Modeling of water table profile variations owing to stream-aquifer interaction.

Spatial and temporal variations of the water table could be explained by the one-dimensional Boussinesq equation by incorporating the variables of evapotranspiration and groundwater recharge with appropriate initial and boundary conditions. In this study, the stream-aquifer interaction has been investigated through a numerical example model with the implementations of Galerkin's method-based Finite Element Solution (FES), Hybrid Finite Analytic Solution (HFAS), Fully Implicit Finite Difference Solution (FIFDS) of one-dimensional nonlinear Boussinesq equation, and analytical solutions of the Boussinesq equation linearized by Baumann's transformation (AS I) as well as linearized by Werner's transformation (AS II). Considering HFAS as the benchmark solution, it was observed that in both recharging and discharging aquifers, water table profiles at 1 day and 5 days as obtained from FES followed by FIFDS were observed quite close to HFAS. Based on L2 and Tchebycheff norms, FES and FIFDS were ranked in first and second place, respectively. L2 and Tchebycheff norms could not consistently establish the performance ranking of analytical solutions but their performance ranking was certainly below the numerical solutions. The performance ranking of analytical solutions could not consistently be established using the L2 and Tchebycheff norms, but it was certainly below the numerical solutions.

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.

Posterior Reversible Encephalopathy Syndrome (PRES) in Systemic Lupus Erythematosus: A Rare Presentation.

Posterior reversible encephalopathy syndrome (PRES) is a clinical condition that is characterized by intense headache and neurological deficits such as vision loss which are attributed to the vasogenic edema that occurs in the posterior cerebral cortex involving the occipital and parietal lobes. Although the classical demographies that are affected by the PRES are middle-aged postpartum females and those with renal dysfunction, rarely it is also seen in patients with collagen vascular disorders such as systemic lupus erythematosus (SLE). We report a case of PRES in a 32-year-old SLE patient.

Rhupus Syndrome: A Diagnostic Dilemma.

Rhupus syndrome, a rare coexistence of systemic lupus erythematosus (SLE) and rheumatoid arthritis, is characterized by symmetrical erosive polyarthritis and permanent deformities in addition to the clinical and serological characteristics of SLE. Its prognosis is further complicated by neurological and hematological involvement, which dramatically lowers patients' perceptions of their quality of life in terms of their health. Rhupus individuals have significantly less kidney involvement than SLE patients do. We present a case of a young female who had symmetric, bilateral, erosive polyarthritis for one and a half years preceding the signs and symptoms of SLE, which occurred about six months later.

Scrub Typhus Meningoencephalitis: An Overlooked Entity.

Scrub typhus is common in rural parts of Nepal, but its diagnosis remains difficult due to a lack of clinical suspicion and poor diagnostic resources. The absence of common clinical features further complicates this problem. Acute kidney injury (AKI), myocarditis, rhabdomyolysis, hepatitis, acute respiratory distress syndrome, and meningoencephalitis are complications of the disease associated with high mortality. Overlap findings can be noted in scrub typhus meningoencephalitis and other tropical infections. This makes diagnosing the disease more challenging, especially in areas where the burden of infectious diseases is high. We report three cases of scrub typhus meningoencephalitis. All three patients were treated successfully with doxycycline. Because patients with scrub typhus have an excellent response to treatment, delay in treatment and rate of complications can be prevented with high clinical suspicion of the condition.

A Rare Presentation of Hand, Foot, and Mouth Disease During Pregnancy.

This case report is about an 18-year-old primigravida diagnosed with hand, foot, and mouth disease (HFMD) at 34 weeks of gestation. She had classic rashes on her hands and mouth but was otherwise healthy. The baby was delivered at 39 weeks via spontaneous normal vaginal delivery and was well after delivery. We provide a brief literature review on HFMD in pregnancy and a brief discussion on complications caused by the causative organisms.

Pure Autonomic Failure: A Case Report of Recurrent Orthostatic Hypotension.

Pure autonomic failure is a neurodegenerative disorder affecting the autonomic nervous system which clinically presents with orthostatic hypotension. It is a diagnosis of exclusion after detailed clinical examinations and relevant investigations. Here, we discuss a case of 68 years old male who had complaints of multiple episodes of loss of consciousness on standing from a sitting position for the last 3 years. The diagnosis was considered by clinical examinations revealing autonomic dysfunctions with normal appropriate investigations. The patient was treated successfully with midodrine, fludrocortisone, and other non-pharmacological interventions. We focused on doing various autonomic dysfunction tests in the evaluation of a patient with recurrent orthostatic hypotension. We suspect that pure autonomic failure might not have been considered in the differential diagnosis of recurrent orthostatic hypotension and suggest that it is to be kept as a differential in such a scenario. Midodrine has an effective role in syncope due to sympathetic vasoconstrictor failure.