Depression during pregnancy in a tertiary care center of eastern Nepal.

This is a cross sectional study, conducted in 45 pregnant women coming for antenatal check ups in the eastern regional hospitals in Nepal. Hamilton -Depression Scale (HAM-d) was applied after initial psychiatry work up to all women who were selected for the interview. Analysis revealed about half of the pregnant women having some form of depression. Life events (e.g. chronic illness in the family, marital disharmony, economic crisis to sustain the family) were found to be important risk factors (P<0.05). Antenatal depression is a more common than generally thought.

Psychiatric emergencies in a tertiary care hospital.

People with psychiatric problems often visit a general hospital. Many of them require emergency service. B P Koirala Institute of Health Sciences (BPKIHS) is one of the few health institutes in Nepal providing comprehensive 24-hour psychiatric emergency service. This study aims to document the pattern of psychiatric emergencies in a tertiary care hospital of Eastern Nepal. All psychiatric emergencies referred from different departments in 30 random days during a six-month period were enrolled. This is a descriptive study with convenience sampling method where the diagnoses were made based on the'International Classification of Disease and Infirmity' (ICD-10). One hundred twenty-nine cases were referred in the study period. The M:F ratio was 1.3:1. The service users were predominantly young adults. The majority of cases were seen in the emergency department and medical ward. The most common causes for the consultation were behavioral problems (39%), altered consciousness (32%) and somatic complaints (17%). Approximately 83% received the diagnosis of Category F of the ICD-10. Mental and behavioral disorder due to substance use (F10-19) was the most common disorder (30%), followed by mood/affective disorders (23%) and neurotic, stress-related anxiety disorders (16%). Roughly 46% had co-morbid physical illnesses and 8% received only a physical diagnosis. About 20% had attempted suicide using different means, poisoning being the most common. Emergency psychiatric consultation for mental problems is sought by almost all departments of a general hospital. These consultations are most commonly sought for substance use, mood or anxiety disorders.

Management of antitubercular drugs-induced hepatotoxicity and therapy reintroduction strategy in a TB clinic of Nepal.

BACKGROUND: PZA, INH and R have potential for hepatotoxic side effects. Although anti-tuberculosis drug-induced hepatotoxicity is well known, there is no agreement on the clinical approach for cases in whom hepatotoxicity has developed. OBJECTIVE: To study the management of anti-TB drugs induced hepatotoxicity and the standard anti-TB drugs therapy reintroduction procedure. DESIGN: In prospective cohort analysis, 4 patients with active TB infection had developed anti-TB drugs induced hepatotoxicity. Retreatment of therapy was done on the basis of severity of hepatitis. If damage is mild, all the drugs were reintroduced at once in a tapering dose and if patient's condition is worse, INH and E is introduced in lower dose, later increasing the dose and the number of drugs. Results: All the patients tolerated anti-TB drugs well after reintroduction. There was no incidence of recurrence. All the patients completed their 8 months treatment regimen and all are cured. CONCLUSION: Timely detection and temporary withdrawal of the offending agent can completely cure anti-TB drugs induced hepatotoxicity. The recurrence of hepatotoxicity is rare if reintroduction in done in a well planned manner.