Thyroid storm is a rare endocrine emergency that rarely presents with septic shock. It occurs inthyrotoxic patients and is manifested by decompensation of multiple organs, triggered by severestress. The diagnosis and response to treatment is made by Burch-Wartofsky point scale or Japanesethyroid association criteria due to lack of pathophysiology of thyroid storm. We reported series ofpatients that presented with altered sensorium, cough, fever, palpitation, shortness of breath andshock. Patient were treated initially for septic shock, later diagnosed as thyroid storm and was treatedwith oral carbimazole, propanolol and digoxin. From this, we want to emphasize that thyroid stormcan have any presentation that should be kept in differential diagnosis of septic shock not respondingto usual treatment; early diagnosis and treatment with oral medication can decrease morbidity andmortality in rural setting where intravenous form of antithyroid drug are not available for thyroidstorm.

Introduction: Nosocomial infection is common due to poor practice of hand hygiene. There is a variation in the level of knowledge of handwashing among different health professionals. Objectives: The aim of the study was to assess the basic knowledge of handwashing among health professionals. Methodology: This cross-sectional study was done in 370 healthcare professionals like doctors, nurses, health assistants of a National medical college. The questionnaire used was adapted from the World Health Organization about hand hygiene knowledge for health professionals. There were 18 questions assessing the basic knowledge and practice of handwashing. The level of hand hygiene knowledge was calculated by dividing the responses into four groups based on score more than 90% as excellent, 75-90% considered as good, 50-74% moderate, and less than 50% considered as low.. All data was transferred to the excel sheet and transferred to a statistical package for the social sciences-17. The result was presented using frequency tables, graphs, and charts. Result: Out of 370 participants, 318(85.9%) were females, and 52(14.1%) males. The mean age was 24.59±4.48 years. Of all the respondents, 24% had low, 30% moderate, 26% good, and 21% had excellent knowledge of hand hygiene. In terms of practice, only 34% had a moderate level of practice of hand hygiene. Conclusion: Regular training and re-training through simulations of hand hygiene will lead to an improvement in the knowledge and practice of handwashing.