Jejunal duplication cyst in a female neonate: a case report.

Introduction and importance: Duplications are the abnormal portion of the intestine, either externally attached to the intestine or intrinsically placed within the bowel lumen. Their prevalence is noted to be around one in 25 000 deliveries. The rare gastrointestinal tract duplication may be located in any part of the gastrointestinal system from the oral cavity to the anus. The most common site of enteric duplication cyst (DC) is the terminal part of the ileum. Hence, duplications in jejunum are rare. Case presentation: Hereby, the authors report a case of jejunal DC in a female neonate which was managed successfully via surgery and adequate post-operative care without any complications. Clinical discussion: Duplications are more frequently single. They are usually located in the mesenteric border of the associated native bowel and may vary in shape and size. Most of them are cystic, followed by tubular and mixed type, with or without other congenital anomalies. More than 80% of the cases present before the age of 2 years as an acute abdomen or bowel obstruction, but many duplications remain silent unless complications occur, and therefore may not be diagnosed until adulthood. Complications of enteric DC include volvulus, bleeding, and, rarely, malignant degeneration. Conclusion: It is important for paediatric surgeons to include DC in the differential diagnosis if a neonate presents with features of intestinal obstruction.

Ketorolac-induced anaphylaxis following oral administration: a case series.

Background: Ketorolac is a commonly used non-steroidal anti-inflammatory drug for reducing pain and inflammation. Anaphylaxis is a medical emergency that occurs after exposure to an allergen, with a varied clinical presentation requiring prompt and appropriate measures to prevent or manage it. Although uncommon, ketorolac can cause anaphylaxis requiring immediate medical care. The authors present two cases of anaphylaxis in females induced after oral intake of ketorolac with successful outcomes. Case presentations: The cases involve two adult women who experienced an allergic reaction to ketorolac. The first woman, aged 36, and the second woman, aged 26, on her second postpartum day, both developed similar types of symptoms like periorbital swelling, itching, and difficulty breathing after taking oral ketorolac. The second woman had a history of allergic rashes. They received immediate treatment with epinephrine, oxygen therapy, intravenous fluids, and other medications. They showed a rapid improvement and were discharged after observation. Clinical discussion: Anaphylactic reactions to ketorolac, a commonly used pain management drug, have been reported. Symptoms include swelling, difficulty breathing, and hypotension. Treatment involves medications like epinephrine, hydrocortisone, and pheniramine. A detailed medical history, laboratory investigations, appropriate medication, oxygen therapy, and follow-up care are important in managing anaphylactic reactions, which can be life-threatening. Conclusion: Although rare, ketorolac can cause anaphylactic reactions in patients with or without a history of drug allergy. Immediate recognition and management are essential, along with a detailed medical history and follow-up care.

Hepatitis-E-induced cholestasis in a child: a case report.

Hepatitis E virus (HEV) is a major cause of epidemic water-borne hepatitis in tropical and subtropical countries in areas with poor sanitary conditions. The infection by HEV in children is frequent but typically asymptomatic or manifested only as a very mild disease without jaundice, and usually, it often goes undiagnosed. In this case report, the authors describe a case of hepatitis-E-induced cholestasis in a child. Case presentation: An 8-year-old male child presented to a Pediatrics emergency with fever and features of acute cholestasis. On abdominal examination, there was non-tender hepatomegaly. The rest of the systemic examinations were normal. Ultrasonography findings were suggestive of acute hepatitis. The liver biopsy report showed hepatic cholestasis and hepatitis. The serological test for hepatitis E IgM was positive. The child was managed symptomatically. Conclusion: Although cholestasis is uncommon in children with HEV infection, it should be considered for non-improving clinical status in children with hepatitis. Also, patients with jaundice and Hepatitis E should be followed up by treating physicians until resolution occurs. To the authors' knowledge, this is the first case report from Nepal describing cholestasis in a child due to HEV infection.

Steroid induced psychosis in a child with nephrotic syndrome: A case report.

Background: and Importance: Steroids induced psychosis is one of major adverse effects of corticosteroids therapy especially in patients with disease causing low serum albumin level like nephrotic syndrome. The literature review about this adverse effects is lesser in children than adults population. The management is done by tapering dose of steroids in aid of immunosuppressive drug with an antipsychotics drug. Case presentation: Here we present a case of 14 years old female child known case of nephrotic syndrome secondary to Focal segmental glomerulosclerosis with steroids induced psychosis who is managed by tapering dose of prednisolone with Tacrolimus as immunosuppressive and Quetiapine as antipsychotic. Conclusion: The prevalence of steroids induced psychosis is higher in our locality which is still unreported due to lack of detailed history and proper diagnosis and it is manageable if early diagnosis and treatment is initiated. Thus, proper counselling to parents about the adverse effect of steroids therapy and timely follow up will prevent Nepalese children from this illness.

The use of sodium nitrite for deliberate self-harm, and the online suicide market: Should we care?

Sodium nitrite is a common household product with a variety of uses such as curing meat, food additive, colouring agent, anti-freezing agent and disinfectant. We report a case of sodium nitrite intoxication for deliberate self-harm and discuss the increasing number of such cases in recent times.

Case Report: Ziprasidone induced neuroleptic malignant syndrome.

Neuroleptic malignant syndrome (NMS) is a well-recognized neurologic emergency. It presents with classic features including hyperthermia, autonomic instability, muscle hypertonia, and mental status changes. The syndrome is potentially fatal and is associated with significant morbidity due to complications such as rhabdomyolysis, acute kidney injury, and ventricular arrhythmias due to the trans-cellular electrolyte shift. NMS is conventionally associated with the first-generation antipsychotic agents, however, has been described with the use of atypical and novel antipsychotics including Ziprasidone. A case of NMS with Ziprasidone use at the therapeutic dose is reported here.

Diesel siphoner's lung: An unusual cause of hydrocarbon pneumonitis.

The practice of manual siphoning of diesel from fuel tanks is common among automobile mechanics in Nepal. When an automobile mechanic with a history of diesel siphonage presents with respiratory symptoms, the diesel siphoner's lung diagnosis should be considered. Clinical suspicion confirmed by radiological findings can help in early management and prevention of permanent damage.