Browsing by Author "Joshi, Anjali"
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Publication Cecal Perforation Following Intraperitoneal Abscess after Anti-tubercular Therapy: A Case Report(Nepal Medical Association, 2023) Prasai, Parikshit; Joshi, Anjali; Poudel, Santosh; K.C., Sarjan; Pahari, RabinAbstract Abdominal tuberculosis is defined as infection of gastrointestinal tract, peritoneum, abdominal solid organs, and/or abdominal lymphatics constituting approximately 12% of extra-pulmonary tuberculosis cases. Intestinal perforation is an acute presentation of abdominal tuberculosis. Intestinal perforation can occur before or at the beginning of anti-tubercular therapy. It is considered to be a paradoxical reaction if it occurs during or after treatment. Intestinal perforation is uncommon but serious and life-threatening as complication-mortality rate secondary to perforation are estimated to be >30%. We present a case of an 18-year-old female who developed cecal perforation following an intraperitoneal abscess after completion of anti-tubercular therapy for intestinal tuberculosis. She was a known case of intestinal tuberculosis. She had undergone pigtail catheterisation for an intraperitoneal abscess and completed 18 months of anti-tubercular therapy after which she developed cecal perforation. A paradoxical response was observed following the completion of anti-tubercular therapy. Early diagnosis and treatment reduce the complications and mortality rates of cecal perforation due to abdominal tuberculosis.Publication Survival of Misdiagnosed 2,4-Dichlorophenoxyacetic Acid Poisoning Masquerading as Organophosphorus Poisoning: A Case Report(Nepal Medical Association, 2024) Joshi, Anjali; Joshi, Aatish; Pant, Shubham; Bhurtyal, Aakanksha; Yadav, SunilAbstract Herbicide such as 2,4-Dichlorophenoxyacetic acid is commonly used in wheat growing regions and is being ingested with suicidal intent due to easy availability and lack of regulation for buying it. Various articles suggest high fatality upon ingestion of this compound. We report a rare survival of a 24-year-old male who ingested about 45 ml of the compound and presented with symptoms similar to organophosphate poisoning. Before presenting to our hospital, the patient was misdiagnosed and an atropine challenge test and gastric lavage was done. However, after presenting to our center, detailed history was taken and the bottle containing the compound was retrieved, following which the patient was shifted to the intensive care unit where urinary alkalinization and forced diuresis was done. He started getting better and was discharged on fourth day. Detailed history taking can prevent misdiagnosis of 2,4-Dichlorophenoxyacetic acid poisoning. Early diagnosis and adequate supportive management of urinary alkalinization and forced diuresis can improve patient outcomes and reduce fatality.