Massive Superinfected Thrombosis of Dual-Frame Transcatheter Mitral Valve Replacement.

Dual-frame transcatheter mitral valve replacement has emerged over the last decade as an alternative to mitral valve surgery in patients with severe mitral regurgitation, especially in the presence of prohibitive operative risk. This paper presents a case of massive superinfected thrombosis of the Tendyne valve tether along with its risk factors, diagnosis, and management.

Granulosis rubra nasi: A rare dermatosis not limited to nose.

Granulosis rubra nasi (GRN) is a rare genodermatosis involving the eccrine glands with an unknown aetiology. It is clinically characterized by localized hyperhidrosis, erythema, papules, pustules, and vesicles over central region of face and usually manifests during early childhood. GRN is asymptomatic, spontaneously resolves during puberty, and treatment options have inconsistent results. We hereby present a case of GRN in 38 years female with sites and dermoscopy findings not defined so far.

Transplanted Heart Complicated by Intracardiac Aspergilloma With Pericardial Involvement.

A cardiac transplant recipient initially presented with right eye pain and blurry vision. After extensive workup, she was diagnosed with intracardiac aspergilloma with pericardial involvement complicated by endogenous endophthalmitis and acute myocardial infarction, treated in part with mechanical debulking using the Angiovac system (AngioDynamics).

Metabolic syndrome in patients with lichen planus: A case-control study.

Background: Lichen Planus (LP) is a chronic dermatosis affecting the skin and mucous membranes. Chronic inflammation and oxidative stress in patients with LP is a trigger predisposing to Metabolic Syndrome. Objectives: To study the association of Metabolic Syndrome in patients with LP. Materials and Methods: A hospital-based prospective case-control study was conducted from April 2021 to January 2023 including 75 histopathologically confirmed patients with LP and 82 age and sex-matched controls according to the inclusion and exclusion criteria. Metabolic Syndrome was diagnosed using Modified National Cholesterol Education Programme Adult Treatment Panel III criteria. Statistical analysis of the data was performed using Statistical Package for the Social Sciences software, version 26. The chi-square test was used for data analysis. Results: The majority (30.6%) of the patients belonged to the age group 31-40 years. The mean age of patients with LP was 46.13 ± 14.9 years. Female predominance (69.3%) was observed in our study. Patients with classic LP (54.6%) were predominantly observed. Metabolic Syndrome was significantly prevalent in LP patients than in controls (32% vs. 13.4%, p = 0.005, OR 3.037) and was significantly associated with morphology (only oral mucosal involvement, 61.5%, p 0.027, OR 3.9), severity (severe LP, 58.6%, p < 0.001, OR 7.79), and duration of the disease (≥6 months, 55.5%, p 0.001, OR 5.42). 71% of Metabolic Syndrome was observed in females (p 0.847). Among patients with metabolic syndrome, the majority belonged to the age group between 31 and 40 years (37.5%, p 0.378). Systolic and Diastolic Blood Pressure values (≥130/85 mm of Hg), Serum Triglycerides (≥150 mg/dl), and Low-Density Lipoprotein (>130 mg/dl) were significantly elevated, and High-Density Lipoprotein (<40 mg/dl) was significantly low in LP than in controls (p < 0.05). Conclusion: The study showed a significant association of Metabolic Syndrome in patients with LP. Thus, patients with LP need to be screened to avoid complications associated with Metabolic Syndrome that is, Diabetes Mellitus, Cardiovascular Disease, colorectal cancer, and stroke.

Recurrent toxic epidermal necrolysis with two different drugs in a patient with chronic kidney disease-A case report with an atypical presentation.

Toxic epidermal necrolysis (TEN) is a dermatologic emergency usually attributed to drugs. Recurrent episodes of TEN are more common in the pediatric population than in adults. Patients carrying susceptible specific haplotypes, cross-reactivity between the drugs, and drug metabolites generated by the Cytochrome P450 are the key factors for the recurrent episodes. Chronic kidney disease (CKD) increases the risk of toxic epidermal necrolysis by altering the pharmacokinetics and pharmacodynamics of the drug with comparatively higher mortality in this group of patients. We hereby present an elderly female with 2 episodes of TEN following intake of furosemide at present and Nimesulide 3 years back. Cross-reactivity between these drugs because of the similar stereochemical structure might have triggered the second episode. The second episode of TEN was milder in presentation with a short latency period without any constitutional symptoms as compared to the first episode. Thus, treating physicians should always consider cross-reactivity between the chosen drugs in order to prevent subsequent life-threatening episodes, especially in patients with CKD.

Herpes zoster occurring over the site of tinea cruris-A case report based on the model of T-cell exhaustion in the Ruocco's immunocompromised cutaneous district.

Immunocompromised district refers to the area of the skin with altered immune response predisposing secondary diseases to develop in an immunocompetent individual. This might be explained by the theory of T-cell exhaustion which is characterized by the impairment of the effector function of antigen-specific T cells due to chronic persistence of the primary antigen. T-cell exhaustion model is not well known; however, it serves as a newer concept in the pathogenesis of diseases occurring simultaneously over the same site. Thus, it is not surprising to have two different infectious or non-infectious dermatoses over the same site one preceding the other as observed in our patient. The concept of immunocompromised district and T-cell exhaustion is a rare phenomenon; however, it should be identified by the treating physicians/dermatologists for the optimum management of the atypical presentation of the diseases.

Nuclear myosin VI maintains replication fork stability.

The actin cytoskeleton is of fundamental importance for cellular structure and plasticity. However, abundance and function of filamentous actin in the nucleus are still controversial. Here we show that the actin-based molecular motor myosin VI contributes to the stabilization of stalled or reversed replication forks. In response to DNA replication stress, myosin VI associates with stalled replication intermediates and cooperates with the AAA ATPase Werner helicase interacting protein 1 (WRNIP1) in protecting these structures from DNA2-mediated nucleolytic attack. Using functionalized affinity probes to manipulate myosin VI levels in a compartment-specific manner, we provide evidence for the direct involvement of myosin VI in the nucleus and against a contribution of the abundant cytoplasmic pool during the replication stress response.

Factors Influencing Health Seeking Behaviour among Persons with Diabetes Attending Urban Health Care Settings.

BACKGROUND: Health seeking behaviour can influence outcomes in chronic diseases such as diabetes. As diabetes burden is higher in urban areas and under half receive adequate diabetes care and support in Nepal, this study aimed to assess factors influencing health behaviour among persons with diabetes attending urban health care settings. METHODS: A cross-sectional study was conducted at two private healthcare settings with a pretested semi-structured questionnaire to assess health behaviour in particular with gender and regular diabetes follow-up. Bivariate analysis alongwith univariate and multivariate logistic regression was used to assess factors that influence HSB (P<0.05). Adjusted odds were reported within 95% confidence intervals. RESULTS: Among 385 PWDs (42.3% women) with a median diabetes duration of 7 years (IQR: 3 to 14 years), three fourths (75.1%, 95% CL: 70.5 to 79.1%) reported regular follow-up for diabetes care. After adjusting for confounders, the odds of regular follow-up were higher for those with a family history of diabetes (AOR: 1.82, 95% CI: 1.11 to 3.00) and non-smokers (AOR: 2.08, 95% CI: 1.34 to 3.61). The odds of follow-up were lower among the elderly (? 60 years) (AOR: 0.59, 95% CI: 0.35 to 0.97) and those with a family income below 35,000 Nepali rupees (AOR:0.39, 95% CI: 0.23 to 0.67). CONCLUSIONS: A plurality of health seeking behaviours such as regular follow-up care, taking glucose lowering medications and diabetes information seeking was observed among persons with diabetes attending private urban heath care settings during the COVID-19 pandemic period. Older age, family history of diabetes, non-smoking status and low family income were found to influence regular follow-up. In particular, psychosocial mechanisms that influence behavior among persons who smoke may need exploration.

Dermatomyositis in an Elderly with Respiratory Presentation: A Case Report.

Dermatomyositis is an idiopathic inflammatory disease that affects the skin and proximal skeletal muscles. To our best knowledge, there are very few cases of Dermatomyositis reported in Nepal and almost none with respiratory manifestation. We present to you the case of dermatomyositis complicated with interstitial lung disease of a 74 years old male patient with a three-week history of generalized weakness, weight loss, Gottron's papule, and heliotrope rash, with features of interstitial lung disease such as shortness of breath, fever, and productive cough, later confirmed by high-resolution computed tomography. We monitored his serum creatine kinase/creatine phosphokinase level for two consecutive days which showed a progressive increase (281 U/L to 290 U/L). His antinuclear antibody test was positive. He was managed with standard treatment of dermatomyositis. This report might help understand the presentation of disease in our setting which can help in early diagnosis and early initiation of treatment. Keywords: case reports; dermatomyositis; interstitial; lung diseases; Nepal.