An unusual case of transverse myelitis in dengue fever: A case report from Nepal.

Key Clinical Message: Dengue fever can also have various neurological complications but involvement of the spinal cord is often unusual. This is a case where the patient had transverse myelitis as a complication of dengue fever. Abstract: Dengue fever can have various neurological complications but involvement of the spinal cord is often unusual. We report a case of a 49-year-old female, a known case of dengue fever, who presented with urine retention, inability to stand and walk with tingling sensation of bilateral lower limbs. Her vibration and joint position sensation was reduced below T2 level along with altered reflexes but MRI could not explain the examination findings. She was diagnosed clinically as transverse myelitis (TM) in the background of dengue fever. She showed drastic improvement with treatment of steroids. As TM as a complication in a patient with dengue fever is rare, and due to the paucity of similar case reports in Nepal, this case report is of value for the scientific community.

Disseminated cysticercosis with tongue involvement: a rare case report from Nepal.

Introduction and importance: Cysticercosis is a condition in which humans are infected by the larval form of the pork tapeworm Tenia solium. Cysticercosis in humans is common in the cerebral tissue but rare in the tongue. Case presentation: Here, the authors report a rare case of a 38-year-old male with neurocysticercosis and cysticercosis of the tongue. The patient presented with a complaint of loss of consciousness for 4-5 min. Local examination of his oral cavity revealed a swelling of ~2×2 cm on the tongue. An MRI of the brain showed various stages of neurocysticercosis involving the neuroparenchyma and tongue. For this, he was started on low-dose prednisolone of 50 mg tapered over 6 weeks and levetiracetam of 500 mg BD continued for his seizure episodes. He is responding well with the medications and is planned to start antiparasitic agent only after the perilesional edema decreases. Clinical discussion: Cysticercosis may involve the central nervous system, muscle, heart, lungs, peritoneum, eye, and subcutaneous tissue. Oral cavity and perioral involvement by cysticercous larva is rare in humans. Radiologic imaging, serology, and tissue biopsy can be used to confirm a diagnosis of cysticercosis. The most common locations for oral cysticercosis are the tongue, buccal mucosa, lower lip, and upper lip.Only 102 cases of oral cysticercosis have been reported based on a PubMed English-language literature search. Conclusion: Oral cysticercosis is a rare event, and it represents a difficulty in clinical diagnosis. But a patient with a mass in the tongue should be considered as a possible case of cysticercosis especially in endemic regions like Nepal.

Long COVID syndrome: psychological and sexual dysfunction among survivors of COVID-19 infection.

Background: To explore the neuropsychiatric symptoms, sleep disturbances, and sexual dysfunction in patients with long COVID syndrome, which can help in building better follow-up strategies for coronavirus disease 2019 (COVID-19) survivors. Material and methods: A cross-sectional research was undertaken at the premises of a psychiatry unit at a tertiary care unit in Karachi, Pakistan, between August 2022 and April 2023. All individuals aged 18 years or older, who had a history of contracting COVID-19 infection in the last 12 months presented to the department of Psychiatry with neuropsychiatric symptoms were recruited. Using a predefined questionnaire, data was collected from the participants. A linear logistic regression was used to find the impact of age, sex, hospitalization, and duration of home isolation on the likelihood of persistent neuropsychiatric symptoms or sexual dysfunction. Results: A total of 457 patients were included. It was found that individuals were less likely to experience neuropsychiatric symptoms as age increased (OR=0.968, 95% CI: 0.949-0.986, P=0.001). Females were 4.8 times more likely to experience neuropsychiatric symptoms than males, and the association was extremely significant (OR=4.851, 95% CI: 3.085-7.626, P<0.0001). An increase in age raised the odds of having sleep disturbances among the survivors by 2.7 times (OR=2.672, 95% CI: 2.654-2.684, P<0.0001). The odds of having sleep disturbances were three times more likely in female participants as compared to male participants (OR=3.00, 95% CI: 1.771-5.094, P<0.0001). Conclusion: The majority of the COVID-19 survivors are presenting with persistent neuropsychiatric and sexual symptoms in our setting. Therefore, it is necessary to maintain proper follow-up with the survivors of COVID-19 and counsel the patients to inform the family physician if these symptoms persist for longer than a month. Increasing such practices of regular follow-ups with COVID-19 survivors can help in detecting early neuropsychiatric and sexual changes.

Pressure sore at an unusual site: the bilateral knee - a case report.

A pressure ulcer is a skin and soft tissue injury that commonly occur on bony prominences like the ischium, sacrum, heel, malleolus, and occiput but the knee is not the usual site for pressure ulcers. Here, the authors present a case of a pressure ulcer over an unusual site, the knee. Case presentation: The authors reported a case of a 66-year-old male, last seen 5 days ago by his son, who was found on the floor (with the knee on the ground) and was brought to the hospital. The patient had no history of mobility issue. On initial assessment his vitals were unstable but Glasgow Coma Scale 15/15 and CT head and ECG were unremarkable. On knee examination, there was bilateral grazing and bruising diagnosed as grade 3 and grade 4 pressure sore in the right and left knee, respectively. The pressure ulcer was managed adhering to the principles to remove all pressure, keep the ulcer clean, prevent further injury, and regular dressing by tissue viability nurses. On 17 March 2023, the patient was discharged from the hospital to a care home after his condition improved. Clinical discussion: A comprehensive review of the medical literature found no other reports of pressure sore at knee. A few published articles showed pressure sore as a complication of prone positioning. It is postulated that fall and long-term lie on the knees have developed this pressure ulcer. Conclusion: The Clinicians should be vigilant to check for pressure ulcers especially in all the bony prominences in any patients having an unwitnessed fall.

Preterm Neonates Admitted in the Neonatal Intensive Care Unit at a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Preterm birth, one of the leading causes of admissions to the Neonatal intensive care unit, is a major contributor to neonatal morbidity and mortality in developing countries. This study aimed to find out the prevalence of premature neonates admitted to the Neonatal Intensive Care Unit of a tertiary care centre. Methods: This descriptive cross-sectional study was conducted from clinical records of preterm neonates (born before 37 completed weeks of gestation) admitted in the Neonatal Intensive Care Unit from 16 July 2020 to 14 July 2021. Following ethical approval from the Institutional Review Committee (Reference number: 077/78-018), the patient's clinical characteristics and systemic morbidities were recorded. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 646 admissions, the prevalence of preterm neonates was found to be 147 (22.75%) (19.52-25.98, 95% Confidence Interval). The male: female ratio was 1.53:1. The median gestational age and birth weight were 33 weeks (Range: 24-36 weeks) and 1680 g respectively. A total of 73 (49.65%) delivery was followed by premature rupture of membrane. The morbidity due to respiratory problems was highest at 127 (86.39%), followed by metabolic at 104 (70.74%) and sepsis at 91 (61.90%). The renal system was the least affected 5 (3.40%). Conclusions: The prevalence of preterm neonates in the neonatal intensive care unit was higher than in other studies done in similar settings. Keywords: morbidity; neonatal; neonatal intensive care unit; premature birth.

Liver metastases - An unusual cause of portal hypertension: A case report.

Introduction: Portal hypertension is a rare complication of liver metastases. The study highlights that clinician should be aware of conditions mimicking cirrhosis with similar clinical presentation and imaging findings. Case presentation: We present the case of a 29-year-old non-alcoholic lady who presented to our hospital with a history of two months of progressive, painless abdominal distension and progressively increasing yellowish discoloration of the eyes. Physical examination, laboratory investigations, and imaging tests led to a diagnosis of multiple metastases from breast carcinoma to the liver leading to portal hypertension after exclusion of other causes of portal hypertension. However, after three weeks of presentation to the hospital, the patient died before any therapeutic measures were initiated to address breast carcinoma. Clinical discussion: Liver metastasis from primary breast carcinoma rarely presents with clinical symptoms of portal hypertension. Although portal hypertension secondary to pseudocirrhosis, predominantly linked to ongoing chemotherapy for known cancers, has been previously described in case studies, our case had an unusual presentation leading to diagnostic uncertainty. Conclusion: Our case highlights the rare cause of liver metastasis secondary to breast carcinoma, which presented as portal hypertension.