Browsing by Author "Sapkota, Sulav"
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Publication Evans Syndrome: A Case Report(Nepal Medical Association, 2022) Dhakal, Sanam; Neupane, Sulochana; Mandal, Ankit; Parajuli, Surya Bahadur; Sapkota, SulavAbstract Evans syndrome is defined as the concomitant or sequential association of warm autoimmune hemolytic anaemia with immune thrombocytopenia, and less frequently autoimmune neutropenia. It is associated with non-cross-reacting auto-antibodies directed against antigens specific to red blood cells, platelets or neutrophils. Clinical symptoms could be related to hemolysis and thrombocytopenia. Evans syndrome is a rare diagnosis of exclusion. The first-line treatment of Evans syndrome is intravenous corticosteroids or intravenous immunoglobulins and second-line treatment with rituximab or splenectomy for those who are refractory to steroids. Here is a case of a fifty-year-old- female who presented with bleeding from the mouth and gums, bluish patches over the shin and trunk along with generalised weakness and severe backache. We are interested in reporting this case because the presentation of patients with such scenarios on our part will compel the treating physician to overlook Evans syndrome and get it underdiagnosed.Publication Lung Cancer with Brain Metastases Treated with Radiotherapy Followed by Bevacizumab Maintenance: A Case Report(Nepal Medical Association, 2022) Khan, Sajjad Ahmed; Gautam, Sakshyam; Sapkota, SulavAbstract Brain metastases in a patient with non-small cell lung cancer carry a grave prognosis. Without effective interventions, the average survival rate is 6 months. Here, we present a case of a 59-year-old male with non-small cell lung cancer and multiple brain metastases treated with radiotherapy followed by bevacizumab maintenance with prolonged survival. There are limited studies establishing the efficiency and toxicity profile of anti-vascular endothelial growth factors for brain metastases. This reported case had a remarkable response with marked clinical and radiological improvement along with a tolerable toxicity profile. Showing the extent of effectiveness and efficacy of anti-vascular endothelial growth factor agents in the case of lung cancer with brain metastases is the main motto of our study.Publication Primary Anorectal Melanoma: A Case Report(Nepal Medical Association, 2023) Khan, Sajjad Ahmed; Neupane, Adarsha; Gautam, Samit Kumar; Sapkota, SulavAbstract Primary anorectal melanoma is an extremely rare and aggressive mucosal melanocytic malignancy of the anorectal region. Because of the rarity of the tumor and vague clinical presentations, diagnosis at an early stage is a challenge for clinicians. In our context, where the hemorrhoid is a diagnosis of cultural familiarity for any sort of rectal pathology, these patients often present to us at a very advanced stage of the disease. Here, we present a case of a 55-year-old male patient with stage 2 anorectal melanoma who is on adjuvant chemotherapy following abdominoperineal resection with a permanent colostomy. Five cycles of dacarbazine and carboplatin have been given and the patient is doing well with the treatment. Abdominoperineal resection with excision of the tumor remains the mainstay of treatment; however, poor patient compliance with permanent colostomy is a major limiting factor of abdominoperineal resection. Even with the best interventions and care, the survival rate is not very good.Publication Promising Response of Paclitaxel in Metastatic Transitional Cell Carcinoma of Distal Ureter Complicated with Hydroureteronephrosis: A Case Report(Nepal Medical Association, 2023) Khan, Sajjad Ahmed; Sah, Santosh; Parajuli, Surya Bahadur; Sapkota, Sulav; Rayamajhi, AsmitaAbstract Ureteric carcinoma is the rarest of all urothelial malignancies, and little attention has been given to it. Palliation in these groups of patients is a dilemma in the clinics. Use of chemotherapeutic agents in ureteric carcinoma is a double edged sword, as these patients had already impaired renal function due to post-renal failure and nephrotoxic nature of most of the chemotherapeutic agents can further deteriorate the renal function, making the management approach, a relatively visionary task. Here, we present a case of a 77-year-old female with metastatic ureteric carcinoma locally complicated with hydroureteronephrosis, coming to us with gross haematuria, lower abdominal pain along with cough. Apart from age factor of the lady, presence of hydroureteronephrosis and pulmonary metastases was another challenge for us. Paclitaxel remains the mainstay of our treatment.