Meningococcemia in an 11 Months Old Infant.

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.

Importance of clinical history in the diagnosis of psittacosis: A case report.

Introduction: Psittacosis, caused by the bacteria Chlamydia psittaci, is primarily a disease of birds that can be transmitted to humans. The clinical manifestations of the disease are wide, ranging from asymptomatic illness to fulminant psittacosis with multi-organ failure. The organism gets attached to the upper respiratory mucosa after inhalation and the majority remain asymptomatic. However, some people may develop symptoms of atypical pneumonia. Case presentation: Psittacosis usually presents with sudden onset fever with chills and rigor, headache, and myalgia. Here we present a case of a 35 years old female with a history of close contact with parrots who presented to the ER with complaints of high-grade fever and headache for 2 weeks which started 2 days after her parrots died. Discussion: The disease usually manifests as flu-like symptoms or pneumonia and is included in the differential diagnosis of community-acquired pneumonia. Investigations reveal neutrophilia, raised erythrocyte sedimentation rate, C-reactive protein, and elevated liver enzymes which were consistent with the findings of our patient. Chest X-ray showed ill-defined consolidation in the right middle and lower lobes which were inconclusive. Hence, a CT chest was done which revealed patchy ground glass opacities with surrounding consolidation giving a reverse halo sign. Due to her contact with birds and CT findings which were suggestive of psittacosis, she was started on doxycycline and her condition improved thereafter. Conclusion: We highlight the importance of proper history taking and awareness on zoonotic diseases to the general public to prevent, diagnose and treat the disease effectively.

Case of Budd-Chiari syndrome, an enigma as abdominal tuberculosis in a tubercular endemic country: A case report.

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.

Ruptured dermoid cyst of ovary developing into chronic peritonitis; a rare complication diagnosed by contrast CT: A case study.

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.

A multidisciplinary approach to accidental inhalational ammonia injury: A case report.

Introduction: Ammonia is a highly toxic irritant gas, and its toxicity usually occurs from occupational exposure. Most are unintentional toxicity. It causes tissue damage via exothermic reaction with body tissues causing liquefactive necrosis. Presentation depends on the level and duration of exposure. Management is supportive and its antidote is not available yet. Presentation of case: We report a case of a 22-year-old male with accidental workplace exposure from coolant damage and leakage. He had altered mental status with visible injury to the nasal cavity, and ulcerated laryngeal mucosa with asymmetric vocal cords on bronchoscopy. Computed tomography showed right lower lobe consolidations. A muti-disciplinary approach and prompt management with respiratory support along with inhaled steroids and bronchodilators, antibiotics, electrolyte replacement, analgesics, and supportive eye and oral treatments were initiated. He had to be managed with a high-flow nasal cannula with subsequent tapering of the oxygen supplementation with titration. Discussion: Inhalation injury due to ammonia toxicity can have varied presentations from mild to severe life-threatening respiratory distress and neurological deterioration. Complications can range from upper airway edema to pulmonary edema. Most of these are usual findings except for the presence of pneumothorax. It could be due to the pre-existing lung status or oxygen therapy but the literature is inadequate. Conclusion: Ammonia inhalational injury may be associated with pneumothorax. It is important to have a multi-disciplinary approach and in-hospital management of ammonia toxicity as well as to raise awareness regarding the work environment and timely recognition of the possible occupational health hazards.

Pseudomonas aeruginosa as a culprit of cervical necrotizing fasciitis: A case report.

INTRODUCTION AND IMPORTANCE: Necrotizing fasciitis is usually a polymicrobial infection and odontogenic source is usually the foci for infection in the neck region. Cervical necrotizing fasciitis due to Pseudomonas is a rare and potentially fatal complication in diabetic patients. The study highlights the importance of early intervention to improve the outcome of the patient. CASE PRESENTATION: We report a case of a 48-year female who presented with neck pain for 10 days. On further investigations, she had diabetic ketoacidosis, and a culture of the wound showed Pseudomonas. With appropriate antibiotics and surgical intervention, her condition gradually improved. CLINICAL DISCUSSION: Necrotizing fasciitis in the neck region with Pseudomonas without odontogenic infections is a rare occurrence. Early medical and surgical intervention leads to a better outcome. The location of the infection and its extensions can affect the prognosis. CONCLUSION: Physicians should be aware of cervical necrotizing fasciitis as a complication in diabetic ketoacidosis and install early treatment to improve survivability and the outcome.

Lipofibromatous hamartoma of sciatic nerve: A case report.

Introduction: Lipofibromatous hamartoma of the nerve is the fibro-fatty overgrowth within the nerve. Most commonly they occur in the median nerve, ulnar nerves, and a few other nerves but the involvement of the sciatic nerve is very rare. The fibro-fatty infiltration causes palpable neurogenic mass and clinically presents lump, moderate numbness, tingling sensation, and pain in its territory. Magnetic resonance imaging is the gold standard for diagnosis. Case presentation: We present a case of a 65 years old female, who presented to OPD with a tingling sensation which progressed to pain in the gluteal region and was associated with a tender swelling. MRI showed a giant space-occupying lesion in the sciatic nerve course. The mass was excised and then sent to the histopathological examination which designated the mass as lipofibromatous hamartoma. Discussion: Unless debilitating, lipomatosis of the nerve doesn't require any intervention as it is a benign condition. Lipofibromatous hamartoma is attributed to the accumulation of fatty and fibrous tissue in the epineurium. Diffusion-weighted imaging in association with conventional magnetic resonance imaging has increased diagnostic yield. The lesion was iso-intense to the subcutaneous fat and there were fine fibrillar appearances inside of it. Simple mass excision was performed on our patient without complications. Conclusion: Lipofibromatous hamartoma of the nerve are rare soft tissue tumors of nerves and sciatic nerve involvement is even rarer. Correct and careful interpretation of the MRI findings can lead to diagnosis with ease and help prevent unnecessary biopsies.

Ruptured pulmonary hydatid cyst presenting as hemoptysis in TB endemic country: A case report.

Introduction: Hydatid disease is a major zoonotic disease. After the liver, the lungs are the common site of involvement. Clinical manifestations of the disease depend on the site and size of the cysts as well as the presence of complications. The majority of the cases remain asymptomatic. Complicated pulmonary cysts can present as chest pain, cough, shortness of breath, and hemoptysis. Sometimes, imaging is not sufficient for diagnosis and histopathological evaluation can provide the confirmatory diagnosis. Case presentation: A 32-year-old female presented with the complaints of episodic hemoptysis for the duration of two years. Radiological imaging could not provide a confirmatory diagnosis. Bronchoscopy was planned further. An endobronchial biopsy was taken for histopathological evaluation after seeing the whitish membranous structure within the right middle lobe bronchus. Hence, the diagnosis of ruptured cystic pulmonary hydatidosis was made. Clinical discussion: Echinococcus granulosus is the cause of cystic pulmonary hydatid disease which is transmitted through contamination by the infected definitive host, mostly dogs. Most cases remain asymptomatic for a long period. Hydatid disease has many clinical and radiological forms which should be recognized and included in the differential diagnosis of many pulmonary problems. Sometimes, imaging and serological studies may not confirm the diagnosis, histopathological evaluation may be required. Conclusion: Uncomplicated hydatid cysts are most commonly diagnosed incidentally in the adult population. Complicated hydatid cyst can present with various clinical manifestations. Episodic hemoptysis is one of the manifestations in our case. Clinicians should be aware of the typical as well as atypical manifestations of pulmonary hydatid disease.

Multiple tracheobronchial diverticula in a post-TB patient: A case report.

The presence of multiple tracheal and bronchial diverticula is a rare condition. We present a case of a 22-years old non-smoker male with a history of pulmonary tuberculosis, having multiple tracheal and bronchial diverticula along with other common sequelae such as stenosed and collapsed upper lobe bronchi.

Socio-psychological Study of COVID-19 Pandemic among Healthcare Workers in a Medical College of Nepal: A Descriptive Cross-sectional Study.

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.