Cytomegalovirus hemorrhagic colitis in an immunocompetent patient with COVID-19 infection: A case report.

In coronavirus disease-19, we should suspect the opportunistic coinfections even in immunocompetent individuals. In the presence of recurrent gastrointestinal problems, colonoscopy should be done with biopsy and histopathology to diagnose the opportunistic infection, such as cytomegalovirus colitis, in patient with coronavirus disease-19. Here, we report a case of immunocompetent male with coronavirus disease-19 presenting with per rectal bleeding diagnosed as cytomegalovirus colitis.

Multiple myeloma with plasmacytoma of the clivus bone presenting with multiple cranial nerve III, IV, and VI palsy: A diagnostic dilemma.

Central nervous system (CNS) manifestation with cranial nerve palsy in multiple myeloma (MM) is a rare manifestation. Plasmacytoma originates from the bones of the skull base in 3% patients with MM but rarely develops from the soft tissues of the nasal cavity and paranasal sinuses. Here, we present a case of 68-year-old male patient with multiple myeloma, clivus bone plasmacytoma, and cavernous sinus syndrome.

Teenager with acute psychosis due to non-paraneoplastic anti-N-methyl-d-aspartate receptor encephalitis with a successful recovery: A case report.

Introduction: Anti NMDAR encephalitis is a neuropsychiatric syndromic disease caused by an immunological response. Acute behavioral changes, psychosis, and catatonia are common clinical manifestations, are seizures, amnesia, speech difficulties, dyskinesia, and autonomic dysregulation. Case presentation: We discuss the case of a 14-year-old girl who had psychotic symptoms and tested positive for anti-NMDAR antibodies. Discussion: Patients present with psychiatric symptoms such as delusions, hallucinations, agitation, changes in speech mania, disorganized thinking, catatonia, insomnia, and often seizures. Anti-NMDAR encephalitis should be suspected in teenage patient with acute psychotic symptoms and seizure episodes. A multidisciplinary treatment strategy is required. Conclusion: The delayed treatment can lead to complications and delayed recovery complicating the disease process so multidisciplinary approach of treatment is necessary.

CT-IGFBP-4 as a Predictive Novel Biomarker of Ischemic Cardiovascular Events and Mortality: A Systematic Review.

Methods: The electronic databases PubMed, medRxiv, ScienceDirect, and Google Scholar were searched for relevant literature from inception to the 10th of December, 2021. Thus, retrieved literature was screened by title and abstract, followed by full-text screening based on the eligibility criteria. The risk of bias was accessed using the quality in prognostic studies (QUIPSs) tool. The data on cardiovascular outcomes about CT-IGFBP-4 levels were studied and the results were synthesized. Results: Five studies with a total of 1,417 participants were included in our study. The studies reported a low risk of bias. The mean age of the participants was 66.14 and more than 65% were males. Elevated CT-IGFBP-4 levels were associated with poor cardiovascular outcomes and increased mortality in severely ill patients. In contrast, there were no significant findings in the case of stable patients. Sandwich ELISA using lithium-heparin plasma provided a better detection limit of 0.15 ng/ml, low cross-reactivity (<2%), and generated linear results between 12 and 500 ng/ml. Conclusion: CT-IGFBP-4 is an efficient biomarker for the prediction of MACE and mortality in patients with severe ischemic cardiovascular events.

Pegcetacoplan in paroxysmal nocturnal hemoglobinuria: A systematic review on efficacy and safety.

Introduction: Pegcetacoplan, a pegylated penta-decapeptide, targets complement C3 to control both intravascular and extravascular hemolysis. This systematic review aims to study the efficacy and safety of pegcetacoplan in paroxysmal nocturnal hemoglobinuria (PNH). Methods: We performed a comprehensive and systematic literature search for all studies on PubMed, Google Scholar, Cochrane Library, and clinicaltrials.gov. The studies were searched using keywords "paroxysmal nocturnal hemoglobinuria" or "PNH," "Pegcetacoplan" or "Empaveli." The primary outcomes included change in hemoglobin level, transfusion independence, absolute reticulocyte count, and lactate dehydrogenase (LDH) level after pegcetacoplan therapy. The safety outcomes included the proportion of deaths and adverse effects. Results: We included a total of three studies. The total number of patients with PNH was112. 59.83% were female. In the PADDOCK study and study by Hillmen et al., the average increase in hemoglobin was 3.68 g/L and 2.37 g/L, respectively. In the study by de Castro et al., the hemoglobin level increased from below the lower limit of normal and stayed in the normal range (11.1-15.9 g/L). Absolute reticulocyte count and LDH levels decreased in all patients receiving pegcetacoplan. In the study by de Castro et al., LDH level remained stable, and within <1.5× upper limit of normal, whereas in the study by Hillman, the mean change of LDH from baseline was -15 ± 43 U/L. Two of six, seven of 23, and seven of 41 patients reported adverse events in the study by de Castro et al., PADDOCK, and Hillmen et al., respectively. Conclusion: Pegcetacoplan effectively improves hemoglobin level and transfusion requirements in patients with PNH, including those unresponsive to eculizumab.

Post-COVID syndrome: A prospective study in a tertiary hospital of Nepal.

INTRODUCTION: The post-coronavirus disease 2019 (COVID-19) syndrome is defined as the persistence of symptoms after viral clearance and the emergence of new symptoms after a few months following recovery from COVID-19. This study aimed to assess the prevalence of post-COVID-19 syndrome and the risk factors that contribute to its development. METHODS: This study was conducted prospectively in Tribhuvan University Teaching Hospital (TUTH), located in Maharajgunj, Kathmandu. The patients were followed up for three months. RESULTS: The post-COVID status of 300 patients admitted to the COVID emergency of TUTH was studied. The mean age of the patients was 46.6±15.7 years, and the proportion of male (56%) was slightly higher than female (44%). Most of the patients (81.7%) had fever on their presentation to the emergency which was followed by fatigue (81.3%) and cough (78.3%). During the post-COVID phase, fatigue was the most common persistent symptom, with 34% experiencing fatigue after 60 days and 28.3% even after 90 days from the onset of symptoms. Univariate logistic regression showed sore throat (OR 4.6; 95% CI (2.8-7.6)), rhinitis (OR 3.6; 95% CI (2.1-5.9)), fatigue (OR 3.7; 95% CI (1.8-7.6)), diarrhea (OR 4.1; 95% CI (2.4-6.9)), anosmia (OR 6.7; 95% CI (3.9-11.3)), ageusia (OR 7.8; 95% CI (4.5-13.4)) and shortness of breath (OR 14.9; 95% CI (1.8-119.6)) at admission were all predictors of post-COVID syndrome after three months. CONCLUSION: Even after recovering from COVID-19, people with COVID-19 may develop symptoms. As a result, COVID-19's long-term consequences should not be neglected, as they may lead to increased morbidity among patients, consumption of financial resources, and added burden on the health system.

Safety and efficacy of coronavirus disease-19 vaccines in chronic kidney disease patients under maintenance hemodialysis: A systematic review.

Background and aims: Patients on maintenance dialysis are a high-risk, immune-compromised population with 15%-25% coronavirus disease (COVID-19) mortality rate that has been underrepresented in COVID-19 vaccination clinical trials. The aim of study was to review of those studies to determine the safety and efficacy of the COVID-19 vaccination in chronic kidney disease (CKD) patients receiving maintenance hemodialysis systematically. Methods: The effectiveness was assessed by looking at the humoral and cellular responses. The humoral response is defined as de novo IgG- or IgA-anti-SpikeS1 antibody positivity. The establishment of de novo T-cell immunity after immunization was used to measure cellular response. Adverse results were also reported of the included studies to analyze the safety of COVID-19 vaccines. Eight previous works were included in our study. Results: Two doses of COVID-19 vaccines were shown to be effective with seroconversion rate of humoral response ranging from 81% to 97% among eight studies. The T-cell response was shown 67% and 100% in two studies. COVID-19 vaccines did not have notable adverse events and hence can be considered safe. Conclusion: Although a single dosage has not shown to improve humoral immune response in most hemodialysis trials, a double dose has been reported to improve seroconversion rate and humoral immune response. Further research are required to observe if hemodialysis patients generate effective T-cell responses.

Therapeutic drug level of tacrolimus causing intracranial hemorrhage in a patient with renal transplant.

Tacrolimus is used in solid organ transplant patients to prevent rejection, and no case of intracerebral hemorrhage (ICH) has been reported till date. We report a case of 31-year-old man with diabetes and hypertension for ten years who had a renal transplant four years back; diagnosed with tacrolimus-induced ICH.

Late onset ST-elevation myocardial infarction (STEMI) in patient with COVID-19: A case report from Nepal.

Introduction: Although pulmonary consequences are less common in COVID-19 than cardiac issues, it is critical to understand the cause of probable cardiac complications and put the patient on constant watch, especially if they have risk factors such as diabetes mellitus. Case presentation: Here, we report a case of 82-years old male with ST-segment elevated myocardial infarction (STEMI) that was developed as a complication of COVID-19. Discussion: COVID-19 is now known to cause cardiovascular issues such as myocardial damage, heart failure, arrhythmia, and venous thromboembolism. With the involvement of COVID-19, the prevalence of cardiovascular manifestation has increased. The precise processes of extrapulmonary and systemic manifestations following COVID-19 are unknown. There is an elevated risk of cardiovascular harm, notably myocardial infraction followed by acute infection. Conclusion: It is essential to understand the mechanism of potential cardiac complications and to keep the patient on close watch, especially if the patient has risk factors such as diabetes mellitus.

Intestinal Perforation Due to Adult Tapeworm of Taenia: A Case Report and Review of the Literature.

Taeniasis is an intestinal helminth infection due to adult tapeworms belonging to the genus Taenia. Taeniasis remains a major burden in low-income countries in Asia. We present a case of intestinal perforation caused by adult tapeworm of Taenia in a 50-year-old Nepali male. The patients presented to the hospital with severe abdominal pain and intermittent vomiting. Following clinical presentations and imaging features, gastrointestinal perforation was suspected. Surgical removal of adult tapeworm of Taenia, suspected to be T. saginata or T. asiatica, was carried out during exploratory laparotomy, which was followed by an uneventful postoperative period. In addition to case presentation, we systematically review published case reports on taeniasis-related intestinal perforation. A learning point from this case is clinician should maintain a clinical suspicion of taeniasis as a possible cause of intestinal perforation in endemic areas.

Acute Lower Limb Ischemia in COVID-19 Patient with Delayed Presentation.

Thromboembolism is a common complication of SARS-CoV-2, which generally involves venous thromboembolism, although there have been reported cases of arterial thrombosis affecting cerebral, coronary, and visceral arteries, as well as arteries in the extremities. We discuss a case of a 45-year-old diabetic man with COVID-19 who developed late-onset acute lower limb ischemia.

Ileocaecal Tuberculosis Presenting with Massive Hematochezia: A Rare Clinical Manifestation.

Abdominal pain, diarrhea, weight loss, anorexia, and fever are common symptoms of intestinal tuberculosis, while bleeding from the lumen, intestinal obstruction, perforation, and fistula formation are uncommon presentations in ileocaecal tuberculosis. Here, we present a case of a 33-year-old male with intestinal tuberculosis who initially presented with massive bleeding per rectum.

Reactivation of herpes zoster after vaccination with an inactivated vaccine: A case report from Nepal.

COVID-19 has been linked to a number of cutaneous symptoms in COVID-19 patients. Although herpes zoster (HZ) was the first sign of COVID-19 infection in several patients, cases of HZ after COVID-19 vaccination are rare. Here, we report a case of 51-year-old male patient with herpes zoster after Sinopharm (Vero cell) vaccination.

Bronchopleural fistula and bilateral pneumothorax in a patient with COVID-19.

COVID-19 pneumonia causes several complications that include pneumothorax, hydropneumothorax, empyema, and rarely leads to bronchopleural fistula (BPF). BPF is a communication between the pleural space and the bronchial tree. We report a case of 24 years man with pneumothorax, hydropneumothorax, and BPF that appeared after COVID-19 infection.

Efficacy and Safety of Sarilumab in COVID-19: A Systematic Review.

BACKGROUND: It has been found that there is overactivation of immune response in patients with COVID-19. Several studies are going on to assess the role of immunomodulation. IL-6 antibodies such as tocilizumab have been found to have efficacy in the treatment of COVID-19. We aim to assess the role of sarilumab in the treatment of COVID-19 through this review. Main Body. Functional outcomes were assessed on the basis of PaO2/FiO2 ratio, mortality, and ventilation. Adverse events of studies were also noted. Five studies were included in the study. There was improvement in PaO2/FiO2 ratio, reduction in the mortality of the patients, and less number of patients were on ventilation, but there were no significant differences among the comparison and sarilumab group. Sarilumab did not have notable adverse events and can be considered a safe drug. CONCLUSION: Sarilumab is a safe drug with good clinical outcomes in patients with COVID-19 and, hence, could be used as an alternative regimen for the treatment. Further prospective studies exploring the relations with baseline biomarkers of inflammation commonly measured such as C-reactive protein and IL-6 would be necessary for a correlation with the treatment.

Case report of a spontaneous pneumothorax after the recovery from COVID-19 pneumonia: A delayed complication.

This case demonstrates pneumothorax as a consequence of COVID-19 and emphasizes the significance of follow-up of the COVID-19 patients.

Retroperitoneal Fibrosis as a presentation with masked multiorgan involvement of IgG4-related disease-demystifying the diagnosis: A case report from Nepal.

The timely diagnosis of the disease helps in preventing the progression of RF and unnecessary interventions that may mislead the diagnosis. Biopsy and serum IgG4 both can be non-specific.

CNS tuberculoma in patient with tetralogy of fallot: A case report.

We report this case to focus on the importance of early diagnosis, challenges to reach the diagnosis in a low-resource setting, and management that may result in a better prognosis of the patients.

Pancreatic ascites managed with a conservative approach: a case report.

BACKGROUND: Pancreatic ascites refers to the massive accumulation of pancreatic fluid in the peritoneal cavity and is a rare entity. Chronic alcoholic pancreatitis is the most common cause. Ascites is commonly seen in patients with alcoholic liver disease and is usually a consequence of portal hypertension. Biliary pancreatitis, pancreatic trauma and cystic duplications of biliopancreatic ducts, ampullary stenosis, or ductal lithiasis are the remaining causes. CASE PRESENTATION: A 53-year-old Chhetri man, a chronic alcoholic, presented with epigastric pain and abdominal distension. He had made several previous visits to a local hospital within the past 6 months for a similar presentation. Serum alkaline phosphatase 248 IU/L, serum amylase 1301 IU/L, and lipase 1311 IU/L were elevated while serum calcium was decreased (1.5 mmol/l). Ascitic fluid amylase was elevated (2801 IU/L). A computed tomography scan of his abdomen revealed features suggestive of acute-on-chronic pancreatitis. The case was managed with a conservative approach withholding oral feedings, starting total parenteral nutrition, paracentesis, octreotide, and pigtail drainage. CONCLUSION: Pancreatic ascites is a rare entity. Diagnosis is suspected with raised ascitic fluid amylase in the presence of pancreatic disease. Such cases can be managed by conservative approach or interventional approach. We managed this case through a conservative approach.