Ventricular tachycardia storm after accidental poisoning of delphinium species: a rare case report.

Introduction: Delphinium species are commonly used as medicinal herbs, with a wide range of implications for medical conditions. The injudicious use of this plant has been known to cause devastating side effects, including cardiac arrhythmias. Case presentation: Here, the authors present an 80-year-old male with incessant ventricular tachycardia after ingestion of this herb. The sinus rhythm was restored after electrical cardioversion and aggressive intravenous antiarrhythmics. Clinical discussion: To the best knowledge of the authors, no case of a ventricular storm following ingestion of Delphinium has been reported till now, probably rendering this case the first one. Conclusion: This report aims to present the rare case using theoretical concepts from the discipline and to share our approach in the hope of achieving a better understanding of similar cases.

Traumatic Brain Injury among Patients Admitted in Neurosurgical Unit in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Traumatic brain injuries are one of the leading causes of mortality, morbidity, and economic burden in context to Nepal. Non-contrast computed tomography is used for rapid diagnosis and repeat computed tomography helps to detect the progression and complications of cerebral injury. The aim of this study was to find out the prevalence of traumatic brain injury among patients admitted in the neurosurgical unit in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among patients admitted to the neurosurgery unit in the tertiary care centre from 1 August 2019 to 29 August 2020. Ethical approval was taken from Institutional Review Committee (Reference number: CMC-IRC/075/076-156). Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 350 patients admitted in the neurosurgical unit, the prevalence of traumatic brain injury was 140 (40%) (34.87-45.13, 95% Confidence Interval). Change in management was required among 28 (20%) when computed tomography was done within 12-24 hours. Among them, 27 (19.29%) underwent surgical intervention after a repeat computed tomography scan. Conclusions: The prevalence of traumatic brain injury was found to be higher than similar studies done in similar settings. Keywords: contusion; craniotomy; traumatic brain injury.

Kawasaki disease - often a diagnostic dilemma in pediatric population: a case report.

Kawasaki disease (KD) is the most common cause of childhood vasculitis affecting small- and medium-sized arteries. The cause of this disease is unknown with an overall prevalence of 0.10% making this a rare entity. Case presentation: Here the authors present an index case of a 2-year-old child presenting with a persistent high-grade fever of more than 5 days and a 3-day history of bilateral swelling of hands and feet along with cervical lymphadenopathy. On the subsequent day of admission, the child developed mucocutaneous symptoms and cervical lymphadenopathy. The diagnosis of KD was made, and it was successfully treated with intravenous immunoglobulin and aspirin. Clinical discussion: Timely diagnosis and early treatment of KD are challenging due to the lack of definitive diagnostic tests. Watchful waiting for symptoms may be necessary before a diagnosis can be made because not all clinical symptoms are present simultaneously as in the index case. Conclusions: This case highlights considering KD as a differential diagnosis of nonresolving fever in children with mucocutaneous findings. Intravenous immunoglobulin along with aspirin is the mainstay of therapy and should be started as early as possible to prevent detrimental cardiac complications. There is a high tendency of diagnostic dilemmas due to a wide array of nonspecific presentations thus healthcare providers must be more vigilant of this entity.

Nutritional and post-harvest quality preservation of mushrooms: A review.

The purpose of this review is to provide information on the nutritional value of mushrooms and how to preserve that quality after harvest. Mushrooms contain a variety of vitamins and minerals, including B, C, and D, and are low in calories and high in fiber (iron, phosphorus, copper, potassium and selenium). Consuming mushrooms may help prevent or treat serious health conditions like cancer, diabetes, and cardiac diseases. Mushrooms are high in protein and low in cholesterol. After being harvested, mushrooms' quality continues to deteriorate, showing signs of discoloration, moisture loss, texture changes, an increase in the number of microorganisms, and nutrient and flavor loss. Maintaining postharvest quality and extending the shelf life of mushrooms requires postharvest preservation techniques, such as physical, chemical, and thermal processes. To preserve its quality during post-harvest, there are a number of steps that must be taken, including precooling and refrigeration, washing with hydrogen peroxide, citric acid, sodium erythorbate, and calcium chloride, edible coating with Aloe vera, apple peel powder, carboxymethyl cellulose, lecithin, and tartaric acid, modified atmosphere packages, and use of high-quality packaging materials like polypropylene. Mushrooms can be kept fresher for longer by steeping and canning. Researchers, farmers, and academics interested in mushroom cultivation and its product diversification could benefit from this review.

Epidemiology of dengue in SAARC territory: a systematic review and meta-analysis.

BACKGROUND: Dengue is one of the common arboviral infections and is a public health problem in South East Asia. The aim of this systematic review and meta-analysis was to evaluate the prevalence and distribution of dengue in SAARC (South Asian Association for Regional Cooperation) countries. METHODS: The PubMed, PubMed Central, Embase and Scopus databases were searched for relevant studies. Statistical analysis on data extracted from the selected studied was conducted using the Comprehensive Meta-Analysis Software (CMA) version 3 software package. Proportions were used to estimate the outcome with a 95% confidence interval (CI). RESULTS: Across all studies, among cases of suspected dengue, 30.7% were confirmed dengue cases (proportion: 0.307, 95% CI: 0.277-0.339). The seroprevalence of dengue immunoglobulin (Ig)G, IgM or both (IgM and IgG) antibodies and dengue NS1 antigen was 34.6, 34.2, 29.0 and 24.1%, respectively. Among the different strains of dengue, dengue virus (DENV) strains DENV-1, DENV-2, DENV-3 and DENV-4 accounted for 21.8, 41.2, 14.7 and 6.3% of cases, respectively. The prevalence of dengue fever, dengue hemorrhagic fever and dengue shock syndrome was 80.5, 18.2 and 1.5%, respectively. Fever was a commonly reported symptom, and thrombocytopenia was present in 44.7% of cases. Mortality was reported in 1.9% of dengue cases. CONCLUSIONS: Dengue is a common health problem in South East Asia with high seroprevalence. DENV-2 was found to be the most common strain causing infection, and most dengue cases were dengue fever. In addition, thrombocytopenia was reported in almost half of the dengue cases.

Methemoglobinemia due to Hemolysis Secondary to Infection in a Child: A Case Report.

Methemoglobinemia is a rare condition characterised by hypoxic state manifesting as headache, nausea, fatigue, and confusion. We report a 2-year-old boy presenting with fever and cough for 7 days with an episode of hypoxia as the saturation declined and did not improve on face mask oxygenation. On further evaluation, acute intravascular hemolysis was established following decreased haemoglobin level, increased levels of lactate dehydrogenase, and unconjugated bilirubin in the setting of documented infection. Assessment of arterial blood gas showed a significantly raised saturation gap and detection of methemoglobin confirmed the diagnosis. He was managed conservatively with packed red blood cells transfusion following which hypoxia was corrected. Methemoglobinemia as a result of hemolysis can be a non-cardio-respiratory cause of hypoxia and inciting aetiology needs to be addressed. Keywords: case reports; hemolysis; hypoxia; infection; methemoglobinemia.

Production and distribution system of maize seed in Nepal.

This study analyses the gaps and issues in the production and distribution system of maize seed in Nepal. A total of 682 households were surveyed in 2017 by employing multistage random sampling with probability proportionate to size by representing different (tarai and hill) agro-ecological zones. Twelve focus group discussions (FGDs) and four key informant interviews (KII) were also carried out. Results showed that the old varieties like Rampur Composite and Manakamana-3 are still popular in the farmers' fields. The cost of seed production was about 48% and the profit of the producer was 18% of the consumer price. The share of wholesalers was 15% of the consumer price whereas it was 19% for retailer/agro-vet. The average total cost of production was found to be $1392/ha and gross income was $1925/ha with the 1.38 average B: C ratio; it is, therefore, a lucrative enterprise. Out of a total of 27 released varieties, only 12 varieties have been used in seed production. Results revealed that 83% of the farmers cultivate open-pollinated maize varieties whereas 17% of them cultivate hybrid maize varieties. Seventy-five per cent of seed was from a formal source. The maize productivity, hybrid maize area, and seed replacement were below the targets set in Nepals' National Seed Vision, a policy document of the government. Focus on the production of nucleus and breeder seed by Government research farms and use of these seeds by private seed companies and community seed producing groups to produce next generation foundation seeds are urgently required. Equally important is enabling private and community-based organizations to produce hybrid seeds of the crop.

Balloon enteroscopy versus spiral enteroscopy for small-bowel disorders: a systematic review and meta-analysis.

BACKGROUND AND AIMS: Two novel enteroscopic procedures, balloon enteroscopy and spiral enteroscopy, have revolutionized the diagnostic and therapeutic approach to small-bowel disorders. These disorders that historically required surgical interventions are now investigated and managed nonsurgically. Only a few weakly powered studies have compared the outcomes of spiral enteroscopy and balloon enteroscopy. We conducted a systematic review and meta-analysis to compare the efficacy and safety of these 2 procedures. METHODS: PubMed, Cochrane Library, Scopus, and clinicaltrials.gov databases were searched for all studies published up to January 12, 2017 comparing the efficacy and safety of balloon enteroscopy (single or double) and spiral enteroscopy. Primary outcomes of interest were diagnostic and therapeutic success rates. Other outcomes included procedure length, depth of maximal insertion (DMI), rate of complete enteroscopy, and adverse events. We calculated Odds ratios (ORs) for categorical variables and mean difference (MD) for continuous variables. The Mantel-Haenszel method was used to analyze the data. Fixed and random effect models were used for <50% heterogeneity and >50% heterogeneity, respectively. RESULTS: Eight studies met the inclusion criteria for this meta-analysis. A total of 615 procedures were analyzed, which included 394 balloon enteroscopy and 221 spiral enteroscopy procedures. There were no significant differences in diagnostic and therapeutic success rates (OR, 1.27; 95% confidence interval [CI], .86-1.88; P = .22; and OR, 1.23; 95% CI, .82-1.84; P = .32, respectively) between the 2 procedures. Similarly, DMI was not significantly different between the 2 groups (MD, 26.29; 95% CI, 20.92-73.49; P = .28). However, the procedure time was significantly shorter for the spiral enteroscopy group compared with the balloon enteroscopy group (MD, 11.26; 95% CI, 2.72-19.79; P = .010). A subgroup analysis comparing double balloon enteroscopy with spiral enteroscopy yielded similar results. CONCLUSIONS: Both procedures achieved similar diagnostic and therapeutic outcomes and with similar depth of insertion. Spiral enteroscopy has the benefit of shorter procedural time.

Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage after failed endoscopic retrograde cholangiopancreatography: a meta-analysis.

The failure rate of endoscopic retrograde cholangiopancreatography for biliary cannulation is approximately 6%-7% in cases of obstructive jaundice. Percutaneous transhepatic biliary drainage (PTBD) is the procedure of choice in such cases. Endoscopic ultrasound-guided biliary drainage (EGBD) is a novel technique that allows biliary drainage by echoendoscopy and fluoroscopy using a stent from the biliary tree to the gastrointestinal tract. Information in PubMed, Scopus, clinicaltrials.gov and Cochrane review were analyzed to obtain studies comparing EGBD and PTBD. Six studies fulfilled the inclusion criteria. Technical (odds ratio (OR): 0.34; confidence interval (CI) 0.10-1.14; p=0.05) and clinical (OR: 1.48; CI 0.46-4.79; p=0.51) success rates were not statistically significant between the EGBD and PTBD groups. Mild adverse events were nonsignificantly different (OR: 0.36; CI 0.10-1.24; p=0.11) but not the moderate-to-severe adverse events (OR: 0.16; CI 0.08-0.32; p≤0.00001) and total adverse events (OR: 0.34; CI 0.20-0.59; p≤0.0001). EGBD is equally effective but safer than PTBD.