Marchiafava-Bignami Disease in a Patient With Polysubstance Use Disorder.

Marchiafava-Bignami disease (MBD) is a rare demyelinating disease associated with chronic alcohol use and/or malnutrition leading to vitamin deficiency. Clinical presentation is diverse and can range from mild neurological deficits of dysarthria and confusion to severe symptoms such as coma or even death. Diagnosis is made using imaging modalities including magnetic resonance imaging (MRI) and computed tomography (CT) with the rise in technological advances placing MRI as the most sensitive and specific imaging technology for diagnosis. Classic MBD imaging demonstrates demyelination and necrotic damage of the corpus callosum. While MBD is a well-documented neurologic complication of chronic alcoholism, its occurrence and presentation in the context of concurrent polysubstance abuse remain underexplored. We outline the case of a 27-year-old male with polysubstance use disorder presenting with subacute neurological deterioration and demyelination of the splenium of the corpus callosum.

Prevalence of Smoking among Medical Students in a Tertiary Care Teaching Hospital.

INTRODUCTION: Tobacco smoking is one of the most important preventable risk factors for noncommunicable diseases. It has been seen that medical students have a higher frequency of smoking compared to the general population. This study aims to determine the prevalence of smoking among third-year medical students in a tertiary care teaching hospital in Nepal. METHODS: This descriptive cross-sectional study was conducted among the hospital's third-year undergraduate medical students over a four-month period (October 2019 to January 2020). Ethical clearance was received from the Institutional Review Committee of Kathmandu Medical College and Teaching Hospital. The whole sampling technique was used to collect data. The Global Health Professional Students Survey questionnaire was used to collect data. Data analysis was done in the statistical package for social sciences. RESULTS: The prevalence of current smoking among selected medical students of Kathmandu Medical College and Teaching Hospital is 34 (30.1%), majority male 26 (23%). Fifty-six (49.4%) of them had ever smoked cigarettes in their life, and 27 (23.9%) had their first cigarette in late adolescence. The number of students who used other forms of tobacco was comparatively lower i.e. 6 (5.3%). Many of the students 53 (46.9%) were exposed to second-hand smoke both at home and in public, while 18(15.9) exposed only at public places, and 6 (5.3%) only at home. CONCLUSIONS: Our study has concluded that there is a notable prevalence of smoking among the participants. This points to the need for specific training sessions in their clinical years about smoking cessation for themselves and regarding counseling for patients.

Severe Birth Asphyxia without Sequelae: A Case Report.

Perinatal asphyxia is one of the major causes of neonatal morbidity and mortality. It mainly causes neurodevelopmental delay leading to hypoxic-ischemic encephalopathy. We present here the case of a preterm male baby of 1670 grams born at 31+3 weeks of gestation delivered by 25-year-old primi mother through vaginal delivery with history of umbilical cord prolapse. At birth, the baby had no heart rate and cyanosed following which he was resuscitated according to the Neonatal Advanced Life Support 2015 guidelines protocol. After 5 minutes of neonatal resuscitation, the baby's heart rate reappeared, but was only upto 20 beats/min and resuscitation thus continued. But heart rate did not improve despite of using all form of resuscitation procedure including intubation and drugs. After 2 hours, baby cried spontaneously and later baby was managed in Neonatal Intensive Care Unit according to the neonatal unit protocol of the hospital. Keywords: birth asphyxia; cord prolapse; hypoxic ischemic encephalopathy.

An Unwanted Guest in the Biliary Tract: A Case Report.

Ascariasis is a frequent human gastrointestinal tract helminthic disease caused by Ascaris lumbricoide. It usually stays in the intestinal lumen and occasionally migrates into the biliary tract through ampulla of Vater .Biliary ascariasis is a critical complication of intestinal ascariasis with life-threatening manifestations .We report a case of a-38 year-old lady who presented with colicky type epigastric pain radiating to back with diffuse tenderness over abdomen on examination. Ultrasonography abdomen showed linear echogenic structure in common bile duct .Biliary ascariasis was noted on Endoscopic Retrograde CholangioPancreaticography following which extraction was done .Our report highlights the varied clinical features of biliary ascariasis. Keywords: ascariasis; ascaris lumbricoides; cholangiopancreatography endoscopic retrograde; common bile duct.