Lynchrode7252

Xanthomas are subcutaneous lipid deposits containing macrophages loaded with cholesterol and cholesterol esters. Although quite common in adults, xanthomas in pediatric population are infrequent and when present, may represent a cutaneous manifestation of underlying lipoprotein disorders which most often are familial. We report a case of an eleven-year-old female child, with multiple eruptive xanthomas of skin since two years of age, a positive family history and deranged lipid profile consistent with possible familial hypercholesterolemia.INTRODUCTION Scrub typhus is an under-diagnosed and undertreated zoonotic human infection. There are no data related to profile of adult patients in Nepal. We conducted this study to report socio-demographic, clinical profile and complications of scrub typhus in our scenario. METHODS This was a descriptive cross-sectional study carried out in Nobel Medical College Teaching Hospital, eastern Nepal. The sample enrollment process was consecutively who were admitted under medical ward and intensive care unit. Diagnosis was established serologically with positive test of IgM antibodies against scrub typhus using immuno-chromatography. Operational definitions for organ system dysfunction were based upon simple available clinic laboratory profiles and imaging. Collected data were entered in Microsoft Excel 2007 and converted it into Statistical Package for Social Science 11.5 Version for statistical analysis. RESULTS A total of 47 patients were analyzed during this study. Diagnosis of scrub typhus was more common 17 (36.17%) in age group of (40-60 years) with female predominance 32 (68.08%). Most patients (70.15%) were of above 40 years. Fever 47 (100%), asthenia 40 (85.10%), generalized body-ache 41 (87.23%), anorexia 46 (97.87%) and headache 39 (82.97%) were present in most of our patients at sometime during their illness. Respiratory dysfunction was the commonest 37 (78.72%) system dysfunction followed by renal 30 (63.82%) and hepatic 20 (42.55%) impairment. Fortunately no deaths occurred. CONCLUSIONS Scrub typhus occurred more commonly in elderly female patients. Early empirical treatment may prevent mortality. Large studies involving whole country is needed to see real scenario of disease in this setting.INTRODUCTION Medical thoracoscopy has recently gained renewed interest due to its minimal invasive nature and high yield diagnostic outcome. This study aims to observe diagnostic yield and safety of medical thoracoscopy in undiagnosed exudative pleural effusion. METHODS This is a descriptive cross-sectional study conducted in two tertiary care hospitals in Chitwan from March 2018 to May 2018. Ethical approval from the Institutional Review Board was obtained. Convenient sampling was done that included all the patients who met criteria for undiagnosed exudative pleural effusion after diagnostic thoracocentesis. Patients having contraindication to procedure and who refused consent were excluded. Statistical analysis was performed using IBM SPSS Statistics 20 and data are presented as mean ±SD and frequency (percentage). RESULTS A total of 14 patients underwent rigid medical thoracoscopy. All 14 patients had unilateral pleural effusion. The overall diagnostic yield was 100%. Malignancy was the most frequent histopathology diagnosis seen in 11 (78.57%) patients, the commonest being metastatic adenocarcinoma in 8 (57.1%). Pleural tuberculosis and acute-on-chronic pleuritis were seen in 2 (14.3%) and 1 (7.1%) patients, respectively. Pleural deposits and hemorrhagic pleural fluid were the two commonest findings, seen in 10 (70.1%) and 9 (64.3%) patients, respectively. Two (14.3%) patients clinically treated as tuberculous pleural effusion was re-diagnosed to have metastatic adenocarcinoma. Coleonol Procedure related mortality and major complications were nil. Common procedure-related minor complications observed were mild to moderate pain and mild bleeding, observed in 3 (21.4%) and 2 (14.3%) patients, respectively. CONCLUSIONS Medical thoracoscopy is a safe, well-tolerated and high yield procedure in undiagnosed exudative pleural effusion. This art of medicine should be promoted in daily medical practice.INTRODUCTION Supracondylar fracture of humerus is one of the common pediatric fractures encountered in our daily clinical practice. The purpose of this study is to determine the pattern of supracondylar fracture operated at rural teaching hospital of Jumla, Karnali Nepal. METHODS A descriptive cross sectional study was conducted at Jumla, Karnali after Institutional Review Committee approval. Operating room notes from 15 May 2017 to 16 November 2019 were retrieved to gather the following information patients address, age, sex, side, injury mechanism, displacement, neurovascular injury, concurrent injuries, initial management by traditional bone setters, time between injury and surgery, operative technique. Data analysis was done using Statistical Package for Social Sciences version 20. RESULTS Left side predominated with 88 (63.7%) and extension type was common in 135 (97.8%). Thirteen (9.4%) patients were initially managed by traditional bonesetters. A total of 138 children underwent operative fixation with mean age of 7.47 years and gender ratio of 21 boy to girl. Fall from cliff, ladders and rooftops were the prevailing cause of injury 73 (52.8%). Average time between injury and surgery was 5.2 days. Closed reduction was done in 100 (72.4%) patients whereas open reduction was necessary in 38 (27.5%) patients. CONCLUSIONS Closed extension type pediatric supracondylar fracture was common in this study. Fall from cliff, rooftop and ladder are the major cause of fracture. Delayed presentation and initial management of the fracture by the traditional bonesetters makes supracondylar fracture more challenging in resource limited setting like ours.INTRODUCTION Chronic kidney disease affects almost all aspects of life of the patients and caregivers. Dialysis is a common treatment modality for chronic renal failure. The caregivers of patients undergoing hemodialysis bear the emotional and psychological stress of having a chronically ill patient. The physical and psychological distress, limitations in personal and social activities, loss of freedom, financial limitations directly or indirectly affect the level of burden among caregivers. This study aims to study the level of burden among caregivers of patient undergoing hemodialysis. METHODS A descriptive cross-sectional study among 123 caregivers giving care to hemodialysis patients for at least 3 months at Teaching Hospitals, Chitwan was carried out using simple random sampling technique. Level of burden was evaluated using the burden questionnaire (Zarit Burden Interview). RESULTS The study revealed that 60 (48.78%) had mild to moderate, 53 (43.08%) had moderate to severe. The median scores for burden among the caregivers was (39.