A case report and overview of organophosphate (OP) poisoning

A case of organophosphate (OP) poisoning who recovered after requiring almost 1000 mg of atropine, 10 gm of PAM and ventilatory support for 7 days is presented here. The overview of organophosphate poisoning and its management is given. With the approach adopted, the mortality reported in the general medicine unit in the central hospital in Nepal is 7.4%. The two important aspects of the management are vigilance of the atropine drip, especially at night, and other physical and psychological support care of the patients.     

Informed consent: is it really understood?

Pre-operative counselling is an important part of the care that we give to our patients undergoing surgery. It ensures that the patients understand about their disease and the procedure that they are undergoing. This study was done with the objective of finding whether or not the patients do actually understand what has been explained to them. This is a prospective study done in the form of a survey with a set questionnaire in two hospitals in Kathmandu namely Patan hospital and Tribhuvan University Teaching Hospital. The patients surveyed were those who were admitted for elective surgery after counselling has been done and consent forms signed. The result showed that the level of understanding was poor in 11%, unsatisfactory in 33%, satisfactory in 37% and excellent in 19%. The level of understanding was affected by the education level of the patients. To conclude, the level of understanding was unsatisfactory in nearly half the patients. Only 19% had optimal understanding. This may reflect the education level of the many of our patients but it clearly points out that the medical profession needs to make more effort to make the patients understand more about their disease process. This can be said to be a reflection of our quality of care.     

Multifocal Childhood Cutaneous Tuberculosis: Report of Two Interesting Cases from Sikkim,India

Abstract: Cutaneous tuberculosis is an important health problem in developing countries such as India. Poverty, overcrowding, malnutrition, and ignorance are predisposing factors. The commonly seen variants of cutaneous tuberculosis are scrofuloderma, lupus vulgaris, and tuberculosis verrucosa cutis. Malnourished children may present with unusual forms of cutaneous tuberculosis. Herein we report two interesting cases of multifocal cutaneous tuberculosis in malnourished children.     

Role of bromocriptine in multi-spectral manifestations of traumatic brain injury

Purpose: Despite the prevalence and cost of traumatic brain injury related disabilities, there is paucity in the literature on modern approaches to pharmacotherapy. Medications may promote recovery by enhancing some neurological functions without impacting others. Herein we discussed the role of bromocriptine in neurorehabilitation for patients with traumatic brain injury. Methods: A cohort comprising of 36 selective nonsurgical cases of traumatic brain injury in minimally conscious state were enrolled in the study. After hemodynamic stability, bromocriptine was given at paediatric dose of 3.75 mg/d and adult dose of 7.5 mg/d. It was administered through a naso-gastric (NG) feeding tube in the patients with minimally conscious state, then changed to oral route after proper swallowing and good gag reflex were ensured in the patient. The drug was slowly reduced over three weeks after neurological improvement in the patients. Positive result was determined by improvd GCS score of 2 and motor power by at least 1 British Medical Council (BMC) motor score. Improvement of deficits was evaluated in terms of fluency of speech for aphasia, task switching, digit span double tasking and trail-making test for cognition and attention, and functional independence measure score for motor functioning and self-independence. Results: Accelerated arousal was seen in 47.0% of cases (8/17) in 4e40 days. In 41.2% of cases (7/17), Glasgow outcome score (GOS) was improved to 4/5 in 90 days. Improvement in hemiparesis by at least 1 BMC score was seen in 55.6% of cases (5/9) in 40 days. Aphasia was improved in 80% of cases (4/5) in 7-30 days. Moderate improvement in cognitive impairment was seen in 66.7% of cases (2/3) in 14e20 days. Improvement in memory was observed in 50% of cases (1/2) in over 30 days. No cases were withdrawn from the study because of adverse reactions of the drug. There was no mortality in the study group. Conclusion: Bromocriptine improves neurological sequelae of traumatic brain injury as well as the overall outcome in the patients. If medication is given to promote recovery and treat its associated disabilities, clinicians should thoroughly outline the goals and closely monitor adverse effects.     

Use of bone marrow derived stem cells in a fracture non-union

This is an attempt of using in vitro cultured mesenchymal stem cells (MSCs) from bone marrow in joining of a fracture non-union. Bone marrow cells were obtained and differentially centrifuged for MSCs that were grown in vitro in mesenchymal stem cell basal medium aseptically, for 10 d. The cell mass was injected around the fracture non-union. Healthy conditions of development of tissue regeneration at the trauma site and due bone joining were recorded. It is concluded that in vitro cultured MSCs had a blithesome effect on the fracture non-union.