High elevation adventures are popular among travelers; however, they carry significant health risks, such as altitude sickness. This study aims to identify risk factors associated with high altitude sickness among travelers to Mustang district. A health-facility-based, age-sex matched 1:1 case-control study was conducted in Mustang district hospital, Nepal. Measurements included Acute Mountain Sickness/High Altitude Cerebral Edema/High Altitude Pulmonary Edema assessment via LLS questionnaire, demographics, medical history, ascent rate, and prophylactic medicine intake. Data were collected between September and November, 2023 via predesigned structured questionnaire by trained medical officers in, and analyzed using SPSS version 25. Using binary logistic regression, the study tested potential risk factors associated with altitude sickness. Ethical approval was obtained from the NHRC, and written informed consent was obtained from all participants. A total of 63 cases (individuals with altitude sickness) and 63 controls (without) were interviewed. The mean age of cases and controls was 48.5 years (SD = 16.5) and 48 years (SD = 16.9) respectively. 38 were rapid ascenders, and 88 were slow ascenders. Awareness of altitude sickness was reported by 65 individuals, with 36 taking prophylactic medication (Acetazolamide 125/250mg). Among cases, 8 experienced HACE, 42 had AMS, and 13 had HAPE. Rapid ascent (Adjusted Odds Ratio [AOR]: 6.41, 95% Confidence Interval [CI]: 2.36-17.54), individuals with a previous history of illness (AOR: 10.20, 95% CI: 2.70-38.46), and failing to take prophylactic medication (AOR: 10.01, 95% CI: 1.896-10.680) were linked to an increased risk of altitude sickness. Our study highlights the critical role of ascent speed, previous history of illness, and use of prophylactic measures in development of altitude sickness.

Sarcoidosis is a multiorgan disease characterized by noncaseating granulomatous lesions, most commonly affecting the lungs. It typically presents with cough, dyspnea, wheezing, and chest pain. Chest X-rays often show bilateral hilar adenopathy. Extrapulmonary symptoms are also common. However, diagnosis requires ruling out other potential causes. We present a case of a 58-year-old African-American woman with diabetes mellitus who presented with right flank pain and was found to have elevated creatinine (4.4 mg/dL) and severe hypercalcemia (15.3 mg/dL). Imaging revealed extensive lymphadenopathy, leading to suspicion of lymphoma. A comprehensive workup, including lymph node biopsy, ruled out lymphoma, and sarcoidosis was diagnosed. The patient was treated with intravenous (IV) hydration, calcitonin, and pamidronate for hypercalcemia, with subsequent normalization of calcium and improvement in creatinine levels. A lymph node biopsy confirmed granulomatous disease consistent with sarcoidosis. Flow cytometry showed no evidence of lymphoma, and the patient was started on prednisone. Sarcoidosis presents a diagnostic challenge due to its varied presentation and the need for more sensitive and specific diagnostic tests, often leading to under-recognition and misdiagnosis. Studies have found that most patients with pulmonary sarcoidosis also have extrapulmonary involvement, with extrathoracic lymph nodes and skin being the most commonly affected sites. Sarcoidosis-lymphoma syndrome should also be considered, as the incidence of lymphoma is higher in patients with sarcoidosis. However, it can be missed due to similar presentations and a need for more awareness, impacting patient care and prognosis. Our case emphasizes the importance of accurately diagnosing sarcoidosis and ruling out lymphoma and other lymphoproliferative diseases, given their increased incidence in sarcoidosis patients. However, treatment for lymphoma should not be initiated until the diagnosis is confirmed, as sarcoidosis can mimic lymphoma.

Infectious aortitis is an uncommon but potentially fatal condition that can lead to aortic dissection or rupture. We describe a case of a 69-year-old woman who developed a Stanford type B aortic dissection, presumptively caused by Salmonella, which was successfully managed with thoracic endovascular aneurysm repair (TEVAR) and long-term antibiotics. A literature review of 17 reported cases from 2000 to 2024 of aortic dissection secondary to infectious aortitis was conducted. The most frequently implicated causative organisms were Salmonella and Staphylococcus species. Presenting symptoms were non-specific, such as fever, chest or abdominal pain, and constitutional symptoms. Predisposing factors included hypertension, malignancy, diabetes, atherosclerosis, and hyperlipidemia. The proposed pathogenesis involves bacterial seeding of the aortic wall, leading to enzymatic degradation and structural weakening. Management requires prompt surgical intervention (open or endovascular) based on Stanford dissection type, combined with long-term antibiotic therapy. Early diagnosis is crucial, as infectious aortitis can rapidly progress to life-threatening sequelae like rupture or dissection. Clinicians must maintain a high index of suspicion in at-risk patients presenting with suggestive symptoms or imaging findings.

Metformin is a widely prescribed, oral, anti-diabetic agent for the treatment of type 2 diabetes mellitus (DM2). While generally well-tolerated, metformin can accumulate in patients with acute kidney injury (AKI) or chronic kidney disease (CKD), leading to potentially life-threatening complications such as metforminassociated lactic acidosis (MALA). Severe hyperkalemia is a rare but serious manifestation of metformin toxicity. We report a case of a 74-year-old African American man with DM2, hypertension, and CKD stage 3a, who presented with nausea, vomiting, lethargy, and diarrhea. Laboratory findings revealed severe AKI with a creatinine level of 8 mg/dL (baseline 1.7 mg/dL) and a potassium level of 7.8 mEq/L. The patient developed refractory hyperkalemia requiring multiple interventions and eventually continuous renal replacement therapy. Further evaluation revealed metformin-induced severe lactic acidosis with a metformin level of 21 mcg/mL (therapeutic range <5 mcg/mL). This case highlights the importance of recognizing metformin toxicity as a potential cause of severe, refractory hyperkalemia and metabolic acidosis in patients with AKI or CKD. Early recognition and prompt discontinuation of metformin, along with appropriate management of electrolyte disturbances and metabolic derangements, are crucial in preventing life-threatening complications.

Introduction: With the growing incidence of cancer, the role of caregivers has become increasingly critical in ensuring comprehensive patient care. However, the prolonged and sustained nature of caregiving responsibilities can adversely affect the mental health of caregivers. This study aims to explore the prevalence of depression and anxiety among caregivers of cancer patients. Methods: We enrolled 101 caregivers of cancer patients from a tertiary care hospital in Kathmandu in this study and obtained demographic information from the patients and their caregivers. The prevalence of depression and anxiety were assessed by the use of PHQ9 and GAD 7 score respectively. We used Chisquare/Fischer’s exact test to analyze association between variables. Results: Out of 101 caregivers, 80 (79.2%) were males and 21(20.8%) were females. 58.4% had either mild, moderate or severe anxiety according to GAD 7 Scale. 28.7% had either mild moderate or moderately severe depression according to the PHQ 9. Male gender, relationship with the patient, the patient’s ECOG performance score had significant association with higher severity of anxiety. Closer relationships with patients showed higher severity of depression. Conclusion: Anxiety and depression were considerably present among caregivers of the patient. Interventions aimed at reducing the mental health impact of cancer should focus not only on the patient but also to their caregiver.

We herein report a case of an unusual variant of Guillain-Barr & eacute; syndrome (GBS) where the patient presented with multiple bilateral cranial nerve palsies involving nerves V, VII, IX, and X, leading to difficulties with eye closure, eyebrow-raising, chewing, swallowing, and speech. Sensation and motor examination were normal. Bilateral knee reflexes were absent. Lumbar puncture showed cerebrospinal fluid albuminoid-cytologic dissociation. Prompt initiation of plasmapheresis therapy facilitated a successful recovery. This case report underscores the significance of early identification and tailored intervention for atypical GBS presentations, highlighting the potential for improved patient outcomes through targeted management strategies.