Rhinocerebral Mucormycosis in a COVID-19 Patient from Nepal: A Case Report.

With the surge of cases during the second wave of COVID-19 in Nepal, a number of mucormycosis coinfection cases have also come to our attention. We present a case of a 65-year-old female who was admitted to our emergency department with complaints of pain, swelling, and tingling sensation of the left side of the face along with blood-tinged nasal discharge for 20 days. She had been tested positive for COVID-19 a month back and managed with oxygen support and corticosteroids. Magnetic Resonance Imaging showed invasive fungal sinusitis, with the positive black turbinate sign and mild extension along with the dura mater of the left temporal lobe, and left cavernous sinus. She was diagnosed with rhinocerebral mucormycosis and managed with systemic antifungal therapy and insulin. As per the treatment modality, surgical debridement could not be done because the patient did not give consent.

Composite Anxiety-depression among Medical Undergraduates during COVID-19 Pandemic in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Fear and anxiety is a natural response during crisis. From constant worry of getting infected, death of loved ones, transitioning of lifestyle to loss of social connection; there can be several psychological triggers. The effect on mental health on the general population could be greater than those affected by the infection itself during the pandemic. Among medical students, who already have several other psychological afflictions, these triggers might be detrimental. Hence, this study aims to find out the prevalence of composite anxiety-depression among medical undergraduates in a tertiary care hospital. METHODS: A descriptive cross-sectional study was conducted among medical undergraduates in a tertiary care hospital from 20th December 2020 to 5th January 2021. Ethical approval was taken from the Institutional Review Committee. The sample size was calculated and convenient sampling was done. The data were entered in International Business Machines Statistical Package for Social Sciences version 20.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 315 participants on the Patient Health Questionnaire-Anxiety and Depression Scale, severe composite anxiety-depression was seen in 10 (3.17%) at 95% Confidence Interval (1.23-5.1) participants, moderate in 35 (11.11%) at 95% Confidence Interval (7.63-14.58) and mild in 98 (31.11%) at 95% Confidence Interval (25.99-36.22). And 172 (54.6%) at 95% Confidence Interval (49.1-60) were normal. CONCLUSIONS: The rapid rise of apprehension among people amidst infectious outbreaks can ensue and medical students are no exception. So, at this time of crisis, there is a need to protect their mental health and it should be emphasized and endorsed.

Effectiveness of mental health community training on depression and anxiety to the health care profession working in rural centers of eastern Nepal.

BACKGROUND: Depression and anxiety is the leading cause of disease burden in low- and middle-income countries. It is associated with a worse clinical course over the lifespan. This study aims the post-effect on the approach of managing depression and anxiety after the training on diagnosis and management of depression and anxiety. METHODS: This is a prospective observational study done in the health care professionals who had done training on diagnosis and management of depression and anxiety from me. The participants were evaluated with the questionnaire. RESULTS: The training was given in three parts in three different places of eastern Nepal with the health care professionals working near to those centers. There were total of 49 participants from 17 different primary health care centers. The referral rate of patients with depression and anxiety was decreased by 27% as stated by the participants as they can give psychoeducation and counseling in a very well manner after training which was lacking before training. CONCLUSIONS: Overall, the findings from the current data suggest that there is merit in continuing to evaluate and deliver community health training programs for depression and anxiety. While prevention type and personnel delivering the intervention account for aspects of the heterogeneity observed, more research is needed to identify how program completion and fidelity impact outcomes.

Tuberous sclerosis complex-associated neuropsychiatric disorder (TAND) in a low-resource setting - From seizure to psychosis: A case report.

INTRODUCTION: Tuberous sclerosis complex (TSC) patients commonly present with neuropsychiatric symptoms - grouped as TSC-associated neuropsychiatric disorder (TAND) - incorporating Autism Spectrum Disorder (ASD) symptoms, intellectual and learning disabilities, psychiatric and behavioral problems. A structured symptomatic assessment known as the TAND-checklist can be useful in reviewing these symptoms systematically and comprehensively. CASE SUMMARY: A 21-year-old woman presented with delusions of reference, auditory hallucinations, irritability, restlessness, aggressive behavior, new-onset tremors and rigidity in both upper limbs, and refusal of food and medication intake for 1 week. She has a history of several seizure episodes since 3 years of age which was controlled on oral sodium valproate, carbamazepine, and clobazam. MRI revealed tubers in frontal and insular cortex.Ultrasound of the abdomen showed bilateral renal angiomyolipomas. She was diagnosed with TSC with psychotic symptoms. DISCUSSION: TSC2 mutations usually present early with epileptic spasms (ES), complex epilepsies, intellectual and cognitive deficits, cardiac rhabdomyomas, and sub-ependymal giant-cell astrocytomas (SEGAs) with high tuber-to-brain proportions (TBP). There is also a remarkable symptom overlap between autism spectrum disorder (ASD) and TSC with behavioral/psychiatric disorders. Social and behavioral problems seen in our patient may be a manifestation of either TSC, ASD, or both. Cost-effectiveness and pragmatism must be considered for TAND-patients in low-resource settings. While it may be theoretically valid to seek genetic testing, TBP-measurement, and mTOR-inhibitor therapy to address TAND-symptoms, they are impractical when compared to TAND-checklist during follow-up.