Birendra Hospital

Abstract Background Vaginal discharge is a common gynecological complaint among women of reproductive age in low- and middle-income countries, including Nepal. However, formal healthcare utilization remains low due to stigma and access barriers. This creates conditions favorable to self-medication based on unverified social media content. Case presentation A 33-year-old multiparous woman presented with severe lower abdominal pain and progressive vulval swelling for three days, with chronic whitish vaginal discharge for several months, but had not sought medical care due to shame. Directed history-taking revealed self-insertion of solid potash alum fragments into the vaginal canal after watching a social media video recommending it as a home remedy. On examination, the vaginal introitus was narrowed with wart-like lesional changes, diffuse mucosal exfoliation, blackish flaky discharge, and a hard, irregular intravaginal mass, raising initial suspicion for vulvovaginal malignancy, condyloma acuminata, or retained foreign body. Investigations showed leukocytosis with neutrophilia; abdomen and pelvis ultrasonography was normal. A 2 × 2 cm alum fragment was retrieved under aseptic precautions. The vaginal canal was irrigated with normal saline; empirical broad-spectrum antibiotics and intravenous analgesia were administered. The patient was discharged on day four. At one-week follow-up, mucosal healing was complete, and discharge had resolved. Pap smear was negative for intraepithelial lesion or malignancy. Histopathological examination showed degenerated tissue with foreign particles and no evidence of granuloma, dysplasia, or malignancy, confirming chemical injury from the self-inserted alum. Conclusions Self-insertion of solid potash alum caused severe chemical vaginitis closely mimicking vulvovaginal malignancy. Digital health misinformation poses direct patient safety risks, and non-judgmental elicitation of self-treatment history is essential in atypical gynecological emergencies.

Introduction: Non-alcoholic fatty liver disease is a condition in which excess fat accumulates in the liver. It is becoming increasingly prevalent, affecting more than one-quarter of adults worldwide, 60% of patients with diabetes, and up to 90% of people with obesity. The main objective of this study was to evaluate the clinical profile of patients with non-alcoholic fatty liver disease undergoing Fibroscan in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in the outpatient Department of Internal Medicine, Kathmandu Medical College and Teaching Hospital, from 15 November 2024 to 16 May 2025 after ethical approval from the Institutional Review Committee. Patients with non-alcoholic fatty liver disease on Fibroscan who fulfilled the inclusion criteria were enrolled. Pregnant women, patients with a prior history of alcohol use, those younger than 8 years, those with human immunodeficiency virus infection, and those using steatogenic medications such as tamoxifen, corticosteroids, amiodarone, methotrexate, or valproic acid were excluded. Data were expressed as frequency and percentage. Results: A total of 56 patients with non-alcoholic fatty liver disease on Fibroscanwere studied. Among them, 25 (44.64%) had severe steatosis. Most participants, 27 (48.21%), were in the 41-60-year age group. Forty-five (80.36%) participants had elevated total cholesterol levels. Conclusion: Severe hepatic steatosis was the most common grade of NAFLD, predominantly among middle-aged male patients. Overweight, dyslipidemia, and elevated alkaline phosphatase were common findings.

Acute calculous cholecystitis (ACC) is a common surgical emergency often requiring laparoscopic cholecystectomy (LC), though some cases necessitate conversion to open cholecystectomy (OC). Predicting difficult LC or conversion is crucial for operative planning. This study evaluates the role of C-reactive protein (CRP) as a predictor of surgical complexity in ACC. A prospective observational study was conducted at Shree Birendra Hospital, Kathmandu, from April 2024 to March 2025, including 108 patients undergoing emergency LC for ACC. Patients with conditions confounding CRP levels were excluded. Preoperative CRP levels were measured, and operative time was recorded. LC lasting more than 60 min was defined as difficult. Statistical analysis was performed using SPSS 26.0. Among 108 patients (mean age 49.8 years, male to female ratio 1:3.5), 71 underwent simple LC, 28 difficult LC, and 9 were converted to OC. Mean CRP levels were 18.2 mg/L in simple, 36 mg/L in difficult, and 50.1 mg/L in converted cases (p = 0.002). A significant association was found between elevated CRP and surgical complexity (p < 0.001). Duration of surgery and hospital stay increased with complexity (p < 0.001), while age and gender showed no significant association. Elevated preoperative CRP levels are significantly associated with increased surgical complexity and likelihood of conversion in ACC. CRP can serve as a valuable tool for anticipating technical challenges and optimizing resource, especially in resource limited setting.

Unilateral pulmonary agenesis is a rare congenital anomaly with an incidence of 1:15,000, affecting both sides and sexes equally. It's classified by Schneider-Schwalbe (Types 1–3) and Boyden systems (Groups 1–3) based on developmental severity. Children commonly experience recurrent respiratory tract infections and breathing difficulties due to aberrant tracheal function and increased vulnerability from airway constriction. A 9-year-old male presented with fever and nonproductive cough. Physical examination revealed severe malnutrition (weight and BMI < -3Z score) with tracheal deviation, decreased left chest movement, dullness to percussion, and diminished breath sounds on the left side. Chest X-ray showed complete left hemithorax opacification with mediastinal shift. High-resolution computed tomography revealed left lung aplasia with compensatory right lung hyperinflation. Computed tomography pulmonary angiogram (CTPA) confirmed left pulmonary artery agenesis. Bronchoscopy demonstrated hypoplastic left bronchial tree with blind-ending left main bronchus and tracheal bronchus supplying the right upper lobe. The patient was treated with antibiotics for secondary infection, chest physiotherapy, inhaled corticosteroids, and nutritional support. This rare congenital anomaly highlights the importance of advanced imaging in diagnosing complex respiratory presentations in pediatric patients with recurrent respiratory infections.