Browsing by Author "Sunuwar, Neela"
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Publication Acid-Base Disorder in the Patients Visiting the Emergency Department of a Tertiary Care Hospital: A Descriptive Cross-sectional Study Authors(Nepal Medical Association, 2021) Yadav, Sudeep; Jha, Suman Kumar; Sunuwar, Neela; Twayana, Anu RadhaAbstract: Introduction: An acid-base disorder is a change in the normal value of extracellular pH that may result when renal or respiratory function is abnormal or when an acid or base load overwhelms their excretory capacity. Clinical acid-base disorders are conventionally defined from the vantage point of their impact on carbonic-acid-bicarbonate buffer system. The aim of the study is to find out the prevalence of acid-base disorder among patients visiting the emergency department of a tertiary care hospital. Methods: This is a descriptive cross-sectional study conducted among 370 patients who underwent arterial gas analysis at the emergency department of a tertiary care hospital. The study was carried out from 15th July 2016 to 15th July 2017 after receiving ethical approval from Institutional Review Committee. Convenient sampling was done. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Data were entered in Microsoft-Excel. Statistical Package for Social Sciences version 17 was used for analysis. Results: Out of 370 patients analyzed, 329 (88.91%) (84.68-91.311 at 95% Confidence Interval) had acid-base disorder. The mixed disorder was the most common finding 80 (21.6%), followed by compensated Respiratory Acidosis 56 (17.8%). The mean age group of male patients studied was 50.72±20.586 and among females, it was 49.95±20.908 Among those most common symptoms were shortness of breath 151 (40.81%) followed by vomiting 91 (24.59%). Conclusions: Most common acid-base disorder was mixed disorder presenting with prominent symptoms of shortness of breathe in non-geriatric patients wherein the geriatric patient, the most common disorder was compensated respiratory acidosis with the prominent symptom of shortness of breath.Publication Congenital Upper Limb Deficiency with Oligodactyly: A Case Report(Nepal Medical Association, 2022) Twayana, Anu Radha; Sunuwar, Neela; Deo, Sulav; Rayamajhi, Sushil; Sherpa, Ninda Tashi Tenzing; Anjum, FirozAbstract Congenital upper limb deficiency care and management have undergone drastic changes over the past 50 years. Given the low incidence of this defect nationwide, this case report adds to the existing database to analyze the etiological investigations, descriptive epidemiology, and trend detection. We present a case of a 2-month-old male child with congenital upper limb deficiency and explore the possible etiologies and difficulties during early diagnosis of such rare disorders in a low and middle-income countrries and present implications at the primary health care level to improve the prognosis. Poor nutrition during pregnancy due to an unplanned pregnancy is a possible cause. The prognosis is unfavourable due to sociocultural barriers. To address these limitations, it is pertinent to address disability-adequate knowledge among communities, promote early diagnosis, and timely rehabilitation using a multidisciplinary approach. Further, we provide a framework to optimize care.Publication Hereditary Vitamin-D Dependent Rickets Type II: A Case Report(Nepal Medical Association, 2021) Sunuwar, Neela; Gautam, Swotantra; Twayana, Anuradha; Yadav, Saroj Adhikari; Anjum, Firoz; Kandel, KritiAbstract: Hereditary vitamin D dependent rickets type II is a rare genetic disorder in children characterized by early onset of rickets and deranged biochemical parameters. Low serum calcium level, high alkaline phosphatase, high parathyroid hormone, and high values of 1,25-dihydroxy vitamin D are characteristic biochemical findings. We are reporting a rare case of Vitamin D Dependent Rickets and subsequent improvement after addition of cinacalcet. This is a case report of a 2.5-year-child with Hereditary Vitamin D Dependent Rickets type II receiving cinacalcet as adjunct to oral calcium and calcitriol. Oral cinacalcet (0.25mg/kg/day) was added to the regimen as an adjunct after treatment failure with high dose of oral calcium and calcitriol. A significant improvement in radiological findings and normal homeostasis of calcium, phosphate and parathyroid hormone was achieved after initiation of cinacalcet.Publication Maggots Around Colostomy Site: A Case Report Authors(Nepal Medical Association, 2021) Twayana, Anu Radha; Sunuwar, Neela; Devkota, Amrit; Dahal, Aakrit; Tamang, Rabindra; Gautam, KushalAbstract: Myiasis is a skin infection caused by developing larvae (maggots) of various Diptera fly species. The two most frequent flies that cause human infestations around the world are Dermatobia hominis (human botfly) and Cordylobia anthropophaga (tumbu fly). Maggots have been found to infest the nose, ear, orbit, tracheostomy wound, face, gums, and serous cavities, among other places. Maggots at the colostomy site are an uncommon occurrence. We report a case of maggots infestation surrounding the colostomy site. We came across a rather rare finding in a patient with advanced inoperable rectum cancer who initially complained of persistent nonspecific pain, discomfort, and foul-smelling discharge from the colostomy site. The issue at hand was identified to be maggots, and their removal alleviated the patient's symptoms. We underline the importance of regularly monitoring stoma sites to avoid maggot infestation, especially in tropical regions.