Nischal Shrestha

Introduction and importance: Ogilvie syndrome (OS) is characterized by marked colonic dilation without mechanical obstruction, typically seen in hospitalized patients. Its occurrence in ambulatory individuals without classic risk factors is uncommon and may create diagnostic uncertainty. Case presentation: A 37-year-old ambulatory man with well-suppressed HIV presented with progressive abdominal distention, dull pain, and urinary retention over 3 weeks. Computed tomography (CT) imaging revealed marked colonic dilation without evidence of mechanical obstruction, ischemia, or perforation, and incidentally demonstrated nutcracker anatomy. Flexible sigmoidoscopy excluded distal obstruction. The patient was managed conservatively with bowel rest, laxatives, and decompression, with complete resolution of symptoms by day 7 without neostigmine or invasive intervention. Clinical discussion: This case highlights OS occurring in an atypical ambulatory patient without typical risk factors. HIV-associated autonomic dysfunction may represent a possible contributing mechanism despite viral suppression. The incidental finding of nutcracker anatomy did not influence management, underscoring the importance of correlating imaging findings with clinical presentation and avoiding diagnostic distraction. Conclusion: OS should be considered in patients with unexplained colonic dilatation, even in atypical ambulatory settings. A structured diagnostic approach and careful interpretation of incidental findings are essential, and conservative management may be effective in uncomplicated cases, avoiding unnecessary invasive interventions.

We present the case of a 78‐year‐old woman with metabolic syndrome and a history of multiple ischemic strokes who developed progressive symmetrical proximal muscle weakness, predominantly affecting the lower extremities, while on atorvastatin. Laboratory evaluation revealed markedly elevated creatine kinase (CK) and positive anti‐HMG‐CoA reductase (anti‐HMGCR) antibodies, with MRI confirming myositis consistent with statin‐induced necrotizing autoimmune myopathy (SINAM). Despite statin discontinuation and immunosuppressive treatment, her muscle weakness persisted, and she remained bedbound at long‐term follow‐up. This case underscores the diagnostic and therapeutic challenges of SINAM in elderly patients with significant comorbidities and highlights the importance of early recognition and tailored management.

Stercoral colitis can develop rapidly and present atypically in elderly patients, particularly those with cognitive impairment and psychiatric illness, where nonspecific symptoms may delay diagnosis. Clinicians should maintain a high index of suspicion, especially in socially vulnerable individuals where elder neglect, malnutrition, and poor functional status may further obscure the clinical picture.

Typhoid fever, caused by Salmonella Typhi and Salmonella Paratyphi A, remains endemic in Nepal. Typhoid fever can affect nearly all systems of the body, leading to various complications; however, sensorineural hearing loss (SNHL) remains an exceptionally rare occurrence. This case report describes a 24‐year‐old female school teacher who presented with an 8‐day history of fever, followed by a 6‐day history of bilateral hearing loss and tinnitus. She was diagnosed with typhoid fever based on a positive Widal test and was treated with intravenous antibiotics, antipyretics, and oral steroids, but her hearing did not improve. She was referred to a tertiary center for further evaluation, where she was diagnosed with profound SNHL. A cochlear implant was recommended but declined by the patient due to financial constraints and uncertainty regarding the outcome. This case highlights the need for further research into the pathogenesis and treatment of SNHL associated with typhoid fever.

Superior Mesenteric Artery Syndrome (SMAS) is a rare but potentially life-threatening condition caused by the compression of the duodenum by the superior mesenteric artery. We report a case of an 11-year-old male who complaint of abdominal pain and intermittent vomiting for last 3 weeks. Diagnosis of SMAS was made with the help of radiological findings. The patient was managed conservatively with nutritional support, prokinetic agents, and stomach decompression. After 2 weeks of treatment, the patient’s symptoms improved, and he was discharged from the hospital.

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.

Pleomorphic adenoma is the commonest benign salivary glands tumor. Major salivary glands are mainly involved, and there is very low reported incidence of such tumor in minor salivary glands of nasal cavity. We report a case of 69-year-old woman who complaint of chronic left nasal obstruction and recurrent scanty bleeding from left nostril for last 2 months. On anterior Rhinoscopy examination, there was a pinkish non-tender mass in left nasal cavity arising from cartilaginous part of nasal septum. Intranasal endoscopic excision was done under general anesthesia and histopathological examination of excised tissue revealed pleomorphic adenoma. Patient was discharged after 3 days. There was no recurrence at sixth month of follow-up.

Succenturiate placenta can be associated with vasa previa, retained placenta, post-partum hemorrhage and infection. Prior knowledge of presence of succenturiate placenta can be helpful to take quick and rational decisions during the labor. We present a case of placenta succenturiate suspected at 34+3 weeks of gestation using findings from ultrasonography.