Healthcare Professionals Providing Direct Care to the COVID-19 Patients: A Descriptive Cross-sectional Study.

INTRODUCTION: COVID-19 highly contagious viruses that have reached every corner of the world. Despite the heroic efforts to control the pandemic, health care professional risk for COVID-19 exposure was an important measure to identify due to lack of personal protective equipment. The objective of the study was to find out the prevalence of healthcare professionals providing direct care to the COVID-19 patient. METHODS: A descriptive cross-sectional was conducted through online questionnaire from June 2020 to August 2020. Ethical approval was obtained from the Ethical Review Board of Nepal Health Research Council (Reference number: 363/2020 P). World Health Organization risk assessment protocol questionnaire was used for COVID-19 and distributed among 300 health care workers of Nepal involved in the management of COVID-19 hospitals. Convenience sampling was used. The KoBo toolbox was used for online data collection. Data analysis was done using Statistical Package for the Social Sciences version 23. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. RESULTS: Among 300 study participants, 109 (36.33%), (30.85-41.74 at 95% Confidence Interval) of participants provide direct care to infected patients. With total respondents, 41 (37.61%) were registered nurses, medical doctors 28 (25.68%) and paramedics 36 (33.02%). CONCLUSIONS: Health care workers who provide direct care to the COVID-19 patient were similar to other studies done in similar settings. About half of the participants were exposed to COVID-19 virus from the hospital setting rather than from community setting which is similar to the study done in similar setting which might be due to lack of follow of protocols during COVID-19 patient care.

Carbamazepine induced toxic epidermal necrolysis and Stevens-Johnson syndrome overlapping during pregnancy in a South-East Asian patient: A case report.

INTRODUCTION: Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are rare and severe forms of drug-induced skin reaction. Most frequently involved drugs are noted to be non-steroidal anti-inflammatory agents, antibiotics, and anticonvulsants. These have high morbidity and mortality and counts among dermatological emergencies. CASE PRESENTATION: We report an eventful case of a 22-year-old lady who suffered and recovered from carbamazepine-induced SJS/TEN overlapping during her pregnancy. Our patient had a history of epilepsy for which she was under sodium valproate. Switching to carbamazepine due to its low teratogenicity led our patient to this condition. History of prodromal symptoms and exposure to carbamazepine helped in the diagnosis. Carbamazepine abstinence and a multidisciplinary approach in symptomatic management worked very well for the patient. CLINICAL DISCUSSION: Carbamazepine-induced TES/SJS manifests multisystem effects and requires a multidisciplinary approach for management. The condition itself is life-threatening and in its addition, their sequelae further threaten the life of the patients. Early intervention is the key. Genetically susceptible are thought to be the ones carrying human leukocyte antigen B*15:02 (HLA-B*15:02) allele and it is most prevalent in South-East Asian populations. Screening of this allele before using carbamazepine prevents the incidence of carbamazepine-induced SJS/TEN. CONCLUSION: Prodromal symptoms of carbamazepine-induced SJS/TEN constitute flu-like symptoms that should not be missed. Early intervention and multidisciplinary approach prevent secondary infections and complications. Screening for HLA-B*15:02 variant allele and close monitoring of these adverse reactions along with proper counseling to patients goes a long way in preventing the development of this life-threatening condition.