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Introduction: Epistaxis is a common otolaryngological emergency condition. It occurs due to local and systemic cause. Local cause lies within the nose bleeding either anterior or posterior. Commonest site of bleeding anterior epistaxis is kiesselbach’s plexus. In posterior epistaxis, it is difficult to locate bleeding site. Epistaxis is controlled by simply pinching of nose, decongested nasal drop and abgel packing. Some cases become more challenging required nasal packing and arterial ligation. Objectives: To study the epidemiological pattern and management of epistaxis. Methods: This was a retrospective study on pattern of epistaxis man­aged at Gandaki Medical College Teaching Hospital over a period from April 2015 to April 2016. Information regarding demographic profile, presentation and management of epistaxis was obtained from the Hospital records, ENT Outpatient clinic, Emergency Department, ENT ward and operation theatre. Results: A total of 78 cases were managed during study period. There was a significant male preponderance with male to female ratio 1.78:1. Patients’ age varied from eight to 80 years with mean age 40.7 years. The peak age of incidence was 21 - 30 years group. Idiopathic nasal bleeding 27 (34.6%) was commonest followed by nasal trauma 23 (29.5%) cases and hypertension 16 (20.5%) cases. Seventeen (21.8%) cases managed in day care basis with decongested nasal drop, chemi­cal cautery and abgel packing. Remaining cases required nasal packing and bipolar cautery and other specific form of treatment. Five (6.4%) cases required sphenopalatine artery ligation with no recurrence of bleeding. Conclusions: Epistaxis is common ENT emergency. Most common causes are idiopathic followed by nasal trauma and hypertension. Prompt management is instituted according to cases. Most of the cas­es are managed by non-surgical method.

Background: Testicular tumors are rare type of tumors affecting adolescents and young adults. The testicular tumors constitute 4th most common cause of death from neoplasm in a younger male.The present study is undertaken to analyze the pattern and age wise distribution of testicular lesions in our hospital.Materials and methods: This was a prospective study done over a period of 4 years from November 2012 to October 2016, after taking approval of the ethics committee and informed consent from the patients. Histopathological slides were retrieved and reviewed for tumor and its subtype.Results: A total of 60 cases of testicular lesions were encountered in our study. Out of the total 60 cases,15% (9/60) were diagnosed as malignant testicular tumor.Most of these tumors were seen between 3rd and 4th decades.Germ cell tumor was the most common type (77.7%) among which seminomas (44.44%) and mixed germ cell tumors(28.57%) were most frequently encountered.Other tumor diagnosed was Non-Hodgkin lymphoma. Non-neoplastic lesions of the testis are most common in the second decade of life. The youngest patient was at birth and oldest was 71 years of age. Out of all non-neoplastic lesions, vascular lesions like torsion and infarction are the most common findings (54.90%) followed by tuberculous abscess (15.68%).Conclusion: Testicular tumors are uncommon in our population. Histopathological spectrum of our study was comparable with other parts of the world,germ cell tumor accounted for highest percentage of cases in neoplastic lesions and torsion and infarction are the common findings in non-neoplastiic lesions of testis.

Background: Abnormal uterine bleeding may be defined as changes in frequency of menstruation, duration of flow or amount of blood loss. Early accurate diagnosis and proper treatment is essential to prevent progress to endometrial cancer. Objective: This study was done to evaluate the histopathology of endometrium for identifying the endometrial causes of abnormal uterine bleeding. Method: This was a retrospective study done in department of pathology, Patan Hospital from 1 August 2011- to 31 July 2012; total 413 cases were included in this study. Results: The age of the patients ranged from 19 to 70 years. The most common clinical presentation was menorrhagia (47.46%), followed by continuous bleeding (14.04%) and metrorrhagia (13%). The commonest histopathological diagnosis was secretory endometrium 128 cases (30.99%), followed by proliferative endometrium 91 cases (22.03 %). Secretory endometrium was most commonly (52 cases) observed in 41-50 years age group followed by 43 cases in 30-40 years age group. Similarly proliferative endometrium was also most commonly seen in 41-50 age group (44 cases) followed by 31-40 years of age group (32cases). Malignant disease was most commonly seen in 51-60 years age group. Conclusions: Abnormal uterine bleeding is most common in 21-30 years age group.The most common clinical presentation is menorrhagia followed by continuous bleeding. Secretory endometrium is the most common histopathological findings. Malignancy is more common in postmenopausal group. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-2, 20-24 DOI: http://dx.doi.org/10.3126/jcmsn.v9i2.9683

Background: Urinary bladder diseases constitute an important source of clinical signs and symptoms which are more disabling than lethal. The prevalence of bladder tumor in developed countries is approximately six times higher compared with that in developing countries. The aim of this study was to find out various lesions in urinary bladder biopsies and its frequencies.Materials and Methods: This was a five year retrospective study from January 2008 to December 2013, carried out at B&B Hospital, Lalitpur. All the relevant data of 324 patients who had undergone cystoscopic biopsy of urinary bladder were included in the study. All blocks were retrieved and stained with Hematoxylin and Eosin stain and examined under light microscope.Results: The spectrum of pathological lesions included inflammations and tumors. Non-neoplastic lesions were predominant (61.11%) followed by Transitional cell tumors accounted for 124 cases (38.27%). Non-neoplastic lesions comprises of cystitis and tuberculosis. Papillary urothelial neoplasms was the most common tumors seen in this study with 55 low grade, and 54 high grade Papillary urothelial carcinoma according to recent WHO grading. Single cases each of adenocarcinoma and paraganglioma were diagnosed.Conclusion: Cystoscopic biopsies help in the early diagnosis and treatment of various bladder lesions. Analysis of cystoscopic biopsies was done to ascertain the type of urinary bladder lesions in our country.Journal of Pathology of Nepal (2015) Vol. 5, 717-719

Background: Chordoma is a rare slow growing but malignant midline bone tumor arising from the notochordal remnant and recapitulates the notochord at various stages of differentiation. They involve the axial skeleton. The aim of this study was to find the frequency of this tumor and to analyze the clinical, radiological and pathological findings.Materials and Methods: Cases of chordoma diagnosed at B & B Hospital from January 1999 to November 2011 were studied for clinicopathologic features and immunohistochemical profile.Results: There were 5 cases of chordoma during the study period. Females were affected more with male to female ratio of 1:1.5. Sixty percent of the tumors involved the sacrum, while 40% were intracranial and located at the base of the skull. Median age of diagnosis was 44.8 years. Four cases (80%) were conventional chordoma and 1 case (20%) was a chondroid variant. Two cases evaluated were immunoreactive for S-100 protein, pan-cytokeratin and EMA.Conclusion: Though a low grade tumor with prolonged clinical course, chordomas can cause extensive local destruction with significant morbidity and mortality. Hence a prompt diagnosis with adequate excision is important to save the patient’s life.Journal of Pathology of Nepal (2012) Vol. 2, 260-264DOI: http://dx.doi.org/10.3126/jpn.v2i4.6874

Congenital granular cell tumor is very rare and it arises from the gum pad of neonates. Surgery is required immediatly after birth as the tumor interfares with feeding and respiration. Although a benign tumor, it can create immense anxiety amongst the attending physician and family members. Its recognition is important so as to avoid over diagnosis leading to radical surgery. We report a case of congenital epulis arising from the maxillary alveolar ridge in a newborn female child, which was successfully excised and the diagnosis confirmed histologically. No tumor recurrence has been reported in the patient postoperatively. Keywords: Congenital; Epulis; Granular cell DOI: 10.3126/jpn.v1i1.4458 Journal of Pathology of Nepal (2011) Vol.1, 69-72

Background: Mutation of the C-KIT oncogene is the central event in gastrointestinal stromal tumors which are the most common mesenchymal tumors arising from the tubular gastrointestinal tract. Materials and Methods: A study was conducted in Patan hospital from April 2003 to May 2010. Mesenchymal tumors arising from the tubular gastrointestinal tract with the microscopic features suggesting gastrointestinal stromal tumor were included in the study. Results: A total of 22 cases were studied. The incidence was highest amongst the older age group (86.36%), than in younger people (13.63%). The tumor most commonly involved the small intestine (54.54%), followed by the stomach (36.36%). Most (59.09%) of the tumors were of huge size measuring >100 mm, and showed necrosis, hemorrhage and cystic degeneration. Mitotic activity was high (>5/50 high power fields) in 55% of the cases. Conclusion: C-KIT immunostaining showed positivity in 19 (86.36%) of the tumors in this study. Mutation of the C-KIT oncogene is seen in most of the gastrointestinal stromal tumors. Keywords: Gastrointestinal; Stromal tumors; C-KIT oncogene DOI: 10.3126/jpn.v1i1.4450 Journal of Pathology of Nepal (2011) Vol.1, 41-44

Phylloides tumor constitutes less than 1% of all breast tumors and 2 - 3% of fibroepithelial breast tumors. Several histological parameters should be evaluated, including stromal cellularity, atypia, mitoses, stromal overgrowth, infiltrative borders, and presence or absence of necrosis. Here we report a case of a 60 years- old female who presented with left breast lump. Fine needle aspiration cytology was done which suggested epithelial hyperplasia with fibrocystic changes. Biopsy was performed which showed predominance of stromal hypercellularity with proliferation of spindle cells (no atypia, mitosis and stromal overgrowth were noticed). However, a focus showed proliferation of discohesive tumor cells arranged singly and in single file. A diagnosis of benign phylloides tumor with foci of invasive lobular carcinoma was made. The diagnosis was confirmed with IHC which showed intense 80%positivity for estrogen and progesterone receptor and spindle cells showing positivity for bcl-2. In situ lobular carcinoma component was not observed. DOI: http://dx.doi.org/10.3126/jpn.v4i7.10321 Journal of Pathology of Nepal (2014) Vol. 4, 597-599

Background: Prostate cancer is the most common cancer in men. Prostate specifi c antigen is a key tumor marker to screen for prostate cancer. However, controversy exits regarding the impact of prostate cancer screening. Materials and Methods: This was a retrospective study carried out in the Department of Histopathology of B and B Hospital during a period of 2 years from 01-05-2064 to 01-05-2066. The study included 26 cases of prostate needle biopsy specimens. Results: The more common age group (43.9%) was 70-79 years followed by the age group above 80 years old (7.5%). The most common benign lesion observed was benign prostatic hyperplasia (5 out of 11, 45.45%), followed by benign prostatic hyperplasia with chronic prostatitis (3 out of 11, 27.27%). The most common malignant types of lesion encountered was prostatic adenocarcinoma with an incidence of 84.62% (11 out of 13 cases), following nodular hyperplasia of prostate with low grade prostatic intraepithelial neoplasm 15.38% (2 out of 13 cases). Among the benign and the malignant cases serum PSA ranged from 0 - ?10.1 ng/ml. Conclusion: Serum PSA value has signifi cant role in the diagnosis of malignant prostatic lesions. However, Histological diagnosis still remains the gold standard for the diagnosis of prostatic cancer. Journal of Pathology of Nepal (2013) Vol. 3, No.1, Issue 5, 394-396 DOI: http://dx.doi.org/10.3126/jpn.v3i5.7865

A granular cell tumor is an unusual benign soft tissue neoplasm, occurring in the tongue, oral cavity or subcutaneous tissue and rarely occurs in the breast. We report a case of 44 years old male, who presented with a swelling in the right breast since 7 years measuring 6 x 4 cm. Fine needle aspiration cytology was suggestive of low grade carcinoma and on histopathologic examination, it was diagnosed as granular cell tumour, with S-100 immunopositivity. Keywords: Granular cell tumour; Male breast; S-100 DOI: http://dx.doi.org/10.3126/jpn.v1i2.5414 JPN 2011; 1(2): 161-163

Background: Gallstone is a very common gastrointestinal disorder. It is known to produce histopathological changes in the gallbladder. It is also one of the predisposing factors for the development of cancer of gallbladder. Materials and Methods: This was a retrospective study carried out in the Department of Histopathology, B and B Hospital during a period of 1 year from April 2010 to May 2011. The study included 396 cases of cholecystectomy specimens. Results: On gross examination, outer gallbladder surface was congested in 116 patients (28%), wall thickness was increased in 181 (45.7%) and mucosal abnormalities were present in 126 (31.6%) patients. At microscopy, epithelial hyperplasia was observed in 183 (46.2%), intestinal metaplasia in 112 (28.2%), dysplasia in 5 (1.3%) and cholesterolosis in 56 (14%) patients. Conclusion: The pathological changes of the gallbladder epithelium may play an important role in the process of gallstone formation. DOI: http://dx.doi.org/10.3126/jpn.v2i3.6027 JPN 2012; 2(3): 224-225

Foreign bodies such as bone with a sharp end can penetrate the esophageal wall and lie extramurally. When a foreign body is not found on rigid oesophagoscopy, reassessing with imaging is important. The transcervical approach is a better alternative for such patients to remove the foreign bodies., Competing Interests: None., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Background: This study was conducted to assess the prevalence of dental caries, tobacco usage, and associated risk factors for dental caries in patients who visited a government hospital in Western, Nepal., Methods: This analytical cross-sectional study was conducted from January to April 2022. Patients above 18 years visiting the dental OPD of a government hospital, and who had provided informed consent were enrolled in the study using a convenience sampling technique. As the study also involved an illiterate population, in that case, informed consent was obtained from their respective legal guardian as well. A pretested standardized, close-ended questionnaire was administered by researchers to gather information regarding the associated risk factors and oral hygiene practices. Clinical examination was done for dental caries according to the criteria by the World Health Organization (WHO) using the "DMFT" index (WHO modification 1987). Bivariate and multivariable logistic regression was done and the odds ratio and p-value was calculated. For all tests, statistical significance was set at p < 0.05., Results: A total of 219 participants completed the study with a mean age of 31.73 ± 12.46. The prevalence of dental caries and tobacco was found to be 80.36% and 5.02% respectively. Participants without health insurance had 2.35 times higher odds of dental caries (95% CI: 1.03-5.36). Not rinsing the mouth after eating sweets was associated with 3.07 times higher odds of dental caries (95% CI: 1.31-7.18). Those who hadn't visited a dentist in the past 12 months had lower odds (0.42; 95% CI: 0.18-0.94). Eating fresh fruit daily showed statistically higher odds (2.70; 95% CI: 1.04-6.99) of dental caries. Non-tobacco users had higher odds (14.19; 2.55-78.99) of dental caries., Conclusion: Dental caries is highly prevalent, while tobacco usage is relatively low. Factors associated with dental caries included lack of health insurance coverage, consumption of fruits once daily, recent dental visits within the past year, not rinsing the mouth with water after consuming sweets, and non-tobacco users., (© 2024. The Author(s).)

Background: Pediatric intensive care provides better observation as well as an intensive treatment, which helps to cure, support, and provide better outcomes for sick children. This study aimed to describe the demographic profile and the outcome of PICU patients, and evaluate the relationship of diagnostic categories with treatment and outcome., Methods: This retrospective cross-sectional study was conducted in a six-bedded PICU from 1 March 2021 to 1 March 2022. Bivariate analysis was used to identify the association between dependent and independent variables., Results: The infants admitted below 6 months of age were 63 (22.3%) and had male predominance accounting for 64%. The main portal of entry of the admitted cases was emergency ward 214(75.6%). Most of the patients 153(54.1%) were admitted for intensive monitoring of their abnormal vitals along with critical care according to our PICU protocol. Respiratory illness 122(43.1%), neurosurgical illness 59(20.8%), and primary infectious disease 52(18.3%) were the common reason for PICU admission. Post-major surgery 2(66.7%), hematological illness 3(37.5%), and cardiac disorders 1(20%) had high mortality rates. Among the portal of admission, the majority of the children (80.0 %) who were admitted to the PICU through the emergency ward died before exiting from the PICU (p<0.0001)., Conclusions: Respiratory illness was the most common cause of admission and post-major surgery had the highest mortality rate. Portal of entry was statistically associated with patient characteristics and had a significant relationship with the outcome. Similar studies in other health institutions are required to further analyze the demographic profile and outcome of pediatric critical care in Nepal.

Hemangioma of the paranasal sinus is an infrequent condition. Two types of hemangioma are present at the nose; cavernous and capillary. Capillary hemangioma is rare in the sinonasal tract. Patients presented with massive epistaxis should think of nasal hemangioma. Resuscitation of patients is important and urgent Computerized Tomography scans should be performed which will help character and extension of any mass present at the nasal cavity. Initial nasal packing may help to prevent bleeding. We report a case of capillary hemangioma of a 30-year lady present with massive epistaxis initially controlled by Nasal packing. Her CT scan shows a homogenous mass at left maxillary sinuses and underwent left endoscopic sphenopalatine artery ligation and removal of the mass., Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04046-z., Competing Interests: Conflict of InterestThere was no conflict of interest., (© Association of Otolaryngologists of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Introduction: Mandibular third molar impaction is the most common impaction as third molars are last to erupt at the age of 17-25 years. Despite its high prevalence and negative impacts, there is limited study about mandibular third molar impaction. The aim of this study is to find out the prevalence of mandibular third molar impaction among patients visiting the outpatient Dental Department of a tertiary care centre., Methods: A descriptive cross-sectional study was conducted among patients visiting the Outpatient Dental Department of a tertiary care centre from 1 January 2023 to 30 June 2023. Ethical approval was taken from the Institutional Review Committee of the same institute. A total of 414 orthopantomograms were prospectively reviewed for the angulation of impaction, depth and position. The indication for extraction was recorded from patients' cards during the time of extraction. Convenience sampling method was used. The point estimate at a 95% confidence interval was calculated., Results: The prevalence of mandibular third molar impaction was 37.13% (34.29-39.97, 95% Confidence Interval). There was a high prevalence of mesioangular 344 (45.38%) pattern followed by vertical 249 (32.85%) for mandibular third molar impaction, the most commonly involved group was 20-30 years, with female 247 (59.70%) predominance. Bilateral impaction 344 (83.10%) was more prevalent than unilateral. Depth A, 639 (84.3%), ramus relation level I, 602 (79.42%) was the most common level of impaction. Recurrent pericoronitis 160 (38.6%) was the common indication for extraction followed by dental caries 145 (35%)., Conclusions: The prevalence of mandibular third molar impaction was lower than other similar studies done in similar settings., Keywords: impacted tooth; pericoronitis; prevalence; third molar.

Background: Viral load assessment is the preferred method for diagnosing and confirming virologic failure for patients on antiretroviral therapy. This study aimed to assess the proportion of viral load suppression and identify associated factors among HIV-positive patients receiving antiretroviral therapy at the Pokhara academy of health science in Nepal., Methods: This institution-based retrospective cohort study was conducted at Pokhara academy of health science in Pokhara, Nepal. The study included 567 HIV patients who were enrolled between January 2016 and December 2019 and had their viral load measured within a one-year period. Statistical analysis was performed using STATA version 13.0. The proportions of viral load suppression and non-suppression were determined. Bivariate and multivariate logistic regressions were performed to identify factors associated with viral load suppression. Statistical significance was determined at a 95% confidence interval and p < 0.05 Results: Out of the 567 HIV patients, 95.76 % (95% CI: 94.10-97.42) achieved viral suppression. In multivariate analysis, longer duration of antiretroviral therapy treatment (> 3 years) was independently associated with higher odds of achieving viral suppression compared to those on antiretroviral therapy for less than 6 months (adjusted odds ratio [aOR] = 11.98, 95% confidence interval: 1.32-108.81, p < 0.0027). Conversely, individuals in second-line treatment had significantly lower odds of viral suppression compared to those in first-line treatment (aOR = 0.19, 95% CI: 0.05-0.66, p < 0.009)., Conclusions: Our study demonstrated a high rate of viral suppression among HIV patients receiving antiretroviral therapy, exceeding the UNAIDS 90-90-90 target. Longer duration of antiretroviral therapy and being in second-line treatment were identified as factors influencing viral load suppression. These findings emphasize the importance of early initiation and adherence to first-line treatment for optimal outcomes.

Background: In Chronic Suppurative Otitis Media, mucosal type, most common organisms are Pseudomonas aeruginosa and Proteus species (P. mirabilis and P. vulgaris). It is important to prescribe culture-directed antibiotics to prevent resistance. This study was conducted to determine the bacteriological profile and drug susceptibility in patient with chronic suppurative otitis media., Methods: This is a hospital-based descriptive study done at Gandaki Medical College, Pokhara, Nepal from July 2019 to June 2020. Under aseptic condition, the swab specimens were obtained from patients with history of ear discharge of >12 weeks duration and findings central perforation of the tympanic membrane. The sample was labeled and immediately transferred to the microbiology lab for culture/sensitivity test according to the guidelines of the Clinical and Laboratory Standards Institute., Results: Out of total 127 patients, 48 (37.8%) were male and 79 (62.2%) were female. One hundred and seven samples (84.3%) had positive culture while 20 samples (15.7%) had no growth. Staphylococcus aureus (43%), was the most common isolate followed by Pseudomonas aeruginosa (23.4%), Proteus mirabilis (9.3%), and Escherichia coli (8.4%). All the organisms isolated were 100% sensitive to imipenem followed by 96.2% sensitive to gentamicin and 95.3% to amikacin., Conclusions: Staphylococcus aureus (43%) was the most predominant isolate followed by Pseudomonas aeruginosa (23.4%), Proteus mirabilis (9.3%), and Escherichia coli (8.4%). Imipenem was the most sensitive antibiotic (100%) followed by gentamicin (96.2%), amikacin (95.3%), and ofloxacin (88.78%).

Transcorneal electrical stimulation (TES) is used as therapy for retinal diseases such as retinitis pigmentosa (RP) and was suggested for assessing retinal sensitivity by determining phosphene thresholds, subjective luminance impressions caused by retinal stimulation. Further applications concerned the accommodation process, revealing an improved accommodative amplitude in presbyopic eyes after TES treatment. The respective changes of the ciliary muscle (CM), the structure most important for near vision, during TES are yet unknown. In a pilot study, we aimed to assess whether monocular TES leads to morphological and functional CM changes and whether central accommodation control is affected. Ten healthy, near-emmetropic adults participated in the trial (4 females, age 26.3 ± 3.6 years). Using a wavefront and a stimulus generator, a biphasic square-wave stimulus (2 s positive and 6 s negative amplitude) of 0 μA average current was produced and transferred to the eye by means of a Dawson-Trick & Litzkow electrode. Prior to the stimulation, an individual determination of phosphene thresholds served to define individual TES current amplitudes, which ranged between 60 and 100 μA. Optical coherence tomography (OCT) imaging of the right eye's temporal ciliary muscle was performed before and during ipsi- as well as contralateral monocular TES in randomized order in the morning and afternoon of the same day. During imaging, subjects fixated a target at 4 m distance and refraction was simultaneously recorded via eccentric infrared photorefraction. OCT images were assessed using previously published custom-developed software, allowing the definition of selective CM thickness (CMT) readings, and plotting of continuous CMT profiles along the muscle border. CMT profiles revealed that both stimulations, on the ipsi- and contralateral eye, induced a thickening of the CM compared to the non-stimulated state. The selective CMT readings confirmed a significant increase with ipsi- (31 ± 30 μm; p = 0.010) and contralateral (25 ± 16 μm; p = 0.001) TES. However, refraction during far vision was not significantly affected by either stimulation (ipsilateral [n = 5]: median Δ w/-w/o  = 0 D; contralateral [n = 7]: Δ w/-w/o  = 0.13 D). Pupil size on average increased during TES, but without reaching significance (ipsilateral [n = 5] median Δ w/-w/o  = 0.23 mm, contralateral [n = 7] Δ w/-w/o  = 0.39 mm). Ipsilateral CM thickening could be explained by local changes within the stimulated ciliary muscle, such as increased blood flow or interstitial fluid rise induced by TES. However, the CMT increase in the right eye when TES was performed contralaterally, on the left eye, indicates an involvement of the central control circuit of accommodation. Further possible explanations for this finding are a synchronization of neuronal activities in the visual pathway, the release of vasoactive neuropeptides, or effects on the central blood pressure regulation. Given a neuromodulation effect on the CM function, TES might have implications for children with accommodation insufficiencies and as additional therapy in myopia control management, e.g. in combination with multifocal contact lens treatment. Our study is important for the clinical application of TES, and the outcome might add crucial knowledge to the current understanding of the accommodation process and inform research and treatment of both myopia and presbyopia., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Childhood immunization is one of the most important public health interventions to reduce child morbidity and mortality. Reaching all children with full immunization services is critical to meet Nepal's commitment to Sustainable Development Goals (SDGs). This study aimed to identify factors affecting compliance with childhood immunization in children aged 16 to 36 months in Nepal. A community-based unmatched case-control study was conducted with 250 (83 cases and 167 controls) respondents in the Ilam district of Nepal. Respondents were randomly selected using a multi-stage cluster sampling technique. Data were collected using a structured questionnaire and analysed using SPSS version 16 statistical software. Bivariate and multivariate logistic regression analyses were done to identify the factors influencing compliance with childhood immunization of the sampled respondents. More than two-thirds (66.8%) of the sampled children were fully immunized, and 19.3% of the children defaulted to the Measles-Rubella vaccines. Only 19.2% of the respondents had good knowledge about the type of vaccine, and more than half (59.2%) of the respondents had a positive attitude towards immunization. Multivariate logistic regression analysis revealed that lack of knowledge about vaccines (AOR = 49.4, 95% CI = 12.94 to 188.59), father's level of education (AOR = 2.1, 95% CI = 1.05 to 4.30), not getting immunization on the day of the appointment (AOR = 4.8, 95% CI = 2.30 to 9.89), lack of knowledge about immunization schedule (AOR = 2.4, 95% CI = 1.14 to 4.84), and negative attitude towards immunization (AOR = 2.1, 95% CI = 1.03 to 4.19) were independently impeded on compliance on the childhood immunization. Targeted intervention in health promotion activities at the household level should be promoted and integrated immunization services into the existing primary health care services., Competing Interests: The authors declare no conflicts of interest., (© 2023 The Authors.)

Hemangioma is a common benign vascular tumor. However, bleeding cavernous hemangioma of the lower lip are a rare condition., Case Presentation: A 67-year-old female presented with bleeding from the lower lip. The bleeding increased with palpation. A clinical diagnosis of hemangioma of the lower lip was made. It was difficult to localize with ultrasound. It was explored and excised successfully., Clinical Discussion: Hemangioma can be superficial, deep, or mixed. Generally, hemangioma involute spontaneously. Bleeding hemangioma causing functional disturbances need to be treated, for which various modalities are available, including excision., Conclusion: Hemangioma of the lip is a benign tumor of vascular origin. In selected cases, excision can be performed., Competing Interests: The authors have no conflict of interest to declare., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

To predict stone-free and complication rates following mini-percutaneous nephrolithotomy (m-PCNL) using STONE nephrolithometry score, this prospective observational study was conducted in the Department of Surgery, Urology Unit, Patan Hospital. All the patients undergoing m-PCNL were included. The cases were performed in the prone position, a single tract less than 18 French was made, and pneumatic lithotripsy was done. Stone-free rates were assessed with plain X-ray kidney, ureter, and bladder (X-ray KUB) on the first post-operative day or at 15 days follow-up. Complications within 30 days were graded using modified Clavien grading. A total of 106 patients were included in the final analysis. The overall stone-free rate was 83%. Among the individual variables, only staghorn calculus was associated with residual stone (p = 0.007). Patients who were rendered stone-free had statistically significantly lower STONE scores than those with residual stone (p < 0.001). The complication rate was 23%, and the majority were Clavien grade I complications. A higher STONE score had a greater risk of having complications but was not statistically significant (p = 0.11). STONE nephrolithometry score can predict stone complexity pre-operatively and subsequent stone-free status and thus, helps in pre-operative surgical planning and counseling for possible outcomes following m-PCNL., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction and Importance: Parathyroid carcinoma is an extremely rare endocrine neoplasm. Most of the patients present with severe hyperparathyroidism with altered serum calcium levels., Case Presentation: We describe a patient who presented with a neck mass and secondary hyperparathyroidism Ultrasound (USG) suggested a tumor located near the lower pole of the thyroid gland. USG guided FNAC suggested parathyroid neoplasm. CT scan showed tumor infiltration of the parathyroid gland. The patient underwent total resection of the tumor along with total thyroidectomy and right central compartment clearance. The biopsy of the mass confirmed the parathyroid carcinoma infiltrating the thyroid gland., Clinical Discussion: Parathyroid carcinoma is a rare endocrine carcinoma. Due to its location, it is often misdiagnosed as thyroid carcinoma. It can present with problems related to bones, kidney stones, psychiatric problems and many others. Serum calcium, Parathormone level, Ultrasound neck, CT scan and MIBI scan are the imaging study for early diagnosis of Parathyroid carcinoma. Complete removal of tumor followed by regular follow up with serum calcium and Parathormone level will help to improve the survival of Patient., Conclusion: Diagnosis of parathyroid carcinoma is very challenging due to the limited contribution of imaging. It mimics thyroid carcinoma due to the origin of the tumor from the lower pole of the thyroid area. It is extremely important for suspicion of parathyroid tumor in case of neck mass who have an abnormality in serum calcium and parathormone level. Total resection of the tumor with a negative margin is important to control hyperparathyroidism and increase the survival., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Emphysematous pyelonephritis (EPN) is an uncommon suppurative infection of renal parenchyma and perirenal tissue characterized by production of gas within renal parenchyma, collecting system or perinephric tissue., Case Presentation: We report a case of young non diabetic female with past history of extracorporeal shock wave lithotripsy (ESWL) who presented with intermittent lower abdominal pain, dysuria and left lower limb swelling. Abdomen examination was notable for tenderness at left iliac fossa and fullness at left renal angle. Blood investigation showed leukocytosis and deranged creatinine levels. Urine analysis showed pyuria. Transabdominal ultrasound revealed left nephrolithiasis with moderate hydronephrosis, vesical calculus and double J (DJ) stent in situ. Patient was diagnosed as acute pyelonephritis and started on intravenous antibiotics. Despite on medical management, the condition deteriorated and progressed to septic shock. Computed tomography of kidneys, ureters and bladder (CT KUB) showed air fluid level in calyceal system with perinephric collection and confirmed diagnosis as emphysematous pyelonephritis. Patient underwent surgical drainage to control the sepsis. Few days later after control of sepsis and optimization, left nephrectomy and removal of retained DJ stent was done., Clinical Discussion: This case report highlights the need to consider emphysematous pyelonephritis as a possible diagnosis in patients harbouring DJ stents even in young non diabetics. Early aggressive medical management coupled with urological intervention is a valuable alternative to upfront emergent nephrectomy. However, surgery should not be delayed in patient with fulminant infection at presentation or who failed on conservative management., Conclusion: Emphysematous pyelonephritis warrants high index of suspicion for timely diagnosis and can be fatal if not recognized early and promptly treated., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction and Importance: Hemangiomas of paranasal sinuses are rare. Unexpected hemangiomas of this region can bleed profusely leading to operative morbidity and mortality. Hemangiomas of paranasal sinuses may be associated with concha bullosa., Case Presentation: We report a case of 41-year-old female who presented with difficulty in nose breathing and headache since two years. She was diagnosed with concha bullosa with deviated nasal septum and was planned for endoscopic septoplasty and conchoplasty. During the procedure, profuse, unexpected hemorrhage resulted from the undiagnosed hemangioma which was managed by endoscopic intranasal cauterization of anterior ethmoidal artery., Discussion: Hemangiomas of paranasal sinuses such as ethmoidal sinus are rare. These are slow growing tumors and may be radiologically silent. Due to high vascularity of these lesions, it may be very difficult to manage associated bleeding. A sound knowledge of vascular anatomy of this area is important in managing intraoperative complications. Until now, only a few cases of ethmoidal hemangiomas have been reported in association with concha bullosa. Screening for these lesions may be important in patients with concha bullosa., Conclusion: Sound knowledge of surgical anatomy forms the basis of managing intraoperative complications in endoscopic sinus surgery. Further research should be carried out to find out the association between concha bullosa and ethmoidal hemangioma and patients with concha bullosa should be screened with advanced imaging techniques for such vascular lesions where feasible., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: Declaration of interests We declare no competing interests.

Background: Management of pediatric drowning often includes evaluation and treatment of infectious disease. There are few data describing the infections associated with pediatric drowning., Methods: A descriptive retrospective study was designed, and patients aged < 19 years admitted for > 24 hours to our institution after a drowning were included from January 2011 through June 30, 2017. Data collection included patient demographics, submersion injury details, resuscitation details, patient admission details, chest radiograph on admission, use of intubation and mechanical ventilation, hospital length of stay, culture data, antimicrobial use, and mortality. Descriptive statistical methods (mean and standard deviation, median and range, percentage) were used to characterize the patient population, and Fisher exact test was used to evaluate the association between antimicrobial use in the first 72 hours of admission and mortality., Results: A total of 114 patients met study criteria (male, 59.7%; median age, 3.7 years [range, 0.15-17.79 years]). Median hospital length of stay was 2 days (range, 1-60 days). Intensive care unit admission occurred in 80.7%, intubation occurred in 46.5%, and mortality was 18.4%. The most common submersion location was a pool (76.3% [n = 87]) with water primarily characterized as freshwater (82.5% [n = 94]). Reported submersion time for the majority of patients was < 5 minutes (54.4%) with cardiopulmonary resuscitation in 78.1%. In the first 72 hours after admission, culture were obtained in 40 patients (35.1%), and 27.5% of these cultures were positive. The primary organisms identified were consistent oropharyngeal flora. Antimicrobials were initiated in 50% of the patient population with clindamycin as most common. There was not a significant association between antimicrobial use in the first 72 hours after admission and mortality (17.2% vs 19.6%, P = .81)., Conclusions: Infectious disease associated with pediatric drowning in pools is uncommon. Empiric use of antimicrobials does not appear to affect outcomes., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The asymmetric unit of the title compound, 2,4,6-tri-amino-1,3,5-triazin-1-ium cyano-acetate monohydrate, C 3 H 7 N 6 + ·NCCH 2 COO - ·H 2 O, consists of a melaminium cation, a cyano-acetate anion and a water mol-ecule, which are connected to each other via N-H⋯O and O-H⋯O hydrogen bonds, generating an eight-membered ring. In the crystal, the melaminium cations are connected by two pairs of N-H⋯N hydrogen bonds, forming tapes along [110]. These tapes develop a three-dimensional network through N-H⋯O, O-H⋯O, N-H⋯N and C-H⋯O hydrogen bonds between the cations, anions and water mol-ecules., (© Sigdel Regmi et al. 2020.)

Objectives: To determine the antipyretic efficacy of acetaminophen (IV, enteral, rectal) and ibuprofen (enteral) in critically ill febrile pediatric patients., Design: Retrospective cohort study., Setting: Quaternary care pediatric hospital ICUs., Patients: Pediatric patients less than 19 years old who were febrile (≥ 38.0°C), received a dose of IV acetaminophen, enteral acetaminophen, rectal acetaminophen, or enteral ibuprofen and had at least one temperature measurement in the following 6 hours., Interventions: None., Measurements and Main Results: A total of 3,341 patients (55.8% male, median age 2.5 yr [interquartile range, 0.63-9.2 yr]) met study criteria. Baseline temperature was median 38.6°C (interquartile range, 38.3-38.9°C) measured via axillary (76.9%) route. Patients became afebrile (87.5%) at median 1.4 hours (interquartile range, 0.77-2.3 hr) after the first dose of medication, a -2.9 ± 1.6% change in temperature. Antipyretic medications included as follows: enteral acetaminophen (n = 1,664), IV acetaminophen (n = 682), rectal acetaminophen (n = 637), and enteral ibuprofen (n = 358). Enteral ibuprofen had a significantly greater odds of defervescence on multivariable logistic regression analysis (p = 0.04) with a decrease of -1.97 ± 0.89°C while IV acetaminophen was significant for a decreased time to defervescence at median 1.5 hours (interquartile range 0.8-2.3 hr) after a dose (p = 0.03). Patient age, presence of obesity, and baseline temperature were significant for decreased antipyretic efficacy (p < 0.05)., Conclusions: Enteral ibuprofen was the most efficacious antipyretic and IV acetaminophen had the shortest time to defervescence.

Pneumococcal-associated hemolytic uremic syndrome (pHUS) is a rare but severe complication of invasive Streptococcus pneumoniae infection. We report the case of a 12-year-old female with steroid-resistant nephrotic syndrome treated with adrenocorticotrophic hormone (H.P. Acthar(®) Gel), who developed pneumococcal pneumonia and subsequent pHUS. While nephrotic syndrome is a well-known risk factor for invasive pneumococcal disease, this is the first reported case of pHUS in an adolescent patient with nephrotic syndrome, and reveals novel challenges in the diagnosis, treatment and potential prevention of this complication.

Capillary haemangioma is a common benign lesion occurring at multiple areas of body. They have unique radiological appearances and are confirmed by histological examinations. However capillary haemangioma of cervical region is a very rare condition. Such a case is presented here. It presented as an extramedullary intradural mass compressing the cord and corresponding root giving rise to myeloradiculopathic symptoms. Total enblock excision of the lesion gave a total cure.

Cysticercosis is a condition in which a human being acts as the intermediate host of Taenia solium, a pork tape worm. The oral mucosa is an uncommonly involved site. A rurally living 35 year old vegetarian female presented with a swelling over the right side of her tongue of seven months duration. Histopathology of excisional biopsy revealed it to be cysticercosis. Diagnosis of cysticercosis was clinically unsuspected. The patient was referred to the general medical clinic for further treatment.