Sneha Shrestha

Author DetailsSneha Shrestha1, Uttam Laudari2, Bimas Payangu2, Bala Ram Malla2, Inesh Khanal1Sneha Shrestha, S., Shrestha, Patan Hospital, Lalitpur, NepalEmail: snehashrestha091@gmail.comORCid: 0000-0002-5575-7882Uttam Laudari, U., Laudari, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, 45210, NepalEmail: youttam@hotmail.comBimas Payangu, B., Payangu, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, 45210, NepalEmail: subbabimas30@gmail.comBala Ram Malla, B., Malla, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, 45210, NepalEmail: mallabr504@yahoo.comInesh Khanal, I., Khanal, Patan Hospital, Lalitpur, NepalEmail: std.ineshkhanal@pahs.edu.npORCid: 0009-0006-1377-3362Corresponding Author :Inesh Khanal, I., Khanal, Patan Hospital, Lalitpur, NepalEmail: std.ineshkhanal@pahs.edu.npORCid: 0009-0006-1377-3362Abstract

Introduction and importance: Williams–Campbell syndrome (WCS) is a rare congenital syndrome that can lead to bronchiectasis. Although commonly found in pediatric age groups, it can also be seen in adults due to delayed diagnosis with respiratory symptoms of cough, sputum, and wheezing. Presentation of case: A 31-year-old male presented with an incidental finding of bilateral cystic lesions in the lung field for which high-resolution computed tomography of the chest was done, which showed bilateral multiple cystic lesions without any clinical findings except mild inspiratory wheeze. Clinical discussion: Diagnosis: Any suspected case of bronchiectasis must undergo imaging: chest radiograph or computed tomography scan, along with blood investigations, sputum tests, and, if needed, a biopsy to help establish a diagnosis. Diagnosis of WCS is made after exclusion of common causes, which can be cystic fibrosis, foreign body aspiration, tuberculosis, COPD, and congenital causes like bronchomalacia, Mounier–Kuhn syndrome, tracheoesophageal fistula, etc. Therapeutic intervention: Chest physiotherapy, antibiotic therapy, vaccination, and pulmonary rehabilitation are primary modes of treatment. En bloc lung transplantation can be done in some cases. Conclusion: Diagnosis is made by ruling out all other causes of bronchiectasis, but a dynamic CT scan confirms the diagnosis. Chest physiotherapy and antibiotics are the treatment of choice.

Introduction and Importance: One of the very rare causes of obstructive jaundice, Lemmel’s syndrome is caused due to biliary mechanical compression by a juxtapapillary diverticulum. It is defined as obstructive jaundice due to juxtapapillary diverticulum in the absence of cholelithiasis, periampullary tumours or other detectable obstacles. It is extremely rare syndrome therefore studies need to be done for proper diagnosis and management. Case Presentation: Our patient, a 73-year-old woman, gave a history of recent acute right hypochondriac pain that had subsided the day before. Lab investigations were performed and liver enzymes were found to be significantly raised. An endoscopy followed by an endoscopic ultrasound was performed for further diagnosis which showed the diverticulum outpouching from the duodenum. MRCP was then performed which revealed a dilated common bile duct and common hepatic duct, with tapering at the distal end, most likely to be a stricture. Lemmel syndrome was identified based on the clinical presentation and imaging results. A dilated common bile duct, and two large duodenal diverticula with interdiverticular papilla was discovered during the patient’s endoscopic ultrasound which was performed by the gastrointestinal team. Clinical Discussion: Duodenal diverticula are the second most common site of diverticula after colon with an incidence of 1-5% in radiological series³. Lemmel’s syndrome is a rare cause of obstructive jaundice associated with juxtapapillary diverticulum. With a low incidence rate, only a few cases of Lemmel’s syndrome are reported with the first case reported in 1934 by Lemmel.⁴ Imaging techniques such as barium meal, EUS, ERCP, or magnetic resonance cholangiopancreatography are used to confirm the diagnosis. Our observations demonstrate that the diverticulum which is often found on the medial wall of the second half of the duodenum and contains bezoar, compresses the distal common bile duct laterally. Nowadays, ERCP and EUS are used to confirm the diagnosis.⁵ Only symptomatic periampullary duodenal diverticulum(PDD) requires conservative or surgical therapy. The first line of treatment for biliopancreatic PDD problems is endoscopic sphincterotomy, which is 95% effective.⁶ Conclusion: Lemmel syndrome occurs due to the compression of the common bile duct by a duodenal diverticulum. Imaging including CT scan and MRCP are important for the diagnosis of this syndrome. Treatment modalities are not the same for each patient, however.

Varicella Zoster is a neurotropic virus which leads to acute varicella or it may lay dormant in the spinal root ganglion. Reactivation of varicella zoster causes Herpes Zoster (HZ) and occurs commonly in immunosuppressed conditions like COPD. Severity of Herpes Zoster is also higher among those with comorbidities like COPD. Even among COPD patients, the severity of HZ is said to be higher among those using oral corticosteroids than those using inhaled steroids due to greater immunosuppressive effect. It has also been found that incidence rate of COPD exacerbations, transient ischemic attack and stroke are higher among COPD patients with HZ compared to those without HZ. Herpes zoster vaccinations prevent reactivation of latent HZ and reduce the associated complications. Live attenuated and recombinant vaccines are available for vaccination among which recombinant vaccine is found to be more effective. The cost burden due to HZ among COPD patients was also higher compared to those without HZ. Childhood varicella vaccination is cost effective, however cost effectiveness of adolescent vaccination is unclear.

A document by Abhigan Shrestha. Click on the document to view its contents.

Introduction: Caesarean section is performed when there are pregnancy related complications and vaginal delivery cannot be tried or fails. The effect of pandemic lockdown on the availability as well as accessibility of health services is a global concern. The aim of this study was to find out the caesarean section rate and its indication at a tertiary care hospital during COVID-19 pandemic. Methods: A hospital-based cross-sectional study was conducted among women admitted for delivery in the Department of Obstetrics and Gynecology of a tertiary teaching hospital during the second wave of COVID-19 (1 May 2021–30 July 2021). Convenience sampling technique was applied and 1350 women were categorized into groups using Robson ten group classification system. Group size, group caesarean rate, absolute and relative contribution of each group to overall caesarean rate were calculated. Results: Out of 1350 total deliveries during COVID-19, lower segment caesarean section was done in 446 (33.04%) (30.53–35.55 at 95% Confidence Interval). Major indication for caesarean section was previous caesarean in 185 (41.48%). Most women 202 (45.29%) were from the age group 24–30 years and gestational age between 37 and 42 weeks. Major contributor to the overall caesarean section rate was Robson group 5 (37%). Conclusions: This study showed higher prevalence of caesarean section delivery rate during COVID-19 pandemic than that compared with 2016 national statistics of Nepal. Despite of several challenges brought by the pandemic, pregnant women were still able to access the emergency obstetric care services in the Eastern part of Nepal. However, future studies should focus on exploring the situation in rural areas too.