A retrospective study of COVID during pregnancy and the outcome of vaginal delivery.

Introduction: SARS-CoV, MERS-CoV, and SARS-CoV-2, later named coronavirus disease 2019 (COVID-19), are three highly pathogenic and lethal human coronaviruses that have arisen in the last two decades. Pregnant women have a higher risk due to a special state of immunosuppression. However, there is no proof that pregnant women and their babies are more vulnerable to infection, as data is limited.The primary goal of this retrospective study is to examine the effects of early COVID-19 diagnosis and to address the best method of delivery based on medical records of neonatal and maternal outcomes observed at Nepal's Paropakar Maternity Hospital. This retrospective research will determine whether vaginal delivery is healthy compared to cesarean delivery and whether the outcome of a COVID-19 pregnancy in both mother and the baby is independent of the disease's status of the mother. Methods: Study design: The proposed study is a retrospective cross-sectional study. Patients population: 104 cases of COVID positive pregnancy with vaginal delivery or caesarean section. Results: The neonatal outcomes of COVID pregnancy revealed at least 51% baby born with Low APGAR score, 18% born prematurely, 19% with low birth weight, 7% requiring NICU admission, 3% Neonatal asphyxia, and 2% Neonatal death. Furthermore, when normal vaginal delivery and Cesarean section were compared there was no significant between the differences found in the outcomes. Conclusion: The COVID positive status had no association with the perinatal outcomes. Moreover, COVID status rarely affected the course of pregnancy. Guideline: STROCSS 2021.

A rare case report on hypertrophic pachymeningitis: Serum IgG4-related disease.

IgG4-related disease (IgG4-RD) is an immune-mediated inflammatory condition of unknown etiology characterized by invasion of tissue by IgG4-producing plasma cells. It can affect almost any organ system, but central nervous system involvement is a rare occurrence. A careful clinicopathological correlation is required to establish the diagnosis. The condition is highly treatable with glucocorticoids, but it is likely that it is underdiagnosed. Although IgG4-related disease responds quickly to glucocorticoids, if left untreated, can lead to end-stage organ failure and even death. We present a case of a 46-year-old female patient who presented with headache, tingling, numbness, flickering movement in her left lower limb gradually extending to torso and head, and loss of consciousness. After radiological and immunohistochemical studies, the diagnosis of IgG4-related hypertrophic pachymeningtis was confirmed. Corticosteroid therapy was administered, and the patient symptomatically improved. Clinicians should be aware of this rare condition, and the importance of early diagnosis and appropriate corticosteroid therapy should be emphasized.

Salt-Wasting Form of Congenital Adrenal Hyperplasia: A Case Report.

Congenital adrenal hyperplasia (CAH) is a set of autosomal recessive disorders characterized by enzyme abnormalities in the adrenal steroidogenesis pathway, which cause impaired cortisol biosynthesis. Glucocorticoid, mineralocorticoid, and sex steroid production can all be altered in individuals, necessitating hormone replacement therapy. The symptoms might range from prenatal salt loss and abnormal genitalia to adult hirsutism and irregular menses. We present the case of a girl who presented with a seizure initially at the age of three months. Laboratory results revealed hypoglycemia, hyponatremia, and hyperkalemia with increased renin activity, increased adrenocorticotropic hormone (ACTH), low aldosterone, low cortisol, high dehydroepiandrosterone sulfate (DHEAS), and high 17 hydroxyprogesterone levels. Imaging findings were normal. The patient was managed with hydrocortisone and fludrocortisone. She is currently on regular follow-up and is doing well with dexamethasone therapy.

Congenital Upper Limb Deficiency with Oligodactyly: A Case Report.

Congenital upper limb deficiency care and management have undergone drastic changes over the past 50 years. Given the low incidence of this defect nationwide, this case report adds to the existing database to analyze the etiological investigations, descriptive epidemiology, and trend detection. We present a case of a 2-month-old male child with congenital upper limb deficiency and explore the possible etiologies and difficulties during early diagnosis of such rare disorders in a low and middle-income countrries and present implications at the primary health care level to improve the prognosis. Poor nutrition during pregnancy due to an unplanned pregnancy is a possible cause. The prognosis is unfavourable due to sociocultural barriers. To address these limitations, it is pertinent to address disability-adequate knowledge among communities, promote early diagnosis, and timely rehabilitation using a multidisciplinary approach. Further, we provide a framework to optimize care. Keywords: congenital limb deficiency; prevalence; upper limb defect.

Case Report: A rare case of choledochal cyst.

Background: Choledochal cysts are dilated portions of the biliary tract that account for 1% of all benign biliary diseases. It is prevalent among Asian and female populations and the incidence is 1:100,000-150,000. Among the different types, only 15-35% of all choledochal cysts are type IV cysts, with type I being the most common representing 50-80%. Clinical presentation and therapy of biliary cysts (BC) differ depending on the type. Case: We present a case of a 2-year-old male who presented with non-specific symptoms of multiple episodes of vomiting. Laboratory investigations revealed raised alkaline phosphatase and gamma-glutamyl transpeptidase. His symptoms of acute pancreatitis were resolved with conventional therapy. Ultrasonography of the abdomen showed intra and extra-hepatic cystic biliary tree dilatation suggestive of choledochal cyst Type IV A. Conclusions: Choledochal cysts present with clinical features varying with age and anatomical variants and can pose challenges in management that can be addressed by surgery to avoid further complications.

Facemasks Readily Available in Common Stores used by Nepalese, How much Protection is Enough Protection against COVID-19?

During the COVID-19 pandemic, the Centers for Disease Control and Prevention and World Health Organization strongly recommend that people wear face masks to cover their mouths and noses while they are out and about in any other public area. There are a lot of masks available on the market, and people get a lot of mixed messages about what is safe. This article explores what kind of facemasks are readily available in Nepali General stores and what are the things to keep in mind before buying a mask. We will also discuss how many times a face mask can be used, proper ways to store them, correct ways to use facemasks, and the rationale behind its use.

Hereditary Vitamin-D Dependent Rickets Type II: A Case Report.

Hereditary vitamin D dependent rickets type II is a rare genetic disorder in children characterized by early onset of rickets and deranged biochemical parameters. Low serum calcium level, high alkaline phosphatase, high parathyroid hormone, and high values of 1,25-dihydroxy vitamin D are characteristic biochemical findings. We are reporting a rare case of Vitamin D Dependent Rickets and subsequent improvement after addition of cinacalcet. This is a case report of a 2.5-year-child with Hereditary Vitamin D Dependent Rickets type II receiving cinacalcet as adjunct to oral calcium and calcitriol. Oral cinacalcet (0.25mg/kg/day) was added to the regimen as an adjunct after treatment failure with high dose of oral calcium and calcitriol. A significant improvement in radiological findings and normal homeostasis of calcium, phosphate and parathyroid hormone was achieved after initiation of cinacalcet.

Acid-Base Disorder in the Patients Visiting the Emergency Department of a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: An acid-base disorder is a change in the normal value of extracellular pH that may result when renal or respiratory function is abnormal or when an acid or base load overwhelms their excretory capacity. Clinical acid-base disorders are conventionally defined from the vantage point of their impact on carbonic-acid-bicarbonate buffer system. The aim of the study is to find out the prevalence of acid-base disorder among patients visiting the emergency department of a tertiary care hospital. METHODS: This is a descriptive cross-sectional study conducted among 370 patients who underwent arterial gas analysis at the emergency department of a tertiary care hospital. The study was carried out from 15th July 2016 to 15th July 2017 after receiving ethical approval from Institutional Review Committee. Convenient sampling was done. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Data were entered in Microsoft-Excel. Statistical Package for Social Sciences version 17 was used for analysis. RESULTS: Out of 370 patients analyzed, 329 (88.91%) (84.68-91.311 at 95% Confidence Interval) had acid-base disorder. The mixed disorder was the most common finding 80 (21.6%), followed by compensated Respiratory Acidosis 56 (17.8%). The mean age group of male patients studied was 50.72±20.586 and among females, it was 49.95±20.908 Among those most common symptoms were shortness of breath 151 (40.81%) followed by vomiting 91 (24.59%). CONCLUSIONS: Most common acid-base disorder was mixed disorder presenting with prominent symptoms of shortness of breathe in non-geriatric patients wherein the geriatric patient, the most common disorder was compensated respiratory acidosis with the prominent symptom of shortness of breath.

Maggots Around Colostomy Site: A Case Report.

Myiasis is a skin infection caused by developing larvae (maggots) of various Diptera fly species. The two most frequent flies that cause human infestations around the world are Dermatobia hominis (human botfly) and Cordylobia anthropophaga (tumbu fly). Maggots have been found to infest the nose, ear, orbit, tracheostomy wound, face, gums, and serous cavities, among other places. Maggots at the colostomy site are an uncommon occurrence. We report a case of maggots infestation surrounding the colostomy site. We came across a rather rare finding in a patient with advanced inoperable rectum cancer who initially complained of persistent nonspecific pain, discomfort, and foul-smelling discharge from the colostomy site. The issue at hand was identified to be maggots, and their removal alleviated the patient's symptoms. We underline the importance of regularly monitoring stoma sites to avoid maggot infestation, especially in tropical regions.