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.
Recent Publications
Early Undifferentiated Arthritis: A Developing Country Perspective from Nepal
(Nepal Medical Association, 2018) Vaidya, Binit; Baral, Rikesh; Nakarmi, Shweta
Abstract
Early undifferentiated arthritis is a group of inflammatory joint disease of less than 3 months duration that do not classify under any of the specific rheumatic or connective tissue disorder. Previously, inflammatory arthritis used to be treated only when there was a clear evidence of damage or deformity occurring with it. Use of disease modifying anti-rheumatic drugs were considered potentially harmful early in the course of arthritis which could be self-limiting. However, with the abundance of data on outcomes of early arthritis and identification of factors that can help to predict those outcomes lead to earlier use of such DMARDs. Better understanding of serological tests like anti-CCP antibodies and imaging modalities like high frequency ultrasound with power doppler and magnetic resonance imaging has increased the diagnostic and prognostic yield of such early arthritis cases. It is now imperative that the risk be assessed early in the course of disease and early DMARDs be instituted for better outcome in these cases.
This review analyses the historical evolution of evidence in the management of early undifferentiated arthritis and summarises the treatment approach, monitoring and disease outcomes till date.
Keywords: Arthritis, Rheumatoid, Ultrasonography
Prolonged Intubation Induced Tracheoesophageal Fistula in Suspected Meningococcal Sepsis with ARDS: A Case Report
(Nepal Medical Association, 2018) Rana, Ramesh; Sapkota, Rikesh; Shakya, Binesh; Gautam, Samir
Abstract
Tracheoesophageal fistula is an abnormal communication between trachea and esophagus. Benign acquired types are rare with the incidence of less than 1%. Prolonged endotracheal intubation remains the most common cause. We are reporting a 28 years old female patient presented with chief complaint of a cough after each meal intake in the outpatient clinic. She had a recent history of admission in the intensive care unit with prolonged intubation (11 days). Her general physical examination, laboratory examination, and chest x-ray were normal. Esophagogastroscopy was performed and revealed communication between upper esophagus and trachea approximately at 14-17cm embedded in longitudinal mucosal folds of the esophagus. She was referred to the higher center for surgical repair. Though, a rare complication, high suspicion is necessary to accurately diagnose the disease in a patient with the history of prolonged intubation.
Keywords: Case report; Endotracheal intubation; Mechanical ventilation; Tracheoesophageal fistula
Amelogenesis Imperfecta: A Case Series from the Community
(Nepal Medical Association, 2018) Singh, Abanish; Agrawal, Santosh Kumari; Shrestha, Ashish; Bhagat, Tarakant
Abstract
Amelogenesis Imperfecta is a hereditary disorder affecting the formation of enamel structure. Two female children and one male (11 years, 12 years and 6 years respectively) reported with chief complaint of yellowish discoloration of teeth since their childhood. They reported that they had similar discoloration in their deciduous teeth. Examination showed generalized deposits of plaque and calculus, yellowish discoloration of the teeth with chipping off of the incisal and cuspal enamel structures. OPG revealed thin lining of enamel with thick dentin layer and pulp chamber. PA view revealed unfused anterior fontanels and lateral cephalogram indicated vertebrae in growing phase. The patients were instructed to maintain proper oral hygiene and regular follow up till the growth cessation. Permanent skeletal, functional, esthetic needs is addressed after growth completion. Oral rehabilitation through multidisciplinary approach can certainly provide a good prognosis and patient was counseled and motivated to maintain good oral hygiene.
Keywords: Amelogenesis imperfecta, Esthetic, Yellowish discoloration
Sirenomelia: A Case Report
(Nepal Medical Association, 2018) Kattel, Pramod
Abstract
Sirenomelia is primarily a congenital anomaly where a normally paired lower limb is replaced by a single midline limb and is characterized by single umbilical artery. Such cases though considered rare do occur at our set-up and to make health workers aware regarding the condition, so that they can be managed well when encountered, lays the importance of reporting such case. A referred case of Sirenomelia from Dhading district hospital was presented to Emergency department of Paropakar Maternity and Women’s Hospital on 6th March 2016 of 18 year “Young Primigravida at 34 week and 5 days of gestation in second stage of labor†following ultrasonography diagnosis for better management. After confirming the diagnosis, preterm vaginal delivery was performed with a live baby of 1250 gm consisting of multiple congenital anomalies and poor Apgar score. Such cases do occur at our set-up so that if anomaly scanning is done routinely,
Keywords: Case report; Ectromelia; Fused legs and feet; Mermaid syndrome; Sirenomelia.
Diffuse Alveolar Haemorrhage as Initial Presentation of Systemic Lupus Erythematosus: A Case Report
(Nepal Medical Association, 2018) Dhungana, Ashesh; Shrestha, Prajowl; Shrestha, Bhakta Dev; Baral, Anil; Sayami, Gita
Abstract
Diffuse alveolar hemorrhage results from accumulation of red blood cells in the alveolar space originating from alveolar capillaries. Alveolar hemorrhage in Systemic Lupus Erythematosus is rare but catastrophic and can rapidly progress to respiratory failure. We report a 22-year old lady who presented with dyspnoea on exertion, hemoptysis, bilateral leg swelling and oliguria. Diffuse alveolar hemorrhage was confirmed by bronchoalveolar lavage fluid analysis. Serologic tests and renal biopsy confirmed lupus nephritis. She was treated with systemic immunosuppressive therapy and plasma exchange, to which she had a favourable response. Lupus presenting as alveolar hemorrhage is rare which warrants prompt diagnosis and treatment to prevent complications.
Keywords: Bronchoalveolar lavage (BAL), Diffuse alveolar hemorrhage (DAH), Systemic lupus erythematosus (SLE)