From inguinal to giant femoral hernia: An unusual postoperative twist - A rare case report.

INTRODUCTION AND IMPORTANCE: Femoral hernias following inguinal hernia repairs are an unusual occurrence that presents diagnostic challenges for healthcare providers. Surgical repair of inguinal hernias is generally successful, but complications and recurrence can arise. The coexistence of femoral hernias following inguinal hernia repairs is rare, requiring careful evaluation and management. CASE PRESENTATION: A middle-aged patient sought medical attention with complaints of recurrent groin pain and a palpable bulge in the inguinal region. Initial imaging studies, including ultrasonography and contrast-enhanced computed tomography (CT), pointed towards an inguinal hernia, leading to the scheduling of surgical repair. However, during the operation, the surgeon discovered a femoral hernia, highlighting the limitations of imaging techniques in accurately diagnosing these hernia types. CLINICAL DISCUSSION: Due to anatomical variations and overlapping signs and symptoms, distinguishing between femoral and inguinal hernias can be challenging. Scar tissue from previous inguinal hernia repairs can further complicate imaging interpretations. Intraoperative exploration becomes crucial to confirm the diagnosis and facilitate proper surgical repair. CONCLUSION: The reported case emphasizes the importance of maintaining vigilance in evaluating patients with suspected hernias, particularly those with prior inguinal hernia repairs. Relying solely on imaging studies can lead to misdiagnosis, as illustrated by the discovery of a femoral hernia during surgery. Healthcare providers should be aware of the possibility of femoral hernias and conduct comprehensive evaluations to ensure timely intervention and improve patient outcomes. Further research and awareness are essential to optimize the care of such uncommon clinical scenarios.

Infection-associated hemophagocytic lymphohistiocytosis: a case report.

Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a rare hyperinflammatory disorder characterized by fever, cytopenia, splenomegaly, and hemophagocytosis. Without prompt treatment, HLH can rapidly progress to life-threatening multiorgan failure. The authors present a case of occult HLH with severe bicytopenia and organ dysfunction requiring intensive care. Case presentation: A 20-year-old male presented with fever, cough, and constitutional symptoms. He developed hypoxia, elevated transaminases, and bicytopenia. Despite transfusions, platelet counts remained critically low. With high suspicion for HLH, head computed tomography and bone marrow biopsy was although panned but couldn't be performed due to resource less settings. And with suspicion for HLH treatment with high-dose dexamethasone was initiated as counts improved. Clinical course: The patient required mechanical ventilation for pulmonary infiltrates. He exhibited seizure activity and epistaxis related to coagulopathy. On hospital day 9, he was successfully extubated as counts normalized. He was discharged from the intensive care unit once stable. Conclusion: This case illustrates a delayed diagnosis of HLH masquerading as a fever of unknown origin. HLH should be urgently considered in patients with unexplained cytopenia, organ dysfunction, and systemic inflammation. Early treatment with immunotherapy can be lifesaving, whereas delays may precipitate irreversible end-organ damage.

A case report on serendipitous diagnosis of wilson's disease in a child with brucellosis and pseudomonal infection.

Wilson's disease can have varied clinical manifestations and initial presentation can be misleading as in our case. Our case depicts the necessity of suspicion of WD in variable presentation of liver disorders, especially in pediatrics population.

Appendicitis as a presentation of COVID-19: A case report.

BACKGROUND: Coronavirus disease-19 (COVID-19) is an infectious respiratory disease caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2). Respiratory symptoms and flu-like presentation are the most defined clinical manifestations. However, gastrointestinal symptoms with acute abdomen have been reported in a small percentage, occasionally mimicking acute appendicitis. Hence, the diagnosis of COVID-19 should be suspected and investigated in every case of acute abdomen in the present situation. CASE PRESENTATION: We report a case of a 25-year-old male who presented with features of acute appendicitis. Despite the equivocal ultrasound results, he was scheduled for an emergency appendectomy for Alvarado's score 7 out of 10, who underwent a successful appendectomy. The patient had initially tested negative on an upper respiratory COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) with normal chest X-ray but few hours after the surgery patient developed a high-grade fever. An RT-PCR for COVID-19 was resent following a suspicion that came out to be positive. CLINICAL DISCUSSION: Several case reports have suggested a probable association between COVID-19 and appendicitis. This case shows the limited effectiveness of clinical diagnosis for the surgical abdomen in COVID-19 patients as these two conditions share similar symptoms often needing a clinical vigilance. CONCLUSION: This case reports acute appendicitis in a patient who tested positive for SARS-CoV-2 subsequently following emergency appendectomy highlighting the acute gastrointestinal presentation of COVID-19. This case exemplifies the necessity to be familiar with the gastrointestinal symptoms of COVID-19 and maintain a high level of suspicion for COVID-19 infection in cases of abdominal pain.

Prevalence, Risk Factors and Outcome of Pregnancy induced Hypertension in Nepal: A Meta-Analysis of Prevalence Studies.

BACKGROUND: Pregnancy induced hypertension is a major cause of global maternal mortality and morbidity. This review was conducted to fulfill the objective of evaluating the status of pregnancy induced hypertension in Nepal. METHODS: The protocol for this review was registered in PROSPERO (CRD42020211210). Pubmed, Embase, Google Scholar, Scopus and Pubmed Central were searched using appropriate keywords for relevant studies. Data analysis was performed using Comprehensive Meta-Analysis Software version 3. Forest plot was used to visualize the prevalence and risk factors of Pregnancy induced hypertension. Random effect model was used and the level of heterogeneity was high. Joanna Briggins Institute bias assessment tool was used for the analysis of bias in the included studies. RESULTS: Twenty studies were included in the review. The pooled prevalence of pre-eclampsia and eclampsia were 2.6% (95% CI, 1.2%-5.3%) and 0.5% (95% CI, 0.2%-1.1%) respectively. The majority of cases were young women and had not complete or unbooked antenatal visits. Cesarean delivery was the most common mode of deliveries in 50% of deliveries (proportion, 0.50; 95% CI, 0.40-0.60) among patients with PIH followed by vaginal deliveries in 43.1% (proportion, 0.431; 95% CI, 0.336-0.532); and rest 6.9% were vacuum/forceps assisted deliveries (proportion, 0.069; 95% CI, 0.050-0.093). Common maternal complications were abruption in 6.56% of Pregnancy induced hypertension cases, rest were pulmonary embolism, renal injury. CONCLUSIONS: The prevalence of pre-eclampsia and eclampsia in Nepal were 2.6% and 0.5%. Younger woman and women with poor antenatal checkups had increased risk of Pregnancy induced hypertension. Cesarean delivery was the most common route of delivery and common maternal complications were abruption placenta, pulmonary embolism, renal injury etc. Keywords: Eclampsia; hypertension; maternal mortality; Nepal; pre-eclampsia; pregnancy-induced.

Successfully managed aluminum phosphide poisoning: A case report.

INTRODUCTION: and Importance: Aluminum phosphide (ALP) is a commonly available pesticide in agricultural countries like Nepal. Upon ingestion, this releases highly toxic phosphine gas in the gastrointestinal tract when it comes in contact with humidity. This leads to refractory shock, metabolic acidosis, cardiac arrhythmia, renal failure, and hepato-biliary impairment. CASE PRESENTATION: We present a successfully managed case of a 17-year-old girl who ingested 6 g (2 tablets) of ALP tablets with suicidal intent. Although the mortality has been reported as 70-100% with mere ingestion of 150-500 mg of ALP, this case survived even after developing severe metabolic acidosis, acute renal failure, refractory shock, and ventricular tachycardia. CLINICAL DISCUSSION: ALP poisoning is most often lethal. However, there is an emerging evidence of successful use of various drugs such as magnesium sulfate, trimetazidine, and other interventions such as intra-aortic balloon pump and extra corporeal membrane oxygenation in case of ALP poisoning. CONCLUSION: Owing to the unavailability of an effective antidote of ALP to date, we emphasize early initiation of supportive management, intensive monitoring, and potential role of membrane stabilizers like magnesium sulfate, and cardio-protective agents like trimetazidine, N-Acetyl cysteine, thiamine, vitamin C, and hydrocortisone in decreasing the likelihood of fatal outcome.