Burkitt lymphoma in a scalp region: a case report of it's recurrence in a 13-year-old child.

Introduction: Burkitt lymphoma (BL) is an aggressive non-Hodgkin lymphoma characterized by chromosome 8 MYC gene translocation. It manifests in three clinical types: immunodeficiency-related, sporadic (nonendemic), and endemic (African), each differing in epidemiology and clinical behavior. Treatment typically involves enrollment in clinical trials or intensive chemotherapy regimens like R-CODOX-M/IVAC. The authors present a case of recurrent BL following treatment. Case report: A 13-year-old female presented with a gradually progressive swelling in the left parieto-occipital region. Examination revealed normal vital signs and a Glasgow coma scale, with seronegative findings on investigations. An excision of a subganglion soft tissue tumor was performed, revealing histopathological features suggestive of a small round blue cell tumor. After chemotherapy, the patient experienced a recurrence in the scalp region, diagnosed as BL. Discussion: While scarce reports exist on BL in the scalp region, cases have been documented in various body locations. Treatment strategies, including chemotherapy and surgery, have shown promising results in managing the disease and improving symptoms. Conclusion: The recurrence of BL is rare, highlighting the importance of vigilance in monitoring patients post-treatment. The authors report a case of recurrent BL in a 13-year-old female, emphasizing the need for continued research and surveillance in managing this aggressive malignancy.

Epidermal cyst protruding from the occipital region of the scalp: a case report.

Introduction and importance: Epidermal cysts are the most common subcutaneous tumor typically observed on the scalp, face, neck, back, or trunk. Epidermal cysts conventionally range in size from 1 to 5 cm, with sizes greater than 5 cm rarely reported. Case presentation: Here, we present a case of a 58-year-old female housewife who presented to our surgery outpatient department (OPD) with a history of a mass in the left occipital region. The mass was first noticed 3 years back and was small and associated with mild itching. The mass progressively increased in size over the course of 3 years. Her present complaint was a painful mass associated with itching, headache, and pus discharge when compressed. The pain was relieved by taking medication. Clinical discussion: The epidermal cyst was confirmed on biopsy, and subsequent excision of the cyst was done under general anesthesia; the occipital bone was eroded by the inferior part of the cyst - reconstruction of scalp defect done by rotational scalp flap. Conclusion: Epidermal cysts, being a slow-growing benign tumor, can pose diagnostic difficulties, especially when located in the scalp area. In addition to that, when cranial bones and intracranial structures are affected by the cyst, they can even lead to complications and interventional difficulties.

Dilemma in diagnosing incomplete Kawasaki disease in a resource limited setting.

Introduction and importance: Kawasaki disease (KD) is an acute febrile systemic vasculitis that predominantly affects small to medium sized vessels and mostly occurs in children below 5 years of age. The morbidity and mortality mostly occur due to cardiac involvement. Case presentation: The authors present a case of a 5-year-old male child from hilly region of Nepal who presented with fever for 7 days along with strawberry tongue and non-exudative conjunctivitis without rashes, extremity changes or lymphadenopathy. A suspicion of incomplete KD (IKD) was made. The notable investigation findings were increased erythrocyte sedimentation rate, C-reactive protein, leucocyte count and platelets. Echocardiography showed normal findings. Based on the clinical features and supplemental laboratory findings, a diagnosis of IKD was made. The patient improved after intravenous immunoglobulin and Aspirin. Clinical discussion: The main learning objective that the authors get from this case is the challenges in the diagnosis of IKD in the resource limited setting like Nepal. Whether or not to start intravenous immunoglobulin is a dilemma for the physician in most of the cases of suspected IKD, due to the high cost and poor availability of intravenous immunoglobulin in this setting. Hence, the use of inflammatory markers, supplemental laboratory findings together with the few diagnostic criteria met by the patient helps in making a diagnosis and institute timely treatment with intravenous immunoglobulin and aspirin. Conclusion: Diagnosis of KD in difficult in resource limited setting.

Acute reversible monoparesis in multiple neurocysticercosis: A case report and review of literature.

Focal neurological deficit like monoparesis due to cortical lesions is a rare entity. In spite of the common presentations like seizures and headaches in neurocysticercosis, occurrence of reversible monoparesis is an atypical phenomenon. Even in the absence of infarct or hemorrhages, manifestation of neural deficit due to compressive effect only is an interesting finding. And on top of that, reversible nature of the deficit in space occupying lesion is a rare occurrence in the existing literature. Here, we describe a known case of neurocysticercosis with reversible acute monoparesis secondary to multiple neurocysticercosis. The variations with which neurocysticercosis can present broaden our understanding in its pathophysiology and management protocol.

Overlapping Symptoms of COVID-19 and Giant Cell Arteritis: The Need for a Higher Degree of Suspicion for Diagnostic Differentiation.

Giant cell arteritis (GCA) is a large cell vasculitis that can present with a plethora of symptoms affecting several different systems. Before the COVID-19 pandemic, diagnosis of GCA was straightforward since the list of differential diagnoses for this disease was relatively short. However, the development of a SARS-CoV-2 viral infection challenges this standard. COVID-19 is a viral illness that also can present with similar vascular symptoms as GCS and creates a substantial inflammatory reaction, similar to most vasculitis. We present a case of a patient who had developed GCA after recovering from a COVID-19 viral illness. This is a rare presentation of GCA in the setting of COVID-19, and recognition of the nuanced differences between the two diseases may significantly change a patient's prognosis if not detected early.

Internet Addiction among Undergraduate Medical Students of a Medical College: A Descriptive Cross-sectional Study.

Introduction: Internet addiction denotes the compulsive use of the internet which affects physical, mental, social, psychological and academic aspects of life of an individual. Very few studies among medical students in regard to internet addiction have been conducted. Our study aimed to determine the prevalence of internet addiction among undergraduate medical students of a medical college. Methods: This is a descriptive cross-sectional study conducted in a medical college from September to December, 2021 after obtaining ethical clearance from the Institutional Review Committee (Registration number: 442). The study was conducted among 229 medical students using convenience sampling technique. Internet addiction test questionnaire was used for collecting data. Data were entered in Google Spreadsheet and analysed with Microsoft Excel 2016. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: The prevalence of internet addiction among 229 undergraduate students was found to be 121 (52.84%) (43.95-61.73 at 95% Confidence Interval). Out of them, mild and moderate internet addiction accounted for 90 (74.38%) and 31 (25.62%) respectively. Conclusions: The prevalence of internet addiction in this study was higher in comparison to the other studies conducted in similar settings. Keywords: internet addiction; medical students; Nepal; prevalence.

Case Report: Pulmonary sarcomatoid carcinoma in a female patient from Nepal.

Sarcomatoid carcinoma of the lung is an uncommon subtype of non-small-cell lung cancer (NSCLC). Even in the early stages, pulmonary sarcomatoid carcinoma (PSC) has a dismal prognosis when compared to other kinds of NSCLC with a mean survival of 9-12 months and a five-year survival rate of around 20%. We present the case of a 68-year-old woman with a two-month history of shortness of breath and cough. Initial computed tomography (CT) scan showed features of interstitial lung disease with chronic obstructive airway changes. After 34 months, the patient's condition worsened with newer complaints of sore throat and hemoptysis. A repeat CT scan showed a ∼49x38x59mm size lesion in the superior segment of the left lower lobe. A core needle biopsy was performed, which revealed tumor cells consisting of irregular tubules and sarcomatoid components. The patient was started on chemotherapy. Unfortunately, she succumbed to her disease. Our case highlights the aggressiveness of PSC.

Scenario of Head Injury Patients in Tertiary Care Hospital of Nepal.

BACKGROUND: The aim of the study is to find out the age and sex distribution, modes of head injury and correlate Glasgow Coma Scale with Computed Tomography in patients with head trauma in our center. METHODS: A cross-sectional study was performed among 113 patients of acute head trauma presenting to Emergency department of our hospital for three months. The severity of the head injury was assessed on admission by the Glasgow Coma Scale score and categorized as mild, moderate, or severe head injury. Non contrast head computed tomography was obtained. RESULTS: The mean age of patients studied in this study was 35.53 year in males and 32.1 year in female with male to female ratio being 1.86:1. The most common causes of head injury were road-traffic accident 58 (51%), falls 42 (37%) and physical assault 13 (12%). In our present study, 67 (59.3%) of patients had mild head injury, 27 (23.9%) had moderate head injury and 19(16.8%) had severe head injury. Our study shows presence of multiple lesions with depressed bone fracture of skull bone was associated with lower Glasgow Coma Scale. Significant association between Glasgow Coma Scale and computed tomography finding was seen(p less than 0.001). CONCLUSIONS: Glasgow Coma Scale is strongly associated with computed tomography in patients with head injury. Road traffic accident is the commonest mode of injury. Most present with mild head injury.

Prevalence of Ruptured Intracranial Aneurysms in a Tertiary Care Hospital of Nepal.

INTRODUCTION: Intracranial aneurysms affect 3-8 percent of the world's population, with ruptured aneurysms being the most common cause of subarachnoid hemorrhage. The sensitivity of Computed Tomography Angiogram in diagnosing intracranial aneurysm is 97%. The aim of our study is to find out the prevalence of ruptured intracranial aneurysms among all the admitted cases encountered in our hospital. METHODS: A descriptive cross-sectional study was done at Upendra Devkota Memorial National Institute of Neurological and Allied Sciences from 2016 to 2018. Convenience sampling method was done. In order to detect the site and size of aneurysms, 16 slice Siemens Computed Tomography with Computed Tomography angiogram was used. Ethical approval was obtained from the Institutional Review Committee at Upendra Devkota Memorial National Institute of Neurological and Allied Sciences. Based on demographic data and computed tomography angiography findings, various morphometric parameters along with demographic parameters were considered for the study. RESULTS: Among 10,856 cases, prevalence of ruptured intracranial aneurysms were found in 42 (0.386%) [Confidence Interval= 0.395 to 0.377]. Among 42 cases, Middle Cerebral Artery aneurysm was present on 16 (39.02%) followed by Anterior Communicating Artery on 14 (34.14%), then Posterior Communicating Artery on 5 (12.19%). The largest neck and dome size were seen in basilar tip aneurysm with size of 11mm and 8mm respectively. The most common type was Fischer grade 4. CONCLUSIONS: The prevalence of ruptured intracranial aneursyms were found to be higher as compared to the other international studies.