Cutaneous larva migrans in a child: a case report and review of literature.

Introduction: Cutaneous larva migrans (CLM) is a dermatitis caused by the invasion and migration of parasitic larvae of hookworms, primarily affecting tropical and subtropical regions. This report presents a case of CLM in a Nepali child and provides an overview of the literature on this condition. Case report: A 4-year-old boy from a rural area in Nepal presented with a pruritic skin lesion on his left foot, initially misdiagnosed as fungal infection. The lesion gradually expanded, forming a serpiginous erythema, and became intensely pruritic. The patient's family had poor socioeconomic conditions, and the child frequently walked barefoot in an area with many domestic and stray dogs. Diagnosis was confirmed clinically, and treatment with oral albendazole and antihistamines resulted in complete resolution of symptoms. Discussion: CLM is a neglected zoonotic disease, with an underestimated burden in developing countries due to underreporting and misdiagnosis. The larvae of Ancylostoma spp. are common culprits, causing a localized inflammatory reaction as they migrate through the skin. Diagnosis is mainly clinical and routine investigations usually reveal no abnormality. Complications may include secondary bacterial infections, allergies, and rare migration to internal organs. Treatment options include albendazole or ivermectin, with preventive measures emphasizing hygiene, footwear use, and pet deworming. Conclusion: CLM is a neglected disease that primarily affects marginalized communities in tropical regions. Raising awareness among healthcare providers, conducting observational studies, and developing treatment guidelines, especially for children, are essential steps to address this public health concern. Preventive efforts, such as promoting hygiene and footwear use, should be encouraged to reduce CLM incidence.

Uncommon presentation of cutaneous leishmaniasis: late-onset facial involvement after a decade-a rare case report.

Leishmaniasis is a parasitic infection that can involve the skin, mucosal membranes, and internal organs. It is endemic to the tropics. A forty-three-year-old male, diagnosed and treated for visceral leishmaniasis 15 years ago, presented with a complaint of a progressively growing lesion on his face for five years. A detailed history, clinical examination, and histopathological examination were done to reach a diagnosis of cutaneous leishmaniasis (CL). Treatment with oral fluconazole 300 mg daily for six months, followed by 50 mg miltefosine three times a day for another two months, led to complete resolution of symptoms, and the lesion on the face was cured. Early diagnosis is crucial to averting unwarranted treatment and potential complications. This case aims to inform clinicians of the high index of suspicion when diagnosing CL; given the delayed presentation, the previous medical history and the natural course of the lesion are of utmost importance.

Evaluation of junior doctors' retention of knowledge and skills after simulation training in shockable rhythm cardiac arrest in a low-resource setting in Nepal.

Aims: To test junior doctors' abilities to retain advanced life support psychomotor skills and theoretical knowledge in management of shockable rhythm cardiac arrest. Methods: A repeated measure pre-post study design was used with 43 junior doctors, recruited after notifying them with robust method of attraction through flyers, brochures, email and phone calls. Written and performance tests, initial pre-test, immediate post-training, 30-days post-training and 60-days post-training, using simulation-based scenarios with a low-fidelity manikin were used with recording performance of ALS. Instrumentation: Resuscitation Council UK ALS algorithms and guidelines1 were used in a simulated testing environment. Results: There was a highly significant improvement in knowledge immediately after training (p < 0.00), with a net gain of marks from a mean value of 63.2% before training to 87.7% after training by 24.5% (95% CI 19.4, 29.6).There was a gradual decline of retained knowledge with time from immediate post-training over, 30-days and 60-days post-training (p < 0.00). The simulation pre-training assessments and immediate post-training assessments results were statistically significant (p < .00). The mean difference was 44.1% (95% CI 50.11, 38.10). There was a statistically significant decline of the competency with time (p < .00). Unlike for the knowledge test, the drop was significant on the 30th day (p < .00) with a mean difference of -10.5% (95% CI -13.55, -7.40). Conclusion: The training of junior doctors in shockable rhythm cardiac arrest in a low resource setting, improved knowledge and skills in the participants after training. However, retention of knowledge declined at 30 days and more significantly after 60 days and retention of skill was declined more significantly at 30 days.

Use of Computed Tomography of the Head in Patients With Acute Atraumatic Altered Mental Status: A Systematic Review and Meta-analysis.

Importance: The usefulness of computed tomography of the head (CTH) in patients with acute-onset atraumatic altered mental status (AMS) is poorly understood, but use in these patients remains high. Objective: To evaluate the use of CTH (event rate) in patients with AMS and the positive outcome event rate of the performed CTH studies. Data Sources: The PubMed/MEDLINE, PubMed Central, Embase, and CINAHL databases were searched using predefined Boolean parameters. All studies that met inclusion criteria until January 31, 2022, were included. Study Selection: Randomized clinical trials and observational, cohort, and case-control studies were included. Conference abstracts, reviews, letters, case reports, case series, systematic literature, and meta-analyses were excluded. Data Extraction and Synthesis: The systematic literature review was performed per Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Data were independently extracted by 2 authors. Data were pooled using a random-effects method. Main Outcomes and Measures: Event rate of CTH use in patients with acute atraumatic AMS. The CTH event rates and positive CTH event rates were calculated with 95% CIs. Results: Of 9338 studies identified, 26 qualified for the systematic review and 25 for the meta-analysis. The 25 studies in the meta-analysis included a total of 79 201 patients. The CTH event rate was 94% (proportion, 0.94; 95% CI, 0.76-1.00), and the positive CTH event rate was 11% (proportion, 0.11; 95% CI, 0.07-0.15). There was significant heterogeneity among the studies included (I2 > 50%, P < .001), for which a random-effects model was used. There was significant publication bias, as evident by an asymmetric funnel plot. There was no fluctuation of the results during the sensitivity analysis, which reassured the reliability of the data. Conclusions and Relevance: In this meta-analysis, CTH use among patients with acute-onset atraumatic AMS was very high with a low yield. Large-scale studies are needed to guide clinical decision-making in such a situation.

The effect of low-pH concrete on microbial community development in bentonite suspensions as a model for microbial activity prediction in future nuclear waste repository.

Concrete as an important component of an engineered barrier system in deep geological repositories (DGR) for radioactive waste may come into contact with bentonite, or other clays, rich in indigenous microorganisms, with potentially harmful impacts on barrier integrity. Our study aimed to assess the effect of a concrete environment on indigenous bentonite and groundwater microbial communities as these particular conditions will select for the potentially harmful microorganisms to the concrete in the future DGR. The two-month experiment under anoxic conditions consisted of crushed, aged, low-pH concrete, Czech Ca-Mg bentonite, and anoxic groundwater, with control samples without concrete or with sterile groundwater. The microbial diversity and proliferation were estimated by qPCR and 16S rRNA gene amplicon sequencing. The presence of concrete had a strong effect on microbial diversity and reduced the increase in total microbial biomass, though low-pH concrete harbored indigenous bacteria. The growth of sulfate reducers was also limited in concrete samples. Several genera, such as Massilia, Citrifermentans, and Lacunisphaera, dominant in bentonite controls, were suppressed in concrete-containing samples. In contrast, genera such as Bacillus, Dethiobacter and Anaerosolibacter specifically proliferated in the presence of concrete. Genera such as Thermincola or Pseudomonas exhibited high versatility and proliferated well under both conditions. Because several of the detected bacterial genera are known to affect concrete integrity, further long-term studies are needed to estimate the effect of bentonite and groundwater microorganisms on concrete stability in future DGR.

Anaerobic microbial corrosion of carbon steel under conditions relevant for deep geological repository of nuclear waste.

We examined microbial corrosion of carbon steel in synthetic bentonite pore water inoculated with natural underground water containing microorganisms over a period of 780-days under sterile and anaerobic conditions. Corrosion behaviour was determined using the mass loss method, SEM-EDS analysis and Raman spectroscopy, while qualitative and quantitative changes in the microbial community were analysed using molecular-biological tools (16S rDNA amplicon sequencing and qPCR analysis, respectively). Corrosion rates were significantly higher in the biotic environment (compared with an abiotic environment), with significant localisation of corrosion attacks of up to 1 mm arising within 12-months. Nitrate reducing bacteria, such as Pseudomonas, Brevundimonas and Methyloversatilis, dominated the microbial consortium, the high abundance of Methyloversatilis correlating with periods of highest localised corrosion penetrations, suggesting that this bacterium plays an important role in microbially influenced corrosion. Our results indicate that nitrate-reducing bacteria could represent a potential threat to waste canisters under nuclear repository conditions.

Deciphering indigenous bacteria in compacted bentonite through a novel and efficient DNA extraction method: Insights into biogeochemical processes within the Deep Geological Disposal of nuclear waste concept.

Compacted bentonites are one of the best sealing and backfilling clays considered for use in Deep Geological Repositories of radioactive wastes. However, an in-depth understanding of their behavior after placement in the repository is required, including if the activity of indigenous microorganisms affects safety conditions. Here we provide an optimized phenol:chloroform based protocol that facilitates higher DNA-yields when other methods failed. To demonstrate the efficiency of this method, DNA was extracted from acetate-treated bentonites compacted at 1.5 and 1.7 g/cm3 densities after 24 months anoxic incubation. Among the 16S rRNA gene sequences identified, those most similar to taxa mediating biogeochemical sulfur cycling included sulfur oxidizing (e.g., Thiobacillus, and Sulfurimonas) and sulfate reducing (e.g., Desulfuromonas and Desulfosporosinus) bacteria. In addition, iron-cycling populations included iron oxidizing (e.g., Thiobacillus and Rhodobacter) plus reducing taxa (e.g., Geobacillus). Genera described for their capacity to utilize acetate as a carbon source were also detected such as Delftia and Stenotrophomonas. Lastly, microscopic analyses revealed pores and cracks that could host nanobacteria or spores. This study highlights the potential role of microbial driven biogeochemical processes in compacted bentonites and the effect of high compaction on microbial diversity in Deep Geological Repositories.

Varicose veins and its risk factors among nurses at Dhulikhel hospital: a cross sectional study.

BACKGROUND: Women in nursing professions are at high risk for developing varicose veins as it requires physical work and prolonged standing. The aim of the study is to estimate the current prevalence of varicose veins among nurses at Dhulikhel Hospital and assess its risk factors. METHODS: A cross sectional study was carried out among 181 female nurses from different clinical settings of Dhulikhel Hospital. A structured questionnaire was administered to gather the demographic, work related and medical history information. The participants underwent Doppler ultrasound for varicose veins confirmation. Varicose veins was defined as Doppler finding of reflux or vein diameter equal or greater than 5 mm. RESULTS: A total of 181 nurses participated in this study and 83 (46%) had varicose veins. The mean standing time was 4.28 (0.8) hours /day, mean sitting time was 1.28 (0.6) hours/day, mean walking time was 2.37 (0.8) hours/day. In the adjusted model the odds of having varicose veins was 27 times greater with every 1 hour increase in standing time per day (adjusted OR: 27.44; 95% CI 4.09-180.77; p-value <0.00). CONCLUSIONS: Varicose veins was prevalent among nurses' at Dhulikhel Hospital. Prolonged standing was found to be a significant factor for varicose veins.

Prevalence of dengue and diversity of cultivable bacteria in vector Aedes aegypti (L.) from two dengue endemic districts, Kanchanpur and Parsa of Nepal.

BACKGROUND: Dengue fever, an endemic arboviral disease, represents one of the major public health concerns in Nepal. It is transmitted by bites of infected Aedes aegypti and Aedes albopictus, the former being primary vector. The bacterial community plays a significant role in biology of mosquitoes; however, the bacterial communities of primary vector A. aegypti remain unstudied in Nepal. The study was designed to determine the rate of dengue seropositivity and to explore the bacterial diversity of A. aegypti from dengue endemic districts, Kanchanpur and Parsa of Nepal. METHODS: A cross-sectional study was conducted between June 2013 and November 2013 at two hospitals of Kanchanpur and Parsa. A total of 221 serum samples were collected from patients (inpatients and outpatients) suspected of suffering from dengue fever and attending Mahakali Zonal Hospital, Mahendranagar, Kanchanpur, and Narayani Zonal Hospital, Birgunj, Parsa. Detection of anti-dengue IgM was performed by using human dengue IgM capture ELISA. The larvae and pupae of mosquitoes (A. aegypti) were collected, reared, and emerged. Then, the bacteria were isolated and identified from the gut of identified mosquitoes by using standard methods. RESULTS: Out of total 221 serum samples collected from patients suspected of suffering from dengue fever, 34 (15.38%) were positive for anti-dengue IgM. Gram-negative bacteria were isolated in largest proportion (63%) followed by gram-positive cocci (23.27%) and gram-positive rods (13.73%). The most common cultivable bacteria isolated were Staphylococcus spp., Pseudomonas spp., and Acinetobacter spp. The average bacterial load in the vectors was 3.91 × 104 cfu/ml. CONCLUSIONS: High rate of anti-dengue IgM seropositivity was reported in our study. The environmental bacteria were predominantly isolated and identified in A. aegypti. The paratransgenic approach to control vector might be possible by spreading the genetically modified bacteria in larval habitat or shelter of adult mosquitoes.

Serological and Entomological Study of Dengue in Dang and Chitwan Districts of Nepal.

A descriptive cross-sectional study was carried out among 264 suspected dengue patients in two districts (Dang and Chitwan) of Nepal from June 2013 to November 2013. The anti-dengue IgM positivity was found to be (51/264)19.31% by capture ELISA, of which 21 (41.2%) were male and 30 (58.8%) were female. Symptoms of seropositive cases were fever, anorexia, nausea, headache, retro-orbital pain, skin rashes, and myalgia. Hematological features like thrombocytopenia and leucopenia were found to be significantly associated with the dengue fever (DF). Discarded tires were found as the commonest breeding habitats for the dengue vectors. Higher sero-positivity was recorded from the area having higher Breteau index (BI). The pH, chloride ion concentration and the salinity of the water from breeding habitats were found to be ranging from 6.9±0.82 to 8, 103.33±17.52 mg/L to 140.65 mg/L, and 0.19±0.032 ppt to 0.25 ppt respectively. This study may be helpful for the health authorities and public health workers for early diagnosis of DF and for the improved preventive measures to be adopted in the epidemic and possible epidemic areas.