Uterine inversion secondary to uterine pathology is a rare scenario that a gynecologist encounters. Unlike puerperal uterine inversion, it is misleading and may not always be possible to reduce to normal position without surgery. We report a case of a 35-year female with per vaginal bleeding for fifteen months with a mass-like sensation in the vaginal canal. She presented in shock and had a globular mass in the vaginal canal with the indistinct cervical os. She was resuscitated with blood transfusions and intravenous fluid. She was posted for emergency surgery where myomectomy was done vaginally, and finally, Haultain’s procedure was carried out. The uterus was preserved.

Background: Sepsis is a common problem encountered in the emergency room which needs to be intervened early. Predicting prognosis is always a difficult task in busy emergency rooms using present scores, which has several variables to calculate. Red cell distribution width (RDW) is an easy, cheap, and efficacious score to predict the severity and mortality of patients with sepsis. Methods: This prospective analytical study was conducted in the emergency room of Tribhuvan University Teaching Hospital among the patients age ≥ 16 years and with a clinical diagnosis of sepsis using qSOFA score. 148 patients were analyzed in the study by using a non-probability purposive sampling method. Results: RDW has fair efficacy to predict the mortality in sepsis (Area under the Curve of 0.734; 95% C. I = 0.649-0.818; p-value = 0.000) as APACHE II (AUC of 0.728; 95% C. I = 0.637 to 0.819; p-value = 0.000) or SOFA (AUC of 0.680, 95% C. I = 0.591-0.770; p-value = 0.001). Youden Index was maximum (37%) at RDW value 14.75, which has a sensitivity of 83% (positive likelihood ratio = 1.81) and specificity of 54% (negative likelihood ratio = 0.32). Out of 44 patients with septic shock 16 died (36.4%) and among 104 patients without septic shock, 24 died (22.9%) which had the odds ratio of 0.713 (p = 0.555, 95% C. I = 0.231-2.194). Overall mortality was 27.02% (n = 40). RDW group analysis showed no mortality in RDW < 13.1 group, 3.6% mortality in 13.1 to 14 RDW group, 22.0% mortality in 14 to > 15.6 RDW group and 45.9% mortality in > 15.6 RDW group. Significant mortality difference was seen in 14 to > 15.6 and > 15.6 RDW subgroups with a p-value of 0.003 and 0.008 respectively. Conclusion: Area under the curve value for RDW is fair enough to predict the mortality of patients with sepsis in the emergency room. It can be integrated with other severity scores (APACHE II or SOFA score) for better prediction of prognosis of septic patients.

Background. Workplace is associated with exposure to various products, which can be associated with adverse health outcomes. It is true with underground construction work. This study calculated the prevalence of common health problems among Nepalese underground construction workers in comparison to heavy construction workers. This type of study is rare in the context of Nepal and other developing countries, and we hope that the findings will help to take precautions for the prevention of these conditions. Method. It was a retrospective study based on the clinical record of outpatient cases and general health checkups of all Nepalese workers available at the Project clinic, Upper Tamakoshi Hydroelectric Project, Gongar, Bigu, Dolakha. We studied three hundred and ninety-eight workers. We used multipurpose analysis and conducted the Chi-square test and calculated correlations and odds ratios. Results. Two hundred and sixteen (54.3%) participants worked inside the tunnel, and 182 (43.2%) participants worked outside the tunnel. Respiratory disease, mainly upper respiratory tract infection (URTI) (23.4%), is the most common presentation among construction workers followed by injuries (16.7%). Injuries and hypertension were significantly higher in inside the tunnel workers, and acute gastroenteritis was significantly ( p value <0.05) higher in outside the tunnel workers. Increasing age increased the chance of hypertension and cutaneous fungal infection among construction workers. Further studies are required for the analysis of risk factors associated with these health conditions. Conclusion. Respiratory problems are the most common health problem in underground construction workers; however, injuries and hypertension were significantly higher in tunnel workers. Acute gastroenteritis was significantly higher among outside the tunnel workers. Workplace safety should be the priority of every construction site, especially focusing to prevent respiratory problems, injuries, and accidents.

Introduction: Breech delivery has always been matter of interest in obstetrics. Cesarean breech delivery has been preferred method of delivery. We aim to find out any differences in outcome between vaginal breech delivery and cesarean breech delivery in our setup. Methods: Data were collected from record book of Department of Gynaecology and obstetrics, Pokhara Academy of Health Sciences, Kaski, Nepal. Pregnant with breech presentation who had delivery in the centre from 2074 Baishak to 2074 chaitra were enrolled in the study. Data of 174 patients were analysed among which 74 underwent vaginal delivery for breech and 110 underwent cesarean breech delivery. Results: Only 1 (1.6%) of newborn delivered by vaginal route were admitted to NCU vs 17 (15.5% )in cesarean group which was significant (odds ratio= 0.071, 95% C.I 0.009-0.574; p= 0.004). There was only one death of newborn which was delivered by vaginal route. Mean APGAR score at 1 and 5 minute in vaginal breech delivery was 6 and 7 and in cesarean breech delivery was 6 and 8. Conclusions: Though perinatal morbidity was more with cesarean breech delivery but further study with more sample size is needed before reaching conclusion.

BackgroundSepsis is common problem encountered in emergency room which needs to be intervened early.Predicting prognosis is always a difficult task in busy emergency room using present scores which has numbers of variables to calculate. Red cell distribution width (RDW) is easy, cheap and efficacious score to predict severity and mortality of patients with sepsis. MethodThis prospective analytical study was conducted in emergency room of Tribhuvan University Teaching Hospital among patients of age ≥16 years with clinical diagnosis of sepsis using qSOFA score. 148 patients were analyzed in study by using nonprobability purposive sampling method. ResultRDW is more efficacious test to predict mortality in sepsis (Area under the Curve of 0.734; 95% C. I= 0.649-0.818) than APACHE II (AUC of 0.728; 95% C. I= 0.637 to 0.819) or SOFA (AUC of 0.680, 95% C.I =0.591-0.770). Cutoff of RDW 15.05 has sensitivity of 73% (positive likelihood ratio 1.82) and specificity of 60% (negative likelihood ratio 0.45) while cutoff of RDW 16.1 has Sensitivity of 56% (PLR 2.07) and specificity of 73% (NLR 0.6). Out of 44 patients with septic shock 16 died (36.4%) and among 104 patients without septic shock,24 died (22.9%) with odds ratio of 0.713 (p=0.555, 95% C. I= 0.231-2.194). Overall mortality was 27.02% (n=40). RDW subgroup analysis showed no mortality in low RDW (<13.1) subgroup, 3.6% mortality in moderate (13.1 to 14) RDW group, 22.0% mortality in high (14 to >15.6) RDW group and 45.9% mortality in very high (>15.6) RDW group. Significant mortality difference seen in high and very high RDW subgroup with p value 0.003 and 0.008 respectively. ConclusionRDW is more efficacious test to predict mortality in sepsis than APACHE II or SOFA. Cutoff of RDW 15.05 has sensitivity of 73% and specificity of 60%. So RDW can be used as a good prognostic score to predict severity and mortality of patients with sepsis in emergency room.