Navigating diagnostic challenges in xanthogranulomatous cholecystitis: A case report.

Xanthogranulomatous cholecystitis (XGC) presents a diagnostic challenge due to its rarity and varied clinical manifestations and nonspecific radiological findings. We here describe a 67-year-old man with right hypochondriac pain, where imaging revealed irregular thickening of the gallbladder wall, prompting consideration of various differential diagnoses including gallbladder malignancy, adenomyomatosis, and complicated cholecystitis. With inconclusive lab results, cholecystectomy with potential extended hepatectomy was advised. Intraoperatively, an inflamed gallbladder was observed. Histopathological examination confirmed XGC, stressing histological verification. Complete cholecystectomy is standard, with partial resection an option. Our case details the complexity in diagnosis and management of XGC.

An uncommon encounter: crossed fused renal ectopia with singular ureter: a case report.

BACKGROUND: Crossed fused renal ectopia (CFRE) is a common congenital anomaly where one kidney is positioned abnormally on the opposite side of the midline, often fused with the other kidney. However, single ureter draining crossed fused renal ectopia is a rare occurrence. CASE REPORT: Here, we report a case of crossed fused renal ectopia with a single ureter in a 46-year-old Nepali male who presented with history of lithuria. Computed tomography revealed that the left kidney was situated on the right side and fused with the right kidney. The renal pelvises of both kidneys were fused, and a single ureter, located on the right side, was draining both kidneys into the bladder. The patient was advised to have regular follow-ups. CONCLUSION: Crossed fused renal ectopia with a single ureter represents a rare renal anomaly. Asymptomatic patients can typically be managed conservatively. Regular follow-up is recommended to monitor renal function, calculus formation, infections, and malignant changes.

Zenker's diverticulum: A case study of dysphagia in an elderly gentleman.

Zenker's diverticulum (ZD) is an acquired, false, and pulsion diverticulum formed by the protrusion of mucosa and submucosa through Killian's dehiscence. The index case is a 91-year-old Nepali patient with a known history of diabetes mellitus, hypertension, rheumatic heart disease, and stage 4 chronic kidney disease, who has been experiencing dysphagia, halitosis, and chronic cough for 25 years. A computed tomography (CT) scan of the chest revealed an outpouching filled with air, fluid, and some solid contents, arising at the level of the cricoid cartilage and extending posteriorly to the esophagus, compressing it. A barium swallow test was performed for confirmation and revealed similar findings. The patient was counseled for surgery but declined due to old age and comorbidities. ZD is commonly seen in the geriatric population and patients with neuromuscular discordance. Barium swallow and CT chest scans can diagnose ZD, and surgery is the mainstay of treatment.

A pea in a peculiar place: Unusual case of left upper lobe bronchial foreign body.

Key Clinical Message: Foreign body aspiration is common in old age, sometimes lodged in unusual locations like the left upper lobe bronchus when aspiration happens in a recumbent position. Computed tomography is the preferred diagnostic tool, while flexible bronchoscopy is effective for removing the foreign body. Abstract: Tracheo-bronchial foreign body aspiration (FBA) is common in children and elderly, but often goes unnoticed due to vague symptoms and atypical imaging findings. We present a case of aspiration of pea in elderly presenting with acute symptoms. Computed tomography (CT) reveled an atypical site of foreign body (FB), that is left upper lobe bronchus and immediate removal of the FB was done using a flexible bronchoscope. The symptoms subsided after removal of the FB. Missed FBs can lead to chronic issues like pneumonia and airway obstruction. Advanced age, psychiatric illness, stroke, seizure disorder, and neuromuscular disease increase the risk of aspiration in older adults. Commonly, FBs get lodged in the right middle and lower lobes after aspiration due to vertical orientation of the airways. CT is a helpful tool for diagnosis of FBA and flexible bronchoscopy is effective in removal of the FB in elderly.

Prevalence of exposure to needle stick and sharp-related injury and status of hepatitis B vaccination among healthcare workers: A cross-sectional study.

Background and Aims: Hepatitis B is a leading cause of chronic liver disease and subsequent liver transplantation. This is a vaccine-preventable illness. Health workers continue to be at risk for blood-borne pathogens due to occupational exposures. The overall goals of our study were to determine the prevalence of exposure to needle sticks and sharp-related injuries (NSSI) and hepatitis B vaccination status among healthcare workers (HCWs) of Nepalgunj Medical College Teaching Hospital (NGMCTH), Kohalpur, Banke, Nepal. Methods: A descriptive cross-sectional study was conducted among HCWs at the NGMCTH following ethics approval by the NGMCTH Ethics Review Committee. A pretested structured questionnaire was used to compile the data. Data was collected from September 15, 2021 to September 14, 2022. Collected data entered in Microsoft Excel and analyzed using statistical package for social sciences version 22. Analyzed data were presented using simple descriptive statistics with appropriate figures and tables. Results: A total of 304 among 506 HCWs (60.1%) participated in the survey were exposed to Needle sticks. Nine of whom (3.7%) were injured substantially (more than 10 times). Among nursing students, 21.3% had experience with NSSI. 71.7% of HCWs had received at least one dose of the hepatitis B vaccine, of whom 61.9% (44.5% of total HCWs) had received three doses. Conclusions: This study demonstrated that more than two-quarters of HCWs were exposed to NSSI. Despite being at risk, vaccination status was still low, and less than half only received three complete doses. Precaution should be taken when working with instrumentation and procedures. Hepatitis B immunization programs for HCWs should be delivered at no cost with 100% coverage and protection. Raising awareness about hepatitis B infection and immunization remains crucial to primary prevention.