Nocardia brasiliensis primary pulmonary nocardiosis with subcutaneous involvement in an immunocompetent patient.

This is a report of an unusual case of Nocardia brasiliensis causing primary pulmonary nocardiosis with disseminated subcutaneous lesions in an immunocompetent patient. This case highlights the importance of considering nocardiosis as a differential diagnosis in patients with pulmonary and cutaneous lesions and the need for vigorous management for complete cure.

Corporal Punishment in Nepalese School Children Facts, Legalities and Implications.

While the Convention on the Rights of the Child (CRC) demands that children be respected as human beings with the right to dignity and physical integrity, in Nepal corporal punishment is often considered necessary to children’s upbringing, to facilitate learning and to instill discipline in the children. The existence of this cruel practice towards children is attributed to the weak national policy, unhealthy academic competition among the schools, poorly trained teachers, superstitious traditional beliefs and hierarchical social structure. Consequently, the children are doomed to suffer this practice resulting in negative physical, mental and social welfare. Besides corporal punishment, sexual abuse in school going children seems to be frequent but mostly unreported. This is high time we eliminated this violence against children in schools and it calls for holistic approach. For this, it is necessary to pursue a set code of conduct and raise awareness among the teachers for the child rights in order to stop undignified, inhuman and undisciplined tradition. The awareness and capacity of the health professionals to deal with complexities of the child abuse also needs to be promoted. Furthermore, the need of improvements in the national laws and their proper implementation is a longstanding challenge for the governmental and nongovernmental organizations.

Prolapsed uterus with huge rectocele and omentocele following cervical amputation: a rare and unusual case presentation.

Pelvic organ prolapse is a common condition whose incidence is increasing. Many cases of prolapse of the posterior vaginal wall occur along with other pelvic support defects. Pelvic surgeons who treat rectocele must have an excellent understanding of the normal anatomy, interactions of the connective tissue and muscular supports of the pelvis, and the relationship between anatomy and function. Pelvic pressure, the need to splint the perineum to defecate, impaired sexual relations, difficult defecation, and faecal incontinence are some of the symptoms that have been described in patients with rectocele.

Spontaneous esophageal perforation

Despite new effective antibiotics, improved caloric intake, better monitoring and life support systems in general as well as many advancements made in thoracic surgery, the management of patients with spontaneous esophageal perforation remains one of the major therapeutic challenges for surgeon and also remains controversial one. We are reporting two cases of spontaneous esophageal perforation with delayed diagnosis. One patient with 10 days history was subjected to conservative management with nasogastric aspiration, antibiotics, tube thoracotomy and feeding jejunostomy. When conservative measures failed with development of sepsis, surgical intervention was performed with an unsuccessful outcome. Another patient presented 16 hours after sudden onset of chest pain and diagnosed to have spontaneous esophageal perforation with esophago-pleural fistula. He was operated within 24 hours with primary repair buttressed with pedicled omental patch. He developed leakage and managed subsequently with asophagectomy with favourable outcome. We conclude that spontaneous esophageal perforation carries a high mortality and delay between rupture and treatment is the major factor affecting outcome