Browsing by Author "Twayana, Anu Radha"
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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 Benign Recurrent Aseptic Meningitis (Mollaret’s Meningitis) in an Elderly Male: A Case Report(Nepal Medical Association, 2021) Chand, Swati; Thapa, Sangharsha; Gautam, Khusal; Twayana, Anu Radha; Laguio-Vila, Maryrose R.; Elshourbagy, TarekAbstract: Mollaret’s meningitis is an aseptic recurrent benign lymphocytic meningitis lasting 2-5 days and occurs over years with spontaneous complete resolution of symptoms between episodes. An 88 years-old-male presented with acute onset headache, lethargy and altered sensorium after a recent ear infection. He had multiple similar episodes in the past, each preceded by ear or sinus infection with cerebrospinal fluid finding consistent with aseptic meningitis. However, no specific causative agent was ever identified. He was confused, disoriented and lethargic with normal vitals and systemic examination. Blood tests showed leukocytosis with neutrophilia. Cerebrospinal fluid analysis revealed increased cell count with lymphocyte predominance, elevated protein and negative polymerase chain reaction. Magnetic resonance imaging of brain showed chronic small vessel ischemic changes. He fulfilled the Bruyn’s criteria for clinical diagnosis. He was empirically administered acyclovir during hospitalization and was discharged without prophylactic antiviral due to negative cerebrospinal fluid analysis, culture, and multiplex polymerase chain reaction.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 Facemasks Readily Available in Common Stores used by Nepalese, How much Protection is Enough Protection against COVID-19?(Nepal Medical Association, 2021) Sunuwar, Neela; Twayana, Anu Radha; Katuwal, Santosh; Gautam, SwotantraAbstract: During the COVID-19 pandemic, the Centers for Disease Control and Prevention and World Health Organization strongly recommend that people wear face masks to cover their mouths and noses while they are out and about in any other public area. There are a lot of masks available on the market, and people get a lot of mixed messages about what is safe. This article explores what kind of facemasks are readily available in Nepali General stores and what are the things to keep in mind before buying a mask. We will also discuss how many times a face mask can be used, proper ways to store them, correct ways to use facemasks, and the rationale behind its use.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.Publication Negative Pleural Fluid Cultures among Patients with Pleural Effusion in a Tertiary Care Hospital: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Ranjit, Srijana; Singh, Amit Kumar; Shrestha, Ishu; Twayana, Anu Radha; Bhandari, Prabha; Siwakoti, Shisir; Singh, ShrijanaAbstract Introduction: A systematic approach to analysis of the fluid in conjunction with the clinical presentation allows clinicians to diagnose the cause of an effusion, narrow the differential diagnoses, and design a management plan. However, the number of cases where pleural fluid examination gives no proper diagnosis is depressingly high. This study aims to find out the prevalence of negative pleural fluid cultures among patients with pleural effusion in a tertiary care hospital. Methods: This was a descriptive cross-sectional conducted among 273 patients with pleural effusion admitted to a tertiary care hospital between January, 2019 and February, 2020. Ethical clearance was taken from the Institutional Review Committee (Reference number: 134/20). Convenience sampling was done. All patients whose pleural fluid was sent for analysis during the study period were included in the study. Pleural fluid analysis was done, and data were analysed using Statistical Package for the Social Sciences 25.0. Point estimate was done at a 95% Confidence Interval along with frequency and percentages for binary data. Results: Among 273 pleural fluid cultures from patients with pleural effusion, negative pleural fluid cultures were seen in 269 (98.53%) (97.12-99.96 at a 95% Confidence Interval). Conclusions: Our study reported that the prevalence of negative pleural fluid cultures was higher when compared to similar studies conducted in similar settings. The routine pleural fluid analysis could add a very little to the diagnosis and management of pleural effusion.Publication Undiagnosed Case of Klippel-Trenaunnay Syndrome Presenting as Extensive Heterotrophic Ossification and Flexion Deformity of Right Lower Limb Requiring Amputation : A Case Report(Nepal Medical Association, 2021) Gautam, Kushal; Thapa, Sangharsha; Twayana, Anu Radha; Chhantyal, Lokendra; Poudel, Puskar; KC, Avinash; Chand, SwatiAbstract: Klippel-Trenaunnay Syndrome is a rare disease characterized by a clinical triad of capillary malformation, soft tissue and bony hypertrophy, and atypical varicosity. This syndrome ranges from asymptomatic disease to life-threatening bleeding, embolism, and deformities. Management includes early diagnosis, prevention, and treatment of complications. We present a case of a 43-year-old male presenting with pain, swelling and deformity of the right leg for 30 years. On examination, diffusely enlarged tender right limb with several dark patchy discolorations, multiple tortuous vessels were found. Right leg X-ray showed heterotrophic ossification and distortion of ankle joint. Due to chronic severe pain, recurrent infection, contracture and flexion deformity of right leg, the patient underwent above knee amputation. This case focuses on the variable presentation and multiple problems faced by patients with Klippel-Trenaununay Syndrome as they get diagnosed late and shows the importance of high index of suspicion for early diagnosis and prevention of complications.Publication Unicystic Ameloblastoma of Mandible: A Case Report(Nepal Medical Association, 2022) Rayamajhi, Sushil; Shrestha, Sunita; Shakya, Samata; Bhandari, Sagar; Twayana, Anu Radha; Shahi, KopilaAbstract Ameloblastomas of jaws are benign odontogenic tumors of epithelial origin with four clinical variants: solid multicystic type, unicystic type, desmoplastic type, and extraosseous type. The incidence rate of ameloblastoma is 0.92 per million person-years. Unicystic ameloblastoma refers to those cystic lesions that show clinical and radiologic characteristics of an odontogenic cyst but shows a typical ameloblastomatous epithelium lining part of the cyst cavity, with or without luminal and/or mural tumor proliferation on histological examination. Here is a unique case of unicystic ameloblastoma involving the mandible in a 70-year-old patient. The case was managed by segmental mandibulectomy and flap repair. Unicystic ameloblastoma accounts for only 13% of all known cases in scientific literature. Considering the rarity of the lesion, the purpose of presenting this report on a clinical case is to emphasize the importance of radiological evaluation and histopathological examination for the diagnosis of ameloblastoma.