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Background: COVID-19 commonly affects the lungs and may lead to mild to severe hypoxemia. The supplemental oxygen requirement gradually reduces with the improvement in lung pathology. However, a few patients may have exertional desaturation, and ongoing oxygen needs at the time of hospital discharge. The objective of this research was to study the requirement of oxygen therapy in the immediate post-COVID-19 period and its associated risk factors. Materials and Methods: An analytical cross-sectional study was conducted on the admitted post-COVID-19 patients who had recently tested real-time polymerase chain reaction (RT-PCR) negative in a tertiary care center from August 2021 to mid of October 2021. Nonprobability consecutive sampling was used, and the sample size was 108. The data were analyzed using the Statistical Package for the Social Sciences (IBM-SPSS), version 23. The mode of oxygen therapy (nasal cannula, face mask, reservoir mask, or mechanical ventilation) in the first two weeks of the study was presented appropriately in a table. The nonparametric statistical tests were applied to determine the association between the duration of post-COVID-19 oxygen therapy and several other risk factors such as age, gender, comorbidities, smoking status, exposure to firewood, COVID-19 vaccination, and severity of COVID-19. Results: 95 (87.96%) cases required oxygen therapy in their immediate post-COVID-19 period. The overall median duration of oxygen therapy was 6.00 (4.00-10.00) days. The nasal cannula was the most commonly used mode of oxygen supplement. The duration of oxygen therapy was significantly higher in patients aged more than 60 years (6.00 [5.00-11.00], p = 0.013), chronic obstructive pulmonary disease (10.00 [6.00-12.75], p = 0.006), history of chronic smoking (9.00 [5.50-13.00], p = 0.044), and severe COVID-19 infection (7.00 [5.00-10.50], p = 0.042). Conclusions: The proportion of patients requiring oxygen therapy in the immediate post-COVID-19 period was higher than that reported in other studies. In addition, old age (>60 years), chronic obstructive pulmonary disease, chronic smoking, and severe COVID-19 infection significantly increased the duration of oxygen therapy. So, these factors should be assessed while discharging patients from COVID-19 facilities, and oxygen supplementation should be planned for needy patients.
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We present a case of a 29-year-old immunocompetent female without any known comorbidities with intermittent headache and vomiting who was ultimately diagnosed with cryptococcal meningitis (CM). Though her neuroimaging findings were atypical to those commonly found in CM, she was diagnosed with CM with a cryptococcal antigen test. However, in contrast to the good prognosis as stated in the literature, she died during her course stay at the hospital. Therefore, cryptococcosis should be taken as differentials, even in an immunocompetent individual presenting with features suggestive of meningitis, to prevent the worst clinical outcome.
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Meningococcemia is the infection of the blood caused by Neisseria meningitidis. Herein, we report a case of meningococcemia in an 11 months old infant who had a high-grade fever, nonblanching purpuric rash over the face and limbs, low blood pressure, tachycardia, and prolonged capillary refill time, but without neck rigidity and focal neurologic signs. He recovered after supportive care and treatment with antibiotics (intravenous ceftriaxone, vancomycin, and teicoplanin). Therefore, in a febrile, ill-looking child in shock with a nonblanching rash, meningococcal disease should be suspected. The study shows the importance of vaccination against meningococcal disease.
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Introduction: Systemic Lupus Erythematosus (SLE) is a chronic auto-immune disorder with the involvement of multiple organ systems. It is more common in females. Case presentation: Here, we present a case of 12-year-old female, known case of SLE with lupus nephritis, presenting with neuropsychiatric symptoms. She was under steroids as well for a few weeks due to flare-up of symptoms prior to that. Due to this, there was a diagnostic dilemma between lupus psychosis and steroid induced psychosis. Clinical discussion: Approximately one third to half of the patients may have neurological involvement in Systemic Lupus Erythematosus. However, neuropsychiatric symptoms in them could be due to corticosteroids, which are frequently used in treatment. There are no definitive and easily available laboratory markers to distinguish these two aetiologies. Conclusions: Systemic Lupus Erythematosus patients, who are on steroids, with neuropsychiatric features should be assessed adequately. As there are no specific guideline and biomarkers to distinguish between these two, meticulous evaluation is necessary for appropriate management.
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Introduction and importance: Multisystem Inflammatory Syndrome in Children (MIS-C) is an uncommon condition that can present with a wide range of clinical features and complications. As it can be confused with various diseases, diagnosis is crucial as proper management can improve the patient's condition. Case presentation: 14-year male presented with fever, abdominal pain, and cough on September 2021. On examination, he was febrile with a distended abdomen and enlarged liver. Following investigations, abdominal tuberculosis was suspected but his condition improved with broad-spectrum antibiotics, intravenous immunoglobulins, and high-dose steroids. Clinical discussion: Any children with COVID 19 infection who have fever with multiple systems involved after ruling out other causes of infections should be suspected to have MIS-C. Diagnosis can be challenging as its clinical presentation mimics conditions like Kawasaki disease, ricketssial disease and acute appendicitis, etc. In high prevalence countries, with predominant gastrointestinal features, it can be confused with abdominal tuberculosis as well, hence, proper diagnosis is crucial. Conclusion: The course of MIS-C can be fatal where most children require intensive care units and early institution of immunomodulatory therapy for their recovery. Also, all pediatricians need to have a high degree of suspicion to diagnose MIS-C as it can be confused with different illnesses.
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Introduction and importance: Bud-Chiari syndrome is an uncommon disease due to obstruction of hepatic venous outflow. Clinical manifestations range from asymptomatic cases to those requiring liver transplants. The study highlights the importance of diagnosing a case of Budd-Chiari syndrome which has been suspected with abdominal tuberculosis where anti-tubercular drugs may themselves damage the liver. Case presentation: Herein we report a case of 18 years old female presenting with upper abdominal pain along with recurrent abdominal distention, jaundice, and deranged liver function. Also, adenosine deaminase level was raised in both pleural and peritoneal fluids, hence, anti-tubercular treatment was started but could not be continued as she developed adverse reactions to these drugs. CT scan later revealed features suggestive of Budd-Chiari syndrome. Initially, she was managed with balloon angioplasty, but her condition worsened ultimately requiring a liver transplant. Clinical discussion: Budd Chiari syndrome can present with subtle presentation and since abdominal tuberculosis is very non-specific, the two conditions can be very confusing, particularly in the tubercular endemic region. Detailed clinical assessment along with proper investigations and imaging should be performed for early recognition as both conditions are associated with high morbidity and mortality if not treated timely. Conclusion: The necessity of careful investigation and consideration of Budd-Chiari syndrome as an important cause of ascites with jaundice and deranged liver function in TB endemic regions along with early anticipation of liver transplant is necessary, as in this case.
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Introduction: Dermoid cyst also called Mature cystic teratoma is the most common ovarian germ cell tumor of pre-menopausal females, composed of skin, hair, teeth, and sebum covered by thick fibrous tissue. It can present with complications like torsion, rupture, infection, and autoimmune hemolytic anemia. The case highlights the role of imaging in the diagnosis of ruptured dermoid cyst which can have subtle clinical features. Case Presentation: Herein we present a case of 53 years multiparous postmenopausal female who presented with lower abdominal pain. Examination findings at presentation were normal. 2 years back patient was evaluated for the abdominopelvic mass which was diagnosed radiologically as an ovarian dermoid cyst. This time, Ultrasonography (USG) of the abdomen and pelvis followed by Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis revealed the features consistent with a ruptured dermoid cyst. Exploratory laparotomy and histopathological examination of the specimen confirmed the diagnosis. Clinical Discussion: Rupture of a dermoid cyst is a very infrequent complication. Following rupture patient may present with peritonitis which may be acute or chronic. Chronic peritonitis may not show any clinically distinguishable features such that the clinical diagnosis of the rupture dermoid cyst is difficult to make. The radiological assessment helps to make an accurate diagnosis so that appropriate surgical intervention can be instituted. Conclusion: Following the rupture of the dermoid patients may progress to a stage of chronic peritoneal inflammation. At this stage, the radiological assessment may be crucial for appropriate diagnosis and thus further management.
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Leishmaniasis is a parasitic disease, endemic to Africa, Asia, and South America due to inadequate access to medication and underreporting of leishmaniasis cases. Leishmaniasis has two forms: cutaneous and visceral. The fight against leishmaniasis has been greatly affected by the coronavirus disease 2019 (COVID-19) pandemic that impacted resource distribution and access to medication. Continuous effort in vaccine development and affordable therapeutics are necessary to eliminate leishmaniasis in low-income countries. Further research is necessary to determine molecular drug resistance markers in leishmaniasis patients. In this analysis, we focus on the effect of COVID-19 on leishmaniasis in Africa.
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INTRODUCTION: Health care workers experienced considerable psychological distress as a result of COVID-19 due to providing direct patient care, quarantine or self-isolation, and lockdown experience. They are front line workers handling the patients and are at greater risk than others. This study aims to determine the socio-psychological impact of COVID-19 pandemic among healthcare workers of a medical college in Nepal. METHODS: A descriptive cross-sectional study from different institutions of the Nepalese Army Institute of Health Sciences from May 2020 to July 2020 was conducted. Ethical approval was taken from the Institutional Review Committee, Nepalese Army Institute of Health Sciences. A total of 212 responses were collected through Google form along with the Depression, anxiety, stress and scale-21 to assess the level of Depression, Anxiety, and Stress. Analysis of the data was done using Statistical Package of Social Sciences version 22. RESULTS: Respondents with extremely severe depression, anxiety, and stress was found to be 16 (7.5%), 24 (11.3%), and 4 (1.95%) respectively. Most of the respondents do not have travel history, but 6 (2.8%) and 28 (13.2%) have direct and indirect contact respectively with the COVID patients. Daily activities such as food intake, the workload at home, and relationships with family members were increased. 208 (98%) have followed preventive measures such as mouth mask, hand washes, and physical distance. CONCLUSIONS: COVID-19 pandemic has imposed a significant level of depression, anxiety, and stress on health care workers caring for infected patients, with their main concern being the risk of transmitting the infection to their families or acquiring it themselves.
