Lister Hospital

Scrub typhus is a mite-borne rickettsial infection endemic in many parts of India and typically causes small-vessel vasculitis; large-vessel involvement is rare. We report a 52-year-old immunosuppressed man on long-term tofacitinib who presented with prolonged fever, weight loss, and systemic inflammation, and was found to have multiple pseudoaneurysms involving the abdominal aorta, carotid, and popliteal arteries, along with pulmonary nodules and necrotic lymphadenopathy. Extensive evaluation for tuberculosis, fungal infections, and bacterial endocarditis was negative, with no response to broad-spectrum antimicrobials or antitubercular therapy. Serology for scrub typhus was positive following identification of travel to an endemic area, and doxycycline led to rapid clinical and biochemical improvement. Selected pseudoaneurysms were managed surgically and endovascularly with good outcomes. This case highlights scrub typhus as a rare cause of large-vessel pseudoaneurysms in immunosuppressed patients in endemic regions.

Provision of hearing healthcare in Nepal is evolving due to expanding screening programmes, new epidemiologic data and growing surgical and rehabilitative capacity. Recent literature offers updated prevalence estimates, insights into rural disparities, and evidence on the lack of ear care and hearing health amongst the population including health professionals. Recent studies highlight the high burden of hearing impairment in remote provinces where there is often limited knowledge, the feasibility of infant-hearing screening in low-resource settings, and new data on paediatric cochlear implant outcomes. Earlier literature contextualises chronic otitis media, school-aged hearing loss, and sociocultural barriers. Workforce limitations, financing, and patchy geographic distribution of services remain substantial challenges. Despite resource constraints, Nepal is making meaningful progress in screening, epidemiologic characterisation, and surgical rehabilitation. Further advances will require integration of ear and hearing care into primary health systems, scaling of newborn screening, equitable cochlear implant access, workforce expansion, and implementation research to guide policy.

To evaluate the concordance of the NBCL CONNECT Point-of-Care (POC) Intraoperative Parathyroid Hormone (IOPTH) assay with a Central Laboratory standard, with a focus on percentage drops and the usefulness of POC testing in parathyroid surgeries. In this prospective single-centre study (Nov 2023-May 2025), blood samples were drawn from patients undergoing parathyroidectomy for simultaneous analysis on the NBCL CONNECT POC assay and the central laboratory platform. The timing of the blood sample would typically be at induction of anaesthesia, 5 min and 10 min post-excision. Statistical analyses were performed using Python with the SciPy and Matplotlib libraries. Wilcoxon signed-rank test was used to determine the presence of a systematic difference between the two assays. Bland-Altman analysis was performed to calculate the mean difference and the 95% limits of agreement. Pearson correlation coefficient was used to evaluate the linear relationship between the two methods. Fifty-seven consecutive patients were identified and included in this study. No significant difference was found at baseline (p = 0.943) or 5 min (p = 0.098). However, a statistically significant difference emerged at 10 min (p = 0.003). Bland-Altman analysis revealed wide limits of agreement at all time points and correlation between the methods was poor at the 10-minute mark (r = 0.11). The mean percentage PTH drop reported by NBCL CONNECT was significantly greater than the laboratory values at both 5 min (58.6% vs. 49.0%, p = 0.001) and 10 min (51.2% vs. 36.2%, p = 0.009). The NBCL CONNECT provides a reliable baseline PTH measurement but consistently reports a larger percentage drop post-excision. Surgeons using this assay must be aware of its specific characteristics and the potential for both false-positive and false-negative results to ensure optimal surgical outcomes. Not applicable.

PurposeTo determine whether there is a significant decrease in intimal hyperplasia post percutaneous transluminal angioplasty (PTA) of AV access stenosis. Comparing drug-coated balloon (DCB) angioplasty with plain uncoated balloon (PUB) angioplasty by examining B-mode ultrasound measurements of percentage intimal medial thickening (%IMT) in stenotic lesions pre and post PTA.MethodsOne hundred ninety-one consecutive PTA procedures for AV access dysfunction were screened retrospectively for inclusion. Those procedures where there was an ultrasound prior to and following PTA with measurements of IMT were included.ResultsNinety-nine stenotic lesions were included in a total of 87 patients. A total of 26/99, 26%, were treated by DCB angioplasty, and a total of 73/99, 74%, were treated by PUB angioplasty.The difference between the pre-PTA and post-PTA %IMT was calculated and defined as the delta-%IMT for each group. There was a greater reduction in %IMT in the DCB group (mean delta-%IMT = − 22.35%) when compared with the PUB group (mean delta-%IMT = − 5.94%), p = 0.0005.Delta-%IMT for those lesions where there was a baseline pre-PTA %IMT of greater than 25% was examined. The mean delta-%IMT reduced in the PUB group from − 5.94% to − 2.20% and remained similar in the DCB group at − 20.05%, p = 0.0003.A Kaplan–Meir survival analysis examining primary patency over 24 months did not demonstrate any significant difference between the 2 groups.ConclusionThe statistically significant decrease in %IMT post PTA using a DCB compared with PUB angioplasty appears to demonstrate an anti-proliferative drug effect on lesion intimal hyperplasia. However, this did not translate into a sustained difference in target lesion primary patency.Graphical

Kikuchi-Fujimoto disease (KFD) is a rare, self-limiting necrotising lymphadenitis, mainly affecting young adults, and commonly presenting with fevers and lymphadenopathy. Diagnosis is confirmed by histopathological examination via lymph node biopsy, and management is primarily supportive with non-steroidal anti-inflammatory drugs and/or a tapering course of steroids.We herein describe a case of a 23-year-old Caucasian female with severe KFD. She presented to the same day emergency care (SDEC) with a six-week history of systemic symptoms, including myalgia, arthralgia, fevers, and weight loss. Her initial blood tests showed normocytic anaemia, leukopenia, abnormal liver function tests, and a raised erythrocyte sedimentation rate. Notable aspects of this case include the large range of presenting symptoms, a coexisting Epstein-Barr virus (EBV) infection, and a delay in diagnosis of 14 days with a long inpatient admission.KFD poses a diagnostic dilemma due to its non-specific presentation, with differentials from a range of varying aetiologies, including infective (EBV), rheumatological (systemic lupus erythematosus (SLE), adult Still's disease), haematological (lymphoma), and others (sarcoidosis, tuberculosis). For our patient, the early working diagnoses of SLE and lymphoma prompted consideration of a transfer to a specialist haematology oncology bed.This case highlights the importance of early histopathological diagnoses in KFD and the need for a multidisciplinary approach, including haematology colleagues, commenced early in the acute setting to avoid misdiagnoses and unnecessary anxiety for patients. Currently, no specific national guidelines exist for KFD, and management is focused on supportive care. By sharing our experience, we hope to increase awareness of KFD's clinical presentation, diagnosis, and management amongst clinicians to avoid diagnostic delay or unnecessary interventions and guide timely therapeutic decisions.

BackgroundSeizures are a common consequence of acute hemorrhagic stroke, which has a high morbidity and fatality rate. It is yet unknown how they relate to age, the National Institutes of Health Stroke Scale (NIHSS), the modified Rankin Scale (mRS), and discharge status.MethodsWe conducted a cross-sectional study of 75 patients (aged 16-92 years) with acute hemorrhagic stroke admitted to the Neuropsychiatry Department of Qena University Hospitals, a tertiary care center serving a large catchment area in Upper Egypt. Data were collected over six months, from September 2024 to February 2025. Neurological impairment was assessed using the NIHSS, and functional outcome was measured using the mRS at admission and discharge. Statistical comparisons included paired t-tests and Wilcoxon signed-rank tests. Associations between seizures, age, stroke severity, and outcomes were also analyzed.ResultsSeizures were not correlated with age. During hospitalization, a noteworthy mean improvement in NIHSS (+0.97; t = 10.70 and p < 0.0001; W = 21.50 and p < 0.0001) was noted, suggesting neurological recovery. On the other hand, mRS remained at a median 3 (t = -0.51 and p = 0.6113; W = 275 and p = 0.9173), indicating no discernible change. There was no discernible change in NIHSS or mRS among patients who were released on demand (n = 10). Ten out of the 12 in-hospital fatalities had seizures, and the majority had moderate-to-severe strokes (NIHSS ≥9; mRS ≥3). Patients with very severe strokes (NIHSS 16-17; mRS = 5) and no recovery experienced two non-seizure fatalities. Admission NIHSS (1-17) and mRS (1-5) showed a broad variety of stroke presentations and recovery trajectories.ConclusionThe baseline of stroke severity was the best indicator of a bad prognosis in acute hemorrhagic stroke, and seizure incidence was not age-dependent. Significant neurological recovery was recorded by NIHSS, but short-term functional improvement was not reflected by mRS. These results indicate that seizures are more common in fatal cases but secondary to the total load of strokes, underscoring the prognostic significance of baseline severity.

Background: This review discusses tocilizumab, a monoclonal antibody, as a promising therapeutic option for Neuromyelitis optica (NMO) spectrum disorders. NMO is characterized as an autoimmune disorder that is rare. It affects the eyes and the spinal cord. By binding to the IL-6 receptor, tocilizumab reduces inflammatory cytokines and inhibits the immune response that leads to NMO. Methodology: For this article, a comprehensive search of the relevant literature was conducted using electronic databases namely PubMed, Cochrane Library, and Embase, from inception till August 2021. Results: Clinical trials that were included in this literature review showed promising results that tocilizumab reduces disease activity, and relapses, and improves clinical outcomes. Conclusion: In conclusion, tocilizumab represents a significant advance in treating NMO, but more studies might be needed to determine its long-term safety and the best way to use it for treating NMO spectrum disorders. However, the optimal dosing regimen and long-term safety of tocilizumab are yet to be determined.