Spigelian Hernia: A Case report.

A Spigelian hernia is a hernia through the Spigelian fascia which are difficult to diagnose as they do not present with a subcutaneous swelling and can be dangerous as there is a high risk of incarceration. We report a case of a 51-year-old female who presented to our surgical unit with epigastric pain for 5 days. She was diagnosed with Spigelian hernia with esophagitis and antral gastritis with the help of a computed tomography scan and upper gastrointestinal endoscopy. The diagnosis was confirmed on diagnostic laparoscopy and transabdominal preperitoneal repair of the defect was performed using prolene mesh. Her post-operative period was uneventful. Spigelian hernias are rare and patients can present with atypical symptoms as in this case. Thus, imaging plays a vital role in diagnosis. Management is surgical and has good outcomes. Keywords: case reports; rectus abdominis; ventral hernia.

A cystic non-Wilms renal tumor in a Nepalese boy: A rare case of clear cell sarcoma.

INTRODUCTION: Clear cell sarcoma of the kidney (CCSK) is an uncommon childhood malignancy known for its aggressive behavior and tendency to recur and metastasize to the brain and bones. CASE PRESENTATION: We report a four-year-old boy evaluated for non-specific abdominal pain with an incidental radiological finding of a right lower pole cystic renal mass initially thought to be cystic Wilms' tumor. A pretherapy core biopsy of the mass suggested a clear cell tumor. An open transperitoneal radical nephroureterectomy with aortocaval lymph node sampling was done. Based on histopathological findings and immunohistochemical analysis, CCSK was diagnosed. Appropriate chemotherapy and radiotherapy were instituted postoperatively. At six years follow-up, he was tumor-free and doing well. CLINICAL DISCUSSION: The workup for CCSK includes diagnostic and metastatic imaging, histopathology, and immunohistochemistry analysis. Diagnostic segregation of CCSK and Wilms' tumor is imperative to institute optimal oncological management and improve overall treatment outcomes. CONCLUSION: Considering the age of presentation and clinico-radiological appearance, CCSK can be mistaken for Wilms' tumor, which is much more common in occurrence despite the distinguishable histopathological features, treatment modalities, and prognosis.

Sputum Eosinophil Level among Healthy Individuals Visiting Medicine Outpatient Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Sputum differential is the most comprehensive, and non-invasive investigation for evaluating airway inflammation because of its reliability, reproducibility and responsiveness. The interpretation of the results of induced sputum examination depends on knowledge of normal values from a healthy population. So far, the reference values of sputum differential cells in Nepalese population are not reported. Neutrophil and eosinophil are used to assess the inflammatory response of the airway. The aim of our study was to detect the eosinophil level in the sputum of healthy individuals with normal pulmonary function. Methods: A descriptive cross-sectional study was conducted in a tertiary care hospital, from November 1, 2021 to December 31, 2021 after taking ethical clearance from Institutional Review Board (Reference number: 1507202106). Convenience sampling was done. Collected data was entered and analysed using Statistical Package for the Social Sciences version 24.0. Point estimate at 95% was calculated along with mean and standard deviation for continuous data. Results: Among 139 induced sputum samples, 7 (5.03%) had eosinophils present in their sputum (1.40 to 8.67 at 95% Confidence Interval). The age range of the participants was 18 years to 79 years with mean age of 39.5 ± 15.06. Prevalence of eosinophilia (percentage of eosinophil ≥3) was 4 (2.88%). Conclusions: The prevalence of eosinophilia in our study was found to be similar to published literature. The results of the present study show that there is a paucity of eosinophils with predominance of neutrophils, macrophages and lymphocytes in induced sputum samples of healthy non-smoker adults with normal pulmonary function test. Keywords: eosinophils; healthy volunteers; leukocyte count; reference values; sputum.

Obstructive Lung Disease among Patients Performing Spirometry in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

INTRODUCTION: Obstructive lung disease is a leading cause of morbidity and mortality worldwide which causes economic and social burdens. Spirometry is a standard test for screening and evaluating patients with symptoms of chronic respiratory diseases and is the investigation of choice for identifying airflow obstruction. Chronic obstructive lung disease prevalence, mortality, and morbidity vary across different countries. The study aimed to find out the prevalence of obstructive lung disease among the patients performing spirometry in a tertiary care centre. METHODS: A descriptive cross-sectional study was conducted in the pulmonary function test clinic of the Department of Internal Medicine of a tertiary care hospital between 1 October 2021 and 31 March 2022 from hospital records. Ethical approval was taken from the Institutional Review Committee (Reference number: 200320203). Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. RESULTS: Among 401 patients, obstructive lung disease was present in 173 (43.14%) (38.29-47.99, 95% Confidence Interval). The mean age was 55.78±18.54 years. The most common symptom for referral was dyspnea seen in 151 (87.30%). CONCLUSIONS: The prevalence of obstructive lung disease in our study was higher compared to other studies from the similar setting. Spirometry should be used more frequently for diagnosis and to stratify patients for appropriate treatment.

Mean Six Minute Walk Distance of Healthy Healthcare Workers of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: The six-minute walk test is a sub-maximal exercise test used in clinical populations to determine functional exercise capacity. It is a safe, simple, and inexpensive test. There are a number of reference equations described for estimating six-minute walk distance in healthy subjects in different countries. However, there is a lack of standard reference value for six minute walk distance in healthy Nepalese population. The aim of the study was to find the mean six minute walk distance of healthy healthcare workers of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among healthy health care workers of a tertiary care centre from 1 August 2021 to 30 November 2021 after taking ethical approval from Institutional Review Committee (Reference number: 1507202105). Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: The mean six-minute walk distance of the 162 healthy health care workers was 486.74±74.73 (475.23-498.24, 95% Confidence Interval) m. Men walked 519.61±79.19 m and women walked 474.12±75.62 m. The mean age of the participants was 29.25±8.25 years. Conclusions: The mean six-minute walk distance was found to be lower when compared to similar studies conducted in similar settings. Keywords: exercise test; health personnel; healthy volunteer; walk test.

Experience of a Final Year Medical Student: Pre- and Post-COVID-19 Era.

Medical education provides both knowledge and clinical skills to students. Clinical skills program including bedside teaching is considered an irreplaceable part of the undergraduate medical curriculum. COVID-19 pandemic has halted the delivery of effective clinical skills to medical students which has especially affected the final year students. So, we need to find an alternate approach to teach clinical skills to medical students in this era of COVID-19. This public health crisis has also demonstrated the significance of resilience and adaptability in the medical education system and the need to inculcate these values in our generation of medical students. This will help the students to complete their transition from a 'student' to a 'doctor'. This article highlights the experience of a final year medical student in the pre- and post-COVID-19 period, problems faced by final year medical students during this crisis, and effective ways to cope up with them.