Upper Gastrointestinal Bleeding Induced by Gastric Ulcer Secondary to Strongyloidiasis: A Case Report

Strongyloidiasis, a parasitic infestation by Strongyloides stercoralis, involves the gastrointestinal tract with a spectrum from duodenitis to enterocolitis. However, gastric involvement with the manifestation of upper gastrointestinal bleeding is an extremely rare condition due to Strongyloides stercoralis. Due to irregular excretion of larvae, unclear symptoms, paucity of effective diagnostic tools and low parasitic load, makes clinicians difficult to reach the diagnosis of strongyloidiasis. Here, we present a case of upper gastrointestinal bleeding due to a large gastric ulcer whose aetiology was identified to be Strongyloides stercoralis infection of the gastric region by the diagnosis of exclusion

Accuracy of magnetic resonance cholangiopancreaticography in the diagnosis of benign and malignant cause of obstructive jaundice: Accuracy of MRCP in obstructive jaundice

Introduction: Magnetic Resonance Cholangiopancreatography (MRCP) is non-invasive technique for overall assessment for obstructive jaundice. This study aims to compare accuracy of MRCP in benign and malignant obstructive jaundice with gold standard but the invasive procedure of Endoscopic Retrograde Cholangiopancreatography (ERCP) and histopathology. Method: This was a retrospective study reviewing MRCP findings of clinically diagnosed obstructive jaundice from 2018 to 2021 at Patan Hospital, Kathmandu, Nepal. Study was conducted after ethical clearance of the institutional review committee. Sensitivity, Specificity, PPV and NPV and overall accuracy of MRCP was compared with the ERCP and histopathology. Chi square test was used for analysis, a p<0.05 considered significant. Result: Among 66 patients, the Sensitivity, Specificity, PPV and NPV of MRCP for biliary obstruction due to malignant pathology were 89.50%, 93.60%, 85.00% and 95.70% respectively. Similarly, for benign etiology, it was 93.60%, 89.50%, 95.70% and 85.00% respectively. The overall diagnostic accuracy was 92.40%. Choledocholithiasis were 31(46.97%) among benign cause and periampullary carcinoma 8(12.12%) among malignant. Conclusion: MRCP is highly sensitive and specific test in the evaluation of benign and malignant biliary pathology. Being noninvasive and can have good diagnostic value despite use of contrast. So minimally invasive procedure ERCP can be reserved for therapeutic or diagnostic biopsy purpose only

Purtscher-like retinopathy with serous macular detachment in a case of acute pancreatitis: A case report

A 28-year-old male hospitalized with a diagnosis of acute pancreatitis presented with sudden onset of blurred vision in both eyes after 48 h of admission. Visual acuity was counting fingers in both eyes. Fundus examination revealed multiple cotton wool spots and intraretinal hemorrhages typical of Purtscher’s retinopathy. Optical coherence tomography macula showed serous macular detachment. In 8 weeks follow-up, visual acuity improved to 6/18 oculus dexter (OD) and 6/60 oculus sinister (OS) with resolution of fundus lesions and resorbed subretinal fluid. Purtscher-like retinopathy, though rare should be considered as a differential in all cases with vision loss in acute pancreatitis. This particular case highlights the significance of a thorough examination of the fundus by an ophthalmologist in identifying this infrequent condition that is often overlooked

Recurrent left ischemic stroke in a patient with systemic lupus erythematosus: A case report

Key Clinical Message Some studies have manifested the relationship between SLE and stroke. Therefore, it is very important to pay close attention to the diagnosis of SLE in recurring stroke. In our case, her recurrent stroke attack might be due to the undiagnosed cause of SLE. Abstract An ischemic stroke is a medical emergency condition which occurs when blood supply to part of the brain is blocked. Early action is needed; therefore, time is crucial. SLE is an autoimmune disease with multiple joint pain, fever, rashes, and organ damage. We report an old lady who was recently diagnosed with SLE with multiple stroke attack. Although she was diagnosed with SLE much later there was a suspicious about the possible mechanism for her recurrent ischemic stroke. She was given antiplatelet, antiepileptic, antihypertensive, and hydroxychloroquine medicines for the treatment. The neurological symptoms improved only after we provided physiotherapy

Post‐Coronavirus disease syndrome (post‐COVID‐19) syndrome: A case report

Abstract Post‐COVID syndrome, a cluster of symptoms that develops or persists even after the recovery from COVID‐19 or viral clearance, can have multi‐system manifestations. This entity should be considered in patients who recently tested positive for COVID‐19 after ruling out other possible obvious causes. Its management should involve a multidisciplinary approach

Portal Hypertension among Patients with Chronic Liver Disease Admitted to the Department of Internal Medicine of a Tertiary Care Centre

Introduction: Portal hypertension is increased pressure within the portal vein. A portal pressure gradient of more than 10 mmHg is defined as "clinically significant portal hypertension" due to manifestations such as splenomegaly, gastroesophageal varices, ascites, hepatorenal syndrome, hepatopulmonary syndrome, hepatic encephalopathy, and spontaneous bacterial peritonitis. The aim of this study was to find out the prevalence of portal hypertension among patients with chronic liver disease admitted to the Department of Internal Medicine of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients with chronic liver disease in the Department of Internal Medicine of a tertiary care centre from 1 January 2021 to 31 December 2022 after obtaining ethical approval from the Institutional Review Committee. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 247 patients with chronic liver disease, the prevalence of portal hypertension was 38 (15.38%) (10.88-19.88, 95% Confidence Interval). A total of 16 (42.11%) patients were in the age group of 51-60 years and males were 36 (94.74%). Ascites as a complication were found in 4 (10.53%). Conclusions: The prevalence of portal hypertension among chronic liver disease inpatients in a tertiary care centre was found to be lower than other studies done in international settings

Prevalence of migraine and tension‐type headache among undergraduate medical students of Kathmandu Valley: A cross‐sectional study

Abstract Background Headache is the most prevalent neurological symptom which can be of a serious condition, as in brain tumor, but mostly it is a benign condition that includes primary headache such as migraine or tension‐type headache (TTH). Migraine reoccurs frequently and is more severe but owing to the high prevalence of TTH, however, impaired quality of life due to TTH is greater than that of migraine at the population level. Medical students are constantly subjected to stress and in such a condition, it was necessary to find out the burden of headache among medical students. This cross‐sectional study done among medical students aims to generate some data and literature which will change the outlook of stakeholders towards headache disorders among medical students. Methods This cross‐sectional study is based upon Headache Screening Questionnaire—English Version questionnaire based upon the ICHD‐3 beta criteria. Medical students of Kathmandu valley were sampled by using convenient sampling and data were collected. Data were refined in Microsoft Excel and imported to SPSS 20 for analysis. Results A total of 352 individuals were part of this study, out of which 229 (65.1%) were males and 123 (34.9%) were females with a mean age of 21.72 ±  1.601 years (mean ± SD). Prevalence of migraine and TTH was found to be 15.3% (95% confidence interval [CI]: 11.7%–19.3%) and 40.3% (95% CI: 34.9–45.2), respectively. Through multivariate binomial regression, it was observed that the odds of being diagnosed with migraine increased with age (adjusted odds ratio [AOR] = 1.266 [1.013–1.583], p = 0.038), females had twice the odds of experiencing migraine headaches compared to males (AOR = 2.119 [1.074–4.180], p = 0.03), and medical students who stayed at the hostel were at lesser odds of experiencing migraine headache (AOR = 2.772 [1.501–5.118], p = 0.01). Conclusion Prevalence of migraine and TTH among undergraduate medical students was found to be 15.3% and 40.3%, respectively

Targeted Knockdown of GDCH in Rice Leads to a Photorespiratory-Deficient Phenotype Useful as a Building Block for C4 Rice

The glycine decarboxylase complex (GDC) plays a critical role in the photorespiratory C2 cycle of C3 species by recovering carbon following the oxygenation reaction of ribulose-1,5-bisphosphate carboxylase/oxygenase. Loss of GDC from mesophyll cells (MCs) is considered a key early step in the evolution of C4 photosynthesis. To assess the impact of preferentially reducing GDC in rice MCs, we decreased the abundance of OsGDCH (Os10g37180) using an artificial microRNA (amiRNA) driven by a promoter that preferentially drives expression in MCs. GDC H- and P-proteins were undetectable in leaves of gdch lines. Plants exhibited a photorespiratory-deficient phenotype with stunted growth, accelerated leaf senescence, reduced chlorophyll, soluble protein and sugars, and increased glycine accumulation in leaves. Gas exchange measurements indicated an impaired ability to regenerate ribulose 1,5-bisphosphate in photorespiratory conditions. In addition, MCs of gdch lines exhibited a significant reduction in chloroplast area and coverage of the cell wall when grown in air, traits that occur during the later stages of C4 evolution. The presence of these two traits important for C4 photosynthesis and the non-lethal, down-regulation of the photorespiratory C2 cycle positively contribute to efforts to produce a C4 rice prototype