Eosinophilic cholecystitis is a rare post-cholecystectomy inflammatory histopathological condition characterized by more than 90% eosinophilic infiltrate in the gallbladder. We present a case of 27-year female presented with abdominal pain, fever, jaundice, altered mental status, shock, leucocytosis, deranged liver function test, and peripheral blood eosinophilia. The patient underwent cholecystectomy and common bile duct exploration. She developed adult respiratory distress syndrome and hospital-acquired pneumonia. From this, we want to emphasize that eosinophilic cholecystitis and cholangiopathy should be a differential diagnosis in patients presenting with allergy, peripheral eosinophilia, obstructive jaundice that are planned to undergo cholecystectomy that will have early critical care intervention.

Background: Perianal fistula is a troublesome condition both for patient and surgeon with significant morbidity and challenging treatment. MRI is considered as the technique of choice for preoperative evaluation of perianal fistulae, as it provides accurate anatomical information for appropriate surgical treatment, decreasing the incidence of recurrence and allowing side effects such as fecal incontinence to be avoided. The study aimed to describe the role of magnetic resonance imaging (MRI) in the diagnosis and classification of perianal fistulae. Methods: This retrospective study looked at 52 patients referred to the radiology department with a clinical diagnosis of perianal fistula. MRI grading of anal fistula done according to St. James’s University Hospital classification. Results: The MRI showed 46 internal openings in 44 patients; two patients had more than one. The internal opening was mostly at the 6 o’clock position in 59.9% patients, followed by 7 o’clock and 5 o’clock position in 11.3% of patients. According to the St. James’s University Hospital classification, 21 (47.7%) patients had grade 1, 11 (25%) patients had grade 2, 2 (4.5%) had grade 3, 7 (15.9%) had grade 4, and 4 (9%) had grade 5 fistulae. Twenty-five patients had associated abscesses. The most common location of the abscess was in the perianal region (8 patients). Conclusions: MR imaging examinations is a highly accurate imaging method for preoperative evaluation perianal fistula. It provides precise information of the fistulous track, along with its relationship to pelvic structures and plays crucial role for surgical planning.

Aims: To audit and evaluate the surgical indications, routes of surgery and types of hysterectomies performed along with histopathological analysis of those hysterectomies in respect to disease of endometrium, myometrium, cervix and fallopian tubes and ovaries for benign conditions. Methods: This is retrospective cross sectional study of all hysterectomy specimens received in the department of Pathology, B and C teaching hospital and research center, Jhapa, Birtamode, Nepal from May 2017 to May 2019. Clinical details were received from the data provided by gynecologists in histopathological requisition forms. Only specimens received for the benign indication for hysterectomy were taken. Results: Out of 115 specimens, the number was equal on both abdominal and vaginal route. The common indications were leiomyoma (60%, n=69), abnormal uterine bleeding (24%, n=28) and uterine prolapsed in 11% (n=13). Uterovaginal prolapse was seen commonest indication for hysterectomy in age group of 5th and 6th decade of life. Myometrial pathology was seen in 74% (n=75) comprising mostly of leiomyoma. Endometrial pathology was present in 14% (n=16) and chronic non-specific cervicitis in 24% (n=28). Abnormal tubo-ovarian pathology was found in 40% (n=51). Conclusions: Leiomyoma, abnormal uterine bleding and uterovaginal prolapsed are the common benign conditions undergoing hysterectomy.

Background: Chest X-rays are important for tracking the progression of lung abnormalities, particularly in critically ill COVID-19 patients in the intensive care units (ICU). We aimed to assess correlation of chest X-ray findings with the COVID-19 disease severity and outcome. Methods: This prospective observational study was conducted at B & C Teaching Hospital, Birtamode from 15 March to 15 July 2021. All diagnosed COVID-19 patients admitted in the ICU for respiratory distress with oxygen saturation < 90% and evaluated by portable X-rays were enrolled. The radiographic findings were evaluated for the distribution and patterns of affection, and the total severity score was calculated using RALE scales of 0 - 8 and Brixia scales of 0 - 18. The scores were then compared between the expired and improved patients. Results: The age of patients (mean ± SD) was 48.2 ± 13.84 years. During the first four days of hospitalization, there was no significant difference in Brixia score (p = 0.793) or RALE score (p = 0.842) between expired and improved patients.The differences in both (Brixia and RALE) scores grew with each passing day (p < 0.05). The Brixia and RALE severity scores had a strong positive correlation at various stages of disease in both expired and improved patients. (r > 0.75, p < 0.001). Conclusion: In resource limited setting, the severity scores (RALE or Brixia) can be used as a quantitative method of the extent of COVID-19 pneumonia, correlating with an increased risk of ICU admission.

Background: Pulmonary nodule ranges from infective to neoplastic lesion and thus at times remain diagnostic challenge for the management of patient. Therefore, proper diagnosis is very essential for appropriate treatment. Biopsy and FNAC plays important role in diagnosing these cases. After 2004 with establishment of therapeutic implication of distinguishing histologic subtypes of lung carcinoma with immunohistochemistry, lung biopsy has become inevitable even for molecular analysis as well. We studied our institution’s experience with percutaneous CT guided biopsy of lung nodules to determine the impact of this procedure in diagnosis of disease. Methods: This is hospital based descriptive study, of two years’ duration (March 2019 to April 2021), carried out at Department of Pathology, B&C Medical College Teaching Hospital and Research Centre Pvt. Ltd., Birtamode, Jhapa. Total 97 cases of CT guided biopsy were performed. Histopathologic analysis was performed and data were analyzed. Results: The most common malignancy diagnosed was Non-small cell carcinoma (NSCC), lung comprising 43.7% which required further immunohistochemistry testing for subcategorization. All infective cases were of Tuberculosis constituting 9.37% of all the cases. Benign cases were of mature cystic teratoma, thymoma and fibroma. Conclusions: Nowadays biopsy of lung in suspicious lesion is mandatory to establish diagnosis for appropriate management, moreover in malignancy cases for which most of the cases require immunohistochemistry and molecular analysis.