Browsing by Author "Nakarmi, Shweta"
Now showing 1 - 3 of 3
Results Per Page
Sort Options
Publication A Simplified Understanding of the Black Swan: Anti-phospholipid Antibody Syndrome(Nepal Medical Association, 2019) Vaidya, Binit; Nakarmi, Shweta; Joshi, Rakshya; Baral, RikeshAbstract Anti-phospholipid antibody syndrome is caused by the presence of specific antibodies against phospholipid-binding plasma proteins in serum of patient, with or without underlying autoimmune diseases, that causes prolongation of tests of coagulation. High index of clinical suspicion is required for diagnosis. Stroke or myocardial infarction in young, unprovoked recurrent deep vein thrombosis and recurrent pregnancy loss are typical scenarios where it should be suspected. Presence of non-criteria manifestations like livedoreticularis, skin ulcers, nephropathy, valvular-heart disease and thrombocytopenia adds to diagnostic clue for presence of the syndrome. Therapeutic anti-coagulation with heparin followed by warfarin is required for patients with acute thrombosis. Those with venous thrombosis are given moderate-intensity warfarin(INR 2-3), whereas those with arterial thrombosis or recurrent venous thrombosis even on warfarin are treated with high intensity warfarin (INR 3-4). Similarly, anticoagulation with heparin is advised throughout pregnancy and up to six weeks postpartum. Treatment recommendations are still not clear for asymptomatic patients and in those with non-criteria manifestations of the disease. Steroids, intravenous immunoglobulin and immunosuppressant are reported to be effective in catastrophic cases characterized by rapid small vessel thrombotic involvement of multiple organ systems. Studies are evaluating the efficacy of direct thrombin inhibitors in the management of refractory cases. Keywords: Anticoagulants; Anti-phospholipid syndrome; Obstetric APS; Thrombotic APS.Publication Early Undifferentiated Arthritis: A Developing Country Perspective from Nepal(Nepal Medical Association, 2018) Vaidya, Binit; Baral, Rikesh; Nakarmi, ShwetaAbstract 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, UltrasonographyPublication Sustained Drug Free Remission of Lupus Panniculitis with Methotrexate: A Case Report From Nepal(Nepal Medical Association, 2018) Vaidya, Binit; Baral, Rikesh; Baral, Hritu; Nakarmi, ShwetaAbstract Cutaneous manifestations are second most common presenting feature of lupus. Discoid lupus erythematosus is the most common variant amongst all; lupus panniculitis being described in only 2-5% of cases. Most cases of cutaneous lupus are associated with autoantibodies and either precede or follow the systemic manifestations of lupus. There is no proven treatment for cutaneous manifestations of lupus including lupus panniculitis. Available non-randomized studies show efficacy of hydroxychoroquine in most cases, whereas methotrexate and other immunosuppressant are used in relapsing cases. We describe a case of lupus panniculitis presenting as an isolated manifestation of lupus with negative autoantibody titers which responded well to methotrexate. We observed that lesions went into drug-free remission in 1year and did not recur on 1year follow-up. There was no residual skin atrophy or scarring. Drug-free remission in isolated cases of lupus panniculitis variant could be possible with timely intervention in the absence of autoantibodies Keywords: Lupus; panniculitis; Nepal; Methotrexate