Prolonged use of noninvasive ventilation in the management of COVID-19-induced ARDS: a case report.

The severity of coronavirus disease 2019 and its manifestations varies considerably from person to person. Acute respiratory distress syndrome is the more feared and severe complication usually managed with early intubation and invasive ventilation. We report a case from a tertiary hospital in Nepal admitted with coronavirus disease 2019 acute respiratory distress syndrome and managed primarily on noninvasive ventilation. Considering the scarcity of invasive ventilation and the rising number of cases during the pandemic and its complications, early use of noninvasive ventilation in appropriate patients can decrease the need for invasive ventilation.

Acute liver failure in a young patient with dengue shock syndrome: a case report.

Dengue fever is caused by dengue virus, which has four different serotypes and is transmitted by the Aedes mosquitos. This disease is endemic to Southeast Asian countries, including Nepal. Liver involvement in dengue is a crucial feature, and the effect ranges from an asymptomatic rise in liver enzymes to the development of acute liver failure. Acute liver failure often results in multiorgan dysfunction including hemodynamic instability, renal failure, cerebral edema, and even death because of shock. Prompt diagnosis and management are necessary to prevent complications. However, there is no proven proper treatment for this condition, and the only treatment modality is to prevent the symptoms. We presented the case of a young female with dengue fever who developed a life-threatening acute liver failure because of dengue shock syndrome.

Diagnosis and management of hepatolithiasis in an adult patient: A case report.

Hepatolithiasis or intrahepatic calculi are common in South East Asia but are rare in Western nations. The primary symptom of the condition is recurrent pain in the upper abdomen. Stones in the cystic duct or common bile duct are also common findings. Recurrent pyogenic cholangitis is the most frequent complication. Radiological studies and percutaneous procedures are vital for diagnosing and managing this condition. The primary goal in treating the condition is to decrease the chance of developing cholangitis and to stop the progression of the disease, which may lead to biliary cirrhosis.

Association of asthma and herpes zoster, the role of vaccination: A literature review.

Herpes Zoster (HZ) is the reactivation of a previous infection with varicella-zoster virus (VZV) which shares the same mode of transmission as HZ. It presents with painful erythematous vesicles in a dermatome which is characterized by a burning sensation before and after the rash. Any conditions with suppressed cellular immunity example diabetes mellitus, chronic obstructive pulmonary disease, asthma, cardiovascular diseases, chronic steroid uses, malignancy, etc. causes reactivation of the virus. Impaired immune responses in asthma patients either in any age group may increase their susceptibility to HZ infection owing to skewed Th1/Th2 immunity, resulting in predominant Th2 conditions and an unwarranted Th2 cell response against respiratory allergens. Similarly, many studies have delineated the association of asthma with HZ. However, the relation between steroid use in asthma and HZ is uncertain, its immunosuppressive effect might be responsible for increased susceptibility to the infection. As HZ increases the economic burden and morbidity, its prevention should use vaccines. There are two types of Food and Drug Administration (FDA)-approved vaccine available against HSV one of which is given as a single dose vaccine called Zostavax, for people 50-59 years but its efficacy falls after 3rd dose and on the subsequent 4th dose and is also contraindicated in human immunodeficiency virus/acquired immunodeficiency syndrome, pregnancy and people taking immunosuppressive drugs. Shingrix is preferred by FDA which is a two doses vaccine that is given 6 months apart for people above 50 years and to immunocompromised people. Hence, proper counseling and education about the risks of herpes should be informed to the patients with timely utilization of the vaccine.

Cefixime induced Steven Johnson syndrome: A case report from Bangladesh.

Introduction: Stevens Jonson syndrome, a type IV mediated hypersensitivity reaction is a rare mucocutaneous disorder accounting for <10% of TBSA. It affects skin, oral mucosa, eyes, esophagus, mouth, pharynx, larynx, skin and genitals. SJS is caused mainly due to drugs, infectious agents, immunization, and radiation therapy. Presentation of case: We present a case of a 40 years old male who developed SJS after being administered cefixime for a short period. Given the patient's past profile, he was admitted due to RTA and was under treatment with cefixime. Irrespective of any symptoms of SJS in the past, he started developing symptoms soon after being treated with cefixime giving us a clue about cefixime-induced SJS. Discussion: Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are opposite ends of a spectrum of diseases arising usually from an adverse reaction to medications. The most common drug reactions include penicillin in antibiotics, carbamazepine in antiepileptics and allopurinol in gout treatment in the Asian community. In our case, the patient was under Cefixime for 6 days after which cutaneous manifestations were seen. SJS is a fatal condition, with a global mortality rate stretching between 10% and 34%. The first step in its management is to identify the culprit drug and stop its use. Other is symptomatic, with special attention to airway and hemodynamic stability, wound care, and pain alleviation measures. Medical therapy include corticosteroids, cyclosporine, intravenous immunoglobulin (IVIG), and TNF- α inhibitors. Conclusion: Cephalosporin group, like cefixime, is a commonly prescribed drug in developing countries due to its efficacy and cost-effectiveness. Therefore, physicians must beforehand be mindful of the consequences of its use and advice patients to visit the hospital with even the slightest cutaneous manifestation.