Infantile tremor syndrome with global developmental delay and microcephaly in a 16-month-old male: a case report.

Introduction and importance: Infantile tremor syndrome (ITS) affects children aged 6-18 months, and is characterized by tremors, pallor, developmental regression, skin pigmentation changes, and sparse hypopigmented hair. This case report highlights an ITS presentation in a 16-month-old exclusively breastfed male, emphasizing the significance of complementary feeding. Case presentation: The patient presented with abnormal body movements, loss of developmental milestones, hyperpigmented skin changes, hypopigmented scalp hairs, pallor, and microcephaly. Born to a vegetarian mother with inadequate prenatal care, the child's exclusive breastfeeding till 16 months of age without complementary feeding led to severe developmental delay and moderate malnutrition. Diagnostic workup revealed vitamin B12 deficiency, anaemia, and neurologic abnormalities. Clinical discussion: ITS is associated with various manifestations, including pallor, hyperpigmentation, and tremors, commonly linked to vitamin B12 deficiency. In this case, developmental delays and malnutrition underscored the importance of early recognition. Despite neurological improvement with vitamin B12 supplementation, ITS's long-term impact on cognitive functions necessitates vigilance and appropriate nutritional interventions. Conclusion: Early recognition of ITS is vital for the prevention of long-term neurodevelopmental sequelae. Injectable vitamin B12 supplementation and nutritional interventions have demonstrated significant developmental gains. Increased awareness among mothers about nutritional intake during pregnancy and lactation is crucial, especially among vegetarians.

Thrombosis of sigmoid sinus, transverse sinus, and internal jugular vein in chronic otitis media in 9-year-old girl: a case report.

Introduction and importance: Chronic otitis media can lead to dreadful intracranial complications, the most common being meningitis. A concomitant finding of thrombosis in more than one sinus with a cerebral vein is extremely rare. Septic sigmoid sinus thrombosis has an infectious origin and the treatment is debatable between antibiotics and surgery. Case presentation: A case of 9-year-old female with prolonged symptoms of right sided ear discharge, fever, right sided neck pain, and vomiting. Examination revealed tachycardia and neck rigidity suggesting meningitis. The child developed shock, generalized seizure, and a persistent high grade fever in the course of hospital stay. Brain imaging revealed sigmoid, transverse, and internal jugular thrombosis. Blood culture grew both gram-positive and gram-negative bacteria, suggesting the infectious origin of the thrombus. The authors treated meningitis with cephalosporin and vancomycin at first, and then additional antibiotics to treat the septic sigmoid sinus thrombosis. Clinical discussion: Sigmoid sinus thrombosis is a rare condition caused by infections, thrombophilia, head trauma, some types of cancer, and intravenous drug use. Cerebral vein or sinus thrombosis can lead to raised intracranial pressure and can cause fever, otalgia, headache, vomiting, cranial nerve palsies, papilledema altered mental status and may cause seizures, stupor, and coma. Prompt diagnosis by CT scan or MRI and prompt treatment with antibiotics are crucial. Conclusion: Sigmoid sinus thrombosis with involvement of the transverse sinus and internal jugular vein is a rare complication of chronic otitis media, and should be suspected if a recurring fever with features of raised intracranial pressure is present in a child with chronic otitis media.

Postpartum Guillain-Barré syndrome: a case report.

Guillain-Barré syndrome (GBS) is an immune-mediated disorder of the central nervous system presenting as symmetrical, progressive weakness and areflexia. The incidence of GBS is very low during pregnancy, but the risk increases in the postpartum period. The management is done by intravenous immunoglobulin or conservatively. Case Presentation: Case of 27 years female with parity 1, living 1, on postpartum day 20 presented to the emergency department (ED) with weakness over legs and hands since 20 days following emergency lower segment cesarean section for her delivery. The weakness prevailed over the lower extremities and progressed to the upper extremities in 4-5 days, affecting her grip strength and ability to stand alone. No history of prior diarrheal or respiratory illness. Cerebrospinal fluid analysis revealed albuminocytologic dissociation. A nerve conduction study showed in-excitable bilateral radial, median, ulnar, and sural nerves. Intravenous immunoglobulin was administered at the rate of 0.4 g/kg once daily for 5 days. Patient was discharged after 2 weeks with regular physiotherapy follow-up. Conclusion: GBS in the postpartum period is very rare. There must be a high degree of suspicion among physicians for GBS if a pregnant female or a woman during her postpartum period presents with ascending muscle paralysis, even if there is no recent antecedent history of diarrheal episodes or respiratory illness. An early diagnosis with multidisciplinary supportive measures helps improve the prognosis for both the mother and the fetus.

Vulval Aggressive Angiomyxoma in a 19 year teenager: a case report.

BACKGROUND: Aggressive Angiomyxoma is a benign, slowly growing, locally aggressive and recurrent tumour that occurs in the pelvic-perineal region of females in their reproductive years. It presents as a painless, soft, gelatinous mass and metastasizes rarely. Suspicion can be made based on clinical examination and radiological imaging but final diagnosis is confirmed only after histopathology and immunohistochemistry. The choice of treatment is surgical wide local excision. CASE PRESENTATION: We hereby present a case of a 19-year, unmarried lady, with a body mass index of 21 kg/m2, who presented with a chief complaint of painless mass in left vulva which progressively increased in size in the past one year. Clinical examination revealed a large, cauliflower like, exophytic mass of 10 cm × 10 cm size. Radiological imaging confirmed involvement of lymph nodes. Wide local excision with adequate tumour free margin and depth was used as a treatment modality. The diagnosis was confirmed via histopathological examination of the excised specimen. There is no recurrence in the patient up to date. CONCLUSION: Aggressive Angiomyxoma is a rare tumour and it is most often misdiagnosed. This report highlights the importance of considering Aggressive Angiomyxoma as a differential diagnosis of vulval masses and the two-step surgical approach for its treatment in low resource setting.

Prevalence of Menstrual Abnormalities and its Effect among Undergraduate Students.

BACKGROUND: Menstrual abnormalities are menstrual problems that women face during their reproductive years. Globally, they are the most prevalent disorders affecting quality of life in females. This study aimed to assess the prevalence of menstrual abnormalities, its effects and health seeking behaviour of the respondents. METHODS: A cross-sectional study of 30 days was conducted among the undergraduate female students of BP Koirila Institute of Health Sceince who were more than 18 years and had attained their menarche. Total number of responses recorded were 137. Data was collected online via google forms and descriptive analysis was done using SPSS 23. RESULTS: Out of 137 participants, 94.89% had menstrual abnormalities. Among which, 75.38% females sought treatment. Dysmenorrhea and Pre-menstrual syndrome were found to be the most prevalent abnormality. The quality of life was affected in most of the females in terms of lack of concentration in study (91.54%), missing the opportunity for socialization (95.39%), inability to perform physical exercises (82.31%), extra hours of confinement to bed (38.46%) and unable to attend lectures (30%). CONCLUSIONS: The prevalence of menstrual abnormalities were high. Quality of life was affected in all the subjects with menstrual abnormality but only few of them were seeking treatment with a professional doctor.