A hospital-based, prospective study was done in 350 women of 20-50 years to compare VIA withPap smear for early detection of cervical dysplasia at Maternity Hospital, Thapathali, from May2004 to December 2004. Pap smear was taken from each woman followed by VIA. Women withpositive VIA and/or positive Pap smear were referred for colposcopy-directed cervical biopsy. Thevariables studied were age group, presenting complaint, age of marriage, parity, smoking habit andappearance of cervix.The incidence of positive VIA and Pap smear was 2.86 and 0.57 respectively. Pelvic pain was themost common presenting complaint. The majority of the women were married before 20 years ofage. All women with either positive VIA and/or Pap smear were of parity two or above. Therewas no significant association between smoking and positive VIA (P=0.699) or Pap smear (P=0.397).Approximately 36.57% of the women screened had abnormal looking cervix. There were two womenwith high grade intraepithelial lesion (HSIL) and both were VIA positive and this was statisticallysignificant (Fischer exact P=0.0007). Of the ten VIA positive women, on histopathological examinationsix showed chronic cervicitis, one acute cervicitis, one showed cervical intraepithelial neoplasia (CIN)II, one had normal finding and one was lost to follow up.VIA as a screening test for cervical neoplasia did not miss any lesion detected by Pap smear andconfirmed by cervical biopsy.Key words: cervical neoplasia, pap smear, visual inspection

Monkeypox (MPOX according to the Centers for Disease Control and Prevention) has been a disease of interest in populations with high-risk sexual behavior. As sporadic outbreaks of MPOX have led to a worldwide spread, it has been declared a public health emergency by the World Health Organization. Here, we describe the case of a 44-year-old male with high-risk sexual behavior who presented with typical rashes of MPOX and altered mental status. MPOX polymerase chain reaction from the skin lesion and cerebrospinal fluid-Venereal Disease Research Laboratory tests were positive, raising the possibility of concomitant infection with neurosyphilis. The patient was treated with tecovirimat and aqueous penicillin G resulting in an improvement in the patient’s clinical condition. Our case describes that MPOX has the potential to cause central nervous system manifestations through possibly a direct viral invasion or an immune-meditated insult.

Tetanus is a life-threatening infectious neurological disorder that is now a rare disease due to the institution of wide-spread vaccination strategies. We present an uncommon case of generalized severe tetanus with consequent respiratory failure requiring mechanical ventilation, which was associated with dysautonomia. A 20-year-old unvaccinated female presented with neck stiffness and diffuse muscle spasms following a laceration sustained 3 weeks prior. She was admitted to the intensive care unit for mechanical ventilation and was treated with immunoglobulin, tetanus toxoid, metronidazole, and high doses of sedatives. She also developed dysautonomia, with alternating bradycardia and tachycardia, as well as fluctuating blood pressure. She was successfully extubated and discharged. We also review the epidemiology, pathophysiology, and management of tetanus and discuss dysautonomia in the setting of tetanus.

Background: Significant outbreaks of SARS-CoV-2 infections have occurred in healthcare personnel (HCP). We used an electronic tracking system (ETS) as a tool to link staff cases of COVID-19 in place and time during a COVID-19 outbreak in a community hospital. Methods: We identified SARS-CoV-2 infection cases through surveillance, case investigation and contact tracing, and voluntary testing. For those wearing ETS badges (Centrak), data were reviewed for places occupied by the personnel during their incubation and infectious windows. Contacts beyond 15 minutes in the same location were considered close contacts. Results: Over 6 weeks (August 10–September 14, 2020), 35 HCPs tested positive for SARS-CoV-2 by NAAT testing. In total, 18 nurses and aides were clustered on 1 hospital unit, 7 cases occurred among respiratory therapists that visited that unit, and 10 occurred in other departments. Overall, 17 individuals wore ETS badges as part of hand hygiene monitoring. ETS data established potential transmission opportunities in 17 instances, all but 2 before symptom onset or positive test result. Contacts were most often (10 of 17) in common work areas (nursing stations), with a median time of 45 minutes (IQR, 21–137). Contacts occurred within and between departments. A few COVID-19 patients were cared for in this location at the time of the outbreak. However, we did not detect HCP-to-patient nor patient-to-HCP transmission. Conclusions: Significant HCP-to-HCP transmission occurred during this outbreak based on ETS location. These events often occurred in shared work areas such as the nursing station in addition to break areas noted in other reports. ETS systems, installed for other purposes, can serve to reinforce standard epidemiology.Funding: NoDisclosures: None

Herpes pneumonia, or active infection of pulmonary tissue by Herpes Simplex Virus type-1 (HSV), is a rare condition, usually observed in immunocompromised individuals. We present a rare case of HSV pneumonia that was complicated by a pneumothorax, ultimately proving fatal in an elderly, immunocompetent individual. Case Description: An 82year-old male with a history of chronic obstructive pulmonary disease and hypothyroidism presented to our facility with acute respiratory failure requiring mechanical ventilation. Computed Tomography (CT) scan of the thorax demonstrated diffuse bilateral ground glass opacities, and consolidative changes. Broad spectrum antibacterial coverage and high dose steroids were initiated. Blood and tracheal aspirate bacterial and fungal cultures did not yield any growth. A bronchoscopy, performed to better characterize his pulmonary pathology, demonstrated diffuse airway erythema and secretions. Immunoglobulin G (IgG) to Herpes Simplex Virus (HSV) Type 1 was detected on bronchoalveolar lavage (BAL) sample; additionally, HSV-1 was isolated on viral culture. Histopathological analysis of BAL sample was notable for viral inclusion bodies (figure 1). Additional testing for cytomegalovirus, epstein-barr virus, human immunodeficiency virus (HIV), hepatitis viruses, tuberculosis, mycoplasma, legionella and cryptococcus was negative. Acyclovir was initiated, with subsequent clinical improvement and reduction in ventilation requirements. The patient was extubated, but his hospital course was complicated by a large left sided pneumothorax. Following a discussion regarding goals of care, comfort care measures were instituted, with demise following shortly thereafter. Discussion: HSV pneumonia is an uncommon respiratory infection that is usually seen in association with immunocompromising conditions such as Systemic Lupus Erythematosus 1 , Chronic Lymphocytic Leukemia 2 , and HIV infection. 3 There are scarce published reports about the occurrence of this infection in immunocompetent patients. [4][5][6] HSV has been known to be a contaminating agent in the respiratory tract of ventilated patients. 7 However, the presence of a clinical picture consistent with viral pneumonitis, with ground glass opacities, detection of viral on BAL polymerase chase reaction, and intranuclear inclusion bodies on histopathological analysis of BAL sample are indicators of active infection. 8 Clinically, our patient responded to acyclovir, further lending credence to the probability of our diagnosis of HSV pneumonia. Unfortunately, the clinical course was complicated by a pneumothorax, which is a rare complication of HSV pneumonia, only one other case was found. 9 Our case demonstrates that herpes pneumonitis can affect the immunocompetent, and can be associated with a pneumothorax. HSV infection should be considered in patients with pneumonia who fail to respond to antibacterial therapy.