NepMed Repository

NepMed is a Nepal MEDLINE(Medical Literature Analysis and Retrieval System Online) by Nepal Health Research Council(NHRC). It includes bibliographic information for articles from academic biomedical journals covering medicine, dentistry, nursing, pharmacy, dentistry veterinary medicine, and allied health sciences.

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Article

Management of acute lower gastrointestinal bleeding: principles and current practice in the united kingdom

(Nepal Medical Association, 2015) James Robins; Shrestha, Anne; James Hampton; Shrestha, Badri Man

Abstract Acute lower gastrointestinal bleeding is a common cause for hospital admission that results in significant morbidity and mortality. The major objectives of all involved in the management of ALGBI patients are to reduce mortality and the need for major surgery. A secondary objective is to prevent unnecessary hospital admission for patients presenting with bleeding that is not lifethreatening. The management of ALGBI has evolved over last decade with the changing modalities of diagnostic facilities. On review of the published literature, there is paucity of randomised control trials in relation to the diagnostic tools and management of ALGBI. The aim of this review is to summarise the principles and current methods available for the diagnosis and treatment of ALGIB and based on the available evidence and the current practice in the United Kingdom, outline an algorithm for the management of ALGIB. Keywords: Lower gastrointestinal bleeding; Aetiology; Prognosis; Management algorithm.

Article

En bloc Pancreaticodudenectomy with colectomy for locally advanced right sided colon cancer

(Nepal Medical Association, 2015) Bhandari, Ramesh Singh; Lakhey, Paleswan Joshi; Mishra, Parsu Ram

Abstract A 57 year old male presented to our outpatient clinic with history of on and off melena, weight loss and decreasing appetite for 10 months duration and a noticeable mass on the right upper quadrant. Abdominal examination revealed an intra-abdominal lump in right upper quadrant which was subsequently evaluated by colonoscopy, which revealed an ulcero-proliferative growth in the hepatic flexure and the biopsy from it confirmed well-differentiated adenocarcinoma. Contrast enhanced computed tomography demonstrated hepatic flexure mass with possible invasion into adjacent duodenum without features of advanced disease. After completion of necessary preoperative assessment and investigations, patient was explored with curative intent and underwent extended right hemicolectomy with en bloc pancreaticodudenectomy. Patient was discharged on 10th postoperative day and at 14 months follows up; he was doing well without any evidence of recurrence. Keywords: Colectomy; Locally advanced; Pancreaticoduodenectomy.

Article

Methotrexate in the treatment of recalcitrant nodular vasculitis

(Nepal Medical Association, 2015) Parajuli, Sudip; Dhital, Kamal Raj

Abstract We report a case of recalcitrant nodular vasculitis in a 23 years old male who was treated successfully with methotrexate. He presented to our Dermatology out Patient Department, Tribhuvan university teaching hospital with complaints of recurrent painful discharging ulcer over bilateral calf and lower legs of three years duration. The diagnosis of nodular vasculitis was made on the basis of the clinical presentation and the histopathological findings. The patient was treated with antituberculosis treatment with initial good response; however the lesions persisted later on, despite completing the course of ATT. The patient did not respond to treatment with systemic corticosteroids also. On starting methotrexate, the lesion started healing within a period of two weeks and there was significant improvement in subsequent one month. This case report highlights the efficacy of methotrexate in the treatment of recalcitrant nodular vasculitis. Keywords: ATT; Methotrexate; Nodular vasculitis.

Article

Folie a deux

(Nepal Medical Association, 2015) Chalise, Pratikshya; Subedi, Sandip; Sharma, Pawan

Abstract Shared psychotic disorderis a rare psychiatric disorder. It is defined when a primary psychotic person imposes his/her delusional beliefs to the other person usually in a close relationship. Occurrence of this disorder among family members and close friends has been described. However, its exact incidence and prevalence is not known. Since such case has not been reported in Nepal to best of our knowledge, we present a case of shared delusional disorder along with brief review of literature. This case report describes a case of common shared persecutory delusion in husband and wife. Keywords: Folie a deux; Shared psychotic disorder.

Article

The man behind the royal massacre

(Nepal Medical Association, 2015) Sherchan, Surendra; Joshi, Devavrat

Abstract Delusional disorder is a relatively uncommon psychiatric condition in which patients present with non-bizarre delusions, but with no accompanying prominent perceptual disturbances, thought disorder or significant and sustained mood symptoms. Apart from their delusions, people with delusional disorder may continue to socialize and function in a normal manner and their behavior does not generally seem odd or bizarre to others for many years of the onset of their symptoms. Because of this, they are brought to the clinician many years after the onset of their symptoms, only when their delusional behavior becomes overt. Thus, identifying and treating delusional disorders in time is a challenging task. Keywords: Delusion; Grandiose; Persistent delusional disorder.

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