A case report on agenesis of dorsal pancreas with insulin-dependent diabetes mellitus: a rare entity.

Agenesis of the dorsal pancreas (ADP) is a clinically rare entity that occasionally presents with abdominal pain. It is also association with various disorders of glucose metabolism. Case presentation: A 23-year-old male presented with continuous epigastric pain for 4 h and intermittent vomiting. He has a history of experiencing recurrent abdominal pain and diarrhoea for the past 5 years. Additionally, he has been diagnosed with type 1 diabetes mellitus for 15 years. Contrast-enhanced computed tomography of the abdomen showed the absence of body and tail of the pancreas. Discussion: ADP is caused by unknown factors, but may be linked to genetic mutations or changes in signalling pathways related to retinoic acid and hedgehog. Symptoms can be absent, but may include abdominal pain, pancreatitis, and hyperglycaemia due to beta-cell dysfunction and insulin deficiency. Imaging modalities, such as contrast tomography or magnetic resonance cholangiopancreatography, or endoscopic retrograde cholangiopancreatography, are crucial in the diagnosis of ADP. Conclusion: It is important to consider ADP as a differential diagnosis in patients with glucose metabolism disorders and associated symptoms such as abdominal pain, pancreatitis, or steatorrhea. It requires the combined use of imaging modalities such as ultrasound, contrast tomography, magnetic resonance cholangiopancreatography, or endoscopic retrograde cholangiopancreatography, as ultrasound alone may not provide a complete diagnosis.

Refractive Error among Children Presenting to the Outpatient Department of Ophthalmology in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Refractive error is an important component of the priority disease 'childhood blindness' within the vision 2020 initiative to eliminate avoidable blindness. Some 12.8 million in the age group 5-15 years are visually impaired from uncorrected or inadequately corrected refractive errors. Early detection and treatment of uncorrected refractive errors enable them to perform better in daily activities. This study aimed to find the prevalence of refractive error among children presenting to the outpatient Department of Ophthalmology in a tertiary care centre. Methods: A descriptive cross-sectional study was done among children at a tertiary care centre from 19 June 2021 to 25 December 2021 after receiving ethical approval from the Institutional Review Committee (Registration number: 2078/79/12). Children of the age group 6 to 15 years were included whereas those with other ocular problems such as corneal opacities, cataracts, ocular trauma, and conjunctivitis or submitted incomplete data forms were excluded from the study. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of 239 children, 118 (49.37%) (43.03-55.71, 95% Confidence Interval) were found to have refractive error. Conclusions: The prevalence of refractive error among children was higher compared to other studies conducted in similar settings. Keywords: children; ophthalmology; prevalence; refractive error.

A case report: Lateral medullary syndrome with facial nerve palsy and hemiparesis.

Lateral medullary syndrome (LMS) is the most common and severe neurological syndrome associated with atherothrombotic occlusion of the intracranial vertebral artery, followed by posterior inferior cerebellar artery and medullary artery occlusion. It presents as a typical triad of oculosympathetic palsy (Horner's syndrome), ipsilateral gait ataxia, and hypoalgesia with ipsilateral thermoanesthesia of the face. In LMS, the upper motor neuron facial palsy is caused by the involvement of aberrant supranuclear fibers of the facial nerve. The caudal extension of the infarction to the pyramidal tracts may explain contralateral hemiparesis. Here, we have discussed a 42-year-old non-diabetic, hypertensive male with LMS, hemiparesis, and left UMN-type facial palsy. We reported this case because developing nations, have few tertiary level health facilities for neurological examination, and non-neurologists often miss the diagnosis; therefore, the characteristics must be known and understood.

Clinico-Radiological Profile of Patients With Lateral Medullary Syndrome: A Five Years Observation From a Single-Centered Tertiary Hospital in Nepal.

OBJECTIVE: We aim to correlate the prevalence of symptoms of the lateral medullary syndrome (LMS) based on radiological classification. METHODS: A five-year record of 41 patients diagnosed with LMS and admitted to a tertiary care center in Nepal was reviewed. We used chi-square tests to compare symptoms between rostral and caudal groups and different horizontal subtypes. RESULTS: The subtype prevalence in the horizontal classification of LMS was large (31.7%), lateral (22%), dorsal (19.5%), typical (14.6%), and ventral (12.2%). The most common symptoms in the typical subtype of the horizontal classification were: pain/temperature loss in the contralateral body (7.3%) and dysphagia (7.3%); in the ventral subtype, swaying on the Romberg test (12.2%), dysarthria (9.8%) and dizziness (9.8%); in the dorsal subtype, headache (12.2%) and vomiting (12.2%). Whereas headache (22.2%) and lateropulsion on standing (14.6%), swaying on the Romberg test (14.6%), nausea/vomiting (14.6%) were common in the large subtype, and nausea/vomiting (19.5%) and headache (17.1%) in the lateral subtypes. Whereas, in rostrocaudal classification, the rostral subtype (61%) was more common than the caudal subtype (31%). There was no significant variation in symptoms based on the rostrocaudal classification of LMS. CONCLUSION: The common clinical manifestations are different for different radiological subtypes of LMS. Further comprehensive studies are essential to understand the prevalence of symptoms in different radiological subtypes and the clinical-radiologic correlation in LMS.

Digital Eye Strain among Adults Presenting to Tertiary Care Hospital in the Era of COVID-19 Pandemic: A Descriptive Cross-sectional Study.

INTRODUCTION: The Novel Coronavirus disease 2019 pandemic has sent humanity indoors, replacing human contact with an electronic connection. The mandatory online classes and work from home policy to maintain the social distancing during the pandemic has forced the individual to spend most of the time in front of laptops or mobile screens. Digital eye strain is a group of vision-related symptoms that result from the continuous use of devices with digital displays, such as computers, tablets, and smartphones. The present study is done to find out the prevalence of digital eye strain among the adult population in a tertiary care hospital in the era of the COVID-19 pandemic. METHODS: This descriptive cross-sectional study was done from January 2021 to July 2021 in a tertiary care hospital of Nepal after receiving ethical approval from the Institutional Review Committee (Registration number: 077/78/30). Convenience sampling was done. The sample size calculated in our study was 322. Data collection and entry were done in Microsoft Excel, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: The prevalence of digital eye strain was 300 (94.3%) (91.8-96.8 at 95% Confidence Interval) among 318 respondents. Eye strain (irritation, heaviness) was the most common digital eye strain symptom 199 (62.6%) followed by the tiredness of eyes 162 (50.9%). CONCLUSIONS: The present study concluded that the prevalence of digital eye strain in the era of COVID-19 is high as compared to other studies conducted among adults.