Vincristine induced fever in a child with embryonal rhadbomyosarcoma

Introduction: Febrile episodes in oncology is common are mostly of infectious etiology requiring repeated investigations and escalation of antibiotics. But, drug induced fever occur more often than we think in oncological set-up. Case Report: A 5 year old male child with rhabdomyosarcoma, developed high grade fever spikes following Vincristine monotherapy. Infective etiology work up was negative and the fever responded to corticosteroids. Management and Outcome: He was treated with corticosteroids as premedication considering vincristine induced fever. The further courses of VCR- monotherapy were uneventful with steroids as premedication. Discussion: We present the case of vincristine induced fever in a child with embryonal rhabdomyosarcoma. Clinician’s should consider drug induced fever at appropriate conditions, to avoid leading to antibiotic resistance.

Pediatric Optic Neuritis: Description of Four Cases and Review of the Literature

Pediatric optic neuritis (PON) may be a clinically isolated and self-limiting event or may present in the context of underlying neurologic, infective, or systemic disease. PON has a high impact on the quality of life as it may or may not evolve into other acquired demyelinating syndromes (ADSs), such as multiple sclerosis (MS), neuromyelitis optica (NMO), or other syndromes related to the myelin oligodendrocyte glycoprotein IgG antibodies (MOG-IgG). These different PON phenotypes present variable clinical and radiological features, plasma and liquor biomarkers, and prognosis. We describe four pediatric cases presenting clinically with ON, with different etiopathogenetic pictures: one case had a probable infective etiology, while the others were associated with different demyelinating disorders (MS, NMO, syndrome related to MOG-IgG). We discuss the possible evolution of presenting ON in other ADSs, based on recent literature. A careful evaluation of the clinical and investigation findings and the natural course of PON is necessary to define its pathogenic pathway and evolution. Further prolonged follow-up studies are needed to highlight the predictors of PON evolution, its potential sequelae, and the best treatment options.

Clinicopathological Study of Subcutaneous Heminthicnodules : Unusual Sites and Diagnostic Dilemmas

Introduction: Superficial palpable swellings with helmintic infection as an underlying etiology is usually an accidental finding in the surgically excised specimens. Somatic nematodes and cestodes are the commonly implicated organisms, and the zoonotic nematodes show an emerging trend. The present study aims to reappraise the histopathological findings of helminthic etiology in superficial swellings which were clinically suspected to be of neoplastic/non neoplastic nature. Materials and methods: Thirty six cases of palpable superficial nodules with infective etiology over a period of five years were reviewed. 19/36 were of helminthic etiology were included in the present study. Pertinent demographic and clinical data were retrieved from the medical archives. Results: Amongst the 19 cases, 8 were males and 11 females. Chest wall (4/19), and eyelids (3/19) were the most common sites involved. The size ranged from 0.8-15 cm in greatest dimension. Presence of histiocytes (13/19), granulomas (11/19), eosinophils (10/19), and giant cells (9/19) were the most consistent histological findings. 14 cases had discernible parasite morphology with diagnosis of filarial worms (7/19), Dirofilaria (3/19), cysticercosis (4/19), and hydatid cyst (1/19). Four cases had dead and calcified parasites with no discernible morphology. Conclusion: Granulomatous inflammation and tissue eosinophilia are strong indicators of a parasitic etiology. Subcutaneous and intramuscular filariasis, cysticercosis and hydatid cyst are well documented etoiologies whereas Dirofilariasis is an emerging zoonotic infection with worldwide case reports. Imaging techniques and fine needle aspiration can point towards the diagnosis; however in the absence of characteristic features, histopathology can be relied upon to diagnose a helminthicetiology.

A rare case of chickenpox induced myoclonus

In presence of abnormal neurological features, infective etiology should be kept as one of the differential diagnoses. This case report was about 38 years old male patient who presented with fever with blister-like rashes in centripetal distribution over the body and myoclonus. CSF examination showed the presence of varicella-zoster Ig M antibodies. Diagnosis of chickenpox induced myoclonus was made. Appropriate treatment recovered the patient completely. This case report highlighted the clinical spectrum of chickenpox as well as the possible pathogenesis and diagnostic, therapeutic approach of this uncommon entity.

The Management of Patients With Penetrating Aortic Ulcers: A Systematic Review

Background: Penetrating aortic ulcers (PAUs) are an entity within acute aortic syndrome. They often remain undiagnosed and are found incidentally or when they become symptomatic. Management is currently guided by clinical judgment. This review aims to identify indications for treatment and inform management. Methods: We searched PubMed for studies on the management of PAUs. The outcome measures were mortality, progression and resolution of symptoms. Results: This review incorporates 27 studies involving 1356 patients with PAU. Data was available regarding symptoms for 1213 patients (494 symptomatic, 719 asymptomatic). Overall late mortality for PAUs was found to be higher than 30-day mortality. Early mortality was higher for symptomatic patients as compared to those with asymptomatic PAUs. Early mortality was lowest for PAUs treated with endovascular interventions (5%), followed by PAUs managed medically and highest following open surgical management. Indications for treatment included symptoms, progression/instability, aortic diameter >5 cm, concomitant aortic pathology or pleural effusion. 13% of patients managed conservatively at initial presentation demonstrated progression and were considered for intervention subsequently. 9% of patients required reintervention after initial endovascular surgery. Conclusion: Endovascular treatment, if anatomically suitable, should be considered as first line treatment for symptomatic PAUs. Patients with asymptomatic PAUs, if associated with high-risk features such as PAU diameter >20 mm, PAU depth >10 mm, aortic diameter >42 mm, concomitant pathology, morphological change or an infective etiology, should also be considered for intervention. Small asymptomatic PAUs with no high-risk features may be managed conservatively but must undergo regular surveillance.

Epidemiological Profile of Skin Diseases in a Tertiary Hospital of Kathmandu: An Annual Census

Introduction: Skin diseases are eighth most common reasons for outpatient in Nepal, and fourth cause of disability globally. Skin diseases varies with the reason, season and socioeconomic status. As the socioeconomic conditions are changing, so are the disease patterns. We planned to report the current trend of skin diseases in Kathmandu and compare with similar studies in past. Materials and methods: Outpatient department records of Civil Service Hospital from the year 2075 Bikram Sambat were reviewed after ethical clearance from institution review committee and were analyzed after tabulation. Results: Total number of cases were 9886 (4.51% of total hospital attendance). In total 8097 cases were new, males were 4218 (52.1%) and females 3879 (47.9%). Most common diagnosis was eczemas (18.47%), followed by dermatophytosis (15.29%). Eczemas, chronic urticaria, psoriasis and lichen planus were more common in the adult population of more than 30 years. While infections and acne were more common in young adults, 15-30 years, in both the sexes. Tinea was common during summer and so was scabies in males, while in females, melasma peaked in summer and chronic urticaria during spring and winter. Conclusion: The pattern of skin diseases is changing with the time. Diseases of possible allergic and immunologic etiology are increasing and diseases with infective etiology are still a huge burden on society.

Evaluation of clinico-epidemiological factors and outcome of COVID-19 disease in perinatal period

Background: The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is well accepted that pregnant women are at increased risk of infections, morbidity from known respiratory viruses like H1N1, varicella, influenza. COVID-19, a virus from the same family poses a greater and influential risk to the health of our mothers and their babies. Raised concerns of pregnant women, being physiologically immunocompromised with associated comorbidities like hypertension, diabetes, heart disease, anemia is very challenging for the obstetrician to conquer.Methods: We tested 405 pregnant women for PCR SARS CoV-2 during the pandemic out of which 59 pregnant women turned out to be positive, and were included in the study analysis. These women had singleton live pregnancy beyond 37 weeks and opted for in patient management. Study participants did not have any known obstetric complications.Results: 81% of women were delivered by cesearean section, indication being premature rupture of membranes and anhydramnios in 45 % of women reflecting the infective etiology of the disease. 60% women were asymptomatic, yet positive for the disease. Community spread was seen in 75% of the women. No ICU admissions were recorded.Conclusions: The substantial impact on the vulnerable groups like pregnancy has necessitated need for further studies and research and to build more service models as frontline obstetric COVID health care workers.

Utility of a real-time fluorescence imaging device in guiding antibiotic treatment in superficial skin infections

The prescription of antibiotics empirically without confirmation of an infective etiology is on the rise. Administration of appropriate antibiotics can be guided by real-time fluorescence imaging using a point-of-care device. These composite images show the presence, type and the burden of infection. The time saved by this method over microbiological testing, especially in resource-poor settings, can lead to a paradigm shift in treatment by facilitating prompt and adequate antimicrobial therapy, surgical debridement as well as follow-up. Thumbnail sketches of a series of four cases highlighting different scenarios in which a fluorescent imaging device utilizing artificial intelligence and machine learning was found useful is presented in this report.

Progressive Bilateral Childhood Urolithiasis of Rare Etiology: Ultrasound Images and Evidence-Based Therapeutic Recommendations.

Background: Multiple, recurrent and bilateral renal stones causing progressive bilateral urolithiasis is rare during childhood and metabolic disorder such as cystinuria and oxalosis are commonly. The aim of this paper is to report the very rare presentation of hypercalciuria and hypercalciuria with progressive bilateral renal stone disease, with stones predominantly composed of ammonium and phosphate suggesting infective etiology. Patients and methods: A boy with progressive bilateral renal stone disease since early infancy and had been treated by several urologist during the previous three years was studied. He was first referred at the age of five years requesting the opinion about the use of medical therapies and therefore an evidence-based recommendation was made. Results: The boy was initially diagnosed as having bilateral urolithiasis at about the age of two years and during the previous three years with three surgical operations and two lithotripsy sessions. Stone were predominantly composed of ammonium (++++) and phosphate (++++), but they also contained calcium (+++) and uric acid (+). There was evidence of urinary infections with Klebsiella and Enterobacter species suggesting an infective etiology of the stone disease. On referral, Sodium nitroprusside test for cystine was negative and paper chromatography for cystine was also negative. 24-hour urine examination (volume 1600 ml): Calcium 264 mg/24 hr (more than 12 mg/kg/24hr) and oxalate 0.17 g/24 hr (Normal: 0.01-0.04 g /24). Conclusion: Urologists should make an early consultation with a pediatrician expert in renal disorders to provide the necessary medical therapies. Bilateral progressive renal stone disease is rarely caused by infective etiologies alone and the presence of recurrent urinary infections should not lead to ignoring the possibility of metabolic abnormalities.

Non-Veneral Genital Dermatoses: A Study from Western Nepal

Introduction: The etiology of dermatoses involving genital areas could be venereal or on-venereal. These disorders are responsible for mental distress and guilt which can be minimized by appropriate diagnosis and information to the patients. Objectives: To assess the clinical pattern and prevalence of various non venereal genital dermatoses in a referral center. Materials and Methods: This was a hospital-based descriptive study involving patients with non-venereal diseases visiting outpatient clinics of Department of Dermatology. After informed consent, all the parameters were recorded in a proforma and analyzed. Results: Total of 70 patients with non-venereal genital dermatoses were included. Mean age of the patients was 33 years. Majority were male, married and had history of irregular use of contraceptives. Duration of symptoms ranged from one to 36 months with mean of four months. Total 19 types of non-venereal skin diseases were noted with major complaint of itching in genitalia in 22 (31.4%). Primary site of involvement/complaint was vulva in 19 (27.1%), scrotum in 17 (24.3%), groin in 18 (25.7%) and penile area in 14 (20.0%). The most common final dermatological diagnosis in majority was fungal infections and neurodermatitis in 12.9% each. Extramarital relationship was reported by 37 out of 70 patients (52.9%), while 31 patients correlated their symptoms with sexual exposure. Conclusions: Itching was the most common presenting complaint with infective etiology. The current study highlighted the relevance of addressing non-venereal genital dermatoses in order to avoid the general misconception that all genital lesions are sexually transmitted.