Most psychiatry residencies begin clinical training assigned to an inpatient service. This exposes residents to acute, hospitalized mental health crises cases and teaches them teamwork in collaboration with a variety of healthcare professionals. Faculty and staff can facilitate resident transition to hospital practice by orienting them ahead of time with an introduction to clinical and documentation procedures. International medical graduates might benefit from extra training about the American health care system and culture. Once on service, resident guidance by faculty includes educational supervision about interviewing skills, making diagnoses, and clinical management. A self-guided study plan with appropriate literature can initiate a practice of independent learning.

The aim of this manuscript is to evaluate retrospectively, the symptoms, treatment and long-term outcome of idiopathic intracranial hypertension (IIH) in adolescents with severe visual impairment, particularly in relation to body weight and compliance to treatment. We reviewed the clinical notes of adolescent patients treated in our department for IIH through a one-year period. From January 2004 to Feb 2005 four patients, aged between 12 and 13 years were diagnosed with IIH. Inclusion criteria were cerebrospinal fluid (CSF) opening pressure greater than 250 mmH2O, normal CSF composition, severe visual impairment, normal brain imaging and nonfocal neurological examination except for sixth nerve palsy. All patients were followed for a minimum of 3 years. All patients were either overweight or obese. The sex distribution was 3 girls, 1 boy. The most common presenting symptom was headache. Visual field abnormalities were present in all cases with severe visual loss. All patients were treated with acetazolamide while two of them received steroids in conventional dose and one needed high-dose methylprednisolone. The use of transcranial Doppler (TCD) was available only after treatment with minimum impact on results. Adolescents represent an age group with special emotional and biological needs leading in difficulties when compliance to specific treatment is necessary. Although IIH in adolescents is rare, it could lead in permanent visual loss. Especially in obese patients, successful weight management in combination with good compliance to treatment seems important for a favorable long-term outcome.

To assess the protective measures taken at a public sector hospital in preventing nosocomial transmission of pulmonary tuberculosis (TB) among health-care workers, a study was conducted in Civil Hospital Karachi during the period of January 2011 to June 2011. The sample comprised of doctors, registered nurses and non-medical staff working in medical units. Participants were asked about the routine precautionary measures taken against TB as well as those they taken while attending patients suspected of having TB as well as diagnosed TB patients. They were also questioned about the administrative and personal protective measures which were employed against TB. Collected data was entered and analyzed by SPSS software, version 17.0. Chi-square test was applied to test association between categorical variables and Student’s t-test for continuous variables. Total of 150 participants were included in the study. 26.7% of the participants had undergone screening test for TB at the time of their employment while only 16% undergo regular screening test. None of those interviewed ever took any precautionary medication against TB. 46.7% of the participants ensured proper ventilation at their working place. 72.7% stated that the management didn’t take appropriate steps to ensure their safety. 6% of the participants had suffered from TB during their service while 13.3% had suffered some other respiratory disease. Participants were more cautious when attending diagnosed TB patients as compared to those who were suspected of having TB. Measures taken to prevent the nosocomial transmission of TB in health-care workers are suboptimal. Factors contributing to the transmission should be explored and subsequently addressed.

Sepsis is the commonest cause of neonatal mortality. However the incidence of the latter varies with the geographical area, the socio-economic structure and various customs and practices in the perinatal period. Till date there have been no published data regarding the latter in Nepal. With the neonatal services coming of age in Nepal it becomes pertinent to study the magnitude and characteristics of the burden of neonatal sepsis. We conducted a retrospective study over a period of six years to elucidate the risk factors, clinical spectrum, diagnostic parameters and the outcome of neonatal sepsis at a tertiary care neonatal intensive care unit. In all 265 cases of suspected sepsis were screened using a panel consisting of C – reactive protein, absolute neutrophil count and immature to total neutrophil count ratio and subsequently confirmed by cultures. The cases were early onset (n=44), late onset (n=56) and nosocomial groups (n=40). The data for the intramural (n=32) and extramural (n=68) cases was analyzed separately. In all 265 neonates (male: female = 1.86:1) were screened for sepsis, out of which 183 resulted a positive screen, of which, 100 had pathogenic organisms (37.76%). Prematurity (22 to 71%) was most frequently associated with all the categories: suspect, early onset, late onset, nosocomial, irrespective of whether they were in- or out-born. The major risk factor associated with out-born babies was asepsis during labour (57.4%). Respiratory signs and symptoms were commoner in the in-borns as well as the nosocomials. The commonest complication associated with neonatal sepsis in our study was exaggeration of neonatal jaundice/hepatitis (80 to 92%). The sensitivity and specificity for C – reactive protein, immature to total neutrophil count and absolute neutrophil count were found to be 93% and 49.7%, 36% and 75.6% and 20% and 83.4% respectively. Among the culture positive neonates (n=100), 32 were in-house deliveries, and the rest were out-born. The frequency of early and late-onset sepsis was similar. In all there were 131 isolates from blood, cerebrospinal fluid and urine, out of which 38 (29.0%) were in the in-born babies. Nosocomial sepsis accounted for 44 (33.59 %) of the isolates out of both the in and out-born babies combined. The mortality (10%) and sequelae (7.5%) was higher in the nosocomial sepsis group. We observed that there is a high rate of aseptic home deliveries. Nosocomial sepsis was an important problem in the study though the outcome was not un-encouraging. There is a need for extension and intensification of the maternal and child health services in Nepal.

Immunization is the most successful component of preventive medicine and is a cost effective strategy to reduce both the morbidity and mortality associated with infectious diseases. The caretakers of six hundred children, who attended our immunization clinic, were included in the present study to assess their knowledge and attitude regarding immunization. Maximum numbers of caretakers were aware of poliomyelitis, followed by tuberculosis and hepatitis. Health institutions were the most frequent sources of information regarding immunization. Television was providing better information regarding immunization. A maximum number of caretakers believed that the immunization was important and majority of them were aware of importance of vaccination to be done as per schedule. Health facility was preferred for immunization. A need to encourage more male participation as caretaker, augment awareness for less known vaccine preventable diseases using mass media and non government organizations was observed.

Hydatid cyst is caused by infection of larvae of the parasite Echinococcus granulosus. The most common sites of hydatidosis are liver and lungs. We present a rare case of simultaneous hydatid cyst of the liver and spleen with spontaneous intraperitoneal rupture of both cysts.

Hepatitis A (HA) is a common illness, with prevalence rates highest in areas with limited hygiene and sanitation practices. In developing countries, where infection is endemic, most people are infected during the first decade of life. The illness is self limited, and severity is age dependent. One of the rare extrahepatic complications of hepatitis A is anasarca. The anasarca presenting as pleural effusion with ascites is a rare and possible benign complication of hepatitis A, and its appearance doesn't seem to correlate with seriousness of illness in children. We present a case of anasarca as an atypical presentation of hepatitis A.

Coronary arterial microfistulae are abnormal connections between one or multiple coronary arteries and any cardiac chamber. The frequency of this rare congenital anomaly is not known exactly, because at least 75% of cases may be asymptomatic. The diagnosis of the microfistulae is based on coronary angiography.

Neuronal ceroid lipofuscinoses are the most common neurodegenerative childhood-onset disorders characterized by autosomal recessive inheritance, epileptic seizures, progressive psychomotor deterioration, visual failure, and premature death. At least eleven subtypes of childhood-onset neuronal ceroid lipofuscinoses have been identified. The most common types are the infantile and classic juvenile forms. In this article, we present a 5-year- old girl with late infantile neuronal ceroid lipofuscinosis who presented with seizures and decreased visual acuity. She was healthy and her developmental milestones were normal until 3 years of age. At the age of 3-year-old, her intractable seizures started and decreased visual acuity was recognized. Based on the clinical findings and enzymatic test results, she was diagnosed as late-infantile ceroid lipofuscinosis.

Peritonitis is a common complication in patients on continuous ambulatory peritoneal dialysis. In some cases peritoneal fluid is unremarkable. In these instances, one must evaluate for other causes of gastrointestinal pathology or a myriad of other causes. We report an unusual case of acute myeloid leukemia who presented with peritonitis in a continuous ambulatory peritoneal dialysis patient.

Thrombocytopenia may develop after drug therapy and is a life-threatening condition. Thrombocytopenia may also occur after high-dose use of rifampicin which is an antibiotic. Here, we report five cases of thrombocytopenia developing after the use of rifampicin for the treatment of brucellosis. Four cases had experienced diffuse petechiae and ecchymosis with severe thrombocytopenia. The other patient had a complicated thrombocytopenia with intracerebral hemorrhage. As a result, the usage of rifampicin in the treatment of brucellosis could lead to systemic or central complications.

Acute white matter insult in a non traumatic, non ischemic background has been recently identified in certain clinical situations. Named toxic leukoencephalopathy, it may be caused by exposure to a wide variety of agents, including cranial irradiation, therapeutic agents, drugs of abuse, and environmental toxins. Extensive central white matter restriction of diffusion in the absence of significant T2 or Fluid-attenuated inversion recovery (FLAIR) abnormality is the imaging hallmark on Magnetic Resonance Imaging (MRI). Reversibility of the symptoms after the withdrawal of toxin has been shown in a few reports. We present one such case with reversal of changes on MRI and clinical improvement.