Objective: Refractory status epilepticus is a serious condition in which seizure continues despite use of two antiepileptic medications. Retrospective studies have shown that 29%-43% of SE patients progress into RSE despite treatment. Mortality following RSE is high. We aimed to evaluate the predictors of outcome in patients with RSE at a tertiary care center. Methods: Sixty-eight consecutive patients with RSE who presented to our hospital between February 2018 and January 2020 were evaluated for outcome. Result: In our study 28(41.2%), patients who failed to respond to first-and secondline antiepileptic drug responded to the third-line antiepileptic drug thus avoiding mechanical ventilation and intravenous anesthesia. Low GCS at admission (P < .001), need for mechanical ventilation and intravenous anesthesia (P = .018), and long duration of RSE before recovery (P = .035) were strongly associated with worse outcome. Duration of RSE before starting treatment (P = .147), previous history of seizure (P = .717), and age of the patient (P = .319) did not influence the outcome. Significance: In our study, we prospectively evaluated patients with RSE and followed them for one month after discharge from the hospital. Unlike some of the previous studies, we identified an interesting finding whereby a significant proportion of the patients responded to the third-line antiepileptic drug and thus avoiding the complications related to mechanical ventilation. K E Y W O R D S disability, EEG, GCS, predictors, refractory status epilepticus [Correction added on May 11, 2020, after first online publication: The Country name, India has been replaced by Nepal in the affiliation and correspondence section.] | 249 KAFLE Et AL.

BACKGROUND The optimal cost benefit of standard plasma exchange (SPE) has not been met where most of the patients do not afford the treatment. As an alternative, low volume plasma exchange (LVPE) is cost-effective than SPE where albumin replacement is eliminated. The aim of this study was to analyse the efficacy and safety of LVPE in various Immune mediated neurological diseases (IMND). METHODS A hospital-based retrospective study was conducted in patients with IMND who were admitted in TUTH between October 15, 2020, and October 14, 2022. Hemodynamically stable patients over the age of 18 who met the plasma exchange criteria were eligible. Outcomes and treatment-related complications were studied separately for the different diseases. RESULTS Of the 29 patients enrolled, 3 had Myasthenia gravis (MG), 6 had Neuromyelitis optica spectrum disorder (NMOSD), 11 had Gullian Barre syndrome (GBS), 6 had Chronic inflammatory demyelinating polyneuropathy (CIDP), and 3 had Autoimmune encephalitis (AE). Patients with MG, GBS, and CIDP all showed statistically significant improvement in mRS scores from 2.3±0.6 to 0 (p value = 0.0198), 3.03±1.8 to 2.2±1.4 (p value=0.0046) and 2.5±1.4 to 1.8±1(p value=0.025) respectively by the time they were discharged following treatment. Two patients developed Deep vein thrombosis (DVT), and two developed anaphylaxis during the course of their treatment, although none deteriorated further while in the hospital. CONCLUSION LVPE was effective in MG, GBS and CIDP. Myasthenia crisis patients who re-quired mechanical ventilation demonstrated complete resolution with LVPE making it a potential life-saving alternative for those who cannot afford standard therapy.

Wild and underutilized vegetables are important sources of food, nutrition, and income for rural communities and indigenous people. Cultivation of high-yielding hybrid varieties, change in food habits, climate change and over-harvesting have resulted in genetic erosion of these vegetables. In addition to this, their availability, distribution and uses are poorly documented. This study aims to document the wild, neglected, and underutilized vegetable species in Jaimini Municipality of Baglung District, Western Nepal. Complete information on wild and underutilized vegetables were collected using semi-structured interviews, guided field walks, and field observation. We recorded 64 species of wild and underutilized vegetables belonging to 27 different families in the study area. Leaf was the most used plant part (26 species) and majority of the plants species were herbs (33 species). Most of these vegetables were consumed in rainy and summer seasons and their availability decreased during winter season. Knowledge regarding their utilization, cultivation, and conservation were also gradually disappearing. Therefore, consumer awareness, evaluation of their nutritional value, and promotion for their commercial use should be emphasized for the inclusion of these vegetable species in our daily diet.

ChAdOx1 nCoV-19 is an effective and well-tolerated coronavirus disease 2019 vaccine. However, rare cases of serious adverse events have been reported with it. We report a patient who did not have active or prior coronavirus disease 2019 infection, who developed Guillain–Barré syndrome 7 days following the first dose of ChAdOx1 nCoV-19 vaccination. He was treated with intravenous immunoglobulin, with stabilization of the disease. Proper monitoring and prompt reporting of such cases are required to ensure the safety of the vaccine.

Neurotoxin-related optic neuritis (ON) after snake bite is uncommon. Here, we present a case of a 70-year-old female who developed bilateral painless loss of vision after she received treatment with anti-snake venom (ASV). She had only perception of light on assessment of visual acuity on admission which then improved drastically after administration of intravenous methylprednisolone (MP) after making the provisional diagnosis of ON on the basis of history and clinical findings of the patient. Imaging and visual-evoked potential could not be done initially, and they were done after the administration of intravenous MP which had normal findings. ASV, though being a lifesaving treatment, has been sometimes associated with ON.