Diclofenac induced anaphylaxis: A case report from Nepal.

Introduction: Diclofenac is considered a generally safe medication, and cause few side effects like dyspepsia, diarrhea/constipation, nausea, and vomiting, stomach bleeding, rash, urticaria, photosensitivity reactions, acute renal failure, analgesic nephropathy, bone marrow and liver diseases. Rarely, it causes anaphylactic reaction. Case presentation: We report a case of 40 years male who developed anaphylactic reaction after intravenous infusion with diclofenac. Discussion: Both the pulmonary embolism and anaphylaxis guidelines emphasize the importance of a thorough evaluation when making a diagnosis. Mast cells secrete tryptase, a neutral protease that is specifically concentrated in the secretory granules of human mast cells (but not basophils), along with histamine, as a marker of mast cell activation. Conclusion: Although intravenous diclofenac sodium is a safe and often used medicine, it can cause severe and perhaps fatal anaphylactic responses.

A case report of anaphylaxis induced by topical use of extract of Cynoglossum wallichii var. golchidiatum.

Introduction: Cyanoglossum wallichii var. golchidiatum is a perennial plant that contains pyrrolizidine alkaloids of many types and used as traditional medicine for wounds, burns, and infections. Case presentation: We report the first diagnosed case of 50 years old male who presented with anaphylaxis after the use of local herbal remedies ( Cyanoglossum wallichii var. golchidiatum ) in his cut injury. Discussion: Without seeing a doctor, individuals in our region of the world administer herbal plants for conditions like burn healing, infections, and wound healing. As a result, there is a delay in the course of treatment, and the herbal therapies have a number of negative side effects. Numerous academic studies have demonstrated the numerous advantages of herbal plants, but despite these advantages, there is a lack of sufficient scientific evidence and knowledge regarding their use and potential drawbacks. Conclusion: Non-judicial use of Cyanoglossum wallichii var. golchidiatum may lead to potentially life-threatening condition like anaphylaxis.

Steroid-induced avascular necrosis: A case report on a patient treated with steroid therapy for COVID-19.

Introduction: COVID-19 must get a combined approach that involves epidemiology, surveillance, accurate diagnosis, and prophylaxis. Corticosteroids use in the treatment of COVID-19, for a long time at high doses, can cause steroid-induced avascular necrosis. Case report: The patient is a 22-year-old female. She came with a complaint of bilateral groin pain for 4 months. The pain was abrupt in onset, continuous, non-radiating, aggravated by walking and relieved with rest. We did an X-ray of the bilateral hips, blood tests, and MRI. With the investigations, we established the diagnosis of avascular necrosis of the femoral head. Discussion: Ischemia of the femoral head is caused by any interruption in the blood supply of the acetabulum. It is induced by high-dose and long-term steroid usage. Glucocorticoids affect the metabolism of lipids which results in the formation of fat emboli and lipoprotein globules. This blocks peripheral vessels and leads to necrosis of the bone due to ischemia. Conclusion: Avascular necrosis of the femoral head has been reported in patients treated with corticosteroids while being treated for COVID-19. So, physicians should keep it as a possible diagnosis and enhance their knowledge on this topic.

Hypothyroidism Induced Hyponatremia: A Case Report.

Thyroid hormones have various effects on the body which include electrolyte and water hemostasis. It is also involved in renal development and physiology. Hyponatremia is a serious electrolyte imbalance that can be associated with the involvement of different body systems and a wide range of deleterious changes. We report a case of a 62-years-old female with the symptoms of severe hyponatremia like altered mental sensorium with a serum sodium level of 110 meq/l. After ruling out other causes, a final diagnosis of hypothyroidism was made. On treating hypothyroidism the symptoms of hyponatremia were resolved. Therefore, thyroid stimulating hormone determination is mandatory during the evaluation of hyponatremia. And, those patients should be treated with fluid restriction and treatment of hypothyroidism.

Status Dystonicus with Atypical Presentation in Developmentally Delay Child: A Case Report.

Status dystonicus is characterised by involuntary sustained or intermittent muscle contractions of muscles causing repetitive twisting movements, abnormal postures of the body, or both is a rare but life-threatening movement disorder. Early diagnosis and management of status dystonicus prevent serious complications. We report a 2 years old previously developmental delay diagnosed girl who presented with generalised contractions of the whole body. Tightening of limbs is aggravated by touching her backside which is a very unique feature. Dystonia is associated with severe sweating and was confused with a seizure event. The patient was treated with midazolam, clonidine, phenytoin, gabapentin, pyridoxine, baclofen, and trihexyphenidyl. She was admitted to the intensive care unit for monitoring. The patient partially recovered after 10 days of treatment. Keywords: aspiration; children; dystonia; epilepsy; pneumonia.