Dengue fever complicated with ST elevation myocardial infarction with atypical features: A case report

Dengue fever is an arboviral infection whose presentation ranges from a mild febrile illness to a multisystem complicated syndrome. We report a case of 58-year-old female presenting with fever, myalgia, arthralgia, and vomiting who was found to be infected with dengue and had electrocardiography changes revealing ST-segment elevation myocardial infarction, a rare manifestation in dengue. Dengue fever can affect the cardiovascular system leading to conduction abnormalities, hypotension, arrhythmias, myocarditis, cardiomyopathy, and occasionally myocardial infarction, which has been reported in only a few case reports prior to this. The differentiation between myocarditis and myocardial infarction is essential for which echocardiography and coronary angiography can be helpful. It is essential to keep an eye on the cardiovascular complications in a dengue patient as the presentation can be quite subtle with devastating consequences.

Disseminated tuberculosis in an immunocompetent woman from the Himalayan region of Nepal: A case report

Disseminated tuberculosis (TB) resulting from lymphohematogenous dissemination of Mycobacterium tuberculosis during primary infection or reactivation of latent disease is rare among young immunocompetent patients. Central nervous system TB (CNS TB) is one of the most challenging clinical diagnoses with high fatality. Here, we describe a young immunocompetent female with no known comorbidities initially presented with military pulmonary TB and later developed CNS TB. This presentation of disseminated TB in immunocompetent patient warrant early diagnosis and treatment.

Health seeking behavior during pregnancy and child birth among Muslim women of Biratnagar, Nepal

Maternal mortality remains one of the biggest public health challenges in Nepal. This paper explores the health seeking behavior, during pregnancy and child birth in certain ethnic group. The poverty, illiteracy, women's low status in the society, lack of access and difficult geographical terrain are major reasons for poor maternal health status in Nepal. Cross-sectional study was conducted among 200 Muslim women of ward # 7 of Biratnagar municipality. They were interviewed to understand their health seeking behavior during pregnancy and childbirth, factors associated with use of health services and their role in the family. Information's on usages of health services, education level, family stricture, and occupational status, information were collected using a pretested and structured questionnaire. The overall institutional delivery in study population was found 24.5%. Low socio-economic status, Illiteracy and poverty in women are the major challenging features of pregnancy and child birth.

Assessment of iodine nutrition status among school age children of Nepal by urinary iodine assay

The present study was undertaken to evaluate the iodine status of Nepalese school age children by measuring urinary iodine excretion (UIE). A population based cross-sectional study was conducted during November-December 2006 among 1,094 school age children. Spot urine samples were collected from all children and UIE was measured during February to March 2007 by an ammonium persulfate digestion microplate (APDM) method. The median UIE at the national level was 193.10 microg/l, indicating adequate iodine intake in Nepalese schoolchildren. The proportion of the population having UIE below 50 microg/l and below 100 microg/l were 4.5% and 22.0%, respectively. Determination of precision of the method was done following calculation of the inter- and intra-assay coefficient of variation (CV). At low, medium and high concentrations of urinary iodine the intra-assay CVs were 6.3, 1.8 and 1.9%, respectively. The inter-assay CVs for low, medium and high concentrations of urinary iodine were 11.9, 4.9 and 6.2%, respectively. Therefore, current iodine nutrition status is at satisfactory levels in Nepal. An effective monitoring program must be continued to ensure optimal iodine status and prevent the population from developing iodine deficiency disorder (IDD).