HLA-B27 Negative Reactive Monoarthritis of the Hip Joint Triggered by Scrub Typhus: A Case Report.

Scrub typhus is common in rural Nepal's southern plains, but its diagnosis remains difficult due to a lack of clinical suspicion and poor diagnostic resources. The absence of common manifestations of the condition including eschar might further complicate this problem and may result in treatment delays. We report a case of scrub typhus with the primary presentation of reactive monoarthritis of the left hip joint in a 19-year-old male who presented with difficulty in walking, and pain over the left hip joint. Ultrasonography of the left hip and thigh showed features of synovitis and iliopsoas bursitis. After a meticulous workup, a diagnosis of human leukocyte antigen B27 negative reactive monoarthritis of the left hip joint triggered by scrub typhus infection was made and the patient was treated with doxycycline. Delays in treatment and the rate of complications can be prevented with high clinical suspicion and awareness of the atypical presentation of the condition. Keywords: HLA-B27; case reports; reactive arthritis; scrub typhus.

Variation in Prices of Cardiovascular Drugs in Public and Private Pharmacies in Nepal.

INTRODUCTION: Higher price of cardiovascular drugs is one of the reasons for high out-of-pocket expenditure in cardiovascular care. The objective of the study was to determine the price variation in commonly available cardiovascular drugs between public and private hospital pharmacies in Nepal. METHODS: A cross-sectional survey was conducted in 3 public and 3 private pharmacies in tertiary-level hospitals in Nepal. The price was recorded for the list of drugs commonly available in those pharmacies. A total of 23 drugs were selected for data collection. The price was recorded based on the payment receipt and price reported by surrogate customers. We defined the price variation as the difference between price of cardiovascular drugs between public hospital and private pharmacy. The price variation was expressed as percentage. RESULTS: Price of Amlodipine 5 mg was higher by 667% in private pharmacy nearby Tribhuvan University Teaching Hospital (TUTH) compared to that of TUTH pharmacy. Price of Enalapril 5 mg was higher by 14.47% in Manmohan Cardio Thoracic and Vascular Transplant Centre (MCVTC) compared to nearby private pharmacy. We observed that the price of cardiovascular drugs varied significantly between hospital and private retail pharmacies in TUTH (P < .001) and MCVTC (P < .001). CONCLUSION: For most of the cardiovascular drugs, the price in private retail pharmacies were significantly higher than in hospital pharmacies. Future steps should be taken to establish and run own pharmacies in hospitals which would reduce the cost of medicine and thereby, increase access to medicine.