Dengue fever and scrub typhus are common causes of acute febrile illness of unclear origin in Asia. Though coinfections of many vector-borne diseases have been described, articles on dengue and scrub typhus coinfection are distinctly limited. In case of coinfection with dengue and scrub typhus, vigilant monitoring of vitals, platelets transfusion, and timely treatment with doxycycline are necessary. High degree of suspicion has to be made for coinfection in a patient presenting with febrile illness with thrombocytopenia and deranged laboratory parameters in postmonsoon season in endemic regions in Asia.

BackgroundEchinostomiasis is a food-borne infection caused by an intestinal trematodes belonging to the family Echinostomatidae. They infect the gastrointestinal tract of humans. Patients are usually asymptomatic. However, with heavy infections, the worms can produce catarrhal inflammation with mild ulceration and the patient may experience abdominal pain, anorexia, nausea, vomiting, diarrhea and weight loss. Infection are associated with common sociocultural practices of eating raw or insufficiently cooked mollusks and fish.Case presentationWe report a first case of echinostomiasis from Nepal in a 62 years old, hindu male who presented to Tribhuvan University Teaching Hospital, Kathmandu with a complaint of abdominal pain and distension with vomiting on and off for 3–4 months. He had history of consumption of insufficiently cooked fish and snail with alcohol. During endoscopy, an adult flat worm was seen with mild portal hypertensive gastropathy (McCormack’s classification) and erosive duodenopathy. The adult worm was identified as Echinostoma species based on its morphology and characteristic ova found on stool routine microscopic examination of the patient. Patient was treated with praziquantel 40 mg/kg (single dose) which is the drug of choice for Echinostoma species infection by which he got improved and on follow up stool examination after 2 weeks revealed no ova of Echinostoma species.ConclusionsThe patients having history of consumption of insufficiently cooked snail and fish with suggestive clinical features of echinostomiasis should be suspected by physicians and ova of Echinostoma species should be searched by trained microscopists. An epidemiological survey is required to know the exact burden of Echinostoma species infection in the place where people have habit of eating insufficiently cooked fish and snails, as it can be endemic in that community or geographical area.

Introduction: Malnutrition is one of the most common complications of liver cirrhosis. Yet, little attention is paid in evaluating nutrition in this group of patients. This study aims to assess malnutrition among cirrhotic patients using a nutrition screening tool and anthropometry. Methods: This was a prospective, observational study of admitted patients with liver cirrhosis. In the study duration of 3months, 50 patients met the inclusion criteria and were included. Nutritional assessment was performed using the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT), BMI and standard anthropometry including TSF,MUAC and MAMC. Results: The mean age was 51.56 ± 11.50 with a Male to Female ratio of 3:2. Chronic alcohol consumption (72%) was the most common etiology while management of tense as cites (40%) was the most common reason for hospital admission. 58% had Child Pugh Class C cirrhosis while the remaining 42% were Class B. The average MELD Nascore was 19.64 ± 6. Significant differences in anthropometric measurements including BMI, MUAC, TSF and MAMC were found between Child B and C cirrhosis. Similarly, those patients who had low, moderate and high-risk of malnutrition by the RFH-NPT had significant differences in anthropometric measurements between them. Conclusion: A significant number of patients had moderate to severe risk of malnutrition that correlated well with anthropometric measurements. The degree of malnutrition is parallel with the severity of liver disease among these patients. Both the RFH-NPT and anthropometry are relatively easy to perform and effective. Hence, they can be used as a practical means for identifying malnutrition among cirrhotic patients in routine clinical practice.

Introduction: The prevalence of ulcerative colitis (UC) has gradually increased in Asia over the last few decades. However, there is a paucity of data regarding UC in Nepal. This study analyzed the socio-demographic and clinical characteristics of patients hospitalized with UC. Methods: This is a hospital based, cross-sectional study. Data was collected among 100 individuals admitted to the hospital with UC from June 2016 to May 2018. A descriptive analysis of the demographic and clinical characteristics was done. Results: Of the 100 patients 51 were male (M:F ratio 1.04:1). Average age at diagnosis was 38}12.53 years. 55% of the patients were Brahmins, 16% Kshetris, 8% Newars, 1% Muslim while the remaining 20% belonged to other indigenous ethnic groups. 79% of the patients were newly diagnosed cases while remaining 21% were admitted for acute flares of the disease. Rectal bleeding (85%) was the most common symptom followed by diarrhea (70%), tenesmus (63%), urgency (61%), pain abdomen (44%), weight loss (14%), fever (7%) and constipation (4%). Clinically, 41% had mild, 46% had moderate and 12% had severe disease activity. Extra intestinal manifestations were seen only in 12% of the patients. On colonoscopic examination, 41% had proctitis, 46% had left sided colitis and 13% had extensive colitis. Conclusion: Our study showed some differences in the demographic variables as well as clinical manifestations in the patients when compared to data from the west and even other Asian countries like India and China. Larger population-based studies are needed to better understand the epidemiology and characteristics of the disease in Nepal.

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