Hemophagocytic Lymphohistiocytosis (HLH) is a rare life‐threatening condition characterized by widespread activation of the immune system leading to tissue damage all over the body. It is divided into primary HLH due to inborn error in lymphocytes, T cells, and macrophages and secondary HLH which is mostly due to infections, systemic connective tissue diseases, and lymphoid malignancies. Here, we report a 34‐year‐old man with a history of high‐grade fever, chills, and rigor, eschar, splenomegaly with the laboratory findings of thrombocytopenia, hypochromic RBCs with anisocytosis and basophilic stippling, elevated transaminases, and a positive Weil Felix test along with positive PCR results for Orientia tsutsugamushi and the presence of IgG and IgM antibodies. A detailed workup was done to rule out other etiology for fever. Diagnosis of HLH secondary to Rickettsia infection was made with a thorough history, clinical evaluation, and a variety of investigations. The patient was treated with Doxycycline, Ciprofloxacin, Etoposide, and Dexamethasone but unfortunately, the patient died during treatment due to multiorgan failure. Patients with scrub typhus typically respond well to therapy; therefore, early detection and antibiotic treatment can help avoid serious complications. Scrub typhus with the hemophagocytic syndrome can result in DIC and multiorgan failure. Despite its rarity, scrub typhus may be lethal; as a result, practitioners must be aware of the necessity of detecting and treating suspected cases as soon as possible. We learned that a systematic diagnostic approach, use of diagnostic criteria, and prompt treatment are very crucial in this disease.

Background. COVID‐19 commonly affects the lungs and may lead to mild to severe hypoxemia. The supplemental oxygen requirement gradually reduces with the improvement in lung pathology. However, a few patients may have exertional desaturation, and ongoing oxygen needs at the time of hospital discharge. The objective of this research was to study the requirement of oxygen therapy in the immediate post‐COVID‐19 period and its associated risk factors. Materials and Methods. An analytical cross‐sectional study was conducted on the admitted post‐COVID‐19 patients who had recently tested real‐time polymerase chain reaction (RT‐PCR) negative in a tertiary care center from August 2021 to mid of October 2021. Nonprobability consecutive sampling was used, and the sample size was 108. The data were analyzed using the Statistical Package for the Social Sciences (IBM‐SPSS), version 23. The mode of oxygen therapy (nasal cannula, face mask, reservoir mask, or mechanical ventilation) in the first two weeks of the study was presented appropriately in a table. The nonparametric statistical tests were applied to determine the association between the duration of post‐COVID‐19 oxygen therapy and several other risk factors such as age, gender, comorbidities, smoking status, exposure to firewood, COVID‐19 vaccination, and severity of COVID‐19. Results. 95 (87.96%) cases required oxygen therapy in their immediate post‐COVID‐19 period. The overall median duration of oxygen therapy was 6.00 (4.00–10.00) days. The nasal cannula was the most commonly used mode of oxygen supplement. The duration of oxygen therapy was significantly higher in patients aged more than 60 years (6.00 [5.00–11.00], p = 0.013), chronic obstructive pulmonary disease (10.00 [6.00–12.75], p = 0.006), history of chronic smoking (9.00 [5.50–13.00], p = 0.044), and severe COVID‐19 infection (7.00 [5.00–10.50], p = 0.042). Conclusions. The proportion of patients requiring oxygen therapy in the immediate post‐COVID‐19 period was higher than that reported in other studies. In addition, old age (>60 years), chronic obstructive pulmonary disease, chronic smoking, and severe COVID‐19 infection significantly increased the duration of oxygen therapy. So, these factors should be assessed while discharging patients from COVID‐19 facilities, and oxygen supplementation should be planned for needy patients.

Introduction: Corona viruses may also affect the central nervous system, inducing various neurological problems. Guillain-Barré Syndrome (GBS) is a rare immune-mediated post-infectious neuropathy typically leading to ascending weakness. Herein, we present a case of the patient to show an association of GBS and SARS-CoV-2 infection in Nepal Case presentation: Twenty-seven yrs old man show an association of GBS and SARS-CoV-2 infection in Nepal who presented with difficulty in walking, backache, tingling sensations over the bilateral wrist and ankle, and features of facial nerve palsy. The diagnosis of GBS was made. Following Intravenous Immunoglobulin (IVIg) administration, the patient started showing motor recovery within a week. Clinical discussion: Patient who developed GBS as a likely post-infectious complication after the initial onset of infectious symptoms with persistent mild dry cough. Conclusion: GBS has severe complications and early diagnosis is important to monitor for loss of ambulation and initiation of immunoglobulin treatment. GBS should be considered as a potential rare but serious complication due to COVID-19 HIGHLIGHTS Corona viruses may also affect the central nervous system, inducing various neurological problems. GBS is a rare immune-mediated post-infectious neuropathy typically leading to ascending weakness. There is association od GBS and SARS-CoV-2 infection. GBS should be considered as a potential rare but serious complication due to COVID-19.

Introduction: Acute exacerbation of chronic obstructive pulmonary disease is a life-threatening condition triggered by infections or non-infectious agents. Antibiotics use in such cases prevents severe deterioration and treatment failure. Past studies have shown inappropriate use of antibiotics in different health care settings. The objective of this study was to find out the prevalence of antibiotics use in patients with acute exacerbation of chronic obstructive pulmonary disease in the Department of Internal Medicine of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients with acute exacerbation of Chronic Obstructive Pulmonary Disease admitted to Department of Internal Medicine of a tertiary care centre from 12th February, 2022 to 15th April, 2022 after taking ethical clearance from Institutional Review Committee (Reference number: 417). Convenience sampling was done. Data analysis was done using the Statistical Package for the Social Sciences version 23.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data along with median and interquartile range for continuous data. Results: The prevalence of antibiotics use among study participants was 106 (98.15%) (95.61-100 at a 95% Confidence Interval). Penicillin 82 (75.93%) was the most commonly used antibiotics group. Conclusions: The use of antibiotics in acute exacerbation of chronic obstructive pulmonary disease was higher as compared to other similar studies.

Left ventricular non-compaction syndrome (LVNC) is an uncommon congenital disease characterized by prominent trabeculations and deep inter-trabecular recesses of the left ventricle wall. We present the first reported case of Impella 5.5 use in LVNC as a bridge to transplant in a highly sensitized patient. A 50-year-old female with a family history of sudden cardiac death, LVNC cardiomyopathy associated with TPM1 gene mutation, and recurrent hospitalizations due to heart failure was listed for heart transplantation. She had severely reduced systolic function (EF 20%) and high panel reactive antibodies (PRA). She was admitted for desensitization therapy. Hospitalized, she escalated to Dobutamine and Milrinone due to progressive shock. Impella 5.5 was inserted, and inotropes were reduced as her condition steadied. She tolerated desensitization and eventually underwent heart transplantation after 120 days of continuous Impella 5.5 support without developing hemolysis or pump thrombosis. Post-transplant she was found to have concern for left sided stroke symtpoms but completely recovered and remians stable on follow up at 6 months. Due to the lack of prospective trials with large cohorts, managing patients with LVNC and cardiogenic shock is challenging. Novel approaches to complex patients with both Impella 5.5 support and desensitization therapies should be considered in the appropriate setting. Our case highlights the use of mechanical circulatory support in the management of cardiogenic shock within a small left ventricluar cavity in a sensitized patient. This approach should be considered in high-risk patients in whom durable left ventricular assist therapy is not feasible.