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Introduction: Glue sniffing usually refers to volatile substance abuse (VSA) for psychoactive effects. Street children are the children who live, work, and earn their livelihood through the streets of urban settlements. Street children are mostly attracted to substance abuse and more particularly towards volatile substances as they are cheap, easy to access and have psychoactive effects as alcohol intoxication. This study aimed to assess the general characteristics of street children of Pokhara Metropolitan, Nepal who are addicted to glue sniffing. Methods: A cross-sectional study was conducted among street children who were addicted to glue sniffing through the snowball sampling method in Pokhara Metropolitan, Nepal. Results: All 88 children who were addicted to glue sniffing were males. Of the total children, 59 (67%) children started glue-sniffing at the age of five to ten years of age while nine (10.2%) children started sniffing even before they were five years old. Addiction to glue (n = 33, 37.5%), pleasure (n = 18, 20.5%)), coping with hunger (n = 14, 15.9%), and being a part of street children group (n = 13, 14.8%) were the major reasons to sniff glue for these children. Conclusions: It has been observed that the majority of street children are at increased risk of getting involved in glue sniffing. It has resulted in different ill outcomes such as self-destruction and problematic behavior, fights and police arrest. There is a need to focus on the issue of glue sniffing among the street children to save and ensure the quality of life of these vulnerable children. [ABSTRACT FROM AUTHOR]

Background: Aluminum phosphide is a very common suicide agent in developing countries like Nepal. Due to the unavailability of a specific antidote, mortality is very high because the phosphine molecule that is formed leads to inhibition of the cytochrome oxidase enzyme system in mitochondria. Extracorporeal membrane oxygenation provides life-saving support to the cardiovascular and respiratory systems until the deadly poison is eliminated from the body., Case Presentation: We encountered one case of 67-year-old Asian woman, a known case of major depressive disorder, who presented to our center with suicidal ingestion of aluminum phosphide with cardiovascular and respiratory dysfunction. On presentation in our emergency room, she had an ejection fraction of 20% and had to be immediately intubated for respiratory failure. Based on the evidence of almost 100% mortality with aluminum phosphide poisoning, extracorporeal membrane oxygenation was initiated in our intensive care unit. Her general condition and hemodynamics gradually improved over the course of 2 days and she was weaned from extracorporeal membrane oxygenation and ventilator by post-extracorporeal membrane oxygenation days 3 and 4, respectively. After psychiatric evaluation and establishment of normal vital parameters, she was moved out of intensive care unit on post-extracorporeal membrane oxygenation day 6 and discharged to home on post-extracorporeal membrane oxygenation day 10., Conclusions: Although this seems to be a small step in terms of global perspective, it is a giant stride for a developing country. The management of reversible but severe cardiac and respiratory failure certainly opens up newer scopes where we can ensure a quality health care service being made accessible even to the most underprivileged people.

Background: Posttubercular constrictive pericarditis is prevalent pericardial disease in developing countries. Pericardiectomy is the treatment of choice but considered a procedure of high morbidity and mortality., Methods: From January 2003 to December 2013 we performed 130 pericardiectomies. The patients' mean age was 22.95 ± 12.55 years, and there were 92 (71%) male patients. All patients were symptomatic; 118 (91%) were in New York Heart Association functional class III or IV. Almost all patients were diagnosed to be of tubercular origin: 14 (11%) were histopathologically proven, 77 (59%) had definitive history, 39 (30%) were suspected to be of tubercular origin, and 91 (70%) received prior antitubercular treatment., Results: Anterior pericardiectomy was done without the use but with provision for cardiopulmonary bypass, which was required in 5 (3.8%) patients for repair of tear in right atrium. Following pericardiectomy central venous pressure dropped from 20.9 to 10.8 mm Hg. Early mortality was 10 (7.69%). Prolonged ventilation was required in 22 (16.92%) patients, 31 (23.84%) developed renal dysfunction, and there were 3 (3.12%) cases of new-onset atrial fibrillation. On analysis of univariate predictors for early mortality, low ejection fraction (p < 0.001) and preoperative atrial fibrillation (p < 0.001) were found to be significant. In a follow-up of 12 months, 85% patients were in New York Heart Association functional class I or II with mean ejection fraction of 52%. There was no recurrence of constriction from residual pericardium on 1-year follow-up., Conclusions: Anterior pericardiectomy is sufficient in patients with constrictive pericarditis of infective etiology. Preoperative low ejection fraction, atrial fibrillation, poor functional class, and constrictive effusive pericarditis results in poor surgical outcome., (Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)