a serious paucity of credible data on these issues that can be used for policy and programmatic development. This article presents a systematic review of studies on overweight and obesity to present a more accurate estimate by pooling results. STUDY DESIGN: Systematic review. METHODS: The study systematically reviewed relevant literature published between 1998 and 2015 using predefined inclusion/exclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to identify relevant studies. Measures of heterogeneity and variability were calculated, and a random effect model was used to report pooled prevalence rates of overweight and obesity. RESULTS: The findings show that prevalence rates of overweight and obesity among children and adolescents varied widely from 1.0% to 20.6% and 0.3% to 25.6%, respectively. The pooled prevalence rates of overweight and obesity were 7.0% (95% confidence interval [CI] 5.0-10.0) and 6.0% (95% CI 4.0-8.0), respectively. The pooled prevalence rate of overweight increased substantially over the years, from 3.6% during 1998-2003 (95% CI 0.3-29.2) to 5.7% during 2004-2009 (95% CI 0.8-30.2) and 7.9% by 2010-2015 (95% CI 5.1-12.1). However, the pooled prevalence rate of obesity registered a sharp decline between 1998-2003 and 2004-2009 - from 9.7% (95% CI 5.7-16.2) to 2.0% (95% CI 0.3-11.1) - and subsequently increased significantly to 9.0% by 2010-2015 (95% CI 5.3-14.6). CONCLUSIONS: This review identified increasing trends in the prevalence of overweight and obesity among children and adolescents in Bangladesh. This study underscores the urgent need to promote healthy lifestyles among children and adolescents with a view to effectively address the increasing problem of overweight and obesity. This would also help to prevent the development of chronic non-communicable diseases in adulthood.

Changes in expression of monocarboxylate transporters, heat shock proteins and meat quality of Large White Yorkshire and Ghungroo pigs during hot summer period.

OBJECTIVE: Present study explores the effect of hot summer period on the glycolytic rate of early post-mortem meat quality of Ghungroo and Large White Yorkshire (LWY) pig and comparative adaptability to high temperature between above breeds by shifting the expression of stress related genes like mono-carboxylate transporters (MCTs) and heat shock proteins (HSPs). METHODS: Healthy pigs of two different breeds, viz., LYW and Ghungroo (20 from each) were maintained during hot summer period (May to June) with a mean temperature of about 38°C. The pigs were slaughtered and meat samples from the longissimus dorsi (LD) muscles were analyzed for pH, glycogen and lactate content and mRNA expression. Following 24 h of chilling, LD muscle was also taken from the carcasses to evaluate protein solubility and different meat quality measurements. RESULTS: LWY exhibited significantly (p<0.01) higher plasma cortisol and lactate dehydrogenase concentration than Ghungroo indicating their higher sensitivity to high temperature. LD muscle from LWY pigs revealed lower initial and ultimate pH values and higher drip loss compared to Ghungroo, indicating a faster rate of pH fall. LD muscle of Ghungroo had significantly lower lactate content at 45 min postmortem indicating normal postmortem glycolysis and much slower glycolytic rate at early postmortem. LD muscle of LWY showed rapid postmortem glycolysis, higher drip loss and higher degrees of protein denaturation. Ghungroo exhibited slightly better water holding capacity, lower cooking loss and higher protein solubility. All HSPs (HSP27, HSP70, and HSP90) and MCTs (MCT1, MCT2, and MCT4) in the LD muscle of pigs inclined to increase more in Ghungroo than LWY when exposed to high temperature. CONCLUSION: Effect of high temperature on the variation of HSPs and MCTs may play a crucial role in thermal tolerance and adaptation to different climatic conditions, pH regulation, muscle acidification, drip loss, protein denaturation and also in postmortem meat quality development.

Clinical evaluation of purified Shilajit on testosterone levels in healthy volunteers.

Purified Shilajit, an Ayurvedic rasayana, was evaluated in healthy volunteers of age between 45 and 55 years for its effect on male androgenic hormone viz. testosterone in a randomised, double-blind, placebo-controlled clinical study at a dose of 250 mg twice a day. Treatment with Shilajit for consecutive 90 days revealed that it has significantly (P < 0.05) increased total testosterone, free testosterone and dehydroepiandrosterone (DHEAS) compared with placebo. Gonadotropic hormones (LH and FSH) levels were well maintained.

Increasing prevalence of diabetes in Bangladesh: a scoping review.

BACKGROUND: The prevalence of type 2 diabetes is increasing rapidly in Bangladesh. However, studies documenting the increasing trend of diabetes prevalence are scarce. The aim of this study was to conduct a scoping review of published literature to ascertain the changing patterns of diabetes prevalence in Bangladesh. METHODOLOGY: We conducted a scoping review based on York scoping reviews framework and performed a comprehensive search of published literature through Medline, BanglaJOL, and Google Scholar published between 1994 and 2013. We summarised and calculated the time trends and pooled prevalence for type 2 diabetes among adults (≥18 years) in both urban and rural areas in Bangladesh. RESULTS: Of 152 studies identified, we included 22 studies for the scoping review which met the inclusion criteria. Overall, 11 studies (50%) were conducted in rural areas, eight in urban (36%) and three (14%) in semi-urban, semi-rural and tribal areas. The overall prevalence of type 2 diabetes ranged between 4.5% and 35.0%. The final estimate of diabetes prevalence obtained after pooling of data from individual studies among 51,252 participants was 7.4% (95% CI 7.2-7.7%). The prevalence of diabetes was higher in males compared to females in urban areas and vice-versa in rural areas. Analyses of exponential trend revealed an increasing trend of diabetes prevalence among urban and rural population at a rate of 0.05% (R = 0.18) and 0.06% (R = 0.35) per year, respectively. CONCLUSION: The prevalence of type 2 diabetes showed an increasing trend in both urban and rural population in Bangladesh. Our findings suggest the need for an all-out effort by the government and stakeholders to implement preventive strategies for diabetes in Bangladesh.

Remote sensing in hybridized arrays of nanostrings.

We study high-Q nanostrings that are joined end-to-end to form coupled linear arrays. Whereas isolated individual resonators exhibit sinusoidal vibrational modes with an almost perfectly harmonic spectrum, the modes of the interacting strings are substantially hybridized. Even far-separated strings can show significantly correlated displacement. This remote coupling property is exploited to quantify the deposition of femtogram-scale masses with string-by-string positional discrimination based on measurements of one string only.

Femtogram-scale photothermal spectroscopy of explosive molecules on nanostrings.

We demonstrate detection of femtogram-scale quantities of the explosive molecule 1,3,5-trinitroperhydro-1,3,5-triazine (RDX) via combined nanomechanical photothermal spectroscopy and mass desorption. Photothermal spectroscopy provides a spectroscopic fingerprint of the molecule, which is unavailable using mass adsorption/desorption alone. Our measurement, based on thermomechanical measurement of silicon nitride nanostrings, represents the highest mass resolution ever demonstrated via nanomechanical photothermal spectroscopy. This detection scheme is quick, label-free, and is compatible with parallelized molecular analysis of multicomponent targets.

A Morphometric Study of Glenoid Cavity of Scapula in Bangladeshi Population.

This cross-sectional descriptive purposive study was conducted among 150 (70 right and 80 left) fully ossified dry human scapulae of Bangladeshi people from January 2019 to December 2019 in the Department of Anatomy, Mymensingh Medical College, Mymensingh. Shape of the glenoid cavity was observed as pear, oval or inverted comma shape. Morphometric parameters such as length and breadth of glenoid cavity were measured by digital Vernier slide calipers. In this study, 19.13% cases were found inverted comma shaped, 35.65% cases were oval and 45.22% cases were pear shaped. The mean±SD length of glenoid cavity was 37.5±3.61 mm and 36.19±3.68 mm on right and left sided scapulae respectively and mean±SD breadth was 23.6±2.73 mm on right and 23.42±2.75 mm on left side respectively. Mean±SD glenoid cavity index was 62.89±4.39 on right and 64.61±4.74 on left sided scapulae. Morphometric analysis of glenoid fossa of scapula might help clinicians in shoulder and its associated diseases.

Prevalence of ESBL producing Escherichia Coli and Klebsiella species with their co-resistance pattern to antimicrobials.

Extended spectrum ß-lactamase producing bacteria are potential emerging pathogens and continue to be a major challenge in clinical setup worldwide. In the present study an attempt was made to study the prevalence of extended spectrum ß-lactamase producing Escherichia coli and Klebsiella species from clinical isolates in a rural tertiary care hospital in West Bengal, India with their antimicrobial susceptibility as well as co-resistance pattern to different antimicrobials. A total of 179 Escherichia coli and 62 Klebsiella isolates recovered from various clinical samples of urine, pus, aural swabs and respiratory secretions (including sputum) for a period of six months were subjected to routine antimicrobial susceptibility testing and also tested for extended spectrum ß-lactamase production as per NCCLS recommendations. Extended spectrum ß-lactamase was detected in 32.40% of Escherichia coli and 40.32% of Klebsiella species isolates. Urine, pus and respiratory samples were common source of extended spectrum ß-lactamase producers and resistance rate of these organisms to third generation cephalosporins were more than 30 to 40%. Co-resistance pattern of these extended spectrum ß-lactamase producers to other commonly used antimicrobials were also statistically significant (p≤0.05). From the study it is concluded that indiscriminate use of third generation cephalosporins may be responsible for the selection of extended spectrum ß-lactamase producing multidrug resistant strains in hospital setup and amikacin is a reliable drug against them.

Implementation and experimental results of 4D tumor tracking using robotic couch.

PURPOSE: This study presents the implementation and experimental results of a novel technique for 4D tumor tracking using a commercially available and commonly used treatment couch and evaluates the tumor tracking accuracy in clinical settings. METHODS: Commercially available couch is capable of positioning the patient accurately; however, currently there is no provision for compensating physiological movement using the treatment couch in real-time. In this paper, a real-time couch tracking control technique is presented together with experimental results in tumor motion compensation in four dimensions (superior-inferior, lateral, anterior-posterior, and time). To implement real-time couch motion for tracking, a novel control system for the treatment couch was developed. The primary functional requirements for this novel technique were: (a) the treatment couch should maintain all previous∕normal features for patient setup and positioning, (b) the new control system should be used as a parallel system when tumor tracking would be deployed, and (c) tracking could be performed in a single direction and∕or concurrently in all three directions of the couch motion (longitudinal, lateral, and vertical). To the authors' best knowledge, the implementation of such technique to a regular treatment couch for tumor tracking has not been reported so far. To evaluate the performance of the tracking couch, we investigated the mechanical characteristics of the system such as system positioning resolution, repeatability, accuracy, and tracking performance. Performance of the tracking system was evaluated using dosimetric test as an endpoint. To investigate the accuracy of real-time tracking in the clinical setting, the existing clinical treatment couch was replaced with our experimental couch and the linear accelerator was used to deliver 3D conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy (IMRT) treatment plans with and without tracking. The results of radiation dose distribution from these two sets of experiments were compared and presented here. RESULTS: The mechanical accuracies were 0.12, 0.14, and 0.18 mm in X, Y, and Z directions. The repeatability of the desired motion was within ±0.2 mm. The differences of central axis dose between the 3D-CRT stationary plan and two tracking plans with different motion trajectories were 0.21% and 1.19%. The absolute dose differences of both 3D tracking plans comparing to the stationary plan were 1.09% and 1.20%. Comparing the stationary IMRT plan with the tracking IMRT plan, it was observed that the central axis dose difference was -0.87% and the absolute difference of both IMRT plans was 0.55%. CONCLUSIONS: The experimental results revealed that the treatment couch could be successfully used for real-time tumor tracking with a high level of accuracy. It was demonstrated that 4D tumor tracking was feasible using existing couch with implementation of appropriate tracking methodology and with modifications in the control system.

Hypokalemic periodic paralysis, facial dysmorphism and ventricular arrhythmia (clinical triad of Andersen-Tawil syndrome).

Andersen-Tawil Syndrome (ATS) is a rare potassium channel disorder, characterized by episodic weakness, ventricular arrhythmias and dysmorphic features (short stature, scoliosis, clinodactyly, hypertelorism, small or prominent low set ears, micrognathia and broad forehead). We report a case of hypokalemic periodic paralysis with dysmorphic facial features and ventricular arrhythmia resembling Andersen-Tawil syndrome.

Outcomes and toxicities in oligometastatic patients treated with stereotactic body radiotherapy for adrenal gland metastases: A multi-institutional retrospective study.

BACKGROUND: Studies reporting SBRT outcomes in oligometastatic patients with adrenal gland metastases (AGM) are limited. Herein, we present a multi-institutional analysis of oligometastatic patients treated with SBRT for AGM. MATERIAL/METHODS: The Consortium for Oligometastases Research (CORE) is among the largest retrospective series of patients with oligometastases. Among CORE patients, those treated with SBRT for AGM were included. Clinical and dosimetric data were collected. Adrenal metastatic burden (AMB) was defined as the sum of all adrenal GTV if more than one oligometastases is present.Competing risk analysis was used to estimate actuarial cumulative local recurrence (LR) and widespread progression (WP). Kaplan-Meier method was used to report overall survival (OS), local recurrence-free survival (LRFS), and progression-free survival (PFS). Treatment related toxicities were also reported. RESULTS: The analysis included 47 patients with 57 adrenal lesions. Median follow-up was 18.2 months. Median LRFS, PFS, and OS were 15.3, 5.3, and 19.1 months, respectively. A minimum PTV dose BED10 > 46 Gy was associated with an improved OS and LRFS. A prescribed BED10 > 70 Gy was an independent predictor of a lower LR probability. AMB>10 cc was an independent predictor of a lower risk for WP. Only one patient developed an acute Grade 3 toxicity consisting of abdominal pain. CONCLUSION: SBRT to AGM achieved a satisfactory local control and OS in oligometastatic patients. High minimum PTV dose and BED10 prescription doses were predictive of improved LR and OS, respectively. Prospective studies are needed to determine comprehensive criteria for patients SBRT eligibility and dosimetric planning.

Dermoid Cyst with Intracranial Extension Presenting With Headache.

Dermoid cysts (DC) are benign cutaneous developmental anomalies comprising of hair follicles, sweat glands and sebaceous glands, and lined by stratified squamous epithelium. They are most commonly found on the face, lower back, and ovaries. We present a case of DC with intracranial extension in a 9 year old boy who presented with headache and a fluctuant scalp swelling. Magnetic resonance imaging revealed a midline scalp mass with intracranial extension. The lesion was excised with superior sagittal sinus preservation; and confirmed as DC by histopathological examination. The boy made good recovery.

Clinical evaluation of spermatogenic activity of processed Shilajit in oligospermia.

The safety and spermatogenic activity of processed Shilajit (PS) were evaluated in oligospermic patients. Initially, 60 infertile male patients were assessed and those having total sperm counts below 20 million ml(-1) semen were considered oligospermic and enrolled in the study (n = 35). PS capsule (100 mg) was administered twice daily after major meals for 90 days. Total semenogram and serum testosterone, luteinising hormone and follicle-stimulating hormone were estimated before and at the end of the treatment. Malondialdehyde (MDA), a marker for oxidative stress, content of semen and biochemical parameters for safety were also evaluated. Twenty-eight patients who completed the treatment showed significant (P < 0.001) improvement in spermia (+37.6%), total sperm count (+61.4%), motility (12.4-17.4% after different time intervals), normal sperm count (+18.9%) with concomitant decrease in pus and epithelial cell count compared with baseline value. Significant decrease of semen MDA content (-18.7%) was observed. Moreover, serum testosterone (+23.5%; P < 0.001) and FSH (+9.4%; P < 0.05) levels significantly increased. HPLC chromatogram revealed inclusion of PS constituents in semen. Unaltered hepatic and renal profiles of patients indicated that PS was safe at the given dose. The present findings provide further evidence of the spermatogenic nature of Shilajit, as attributed in Ayurvedic medicine, particularly when administered as PS.

A novel Gymnema sylvestre extract stimulates insulin secretion from human islets in vivo and in vitro.

Many plant-based products have been suggested as potential antidiabetic agents, but few have been shown to be effective in treating the symptoms of Type 2 diabetes mellitus (T2DM) in human studies, and little is known of their mechanisms of action. Extracts of Gymnema sylvestre (GS) have been used for the treatment of T2DM in India for centuries. The effects of a novel high molecular weight GS extract, Om Santal Adivasi, (OSA(R)) on plasma insulin, C-peptide and glucose in a small cohort of patients with T2DM are reported here. Oral administration of OSA(R) (1 g/day, 60 days) induced significant increases in circulating insulin and C-peptide, which were associated with significant reductions in fasting and post-prandial blood glucose. In vitro measurements using isolated human islets of Langerhans demonstrated direct stimulatory effects of OSA(R) on insulin secretion from human ß-cells, consistent with an in vivo mode of action through enhancing insulin secretion. These in vivo and in vitro observations suggest that OSA(R) may provide a potential alternative therapy for the hyperglycemia associated with T2DM.

Survey of current practices from an international task force for gynecological stereotactic ablative radiotherapy.

BACKGROUND: Stereotactic Ablative Radiotherapy (SABR) is an effective treatment that improves local control for many tumours. However, the role of SABR in gynecological cancers (GYN) has not been well-established. We hypothesize that there exists considerable variation in GYN-SABR practice and technique. The goal of this study is to describe clinical and technical factors in utilization of GYN-SABR among 11 experienced radiation oncologists. MATERIALS AND METHODS: A 63 question survey on GYN-SABR was sent to 11 radiation oncologists (5 countries) who have published original research, conducted trials or have an established program at their institutions. Responses were combined and analyzed at a central institution. RESULTS: Most respondents indicated that salvage therapy (non-irradiated or re-irradiated field) for nodal (81%) and primary recurrent disease (91%) could be considered standard options for SABR in the setting of inability to administer brachytherapy. All other indications should be considered on clinical trials. Most would not offer SABR as a boost in primary treatment off-trial without absolute contraindications to brachytherapy. Multi-modality imaging is often (91%) used for planning including PET, CT contrast and MRI. There is a wide variation for OAR tolerances however small bowel is considered the dose-limiting structure for most experts (91%). Fractionation schedules range from 3 to 6 fractions for nodal/primary definitive and boost SABR. CONCLUSIONS: Although SABR has become increasingly standard in other oncology disease sites, there remains a wide variation in both clinical and technical factors when treating GYN cancers. Nodal and recurrent disease is considered a potential indication for SABR whereas other indications should be offered on clinical trials. This study summarizes SABR practices among GYN radiation oncologists while further studies are needed to establish consensus guidelines for GYN-SABR treatment.

Serological evidence of antibodies against Chlamydophila abortus in free-ranging yak (Poephagus grunniens) in Arunachal Pradesh, India.

Serum samples were randomly collected from 172 free-ranging yak (Poephagus grunniens, presently Bos grunniens) from six different yak tracts of Arunachal Pradesh, India, and subjected to enzyme-linked immunosorbent assay to detect the presence of specific antibodies against Chlamydophila abortus. The overall prevalence of this disease in yak was 35%. The prevalence of Cp. abortus-specific antibodies was significantly higher in yak cows (41%) than among bulls (25%). The highest prevalence (39%: 95% confidence interval [Cl] = 27, 55) was found in yak between one and three years of age, while the lowest prevalence (20%: 95% CI = 10, 41) was reported in yak below one year of age.

A serological survey of antibodies against bovine herpesvirus-1 in yak (Poephagus grunniens) in Arunachal Pradesh in India.

Serum samples were collected from 254 yak (Poephagus grunniens, presently Bos grunniens) in different yak tracts of India. These samples were then screened by virus neutralisation test (VNT) and avidin-biotin enzyme-linked immunosorbent assay (AB-ELISA) to study the seroprevalence of antibodies against bovine herpesvirus type 1 (BHV-1). The overall seroprevalence in yak was found to be 41% (105) by VNT and AB-ELISA. The sex of the animal, whether it was on a farm or free-ranging and the location of the different yak tracts did not seem to have any effect on seroprevalence. However, seroprevalence was found to increase with the age of the animals, being highest in yak older than three years of age (49%). Yak generally share feeding, watering and grazing areas with other domestic and wild animals and this common ecological niche is thought to be a possible avenue of infection. This is the first time that the seroprevalence of antibodies against BHV-1 has been studied in yak in India.

Septicemia, Meningitis and Bilateral Subdural Empyema in an Infant Caused by Staphylococcus aureus.

Staphylococcus aureus is a global bacterial pathogen. It is an uncommon pathogen causing central nervous system infections, accounting for <1% cases of bacterial meningitis. Sinusitis, trauma and presence of an intracranial device have been reported as risk factors for developing meningitis and brain abscesses. A previously healthy 5-month-old female infant presented to a hospital in North-Eastern India in February 2018 with Staphylococcus aureus sepsis and meningitis and was subsequently detected to have developed bilateral subdural empyema on computed tomography scan of the brain. Burr hole evacuation procedure of subdural empyema was done on day-18 subsequent to which inflammatory markers and temperature gradually normalized. Prolonged course of intravenous antibiotics (5-weeks) and anticonvulsants were needed. This case highlights the importance of considering brain abscess and empyema in a child with meningitis whose temperature do not settle down after being treated appropriately and adequately with intravenous antibiotics and features such as seizures develop. It also reflects the challenges that may be faced by clinicians in resource-limited settings both during acute and follow-up stages.