Etoricoxib-induced pleural effusion: A case report.

Key Clinical Message: Drug-induced pleural effusion is extremely rare. It is the diagnosis of exclusion. This condition can be suspected if the patient has been exposed to a likely causative drug, develops new signs and symptoms, and has a remittance of these symptoms once the drug is withheld. Abstract: Etoricoxib has been a very popular nonsteroidal anti-inflammatory drug and is prescribed widely due to its fewer gastrointestinal side effects. Pleural effusion caused by etoricoxib is rarest among the side effects. Here, we report a case of a 45-year-old female with pleural effusion induced by etoricoxib.

Eschar of scrub typhus.

We report a case of a 60-year-old farmer presented with chief complaints of fever, myalgia, and headache of one week duration. Head-to-toe examination revealed an area of central necrosis surrounded by erythema (suggestive of eschar) on nape of the neck. A diagnosis of scrub typhus was made and the patient improved following 7-days course of doxicycline. Eschar is pathognomonic finding for clinical diagnosis of scrub typhus. This is to conclude, head-to-toe examination is indispensable for all the patients presenting with fever, myalgia, and headache.

Inadvertent extravasations of norepinephrine.

A male patient of diabetic ketoacidosis and septic shock was started on norepinephrine infusion following which he developed bulla and subcutaneous tissue ischemia in the event of inadvertent extravasations of norepinephrine. The patient improved after management with mechanical debridement of necrosed tissue and regular dressing of the wound. The use of higher concentration of norepinephrine via peripheral intravenous route may lead to vasoconstriction and subcutaneous tissue ischemia due to inadvertent extravasations.

Knowledge, attitude, and practice of stroke and thrombolysis among students preparing for undergraduate medical entrance examination in Kathmandu, Nepal.

BACKGROUND: Stroke is a major disabling disease, especially for low and middle-income countries like Nepal. The aim of our study is to assess knowledge, attitude, and practice (KAP) among the students preparing for undergraduate medical entrance examination regarding risk factors, warning signs and symptoms, and management of stroke. METHODS: A cross-sectional, single staged study using self-structured questionnaire intended to assess KAP about stroke and thrombolysis was conducted. RESULTS: A total of 378 students participated in our study (53% male; mean age = 18.12 ± 0.97). Majority of the participants (88.4%) had heard about stroke. The more common risk factors identified by them were hypertension (86.2%), oily food (48%), alcohol (37.8%), and smoking (32.8%). Limb weakness, slurring of speech and facial weakness as symptoms and signs of stroke were indicated by 43.4%, 30.2%, and 18.8% of the participants, respectively. Only 23.8% of the participants had heard about thrombolysis and 10% of all could rightly mention the window period of thrombolysis. Male participants had better knowledge about smoking [86 (43.0) vs 38 (21.3); P < .001] and oily food [108 (54.0) vs 73 (41.0); P = .012] being risk factors and facial weakness [50 (37.6) vs 21 (11.8); P = .001] being symptom of stroke compared with females. Similarly, male participants had heard more about thrombolysis than females [68 (34.0) vs 22 (12.4); P < .001]. CONCLUSION: Knowledge regarding risk factors and signs and symptoms of stroke was adequate among the students preparing for undergraduate medical entrance examination. However, knowledge about thrombolysis was poor. Male participants had better knowledge about risk factors, warning signs and symptoms of stroke, and thrombolysis compared with female.

Ramsay Hunt syndrome.

We report a case of a 26-year-old previously healthy male who presented with peripheral facial nerve palsy and painful vesicular eruptions over an erythematous base on pinna and external auditory canal. A diagnosis of Ramsay Hunt syndrome was made. Patient improved with prednisolone, acyclovir, and physiotherapy. Sometimes it may be difficult to differentiate Ramsay Hunt syndrome from Bell's palsy, as patient may develop vesiscles after the onset of facial weakness.

Safety and Efficacy of Mepolizumab in Patients with Eosinophilic Granulomatosis with Polyangiitis.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of vasculitis disorder which involves multiple organ systems and is characterized by asthma, pulmonary infiltrates, sinusitis, neuropathy, and peripheral eosinophilia. It also has an effect on the heart, skin, kidneys, and gastrointestinal tract. Interlukin-5 (IL-5) is involved in maturation and activation of eosinophil, the production of which is increased in the EGPA. Treatments of EGPA are limited to systemic corticosteroids and immunomodulators. These drugs are associated with significant side effects. Besides this, the response of patients to these drugs may be disappointing. Frequent relapses, the need for long-term medium-to-high-dose glucocorticoid therapy, and failure to achieve remission are not uncommon findings. There is a need for noble agents that could reduce frequent relapses and the dose of systemic glucocorticoids and maintain a sustained remission without significant side effects. Mepolizumab is IL-5 antagonist and may have value in treating patients with EGPA. Therefore, we did a systematic review to evaluate the efficacy and safety of mepolizumab in patients with EGPA.