Metastatic choriocarcinoma presenting as upper gastrointestinal bleeding: A case report.

Choriocarcinoma is a type of gestational trophoblastic disease that occurs as a complication of pregnancy-related events. The gestational trophoblastic disease includes both benign and malignant conditions including complete and partial mole, invasive mole, choriocarcinoma, and placental site trophoblastic disease. Choriocarcinoma generally presents with pervaginal bleeding, symptoms of anemia, and symptoms of its metastatic lesion. The common sites of metastasis are the lung, vagina, brain, and liver. The gastrointestinal (GI) tract is an uncommon site of metastasis occurring in <5% of patients. Upper GI bleeding as presenting complaints without pervaginal bleeding is also very rare with only a few reported cases. Here we present a case of 29 years young female who presented in our emergency department with complaints of hematemesis and altered sensorium where clinical suspicion was peptic ulcer disease but imaging modality with computed tomography showed hypervascular lesions in the brain with suspicion of choriocarcinoma. With further imaging and laboratory tests, confirmatory diagnosis of choriocarcinoma was made. This case highlights the importance of imaging in the diagnosis of choriocarcinoma where the history of the patient is misleading.

Low back pain with axillary mass in a perimenopausal woman: A case of schwannomatosis mimicking metastasis.

Schwannomatosis is a rare neurocutaneous syndrome characterized by the presence of multiple schwannomas along the peripheral nerves, distinctly excluding the vestibular nerves. It is recognized as the third principal form of neurofibromatosis, alongside neurofibromatosis types 1 and 2. In this report, we discuss the case of a 45-year-old woman who initially sought medical attention for low back pain and swelling in her left axilla. Her magnetic resonance imaging revealed multiple enhancing intradural extramedullary lesions, along with a mass in the right upper thoracic region and another in the left axilla, raising suspicions of metastasis. However, a comprehensive analysis that aligned imaging results with histopathological findings confirmed the diagnosis of schwannomatosis. This case highlights the importance of differentiating between various conditions that can cause multiple intradural extramedullary masses, such as nerve sheath tumors, meningiomas, and metastasis. The presence of multiple schwannomas suggests a diagnosis of either neurofibromatosis type 2 or schwannomatosis, making the distinction between these two conditions critical for appropriate management.

Getting the diagnostic clue, role of MRI in the diagnosis of type 1 Glutaric aciduria in resource-limited settings.

Glutaric aciduria type 1 is a rare autosomal recessive disorder caused by a deficiency of glutaryl-CoA dehydrogenase, which is the key mitochondrial enzyme involved in the final degradation of lysine, L-hydroxylysine, and L-tryptophan. It is an inherited organic acidemia characterized by macrocephaly and dystonia, which results in high morbidity and mortality. In resource-limited countries like Nepal, where enzyme assays are not available, MRI has a great role to play in supporting diagnosis in such situations. Here, we present 2 cases of glutaric aciduria type 1 in brothers from the same parent that were diagnosed by MRI, and subsequent diet modification and L-carnitine therapy led to improvement of clinical symptoms.

The double target sign as ultrasonographic finding in a case of double intussusception: A case report.

Intussusception is one of the common conditions in children presenting with abdominal pain. The exact etiology of intussusception is unknown. Lead point is not identified in the majority of cases in children. Commonly, radiographic evidence suggests the presence of a target sign is diagnosis of intussusception. However, the presence of a double target sign in the case of intussusception is rare and depicts the presence of double intussusception. We present a case report of a 1-year-old child who presented to the emergency department with excessive crying for more than 10 hours. After the initial clinical assessment and acute management, an abdominal ultrasound revealed a double target sign on the sub-hepatic and left para-umbilical region which suggested double intussusception. No lead point was identified in our case. Early diagnosis and prompt treatment are the mainstay of management in such cases.

Late Presentation of Hypoxic Injury of Brain in an Infant.

Perinatal asphyxia is one of the leading causes of hypoxic-ischemic encephalopathy. In a developing country like Nepal, home delivery is the leading cause of perinatal asphyxia. Neuroimaging remains the diagnostic modality of choice. We present a case report of a 10-month-old infant who presented to the pediatric Out-patient-department with complaints of being unable to hold his head and unable to sit without support. Detailed history, physical examination, and developmental assessment along with lab investigation flash visual evoked potentials and Magnetic Resonance Imaging of the brain was performed. Hypoxic ischemic injury has common five types of imaging patterns in neonates. There are a few imaging differentials to be considered while evaluating the case for hypoxic injury. Clinicians and radiologists must go hand in hand to narrow down the possibilities which can fasten the treatment thereby decreasing morbidity and mortality. Keywords: Hypoxic ischemic encephalopathy, Infant, Magnetic Resonance Imaging.

Study of thermodynamics of a thermal electron in scattering.

This work presents the study of the thermodynamic properties of thermal electrons participating in scattering events. This is necessary because scattering with a thermal electron in presence of a laser field was not studied yet and it reduces the complexity of event measurement (differential cross-section). To study thermodynamic properties, the authors model the thermal Hamiltonian in presence of a laser field and used it to study the thermodynamic properties using the partition function. The study shows thermodynamic energy, around the target with distance at field amplitude 0.1 a.u. to 0.9 a.u. has destructive interference, above field amplitude 1 a.u. to 2.5 a.u. has superposition and at field amplitude 2.5 a.u. and 3 a.u. have coulomb potential like nature. Also, thermodynamic energy with temperature was found constant except at field amplitude 2.5 a.u. and at field amplitude 2.5 a.u. destructive interference at 10 °C and 21 °C. The thermodynamical potential at field amplitude 0.1 to 3.5 a.u. found constant and above field amplitude 3.5 a.u. increased linearly when studied with respect to temperature at 10 Å . The thermal Hamiltonian increase sharply when thermal electrons enter in 1-5 Å , slowly in 5-10 Å and beyond 10 Å constant, and the thermal Hamiltonian nature is like coulomb potential.

Length of Stay in the Emergency Department during COVID-19 Pandemic in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Emergency Department overcrowding has become worsening problem internationally which may affect patient, emergency department efficiency and quality of care and this may lead to increased risk of in hospital mortality, higher costs, medical errors and longer times to treatment. With this pandemic COVID-19 likely to go on for months, if not a year or longer, the Emergency Department should be prepared for large influx of patients infected with COVID-19. The aim of this study is to find-out the length of stay in emergency department during COVID-19 pandemic at a tertiary care hospital in Nepal. METHODS: This is a descriptive cross-sectional study conducted in the Emergency Department of Kanti Children's Hospital. Ethical clearance was obtained from Institutional review committee Kanti Children's Hospital. Data collection was done from the emergency records from July 23, 2020 to July 29, 2020. The calculated sample size was 211. The data thus obtained was entered in Statistical Package for the Social Science software version 20 and necessary calculations were done. RESULTS: The median length of stay in emergency department was found to be 1.75 hours (Interquartile range 0 to 30 hours). CONCLUSIONS: Definitive management starts in respective wards and Intensive Care Units. During COVID-19, with longer emergency stay, chances of cross-infection increases, and the health workers serving in emergency department will be at risks. So guidelines for shorter emergency stay should be implemented.

Staphylococcus pseudintermedius: a common zoonotic pathogen causing postprocedural urosepsis in humans.

Staphylococcus pseudintermedius is a common cause of zoonotic infections in dogs and cats. Recently, there has been an increasing number of infections being reported in humans caused by this organism. We report a case of complicated urinary tract infection in an elderly patient with recent bilateral ureteral stent placement caused by this organism with associated persistent high-grade bacteraemia.

Congenital Partial Intercostal Liver Herniation.

Congenital intercostal liver herniation is a rare entity. The exact etiology of congenital intercostal liver herniation is unknown. Left sided intercostal herniation is even rarer. We present a case report of an eight-day old female who presented to the emergency department of Kanti Children's Hospital with tissue mass protruding through a defect in the left side of anterior chest wall since birth. Sonographic and radiological investigation revealed the tissue to be an extension of the part of the left lobe of the liver with decreased vascularity. There were no other congenital anomalies. Laparotomy with thoracotomy with resection of the non-viable herniated part and closure of defect was done. During postoperative period patient developed surgical site infection and wound dehiscence for which daily dressing and later secondary suturing was done. Keywords: Intercostal liver herniation.

Properdin Levels in Individuals with Chemotherapy-Induced Neutropenia.

BACKGROUND: Neutrophils produce and carry key components of the alternative pathway (AP) of complement, including properdin (P). The effect of chemotherapy-induced absolute neutropenia on circulating P levels and AP function has not been previously established. METHODS: We prospectively measured free P levels in serum from 27 individuals expected to develop neutropenia after administration of chemotherapy for hematological malignancies in preparation for hematopoietic stem cell transplantation and here describe the relationship between serum P levels and the neutrophil count over time. RESULTS: When the absolute neutrophil count (ANC) was >500 cells/mm3 pre-chemotherapy, P levels were significantly higher than P levels associated with an ANC ≤500 cells/mm3 (median values 8392 ng/mL and 6355 ng/mL, respectively; P = .001). Pairwise comparison between pre-chemotherapy P levels and P levels at initial or last documented neutropenia before recovery showed a significant decline (P < .0001). No correlation was observed between P levels during neutropenia and after recovery of neutropenia in 20 subjects for which postneutropenia samples were obtained. A small but significant (P = .02) decrease in AP hemolytic activity was noted between baseline (preneutropenia) and samples obtained at the onset of neutropenia, but only with low (6.25%) and not higher (12.5 or 25%) serum concentrations. CONCLUSIONS: A decline in P levels and AP activity could contribute to the increased risk of infection in neutropenic patients and warrants further study.

Extranodal natural killer/T cell lymphoma, nasal type presenting as a palatal perforation and naso-oral fistula.

Extranodal natural killer/T cell lymphoma (ENKL), nasal type, a rare disease presenting with vague non-specific symptoms, can impose great diagnostic difficulties and may masquerade several infectious, rheumatological or neoplastic conditions. Here, the authors report a case of ENKL presenting as a palatal perforation, naso-oral fistula and fever in a 21-year-old man, which was initially misdiagnosed as bacterial osteomyelitis, invasive fungal infection and Wegener's granulomatosis. The case report underlines the possibility of ENKL occurring at a young age, its rapidly progressive and locally destructive nature, associated diagnostic challenges and the importance of immunophenotyping in establishing the diagnosis.