IntroductionTransversus abdominis plane and Erector spinae plane blocks are used regional anaesthesia techniques for abdominal surgery. This study compares the analgesic efficacy of ESP versus TAP blocks in patients undergoing total abdominal hysterectomy. MethodsThis randomized study enrolled 44 patients undergoing total abdominal hysterectomy under general anesthesia. Patients were randomly assigned to two equal groups. Group A received bilateral erector spinae plane block, while Group B received bilateral transversus abdominis plane block under ultra sound guidance using 20 ml of 0.25% bupivacaine on each side. Outcomes assessed included time to first rescue analgesia, 24-hour analgesic consumption, postoperative pain scores at predefined intervals, and complications. ResultsThe median time to first request for rescue analgesia was 1 hour in both groups and was not statistically significant (p = 0.408). The 24-hour median dose of rescue analgesia was 50 mg in the ESP group and 100 mg in the TAP group, which was statistically significant (p = 0.022). Comparison of Numeric Rating Scale (NRS) scores between the two groups at 0 and 1 hour postoperatively showed statistically significant differences (p = 0.010 and p < 0.001, respectively). NRS scores at 6, 8, 12, and 24 hours did not differ significantly between the groups, although median scores were lower in both. Complication rates were not significant in either group. ConclusionsESP block significantly reduced 24-hour rescue analgesia consumption compared with TAP. NRS scores differed at 0 and 1 hour, but were similarly low thereafter, indicating comparable overall postoperative analgesic efficacy profiles.
IntroductionThe head and neck defects have multiple reconstructive options available among which pectoralis major myocutaneous flap has remained a reliable option for reconstruction. This study aimed to evaluate outcome of pectoralis major myocutaneous flap reconstruction in head and neck surgery. MethodsThis is a retrospective observational study done by analyzing the clinical records of 29 cases with reconstruction of head and neck defects due to various etiologies with PMMC flap from January 2021 to December 2025. The data were analyzed using IBM SPSS statistics version 25. ResultsOut of 29 cases, 21 were males and 8 were females. The most common pathology was squamous cell carcinoma (SCC) (n=27) (93.1%) that involved gingivobuccal sulcus in 12 cases (41.37%). It was followed by buccal mucosa (20.68%), floor of mouth (13.79%), one case each of lip and angle of left mandible (3.45%), tongue (10.34%) and retromolar trigone (6.9%). The PMMC flap had 100% survival rate no partial or total flap loss. However, the flap had complication rates of 34.48% in this study. Gingivobuccal sulcus accounted for most of the complications including four cases (13.79%) and it was followed by two cases each of buccal mucosa and floor of mouth (6.89%), one case each of tongue and lip (3.44%). ConclusionThe PMMC flap showed complications like wound dehiscence, seroma and surgical site infection. However, it showed promising result regarding its survival rate and coverage of defects in head and neck.
IntroductionBlepharospasm is a condition characterized by involuntary and excessive blinking of eyelids. It is focal dystonia. The purpose of the study was to assess the severity of blepharospasm by both patient and physician rating scales and to compare the correlation between these two scores.Methods It was a single centred retrospective cross-sectional study in outpatient department (OPD) of neurology and Neuro-Ophthalmology of tertiary hospitals of Institute of Medicine (IOM). Data was extracted from the patient files who visited hospital between January 2023 till December 2023. Jankovic Rating Scale (JRS) was used to assess the severity by physician and Blepharospasm Disability Index (BSDI) by patient to self-score their disability. Analysis was done using IBM SPSS version 26. Correlation between physician scored scale and patient reported scores were done by using Spearman’s rho. p-value of <0.05 was considered statistically significant.Results Seventeen patients were included. The mean age of study population was 56.84 ± 14.37 years, and 58.8% of patients were female. Only 29% were receiving botulinum toxin injection. Mean BSDI score was 5.41 ± 4.77 and mean JRS score was 5.82 ± 0.88. No significant correlation was observed between the BSDI and JRS scores (rho = 0.418, p = 0.095).Conclusion JRS and BDSI are both useful and widely used tools to assess severity of blepharospasm. However, our study showed only moderate correlation between physician and patient rating scales. Reason could be due to small sample size. Larger multicentre studies are advisable.
IntroductionDialysis adequacy and malnutrition are key factors contributing to high mortality and morbidity rate in maintenance hemodialysis patients. Previous studies from Nepal have reported very low mean spKt/V and very high malnutrition rates. However, contemporary data on these parameters are lacking in Nepalese patients. So, this study was done to assess the current status of adequacy of dialysis, nutritional status and to determine the association between them in dialysis population in a tertiary care center of Nepal. MethodsA cross-sectional study was conducted among 118 maintenance hemodialysis patients at Tribhuvan University Teaching Hospital. Dialysis adequacy was measured using spKt/V and nutritional status was assessed using MQSGA, anthropometric measurements and serum albumin. Chi-squared test, t-test and logistic regression analysis were done to determine independent factors associated with inadequate dialysis. ResultsThe mean spKt/V was 1.3 ± 0.36, with 59.3% of patients achieved adequate dialysis. MQSGA showed that 62.7% of patients had normal nutrition, while 37.3% had mild-to-moderate malnutrition and none had severe malnutrition. Mid arm circumference and mid arm muscle circumference were significantly higher in patients with adequate dialysis. On logistic regress analysis, mid arm circumference was found to be an independent risk factor associated with inadequate hemodialysis (p = 0.03). MQSGA, triceps skinfold thickness, biceps skinfold thickness and serum albumin did not show significant associations. ConclusionsDespite improvements in dialysis adequacy and nutritional status over time, many patients continue to receive inadequate dialysis and have malnutrition. Dialysis adequacy is significantly associated with objective measures of muscle mass rather than subjective nutritional scores, highlighting the importance of incorporating simple anthropometric assessments into routine care.
IntroductionAutism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects both children and their families. Raising a child with ASD presents unique challenges and experiences that this study has aimed to explore to in the Nepalese context. MethodsA phenomenological qualitative study was conducted with the inclusion of 10 primary caregivers via purposive sampling of children with ASD of age five to ten years and diagnosis of at least six months from January 2024 to November 2024 in Kathmandu, Nepal. Data were collected through face-to-face in-depth interviews with approval from the Institutional Review Committee of NAIHS. Data analysis was done based on Braun and Clarke’s (2006) thematic analysis method. ResultsFollowing six themes as daily parental challenges; Financial constraint; Mixed impact on the health of caregivers; Impact on relationships; Support from government level and quality medical care were extracted based on total 13 subthemes and 54 codes mentioned below with verbatim of participations. ConclusionCaregivers on a personal-level reported challenges arising from a lack of knowledge in managing nutritional needs and behavioral issues, along with financial constraints. At the institutional level, special attention was drawn to the lack of autism-specialized healthcare and high financial expenditures when seeking treatment in Nepal. These findings highlight the need for accessible and specialized healthcare services in Nepal with increase in governmental allowance for children with ASD.
IntroductionPostoperative delirium (POD) in geriatric patients significantly increases morbidity and mortality. Frailty predisposes patients to significant adverse postoperative outcomes. This study evaluates the occurrence of preoperative frailty using Edmonton Frail Scale (EFS) and its association with postoperative delirium in elderly patients. MethodsAn analytical cohort study was conducted among patients aged ≥ 65 undergoing elective non-cardiac surgery. Preoperative frailty, cognitive reserve and comorbidities were assessed with validated tools. Intraoperative variables including anesthesia type, surgery, surgical duration, intraoperative complications including hypotension were recorded. Postoperative delirium was assessed twice daily for 72 hours postoperatively using confusion assessment method (CAM). Unadjusted and multivariable logistic regression analyses were performed to identify independent risk factor and evaluate the association between frailty and delirium after adjusting for relevant covariates. ResultsThe occurrence of delirium was 9.70%(16/165). Preoperative frailty was present in 55(33.33%) participants. Postoperative delirium was seen in 43.33% of moderate to severe frail group compared to 0.91% in the non-frail group (p <0.001). In the multivariable analysis, after adjustment for age and intraoperative hypotension, the odds of postoperative delirium increased about twofold for every one-point increase in Edmonton Frail Scale score (aOR 2.20; 95% CI 1.57-3.50, p <0.001). Intraoperative hypotension was another significant factor (aOR 12.88; 95% CI 2.66-77.58 p <0.002). ConclusionsThe preoperative frailty score and intraoperative hypotension were significant predictors of postoperative delirium. Implementing routine frailty screening and hemodynamic stability in frail elderly population are essential strategies to decrease the risk of postoperative delirium.
IntroductionCoronary Artery Bypass Grafting (CABG) is a standard procedure to revascularize the ischemic myocardium.Left Internal Mammary Artery (LIMA)is preferred graft due to its superior long term patency. LIMA can be harvested through either pedicled and skeletonized technique. Skeletonized LIMA is becoming popular due to favourable clinical advantage. This study aimed to compare the clinical outcomes between two harvesting technique. MethodsThis is a prospective comparative observational study of 41 patients who underwent CABG procedure at cardiac Centre from January 2020 to December 2020. Observational comparative study of 41 patients with 20 patients in Group A(skeletonized LIMA) and 21 patients in Group B (pedicled LIMA ).The clinical parameters like postoperative drain output and patency of LIMA with selective Angiogram of LIMA at 3 to 6 months were compared. ResultsThe mean age of patients in group A was 54.35±6.8 years and in group B it was 57.80±10.88 years. Postoperative drain output was significantly lower in the skeletonized group (426±159.4 mL) compared to the pedicled group (682.85±312.15 mL; p=0.002).The patency of LIMA was 100 percent in Group B and 83% in Group A (p =0.40).Among the three atretic LIMA , two were associated with competitive flow due to recanalized LAD and one patient had proximal LIMA stenosis ,unrelated to harvesting method. There were 3 mortalities, not attributable to the harvesting technique. ConclusionBoth skeletonized or pedicled LIMA technique has similar patency at 3 to 6 months following CABG however skeletonized technique is associated with significant lesser postoperative bleeding.
Introduction This study aims to review the magnetic resonance imaging (MRI) findings in cases with asymmetric sensorineural hearing loss (ASNHL) and to evaluate the clinical features in cases with abnormal findings in MRI that could act as the clinical predictors for intracranial pathology. Methods This study was conducted at the Department of ENT-HNS, T.U. Teaching Hospital, Kathmandu, Nepal. A review of prospectively recorded data from five years (October 2019 to October 2024) on MRI findings and clinical features of cases presenting with ASNHL loss was done. Results A total of 47 cases met the inclusion criteria. Most cases had sudden sensorineural hearing loss (35), while the rest (12) had progressive hearing loss. Seven cases had abnormal MRI findings with vestibular schwannoma being the commonest pathological finding. Symptoms such as tinnitus, imbalance, headache, and tingling sensation in one half of the face had a statistically significant association with the detection of pathological findings in MRI. Conclusion MRI of the brain focusing on the CPA should be advised in all cases with asymmetric hearing loss. However, in scenarios where ordering an MRI is not feasible or can add much more financial burden to the patients, clinical features like tinnitus, headache, imbalance, and symptoms resulting from nerve compression such as tingling sensation in one half of the face can be taken into consideration to selectively scrutinize the patients with MRI.
IntroductionHypertension is a modifiable risk factor for cardiovascular disease with rising burden in low- and middle-income countries (LMIC) like Nepal. However, reliable community level data from rural Terai regions are scarce. This study was conducted to determine the prevalence of hypertension and to identify its socio-demographic and behavioural risk factors among a rural village of Rupandehi district. MethodsA community-based cross-sectional study was carried out in Materiya Village of Rupandehi district, Nepal, from April to July 2025. A total of 290 adults were recruited using systematic sampling, and data were collected with a structured case proforma. Hypertension was defined according to the 2025 ACC/AHA criteria. Descriptive statistics summarized data, and chi-square test, ANOVA, and t-test were applied. ResultsThe mean age of the participants was 39.30±13.9 years, 71.4% were female, and 50% were illiterate. The overall prevalence of hypertension was 46.9%, with males having a significantly higher prevalence (60.2%) than females (41.5%). Prevalence increased progressively with age, from 27.6% in the 20-29 years group to 66.7% in those ≥60 years. Hypertension was significantly associated with alcohol consumption, occupation, and marital status. Only 19% of the hypertensive participants were on treatment. ConclusionThis study reveals an alarmingly high burden of hypertension (nearly one in two adults) in the rural western Terai region of Nepal, while awareness and treatment remained low. The strong links with male gender, advancing age, alcohol use, and certain occupations suggest the urgent need for targeted, community-based screening and need for lifestyle modifications.
Introduction Renal dimensions and weight are important indicators of kidney function. This study aimed to assess renal dimensions, weight, lobulation, and variations in hilar pattern, and to compare these parameters between the right and left kidneys. Methods A descriptive cross-sectional study was conducted on 124 pairs of morphologically normal kidneys obtained from adult cadavers of the Department of Forensic Medicine, Maharajgunj Medical Campus. Renal length, breadth, thickness, and weight were measured. Lobulation and antero-posterior arrangement of structures at the hilar structures were assessed. Results Among 124 cadavers, 82 were male, and 42 were female. The age ranged from 18 to 81 years, with a mean age of 38.06 years. The mean weight of kidney was 124.71±23.96 g in males and 110.63±24.33 g in females. The mean weight of the kidney was 116.65±24.46 g (right) and 123.25±26.72 g (left). The median length was 10.04 cm (right) and 10.43 cm (left). The median breadth was 5.56 cm (right) and 5.61 cm (left). The median thickness was 2.81 cm (right) and 3.05 cm (left). Lobulation was observed in 8% of right and 16% of left kidneys. The typical pattern of hilar arrangement was seen in 56.5 % of right kidneys and 49.2% of left kidneys. Conclusions The left kidney was greater than the right in length, breadth, thickness, and weight. Renal dimensions were higher in males. Lobulation and variations in hilar arrangement were more frequent on the left side.
IntroductionHealth promotion is important for health-promoting behaviour and disease prevention, which is associated with improved physical and mental health outcomes. So, this study aimed to find out the health-promoting lifestyle profile of health professionals working in Karnali Province. MethodsA descriptive cross-sectional study was done among 217 randomly selected doctors, nurses, and paramedics in Karnali Province. Participants who had at least six months of experience and had no conditions that limited their physical activity. Data were collected by using the structured questionnaire. Mean scores of overall and subscale health-promoting lifestyle were calculated, and a t-test was used to compare differences between demographic variables and health-promoting lifestyle of health professionals. ResultsThe majority of participants (67.74%) were younger than 30 years, with a mean age of 28.92 ± 6.516, and 62.67% were female. A majority (69.12%) of participants perceived their current health as good. In terms of health-promoting behaviours, 62.67% showed a moderate level of engagement. The overall mean health-promoting lifestyle score was 123.99 ± 16.66 out of 208, indicating a moderate practice level among health professionals. Furthermore, a statistically significant difference in health-promoting lifestyle scores with age groups (p = .035) was found, which suggests that age may influence the adoption of health-promoting behaviours. ConclusionsFindings indicate that health professionals practiced a moderate level of health-promoting behaviours, underscoring the need for targeted advocacy and awareness to improve the health-promoting practices.
IntroductionFlexor hallucis longus (FHL) tendon augmentation in late presenting Tendo Achilles (TA) tear gives good patient satisfaction. This study aims to analyze the functional outcome of FHL use in TA tear in our setting. MethodsA retrospective observational study was conducted at National Trauma Center, Nepal of all the cases of FHL use in TA tears during the last one year. The data were collected from the hospital records and functional outcome assessed at the follow up visit of 6 months. Statistical analyses were performed using SPSS 24. The central tendency was represented with median with Interquartile range (IQR) and mean and standard deviation(SD) were used. To compare the means and median, paired t-test and Wilcoxon ranked-sum test were used, respectively. The p-value less than 0.05 was considered statistically significant. ResultsTotal 30 cases were included in the study. The mean age was 52.27 + 5.32 years. The mean duration to surgery from injury was 9.53 + 4.13 weeks. The mean tear gap preoperatively was 3.02 + 0.69 cm, which after debridement increased to 3.88 + 0.45 cm. The median total AOFOS score preoperative was 48 (IQR 10)which increased to 82(IQR 3), which was statistically significant, p <0.001. Post-operatively, 29(96.67%) cases had good and 1(3.33%) case had excellent outcome. The most common complaints of the patient were pain post-operatively in 22(73.33%) cases, followed by ankle weakness in 19 (63.33%) cases. ConclusionThe flexor hallucis longus tendon augmentation in late presenting Tendo Achilles tear gives good functional outcome. But most patients complained of pain and weakness post-operatively.
IntroductionThe success of a removable prosthodontics hinges upon both the dentists and patient’s factors like retention, support, speech, mastication. The finish of the prosthesis which includes finalizing the shape, texture and polishing of the dentures also play vital role in the clinical outcomes. Besides, there are other important aspects that affect the success of dentures. The aim of the study is to determine factors affecting the patient satisfaction undergoing removable prosthodontic rehabilitation. MethodsThis is a cross‑sectional descriptive study conducted among 120 patients undergone removable prosthodontic rehabilitation in Nobel Medical College and Teaching Hospital in 1 year assessed from August to November 2025. Demographic details of participants, patient satisfaction score, prosthodontic history and patient behaviors were studied. ResultsMajority of study participants were moderately satisfied with the retention, esthetics, speech, mastication, finish of the denture, and overall satisfaction for maxillary and mandibular dentures. The gender, marital and educational status were significantly associated with esthetics of the denture; p = 0.014*, p = 0.034*, p = 0.05* respectively. Smoking habits was significantly associated with retention and duration of wear of prosthesis with the aesthetics of the denture. Total number of removable prostheses used by the patient and their behavior were significantly associated with masticatory performance of denture; p = 0.015* and p = 0.034* respectively. ConclusionIn this study, majority of patients were found to be moderately satisfied with the retention, esthetics, mastication, finish and overall satisfaction for denture treatment while majority of them were poorly satisfied with the speech associated to the dentures.
Radiology serves as the preeminent diagnostic tool of modern pediatric radiology. It is crucial for pinpointing subtle pathologies and directing targeted, life-saving treatments in children who often cannot articulate their symptoms. However, providing equitable, high-quality pediatric imaging in low and middle-income countries (LMICs) remains a monumental global health challenge. These regions continuously struggle against infrastructural hurdles: a severe shortage of subspecialized personnel, advanced equipment costs, and severely limited governmental investment in targeted healthcare. Furthermore, adhering to stringent dose-reduction protocols for children proves to be a daunting daily task in these resource-constrained environments. This viewpoint article explores the multifaceted challenges of pediatric radiology in LMICs, systematically categorized into service delivery, educational deficits, and socioeconomic barriers. We critically examine the disparities in specialized care between the western and eastern regions, highlighting the absolute necessity for tailored, pediatric-specific imaging protocols that prioritize patient safety and minimize ionizing radiation exposure. Crucially, this perspective explores the transformative potential of teleradiology and the ethical integration of artificial intelligence (AI) to alleviate severe workforce burdens, alleviate diagnostic burden, and standardize care across borders. By fostering robust international collaboration, advancing targeted educational fellowships, and deploying trustworthy AI, the global pediatric radiology community can actively narrow the alarming gap in pediatric radiological services, ensuring that life-saving diagnostics are accessible to the most vulnerable populations, regardless of geographic or economic boundaries.
IntroductionChildhood disabilities pose a significant risk to maternal mental health. This study aims to compare the mental health of mothers raising children with autism spectrum disorder (ASD) and developmental delays (DD), comparing their stress levels including anxiety and depression with those of mothers of neurotypical (NT) children. MethodA cross-sectional survey of mothers attending Pediatric outpatient Department of TU Teaching Hospital in Kathmandu was conducted immediately post-pandemic. The Hopkins Symptom Checklist-25 (HSCL-25) was used to measure stress including anxiety and depression. Mothers of children with ASD, DD, and NT children, without other comorbid health conditions were included in the study. ResultsOf the total 150 participant mothers, 34 (22.6%) were mothers of children with ASD, 32 (21.3%) were mothers of children with DD, and 84 (54.6%) were mothers of NT children. More than half of the mothers with children with ASD and DD were found to have stress including anxiety and depression, as compared to 9.5% of the mothers with NT children. Mothers of children with ASD had significantly higher odds of stress (OR 15.7; 95% CI: 5.6–44.1; p < 0.01). Similarly, mothers of children with DD also showed higher odds of stress (OR 11; 95% CI: 3.9–31.1; p < 0.01). Maternal education was identified as an important predictor of stress. Higher stress level was observed among mothers of children with ASD who had education below the 10th grade, with an odds ratio of 7 (95% CI: 0.75–65.2). ConclusionThere is high level of anxiety and depression in mothers with children with ASD and DD as compared to mothers with NT children.
IntroductionCandida species are the most common cause of mycosis, especially among patients who are immunocompromised, receiving broad spectrum antimicrobial therapy and/or chemotherapy, hospitalized and with diabetes mellitus. The increasing cases of Candida infection by its different species is a subject of concern because each species possess different characteristics features to fail the treatment. Thus, speciation and its prevalence is imperative for the management of candidiasis infection.MethodsThis is a laboratory-based cross-sectional descriptive study. A total of 149 isolates of Candida were identified from 16,234 clinical specimens and those specimens were processed at Department of Microbiology, Tribhuvan University Teaching Hospital. Growth on Sabouraud dextrose agar were evaluated for colony appearance, germ tube test, chlamydospore formation on corn meal agar and Candida speciation from CHROMagar. Data were analyzed using descriptive statistics and all the statistical evaluation were done by using SPSS version 16.0 software.ResultsC. albicans was the most common isolate out of 149 Candida spp. which was 53.70% of total isolates. Similarly, among NAC species C. tropicalis was the most common isolate followed by C. krusei, C. dubliniensis, C. parapsilosis and C. glabrata. The study revealed that the prevalence of isolates is 0.92% in overall specimens.ConclusionAlthough C. albicans is the most common isolate of Candida spp., NAC species infection is increasing especially in case of urine and blood stream infection.
IntroductionDeath certificate is a medico-legal document required for formulating policies for improving the healthcare system of any nation. Occurrence of errors while filling up these documents has negatively affected on reliability and validity of these pivotal documents.MethodsThis was a cross-sectional study conducted at Gandaki Medical College (GMC), Pokhara. The mortality file records of ICU and ER patients from14th April 2019 to 14th April 2022 were collected. Errors in the death certificates were noted in proforma. The data was entered in Microsoft Excel and further analysis was done by SPSS 16.0. ResultsA total of 139 death certificates were assessed. The occurrence of errors in death certificates was 97.84% (136/139) with the majority of errors i.e.; 82% (112/136) was noted in the immediate cause of death (ICOD) section of the death certificate followed by 79% (108 out of 136) of errors were noted in other significant conditions (OSC) and 74% (101/136) error was noted in the underlying cause of death (UCOD) section. The most frequent error was ‘not reporting the time interval from onset to death’, observed in 99.3% (138/139) of cases followed by the ‘use of abbreviations’ when certifying the cause of death in 64% (89/139) of death certificates.ConclusionThe findings of this study highlight the need for improved education and training of doctors to ensure accurate documentation of death certificates. Regular training programs and workshops may ultimately contribute to improved healthcare policy formulation and decision making based on these findings.
IntroductionCoronary angiography often misjudges intermediate (50-70%) lesions. Fractional flow reserve (FFR) accurately assesses their physiological significance to safely guide revascularization. Addressing limited local evidence, this Nepalese study evaluates role of FFR in determining lesion severity and guiding treatment decisions. MethodsThis quantitative, cross-sectional study evaluated 43 patients with intermediate coronary lesions undergoing coronary angiography (CAG) at the Manmohan Cardiothoracic Vascular and Transplant Centre, Institute of Medicine, over one year. Patients with prior fibrinolytic treatment, connective tissue disorders, or skip lesions were excluded. Initially, revascularization or medical management was planned based on visual CAG stenosis. Next, resting full-cycle ratio (RFR) and FFR were measured. Significant lesions (FFR ≤0.80, RFR ≤0.89) received percutaneous coronary intervention (PCI); others received medical therapy. This study analysed how FFR/RFR altered initial visually-guided treatment plans. ResultsThis study evaluated 43 intermediate coronary lesions (median age 66; 74% male) mostly presenting with chronic coronary syndrome. It compared visually estimated treatment plans after CAG against RFR/FFR-guided management. Visual assessment planned medical therapy for 88% (n=38) and intervention (PCI) for 12% (n=5). Functional assessment altered management strategy in 18 cases, deferring all five initially planned interventions to medical therapy and upgrading 13 medical management cases to revascularization. ConclusionsFunctional assessment (FFR/RFR) prevented suboptimal treatment of intermediate lesions. By altering planned management after CAG, FFR showed a promising role in optimal revascularization for intermediate coronary lesions.
Myxedema coma is a rare endocrine emergency and is often forgotten differential diagnosis in a patient with altered mental status. Despite its rare occurrence, clinical suspicion is needed in any patient with clinical features and biochemical evidence of hypothyroidism. It ideally requires intravenous levothyroxine for treatment. We report a case of 76 year old male, nonsmoker, non-alcohol consumer who presented with acute onset altered mental status and stupor, which was attributed to untreated severe hypothyroidism and successfully treated with oral levothyroxine despite unavailability of its intravenous form.
Introduction Melasma is a common skin condition presenting with symmetric brown pigmentation on sun exposed areas, especially face. Most of the studies in melasma have been focused on females. Few studies in male melasma have revealed lower level of serum testosterone level. This study aimed to describe male melasma in terms of clinical presentation, severity, and relationship with serum testosterone levels. Methods: This was a descriptive study where cases of male melasma were assessed for clinical patterns and severity using modified melasma area severity index(mMASI). The association of severity of melasma with serum testosterone level was determined. Results: Forty-two males with melasma were enrolled in the study. The age ranged from 20 years to 57 years, with a mean age of 32.7±7.5 years. Majority had Fitzpatrick’s skin type IV and malar pattern was predominant. Average time of sun exposure ranged from 30 minutes to 8 hours. mMASI score ranged from 2.40 to 14.90. The association between duration of sun exposure and melasma severity was not statistically significant (p= 0.158). Serum testosterone level was lower than the reference range in 14(33.3%) cases. The association of melasma severity with low serum testosterone level was statistically significant (p= 0.031). Conclusion: This study described an association between melasma severity and low serum testosterone level in men. However, a multicenter case and control study with more detailed epidemiological exploration is needed.
