RESUMEN
Ewing sarcoma/primitive neuroectodermal tumor (ES/PNET) is a type of malignancy that usually appears as a tumor in the bone. However, in a few patients with ES/PNET, it can occur outside of the bone. Although extraosseous ES/PNET can appear in various parts of the body, involvement of small bowel is rare. If it does, it can present with vague abdominal pain and gastrointestinal bleeding. This case report presents a 28-year-old gentleman with extraosseous ES/PNET in the duodenum who experienced gastrointestinal bleeding as a presenting symptom.
RESUMEN
Information on the burden of healthcare-associated infections (HAIs) and patterns of antibiotic use are prerequisites for infection prevention and control (IPC) and antibiotics stewardship programmes. However, a few studies have been reported from resource-limited settings and many of them have not used standard definitions to diagnose HAI precluding benchmarking with regional or international data. This study aims to estimate the prevalence of HAIs and antibiotic use in our centre. We conducted a point prevalence survey in a 350-bed university hospital in Kathmandu, Nepal in April 2019. We reviewed all patients aged ⩾ 18 years admitted to the hospital for at least two calendar days and evaluated for the three common HAIs-pneumonia, urinary tract infection and surgical site infection. We used the clinical criteria by the European Center for Disease Prevention and Control to diagnose the HAIs. We also collected information on the antibiotics used. Of 160 eligible patients, 18 (11.25%) had HAIs and 114 (87.5%) were on antibiotics, with more than half of them (61/114 patients, 53.5%) receiving two or more antibiotics. This highlights the need for effective implementation of IPC as well as antibiotics stewardship programmes in our centre.
RESUMEN
Nitrobenzene is an aromatic compound commonly used in agricultural fertilizers. It is capable of inducing methemoglobinemia when ingested in sufficient quantities. Methemoglobinemia impairs oxygen transport by dual mechanism of impaired oxygen binding and diminished oxygen unloading. We report a case of nitrobenzene poisoning accompanied by methemoglobinemia and later complicated by unconjugated hyperbilirubinemia secondary to hemolysis. Prompt treatment with intravenous methylene blue based on a clinical diagnosis in view of dropping SpO2 unresponsive to oxygen with chocolate cyanosis and paradoxically elevated PaO2 enabled favorable patient outcome. Other recommended modalities of treatment in acquired acute methemoglobinemia include vitamin C, hyperbaric oxygen and exchange transfusions. Keywords: Methemoglobinemia; methylene blue; nitrobenzene; nitroboom.