Congenital unilateral absence of right pulmonary artery with VSD and wide aortopulmonary window in an adult patient: a case report.

Unilateral absence of pulmonary artery (UAPA) is a very rare condition, with an estimated prevalence of 1 in 200,000 population, which is commonly associated with various cardiovascular anomalies or can occur in an isolated manner. Isolated cases survive to adulthood and remain asymptomatic, but they may frequently experience hemoptysis, repeated infections, or symptoms like dyspnea and chest pain. Due to the rarity of the disorder and its ambiguous appearance, diagnosis can be very challenging. Case presentation: We present a case of a 28-year-old male who visited our center with the diagnosis of ventricular septal defect with Eisenmenger syndrome elsewhere for further evaluation and was found to have right-sided UAPA with ipsilateral pulmonary hypoplasia and some associated cardiac anomalies. Clinical discussion: Discussions are held regarding typical chest radiograph findings, diagnostic methods, and possible therapies. Conclusion: Physicians should be aware of UAPA, which might go undiagnosed for several years despite regular medical care and can show up later in life, causing chronic respiratory symptoms along with Eisenmenger syndrome and ventricular septal defect like in our case.

Radiologic finding of intraosseous gas: A rare case of emphysematous osteomyelitis of the foot.

Emphysematous osteomyelitis is a rare but potentially life-threatening infection which is characterized by presence of intraosseous gas. It is a very rare form of osteomyelitis which is complicated by infection with gas forming organisms. In majority of the cases, it has been found to be associated with comorbidities like immunosuppressive therapies, diabetes mellitus, alcohol use, and several others. Early identification on radiologic imaging is necessary to enable implementation of prompt treatment plan.

A rare case of isolated single coronary artery, Lipton's type LIIB diagnosed by computed tomography coronary angiography.

Single coronary artery (SCA) is a very rare coronary artery anomaly of origin and course with a reported prevalence of only 0.024%-0.066% among patients undergoing routine coronary angiography. The majority of the individuals remain asymptomatic and thus SCA is found only incidentally on conventional or computed tomography coronary angiography done for other reasons. A minority of the patients may have non-specific cardiac symptoms (such as ischemic pain, tachycardia, etc.) or even sudden death. SCA can occur in isolation or in association with other congenital cardiac defects like such as persistent truncus arteriosus, tetralogy of Fallot (TOF), pulmonary atresia, transposition of great vessels (TGA), ventricular septal defect (VSD), coronary arteriovenous fistula (AVF), patent foramen ovale (PFO) and bicuspid aortic valve. We present a case of 50 years male with incidental finding of SCA arising from the left coronary sinus which had an inter-arterial course before branching (SCA Type: LIIB based on the Lipton-Yamanaka classification) which was revealed on computed tomography coronary angiography (CTCA) performed after the patient complained of infrequent chest pain. Management of the diagnosed cases can be either conservative, stent placement or surgical correction based on the symptomatology and clinico-lab findings.

A rare incidental finding of an isolated S1 butterfly vertebra: A case report.

Butterfly vertebra is an uncommon type of vertebral anomaly (sometimes referred to as a sagittal cleft vertebra or an anterior rachischisis) caused by persistent notochordal tissue. Butterfly vertebrae of S1, which is rarer anomaly compared to thoraco-lumbar region, may be associated with syndromic causes and usually asymptomatic with a funnel shaped defect seen in imaging which can later give rise to disk problems, facet joint degeneration and chronic low back pain. We here share a case of 35-year female presented with intermittent low back pain diagnosed with S1 butterfly vertebrae as an incidental finding in radiograph and magnetic resonance imaging. Radiologist and orthopedicians should be vigilant about this rare entity as a differential of low back pain and its association with other syndromes.

Duplication of the gallbladder: Case report of a rare biliary malformation.

Duplication of the gall bladder is a rare anatomic variation. The incidence is approximately 1 in 4000 in literature. Preoperative identification of such anomaly and its various types is very important since it can avoid damage to possible vascular and biliary aberrant anatomy during surgery. My case is a 29-year-old male patient with a complaint of epigastric pain which was on and off type. An abdominal ultrasonogram showed multiple calculi in the gallbladder lumen with normal wall thickness and no evidence of intra or extra-hepatic biliary tree dilatation. Another cystic structure was noted adjacent to it with no intraluminal pathology. Magnetic resonance cholangiopancreatography revealed the duplication of the gallbladder and a common cystic duct for both the cavities draining into a common hepatic duct. Multiple filling defects were noted within one of the cavities. The patient was discharged and advised to follow-up. Two months later the patient presented with an episode of acute cholecystitis which was managed by laparoscopic cholecystectomy. Preoperative radiological identification of this anatomic variation helps in planning the surgery accordingly and can prevent perioperative complications.

The relationship between pelvic organ prolapse and short birth intervals in a rural area of Nepal.

BACKGROUND: Pelvic organ prolapse (POP) is one of the main contributors to reproductive health problems that affect women's quality of life. Previous studies have reported the risk factors and prevalence of POP. The aim of this study is to examine the association between POP and short birth intervals in a rural area of Nepal. METHODS: A cross-sectional study was conducted in Panchapuri municipality, located in Surkhet District of Karnali Province in Nepal. A questionnaire was used to collect information on POP, birth intervals, and other known confounding factors, such as age and parity. Multiple logistic regression analysis was used to examine the association between minimum birth intervals and POP. RESULTS: The study recruited 131 women. The prevalence of POP was 29.8%. The mean (SD) of maternal age was 32.3 (0.7) years. The median parity was 2, with a range of 2-6 children. More than half (64.9%) of the women reported a minimum birth interval of less than 2 years. Maternal age at birth, minimum birth interval, parity, and latest birth interval were significantly associated with POP in univariate analyses. After adjusting for the potential confounding factors such as age and occupation, the minimum birth interval was significantly associated with POP [AOR = 3.08, 95% CI 1.04-9.19]. CONCLUSION: The prevalence of POP was high in this rural area of Nepal. Age, parity, occupation, and minimum birth interval were significantly associated with POP.

Prevalence and genetic analysis of phenotypically Vi- negative Salmonella typhi isolates in children from Kathmandu, Nepal.

The Vi capsular polysaccharide (ViPS) protects Salmonella enterica subspecies enterica serotype Typhi (S.Typhi) in vivo by multiple mechanisms. Recent microbiological reports from typhoid endemic countries suggest that acapsulate S.Typhi may occur in nature and contribute to clinical typhoid fever that is indistinguishable from disease caused by capsulate strains. The prevalence and genetic basis of ViPS-negative S.Typhi isolates in children from Kathmandu, Nepal, were tested in 68 isolates. Although 5.9% of isolates tested negative for capsular expression by slide agglutination tests, a novel multiplex PCR assay and individual PCR analyses demonstrated the presence of all 14 genes responsible for the synthesis, transportation and regulation of the ViPS. These data suggest that phenotypically acapsulate S.Typhi may not have a genetic basis for the same.

The burden of vaccine-preventable invasive bacterial infections and pneumonia in children admitted to hospital in urban Nepal.

BACKGROUND: Protein-polysaccharide vaccines have made a significant impact on the burden of disease caused by encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and have the potential to do so for Salmonella Typhi. Nepal is one of many resource-poor nations with limited information on the epidemiology of childhood infections caused by these pathogens. METHODS: Over a 21-month period, we studied children aged ≤12 years admitted to an urban hospital in Nepal with suspected bacteremia, meningitis, or pneumonia. Patan Hospital is a non-profit hospital with the second largest pediatric unit in the Kathmandu Valley. RESULTS: Of 2039 children enrolled in the study, 142 (7.5%) included in the analysis had positive blood cultures. The agents of enteric fever, Salmonella Typhi and Salmonella Paratyphi, accounted for 59/142 (42%) of all bacteremias and were the most frequently cultured pathogens in children ≥1 year of age. S. pneumoniae was isolated in 16% of positive blood cultures and was the most common cause of bacteremia in children <1 year of age. Pneumonia accounted for 51% of admissions in children ≥2 months, with 44% of these children having radiographically defined primary endpoint pneumonia. S. pneumoniae was the most commonly identified pathogen in cases of pneumonia and meningitis. The S. pneumoniae serotype distribution indicated that the 10-valent and 13-valent pneumococcal conjugate vaccines would cover 44% and 47%, respectively, of all S. pneumoniae cultured from blood or cerebrospinal fluid (CSF) isolates and 62% and 67%, respectively, of isolates associated with pneumonia. H. influenzae type b was isolated infrequently from blood or CSF cultures, but is likely to be more important as a cause of pneumonia. CONCLUSIONS: The data on the burden of invasive bacterial infections and pneumonia from this study suggest that vaccines in development against Salmonella Typhi and the pneumococcus have the potential to significantly improve the health of children in Nepal.

Hospital-based surveillance of invasive pneumococcal disease among young children in urban Nepal.

BACKGROUND: Streptococcus pneumoniae is a leading cause of pneumonia and meningitis in young children. Before implementation of the pneumococcal conjugate vaccine in developing countries, there is an urgent need to provide regional epidemiological data on pneumococcal disease. The aims of this study were to determine the prevalence and serotype distribution of invasive pneumococcal disease among young children hospitalized in urban Nepal. METHODS: Children aged 2 months to 5 years who were admitted to Patan Hospital, Kathmandu, with fever and/or suspected pneumonia, meningitis, or bacteremia were recruited. Blood culture specimens were collected from all participants. In cases of suspected meningitis, cerebrospinal fluid specimens were cultured and were tested for S. pneumoniae antigen. RESULTS: A total of 885 children were recruited during the 21-month study period. Of these, 76 (9%) had meningitis and 498 (56%) had pneumonia, on the basis of clinical criteria. Radiographically confirmed pneumonia occurred in 354 (40%), and probable or definite meningitis occurred in 47 (5%). S. pneumoniae was isolated in specimens from 17 (2%) of the children. Serotypes 1 and 12A were isolated most frequently, and only 1 of 17 isolates had a serotype contained in the currently available 7-valent pneumococcal conjugate vaccine. CONCLUSIONS: More than 60% of children aged <5 years who were admitted with fever and/or suspected invasive bacterial disease in urban Nepal had the clinical syndromes of meningitis and/or pneumonia. A new generation of pneumococcal vaccines that prevent infection with a broader range of serotypes may be necessary to most effectively control pneumococcal disease in young children in Kathmandu.