Endovascular management of residual intracranial aneurysm after neurosurgical clipping: a case report.

Introduction and importance: Endovascular coiling can be used to treat residual intracranial aneurysms with prior neurosurgical clipping in aneurysmal subarachnoid haemorrhage. Aneurysmal subarachnoid haemorrhage is a rare subtype of stroke which can be life-threatening. Case presentation: The authors herein report a case of successful management by endovascular coiling of residual intracranial aneurysm post-surgical clipping in a 60-year-old male who was previously diagnosed as diffuse subarachnoid haemorrhage (SAH) Fisher grade 4. On examination, he had a Glasgow Coma Scale 14/15 with verbal confusion present and was hypertensive. Clinical discussion: Aneurysmal subarachnoid haemorrhage is a rare and serious type of stroke and may result in dependency. Endovascular coiling can be used to treat residual intracranial aneurysms with prior neurosurgical clipping. It further helps in decreasing dependency and mortality. Conclusion: Endovascular coiling is a good treatment option for patients who have undergone neurosurgical clipping as their prior surgical attempt in aneurysmal subarachnoid haemorrhage. An endovascular approach may further lead to a better prognosis.

Cutaneous Reactions Following Anticancer Drug Therapy in a Tertiary Care Centre.

Introduction: Cutaneous reactions are dermatological abnormalities that can occur after anticancer drug therapy in cancer patients. Cutaneous reactions can range from mild dermatological disorders to life-threatening medical conditions and may worsen a patient's quality of life. This study aimed to find out the prevalence of cutaneous reactions following anticancer drug therapy in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among cancer patients following anticancer therapy in the outpatient department of dermatology of a tertiary care centre between 1 October 2021 to 30 December 2022. Convenience sampling was done. The point estimate was calculated at a 95% Confidence Interval. Results: Among 3,288 patients, the prevalence of cutaneous reactions following anticancer drug therapy was seen in 73 (2.22%) cancer patients. The mean age was found to be 49.42±1.45 years. Anagen effluvium was the frequently observed cutaneous reaction (30.10%) followed by palmar-plantar erythrodysesthesia (19.94%). Conclusions: The prevalence of cutaneous reactions following anticancer drug therapy among cancer patients was found to be lower as compared to the studies conducted in similar settings. An interdisciplinary approach is required to identify cutaneous reactions to anticancer therapy and to navigate change in the treatment plan. Keywords: cancer; chemotherapy; drug side effects; skin.

First case of congenital methemoglobinemia in Nepalese population: a case report.

Introduction and importance: Congenital methemoglobinemia is a rare hereditary disorder that leads to decreased oxygen delivery to the tissues. The severity of symptoms is directly proportional to the methemoglobin levels in the blood. Furthermore, this is the first case of congenital methemoglobinemia reported in the Nepalese population. Case presentation: We herein present a case of a 33-year-old male with congenital methemoglobinemia, the first reported case among the Nepalese population. His peripheral oxygen saturation level did not improve despite increasing the oxygen supplementation, and a saturation gap of more than 5% was present. The dark brown color of the blood was noted on the blood sample. On investigations, the methemoglobin level was 9%. Clinical discussion: Congenital methemoglobinemia can occur due to a deficiency of an enzyme known as cytochrome b5 reductase, which primarily converts methemoglobin to hemoglobin. There are two types of congenital methemoglobinemia, type I and type II which can be distinguished clinically by the presence of neurological impairment and mental retardation, which can be seen in type II congenital methemoglobinemia. Conclusion: Congenital methemoglobinemia is a rare syndrome and has not been previously reported in the Nepalese population. Although there are various diagnostic clues including relevant medical history, saturation gap of more than 5%, dark brown coloration of blood, and investigations such as methemoglobin level, healthcare services like cytochrome b5 reductase enzymatic activity and molecular genetic testing regarding congenital methemoglobinemia is recommended.