Prevalence of non-convulsive seizures and electroencephalographic abnormalities in critically ill patients-A retrospective observational study.

Objective: Electroencephalographic (EEG) abnormalities especially non-convulsive status epilepticus (NCSE) have been found to be associated with worse outcomes in critically ill patients. We aimed to assess the prevalence of non-convulsive seizures and electroencephalographic abnormalities in critically ill patients. Furthermore, we aimed to investigate any association between the type of EEG abnormality and outcomes including ICU mortality and successful ICU discharge.

Delayed CSF rhinorrhea presenting as a lethal acute bacterial meningitis 5 years post trauma.

Key Clinical Message: Delayed presentation of cerebrospinal fluid rhinorrhea is rare following head trauma. It is frequently complicated by meningitis if not addressed in time. This report highlights the importance of its timely management, the lack of which can lead to a fatal outcome.

Pulmonary embolism in an ESRD patient following minimal venotomy and milking for salvage of dysfunctional autogenous arteriovenous fistula.

Pulmonary embolism can be a complication following an attempted salvage of a dysfuctional arteriovenous fistula (AVF). We report a case of bilateral pulmonary embolism in a patient with underlying pericardial effusion who, following minimal venotomy and milking of the AVF, developed sudden and significant respiratory distress, and later improved.

Use of Bedside Ultrasound for Ophthalmic Evaluation in a Case of Traumatic Brain Injury: A Case Report.

Background: Ophthalmological examination is an important aspect of the neurological assessment in a patient with traumatic brain injury. However, significant periorbital swelling can make direct visualization of the pupils difficult. Ultrasonic examination can be a valuable bedside tool when direct visualization fails.

Hepatic Encephalopathy Induced Transient Cortical Blindness.

Hepatic encephalopathy describes a spectrum of potentially reversible neuropsychiatric abnormalities seen in a patient with severe liver dysfunction with porto-systemic shunting. Cortical blindness can be a rare presentation of hepatic encephalopathy and can even precede the onset of altered sensorium. We report a case of 57 years female with chronic liver disease who presented with bilateral loss of vision, with no focal neurological deficits.

Massive Middle Cerebral Artery Ischemic Stroke Associated with Severe Acute Respiratory Distress Syndrome in H1N1 Influenza: A Case Report.

Influenza has a common occurrence during its peak seasons. It usually causes disease of the respiratory tract including severe acute respiratory distress syndrome. However, it may also cause disease and complication of other organ systems.

Symptomatic Hyponatremia following Bowel Preparation for Colonoscopy: A Case Report.

Colonoscopy is considered a gold standard tool for the diagnostic evaluation of colorectal diseases. Bowel preparation, a pre-requisite for colonoscopy, usually involves ingestion of purgatives for the cleansing of the bowel so that visualization is not obscured during the procedure. Commonly used preparations are sodium phosphate-based solutions, sodium picosulphate and polyethylene glycol.

Congenital absence of left circumflex artery with right coronary dominance.

Absent left circumflex coronary (LCX) artery though rare and benign should be considered in patients with chest pain and differentiated from atherosclerotic coronary artery disease for better management & prognosis.

Cypermethrin poisoning manifesting with prolonged bradycardia: A case report.

Pyrethrins and their synthetic derivatives known as pyrethroids are highly effective insecticides used worldwide in the agricultural fields and households. Cypermethrin is a type II pyrethroid which acts primarily by delaying the closure of voltage-sensitive sodium channels at higher concentrations. Its toxicity in humans occur due to accidental or intentional exposure through inhalation, skin contact or via ingestion.

Pretilachlor poisoning: A rare case of a herbicide masquerading as organophosphate toxicity.

Acute oral intoxication of pretilachlor, a chloroacetanilide herbicide, in humans can present with similar clinical manifestations of organophosphate toxicity. Clinicians should be aware of such mimickers for proper management of the patient.

Superior mesenteric artery syndrome.

Superior mesenteric artery (SMA) syndrome, though rare, should be considered in patients with duodenal obstruction with no other causes. History of recent weight loss and imaging modalities help in the diagnosis. Conservative management can be tried before going for surgery.

Multiple Organ Dysfunction and Acute Pancreatitis Following Wasp Stings.

Wasp stings are common in our part of the world and may cause complications ranging from mild local reactions to fatal anaphylaxis. Severe cases may present with multisystem involvement causing acute kidney injury, hepatic dysfunction, clotting abnormalities, rhabdomyolysis or even death. However, cases with acute pancreatitis as a complication of wasp sting is not usual and have been very rarely reported.

Management of nitrobenzene poisoning with oral methylene blue and vitamin C in a resource limited setting: A case report.

Nitrobenzene can cause life threatening methaemoglobinemia. Its management includes the use of intravenous methylene blue to reduce the iron moiety from its ferric to ferrous state. Due to unavailability of intravenous preparation, enteral methylene blue was used in our case.

Topical nitroglycerin for management of peripheral extravasation of vasopressors: a case report.

Peripheral route for administration of vasopressors is often opted due to resource limitations or as a rescue until central venous access is established. This, however, is not devoid of complications, the most common being extravasation and tissue injury. Phentolamine is the only drug approved for management of vasopressor extravasation; however, successful use of other agents has been reported.

Acupuncture induced pneumothorax: A case report.

Various forms of alternative medicinal practices are gaining popularity. With this, there will be rise in the complications arising from these practices. Acupuncture is also such practice which though safe can rarely cause life-threatening complications.

Delayed Neurological Recovery After Ultrasound-Guided Brachial Plexus Block: A Case Report.

Introduction: Brachial plexus blocks are frequently practiced and safe mode of anaesthsia. Although minor complications may occur, major complications are a rarity. However, we report a rare case of prolonged supraclavicular brachial plexus block which required almost 4 months to recover without a perceivable cause.

Inter-instrumental comparison for the measurement of electrolytes in patients admitted to the intensive care unit.

Objective: To investigate whether benchtop auto-analyzers (AAs) and arterial blood gas (ABG) analyzers, for measuring electrolyte levels of patients admitted to intensive care units (ICU), are equal and whether they can be used interchangeably.

Materials And Method: This study was conducted on 98 patients admitted to the ICU of the Institute of Medicine, Kathmandu, Nepal between 15 October and 15 December 2016. The sample for AA was collected from the peripheral vein through venipuncture, and that for ABG analyzer was collected from radial artery simultaneously.