CBIMNCI (CB IMNCI) protocol Nepal for Health professionals
CBIMNCI protocol has been one of the driving guideline for treatment of neonatal and childhood illnesses in Nepal.
Here we have uploaded the latest CBIMNCI protocol book in pdf format for your reference.
You can either refer it here or please download for future reference.
Download CBIMNCI (CB IMNCI) protocol
Community based integrated management of childhood and neonatal illness protocol has been developed by government of Nepal, child health division. This protocol has been the main guidelines for Nepal.
There are these protocols and guidelines developed for health care workers in Nepal.
Please use this link for downloading the book in pdf format. These guidelines are updated accordingly to date of this post and updates will be posted subsequently.
Difference between CBIMNCI (CB IMNCI) and CB-IMCI
CBIMCI stands for community based integrated management of childhood illnesses. This guideline is the past form of CBIMNCI.
CBIMNCI was developed with addition of neonatal illnesses guidelines to the childhood illnesses. The main reason for this was that childhood illnesses cannot be separated from neonatal illnesses.
CBIMCI was also derived from IMCI (read below).
Definition of IMCI
IMCI stands for integrated management of childhood illnesses. As the childhood mortality rate in our country were relatively high this must have been addressed quickly and in a economic way. For this, healthcare workers like CMA, HA and volunteers like FCHV needed to be trained and upgraded to manage childhood illnesses.
Gradually, this protocol was update to change into CBIMCI and subsequently into CBIMNCI and FBIMNCI.
IMCI vs IMNCI
The main difference between IMCI and IMNCI is that IMNCI includes neonatal ilnesses.
Lately, IMNCI is updated into FB-IMNCI (Facility based integrated management of childhood and neonatal illnesses )
Tear gas, commonly used in crowd control, consists of chemical irritants such as chloroacetophenone (CN), chlorobenzylidene malononitrile (CS), and dibenzoxazepine (CR). While classified as a “riot control agent,” its effects on human health can be severe, particularly with prolonged or high-concentration exposure.
Here are key risks supported by scientific and medical literature:
1. Respiratory Effects
• Acute Respiratory Distress Syndrome (ARDS): High exposure can lead to severe lung injury and ARDS, particularly in individuals with pre-existing conditions such as asthma or COPD.
• Bronchoconstriction & Asthma Exacerbation: CS gas can trigger acute bronchospasm, posing a significant risk for asthmatics.
• Lung Damage & Chronic Bronchitis: Prolonged exposure may result in chemical pneumonitis and chronic respiratory symptoms (Karagama et al., 2003).
2. Ocular Injuries & Blindness
• Severe Eye Irritation: Tear gas causes lacrimation, conjunctivitis, corneal abrasions, and in some cases, permanent vision impairment (Hu et al., 1989).
• Risk of Secondary Trauma: People often rub their eyes vigorously, leading to corneal damage and infection.
3. Skin Burns & Chemical Dermatitis
• Blister Formation & Irritation: CS and CN can cause second-degree burns, dermatitis, and allergic skin reactions (CDC, 2018).
• Delayed Hypersensitivity Reactions: Some individuals develop long-term skin sensitivity to tear gas chemicals.
4. Neurological & Psychological Effects
• Seizures & Nerve Damage: Reports suggest potential neurotoxicity with repeated exposure, including seizures in susceptible individuals (Papirmeister et al., 1991).
• PTSD & Anxiety Disorders: Tear gas exposure during stressful events has been linked to increased rates of PTSD, panic attacks, and acute stress reactions (Chorley et al., 2021).
5. Cardiovascular Risks
• Hypertension & Cardiac Events: Tear gas can increase blood pressure and heart rate, posing a risk for individuals with heart disease (Schep et al., 2015).
• Increased Risk of Heart Attacks: The sympathetic nervous system activation triggered by tear gas can induce myocardial infarction in vulnerable individuals.
6. Reproductive & Developmental Toxicity
• Increased Miscarriage Risk: Exposure to tear gas has been associated with miscarriages and menstrual irregularities in some studies (Karam et al., 2020).
• Potential Teratogenic Effects: Although data is limited, animal studies suggest possible fetal toxicity with prolonged exposure.
7. Long-Term Pulmonary & Systemic Effects
• Pulmonary Fibrosis & Chronic Lung Disease: Persistent exposure may lead to lung fibrosis, similar to occupational chemical exposures (Weisenburger et al., 2020).
• Potential Carcinogenicity: Some solvents used in tear gas formulations have been linked to DNA damage, though direct human studies are lacking.
Conclusion
Tear gas is not a harmless deterrent; it poses significant acute and chronic health risks, particularly for vulnerable populations (children, elderly, and those with pre-existing conditions). Its use in enclosed spaces or at high concentrations greatly increases risks of severe respiratory, ocular, and systemic effects.
Model MCQs for Nepal Government 8th Level Medical Officer Exam
General Medicine
Which of the following is NOT a common cause of Chronic Obstructive Pulmonary Disease (COPD)? a) Smoking b) Air pollution c) Alpha-1 antitrypsin deficiency d) Tuberculosis
A patient presents with fever, murmur, and Janeway lesions. What is the most likely diagnosis? a) Myocardial infarction b) Rheumatic heart disease c) Infective endocarditis d) Pericarditis
Which investigation is most specific for diagnosing Hepatitis B infection? a) ALT/AST ratio b) HBsAg c) Anti-HBc IgM d) Anti-HAV IgM
What is the most common type of anemia worldwide? a) Megaloblastic anemia b) Iron deficiency anemia c) Aplastic anemia d) Sickle cell anemia
Which neurological condition is characterized by resting tremor, rigidity, and bradykinesia? a) Multiple sclerosis b) Parkinson’s disease c) Myasthenia gravis d) Guillain-Barré syndrome
General Surgery
The most common cause of acute appendicitis is: a) Fecalith obstruction b) Intestinal tuberculosis c) Volvulus d) Hernia
Which is a common complication of deep vein thrombosis (DVT)? a) Pulmonary embolism b) Myocardial infarction c) Stroke d) Peripheral artery disease
The first-line management for pneumothorax in a hemodynamically stable patient is: a) Chest tube insertion b) Needle decompression c) Oxygen therapy d) Observation
Which condition is characterized by sudden onset of severe scrotal pain and absent cremasteric reflex? a) Testicular torsion b) Epididymitis c) Hydrocele d) Varicocele
Which of the following is the best initial investigation for breast carcinoma? a) Mammography b) FNAC c) MRI d) Ultrasound
Obstetrics and Gynecology
A patient at 32 weeks gestation presents with painless vaginal bleeding. The most likely diagnosis is: a) Placenta previa b) Abruptio placentae c) Ectopic pregnancy d) Uterine rupture
Which of the following is NOT a risk factor for ectopic pregnancy? a) Pelvic inflammatory disease b) Previous ectopic pregnancy c) In vitro fertilization d) Multiparity
Nonspecific urethritis (NSU) is urethral inflammation not caused by Neisseria gonorrhoeae. It is usually due to other bacterial, viral, or non-infectious causes. This article has PSC Nepal focused notes on Nonspecific urethritis (NSU).
Etiology:
Infectious Causes:
Chlamydia trachomatis (most common)
Mycoplasma genitalium
Ureaplasma urealyticum
Trichomonas vaginalis
Herpes simplex virus (HSV)
Adenoviruses
Non-infectious Causes:
Chemical irritants (e.g., soaps, spermicides)
Trauma (e.g., catheterization, vigorous sexual activity)
Risk Factors:
Unprotected sexual intercourse
Multiple sexual partners
History of sexually transmitted infections (STIs)
Poor genital hygiene
Clinical Features:
Urethral discharge (clear, mucoid, or purulent)
Dysuria (burning sensation while urinating)
Urethral pruritus or discomfort
Possible hematuria (rare)
Symptoms may be mild or asymptomatic in some cases
Diagnosis:
Clinical Diagnosis: Based on symptoms and exclusion of gonorrhea
Laboratory Tests:
Urinalysis (pyuria without bacteriuria)
Gram stain of urethral discharge (absence of intracellular diplococci)
Nucleic Acid Amplification Test (NAAT) for Chlamydia trachomatis and Mycoplasma genitalium
Culture for Ureaplasma and Mycoplasma (if available)
Differential Diagnosis:
Gonococcal urethritis
Prostatitis
Cystitis
Epididymitis
Management:
Empirical Antibiotic Therapy:
First-line:
Azithromycin 1g single dose OR
Doxycycline 100mg BID for 7 days
Alternative:
Moxifloxacin 400mg daily for 7-14 days (if M. genitalium is suspected and resistant to doxycycline)
Adjunct Measures:
Avoid sexual intercourse until symptoms resolve and treatment is completed
Partner notification and treatment (to prevent reinfection)
a. Occurs typically usually after breech delivery of smaller babies
b. Is due to injury of C5 and C6 nerve roots
c. All fingers muscles are paralysed
d. There may be unilateral Horner’s syndrome
Ans: ‘b’
Solution
Explanation: Injury to upper trunk of Brachial plexus (C5, C6, C7) leads t60 Erb’s palsy.
Erb’s palsy
❖ Brachial plexus may be injured when person falls from a height on the side of head and shoulder whereby the nerves of the plexus are violently stretched. (upper trunk of the plexus injured).
Clinical features of Erb’s Palsy
Paralysis of Ms Deltoid, biceps, brachialis, intraspinatus and spinator.
The position of limb is characteristic i.e., the arm hanges by the side medially rotated and the forearm is extended and pronated (Policeman’s tip)
Weakness of proximal upper limb muscles
Loss of sensation in area supplied by c5,6,7 dermatome distribution
Klumpke’s Paralysis
Cause (pathoanatomy) of Klumpke’s Paralysis
Klumpke’s paralysis caused by injury in lower trunk of brachial plexus (C8, T1) characterized by paralysis of intrinsic hand Ms & C8/T1 dermatome distribution numbness.
Clinical features of Klumpke’s Paralysis
Clinically Klumpke’s Paralysis has following features
Weakness of distal muscle of upper limbs
Wasting of forearm muscles
Flexion of wrist (wrist drop)
Clawing of hand
Numbing/loss of sensation of c8 and t1 distribution
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