NepMed Repository :: Browsing Publications by Title

Publications

Permanent URI for this collection

https://hdl.handle.net/20.500.14572/6

Browse

Now showing 1 - 20 of 2298

11β Hydroxylase Deficiency in a Child with Hypothyroidism: A Case Report
(Nepal Medical Association, 2023) Shah, Bipesh Kumar; Koirala, Richa; Dhamala, Sumit; Bhatta, Mukesh; Khatiwada, Shekhar
Abstract Congenital adrenal hyperplasia occurs due to enzymatic defects in the adrenocortical steroidogenesis. 11β hydroxylase deficiency is the second most common cause of congenital adrenal hyperplasia which presents with hypertension and features of androgen excess. Hypertension has also been found to cause end-organ damage in children with 11β hydroxylase deficiency. We report a case of a 10-year-old male child with hypothyroidism under thyroid replacement therapy, presenting with features of severe hypertension and androgen excess, later on, diagnosed as congenital adrenal hyperplasia due to 11β hydroxylase deficiency.
64-Slice CT Scan in Kathmandu Medical College Teaching Hospital
(Kathmandu University, 2008) Karki, DB; Neopane, A; Regmi, S; Acharya, S
Abstract 64-slice CT scan is a versatile newly introduced imaging technology, which is capable of diagnosing various diseases from head to toe. The 64-slice CT coronary angiography has a negative predictive value of 100%. Virtual images of bronchi, stomach and colon can provide definite diagnosis. Coronary artery calcification score which predicts coronary artery disease can be calculated by 64-slice CT scan. Key words: coronary angiography, coronary calcification
A Case of Dirty Dermatosis (Dermatitis Neglecta)
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2022) Henry, Daniel; Henry, David
Abstract: Dermatitis Neglecta, also known dermatosis neglecta refers to a dermatological condition that occurs from lack of hygiene. It is a condition that results from insufficient frictional cleansing leading to accumulation of corneocytes sebum and sweat eventually resulting in hyperpigmented patch or verrucous plaque. Regular bathing is very important for keeping the skin clean. Bathing and scrubbing the skin helps to remove germs, oils, and dead skin cells. Lack of bathing for a long time can also cause Dermatitis Neglecta. We are presenting a case of 22 years old boy who had itching in the scrotum for 4 years and he was being treated for scabies and tinea cruris by various practitioners. On observation we found it to be covered with dark coloured raised lesions, after we rubbed it with cotton and spirit, we found it to be Dermatitis Neglecta of scrotum. Terra firma forme dermatosis is differentiated from it by presence of sufficient hygiene, absence of corn flake-like brownish scales and successful annihilation of pigmentation with isopropyl alcohol in the former and effective clearance of lesions with soap and water in the latter. However, isopropyl alcohol is operative in both disorders.
A Case of Juvenile Polyposis Syndrome in a 13-year-old: A Case Report
(Nepal Medical Association, 2023) Bhandari, Abashesh; Basnet, Bhupendra Kumar; Chaudhary, Ashlesha; Chaudhary, Aashutosh
Abstract Juvenile polyposis syndrome is an autosomal dominant syndrome characterised by hamartomatous polyps in the gastrointestinal tract and has a high risk for colon carcinoma. This case explores the presentation of multiple polyps throughout the gastrointestinal tract, located in the stomach, proximal duodenum, colon, rectum and up to the anal canal. The locations and number of these polyps themselves were not typical and the histopathological studies suggested the condition to be an inflammatory fibroid polyp, which is a rare, benign and solitary neoplasm. Prompt and accurate diagnostic modality remains the keystone in the identification and management of such condition which was a limitation in this case as the patient was lost to follow up before a definitive diagnosis was made.
A case of left atrial myxoma: Anaesthetic management
(Kathmandu University, 2006) Pradhan, B; Acharya, SP
Left Atrial Myxomas are notorious for their varied presentations. We describe one such case which initially presented with hemiparesis and seizures and was diagnosed as cerebral infarction and treated accordingly and decompression craniotomy with hinge flap was done for raised ICP and impending brain herniation. The main cause was a left atrial myxoma, which was diagnosed only in follow up. The myxoma has embolised to give rise to cerebral infarction. The LA myxoma was then successfully operated under general anaesthesia and Cardiopulmonary bypass (CPB). Key words: Hemiparesis, Cerebral infarction, Left Atrial (LA) Myxoma
A Case of Precocious Puberty in a Setting with Limited Resources
(Kathmandu University, 2011) Paudel, KP; Giri, S; Shrestha, PS; Shrestha, L; Thapa, SB; Shrestha, M
ABSTRACT Precocious puberty is a rare condition characterized by the development of secondary sexual characteristics before the median age for the sex. It is either gonadotropin dependent also called as central or gonadotropin independent also known as peripheral type. Hypothalamamic Hamartoma is a common cause of the central or precocious puberty due to organic brain lesion. Here we present a two year male who presented us with precocious puberty due to a hypothalamic Hamartoma. KEY WORDS hypothalamic hamartoma, precociuos puberty
A Case of Refractory Idiopathic Tumoral Calcinosis Cutis
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2016) Siddiqui, S.; Ahmed, G.; Qaisar, H.; Wahid, Z.; Talat, H.
Abstract: A case of idiopathic tumoral calcinosis cutis in a normocalcemic patient. The lesions were localized to multiple large and small joints throughout the body and confirmed on biopsy. The lesions are refractory to intralesional steroids, aluminum hydroxide and diltiazem after 5 months. The patient is being considered for surgical intervention for large lesions while he will be further tried on dialitiazem for the smaller ones. Keywords: Calcinosis Cutis, Tumoral, Refractory, Diltiazem
A Case of Squamous Cell Carcinoma of Skin Subsequent to Subcutaneous Foreign Body
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2014) Anwar, P; Mubashir, S; Hassa, I; Arif, T
Abstract: Squamous cell carcinoma (SCC) of the skin is one of the most common non melanoma skin cancers (NMSC), along with basal cell carcinoma (BCC). Besides ultraviolet radiation, the role of exposure to industrial agents, ionizing radiation and areas of chronic inflammation is associated with the development of SCC. SCC may also be associated with foreign bodies. We report a rare case of cutaneous SCC in an elderly Kashmiri female, developing subsequent to subcutaneous non metallic foreign body, which was successfully excised with negative margins, and transposition flap closure. Keywords: Squamous cell carcinoma, Foreign body, Transposition flap closure
A case of Synchronous Malignancy of Stomach and Kidney
(Kathmandu university, 2013) Aslam, S SM; Sridhar, H; Rao, MY
ABSTRACT The synchronous occurrence of primary renal cell carcinoma with gastric cancer is very rare. We report a case of 41 year old male who presented on 05/07/2011 to M S Ramaiah hospital, Bangalore with history of fever, pain abdomen and malena. Ultrasound abdomen and pelvis showed large heterogenous mass arising from the upper pole of left kidney. Computed tomography of the abdomen showed left renal cell carcinoma. Renal biopsy showed features consistent with renal cell carcinoma – clear cell type. Oesophagogastroduodenoscopy revealed gastric polypoidal growth. Gastric biopsy from the growth revealed poorly differentiated adenocarcinoma of stomach. We report this case to highlight a rare occurrence of synchronous malignancy of stomach and kidney. KEYWORDS Gastric adenocarcinoma, gastric cancer, renal cell carcinoma, synchronous malignancy
A case report and overview of organophosphate (OP) poisoning
(Kathmandu University, 2006) Bhattarai, MD; Singh, DL; Chalise, BS; Koirala, P
A case of organophosphate (OP) poisoning who recovered after requiring almost 1000 mg of atropine, 10 gm of PAM and ventilatory support for 7 days is presented here. The overview of organophosphate poisoning and its management is given. With the approach adopted, the mortality reported in the general medicine unit in the central hospital in Nepal is 7.4%. The two important aspects of the management are vigilance of the atropine drip, especially at night, and other physical and psychological support care of the patients. Key words: Organophosphate poisoning, atropine drip, counselling, Nepal.
A case report of Gilbert Syndrome
(Kathmandu University, 2003) Manandhar, SR; Gurubacharya, RL; Baral, MR; Manandhar, DS
Gilbert syndrome is benign, often familial condition characterized by recurrent but asymptomatic mild unconjugated hyperbilirubinemia in the absence of haemolysis or underlying liver disease. If, it becomes apparent, it is not until adolescence and then usually in association with stress such as intercurrent illness, fasting or strenuous exercise. Virtually all patients have decreased level of UDP- Glucuronosyltransferase, but there also is evidence for a defect in hepatic uptake of bilirubin as well. This case is reported due to its rarity. The prevalence of Gilbert syndrome in U.S is 3-7% of the population. Keywords: Gilbert Syndrome, familial non-haemolytic jaundice, hereditary non-haemolytic bilirubinaemia, low- grade chronic hyperbilirubinemia
A Clinical Study of Steroid Induced Dermatoses
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2018) Parajuli, Sudip; Paudel, Upama; Poudyal, Amod Kumar; Pokhrel, Dinesh Binod
Abstract: Introduction: Steroid induced dermatoses on face are one of the common presentations in Dermatological practice. Objectives: 1) Understand the clinical patterns of adverse effects of long term abuse of topical steroid on face and 2) Assess the factor which promotes its abuse. Materials and Methods: This was a descriptive exploratory cross-sectional study carried out from December, 2013 through November, 2014. A total of 39 patients fulfilling the inclusion criteria were enrolled into the study. All the study variables were recorded using preformed structured questionnaire and analyzed. Results: The following effects of steroid abuse on face were seen: pruritus (38.5%), burning (15.4%), eythema (74.4%), telangiectasias (66.7%), acneiform eruptions (59%), comedones (35.9%), xerosis (55.1%), photosensitivity (51.3%), rebound phenomenon (38.5%) and others (38.5%). Most of them used steroids on recommendation of their friends (38.5%) and pharmacists (20.5%). All of them used steroid for different dermatoses on their face. Limitations: This is a hospital-based small-scale study and might not be true picture of problem in the community. Conclusion: Long term use of steroid on face results in different clinical presentations. Most of the patients used steroid on recommendation of their friends facilitated by easy availability of the drug over- the -counter. Keywords: Comedones, erythema, non prescription drugs, papules, pustules, rosacea, steroids
A Combination Of Vein Of Galen Aneurysmal Malformation And Bovine Aortic Arch In Newborn: A Case Report
(Nepal Medical Association, 2025) Mandal, Krishna Deo; Subedi, Kalpana; Amatya, Unnati; Pathak, Janak
Abstract Vein of Galen aneurysmal malformation is a rare intracranial arteriovenous malformation, coexistence with aortic arch anomalies is even more uncommon, carry high risk of morbidity and mortality related to endovascular procedure and poor neurological outcome. Vein of Galen aneurysmal malformation is a dilated venous pouch, a persistence of the embryonic median prosencephalic vein of Markowski. Often presents with high output cardiac failure, severe pulmonary hypertension, and systemic steal leading to hemodynamic compromise and multi organ failure. Bicêtre score scale determines the potential treatment option and prognosis of the disease. Aim of the medical treatment is initial stabilization of life threatening condition of severe heart failure followed by the definitive treatment with endovascular embolization. Treatment is a big challenge, specially if coexistence with aortic arch anomalies which increases the morbidity and mortality. We describe a term neonate found to have vein of Galen aneurysmal malformation associated with bovine aortic arch.
A Comparative Efficacy and Adverse Clinical Events of Methotrexate versus Azathioprine with Steroid Mini Pulse Therapy in the Management of Moderate to Severe Alopecia Areata: A Tertiary Centre Based Interventional Study
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2022) Mishra, Aditi; KC, Shekhar; Shrestha, Elisha; Pandey, Chandranshu; Karn, Dharmendra
Abstract: Introduction: Alopecia areata is a T cell-mediated autoimmune disorder of hair follicles resulting in partial or total hair loss. Treatment of alopecia areata is difficult, and it has variable severity. Objectives: To compare the clinical efficacy and adverse clinical events of azathioprine versus methotrexate with steroid minipulse therapy in managing moderate to severe alopecia areata. Materials and Methods: Prospective non-blinded clinical trial conducted for 6 months in Department of Dermatology at Dhulikhel Hospital. Dermoscopic evidence of alopecia areata patients treated according to group assigned and effects and adverse event were noted. Results: There was a total of 36 patients enrolled. Twenty patients were in Group A (AZT+MPT) and 16 in group B (MTX+MPT). There was a significant improvement in SALT score at 6 months (Group A p-value: 0.03; group B p-value: 0.001). Treatment efficacy (percent scalp hair regrowth) in group A was 79.2%, and in group B was 89.01%. Conclusion: Both treatment regimens showed marked improvement with SALT score reduction; however, methotrexate with steroid minipulse therapy showed slightly higher treatment efficacy than azathioprine with steroid minipulse therapy.
A comparative study between nifedipine and isoxsuprine in the suppression of preterm labour
(Kathmandu University, 2003) Rayamajhi, R; Pratap, K
Preterm labour and delivery remains a major cause of perinatal morbidity and mortality. Numerous drugs and interventions have been used to prevent and inhibit preterm labour but none have been found to be completely effective with the choice being further limited by troublesome side effects. This study compares in a prospective and randomised design the efficacy and safety of the calcium antagonist Nifedipine with the ?mimetic Isoxsuprine. 81.25% of patients receiving Nifedipine and 70% of those receiving Isoxsuprine achieved successful tocolysis. The mean prolongation of pregnancy with Nifedipine was 25?19.85 days and with Isoxsuprine it was 19.18?17.82 days. Maternal side effects were similar in both groups with hypotension and tachycardia being the commonest. Discontinuation rates were also similar with pulmonary oedema and severe hypotension being the reasons for foregoing tocolysis. It can be concluded that Nifedipine is a safe and effective alternative to Isoxsuprine for suppressing preterm labour. Key words: Nifedipine, Isoxsuprine, tocolysis, efficacy.
A Comparative Study of Azithromycin Versus Doxycycline in the Treatment of Acne Vulgaris
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2012) Amatya, A; Chaudhary, M K; Khan, D K; Rajouria, E A
NA Keywords: Acne vulgaris, Azithromycin, Body dysmorphic disorder, Doxycycline
A comparative study of body mass index (BMI) in diabetic and non- diabetic individuals in Nepalese population
(Kathmandu University, 2006) Shah, A; Parthasarathi, D; Sarkar, D; Saha, CG
Introduction and Objectives: Diabetes Mellitus (DM) is the most common endocrine disorder world-wide. The prevalence of diabetes mellitus is increasing. In the present study an attempt has been made (i) to examine the relation between obesity and diabetes mellitus in Nepalese people, (ii) to find out whether BMI cut-off points for determining over weight and obesity as per WHO criteria are applicable in Nepalese study population. Materials and methods: The present study was carried out in Manipal College of Medical Sciences (MCOMS) and Manipal Teaching Hospital (MTH), Pokhara. The Diabetic patients of Pokhara and surroundings who attended the 'Diabetic Clinic' and Out Patient Department (OPD) during August 2004 to November 2004 at Manipal Teaching Hospital were included in the present study. The number of diabetic patients was two hundred (200), out of which, one hundred and fourteen (114) were male and eighty six (86) were female. In addition one hundred (100) non- diabetic subjects who attended the OPD at MTH were taken for comparison with the diabetic patients, of which, forty seven (47) were male and fifty three (53) were female. Age, height and weight were recorded for every subject. BMI was calculated by the standard formula. In the present study, body mass index (BMI) of the diabetic subjects was found to be more than that of non-diabetic subjects. BMI of non-diabetic males and females were found to be around 22 kg/m2 which is within normal range as per WHO recommendations. On the other hand, diabetic subjects’ BMI were found to be around 25 kg/m2, which denotes borderline obesity. It is clear from the present study that 51.5% of the diabetic subjects were within the normal range (BMI 18.5-24.9 kg/m2 ). More diabetic subjects were found in over-weight (25-29.9) category than non-diabetic subjects. As per WHO criteria 56% of the non-diabetic subjects were within the normal BMI range (BMI 18.5-24.9 kg/m2). It is also evident that when BMI in the range of 25.0-29.9 kg/m2 is considered as over-weight, only 33% were found to be over-weight in diabetic subjects. But when BMI ≥23 kg/m2 (as recommended for Asians) is taken as the determining factor for overweight, 64% of overweight male subjects and 72.09% of overweight female subjects were found to be diabetic. Conclusion: According to the observations of the present study on Nepalese it can be concluded that BMI cut-off points for determining over-weight and obesity should be lowered to 23 kg/m2 or less which can provide an adequate basis of taking action on risks related to overweight and obesity in Nepal. Key words: Diabetes, Nepalese Population, BMI, Obesity
A comparative study of coronary and contributory risk factors in rural and urban type 2 diabetics
(Kathmandu University, 2004) Jha, N
A prospective study of various coronary and contributory risk factors in urban and rural diabetic population is presented. For the coronary risk factors, smoking prevalence was high for urban diabetics (27%), also high TC levels (57%), and low levels of HDL cholesterol (17%) were comparatively greater in urban diabetics. Prevalence of hypertension was higher, (40%) in rural diabetics. High LDL levels were (>130mg/dl) were observed in 20% of rural subjects and 47% of urban diabetics. High TG levels (34%) were seen in rural diabetics. 54% of urban diabetics were centrally obese and 57% were obese from the rural study site. From this study, it was seen that, illiteracy percentage was found to be higher in rural subjects. Also, greater number of people (70%) were in inadequate status for the needed patient awareness. 77% of patients belonging to the rural study area were found to be unaware for the hypoglycaemia. Low patient compliance was seen in urban diabetics as compared to their rural counterparts, and 34% of patients belonging to both study sites were found to have no knowledge for diabetic complications. High total cholesterol was found to be the commonest lipid profile abnormality in this study. Second commonest lipid abnormality was high LDL levels. Low HDL cholesterol was found to be more commonly in patients of age > 60 years than <60 years (21.42% vs. 18.18%). More female patients were overweight and obese as compared to male (33.33% vs. 19.23%). A Large population of diabetics was found to have a sedentary lifestyle. Rural patients were progressing towards more coronary risk factors as compared to the urban ones, mainly with the lipid profile abnormalities. Although our type 2 diabetic patients share similar coronary risk factors as compared to diabetic patients from different countries, our type 2 patients have got high prevalence of hypertension. Male diabetics had high prevalence of smoking habits. Keywords: Coronary risk factors, Contributory risk factors, Lipid profile abnormalities
A comparative study of early vs. delayed laparoscopic cholecystectomy in acute cholecystitis
(Kathmandu University, 2009) Yadav, RP; Adhikary, S; Agrawal, CS; Bhattarai, B; Gupta, RK; Ghimire, A
NA
A comparative study of fluorescent microscopy with Ziehl-Neelsen staining and culture for the diagnosis of pulmonary tuberculosis
(Kathmandu University, 2009) Laifangbam, S; Singh, HL; Singh, NB; Devi, KM; Singh, NT
Abstract Background: For developing countries with a large number of cases and financial constraints, evaluation of rapid and inexpensive diagnostic methods has great importance. The bacilli in the sputum can be detected microscopically by ZN stain and fluorochrome stain. Objectives : To study the efficacy of fluorescence microscopy in the diagnosis of pulmonary tuberculosis in comparison to Ziehl-Neelsen staining and culture of sputum samples from patients suspected of pulmonary tuberculosis. Materials and methods : 306 sputum samples collected from 102 patients suspected of pulmonary tuberculosis were processed by the Petroff’s method, and subjected to Ziehl-Neelsen staining (ZN), fluorescent Auramine-O staining (AO) and culture on modified Lowenstein-Jensen media (gold standard) for detection of Mycobacterium tuberculosis. Positive smears were graded according to Forbes BA et al, and culture isolates were biochemically tested for confirmation of species. Results : Out of 102 patients, 44.1%, 71.6% and 70% were found positive by ZN, AO and culture respectively. AO was found to be superior to ZN on several aspects. The difference in their case detection rates was statistically significant (χ2 = 24.93, p < 0.001). AO was also able to detect more pauci-bacillary cases than ZN. There was more agreement between culture and fluorescence microscopy (95.1%) than with ZN microscopy (69.6%). The percentage of false negative by AO staining was only 2.78% which was in sharp contrast to that of ZN (40.27%). Conclusion: The better case detection rates of AO over ZN were comparable to those found by several studies. Since screening was done under lower power of magnification (400x), fluorescence microscopy has been found to be less time consuming as compared to ZN method (1000x) in the diagnosis of tuberculosis. The tubercle bacilli stood out as bright objects against a dark background in fluorescence microscopy which makes them easily identifiable hence causing less eye-strain. The efficacy of fluorescence microscopy proved to be much higher than conventional light microscopy and comparable to that of culture. Key words: Ziehl-Neelsen staining, Mycobacterium tuberculosis, Auramine-O