Superior Mesenteric Artery Syndrome in an 11-Year-Old Boy: A Case Report.

Superior Mesenteric Artery Syndrome (SMAS) is a rare but potentially life-threatening condition caused by the compression of the duodenum by the superior mesenteric artery. We report a case of an 11-year-old male who complaint of abdominal pain and intermittent vomiting for last 3 weeks. Diagnosis of SMAS was made with the help of radiological findings. The patient was managed conservatively with nutritional support, prokinetic agents, and stomach decompression. After 2 weeks of treatment, the patient's symptoms improved, and he was discharged from the hospital.

Cap Polyposis: A Case Report.

Cap polyposis is a gastrointestinal disease with multiple inflammatory polyps between the distal colon and rectum. Its symptoms overlap with inflammatory bowel disease with typical endoscopic features of multiple sessile polyps in the rectum and sigmoid colon, located at the apices of transverse folds. Microscopically, the polyps consist of elongated, tortuous, and distended crypts covered by a "cap" of inflammatory granulation tissue. In this report, we present a case of a 18-year-old male patient who underwent polypectomy for polyposis in multiple settings. He presented with one year of painless rectal bleeding and polyposis in a recto-sigmoid area on colonoscopy, with a single polyp in the sigmoid area and multiple polyps in the rectum. He was managed with immediate and interval polypectomy. Though cap polyposis is rare, it can be cured as it is laparoscopically resectable. Keywords: case reports; granulation tissue; inflammatory bowel diseases; polyps.

Profile of cesarean section during COVID-19 using Robson ten group classification system in a tertiary teaching hospital, Nepal: a cross-sectional study.

Caesarean section is performed when there are pregnancy related complications and vaginal delivery cannot be tried or fails. The effect of pandemic lockdown on the availability as well as accessibility of health services is a global concern. The aim of this study was to find out the caesarean section rate and its indication at a tertiary care hospital during COVID-19 pandemic. Methods: A hospital-based cross-sectional study was conducted among women admitted for delivery in the Department of Obstetrics and Gynecology of a tertiary teaching hospital during the second wave of COVID-19 (1 May 2021-30 July 2021). Convenience sampling technique was applied and 1350 women were categorized into groups using Robson ten group classification system. Group size, group caesarean rate, absolute and relative contribution of each group to overall caesarean rate were calculated. Results: Out of 1350 total deliveries during COVID-19, lower segment caesarean section was done in 446 (33.04%) (30.53-35.55 at 95% Confidence Interval). Major indication for caesarean section was previous caesarean in 185 (41.48%). Most women 202 (45.29%) were from the age group 24-30 years and gestational age between 37 and 42 weeks. Major contributor to the overall caesarean section rate was Robson group 5 (37%). Conclusions: This study showed higher prevalence of caesarean section delivery rate during COVID-19 pandemic than that compared with 2016 national statistics of Nepal. Despite of several challenges brought by the pandemic, pregnant women were still able to access the emergency obstetric care services in the Eastern part of Nepal. However, future studies should focus on exploring the situation in rural areas too.

Acute Kidney Injury in COVID-19 Patients Admitted at a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Coronavirus disease can affect the renal system in various forms ranging from mild proteinuria to acute kidney injury, some even needing renal replacement therapy. This study aimed to find out the prevalence of acute kidney injury in patients admitted with COVID-19 at a tertiary care centre. Methods: This descriptive cross-sectional study was done in patients admitted in COVID-19 ward in our hospital from July 2021 to June 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 066-077/078). The serum creatinine level was used for the diagnosis of acute kidney injury. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of 80 patients with COVID-19, the prevalence of acute kidney injury was 25 (31.25%) (21.09-41.41, 95% Confidence Interval). Conclusions: The prevalence of acute kidney injury in COVID-19 patients was similar to other studies done in similar settings. Keywords: acute kidney injury; COVID-19; Nepal.

Himalayan watersheds in Nepal record high soil erosion rates estimated using the RUSLE model and experimental erosion plots.

The rising unpredictability in the food supply chain in many parts of the world is related to soil loss and poor agricultural output. The Revised Universal Soil Loss Equation (RUSLE), widely used for estimating soil loss, was applied in the western mid-hills in Nepal, with steep slopes and fragile geology. This region is at high risk for rapid soil erosion and mass wasting. To estimate soil loss, this study utilized the RUSLE model with experimental erosion plots in the Aadhikhola and Tinahukhola watersheds, capturing real-time erosion in the field. The annual soil loss for the Aadhikhola watershed is estimated at ∼41.4 tons ha-1 yr-1. In contrast, in the Tinahukhola watershed, soil loss is low (∼24.1 tons ha-1 yr-1). Although annual rainfall showed an increasing trend in both watersheds, the change in soil loss was statistically insignificant. The high erosion rates from the experimental plots in both watersheds support the model outputs. Results from the experimental plots recorded the rate of soil erosion for different land use as: irrigated agricultural land > rainfed agricultural land > forests. The trends highlight the role of human activities in enhancing soil erosion in these mountainous terrains in terms of medium to long-term perspectives. Therefore, sustainable agriculture practices in these terrains must investigate alternate ways to decrease soil erosion to support people's livelihoods.

Pleomorphic adenoma of nasal septum, an unusual site: a case report from Nepal.

Pleomorphic adenoma is the commonest benign salivary glands tumor. Major salivary glands are mainly involved, and there is very low reported incidence of such tumor in minor salivary glands of nasal cavity. We report a case of 69-year-old woman who complaint of chronic left nasal obstruction and recurrent scanty bleeding from left nostril for last 2 months. On anterior Rhinoscopy examination, there was a pinkish non-tender mass in left nasal cavity arising from cartilaginous part of nasal septum. Intranasal endoscopic excision was done under general anesthesia and histopathological examination of excised tissue revealed pleomorphic adenoma. Patient was discharged after 3 days. There was no recurrence at sixth month of follow-up.

Ileal perforation secondary to bowel obstruction caused by foreign body bezoar: A case report.

Introduction and importance: Foreign body bezoar is a relatively uncommon variant of bezoars leading to intestinal obstruction and perforation. These are caused by the ingestion of indigestible materials that gradually grow in size. Case presentation: Following is the case of a young female patient with abdominal pain and distension which was associated with nausea, vomiting, and obstipation. Contrast-enhanced computed tomography of the abdomen showed dilated jejunal and ileal loops, and a tubular hypodense structure on terminal ileum. During surgery, we discovered intraluminal foreign bodies and ileal perforation proximal to the ileocecal valve. The findings were suggestive of obstruction and perforation of terminal ileum secondary to foreign body obstruction. The patient was managed successfully with ileocolic resection and anastomosis. Discussion: Patients with bezoars can remain asymptomatic or present with features of bowel obstruction. These are usually discovered while performing radiological imaging for the evaluation of symptoms. Though mild to moderate cases of bezoars resolve with the treatment by chemical dissolution, surgeries should be performed in patients with foreign body bezoars and in whom complications have arose. Conclusion: Ingested foreign body could lead to formation of a bezoar which may cause obstruction and perforation-the sequelae must be kept in mind while managing a patient.

Adenocarcinoma among Patients Diagnosed with Lung Cancer in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Lung cancer is the leading cause of cancer deaths all over the world and adenocarcinoma is the most common type. Diagnosis is made usually at an advanced stage of lung cancer in patients, making it nearly impossible to cure. The aim of this study is to find out prevalence of adenocarcinoma among patients diagnosed with lung cancer in a tertiary care centre. Methods: A descriptive cross-sectional study was carried out in the Department of Pulmonary Medicine of a tertiary care centre among 69 patients from October, 2018 to September, 2019. Ethical approval was taken from the Institutional Review Committee of a tertiary care hospital (Reference number: 54/2018). A convenience sampling technique was used. Data were entered and analysed using the Statistical Package for the Social Sciences version 21.0. Point estimate at 90% Confidence Interval and descriptive statistics were interpreted as frequency, percentage, or as mean and standard deviations. Results: Among 69 lung cancer patients, adenocarcinoma was seen in 27 (39.13%) (29.47-48.79 at 90% Confidence Interval). Out of 27, 10 (37.04%) were male and 17 (62.96%) were female. Chronic obstructive pulmonary disease was the major comorbidity seen among 17 (62.96%) patients. Conclusions: The prevalence of adenocarcinoma was similar to other studies done in similar settings. Keywords: adenocarcinoma; lung cancer; Nepal; smoking.

Tympanic Membrane Perforation among Patients Presenting to Department of Otorhinolaryngology of a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Introduction: Intact tympanic membrane acts as a partition between the external ear and middle ear. Tympanic membrane perforation is one of the commonest causes of conductive hearing loss. Perforation size is the most important determination of hearing loss. The aim of this study was to find out the prevalence of tympanic membrane perforation among patients presenting to the otorhinolaryngology department of a tertiary care hospital. Methods: A descriptive cross-sectional study was carried out in the Department of Otorhinolaryngology and Head Neck Surgery of a tertiary care hospital from March 2021 to August 2021. Ethical approval was taken from Institutional Review Committee (Reference number: 57112021). Convenience sampling was done and data was collected from 414 patients presenting to the department. Collected data were entered, analyzed in Statistical Package for the Social Sciences version 21.0 and documented for study. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: Among 414 patients, tympanic membrane perforation was seen in 100 (24.15%) (20.02-28.27 at 95% Confidence Interval). Among 100 patients with a total of 153 perforated eardrums, mild hearing loss was seen in the majority of the cases. Posterior perforation had a mean hearing loss of 40.41±5.96 dB, central had 39.09±3.13 dB, and anterior had 35.15±5.88 dB. Conclusions: Our study showed the prevalence of tympanic membrane perforation to be high when compared to other similar studies. Hearing loss was observed in all cases; the majority with mild hearing loss. The degree of hearing loss was more in larger and posterior perforation. Keywords: eardrum perforation; hearing loss; otitis media.

A Baby Born with Ectopia Cordis, Omphalocele, Cleft Lips and Palate: A Case Report.

Ectopia cordis is a rare congenital defect with the prevalence of 5 to 8 per million live births. Here we report a rare case of preterm female live birth with ectopia cordis associated with omphalocele, cleft lip, and palate. In this case, 14+ weeks ultrasound did not show any fetal abnormalities and parents were unaware of the condition until 35+ weeks when ultrasound detected the anomaly a few days before delivery. After delivery, they didn't give consent for further intervention which led to neonatal mortality 3 hours after birth. If the condition was diagnosed in time, an earlier intervention could have been done.

An unusual case of subacute small bowel obstruction - Gallstone ileus.

INTRODUCTION AND IMPORTANCE: Gallstone ileus is caused by an impaction of one or more gallstones within the gastrointestinal tract, leading to mechanical intestinal obstruction. It is a rare complication of cholelithiasis leading to the formation of a cholecystoenteric fistula and is associated with high mortality rates. We report a case of atypical subacute small bowel obstruction due to gallstone ileus. PRESENTATION OF CASE: An 82-year-old man, with previously diagnosed cholelithiasis, presented with abdominal pain and vomiting for nine days. The contracted gallbladder with distended bowel loops was visualized on abdominal ultrasound. Computed tomography of the abdomen and pelvis revealed dilated loops of the small intestine with a gallstone in the proximal ileum, causing intestinal obstruction with pneumobilia, suggesting gallstone ileus with cholecystoduodenal fistula. The patient underwent an emergency laparotomy and enterolithotomy to remove the impacting gallstone. The cholecystoduodenal fistula was left undisturbed due to the significant risk of duodenal injury. The patient had an uneventful postoperative recovery. CONCLUSION: Gallstone ileus almost always requires surgical management. However, performing an interval biliary surgery is based on the clinical judgment of the surgeon. In our case, the patient's clinical status determined the treatment in which an enterotomy with stone extraction alone was largely sufficient, and has supported the literature. Gallstone ileus is an important differential diagnosis in elderly patients with gallstone disease, untreated or undiagnosed, presenting with features of small bowel obstruction.

Varicella Pneumonia in an Immunocompetent Middle-aged Adult Male: A Case Report.

Varicella pneumonia is uncommon among adults and can present as potentially life-threatening complications of varicella. Here we report a case of a 43-year-old man with no known history of chronic disease and no allergic history who presented to our hospital emergency department with widespread skin eruptions over the entire body and hemoptysis. Varicella pneumonia was diagnosed based on the patient being in contact with his 6-year-old son who had contracted chickenpox 10 days back, typical cutaneous lesions, pulmonary symptoms and radiographic findings. The patient was treated with oral acyclovir and was admitted to the intensive care unit for monitoring. The patient recovered completely after 10 days of treatment. Keywords: chickenpox; pneumonia; skin eruptions.

Typhoid Fever among Patients Diagnosed with Dengue in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Dengue and typhoid fever are different entities with overlapping signs and symptoms which are indistinguishable and there have been few reports of co-infections from endemic areas. The resemblance of symptoms makes accurate clinical diagnosis and treatment difficult. Both are major health problems mainly during monsoon and co-infection, if not timely diagnosed and treated can be fatal. The aim of this study was to find out the prevalence of typhoid fever among patients diagnosed with dengue at a tertiary care centre. Methods: A descriptive cross-sectional study was done among patients of age >15 years with dengue fever attending the medicine outpatient department in a tertiary care centre from 1 July 2021 to 30 June 2022. Ethical approval was taken from the Institutional Review Committee (Reference number: 466/2020). Convenience sampling was used. Patients with other risk factors for febrile illness were excluded from the study. Point estimate and 90% Confidence Interval were calculated. Results: Among 95 dengue cases, typhoid fever was observed in 18 (18.95%) (12.36-25.54, 90% Confidence Interval). The mean age of presentation was 35±9 years with a male to female ratio of 0.8:1. Fever was the most common presentation with a mean temperature of 100.8±2.1°F. Conclusions: The prevalence of typhoid fever among dengue-positive cases was higher as compared to other studies done in similar settings. Keywords: dengue; fever; typhoid fever.

Pain-related factors associated with lost work days in nurses with low back pain: A cross-sectional study.

BACKGROUND AND AIMS: Chronic low back pain is known to contribute to lost work days (LWDs) in nurses. However, there is a limited understanding of the factors that moderate the impact of low back pain (LBP) on LWDs - in particular factors that are modifiable and that could therefore be the treatment targets of interventions designed to help nurses more effectively manage LBP. This study aims to identify pain-related factors that are associated with LWDs in nurses with LBP, in order to inform the development of interventions that could reduce LBP-related work dysfunction and improve patient care. METHODS: A cross sectional study was conducted on 111 female nurses who were asked to answer questions regarding demographic information, work history, presence or absence of LBP, number of LWDs due to illness, and a number of factors that could potentially be related to LWDs including: (1) average and worst pain intensity; (2) the temporal pattern of LBP (constant versus intermittent); (3) pain aggravating factors (lifting, bending, walking, and standing); and (4) pain alleviating factors (medications, rest, exercise). RESULTS: Sixty-five percent (n=72) of the sample reported LBP. Constancy of pain and having a LBP problem that was alleviated by rest were significantly associated with the number of LWDs, while maximum and average LBP intensity were only weakly associated. CONCLUSION: The findings provide important new information regarding what is (and of equal importance) what is not associated with LWDs in nurses with LBP. IMPLICATIONS: To effectively reduce LBP-related work disability, interventions may need to teach nurses how to better manage constant pain and remain active despite pain, rather than focus on pain reduction. Research to examine the potential efficacy of such treatment approaches for nurses with LBP is warranted.