Clinical, Laboratory and Radiological Features of Paragonimiasis Misdiagnosed as Pulmonary Tuberculosis.

Background: Paragonimiasis presents with nonspecific symptoms and radiologic findings, allowing for the possibility of misdiagnosis. Diagnosis is generally delayed due to lack of suspicion and presentation similar to pulmonary tuberculosis. Methods: A prospective observational study was carried out on 20 subjects at Civil Service Hospital of Nepal from March 2015 to June 2019 who presented with eosinophilia and pulmonary symptoms, and were treated empirically with Anti-tubercular therapy for suspicion of pulmonary tuberculosis. Results: The median age of the patient was 34 years. Mean blood absolute eosinophil count was 16678/ul. Fever was present in 80% (n=16). Cough was present in 90% (n=18). Pleural effusion was noticed in 100% (n=20). Chest computed tomography showed ground-glass opacities in 65% (n=13) of patients. Pleural fluid eosinophilia (>10%) was evident in all patients. Pleural fluid LDH was elevated in 85% (n=17) of patients. Similarly, ADA was high (>40U) in 75% (n= 15) of patients, and pleural fluid sugar was low in 80% (n=16) of patients. All patients (100%) gave a history of crab or snail consumption. Paragonimus egg was detected in five (25%) patients. Twenty patients fulfilled definite or probable diagnostic criteria of paragonimiasis. Ninety-five (n=19) patients responded to praziquantel. Conclusion: Unavailability of serologic tests or failure to demonstrate parasitic egg under the microscope should not discourage physicians to consider the diagnosis of paragonimiasis when marked eosinophilia, high LDH levels, and low glucose levels are identified in pleural fluid of a patient with a history of raw crab or snail consumption.

Success of Using Iodopovidone as a Sclerosing Agent for Chemical Pleurodesis in a Tertiary Care Center: A Descriptive Cross-Sectional Study.

INTRODUCTION: Pleurodesis is a procedure to achieve symphysis between the two layers of pleura aimed at preventing the accumulation of either air or fluid in the pleural space. In Nepal, intrapleural instillation of the chemical sclerosing agent is more commonly done as  thoracoscopy facility is not easily available. However, iodopovidone is rarely used for this purpose in Nepal. The study aims to find the prevalence of success using iodopovidone as the chemical sclerosing agent. METHODS: The study included cases undergoing pleurodesis over a two-year period. The clinicodemographic data, diagnosis, treatment effect and treatment response were analyzed. The treatment response was graded as Treatment Success (Complete Response or Partial Response) and Treatment Failure. RESULTS: Pleurodesis was done in a total of 54 cases. Of those, 39 cases were Secondary Spontaneous Pneumothorax, 11 were Malignant Pleural Effusion, 3 were Primary Spontaneous Pneumothorax, and 1 was a case of Hepatic Hydrothorax. Among Secondary Spontaneous Pneumothorax, Pleurodesis was successful in 37 (95%) out of 39 cases, with 35 (90%) having a Complete Response and 2 (5%) having a Partial Response while 2 (5%) had Treatment failure. Among Malignant Pleural Effusion, treatment success was achieved in 6 (55%) out of 11, whereas 5 (45%) failed the treatment. The commonest complication was burning sensation, and the commonest pain scale was "distressing." CONCLUSIONS: This study highlights the safety and ease of use of iodopovidone as an agent for chemical pleurodesis. It confirms the high rate of success of pleurodesis in cases of pneumothorax as found in other studies. In contrast, the success rate is understandably lower in cases of Malignant Pleural effusion.

Tofacitinib as an Adjunct Immunomodulator for Treatment of a Patient with Severe COVID-19: A Case Report.

Severe coronavirus disease 2019 can be associated with progressive respiratory failure. In addition to respiratory support and other supportive care, use of corticosteroids has shown to improve outcome. Despite the use of steroids, a significant proportion of patients progressively worsen. Adjunct immunomodulators have been studied in addition to steroids in these patients. Here we present a successful use of tofacitinib, a Janus Kinase inhibitor, in conjunction with dexamethasone for a patient with rapid worsening of respiratory status and with high level of serum inflammatory biomarkers.

Air due to Glue: Spontaneous Pneumothorax in a Young Adult with Glue Sniffing.

Solvent abuse, as inhalant specially, in the form of low cost adhesives like dendrite is common in low income countries among children and the teens. This habit is often a stepping stone to harder drugs. The neurological and neuropsychological effects of solvent abuse are well explored. But the respiratory effects are often overlooked. In this report, we present a case of a 19 year old gentleman, with regular history of sniffing of commercial "glue" compounds. This patient presented with right sided chest pain and chest x-ray showed a right sided pneumothorax. The pulmonary barotrauma, possibly due to increased intra-alveolar pressure, during the sniffing process can lead to alveolar rupture and in turn, pneumothorax. In the absence of other risk factors for Pneumothorax, the link between inhalant abuse and respiratory complications has to be explored in patients with history of such abuse. Keywords: inhalant abuse; pneumothorax; solvent.

Carbon Monoxide Poisoning due to Gas Water Heater

Background and Objectives: Carbon Monoxide (CO) poisoning is a leading cause of injury and death due to poisoning in many parts of the world. Among numerous sources of CO, the gas water heater can be a potential under looked source causing an accidental Carbon monoxide poisoning. In the perspective of Kathmandu valley, where there are houses with small bathrooms, inadequate ventilation and absent CO detectors, gas water heaters can be extremely dangerous even if it liberates small amount of CO gas. Herein, we present a case of CO poisoning to increase awareness about the gas water heater use and the possible risk of CO poisoning in our community.Presentation of Case: A 34 years old healthy female from Patan, presented with the history of loss of consciousness for 15 minute while taking bath on a gas water heater. There was no spontaneous respiration, no cardiac activity and her body temperature was below normal.Discussion: CO is toxic to all aerobic forms to life. CO binds to hemoglobin 230 times faster than oxygen causing cellular hypoxic damage and death. CO poisoning is not uncommon in our society and many such cases are misdiagnosed for some other illness.Conclusion: Use of the gas water heaters and likelihood of CO poisoning should be notified as a public concern. People need to be aware of these hazards to prevent fatal events and likely death due to exploitation of gas water heaters.

ECG findings in elderly.

There are not sufficient studies on ECG in elderly population in Nepal. This study attempts to evaluate the findings of ECG in elderly population in Nepal. ECG recordings from 171 apparently healthy geriatric subjects aged above 60 yrs (Mean age 70.66 +/- 7.14 yrs) from different geriatric homes were studied. The ECG was entirely normal in 38.6% of the study population. The major abnormalities were sinus bradycardia in 31 (18.1%) subjects, LVH in 25 (14.6%) subjects, premature supraventricular beats in 16 (9.4%) subjects, T wave changes in 11 (6.4%) subjects and right bundle branch block 16 (9.4%) subjects. Poor R wave progression in precordial leads in 9 (5.3%) subjects and right atrial overload in 4 (2.4%) were other common findings. More than one third of the elderly population in our study had entirely normal ECG. Majority of the abnormalities found in this study were very minor. These observations are important for the future studies evaluating healthy ageing in this region.

ECG findings in elderly.

There are not sufficient studies on ECG in elderly population in Nepal. This study attempts to evaluate the findings of ECG in elderly population in Nepal. ECG recordings from 171 apparently healthy geriatric subjects aged above 60 yrs (Mean age 70.66 +/- 7.14 yrs) from different geriatric homes were studied. The ECG was entirely normal in 38.6% of the study population. The major abnormalities were sinus bradycardia in 31 (18.1%) subjects, LVH in 25 (14.6%) subjects, premature supraventricular beats in 16 (9.4%) subjects, T wave changes in 11 (6.4%) subjects and right bundle branch block 16 (9.4%) subjects. Poor R wave progression in precordial leads in 9 (5.3%) subjects and right atrial overload in 4 (2.4%) were other common findings. More than one third of the elderly population in our study had entirely normal ECG. Majority of the abnormalities found in this study were very minor. These observations are important for the future studies evaluating healthy ageing in this region.