Introduction: Headache has multi-factorial causes; many primary or secondary headache disorders have ocular manifestations and benefit from the systematic ocular examination. Physicians at the point of the first contact should therefore be familiar with common ocular pathologies associated with a headache for appropriate referral.
Method: This hospital-based descriptive cross-sectional study was conducted in the Ophthalmology Department of Patan Hospital. All patients with headache as primary symptom and were referred to an ophthalmology clinic for ocular evaluation by other departments were included. The study was done for 15 mo and 354 patients were evaluated for the cause of headache. Findings and diagnoses of consenting participants were recorded and analyzed.
Result: All enrolled patients completed all the study procedures and were analyzed. The majority 61% were in 14-40 years. Homemaker was commonly affected 30.2% followed by students 25.4%. Any form of ocular pathology was detected in 76 % of patients. The majority of patients had no refractive errors (67.8%). Although any form of refractive error was more common in the presbyopia age group there was no statistically significant difference between different age groups. Most patients were orthophoric and only 11% of patients had vergence insufficiency. Among the ocular pathology dry eye, glaucoma suspects were more common.
Conclusion: This study supports the ocular morbidities and headache symptoms are linked very frequently. Good ocular history is needed for appropriate patient referral to a specialist. Correction of a minor degree of refractive error and lubricating eye drop may relieve worrisome headaches for many patients.
Background Influence of timing of injury surgery interval in outcome of osteosynthesis of neck of femur has always been a matter of debate. Patients in our set up have been surgically treated for neck of femur fracture with wide range of injury surgery interval which could have resulted in varied functional outcome and radiological outcome. Objective To evaluate the difference in functional outcome, femoral head osteonecrosis and non-union in fracture neck of femur fixed within and after twenty-four hours. Method All patients, who had undergone osteosynthesis for the neck of femur fractures via open or closed technique from 2010 to 2018 were analyzed retrospectively. The cases were examined and evaluated in terms of injury surgery interval, fracture union, functional status using Modified Harris Hip Score, complications like femoral head osteonecrosis and non-union. Result Fifty patients with an average injury surgery interval of 34±28 hours were evaluated. Twenty three (46%) cases were included in early surgery group (< 24 hours) and 27 (54%) patients were included in delayed (> 24 hours) surgery group. Incidence of femoral head osteonecrosis was reported in two (4%) cases, both being in delayed fixation group (p=0.49). Non-union was reported in four (8%) patients, one in early fixation group and three in delayed fixation group (p=0.61). The average Modified Harris Hip Score in early fixation group was 87 and in delayed fixation group was 84 (p=0.1). Forty two (84%) cases had a good quality of reduction and eight (16%) had a poor reduction. Non-union and functional outcome significantly differed between the good and poor reduction group (p=0.001 and 0.004 respectively). Conclusion There is no significant difference in the functional and radiological outcome of cases operated before and after 24 hours for osteosynthesis of neck of femur fractures in patients 16 to 65 years age group. However, poor reduction is significantly associated with the increased rate of non-union and poor functional outcome.
This review article explores the potential of ChatGPT as a substitute for diabetes educators. Diabetes is a prevalent chronic disease that requires ongoing education and support for patients to effectively manage their condition. However, there is a shortage of diabetes educators, and traditional education methods have limitations in addressing patients' individual needs. ChatGPT is an artificial intelligence technology that offers a personalized and interactive approach to education and support. In this review, we provide an overview of ChatGPT technology, discuss the challenges facing diabetes educators, review evidence supporting the use of ChatGPT in diabetes education, and examine ethical considerations related to its use. We also provide recommendations for further research and development of ChatGPT in diabetes education and integration into clinical practice. ChatGPT has the potential to improve access to education and support for patients with diabetes, but further research is needed to better understand its effectiveness and limitations. It is important to ensure that ChatGPT is developed and integrated in an ethical and equitable manner to maximize its potential benefits and minimize potential risks.
Introduction: Mucinous Cystadenoma carcinoma is a type of tumor in the cyst adenocarcinoma grouping it can occur in the breast as well as the ovary. Tumors are normally multiocular with various smooth thin-walled cysts. Within the cyst is found an emergence or cellular debris.
Patient History: The female patient 63-year-old who was admitted to AVBRH on the date 21/05/2021 in the obstetric and gynae ward with a chief complaint of generalized weakness, loss of appetite, fever for 2 days 7 days ago, 2-3 fever spikes and burning micturition. All over investigation observed like blood and urine investigation, CT scan of the abdomen, histopathology then the final diagnosis is confirmed as mucinous Cystadenoma carcinoma.
Pharmacology: The patient was treated with antibacterial medicine, antibiotics, and diabetics, thyroxin stimulating drugs, etc. Management: Inj. Ceftriaxone 1gm 12 hourly, Inj.-piptaz 4.45 gm, 8 hourly, tab. Gimipride 0.5 mg with tab. Metformin 500 mg 12 hourly, tab. Thyrox 62.5 mcg, tab telmisartan 40 mg with tab. Chlorthalidone 12.512.5 mg 12 hourly, Inj.-pan 40 mg, 12 hourly, Inj.- Neomol 100 ml, and Tablet- nitrofurantoin 6 hourly.
Nursing Management: Monitor the vital sign, monitor nutritional status and monitor random blood sugar. Maintained bed rest of patient, managed the pain level of the patient. The patient was assessed for risk of bleeding.
Conclusion: The patient was admitted to the hospital with the chief complaint of generalized weakness, loss of appetite, fever for 2 days 7 days ago, 2-3 fever spikes and burning micturition. and the patient was admitted to AVBR Hospital in the obstetric and gynae ward, immediate treatment was started by a health team member and all possible treatments were given and now the patient's condition is satisfactory.
Introduction: Sickle cell anemia may cause pain such as stiffness of the joint, bone pain,muscle weakness, chest or abdominal pain. It is often not recommended to use over - thecounter painkillers (such as ibuprofen, mortin, advil, or aleve) because they can adverselyaffect the function of the kidney and/or liver. Try to use hot compresses for about 15 minutes up to 2-3 timesper day to treat pain spontaneously. Beyond healing irritated skin, increasing endurance and encouragingrelaxing, herbs Are always an effective way to manage pain. It is possible to apply peppermintessential oil on the skin to decrease muscles sore or joint pain1.Objectives:-1. To assess the level of joint pain among sickle cell anemia patients.2. To assess the effectiveness of peppermint oil for joint pain among sickle cell anemia patients.3. To assess the effectiveness of hot fomentation for joint pain among sickle cell anemia patients.4. To compare the effectiveness of peppermint oil and hot fomentation for joint pain among sickle cellanemia patients.5. To associate the effectiveness of peppermint oil for joint pain among sickle cell anemia patients withtheir selected demographic variables.6. To associate the effectiveness of hot fomentation for joint pain among sickle cell anemia patients withtheir selected demographic variables.Material and Methods: For this research, true experimental pre-test post-test research design has beenadopted. The study was conducted in selected area of Wardha district. Simple random sampling techniquewas used to select 60 participants and 30 were recruited for each group. To evaluate joint pain, the toolused for data collection was a scale of (0-10 scale of pain severity) pain scale. Both each groups were givenpeppermint oil and hot fomentation for seven days for three times a day.Result:- The after intervention mean score of hot fomentation 2.90±0.71was higher than that of peppermintoil 1.53 ±0.68 and the calculated ‘ t’ value 7.59 was significant at p<0.0001.Conclusion:- The study proved that peppermint oil was effective than the hot fomentation for reduction ofjoint pain among sickle cell anemia patients
The association between ophthalmic anomalies and headache still needs to be investigated largely. We aimed to look for it in the context of a rural community hospital of Nepal. Hundred patients with headache were investigated for ophthalmic anomalies after the probable systemic association was ruled out. All the patients were first examined by general physician, otorhinolaryngologist and psychiatrist. Ocular evaluation consisted of detailed refractive, binocularity assessment and anterior and posterior segment examination. Data were analyzed using t-test, chi-square test, multiple logistic regression, odds ratio as well as frequency and percentages. Female above the age of 17 suffered more (p < 0.05). Frontal headache was more common than occipital (p > 0.05). In students and housewives frontal headache was more common (OR 3.467, 0.848–14.174; 95% CI and 1.167, 0.303–4.499; 95% CI). Refractive error was associated with frontal headache (OR, 1.429, 1.130–0.806, 95% CI). On presentation, 88% had visual acuity 6/9 or better. Forty-four percent had refractive error among whom astigmatism was more frequent (63.63%) followed by hyperopia (27.27%) and myopia (9.09%). Known eye problems were significantly associated with refractive error and binocular vision anomalies (p < 0.001). Convergence insufficiency (16.25%) and fusional vergence (11.25%) deficiencies were common among unstable binocularity. Ocular anomalies co-exist with headache complains very frequently. Refractive and binocular vision anomalies need to be largely investigated in all headache patients. It is important to get a good headache history so that patients can be referred to the appropriate specialist. La asociación entre anomalías oftálmicas y cefalea todavía debe investigarse a fondo. Nuestro objetivo fue examinarlo en el contexto de un hospital de una comunidad rural de Nepal. Se examinaron cien pacientes con cefalea en busca de anomalías oftálmicas una vez descartada una posible asociación sistémica. Todos los pacientes fueron explorados por un médico general, un otorrinolaringólogo y un psiquiatra. La evaluación ocular consistió en un examen detallado refractivo de la binocularidad y un examen del segmento anterior y posterior. Los datos se analizaron utilizando la prueba de la t, la prueba de la χ2 al cuadrado, regresión logística múltiple, razón de probabilidades, así como frecuencia y porcentajes. Las mujeres mayores de 17 años sufrieron más (p < 0,05). La cefalea frontal fue más frecuente que la occipital (p > 0,05). En estudiantes y amas de casa fue más frecuente la cefalea frontal (OR 3,467, 0,848 - 14,174; IC del 95% y 1,167, 0,303 - 4,499; IC del 95%). El error de refracción se asoció con cefalea frontal (OR, 1,429, 1,130-0,806, IC del 95%). En la presentación, el 88% tenían una agudeza visual de 6/9 o mejor. Un 40% presentaron errores de refracción, entre los cuales el más frecuente fue astigmatismo (63,63%), hipermetropía (27,27%) y miopía (9,09%). Los problemas oculares conocidos se asociaron de manera significativa con error de refracción y anomalías de visión binocular (p < 0,001). La insuficiencia de convergencia (16,25%) y los déficits de vergencia fusional (11,25%) fueron frecuentes en la visión binocular inestable. Las anomalías oculares coexisten muy frecuentemente con casos de cefalea. Las anomalías de refracción y de visión binocular deben investigarse a fondo en todos los pacientes con cefalea. Es importante obtener buenos antecedentes de cefalea para poder remitir a los pacientes al especialista adecuado.
Background: Patients with LeFort III fractures are at an elevated risk of needing emergency airway management because of midface instability and oropharyngeal airway obstruction. Lefort fracture includes fracture of the nasofrontal junction, bilateral area of the frontozygomatic suture, and probable fracture of the zygomatic arch. This fracture is also referred to as cranial facial disjunction. The Novel treatment for bilateral Lefort III is surgical management and medical management. It may be present in anyone who meets with an accident. Here we present the case of a 41-year adult man who came to the emergency department with complaints of head injury, absence of consciousness, nasal bleed drop by drop, swelling in the face, tooth avulsion, and prickling sensation over the lower right side of the face. The patient was kept in emergency ICU for observation and monitoring for one day, then referred to neurosurgery ICU where he was administered intravenous pan 40mg, Inj emset 2ml, Inj pause 1gm, Inj levopril 1gm, Inj ceftriaxone 1gm, Inj optineurin with 500ml ns, Tab zeredol 20 mg, Tab limce 500mg. The Patient was taken to the ophthalmology operation theater for suturing. Open reduction and internal fixation this surgical procedure is done on my patient. The patient's prognosis was good.
Background- The occurrence of meconium-stained amniotic uid (MSAF) during labor has long been considered the predictor of adverse fetal outcomes such as meconium aspiration syndrome and perinatal asphyxia, which leads to perinatal and neonatal morbidity and mortality Methods- A Prospective observational study was carried out in Smt. Hira Kunwar Ba Mahila Hospital, Jhalawar attached to Jhalawar Medical College,over one year from January 2020 to January 2021. Total 278 cases taken at random basis having following inclusion criteria Result- MSL is responsible for neonatal morbidity in 15.1% of cases. Rate of neonatal morbidity was higher in thick meconium group (24.9%) as compared to thin meconium group (6.2%) and this difference was statistically signicant. In our study birth asphyxia (5.8%) was the most common complication followed by MAS (4%), Pneumonitis (3.6%) and Sepsis (1.8%). Conclusion- Passage of meconium still remains as an enigma to the obstetrician and equally worries the paediatrician. As shown in the study, thick meconium is associated with increased operative intervention, low apgar score, increased rate of NICU admission and increased risk of neonatal morbidity and mortality as compared to thin meconium.
The COVID-19 pandemic has had a devastating impact on a global scale, causing significant morbidity and mortality. The virus affects multiple organ systems, including the respiratory, cardiovascular, and coagulation systems, leading to severe pneumonia in some patients. Moreover, COVID-19 patients with severe pneumonia have a high incidence of thrombotic events, which can result in significant morbidity and mortality. Given the potential benefits of anticoagulation therapy in COVID-19 patients with thrombotic complications, recent studies have proposed high-dose prophylactic anticoagulation (HD-PA) therapy as a potential treatment option. In fact, some studies have suggested that HD-PA therapy may be more effective in reducing thrombotic events and mortality rates than other treatment options. This review aims to provide a comprehensive overview of the benefits and risks of HD-PA therapy for COVID-19 pneumonia patients. By synthesizing and analyzing the latest available research, we highlight patient selection criteria and discuss the optimal dosage, duration, and timing of therapy. Additionally, we review the potential risks associated with HD-PA therapy and provide recommendations for clinical practice. Ultimately, this review provides valuable insights into the use of HD-PA therapy in COVID-19 pneumonia patients and paves the way for further research in this critical area. By exploring the benefits and risks of this treatment option, we hope to provide healthcare professionals with the information they need to make informed decisions about the best course of treatment for their patients.
Background Pneumothorax is a condition in which air or other gas is present in the pleural cavity. Mainstay of management of pneumothorax is to remove the air from the pleural space usually done by chest tube insertion. There is still uncertainty whether minimal invasive management with pigtail catheter is sufficient for the management of pneumothorax. Objective To find the effectiveness, safety, tolerability, efficacy of pigtail catheters and large bore chest tubes. Method Prospective comparative study was done in Dhulikhel Hospital between August 2019 till August 2021. Chest tube insertion used to be the only available treatment modality till December 2020 (15 months). Following January 2021 after obtaining ethical clearance for use of pigtail insertion for pneumothorax, this treatment modality was done (8 months). Result Among 76 patients, 52(68.4%) underwent a large bore chest tube and 24 (34.6%) pigtail catheter patients. Mean age of the patients was 48 years (SD 18.01). Duration of hospital stay and length of hospital stay was more in large bore catheters and less in pigtail catheters. Eight hours post tube placement of the expansion of the lungs was present in pigtail and was statistically significant. Pain killer used in pigtail catheters was limited to Non-steroidal anti-inflammatory drugs, for large bore catheter opioids were added and were statistically significant. Conclusion Pigtail catheter is nearly effective as compared to traditional wide bore catheters.
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