Category: Uncategorized

A day out with Swayambhu and White Gumba Kathmandu Nepal (places to go near kathmandu)

Swayammbhunath swayambhu pictures

Swoyambhu stupa buddha statue

The gate

Kathmandu city from swoyambhu siphal

The sky

Sitting in front of monastry gate

White gumba seto gumba, white monastry pictures

Mahadev temple gate

A ride white gumba

Monastery gate

Yuca fries: How to make them 2023?

Yuka fries cassava fries french fries alternative

 

Introduction to yuka

Types of Yuka recipe

Steps of making yuka fries recipe

Yucca fries, also known as cassava fries, are a delicious and crispy alternative to traditional potato fries. Here are the steps to make yucca fries:

raw yuka before making yuka fries

Ingredients:

1. One large yucca root (cassava)
2. Vegetable oil, for frying
3. Salt, to taste
4. Optional: any preferred seasoning or spices (e.g., paprika, garlic powder, etc.)

 

Instructions:

 

1. Peel the yucca: Start by cutting off the ends of the yucca root with a sharp knife. Then, use a vegetable peeler or a knife to remove the thick, waxy skin from the yucca. Make sure to remove all the brown outer layer to reveal the white flesh inside.
2. Cut the yucca into fry shapes: Slice the yucca root in half lengthwise, and then cut each half into long, thin strips, just like you would cut regular potato fries. You can adjust the thickness according to your preference, but aim for relatively uniform sizes to ensure even cooking.
3. Boil the yucca: Fill a large pot with water and bring it to a boil. Add the yucca fries to the boiling water and cook for about 5-7 minutes until they are partially cooked but still firm. This step helps to soften the yucca and speeds up the frying process.
4. Drain and cool: Drain the partially cooked yucca fries in a colander and let them cool down for a few minutes. This will help remove excess moisture from the surface, making them crispier when fried.
5. Preheat the oil: In a deep fryer or a large, heavy-bottomed pot, add enough vegetable oil to submerge the yucca fries completely. Preheat the oil to around 350°F (175°C). If you don’t have a thermometer, you can test the oil readiness by adding a small piece of yucca; it should sizzle immediately without burning.

    

   Yuca fries french fries

    

6. Fry the yucca: Carefully add the yucca fries to the hot oil in batches to avoid overcrowding the fryer. Fry them for about 3-5 minutes or until they turn golden brown and crispy. Stir them occasionally during frying to ensure even cooking.
7. Drain and season: Using a slotted spoon, remove the fried yucca fries from the oil and place them on a plate lined with paper towels to drain any excess oil. Immediately sprinkle them with salt and any other desired seasoning while they are still hot.
8. Serve and enjoy: Yucca fries are best enjoyed immediately while they are still hot and crispy. Serve them as a delicious side dish or a snack, and optionally pair them with your favorite dipping sauce or salsa.

Enjoy your homemade yucca fries!

Nutritional values off yuca fries

Introduction:

If you’re looking for a healthy and tasty alternative to potatoes, yuca or cassava might be just what you need. This starchy root vegetable, also known as manioc, is a staple food in many parts of the world, from South America and Africa to Asia and the Caribbean. But is yuca or cassava healthy? And what are some of the most popular ways to cook and serve it? Let’s find out.

cassava or yuka

Is Yuca or Cassava Healthy?

Yuca or cassava is a great source of carbohydrates, fiber, and various vitamins and minerals. Here are some of the health benefits of this versatile root vegetable:

• Yuca or cassava is rich in resistant starch, which can improve digestive health, lower blood sugar levels, and promote satiety and weight loss.
• Yuca or cassava is a good source of vitamin C, which can boost immunity, collagen production, and iron absorption.
• Yuca or cassava is a decent source of potassium, which can regulate blood pressure, fluid balance, and muscle function.
• Yuca or cassava is low in fat and cholesterol, which can benefit heart health and overall health.

However, it’s worth noting that yuca or cassava also contains cyanide, a toxic substance that can cause poisoning if consumed in large amounts. To avoid this risk, make sure to peel and cook yuca or cassava properly before eating it.

Pneumonia and respiratory infection  illness

DEFINITION: 

chest anatomy

Pneumonia is an infection of the pulmonary parenchyma

How to get covid card

Factors that predispose to pneumonia 

• Cigarette smoking 
• Upper respiratory tract infections 
• Alcohol 
• Corticosteroid therapy 
• Old age 
• Recent influenza infection 
• Pre-existing lung disease 
• HIV 
• Indoor air pollution 

Classification: setting in which the person has contracted their infection

Community-acquired pneumonia (CAP) definition :

   It   occurs  outside hospital setting or less than 48 hours after admission

Hospital-acquired pneumonia (HAP):

       Hospital-acquired or nosocomial pneumonia refers to a new episode of pneumonia occurring at least 2 days after admission to hospital. 

Contd…

Health care-associated pneumonia (HCAP) :

      refers to the development of pneumonia in a person who has spent at least 2 days in hospital within the last 90 days, attended a haemodialysis unit, received intravenous antibiotics, or been resident in a nursing home or other long-term care facility. 

Immunocompromised host :

Neutropenic, HIV +, Cancer,Mycobacterium tuberculosis, Pneumocystis jiroveci ,Immunosuppressives  

Classification by site of pneumonia

Lobar pnemonia :

Infection can be localized with the whole of one or more lobes affected. >90% of the cases is due to Strep.pneumoniae

Interstitial Pneumonia

Inflammation confined to interalveolar septa

Mycoplasma pneumoniae, Pneumocystis jiroveci

Bronchopnemonia:

often due to infection centred on the bronchi and bronchioles

Staphylococcal pneumonia

CLASSIFICATION BY ETIOLOGY

• PRIMARY PNEUMONIA (due to specific pathogenic organism)

Common: 

• Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus

Less common:

• Klebsiella pneumoniae, Strep pyogenes, Pseudomonas aeruginosa, Virus: H1N1 Influenza Virus, Corona Virus

 ATYPICAL PNEUMONIA)**

**Mycoplasma pneumoniae, Legionella, Chlamydophila, and Coxiella burnetii

2. SECONDARY PNEUMONIA

(absence of any specific pathogenic organism in sputum and presence of some pre-existing abnormality of respiratory system)

• Aspiration of pus from nasal sinuses
• Vomitus
• Aspiration of gastric contents in GERD
• Inhalation of septic matter during procedures like dental extraction
• Community-acquired pneumonia (CAP) 
• World-wide, CAP continues to kill more children than any other illness. 
• Most cases are spread by droplet infection
•  Strep. pneumoniae  remains the most common infecting agent
• Viral infections are an important cause of CAP in children 

Clinical features of CAP

The clinical presentation varies according to the immune state of the patient and the infecting agent.

Cough: In pneumococcal pneumonia, sputum is characteristically rust-coloured. 

 Breathlessness: Coarse crackles are often heard on auscultation,  Bronchial breath sounds may be heard over areas of consolidated lung.

 Fever: this can be as high as 39.5–40°C. If swinging fevers are present this often indicates empyema 

Clinical features

Chest pain: this is commonly pleuritic in nature. A pleural rub may be heard early on in the illness.

Extrapulmonary features : 

Haemolysis due to cold agglutinins occurs (in approximately 50% cases of Mycoplasma pneumonia). Thrombocytopenia is relatively common.

Other features: in the elderly, CAP can present with confusion or nonspecific symptoms such as recurrent fall.

Initial Assessment

INVESTIGATIONS

1. CBC and DLC: Leucocytosis suggests bacterial pneumonia. In viral and atypical pneumonias, total leucocyte count is often less 5000/m3.
2. CRP levels are raised.
3. Blood culture: Recommended only in hospitalized patients, particularly in case of pneumococcal pneumonia
4. Respiratory secretions: Do Gram Stain and Ziehl Neelsen Stain. Culture and Sensitivity.
5. Pulse oximetry and arterial blood gas analysis is necessary if oxygen saturation is below 94%.
6. HIV testing: since pneumonia is a common initial presenting illness 

Investigations for pnneumonia

Chest x-ray

Strep. Pneumoniae : Consolidation with air bronchograms, effusions and collapse can  be seen. Radiological abnormalities can lag behind clinical signs. 

     Repeat a normal chest X-ray where CAP is suspected

Mycoplasma. Usually one lobe is involved but infection

    can be bilateral and extensive.

Legionella: There is lobar and then multi-lobar  shadowing

 Radiological examination is helpful if a complication such as parapneumonic effusion, intrapulmonary abscess formation or empyema is suspected. 

General management of pneumonia

Oxygen :Supplemental oxygen should be administered to maintain saturations between 94% and 98%

Intravenous fluids : Required in hypotensive patients

     showing any evidence of volume depletion.

Thromboprophylaxis. If admitted for >12 hours

 Physiotherapy: Chest physiotherapy is not needed unless sputum retension

Nutritional supplementation:

Analgesics : paracetamol ,  Non steroidal anti-inflammatory medication helps treat pleuritic pain, thereby reducing the risk of further complication

Management continued

Antibiotics. The first dose of antibiotic should be

     administered within 4 hours of presentation 

– Parenteral antibiotics should be switched to oral once

      the temperature has settled for a period of 24 hours

MANANGEMENT: ANTIBIOTICS

COMPLICATIONS OF PNEUMONIA

• Para-pneumonic effusion-common 
• Empyema
• Retention of sputum causing lobar collapse 
• Development of thromboembolic disease 
• Pneumothorax-particularly with Staph. aureus 
• Suppurative pneumonia/lung abscess
• ARDS, renal failure, multi-organ failure 
• Hepatitis, pericarditis, myocarditis, meningoencephalitis 

Prevention of further episodes

• Smoking cessation advice and support

Influenza vaccination is recommended to those at high risk of mortality from influenza or pneumonia

All patients over the age of 65 who have not previously been vaccinated and are admitted with CAP should have the pneumococcal vaccine before discharge 

Pneumonia MCQs

Dr Chaitanya

1

Most common symptom of the respiratory disease is?

1. a) Wheeze
2. b) Cough
3. c) Fever
4. d) Hemoptysis

Ans:

B cough

2

Common sound heard on auscultation in pneumonia is

1. • Rales
2. • Ronchi
3. • Wheeze
4. • Crackles

crackles

3

An old man comes to u with complaint of fever for 4 days and cough associated with chills. On examination the patient is in respiratory distress and AND HAS HIGH GRADE FEVER OF 104 DEGREE FAHRENHEIT.  The most possible diagnosis is

1. • COPD
2. • PTB
3. • Bronchial asthma
4. • Pneumonia

Pneumonia

4

A pus sample is called purulent if

Pneumonia depiction

1. • Pus cells > 25 and epithelial cells < 10
2. • Pus cells > 15 and epithelial cells < 5
3. • Pus cells > 30 and epithelial cells < 10
4. • Pus cells > 20 and epithelial cells < 5

A. Pus cells > 25 and epithelial cells < 10

5

A patient who is known case of COPD under medication has complained of increased shortness of breath. He said that he could walk on plane level with his friends easily but now he needs to take break every 100 m or so due to shortness of breath. What is the mMRC grade of SOB for this patient?

1. 1
2. 2
3. 3
4. 4
5. 0

3

6 Difficulty in breathing is called

1. Dyspnoea
2. Orthopnoea
3. Tachypnoea
4. Apnoea

Dyspnoea

7

Which organism causes the so called walking pneumonia (Hint: atypical pneumonia)

1. Streptococcus
2. Klebsiella
3. H1n1
4. SARS-CoV2
5. Mycoplasma

Mycoplasma

8

HAP is called if symptoms/diagnosis

1. Within 2 days of admission
2. After 48 hours of admission
3. 2 days of admission to 2 days of discharge
4. If patient admitted to ICU

2 days of admission to 2 days of discharge

9

Common causative agent for congenital or neonatal oneumonia is

1. H. influenziae
2. Chlamydia pneumoniae
3. Streptococcus pneumoniae
4. Broup B streptococcus

Gr. B strep

10

In CURB 65 scoring B stands for

1. Blood urea nitrogen
2. Blood count
3. Blood pressure 
4. Breathing

Blood pressure ( sys<90 or dias <60)

11

Lung abscess following pneumonia is caused by

1. Staphylococcus
2. Streptococcus
3. Pneumocystis
4. Coronavirus

Staphylococcus

12

Antibiotic of choice for CAP in OPD setting is

1. Amoxycillin
2. Ciprofloxacin
3. Metronidazole
4. Doxycycline

Amoxycillin

13

Pneumothorax is

1. Hyperexpansion of lungs
2. Air in thoracic cavity
3. No breathing by lungs
4. Lung mixed with ait

Air in thoracic cavity

14

Your patient has BP of 130/90 mm of Hg. What is his MAP

1. 103
2. 101
3. 109
4. 122

What is his pulse pressure in above case

1. 103
2. 40
3. 20
4. 90

103 and 40

Thank you

Mycoplasma pneumonia : The dangerous walking talking pneumonia

Introduction

Mycoplasma pneumonia is a common cause of respiratory tract infections in
adolescents. It can present with fever, cough, and infiltrates on chest X-ray.
In some cases, mycoplasma infection can also cause skin manifestations such as
vesicles or blisters.

Presenting symtoms of mycoplasma pneumonia

The patient is presenting with symptoms suggestive of Mycoplasma pneumonia,
including fever, cough, and infiltrates on chest X-ray. The presence of
vesicles or blisters on the skin further supports the possibility of
Mycoplasma-induced skin manifestations.

57.Following drugs are effective against Mycoplasma pneumoniae except:

a. Clarithromycin

c. Amoxycillin

b. Rifampicin

d. Doxycycline

T

Ans: ‘c’

Solution

Mycoplasma pneumoniae lacks cell wall. Bacterial membrane contains sterol for stability.

Antimicrobial activity of Amoxycillin is via inhibition of cell wall synthesis which has no role in Mycoplasma.

Penicillin ineffective since mycoplasma have no cell wall.

Treatment (Mycoplasma)

Macrolides

Doxycycline or

Fluoroquinolone

3

MOA

Macrolides

Clarithromycin

Azithromycion

inhibit protein synthesis by blocking translocation: blinds to 23srRNA of 50s ribosomal subunit

Bacteriostatic

Tetracyclines

Tetracycline

Doxycycline

Bind to 30S & prevent attachment of aminoacyl-t RNA Bacteriostatic

Rifamycin

Rifampin

Inhibit DNA dependent RNA polymerase

Rifabutin

Fluroquinolones

Ciprofloxacin

Norfloxacin

Levofloxacin

Inhibit prokaryotic

enzymes topo isomerase II (DNA gyrase) & topoisomerase IV.

FAQs:

1. Can Mycoplasma pneumonia cause skin manifestations? 

Yes, in some cases, Mycoplasma pneumonia can cause skin manifestations such as
vesicles or blisters.

2. How is Mycoplasma pneumonia diagnosed? 

Mycoplasma pneumonia can be diagnosed through serological testing for
Mycoplasma antibodies or PCR testing for Mycoplasma DNA in respiratory
samples.

3. What is the treatment for Mycoplasma pneumonia? 

The treatment for Mycoplasma pneumonia involves the use of antibiotics such as
macrolides or tetracyclines.

4. Is Mycoplasma pneumonia contagious? 

Yes, Mycoplasma pneumonia is contagious and can spread through respiratory
droplets.

5. Can Mycoplasma pneumonia cause complications? 

Yes, Mycoplasma pneumonia can lead to complications such as pneumonia,
bronchitis, or ear infections.

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How to read chest X ray : a systematic approach guide for everyone

How to read chest X ray

How to read chest X ray

Urinary tract infections and calculus UTI and renal stones (nepphrolithiasis), bladder stones 

Introduction to UTI

A urinary tract infection (UTI) is an infection in any part of the urinary system, which includes the kidneys, ureters, bladder, and urethra. Most infections involve the lower urinary tract, specifically the bladder and urethra. UTIs are typically caused by bacteria, most commonly Escherichia coli (E. coli), that enter the urinary tract through the urethra and begin to multiply in the bladder. 

Symptoms of uti

Symptoms of a UTI can include a strong, persistent urge to urinate, a burning sensation when urinating, passing frequent, small amounts of urine, urine that appears cloudy, or urine that has a strong odor. If the infection spreads to the kidneys, it can cause more severe symptoms, including fever, back pain, and nausea.

Treatment of UTI

UTIs are more common in women than in men, and they can usually be treated effectively with antibiotics.

Introduction to Nephrolithiasis

Nephrolithiasis, commonly known as kidney stones, refers to the formation of hard mineral and salt deposits in the kidneys. These stones can vary in size and may develop when urine becomes concentrated, allowing minerals to crystallize and stick together. 

Treatment of kidney stones

Treatment for nephrolithiasis depends on the size and type of stone. Smaller stones may pass on their own with increased fluid intake and pain management, while larger stones may require medical intervention, such as extracorporeal shock wave lithotripsy (ESWL) to break the stone into smaller pieces, or surgical removal. Preventative measures often include dietary adjustments and medications to reduce the risk of recurrence.

See the complete powerpoint presentation here. 

See UTI and Dysuria Home remedy here

Introduction of urethral dilation in female: 30 causes of painful intercourse

female genitourinary system

Anatomy of female urethra

Female urinary system anatomy

Indications of urethral dilation : an introduction

Sex after female urethra dilation

Sexual intercourse after female urrthra dilatation may become difficult rarely. Difficult or painful sexual intercourse is called dysparaunia and it may have several other causes including vaginal infection, dry vagina and many more listed as below. 

Read this also: Vitamin D and role of kidney in it

Causes of painful sexual intercourse

Painful sexual intercourse or dyspareunia can be because of external genital problems to internal vaginal, uterine or pelvic disorders. Urethra also being near vagina can be the reason for dyspareunia where as other nearby organs and structures can also be part of it. It is also called genitopelvic pain. The causes of painful intercourse can be listed as below:

1. Vulvovaginal atrophy 
2. Endometriosis
3. Physical assault
4. Sexual assaults
5. Emotional and mental trauma
6. Abuse
7. Gastrointestinal causes
8. Constipation
9. Vulvar skin atrophy
10. Vulvar cancer
11. Lichen
12. Condyloma, HPV
13. Fibromyalgia
14. Musculoskeletal
15. Vulvodynia
16. Vaginismus
17. Vestibulodynia
18. Vulvitis
19. Vaginitis
20. Adenomyosis
21. Uterine fibroids
22. PID /infection
23. Pelvic adhesive disease
24. Ovarian mass
25. Diabetes
26. Thyroid disorders
27. Vitamin deficiency
28. Hormone imbalance (estrogen, progesterone)
29. Cancers

Anatomy of female urinary system

Extreme female urethra dilation

This will be done in case of following indications

1. Severe structure 
2. Recurring stricture
3. Severe trauma
4. Bladder infections
5. Prostate problems
6. Uncured symptoms despite previous procedure
7. Risk of need for repeated procedure
8. Co-morbidities

When to visit a doctor after urethra dilation?

1. Retention
2. Hesitant
3. Urgency
4. Dribbling
5. Dysuria
6. Frequency
7. Nocturia
8. Intermittent stream
9. Incomplete urination
10. Painful sexual intercourse
11. Vaginal discharge
12. Foul smelling urine
13. Urine color change
14. Abdominal pain
15. Fever and weakness
16. Leakage of urine

Left kidney sketch

Female sexual dysfunction/disorders list

Lecture on Aseptic Meningitis (Viral Meningitis) lecture 2025

Aseptic Meningitis (Viral Meningitis)

Definition of aseptic meningitis:

• The clinical course is less fulminant than in pyogenic
  meningitis.  
• In contrast to pyogenic meningitis, examination of the CSF often shows
  lymphocytosis, moderate protein elevation, and a normal glucose
  level. 
• The disease typically is self-limiting

Causes and causative agents of viral meningitis

Shock and Burn Powerpoint PPT : Loksewa, NMCLE, NNC, NHPC and MDMS MEC

Introduction

Introduction to BURN 

Parkland Formula:

$4\text{mL}\times \text{body weight (kg)}\times \text{\% TBSA burned}$

Shock and Burn PPT

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Bluish tinge to lips or fingernails (or gray in the case of dark complexions)
Rapid pulse
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Nausea or vomiting
Enlarged pupils
Weakness or fatigue
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Cardiogenic Shock
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Anaphylatic Shock
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Radiation burn: X-rays, Gamma rays”
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Third degree – Full thickness
Fourth degree”
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Do not rupture blister.
TT injection
First-degree burns:
Run cool water over the burn. Don’t apply ice. For sunburns, apply aloe vera gel. For thermal burns, apply antibiotic cream and cover lightly with gauze. You can also take over-the-counter pain medication.
Second-degree burns:
Treatment for second- and first-degree burns is similar.
Stronger antibiotic – such as silver sulfadiazine, to kill bacteria
Elevating the burned area can reduce pain and swelling.
May need dressing to be applied
Third-degree burns:
Third-degree burns can be life-threatening and often require skin grafts. Skin grafts replace damaged tissue with healthy skin from another of the uninjured part of the person’s body.”
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