Cutaneous leishmaniasis, a vector borne protozoan infection of skin manifests as chronic nodulo-ulcerative growth in skin. In Nepal, cutaneous leishmaniasis, the most common form, supposed to be rare is gradually rising as an emerging public health concern. These days, a number of imported and native patients are being reported from different parts of Nepal. Since, it's less endemic here; there is high chance of being treated as other diseases. Here, we report a series of cases of cutaneous leishmaniasis, who presented in the outpatient department of dermatology, TU Teaching Hospital in the year 2015-2016 and was treated with meltifosine.
Toxic epidermal necrolysis is a life-threatening dermatological emergency with high mortality if not treated in time. Here we report a case of toxic epidermal necrolysis due to carbamazepine in rural Nepal in COVID-19 pandemic who was successfully treated with the help of mobile teledermatology. The clinical impression of toxic epidermal necrolysis was made from “WhatsApp” video calls using a smart phone. The supportive features were the history of starting of carbamazepine 2 weeks prior for seizure disorder, clinical findings in serial photographs of skin with 40 percent body surface area involvement of necrotic skin lesions and bulla, and involvement of oral mucosa and eyes. The patient was immediately asked to stop carbamazepine and was treated with intravenous fluids and systemic steroids along with symptomatic management. As the whole world was suffering from lockdown due to COVID-19 crisis, it was impossible for the rural area patient to visit a dermatologist. Thus, with the help of paramedics staff in a community health center and mobile teledermatology, the patient was diagnosed as carbamazepine-induced toxic epidermal necrolysis and treated successfully with good outcome.
Introduction
Oligohydramnios has increased incidence of fetal distress, meconium-stained liquor, prolonged labor, low Apgar score, low birth weight, admission to NICU, cord compression, birth asphyxia, and operative interference. The objective of the study was to determine the pregnancy outcome in amniotic fluid index 5 cm or less in term pregnancy.
Materials and Methods
This was a hospital-based cross-sectional study conducted at National Medical College & Teaching Hospital from June 2017 to May 2018. A total of 72 obstetric cases with AFI ≤ 5 cm and 72 cases with AFI > 5 cm with meeting the inclusion criteria were enrolled in the study after taking consent.
Results
Incidence of oligohydramnios was 2.2% out of 4318 deliveries and term oligohydramnios was 1.66%. AFI ≤ 5 cm was associated with increased induction of labor (p < 0.001), caesarean section (p = 0.01)), meconium stained liquor (p = 0.106), Apgar score <7 at 5 minutes (p = 0.001), NICU admission (p = 0.003), neonatal deaths (p = 0.053) were comparable with AFI >5 cm.
Conclusion
Amniotic fluid index ≤ 5 cm at term is an indicator of poor perinatal outcome. Women with AFI ≤ 5 cm can expect a good outcome if they have regular ANC visits and intrapartum monitoring than the AFI > 5 cm.
Alopecia universalis is an uncommon form of alopecia areata involving hair loss over the entire scalp and body. This condition is difficult to treat and sustain the growth of hair for longer duration. We report a case of alopecia universalis associated with severe hyperthyroidism. A lady in her fourth decade presented to us with gradual onset of alopecia universalis, who later found to have hyperthyroidism which was refractory to multiple treatment modalities. She was treated successfully with azathioprine and hydroxychloroquine. Alopecia universalis with less response to oral steroidtherapy was successfully managed with azathioprine with hydroxychloroquine.
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